Pediatric Nursing Exam II
A child receiving chemotherapy for the treatment of cancer is at risk for mouth lesions from the chemotherapy. The nurse teaching the child and the mother should stress the importance of: 1. Brushing with a sponge applicator 2. Frequent rinsing with undiluted mouthwash 3. Brushing three times a day with a toothbrush 4. Frequent mouth rinsing with hydrogen peroxide
1. Brushing with a sponge applicator
The mother is a 2-year-old child tells the nurse she is having difficulty disciplining her child. The nurse's response most appropriate to this comment would be: 1. "This is a difficult age that your child is going through right now." 2. "I'm not sure what you mean by difficulty. Tell me more about this." 3. "I can understand what you mean; that's why it's called the terrible twos." 4. "You know you have to be consistent with toddlers when you are disciplining them."
2. "I'm not sure what you mean by difficulty. Tell me more about this."
Which discharge instruction for a child diagnosed with encopresis should the nurse question? 1. Limit the intake of milk. 2. Offer a diet high in protein. 3. Obtain a complete dietary log. 4. Follow up with a child psychologist.
2. Offer a diet high in protein.
When reviewing the immunization schedule for an 11 month old, the nurse would expect that the infant has been previously immunized against: 1. Pertussis, tetanus, polio, and measles 2. Polio, pertussis, tetanus, and diphtheria 3. Measles, mumps, rubella, and tuberculosis 4. Measles, rubella, polio, tuberculosis, and pertussis
2. Polio, pertussis, tetanus, and diphtheria Rationale: The recommended immunization schedule for infants is administration of the combined diphtheria, pertussis, and tetanus vaccine and the polio virus vaccine at ages 2, 4, and 6 months.
Which is the nurse's best response to the parent of an infant diagnosed with the first otitis media who wonders about the long-term effects? 1. "The child could suffer hearing loss." 2. "The child could suffer some speech delays." 3. "The child could suffer recurrent ear infections." 4. "The child could require ear tubes."
3. "The child could suffer recurrent ear infections." Rationale: When children acquire an ear infection at such a young age, there is an increased risk of recurrent infections.
A 4-month old has had vomiting and diarrhea for 24 hours. The infant is fussy, and the anterior fontanel is sunken. The nurse notes the infant does not produce tears when crying. Which task will help confirm the diagnosis of dehydration? 1. Urinalysis obtained by bagged specimen. 2. Urinalysis obtained by sterile catheterization. 3. Analysis of serum electrolytes. 4. Analysis of cerebrospinal fluid.
3. Analysis of serum electrolytes.
The nurse is caring for a 3-month old being evaluated for possible Hirschsprung disease. His parents call the nurse and show her his diaper containing a large amount of mucus and bloody diarrhea. The nurse notes that the infant is irritable and his abdomen appears very distended. Which should be the nurse's next action? 1. Reassure the parents that this is an expected finding and not uncommon. 2. Call a code for potential cardiac arrest, and stay with the infant. 3. Immediately obtain all vial signs with a quick head-to-toe assessment. 4. Obtain a stool sample for occult blood.
3. Immediately obtain all vial signs with a quick head-to-toe assessment.
A child is diagnosed with chronic constipation that has been unresponsive to dietary and activity changes. Which pharmacological measure is most appropriate? 1. Natural supplements and herbs. 2. Stimulant laxative. 3. Osmotic agent. 4. Pharmacological measures are not used in pediatric constipation.
3. Osmotic agent.
The mother of a newborn asks the nurse why the infant has to nurse so frequently. Which is the best response? 1. Formula tends to be more calorically dense, and formula-fed babies require fewer feedings than breastfed babies. 2. The newborn's stomach capacity is small, and peristalsis is slow. 3. The newborn's stomach capacity is small, and peristalsis is more rapid than in older children. 4. Breastfed babies tend to take longer to complete a feeding than formula-fed babies.
3. The newborn's stomach capacity is small, and peristalsis is more rapid than in older children.
An infant receiving parenteral therapy. The IV orders are for 400 mL of D₅ 0.45 NS to run in 8 hours. The nurse should maintain the hourly rate at: 1. 20 mL per hour 2. 30 mL per hour 3. 40 mL per hour 4. 50 mL per hour
4. 50 mL per hour
When providing physical hygiene and comfort for a child with leukemia who is receiving chemotherapy, the nurse should avoid the use of: 1. Straws 2. Mouthwash 3. Any powder 4. A firm toothbrush
4. A firm toothbrush
The nurse is caring for an infant diagnosed with Hirschsprung disease. The mother states she is pregnant with a boy and wants to know if her new baby will likely have the disorder. Select the nurse's best response. 1. "Genetics play a small role in Hirschsprung disease, so there is a chance the baby will develop it as well." 2. "There is no evidence to support a genetic link, so it is very unlikely the baby will also have it." 3. "It is rarely seen in boys, so it is not likely your new baby will have Hirschsprung disease." 4. "Hirschsprung is seen in only girls, so your new baby will not be at risk."
1. "Genetics play a small role in Hirschsprung disease, so there is a chance the baby will develop it as well."
