PEDS Evolve Questions Chapters 1-6, 22-23

When giving liquid medication to a crying 10-month-old infant, which approach minimizes the possibility of aspiration? Keep the child upright with the nasal passages blocked for 1 minute after administration. Mix the medication with the infant's regular formula or juice and administer by bottle. Administer the medication with a cup as rapidly as possible with the infant securely restrained. Administer the medication with a syringe (without needle) placed along the side of the infant's tongue.

Administer the medication with a syringe (without needle) placed along the side of the infant's tongue. Administering the medication with a syringe (without a needle) placed along the side of the infant's tongue allows the contents to be administered slowly in small amounts. The child is able to swallow between deposits. Holding the child's nasal passages will increase the risk of aspiration. The medication should be mixed with only a small amount of food or liquid. If the child does not finish drinking or eating, it is difficult to determine how much medication was consumed. Essential foods also should not be used. Medications should be given slowly to avoid aspiration. REF: p. 916

A 3-year-old child is being admitted for about 1 week of hospitalization. Her parents tell the nurse that they are going to buy her "a lot of new toys because she will be in the hospital." The nurse's reply should be based on an understanding of which of the following? New toys make hospitalization easier. New toys are usually better than older ones for children of this age. At this age, children often need the comfort and reassurance of familiar toys from home. Buying new toys for a hospitalized child is a maladaptive way to cope with parental guilt.

At this age, children often need the comfort and reassurance of familiar toys from home. Parents should bring favorite items from home for the child. Young children associate inanimate objects with significant people, and they gain comfort and reassurance from these items. Because the parents leave the objects at the hospital, the preschooler knows the parents will return. New toys will not serve the purpose of familiar toys and objects from home. The parents may experience some guilt as a response to the hospitalization, but there is no evidence that it is maladaptive. REF: p. 870

The nurse is beginning to administer the Denver II to a small child when his mother asks, "Can you tell me again what this Denver II is?" The nurse's best response is which of the following? "It's a simple intelligence test for young children." "It tells us what a child can do at a particular age." "It's a test we give to measure a child's development." "It's an excellent way to see if a child's development is normal."

"It tells us what a child can do at a particular age." The Denver II is a developmental screening tool that assesses the child's abilities at different ages. The Denver II is a screening tool for developmental milestones, not intelligence. Children are not expected to perform each item on the Denver II. Most children will perform tasks in a range. The Denver II is used to provide an indication of the child's developmental level. REF: p. 148

The hepatitis A vaccine is now recommended at which of the following ages? 1 year 1 month 12 years It is not recommended at any age.

1 year Hepatitis A has been recognized as a significant child health problem, particularly in communities with unusually high infection rates. Hepatitis A virus is spread by the fecal-oral route and from person-to-person contact, by ingestion of contaminated food or water, and rarely by blood transfusion, so the immunization is recommended at 1 year of age. REF: p. 201

Which of the following is most suggestive that a nurse has a nontherapeutic relationship with a patient or family? Staff members are concerned about the nurse's actions with the patient or family. Staff assignments allow the nurse to care for the same patient or family over an extended time. The nurse uses teaching skills to instruct the patient or family rather than doing everything for them. The nurse is able to withdraw emotionally when emotional overload occurs but still remain committed.

Staff members are concerned about the nurse's actions with the patient or family The concern of other staff members may indicate that the nurse is exhibiting negative behaviors and may be involved in a nontherapeutic relationship. Consistent staff assignments are important to provide continuity of care and contribute to therapeutic relationships. Using teaching skills to instruct the patient or family rather than doing everything for them empowers the family and facilitates their caring for the child. In therapeutic relationships, the nurse must recognize and maintain professional boundaries. The ability to recognize when these are being eroded is essential. REF: p. 9

What is the most common piece of medical equipment that can transmit harmful microorganisms among patients? Thermometer Stethoscope Injection needle Disposable gloves

Stethoscope A stethoscope is commonly used between patients, and if not correctly disinfected, it can be a dangerous source of spreading microorganisms. Thermometers of all types have barriers to prevent this. Needles are discarded immediately after injections and never reused, so they are not a common source of transmission. Disposable gloves are not reused, so they are not a common source of transmission. REF: p. 194

Which of the following genetic terms refers to a recognized pattern of malformations with a single specific cause? Syndrome Polygenic Aberration Association

Syndrome A syndrome is a collection of primary malformations or defects with a single underlying cause. Polygenic describes a given phenotype produced through the additive effects of genes at separate loci. Aberration is any variation from the usual or expected, such as in the number or structure of chromosomes. Association refers to a nonrandom cluster of malformations without a specific cause. REF: p. 48

Which of the following is most likely to encourage parents to talk about their feelings related to their child's illness? Be sympathetic. Ask direct questions. Use open-ended questions. Avoid periods of silence.

Use open-ended questions. Open-ended questions require the parent to answer with more than a brief answer. Closed-ended questions should be avoided when attempting to elicit parents' feelings. Sympathy is having feelings or emotions in common with another person rather than understanding those feelings (empathy). Sympathy is not therapeutic in the helping relationship. Direct questions may obtain limited information. In addition, they may be considered threatening by the parent. Silence can be an effective interviewing tool. It allows a sharing of feelings in which two or more people absorb the emotion in depth. Silence permits the interviewee to sort out thoughts and feelings and search for responses to questions. REF: p. 93

The health promotion interventions that have the greatest impact on injury prevention are which of the following? Utilization of auditory learning strategies for all families Including the nutritional counseling for the food pyramid Integrating Maslow's hierarchy of needs in the lesson Using a developmental approach to safety counseling

Using a developmental approach to safety counseling Utilizing a developmental approach to safety counseling will ensure that the parents are taught risks associated with developmental age and increased risk factors for that population. Family members may have different learning styles, so the nurse should include several strategies in the health promotion teaching session. Although nutritional counseling is important, it is not an injury prevention health promotion priority for preventing injury. Maslow's hierarchy of needs is a theoretical model to assist in assuring all the needs of an individual are met, but it is not the theoretical model of choice in this scenario.

