Peds Exam 1: Genitourinary & Respiratory

3. The parent of a 4-month-old with CF asks the nurse what time to begin the child's first CPT each day. Which is the nurse's best response? 1. "You should do the first CPT 30 minutes before feeding the child breakfast." 2. "You should do the first CPT after deep-suctioning the child each morning." 3. "You should do the first CPT 30 minutes after feeding the child breakfast." 4. "You should do the first CPT only when the child has congestion or coughing."

3. 1. CPT should be done in the morning prior to feeding to avoid the risk of the child vomiting.

Which best describes the electrolyte imbalance that occurs in chronic renal failure (CRF)? 1. Decreased serum phosphorus and calcium levels. 2. Depletion of phosphorus and calcium stores from the bones. 3. Change in the structure of the bones, causing calcium to remain in the bones. 4. Nutritional needs are poorly met, leading to a decrease in many electrolytes such as calcium and phosphorus.

2. The calcium and phosphorus levels are drawn from the bones in response to low calcium levels.

Which needs to be present to diagnose hemolytic uremic syndrome (HUS)? 1. Increased red blood cells with a low reticulocyte count, increased platelet count, and renal failure. 2. Decreased red blood cells with a high reticulocyte count, decreased platelet count, and renal failure. 3. Increased red blood cells with a high reticulocyte count, increased platelet count, and renal failure. 4. Decreased red blood cells with a low reticulocyte count, decreased platelet count, and renal failure.

2. The triad in HUS includes decreased red blood cells (with a high reticulo- cyte count as the body attempts to produce more red blood cells), decreased platelet count, and renal failure.

53. A 3-year-old is seen in the physician's office for a dry, hacking cough that is preventing the child from sleeping. The child is diagnosed with a URI. Which of the following interventions is most appropriate for this patient? 1. The child should be given cough suppressants at night. 2. The child should be given a cough expectorant every 4 hours. 3. The child should be given cold and flu medication every 8 hours. 4. The child should be given 1/2 teaspoon honey four to five times per day.

53. 1. Cough suppressants are not recommended for children. Coughing is a protective mechanism, so do not try to stop it. 2. Cough expectorants are not recommended for children younger than 6 years of age. There is no research information that they are effective. 3. Cold and flu medications are not indi cated for children younger than 6 years of age as there is no indication they are effective.

Which laboratory results besides hematuria are most consistent with hemolytic uremic syndrome (HUS)? 1. Massive proteinuria, elevated blood urea nitrogen, and creatinine. 2. Mild proteinuria, decreased blood urea nitrogen, and creatinine. 3. Mild proteinuria, increased blood urea nitrogen, and creatinine. 4. Massive proteinuria, decreased blood urea nitrogen, and creatinine.

3. Hematuria, mild proteinuria, increased BUN, and creatinine are all present in HUS.

54. Which of the following statements about pneumonia is accurate? 1. Pneumonia is most frequently caused by bacterial agents. 2. Children with bacterial pneumonia are usually sicker than children with viral pneumonia. 3. Children with viral pneumonia are usually sicker than those with bacterial pneumonia. 4. Children with viral pneumonia must be treated with a complete course of antibiotics.

54. 1. Pneumonia is most frequently caused by viruses but can also be caused by bacteria such as Streptococcus pneumoniae. 2. Children with bacterial pneumonia are usually sicker than children with viral pneumonia. Children with bacterial pneumonia can be treated effectively, but they require a course of antibiotics. 3. Children with viral pneumonia are not usually as ill as those with bacterial pneu monia. Treatment for viral pneumonia in cludes maintaining adequate oxygenation and comfort measures. 4. Treatment for viral pneumonia includes maintaining adequate oxygenation and comfort measures.

The nurse evaluates post-operative teaching for repair of testicular torsion as successful when the parent of an adolescent says which the following? 1. "I will encourage him to rest for a few days, but he can return to football practice in a week." 2. "I will keep him in bed for 4 days and let him gradually increase his activity after that." 3. "I will seek therapy as he ages because he is now infertile." 4. "I will make sure he does testicular self-examination monthly."

4. The child and family should be taught the importance of testicular self-examination.

Which child does not need a urinalysis to evaluate for a urinary tract infection (UTI)? 1. A 4-month-old female presenting with a 2-day history of fussiness and poor appetite; current vital signs include axillary T 100.8°F (38.2°C), HR 120 beats per minute. 2. A 4-year-old female who states, "It hurts when I pee"; she has been urinating every 30 minutes; vital signs are within normal range. 3. An 8-year-old male presenting with a finger laceration; mother states he had surgical reimplantation of his ureters 2 years ago. 4. A 12-year-old female complaining of pain to her lower right back; she denies any burning or frequency at this time; oral temperature of 101.5°F (38.6°C).

3. Although this child has had a history of urinary infections, the child is currently not displaying any signs and therefore does not need a urinalysis at this time.

7. A female child with CF is hospitalized with constipation. The parent asks the nurse what will need to be done to relieve the child's constipation. Which is the nurse's best response? 1. "Your child likely has an obstruction and will require surgery." 2. "Your child will likely be given IV fluids to relieve her constipation." 3. "Your child will likely be given GoLYTELY to relieve her constipation." 4. "Your child will be placed on a clear liquid diet to relieve her constipation."

3. CF patients with constipation commonly receive a stool softener or an osmotic so lution orally to relieve their constipation.

A child diagnosed with acute renal failure (ARF) complains of "not feeling well," having "butterflies in the chest," and arms and legs "feeling like Jell-O." The cardiac monitor shows that the QRS complex is wider than before and that an occasional premature ventricular contraction (PVC) is seen. Which would the nurse expect to administer? 1. An isotonic saline solution with 20 mEq KCl/L. 2. Sodium bicarbonate via slow intravenous push. 3. Calcium gluconate via slow intravenous push. 4. Oral potassium supplements.

3. Calcium gluconate is the drug of choice for cardiac irritability secondary to hyperkalemia.

A 5-year-old is discharged from the hospital following the diagnosis of hemolytic uremic syndrome (HUS). The child has been free of diarrhea for 1 week, and renal function has returned. The parent asks the nurse when the child can return to school. Which is the nurse's best response? 1. "Immediately, as your child is no longer contagious." 2. "It would be best to keep your child home for a few more weeks because the immune system is weak, and there could be a relapse of HUS." 3. "Your child will be contagious for approximately another 10 days, so it is best to not allow a return just yet." 4. "It would be best to keep your child home to monitor urinary output."

3. Children with HUS are considered contagious for up to 17 days after the resolution of diarrhea and should be placed on contact isolation.

The parents of a child hospitalized with minimal change nephrotic syndrome (MCNS) ask why the last blood test revealed elevated lipids. Which is the nurse's best response? 1. "If your child had just eaten a fatty meal, the lipids may have been falsely elevated." 2. "It's not unusual to see elevated lipids in children because of the dietary habits of today." 3. "Since your child is losing so much protein, the liver is stimulated and makes more lipids." 4. "Your child's blood is very concentrated because of the edema, so the lipids are falsely elevated."

3. In MCNS, the lipids are truly elevated. Lipoprotein production is increased because of the increased stimulation of the liver hypoalbuminemia.

A child with minimal change nephrotic syndrome (MCNS) has generalized edema. The skin appears stretched, and areas of breakdown are noted over the bony promi- nences. The child has been receiving Lasix twice daily for several days. Which does the nurse expect to be included in the treatment plan to reduce edema? 1. An increase in the amount and frequency of Lasix. 2. Addition of a second diuretic, such as mannitol. 3. Administration of intravenous albumin. 4. Elimination of all fluids and sodium from the child's diet.

3. In cases of severe edema, albumin is used to help return the fluid to the bloodstream from the subcutaneous tissue.

9. A 7-month-old is taken to the pediatrician's office with a low-grade fever, nasal congestion, and a mild cough. Which should the nursing care management of this child include? 1. Maintaining strict bedrest. 2. Avoiding contact with family members. 3. Instilling saline nose drops and bulb suctioning. 4. Keeping the head of the bed flat.

3. Infants are nose breathers and often have increased difficulty when they are congested. Nasal saline drops and gen tle suctioning with a bulb syringe are often recommended.

The nurse is caring for a newborn with hypospadias. His parents ask if circumcision is an option. Which is the nurse's best response? 1. "Circumcision is a fading practice and is now contraindicated in most children." 2. "Circumcision in children with hypospadias is recommended because it helps prevent infection." 3. "Circumcision is an option, but it cannot be done at this time." 4. "Circumcision can never be performed in a child with hypospadias."

3. It is usually recommended that circumcision be delayed in the child with hypospadias because the foreskin may be needed for repair of the defect.

A child diagnosed with a Wilms tumor is scheduled for an MRI scan of the lungs. The parent asks the nurse the reason for this test as a Wilms tumor involves the kidney, not the lung. Which is the nurse's best response? 1. "I'm not sure why your child is going for this test. I will check and get back to you." 2. "It sounds like we made a mistake. I will check and get back to you." 3. "The test is done to check to see if the disease has spread to the lungs." 4. "We want to check the lungs to make sure your child is healthy enough to tolerate surgery."

3. The test is done to see if the disease has spread to the lungs.

21. There are several children in the ER waiting area who all have asthma. The nurse has only one room left in the ER. Based on the following information, which child should be seen first? 1. A 5-year-old who is speaking in complete sentences, is pink in color, is wheezing bilaterally, and has an oxygen saturation of 93%. 2. A 9-year-old who is quiet, is pale in color, and is wheezing bilaterally with an oxygen saturation of 92%. 3. A 12-month-old who has a mild cry, is pale in color, has diminished breath sounds, and has an oxygen saturation of 93%. 4. A 16-year-old who is speaking in short sentences, is wheezing, is sitting upright, and has an oxygen saturation of 93%.