A mother asks the nurse how to tell the difference between measles (rubeola) and German measles (rubella). The nurse tells the mother that with rubeola, the child has: 1. A high fever and Koplik's spots 2. A rash on the trunk with pruritus 3. Nausea, vomiting, and abdominal cramps 4. Symptoms similar to a child, followed by a rash
1. A high fever and Koplik's spots Rationale: Rubeola signs and symptoms include a high fever, photophobia, Koplik's spots (white patches on mucous membranes of the oral cavity), and a rash. Rubella usually does not have a high fever, runs a 3- to 6-day course, and never causes Koplik's spots.
As a child with nephrotic syndrome gets older and has repeated attacks, it is most important for the nurse to help the child develop: 1. A positive body image 2. The ability to test urine 3. Fine muscle coordination 4. Acceptance of possible sterility
1. A positive body image Rationale: During an exacerbation of nephrotic syndrome children have a characteristic pale, overweight appearance from the malnutrition and edema. They may become very sensitive about these changes as they grow older.
A 4-month old is brought to the emergency department with severe dehydration. The heart rate is 198, and her blood pressure is 68/38. The infant's anterior fontanel is sunken. The nurse notes that the infant does not cry when the intravenous line is inserted. The child's parents state that she has not "held anything down" in 18 hours. The nurse obtains a finger-stick blood sugar of 94. Which would the nurse expect to do immediately? 1. Administer a bolus of normal saline. 2. Administer a bolus of D₁₀W. 3. Administer a bolus of normal saline with 5% dextrose added to the solution. 4. Offer the child an oral rehydrating solution such as Pedialyte.
1. Administer a bolus of normal saline.
Before surgery to relieve an intestinal obstruction, a 3-month-old is kept NPO and has a nasogastric tube in place. To calm the infant, as well as meet developmental needs, the nurse should: 1. Allow the infant to suck on a pacifier 2. Offer the infant a favorite toy to hold 3. Hang a brightly color mobile in the infant's crib 4, Place the infant on the abdomen and permit crawling
1. Allow the infant to suck on a pacifier
Attendance of parents during painful procedures on their toddlers should be: 1. Based on individual assessment of the parents 2. Based on the type of procedure being performed 3. Discouraged for the benefit of the parents and the child 4. Encouraged and permitted if the child desires their presence
1. Based on individual assessment of the parents Rationale: If able to handle personal anxiety and give comfort to the child, parents can be helpful to the staff as well as the child. If, however, the parents have moderate to severe anxiety, their anxiety can be transmitted to the child.
During the second week of hospitalization, a 2-year-old girl smiles easily, goes to all the nurses happily, and does not express interest in her mother when she visits. The mother tells the nurse she is pleased about the adjustment but somewhat concerned about her child's reaction to her. Before responding to the mother, the nurse should understand that the behavior probably means that the child: 1. Is repressing her feelings for her mother 2. Has established a routine and feels safe 3. Has given up fighting and accepts separation 4. Feels better physically so her behavior has improved
1. Is repressing her feelings for her mother Rationale: Detachment is the result of trying to escape the emotional pain of desiring the mother by repressing feelings for her.
The nurse in the emergency department observes large welts and scars on the back of a child who has been admitted for an asthma attack. The nurse should assess further for: 1. Signs of child abuse 2. A history of an injury 3. The presence of food allergies 4. Recent recovery from chickenpox
1. Signs of child abuse Rationale: When unexplained injuries are found, further assessment is required because it is the nurse's legal responsibility to report suspected child abuse.
The nurse is caring for an infant newly diagnosed with Hirschsprung disease. What does the nurse understand about this infant's condition? 1. There is a lack of peristalsis in the large intestine and an accumulation of bowel contents, leading to abdominal distention. 2. There is excessive peristalsis throughout the intestine, resulting in abdominal distention. 3. There is a small-bowel obstruction leading to ribbon-like stools. 4. There is inflammation throughout the large intestine, leading to accumulation of intestinal contents and abdominal distention.
1. There is a lack of peristalsis in the large intestine and an accumulation of bowel contents, leading to abdominal distention.
A 4-year-old boy being admitted for surgery arrives on the ambulatory surgical unit crying and pulling at his hospital gown while clutching a teddy bear. The nurse's best response should be: 1. "Please stop crying. Nobody will hurt you." 2. "I know you feel scared. Is this your special teddy bear?" 3. "Hello, I'm your nurse. Let's go and see where your room is." 4. "Hello young man. Let me show you the playroom. Then we can play."
2. "I know you feel scared. Is this your special teddy bear?" Rationale: This focuses on the child's feelings and a familiar object of security.
The parent of a child with frequent ear infections asks the nurse if there is anything that can be done to help avoid future ear infections. Which is the nurse's best response? 1. "Your child should be put on a daily dose of Singulair (montelukast)." 2. "Your child should be kept away from tobacco smoke." 3. "Your child should be kept away from other children with otitis media." 4. "Your child should always wear a hat when outside."
2. "Your child should be kept away from tobacco smoke." Rationale: Tobacco smoke has been proved to increase the incidence of ear infections. The tobacco smoke damages mucociliary function, prolonging inflammatory response and impending drainage through the Eustachian tube.