Which of the following is a potential cause of a postoperative decrease in blood pressure? Shock (early sign) Carbon dioxide retention Vasodilating anesthetic agents Increased intracranial pressure

Vasodilating anesthetic agents Anesthetic agents and opioids can contribute to a decrease in blood pressure in the postoperative period. Decreased blood pressure is a late sign of shock. Carbon dioxide retention results in increased blood pressure. Increased intracranial pressure results in increased blood pressure. REF: p. 893

The nurse wears gloves during a dressing change. When the gloves are removed, the nurse should do which of the following? Wash hands thoroughly. Check the gloves for leaks. Rinse gloves in disinfectant solution. Apply new gloves before touching the next patient.

Wash hands thoroughly. When gloves are worn, the hands are washed thoroughly after removing the gloves because both latex and vinyl gloves fail to provide complete protection. Gloves should be disposed of after use. Hands should be thoroughly washed before new gloves are applied. REF: p. 903

The nurse needs to do a heel stick on an ill neonate to obtain a blood sample. Which of the following is recommended to facilitate this? Elevate the foot for 5 minutes. Apply a tourniquet to the ankle. Apply cool, moist compresses. Wrap the foot in a warm washcloth.

Wrap the foot in a warm washcloth. Before the blood sample is taken, the heel is heated with warm moist compresses for 5 to 10 minutes to dilate the blood vessels in the area. Elevating the foot will decrease the blood in the foot available for collection. A tourniquet is used to constrict superficial veins. It will have an insignificant effect on capillaries. Cooling causes vasoconstriction, making blood collection more difficult. REF: 912

Which of the following is an important nursing intervention when performing a bladder catheterization on a young boy? Insert 2% lidocaine lubricant into the urethra. Clean technique, not Standard Precautions, is needed. Lubricate the catheter with water-soluble lubricant such as K-Y Jelly. Delay catheterization for 20 minutes while anesthetic lubricant is absorbed.

Insert 2% lidocaine lubricant into the urethra. The anxiety, fear, and discomfort experienced during catheterization can be significantly decreased by preparing the child and parents, by selecting the correct catheter, and by using an appropriate technique for insertion. Generous lubrication of the urethra before catheterization and use of lubricant containing 2% lidocaine may reduce or eliminate the burning and discomfort associated with this procedure. Catheterization is a sterile procedure, and Standard Precautions for body-substance protection should be followed. Water-soluble lubricants do not provide appropriate local anesthesia. Catheterization should be delayed only 2 to 3 minutes. This provides sufficient local anesthesia for the procedure. REF: p. 910

The nurse has a 2-year-old boy sit in "tailor" position while palpating for the presence of the testes. What is the rationale for this position? It prevents the cremasteric reflex. Undescended testes can be palpated. The child has an inguinal hernia. The child does not yet have a need for privacy.

It prevents the cremasteric reflex. The tailor position stretches the muscle responsible for the cremasteric reflex. This prevents its contraction, which pulls the testes into the pelvic cavity. Undescended testes cannot be predictably palpated. Inguinal hernias are not detected by this method. Privacy should always be provided for children. p. 143

A 6-year-old child needs to be hospitalized again because of a chronic illness. The clinic nurse overhears her school-age siblings tell her that they are "sick of Mom always sitting with her in the hospital and playing with her. . . . It isn't fair that you get everything and we have to stay with the neighbors." Which of the following is the nurse's best assessment of this situation? The siblings are immature and probably spoiled. The siblings need to better understand their sister's illness and needs. Jealousy and resentment are common reactions to the illness and hospitalization of a sibling. The family has ineffective coping mechanisms to deal with chronic illness.

Jealousy and resentment are common reactions to the illness and hospitalization of a sibling. Siblings experience loneliness, fear, and worry, as well as anger, resentment, jealousy, and guilt. The siblings experience stress equal to that of the hospitalized child. These comments are common responses by normal siblings. There is no evidence that the family has maladaptive coping. REF: p. 868

An intravenous line is needed in a school-age child. The most appropriate action to provide analgesia during this procedure is to apply TAC (tetracaine, epinephrine [Adrenalin], cocaine) 15 minutes before the procedure. a transdermal fentanyl (Duragesic) patch at the site of venipuncture. EMLA (eutectic mixture of local anesthetics) immediately before the procedure. LMX (4% liposomal lidocaine cream) 30 minutes before the procedure.

LMX (4% liposomal lidocaine cream) 30 minutes before the procedure. LMX is an effective analgesic agent when applied to the skin 30 minutes before a procedure. It eliminates or reduces the pain from most procedures involving skin puncture. TAC provides skin anesthesia about 15 minutes after application to nonintact skin. The gel can be placed on the wound for suturing. It is not useful for intact skin. Transdermal fentanyl patches are useful for continuous pain control, not rapid pain control. For maximum effectiveness, EMLA must be applied approximately 60 minutes in advance. REF: p. 177

The nurse is preparing a 12-year-old girl for a bone marrow aspiration. She tells the nurse she wants her mother with her "like before." The most appropriate nursing action is to grant her request. explain why this is not possible. identify an appropriate substitute for her mother. offer to provide support to her during the procedure.

Medication under the skin "Medication under the skin" clearly and simply describes what will be occurring. A 4-year-old child is in the stage of preoperational thought. The child may literally think the nurse is going to use a stick. This could be frightening to a child at this age. Most likely, there would be no prior experience with a bee sting. "Injection" is a technical term that the child may not understand. It could add additional anxiety. REF: p. 888, 919

When administering a gavage feeding to a school-age child, the nurse should do which of the following? Administer feedings over 5 to 10 minutes. Position the child on the right side after administering the feeding. Check the placement of the tube by inserting 20 ml of sterile water. Lubricate the tip of the feeding tube with Vaseline to facilitate passage.

