Pediatrics Unit 7

82. The nurse should palpate the adrenal glands when a person has a diagnosis of pheocromocytoma during every shift to check for size. True or False

False Palpation can increase the release of catecholamine and cause a hypertensive crisis or tachyarrhythmia.

The nurse is providing care for a 12-month-old patient who is experiencing poor weight gain. Physical assessment reveals an open anterior fontanel and open cranial sutures. To differentiate between a decrease in growth hormone and a congenital thyroid problem, which laboratory test does the nurse expect to be ordered? 1. Serum calcium 2. CBC 3. TSH 4. FSH

ANS 3 1 This is incorrect. Serum calcium will indicate parathyroid activity. 2 This is incorrect. A complete blood count (CBC) will provide information regarding blood cells, which is not affected by either condition. 3 This is correct. A laboratory test for thyroid-stimulating hormone (TSH) will indicate the functioning of the pituitary gland and the effects it has on the thyroid gland. 4 This is incorrect. Follicle-stimulating hormone (FSH) will indicate functioning of the pituitary as it affects the ovary follicles.

12. Trisomy 13, also known as Patau syndrome, is the least common and most severe of the autosomal trisomies. It has an average survival of: 1. Less than three days. 2. Less than two weeks. 3. Less than six months. 4. Less than five years.

ANS: 1 ANS: 1 Feedback 1. Trisomy 13 is the most severe of the autosomal trisomies. It has an average survival of less than three days. 2. Trisomy 13 neonates usually do not live to two weeks of age. 3. Trisomy 13 neonates do not usually live to six months of age. 4. Trisomy 13 do not live to five years of age.

62. Which of the following children are at an increased risk for seizures? 1. A 2-year-old girl with Turners syndrome 2. An 8-year-old boy with neurofibromatosis Type 2 3. An infant born with Trisomy 13 4. A 16-year-old boy with Downs syndrome

ANS: 2 Feedback 1. Girls with Turners syndrome are not at an increased risk for seizure activity. 2. This child is at a higher risk for seizures because of the tumor locations on the brain. 3. A child with Trisomy 13 is not at a higher risk for seizures. 4. A boy with Downs syndrome is not at an increased risk for seizure activity.

25. An infant is diagnosed with diabetes insipidus. An electrolyte panel has returned from the laboratory. The following results indicate which condition? NA: 162 mEq/L K+: 4.0 mEq/L CL: 99 CO2: 18 Ca+: 6.4 1. Hypokalemia 2. Hypernatremia 3. Hyperkalemia 4. Hyponatremia

ANS: 2 Feedback 1. The laboratory results do not indicate hypokalemia. 2. The increase in sodium is common in a patient with diabetes insipidus because of the risks of dehydration. 3. The potassium is in a normal range for the child. 4. The sodium level is elevated.

61. Which of the following diseases are screened for in the newborn screen procedure? 1. Sickle Cell disease 2. Neurofibromatosis 3. PKU 4. Downs syndrome

ANS: 3 Feedback 1. A separate blood screen is needed for children at risk for Sickle Cell disease. 2. This is not diagnosed in children until the teen years. 3. This is identified on the newborn screen. Results are quickly given to identify if an adjustment to the newborns diet should be made. 4. Testing for Downs syndrome is done if physical characteristics or assessments indicate concern.

10. The purpose of exocrine release is to: 1. Restore energy while sleeping. 2. Provide a fight-or-flight response when scared. 3. Increase the release of glycogen to the muscles when running. 4. Aid in the digestion of pizza.

ANS: 4 Feedback 1. Exocrine, which sits in the pancreas, does not influence sleeping. 2. Adrenaline is not excreted in the pancreas to influence a fight-or-flight response. 3. Glycogen is formed and pushed into the cells, which breaks down, not releasing any exocrine. 4. The main purpose of exocrine is to help digest amylase, lipase, and trypsin. Pizza has a high level of lipase.

To ensure that an infant with congenital hypothyroidism is getting the full dose of his/her thyroid replacement medication, the nurse should instruct the parents to put the medication in the infants bottle of formula. True or False

False It is best to use a medicine dropper or medication syringe to administer the medication to an infant.2.Medications should never be mixed in a bottle, as there is no guarantee that the infant will receive the full dose if they choose not to drink all the liquid in the bottle.

The nurse is providing care for a child who is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Which laboratory result does the nurse expect with this condition? 1. Low urine-specific gravity 2. High urine and low serum osmolarity 3. High serum sodium level 4. Increase in the hematocrit level

ANS 2 1 This is incorrect. Because fluid is retained with the diagnosis of SIADH, the specific gravity of urine is expected to be high (less fluid to the ratio of solutes). 2 This is correct. With a diagnosis of SIADH, the nurse will expect to see high urine osmolarity but low serum osmolarity on laboratory tests. The kidneys are unable to conserve appropriate amounts of water, so the body retains water, leading to water intoxication, hyponatremia, and cellular edema. 3 This is incorrect. The expected laboratory finding with SIADH is a low serum sodium level. Sodium will follow water back into the cells. 4 This is incorrect. The expected laboratory finding with SIADH is a decreased hematocrit.

3. A 15-year-old female asks the pediatric nurse how tall she may be as an adult. The adolescent's father is 6 feet 0 inches tall; her mother is 5 feet 4 inches tall. Which calculation will the nurse use to provide a probable answer? 1. Add the parents' heights in inches together; divide by 2; add 2.5 inches. 2. Add the parents' heights in inches together; divide by 2; subtract 2.5 inches. 3. Add the parents' heights in inches together and divide the total by 4. 4. Add the parents' heights in inches together; divide by 4; add 2.5 inches.

ANS 2 2. Add the parents' heights in inches together; divide by 2; subtract 2.5 inches. 2 This is correct. The height of both parents is 136 inches; divided by 2 = 68 minus 2.5 inches for a female. The patient will

The coroner is informed of the unexpected death of an infant at 3 months of age. The infant died during the night in the home of the parents. Which expectation does the nurse have regarding follow-up to the infant's death? 1. The hospital will pay for an autopsy if requested by the physician. 2. The coroner's office will not charge the parents if they request an autopsy. 3. The coroner can legally request an autopsy without the parent's consent. 4. The parents must give consent before an autopsy is performed for any reason.

ANS 3 3 This is correct. The coroner has the legal right to request an autopsy in any suspicious or unexpected death and does not need consent of the family if it is considered legally necessary. 1 This is incorrect. The physician may request an autopsy if the patient's cause of death is not known; however, the cost of the autopsy is covered by the coroner's office if the coroner agrees. The hospital is unlikely to be responsible for the cost. 2 This is incorrect. Families may request an autopsy if they wish to know the exact cause of the death of their child; if the coroner does not agree that an autopsy needs to be performed, the family may be responsible for the cost of the autopsy. 4 This is incorrect. The consent of the family is not needed if the autopsy is considered legally necessary, as in an unexpected or suspicious death.

34. A common psychological issue in children with Cushings syndrome is: 1. Depression due to not looking like others. 2. Post-traumatic stress disorder related to the body. 3. Autism. 4. Difficulty maintaining eye contact and meaningful relationships.

ANS: 1 Feedback 1. A child with Cushings will have an altered appearance from his/her peers. This leads to issues of depression for many children. 2. This is not an issue because a traumatic event does not occur in order for the disease to be present. 3. Few children with Cushings have an autism diagnosis. 4. Eye contact can be maintained and relationships can be made.

65. A nurse is planning care for a child with Adrenal Insufficiency (Addisons Disease). The priority nursing diagnosis is: 1. Risk for deficient fluid volume. 2. Risk for injury, secondary to hypertension. 3. Acute pain. 4. Imbalanced nutrition.

ANS: 1 Feedback 1. Adrenal insufficiency can cause a fluid deficit. The goal of care is to maintain fluid and electrolyte balance while normal levels of mineralcorticoids and corticosteroids are established. Therefore, acute pain and imbalanced nutrition are not a priority nursing diagnosis. 2. A symptom of adrenal insufficiency is hypotension, not hypertension. 3. Acute pain and imbalanced nutrition are not priority nursing diagnoses. 4. The goal of care is to maintain fluid and electrolyte balance while normal levels of mineralcorticoids and corticosteroids are established. Therefore, acute pain and imbalanced nutrition are not priority nursing diagnoses.

71. Mandatory newborn screening tests can identify children with which of the following endocrine disorders? 1. Congenital hypothyroidism 2. Hypopituitarism 3. SIADH 4. Congenital Hyperthyroidism

ANS: 1 Feedback 1. Although the newborn screening tests for many conditions, the primary endocrine disorder tested for is Congenital Hypothyroidism. The other listed disorders are not part of the newborn screening test. 2. The primary endocrine disorder tested for is Congenital Hypothyroidism. 3. SIADH occurs after birth and usually occurs in older children. 4. The primary endocrine disorder tested for is Congenital Hypothyroidism

4. Common injuries to pediatric and adolescent female genital tract include straddle injuries. These injuries result from a fall on a: 1. Bicycle. 2. Wagon. 3. Sidewalk. 4. Step.

ANS: 1 Feedback 1. Bicycles are a common cause of straddle injuries to childrens genitals as a result of falling over a blunt object. 2 Wagons are not a common cause of straddle injuries as they are not a blunt object. 3. Sidewalks are not a common cause of straddle injuries. A child does not fall easily into the periarea when on the sidewalk. 4. Steps are not a common cause of straddle injuries. A child does not fall into a straddled position on the steps easily.

22. Children with Sturge-Webers syndrome are at a high risk for: 1. Pediatric stroke. 2. Congenital heart complications. 3. Juvenile arthritis. 4. Type I diabetes.

ANS: 1 Feedback 1. Children with Sturge-Weber syndrome may have blood vessel angiomas in the brain, leading to a higher incidence for pediatric stroke. 2. Children with Sturge-Weber syndrome may have blood vessel angiomas, but this does not affect the heart. 3. Children with Sturge-Weber syndrome may have blood vessel issues, but this does not affect the joints. 4. The child is not at an increased risk for Type I diabetes

9. An example of the medulla of the adrenal glands working properly would be: 1. A child having an increase in heart rate and dilated pupils when scared. 2. A child relaxing and watching a video. 3. A child running a race with an increased respiratory rate. 4. A child having constricted pupils and a rapid heart rate after jumping rope.

ANS: 1 Feedback 1. The medulla contains adrenaline, which controls the fight-or-flight response, which causes an increase in heart rate and dilated pupils. 2. Relaxation is not a primary concern for the adrenal medulla. 3. The race is a planned event and does not create more stress, requiring the release of the adrenaline response. 4. The pupils will dilate if the medulla requires an increase in the release of adrenaline.

33. A child exhibits a positive Chvostek sign. This indicates that the child is at risk for: 1. Hyperparathyroidism. 2. Hypoparathyroidism. 3. Hypopituitarism. 4. Hyperpituitarism.

ANS: 2 Feedback 1. A child will not exhibit the positive Chvostek sign with hyperparathyroidism. 2. The lack of calcium in a child with hypoparathyroidism will exhibit tetany, which will give a positive Chvostek sign. 3. A child will not have the positive Chvostek sign with hypopituitarism. 4. A child with hyperpituitarism will not have a positive Chvostek sign.

25. Angelman syndrome is the deletion of which chromosome? 1. Maternal chromosome 12 2. Maternal chromosome 15 3. Paternal chromosome 17 4. Paternal chromosome 19

ANS: 2 Feedback 1. Angelman syndrome is not the deletion of the maternal chromosome 12. 2. Angelman syndrome is the deletion of the maternal chromosome 15. 3. Angelman syndrome is not the deletion of the maternal chromosome 17 4. Angelman syndrome is not the deletion of the maternal chromosome 19

20. Malignancies are common in children with Downs syndrome. The incidence is 18 times that of the general population for developing: 1. Colon cancer. 2. Leukemia. 3. Pancreatic cancer. 4. Bladder cancer.

ANS: 2 Feedback 1. Children with Downs syndrome are not at high risk for colon cancer. 2. The incidence of children with Downs syndrome developing leukemia is 18 times that of the general population. 3. Children with Downs syndrome are not at an increased risk for pancreatic cancer. 4. Children with Downs syndrome are not at an increased risk for bladder cancer.

57. A mother reports that her 3-year-old child with Downs syndrome snores loudly when sleeping. This occurs because: 1. Small nasal passageways are common with the syndrome 2. Hypopharynx and hypotonia are present with this syndrome. 3. Large tonsils are common with the syndrome. 4. Large adenoids are common with the syndrome

ANS: 2 Feedback 1. The nasal passageways are of normal size. 2. The hypopharynx and hypotonia leads to an airway that is obstructed, causing the snoring. 3. Tonsils are a normal size. 4. Adenoids are a normal size.

66. Hydrocephalus has been diagnosed in a fetus. At the delivery for the neonate, the nurse should anticipate: 1. A lethargic neonate. 2. A larger than average head circumference. 3. A stillbirth. 4. A neonate that appears the same as a counterpart without the diagnosis.

ANS: 2 Feedback 1. The neonate may have a tone similar to a healthy baby. 2. The head will be larger because of the extra fluid around the brain. 3. There is no indication of fetal demise. 4. The head circumference will be enlarged, and thus will not look similar to other newborns.

26. A 4 year-old has been admitted through the ER because of a diagnosis of the syndrome of Inappropriate Antidiuretic Hormone (SIADH). The nurse will need to monitor for: 1. Rapid weight loss. 2. Laboratory tests for hyponatremia. 3. Decreased turgor. 4. An increase in urine output.

ANS: 2 Feedback 1. The nurse will see a weight gain because of fluid retention. 2. SIADH causes fluid retention, thus the sodium level rises. 3. Turgor will be increased and doughy. 4. Urine is retained, so the output will be low.

58. Glucocorticoids, mineralcorticoids, and sex steroids are secreted by the: 1. Thyroid gland. 2. Adrenal cortex. 3. Anterior pituitary gland. 4. Parathyroid gland.

ANS: 2 Feedback 1. The thyroid gland supports the bodys metabolism. 2. The adrenal cortex of the adrenal gland is where glucocorticoids, mineralcorticoids, and sex steroids are produced. 3. The adrenal cortex of the adrenal gland is where glucocorticoids, mineralcorticoids, and sex steroids are produced. 4. The parathyroid gland is responsible for calcium and phosphorous regulation.

60. A goiter is an enlargement of which gland? 1. Adrenal gland 2. Anterior pituitary gland 3. Thyroid gland 4. Posterior pituitary gland

ANS: 3 Feedback 1. A goiter is an enlargement of the thyroid gland. 2. A goiter is an enlargement of the thyroid gland. 3. A goiter is an enlargement of the thyroid gland. The thyroid gland produces an oversecretion of the thyroid hormone that causes the gland to become enlarged. 4. A goiter is an enlargement of the thyroid gland.

27. The nurse receives the doctors order for a child with SIADH. She should clarify which of the following orders? 1. Weight check every 24 hours 2. Diet high in protein 3. IV of Normal Saline at 120ml/hr 4. Strict intake and output documentation

ANS: 3 Feedback 1. Because of water retention, weight should be checked every 24 hours. 2. A diet high in protein is needed to provide adequate nutrition and keep the amount of sodium low. 3. A hypertonic solution of sodium chloride should be used. 4. Strict I/O will provide the information to find out if water retention is occurring.

57. Which of the following is the most common cause of secondary hyperparathyroidism? 1. Diabetes mellitus 2. Congenital heart disease 3. Anterior pituitary gland 4. Parathyroid gland

ANS: 3 Feedback 1. Rarely occurs 2. Does not frequently occur 3. The most common cause of secondary hyperparathyroidism. 4. Does not frequently occur

8. A child has a history of hypoparathyroidism. While assessing the child, a nurse would expect to find: 1. A short, thick neck for a girl. 2. A malnourished child. 3. A small-statured boy. 4. A tall-statured girl.

ANS: 3 Feedback 1. The disease occurs in boys. 2. Nutrition is not an issue for growth for a child with hypoparathyroidism. 3. The disease occurs in boys. 4. The disease occurs in boys.

19. Which of the following statements is true of Turners syndrome? 1. It affects only girls. There are no living males with Turners syndrome. 2. It is the result of the loss of an entire X chromosome. 3. Both 1 and 2 4. None of the above

ANS: 3 Feedback 1. Turners syndrome is a condition that only occurs in females. 2. Turners syndrome is the result of an entire X chromosome loss. 3. Turners syndrome only affects females, and it is the result of an entire X chromosome loss. 4. Turners syndrome is the result of an entire X chromosome loss, and it only affects females.

50. Manifestations of hypoglycemia include which of the following? 1. Lethargy 2. Confusion 3. Nausea and Vomiting 4. Shakiness and Dizziness

ANS: 4 Feedback 1. A child is least likely to be lethargic with hypoglycemia. 2. If the child has reached a state of confusion, the child is very ill and needs medical attention immediately. 3. Nausea and vomiting are usually the cause for hypoglycemia. 4. The most common side effects of children with hypoglycemia include shakiness, dizziness, headache, extreme hunger, and perspiration.

