OB/Pedi Exam 3 Questions

A 62-pound child has a spinal cord injury and has completed the bolus dose of IV steroids. The nurse is preparing to hang an IV infusion of steroids for the next 23 hours. How much medication should this child get per hour? Record your answer using 1 decimal place. Administer _______ mg/hour.

ANS: 152.2 First calculate the child's weight in kilograms: 62/2.2 = 28.181818 kilograms. Next multiply the weight by the standard dose of 5.4 mg/kg/hour × 28.181818 = 152.181818. Last, round to 1 decimal place = 152.2 mg/hour.

A 62-pound child has a spinal cord injury and is to receive steroid therapy. How much medication does the nurse draw up for the bolus dose? Record your answer in a whole number. Administer _____ mg.

ANS: 845 First calculate the child's weight in kilograms: 62/2.2 = 28.181818 kilograms. Next multiply the child's weight by the standard bolus dose: 28.181818 × 30 = 845.454545 mg. Round to the nearest whole number = 845 mg.

Bodily fluids are composed of two elements: water and _____.

ANS: Solutes Water is the primary constituent of bodily fluids. An infant's weight is approximately 75% water compared to the adult's weight, which is 55% to 60% water. Solutes are composed of both electrolytes and nonelectrolytes. The body's solutes include sodium, potassium, chloride, calcium, and magnesium.

What should the nurse teach parents when the child is taking phenytoin (Dilantin) to control seizures? a. The child should use a soft toothbrush and floss the teeth after every meal. b. The child will require monitoring of renal function while taking this medication. c. Dilantin should be taken with food because it causes gastrointestinal distress. d. The medication can be stopped when the child has been seizure free for 1 month.

ANS: A A side effect of Dilantin is gingival hyperplasia. Good oral hygiene will minimize this adverse effect. The child should have liver function studies because this anticonvulsant may cause hepatic dysfunction, not renal dysfunction. Dilantin has not been found to cause gastrointestinal upset. The medication can be taken without food. Anticonvulsants should never be stopped suddenly or without consulting the physician. Such action could result in seizure activity.

In counseling a patient who has decided to relinquish her baby for adoption, the nurse should do which of the following? a. Affirm her decision while acknowledging her maturity in making it. b. Question her about her feelings regarding adoption. c. Tell her she can always change her mind about adoption. d. Ask her if anyone is coercing her into the decision to relinquish her baby.

ANS: A A supportive, affirming approach by the nurse will strengthen the patient's resolve and help her to appreciate the significance of the event. The teen needs help in coping with her feelings about this decision. It is important for the nurse to support and affirm the decision the patient has made. This will strengthen the patient's resolve to follow through. Later the patient should be given an opportunity to express her feelings. Telling her she can always change her mind should not be an option after the baby is born and placed with the adoptive parents. It is important that the teenager is treated as an adult, with the assumption that she is capable of making an important decision on her own.

Which clinical finding is an overt sign of retinoblastoma in children? a. Whitish reflex in the eye b. Lymphadenopathy c. Bone pain d. Change in gait

ANS: A A whitish reflex in the eye, leukocoria, is a common finding of retinoblastoma. It is an overt sign of cancer in children. Persistent lymphadenopathy is a manifestation of several forms of childhood cancers. It is a covert sign of cancer in children. Bone pain is not a sign of retinoblastoma and is considered a covert sign. A change in gait may be a sign of a brain tumor. It is considered a covert sign of cancer in children.

A mother reports that her child has episodes where he appears to be staring into space. This behavior is characteristic of which type of seizure? a. Absence b. Atonic c. Tonic-clonic d. Simple partial

ANS: A Absence seizures are very brief episodes of altered awareness. The child has a blank expression. Atonic seizures cause an abrupt loss of postural tone, loss of consciousness, confusion, lethargy, and sleep. Tonic-clonic seizures involve sustained generalized muscle contractions followed by alternating contraction and relaxation of major muscle groups. There is no change in level of consciousness with simple partial seizures. Simple partial seizures consist of motor, autonomic, or sensory symptoms.

A nurse is assessing a woman receiving magnesium sulfate. The nurse assesses her deep tendon reflexes at 0 and 1+. What action by the nurse is best? a. Hold the magnesium sulfate. b. Ask the provider to order a 24-hour UA. c. Assess the woman's temperature. d. Take the woman's blood pressure.

ANS: A Absent or hypoactive deep tendon reflexes are indicative of magnesium sulfate toxicity. The nurse should hold the magnesium and notify the provider. There is no need for a 24- hour UA at this point. Temperature changes are not related to magnesium. Blood pressure can be assessed, but that is not the priority.

What is the priority nursing intervention for a child hospitalized with hemarthrosis resulting from hemophilia? a. Immobilization and elevation of the affected joint b. Administration of acetaminophen for pain relief c. Assessment of the child's response to hospitalization d. Assessment of the impact of hospitalization on the family system

ANS: A Although acetaminophen may help with pain associated with the treatment of hemarthrosis, it is not the priority nursing intervention. Although acetaminophen may help with pain associated with the treatment of hemarthrosis, it is not the priority nursing intervention. Assessment of a child's response to hospitalization is relevant to all hospitalized children; however, in this situation, psychosocial concerns are secondary to physiologic concerns. A priority nursing concern for this child is the management of hemarthrosis. Assessing the impact of hospitalization on the family system is relevant to all hospitalized children, but it is not the priority in this situation.

The nursing student learns that spontaneous termination of a pregnancy is considered to be an abortion if a. the pregnancy is less than 20 weeks. b. the fetus weighs less than 1000 g. c. the products of conception are passed intact. d. no evidence exists of intrauterine infection.

ANS: A An abortion is the termination of pregnancy before the age of viability (20 weeks). The weight of a fetus is not considered because some fetuses of an older age may have a low birth weight. A spontaneous abortion may be complete or incomplete. A spontaneous abortion may be caused by many problems, one being intrauterine infection.

The nurse closely monitors the temperature of a child with nephrotic syndrome. The purpose of this is to detect an early sign of which possible complication? a. Infection b. Hypertension c. Encephalopathy d. Edema

ANS: A An exacerbation of the disease can occur after an infection. Temperature is not an indication of hypertension or edema. Encephalopathy is not a complication usually associated with nephrosis. The child will most likely have neurologic signs and symptoms. Edema does not manifest with an elevated temperature.

The nurse learns that which is the most common cause of spontaneous abortion? a. Chromosomal abnormalities b. Infections c. Endocrine imbalance d. Immunologic factors

ANS: A Around 60% of pregnancy losses from spontaneous abortion in the first trimester result from chromosomal abnormalities that are incompatible with life. Maternal infection, endocrine imbalances, and immunologic factors may also be causes of early miscarriage.

A parent of a child with a chronic illness is complaining about "all these care planning meetings." What response by the home health care nurse is best? a. "Our plan will change with your child's growth and development." b. "We have legal regulations and company policies to follow." c. "Do you want to change the frequency of our meetings?" d. "If you don't want to come to the meetings you don't have to."

ANS: A As the child goes through the different phases of growth and development, goals and interventions will change to meet the changing needs of the child. This may require frequent care planning meetings and plan updates. The nurse may be also following regulations, but that response does not give the parent useful information. The plan should be based on the child's needs. Asking if the parent wants to change the frequency of meetings is a yes/no question and does not explain the rationale. Of course the parent can opt out of meetings, but the plan will be substandard, and again this does not give the parent useful information.

The priority nursing intervention when admitting a pregnant woman who has experienced a bleeding episode in late pregnancy is to a. assess fetal heart rate (FHR) and maternal vital signs. b. perform a venipuncture for hemoglobin and hematocrit levels. c. place clean disposable pads to collect any drainage. d. monitor uterine contractions.

ANS: A Assessment of the FHR and maternal vital signs will assist the nurse in determining the degree of the blood loss and its effect on the mother and fetus. The blood levels can be obtained later. It is important to assess future bleeding and provide for comfort, but the top priority is mother/fetal well-being. Monitoring uterine contractions is important but not the top priority.

The management of a child who has just been stung by a bee or wasp should include the application of which of the following? a. Cool compresses b. Warm compresses c. Antibiotic cream d. Corticosteroid cream

ANS: A Bee or wasp stings are initially treated by carefully removing the stinger, cleansing with soap and water, application of cool compresses or ice, and the use of common household agents such as lemon juice or a paste made with aspirin and baking soda. Warm compresses are avoided. Antibiotic cream is unnecessary unless a secondary infection occurs. Corticosteroid cream is not part of the initial therapy. If a severe reaction occurs, systemic corticosteroids may be indicated.

A common effect of both smoking and cocaine use on the pregnant woman is a. vasoconstriction. b. increased appetite. c. inactivates fetal hemoglobin. d. euphoria.

ANS: A Both smoking and cocaine use cause vasoconstriction, which results in impaired placental blood flow to the fetus. Both smoking and cocaine use decrease the appetite. Smoking inactivates fetal hemoglobin. Euphoria can be seen with cocaine use.

Latex allergy is suspected in a child with spina bifida. Appropriate nursing interventions include which of the following? a. Avoiding using any latex product b. Using only non-allergenic latex products c. Administering medication for long-term desensitization d. Teaching family about long-term management of allergic manifestations

ANS: A Care must be taken that individuals who are at high risk for latex allergies do not come in direct or secondary contact with products or equipment containing latex at any time during medical treatment. Latex allergy is estimated to occur in 75% of this patient population. There are no non- allergenic latex products. At this time, desensitization is not an option. There are no treatment options for long-term management of allergic symptoms for latex allergy.

The parents of a child born with disabilities ask the nurse for advice about discipline. The nurse's response should be based on knowledge that discipline is a. essential for the child. b. too difficult to implement with special-needs child. c. not needed unless the child becomes problematic. d. best achieved with punishment for misbehavior.

ANS: A Discipline is essential for the child. It provides boundaries on which to test out their behavior and teaches them socially acceptable behaviors. All children in the family should be held to the same standards of behavior to prevent resentment. The nurse should teach the parents ways to manage the child's behavior before it becomes problematic. Punishment is not effective in managing behavior.

A woman has been admitted to the labor and delivery unit who is HIV positive. She is in active labor. What action by the nurse is most appropriate? a. Prepare to administer IV zidovudine. b. Place the mother on contact precautions. c. Administer oxygen by face mask. d. Notify social services.

ANS: A During labor, an IV infusion of zidovudine is administered. The woman does not need contact precautions; standard precautions suffice. The woman does not need oxygen because of her HIV status. There is no reason to notify social services.

What nursing intervention holds the highest priority in the initial care of a child with a major burn injury? a. Establishing and maintaining the child's airway b. Establishing and maintaining intravenous access c. Inserting a catheter to monitor hourly urine output d. Inserting a nasogastric tube to supply adequate nutrition

ANS: A Establishing and maintaining the child's airway is always the priority focus for assessment and care. Establishing intravenous access is the second priority in this situation, after the airway has been established. Inserting a catheter and monitoring hourly urine output is the third most important nursing intervention. Nasogastric feedings are not begun initially on a child with major or severe burns. The initial assessment and care focus for a child with major burn injuries is the ABCs.

Rh incompatibility can occur if the woman is Rh negative and her a. fetus is Rh positive. b. husband is Rh positive. c. fetus is Rh negative. d. husband and fetus are both Rh negative.

ANS: A For Rh incompatibility to occur, the mother must be Rh negative and her fetus Rh positive. The husband's Rh factor is a concern only as it relates to the possible Rh factor of the fetus. If the fetus is Rh negative, the blood types are compatible and no problems should occur. If the fetus is Rh negative, the blood type with the mother is compatible. The husband's blood type does not enter into the problem.

What is a sign of increased intracranial pressure (ICP) in a 10-year-old child? a. Headache b. Bulging fontanel c. Tachypnea d. Increase in head circumference

ANS: A Headaches are a clinical manifestation of increased ICP in children. A change in the child's normal behavior pattern may be an important early sign of increased ICP. Bulging fontanel or increased head circumference is seen in infants. A change in respiratory pattern is a late sign of increased ICP. Cheyne-Stokes respiration may be evident. This refers to a pattern of increasing rate and depth of respirations followed by a decreasing rate and depth with a pause of variable length.

The mother of a child with hemophilia asks the nurse how long her child will need to be treated for hemophilia. What is the best response to this question? a. "Hemophilia is a lifelong blood disorder." b. "There is a 25% chance that your child will have spontaneous remission." c. "Treatment continues until after the toddler years." d. "Since your first child did not have hemophilia, treatment for this child is temporary."

ANS: A Hemophilia is a lifelong hereditary blood disorder with no cure. Treatment is life long.

In teaching family members about their child's von Willebrand disease, what is the priority outcome for the child that the nurse should discuss? a. Prevention of injury b. Maintaining adequate hydration c. Compliance with chronic transfusion therapy d. Prevention of respiratory infections

ANS: A Hemorrhage as a result of injury is the child's greatest threat to life. Fluid volume status becomes a concern when hemorrhage has occurred. The treatment of von Willebrand disease is desmopressin acetate (DDAVP), which is administered intranasally or intravenously. Respiratory infections do not constitute a major threat to the child with von Willebrand disease.

Impetigo ordinarily results in a. no scarring. b. pigmented spots. c. slightly depressed scars. d. atrophic white scars.

ANS: A Impetigo tends to heal without scarring unless a secondary infection occurs or the child picks at the lesions. Hyperpigmentation may occur but only in dark-skinned children.

Which finding in an analysis of cerebrospinal fluid (CSF) is consistent with a diagnosis of bacterial meningitis? a. CSF appears cloudy. b. CSF pressure is decreased. c. Few leukocytes are present. d. Glucose level is increased compared with blood.

ANS: A In acute bacterial meningitis, the CSF is cloudy to milky or yellowish in color. The CSF pressure is usually increased in acute bacterial meningitis. Many polymorphonuclear cells are present in CSF with acute bacterial meningitis. The CSF glucose level is usually decreased compared with the serum glucose level.

A child with acute myeloblastic leukemia is scheduled to have a bone marrow transplant (BMT). The donor is the child's own umbilical cord blood that had been previously harvested and banked. This type of BMT is termed a. autologous. b. allogeneic. c. syngeneic. d. stem cell.

ANS: A In an autologous transplant, the child's own marrow or previously harvested and banked cord blood is used. In an allogeneic BMT, histocompatibility has been matched with a related or an unrelated donor. In a syngeneic transplant, the child receives bone marrow from an identical twin. A stem cell transplantation uses a unique immature cell present in the peripheral circulation.

What is true about the genetic transmission of sickle cell disease? a. Both parents must carry the sickle cell trait. b. Both parents must have sickle cell disease. c. One parent must have the sickle cell trait. d. Sickle cell disease has no known pattern of inheritance.

ANS: A In this scenario, there is a 50% risk of having a child with sickle cell disease. The sickle cell trait, not the disease itself, must be present in the parents for the child to have the disease. An autosomal recessive pattern of inheritance means that both parents must be carriers of the sickle cell trait. Sickle cell disease is known to have an autosomal recessive pattern of inheritance.

In assessing the knowledge of a pregestational woman with type 1 diabetes concerning changing insulin needs during pregnancy, the nurse recognizes that further teaching is warranted when the patient states a. "I will need to increase my insulin dosage during the first 3 months of pregnancy." b. "Insulin dosage will likely need to be increased during the second and third trimesters." c. "Episodes of hypoglycemia are more likely to occur during the first 3 months." d. "Insulin needs should return to normal within 7 to 10 days after birth if I am bottle feeding."

ANS: A Insulin needs are reduced in the first trimester due to increased insulin production by the pancreas and increased peripheral sensitivity to insulin. Also the woman may be experiencing nausea, vomiting, and anorexia that would decrease her insulin needs. The other statements show good understanding of this topic.

A nurse is teaching a class on acute kidney injury. The nurse relates that acute kidney injury as a result of hemolytic-uremic syndrome (HUS) is classified as a. Intrinsic renal. b. Prerenal. c. Postrenal. d. Chronic.

ANS: A Intrinsic renal acute renal failure is the result of damage to kidney tissue. Possible causes include HUS, glomerulonephritis, and pyelonephritis. Prerenal acute renal failure is the result of decreased perfusion to the kidney. Possible causes include dehydration, septic and hemorrhagic shock, and hypotension. Postrenal acute renal failure results from obstruction of urine outflow. Conditions causing postrenal failure include ureteropelvic obstruction, ureterovesical obstruction, or neurogenic bladder. Renal failure caused by HUS is of the acute nature. Chronic renal failure is an irreversible loss of kidney function, which occurs over months or years.

With regard to anemia, nurses should be aware that a. it is the most common medical disorder of pregnancy. b. it can trigger reflex brachycardia. c. the most common form of anemia is caused by folate deficiency. d. thalassemia is a European version of sickle cell anemia.

ANS: A Iron deficiency anemia causes 75% of anemias in pregnancy. It is difficult to meet the pregnancy needs for iron through diet alone. It does not cause bradycardia. Thalassemia is a distinct disease from sickle cell anemia.

The student nurse learns that the most important reason marijuana should not be used during pregnancy is which of the following? a. Unknown effects, more research is needed b. Causes a higher rate of spontaneous abortions c. Leads to multiple organ dysfunction in the newborn d. Responsible for severe cognitive deficits

ANS: A Marijuana's effects on the fetus are largely unknown. More research is needed in this area.

When assessing the child with atopic dermatitis, the nurse should ask the parents about a history of which of the following? a. Asthma b. Nephrosis c. Lower respiratory tract infections d. Neurotoxicity

ANS: A Most children with atopic dermatitis have a family history of asthma, hay fever, or atopic dermatitis, and up to 80% of children with atopic dermatitis have asthma or allergic rhinitis. Complications of atopic dermatitis relate to the skin. The renal system is not affected by atopic dermatitis. There is no link between lower respiratory tract infections and atopic dermatitis. Atopic dermatitis does not have a relationship to neurotoxicity.

The most common problem of children born with a myelomeningocele is a. bladder incontinence. b. intellectual impairment. c. respiratory compromise. d. cranioschisis.

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

An assessment of a 7-month-old infant with a hemoglobin level of 6.5 mg/dL is likely to reveal an infant who is a. lethargic, pale, and irritable. b. thin, energetic, and sleeps little. c. anorexic, vomiting, and has watery stools. d. flushed, fussy, and tired.

ANS: A Pallor, lethargy, irritability, and tachycardia are clinical manifestations of iron-deficiency anemia. A child with a hemoglobin level of 6.5 mg/dL has anemia. Typically these children will not be thin, energetic, anorexic, have GI complaints, or flushed. They may be tired, fussy, and sleep a lot.

Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care, the nurse and the woman mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. The nurse identifies that the fetus is at greatest risk for a. macrosomia. b. congenital anomalies of the central nervous system. c. preterm birth. d. low birth weight.

ANS: A Poor glycemic control later in pregnancy increases the rate of fetal macrosomia. Poor glycemic control during the preconception time frame and into the early weeks of the pregnancy is associated with congenital anomalies. Preterm labor or birth is more likely to occur with severe diabetes and is the greatest risk in women with pregestational diabetes. Increased weight, or macrosomia, is the greatest risk factor for this woman.

With regard to the association of maternal diabetes and other risk situations affecting mother and fetus, nurses should be aware that a. Diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy. b. Hydramnios rarely occurs in diabetic pregnancies. c. Infections occur about as often and are considered about as serious in diabetic and nondiabetic pregnancies. d. Women should not use insulin pumps during pregnancy.

ANS: A Prompt treatment of DKA is necessary to save the fetus and the mother. Hydramnios is a potential complication for the diabetic pregnancy. Infections are more common and more serious in pregnant women with diabetes. Women who were treated with an insulin pump before pregnancy can continue this therapy.

What should the nurse include in a teaching plan for the parents of a child with vesicoureteral reflux? a. The importance of taking prophylactic antibiotics if prescribed b. Suggestions for how to maintain fluid restrictions c. The use of bubble baths as an incentive to increase bath time d. The need for the child to hold urine for 6 to 8 hours

ANS: A Prophylactic antibiotics are sometimes used to prevent urinary infection in a child with vesicoureteral reflux, especially if they are waiting for the results of imaging studies or have recurrent UTIs. If prescribed, the parents should be taught that the child must finish the entire course of antibiotics to prevent bacterial resistance. Fluids are not restricted when a child has vesicoureteral reflux. In fact, fluid intake should be increased as a measure to prevent UTIs. Bubble baths should be avoided to prevent urethral irritation and possible UTI. To prevent UTIs, the child should be taught to void frequently and never resist the urge to urinate.

Prophylaxis of subacute bacterial endocarditis (SBE) is given before and after birth when a pregnant woman has a. valvular disease. b. congestive heart disease. c. dysrhythmias. d. postmyocardial infarction.

ANS: A Prophylaxis for intrapartum endocarditis and pulmonary infection may be provided for women who have mitral valve prolapse. It is not indicated for congestive heart failure, dysrhythmias, or myocardial infarctions.

Which dietary modification is appropriate for a child with chronic renal failure? a. Decreased protein b. Decreased fat c. Increased potassium d. Increased phosphorus

ANS: A Protein intake is restricted or strictly regulated because of the kidney's inability to remove waste products. A low-fat diet is not relevant to chronic renal failure. Potassium intake may be restricted because of the kidney's inability to remove it. Phosphorus is restricted to help prevent bone disease.

Which activity should the nurse implement for the toddler hospitalized with a chronic illness to promote autonomy? a. Provide opportunities for play b. Making play dates with other toddlers in the unit c. Give the toddler art supplies d. Turn the television on to cartoons

ANS: A Providing play gives the toddler some time to work on growth and development skills and normalizes hospitalization at least for that time. Toddlers typically don't play together in groups. Art supplies may or may not be too advanced for the toddler, but in any case, this would be a form of play. Watching cartoons on television is passive and will not promote autonomy.

A child experiences frostbite of the fingers after prolonged exposure to the cold. Which intervention should the nurse implement first? a. Rapid rewarming of the fingers by placing in warm water b. Placing the hand in cool water c. Slow rewarming by wrapping in warm cloth d. Using an ice pack to keep cold until medical intervention is possible

ANS: A Rapid rewarming is accomplished by immersing the part in well-agitated water at 37.8° C to 42.2° C (100° F to 108° F). Cool water will worsen the problem. Rapid rewarming results in less tissue necrosis than slow thawing. The frostbitten area should be rewarmed as soon as possible to avoid further tissue damage. The frostbitten area should be rewarmed, as soon as possible, to avoid further tissue damage.

Which of the following items are inconsistent with the nurse's knowledge of symptoms of fetal alcohol syndrome? a. Respiratory conditions b. Impaired growth c. CNS abnormality d. Facial abnormalities

ANS: A Respiratory difficulties are not a category of conditions that are related to FAS. Abnormalities related to FAS include impaired growth (intrauterine growth restriction), CNS abnormalities, and a constellation of typical facial features.

What should be the major consideration when selecting toys for a child with an intellectual or developmental disability? a. Safety b. Age appropriateness c. Ability to provide exercise d. Ability to teach useful skills

ANS: A Safety is the primary concern in selecting recreational and exercise activities for all children. This is especially true for children who are intellectually disabled. Age appropriateness should be considered in the selection of toys, but safety is of paramount importance since their intellectual age will be less than their chronological age. Ability to provide exercise and teach skills is also important but not as vital as safety.

When changing an infant's diaper, the nurse notices small bright red papules with satellite lesions on the perineum, anterior thigh, and lower abdomen. This rash is characteristic of a. candidiasis. b. irritant contact dermatitis. c. intertrigo. d. seborrheic dermatitis.

ANS: A Small red papules with peripheral scaling in a sharply demarcated area involving the anterior thighs, lower abdomen, and perineum are characteristic of candidiasis. A shiny, parchment- like erythematous rash on the buttocks, medial thighs, mons pubis, and scrotum, but not in the folds, is suggestive of irritant contact dermatitis. Intertrigo is identified by a red macerated area of sharp demarcation in the groin folds. It can also develop in the gluteal and neck folds. Seborrheic dermatitis is recognized by salmon- colored, greasy lesions with a yellowish scale found primarily in skinfold areas or on the scalp.

Parents have learned that their 6-year-old child has autism. The nurse may help the parents to cope by explaining that the child may a. have an extremely developed skill in a particular area. b. outgrow the condition by early adulthood. c. have average social skills. d. have age-appropriate language skills.

ANS: A Some children with autism have an extremely developed skill in a particular area such as mathematics or music. This information may be comforting, although the nurse should avoid giving false hope. No evidence supports that autism is outgrown. Autistic children have abnormal ways of relating to people (social skills). Speech and language skills are usually delayed in autistic children.

A child had surgery for a brain tumor. Which provider orders does the nurse question? a. Place the child in the Trendelenburg position. b. Perform neurologic assessments. c. Assess dressings for drainage. d. Monitor temperature.

ANS: A The child is never placed in the Trendelenburg position because it increases intracranial pressure and the risk of bleeding. Increased intracranial pressure is a risk in the postoperative period. The nurse would assess the child's neurologic status frequently. Hemorrhage is a risk in the postoperative period. The child's dressing would be inspected frequently for bleeding. Temperature is monitored closely because the child is at risk for infection in the postoperative period.

The nurse should expect a child who has frequent tension-type headaches to describe headache pain as which of the following? a. "There is a rubber-band squeezing my head." b. "It's a throbbing pain over my left eye." c. "My headaches are worse in the morning and get better later in the day." d. "I have a stomachache and a headache at the same time."

ANS: A The child who has tension-type headaches may describe the pain as a bandlike tightness or pressure, tight neck muscles, or soreness in the scalp. A common symptom of migraines is throbbing headache pain, typically on one side of the eye. A headache that is worse in the morning and improves throughout the course of the day is typical of ICP. Abdominal pain may accompany headache pain in migraines.

What food choice by the parent of a 2-year-old child with celiac disease indicates a need for further teaching? a. Oatmeal b. Rice cake c. Corn muffin d. Meat patty

ANS: A The child with celiac disease is unable to fully digest gluten, the protein found in wheat, barley, rye, and oats. Oatmeal contains gluten and is not an appropriate food selection. Rice, corn, and meat are appropriate selections.

When a 2-week-old infant is seen for irritability, poor appetite, and rapid head growth with observable distended scalp veins, the nurse recognizes these signs as indicative of which disorder? a. Hydrocephalus b. Syndrome of inappropriate antidiuretic hormone (SIADH) c. Cerebral palsy d. Reye's syndrome

ANS: A The combination of signs is strongly suggestive of hydrocephalus. SIADH would not manifest in this way. The child would have decreased urination, hypertension, weight gain, fluid retention, hyponatremia, and increased urine specific gravity. The manifestations of cerebral palsy vary but may include persistence of primitive reflexes, delayed gross motor development, and lack of progression through developmental milestones. Reye's syndrome is associated with an antecedent viral infection with symptoms of malaise, nausea, and vomiting. Progressive neurologic deterioration occurs.

The home health care nurse is working with a family with three children, one of whom has a chronic condition. What statement by a parent indicates that goals for a primary nursing diagnosis have been met? a. "We take turns going to soccer practice with our other two kids." b. "Each sibling has one night when he or she is in charge so we can go out." c. "We are looking into local support groups for parents." d. "We can't afford home health care, so one of us will quit our job."

ANS: A The family that is demonstrating good ability to balance the needs of all family members is meeting an important goal for the diagnosis Interrupted Family Processes. The other siblings may not want to be "in charge" for an entire evening, but that does not show good balance. Looking into support groups and having to quit a job also do not demonstrate that a goal for this diagnosis is being met.

The parents of a chronic illness say, "Living with this disease is really hard; it's not fair." What response by the nurse is best? a. "Tell me about what is hard for you." b. "I know exactly how you must feel." c. "I know a local support group for families." d. "I am going to ask the grief counselor to meet with you."

ANS: A The first step in supporting families and helping them deal with chronic sorrow is to listen to and recognize their pain. Each individual's perception of a situation is different. A nurse can never know exactly how parents feel about having a child with a chronic illness. The family may welcome involvement in a support group or meeting with a counselor, but that should not be the first action.

A woman who delivered her third child yesterday has just learned that her two school-age children have contracted chickenpox. What action by the nurse is best? a. Assess if the woman has had chickenpox or been vaccinated. b. Tell her that the baby has immunity from her and is not susceptible. c. Advise her if she is non-immune, she will get vaccinated at her 2-week postpartum checkup. d. The infant will receive prophylactic acyclovir before discharge.

ANS: A The first thing the nurse should do is to determine the woman's susceptibility to this infection. If she is non-immune, she will get her first vaccination prior to discharge. The nurse does not know the baby's immune status without knowing the mother's. Acyclovir is not used to treat chickenpox.