When evaluating the laboratory reports for a 1-year-old child, the nurse recalls that the normal hematocrit range for a child of this age is: 1. 19% to 32% 2. 29% to 41% 3. 37% to 47% 4. 42% to 68%
2. 29% to 41%
Which child can be discharged without further evaluation? 1. A 2-year-old who has had 24 hours of watery diarrhea that has changed to bloody diarrhea in the past 12 hours. 2. A 2-year-old who had a relapse of one diarrhea episode after restarting a normal diet. 3. A 6-year-old who has been having vomiting and diarrhea for 2 days and has decreased urine output. 4. A 10-year-old who has just returned from a Scout camping trip and has had several episodes of diarrhea.
2. A 2-year-old who had a relapse of one diarrhea episode after restarting a normal diet.
A 4-year-old girl is brought to the emergency department after falling on the handlebars of her tricycle. She is guarding her abdomen, crying, and not allowing anyone to touch her. Which actions would best enable the nurse to initiate the assessment process? 1. Medicate the child for pain and then proceed 2. Allow the child to guide the examiner's hand to the area that hurts 3. Have the parents restrain the child while the abdomen is auscultated 4. Have the physician order a CAT scan since a child this age is unable to cooperate
2. Allow the child to guide the examiner's hand to the area that hurts
The nurse, realizing that the mother of a 2-month-old boy with colic needs help coping, suggests that she: 1. Give her son a warm bath to calm him down 2. Arrange for some time away from her son each day to rest 3. Provide her son with warm sweetened tea when he begins to cry 4. Sit comfortably in a quiet, darkened room to hold her son when he cries
2. Arrange for some time away from her son each day to rest
The nurse is aware that infants are at greater risk for a fluid volume deficit and hyperosmolar imbalance primarily because: 1. They have a decreased glomerular filtration rate 2. Body fluid loss is proportionately greater per kilogram of weight 3. A generalized response to insensible fluid loss has not yet developed 4. They have increased metabolic processes and increased water production
2. Body fluid loss is proportionately greater per kilogram of weight Rationale: Infants are not protected from water loss because they ingest and excrete a relatively greater daily water volume than adults; therefore the proportion of total body water is higher.
On the third day of hospitalization, a 2-year-old child woh had been screaming and crying inconsolably begins to regress and is now lying quietly in the crib with a blanket. The nurse recognizes that the child is in the stage of: 1. Denial 2. Despair 3. Mistrust 4. Rejection
2. Despair
As a preschooler, a 4 year old's response to hospitalization is influenced by: 1. Fear of separation 2. Fear of bodily harm 3. Belief in death's finality 4. Belief in the supernatural
2. Fear of bodily harm Rationale: According to Freud, fear of mutilation is typical of the preschooler.
A toddler has been diagnosed with classic hemophilia and has a subcutaneous venous port inserted. The child's mother is being taught to administer Factor VIII prophylactically 3 times a week. To receive the most benefit from this therapy, the mother should be taught to administer the factor: 1. Whenever a bleed is suspected 2. In the morning on scheduled days 3. On a regular schedule at the mother's convenience 4. At bedtime when the child will be lying in bed quietly
2. In the morning on scheduled days Rationale: Factor VIII has a short half-life, therefore the prophylactic treatment involves administering the factor on the scheduled days in the morning so that the child will get the most benefit from the factor.
The nurse explains to a mother whose child has just received a tetanus toxoid injection the the toxoid confers: 1. Lifelong passive immunity 2. Long-lasting active immunity 3. Lifelong active natural immunity 4. Temporary passive natural immunity
2. Long-lasting active immunity
The nurse is teaching a nursing education class emphasizes that the common nursing care to help prevent both sickle cell crisis and celiac crisis: 1. Limitation of activity 2. Protection from infection 3. High-iron, low-fat, high-protein 4. Careful observation of all vital signs
2. Protection from infection Rationale: Both cause inadequate resistance to infection. With sickling, it results from low oxygen levels; with celiac disease it results from malnourishment and immunologic defects.
A viral disease that begins with respiratory inflammation and skin rash and may result in grave complications is: 1. Rubella 2. Rubeola 3. Yellow fever 4. Chickenpox
2. Rubeola Rationale: Rubeola, or measles, produces childlike respiratory symptoms, after 3 or 4 days, a dark-red macular or maculopapular skin rash. Complications include seizures in young children and secondary infection with hemolytic streptococci. Such infection can result in otitis media and pneumonia, which are especially dangerous in children under 2 years of age.
Chickenpox can sometimes be fatal to children who are receiving: 1. Insulin 2. Steroids 3. Antibiotics 4. Anticonvulsants
2. Steroids Rationale: Steroids have an anti-inflammatory effect. It is believed that resistance to certain viral diseases, inducing chickenpox, is greatly decreased when child takes steroids regularly.
An essential nursing action when caring for the small child with severe diarrhea is to: 1. Maintain the IV 2. Take daily weights 3. Replace lost calories 4. Keep the body temperature below 100℉
2. Take daily weights Rationale: Weight is the best indicator of fluid loss or gain if measured each day at the same time, on the same scale, and with the same amount of clothing.