3. This child is exhibiting signs of severe asthma. This child should be seen first. The child no longer has wheezes and now has diminished breath signs.

24. A pediatric client was seen at the pediatrician's office and was diagnosed with viral tonsillitis. The parent asks how to care for the child at home. Which is the nurse's best response? 1. "You will need to give your child a prescribed antibiotic for 10 days." 2. "You will need to schedule a follow-up appointment in 2 weeks." 3. "You can give your child Tylenol every 4 to 6 hours as needed for pain." 4. "You can place warm towels around your child's neck for comfort."

3. Tylenol is recommended prn for pain relief.

The parents of a 7-year-old tell the nurse they do not understand the difference be- tween chronic renal failure (CRF) and acute renal failure (ARF). Which is the nurse's best response? 1. "There really is not much difference because the terms are used interchangeably." 2. "Most children experience ARF. It is highly unusual for a child to experience CRF." 3. "CRF tends to occur suddenly and is irreversible." 4. "ARF is often reversible, whereas CRF results in permanent deterioration of kidney function."

4. ARF is often reversible, whereas CRF results in permanent deterioration of kidney function.

Which is the best way to obtain a urine sample in an 8-month-old being evaluated for a urinary tract infection (UTI)? 1. Carefully cleanse the perineum from front to back, and apply a self-adhesive urine collection bag to the perineum. 2. Insert an indwelling Foley catheter, obtain the sample, and wait for results. 3. Place a sterile cotton ball in the diaper, and immediately obtain the sample with a syringe after the first void. 4. Using a straight catheter, obtain the sample, and immediately remove the catheter without waiting for the results of the urine sample.

4. An in-and-out catheterization is the best way to obtain a urine culture in a child who is not yet toilet-trained.

One week after kidney transplant, a child complains about abdominal pain, and the parents note that the child has been very irritable. The nurse notes a 10% weight gain as well as elevated BUN and creatinine levels. Which of the following medications would the child most likely be taking? 1. Codeine tablets. 2. Furosemide. 3. MiraLAX powder. 4. Corticosteroids.

4. Corticosteroids are considered to be part of the antirejection regimen that is essential after a kidney transplant.

14. A school-age child is admitted to the hospital for a tonsillectomy. The nurse caring for this patient is assessing the child 8 hours after surgery. During the nurse's assessment, the child's parent tells the nurse that the child is in pain. Which of the following observations should be of most concern to the nurse? 1. The child's heart rate and blood pressure are elevated. 2. The child complains of having a sore throat. 3. The child is refusing to eat solid foods. 4. The child is swallowing excessively.

4. Excessive swallowing is a sign that the child is swallowing blood. This should be considered a medical emer gency, and the physician should be contacted immediately. The child is likely bleeding and will need to return

A parent asks the nurse how to prevent the child from having minimal change nephrotic syndrome (MCNS) again. Which is the nurse's best response? 1. "It is very rare for a child to have a relapse after having fully recovered." 2. "Unfortunately, many children have cycles of relapses, and there is very little that can be done to prevent it." 3. "Your child is much less likely to get sick again if sodium is decreased in the diet." 4. "Try to keep your child away from sick children because relapses have been associated with infectious illnesses."

4. Exposure to infectious illness has been linked to the relapse of nephrotic syndrome.

2. Which of the following statements about the inheritance of CF is most accurate? 1. CF is an autosomal-dominant trait that is passed on from the child's mother. 2. CF is an autosomal-dominant trait that is passed on from the child's father. 3. The child of parents who are both carriers of the gene for CF has a 50% chance of acquiring CF. 4. The child of a mother who has CF and a father who is a carrier of the gene for CF has a 50% chance of acquiring CF.

4. If the child is born to a mother with CF and a father who is a carrier, the child has a 50% chance of acquiring the dis ease and a 50% chance of being a carrier of the disease.

Which should the nurse teach a group of girls and parents about the importance of preventing urinary tract infections (UTIs)? 1. Avoiding constipation has no effect on the occurrence of UTIs. 2. After urinating, always wipe from back to front to prevent fecal contamination. 3. Hygiene is an important preventive measure and can be accomplished with frequent tub baths. 4. Increasing fluids will help prevent and treat UTIs.

4. Increasing fluids will help flush the bladder of any organism, encourage urination, and prevent stasis of urine.

23. The parents of a 6-year-old who has a new diagnosis of asthma asks the nurse what to do to make their home a more allergy-free environment for the child. Which is the nurse's best response? 1. "Use a humidifier in your child's room." 2. "Have your carpet cleaned chemically once a month." 3. "Wash household pets weekly." 4. "Avoid purchasing upholstered furniture."

4. Leather furniture is recommended rather than upholstered furniture. Upholstered furniture can harbor large amounts of dust, whereas leather furniture may be wiped off regularly with a damp cloth.

12. A 5-year-old female is diagnosed with pharyngitis. The child is complaining of throat pain. Which of the following statements by the mother indicates that she needs more education regarding the care and treatment of her daughter's throat pain? 1. "I will have my daughter gargle with warm saline three times a day." 2. "I will offer my daughter ice chips several times a day." 3. "I will give my daughter Tylenol every 4 to 6 hours as needed." 4. "I will give my daughter her amoxicillin until all doses of the antibiotic are gone."

4. Pharyngitis is a self-limiting viral ill ness that does not require antibiotic therapy. Pharyngitis should be treated with rest and comfort measures, in cluding Tylenol, throat sprays, cold liquids, and popsicles.

The nurse is caring for a 1-year-old diagnosed with acute renal failure (ARF). Edema is noted throughout the child's body, and the liver is enlarged. The child's urine out- put is less than 0.5 mL/kg/hr, and vital signs are as follows: HR 146, BP 176/92, and RR 42. The child is noted to have nasal flaring and retractions with inspiration. The lung sounds are coarse throughout. Despite receiving oral Kayexalate, the child's serum potassium continues to rise. Which treatment will provide the most benefit to the child? 1. Additional rectal Kayexalate. 2. Intravenous furosemide. 3. Endotracheal intubation and ventilatory assistance. 4. Placement of a Tenckhoff catheter for peritoneal dialysis.

4. Placement of a Tenckhoff catheter for peritoneal dialysis is needed when the child's condition deteriorates despite medical treatment.

Which statement by a parent is most consistent with minimal change nephrotic syndrome (MCNS)? 1. "My child missed 2 days of school last week because of a really bad cold." 2. "After camping last week, my child's legs were covered in bug bites." 3. "My child came home from school a week ago due to vomiting and stomach cramps." 4. "We have a pet turtle but no one washes their hands after playing with the turtle."

1. An upper respiratory infection often precedes MCNS by a few days.

A 13-month-old is discharged following repair of his epispadias. Which statement made by the parents indicates they understand the discharge teaching? 1. "If a mucous plug forms in the urinary drainage tube, we will irrigate it gently to prevent a blockage." 2. "If a mucous plug forms in the urinary drainage tube, we will allow it to pass on its own because this is a sign of healing." 3. "We will make sure the dressing is loosely applied to increase the toddler's comfort." 4. "If we notice any yellow drainage, we will know that everything is healing well."

1. Any mucous plugs should be removed by irrigation to prevent blockage of the urinary drainage system.

A child with hemolytic uremic syndrome (HUS) is very pale and lethargic. Stools have progressed from watery to bloody diarrhea. Blood work indicates low hemoglo- bin and hematocrit levels. The child has not had any urine output in 24 hours. The nurse expects administration of blood products and what else to be added to the plan of care? 1. Initiation of dialysis. 2. Close observation of the child's hemodynamic status. 3. Diuretic therapy to force urinary output. 4. Monitoring of urinary output.

1. Because the child is symptomatic, dialysis is the treatment of choice.

Which would the nurse expect to hear the parents of an infant with an incarcerated hernia report? 1. Acute onset of pain, abdominal distention, and a mass that cannot be reduced. 2. Gradual onset of pain, abdominal distention, and a mass that cannot be reduced. 3. Acute onset of pain, abdominal distention, and a mass that is easily reduced. 4. Gradual onset of pain, abdominal distention, and a mass that is easily reduced.

1. Signs of an incarcerated hernia include an acute onset of pain, abdominal distention, and a mass that cannot be reduced. Other signs are bloody stools, edema of the scrotum, and a history of poor feeding.

Which causes the symptoms in testicular torsion? 1. Twisting of the spermatic cord interrupts the blood supply. 2. Swelling of the scrotal sac leads to testicular displacement. 3. Unmanaged undescended testes cause testicular displacement. 4. Microthrombi formation in the vessels of the spermatic cord causes interruption of the blood supply.

1. Testicular torsion is caused by an interruption of the blood supply due to twisting of the spermatic cord.

A child had a urinary tract infection (UTI) 3 months ago and was treated with an oral antibiotic. A follow-up urinalysis revealed normal results. The child has had no other problems until this visit when the child was diagnosed with another UTI. Which is the most appropriate plan? 1. Urinalysis, urine culture, and VCUG. 2. Evaluate for renal failure. 3. Admit to the pediatric unit. 4. Discharge home on an antibiotic.

1. Urinalysis and urine culture are rou- tinely used to diagnose UTIs. VCUG is used to determine the extent of urinary tract involvement when a child has a second UTI within 1 year.

The parents of a child with glomerulonephritis ask how they will know their child is improving after they go home. Which is the nurse's best response? 1. "Your child's urine output will increase, and the urine will become less tea-colored." 2. "Your child will rest more comfortably as lab tests become more normal." 3. "Your child's appetite will decrease as urine output increases." 4. "Your child's laboratory values will become more normal."

1. When glomerulonephritis is improv- ing, urine output increases, and the urine becomes less tea-colored. These are signs that can be monitored at home by the child's parents.