The nurse is providing support to a family who is experiencing anticipatory grief related to their child's imminent death. An appropriate nursing intervention is to a. be available to family. b. attempt to "lighten the mood." c. not allow visitors at this time. d. discourage crying because the child can hear it.

ANS: A The most valuable nursing intervention at this time is to be available to the family. Attempting to lighten the mood or to cheer people up is inappropriate. The family's wishes determine who can visit. The nurse should never discourage the expression of emotions.

Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother? a. Hypoglycemia b. Hypercalcemia c. Hypobilirubinemia d. Hypoinsulinemia

ANS: A The neonate is at highest risk for hypoglycemia because fetal insulin production is accelerated during pregnancy to metabolize excessive glucose from the mother. At birth, the maternal glucose supply stops and the neonatal insulin exceeds the available glucose, leading to hypoglycemia. Hypocalcemia is associated with preterm birth, birth trauma, and asphyxia, all common problems of the infant of a diabetic mother. Excess erythrocytes are broken down after birth, releasing large amounts of bilirubin into the neonate's circulation, which results in hyperbilirubinemia. Because fetal insulin production is accelerated during pregnancy, the neonate shows hyperinsulinemia.

The nurse notes that a child's gums bleed easily and that the child has bruising and petechiae on his extremities. What laboratory values are consistent with these symptoms? a. Platelet count of 19,000/mm3 b. Prothrombin time of 11 to 15 seconds c. Hematocrit of 34 d. Leukocyte count of 14,000/mm3

ANS: A The normal platelet count is 150,000 to 400,000/mm3 . This finding is very low, indicating an increased bleeding potential. The child should be monitored closely for signs of bleeding. The prothrombin time of 11 to 15 seconds is within normal limits. The normal hematocrit is 35 to 45, and although this finding is low, it would not create the symptoms presented. This value indicates the probable presence of infection, but it is not a reflection of bleeding tendency.

When the nurse is alone with a battered patient, the patient seems extremely anxious and says, "It was all my fault. The house was so messy when he got home and I know he hates that." The best response by the nurse is a. "No one deserves to be hurt. It's not your fault. How can I help you?" b. "What else do you do that makes him angry enough to hurt you?" c. "He will never find out what we talk about. Don't worry. We're here to help you." d. "You have to remember that he is frustrated and angry so he takes it out on you."

ANS: A The nurse should stress that the patient is not at fault and offer to help. Asking what else the woman does to make the partner angry or reminding her that he is frustrated is placing blame on the woman. Telling her "don't worry" is giving false reassurance.

In helping bereaved parents cope and move on, nurses should keep in mind that a. a perinatal or parental grief support group is more likely to be helpful if the needs of the parents are matched with the focus of the group. b. when pictures of the infant are taken for keepsakes, no close-ups should be taken of any congenital anomalies. c. no significant differences exist in grieving individuals from various cultures, ethnic groups, and religions. d. calling the hospital clergy for emergency baptism is always appropriate.

ANS: A The nurse should try when possible to match the recommended support resources to the parents. For example, a religious-based group may not work for nonreligious parents. Close-up pictures of the baby must be taken as the infant was, congenital anomalies and all. Although death and grieving are events shared by all people, mourning rituals, traditions, and taboos vary by culture, ethnicity, and religion. Differences must be respected. Parents may or may not want the newborn to be baptized; the nurse must assess the family for their religious wishes and facilitate them.

The nurse is caring for a child who has just died. The parents ask to be left alone so that they can rock their child one more time. What response by the nurse is best? a. Grant their request. b. Assess why they feel this is necessary. c. Discourage this because it will only prolong their grief. d. Kindly explain that they need to say good-bye to their child now and leave.

ANS: A The parents should be allowed to remain with their child after the death for as long as they need to. No other response is needed.

A nurse has taught a pregnant woman about toxoplasmosis. What statement by the patients indicates a need for further instruction? a. "I will be certain to empty the litter boxes regularly." b. "I won't eat raw eggs." c. "I had better wash all of my fruits and vegetables." d. "I need to be cautious when cooking meat."

ANS: A The patient should avoid contact with materials that are possibly contaminated with cat feces while pregnant. This includes cat litter boxes, sand boxes, and garden soil. She should wash her hands thoroughly after working with soil or handling animals. The other statements show good understanding.

The mother of a child who was recently diagnosed with acute glomerulonephritis asks the nurse why the physician keeps talking about "casts" in the urine. The nurse explains that casts in the urine indicate a. glomerular injury. b. glomerular healing. c. recent streptococcal infection. d. excessive amounts of protein in the urine.

ANS: A The presence of red blood cell casts in the urine indicates glomerular injury. Casts in the urine are abnormal findings and are indicative of glomerular injury, not glomerular healing. A urinalysis positive for casts does not confirm a recent streptococcal infection. Casts in the urine are unrelated to proteinuria.

A nurse is caring for a dying child. What action by the nurse best meets the the primary concern of the parents? a. Giving the child pain medication on a schedule b. Placing the child on fall and safety precautions c. Providing the child with favorite foods when requested d. Ensuring the child gets the minimum fluid requirement

ANS: A The primary concern of all parents of dying children is the possibility of their child feeling pain. The nurse works vigilantly to assess and treat the child's pain. The other options are also important considerations but usually not the priority concern.

A woman has tested human immunodeficiency virus (HIV)-positive and has now discovered that she is pregnant. Which statement indicates that she understands the risks of this diagnosis? a. "Even though my test is positive, my baby might not be affected." b. "I know I will need to have an abortion as soon as possible." c. "This pregnancy will probably decrease the chance that I will develop AIDS." d. "My baby is certain to have AIDS and die within the first year of life."

ANS: A The rate of perinatal transmission of HIV has decreased with the use of antiretroviral medications during pregnancy. There is no need to have an abortion. The mother may or may not go on to develop AIDS.

What order should the nurse expect for a patient admitted with a threatened abortion? a. Abstinence from sexual activity b. Pitocin IV c. NPO d. Narcotic analgesia every 3 hours, prn

ANS: A The woman may be counseled to avoid sexual activity with a threatened abortion. Activity restrictions were once recommended, but they have not shown effectiveness as treatment. Pitocin would be contraindicated. There is no reason for the woman to be NPO. In fact, hydration is important. Narcotic analgesia is not indicated.

What is most likely to be a concern for the older mother? a. The importance of having enough rest and sleep b. Information about effective contraceptive methods c. Nutrition and diet planning d. Information about exercise and fitness

ANS: A The woman who delays childbearing may have unique concerns, one of which is having less energy than younger mothers. The older mother usually has more financial means to search out effective contraceptive methods. The older mother often is better off financially and can afford better nutrition. Information about exercise and fitness is readily available.

A child has small red macules and vesicles that become pustules around the child's mouth and cheek. Older lesions are crusted and honey-colored. What should the nurse teach the parents about this condition? a. Keep the child home from school for 24 hours after starting antibiotics. b. Clean the rash vigorously with Betadine three times a day. c. Notify the physician for any itching. d. Keep the child home from school until the lesions are healed.

ANS: A This child has impetigo. To prevent the spread of impetigo to others, the child should be kept home from school for 24 hours after treatment is initiated. Good handwashing is imperative in preventing the spread of impetigo. The lesions should be washed gently with a warm soapy washcloth. Itching is common and does not necessitate medical treatment. Rather, parents should be taught to clip the child's nails to prevent maceration of the lesions. The washcloth should not be shared with other members of the family. The child may return to school 24 hours after initiation of antibiotic treatment.

What is a priority nursing diagnosis for the preschool child with chronic illness? a. Risk for delayed growth and development related to chronic illness or disability b. Chronic pain related to frequent injections and invasive procedures c. Anticipatory grieving related to impending death d. Anxiety related to frequent hospitalizations

ANS: A This is the priority nursing diagnosis that is appropriate for the majority of chronic illnesses. The child may or may not have frequent injections and invasive procedures. A chronic illness is one that does not have a cure. It does not mean the child will die prematurely. Frequent hospitalizations are not required for all chronic illnesses.

A pregnant diabetic woman is in the hospital and her blood glucose reading is 42 mg/dL. What action by the nurse is best? a. Provide her with 15 grams of oral carbohydrate if she can swallow. b. Administer a bolus of rapid-acting insulin. c. Order the woman a meal tray from the cafeteria. d. Notify the provider immediately.

ANS: A This woman has hypoglycemia and needs to injest 15 grams of carbohydrate if she is able to swallow. Insulin would make the problem worse. The meal tray is a good idea but not as the first response as it will take too long. The provider should be notified but only after the nurse takes corrective action.

Which information should the nurse give to a child who is to have magnetic resonance imaging (MRI) of the brain? a. "You won't be able to move your head during the procedure." b. "You will have to drink a special fluid before the test." c. "You will have to lie flat after the test is finished." d. "You will have electrodes placed on your head with glue."

ANS: A To reduce fear and enhance cooperation during the MRI, the child should be made aware that head movement will be restricted to obtain accurate information. The child does not need to drink special liquids, lie on the back afterward, or have electrodes placed.

Congenital anomalies can occur with the use of antiepileptic drugs, including (Select all that apply.) a. Craniofacial abnormalities b. Congenital heart disease c. Neural tube defects d. Gastroschisis e. Diaphragmatic hernia

ANS: A, B, C Congenital anomalies that can occur with antiepileptic drugs include craniofacial abnormalities, congenital heart disease, and neural tube defects. They are not known to cause gastroschisis or diaphragmatic hernias.

Which nursing interventions are significant for a child with cirrhosis who is at risk for bleeding? (Select all that apply.) a. Guaiac all stools b. Provide a safe environment c. Administer vitamin K d. Inspect skin for pallor and cyanosis e. Monitor serum liver panels

ANS: A, B, C Identification of bleeding includes stool guaiac testing, which can detect if blood is present in the stool; protecting the child from injury by providing a safe environment; administering vitamin K to prevent bleeding episodes; and avoiding injections.

A nurse is assessing a newborn for facial feature characteristics associated with fetal alcohol syndrome. Which characteristics should the nurse expect to assess? (Select all that apply.) a. Short palpebral fissures b. Smooth philtrum c. Low-set ears d. Inner epicanthal folds e. Thin upper lip

ANS: A, B, C, E Infants with fetal alcohol syndrome may have characteristic facial features, including short palpebral fissures, a smooth philtrum (the vertical groove in the median portion of the upper lip), low-set ears, and a thin upper lip. Low-set ears and inner epicanthal folds are associated with Down syndrome.

Many teens wait until the second or even third trimester to seek prenatal care. The nurse should understand that the reasons behind this delay include which of the following? (Select all that apply.) a. Lack of realization that they are pregnant b. Uncertainty as to where to go for care c. Continuing to deny the pregnancy d. A desire to gain control over their situation e. Wanting to hide the pregnancy as long as possible

ANS: A, B, C, E Not realizing they are pregnant, uncertainty over where to get care, denial, and wanting to hide the pregnancy are all reasons some teens delay prenatal care. Wanting to gain control over the situation does not lead to delaying care.

When an adolescent with a new diagnosis of Ewing sarcoma asks the nurse about treatment, the nurse's response is based on the knowledge that (Select all that apply.) a. this type of tumor invades the bone. b. management includes chemotherapy, surgery, and radiation. c. Ewing sarcoma is usually not responsive to either chemotherapy or radiation. d. affected bones such as ribs and proximal fibula may be removed to excise the tumor. e. is the most common bone tumor seen in children.

ANS: A, B, D Ewing sarcoma invades the bone and is found most often in the midshaft of long bones, especially the femur, vertebrae, ribs, and pelvic bones. Treatment for Ewing sarcoma begins with chemotherapy to decrease tumor bulk, followed by surgical resection of the primary tumor. Local control of the tumor can be achieved with surgery or radiation. The affected bone may be removed if it will not affect the child's functioning. Ribs and the proximal fibula are considered expendable and may be removed to excise the tumor without affecting function. Ewing sarcoma is responsive to both chemotherapy and radiation. Osteosarcoma is the most common primary bone malignancy in children. The second most common bone tumor seen in children is Ewing sarcoma.

The nurse is assessing a 3-year-old child who has characteristics of autism. Which observed behaviors are associated with autism? (Select all that apply.) a. The child flicks the light in the examination room on and off repetitiously. b. The child has a flat affect. c. The child demonstrates imitation and gesturing skills. d. The mother reports the child has no interest in playing with other children. e. The child is able to make eye contact.

ANS: A, B, D Self-stimulation is common and usually involves repetition of a sensory stimulus. Autistic children show a fixed, unchanging response to a particular stimulus. Autistic children play alone or involve others only as mere objects. Autistic children lack imitative skills. These children lack social ability and make poor eye contact.

A nurse working in a trauma center would facilitate referrals to a burn center for which of the following children? (Select all that apply.) a. Electrical burn b. Chemical burn c. Burn from child abuse d. Burn in the perineal area e. 5% second-degree burn

ANS: A, B, D Specific criteria exist for transferring a child to a burn center for treatment, including electrical and chemical burns and burns in the perineal area. Burns from child abuse and a second-degree burn <10% in total body surface area do not need transfers.

The nurse who suspects that a patient has early signs of ectopic pregnancy should be observing her for which symptoms? (Select all that apply.) a. Pelvic pain b. Abdominal pain c. Unanticipated heavy bleeding d. Vaginal spotting or light bleeding e. Missed period

ANS: A, B, D, E Early signs of ectopic pregnancy include pelvic pain, abdominal pain, spotting or light bleeding, and a woman's report of a "missed period." Heavy bleeding is a later sign and occurs after the tube has ruptured.

A nurse is teaching parents about prevention of diaper dermatitis. Which should the nurse include in the teaching plan? (Select all that apply.) a. Clean the diaper area gently after every diaper change with a mild soap. b. Use a protective ointment to clean dry intact skin. c. Use a steroid cream after each diaper change. d. Use rubber or plastic pants over the diaper. e. Wash cloth diapers in hot water with a mild soap and double rinse.

ANS: A, B, E Prompt, gentle cleaning with water and mild soap (e.g., Dove, Neutrogena Baby Soap) after each voiding or defecation rids the skin of ammonia and other irritants and decreases the chance of skin breakdown and infection. A bland, protective ointment (e.g., A&D, Balmex, Desitin, zinc oxide) can be applied to clean, dry, intact skin to help prevent diaper rash. If cloth diapers are laundered at home, the parents should wash them in hot water, using a mild soap and double rinsing. Occlusion increases the risk of systemic absorption of a steroid; thus steroid creams are rarely used for diaper dermatitis because the diaper functions as an occlusive dressing. Rubber or plastic pants increase skin breakdown by holding in moisture and should be used infrequently. A steroid cream is not recommended.

A 14-year-old is in the intensive care unit after a spinal cord injury 2 days ago. Nursing care for this child includes (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.

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. Spinal cord injury is a catastrophic event. Discussion of long-term care should be delayed until the child is stable.

The nurse is caring for a child who has beta-thalassemia. What unique facial features does the nurse assess in this child? (Select all that apply.) a. Frontal bossing b. Strabismus c. Wide-set eyes d. Maxillary prominence e. Distinct overbite

ANS: A, C, D Children with undertreated beta-thalassemia have distinct facial features including frontal bossing, wide-set eyes, and maxillary prominence. They do not have strabismus or overbites.

The nurse cares for many children with different types of hepatitis. What information about this disease is correct? (Select all that apply.) a. Hepatitis A can be contracted from contaminated water. b. Only a small percentage of children infected with hepatitis B fully recover. c. People infected with chronic hepatitis C are usually asymptomatic. d. Hepatitis D is the most likely to cause a fulminating illness. e. Hepatitis E is the most common type in children in the United States.

ANS: A, C, D Hepatitis A can be contracted from contaminated food or water. Hepatitis C infections usually are asymptomatic. Hepatitis D is the strain most likely to cause a fulminating illness. Most children with hepatitis B recover fully. Hepatitis E is rate in the United States.

The nurse assesses the lab values of a child hospitalized with DIC. What findings are consistent for this disorder? (Select all that apply.) a. Decreased platelet count b. Increased hemoglobin c. Prolonged prothrombin time d. Elevated D-dimer e. Pancytopenia

ANS: A, C, D Laboratory findings in DIC include decreased platelet count, prolonged prothrombin time, and elevated D-dimer. Increased hemoglobin and pancytopenia are not seen.

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

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

A nurse routinely administers chemotherapy to hospitalized children with cancer. What safety measures does this nurse take as a routine part of practice? (Select all that apply.) a. Calculates child's body-surface area in meters squared b. Ensures a CBC is obtained within 72 hours of starting chemotherapy c. Double checks ordered doses against established protocols d. Obtains emergency equipment e. Monitors child based on provider orders

ANS: A, C, D The nurse providing chemotherapy has many responsibilities including calculating the child's body-surface area, double checking orders against protocols, and having emergency equipment available. A CBC should be obtained within 48 hours of administering chemotherapy. The nurse should monitor the child based on the child's condition and not just follow the orders left by the provider.

Which should a nurse identify as common chronic illnesses of childhood? (Select all that apply.) a. Reactive airway disease (asthma) b. Respiratory syncytial virus (RSV) c. Cerebral palsy d. Diabetes mellitus e. Human immunodeficiency virus infection (HIV)

ANS: A, C, D, E A chronic illness is defined as a condition that is long term, does not spontaneously resolve, is usually without a complete cure, and affects activities of daily living. Reactive airway disease (asthma), cerebral palsy, diabetes mellitus, and HIV are all chronic illnesses that may occur during childhood. RSV is a virus that is highly contagious and causes bronchiolitis and pneumonia in children. It does not cause chronic illness.

The student nurse learns that maternal risks of systemic lupus erythematosus include (Select all that apply.) a. Premature rupture of membranes (PROM) b. Fetal death resulting in stillbirth c. Hypertension d. Preeclampsia e. Renal complications

ANS: A, C, D, E PROM, hypertension, preeclampsia, and renal complications are all maternal risks associated with SLE. Stillbirth and prematurity are fetal risks of SLE.

What should the nurse recognize as symptoms of a brain tumor in a school-age child? (Select all that apply.) a. Blurred vision b. Increased head circumference c. Vomiting when getting out of bed d. Intermittent headache e. Declining academic performance

ANS: A, C, D, E Visual changes such as nystagmus, diplopia, and strabismus are manifestations of a brain tumor. The change in position on awakening causes an increase in intracranial pressure, which is manifested as vomiting. Vomiting on awakening is considered a hallmark symptom of a brain tumor. Increased intracranial pressure resulting from a brain tumor is manifested as a headache. School-age children may exhibit declining academic performance, fatigue, personality changes, and symptoms of vague, intermittent headache. Other symptoms may include seizures or focal neurologic deficits. Manifestations of brain tumors vary with tumor location and the child's age and development. Infants with brain tumors may have increased head circumference with a bulging fontanel. School -age children have closed fontanels, and therefore their head circumferences do not increase with brain tumors.

Which interventions should a nurse implement when caring for a child with hepatitis? (Select all that apply.) a. Provide a well-balanced low-fat diet. b. Schedule playtime in the playroom with other children. c. Teach parents not to administer any over-the-counter medications. d. Arrange for home schooling because the child will not be able to return to school. e. Instruct parents on the importance of good handwashing.

ANS: A, C, E The child with hepatitis should be placed on a well-balanced low-fat diet. Parents should be taught to not give over-the-counter medications because of impaired liver function. Hand hygiene is the most important preventive measure for the spread of hepatitis. The child will be in contact isolation in the hospital so playtime with other hospitalized children is not scheduled. The child will be on contact isolation for a minimum of 1 week after the onset of jaundice. After that period, the child will be allowed to return to school.

Where do the lesions of atopic dermatitis most commonly occur in the infant? (Select all that apply.) a. Cheeks b. Buttocks c. Extensor surfaces of arms and legs d. Back e. Scalp

ANS: A, C, E The lesions of atopic dermatitis are generalized in the infant. They are most commonly on the cheeks, scalp, and extensor surfaces of the extremities. These lesions are not typically on the back or the buttocks.

A nurse is assessing an infant for urinary tract infection (UTI). Which assessment findings should the nurse expect? (Select all that apply.) a. Change in urine odor or color b. Enuresis c. Fever or hypothermia d. Voiding urgency e. Poor weight gain

ANS: A, C, E The signs of a UTI in an infant include fever or hypothermia, irritability, dysuria as evidenced by crying when voiding, change in urine odor or color, poor weight gain, and feeding difficulties. Enuresis and voiding urgency should be assessed in an older child.

The nurse should provide which information to parents about preventing parasitic infections? (Select all that apply.) a. Perform good handwashing. b. Diaper a child when swimming. c. Avoid cleaning the bathroom facilities with bleach. d. Shoes should be worn outside. e. Fruits and vegetables should be washed before eating.

ANS: A, D, E Children are more commonly infected with parasites than adults, primarily as a result of frequent hand-to- mouth activity and the likelihood of fecal contamination. Good handwashing can prevent the transmission. Shoes should be worn when outside to prevent transmission, and fruits and vegetables should be washed before eating. The child should not swim in a pool that allows diapered children. The bathroom facilities should be cleaned with bleach to decrease the chance of transmission.

A nurse should plan to implement which interventions for a child admitted with inorganic failure to thrive? (Select all that apply.) a. Observation of parent-child interactions b. Assignment of different nurses to care for the child from day to day c. Use of 28-calorie-per-ounce concentrated formulas d. Administration of daily multivitamin supplements e. Role-modeling appropriate adult-child interactions

ANS: A, D, E The nurse should plan to assess parent-child interactions when a child is admitted for nonorganic failure to thrive. The observations should include how the child is held and fed, how eye contact is initiated and maintained, and the facial expressions of both the child and the caregiver during interactions. Role-modeling and teaching appropriate adult-child interactions (including holding, touching, and feeding the child) will facilitate appropriate parent-child relationships, enhance parents' confidence in caring for their child, and facilitate expression by the parents of realistic expectations based on the child's developmental needs. Daily multivitamin supplements with minerals are often prescribed to ensure that specific nutritional deficiencies do not occur in the course of rapid growth. The nursing staff assigned to care for the child should be consistent. Providing a consistent caregiver from the nursing staff increases trust and provides the child with an adult who anticipates his or her needs and who is able to role-model child care to the parent. Caloric enrichment of food is essential, and formula may be concentrated in titrated amounts up to 24 calories per ounce. Greater concentrations can lead to diarrhea and dehydration.

The nurse is caring for a child with iron-deficiency anemia. What should the nurse expect to find when reviewing the results of the complete blood count (CBC)? (Select all that apply.) a. Low hemoglobin levels b. Elevated red blood cell (RBC) levels c. Elevated mean cell volume (MCV) levels d. Low reticulocyte count e. Decreased MCV levels

ANS: A, D, E The results of the complete blood count in a child with iron-deficiency anemia will show low hemoglobin levels (6 to 11 g/dL) and microcytic, hypochromic RBCs; this manifests as decreased MCV and decreased mean cell hemoglobin. The reticulocyte count is usually slightly elevated or normal, and MCV levels are decreased, not increased.

A child has a brain tumor. What assessment finding leads the nurse to request a physical therapy consultation? a. Dizziness b. Ataxia c. Slurred speech d. Visual changes

ANS: B A child with ataxia would benefit from a physical therapy consultation to help regain coordination. Physical therapy would not help with dizziness, slurred speech, or visual changes.

A woman is in the emergency department with severe abdominal pain. When her pregnancy test comes back positive, she yells "I can't be pregnant! I had a tubal ligation two months ago!" What action by the nurse is the priority? a. Provide emotional support to the woman. b. Facilitate an ultrasound examination. c. Call the lab to have them repeat the test. d. Administer an opioid pain medication.

ANS: B A failed tubal ligation is a risk factor for ectopic pregnancy. After a blood pregnancy test, a transvaginal ultrasound is needed to look for a gestational sac within the uterus. Of course the nurse provides emotional support, but that is not the priority. There is no need to repeat the test. Pain medications may be contraindicated if surgery is needed and consents have not yet been signed.

A woman has a history of drug use and is screened for hepatitis B during the first trimester. What is an appropriate action? a. Provide a low-protein diet. b. Offer the vaccine. c. Discuss the recommendation to bottle-feed her baby. d. Practice respiratory isolation.

ANS: B A person who has a history of high-risk behaviors should be offered the hepatitis B vaccine. A low-protein diet will not prevent the infection. The first trimester is too early to discuss feeding methods. Respiratory isolation is not needed for this blood- and body fluid-borne disease.

Which statement best describes a subdural hematoma? a. Bleeding occurs between the dura and the skull. b. Bleeding occurs between the dura and the cerebrum. c. Bleeding is generally arterial, and brain compression occurs rapidly. d. The hematoma commonly occurs in the parietotemporal region.

ANS: B A subdural hematoma is bleeding that occurs between the dura and the cerebrum as a result of a rupture of cortical veins that bridge the subdural space. An epidural hemorrhage occurs between the dura and the skull, is usually arterial with rapid brain concussion, and occurs most often in the parietotemporal region. An epidural hemorrhage occurs between the dura and the skull, is usually arterial with rapid brain concussion, and occurs most often in the parietotemporal region. An epidural hemorrhage occurs between the dura and the skull, is usually arterial with rapid brain concussion, and occurs most often in the parietotemporal region.

The nurse understands that postpartum care of the woman with cardiac disease a. is the same as that for any pregnant woman. b. includes rest and monitoring of the effect of activity. c. includes ambulating frequently, alternating with active range of motion. d. includes limiting visits with the infant to once per day.

ANS: B After delivery, the woman with cardiac disease should rest, and the nurse monitors her for the effect activity has on her cardiovascular status. Care of the woman with cardiac disease in the postpartum period is tailored to the woman's functional capacity. Although the woman may need help caring for the infant, breastfeeding and infant visits are not contraindicated.

A woman who is 8 months pregnant is brought to the emergency department after a serious motor vehicle crash. Although she has no apparent injuries, she is admitted to the hospital. Her partner is upset and wants to know why she just can't come home. What response by the nurse is best? a. "This is standard procedure for all pregnant crash victims." b. "She needs to be monitored for some potential complications." c. "We may have to deliver the baby at any time now." d. "We are giving her medicine to keep her from laboring."

ANS: B After serious trauma, a woman may be admitted and observed because an abruptio placentae may take up to 24 hours to become apparent. Not all motor vehicle crash patients will need to be admitted. The baby may or may not need to be delivered at any time, but this statement will frighten the partner. There is no indication the patient is in labor.

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 response? a. Denial b. Anger c. Social reintegration d. Acceptance of child's limitations

ANS: B After the initial shock has worn off, families often respond to a chronic illness diagnosis with anger. Social reintegration and acceptance may or may not ever occur but if they do it is the culmination of the grief process.

A woman with severe preeclampsia is being treated with bed rest and intravenous magnesium sulfate. The drug classification of this medication is a. tocolytic. b. anticonvulsant. c. antihypertensive. d. diuretic.

ANS: B Anticonvulsant drugs act by blocking neuromuscular transmission and depress the central nervous system to control seizure activity. A tocolytic drug does slow the frequency and intensity of uterine contractions, but it is not used for that purpose in this scenario. Decreased peripheral blood pressure is a therapeutic response (side effect) of the anticonvulsant magnesium sulfate. Diuresis is a therapeutic response to magnesium sulfate.

What should be the nurse's first action when a child with a head injury complains of double vision and a headache, and then vomits? a. Immobilize the child's neck. b. Report this information to the physician. c. Darken the room and put a cool cloth on the child's forehead. d. Restrict the child's oral fluid intake.

ANS: B Any indication of ICP such as double vision, headache, or vomiting should be promptly reported to the physician. Stabilizing the child's neck does not address the child's symptoms. Darkening the room and giving a cool cloth are comfort measures. A fluid restriction is not needed.

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

ANS: 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.

Parents of a child with lice infestation should be instructed carefully in the use of antilice products because of which potential side effect? a. Nephrotoxicity b. Neurotoxicity c. Ototoxicity d. Bone marrow depression

ANS: B Because of the danger of absorption through the skin and potential for neurotoxicity, antilice treatment must be used with caution. A child with many open lesions can absorb enough to cause seizures. Antilice products are not known to be nephrotoxic or ototoxic and do not cause bone marrow depression.

The perinatal nurse is giving discharge instructions to a woman, status post suction and curettage secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the next 12 months. The best response from the nurse is a. "If you get pregnant within 1 year, the chance of a successful pregnancy is very small. Therefore, if you desire a future pregnancy, it would be better for you to use the most reliable method of contraception available." b. "The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produces during pregnancy. If you were to get pregnant, it would make the diagnosis of this cancer more difficult." c. "If you can avoid a pregnancy for the next year, the chance of developing a second molar pregnancy is rare. Therefore, to improve your chance of a successful pregnancy, it is better not to get pregnant at this time." d. "Oral contraceptives are the only form of birth control that will prevent a recurrence of a molar pregnancy."

