Exam 4 study

4 Rationale: Fresh cow's milk, as the sole source of nutrition, is not an adequate source of nutrition for an infant at 13 months of age and can lead to an iron deficiency anemia. Many parents believe that cow's milk can provide all of an infant's nutritional needs and need to be educated that cow's milk is deficient in iron, zinc, and vitamin C. Fresh cow's milk does contain a heat labile protein that can induce Gastrointestinal bleeding in infants but only in infants younger than 12 months of age. Sickle cell anemia is an inherited genetic disease and is not caused by fresh cow's milk.

A 13-month-old infant is brought in for a routine well-child check. The parent reports transitioning to fresh cow's milk from formula but states that the infant refuses to eat any solid foods and will only drink the cow's milk. Which is the MOST appropriate response by the nurse? 1. Fresh cow's milk is an appropriate source of nutrition for a 13-month-old. Do not worry if the infant does not want to eat solid foods. 2. Fresh cow's milk contains a heat labile protein that can lead to gastrointestinal bleeding in infants younger than 15 months of age. 3. Fresh cow's milk should be avoided in infants younger than 15 months of age because of the known associated complication of sickle cell anemia 4. Fresh cow's milk as the only source of nutrition for a 13-month-old is not nutritionally adequate and can lead to iron-deficiency anemia

ANS: A, B, E Spinal cord injury patients are physiologically labile, and close monitoring is required. They may be unstable for the first few weeks after the injury. Corticosteroids are administered to minimize the inflammation present with the injury. It is not necessary to minimize environmental stimuli for this type of injury. Discussing long-term care issues with the family is inappropriate. The family is focusing on of their child. It will not be known until the rehabilitation period how much function the child may recover. DIF: Cognitive Level: Apply REF: p. 1000TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

A 14-year-old girl is in the intensive care unit after a spinal cord injury 2 days ago .Nursing care for this child includes which action(s)? (Select all that apply.) a. Monitoring and maintaining systemic blood pressure b. Administering corticosteroids c. Minimizing environmental stimuli d. Discussing long-term care issues with the family e. Monitoring for respiratory complications

3. Incompatible with life Born stillborn If born alive infant will receive comfort measures and made a DNR

A baby born with both cerebral hemispheres absent is thought to have what disorder and what quality of life? 1. Spina bifida 12 months 2. Anencephaly with a long life 3. Anencephaly with no quality of life 4. Cerebral Palsy 2 years.

4 Rationale: Diastematomyelia is an intraspinal abnormality that causes scoliosis. signs of pain in the lumbosacral region, sacral dimpling, left thoracic curve, and bladder incontinence indicate the presence of an intraspinal abnormality. It may signigy a tethered spinal cord, so the primary health care provider should be notified immediately and orders for an MRI of the spine obtained. An MRI of the abdomen will not be beneficial in identifying the complications associated with this condition. The problem should not be dismissed because the child will not outgrow this condition. The parents will not need a referral to urology to manage urinary incontinence because the causative problem needs to be addressed first.

A child has pain and sacral dimpling in the lumbosacral region, a left thoracic curve, and bladder incontinence. Which would the nurse expect as the follow-up plan of care? 1. Provide reassurance because the child will normally outgrow the issue 2. Refer the patient and parents to a urologist for the management of incontinence 3. Conduct a magnetic resonance imaging (MRI) of the abdomen to identify the cause of urinary incontinence and pain 4. Take an MRI of the spine for further evaluation of the severity of the issue.

1,2,3,4 Rationale: Compartment syndrome is a serious complication that results from compression of nerves, blood vessels, and muscle inside a closed space. It can occur after a cast is applied. Clinical signs of compartment syndrome include pain, pallor, pulselessness, paresthesia, paralysis, and pressure

A child has recently been fitted with a cast to enable healing of a fractured arm. Which finding would the nurse recognize as a clinical sign of compartment syndrome? select all that apply 1. Pain 2. Pallor 3. Paresthesia 4. Pulselessness 5. Palpable pulses

1. Rationale: A transmucosal route of administration helps in rapid absorption of drug due to the rich blood supply to the oral mucosa.

A child is prescribed analgesic for pain relief. How would the nurse administer the drug to the child? 1. Place the drug between cheeks and gums 2. Place the drug above the tongue 3. Instruct the child to swallow the drug 4. Instruct the child to chew the drug

ANS: C Puncture wounds should be cleansed by soaking the foot in warm water and soap. Chlorhexidine, hydrogen peroxide, and povidone-iodine should not be used because they have a cytotoxic effect on healthy cells and minimal effect on controlling infection .DIF: Cognitive Level: Apply REF: p. 998TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

A child steps on a nail and sustains a puncture wound of the foot. Which is the most appropriate method for cleansing this wound? a. Wash wound thoroughly with chlorhexidine. b. Wash wound thoroughly with povidone-iodine. c. Soak foot in warm water and soap. d. Soak foot in solution of 50% hydrogen peroxide and 50% water.

ANS: B A recent Cochrane review reported that various medications have been used for phantom limb pain but complete pain relief has been unsuccessful. Morphine, gabapentin, and ketamine are effective for short-term pain relief.

A child with osteosarcoma is experiencing phantom limb pain after an amputation. What prescribed medication is effective for short-term phantom pain relief? a. Phenytoin (Dilantin) b. Gabapentin (Neurontin) c. Valproic Acid (Depakote) d. Phenobarbital (Phenobarbital)

ANS: C The adolescent is experiencing an autonomic dysreflexia episode. The paralytic nature of autonomic function is replaced by autonomic dysreflexia, especially when the lesions are above the mid-thoracic level. This autonomic phenomenon is caused by visceral distention or irritation, particularly of the bowel or bladder. Sensory impulses are triggered and travel to the cord lesion, where they are blocked, which causes activation of sympathetic reflex action with disturbed central inhibitory control. Excessive sympathetic activity is manifested by a flushing face, sweating forehead, pupillary constriction, marked hypertension, headache, and bradycardia. The precipitating stimulus may be merely a full bladder or rectum or other internal or external sensory input. It can be a catastrophic event unless the irritation is relieved. Placing a cool washcloth on the adolescent's forehead, continuing to monitor blood pressure and vital signs, and notifying the healthcare provider would not reverse the sympathetic reflex situation.

A home care nurse is caring for an adolescent with a T1 spinal cord injury. The adolescent suddenly becomes flushed, hypertensive, and diaphoretic. Which intervention should the nurse perform first? a. Place the adolescent in a flat right side-lying position. b. Place a cool washcloth on the adolescent's forehead and continue to monitor the blood pressure. c. Implement a standing prescription to empty the bladder with a sterile in and out Foley catheter. d. Take a full set of vital signs and notify the health care provider.

B, D, E Physical signs of approaching death include: tactile sensation beginning to decrease, a change in respiratory pattern, and difficulty swallowing. Even though there is a sensation of heat the body feels cool, not warm, and speech becomes slurred, not rapid.

A nurse is caring for a child who is near death. Which physical signs indicate the child is approaching death? (Select all that apply.) a. Body feels warm b. Tactile sensation decreasing c. Speech becomes rapid d. Change in respiratory pattern e. Difficulty swallowing

1. Rationale: Sequestration crisis is pooling of blood in the spleen or liver (infrequently) that leads to decreased blood volume and shock. Vasooclusive crisis is a painful episode characterized by ischemia, which causes mild to severe pain for minutes or days. Aplastic crisis is generally triggered by a viral infection and is characterized by diminished RBC production and may lead to profound anemia. Hyperhemolytic crisis is caused by an accelerated rate of RBC destruction and is characterized by anemia, jaundice, and reticulocytosis.