The maintenance of fluid and electrolyte balance is more critical in children than in adults because: 1. Cellular metabolism is less stable than in adults 2. The proportion of water in the body is less than in adults 3. Renal function is immature in children below 4 years of age 4. The extracellular fluid requirement per unit of body weight is greater than in adults
2. The proportion of water in the body is less than in adults Rationale: The extracellular body fluid represents 45% at birth, 25% at 2 years of age, and 20% at maturity. Another measurement is percentage of total body weight, which is 80% at birth, 63% at 3, and approximately 60% at 12 years.
The parent of a 5-year old states that the child has been having diarrhea for 24 hours, vomited twice 2 hours ago, and now claims to be thirsty. The parent asks what to offer the child because the child is refusing Pedialyte. Select the nurse's most appropriate response. 1. "You can offer clear diet soda such as Sprite and ginger ale." 2. "Pedialyte is really the best thing for your child, who, if thirst enough, will eventually drink it." 3. "Pedialyte is really the best thing for your child. Allow your child some choice in the way to take it by offering small amounts in a spoon, medicine cup, or syringe." 4. "It really does not matter what your child drinks as long as it is kept down. Try offering small amounts of fluids in medicine cups."
3. "Pedialyte is really the best thing for your child. Allow your child some choice in the way to take it by offering small amounts in a spoon, medicine cup, or syringe."
The physician orders an isotonic enema for a 2-year-old child. The nurse is aware that the maximum amount of fluid to be given to a small child without a physician's specific order is: 1. 100 to 150 mL 2. 155 to 250 mL 3. 255 to 360 mL 4. 365 to 500 mL
3. 255 to 360 mL Rationale: No more than 360 mL of solution should be administered to an infant or child unless ordered, because fluid and electrolyte balance in an infant or child is easily disturbed.
The nurse is caring for a 2-year-old child who was admitted to the pediatric unit for moderate dehydration due to vomiting and diarrhea. The child is restless, with periods of irritability. The child is afebrile with a heart rate of 148 and a blood pressure of 90/42. Baseline laboratory tests reveal the following: Na 152, Cl 119, and glucose 115. The parents state that the child has not urinated in 12 hours. After establishing a saline lock, the nurse reviews the physician's orders. Which order should the nurse question? 1. Administer a saline bolus of 10 mL/kg, which may be repeated if the child does not urinate. 2. Recheck serum electrolytes in 12 hours. 3. After the saline bolus, begin maintenance fluids of D5 ¼ NS with 10 mEq KCl/L. 4. Give clear liquids as tolerated.
3. After the saline bolus, begin maintenance fluids of D5 ¼ NS with 10 mEq KCl/L.
When vomiting is uncontrolled in an infant, the nurse should observe for signs of: 1. Tetany 2. Acidosis 3. Alkalosis 4. Hyperactivity
3. Alkalosis Rationale: Excessive vomiting causes an increased loss of hydrogen ions (hydrochloric acid), which leads to metabolic alkalosis, an excess of base bicarbonate.
Occasionally infants are born without an immune system. They can live with no apparent problems during their first months after birth because: 1. Exposure to pathogens are produced by the infant's colonic bacteria 2. Limited antibodies are produced but he infant's colonic bacteria 3. Antibodies are passively received from the mother through the placenta and breast milk 4. Limited antibodies are produced but he fetal themes during the eighth and ninth months of gestation
3. Antibodies are passively received from the mother through the placenta and breast milk
An adolescent in sickle cell crisis (pain episode) is complaining of right-knee pain. The best nursing intervention would be to: 1. Decrease IV fluids 2. Wrap the right knee in a cold pack 3. Apply a warm soak to the right knee 4. Give morphine sulfate 0.5 mg as ordered
3. Apply a warm soak to the right knee Rationale: Warmth causes vasodilation, which will help lessen the pain of a vasooclusive crisis. IV fluids, if ordered, should be increased to dilute the blood and prevent further sickling. Cold will cause more vasoconstriction and increase pain. This is an inadequate dose of morphine for an adolescent.
At 2 years of age, a child is readmitted for additional surgery. The most important factor in preparing the child for this experience is: 1. Gratification of the child's wishes 2. The child's previous hospital visits 3. Assurance of affection and security 4. Avoiding leaving the child with strangers
3. Assurance of affection and security Rationale: The 2-year-old' is still attached to and dependent on the parents. Fear of separation is a great stress.
Using live virus vaccines against measles is contraindicated in children receiving corticosteroid, antineoplastic, or irradiation therapy because these children may: 1. Have had the disease or have been immunized previously 2. Be unlikely to need this protection during their shortened life span 3. Be susceptible to infection because of their depressed immune response 4. Have an allergy to rabbit serum, which is used as a basis for these vaccines
3. Be susceptible to infection because of their depressed immune response
A 6-year-old child is admitted with severe anemia (hemoglobin of 6.4 g/dL). The nurse's priority assessment would include observing for: 1. Hemoglobinuria 2. A shift to the left 3. Cardiac decompensation 4. The presence of jaundice
3. Cardiac decompensation
When a nurse administers IV fluids to a dehydrated infant, the most critical factor is: 1. Ensuring sterility 2. Calculating the total necessary intake 3. Continuing the prescribed rate of flow 4. Maintaining the fluid at body temperature
3. Continuing the prescribed rate of flow Rationale: An infant's intravascular compartment is fairly limited and cannot accommodate large volumes of fluid administered in such a short time. Equipment such as infusion pumps with volume-control chambers should be used, since they help control or limit the volume of fluid to be infused.
