Peds Chapters 33,34,35,36

The nurse is researching behavioral-cognitive pain relief strategies to use on a 5-year-old child with unrelieved pain. Which methods might the nurse choose? Select all that apply. A) Relaxation B) Distraction C) Thought stopping D) Massage E) Sucking

A, B, C Common behavioral-cognitive strategies include relaxation, distraction, imagery, thought stopping, and positive self-talk. - Sucking and massage are examples of biophysical interventions.

The nurse is caring for medically fragile children in a hospital setting. What nursing role has the greatest impact on the child and family when caring for this population? A) Teacher B) Advocate C) Coordinator D) Caregiver

A.

A 6-month-old infant requires restraint to prevent removal of his nasogastric tube. What is the priority nursing intervention? A.Tie the restraint loosely to prevent skin breakdown. B.Leave the baby unrestrained when directly observed. C.Position the restrained infant prone to prevent aspiration. D. Place the infant in a room near the nurses' station.

B. Infants should be restrained only when necessary. Remove the restraints and provide direct observation as often as possible. Provide appropriate developmental stimulation while the restraints are on as well as off.

A child is admitted to the hospital with a spinal cord injury resulting in paralysis below the level of the waist. When should the nurse begin planning with the parents for rehabilitation placement for this child after acute hospitalization? A) After hospitalization when the parents are ready B) As soon after the patient is admitted as possible C)When the child starts showing improvement in their condition

B. It is important to begin planning for discharge to a rehabilitation facility as soon as possible so that all necessary arrangements can be made prior to discharge.

The nurse is looking into the Individuals with Disabilities Education Improvement Act of 2004 to help provide resources for a client with multiple chronic diseases. What are mandates of this legislation? Select all that apply. A) The law mandates government-funded care coordination and special education for children up to 8 years of age. B) This early intervention program is a state-funded program run at the federal level. C) This federal law allows each state to define "developmental disability" differently. D) An evaluation of the child's physical, language, emotional, and social capabilities is performed to determine eligibility. E) The primary care nurse manages the developmental services and special education that the child requires. F) The goal is to maintain a natural environment, so most services occur in the home or day care center.

C, D, F The Individuals with Disabilities Education Improvement Act of 2004 mandates government-funded care coordination and special education for children up to 3 years of age. Federal law allows each state to define "developmental disability" differently, but in general an evaluation of the child's physical, language, emotional, and social capabilities is performed by qualified personnel to determine eligibility. The goal of the program is that the child receives services in a "natural environment," so most services occur in the home or day care center. This early intervention program is administered through each state. Children who qualify for services receive care coordination, and the service coordinator manages the developmental services and special education that the child requires.

What would the nurse include in the plan of care for a dying child with pain? A) Administering analgesics as needed B) Using measures the nurse finds comforting C) Playing the television or radio so the child can hear it D) Changing the child's position frequently but gently

D. Pain management includes changing the child's position frequently but gently to minimize discomfort. Analgesics are given around the clock rather than as needed. The nurse would use measures that the child finds comforting to provide additional relief. A calm environment with minimal noise and light is helpful.

The nurse is conducting an assessment of a high school track athlete. The client tells the nurse he is experiencing pain along his outer thigh. He describes it as tight, achy, and tender, particularly after he runs. The nurse understands that he is most likely experiencing what kind of pain? A) Cutaneous B) Neuropathic C) Visceral D) Deep somatic

D. Deep somatic pain typically involves the muscles, tendons, joints, fasciae, and bones. It can be localized or diffuse and is usually described as dull, aching, or cramping with tenderness. It can also be due to overuse injuries commonly experienced by athletes. Cutaneous pain usually involves the skin and is described as sharp or burning. Neuropathic pain is due to a malfunctioning of the peripheral nervous system and is described as burning or tingling. Visceral pain is pain that develops within organs.

A 10-year-old child on a regular diet refuses to eat the food on her meal tray. She requests chicken nuggets, French fries, and ice cream. What is the best nursing action?

Within reason, the child on an unrestricted diet should be allowed to choose the foods that she likes. This increases the likelihood that she will get enough nutrition to support the healing process.

When the nurse is assessing a child's pain, which is most important? A) Obtaining a pain rating from the child with each assessment B) Using the same tool to assess the child's pain each time C) Documenting the child's pain assessment D) Asking the parents about the child's pain tolerance

b. the most important aspect of pain assessment is to use the same tool each time so that appropriate comparisons can be made and effective interventions can be planned and implemented. Consistency allows the most accurate assessment of the child's pain.

The nurse is preparing to administer a topical anesthetic for a 10-year-old girl with a chin laceration. The nurse would expect to apply what as ordered in preparation for sutures? A) TAC (tetracaine, epinephrine, cocaine) B) Iontophoretic lidocaine C) EMLA D) Vapocoolant spray

A. TAC (tetracaine, epinephrine, cocaine) is commonly used for lacerations that require suturing. The agent can be applied directly to the wound with a cotton ball or swab for 20 to 30 minutes until the area is numb. - EMLA and iontophoretic lidocaine are applied to intact skin, not to open wounds or lacerations. - A vapocoolant spray, which should not be applied over a wound, is only effective for 1 to 2 minutes.

30. The nurse will be administering a medication to a child that is primarily excreted by the kidney. The nurse is aware that this action is especially dangerous until the child reaches what age? Record your answer in years.

Ans: 2 Feedback: The immaturity of the kidneys until the age of 1 to 2 years affects renal blood flow, glomerular filtration, and active tubular secretion. This results in a longer half-life and increases the potential for toxicity of drugs primarily excreted by the kidneys.

3. The nurse is teaching the student nurse the factors that affect the pharmacodynamics of the drugs they are administering. What is a factor affecting this property of drugs? A) Immature body systems B) Weight C) Body surface D) Body composition

Ans: A Feedback: Although a drug's mechanism of action is the same in any individual, the physiologic immaturity of some body systems in a child can affect a drug's pharmacodynamics (behavior of the medication at the cellular level). The child's age, weight, body surface area, and body composition also can affect the drug's pharmacokinetics (movement of drugs throughout the body via absorption, distribution, metabolism, and excretion).

5. The nurse is caring for a hospitalized 13-year-old girl, who is questioning everything the medical staff is doing and is resistant to treatment. How should the nurse respond? A) "Let's work together to plan your day along with your treatments." B) "The sooner you cooperate, the sooner you are going to leave." C) "If you are more cooperative, perhaps we can arrange a visit from friends." D) "Please don't make me call your parents about this."

Ans: A Feedback: Collaborating with the adolescent will provide the teen with increased control. The nurse should work with the teen to provide a mutually agreeable schedule that allows for the teen's preferences while incorporating the required nursing care. Threatening to call the parents will most likely promote further resistance. The nurse should try to immediately engage the girl, rather than making the nurse's cooperation conditional upon the girl's cooperation. Telling the girl that the sooner she cooperates, the sooner she will leave is inappropriate. The nurse is incorrectly implying that her behavior, rather than her medical needs, is going to determine when she will be discharged from the hospital.

6. The nurse is caring for a special needs infant. Which intervention will be most important in helping the child reach her maximum developmental potential? A) Directing her parents to an early intervention program B) Monitoring her progress in elementary school C) Serving on an individualized education program committee D) Preparing a plan for her to transition to college

Ans: A Feedback: Early intervention is critical to maximizing the child's developmental potential by laying the foundation for health and development. While important, intervention in elementary or secondary school does not have the impact of early intervention. When the time arrives, it is important to have a written plan for transition to college, if this is a possibility for the grown child.

27. The parents of a child with physical and developmental special needs state, "We wish our child could get some kind of educational experience." How should the nurse respond? A) "This must be difficult for you. Let's talk with the social worker to see what programs are available for your child." B) "I am sure it must be difficult to know that your child will never be able to go to school like other children." C) "Since all children can attend school regardless of their special need, I suggest you talk with your local school about enrolling your child." D) "It would be very difficult for your child to attend school with all of their disabilities. It's unfortunate, but it is reality."

Ans: A Feedback: Education is federally mandated. Contacting the social worker gives the parents the support they need to find and choose the appropriate school. Telling them to contact their local school is not supportive of the parent's needs.

