Maternity & Pediatric Nursing - Ricci - Ch's 32-50, 52

Chapter 35, 11 Format: Multiple Choice Chapter: 35 Client Needs: D-1 Cognitive Level: Comprehension Difficulty: Moderate Integrated Processes: Teaching/Learning Objective: 6 Page: 1081 279. The nurse is explaining the effects of heat application for pain relief. Which of the following would the nurse be likely to include as an effect? A) Increased blood flow to the area B) Increased pressure on nociceptive fibers C) Possible release of endogenous opioids D) Altered capillary permeability

B Response: Heat causes an increase in blood flow. This alters capillary permeability, leading to a reduction in swelling and pressure on nociceptive fibers. Heat also may trigger the release of endogenous opioids, which mediate the pain response.

Chapter 36, 10 Format: Multiple Choice Chapter: 36 Client Needs: D-3 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 4 Page: 1102 293. The nurse plans to implement airborne precautions for children with which of the following infections? A) Measles B) Streptococcal group A C) Rubella D) Scarlet fever

A Response: Airborne precautions are designed to reduce the risk of infectious agents transmitted by airborne droplet nuclei or dust particles such as for clients with measles, varicella, or tuberculosis. Droplet precautions would be used for children with streptococcal group A infections, rubella, and scarlet fever.

Chapter 38, 3 Format: Multiple Choice Chapter: 38 Client Needs: D-3 Cognitive Level: Comprehension Difficulty: Moderate Integrated Processes: Nursing Process Objective: 5 Page: 1192 316. The nurse is caring for a 10-year-old with allergic conjunctivitis. The nurse understands that the child is also at risk specifically for what other problem? A) Atopic dermatitis B) Insect bite sensitivity C) Acute otitis media D) Frequent sore throats

A Response: Atopic dermatitis is a risk factor specifically for allergic conjunctivitis because of repeated exposure to the particular allergens. Acute otitis media, insect bite sensitivity and frequent sore throats can occur but are not related to the allergic conjunctivitis.

Chapter 32, 2 Format: Multiple Choice Chapter: 32 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Processes: Caring Objective: 1 Page: 983 225. The nurse is caring for a hospitalized 13-year-old girl who is questioning everything the medical staff is doing and is resistant to treatment. How should the nurse respond? A) "Let's work together to plan your day along with your treatments." B) "The sooner you cooperate, the sooner you will get to leave." C) "If you are more cooperative, perhaps we can arrange a visit from your friends." D) "Please don't make me call your parents about this."

A Response: Collaborating with the adolescent will provide her with increased control. The nurse should work with the teen to provide a mutual agreeable schedule that allows for the teen's preferences while incorporating the required nursing care. Threatening to call the parents will most likely promote further resistance. The nurse should try to immediately engage the girl rather than making the nurse's cooperation conditional upon the girl's cooperation. Telling the girl that the sooner she cooperates, the sooner she will leave is inappropriate: the nurse is incorrectly implying that the girl's behavior, rather then her medical needs, are going to determine when she will be discharged from the hospital.

Chapter 37, 4 Format: Multiple Choice Chapter: 37 Client Needs: D-2 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Teaching/Learning Objective: 4 Page: 1142 302. The physician has ordered rectal diazepam (Valium) for a 2-year-old boy with status epilepticus. Which of the following instructions is essential for the nurse to teach the parents? A) Monitor the level of sedation and the respiratory rate. B) Watch for a temperature elevation, indicating infection. C) Gradually reduce the dose of medication. D) Monitor for an allergic reaction to the medication.

A Response: Diazepam is useful for home management of prolonged seizures, but the parents must be educated in its proper administration. Monitoring sedation and respiratory status is necessary when a central nervous system depressant has been ordered. Parents need to monitor the overall health of the child, including temperature when needed, but this has nothing to do with the diazepam. When an anticonvulsant is stopped, gradual reduction of the dosage is necessary to prevent seizures or status epilepticus. This is not done without a physician's order. Monitoring for allergic reactions is necessary when any medications have been prescribed but is not specific to diazepam.

Chapter 33, 7 Format: Multiple Choice Chapter: 33 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 5 Page: 1019 245. The nurse is caring for a special needs infant. Which intervention will be most important in helping the child reach her maximum developmental potential? A) Directing the parents to an early intervention program B) Monitoring the child's progress in elementary school C) Serving on an individualized education program committee D) Preparing a plan for the child to make the transition to college

A Response: Early intervention is critical to maximizing the child's developmental potential by laying the foundation for health and development. While important, intervention at the elementary or secondary school level does not have the impact of early intervention. When the time arrives, it is important to have a written plan for transition to college, if this is a possibility for the grown child.

Chapter 36, 15 Format: Multiple Choice Chapter: 36 Client Needs: D-3 Cognitive Level: Comprehension Difficulty: Moderate Integrated Processes: Nursing Process Objective: 2 Page: 1100 298. When describing the role of white blood cells in infection, the nurse identifies which type as important in combating bacterial infections? A) Neutrophils B) Eosinophils C) Basophils D) Lymphocytes

A Response: Elevations in certain portions of white blood cell count reflect different processes occurring in the body. Neutrophils function to combat bacterial infection. Eosinophils function in allergic disorders and parasitic infections. Basophils combat parasitic infections and some allergic disorders. Lymphocytes function in viral infections.

Chapter 37, 11 Format: Multiple Choice Chapter: 37 Client Needs: D-3 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 4 Page: 1141 309. A child with increased intracranial pressure is being treated with hyperventilation. The nurse understands that which of the following is the rationale for this treatment? A) PaCO2 levels decrease, causing vasoconstriction. B) Drainage of cerebrospinal fluid occurs. C) Activity is controlled via a stimulator. D) Hyperexcitability of the nerves is reduced.

A Response: Hyperventilation decreases PaCO2, which results in vasoconstriction and therefore decreases intracranial pressure. A shunt would allow for drainage of cerebrospinal fluid. A vagal nerve stimulator is used to provide an appropriate dose of stimulation to manage seizure activity. Anticonvulsants decrease the hyperexcitability of nerves.

Chapter 32, 12 Format: Multiple Choice Chapter: 32 Client Needs: D-1 Cognitive Level: Analysis Difficulty: Easy Integrated Processes: Communication and Documentation Objective: 6 Page: 1002 235. The mother of a hospitalized child reports that her daughter, who is having some difficulty eating, just had a 4-ounce cup of ice chips. The nurse documents this on the child's intake flow sheet as which of the following? A) 2 ounces B) 4 ounces C) 6 ounces D) 8 ounces

A Response: Ice chips are included as fluid intake, and the amount is approximately equivalent to half the same amount of water. Therefore, the nurse would document this fluid intake as 2 ounces.

Chapter 38, 1 Format: Multiple Choice Chapter: 38 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 10 Page: 1214 314. The nurse is providing psychosocial support to a 5-year-old child with a severe visual impairment. Which behavior would the nurse be least likely to find? A) Immature emotional behavior B) Self-stimulatory actions C) Inattention and vacant stare D) Head tilt or forward thrust

A Response: Immature emotional behavior would be seen most frequently in children with hearing impairments because the inability to hear affects the socialization process and causes social problems for the child, inhibiting normal development. Self-stimulatory actions, inattention, vacant stare, head tilt, or forward thrust are typical behaviors of visually impaired children.

Chapter 36, 12 Format: Multiple Choice Chapter: 36 Client Needs: D-4 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 4 Page: 1126 295. A mother brings her 8-year-old son for evaluation because of a rash on his lower leg. Which finding would support the suspicion that the child has Lyme disease? A) Playing in the woods about a week ago B) Rash is papular and vesicular C) High fever occurring about 4 days before the rash D) Complaints of extreme pruritus with visible nits

A Response: Lyme disease is caused by the bite of an infected tick, with a rash appearing 7 to 14 days after the tick bite. Ticks are commonly found in wooded areas. Therefore, reports of the child playing in the woods about 7 days ago would support the diagnosis of Lyme disease. A papular and vesicular rash is commonly associated with varicella (chickenpox). A high fever for 3 to 5 days before a rash suggests roseola. Extreme pruritus with visible nits would suggest pediculosis.

Chapter 36, 7 Format: Multiple Choice Chapter: 36 Client Needs: D-4 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 4 Page: 1117 290. The nurse is performing a physical examination on an 8-year-old girl who was bitten by her kitten. Which of the following findings would indicate cat scratch disease? A) Swollen lymph nodes B) Strawberry tongue C) Infected tonsils D) Swollen neck

A Response: Lymph nodes, especially under the arms, can become painful and swollen with cat scratch disease. Strawberry tongue is typical of scarlet fever. Infected tonsils and an edematous neck are symptoms of diphtheria.

