Pediatrics NCLEX

The nurse is performing an assessment on a child admitted to the hospital with a probably diagnosis of nephrotic syndrome. Which assessment findings should the nurse expect to observe? (Select all that apply) A. pallor B. edema C. anorexia D. proteinuria E. weight loss F. decreased serum lipids

A. pallor B. edema C. anorexia D. proteinuria Nephrotic syndrome is a kidney disorder characterized by massive proteinuria, hypoalbuminemia, edema, elevated serum lipids, anorexia and pallor. The child gains weight.

The nurse is caring for a child after a tonsillectomy. The nurse monitors the child, knowing that which finding indicates the child is bleeding? A. frequent swallowing B. a decreased pulse rate C. complaints of discomfort D. an elevation in blood pressure

A frequent swallowing A tonsillectomy is the surgical removal of the tonsils. Frequent swallowing, restlessness, a fast and thready pulse, and vomiting bright red blood are signs of bleeding. an elevated blood pressure and complaints of discomfort are not indications of bleeding

The mother of a 3 year old child arrives at a clinic and tells the nurse that the child has been scratching the skin continuously and has developed a rash. The nurse assesses the child and suspects the presence of scabies. The nurse bases this suspicion on which finding noted on assessment of the child's skin? A. fine grayish red lines B. Purple-colored lesions C. thick, honey-colored crusts D. clusters of fluid-filled vesicles

A. Fine grayish red lines Scabies is a parasitic skin disorder caused by an infestation of sarcoptes scabiei (itch mite). Scabies appears as burrows of fine, grayish red, threadline lines. They may be difficult to see if they are obscured by excoriation and inflammation. Purple-colored lesions may indicate various disorders including systemic conditions. Thick, honey-colored crusts are characteristic of impetigo or secondary infections in eczema. Clusters of fluid-filled vesicles are seen in herpesvirus infection.

The home care nurse provides instructions regarding basic infection control to the parent of an infant with HIV infection. Which statement, if made by the parent, indicates the need for more teaching? A. I will clean up any spills from the diaper with diluted alcohol B. I will wash baby bottles, nipples, and pacifiers in the dishwasher. C. I will be sure to prepare foods that are high in calories and high in protein D. I will be sure to wash my hands carefully before and after caring for my infant.

A. I will clean up any spills from the diaper with diluted alcohol HIV is transmitted through blood, semen, vaginal secretions, and breast milk. The mother of an infant with HIV should be instructed to use bleach solution for disinfecting contaminated objects of cleaning up spills from the child's diaper. Alcohol would not be effective in destroying the virus.

A child undergoes surgical removal of a brain tumor. During the postoperative period, the nurse is monitoring the child and notes that the child is restless, the pulse rate is elevated, and the blood pressure has decreased significantly from the baseline value. The nurse suspects that the child is in shock. Which is the most appropriate nursing action? A. Notify the HCP B. Place the child in a supine position C. Place the child in Trendelenburg's position D. Increase the flow rate of the intravenous fluids

A. Notify the HCP In the event of shock, the HCP is notified immediately before the nurse changes the child's position or increases intravenous fluids. After craniotomy, a child is never placed in the supine of Trendelenburg's position because it increases intracranial pressure (ICP) and the risk of bleeding. The head of the bed should be elevated. Increasing intravenous fluids can cause an increase in ICP.

The mother of a 4-year old child tells the pediatric nurse that the child's abdomen seems to be swollen. during further assessment of subjective data, the mother tells the nurse that the child is eating well and that the activity level of the child is unchanged. The nurse, suspecting the possibility of Wilm's tumor, should avoid which during the physical assessment? A. Palpating the abdomen for a mass B. assessing the urine for the presence of hematuria C. monitoring the temperature for the presence of fever D. monitoring the blood pressure for the presence of hypertension

A. Palpating the abdomen for a mass Wilm's tumor is the most common intraabdominal and kidney tumor of childhood. If Wilms' tumor is suspected, the tumor mass should not be palpated by the nurse. Excessive manipulation can cause seeding off the tumor and spread of the cancerous cells. Hematuria, fever and hypertension are clinical manifestations associated with Wilm's tumor

Which interventions should the nurse include when preparing a care plan for the child with hepatitis? (Select all that apply) A. Providing a low-fat, well-balanced diet. B. Teaching the child effective hand-washing techniques C. Scheduling playtime in the playroom with other children D. Notifying the health provider if jaundice is present E. instructing the parents to avoid administering medications unless prescribed F. Arranging for indefinite home schooling because the child will not be able to return to school

A. Providing a low-fat, well-balanced diet. B. Teaching the child effective hand-washing techniques E. instructing the parents to avoid administering medications unless prescribed Hepatitis is an acute or chronic inflammation of the liver that may be caused by a virus, a medication reaction, or another disease process. Because hepatitis can be viral, standard precautions should be instituted in the hospital. The child should be discouraged from sharing toys, so playtime in the playroom with the other children is not part of the plan of care. The child will be allowed to return to school 1 weeks after the onset of jaundice, so indefinite home schooling would not need to be arranged. Jaundice is an expected finding with hepatitis and would not warrant notification of the HCP. Provision of a low-fat, well-balanced diet is recommended. Patients are cautioned about administering any medication to the child because normal doses of many medications may become dangerous owing to the liver's inability to detoxify and excrete them. Hand-washing is the most effective measure for control of hepatitis in any setting, and effective hand-washing can prevent the immunocompromised child from contracting an opportunistic type of infection.

The nurse is reviewing a health care provider's prescriptions for a child with sickle cell anemia who was admitted to the hospital for the treatment of vaso-occlusive crisis. Which prescriptions documented in the child's record should the nurse question? (Select all that apply) A. Restrict fluid intake B. position for comfort C. avoid strain on painful joints D. apply nasal O2 at 2L/min E. provide a high-calorie, high-protein diet F. Give meperidine (Demerol), 25mg intravenously ever 4 hours for pain

A. Restrict fluid intake F. Give meperidine (Demerol), 25mg intravenously ever 4 hours for pain Sickle cell anemia is one of a group of diseases termed hemoglobinopathies, in which hemoglobin A is partly or completely replaced by abnormal sickle hemoglobin S. It is caused by the inheritance of a gene for a structurally abnormal portion of the hemoglobin chain. Hemoglobin S is sensitive to changes in the oxygen content of the red blood cell; insufficient oxygen causes the cells to assume a sickle shape, and the cells become rigid and clumped together, obstructing capillary blood flow. Oral and intravenous fluids are an important part of treatment. Meperidine (Demerol) is not recommended for a child with sickle cell disease because of the risk for normeperidine-induced seizures. Normepheridine, a metabolite of meperidine, is a central nervous system stimulant that produces anxiety, tremors, myoclonus, and generalized seizures when it accumulates with repetitive dosing. The nurse would question the prescription for restricted fluids and meperidine for pain control. Positioning for comfort, avoiding strain on painful joints, oxygen, and a high-calorie and high-protin diet are also important parts of the treatment plan.

The clinic nurse is reviewing the health care provider's prescription for a child who has been diagnosed with scabies. Lindane has been prescribed for the child. The nurse questions the prescription if which is noted in the child's record? A. The child is 18 months old B. The child is being bottle-fed. C. A sibling is using lindane for the treatment of scabies D. The child has a history of frequent respiratory infections.

A. The child is 18 months old Lindane is a pediculicide product that may be prescribed to treat scabies. It is contraindicated for children younger than 2 years old because they have more permeable skin, and high systemic absorption may occur, placing the children at risk for central nervous system toxicity and seizures. Lindane also is used with caution in children between the ages of 2 and 10 years. Siblings and other household members should be treated simultaneously. Lindane is not recommended for use by a breast-feeding woman because the medication is secreted into breast milk.

The nurse is performing an assessment on a 10 year old child suspected to have Hodgkin's disease. The nurse understands that which assessment findings are specifically characteristic of this disease? (Select all that apply) A. abdominal pain B. fever and malaise C. anorexia and weight loss D. painful, enlarged inguinal lymph nodes E. painless, firm and movable adenopathy in the cervical area.

A. abdominal pain E. painless, firm and movable adenopathy in the cervical area. Hodgkin's disease (a type of lymphoma) is a malignancy of the lymph nodes. Specific clinical manifestations associated with Hodgkin's disease include painless, firm, and movable adenopathy in the cervical and supraclavicular areas and abdominal pain as a result of enlarged retrooperitoneal nodes. Hepatosplenomegaly also is noted. Although fever, malaise, anorexia, and weight loss are associated with Hodgkin's disease, these manifestations are seen in many disorders.

Antibiotics are prescribed for a child with otitis media who underwent a myrinotomy with insertion of tympanostomy tubes. The nurse provides discharge instructions to the parents regarding the administration of the antibiotics. Which statement, if made by the parents, indicates understanding of the instructions provided? A. administer the antibiotics until they are gone. B. administer the antibiotics if the child has a fever. C. administer the antibiotics until the child feels better D. Begin to taper the antibiotics after 3 days of full course.

A. administer the antibiotics until they are gone. A myringotomy is the insertion of tympanoplasty tubes into the middle ear to promote drainage of purulent middle ear fluid, equalize pressure, and keep the ear aerated. The nurse must instruct parents regarding the administration of antiboticsAntibiotics need to be taken as prescribed and the full course needs to be completed. Antibiotics are not tapered but are administered for the full course of therapy.

The nurse is conducting staff in-service training on von Willebrand's disease. Which should the nurse include as characeristics of von Willebrand's disease? (Select all that apply) A. easy bruising occurs B. gum bleeding occurs C. it is a hereditary bleeding disorder D. treatment and care are similar to that for hemophilia. E. It is characterized by extremely high creatinine levels F. the disorder causes platelets to adhere to damaged endothelium.

A. easy bruising occurs B. gum bleeding occurs C. it is a hereditary bleeding disorder D. treatment and care are similar to that for hemophilia. F. the disorder causes platelets to adhere to damaged endothelium. von Willebrand's disease is a hereditary bleeding disorder characteried by a deficiency of or a defect in a protein termed von Willebrand factor. The disorder causes platelets to adhere to damaged endothelium. It is characterized by an increased tendency to bleed from mucous membranes. Assessment findings include epistaxis, gum bleeding, easy bruising, and excessive menstrual bleeding. An elevated creatinine level is not associated with this disorder.

The nurse analyzes the laboratory values of a child with leukemia who is receiving chemotherapy. The nurse notes that the platelet count is 19,500 cells/mm3. On the basis of this laboratory result, which intervention should the nurse include in the plan of care? A. initiate bleeding precautions B. monitor closely for signs of infection C. monitor the temperature every 4 hours D. initiate protective isolation precautions

A. initiate bleeding precautions Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing anemia from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production (thrombocytopenia). If a child is severely thrombodytopenic and has a platelet count less than 20,000 cells/mm3, bleeding precautions need to be initiated because of the increased risk of bleeding or hemorrhage. Precautions include limiting activity that could result in head injury using soft toothbrushes, checking urine and stools for blood, and administering stool softeners to prevent straining with constipation. In addition, suppositories, enemas, and rectal temperatures should be avoided.

Which home care instructions should the nurse provide to the parent of a child with AIDS? Select all that apply A. monitor the child's weight B. frequent hand-washing is important C. The child should avoid exposure to other illnesses D. The child's immunization schedule will need revision E. Clean up body fluid spills with bleach solution (10:1 ratio of water to bleach) F. Fever, malaise, fatigue, weight loss, vomiting, and diarrhea are expected to occur and do not require special intervention.

A. monitor the child's weight B. frequent hand-washing is important C. The child should avoid exposure to other illnesses E. Clean up body fluid spills with bleach solution (10:1 ratio of water to bleach) AIDS is a disorder caused by HIV and is characterized by a generalized dysfunction of the immune system. Home care instructions include the following: frequent handwashing, monitoring for fever, malaise, fatigue, weight loss, vomiting, and diarrhea and notifying the health care provider if these occur; monitoring for signs and symptoms of opportunistic infections; administering antiretroviral medications and other medications as prescribed; avoiding exposure to other illnesses; keeping immunizations up to date; monitoring weight and providing a high-calorie, high-protein diet; washing eating utensils in the dishwasher; and avoiding sharing eating utensils. Gloves are worn for care, especially when in contact with body fluids and changing diapers; diapers are changed frequently and away from food areas, and soiled disposable diapers are folded inward, closed with the tabs and disposed of in a tightly covered plastic-lined container. Any body fluid spills are cleaned with a bleach solution (10:1 ratio of water to bleach).