8. The nurse is administering a crushed tablet to an 18-month-old infant. What is a recommended guideline for this intervention? A) Mix the crushed tablet with a small amount of applesauce. B) Place the crushed tablet in the infant's formula. C) Mix the crushed tablet with the infant's cereal. D) Crushed tablets should only be mixed with water.

Ans: A Feedback: If a tablet or capsule is the only oral form available for children younger than 6 years, it needs to be crushed or opened and mixed with a pleasant-tasting liquid or a small amount (generally no more than a tablespoon) of a nonessential food such as applesauce. The crushed tablet or inside of a capsule may taste bitter, so it should never be mixed with formula or other essential foods. Otherwise, the child may associate the bitter taste with the food and later refuse to eat it.

22. The nurse is caring for a 6-year-old child who has multisystem trauma due to a motor vehicle accident. The child is receiving total parenteral nutrition (TPN). What is a recommended nursing intervention for children on TPN? A) Initially, check blood glucose levels frequently, such as every 4 to 6 hours, to evaluate for hyperglycemia. B) Be vigilant in monitoring the infusion rate, change the rate as necessary, and report any changes to the physician or nurse practitioner. C) If for any reason the TPN infusion is interrupted or stops, begin an infusion of a 10% saline at the same infusion rate as the TPN. D) Administer TPN continuously over an 8-hour period, or after initiation it may be given on a cyclic basis, such as over a 12-hour period during the night.

Ans: A Feedback: Initially, the nurse should check blood glucose levels frequently, such as every 4 to 6 hours, to evaluate for hyperglycemia. Throughout TPN therapy, the nurse should be vigilant in monitoring the infusion rate, and report any changes in the infusion rate to the physician or nurse practitioner immediately. Adjustments may be made to the rate, but only as ordered by the physician or nurse practitioner. If for any reason the TPN infusion is interrupted or stops, the nurse should begin an infusion of a 10% dextrose solution at the same infusion rate as the TPN. TPN can be administered continuously over a 24-hour period, or after initiation it may be given on a cyclic basis, such as over a 12-hour period during the night.

Origin: Chapter 14, 3 3. The nurse is caring for a child who is recovering from an appendectomy. What is the appropriate term for the pain this child is experiencing? A) Nociceptive pain B) Neuropathic pain C) Chronic pain D) Superficial somatic pain

Ans: A Feedback: Nociceptive pain reflects pain due to noxious stimuli that damages normal tissues or has the potential to do so if the pain is prolonged. Nociceptive pain ranges from sharp or burning; to dull, aching, or cramping; to deep aching or sharp stabbing. Examples of conditions that result in nociceptive pain include chemical burns, sunburn, cuts, appendicitis, and bladder distention. Neuropathic pain is pain due to malfunctioning of the peripheral or central nervous system. Chronic pain is defined as pain that continues past the expected point of healing for injured tissue. Superficial somatic pain, often called cutaneous pain, involves stimulation of nociceptors in the skin, subcutaneous tissue, or mucous membranes.

Origin: Chapter 14, 18 18. For which child would nonopioid analgesics be recommended? A) A child with juvenile arthritis B) A child with end-stage cancer C) A child with a broken arm D) A child with severe postoperative pain

Ans: A Feedback: Nonopioid analgesics may be used to treat mild to moderate pain, often for conditions such as arthritis; joint, bone, and muscle pain; headache; dental pain; and menstrual pain. Opioid analgesics are typically used for moderate to severe pain as can occur with cancer, broken bones, and postoperative healing.

Origin: Chapter 14, 19 19. Prior to administering morphine to a 10-year-old child, the nurse reviews the adverse effects of the drug. Which system is primarily affected by the drug, causing most of the adverse effects? A) Central nervous system B) Peripheral nervous system C) Digestive system D) Musculoskeletal system

Ans: A Feedback: Opioid agonists, such as morphine, are associated with numerous adverse effects, resulting primarily from their depressant action on the central nervous system.

7. The nurse is caring for a 4-year-old girl with special care needs in the hospital. Which intervention would have the most positive effect on this child? A) Taking her on an adventure down the hall B) Helping her do a simple craft project C) Introducing her to children in the playroom D) Limiting the staff providing care for her

Ans: A Feedback: Preschool-age children need to develop a sense of initiative, and helping the child to explore her area of the hospital would help accomplish this developmental need. Craft projects and introducing the child to other children would help build a sense of industry and peer relationships, both of which are needs of the school-age, not preschool, child. Limiting the number of people providing care is a trust-building intervention, beginning in infancy.

11. The nurse is preparing to administer insulin to a diabetic child. Which would be the recommended route for this administration? A) Subcutaneous B) Intradermal C) Intramuscular D) Oral

Ans: A Feedback: Subcutaneous (SQ) administration distributes medication into the fatty layers of the body. It is used primarily for insulin administration, heparin, and certain immunizations, such as MMR. Intradermal administration is used primarily for tuberculosis screening and allergy testing. Intramuscular administration is used to administer certain medications, such as many immunizations. Insulin is not administered orally.

2. The nurse is caring for a 7-year-old girl hospitalized in isolation. The nurse notices that she has begun sucking her thumb and changing her speech patterns to those of a toddler. What condition is the girl manifesting? A) Regression B) Suppression C) Repression D) Denial

Ans: A Feedback: Sucking the thumb and changing of speech pattern (such as to baby talk) are signs of regression, a defense mechanism used by children to deal with unpleasant experiences by returning to a previous stage that may be more comfortable to the child. Suppression is a conscious inhibition of an idea or desire. Repression is an unconscious inhibition of an idea or desire. Denial would be exhibited by expressions of resignation instead of true contentment, not thumb sucking or baby talk.

Origin: Chapter 14, 13 13. The nurse is assessing the pain of a postoperative newborn. The nurse measures the infant's facial expression, body movement, sleep, verbal or vocal ability, consolability, and response to movements and touch. Which behavioral assessment tool is being used by the nurse? A) Riley Infant Pain Scale B) Pain Observation Scale for Young Children C) CRIES Scale for Neonatal Postoperative Pain Assessment D) FLACC Behavioral Scale for Postoperative Pain in Young Children

Ans: A Feedback: The Riley Infant Pain Scale measures six parameters: facial expression, body movement, sleep, verbal or vocal ability, consolability, and response to movements and touch. The Pain Observation Scale for Young Children (POCIS) measures seven parameters: facial expression, cry, breathing, torso, arms and fingers, legs and toes, and state of arousal. The CRIES tool assesses five parameters: cry, oxygen required for saturation levels less than 95%, increased vital signs, facial expression, and sleeplessness. The FLACC tool measures five parameters: facial expression, legs, activity, cry, and consolability.

24. A physician orders a medication dosage that is above the normal dosage. The nurse administers the medication without questioning the dosage. What error did the nurse make? A) The nurse violated one of the "rights" of medication administration. B) The nurse performed an act outside the scope of practice for nursing. C) The nurse has not made an error, but the physician did by ordering the wrong dosage of medication. D) The nurse has committed an act of maleficence by administering the medication.

Ans: A Feedback: The nurse violated one of the "rights" of medication administration, the right dosage, because the nurse is responsible for being aware and questioning an incorrect dosage of medication. Medication administration is within the scope of nursing practice. Maleficence is performing a harmful act intentionally.

5. A 7-year-old boy has reentered the hospital for the second time in a month. Which intervention is particularly important at this time? A) Assessing his parents' coping abilities B) Seeking his parents' input about their child's needs C) Educating his family about the procedure D) Notifying the care team about his hospitalization

Ans: A Feedback: Transition times, such as when the child reenters the hospital, create additional stress on the parents and child. Assessing the parents' coping abilities is particularly important at this time. Seeking parental input, educating about a procedure, and notifying the care team are basic activities of family-centered care and care coordination.

Origin: Chapter 14, 25 25. The nurse is providing teaching to the parents of a newborn prior to a heelstick. The nurse is describing the procedure and recommending various methods for the parents to help comfort their baby. Which statement by the parents indicates a need for further teaching? A) "It's better if we are not in the room for this." B) "We can use kangaroo care before and after." C) "We hope you are using a very tiny needle." D) "We can offer him nonnutritive sucking to calm him."

Ans: A Feedback: Unless contraindicated, the parents should be encouraged to be present before, during, and after the procedure to provide comforting support to the child. Kangaroo care, small-gauge needles, and nonnutritive sucking are other methods to provide atraumatic care.