Chapter 33, 3 Format: Multiple Choice Chapter: 33 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Processes: Caring Objective: 1 Page: 1011 241. The nurse is caring for a 4-year-old girl with special care needs in the hospital. Which intervention would have the most positive effect on this child? A) Taking her on an adventure down the hall B) Helping her do a simple craft project C) Introducing her to children in the play room D) Limiting the staff providing care for her

A Response: Preschool-age children need to develop a sense of initiative, and helping the child to explore her area of the hospital would help meet this developmental need. Craft projects and introducing the child to other children would help build a sense of industry and peer relationships, both of which are needs of the school-age child. Limiting the number of people providing care is a trust-building intervention, beginning in infancy.

Chapter 37, 3 Format: Multiple Choice Chapter: 37 Client Needs: D-4 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 7 Page: 1174 301. The nurse is caring for a child hospitalized with Reye's syndrome. The nurse would closely monitor the child for which of the following during the acute stage? A) Increased intracranial pressure B) An increase in the blood glucose level C) A decrease in liver enzymes D) Protein in the urine

A Response: Reye's syndrome is characterized by encephalopathy and liver dysfunction; therefore, increased intracranial pressure could occur. Blood glucose usually decreases and liver enzymes increase. Protein in the urine is not seen with this illness.

Chapter 32, 9 Format: Multiple Choice Chapter: 32 Client Needs: C Cognitive Level: Comprehension Difficulty: Easy Integrated Processes: Nursing Process Objective: 2 Page: 980 232. The nurse is caring for a 7-year-old girl hospitalized in isolation. The nurse notices that the girl has begun sucking her thumb and changing her speech patterns to those of a toddler. What is the girl exhibiting signs of? A) Regression B) Suppression C) Repression D) Denial

A Response: Sucking the thumb and reverting to baby talk are signs of regression, a defense mechanism used by children to deal with unpleasant experiences by returning to a previous stage that may be more comfortable to the child. Suppression is a defense mechanism of conscious inhibition of an idea or desire. Repression is an unconscious inhibition of an idea or desire. Denial would be exhibited by expressions of resignation instead of true contentment, not thumb sucking or baby talk.

Chapter 35, 3 Format: Multiple Choice Chapter: 35 Client Needs: D-2 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 7 Page: 1087 271. The nurse is preparing to administer a topical anesthetic to a 10-year-old girl with a chin laceration. The nurse would expect to apply which of the following as ordered in preparation for sutures? A) TAC (tetracaine, epinephrine, cocaine) B) Iontophoretic lidocaine C) EMLA D) Vapocoolant spray

A Response: TAC (tetracaine, epinephrine, cocaine) is commonly used for lacerations that require suturing. The agent can be applied directly to the wound with a cotton ball or swab for 20 to 30 minutes until the area is numb. EMLA and iontophoretic lidocaine are applied to intact skin, not to open wounds or lacerations. A vapocoolant spray, which should not be applied over a wound, is effective for only 1 to 2 minutes.

Chapter 37, 10 Format: Multiple Choice Chapter: 37 Client Needs: D-1 Cognitive Level: Analysis Difficulty: Difficult Integrated Processes: Nursing Process Objective: 8 Page: 1141 308. A 4-year-old has a history of seizures and has been started on a ketogenic diet. Which of the following food selections would be most appropriate for his lunch? A) Fried eggs, bacon, and iced tea B) A hamburger on a bun, French fries, and milk C) Spaghetti with meatballs, garlic bread, and a cola drink D) A grilled-cheese sandwich, potato chips, and a milkshake

A Response: The ketogenic diet involves a high intake of fats, adequate protein, and a very low intake of carbohydrates, resulting in a state of ketosis. The child is kept in a mild state of dehydration. Eggs and bacon are high in fat, and the tea does not contain any carbohydrates. The hamburger is fat and protein, the bun is a carbohydrate, and the French fries and the milk both contain fat and protein, but both contain a lot of carbohydrates. The pasta and the sauce for the spaghetti are carbohydrates, the meatballs are protein, and the garlic bread is a carbohydrate, as is the cola drink. The grilled-cheese sandwich has the fat and protein from the cheese, but the bread and chips are primarily carbohydrates, and the milkshake has fat, protein, and carbohydrates. Only the selection in "A" contains a ketogenic meal.

Chapter 32, 6 Format: Multiple Choice Chapter: 32 Client Needs: A-2 Cognitive Level: Application Difficulty: Difficult Integrated Processes: Communication and Documentation Objective: 6 Page: 97 229. The nurse is enlisting the parents' assistance for therapeutic hugging prior to an otoscopic examination. What should the nurse emphasize to the parents? A) "You will need to keep his hands down and his head still." B) "If this does not work, we will have to apply restraints." C) "If you aren't capable of this, let me know so I can get some assistance." D) "I may need you to leave the room if your son will not remain still."

A Response: The nurse needs to provide a specific explanation of the parents' role and what body parts to hold still in a safe manner. Implying that the parents may not be capable or may have to leave the room is inappropriate. Telling the parents that restraints may be required is not helpful, does not teach, and may be perceived as a threat.

Chapter 34, 3 Format: Multiple Choice Chapter: 34 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Processes: Communication and Documentation Objective: 1 Page: 1030 256. The nurse is caring for a 10-year-old girl who has required multiple venipunctures and a CT scan in a single day. The girl has expressed no fear or need for comfort. How should the nurse respond? A) "Tell me about your day today." B) "Are you doing okay?" C) "Are you feeling okay?" D) "You have done really well today."

A Response: The nurse should ask an open-ended question to start a conversation so that the girl has the opportunity to express her feelings and be comforted. School-age children and adolescents may not demonstrate behavior indicating the need for comforting. It is important to praise the girl for her appropriate behavior, but the nurse should first give the girl an opportunity to express her feelings so the nurse can address her concerns. Asking the girl whether she is feeling okay or doing okay is likely to elicit a positive response no matter how she is feeling.

Chapter 33, 6 Format: Multiple Choice Chapter: 33 Client Needs: C Cognitive Level: Application Difficulty: Difficult Integrated Processes: Nursing Process Objective: 3 Page: 1012 244. A 7-year-old boy has entered the hospital for the second time in a month. Which intervention is particularly important at this time? A) Assessing his parents' coping abilities B) Seeking the parents' input about the child's needs C) Educating the family about a procedure D) Notifying the care team about hospitalization

A Response: Transition times, such as when the child reenters the hospital, create additional stress on the parents and child. Assessing the parents' coping abilities is particularly important at this time. Seeking the parents' input, educating the family about a procedure, and notifying the care team are basic activities of family-centered care and care coordination.

Chapter 35, 7 Format: Multiple Choice Chapter: 35 Client Needs: D-1 Cognitive Level: Application Difficulty: Difficult Integrated Processes: Teaching/Learning Objective: 7 Page: 1090 275. The nurse is teaching the parents of a newborn prior to a heel stick. The nurse is describing the procedure and recommending various ways the parents can comfort their baby. Which of the following statements by the parents indicates a need for further teaching? A) "It's better if we are not in the room for this." B) "We can use kangaroo care before and after." C) "We hope you are using a very tiny needle." D) "We can offer him nonnutritive sucking to calm him."

A Response: Unless contraindicated, the parents should be encouraged to be present before, during, and after the procedure to provide comforting support to the child. Kangaroo care, small-gauge needles, and nonnutritive sucking are other methods to provide atraumatic care.

Chapter 33, 13 Format: Multiple Choice Chapter: 33 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 7 Page: 1023 251. When providing care to a dying child and his family, which of the following would be most important? A) Focusing on the family as the unit of care B) Teaching the family appropriate care measures C) Offering the child support and encouragement D) Assisting the parents in decision-making

A Response: When caring for a dying child and his family, the most important aspect of care is focusing on the family as the unit of care. Teaching, offering support, and assisting in decision-making are important, but these actions must be implemented while focusing on the family as the unit of care.

Chapter 38, 8 Format: Multiple Choice Chapter: 38 Client Needs: B Cognitive Level: Application Difficulty: Difficult Integrated Processes: Nursing Process Objective: 1 Page: 1202 321. The nurse is caring for a newborn and knows that his vision, unlike his hearing, is not fully developed. Which aspect of the child's vision may be similar to his father's vision? A) Poor color detection B) Visual acuity of 20/100 C) Nearsightedness D) Monocular vision

B Response: If the child's father has lost visual acuity, he and his new son could possibly have the same 20/100 vision. Poor color detection, nearsightedness, and monocular vision are characteristic of newborns and result from their lack of development.

Chapter 32, 1 Format: Multiple Choice Chapter: 32 Client Needs: D-3 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Teaching/Learning Objective: 8 Page: 1001 224. The nurse caring for an immunosuppressed 3-year-old is teaching the mother about proper oral hygiene. Which of the following responses from the mother indicates a need for further teaching? A) "I need to carefully check for skin breakdown." B) "I must really scrub her teeth and gums well." C) "I must use a soft toothbrush." D) "I can use a soft gauze sponge to care for her gums."

