Pediatrics - NCLEX questions: Exam 2

28. The nurse is caring for a 9-month-old who was born with a congenital heart defect (CHD). Assessment reveals a HR of 160, capillary refill of 4 seconds, bilateral crackles, and sweat on the scalp. These are signs of _____________________.

Congestive heart failure (CHF).

36. A child born with Down syndrome should be evaluated for which associated cardiac manifestation? 1. Congenital heart defect (CHD). 2. Systemic hypertension. 3. Hyperlipidemia. 4. Cardiomyopathy

1. Congenital heart defect (CHD).

Which of the following measures should be implemented for a child with von Willebrand disease who has a nosebleed? 1. Apply pressure to the nose for at least 10 minutes. 2. Have the child lie supine and quiet. 3. Avoid packing of the nostrils. 4. Encourage the child to swallow frequently.

1. Apply pressure to the nose for at least 10 minutes. Applying pressure to the nose may stop the bleeding. In von Willebrand disease, there is an increased tendency to bleed from mucous membranes, leading to nosebleeds commonly from the anterior part of the nasal septum.

Which of the following is the best method to prevent the spread of infection to an immunosuppressed child? 1. Administer antibiotics prophylactically to the child. 2. Have people wash their hands prior to contact with the child. 3. Assign the same nurses to care for the child each day. 4. Limit visitors to family members only.

2. Have people wash their hands prior to contact with the child. Hand washing is the best method to prevent the spread of germs and protect the child from infection.

Which of the following measures should the nurse teach the parent of a child with hemophilia to do first if the child sustains an injury to a joint causing bleeding? 1. Give the child a dose of acetaminophen (Tylenol). 2. Immobilize the joint and elevate the extremity. 3. Apply heat to the area. 4. Administer factor per the home-care protocol.

4. Administer factor per the home-care protocol. Administration of factor should be the first intervention if home-care transfusions have been initiated.

11. For the child with hypoplastic left heart syndrome, which drug may be given to allow the patent ductus arteriosus (PDA) to remain open until surgery? _____________________

Prostaglandin E.

46. A child with Ewing sarcoma is receiving chemotherapy and is experiencing severe nausea. The nurse has to administer lorazepam (Ativan) at 0.04 mg/kg, and the child weighs 65 lb. What dose should the nurse administer? ___________

1.2 mg. Change pounds to kilograms (2.2 lb = 1 kg: 65/2.2 = 29.5 kg). Then multiply kilograms by the dose of 0.04 mg/kg: 29.5 × 0.04 = 1.18 mg or round to 1.2 mg.

63. Nursing care of a child with a fractured extremity in whom there is suspected compartment syndrome includes which of the following? Select all that apply. 1. Assess pain. 2. Assess pulses. 3. Elevate extremity above the level of the heart. 4. Monitor capillary refill. 5. Provide pain medication as needed.

1. Assess pain. 2. Assess pulses. 4. Monitor capillary refill. 5. Provide pain medication as needed.

42. The nurse is teaching an adolescent about Ewing sarcoma and indicates which as a common site? 1. Shaft. 2. Growth plate. 3. Ball of the femur. 4. Bone marrow.

1. Shaft.

28. A spinal curve of less than __________ degrees that is nonprogressive does not require treatment for scoliosis.

20 A 20-degree spinal curve that is nonprogressive will not disfigure or interfere with normal functioning, so it is not treated with bracing or surgery. TEST-TAKING HINT: The test taker must know about treatment for scoliosis.

41. The most common cardiac dysrhythmia in the pediatric population is: 1. Ventricular tachycardia. 2. Sinus bradycardia. 3. Supraventricular tachycardia. 4. First-degree heart block.

3. Supraventricular tachycardia.

33. The nurse should be suspicious of which condition in the following figure?

DDH. The asymmetry of the thigh folds suggests DDH.

26. The _____________________ serves as the septal opening between the atria of the fetal heart.

Foramen ovale.

38. A child with osteosarcoma is going to receive chemotherapy before surgery. Which statement by the parents indicates they understand the side effect of neutropenia? 1. "My child will be more at risk for diarrhea." 2. "My child will be more at risk for infection." 3. "My child ' s hair will fall out." 4. "My child will need to drink more."

2. "My child will be more at risk for infection."

45. A child with Ewing sarcoma is undergoing a limb salvage procedure. Which statement indicates the parents understand the procedure? 1. "Our child will have a bone graft to save the limb." 2. "Our child will need follow-up lengthening procedures." 3. "Our child will need shorter shirt sleeves." 4. "Our child will not need chemotherapy."

2. "Our child will need follow-up lengthening procedures."

23. What associated manifestation might the nurse occasionally find in a child diagnosed with Wilms tumor? 1. Atrial fibrillation. 2. Hypertension. 3. Endocarditis. 4. Hyperlipidemia.

2. Hypertension.

37. The Norwood procedure is used to correct: 1. Transposition of the great vessels. 2. Hypoplastic left heart syndrome. 3. Tetralogy of Fallot (TOF). 4. Patent ductus arteriosus (PDA).

2. Hypoplastic left heart syndrome.

A teen is seen in clinic for a possible diagnosis of Hodgkin disease. The nurse is aware that which of the following symptoms should make the health-care provider suspect Hodgkin disease? 1. Fever, fatigue, and pain in the joints. 2. Anorexia with weight loss. 3. Enlarged, painless, and movable lymph nodes in the cervical area. 4. Enlarged liver with jaundice.

3. Enlarged, painless, and movable lymph nodes in the cervical area. Enlarged, painless, and movable lymph nodes in the cervical area are the most common presenting manifestations of Hodgkin disease.

59. A heart transplant may be indicated for a child with severe heart failure and: 1. Patent ductus arteriosus (PDA). 2. Ventricular septal defect (VSD). 3. Hypoplastic left heart syndrome. 4. Pulmonic stenosis (PS).

3. Hypoplastic left heart syndrome.

20. A 6-month-old who has episodes of cyanosis after crying could have the congenital heart defect (CHD) of decreased pulmonary blood fl ow called _____________________.

Tetralogy of Fallot (TOF). "Tet" spells are characteristic of TOF.

22. Where should the top of the crutch bar be in relation to the axilla? ________________

The crutch bar should not put pressure on nerves in the axilla. TEST-TAKING HINT: The axillae do not rest on the crutch bar.

4. A 10-year-old child is recovering from a severe sore throat. The parent states that the child complains of chest pain. The nurse observes that the child has swollen joints, nodules on the fingers, and a rash on the chest. The likely cause is _____________________.

Rheumatic fever (RF). To make the diagnosis of RF, major and minor criteria are used. Major criteria include carditis, subcutaneous nodules, erythema marginatum, chorea, and arthritis. Minor criteria include fever and previous history of RF.

15. A child who has reddened eyes with no discharge; red, swollen, and peeling palms and soles of the feet; dry, cracked lips; and a "strawberry tongue" most likely has _____________________.

Kawasaki disease (KD).

Which of the following activities should a nurse suggest for a client diagnosed with hemophilia? Select all that apply. 1. Swimming. 2. Golf. 3. Hiking. 4. Fishing. 5. Soccer.

1, 2, 3, 4. 1. Children with hemophilia should be encouraged to take part in noncontact activities that allow for social, psychological, and physical growth, such as swimming. 2. Children with hemophilia should be encouraged to take part in noncontact activities that allow for social, psychological, and physical growth, such as golf. 3. Children with hemophilia should be encouraged to take part in noncontact activities that allow for social, psychological, and physical growth, such as hiking. 4. Children with hemophilia should be encouraged to take part in noncontact activities that allow for social, psychological, and physical growth, such as fishing. 5. Contact sports like soccer should be discouraged. TEST-TAKING HINT: Soccer is the only contact sport listed, so the other answers can be selected.

The nurse is caring for a child with leukemia. The nurse should be aware that children being treated for leukemia may experience which of the following complications? Select all that apply. 1. Anemia. 2. Infection. 3. Bleeding tendencies. 4. Bone deformities. 5. Polycythemia.

1, 2, 3. 1. Anemia is caused by decreased production of red blood cells. 2. Infection risk in leukemia is secondary to the neutropenia. 3. Bleeding tendencies are from decreased platelet production. 4. There are no bone deformities with leukemia, but there is bone pain from the proliferation of cells in the bone marrow. 5. Polycythemia is an increase in red blood cells. TEST-TAKING HINT: Leukemia is cancer of the blood forming organs. Leukemia can be either acute or chronic. Review the pathophysiology of leukemia to determine the clinical problems.

Which of the following can be a manifestation of leukemia in a child? Select all that apply. 1. Leg pain. 2. Fever. 3. Excessive weight gain. 4. Bruising. 5. Enlarged lymph nodes.

1, 2, 4, 5. 1. The proliferation of cells in the bone marrow can cause leg pain. 2. Fever is a result of the neutropenia. 3. There is usually a decrease in weight because the child will feel sick and not as hungry. 4. A decrease in platelets causes the bruising. 5. The lymph nodes are enlarged by the infi ltration of leukemic cells. TEST-TAKING HINT: Review the consequences of depressed bone marrow and relate them to the clinical manifestations.

A child with hemophilia A fell and injured a knee while playing outside. The knee is swollen and painful. Which of the following measures should be taken to stop the bleeding? Select all that apply. 1. The extremity should be immobilized. 2. The extremity should be elevated. 3. Warm moist compresses should be applied to decrease pain. 4. Passive range-of-motion exercises should be administered to the extremity. 5. Factor VIII should be administered.

1, 2, 5. 1. Measures are needed to induce vasoconstriction and stop the bleeding, including immobilization of the extremity. 2. Measures are needed to induce vasoconstriction and stop the bleeding. Treatment should include elevating the extremity. 3. Measures are needed to induce vasoconstriction and stop the bleeding. Treatment should include an application of cold compression. Warmth will slow the vasoconstriction and clotting process. 4. Measures are needed to induce vasoconstriction and stop the bleeding. Passive ROM is not started until the bleeding has stopped. 5. Hemophilia A is a defi ciency in factor VIII, which causes delay in clotting when there is a bleed. Giving a dose of Factor VIII concentrate will assist in the clotting process. TEST-TAKING HINT: Focus on the disease process and measures to stop bleeding.