The nurse is preparing for the administration of an infant with a diagnosis of bronchiolitis caused by respiratory syncytial virus (RSV). Which interventions should the nurse include in the plan of care? (Select all that apply) A. place the infant in a private room B. ensure that the infant's head is in a flexed position C. wear a mask at all times when in contact with the infant D. place the infant in a tent that delivers warm humidified air E. position the infant on the side, and the head lower than the chest F. ensure that nurses caring for the infant with RSV do not care for other high-risk children

A. place the infant in a private room F. ensure that nurses caring for the infant with RSV do not care for other high-risk children Respiratory syncytial virus (RSV) is a highly communicable disorder and is not transmitted via the airborne route. The virus usually is transferred by the hands. Use of contact and standard precautions during care (wearing gloves and a gown) reduces nosocomial transmission of RSV. A mask is unnecessary. In addition, it is important to ensure that nurses caring for a child with RSV do not care for other high-risk children to prevent the transmission of the infection. An infant with RSV should be isolated in a private room or in a room with another infant with RSV infection. The infant should be positioned with the head and chest at a 30-40 degree angle and the neck slightly extended to maintain an open airway and decrease pressure on the diaphragm. Cool humidified oxygen is delivered to relieve dyspnea, hypoxemia, and insensible water loss from tachypnea.

The clinic nurse reads the results of a tuberculosis skin test (TST) on a 3-year old child. The results indicate an area of induration measuring 10mm. The nurse should interpret these results as which finding? A. positive B. negative C. inconclusive D. definitive and requiring a repeat test

A. positive Induration measuring 10 mm or more is considered to be a positive result in children younger than 4 years of age and in children with chronic illness or at high risk for exposure to tuberculosis. A reaction of 5mm or more is considered to be a positive result for the highest risk groups, such as a child with an immunosuppressive condition or a child with human immunodeficiency virus (HIV) infection. A reaction of 15mm or more is positive in children 4 years or older without any risk factors.

A child has been diagnosed with acute otitis media of the right ear. Which interventions should the nurse include in the plan of care? (Select all that apply) A. provide a soft diet B. position the child on the left side C. Administer an antihistamine twice daily D. Irrigate the right ear with normal saline every 8 hours E. Administer ibuprofen (Motrin IB) for fever every 4 hours as prescribed and as needed F. Instruct the parents about the need to administer the prescribed antibiotics for the full course of therapy.

A. provide a soft diet E. Administer ibuprofen (Motrin IB) for fever every 4 hours as prescribed and as needed F. Instruct the parents about the need to administer the prescribed antibiotics for the full course of therapy. Acute otitis media is an inflammatory disorder caused by an infection of the middle ear. The child often has fever, pain, loss of appetite, and possible ear drainage. The child also is irritable and lethargic and may roll the head or pull on or rub the affected ear. Otoscopic examination may reveal a red, opaque, bulging, and immobile tympanic membrane. Hearing loss may be noted particularly in chronic otitis media. The child's fever should be treated with ibuprofen (Motrin IB). The child is positioned on his or her affected side to facilitate drainage. A soft diet is recommended during the acute stage to avoid pain that can occur with chewing. Antibiotics are prescribed to treat the bacterial infection and should be administered for the full prescribed course. The ear should not be irrigated with normal saline because it can exacerbate the inflammation further. Antihistamines are not usually recommended as part of therapy.

The nurse is planning care for a child with hemolytic-uremic syndrome who has been anuric and will be receiving peritoneal dialysis treatment. The nurse should plan to implement which measure? A. restrict fluids as prescribed B. care for the arteriovenous fistula C. encourage foods high in potassium D. administer analgesics as prescribed

A. restrict fluids as prescribed Hemolytic-uremic syndrome is thought to be associated with bacterial toxins, chemicals, and viruses that result in acute kidney injury in children. Clinical manifestations of the disease include acquired hemolytic anemia, thrombocytopenia, renal injury, and central nervous system symptoms. A child with hemolytic-uremic syndrome undergoing peritoneal dialysis because of anuria would be on fluid restriction. Pain is not associated with hemolytic-uremic syndrome, and potassium would be restricted, not encouraged, if the child is anuric. Peritoneal dialysis does not require an arteriovenous fistula (only hemodialysis.)

The nurse provides home care instructions to the parents of a child with celiac disease. The nurse should teach the parents to include which food item in the child's diet? A. rice B. oatmeal C. rye toast D. wheat bread

A. rice Celiac disease also is known as gluten enteropathy or celiac sprue and refers to an intolerance to gluten, the protein component of wheat, barley, rye, and oats. The important factor to remember is that all wheat, rye, barley and oats should be eliminated from the diet and replaced with corn, rice, or millet. Vitamin supplements - especially the fat-soluble vitamins, iron and folic-acid - may be needed to correct deficiencies. Dietary restrictions are likely to be lifelong.

The nurse is assigned to care for an 8 year old child with a diagnosis of a basilar skull fracture. The nurse reviews the health care provider's (HCP's) prescriptions and should contact the HCP to question which prescription? A. suction as needed B. obtain daily weight C. provide clear liquid intake D. maintain a patent intravenous line.

A. suction as needed A basilar skull fracture is a type of head injury. Nasotracheal suctioning is contraindicated in a child with a basilar skull fracture: Because of the nature of the injury, there is a possibility that the catheter will enter the brain through the fracture, creating a high risk of secondary infection. Fluid balance is monitored closely by daily weight determination, intake and output measurement, and serum osmolality determination to detect early signs of water retention, excessive dehydration, and states of hypertonicity or hypotonicity. The child is maintained on NPO status or restricted to clear liquids until it is determined that vomiting will not occur. An intravenous line is maintained to administer fluids or medications if necessary.

The nurse is developing a plan of care for a child who is at risk for seizures. Which interventions apply if the child has a seizure? (Select all that apply) A. time the seizure B. restrain the child C. stay with the child D. place the child in a prone position E. move furniture away from the child F. insert a padded tongue blade in the child's mouth

A. time the seizure C. stay with the child E. move furniture away from the child A seizure is a disorder that occurs as a result of excessive and unorganized neuronal discharges in the brain that activate associated motor and sensory organs. During a seizure the child is placed on his or her side in a lateral position. Positioning on the side prevents aspiration because saliva drains out of the corner of the child's mouth. The child is not restrained because this could cause injury to the child. The nurse would loosen clothing around the child's neck and ensure a patent airway. Nothing is paced into the child's mouth during a seizure because this action may cause injury to the child's mouth, bums, or teeth. The nurse would stay with the child to reduce the risk of injury and allow for observation and timing of the seizure.

The nurse is assisting a health care provider examining an infant with developmental dysplasia of the hip perform Ortolani maneuver. The nurse understands that this maneuver is performed for which purpose? A. to assess for hip instability B. To assess for movement of the hips C. To push the femoral head out of the acetabulum D. To ensure that hyperextension and full range of motion exist.

A. to assess for hip instability In developmental dysplasia of the hip, the head of the femur is seated improperly in the acetabulum or hip socket. of the pelvis. Ortolani's maneuver is a test to asses for hip instability. the examiner abducts the thigh and applies gentle pressure forward over the greater trochanter. A "clicking" sensation indicates a dislocated femoral head moving into the acetabulum. This maneuver does not assess for hip movement or ensure that hyperextension and full range of motion exist. Pushing the femoral head out of the acetabulum is not the purpose of Ortolani's maneuver.

The nurse is monitoring a 3 year old child for signs and symptoms of increased intracranial pressure (ICP) after a craniotomy. The nurse plans to monitor for which early sign or symptom of increased ICP? A. vomiting B. bulging anterior fontanel C. increasing head circumference D. complaints of a frontal headache

A. vomiting The brain, although well-protected by the solid bony cranium, is highly susceptible to pressure that may accumulate within the enclosure. Volume and pressure must remain constant within the brain. A change in the size of the rain, such as occurs with edema or increased volume of intracranial blood or cerebrospinal fluid without a compensatory change, leads to an increase in intracranial pressure (ICP), which may be life-threatening. Vomiting, an early sign of increased ICP, can become excessive as pressure builds up and stimulates the medulla in the brainstem, which houses the vomiting center. Children with open fontanels (posterior fontanel closes at 2-3 months; anterior fontanel closes at 12-18 months) compensate for ICP changes by skull expansion and subsequent bulging fontanels. When the fontanels have closed, nausea, excessive vomiting, diplopia, and headaches become pronounced, with headaches becoming more prevalent in older children.

The nurse is closely monitoring the intake and output of an infant with heart failure who is receiving diuretic therapy. The nurse should use which most appropriate method to assess the urine output? A. weighing the diapers B. inserting a Foley catheter C. comparing intake with output D. measuring the amount of water added to formula

A. weighing the diapers Heart failure is the inability of the heart to pump a sufficient amount of blood to meet the oxygen and metabolic needs of the body. The most appropriate method for assessing urine output in an infant receiving diuretic therapy is to weight the diapers. Comparing intake with output would not provide an accurate measure of urine output. Measuring the amount of water added to formula is unrelated to the amount of output. Although Foley catheter drainage is most accurate in determining output, it is not the most appropriate method in an infant and places the infant at risk for infection

The nurse caring for a child who sustained a burn injury plans care based on which pediatric considerations associated with this injury? (Select all that apply) A. Scarring is less severe in a child than in an adult B. A delay in growth may occur after a burn injury C. An immature immune system presents an increased risk of infection for infants and young children D. The lower proportion of body fluid to mass in a child increases the risk of cardiovascular problems. E. Fluid resuscitation is unnecessary unless the burned area in more than 25% of the total body surface area. F. Infants and young children are at increased risk for protein and calorie deficiency because they have smaller muscle mass and less body fat than adults.

B. A delay in growth may occur after a burn injury C. An immature immune system presents an increased risk of infection for infants and young children F. Infants and young children are at increased risk for protein and calorie deficiency because they have smaller muscle mass and less body fat than adults. Pediatric considerations in the care of a burn victim include the following: Scarring is more severe in a child than in an adult. A delay in growth may occur after a burn injury. An immature immune system presents an increased risk of infection for infants and young children. The higher proportion of body fluid to mass in a child increases the risk of cardiovascular problems. Burns involving more than 10% of total body surface area require some form of fluid resuscitation. Infants and young children are at increased risk for protein and calorie deficiencies because they have smaller muscle mass and less body fat than adults.

The nurse has provided home care instructions to the parents of a child who is being discharged after cardiac surgery. Which statement made y the parents indicates a need for further instructions? A. a balance of rest and exercise is important B. I can apply lotion or powder to the incision if it is itchy C. Activities in which my child could fall need to be avoided for 2-4 weeks. D. large crowds of people need to be avoided for at least 2 weeks after surgery

B. I can apply lotion or powder to the incision if it is itchy The mother should be instructed that lotions and powders should not be applied to the incision site after cardiac surgery. Lotions and powders can irritate the surrounding skin, which could lead to skin breakdown and subsequent infection of the incision site.

A 4-year old child sustains a fall at home and after an x-ray examination, the child is determined to have a fractured arm and a plaster cast is applied. The nurse provides instructions to the parents regarding care for the child's cast. Which statement by the parents indicates a need for further teaching? A. The cast may feel warm as the cast dries. B. I can use lotion or powder around the cast edges to relieve itching. C. A small amount of white shoe polish can touch up a soiled white cast. D. If the cast becomes wet, a blow drier set on the cool setting may be used to dry the cast.

B. I can use lotion or powder around the cast edges to relieve itching. Teaching about cast care is essential to prevent complications from the cast. The parents need to be instructed not to use lotion or powders on the skin around the cast edges or inside the cast. Lotions or powders can become sticky or caked and cause skin irritation.

