Pediatrics RN Unit III

Amoxicillin

First-line choice antibiotic for the treatment of acute otitis media.

Isoniazid

First-line drug for pulmonary tuberculosis infection.

Ascites

Fluid accumulation in the abdominal cavity.

Extracellular fluid

Fluid compartment that constitutes over half of the total body water at birth.

Intracellular fluid

Fluid compartment, 40% of which is lost when a child is dehydrated.

Tachycardia

Faster than normal heart rate.

Another word for Epistaxis is?

Nosebleed.

Allergens

Proteins that are capable of inducing IgE antibody formation.

The primary manifestation of acute renal failure is: a. edema. b. oliguria. c. metabolic acidosis. d. weight gain and proteinuria.

b. oliguria

List 3 essential guidelines for the effective administration of oral iron supplements to small children.

Administer between meals administer with a fruit juice administer through a straw or with a medication syringe

Describe major principles of emergency treatment for accidental poisoning in a child brought to the emergency department.

Assessment support respiratory system other supportive measures gastric decontamination with assessment monitoring and supportive measures family support prevention of recurrence

Describe the 3 phases of parenteral rehydration therapy for the child diagnosed with moderate dehydration.

Phase 1— expand ECF volume quickly and improve circulatory and renal function; an isotonic solution is used at a rate of 20 mL/kg, given as an IV bolus over 20 minutes and repeated as necessary after assessment of the child's response to therapy. Phase 2— replace deficits, meet maintenance water and electrolyte requirements, and catch up with ongoing losses. Water and sodium requirements for the deficit, maintenance, and ongoing losses are calculated at 8-hour intervals, taking into consideration the amount of fluids given with the initial boluses and the amount administered during the first 24-hour period. With improved circulation during this phase, water and electrolyte deficits can be evaluated, and acid-base status can be corrected either directly through the administration of fluids or indirectly through improved renal function. Potassium is withheld until kidney function is restored and assessed and circulation has improved. Phase 3— begin oral fluids slowly and advance as tolerated to full feedings (see below). The BRATT diet is no longer recommended.

List 8 assessment findings that may be used to determine dehydration in a child.

Skin turgor capillary refill body weight level of consciousness activity level respiratory pattern status of oral mucosa (dry) thirst (in older child) urine output in last 24 hours

Inhaled corticosteroid

Considered the cornerstone in the pharmacologic management of asthma.

Airway clearance therapies

Considered to be the cornerstone treatment for children and adolescents with cystic fibrosis.

List the four cardinal signs of impending respiratory failure.

1. Restlessness 2. Tachypnea 3. Tachycardia 4. Diaphoresis

Encopresis

Constipation with fecal soiling.

Cardiomyopathy

Refers to abnormalities of the myocardium in which the cardiac muscles' ability to contract is impaired; relatively rare in children.

Hypoxemia

Refers to an arterial oxygen tension (or pressure) that is less than normal and can be identified by a decreased arterial saturation or a decreased PaO2.

Cyanosis

A blue discoloration in the mucous membranes, skin, and nail beds of the child with reduced oxygen saturation; results from the presence of deoxygenated hemoglobin (hemoglobin not bound to oxygen); determined subjectively

Anemia is?

A condition in which the number of red blood cells and/or hemoglobin concentration is reduced below normal; oxygen-carrying capacity of the blood is diminished; less oxygen is available to the tissues.

Hyperlipidemia

A general term for excessive lipids (fat) and fatlike substances; believed to play an important role in atherosclerosis development.

Salmeterol

A long-acting ß2-agonist (bronchodilator) that is used twice a day (no more frequently than every 12 hours).

Peak expiratory flow rate (PEFR)

A measurement of the maximum flow of air that can be forcefully exhaled in 1 second; a key measurement of pulmonary function.

Omalizumab (Xolair)

A monoclonal antibody that blocks the binding of IgE to mast cells; inhibits the inflammation that is associated with asthma and it is used in patients with moderate to persistent asthma who have confirmed perennial aeroallergen sensitivity.

Magnesium sulphate

A potent muscle relaxant that acts to decrease inflammation and improves pulmonary function and peak flow rate among pediatric patients with severe asthma.

Hypoalbuminemia

A reduction in the serum albumin level.

Hypoxia

A reduction in tissue oxygenation that results from low oxygen saturation and PaO2 and results in impaired cellular processes.

Acute epiglottitis

A serious obstructive inflammatory process in the upper airway that occurs most often in children 2 to 8 years of age.

Clubbing

A thickening and flattening of the tips of the fingers and toes; thought to be a result of chronic tissue hypoxemia and polycythemia.

Exacerbation

A worsening of symptoms, either abrupt or progressive.

Hypercholesterolemia

Refers to excessive cholesterol in the blood; believed to play an important role in atherosclerosis development.

Recent concerns regarding the incidence of hypertension in children and adolescents has lead to the recommendation that children older than _A_ years receive _B_ BP screening.

A. 3 B. yearly

Gastric decontamination is aimed at removing ingested toxic products by _A_ , _B_, or _C_ .

A. Absorbing the toxin with activated charcoal B. performing gastric lavage [or] C. increasing bowel motility to expel the toxins

_A_ dehydration occurs when electrolyte and water deficits are present in balanced proportion.

A. Isotonic

_A_ is often a significant problem in children with biliary atresia that is addressed by drug therapy or comfort measures such as baths in colloidal oatmeal compounds.

A. Pruritus

The single most effective strategy to prevent and control hepatitis is _A_ .

A. hand-washing

Methods of dialysis for management of renal failure are A, B, and C.

A. hemodialysis, B. peritoneal dialysis, and C. hemofltration

_A_ dehydration results from water loss in excess of electrolyte loss. This is often caused by a large _B_ of water and/ or a large _C_ of electrolytes. Plasma sodium concentration is _D_ than 150 mEq/L.

A. hypertonic B. loss C. intake D. greater

_A_ dehydration occurs when the electrolyte deficit exceeds the water deficit. There is a greater loss of extracellular fluid, and plasma sodium concentration is usually _B_ than 130 mEq/L.

A. hypotonic B. less

_A_ is the most important cause of serious gastroenteritis among children 3 to 24 months of age and a significant nosocomial (hospital-acquired) pathogen.

A. rotavirus

Tachydysrhythmias

Abnormally fast heart rate.

Bradydysrhythmias

Abnormally slow heart rate.

Edema

Accumulation of body fluid in the interstitial spaces and body cavities.

Azotemia

Accumulation of nitrogenous waste in the blood, resulting in elevated blood urea nitrogen and creatinine levels.

Dornase Alpha (Pulmozyme)

Acts to decrease the viscosity of mucus to improve airway clearance.

Describe the assessment parameters to use with a 3-year-old child complaining of constipation.

Assessment should include accurate history of bowel habits; diet and events that may be associated with the onset of constipation; drugs or other substances that the child may be taking; and consistency, color, frequency, and other characteristics of the stool.

Polycythemia

An increased number of red blood cells; increases the oxygen carrying capacity of the blood.

Bacterial tracheitis

An infection of the mucosa of the upper trachea with features of both croup and epiglottis.

Describe the best way to manage pain during a sickle cell crisis that will help avoid clock watching and under-medicating.

Analyze the drug and dosage and administer medication on a regular schedule. Suggest changes to prevent rather than treat pain after it occurs.

Ceftriaxone

Antibiotic of choice in otitis media when causative organism is a highly resistant pneumococcus.

Ipratropium

Anticholinergic that acts as a bronchodilator to relieve asthma symptoms.

Identify the emergency measures (with rationales) that are used when a child with hemophilia starts to bleed.

Apply pressure to area of bleeding for 10 to 15 minutes to allow for clot formation. Immobilize and elevate area above the level of the heart to decrease blood flow. Apply cold to promote vasoconstriction.

Sickle cell anemia occurs in?

People who are homozygous with predominantly HbS (sickle hemoglobin).