B Response: The nurse should caution the mother that overly vigorous brushing should be avoided as it can injure or irritate the gums. The other statements are correct.

Chapter 34, 4 Format: Multiple Choice Chapter: 34 Client Needs: D-2 Cognitive Level: Analysis Difficulty: Moderate Integrated Processes: Nursing Process Objective: 4 Page: 1035 257. The nurse is preparing to administer prednisolone to a 5-year-old who weighs 35 pounds. The prescribed single dose is 1 to 2 mg/kg per day. Which of the following is the appropriate dose range for this child? A) 8 to 16 mg B) 16 to 32 mg C) 35 to 70 mg D) 70 to 140 mg

B Response: The nurse should convert the child's weight in pounds to kilograms by dividing the child's weight in pounds by 2.2 (35 pounds/2.2 = 16 kg). The nurse would then multiply the child's weight in kilograms by 1 mg (16 kg 1 mg = 16 mg) for the low end and then by 2 mg for the high end (16 kg 2 mg = 32 mg).

Chapter 32, 11 Format: Multiple Choice Chapter: 32 Client Needs: A-2 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 7 Page: 996 234. When preparing to apply a restraint to a child, which of the following would be most important for the nurse to do? A) Expect to keep the restraint on for at least 8 hours. B) Explain that safety, not punishment, is the reason for the restraint. C) Plan to use a square knot to secure the restraint to the side rails. D) Use a limb restraint rather than a jacket restraint for most issues.

B Response: Before applying a restraint, the nurse needs to explain the reason for the restraint to the child, emphasizing that the restraint is for safety, not to punish the child. The least restrictive type of restraint should be used, and it should be applied for the shortest time necessary. A clove hitch knot is used to secure the restraint with ties to the bed or crib frame, not the side rails.

Chapter 37, 2 Format: Multiple Choice Chapter: 37 Client Needs: D-3 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 1 Page: 1175 300. The nurse understands that infants and toddlers have large heads and mobile spines, placing them at risk for which of the following: A) Febrile seizures B) Acceleration/deceleration injuries C) Caput succedaneum D) Posterior plagiocephaly

B Response: Acceleration/deceleration injuries are a significant risk for infants and children under 3 years of age because of their large heads and mobile spines. Febrile seizures are not related to anatomy or physiology. Caput succedaneum is an edematous area on the scalp caused by pressure of the uterus or vagina during head-first delivery. Posterior plagiocephaly is caused by early closure of the lamboid suture.

Chapter 35, 13 Format: Multiple Choice Chapter: 35 Client Needs: D-1 Cognitive Level: Application Difficulty: Difficult Integrated Processes: Nursing Process Objective: 4 Page: 1069 281. When assessing a child's pain, which of the following is most important? A) Obtaining a pain rating from the child with each assessment B) Using the same tool to assess the child's pain each time C) Documenting the child's pain assessment D) Asking the parents about the child's pain tolerance

B Response: Although obtaining a pain rating, documenting the assessment, and asking the child's parents about the pain are important, the most important aspect of pain assessment is to use the same tool each time so that appropriate comparisons can be made and effective interventions can be planned and implemented. Consistency allows the most accurate assessment of the child's pain.

Chapter 32, 10 Format: Multiple Choice Chapter: 32 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Processes: Communication and Documentation Objective: 7 Page: 995 233. The nurse is caring for a 7-year-old boy whose left leg is immobilized. What is the priority nursing intervention? A) Enlist the assistance of a child life specialist. B) Explain to the boy that he must keep his leg very still. C) Apply a clove hitch restraint to the boy's left leg. D) Explain that a restraint will be applied if he cannot hold still.

B Response: An explanation about the goal is necessary and appropriate for a 7-year-old child so he can understand what is required. In many cases, this will be all that is needed. Explaining that a restraint will be applied if the boy cannot hold still will likely be perceived as a threat or punishment. All alternative measures need to be tried before restraints are used. Enlisting the assistance of the child life specialist is not a priority.

Chapter 35, 5 Format: Multiple Choice Chapter: 35 Client Needs: D-4 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 5 Page: 1091 273. The nurse is caring for a child who is complaining of chronic pain. Which of the following is the priority nursing assessment? A) How the pain affects the child and family's stress level B) The pain's history, onset, intensity, duration, and location C) The child's and parents' feeling of anxiety and depression D) The child's cognitive level and emotional response

B Response: Assessment of the child's pain is key. This is the priority assessment and is the only answer that focuses on the child's physiological need. How the pain affects the child and family's stress and their feelings of anxiety, hopelessness, and depression, as well as the child's cognitive level and emotional response, are secondary after the pain is explored.

Chapter 38, 10 Format: Multiple Choice Chapter: 38 Client Needs: D-4 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 3 Page: 1209 323. The nurse is examining a 3-year-old boy with acute otitis media. He has a mild earache and a temperature of 38.5 degrees C. Which action would be most appropriate? A) Obtain a culture of the middle ear fluid. B) Advise the parents to watch for worsening of symptoms. C) Administer antibiotics. D) Administer antivirals.

B Response: In this case, the child should be continually observed. If the symptoms persist or become worse, antibiotics will be prescribed. This clinical practice guideline was developed by the American Academy of Pediatrics and American Academy of Family Physicians in order to avoid overusing antibiotics or obtaining a middle ear fluid culture with every occurrence of acute otitis media.

Chapter 33, 2 Format: Multiple Choice Chapter: 33 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Processes: Caring Objective: 7 Page: 1023 240. The nurse is providing home care for the family of an 8-year-old boy who is dying of leukemia. Which action will be most supportive to the parents of the child? A) Encouraging organ and tissue donation B) Being patient with parental indecision C) Getting prior authorization for treatments D) Explaining how anorexia is a natural process

B Response: It is critical to be patient with parents who may vacillate when making decisions. Give them the information and time they need to make decisions and avoid being judgmental. Explaining about anorexia and encouraging organ donation may be discussed when the parents indicate they are concerned. Getting prior authorization facilitates care delivery and is not a supportive intervention.

Chapter 36, 8 Format: Multiple Choice Chapter: 36 Client Needs: A-2 Cognitive Level: Application Difficulty: Difficult Integrated Processes: Nursing Process Objective: 3 Page: 1102 291. When performing measures to break the chain of infection, which measure would be most important related to the susceptible host? A) Keeping linens dry and clean B) Maintaining skin integrity C) Washing hands frequently D) Coughing into a handkerchief

B Response: Maintaining the integrity of the client's skin and mucous membranes is a precaution that will break the chain of infection at the susceptible host. Keeping linens dry and clean is a precaution to break the reservoir link. Washing hands frequently breaks the chain at the mode of transmission. Coughing into a handkerchief is a precaution for the portal of exit.

Chapter 38, 2 Format: Multiple Choice Chapter: 38 Client Needs: D-4 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 7 Page: 1197 315. The nurse is caring for a 3-month-old with nasolacrimal duct obstruction. Which of the following interventions would the nurse include when planning this child's care? A) Being careful to prevent spread of infection B) Teaching the parents how to gently massage the duct C) Applying hot moist compresses to the affected eye D) Referring the child to an ophthalmologist

B Response: Massaging the nasolacrimal duct can cause it to open and drain. Teaching the parents how to do this would be part of the plan of care. Nasolacrimal duct obstruction is not infectious. Applying hot moist compresses to the eye is an intervention for conjunctivitis. Many times nasolacrimal duct obstruction resolves on its own, so there would be no need for a specialist's care.

Chapter 37, 12 Format: Multiple Choice Chapter: 37 Client Needs: D-3 Cognitive Level: Comprehension Difficulty: Moderate Integrated Processes: Nursing Process Objective: 6 Page: 1142 310. The nurse assesses a child's level of consciousness, noting that the child falls asleep unless he is stimulated. The nurse documents this finding as: A) Confusion B) Obtunded C) Stupor D) Coma

B Response: Obtunded is a state in which the child has limited responses to the environment and falls asleep unless stimulation is provided. Confusion involves disorientation; the child may be alert but responds inappropriately to questions. Stupor exists when the child responds only to vigorous stimulation. Coma is a state in which the child cannot be aroused even with painful stimuli.

Chapter 34, 8 Format: Multiple Choice Chapter: 34 Client Needs: D-2 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 5 Page: 1039 261. The nurse is teaching about how to administer nasal drops. Which of the following response by the parents indicates a need for further teaching? A) "We need to be careful not to stimulate a sneeze." B) "She needs to remain still for at least 10 minutes after administration." C) "Our daughter should lie on her back with her head hyperextended." D) "We must not let the dropper make contact with the nasal membranes."

B Response: Once the drops are instilled, the child should remain in hyperextension for at least 1 minute to ensure the drops have come in contact with the nasal membranes, but 10 minutes would be excessive. The other statements are correct.