The response that would be most unusual in infants subjected to prolonged hospitalization would be: 1. Lack or slowness of weight gain 2. Limited emotional response to stimuli 3. Excessive crying or clinging when approached 4. Looking at ceiling lights rather than at persons caring for them
3. Excessive crying or clinging when approached Rationale: Excessive crying and clinging are the usual responses of an infant who expects to be comforted, not one who has experienced prolonged separation from a parent because of illness.
To control a bleed in a child with hemophilia A, the nurse would expect to give: 1. Albumin 2. Fresh frozen plasma 3. Factor VIII concentrate 4. Factor II, VII, IX, X complex
3. Factor VIII concentrate
Nutritional anemia, a problem encountered in children and adults, involves several different nutrients. The nutrients include proteins, iron, vitamin B₁₂, and: 1. Calcium 2. Thiamine 3. Folic acid 4. Carbohydrates
3. Folic acid Rationale: Folic acid acts as a necessary coenzyme in the formation of heme, the iron-containing protein in hemoglobin.
A pale, lethargic 1 year old who weighs 12.6 kg (28 pounds) has an enlarged heart and a hemoglobin of 8 g/dL. The mother tells the nurse that her infant spits out food fed with a spoon, so she provides a quart of milk per day from a bottle. The nurse should encourage the mother to: 1. Immediately begin the weaning process 2. Take the infant to the metabolic clinic for a checkup 3. Give the infant finger foods such as bread crusts and chopped meat 4. Make a large whole in the nipple and add baby meats and vegetables to the milk
3. Give the infant finger foods such as bread crusts and chopped meat Rationale: A diet of only milk is not sufficient enough to meet the infant's iron needs. Meat and crusts of fortified whole wheat bread are high in iron. Finger foods are appropriate for older infants.
A child has been admitted for surgery to correct a congenital megacolon. Enemas are ordered preoperatively to please the bowel. The Nurs should use: 1. Tap water 2. Soap suds 3. Isotonic saline 4. Hypertonic phosphate
3. Isotonic saline Rationale: Isotonic saline is compatible with body fluids. It is neither hypertonic not hypotonic, so it does not cause a change in osmotic pressure and upset the balance of intracellular and extracellular fluid and electrolytes.
When preparing an infant who is immunosuppressed after chemotherapy for discharge, the nurse explains to the parents that the measles, mumps, and rubella (MMR) immunization must: 1. Be discussed with the pediatrician on the next visit 2. Not be given until the infant is at least 2 years of age 3. Not be given as long as the infant is receiving chemotherapy 4. Be given to protect the infant from getting any of these diseases
3. Not be given as long as the infant is receiving chemotherapy Rationale: The MMR vaccine is composed of live viruses, and its administration could be life-threatening for an immunosuppressed child.
A central venous access catheter has just been inserted in a 7-year-old child with cancer. A peripheral intravenous line is still in place. An antibiotic is to be given. To administer the ordered antibiotic, the nurse should use the: 1. Central venous catheter, because this will help determine its patency 2. Peripheral line, because the central venous catheter is reserved for fluids 3. Peripheral line, because the central venous catheter placement has not been confirmed by x-ray 4. Central venous catheter, because the child has cancer and the antibiotics must be given systemically as quickly as possible
3. Peripheral line, because the central venous catheter placement has not been confirmed by x-ray Rationale: The peripheral line must be used until the placement of the central venous line is confirmed by x-ray or fluoroscopy; this prevents fluid from entering the lung or interstitial space if the catheter is misplaced.
A child with β thalassemia (Cooley's anemia) is admitted to the ambulatory care unit for a transfusion. When developing the nursing care plan, the discharge instructions should include teaching the parents to: 1. Encourage fluids 2. Restrict activity 3. Prevent infection 4. Provide small, frequent meals
3. Prevent infection Rationale: Children with chronic illness, such as hemolytic anemia, should not be exposed to the additional stress of infection.
A mother asks the nurse how the DTaP immunization works. The nurse, when formulating a response, recalls that with active immunity: 1. Lipid agents are formed by the body against antigens 2. Protein antigens are formed in the blood to fight invading antibodies 3. Protein substances are formed by the body to destroy or neutralize antigens 4. Blood antigens are aided by phagocytes in defending the body against pathogens
3. Protein substances are formed by the body to destroy or neutralize antigens Rationale: The body's immune system constructs proteins called antibodies that possess a specificity toward another protein called the antigen. The antibody neutralizes or damages the antigen, this rendering it harmless.
The nurse's background knowledge of the basic nutrients that act as partners in building red blood cells will be used to develop a teaching plan for a child with nutritional anemia. These nutrient partners of iron are: 1. Calcium and vitamins 2. Vitamin D and riboflavin 3. Proteins and ascorbic acid 4. Carbohydrates and thiamine
3. Proteins and ascorbic acid Rationale: Proteins are essential for the synthesis of the blood proteins, albumin, fibrinogen, and hemoglobin. Ascorbic acid influences the removal of iron from ferritin (making more iron available for production of heme) and influences the conversion of folic acid to folinic acid.