Position the child on the right side after administering the feeding. Position the child with the head elevated about 30 degrees and on the right side or abdomen for at least 1 hour. This is in the same manner as after any infant feeding to minimize the possibility of regurgitation and aspiration. Feedings should be administered via gravity flow and take from 15 to 30 minutes to complete. With a syringe attached to the feeding tube, apply negative pressure. Aspiration of stomach contents indicates proper placement. Then inject a small amount of air into the tube while simultaneously listening with a stethoscope over the stomach area. Insert the tube that has been lubricated with sterile water or water-soluble lubricant. REF: p. 934

What nursing intervention is most descriptive of atraumatic care of children? Preparing a child before any unfamiliar treatment or procedure Preparing a child for separation from parents during hospitalization Helping a child accept pain that is associated with a treatment or procedure Helping a child accept the loss of control associated with hospitalization

Preparing a child before any unfamiliar treatment or procedure Proper preparation of a child before any unfamiliar procedure is an essential component of atraumatic care. A major principle of atraumatic care is to minimize the separation from parents. Interventions are used to reduce and eliminate bodily injury and pain whenever possible. Children should be allowed choices and control whenever possible. REF: p. 8

What do morbidity rates measure? Life span statistics Acute illness, chronic disease, or disability Cost-effective treatment for the general population Prevalence of a specific illness in a population

Prevalence of a specific illness in a population Morbidity measures prevalence of a specific illness in a population over a specific period. Life span statistics are included in mortality data. Acute illness, chronic disease, and disability are factors that give morbidity statistics. Cost is not included in morbidity rates.

When a preschool child is hospitalized without adequate preparation, the nurse should recognize that the child may likely see hospitalization as which of the following? Punishment Loss of parental love Threat to child's self-image Loss of companionship with friends

Punishment If a preschool child is not prepared for hospitalization, a typical fantasy is to attribute the hospitalization to punishment for real or imagined misdeeds. School-age children may see hospitalization as loss of parental love and loss of companionship with friends. A threat to child's self image is a response characteristic of toddlers when threatened with loss of control. REF: p. 864

The nurse understands that respiratory hygiene and cough etiquette is recommended by the Centers for Disease Control and Prevention (CDC) to prevent which of the following? HBV, Hib, and pertussis HSV, influenza, and HBV RSV, influenza, and adenovirus RSV, pertussis, and varicella

RSV, influenza, and adenovirus The CDC (2007) recommends respiratory hygiene and etiquette to prevent the transmission of RSV, influenza, adenovirus, and other droplet-transmitted unknown viruses. HBV, HSV, and varicella are not transmitted via droplets. REF: p. 193

Which of the following statements explains why it can be difficult to assess a child's dietary intake? No systematic assessment tool has been developed. Biochemical analysis for assessing nutrition is expensive. Families usually do not understand much about nutrition. Recall of food consumption is frequently unreliable.

Recall of food consumption is frequently unreliable. An individual's recall of food intake, especially amounts eaten, is frequently unreliable. Systematic tools such as the 24-hour recall and detailed dietary history questionnaires are available. Biochemical analysis is not necessary for assessing dietary intake. Family knowledge of nutrition is not required. Detailed questions can elicit the child's patterns of eating and food intake. REF: p. 105

Which of the following represents the major stressor of hospitalization for children from middle infancy throughout the preschool years? Fear of pain Loss of control Separation anxiety Fear of bodily injury

Separation anxiety The major stressor of hospitalization for children from infancy through the preschool years is separation anxiety, also called anaclitic depression. Fear of pain, loss of control, and fear of bodily injury are all stressors associated with hospitalization. However, separation from family is a primary stressor in this age group. REF: p. 864

Maria is a Spanish-speaking 5-year-old girl who has started kindergarten in an English-speaking school. Crying most of the time, she appears helpless and unable to function in this new situation. What is the best explanation for this behavior? She lacks adequate maturity for attending school. She lacks the knowledge needed in school. She is experiencing cultural shock. She is experiencing minority group discrimination.

She is experiencing cultural shock. Cultural shock is the helpless feeling and state of disorientation felt by an outsider attempting to adapt to a different culture group. Maria's inability to speak English inhibits her ability to interact. This would explain Maria's inability to function in this new situation. There is no evidence that the child lacks the maturity or knowledge needed in school or is experiencing minority group discrimination. REF: p. 23

The nurse working in an outpatient surgery center for children should understand that children's anxiety is minimal in such a center. waiting is not stressful for parents in such a center. families need to be prepared for what to expect after discharge. accurate and complete discharge teaching is the responsibility of the surgeon.

families need to be prepared for what to expect after discharge. Parents need explicit instructions when taking their child home. The guidelines should include what observations need to be made and when to call the practitioner about changes in the child's condition. Less stress will exist because of the shortened hospital stay, but the parents will still have anxiety related to the surgery setting. Families will still be waiting during the procedure. This is reported to be one of the most stressful times. The surgeon will provide prescriptions and instructions related to the surgical procedure. The nurse's role is to prepare the family with both written and verbal instructions before discharge. REF: p. 877

Which of the following would be helpful word(s) to substitute for the word "shot" when working with a 4-year-old? Stick Bee sting Injection Medication under the skin

grant her request. The parents' preferences for assisting, observing, or waiting outside the room should be assessed, as well as the child's preference for parental presence. The child's choice should be respected. If the mother and child agree, then the mother is welcome to stay. An appropriate substitute for the mother is necessary only if the mother does not wish to stay. Support is offered to the child regardless of parental presence. REF: p. 887

Nonpharmacologic strategies for pain management may reduce pain perception. make pharmacologic strategies unnecessary. usually take too long to implement. trick children into believing they do not have pain.

may reduce pain perception. Nonpharmacologic techniques provide coping strategies that may help reduce pain perception, make the pain more tolerable, decrease anxiety, and enhance the effectiveness of analgesics. Nonpharmacologic techniques should be learned before the pain occurs. It is best to use both pharmacologic and nonpharmacologic measures for pain control. The nonpharmacologic strategy should be matched with the child's pain severity and taught to the child before the onset of the painful experience. Some of the nonpharmacologic techniques may mitigate the child's experience with mild pain, but the child will still know the discomfort was present. REF: p. 163

Physiologic measurements in children's pain assessment are not useful as the sole indicator for pain. the best indicator of pain in children of all ages. of most value when children also report having pain. essential to determine whether a child is telling the truth about pain.

not useful as the sole indicator for pain. Physiologic manifestations of pain may vary considerably, so they do not provide a consistent measure of pain. Heart rate may increase or decrease. The same signs that may suggest fear, anxiety, or anger also indicate pain. In chronic pain, the body adapts, and these signs decrease or stabilize. Physiologic measurements are of limited value and must be viewed in the context of a pain rating scale, behavioral assessment, and parental report. When the child reports pain on an appropriate pain scale, the appropriate interventions should be used. REF: p. 158