ANS: B Beta-hCG levels will be drawn for 1 year to ensure that the mole is completely gone. There is an increased chance of developing choriocarcinoma after the development of a hydatidiform mole. The goal is to achieve a "zero" hCG level. If the woman were to become pregnant, it may obscure the presence of the potentially carcinogenic cells. Any contraceptive method except an IUD is acceptable.

Which statement by a school-age girl indicates the need for further teaching about the prevention of urinary tract infections (UTIs)? a. "I always wear cotton underwear." b. "I really enjoy taking a bubble bath." c. "I go to the bathroom every 3 to 4 hours." d. "I drink four to six glasses of fluid every day."

ANS: B Bubble baths should be avoided because they tend to cause urethral irritation, which leads to UTI. It is desirable to wear cotton rather than nylon underwear. Nylon tends to hold in moisture and promote bacterial growth, whereas cotton absorbs moisture. Children should be encouraged to urinate at least four times a day. An adequate fluid intake prevents the buildup of bacteria in the bladder.

What information about caffeine in pregnancy does the nurse provide the prenatal class with? a. It stays in your body twice as long as when you are not pregnant. b. It causes vasoconstriction, which could keep the fetus from growing. c. Caffeine depresses your heart's ability to pump and function. d. Severe diuresis can leave you at risk for dehydration during pregnancy.

ANS: B Caffeine is a vasoconstrictor. Its half-life is 3 times as long in the pregnant woman. It stimulates cardiac function. It does cause mild but not severe diuresis.

The nurse understands that the types of precautions needed for children receiving chemotherapy are based on which action of chemotherapeutic agents? a. Gastrointestinal upset b. Bone marrow suppression c. Decreased creatinine level d. Alopecia

ANS: B Chemotherapy agents cause bone marrow suppression, which creates the need to institute precautions related to reduced white blood cell, red blood cell, and platelet counts. These precautions focus on preventing infection and bleeding. Although gastrointestinal upset may be an adverse effect of chemotherapy, it is not caused by all chemotherapeutic agents. No special precautions are instituted for gastrointestinal upset. A decreased creatinine level is consistent with renal pathologic conditions, not chemotherapy. Not all chemotherapeutic agents cause alopecia. No precautions are taken to prevent alopecia.

You are the nurse caring for a 4-year-old child who has developed acute renal failure as a result of hemolytic-uremic syndrome (HUS). Which bacterial infection was most likely the cause of HUS? a. Pseudomonas aeruginosa b. Escherichia coli c. Streptococcus pneumoniae d. Staphylococcus aureus

ANS: B Children with HUS become infected by Escherichia coli, which is usually contracted from eating improperly cooked meat or contaminated dairy products. Pseudomonas aeruginosa, Streptococcus pneumoniae, and Staphylococcus aureus are not associated with HUS.

A child with autism is hospitalized with asthma. The nurse should plan care so that the a. parents' expectations are met. b. child's routine habits and preferences are maintained. c. child is supported through the autistic crisis. d. parents need not be at the hospital.

ANS: B Children with autism are often unable to tolerate even slight changes in routine. The child's routine habits and preferences are important to maintain. Focus of care is on the child's needs rather than on the parent's desires. Autism is a life -long condition. The presence of the parents is almost always required when an autistic child is hospitalized.

How can chronic illness and frequent hospitalizations affect the psychosocial development of a toddler? a. They can create a distortion or differentiation of self from parent. b. They can interfere with the development of autonomy. c. They can interfere with the acquisition of language, fine motor, and self-care skills. d. They can create feelings of inadequacy.

ANS: B Chronic illness may interfere in the development of autonomy, which is the major psychosocial task of the toddler. The infant with a chronic illness may have distortion of differentiation of self from parents. Chronic illness with frequent hospitalizations can inhibit the acquisition of language, motor, and self-care skills in the preschool-age child. Feelings of inadequacy and inferiority can occur if independence is compromised by chronic illness in the school-age child.

Which laboratory marker is indicative of disseminated intravascular coagulation (DIC)? a. Positive KB test b. Presence of fibrin split products c. Thrombocytopenia d. Positive drug screen

ANS: B Degradation of fibrin leads to the accumulation of multiple fibrin clots throughout the body's vasculature. The other lab tests are not indicative of DIC.

An infant with short bowel syndrome will be discharged home on total parenteral nutrition (TPN) and gastrostomy feedings. Nursing care should include a. preparing family for impending death. b. teaching family signs of central venous catheter infection. c. teaching family how to calculate caloric needs. d. securing TPN and gastrostomy tubing under the diaper to lessen risk of dislodgment.

ANS: B During TPN therapy, care must be taken to minimize the risk of complications related to the central venous access device, such as catheter infections, occlusions, or accidental removal. This is an important part of family teaching. The prognosis for patients with short bowel syndrome depends in part on the length of residual small intestine. It has improved with advances in TPN. Although parents need to be taught about nutritional needs, the caloric needs and prescribed TPN and rate are the responsibility of the health care team. The tubes should not be placed under the diaper due to risk of infection.

During which phase of the cycle of violence does the batterer become contrite and remorseful? a. Battering phase b. Honeymoon phase c. Tension-building phase d. Increased drug-taking phase

ANS: B During the honeymoon phase, the battered person wants to believe that the battering will never happen again, and the batterer will promise anything to get back into the home. During the battering phase violence actually occurs, and the victim feels powerless. During the tension-building phase, the batterer becomes increasingly hostile, swears, threatens, throws things, and pushes the battered. Often the batterer increases the use of drugs during the tension-building phase; however, this is not an actual phase of the cycle.

A parent asks the nurse why a developmental assessment is being conducted for a child during a routine well-child visit. The nurse answers based on the knowledge that routine developmental assessments during well-child visits are a. not necessary unless the parents request them. b. the best method for early detection of cognitive disorders. c. frightening to parents and children and should be avoided. d. valuable in measuring intelligence in children.

ANS: B Early detection of cognitive disorders can be facilitated through assessment of development at each well-child examination. Developmental assessment is a component of all well-child examinations. Developmental assessments are not as frightening when the parent and child are educated about the purpose of the assessment. Developmental assessments are not intended to measure intelligence.

What is an appropriate nursing action before surgery when caring for a child diagnosed with a Wilms' tumor? a. Limit fluid intake. b. Do not palpate the abdomen. c. Force oral fluids. d. Palpate the abdomen every 4 hours.

ANS: B Excessive manipulation of the tumor area can cause seeding of the tumor and spread of the malignant cells. Fluids are not routinely limited in a child with a Wilms' tumor. However, intake and output are important because of the kidney involvement. Fluids are not forced on a child with a Wilms' tumor. Normal intake for age is usually maintained. The abdomen of a child with a Wilms' tumor should never be palpated because of the danger of seeding the tumor and spreading malignant cells.

The nurse is preparing a school-age child for computed tomography (CT scan) to assess cerebral function. Which statement should the nurse include when preparing the child? a. "Pain medication will be given." b. "The scan will not hurt." c. "You will be able to move once the equipment is in place." d. "Unfortunately no one can remain in the room with you during the test."

ANS: B For CT scans, the child must be immobilized. It is important to emphasize to the child that at no time is the procedure painful. Pain medication is not required; however, sedation is sometimes necessary. The child will not be allowed to move and will be immobilized. Someone is able to remain with the child during the procedure.

What is an appropriate intervention for a child with nephrotic syndrome who is edematous? a. Teach the child to minimize body movements. b. Change the child's position every 2 hours. c. Avoid the use of skin lotions. d. Bathe every other day.

ANS: B Frequent position changes decrease pressure on body parts and help relieve edema in dependent areas. The child with edema is at risk for impaired skin integrity. It is important for the child to change position frequently to prevent skin breakdown. Good skin hygiene consists of daily baths to remove irritating body secretions and applying lotion.

A patient with pregnancy-induced hypertension is admitted complaining of pounding headache, visual changes, and epigastric pain. Nursing care is based on the knowledge that these signs indicate a. Anxiety due to hospitalization b. Worsening disease and impending seizure c. Effects of magnesium sulfate d. Gastrointestinal upset

ANS: B Headache and visual disturbances are due to increased cerebral edema. Epigastric pain indicates distention of the hepatic capsules and often warns that a seizure is imminent. These sign are not due to anxiety or magnesium sulfate or related to gastrointestinal upset.

What are the nursing priorities for a child with sickle cell disease in vaso-occlusive crisis? a. Administration of antibiotics and nebulizer treatments b. Hydration and pain management c. Blood transfusions and an increased calorie diet d. School work and diversion

ANS: B Hydration and pain management decrease the cells' oxygen demands and prevent sickling. Antibiotics may be given prophylactically. Oxygen therapy rather than nebulizer treatments is used to prevent further sickling. Although blood transfusions and increased calories may be indicated, they are not primary considerations for vaso-occlusive crisis. School work and diversion are not major considerations when the child is in a vaso-occlusive crisis.

An infant is born with bladder exstrophy. What action by the nurse is the priority? a. Obtain surgical consent for the corrective operation. b. Cover the exposed bladder with non-adherent plastic wrap. c. Insert an indwelling catheter to collect all the urine. d. Obtain consent for genetic testing on parents and infant.

ANS: B In bladder exstrophy, the bladder is outside the body and must be covered with a non- adherent plastic wrap until surgical correction. This is the priority action. Consent will be obtained prior to surgery. A catheter is not needed. Genetic testing is not necessarily done.

Which maternal condition always necessitates delivery by cesarean section? a. Partial abruptio placentae b. Total placenta previa c. Ectopic pregnancy d. Eclampsia

ANS: B In total placenta previa, the placenta completely covers the cervical os. The fetus would die if a vaginal delivery occurred. In a partial abruptio placentae, if the mother has stable vital signs and the fetus is alive, a vaginal delivery can be attempted. If the fetus has died, a vaginal delivery is preferred. The most common ectopic pregnancy is a tubal pregnancy, which is usually detected and treated in the first trimester. Labor can be safely induced if the eclampsia is under control.

What data on a patient's health history places her at risk for an ectopic pregnancy? a. Use of oral contraceptives for 5 years b. Recurrent pelvic infections c. Ovarian cyst 2 years ago d. Heavy menstrual flow of 4 days' duration

ANS: B Infection and subsequent scarring of the fallopian tubes prevents normal movement of the fertilized ovum into the uterus for implantation. Oral contraceptives, ovarian cysts, and heavy menstrual flows do not increase risk.

The nurse caring for a woman hospitalized for hyperemesis gravidarum should expect that initial treatment involves a. corticosteroids to reduce inflammation. b. IV therapy to correct fluid and electrolyte imbalances. c. an antiemetic, such as pyridoxine, to control nausea and vomiting. d. enteral nutrition to correct nutritional deficits.

ANS: B Initially, the woman who is unable to down clear liquids by mouth requires IV therapy for correction of fluid and electrolyte imbalances. Corticosteroids are not the expected treatment for this disorder. Pyridoxine is vitamin B6, not an antiemetic. Promethazine, a common antiemetic, may be prescribed. In severe cases of hyperemesis gravidarum, enteral nutrition via a feeding tube may be necessary to correct maternal nutritional deprivation. This is not an initial treatment for this patient.

A child with non-Hodgkin lymphoma will be starting chemotherapy. What intervention is initiated before chemotherapy to prevent tumor lysis syndrome? a. Insertion of a central venous catheter b. Intravenous (IV) hydration containing sodium bicarbonate c. Placement of an externalized ventriculoperitoneal (VP) shunt d. Administration of pneumococcal and Haemophilus influenzae type B vaccines

ANS: B Intensive hydration with an IV fluid containing bicarbonate alkalinizes the urine to help prevent the formation of uric acid crystals, which damage the kidney. A central venous catheter is placed to assist in delivering chemotherapy. An externalized VP shunt may be placed to relieve intracranial pressure caused by a brain tumor. If a splenectomy is necessary for a child with Hodgkin disease, the pneumococcal and Haemophilus influenzae vaccines are administered before the surgery.

How much folic acid does the nurse tell female patients is recommended for women of childbearing age? a. 1.0 mg b. 0.4 mg c. 1.5 mg d. 2.0 mg

ANS: B It has been estimated that a daily intake of 0.4 mg of folic acid in women of childbearing age has contributed to a reduction in the number of children with neural tube defects. The other doses are not the recommended dose.

A nurse is assessing lab results on four patients in the general pediatric unit. What child should the nurse go see first? a. Urine specific gravity: 1.025 b. Urine ketones: positive in large amounts c. Serum BUN 21 mg/dL d. Serum creatinine 0.7 mg/dL

ANS: B Ketones should not be present in the urine. When found, they are indicative of starvation, diabetic ketoacidosis, fever, prolonged vomiting, anorexia, and severe diarrhea. The nurse should see this child first. The other lab values are normal.

What is a priority nursing diagnosis for the 4-year-old child newly diagnosed with leukemia? a. Ineffective Breathing Pattern related to mediastinal disease b. Risk for Infection related to immunosuppressed state c. Disturbed Body Image related to alopecia d. Impaired Skin Integrity related to radiation therapy

ANS: B Leukemia is characterized by the proliferation of immature white blood cells, which lack the ability to fight infection. Ineffective Breathing Pattern applies to a child with non-Hodgkin lymphoma or any cancer involving the chest area. Disturbed Body Image relates to children taking chemotherapy or radiation therapy and does not occur for all children. It would not be the highest priority even if the child had the diagnosis. Radiation therapy is not a treatment for leukemia.

While completing an assessment on a 6-month-old infant, which finding should the nurse recognize as a symptom of a brain tumor? a. Blurred vision b. Increased head circumference c. Vomiting when getting out of bed d. Headache

ANS: B Manifestations of brain tumors vary with tumor location and the child's age and development. Infants with brain tumors may be irritable or lethargic, feed poorly, and have increased head circumference with a bulging fontanel. Visual changes such as nystagmus, diplopia, and strabismus are manifestations of a brain tumor but would not be able to be verbalized by an infant. The change in position on awakening causes an increase in intra- cranial pressure, which is manifested as vomiting. Vomiting on awakening is considered a hallmark symptom of a brain tumor, but infants do not get themselves out of bed in the morning. Increased intracranial pressure resulting from a brain tumor is manifested as a headache but could not be verbalized by an infant.

An abortion in which the fetus dies but is retained in the uterus is called ________ abortion. a. inevitable b. missed c. incomplete d. threatened

ANS: B Missed abortion refers to a dead fetus being retained in the uterus. An inevitable abortion means that the cervix is dilating with the contractions. An incomplete abortion means that not all of the products of conception were expelled. With a threatened abortion the woman has cramping and bleeding but not cervical dilation.

A child with a head injury sleeps unless aroused, and when aroused responds briefly before falling back to sleep. What should the nurse chart for this child's level of consciousness? a. Disoriented b. Obtunded c. Lethargic d. Stuporous

ANS: B Obtunded describes an individual who sleeps unless aroused and once aroused has limited interaction with the environment. Disoriented refers to lack of ability to recognize place or person. An individual is lethargic when he or she awakens easily but exhibits limited responsiveness. Stupor refers to requiring considerable stimulation to arouse the individual.

What is an expected physical assessment finding for an adolescent with a diagnosis of Hodgkin disease? a. Protuberant, firm abdomen b. Enlarged, painless, firm cervical lymph nodes c. Soft tissue swelling d. Soft to hard, nontender mass in pelvic area

ANS: B Painless, firm, movable adenopathy (enlarged lymph nodes) palpated in the cervical region is an expected assessment finding in Hodgkin disease. Other systemic symptoms include unexplained fevers, weight loss, and night sweats. A protuberant, firm abdomen is present in many cases of neuroblastoma. Soft tissue swelling around the affected bone is a manifestation of Ewing sarcoma. A soft to hard, nontender mass can be palpated when rhabdomyosarcoma is present.

The nurse comes into the room of a child who was just diagnosed with a chronic disability. The child's parents begin to yell at the nurse about a variety of concerns. The nurse's best response is a. "What is really wrong?" b. "Being angry is only natural." c. "Yelling at me will not change things." d. "I will come back when you settle down."

ANS: B Parental anger after the diagnosis of a child with a chronic disability is a common response. One of the most common targets for parental anger is members of the staff. The nurse should recognize the common response of anger to the diagnosis and allow the family to ventilate. The other responses do not validate the parents' feelings and concerns and may hamper a therapeutic nurse-family relationship.

The narrowing of preputial opening of foreskin is called a. chordee. b. phimosis. c. epispadias. d. hypospadias.

ANS: B Phimosis is the narrowing or stenosis of the preputial opening of the foreskin. Chordee is the ventral curvature of the penis. Epispadias is the meatal opening on the dorsal surface of the penis. Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis.

What is the most appropriate nursing action when a child is in the tonic phase of a generalized tonic-clonic seizure? a. Guide the child to the floor if standing and go for help. b. Turn the child's body on the side. c. Place a padded tongue blade between the teeth. d. Quickly slip soft restraints on the child's wrists.

ANS: B Positioning the child on his side will prevent aspiration. It is inappropriate to leave the child during the seizure. Nothing should be inserted into the child's mouth during a seizure to prevent injury to the mouth, gums, or teeth. Restraints could cause injury. Sharp objects and furniture should be moved out of the way to prevent injury.

Anticipatory guidance for the family of a preadolescent with a cognitive dysfunction should include information about a. institutional placement. b. sexual development. c. sterilization. d. appropriate clothing.

ANS: B Preadolescents who have a cognitive dysfunction may have normal sexual development without the emotional and cognitive abilities to deal with it. It is important to assist the family and child through this developmental stage. The child may or may not need institutional placement at some point. Sterilization is not an appropriate intervention when a child has a cognitive dysfunction. By the time a child reaches preadolescence, the family should have received counseling on age-appropriate clothing.

Preconception counseling is critical to the outcome of diabetic pregnancies because poor glycemic control before and during early pregnancy is associated with a. frequent episodes of maternal hypoglycemia. b. congenital anomalies in the fetus. c. polyhydramnios. d. hyperemesis gravidarum.

ANS: B Preconception counseling is particularly important because strict metabolic control before conception and in the early weeks of gestation is instrumental in decreasing the risks of congenital anomalies. Frequent episodes of maternal hypoglycemia may occur during the first trimester (not before conception) as a result of hormone changes and the effects on insulin production and usage. Hydramnios occurs about 10 times more often in diabetic pregnancies than in nondiabetic pregnancies. Typically, it is seen in the third trimester of pregnancy. Hyperemesis gravidarum may exacerbate hypoglycemic events as the decreased food intake by the mother and glucose transfer to the fetus contribute to hypoglycemia.

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

ANS: B Preschoolers are most likely to be affected by feelings of guilt that they caused the illness/disability or are being punished for wrongdoings.

What is the nurse's best response to parents with questions about how her child's blood disorder will be treated? a. "Your child may be able to receive home care." b. "What did the provider tell you?" c. "Blood diseases are transient, so there is no need to worry." d. "Your child will be tired for a while and then be back to normal."

ANS: B Providing the parents an opportunity to express what they were told by the physician allows the nurse to assess the parents' understanding and provide further information. Treatment depends on the child's condition and the type of blood disorder. Although it is possible that the child could be treated in the home, the child may need to be treated as an outpatient or in the hospital. It is best to first assess what the parents have been told by the physician. Minimizing the parents' concern is inappropriate. The nurse needs to assess the parents' knowledge before teaching about the disease.

Which statement is descriptive of renal transplantation in children? a. It is an acceptable means of treatment after age 10 years. b. It is preferred means of renal replacement therapy in children. c. Children can receive kidneys only from other children. d. The decision is difficult, since a normal lifestyle is not possible.

ANS: B Renal transplant offers the opportunity for a relatively normal life and is the preferred means of renal replacement therapy in end-stage renal disease. It can be done in children as young as age 6 months. Both children and adults can serve as donors for renal transplant purposes. Renal transplantation affords the child a more normal lifestyle than dependence on dialysis.

Rocky Mountain spotted fever is caused by the bite of a a. flea. b. tick. c. mosquito. d. mouse or rat.

ANS: B Rocky Mountain spotted fever is caused by a tick. The tick must attach and feed for at least 1 to 2 hours to transmit the disease. The usual habitat of the tick is in heavily wooded areas. The other organisms do not transmit Rocky Mountain spotted fever.

For which of the infectious diseases can a woman be immunized? a. Toxoplasmosis b. Rubella c. Cytomegalovirus d. Herpesvirus type 2

ANS: B Rubella is the only infectious disease listed for which a vaccine is available.

A condition in which the normal adult hemoglobin is partly or completely replaced by abnormal hemoglobin is known as a. aplastic anemia. b. sickle cell anemia. c. thalassemia major. d. iron-deficiency anemia.

ANS: B Sickle cell anemia is one of a group of diseases collectively called hemoglobinopathies, in which normal adult hemoglobin is replaced by an abnormal hemoglobin. Aplastic anemia is a lack of cellular elements being produced. Hemophilia refers to a group of bleeding disorders in which there is deficiency of one of the factors necessary for coagulation. Iron-deficiency anemia affects size and depth of color and does not involve an abnormal hemoglobin.

What finding should cause the nurse to suspect a diagnosis of spastic cerebral palsy? a. Tremulous movements at rest and with activity b. Sudden jerking movement caused by stimuli c. Writhing, uncontrolled, involuntary movements d. Clumsy, uncoordinated movements

ANS: B Spastic cerebral palsy, the most common type of cerebral palsy, will manifest with hypertonicity and increased deep tendon reflexes. The child's muscles are very tight, and any stimuli may cause a sudden jerking movement. Tremulous movements, slow writhing movements, and loss of kinesthetic sense are not manifestations of spastic cerebral palsy.

What is the priority nursing intervention for the child with ascending paralysis as a result of Guillain-Barré syndrome (GBS)? a. Immunosuppressive medications b. Respiratory assessment c. Passive range-of-motion exercises d. Anticoagulant therapy

ANS: B Special attention to respiratory status is needed because most deaths from GBS are attributed to respiratory failure. Respiratory support is necessary if the respiratory system becomes compromised and muscles weaken and become flaccid. Children with rapidly progressing paralysis are treated with intravenous immunoglobulins for several days. Administering this infusion is not the nursing priority. The child with GBS is at risk for complications of immobility. Performing passive range-of-motion exercises is an appropriate nursing intervention but not the priority intervention. Anticoagulant therapy may be initiated because the risk of pulmonary embolus as a result of deep vein thrombosis is always a threat. This is not the priority nursing intervention.

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

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

The Glasgow Coma Scale consists of an assessment of a. pupil reactivity and motor response. b. eye opening and verbal and motor responses. c. level of consciousness and verbal response. d. ICP and level of consciousness.

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

Appropriate interventions to facilitate socialization of the cognitively impaired child include a. providing age-appropriate toys and play activities. b. providing peer experiences, such as scouting, when older. c. avoiding exposure to strangers who may not understand cognitive development. d. emphasizing mastery of physical skills because they are the most delayed.

ANS: B The acquisition of social skills is a complex task. Children of all ages need peer relationships. Parents should enroll the child in preschool. When older, they should have peer experiences similar to other children such as group outings, Boy and Girl Scouts, and Special Olympics. Providing age-appropriate toys and play activities is important. However, peer interactions will better facilitate social development. Parents should expose the child to strangers so that the child can practice social skills. Verbal skills are delayed more than physical skills.

A woman who is 6 months pregnant has sought medical attention saying she fell down the stairs. What scenario would cause an emergency department nurse to suspect that the woman has been battered? a. The woman and her partner are having an argument that is loud and hostile. b. The woman has injuries on various parts of her body in different stages of healing. c. Examination reveals a fractured arm and fresh bruises. Her husband asks her about her pain. d. She loudly complains about having several injuries.

ANS: B The battered woman often has multiple injuries in various stages of healing. Arguing may or may not be sign of battering; many times the batterer will be attentive and refuse to leave the woman's side. A battered woman often has a flat affect or avoids eye contact and is vague about how the injuries occurred.

Which finding indicates that a child receiving prednisone for primary nephrotic syndrome is in remission? a. Urine is negative for casts for 5 days. b. Urine has <1+ protein for 3 to 7 consecutive days. c. Urine is positive for glucose for 1 week. d. Urine is up to a trace for blood for 1 week.

ANS: B The child receiving steroids for the treatment of primary nephrotic syndrome is considered in remission when the urine has <1+ protein for 3 to 7 consecutive days. The absence of casts, presence of glucose, and presence of hematuria do not constitute remission.

Which nursing assessment is applicable to the care of a child with herpetic gingivostomatitis? a. Comparison of range of motion of the extremities b. Urine output, mucous membranes, and skin turgor c. Growth pattern since birth d. Bowel elimination pattern

ANS: B The child with herpetic gingivostomatitis is at risk for deficient fluid volume. Painful lesions on the mouth make drinking unpleasant and undesirable, with subsequent dehydration becoming a real danger. An oral herpetic infection does not affect joint function. Herpetic gingivostomatitis is not a chronic disorder that would affect the child's long-term growth pattern. Although constipation could be caused by dehydration, it is more important to assess urine output, skin turgor, and mucous membranes to identify dehydration before constipation is a problem.

Parents ask the nurse, "When should our child's hypospadias be corrected?" The nurse responds that correction of hypospadias should be accomplished by the time the child is a. 1 month of age. b. 6 to 12 months of age. c. school age. d. sexually mature.

ANS: B The correction of hypospadias should ideally be accomplished by the time the child is 6 to 12 months of age and before toilet training. One month of age is too young for this procedure. It is preferable for hypospadias to be surgically corrected before the child enters school so that the child has normal toileting behaviors in the presence of his peers. Corrective surgery for hypospadias is done long before sexual maturity.

At the time of a child's death, the nurse tells his mother, "We will miss him so much." The best interpretation of this is that the nurse is a. pretending to be experiencing grief. b. expressing personal feelings of loss. c. denying the mother's sense of loss. d. talking when listening would be better.

ANS: B The death of a patient is one of the most stressful experiences for a nurse. Nurses experience reactions similar to those of family members because of their involvement with the child and family during the illness. Nurses often have feelings of personal loss when a patient dies. The nurse is not pretending, denying the mother's sense of loss, or talking when listening would be better.

In order to minimize the negative effects of illness and hospitalization on an infant, the nurse focuses care on which of the following? a. Bodily injury and pain b. Separation from caregivers and fear of strangers c. Loss of control and altered body image d. The unknown and being left alone

ANS: B The major fear of infants during illness and hospitalization are separation from caregivers and fear of strangers. Bodily injury and pain are fears of preschool and school-age children. Loss of control is a fear of children from the preschool period through adolescence. Altered body image applies to adolescents. Fear of the unknown and being left alone are applicable to preschoolers.

A nurse is giving a parent information about autism. Which statement made by the parent indicates understanding of the teaching? a. Autism is characterized by periods of remission and exacerbation. b. The onset of autism usually occurs before 3 years of age. c. Children with autism have imitation and gesturing skills. d. Autism can be treated effectively with medication.

ANS: B The onset of autism usually occurs before 3 years of age. Autism does not have periods of remission and exacerbation. Autistic children lack imitative skills. Medications are of limited use in children with autism.

Which factor predisposes the urinary tract to infection? a. Increased fluid intake b. Short urethra in young girls c. Prostatic secretions in males d. Frequent emptying of the bladder

ANS: B The short urethra in females provides a ready pathway for invasions of organisms. Increased fluid intake offers protective measures against UTIs. Prostatic secretions have antibacterial properties that inhibit bacteria. Frequent emptying of the bladder also offers protection against UTIs.

Many parents who have children diagnosed with a chronic illness experience recurrent feelings of grief, loss, and fear related to the child's condition and loss of the ideal healthy child. The nurse recognizes this process as a. anticipatory grieving. b. chronic sorrow. c. bereavement. d. illness trajectory.

ANS: B The stated recurrent feelings define chronic sorrow, which is considered a normal process involving grief that may never be resolved. Anticipatory grieving is the process of mourning, coping, interacting, planning, and psychosocial reorganization that is begun as a response to the impending loss of a loved one. Bereavement is defined as the objective condition or state of loss. Illness trajectory is defined as the impact of the disease or condition on all family members, physiologic unfolding of the disease, and work organization done by the family to cope.

The depth of a burn injury may be classified as a. localized or systemic. b. superficial, superficial partial thickness, deep partial thickness, or full thickness. c. electrical, chemical, or thermal. d. minor, moderate, or major.

