Ped's Exam 3

A nurse is teaching the parents of a child who has been diagnosed with spina bifida. Which statement by the nurse would be the most accurate description of spina bifida? A. "It has little influence on the intellectual and perceptual abilities of the child." B. "It's a simple neurologic defect that's completely corrected surgically within 1 to 2 days after birth." C. "Its presence indicates that many areas of the central nervous system (CNS) may not develop or function adequately." D. "It's a complex neurologic disability that involves a collaborative health team effort for the entire first year of life"

ANS: C Rationale: When a spinal cord lesion exists at birth, it commonly leads to altered development or function of other areas of the CNS. Spina bifida is a complex neurologic defect that heavily impacts the physical, cognitive, and psychosocial development of the child and involves collaborative, lifelong management due to the chronicity and multiplicity of the problems involved.

At a well-child visit, a urine specimen is obtained from a child for testing. The nurse is reviewing the results which reveal positive leukocytes. The nurse interprets this as indicating which of the following? A. Possible urinary tract infection B. Diabetes C. Renal disease D. Bleeding

ANS: A Rationale: The evidence of leukocytes in a urine specimen suggests a possible urinary tract infection. Glucose in the urine may suggest diabetes. Elevated protein levels suggest renal disease. Elevated levels of red blood cells in the urine indicate possible calculus, trauma and renal parenchymal disease

The nurse is taking a health history for a 9-year-old with conjunctivitis. Which statement by the parents leads the nurse to suspect that the child is experiencing allergic conjunctivitis? A. "He recently helped clean the basement. B. "He was exposed to several family members with an infection. C. He just recovered from an upper respiratory infection. D. We have a family history of conjunctivitis.

ANS: A Rationale: Allergic conjunctivitis may be induced by animal dander, dust mites, or some other ever-present antigen. Exposure to infective agents is related to infectious conjunctivitis. Recent upper respiratory infection and a family history of conjunctivitis are not contributing factors for allergic conjunctivitis

An 8-year-old child is being treated for tonic-clonic seizures. What should the nurse emphasize when teaching the parents about this disorder? A. The child should maintain an active lifestyle. B. Immediately provide medication if a seizure begins. C. Have the child carry a padded tongue blade with her at all times. D. Ensure quiet time late in the day, when seizure activity is most likely to occur

ANS: A Rationale: As a rule, children with seizures should attend regular school and participate in physical education classes and active sports. Antiseizure medication is ineffective during a seizure because most medication needs to achieve a therapeutic level to be effective. Padded tongue blades are not used in people with a seizure disorder. There is no specific time of day when a seizure can occur.

After teaching a group of students about medications commonly used for neuromuscular disorders, the nursing instructor determines that the teaching was successful when the students identify which agent as a centrally acting skeletal muscle relaxant? A. Baclofen B. Prednisone C. Lorazepam D. Botulin toxin

ANS: A Rationale: Baclofen is a centrally acting skeletal muscle relaxant used to treat painful spasms and decrease spasticity in children with motor neuron lesions. Prednisone is a corticosteroid that is used to help slow the progression of Duchenne muscular dystrophy. Lorazepam is a benzodiazepine used for adjunctive relief of skeletal muscle spasm associated with cerebral palsy. Botulin toxin is a neurotoxin used to relieve spasticity in cerebral palsy.

The nurse is doing an in-service training on clinical manifestations seen in communicable diseases. Which skin condition best describes erythema? A. Redness of the skin produced by congestion of the capillaries B. Small, circumscribed, solid elevation of the skin C. Discolored skin spot not elevated at the surface D. Small elevation of epidermis filled with a viscous fluid

ANS: A Rationale: Erythema is redness of the skin produced by congestion of the capillaries

How would the nurse best describe Gowers sign to the parents of a child with muscular dystrophy? A. A transfer technique B. A waddling-type gait C. The pelvis position during gait D. Muscle twitching present during a quick stretch

ANS: A Rationale: Gowers' sign is a description of a transfer technique present during some phases of muscular dystrophy. The child turns on the side or abdomen, extends the knees, and pushes on the torso to an upright position by walking his hands up the legs. The child's gait is unrelated to the presence of Gowers sign. Muscle twitching present after a quick stretch is described as clonus.

The nurse is caring for a child diagnosed with a urinary tract infection. The caregiver asks the nurse why it is so important for the child to have so much fluid. What is the most important reason the child needs increased fluids? A. To dilute the urine and flush the bladder B. To fill the bladder so a specimen can be obtained C. To prevent the child from developing a fever D. To decrease the pain of urination

ANS: A Rationale: Increasing the child's fluid intake is necessary to help dilute the urine and flush the bladder

The parent of a child with mumps on one side of the face is concerned that the disease can develop on the other side in the future. How should the nurse respond to the mother about this concern? A. The child is immune to further attacks of the disease. B. It does not matter because mumps in adulthood is not serious. C. The child should receive active immunization against mumps. D. There is nothing that can be done to prevent another attack of mumps in the future

ANS: A Rationale: Some parents worry that because their child had swelling only on one side, the child will develop mumps on the opposite side in the future. One attack of mumps gives lasting immunity, and the child will not contract the disease again. Mumps is a potentially dangerous disease and should not be minimized. The child does not need immunization against mumps

A child comes to the clinic for evaluation of skin lesions and is diagnosed with impetigo. Which medications are potentially ordered with instructions placed on the discharge summary? Select all that apply. A. Penicillin B. Erythromycin C. Mupirocin D. Tetracycline E. Lindane

ANS: A, B, C Rationale: Treatment of impetigo includes oral administration of penicillin or erythromycin or the application of mupirocin. Tetracycline is not used. Lindane is used to treat tinea infections

A nurse is developing a teaching plan for the parents of a child with myasthenia gravis. Which of the following would the nurse include? A. How to administer anticholinergic drugs B. Establishment of plans for rest periods C. Signs and symptoms of infection D. Stress management techniques E. Ways to increase the temperature of the child's environment

ANS: A, B, C, D Rationale: The teaching plan for a child with myasthenia gravis should include instructions about administering anticholinergic agents, usually 30 to 45 minutes before meals, on time and exactly as ordered; measures to allow for rest periods for energy conservation; signs and symptoms of infection and the need to notify the physician because infection can precipitate a myasthenic crisis; stress management techniques because stress can precipitate a myasthenic crisis; and ways to maintain the child's environmental temperature because exposure to extreme temperatures can precipitate a myasthenic crisis

The nurse is creating a care plan for a child with a leg cast. What interventions would be appropriate for the nursing diagnosis of Risk for ineffective peripheral tissue perfusion related to pressure from cast? Select all that apply. A. Assess foot and toes every 4 hours for color, warmth, and presence of pedal pulses. B. Keep leg elevated by a pillow at all times. C. Remind the parents to not allow the child to put anything in the cast. D. Assess capillary refill of toes every 4 hours. E. Educate the child's parents on use of good body mechanics when repositioning the child

ANS: A, B, D Rationale: Assessment of the foot and toes for warmth, color, pedal pulses, and capillary refill are all appropriate interventions for the nursing diagnosis of Risk for ineffective peripheral tissue perfusion. Elevating the leg will help to reduce edema and is also an appropriate intervention. While educating the parents about using proper body mechanics and not putting anything in the cast are appropriate when caring for a child in a cast, they are not appropriate interventions for this diagnosis

The nurse is caring for a school-age child recovering from an open reduction for a fractured femur. Which assessment findings indicate that the child is developing an infection? Select all that apply. A. Lethargy B. Increased pulse rate C. Reduced pulse in the ankle D. Cyanosis of the casted foot E. Increased body temperature

ANS: A, B, E Rationale: Children with an open reduction are prone to infection. The nurse should suspect an infection if the systemic symptoms of increased pulse, increased temperature, and lethargy are present. Reduced pulse in the ankle and cyanosis of the casted foot are manifestations of compartment syndrome.

A child is diagnosed with hemolytic-uremic syndrome (HUS). Review of the child's laboratory test results would reveal which finding? A. Decreased blood urea nitrogen (BUN) and creatinine B. Decreased platelets and leukocytosis C. Hypernatremia and hypokalemia D. Respiratory acidosis and proteinuria

ANS: B Rationale: The child with HUS typically exhibits severe thrombocytopenia (decreased platelets) and leukocytosis. BUN and creatinine are elevated. Hyponatremia, hyperkalemia, metabolic acidosis, and proteinuria also may be noted.