If the mother of a child is hepatitis B surface antigen (HBsAg) negative, the nurse knows that the child should receive his or her first dose of the hepatitis B virus (HBV) vaccine at 2 months of age, at the first well-child visit. birth before discharge from the hospital. 6 months of age, at the third well-child visit. no time (this vaccine is not currently recommended).

birth before discharge from the hospital. It is recommended that newborns receive the hepatitis B vaccine before hospital discharge if the mother is HBsAg negative. The second dose of the vaccine is given at the first well-child visit. The third dose of the vaccine is given at the third well-child visit. The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention and the Committee on Infectious Diseases of the American Academy of Pediatrics govern the recommendations for immunization, which include the hepatitis B virus vaccine. REF: p. 196

Binocularity, the ability to fixate on one visual field with both eyes simultaneously, is normally present by what age? 1 month 3 to 4 months 6 to 8 months 12 months

3 to 4 months Binocularity is usually achieved by age 3 to 4 months. One month is too young for binocularity. If binocularity is not achieved by 6 to 12 months, the child must be observed for strabismus. REF: p. 127-128

Which of the following statements is true concerning the increased use of telephone triage by nurses? Health care costs have increased as a result. Emergency department visits are not recommended. Access to high-quality health care services has increased. Home care is recommended when it is not appropriate.

Access to high-quality health care services has increased. With well-designed telephone triage programs, access to high-quality health care services and patient satisfaction have increased. With the reduction in unnecessary emergency department and clinic visits, health care costs have decreased. Emergency department visits are recommended based on the response to screening questions and when the child's condition is in doubt. Guidelines are given for home management if the triage assessment indicates that level of care. Parents are given instructions about changes in the child's condition to report. REF: p. 92

When taking a child's blood pressure, the nurse should select a cuff with a bladder width that is large enough to cover what percentage of the upper arm? 20% 40% 60% 80%

40% The width of the cuff bladder ideally covers 40% of the arm circumference at the midpoint of the upper arm. Twenty percent is too small and may give falsely elevated blood pressure values. Sixty percent and 80% are too large and may give falsely low blood pressure values. REF: p. 121

Chromosome analysis of the fetus is usually accomplished through the testing of which of the following? Fetal serum Amniotic fluid Maternal urine Maternal serum

Amniotic fluid Currently, fluid obtained by amniocentesis forms the basis for diagnostic prenatal testing. Fetal blood cells can be obtained after 18 weeks of gestation. Fetal serum may not have sufficient cells for culture. Maternal urine and maternal serum do not have fetal cells that can be cultured. REF: p. 80

The change from the exclusive use of oral polio vaccine (OPV) to the exclusive use of inactivated poliovirus vaccine (IPV) related to the rare risk of vaccine-associated polio paralysis (VAPP) from OPV has resulted in which of the following? An increase in the risk of VAPP An increased number of injections and increased cost A better antibody conversion than the oral formulation A measureable decrease in immunity in the community

An increased number of injections and increased cost There is an increased number of injections and increased cost associated with IPV. The exclusive use of IPV eliminates the risk of VAPP. There is no increased antibody conversion from IPV. The same immunity is provided by both vaccines. REF: p. 202

The Hib conjugate vaccines protect an infant against which of the following diseases? (Select all that apply.) Bacterial meningitis Epiglottitis Bacterial pneumonia Septic arthritis Sepsis

Bacterial meningitis Epiglottitis Bacterial pneumonia Septic arthritis Sepsis Hib conjugate vaccines protect against a number of serious infections caused by Haemophilus influenza type b, especially bacterial meningitis, epiglottitis, bacterial pneumonia, septic arthritis, and sepsis. REF: p. 203

The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) and American College of Obstetricians and Gynecologists has recommended that pregnant adolescents and women who are not protected against pertussis receive the tetanus, diphtheria and pertussis (Tdap) vaccine optimally at which of the following times? Between 27 and 36 weeks of gestation or postpartum before discharge from the hospital During the first pre-natal visit when pregnancy is confirmed The vaccine should be administered 24 hours prior to delivery This vaccine is only recommended during the first trimester

Between 27 and 36 weeks of gestation or postpartum before discharge from the hospital The ACIP of the CDC and American College of Obstetricians and Gynecologists has recommended that pregnant adolescents and women who are not protected against pertussis receive the Tdap vaccine optimally between 27 and 36 weeks of gestation or postpartum before discharge from the hospital. The vaccine is not recommended during the first trimester. The vaccine is not recommended between 27 and 36 weeks to allot for antibody formation that will protect the mother and passive immunity to the infant.The vaccine is not recommended during the first trimester. REF: p. 202

A couple has given birth to their first child, a boy with a recessive disorder. The genetic counselor tells them that the risk of recurrence is one in four. Which of the following statements is a correct interpretation of this information? The risk factor remains the same for each pregnancy. The risk factor will change when they have a second child. Because the parents have one affected child, the next three children should be unaffected. Because the parents have one affected child, the next child is four times more likely to be affected.

The risk factor remains the same for each pregnancy. Because each pregnancy is an independent event, each child has the same one in four risk of receiving the two genes required for a recessive trait to be apparent. The odds ratio does not change. REF: p. 81

Which of the following should the nurse consider when having informed consent forms signed for surgery and procedures on children? Only a parent or legal guardian can give consent. The person giving consent must be at least 18 years old. The risks and benefits of a procedure are part of the consent process. A mental age of 7 years or older is required for a consent to be considered "informed."

The risks and benefits of a procedure are part of the consent process. The informed consent must include the nature of the procedure, benefits and risks, and alternatives to the procedure. In special circumstances, such as emancipated minors, the consent can be given by someone younger than age 18 years without the parent or legal guardian. A mental age of 7 years is too young for consent to be informed. REF: p. 883

Which of the following approaches is the most appropriate when performing a physical assessment on a toddler? Demonstrate use of equipment. Perform traumatic procedures first. Use minimum physical contact initially. Always proceed in a head-to-toe direction.