Which of the following factors need(s) to be included in a teaching plan for a child with sickle cell disease? Select all that apply. 1. The child needs to be taken to a physician when sick. 2. The parent should make sure the child sleeps in an air-conditioned room. 3. Emotional stress should be avoided. 4. It is important to keep the child well hydrated. 5. It is important to make sure the child gets adequate nutrition.

1, 3, 4, 5. 1. Seek medical attention for illness to prevent the child from going into a crisis. 2. A cold environment causes vasoconstriction, which needs to be prevented to get good tissue perfusion. 3. Stress can cause a depressed immune system, making the child more susceptible to infection and crisis. Parents and children are advised to avoid stress. 4. The child needs good hydration and nutrition to maintain good health. 5. The child needs good hydration and nutrition to maintain good health. TEST-TAKING HINT: Focus on how to prevent a sickle cell crisis.

The nurse is caring for a child who is receiving a transfusion of PRBCs. The nurse is aware that if the child has a hemolytic reaction to the blood, the signs and symptoms would include which of the following? Select all that apply. 1. Fever. 2. Rash. 3. Oliguria. 4. Hypotension. 5. Chills.

1, 3, 4. 1. Hemolytic reactions include fever, pain at insertion site, hypotension, renal failure, tachycardia, oliguria, and shock. 2. Febrile reactions are fever, rash, and chills. Allergic reactions include hives, itching, and respiratory distress. 3. Hemolytic reactions include fever, pain at insertion site, hypotension, renal failure, tachycardia, oliguria, and shock. 4. Hemolytic reactions include fever, pain at insertion site, hypotension, renal failure, tachycardia, oliguria, and shock. 5. Febrile reactions are fever, chills, and rash. Allergic reactions include rash, hives, and respiratory distress. TEST-TAKING HINT: Review the signs and symptoms of hemolytic reaction, febrile reaction, and allergic reaction. Understanding the causes of the reactions will help identify the symptoms.

A nurse educator is providing a teaching session for the nursing staff. Which of the following individuals is at greatest risk for developing beta-thalassemia (Cooley anemia)? 1. A child of Mediterranean descent. 2. A child of Mexican descent. 3. A child whose mother has chronic anemia. 4. A child who has a low intake of iron.

1. A child of Mediterranean descent. Beta-thalassemia is an inherited recessive disorder that is found primarily in individuals of Mediterranean descent. The disease has also been reported in Asian and African populations.

25. A 16-year-old being treated for hypertension has a history of asthma. Which drug class should be avoided in treating this client's hypertension? 1. Beta blockers. 2. Calcium channel blockers. 3. ACE inhibitors. 4. Diuretics.

1. Beta blockers.

39. Exposure to which illness should be a cause to discontinue therapy and substitute dipyridamole (Persantine) in a child receiving aspirin therapy for Kawasaki disease (KD)? 1. Chickenpox or influenza. 2. E. coli or Staphylococcus . 3. Candida or Streptococcus A. 4. Streptococcus A or staphylococcus.

1. Chickenpox or influenza.

A child diagnosed with leukemia is receiving allopurinol (Zyloprim) as part of the treatment plan. The parents ask why their child is receiving this medication. What information about the medication should the nurse provide? 1. Helps reduce the uric acid level caused by cell destruction. 2. Helps make the chemotherapy more effective. 3. Helps reduce the nausea and vomiting associated with chemotherapy. 4. Helps decrease pain in the bone marrow.

1. Helps reduce the uric acid level caused by cell destruction. Allopurinol (Zyloprim) reduces serum uric acid. When there is lysis of cells from chemotherapy, there will be an increase in serum uric acid.

30. A child diagnosed with congestive heart failure (CHF) is receiving maintenance doses of digoxin (Lanoxin) and furosemide (Lasix). She is rubbing her eyes when she is looking at the lights in the room, and her HR is 70 beats per minute. The nurse expects which laboratory finding? 1. Hypokalemia. 2. Hypomagnesemia. 3. Hypocalcemia. 4. Hypophosphatemia.

1. Hypokalemia.

16. The nurse is caring for a child with Kawasaki disease (KD). A student nurse who is on the unit asks if there are medications to treat this disease. The nurse ' s response to the student nurse is: 1. Immunoglobulin G and aspirin. 2. Immunoglobulin G and ACE inhibitors. 3. Immunoglobulin E and heparin. 4. Immunoglobulin E and ibuprofen (Motrin).

1. Immunoglobulin G and aspirin.

19. Hypoxic spells in the infant with a congenital heart defect (CHD) can cause which of the following? Select all that apply. 1. Polycythemia. 2. Blood clots. 3. Cerebrovascular accident (CVA). 4. Developmental delays. 5. Viral pericarditis. 6. Brain damage. 7. Alkalosis.

1. Polycythemia. 2. Blood clots. 3. Cerebrovascular accident (CVA). 4. Developmental delays. 6. Brain damage.

Which of the following confi rms a diagnosis of Hodgkin disease in a 15-year-old? 1. Reed-Sternberg cells in the lymph nodes. 2. Blast cells in the blood. 3. Lymphocytes in the bone marrow. 4. VMA in the urine.

1. Reed-Sternberg cells in the lymph nodes. A lymph node biopsy is done to confirm a histological diagnosis and staging of Hodgkin disease. The presence of Reed- Sternberg cells is characteristic of the disease.

Which of the following describes idiopathic thrombocytopenia purpura (ITP)? Select all that apply. 1. ITP is a congenital hematological disorder. 2. ITP causes excessive destruction of platelets. 3. Children with ITP have normal bone marrow. 4. Platelets are small in ITP. 5. Purpura is observed in ITP.

2, 3, 5. 1. ITP is an acquired hematological condition that is characterized by excessive destruction of platelets, purpura, and normal bone marrow along with an increase in large, yellow platelets. 2. ITP is characterized by excessive destruction of platelets. 3. The bone marrow is normal in children with ITP. 4. Platelets are large, not small. 5. ITP is characterized by purpura, which are areas of hemorrhage under the skin. TEST-TAKING HINT: Review the pathophysiology of ITP to determine the manifestations of the disease.

5. What should the nurse assess prior to administering digoxin (Lanoxin)? 1. Sclera. 2. Apical pulse rate. 3. Cough. 4. Liver function test.

2. Apical pulse rate.

The parent of a child with hemophilia is asking the nurse what caused the hemophilia. Which is the nurse ' s best response? 1. It is an X-linked dominant disorder. 2. It is an X-linked recessive disorder. 3. It is an autosomal dominant disorder. 4. It is an autosomal recessive disorder.

2. It is an X-linked recessive disorder. Hemophilia is transmitted as an X-linked recessive disorder. About 60% of children have a family history of hemophilia. The usual transmission is by a female with the trait and an unaffected male.

The parent of a 2-year-old who is HIV + questions the nurse about placing the child in day care. Which of the following is the best response? 1. The child should not go to day care until older, because there is a high risk for transmission of the disease. 2. The child can go to day care without restrictions and should be allowed to participate in all activities. 3. The child can go to day care but should avoid physical activity. 4. The child may go to day care, but the parent must inform all the parents at the day care that the child is HIV + .

2. The child can go to day care without restrictions and should be allowed to participate in all activities. The child can attend day care without any limitations but should not attend with a fever.

The nurse is caring for a child with sickle cell disease who is scheduled to have a splenectomy. What information should the nurse explain to the parents regarding the reason for a splenectomy? 1. To decrease potential for infection. 2. To prevent splenic sequestration. 3. To prevent sickling of red blood cells. 4. To prevent sickle cell crisis.

2. To prevent splenic sequestration. Splenic sequestration is a life-threatening situation in children with sickle cell disease. Once a child is considered to be at high risk of splenic sequestration or has had this in the past, the spleen will be removed.

A nurse is caring for a 5-year-old with sickle cell vaso-occlusive crisis. Which of the following orders should the nurse question? Select all that apply. 1. Position the child for comfort. 2. Apply hot packs to painful areas. 3. Give meperidine (Demerol) 25 mg intravenously every 4 hours as needed for pain. 4. Restrict oral fluids. 5. Apply oxygen per nasal cannula to keep oxygen saturations above 94%.

3, 4, 5. 1. Medical treatment of sickle cell vasoocclusive crises is directed toward preventing hypoxia. Tissue hypoxia is very painful, so placing the child in a position of comfort is important. 2. Hot packs help relieve pain because they cause vasodilation, which allows increased blood fl ow and decreased hypoxia. 3. Tissue hypoxia is very painful. Narcotics such as morphine are usually given for pain when the child is in a crisis. Meperidine (Demerol) should be avoided because of the risk of Demerol-induced seizures. 4. The child should receive hydration because when the child is in crisis, the abnormal S-shaped red blood cells clump, causing tissue hypoxia and pain. 5. Oxygen is of little value unless the tissue is hypoxic. The objective of treatment is to minimize hypoxia. TEST-TAKING HINT: Focus on the pathophysiology of a vaso-occlusive crisis. Keep in mind measures that decrease tissue hypoxia.

10. Indomethacin (Indocin) may be given to close which congenital heart defect (CHD) in newborns? _____________________

Patent ductus arteriosus (PDA).

The nurse is taking care of a child with sickle cell disease. The nurse is aware that which of the following problems is (are) associated with sickle cell disease? Select all that apply. 1. Polycythemia. 2. Hemarthrosis. 3. Aplastic crisis. 4. Thrombocytopenia. 5. Vaso-occlusive crisis.

3, 5. 1. Polycythemia is seen in children with chronic hypoxia, such as cyanotic heart disease. 2. Hemarthrosis, bleeding into a joint, is commonly seen in children with hemophilia. 3. Aplastic crisis, temporary cessation of red blood cell production, is associated with sickle cell anemia. 4. Thrombocytopenia is associated with idiopathic thrombocytopenia purpura, high altitude, medication side effects, and pregnancy. 5. Vaso-occlusive crisis is the most common problem in children with sickle cell disease. TEST-TAKING HINT: Defining the terms will make the correct responses evident.

24. Which drug should not be used to control secondary hypertension in a sexually active adolescent female who uses intermittent birth control? 1. Beta blockers. 2. Calcium channel blockers. 3. ACE inhibitors. 4. Diuretics.

3. ACE inhibitors.

The parent of a child diagnosed with Wilms tumor asks the nurse what the treatment plan will be. The nurse explains the usual protocol for this condition. Which information should the nurse give to the parent? 1. The child will have chemotherapy and, after that has been completed, radiation. 2. The child will need to have surgery to remove the tumor. 3. The child will go to surgery for removal of the tumor and the kidney and will then start chemotherapy. 4. The child will need radiation and later surgery to remove the tumor.