The nurse caring for a toddler immediately after a fall from a grocery cart will avoid moving which body area as the child is examined? A. Lower extremities B. Head and neck C. Torso D. Clavicle

ANS: B Rationale: The head and neck should remain immobilized until cervical spine injury is ruled out. Motion in this area could damage the spinal cord. The rest of the child's body should be examined carefully so as not to aggravate an unsuspected injury. The clavicle is the bone most frequently fractured during childhood

The school nurse is educating the parents of a child with infectious conjunctivitis. Which of the following statements by the nurse would be most helpful for the parents related to prevention? A. "Use all the medication as directed." B. "Don't use anything that touches her face." C. "This could have started with a head cold." D. "Place the ointment inside the lower eyelid"

ANS: B Rationale: Warning the parents how infectious conjunctivitis is spread is most valuable for preventing infection within the family. Directing the parents to use a full course of medication is very important to help prevent a recurrence in the child but is not the most valuable for prevention. Telling of a possible cause or proper administration of medication has little preventive value.

What will be the nurse's next action after noting dimpling and a tuft of hair located in the lumbosacral area of the preschool child during examination? A. Snip the tuft of hair off close to the skin for hygienic reasons B. Move on to other assessments without calling attention to the difference C. Record and refer the finding for follow-up to the pediatrician D. Inspect for precocious hair growth in the genital and underarm areas

ANS: C Rationale: Dimpling and hair growth may signal spina bifida occulta, which usually is benign. However, some complications can be associated, and further investigation is warranted to prevent possible damage to the spinal cord. Magnetic resonance imaging (MRI) is often the diagnostic tool used. No hygienic concerns need prevail. These findings do not suggest development of precocious puberty or any other hormonal problem. The dimpling and hair tuft must be clearly explained to the parents

The nurse instructs a school-age patient and the parents on continuous cycling peritoneal dialysis. Which statement indicates that teaching has been effective? A. "The solution should be infused cold." B. "Redness and warmth around the tube insertion site is expected." C. "We should notify the health care provider if the drainage is cloudy." D. "Weight gain and a productive cough are expected with the treatments."

ANS: C Rationale: Cloudy drainage could indicate an infection such as peritonitis and should be reported to the health care provider. The solution should be infused at body temperature. Redness and warmth around the tube insertion site could indicate an infection and should be reported to the health care provider. Weight gain and a productive cough could indicate fluid retention and should be reported to the health care provider

A 3-year-old child is admitted to the hospital with osteomyelitis of the right femur. The nurse would expect to start an IV and antibiotic after blood is drawn for which lab test? A. Hemoglobin and hematocrit B. White blood cell count C. Culture D. Platelets

ANS: C Rationale: Only the culture will indicate which antibiotic is the correct medication to give for the infection

The nurse is caring for a female preschool-aged patient with a urinary tract infection. What measures should the nurse teach the mother to prevent future infections? A. Suggest the child drink less fluid daily to concentrate urine. B. Encourage the child to be more active to increase urine output. C. Teach the child to wipe the perineum front to back after voiding. D. Teach the child to take frequent tub baths to clean the perineal area.

ANS: C Rationale: Urinary tract infections occur more often in girls than boys because the urethra is shorter in girls and, because it is located close to the vagina and anus, vulvovaginitis or rectal bacteria can easily spread to the urethra. Girls should be taught early to wipe themselves from front to back after voiding and defecating to avoid contaminating the urethra. The child should be encouraged to drink more fluid to prevent concentrated urine. Activity level does not influence the development of urinary tract infections. There is a suggested correlation between the use of hot tubs and urinary tract infections in girls so use of these should be discouraged or minimized

The nurse is assessing a toddler. The mother states that he constantly is tripping over his own feet. What is the best response by the nurse? A. "At this age, your child is still learning how to control all of the muscles in the legs. As your child grows older, this clumsiness will get better." B. "Tripping over feet is a symptom of a severe bone disorder, metatarsus adductus. We will need to refer you to an orthopedic surgeon." C. "We will have your child stand on a copier and make a print of the feet. It will show us if the feet are turning in. If they are, your child may need some stretching exercises for the feet." D. "Turning in of feet or toeing in, is common at this age. As your child keeps walking, it will correct on its own."

ANS: C Rationale: When a parent describes a child as always falling over the feet or awkward, the nurse needs to assess for toeing-in or metatarsus adductus. One way to assess for this is to have the child stand on a copier and make a print of the feet. It will show any inward turning of the feet. For most instances, it resolves without therapy. If it persists past 1 year, passive stretching exercises may be prescribed. It is not a severe bone disorder and typically does not need surgical intervention.

Parents usually ask when their child can return to school after having chickenpox. The correct answer would be: A. not until all lesions have completely faded B. as soon as the temperature is normal. C. 10 days after the initial lesions appear. D. as soon as all lesions are crusted

ANS: D Rationale: Chickenpox lesions are infectious until they crust

The child has been diagnosed with rickets. The child's mother is educated about the importance of providing the child with 10 micrograms (400 International Units) of an oral vitamin D supplement each day. The child's mother purchases over-the-counter vitamin D drops. The supplement is noted to contain 5 mcg of vitamin D in each 0.5 mL. How much of the supplement should the mother administer to the child each day? Record your answer using one decimal place.

ANS: 1 Rationale: The supplement has 5 mcg of vitamin D in each 0.5 mL. The child is supposed to receive 10 mcg each day of supplemental vitamin D. Desired/Have x Quantity = dose 10 mcg/5 mcg x 0.5 mL = 1.0 mL Ratio/proportion: 0.5 mL/5 micrograms = x/10 micrograms = 1.0 mL

The nurse is doing an in-service training on clinical manifestations seen in communicable diseases. Which best describes a macule? A. Redness of the skin produced by congestion of the capillaries B. Small, circumscribed, solid elevation of the skin C. Discolored skin spot not elevated at the surface D. Small elevation of epidermis filled with a viscous fluid

ANS: C Rationale: A macule is a discolored skin spot not elevated above the surface.

A child with spastic cerebral palsy is to receive botulin toxin. The nurse prepares the child for administration of this drug by which route? A. Oral B. Subcutaneous injection C. Intramuscular injection D. Intravenous infusion

ANS: C Rationale: Botulin toxin is administered by injection into the muscle. It may cause dry mouth. It is not administered orally, by subcutaneous injection, or by intravenous infusion.

A 6 month old infant is admitted with a diagnosis of bacterial meningitis. The nurse would place the infant in which room? a. A room with a 12 month old infant with a urinary tract infection b. A room with an 8 month old infant with failure to thrive c. A private room near the nurses station d. A two-bed room in the middle of the hall

c. A private room near the nurses station A child who has the diagnosis of bacterical meningitis will need to be placed in a private room until that child has recieved I.V. antibiotics for 24 hours because the child is considered contagious. Additionally, bacterial meningitis can be quite serious; therefore, the child should be placed near the nurses station for close monitoring and easier access in case of a crisis

The nurse is conducting a routine physical examination of a newborn to screen for developmental DDH. The nurse correctly assesses the infant by placing the infant: A. In a prone position, noting asymmetry of the thigh or gluteal folds. B. With both legs extended and observes the hip and knee joint relationship. C. With both legs extended and observes the feet. D. In a supine position with both legs extended and observes the tibia/fibula.

ANS: A Rationale: Asymmetry of the thigh or gluteal folds is indicative of DDH. Hip and knee joint relationship are not indicative of DDH. The lower extremities of the infant typically have some normal developmental variations due to in utero positioning

Parents of a preschooler with cerebral palsy ask the nurse what the surgeon plans to implant in their child's body to control spasticity. What is the nurse's answer? A. Baclofen pump B. Vagal nerve stimulator C. Central venous catheter D. Botulinum toxin

ANS: A Rationale: A baclofen pump can be placed surgically to deliver continuous medication intrathecally. Baclofen can also be taken orally. Botulinum toxin is injected by a practitioner into specified muscle groups to reduce spasticity. A central venous catheter places medication directly into rapidly moving blood and would not be used. A vagal nerve stimulator is used to control seizures

The nurse is working with a child with altered genitourinary status. Which intervention would be included in the plan of care for the client with excess fluid volume? A. Weigh the child daily on the same scale. B. Hold all medication until the fluid retention is improving. C. Avoid administering IV therapies. D. Measure the amount of nitrates in the urine.