6. Overproduction of the anterior pituitary hormones can cause all of the following except: 1. Hyperthyroidism. 2. Hypercorticosolism. 3. Precocious puberty. 4. Diabetes.

ANS: 4 Feedback 1. Hyperthyroidism occurs because of the oversecretion of thyroid stimulating hormone (TSH). 2. Hypercorticosolism occurs because of oversecretion in the anterior pituitary gland. 3. Precocious puberty occurs because of oversecretion in the anterior pituitary gland. 4. The cortex produces the hormones called glucocorticoids, which increase blood sugar, leading to a risk of diabetes.

32. Inderal has been prescribed for a 14 year old with hyperthyroidism because it helps: 1. Decrease the chance for thyroid storms. 2. Decrease the size of the goiter. 3. Treat a systolic murmur. 4. Decrease the episodes of tachycardia.

ANS: 4 Feedback 1. Inderal is a beta blocker that helps with tachycardia issues. 2. Inderal does not have an effect on a goiter because it is a medication for cardiac issues. 3. A systolic murmur will not respond to a beta blocker. 4. Inderal is a beta blocker that helps with tachycardia issues.

52. The nurse is discussing the various sites used for insulin injections with a child and family. Which of the following sties usually has the fastest rate of absorption? 1. Arm 2. Leg 3. Buttock 4. Abdomen

ANS: 4 Feedback 1. The arm has a lower level of subcutaneous tissue, so the absorption rate is slower. 2. The leg has a lower level of subcutaneous tissue, so the absorption rate is slower. 3. The buttock has a lower level of subcutaneous tissue, so the absorption rate is slower and is not easily accessible for self-injections. 4. Because of a larger amount of subcutaneous tissue in the abdomen, the medication is absorbed faster.

54. Which of the following is a characteristic of Type 1 diabetes mellitus? 1. Ketoacidosis is infrequent 2. Onset of the condition is gradual 3. Oral anti-hyperglycemic agents are an effective treatment options 4. Age at onset is usually less than 20 years old

ANS: 4 Feedback 1. The onset of Type 1 DM is very rapid and usually results in the emergent condition known as diabetic ketoacidosis. 2. This condition can be frequent, especially in children or teens who are poorly managed. 3. Oral anti-hyperglycemics are not indicated for Type 1 diabetes mellitus. 4. Diabetes mellitus Type 1 is a childhood disease and is mostly diagnosed before the age of 20. Type 2 diabetes mellitus usually occurs in middle-aged or older adults.

The nurse is assessing a 4-month-old infant who has a diagnosis of hypoparathyroidism. In which manner will the nurse assess the infant for pain related to the diagnosis? 1. Tap on a facial nerve and note the response. 2. Monitor closely for signs of seizure activity. 3. Assess for hyperreflexia of the muscles. 4. Carefully monitor cardiovascular status.

ANS 1 1 This is correct. Assessment of hyperreflexia of the muscles can be performed by tapping on the facial nerve. If a spasm occurs in the facial muscles, then a positive Chvostek sign has occurred. This confirms that the child has muscle spasms, pain, cramping, and twitches. 2 This is incorrect. Seizure activity is possible with a diagnosis of hypoparathyroidism, and recognition and management is essential. However, a seizure does not indicate the presence of pain. 3 This is incorrect. Assessment for hyperreflexia of the muscles should be performed frequently while calcium levels are unstable. However, this assessment alone does not indicate the presence of pain. 4 This is incorrect. The diagnosis of hypoparathyroidism can cause prolonged QT interval confirmed by 12-lead electrocardiogram (EKG) related to low calcium levels. Cardiac telemetry may be indicated, and the nurse should carefully monitor cardiovascular status. However, this action does not indicate the presence of pain.

The nurse is providing care for a pediatric patient who is receiving end-of-life care at the age of 12 years. In addition to the patient, the nurse is caring for the family members from a Middle Eastern culture, including younger siblings of the patient. Which comment by the nurse exemplifies appropriate communication? 1. "Please let me know if you have pain so that I can make you more comfortable." 2. "I know your son is going to heaven and all of you will be together in the future." 3. "Your brother is suffering, and you need to be strong and brave for him now." 4. "I understand you will be ready to move away from this life and on to the next."

ANS 1 1 This is correct. End-of-life communication with the patient needs to be compassionate and developmentally appropriate. The nurse needs to communicate a caring attitude about the patient's pain and comfort status. This comment is appropriate. 2 This is incorrect. When the nurse expresses personal beliefs, the cultural beliefs of the patient and family is violated. 3 This is incorrect. Telling a sibling younger than 12 years of age that their brother is suffering is likely to cause anguish to the sibling. Encouraging the sibling to be strong and brave is suggesting denial of feelings. 4 This is incorrect. When the nurse expresses feelings related to the patient's impending death, the nurse is interjecting personal feelings into the patient's situation; the nurse needs to focus on the patient's and family's feelings.

The nurse is counseling parents of an infant who have just learned their child has a cancerous tumor on a kidney. The parents keep repeating that nothing like this has happened in either of their families. Which explanation does the nurse provide to the parents? 1. Errors or changes in the process of cell division accounts for diseases such as cancers. 2. Some cells just randomly begin to divide differently and create a health risk or change. 3. Somewhere in one of the parents, a genetic defect has gone unidentified until now. 4. Most commonly defects such as cancer come equally from the genes of both parents.

ANS 1 1 This is correct. It is important that the nurse inform the parents that errors or changes in the process of cell division accounts for diseases such as cancers; however, genetic errors do not contribute to inherited disorders. 2 This is incorrect. Defects can occur when the ongoing process of cell reproduction is altered, which occurs by the process of mitosis—cell division into identical sister cells, each with 46 chromosomes or 23 pairs of alleles. 3 This is incorrect. The presence of cancer in a baby is not the result of a genetic defect; it is caused by a process error during mitosis. 4 This is incorrect. Cancer is not a genetic disorder caused by defective DNA from either parent. Errors during mitosis will manifest as illnesses.

A 13-year-old male patient is diagnosed with hypopituitarism and is prescribed to begin growth hormone replacement therapy. Which patient teaching information will best optimize the replacement therapy outcomes for the patient? 1. Clear communication about side effects of therapy and how they are managed 2. The chemical makeup and differences between the brands of somatotropin 3. How much and how quickly the patient will see the effects of the therapy 4. Psychotherapy for the family to deal with emotional problems of the condition

ANS 1 1 This is correct. Some of the side effects include headache and achiness in the joints and muscles, particularly the knees, ankles, and wrists. If side effects occur, the physician may decrease the starting dose and then increase the dose slowly until the side effects resolve. This information will best optimize the patient's outcomes. 2 This is incorrect. GH replacement therapy consists of daily subcutaneous injections of manufactured GH called somatropin. Several manufacturers have developed GH with different trade names. These derivatives of GH lack one amino acid but are otherwise identical to human GH. 3 This is incorrect. It is recommended to start children on GH therapy as early as possible to achieve the maximum growth benefit; however, the specific outcome is not predictable. 4 This is incorrect. Psychotherapy for the family to deal with emotional problems of the condition may or may not be necessary. If psychotherapy is recommended, it does not influence the physical outcomes of the hormone replacement therapy.

The nurse assesses the pain level of a school-age patient who is receiving end-of-life care and determines a need for pain medication. The physician has prescribed morphine sulfate to be administered either orally or rectally. For which reason will the nurse decide to administer the medication orally? 1. To prevent the patient from being embarrassed by rectal administration 2. To ensure the pain medication is absorbed as quickly as possible 3. To avoid stimulation of rectal spasms during insertion of the medication 4. To decrease the risk of respiratory suppression

ANS 1 1 This is correct. The administration of medication rectally is likely to cause a school-age client to be embarrassed. When possible, the nurse will prevent psychosocial discomfort as well as physical discomfort. 2 This is incorrect. The oral form of morphine sulfate is effective; however, the rectal route is likely to be absorbed more quickly. 3 This is incorrect. The rectal insertion of morphine sulfate is not likely to stimulate rectal spasms. 4 This is incorrect. The side effects of morphine sulfate are the same regardless of the route of administration.

The nurse is providing end-of-life care to a pediatric patient and family. The nurse understands the need for communicating with the multidisciplinary care team regarding the patient and family needs. For which reason is multidisciplinary communication with the patient's nurse so important? 1. The nurse has the most contact with the patient and family and acts as an advocate and voice for their care. 2. The multidisciplinary team relies on the nurse to provide appropriate education to the patient and family during end-of-life care. 3. As the sole communicator, the nurse can make sure that all members of the multidisciplinary team are equally informed. 4. The patient and family can communicate with the nurse with whom they have built a trusting relationship.

ANS 1 1 This is correct. The nurse has the most contact with the patient and family and acts as an advocate and voice for their care. The nurse can determine effectively which member of the multidisciplinary team should be contacted in order to provide the best care. 2 This is incorrect. The nurse, during end-of-life care, is not expected to provide education to the patient and family; this task is more appropriate for hospice nurses. 3 This is incorrect. The nurse is not the sole communicator during end-of-life care; in addition, not all multidisciplinary team members need to receive the exact same communication. 4 This is incorrect. When the nurse is providing appropriate and effective end-of-life care, the patient and family will build a trusting relationship with the nurse. However, this role as advocate is different than the communication role with multidisciplinary team members.

The pediatric nurse is providing care for a terminally ill patient who is 17 years of age. The patient has been resistant to aggressive chemotherapy because of undesirable side effects. The patient states, "I have finally convinced my parents to sign a DNR order. It is my life, and I should be able to decide how I want to live." Which legal consideration causes the nurse greatest concern? 1. A DNR order can be reversed at any time by the legal guardians. 2. The primary physician can deny a DNR if the patient is a minor. 3. The patient does not understand all aspects of the DNR order. 4. A DNR can be written to provide partial life-sustaining interventions.

ANS 1 1 This is correct. The nurse is aware that the patient is a minor and only legal guardians can determine a minor's DNR status. The patient's sense of satisfaction is the nurse's greatest concern, because legal guardians can reverse a DNR decision at any time. 2 This is incorrect. Primary physicians cannot deny a DNR order just because the patient is a minor. The legal guardians have the right to request the order and the physician has the responsibility to make sure they understand all aspects of the decision. 3 This is incorrect. The minor patient may or may not understand all aspects of a DNR order; this is not likely to be the nurse's greatest legal concern. 4 This is incorrect. It is true that a DNR order can be written to provide partial or limited life-sustaining interventions. This is not the nurse's greatest legal concern.

The nurse is presenting information to pregnant couples about the "safe to sleep" campaign to prevent SIDS. One attendee states, "Babies sleep best on their bellies. What difference does position make?" Which answer by the nurse is best? 1. "Positioning on the back opens the airway fully." 2. "Sleeping face down increases the risk of aspiration." 3. "The most dangerous time is 2 to 4 months of age." 4. "Of greater importance is not using blankets."

ANS 1 1 This is correct. The nurse should always educate parents to put their infants on their backs to sleep to help prevent sudden infant death syndrome by keeping the airway fully open. 2 This is incorrect. Placing the infant face down may increase the risk of aspiration if the infant vomits or spits up. However, the best answer is the one that defends how the parents can avoid the incidence of SIDS, which is the primary cause of unexpected infant death. 3 This is incorrect. The nurse can share that the most vulnerable age for SIDS is between 2 and 4 months of age. However, this does not reinforce the physiological reason why infants need to sleep on their back. 4 This is incorrect. Parents are instructed to keep blankets and other objects that can cause suffocation out of the infant's crib. However, this comment does not reinforce the physiological reason why infants need to sleep on their back.

5. The nurse on a pediatric unit is admitting a 6-week-old infant. Symptoms include a wet daily diaper count of 10 to 12 a day, irritability, constipation, and dehydration. For which medical prescription does the nurse contact the physician? 1. Limit oral intake of water to 200 mL per shift. 2. Weigh diapers to measure 24-hour urine output. 3. Check urine-specific gravity every 8 hours. 4. Allow the mother to continue breastfeeding.

ANS 1 1 This is correct. The patient is exhibiting the symptoms of diabetes insipidus (DI). Dehydration is a critical effect of DI in children. Severe dehydration can occur very quickly in infants and smaller children, so fluids must be increased as soon as possible during exacerbation. Water deprivation testing is the only time water is restricted with this diagnosis. The nurse will contact the physician about this prescription. 2 This is incorrect. A 24-hour output will help confirm the diagnosis of DI. 3 This is incorrect. It is not unusual for the urine-specific gravity of a patient suspected of DI to be checked every 8 hours. 4 This is incorrect. The method of feeding is not an issue; however, irritability in infants can only be relieved by giving water instead of formula or breast milk.

The nurse is presenting a workshop about reproduction to other nurses. In which manner will the nurse explain the reason why all offspring from the same parents do not look exactly alike? 1. The rapid process of meiosis can result in some loss or gain of genetic material. 2. The meiosis in the oocyte will change as the age of the contributing female increases. 3. Meiosis in a male creates a spermatocyte, which is extremely genetically unstable. 4. Meiosis commonly causes some chromosomes to be normal and others abnormal.

ANS 1 1 This is correct. The rapid process of meiosis can result in some loss or gain of genetic material, which is the reason for genetic variance. 2 This is incorrect. Increased maternal age can result in increased gene errors, because these oocytes have been present for the lifespan of the mother; however, this is not the reason for genetic variance. 3 This is incorrect. Although meiosis in a male does produce spermatocytes, spermatocytes are not genetically unstable. 4 This is incorrect. Rarely, some of the cell's chromosomes are normal and others are abnormal, a condition called mosaicism.

58. An infant has been born with a known diagnosis of Trisomy 13. The nurse should note that: 1. End-of-life care will be important for the family and the infant. 2. Genetic testing will need to be done immediately after arriving to the neonatal intensive care unit. 3. The family should not hold the child. 4. Education about reducing the chance for another child with Trisomy 13 should be provided for the family.

ANS 1 1. A child with Trisomy 13 has a short life expectancy. Helping the parents provide comfort care for the infant will be an important care for the nurse to provide. 2. Children with Trisomy 13 have particular markers for the disease. The genetic testing will need to be done, but not immediately upon arrival to the unit. 3. Holding and comforting the infant helps with bonding between the parent and child. 4. Trisomy 13 is not known to have a genetic link, so other pregnancies are at little risk. KEY: Content Area: G

1. The school nurse is teaching a middle-school class about the hormones that regulate body functions. Which information provided by the nurse is accurate? 1. Hormones are chemicals secreted by endocrine glands. 2. Hormones act specifically on the glands that produce them. 3. Hormones react with negative feedback as levels decline. 4. Hormones are made from proteins, fats, and carbohydrates.

ANS 1 1. Hormones are chemicals secreted by endocrine glands. It is true that hormones are chemicals produced by the endocrine glands and circulated in the bloodstream to another part of the body.

The parents of a dying child have decided to withdraw medical treatment and allow their child to die peacefully. Which nursing actions will occur after the withdrawal is implemented? Select all that apply. 1. Monitoring equipment is turned off. 2. All invasive lines are disconnected. 3. Periodic validation is sought from the family regarding the decision to end care. 4. A comfortable, peaceful environment is created for the patient and family. 5. The family is provided with undisturbed privacy.

ANS 1, 2, 4, 5 1. This is correct. Monitoring equipment is turned off; when operating, the equipment can be a disturbing distraction. 2. This is correct. Invasive lines and equipment are removed in order to present the patient with an appearance as normal as possible. 4. This is correct. The patient's linens can be changed or straightened, lights can be dimmed, and the patient placed in a comfortable position. Chairs and other desired accommodations are provided for the family. 5. This is correct. In order to ensure uninterrupted privacy, the door should be closed and the family left undisturbed unless they seek assistance. 3. This is incorrect. The family can decide to reinstate medical care if they desire; however, the nurse does not check periodically to see if the decision for withdrawal of care is changed.

The nurse is providing end-of-life education to parents of a child diagnosed with a terminal illness. Which topics of education are important for the nurse to provide? Select all that apply. 1. Explain how the progression of the disease will affect their child. 2. Describe the physical changes that will occur during the dying process. 3. Suggest several funeral homes to be contacted before death. 4. Explain that pain management will interfere with communication. 5. Describe what to expect after death including how the child will look.

ANS 1, 2, 5 1. This is correct. The nurse needs to cover the topic of how the progression of the disease will affect their child. This information will help the parents to distinguish between expected and unexpected changes. 2. This is correct. The nurse needs to cover the topic of the physical changes that will occur during the dying process. Some topics will include skin alterations, breathing alterations, altered consciousness, and changes in verbalization. 3. This is incorrect. End-of-life education does not involve providing a list of funeral homes to contact prior to the death. Families may have a funeral home in mind, and planning before the death may be offensive to some families. 4. This is incorrect. Pain management may or may not interfere with communication. The parents need to be encouraged to talk to their child even when two-way communication is not possible. 5. This is correct. The nurse needs to cover the topic of what to expect after death. Some families are concerned that the physical appearance is grossly altered. The parents also need to know about how the body will be cared for and about making funeral arrangements.