________ dialysis is usually recommended for small children.

Peritoneal

Meconium

Stool normally passed within 24 to 36 hours after birth. (Newborns with irregularities in the passing of this stool should be evaluated further for possible congenital anomalies.)

Hypertension

The consistent elevation of blood pressure beyond values considered to be the upper limits of normal.

Meconium ileus

The earliest manifestation of cystic fibrosis where the small intestine is blocked with thick, puttylike, tenacious, mucilaginous meconium in the newborn.

Uncompensated shock

Cardiovascular efficiency diminished; microcirculatory perfusion marginal despite compensatory adjustments; tissue hypoxia, metabolic acidosis, and impairment of organ systems function.

Apnea

Cessation of breathing for more than 20 seconds or for a shorter period of time when associated with hypoxemia or bradycardia.

Unit III includes:

Chapter 40: Respiratory Dysfunction Chapter 41: Gastrointestinal Dysfunction Chapter 42: Cardiovascular Dysfunction Chapter 43: Hematologic & Immunologic Dysfunction Chapter 44: Genitourinary Function

Obstipation

Characterized by extremely long intervals between defecation.

Croup

Characterized by hoarseness and a "barking" cough.

Describe the parameters that the nurse should assess to recognize status asthmaticus.

Child sweats profusely, remains sitting upright, and refuses to lie down. A child who suddenly becomes agitated or suddenly becomes quiet may be seriously hypoxic.

Hepatitis D?

Children with chronic hepatitis B should be tested for this type of hepatitis.

List the components of the maternal or child's history that could indicate a high risk for congenital heart disease.

Components of a child's history that could indicate a high risk for congenital heart disease include the following: maternal rubella poor nutrition maternal type 1 diabetes maternal age over 40 years maternal alcoholism a sibling or parent with a congenital heart defect a chromosomal abnormality, especially Down syndrome or other non-cardiac congenital anomalies

Irreversible shock

Condition in which actual damage to vital organs occurs and disruption/death occurs even if homeostasis returns to normal with therapy.

Hyperalbuminuria

Condition in which albumin is lost into the urine because of increased glomerular permeability.

At birth the healthy full-term newborn has maternal stores of iron sufficient to last: a. 5 to 6 months. b. 2 to 3 months. c. 8 months. d. less than l month.

a. 5 to 6 months

Vagal maneuvers

The first treatment strategy to try for supraventricular tachycardia (SVT); performed by applying ice to the face, massaging one carotid artery, or having the child exhale against a closed glottis.

Hepatitis A ?

The highest incidence of this type of hepatitis occurs in preschool and school-age children.

Tetralogy of Fallot

Defects with decreased pulmonary blood flow

Tricuspid atresia

Defects with decreased pulmonary blood flow

Atrial septal defect

Defects with increased pulmonary blood flow

Atrioventricular canal defect

Defects with increased pulmonary blood flow

Patent ductus arteriosus

Defects with increased pulmonary blood flow

Ventricular septal defect

Defects with increased pulmonary blood flow

Vegetarianism

Dietary patterns that exclude meat.

Explain why a child with congestive heart failure should be placed on a regimen of oral digitalis and diuretics.

Digitalis improves cardiac functioning by : increasing cardiac output decreasing heart size decreasing venous pressure decreasing edema. Diuretics remove accumulated fluid and sodium, thereby decreasing the work of the heart.

Hydronephrosis

Dilation of the renal pelvis from distention caused by a backup of urine above an obstruction.

Acquired cardiac disorders

Disease processes or abnormalities that occur after birth and can be seen in the normal heart or in the presence of congenital heart defects; resulting from factors such as infection, autoimmune responses, environmental factors, and familial tendencies.

Macrominerals

Elements with daily requirements greater than 100 mg (e.g., calcium, phosphorus, magnesium, sodium, potassium, chloride, and sulfur).

Passive smoking

Exposure to environmental tobacco smoke; a well-established danger to children.

Urosepsis

Febrile urinary tract infection coexisting with systemic signs of bacterial illness; blood culture reveals presence of urinary pathogen.

True or False? Lead-containing pottery or dishes usually do not contribute to lead poisoning.

FALSE

________ is the preferred method of dialysis for children with life-threatening hyperkalemia that needs to be rapidly corrected.

Hemodialysis

Sickle cell trait is found in ?

Heterozygous people who have hemoglobin containing HbA as well as abnormal HbS (sickle hemoglobin).

Pertussis

Highly contagious respiratory disease in non-vaccinated children; young infants demonstrate a characteristic expiratory whoop but older children may only have a cough.

Hepatitis B ?

Immunity by hepatitis B vaccine is available.

Respiratory insufficiency

In general, applies to two conditions: increased work of breathing with near normal gas exchange function or the inability to maintain normal blood gas tensions that develops from carbon dioxide retention with subsequent hypoxemia and acidosis.

Respiratory failure

Inability of the respiratory apparatus to maintain adequate oxygenation of the blood, with or without carbon dioxide retention.

Congenital heart disease

Includes primarily anatomic abnormalities present at birth that result in abnormal cardiac function, the consequences of which are hypoxemia and heart failure.

Sensitization

Induction of IgE antibody formation—initial exposure resulting in an immune response and subsequent exposure inducing a much stronger response.

Describe the nursing interventions to provide proper nutrition for the child who has minimal-change nephrotic syndrome.

Interventions should include the following: offer a nutritious diet limit salt during edematous phase enlist the aid of the child and parents in formulation of a diet provide a cheerful, relaxed environment during meals; provide special and preferred foods serve food in an attractive manner serve small quantities

Sweat chloride test

Involves stimulating the production of sweat with a special device (stimulation with 3-mA electric current), collecting the sweat on filter paper, and measuring the sweat electrolytes; used in the diagnosis of cystic fibrosis.

Cystitis

Inflammation of the bladder.

Pyelonephritis

Inflammation of the upper urinary tract and kidneys.

Urethritis

Inflammation of the urethra.

Allergen

Irritants such as house dust mites, whose prevention (or reduced exposure to) is the goal of non-pharmacologic therapy for asthma.

Singulair

Leukotriene modifier used for long-term management of asthma.

Hypoplastic left heart syndrome

Mixed defects

Transposition of the great vessels

Mixed defects

Truncus arteriosus

Mixed defects

Hepatitis E?

Non-A, non-B hepatitis with transmission through the fecal-oral route or with contaminated water.

Describe the nursing interventions to promote optimum home care for a 15-year-old who will receive home peritoneal dialysis.

Nursing interventions should include the following: assess home situation teach the family home care help the family acquire needed drugs and equipment assist the family in problem solving and diet planning prepare the child and family for home peritoneal dialysis and/or kidney transplantation maintain periodic contact with the family refer the family to special agencies and support groups.

Direct observation therapy (DOT)

Observation of medication being taken by trained observer; often used with tuberculosis medications to shorten therapy and improve effectiveness.

Aortic stenosis

Obstructive defects

Coarctation of the aorta

Obstructive defects

Pulmonic stenosis

Obstructive defects

Subvalvular aortic stenosis

Obstructive defects

Valvular aortic stenosis

Obstructive defects

Bacteriuria

Presence of bacteria in the urine.

Cardiac catheterization

Procedure in which a radiopaque catheter is inserted through a peripheral blood vessel into the heart; contrast material injected; films taken of the dilution and circulation of the contrast material; used for diagnosis, treatment of valves/vessels, and electrophysiology studies.

Hemodialysis

Procedure in which colloids and crystalline substance are separated by circulating the blood outside the body through artificial membranes, which permits a similar passage of water and solutes.

Peritoneal dialysis

Procedure in which colloids and crystalline substances are separated by using the abdominal cavity as a semipermeable membrane through which water and solute of small molecular size move by osmosis and diffusion based on concentrations on either side of the membrane.

Hemofltration

Procedure of separating colloids and crystalline substances by circulating a blood filtrate outside the body and exerting hydrostatic pressure across a semipermeable membrane with simultaneous infusion of a replacement solution.

Explain why a child with glomerulonephritis is placed on a low-protein diet while in acute renal failure.