A nursing student caring for a patient admitted for treatment of a sequestration sickle cell crisis is discussing this type of crisis with the instructor. Which statement by the nursing student indicates proper understanding of this type of crisis? 1. This type of crisis is characterized by pooling of a large amount of blood in the spleen. 2. This crisis is a painful episode characterized by ischemia, which causes mild to severe pain. 3. It is often triggered by a viral infection and is characterized by diminished red blood cell (RBC) production. 4. Anemia, jaundice, and reticulocytotic occur in this type of crisis because of an accelerated rate of RBC destruction.

2 Rationale: Hair may regrow in 3 to 6 months for a child with alopecia as a result of radiation therapy. Hair loss occurs within 2 weeks of the initiation of radiation therapy. The child's hair will regrow before a year. The response "Every child is different, so we are not sure" is an inappropriate response.

A parent of a child receiving radiation therapy experiencing alopecia asks the nurse. "when will my child's hair grow back?" Which would be the nurse's best response? 1. Within 2 weeks 2. In 3-6 months 3. In about a year 4. Every child is different, so we are not sure

4 Rationale: SLE is chronic inflammatory autoimmune disease, which is characterized by a red, plaque-like, asymmetric, butterfly-patterned lesion over the nose and cheeks, as well as painless ulcers in the mouth and patchy erythematous lesions. The most important aspect to teach patients about SLE is to use appropriate-level sunscreens when outside. This decreases the risk for sunburn and skin damage. Scented lotions should not be applied because they may further irritate the skin. The patient should limit outside activities because they increase sun exposure and can damage the skin. Beginning oral contraceptive will not impact the management of the disease

A patient presents with a red-colored. butterfly-patterned lesion over the nose and cheeks as well as painless ulcers in the mouth and is diagnosed with systemic lupus erythematosus (SLE). Which is MOST important for the nurse to incorporate when instructing the patient about skin care? 1. Apply scented lotions to the skin 2. Begin an outside exercise regimen 3. Begin oral contraceptive management 4. Use appropriate-level sunscreens when outside

a. drugs. Drugs, such as chemotherapeutic agents and several antibiotics (e.g., chloramphenicol), can cause aplastic anemia. Injury, deficient diet, and congenital defect are not causative agents in acquired aplastic anemia.

A possible cause of acquired aplastic anemia in children is: a. drugs. b. injury. c. deficient diet. d. congenital defect.

b. adequate hydration and pain management. The management of crises includes adequate hydration, minimization of energy expenditures, pain management, electrolyte replacement, and blood component therapy if indicated. Hydration and pain control are two of the major goals of therapy. The acidosis will be corrected as the crisis is treated. Heparin and factor VIII is not indicated in the treatment of vasoocclusive sickle cell crisis. Oxygen may prevent further sickling, but it is not effective in reversing sickling because it cannot reach the clogged blood vessels.

A school-age child is admitted in vasoocclusive sickle cell crisis. The child's care should include: a. correction of acidosis. b. adequate hydration and pain management. c. pain management and administration of heparin .d. adequate oxygenation and replacement of factor VIII.

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

A young child with human immunodeficiency virus (HIV) 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 carinii pneumonia.

2 Rationale: Loss of neural function below an acute spinal cord lesion and flaccid paralysis indicate that the patient has spinal cord concussion. Central cord syndrome is spinal injury associated with gray matter destruction in which the patient may have tetraplegia or loss of functional use of the limbs. Spinal cord concussion may last from a few hours to several weeks. Posterior cord syndrome is a spinal cord injury in which the patient may have loss of sensation and pain but may have slight movements. Brown-Sequard syndrome involves a unilateral cord lesion in which the patient may have loss of motor function on the opposite side of the body.

After assessing a teenager who has had a spinal cord injury, the nurse identifies a loss of neural function below the acute spinal cord lesion and flaccid paralysis. Which condition would the nurse deduce from the finding? 1. The teenager has central cord syndrome 2. The teenager has spinal cord concussion 3. The teenager has posterior cord syndrome 4. The teenager has a brown-sequard syndrome

2,4,5 rationale: The most common clinical manifestations of hemophilia are prolonged bleeding anywhere from or in the body, hemorrhage from any trauma, and excessive bruising. Fever and Nausea and vomiting are not common clinical manifestations of hemophilia.

Which are the MOST common clinical manifestations of hemophilia? select all that apply 1. Fever 2. Excessive bruising 3. N/V 4. Hemorrhage from any trauma 5. Prolonged bleeding from or in the body

3. this is the most common area. Diagnosed prenatally or at birth. The sac contains meninges, spinal fluid, and nerves. loss of sensation and complete partial paralysis

As the Nurse taking care of a infant with Myelomeningocele you know that this occurs in what most common area? 1. Brain 2. Thoracic 3. Lumbar, lumbar sacral 4. neck WHAT DOES THE SAC CONTAIN??? if you guess i will bring you coffee tomorrow... ALSO what deficit will be seen?

C By age 9 to 11 years, children have an adult concept of death. They realize that it is inevitable, universal, and irreversible

At what age do most children have an adult concept of death as being inevitable, universal, and irreversible? a. 4 to 5 years b. 6 to 8 years c. 9 to 11 years d. 12 to 16 years

ANS: C One hallmark of autism spectrum disorders is the child's inability to maintain eye contact with another person. Parallel play is play typical of toddlers and is usually not affected. Social, not gross motor, development is affected by autism. Physical growth and development are not usually affected.

Autism is a complex developmental disorder. The diagnostic criteria for autism include delayed or abnormal functioning in which area with onset before age 3 years? a. Parallel play b. Gross motor development c. Ability to maintain eye contact d. Growth below the fifth percentile

4 Rationale: The most common currently identifiable cause of CP is existing brain abnormalities during the prenatal period. Birth asphyxia had previously been considered a factor in the development of CP. Cerebral trauma has previously been considered a factor in the development of CP. Neonatal diseases have previously been considered factors in the development of CP.

Cerebral Palsy (CP) may result from a variety of causes. It is now known that the MOST common cause of CP is which complication? 1. Birth asphyxia 2. Cerebral trauma 3. Neonatal diseases 4. Prenatal brain abnormalities

b. eliminate excess iron .A complication of the frequent blood transfusions in thalassemia is iron overload. Chelation therapy with deferoxamine (an iron-chelating agent) is given with oral supplements of vitamin C to increase iron excretion. Chelation therapy treats the side effect of the disease management. Decreasing the risk of hypoxia and managing nausea and vomiting are not the purposes of chelation therapy.

Chelation therapy is begun on a child with -thalassemia major. The purpose of this therapy is to: a. treat the disease. b. eliminate excess iron .c. decrease risk of hypoxia. d. manage nausea and vomiting.

B For most families, the adjustment phase is accompanied by several responses. Guilt, self-accusation, bitterness, and anger are common reactions. The initial diagnosis of a chronic illness or disability often is met with intense emotion, characterized by shock and denial. Social reintegration and acceptance of the child's limitations are the culmination of the adjustment process.

Families progress through various stages of reactions when a child is diagnosed with a chronic illness or disability. After the shock phase, a period of adjustment usually follows. This is often characterized by which of the following responses? a. Denial b. Guilt and anger c. Social reintegration d. Acceptance of child's limitations

4 Rationale: The malignancy in Hodgkin disease originates from the lymphatic system and subsequently metastasizes to other nonnodal or extralymphatic sites, especially the spleen, liver, bone marrow, lungs, and mediastinum in the body. Malignancies other than that of Hodgkin Disease originate in the musculoskeletal, circulatory, and neurologic systems.