The nurse works on a pediatric unit that allows parents to remain in the room if the patient is coded. The nurse is aware that having persons in the room other than medical personnel can present safety issues. Which concerns are important to address? Select all that apply. 1. The possibility of an accidental shock during cardiac shock delivery 2. The possibility of accidental contamination of sterile fields and procedures 3. The possibility of medical staff being blocked from access to the patient 4. The possibility of medical staff being interrupted by emotional verbalization 5. The possibility of overcrowding interfering with needed medical equipment

ANS 1, 3, 5 1. This is correct. It is important for the nurse to be concerned about the safety of the family. The concern about family members not touching the bed or medical equipment during cardiac shock delivery will need to be addressed. 3. This is correct. For the safety of all involved, it is important to ensure that family members are not in the way of medical staff or interfere with treatment. 5. This is correct. For the safety of all involved, it is important to ensure that family members are not in the way of medical equipment. 2. This is incorrect. Most codes are not run in a sterile location. It is unlikely that the presence of a family member would cause more contamination than other members of the code team. 4. This is incorrect. It would be unexpected for emotional verbalization from a family member to interrupt the medical staff. A staff member should always be with the family to monitor behaviors and provide information.

A 19-year-old patient has a history of hyperthyroidism that is managed with medication. The patient recently moved into an apartment and is living independently. Which behavior indicates to the nurse the patient is continuing appropriate health management? Select all that apply. 1. The patient called for refills of antithyroid medications and beta-blocking agents. 2. The patient went to an urgent care facility over the weekend for a sore throat and fever. 3. The patient reports experiencing tachycardia, restlessness, and tremors for a week. 4. The patient's last laboratory results indicates a high level of T4. 5. The patient stops the medication for 1 month once a year to promote hair regrowth.

ANS 1,2 1. This is correct. Calling for refills of antithyroid medications and beta-blocking agents indicates to the nurse that the patient is managing health care appropriately and understands medication compliance. 2. This is correct. Going to an urgent care facility over the weekend for a sore throat and fever indicates the patient understands the manifestations of agranulocytosis, which can be fatal. 3. This is incorrect. Beta-blocking agents do not decrease the amount of thyroid hormone they provide comfort for the patient who is experiencing tachycardia, restlessness, and tremors. Experiencing these symptoms for a week indicates a lack of medication compliance. 4. This is incorrect. Laboratory results indicating a high level of T4 are a sign of noncompliance with antithyroid medications. 5. This is incorrect. Stopping the medication for 1 month once a year to promote hair regrowth is indicative of medication noncompliance and lack of knowledge regarding medication side effects.

The nurse is preparing a teaching plan for a patient and family. The patient is diagnosed with hyperpituitarism. Which teaching information will optimize therapy outcomes for the patient? Select all that apply. 1. Education about home administration of medications 2. Education about the disorder and treatment options 3. Explanations of long-term complications for noncompliance 4. Signs of excess bone growth and other features of gigantism 5. The impact of a tumor on or near the hypothalamus or pituitary gland

ANS 1,2,3 1. This is correct. Information about home medications such as somatostatin analogs, dopamine agonists, and GH receptor antagonist will optimize the outcomes for a patient with hyperpituitarism. 2. This is correct. Education about the disorder and treatment options will broaden the patient's and family's understanding of the condition and promote better informed decisions. 3. This is correct. The severity of long-term complications related to noncompliance is likely to optimize the outcomes for a patient with hyperpituitarism. Complications include hypertension, cardiomegaly, subsequent cardiovascular disease, diabetes mellitus, osteoarthritis, sleep apnea, and early death. 4. This is incorrect. Signs of excess bone growth and other features of gigantism are manifestations of the condition, and information is not likely to optimize the outcomes for the patient with hyperpituitarism. 5. This is incorrect. If the patient has a tumor on or near the hypothalamus or pituitary gland, the patient may have precocious puberty in conjunction with the other manifestations of hyperpituitarism. This information is not likely to optimize the outcomes for the patient.

The nurse is providing care for a neonate born to a mother with a history of alcoholism. The nurse is concerned the neonate will need special attention because of fetal alcohol spectrum disorder. Which specific concerns will the nurse relay to the assigned case worker? Select all that apply. 1. The probability of delay in physical growth 2. Adequate feeding opportunities and amounts 3. Expected overreactivity to the environment 4. The possibility of developmental delay 5. Susceptibility to respiratory disorders

ANS 1,2,3,4 1. This is correct. Growth deficiency in the child with fetal alcohol spectrum disorder starts at infancy and lasts throughout life. Affective interventions are not likely. 2. This is correct. Neonates with fetal alcohol spectrum disorder have difficulties with suck/swallow/breath coordination and are prone to aspiration. These manifestations may cause a mother with a history of alcoholism to be impatient with feeding the neonate. The mother may be negligent during periods of drinking. 3. This is correct. Neonates with fetal alcohol spectrum disorder are over-reactive to environmental stimuli. 4. This is correct. Neonates diagnosed with any of the FASD subtypes are at risk for significant cognitive impairment and physical anomalies. Impulsivity, attention issues, and frank ADHD are common. 5. This is incorrect. Fetal alcohol spectrum syndrome primarily affects the brain. There is no specific concern over the susceptibility to respiratory disorders.

The pediatric nurse is preparing a community education program for parents and children who have endocrine disorders. With which normal regulatory functions does the nurse begin the presentation before covering endocrine disorders? Select all that apply. 1. Growth and development 2. Sexual development 3. Energy use and storage 4. An individual's response to stress 5. Levels of glucose, fluid, and sodium in the blood

ANS 1,2,3,4,5 1. This is correct. The endocrine system regulates growth and development. 2. This is correct. The endocrine system regulates sexual development. 3. This is correct. The endocrine system regulates energy use and storage. 4. This is correct. The endocrine system regulates an individual's response to stress. 5. This is correct. The endocrine system regulates the levels of glucose, fluid, and sodium in the blood.

The nurse in a pediatric clinic is performing a scheduled check-up for a 6-year-old child diagnosed with Williams syndrome. The child will be mainstreamed during the first year of school. Which information will the nurse provide to the parent of this child? Select all that apply. 1. The child is most likely to have a low normal IQ score. 2. Frequently attention deficit-hyperactivity disorder (ADHD) is present. 3. Appearance-wise, the child should fit in with other children. 4. Stairs and other uneven surfaces may be difficult for the child to negotiate. 5. The child has a strong memory for auditory information.

ANS 1,2,4,5 1. This is correct. IQ scores on standard tests range from severe intellectual delay to low normal. 2. This is correct. Attention deficit-hyperactivity disorder (ADHD) is present in about 70% of the children with Williams syndrome. 3. This is incorrect. The child with Williams syndrome will have a characteristic pattern of dysmorphic facial features, including broad forehead, bitemporal narrowing, low nasal root, and periorbital fullness, to name a few. 4. This is correct. The child with Williams syndrome will exhibit difficulty with gross motor function and depth perception; it will be very difficult to negotiate uneven surfaces and stairs. 5. This is correct. The child with Williams syndrome will have difficulty with handwriting, drawing, buttoning, and pattern construction, as well as poor math skills. However, there is a strong memory for auditory information, such as instructions read out loud.

The pediatric nurse conducts a blood sampling for PKU, which is a standard policy in most states of the United States. The parents want to void a heel stick for the blood screening and ask why the test is so important. Which answers will the nurse provide? Select all that apply. 1. PKU stands for a genetic mutation of a single base pair of chromosomes. 2. PKU results in an accumulation of phenylketonuria in the kidneys. 3. PKU is a required newborn screening for metabolic disorders. 4. Phenylalanine is an essential protein present in many foods. 5. Once PKU is diagnosed, the child's diet can resume to normal.

ANS 1,3,4 1. This is correct. Phenylketonuria (PKU) is caused by a single mutation at a single site or base pair mutation. PKU results in an abnormality in the production of phenylalanine hydroxylase, the enzyme that breaks down the protein phenylalanine. 2. This is incorrect. The result is an accumulation of phenylalanine in the blood and the brain, causing brain damage with progressive intellectual disability. 3. This is correct. All 50 states now screen for PKU as part of the standard newborn screening. The nurse needs to ensure the screen is performed when a child has been fed full-strength formula or breast milk, ideally for 48 hours. 4. This is correct. Phenylalanine is an essential protein; it cannot be removed completely from the human diet, but caregivers need to provide a phenylalanine-free formula and low-protein diet with very close monitoring by a nutrition specialist. 5. This is incorrect. Once brain injury occurs it is irreversible, so the restrictive diet is recommended for life. Once screened as abnormal, individuals require immediate referral to a geneticist and a metabolic nutritionist for information on protein restriction.

A pediatric patient with a terminal disease is placed in hospice care. In addition to patient care, which other services provided by a multidisciplinary team will meet the needs of the patient and family? Select all that apply. 1. Social work 2. Child-life specialist 3. Community programs 4. Physician 5. Grief counselor

ANS 1. 2. 4 1. This is correct. Social work ensures that the family's nonmedical needs, such as housing and employer notification, are met. 2. This is correct. The child-life specialist provides age- and developmentally appropriate toys and environment for patient and siblings. 3. This is incorrect. Community programs and support programs will most likely be recommended to the family after the death of the patient. 4. This is correct. The physician leads medical care and orders medications and interventions while providing the patient and family with education regarding the diagnosis. 5. This is incorrect. A grief counselor is most likely to assist the family after the death of the patient.

A 10-year-old patient is diagnosed with type 2 diabetes mellitus. Which medical history finding will help the nurse identify alternative interventions for managing the patient's condition? 1. The patient's ethnicity group is African American. 2. The patient's BMI is greater than 85th percentile for age and weight. 3. The patient's mother had gestational diabetes during her pregnancy. 4. The patient's extended family exhibits a high incidence of diabetes.

ANS 2 1 This is incorrect. Certain race/ethnicity groups such as African American, Latino, Asian American, American Indians, and Pacific Islanders have a higher risk for type 2 diabetes mellitus. However, there is no alternative intervention that will diminish this risk. 2 This is correct. A BMI greater than the 85th percentile for age and weight is an indication of childhood obesity, which is a major contributor to the increasing numbers of type 2 diabetes mellitus in children. The alternative intervention the nurse will recommend is increased exercise and a decrease in sedentary lifestyle. 3 This is incorrect. Maternal history of gestational diabetes or diabetes during pregnancy puts the child at higher risk for type 2 diabetes mellitus. However, there is no alternative intervention that will diminish this risk. 4 This is incorrect. A family history of type 2 diabetes mellitus places the child at a greater risk for the condition. The nurse may or may not be able to suggest alternative interventions that will diminish this risk.

An adolescent female, age 17 years, independently seeks care at the public health department. The adolescent reports lower abdominal pain with walking but no vaginal discharge. The adolescent also shares being sexually active with multiple partners. After confirming a pelvic inflammatory infection (PID), which is the most important teaching by the nurse? 1. Information about the probability of infertility with PID 2. Instructions about taking and completing antibiotic therapy 3. Reasons for contacting sexual partners for necessary treatment 4. Importance of not being sexually active with multiple partners

ANS 2 1 This is incorrect. PID may cause a variety of pelvic organ infections. Repeated infections can result in infertility. This teaching is important; however, other information is most important. 2 This is correct. Because PID is a serious infection caused most often by genital gonorrhea or the effects of other infections, the nurse's most important teaching is focused on instructions about taking and completing antibiotic therapy. Failure to treat the infection correctly will result in complications. 3 This is incorrect. Because PID is caused most often by genital gonorrhea and the effect of other infections, the patient needs to inform her sexual partners of the likelihood of them having an STI. This is important, but the nurse's first focus is on the patient. 4 This is incorrect. The importance of not being active with multiple partners is good information; however, the patient needs to know that even one sexual partner can be a source of STIs. The better information is about safe sex and/or abstinence.

. A parent brings a 15-year-old adolescent to the emergency department because of severe lower abdominal pain, with nausea and vomiting. Physical examination reveals a swollen scrotum and tenderness of one testicle. Which additional assessment finding supports the possibility of testicular torsion? 1. The symptoms have been intermittent since the patient's birth. 2. The testis lies horizontally and there is a reactive hydrocele. 3. The unaffected testicle is lifted higher in the scrotal sac. 4. The symptoms are intermittent and resolve suddenly.

ANS 2 1 This is incorrect. Peak incidence is in boys 12 to 18 years old; it is a smaller group in neonatal period. Torsion is corrected regardless of the age when it is first diagnosed. 2 This is correct. Along with being tender and swollen, the testis may lie horizontally and may have a reactive hydrocele. 3 This is incorrect. With scrotal edema, the affected testis is tender, swollen, and slightly elevated. The unaffected testis is not elevated. 4 This is incorrect. Intermittent torsion can present with intermittent sharp pain and swelling, then rapid resolution; however, there is no information in the scenario that validates the patient having prior experience with the condition.

With endorsement from the family, the physician initiates hospice care for an adolescent patient who is terminally ill. For which family expectation about hospice care will the nurse provide additional information? 1. The patient will have a graceful, natural death. 2. The patient will die in the hospital. 3. Compassionate care will be focused on patient comfort. 4. The family can be involved in care as much as desired.

ANS 2 1 This is incorrect. There is no need to provide additional information if the family understands that a hospice goal is for the patient to have a graceful, natural death. 2 This is correct. If the family anticipates that the patient will die in the hospital, the nurse can provide additional information that hospice care can also take place in the patient's home with visiting nurses and care aides. Some hospice groups have an independent facility. 3 This is incorrect. There is no need to provide additional information if the family understands that hospice will provide compassionate care focused on patient comfort. 4 This is incorrect. There is no need to provide additional information if the family understands they can be as involved as much as desired in the patient's care.

A 16-year-old patient is approaching the terminal stage of a brain tumor. The nurse notices the patient is calling friends and making plans for a social gathering several months away. When friends are present the patient assures them of a full recovery because of a new doctor. The nurse recognizes the patient is experiencing which stage of grief? 1. Acceptance 2. Denial 3. Anger 4. Bargaining

ANS 2 2 This is correct. Unwillingness to accept the diagnosis and lack of trust in medical staff are indicative of denial. 1 This is incorrect. Statements of understanding of the loss, positive outlook, and discussion of the future are indicative of acceptance. 3 This is incorrect. Anger or aggression toward staff or family members and verbal arguments and confrontations are common during the grief stage of anger. 4 This is incorrect. Reliance on a higher power to prevent death and believing that promises of future behavior will prevent death are indicative of bargaining.

The nurse at a pediatric clinic is examining a 1-month-old infant. The nurse notices eight café au lait spots on the infant's skin and two nodelike lesions on the upper extremities. When questioned, the parent tells the nurse, "All three of my kids have those. In fact I have some myself." Which conclusion will the nurse make based on assessment findings and the parent's comments? Select all that apply. 1. The parent, the infant, and the infant's siblings will have the same manifestations. 2. The infant displays two of seven criteria for diagnosing neurofibromatosis type 1. 3. The parent needs to have testing to identify an autosomal dominant genetic defect. 4. The siblings of the infant are likely to be diagnosed with neurofibromatosis type 1. 5. The affected family members are at a greater lifelong risk for malignancies.

ANS 2,3,4,5 1. This is incorrect. Individuals in the same family will present with unique manifestations. 2. This is correct. The infant does present with 2 of the 7 criteria for diagnosing neurofibromatosis type 1: eight café au lait spots and two nodelike lesions on the upper extremities. 3. This is correct. Because the parent and three older siblings to the infant are exhibiting the symptoms of the disorder, the parent needs to have testing to identify an autosomal dominant genetic defect. 4. This is correct. If the infant's siblings exhibit the manifestations of neurofibromatosis type 1, it is safely assumed they also have the disease. 5. This is correct. The lifelong risk for malignancy in affected individuals is increased. Malignant peripheral nerve sheath tumors represent the most common neoplasm. The family will be closely monitored for this and multiple other manifestations.

The nurse is providing care for a neonate with a port-wine stain on the left side of the face, which involves the eye. The nurse recognizes which nursing interventions are likely to be initiated as the neonate grows? Select all that apply. 1. Obtaining genetic testing before planning another pregnancy 2. Assisting parents to locate treatment for the facial deformity 3. Stressing the importance of early and regular eye examinations 4. Teaching about the management of seizure activity, if present 5. Reinforcing the reasons for an MRI of the brain and blood vessels

ANS 2,3,4,5 1. This is incorrect. Sturge-Weber syndrome is a rare condition caused by a spontaneous genetic mutation in the GNAC gene that affects the skin and the brain. This mutation cannot be transmitted from parent to child, and there is no reason for genetic testing of the parents. 2. This is correct. In some cases, laser surgery can be done for infants as young as 1 month to reduce the size (and therefore the long-term effects) of the port-wine stain lesion. 3. This is correct. Glaucoma is also common, usually in the eye affected by the port-wine stain. The eye may sometimes become enlarged. Glaucoma can be managed with medications; early diagnosis is important. 4. This is correct. If brain lesions are present, they can cause seizures, usually occurring before the first birthday. The seizures tend to worsen with age and may be convulsions on the opposite side of the body from the skin discoloration. 5. This is correct. Blood vessel growths called angiomas can occur on the brain and cause seizures. These angiomas may or may not be surgically repairable, depending on their size and location. An MRI of the brain and the brain blood vessels should be performed to identify angiomas.