The nurse prepares a list of home care instructions for the parents of a child who has a plaster cast applied to the left forearm. Which instructions should be included on the list? (Select all that apply) A. Use the fingertips to lift the cast while it is drying B. Keep small toys and sharp objects away from the cast C. Use a padded ruler or another padded object to scratch the skin under the cast if it itches D. Place a heating pad on the lower end of the cast and over the fingers if the fingers feel cold. E. elevate the extremity on pillows for the first 24-48 hours after casting to prevent swelling F. Contact the health care provider if the child complains of numbness or tingling in the extremity

B. Keep small toys and sharp objects away from the cast E. elevate the extremity on pillows for the first 24-48 hours after casting to prevent swelling F. Contact the health care provider if the child complains of numbness or tingling in the extremity While the cast is drying, the palms of the hands are used to lift the cast. If the fingertips are used, indentations in the cast could occur and cause constant pressure on the underlying skin. Small toys and sharp objects are kept away from the cast, and no objects (including padded objects) are placed inside the cast because of the risk of altered skin integrity. The extremity is elevated to prevent swelling, and the HCP is notified immediately if any signs off neurovascular impairment develop. A heating pad is not applied to the cast or fingers. Cold fingers could indicate neurovascular impairment, and the HCP should be notified.

The clinic nurse is assessing a child who is scheduled to receive a live virus vaccine (immunization). What are the general contraindications associated with receiving a live virus vaccine? (Select all that apply) A. the child has symptoms of a cold. B. The child had a previous anaphylactic reaction to the vaccine. C. mother reports that the child is having intermittent episodes of diarrhea D. mother reports that the child has not had an appetite and has been fussy. E. the child has a disorder that caused a severely deficient immune system F Mother reports that the child has recently been exposed to an infectious disease.

B. The child had a previous anaphylactic reaction to the vaccine. E. the child has a disorder that caused a severely deficient immune system The general contraindications for receiving live virus vaccines include a previous anaphylactic reaction to a vaccine or a component of a vaccine. In addition, live virus vaccines generally are not administered to individuals with a severely deficient immune system, individuals with a severe sensitivity to gelatin, or pregnant women. A vaccine is administered with caution to an individual with a moderate or severe acute illness, with or without fever.

The emergency department nurse is caring for a child diagnosed with epiglottitis. In assessing the child, the nurse should monitor for which indication that the child may be experiencing airway obstructions? A. the child exhibits nasal flaring and bradycardia B. The child is leaning forward, with the chin thrust out C. the child has a low-grade fever and complains of a sore throat. D. the child is leaning backward, supporting himself or herself with the hands and arms.

B. The child is leaning forward, with the chin thrust out Epiglottitis is a bacterial form of croup. A primary concern is that it can progress to acute respiratory distress. Clinical manifestations suggestive of airway obstruction include tripod positioning (leaning forward while supported by arms, chin thrust out, mouth open), nasal flaring, the use of accessory muscles for breathing, and the presence of stridor. Epiglottitis also causes tachycardia and a high fever.

The clinic nurse is instructing the parent of a child with human immunodeficiency virus infection regarding immunizations. The nurse should provide which instruction to the parent? A. The hepatitis B vaccine will not be given to the child. B. The inactivated influenza vaccine will be given yearly. C. The varicella vaccine will be given before 6 months of age. D. A western blot test needs to be performed and the results evaluated before immunizations.

B. The inactivated influenza vaccine will be given yearly. Immunizations against common childhood illnesses are recommended for all children exposed to or infected with HIV. The inactivated influenza vaccine that is given intramuscularly will be administered (influenza vaccine should be given yearly). The hepatitis B vaccine is administered according to the recommended immunization schedule. Varicella-zoster virus vaccine should not be given because it is a live virus vaccine; varicella-zoster immunoglobulin may be prescribed after chickenpox exposure.

The nursing student is presenting a clinical conference and discusses the cause of beta-thalassemia. The nursing student informs the group that a child at greatest risk of developing this disorder is which one? A. a child of Mexican descent B. a child of Mediterranean descent C. a child whose intake of iron is extremely poor D. a breast-fed child of a mother with chronic anemia

B. a child of Mediterranean descent Beta-thalassemia is an autosomal recessive disorder characterized by the reduced production of one of the globin chains in the synthesis of hemoglobin (both parents must be carriers to produce a child with Beta-thalassemia major). This disorder is found primarily in individuals of Mediterranean descent.

The nurse is instructing the parents of a child with iron deficiency anemia regarding the administration of a liquid oral iron supplement. Which instruction should the nurse tell the parents? A. administer the iron at mealtimes B. administer the iron through a straw C. mix the iron with cereal to administer D. add the iron to formula for easy administration

B. administer the iron through a straw In iron deficiency anemia, iron stores are depleted, resulting in a decreased supply of iron for the manufacture of hemoglobin in red blood cells. An oral iron supplement should be administered through a straw or medicine dropper placed at the back of the mouth because the iron stains the teeth. The parents should be instructed to brush or wipe the child's teeth or have the child brush the teeth after administration. Ion is administered between meals because absorption is decreased if there is food in the stomach. Iron requires an acid environment to facilitate its absorption in the duodenum. Iron is not added to formula or mixed with cereal or other food items.

A child with rubeola (measles) is being admitted to the hospital. In preparing for the admission of the child, the nurse should plan to place the child on which precautions? A. enteric B. airborne C. protective D. neutropenic

B. airborne Rubeola is transmitted via airborne particles of direct contact with infectious droplets. Airborne droplet precautions are required, and persons in contact with the child should wear masks. The child is placed in a private room if hospitalized, and the hospital room door remains closed. Gowns and gloves are unnecessary; but standard precautions are used. Articles that are contaminated should be bagged and labeled. special enteric precautions and protective (neutropenic) isolation are not indicated in rubeola.

The nurse reviews the record of a child who is suspected to have glomerulonephritis and expects to note which finding that is associated with this diagnosis? A. hypotension B. brown-colored urine C. low urinary specific gravity D. low blood urea nitrogen level

B. brown-colored urine Glomerulonephritis refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. Gross hematuria, resulting in dark, smoky, cola-colored or brown-colored urine, is a classic symptom of glomerulonephritis. Hypertension is also common. Blood urea nitrogen levels may be elevated. A moderately elevated to high urinary specific gravity is associated with glomerulonephritis.

The nurse is caring for an infant with a diagnosis of bladder exstrophy. To protect the exposed bladder tissue, the nurse should plan which intervention? A. cover the bladder with petroleum jelly gauze B. cover the bladder with a nonadhering plastic wrap C. Apply sterile distilled water dressings over the bladder mucosa D. keep the bladder tissue dry by covering it with dry sterile gauze

B. cover the bladder with a nonadhering plastic wrap In bladder exstrophy, the bladder is exposed and external to the body. In this disorder, one must take care to protect the exposed bladder tissue from drying, while allowing the drainage of urine. This is accomplished best by covering the bladder with a nonadhering plastic wrap. The use of petroleum jelly gauze should be avoided because this type of dressing can dry out, adhere to the mucosa, and damage the delicate tissue when removed. Dry sterile dressings and dressings soaked in solutions (that can dry out) also damage the mucosa when removed.

A 10-year old child with asthma is treated for acute exacerbation in the emergency department. The nurse caring for the child should monitor for which sign, knowing that it indicates a worsening of the condition? A. Warm, dry skin B. decreased wheezing C. pulse rate of 90 beats/minute D. respirations of 18 breaths/minute

B. decreased wheezing Asthma is a chronic inflammatory disease of the airways. Decreased wheezing in a child with asthma may be interpreted incorrectly as a positive sign when it may actually signal an inability to move air. A "silent chest" is an ominous sign during an asthma episode. With treatment, increased wheezing actually may signal that the child's condition is improving. Warm, dry skin indicates an improvement in the child's condition because the child is normally diaphoretic during exacerbation. The normal pulse rate in a 10-year old is 70-110 beats/minute The normal respiratory rate in a 10-year old is 16-20 breaths/minute.

The nurse performing an admission assessment on a 2 year old child who has been diagnosed with nephrotic syndrome notes that which most common characteristic is associated with this syndrome? A. hypertension B. generalized edema C. increased urinary output D. frank, bright red blood in the urine

B. generalized edema Nephrotic syndrome is defined as massive proteinuria, hypoalbuminemia, hyperlipemia, and edema. Other manifestations include weight gain; periobital and facial edema that is most prominent in the morning; leg, ankle, labial, or scrotal edema; decreased urine output and urine that is dark and frothy; abdominal swelling and blood pressure that is normal or slightly decreased.

A mother brings her 3 week old infant to a clinic for a phenylketonuria rescreening blood test. The test indicates a serum phenylalanine level of 1 mg/dL. The nurse reviews this result and makes which interpretation? A. it is positive B. it is negative C. it is inconclusive D. it requires rescreening at age 6 weeks.

B. it is negative Phenylketonuria is a genetic (autosomal recessive) disorder that results in central nervous system damage from toxic levels of phenylalanine (an essential amino acid) in the blood. It is characterized by blood phenylalanine levels greater than 20mg/dL (normal level is 1.2-3.4 mg/dL in newborns and 0.8 to 1.8 mg/dL therafter). A result of 1 mg/dL is a negative test result.

The nurse is caring for an infant with bronchiolitis, and diagnostic tests have confirmed respiratory syncytial virus (RSV). On the basis of this finding, which is the most appropriate nursing action? A. Initiate strict enteric precautions B. move the infant to a room with another child with RSV C. leave the infant in the present room because RSV is not contagious d. inform the staff that they must wear a mask, gloves, and a gown when caring for the child.

B. move the infant to a room with another child with RSV Respiratory syncytial virus (RSV) is a highly contagious communicable disorder and is not transmitted via the airborne route. The virus usually is transferred by the hands. Use of standard and contact precautions during care is necessary. using good hand-washing techniques and wearing gloves and gowns are also necessary. Masks are not required. An infant with RSV is isolated in a single room or placed in a room with another child with RSV. Enteric precautions are unnecessary.

The nurse is monitoring a child with burns during treatment for burn shock. The nurse understands that which assessment provides the most accurate guide to determine the adequacy of fluid resuscitation? A. skin turgor B. neurological assessment C. Level of edema at burn site D. quality of peripheral pulses

B. neurological assessment Sensorium is an accurate guide to determine the adequacy of fluid resuscitation. The burn injury itself does not affect the sensorium, so the child should be alert and oriented. Any alteration in sensorium should be evaluated further. A neurological assessment would determine the level of sensorium in the child.

The nurse is monitoring a child for bleeding after surgery for removal of a brain tumor. The nurse checks the head dressing for the presence of blood and notes a colorless drainage on the back of the dressing. Which intervention should the nurse perform immediately? A. reinforce the dressing B. notify the health care provider C. document the findings and continue to monitor D. circle the area of drainage and continue to monitor

B. notify the health care provider Colorless drainage on the dressing in a child after craniotomy indicates the presence of cerebral spinal fluid and should be reported to the HCP immediately.

The mother of a 6 year old child arrives at a clinic because the child has been experiencing scratchy, red, and swollen eyes. The nurse notes a discharge from the eyes and sends a culture to the laboratory for analysis. Chlamydial conjunctivitis is diagnosed. On the basis of this diagnosis, the nurse determines that which requires further investigation? A. possible trauma B. possible sexual abuse C. presence of an allergy D. presence of a respiratory infection

B. possible sexual abuse Conjunctivitis is an inflammation of the conjunctiva. A diagnosis of chlamydial conjunctivitis in a child who is not sexually active should signal the health care provider to assess the child for possible sexual abuse. Trauma, allergy and infection can cause conjunctivitis, but the causative organism is not likely to be chlamydia.

The nurse admits a child to the hospital with a diagnosis of pyloric stenosis. On assessment, which data would the nurse expect to obtain when asking the mother about the child's symptoms? A. watery diarrhea B. projectile vomiting C. increased urine output D. vomiting large amounts of bile

B. projectile vomiting In pyloric stenosis, hypertrophy of the circular muscles of the pylorus causes narrowing of the pyloric canal between the stomach and the duodenum. Clinical manifestations of pyloric stenosis include projectile vomiting, irritability, hunger and crying, constipation, and signs of dehydration, including a decrease in urine output.

The nurse is reviewing the laboratory results for a child scheduled for tonsillectomy. The nurse determines that which laboratory value is most significant to review? A. creatinine level B. prothrombin time C. sedimentation rate D. blood urea nitrogen level

B. prothrombin time. A tonsillectomy is the surgical removal of the tonsils. Because the tonsillar area is so vascular, postoperative bleeding is a concern. Prothrombin time, partial thromboplastin time, platelet count, hemoglobin and hematocrit, white blood cell count, and urinalysis are performed preoperatively. The prothrombin time results would identify a potential for bleeding. Creatinine level, sedimentation rate, and blood urea nitrogen would not determine the potential for bleeding.