Chapter 33, 15 Format: Multiple Choice Chapter: 33 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Processes: Caring Objective: 7 Page: 1024 253. When describing organ donation to a family of a dying child, which of the following would the nurse include in the discussion? A) Telling them that they are responsible for organ procurement expenses B) Having them sign a written informed consent for the donation C) Including this topic in the discussion of impending death D) Informing the family that organ donation will delay the funeral

B Response: Organ donation requires that a written consent be obtained after the family is appropriately informed and educated. The recipient's family is responsible for organ procurement expenses. The topic of organ donation should be separated from the discussion of impending death or brain death notification. Organs are harvested in a timely fashion after the declaration of death so the family need not worry about delay of the wake or funeral.

Chapter 34, 2 Format: Multiple Choice Chapter: 34 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Processes: Caring Objective: 1 Page: 1031 255. The nurse is preparing to assess the vital signs of a 4-year-old. Which of the following would be the best approach? A) "We need to assess your vital signs." B) "I am going to see how warm you are and give your arm a hug." C) "Can I take your temperature and blood pressure?" D) "I am going to take your temperature and blood pressure."

B Response: The nurse should approach the 4-year-old at his or her level of development and avoid terms that may be confusing or misunderstood. Telling the child that the nurse is going to "take" his blood pressure may be misinterpreted to mean "take something away." The nurse should avoid phrasing the question in a way that would allow the child to say "no." The child is unlikely to understand the term "vital signs."

Chapter 32, 13 Format: Multiple Choice Chapter: 32 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 9 Page: 991 236. An adolescent is scheduled for outpatient arthroscopic surgery on his knee next week. As part of preparing him for the procedure, which action would be most appropriate? A) Discussing the events with the adolescent and his mother upon arrival the morning of the procedure B) Providing detailed explanations of the procedure at least a week in advance of the procedure C) Encouraging the parent to stay with the adolescent as much as possible before the procedure D) Answering the adolescent's questions with simple answers, encouraging him to ask the surgeon

B Response: The adolescent needs a detailed explanation about the procedure at least 7 to 10 days beforehand. Waiting until the morning of the procedure would be inappropriate. However, information could be clarified and additional questions could be answered at this time. Having the parent stay with the adolescent is something that the adolescent would need to decide; he may or may not want a parent present. Referring the adolescent to the surgeon for his questions is inappropriate and ignores the adolescent's desire for control and information.

Chapter 36, 1 Format: Multiple Choice Chapter: 36 Client Needs: D-3 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 5 Page: 1113 284. A 3-year-old boy who has been on chemotherapy for cancer complains about a sore throat, is experiencing malaise, and has a temperature of 99.8 degrees F orally. His mother calls the office. Which instruction by the nurse would be most appropriate at this time? A) Continue watching him and give him aspirin and cool fluids. B) Plan to bring the child into the physician's office today. C) Monitor the temperature, but don't worry unless it gets above 104 degrees F. D) Keep the child as warm and as comfortable as possible.

B Response: The child could be very ill, and some chemotherapy agents mask the signs of infection. The child needs to be evaluated. Aspirin is not used for children of this age because of the risk for Reye's syndrome. Continued monitoring is appropriate but only after the child is evaluated. The child should be dressed lightly, and warm binding clothes or blankets should be avoided.

Chapter 33, 10 Format: Multiple Choice Chapter: 33 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Processes: Caring Objective: 7 Page: 1024 248. The parents of an 11-year-old boy who is dying of cancer are concerned that he isn't eating. Which intervention would serve both the parents' and child's needs? A) Urging the child to eat one good meal per day B) Serving small meals of things the child likes C) Straightening up around the child before meals D) Administering antiemetics as ordered for nausea

B Response: The child is more likely to eat small amounts of foods of his choosing. This accommodates the child's reduced appetite, reassures the parents that he is not starving, and gives the child a sense of control. Straightening up the child's area before meals provides a more pleasant eating environment. The use of antiemetics controls nausea but may not increase appetite. Urging the child to eat a substantial meal is unnecessary and creates stress.

Chapter 33, 5 Format: Multiple Choice Chapter: 33 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 2 Page: 1016 243. The nurse is coordinating home care for a 3-year-old girl with special care needs. Which approach provides the greatest benefit to the family of this child? A) Asking the father for his observations on his daughter's progress B) The nurse adjusting her office schedule to be available C) Urging parents to arrange respite care whenever possible D) Monitoring the mother for depression

B Response: The family would benefit most if the nurse adjusted the office schedule to be available when they need help. Asking the father for his observations, urging parents to arrange respite care, and monitoring the mother for depression are not uniquely special needs interventions.

Chapter 34, 6 Format: Multiple Choice Chapter: 34 Client Needs: D-2 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 5 Page: 1037 259. The nurse is caring for an 8-year-old girl who requires medication that is available only in an enteric tablet form. The nurse is teaching the mother how to help the girl swallow the medication. Which of the following statements indicates a need for further teaching? A) "I can encourage her to place it on the back of her tongue." B) "I can pinch her nose to make it easier to swallow." C) "We cannot crush this type of pill as it will affect the delivery of the medication." D) "We can place the tablet in a spoonful of applesauce."

B Response: The mother should never pinch the child's nose, as this increases the risk for aspiration. The other statements are correct.

Chapter 34, 1 Format: Multiple Choice Chapter: 34 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Processes: Teaching/Learning Objective: 9 Page: 1054 254. The nurse is teaching the mother of an infant who receives all of his nutrition through tube feeding. The nurse is reviewing interventions to promote growth and development. Which of the following responses from the mother indicates a need for further teaching? A) "I will give him a pacifier during feeding time." B) "We need to keep feeding time very quiet." C) "We need to make sure he doesn't lose the desire to eat by mouth." D) "Sucking produces saliva, which aids in digestion."

B Response: The nurse needs to emphasize that it is important to talk, play music, and cuddle and rock the infant to simulate a "normal" feeding time. The other statements are correct.

Chapter 32, 8 Format: Multiple Choice Chapter: 32 Client Needs: D-3 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 4 Page: 982 231. The nurse is caring for an 11-year-old girl preparing to undergo an MRI. Which of the following statements would best prepare the girl for the test and decrease anxiety? A) "You won't hear a sound if you wear your headphones." B) "The machine makes a very loud rattle, but the headphones will help." C) "There are a variety of loud sounds you will hear." D) "The MRI scanner sounds like a machine gun."

B Response: The nurse should acknowledge that an MRI is loud and briefly describe the noises the machine makes. Then, the nurse should immediately offer a solution: headphones. Telling the girl she won't hear a sound is untrue. Telling the child that there are loud sounds isn't enough and could increase her anxiety. Comparing the MRI scanner to the sounds of a machine gun is not appropriate imagery for a child.

Chapter 32, 3 Format: Multiple Choice Chapter: 32 Client Needs: C Cognitive Level: Application Difficulty: Difficult Integrated Processes: Caring Objective: 6 Page: 1003 226. The nurse is caring for a 10-year-old in traction who has a nursing diagnosis of deficient diversional activity related to confinement in bed, evidenced by verbalization of boredom and lack of participation in play, reading, and schoolwork. Which of the following would be the best intervention? A) Offer the child reading materials. B) Enlist the aid of a child life specialist. C) Encourage the child to complete his homework. D) Ask for the parents' assistance.

B Response: The nurse should enlist the aid of a child life specialist to provide suggestions for appropriate activities. Offering the child reading materials or encouraging him to complete his homework would most likely be met with resistance, as he has already verbalized his boredom and disinterest in play, reading, and schoolwork. The parents could offer the child life specialist ideas about the boy's likes and dislikes; however, the child life specialist has expertise in assisting hospitalized children.

Chapter 34, 15 Format: Multiple Choice Chapter: 34 Client Needs: D-2 Cognitive Level: Application Difficulty: Easy Integrated Processes: Nursing Process Objective: 5 Page: 1040 268. The nurse is preparing to administer an intramuscular injection to an 8-month-old infant. Which site would the nurse select? A) Rectus femoris B) Vastus lateralis C) Dorsogluteal muscle D) Deltoid

B Response: The preferred injection site in infants is the vastus lateralis muscle. An alternative site is the rectus femoris. The dorsogluteal site is not used in children until the child has been walking for at least 1 year. The deltoid muscle is used as a site in children after the age of 4 or 5 years.

Chapter 32, 14 Format: Multiple Choice Chapter: 32 Client Needs: B Cognitive Level: Analysis Difficulty: Moderate Integrated Processes: Teaching/Learning Objective: 8 Page: 1004 237. After teaching a group of students about therapeutic play, the instructor determines that additional teaching is needed when the students identify which of the following as a characteristic? A) Focus on coping B) Use of a highly structured format C) Dramatization of emotions D) Expression of feelings

B Response: Therapeutic play is nondirected play, focused on helping the child cope with feelings and fears. Real-life stressors and emotions can be acted or dramatized, allowing the child to express his or her feelings.

