Peds Exam 3

Assessment of a 12-year-old who crashed his bicycle without a helmet reveals the following: Temperature of 99.2; pulse of 110 beats per minute; respiratory rate 24 breaths per minute with easy work of breathing rate 24 and BP of 102/70. What is the priority action by the nurse? A. Assess the neurologic status while observing for obvious injuries. B. Administer IV fluid bolus of normal saline at 20 ml/kg. C. Remove cervical collar if he complains that it bothers him. D. Listen for bowel sounds while assessing for pain.

ANS: A

The nurse is providing care to a child with a long-leg hip spica cast. What is the priority nursing diagnosis? a. Risk for impaired skin integrity due to cast and location b. Deficient knowledge related to cast care c. Risk for delayed development related to immobility d. Self-care deficit related to immobility

ANS: A Feedback: Although deficient knowledge, risk for delayed development, and self-care deficit may be applicable, the child is at increased risk for skin breakdown due to the size of the cast and its location. In addition, the cast has an opening, which allows for elimination. Soiling of cast edges or leakage of urine or stool can lead to skin breakdown.

The nurse is planning a discussion group for parents with children who have cancer. How would the nurse describe a difference between cancer in children and adults? a. Most childhood cancers affect the tissues rather than organs. b. Childhood cancers are usually localized when found. c. Unlike adult cancers, childhood cancers are less responsive to treatment. d. The majority of childhood cancers can be prevented.

ANS: A Feedback: Childhood cancers usually affect the tissues, not the organs, as in adults. Metastasis often is present when the childhood cancer is diagnosed. Childhood cancers, unlike adult cancers, are very responsive to treatment. Unfortunately, little is known about cancer prevention in children.

A child with Duchenne muscular dystrophy is to receive prednisone as part of his treatment plan. After teaching the child's parents about this drug, which statement by the parents indicates the need for additional teaching? a. "We should give this drug before he eats anything." b. "We need to watch carefully for possible infection." c. "The drug should not be stopped suddenly." d. "He might gain some weight with this drug."

ANS: A Feedback: Corticosteroids such as prednisone can cause gastric upset, so the medication should be given with food to reduce this risk. The drug may mask the signs of infection, so the parents need to monitor the child closely for any changes. Treatment with this drug should not be stopped abruptly due to the risk for acute adrenal insufficiency. Common side effects of this drug include weight gain, osteoporosis, and mood changes.

The nurse is preparing a teaching plan for the family and their 6-year-old son who has just been diagnosed with diabetes mellitus. What would the nurse identify as the initial goal for the teaching plan? a. Developing management and decision-making skills b. Educating the parents about diabetes mellitus type 1 c. Developing a nutritionally sound, 30-day meal plan d. Promoting independence with self-administration of insulin

ANS: A Feedback: Developing basic management and decision-making skills related to the diabetes is the initial goal of the teaching plan for this child and family. The nurse would have provided a basic description of the disorder after it was diagnosed. Development of a detailed monthly meal plan would come later, perhaps after consulting with a nutritionist. It is too soon to expect the boy to administer his own insulin.

The healthcare provider has ordered rectal diazepam for a 2-year-old boy with status epilepticus. Which instruction is essential for the nurse to teach the parents? a. Monitor their child's level of sedation b. Watch for fever indicating infection c. Gradually reduce the dosage as seizures stop d. Monitor for an allergic reaction to the medication

ANS: A Feedback: Diazepam is useful for home management of prolonged seizures and requires that the parents be educated on its proper administration. Monitoring the child's level of sedation is key when giving diazepam because it slows the central nervous system. Parents need to monitor the overall health of the child, including temperature when needed, but that has nothing to do with the diazepam. When the use of an anticonvulsant is stopped, gradual reduction of the dosage is necessary to prevent seizures or status epilepticus. This is not done without a healthcare provider's order. Monitoring for allergic reactions is necessary when any medications have been prescribed, but is not specific to diazepam.