ANS: B The vocabulary to classify the depth of a burn is superficial, partial thickness, or full thickness. A partial-thickness burn can be either superficial or deep. The other terms do not relate to depth of burn.

A parent whose child has been diagnosed with a cognitive deficit should be counseled that intellectual impairment a. is usually due to a genetic defect. b. may be caused by a variety of factors. c. is rarely due to first trimester events. d. is usually caused by parental intellectual impairment.

ANS: B There are a multitude of causes for intellectual impairment. In most cases, a specific cause has not been identified. Only a small percentage of children with intellectual impairment are affected by a genetic defect. One third of children with intellectual impairment are affected by first trimester events. Intellectual impairment can be transmitted to a child only if the parent has a genetic disorder.

A newborn assessment shows separated sagittal suture, oblique palpebral fissures, depressed nasal bridge, protruding tongue, and transverse palmar creases. These findings are most suggestive of a. microcephaly. b. Down syndrome. c. cerebral palsy. d. fragile X syndrome.

ANS: B These are characteristics associated with Down syndrome. The infant with microcephaly has a small head. Cerebral palsy is a diagnosis not usually made at birth. No characteristic physical signs are present. The infant with fragile X syndrome has increased head circumference; long, wide, and/or protruding ears; long, narrow face with prominent jaw; hypotonia; and high arched palate.

Developmental delays, self-injury, fecal smearing, and severe temper tantrums in a preschool child are symptoms of a. Down syndrome. b. intellectual disability. c. psychosocial deprivation. d. separation anxiety.

ANS: B These are symptoms of intellectual disability. Down syndrome is often identified at birth by characteristic facial and head features, such as brachycephaly (disproportionate shortness of the head); flat profile; inner epicanthal folds; wide, flat nasal bridge; narrow, high-arched palate; protruding tongue; and small, short ears, which may be low set. Although intellectual impairment may be present, the symptoms listed are not the primary ones expected in the diagnosis of Down syndrome. Psychosocial deprivation may be a cause of mild intellectual disability. The symptoms listed are characteristic of severe intellectual disability. Symptoms of separation anxiety include protest, despair, and detachment.

The nurse teaches parents to alert their health care provider about which adverse effect when a child receives valproic acid (Depakene) to control generalized seizures? a. Weight loss b. Bruising c. Anorexia d. Drowsiness

ANS: B Thrombocytopenia is an adverse effect of valproic acid. Parents should be alert for any unusual bruising or bleeding. Weight gain, not loss, is a side effect of valproic acid. Drowsiness is not a side effect of valproic acid, although it is associated with other anticonvulsant medications. Anorexia is not a side effect of valproic acid.

What should the nurse teach an adolescent who is taking tretinoin (Retin-A) to treat acne? a. The medication should be taken with meals. b. Apply sunscreen before going outdoors. c. Wash with benzoyl peroxide before application. d. The effect of the medication should be evident within 1 week.

ANS: B Tretinoin causes photosensitivity, and sunscreen should be applied before sun exposure. Tretinoin is a topical medication. Application is not affected by meals. If applied together, benzoyl peroxide and tretinoin have reduced effectiveness and a potentially irritant effect. Optimal results from tretinoin are not achieved for 3 to 5 months.

In terms of the incidence and classification of diabetes, maternity nurses should know that a. type 1 diabetes is most common. b. type 2 diabetes often goes undiagnosed. c. there is only one type of gestational diabetes. d. type 1 diabetes may become type 2 during pregnancy.

ANS: B Type 2 often goes undiagnosed, because hyperglycemia develops gradually and often is not severe. Type 2, previously called adult onset diabetes, is the most common. There are 2 subgroups of gestational diabetes. Type GDM A1 is diet-controlled whereas type GDM A2 is controlled by insulin and diet. People do not go back and forth between type 1 and type 2 diabetes.

A child is admitted with acute glomerulonephritis. The nurse expects the urinalysis during this acute phase to show which of the following? a. Bacteriuria and hematuria b. Hematuria and proteinuria c. Bacteriuria and increased specific gravity d. Proteinuria and decreased specific gravity

ANS: B Urinalysis during the acute phase characteristically shows hematuria and proteinuria. Bacteriuria and changes is specific gravity would not be expected.

A woman has several relatives who had gestational hypertension and wants to decrease her risk for it. What information does the nurse provide this woman? (Select all that apply.) a. There is no way to reduce risk factors for gestational hypertension. b. Losing weight before you get pregnant will help prevent it. c. Eating a diet high in protein and iron may help prevent it. d. The father contributes no risk factors for hypertension in pregnancy e. Waiting until you are 35 to get pregnant cuts the risk in half.

ANS: B, C There are many risk factors for gestational hypertension, including obesity and anemia. The woman can take action to address these factors prior to becoming pregnant. The father's risks include the first baby and having fathered other preeclamptic pregnancies. Maternal age >35 increases the risk.

A nurse is planning care for a child admitted with nephrotic syndrome. Which interventions should be included in the plan of care? (Select all that apply.) a. Administration of antihypertensive medications b. Daily weights c. Salt-restricted diet d. Frequent position changes e. Teaching parents to expect tea-colored urine

ANS: B, C, D A child with nephrotic syndrome will need to be monitored closely for fluid excess so daily weights are important. The diet is salt restricted to prevent further retention of fluid. Because of the fluid excess, frequent position changes are required to prevent skin breakdown. Nephrotic syndrome does not require antihypertensive medications. These are administered for acute glomerulonephritis. Tea-colored urine is expected with acute glomerulonephritis but not nephrotic syndrome. The urine in nephrotic syndrome is frothy, indicating that protein is being lost in the urine.

The nurse has educated the parents of a child with celiac disease on diet modifications. Which food choices by the child's parents indicate understanding of teaching? (Select all that apply.) a. Oatmeal b. Steamed rice c. Corn on the cob d. Baked chicken e. Peanut butter and jelly sandwich on wheat bread

ANS: B, C, D Rice, corn, and chicken do not contain gluten and so are appropriate choices. Oatmeal and wheat bread are not.

What assessment findings indicate to the nurses that a woman's preeclampsia should now be considered severe? (Select all that apply.) a. Urine output 40 mL/hour for the past 2 hours b. Serum creatinine 3.1 mg/dL c. Seeing "sparkly" things in the visual field d. Crackles in both lungs e. Soft, non-tender abdomen

ANS: B, C, D Signs of severe preeclampsia include elevated creatinine, seeing sparkles, and pulmonary edema (manifested by crackles). The urine output is above the minimum requirements, and a soft non-tender abdomen is a reassuring sign.

The nurse is caring for a child with aplastic anemia. What nursing diagnoses are appropriate? (Select all that apply.) a. Acute Pain related to vaso-occlusion b. Risk for Infection related to inadequate secondary defenses or immunosuppression c. Ineffective Protection related to thrombocytopenia d. Ineffective Tissue Perfusion related to anemia e. Ineffective Protection related to abnormal clotting

ANS: B, C, D These are appropriate nursing diagnosis for the nurse planning care for a child with aplastic anemia. Aplastic anemia is a condition in which the bone marrow ceases production of the cells it normally manufactures, resulting in pancytopenia. The child will have varying degrees of the disease depending on how low the values are for absolute neutrophil count (affecting the body's response to infection), platelet count (putting the child at risk for bleeding), and absolute reticulocyte count (causing the child to have anemia). Acute pain related to vaso-occlusion is an appropriate nursing diagnosis for sickle cell anemia for the child in vaso-occlusive crisis, but it is not applicable to a child with aplastic anemia. Ineffective protection related to abnormal clotting is an appropriate diagnosis for von Willebrand disease.

The student nurse learns the stages of grief according to Kübler-Ross. What stages does this include? (Select all that apply.) a. Shock b. Denial c. Anger d. Bargaining e. Acceptance

ANS: B, C, D, E The stages of grief outlined by Kübler-Ross include denial, anger, bargaining, sadness or depression, and acceptance. Shock occurs during the denial stage.

A nurse is providing anticipatory guidance to parents of a child with an intellectual disability. Which safety information is correct based on the child's age? (Select all that apply.) a. Elementary age: safe use of grooming products b. High school age: safety while cooking c. Preschool age: keep hands inside car d. High school age: stranger danger e. Elementary age: water safety

ANS: B, C, E Many factors related to anticipatory guidance and safety will be similar for the cognitively impaired child as for the other children, based on the child's intellectual age. Teaching high school-age children about safety in the kitchen, preschool-age children to keep their hands inside the car, and elementary-age children water safety are appropriate areas to start with, tailored to intellectual age. Elementary-age children are too young for grooming product safety, and high school-age children are too old for stranger danger.

Approximately 82% of teen pregnancies are unintended. Seventy percent of teens have had sex by their 19th birthday. Factors that contribute to an increased risk for teen pregnancy include which of the following? (Select all that apply.) a. High self-esteem b. Peer pressure c. Limited access to contraception d. Planning sexual activity e. Lack of role models

ANS: B, C, E Peer pressure to begin sexual activity is a contributing factor toward teen pregnancy. Limited access to contraceptive devices and lack of accurate information about how to use these devices are also factors. Lack of appropriate role models, desire to alleviate or escape the present situation at home along with feelings of invincibility also contribute to teen pregnancy. Low self-esteem and the consequent inability to set limits on sexual activity place the adolescent at risk for teen pregnancy. Ambivalence toward sexuality and not planning intercourse are more likely to result in teen pregnancy.

The nurse is providing home care instructions to the parents of an infant being discharged after repair of a bilateral cleft lip. Which instructions should the nurse include? (Select all that apply.) a. Acetaminophen (Tylenol) should not be given to your infant. b. Feed your infant in an upright position. c. Place your infant prone for a period of time each day. d. Burp your child frequently during feedings. e. Apply antibiotic ointment to the lip as prescribed.

ANS: B, D, E After cleft lip surgery the parents are taught to feed the infant in an upright position to decrease the chance of choking. The parents are taught to burp the infant frequently during feedings because excess air is often swallowed. Parents are taught to cleanse the suture line area with a cotton swab using a rolling motion and apply antibiotic ointment with the same technique. Tylenol is used for pain, and the child should never be placed prone as this position can damage the suture line.

A child with a brain tumor is undergoing radiation therapy. What should the nurse include in the discharge instructions to the child's parents? (Select all that apply.) a. Apply over-the-counter creams to the area daily. b. Avoid excessive skin exposure to the sun. c. Use a washcloth when cleaning the area receiving radiation. d. Plan for adequate rest periods for the child. e. A darkening of the skin receiving radiation is expected.

ANS: B, D, E Children receiving cranial radiation are particularly affected by fatigue and an increased need for sleep during and shortly after completion of the course of radiation. Skin damage can include changes in pigmentation (darkening), redness, peeling, and increased sensitivity. Extra care must be taken to avoid excessive skin exposure to heat, sunlight, friction (such as rubbing with a towel or washcloth), and creams or moisturizers. Only topical creams and moisturizers prescribed by the radiation oncologist should be applied to the radiated skin.

What nursing actions are indicated when the nurse is administering phenytoin (Dilantin) by the intravenous route to control seizures? (Select all that apply.) a. It must be given with D51/2 NS. b. Occasional blood levels will be assessed. c. Dilantin should be given with food because it causes gastrointestinal distress. d. It must be given in normal saline. e. It must be filtered.

ANS: B, D, E The child should have serum levels drawn to monitor for optimal therapeutic levels. In addition, liver function studies should be monitored because this anticonvulsant may cause hepatic dysfunction. The IV dose must be given in normal saline, not D51/2 NS. The IV dose must be filtered. The IV dose must be given in normal saline, not D51/2 NS. Dilantin has not been found to cause gastrointestinal upset, and since it is being given by the IV route, this is not a concern. The medication can be taken without food.

Which neurologic diagnostic test gives a visualized horizontal and vertical cross section of the brain at any axis? a. Nuclear brain scan b. Echoencephalography c. CT scan d. MRI

ANS: C A CT scan provides a visualization of the horizontal and vertical cross sections of the brain at any axis. A nuclear brain scan uses a radioisotope that accumulates where the blood-brain barrier is defective. Echoencephalography identifies shifts in midline structures of the brain as a result of intracranial lesions. MRI permits visualization of morphologic features of target structures and permits tissue discrimination that is unavailable with any other techniques.

The student nurse is assessing a woman with abruptio placentae. The student reports to the registered nurse "I can't really palpate her abdomen, it's as hard as a board." What action by the nurse is the priority? a. Tell the student to document the findings. b. Have the student teach the woman relaxation techniques. c. Assess the woman's fundal height and vital signs. d. Administer a dose of opioid pain medication.

ANS: C A hard, board- like abdomen in this setting is characteristic of concealed hemorrhage. The nurse assesses the woman's fundal height (which will rise with bleeding) and vital signs to detect shock. Documentation occurs after interventions are complete. Relaxation techniques may help the woman cope with the situation, but anxiety is not the reason for the findings. The woman may or may not need pain medication, and if she is going to need surgery, she should not get opioids until consents are signed.

Which is an important nursing consideration when caring for a child with impetigo? a. Apply topical corticosteroids to decrease inflammation. b. Carefully remove dressings so as not to dislodge undermined skin, crusts, and debris. c. Carefully wash hands and maintain cleanliness when caring for an infected child. d. Examine child under a Wood lamp for possible spread of lesions.

ANS: C A major nursing consideration related to bacterial skin infections, such as impetigo, is to prevent the spread of the infection and complications. This is done by thorough handwashing before and after contact with the affected child. Corticosteroids are not indicated in bacterial infections. Dressings are usually not indicated. The undermined skin, crusts, and debris are carefully removed after softening with moist compresses. A Wood lamp is used to detect fluorescent materials in the skin and hair. It is used in certain disease states, such as tinea capitis. It is not used in impetigo.

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 the child's care d. Primary care physician and key health professionals involved in the child's care

ANS: C A multidisciplinary conference is necessary for coordination of care for children with complex health needs. The family is involved as well as key health professionals who are involved in the child's care. The nursing staff can address the nursing care needs of the child with the family, but other involved disciplines must be included. The family must be included in the discharge conferences, which allow 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 nursing needs of the child.

What best describes a full-thickness (third-degree) burn? a. Erythema and pain b. Skin showing erythema followed by blister formation c. Destruction of all layers of skin evident with extension into subcutaneous tissue d. Destruction injury involving underlying structures such as muscle, fascia, and bone

ANS: C A third-degree or full-thickness burn is a serious injury that involves the entire epidermis and dermis and extends into the subcutaneous tissues. Erythema and pain are characteristic of a first-degree burn or superficial burn. Erythema with blister formation is characteristic of a second-degree or partial-thickness burn. A fourth-degree burn is a full-thickness burn that also involves underlying structures such as muscle, fascia, and bone.

The parents of a school-age child are told that their child is diagnosed with leukemia. As the nurse caring for this child, what is the expected first response of the parents to the diagnosis of chronic illness in their child? a. Anger and resentment b. Sorrow and depression c. Shock and disbelief d. Acceptance and adjustment

ANS: C According to Kübler-Ross, denial is the initial stage of the grieving process when an individual reacts with shock and disbelief to the diagnosis of chronic illness. The other responses are also part of the grieving process although not usually the initial response.

When teaching the pregnant woman with class II heart disease, what information should the nurse provide? a. Advise her to gain at least 30 lb. b. Explain the importance of a diet high in calcium. c. Instruct her to avoid strenuous activity. d. Inform her of the need to limit fluid intake.

ANS: C Activity may need to be limited so that cardiac demand does not exceed cardiac capacity. Weight gain should be kept at a minimum with heart disease. Iron and folic acid intake is important to prevent anemia. Fluid intake should not be limited during pregnancy. She may also be put on a diuretic. Fluid intake is necessary to prevent fluid deficits.

The nurse assessing a child with acute poststreptococcal glomerulonephritis should be alert for which finding? a. Increased urine output b. Hypotension c. Tea-colored urine d. Weight gain

ANS: C Acute poststreptococcal glomerulonephritis is characterized by hematuria, proteinuria, edema, and renal insufficiency. Tea-colored urine is an indication of hematuria. In acute poststreptococcal glomerulonephritis the urine output may be decreased. In acute poststreptococcal glomerulonephritis blood pressure may be increased. Edema may be noted around the eyelids and ankles in patients with acute post streptococcal glomerulonephritis and can contribute to weight gain; however, weight gain is associated more with nephrotic syndrome.

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 By age 9 or 10 years, children have an adult concept of death. They realize that it is inevitable, universal, and irreversible. Preschoolers and young school-age children are too little to have an adult concept of death. Adolescents have a mature understanding of death.

A woman taking magnesium sulfate has respiratory rate of 10 breaths/min. In addition to discontinuing the medication, the nurse should a. vigorously stimulate the woman. b. instruct her to take deep breaths. c. administer calcium gluconate. d. increase her IV fluids.

ANS: C Calcium gluconate reverses the effects of magnesium sulfate. Stimulation, instruction on taking deep breaths, and increasing her fluid rate will not increase the respirations.

Parents of a child with acute lymphoblastic leukemia (ALL) ask about their child's prognosis. The nurse should base the response on the knowledge that a. leukemia is a fatal disease, although chemotherapy provides increasingly longer periods of remission. b. research to find a cure for childhood cancers is very active. c. the majority of children go into remission and remain symptom free when treatment is completed. d. it usually takes several months of chemotherapy to achieve a remission.

ANS: C Children diagnosed with the most common form of leukemia, ALL, can almost always achieve remission, with a 5-year disease- free survival rate approaching 85%. With the majority of children surviving 5 years or longer, it is inappropriate to refer to leukemia as a fatal disease. Telling parents about current research to answer their question does not address their concern. About 95% of children achieve remission within the first month of chemotherapy.

The child with Down syndrome should be evaluated for which condition before participating in some sports? a. Hyperflexibility b. Cutis marmorata c. Atlantoaxial instability d. Speckling of iris (Brushfield spots)

ANS: C Children with Down syndrome are at risk for atlantoaxial instability. Before participating in sports that put stress on the head and neck, a radiologic examination should be done. Although hyperflexibility is characteristic of Down syndrome, it does not affect the child's ability to participate in sports. Although cutis marmorata is characteristic of Down syndrome, it does not affect the child's ability to participate in sports. Although Brushfield spots are characteristic of Down syndrome, they do not affect the child's ability to participate in sports.

What should the nurse keep in mind when planning to communicate with a child who has autism? a. The child has normal verbal communication. b. Expect the child to use sign language. c. The child may exhibit monotone speech and echolalia. d. The child is not listening if she is not looking at the nurse.

ANS: C Children with autism have abnormalities in the production of speech such as a monotone voice or echolalia or inappropriate volume, pitch, rate, rhythm, or intonation. The child has impaired verbal communication and abnormalities in the production of speech. Some autistic children may use sign language, but it is not assumed. Children with autism often are reluctant to initiate direct eye contact.

A major complication in a child with chronic renal failure is a. hypokalemia. b. metabolic alkalosis. c. water and sodium retention. d. excessive excretion of blood urea nitrogen.

ANS: C Chronic renal failure leads to water and sodium retention, which contributes to edema and vascular congestion. Hyperkalemia is a complication of chronic renal failure. Metabolic acidosis is a complication of chronic renal failure. Retention of blood urea nitrogen is a complication of chronic renal failure.

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

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

Which type of fracture describes traumatic separation of cranial sutures? a. Basilar b. Linear c. Comminuted d. Depressed

ANS: C Comminuted skull fractures include fragmentation of the bone or a multiple fracture line. A basilar fracture involves the basilar portion of the frontal, ethmoid, sphenoid, temporal, or occipital bone. A linear fracture includes a straight-line fracture without dural involvement. A depressed fracture has the bone pushed inward, causing pressure on the brain.

What fluid is the best choice when a child with mucositis asks for something to drink? a. Hot chocolate b. Lemonade c. Popsicle d. Orange juice

ANS: C Cool liquids are soothing, and ice pops are usually well tolerated. A hot beverage can be irritating to mouth ulcers. Citrus products may be very painful to an ulcerated mouth.

A nurse is teaching a student nurse in the pediatric clinic about vomiting in children. The nurse states that getting parents to estimate the amount a child has vomited is quite difficult. What is the best explanation for this problem? a. Parents are too upset by the vomiting to pay close attention. b. Parents don't know how to accurately estimate the amount. c. Descriptions about vomitus are vague and non-specific. d. Infants and small children often swallow the vomitus.

ANS: C Descriptive words used to describe vomitus are often vague and used inconsistently. The astute nurse uses specific questions to elicit the most accurate information. See Nursing Quality Alert Box 43-2 for examples of good questions to ask. Parents may or may not be too upset to pay attention. It is belittling to state that parents don't know how to estimate amounts. Infants and children may swallow some vomitus, but that is not the main problem.

How can chronic illness and frequent hospitalizations affect the psychosocial development of an adolescent? a. They can lead to feelings of inadequacy. b. They can interfere with parental attachment. c. They can block the development of identity. d. They can prevent the development of imagination.

ANS: C Development of identity is the task of the adolescent. Inadequacy and inferiority refer to the school-age period. Parental attachment is a task of the infant. Development of imagination occurs in the preschool period.

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

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

The nurse is explaining how to assess edema to the nursing students working on the antepartum unit. Which score indicates edema of lower extremities, face, hands, and sacral area? a. +1 edema b. +2 edema c. +3 edema d. +4 edema

ANS: C Edema of the extremities, face, and sacral area is classified as +3 edema. Edema classified as +1 indicates minimal edema of the lower extremities. Marked edema of the lower extremities is termed +2 edema. Generalized massive edema (+4) includes accumulation of fluid in the peritoneal cavity.

A child has beta-thalassemia and is receiving deferoxamine. The parent asks what the purpose of this medication is. Which response by the nurse is best? a. "To improve the anemia" b. "To decrease liver and spleen swelling" c. "To eliminate excessive iron being stored in the organs" d. "To prepare your child for a bone marrow transplant"

ANS: C Excessive iron overload (hemosiderosis) causes organ damage. Chelation therapy with deferoxamine removes the iron stored in organs. It is not a treatment for existing conditions such as hepatosplenomegaly nor is it used prior to a bone marrow transplant.

What is an important focus of nursing care for the dying child and his or her family? a. Nursing care should be organized to minimize contact with the child. b. Adequate oral intake is crucial to the dying child. c. Families should be taught that hearing is the last sense to stop functioning before death. d. It is best for the family if nursing care takes place during periods when the child is alert.

ANS: C Families should be encouraged to talk to the child because verbal communication and physical touch are important both for the family and child. Nursing care should minimize disruptions but not contact. When a child is dying, fluids should be based on the child's requests, with a focus on comfort and preventing a dry mouth. The times when the child is alert should be devoted to family contacts.

What is the predominant trait of the resilient family associated with chronic illness? a. Social separation b. Family flexibility c. Family cohesiveness d. Clear family boundaries

ANS: C Family cohesiveness is the predominant trait of the resilient family. Social integration, not separation is another trait. Family flexibility and clear family boundaries are other traits of the resilient family but not the predominant one.

Which statement best describes fragile X syndrome? a. Chromosomal defect affecting only females. b. Chromosomal defect that follows the pattern of X-linked recessive disorders. c. It is a common genetic cause of cognitive impairment. d. Most common cause of noninherited cognitive impairment.

ANS: C Fragile X syndrome is the most common inherited cause of cognitive impairment and the second most common cause of cognitive impairment after Down syndrome. Fragile X primarily affects males. Fragile X follows the pattern of X-linked dominant with reduced manifestation of the syndrome in female and moderate to severe dysfunction in males. Fragile X is inherited.

A pregnant woman has been diagnosed with gestational hypertension and is crying. She asks the nurse if this means she has to take blood pressure medicine for the rest of her life. What answer by the nurse is best? a. "Yes, you will have hypertension for the rest of your life." b. "No, this always goes away after you deliver." c. "Maybe, we have to wait and see at your 6-week postpartum checkup." d. "I don't know. But if you need medicine you should take it."

ANS: C Gestational hypertension can last after delivery. If it has not resolved by postpartum week 6, it is considered chronic, and the woman will probably have to take medication. It may or may not resolve, but the nurse should not provide false reassurance or state that he or she does not know without finding more information. Telling the woman to take medicine if she needs it belittles her concerns.

The most appropriate nursing diagnosis for the child with acute glomerulonephritis is a. Risk for Injury related to malignant process and treatment. b. Deficient Fluid Volume related to excessive losses. c. Risk for Imbalanced Fluid Volume related to a decrease in plasma filtration. d. Excess Fluid Volume related to fluid accumulation in tissues and third spaces.

ANS: C Glomerulonephritis has a decreased filtration of plasma. The resulting decrease in plasma filtration results in an excessive accumulation of water and sodium that expands plasma and interstitial fluid volumes, leading to circulatory congestion and edema. No malignant process is involved in acute glomerulonephritis. Excess fluid volume is found in this disease process. The fluid accumulation is related to the decreased plasma filtration.

With what beverage should the parents of a child with ringworm be taught to give griseofulvin? a. Water b. A carbonated drink c. Milk d. Fruit juice

ANS: C Griseofulvin is insoluble in water. Giving the medication with a high-fat meal or milk increases absorption. Carbonated drinks do not contain fat, which aids in the absorption of griseofulvin. Fruit juice does not contain any fat; fat aids absorption of the medication.

Nursing care of the infant who has had a myelomeningocele repair should include a. securely fastening the diaper. b. measurement of pupil size. c. measurement of head circumference. d. administration of seizure medications.

ANS: C Head circumference measurement is essential because hydrocephalus can develop in these infants. A diaper should be placed under the infant but not fastened. Keeping the diaper open facilitates frequent cleaning and decreases the risk for skin breakdown. Pupil size measurement is usually not necessary. Seizure medications are not routinely given to infants who do not have seizures.

Which condition is characterized by a history of bloody diarrhea, fever, abdominal pain, and low hemoglobin and platelet counts? a. Acute viral gastroenteritis b. Acute glomerulonephritis c. Hemolytic-uremic syndrome d. Acute nephrotic syndrome

ANS: C Hemolytic-uremic syndrome is an acute disorder characterized by anemia, thrombocytopenia, and acute renal failure. Most affected children have a history of gastrointestinal symptoms, including bloody diarrhea. Anemia and thrombocytopenia are not associated with acute gastroenteritis. The symptoms described are not suggestive of acute glomerulonephritis. The symptoms described are not suggestive of nephrotic syndrome.

Children with non-Hodgkin lymphoma are at risk for complications resulting from tumor lysis syndrome (TLS). What findings would the nurse assess for to identify this complication early? a. Increased ALT, AST b. Change in level of consciousness c. Elevated BUN and creatinine d. Oxygen saturation of 93%

ANS: C In TLS, the tumor's intracellular contents are dumped into the child's extracellular fluid as the tumor cells are lysed in response to chemotherapy. Because of the large volume of these cells, their intracellular electrolytes overload the kidneys and, if not monitored, can cause kidney failure. Kidney failure would manifest in rising BUN and creatinine. This does not affect the liver so increased ALT and AST are not related. Changes in level of consciousness would not help identify this specific complication. An oxygen saturation of 93% is related to the lungs.

Which statement best describes beta-thalassemia major (Cooley anemia)? a. All formed elements of the blood are depressed. b. Inadequate numbers of red blood cells are present. c. Increased incidence occurs in families of Mediterranean extraction. d. Increased incidence occurs in persons of West African descent.

ANS: C Individuals who live near the Mediterranean Sea and their descendants have the highest incidence of thalassemia. An overproduction of red cells occurs. Although numerous, the red cells are relatively unstable. Sickle cell disease is common in blacks of West African descent.

The nurse is counseling the family of a 12-month-old child who has lost his mother in a car accident. How should you explain to the father what the child's understanding of death is, related to theories of growth and development? a. Temporary b. Permanent c. Loss of caretaker d. Punishment

ANS: C Infants and toddlers view death as loss of a caretaker. The preschool-age child views death as temporary. The school-age child and adolescent understand the permanence of death. The preschool-age child facing impending death may view his or her condition as punishment for behaviors or thoughts.

What is the best response to a parent who asks the nurse whether her 5-month-old infant can have cow's milk? a. "You need to wait until she is 8 months old and eating solids well." b. "Yes, if you think that she will eat enough meat to get the iron she needs." c. "Infants younger than 12 months need iron-rich formula to get the iron they need." d. "Try it and see how she tolerates it."

ANS: C Infants younger than 12 months need iron-fortified formula or breast milk. Infants who drink cow's milk do not get adequate iron and are at risk for iron-deficiency anemia. A 5- month- old infant cannot get adequate iron without drinking an iron-fortified formula or taking an iron supplement. Counseling a parent to give a 5-month-old infant cow's milk is inappropriate.