18. When providing care to a dying child and his family, which would be most important? A) Focusing on the family as the unit of care B) Teaching the family appropriate care measures C) Offering the child support and encouragement D) Assisting the parents in decision making

Ans: A Feedback: When caring for a dying child and his family, the most important aspect of care is focusing on the family as the unit of care. Teaching, offering support, and assisting in decision making are important, but these actions must be implemented while focusing on the family as the unit of care.

8. The nurse is caring for infants having the condition failure to thrive (FTT). Which infants would be at risk for this condition? Select all that apply. A) A newborn baby with tetralogy of Fallot B) An infant with a cleft palate C) An infant born to a diabetic mother D) An infant born to an impoverished mother E) An infant with bronchopulmonary dysplasia F) An infant born to a teenage mother

Ans: A, B, D, E Feedback: Infants and children with cardiac or metabolic disease, chronic lung disease (bronchopulmonary dysplasia), cleft palate, or gastroesophageal reflux disease are at particular risk for FTT. Also, poverty is the single greatest contributing risk factor (Block et al., 2005). An infant born to a diabetic mother or an infant born to a teenage mother does not have increased risk for FTT.

The nurse is managing children who have chronic diseases in a neighborhood clinic. What are some examples of chronic conditions? Select all that apply. A) Diabetes mellitus B) Myocardial infarction C) Rheumatoid arthritis D) Compound fracture E) Acute asthma F) Bronchopneumonia

Ans: A, C, E Feedback: Chronic pain is defined as pain that continues past the expected point of healing for injured tissue. Diabetes, arthritis, and asthma are examples of chronic pain. Acute pain is defined as pain that is associated with a rapid onset of varying intensity. It usually indicates tissue damage and resolves with healing of the injury. Examples include heart attack, fractures, and bronchopneumonia.

Origin: Chapter 14, 6 6. The nurse caring for infants in the neonatal intensive care unit (NICU) relies on the use of behavioral and physiologic indicators for determining pain. Which examples are behavioral indicators? Select all that apply. A) The infant grimaces. B) The infant's heart rate is elevated. C) The infant flails his arms and legs. D) The infant's respiratory rate is elevated. E) The infant is crying uncontrollably. F) The infant's oxygen saturation is low.

Ans: A, C, E Feedback: In preterm and term newborns, behavioral and physiologic indicators are used for determining pain. Behavioral indicators include facial expression, body movements, and crying. Physiologic indicators include changes in heart rate, respiratory rate, blood pressure, oxygen saturation levels, vagal tone, palmar sweating, and plasma cortisol or catecholamine levels.

9. The nurse is preparing to administer medication to a child with a gastrostomy tube in place. What is a recommended guideline for this procedure? Select all that apply. A) Verify proper tube placement prior to instilling medication. B) Mix liquid medications with a small amount of water and add directly into the tube. C) Mix powdered medications well with cold water first. D) Crush tablets and mix with warm water to prevent tube occlusion. E) Open up capsules and mix the contents with warm water. F) Flush the tube with water after administering medications.

Ans: A, D, E, F Feedback: The correct procedure includes checking proper tube placement prior to instilling medication, crushing tablets and mixing with warm water to prevent tube occlusion, opening up capsules and mixing the contents with warm water, and flushing the tube with water after administering medications. The nurse should give liquid medications directly into the tube and mix powdered medications well with warm water first.

4. The nurse is caring for families with vulnerable child syndrome. Which situation would be most likely to predispose the family to this condition? A) Having a postterm infant B) Having an infant who is reluctant to feed properly C) Having a child diagnosed with impetigo at age 10 D) Having a child with juvenile diabetes

Ans: B Feedback: "Vulnerable child syndrome" is a clinical state in which the parents' reactions to a serious illness or event in the child's past continue to have long-term psychologically harmful effects on the child and parents for many years. Risk factors for the development of vulnerable child syndrome include preterm birth, congenital anomaly, newborn jaundice, handicapping condition, an accident or illness that the child was not expected to recover from, or crying or feeding problems in the first 5 years of life.

17. The nurse is caring for children who are receiving IV therapy in the hospital setting. For which children would a central venous device be indicated? A) A child who is receiving an IV push B) A child who is receiving chemotherapy for leukemia C) A child who is receiving IV fluids for dehydration D) A child who is receiving a one-time dose of a medication

Ans: B Feedback: Although central venous access devices can be used short term, the majority are used for moderate- to long-term therapy, such as chemotherapy. Central venous access devices are indicated when the child lacks suitable peripheral access, requires IV fluid or medication for more than 3 to 5 days, or is to receive specific treatments, such as the administration of highly concentrated solutions or irritating drugs that require rapid dilution. Peripheral IV devices are used for most other IV therapies.

Origin: Chapter 14, 23 23. The nurse is caring for a child who reports chronic pain. What is the priority nursing assessment? A) How the pain impacts the child's and family's stress level B) The pain's history, onset, intensity, duration, and location C) The child's and parents' feeling of anxiety and depression D) The child's cognitive level and emotional response

Ans: B Feedback: Assessment of the child's pain is key; it is the priority assessment and is the only answer that focuses on the child's physiologic need. Assessment of how the pain impacts the child's and family's stress, feelings of anxiety, hopelessness, and depression, as well as the child's cognitive level and emotional response, are secondary after the pain is explored.

Origin: Chapter 14, 16 16. The student nurse is learning about the effects of heat and cold when used in a pain management plan. What accurately describes one of these effects? A) Cold results in vasodilation. B) Cold alters capillary permeability. C) Heat results in vasoconstriction. D) Heat decreases blood flow to the area.

Ans: B Feedback: Cold results in vasoconstriction and alters capillary permeability, leading to a decrease in edema at the site of the injury. Heat results in vasodilation and increases blood flow to the area.

Origin: Chapter 14, 14 14. The nurse tells a joke to a 12-year-old to distract him from a painful procedure. What pain management technique is the nurse using? A) Relaxation B) Distraction C) Imagery D) Thought stopping

Ans: B Feedback: Distraction involves having the child focus on another stimulus, thereby attempting to shield him from pain. Humor has been demonstrated to be an effective distracting technique for pain management.

24. When describing organ donation to the family of a dying child, what would the nurse include in the discussion? A) Telling them that further harm may occur to the child through the process B) Tell them that their cultural and religious beliefs will be considered C) Including this topic in the discussion of impending death D) Informing the family that organ donation will delay the funeral

Ans: B Feedback: During organ donation, the family's cultural and religious beliefs must be considered, and the team discussing organ donation with the family must do so in a sensitive and ethical manner. The donating child will not suffer further because of organ donation. The topic of organ donation should be separated from the discussion of impending death or brain death notification. Organs are harvested in a timely fashion after the declaration of death so the family need not worry about delay of the wake or funeral.

Origin: Chapter 14, 28 28. The nurse is explaining the effects of heat application for pain relief. Which effect would the nurse be likely to include? A) Decreased blood flow to the area B) Increased pressure on nociceptive fibers C) Possible release of endogenous opioids D) Altered capillary permeability

Ans: B Feedback: Heat causes an increase in blood flow. This alters capillary permeability, leading to a reduction in swelling and pressure on nociceptive fibers. Heat also may trigger the release of endogenous opioids, which mediate the pain response.

16. The nurse is providing home care for the family of an 8-year-old boy who is dying of leukemia. Which action will be most supportive to the parents of the child? A) Encouraging organ and tissue donation B) Being patient with parental indecision C) Getting prior authorization for treatments D) Explaining how anorexia is a natural process

Ans: B Feedback: It is critical to be patient with parents who may vacillate when making decisions. Give them the information and time they need to make decisions and avoid being judgmental. Explaining about anorexia and encouraging organ donation may be discussed when the parents indicate they are concerned. Getting prior authorization facilitates care delivery and is not a supportive intervention.

13. The nurse is providing teaching on how to administer nasal drops. Which response by the parents indicates a need for further teaching? A) "We need to be careful not to stimulate a sneeze." B) "She needs to remain still for at least 10 minutes after administration." C) "Our daughter should lie on her back with her head hyperextended." D) "We must not let the dropper make contact with the nasal membranes."