The nurse in a pediatrician office has been providing care for a patient with Angelman syndrome since birth. The nurse performs a general physical assessment, reviews documentation of dysmorphic features or obvious abnormalities, and assesses for the presence or absence of developmental milestones. Which information shared by the parent indicates appropriate care of the patient? 1. The parent expresses concern about the cost of special therapies. 2. The parent and child are using basic sign language to communicate. 3. The parent tells the nurse that sleep cycles are still 2 hours long. 4. The parent responds in like to the child's happy, laughing demeanor. 5. The parent informs the nurse of the child's dyspnea during playtime.

ANS 2,4,5 1. This is incorrect. When the parent expresses concern about the cost of special therapies, it may be an indication to the nurse that the parent is experiencing financial stress, which may impact the care of the child. 2. This is correct. The child with Angelman syndrome will have intellectual disabilities and severe speech and language impairment. Using sign language as a means of communication is indicative of effort to meet the child's needs. 3. This is incorrect. When the parent states that the child's sleep cycles are still 2 hours long, the parent is expressing fatigue related to the short sleep cycles of the child with Angelman syndrome. Caregiver fatigue can affect the care of the child. 4. This is correct. Children with Angelman syndrome are often laughing and happy in demeanor; when the parent responds in like, the parent is embracing the child's behavior. 5. This is correct. Some chromosomal disorders associated with Angelman syndrome may cause multiple malformations, such as heart defects or kidney defects. The fact that the parent is involved enough to notice a possible physical problem indicates appropriate care of the patient.

The nurse works in a pediatric hospice unit in an acute care facility. The nurse is currently providing care to an infant. Which assessment tool does the nurse use to identify the infant's level of pain? 1. Faces scale 2. FLACC 3. Visual analogy scale 4. NIPS

ANS 2. 2 This is correct. The FLACC scale (faces, legs, activity, cry, consolability scale) is used for newborn to 7 years. This assesses the patient's facial expression, leg positioning and flexion, activity level, crying level, and consolability. This is the appropriate scale for this patient. 1 This is incorrect. The faces scale is only for patients aged 3 years and older; the child must be developmentally able to read and recognize faces drawn with various levels of painful expressions. This pain scale asks the child to choose the face that best represents his or her pain level. The patient is too young for this scale 3 This is incorrect. The VAS is for children aged 7 years and older who have the developmental ability to use the traditional pain scale based on numbers 0 to 10 for pain rating. The patient is too young for this scale. 4 This is incorrect. The neonatal and infant pain scale (NIPS) is for newborns. This assesses the newborn's cry, facial expression, respiratory pattern, position and flexion of the arms and legs, and level of alertness. The scale is better suited for newborns.

The nurses on a unit that cares for terminal pediatric patients wish to implement a change in facility policy to allow parents/guardians to remain during a patient code. Which is the most powerful reason that nurses can present to administration? 1. Family-centered care can be continued during a very stressful situation. 2. The family knows everything possible was done to save the patient. 3. The family experiences greater communication and decreased confusion. 4. Family may desire to stay during specific interventions that seem inappropriate.

ANS 2. 2 This is correct. Having family stay during a code can be positive because the family knows everything possible was done to save the patient. This is the most powerful reason for the nurses to present to administration. 1 This is incorrect. Family involvement in pediatric code situations provides family-centered care during a very stressful situation. Without additional planning and discussion, this is not the most powerful reason for the nurses to present to administration 3 This is incorrect. Continuation of family-centered care in pediatric code situations is to create greater communication and decrease confusion for the family. However, this is not the most powerful reason for the nurses to present to administration unless there is strong support from other members of the multidisciplinary team members. 4 This is incorrect. The family may attempt to be at the bedside, which can be inappropriate with specific interventions; an example would be open-chest procedures. This point would require discussion and the development of guidelines.

The nurse is providing care for a pediatric patient and family during the time when death of the patient seems imminent. The family is of American Indian culture and has summoned tribal members to come and chant and pray at the bedside. Which behavior by the nurse is culturally correct? 1. Move the patient, family, and tribal members to an isolated location. 2. Ask the family to respect other patients by keeping the volume of chanting low. 3. Ask if the family has any additional needs, close the door, and provide privacy. 4. Call the nursing supervisor and ask for assistance in managing the situation.

ANS 3 3 This is correct. Cultural considerations for pediatric end of life include respecting the cultural beliefs of the family and patient. Providing culturally competent care requires the nurse to incorporate the cultural beliefs of the family and patient into daily care. The spiritual needs of family and patient require the nurse to incorporate the spiritual beliefs of the family and patient into daily care. 1 This is incorrect. Moving the family to an isolated location can be interpreted as disrespect for the patient's and family's culture. 2 This is incorrect. Asking the family to respect other patients by keeping the volume of chanting low can be interpreted as disrespect for the patient's and family's culture. 4 This is incorrect. There is no reason to call the supervisor, and there is no situation to manage. The nurse can effectively provide the family cultural support by closing the patient's door and giving the family and tribal members' privacy.

The nurse is counseling a couple who has a neonate exhibiting the manifestations of trisomy 21. This is the couple's first child, and they have no identifiable risks. Which explanation does the nurse provide to the parents? 1. Advanced maternal age will cause an alteration in an oocyte before reproduction. 2. An exposure to a highly contagious viral infection is responsible for the defect. 3. Errors or abnormalities in a child can occur at any time during the process of development. 4. Fertilization is likely to have occurred with an immature spermatocyte from the male.

ANS 3 1 This is incorrect. Advanced maternal age can cause an alteration in an oocyte before reproduction; however, the scenario states no identifiable risks were associated with the parents. 2 This is incorrect. No information in the scenario identifies an exposure to a highly contagious viral infection. 3 This is correct. Errors or abnormalities can occur at any time during the process of development, from meiosis, to mitotic division after fertilization, to cell differentiation, and organ formation and development. 4 This is incorrect. Spermatocytes are immature sperm cells that are not capable of fertilization.

The nurse in a NICU nursery is providing care for a newborn diagnosed with congenital hypothyroidism. During hospitalization, which home-care concept will the nurse include in the newborn's care? 1. Mix thyroid replacement hormone medication in a bottle of milk. 2. Increase dietary fiber with a soy-based formula to prevent constipation. 3. Ask the breastfeeding mother to bring breastmilk to the hospital. 4. Administer hormone replacement medication using a medicine dropper.

ANS 3 1 This is incorrect. Instruct parents to administer medication via needleless syringe and not to put medication in a bottle, which may or may not be completely consumed. 2 This is incorrect. Instruct parents that formula should be milk-based and not soy-based, because soy-based formulas can break down the effects of the medication. 3 This is correct. Because the mother is breastfeeding, the nurse can use breastmilk for the administration of thyroid hormone replacement medications. The medication will be crushed and mixed with a small amount of breastmilk. 4 This is incorrect. Medications are administered to newborns and infants using a needleless syringe to assure accurate dosage.

The school nurse is teaching a high school class about sexually transmitted infections (STIs) and specifically covers gonorrhea. A student states, "We all practice safe sex; no vaginal intercourse ever." Which reply by the nurse directly addresses the student's comment? 1. "That is good practice but still requires a condom." 2. "The only advantage is a low risk for pregnancy." 3. "Gonorrhea is spread by multiple sexual practices." 4. "I'm surprised that adolescents will admit that."

ANS 3 1 This is incorrect. Rather than encouraging sexual activity among high school students, the nurse needs to address the risks and prevention. 2 This is incorrect. The only advantage to non-vaginal sex is not about the prevention of pregnancy. The nurse needs to address the other risks related to non-vaginal sex. 3 This is correct. Infection from STIs can occur in the cervix, vagina, and fallopian tubes in women but also the eyes, throat, urethra, and anus of males and females. Gonorrhea may also spread to the blood or the joints, causing painful arthritis with red, swollen joints. Gonorrhea is spread by contact with infected sites, most often through sexual contact in adolescents. 4 This is incorrect. The nurse expressing surprise about the student's information is not therapeutic and will shut down communication between the nurse and the students about the topic.

The school nurse is answering questions about anatomy and physiology in a middle school science class. One student asks, "How does our body become either a girl or a boy?" Which answer will the nurse provide? 1. "Girls are born more frequently because the mother's sex chromosome is bigger." 2. "Fathers always give a male chromosome and the mother can give one of either sex." 3. "Depending on the sex chromosome from the father, the baby will be a boy or a girl." 4. "There is no single chromosome that makes the sex determination; it's by chance."

ANS 3 1 This is incorrect. The female sex chromosome is larger, but the sex of a baby is actually determined by the male. 2 This is incorrect. The female always gives an X chromosome (XX), and the male (XY) will give either an X chromosome (XX = female) or a Y chromosome (XY = male). 3 This is correct. The male, with two different sex chromosomes, always determines the sex of the child. 4 This is incorrect. The sex of a child is not determined by chance; XX for female and XY for male offspring.

The nurse is planning a teaching session for a 10-year-old patient and the patient's parents. The patient is newly diagnosed with type 1 diabetes mellitus. Which is the most important topic for the nurse to cover? 1. Methods for preventing hypoglycemia during exercise 2. The purpose of setting up a dietary consult for the patient 3. All procedures involved in insulin administration 4. Instructions for blood glucose and urine ketone testing

ANS 3 1 This is incorrect. The patient and parents need to understand the actions that are necessary for preventing hypoglycemia during exercise. Teaching will include eating an extra complex carbohydrate and protein serving at least 30 minutes to 1 hour before engaging in exercise or sports. Another topic is most important. 2 This is incorrect. The patient and parents should have a dietary consult so that the patient can be placed on a diabetic diet or be taught to count carbohydrate exchanges and adjust insulin requirements based on dietary intake. This an important action, but one other is more important. 3 This is correct. Because the patient is insulin dependent, insulin management is crucial and procedures for insulin administration are vital; this is the most important topic for the nurse to present in patient and parent teaching. 4 This is incorrect. The second most important teaching for the nurse to present is the methods by which the patient and parents will monitor the patient's blood glucose levels and test for the presence of urine ketones.

2. The nurse at a pediatric clinic is assessing a 12-year-old female. The patient ask the nurse, "I am scared about what's happening to my body. How does it happen?" Which information from the nurse is most appropriate? 1. The ovaries are located on each side of the uterus. 2. The ovaries secrete hormones that regulate the menstrual cycle. 3. The ovaries play a role in the regulation of puberty and fertility. 4. The body changes will indicate the patient is a woman and not a child.

ANS 3 3. The ovaries play a role in the regulation of puberty and fertility. 3 . The most appropriate answer to the patient's "how" is to explain how the sex glands play a role in the regulation of puberty and fertility. The nurse will use language and examples that are within the realm of the patient's understanding.

The nurse works on a pediatric unit where patients are on life support. Frequently, death is delayed for the benefit of organ donation and procurement. Which protocols for organ donation and procurement does the nurse always need to follow? Select all that apply. 1. The nurse approaches the family of a patient who is a viable candidate. 2. The best matched pediatric patients on the transplant list are notified. 3. The consent for organ donation can be given only by legal guardians. 4. The facility pediatric surgical team will procure the organs for transplant. 5. The parents only can accompany the patient to the operating room.

ANS 3 3. This is correct. Consent is needed from the legal guardians for organ donation. 1. This is incorrect. When a child is considered a viable candidate for organ donation, the family is approached by an organ donation approach team. This multidisciplinary team of health-care providers and ancillary staff is specially trained in approaching families to request that they donate the patient's organs. 2. This is incorrect. Once consent is given, blood is drawn from the patient to determine the patients on the transplant list who are the best match for the organs available. However, pediatric organs can be transplanted into pediatric or adult patients. 4. This is incorrect. Procurement of organs is commonly done by the transplanting surgical team. The team travels to the site of the organ donor, and the patient is taken to the operating room to remove the organs. 5. This is incorrect. Parents and family members should say goodbye to the patient before transfer to the operating room; the patient will die in the operating room.

The nurse is providing care for a pediatric patient who is 11 years of age. The patient is diagnosed with an aggressive form of cancer and is scheduled to begin chemotherapy. The patient tells the nurse, "I think I am going to die, but I also think I will get much sicker first." Which communication by the nurse is most appropriate for this patient? 1. Explain to the patient the importance of maintaining a hopeful outlook. 2. Encourage the patient to ask the doctor to explain what is going to happen. 3. Use basic terms to explain the disease progression and side effects of treatment. 4. Provide information about the different options that can be considered for the patient.

ANS 3 3 This is correct. Nursing education to the pediatric patient in this scenario should include age-appropriate information about the disease and treatment. 1 This is incorrect. The patient is 11 years of age and has stated expectations related to the medical diagnosis. Encouraging the patient to maintain a hopeful outlook does not address the thoughts and concerns that already exist. 2 This is incorrect. Nurses have the capability to answer questions about the patient's condition and treatment; it is unnecessary to delay meaningful communication until the physician can answer. The nurse can encourage the patient to also talk with the physician and parents, but information does not need to be delayed. 4 This is incorrect. The patient is 11 years of age and unable to contemplate and decide about the medical treatment. The parents or legal guardian are considered to be the decision makers.

The nurse is providing family teaching for a child diagnosed with hypoparathyroidism. Which additional teaching will the nurse include related to alternative dietary management? Select all that apply. 1. Avoiding caffeine and limiting the intake of carbonated beverages 2. Encouraging foods high in calcium and vitamin K 3. Including dietary supplements such as magnesium and boron 4. Giving calcium and vitamin D with acidic substances 5. Providing green leafy vegetables as the primary source of calcium

ANS 3,4 1. This is incorrect. Encouraging dietary compliance, such as avoiding caffeine and limiting the intake of carbonated beverages, is not considered an alternative intervention for dietary management. 2. This is incorrect. Encouraging foods high in calcium and vitamin K is not considered an alternative intervention for dietary management. 3. This is correct. Providing dietary instruction regarding alternative dietary supplements in addition to calcium and vitamin D, such as magnesium, boron, and vitamin K, is a suggestion for an alternative intervention. 4. This is correct. Instructing parents to give calcium and vitamin D with acidic substances such as orange juice or with salads that contain lemon juice in the dressing is an alternative intervention aimed at increasing absorption. 5. This is incorrect. The patient will need calcium and vitamin D in order to maintain health; however, no preference for the source of calcium is given.

The nurse on a pediatric unit is providing care for a preschool child with syndrome of inappropriate antidiuretic hormone (SIADH). The parents brought the child to the hospital to receive IV therapy. Which statements by the parents indicate to the nurse that the child is receiving appropriate care? Select all that apply. 1. "We were getting concerned about her loving salt." 2. "Popsicles have become a favorite daytime snack." 3. "We recognized the symptoms of sodium depletion." 4. "The confusion, headache, and irritability are unusual." 5. "She loves her new little bracelet and shows it to everyone."

ANS 3,4,5 1. This is incorrect. If the parents express concern about the patient "loving salt," the nurse will remind the parents that a diet high in sodium and protein is encouraged. 2. This is incorrect. When the parents share that popsicles have become a favorite daytime snack, the nurse needs to be concerned that fluid restrictions are not being observed, because the parents do not understand hidden fluid sources. 3. This is correct. The nurse will determine the child with SIADH is getting good care when the parents recognize the signs of sodium depletion and seek IV fluid replacement. 4. This is correct. The nurse will determine the child with SIADH is getting good care when the parents pay attention to unusual behaviors and associate them with a manifestation of the child's condition. 5. This is correct. The nurse will determine the child with SIADH is getting good care when the parents have the child wear a medical alert bracelet.

The nurse in a pediatric emergency department is providing care for a 1-year-old patient with a history of congenital adrenal hyperplasia (CAH). The patient is exhibiting the manifestations of a febrile illness. Which medical intervention does the nurse expect to be prescribed? 1. Laboratory testing for elevated serum 17-OHP level 2. Cultures and testing for the cause of the febrile illness 3. A quiet, cool environment for the patient 4. Administration of corticosteroids by injection

ANS 4 1 This is incorrect. Elevated serum 17-OHP at birth, along with other presenting symptoms, is a potential for CAH. If the levels continue to be elevated after birth, CAH is expected because normal growth and development will decrease 17-OHP as the infant matures. However, this testing is not expected for this patient. 2 This is incorrect. The cause of the febrile condition is not as important at this time as recognition and treatment of a possible adrenal crisis. 3 This is incorrect. The patient is not likely to need or benefit from being placed in a quiet, cool environment. 4 This is correct. Emergency administration of corticosteroids given via injection should be taught to the parents for use when the child is in a crisis, such as febrile illness, surgery, trauma, or severe stress. The nurse expects a prescription to continue the medication. The doses will need to be doubled or tripled during the period of crisis. This is referred to as "stress dosing."