An infant is not sleeping well, crying frequently, has yellow drainage from the ear, and is diagnosed with an ear infection. Which nursing objective is the priority for the family? 1. Educating the parents about signs and symptoms of an ear infection. 2. Providing emotional support for the parents. 3. Providing pain relief for the child. 4. Promoting the flow of drainage from the ear.
3. Providing pain relief for the child. Rationale: Providing pain relief for the infant is essential. With pain relief, the child will likely stop crying and rest better.
A 4 year old, newly diagnosed with leukemia, is placed on bedrest. While assisting with morning care, the nurse notes bloody expectorant after the child has brushed the teeth. The nurse should first: 1. Secure a smaller toothbrush for the child's use 2. Tell the child to be more careful when brushing the teeth 3. Record and report the incident without alarming the child 4. Rinse the child's mouth with half-strength hydrogen peroxide
3. Record and report the incident without alarming the child Rationale: Because of the increased capillary fragility and decreased platelet counts that accompany leukemia, even the slightest trauma can cause hemorrhage. Therefore the toothbrush can produce gingival hemorrhage, and the physician should be informed of this happening; this may also assist in defining the treatment plan.
The acid-base imbalance resulting from severe asthma attack is: 1. Metabolic alkalosis caused by excessive production of acid metabolites 2. Respiratory alkalosis caused by the accelerated respirations and loss of carbon dioxide 3. Respiratory acidosis caused by impaired respirations and increased formation of carbonic acid 4. Metabolic acidosis caused by the kidneys' inability to help compensate for the increased carbonic acid formed
3. Respiratory acidosis caused by impaired respirations and increased formation of carbonic acid Rationale: The restricted ventilation accompanying an asthma attack limits the body's ability to blow off carbon dioxide. As carbon dioxide accumulates in the body fluids, it reacts with water to produce carbonic acid (H₂CO₃); the result is respiratory acidosis.
A viral infection characterized by a red, blotchy rash and Koplik's spots in the mouth is: 1. Mumps 2. Rubella 3. Rubeola 4. Chickenpox
3. Rubeola Rationale: Rubeola, or measles, is generally a viral-induced childhood disease, diagnosed on or about the second day by the presence of Koplik's spots on the oral mucosa.
A child is to received a blood transfusion. If an allergic reaction to the blood occurs, the nurse's first intervention should be to: 1. Call the physician 2. Slow the flow rate 3. Shut off the infusion 4. Relieve the symptoms with an ordered antihistamine
3. Shut off the infusion Rationale: The child is having an allergic reaction, and the flow of blood should be stopped immediately to prevent serious complications.
The mother of a toddler with hemophilia has just told the nurse, "Every time my son bumps his head, I'll give him two children's aspirin. Is that right?" The nurse's best response would be: 1. "That is exactly right; use aspirin or acetaminophen." 2. "Are you concerned about giving drugs to your child?" 3. "No. Give him acetaminophen every day to prevent bleeding." 4. "Aspirin may cause more bleeding. Give him acetaminophen instead."
4. "Aspirin may cause more bleeding. Give him acetaminophen instead."
The parents of a 10-year-old boy with hemophilia are very worried about their other children, two girls and another boy. They want to know what the chances are concerning the other children having the disorder or being carriers. An appropriate response to this question would be that: 1. "Neither of the girls will be affected, but the other son will be a carrier." 2. "Both of the girls will be carriers, but half of the boys will be affected." 3. "Each son has a 50% chance of being either affected or a carrier, and the girls will all be carriers." 4. "Each son has a 50% chance of being affected, and each daughter has a 50% chance of being a carrier."
4. "Each son has a 50% chance of being affected, and each daughter has a 50% chance of being a carrier."
The parents of a newborn asks, "Will my baby spit out the formula if it is too hot or too cold?" Select the nurse's best response. 1. "Babies have a tendency to reject hot fluids but not cold fluids, which could result in abdominal discomfort." 2. "Babies have a tendency to reject cold fluids but not hot fluids, which could result in esophageal burns." 3. "Your baby would most likely spit out formula that was too hot, but your baby could swallow some of it, which could result in a burn" 4. "Your baby is too young to be physically capable of spitting out fluids and will automatically swallow anything."
4. "Your baby is too young to be physically capable of spitting out fluids and will automatically swallow anything."
The parents of a chronically ill child with a central intravenous line arrive at the emergency department complaining of problems with the child's central line. On assessment the central line allows blood to be withdrawn but flushes sluggishly. The nurse observes that the upper chest and neck area appear edematous and very pale; the hands and feet blanch quickly; and there is no edema. The nurse should suspect that the child has developed: 1. Sepsis 2. An allergic reaction 3. A catheter occlusion 4. Central vein thrombosis
4. Central vein thrombosis Rationale: A central thrombosis occurs when a clot forms around the exterior of the catheter. The line may flush or allow blood to be withdrawn, but the significant findings are the edematous upper chest and neck with associated paleness. This is a medical emergency and should be reported immediately.