Protein is restricted in children with acute renal failure to prevent the accumulation of nitrogenous wastes.

Describe the interventions (with rationales) that the nurse should use to maintain skin integrity in a child with a diagnosis of leukemia.

Provide meticulous skin care, especially in the mouth and perianal regions, because they are prone to ulceration. Change position frequently to stimulate circulation and relieve pressure. Encourage adequate calorie/protein intake to prevent negative nitrogen balance.

Explain how the nurse might help provide diversional activities for a school-age child admitted for acute glomerulonephritis.

Response should include the following: encourage the parents to room in with the child spend time with the child provide opportunities for the child to socialize with other children who have no infection provide age-appropriate play activity in the room or in a playroom

Identify the clinical manifestations that could indicate the presence of a congenital heart defect in an infant or young child.

Responses should include the following clinical manifestations: growth delay feeding difficulty dyspnea weak cry cyanosis dry, hot skin.

Describe how to help families decrease their fear and anxiety and increase their coping behaviors when facing their child's surgery to correct a congenital heart defect.

Responses should include the following: encourage parents to express their fears and concerns regarding the child's cardiac defects and physical symptoms encourage family to participate in child's care; encourage family to include others in child's care to prevent exhaustion assist family in determining appropriate physical activity

Hypovolemia

Shift of fluid from the plasma to the interstitial spaces, resulting in a reduction in the vascular fluid volume.

Bradycardia

Slower than normal heart rate.

True or False? Asymptomatic young children may have lead levels sufficiently elevated to cause neurologic and intellectual damage.

TRUE

True or False? Lead-based paint from older-built houses remains the most frequent source of lead poisoning in children.

TRUE

Tripod position

The child insists on sitting upright and leaning forward with the chin thrust out, mouth open, and tongue protruding.

Describe the instructions the nurse should give to a mother of a child with tuberculosis infection about returning to school.

The child may return to school. There is no need for isolation because the disease is almost always non-infectious in children. Child should refrain from vigorous activity/sports and be protected from stress during the active stage of primary tuberculosis.

Congestive heart failure

The inability of the heart to pump an adequate amount of blood to meet the metabolic demands of the body; not a disease; in children, most common in infants; usually secondary to increases in blood volume and pressure from anomalies; result of an excessive workload imposed on normal myocardium.

Constipation

The infrequent passage of firm or hard stools or of small, hard masses with associated symptoms such as difficulty in expulsion, blood streaked bowel movements, and abdominal discomfort; frequency not diagnostic.

Hepatitis C ?

The major route of infection in children is mother-to-infant transmission

Hyperkalemia

The most immediate threat to the life of a child with acute renal failure; excess potassium in the blood; treated with an ion-exchange resin such as Kayexalate and dialysis.

List the most significant complications following a cardiac catheterization in an infant or young child.

The most significant complications include: stroke seizures tamponade death. The patient may also suffer loss of circulation to the affected extremity dysrhythmias, hemorrhage cardiac perforation, hematoma hypovolemia dehydration hypoglycemia in infants changes in the temperature and color of the affected extremity

Hemostasis is?

The process that stops bleeding when a blood system vessel is injured. Hemarthrosis is? ! Bleeding into the joints.

Uremia

The retention of nitrogenous products that produces toxic symptoms; a serious condition that often involves body systems other than the renal system.

Microminerals

Trace elements with a daily requirement of less than 100 mg; exact role in nutrition unclear.

Differentiate between ulcerative colitis and Crohn disease in regard to pathology, rectal bleeding, diarrhea, pain, anorexia, weight loss, and growth restriction.

Ulcerative colitis (UC) is a chronic inflammatory reaction involving the mucosa and submucosa of the large intestine. Mucosa becomes hyperemic and edematous with patchy granulation that bleeds easily and leads to superficial ulceration. Crohn disease (CD) affects the terminal ileum and involves all layers of the bowel wall. Edema and inflammation progress to deep ulceration with fissure and obstruction. Rectal bleeding: common in UC; uncommon in CD Diarrhea: often severe in UC; moderate to absent in CD Pain: less frequent in UC; common in CD Anorexia: mild to moderate in UC; can be severe in CD Weight loss: moderate in UC; severe in CD Growth restriction: usually mild in UC; often pronounced in CD

Oral rehydration solution

Used to successfully treat infants with isotonic, hypotonic, and hypertonic dehydration; the first line of treatment for diarrhea and dehydration.

Compensated shock

Vital organ function is maintained by intrinsic compensatory mechanism; blood flow is usually normal or increased, but generally uneven or mal-distributed in the microcirculation.

Hypertonic saline

When nebulized it has been shown to be effective in improving airway hydration & increasing mucus clearance in patients with CF.

Explain the rationale and methodology for oral rehydration management in a child with mild dehydration.

When the child is alert, awake, and not in danger, correction of dehydration may be attempted with oral fluid administration. Mild cases of dehydration can be managed at home or in the ED or urgent care by this method. Oral rehydration management consists of replacement of fluid loss over 4 to 6 hours, replacement of continuing losses, and provision for maintenance fluid requirements. Clear fluids are preferred initially; breastfeeding may be resumed, and the child tolerating clear fluids can be advanced to solid foods after tolerance is demonstrated. Avoid fatty foods like French fries and pizza during this phase. In general, a mildly dehydrated child may be given 50 mL/kg of oral rehydration solution (ORS), and a child with moderate dehydration may be given 100 mL/kg of ORS.

Reduction of accidental poisonings in children and infants can be accomplished by: a. use of child-resistant containers. b. educating parents and grandparents to place products out of reach of small children. c. educating parents to place plants out of reach of infants, toddlers, and small children. d. a, b, and c.

a, b, and c.

An infant is receiving Lanoxin elixir 0.028 mg once daily. Lanoxin is available in an elixir concentration of 50 mcg/mL. The correct dose to draw up and administer is: a. 0.56 mL. b. 0.28 mL. c. 0.84 mL. d. 1.12 mL.

a. 0.56 mL

Which of the following signs is an early indication of hemorrhage in a child who has had a tonsillectomy? a. Continuous swallowing b. Decreasing blood pressure c. Restlessness d. a, b, and c

a. Continuous swallowing

A 5-month-old infant suspected of having intussusception would most likely have what clinical manifestations? a. Crying, vomiting, and currant-jelly-appearing stools b. Fever, diarrhea, vomiting, and decreased WBC c. Weight gain, constipation, and refusal to eat d. Abdominal distention, periodic pain, and hypotension

a. Crying, vomiting, and currant-jelly-appearing stools

The nurse observes frothy saliva in the mouth and nose of the neonate who is a few hours old. When fed, the infant swallows normally, but suddenly the fluid returns through the nose and mouth of the infant. The nurse suspects: a. Esophageal atresia b. Pyloric stenosis c. Anorectal malformation d. Biliary atresia

a. Esophageal atresia

The primary consequences of leukemia in children are: I. Infection, from neutropenia II. Anemia, from decreased RBCs III. Vascular inflammation, from entanglement and enmeshing of RBCs IV. Bleeding, from decreased platelets a. I, II, and IV b. II, III, and IV c. I, II, and III

a. I, II, and IV

An infant who weighs 7 kg has just returned to the intensive care unit following cardiac surgery. The chest tube has drained 40 mL in the past hour. In this situation, what is the first action for the nurse to take? a. Notify the surgeon. b. Identify any other signs of hemorrhage. c. Suction the patient. d. Identify any other signs of renal failure.

a. Notify the surgeon

Explain the rationale for each of the following clinical manifestations of cystic fibrosis.

a. Respiratory symptoms include obstruction of bronchioles and bronchi with abnormally thick mucus. b. Delayed growth and development as a result of decreased absorption of nutrients, including vitamins and fat; increased oxygen demands for pulmonary function; and delayed bone growth. c. Anorexia is common in children with CF due to poor absorption and passage of intestinal waste; large amount of mucus and sputum which is often swallowed; at times violent coughing episodes; frequent respiratory treatments; and the large amounts of medications in pill form which must be taken (these are filling).