Use minimum physical contact initially. Parents can remove clothing, and the child can remain on the parent's lap. The nurse should use minimum physical contact initially to gain the cooperation of the child. The nurse should introduce the equipment slowly. The child can inspect the equipment, but demonstrations are usually too complex for this age group. Traumatic procedures should always be performed last. These will most likely upset the child and inhibit cooperation. The head-to-toe assessment can be done in older children but usually must be adapted in younger children. REF: p. 112

Which of the following statements best represents the risk of recurrence in autosomal dominant inheritance? Unaffected children of affected individuals will have affected children. Each child of a heterozygous affected parent has a 50% chance of inheriting the mutated allele. Males are affected with greater frequency than females. Any child of two unaffected heterozygous parents has a 25% chance of being affected.

Each child of a heterozygous affected parent has a 50% chance of inheriting the mutated allele. The mutated allele is present on one chromosome of one parent. There is a 50% chance that the child will receive the chromosome with the allele. With autosomal dominant inheritance only one single gene will result in the phenotype. The parent of an affected child will have the phenotype. The mutated allele is present on an autosome, not the X or Y chromosome. There is no sex differential. "Any child of two unaffected heterozygous parents has a 25% chance of being affected" describes autosomal recessive inheritance. REF: p. 55 Whut

An appropriate nursing intervention to minimize separation anxiety in a hospitalized toddler would be which of the following? Provide for privacy. Encourage parents to room-in. Explain procedures and routines. Encourage contact with children of the same age.

Encourage parents to room-in. A toddler experiences separation anxiety secondary to being separated from the parents. To avoid this, the parents should be encouraged to room-in as much as possible. Explaining routines and ensuring privacy are helpful interventions, but they would not substitute for the parents' presence. Encouraging contact with children of the same age would not substitute for having the parents present. REF: p. 864

Which of the following self-report pain rating scales can be used in children as young as 3 years of age? Poker Chip Tool Visual Analog Scale FACES Pain Rating Scale Word-Graphic Rating Scale

FACES Pain Rating Scale The Poker Chip Tool has been validated for children 4 years of age who have been determined to have the cognitive ability to identify the larger of two numbers. The Visual Analog Scale can be used for children older than 4 years of age but is most appropriate for ages 7 and older. The FACES Pain Rating Scale is for children as young as 3 years of age. The Word-Graphic Rating Scale uses descriptive words and is recommended for children 4 to 17 years of age. REF: p. 155

Which of the following is the most consistent and commonly used indicator of pain in infants? Increased respirations Increased heart rate Thrashing of arms and legs Facial expression of discomfort

Facial expression of discomfort Facial expression has consistently been validated as an indicator of pain in infants. Behavioral pain measures are most reliable for sharp procedural pain in infants. Increased heart rate and respirations are indicative of a generalized and complex response to stress. They are not specific for pain in infants. Thrashing of arms and legs is a reliable indicator in young children, not infants. REF: p. 152

Currently, the fastest-growing segment of the homeless population in the United States consists of which of the following? Families "Runaway" adolescents Migrant farm workers Individuals with mental disorders

Families Homeless individuals lack the resources and community ties necessary to provide for their own adequate shelter. One of the most pressing problems in the United States is the rapidly increasing number of homeless families, which currently account for 50% of the nation's homeless. "Runaway" or throwaway adolescents are often victims of physical and social abuse. Although it is a significant issue, these adolescents do not represent the fastest-growing segment of the homeless population. Migrant farm workers are some of the most severely disadvantaged in the United States. They have a mobile existence that is detrimental for children. They do not constitute the fastest-growing segment of the homeless population. Individuals with mental disorders may be homeless. They do not constitute the fastest-growing segment of the homeless population. REF: p. 35

Which of the following is usually the greatest threat to a hospitalized adolescent? Fear of pain Fear of altered body image Restricted motor activity Separation from home and family

Fear of altered body image Injury, pain, disability, and death are viewed primarily in terms of how each affects the adolescents' views of themselves in the present. Any change that differentiates them from their peers is regarded as a major tragedy. Pain is a concern because it affects body image. Adolescents are able to react with much more self-control than are younger children. Restricted motor activity would be an issue if it affected body image in the long term. Adolescents are able to tolerate separation from family. REF: p. 873

A 3-year-old child has a fever. Her mother calls the nurse reporting a fever of 38.8º C (102º F) even though the child had acetaminophen 2 hours ago. The nurse's action should be based on which of the following? Fevers such as this are common with viral illnesses. Temperatures this high indicate greater severity of illness. Fevers over 102º F indicate a probable bacterial infection. Seizures are common in children when antipyretics are ineffective.

Fevers such as this are common with viral illnesses. Most fevers are of brief duration, with limited consequences, and are viral. Neither the increase in temperature nor its response to antipyretics indicates the severity or etiology of infection. Little evidence supports the use of antipyretic drugs to prevent febrile seizures. REF: p. 899

Which one of the following approaches would be best to use to ensure a receptive response from a toddler? Focus communication on the child and tell him or her how a procedure will feel. Call the toddler's name while picking up him or her. Call the toddler's name and say, "I am your nurse." Stand by the toddler, addressing him or her by name.

Focus communication on the child and tell him or her how a procedure will feel. Toddlers see things only in relation to themselves and from their point of view. A stranger picking up a child up in an unfamiliar environment is very frightening for the toddler. Toddlers will not know the meaning of "nurse." Unknown adults who call the toddler by name can frighten the child. REF: p. 98

A common initial reaction of parents to illness or injury and hospitalization in their child is which of the following? Relief Anger Frustration Depression

Frustration Fear, anxiety, and frustration are common initial responses of parents. Relief is not a common reaction to hospitalization. Anger or guilt is usually the second reaction stage. Parents may finally react with some form of depression related to the physical and emotional exhaustion associated with a hospitalized child. REF: p. 868

Elevation of triple marker screening results indicates the need for which of the following? Termination of pregnancy Further diagnostic testing Repeating the triple marker screening test Counseling to prepare for the birth of a child with a defect

Further diagnostic testing The triple marker is a screening test. Further diagnostic testing is indicated for unexplained results outside the expected limits. Termination of the pregnancy is not indicated based on the results of the screening test. Definitive testing is done after unexplained positive screening results. Counseling in preparation for the birth of a child with a defect is not indicated based on the results of the screening test. REF: p. 77

An appropriate intervention to encourage food and fluid intake in a hospitalized child is which of the following? Force the child to eat to combat caloric losses. Administer large quantities of flavored fluids at frequent intervals. Give high-quality foods and snacks whenever the child expresses hunger. Discourage participation in noneating activities until caloric intake is sufficient.