Chapter 37, 13 Format: Multiple Choice Chapter: 37 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 5 Page: 1144 311. The nurse is assessing an infant's ability to suck on a pacifier. The nurse is assessing which cranial nerve? A) Olfactory B) Trigeminal C) Facial D) Accessory

B Response: To test the trigeminal nerve, the nurse would note the strength of the infant's suck on a pacifier, thumb, or bottle. The olfactory nerve is not assessed in infants and young children. The facial nerve is assessed by noting the symmetry of facial expressions. For the infant, this would be assessed during spontaneous crying or smiling. The accessory nerve is assessed when the infant is in the sitting position and symmetry of the head position is noted.

Chapter 36, 6 Format: Multiple Choice Chapter: 36 Client Needs: A-2 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Teaching/Learning Objective: 6 Page: 1129 289. The nurse is describing to a mother how to remove a tick from her 6-year-old boy's arm. Which of the following statements is incorrect? A) Protect the fingers with a paper towel. B) Grasp the tick and pull it away quickly. C) Put the tick in a plastic bag in the freezer. D) Grasp the tick close to the child's skin.

B Response: When removing a tick, it should be grasped as close to the skin as possible and pulled upward with steady, even pressure. Protecting the fingers and placing the tick in plastic are appropriate instructions.

Chapter 35, 10 Format: Multiple Choice Chapter: 35 Client Needs: D-2 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 7 Page: 1086 278. The nurse is preparing a child for a lumbar puncture. How far ahead of the procedure should the nurse apply the EMLA cream? A) Thirty minutes B) One hour C) Three hours D) Four hours

C Response: For a deeper procedure such as a lumbar puncture, the nurse needs to apply the cream 2 to 3 hours before the procedure. For a superficial procedure the EMLA should be applied at least 1 hour before the procedure.

Chapter 36, 9 Format: Multiple Choice Chapter: 36 Client Needs: D-4 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 3 Page: 1125 292. The nurse is performing a physical exam on a 9-year-old boy who complains of a stiff neck and pain in his arms and legs. He has never been vaccinated for polio. Which of the following assessment findings would suggest the child has polio? A) Swelling in the neck B) Confusion and anxiety C) Positive Kernig's sign D) Conjunctivitis

C Response: A positive Kernig's sign would further suggest that this unvaccinated child could have polio. Swelling in the neck is a symptom of mumps. Confusion and anxiety are symptoms of rabies. Conjunctivitis is a symptom of Lyme disease.

Chapter 38, 9 Format: Multiple Choice Chapter: 38 Client Needs: D-3 Cognitive Level: Application Difficulty: Difficult Integrated Processes: Nursing Process Objective: 2 Page: 1206 322. The nurse is taking a health history for a 9-year-old girl. Which of the following findings would alert the nurse that the child is at risk for visual impairment? A) Being born at 39 weeks B) Doing several hours of homework daily C) Being of African-American heritage D) Participating actively in sports

C Response: African-American heritage is a risk factor specifically for visual impairment.

Chapter 34, 5 Format: Multiple Choice Chapter: 34 Client Needs: D-2 Cognitive Level: Application Difficulty: Easy Integrated Processes: Nursing Process Objective: 9 Page: 1037 258. A nurse has just administered medication via an orogastric tube. What is the priority nursing action following administration? A) Check tube placement. B) Re-tape the tube. C) Flush the tube. D) Remove the tube.

C Response: After medication administration the nurse should flush the tube to maintain patency and ensure that the entire amount of medication has been given. The tube should be checked before administering the medication. It is not necessary to re-tape the tube after administration. It is not appropriate to remove the tube unless this has been specifically ordered.

Chapter 33, 12 Format: Multiple Choice Chapter: 33 Client Needs: D-3 Cognitive Level: Analysis Difficulty: Moderate Integrated Processes: Teaching/Learning Objective: 2 Page: 1016 250. The nurse is teaching a group of parents with premature infants about the various medical and developmental problems that may occur. The nurse determines that additional teaching is needed when the group identifies which of the following as a problem? A) Sudden infant death syndrome B) Hydrocephalus C) Peptic ulcer D) Bronchopulmonary dysplasia

C Response: Gastroesophageal reflux disease, not peptic ulcer, is a medical problem that commonly affects premature infants. A myriad of problems may occur, including sudden infant death syndrome, hydrocephalus, bronchopulmonary dysplasia, cardiac changes, growth retardation, nutrient deficiencies, bradycardia, rickets, inguinal or umbilical hernias, visual problems, hearing deficits, delayed dentition, and growth delays.

Chapter 33, 8 Format: Multiple Choice Chapter: 33 Client Needs: C Cognitive Level: Application Difficulty: Difficult Integrated Processes: Nursing Process Objective: 7 Page: 1023 246. The nurse is providing palliative care for a 9-year-old boy in a hospice. Which is unique to hospice care for children? A) Encouraging visits from friends and family B) Educating parents about terminal dehydration C) Prolonging treatment that might possibly help D) Treating constipation to relieve abdominal pain

C Response: Hospice for children allows for continuation of hopeful treatment so long as certain criteria are met. This differs from adult hospice. Encouraging visits from friends and family, educating parents about terminal dehydration, and treating constipation are common to family-centered care.

Chapter 36, 3 Format: Multiple Choice Chapter: 36 Client Needs: D-4 Cognitive Level: Analysis Difficulty: Moderate Integrated Processes: Nursing Process Objective: 4 Page: 1114 286. The nurse is caring for a neonate who is suspected of having sepsis. Which of the following assessment findings would be most indicative of sepsis? A) Rash on face B) Edematous neck C) Hypothermia D) Coughing

C Response: Hypothermia is a sign of sepsis in neonates. A rash on the face is a sign of scarlet fever. Edematous neck is a sign of diphtheria. Paroxysmal coughing is a sign of pertussis.

Chapter 38, 7 Format: Multiple Choice Chapter: 38 Client Needs: D-4 Cognitive Level: Analysis Difficulty: Moderate Integrated Processes: Nursing Process Objective: 6 Page: 1197 320. When examining a 7-year-old boy with hordeolum, which of the following would the nurse expect to find? A) Redness B) Scaling C) Pain D) Edema

C Response: Pain is typical of hordeolum. Blepharitis has symptoms of redness, scaling, and edema but not pain.

Chapter 36, 11 Format: Multiple Choice Chapter: 36 Client Needs: D-2 Cognitive Level: Comprehension Difficulty: Moderate Integrated Processes: Nursing Process Objective: 3 Page: 1106 294. A child is diagnosed with scarlet fever. Which medication would the nurse anticipate being prescribed for this child? A) Ibuprofen B) Acyclovir C) Penicillin V D) Doxycycline

C Response: Penicillin V is the antibiotic of choice for the treatment of scarlet fever. Ibuprofen is used to treat fever. Acyclovir is used to treat viral infections. Doxycycline, a tetracycline, is the drug of choice for treating Rocky Mountain spotted fever.

Chapter 37, 1 Format: Multiple Choice Chapter: 37 Client Needs: D-3 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 1 Page: 1139 299. The nurse would be especially alert for the development of which of the following in a neonate born at 29 weeks' gestation? A) Neonatal conjunctivitis B) Facial deformities C) Intracranial hemorrhage D) Incomplete myelinization

C Response: Premature infants have more fragile capillaries in the periventricular area than term infants, which puts them at greater risk for intracranial hemorrhage. Neonatal conjunctivitis can occur in any newborn during birth and is caused by virus, bacteria, or chemicals. Facial deformities are typical of babies of alcoholic mothers. Incomplete myelinization is present in all newborns.

Chapter 34, 14 Format: Multiple Choice Chapter: 34 Client Needs: D-2 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 5 Page: 1038 267. After administering eye drops to a child, the nurse applies gentle pressure to the inside corner of the eye at the nose for which reason? A) To promote dispersion over the cornea B) To enhance systemic absorption C) To ensure the medication stays in the eye D) To stabilize the eyelid

C Response: Punctal pressure, or gentle pressure to the inside corner of the eye at the nose, helps to slow systemic absorption and ensure that the medication stays in the eye. Having the head lower than the body aids in dispersing the medication over the cornea. Placing the heel of the hand on the child's forehead and then retracting the lower lid helps to stabilize it.

Chapter 36, 5 Format: Multiple Choice Chapter: 36 Client Needs: D-3 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Teaching/Learning Objective: 6 Page: 1113 288. The nurse is teaching the mother of a 4-year-old girl with a cold and fever how to care for the child. Which of the following would the nurse include? A) Keep the child covered and warm. B) Call the doctor if the fever is 102 degrees F. C) Give the child fluids frequently. D) Watch for signs of brain damage.

C Response: Teaching the mother that fever can cause dehydration and that maintaining adequate fluid intake is important would be part of the teaching. The child should be dressed lightly. There is no need to call the doctor until the fever is higher than 105 degrees F. A rapid rise to a high fever can cause a febrile convulsion, but it does not lead to brain damage.