A child had a tonsillectomy 6 days ago and was seen in the emergency room 4 hours ago due to post-operative hemorrhage. The parent noted that her child was "swal- lowing a lot and finally began vomiting large amounts of blood." The child's vital signs are as follows: T 99.5°F (37.5°C), HR 124, BP 84/48, and RR 26. The nurse knows that this child is at risk for which type of renal failure? 1. CRF due to advanced disease process. 2. Prerenal failure due to dehydration. 3. Primary kidney damage due to a lack of urine flowing through the system. 4. Postrenal failure due to a hypotensive state.

2. Examples of causes of prerenal failure include dehydration and hemorrhage.

Which protrusion into the groin of a female most likely causes inguinal hernias? 1. Bowel. 2. Fallopian tube. 3. Large thrombus formation. 4. Muscle tissue.

2. Fallopian tube or an ovary is the most common tissue to protrude into the groin in females.

Which would the nurse most likely find in the history of a child with hemolytic uremic syndrome (HUS)? 1. Frequent UTIs and possible vesicoureteral reflux (VUR). 2. Vomiting and diarrhea before admission. 3. Bee sting and localized edema of the site for 3 days. 4. Previously healthy and no signs of illness.

2. HUS is often preceded by diarrhea that may be caused by E. coli present in undercooked meat.

The parents of a 6-week-old male ask the nurse if there is a difference between an inguinal hernia and a hydrocele. Which is the nurse's best response? 1. "The terms are used interchangeably and mean the same thing." 2. "The symptoms are similar, but an inguinal hernia occurs when tissue protrudes into the groin, whereas a hydrocele is a fluid-filled mass in the scrotum." 3. "A hydrocele is the term used when an inguinal hernia occurs in females." 4. "A hydrocele presents in a manner similar to that of an inguinal hernia but causes increased concern because it is often malignant."

2. The symptoms are similar, but an inguinal hernia occurs when tissue pro- trudes into the groin, and a hydrocele is a fluid-filled mass in the scrotum.

The parents overhear the health-care team refer to their child's disease as in stage III. The parents ask the nurse what this means. Which is the nurse's best response? 1. The tumor is confined to the abdomen, but it has spread to the lymph nodes or peritoneal area; the prognosis is poor. 2. The tumor is confined to the abdomen, but it has spread to the lymph nodes or peritoneal area; the prognosis is very good. 3. The tumor has been found in three other organs beyond the peritoneal area; the prognosis is good. 4. The tumor has spread to other organs beyond the peritoneal area; the prognosis is poor.

2. The tumor is confined to the abdomen but has spread to the lymph nodes or peritoneal area. The prognosis is still very good.

The nurse anticipates that the child who has had a kidney removed will have a high level of pain and will require invasive and noninvasive measures for pain relief. The nurse anticipates that the child will have pain because of which of the following? 1. The kidney is removed laparoscopically, and there will be residual pain from accumulated air in the abdomen. 2. There is a post-operative shift of fluids and organs in the abdominal cavity, leading to increased discomfort. 3. The chemotherapy makes the child more sensitive to pain. 4. The radiation therapy makes the child more sensitive to pain.

2. There is a post-operative shift of fluids and organs in the abdominal cavity, leading to increased discomfort.

18. A 2-year-old is diagnosed with asthma. The parents are big sports fans and want their child to play sports. The parents ask the nurse what impact asthma will have on the child's future in sports. Which is the nurse's best response? 1. "As long as your child takes prescribed asthma medication, the child will be fine." 2. "The earlier a child is diagnosed with asthma, the more significant the symptoms." 3. "The earlier a child is diagnosed with asthma, the better the chance the child has of growing out of the disease." 4. "Your child should avoid playing contact sports and sports that require a lot of running."

2. When a child is diagnosed with asthma at an early age, the child is more likely to have significant symptoms on aging.

27. The school nurse is planning to educate kindergarten children on how to stop the spread of influenza in the classroom. Which of the following should the nurse instruct the children? 1. Stay home if they have a runny nose and cough. 2. Wash their hands after using the restroom. 3. Wash their hands after sneezing. 4. Have a flu shot annually.

27. 1. Children do not need to stay home unless they have a fever. However, the children should be taught to cough or sneeze into their sleeve and to wash their hands after sneezing or coughing. 2. Children should always wash their hands after using the restroom. In order to de crease the spread of influenza, however, it is more important for the children to wash their hands after sneezing or coughing. *3. It is essential that children wash their hands after any contact with nasopharyngeal secretions.* 4. Children should have a flu shot annually, but that information is best included in an educational session for the parents. There is little that children can do directly to en sure they receive flu shots. Children of this age are often frightened of shots and would not likely pass that information on to their parents.

28. Which of the following is the highest priority for receiving the flu vaccine? 1. An 18-year-old who is living in a college dormitory. 2. A healthy 8-month-old who attends day care. 3. A 7-year-old who attends public school. 4. A 3-year-old who is undergoing chemotherapy.

28. 1. The flu vaccine is recommended for all ages, but the 18-year-old is not the highest priority. A person this age will likely recover without any complications. *2. Children between the ages of 6 and 23 months are at the highest risk for having complications as a result of the flu. Their immune systems are not so developed, so they are at a higher risk for influenza-related hospitalizations.* 3. The flu vaccine is recommended for all ages, but the 7-year-old is not the highest priority. A child this age will likely recover without any complications. 4. The flu vaccine should not be given to anyone who is immunocompromised.

20. A 7-year-old female with asthma is playing a soccer game in gym class. During the game the child begins to cough, wheeze, and have difficulty catching her breath. The school nurse is called to the soccer field. Which of the following should the nurse administer to provide quick relief? 1. Prednisone. 2. Singulair. 3. Albuterol. 4. Flovent.

3. Albuterol is the quick-relief bron chodilator of choice for treating an asthma attack.

15. A pediatric client had a tonsillectomy 24 hours ago. The nurse is reviewing discharge instructions with the parents. The parents tell the nurse that the child is a big eater, and they want to know what foods to give the child for the next 24 hours. What is the nurse's best response? 1. "The child's diet should not be restricted at all." 2. "The child's diet should be restricted to clear liquids." 3. "The child's diet should be restricted to ice cream and cold liquids." 4. "The child's diet should be restricted to soft foods."

4. Soft foods are recommended to limit the child's pain and to decrease the risk for bleeding.

In addition to increased blood pressure, which findings would most likely be found in a child with hydronephrosis? 1. Metabolic alkalosis, polydipsia, and polyuria. 2. Metabolic acidosis, and bacterial growth in the urine. 3. Metabolic alkalosis, and bacterial growth in the urine. 4. Metabolic acidosis, polydipsia, and polyuria.

4. The blood pressure is increased as the body attempts to compensate for the decreased glomerular filtration rate. Metabolic acidosis is caused by a reduction in hydrogen ion secretion from the distal nephron. Polydipsia and polyuria occur as the kidney's ability to concentrate urine decreases. There is bacterial growth in the urine due to the urinary stasis caused by the obstruction.

The bladder capacity of a 3-year-old is approximately how much? 1. 1.5 fl. oz. 2. 3 fl. oz. 3. 4 fl. oz. 4. 5 fl. oz.

4. The capacity of the bladder in fluid ounces can be estimated by adding 2 to the child's age in years.

The nurse evaluates the parents' understanding of the teaching about an inguinal hernia as successful when they say which of the following? 1. "There are no risks associated with waiting to have the hernia reduced; surgery is done for cosmetic reasons." 2. "It is normal to see the bulge in the baby's groin decrease with a bowel movement." 3. "We will wait for surgery until the baby is older because narcotics for pain control will be required for several days." 4. "It is normal for the bulge in the baby's groin to look smaller when the baby is asleep."

4. The hernia often appears smaller when the child is asleep.

17. A pediatric client is admitted in status asthmaticus. The parent reports that the child is currently taking Singulair, albuterol, and Flovent. What is the most important piece of information that the nurse must ask the parent in order to best treat the patient? 1. "What time did your child eat last?" 2. "Has your child been exposed to any of the usual asthma triggers?" 3. "When was your child last admitted to the hospital for asthma?" 4. "When was your child's last dose of medication?"

4. The nurse needs to know what med ication the child had last and when the child took it in order to know how to begin treatment for the current asthmatic condition.

62. A sweat chloride test is used to diagnose CF. A chloride level greater than _____________________ is a positive diagnostic indicator of CF.

62. 60 mEq/L. The definitive diagnosis of CF is made when a patient has a sweat chloride test with a chloride level >60 mEq/L. A normal chloride level is <40 mEq/L.

39. An 8-month-old male twin is in the hospital with RSV. The nurse educated the parent on how to prevent the healthy twin at home from contracting RSV. Which statement indicates the parent needs further teaching? 1. "I should make sure that both my children receive Synagis injections for the remainder of this year." 2. "I should be sure to keep my infected son away from his brother until he has recovered." 3. "I should insist that all people who come in contact with my twins thoroughly wash their hands before playing with them." 4. "I should insist that anyone with a respiratory illness avoid contact with my children until the children are well."

*39. 1. Synagis will not help the child who has already contracted the illness. Synagis is an immunization and a method of primary prevention.* 2. RSV is spread through direct contact with respiratory secretions, so it is a good idea to keep the ill child away from the healthy one. 3. RSV is spread through direct contact with respiratory secretions, so it is a good idea to have all persons coming in contact with the child wash their hands. 4. RSV is spread through direct contact with respiratory secretions, so it is a good idea to have ill persons avoid any contact with the children until they are well.

44. Which of the following children is in the greatest need of emergency medical treatment? 1. A 6-year-old who has high fever, no spontaneous cough, and frog-like croaking. 2. A 3-year-old who has a barky cough, is afebrile, and has mild intercostal retractions. 3. A 7-year-old who has abrupt onset of moderate respiratory distress, a mild fever, and a barky cough. 4. A 13-year-old who has a high fever, stridor, and purulent secretions.