Which specific nursing interventions are implemented in the care of a child with leukemia who is at risk for infection? (Select all that apply) A. maintain the child in a semiprivate room B. reduce exposure to environmental organisms C. use strict aseptic technique for all procedures D. ensure that anyone entering the child's room wears a mask E. apply firm pressure to a needle stick area for at least 10 minutes.

B. reduce exposure to environmental organisms C. use strict aseptic technique for all procedures D. ensure that anyone entering the child's room wears a mask Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing anemia from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production (thrombocytopenia). A common complication of leukemia is overwhelming infection secondary to neutropenia. Measures to prevent infection include the use of a private room, strict aseptic technique, restriction of visitors and health care personnel with active infection, strict hand-washing, ensuring that anyone entering the child's room wears a mask, and reducing exposure to environmental organisms by eliminating raw fruits and vegetables from the diet and fresh flowers from the child's room and by not leaving standing water in the child's room. Applying firm pressure to a needle stick area for least 10 minutes is a measure to prevent bleeding.

An infant with a diagnosis of hydrocephalus is scheduled for surgery. Which is the priority nursing intervention in the preoperative period? A. test the urine for protein B. resposition the infant frequently C. provide a stimulating environment D. assess blood pressure every 15 minutes

B. resposition the infant frequently Hydrocephalus occurs as a result of an imbalance of cerebrospinal fluid absorption or production that is caused by malformations, tumors, hemorrhage, infections, or trauma. It results in head enlargement and increased intracranial pressure. In infants with hydrocephalus, the head grows at an abnormal rate, and if the infant is not respositioned frequently, pressure ulcers can occur on the back and side of the head. An egg crate mattress under the head is also a nursing intervention that can help prevent skin breakdown. Proteinuria is not specific to hydrocephalus. Stimulus should be kept at a minimum because of the increase in intracranial pressure. It is not necessary to check the blood pressure every 15 minutes.

The nurse is preparing to care for a child after a tonsillectomy. The nurse documents on the plan of care to place the child in which position? A. supine B. side-lying C. high Fowler's D. Trendelenburg's

B. side-lying A tonsillectomy is the surgical removal of the tonsils. The child should be placed in a prone or side-laying position after the surgical procedure to facilitate drainage.

After a tonsillectomy, the nurse reviews the health care provider's postoperative prescriptions. Which prescription should the nurse question? A. monitor for bleeding B. suction every 2 hours C. give no milk or milk, products D. give clear, cool liquids when awake and alert

B. suction every 2 hours A tonsillectomy is the surgical removal of the tonsils. After tonsillectomy, suction equipment should be available, but suctioning is not performed unless there is an airway obstruction because of the risk of trauma to the surgical site. Monitoring for bleeding is an important nursing intervention after any type of surgery. Milk and milk products are avoided initially because they coat the throat, cause the child to clear the throat, and increase the risk of bleeding. Clear cool liquids are encouraged.

The day care nurse is observing a 2 year old child and suspects that the child may have strabismus. Which observation made by the nurse indicates the presence of this condition? A. the child has difficulty hearing B. the child consistently tilts the head to see C. the child does not respond when spoken too D. the child consistently turns the head to hear.

B. the child consistently tilts the head to see Strabismus is a condition in which the eyes are not aligned because of lack of coordination of the extraocular muscles. The nurse may suspect strabismus in a child when the child complains of frequent headaches, squints, or tilts the head to see. Other manifestations include crossed eyes, closing one eye to see, diplopia, photophobia, loss of binocular vision, or impairment of depth perception.

The pediatric nurse specialist provides a teaching session to the nursing staff regarding osteosarcoma. Which statement by a member of the nursing staff indicates a need for information? A. the femur is the most common site of this sarcoma B. the child does not experience pain at the primary tumor site C. Limping, if a weight-bearing limb is affected, is a clinical manifestation D. The symptoms of the disease in the early stage are almost always attributed to normal growing pains.

B. the child does not experience pain at the primary tumor site Osteosarcoma is the most common bone cancer in children. Cancer usually is found in the metaphysis of long bones, especially in the lower extremities, with most occurring int he femur. Osteosarcoma is manifested clinically by progressive, insidious and intermittent pain at the tumor site. By the time these children receive medical attention, they may be in considerable pain from the tumor.

After a tonsillectomy, a child begins to vomit bright red blood. The nurse should take which initial action? A. maintain NPO status B. turn the child to the side. C. administer the prescribed antiemetic D. notify the health care provider

B. tun the child to the side. After tonsillectomy, if bleeding occurs, the nurse immediately turns the child to the side to prevent aspiration and then notifies the health care provider. PO status would be maintained, and an antiemetic may be prescribed; however, the initial nursing action would be to turn the child to the side.

The mother of a hospitalized 2-year old child with viral laryngotracheobronchitis (croup) asks the nurse why the health care provider did not prescribe antibiotics. Which response should the nurse make? A. The child may be allergic to antibiotics B. the child is too young to receive antibiotics C. Antibiotics are not indicated unless a bacterial infection is present D. The child still has the maternal antibodies from birth and does not need antibiotics.

C. Antibiotics are not indicated unless a bacterial infection is present Larngotracheobronchitis (croup) is the inflammation of the larynx, trachea, and bronchi and is the most common type of croup. It can be viral or bacterial. Antibiotics are not indicated in the treatment of croup unless a bacterial infection is present. There is no supporting data that the child may be allergic to antibiotics.

A 1-month old infant is seen in a clinic and is diagnosed with developmental dysplasia of the hip. On assessment, the nurse understands that which finding should be noted in this condition? A. Limited range of motion in the affected hip B. an apparent lengthened femur on the affected side C. Asymmetrical adduction of the affected hip when the infant is placed supine with the knees and hips flexed. D. Symmetry of the gluteal skinfolds when the infant is placed prone and the legs are extended against the examining table.

C. Asymmetrical adduction of the affected hip when the infant is placed supine with the knees and hips flexed. In developmental dysplasia of the hip, the head of the femur is seated improperly in the acetabulum or hip socket of the pelvis. Asymmetrical and restricted abduction of the affected hip, when the child is placed supine with the knees and hips flexed would be an assessment finding in developmental dysplasia of the hip in infants beyond the newborn period. Other findings include an apparent short femur on the affected side, asymmetry of the gluteal skinfolds, and limited range of motion in the affected extremity.

The nurse is caring for a newborn with a suspected diagnosis of imperforate anus. The nurse monitors the infant, knowing that which is a clinical manifestation associated with this disorder? A. bile-stained fecal emesis B. The passage of currant jelly-like stools. C. Failure to pass meconium stool in the first 24 hours after birth. D. Sausage-shaped mass palpated in the upper right abdominal quadrant

C. Failure to pass meconium stool in the first 24 hours after birth Imperforate anus is the incomplete development or absence of the anus in its normal position in the perineum. During the newborn assessment, this defect should be identified easily on sight. A rectal thermometer or tube may be necessary, however, to determine patency if meconium is not passed within the first 24 hours after birth. Other assessment findings include absence of stenosis of the anal rectal canal, presence of an anal membrane and an external fistula to the perineum.

The nurse should implement which interventions for a child older than 2 years with type 1 diabetes mellitus who has a blood glucose level of 60 mg/dL? (Select all that apply) A. Administer regular insulin B. Encourage the child to ambulate C. Give the child a teaspoon of honey D. Provide electrolyte replacement therapy intravenously. E. Wait 30 minutes and confirm the blood glucose reading F. Prepare to administer glucagon subcutaneously if unconsciousness occurs.

C. Give the child a teaspoon of honey F. Prepare to administer glucagon subcutaneously if unconsciousness occurs. Hypoglycemia is defined as a blood glucose level less than 70 mg/dL. Hypoglycemia occurs as a result of too much insulin, not enough food, or excessive activity. If possible, the nurse should confirm hypoglycemia with a blood glucose reading. Glucose is administered orally immediately; rapid-releasing glucose is followed by a complex carbohydrate and protein, such as a slice of bread or a peanut butter cracker. An extra snack is given if the next meal is not planned for more than 30 minutes or if activity is planned. If the child becomes unconscious, cake frosting or glucose paste is squeezed on the gums, and the blood glucose level is retested in 15 minutes; if the reading remains low, additional glucose is administered . If the child remains unconscious, administration of glucagon may be necessary, and the nurse should be prepared for this intervention. Encouraging the child to ambulate and administering regular insulin would result in a lowered blood glucose level. Providing electrolyte replacement therapy intravenously is an intervention to treat diabetic ketoacidosis. Waiting 30 minutes to confirm the blood glucose level delays necessary intervention.

The parents of a child with juvenile idiopathic arthritis call the clinic nurse because the child is experiencing a painful exacerbation of the disease. The parents ask the nurse if the child can perform range of motion exercises at this time. The nurse should make which response? A. Avoid all exercise during painful periods B. Range of motion exercises must be performed every day C. Have the child perform simple isometric exercises during this time. D. Administer additional pain medication before performing range of motion exercises

C. Have the child perform simple isometric exercises during this time. Juvenile idiopathic arthritis is an autoimmune inflammatory disease affecting the joints and other tissues, such as articular cartilage. During painful episodes of juvenile idiopathic arthritis, hot or cold packs and splinting and positioning the affected joint in a neutral position help reduce the pain. Although resting the extremity is appropriate, beginning simple isometric or tensing exercises as soon as the child is able is important. These exercises do not involve joint movement.

A 6 year old child with HIV has been admitted to the hospital for pain management. The child asks the nurse if the pain will ever go away. the nurse should make which best response to the child? A. The pain will go away if you lie still and let the medicine work. B. Try not to think about it. The more you think it hurts, the more it will hurt. C. I know it must hurt, but if you tell me when it does, I will try and make it hurt a little less. D. Every time it hurts, press on the call button and I will give you something to make the pain all go away.

C. I know it must hurt, but if you tell me when it does, I will try and make it hurt a little less. The multiple complications associated with HIV are accompanied by a high level of pain. Aggressive pain management is essential for the child to have an acceptable quality of life. The nurse must acknowledge the child's pain and let the child know that everything will be done to decrease the pain. Telling the child that movement or lack thereof would eliminate the pain is inaccurate. Allowing a child to think that he or she can control the pain simply by thinking or not thinking about it oversimplifies the pain cycle associated with HIV. Giving false hope by telling the child that the pain will be taken "all away" is neither truthful nor realistic.

Parents bring their 2 week old infant to a clinic for treatment after a diagnosis of clubfoot made at birth. Which statement by the parents indicates a need for further teaching regarding this disorder? A. Treatment needs to be started as soon as possible. B. I realize my infant will require follow-up care until fully grown. C. I need to bring my infant back to the clinic in 1 month for a new cast. D. I need to come to the clinic every week with my infant for the casting.

C. I need to bring my infant back to the clinic in 1 month for a new cast. Clubfoot is a complex deformity of the ankle and foot that includes forefoot adduction, midfoot supination, hindfoot varus, and ankle equinus; the defect may be unilateral or bilateral. Treatment for clubfoot is started as soon as possible after birth. Serial manipulation and casting are performed at least weekly. if sufficient correction is not achieved in 3-6 months, surgery usually is indicated. Because clubfoot can recur, all children with clubfoot require long-term interval follow-up until they reach skeletal maturity to ensure an optimal outcome.

The nurse is providing instructions to the parents of a child with scoliosis regarding the use of a brace. Which statement by the parents indicates a need for further information? A. I will encourage my child to perform prescribed exercises B. I will have my child wear soft fabric clothing under the brace C. I should apply lotion under the brace to prevent skin breakdown. D. I should avoid the use of powder because it will cake under the brace

C. I should apply lotion under the brace to prevent skin breakdown. A brace may be prescribed to treat scoliosis. Braces are not curative, but may slow the progression of the curvature to allow skeletal growth and maturity. The use of lotions or powders under a brace should be avoided because they can become sticky and cake under the brace, causing irritation.

The nurse prepares a teaching plan for the mother of a child diagnosed with bacterial conjunctivitis. Which, if stated by the mother, indicates a need for further teaching? A. I need to wash my hands frequently B. I need to clean the eye as prescribed C. It is okay to share towels and washcloths D. I need to give the eye drops as prescribed

C. It is okay to share towels and washcloths Conjunctivitis is an inflammation of the conjunctiva. Bacterial conjunctivitis is highly contagious, and the nurse should teach infection control measures. These include good hand-washing and not sharing towels and washcloths.