Nursing intervention for the pregnant diabetic is based on the knowledge that the need for insulin a. increases throughout pregnancy and the postpartum period. b. decreases throughout pregnancy and the postpartum period. c. varies depending on the stage of gestation. d. should not change because the fetus produces its own insulin.

ANS: C Insulin needs decrease during the first trimester, when nausea, vomiting, and anorexia are a factor. They increase during the second and third trimesters, when the hormones of pregnancy create insulin resistance in maternal cells.

A woman in the perinatal clinic asks the nurse how her asthma will affect her pregnancy and fetus. What response by the nurse is best? a. Asthma medications cannot be used during pregnancy. b. The only problem is that you will not be able to breastfeed. c. Medications for asthma do not appear to harm the fetus. d. Pregnancy tends to make asthma worse.

ANS: C Medications for asthma seem to be well tolerated during pregnancy. Breastfeeding is safe for the newborn. The course of asthma is variable in pregnancy.

Methotrexate is recommended as part of the treatment plan for which obstetric complication? a. Complete hydatidiform mole b. Missed abortion c. Unruptured ectopic pregnancy d. Abruptio placentae

ANS: C Methotrexate is an effective, nonsurgical treatment option for a hemodynamically stable woman whose ectopic pregnancy is unruptured and less than 3.5 cm in diameter. Methotrexate is not indicated or recommended as a treatment option for a complete hydatidiform mole, a missed abortion, or abruptio placentae.

A mother calls the emergency department nurse because her child was stung by a scorpion. The nurse should recommend a. administering antihistamine. b. cleansing with soap and water. c. keeping child quiet and coming to emergency department. d. removing stinger and applying cool compresses.

ANS: C Most scorpions in the US are not venomous but their stings are painful and some species' stings can produce systemic manifestations so the child should be seen in the ED. The other actions are not warranted.

The nurse is aware that an abdominal mass found in a 10-month-old infant corresponds with which childhood cancer? a. Osteogenic sarcoma b. Rhabdomyosarcoma c. Neuroblastoma d. Non-Hodgkin lymphoma

ANS: C Neuroblastoma is found exclusively in infants and children. In most cases of neuroblastoma, a primary abdominal mass and protuberant, firm abdomen are present. Osteogenic sarcoma is a bone tumor. Bone tumors typically affect older children. Rhabdomyosarcoma is a malignancy of muscle or striated tissue. It occurs most often in the periorbital area, in the head and neck in younger children, or in the trunk and extremities in older children. Non-Hodgkin lymphoma is a neoplasm of lymphoid cells. Painless, enlarged lymph nodes are found in the cervical or axillary region. Abdominal signs and symptoms do not include a mass.

A woman who is older than 35 years may have difficulty achieving pregnancy, because a. personal risk behaviors influence fertility. b. she has used contraceptives for an extended time. c. her ovaries may be affected by the aging process. d. prepregnancy medical attention is lacking.

ANS: C Once the mature woman decides to conceive, a delay in becoming pregnant may occur because of the normal aging of the ovaries. The older adult participates in fewer risk behaviors than the younger adult. The problem is the age of the ovaries, not the past use of contraceptives. Prepregnancy medical care is available and encouraged.

A nurse in labor and delivery learns about metabolic changes that occur throughout pregnancy in diabetes. What information does the nurse know? a. Insulin crosses the placenta to the fetus only in the first trimester, after which the fetus secretes its own. b. Women with insulin-dependent diabetes are prone to hyperglycemia during the first trimester, because they are consuming more sugar. c. During the second and third trimesters, pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus. d. Maternal insulin requirements steadily decline during pregnancy.

ANS: C Pregnant women develop increased insulin resistance during the second and third trimesters. Insulin never crosses the placenta; the fetus starts making its own around the tenth week. As a result of normal metabolic changes during pregnancy, insulin-dependent women are prone to hypoglycemia. Maternal insulin requirements may double or quadruple by the end of pregnancy.

When helping the mother, father, and other family members actualize the loss of the infant, nurses should a. use the words lost or gone rather than dead or died. b. make sure the family understands that it is important to name the baby. c. if the parents choose to visit the baby, apply lotion to the baby and wrap the infant in a pretty blanket. d. set a firm time for ending the visit with the baby so that the parents know when to let go.

ANS: C Presenting the baby in a nice way stimulates the parents' senses and provides pleasant memories of their baby. Nurses must use dead and died to assist the bereaved in accepting reality. Although naming the baby can be helpful, it is important not to create the sense that parents have to name the baby. In fact, some cultural taboos and religious rules prohibit the naming of an infant who has died. Parents need different time periods with their baby to say goodbye. Nurses need to be careful not to rush the process.

Which factor is known to increase the risk of gestational diabetes mellitus? a. Underweight before pregnancy b. Maternal age younger than 25 years c. Previous birth of large infant d. Previous diagnosis of type 2 diabetes mellitus

ANS: C Previous birth of a large infant suggests gestational diabetes mellitus. Obesity (BMI of 30 or greater) creates a higher risk for gestational diabetes. A woman younger than 25 generally is not at risk for gestational diabetes mellitus. The person with type 2 diabetes mellitus already is a diabetic and will continue to be so during and after pregnancy.

The prenatal clinic nurse monitored women for preeclampsia. If all four women were in the clinic at the same time, which one should the nurse see first? a. Blood pressure increase to 138/86 mm Hg b. Weight gain of 0.5 kg during the past 2 weeks c. A dipstick value of 3+ for protein in her urine d. Pitting pedal edema at the end of the day

ANS: C Proteinuria is defined as a concentration of 1+ or greater via dipstick measurement. A dipstick value of 3+ is indicative of severe preeclampsia and should alert the nurse that additional testing or assessment should be made. Generally, hypertension is defined as a BP of 140/90 or higher. Preeclampsia may be manifested as a rapid weight gain. Gaining 0.5 kg during the past 2 weeks does not qualify as rapid. Edema occurs in many normal pregnancies as well as in women with preeclampsia. Therefore, the presence of edema is no longer considered diagnostic of preeclampsia.

Which viral pathogen frequently causes acute diarrhea in young children? a. Giardia organisms b. Shigella organisms c. Rotavirus d. Salmonella organisms

ANS: C Rotavirus is the most frequent viral pathogen that causes diarrhea in young children. The other organisms are bacterial.

Throughout their life span, cognitively impaired children are less capable of managing environmental challenges and are at risk for a. nutritional deficits. b. visual impairments. c. physical injuries. d. psychiatric problems.

ANS: C Safety is a challenge for cognitively impaired children. Decreased capability to manage environmental challenges may lead to physical injuries. Nutritional deficits are related more to dietary habits and the caregivers' understanding of nutrition. Visual impairments are unrelated to cognitive impairment. Psychiatric problems may coexist with cognitive impairment; however, they are not environmental challenges.

The primary clinical manifestation of scabies is a. edema. b. redness. c. pruritus. d. maceration.

ANS: C Scabies is caused by the scabies mite. The inflammatory response and intense itching occur after the host has become sensitized to the mite. This occurs approximately 30 to 60 days after initial contact. In the previously sensitized person, the response occurs within 48 hours. Edema, redness, and maceration are not seen in scabies.

A pregnant woman who abuses cocaine admits to exchanging sex for her drug habit. This behavior puts her at a greater risk for which of the following? a. Depression of the central nervous system b. Hypotension and vasodilation c. Sexually transmitted diseases d. Postmature birth

ANS: C Sex acts exchanged for drugs place the woman at increased risk for sexually transmitted diseases because of multiple partners and lack of protection. Cocaine is a central nervous system stimulant. Cocaine causes hypertension and vasoconstriction. Premature delivery of the infant is one of the most common problems associated with cocaine use during pregnancy.

A father calls the clinic nurse because his 2-year-old child was bitten by a black widow spider. The nurse should advise the father to a. apply warm compresses. b. carefully scrape off the stinger. c. take the child to the emergency department. d. apply a thin layer of corticosteroid cream.

ANS: C The black widow spider has a venom that is toxic enough to be harmful. The father should take the child to the emergency department for immediate treatment. The other actions are contraindicated.

A patient at 24 weeks of gestation says she has a glass of wine with dinner every evening. The nurse will counsel her to eliminate all alcohol intake. What is the best rationale provided by the nurse? a. A daily consumption of alcohol indicates a risk for alcoholism. b. She will be at risk for abusing other substances as well. c. The fetus is placed at risk for altered brain growth. d. The fetus is at risk for multiple organ anomalies.

ANS: C The brain grows most rapidly in the third trimester and is most vulnerable to alcohol exposure during this time. A risk for alcoholism is not the major risk for the infant. Multiple organ anomalies are not a major concern.

A school-age child is diagnosed with a life-threatening illness. The parents want to protect their child from knowing the seriousness of the illness. What should the nurse explain to the parents? a. This will help the child cope effectively by denial. b. This attitude is helpful to give parents time to cope. c. Terminally ill children know when they are seriously ill. d. Terminally ill children usually choose not to discuss their illness.

ANS: C The child needs honest and accurate information about the illnesses, treatments, and prognosis. Children, even at a young age, realize that something is seriously wrong and that it involves them. The nurse should help parents understand the importance of honesty. The child will know that something is wrong because of the increased attention of health professionals. The focus should be on the child's needs, not the parents'. Children will usually tell others how much information they want about their condition.

What is a priority intervention in planning care for the child with disseminated intravascular coagulation (DIC)? a. Hospitalization at the first sign of bleeding b. Teaching the child relaxation techniques for pain control c. Management in the intensive care unit d. Provision of adequate hydration to prevent complications

ANS: C The child with DIC is seriously ill and needs to be monitored in an intensive care unit. DIC typically develops in a child who is already hospitalized. Relaxation techniques and pain control are not high priorities for the child with DIC. Hydration is not the major concern for the child with DIC.

What action is contraindicated when a child with Down syndrome is hospitalized? a. Determine the child's vocabulary for specific body functions. b. Assess the child's hearing and visual capabilities. c. Encourage parents to leave the child alone to encourage adaptation. d. Have meals served at the child's usual meal times.

ANS: C The child with Down syndrome needs routine schedules and consistency. Having familiar people present, especially parents, helps to decrease the child's anxiety. To communicate effectively with the child, it is important to know the child's particular vocabulary for specific body functions. Children with Down syndrome have a high incidence of hearing loss and vision problems and should have hearing and vision assessed whenever they are in a health care facility. Routine schedules and consistency are important to children.

What should the nurse teach parents about oral hygiene for the child receiving chemotherapy? a. Brush the teeth briskly to remove bacteria. b. Use a mouthwash that contains alcohol. c. Inspect the child's mouth daily for ulcers. d. Perform oral hygiene twice a day.

ANS: C The child's mouth is inspected regularly for ulcers. At the first sign of ulceration, an antifungal drug is initiated. The teeth should be brushed with a soft-bristled toothbrush. Excessive force with brushing should be avoided because delicate tissue could be broken, causing infection or bleeding. Mouthwashes containing alcohol may be drying to oral mucosa, thus breaking down the protective barrier of the skin. Oral hygiene should be performed four times a day.

What 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 red blood cell destruction occurs.

ANS: C 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 red blood cell destruction occurs.

A nurse has taught parents about diagnostic testing for their child who is suspected of having leukemia. What test described by the parents shows good understanding of this information? a. Complete blood cell count (CBC) b. Lumbar puncture c. Bone marrow biopsy d. Computed tomography (CT) scan

ANS: C The confirming test for leukemia is microscopic examination of bone marrow obtained by bone marrow aspiration and biopsy. A CBC may show blast cells that would raise suspicion of leukemia. It is not a confirming diagnostic study. A lumbar puncture is done to check for central nervous system involvement in the child who has been diagnosed with leukemia. A CT scan may be done to check for bone involvement in the child with leukemia. It does not confirm a diagnosis.

What is the best response to a father who tells the nurse that his son "daydreams" at home and that his teacher has observed this behavior at school? a. "Your son must have an active imagination." b. "Can you tell me exactly how many times this occurs in one day?" c. "Tell me about your son's activity when you notice the daydreams." d. "He is probably overtired and needs more rest."

ANS: C The daydream episodes are suggestive of absence seizures, and data about activity associated with the daydreams should be obtained. Describing an active imagination or an overtired child does not address the symptoms of the father's concern. Determining the number of times the behavior occurs is not as helpful as information about the behavior.

What 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

ANS: C The inheritance pattern in 80% of all cases of hemophilia is X-linked recessive and results in deficient amounts of blood- clotting factors. The disorder involves coagulation factors, not platelets. The disorder does not involve red cells or the Y chromosome.

The most appropriate nursing diagnosis for a child with a cognitive dysfunction is a. impaired social interaction. b. deficient knowledge. c. risk for injury. d. ineffective coping.

ANS: C The nurse needs to know that limited cognitive abilities to anticipate danger lead to risk for injury. Safety is a priority for all children with cognitive dysfunction. Impaired social interaction is indeed a concern for the child with a cognitive disorder but does not address the limited ability to anticipate danger. Because of the child's cognitive deficit, knowledge will not be retained and will not decrease the risk for injury. Ineffective individual coping does not address the limited ability to anticipate danger.

A 5-year-old sustained a concussion after falling out of a tree. In preparation for discharge, the nurse is discussing home care with the parents. Which statement made by the parents indicates a correct understanding of the teaching? a. "I should expect my child to have a few episodes of vomiting." b. "If I notice sleep disturbances, I should contact the physician immediately." c. "I should expect my child to have some behavioral changes after the accident." d. "If I notice diplopia, I will have my child rest for 1 hour."

ANS: C The parents are advised of probable posttraumatic symptoms. These include behavioral changes and sleep disturbances. Vomiting and diplopia should be reported immediately. Sleep disturbances may occur with postconcussive syndrome, but difficulty waking the child up should be reported.

What finding on a prenatal visit at 10 weeks might suggest a hydatidiform mole? a. Complaint of frequent mild nausea b. Blood pressure of 120/80 mm Hg c. Fundal height measurement of 18 cm d. History of bright red spotting for 1 day, weeks ago

ANS: C The uterus in a hydatidiform molar pregnancy is often larger than would be expected on the basis of the duration of the pregnancy. Many women have nausea in the first trimester. A woman with a molar pregnancy may have early-onset pregnancy-induced hypertension. The history of bleeding is normally described as being brownish.

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

ANS: C The widespread use of folic acid among women of childbearing age is expected to decrease the incidence of spina bifida significantly. Vitamin A, multivitamins, and folic acid only during specific points during the pregnancy have not been shown to prevent neural tube defects.

A woman who had no prenatal care has just delivered after a brief labor. The baby has rough, dry skin; is large for gestational age; and has an umbilical hernia. What action by the nurse is most appropriate? a. Question the mother about substance abuse. b. Reassess the baby's gestational age. c. Inform the mother her thyroid levels will be checked. d. Perform a bedside blood glucose test on the mother.

ANS: C These signs in the newborn are indicative of hypothyroidism. The mother will have thyroid levels checked. Asking about substance abuse, reassessing gestational age, and obtaining a blood glucose reading are all unnecessary.

A child has painful, fluid-filled vesicles on the upper lip. What medication does the nurse anticipate teaching parents about? a. Corticosteroids b. Oral griseofulvin c. Oral antiviral agent d. Topical antibiotic

ANS: C This child has a herpes infection. Oral antiviral agents are effective for viral infections such as herpes simplex. Corticosteroids are not effective for viral infections. Griseofulvin is an antifungal agent and not effective for viral infections. Antibiotics are not effective in viral diseases.

What assessment finding best indicates that a 66-pound child with a serious burn has met goals for the priority nursing diagnosis? a. Distal pulses are equal and strong bilaterally. b. Oxygen saturation is 94% on room air. c. Urine output is 45 mL/hour. d. Mucous membranes are pink and moist.

ANS: C This child weighs 30 kilograms, so a normal urine output is 30 to 60 mL/hour. This child's urine output indicates that fluid resuscitation is adequate and perfusion to organs is good. All the other assessment findings are normal, but for this situation the finding associated with good perfusion to the kidneys best shows the child has met the goal for Fluid Volume Deficit.

A child has just been diagnosed with acute lymphoblastic leukemia, and the mother is expressing guilt about not taking the child to the doctor right away. What response by the nurse is best? a. "Always call the physician when your child has a change in what is normal for him." b. "It is better to be safe than sorry." c. "It is common for parents not to notice subtle changes in their children's health." d. "I hope this delay does not affect the treatment plan."

ANS: C This statement is not only true, but it will also help minimize the mother's guilt and help establish a therapeutic relationship with the nurse. Identifying concerns and clarifying misconceptions will help families cope with the stress of chronic illness.

The labor of a pregnant woman with preeclampsia is going to be induced. The nurse reviews the woman's latest laboratory test findings, which reveal a low platelet count, an elevated aspartate transaminase (AST) level, and a falling hematocrit. What action by the nurse is most important? a. Palpate the woman's abdomen for tenderness. b. Document findings and begin the Pitocin infusion. c. Instruct the woman to ask for help getting out of bed. d. Assess the woman's drinking history.

ANS: C This woman has HELLP syndrome, with is characterized by low platelet counts and hepatic dysfunction. She is at risk for bleeding, so the nurse instructs her to call for assistance in getting in and out of bed. The nurse does not palpate the abdomen even though the woman may complain of abdominal pain because of possible rupture of a subcapsular hematoma. The findings should be documented but the nurse should intervene based on the abnormal findings. The liver enzymes are not elevated because of alcohol intake.

A nurse is interviewing a pregnant woman in the clinic. She seems hostile and answers many questions with "Whatever" and "I don't really know." At her last appointment she was late and disheveled. What action by the nurse is best? a. Ask the woman if this pregnancy was planned or is wanted. b. Call social services to come evaluate the situation. c. Ask the woman about drug use, including over the counter. d. Encourage the woman to be more forthright with answers.

ANS: C This woman is displaying some signs of substance abuse. In a non- judgmental manner, the nurse should ask about all drugs and medications she is using. The questions will appear less confrontative if the nurse begins by asking about over-the-counter medications first. Asking if the pregnancy is planned or wanted is conveying disapproval to the woman for her choices and behavior. Social services may or may not need to be involved, but the nurse needs to assess the woman more completely first. Encouraging the woman to be more forthright implies that she is being dishonest and will not gain more cooperation.

What is a major barrier to health care for teen mothers? a. The hospital/clinic is within walking distance of the girl's home. b. The institution is open days, evenings, and Saturdays by special arrangement. c. The teen must be prepared to see a different nurse or doctor or both at every visit. d. The health care workers have a positive attitude.

ANS: C Whenever possible, the teen should be scheduled to see the same nurses and practitioners for continuity of care. If the hospital/clinic were within walking distance of the girl's home, it would prevent the teen from missing appointments because of transportation problems. If the institution were open days, evenings, and Saturdays by special arrangement, this availability would be helpful for teens who work, go to school, or have other time-of-day restrictions. Scheduling conflicts are a major barrier to health care. A negative attitude is unfortunate, because it discourages families who would benefit most from consistent prenatal care.

A nurse is instructing parents on the treatment of pediculosis (head lice). Which should the nurse include in the teaching plan? (Select all that apply.) a. Bedding should be washed in warm water and dried on a low setting. b. After treating the hair and scalp with a pediculicide, shampoo the hair with regular shampoo. c. Retreat the hair and scalp with a pediculicide in 7 to 10 days. d. Items that cannot be washed should be dry cleaned or sealed in plastic bags for 2 to 3 weeks. e. Combs and brushes should be boiled in water for at least 10 minutes.

ANS: C, D, E An over-the-counter pediculicide, permethrin 1% (Nix, Elimite, Acticin), kills head lice and eggs with one application and has residual activity (i.e., it stays in the hair after treatment) for 10 days. Nix crème rinse is applied to the hair after it is washed with a conditioner-free shampoo. The product should be rinsed out after 10 minutes. The hair should not be shampooed for 24 hours after the treatment. Even though the kill rate is high and there is residual action, retreatment should occur after 7 to 10 days. Combs and brushes should be boiled or soaked in antilice shampoo or hot water (greater than 60° C [140° F]) for at least 10 minutes. Advise parents to wash clothing (especially hats and jackets), bedding, and linens in hot water and dry at a hot dryer setting.

What should the nurse identify as major fears in the preschool child who is hospitalized with a chronic illness? (Select all that apply.) a. Altered body image b. Separation from peer group c. Bodily injury d. Mutilation e. Being left alone

ANS: C, D, E Body injury, mutilation, and being left alone are major fears of the preschooler. Altered body image and separation from peer group are fears of the adolescent.

A nurse is teaching home care instructions to parents of a child with sickle cell disease. Which instructions should the nurse include? (Select all that apply.) a. Limit fluid intake. b. Administer aspirin for fever. c. Administer penicillin as ordered. d. Avoid cold and extreme heat. e. Provide for adequate rest periods.

ANS: C, D, E Parents should be taught to avoid cold, which can increase sickling, and extreme heat, which can cause dehydration. Adequate rest periods should be provided. Penicillin should be administered daily as ordered. The use of aspirin should be avoided; acetaminophen or ibuprofen should be used as an alternative. Fluids should be encouraged, and an increase in fluid intake is encouraged in hot weather or when there are other risks for dehydration.

When caring for a pregnant woman with suspected cardiomyopathy, the nurse must be alert for signs and symptoms of cardiac decompensation, which include (Select all that apply.) a. A regular heart rate b. Hypertension c. Shortness of breath d. Weakness e. Crackles in the lung bases

ANS: C, D, E Some symptoms of cardiomyopathy include shortness of breath, weakness, and crackles in the lung bases. A regular heart rate may or may not be present. Hypertension is not a typical finding.

A placenta previa in which the placental edge just reaches the internal os is called a. total. b. partial. c. complete. d. marginal.

ANS: D A placenta previa that does not cover any part of the cervix is termed marginal. With a total placenta previa the placenta completely covers the os. With a partial previa the lower border of the placenta is within 3 cm of the internal cervical os but does not completely cover the os. A complete previa is termed total. The placenta completely covers the internal cervical os.

Which type of hernia has an impaired blood supply to the herniated organ? a. Hiatal hernia b. Incarcerated hernia c. Omphalocele d. Strangulated hernia

ANS: D A strangulated hernia is one in which the blood supply to the herniated organ is impaired. A hiatal hernia is the intrusion of an abdominal structure, usually the stomach, through the esophageal hiatus. An incarcerated hernia is a hernia that cannot be reduced easily. Omphalocele is the protrusion of intraabdominal viscera into the base of the umbilical cord. The sac is covered with peritoneum and not skin.

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

ANS: D A vaso-occlusive crisis is characterized by severe pain in the area of involvement. If it is 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 vaso-occlusive phenomena.

At what developmental period do children have the most difficulty coping with death, particularly if it is their own? a. Toddlerhood b. Preschool c. School-age d. Adolescence

ANS: D Adolescents, because of their mature understanding of death, remnants of guilt and shame, and issues with deviations from normal, have the most difficulty coping with death. Toddlers and preschoolers will fear separation from parents. School -age children will fear the unknown, such as the consequences of the illness and the threat to their sense of security.

The father of a child recently diagnosed with developmental delay is very rude and hostile toward the nurses. This father was cooperative during the child's evaluation a month ago. What is the best explanation for this change in parental behavior? a. The father is exhibiting symptoms of a psychiatric illness. b. The father may be abusing the child. c. The father is resentful of the time he is missing from work for this appointment. d. The father is experiencing a symptom of grief.

ANS: D After a child is diagnosed with a developmental delay, families typically experience a cycle of grieving that is repeated when developmental milestones are not met. One cannot determine that a parent is exhibiting symptoms of a psychiatric illness on the basis of a single situation. The scenario does not give any information to suggest child abuse. Although the father may have difficulty balancing his work schedule with medical appointments for his child, a more likely explanation for his behavior change is that he is grieving the loss of a normal child.

What procedure is contraindicated in the care of a child with a minor partial-thickness burn injury wound? a. Cleaning the affected area with mild soap and water b. Applying antimicrobial ointment to the burn wound c. Changing dressings daily d. Leaving all loose tissue or skin intact

ANS: D All loose skin and tissue should be debrided, because it can become a breeding ground for infectious organisms. Cleaning with mild soap and water is important to the healing process. Antimicrobial ointment is used on the burn wound to fight infection. Clean dressings are applied daily to prevent wound infection. When dressings are changed, the condition of the burn wound can be assessed.

A nurse has taught the parents about home care of their child who has leukemia. Which statement made by the parents indicates an understanding of this teaching? a. "We will take our child's blood pressure daily." b. "We will restrict fluids in case there is central nervous system involvement." c. "We will make sure our child gets all immunizations in a timely manner." d. "We will take our child's temperature frequently."

ANS: D An elevated temperature may be the only sign of an infection in an immunosuppressed child. Parents should be instructed to monitor their child's temperature as often as necessary. It is not necessary to monitor blood pressure daily. Fluids are never withheld as a precautionary measure. Children who are immunosuppressed should not receive live virus vaccines.

Which is the best setting for daytime care for a 5-year-old autistic child whose mother works? a. Private day care b. Public school c. His own home with a sitter d. A specialized program that uses behavioral methods

ANS: D Autistic children can benefit from specialized educational programs that address their special needs. Day care programs generally do not have resources to meet the needs of severely impaired children. To best meet the needs of an autistic child, the public school may refer the child to a specialized program. A sitter might not have the skills to interact with an autistic child.

Many of the physical characteristics of Down syndrome present feeding problems. Care of the infant should include a. delaying feeding solid foods until the tongue thrust has stopped. b. modifying diet as necessary to minimize the diarrhea that often occurs. c. providing calories appropriate to child's age. d. using special bottles that may assist the infant with feeding.

ANS: D Breastfeeding may not be possible if the infant's muscle tone or sucking reflex is immature. Mothers should be encouraged to pump breast milk and use special bottles for assistance with feeding. Some children with Down syndrome can breastfeed adequately. The child has a protruding tongue, which makes feeding difficult. The parents must persist with feeding while the child continues the physiologic response of the tongue thrust. The child is predisposed to constipation. Calories should be appropriate to the child's weight and growth needs, not age.

When taking a history on a child with a possible diagnosis of cellulitis, what should be the priority nursing assessment to help establish a diagnosis? a. Any pain the child is experiencing b. Enlarged, mobile, and nontender lymph nodes c. Child's urinalysis results d. Recent infections or signs of infection

ANS: D Cellulitis may follow an upper respiratory infection, sinusitis, otitis media, or a tooth abscess. The affected area is red, hot, tender, and indurated. Pain is important, but the history of recent infections is more relevant to the diagnosis. Lymph nodes may be enlarged (lymphadenitis), but they are not mobile and are nontender. Lymphangitis may be seen with red "streaking" of the surrounding area. An abnormal urinalysis result is not usually associated with cellulitis.

Which clinical finding warrants further intervention for the child with acute post streptococcal glomerulonephritis? a. Weight loss to within 1 lb of the preillness weight b. Urine output of 1 mL/kg/hr c. A positive antistreptolysin O (ASO) titer d. Inspiratory crackles

ANS: D Children with excess fluid volume may have pulmonary edema. Inspiratory crackles indicate fluid in the lungs. Pulmonary edema can be a life-threatening complication. Weight loss is an indication that the child is responding to treatment. The urine output of 1 mL/kg/hr is acceptable. A positive ASO titer indicates the presence of antibodies to streptococcal bacteria; it is used to aid in diagnosis of acute post streptococcal glomerulonephritis. This is an expected finding if the child has this acute illness.

What should the discharge plan for a school-age child with sickle cell disease include? a. Restricting the child's participation in outside activities b. Administering aspirin for pain or fever c. Limiting the child's interaction with peers d. Administering penicillin daily as ordered

ANS: D Children with sickle cell disease are at high risk for pneumococcal infections and should receive long-term penicillin therapy and preventive immunizations. Sickle cell disease does not prohibit the child from outdoor play. Active and passive exercises help promote circulation. Aspirin use should be avoided. Acetaminophen or ibuprofen should be administered for fever or pain. The child needs to interact with peers to meet his or her developmental needs.

Which of these substances can lead to miscarriage, preterm labor, placental separation (abruption), and stillbirth? a. Heroin b. Alcohol c. PCP d. Cocaine

ANS: D Cocaine is a powerful CNS stimulant. Effects on pregnancy associated with cocaine use include abruptio placentae, preterm labor, precipitous birth, and stillbirth. Heroin is an opiate. Its use in pregnancy is associated with preeclampsia, intrauterine growth restriction, miscarriage, premature rupture of membranes, infections, breech presentation, and preterm labor. The most serious effect of alcohol use in pregnancy is FAS. The major concerns regarding PCP use in pregnant women are its association with polydrug abuse and the neurobehavioral effects on the neonate.