*44. 1. This child has signs and symptoms of epiglottitis and should receive immedi ate emergency medical treatment. The patient has no spontaneous cough and has a frog-like croaking because of a significant airway obstruction.* 2. This child has signs and symptoms of acute laryngitis and is not in a significant amount of distress. 3. This child has signs and symptoms of LTB and is not in significant respiratory distress. 4. This child has signs and symptoms of bac terial tracheitis and should be treated with antibiotics but is not the patient in the most significant amount of distress.

49. A pediatric client is diagnosed with epiglottitis. The parents ask the nurse what treatment their child will receive. Which is the nurse's best response? 1. "Your child will need to complete a course of intravenous antibiotics." 2. "Your child will need to have surgery to remove her tonsils." 3. "Your child will need 10 days of aerosolized ribavirin." 4. "Your child will recover without any intervention in about 5 days."

*49. 1. Epiglottitis is bacterial in nature and requires intravenous antibiotics. A 7- to 10-day course of oral antibiotics is usually ordered following the intra venous course of antibiotics.* 2. Surgery is not the course of treatment for epiglottitis. Epiglottal swelling usually diminishes after 24 hours of intravenous antibiotics. 3. Ribavirin is an antiviral medication that is used to treat RSV. 4. Epiglottitis is bacterial in nature and re quires intervention. A course of intravenous antibiotics is indicated for this patient.

The parents of a 3-year-old are concerned that the child is having "more accidents" during the day. Which question would be appropriate for the nurse to ask to obtain more information? Select all that apply. 1. "Has there been a stressful event in the child's life, such as the birth of a sibling?" 2. "Has anyone else in the family had problems with accidents?" 3. "Does your child seem to be drinking more than usual?" 4. "Is your child more irritable, and does your child seem to be in pain when urinating?" 5. "Is your child having difficulties at preschool?"

1, 2, 3, 4. 1. Stressors such as the birth of a sibling can lead to incontinence in a child who previously had bladder control. 2. A pattern of enuresis can often be seen in families. 3. Increased thirst and incontinence can be associated with diabetes. 4. Irritability and incontinence can be associated with UTIs. 5. Preschool-age children do not habitually share, so this information would not help the nurse in gathering more information

22. A 3-year-old female is admitted to the hospital with asthma. The nurse is trying to work with the child on breathing exercises to increase her expiratory phase. What should the nurse have the child do? 1. Use an incentive spirometer. 2. Breathe into a paper bag. 3. Blow a pinwheel. 4. Take several deep breaths.

3. Blowing a pinwheel is an excellent means of increasing a child's expira tory phase. Play is an effective means of engaging a child in therapeutic activities. Blowing bubbles is another method to increase the child's expiratory phase.

The nurse is caring for a 4-year-old who weighs 15 kg. At the end of a 10-hour period, the nurse notes the urine output to be 150 mL. What action does the nurse take? 1. Notifies the physician because this urine output is too low. 2. Encourages the child to increase oral intake to increase urine output. 3. Records the child's urine output in the chart. 4. Administers isotonic fluid intravenously to help with rehydration.

3. Recording the child's urine output in the chart is the appropriate action because the urine output is within the expected range of 0.5-1 mL/kg/hr, or 75-150 mL for the 10-hour period.

An infant is scheduled for a hypospadias and chordee repair. The parent tells the nurse, "I understand why the hypospadias repair is necessary, but do they have to fix the chordee as well?" Which is the nurse's best response? 1. "I understand your concern. Parents do not want their children to undergo extra surgery." 2. "The chordee repair is done strictly for cosmetic reasons that may affect your son as he ages." 3. "The repair is done to optimize sexual functioning when he is older." 4. "This is the best time to repair the chordee because he will be having surgery anyway."

3. Releasing the chordee surgically is necessary for future sexual function.

A renal transplantation is which of the following? 1. A curative procedure that will free the child from any more treatment modalities. 2. An ideal treatment option for families with a history of dialysis noncompliance. 3. A treatment option that will free the child from dialysis. 4. A treatment option that is very new to the pediatric population.

3. Renal transplantation frees the patient from dialysis.

Which would the nurse expect to find on assessment in a child with Wilms tumor? 1. Decreased blood pressure, increased temperature, and a firm mass located in one flank area. 2. Increased blood pressure, normal temperature, and a firm mass located in one flank area. 3. Increased blood pressure, normal temperature, and a firm mass located on one side of the midline of the abdomen. 4. Decreased blood pressure, normal temperature, and a firm mass located on one side or the other of the midline of the abdomen.

3. The blood pressure may be increased if there is renal damage. The mass will be located on one side or the other of the midline of the abdomen. There is no reason for the child's temperature to be affected.

Which medication would most likely be included in the post-operative care of a child with repair of bladder exstrophy? 1. Lasix. 2. Mannitol. 3. Meperidine. 4. Oxybutynin.

4. Oxybutynin is used to control bladder spasms.

40. Which of the following patients is at highest risk for requiring hospitalization as a result of RSV? 1. A 3-year-old with a congenital heart defect. 2. A 2-month-old who is a former 32-week preemie. 3. A 4-year-old who is a former 30-week preemie. 4. A sixteen-month-old with a tracheostomy.

40. 1. Most children with RSV can be managed at home. Children 2 years and younger are at highest risk for developing complica tions related to RSV. Children who were premature, have cardiac conditions, or have chronic lung disease are also at a higher risk for needing hospitalization. The 3-year-old with a congenital heart disease is not the highest risk among this group of patients. *2. The younger the child, the greater the risk for developing complications re lated to RSV. The age and the prema ture status of this child make the the patient the highest risk.* 3. Children who were premature, have cardiac conditions, or have chronic lung disease are also at a higher risk for needing hospitaliza tion. This child was a former premature in fant but is now 4 years of age. 4. This child has a tracheostomy, but this is not an indication that the child cannot be managed at home.

41. A 6-month-old is admitted to the hospital with RAD. The nurse is assessing the child. Which of the following physical findings should be of most concern? 1. The baby has tachypnea. 2. The baby has mild retractions. 3. The baby is wheezing. 4. The baby is grunting.

41. 1. Tachypnea, an increase in respiratory rate, should be monitored but is a common symptom of RAD. 2. Retractions should be monitored, but they are a common symptom of respiratory distress and RAD. 3. Wheezing should be monitored but is a common symptom of RAD. *4. Grunting is a sign of impending respi ratory failure and is a very concerning physical finding.*

42. A 6-year-old presents to the ER with respiratory distress and stridor. The child is diagnosed with RSV. The parent asks the child's nurse how the child will be treated. Which is the nurse's best response? 1. "We will treat your child with intravenous antibiotics." 2. "We will treat your child with intravenous steroids." 3. "We will treat your child with nebulized racemic epinephrine." 4. "We will treat your child with alternating doses of Tylenol and Motrin."

42. 1. RSV is a viral illness and is not treated with antibiotics. 2. Steroids are not used to treat RSV. *3. Racemic epinephrine promotes mucosal vasoconstriction.* 4. Tylenol and Motrin can be given to the child for comfort, but they do not improve the child's respiratory status.

43. The parent of a pediatric client calls the ER. The parent reports that the child has had a barky cough for the last 3 days and it always gets worse at night. The parent asks the nurse what to do. Which is the nurse's best response? 1. "Take your child outside in the night air for 15 minutes." 2. "Bring your child to the ER immediately." 3. "Give your child an over-the-counter cough suppressant." 4. "Give your child warm liquids to soothe the throat."

43. *1. The night air will help decrease sub glottic edema, easing the child's respi ratory effort. The coughing should diminish significantly, and the child should be able to rest comfortably. If the symptoms do not improve after taking the child outside, the parent should have the child seen by a health-care provider.* 2. There is no immediate need to bring the child to the ER. The child's symptoms will likely improve on the drive to the hospital because of the child's exposure to the night air. 3. Over-the-counter cough suppressants are not recommended for children because they reduce their ability to clear secretions. 4. Warm liquids may increase subglottic edema and actually aggravate the child's symptoms. Cool liquids or a popsicle are the best choice.

45. A pediatric client is seen in the ER with a nonproductive cough, clear nasal drainage, and congestion. The child is diagnosed with nasopharyngitis. What information should the nurse include in the discharge instructions? 1. Inform the parents to complete the entire prescription of antibiotics. 2. Recommend that the parents avoid sending the child to day care. 3. Educate the parents on comfort measures for the child. 4. Instruct the parents to restrict the child to clear liquids for 24 hours.

45. 1. Nasopharyngitis is a viral illness and does not require antibiotic therapy. 2. Children who attend day care are more prone to catching viral illnesses, but it is not the nurse's place to tell the parents not to send their child to day care. Often families do not have a choice about using day care. *3. Nursing care for nasopharyngitis is primarily supportive. Keeping the child comfortable during the course of the illness is all the parents can do. Nasal congestion can be relieved using normal saline drops and a bulb suction. Tylenol can also be given for discomfort or a mild fever.* 4. There is no reason to restrict the child to clear liquids. Many children have a de creased appetite during a respiratory ill ness, so the most important thing is to keep them hydrated.

46. A 15-month-old is brought to the ER. The parents tell the nurse that the child has not been eating well and has had an increased respiratory rate. Which of the following assessments is of greatest concern? 1. The patient is lying down and has moderate retractions, low-grade fever, and nasal congestion. 2. The patient is in the tripod position and has diminished breath sounds and a muffled cough. 3. The patient is sitting up and has coarse breath sounds, coughing, and fussiness. 4. The patient is restless, crying, has bilateral wheezes and poor feeding.