The school nurse has provided an instructional session about impetigo to parents of the children attending the school. Which statement, if made by a parent, indicates a need for further instruction? A. It is extremely contagious B. It is most common in humid weather. C. Lesions most often are located on the arms and chest. D. It might show up in an area o broken skin, such as an insect bite.

C. Lesions most often are located on the arms and chest. Impetigo is a contagious bacterial infectdion of the skin caused by beta-hemolytic streptococci or staphylococci, or both. Impetigo is most common during hot, humid summer months. Impetigo may begin in an area of broken skin, such as an insect bite or atopic dermatitis. Impetigo is extremely contagious. Lesions usually are located around the mouth and nose, but may be present on the hands and extremities.

A child is scheduled to receive inactivated polio vaccine (IPV), and the nurse preparing to administer the vaccine reviews the child's record. The nurse questions the administration of IPV if which is documented in the child's record? A. recent recovery from a cold B. a history of frequent respiratory infections C. a history of an anaphylactic response to neomycin D. a local reaction at the site of injection of a previous IPV

C. a history of an anaphylactic response to neomycin Inactivated poliovirus (IPV) vaccine contains neomycin. A history of an anaphylactic reaction to neomycin is considered a contraindication to IPV. The presence of a minor illness such as the common cold is not a contraindication. In addition, a history of frequent respiratory infections is not a contraindication to receiving a vaccine. A local reaction to an immunization is not a contraindication to receiving a vaccine.

The nurse collects a urine specimen preoperatively from a child with epispadias who is scheduled for surgical repair. When analyzing the results of the urinalysis, which should the nurse most likely expect to note? A. hematuria B. proteinuria C. bacteriuria D. glucosuria

C. bacteriuria Epispadias is a congenital defect involving abnormal placement of the urethral orifice of the penis. The urethral opening is located anywhere on the dorsum of the penis. This anatomical characteristic facilitates entry of bacteria into the urine.

A 4-year old child is admitted to the hospital for abdominal pain. The mother reports that the child has been pale and excessively tired and is bruising easily. On physical examination, lymphadenopathy and hepatosplenomegaly are noted. Diagnostic studies are being performed on the child because acute lymphocytic leukemia is suspected. The nurse understands that which diagnostic study should confirm the diagnosis? A. Platelet count B. lumbar puncture C. bone marrow biopsy D. white blood cell count

C. bone marrow biopsy Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. The confirmatory test for leukemia is microscopic examination of bone marrow obtained by bone marrow aspirate and biopsy. A lumbar puncture may be done to look for blast cells in the spinal fluid that indicate central nervous system disease. The white blood cell count may be normal, high, or low in leukemia. An altered platelet count occurs as a result of the disease, but also may occur as a result of chemotherapy and does not confirm the diagnosis.

The nurse reviews the record of a newborn infant and notes that a diagnosis of esophageal atresia with tracheoesophageal fistula is suspected. The nurse expects to note which most likely sign of this condition documented in the record? A. incessant crying B. coughing at nighttime C. choking with feedings D. severe projectile vomiting

C. choking with feedings In esophageal atresia and tracheoesophageal fistula, the esophagus terminates before it reaches the stomach, ending in a blind pouch, and a fistula is present that forms an unnatural connection with the trachea. Any child who exhibits the "3 Cs" - coughing and choking with feedings and cyanosis - should be suspected to have tracheoesophageal fistula.

A lumbar puncture is performed on a child suspected to have bacterial meningitis, and cerebrospinal fluid (CSF) is obtained for analysis. The nurse reviews the results of the CSF analysis and determines that which results would verify the diagnosis? A. clear CSF, decreased pressure, and elevated protein level B. clear CSF, elevated protein and decreased glucose levels C. cloudy CSF, elevated protein and decreased glucose levels D. cloudy CSF, decreased protein, and decreased glucose levels.

C. cloudy CSF, elevated protein and decreased glucose levels Meningitis is an infectious process of the central nervous system caused by bacteria and viruses; it may be acquired as a primary disease or as a result of complications of neurosurgery, trauma, infection of the sinus or ears, or systemic infections. Meningitis is diagnosed by testing cerebrospinal fluid obtained by lumbar puncture. In the case of bacterial meningitis, findings usually include an elevated pressure; turbid or cloudy cerebrospinal fluid and elevated leukocyte, elevated protein, and decreased glucose levels.

On assessment of a child admitted with a diagnosis of acute-stage Kawasaki disease, the nurse expects to note which clinical manifestation of the acute stage of the disease? A. cracked lips B. normal appearance C. conjunctival hyperemia D. desquamation of the skin

C. conjunctival hyperemia Kawasaki disease, also known as mucocutanous lymph node syndrome, is an acute systemic inflammatory illness. In the acute stage, the child has a fever, conjunctival hyperemia, red throat, swollen hands, rash, and enlargement of the cervical lymph nodes. In the subacute stage, cracking lips and fissures, desquamation of the skin on the tips of the fingers and toes, joint pain, cardiac manifestations, and thrombocytosis occur. In the convalescent stage, the child appears normal, but signs of inflammation may still be present.

The mother of a 6 year old child who has type 1 diabetes mellitus calls a clinic nurse and tells the nurse that the child has been sick. The mother reports that she checked the child's urine and it was positive for ketones. The nurse should instruct the mother to take which action? A. hold the next dose of insulin B. come to the clinic immediately C. encourage the child to drink liquids D. administer the additional dose of regular insulin

C. encourage the child to drink liquids When the child is sick, the mother should test for urinary ketones with each voiding. If ketones are present, liquids are essential to aid in clearing the ketones. The child should be encouraged to drink liquids. Bringing the child to the clinic immediately is unnecessary. Insulin doses should not be changed or adjusted.

The mother of an 8-year old child being treated for right lower lobe pneumonia at home calls the clinic nurse. The mother tells the nurse that the child complains of discomfort on the right side and that ibuprofen (Motrin IB) is not effective. Which instruction should the nurse provide to the mother? A. increase the dose of ibuprofen B. increase the frequency of ibuprofen C. encourage the child to lie on the left side D. encourage the child to lie on the right side.

C. encourage the child to lie on the left side Pneumonia is an inflammation of the pulmonary parenchyma or alveoli or both caused by a virus, mycoplasmal agents, bacteria, or aspiration of foreign substances. Splinting of the affected side by lying on that side may decrease discomfort. It would be inappropriate to advise the mother to increase the dose or frequency of the ibuprofen. Lying on the left side would not be helpful in alleviating discomfort.

The clinic nurse reviews the record of a child just seen by a healthcare provider and diagnosed with suspected aortic stenosis. The nurse expects to note documentations of which clinical manifestation specifically found in this disorder? A. pallor B. hyperactivity C. exercise intolerance D. gastrointestinal disturbances

C. exercise intolerance Aortic stenosis is a narrowing or stricture of the aortic valve, causing resistance to blood flow in the left ventricle, decreased cardiac output, left ventricular hypertrophy, and pulmonary vascular congestion. A child with aortic stenosis shows signs of exercise intolerance, chest pain, and dizziness when standing for long periods. Pallor may be noted, but is not specific to this type of disorder alone.

A 10-year old child with hemophilia A has slipped on the ice and bumped his knee. the nurse should prepare. The nurse should prepare to administer which prescription? A. injection of factor X B. intravenous infusion of iron C. intravenous infusion of factor VIII D. intramuscular injection of iron using the Z-track method

C. intravenous infusion of factor VIII Hemophilia refers to a group of bleeding disorders resulting from a deficiency of specific coagulation proteins. The primary treatment is replacement of the missing clotting factor; additional medications, such as agents to relieve pain, may be prescribed depending on the source of bleeding from the disorder. A child with hemophilia A is at risk for joint bleeding after a fall. Factor VIII would be prescribed intravenously to replace the missing clotting factor and minimize the bleeding. Factor X and iron are not used to treat children with hemophilia A.

An infant has just returned to the nursing unit after surgical repair of a cleft lip on the right side. The nurse should place the infant in which best position at this time? A. prone position B. on the stomach C. left lateral position D. right lateral position

C. left lateral position A cleft lip is a congenital anomaly that occurs as a result of failure of soft tissue or bony structure to fuse during embryonic development. After cleft lip repair, the nurse avoids positioning the infant on the side of the repair or in the prone position because these positions can cause rubbing of the surgical site on the mattress. The nurse positions the infant on the side lateral to the repair or on the back upright and positions the infant to prevent airway obstruction by secretions, blood or the tongue. From the options provided, placing the infant on the left side immediately after surgery is best to prevent the risk of aspiration if the infant vomits.

A child is hospitalized because of persistent vomiting. The nurse should monitor the child closely for which problem? A. diarrhea B. metabolic acidosis C. metabolic alkalosis D. hyperactive bowel sounds

C. metabolic alkalosis Vomiting causes the loss of hydrochloric acid and subsequent metabolic alkalosis. Metabolic acidosis would occur in a child experiencing diarrhea because of the loss of bicarbonate. Diarrhea might or might not accompany vomiting. Hyperactive bowel sounds are not associated with vomiting.

Assessment findings of an infant admitted to the hospital reveal a machinery-like murmur on auscultation of the heart and signs of heart failure. The nurse reviews congenital cardiac anomalies and identifies the infant's condition as which disorder? A. aortic stenosis B. atrial septal defect C. patent ductus arteriosis D. ventricular septal defect

C. patent ductus arteriosus A patent ductus arteriosus is failure of the fetal ductus arteriosus (artery connecting the aorta and the pulmonary artery) to close. A characteristic machinery-like murmur is present and the infant may show signs of heart failure. Aortic stenosis is a narrowing of stricture of the aortic valve. Atrial septal defect is an abnormal opening between the atria,. Ventricular septal defect is an abnormal opening between the right and left ventricles.

The nurse is reviewing the record of a child with increased intracranial pressure and notes that the child has exhibited signs of decerebrate posturing. On assessment of the child, the nurse expects to note which characteristic of this type of posturing? A. flaccid paralysis of all extremities B. adduction of the arms at the shoulders C. rigid extension and pronation of the arms and legs D. abnormal flexion of the upper extremities and extension and adduction of the lower extremities.

C. rigid extension and pronation of the arms and legs Decerebrate (extension) posturing is characterized by the rigid extension and pronation of the arms and legs.

The clinic nurse prepares to administer a measles, mumps, rubella (MMR) vaccine to a 5 year old child. The nurse should administer this vaccine by which best route and in which best site? A. subcutaneously in the gluteal muscle B. intramuscularly in the deltoid muscle C. subcutaneously in the outer aspect of the upper arm D. intramuscularly in the anterolateral aspect of the thigh

C. subcutaneously in the outer aspect of the upper arm measles, mumps, rubella (MMR) vaccine is administered subcutaneously in the outer aspect of the upper arm. The gluteal muscle is not recommended for injections. MMR vaccine is not administered by the intramuscular route.

The nurse is providing home care instructions to the parents of a 10-year old child with hemophilia. Which sport activity should the nurse suggest for this child? A. Soccer B. basketball C. swimming D. field hockey

C. swimming Children with hemophilia need to avoid contact sports and to take precautions such as wearing elbow and knee pads and helmets with other sports. The safe activity for them is swimming.

The nurse is monitoring an infant with congenital heart disease closely for signs of heart failure (HF). The nurse should assess the infant for which early sign of HF? A. pallor B. cough C. tachycardia D. slow and shallow breathing

C. tachycardia Heart failure (HF) is the inability of the heart to pump a sufficient amount of blood to meet the oxygen and metabolic needs of the body. The early signs of HF include tachycardia, tachypnea, profuse scalp sweating, fatigue and irritability, sudden weight gain and respiratory distress. A cough may occur in HF as a result of mucosal swelling and irritation, but is not an early sign. Pallor may be noted in an infant with HF, but it is not an early sign.