ANS: A Rationale: A child with edema and fluid overload should be weighed daily, on the same scale, at the same time, with the same amount of clothing. This gives the most accurate picture of fluid gain or loss. The nurse also should assess the blood pressure and pulse rate regularly to determine if hypovolemia is occurring. This can occur from fluid shifts occurring if fluid is lost too quickly. Medications need to be administered, especially diuretics to help reduce the edema. The child should be on fluid restriction. This includes PO and IV. If IV fluids are necessary the volume should be calculated into the daily amount of fluid restriction. Nitrates in the urine do not affect edema. They indicate an infection.

A voiding cystourethrogram (VCUG) is prescribed for a child. What education should be provided to the parents? A. The VCUG will rule out vesicoureteral reflux. B. The VCUG will detect if the infection is gone. C. The VCUG will rule out kidney stones. D. The VCUG will prevent further complications of the urinary tract infection (UTI).

ANS: A Rationale: A voiding cystogram (VCUG) is performed by having the bladder filled with a contrast medium via catheterization. Under fluoroscopy the bladder is visualized filling and emptying. A VCUG is used to rule out reflux in the urinary tract, causes of hematuria, UTI, and structural anomalies. Reflux may cause frequent infections and scarring in the urinary tract if not diagnosed and treated. A VCUG will not diagnose renal stones. Renal stones would be detected by a CT scan. A VCUG would not be performed to detect if infections of the UTI have cleared. This would be done by assessing a urinalysis

A nurse is developing a teaching plan for the parents of an 8-year-old experiencing nocturnal enuresis. The nurse determines that additional teaching is needed when the parents identify what as an appropriate measure? A. Encouraging fluid intake after dinner B. Practicing bladder-stretching exercises C. Giving desmopressin intranasally D. Engaging the child in stress reduction measures

ANS: A Rationale: In many children, limiting fluids after dinner can be helpful for nocturnal enuresis. Bladder-stretching exercises also can be helpful. If these measures are ineffective, desmopressin may be prescribed. Stress factors may be contributing to the child's problem. Therefore, measures to address stress and promote coping would be appropriate

A nurse is assessing a child who may have peritonitis. Which of the following would be signs of this problem? A. Increased white blood cell count of dialysate outflow B. Diarrhea C. Increased red blood cell count of dialysate outflow D. Syncope

ANS: A Rationale: Increased white blood cell count of dialysate outflow is one of the signs of peritonitis. Vomiting, fever, and abdominal pain are also signs of peritonitis

A 15-year-old boy visits his primary care physician's office with fever, headache, and malaise, along with complaints of pain on chewing and pain in the jawline just in front of the ear lobe. The boy asks his mother to leave the exam room for a minute and then tells the nurse that he is also experiencing testicular pain and swelling. The nurse recognizes that this client most likely has which condition? A. Mumps B. Infectious mononucleosis C. Poliomyelitis D. Herpes zoster

ANS: A Rationale: Initial symptoms of mumps include fever, headache, anorexia, and malaise. Within 24 hours, pain on chewing and an "earache" occurs. When the child points to the site of the earache, however, he points to the jawline just in front of the ear lobe, the site of the parotid gland. By the next day, the gland appears swollen and feels tender; the ear becomes displaced upward and backward. Boys may also develop testicular pain and swelling (orchitis). None of the other conditions listed matches the symptoms indicated

The nurse is caring for a 7-year-old with Guillain-Barré syndrome (GBS). Which of the following would be the most effective intervention to monitor for respiratory deterioration? A. Serial measurement of tidal volume B. Pulse oximetry C. Ineffective cough D. Diminished breath sounds

ANS: A Rationale: Serial measurement of tidal volumes may reveal respiratory deterioration in a child with GBS. Pulse oximetry gives no information regarding ventilation, only oxygen saturation. A decrease in oxygen saturation noted on pulse oximetry would be helpful for determining a change in respiratory function. However, it would not be the most effective method. Ineffective cough may indicate a change in respiratory function, but this change is nonspecific. Diminished breath sounds reveal a change in respiratory function; however, they are nonspecific

The nurse is teaching a group of parents about head lice. Which statement is essential to include during the presentation? A. Head lice are becoming very resistant to treatment. B. Send your child to school even if you suspect head lice, but have the school nurse check the child. C. Discourage the children from going to sleepovers. D. Wash the bed linens in hot water to kill the lice

ANS: A Rationale: The accurate advice is that head lice are becoming resistant to treatment. Children with head lice do not need to stay home, but parents should follow school policies regarding whether children are allowed in school until they are nit-free. Children should be allowed to participate in sleepovers, preferably bringing their own pillows. Head lice do not survive long once they have fallen off. Most children can be treated effectively without treating their bedding and clothing.

A nurse is working with a 12-year-old girl with osteomyelitis who is recovering from surgery. What nursing interventions should be implemented? Select all that apply. A. Administration of IV antibiotics at the hospital B. Instruct the parents on how to care for an IV line at home C. Instruct the parents regarding the importance of maintaining bed rest D. Institute infection-control precautions related to drainage tubes E. Cast care of the affected limb F. Instruction to the parents regarding proper traction of the limb

ANS: A, B, C, D Rationale: Osteomyelitis is infection of the bone. Medical therapy includes limitation of weight bearing on the affected part, bed rest, immobilization, and a short administration of an IV antibiotic such as oxacillin (Bactocill), as indicated by the blood culture. Intravenous therapy is usually initiated in the hospital and then continued at home for as long as 2 weeks. When the child is discharged from the hospital, be certain to review with parents measures to care for the antibiotic intravenous line if this will be continued at home. Keep in mind young children are active, even if they are on bed rest so need age appropriate activities so they maintain rest, not activity. If a child had surgery and drainage tubes are in place, institute infection-control precautions, because the drain evacuates infected material. Neither casting nor traction is required for osteomyelitis

The student nurse is preparing a presentation on bones and bone growth. What information should the student include? Select all that apply. A. Calcium and vitamin D play important roles in bone growth and bone breakdown. B. Calcitonin plays a role in remodeling of bone. C. Adipose cell formation happens in the red bone marrow. D. Periosteum is the outer covering of the bone. E. The diaphysis is the rounded end portion of the bone

ANS: A, B, D Rationale: Calcium, vitamin D, and calcitonin are involved in original bone formation, replacement of old by new bone tissue (remodeling), and bone breakdown (resorption). Adipose cell formation happens in the yellow, not red, marrow. The diaphysis is the lengthy central shaft of the long bone; the epiphysis is the rounded end portion of the long bone

In the emergency room, the nurse is assessing a toddler who is currently being treated for a radius fracture and has a history of multiple fractures. The assessment reveals short stature, blue sclera, and no bruising or swelling at the fracture site. The nurse suspects: A. Child abuse. B. Attention deficit/hyperactivity disorder. C. Osteogenesis imperfecta. D. Lack of parental supervision

ANS: C Rationale: Children with osteogenesis imperfect often have blue sclera and fractures often lack swelling or bruising at the site. Child abuse or lack of parental supervision might be valid concerns if the sign and symptoms of osteogenesis imperfecta were absent. ADHD alone would not cause multiple fractures

A nurse is teaching parents about erythema infectiosum and describing the progression of the disease from earliest to latest. Place the following manifestations in the order in which the nurse would describe them. A. Intense red rash on the face B. Rash on the flexor surfaces of extremities and trunk C. Rash on extremity extensor surfaces D. Fever and headache E. Lace-like lesion appearance

ANS:D, A, C, B, E Rationale: The first phase of the infection includes fever, headache, and malaise. A week later, a rash, which erupts in three stages, appears. The rash is intensely red and appears first on the face. The lesions are maculopapular and coalesce on the cheeks to form a "slapped face" appearance. The facial lesions fade in 1 to 120 days. A day after the facial lesions appear, a rash appears on the extensor surfaces of the extremities. One day later, the rash appears on the flexor surfaces and the trunk. These lesions last for 1 week or more. When they fade, they fade from the center outward, giving the lesions a lace-like appearance

The parents of a child with a history of seizures who has been taking phenytoin (Dilantin) ask the nurse why it's difficult to maintain therapeutic plasma levels of this medication. Which statement by the nurse would be most accurate? a. "A drop in the plasma drug level will lead to a toxic state" b. "The capacity to metabolize the drug becomes overwhelmed over time" c. "Small increments in dosage lead to sharp increases in plasma drug levels" d. "Large increments in dosage lead to a more rapid stabilizing therapeutic effect"

c. "Small increments in dosage lead to sharp increases in plasma drug levels" Within the therapeutic range for phenytoin, small increments in dosage produce sharp increases in plasma drug levels. The capacity of the liver to metabolize phenytoin is affected by slight changes in the dosage of the drug, not necessarily the length of time the client has been taking the drug. Large increments in dosage will greatly increase plasma levels, leading to drug toxicity

The nurse is teaching the parent of a child with chronic renal failure on high-potassium foods that should be restricted. Which foods will the nurse include in this teaching? Select all that apply. A. Bananas, carrots, nuts, and milk B. Peaches, broccoli, and red meat C. Oranges, potatoes, wheat, and bran D. Spinach, chicken, fish, and green beans

ANS: A Rationale: Foods that are high in potassium include bananas, carrots, nuts, and milk. Broccoli, wheat, bran, chicken, fish, and green beans are not high in potassium and do not need to be restricted.