3. The child will go to surgery for removal of the tumor and the kidney and will then start chemotherapy. Combination therapy of surgery and chemotherapy is the primary therapeutic management. Radiation is done depending on clinical stage and histological pattern.

A child with leukemia is receiving chemotherapy and is complaining of nausea. The nurse has been giving the scheduled antiemetic. Which of the following should the nurse do when the child is nauseated? 1. Encourage low-protein foods. 2. Encourage low-caloric foods. 3. Offer the child ' s favorite foods. 4. Offer cool, clear liquids.

4. Offer cool, clear liquids. Cool, clear liquids are better tolerated. Milk-based products cause secretions to be thick and can cause vomiting.

Which of the following will be abnormal in a child with the diagnosis of hemophilia? 1. Platelet count. 2. Hemoglobin level. 3. White blood cell count. 4. Partial thromboplastin time (PTT).

4. Partial thromboplastin time (PTT). The abnormal laboratory results in hemophilia are related to decreased clotting function. Partial thromboplastin time is prolonged.

Which of the following is the most common opportunistic infection in children infected with human immunodefi ciency virus (HIV)? 1. CMV. 2. Encephalitis. 3. Meningitis. 4. Pneumocystic pneumonia.

4. Pneumocystic pneumonia. Pneumocystis jiroveci pneumonia is the most common opportunistic infection that can occur in HIV-infected children, and such children are treated prophylactically for this.

10. Which factor is associated with slipped capital femoral epiphysis (SCFE)? Select all that apply. 1. Obesity. 2. Female gender. 3. Family history of SCFE. 4. Age of 5 to 9 years. 5. Pubertal hormonal changes. 6. Endocrine disorders.

1. Obesity. 3. Family history of SCFE. 5. Pubertal hormonal changes. 6. Endocrine disorders.

Which of the following measures should the nurse implement to help with the nausea and vomiting caused by chemotherapy? Select all that apply. 1. Give an antiemetic 30 minutes prior to the start of therapy. 2. Continue the antiemetic as ordered until 24 hours after the chemotherapy is complete. 3. Remove food that has a lot of odor. 4. Keep the child on a nothing-by-mouth status. 5. Wait until the nausea begins to start the antiemetic.

1, 2, 3. 1. The first dose should be given 30 minutes prior to the start of the therapy. 2. Antiemetic should be administered around the clock until 24 hours after the chemotherapy is completed. 3. It is also helpful to remove foods with odor so that the smell of the food does not make the child nauseated. 4. The child should be allowed to take food and fluids as tolerated. 5. Antiemetics are most beneficial if given before the onset of nausea and vomiting. TEST-TAKING HINT: These are measures to prevent nausea and vomiting.

A nurse is caring for a child with von Willebrand disease. The nurse is aware that which of the following is a clinical manifestation of von Willebrand disease? Select all that apply. 1. The child bruises easily. 2. Excessive menstruation. 3. The child has frequent nosebleeds. 4. Elevated creatinine levels. 5. Elevated blood pressure.

1, 2, 3. 1. Von Willebrand disease is a hereditary bleeding disorder characterized by defi ciency of or defect in a protein. The disorder causes adherence of platelets to damaged endothelium and a mild defi ciency of factor VIII. One of the manifestations of this disease is bleeding of the mucous membranes. 2. Excessive menstruation may be a manifestation of this disease. 3. Frequent nosebleeds are a common manifestation of this disease. 4. There is no increase in creatinine in this disease. 5. There is no increase in blood pressure. TEST-TAKING HINT: Von Willebrand disease is a minor factor VIII defi ciency.

Which of the following can lead to a possible diagnosis of human immunodeficiency virus (HIV) in a child? Select all that apply. 1. Repeated respiratory infections. 2. Intermittent diarrhea. 3. Excessive weight gain. 4. Irregular heartbeat. 5. Poor weight gain.

1, 2, 5. 1. Symptoms of HIV include frequent respiratory infections. The symptoms present based on the underlying cellular immunodeficiency-related disease. 2. Symptoms of HIV include intermittent diarrhea. The symptoms present based on the underlying cellular immunodeficiency-related disease. 3. Children with HIV are unable to create an immune response to infection. They develop recurrent bacterial infections and have poor weight gain. The symptoms present based on the underlying cellular immunodeficiency related disease. 4. Irregular heartbeat is not associated with HIV. 5. Symptoms of HIV include poor weight gain. TEST-TAKING HINT: Symptoms of HIV in children include lymphadenopathy, hepatosplenomegaly, chronic diarrhea, failure to thrive, and parotitis. Review common clinical signs and health conditions associated with the virus.

19. Which should the nurse include in the teaching plan for a child who had surgery to correct bilateral clubfeet and had the casts removed? Select all that apply. 1. "Your child will need to wear a brace on the feet 23 hours a day for 12 months." 2. "Your child should see an orthopedic surgeon regularly until the age of 18 years." 3. "Your child will not be able to participate in sports that require a lot of running." 4. "Your child may have a recurrence of clubfoot in a year or more." 5. "Most children treated for clubfeet develop feet that appear and function normally." 6. "Most children treated for clubfeet require surgery at puberty."

1. "Your child will need to wear a brace on the feet 23 hours a day for 12 months." 2. "Your child should see an orthopedic surgeon regularly until the age of 18 years." 4. "Your child may have a recurrence of clubfoot in a year or more." 5. "Most children treated for clubfeet develop feet that appear and function normally."

51. Which of the following applies to the care of a child with a retroperitoneal rhabdomyosarcoma? Select all that apply. 1. Acute pain. 2. Risk for impaired urinary elimination. 3. Impaired gas exchange. 4. Self-care deficit. 5. Risk for constipation.

1. Acute pain. 2. Risk for impaired urinary elimination. 5. Risk for constipation.

The parent of a 4-year-old brings the child to the clinic and tells the nurse the child ' s abdomen is distended. After a complete examination, a diagnosis of Wilms tumor is suspected. Which of the following is most important when doing a physical examination on this child? 1. Avoid palpation of the abdomen. 2. Assess the urine for the presence of blood. 3. Monitor vital signs, especially the blood pressure. 4. Obtain an accurate height and weight.

1. Avoid palpation of the abdomen. Palpating the abdomen of the child in whom a diagnosis of Wilms tumor is suspected should be avoided because manipulation of the abdomen may cause seeding of the tumor.

The parent of a teen with a diagnosis of Hodgkin disease asks what the child ' s prognosis will be with treatment. What information should the nurse give to the parent and child? 1. Clinical staging of Hodgkin disease will determine the treatment; long-term survival for all stages of Hodgkin disease is excellent. 2. There is a considerably better prognosis if the client is diagnosed early and is less than 5 years of age. 3. The prognosis for Hodgkin disease depends on the type of chemotherapy. 4. The only way to obtain a good prognosis is by chemotherapy and bone marrow transplant.

1. Clinical staging of Hodgkin disease will determine the treatment; long-term survival for all stages of Hodgkin disease is excellent. Long-term survival for all stages of Hodgkin disease is excellent. Early-stage disease can have a survival rate greater than 90%, with advanced stages having rates between 65% and 75%.

42. A nursing action that promotes ideal nutrition in an infant with congestive heart failure (CHF) is: 1. Feeding formula that is supplemented with additional calories. 2. Allowing the infant to nurse at each breast for 20 minutes. 3. Providing large feedings every 5 hours. 4. Using firm nipples with small openings to slow feedings.

1. Feeding formula that is supplemented with additional calories.

56. One nursing diagnosis for juvenile idiopathic arthritis (JIA) is impaired physical mobility. Select all that apply. 1. Give pain medication prior to ambulation. 2. Assist with range-of-motion activities. 3. Encourage the child to eat a high-fat diet. 4. Provide oxygen as necessary. 5. Use nonpharmacological methods, such as heat.

1. Give pain medication prior to ambulation. 2. Assist with range-of-motion activities. 5. Use nonpharmacological methods, such as heat.

4. The nurse is teaching about congenital clubfoot in infants. The nurse evaluates the teaching as successful when the parent states that clubfoot is best treated when? 1. Immediately after diagnosis. 2. At age 4 to 6 months. 3. Prior to walking (age 9 to 12 months). 4. After walking is established (age 15 to 18 months).

1. Immediately after diagnosis.

53. Which client could require feeding by gavage? Select all that apply. 1. Infant with congestive heart failure (CHF). 2. Infant with significant pulmonary stenosis. 3. Toddler with repair of transposition of the great vessels. 4. Toddler with Kawasaki disease (KD) in the acute phase. 5. School-age child with rheumatic fever (RF) and chorea.

1. Infant with congestive heart failure (CHF). 2. Infant with significant pulmonary stenosis.

29. Which of the following are examples of acquired heart disease? Select all that apply. 1. Infective endocarditis. 2. Hypoplastic left heart syndrome. 3. Rheumatic fever (RF). 4. Cardiomyopathy. 5. Kawasaki disease (KD). 6. Transposition of the great vessels.

1. Infective endocarditis. 3. Rheumatic fever (RF). 4. Cardiomyopathy. 5. Kawasaki disease (KD).

What can an electrocardiogram (ECG) detect? Select all that apply. 1. Ischemia. 2. Injury. 3. Cardiac output (CO). 4. Dysrhythmias. 5. Systemic vascular resistance (SVR). 6. Occlusion pressure. 7. Conduction delay.

1. Ischemia. 2. Injury. 4. Dysrhythmias. 7. Conduction delay.

32. After the birth of an infant with clubfoot, the nursery nurse should do which of the following when instructing the parents? Select all that apply. 1. Speak in simple language about the defect. 2. Avoid the parents unless providing direct care so that they can grieve privately. 3. Keep the infant ' s feet covered at all times. 4. Present the infant as precious; emphasize the well-formed parts of the body. 5. Tell the parent that defects could be much worse. 6. Be prepared to answer questions multiple times.

1. Speak in simple language about the defect. 4. Present the infant as precious; emphasize the well-formed parts of the body. 6. Be prepared to answer questions multiple times.