One of the most important factors in preventing bacterial endocarditis is: a. administration of prophylactic antibiotic therapy. b. surgical repair of the defect. c. administration of prostaglandin to maintain patent ductus arteriosus. d. administration of antibiotics after dental work.

a. administration of prophylactic antibiotic therapy

The infant is predisposed to developing otitis media because the Eustachian tubes: a. are relatively short and open. b. have a limited amount of lymphoid tissue. c. are relatively long and narrow. d. are completely underdeveloped.

a. are relatively short and open.

The best pain medication administration regimen for a child in the initial postoperative period following a tonsillectomy is: a. at regular intervals. b. as needed.

a. at regular intervals.

Coarctation of the aorta should be suspected when the: a. blood pressure is higher in the arms than in the legs. b. blood pressure in the right arm is different from the blood pressure in the left arm. c. apical pulse is greater than the radial pulse. d. point of maximum impulse is shifted to the right.

a. blood pressure is higher in the arms than in the legs

In Wiskott-Aldrich syndrome, the most notable effect of the disease at birth is: a. bloody diarrhea. b. infection. c. eczema. d. malignancy.

a. bloody diarrhea

For the child with nephrosis, one aim of the therapy is to reduce: a. excretion of urinary protein. b. excretion of fluids. c. serum albumin levels. d. urinary output.

a. excretion of urinary protein

Diagnosis of severe combined immunodeficiency disease (SCID) is primarily based on: a. failure to thrive. b. delayed development. c. feeding problems. d. susceptibility to infections.

a. failure to thrive

A common feature of inflammatory bowel disease is: a. growth restriction. b. chronic constipation. c. obstruction. d. burning epigastric pain.

a. growth restriction.

In the child who is suspected of having epiglottitis, the nurse should. a. have intubation equipment available. b. visually inspect the child's oropharynx with a tongue blade. c. obtain a throat culture. d. prepare to immunize the child for Haemophilus influenzae.

a. have intubation equipment available.

Clinical manifestations of nephrotic syndrome include: a. hypercholesterolemia, hypoalbuminemia, edema, and proteinuria. b. hematuria, hypertension, periorbital edema, and flank pain. c. oliguria, hypocholesterolemia, and hyperalbuminemia. d. hematuria, generalized edema, hypertension, and proteinuria.

a. hypercholesterolemia, hypoalbuminemia, edema, and proteinuria.

The most immediate threat to the life of the child with acute renal failure is: a. hyperkalemia. b. anemia. c. hypertensive crisis. d. cardiac failure from hypovolemia.

a. hyperkalemia

A common term used in describing an abnormal CBC is shift to the left, which is usually caused by a(n): a. infection. b. anemia. c. hemolysis d. bleeding.

a. infection

An invagination of one portion of the intestine into another is called: a. intussusception. b. pyloric stenosis. c. tracheoesophageal fistula. d. Hirschsprung disease.

a. intussusception.

The Reed-Sternberg cell is a significant finding because it: a. is characteristic of Hodgkin disease. b. eliminates the need for a lymph node biopsy for staging. c. eliminates the need for laparotomy for staging. d. is characteristic of leukemia.

a. is characteristic of Hodgkin disease

Prostaglandin is administered to the newborn with a congenital heart defect to: a. keep the ductus arteriosus open. b. close the ductus arteriosus. c. keep the foramen ovale open. d. close the foramen ovale.

a. keep the ductus arteriosus open.

When an abnormal connection exists between the heart chambers (e.g., a septal defect), blood will necessarily flow from an area of higher pressure (left side) to one of lower pressure (right side). This is called a: a. left-to-right shunt. b. right-to-left shunt.

a. left-to-right shunt

The nurse examines a 6-year-old child with asthma and finds that there is hyper-resonance on percussion. Breath sounds are coarse and loud with sonorous crackles throughout the lung fields. Expiration is prolonged; rales can be heard. There is generalized inspiratory and expiratory wheezing. The child has these symptoms two times a week, with nighttime episodes a few times per month. He uses a short-acting b-agonist daily and his FEV1 is 80%. Based on these findings, the nurse suspects that there is: a. moderate persistent asthma. b. severe persistent asthma. c. mild persistent asthma. d. mild intermittent asthma.

a. moderate persistent asthma.

The clinical manifestations of influenza usually include all of the following except: a. nausea and vomiting. b. fever and chills. c. sore throat and dry mucous membranes. d. photophobia and myalgia.

a. nausea and vomiting.

Children with pinworm infections present with the principal symptom of: a. perianal itching. b. diarrhea with blood. c. evidence of small rice-like worms in their stool and urine. d. abdominal pain.

a. perianal itching.

In fetal circulation only a small amount of blood flows through the nonfunctioning: a. pulmonary circulation. b. ductus arteriosus. c. hepatic circulation. d. ductus venosus.

a. pulmonary circulation

A child, age 12, had a renal transplant 5 months ago. He now presents to the outpatient clinic with fever, tenderness over the graft area, decreased urinary output, and a slightly elevated blood pressure. The nurse's priority at this time is to: a. recognize that the child is probably undergoing acute rejection and to notify the physician immediately. b. recognize that this is an episode of increased inflammation within the donor kidney because the child has probably been noncompliant with his immunosuppressant drugs. c. obtain urine for culture and sensitivity and a blood count to quickly identify the child's infection before alerting the physician. d. recognize that the child is in chronic rejection and that no present therapy can halt the progressive process.

a. recognize that the child is probably undergoing acute rejection and to notify the physician immediately.

Because an incision is made through muscle, most children consider the most painful part of cardiac surgery to be the: a. thoracotomy incision site. b. graft site on the leg. c. sternotomy incision site. d. intravenous insertion sites.

a. thoracotomy incision site

A 5-year-old with sickle cell anemia is admitted because of diminished RBC production triggered by a viral infection. The episode is characterized by distal ischemia and pain. The crisis the child is most likely to be experiencing is: a. vasoocclusive crisis. b. splenic sequestration crisis. c. aplastic crisis. d. hyperhemolytic crisis.

a. vasoocclusive crisis

Albuterol

b-adrenergic agonist used as an inhaled bronchodilator.

The parents of a 2-month-old with gastroesophageal reflux are counseled by the nurse to include which of the following in the infant's care? a. After feeding and burping, place the infant prone for two hours. b. After feeding and burping, position the infant in an infant seat with the head elevated 30 degrees. c. After feeding and burping, position the infant on his or her back with the head turned to the side. d. Increase feeding volume right before bedtime.

b. After feeding and burping, position the infant in an infant seat with the head elevated 30 degrees

Which of the following is the best choice for the child with a respiratory disorder who needs rest but is resisting staying in bed? a. Be sure the mother takes the advice seriously. b. Allow the child to play quietly on the bed or floor. c. Insist that the child play quietly in bed. d. Allow the child to cry until he or she stays in bed.

b. Allow the child to play quietly on the bed or floor.