Ans: B Feedback: Once the drops are instilled, the child should remain in hyperextension for at least 1 minute to ensure the drops have come in contact with the nasal membranes. Ten minutes would be excessive. The other statements are correct.

19. The parents of an 11-year-old boy who is dying from cancer are concerned that he is not eating. Which intervention would serve both the parents' and child's needs? A) Urging the child to eat one good meal per day B) Serving small meals of things the child likes C) Straightening up around the child before meals D) Administering antiemetics as ordered for nausea

Ans: B Feedback: The child is more likely to eat small amounts of foods of his choosing. This accommodates the child's reduced appetite, reassures his parents that he is not starving, and gives the child a sense of control. Straightening up the child's area before meals provides a more pleasant eating environment. The use of antiemetics controls nausea but may not increase appetite. Urging the child to eat a substantial meal is unnecessary and creates stress.

12. The nurse is caring for an 8-year-old girl who requires medication that is only available in an enteric tablet form. The nurse is teaching the mother how to help the girl swallow the medication. Which statement indicates a need for further teaching? A) "I can encourage her to place it on the back of her tongue." B) "I can pinch her nose to make it easier to swallow." C) "We cannot crush this type of pill as it will affect the delivery of the medication." D) "We can place the tablet in a spoonful of applesauce."

Ans: B Feedback: The mother should be advised to never pinch the child's nose as it increases the risk for aspiration. The other statements are correct.

5. The nurse is providing teaching for the mother of an infant who receives all of his nutrition through a tube. The nurse is reviewing interventions to promote growth and development. Which response from the mother indicates a need for further teaching? A) "I will give him a pacifier during feeding time." B) "We need to keep feeding time very quiet." C) "We need to make sure he doesn't lose the desire to eat by mouth." D) "Sucking produces saliva, which aids in digestion."

Ans: B Feedback: The nurse needs to emphasize that it is important to talk, play music, cuddle, and rock the infant to promote a normalized feeding time. The other statements are correct.

7. The nurse is preparing to administer a medication to a 5-year-old who weighs 35 pounds. The prescribed single dose is 1 to 2 mg/kg/day. Which is the appropriate dose range for this child? A) 8 to 16 mg B) 16 to 32 mg C) 35 to 70 mg D) 70 to 140 mg

Ans: B Feedback: The nurse should convert the child's weight in pounds to kilograms by dividing the child's weight in pounds by 2.2. (35 pounds divided by 2.2 = 16 kg). The nurse would then multiply the child's weight in kilograms by 1 mg for the low end (16 kg × 1 mg = 16 mg) and then by 2 mg for the high end (16 kg × 2 mg = 32 mg).

16. The nurse is preparing to administer an intramuscular injection to an 8-month-old infant. Which site would the nurse select? A) Rectus femoris B) Vastus lateralis C) Dorsogluteal muscle D) Deltoid

Ans: B Feedback: The preferred injection site in infants is the vastus lateralis muscle. An alternative site is the rectus femoris. The dorsogluteal site is not used in children until the child has been walking for at least 1 year. The deltoid muscle is used as a site in children after the age of 4 or 5 years.

4. When describing the differences affecting the pharmacokinetics of drugs administered to children, which would the nurse include? A) Oral drugs are absorbed more quickly in children than adults. B) Absorption of intramuscularly administered drugs is fairly constant. C) Topical drugs are absorbed more quickly in young children than adults. D) Absorption of drugs administered by subcutaneous injection is increased.

Ans: C Feedback: Topical absorption of drugs is increased in infants and young children because the stratum corneum is thinner and well hydrated. The absorption of oral drugs is slowed by slower gastric emptying, increased intestinal motility, a proportionately larger small intestine surface area, high gastric pH, and decreased lipase and amylase secretion. The absorption of drugs given intramuscularly or subcutaneously is erratic and may be decreased.

26. The parents of a child receiving total parenteral nutrition ask the nurse why their child must have their blood glucose monitored so frequently since they are not diabetic. What is the best response by the nurse? A) "We like to keep a close check on the blood glucose for all children receiving total parenteral nutrition." B) "It is important to monitor the blood glucose level because the solution has a high concentration of carbohydrates that convert to glucose." C) "This is a good time for us to monitor your child in case they start developing signs of diabetes related to receiving total parenteral nutrition." D) "I would suggest you ask the physician why blood glucose checks have been ordered so frequently."

Ans: B Feedback: Total parenteral nutrition has a high concentration of carbohydrates, which convert to glucose. Informing the parents that this is the reason for frequent monitoring of the blood glucose adequately addresses their question. It is routine for any patient receiving total parenteral nutrition to have frequent monitoring of blood glucose, but this does not answer the parent's question. There is no need to monitor a child for diabetes without reason. There is no reason to suggest asking the physician when this question can be answered by the nurse.

14. The nurse is helping a 20-year-old woman transition to adult care. Which would be the most important role of the nurse following a successful transition? A) Teacher B) Consultant C) Care provider D) Advocate

Ans: B Feedback: Transition planning involves multidisciplinary care coordination; acknowledgement of the changing roles among the youth, family, and health care professionals; and fostering of the youth's self-determination skills. Prior to transition, educating the client is the most important role of the nurse. After the transition, the nurse serves as a consultant to the adult office in relation to the teen's needs. The nurse consults with a transition services coordinator or other service agency as available in the local community.

20. The nurse is caring for a child involved in an automobile accident whose family has been informed that the child is brain dead. What teaching might the nurse provide the family regarding organ donation? A) The nurse should ask about organ donation when the family is informed of their child's condition. B) The nurse should explain that written consent is necessary for the organ donation. C) The nurse should make sure the parents know that procurement of organs may mar their child's appearance. D) The nurse should make sure the parents know that they will be responsible for expenses related to organ procurement.

Ans: B Feedback: Written consent is necessary for organ donation, so the family must be appropriately informed and educated. The discussion of organ donation should be separate from the discussion of impending death or brain death notification. Families need to know that procurement of the organs does not mar the child's appearance, so that an open casket at the child's funeral is still possible if the family desires. All expenses for organ procurement are borne by the recipient's family, not the donor's.

25. The nurse notes that a child with swallowing difficulty is receiving a continuous tube feeding. The child is very active and the feeding frequently gets interrupted because the tube becomes disconnected. What should the nurse discuss with the physician about the tube feeding? A) The nurse should ask the physician if the patient could receive total parenteral nutrition. B) The nurse should ask the physician if the patient could receive bolus rather than continuous tube feedings. C) The nurse should ask the physician if the patient could receive the tube feedings during the night rather than continuously during all hours. D) The nurse should ask the physician if the patient could be given oral rather than tube feedings. E) The nurse should ask the physician if the patient could be given a sedative in order to prevent disruption of the tube feedings.

Ans: B, C Feedback: A bolus feeding is a specified amount of feeding solution that is given at specific intervals, usually over a short period of time such as 15 to 30 minutes, and is given via a syringe, feeding bag, or infusion pump. Continuous feedings are given at a slower rate over a longer period of time. In some cases, the feeding may be given during the night so that the child can be free to move about and participate in activities during the day. Either of these methods could help in the disruption of the feedings. Total parenteral nutrition is intravenous feeding and cannot be given for extended periods of time, nor would it help the active child. The child has a swallowing difficulty so oral feedings are not possible at this time. Sedatives would be considered a chemical restraint if given for this purpose.

The nurse is teaching the student nurse the physiology involved in pain transmission. Which statements accurately describes a physiologic event in the nervous system related to pain transmission? Select all that apply. A) Thermal stimulation may involve the release of mediators, such as histamine, prostaglandins, leukotrienes, or bradykinin. B) When nociceptors are activated by noxious stimuli, the stimuli are converted to electrical impulses that are relayed to the spinal cord and brain. C) Myelinated A-delta fibers are large fibers that conduct the impulse at very rapid rates; unmyelinated small C fibers transmit the impulse slowly. D) Once in the dorsal horn of the spinal cord, the nerve fibers divide and then cross to the opposite side and rise upward to the thalamus. E) The point at which the person first feels the highest intensity of the painful stimulus is termed the pain threshold. F) Peripheral sensitization allows the nerve fibers to react to a stimulus that is of lower intensity than would be needed to cause pain.