Which of the following best describes the action of chemotherapeutic agents used in the treatment of cancer in children? Select all that apply. 1. Suppress the function of normal lymphocytes in the immune system. 2. Are alkylating agents and are cell-specific. 3. Cause a replication of DNA and are cell-specific. 4. Interrupt cell cycle, thereby causing cell death. 5. Prednisone is a natural hormone.

1. Suppress the function of normal lymphocytes in the immune system. 4. Interrupt cell cycle, thereby causing cell death. 5. Prednisone is a natural hormone.

54. Which would the nurse teach a patient when NSAIDs are prescribed for treating juvenile idiopathic arthritis (JIA)? 1. Take with food. 2. Take on an empty stomach. 3. Blood levels are required for drug dosages. 4. Good oral hygiene is needed.

1. Take with food.

The nurse is caring for a child being treated for ALL. Laboratory results indicate that the child has a white blood cell count of 5000/mm 3 with 5% polys and 3% bands. Which of the following analyses is most appropriate? 1. The absolute neutrophil count is 400/mm 3 , and the child is neutropenic. 2. The absolute neutrophil count is 800/mm 3 , and the child is neutropenic. 3. The absolute neutrophil count is 4000/mm 3 , and the child is not neutropenic. 4. The absolute neutrophil count is 5800/mm 3 , and the child is not neutropenic.

1. The absolute neutrophil count is 400/mm 3 , and the child is neutropenic. The calculated absolute neutrophil count is 400/mm3 (0.08 × 5000), and the child is neutropenic because the count is less than 500/mm3.

Which of the following is a reason to perform a lumbar puncture on a child with a diagnosis of leukemia? Select all that apply. 1. Rule out meningitis. 2. Assess the central nervous system for infi ltration. 3. Give intrathecal chemotherapy. 4. Determine increased intracranial pressure. 5. Stage the leukemia.

2, 3. 1. There is no need to perform a spinal tap to rule out meningitis unless the patient has symptoms of meningitis. 2. A lumbar puncture is done to determine whether the cancer cells have entered the CNS, but this would not be routine unless the child was symptomatic. 3. Chemotherapy can also be given through a lumbar puncture (spinal tap). 4. ICP would be considered if the child had symptoms of headache, nausea, forceful vomiting, blurred or double vision, drowsiness, or seizure; an LP might then be performed. 5. Leukemia is not staged. TEST-TAKING HINT: The primary site for leukemia involvement is the bone marrow. Rarely do children have CNS involvement.

A 10-year-old with severe factor VIII defi ciency falls, injures an elbow, and is brought to the ED. The nurse should prepare which of the following? 1. An IM injection of factor VIII. 2. An IV infusion of factor VIII. 3. An injection of desmopressin. 4. An IV infusion of platelets.

2. An IV infusion of factor VIII. The child is treated with an IV infusion of factor VIII to replace the missing factor and help stop the bleeding.

49. A child has been seen by the school nurse for dizziness since the start of the school term. It happens when standing in line for recess and homeroom. The child now reports that she would rather sit and watch her friends play hopscotch because she cannot count out loud and jump at the same time. When the nurse asks her if her chest ever hurts, she says yes. Based on this history, the nurse suspects that she has: 1. Ventricular septal defect (VSD). 2. Aortic stenosis (AS). 3. Mitral valve prolapse. 4. Tricuspid atresia.

2. Aortic stenosis (AS).

9. When counseling the parents of a child with osteogenesis imperfecta (OI), the nurse should include which of the following? Select all that apply. 1. Discourage future children because the condition is inherited. 2. Provide education about the child's physical limitations. 3. Give the parents a letter signed by the primary care provider explaining OI. 4. Provide information on contacting the Osteogenesis Imperfecta Foundation. 5. Encourage the parents to treat the child like their other children. 6. Encourage use of calcium to decrease risk of fractures.

2. Provide education about the child's physical limitations. 3. Give the parents a letter signed by the primary care provider explaining OI. 4. Provide information on contacting the Osteogenesis Imperfecta Foundation.

33. A 10-year-old has undergone a cardiac catheterization. At the end of the procedure, the nurse should first assess: 1. Pain. 2. Pulses. 3. Hemoglobin and hematocrit levels. 4. Catheterization report.

2. Pulses.

55. Aspirin has been ordered for the child with rheumatic fever (RF) in order to: 1. Keep the patent ductus arteriosus (PDA) open. 2. Reduce joint inflammation. 3. Decrease swelling of strawberry tongue. 4. Treat ventricular hypertrophy of endocarditis

2. Reduce joint inflammation.

40. The nurse is caring for an 8-year-old girl whose parents indicate she has developed spastic movements of her extremities and trunk, facial grimace, and speech disturbances. They state it seems worse when she is anxious and does not occur while sleeping. The nurse questions the parents about which recent illness? 1. Kawasaki disease (KD). 2. Rheumatic fever (RF). 3. Malignant hypertension. 4. Atrial fibrillation.

2. Rheumatic fever (RF).

7. Which finding might delay a cardiac catheterization procedure on a 1-year-old? 1. 30th percentile for weight. 2. Severe diaper rash. 3. Allergy to soy. 4. Oxygen saturation of 91% on room air.

2. Severe diaper rash.

59. Which is an important nursing intervention to teach about photosensitivity to the parents of a child with systemic lupus erythematosus (SLE)? 1. Regular clothing is appropriate for sun exposure. 2. Sunscreen application is necessary for protection. 3. Teenage patients cannot participate in outdoor sports. 4. Uncovered fluorescent lights offer no danger.

2. Sunscreen application is necessary for protection.

55. Why are chemotherapeutic agents such as methotrexate (Trexall) and cyclophosphamide (Cytoxan) sometimes used to treat juvenile idiopathic arthritis (JIA)? 1. Are effective against cancer-like JIA. 2. Suppress the immune system. 3. Are similar to NSAIDs. 4. Are absorbed into the synovial fluid.

2. Suppress the immune system.

47. The nurse is explaining rhabdomyosarcoma cancer to an adolescent. From which of the following muscles does the cancer arise? 1. Skeletal. 2. Cardiac. 3. Striated. 4. Connective.

3. Striated.

61. Which assessments indicate that the parent of a 7-year-old is following the prescribed treatment for congestive heart failure (CHF)? Select all that apply. 1. HR of 56 beats per minute. 2. Elevated red blood cell count. 3. 50th percentile height and weight for age. 4. Urine output of 0.5 cc/kg/hr. 5. Playing basketball with other children his age.

3. 50th percentile height and weight for age. 5. Playing basketball with other children his age.

23. Select the number of inches lateral to the heel where a crutch should be placed. 1. 1 to 3. 2. 4 to 5. 3. 6 to 8. 4. 9 to 10.

3. 6 to 8.

12. On examination, a nurse hears a murmur at the left sternal border (LSB) in a child with diarrhea and fever. The parent asks why the health-care provider never said anything about the murmur. The nurse explains: 1. "The health-care provider is not a cardiologist." 2. "Murmurs are diffi cult to detect, especially in children." 3. "The fever increased the intensity of the murmur." 4. "We need to refer the child to an interventional cardiologist."

3. "The fever increased the intensity of the murmur."

39. Which is most important to discuss with an adolescent who is going to have a leg amputation for osteosarcoma? 1. Pain. 2. Spirituality. 3. Body image. 4. Lack of coping

3. Body image.

53. Which would the nurse teach an adolescent is a complication of corticosteroids used in the treatment of juvenile idiopathic arthritis (JIA)? 1. Fat loss. 2. Adrenal stimulation. 3. Immune suppression. 4. Hypoglycemia.

3. Immune suppression.

48. A child is diagnosed with stage IV rhabdomyosarcoma, and the parent asks what that means. The nurse provides which of the following explanations? 1. The tumor is limited to the organ site. 2. There is regional disease from the organ involved. 3. There is distant metastatic disease. 4. The disease is limited to the lymph nodes.

3. There is distant metastatic disease.

49. The nurse evaluates teaching as successful when the parent explains that an excisional biopsy is done for which reason? 1. To find metastatic disease. 2. To remove all metastatic disease. 3. To confirm the type of metastatic disease. 4. To treat metastatic disease.

3. To confirm the type of metastatic disease.

35. A child has been diagnosed with valvular disease following rheumatic fever (RF). During patient teaching, the nurse discusses the child's long-term prophylactic therapy with antibiotics for dental procedures, surgery, and childbirth. The parents indicate they understand when they say: 1. "She will need to take the antibiotics until she is 18 years old." 2. "She will need to take the antibiotics for 5 years after the last attack." 3. "She will need to take the antibiotics for 10 years after the last attack." 4. "She will need to take the antibiotics for the rest of her life."

4. "She will need to take the antibiotics for the rest of her life."

A nurse is doing discharge education with a parent who has a child with betathalassemia (Cooley anemia). The nurse informs the parent that the child is at risk for which of the following conditions? 1. Hypertrophy of the thyroid. 2. Polycythemia vera. 3. Thrombocytopenia. 4. Chronic hypoxia and iron overload.

4. Chronic hypoxia and iron overload. In beta-thalassemia, there is increased destruction of red blood cells, causing anemia. This results in chronic anemia and hypoxia. The children are treated with multiple blood transfusions, which can cause iron overload and damage to major organs.

Prednisone is given to children who are being treated for leukemia. Why is this medication given as part of the treatment plan? 1. Enhances protein metabolism. 2. Enhances sodium excretion. 3. Increases absorption of the chemotherapy. 4. Destroys abnormal lymphocytes.

4. Destroys abnormal lymphocytes. Prednisone is used in many of the treatment protocols for leukemia because there is abnormal lymphocyte production. Prednisone is thought to destroy abnormal lymphocytes.

The nurse is instructing the parent of a child with HIV about immunizations. Which of the following should the nurse tell the parent? Select all that apply. 1. Hepatitis B vaccine will not be given to this child. 2. Members of the family should be cautioned not to receive the varicella vaccine. 3. The child will need to have a Western blot test done prior to all immunizations. 4. Pneumococcal and influenza vaccines are recommended. 5. Meningitis immunization.

4. Pneumococcal and influenza vaccines are recommended. 5. Meningitis immunization.

40. Which would be the best nursing intervention for a child with phantom pain after an amputation? 1. Tell the child that the pain does not exist. 2. Request a PCA pump from the physician for pain management. 3. Encourage the child to rub the stump. 4. Provide amitriptyline (Elavil) to help with pain.