From which body system does the malignancy in Hodgkin disease originate? 1. Musculoskeletal 2. Circulatory 3. Neurologic 4. Lymphatic

b. 0.4 mg ANS: B It has been estimated that a daily intake of 0.4 mg of folic acid in women of childbearing age will prevent50% to 70% of cases of neural tube defects; 1.0 mg is too low a dose; 1.5 to 2.0 mg are not the recommended dosages of folic acid. DIF: Cognitive Level: Remember REF: p. 988TOP: Integrated Process: Nursing Process: Evaluation MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies

How much folic acid is recommended for women of childbearing age? a. 1.0 mg b. 0.4 mg c. 1.5 mg d. 2.0 mg

4

In whom are serious sports injuries MOST likely to occur? 1. In children given extra fluids on a hot day 2. In children who are physically fit but tired 3. In children who take the appropriate safety precautions 4. In children who are not physically prepared for the activity

B Attendance at school is an important part of normalization for Kelly. The school nurse should prepare teachers and classmates about her condition, abilities, and special needs. A visit by the parents can be helpful, but unless the classmates are prepared for the changes, it alone will not prevent teasing. Kelly's school experience should be normalized as much as possible. Children need the opportunity to interact with healthy peers, as well as to engage in activities with groups or clubs composed of similarly affected persons. Children with special needs are encouraged to maintain and reestablish relationships with peers and to participate according to their capabilities.

Kelly, an 8-year-old girl, will soon be able to return to school after an injury that resulted in several severe, chronic disabilities. Which is the most appropriate action by the school nurse? a. Recommend that the child's parents attend school at first to prevent teasing. b. Prepare the child's classmates and teachers for changes they can expect. c. Refer the child to a school where the children have chronic disabilities similar to hers. d. Discuss with the child and her parents the fact that her classmates will not accept her as they did before.

B Parenting a child with a chronic illness can be stressful for parents. There are anticipated times that parental stress increases. One of these identified times is when the child begins school. Nurses can help parents recognize and plan interventions to work through these stressful periods. The parents are not in denial; they are responding to the child's placement in school. The parents are not exhibiting signs of a knowledge deficit; this is their first interaction with the school system with this child.

Lindsey, age 5 years, will be starting kindergarten next month. She has cerebral palsy, and it has been determined that she needs to be in a special education classroom. Her parents are tearful when telling the nurse about this and state that they did not realize her disability was so severe. The best interpretation of this situation is that: a. this is a sign parents are in denial. b. this is a normal anticipated time of parental stress. c. the parents need to learn more about cerebral palsy. d. the parents are used to having expectations that are too high.

ANS: D Fading is physically taking the child through each sequence of the desired activity and gradually fading out the physical assistance so the child becomes more independent. Positive reinforcement when tasks or behaviors are mastered is part of behavior modification. An essential component is ignoring undesirable behaviors. Verbal explanations are not as effective as demonstration and physical guidance. Consistent negative reinforcement is helpful, but positive reinforcement that focuses on skill attainment should be incorporated.

One of the techniques that has been especially useful for learners having cognitive impairment is called fading. What description best explains this technique? a. Positive reinforcement when tasks or behaviors are mastered b. Repeated verbal explanations until tasks are faded into the child's development c. Negative reinforcement for specific tasks or behaviors that need to be faded out d. Gradually reduces the assistance given to the child so the child becomes more independent

a. Normal adult hemoglobin is replaced by abnormal hemoglobin. Sickle cell anemia is one of a group of diseases collectively called hemoglobinopathies, in which normal adult hemoglobin is replaced by abnormal hemoglobin. Aplastic anemia is a lack of cellular elements being produced. Thalassemia major refers to a variety of inherited disorders characterized by deficiencies in production of certain globulin chains. Iron deficiency anemia affects the size and depth of the color.

Parents of a child with sickle cell anemia ask the nurse, "What happens to the hemoglobin in sickle cell anemia?" Which statement by the nurse explains the disease process? "a. Normal adult hemoglobin is replaced by abnormal hemoglobin .b. There is a lack of cellular hemoglobin being produced. c. There is a deficiency in the production of globulin chains. d. The size and depth of the hemoglobin are affected.

c. X-linked recessive inherited disorder in which a blood-clotting factor is deficient ANS: C The inheritance pattern in 80% of all of the cases of hemophilia is X-linked recessive. The two most common forms of the disorder are factor VIII deficiency, hemophilia A or classic hemophilia; and factor IX deficiency, hemophilia B or Christmas disease. The inheritance pattern is X-linked recessive. The disorder involves coagulation factors, not platelets, and does not involve red cells or the Y chromosomes.

Parents of a hemophiliac child ask the nurse, "Can you describe hemophilia to us?" Which response by the nurse is descriptive of most cases of hemophilia? a. Autosomal dominant disorder causing deficiency in a factor involved in the blood-clotting reaction b. X-linked recessive inherited disorder causing deficiency of platelets and prolonged bleeding c. X-linked recessive inherited disorder in which a blood-clotting factor is deficient d. Y-linked recessive inherited disorder in which the red blood cells become moon-shaped

b. Swimming d. Golf e. Bowling ANS: B, D, E Because almost all persons with hemophilia are boys, the physical limitations in regard to active sports may be a difficult adjustment, and activity restrictions must be tempered with sensitivity to the child's emotional and physical needs. Use of protective equipment, such as padding and helmets, is particularly important, and noncontact sports, especially swimming, walking, jogging, tennis, golf, fishing, and bowling, are encouraged. Contact sport such as soccer and basketball are not recommended.

Parents of a school-age child with hemophilia ask the nurse, "Which sports are recommended for children with hemophilia?" Which sports should the nurse recommend? (Select all that apply.) a. Soccer b. Swimming c. Basketball d. Golf e. Bowling

ANS: D The child with an infratentorial procedure is usually positioned flat and on either side. Pillows should be placed against the child's back, not head, to maintain the desired position. The Trendelenburg position is contraindicated in both infratentorial and supratentorial surgeries because it increases intracranial pressure and the risk of hemorrhage.

Postoperative positioning for a child who has had a medulloblastoma brain tumor (infratentorial) removed should be which? a. Trendelenburg b. Head of bed elevated above heart level c. Flat on operative side with pillows behind the head d. Flat, on either side with pillows behind the back

ANS: D Secondary prevention involves activities that are designed to identify the condition early and initiate treatment to avert cerebral damage. Inborn errors of metabolism such as hypothyroidism, phenylketonuria, and galactosemia can cause cognitive impairment. Genetic counseling and avoidance of prenatal rubella infections are examples of primary prevention strategies to preclude the occurrence of disorders that can cause cognitive impairment. Preschool education and counseling services are examples of tertiary prevention. These are designed to include early identification of conditions and provision of appropriate therapies and rehabilitation services.

Secondary prevention for cognitive impairment includes what activity? a. Genetic counseling b. Avoidance of prenatal rubella infection c. Preschool education and counseling services d. Newborn screening for treatable inborn errors of metabolism

c. topical application of local anesthetic can eliminate venipuncture pain. Preschool children are concerned with both pain and the loss of blood. When preparing the child for venipuncture, the nurse will use a topical anesthetic to eliminate any pain. This is a traumatic experience for preschool children. They are concerned about their bodily integrity. A local anesthetic should be used, and a bandage should be applied to maintain bodily integrity. The nurse should not promise one attempt in case multiple attempts are required. Both finger punctures and venipunctures are traumatic for children. Both require preparation.

Several blood tests are ordered for a preschool child with severe anemia. The child is crying and upset because of memories of the venipuncture done at the clinic 2 days ago. The nurse should explain :a. venipuncture discomfort is very brief .b. only one venipuncture will be needed. c. topical application of local anesthetic can eliminate venipuncture pain. d. most blood tests on children require only a finger puncture because a small amount of blood is needed.