The nurse is caring for a 12-year-old girl with nephrotic syndrome. The girl confides that she feels like a "freak" compared to her peers because of her weight, edema, and moon face. Which response by the nurse would be most appropriate? A. "Let's put you in touch with some other girls who are also having the same body changes." B. "Luckily, this is just a temporary, unfortunate part of your condition; you need to accept it." C. "Your real friends do not care about your appearance and just want you to get well." D. "You are beautiful in your own way; what matters is what is on the inside."

ANS: A Rationale: It is important to introduce the girl to other youngsters with chronic renal conditions so she does not feel so isolated. Adolescents need interaction with peers. Telling the girl that this is a temporary condition, her real friends don't care about her appearance, and she is beautiful in her own way dismisses the girl's concerns and does not offer solutions. Nephrotic syndrome is a chronic condition, so telling her the condition is temporary also is inaccurate

The nurse is assessing a child with spastic cerebral palsy. What findings would the nurse expect to assess? Select all that apply. A. Exaggerated deep tendon reflexes B. Hemiplegia C. Poor control of balance D. Hypertonicity E. Drooling F. Dysarthria

ANS: A Rationale: Spastic cerebral palsy is associated with exaggerated deep tendon reflexes; poor control of posture, balance, and movement; hypertonicity of the affected extremities; and hemiplegia, quadriplegia, or diplegia, based on the limbs affected. Drooling and dysarthria are associated with athetoid cerebral palsy.

The nurse is assessing the neuromusculoskeletal system of a newborn. What is an abnormal assessment finding? A. Sluggish deep tendon reflexes B. Full range of motion in extremities C. Absence of hypotonia D. Lack of purposeful muscular control

ANS: A Rationale: Deep tendon reflexes are present at birth and are initially brisk in the newborn and progress to average over the first few months. Sluggish deep tendon reflexes indicate an abnormality. The newborn is capable of spontaneous movement but lacks purposeful control. Full range of motion is present at birth. Healthy infants and children demonstrate normal muscle tone; hypertonia or hypotonia is an abnormal finding.

The mother of a 12-year-old with Reye syndrome approaches the nurse wanting to know how this happened to her child, saying, "I never give my kids aspirin!" Which response by the nurse would be most appropriate? A. "Sometimes it's hard to tell if a product contains aspirin." B. "Do you think that maybe your child took aspirin on his own?" C. "Don't worry; you're in good hands. We have it under control now." D. "Aspirin in combination with the virus will make the brain swell and the liver fail."

ANS: A Rationale: Although warning labels are placed on containers of salicylates, salicylates are in a wide variety of products, so consumers must read the small print very carefully or they will miss the warning. The parent needs to be receptive to further education. Don't state the obvious, but also don't minimize the situation. Encourage the mother to ask for information, and be sure to explain in terms she will understand

The nurse is providing education to the parents of a female with hydrocephalus who has just had a shunt inserted. When discussing the child's condition with the parents, which of the following would be most appropriate? A. "Tell me your concerns about your child's shunt." B. "Be sure to call the doctor if she gets a persistent headache." C. "Her autoregulation mechanism to absorb spinal fluid has failed." D. "Always keep her head raised 30 degrees."

ANS: A Rationale: Always start by assessing the family's knowledge. Ask them what they feel they need to know. Knowing when to call the doctor and how to raise the child's head are important, but they might not be listening if they have another question on their minds. "Autoregulation" is too technical—base information on the parents' level of understanding.

The nurse is assessing a 7-year-old with a hearing aid. His mother says he is losing his hearing again. Which finding would the nurse identify as contributing to this current complaint? A. Overproduction of cerumen B. Soreness of the outer ear C. History of a normal term birth D. The eardrum responds to a puff of air

ANS: A Rationale: Approximately 10% of children either produce larger than normal amounts or have difficulty with cerumen removal that results in hearing impairment. Cerumen impaction can affect hearing, even with a hearing aid. Soreness of the outer ear is a sign of otitis externa. Full-term birth would not play role in continued loss of hearing. Eardrum response to a puff of air indicates the absence of fluid in the middle ear.

A 3-year-old demonstrates lateral bowing of the tibia. Which signs would indicate that the boy's condition is Blount disease rather than the more typical developmental genu varum? A. A sharp, beaklike appearance to the medial aspect of the proximal tibia on x-ray B. The medial surfaces of the knees are more than 2 in apart C. The malleoli are touching D. The condition is bilateral

ANS: A Rationale: Blount disease is retardation of growth of the epiphyseal line on the medial side of the proximal tibia (inside of the knee) that results in bowed legs. Unlike the normal developmental aspect of genu varum, Blount disease is usually unilateral and is a serious disturbance in bone growth that requires treatment. In those with Blount disease, the medial aspect of the proximal tibia will show a sharp, beaklike appearance. The other answers all describe genu varum, not Blount disease

An 8-year-old boy and his father visit the pediatrician's office with reports of a sudden onset of abdominal pain and reddish-brown urine. A urinalysis shows 4+ protein. On taking the boy's health history, the nurse learns that he had strep throat a little over a week ago. Which condition should the nurse suspect? A. Acute glomerulonephritis B. Kidney agenesis C. Polycystic kidney D. Nephrosis

ANS: A Rationale: Glomerulonephritis, inflammation of the glomeruli of the kidney, is most common in children between the ages of 5 and 10 years. The child typically has a history of a recent streptococcal respiratory infection (within 7 to 14 days). Symptoms are as described above. Kidney agenesis (absence of kidneys) and polycystic kidneys (formation of large, fluid-filled cysts in the place of normal kidney tissue) are serious congenital conditions that would likely be discovered either in utero or shortly after birth, not conditions that would appear acutely in an 8-year-old. Nephrosis is altered glomerular permeability apparently due to an autoimmune process or a T-lymphocyte dysfunction that results in fusion of the glomeruli membrane surfaces, which, in turn, leading to abnormal loss of protein in urine. The highest incidence is at 3 years of age, and it occurs more often in boys than in girls. In addition to proteinuria, a major symptom of nephrosis is edema, which is absent in this case

A nurse is caring for a 3-year-old girl with microcephaly. Which of the following actions is appropriate for the nurse to take? A. Playfully ask the child to touch her nose B. Teach the parents about ventriculoperitoneal (VP) shunts C. Prepare the child for the experience of cranial surgery D. Administer antipyretics as ordered

ANS: A Rationale: Having the child touch her nose will assist the nurse in assessing probable neurologic and cognitive deficits. A VP shunt may be necessary for hydrocephaly. Surgery is often an intervention for craniosynostosis but cannot correct microcephaly. Hyperthermia is not a complication with microcephaly

The parents of a 5-year-old have just found out that their child has head lice. Which statement by the parents would support the nursing diagnosis of deficient knowledge? A. "I can't believe it. We're not unclean, poor people." B. "We'll have to get that special shampoo." C. "Everybody in the house will need to be checked." D. "That explains his complaints of itching on his neck."

ANS: A Rationale: Head lice is not an indication of poor hygiene or poverty. It occurs in all socioeconomic groups. Thus, the parents' statement about being unclean and poor reflects a lack of knowledge about the infection. A pediculicide is used to wash the hair to treat the infestation. Household contacts need to be examined and treated if affected. Extreme pruritus is the most common symptom, with nits or lice especially behind the ears or at the nape of the neck.