The mother of a child who has received all of the primary immunizations asks the nurse which ones her child should receive before starting kindergarten. The nurse suggests the child receive the following boosters: 1. IPV, Hep-B, Td 2. DTaP, Hep-B, Td 3. MMR, DTaP, Hib 4. DTaP, IPV, MMR
4. DTaP, IPV, MMR Rationale: Adequate immunization boosters for preschool children include DTaP, IVP, and MMR at 4 to 6 years (usually required by law).
A child with sickle cell anemia has a sequestration crisis. The nurse is aware that this type of crisis is characterized by: 1. Distal ischemia and pain 2. Diminished red blood cell production 3. Accelerated red blood cell destruction 4. Decreased blood volume and signs of shock
4. Decreased blood volume and signs of shock Rationale: In this type of episode there is a pooling of blood in the liver and spleen with a decreased circulating blood volume and subsequent shock. Painful episodes are characteristic of vasooclusive crisis. Decreased red blood cell production and the profound anemia that ensues are characteristic of aplastic crisis. Increased red blood cell destruction and concomitant anemia, jaundice, and reticulocytosis is termed hyperhemolytic crisis.
A 6-year-old with sickle cell disease is admitted with a vasoocclusive crisis. Priority nursing concerns should be: 1. Nutrition and hydration 2. Nutrition and infection 3. Pain management and infection 4. Hydration and pain management
4. Hydration and pain management
The nurse is caring for a child with sickle cell anemia. To prevent thrombus formation in capillaries, as well as other problems from stasis and clotting of blood in the sickling process, the nurse should: 1. Administer oxygen 2. Administer prescribed anticoagulants 3. Encourage the child to maintain bedrest 4. Increase fluids by mouth and use a humidifier
4. Increase fluids by mouth and use a humidifier Rationale: Sickling is related to the concentration of hemoglobin within the cell. Because hypertonicity of the blood plasma increases the intracellular concentration of hemoglobin, dehydration promotes sickling.
The outpatient clinic nurse is caring for a 7-year-old child with sickle cell anemia. The child's history includes having a splenectomy at age 4. At this time the nurse's priority of care would be: 1. Assessing for jaundice 2. Monitoring serial hematocrit readings 3. Frequent assessments of the abdomen 4. Keeping the child away from infectious contacts
4. Keeping the child away from infectious contacts Rationale: The spleen plays a role in immunity; without a spleen, a child is more prone to infection, which can precipitate a crisis.
In a child with a diagnosis of acute lymphoid leukemia (ALL) the nurse should consider it unusual to observe: 1. Marked fatigue and pallor 2. Multiple bruises and petechiae 3. Enlarged lymph nodes, spleen, and liver 4. Marked jaundice and generalized edema
4. Marked jaundice and generalized edema
During a vaccination drive at a well-child clinic, a nurse observes that a recently hired nurse is not wearing gloves. The nurse should advise the other nurse to: 1. Speak with the nurse manager regarding techniques 2. Continue with the immunizations since gloves are not needed 3. Evaluate the child's appearance to determine whether gloves are needed 4. Put on gloves immediately because standard precautions will be required
4. Put on gloves immediately because standard precautions will be required
An infant is hospitalized for dehydration. The child has just urinated, and the practitioner has changed the IV order to 5% dextrose in ½ normal saline and 20 mEq/L of potassium chloride. A 500 mL bag of 5% dextrose in ½ normal saline is available. The potassium chloride label reads 2 mEq/mL. How many milliliters of potassium chloride should the nurse add to the 500 mL bag?
5 mL Rationale: For a 500 mL bag, 10 mEq of potassium chloride is needed to achieve a concentration of 20 mEq/L.
Which should be included in instructions to the parent of a child prescribed amoxicillin to treat an ear infection? 1. "Continue the amoxicillin until your child's symptoms subside." 2. "Administer an over0the-counter antihistamine with the antibiotic." 3. "Administer the amoxicillin until all the medication is gone." 4. "Allow your child to administer his own dose of amoxicillin."
3. "Administer the amoxicillin until all the medication is gone." Rationale: It is essential that all the medication be given.
The parents of a 4-year-old ask the nurse how to manage their child's constipation. Select the nurse's best response. 1. "Add 2 ounces of apple or pear juice to the child's diet." 2. "Be sure your child eats a lot of fresh fruit such as apples and bananas." 3. "Encourage your child to drink more fluids." 4. "Decrease bulky foods such as whole-grain breads and rice."
3. "Encourage your child to drink more fluids."
The nurse is caring for a 9-month-old with diarrhea secondary to rotavirus. The child has not vomited and is mildly dehydrated. Which is likely included in the discharge teaching? 1. Administer Imodium as needed. 2. Administer Kaopectate as needed. 3. Continue breastfeeding per routine. 4. The infant may return to day care 24 hours after antibiotics have been started.