Ans: B, C, D, F Feedback: When nociceptors are activated by noxious stimuli, the stimuli are converted to electrical impulses that are relayed along the peripheral nerves to the spinal cord and brain. Myelinated A-delta fibers are large fibers that conduct the impulse at very rapid rates; unmyelinated small C fibers transmit the impulse slowly. Once in the dorsal horn of the spinal cord, the nerve fibers divide and then cross to the opposite side and rise upward to the thalamus. Peripheral sensitization allows the nerve fibers to react to a stimulus that is of lower intensity than would be needed to cause pain. Chemical stimulation may involve the release of mediators, such as histamine, prostaglandins, leukotrienes, or bradykinin. The point at which the person first feels the lowest intensity of the painful stimulus is termed the pain threshold.

The nurse is monitoring the output for a 10-year-old child. The medical record indicates the child weighs 78 pounds. How much urine can be anticipated for this child for a 12-hour period? 1. 78 pounds = 35kg 2. 1 mL X 35kg = 35 mL/hr and 2 mL X 35 = 70 mL/hr 3. 35 mL X 12 hours = 420 mL 4. 70 mL X 12 hours = 840 mL A) 300 to 1200 mL B) 360 to 900 mL C) 420 to 840 mL D) 600 to 1200 mL

Ans: C Feedback: Urinary output for a child will vary. As a general rule, output anticipated will be approximately 1.0 to 2.0 mL/kg/hour for children and adolescents. In a child who weighs 78 pounds, this will calculate as follows: (the rest of this was not available)

27. The student nurse is preparing to administer eye drops to a 2-year-old child. Which actions indicate the need for additional instruction? Select all that apply. A) The student nurse explains the medication regimen to the child's parents. B) The nurse holds the medication bottle 3 inches from the child's nurse during administration. C) The child is instructed to look down during the instillation of the medication in the eyes. D) The student nurse seeks assistance to hold the child during the medication administration. E) The child is turned so the medication flows toward the outer corner of the eye.

Ans: B, C, E Feedback: When preparing to administer medications to a child teaching to the parents and the child (based upon the child's ability to comprehend) about the medication and the procedure that will be used. When a child is under the age of 3, assistance should be obtained from another health care provider. The bottle should be held one inch from the child's nose. The child should be instructed to look up and to the side for the administration. The medication should flow toward the nose.

19. A nurse has just administered medication via an orogastric tube. What is the priority nursing action following administration? A) Check tube placement. B) Retape the tube. C) Flush the tube. D) Remove the tube.

Ans: C Feedback: After administration, the nurse should flush the tube to maintain patency and ensure that the entire amount of medication has been given. The tube should be checked prior to administering the medication. It is not necessary to retape the tube following administration. It is not appropriate to remove the tube unless it has been specifically ordered.

12. The nurse is reviewing the Adolescent Health Transition Project's recommended schedule for transition planning. According to the schedule, at what age should the nurse explore health care financing for young adults? A) 12 years old B) 14 years old C) 17 years old D) 19 years old

Ans: C Feedback: By age 14, the nurse should ensure that a transition plan is initiated and that the individualized education plan (IEP) reflects post-high school plans. By age 17, the nurse should explore health care financing for young adults. The nurse should check the teen's eligibility for Supplemental Security Income (SSI) the month the child turns 18. By age 21, the nurse should ensure that the young adult has registered with the Division of Developmental Disabilities for adult services if applicable.

29. The mother of a 7-year-old boy with autism tearfully reports feeling as if she is not qualified to care for her child. Which initial action by the nurse is most appropriate? A) Tell the child's mother that this is a common feeling when caring for a special needs child. B) Encourage the child's mother to keep a journal to best identify areas needing improvement in the home routine. C) Recognize the mother's positive accomplishments in caring for her child. D) Recommend the child's mother seek counseling.

Ans: C Feedback: Caring for a special needs child can be overwhelming for the parents. Feeling overwhelmed is not uncommon. Recognition of positive outcomes and activities should be performed. The child's mother may indeed benefit from counseling or participation in a support group but it is not of the highest priority. Explaining to the child's mother that others feel the same way does not address her personal concerns. Keeping a journal may be effective but suggestions that this will help improve her performance are not meeting her immediate needs.

Origin: Chapter 14, 27 27. The nurse is preparing a child for a lumbar puncture. How far ahead of the procedure should the nurse apply the EMLA cream? A) 30 minutes B) 1 hour C) 3 hours D) 4 hours

Ans: C Feedback: For a deeper procedure such as a lumbar puncture, the nurse needs to apply the cream 2 to 3 hours before the procedure. For a superficial procedure, the EMLA cream should be applied at least 1 hour before the procedure.

29. The nurse if checking placement on a child's feeding tube. When the pH is checked, it is 5.3. What action by the nurse is indicated? A) Remove the tube. B) Document the findings as normal. C) Contact the health care provider. D) Re-evaluate the pH again in 2 hours.

Ans: C Feedback: Gastric pH may be used to evaluate feeding tube placement. Normal gastric pH is less than 5.0. Findings greater than 5.0 indicate the need for further action. The nurse cannot remove the tube. The findings cannot be documented as normal. Evaluating the gastric pH again in 2 hours is not appropriate as the matter warrents more immediate action.

17. The nurse is providing palliative care for a 9-year-old boy in hospice. Which is unique to hospice care for children? A) Encouraging visits from friends and family B) Educating parents about terminal dehydration C) Prolonging treatment that might possibly help D) Treating constipation to relieve abdominal pain

Ans: C Feedback: Hospice for children allows for continuation of hopeful treatment so long as certain criteria are met. This is different from adult hospice. Encouraging visits from friends and family, educating parents about terminal dehydration, and treating constipation are common to family-centered care.

2. The nurse is caring for a toddler with special needs. Which developmental tasks related to toddlerhood might be delayed in the child with special needs? A) Developing body image B) Developing peer relationships C) Developing language and motor skills D) Learning through sensorimotor exploration

Ans: C Feedback: In special needs children, developmental delays may occur in all stages. In particular, motor and language skill development may be delayed if the toddler is not given adequate opportunities to test his or her limits and abilities. Development of body image may be hindered in the preschooler due to painful exposures and anxiety. Development of peer relationships may be delayed in the school-age and adolescent child. The infant's ability to learn through sensorimotor exploration may be impaired due to lack of appropriate stimulation, confinement to a crib, or increased contact with painful experiences.

Origin: Chapter 14, 5 5. The nurse is caring for a child who is experiencing pain related to chemotherapy treatment. What is a behavioral factor that might affect the child's pain experience? A) Knowledge of the therapy B) Fear about the outcome of therapy C) Participation in normal routine activities D) Ability to identify pain triggers

Ans: C Feedback: Participation in normal routine activities is a behavior factor. Knowledge of the therapy and ability to identify pain triggers are cognitive factors. Fear about the outcome of therapy is an emotional factor. Situational factors involve factors or elements that interact with the child and his or her current situation involving the experience of pain.

4. The nurse is caring for a 4-year-old girl who has been hospitalized for over a week with severe burns. Which would be a priority intervention to help satisfy this preschool child's basic needs? A) Encourage friends to visit as often as possible. B) Suggest that a family member be present with her 24 hours a day. C) Explain necessary procedures in simple language that she will understand. D) Allow her to make choices about her meals and activities as much as permitted.

Ans: C Feedback: Preschoolers fear mutilation and are afraid of intrusive procedures since they do not understand the body's integrity. They interpret words literally and have an active imagination; therefore, procedures should be demonstrated and/or explained in simple terms. Adolescents typically do not experience separation anxiety from being away from their parents; instead, their anxiety comes from being separated from friends, and therefore encouraging friends to visit is a priority intervention. Toddlers are especially susceptible to separation anxiety and would benefit from a family member being present as much as possible. School-age children are accustomed to controlling self-care and typically are highly social; they would benefit from being involved in choices about meals and activities.

15. After administering eye drops to a child, the nurse applies gentle pressure to the inside corner of the eye at the nose for which reason? A) To promote dispersion over the cornea B) To enhance systemic absorption C) To ensure the medication stays in the eye D) To stabilize the eyelid

Ans: C Feedback: Punctal occlusion, or gentle pressure to the inside corner of the eye at the nose, helps to slow systemic absorption and ensure that the medication stays in the eye. Having the head lower than the body aids in dispersing the medication over the cornea. Placing the heel of the hand on the child's forehead and then retracting the lower lid helps to stabilize it.