46. 1. Retractions, low-grade fever, and nasal congestion are common symptoms of a respiratory illness and are not overly concerning. *2. When children are sitting in the tripod position, that is an indication they are having difficulty breathing. The child is sitting and leaning forward in order to breathe more easily. Diminished breath sounds indicate that there is fluid in* the lungs and are indicative of a worsening condition. A muffled cough indicates that the child has some subglottic edema. This child has several signs and symptoms of a worsening respiratory condition. 3. Coarse breath sounds, cough, and fussiness are common signs and symptoms of a respiratory illness. 4. Restlessness, wheezes, poor feeding, and crying are common signs and symptoms of a respiratory illness

47. A 3-year-old female is admitted to the ER with drooling, difficulty swallowing, sore throat, and a fever of 39°C (102.2° F). The physician suspects epiglottitis. The parents ask the nurse how the physician will know for sure if their daughter has epiglottitis. Which is the nurse's best response? 1. "A simple blood test will tell us if your daughter has epiglottitis." 2. "We will swab your daughter's throat and send it for culture." 3. "We will do a lateral neck x-ray of the soft tissue." 4. "The diagnosis is made based on your daughter's signs and symptoms."

47. 1. A blood test does not indicate a diagnosis of epiglottitis. A CBC may show an in creased white blood cell count indicating that the child has some sort of infection. 2. A throat culture is not done to diagnose epiglottitis. It is contraindicated to insert anything into the mouth or throat of any patient who is suspected of having epiglot titis. Inserting anything into the throat could cause the child to have a complete airway obstruction. *3. A lateral neck x-ray is the method used to diagnose epiglottitis definitively. The child is at risk for complete airway obstruction and should always be ac companied by a nurse to the x-ray department.* 4. Epiglottitis is not diagnosed based on signs and symptoms. A lateral neck film is the definitive diagnosis.

48. A 2-year-old child is brought to the ER with a high fever, dysphagia, drooling, rapid pulse, and tachypnea. What should the nurse's first action be? 1. Prepare for immediate IV placement. 2. Prepare for immediate respiratory treatment. 3. Place the child on a stretcher for a thorough physical assessment. 4. Allow the child to sit in the parent's lap while awaiting an x-ray.

48. 1. This child is exhibiting signs and symp toms of epiglottitis and should be kept as comfortable as possible. Agitating the child may cause increased airway swelling and may lead to complete obstruction. 2. Respiratory treatments often frighten chil dren. This child is exhibiting signs and symptoms of epiglottitis and should be kept as comfortable as possible. Agitating the child may cause increased airway swelling and may lead to complete obstruction. 3. This child is exhibiting signs and symp toms of epiglottitis and should be kept as comfortable as possible. Agitating the child may cause increased airway swelling and may lead to complete obstruction. The child should be allowed to remain on the parent's lap and kept as comfortable as possible until a lateral neck film is obtained. *4. This child is exhibiting signs and symptoms of epiglottitis and should be kept as comfortable as possible. The child should be allowed to remain in the parent's lap until a lateral neck film is obtained for a definitive diagnosis.*

50. A 3-year-old is admitted to the hospital with a diagnosis of epiglottitis. The child is in severe distress and needs to be intubated. The mother is crying and tells the nurse that she should have brought her son in yesterday when he said his throat was sore. Which is the nurse's best response? 1. "Children this age rarely get epiglottitis; you should not blame yourself." 2. "It is always better to have your child evaluated at the first sign of illness rather than wait until symptoms worsen." 3. "Epiglottitis is slowly progressive, so early intervention may have decreased the extent of your son's symptoms." 4. "Epiglottitis is rapidly progressive; you could not have predicted that his symptoms would worsen so quickly."

50. 1. Epiglottitis is most common in children from 2 to 5 years of age. The onset is very rapid. Telling parents not to blame themselves is not effective. Parents tend to blame themselves for their child's illnesses even though they are not responsible. 2. The nurse should not tell the parent to seek medical attention for any and all signs of illness. 3. Epiglottitis is rapidly progressive and can not be predicted. *4. Epiglottitis is rapidly progressive and cannot be predicted.*

51. A 2-year-old is admitted to the hospital with croup. The parent tells the nurse that her 7-year-old just had croup and it cleared up in a couple of days without intervention. She asks the nurse why her 2-year-old is exhibiting worse symptoms and needs to be hospitalized. Which is the nurse's best response? 1. "Some children just react differently to viruses. It is best to treat each child as an individual." 2. "Younger children have wider airways that make it easier for bacteria to enter and colonize." 3. "Younger children have short and wide eustachian tubes, making them more susceptible to respiratory infections." 4. "Children younger than 3 years usually exhibit worse symptoms because their immune systems are not as developed."

51. 1. All children should be treated as individuals when they are being treated for a particular illness. However, most children exhibit similar symptoms when they have the same diagnosis. Younger children have worse symptoms than older children because their immune systems are less developed. 2. Children have airways that are shorter and narrower than those of an adult. As chil dren age, their airways begin to grow in length and diameter. 3. Children are more prone to ear infections because they have eustachian tubes that are short and wide and lie in a horizontal plane. 4. Younger children have less developed immune systems and usually exhibit worse symptoms than older children.

52. A 5-year-old is brought to the ER with a temperature of 99.5° F (37.5°C), a barky cough, stridor, and hoarseness. Which of the following nursing interventions should the nurse prepare for? 1. Immediate IV placement. 2. Respiratory treatment of racemic epinephrine. 3. A tracheostomy set at the bedside. 4. Informing the child's parents about a tonsillectomy.

52. 1. The child is exhibiting signs and symp toms of croup and is not in any significant respiratory distress. 2. The child has stridor, indicating airway edema, which can be relieved by aerosolized racemic epinephrine. 3. A tracheostomy is not indicated for this child. A tracheostomy would be indicated for a child with a complete airway obstruction. 4. This child is exhibiting signs and symptoms of croup and has no indication of tonsillitis. A tonsillectomy is usually reserved for chil dren who have recurrent tonsillitis.

55. Which of the following children diagnosed with pneumonia would benefit most from hospitalization? 1. A 14-year-old with a fever of 38.6°C (101.5°F), rapid breathing, and a decreased appetite. 2. A 15-year-old who has been vomiting for 3 days and has a fever of 38.5°C (101.3°F). 3. A 13-year-old who is coughing, has coarse breath sounds, and is not sleeping well. 4. A 16-year-old who has a cough, chills, fever of 38.5°C (101.3°F), and wheezing.

55. 1. These are all common symptoms of pneu monia and should be monitored but do not require hospitalization. Most people with pneumonia are treated at home, with a focus on treating the symptoms and keeping the patient comfortable. Comfort measures include cool mist, CPT, an tipyretics, fluid intake, and family support. 2. The teen who has been vomiting for several days and is unable to tolerate oral fluids and medication should be admitted for intravenous hydration. 3. These are all common symptoms of pneumonia and should be monitored but do not require hospitalization. 4. These are all common symptoms of pneumonia and should be monitored but do not require hospitalization.

56. A pediatric client is admitted to the hospital with left-sided pneumonia. The client is complaining of pain and wants to be repositioned in the bed. The nurse knows the patient may be most comfortable in which position? 1. Lying in the Trendelenburg position. 2. Lying on the left side. 3. Lying on the right side. 4. Lying in the supine position.

56. 1. The Trendelenburg position is not effective for improving respiratory difficulty. Patients with pneumonia are usually most comfortable in a semierect position. 2. Lying on the left side may provide the patient with the most comfort. Lying on the left splints the chest and reduces the pleural rubbing. 3. It is most comfortable for the patient to lie on the affected side. Lying on the left splints the chest and reduces the pleural rubbing. 4. Lying in the supine position does not provide comfort for the patient and does not improve the child's respiratory effort.

57. A pediatric client with severe cerebral palsy is admitted to the hospital with aspira tion pneumonia. What is the most beneficial educational information that the nurse can provide to the parents? 1. The signs and symptoms of aspiration pneumonia. 2. The treatment plan for aspiration pneumonia. 3. The risks associated with recurrent aspiration pneumonia. 4. The prevention of aspiration pneumonia.

57. 1. The nurse should instruct the parents on signs and symptoms of aspiration pneumonia, but that is not the most beneficial piece of information the nurse can provide. The most valuable information relates to preventing aspiration pneumonia from occurring in the future. 2. The nurse should instruct the parents on the treatment plan of aspiration pneumonia, but that is not the most beneficial piece of information the nurse can provide. The most valuable information relates to preventing aspiration pneumonia from occurring in the future. 3. The nurse should instruct the parents on the risks associated with recurrent aspiration pneumonia, but that is not the most beneficial piece of information the nurse can provide. The most valuable information relates to preventing aspiration pneumonia from occurring in the future. 4. The most valuable information the nurse can give the parents is how to prevent aspiration pneumonia from occurring in the future.

58. A 3-year-old is brought to the ER with coughing and gagging. The parent reports that the child was eating carrots when she began to gag. What diagnostic evaluation will be used to determine if the child has aspirated the carrot? 1. A chest x-ray will be taken. 2. A bronchoscopy will be performed. 3. A blood gas will be drawn. 4. A sputum culture will be done.

58. 1. A chest x-ray will only show radiopaque items (items that x-rays cannot go through easily), so it is not helpful in determining if the child aspirated a carrot. 2. A bronchoscopy will allow the physi cian to visualize the airway and will help determine if the child aspirated the carrot. 3. A blood gas will identify whether the child has suffered any respiratory compromise, but the blood gas cannot definitively determine the cause of the compromise. 4. A sputum culture may be helpful several days later to determine if the child has developed aspiration pneumo nia. Aspiration pneumonia may take several days or a week to develop following aspiration.

59. The parent of a 9-month-old calls the ER because his child is choking on a marble. The parent tells the nurse that he knows cardiopulmonary resuscitation. The parent asks how to help his child while waiting for Emergency Medical Services. Which is the nurse's best response? 1. "You should administer five abdominal thrusts followed by five back blows." 2. "You should try to retrieve the object by inserting your finger in your daughter's mouth." 3. "You should perform the Heimlich maneuver." 4. "You should administer five back blows followed by five chest thrusts."