3. Continue breastfeeding per routine.
A 3-year-old preschooler has been hospitalized with nephrotic syndrome. The best way to detect fluid retention would be to: 1. Have the child urinate in a bedpan 2. Measure the child's abdominal girth daily 3. Weigh the child at the same time every day 4. Test the child's urine for hematuria and proteinuria
3. Weigh the child at the same time every day
The nurse receives a call from the parent of a 10-month-old who has vomited three times in the past 8 hours. The parent describes the baby as playful and wanting to drink. The parent asks the nurse what to give the child. Select the nurse's best response. 1. "Replace the next feeding with regular water, and see if that is better tolerated." 2. "Do not allow your baby to eat any solids; give half the normal formula feeding, and see if that is better tolerated." 3. "Do not let your baby eat or drink anything for 24 hours to give the stomach a chance to rest." 4. "Give your child ½ ounce of Pedialyte every 10 minutes. If vomiting continues, wait an hour, and then repeat what you previously gave."
4. "Give your child ½ ounce of Pedialyte every 10 minutes. If vomiting continues, wait an hour, and then repeat what you previously gave."
When discussing hemophilia with the parents of a child recently diagnosed with this disorder, the nurse should explain that: 1. Hemophilia is an autosomal dominant disorder in which the woman carries the trait 2. Hemophilia follows regular laws of Mendelian inherited disorders, such as sickle cell anemia 3. This disorder can be carried by either males or females but occurs in the opposite sex of that carrier 4. Hemophilia is an X-linked disorder in which the mother is usually the carrier of the illness but is not affected by it
4. Hemophilia is an X-linked disorder in which the mother is usually the carrier of the illness but is not affected by it
Of primary importance when the nurse plans for the discharge of a child after a sickle cell pain episode (crisis) is the child's need for: 1. High-calorie diet 2. Rigorous exercise 3. At least 14 hours of sleep per day 4. Ingestion of large quantities of liquids
4. Ingestion of large quantities of liquids Rationale: Dehydration promotes the sickling of erythrocytes. Increased fluid intake minimizes the chance that a sick cell pain episode will occur.
A 5 month old develops severe diarrhea and is given IV fluids. The rate of flow must be observed often by the nurse to: 1. Avoid IV infiltration 2. Replace the fluids lost 3. Prevent increased output 4. Prevent cardiac overload
4. Prevent cardiac overload Rationale: If the circulation is overloaded with too much fluid or the rate is too rapid, the stress on the heart becomes too great and cardiac embarrassment may occur.
A child with the diagnosis of acute lymphoid leukemia (ALL) is scheduled to receive cranial radiation. The teaching plan should reflect the fact that this is done to: 1. Improve the quality of life 2. Reduce the risk for systemic infection 3. Avoid metastasis to the lymphatic system 4. Prevent central nervous system involvement
4. Prevent central nervous system involvement Rationale: Radiation destroys leukemic cells in the brain because chemotherapeutic agents are inadequately absorbed through he blood-brain barrier.
Which child would benefit most from having ear tubes placed? 1. A 2-month-old who has had one ear infection. 2. A 2-year-old who has had five previous ear infections. 3. A 3-year-old whose sibling has had four ear infections. 4. A 7-year-old who has had two ear infections this year.
2. A 2-year-old who has had five previous ear infections. Rationale: A 2-year-old who has had multiple ear infections is a perfect candidate for ear tubes. The other issue is that a 2-year-old is at the height of language development, which can be adversely affected by recurrent ear infections.
The physician orders a tap-water enema for a 6-month old infant. The nurse should question the order because it could: 1. Result in loss of necessary nutrients 2. Cause a fluid and electrolyte imbalance 3. Increase the infant's fear of invasive procedures 4. Result in shock from a sudden drop in temperature
2. Cause a fluid and electrolyte imbalance Rationale: Tap-water enemas are hypotonic and are contraindicated; they may cause increased absorption of fluid via the bowel and may upset the balance of fluid in the body. There is also interference with potassium ion balance; this electrolyte can be lost via the large intestine.
When teaching parents at the school about communicable diseases, the nurse reminds them that these disease are serious, and that encephalitis can be a complication of: 1. Pertussis 2. Chickenpox 3. Poliomyelitis 4. Scarlet fever
2. Chickenpox Rationale: Chickenpox is caused by a virus and may be followed by encephalitis. It is characterized by skin lesions.
Two second-graders are brought to the school health office after a fight during gym class. The school nurse's most therapeutic response would be: 1. "Why did you do this?" 2. "Tell me what happened." 3. "You are both in a lot of trouble." 4. "How many fights have you two had?"
2. "Tell me what happened."
Before administering a tube feeding to an infant, the nurse should: 1. Irrigate the tube with water 2. Slowly instill 10 mL of formula 3. Provide the baby with a pacifier 4. Place in the Trundelenburg position
3. Provide the baby with a pacifier
The nurse is caring for an 8-week old male who has just been diagnosed with Hirschsprung disease. The parents ask what they should expect. Select the nurse's best response. 1. "It is really an easy disease to manage. Most children are placed on stool softeners to help with constipation until it resolves." 2. "A permanent stool diversion, called an colostomy, will be placed by the surgeon to bypass the narrowed area." 3. "Daily bowel irrigations will help your child maintain regular bowel habits." 4. "Although your child will require surgery, there are different ways to manage the disease, depending on how much bowel is involved."
4. "Although your child will require surgery, there are different ways to manage the disease, depending on how much bowel is involved."