Which of the following is included in dietary regulation of the child with chronic renal failure? a. Restricting protein intake below the recommended daily allowance b. Dietary protein intakes allowed only to the dietary reference intake (DRI) for the child's age. c. Restricting potassium when creatinine clearance falls below 50 mL/min d. Giving vitamin A, E, and K supplements

b. Dietary protein intakes allowed only to the dietary reference intake (DRI) for the child's age

Which of the following sets of assessment findings are the most frequent clinical manifestations of an atrial septal defect in an infant or child? a. Decreased cardiac output and low blood pressure b. Heart failure and a murmur c. Increased blood pressure and pulse d. Dyspnea and bradycardia

b. Heart failure and a murmur

Priority nursing responsibilities after cardiac catheterization in children includes: I. monitoring oral fluid intake. II. checking pulses below the site of catheterization. III. assessing the temperature and color of the affected extremity. IV. checking vital signs including blood pressure every 15 minutes. V. monitoring blood glucose levels in infants. VI. checking the dressing for bleeding. a. I, II, and VI b. I, II, III, IV, V, and VI c. II, III, and VI

b. I, II, III, IV, V, and VI

Tetralogy of Fallot consists of these defects: I. VSD II. ASD III. Right ventricular hypertrophy IV. Pulmonic stenosis V. Overriding aorta VI. Patent ductus arteriosus a. II, III, IV, and VI b. I, III, IV, and V . c. II, IV, V, and VI

b. I, III, IV, and V

The best dietary sources of iron for a 7-month-old infant are? I. Whole milk II. Oral iron supplements III. Iron fortified rice cereal IV. Iron-fortified commercial formula a. I and II b. III and IV c. I, II, III, and IV

b. III and IV

Which of the following choices most accurately describes dehydration or fluid loss in infants and young children? a. As a percentage b. In milliliters per kilogram of body weight c. By the amount of edema present d. By the degree of skin elasticity

b. In milliliters per kilogram of body weight

Supplements are given in cystic fibrosis in the form of: a. multivitamins. b. a water-miscible form of fat-soluble vitamins. c. pancreatic enzymes. d. a, b, and c.

b. a water-miscible form of fat-soluble vitamins

The nurse may anticipate intubation as the care management for the young child diagnosed with: a. acute spasmodic laryngitis. b. bacterial tracheitis. c. acute laryngotracheobronchitis. d. acute laryngitis.

b. bacterial tracheitis.

Dehydration must be prevented in children who are hypoxemic because dehydration places the child at risk for: a. infection. b. cerebral vascular accident. c. fever. d. air embolism.

b. cerebral vascular accident.

Acute glomerulonephritis is most likely to be suspected when the child presents with the clinical manifestations of: a. normal blood pressure, generalized edema, and oliguria. b. edema, hematuria, and oliguria. c. fatigue, elevated serum lipid levels, and elevated serum protein levels. d. temperature elevation, circulatory congestion, and normal creatinine serum levels.

b. edema, hematuria, and oliguria

The two main angiotensin-converting enzyme (ACE) inhibitors most commonly used for children with congestive heart failure are: a. digoxin and captopril. b. enalapril and captopril. c. enalapril and furosemide. d. spironolactone and captopril.

b. enalapril and captopril

Since the advent of immunization for Haemophilus influenzae, there has been a decrease in the incidence of: a. laryngotracheobronchitis. b. epiglottitis. c. influenza (seasonal). d. croup.

b. epiglottitis.

One of the major problems for infants born with cleft lip and palate is related to: a. rejection by the mother. b. feeding problems and weight loss. c. apnea and bradycardia. d. aspiration pneumonia.

b. feeding problems and weight loss.

During fetal life, oxygenated blood travels into the left atrium through a structure known as the: a. truncus arteriosus. b. foramen ovale. c. sinus venosus. d. ductus venosus.

b. foramen ovale.

The manifestation of chronic renal failure that probably has the most detrimental social consequences for the developing child is: a. anemia. b. growth restriction. c. bone demineralization. d. septicemia.

b. growth restriction

Typically the measure used to control the transmission of infection in the immunocompromised child during hospitalization includes: a. use of any semiprivate room. b. hand-washing. c. chemotherapy. d. prophylactic antibiotics.

b. hand-washing

The use of the monoclonal antibody palivizumab for the prevention of RSV is preferred in high-risk children because: a. it is administered intravenously. b. of its ease of administration, safety, and effectiveness. c. it is licensed only for the prevention of RSV disease. d. it is an immune globulin that neutralizes antibodies.

b. of its ease of administration, safety, and effectiveness.

A 12-month-old would be classified as significantly hypertensive with a blood pressure that: a. falls above the 99th percentile one time. b. persistently falls between the 95th and 99th percentiles. c. falls between the 95th and 99th percentiles one time. d. falls below the 99th percentile one time.

b. persistently falls between the 95th and 99th percentiles

A 12-month-old infant in heart failure is taking enalapril (ACE inhibitor) and spironolactone. The nurse should be especially alert for: a. sodium 142 mEq/L. b. potassium 5.0 mEq/L. c. potassium 3.1 mEq/L. d. sodium 132 mEq/L.

b. potassium 5.0 mEq/L.

The definition of biliary atresia is: a. persistent jaundice with elevated direct bilirubin levels. b. progressive inflammatory process causing bile duct fibrosis. c. absence of bile pigment. d. hepatomegaly and palpable liver.

b. progressive inflammatory process causing bile duct fibrosis.

A l-month-old infant is brought to the clinic by his mother. The nurse suspects pyloric stenosis because the mother gives a history of: a. diarrhea. b. projectile vomiting. c. fever and dehydration. d. abdominal distention.

b. projectile vomiting

Primary prophylaxis in hemophilia patients involves the infusion of factor VIII: a. regularly at the emergency room before joint damage occurs. b. regularly at home before the onset of joint damage. c. whenever bleeding into a joint occurs. d. when bleeding begins to impair joint function.

b. regularly at home before the onset of joint damage

During influenza epidemics, it is generally believed the age group that provides a major source of transmission is the: a. infant. b. school-age child. c. adolescent. d. preschool-age child

b. school-age child.

In the United States, protein and energy malnutrition (PEM) occurs when: a. the food supply is inadequate. b. the food supply may be adequate. c. the adults eat first, leaving insufficient food for children. d. the diet consists mainly of starch grains.

b. the food supply may be adequate.

The best technique to prevent spread of nasopharyngitis is: a. prompt immunization. b. to avoid contact with infected people. c. mist vaporization. d. to ensure adequate fluid intake.

b. to avoid contact with infected people.

The peak age for the incidence of Kawasaki disease is in the: a. infant age group. b. toddler age group. c. school-age group. d. adolescent age group.

b. toddler age group

A common long-term complication after surgical repair of esophageal atresia is: a. feeding difficulties. b. tracheomalacia. c. pneumothorax. d. short bowel syndrome.

b. tracheomalacia.

The best test to screen for tuberculosis infection is the: a. chest radiograph. b. tuberculin skin test (TST). c. sputum culture. d. DNA blood test.

b. tuberculin skin test (TST).

Most respiratory infections in children are caused by: a. pneumococci. b. viruses. c. streptococci. d. Haemophilus influenzae.

b. viruses.

The nurse caring for the child with acute glomerulonephritis would expect to: a. enforce complete bed rest. b. weigh the child daily. c. perform peritoneal dialysis. d. ensure a diet low in protein.

b. weigh the child daily

Which of the following questions would be most important for the nurse to ask the parents of a child admitted to the hospital with a diagnosis of reactive airway disease? a. "What brings you to the hospital?" b. "What is your ethnic background?" c. "Do you have a history of asthma in your family?" d. "Were your pregnancy and delivery uneventful?"

c. "Do you have a history of asthma in your family?"

Which of the following diagnostic strategies is considered the most definitive for identifying a cow's milk allergy? a. Stool analysis for blood b. Serum IgE levels c. A reintroduction of milk after elimination from diet d. Skin prick or scratch testing

c. A reintroduction of milk after elimination from diet

An 8-year-old has been diagnosed with giardiasis. The nurse should expect which of these signs and symptoms? a. Diarrhea with blood in the stools b. Nausea and vomiting with a mild fever c. Abdominal cramps with intermittent loose stools d. Weight loss of 5 lb over the last month

c. Abdominal cramps with intermittent loose stools

Which of the following congenital heart defects usually has the best prognosis? a. Tetralogy of Fallot b. Ventricular septal defect c. Atrial septal defect d. Hypoplastic left heart syndrome

c. Atrial septal defect

The most common clinical manifestations expected with Meckel diverticulum include: a. Fever, vomiting, and constipation b. Weight loss, hypotension, and obstruction c. Painless rectal bleeding, abdominal pain, or intestinal obstruction d. Abdominal pain, bloody diarrhea, and foul-smelling stool

c. Painless rectal bleeding, abdominal pain, or intestinal obstruction

Which of the following strategies would most likely be contraindicated for a child with cystic fibrosis to use? a. Forced expiration b. Aerobic exercise c. Supplemental oxygen as desired d. Percussion and postural drainage

c. Supplemental oxygen as desired

Respiratory syncytial virus (RSV) is: a. an uncommon virus that causes severe bronchiolitis. b. an uncommon virus that usually does not require hospitalization. c. a common virus that usually causes moderate to-severe bronchiolitis. d. a common virus that usually does not require hospitalization.

c. a common virus that usually causes moderate to-severe bronchiolitis.