Give high-quality foods and snacks whenever the child expresses hunger. Small, frequent meals and nutritious snacks should be provided for the child. Favorite foods such as peanut butter and jelly sandwiches, fruit yogurt, cheese, pizza, and macaroni and cheese should be available. Forcing a child to eat only meets with rebellion and reinforces the behavior as a control mechanism. Large quantities of fluid may decrease the child's hunger and further inhibit food intake. REF: p. 897, 898

A child who has been receiving morphine intravenously will now start receiving it orally. The nurse should anticipate that to achieve equianalgesia (equal analgesic effect), the oral dose will be which of the following? Same as the intravenous dose Greater than the intravenous dose One half of the intravenous dose One fourth of the intravenous dose

Greater than the intravenous dose Oral morphine undergoes significant metabolism from the first-pass effect. For this reason, a higher oral dose is necessary to achieve the same effect as parenteral morphine. The same dose given orally will provide less pain relief. A dose larger than the intravenous dose must be given to achieve an equianalgesic effect. REF: p. 187

Which of the following vaccinations are included in health promotion during infancy? (Select all that apply.) Haemophilus influenzae type b (Hib) Hepatitis C virus (HCV) Diphtheria, tetanus, and pertussis (DTaP) Poliovirus Hepatitis B virus (HBV)

Haemophilus influenzae type b (Hib) Diphtheria, tetanus, and pertussis (DTaP) Poliovirus Hepatitis B virus (HBV) The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention and the Committee on Infectious Diseases of the American Academy of Pediatrics govern the recommendations for immunization, which include diphtheria, tetanus, and pertussis (DTaP using acellular pertussis); poliovirus; measles, mumps, and rubella (MMR); Hib; HBV; hepatitis A virus (HAV); meningococcal; pneumococcal conjugate vaccine (PCV); and influenza (and H1N1) during infancy. There is no current vaccination to prevent the transmission of hepatitis C virus. REF: p. 201

Kimberly is having a checkup before starting kindergarten. The nurse asks her to do the "finger-to-nose test." The nurse is testing for which of the following? Deep tendon reflexes Cerebellar function Sensory discrimination Ability to follow directions

Cerebellar function The finger-to-nose test is an indication of cerebellar function. This test checks balance and coordination. Each deep tendon reflex is tested separately. Each sense is tested separately. Although performing this test can demonstrate the child's ability to follow directions, it is used primarily for cerebellar function. REF: p. 146

The nurse is taking a health history on a child. At the beginning of the interview, a parent says, "I brought him here because he always has diarrhea." This should be recorded under which of the following headings? History Chief complaint Review of systems Nutritional assessment

Chief complaint The mother has verbalized the specific reason for the child's visit to the health care provider. The chief complaint is the reason for which the child has been brought to the clinic, office, or hospital. History refers to information that relates to previous aspects of the child's health, not the current health. The review of systems is a specific review of each body system. It usually begins with a statement similar to asking the parent to describe how the child's general health has been. A nutritional assessment combines a nutrition history with a physical examination. REF: p. 99

In 1935 Title V of the Social Security Act was passed. This was significant in the evolution of child health care in the United States because it established what? Medicaid Children's Bureau Child Welfare Services White House Conferences on Children

Child Welfare Services This legislation provided for federal grants to be given to states for three major programs, Maternal Child Health, Crippled Children's Services, and Child Welfare Services. Medicaid was created in 1965 to reduce financial barriers to health care for poor individuals. The Children's Bureau was established in 1912 and was placed under the Department of Health, Education and Welfare. The White House Converences on Children was first convened in 1909. REF: p. 9

An 18-month-old child has just been admitted with croup. His parent is tearful and tells the nurse, "This is all my fault. I should have taken him to the doctor sooner so he wouldn't have to be here." Which of the following is appropriate in the care plan for this parent? Clarify misconception about the illness. Explain to the parent that the illness is not serious. Encourage the parent to maintain a sense of control. Assess further why the parent has excessive guilt feelings.

Clarify misconception about the illness. Guilt is a common response of parents when a child is hospitalized. They may blame themselves for the child's illness or for not recognizing it soon enough. The nurse should clarify the nature of the problem and reassure parents that the child is being cared for. Croup is a potentially serious illness. The nurse should not minimize the parents' feelings. It would be difficult for the parents to maintain a sense of control while their child is seriously ill. No further assessment is indicated at this time; guilt is a common response for parents. REF: p. 868

Which of the following terms best describes a group of people who share a set of values, beliefs, practices, social relationships, laws, politics, economics, and norms of behavior? Race Culture Ethnicity Social group

Culture Culture is a pattern of assumptions, beliefs, and practices that unconsciously frames the outlook and decisions of a group of people. Race is defined as a division of humankind possessing traits that are genetically transmissible. Ethnicity is the affiliation of a set of persons who share a unique cultural, social, and linguistic heritage. A social group consists of a system of roles carried out in both primary and secondary groups. Socialization is the process by which individuals learn the roles that are expected of them. REF: p. 39

When the nurse interviews an adolescent, which of the following is especially important? Focus the discussion on the peer group. Display a genuine interest in the adolescent. Emphasize that confidentiality will always be maintained. Use the same type of language as the adolescent.

Display a genuine interest in the adolescent. Adolescents accept anyone who shows a genuine interest in them. Although peers are important to this age group, the focus of the interview should be on the adolescent. The nurse should clarify which information will be shared with other members of the health care team and any limits to confidentiality. The nurse should maintain a professional relationship with adolescents. To avoid misinterpretation of words and phrases that the adolescent may use, the nurse should clarify terms frequently. REF: p. 97

What is the leading cause of death from unintentional injuries in children? Poisoning Drowning Motor vehicles Fires and burns

Motor vehicles Motor vehicle-related injuries are responsible for more than half of the injury-related deaths in children. Half of all poisonings occur in children younger than the age of 4 years, and it is the third leading cause of injury in those 15 to 24 years of age. Drowning and burns are among the top three causes of death for boys and girls throughout childhood.