The parents of a child recently diagnosed with cerebral palsy ask the nurse about the disorder. The nurse bases the response on the understanding that cerebral palsy is which type of condition? A. An infectious disease of the central nervous system B. An inflammation of the brain as a result of a viral illness C. A congential condition that results in moderate to severe retardation D. A chronic disability characterized by impaired muscle movement and posture

D. A chronic disability characterized by impaired muscle movement and posture Cerebral palsy is a chronic disability characterized by impaired movement and posture resulting from an abnormality in the extrapyramidal or pyramidal motor system. Meningitis is an infectious process of the central nervous system. Encephalitis is an inflammation of the brain that occurs as a result of viral illness or central nervous system infection. Down syndrome is an example of a congenital condition that results in moderate to severe retardation.

An infant receives a diptheria, tetanus, and acellular pertussis (DTaP) immunization at a well-baby clinic. The parent returns home and calls the clinic to report that the infant has developed swelling and redness at the site of the injection. Which intervention should the nurse suggest to the parent? A. monitor the infant for a fever B. bring the infant back to the clinic C. Apply a hot pack to the injection site D. Apply a cold pack to the injection site

D. Apply a cold pack to the injection site On occasion, tenderness, redness or swelling may occur at the site of the DTaP injection. This can be relieved by cold packs for the first 24 hours, followed by warm or cold compresses if the inflammation persists. Bringing the infant back to the clinic is unnecessary. Option 1 may be an appropriate intervention, but is not specific to the subject of the question, a localized reaction at the injection site. Hot packs are not applied and can be harmful by causing burning of the skin.

A topical corticosteroid is prescribed by a health care provider for a child with atopic dermatitis (eczema). Which instruction should the nurse give the parent about applying the cream? A. Apply the cream over the entire body. B. Apply a thick layer of cream to affected areas only C. Avoid cleansing the area before application of the cream D. Apply a think layer of cream and rub it into the area thoroughly.

D. Apply a think layer of cream and rub it into the area thoroughly. Atopic dermatitis is a superficial inflammatory process involving primarily the epidermis. A topical corticosteroid may be prescribed and should be applied sparingly (thin layer) and rubbed into the area thoroughly. The affected area should be cleaned gently before application. A topical corticosteroid should not be applied over extensive areas. Systemic absorption is more likely to occur with extensive application

Permethrin (Elimite) is prescribed for a child with a diagnosis of scabies. The nurse should give which instruction to the parents regarding the use of this treatment? A. apply the lotion to areas of the rash only B. apply the lotion and leave it on for 6 hours C. Avoid putting clothes on the child over the lotion D. Apply the lotion to cool, dry skin at least 30 minutes after bathing.

D. Apply the lotion to cool, dry skin at least 30 minutes after bathing. Permethrin is massaged thoroughly and gently into all skin surfaces (not just the areas that have the rash) from the head to the soles of the feet. Care should be taken to avoid contact with the eyes. The lotion should not be applied until at least 30 minutes after bathing and should be applied only to cool, dry skin. The lotion should be kept on for 8-14 hours, and then the child should be given a bath. The child should be clothed during the 8-14 hours of treatment contact time.

The nurse is caring for a 4 year old child with HIV infection. The nurse should plan care with the understanding that which childhood psychosocial need occurs in this age? A. expressing fear, withdrawal and denial B. beginning to understand that something is wrong C. Unable to grasp the concept of illness and death D. Beginning to conceptualize the death process as involving physical harm.

D. Beginning to conceptualize the death process as involving physical harm. A preschool child begins to conceptualize the death process as involving physical harm. A child from birth to 2 years of age is unable to grasp the concept of illness and death. A school-age child begins to understand that something is wrong. An adolescent expresses fear, withdrawal and denial.

A child is placed in skeletal traction for treatment of a fractured femur. The nurse develops a plan of care and includes which intervention? A. Ensure that all ropes are outside the pulleys B. Ensure that the weights are resting lightly on the floor C. Restrict diversional and play activities until the child is out of traction D. Check the health care provider's prescriptions for the amount of weight to be applied

D. Check the health care provider's prescriptions for the amount of weight to be applied When a child is in traction, the nurse would check the HCP's prescription to verify the prescribed amount of traction weight. The nurse would maintain the correct amount of weight as prescribed, ensure that the weights hang freely, check the ropes for fraying and ensure that they are on the pulleys appropriately, monitor the neurovascular status of the involved extremity, and monitor for signs and symptoms of immobilization. The nurse would provide therapeutic and diversional play activities for the child.

The nurse reviews the laboratory results for a child with a suspected diagnosis of rheumatic fever., knowing that which laboratory study would assist in confirming this diagnosis? A. immunoglobulin B. red blood cell count C. white blood cell count D. anti-streptolysin O titer

D. anti-streptolysin O titer Rheumatic fever is an inflammatory autoimmune disease that affects the connective tissues of the heart, joints, skin (subcaneous tissues), blood vessels, and central nervous system. A diagnosis of rheumatic fever is confirmed by the presence of two major manifestations or one major and two minor manifestations from the Jones criteria. In addition, evidence of a recent streptococcal infection is confirmed by a positive anti-streptolysin O titer, Streptozyme assay or anti DNase B assay.

A parent brings her 4 month old infant to a well-baby clinic for immunizations. The child is up to date with the immunization schedule. The nurse should prepare to administer which immunization to this infant? A. Varicella, hepatitis B vaccine (HepB) B. Diphtheria, tetanus, acellular pertussis (DTaP); measles, mumps, rubella (MMR), inactivated poliovirus vaccine (IPV) C. MMR, Haemophilius influenzae type b (Hib), DTaP D. DTaP, Hib, IPV, pneumococcal vaccine (PCV), rotavirus (RV)

D. DTaP, Hib, IPV, pneumococcal vaccine (PCV), rotavirus (RV) Diphtheria, tetanus, acellular pertussis, Haemophilus influenzae type b conjugate vaccine (Hib), inactivated poliovirus vaccine (IPV), pneumococcal vaccine (PCV), and rotavirus vaccine (RV) are administered at 4 months of age. DTaP is administered at 2, 4, and 6 months of age; at 15-18 months of age, and at 4-6 years of age. Hib is administered at 2, 4 and 6 months of age and at 12 to 15 months of age. IPV is administered at 2, 4, and 6 months of age and at 4-6 years, PCV is administered at 2, 4 and 6 months, at at 12 -15 months. The first dose of measles, mumps, rubella (MMR) vaccine is administered at 12-15 months, the second dose is administered at 4-6 years (if the second dose was not given by 4-6 years of age , it should be given at the next visit). The first dose of hepatitis B vaccine is administered at birth, and the second dose is administered at 1 month and the third dose is administered at 6 months. Varicella-zoster vaccine is administered at 12-15 months and again at 4-6 years.

A child with Beta-thalassemia is receiving long-term blood transfusion therapy for the treatment of the disorder. Chelation therapy is prescribed as a result of too much iron from the transfusions. Which medication should the nurse anticipate to be prescribed? A. Fragmin B. Meropenem (Merrem) C. Metoprolol (Toprol-XL) D. Deferoxamine (Desferal)

D. Deferoxamine (Desferal) Beta-thalassemia is an autosomal recessive disorder characterized by the reduced production of one of the globin chains in the synthesis of hemoglobin (both parents must be carriers to produce a child with B-thalassemia major). The major complication of long-term transfusion therapy is hemosiderosis. To prevent organ damage from too much iron, chelation therapy with either Ejade or deferoxamine (Desferal) may be prescribed. Deferoxamine is classified as an antidote for acute iron toxicity. Fragmin is an anticoagulant used as prophylaxis for postoperative deep vein thrombosis. Meropenem is an antibiotic. Metoprolol is a beta-blocker used to treat hypertension.

A school-age child with type 1 diabetes mellitus has soccer practice three afternoons a week. the school nurse provides instructions regarding how to prevent hypoglycemia during practice. Which should the school nurse tell the child to do? A. eat twice the amount normally eaten at lunchtime B. Take half the amount of prescribed insulin on practice days C. Take the prescribed insulin at noontime rather than in the morning. D. Eat a small box of raisins or drink a cup of orange juice before soccer practice.

D. Eat a small box of raisins or drink a cup of orange juice before soccer practice. Hypoglycemia is a blood glucose level less than 70 mg/dL and results from too much insulin, not enough food, or excessive activity. An extra snack of 15 to 30g of carbohydrates eaten before activities such as soccer practice would prevent hypoglycemia. A small box of raisins or a cup of orange juice provides 15-30g of carbs. The child or parents should not be instructed to adjust the amount of insulin administration. Meal amounts should not be doubled.

The nurse provides home care instructions to the parent of a child with acquired immunodeficiency syndrome (AIDS). Which statement by the parent indicates the need for further teaching? A. I will wash my hands frequently B. I will keep my child's immunizations up to date C. I will avoid direct unprotected contact with my child's body fluids D. I can send my child to day care if he has a fever as long as it is a low-grade fever

D. I can send my child to day care if he has a fever as long as it is a low-grade fever AIDS is a disorder caused by HIV and characterized by generalized dysfunction of the immune system. A child with AIDS who is sick or has a fever should be kept home and not be brought to a day care center.

The nurse provided discharge instructions to the parents of a 2 year old child who had an orchiopexy to correct cryptorchidism. Which statement by the parents indicate that further teaching is necessary? A. I'll check his temperature B. I'll give him medication so he'll be comfortable C. I'll check his voiding to be sure there's no problem D. I'll let him decide when to return to his play activities.

D. I'll let him decide when to return to his play activities. Cryptorchidism is a condition in which one or both testes fail to descend through the inguinal canal into the scrotal sac. Surgical correction may be necessary. All vigorous activities should be restricted for 2 weeks after surgery to promote healing and prevent injury. This prevents dislodging of the suture, which is internal. Normally, 2 year olds want to be active; allowing the child to decide when to return to his play activities may prevent healing and cause injury. The parents should be taught to monitor the temperature, provide analgesics as needed and monitor the urine outputt.

A child with laryngotracheobronchitis (croup) is placed in a cool mist tent. The mother becomes concerned because the child is frightened, consistently crying and trying to climb out of the tent. Which is the most appropriate nursing action? A. tell the mother that the child must stay in the tent B. Place a toy in the tent to make the child feel more comfortable. C. Call the health care provider and obtain a prescription for a mild sedative D. Let the mother hold the child and direct the cool mist over the child's face.

D. Let the mother hold the child and direct the cool mist over the child's face. Laryngotracheobronchitis (croup) is the inflammation of the larynx, trachea, and bronchi and is the most common type of croup. Cool mist therapy may be prescribed to liquefy secretions and to assist in breathing. If the use of a tent or hood is causing distress, treatment may be more effective if the child is held by the parent and a cool mist is directed toward the child's face (blow-by). A mild sedative would not be administered to the child. Crying would increase hypoxia and aggravate laryngospasm, which may cause airway obstruction.

A new parent expresses concern to the nurse regarding sudden infant death syndrome (SIDS). She asks the nurse how to position her new infant for sleep. In which position should the nurse tell the parent to place the infant? A. side or prone B. back or prone C. stomach with the face turned D. back rather than on the stomach

D. back rather than on the stomach Sudden infant death syndrome (SIDS) is the unexpected death of an apparently healthy infant younger than 1 year for whom an investigation of the death and a thorough autopsy fail to show an adequate cause of death. Several theories are proposed regarding the cause, but the exact cause is unknown. Nurses should encourage parents to place the infant on the back (supine) for sleep. Infants in the prone position (on the stomach) may be unable to move their heads to the side, increasing the risk of suffocation. The infant may have the ability to turn to a prone position from the side-lying position.

The mother with HIV infection brings her 10 month old infant to the clinic for a routine checkup. The health care provider has documented that the infant is asymptomatic for HIV infection. After the checkup the mother tells the nurse that she is so pleased that the infant will not get HIV. The nurse should make which most appropriate response to the mother? A. I am so pleased also that everything has turned out fine. B. Because symptoms have not developed, it is unlikely that your infant will develop HIV infection C. Everything looks great, but be sure that you return with your infant next month for the scheduled visit. D. Most children infected with HIV develop symptoms within the first 9 months of life, and some become symptomatic sometime before they are three years old.

D. Most children infected with HIV develop symptoms within the first 9 months of life, and some become symptomatic sometime before they are three years old. AIDS is caused by HIV and characterized by generalized dysfunction of the immune system. Most children infected with HIV develop symptoms within the first 9 months of life. The remaining infected children become symptomatic sometime before age 3. With their immature immune systems, children have a much shorter incubation period than adults.