A 10-year-old girl is experiencing acute renal failure due to dehydration. The nurse is preparing to administer IV fluid. Which of the following interventions should the nurse take in caring for this child? A. Administer the IV fluid slowly B. Make sure the IV fluid contains potassium C. Increase oral intake of fluid D. Provide a diet high in protein and sodium

ANS: A Rationale: If the child is dehydrated (as with diarrhea or hemorrhage), IV fluid is needed to replace plasma volume. Administer such fluid slowly, however, to avoid heart failure as extra fluid cannot be removed by the nonfunctioning kidneys. Be certain the fluid prescribed does not contain potassium until it is established kidney function is adequate; otherwise, the buildup of potassium could cause heart block. The child's diet should be low in protein, potassium, and sodium and high in carbohydrate to supply enough calories for metabolism yet limit urea production and control serum potassium levels. Oral fluid intake may be limited to prevent heart failure due to accumulating fluid that cannot be excreted

An infant has been born and diagnosed with a meningocele. Which action will the nurse incorporate into each contact with this infant? A. Inspection of the cystic sac on the child's back for leakage B. Auscultation for bowel sounds C. Listening for a shrill cry D. Careful supine positioning

ANS: A Rationale: Leakage from the cystic area indicates loss of cerebrospinal fluid (CSF) and risk of infection of the central nervous system. Prompt intervention is needed, probably surgical. Listening for bowel sounds confirms intestinal peristalsis but is not necessary with each infant contact. A shrill cry may indicate increased intracranial pressure (ICP). This is important to note yet is not as pressing as being aware of leakage. The baby would be positioned prone, not supine, to protect the sac

The nurse is educating parents of a male infant with Chiari type II malformation about the condition. Which of the following would be most important for the nurse to include? A. Taking time to feed the infant B. Laying the infant down after a feeding C. Being able to see major difference after surgery D. Not needing to change diapers as often

ANS: A Rationale: One of the problems associated with Chiari type II malformation is poor gag and swallowing reflexes, so the infant must be fed slowly. There is a great risk of aspiration, requiring that the child be placed in an upright position after feeding. The goal of surgery is to prevent further symptoms rather than to relieve existing ones. Infrequent urination is a problem associated with type I malformations.

The mother of a 10-year-old child diagnosed with rubella asks what can be done to help her child feel better during her illness. What information can be provided? A. Encourage rest and relaxation. B. Antibiotic therapy may be initiated. C. Antiviral medications can be prescribed. D. Range of motion to prevent contractures

ANS: A Rationale: Rubella infection is usually mild and self-limited. The care given is normally supportive. Rest is encouraged. Medications administered are normally limited to anti-pyretics and analgesics. Antibiotic and antiviral therapies are not normally included in the plan of treatment. Range of motion is not needed as mobility of the client is not limited.

The nurse is caring for a 3-year-old girl who has just undergone a ventriculostomy. Which of the following would the nurse include in this child's plan of care to manage increased intracranial pressure (ICP)? A. Use pillows to support the child when lying on her side B. Support the parents in starting a ketogenic diet C. Pad the side rails on the bed D. Teach her to do deep breathing techniques

ANS: A Rationale: The nurse should use pillows to prevent the child from sliding down in bed and to support the head in a neutral position when the child lies on his or her side. Beginning a ketogenic diet and padding the side rails for safety are interventions for a child with seizures. A 3-year-old is not likely to understand deep breathing techniques.

The nurse is teaching the parents of a child with varicella about the disorder. The nurse determines that the teaching was successful when the parents state which of the following? A. "We will make sure to remind him not to scratch the lesions." B. "We can give him aspirin for fever." C. "We should put him in a warm bath if he is itchy." D. "We can use salt solutions to help heal his oral lesions."

ANS: A Rationale: The parents understand the teaching when they state that they will help make sure to remind him not to scratch the lesions. Acetaminophen should be administered for fever, not aspirin, due to the link with Reye's syndrome. The best treatment for skin discomfort is a cool bath with soothing colloidal oatmeal every 3 to 4 hours for the first few days. The child should avoid citrus, spicy, or salty foods

A panicked mother calls the health care provider's office and reports that her 5-year-old has a high fever and just had a seizure. The mother asks the nurse what she should do. Which is the nurse's best response? A. Report to the emergency room for medical evaluation B. Immerse the child in a bathtub of tepid water C. Administer oral acetaminophen per package directions D. Remove any heavy clothing and cover with a thin sheet

ANS: A Rationale: When a child has a febrile seizure associated with a high fever, it is important to seek medical evaluation. Medical evaluation will identify the source of the high fever. If the fever is viral, the child may be able to be managed at home. Advise them not to put the child in a bathtub of water to do this because it would be easy for the child to slip under water should a second seizure occur. Caution them not to apply alcohol or cold water as extreme cooling causes shock to an immature nervous system. Parents should not attempt to give oral medications such as acetaminophen, because the child will be in a drowsy, or postictal, state after the seizure and might aspirate the medicine. It is appropriate to remove heavy clothing but not the best response.

The nurse is working with a child with altered genitourinary status. The child demonstrates excess fluid volume. Which of the following would the nurse most likely do? A. Weigh the child 2 times a day on the same scale. B. Hold all medication until the fluid retention improves. C. Avoid administering IV fluids. D. Measure the amount of nitrates present in the urine.

ANS: A Rationale: A child with altered genitourinary status with excess fluid volume needs to be weighed twice daily always with the same scale, wearing the same amount of clothing at the same time each day. A weight gain of greater than 0.5 kg can indicate fluid retention. Withholding all medication and avoiding IV fluids would be inappropriate. IV fluid administration should be monitored closely and given at the prescribed rate. The nurse should also monitor laboratory values such as BUN and creatinine, urine and serum sodium, serum potassium, hemoglobin and hematocrit for changes

A 6-month-old child has developed skin irritation due to an allergic reaction. He has been prescribed a topical skin ointment. The nurse will consider which of the following before administering the drug? A. That the infant's skin has greater permeability than that of an adult B. That there is less body surface area to be concerned about. C. That there is decreased absorption rates of topical drugs in infants. D. That there is a lower concentration of water in an infant's body compared with an adult

ANS: A Rationale: Compared to adult skin, infants' skin exhibits greater permeability. This can result in increased absorption, which may result in adverse effects that usually do not occur in the adult patient. The nurse must consider this fact before administering skin ointment. Infants have greater, not lesser, body surface area. Greater body surface area plus increased permeability results in increased absorption of topical agents. Infants tend to have a higher concentration of water in their bodies than do adults

The nurse is caring for a child diagnosed with a sprain of the lower extremity. Which health care prescription(s) would the nurse clarify with the provider before implementing? Select all that apply. A. Apply a heating pad four times daily for 20 minutes per application B. Offer aspirin (ASA) three times daily orally to the child for pain and inflammation C. Avoid bearing weight on the affected extremity for 3 to 4 days D. Compress the site using an elastic bandage to wrap the area E. Assure the parents understand when to return and to call or follow-up with concerns

ANS: A, B Rationale: For a sprain or strain, ice is applied to the site to reduce swelling. Heat is not applied as this would increase swelling. Aspirin is rarely used to relieve pain and swelling in children due to the risk of Reye syndrome. If the provider prescribed either heat or aspirin, the nurse would clarify these prescriptions before implementing them. Compression and rest of the extremity (non-weight bearing), and teaching about follow-up needs are typical and expected prescriptions.

The nurse is caring for a child admitted to the pediatric medical unit with chickenpox who has infected vesicles. What personal protective equipment should the nurse use when measuring the child's vital signs? A. Gloves B. Gown C. N95 respirator D. Face mask E. Eye wear

ANS: A, B, C Rationale: Transmission of chickenpox (Varicella zoster) occurs through direct contact with infected persons' nasopharyngeal secretions or via air-borne spread, to a lesser degree by contact with unscabbed lesions. Airborne and contact precautions (gloves, gown, N95 respirator) should be used with the hospitalized child for a minimum of 5 days after onset of rash and as long as vesicular lesions are present. A simple face mask is used for droplet precautions. Eye wear would only be necessary if splashing was likely.

The nurse caring for a neonate experiencing seizures asks the charge nurse: "How can I tell if a baby is having a seizure or is just crying for attention?" Which response would be most appropriate? Select all that apply. A. "You will not be able to stop a seizure with gentle restraint." B. "The baby experiencing a seizure will be tachycardic." C. "Stimulating the baby by singing to him will not stop a seizure." D. "There will be no changes in the baby's vital signs with a seizure" E. "The baby will become more active with sensory stimulation with a seizure." F. "The baby will stop the seizure activity when swaddled in a blanket."

ANS: A, B, C Rationale: With seizure activity, the neonate experiences tachycardia and increased blood pressure, and movements are not suppressed by general restraint and are unchanged by sensory stimuli. With nonepileptic movements, there is no change in vital signs, the movement is suppressed easily with gentle restraint, and movements are enhanced with sensory stimuli.