4. Provide amitriptyline (Elavil) to help with pain.

43. Which nursing diagnosis is most important for a child with Ewing sarcoma who will be undergoing chemotherapy? 1. Risk for fluid volume deficit. 2. Potential for chronic pain. 3. Risk for skin impairment. 4. Ineffective airway clearance.

1. Risk for fluid volume deficit.

44. A child is going to receive radiation for Ewing sarcoma. Which of the following is the best nursing intervention to prevent skin breakdown during therapy? 1. Advise the child to wear loose-fi tting clothes to minimize irritation. 2. Advise the child to use emollients to prevent dry skin. 3. Apply cold packs nightly to reduce the warmth caused by the treatments. 4. Apply hydrocortisone to soothe itching from dry skin.

1. Advise the child to wear loose-fitting clothes to minimize irritation.

57. The nurse is teaching the parent of a child diagnosed with systemic lupus erythematosus (SLE). The nurse evaluates the teaching as effective when the parent states: 1. "The cause is unknown." 2. "There is no genetic involvement." 3. "Drugs are not a trigger for the illness." 4. "Antibodies improve disease outcome."

1. "The cause is unknown."

9. Which interventions decrease cardiac demands in an infant with congestive heart failure (CHF)? Select all that apply. 1. Allow parents to hold and rock their child. 2. Feed only when the infant is crying. 3. Keep the child uncovered to promote low body temperature. 4. Make frequent position changes. 5. Feed the child when sucking the fists. 6. Change bed linens only when necessary. 7. Organize nursing activities.

1. Allow parents to hold and rock their child. 4. Make frequent position changes. 5. Feed the child when sucking the fists. 6. Change bed linens only when necessary. 7. Organize nursing activities.

5. Which is the definition of "talipes varus"? 1. An inversion or bending inward of the foot. 2. An eversion or bending outward of the foot. 3. A high arch of the foot. 4. A turning in of the forefoot.

1. An inversion or bending inward of the foot.

29. A 13-year-old just returned from surgery for scoliosis. Which nursing intervention is appropriate in the fi rst 24 hours? Select all that apply. 1. Assess for pain. 2. Logroll to change positions. 3. Get the teen to the bathroom 12 to 24 hours after surgery. 4. Check neurological status. 5. Monitor blood pressure.

1. Assess for pain. 2. Logroll to change positions. 4. Check neurological status. 5. Monitor blood pressure.

17. Which instruction should the nurse give the parents of an adolescent with slipped capital femoral epiphysis (SCFE)? Select all that apply. 1. Continue upper body exercises to limit loss of muscle strength. 2. Do not turn the teen in bed when complaining of pain. 3. Provide homework, computer games, and other activities to decrease boredom. 4. Do most activities of daily living for the teen. 5. Expect expressions of anger and hostility. 6. Continue setting limits on behavior.

1. Continue upper body exercises to limit loss of muscle strength. 3. Provide homework, computer games, and other activities to decrease boredom. 5. Expect expressions of anger and hostility. 6. Continue setting limits on behavior.

14. Which are the most serious complications for a child with Kawasaki disease (KD)? Select all that apply. 1. Coronary thrombosis. 2. Coronary stenosis. 3. Coronary artery aneurysm. 4. Hypocoagulability. 5. Decreased sedimentation rate. 6. Hypoplastic left heart syndrome.

1. Coronary thrombosis. 2. Coronary stenosis. 3. Coronary artery aneurysm.

3. Which can occur in untreated developmental dysplasia of the hip (DDH)? Select all that apply. 1. Duck gait. 2. Pain. 3. Osteoarthritis in adulthood. 4. Osteoporosis in adulthood. 5. Increased flexibility of the hip joint in adulthood

1. Duck gait. 2. Pain. 3. Osteoarthritis in adulthood.

62. A 6-year-old involved in a bicycle crash has a spleen injury and a right tibia/fi bula fracture that has been casted. Which is an early sign of compartment syndrome in this child? Select all that apply. 1. Edema. 2. Numbness. 3. Severe pain. 4. Weak pulse. 5. Anular rash.

1. Edema. 3. Severe pain.

31. A 14-year-old with osteogenesis imperfecta (OI) is confined to a wheelchair. Which nursing interventions will promote normal development? Select all that apply. 1. Encourage participation in groups with teens who have disabilities or chronic illness. 2. Encourage decorating the wheelchair with stickers. 3. Encourage transfer of primary care to an adult provider at age 18 years. 4. Allow the teen to view the radiographs. 5. Help the teen set realistic goals for the future. 6. Discourage discussion of sexuality, because the child is not likely to date.

1. Encourage participation in groups with teens who have disabilities or chronic illness. 2. Encourage decorating the wheelchair with stickers. 4. Allow the teen to view the radiographs. 5. Help the teen set realistic goals for the future.

School-age children with cancer often have a body image disturbance related to hair loss, moon face, or debilitation. Which of the following interventions is (are) most appropriate? Select all that apply. 1. Encourage them to wear a wig similar to their own hairstyle. 2. Emphasize the benefits of the therapy they are receiving. 3. Have them play only with other children with cancer. 4. Use diversional techniques to avoid discussing changes in the body because of the chemotherapy. 5. Help them find a "special friend" who understands what they are experiencing.

1. Encourage them to wear a wig similar to their own hairstyle. 5. Help them find a "special friend" who understands what they are experiencing.

6. The nurse tells the parent that other conditions can be associated with congenital clubfoot. Select all that apply. 1. Myelomeningocele. 2. Cerebral palsy. 3. Diastrophic dwarfism. 4. Breech position in utero. 5. Prematurity. 6. Fetal alcohol spectrum disorder.

1. Myelomeningocele. 2. Cerebral palsy. 3. Diastrophic dwarfism.

25. The nurse caring for a child with osteomyelitis assesses poor appetite. Which intervention is most appropriate for this child? Select all that apply. 1. Offer high-calorie liquids. 2. Offer favorite foods. 3. Do not worry about intake, because appetite loss is expected. 4. Suggest removal of the intravenous line to encourage oral intake. 5. Decrease pain medication that might cause nausea. 6. Offer frequent small meals.

1. Offer high-calorie liquids. 2. Offer favorite foods. 6. Offer frequent small meals.

58. A child is admitted to the pediatric unit with the diagnosis of systemic lupus erythematosus (SLE). On assessment, the nurse expects the child to have which of the following signs and symptoms? Select all that apply. 1. Oral ulcers. 2. Malar rash. 3. Weight gain. 4. Heart failure. 5. Anemia

1. Oral ulcers. 2. Malar rash. 5. Anemia

54. Which physiological changes occur as a result of hypoxemia in congestive heart failure (CHF)? 1. Polycythemia and clubbing. 2. Anemia and barrel chest. 3. Increased white blood cells and low platelets. 4. Elevated erythrocyte sedimentation rate and peripheral edema.

1. Polycythemia and clubbing.

7. When planning a rehabilitative approach for a child with osteogenesis imperfecta (OI), the nurse should prevent which of the following? Select all that apply. 1. Positional contractures and deformities. 2. Bone infection. 3. Muscle weakness. 4. Osteoporosis. 5. Misalignment of lower extremity joints.

1. Positional contractures and deformities. 3. Muscle weakness. 4. Osteoporosis. 5. Misalignment of lower extremity joints.

26. The nurse on the pediatric floor is receiving a child with the possible diagnosis of septic arthritis of the elbow. Which would the nurse expect on assessment? Select all that apply. 1. Resistance to bending the elbow. 2. Nausea and vomiting. 3. Fever. 4. Bruising of the elbow. 5. Swelling of the elbow. 6. A history of nursemaid's elbow as a toddler.

1. Resistance to bending the elbow. 2. Nausea and vomiting. 3. Fever. 5. Swelling of the elbow.

Which of the following is correct regarding prognostic factors for determining survival for a child newly diagnosed with ALL? 1. The initial white blood cell count on diagnosis. 2. The race of the child. 3. The amount of time needed to initiate treatment. 4. Children aged 12 to 15 years.

1. The initial white blood cell count on diagnosis. Children with a normal or low white blood cell count who do not have non-T, non-B acute lymphoblastic leukemia and who are CALLA-positive have a much better prognosis than those with high cell counts or other cell types.

The nurse is caring for a child with sickle cell disease who is scheduled to have an exchange transfusion. What information should the nurse teach the family? 1. The procedure is done to prevent further sickling during a vaso-occlusive crisis. 2. The procedure reduces side effects from blood transfusions. 3. The procedure is a routine treatment for sickle cell crisis. 4. Once the child ' s spleen is removed, it is not necessary to do exchange transfusions.

1. The procedure is done to prevent further sickling during a vaso-occlusive crisis. Exchange transfusion reduces the number of circulating sickle cells and slows down the cycle of hypoxia, thrombosis, and tissue ischemia.

65. A nurse is caring for a 5-year-old who has a fracture of the tibia involving the growth plate. When providing information to the parents, the nurse should indicate that: 1. This is a serious injury that could cause long-term growth issues. 2. The fracture usually heals within 6 weeks without further complications. 3. The child will never be able to play contact sports. 4. Fractures involving the growth plate require pain medication.

1. This is a serious injury that could cause long-term growth issues.

13. Which would the nurse assess in a child diagnosed with osteomyelitis? Select all that apply. 1. Unwillingness to move affected extremity. 2. Severe pain. 3. Fever. 4. Previous closed fracture of an extremity. 5. Redness and swelling at the site.

1. Unwillingness to move affected extremity. 2. Severe pain. 3. Fever. 5. Redness and swelling at the site.

3. Tetralogy of Fallot (TOF) involves which defects? Select all that apply. 1. Ventricular septal defect (VSD). 2. Right ventricular hypertrophy. 3. Left ventricular hypertrophy. 4. Pulmonic stenosis (PS). 5. Pulmonic atresia. 6. Overriding aorta. 7. Patent ductus arteriosu

1. Ventricular septal defect (VSD). 2. Right ventricular hypertrophy. 4. Pulmonic stenosis (PS). 6. Overriding aorta.

The nurse is caring for a child diagnosed with thalassemia major who is receiving the first chelation therapy. What information should the nurse provide to the parent regarding the therapy? Select all that apply. 1. Decreases the risk of bleeding. 2. Eliminates excess iron. 3. Prevents further sickling of the red blood cells. 4. Provides an iron supplement. 5. Hydration is necessary for the process to be effective.