A child has a right femur fracture caused by a motor vehicle crash and is placed in skin traction temporarily until surgery can be performed. During assessment, the nurse notes that the dorsalis pedis pulse is absent on the right foot. Which action should the nurse take? A. administer an analgesic B. Release the skin traction C. Apply ice to the extremity D. Notify the health care provider

D. Notify the health care provider An absent pulse to an extremity of the affected limb after a bone fracture could mean that the child is developing or experiencing compartment syndrome. This is an emergency situation, and the HCP should be notified immediately. Administering analgesics would not improve circulation. The skin traction should not be released without an HCP's prescription. Applying ice to an extremity with absent perfusion is incorrect. Ice may be prescribed when perfusion is adequate to decrease swelling.

The nurse notes documentation that a child with meningitis is exhibiting a positive Kernig's sign. Which observation is characteristic of this sign? A. The child complains of muscle and joint pain B. Petechial and purpuric rashes are noted on the child's trunk C. Neck flexion causes adduction and flexion movements of the lower extremities D. The child is not able to extend the leg when the thigh if flexed anteriorly at the hip

D. The child is not able to extend the leg when the thigh if flexed anteriorly at the hip Meningitis is an infectious process of the central nervous system caused by bacteria and viruses. The inability to extend the leg when the thigh is flexed anteriorly at the hip is a positive Kernig's sign, noted in meningitis. Muscle and joint pain is characteristic of meningococcal infection and H. influenzae infection. A petechial or purpuric rash is characteristic of meningococcal infection. a positive Brudzinski's sign is noted when neck flexion causes adduction and flexion movements of the lower extremities in children and adolescents. this is also a characteristic of meningitis.

The clinic nurse is providing instructions to a parent of a child with cystic fibrosis regarding the immunization schedule for the child. Which statement should the nurse make to the parent? A. The immunization schedule will need to be altered. B. The child should not receive any hepatitis vaccines. C. The child will receive all the immunizations except for the polio series. D. The child will receive the recommended basic series of immunizations along with a yearly influenza vaccination.

D. The child will receive the recommended basic series of immunizations along with a yearly influenza vaccination. Cystic fibrosis is a chronic multisystem disorder (autosomal recessive trait disorder) characterized by exocrine gland dysfunction. The mucus produced by the exocrine glands is abnormally thick, tenacious, and copious, causing obstruction of the small passageways of the affected organs, particularily in the respiratory, gastrointestinal, and reproductive systems. Adequately protecting children with cystic fibrosis from communicable diseases by immunization is essential. In addition to the basic series of immunizations, a yearly influenza immunization is recommended for children with cystic fibrosis.

The nurse provides feeding instructions to a parent of an infant diagnosed with gastroesophageal reflux disease. Which instruction should the nurse give to the parent to assist in reducing the episodes of emesis? A. provide less frequent, larger feedings B. Burp the infant less frequently during feedings. C. thin the feedings by adding water to the formula D. Thicken the feedings by adding rice cereal to the formula

D. Thicken the feedings by adding rice cereal to the formula Gastroesophageal reflux is backflow of gastric contents into the esophagus as a result of relaxation or incompetence of the lower esophageal or cardiac sphincter. Small, more frequent feedings with frequent burping often are prescribed in the treatment of gastroesophageal reflux. Feedings thickened with rice cereal may reduce episodes of emesis. If thickened formula is used, cross-cutting of the nipple may be required.

The nurse provides home care instructions to the parents of a child hospitalized with pertussis who is in the convalescent stage and is being prepared for discharge. Which statement by a parent indicates a need for further instruction? A. we need to encourage our child to drink fluids B. Coughing spells may be triggered by dust or smoke C. Vomiting may occur when our child has coughing episodes D. We need to maintain droplet precautions and a quiet environment for at least 2 weeks.

D. We need to maintain droplet precautions and a quiet environment for at least 2 weeks. Pertussis is transmitted by direct contact or respiratory droplets from coughing. The communicable period occurs primarily during the catarrhal stage. Respiratory precautions are not required during the convalescent phase.

A child is receiving a series of the hepatitis B vaccine and arrives at the clinic with his parent for the second dose. Before administering the vaccine, the nurse should ask the child and parent about a history of severe allergy to which substance? A. eggs B. penicillin C. sulfonamides D. a previous dose of hepatitis B vaccine or component

D. a previous dose of hepatitis B vaccine or component A contraindication to receiving the hepatitis B vaccine is a previous anaphylactic reaction to a previous dose of hepatitis B vaccine or to a component (aluminum hydroxide or yeast protein) of the vaccine. An allergy to eggs, penicillin, and sulfonamides is unrelated to the contraindication to receiving this vaccine.

A mother arrives at an emergency department with her 5 year old child and states that the child fell off a bunk bed. A head injury is suspected and the nurse checks the child's airway status and assesses the child for early and late signs of increased intracranial pressure (ICP). Which is a late sign of increased ICP? A. nausea B. irritability C. headache D. bradycardia

D. bradycardia Head injury is the pathological result of any mechanical force to the skull, scalp, meninges, or brain. A head injury can cause bleeding in the brain and result in increased intracranial pressure (ICP). In a child, early signs include a slight change in level of consciousness, headache, nausea, vomiting, visual disturbances (diplopia), seizures. Late signs of increased ICP include a significant decrease in level of consciousnes, bradycardia, decreased motor and sensory responses, alterations in pupil size and reactivity, posturing, Cheyne-Stokes respirations and coma

The nurse is preparing to care for a child with a diagnosis of intussusception. The nurse reviews the child's record and expects to note which symptom of this disorder documented? A. watery diarrhea B. ribbon-like stools C. profuse projectile vomiting D. bright red blood and mucus in the stools.

D. bright red blood and mucus in the stools Intussusception is a telescoping of one portion of the bowel into another. The condition results in an obstruction to the passage of intestinal contents. A child with intussusception typically has severe abdominal pain that is crampy and intermittent, causing the child to draw in the knees to the chest. Vomiting may be present, but is not projectile. Bright red blood and mucus are passed through the rectum and commonly are described as currant jelly-like stool. Watery diarrhea and ribbon-like stools are not manifestations of this disorder.

A child has fluid volume deficit. The nurse performs an assessment and determines that the child is improving and the deficit is resolving if which finding is noted? A. The child has no tears. B. Urine specific gravity is 1.030 C. Urine output is less than 1 mL/kg/hr. D. capillary refill is less than 2 seconds

D. capillary refill is less than 2 seconds Indicators that fluid volume deficit is resolving would be capillary refill less than 2 seconds, specific gravity of 1.002 to 1.025, urine output of at least 1 mL/kg/hour, and adequate tear production. A capillary refill time less than 2 seconds is the only indicator that the child is improving. Urine output of less than 1 mL/kg/hour, a specific gravity of 1.030 and no tears would indicate that the deficit is not resolving.

A health care provider prescribes an intravenous (IV) solution of 5% dextrose and half-normal saline (0.45%) with 40 mEq of potassium chloride for a child with hypotonic dehydration. The nurse performs which priority assessment before administering this IV prescription? A. obtains a weight B. takes the temperature C. takes the blood pressure D. checks the amount of urine output

D. checks the amount of urine output In hypotonic dehydration, electrolyte loss exceeds water loss. The priority assessment before administering potassium chloride intravenously would be to assess the status of the urine output. Potassium chloride should never be administered in the presence of olliguria or anuria. If the urine output is less than 1-2 mL/kg/hr, potassium chloride should not be admninistered.

A child with rheumatic fever will be arriving in the nursing unit for admission. on admission assessment, the nurse should ask the parents which question to elicit assessment information specific to the development of rheumatic fever? A. has the child complained of back pain? B. has the child complained of headache? C. has the child had any nausea or vomiting? D. did the child have a sore throat or fever within the last 2 months?

D. did the child have a sore throat or fever within the last 2 months? Rheumatic fever is an inflammatory autoimmune disease that affects the connective tissues of the heart, joints, skin (subcutaneous tissues), blood vessels, and the central nervous system. Rheumatic fever characteristically manifests 2 to 6 weeks after an untreated or partially treated group A beta-hemolytic streptococcal infection of the upper respiratory tract. Initially, the nurse determines whether the child had a sore throat or an unexplained fever within the past 2 months.

The clinic nurse instructs parents of a child with sickle cell anemia about the precipitating factors related to sickle cell crisis. Which, if identified by the parents as a precipitating factor, indicates the need for further instructions? A. stress B. trauma C. infection D. fluid overload

D. fluid overload Sickle cell crises are acute exacerbations of the disease, which vary considerably in severity and frequency; these include vaso-occlusive crisis, splenic sequestration, hyperhemolytic crisis, and aplastic crisis. Sickle cell crisis may be precipitated by infection, dehydration, hypoxia, trauma, or physical or emotional stress. The mother of a child with sickle cell disease should encourage fluid intake of 1 1/2 to 2 times the daily requirement to prevent dehydration.

The clinic nurse reviews the record of an infant and notes that the health care provider has documented a diagnosis of suspected Hirschsprung's disease. The nurse reviews the assessment findings documented in the record, knowing that which symptom most likely led the mother to seek health care for the infant? A. diarrhea B. projectile vomiting C. regurgitation of feedings D. foul-smelling ribbon-like stools.

D. foul-smelling ribbon-like stools Hirschsprung's disease is a congenital anomaly also known as congenital aganglionosis or aganglionic megacolon. It occurs as a result of an absence of ganglion cells in the rectum and other areas of the affected intestine. Chronic constipation beginning in the first month of life and resulting in pellet-like or ribbon-like stools that are foul-smelling is a clinical manifestation of this disorder. Delayed passage or absence of meconium stool in the neonatal period is also a sign. Bowel obstruction, especially in the neonatal period, abdominal pain and distension, and failure to thrive are also clinical manifestations.

An adolescent client with type 1 diabetes mellitus is admitted to the emergency department for treatment of diabetic ketoacidosis. Which assessment findings should the nurse expect to note? A. sweating and tremors B. hunger and hypertension C. cold, clammy skin and irritability D. fruity breath odor and decreasing level of consciousness

D. fruity breath odor and decreasing level of consciousness Diabetic ketoacidosis is a complication of diabetes mellitus that develops when a severe insulin deficiency occurs. Hyperglycemia occurs with diabetic ketoacidosis. Signs of hyperglycemia include fruity breath odor and a decreasing level of consciousness. Hunger can be a sign of hypoglycemia or hyperglycemia, but hypertension is not a sign of diabetic ketoacidosis. Hypotension occurs because of a decrease in blood volume related to the dehydrated state that occurs during diabetic ketoacidosis. Cold clammy skin, irritability, sweating, and tremors all are signs of hypoglycemia.

The nurse provides home care instructions to the parents of a child with heart failure regarding the procedure for administration of digoxin (Lanoxin). Which statement made by the parent indicates the need for further instruction? A. I will not mix the medication with food. B. I will take my child's pulse before administering the medication C. If more than one dose is missed, I will call the health care provider D. if my child vomits after medication administration, I will repeat the dose.

D. if my child vomits after medication administration, I will repeat the dose. Digoxin is a cardiac glycoside. The parents need to instructed that if the child vomits after digoxin is administered, they are not to repeat the dose. The other choices are accurate instructions regarding this medication. In addition, the parents should be instructed that if a dose is missed, and is not identified until 4 hours later, the dose should not be administered.

The nurse is planning care for a child with acute bacterial meningitis. Based on the mode of transmission of this infection, which precautionary intervention should be included in the plan of care? A. maintain enteric precautions B. maintain netropenic precautions C. no precautions are required as long as antibiotics have been started D. maintain respiratory isolation precautions for at least 24 hours after the initiation of antibiotics.

D. maintain respiratory isolation precautions for at least 24 hours after the initiation of antibiotics. Meningitis is an infectious process of the central nervous system caused by bacteria and viruses; it may be acquired as a primary disease or as a result of complications of neurosurgery, trauma, infection of the sinus or ears, or systemic infections. A major priority of nursing care for a child suspected to have meningitis is to administer the antibiotic as soon as prescribed. The child also is placed on respiratory isolation precautions for at least 24 hours while culture results are obtained and the antibiotic is having an effect. Enteric precautions and neutropenic precautions are not associated with the mode of transmission of meningitis. Enteric precautions are instituted when the mode of transmission is through the gastrointestinal tract. Neutropenic precautions are instituted when a child has a low neutrophil count.