A nurse is teaching parents of a child with a nursing diagnosis of pain related to pruritus from skin lesions. Which of the following would the nurse include in the instructions? Select all that apply. A. "Keep the child's fingernails short." B. "Wrap your child up snugly with blankets." C. "Bathe the child in lukewarm water and baking soda." D. "Have the child press on the itching area instead of scratching it." E. "Avoid having your child wear cotton clothing."

ANS: A, C, D Rationale: Measures to reduce pruritus include keeping the child's fingernails short to prevent injury from scratching; bathing the child in lukewarm water with oatmeal or baking soda; dressing the child in loose, light cotton clothing to prevent overheating and perspiration, which can intensify the itching; having the child press on the itching area rather than scratching it; and avoiding wool, which can irritate the skin and worsen the itching

The child has a meningocele and a neurogenic bladder. Which of the following topics should the nurse include in the teaching plan when educating the child and the child's caregivers? Select all that apply. A. How and when to administer oxybutynin chloride B. The importance of antibiotic use to prevent urinary tract infections from occurring C. How and when to perform clean intermittent urinary catheterization D. Signs and symptoms of a urinary tract infection E. Different types of surgeries used to treat this condition

ANS: A, C, D, E Rationale: Ditropan is used to increase the child's bladder capacity when they have a spastic bladder. The caregivers and the child should be taught about urinary catheterization techniques to allow the bladder to empty. The child and caregivers should be educated about the clinical manifestations associated with a urinary tract infection so that it can be treated promptly. Sometimes surgical interventions such as vesicostomy and the creation of a continent urinary reservoir are used to treat neurogenic bladders.

A nurse is obtaining the history from a parent of a child who experiences absence seizures. Which of the following would the nurse expect the mother to describe? A. Brief, sudden onset with muscles that become tense B. Loss of motor activity accompanied by a blank stare C. Sudden, brief jerking motions of a muscle group D. Loss of muscle tone and loss of consciousness

ANS: B Rationale: An absence seizure consists of a sudden, brief arrest of the child's motor activity accompanied by a blank stare and loss of awareness. A tonic seizure consists of a brief onset of increased tone. A myoclonic seizure is characterized by sudden, brief jerks of muscle groups. An atonic seizure involves a sudden loss of muscle tone and loss of consciousness.

The nurse is assessing an infant at a well-check visit. The infant's mother states that she is worried about her child's feet because they are so flat and wide. What the appropriate response by the nurse? A. "You don't need to worry about your child's feet. They will change as your child grows." B. "Your child's feet are normal for an infant. A child's longitudinal arch will not develop until the child is walking for several months." C. "Flat feet are normal in infants. Their longitudinal arch doesn't appear until they are 3 to 5 years old." D. "When your child starts walking, encourage walking on the heels. This will help to develop the arch more so your child doesn't have a problem with flat feet as an adult."

ANS: B Rationale: A newborn's foot is flatter and proportionately wider than an adult's foot. Feet do change as a child grows, but this answer does not address the mother's concern. The longitudinal arch may not be present until the child has been walking for a few months, not at 3 to 5 years of age. Encouraging a child to walk on the heels does not help with arch development.

The nurse is conducting a wellness examination of a 6-month-old child. The mother points out some dimpling and skin discoloration in the child's lumbosacral area. How should the nurse respond? A. "This could be an indicator of spina bifida; we need to evaluate this further." B. "This can be considered a normal variant with no indication of a problem; however, the doctor will want to take a closer look." C. "Dimpling, skin discoloration, and abnormal patches of hair are often indicators of spina bifida occulta." D. "This is often an indicator of spina bifida occulta as opposed to spina bifida cystica."

ANS: B Rationale: Dimpling and skin discoloration in the child's lumbosacral area can be an indication of spina bifida occulta. It would be best to respond that the dimpling and discoloration is possibly a normal variation with no problems and indicate that the doctor will want to take a closer look; this response will not alarm the parent, but it also does not ignore the findings. Spina bifida is a term that is often used to generalize all neural tube disorders that affect the spinal cord. This can be confusing and a cause of concern for parents. It is probably best to avoid the use of the term initially until a diagnosis is confirmed. Nursing care would then focus on educating the family

When performing physical assessments of children with musculoskeletal disorders, the nurse distinguishes normal variations in children's muscles versus adult muscles. Which of the following would be most important for the nurse to keep in mind? A. The infant's muscles account for 45% of total body weight as opposed to 25% of adult body weight. B. During adolescence, muscle growth is influenced by increased production of androgenic hormones. C. The young child has rigid soft tissue, so dislocations and sprains are common occurrences. D. Rapid bone and muscle growth in adolescents increase their agility, thereby decreasing the incidence of injuries

ANS: B Rationale: During adolescence, muscle growth is influenced by hormonal changes, primarily the increased production of androgenic hormones. The infant's muscles account for only 25% of total body weight, whereas they account for 40% to 45% in an adult. The young child has resilient soft tissue, so dislocations and sprains are unusual occurrences. Rapid bone and muscle growth may contribute to the appearance of "clumsy" and awkward motions of the adolescent who is trying to adjust to new body dimensions.

A child in the clinic has a fever and reports a sore neck. Upon assessment the nurse finds a swollen parotid gland. The nurse suspects which infectious disease? A. Measles B. Mumps C. Whooping cough D. Scabies

ANS: B Rationale: Mumps is an infectious disease with a primary symptom of a swollen parotid gland. It is a contagious disease spread by droplets. The child is contagious 1 to 7 days prior to the onset of the swelling and 4 to 9 days after the onset of the swelling. Pertussis is a respiratory disorder which causes severe paroxysmal coughing which produces a whooping sound. Measles is recognized by Koplick spots in the mouth and the classic maculopapular rash that starts on the head and spreads downward. Scabies is a skin condition where lice lay eggs under the skin. The rash is very puritic and is seen on the hands, feet, and folds of the skin.

A child is having their urine checked for complaints of polyuria. When analyzing the results, what would positive glucose indicate? A. This may indicate a urinary tract infection. B. This determines the presence of sugar in the urine. C. This indicates renal disease. D. This determines the presence of bacteria in the urine

ANS: B Rationale: Positive glucose determines the presence of sugar in the urine. This could signify diabetes and needs to be evaluated immediately. Positive leukocytes may indicate a urinary tract infection. The urine would also need to be cultured to determine the type and amount of bacteria growth

A nurse is caring for an infant with spinal muscle atrophy (SMA) type 1. What will the nurse note when assessing the child? A. Spastic upper and lower extremities B. Narrow chest and protuberant abdomen C. Enlarged head with low-set ears D. Lusty cry with voracious appetite

ANS: B Rationale: SMA type 1 is also known as Werdnig-Hoffman disease and infantile SMA. It is the most severe of the three types. This disease is autosomal recessive and affects the ability of spinal nerves to communicate with muscle, eventually leading to atrophy. The infantile form progresses rapidly to early childhood death, usually from respiratory complications. The narrow chest and large abdomen are characteristic. Over time, the chest develops pectus excavatum, which restricts respiration further when combined with muscle weakness. Extremities would not be spastic but hypotonic. Head size and ear placement are normal in the infant with SMA type 1. Difficulties in sucking and swallowing are common, and a lusty cry is not found

Which diagnostic measure is most accurate in detecting neural tube defects? A. Flat plate of the lower abdomen after the 23rd week of gestation B. Significant level of alpha-fetoprotein present in amniotic fluid C. Amniocentesis for lecithin-sphingomyelin (L/S) ratio D. Presence of high maternal levels of albumin after 12th week of gestation

ANS: B Rationale: Screening for significant levels of alpha-fetoprotein is 90% effective in detecting neural tube defects. Prenatal screening includes a combination of maternal serum and amniotic fluid levels, amniocentesis, amniography, and ultrasonography and has been relatively successful in diagnosing the defect. Flat plate X-rays of the abdomen, L/S ratio, and maternal serum albumin levels aren't diagnostic for the defect

A 4-month-old infant is seen at the ambulatory care clinic and diagnosed with nasolacrimal duct obstruction. The mother asks what can be done. What information should be included in the information provided to the parent? A. Once the child is 6 to 9 months old a specialist will be able to drain the duct. B. Most of these conditions will spontaneously resolve. C. Antiviral therapy can be prescribed to manage this condition. D. Over-the-counter drops can be used sparingly

ANS: B Rationale: Stenosis or simple obstruction of the nasolacrimal duct is a common disorder of infancy, occurring in about 6% to 20% of newborns and infants. It is unilateral in about 65% of cases. Chronic tearing occurs and buildup in the lacrimal sac causes a mucoid or mucopurulent drainage. Over 90% of all cases resolve spontaneously by 1 year of age.