2, 5. 1. There are no bleeding tendencies in thalassemia major (beta-thalassemia or Cooley anemia), and chelation does not affect clotting. 2. Chelation therapy is used to rid the body of excess iron stores that result from frequent blood transfusions. 3. There is no sickling of red blood cells in thalassemia, and chelation therapy has no direct effect on red blood cells. 4. Chelation does not provide an iron supplement. 5. Hydration is necessary for the process to be effective. TEST-TAKING HINT: Focus on the treatment of beta-thalassemia and how chelation therapy works.

14. The parent of a child diagnosed with osteomyelitis asks how the child acquired the illness. Which is the nurse ' s best response? 1. "Direct inoculation of the bone from stepping barefoot on a sharp stick." 2. "An infection from a scratched mosquito bite carried the infection through the bloodstream to the bone." 3. "The blood supply to the bone was disrupted because of the child ' s diabetes." 4. "An infection of the upper respiratory tract."

2. "An infection from a scratched mosquito bite carried the infection through the

The nurse receives a call from a parent of a child with leukemia in remission. The parent says the child has been exposed to chickenpox and has never had it. Which of the following responses is most appropriate for the nurse? Select all that apply. 1. "You need to monitor the child ' s temperature frequently and call back if the temperature is greater than 101°F (38.3°C)." 2. "The child has had two varicella immunizations as an infant but is no longer immune after chemotherapy." 3. "You need to bring the child to the clinic for a varicella immunoglobulin vaccine." 4. "Your child will need to be isolated for the next 2 weeks." 5. "Your child may develop chicken pox lesions about 14 to 21 days after exposure."

2. "The child has had two varicella immunizations as an infant but is no longer immune after chemotherapy." 3. "You need to bring the child to the clinic for a varicella immunoglobulin vaccine."

46. The parents of a 3-month-old ask why their baby will not have an operation to correct a ventricular septal defect (VSD). The nurse's best response is: 1. "It is always helpful to get a second opinion about any serious condition like this." 2. "Your baby's defect is small and will likely close on its own by 1 year of age." 3. "It is common for health-care providers to wait until an infant develops respiratory distress before they do the surgery." 4. "With a small defect like this, they wait until the child is 10 years old to do the surgery."

2. "Your baby's defect is small and will likely close on its own by 1 year of age."

44. Treatment for congestive heart failure (CHF) in an infant began 3 days ago and has included digoxin (Lanoxin) and furosemide (Lasix). The child no longer has retractions, lungs are clear, and HR is 96 beats per minute while the child sleeps. The nurse is confident that the child has diuresed successfully and has good renal perfusion when the nurse notes the child's urine output is: 1. 0.5 cc/kg/hr. 2. 1 cc/kg/hr. 3. 30 cc/hr. 4. 1 oz/hr.

2. 1 cc/kg/hr.

22. BP screenings to detect end-organ damage should be done routinely beginning at what age? 1. Birth. 2. 3 years. 3. 8 years. 4. 13 years.

2. 3 years.

38. A child has a Glasgow Coma Scale of 3, HR of 88 beats per minute and regular, respiratory rate of 22, BP of 78/52, and blood sugar of 35 mg/dL. The nurse asks the caregiver about accidental ingestion of which drug? 1. Calcium channel blocker. 2. Beta blocker. 3. ACE inhibiter. 4. ARB.

2. Beta blocker.

When a child is suspected of having osteomyelitis, the nurse can prepare the family to expect which of the following? Select all that apply. 1. Pain medication is contraindicated so that symptoms are not masked. 2. Blood cultures will be obtained. 3. Pus will be aspirated from the subperiosteum. 4. An intravenous line with antibiotics will be started. 5. Surgery will be necessary.

2. Blood cultures will be obtained. 3. Pus will be aspirated from the subperiosteum. 4. An intravenous line with antibiotics will be started.

Which test provides a definitive diagnosis of aplastic anemia? 1. Complete blood count with differential. 2. Bone marrow aspiration. 3. Serum IgG levels. 4. Basic metabolic panel.

2. Bone marrow aspiration. Definitive diagnosis is determined from bone marrow aspiration, which demonstrates the conversion of red bone marrow to yellow, fatty marrow.

A child has completed treatment for leukemia and comes to the clinic for a checkup with the parents. The parents express to the nurse that they are glad their child has been cured of cancer and is safe from getting cancer later in life. Which of the following should the nurse consider in responding? 1. Childhood cancer usually instills immunity to all other cancers. 2. Children surviving one cancer are at higher risk for a second cancer. 3. The child may have a remission of the leukemia but is immune to all other cancers. 4. As long as the child continues to take steroids, there will be no other cancers.

2. Children surviving one cancer are at higher risk for a second cancer. The most devastating late effect of leukemia treatment is development of secondary malignancy.

50. The school nurse has been following a child who comes to the office frequently for vague complaints of dizziness and headache. Today, she is brought in after fainting in the cafeteria following a nosebleed. Her BP is 122/85, and her radial pulses are bounding. The nurse suspects she has: 1. Transposition of the great vessels. 2. Coarctation of the aorta (COA). 3. Aortic stenosis (AS). 4. Pulmonic stenosis (PS).

2. Coarctation of the aorta (COA).

What are the clinical manifestations of non-Hodgkin lymphoma? 1. Basically the same as those in Hodgkin disease. 2. Depends on the anatomical site and extent of involvement. 3. Nausea, vomiting, abdominal pain. 4. Behavior changes, jaundice, dry mouth.

2. Depends on the anatomical site and extent of involvement. The clinical manifestations include symptoms of involvement. Rarely is a single sign or symptom diagnostic. Metastasis to the bone marrow or central nervous system may produce manifestations of leukemia.

50. It is recommended that a child with metastatic rhabdomyosarcoma undergo a bone marrow transplant. Education regarding life-threatening side effects should include: 1. Diarrhea. 2. Fever. 3. Skin breakdown. 4. Tumor shrinkage.

2. Fever.

43. An 18-month-old with a myelomeningocele is undergoing a cardiac catheterization. The mother expresses concern about the use of dye in the procedure. The child does not have any allergies. In addition to the concern for an iodine allergy, what other allergy should the nurse bring to the attention of the catheterization staff? 1. Soy. 2. Latex. 3. Penicillin. 4. Dairy.

2. Latex.

57. The mother of a toddler reports that the child's father has just had a myocardial infarction (MI). Because of this information, the nurse recommends the child have a(n): 1. Electrocardiogram. 2. Lipid profile. 3. Echocardiogram. 4. Cardiac catheterization.

2. Lipid profile.

24. Which is most important when teaching a parent about preventing osteomyelitis? 1. Parents can stop worrying about bone infection once their child reaches school age. 2. Parents need to clean open wounds thoroughly with soap and water. 3. Children will always get a fever if they have osteomyelitis. 4. Children should wear long pants when playing outside because their legs might get scratched

2. Parents need to clean open wounds thoroughly with soap and water.

30. A 9-year-old is in a spica cast and complains of pain 1 hour after receiving intravenous opioid analgesia. What should the nurse do fi rst? 1. Give more pain medication. 2. Perform a neuromuscular assessment. 3. Call the surgeon for orders. 4. Change the child ' s position.

2. Perform a neuromuscular assessment.

34. Name the harness in the following figure. (its used for hip dysplasia)

Pavlik harness. The Pavlik harness is used to treat DDH diagnosed in the newborn period.

8. Which classification of osteogenesis imperfecta (OI) is lethal in utero and in infancy? 1. Type I. 2. Type II. 3. Type III. 4. Type IV.

2. Type II.

61. Because estrogen is a possible trigger for a systemic lupus erythematosus (SLE) flare, advice for a teenage girl who may become sexually active includes which of the following? Select all that apply. 1. Use Ortho Tri-Cyclen. 2. Use Depo-Provera. 3. Practice abstinence. 4. Use condoms. 5. Use Ortho Evra.

2. Use Depo-Provera. 3. Practice abstinence. 4. Use condoms.

Which of the following is the most effective treatment for pain in a child with sickle cell crisis? Select all that apply. 1. Meperidine (Demerol). 2. Aspirin. 3. Morphine. 4. Behavioral techniques. 5. Acetaminophen (Tylenol) with codeine.

3, 4, 5. 1. Meperidine (Demerol) should not be used because it may potentiate seizures. 2. Aspirin should not be used in children because of the risk for Reye syndrome. 3. Morphine is the drug of choice for a child with sickle cell crises. Usually the child is started on oral doses of acetaminophen (Tylenol) with codeine. When that is not suffi cient to alleviate pain, stronger narcotics are prescribed, such as morphine. Ketorolac (Toradol) may be indicated for short-term use for moderate-severe pain. 4. Behavioral techniques such as positive self-talk, relaxation, distraction, and guided imagery are helpful when pain is occurring. 5. Usually the child is started on oral doses of acetaminophen (Tylenol) with codeine when pain is described as mild to moderate. TEST-TAKING HINT: One needs to consider using narcotics when a child has sickle cell crises, because tissue hypoxia can cause severe pain.

48. Patent ductus arteriosus causes what type of shunt? _____________________

Left to right. Blood fl ows from the higher-pressure aorta to the lower-pressure pulmonary artery, resulting in a left to right shunt.

60. Family discharge teaching has been effective when the parent of a toddler diagnosed with Kawasaki disease (KD) states: 1. "The arthritis in her knees is permanent. She will need knee replacements." 2. "I will give her diphenhydramine (Benadryl) for her peeling palms and soles of her feet." 3. "I know she will be irritable for 2 months after her symptoms started." 4. "I will continue with high doses of Tylenol for her inflammation."

3. "I know she will be irritable for 2 months after her symptoms started."

52. Which statement by the mother of a child with rheumatic fever (RF) shows an understanding of prevention for her other children? 1. "Whenever one of them gets a sore throat, I will give that child an antibiotic." 2. "There is no treatment. It must run its course." 3. "If their culture is positive for group A Streptococcus , I will give them their antibiotic." 4. "If their culture is positive for Staphylococcus A, I will give them their antibiotic."

3. "If their culture is positive for group A Streptococcus , I will give them their antibiotic."

Where is the primary site of origin of the tumor in children who have neuroblastoma? 1. Bone. 2. Kidney. 3. Abdomen. 4. Liver.