1,2,3,5,6

Spina Bifida Occulta has specific skin indicators they can be absent, singly or combination. What are some skin indicators that you can see that would result in further investigation for spina bifida? 1. Sacral dimple 2. Sacral angiooma 3. Port wine nevus 4. Tuft of hair at base of neck light in color 5. tuft of hair at the sacral area dark in color 6. Sacral lipoma

2 Rationale: One risk factor associated with the development of tumor lysis syndrome is a high WBC count at diagnosis. Other symptoms associated with tumor lysis syndrome are sensitivity to chemotherapy, not tolerance of it; a high cancer cellular proliferation rate, not a low one; and large tumor bodies, not small ones.

Which risk factor is associated with the development of tumor lysis syndrome? 1. Tolerance of chemotherapy 2. High WBC count at diagnosis 3. Low cancer cellular proliferation rate 4. Small tumor bodies

ANS: C The AAIDD has categorized cognitive impairment into adaptive skill domains. The child must demonstrate functional impairment in at least two of the following adaptive skill domains: communication, self-care, home living, social skills, use of community resources, self-direction, health and safety, functional academics, leisure, and work. Age of onset before 18 years is part of the former criteria. Low intelligence quotient (IQ) alone is not the sole criterion for cognitive impairment. Etiology is not part of the classification.

The American Association on Intellectual and Developmental Disabilities (AAIDD), formerly the American Association on Cognitive Impairment, classifies cognitive impairment based on what parameter? a.Age of onset b.Subaverage intelligence c.Adaptive skill domains d.Causative factors for cognitive impairment

ANS: D Toys are selected for their recreational and educational value. For example, a large inflatable beach ball is a good water toy; encourages interactive play; and can be used to learn motor skills such as balance, rocking, kicking, and throwing. Dive rings, an inner tube, and floating ducks are not interactive toys.

The camp nurse is choosing a toy for a child with cognitive impairment to play with during swimming time. What toy should the nurse choose to encourage improvement of developmental skills? a. Dive rings b. An inner tube c. Floating ducks d. A large beach ball

B Preschoolers are most likely to be affected by feelings of guilt that they caused the illness or disability or are being punished for wrongdoings. Toddlers are focused on establishing their autonomy. The illness will foster dependence. The school-age child will have limited opportunities for achievement and may not be able to understand limitations. Adolescents face the task of incorporating their disabilities into their changing self-concept.

The feeling of guilt that the child "caused" the disability or illness is especially critical in which child? a. Toddler b. Preschooler c. School-age child d. Adolescent

C A multidisciplinary conference is necessary for coordination of care for children with complex health needs. The family is included, along with key health professionals who are involved in the child's care. The nursing staff can address the child's nursing care needs with the family, but other involved disciplines must be included. The family must be included in the discharge conferences, which allows them to determine what education they will require and the resources needed at home. A member of the nursing staff must be included to review the child's nursing needs.

The nurse case manager is planning a care conference about a young child who has complex health care needs and will soon be discharged home. Who should the nurse invite to the conference? a. Family and nursing staff b. Social worker, nursing staff, and primary care physician c. Family and key health professionals involved in child's care d. Primary care physician and key health professionals involved in the child's care

c. Progressive weakness and wasting of skeletal muscle ANS: C Werdnig-Hoffmann disease (spinal muscular atrophy type 1) is the most common paralytic form of floppy infant syndrome (congenital hypotonia). It is characterized by progressive weakness and wasting of skeletal muscle caused by degeneration of anterior horn cells. Kugelberg-Welander disease is a juvenile spinal muscular atrophy with a later onset. Charcot-Marie-Tooth disease is a form of progressive neuralatrophy of muscles supplied by the peroneal nerves. Progressive weakness is found of the distal muscles of the arms and feet. Duchenne muscular dystrophy is characterized by muscles, especially in the calves,thighs, and upper arms, which become enlarged from fatty infiltration and feel unusually firm or woodyon palpation. The term pseudohypertrophy is derived from this muscular enlargement.DIF: Cognitive Level: Understand REF: p. 991TOP: Integrated Process: Nursing Process: AssessmentMSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

The nurse is admitting a child with Werdnig-Hoffmann disease (spinal muscularatrophy type 1). Which signs and symptoms are associated with this disease? a. Spinal muscular atrophy b. Neural atrophy of muscles c. Progressive weakness and wasting of skeletal muscle d. Pseudohypertrophy of certain muscle groups

2, 3, 4, 5 Rationale: Increased muscle tone; pallor or flushing; rapid, shallow respirations; and dilated pupils indicate that the infant experiences acute pain. Acute pain is indicated by increased heart rate, not decreased heart rate.

The nurse is assessing pain in a 3-month-old infant. Which physiologic sign indicates acute pain in the infant? select all that apply 1. Decreased HR 2. Increased muscle tone 3. Pallor or flushing 4. Rapid, shallow respirations 5. Dilated pupils

3 Rationale: Children with decreased metabolic rate should consume a high-protein, high-fiber diet. Soybeans and other legumes are excellent sources of proteins and should be included in the child's diet. Butter is a high-fat foot item and is not recommended. Bananas and strawberries are rich in vitamins, potassium, and other nutrients but are not very good sources of proteins.

The nurse is caring for a child who has a decreased metabolic rate. Which food item would be the best choice for the nurse to include in the child's diet? 1. Butter 2. Bananas 3. Soybeans 4. Strawberries

2.

The nurse is caring for a child with poor gastrointestinal (GI) tract muscle tone who reports constipation. Which suggestion of the nurse helps the child in relieving constipation? 1. "You should eat a high-fat diet" 2. "You should eat a high-fiber diet" 3. "You should eat a high-vitamin diet" 4. "You should eat a high-protein diet"

3 Rationale: Because the child cannot communicate pain through on e of the standard pain rating scales, the nurse must focus on physiologic and behavioral manifestations to accurately assess pain. Pain can occur in the comatose child. The child can be in pain while comatose. The family can provide insight into the child's different responses, but the nurse should be monitoring physiologic and behavioral manifestations.

The nurse is caring for a comatose child with multiple injuries. The nurse would recognize which fact about pain? 1. It cannot occur if the child is comatose 2. It may occur if the child regains consciousness 3, It requires astute nursing assignment and management 4. It is best assessed by family members who are familiar with the child

3 Rationale Because the child cannot communicate pain through one of the standard pain-rating scales, the nurse must focus on physiologic and behavioral manifestations to accurately assess pain. Pain can occur in the comatose child. The family can provide insight into the child's responses, but the nurse should be monitoring physiologic and behavioral manifestations.

The nurse is caring for a comatose child with multiple injuries. Which statement would the nurse recognize? 1. Pain cannot occur if a child is comatose 2. Pain may occur if the child regains consciousness 3. Pain requires astute nursing assessment and management. 4. Pain is best assessed by family members who are familiar with the child

ANS: B In the prone position, feeding is a problem. The infant's head is turned to one side for feeding. If the child is able to nipple-feed, tube feeding is not needed. Before surgery, the infant is kept in the prone position to minimize tension on the sac and risk of trauma.

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 which position? a. Prone and tube-fed b. Prone, head turned to side, and nipple-fed c. Supine in an infant carrier and nipple-fed d. Supine, with defect supported with rolled blankets, and nipple-fed

ANS: A Hydrocephalus is a frequently associated anomaly in 80% to 90% of children. Craniostenosis is the preterm closing of the cranial sutures and is not associated with myelomeningocele. Biliary and esophageal atresia is not associated with myelomeningocele. DIF: Cognitive Level: Understand REF: p. 984TOP: Integrated Process: Teaching/LearningMSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

The nurse is conducting a staff in-service on common problems associated with myelomeningocele. Which common problem is associated with this defect? a. Hydrocephalus b. Craniostenosis c. Biliary atresia d. Esophageal atresia

c. Increased red blood cell destruction occurs The clinical features of sickle cell anemia are primarily the result of increased red blood cell destruction and obstruction caused by the sickle-shaped red blood cells. Sickled red cells have decreased oxygen-carrying capacity and transform into the sickle shape in conditions of low oxygen tension. When the sickle cells change shape, they increase the viscosity in the area where they are involved in the microcirculation. Increased adhesion and entanglement of cells occurs.