In the child with peptic ulcer disease, it would be unlikely to find: a. Helicobacter pylori. b. a blood type O. c. a diet consisting of spicy foods. d. psychologic factors such as stressful life events.

c. a diet consisting of spicy foods.

The primary concern of the nurse when giving tips for how to increase humidity in the home of a child with a respiratory infection should be to make sure the child has: a. continuous contact with the humidification source. b. a warm humidification source. c. a humidification source that is safe. d. a cool humidification source.

c. a humidification source that is safe.

The nurse should suspect epiglottitis if the child has: a. cough, sore throat, and agitation. b. cough, drooling, and retractions. c. absence of cough in the presence of drooling and agitation. d. absence of cough, hoarseness, and retractions.

c. absence of cough in the presence of drooling and agitation.

A child with a diagnosed food allergy (peanuts) in the school cafeteria suddenly complains of being short of breath and is observed wheezing. The most critical nursing intervention is for the school nurse to: a. call the child's parents. b. call the child's physician of record. c. administer intramuscular epinephrine. d. take the child to the nurse's office.

c. administer intramuscular epinephrine.

Nursing care for a child with leukemia undergoing chemotherapy with resultant nausea and vomiting should focus on: a. administration of an antiemetic after the chemotherapeutic drug is administered. b. close observation of the child for side effects from the chemotherapeutic drug. c. administration of an antiemetic before the chemotherapeutic drug is given. d. avoidance of foods in the child's environment that trigger nausea.

c. administration of an antiemetic before the chemotherapeutic drug is given.

When teaching the family of a child with nephrotic syndrome about prednisone therapy, the nurse includes the information that: a. corticosteroid therapy begins after BUN and serum creatinine elevation. b. prednisone is administered orally in a dosage of 4 mg/kg of body weight. c. after proteinuria and edema resolve, the dose is gradually tapered. d. the drug is discontinued as soon as the urine is free from protein.

c. after proteinuria and edema resolve, the dose is gradually tapered

Of the foods listed, the most appropriate selection to offer first to an alert child who is in the postoperative period following a tonsillectomy is: a. strawberry ice cream. b. red cherry-flavored gelatin. c. an apple-flavored ice pop. d. cold diluted orange juice.

c. an apple-flavored ice pop.

An abnormal otoscopic examination would reveal: a. visible landmarks. b. a light reflex. c. an opaque immobile tympanic membrane. d. a mobile tympanic membrane.

c. an opaque immobile tympanic membrane.

Group A b-hemolytic streptococcal (GABHS) infection is usually a: a. serious infection of the upper airway. b. common cause of pharyngitis in children over the age of 15 years. c. brief illness that places the child at risk for serious sequelae. d. disease of the heart, lungs, joints, and central nervous system.

c. brief illness that places the child at risk for serious sequelae.

The first action parents should be taught to initiate in an accidental poisoning is to: a. induce vomiting. b. take the child to the family physician's office or emergency center. c. call the poison control center. d. follow the instructions on the label of the household product.

c. call the poison control center.

Children with croup syndrome and mild mucosal swelling: a. require hospitalization. b. will need to be intubated. c. can be cared for at home. d. are over 6 years old.

c. can be cared for at home.

Treatment of diagnosed cow's milk allergy in infants ideally involves changing the formula to: a. soy-based formula. b. goat's milk. c. casein/whey hydrolysate milk. d. whole milk.

c. casein/whey hydrolysate milk.

A 5-month-old infant's intussusception is treated with hydrostatic reduction. The nurse should expect care after the reduction to include: a. administration of antibiotics. b. enema administration to remove remaining stool. c. close observation of stools. d. blood pressure every 4 hours.

c. close observation of stools

General signs of pneumonia include: a. low fever and nausea. b. clear breath sounds and brown sputum. c. cough, tachypnea, and retractions. d. nasal flaring and tympani with percussion.

c. cough, tachypnea, and retractions.

The most frequent cause of transient acute renal failure in infants and children is: a. nephrotoxic agents. b. obstructive uropathy. c. dehydration. d. burn shock.

c. dehydration

An infant with moderate dehydration may demonstrate: a. mottled skin color and decreased pulse and respirations. b. decreased urine output, tachycardia and fever. c. dry mucous membranes and capillary filling of more than 2 to 3 seconds. d. tachycardia, bulging fontanel and decreased blood pressure.

c. dry mucous membranes and capillary filling of more than 2 to 3 seconds.

The most important therapeutic management for the child with celiac disease is: a. eliminating corn, rice, and millet from the diet. b. adding iron, folic acid, and fat-soluble vitamins to the diet. c. eliminating wheat, rye, barley, and oats from the diet. d. educating the child's parents about the short-term effects of the disease and the necessity of reading all food labels for content until the disease is in remission.

c. eliminating wheat, rye, barley, and oats from the diet.

A 16-year-old is receiving radiation for Hodgkin Lymphoma. When providing information about the radiation treatments, the nurse informs the adolescent and his mother that the most common effect of radiation is: a. moon face. b. nausea and vomiting. c. fatigue. d. alopecia.

c. fatigue.

Renal injury, acquired hemolytic anemia, central nervous system symptoms, and thrombocytopenia are characteristic clinical manifestations of the disorder known as: a. minimal-change nephrotic syndrome. b. Wilms tumor. c. hemolytic-uremic syndrome. d. vesicoureteral reflux.

c. hemolytic-uremic syndrome

Complications of acute renal failure include all of the following except: a. anemia. b. hypertension. c. hypernatremia. d. cardiac failure with pulmonary edema.

c. hypernatremia

A 7-year-old with leukemia is receiving an intravenous dose of a chemotherapeutic drug when he tells his mother that the IV site is burning and stinging. The nurse's priority intervention is to: a. call the physician who ordered the drug. b. slow down the infusion and observe the child for 20 minutes. c. immediately stop the infusion. d. reassure the child and his mother that this is a common reaction to chemotherapy.

c. immediately stop the infusion.

In an 8-month-old infant admitted to the hospital with pertussis, the nurse should inquire about the: a. living conditions of the infant and family. b. labor and delivery history of the mother. c. immunization status of the infant. d. alcohol and drug intake of the mother.

c. immunization status of the infant.

The calories are usually modified for an infant with congestive heart failure by: a. feeding every 2 hours. b. increasing the volume of each feeding. c. increasing the caloric density of the formula. d. increasing the feeding duration to 1 hour.

c. increasing the caloric density of the formula.

The drug therapy used for the removal of elevated serum potassium is: a. furosemide. b. vasopressin. c. ion exchange resin. d. calcium gluconate.

c. ion exchange resin

The cancer that occurs with the most frequency in children is: a. lymphoma. b. neuroblastoma. c. leukemia. d. melanoma.

c. leukemia

The most likely reason that the respiratory infection rate increases drastically in the age range from 3 to 6 months is that the: a. infant's exposure to pathogens is greatly increased during this time. b. viral agents that are mild in older children are extremely severe in infants. c. maternal antibodies have decreased and the infant's own antibody production is immature. d. diameter of the airways is smaller in the infant than in the older child.

c. maternal antibodies have decreased and the infant's own antibody production is immature.

The American Academy of Pediatrics recommends that all children infected with HIV receive the routine childhood immunizations, but the nurse recognizes that children with HIV who are receiving intravenous immunoglobulin (IVIG) prophylaxis may not respond to the: a. varicella vaccine. b. poliovirus vaccine. c. measles-mumps-rubella vaccine. d. pneumococcal vaccine.

c. measles-mumps-rubella vaccine

To assess for the presence of a cleft palate, the nurse should: a. assess the infant's ability to swallow. b. assess the color of the infant's oral mucosa. c. palpate the hard palate with a gloved finger. d. flick the infant's foot and make it cry.

c. palpate the hard palate with a gloved finger.