The nurse is providing care to a child with folliculitis. What would the nurse expect to administer? a. Topical mupirocin b. Oral cephalosporin c. Intravenous oxacillin d. Topical Eucerin cream

ANS: A Feedback: For folliculitis, topical mupirocin is indicated in conjunction with aggressive hygiene and warm compresses. Oral cephalosporins are used for nonbullous impetigo if there are numerous lesions. Intravenous oxacillin is used for severe cases of staphylococcal scalded skin syndrome. Topical Eucerin cream is used for atopic dermatitis.

A child with increased intracranial pressure is being treated with hyperventilation. The nurse understands the need for this treatment is based on what? a. PaCO2 levels decrease, causing vasoconstriction. b. Drainage of cerebrospinal fluid occurs. c. Activity is controlled via a stimulator. d. Hyperexcitability of the nerves is reduced.

ANS: A Feedback: Hyperventilation decreases PaCO2, which results in vasoconstriction and therefore decreases intracranial pressure. A shunt would allow for drainage of cerebrospinal fluid. A vagal nerve stimulator is used to provide an appropriate dose of stimulation to manage seizure activity. Anticonvulsants decrease the hyperexcitability of nerves.

The nurse is providing care to a child experiencing shock. Which intravenous solution would the nurse expect to administer? a. Ringer lactate b. Dextrose 5% and water c. Dextrose 5% and normal saline d. Dextrose 10% and water

ANS: A Feedback: Isotonic fluids, such as Ringer lactate or normal saline, are the fluids of choice given rapidly to children experiencing shock. Dextrose solutions are contraindicated in shock because of the risk of complications such as osmotic diuresis, hypokalemia, hyperglycemia, and worsening of ischemic brain injury

A child with hypogammaglobulinemia is to receive intravenous immunoglobulin (IVIG). What action would not be correct to take? a. Shake the vial after reconstituting it b. Premedicate the child with acetaminophen c. Obtain preinfusion vital signs d. Check serum blood urea nitrogen and creatinine levels

ANS: A Feedback: Many IVIG products are packed as two vials, one the IVIG powder and one the sterile diluents. Once reconstituted, the IVIG should not be shaken because this leads to foaming and may cause the immunoglobulin protein to degrade. The child can be premedicated with acetaminophen or diphenhydramine. Baseline serum blood urea nitrogen and creatinine should be assessed because acute renal insufficiency may occur as a serious adverse reaction.

A nurse is preparing a presentation for a local health fair about meningitis and has developed a display that lists the following causes: Streptococcus group B Haemophilus influenzae type B Streptococcus pneumoniae Neisseria meningitidis What would the nurse highlight as the most common cause of meningitis in newborns? a. Streptococcus group B b. Haemophilus influenzae type B c. Streptococcus pneumoniae d. Neisseria meningitides

ANS: A Feedback: Meningitis due to Streptococcus group B along with Escherichia coli is most common in newborns and infants. H. influenzae type B, S. pneumoniae and N. meningitides are common causes in children older than 3 months and in adults.

The nurse is caring for a 19-month-old boy who has been admitted to the emergency department with a skull fracture. The parents state that the child fell down when running through the house and hit his head on the floor. Based on normal characteristics of skull fractures, what should be the initial focus of the assessment? a. Possible physical abuse b. Possible bone cancer c. Possible chronic neurologic disease d. Possible developmental delay

ANS: A Feedback: Physical abuse must be investigated first because it takes a great deal of force to produce a skull fracture in infants and children younger than 2 years old. Due to the flexibility of the immature skull, it is able to withstand a great degree of deformation before a fracture will occur.

The nurse is assessing a 13-year-old girl with a family history of kidney cancer who has come to the clinic complaining of abdominal pain, nausea, and vomiting. Which finding would the nurse identify as least likely indicative of cancer in a child? a. The child reports rectal bleeding and diarrhea. b. Observation reveals an asymmetric abdomen. c. The child experiences a broken bone without trauma. d. Palpation determines an abdominal mass.

ANS: A Feedback: Rectal bleeding and diarrhea are symptoms of rectal cancer in adults and are not typical of children with cancer. The child reporting that a bone broke without any trauma, the nurse observing asymmetric swelling in the abdomen, or palpation revealing a mass in the abdomen are findings in children with cancer.