The nurse is conducting a staff in-service on sickle cell anemia. Which describes the pathologic changes of sickle cell anemia? a. Sickle-shaped cells carry excess oxygen. b. Sickle-shaped cells decrease blood viscosity. c. Increased red blood cell destruction occurs. d. Decreased adhesion of sickle-shaped cells occurs.

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 otherneurologic disorders.DIF: Cognitive Level: Understand REF: p. 978TOP: Integrated Process: Teaching/LearningMSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

The nurse is planning a staff in-service on childhood spastic cerebral palsy. What characterizes spastic cerebral palsy? 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

c. Puppet play in the child's room Because the basic pathologic process in anemia is a decrease in oxygen-carrying capacity, an important nursing responsibility is to assess the child's energy level and minimize excess demands. The child's level of tolerance for activities of daily living and play is assessed, and adjustments are made to allow as much self-care as possible without undue exertion. Puppet play in the child's room would not be overly tiring. Hide and seek, dancing, and walking to the lobby would not conserve the anemic child's energy.

The nurse is planning activity for a 4-year-old child with anemia. Which activity should the nurse plan for this child? a. Game of "hide and seek" in the children's outdoor play area b. Participation in dance activities in the playroom c. Puppet play in the child's room d. A walk down to the hospital lobby

2 Rationale: Infection is the greatest hazard in the postoperative period. Manifestations of infection include elevated temperature, poor feeding, vomiting, decreased responsiveness, and seizure activity. An obstruction of the shunt can lead to increased ICP. This causes pupillary dilation on the side of the pressure. In the case of increased ICP, the surgeon may prescribe elevation of the head of the bed and allowing the child to sit up. This enhances gravity flow through the shunt and helps reduce ICP. The child has improved feeding in the absence of infection, not during the presence of an infection.

The nurse is providing postoperative care of a ventriculoperitoneal (VP) shunt for a child with hydrocephalus. Which assessment does the nurse recognize as a sign of infection of the cerebrospinal fluid? 1. Increased ICP 2. Elevated Temperature 3. Dilation of the pupils 4. Improved feeding

ANS: A Myelomeningocele is one of the most common causes of neuropathic (neurogenic) bladder dysfunction among children. Risk of mental retardation 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.

The nurse is teaching a group of nursing students about newborns born with the congenital defect of myelomeningocele. Which common problem is associated with this defect? a. Neurogenic bladder b. Mental retardation c. Respiratory compromise d. Cranioschisis

a. Milk is a poor source of iron. Children between the ages of 12 and 36 months are at risk for anemia because cow's milk is a major component of their diet and it is a poor source of iron. Iron is stored during fetal development, but the amount stored depends on maternal iron stores. Fetal iron stores are usually depleted by age 5 to 6 months. Dietary iron can be introduced by breastfeeding, iron-fortified formula, and cereals during the first 12 months of life.

The nurse is teaching parents about the importance of iron in a toddler's diet. Which explains why iron deficiency anemia is common during toddler-hood? a. Milk is a poor source of iron. b. Iron cannot be stored during fetal development. c. Fetal iron stores are depleted by age 1 month. d. Dietary iron cannot be started until age 12 months.

ANS: D The injured extremity should be kept elevated while resting and in a sling when upright. This will increase venous return.

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 of the following 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.

3 Avocado and kiwi fruits are high in latex

The nurse is teaching the parents of a child with spina bifida about latex allergies. Which suggestion given by the nurse is helpful in preventing the occurrence of allergic reactions to latex? 1. "Reduce the intake of apricot" 2. "Reduce the intake of Coconut" 3. "Reduce the intake of avocado" 4. "Reduce the intake of strawberry."

3 Rationale Children with impaired senses are assessed by the non-communicating children's pain checklist. It involves six subscales, and the assessments are scored on a scale of 0-10 based on the severity of pain. The subscale "body and limbs" includes the flinching activity of the child who feels sensitive to touch. Whining is assessed under the "vocal" subscale, agitation is assessed under the "activity" subscale, and shivering is assessed under the "physiologic" subscale.

The nurse is using a pain scale for a nonverbal child. Which behavior would be assessed in the limb subscale? 1. Is the child whining? 2. Is the child agitated? 3. Is the child flinching? 4. Is the child shivering?

1. Withdrawal symptoms such as increased irritability, nausea, diarrhea, sweating, and fever are seen when an opioid is abruptly discontinued. This happens because the use of opioids causes physical dependence.

The nurse observes increased irritability, nausea, diarrhea, sweating, and fever in a child on the second day after discontinuing the opioid dose. What does the nurse conclude from the child's condition? 1. The child having withdrawal symptoms 2. The child is addicted to opioids 3. The child is having a painful episode caused by sickle cell disease 4. The child is displaying side effects of opioids.

C The nurse should be particularly alert to the child who passively accepts all painful procedures. This child may believe that such acts are inflicted as deserved punishment. The child who is hopeful is mobilized into goal-directed actions. This child would actively participate in care. Chronic sorrow is the feeling of sorrow and loss that recurs in waves over time. It is usually evident in the parents, not in the child. A child who believes that procedures are an important part of care would actively participate in care. Nursing interventions should be used to minimize the pain.

The nurse observes that a seriously ill child passively accepts all painful procedures. The nurse should recognize that this is most likely an indication that the child is experiencing a: a. sense of hopefulness .b. sense of chronic sorrow. c. belief that procedures are a deserved punishment. d. belief that procedures are an important part of care.

1 Rationale: One of the more common neurotoxic effects is severe constipation caused from decreased bowel innervation. Visual disturbances, muscle rigidity, and hemorrhage are not associated with vincristine.

The nurse recognizes which neurotoxic effect in the child who is receiving chemotherapy treatment with vincristine? 1. severe constipation 2. Visual disturbances 3. Muscle rigidity 4. Hemorrhage

ANS: A, B, C, E To facilitate lipreading, the nurse should plan to face the child directly, speak at eye level, keep sentences short, and establish eye contact and show interest. The nurse should plan to speak at a slow rate, not a fast one.

The nurse should plan which actions to facilitate lipreading for a child with a hearing impairment? (Select all that apply.) a. Face the child directly. b. Speak at eye level. c. Keep sentences short. d. Speak at a fast, even-paced rate. e. Establish eye contact and show interest.

ANS: A The absence of babbling or inflections in voice by at least age 7 months is an indication of hearing difficulties. Lack of eye contact is not indicative of a hearing loss. An infant with a hearing impairment might react to a loud noise but not respond to the spoken word. The child with hearing impairment uses gestures rather than vocalizations to express desires at this age.

The nurse should suspect a hearing impairment in an infant who fails to demonstrate which behavior? a. Babbling by age 12 months b. Eye contact when being spoken to c. Startle or blink reflex to sound d. Gesturing to indicate wants after age 15 months

4, Rationale: Frequently checking the clock is common in a patient suffering from severe unrelieved pain. They may appear to others to be preoccupied with getting more opioids, but the preoccupation is actually focused on finding relief from the pain. Pseudoaddiction. rather than addiction, is a behavior that the nurse can expect to encounter in a child experience

The nurse would recognize that children with unrelieved severe pain may engage in certain behaviors. Which behaviors would the nurse expect to encounter in a child experiencing severe unrelieved pain? 1. Addiction 2. Increase in Appetite 3. Mental Clarity and Alertness 4. Frequent checking of the clock.