A 7-month-old is scheduled for surgical correction of strabismus. The child's mother says to the nurse, "I'm glad my child will never have to wear that patch again." Which of these responses would be most appropriate for the nurse to make? A. "Your child will never need to wear the patch again." B. "Your child will need to wear the patch for a few days to keep him/her from rubbing or putting pressure on the eye." C. "Your child will need to wear the patch for several months to keep the eye in alignment." D. "Your child will have to be in restraints for a week to keep him/her from rubbing the eye."

ANS: B Rationale: Strabismus refers to a misalignment of the eyes, if the strabismus persists past 6 months of age this warrants referral to an ophthalmologist for further evaluation. Clinical therapy involves occlusion therapy (patching of the good eye) for 1-2 hours a day to force use of the weak eye. The child may have to wear the patch intermittently, no restraints are needed if the patch is left in place, and the surgery on the muscle is what puts the eye back into alignment

The mother of a 3-year-old with a myelomeningocele is thinking about having another baby. The nurse should inform the woman that she should increase her intake of which acid? A. Folic acid to 0.4 mg/day B. Folic acid above 0.4 mg/day C. Ascorbic acid to 0.4 mg/day D. Ascorbic acid to 4 mg/day

ANS: B Rationale: The American Academy of Pediatrics recommends that a woman who has had a child with a neural tube defect increase her intake of folic acid to above 0.4 mg per day 1 month before becoming pregnant and continue this regimen through the first trimester. A woman who has no family history of neural tube defects should take 0.4 mg/day. All women of childbearing age should be encouraged to take a folic acid supplement because the majority of pregnancies in the United States are unplanned. Ascorbic acid hasn't been shown to have any effect on preventing neural tube defects.

Which nursing intervention is the priority for the immobilized child in an acute care setting? A. Ambulate the child up and down the hall twice a day. B. Offer age-appropriate toys and diversional activities. C. Take the child to the playroom at least once a day. D. Encourage active and passive range of motion exercises once a day.

ANS: B Rationale: The immobilized child should be offered age-appropriate toys and diversional activities to stimulate the mind. An immobilized child is not able to walk or be taken to the playroom; they are bedfast. Passive and active range of motion exercises should be performed at least 3 to 4 times a day, not just once daily

The nurse is caring for a child who is undergoing peritoneal dialysis. Immediately after draining the dialysate, which action should the nurse should take immediately? A. Empty the old dialysate B. Weigh the old dialysate C. Weigh the new dialysate D. Start the process over with a fresh bag

ANS: B Rationale: The nurse should weigh the old dialysate to determine the amount of fluid removed from the child. The fluid must be weighed prior to emptying it. The nurse should weigh the new fluid prior to starting the next fill phase. Typically, the exchanges are 3 to 6 hours apart so the nurse would not immediately start the next fill phase.

The nurse is evaluating outcomes for teaching provided to the mother of a school-age child with an itchy rash. Which outcome indicates that teaching has been effective? A. Mother applies hot compresses to itchy skin areas every few hours B. Child drinks a glass of water every 1 to 2 hours throughout the day C. Child showers in hot water and uses soap on the rash every morning D. Child wearing long denim pants and a long-sleeve shirt while playing outside

ANS: B Rationale: To relieve the itchiness of a rash, the child should be encouraged to have an adequate fluid intake to maintain good hydration because dry skin increases discomfort. Cold cloths or compresses applied to itchy areas are appropriate. Heat makes the itch worse. Baking soda should be used when bathing in lukewarm water. Hot water and harsh soap will irritate the rash. The child should be dressed in light cotton clothing so overheating and perspiration does not occur. Perspiration makes the itch worse. Denim pants and long-sleeved shirt would make the child very uncomfortable.

A school-age child with a supracondylar fracture of the humerus has been placed in a partial cast with the elbow region wrapped with an elastic bandage. What should the nurse explain to the parents and child regarding the reason for this type of casting approach? A. Encourages healing B. Ensures edema does not press on the nerves C. Keeps the bones of the forearm in alignment D. Provides additional stability until the bone heals

ANS: B Rationale: With an elbow fracture, the arm will be flexed and put into a cast. In this position, the radial artery and nerve can be compressed at the elbow, causing nerve injury or severe impairment of circulation. In some situations, a cast is applied incompletely for 24 hours, the elbow portion being splinted and wrapped with elastic bandages. After 24 hours, when edema has subsided and the chance of compression is less, the rest of the arm is then casted. The use of an elastic wrap at the elbow is not used to encourage healing, keep the bones in alignment, or provide additional stability

The child has been diagnosed with slipped capital femoral epiphysis. Which of the following characteristics about the patient is risk factor associated with the development of this condition? Select all that apply. A. The child is noted to be underweight by the nurse. B. The child is 13 years old. C. The child is African American. D. The child's parents state that the child has recently experienced a "growth spurt." E. The child is mal

ANS: B, C, D, E Rationale: Slipped capital femoral epiphysis most often occurs in males between the ages of 12 to 15 years. It more commonly affects African American boys. The femoral plate weakens and becomes less resistant to stressors during periods of growth. Boys are more frequently affected. Obese boys are more likely to develop this condition

A nurse is caring for a 13-year-old boy with end-stage renal disease who is preparing to have his hemodialysis treatment in the dialysis unit. Which nursing action is appropriate? A. Administer his routine medications as scheduled B. Take his blood pressure measurement in extremity with AV fistula C. Withhold his routine medication until after dialysis is completed D. Assess the Tenckhoff catheter site

ANS: C Rationale: The nurse should withhold routine medications on the morning that hemodialysis is scheduled since they would be filtered out through the dialysis process. His medications should be administered after he returns from the dialysis unit. A Tenckhoff catheter is used for peritoneal dialysis, not hemodialysis. The nurse should avoid blood pressure measurement in the extremity with the AV fistula as it may cause occlusion

A female preschool patient with a urinary tract infection is scheduled to have a voiding cystourethrogram. What should the nurse include when teaching the patient about this procedure? A. A headache is a common occurrence after the procedure. B. A local anesthetic will be injected prior to the procedure. C. The patient will be expected to void during the procedure. D. The patient will have to drink three glasses of water during the procedure

ANS: C Rationale: A voiding cystourethrogram is a study of the lower urinary tract and looks at the structure of the urethra and bladder and the presence of reflux into the ureters. After bladder catheterization, a radiopaque dye is injected into the bladder, and the catheter is then removed. The child is asked to void into a bedpan while serial X-ray films are taken. Being asked to void while being observed may be the most stressful part of the procedure for children because they have been taught voiding is a private act. Be sure children are told in advance that they will be asked to do this, and that it is alright if a stranger watches them. A headache is not a common occurrence after this procedure. A local anesthetic is not needed for this procedure. The patient will not be asked to drink water during the procedure.

The nurse has been teaching the parents of a child diagnosed with osteogenesis imperfecta about the use of bisphosphonates for this condition. What statement by a parent indicates a need for further education? A. "This medication will help to increase bone mineral density." B. "My child's risk for fractures will hopefully be decreased as by taking this medication." C. "This medication will cure my child of this disorder." D. "This medication doesn't prevent fractures from happening."

ANS: C Rationale: Bisphosphonates are used in the palliative, not curative, treatment of osteogenesis imperfecta. The medication increases bone mineral density, therefore reducing the risk of the child developing fractures. The medication does not actually prevent fractures from happening.

The nurse instructs a hearing-impaired school-age child on to how self-inject a prescribed medication. Which observation indicates to the nurse that additional teaching is required? A. The child pinches the skin together before inserting the needle. B. The child injects the appropriate amount of air into the vial before withdrawing medication. C. The child places the filled syringe and uncapped needle on the bed to open the alcohol wipe. D. The child slowly pushes on the plunger to inject the medication before withdrawing the needle.

ANS: C Rationale: Children who are unable to hear may need additional time for explanations and support. By placing the syringe and uncapped needle on the bed, the child is contaminating the needle. This would indicate that additional teaching is necessary. Pinching the skin, injecting air, and slowly pushing on the plunger all indicate that teaching has been effective.