When developing the plan of care for a child with cerebral palsy, which treatment would the nurse expect as least likely? a. Skeletal traction b. Physical therapy c. Orthotics d. Occupational therapy

ANS: A Feedback: Skeletal traction would be the least likely treatment for a child with cerebral palsy. Physical therapy, orthotics and braces, and occupational therapy are all common treatments used for cerebral palsy.

A 5-year-old girl is cyanotic, dusky, and anxious when she arrives in the emergency department. Which action would be most appropriate? a. Ventilating the child with a bag-valve-mask b. Estimating the child's weight using a Broselow tape c. Providing therapy using automated external defibrillation d. Using rescue breathing and chest compressions

ANS: A Feedback: The child is exhibiting signs of ineffective oxygenation and ventilation. Therefore, ventilating the child with a bag-valve-mask and 100% oxygen would be effective and efficient. Estimating the child's weight with a Broselow tape is typically done by ambulatory care providers. According to the American Heart Association, automated external defibrillators are recommended for use in children who are older than age 1 year who have no pulse and have suffered a sudden, witnessed collapse outside the hospital setting. Rescue breathing and chest compressions are implemented for children who are not breathing and do not have a pulse or when the pulse rate is less than 60 beats per minute.

A 4-year-old boy has a history of seizures and has been started on a ketogenic diet. Which food selection would be most appropriate for his lunch? a. Fried eggs, bacon, and iced tea b. A hamburger on a bun, French fries, and milk c. Spaghetti with meatballs, garlic bread, and a cola drink d. A grilled cheese sandwich, potato chips, and a milkshake

ANS: A Feedback: The ketogenic diet involves a high intake of fats, adequate protein intake, and a very low intake of carbohydrates, resulting in a state of ketosis. The child is kept in a mild state of dehydration. Eggs and bacon are high in fat; the tea does not contain any carbohydrates. Therefore, this is the best choice. The hamburger is fat and protein, the bun is a carbohydrate, and the French fries and the milk both contain fat and protein, but both contain a lot of carbohydrates. The pasta and the sauce for the spaghetti are carbohydrates, the meatballs are protein, and the garlic bread is a carbohydrate, as is the cola drink. The grilled cheese sandwich has the fat and protein from the cheese, but the bread and chips are primarily carbohydrates, and the milkshake has fat, protein, and carbohydrates. Only the selection in A contains a ketogenic meal.

A group of students are reviewing information about head injuries in children. The students demonstrate understanding of this information when they identify what as the most common type of skull fracture in children? a. Linear b. Depressed c. Diastatic d. Basilar

ANS: A Feedback: The most common type of skull fracture in children is a linear skull fracture, which can result from minor head injuries. Other, less common types of skull fractures in children include depressed, diastatic, and basilar.

The nurse is administering intravenous immune globulin (IVIG). The nurse assesses vital signs and for adverse reactions every 15 minutes for the first hour of administration. After the first hour, the nurse most likely would continue to assess the child at which frequency? a. Every 30 minutes b. Every 45 minutes c. Every 60 minutes d. Every 2 hours

ANS: A Feedback: The nurse needs to continue assessments according to institutional protocol. Every 15 minutes for the first hour and every 30 minutes through the remainder of the infusion is the standard assessment.

The nurse is caring for a child with widespread itching and has recommended bathing as a relief measure. After teaching the mother about this, which statement from the mother indicates a need for further instruction? a. "After bathing, I need to rub his skin everywhere to make sure he is completely dry." b. "I must make sure I use lukewarm water instead of hot water." c. "Oatmeal baths are helpful; we can add Aveeno skin relief bath treatment." d. "We should leave his skin moist before applying medication or moisturizer."

ANS: A Feedback: The nurse needs to emphasize to the mother that she must only pat the child dry and not rub his skin. Rubbing can cause further itching. Additionally, the skin should be left moist prior to applying medication or moisturizer. Lukewarm water and oatmeal baths are appropriate.