Elevated cholesterol: a. can predict the long-term risk of heart disease for the individual. b. can predict the risk of hypertension in adulthood. c. plays an important role in causing atherosclerosis. d. plays an important role in causing congestive heart failure.

c. plays an important role in causing atherosclerosis

The electrolyte most commonly depleted with diuretic therapy is: a. sodium. b. chloride. c. potassium. d. magnesium.

c. potassium

To confirm the diagnosis of Hirschsprung disease, the nurse prepares the child for: a. endoscopy. b. sonogram. c. rectal biopsy. d. esophagoscopy.

c. rectal biopsy

A priority goal in the management of acute diarrhea is: a. determining the cause of the diarrhea. b. preventing the spread of the infection. c. rehydrating of the child. d. managing the fever associated with the diarrhea.

c. rehydrating of the child.

The leading cause of death in the first 3 years after heart transplantation (the greatest risk in the first 6 months) in children is: a. heart failure. b. infection. c. rejection. d. renal dysfunction.

c. rejection.

Nutritional marasmus usually occurs in populations in which: a. the food supply is inadequate. b. the food supply is adequate for protein. c. the adults eat first, leaving insufficient food for children. d. the diet consists mainly of starch grains.

c. the adults eat first, leaving insufficient food for children.

A parent and child visit to the intensive care unit before open-heart surgery should ideally take place: a. several days before the surgery. b. at a busy time with a lot to see and hear. c. the day before surgery. d. several weeks before the surgery.

c. the day before surgery

The test in which a transducer is placed behind the heart to obtain images of posterior heart structures is the: a. electrocardiogram. b. echocardiogram. c. transthoracic echocardiography. d. two-dimensional echocardiogram.

c. transthoracic echocardiography

Fluid and nutritional guidelines for an infant with congestive heart failure rarely include: a. sodium restriction. b. sodium supplements. c. fluid restriction. d. decreased caloric intake.

c. fluid restriction

The nurse caring for a child with nephrotic syndrome can expect to administer ______ as the first-line drug therapy.

corticosteroids

The test that provides the most reliable evidence of recent streptococcal infection is the: a. throat culture. b. Mantoux test. c. liver enzymes test. d. antistreptolysin O test.

d. antistreptolysin O test

The nurse is teaching a mother how to administer digoxin (Lanoxin) at home to her 3-year- old child. The nurse tells the mother that as a general rule, digoxin should not be administered to the older child whose pulse is: a. 108. b. 98. c. 78. d. 68.

d. 68

Which of the following does not predispose the child to urinary tract infections? a. The short urethra in the young female b. The presence of urinary stasis c. Urinary reflux d. Acidic urine pH

d. Acidic urine pH

Discharge teaching for a child with Kawasaki disease who received IVIG should include: a. Peeling of the hands and feet should be reported immediately. b. Arthritis, especially in the weight-bearing joints, should be reported immediately. c. Defer measles, mumps, and rubella vaccine for 11 months. d. All of the above should be included in the instructions.

d. All of the above should be included in the instructions

Clinical manifestations of urinary tract infection in infancy include all but which of the following? a. Fever b. Poor feeding c. Frequent urination d. Anemia

d. Anemia

Which of the following principles should be a part of the home self-management program for a child with asthma? a. Individuals must learn not to abuse their medications so that they will not become addicted. b. It is easy to treat an asthmatic episode as long as the child knows the symptoms. c. Although quite uncommon, asthma is very treatable. d. Children with asthma are usually able to participate in the same activities as non-asthmatic children.

d. Children with asthma are usually able to participate in the same activities as non-asthmatic children.

The nurse is teaching parents how to collect a specimen for enterobiasis using the test tape diagnostic procedure. Which of the following is included in the explanation? a. Use a flashlight to inspect the anal area while the child sleeps. b. Perform the test 2 days after the child has received the first dose of mebendazole. c. Test all members of the family at the same time using frosted tape. d. Collect the tape in the morning before the child has a bowel movement or bath.

d. Collect the tape in the morning before the child has a bowel movement or bath

The nurse would expect to see which of the following clinical manifestations in the child diagnosed with Hirschsprung disease? a. History of bloody diarrhea, fever, and vomiting b. Irritability, severe abdominal cramps, and fecal soiling c. Increased serum lipids and positive stool for O&P (ova and parasites) d. Constipation, abdominal distention, and foul smelling stools.

d. Constipation, abdominal distention, and foul smelling stools

Feeding the infant with surgical repair of either a cleft lip or palate postoperatively includes: I. If the infant had cleft lip repair, feeding begins with clear liquids. II. Feedings are resumed whenever tolerated after a cleft lip repair. III. Cleft palate repair feedings include the use of spoons. IV. Cleft palate repair feedings include the use of a cup. a. I and II b. I, II, III, and IV c. I and III d. I, II and IV

d. I, II and IV

A 5-year-old boy previously diagnosed with hemophilia A is being admitted with hemarthrosis. The nurse knows that which of the following would most likely be included in the plan of care? I. Ice packs to the affected area II. Application of a splint or sling to immobilize the area III. Administration of factor VIII concentrate intramuscularly IV. Administration of aspirin or aspirin-containing compounds V. Administration of factor VIII concentrate intravenously VI. Active range-of-motion exercises VII. Teaching him how to administer anti-hemophilic factor to himself a. I, III, and VI b. II, III, IV, and VI c. I, V, and VII d. I, II, V, and VI

d. I, II, V, and VI

An infant who weighs 7 kg has just returned to the intensive care unit following cardiac surgery. The urine output has been 5 mL in the past hour. In this situation, what is the first action the nurse should take? a. Notify the surgeon. b. Identify any other signs of hypervolemia. c. Suction the patient. d. Identify any other signs of renal failure.

d. Identify any other signs of renal failure

Infants and young children are at high risk for fluid and electrolyte imbalance. Which of the following factors contributes to this vulnerability? a. Decreased body surface area b. Lower metabolic rate c. Mature kidney function d. Increased extracellular fluid volume

d. Increased extracellular fluid volume

Which of the following represent the early subtle signs of hypoxia? a. Peripheral cyanosis b. Central cyanosis c. Hypotension d. Mood changes and restlessness

d. Mood changes and restlessness

Children who develop moon face from short-term steroid therapy used to treat cancer may experience symptoms of: a. acute toxicities. b. decreased appetite. c. permanent facial change. d. altered body image.

d. altered body image

Which of the following would alert the nurse to possible peritonitis in a child suspected of having appendicitis? a. Colicky abdominal pain with guarding of the abdomen b. Peri-umbilical pain that progresses to the lower right quadrant of the abdomen with an elevated WBC c. Low-grade fever of 100.6° F with the child having difficulty walking and assuming a side-lying position with the knees flexed toward the chest d. Temperature of 103° F, absent bowel sounds, and sudden relief from acute abdominal pain

d. Temperature of 103° F, absent bowel sounds, and sudden relief from acute abdominal pain

Which one of the following children is most likely to be hospitalized for treatment of croup? a. The 2-year-old child whose croupy cough worsens at night b. The 5-year-old child whose croupy cough worsens at night c. The 2-year-old child using the accessory muscles to breathe d. The 2-year-old child with inspiratory stridor when upright and supine

d. The 2-year-old child with inspiratory stridor when upright and supine

The child who has active tuberculosis infection is treated with: a. isoniazid. b. rifampin. c. pyrazinamide. d. a combination of the above drugs.

d. a combination of the above drugs.