21. The nurse is caring for a preschool child who is receiving palliative care for end-stage cancer. What would be the focus of age-appropriate interventions for this child? A) Providing unconditional love and trust B) Providing a familiar and consistent routine C) Teaching the child that death is not punishment D) Providing specific, honest details of death

Ans: C Feedback: Spirituality in the preschool years focuses on the concept of right versus wrong. The 3- to 5-year-old may see death as punishment for wrongdoing, and the nurse must correct this misunderstanding. For the infant, unconditional love and trust are of utmost importance. The toddler, 1 to 3 years old, thrives on familiarity and routine; the nurse should maximize the toddler's time with parents, be consistent, provide favorite toys, and ensure physical comfort. The school-age child has a concrete understanding of death. Children who are 5 to 10 years old need specific, honest details (as desired).

21. The nurse is explaining to the student nurse the therapeutic effects of total parenteral nutrition (TPN). What accurately describes the use of TPN? A) It is used short term to supply additional calories and nutrients as needed. B) It is delivered via the peripheral vein to allow rapid dilution of hypertonic solution. C) It is a highly concentrated solution of carbohydrates, electrolytes, vitamins, and minerals. D) It is usually used when the child's nutritional status is within acceptable parameters.

Ans: C Feedback: TPN is a highly concentrated solution of carbohydrates, electrolytes, vitamins, and minerals. TPN provides all nutrients to meet a child's needs. It is delivered via central venous access to allow rapid dilution of hypertonic solution. It is usually used in a child with a nonfunctioning gastrointestinal (GI) tract, such as a congenital or acquired GI disorder; a child with severe failure to thrive or multisystem trauma or organ involvement; and preterm newborns.

22. The nurse is caring for a 5-year-old boy who is terminally ill. Which intervention would best meet the needs of this dying child? A) Offer the child decision-making opportunities. B) Provide the child with specific details. C) Assure the child that he did nothing wrong. D) Act as a confidant for the child's concerns.

Ans: C Feedback: The magical thinking of preschool-age children may cause him to think that dying is punishment for doing something wrong. Assuring him that he did nothing wrong is very important. School-age children would benefit from receiving specific details and being given decision-making opportunities. They may also use nurses as their confidants.

Origin: Chapter 14, 7 7. A nurse is providing teaching to the mother of an adolescent girl about how to manage menstrual pain nonpharmacologically. Which statements by the mother indicates a need for further teaching? A) "I need to help her learn techniques to distract her; card games, for example." B) "I need to be able to identify the subtle ways she shows pain." C) "I need to follow these instructions exactly for them to work properly." D) "I need to encourage her to practice and utilize these techniques."

Ans: C Feedback: The mother does not need to follow the instructions exactly; she needs to review the methods and modify them in a way that works best for her daughter. The other statements are correct.

Origin: Chapter 14, 21 21. The nurse has applied EMLA cream as ordered. How does the nurse assess that the cream has achieved its purpose? A) Assess the skin for redness. B) Note any blanching of skin. C) Lightly tap the area where the cream is. D) Gently poke the child with a needle.

Ans: C Feedback: The nurse should verify that sensation is absent by lightly tapping or scratching the area. Blanching or redness indicates that the medication has penetrated the skin adequately but does not indicate that sensation is absent. Using a needle to poke the skin would likely frighten the child.

Origin: Chapter 14, 17 17. The nurse is teaching an 8-year-old child and his family how to manage cancer pain using nonpharmacologic methods. Which parent statement signifies successful child teaching? A) 'I will avoid using descriptive words like pinching, pulling, or heat.' B) 'I will not use positive reinforcement until the technique is perfected.' C) 'I will begin using the technique before he experiences pain.' D) 'I will be honest and tell him that the procedure will hurt a lot.'

Ans: C Feedback: The parents should begin using the technique chosen before the child experiences pain or when the child first indicates he is anxious about, or beginning to experience, pain. The parents should use descriptive terms like pushing, pulling, pinching, or heat and avoid overly descriptive or judgmental statements such as, "This will really hurt a lot" or "This will be terrible." They should offer praise, positive reinforcement, hugs, and support for using the technique even when it was not effective.

Origin: Chapter 14, 20 20. The nurse is administering pain medication for a child with continuous pain from internal injuries. Which method would be ordered to dispense the medication? A) Administer the medication PRN (as needed). B) Administer the mediation when pain has peaked. C) Administer the medication around the clock at timed intervals. D) Administer the medication when the child complains of pain.

Ans: C Feedback: With any medication administered for pain management, the timing of administration is vital. Timing depends on the type of pain. For continuous pain, the current recommendation is to administer analgesia around the clock at scheduled intervals to achieve the necessary effect. As-needed or PRN dosing is not recommended for continuous pain. This method can lead to inadequate pain relief because of the delay before the drug reaches its peak effectiveness. For pain that can be predicted or considered temporary, such as with a procedure, analgesia is administered so that the peak action of the drug matches the time of the painful event. It is not recommended to wait until the child complains of pain because therapeutic levels will be difficult to reach at this point.

2. The nurse is administering acetaminophen PRN to a 9-year-old child on the pediatric ward of the hospital. Which answers reflect nursing actions that follow the rules of the 'eight rights' of pediatric medication administration? Select all that apply. A) The nurse identifies the child by checking the name on the child's chart. B) The nurse makes sure the medication is given within the hour of the ordered time. C) The nurse checks the documented time of the last dosage administered. D) The nurse calculates the dosage according to the child's weight. E) The nurse explains the therapeutic effects of the medication to the child and parents. F) The nurse administers the medication even though the child is adamant about not taking it.

Ans: C, D, E Feedback: Following the 'right patient' rule, the nurse checks the documented time of the last dosage administered. For the 'right dose,' the nurse calculates the dosage according to the child's weight. For the 'right to be educated,' the nurse explains the therapeutic effects of the medication to the child and parents. To ensure the 'right patient,' the nurse confirms the child's identity and then checks with the caregivers for further identification. To administer at the 'right time,' the nurse gives the medication within 20 to 30 minutes of the ordered time, and to protect the child's 'right to refuse,' the nurse respects the child's or parents' option to refuse.

28. The nurse is meeting with the parents of a 7-year-old boy with Down syndrome. The child's mother reports an interest in hippotherapy. The child's father reports that this seems to be a waste of money. The parents then ask the nurse for additional information. What information may be included in the nurse's response? Select all answers that apply. A) Hippotherapy has limited research demonstrating its actual effectiveness. B) This type of therapy is most helpful for teens. C) A variety of conditions including Down syndrome have used hippotherapy with success. D) Self-esteem may be improved with hippotherapy. E) The benefits of hippotherapy are both physical and psychological.

Ans: C, D, E Feedback: Hippotherapy refers to the use of horseback riding for the handicapped, therapeutic horseback riding, or equine-facilitated psychotherapy. Individuals with almost any cognitive, physical, or emotional disability may benefit from therapeutic riding or other supervised interaction with horses. The unique movement of the horse under the child helps the child with physical disabilities to achieve increased flexibility, balance, and muscle strength. Children with mental or emotional disabilities may experience increased self-esteem, confidence, and patience as a result of the unique relationship with the horse.

Which would be least appropriate to include in the discharge plan for a medically fragile child? A) Assisting with referrals for financial support B) Arranging for necessary care equipment and supplies C) Assessing the family's home environment D) Encouraging passive caregiving

Ans: D Feedback: As part of the discharge plan for a medically fragile child, the nurse would encourage active caregiving by the parents to help them increase their self-confidence in the child's care. Assisting with referrals, arranging for equipment and supplies, and determining the adequacy of the home environment are important aspects of the discharge plan.

3. The nurse is providing home care for a 1-year-old girl who is technologically dependent. Which intervention will best support the family process? A) Finding an integrated health program for the family B) Teaching modifications of the medical regimen for vacation C) Assessing family expectations for the special needs child D) Creating schedules for therapies and interventions

Ans: D Feedback: Coordinating care with the schedules and capabilities of the parents provides the greatest support for the family. It gives them a sense of order and control. Integrated health care programs may not be available in the family's area. Teaching therapy modifications for travel and assessing family expectations are not supportive interventions.