59. 1. Abdominal thrusts are not recommended for children younger than 1 year. 2. Inserting a finger in the child's mouth may cause the object to be pushed further down the airway, making it more difficult to remove. 3. The Heimlich should be performed only on adults. 4. The current recommendation for in fants younger than 1 year is to admin ister five back blows followed by five chest thrusts.

60. The community health nurse is teaching a child-safety class to parents of toddlers. Which information will be most helpful in teaching the parents about the primary prevention of foreign body aspiration? 1. Knowledge of the signs and symptoms of foreign body aspiration. 2. Knowledge of the therapeutic management of foreign body aspiration patients. 3. Knowledge of the most common objects that toddlers aspirate. 4. Knowledge of the risks associated with foreign body aspiration.

60. 1. Teaching the parents signs and symptoms of foreign body aspiration is important, but it is a tertiary means of prevention and will not help the parents prevent the aspiration. 2. Teaching the parents the therapeutic management of foreign body aspiration is important, but it is a tertiary means of prevention and will not help the parents prevent the aspiration. 3. Teaching parents the most common objects aspirated by toddlers will help them the most. Parents can avoid having those items in the household or in locations where toddlers may have access to them. 4. Teaching the parents the risks associated with foreign body aspiration is important but it is a tertiary means of prevention and will not help the parents prevent the aspiration.

61. What does the therapeutic management of CF patients include? Select all that apply. 1. Providing a high-protein, high-calorie diet. 2. Providing a high-fat, high-carbohydrate diet. 3. Encouraging exercise. 4. Minimizing pulmonary complication. 5. Encouraging medication compliance.

61. 1, 3, 4, 5. 1. Children with CF have difficulty ab sorbing nutrients because of the block age of the pancreatic duct. Pancreatic enzymes cannot reach the duodenum to aid in digestion of food. These chil dren often require up to 150% of the caloric intake of their peers. The nutri tional recommendation for CF patients is high-calorie and high-protein. 2. A high-fat, high-carbohydrate diet is not recommended for adequate nutrition. 3. Exercise is effective in helping CF patients clear secretions. 4. Minimizing pulmonary complications is essential to a better outcome for CF patients. Compliance with CPT, nebulizer treatments, and medications are all components of minimizing pulmonary complications. 5. Medication compliance is a necessary part of maintaining pulmonary and gastrointestinal function.

26. Nursing care management of the pediatric client with a diagnosis of mononucleosis should include which of the following? 1. Limit the child's visitors to family only. 2. Limit the child's activity to bedrest. 3. Limit the child's diet to clear liquids. 4. Limit the child's daily fluid intake.

*26. 1. Children with mononucleosis are more susceptible to secondary infections. Therefore, they should be limited to visitors within the family, especially during the acute phase of illness.* 2. Children with mononucleosis do not need to be forced to be on bedrest. Children usually self-limit their behavior. 3. Children with mononucleosis do not need a restricted diet. Often they are very tired and are not interested in eating. The nurse and family must ensure that the children are taking in adequate nutrition. 4. Children with mononucleosis usually have decreased appetite, but it is essential that they remain hydrated. There is no reason to restrict fluid.

29. The parent of a pediatric client with influenza is concerned about when the child will be able to return to school. The parent asks the nurse when the child is most infectious. Which is the nurse's best response? 1. "24 hours before and after the onset of symptoms." 2. "1 week after the onset of symptoms." 3. "1 week before the onset of symptoms." 4. "24 hours after the onset of symptoms."

*29. 1. Influenza is most contagious 24 hours before and 24 hours after onset of symptoms.* 2. Influenza is most contagious 24 hours be fore and 24 hours after onset of symptoms. 3. Influenza is most contagious 24 hours be fore and 24 hours after onset of symptoms. 4. Influenza is most contagious 24 hours be fore and 24 hours after onset of symptoms.

32. The parent of a 10-month-old male brings the child to the pediatrician's office with URI symptoms and a fever. The parent asks the nurse what can be done at home to improve the child's current condition. Which is the nurse's best response? 1. "Give your child small amounts of fluid every hour to prevent dehydration." 2. "Give your child Robitussin at night to reduce his cough and help him sleep." 3. "Give your child a baby aspirin every 4 to 6 hours to help reduce the fever." 4. "Give your child an over-the-counter cold medicine at night."

*32. 1. It is essential that parents ensure that their children remain hydrated during a URI. The best way to accomplish thi is by giving small amounts of fluid frequently.* 2. Over-the-counter cough and cold medi cine is not recommended for any child younger than 6 years. 3. Baby aspirin is never given to children because of the risk of developing Reye syndrome. 4. Over-the-counter cough and cold medi cine is not recommended for any child younger than 6 years.

The nurse is caring for a 12-year-old receiving peritoneal dialysis. The nurse notes the return to be cloudy, and the child is complaining of abdominal pain. The child's parents ask what the next step will likely be. Which is the nurse's best response? 1. "We will probably place antibiotics in the dialysis fluid before the next dwell time." 2. "Many children experience cloudy returns. We do not usually worry about it." 3. "We will probably give your child some oral antibiotics just to make sure nothing else develops." 4. "The abdominal pain is likely due to the fluid going in too slowly. We will increase the rate of administration with the next fill."

1. Cloudy returns and abdominal pain are signs of peritonitis and are usually treated with the administration of antibiotics in the dialysis fluid.

Which should be included in the plan of care for a child diagnosed with hydronephrosis? 1. Intake and output as well as vital signs should be strictly monitored. 2. Fluids and sodium in the diet should be limited. 3. Steroids should be administered as ordered. 4. Limited contact with other people to avoid infection.

1. Fluid status is monitored to ensure adequate urinary output. Assessing blood pressure monitors kidney function.

Which causes the clinical manifestations of hydronephrosis? 1. A structural abnormality in the urinary system causes urine to back up and can cause pressure and cell death. 2. A structural abnormality causes urine to flow too freely through the urinary system, leading to fluid and electrolyte imbalances. 3. Decreased production of urine in one or both kidneys results in an electrolyte imbalance. 4. Urine with an abnormal electrolyte balance and concentration leads to increased blood pressure and subsequent increased glomerular filtration rate.

1. Hydronephrosis is due to a structural abnormality in the urinary system, causing urine to back up, leading to pressure and potential cell death.

Which child is at risk for developing glomerulonephritis? 1. A 3-year-old who had impetigo 1 week ago. 2. A 5-year-old with a history of five UTIs in the previous year. 3. A 6-year-old with new-onset type 1 diabetes. 4. A 10-year-old recovering from viral pneumonia.

1. Impetigo is a skin infection caused by the streptococcal organism that is commonly associated with glomerulonephritis.

A child receiving peritoneal dialysis has not been having adequate volume in the return. The child is currently edematous and hypertensive. Which would the nurse anticipate the physician to do? 1. Increase the glucose concentration of the dialysate. 2. Decrease the glucose concentration of the dialysate. 3. Administer antihypertensives and diuretics but not change the dialysate concentration. 4. Decrease the dwell time of the dialysate.

1. Increasing the concentration of glucose will pull more fluid into the return.

Which is a care priority for a newborn diagnosed with bladder exstrophy and a malformed pelvis? 1. Change the diaper frequently and assess for skin breakdown. 2. Keep the exposed bladder open in a warm and dry environment to avoid any heat loss. 3. Offer formula for infant growth and fluid management. 4. Cluster all care to allow the child to sleep, grow, and gain strength for the upcoming surgical repair.

1. Preventing infection from stool contamination and skin breakdown is the top priority of care.

During hemodialysis, the nurse notes that a 10-year-old becomes confused and restless. The child complains of a headache and nausea and has generalized muscle twitching. This can be prevented by which of the following? 1. Slowing the rate of solute removal during dialysis. 2. Ensuring the patient is warm during dialysis. 3. Administering antibiotics before dialysis. 4. Obtaining an accurate weight the night before dialysis.

1. The child is experiencing signs of disequilibrium syndrome, which is caused by free water shifting from intravascular spaces and can be pre- vented by slowing the rate of dialysis.

Chronic hypertension in the child who has chronic renal failure (CRF) is due to which of the following? 1. Retention of sodium and water. 2. Obstruction of the urinary system. 3. Accumulation of waste products in the body. 4. Generalized metabolic alkalosis.

1. The retention of sodium and water leads to hypertension.

The manifestations of hemolytic uremic syndrome (HUS) are due primarily to which event? 1. The swollen lining of the small blood vessels damages the red blood cells, which are then removed by the spleen, leading to anemia. 2. There is a disturbance of the glomerular basement membrane, allowing large proteins to pass through. 3. The red blood cell changes shape, causing it to obstruct microcirculation. 4. There is a depression in the production of all formed elements of the blood.

1. The swollen lining of the small blood vessels damages the red blood cells, which are then removed by the spleen.

The nurse is caring for a child due for surgery on a Wilms tumor. The child's procedure will consist of which of the following? 1. Only the affected kidney will be removed. 2. Both the affected kidney and the other kidney will be removed in case of recurrence. 3. The mass will be removed from the affected kidney. 4. The mass will be removed from the affected kidney, and a biopsy of the tissue of the unaffected kidney will be done.

1. The treatment of a Wilms tumor involves removal of the affected kidney.

19. The parent of a pediatric client with asthma is talking to the nurse about administering the child's albuterol inhaler. Which statement by the parent leads the nurse to believe that the parent needs further education on how to administer the medication? 1. "I should administer two quick puffs of the albuterol inhaler using a spacer." 2. "I should always use a spacer when administering the albuterol inhaler." 3. "I should be sure that my child is in an upright position when administering the inhaler." 4. "I should always shake the inhaler before administering a dose."

19. 1. The parent should always give one puff at a time and should wait 1 minute be fore administering the second puff.