The nurse shares genetic information with the parents of a 12-year-old female with a lack of pubertal development. The child is missing an X chromosome and is diagnosed with Turner syndrome. Which information will the nurse provide regarding secondary sexual characteristics? 1. Estrogen therapy will reverse infertility. 2. Offspring will be positive for Turner syndrome. 3. Height and weight will remain within normal parameters. 4. Estrogen supplementation will prompt development.

ANS 4 1 This is incorrect. Girls with Turner syndrome are missing an entire X chromosome, because the father did not contribute any sex chromosome. The female offspring will be infertile; no treatment is available for the infertility. 2 This is incorrect. The female with Turner syndrome will not be able to produce offspring. 3 This is incorrect. Height and weight are usually within normal parameters at birth, and then deceleration of height velocity occurs. 4 This is correct. Lack of pubertal development can be treated with estrogen supplementation so that girls can develop secondary sexual characteristics; however, they will remain infertile.

A 16-year-old adolescent has Addison's disease. The adolescent's current medication involves corticosteroid and mineralocorticoid replacement therapy. During sports practice, the adolescent collapses and loses consciousness with sudden, penetrating pain in the lower back and legs. Which action is taken by the school nurse? 1. Administer the glucagon kept for the adolescent in the clinic. 2. Place the adolescent in side-lying position in case vomiting occurs. 3. Notify the parents of the incident and request permission to transport to the hospital. 4. Give IM Solu-Cortef and call the paramedics for emergency IV infusion.

ANS 4 1 This is incorrect. Glucagon is administered to increase blood glucose for a patient with hypoglycemia. 2 This is incorrect. Placing the patient in a side-lying position in case of vomiting is not the appropriate intervention for this patient. 3 This is incorrect. In an Addisonian crisis, time is lost by calling parents for permission to have the adolescent transported for acute medical attention. 4 This is correct. The nurse will administer Solu-Cortef IM, because the patient is unconscious. Careful assessment of signs and symptoms of hypovolemic shock in the severely dehydrated patient is critical. IV fluids are needed as quickly as possible; the paramedics are notified immediately.

The nurse is preparing to teach a class about genetics at a workshop for nurses. The nurse will remind the attending nurses that genes are responsible for determining our physical attributes and biological functions. Which other function will the nurse accredit to genes? 1. Organizing the chromosomes and the genetic code 2. Maintaining cell cytoplasm for the preservation of cell organelles 3. Ensuring the development of all the different types of body cells 4. Producing products necessary for the organism's function

ANS 4 1 This is incorrect. The cell nucleus houses the chromosomes, the highly organized structures that contain the genetic code, DNA. Genes are not involved in organizing chromosomes and the genetic code. 2 This is incorrect. The cell is composed of a central enclosed core (nucleus) and the outer area (cytoplasm), which contains fluid and other cell organelles. The genes do not have a role in maintaining the cytoplasm for any purpose. 3 This is incorrect. Humans are composed of almost a trillion cells of different types, each of which derives from a single cell. This single cell then differentiates, or develops, into highly specific cell types. The genes do not play a role in cell differentiation. 4 This is correct. Under the direction of genes, the cell cytoplasm makes products necessary for the organism's functions, such as growth, release of energy, and elimination of waste products at the cellular level.

The parents of a toddler, diagnosed to be in the end stage of a terminal illness, are concerned about how to manage pain without the sedation effects of pain medications. Which suggestion by the nurse is likely to meet the needs of both the parents and the patient? 1. Encourage the parents to bring favorite toys and books. 2. Initiate playtime in the playroom with other patients. 3. Provide age-appropriate videos for patient distraction. 4. Suggest a parent hold the patient and perform gentle massage.

ANS 4 4 This is correct. The parents have expressed a desire for pain management without the sedation effects of pain medication. The unspoken need of the parents is to have the ability to interact with their child and still achieve pain management. When the nurse suggests that a parent hold the patient and perform gentle massage, the needs of both the patient and parents are being met; the suggested actions will promote relaxation and potentially decrease pain. 1 This is incorrect. The toddler in the end stage of terminal illness may or may not be receptive to favorite toys or books. Holding and soothing are likely to be more effective. 2 This is incorrect. It is unlikely that a toddler in the end stage of terminal illness will be willing or able to play with other children. Holding and soothing are likely to be more effective. 3 This is incorrect. The toddler in the end stage of terminal illness may or may not be effectively distracted by age-appropriate videos. Holding and soothing are likely to be more effective.

4. The nurse in a pediatrician's office is assessing a 9-year-old male patient who is being monitored for the possible diagnosis of hypopituitarism. Which assessment finding does the nurse recognize specifically as an indication of growth hormone deficiency? 1. High weight-to-height ratio 2. Large hands and feet for body size 3. Severe aching in knees and ankles 4. Height increase of 1.75 inches in 12 months

ANS 4 4. Height increase of 1.75 inches in 12 months 4 This is correct. A cardinal sign of hypopituitarism is delayed growth of less than 2 inches (3 to 4 cm) per year.

59. A common heart defect noted in children with Trisomy 18 is: 1. Coarctation of the aorta. 2. A one ventricle heart. 3. An ASD and a VSD are present. 4. Obstruction on the right side of the heart.

ANS: 1 1. The lengthening of the aortic arch is common in infants with Trisomy 18. 2. Most infants born with Trisomy 18 have a four ventricle heart. 3. These heart defects are common in children with Downs syndrome, not Trisomy 18. 4. Coarctation of the aorta is the most common defect for a child with Trisomy 18.

65. A nurse is plotting the growth grid for a child with a known diagnosis of achondroplasia. The nurse should know that: 1. A specific growth grid should be used for patients with achondroplasia. 2. The weight of the child will be above the normal limits while the height is below the normal limits. 3. A child with this diagnosis will not usually live past the age of 10. 4. This diagnosis occurs mostly in boys.

ANS: 1 1.A child with this known diagnosis should be tracked on a growth grid specifically for achondroplasia.2.Weight will be within normal limits for a child. 3.A child with this diagnosis can lead a relatively normal life span. 4.This diagnosis can occur in both males and females.

73. The mother of a 6-year-old Hispanic girl comes into the clinic stating that her daughter is developing breasts, pubic hair, and has acne on her forehead. On assessment, you notice that she has Tanner Stage 2 breast and pubic hair, oily skin, and some blemishes on her forehead. You suspect, based on this assessment, that the child could be having precocious puberty. What laboratory result would you expect to see in a child with precocious puberty? 1. High LH 2. Low LH 3. High TSH 4. Low FSH

ANS: 1 Feedback 1. Children with precocious puberty have elevated hormone levels, including LH, FSH and Estradiol in females. Males will have an increase in testosterone levels. The treatment goal is to utilize GnRH Analogs to suppress hormone levels until it is a more appropriate time for the child to experience puberty. 2. LH is usually elevated. 3. TSH is not assessed. 4. FSH is usually elevated.

33. The most common cause of vaginal inflammation and discharge in teenage girls is: 1. Bacterial vaginosis. 2. STIs. 3. Urinary tract infections. 4. Vulvovaginitis.

ANS: 1 Feedback 1. Common in this age range and about one-third of cases resolve on their own. 2. STIs would not resolve on their own and have an increased severity. 3. Urinary tract infections do not resolve on their own and usually do not cause vaginal inflammation. 4. Prepubescent girls more commonly have vulvovaginitis than teens.

77. Infants are screened at birth for Congenital Hypothyroidism because of which of the following conditions that can occur if untreated? 1. Mental Retardation 2. ADHD 3. Cerebral Palsy 4. Failure to Thrive

ANS: 1 Feedback 1. Failure or delay in treatment of newborn infants with Congenital Hypothyroidism can lead to long-term cognitive effects, such as mental retardation. As a result of this, there is a national mandate that states that all infants must have newborn screening tests to rule out Congenital Hypothyroidism. 2. Failure or delay in treatment of newborn infants with Congenital Hypothyroidism can lead to long-term cognitive effects, such as mental retardation. 3. Failure or delay in treatment of newborn infants with Congenital Hypothyroidism can lead to long-term cognitive effects, such as mental retardation. 4. Failure or delay in treatment of newborn infants with Congenital Hypothyroidism can lead to long-term cognitive effects, such as mental retardation.

69. When a child with diabetes is sick, which is the most appropriate intervention to teach the patient and parents? 1. The usual dose of insulin may need to be adjusted to compensate for food intake. 2. Test blood glucose levels only if urine ketones are positive. 3. Maintain fluid intake, avoiding fluids that contain dairy products. 4. Only test for urine ketones when the blood glucose is above 300 ng/dL.

ANS: 1 Feedback 1. Illness, such as a cold, the flu, or infections can cause an elevation in blood glucose levels due to the stress on the body. As a result of elevated glucose levels, the dose of insulin will have to be adjusted to meet the demands of lowering blood glucose levels that may reach high levels until the illness subsides. The urine should be tested 2 to 3 times per day for ketones, even if the blood sugar levels are lower than 300 ng/dL. 2. Blood glucose levels should be continuously monitored when a child is sick. 3. The patient should have a high fluid intake that includes dairy products. 4. The urine should be tested 2 to 3 times per day for ketones, even if the blood sugar levels are lower than 300 ng/dL.

67. When working with a child with Fragile X syndrome, it is important to: 1. Pace the assessment because the child will become anxious if it is done too quickly. 2. Make direct eye contact so that the child knows you are speaking. 3. Perform a passive range of motion exercises. 4. Postpone immunizations until the child is able to understand what is occurring.

ANS: 1 Feedback 1. Keeping the child calm will allow the nurse to complete a full assessment. Children with the syndrome tend to get anxious easily. 2. The child becomes more anxious if direct eye contact is made. 3. The child needs an active range of motion exercises. 4. Immunizations should be given on schedule because the cognitive level of the child is limited in most cases.

40. Sherry, a 15-year-old patient, has been admitted for diabetic ketoacidosis. The nurse knows each of the following statements are true except: 1. This is the most common chronic complication for DM1. 2. This is deadly if not taken care of immediately. 3. This can cause frequent hospitalizations. 4. This is caused by too much insulin being release during illness.

ANS: 1 Feedback 1. Ketoacidosis is an acute condition. 2. This can be deadly because of the rapids shifts in blood glucose levels. 3. Ketoacidosis requires close medical monitoring and insulin infusion. 4. Insulin release increases during the illness, causing further complications.

29. A child with the diagnosis of precious puberty has been given Lupron. The nurse knows that the medication should help: 1. Decrease the hormone levels to slow the puberty process. 2. Increase the process for puberty development. 3. Decrease the growth rate. 4. Increase the growth rate.

ANS: 1 Feedback 1. Lupron suppresses the release of growth hormones. 2. The medication will decrease the progression of puberty if given in the correct pediatric dosage. 3 The medication will help slow the maturation process, not linear growth. 4. The medication will help slow the maturation rate.

37. Signs of an Addisonian crisis would include all of the following except: 1. Sudden pain in the upper extremities. 2. Severe vomiting and diarrhea. 3. Dehydration. 4. High blood pressure.

ANS: 1 Feedback 1. Pain is noted in the lower extremities and lower back, not the upper extremities. 2. Vomiting and diarrhea are common symptoms in a crisis. 3. Dehydration can occur during a crisis. 4. Pain is noted in the lower extremities and lower back.

42. A nurse is teaching a newly diagnosed diabetic mellitus Type 1 patient and family about the administration of insulin. It will be important for the nurse to include: 1. Rotating the injection sites with each dose. 2. Only using 1 mL syringes for dosing. 3. Giving the amount of insulin, then checking the blood glucose levels. 4. Providing sugary snacks when the glucose level is at 120 or above.

ANS: 1 Feedback 1. Rotation of the injection sites will allow areas to heal. 2. Only a unit syringe should be used for insulin administration. 3. Blood glucose levels should be checked prior to the administration of insulin. 4. Sugary snacks should be avoided if the blood glucose level is at 120 or above.

13. A 36-month-old girl is being measured at the nurses station. The nurse knows that she should do which of the following before using the stadiometer? 1. Remove the childs shoes for an accurate height measurement 2. Allow the child to stand on his toes while being measured 3. Allow the child to have a ponytail when the height is being measured 4. All should be asked of the child.

ANS: 1 Feedback 1. Shoes should not be worn during the measurement of height. 2. The child should stand flat during the measurement of height. 3. A ponytail should not be present during the measurement of height. 4. The child should remove his shoes for an accurate height measurement.

63. Ash leaf lesions are a cardinal sign for: 1. Tuberous Sclerosis. 2. Sturge-Weber syndrome. 3. Cri-Du-Chat syndrome. 4. Williams syndrome.

ANS: 1 Feedback 1. The cardinal sign of Tuberous Sclerosis is the ash leaf lesion. 2. Cardinal sign is a port-wine stain 3. Cardinal sign is the cat cry 4. Cardinal sign is the lacy iris pattern

28. A child with a sodium measurement of less than 125 mEq/L and with a diagnosis of SIADH is at risk for: 1. Seizures. 2. Diarrhea. 3. Vomiting. 4. A change in the level of consciousness.

ANS: 1 Feedback 1. The level is low and this increases the risk for seizure activity. 2. Low sodium does not place the child at risk for diarrhea. 3. Low sodium does not place the child at risk for vomiting. 4. A change in the level of consciousness is minimal. The largest risk is seizures.

5. The pineal body is being discussed with a parent. The parent demonstrates the proper understanding of the pineal bodys purpose when the parent states: 1. The pineal body helps my child sleep. 2. The pineal body can improve my childs cognitive ability as he grows. 3. The pineal body will regulate the height of my child. 4. The pineal body can affect the timing of my childs puberty.

ANS: 1 Feedback 1. The pineal body controls the release of melatonin. Melatonin helps to regulate the sleep pattern. 2. There are no influences on the cognitive ability of the child from the pineal body. 3. The pineal body does not influence growth patterns. 4. The pineal body does not influence puberty.

24. A nurse is assessing a child with a known history of untreated hyperpituitarism. The nurse would anticipate: 1. Enlarged hands and feet. 2. A small nose and forehead. 3. A report of headaches. 4. Signs of precocious puberty.

ANS: 1 Feedback 1. These are common signs of untreated hyperpituitarism. 2. There is an overgrowth of bones, so the nose and forehead may be enlarged. 3. This is usually not a reported sign of issues in hyperpituitarism. 4. This only occurs if a tumor is present.

3. A nurse is discussing the production of the somatotropic hormone. Its primary responsibility is best described as: 1. A hormone that regulates bone growth in children. 2. A hormone that increase the rate of sexual/reproductive organ development. 3. A hormone that causes fight-or-flight mechanisms. 4. A hormone that causes the body to fight infections.

ANS: 1 Feedback 1. This hormone is responsible for stopping the release of the growth hormone. 2. The somatotrophic hormone concentrates on the growth rate of children, not the sexual/reproductive hormones. 3. The fight-or-flight response is controlled by the corticotrophin hormones. 4. Immunity is not controlled by a hormone.

53. Children tend to be more active in summer. Which change in the management of the child with diabetes would the nurse teach the patient and family to help treat episodes of hypoglycemia? 1. Increase food intake prior to exercise 2. Decrease food intake prior to exercise 3. Give an additional dose of insulin prior to exercise 4. Avoid foods high in protein

ANS: 1 Feedback 1. This measure should be taken because exercise can lower blood sugar levels, so adding the extra carbohydrate and protein snack will help the blood sugar levels maintain a normal level. This means that the child is less likely to have a hypoglycemic episode. 2. Children with diabetes must have extra carbohydrate and protein servings prior to exercise. This is because exercise can lower blood sugar levels. 3. The extra dose does not stabilize the blood glucose level long term. 4. Protein snacks help keep the blood glucose level stable and within normal limits.

64. A mother who has achondroplasia asks the nurse if her infant will be at risk for the same diagnosis. The nurse knows that: 1. If the father has the same diagnosis, then the child has a 50% chance of having achondroplasia. 2. If the father does not have the same diagnosis, then the child has a75% chance of having achondroplasia. 3. Over 80 percent of the people with achondroplasia are born to parents with normal height, so the infant may be of normal height. 4. Achondroplasia is rare, and the mother should watch for signs and symptoms as the child grows.

ANS: 1 Feedback 1. With both parents having the disorder, the child has a 50% chance of achondroplasia. 2. The child has a lower chance of achondroplasia if the father is of normal height. 3. Most children with achondroplasia have a parent with it. 4. Achondroplasia is usually prevalent at birth.