A young woman who has recently become engaged to be married asks the nurse when genetic counseling is advisable. The couple does not plan to have children for several years. Which of the following should be the nurse's recommendation? As soon as the woman suspects that she may be pregnant Whenever the couple is ready to start their family Now if one of them has a family history of congenital heart disease Now if they are members of a population at risk for certain diseases

Now if they are members of a population at risk for certain diseases Couples who are both members of a group that is at risk for certain diseases or who have concerns about a disorder in one of their families should be advised about the availability of genetic counseling. This should be done at the earliest possible time. When possible, counseling should precede pregnancy. If genetic concerns exist, the information can be used for family planning decisions. Although there is a possible genetic component to congenital heart disease, other risk factors are important to consider. REF: p. 80

The father of a hospitalized child tells the nurse, "He can't have meat. We are Buddhist and vegetarians." What is the nurse's best intervention? Order the child a meatless tray as requested. Ask a Buddhist priest to visit the family. Explain that hospital patients are exempt from dietary rules. Help the parent understand that meat provides protein needed for healing.

Order the child a meatless tray as requested. It is essential for the nurse to respect the religious practices of the child and family. The nurse should arrange a dietary consult to ensure that nutritionally complete vegetarian meals are prepared by the hospital kitchen. It is not necessary to ask a Buddhist priest to visit. The nurse should be able to arrange for a vegetarian tray. The nurse should not encourage the child and parent to go against their religious beliefs. Nutritionally complete, acceptable vegetarian meals should be provided. REF: p. 36

A 2-year-old child is being admitted to the hospital for possible bacterial meningitis. When preparing for a lumbar puncture, the nurse should do which of the following? Place the child in a side-lying position. Set up a tray with equipment the same size as for adults. Apply EMLA to the puncture site 15 minutes before the procedure. Reassure the parents that the test is simple, painless, and risk free.

Place the child in a side-lying position. Children are easiest to control in a side-lying position with the head and knees drawn up toward the chest. Pediatric spinal trays have smaller needles than do adult trays. EMLA should be applied approximately 60 minutes before the procedure. The emergency nature of the spinal tap precludes its use. The test is not simple, painless, or risk free. A spinal tap does have associated risks, and analgesia will be given for the pain. REF: p. 907

The nurse is caring postoperatively for an 8-year-old child with multiple fractures and other trauma resulting from a motor vehicle injury. The child is experiencing severe pain. Which of the following is an important consideration in managing the child's pain? Give only an opioid analgesic at this time. Increase the dosage of analgesic until the child is adequately sedated. Plan a preventive schedule of pain medication around the clock. Give the child a clock and explain when she or he can have pain medications.

Plan a preventive schedule of pain medication around the clock. For severe postoperative pain, a preventive around-the-clock schedule is necessary to prevent decreased plasma levels of medications. The opioid analgesic will help for the present but is not an effective strategy. Increasing the dosage requires an order. The nurse should give the drug on a regular schedule and evaluate the effectiveness. Giving the child a clock and explaining when she or he can have pain medications is counterproductive. It focuses the child's attention on how long he or she will need to wait for pain relief. REF: p. 176

What are some legal and ethical issues that arise for the nurse when using an interpreter? Direct the questions to the interpreter. Ask several questions at a time. The family should be fully informed of all aspects of procedures before consenting. Discourage the interpreter and client from discussing topics not included in the interview.

The family should be fully informed of all aspects of procedures before consenting. In obtaining informed consent through an interpreter, the nurse should fully inform the family of all aspects of the particular procedure to which they are consenting. The communication is with the family members. The nurse directs the questions toward the family while observing nonverbal cues. Questions are asked one at a time to allow the interpreter and family to translate, process, and answer the question. The interpreter and client should build a rapport. Discussion of topics outside of the interview allows the two parties to become acquainted. REF: p. 94

The nurse is planning how to prepare a 4-year-old child for some diagnostic procedures. Guidelines for preparing this preschooler should include which of the following? Keep equipment out of the child's view. Plan for a short teaching session of about 30 minutes. Tell the child procedures are never a form of punishment. Use correct scientific and medical terminology in explanations.

Tell the child procedures are never a form of punishment. Preschoolers may view illness and hospitalization as punishment. Always state directly that procedures are never a form of punishment. Demonstrate the use of equipment and allow the child to play with miniature or actual equipment. Teaching sessions for this age group should be 10 to 15 minutes in length. Explain the procedure and how it affects the child in simple terms. REF: p. 907

The nurse is assessing a 3-year-old African American child who is being seen in the clinic for the first time. The child's height and weight are at the 20th percentile on the commonly used growth chart from the National Center for Health Statistics (NCHS). When interpreting these data, the nurse should recognize which of the following? The data suggest the child requires nutritional intervention. The NCHS charts are accurate for U.S. African American children. A correction factor is used when the NCHS chart is used for nonwhite ethnic groups. No assessment can be made until several measurements are plotted over time.

The NCHS charts are accurate for U.S. African American children. The NCHS growth charts can serve as reference guides for all racial or ethnic groups. U.S. African American children were included in the sample population. The 20th percentile for height and weight are not indicative of nutritional failure. No correction factor exists. The growth chart can be used with the perspective that different groups of children have varying normal distributions on the growth curves. Serial measurements are useful for longitudinal assessment of the child; single data points provide information about the child's current status. REF: p. 110

A 12-month-old child presents to the clinic for a well visit after missing several appointments. The child began her immunization schedule but has missed several follow-up appointments and immunization doses. The nurse knows that the most appropriate action is what? The child must receive initial immunizations from the beginning. The child cannot receive missed immunizations if the schedule is not followed. The child should only receive the missed doses of immunizations. The child should receive double-strength immunizations at this well visit.

The child should only receive the missed doses of immunizations. Children who began primary immunization at the recommended age but fail to receive all the doses do not need to begin the series again but instead should receive only the missed doses. The child may receive missed vaccinations on a catch-up schedule per CDC guidelines. REF: p. 195

Trisomy 13, trisomy 18, and trisomy 21 have which of the following in common? Viability is rare. They are considered deletion syndromes. The diagnosis is difficult, time consuming, and expensive. The diagnosis can be made early based on physical characteristics.