15. The nurse caring for young children in a hospice setting is aware of the following statistics related to the occurrence of death in children. Which statement accurately reflects one of these statistics? A) Each year, about 50,000 children die in the United States; of those, about 15,000 are infants. B) It is unusual for a child's chronic illness to progress to the point of becoming a terminal illness. C) Despite strides made, diabetes remains the leading cause of death from disease in all children older than the age of 1 year. D) Congenital defects and traumatic injuries are the more common causes of diseases leading to death.

Ans: D Feedback: Diseases can lead to terminal illness in children, with congenital defects and traumatic injuries being the more common causes. Each year, about 45,000 children die in the United States; of those, about 24,500 are infants (Heron et al., 2013). In many cases, a child's chronic illness may progress to the point of becoming a terminal illness. Cancer remains the leading cause of death from disease in all children older than the age of 1 year (Heron et al., 2013).

Origin: Chapter 14, 26 26. The nurse is conducting a pain assessment of a 10-year-old boy who has been taking acetaminophen for chronic knee pain. The assessment indicates that the recommended dose is no longer providing adequate relief. What is the appropriate nursing action? A) Increase the dosage of the acetaminophen. B) Tell the child he is experiencing the ceiling effect. C) Use guided imagery to help his pain. D) Obtain an order for a different medication.

Ans: D Feedback: Increasing the dose of the acetaminophen will not help his pain because he has reached as high a dose of that medication that will work. This is known as the ceiling effect, but explaining that to him will not help his pain. Guided imagery is not the best therapy for his pain, so the physician needs to order a different medication to manage his pain.

9. The nurse is weighing an underweight infant diagnosed with failure to thrive (FTT) and notes that the baby does not make eye contact and is less active than the other infants. What would be a probable cause for the FTT related to the infant's body language? A) Congenital heart defect B) Cleft palate C) Gastroesophageal reflux disease D) Maternal abuse

Ans: D Feedback: Infants with FTT related to maternal neglect may avoid eye contact and be less interactive than other infants. Inorganic causes of FTT include neglect, abuse, behavioral problems, lack of appropriate maternal interaction, poor feeding techniques, lack of parental knowledge, or parental mental illness.

Origin: Chapter 14, 29 29. Pentazocine is prescribed for a child with moderate pain. The nurse identifies this drug as an example of which type? A) Nonsteroidal anti-inflammatory drug (NSAID) B) Prostaglandin inhibitor C) Opioid D) Mixed opioid agonist-antagonist

Ans: D Feedback: Pentazocine is classified as a mixed opioid agonist-antagonist. Ibuprofen, ketorolac, and naproxen are examples of NSAIDs that inhibit prostaglandin synthesis. Morphine, codeine, and fentanyl are examples of opioids.

3. The nurse is caring for an 8-year-old boy hospitalized for a bone marrow transplant. His parents are in and out of his room throughout the day. Which behaviors of the child would alert the nurse that he is in the second stage of separation anxiety? A) He ignores his parents when they return to his room. B) He cries uncontrollably whenever they leave. C) He forms superficial relationships with his caregivers. D) He sits quietly and is uninterested in playing and eating.

Ans: D Feedback: Separation anxiety consists of three stages—protest, despair, and detachment. In the protest stage, the child reacts aggressively to separation and exhibits great distress by crying, expressing agitation, and rejecting others who attempt to offer comfort. In the despair phase the child displays hopelessness by withdrawing from others, becoming quiet without crying, and exhibiting apathy, depression, lack of interest in play and food, and overall feelings of sadness. In the detachment stage the child shows interest in the environment, starts to play again, and forms superficial relationships with the nurses and other children. If the parents return, the child ignores them. A child in this phase of separation anxiety exhibits resignation, not contentment.

20. A nurse is caring for a 14-year-old with a gastrostomy tube. The girl has skin breakdown and irritation at the insertion site. Which would be the most appropriate method to clean and secure the gastrostomy tube? A) Make sure the tube cannot be moved in and out of the child's stomach. B) Use adhesive tape to tape the tube in place and prevent movement. C) Place a transparent dressing over the site whether there is drainage or not. D) If any drainage is present, use a presplit 2 × 2 and place it loosely around the site.

Ans: D Feedback: Skin around the gastrostomy or jejunostomy insertion site may become irritated from movement of the tube, moisture, leakage of stomach or intestinal contents, or the adhesive device holding the tube in place. Keeping the skin clean and dry is important and will help prevent most of these problems. If any drainage is present, a presplit 2 × 2 can be placed loosely around the site and changed when soiled. If no drainage is present, the nurse should not place a dressing as it can cause undue pressure and trap moisture, leading to skin irritation. Preventing movement of the tube helps reduce skin irritation; however, the tube should be able to move slightly in and out of the child's stomach.

Origin: Chapter 14, 9 9. The nurse is using the acronym QUESTT to assess the pain of a child. Which is an accurate descriptor of this process? A) Question the child's parents. B) Understand the child's pain level. C) Establish a caring relationship with the child. D) Take the cause of pain into account when intervening.

Ans: D Feedback: The acronym QUESTT stands for the following: Question the child. Use a reliable and valid pain scale. Evaluate the child's behavior and physiologic changes to establish a baseline and determine the effectiveness of the intervention. The child's behavior and motor activity may include irritability and protection as well as withdrawal of the affected painful area. Secure the parent's involvement. Take the cause of pain into account when intervening. Take action.

1. The nurse caring for a 6-year-old patient enters the room to administer an oral medication in the form of a pill. The dad at the bedside looks at the pill and tells the nurse that his daughter has a hard time swallowing pills. Which of the following is the best response by the nurse? A) Ask the child to try swallowing the pill and offer a choice of drinks to take with it. B) Crush the pill and add it to applesauce. C) Request that the physician prescribe the medication in liquid form. D) Call the pharmacy and ask if the pill can be crushed.

Ans: D Feedback: The father is the best source of knowledge on medication administration for the child. The pharmacy should be called to determine if the pill might be crushed. Asking the child to try swallowing the pill disregards the information the father has just given. Requesting that the physician order the medication in liquid form is not necessary at this point.

Origin: Chapter 14, 24 24. The nurse is monitoring a child who has received epidural analgesia with morphine. The nurse is careful to monitor for which adverse effect of the medication? A) Epidural hematoma B) Arachnoiditis C) Spinal headache D) Respiratory depression

Ans: D Feedback: The nurse needs to monitor for signs of respiratory depression, a potential adverse effect of the opioid medication. Epidural hematoma, arachnoiditis, and spinal headache are potential adverse effects of the insertion of the epidural catheter.

23. The nurse is caring for a child who is receiving total parenteral nutrition (TPN) for failure to thrive. Which nursing action might the nurse take to prevent complications from this therapy? A) Adhere to clean technique when caring for the catheter and administering TPN. B) Ensure that the system remains an open system at all times. C) Secure all connections and open the catheter during tubing and cap changes. D) Use occlusive dressings and chlorhexidine-impregnated sponge dressings.

Ans: D Feedback: The nurse should use occlusive dressings and chlorhexidine-impregnated sponge dressings to help prevent infection. The nurse should always follow agency or institution policy and procedures, adhere to strict aseptic technique when caring for the catheter and administering TPN, ensure that the system remains a closed system at all times, and secure all connections and clamp the catheter or have the child perform the Valsalva maneuver during tubing and cap changes.

Origin: Chapter 14, 15 15. The nurse is providing instructions to a mother on how to use thought stopping to help her child deal with anxiety and fear associated with frequent painful injections. Which statement indicates the mother understands the technique? A) "We will imagine that we are on the beach in Florida." B) "We can talk about our favorite funny movie and laugh." C) "She can let her body parts go limp, working from head to toe." D) "We'll repeat 'quick stick, feel better, go home soon' several times."

Ans: D Feedback: Thought stopping is a technique that involves the use of short, concise phrases of positive ideas. Doing so helps to promote the child's sense of control. Imagining a favorite beach in Florida is using imagery. Talking about a favorite funny movie involves humor. Letting body parts go limp is a relaxation technique.