A 7-year old child is seen in a clinic, and the primary health care provider documents a diagnosis of primary nocturnal enuresis. The nurse should provide which information to the parents? A. primary nocturnal enuresis does not respond to treatment B. primary nocturnal enuresis is caused by a psychiatric problem C. primary nocturnal enuresis requires surgical intervention to improve the problem D. most children outgrow the bed-wetting problem without therapeutic intervention.

D. most children outgrow the bed-wetting problem without therapeutic intervention Primary nocturnal enuresis occurs in a child who has never been dry at night for extended periods. The condition is common in children, and most children eventually outgrow bed-wetting without therapeutic intervention. The child is unable to sense a full bladder and does not awaken to void. The child may have delayed maturation of the central nervous system. The condition is not caused by a psychiatric problem.

A child with type 1 diabetes mellitus is brought to the emergency department by the mother, who states that the child has been complaining of abdominal pain and has been lethargic. Diabetic ketoacidosis is diagnosed. Anticipating the plan of care, the nurse prepares to administer which type of intravenous (IV) infusion? A. potassium infusion B. NPH infusion C. 5% dextrose infusion D. Normal saline infusion.

D. normal saline infusion Diabetic ketoacidosis is a complication of diabetes mellitus that develops when a severe insulin deficiency occurs. Hyperglycemia occurs with diabetic ketoacidosis. Rehydration is the initial step in resolving diabetic ketoacidosis. Normal saline is the initial IV rehydration fluid. NPH insulin is never administered by the IV route. Dextrose solutions are added to the treatment when the blood glucose level decreases to an acceptable level. Intravenously administered potassium may be required, depending on the potassium level, but would not be part of the initial treatment.

A child who has undergone spinal fusion for scoliosis complains of abdominal discomfort and begins to have episodes of vomiting. On further assessment, the nurse notes abdominal distention. On the basis of these findings, the nurse should take which action? A. administer an antiemetic B. increase the intravenous fluids C. place the child in a Sim's position D. notify the health care provider

D. notify the health care provider Scoliosis is a three-dimensional spinal deformity that usually involves lateral curvature, spinal rotation resulting in rib asymmetry, and hypokyphosis of the thorax. A complication after surgical treatment of scoliosis is superior mesenteric artery syndrome. This disorder is caused by mechanical changes in the position of the child's abdominal contents, resulting from lengthening of the child's body. The disorder results in a syndrome of emesis and abdominal distention similar to that which occurs with intestinal obstruction or paralytic ileus. Postoperative vomiting in children with body casts or children who have undergone spinal fusion warrants immediate attention because of the possibility of superior mesenteric artery syndrome.

The home health nurse visits a child with infectious mononucleosis and provides home care instructions to the parents about the care of the child. Which instruction would the nurse give to the parents? A. maintain the child on bed rest for 2 weeks B . maintain respiratory precautions for 1 week C. notify the health care provider if the child develops a fever D. notify the health care provider if the child develops abdominal pain or left shoulder pain.

D. notify the health care provider if the child develops abdominal pain or left shoulder pain. Infectious mononucleosis is caused by Epstein-Barr virus. The parents need to be instructed to notify the HCP if abdominal pain, especially in the left upper quadrant, or left shoulder pain occurs because this may indicate splenic rupture. Children with enlarged spleens also are instructed to avoid contact sports until splenomegaly resolves. Bed rest is unnecessary, and children usually self-limit their activity. Respiratory precautions are not required, although transmission can occur via direct intimate contact or contact with infected blood. Fever is treated with acetaminophen (Tylenol) or ibuprofen (Motrin IB) per health care provider preference.

A health care provider prescribes laboratory studies for an infant of a woman positive for HIV to determine the presence of HIV antigen in the infant. The nurse anticipates that which laboratory study will be prescribed for the infant? A. chest x-ray B. western blot C. CD4+ cell count D. p24 antigen assay

D. p24 antigen assay The detection of HIV in infants is confirmed by a p24 antigen assay, virus culture of HIV, or polymerase chain reaction. A western blot test confirms the presence of HIV antibodies. The CD4+ cell count indicates how well the immune system is working. A chest x-ray evaluates the presence of other manifestations of HIV infection, such as pneumonia.

The nurse analyzes the laboratory results of a child with hemophilia. The nurse understands that which result will most likely be abnormal in this child? A. Platelet count B. hematocrit level C. hemoglobin level D. partial thromboplastin time

D. partial thromboplastin time Hemophilia refers to a group of bleeding disorders resulting from a deficiency of specific coagulation proteins. Results of tests that measure platelet function are normal; results of tests that measure clotting factor function may be abnormal. Abnormal laboratory results in hemophilia indicate a prolonged partial thromboplastin time. the platelet count, hemoglobin level and hematocrit level are normal in hemophilia.

An infant of a mother infected with HIV is seen in the clinic each month and is being monitored for symptoms indicative of HIV infection. The nurse assesses the infant, knowing that which infection is the most common opportunistic infection of children infected with HIV? A. meningitis B. gastroenteritis C. cytomegalovirus infection D. pneumocystis jiroveci pneumonia

D. pneumocystis jiroveci pneumonia AIDS is a disorder caused by HIV and characterized by generalized dysfunction of the immune system. The most common opportunistic infection of children infected with HIV is P. jiroveci pneumonia, which occurs most frequently between the ages of 3-6 months, when HIV status may be indeterminate. Cytomegalovirus infection is also characteristic of HIV infection; however, it is not the most common opportunistic infection. Although neurological abnormalities and gastrointestinal disturbances may occur in a child with HIV infection, meningitis and gastroenteritis are not specific opportunistic infections noted in the HIV-infected child.

A child is diagnosed with Reye's syndrome. The nurse develops a nursing care plan for the child and should include which intervention in the plan? A. assessing hearing loss B. monitoring urine output C. changing body position every 2 hours D. providing a quiet atmosphere with dimmed lighting

D. providing a quiet atmosphere with dimmed lighting Reye's Syndrome is an acute encephalopathy that follows a viral illness and is characterized pathologically by cerebral edema and fatty changes in the liver. A definitive diagnosis is made by liver biopsy. In Reye's syndrome, supportive care is directed toward monitoring and managing cerebral edema. Decreasing stimuli in the environment by providing a quiet environment with dimmed lighting would decrease the stress on the cerebral tissue and neuron responses. Hearing loss and urine output are not affected. Changing the body position every 2 hours would not affect the cerebral edema directly. The child should be positioned with the head elevated to decrease the progression of the cerebral edema and promote drainage of cerebrospinal fluid.

Laboratory studies are performed for a child suspected to have iron deficiency anemia. The nurse reviews the laboratory results, knowing that which result indicates this type of anemia? A. elevated hemoglobin level B. Decreased reticulocyte count C. elevated red blood cell count D. red blood cells that are microcytic and hypochromic

D. red blood cells that are microcytic and hypochromic In iron deficiency anemia, iron stores are depleted, resulting in a decreased supply of iron for the manufacture of hemoglobin in red blood cells. The results of a complete blood cell count in children with iron deficiency anemia show decreased hemoglobin levels and microcytic and hyochromic red blood cells. The red blood cell count is decreased. The reticulocyte count is usually normal or slightly elevated.

The nurse has just administered ibuprofen (Motrin IB) to a child with a temperature of 38.8 C (102F). The nurse should also take which action? A. Withhold oral fluids for 8 hours B. sponge the child with cold water C. plan to administer salicylate (aspirin) in 4 hours D. remove excess clothing and blankets from the child

D. remove excess clothing and blankets from the child After administering ibuprofen, excess clothing and blankets should be removed. The child can be sponged with tepid water, but not cold water because the cold water can cause shivering which increases metabolic requirements above those already caused by the fever. Aspirin is not administered to a child with fever because of the risk of Reye's Syndrome. Fluids should be encouraged to prevent dehydration so oral fluids should not be withheld.

The nurse understands that which information collected during the assessment of a child recently diagnosed with glomerulonephritis is most often associated with the diagnosis? A. child fell off a bike into the handlebars B. nausea and vomiting for the past 24 hours C. urticaria and itching for 1 week before diagnosis D. streptococcal throat infection 2 weeks before diagnosis

D. streptococcal throat infection 2 weeks before diagnosis Glomerulonephritis refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. Group A beta-hemolytic streptococcal infection in a cause of glomerulohephritis. Often a child becomes ill with streptococcal infection of the upper respiratory tract and then develops symptoms of acute poststreptococcal glomerulonephritis after an interval of 1-2 weeks.

The nurse develops a plan of care for a child at risk for tonic-clonic seizures. In the plan of care, the nurse identifies seizure precautions and documents that which item(s) need to be placed at the child's bedside? A. emergency cart B. tracheotomy set C. padded tongue blade D. suctioning equipment and oxygen

D. suctioning equipment and oxygen A seizure results from the excessive and unorganized neuronal discharges in the brain that activate associated motor and sensory organs. A type of generalized seizure is a tonic-clonic seizure. This type of seizure causes rigidity of all body muscles, followed by intense jerking movements. Because increased oral secretions and apnea can occur during and after the seizure, oxygen and suctioning equipment are placed at the bedside. A tracheotomy is not performed during a seizure. No object, including a padded tongue blade, is placed into the child's mouth during a seizure. an emergency cart would not be left at the bedside, but would not be available in the treatment room or nearby on the nursing unit.

A diagnosis of Hodgkin's disease is suspected in a 12-year old child seen in the clinic. Several diagnostic studies are performed to determine the presence of this disease. Which diagnostic test result will confirm the diagnosis of Hodgkin's disease? A. elevated vanillylmandelic acid urinary levels B. the presence of blast cells in the bone marrow C. the presence of Epstein-Barr virus in the blood D. the presence of Reed-Sternberg cells in the lymph nodes.

D. the presence of Reed-Sternberg cells in the lymph nodes. Hodgkin's disease (a type of lymphoma) is a malignancy of the lymph nodes. The presence of giant, multinucleated cells (Reed-Sternberg cells) is the classic characteristic of this disease. Elevated levels of vanillylmandelic acid in the urine may be found in children with neuroblastoma. The presence of blast cells in the bone marrow indicates leukemia. Epstein-Barr virus is associated with infectious mononucleosis

A health care provider has prescribed oxygen as needed for an infant with heart failure. In which situation would the nurse administer the oxygen to the infant? A. during sleep B. when changing the infant's diapers C. when the mother is holding the infant D. when drawing blood for electrolyte level testing

D. when drawing blood for electrolyte level testing Heart failure (HF) is the inability of the heart to pump a sufficient amount of blood to meet the oxygen and metabolic needs of the body. Crying exhausts the limited energy supply; increases the workload of the heart, and increases the oxygen demands. Oxygen administration may be prescribed for stressful periods, especially during bouts of crying or invasive procedures.

The school nurse is conducting pediculous capitis (head lice) assessments. Which finding indicates a child has a "positive" head check? A. maculopapular lesions behind the ears B. lesions in the scalp that extend to the hairline or neck C. white flaky particles throughout the entire scalp region D. white sacs attached to the hair shafts in the occipital area.

D. white sacs attached to the hair shafts in the occipital area. Pediculosis capitis is an infestation of the hair and scalp with lice. The nits are visible and attached firmly to the hair shaft near the scalp. The occiput is an area in which nits can be seen. Maculopapular lesions behind the ears of lesions that extend to the hairline or neck are indicative of an infectious process, not pediculosis. White flaky particles are indicative of dandruff.

A 6-year old child with leukemia is hospitalized and is receiving combination chemotherapy. Laboratory results indicate that the child is neutropenic, and protective isolation procedures are initiated. The grandmother of the child visits and brings a fresh bouquet of flowers picked from her garden and asks the nurse for a vase for the flowers. Which response should the nurse provide to the grandmother? A. I have a vase in the utility room, and I will get it for you. B. I will get the vase and wash it well before you put the flowers in it. C. The flowers from your garden are beautiful, but should not be placed in the child's room at this time. D. When you bring the flowers into the room, place them on the bedside stand as far away from the child as possible.

Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing anemia from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production (thrombocytopenia). For a hospitalized neutropenic child, flowers or plants should not be kept in the room because standing water and damp soil harbor Aspergillus and Pseudomonas aeruginosa, to which the child is susceptible. In addition, fresh fruits and vegetables harbor molds and should be avoided until the white blood cell count increases.