Which is true of a Wilms tumor? Select all that apply. 1. It is also referred to as neuroblastoma. 2. It can occur at any age but is seen most often between the ages of 2 and 5 years. 3. It can occur on its own or can be associated with many congenital anomalies. 4. It is a slow-growing tumor. 5. It is associated with a very poor prognosis.

2, 3. 1. It is referred to as a nephroblastoma, not a neuroblastoma. 2. It can occur at any age but is seen most often between the ages of 2 and 5 years. 3. It can occur on its own or can be associated with many congenital anomalies. 4. It is a tumor that grows very quickly. 5. It is associated with a very good prognosis.

A 10-kg toddler is diagnosed with acute renal failure (ARF), is afebrile, and has a 24-hour urine output of 110 mL. After calculating daily fluid maintenance, which would the nurse expect the toddler's daily allotment of fluids to be? 1. Sips of clear fluids and ice chips only. 2. 350 mL of oral and intravenous fluids. 3. 1000 mL of oral and intravenous fluids. 4. 2000 mL of oral and intravenous fluids.

2. 350 mL is approximately a third of the daily fluid requirement and is recom- mended for the child in the oliguric phase of ARF. If the child were febrile, the fluid intake would be increased.

5. The parent of an 18-year-old with CF is excited about the possibility of the child receiving a double lung transplant. What should the parent understand? 1. The transplant will cure the child of CF and allow the child to lead a long and healthy life. 2. The transplant will not cure the child of CF but will allow the child to have a longer life. 3. The transplant will help to reverse the multisystem damage that has already been caused by CF. 4. The transplant will be the child's only chance at surviving long enough to graduate college.

2. A lung transplant does not cure CF, but it does offer the patient an opportunity to live a longer life. The concerns are that, after the lung transplant, the child is at risk for rejection of the new organ and for development of secondary infec tions because of the immunosuppressive therapy.

The parent of a child with glomerulonephritis asks the nurse why the urine is such a funny color. Which is the nurse's best response? 1. "It is not uncommon for the urine to be discolored when children are receiving steroids and blood pressure medications." 2. "There is blood in your child's urine that causes it to be tea-colored." 3. "Your child's urine is very concentrated, so it appears to be discolored." 4. "A ketogenic diet often causes the urine to be tea-colored."

2. Blood in the child's urine causes it to be tea-colored.

13. A school-age child has been diagnosed with strep throat. The parent asks the nurse when the child can return to school. Which is the nurse's best response? 1. "48 hours after the first documented normal temperature." 2. "24 hours after the first dose of antibiotics." 3. "48 hours after the first dose of antibiotics." 4. "24 hours after the first documented normal temperature."

2. Children with strep throat are no longer contagious 24 hours after initia tion of antibiotic therapy.

1. The nurse caring for a female pediatric client with CF sends a stool for analysis. The results show an excessive amount of azotorrhea and steatorrhea. What does the nurse realize about the laboratory values? 1. They reflect that the patient is not compliant with taking her vitamins. 2. They reflect that the patient is not compliant with taking her enzymes. 3. They reflect that the patient is eating too many foods high in fat. 4. They reflect that the patient is eating too many foods high in fiber.

2. If the patient were not taking her en zymes, the result would be a large amount of undigested food, azotorrhea, and steatorrhea in the stool. CF patients must take digestive enzymes with all meals and snacks. Pancreatic ducts become clogged with thick mucus that blocks the flow of digestive enzymes from the pancreas to the duodenum. Therefore, patients must take digestive enzymes to aid in absorption of nutri ents. Often, teens are noncompliant with their medication regimen because they want to be like their peers.

The clinical manifestations of minimal change nephrotic syndrome (MCNS) are due to which of the following? 1. Chemical changes in the composition of albumin. 2. Increased permeability of the glomeruli. 3. Obstruction of the capillaries of the glomeruli. 4. Loss of the kidney's ability to excrete waste and concentrate urine.

2. Increased permeability of the glomeruli in MCNS allows large substances such as protein to pass through and be excreted in the urine.

10. A school-age child has been diagnosed with nasopharyngitis. The parent is concerned because the child has had little or no appetite for the last 24 hours. The parent asks the nurse if this is a concern. Which is the nurse's best response? 1. "Do not be concerned; it is common for children to have a decreased appetite for several days during a respiratory illness." 2. "Be sure your child is taking an adequate amount of fluid. The appetite should return soon." 3. "Try offering the child some favorite food. Maybe that will improve the appetite." 4. "You need to force your child to eat whatever you can; adequate nutrition is essential."

2. It is common for children to have a decreased appetite when they have a respiratory illness. The nurse is appro priately instructing the parent that the child will be fine by taking in an adequate amount of fluid.

The nurse is providing discharge instructions to the parents of an infant born with bladder exstrophy who had a continent urinary reservoir placed. Which statement should be included? 1. "Allow your child to sleep on the abdomen to provide comfort during the immediate post-operative period." 2. "As your child grows, be cautious around playgrounds because the surface could be a health hazard." 3. "As your child grows, be sure to encourage many different foods because it is not likely that food allergies will develop." 4. "Encourage your child's development, by having brightly colored objects around, such as balloons."

2. Many children with urological malfor- mations are prone to latex allergies. The surfaces of playgrounds are often made of rubber, which contains latex.

The nurse in a diabetic clinic sees a 10-year-old who is a new diabetic and has had trouble maintaining blood glucose levels within normal limits. The child's parent states the child has had several daytime "accidents." The nurse knows that this is referred to as which of the following? 1. Primary enuresis. 2. Secondary enuresis. 3. Diurnal enuresis. 4. Nocturnal enuresis.

2. Secondary enuresis refers to urinary incontinence in a child who previously had bladder control.

25. A 2-month-old is seen in the pediatrician's office for his 2-month well-child checkup. The nurse is assessing the patient and reports to the physician that the child is exhibiting early signs of respiratory distress. Which of the following would indicate an early sign of distress? 1. The infant is breathing shallowly. 2. The infant has tachypnea. 3. The infant has tachycardia. 4. The infant has bradycardia.

2. Tachypnea is an early sign of distress and is often the first sign of respiratory illness in infants.

16. A pediatric client is admitted to the ER with an acute asthma exacerbation. The nurse tells the parents that blood will have to be drawn for some diagnostic laboratory studies. Which laboratory result will provide the health-care team with the most important information regarding the child's respiratory status? 1. A CBC. 2. An ABG. 3. A BUN. 4. A PTT.

2. The ABG gives the health-care team valuable information about the child's respiratory status: level of oxygenation, carbon dioxide, and blood pH.

Which finding requires immediate attention in a child with glomerulonephritis? 1. Sleeping most of the day and being very "cranky" when awake; blood pressure is 170/90. 2. Urine output is 190 mL in an 8-hour period and is the color of Coca-Cola. 3. Complaining of a severe headache and photophobia. 4. Refusing breakfast and lunch and stating he "just is not hungry."

3. A severe headache and photophobia can be signs of encephalopathy due to hypertension, and the child needs immediate attention.

The parent of a 7-year-old voices concern over the child's continued bed-wetting at night. The parent, on going to bed, has tried getting the child up at 11:30 p.m., but the child still wakes up wet. Which is the nurse's best response about what the parent should do next? 1. "There is a medication called DDAVP that decreases the volume of the urine. The physician thinks that will work for your child." 2. "When your child wakes up wet, be very firm, and indicate how displeased you are. Have your child change the sheets to see how much work is involved." 3. "Limit fluids in the evening, and start a reward system in which your child can choose a reward after a certain number of dry nights." 4. "Bed-wetting alarms are readily available, and most children do very well with them."

3. Limiting the child's fluids in the evening will help decrease the noctur- nal urge to void. Providing positive reinforcement and allowing the child to choose a reward will increase the child's sense of control.

Which combination of signs is commonly associated with glomerulonephritis? 1. Massive proteinuria, hematuria, decreased urinary output, and lethargy. 2. Mild proteinuria, increased urinary output, and lethargy. 3. Mild proteinuria, hematuria, decreased urinary output, and lethargy. 4. Massive proteinuria, decreased urinary output, and hypotension.

3. Mild-to-moderate proteinuria, hematuria, decreased urinary output, and lethargy are common findings in glomerulonephritis.

4. The parent of a 10-month-old with CF asks the nurse how to meet the child's increased nutritional needs. Which is the nurse's best suggestion? 1. "You may need to increase the number of fresh fruits and vegetables you give your child each day." 2. "You may need to advance your child's diet to whole cow's milk because it is higher in fat than formula." 3. "You may need to change your child to a higher-calorie formula." 4. "You may need to increase your child's carbohydrate intake each day."

3. Often infants with CF need to have a higher-calorie formula to meet their nutritional needs. Infants may also be placed on hydrolysate formulas that contain added medium-chain triglycerides.

The parent of a child diagnosed with acute renal failure (ARF) asks the nurse why peritoneal dialysis was selected instead of hemodialysis. Which is the nurse's best response? 1. "Hemodialysis is not used in the pediatric population." 2. "Peritoneal dialysis has no complications, so it is a treatment used without hesitation." 3. "Peritoneal dialysis removes fluid at a slower rate than hemodialysis, so many complications are avoided." 4. "Peritoneal dialysis is much more efficient than hemodialysis."

3. Peritoneal dialysis removes fluid at a slower rate that is more easily con- trolled than that of hemodialysis.

An adolescent woke up complaining of intense pain and swelling of the scrotal area and abdominal pain. He has vomited twice. Which should the nurse suggest? 1. Encourage him to drink clear liquids until the vomiting subsides; if he gets worse, bring him to the emergency room. 2. Bring him to the pediatrician's office for evaluation. 3. Take him to the emergency room immediately. 4. Encourage him to rest; apply ice to the scrotal area, and go to the emergency room if the pain does not improve.