4. Rationale: An adequate dosage of iron turns the stools a tarry, black color. Tarry, black stools are not a sign of iron-deficiency anemia. Tarry, black stools are not an adverse effect of the iron preparation but an expected effect. Tarry, black stools are not an indicator of iron preparation overdose.

The parent of a child receiving an iron preparation tells the nurse that the child's stools are tarry, black color. Which would be the nurse's best explanation? 1. A symptom of iron deficiency anemia 2. An adverse effect of the iron preparation 3. An indicator of an iron preparation overdose 4. An expected change caused by the iron preparation.

ANS: D The most successful BMTs come from suitable HLA-matched donors. The timing of a BMT depends on the disease process involved. It usually follows intensive high-dose chemotherapy or radiotherapy. Usually, parents only share approximately 50% of the genetic material with their children. A one in four chance exists that two siblings will have two identical haplotypes and will be identically matched at the HLA loci. The decision to continue chemotherapy or radiotherapy if BMT fails is not appropriate to discuss with the parents when planning the BMT. That decision will be made later.

The parents of a child with cancer tell the nurse that a bone marrow transplant (BMT) may be necessary. What information should the nurse recognize as important when discussing this with the family? a. BMT should be done at the time of diagnosis .b. Parents and siblings of the child have a 25% chance of being a suitable donor. c. If BMT fails, chemotherapy or radiotherapy will need to be continued d Finding a suitable donor involves matching antigens from the human leukocyte antigen (HLA) system.

ANS: D Baclofen, given intrathecally, is best suited for children with severe spasticity that interferes with activities of daily living and ambulation. Anticonvulsant medications are used when seizures occur in children with cerebral palsy. The intrathecal route decreases the side effects of the drugs that reduce spasticity. Few medications are currently available for the control of spasticity .DIF: Cognitive Level: Understand REF: p. 979TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies

The parents of a child with cerebral palsy ask the nurse whether any drugs can decrease their child's spasticity. The nurse's response should be based on which statement? a. Anticonvulsant medications are sometimes useful for controlling spasticity. b. Medications that would be useful in reducing spasticity are too toxic for use with children. c. Many different medications can be highly effective in controlling spasticity. d. Implantation of a pump to deliver medication into the intrathecal space to decreasespasticity has recently become available.

Spina bifida OCCULTA meaning NO visible externally Spina bifida CYSTICA has a visible defect and a SAClike protrusion

What are the two types of spina bifida?

4. Rationale: Adjuvant analgesics are the category of medications that can be used alone or in combination with opioids to control pain symptoms. Sublingual, epidural, and nerve block are not categories of medication but instead routes of analgesic drug administration.

What category of medications can be used alone or in combination with opioids to control pain symptoms? 1. Epidural 2. Sublingual 3. Nerve Blocks 4. Adjuvant Analgesics

ANS: B Retinoblastoma is an example of a pediatric cancer that demonstrates inheritance. The absence of the retinoblastoma gene allows for abnormal cell growth and the development of retinoblastoma. Chromosome abnormalities are present in many malignancies. They do not indicate a familial pattern of inheritance. The Philadelphia chromosome is observed in almost all individuals with chronic myelogenous leukemia. There is no evidence of a familial pattern of inheritance for rhabdomyosarcoma or osteogenic sarcoma cancers

What childhood cancer may demonstrate patterns of inheritance that suggest a familial basis? a. Leukemia b. Retinoblastoma c. Rhabdomyosarcoma d. Osteogenic sarcoma

1 Monitor S/S of increased ICP

What is the most frequent ANOMALY associated with SPINA BIFIDA? 1. Hydrocephalus 2. Decreased bladder supply 3. Scoliosis 4. Lack of bowel control

1

When is it appropriate to shift the goals of treatment for a child who has a chronic or complex disease toward preparation for death? 1. When a cure is no longer possible 2. When health care workers are offering supportive care 3. When the child is responding well to the current treatment plan but the future is unknown. 4. when the child is responding well to the current treatment plan but the results of one recent research study have demonstrated positive results with a new medication.

3 Rationale: with diet modification and regular toilet habits (bowel training) to prevent constipation and impaction, some degree of fecal continence can be achieved. Although a lengthy process, continence can be achieved with modification of diet, use of stool softeners, enemas, or a combination thereof. Enemas and stool softeners are part of the strategy to achieve continence. Laxatives should be used only as a last resort. A colostomy is not indicated for the child with myelomeningocele

Which MOST accurately describes bowel function in children born with a Myelomeningocele? 1. Incontinence cannot be prevented 2. Enemas and laxatives are contraindicated 3. Some degree of fecal continence can usually be achieved 4. A colostomy is usually required by the time the child reaches adolescence

3 Rationale: Short stature, protruding tongue, and hypotonia are common clinical manifestations of down syndrome that the nurse is likely to observe during an assessment. A small nose, rather than a large one, and small ears, rather than large ones, with a short, broad neck are common clinical manifestations of down syndrome. A large space, rather than a narrow one, between the big and second toes, along with hypotonia are common clinical manifestations of down syndrome

Which are common clinical manifestations of down syndrome? 1. Small nose, large ears, and hypertonia 2. Large nose, large ears, and short, broad neck 3. Short stature, protruding tongue, and hypotonia 4. Short stature, narrow space between the big and second toes, and hypotonia

1 Rationale: Anemia, infection, and bleeding resulting from decreased PLT production are signs of infiltration of the bone marrow. Petechiae occur as a result of a lowered PLT count, infection occurs because of the depressed number of effective leukocytes, and fatigue occurs as a result of the anemia. Headache, papilledema, and irritability are not signs of bone marrow involvement. Muscle wasting, weight loss, and fatigue are not signs of bone marrow involvement. Decreased ICP, psychosis, and confusion are not signs of bone marrow involvement.

Which are the MOST common signs and symptoms of leukemia related to bone marrow involvement? 1. Anemia, infection, bleeding 2. Headache, papilledema, irritability 3. Muscle wasting, weight loss, fatigue 4. Decreased ICP, psychosis, confusion

B Because of egocentricity, the preschooler may feel guilty and responsible for the death.

Which best describes how preschoolers react to the death of a loved one? a. Preschooler is too young to have a concept of death. b. Preschooler may feel guilty and responsible for the death .c. Grief is acute but does not last long at this age. d. Grief is usually expressed in the same way in which the adults in the preschooler's life are expressing grief.

d. Painful swelling of hands and feet; painful joints A vasoocclusive crisis is characterized by severe pain in the area of involvement. If in the extremities, painful swelling of the hands and feet is seen; if in the abdomen, severe pain resembles that of acute surgical abdomen; and if in the head, stroke and visual disturbances occur. Circulatory collapse results from sequestration crises. Cardiomegaly, systolic murmurs, hepatomegaly, and intrahepatic cholestasis result from chronic vasoocclusive phenomena.

Which clinical manifestation should the nurse expect when a child with sickle cell anemia experiences an acute vasoocclusive crisis? a. Circulatory collapse b. Cardiomegaly, systolic murmurs c. Hepatomegaly, intrahepatic cholestasis d. Painful swelling of hands and feet; painful joints

2 Rationale: Children with fragile X syndrome have an increased head circumference and protruding ears. They are hyperactive and have a short attention span. ASD is indicated when the child is unable to maintain eye contact and has inadequate communication. Aphasia is the inability to express ideas in any form. Down syndrome is indicated by physical characteristics such as a rounded and small skull; protruding tongue; and a short, broad neck.