Following cardiac surgery, in addition to hourly recordings of urine, fluid output calculations in a child should include: a. nasogastric secretions. b. blood drawn for analysis. c. chest tube drainage. d. a, b, and c.

d. a, b, and c

Following cardiac surgery, fluid intake calculations for a child would include: a. intravenous fluids. b. arterial and CVP line flushes. c. fluid used to dilute medications. d. a, b, and c.

d. a, b, and c

In children and adolescents, HIV is most likely to be transmitted: a. perinatally from the mother. b. through contaminated blood or blood products. c. to adolescents engaged in IV drug use. d. a, b, and c.

d. a, b, and c

Nursing care management of the 6-month-old infant with RSV bronchiolitis will include: a. monitoring oxygenation with pulse oximetry. b. suctioning nasal secretions before nursing. c. ensuring adequate oral fluid intake. d. a, b, and c.

d. a, b, and c

Parents of the child with a congenital heart defect should know the signs of congestive heart failure, which include: a. poor feeding. b. sudden weight gain. c. increased efforts to breathe. d. a, b, and c.

d. a, b, and c

Which of the following clinical manifestations is a sign of chronic hypoxemia in a child? a. Squatting b. Polycythemia c. Clubbing d. a, b, and c

d. a, b, and c

Severity of a foreign body aspiration is determined by: a. location of the object in the airway. b. the type of object aspirated. c. the extent of obstruction. d. a, b, and c.

d. a, b, and c.

The preoperative nursing plan for an infant with pyloric obstruction should include: a. rehydration by intravenous fluids for fluid and electrolyte imbalance. b. nasogastric (NG) tube placement to decompress the stomach. c. parental support and reassurance. d. a, b, and c.

d. a, b, and c.

The term latent tuberculosis infection (LTBI) is used to indicate infection in a person with: a. positive TST. b. absence of physical findings of disease. c. a normal chest radiograph. d. a, b, and c.

d. a, b, and c.

Hodgkin disease increases in incidence in children: a. under the age of 5 years. b. between the ages of 5 and 10 years. c. between the ages of 11 and 14 years. d. between the ages of 15 and 19 years.

d. between the ages of 15 and 19 years

Treatment for the child with aplastic anemia will most likely include: a. administration of testosterone. b. administration of iron-chelating agents. c. irradiation. d. bone marrow transplant.

d. bone marrow transplant

Signs and symptoms of supraventricular tachycardia (SVT) in an infant or young child include: a. pallor. b. irritability. c. poor feeding. d. diaphoresis. e. a, b, and c.

d. diaphoresis

The nurse should prepare for an impending emergency situation to care for the child with suspected: a. spasmodic croup. b. laryngotracheobronchitis. c. acute spasmodic laryngitis. d. epiglottitis.

d. epiglottitis.

The assessment finding that is most likely to indicate an anorectal malformation is: a. abdominal distention and vomiting. b. a normal-appearing perineum. c. passage of meconium stool after 24 hours. d. failure to pass meconium through the anal opening.

d. failure to pass meconium through the anal opening.

Common clinical manifestations of HIV in young children include all of the following except: a. oral candidiasis. b. chronic diarrhea. c. failure to thrive. d. frequent URIs.

d. frequent URIs

The nutritional needs of the infant with congestive heart failure are usually: a. the same as an adult's. b. less than a healthy infant's. c. the same as a healthy infant's. d. greater than a healthy infant's.

d. greater than a healthy infant's.

In controlling severe pain related to vasoocclusive sickle cell crisis, the plan of care will most likely include: a. administration of long-term oxygen. b. application of cold compresses to the area. c. intramuscular meperidine (Demerol). d. intravenous or oral opioids.

d. intravenous or oral opioids

The most common early symptom of biliary atresia is: a. projectile vomiting. b. bloody stools. c. alcoholic stools. d. jaundice.

d. jaundice.

Therapeutic management of sickle cell crisis generally includes: a. long-term oxygen use to enable the oxygen to reach the sickled RBCs. b. an increase in activity to promote circulation in the affected area. c. a diet high in iron to decrease anemia. d. oral or intravenous hydration for hemodilution.

d. oral or intravenous hydration for hemodilution

The principal treatment for the insufficiency that occurs in cystic fibrosis is the administration of: a. enemas. b. corticosteroids. c. antibiotics. d. pancreatic enzymes.

d. pancreatic enzymes.

In the postoperative period following a tonsillectomy, the child should be: a. placed in the Trendelenburg position. b. encouraged to cough and deep breathe. c. suctioned vigorously to clear the airway. d. placed on bed rest for the day of surgery.

d. placed on bed rest for the day of surgery.

If bleeding occurs at the insertion site after a cardiac catheterization, the nurse should apply: a. warmth to the unaffected extremity. b. pressure below the insertion site. c. warmth to the affected extremity. d. pressure above the insertion site.

d. pressure above the insertion site

Because of the potential for empyema, closed chest drainage is most likely to be used in the treatment of: a. Haemophilus pneumonia. b. mycoplasmal pneumonia. c. streptococcal pneumonia. d. staphylococcal pneumonia

d. staphylococcal pneumonia

Most cases of hypertension in young children are a result of: a. essential hypertension. b. secondary hypertension. c. primary hypertension. d. structural abnormality or an underlying pathologic process.

d. structural abnormality or an underlying pathologic process

When preparing for discharge, the nurse would include in the home plan of care for the family of an asthmatic child to: a. keep the humidity at home above 50%. b. use only feather pillows. c. limit animal dander by removing cats and/or dogs. d. take long-term control medication even in the absence of symptoms.

d. take long-term control medication even in the absence of symptoms.

Kwashiorkor occurs in populations in which: a. the food supply is inadequate. b. the food supply is adequate for protein. c. the adults eat first, leaving insufficient food for children. d. the diet consists mainly of starch grains.

d. the diet consists mainly of starch grains.

The prognosis for children with short bowel syndrome has improved as a result of: a. dietary supplemental vitamin B12 additions. b. improvement in surgical procedures to correct the deficiency. c. improved home care availability. d. total parenteral nutrition and enteral feeding.

d. total parenteral nutrition and enteral feeding.

Postoperative care for the infant with a cleft palate would not include the strategy of: a. applying bilateral elbow restraints. b. removing restraints one at a time at regular intervals. c. placing child in the upright infant seat position. d. vigorously suctioning the infant's mouth for secretions.

d. vigorously suctioning the infant's mouth for secretions.

Preoperative nursing care of the child with a Wilms tumor includes: a. answering parents' questions regarding postoperative care. b. palpating the tumor to determine location and size. c. discussing the cosmetic effects of abdominal surgery. d. a, b, and c. e. a and c.

e. a and c

In general, during the oliguric phase of acute renal failure, these electrolytes are withheld: a. sodium. b. potassium. c. chloride. d. a and b only. e. a, b, and c.

e. a, b, and c

Clinical manifestations of a Wilms tumor include: a. abdominal swelling. b. fatigue. c. firm abdomen. d. hematuria. e. a, b, c, and d.

e. a, b, c, and d

When preparing a child for cardiac catheterization the nurse should: a. ask about allergies. b. assess and mark distal pulses. c. ask about a fever above 100° F. d. provide information about the procedure to the child and parents. e. a, b, c, and d.

e. a, b, c, and d

Eleven-year-old Juan is in the clinic to receive booster childhood vaccines. The nurse asks Juan's mother if he has ever had cholesterol screening performed. The mother replies that Juan is too young for such screening. The nurse informs Juan's mother that universal cholesterol screening is recommended for: a. all children 5 years old and older. b. children aged 9 to 11 years. c. adolescents 17 to 21 years of age. d. a, b, and c. e. b and c.

e. b and c

An acquired hemorrhagic disorder characterized by excessive destruction of platelets and a discoloration caused by petechiae beneath the skin with normal bone marrow is_______ .

immune thrombocytopenia

The common childhood anemia that occurs more frequently in toddlers between the ages of 12 and 36 months is __________.

iron deficiency

____ _____ ____ is the most common opportunistic infection of children infected with HIV; it occurs most frequently between 3 and 6 months of age.

pneumocystis carinii pneumonia

____ male infants younger than 3 months of age have been reported to have a higher incidence of urinary tract infection than other males or females.

uncircumcised