A child with secondary enuresis who complains of dysuria or urgency should be evaluated for which condition? a. Hypocalciuria b. Nephrotic syndrome c. Glomerulonephritis

ANS: D Complaints of dysuria or urgency from a child with secondary enuresis suggest the possibility of a UTI. An excessive loss of calcium in the urine (hypercalciuria) can be associated with complaints of painful urination, urgency, frequency, and wetting. Nephrotic syndrome is not usually associated with complaints of dysuria or urgency. Glomerulonephritis is not a likely cause of dysuria or urgency.

A child who has been in good health has a platelet count of 45,000/mm3 , petechiae, and excessive bruising that covers the body. The nurse is aware that these signs are clinical manifestations of which disease? a. Erythroblastopenia b. von Willebrand disease c. Hemophilia d. Immune thrombocytopenic purpura (ITP)

ANS: D Excessive bruising and petechiae, especially involving the mucous membranes and gums in a child who is otherwise healthy, are the clinical manifestations of ITP, resulting from decreased platelets. The etiology of ITP is unknown, but it is considered to be an autoimmune process. They are not characteristic of erythroblastopenia, von Willebrand disease, or hemophilia.

A child is in the hospital receiving chemotherapy, and the nurse suspects the child has an infection. What action by the nurse takes priority? a. Monitor the child's temperature. b. Assess the daily white blood cell count. c. Administer antibiotics. d. Obtain blood and urine cultures.

ANS: D For a child with a suspected infection, cultures are taken to determine the site and type of infection. Often these include blood and urine but may include sputum or wound drainage. Antibiotics are only started after cultures have been obtained. Monitoring temperature and WBCs is important, but cultures are the only way to specifically identify an organism so it can be effectively treated.

Which intervention is appropriate when examining a male infant for cryptorchidism? a. Cooling the examiner's hands b. Taking a rectal temperature c. Eliciting the cremasteric reflex d. Warming the room

ANS: D For the infant's comfort, the infant should be examined in a warm room with the examiner's hands warmed. Testes can retract into the inguinal canal if the infant is upset or cold. A rectal temperature yields no information about cryptorchidism. Testes can retract into the inguinal canal if the infant is upset or cold or if the cremasteric reflex is elicited. This can lead to an incorrect diagnosis.

Hematopoietic stem cell transplantation (HSCT) is the standard treatment for a child in his or her first remission with what cancer? a. Acute lymphocytic leukemias b. Non-Hodgkin lymphoma c. Wilms' tumor d. Acute myeloblastic leukemia (AML)

ANS: D HSCT is often used interchangeably with bone marrow transplantation and is currently standard treatment for children in their first remission with AML. Transplantation is standard treatment for a specific type of ALL (Philadelphia chromosome positive). Standard treatment for non-Hodgkin lymphoma is chemotherapy. Bone marrow transplantation is used to treat non-Hodgkin lymphoma that is resistant to conventional chemotherapy and radiation. The treatment for Wilms' tumor consists of surgery and chemotherapy alone or in combination with radiation therapy.

What is the most appropriate response to a school-age child who asks if she can talk to her dying sister? a. "You need to talk loudly so she can hear you." b. "Holding her hand would be better because at this point she can't hear you." c. "Although she can't hear you, she can feel your presence so sit close to her." d. "Even though she will probably not answer you, she can still hear what you say to her."

ANS: D Hearing is the last sense to cease before death. Talking to the dying child is important both for the child and the family. The sense of hearing is intact before death and there is no need to speak loudly. The sibling should be encouraged to speak to the child, as well as hold the child's hand. The sibling should be encouraged to sit close and speak to the dying child.

The skin condition commonly known as "warts" is the result of an infection by which organism? a. Bacteria b. Fungus c. Parasite d. Virus

ANS: D Human warts are caused by the human papillomavirus, not by bacteria, funguses, or parasites.

Hypospadias refers to a. absence of a urethral opening. b. penis shorter than usual for age. c. urethral opening along dorsal surface of penis. d. urethral opening along ventral surface of penis.

ANS: D Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis. The urethral opening is present in hypospadias but not at the glans. Hypospadias refers to the urethral opening, not to the size of the penis. Epispadias is where the urethral opening is along the dorsal surface of the penis.

A woman with preeclampsia has a seizure. What action by the nurse takes priority? a. Insert an oral airway. b. Suction the mouth to prevent aspiration. c. Administer oxygen by mask. d. Stay with the patient and call for help.

ANS: D If a patient seizes, the nurse should stay with her and call for help. Nursing actions during a seizure are directed toward ensuring a patent airway and patient safety. Insertion of an oral airway during seizure activity is no longer the standard of care. The nurse should attempt to keep the airway patent by turning the patient's head to the side to prevent aspiration. Once the seizure has ended, it may be necessary to suction the patient's mouth. Oxygen may or may not be needed after the seizure has ended.

A nurse is evaluating parents' knowledge about caring for their child who has iron-deficiency anemia. Which action shows the parents need further education? a. Decreasing the infant's daily milk intake to 24 oz or less b. Giving oral iron supplements between meals with orange juice c. Including apricots, dark-green leafy vegetables, and egg yolk in the infant's diet d. Allowing the infant to drink the iron supplement from a small medicine cup

ANS: D Iron supplements should be administered through a straw or by a medicine dropper placed at the back of the mouth because iron temporarily stains the teeth. A daily milk intake in toddlers of less than 24 oz will encourage the consumption of iron-rich solid foods. Because food interferes with the absorption of iron, iron supplements are taken between meals. Administering this medication with foods rich in vitamin C facilitates absorption of iron. Apricots, dark-green leafy vegetables, and egg yolks are rich sources of iron. Other iron-rich foods include liver, dried beans, Cream of Wheat, iron-fortified cereal, and prunes.

What should the parents of an infant with thrush (oral candidiasis) be taught about medication administration? a. Give nystatin suspension with a syringe without a needle. b. Apply nystatin cream to the affected area twice a day. c. Give nystatin before the infant is fed. d. Swab nystatin suspension onto the oral mucous membranes after feedings.

ANS: D It is important to apply the nystatin suspension to the affected areas, which is best accomplished by rubbing it onto the gums and tongue, after feedings, until 3 to 4 days after symptoms have disappeared. Medication may not reach the affected areas when it is squirted into the infant's mouth. Rubbing the suspension onto the gum ensures contact with the affected areas. Nystatin cream is used for diaper rash caused by Candida. To prolong contact with the affected areas, the medication should be administered after a feeding.

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

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

A child is brought to the emergency department in status epilepticus. Which medication should the nurse expect to be given initially in this situation? a. Clorazepate dipotassium (Tranxene) b. Fosphenytoin (Cerebyx) c. Phenobarbital d. Lorazepam (Ativan)

ANS: D Lorazepam (Ativan) or diazepam (Valium) is given intravenously to control generalized tonic-clonic status epilepticus and may also be used for seizures lasting more than 5 minutes. The other drugs are used for seizures but are not the first-line treatment for status.

What form of heart disease in women of childbearing years usually has a benign effect on pregnancy? a. Cardiomyopathy b. Rheumatic heart disease c. Congenital heart disease d. Mitral valve prolapse

ANS: D Mitral valve prolapse is a benign condition that is usually asymptomatic. Cardiomyopathy produces congestive heart failure during pregnancy. Rheumatic heart disease can lead to heart failure during pregnancy. Some congenital heart diseases will produce pulmonary hypertension or endocarditis during pregnancy.

Identify the most appropriate nursing response to a parent who tells the nurse, "I don't want my child to know she is dying." a. "I shall respect your decision. I won't say anything to your child." b. "Don't you think she has a right to know about her condition?" c. "Would you like me to arrange for the provider to speak with your child?" d. "I'll answer any questions she asks me as honestly as I can."

ANS: D Nurses can inform parents that they will not initiate any discussion with the child but that they intend to respond openly and honestly if and when the child initiates such a discussion. As the caregiver and advocate, the nurse should first meet the child's needs. Asking the parent if the child has the right to know is judgmental and could affect the nurse's relationship with the child's parents. Having the provider speak with the child does not address the parent's concerns or the nurse's responsibility.

What intervention will best help the siblings of a child with special needs? a. Explaining to the siblings that embarrassment is unhealthy b. Encouraging the parents not to expect siblings to help them care for the child with special needs c. Providing information to the siblings about the child's condition only as they request it d. Suggesting to the parents ways of maintaining the siblings' usual routine and participation in activities

ANS: D Parents should strive for integrating all family members' needs into daily activities. The nurse can help the parents problem solve and come up with ways to maintain as normal a daily routine for the siblings as possible while still meeting the needs of the child with special needs. Siblings may or may not be embarrassed by the special needs of the family member, but this statement belittles their feelings. Parents can ask the siblings if they want to help provide care and offer information but should not force the child into anything.

A nurse is explaining to parents how the central nervous system of a child differs from that of an adult. Which statement accurately describes these differences? a. The infant has 150 mL of CSF compared with 50 mL in the adult. b. Papilledema is a common manifestation of ICP in the very young child. c. The brain of a term infant weighs less than half of the weight of the adult brain. d. Coordination and fine motor skills develop as myelinization of peripheral nerves progresses.

ANS: D Peripheral nerves are not completely myelinated at birth. As myelinization progresses, so does the child's coordination and fine muscle movements. An infant has about 50 mL of CSF compared with 150 mL in an adult. Papilledema rarely occurs in infancy because open fontanels and sutures can expand in the presence of ICP. The brain of the term infant is two thirds the weight of an adult's brain.

Glucose metabolism is profoundly affected during pregnancy because a. pancreatic function in the islets of Langerhans is affected by pregnancy. b. the pregnant woman uses glucose at a more rapid rate than the nonpregnant woman. c. the pregnant woman increases her dietary intake significantly. d. placental hormones are antagonistic to insulin, resulting in insulin resistance.

ANS: D Placental hormones, estrogen, progesterone, and human placental lactogen (HPL) create insulin resistance. Insulin also is broken down more quickly by the enzyme placental insulinase. Pancreatic functioning is not affected by pregnancy. The glucose requirements differ because of the growing fetus. The pregnant woman should increase her intake by 200 calories a day.

The nurse notes a reddened area on the forearm of a neutropenic child with leukemia. What action by the nurse is most appropriate? a. Massage the area. b. Turn the child more frequently. c. Document the finding and continue to observe the area. d. Notify the provider.

ANS: D Skin is the first line of defense against infection. Any signs of infection in a child who is immunosuppressed must be reported. When a child is neutropenic, pus may not be produced, and the only sign of infection may be redness. The area should never be massaged. The forearm is not a typical pressure area; therefore the likelihood of the redness being related to pressure is very small. The observation should be documented, but because it may be a sign of an infection and immunosuppression, the physician must also be notified.

Which clinical sign is not included in the symptoms of preeclampsia? a. Hypertension b. Edema c. Proteinuria d. Glycosuria

ANS: D Spilling glucose into the urine is not one of the three classic symptoms of preeclampsia. Hypertension is usually the first sign noted. Edema occurs but is considered a non- specific sign. Edema can lead to rapid weight gain. Proteinuria should be assessed through a 24-hour UA.

The pediatric nurse understands that cellulitis is most often caused by a. herpes zoster. b. Candida albicans. c. human papillomavirus. d. Streptococcus or Staphylococcus organisms.

ANS: D Streptococcus, Staphylococcus, and Haemophilus influenzae are the organisms usually responsible for cellulitis. Herpes zoster is the virus associated with varicella and shingles. Candida albicans is associated with candidiasis or thrush. Human papillomavirus is associated with various types of human warts.

Which statement by an adolescent indicates an understanding about factors that can trigger migraine headaches? a. "I should avoid loud noises because this is a common migraine trigger." b. "Exercise can cause a migraine. I guess I won't have to take gym anymore." c. "I think I'll get a migraine if I go to bed at 9 PM on week nights." d. "I am learning to relax because I get headaches when I am worried about stuff."

ANS: D Stress can trigger migraines. Relaxation therapy can help the adolescent control stress and headaches. Other precipitating factors in addition to stress include poor diet, food sensitivities, and flashing lights. Visual stimuli, not auditory stimuli, are known to be a common trigger for migraines. Exercise is not a trigger for migraines. The adolescent needs regular physical exercise. Altered sleep patterns and fatigue are common triggers for migraine headaches. Going to bed at 9 PM should allow an adolescent plenty of sleep to prevent fatigue.

A burned child is in the emergency department. The nurse calculates the fluid requirement for the next 24 hours to be 2700 mL. At what rate does the nurse set the pump for initially? a. 50 mL/hour b. 100 mL/hour c. 152.1 mL/hour d. 168.8 mL/hour

ANS: D The amount of fluid needed for fluid resuscitation is generally divided so that half is given in the first 8 hours. This child needs 2700 mL total; half of that volume is 1350 mL, and that volume divided by 8 is 168.75, which is rounded to 168.8 mL/hour.

How should the nurse explain positioning for a lumbar puncture to a 5-year-old child? a. "You will be on your knees with your head down on the table." b. "You will be able to sit up with your chin against your chest." c. "You will be on your side with the head of your bed slightly raised." d. "You will lie on your side and bend your knees so that they touch your chin."

ANS: D The child should lie on her side with knees bent and chin tucked in to the knees. This position exposes the area of the back for the lumbar puncture. The other positions are not used for a lumbar puncture.

Which change in status should alert the nurse to increased intracranial pressure (ICP) in a child with a head injury? a. Rapid, shallow breathing b. Irregular, rapid heart rate c. Increased diastolic pressure with narrowing pulse pressure d. Confusion and altered mental status

ANS: D The child with a head injury may have confusion and altered mental status, a change in vital signs, retinal hemorrhaging, hemiparesis, and papilledema. Respiratory changes occur with ICP. One pattern that may be evident is Cheyne-Stokes respiration. This pattern of breathing is characterized by increasing rate and depth, then decreasing rate and depth, with a pause of variable length. Temperature elevation may occur in children with ICP. Changes in blood pressure occur, but the diastolic pressure does not increase, nor is there a narrowing of pulse pressure.

The father of a newborn infant with myelomeningocele asks about the cause of this condition. What response by the nurse is most appropriate? a. "One of the parents carries a defective gene that causes myelomeningocele." b. "A deficiency in folic acid in the father is the most likely cause." c. "Offspring of parents who have a spinal abnormality are at greater risk for myelomeningocele." d. "There may be no definitive cause identified."

ANS: D The etiology of most neural tube defects is unknown in most cases. There may be a genetic predisposition or a viral origin, and the disorder has been linked to maternal folic acid deficiency; however, the actual cause has not been determined. There may be a genetic predisposition, but no pattern has been identified. Folic acid deficiency in the mother has been linked to neural tube defect. There is no evidence that children who have parents with spinal problems are at greater risk for neural tube defects.

The nurse is providing counseling to the mother of a child diagnosed with fragile X syndrome. She explains to the mother that fragile X syndrome is a. most commonly seen in girls. b. acquired after birth. c. usually transmitted by the male carrier. d. usually transmitted by the female carrier.

ANS: D The gene causing fragile X syndrome is transmitted by the mother. Fragile X syndrome is most common in males. Fragile X syndrome is congenital. Fragile X syndrome is not transmitted by a male carrier.

The infant with Down syndrome is closely monitored during the first year of life for what serious condition? a. Thyroid complications b. Orthopedic malformations c. Dental malformation d. Cardiac abnormalities

ANS: D The high incidence of cardiac defects in children with Down syndrome makes assessment for signs and symptoms of these defects important during the first year. Clinicians recommend the child be monitored frequently throughout the first 12 months of life, including a full cardiac workup. Infants with Down syndrome are not known to have thyroid complications although they can manifest later. Orthopedic malformations may be present, but special attention is given to assessment for cardiac and gastrointestinal abnormalities. Dental malformations are not a major concern compared with the life-threatening complications of cardiac defects.

Which statement best describes why infants are at greater risk for dehydration than older children? a. Infants have an increased ability to concentrate urine. b. Infants have a greater volume of intracellular fluid. c. Infants have a smaller body surface area. d. Infants have an increased extracellular fluid volume.

ANS: D The larger ratio of extracellular fluid to intracellular fluid predisposes the infant to dehydration. Because the kidneys are immature in early infancy, there is a decreased ability to concentrate the urine. Infants have a larger proportion of fluid in the extracellular space. Infants have proportionately greater body surface area in relation to body mass, which creates the potential for greater fluid loss through the skin and gastrointestinal tract.

What is the most dangerous effect on the fetus of a mother who smokes cigarettes while pregnant? a. Genetic changes and anomalies b. Extensive central nervous system damage c. Fetal addiction to the substance inhaled d. Intrauterine growth restriction

ANS: D The major consequences of smoking tobacco during pregnancy are low-birth-weight infants, prematurity, and increased perinatal loss. Cigarettes normally will not cause genetic changes or extensive central nervous system damage. Addiction is not a normal concern with the neonate.

The most common cause of acute kidney injury in children is a. pyelonephritis. b. tubular destruction. c. urinary tract obstruction. d. severe dehydration.

ANS: D The most common cause of acute kidney injury in children is dehydration or other causes of poor perfusion that may respond to restoration of fluid volume. This is a prerenal cause. Pyelonephritis, tubular destruction, and urinary tract obstruction are not common causes of acute kidney injury in children.

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

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

A woman has delivered twins. The first twin was stillborn, and the second is in the intensive care nursery and is recovering quickly from respiratory distress. The woman is crying softly and says, "I wish my baby could have lived." What is the most therapeutic response? a. "Don't be sad. At least you have one healthy baby." b. "How soon do you plan to have another baby?" c. "I have a friend who lost a twin and she's doing just fine now " d. "I am so sorry about your loss. Would you like to talk about it?"

ANS: D The nurse should recognize the woman's grief and its significance and allow her to express her feelings. The other three responses belittle the woman's feelings.

A child with a history of fever of unknown origin, excessive bruising, lymphadenopathy, anemia, and fatigue is exhibiting symptoms most suggestive of which of the following? a. Ewing sarcoma b. Wilms' tumor c. Neuroblastoma d. Leukemia

ANS: D These symptoms reflect bone marrow failure and organ infiltration, which occur in leukemia. Symptoms of Ewing sarcoma involve pain and soft tissue swelling around the affected bone. Wilms' tumor usually manifests as an abdominal mass with abdominal pain and may include renal symptoms, such as hematuria, hypertension, and anemia. Neuroblastoma manifests primarily as an abdominal, chest, bone, or joint mass. Symptoms are dependent on the extent and involvement of the tumor.

What is the priority goal for the child with a chronic illness? a. To maintain the intactness of the family b. To eliminate all stressors c. To achieve complete wellness d. To obtain the highest level of wellness

ANS: D To obtain the highest level of health and function possible is the priority goal of nursing children with a chronic illness. Maintaining intactness of the family is a great goal, but it is for the family, not the child. Eliminating all stressors and achieving complete wellness are not realistic.

What routine nursing assessment is contraindicated in the patient admitted with suspected placenta previa? a. Monitoring FHR and maternal vital signs b. Observing vaginal bleeding or leakage of amniotic fluid c. Determining frequency, duration, and intensity of contractions d. Determining cervical dilation and effacement

ANS: D Vaginal examination of the cervix may result in perforation of the placenta and subsequent hemorrhage and is therefore contraindicated. Monitoring FHR and maternal vital signs is a necessary part of the assessment for this woman. Monitoring for bleeding and rupture of membranes is not contraindicated in this woman. Monitoring contractions is not contraindicated in this woman.

Which statement made by a parent indicates an understanding about the management of a child with cellulitis on the arm? a. "I am supposed to continue the antibiotic until the redness and swelling disappear." b. "I have been putting ice on my son's arm to relieve the swelling." c. "I should call the doctor if the redness disappears." d. "I have been putting a warm soak on my son's arm every 4 hours."

ANS: D Warm soaks applied every 4 hours while the child is awake increase circulation to the infected area, relieve pain, and promote healing. The parent should not discontinue antibiotics when signs of infection disappear. To ensure complete healing, the parent should understand that the entire course of antibiotics should be given as prescribed. A warm soak is indicated for the treatment of cellulitis. Ice will decrease circulation to the affected area and inhibit the healing process. The disappearance of redness indicates healing and is not a reason to seek medical advice.

The process of burn shock continues until what physiologic mechanism occurs? a. Heart rate returns to normal. b. Airway swelling decreases. c. Body temperature regulation returns to normal. d. Capillaries regain their seal.

ANS: D Within minutes of the burn injury, the capillary seals are lost with a massive fluid leakage into the surrounding tissue, resulting in burn shock. The process of burn shock continues for approximately 24 to 48 hours, when capillary seals are restored. The heart rate will be increased throughout the healing process because of increased metabolism. Airway swelling subsides over a period of 2 to 5 days after injury. Body temperature regulation will not be normal until healing is well under way.

Which of the following is a true statement describing the differences in the pediatric genitourinary system compared with the adult genitourinary system? a. The young infant's kidneys can more effectively concentrate urine than an adult's kidneys. b. After 6 years of age, kidney function is nearly like that of an adult. c. Unlike adults, most children do not regain normal kidney function after acute renal failure. d. Young children have shorter urethras, which can predispose them to UTIs.

ANS: D Young children have shorter urethras, which can predispose them to UTIs. The young infant's kidneys cannot concentrate urine as efficiently as can those of older children and adults because the loops of Henle are not yet long enough to reach the inner medulla, where concentration and reabsorption occur. By 6 to 12 months of age, kidney function is nearly like that of an adult. Unlike adults, most children with acute renal failure regain normal function.

A child with secondary enuresis who complains of dysuria or urgency should be evaluated for what conditions? (Select all that apply.) a. Hypocalciuria b. Nephrotic syndrome c. Glomerulonephritis d. UTI e. Diabetes mellitus

ANS: D, E Complaints of dysuria or urgency from a child with secondary enuresis suggest the possibility of a UTI. If accompanied by excessive thirst and weight loss, these symptoms may indicate the onset of diabetes mellitus. An excessive loss of calcium in the urine (hypercalciuria) can be associated with complaints of painful urination, urgency, frequency, and wetting. Nephrotic syndrome is not usually associated with complaints of dysuria or urgency. Glomerulonephritis is not a likely cause of dysuria or urgency.

Alterations in acid-base balance can affect cellular metabolism and enzymatic processes. When alterations in pH become too much for buffer systems to handle, compensatory mechanisms are activated. If the pH drops below normal, then acidosis will occur. Is this statement true or false?

ANS: T Acidosis is the result of a drop in blood pH. The respiratory rate and depth will increase, removing carbon dioxide and raising blood pH. Conversely, in the presence of alkalosis, respiratory rate and depth decrease, lowering blood pH.

Which order should the nurse question when caring for a 5-year-old child after surgery for Hirschsprung disease? a. Monitor rectal temperature every 4 hours. b. Assess stools after surgery. c. Keep the child NPO until bowel sounds return. d. Maintain IV fluids at ordered rate.

ANS: A Rectal temperatures should not be taken after this surgery. Rectal temperatures are generally not the route of choice for children because of the route's traumatic nature. The other interventions are all appropriate after this operation.

The primary clinical manifestations of acute kidney injury are which of the following? a. Oliguria and hypertension b. Hematuria and pallor c. Proteinuria and muscle cramps d. Bacteriuria and facial edema

ANS: A The principal feature of acute kidney injury is oliguria, and many children are hypertensive. Hematuria, pallor, proteinuria, cramps, bacteriuria, and edema are not principal features.

The student nurse learns that maternal complications of diabetes include which of the following? (Select all that apply.) a. Atherosclerosis b. Retinopathy c. IUFD d. Nephropathy e. Caudal regression syndrome

ANS: A, B, D Maternal complications of diabetes include heart disease, retinopathy, nephropathy, and neuropathy. Stillbirth and caudal regression syndrome are fetal complications.

Which indicators of imminent death in a child should the nurse expect to assess? (Select all that apply.) a. Heart rate increases. b. Blood pressure increases. c. Respirations become rapid and shallow. d. The extremities become warm. e. Peripheral pulses become stronger.

ANS: A, C Indicators of imminent death include heart rate increasing, with a concomitant decrease in the strength and quality of peripheral pulses; respiratory effort decline, as evidenced by rapid, shallow respirations; and cool and cyanotic extremities. Increased BP, warm extremities, and strong peripheral pulses are not indicators of imminent death.

What corresponds to a 5-year-old child's understanding of death? a. Loss of a caretaker b. Reversible and temporary c. Permanent d. Inevitable

ANS: B Children in early childhood (2 to 7 years old) view death as reversible and temporary. Loss of a caretaker corresponds to the infant/toddler understanding of death. The school-age child and adolescent understand that death is permanent. The adolescent understands death not only as permanent but also inevitable.

After a tonic-clonic seizure, it would not be unusual for a child to display a. irritability and hunger. b. lethargy and confusion. c. nausea and vomiting. d. nervousness and excitability.

ANS: B In the period after a tonic-clonic seizure, the child may be confused and lethargic. Some children may sleep for a period of time. The other manifestations are not normally seen after a seizure.

Ringworm, frequently found in schoolchildren, is caused by a(n) a. virus. b. fungus. c. allergic reaction. d. bacterial infection.

ANS: B Ringworm is caused by a group of closely related filamentous fungi, which invade primarily the stratum corneum, hair, and nails. They are superficial infections that live on, not in, the skin. Ringworm is not caused by a virus, an allergic reactions, or a bacterial infection.

The primary treatment for warts is a. vaccination. b. local destruction. c. corticosteroids. d. specific antibiotic therapy.

ANS: B Topical treatments include chemical cautery, which is especially useful for the treatment of warts. Local destructive therapy individualized according to location, type, and number. Surgical removal, electrocautery, curettage, cryotherapy, caustic solutions, x-ray treatment, and laser therapies are used. Vaccinations, corticosteroids, and antibiotics will not eradicate warts.

What disorder is caused by a virus that primarily infects a specific subset of T lymphocytes, the CD4+ T cells? a. Raynaud phenomenon b. Idiopathic thrombocytopenic purpura c. Acquired immunodeficiency syndrome (AIDS) d. Severe combined immunodeficiency disease

ANS: C Acquired immunodeficiency is caused by the human immunodeficiency virus (HIV), which primarily attacks the CD4+ T cells. The other disorders are not viral in nature.

Which parasite causes acute diarrhea? a. Shigella organisms b. Salmonella organisms c. Giardia lamblia d. Escherichia coli

ANS: C Giardiasis a parasite that represents 15% of nondysenteric illness in the United States. The other organisms are bacterial.

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

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

To manage her diabetes appropriately and ensure a good fetal outcome, the pregnant woman with diabetes will need to alter her diet by doing which of the following? a. Eating six small equal meals per day b. Reducing carbohydrates in her diet c. Eating her meals and snacks on a fixed schedule d. Increasing her consumption of protein

ANS: C Having a fixed meal schedule will provide the woman and the fetus with a steadier blood sugar level, provide better balance with insulin administration, and help prevent complications. It is more important to have a fixed meal schedule than equal division of food intake or increased protein intake. Approximately 45% of the food eaten should be in the form of carbohydrates.

Which statement best characterizes hepatitis A? a. Incubation period is 6 weeks to 6 months. b. Principal mode of transmission is through the parenteral route. c. Onset is usually rapid and acute. d. There is a persistent carrier state.

ANS: C Hepatitis A is characterized by a rapid acute onset. The incubation period is approximately 3 weeks for hepatitis A. The principal mode of transmission for hepatitis A is the fecal-oral route. Hepatitis A does not have a carrier state.

What is the only known cure for preeclampsia? a. Magnesium sulfate b. Antihypertensive medications c. Delivery of the fetus d. Administration of acetylsalicylic acid (ASA) every day of the pregnancy

ANS: C If the fetus is viable and near term, delivery is the only known definitive treatment for preeclampsia. Magnesium sulfate is one of the medications used to treat but not to cure preeclampsia. Antihypertensive medications are used to lower the dangerously elevated blood pressures in preeclampsia and eclampsia. Low doses of ASA (81 mg) have been administered to women at high risk for developing preeclampsia.

What is an appropriate nursing intervention for the child with a tension headache? a. Assess for an aura. b. Maintain complete bed rest. c. Administer mild pain medication. d. Assess for nausea and vomiting.

ANS: C Mild pain relievers like acetaminophen or ibuprofen are appropriate for the child with a tension headache. The other measures are not warranted.