Which condition would the nurse suspect in the child who has an increased head circumference, protruding ears, is unable to sit quietly in one place, and repeats words? 1. Autism spectrum disorder (ASD) 2. Fragile X syndrome 3. Aphasia 4. Down Syndrome

2 Approach behaviors are coping mechanisms that result in movement toward adjustment and resolution of the crisis. Acknowledging and accepting the diagnosis and prognosis and making realistic plans for the future are examples of approach behaviors.

Which coping mechanism is demonstrated by a 9-year-old girl with several physical disabilities who acknowledges and accepts her diagnosis and prognosis and is making realistic plans for the futute? 1. Denial 2. Approach 3. Avoidance 4. Depression

2, 4, 5

Which criterion is included in the clinical definition of the word cure in childhood cancer? select all that apply 1. Partial remission 2. Completion of therapy 3. A normal white blood cell count 4. No evidence of any disease 5. A period of 5 years since diagnosis

1 Rationale: Iron should be given with ascorbic acid (vitamin C). Iron would be given into large muscles to prevent skin staining and irritation. Iron would be injected deeply into a large muscle with the Z-track, not the air-lock, method to prevent skin staining and irritation.

Which factor is appropriate to consider when administering iron? 1. To administer with ascorbic acid 2. Can be given into a small muscle 3. May be mixed with yogurt for administration to small children 4. Would be injected deeply into a large muscle mass using an air-lock method.

1 Rationale: The definition of a slight hearing loss includes normal speech with difficulty hearing faint or distant speech. With severe hearing loss, the child may hear a loud voice if it is nearby and may be able to identify loud environmental noises. Moderate hearing loss results in the child's being able to understand conversation at a distance of 3 to 5 feet. Children who have difficulty hearing faint or distant speech but have normal speech themselves are by definition experiencing slight hearing loss. The findings in this child are evidence of slight hearing loss, not inattentiveness.

Which hearing loss classification would be demonstrated in a 6-year-old child with difficulty hearing faint or distant speech, whose speech is normal but who is having problems with school performance? 1. Slight 2. Severe 3. Moderate 4. Inattentiveness rather than hearing loss

2

Which intervention by the nurse will provide the family with support at the time a child is found to have a chronic or complex disease? 1. Ending the conference with the prognosis 2. Incorporating the family's input into the care plan 3. Giving the parents detailed information about the disease 4. Giving the parents advice of the treatment options that they should pursue

1,3,5 Rationale: During a nosebleed, the child should be instructed to breathe through the mouth, cotton or wadded tissue can be inserted into the nostrils to stop bleeding, and continuous pressure using the thumb and forefinger should be applied for at least 10 minutes. The child should be instructed to sit up and lean forward, not tilt the head backward. Ice or cold cloths, not warm compresses, can be used on the bridge of the nose if bleeding persists.

Which intervention is included in the management of nosebleeds in children? select all that apply. 1. Instruct the child to breathe through the mouth 2. Have the child sit down and tilt the head backward 3. Insert cotton or wadded tissue each nostril if bleeding persists 4. Apply warm compresses to the bridge of the nose if bleeding is persistent. 5. Apply continuous pressure to the nose with thumb and forefinger for at least 10 minutes.

2

Which intervention would be performed FIRST by the nurse during a blood transfusion? 1. Transfuse blood slowly for initial 20% of blood volume 2. Identify donor and recipient blood types and groups 3. Save donor blood for recrossmatch with patient's blood. 4. Send the patient's blood and urine sample to the laboratory.

ANS: B, C Diagnosis of GBS is based on clinical manifestations, CSF analysis, and EMG findings. CSF analysis reveals an abnormally elevated protein concentration, normal glucose, and fewer than 10 WBCs/mm3. CSF fluid should not contain RBCs.

Which should the nurse expect to find in the cerebral spinal fluid (CSF) results of a child with Guillain-Barré syndrome (GBS)? (Select all that apply.) a. Decreased protein concentration b. Normal glucose c. Fewer than 10 white blood cells (WBCs/mm3) d. Elevated red blood cell (RBC) count

4 Rationale: Fragile X syndrome can now be detected prenatally. The family would be referred for genetic counseling. Assessment for family history would be done, but it does not address the parents' concern and need for genetic counseling. Nurses do not make recommendations about whether parents would become pregnant and have other children. A referral for genetic counseling is indicated, and, depending on the findings, the geneticist can present family planning options, but the decision is strictly up to the family. Fragile X syndrome is inherited on the X chromosome.

Which is MOST appropriate nursing action for the parents of a child with fragile X syndrome who want to have another baby but worry that another child might be similarly affected? 1. Assess for a family history of the syndrome 2. Recommend that they not have another child. 3. Reassure them that the syndrome is not inherited 4. Explain that prenatal diagnosis of the syndrome is now available

1,3,4,6 Rationale: Expected physical examination findings in the adolescent with Hodgkin Disease include night sweats, fever, an enlarged liver, and an enlarged spleen. Paresthesia and bradypnea are not typical findings in adolescents with Hodgkin Disease.

Which is an expected physical examination finding in the adolescent with Hodgkin Disease? select all that apply 1. Night sweats 2. Paresthesia 3. Fever 4. Enlarged Liver 5. Bradypnea 6. Enlarged spleen

3

Which is the MOST appropriate nursing response to the parents of a child with Down syndrome who worry a second child might be similarly affected? 1. Assessing the family for a history of the syndrome 2. Reassuring the family that Down syndrome is not a genetic disorder 3. Recommending genetic counseling because the syndrome is inherited 4. Recommending that the parents take precautions to prevent future pregnancies

4 Rationale: The distal forearm (radius, ulna, or both) is the most common fracture site in children.

Which is the MOST common site of fractures in children? 1. Hand 2. Pelvis 3. Clavicle 4. Distal forearm

1. Rationale: Prevention of pain is the best approach to pain management in children. Administering medications early is not a good approach to pain management in children. Administering medications as needed is not a good approach to pain management. Administering the minimum, not the maximum, dose of pain medications is appropriate.

Which is the best approach in managing pain in children? 1. Preventing the pain 2. Administering medications early 3. Administering medications as needed 4. Administering the maximum dose of pain medications

3,4,5

Which is the initial symptom of tetanus? select all that apply 1. Slow pulse 2. Oral infection 3. Progressive stiffness 4. Difficulty opening mouth 5. Progressive tenderness of muscles in neck and jaw

A The school-age child who is ill may be forced into a period of dependency. To foster normalcy, the child should be given as much control as possible. It is unrealistic to expect one individual to make the child feel normal. The child has a chronic illness. It would be unacceptable to convince the child that nothing is wrong. The family rules should be similar for each of the children in a family. Resentment and hostility can arise if different standards are applied to each child.

Which is the most appropriate nursing intervention to promote normalization in a school-age child with a chronic illness? a. Give child as much control as possible. b. Ask child's peer to make child feel normal. c. Convince child that nothing is wrong with him or her. d. Explain to parents that family rules for the child do not need to be the same as for healthy siblings.

4. Rationale: Replacement of the missing clotting factor is the primary therapy for hemophilia. Diet and exercise are important but are not the primary therapy for hemophilia. Corticosteroids are helpful for hematuria and chronic synovitis but are not the primary therapy for hemophilia. Treatment of pain is important but not the primary therapy for hemophilia.

Which is the primary treatment for hemophilia? 1. Diet and exercise 2. Corticosteroids 3. Pain Management 4. Replacement of missing clotting factor

3

Which is the term given to the care that is provided to patients whose disease is not responsive to curative treatment? 1. Dying care 2. Curative care 3. Palliative care 4. Restorative care

4 Rationale: MedicAlert bracelets should be worn by children who have a risk of developing medical emergencies. These bracelets alert others to the child's condition and whom to contact in an emergency. Teaching the parents about managing hypoglycemia may help them to manage a diabetic emergency, but the parents cannot always be with the child.