3. Abdomen. Neuroblastoma tumors originate from embryonic neural crest cells that normally give rise to the adrenal medulla and the sympathetic nervous system. The majority of the tumors arise from the adrenal gland or from the retroperitoneal sympathetic chain. Therefore, the primary site is within the abdomen.

1. Which would the nurse expect to assess on a 3-week-old infant with developmental dysplasia of the hip (DDH)? Select all that apply. 1. Excessive hip abduction. 2. Femoral lengthening of an affected leg. 3. Asymmetry of gluteal and thigh folds. 4. Pain when lying prone. 5. Positive Ortolani test.

3. Asymmetry of gluteal and thigh folds. 5. Positive Ortolani test.

18. The parent of a 3-week-old states that the infant was re-casted this morning for clubfoot and has been crying for the past hour. Which intervention should the nurse suggest the parent do first? 1. Give pain medication. 2. Reposition the infant in the crib. 3. Check the neurocirculatory status of the foot. 4. Use a cool blow-dryer to blow into the cast to control itching.

3. Check the neurocirculatory status of the foot.

36. When instructing a family about care of an orthosis, the nurse should emphasize which of the following? 1. Clean the brace with diluted bleach. 2. Dry the brace over a heater or in the sun. 3. Clean the brace weekly with mild soap and water. 4. Return the brace to the orthopedic surgeon for cleaning.

3. Clean the brace weekly with mild soap and water.

32. In which congenital heart defect (CHD) would the nurse need to take upper and lower extremity BPs? 1. Transposition of the great vessels. 2. Aortic stenosis (AS). 3. Coarctation of the aorta (COA). 4. Tetralogy of Fallot (TOF).

3. Coarctation of the aorta (COA).

47. The flow of blood through the heart with an atrial septal defect (ASD) is _____________________.

Left to right. The pressures in the left side of the heart are greater, causing the fl ow of blood to be from an area of higher pressure to lower pressure, or left to right, increasing the pulmonary blood fl ow with the extra blood.

12. Which should be included in teaching a family about postsurgical care for slipped capital femoral epiphysis (SCFE)? Select all that apply. 1. The client will receive help with weight-bearing ambulation 24 to 48 hours after surgery. 2. Monitoring of pain medication to prevent drug dependence. 3. Instruction on pin site care. 4. Offering low-calorie meals to encourage weight loss. 5. Correct use of crutches by the client. 6. Exercises to strengthen hip and leg muscles.

3. Instruction on pin site care. 5. Correct use of crutches by the client. 6. Exercises to strengthen hip and leg muscles.

Which of the following should be done to protect the central nervous system from the invasion of malignant cells in a child newly diagnosed with leukemia? 1. Cranial and spinal radiation. 2. Intravenous steroid therapy. 3. Intrathecal chemotherapy. 4. High-dose intravenous chemotherapy.

3. Intrathecal chemotherapy. Giving chemotherapy via lumbar puncture allows the drugs to get to the brain and helps prevent metastasis of the disease.

15. A 10-year-old with osteomyelitis has been on intravenous antibiotics for 48 hours. The child is allergic to amoxicillin. Vital signs are T 101.8°F (38.8°C), BP 100/60, P 96, R 24. Which is the primary reason for surgical treatment? 1. Young age. 2. Drug allergies. 3. Nonresponse to intravenous antibiotics. 4. Health-care provider preference.

3. Nonresponse to intravenous antibiotics.

51. Which medication should the nurse give to an infant diagnosed with transposition of the great vessels? 1. Ibuprofen (Motrin). 2. Betamethasone. 3. Prostaglandin E. 4. Indomethacin (Indocin).

3. Prostaglandin E.

The nurse is caring for a child who is receiving extensive radiation as part of the treatment for Hodgkin disease. Which intervention should be implemented? 1. Administer pain medication prior to the child's going to radiation therapy. 2. Assess the child for neuropathy since this is a common side effect. 3. Provide adequate rest, because the child may experience excessive malaise and lack of energy. 4. Encourage the child to eat a low-protein diet while on radiation therapy.

3. Provide adequate rest, because the child may experience excessive malaise and lack of energy. The most common side effect is extensive malaise, which may be from damage to the thyroid gland, causing hypothyroidism.

27. A 12-year-old diagnosed with scoliosis is to wear a brace for 23 hours a day. What is the most likely reason the child will not wear it for that long? 1. Pain from the brace. 2. Difficulty in putting the brace on. 3. Self-consciousness about appearance. 4. Not understanding what the brace is for.

3. Self-consciousness about appearance.

58. During play, a toddler with a history of tetralogy of Fallot (TOF) might assume which position? 1. Sitting. 2. Supine. 3. Squatting. 4. Standing

3. Squatting.

16. The nurse expects the blood culture report of an 8-year-old with septic arthritis to grow which causative organism? 1. Streptococcus pneumoniae. 2. Escherichia coli. 3. Staphylococcus aureus. 4. Neisseria gonorrhoeae.

3. Staphylococcus aureus.

6. Which statement by a parent of an infant with congestive heart failure (CHF) who is being sent home on digoxin (Lanoxin) indicates the need for further education? 1. "I will give the medication at regular 12-hour intervals." 2. "If he vomits, I will not give a make-up dose." 3. "If I miss a dose, I will not give an extra dose." 4. "I will mix the digoxin in some formula to make it taste better."

4. "I will mix the digoxin in some formula to make it taste better."

11. Which should be obtained to make a diagnosis of slipped capital femoral epiphysis (SCFE)? 1. A history of hip trauma. 2. A physical examination of hip, thigh, and knees. 3. A complete blood count. 4. A radiographic examination of the hip.

4. A radiographic examination of the hip.

Which intervention should be implemented after a bone marrow aspiration? 1. Ask the child to remain in a supine position. 2. Place the child in an upright position for 4 hours. 3. Keep the child nothing by mouth for 6 hours. 4. Administer analgesics as needed for pain.

4. Administer analgesics as needed for pain. Children may experience minor discomfort after the procedure, and analgesics should be given as needed.

37. When teaching parents about osteosarcoma, the nurse knows instruction has been successful when a parent says that this type of cancer is common in which age-group? 1. Infants. 2. Toddlers. 3. School-age children. 4. Adolescents.

4. Adolescents.

8. The nurse is caring for a child who has undergone a cardiac catheterization. During recovery, the nurse notices the dressing is saturated with bright red blood. The nurse's first action is to: 1. Call the interventional cardiologist. 2. Notify the cardiac catheterization laboratory that the child will be returning. 3. Apply a bulky pressure dressing over the present dressing. 4. Apply direct pressure 1 inch above the puncture site.

4. Apply direct pressure 1 inch above the puncture site.

60. Which is an important nursing intervention to monitor in a child with systemic lupus erythematosus (SLE) and renal involvement? 1. Monitor weight. 2. Check for uric salts in urine. 3. Watch for hypotension. 4. Check for protein in urine.

4. Check for protein in urine.

Which should the nurse stress to the parents of an infant in a Pavlik harness for treatment of developmental dysplasia of the hip (DDH)? 1. Put socks on over the foot pieces of the harness to help stabilize the harness. 2. Use lotions or powder on the skin to prevent rubbing of straps. 3. Remove harness during diaper changes for ease of cleaning diaper area. 4. Check under the straps at least two to three times daily for red areas.

4. Check under the straps at least two to three times daily for red areas.

52. The nurse is teaching the parent of a child newly diagnosed with juvenile idiopathic arthritis (JIA). The nurse would evaluate the teaching as successful when the parent is able to say that the disorder is caused by the: 1. Breakdown of osteoclasts in the joint space causing bone loss. 2. Loss of cartilage in the joints. 3. Buildup of calcium crystals in joint spaces. 4. Immune-stimulated inflammatory response in the joint.

4. Immune-stimulated inflammatory response in the joint.

64. Which is the nurse's best explanation to the parent of a toddler who asks what a greenstick fracture is? 1. It is a fracture located in the growth plate of the bone. 2. Because children's bones are not fully developed, any fracture in a young child is called a greenstick fracture. 3. It is a fracture in which a complete break occurs in the bone, and small pieces of bone are broken off. 4. It is a fracture that does not go all the way through the bone.

4. It is a fracture that does not go all the way through the bone.

56. Which vaccines must be delayed for 11 months after the administration of gamma globulin? Select all that apply. 1. Diphtheria, tetanus, and pertussis. 2. Hepatitis B. 3. Inactivated polio virus. 4. Measles, mumps, and rubella. 5. Varicella.

4. Measles, mumps, and rubella. 5. Varicella.

35. Which condition is the harness used for in the following figure? (Pavlik harness)

It is used for DDH. The Pavlik harness is used to treat DDH in neonates.

45. A 3-month-old has been diagnosed with a ventricular septal defect (VSD). The flow of blood through the heart is _____________________.

Left to right. The pressures in the left side of the heart are greater, causing the fl ow of blood to be from an area of higher pressure to lower pressure, or left to right, increasing the pulmonary blood fl ow with the extra blood.

The nurse is caring for a child with a diagnosis of ALL who is receiving chemotherapy. The nurse notes that the child ' s platelet count is 20,000/mm 3 . Based on this laboratory finding, what information should the nurse provide to the child and parents? 1. A soft toothbrush should be used for mouth care. 2. Isolation precautions should be started immediately. 3. The child ' s vital signs, including blood pressure, should be monitored every 4 hours. 4. All visitors should be discouraged from coming to see the family.

1. A soft toothbrush should be used for mouth care. Because the platelet count is decreased, there is a significant risk of bleeding, especially in soft tissue. The use of the soft toothbrush should help prevent bleeding of the gums.

When caring for a child with lymphoma, the nurse needs to be aware of which of the following? 1. The same staging system is used for lymphoma and Hodgkin disease. 2. Aggressive chemotherapy with central nervous system prophylaxis will give the child a good prognosis. 3. All children with lymphoma need a bone marrow transplant for a good prognosis. 4. Despite high-dose chemotherapy, the prognosis is very poor for most children.

2. Aggressive chemotherapy with central nervous system prophylaxis will give the The use of aggressive combination chemotherapy has a major impact on the survival rates for children with a diagnosis of lymphoma. Because there is usually bone marrow involvement, there is a need for central nervous system prophylaxis.

Which of the following should the nurse expect to administer to a child with ITP and a platelet count of 5000/mm 3 ? Select all that apply. 1. Platelets. 2. Intravenous immunoglobulin. 3. Packed red blood cells (PRBCs). 4. White blood cells. 5. Prednisolone.