The primary symptom present in abruptio placentae that distinguishes it from placenta previa is a. vaginal bleeding. b. rupture of membranes. c. presence of abdominal pain. d. changes in maternal vital signs.

ANS: C Pain in abruptio placentae occurs in response to increased pressure behind the placenta and within the uterus. Placenta previa manifests with painless vaginal bleeding, but both may have vaginal bleeding. Rupture of membranes may occur with both conditions. Maternal vital signs may change with both if bleeding is pronounced.

Of adolescents who become pregnant, what percentage have had a previous birth? a. 10% b. 15% c. 17% d. 35%

ANS: C Seventeen percent of pregnant adolescents have had one or more previous births.

In caring for a pregnant woman with sickle cell anemia the nurse is aware that signs and symptoms of sickle cell crisis include a. anemia. b. endometritis. c. fever and pain. d. urinary tract infection.

ANS: C Women with sickle cell anemia have recurrent attacks (crisis) of fever and pain, most often in the abdomen, joints, and extremities. These attacks are attributed to vascular occlusion when RBCs assume the characteristic sickled shape. Crises are usually triggered by dehydration, hypoxia, or acidosis. Signs of crisis do not include anemia, endometriosis, or UTI.

Which statement by a parent of a child with nephrotic syndrome indicates an understanding of a no-added-salt diet? a. "I can give my child sweet pickles." b. "My child can put ketchup on his hotdog." c. "I can let my child have potato chips." d. "I do not put any salt in foods when I am cooking."

ANS: D A no-added-salt diet means that no salt should be added to foods, either when cooking or before eating. Pickles of any type, hotdogs, and potato chips are all prohibited on this diet.

Which of the following is an accurate description of anemia? a. Increased blood viscosity b. Depressed hematopoietic system c. Presence of abnormal hemoglobin d. Decreased oxygen-carrying capacity of blood

ANS: D Anemia is a condition in which the number of red blood cells or hemoglobin concentration is reduced below the normal values for age. This results in a decreased oxygen- carrying capacity of blood. Increased blood viscosity is usually a function of too many cells or of dehydration, not of anemia. A depressed hematopoietic system or abnormal hemoglobin can contribute to anemia, but the definition is dependent on the deceased oxygen-carrying capacity of the blood. A depressed hematopoietic system or abnormal hemoglobin can contribute to anemia, but the definition is dependent on the decreased oxygen-carrying capacity of the blood.

In which situation is a dilation and curettage (D&C) indicated? a. Complete abortion at 8 weeks b. Incomplete abortion at 16 weeks c. Threatened abortion at 6 weeks d. Incomplete abortion at 10 weeks

ANS: D D&C is used to remove the products of conception from the uterus and can be used safely until week 14 of gestation. After that there is a greater risk of excessive bleeding, and this procedure may not be used. If all the products of conception have been passed (complete abortion), a D&C is not used. If the pregnancy is still viable (threatened abortion), a D&C is not used.

Which of the following is an appropriate nursing measure when a baby has an unexpected anomaly? a. Remove the baby from the delivery area immediately. b. Tell the parents that the baby has to go to the nursery immediately. c. Inform the parents immediately that something is wrong. d. Explain the defect, and show the baby to the parents as soon as possible.

ANS: D Parents experience less anxiety when they are told about the defect as early as possible and are allowed to touch and hold the baby. The parents should be both informed and able to touch and hold the baby as soon as possible.

What is the priority in the discharge plan for a child with immune thrombocytopenic purpura (ITP)? a. Teaching the parents to report excessive fatigue to the physician b. Monitoring the child's hemoglobin level every 2 weeks c. Providing a diet that contains iron-rich foods d. Establishing a safe, age-appropriate home environment

ANS: D Prevention of injury is a priority concern for a child with ITP. Excessive fatigue is not a significant problem for the child with ITP. ITP is associated with low platelet levels, not hemoglobin. Increasing the child's intake of iron in the diet will not correct ITP.

A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Nursing care is based on the knowledge that a. bed rest and analgesics are the recommended treatment. b. she will be unable to conceive in the future. c. a D&C will be performed to remove the products of conception. d. hemorrhage is the major concern.

ANS: D Severe bleeding occurs if the fallopian tube ruptures. The recommended treatment is to remove the pregnancy before hemorrhaging. If the tube must be removed, her fertility will decrease but she will not be infertile. A D&C is done on the inside of the uterine cavity. The ectopic pregnancy is located within the tubes.

What is the definitive diagnostic test for sickle cell disease?

hemoglobin electrophoresis

The nursing student learns how infants acquire immunity. Which statement about this process is correct? a. The infant acquires humoral and cell-mediated immunity in response to infections and immunizations. b. The infant acquires maternal antibodies that ensure immunity up to 12 months age. c. Active immunity is acquired from the mother and lasts 6 to 7 months. d. Passive immunity develops in response to immunizations.

ANS: A Infants acquire long-term active immunity from exposure to antigens and vaccines. Immunity is acquired actively and passively. The term infant's passive immunity is acquired from the mother and begins to dissipate during the first 6 to 8 months of life. Passive immunity is acquired from the mother. Active immunity develops in response to immunizations.

The earliest clinical manifestation of biliary atresia is a. jaundice. b. vomiting. c. hepatomegaly. d. absence of stooling.

ANS: A Jaundice is the earliest and most striking manifestation of biliary atresia. It is first observed in the sclera, may be present at birth, but is usually not apparent until age 2 to 3 weeks. Vomiting is not associated with biliary atresia. Hepatomegaly and abdominal distention are common but occur later. Stools are large and lighter in color than expected because of the lack of bile.

Which suggestion is appropriate to teach a mother who has a preschool child who refuses to take the medications for HIV infection? a. Mix medications with chocolate syrup or pudding b. Mix the medications with milk or an essential food. c. Skip the dose of medication if the child protests too much. d. Mix the medication in a syringe, hold the child down firmly, and administer the medication.

ANS: A Adding medication to a small amount of nonessential food the child finds tasty may be helpful in gaining the child's cooperation. Doses of medication should never be skipped. Fighting with the child or using force should be avoided. A nonessential food that will make the taste of the medication more palatable for the child should be the correct action. The administration of medications for the child with HIV becomes part of the family's everyday routine for years.

The nurse is planning care for an adolescent with AIDS. The priority nursing goal is to a. prevent infection. b. prevent secondary cancers. c. restore immunologic defenses. d. identify sources of infection.

ANS: A As a result of the immunocompromise that is associated with HIV infection, the prevention of infection is paramount. Preventing secondary cancers is not currently possible. Current drug therapy is affecting the disease progression; although not a cure, these drugs can suppress viral replication and prevent further deterioration. Case finding is not a priority nursing goal.

Which diet would the nurse recommend to the mother of a child who is having mild diarrhea? a. Rice, potatoes, yogurt, cereal, and cooked carrots b. Bananas, rice, applesauce, and toast c. Apple juice, hamburger, and salad d. Whatever the child would like to eat

ANS: A Bland but nutritious foods including complex carbohydrates (rice, wheat, potatoes, cereals), yogurt, cooked vegetables, and lean meats are recommended to prevent dehydration and hasten recovery. Bananas, rice, applesauce, and toast used to be recommended for diarrhea (BRAT diet). These foods are easily tolerated, but the BRAT diet is low in energy, density, fat, and protein. Fatty foods, spicy foods, and foods high in simple sugars should be avoided. The child should be offered foods he or she likes but should not be encouraged to eat fatty foods, spicy foods, and foods high in simple sugars.

What is the primary nursing concern for a hospitalized child with HIV infection? a. Maintaining growth and development b. Eating foods that the family brings to the child c. Consideration of parental limitations and weaknesses d. Resting for 2 to 3 hours twice a day

ANS: A Maintaining growth and development is a major concern for the child with HIV infection. Frequent monitoring for failure to thrive, neurologic deterioration, or developmental delay is important for HIV-infected infants and children. Nutrition, which contributes to a child's growth, is a nursing concern; however, it is not necessary for family members to bring food to the child. Although an assessment of parental strengths and weaknesses is important, it will be imperative for health care providers to focus on the parental strengths, not weaknesses. This is not as important as the frequent assessment of the child's growth and development. Rest is a nursing concern, but it is not as high a priority as maintaining growth and development. Rest periods twice a day for 2 to 3 hours may or may not be appropriate.

What is an expected outcome for the child with irritable bowel disease? a. Decreasing symptoms b. Adherence to a low-fiber diet c. Increasing milk products in the diet d. Adapting the lifestyle to the lifelong problems

ANS: A Management of irritable bowel disease is aimed at identifying and decreasing exposure to triggers and decreasing bowel spasms, which will decrease symptoms. Management includes maintenance of a healthy, well -balanced, moderate-fiber, lower fat diet. A moderate amount of fiber in the diet is indicated for the child with irritable bowel disease. No modification in dairy products is necessary unless the child is lactose intolerant. Irritable bowel syndrome is typically self-limiting and resolves by age 20 years.

What is the best response for the nurse to give a parent about contacting the physician regarding an infant with diarrhea? a. "Call your pediatrician if the infant has not had a wet diaper for 6 hours." b. "The pediatrician should be contacted if the infant has two loose stools in an 8-hour period." c. "Call the doctor immediately if the infant has a temperature greater than 100° F." d. "Notify the pediatrician if the infant naps more than 2 hours."

ANS: A No urine output in 6 hours needs to be reported because it indicates dehydration. Two loose stools in 8 hours is not a serious concern. If blood is obvious in the stool or the frequency increases to one bowel movement every hour for more than 8 hours, the physician should be notified. A fever greater than 101° F should be reported to the infant's physician. It is normal for the infant who is not ill to nap for 2 hours. The infant who is ill may nap longer than the typical amount.

What is the most common mode of transmission of human immunodeficiency virus (HIV) in the pediatric population? a. Perinatal transmission b. Sexual abuse c. Blood transfusions d. Poor handwashing

ANS: A Perinatal transmission accounts for the highest percentage (91%) of HIV infections in children. Infected women can transmit the virus to their infants across the placenta during pregnancy, at delivery, and through breastfeeding. Cases of HIV infection from sexual abuse have been reported; however, perinatal transmission accounts for most pediatric HIV infections. Although in the past some children became infected with HIV through blood transfusions, improved laboratory screening has significantly reduced the probability of contracting HIV from blood products. Poor handwashing is not an etiology of HIV infection.

Parents report their 3-year-old child appears restless at night and frequently scratches her anal area. What action by the nurse is best? a. Educate parents on the cellophane tape test. b. Review hygiene practices with the parents. c. Suggest the child sleep only in pajama tops. d. Ask parents to bring in a stool sample.

ANS: A The cellophane tape test is used to diagnose pinworms. The parents place a strip of cellophane tape on the child's anus at bedtime and brings it to the clinic for microscopic evaluation. There is no need to review hygienic practices, suggest sleeping in a pajama top only, or to bring in a stool sample.

Which intervention is appropriate for a hospitalized child who has crops of lesions on the trunk that appear as a macular rash and vesicles? a. Place the child in strict isolation with airborne and contact precautions. b. Continue to practice Standard Precautions. c. Pregnant women should avoid contact with the child. d. Screen visitors for immunity to measles.

ANS: A The child's skin lesions are characteristic of varicella. Varicella is transmitted through direct contact, droplets, and airborne particles. In the hospital setting, children with varicella should be placed in strict isolation, and on contact and airborne precautions. The purpose is to prevent transmission of microorganisms by inhalation of small -particle droplet nuclei and to protect other patients and health care providers from acquiring this disease. Standard Precautions are not sufficient for this disease. Certain viral illnesses such as rubella and fifth disease are known to affect the fetus if the woman contracts the disease during pregnancy. This child appears to have varicella. Pregnancy is not a contraindication to caring for a child with varicella. However, all health care personnel should be vaccinated or show immunity to varicella. Screening visitors for immunity to measles is irrelevant. It is important to screen visitors for immunity to varicella.

A nurse in a well-child clinic is teaching parents about their child's immune system. Which statement by the nurse is correct? a. The immune system distinguishes and actively protects the body's own cells from foreign substances. b. The immune system is fully developed by 1 year of age. c. The immune system protects the child against communicable diseases in the first 6 years of life. d. The immune system responds to an offending agent by producing antigens.

ANS: A The immune system responds to foreign substances, or antigens, by producing antibodies and storing information. Intact skin, mucous membranes, and processes such as coughing, sneezing, and tearing help maintain internal homeostasis. Children up to age 6 or 7 years have limited antibodies against common bacteria. The immunoglobulins reach adult levels at different ages. Immunization is the basis from which the immune system activates protection against some communicable diseases. Antibodies are produced by the immune system against invading agents, or antigens.

The mother of an HIV-positive infant who is 2 months old questions the nurse about which childhood immunizations her child will be able to receive. Which immunizations should an HIV-positive child be able to receive? (Select all that apply.) a. Hepatitis B b. DTaP c. MMR d. IPV e. HIB

ANS: A, B, D, E Routine immunizations are appropriate. The MMR vaccination is not given at 2 months of age. If it were indicated, CD4+ counts are monitored when deciding whether to provide live virus vaccines. If the child is severely immunocompromised, the MMR vaccine is not given. The varicella vaccine can be considered on the basis of the child's CD4+ counts. Only IPV should be used for HIV-infected children.

A baby is scheduled for abdominal surgery for hypertrophic pyloric stenosis and has an NG tube to intermittent suction. When the family asks why the child has the tube, what response by the nurse is best? a. "The nasogastric tube decompresses the abdomen and decreases vomiting." b. "We can keep a more accurate measure of intake and output with the tube." c. "The tube is used to decrease postoperative diarrhea." d. "The nasogastric tube makes the baby more comfortable after surgery."

ANS: A The nasogastric tube provides decompression and decreases vomiting. A nursing responsibility when a patient has a nasogastric tube is measurement of accurate intake and output, but this is not why nasogastric tubes are inserted. Nasogastric tube placement does not decrease diarrhea. The presence of a nasogastric tube can be perceived as a discomfort by the patient.

The nurse observes a rash on a teen's face which is characteristic of systemic lupus erythematosus (SLE). What action by the nurse is most appropriate? a. Teach the teen about using sunscreen. b. Prepare the teen for a bone marrow biopsy. c. Educate the teen on proper use of antibiotics. d. Demonstrate how to use an Epi-pen.

ANS: A The nurse needs to provide education on managing the disease; one facet includes minimizing sun exposure so the nurse teaches the teen about the correct use of sunscreen. The teen will not have a bone marrow biopsy, need antibiotics, or have to use an Epi-pen.

Which treatment provides the best chance of survival for a child with cirrhosis? a. Liver transplantation b. Treatment with corticosteroids c. Treatment with immune globulin d. Provision of nutritional support

ANS: A The only successful treatment for end-stage liver disease and liver failure may be liver transplantation, which has improved the prognosis for many children with cirrhosis.

A nurse is working in an allergy clinic and has performed skin testing on an adolescent. Seventeen minutes after the procedure, the nurse note the presence of a wheal at one of the sites. What conclusion does the nurse make about this response? a. The child is allergic to that substance. b. This result is indeterminate. c. The testing should be redone in another location. d. Anaphylaxis is imminent.

ANS: A The presence of a wheal within 30 minutes of skin testing is indicative of an allergy to the substance used. The test does not need to be repeated, and anaphylaxis is not imminent.

Which action is the primary concern in the treatment plan for a child with persistent vomiting? a. Detecting the cause of vomiting b. Preventing metabolic acidosis c. Positioning the child to prevent further vomiting d. Recording intake and output

ANS: A The primary focus of managing vomiting is detection of the cause and then treatment of the cause. Metabolic alkalosis results from persistent vomiting. Prevention of complications is the secondary focus of treatment. The child with persistent vomiting should be positioned upright or side-lying to prevent aspiration. Recording intake and output is a nursing intervention, but it is not the primary focus of treatment.

The nurse notes on assessment that a 1-year-old child is underweight, with abdominal distention, thin legs and arms, and foul-smelling stools. The nurse suspects failure to thrive is associated with a. Celiac disease b. Intussusception c. Irritable bowel syndrome d. Imperforate anus

ANS: A These are classic symptoms of celiac disease. They are not related to intussusception, irritable bowel syndrome, or an imperforate anus.

Bismuth subsalicylate, clarithromycin, and metronidazole are prescribed for a child with a peptic ulcer for what purpose? a. Eradicate Helicobacter pylori b. Coat gastric mucosa c. Treat epigastric pain d. Reduce gastric acid production

ANS: A This combination of drug therapy is effective in the treatment of H. pylori, the most common cause of ulcers in children.

The nurse is caring for a neonate with a suspected tracheoesophageal fistula (TEF). Nursing care should include which of the following? a. Elevating the head but give nothing by mouth b. Elevating the head for feedings c. Feeding glucose water only d. Avoiding suction unless infant is cyanotic

ANS: A When a newborn is suspected of having TEF, the most desirable position is supine with the head elevated on an incline plane of at least 30 degrees. It is imperative that any source of aspiration be removed at once; oral feedings are withheld. Feedings should not be given to infants suspected of having TEF. The oral pharynx should be kept clear of secretion by oral suctioning. This is to avoid cyanosis that is usually the result of laryngospasm caused by overflow of saliva into the larynx.

A nurse is teaching a group of parents about TEF. Which statement made by the nurse is accurate about TEF? a. This defect results from an embryonal failure of the foregut to differentiate into the trachea and esophagus. b. It is a fistula between the esophagus and stomach that results in the oral intake being refluxed and aspirated. c. An extra connection between the esophagus and trachea develops because of genetic abnormalities. d. The defect occurs in the second trimester of pregnancy.

ANS: A When the foregut does not differentiate into the trachea and esophagus during the fourth to fifth week of gestation, a TEF occurs. A TEF is an abnormal connection between the esophagus and trachea. There is no connection between the trachea and esophagus in normal fetal development. This defect occurs early in pregnancy during the fourth to fifth week of gestation.

A preschooler is diagnosed with helminths. The child's mother is very upset and wants to know how her child could have contracted this illness. After obtaining a detailed history, the nurse identifies all possible transmission modes. What do they include? (Select all that apply.) a. Playing in the backyard sandbox b. Not washing hands before eating c. Placing hands in the mouth and nail biting d. Skin-to-skin contact with other children e. Scratches from a neighborhood cat

ANS: A, B, C Common helminths include roundworm, pinworm, tapeworm, and hookworm. Children are frequently infected as the result of frequent hand-mouth activity (unwashed hands, nail biting, not washing hands after using the toilet) and the likelihood of fecal contamination from sandboxes (especially if dogs and cats deposit fecal material in them). Other causes include not adequately washing fruits and vegetables before eating them and drinking contaminated water. Skin-to-skin contact with other children and scratches from a cat are not transmission modes for helminths.

Which home care instructions should the nurse provide to the parents of a child with acquired immunodeficiency syndrome (AIDS)? (Select all that apply.) a. Give supplemental vitamins as prescribed. b. Yearly influenza vaccination should be avoided. c. Administer any antibiotics as prescribed. d. Notify the provider if the child develops a cough or congestion. e. Missed doses of antiretroviral medication should just be skipped.

ANS: A, C, D The parents are taught that vitamins are important, to have the child take all antibiotics (if prescribed) as ordered, and to notify the provider of coughs or congestion. The child should have yearly influenza vaccination, and if missed medication doses are noticed close to their scheduled time, they should be taken.

Which assessment findings indicate to the nurse that a child has excess fluid volume? (Select all that apply.) a. Weight gain b. Decreased blood pressure c. Moist breath sounds d. Poor skin turgor e. Rapid bounding pulse

ANS: A, C, E A child with fluid volume excess will have a weight gain, moist breath sounds due to the excess fluid in the pulmonary system, and a rapid bounding pulse. Other signs seen with fluid volume excess are increased blood pressure, edema, and fatigue. Decreased blood pressure and poor skin turgor are signs of fluid volume deficit.

What is an expected outcome for a 1-month-old infant with biliary atresia? a. Correction of the defect with the Kasai procedure b. Adequate nutrition and age-appropriate growth and development c. Adherence to a salt-free diet with vitamin B12 supplementation d. Remaining compliant with a high-protein diet

ANS: B Adequate nutrition, preventing skin breakdown, adequate growth and development, and family education and support are expected outcomes in an infant with biliary atresia. The goal of the Kasai procedure is to allow for adequate growth until a transplant can be done. It is not a curative procedure. Vitamin B 12 supplementation is not indicated. A salt-restricted diet is appropriate. Protein intake may need to be restricted to avoid hepatic encephalopathy.

A young child with HIV is receiving several antiretroviral drugs. What is the purpose of these drugs? a. Cure the disease. b. Delay disease progression. c. Prevent the spread of disease. d. Treat Pneumocystis jiroveci pneumonia.

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

What is the best response by the nurse to a parent asking about antidiarrheal medication for her 18-month-old child? a. "It is okay to give antidiarrheal medication to a young child as long as you follow the directions on the box for correct dosage." b. "Antidiarrheal medication is not recommended for young children because it slows the body's attempt to rid itself of the pathogen." c. "I'm sure your child won't like the taste, so give extra fluids when you give the medication." d. "Antidiarrheal medication will lessen the frequency of stools, but give your child Gatorade to maintain electrolyte balance."

ANS: B Antidiarrheal medications may actually prolong diarrhea because the body will retain the organism causing the diarrhea, further increasing fluid and electrolyte losses. The use of these medications is not recommended for children younger than 2 years old because of their binding nature and potential for toxicity. Antidiarrheal medications are not recommended for children younger than 2 years old. This action is inappropriate because antidiarrheal medications should not be given to a child younger than 2 years old. It is not appropriate to advise a parent to use antidiarrheal medication for a child younger than 2 years old. Education about appropriate oral replacement fluids includes avoidance of sugary drinks, apple juice, sports beverages, and colas.

What is the best response by the nurse to a mother asking about the cause of her infant's bilateral cleft lip? a. "Did you use alcohol during your pregnancy?" b. "Does anyone in your family have a cleft lip or palate?" c. "This defect is associated with intrauterine infection during the second trimester." d. "The prevalent of cleft lip is higher in Caucasians."

ANS: B Cleft lip and palate result from embryonic failure resulting from multiple genetic and environmental factors. A genetic pattern or familial risk seems to exist. Tobacco during pregnancy (not drinking) has been associated with bilateral cleft lip. The defect occurred at approximately 6 to 8 weeks of gestation. Second-trimester intrauterine infection is not a known cause of bilateral cleft lip. The prevalence of cleft lip and palate is higher in Asian and Native American populations.

Which statement about Crohn disease is the most accurate? a. The signs and symptoms of Crohn disease are usually present at birth. b. Signs and symptoms of Crohn disease include cramping, diarrhea, and weight loss. c. Edema usually accompanies this disease. d. Symptoms of Crohn disease usually disappear by late adolescence.

ANS: B Common manifestations of Crohn disease include abdominal cramping, diarrhea, and weight loss. Signs and symptoms are not usually present at birth. Edema does not accompany this disease. Symptoms do not typically disappear by adolescence.

Which assessment finding should the nurse expect in an infant with Hirschsprung disease? a. "Currant jelly" stools b. Constipation with passage of foul-smelling, ribbon-like stools c. Foul-smelling, fatty stools d. Diarrhea

ANS: B Constipation results from absence of ganglion cells in the rectum and colon and is present since the neonatal period with passage of frequent foul-smelling, ribbon-like, or pellet-like stools. "Currant jelly" stools are associated with intussusception. Foul-smelling, fatty stools are associated with cystic fibrosis and celiac disease. Diarrhea is not typically associated with Hirschsprung disease but may result from impaction.

A child has irritable bowel syndrome. The nurse is teaching the parents about the pathophysiology associated with the symptoms their child is experiencing. Which response indicates to the nurse that teaching has been effective? a. "My child has an absence of ganglion cells in the rectum causing alternating diarrhea and constipation." b. "The cause of my child's diarrhea and constipation is disorganized intestinal contractility." c. "My child has an intestinal obstruction; that's why he has abdominal pain." d. "My child has an intolerance to gluten, and this causes him to have abdominal pain."

ANS: B Disorganized contractility and increased mucous production are precipitating factors of irritable bowel disease. The absence of ganglion cells in the rectum is associated with Hirschsprung disease. Intestinal obstruction is associated with pyloric stenosis. Intolerance to gluten is the underlying cause of celiac disease.

What is the most important action to prevent the spread of gastroenteritis in a daycare setting? a. Administering prophylactic medications to children and staff b. Frequent handwashing c. Having parents bring food from home d. Directing the staff to wear gloves at all times

ANS: B Handwashing is the most the important measure to prevent the spread of infectious diarrhea. Prophylactic medications are not helpful in preventing gastroenteritis. Bringing food from home will not prevent the spread of infectious diarrhea. Gloves should be worn when changing diapers, soiled clothing, or linens. They do not need to be worn for interactions that do not involve contact with secretions. Handwashing after contact is indicated.

What should be included in health teaching to prevent Lyme disease? a. Complete the immunization series in early infancy. b. Use insect repellant with DEET in heavily wooded areas. c. Give low-dose antibiotics to the child before exposure. d. Restrict activities that might lead to exposure for the child.

ANS: B Insect repellant with DEET can prevent insect bites. Currently there is no vaccine available for Lyme disease. Antibiotics are used to treat, not prevent, Lyme disease. Children should be allowed to maintain normal growth and development with activities such as hiking.

What is the most important factor in determining the rate of fluid replacement in the dehydrated child? a. The child's weight b. The type of dehydration c. Urine output d. Serum potassium level

ANS: B Isonatremic and hyponatremic dehydration resuscitation involves fluid replacement over 24 hours. Hypernatremic dehydration involves a slower replacement rate to prevent a sudden decrease in the sodium level. The child's weight determines the amount of fluid needed, not the rate of fluid replacement. One milliliter of body fluid is equal to 1 g of body weight; therefore a loss of 1 kg (2.2 lb) is equal to 1 L of fluid. Urine output is not a consideration for determining the rate of administration of replacement fluids. Potassium level is not as significant in determining the rate of fluid replacement as the type of dehydration.

What should the nurse expect to observe in the prodromal phase of rubeola? a. Macular rash on the face b. Koplik spots c. Petechiae on the soft palate d. Crops of vesicles on the trunk

ANS: B Koplik spots appear approximately 2 days before the appearance of a rash. The macular rash with rubeola appears after the prodromal stage. Petechiae on the soft palate occur with rubella. Crops of vesicles on the trunk are characteristic of varicella.

What is the primary nursing concern for a child having an anaphylactic reaction? a. Identifying the offending allergen b. Ineffective breathing pattern c. Increased cardiac output d. Positioning to facilitate comfort

ANS: B Laryngospasms resulting in ineffective breathing patterns is a life-threatening manifestation of anaphylaxis. The primary action is to assess airway patency, respiratory rate and effort, level of consciousness, oxygen saturation, and urine output. Determining the cause of an anaphylactic reaction is important to implement the appropriate treatment, but the primary concern is the airway. During anaphylaxis, the cardiac output is decreased. Positioning for comfort is not a primary concern during a crisis.

What is an expected outcome for the parents of a child with encopresis? a. The parents will give the child an enema daily for 3 to 4 months. b. The family will develop a plan to achieve control over incontinence. c. The parents will have the child launder soiled clothes. d. The parents will supply the child with a low-fiber diet.

ANS: B Parents of the child with encopresis often feel guilty and believe that encopresis is willful on the part of the child. The family functions effectively by openly discussing problems and developing a plan to achieve control over incontinence. Stool softeners or laxatives, along with dietary changes, are typically used to treat encopresis. Enemas are indicated when a fecal impaction is present. This action is a punishment and will increase the child's shame and embarrassment. The child should not be punished for an action that is not willful. Increasing fiber in the diet and fluid intake results in greater bulk in the stool, making it easier to pass.

How should the nurse respond to a parent who asks, "How can I protect my baby from whooping cough?" a. "Don't worry; your baby will have maternal immunity to pertussis that will last until approximately 18 months old." b. "Make sure your child gets the pertussis vaccine." c. "See the doctor when the baby gets a respiratory infection." d. "Have your pediatrician prescribe erythromycin."

ANS: B Primary prevention of pertussis can be accomplished through administration of the pertussis vaccine. Infants do not receive maternal immunity to pertussis and are susceptible to pertussis. Pertussis is highly contagious and is associated with a high infant mortality rate. Prompt evaluation by the primary care provider for respiratory illness will not prevent pertussis. Erythromycin is used to treat pertussis. It will not prevent the disease.