Which nursing action would help a child with type 1 diabetes mellitus with a risk of hypoglycaemia get medical assistance during an emergency? 1. Teach the parents to manage hypoglycemia 2. Teach the child about his or her disease 3. Instruct the child to avoid going out alone 4. Encourage the use of a MedicAlert bracelet

1, 4, 5 Rationale: Normalization is a process that helps patients and families create a normal life, despite serious medical conditions. Providing support to the family members is essential in managing emotional feelings and helping them on the path to normalization. This path may include encouraging the child to participate in recreational activities and attend regular school if physically possible because these activities may help in the development of self-esteem and independence. Patients do not have to avoid thinking about their condition but would be encouraged to thrive despite the condition. Admitting a patient to hospice care is applicable only if the patient is observed to be irresponsive to medication and is terminally ill.

Which nursing action would help the child with cerebral palsy achieve the HIGHEST level of well-being? select all that apply. 1. Provide support to the family members 2. Remind the patient not to dwell on the conditions 3. Admit the patient to hospice care 4. Encourage the child to engage in recreational activities 5. Encourage the family to enroll the child in traditional school.

3. Rationale: Chelation therapy minimizes the development of hemosiderosis (iron overload), a complication of blood transfusions. Antiemetics help ease N/V. splenectomy is necessary when severe splenomegaly develops. Blood transfusions are the primary medical management.

Which procedure is appropriate when identifying the means of eliminating excess iron in a child with thalassemia major? 1. Antiemetics 2. Splenectomy 3. Chelation therapy 4. Blood Transfusions

2 Rationale: OI is an autosomal dominant inherited disorder, a lifelong problem caused by defective bone mineralization, abnormal bone architecture, and increased susceptibility to fracture. OI has a predictable course that is determined by the pathophysiologic processes, not the time of onset. Lightweight braces and splints can help support limbs and fractures

Which statement concerning osteogenesis imperfecta (OI) is true? 1. OI is easily treated 2. OI is an inherited disorder 3. Braces and exercises are of no therapeutic value 4. With a later onset, the disease usually rubs a more difficult course.

4 Rationale: Developmental delay is any significant lag in a child's physical, cognitive, behavioral, emotional, or social development compared with developmental norms. Behavioral delay is not a medical term. Dysmorphic features is a term that describes certain physical features. Cognitive impairment is a general term that encompasses any type of mental difficulty

Which term describes any significant lag in a child's physical, cognitive, behavioral, emotional, or social development compared with developmental norms? 1. Behavioral Delay 2. Dysmorphic features 3. Cognitive impairment 4. Developmental delay

4 Rationale: Implantation of a pump to deliver medication into the intrathecal space can help ease spasticity in a child with cerebral palsy. Exercises, though beneficial, will not be enough to ease the spasticity found in a child with CP. Diuretics do not help ease spasticity. Anticonvulsant medications are used when seizures occur in children with CP.

Which treatment does the nurse understand can help ease spasticity in a child with cerebral palsy? 1. Exercises 2. Diuretic medications 3. Anticonvulsant medications 4. Implanted medication pump

1 Rationale: Buckle fracture results when porous bone is compressed. In a complete fracture, the bone fragments are divided. In a greenstick fracture, the bone is angulated beyond the limits of bending. Plastic deformation occurs when the bone is bent but not broken.

Which type of fracture in children results when the porous bone is compressed? 1. Buckle Fracture 2. Complete Fracture 3. Greenstick Fracture 4. Plastic Deformation

2 Rationale: A child who has difficulty processing linguistic information through audition with or without a hearing aid has a profound sensory impairment. A slight sensory impairment is defined as difficulty hearing faint or distant speech. A moderate sensory impairment is defined as hearing sufficient to enable successful processing of linguistic information through audition. A moderately severe impairment is defined as hearing sufficient to enable successful processing of linguistic information through audition.

Which type of sensory impairment does a 4-year-old child with difficulty processing linguistic information through audition with or without a hearing aid have? 1. slight 2 profound 3. moderate 4. moderately severe

4 Rationale: The goals of treatment for JIA include the prevention of physical deformity, the preservation of joint function, and the control of pain. There is no cure for JIA. Skin breakdown is not a common complication of JIA. Once the joint is damaged as a result of the physiologic processes of JIA, it may not be possible to regain proper alignment

Which would be considered major goals of the therapeutic management of juvenile idiopathic arthritis (JIA)? 1. Prevention of loss of joint function and complete resolution of disease. 2. Prevention of skin breakdown and relief of symptoms 3. Prevention of joint discomfort and recovery of proper alignment 4. Prevention of physical deformity and preservation of joint function.

3 Rationale: Pain control, physical and occupational therapy, splints, and NSAIDs for inflammation is the most comprehensive therapeutic management for juvenile idiopathic arthritis. Acetaminophen does not reduce inflammation, and warm, moist heat is better than ice for relieving stiffness and pain. Range-of-motion exercises should not be performed during periods of inflammation.

Which would be the MOST comprehensive therapeutic management for juvenile idiopathic arthritis? 1. Pain control, physical and occupational therapy, splints, and ice packs 2. Pain control, physical and occupational therapy, splints, and acetaminophen to reduce inflammation 3. Pain control, physical and occupational therapy, splints, and NSAIDs for inflammation 4. Pain control, physical and occupational therapy, splints, and range-of-motion exercises during periods of inflammation

4 Rationale: Teaching the parents and child how to recognize signs and symptoms of crisis is most important for the well-being and safety of the child. Genetic counseling is important, but teaching the care of the child is priority. Parents need specific instructions on the need to watch for changes in the child's condition, including adequate hydration, and environmental concerns. Sickle cell anemia is a long-term, chronic illness. Multiple blood transfusions are an option for some children with sickle cell disease. The priority for all children with this condition is properly preparing the parents to care for them.

Which would the nurse recognize as the MOST important nursing consideration in the care of a child with sickle cell anemia? 1. Referring the parents and child for genetic counseling 2. Helping the child and family adjust to a short-term disease 3. Teaching caregivers about need for multiple blood transfusions 4. Teaching the parents and child how to recognize signs and symptoms of crisis

1, 2, 4, 6 Rationale: Important prognostic factors in determining long-term survival for children with ALL include the initial WBC count, the patient's age at the time of diagnosis, cytogenetics, and the sex of the child. The amount of bone marrow dysfunction or the presence of hepatosplenomegaly are not prognostic factors in determining the survival rates for children with ALL

Which would the nurse understand is an important prognostic factor in determining long-term survival for children with acute lymphoblastic leukemia (ALL)? select all that apply 1. Initial WBC count 2. Patient's age at diagnosis 3. Bone Marrow Dysfunction 4. Cytogenetics 5. Presence of hepatosplenomegaly 6. The child's sex

3. Physiologic manifestations of pain may vary considerably and therefore do not provide a consistent measure of pain. Children do not tend to underestimate pain when pain is appropriately assessed. Parental report of children's pain has not been found to be more reliable than physiologic measurements. Whether a child is hospitalized or not, Physiologic measurements of pain are not as useful as a child's self-report of pain.

Why are physiologic measurements in the assessment of pain in children not as useful as other measurements of pain? 1. Children tend to underestimate pain. 2. Parental report of children's pain is more reliable than physiologic measurements. 3. The same physiologic signs that suggest fear, anxiety, or anger can also indicate pain 4. Physiologic measurements are of limited value in assessing pain when the child is hospitalized.

2 Rationale A verbal report of pain is the most reliable indicator of pain in school-age children. Crying, increased heart rate, and increased blood pressure are not always indicative of pain but can be complex responses to emotional stress.

which would the nurse recognize as the MOST reliable indicator of pain in school-age children? 1. crying 2. Verbal report 3. Increased HR 4. Increased BP