2. Intravenous immunoglobulin. 5. Prednisolone. 1. In ITP, destruction of platelets is caused from what is believed to be an immune response, so giving additional platelets would only result in new platelets being destroyed. 2. Intravenous immunoglobulin is given because the cause of platelet destruction is believed to be an autoimmune response to disease-related antigens. Treatment is usually supportive. Activity is restricted at the onset because of the low platelet count and risk for injury that could cause bleeding. 3. Red blood cells are not an effective treatment for ITP. 4. Because this is a platelet deficiency, white blood cells are not an effective treatment for ITP. White blood cell infusion is rarely done with any disease process. 5. Treatment in the acute phase is often symptomatic, and prednisolone, IVIG, and anti-D antibody are often given. This tends to shorten the course because the disease tends to resolve over time. Focus on the cause of ITP and which cells are affected.

13. While assessing a newborn with respiratory distress, the nurse auscultates a machine-like heart murmur. Other fi ndings are a wide pulse pressure, periods of apnea, increased Pa CO 2 , and decreased P O 2 . The nurse suspects that the newborn has: 1. Pulmonary hypertension. 2. Patent ductus arteriosus (PDA). 3. Ventricular septal defect (VSD). 4. Bronchopulmonary dysplasia.

2. Patent ductus arteriosus (PDA).

27. While looking through the chart of an infant with a congenital heart defect (CHD) of decreased pulmonary blood fl ow, the nurse would expect which laboratory finding? 1. Decreased platelet count. 2. Polycythemia. 3. Decreased ferritin level. 4. Shift to the left.

2. Polycythemia.

18. During a well-child checkup for an infant with tetralogy of Fallot (TOF), the child develops severe respiratory distress and becomes cyanotic. The nurse's first action should be to: 1. Lay the child fl at to promote hemostasis. 2. Lay the child fl at with legs elevated to increase blood fl ow to the heart. 3. Sit the child on the parent ' s lap, with legs dangling, to promote venous pooling. 4. Hold the child in knee-chest position to decrease venous blood return.

4. Hold the child in knee-chest position to decrease venous blood return.

34. Which statement by the mother of a child with rheumatic fever (RF) shows she has good understanding of the care of her child? Select all that apply. 1. "I will apply heat to his swollen joints to promote circulation." 2. "I will have him do gentle stretching exercises to prevent contractures." 3. "I will give him his ordered anti-inflammatory medication for pain and inflammation." 4. "I will apply cold packs to his swollen joints to reduce pain." 5. "I will take my child every month to the health-care provider's office for his penicillin shot."

3. "I will give him his ordered anti-inflammatory medication for pain and inflammation." 5. "I will take my child every month to the health-care provider's office for his penicillin shot."

A 5-year-old is admitted to the hospital with complaints of leg pain and fever. On physical examination, the child is pale and has bruising over various areas of the body. The health-care provider suspects that the child has ALL. The nurse informs the parent that the diagnosis will be confirmed by which of the following? 1. Lumbar puncture. 2. White blood cell count. 3. Bone marrow aspirate. 4. Bone scan.

3. Bone marrow aspirate. The diagnostic test that confirms leukemia is microscopic examination of the bone marrow aspirate

17. Congenital heart defects (CHDs) are classified by which of the following? Select all that apply. 1. Cyanotic defect. 2. Acyanotic defect. 3. Defects with increased pulmonary blood fl ow. 4. Defects with decreased pulmonary blood fl ow. 5. Mixed defects. 6. Obstructive defects. 7. Pansystolic murmurs.

3. Defects with increased pulmonary blood fl ow. 4. Defects with decreased pulmonary blood fl ow. 5. Mixed defects. 6. Obstructive defects.

31. Which plan would be appropriate in helping to control congestive heart failure (CHF) in an infant? 1. Promoting fluid restriction. 2. Feeding a low-salt formula. 3. Feeding in semi-Fowler position. 4. Encouraging breast milk.

3. Feeding in semi-Fowler position.

The most important reason health-care providers prescribe a combination of antiretroviral drugs to children with HIV is to delay: 1. Progression to AIDS. 2. Enable treatment of multiple symptoms. 3. Recurrence of symptoms. 4. Drug resistance.

4. Drug resistance. A combination of antiretroviral medications is prescribed for a child who is HIV positive to delay development of drug resistance. HIV drugs work on different stages of the HIV life cycle to prevent reproduction of new virus particles.

The nurse expects which of the following clinical manifestations in a child diagnosed with SCID? 1. Prolonged bleeding. 2. Failure to thrive. 3. Fatigue and malaise. 4. Susceptibility to infection.

4. Susceptibility to infection. SCID is characterized by an absence of cell-mediated immunity, with the most common clinical manifestation being infection in children from age 3 months. These children do not usually recover from these infections.

Which of the following laboratory tests will be ordered to determine the presence of the human immunodeficiency virus antigen in an infant whose mother is HIV + ? 1. CD4 cell count. 2. Western blot. 3. IgG levels. 4. p24 antigen assay.

4. p24 antigen assay. Detection of HIV in infants is confirmed by a p24 antigen assay, viral culture of HIV, or polymerase chain reaction.

A nurse is caring for a 15-year-old who has just been diagnosed with non-Hodgkin lymphoma. Which of the following should the nurse include in teaching the parents about this lymphoma? Select all that apply. 1. The malignancy originates in the lymphoid system. 2. The presence of Reed-Sternberg cells in the biopsy is considered diagnostic. 3. Mediastinal involvement is typical. 4. The disease is diffuse rather than nodular. 5. Treatment includes chemotherapy and radiation.

1, 3, 4, 5. 1. Non-Hodgkin disease originates in the lymphoid system. 2. Reed-Sternberg cells are diagnostic for Hodgkin disease and are not seen in non- Hodgkin lymphoma. Reed-Sternberg cells arise from "B" cells and are large, multinucleated cells. 3. Mediastinal involvement is typical. 4. The disease is diffuse rather than nodular. 5. Treatment includes chemotherapy and radiation. TEST-TAKING HINT: The lymphomas are divided into Hodgkin disease (which primarily involves the lymph nodes with metastasis to extra lymphatic sites) and non-Hodgkin lymphoma (a heterogenous condition that has a variety of morphological, cytochemical, and immunological cell features).

A nurse instructs the parent of a child with sickle cell disease about factors that might precipitate a pain crisis in the child. Which of the following factors identifi ed by the parent as being able to cause a pain crisis indicates a need for further instruction? 1. Infection. 2. Overhydration. 3. Stress at school. 4. Cold environment.

2. Overhydration. Overhydration does not cause a crisis.

The nurse is caring for a 10-year-old with leukemia who is receiving chemotherapy. The child is on neutropenic precautions. Friends of the child come to the desk and ask for a vase for the flowers they have brought with them. Which of the following is the best response? 1. "I will get you a special vase that we use on this unit." 2. "The flowers from your garden are beautiful but should not be placed in the room at this time." 3. "As soon as I can wash a vase, I will put the flowers in it and bring it to the room." 4. "Get rid of the flowers immediately. You could harm the child."

2. "The flowers from your garden are beautiful but should not be placed in the room at this time." A neutropenic client should not have flowers in the room because the flowers may harbor Aspergillus or Pseudomonas aeruginosa. Neutropenic children are susceptible to infection. Precautions need to be taken so that the child does not come in contact with any potential sources of infection. Fresh fruits and vegetables can also harbor molds and should be avoided. Telling the friend that the flowers are beautiful but that the child cannot have them is a tactful way not to offend the friend.

An 18-month-old male is brought to the clinic by his mother. His height is in the 50th percentile, and his weight is in the 80th percentile. The child is pale. The physical examination is normal, but his hematocrit level is 20%. Which of the following questions should assist the nurse in making a diagnosis? Select all that apply. 1. "How many bowel movements a day does your child have?" 2. "How much did your baby weigh at birth?" 3. "What does your child eat every day?" 4. "Has the child been given any new medications?" 5. "How much milk does your child drink per day?"

3, 5. 1. Because the child has a low hematocrit level, the child most likely has anemia. Iron-defi ciency anemia is the most common nutritional anemia. The number of bowel movements the child has is important information but not necessary to make the diagnosis of iron-defi ciency anemia. 2. Knowing birth weight can help determine whether the child is following his or her own curve on the growth chart. 3. A diet history is necessary to determine the nutritional status of the child and whether the child is getting suffi cient sources of iron. 4. Knowing if the child is taking any new medication is not necessary to make the diagnosis of iron-defi ciency anemia. 5. By asking how much milk the child consumes, the nurse can determine whether the child is fi lling up on milk and then not wanting to take food. TEST-TAKING HINT: The most common anemia in children and in toddlers is irondefi ciency anemia, frequently the result of drinking too much milk and not eating enough iron-rich foods.

The nurse is discharging a child who has just received chemotherapy for neuroblastoma. Which of the following statements made by the child's parent indicates a need for additional teaching? 1. "I will inspect the skin often for any lesions." 2. "I will do mouth care daily and monitor for any mouth sores." 3. "I will wash my hands before caring for my child." 4. "I will take a rectal temperature daily and report a temperature greater than 101°F (38.3°C) immediately to the health-care provider."

4. "I will take a rectal temperature daily and report a temperature greater than 101°F (38.3°C) immediately to the health-care provider." Monitoring the child ' s temperature and reporting it to the physician are important, but the temperature should not be taken rectally. The risk of injury to the mucous membranes is high. Rectal abscesses can occur in the damaged rectal tissue. The best method for taking the temperature is axillary, especially if the child has mouth sores.

21. A toddler who has been hospitalized for vomiting because of gastroenteritis is sleeping and difficult to wake up. Assessment reveals vital signs of a regular HR of 220 beats per minute, respiratory rate of 30 per minute, BP of 84/52, and capillary refill of 3 seconds. Which dysrhythmia does the nurse suspect in this child? 1. Rapid pulmonary flutter. 2. Sinus bradycardia. 3. Rapid atrial fibrillation. 4. Supraventricular tachycardia.

4. Supraventricular tachycardia.

A newborn is diagnosed with a congenital heart defect (CHD). The test results reveal that the lumen of the duct between the aorta and pulmonary artery remains open. This defect is known as _____________________.

Patent ductus arteriosus (PDA). This is a defect with increased pulmonary fl ow. It should close in the first few weeks of life.