Chapter 37, 9 Format: Multiple Choice Chapter: 37 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Processes: Caring Objective: 10 Page: 1150 307. The nurse is caring for an 8-year-old boy who has epilepsy with no sign of the seizure activity abating. Which of the following would be a priority for this child? A) Multiple corrective surgeries to slowly remove diseased parts of his brain B) Physical, occupational, and speech therapy to maximize his potential C) Support for maintaining self-esteem because of his altered lifestyle D) Hyperventilation therapy to counteract the periods of decreased oxygenation

C Response: The effects of living with a seizure disorder can be devastating. This child needs support to maintain his self-esteem. While corrective surgery is possible, it would be performed only once. Physical, occupational, speech, and hyperventilation therapy are not indicated for treatment of epilepsy.

Chapter 33, 4 Format: Multiple Choice Chapter: 33 Client Needs: C Cognitive Level: Application Difficulty: Difficult Integrated Processes: Caring Objective: 6 Page: 1025 242. The nurse is caring for a 5-year-old boy who is terminally ill. Which intervention would best meet the needs of this dying child? A) Offer the child decision-making opportunities. B) Provide the child with specific details. C) Assure the child that he did nothing wrong. D) Act as confidant for the child's concerns.

C Response: The magical thinking of preschool children may cause him to think that dying is punishment for doing something wrong. Assuring him that he did nothing wrong is very important. School-age children would benefit from receiving specific details and being given decision-making opportunities. They may also use the nurse as their confidant.

Chapter 36, 13 Format: Multiple Choice Chapter: 36 Client Needs: D-3 Cognitive Level: Application Difficulty: Difficult Integrated Processes: Teaching/Learning Objective: 6 Page: 1134 296. Which of the following would be most important to include when teaching the parents of a child with pinworm? A) "Seal the child's clothing in a plastic bag for at least 10 days." B) "Be sure your child wears shoes at all times." C) "Make sure the child washes his hands after using the bathroom." D) "After applying this special cream, leave it on for about 8 to 10 hours."

C Response: The most effective measure to prevent pinworms or its recurrence is good hand hygiene, especially after using the bathroom and before eating. Sealing the child's clothing in a plastic bag is appropriate for pediculosis capitis. Having the child wear shoes at all times is helpful in preventing hookworm. Use of a cream that remains on for a specified time is associated with scabies.

Chapter 35, 2 Format: Multiple Choice Chapter: 35 Client Needs: D-1 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Teaching/Learning Objective: 7 Page: 1081 270. A nurse is providing teaching to the mother of an adolescent girl about how to manage menstrual pain without medications. Which of the following statements by the mother indicates a need for further teaching? A) "I need to help her learn techniques to distract her—card games, for example." B) "I need to be able to identify the subtle ways she shows pain." C) "I need to follow these instructions exactly for them to work properly." D) "I need to encourage her to practice and use these techniques."

C Response: The mother does not need to follow the instructions exactly; she needs to review the methods and modify them in a way that works best for her daughter. The other statements are correct.

Chapter 32, 4 Format: Multiple Choice Chapter: 32 Client Needs: C Cognitive Level: Application Difficulty: Difficult Integrated Processes: Caring Objective: 4 Page: 995 227. The nurse is caring for a 13-year-old girl hospitalized for complications from type 1 diabetes. The girl has a nursing diagnosis of powerlessness related to lack of control of multiple demands associated with hospitalization, procedures, treatments, and changes in unusual routine. How can the nurse help promote control? A) Ask the child to identify her areas of concern. B) Encourage her parents to participate in care activities. C) Offer the girl as many choices as possible. D) Enlist the family's assistance in creating a time schedule.

C Response: The nurse needs to offer the girl as many choices as possible, such as options for food and drink (as her diet allows), hygiene, activities, or clothing, to promote feelings of individuality and control. Two of the other options involve the parents in the process. A 13-year-old girl is capable of making her own choices regarding activities, schedules, and routine, but she may not be able to identify her areas of concern.

Chapter 35, 1 Format: Multiple Choice Chapter: 35 Client Needs: D-2 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 7 Page: 1086 269. The nurse has applied EMLA cream as ordered. How does the nurse determine whether the cream has achieved its purpose? A) Assess the skin for redness. B) Note any blanching of skin. C) Lightly tap the area where the cream is. D) Gently poke the child with a needle.

C Response: The nurse should verify that sensation is absent by lightly tapping or scratching the area. Blanching or redness indicates that the medication has penetrated the skin adequately but does not indicate that sensation is absent. Using a needle to poke the skin would probably frighten the child.

Chapter 37, 5 Format: Multiple Choice Chapter: 37 Client Needs: D-3 Cognitive Level: Comprehension Difficulty: Moderate Integrated Processes: Nursing Process Objective: 5 Page: 1167 303. As a result of seizure activity, a CT scan was performed and showed that an 18-month-old child has an intracranial arteriovenous malformation. The nurse would focus measures on prevention of which of the following? A) Drug interactions B) Developmental disabilities C) Hemorrhagic stroke D) Respiratory paralysis

C Response: The nurse would focus measures on prevention of hemorrhagic stroke. Drug interactions are a risk for children who are treated with combinations of anticonvulsants for epilepsy. Children with hydrocephalus are at an increased risk for developmental disabilities. Respiratory paralysis is a risk of botulism, which typically affects infants less than 6 months of age.

Chapter 34, 12 Format: Multiple Choice Chapter: 34 Client Needs: D-2 Cognitive Level: Comprehension Difficulty: Difficult Integrated Processes: Nursing Process Objective: 3 Page: 1032 265. When describing the differences affecting the pharmacokinetics of drugs administered to children, which of the following would the nurse include? A) Oral drugs are absorbed more quickly in children than adults. B) Absorption of intramuscularly administered drugs is fairly constant. C) Topical drugs are absorbed more quickly in young children. D) Absorption of drugs administered by subcutaneous injection is increased.

C Response: Topical absorption of drugs is increased in infants and young children because the stratum corneum is thinner and well hydrated. The absorption of oral drugs is affected by slower gastric emptying, increased intestinal motility, a proportionately larger small intestine surface area, high gastric pH, and decreased lipase and amylase secretion. The absorption of drugs given intramuscularly or subcutaneously is erratic and may be decreased.

Chapter 38, 4 Format: Multiple Choice Chapter: 38 Client Needs: D-1 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Caring Objective: 7 Page: 1207 317. The nurse is caring for a 6-year-old visually impaired boy. Which of the following interventions would the nurse use to promote communication before beginning the health examination? A) Show him the stethoscope. B) Describe the examination room. C) Use his name before touching him. D) Allow him to explore the exam room.

C Response: When interacting with a visually impaired child, use his name to gain his attention before touching him. Letting him listen to his heart with the stethoscope, describing the examination room, and promoting exploration by touch are sound ways to interact but are not specific to communicating with the child at the beginning of the assessment.

Chapter 36, 14 Format: Multiple Choice Chapter: 36 Client Needs: A-2 Cognitive Level: Analysis Difficulty: Moderate Integrated Processes: Teaching/Learning Objective: 6 Page: 1121 297. After teaching the parents of a child with varicella zoster, the nurse determines that the parents have understood the teaching when they state that their child can return to school at which time? A) After day 5 of the rash B) When the rash is completely healed C) Once the rash appears D) After the lesions have crusted

D Response: Children with chickenpox (varicella zoster) can return to school once the lesions have crusted.

Chapter 38, 5 Format: Multiple Choice Chapter: 38 Client Needs: D-2 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Teaching/Learning Objective: 4 Page: 1197 318. The nurse is instructing the parents of a school-aged child about how to care for their child's eye. Which of the following conditions would the nurse identify as resolving by itself without the use of antibiotics? A) Blepharitis B) Hordeolum C) Periorbital cellulitis D) Chalazion

D Response: Chalazion usually resolves spontaneously but may require surgical drainage. Therapeutic management of blepharitis, hordeolum, and periorbital cellulitis may require antibiotic ointment.

Chapter 35, 4 Format: Multiple Choice Chapter: 35 Client Needs: D-1 Cognitive Level: Analysis Difficulty: Moderate Integrated Processes: Teaching/Learning Objective: 7 Page: 1080 272. The nurse is teaching a mother how to use "thought stopping" to help her child deal with anxiety and fear associated with frequent painful injections. Which of the following statements indicates that the mother understands the technique? A) "We will imagine that we are on the beach in Florida." B) "We can talk about our favorite funny movie and laugh." C) "She can let her body parts go limp, working from head to toe." D) "We'll repeat 'quick stick, feel better, go home soon' several times."