The diagnosis can be made early based on physical characteristics. Trisomy 13, trisomy 18, and trisomy 21 have distinctive clinical manifestations that often allow presumptive diagnosis soon after birth. Viability is variable with each syndrome. Approximately 50% of individuals with trisomy 21 live to age 60 years and older. Individuals with trisomy 13, trisomy 18, and trisomy 21 have extra chromosomal material. Confirmatory diagnosis does require chromosomal testing, but physical examination can provide a presumptive diagnosis. REF: p. 50

Which of the following is the appropriate site to administer an intramuscular (IM) vaccine to a newborn? The dorsal gluteal muscle The vastus lateralis muscle The ventral gluteal muscle The biceps muscle

The vastus lateralis muscle If the vaccine is given intramuscularly, then it is given in the vastus lateralis in newborns or in the deltoid for older infants and children. Regardless of age, the dorsogluteal site should be avoided because it has been associated with low antibody seroconversion rates, indicating a reduced immune response, and it is no longer an acceptable evidence-based practice site for IM injections. The ventral gluteal muscle and the biceps muscle are not appropriate sites for IM injections. REF: p. 196

Which of the following statements is true concerning folk remedies? They may be used to reinforce the treatment plan. They are incompatible with modern medical regimens. They are a leading cause of death in some cultural groups. They are not a part of the culture in large, developed countries.

They may be used to reinforce the treatment plan. Whenever folk remedies are compatible, they should be used to reinforce the treatment plan. This will assist in establishing a caring environment. Depending on the folk remedy, it may not be incompatible with modern medical regimens. Occasionally, a folk remedy can lead to death, but this varies with the remedy and its use. The roles that folk remedies have in large, developed countries vary depending on the remedies and the country's cultures. REF: p. 40

Which of the following is descriptive of nursing diagnoses? They provide the basis for the selection of nursing interventions. They should describe everything for which nursing is responsible. The cause of the problem must be identified before a nursing diagnosis can be made. The cause of the problem implies a cause-and-effect relationship in the nursing diagnosis.

They provide the basis for the selection of nursing interventions. The nursing diagnosis is the clinical judgment about the client's response to actual or potential health problems. The outcome statement guides the necessary interventions. Nursing diagnoses do not describe all areas of nursing practice. An actual problem may not exist. There may be risk factors that predispose a child or family to dysfunctional health patterns. There may not be a direct cause-and-effect relationship expressed in the diagnostic statement. REF: p. 14

The nurses caring for a child are concerned about the child's frequent requests for pain medication. During a team conference, a nurse suggests they consider administering a placebo instead of the usual pain medication. The decision should be based on knowledge of which of the following? This practice is unjustified and unethical. This practice is effective to determine whether a child's pain is real. The absence of a response to a placebo means the child's pain has an organic basis. A positive response to a placebo will not occur if the child's pain has an organic basis.

This practice is unjustified and unethical. Use of placebos without the patient's consent is unethical. Use of placebos does not provide information about the presence or severity of the pain. Individuals may have a positive response to a placebo despite a significant organic cause for their pain. REF: p. 175

When should clear liquids be stopped before scheduled surgery? Two hours before surgery Six hours before surgery The night before surgery at 8 PM The night before surgery at midnight

Two hours before surgery Clear liquids can be given up to 2 hours before surgery to children of any age without risk of aspiration. Six hours is the recommended waiting time for infant formula, nonhuman milk, and light meals. Clear liquids can be given up to 2 hours before surgery to children of any age without risk of aspiration. REF: p. 892

The nurse is caring for an unconscious 10-year-old child. Skin care should include which of the following? Avoid use of a pressure-reduction device on the bed. Massage reddened bony prominences to prevent deep tissue damage. Use a draw sheet to move the child in bed to reduce friction and shearing injuries. Avoid rinsing the skin after cleansing with mild antibacterial soap to provide a protective barrier.

Use a draw sheet to move the child in bed to reduce friction and shearing injuries. A draw sheet should be used to move the child in the bed or onto a gurney to reduce friction and shearing injuries. Do not drag the child from under the arms. Pressure-reduction devices should be used to redistribute weight. Bony prominences should not be massaged if reddened. Deep tissue damage can occur. Pressure-reduction devices should be used instead. The skin should be cleansed with mild nonalkaline soap or soap-free cleaning agents for routine bathing. REF: p. 895

A school-age child with cancer is being prepared for a procedure. The child says, "I have had one of these. They hurt." The nurse's response should be based on knowledge that children often lie about experiencing pain. tolerate pain better than adults. become accustomed to painful procedures. commonly experience treatment-related moderate to severe pain when they have cancer.

commonly experience treatment-related moderate to severe pain when they have cancer. Pain is reported by approximately 84% of children with cancer. Of these, most report it as moderate to severe, and half report the pain as highly distressing. There are no data to support that children misrepresent pain experiences. Pain tolerance is a complex phenomenon that is not based on age. Children do not become accustomed to painful procedures. REF: p. 187

A significant common side effect that occurs with opioid administration is euphoria. diuresis. constipation. allergic reactions.

constipation. Constipation is one of the most common side effects of opioid administration. Preventive strategies should be implemented to minimize this problem. Sedation is a more common result than euphoria. Urinary retention, not diuresis, may occur with opiates. Rarely, some individuals may have pruritus. REF: p. 179

A 5-year-old has patient-controlled analgesia (PCA) for pain management after abdominal surgery. Your explanation to the parents should include the child will be pain free. only the child is allowed to push the button for a bolus. the pump allows for a continuous basal rate and delivers a constant amount of medication to control pain. there is a high risk of overdose, so monitoring is done every 15 minutes.

the pump allows for a continuous basal rate and delivers a constant amount of medication to control pain. The PCA prescription can be set for a basal rate for a continued infusion of pain medication to prevent pain from returning during sleep and when the patient cannot control the infusion. Although the goal of PCA is to have effective pain relief, a pain-free state may not be possible. With a child who is 5 years old, the parents and nurse must assess the child to ensure that adequate medication is being given. A child who is 5 years old may not be able to understand the concept of pushing a button. Evidence suggests that effective analgesia can be obtained with the parents and nurse giving boluses as necessary. The prescription for the PCA includes how much medication can be given in a defined period. Monitoring every 1 to 2 hours for patient response is sufficient. REF: p. 176