Which is the Centers for Disease Control and Prevention (CDC, 2009) recommendation for immunizing infants who are HIV positive? a. Follow the routine immunization schedule. b. Routine immunizations are administered; assess CD4+ counts before administering the MMR and varicella vaccinations. c. Do not give immunizations because of the infant's altered immune status. d. Eliminate the pertussis vaccination because of the risk of convulsions.

ANS: B Routine immunizations are appropriate. CD4+ cells are monitored when deciding whether to provide live virus vaccines. If the child is severely immunocompromised, the MMR vaccine is not given. The varicella vaccine can be considered on the basis of the child's CD4+ counts. Only inactivated polio virus (IPV) should be used for HIV-infected children. The pertussis vaccination is not eliminated for an infant who is HIV positive.

A 4-month-old infant has gastroesophageal reflux (GER) but is thriving without other complications. What should the nurse suggest to minimize reflux? a. Place in the Trendelenburg position after eating. b. Thicken formula with rice cereal. c. Give continuous nasogastric tube feedings. d. Give larger, less frequent feedings.

ANS: B Small frequent feedings of formula combined with 1 teaspoon to 1 tablespoon of rice cereal per ounce of formula have been recommended. Milk thickening agents have been shown to decrease the number of episodes of vomiting and to increase the caloric density of the formula. This may benefit infants who are underweight as a result of GERD. Placing the child in a Trendelenburg position increases the reflux. Continuous nasogastric feedings are reserved for infants with severe reflux and failure to thrive. Smaller, more frequent feedings are recommended in reflux.

Which assessment finding is the most significant to report to the physician for a child with cirrhosis? a. Weight loss b. Change in level of consciousness c. Skin with pruritus d. Black, foul-smelling stools

ANS: B The child with cirrhosis must be assessed for encephalopathy, which is characterized by a change in level of consciousness. Encephalopathy can result from a buildup of ammonia in the blood from the incomplete breakdown of protein. One complication of cirrhosis is ascites. The child needs to be assessed for increasing abdominal girth and edema. A child who is retaining fluid will not exhibit weight loss. Biliary obstruction can lead to pruritus, which is a frequent finding. An alteration in the level of consciousness is of higher priority. Black, tarry stools may indicate blood in the stool. This needs be reported

A nurse is conducting a health education class for a group of school-age children. Which statement made by the nurse is correct about the body's first line of defense against infection in the innate immune system? a. Nutritional status b. Skin integrity c. Immunization status d. Proper hygiene practices

ANS: B The first lines of defense in the innate immune system are the skin and intact mucous membranes. Nutritional status is an indicator of overall health, but it is not the first line of defense in the innate immune system. Immunizations provide artificial immunity or resistance to harmful diseases. Practicing good hygiene may reduce susceptibility to disease, but it is not a component of the innate immune system.

What is the best response to a parent of a 2-month-old infant who asks when the infant should first receive the measles vaccine? a. "Your baby can get the measles vaccine now." b. "The first dose is given any time after the first birthday." c. "She should be vaccinated between 4 and 6 years of age." d. "This vaccine is administered when the child is 11 years old."

ANS: B The first measles, mumps, rubella (MMR) vaccine is recommended routinely at 1 year of age. The other statements are not correct.

A hospitalized child has developed a methicillin-resistant Staphylococcus aureus (MRSA) infection. The nurse plans which interventions when caring for this child? (Select all that apply.) a. Airborne isolation b. Administration of vancomycin c. Contact isolation d. Administration of mupirocin ointment to the nares if colonized e. Administration of cefotaxime (Cefotetan)

ANS: B, C, D Vancomycin is used to treat MRSA along with mupirocin ointment to the nares. The patient is placed in contact isolation to prevent spread of the infection to other patients. The infection is not transmitted by the airborne route so only contact isolation is required. This infection is resistant to cephalosporins.

The nurse caring for a child with suspected appendicitis should question which order from the physician? a. Keep patient NPO. b. Start IV of D5/0.45 normal saline at 60 mL/hr. c. Apply K-pad to abdomen prn for pain. d. Obtain CBC on admission to nursing unit.

ANS: C A K-pad (moist heat device) is contraindicated for suspected appendicitis because it may contribute to the rupture of the appendix. NPO status, an IV, and a CBC are all appropriate for this child.

What maternal assessment is related to an infant's diagnosis of TEF? a. Maternal age more than 40 years b. First term pregnancy for the mother c. Maternal history of polyhydramnios d. Complicated pregnancy

ANS: C A maternal history of polyhydramnios is associated with TEF. Advanced maternal age, first term pregnancy, or complicated pregnancy are not related.

What clinical manifestation should a nurse be alert for when suspecting a diagnosis of esophageal atresia? a. A radiograph in the prenatal period indicates abnormal development. b. It is visually identified at the time of delivery. c. A nasogastric tube fails to pass at birth. d. The infant has a low birth weight.

ANS: C Atresia is suspected when a nasogastric tube fails to pass 10 to 11 cm beyond the gum line. Abdominal radiographs will confirm the diagnosis. Prenatal radiographs do not provide a definitive diagnosis. The defect is not externally visible. Bronchoscopy and endoscopy can be used to identify this defect. Infants with esophageal atresia may have been born prematurely and with a low birth weight, but neither is suggestive of the presence of an esophageal atresia.

Which assessment is most relevant to the care of an infant with dehydration? a. Temperature, heart rate, and blood pressure b. Respiratory rate, oxygen saturation, and lung sounds c. Heart rate, sensorium, and skin color d. Diet tolerance, bowel function, and abdominal girth

ANS: C Changes in heart rate, sensorium, and skin color are early indicators of impending shock in the child. Children can compensate and maintain an adequate cardiac output when they are hypovolemic. Blood pressure is not as reliable an indicator of shock as are changes in heart rate, sensorium, and skin color. Respiratory assessments will not provide data about impending hypovolemic shock. Diet tolerance, bowel function, and abdominal girth are not as important indicators of shock as heart rate, sensorium, and skin color.

What is used to treat moderate to severe inflammatory bowel disease? a. Antacids b. Antibiotics c. Corticosteroids d. Antidiarrheal medications

ANS: C Corticosteroids, such as prednisone and prednisolone, are used in short bursts to suppress the inflammatory response in inflammatory bowel disease. Antacids and antidiarrheals are not used. Antibiotics may be used to treat complications.

A 5-year-old child has acquired immunodeficiency syndrome (AIDS). What statement by the mother indicates good understanding of medications used for this condition? a. "When my child's pain increases, I double the recommended dosage of antiretroviral medication." b. "Addiction is a risk, so I only use the medication as ordered." c. "Doses of the antiretroviral medication are selected on the basis of my child's age and growth." d. "By the time my child is an adolescent she will not need her antiretroviral medications any longer."

ANS: C Doses of antiretroviral medication to treat HIV infection for infants and children are based on individualized age and growth considerations. Antiretroviral medications are not administered for pain relief. Addiction is not a realistic concern with antiretroviral medications. Antiretroviral medications are still needed during adolescence.

What is a priority concern for a 14-year-old child with inflammatory bowel disease? a. Compliance with antidiarrheal medication therapy b. Long-term complications c. Dealing with the embarrassment and stress of diarrhea d. Home schooling due to extreme absenteeism

ANS: C Embarrassment and stress from chronic diarrhea are real concerns for the adolescent with inflammatory bowel disease. Antidiarrheal medications are not typically ordered for a child with inflammatory bowel disease. Long-term complications are not a priority concern for the adolescent with inflammatory bowel disease. Exacerbations may interfere with school attendance, but home schooling is not a usual consideration for the adolescent with inflammatory bowel disease.

A nurse has admitted a child to the hospital with a diagnosis of "rule out" peptic ulcer disease. Which test will the nurse expect to be ordered to confirm the diagnosis of a peptic ulcer? a. A dietary history b. A positive Hematest result on a stool sample c. A fiberoptic upper endoscopy d. An abdominal ultrasound

ANS: C Endoscopy provides direct visualization of the stomach lining and confirms the diagnosis of peptic ulcer. Dietary history may yield information suggestive of a peptic ulcer. Blood in the stool indicates a gastrointestinal abnormality, but it does not conclusively confirm a diagnosis of peptic ulcer. An abdominal ultrasound is used to rule out other gastrointestinal alterations such as gallstones, tumor, or mechanical obstruction.

What is the drug of choice the nurse should administer in the acute treatment of anaphylaxis? a. Diphenhydramine b. Histamine inhibitor (cimetidine) c. Epinephrine d. Albuterol

ANS: C Epinephrine is the first drug of choice in immediate treatment of anaphylaxis. Treatment must be initiated immediately because it may only be a matter of minutes before shock occurs. Diphenhydramine and cimetidine may be used, but the drug of choice is epinephrine. Albuterol is not usually indicated.

The postoperative care plan for an infant with surgical repair of a cleft lip includes a. a clear liquid diet for 72 hours. b. nasogastric feedings until the sutures are removed. c. elbow restraints to keep the infant's fingers away from the mouth. d. rinsing the mouth after every feeding.

ANS: C Keeping the infant's hands away from the incision reduces potential complications at the surgical site. The infant's diet is advanced from clear liquid to soft foods within 48 hours of surgery. After surgery, the infant can resume preoperative feeding techniques. Rinsing the mouth after feeding is an inappropriate intervention. Feeding a small amount of water after feedings will help keep the mouth clean. A cleft lip repair site should be cleansed with a wet sterile cotton swab after feedings.

Therapeutic management of the child with acute diarrhea and dehydration usually begins with a. clear liquids. b. IV solutions while the child is NPO. c. oral rehydration solution (ORS). d. antidiarrheal medications.

ANS: C Orally administered rehydration solution is the first treatment for acute diarrhea. Clear liquids are not recommended because they contain too much sugar, which may contribute to diarrhea. The child might need an IV but would not be NPO. Antidiarrheals are not recommended because they do not get rid of pathogens.

What is an appropriate statement for the nurse to make to parents of a child who has had a barium enema to correct an intussusception? a. "I will call the physician when the baby passes his first stool." b. "I am going to dilate the anal sphincter with a gloved finger to help the baby pass the barium." c. "Your baby can't have anything to eat or drink until bowel function returns." d. "Add cereal to the baby's formula to help him pass the barium."

ANS: C Post procedure, the child is kept NPO until bowel function returns. The physician does not need to be notified when the infant passes the first stool. Dilating the anal sphincter is not appropriate for the child after a barium enema.

What assessment should the nurse make before initiating an intravenous (IV) infusion of dextrose 5% in 0.9% normal saline solution with 10 mEq of potassium chloride for a child hospitalized with dehydration? a. Fluid intake b. Number of stools c. Urine output d. Capillary refill

ANS: C Potassium chloride should never be added to an IV solution in the presence of oliguria or anuria (urine output less than 0.5 mL/kg/hr). Fluid intake does not give information about renal function. Stool count sheds light on intestinal function. Renal function is the concern before potassium chloride is added to an IV solution. Assessment of capillary refill does not provide data about renal function.

What information should the nurse include when teaching the parents of a 5-week-old infant about pyloromyotomy? a. The infant will be in the hospital for a week. b. The surgical procedure is routine and "no big deal." c. The prognosis for complete correction with surgery is good. d. They will need to ask the physician about home care nursing.

ANS: C Pyloromyotomy is the definitive treatment for pyloric stenosis. Prognosis is good with few complications. These comments reassure parents. The infant will remain in the hospital for a day or two postoperatively. Although the prognosis for surgical correction is good, telling the parents that surgery is "no big deal" minimizes the infant's condition. Home care nursing is not necessary after a pyloromyotomy.

What is the most important information to be included in the discharge planning for an infant with gastroesophageal reflux? a. Teach parents to position the infant on the left side. b. Reinforce the parents' knowledge of the infant's developmental needs. c. Teach the parents how to do infant cardiopulmonary resuscitation (CPR). d. Have the parents keep an accurate record of intake and output.

ANS: C Risk of aspiration is a priority nursing diagnosis for the infant with gastroesophageal reflux. The parents must be taught infant CPR. Correct positioning minimizes aspiration. The correct position for the infant is supine for sleeping unless the risk of aspiration is great. Knowledge of developmental needs should be included in discharge planning for all hospitalized infants, but it is not the most important in this case. Keeping a record of intake and output is not a priority and may not be necessary.

What is the major focus of the therapeutic management for a child with lactose intolerance? a. Compliance with the medication regimen b. Providing emotional support to family members c. Teaching dietary modifications d. Administration of daily normal saline enemas

ANS: C Simple dietary modifications are effective in management of lactose intolerance. Symptoms of lactose intolerance are usually relieved after instituting a lactose-free diet. Medications are not typically ordered in the management of lactose intolerance. Providing emotional support to family members is not specific to this medical condition. Diarrhea is a manifestation of lactose intolerance. Enemas are contraindicated for this alteration in bowel elimination.

Which description of a stool is characteristic of intussusception? a. Ribbon-like stools b. Hard stools positive for guaiac c. "Currant jelly" stools d. Loose, foul-smelling stools

ANS: C The characteristic stool of intussusception is described as "currant jelly." Ribbon-like stools are characteristic of Hirschsprung disease. With intussusception, passage of bloody mucous stools occurs. Stools will not be hard. Loose, foul-smelling stools may indicate infectious gastroenteritis.

Which intervention is appropriate for a child receiving high doses of steroids? a. Limit activity and receive home schooling. b. Increase the amount of carbohydrates in the diet. c. Substitute a killed virus vaccine for live virus vaccines. d. Monitor for seizure activity.

ANS: C The child on high doses of steroids should not receive live virus vaccines because of immunosuppression. Limiting activity and home schooling are not routine for a child receiving high doses of steroids. Children on high doses of steroids sometimes get carbohydrate intolerance; the diet should not contain high levels of carbohydrates. Children on steroids are not typically at risk for seizures.

What goal has the highest priority for a child with malabsorption associated with lactose intolerance? a. The child will experience no abdominal spasms. b. The child will not experience constipation and malabsorption syndrome. c. The child will not experience diarrhea associated with malabsorption syndrome. d. The child will receive adequate nutrition as evidenced by a weight gain of 1 kg/week.

ANS: C The child with lactose intolerance will have diarrhea and malabsorption, so a good goal would be no longer having these manifestations. A child usually has abdominal cramping pain and distention rather than spasms. The child usually has diarrhea, not constipation. One kilogram every week may or may not be appropriate depending on the child's age and how long the goal is in place for.

What should the nurse include in a teaching plan for the mother of a toddler who will be taking prednisone for several months? a. The medication should be taken between meals. b. The medication needs to be discontinued if side effects appear. c. The medication should not be stopped abruptly. d. The medication may lower blood glucose.

ANS: C The dosage must be tapered before the drug is discontinued to allow the gradual return of function in the pituitary-adrenal axis. Prednisone should be taken with food to minimize or prevent gastrointestinal bleeding. Although there are adverse effects from long-term steroid use, the medication must not be discontinued without consulting a physician. Acute adrenal insufficiency can occur if the medication is withdrawn abruptly. The dosage needs to be tapered. The medication puts the child at risk for hyperglycemia.

A parent brings a child to the emergency department and reports fever, foul smell coming from the throat, and a gray covering over the tonsils. What action by the nurse takes priority? a. Place the child on a cardiac monitor. b. Attach a pulse oximeter to the child. c. Assess respiratory status immediately. d. Start an IV and draw blood cultures.

ANS: C The manifestations are characteristic of diphtheria, which can cause respiratory compromise and airway obstruction. The nurse first assesses the child's respiratory status. Putting the child on a cardiac monitor and oximeter are important interventions, but first the nurse needs to assess the respiratory system. The child will need an IV, but that can be started after the respiratory assessment.

A histamine-receptor antagonist such as cimetidine (Tagamet) or ranitidine (Zantac) is ordered for an infant with GER. What is the purpose of these drugs? a. Prevent reflux b. Prevent hematemesis c. Reduce gastric acid production d. Increase gastric acid production

ANS: C The mechanism of action of histamine-receptor antagonists is to reduce the amount of acid present in gastric contents and to prevent esophagitis.

The mother of an infant with multiple anomalies tells the nurse that she had a viral infection in the beginning of her pregnancy. Which viral infection is associated with fetal anomalies? a. Measles b. Roseola c. Rubella d. Herpes simplex virus (HSV)

ANS: C The rubella virus can cross the placenta and infect the fetus, causing fetal anomalies. Measles is not associated with congenital defects. Most cases of roseola occur in children 6 to 18 months old. HSV can be transmitted to the newborn infant during vaginal delivery, causing multisystem disease. It is not transmitted transplacentally to the fetus during gestation.

The nurse in the pediatric clinic is caring for a child and assesses this skin rash. What action by the nurse is best? a. Inform parents the child will be contagious for one week. b. Arrange for immediate hospitalization and IV antibiotics. c. Instruct parents to offer the child a soft, bland diet. d. Advise parents the child can maintain normal activities.

ANS: C This rash is characteristic of scarlet fever. The parents should provide soft, bland food. The child is not contagious 24 hours after starting antibiotics. There is no indication the child is sick enough to need hospitalization. The parents should encourage rest.

A child has a 2-day history of vomiting and diarrhea. He has hypoactive bowel sounds and an irregular pulse. Electrolyte values are sodium, 139 mEq/L; potassium, 3.3 mEq/L; and calcium, 9.5 mg/dL. This child is likely to have which of the following electrolyte imbalances? a. Hyponatremia b. Hypocalcemia c. Hyperkalemia d. Hypokalemia

ANS: D A serum potassium level less than 3.5 mEq/L is considered hypokalemia. Clinical manifestations of hypokalemia include muscle weakness, decreased bowel sounds, cardiac irregularities, hypotension, and fatigue. The normal serum sodium level is 135 to 145 mEq/L. A level of 139 mEq/L is within normal limits. A serum calcium level less than 8.5 mg/dL is considered hypocalcemia. A serum potassium level greater than 5 mEq/L is considered hyperkalemia.

What should the nurse teach a school-age child and his parents about the management of ulcer disease? a. Eat a bland, low-fiber diet in small, frequent meals. b. Eat three balanced meals a day with no snacking between meals. c. The child needs to eat alone in a quiet spot to avoid stress. d. Do not give antacids 1 hour before or after antiulcer medications.

ANS: D Antacids can interfere with antiulcer medication if given less than 1 hour before or after antiulcer medications. A bland diet is not indicated for ulcer disease. The diet should be a regular diet that is low in caffeine, and the child should eat a meal or snack every 2 to 3 hours. The child should eat every 2 to 3 hours. Eating alone is not indicated.

Which statement made by a parent about intervention for a child's fever shows the need for further education? a. "I should keep her covered lightly when she has a fever." b. "I'll give her plenty of liquids to keep her hydrated." c. "I can give her acetaminophen for a fever." d. "I'll look for over-the-counter aspirin or ibuprofen."

ANS: D Aspirin products are avoided because of the possibility of development of Reye's syndrome. The parent should check labels on all over- the-counter products to be sure they do not contain aspirin. Ibuprofen is alright to give children. Dressing the child in light clothing and using lightweight covers will help reduce fever and promote the child's comfort. Adequate hydration will help maintain a normal body temperature. Acetaminophen is also recommended for fever in children.

The child with lactose intolerance is most at risk for which imbalance? a. Hyperkalemia b. Hypoglycemia c. Hyperglycemia d. Hypocalcemia

ANS: D Because high-calcium dairy products containing lactose are restricted from the child's diet, alternative sources such as egg yolk, green leafy vegetables, dried beans, and cauliflower must be provided to prevent hypocalcemia. The child with lactose intolerance is not at risk for hyperkalemia. Lactose intolerance does not affect glucose metabolism. Hyperglycemia does not result from ingestion of a lactose-free diet.

What should the nurse stress in a teaching plan for the mother of an 11-year-old boy with ulcerative colitis? a. Preventing the spread of illness to others b. Nutritional guidance and preventing constipation c. Teaching daily use of enemas d. Coping with stress and avoiding triggers

ANS: D Coping with the stress of chronic illness and the clinical manifestations associated with ulcerative colitis (diarrhea, pain) are important teaching foci. Avoidance of triggers can help minimize the impact of the disease and its effect on the child. Ulcerative colitis is not infectious. Enemas are not used in this disease.

A school-age child with diarrhea has been rehydrated. The nurse is discussing the child's diet with the family. Which statement by the parent indicates a correct understanding of the teaching? a. "I will keep my child on a clear liquid diet for the next 24 hours." b. "I should encourage my child to drink carbonated drinks but avoid food for the next 24 hours." c. "I will offer my child bananas, rice, applesauce, and toast for the next 48 hours." d. "I should have my child eat a normal diet with easily digested foods for the next 48 hours."

ANS: D Easily digested foods such as cereals, cooked vegetables, and meats should be provided for the child. Early reintroduction of nutrients is desirable. Continued feeding or reintroduction of a regular diet has no adverse effects and actually lessens the severity and duration of the illness. Clear liquids and carbonated drinks have high carbohydrate content and few electrolytes. Caffeinated beverages should be avoided because caffeine is a mild diuretic. The BRAT diet (bananas, rice, applesauce, and toast) is no longer recommended.

A parent asks the nurse how she will know whether her child has fifth disease. The nurse should advise the parent to be alert for which manifestation? a. Bull's-eye rash at the site of a tick bite b. Lesions in various stages of development on the trunk c. Maculopapular rash on the trunk that lasts for 2 days d. Bright red rash on the cheeks that looks like slapped cheeks

ANS: D Fifth disease manifests with an intense, fiery red, edematous rash on the cheeks, which gives a "slapped cheek" appearance. The bull's-eye rash at the site of a tick bite is a manifestation of Lyme disease. Varicella is manifested as lesions in various stages of development—macule, papule, then vesicle, first appearing on the trunk and scalp. Roseola manifests as a maculopapular rash on the trunk that can last for hours or up to 2 days.

Careful handwashing before and after contact can prevent the spread of which condition in daycare and school settings? a. Irritable bowel syndrome b. Ulcerative colitis c. Hepatic cirrhosis d. Hepatitis A

ANS: D Hepatitis A is spread person to person, by the fecal-oral route, and through contaminated food or water. Good handwashing is critical in preventing its spread. The virus can survive on contaminated objects for weeks. The other conditions are not contagious.

Which action is initiated when a child has been scratched by a potentially rabid animal? a. No intervention unless the child becomes symptomatic b. Administration of immune globulin around the wound c. Administration of rabies vaccine on days 3, 7, 14, and 28 d. Administration of both immune globulin and vaccine as soon as possible after exposure

ANS: D Human rabies immune globulin and the first dose of the rabies vaccine are given after exposure. Transmission of rabies can occur from bites with contaminated saliva, scratches from the claws of infected animals, airborne transmission in bat-infested caves, or in a laboratory setting. Rabies is fatal if no intervention is taken to prevent the disease. Human rabies immune globulin is infiltrated locally around the wound, and the other half of the dose is given intramuscularly. This is only part of the treatment after rabies exposure. The rabies vaccine is given within 48 hours of exposure and again on days 3, 7, 14, and 28.

Which nursing diagnosis has the highest priority for the toddler with celiac disease? a. Disturbed Body Image related to chronic constipation b. Risk for Disproportionate Growth related to obesity c. Excess Fluid Volume related to celiac crisis d. Imbalanced Nutrition: Less than Body Requirements related to malabsorption

ANS: D Imbalanced Nutrition: Less than Body Requirements is the highest priority nursing diagnosis because celiac disease causes gluten enteropathy, a malabsorption condition. A psychosocial diagnosis (Disturbed Body Image) would not take priority over a physical diagnosis. Celiac disease causes disproportionate growth and development associated with malnutrition, not obesity. Celiac crisis causes deficient fluid volume.

A nurse is teaching parents about the importance of immunizations for infants because of immaturity of the immune system. The parents demonstrate that they understand the teaching if they make which statement? a. "We plan to opt out of most childhood vaccinations." b. "There are only a few diseases that have effective immunizations." c. "Babies are born with a sophisticated immune system so they need few, if any, immunizations." d. "Newborns have a hard time fighting infection so they need vaccinations."

ANS: D Immaturity of the immune system places an infant and young child a greater risk of infection, so they need protection through a scheduled series of immunizations. Parents can opt out of many vaccinations, but the nurse should investigate why they plan to do so. Most communicable disease of childhood have immunizations.

A nurse is teaching parents about diarrhea. Which statement by the parents indicates understanding of the teaching? a. Diarrhea results from a fluid deficit in the small intestine. b. Organisms destroy intestinal mucosal cells, resulting in an increased intestinal surface area. c. Malabsorption results in metabolic alkalosis. d. Increased motility results in impaired absorption of fluid and nutrients.

ANS: D Increased motility and rapid emptying of the intestines result in impaired absorption of nutrients and water. Electrolytes are drawn from the extracellular space into stool, and dehydration results. Diarrhea results from fluid excess in the small intestine. Destroyed intestinal mucosal cells result in decreased intestinal surface area. Loss of electrolytes in the stool from diarrhea results in metabolic acidosis.

Therapeutic management of most children with Hirschsprung disease is primarily a. daily enemas. b. low-fiber diet. c. permanent colostomy. d. surgical removal of the affected section of the bowel.

ANS: D Most children with Hirschsprung disease require surgical rather than medical management. Surgery is done to remove the aganglionic portion of the bowel, relieve obstruction, and restore normal bowel motility and function of the internal anal sphincter. Preoperative management may include enemas and a low-fiber, high-calorie, high- protein diet, until the child is physically ready for surgery. The colostomy that is created in Hirschsprung disease is usually temporary.

A stool specimen from a child with diarrhea shows the presence of neutrophils and red blood cells. This is most suggestive of a. protein intolerance. b. parasitic infection. c. fat malabsorption. d. bacterial gastroenteritis.

ANS: D Neutrophils and red blood cells in stool indicate bacterial gastroenteritis. This does not signify protein intolerance, a parasitic infection, or fat malabsorption.

Which intervention should be included in the nurse's plan of care for a 7-year-old child with encopresis who has cleared the initial impaction? a. Have the child sit on the toilet for 30 minutes when he gets up in the morning and at bedtime. b. Increase caffeine in the child's diet to promote bowel elimination. c. Use a Fleet enema daily. d. Give the child a choice of beverage to mix with a laxative.

ANS: D Offering realistic choices is helpful in meeting the school-age child's sense of control. To facilitate bowel elimination, the child should sit on the toilet for 5 to 10 minutes after breakfast and dinner. Caffeine to stimulate the bowels is not recommended. Daily Fleet enemas can result in hypernatremia and hyperphosphatemia and are used only during periods of fecal impaction.

After an infant is born the nurse notices that the child has herniation of abdominal viscera into the base of the umbilical cord. What will the nurse document about this condition? a. Diaphragmatic hernia b. Umbilical hernia c. Gastroschisis d. Omphalocele

ANS: D Omphalocele is the herniation of the abdominal viscera into the base of the umbilical cord. This does not describe a diaphragmatic hernia, umbilical hernia, or gastroschisis.

Which organs and tissues control the two types of specific immune functions? a. The spleen and mucous membranes b. Upper and lower intestinal lymphoid tissue c. The skin and lymph nodes d. The thymus and bone marrow

ANS: D The thymus controls cell-mediated immunity (cells that mature into T lymphocytes). The bone marrow controls humoral immunity (stem cells for B lymphocytes). Both the spleen and mucous membranes are secondary organs of the immune system that act as filters to remove debris and antigens and foster contact with T lymphocytes. Gut-associated lymphoid tissue is a secondary organ of the immune system. This tissue filters antigens entering the gastrointestinal tract. The skin and lymph nodes are secondary organs of the immune system.

What is the priority nursing intervention for a 6-month-old infant hospitalized with diarrhea and dehydration? a. Estimating insensible fluid loss b. Collecting urine for culture and sensitivity c. Palpating the posterior fontanel d. Measuring the infant's weight

ANS: D Weight is a crucial indicator of fluid status. It is an important criterion for assessing hydration status and response to fluid replacement. Infants have a greater total body surface area and therefore a greater potential for fluid loss through the skin. It is not possible to measure insensible fluid loss. Urine for culture and sensitivity is not usually part of the treatment plan for the infant who is dehydrated from diarrhea. The posterior fontanel closes by 2 months of age. The anterior fontanel can be palpated during an assessment of an infant with dehydration.

The nurse who provides care for young children with fluid and electrolyte imbalance understands that they are more vulnerable to changes in fluid balance than adults. Under normal conditions the amount of fluid ingested during the day should equal the amount of fluid lost. Sensible water loss is that which occurs through the respiratory tract and skin. Is this statement true or false?

ANS: F Sensible water loss occurs through urine output. Insensible water loss occurs through the skin and respiratory tract. Insensible water loss per unit of body weight is significantly higher in infants and young children due to the faster respiratory rate and higher evaporative water losses.