D Response: "Thought stopping" is a technique that involves the use of short, concise phrases of positive ideas. Using this technique promotes the child's sense of control. Imagining a favorite beach in Florida is using imagery. Talking about a favorite funny movie involves humor. Letting body parts go limp is a relaxation technique

Chapter 32, 5 Format: Multiple Choice Chapter: 32 Client Needs: A Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 7 Page: 1001 228. The nurse is transporting a 6-month-old with a suspected blood disorder to the nursery. What is the most appropriate method of transporting the child by the nurse? A) A wagon with rails B) The cradle hold C) A football hold D) Over the shoulder

D Response: A 4-month-old should be carried using the "over the shoulder" method. A wagon with rails is for an older child. The cradle method is for infants up to 3 months of age. A football method is for infants up to 2 months of age.

Chapter 34, 11 Format: Multiple Choice Chapter: 34 Client Needs: D-1 Cognitive Level: Application Difficulty: Difficult Integrated Processes: Nursing Process Objective: 1 Page: 1031 264. The nurse is supporting an 8-year-old child who is having blood specimens drawn. Which method would be least appropriate to use for distraction? A) "Squeeze my hand as tight as you can." B) "Look at how many dots there are on the ceiling." C) "Count with me slowly from 1 to 20." D) "It's okay to scream if it hurts."

D Response: Although it is appropriate to tell the child that is okay to scream or cry, this is not a method of distraction. Squeezing the hand, focusing the eyes on the ceiling, and counting slowly are appropriate methods for distraction.

Chapter 36, 2 Format: Multiple Choice Chapter: 36 Client Needs: D-1 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 3 Page: 1109 285. Studies have shown that the use of antipyretics may prolong illness, but they do have benefits to the child with fever. Which of the following statements best explains the benefit of antipyretics? A) They slow the growth of bacteria. B) They increase neutrophil production. C) They encourage T-cell proliferation. D) They help decrease fluid requirements.

D Response: Antipyretics provide symptomatic relief by increasing comfort in the child and decreasing fluid requirements, which helps to prevent dehydration. They do not slow the growth of bacteria, increase neutrophil production, or encourage T-cell proliferation.

Chapter 33, 11 Format: Multiple Choice Chapter: 33 Client Needs: A-1 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 2 Page: 1016 249. Which of the following would be least appropriate to include in the discharge plan for a medically fragile child? A) Assisting with referrals for financial support B) Arranging for necessary care equipment and supplies C) Assessing the family's home environment D) Encouraging passive caregiving

D Response: As part of the discharge plan for a medically fragile child, the nurse would encourage active caregiving by the parents to help them increase their self-confidence in the child's care. Assisting with referrals, arranging for equipment and supplies, and determining the adequacy of the home environment are important aspects of the discharge plan.

Chapter 33, 9 Format: Multiple Choice Chapter: 33 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 2 Page: 1013 247. The nurse is providing home care for a 1-year-old girl who is technology-dependent. Which intervention will best support the family process? A) Finding an integrated health program for the family B) Teaching modifications of the medical regimen for vacation C) Assessing family expectations for the special needs child D) Creating schedules for therapies and interventions

D Response: Coordinating care with the schedules and capabilities of the parents provides the greatest support for the family. It gives them a sense of order and control. Integrated health care programs may not be available in the area. Teaching therapy modifications for travel and assessing family expectations are not supportive interventions.

Chapter 35, 9 Format: Multiple Choice Chapter: 35 Client Needs: D-4 Cognitive Level: Comprehension Difficulty: Moderate Integrated Processes: Nursing Process Objective: 1 Page: 1064 277. The nurse is conducting an assessment of a high school track athlete. He tells the nurse he is experiencing pain along his outer thigh. He describes it as tight, achy, and tender, particularly after he runs. The nurse understands that he is most likely experiencing what kind of pain? A) Cutaneous B) Neuropathic C) Visceral D) Deep somatic

D Response: Deep somatic pain typically involves the muscles, tendons, joints, fasciae, and bones. It can be localized or diffuse and usually is described as dull, aching, or cramping with tenderness. It can also be due to overuse injuries, commonly experienced by athletes. Visceral pain is pain that develops within organs. Cutaneous pain usually involves the skin and is described as sharp or burning. Neuropathic pain is due to a malfunction of the peripheral nervous system and is described as burning or tingling.

Chapter 32, 15 Format: Multiple Choice Chapter: 32 Client Needs: B Cognitive Level: Comprehension Difficulty: Moderate Integrated Processes: Nursing Process Objective: 1 Page: 980 238. When developing a presentation to a group of parents about hospitalization and children, which of the following would the nurse include? A) Most children receive routine care in the hospital than in other child care settings. B) The most common reason for older adolescents to be hospitalized is traumatic injury. C) Children who are chronically ill usually are the most common group requiring hospitalization. D) Respiratory disorders are the major reason for hospitalization in children under age 5.

D Response: Diseases of the respiratory system account for the majority of hospitalizations in children under 5 years of age. Most children receive routine care for illness in community health settings. Older adolescents (between 15 to 19 years) commonly require hospitalization for problems related to pregnancy, childbearing, and mental health. Children who are hospitalized are generally acutely ill.

Chapter 37, 8 Format: Multiple Choice Chapter: 37 Client Needs: D-3 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Teaching/Learning Objective: 9 Page: 1183 306. The nurse has developed a teaching plan for the family of a 2-year-old boy who holds his breath when he gets frustrated. Which of the following would be a priority intervention to teach to the parents? A) Provide "cuddle time" whenever the child begins to act out. B) Explain the severity of the effects of an episode. C) Encourage the parents to interact more with the child. D) Stay close to prevent injury when he gets frustrated.

D Response: Encourage the parents to maintain a safe environment when an episode is occurring. They should avoid giving extra attention to the child after the event, since this could encourage repetition of the behavior. It's important for the parents to understand what is happening, but rewarding the child with "cuddle time" when he is misbehaving is providing incorrect reinforcement of behaviors. Reassure parents that the child will suffer no ill effects from the behavior. Encouraging the parents to interact more with the child may be helpful, but the priority is safety for the child.

Chapter 35, 8 Format: Multiple Choice Chapter: 35 Client Needs: D-2 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Caring Objective: 7 Page: 1082 276. The nurse is conducting a pain assessment of a 10-year-old boy who has been taking acetaminophen for chronic knee pain. The assessment indicates that the recommended dose is no longer providing adequate relief. What is the appropriate nursing action? A) Increase the dosage of the acetaminophen. B) Tell the child he is experiencing the ceiling effect. C) Use guided imagery to help his pain. D) Obtain an order for a different medication.

D Response: Increasing the dose of the acetaminophen will not help his pain because he has reached as high a dose of that medication that will work. This is known as the ceiling effect, but explaining that to him will not help his pain. Guided imagery is not the best therapy for his pain. The physician needs to order a different medication to manage his pain.

Chapter 34, 10 Format: Multiple Choice Chapter: 34 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Processes: Communication and Documentation Objective: 1 Page: 1031 263. The nurse is preparing a 5-year-old for an x-ray. Which of the following would be the best approach to prepare the child for the procedure? A) "We are going to take some x-rays of your body." B) "We need to look inside at some of your organs." C) "X-rays are not painful; you won't feel a thing." D) "We are going to use a big camera to take pictures inside your body."

D Response: It is best to use simple terms and phrases that are easily understood. It is important to avoid certain phrases that might confuse or mislead the younger child. Referring to an "organ" might indicate to the child a musical instrument. Using the term "pain" should be avoided, as it may be too explicit and cause undue worry. The term "x-ray" is too technical and is not likely to be understood by a 5-year-old.

Chapter 33, 14 Format: Multiple Choice Chapter: 33 Client Needs: D-1 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 7 Page: 1024 252. Which of the following would the nurse include in the plan of care for a dying child with pain? A) Administering analgesics as needed B) Using measures the nurse finds comforting C) Playing the television or radio so the child can hear it D) Changing the child's position frequently but gently

D Response: Pain management includes changing the child's position frequently but gently to minimize discomfort. Analgesics are given around the clock rather than as needed. The nurse would use measures that the child finds comforting to provide additional relied. A calm environment with minimal noise and light is helpful.

Chapter 35, 12 Format: Multiple Choice Chapter: 35 Client Needs: D-2 Cognitive Level: Comprehension Difficulty: Easy Integrated Processes: Nursing Process Objective: 6 Page: 1083 280. Pentazocine is prescribed for a child with moderate pain. The nurse identifies this drug as an example of which type? A) NSAID B) Prostaglandin inhibitor C) Opioid D) Mixed opioid agonist-antagonist

D Response: Pentazocine is classified as a mixed opioid agonist-antagonist. Ibuprofen, ketorolac, and naproxen are examples of NSAIDs that inhibit prostaglandin synthesis. Morphine, codeine, and fentanyl are examples of opioids.