18. The nurse is determining the amount of IV fluids to administer in a 24-hour period to a child who weighs 40 kg. How many milliliters should the nurse administer? A) 1,000 mL B) 1,500 mL C) 1,750 mL D) 1,900 mL

Ans: D Feedback: Typically, the amount of fluid to be administered in a day (24 hours) is determined by the child's weight (in kg) using the following formula: 100 mL per kg of body weight for the first 10 kg (1,000) 50 mL per kg of body weight for the next 10 kg (500) 20 mL per kg of body weight for the remainder of body weight in kg (400).

14. The nurse is administering a liquid medication to a 3-year-old using an oral syringe. Which action would be most appropriate? A) Direct the liquid toward the anterior side of the mouth. B) Keep the child's hand away from the oral syringe when squirting the medication. C) Give all of the drug in the syringe at one time with one squirt. D) Allow the child time to swallow the medication in between amounts.

Ans: D Feedback: When using an oral syringe to administer liquid medications, give the drug slowly in small amounts and allow the child to swallow before placing more medication in the mouth. The syringe is directed toward the posterior side of the mouth. The toddler or young preschooler may enjoy helping by squirting the medication into his or her mouth.

Origin: Chapter 14, 12 12. The nurse uses the FLACC behavioral scale to assess a 6-year-old's level of postoperative pain and obtains a score of 9. The nurse interprets this to indicate that the child is experiencing: A) little to no pain. B) mild pain. C) moderate pain. D) severe pain.

Ans: D Feedback: With the FLACC behavioral scale, five parameters are measured and scored as 0, 1, or 2. They are then totaled to achieve a maximum score of 10. The higher the score, the greater the pain. A score of 9 indicates severe pain.

The nurse is coordinating home care for a 3-year-old girl with special care needs. Which approach provides the greatest benefit to the family of this child? A) Asking the father for his observations on his daughter's progress B) The nurse adjusting her office schedule to be available C) Urging parents to arrange respite care whenever possible D) Monitoring the mother for depression

B

The nurse working in the emergency room monitors the admission of children. Statistically, for which disorder would children younger than 5 years most commonly be admitted? A) Mental health problems B) Injuries C) Respiratory disorders D) Gastrointestinal disorders

C According to Child Health USA 2010, diseases of the respiratory system, such as asthma and pneumonia, account for the majority of hospitalizations in children younger than 5 years of age, while diseases of the respiratory system, mental health problems, injuries, and gastrointestinal disorders lead to more hospitalizations in older children.

The nurse is teaching a group of parents with premature infants about the various medical and developmental problems that may occur. The nurse determines that additional teaching is needed when the group identifies what as a problem? A) Sudden infant death syndrome B) Hydrocephalus C) Peptic ulcer D) Bronchopulmonary dysplasia

C Gastroesophageal reflux disease, not peptic ulcer, is a medical problem that commonly affects premature infants. Myriad problems may occur, including sudden infant death syndrome, hydrocephalus, bronchopulmonary dysplasia, cardiac changes, growth retardation, nutrient deficiencies, bradycardia, rickets, inguinal or umbilical hernias, visual problems, hearing deficits, delayed dentition, and growth delays.

The nurse is preparing to administer oral ampicillin to a child who weighs 40 kg. The safe dose for children is 50 to 100 mg/kg/day divided in doses administered every 6 hours. What would be the low single safe dose and high single safe dose per day for this child? A) 50 to 100 mg per dose B) 100 to 500 mg per dose C) 500 to 1,000 mg per dose D) 1,000 to 5,000 mg per dose

C To calculate the dosage, the nurse would set up a proportion to calculate the low dose as follows: 50 mg/1 kg = x mg/40 kg; solve for x by cross-multiplying: 1 × x = 50 × 40; x = 2,000 mg divided by 4 doses per day = 500 mg. Then calculate the high safe dose range using the following proportion: 100 mg/1 kg = x mg/40 kg; solve for x by cross-multiplying: 1 × x = 100 × 40; x = 4,000 mg divided by 4 doses per day = 1,000 mg.

A child is to undergo a tympanostomy tube placement in a freestanding outpatient surgery center. What is the major disadvantage associated with this location? A. Increased risk for infection B. Increased health care costs C. Need to be transferred if overnight stay is required D. Increased disruption of family functioning

C. - Advantages to outpatient surgery centers include decreased risk for infection, decreased cost, decreased separation from family, and decreased disruption of family functioning. - The major disadvantage associated with this site is the inability to accommodate overnight stays if necessary due to complications. The child would usually have to be transferred to a hospital for continued care.

The nurse is administering immunizations to children in a neighborhood clinic. What is the most frequent route of administration? A) Oral B) Intradermal C) Intramuscular D) Topical

C. Intramuscular (IM) administration delivers medication to the muscle. In children, this method of medication administration is used infrequently because it is painful and children often lack adequate muscle mass for medication absorption. However, IM administration is used to administer certain medications, such as many immunizations.

The nurse is caring for a 14-year-old girl with special health needs. What is the priority intervention for this child? A) Encouraging the parents to promote the child's self-care B) Assessing the child for signs of depression C) Discussing how her care will change as she grows D) Monitoring for compliance with treatment

D. The priority intervention is monitoring for compliance with treatment. The girl is struggling to fit in with her peers and may try to hide or ignore her illness. Monitoring for depression and encouraging self-care have a lesser impact on the child's physical health. A transition plan to adulthood may be initiated some time in midadolescence.

The nurse is counseling the parents of a 9-year-old boy who is receiving morphine for postoperative pain. Which statement from the nurse accurately reflects the pain experience in children? A) 'You can expect that your child will tell you when he is experiencing pain.' B) 'Your child will learn to adapt to the pain he is experiencing.' C) 'Your child will experience more adverse effects to narcotics than adults.' D) 'It is very rare that children become addicted to narcotics.'

D. Addiction to narcotics when used in children is very rare. Often children deny pain to avoid a painful situation or procedure, embarrassment, or loss of control. Repeated exposure to pain or painful procedures can result in an increase in behavioral manifestations. The risk of adverse effects of narcotic analgesics is the same for children as for adults.

The parents of a child with a developmental disability tell the nurse that they feel guilty because they sometimes find themselves feeling sad and wondering how their child would be without the disability. Which response by the nurse best shows empathy and encourages the parents to vent their feelings? A) "I'm sure it must be difficult to have a child developmentally delayed." B) "There are lots of parents that are experiencing the difficulty and feelings of hopelessness and grief you're having. Maybe if you talk to someone it might help you both." C) "I can only imagine how hard it is for you. You should know that it is common for parents to have these feelings when having a child with special needs." D) "It's important to focus on the positives that can come from the experience of being the parents of a child that has these issues."

c. Showing empathy by stating, "I can only imagine how hard it is for you" is important when developing rapport and supporting the parents, and letting them know that they are not alone in the feelings they are experiencing allows them to feel less guilty. Just stating, "I'm sure it must be difficult to have a child developmentally delayed" may convey empathy but it does not allow for open conversation. "There are lots of parents that are experiencing the difficulty and feelings of hopelessness and grief you're having. Maybe if you talk to someone it might help you both" doesn't convey empathy. "It's important to focus on the positives that can come from the experience of being the parents of a child that has these issues" does not address the parents' feelings.

The nurse is reviewing the therapist's documentation in the medical record of an assigned client who has cerebral palsy. The therapist has noted the parents may be experiencing vulnerable child syndrome. Which observation of the family unit best supports this potential diagnosis? A) The parents regularly attend a support group for parents of special needs children. B) The child has been diagnosed with pneumonia twice in the past year. C) The parents report they feel their child requires more therapy than the care team has indicated will be needed. D) The child is schooled at home with a private tutor.

c. Vulnerable child syndrome is a clinical state in which the parents' reactions to a serious illness or event in the child's past continue to have long-term psychologically harmful effects on the child and members of the family unit. The parents view the child as being at higher risk for medical, developmental, or behavioral problems. Parents exhibit excessive unwarranted concerns and seek health care for their child very frequently. Requests for additional therapy would be consistent with this syndrome.

Which tool would be the least appropriate scale for the nurse to use when assessing a 4-year-old child's pain? A) FACES pain rating scale B) Oucher pain rating scale C) Poker chip tool D) Numeric pain intensity scale

d. The numeric pain intensity scale can be used with children as young as 5 years of age, but the preferred minimum age for using this tool is 7 years.