81. Please select the most appropriate nursing diagnosis for a 15 year old with hyperthyroidism. Select all that apply. 1. Disturbed body image related to changes in physical appearance 2. Imbalanced nutrition related to increased metabolic demands 3. Risk for decreased fluid volume related to excess salt excretion 4. Constipation related to thyroid medication side effects

ANS: 1, 2 Feedback 1. Body image according to normal growth and development is very important to an adolescent. If the adolescent with hyperthyroidism is having adverse effects, such as drastic weight loss, exopthalmus, or other complications, his/her sense of self-esteem will be altered. He/she will also have imbalanced nutrition since his/her metabolic needs exceed his/her nutritional needs. 2. Body image according to normal growth and development is very important to an adolescent. If the adolescent with hyperthyroidism is having adverse effects, such as drastic weight loss, exopthalmus, or other complications, his/her sense of self-esteem will be altered. He/she will also have imbalanced nutrition since his/her metabolic needs exceed his/her nutritional needs. 3. They do not loose salt with this disorder. Constipation is a side effect of hypothyroidism, not hyperthyroidism. 4. Diarrhea is an adverse event in children who have hyperthyroidism.

74. A child with the diagnosis of a neurofibromatosis requires which of the following nursing interventions? Select all that apply. 1. Blood pressure check 2. Scoliosis screen 3. Maintain a growth grid 4. Skin exam 5. Daily weight checks

ANS: 1, 2, 4 Feedback 1. Almond-shaped eyes are a common characteristic. 2. Aggressive behavior is a common characteristic. 3. Found in males 4. Manipulative behavior patterns are a common characteristic. The child has an average-sized mouth.

75. A nurse is attempting to perform an assessment on a child with a diagnosis of Prayer-Willis Syndrome. Identify characteristics common with this diagnosis. Select all that apply. 1. Almond-shaped eyes 2. Aggressive behavior 3. Only found in females 4. Manipulative behavior patterns 5. Small mouth

ANS: 1, 2, 4 Feedback 1. Almond-shaped eyes are a common characteristic. 2. Aggressive behavior is a common characteristic. 3. Found in males 4. Manipulative behavior patterns are a common characteristic. The child has an average-sized mouth.

78. A child with a known diagnosis of diabetes insipididus is being discharged home. The discharge education should include: (Select all that apply.) 1. Teaching on the signs/symptoms of dehydration. 2. Teaching the parents to decrease the amount of fluid intake when the child is healthy. 3. That medications will only need to be continued for six months. 4. Obtaining an emergency alert bracelet for the child. 5. Making the school aware of the diagnosis.

ANS: 1, 4, 5 Feedback 1. The child is at high risk for dehydration, and the parents should be aware of the signs and symptoms. 2. Fluid intake should be increased to keep the hydration balanced. 3. The medication will be needed for the rest of the childs life. 4. An emergency bracelet is needed so that proper care can be provided when illness occurs away from the parents. 5. The school should be aware so that proper interventions can be made when necessary.

74. Glycosolated hemoglobin is an acceptable method used to: 1. Diagnose diabetes mellitus. 2. Assess control of diabetes. 3. Assess oxygen saturation of the hemoglobin. 4. Determine the insulin levels in the blood.

ANS: 2 Feedback 1. A glycosolated hemoglobin is a diagnostic test that measures serum glucose levels over a 3-month period. Health-care professionals use this laboratory test to determine blood glucose control of the patient over a period of time to see if he/she is maintaining adequate control of his/her blood sugar. 2. A glycosolated hemoglobin is a diagnostic test that measures serum glucose levels over a 3-month period. Health-care professionals use this laboratory test to determine blood glucose control of the patient over a period of time to see if he/she is maintaining adequate control of his/her blood sugar. 3. This assesses glucose levels, not hemoglobin levels. 4. A glycosolated hemoglobin is a diagnostic test that measures serum glucose levels over a 3-month period. Health-care professionals use this laboratory test to determine blood glucose control of the patient over a period of time to see if he/she is maintaining adequate control of his/her blood sugar.

When feeding an infant with Downs syndrome, it is important for the nurse to recognize that: 1. The infant will need extra support because of the weight of the head. 2. Infants with Downs syndrome tend to be lethargic and hypotonic, making it difficult to feed. 3. The infants protruding tongue can may it difficult to breastfeed. 4. The infant usually has a very strong suck and needs to be paced while eating.

ANS: 2 Feedback 1. All infants should have head support while feeding in order to prevent choking. 2. Infants with Downs syndrome tend to be hypotonic, which can make eating difficult. 3. An infant can learn to latch in order to breastfeed. 4. A child with Downs syndrome tends to have a weaker suck and takes a longer period of time to eat.

A mother is asking the nurse about the age her daughter with Downs syndrome can be expected to start walking. Her other three children were walking by 10 months of age. The nurse knows that motor skill development for children with Downs syndrome takes: 1. About the same amount of time as children without Downs syndrome. 2. About twice as long as usual for a child without Downs syndrome. 3. About three times as long as usual for a child without Downs syndrome. 4. A significantly long time, with a large majority never learning to walk.

ANS: 2 Feedback 1. Because of the hypotonia, children with Downs syndrome lag behind in motor skill development. 2. An infant with Downs syndrome usually needs twice the length of time to develop motor skills. 3. An infant with Downs syndrome usually needs twice the length of time to develop motor skills. 4. An infant with Downs syndrome takes more time to develop motor skills, but does eventually learn to walk.

45. The clinic nurse is teaching on the ways to help a child with DM1 when a hypoglycemic incident occurs. The teaching should include: 1. Allowing for 6 oz of diet soda every day. 2. Providing a juice box. 3. Allowing the child to eat, then return to previous activities. 4. Providing the child a bag of Cheetos.

ANS: 2 Feedback 1. Diet soda does not contain the proper sugar level and will not be beneficial to the child. 2. Juice has the proper level of sugar to be beneficial for the child and can be absorbed into the system quickly. 3. A child should rest after eating to help decrease the metabolic demands if in a hypoglycemic state to help prevent an accident. 4. A bag of Cheetos contains carbohydrates that may help increase the glucose level, but will take longer for the body to break down for use.

63. A child with diabetes insipidus has been admitted to the pediatric unit. The nurse would expect the childs laboratory value to demonstrate: 1. Hyperglycemia. 2. Hypernatremia. 3. Hypercalcemia. 4. Hypoglycemia.

ANS: 2 Feedback 1. Glucose levels are not affected with this disorder. 2. In all forms of diabetes insipidus, serum sodium can increase to pathologic levels, so hypernatremia can occur and should be treated. 3. Hypercalcemia does not occur with this disorder. 4. Glucose levels are not affected with this disorder

21. The nurse is discussing follow-up visits with the family of a boy using growth hormone therapy. The parents demonstrate understanding of the teaching with which statement? 1. We will need to track his height every week and record it for the doctor. 2. We will need to have follow-up visits every 3 to 4 months to measure progress. 3. Our next visit will be in one year to assess growth. 4. He will need to watch his weight closely and provide the record at the next visit.

ANS: 2 Feedback 1. Height will change gradually, so measurements on a weekly basis are not recommended. 2. Measurements and visits every 3 to 4 months will allow for growth to occur and for the medical provider to assess for needed changes. 3. Growth patterns should be monitored more closely while taking a growth hormone to make changes to the medication as needed. 4. Weight gain is not an issue with hormone replacement therapy and can be monitored at the medical provider visits.

51. The nurse should recognize that when a child develops diabetic ketoacidosis, this diagnosis is which of the following? 1. An expected outcome 2. A life-threatening outcome 3. Best treated at home 4. Best treated at the practitioners office

ANS: 2 Feedback 1. It is not a normal, expected outcome. 2. Diabetic ketoacidosis is a life-threatening situation. The child should be taken to the emergency room and/or a practitioners office for intervention. 3. This cant be treated effectively at home, as there is no emergency equipment available that might be needed. 4. This cant be treated effectively at home, as there is no emergency equipment available that might be needed.

23. Stereotypic behaviors of males with Fragile X syndrome include a lack of eye contact, aggression, anxiety, and: 1. Jerking legs. 2. Hand flapping. 3. Pill-rolling of the fingers. 4. All of the above

ANS: 2 Feedback 1. Jerking of the legs is not a stereotypical behavior of a child with Fragile X syndrome. 2. Stereotypical behaviors of males with Fragile X syndrome include lack of eye contact, aggression, anxiety, and hand flapping. 3. Pill-rolling of the fingers is not a stereotypical behavior of a child with Fragile X syndrome. 4. Stereotypical behaviors of males with Fragile X syndrome include lack of eye contact, aggression, anxiety, and hand flapping.

43. Kussmaul breathing will occur in children with diabetes mellitus Type 1 when: 1. The body is near death. 2. The body is attempting to correct the metabolic acidosis state. 3. The child has consumed too much sugar. 4. The body is attempting to balance the metabolic alkalosis state.

ANS: 2 Feedback 1. Kussmaul breathing may be seen near death, but the body is attempting to correct the metabolic acidosis. 2. The body is attempting to reach equilibrium and correct the metabolic acidosis, thus creating the slower breathing. 3. The body is producing too much insulin, thus not needing sugar. 4. The body is trying to balance itself from a metabolic acidosis state.

61. The nurse is caring for an adolescent who has just returned to his room after a thyroidectomy. Which of the following indicates complications and should be reported immediately to the physician? 1. Lethargy 2. Feelings of tightness in the throat, hoarseness, and stridor 3. Facial edema 4. Acute neck pain

ANS: 2 Feedback 1. Not a sign of complications from a thyroidectomy 2. It is normal for a post-operative child to have lethargy. Because the surgery involves the neck, facial edema and acute neck pain are also noted post-operatively. An emergent situation would include feelings of tightness in the throat, hoarseness, and stridor. There symptoms would indicate an inability to breath, leading to impaired gas exchange and respiratory distress. 3. The face is not associated with the surgery. 4. The pain can be a sign, but not an emergent complication.

12. A teenage girl and boy have come to the nurses office at school because of a concern of pregnancy. The nurse explains the types of tests that are used to indicate pregnancy. The teens understand that the hormone that indicates pregnancy is: 1. Relaxin. 2. Human chorionic gonadotropin. 3. Estrogen. 4. Progesterone.

ANS: 2 Feedback 1. Relaxin works on the muscles and will not indicate pregnancy. 2. Human chorionic gonadotropin is the hormone released when an embryo is developing, indicating pregnancy. 3. Estrogen is released by females to develop secondary sex characteristics. 4. Progesterone is released to maintain pregnancy.

18. A 7-year-old boy with idiopathic hypopituitarism will need growth hormone replacement and: 1. Require IV hormone infusions. 2. Require subcutaneous injections. 3. Require intramuscular injections. 4. Require oral medications.

ANS: 2 Feedback 1. Subcutaneous injections are required, not an IV. 2. Subcutaneous injections are required for treatment. 3. Subcutaneous injections are required, not IM injections. 4. Subcutaneous injections are required, not oral medications.

38. A child with a diagnosis of pheochromocytoma should have a priority assessment of: 1. Temperature. 2. Blood glucose levels. 3. Urine output. 4. Weight.

ANS: 2 Feedback 1. Temperature instability is not an issue with pheochromocytoma. 2. Blood glucose levels can change rapidly and should have careful assessment. 3. Urine output should be monitored, but it is not the priority. 4. Weight checks should be done pre- and post-op, but are not the priority.

30. A common test result for a child with hypothyroidism is a(n): 1. Increase in T4 levels. 2. Increase in TSH levels. 3. Normal T4 level. 4. Decreased TSH level.

ANS: 2 Feedback 1. The T4 levels tend to be low. 2. The TSH levels will be increased in a child with hypothyroidism. 3. The T4 levels tend to be low. 4. The TSH levels will be increased, not decreased.

66. A child has been admitted to the hospital while unconscious. The child has a history of insulin-dependent diabetes mellitus (IDDM), and according to the childs mother, he took a normal dose of insulin this morning with breakfast. At school, the child had two pieces of birthday cake and some ice cream at a class birthday party. What is the likely reason for this childs unconscious state? 1. Metabolic alkalosis 2. Metabolic ketoacidosis 3. Insulin shock 4. Insulin reaction

ANS: 2 Feedback 1. The child is becoming acidotic in this state. 2. Metabolic acidosis or ketoacidosis could have occurred because of the excessive intake of sugar with no additional insulin. Altered consciousness occurs as symptoms progress. 3. Insulin shock is not occurring because the child is in an acidotic state. 4. The body burns fat and protein stores for energy when no insulin is available to metabolize glucose.

36. Discharge teaching for a child with Congenital Adrenal Hyperplasia includes the administration of medication for stress dosing. This should be followed when: 1. The child is going to be more active for the day. 2. The child has a high fever. 3. A dose has been missed. 4. The child has not had adequate nutrition for a day.

ANS: 2 Feedback 1. The initial dosing should be effective for an active child. 2. A high fever increases metabolism and can create a need for a higher dose of the medication. 3. Missed doses should be taken as soon as remembered. 4. An inadequate diet for one day does not change the medication dosing.

2. The release of the luteinizing hormone causes __________ in teen girls. 1. Primary sexual organ growth 2. The release of the ovum for fertilization 3. Rapid growth 4. Pubic hair growth

ANS: 2 Feedback 1. The luteinizing hormone works during the luteal phase of ovulation and does not have an influence on primary sexual organ growth. 2. The luteinizing hormone controls the release of the ovum for fertilization. 3. The growth hormone is responsible for rapid growth. 4. Pubic hair growth occurs with the release of hormones from the hypothalamus.

17. A classic sign of hypopituitarism in adolescents is: 1. Rapid development of secondary sexual characteristics. 2. Delayed puberty development. 3. A rapid decrease in abdominal circumference. 4. A low-pitched voice.

ANS: 2 Feedback 1. This causes a delay in secondary sexual characteristics. 2. There is a delay in puberty. 3. Increased abdominal fat is present with this condition. 4. Voice is high pitched, not low pitched.

80. The nurse is caring for a child with Syndrome of Inappropriate Antidiuretic Hormone (SIADH). Which of the following interventions should the nurse implement for this child? Select all that apply. 1. Encourage fluid intake 2. Strict intake and output 3. Administration of ordered diuretics 4. Specific gravity of urine

ANS: 2, 3, 4 Feedback 1. Fluid intake should be restricted due to hemodilution. 2. SIADH results from excessive amounts of the serum antidiuretic hormone, causing water intoxication and hyponatremia. Intake and output should be strictly monitored. Diuretics, such as furosemide (Lasix), are administered to eliminate excess body fluid. 3. Diuretics, such as furosemide (Lasix), are administered to eliminate excess body fluid and urine-specific gravity is monitored. 4. Urine-specific gravity is monitored. Fluids are restricted to prevent further hemodilution. Weight should be measured daily in order to monitor fluid balance.

82. The nurse is teaching an 11-year-old girl and her parents how to administer growth hormone injections. The nurse knows that which of the following interventions will promote the best response to therapy? Select all that apply. 1. Give the injections in the morning before breakfast 2. Rotate injection sites each day 3. Strict adherence and minimal doses missed 4. Follow up appointments every 3 to 4 months to monitor growth progress and dose adjustment

ANS: 2, 3, 4 Feedback 1. Injections should be given before bedtime each day, as the growth hormone is secreted mostly during the night when the child is sleeping. 2. To promote the best response to therapy, the patient should always rotate injection sites daily, using the abdomen, lateral thighs, back of the arms, and the buttocks. Patients who miss minimal doses of their growth hormone have better outcomes to therapy. It is important to see the pediatric endocrinologist at least every 3 to 4 months so that response to therapy can be monitored and doses can be adjusted based on growth response and the patients weight. 3. To promote the best response to therapy, the patient should always rotate injection sites daily, using the abdomen, lateral thighs, back of the arms, and the buttocks. Patients who miss minimal doses of their growth hormone have better outcomes to therapy. It is important to see the pediatric endocrinologist at least every 3 to 4 months so that response to therapy can be monitored and doses can be adjusted based on growth response and the patients weight. 4. To promote the best response to therapy, the patient should always rotate injection sites daily, using the abdomen, lateral thighs, back of the arms, and the buttocks. Patients who miss minimal doses of their growth hormone have better outcomes to therapy. It is important to see the pediatric endocrinologist at least every 3 to 4 months so that response to therapy can be monitored and doses can be adjusted based on growth response and the patients weight.

79. You are discussing the discharge needs of a 5 year old with diabetes insipidus. The parents are concerned about the child going back to school. What are the appropriate nursing actions that the nurse can take to help decrease the parents anxiety? Select all that apply. 1. Tell the parents not to worry and recommend a family therapist. 2. Write a letter to the school nurse about the patients condition and possible accommodations that the child might need during class. 3. Provide the parents with the name of a local support group that they can attend to network with other parents of children with this condition. 4. Provide detailed education for the child and parents regarding the management of the condition, and provide them with written resources that they can refer to when needed.