Chapter 37, 6 Format: Multiple Choice Chapter: 37 Client Needs: D-4 Cognitive Level: Analysis Difficulty: Moderate Integrated Processes: Nursing Process Objective: 6 Page: 1170 304. A 16-year-old boy complains to the school nurse of headaches and a stiff neck. Which of the following would lead the nurse to suspect that the child may have bacterial meningitis? A) Fixed and dilated pupils B) Frequent urination C) Sunset eyes D) Sunlight is "too bright"

D Response: Photophobia, or intolerance to light, is another symptom of bacterial meningitis. Fixed and dilated pupils are a symptom of head trauma; this warrants prompt intervention. Frequent urination is a symptom of a type I Arnold-Chiari malformation. Sunset eyes indicates increased intracranial pressure, which is typical of hydrocephalus.

Chapter 37, 15 Format: Multiple Choice Chapter: 37 Client Needs: D-4 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 5 Page: 1146 313. Which of the following would lead the nurse to suspect that a child is beginning to develop increased intracranial pressure? A) Bradycardia B) Cheyne-Stokes respirations C) Fixed, dilated pupils D) Projectile vomiting

D Response: Projectile vomiting is an early sign of increased intracranial pressure. Bradycardia, Cheyne-Stokes respirations, and fixed dilated pupils are late signs of increased intracranial pressure.

Chapter 38, 6 Format: Multiple Choice Chapter: 38 Client Needs: D-3 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 8 Page: 1201 319. The nurse is caring for a 4-year-old boy with infectious conjunctivitis. Which of the following interventions would the nurse be least likely to include in the child's plan of care? A) Using warm compresses to loosen crusts B) Educating the family about the disease C) Encouraging frequent hand-washing D) Promoting eye safety

D Response: Promoting eye safety would be appropriate if the child had an eye injury. Using warm water to loosen crusts, educating the family about the disorder, and encouraging frequent hand-washing are interventions for infectious conjunctivitis.

Chapter 37, 7 Format: Multiple Choice Chapter: 37 Client Needs: A-2 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 7 Page: 1159 305. A 4-year-old boy has a febrile seizure during a well-child visit. Which of the following is the priority nursing intervention? A) Placing the child on his side, hyperextending his head, during the seizure B) Positioning the child on his back while holding him still until the seizure ends C) Loosening the child's clothing to ensure a patent airway D) Protecting the child from harm during the seizure

D Response: Protecting the child's head and body during the seizure is the priority. Placing the child on his back with his head hyperextended is the position for performing cardiopulmonary resuscitation. During a seizure, the child should not be held down in a specific position.. Ensuring a patent airway is an important intervention but is not accomplished by loosening the child's clothing.

Chapter 37, 14 Format: Multiple Choice Chapter: 37 Client Needs: D-4 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 5 Page: 1144 312. The nurse inspects the eyes of a child and observes that the sclera is showing over the top of the iris. The nurse documents this finding as: A) Decorticate posturing B) Nystagmus C) Doll's eye D) Sunsetting

D Response: Sunsetting is when the sclera of the eyes is showing over the top of the iris. Decorticate posturing includes adduction of the arms, flexion at the elbows with the arms held over the chest, and flexion of the wrists with both hands fisted and the lower extremities adducted and extended. Nystagmus is manifested by involuntary rapid rhythmic eye movements. Doll's eye is a maneuver that tests for symmetrical eye movement to the opposite side when the head is turned in the other direction.

Chapter 32, 7 Format: Multiple Choice Chapter: 32 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Processes: Caring Objective: 6 Page: 1004 230. The nurse is caring for an 8-year-old girl who requires numerous venipunctures and injections daily. The nurse understands that the child is exhibiting signs of sensory overload and enlists the assistance of the child life specialist. What should the therapeutic play involve to best deal with the child's stressors? A) Puppets and dolls B) Drawing paper and crayons C) Wooden hammer and pegs D) Needles and dolls

D Response: The child undergoing frequent blood work, injections, or intravenous procedures may benefit from supervised needle play. The child life specialist can determine what form of therapeutic play is best, but the nurse can recommend interventions based on his or her knowledge of the specific child.

Chapter 34, 7 Format: Multiple Choice Chapter: 34 Client Needs: D-3 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 9 Page: 1055 260. A nurse is caring for a 14-year-old with a gastrostomy tube. The girl has skin breakdown and irritation at the insertion site. Which of the following would be most appropriate method to secure the gastrostomy tube? A) Nipple method B) Taping method C) Tension loop method D) Hydroactive dressing method

D Response: The hydroactive skin method is the most appropriate when skin breakdown and irritation are present at the insertion site. The hydroactive dressing material prevents further irritation and allows the skin breakdown to heal. The other methods all stabilize the gastrostomy tube, but the hydroactive dressing method is most appropriate when irritation or skin breakdown is present.

Chapter 35, 14 Format: Multiple Choice Chapter: 35 Client Needs: D-1 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 5 Page: 1071 282. Which tool would be least appropriate to use when assessing a 4-year-old child's pain? A) FACES Pain Rating Scale B) Oucher Pain Rating Scale C) Poker Chip Tool D) Numeric Pain Intensity Scale

D Response: The numeric pain intensity scale can be used with children as young as 5 years of age, but the preferred minimum age for using this tool is 7 years. The FACES and Oucher Pain Rating Scales and the Poker Chip Tool are appropriate pain assessment tools for a 4-year-old.

Chapter 35, 6 Format: Multiple Choice Chapter: 35 Client Needs: D-2 Cognitive Level: Application Difficulty: Easy Integrated Processes: Nursing Process Objective: 7 Page: 1088 274. The nurse is monitoring a child who has received epidural analgesia with morphine. The nurse is careful to monitor for which of the following adverse effects of the medication? A) Epidural hematoma B) Arachnoiditis C) Spinal headache D) Respiratory depression

D Response: The nurse needs to monitor for signs of respiratory depression, which is a potential adverse effect of the opioid medication. Epidural hematoma, arachnoiditis, and spinal headache are potential adverse effects of the insertion of the epidural catheter.

Chapter 34, 9 Format: Multiple Choice Chapter: 34 Client Needs: D-2 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 5 Page: 1039 262. The nurse is preparing to administer ear drops to a 6-year-old. To ensure that the medication is instilled properly, the nurse does which of the following? A) Pulls the pinna downward B) Pulls the pinna downward and back C) Pulls the pinna upward D) Pulls the pinna upward and back

D Response: The nurse should pull the pinna upward and back for children 3 and older. The nurse should pull the pinna downward and back in children under the age of 3.

Chapter 33, 1 Format: Multiple Choice Chapter: 33 Client Needs: D-3 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 4 Page: 1022 239. The nurse is caring for a 14-year-old girl with special health needs. What is the priority intervention for this child? A) Encouraging the parents to promote the child's self-care B) Assessing the child for signs of depression C) Discussing how her care will change as she grows D) Monitoring for compliance with treatment

D Response: The priority intervention is monitoring for compliance with treatment. The girl is struggling to fit in with her peers and may try to hide or ignore her illness. Monitoring for depression and encouraging self-care have a lesser impact on the child's physical health. A transition plan to adulthood may be initiated sometime in mid-adolescence.

Chapter 36, 4 Format: Multiple Choice Chapter: 36 Client Needs: D-4 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 3 Page: 1121 287. The nurse is preparing a plan of care for a 5-year-old boy with chickenpox. Which of the following nursing interventions is incorrect? A) Administering antipyretics as ordered B) Keeping the child's fingernails short C) Monitoring fluid intake and output D) Providing alcohol baths as needed

D Response: Treatments such as sponging the child with alcohol or cold water are not appropriate. Giving antipyretics, keeping the fingernails to avoid scratching, and monitoring intake and output are appropriate interventions for the child with chickenpox.

Chapter 34, 13 Format: Multiple Choice Chapter: 34 Client Needs: D-2 Cognitive Level: Application Difficulty: Moderate Integrated Processes: Nursing Process Objective: 5 Page: 1036 266. The nurse is administering a liquid medication to a 3-year-old using an oral syringe. Which action would be most appropriate? A) Direct the liquid toward the anterior side of the mouth. B) Keep the child's hand away from the oral syringe when squirting the medication. C) Give all of the drug in the syringe at one time with one squirt. D) Allow the child time to swallow the medication in between amounts.

D Response: When using an oral syringe to administer liquid medications, give the drug slowly in small amounts and allow the child to swallow before placing more medication in the mouth. The syringe is directed toward the posterior side of the mouth. The toddler or young preschooler may enjoy helping by squirting the medication into his or her mouth.

Chapter 35, 15 Format: Multiple Choice Chapter: 35 Client Needs: D-1 Cognitive Level: Analysis Difficulty: Difficult Integrated Processes: Nursing Process Objective: 5 Page: 1074 283. The nurse uses the FLACC Behavioral Scale to assess a 6-year-old's level of postoperative pain and obtains a score of 9. The nurse interprets this to indicate that the child is experiencing: A) Little to no pain B) Mild pain C) Moderate pain D) Severe pain

D Response: With the FLACC Behavioral Scale, five parameters are measured and scored as 0, 1, or 2. They are then totaled to achieve a maximum score of 10. The higher the score, the greater the pain. A score of 9 indicates severe pain.