3. The child is having symptoms of testicular torsion, which is a surgical emergency and needs immediate attention.

11. A physician diagnoses a school-age child with strep throat and pharyngitis. The child's parent asks the nurse what treatment the child will need. Which is the nurse's best response? 1. "Your child will be sent home on bedrest and should recover in a few days without any intervention." 2. "Your child will need to have the tonsils removed to prevent future strep infections." 3. "Your child will need oral penicillin for 10 days and should feel better in a few days." 4. "Your child will need to be admitted to the hospital for 5 days of intravenous antibiotics."

3. The child will need a 10-day course of penicillin to treat the strep infection. It is essential that the nurse always tell the family that, although the child will feel better in a few days, the entire course of antibiotics must be completed.

The diet for a child with chronic renal failure (CRF) should be high in calories and include: 1. Low protein, and all minerals and electrolytes. 2. Low protein and minerals. 3. High protein and calcium and low potassium and phosphorus. 4. High protein, phosphorus, and calcium and low potassium and sodium.

3. The child with CRF needs a diet high in calories, protein, and calcium and low in potassium and phosphorus.

30. A 6-week-old male is admitted to the hospital with influenza. The child is crying, and the father tells the nurse that his son is hungry. The nurse explains that the baby is taking nothing by mouth. The parent does not understand why the child cannot eat. Which is the nurse's best response to the parent? 1. "We are giving your child intravenous fluids, so there is no need for anything by mouth." 2. "The shorter and narrower airway of infants increases their chances of aspiration." 3. "When your child eats, he burns too many calories; we want to conserve the child's energy." 4. "Your child has too much nasal congestion; if we feed the child by mouth, the dis tress will likely increase."

30. 1. The child is receiving intravenous fluids, so he is being hydrated. However, this re sponse does not explain to the father why his son cannot eat. *2. Infants are at higher risk of aspiration because their airways are shorter and narrower than those of an adult.* 3. Eating burns calories, but if the baby is upset and crying he is also expending en ergy. Therefore, this is not the best choice of answers. 4. If the child has nasal congestion, that may make it difficult for him to feed. However, the recommendation to parents is to bulb suction an infant with nasal congestion before feeding.

31. The nurse is caring for a 22-month-old male who has had repeated bouts of otitis media. The nurse is educating the parents about otitis media. Which of the following statements from the parents indicates they need additional teaching? 1. "If I quit smoking, my child may have less chance of getting an ear infection." 2. "As my child gets older, he should have fewer ear infections, because his immune system will be more developed." 3. "My child will have fewer ear infections if he has his tonsils removed." 4. "My child may need a speech evaluation."

31. 1. Repeated exposure to smoke damages the cilia in the ear, making the child more prone to ear infections. 2. Children experience fewer ear infections as they age because their immune system is maturing. *3. Removing children's tonsils may not have any effect on their ear infection. Children who have repeated bouts of tonsillitis can have ear infections sec ondary to the tonsillitis, but there is no indication in this question that the child has a problem with tonsillitis.* 4. Children who have repeated ear infections are at a higher risk of having decreased hearing during and between infections. Hearing loss directly affects a child's speech development.

33. A physician prescribes 10 days of amoxicillin to treat a 6-year-old male with an ear infection. The nurse is reviewing discharge instructions with the parent. Which information should be included in the discharge instructions? 1. "Administer the amoxicillin until the child's symptoms subside." 2. "Administer an over-the-counter antihistamine with the antibiotic." 3. "Administer the amoxicillin until all the medication is gone." 4. "Allow your child to administer his own dose of amoxicillin."

33. 1. The parent should administer all of the medication. Stopping the medication when symptoms subside may not clear up the ear infection and may actually cause more severe symptoms. 2. Antihistamines have not been shown to decrease the number of ear infections a child gets. *3. It is essential that all the medication be given.* 4. The child is old enough to participate in the administration of medication but should only do so in the presence of the parents.

34. The parent of a pediatric client who has had frequent ear infections asks the nurse if there is anything that can be done to help the child avoid future ear infections. Which is the nurse's best response? 1. "Your child should be put on a daily dose of Singulair." 2. "Your child should be kept away from tobacco smoke." 3. "Your child should be kept away from other children with otitis." 4. "Your child should always wear a hat when outside."

34. 1. Singulair is an allergy medication, but it has not been proved to help reduce the number of ear infections a child gets. *2. Tobacco smoke has been proved to increase the incidence of ear infec tions. The tobacco smoke damages mucociliary function, prolonging the inflammatory process and impeding drainage through the eustachian tube.* 3. Otitis is not transmitted from one child to another. Otitis is often preceded by a URI, so children who are around other children with URIs may contract one, in creasing their chances of developing an ear infection. 4. Wearing a hat outside will have no impact on whether a child contracts an ear infection.

35. Which of the following children would benefit most from having ear tubes placed? 1. A 2-month-old who has had one ear infection. 2. A 2-year-old who has had five previous ear infections. 3. A 7-year-old who has had two ear infections this year. 4. A 3-year-old whose sibling has had four ear infections.

35. 1. Surgical intervention is not a first line of treatment. Surgery is usually reserved for children who have suffered from recurrent ear infections. *2. A 2-year-old who has had multiple ear infections is a perfect candidate for ear tubes. The other issue is that a 2-year-old is at the height of language development, which can be adversely affected by recurrent ear infections.* 3. A 7-year-old who has had two ear infec tions is not the appropriate candidate. Surgical intervention is usually reserved for children who have suffered from recurrent ear infections. 4. Surgery is not a prophylactic treatment. Just because the sibling has had several ear infections does not suggest that the 3-year-old will also have frequent ear infections. The 3-year-old has not had an ear infection yet.

36. A 2-month-old is diagnosed with otitis. The parent asks the nurse if the otitis will have any long-term effects for the child. Understanding the complications that can occur with otitis, which is the nurse's best response? 1. "The child could suffer hearing loss." 2. "The child could suffer some speech delays." 3. "The child could suffer recurrent ear infections." 4. "The child could require ear tubes."

36. 1. Hearing loss is not an issue that would be discussed following one ear infection. Children with recurrent untreated ear infections are more likely to develop hearing loss. 2. Speech delays are not an issue that would be discussed following one ear infection. Children with recurrent untreated ear infections are more likely to develop some hearing loss, which often results in delayed language development. *3. When children acquire an ear infection at such a young age, there is an in creased risk of recurrent infections.* 4. Surgical intervention is not a first line of treatment. Surgery is usually reserved for children who have suffered from recurrent ear infections.

37. A 6-month-old is diagnosed with an ear infection. The parents report that the child is not sleeping well and is crying frequently. The child also has a moderate amount of yellow drainage coming from the infected ear. This is the parents' first baby. Which of the following nursing objectives is the priority for this family at this time? 1. Educating the parents about signs and symptoms of an ear infection. 2. Providing emotional support for the parents. 3. Providing pain relief for the child. 4. Promoting the flow of drainage from the ear.

37. 1. It is important to educate the family about the signs and symptoms of an ear infection, but that is not the priority at this time. The infant has already been diagnosed with the infection. 2. The parents may need emotional support because they are likely suffering from a lack of sleep because their infant is ill. However, this will not solve their current problems with their infant. *3. Providing pain relief for the infant is essential. With pain relief, the child will likely stop crying and rest better.* 4. Promoting drainage flow from the ear is important, but providing pain relief is the highest priority.

38. A 2-year-old is admitted to the hospital in respiratory distress. The physician tells the parents that the child probably has RSV. The parents ask the nurse how they will determine if their child has RSV. Which is the nurse's best response? 1. "We will need to do a simple blood test to determine whether your child has RSV." 2. "There is no specific test for RSV. The diagnosis is made based on the child's symptoms." 3. "We will swab your child's nose and send those secretions for testing." 4. "We will have to send a viral culture to an outside lab for testing."

38. 1. RSV is not diagnosed by a blood draw. 2. Nasal secretions are tested to determine if a child has RSV. *3. The child is swabbed for nasal secre tions. The secretions are tested to determine if a child has RSV.* 4. Viral cultures are not done very often because it takes several days to receive results. The culture does not have to be sent to an outside lab for evaluation.

8. The parents of a 5-week-old have just been told that their child has CF. The mother had a sister who died of CF when she was 19 years of age. The parents are sad and ask the nurse several questions about CF and the current projected life expectancy. What is the nurse's best initial intervention? 1. The nurse should tell the parents that the life expectancy for CF patients has improved significantly in recent years. 2. The nurse should tell the parents that their child might not follow the same course that the mother's sister did. 3. The nurse should listen to the parents and tell them that the physician will come to speak to them about treatment options. 4. The nurse should listen to the parents and be available to them anytime during the day to answer their questions.

4. The nurse's best intervention is to let the parents express their concerns and fears. The nurse should be available if the parents have any other concerns or questions or if they just need someone with whom to talk.

The parent of a 3-year-old is shocked to hear the diagnosis of Wilms tumor and says, "How could I have missed a lump this big?" Which is the nurse's best response? 1. "Do not be hard on yourself. It's easy to overlook something that has probably been growing for months when we see our children on a regular basis." 2. "I understand you must be very upset. Your child would have had a better prognosis had you caught it earlier." 3. "It really takes a trained professional to recognize something like this." 4. "Do not blame yourself. This mass grows so fast that it was probably not noticeable a few days ago."

4. The tumor is fast-growing and could very easily not have been evident a few days earlier.

6. A 2-year-old has just been diagnosed with CF. The parents ask the nurse what early respiratory symptoms they should expect to see in their child. Which is the nurse's best response? 1. "You can expect your child to develop a barrel-shaped chest." 2. "You can expect your child to develop a chronic productive cough." 3. "You can expect your child to develop bronchiectasis." 4. "You can expect your child to develop wheezing respirations." 50

4. Wheezing respirations and a dry non productive cough are common early symptoms in CF.