ANS: 2, 3, 4 Feedback 1. This is not therapeutic and dismisses the parents concerns. Additionally, referral to a therapist is not an appropriate action unless the parents are having maladaptive coping mechanisms or ask for a therapist. 2. Working with the school nurse by providing information and recommendations is a priority, as is recommending support groups and detailed educational material that the parents can refer to when needed are the three most appropriate actions. 3. Working with the school nurse by providing information and recommendations is priority, as is recommending support groups and detailed educational material that the parents can refer to when needed are the three most appropriate actions. 4. Working with the school nurse by providing information and recommendations is priority, as is recommending support groups and detailed educational material that the parents can refer to when needed are the three most appropriate actions.

14. A nurse is assessing the head of an 18-month-old girl. During the assessment, the nurse should do which of the following to make sure that the child has adequate skull and brain growth? 1. Check the circumference and document the findings on the growth chart 2. Check the suture lines and posterior fontanel for alignment 3. Measure the head circumference, assess the anterior fontanel, and document the findings on the growth chart 4. Check the childs eye tracking with a pen light

ANS: 3 Feedback 1. Assessment of the anterior fontanel is also needed for an accurate assessment of brain and skull growth. 2. The anterior fontanel should be aligned at this age. Head circumference will indicate adequate nutrition. 3. Assessment of the circumference and suture lines in the anterior fontanel will indicate if suture lines have fused. 4. The tracking of the pen light only allows for a minimal assessment.

67. A child is being seen in the clinic with a possible diagnosis of Type 2 diabetes. The mother asks what the physician uses to make the diagnosis. The nurse explains that Type 2 diabetes is suspected if the child demonstrates obesity, acanthosis nigricans, and a blood glucose level without fasting on two separate occasions above: 1. 120 2. 80 3. 200 4. 50

ANS: 3 Feedback 1. Blood glucose level is at a normal level. 2. Blood glucose level is at the normal level. 3. Blood glucose levels at or above 200 ng/dL without fasting is diagnostic of diabetes. 4. Blood glucose level is low.

20. A common blood test that should be done for a child with questionable celiac disease is: 1. TSH. 2. FSH. 3. Antigliadin antibodies. 4. ACTH.

ANS: 3 Feedback 1. Checks the function of the thyroid 2. Indicates follicle stimulation 3. Screens for celiac disease 4. Indicates hormone deficiencies

18. The only known disorder where a fetus can survive despite loss of an entire X chromosome is known as: 1. Edwards syndrome. 2. Sturge-Weber syndrome. 3. Turners syndrome. 4. Williams syndrome.

ANS: 3 Feedback 1. Edwards syndrome is a trisomy disorder with a high fatality rate. 2. Sturge-Weber syndrome has a trisomy chromosome. 3. The only known disorder where a fetus can survive despite the loss of an entire X chromosome is known as Turners syndrome. 4. Williams syndrome has multiple areas of chromosome deletion.

7. One of the most common causes for thyroid disease in adolescents is: 1. Graves Disease. 2. Goiter. 3. Hashimoto disease. 4. Kawasakis disease

ANS: 3 Feedback 1. Graves Disease is rare in adolescents and occurs more in adults. 2. A goiter is more common in adults. 3. The disease is the most common in adolescence. It rarely occurs in adulthood. It is a result of the thyroid malfunction. 4. Kawasakis disease is not a thyroid disorder.

19. The best time of day to give growth hormone injections for hypopituitarism is: 1. After breakfast. 2. Immediately after waking for the day. 3. At bedtime. 4. In the afternoon, before dinner.

ANS: 3 Feedback 1. Growth occurs the most at night, thus the injections should be given prior to bedtime. 2. Growth occurs the most at night, thus the injections should be given prior to bedtime 3. Children grow the most while sleeping, so giving the injections at night will help promote growth with the bodys normal system. 4. Growth occurs the most at night, thus the injections should be given prior to bedtime.

35. An infant born with ambiguous genitalia should be assessed for: 1. Hyperthyroidism. 2. Hypernatremia. 3. Adrenal hyperplasia. 4. Adrenal medulla deficiency.

ANS: 3 Feedback 1. Hyperthyroidism does not affect the formation of ambiguous genitalia. 2. Hypernatremia does not affect the formation of ambiguous genitalia. 3. Children with adrenal hyperplasia have a high risk for ambiguous genitalia because of the excessive amounts of androgen production. 4. The adrenal medulla has too much excretion, not a deficit.

16. Congenital Syphilis occurs when the spirochete Treponema palladium is transferred from the pregnant woman to her fetus. Education to the parent should include all of the following except: 1. Infants can be asymptomatic for up to two years after birth. 2. Any rash involving the palms and soles can have an appearance of copper. 3. The central nervous system is rarely affected. 4. Long bone abnormalities with possible fractures may limit movement and give an appearance of paralysis.

ANS: 3 Feedback 1. Infants with Congenital Syphilis can be asymptomatic for up to two years. 2. The rash in Congenital Syphilis involves the palms and soles. It can start as pink or red in color and can turn dark or coppery. 3. The central nervous system involvement can occur with Congenital Syphilis and may involve seizures, hydrocephalous, and developmental delays. 4. Long bone abnormalities may limit movement, giving the appearance of paralysis.

55. Which of the following is considered a cardinal sign of diabetes mellitus? 1. Impaired vision 2. Seizures 3. Frequent urination 4. Nausea

ANS: 3 Feedback 1. Not a cardinal sign 2. Not a cardinal sign 3. Frequent urination (Polyuria) excessive thirst (Polydipsia) and excessive hunger (Polyphagia) are the cardinal signs of Type 1 diabetes mellitus. 4. Not a cardinal sign

56. A child with hypoparathyroidism is receiving Vitamin D therapy. The parents should be advised to watch for which of the following signs of Vitamin D toxicity? 1. Excessive thirst 2. Anorexia, insomnia, nausea, and vomiting 3. Weakness, fatigue, nausea, and vomiting 4. Headaches and seizures

ANS: 3 Feedback 1. Not a sign of Vitamin D toxicity 2. Not signs of Vitamin D toxicity 3. Signs of Vitamin D toxicity 4. Headaches and seizures are caused by the imbalance of calcium levels.

76. Exopthalmos may occur in children with which of the following conditions? 1. Hypothyroidism 2. Hyperparathyroidism 3. Hyperthyroidism 4. Hypoparathyroidism

ANS: 3 Feedback 1. Not a symptom of Hypothroidism 2. Not a symptom of Hyuperparathyroidism 3. Exopthalmos is a severe, irreversible manifestation in children who have maintained a hyperthyroid state over a long period of time with inadequate or lack of treatment. 4. Not a symptom of Hypoparathyroidism

46. Diabetes mellitus Type 2 has been increasing in children because of: 1. Environmental surroundings. 2. Autoimmune disorders. 3. Obesity. 4. Earlier use of drugs and alcohol in children.

ANS: 3 Feedback 1. Not enough evidence supports environmental surroundings being a cause for DM2 in children. 2. Autoimmune disorders can cause DM2, but they are not the primary reason for the increase. 3. Obesity has increased in children, placing a higher risk on developing DM2 at a young age. 4. The use of drugs and alcohol does not increase the risk for DM2 in children.

72. A 10-year-old boy is two days post-op, following the resection of a pituitary tumor. The nurse is providing post-operative care and notices that he is having enuresis, extreme thirst, and urinating frequently. Based on these clinical manifestations, the nurse suspects that he might be experiencing which condition? 1. Diabetes mellitus 2. Syndrome of Inappropriate Antidiuretic Hormone (SIADH) 3. Diabetes insipidus 4. Acute glomerulonephritis

ANS: 3 Feedback 1. Not seen as a complication 2. Not seen as a complication 3. Diabetes insipidus is a complication of the resection or removal of a pituitary tumor. The main symptoms of this condition are polydipsia, polyuria, and enuresis. 4. Not seen as a complication

68. A new mother has just received news that her newborn has been diagnosed with Prayer-Willis syndrome. The nurse knows that the mother needs more education when she states: 1. My child will need regular checkups for scoliosis and osteoporosis. 2. My baby may not show pain like my other children. 3. I can breastfeed my baby for as long as I want. 4. I need to get early child interventions for her to function on her best level.

ANS: 3 Feedback 1. Regular checkups are needed in order to monitor development. 2. The child may not show pain. 3. The child can breastfeed and is encouraged to, but not for as long as the mother would like. 4. Early interventions will allow for a proactive approach for the child. KEY: Content Area: Genetic Disorders | Integrated Processes:

21. Downs syndrome children often have instability of the neck at the first and second cervical vertebrae. As a nurse, you explain to the caregiver that he/she should look for signs and symptoms of spinal cord changes, such as: 1. Changes in reflexes. 2. Changes in bowel function. 3. All of the above. 4. None of the above.

ANS: 3 Feedback 1. Signs and symptoms of spinal cord compression include changes in reflexes. 2. Signs and symptoms of spinal cord compression include changes in bowel and bladder function. 3. Signs and symptoms of spinal cord compression include changes in gait, reflexes, and bowel and bladder function. 4. One answer is correct. Signs and symptoms of spinal cord compression include changes in gait, reflexes, and bowel and bladder function.

72. A child with Alcohol-Related Neurodevelopmental Disorder (ARND) will exhibit which of the following types of behavior? 1. High scores on math and computation testing 2. Refuse to participate in social events 3. Have difficulty with verbal expression 4. Have high scores on reading, but not comprehension

ANS: 3 Feedback 1. The child may have trouble with computation and math because of the areas of the brain affected by alcohol consumption in utero. 2. The child will be able to participate in social events. 3. The child may have speech delays because of the areas of the brain affected by alcohol consumption in utero. 4. The child will have low reading scores because of the alcohol exposure.

1. The thin fold of skin that lies between the labia minora and can be ruptured as a result of sexual intercourse is known as the: 1. Clitoris. 2. Cervix. 3. Hymen. 4. Uterus.

ANS: 3 Feedback 1. The clitoris does not rupture during sexual intercourse. 2. The cervix does not rupture during sexual intercourse. 3. A thin fold of skin that lies between the labia minora and can be ruptured as a result of sexual intercourse is the hymen. 4. The uterus does not rupture during sexual intercourse.

22. A nurse has received an order for the growth hormone somatropin to be given to a 14-year-old boy. The correct weekly dose for a 110 pound boy is: 1. 20 mg. 2. 10 mg. 3. 15 mg. 4. 25 mg.

ANS: 3 Feedback 1. The dose is too high. 2. The dose is too low. 3. 0.3 mg/kg/week is the recommendation. 15 mg per week is appropriate. 4. The dose is too high.

4. The anterior portion of the pituitary gland secretes all of the following hormones except: 1. The growth hormone. 2. Adrenocorticotrophic hormones. 3. The antidiuretic hormone. 4. The luteinizing hormone.

ANS: 3 Feedback 1. The growth hormone is secreted by the anterior portion of the pituitary gland. 2. Adrenocorticotrophic hormones are secreted in the cortex, which is in the anterior lobe. 3. The antidiuretic hormone is secreted in the posterior lobe of the pituitary gland. 4. The luteinizing hormone is controlled by the anterior portion of the pituitary gland.

11. The sex drive in males occurs in response to: 1. The development of secondary sexual characteristics. 2. Increased levels of progesterone. 3. Increase levels of testosterone. 4. Follicle cell formation.

ANS: 3 Feedback 1. The hormone produces this response and does not react to it. 2. This only occurs in females for relaxing the uterus and stimulating milk production. 3. This is an androgen that can cause the sex drive in males. 4. This only occurs in females for the release of an ovum

41. When a child with diabetes mellitus Type 1 is ill, it is important for the family to provide all of the following except: 1. Blood glucose monitoring every four hours. 2. Adjusting dosing requirements as needed. 3. Discontinuing the insulin until the child is feeling better. 4. Strongly encouraging the intake of fluids

ANS: 3 Feedback 1. The illness causes rapidly changing glucose levels and needs to be frequently monitored. 2. Insulin will need frequent adjustment during the illness. 3. Insulin continues to be important to help the body heal. 4. Fluids should be encouraged to help keep an adequate hydration status.

59. A child with a chronic adrenocortical insufficiency is receiving Hydrocortisone BID. Nursing considerations related to the administration of this medication include which of the following? 1. Take 1 hour before meals or 2 hours after meals. 2. Mix the medication with milk or formula. 3. Take the medication with food. 4. Administer the medication by injection.

ANS: 3 Feedback 1. The medication should be taken with meals. 2. Milk or formula may increase the rate of vomiting, so the medication should be taken with food. 3. The administration of hydrocortisone with food will help decrease the amount of nausea that a child could have with the dose. 4. The medication is taken orally

11. The incidence of sexually transmitted diseases is highest among adolescents. In adolescents age 15 to 24, the percentage is estimated to be: 1. 30 percent. 2. 40 percent. 3. 50 percent. 4. 60 percent.

ANS: 3 Feedback 1. The percentage is too low for the age range. 2. The percentage is too low for the age range. 3. Nearly 50 percent of sexually transmitted diseases occur in 15 to 24 year olds. 4. The percentage is too high for the age range.

48. While assessing a 14 year old with a known history of diabetes mellitus Type 2, the nurse notes darker skin around the teens axilla. The nurse should: 1. Contact the doctor immediately 2. Provide a wash cloth and soap to cleanse the area. 3. Document the findings and note that acanthosis nigricans is present. 4. Ask the patient if he/she has had a recent infection.

ANS: 3 Feedback 1. This is a common condition in a teen with DM2 and does not require immediate doctor notification. 2. The area is clean. This is a discoloration in the skin. 3. Acanthosis nigricans occurs in individuals with DM2 and is a discoloration of the skin. 4. DM2 is the reasoning for the darker skin, not an infection.

64. An adolescent girl with Graves Disease is admitted to the hospital. The nurse expects to find which of the following clinical manifestations? 1. Weight gain, hirsutism, and muscle weakness 2. Dehydration, metabolic acidosis, and hypotension 3. Tachycardia, fatigue, and heat intolerance 4. Hyperglycemia, ketonuria, and glycosuria

ANS: 3 Feedback 1. Weight gain, hirsutism, and muscle weakness are signs of Cushings Syndrome. 2. Dehydration, metabolic acidosis, and hypotension are signs of Congenital Adrenal Hyperplasia. Hyperglycemia, ketonuria, and glycosuria are signs of diabetes mellitus. 3. Graves Disease occurs when thyroid hormone levels are increased, resulting in excessive levels of circulating thyroid hormones. Clinical manifestations include tachycardia, fatigue, and heat intolerance. 4. Graves Disease does not affect circulating glucose.

The nurse is presenting information to a group of parents regarding pediatric safety and the most common causes of death. One attendee states, "I am so happy that my youngest child is now 16." Which information does the nurse present in response to this comment? 1. The 16-year-old child is at high risk for death related to cancer. 2. Life expectancy with congenital or genetic defects is 13 to 19 years. 3. Adolescents between 5 and 19 years of age most commonly die from suicide. 4. Between 15 and 19 years of age the death rate is 45.5 deaths/100,000.

ANS: 4 4 This is correct. Between 15 and 19 years of age the death rate is 45.5 deaths/100,000. This is the pediatric group with the highest incidence of death. The most common causes are accidents, suicide, and homicide. 1 This is incorrect. Cancer is listed as a common cause of pediatric patients between the ages of 5 and 14 years. 2 This is incorrect. Death from congenital malformations, deformations, and chromosomal abnormalities most commonly occurs between 1 and 4 years of age. 3 This is incorrect. Between the ages of 5 and 19 years, suicide is listed as one of the leading causes of death. However, suicide is not singled out as the primary cause of death in this age group.

53. Which of the following features are indications of Downs syndrome? 1. A protruding tongue 2. Small, low-set ears 3. Mid-face hypoplasia 4. All of the above may be features of Downs syndrome.

ANS: 4 Feedback 1. A child with Downs syndrome tends to have a protruding tongue. 2. Low-set ears are a feature of children with Downs syndrome. 3. Mid-face hypoplasia is a common feature for children with Downs syndrome. 4. A protruding tongue, small, low-set ears, and mid-face hypoplasia are common in children with Downs syndrome.

15. A child is born with ambiguous genitalia. The only way to identify if the child is male or female is to obtain an order for: 1. An ultrasound. 2. A follicle stimulating hormone test. 3. An estrogen level test. 4. A sexual chromosome test.

ANS: 4 Feedback 1. A child with ambiguous genitalia may have ovaries/uterus and testicles present. 2. The hormone test is not appropriate because children with ambiguous genitalia can have ovaries and testicles. 3. A child with ambiguous genitalia can have a release of estrogen. 4. A chromosome test is the only test that can identify the DNA makeup of a male or female when a child has ambiguous genitalia.

60. A nurse is caring for a child with Turners syndrome. As the nurse listens to the childs heart and lungs, she would anticipate auscultating: 1. A high-pitched gurgle. 2. A low-pitched gurgle. 3. Wheezing in the lungs. 4. Crackles in the lungs.