The nurse is assessing an infant with suspected hemolytic uremic syndrome. Which characteristics of this condition should the nurse expect to assess or glean from chart review? A. Hemolytic anemia, acute renal failure, and hypotension B. Dirty green colored urine, elevated erythrocyte sedimentation, and depressed serum complement level C. Hemolytic anemia, thrombocytopenia, and acute renal failure D. Thrombocytopenia, hemolytic anemia, and nocturia several times each night

ANS: C Rationale: Hemolytic uremic syndrome is defined by all three particular features - hemolytic anemia, thrombocytopenia, and acute renal failure. Dirty green colored urine, elevated erythrocyte sedimentation, and depressed serum complement level are indicative of acute glomerulonephritis. Hypertension, not hypotension, would be seen and the child would have decreased urinary output which would not cause nocturia.

An 18-month-old child is admitted with signs of increased intracranial pressure. What should the nurse observe when assessing this patient? A. Numbness of fingers and decreased temperature B. Increased pulse rate and decreased blood pressure C. Increased temperature and decreased respiratory rate D. Decreased level of consciousness and increased respiratory rate

ANS: C Rationale: Manifestations of increased intracranial pressure include increased body temperature and decreased respiratory rate. Pulse rate slows, and the blood pressure increases.

A nurse assesses a client who is complaining of calf pain, has a temperature of 101°F (38.3°C) and reports that his leg is very sore. X-rays do not reveal any abnormalities but the client's white count is 21,000 cells and his erythrocyte sedimentation rate is elevated. What problem do these symptoms suggest? A. Muscular dystrophy B. Legg-Calves-Perth disease C. Osteomyelitis D. Compartment syndrome

ANS: C Rationale: Osteomyelitis is a bone infection usually caused by Staphylococcus aureus, which causes leg pain and fever. Labwork reflects an elevated leukocyte count and an increased erythrocyte sedimentation rate. X-rays look normal until 5 to 10 days after onset of symptoms

The nurse caring for an infant with myelomeningocele before surgical intervention will prioritize care in what way? A. Keep the mass uncovered and dry B. Prevent cold stress using an Isolette and blankets C. Cover the sac with a saline-moistened dressing D. Change position from side to side hourly

ANS: C Rationale: Protection of exposed neural tissue is of high priority. Keeping the cystic mass moist prevents damage to neural elements from drying. Blankets may cause trauma to the sac. An Isolette can be used for warmth, but much attention will have to be directed toward keeping the sac moist. Side-to-side hourly position changes increase the risk of damage to protruding nervous tissue. Unnecessary handling should be avoided.

The nurse is educating parents of a child admitted to the hospital with rubella (German measles). Which statement by the parents indicates the further education is needed? A. "Our child is contagious for 1 week after the rash appeared." B. "Acetaminophen or ibuprofen can be given to help with pain." C. "Antibiotics are needed to help our child recover from rubella." D. "Family members should wear a mask when coming to visit us."

ANS: C Rationale: Rubella (German measles) is caused by the rubella virus. Children will be contagious for 1 week before to approximately 1 week after the rash appears. Acetaminophen or ibuprofen can be given to help with pain or fever, and the child will be on droplet precautions (mask) while in the hospital

The nurse is caring for a child recovering from surgery to correct strabismus. Which interventions should the nurse include when planning this child's care? Select all that apply. A. Apply an eye patch. B. Maintain on bed rest for 3 days. C. Support for nausea and vomiting. D. Provide pain medication as prescribed. E. Apply antibiotic ointment as prescribed

ANS: C, D, E Rationale: After eye surgery for strabismus, the patient may experience nausea and vomiting and pain on eye movement. The patient will also be prescribed antibiotic ointment. An eye patch is not usually required. The child will not need to be on bed rest for 3 days

The nurse is caring for a school-age child with varicella. What should the nurse observe about the rash that is associated with this infection? A. Dark red color B. Noticeable crusts but no pruritus C. Dark red, macular, very pruritic lesions D. Various stages of lesions present at the same time

ANS: D Rationale: Most of chickenpox lesions are found on the trunk, although the face, scalp, palate, and neck also may be involved. They appear in approximately three separate series or crops, with each new lesion moving through progressive stages. At some point, all four stages of lesions—macule, papule, vesicle, and crust—can be present. The lesions are not dark red in color. These lesions are very itchy

The nurse receives a report from the admission department that a child with a slipped femoral epiphysis is en route to the care area. For which type of child should the nurse begin to plan care? A. Tall, thin female B. Preadolescent female C. Active school-age male D. Obese preadolescent male

ANS: D Rationale: A slipped femoral epiphysis is a slipping of the femur head in relation to the neck of the femur at the epiphyseal line. This disorder occurs most frequently in preadolescence and its highest incidence is in obese children. It is twice as frequent in boys as girls.

The mother of a an 8-year-old boy with mumps tells the nurse that she does not understand how her son could have gotten mumps since he was immunized according to her physician's recommendations. What is the best response by the nurse? A. "I am sure it must be frustrating. Where did you have the immunizations performed?" B. "I am wondering if your physician followed the immunization schedule correctly?" C. "Are you sure your child received an immunization for mumps?" D. "While immunizations are highly effective they aren't 100% effective at preventing infectious diseases."

ANS: D Rationale: According to the CDC (2014d), one dose of MMR prevents 78% of cases and two doses prevent approximately 88% of cases. Questioning where the immunizations were given, if the immunization was given, and if the physician followed the guidelines correctly is accusatory and unlikely to be the cause of the child contracting the infection

Other than providing direct care to children, what is the major role of nurses in the care of nearly all children with neuromuscular disorders? A. Consoling parents B. Teaching children self-care C. Helping with specialized equipment D. Coordinating care by specialists

ANS: D Rationale: Being part of a multidisciplinary team and coordinating the care the child usually needs from a variety of specialists is an essential and major role. The other nursing activities are important as well, but many children/families require individual interventions.

The nurse is providing teaching to the parents of a child with varicella. Which statement indicates that the parents have understood the instructions? A. "We should apply alcohol to the lesions every four hours." B. "If he has a fever, we can give him some aspirin." C. "The lesions should eventually form soft crusts that drain." D. "We need to make sure that he washes his hands frequently."

ANS: D Rationale: The child with varicella needs to wash his hands frequently with antibacterial soap to reduce bacterial colonization. A cool bath with soothing colloidal oatmeal may help the skin discomfort. Alcohol would be too drying to the skin. Acetaminophen, not aspirin, should be used to reduce fever. The lesions should eventually crust over. Soft crusts with drainage may suggest an infection

A nurse is performing an assessment on a child. What would be indicative of a potential for a urinary tract infection? A. Washing the genital area with water daily B. Not using cleansing towelettes routinely C. Not using soap when cleaning the urethral area D. Holding urine while at school

ANS: D Rationale: UTIs are often caused by children who do not urinate frequently at school. It is important for a child to avoid using towelettes and soap in the genital area because this can increase the chance of a UTI. Washing the genital area with water daily does not increase the chance of a UTI

A school-age child is hospitalized with a fractured left femur. The child is in balanced skeletal traction and is in pain. Orders read "Morphine 2.5 mg IV q 3 hours for severe pain." How many mL of morphine would the nurse administer if the medication on hand is morphine 8 mg/1 mL? Record your answer using two decimal places.

ANS:0.31 Rationale: The medication comes in 8 mg/1 mL. Divide the ordered dose of 2.5 mg by the on-hand medication concentration of 8 mg/1 mL. 2.5 mg ÷ 8 mg/mL= 0.31 mL Question format: Fill in the blank

The young child has been diagnosed with Guillain-Barré syndrome and it is progressing in a classic manner. Rank the following sequence of events in the order that they typically occur. A. The child is having difficulty producing facial expressions. B. The child states that it is difficult to move his legs. C. The child reports numbness and tingling in his toes. D. The child states that it is difficult to move his arms.

ANS:B, C, D, A Rationale: Guillain-Barré syndrome paresthesias and muscle weakness. Classically it initially affects the lower extremities and progresses in an ascending manner to upper extremities and then the facial muscles. Progression is usually complete in 2 to 4 weeks, followed by a stable period leading to the recovery phase.

An otherwise healthy 18 month old child with a history of febrile seizure is in the well child clinic. Which statement by the father would indicate to the nurse that additional teaching should be done? a. "I have ibuprofen available in case it's needed" b. "My child will likely outgrow these seizures by age 5" c. "I always keep phenobarbital with me in case of a fever" d. "The most likely time for a seizure is when the fever is rising"

c. "I always keep phenobarbital with me in case of a fever" Anticonvulsants, such as phenobarbital, are administered to children with prolonged seizures or neurologic abnormalities. Ibuprofen, not phenobarbital, is given for fever. Febrile seizures usually occur after age 6 months and are unusual after age 5. Treatment is to decrease the temperature because seizures occur as the temperature rises