ANS: 4 Feedback 1. A high-pitched gurgle is not noted in the lung sounds because of where the heart defect is located. 2. A low-pitched gurgle is not noted in the lung sounds because of where the heart defect is located. 3. Wheezes are not commonly heard in a child with Turners syndrome. 4. Crackles in lungs are common in a child with Turners syndrome because of the left-sided heart defects.

68. The nurse is administering an 0800 dose of NPH insulin to an insulin dependent diabetic child. Based on when the insulin peaks, the child would be at greatest risk for a hypoglycemic episode between: 1. Breakfast and lunch. 2. Bedtime and breakfast the next morning. 3. 0830 to a mid-morning snack. 4. Lunch and dinner.

ANS: 4 Feedback 1. A hypoglycemic reaction between breakfast and lunch would be associated with a short-acting insulin. 2. Between bedtime to breakfast the next morning would be associated with a long-acting insulin. 3. The 0830 to mid-morning hypoglycemia would be related to a rapid-acting insulin. 4. NPH is an intermediate-acting insulin that peaks in 6-12 hours. If administered at 0800, the risk of a hypoglycemic reaction would be at its peak between lunch and dinner.

24. Fetal Alcohol Syndrome Disorder (FASD) is divided into four subtypes. As a nurse, you know that the most severe type is: 1. Alcohol-Related Birth Defects. 2. Alcohol-Related Neurodevelopmental Disorder. 3. Partial Fetal Alcohol Syndrome. 4. Fetal Alcohol Syndrome

ANS: 4 Feedback 1. Alcohol-related defects demonstrate the physical appearance of the syndrome. 2. Neurodevelopmental disorders can occur with FASD. 3. Partial Fetal Alcohol Syndrome is not a technical term used in treating FASD. 4. Fetal Alcohol Syndrome (FAS) is the most severe form of FASD and is defined by abnormalities in three domains: poor growth, abnormal brain growth or structure, and specific dysmorphic facial features.

A 12-year-old girl diagnosed with hypothyroidism has been placed on Levothyroxine. The parents demonstrate an understanding of the medication when they state: 1. The medication will be taken for three months, then we will reassess to see if she still needs the medication. 2. The medication should only be given at night. 3. The medication will require us to do daily weight checks. 4. The medication will need to be taken for the remainder of her life

ANS: 4 Feedback 1. Assessment will need to be done to make sure that the child is receiving the correct recommended dose, but the child will need the medication for the remainder of her life. 2. The medication should be given in the morning. 3. The medication does not require daily weight checks. 4. The medication will need to be taken for the remainder of the childs life because the body does not naturally regulate the hormones.

75. The nurse is teaching a newly diagnosed diabetic patient about the importance of exercise and physical activity. The nurse knows that prior to exercise or physical activity; the child should: 1. Administer an extra dose of insulin. 2. Decrease the amount of fluids prior to exercise. 3. Restrict exercise to non-contact sports. 4. Eat an extra protein and complex carbohydrate snack.

ANS: 4 Feedback 1. Extra insulin is not indicated prior to exercise or physical activity. 2. Maintaining hydration is important during sports and will help eliminate dehydration. 3. Patients with T1 DM are not limited to any type of exercise or sport unless they have a physical disability and have been advised by a physician. 4. Physical exercise in patients with Type 1 DM will decrease blood glucose levels and is a key element to include in the lifestyle of patients who have hyperglycemia. However, due to the decrease in blood glucose levels during exercise or team sports, the child must add an additional complex carbohydrate and protein snack to help the body maintain glucose levels during exercise. Maintaining hydration is important during sports and will help eliminate dehydration. Patients with T1 DM are not limited to any type of exercise or sport unless they have a physical disability and have been advised by a physician. Extra insulin is not indicated prior to exercise or physical activity.

39. A nurse conducting an assessment of a 3-year-old with diabetes mellitus Type 1 would expect to find: 1. Polyuria. 2. Polydipsia. 3. Polyphagia. 4. All of the above.

ANS: 4 Feedback 1. Known as one of the 3 Ps of DM 1. 2. Known as one of the 3 Ps of DM 1. 3. Known as one of the 3 Ps of DM 1. 4. These are the 3Ps of DM 1.

7. Planning care for a patient with Menorrhagia would include education on all except: 1. Blood count, iron level, and platelet count levels. 2. Blood loss of greater than 80mL is considered a heavy volume. 3. Encouraging a diet of food rich in iron during menses. 4. Avoiding fluid intake with episodes of Menorrhagia.

ANS: 4 Feedback 1. Lab values reflect evidence to support excessive bleeding. 2. The patient should recognize and report accurate amounts of blood loss. 3. Iron-rich foods will help replenish iron lost with heavy bleeding. 4. Fluid intake will help replace volume lost through excessive bleeding.

49. A child drinks a glass of orange juice after experiencing symptoms of hypoglycemia. This rapid-releasing sugar should be followed by which of the following? 1. Protein 2. Fruit juice 3. Several glasses of water 4. Complex carbohydrates and protein

ANS: 4 Feedback 1. Once the childs blood sugar has increased, the child should immediately eat something that contains a protein. 2. Foods and beverages with simple sugars will temporarily increase the blood glucose level and are good for emergency situations. 3. Water lacks the protein and complex carbohydrates needed to help decrease the blood sugar levels. 4. Foods and beverages with simple sugars will temporarily increase blood glucose and are good for emergency situations. But once the childs blood sugar has increased, the child should immediately eat something that contains a protein and complex carbohydrate serving, such as peanut butter and crackers or cheese and wheat crackers.

14. All the following are true of pelvic inflammatory disease (PID) except that: 1. It is caused most often by genital gonorrhea. 2. It may result in oophoritis, which is an infection of the ovaries. 3. It may result in peritonitis, which is an infection of the abdominal lining. 4. Frequent douching does not increase risk of developing PID.

ANS: 4 Feedback 1. PID is most often caused by genital gonorrhea. 2. PID is often accompanied by involvement of the neighboring pelvic organs, such as the ovaries, causing oophoritis. 3. PID can cause infection of the abdominal lining or peritoneum, leading to peritonitis. 4. Frequent douching can increase the risk of developing PID.

70. 4-year-old Michelle has just been diagnosed with precocious puberty. The nurse is administering Lupron Depot Pediatric 7.5 mg. The recommended route of administration and frequency of dose for this medication is: 1. Intramuscular every 14 days. 2. Subcutaneously every 3 months. 3. Intramuscular every 21 days. 4. Intramuscular every 28 to 30 days.

ANS: 4 Feedback 1. Pediatric doses of Lupron Depot are administered via intramuscular injection every 28 to 30 days so that there is no break in therapy and so the patients hormone levels do not start to elevate and exacerbate symptoms of puberty. 2. The medication is to be delivered intramuscularly, not subcutaneously. 3. The dose for the medication is too soon and would not be effective. 4. Pediatric doses of Lupron Depot are administered via intramuscular injection every 28 to 30 days so that there is no break in therapy and so the patients hormone levels do not start to elevate and exacerbate symptoms of puberty. If doses are not given within this time frame, the patient may experience an increase in puberty development, as hormone levels are no longer suppressed.

62. A child with a growth hormone deficiency will be receiving daily subcutaneous injections of a biosynthetic growth hormone. The parents are being trained to administer the injections. It is important for the nurse to instruct the parents to: 1. Avoid cleaning the area with alcohol before giving the injection. 2. Use only the leg for injections. 3. Delay giving the injection by one day if the child becomes upset. 4. Rotate the injections sites daily.

ANS: 4 Feedback 1. The area should be cleansed with alcohol. 2. Lipoatrophy can occur at injection sites; therefore, the sites should be rotated between the arms, lateral thighs, abdomen, and buttocks. 3. Establishing a set time for the injection can create a routine and decrease anxiety for the child. 4. Lipoatrophy can occur at injection sites; therefore, the sites should be rotated between the arms, lateral thighs, abdomen, and buttocks. The injection should be given at the same time each day so a routine can be established. This minimizes the trauma of receiving daily injections. Delaying giving the injection will only heighten the childs anxiety.

17. Congenital Hypothyroidism is common in infants with Downs syndrome. Newborn screening for Congenital Hypothyroidism is required in all 50 states. Thyroid studies should be performed several times during the first years of life, and then a minimum of: 1. Every two months. 2. Every month. 3. Every six months. 4. Yearly.

ANS: 4 Feedback 1. The child only needs to be tested once a year after the initial newborn screening. 2. The child does not need to be tested monthly. Once a year is sufficient for the findings. 3. The child does not need to be tested every six months. Screening once per year is sufficient. 4. Testing is done several times during the first year, and then should be done yearly after the initial screening.

70. Children born with Fetal Alcohol syndrome will have long-term effects when dealing with: 1. Cognitive development. 2. Emotional development. 3. Physical development. 4. All of the above can be long-term effects related to Fetal Alcohol syndrome

ANS: 4 Feedback 1. The child will have long-term effects with cognitive development. 2. The child will have long-term effects with emotional development. 3. The child may have long-term effects with physical development. 4. Cognitive, emotional, and physical development may be impaired because of prenatal alcohol exposure.

1. An example of the bodys response to the endocrine system includes all of the following except: 1. A growth spurt for a 12-year-old boy. 2. Development of breast buds for a 10-year-old girl. 3. A teen reacting quickly, hitting another car while driving. 4. A teen answering a question on a biology test.

ANS: 4 Feedback 1. The endocrine system is responsible for growth rates in children. 2. The development of secondary sexual characteristics is controlled by the endocrine system. 3. The chemical interactions in the brain are controlled by the endocrine system. 4. The cognitive development of a teen is not controlled by the endocrine system.

47. Home management for a teen diagnosed with diabetes mellitus Type 2 would include: 1. Learning to measure foods and count carbohydrates. 2. Participating in exercise, such as riding a bike. 3. Creating a chart to indicate what foods should be eaten each day. 4. All of the above should be included in home management.

ANS: 4 Feedback 1. The measurement and counting of carbohydrates is needed to maintain an adequate balance for a teens blood glucose level. 2. Exercise will help the body burn fat and increase metabolism to decrease the need for insulin. 3. A chart will help a teen identify the correct foods to eat. 4. The measurement and counting of carbohydrates is needed to maintain an adequate balance for a teens blood glucose level. Exercise will help the body burn fat and increase metabolism to decrease the need for insulin. A chart will help a teen identify the correct foods to eat.

23. A 12-year-old girl is diagnosed with hyperpituitarism. Identify the correct primary treatment for this child. 1. A thyroidectomy 2. Chemotherapy 3. Radiation therapy to the thyroid 4. Administrating an antithyroid medication

ANS: 4 Feedback 1. The pituitary gland is the issue, not the thyroid. 2. Chemotherapy is a very aggressive treatment and not recommended as a primary treatment. 3. Radiological therapy is used for testing, not treatment. 4. The antithyroid hormone can help stop the aggressive process.

44. Diabetic ketoacidosis can occur in a known diabetic mellitus Type 1 child because: 1. Of poor compliance with the insulin regimen. 2. The insulin is out of date. 3. Puberty has begun. 4. All of the above can create a diabetic ketoacidosis state.

ANS: 4 Feedback1.Poor compliance can create a diabetic ketoacidotic state.2.Insulin should be date checked to maintain the correct potency.3.The rapid growth and metabolism during puberty can create an increased risk for diabetic ketoacidosis.4.Poor compliance can create a diabetic ketoacidotic state. Insulin should be date checked to maintain the correct potency. The rapid growth and metabolism during puberty can create an increased risk for diabetic ketoacidosis.

Beta blockers are frequently used in clients who have uncontrolled Graves Disease and exhibit clinical symptoms of thyroid storm. True or False

True Children with hyperthyroidism that lead to thyroid storm are often prescribed a beta blocker, along with anti-thyroid medications, to help decrease the workload on the heart. These patients tend to have extreme tachycardia and often experience arrhythmias due to the condition.

2. The nurse in a pediatric clinic is assessing an 11-year-old patient who is experiencing vaginal itching, soreness, and painful urination. Upon physical assessment, the nurse notices two ulcers, each 1 to 1.5 cm in diameter. Which additional assessment does the nurse perform? 1. Asks the patient about any sexual contact 2. Makes inquiries about recent viral infections 3. Inspects for the presence of a foreign vaginal body 4. Determines whether the patient has had pinworms

Makes inquiries about recent viral infections

1. The school nurse is preparing a teaching plan for 13-year-old female students about anatomy, puberty, and reproduction. Which information does the nurse recognize as being most important? 1. Fallopian tubes are at risk for blockage from sexually transmitted infections (STIs). 2. Endometrium is shed during menstrual cycles. 3. Menstruation indicates an ability to become pregnant. 4. The body will undergo observable physical changes.

Menstruation indicates an ability to become pregnant.

. The nurse is interviewing a 13-year-old male who reports a recent inability to retract his foreskin. The patient is uncircumcised and is also experiencing bleeding from the preputial orifice and pain with urination. Which initial action does the nurse take because of the indications of pathological phimosis? 1. Ask the patient about circumcision. 2. Obtain a prescription for steroids. 3. Consult the parents about surgery. 4. Seek a pediatric urological consultation.

Seek a pediatric urological consultation.

The school nurse is conducting a class for 13-year-old male students. After covering male anatomy, a student asks the nurse if the terms "sperm" and "semen" are interchangeable. Which information does the nurse provide? 1. Semen consists of sperm and various other body fluids. 2. Sperm and semen are considered the same substance. 3. Semen is produced by the each of two epididymides. 4. Sperm is not present until a male reaches late teen years.

Semen consists of sperm and various other body fluids.

3. The nurse in a pediatric clinic is obtaining medical information from a female patient who is 18 years of age. The patient expresses concern of a vaginal infection because of the presence of fishy-smelling, thin, whitish-gray discharge. Which information from the nurse is accurate? 1. The condition is identified as bacterial vaginosis. 2. The self-limiting infection will resolve in a week. 3. The existence of the condition is indicative of HIV. 4. The infection will require treatment for all sex partners.

The condition is identified as bacterial vaginosis.

69. A family with a child with genetic defects needs: 1. Education on the syndrome or disease process. 2. To be well-informed about treatment options. 3. Support from trained professionals in order to cope with the situation. 4. All of the above are correct.

1. Education will allow the family to be proactive for the childs needs. 2. Parents who are well-informed about the childs disease process are able to be proactive for the childs needs. 3. A family that has professionals to help with the childs needs will feel supported. 4. Education, information, and support will benefit the childs success.

A 12-year-old patient has a diagnosis of hyperthyroidism and is hospitalized for the manifestations of a thyroid storm. Which home-care concept will the nurse include in the care of the patient during hospitalization? 1. Provide a low-stress, low-pressure environment. 2. Ensure medications are given on the home schedule. 3. Limit intake of caffeine and carbonated fluids. 4. Increase intake of foods high in calcium and vitamin K.

ANS 1 1 This is correct. A low-stress, low-pressure environment is needed after a thyroid storm both during and after hospitalization and until the child's symptoms of hyperthyroidism are decreasing. The nurse needs to integrate this home-care concept. 2 This is incorrect. Medications for hyperthyroidism should be given as prescribed by the physician, regardless of whether the patient is in the hospital or at home. 3 This is incorrect. Limiting the intake of caffeine and carbonated beverages is appropriate for the care of the patient with hypoparathyroidism. 4 This is incorrect. Increasing the intake of foods high in calcium and vitamin K is appropriate care of the patient with hypoparathyroidism.

A 2-year-old has recently been diagnosed with a terminal type of cancer but is not experiencing any severe symptoms of the illness at this time. The mother of the patient is depressed and feels guilt over the illness. She admits to mentally planning the funeral and expecting to be devastated. The nurse identifies the mother as experiencing which stage of grief? 1. Anticipatory 2. Anger 3. Denial 4. Bargaining

ANS 1 1 This is correct. Anticipatory grief occurs before the stages of grief and is common in infant and pediatric death when the family of a patient with a terminal diagnosis prepares for death before the dying process. 2 This is incorrect. Anger concerning death results in feelings of wrath or indignation; it will often manifest as anger toward the disease, the cause of death of the infant or child, or even the medical staff and caregivers of the child. 3 This is incorrect. Following anticipatory grief is denial, which is a refusal to believe that an infant or child is dead or dying. 4 This is incorrect. Bargaining or negotiation is an attempt to create a change in the situation through an agreement for services exchanged.

44. In order to help decrease the pain after an inguinal hernia repair, the nurse should provide the patient with: 1. A pillow when coughing and breathing deeply. 2. Ice to the surgical site. 3. Pain medication as prescribed. 4. All of the above should be provided for the patient.

ANS: 4 Feedback 1. The pillow can be used as a splint to help hold the muscles when coughing. 2. The ice will help relieve pain. 3. The pain medication should be taken as prescribed because the level of pain will be higher and take longer to dissipate if not given on schedule. 4. The pillow can be used as a splint to help hold the muscles when coughing. The ice will help relieve pain. The pain medication should be taken as prescribed because the level of pain will be higher and take longer to dissipate if not given on schedule.