The nurse is providing postoperative care for a 14-month-old girl who has undergone a myelomeningocele repair. The girl's mother is extremely anxious and tells the nurse she is afraid she will never learn how to care for her daughter at home. Which response by the nurse would be most appropriate? a. "I will help you become comfortable in caring for your daughter." b. "You must learn how to care for your daughter at home." c. "You will need to learn to collaborate with all the caregivers." d. "There is a lot to learn, and you need a positive attitude."

ANS: A Feedback: The nurse needs to empower families to become the experts on their child's needs and conditions via education and participation in care. The most positive approach is to let the mother know the nurse will support her and help her become an expert on her daughter's care. Telling the mother that she must learn how to care for her daughter or that she must have a positive attitude is not helpful. Telling her that she needs to collaborate with the caregivers is true, but does not address her fears.

An 8-year-old girl was diagnosed with a closed fracture of the radius at approximately 2 PM. The fracture was reduced in the emergency department and her arm placed in a cast. At 11 PM her mother brings her back to the emergency department due to unrelenting pain that has not been relieved by the prescribed narcotics. Which action would be the priority? a. Notifying the healthcare provider immediately b. Applying ice c. Elevating the arm d. Giving additional pain medication as ordered

ANS: A Feedback: The nurse should notify the healthcare provider immediately because the girl's symptoms are the classic sign of compartment syndrome. Immediate treatment is required to prevent excessive swelling and to detect neurovascular compromise as quickly as possible. The ice should be removed and the arm brought below the level of the heart to facilitate whatever circulation is present. Giving additional pain medication will not help in this situation.

The nurse is caring for a 10-year-old in traction. While performing a skin assessment, the nurse notices that the skin over the calcaneus appears slightly red and irritated. Which action would the nurse take first? a. Reposition the child's foot on a pressure-reducing device. b. Apply lotion to his foot to maintain skin integrity. c. Make sure the skin is clean and dry. d. Gently massage his foot to promote circulation.

ANS: A Feedback: The nurse's first action is to remove continuous pressure from this area. The other actions can help decrease the potential for skin breakdown, but the pressure must be relieved first.

When reviewing the history of a child with suspected primary immunodeficiency, what would the nurse be least likely to find? a. Weight appropriate for height b. Antibiotic therapy for the past 3 months without effect c. Ten episodes of otitis media in the last year d. Three bouts of sinusitis within a year's time

ANS: A Feedback: Weight appropriate for height would not be associated with primary immunodeficiency. Rather, failure to thrive is considered a warning sign. Other warning signs of primary immunodeficiency include four or more episodes of acute otitis media in 1 year; two or more episodes of severe sinusitis in 1 year; treatment with antibiotics for 2 months or longer with little effect; two or more episodes of pneumonia in 1 year; recurrent deep skin or organ abscesses; persistent oral thrush or skin candidiasis after age 1 year; history of infections that do not clear with antibiotics; two or more serious infections; and a family history of primary immunodeficiency.

A 10-month-old is brought to the emergency department by her parents after they found her face down in the bathtub. The mother said, "I just left the bathroom to answer the phone. When I came back, I found her." Which assessment would be the priority? a. Airway, breathing, and circulation b. Level of consciousness c. Vital signs d. Pupillary response

ANS: A Feedback: With a submersion injury, hypoxia is the primary problem. Therefore, assessment of airway, breathing, and circulation are the priority assessments for which the nurse would institute resuscitative measures. Other assessments such as level of consciousness, vital signs, and papillary response would be done once the child's airway, breathing, and circulation are assessed and emergency interventions are instituted.

A 15-year-old adolescent is brought to the emergency department by his parents. The adolescent is febrile with chills that started suddenly. He states, "I had a sinus infection and sore throat a couple of days ago." The nurse suspects bacterial meningitis based on which findings? Select all that apply. a. Complaints of stiff neck b. Photophobia c. Absent headache d. Negative Brudzinski sign e. Vomiting

ANS: A, B, E Feedback: In addition to the adolescent's complaints and history, other findings suggesting bacterial meningitis include complaints of a stiff neck, photophobia, headache, positive Brudzinski sign, and vomiting.

A group of students are reviewing information about respiratory arrest in children. The students demonstrate understanding of this information when they identify what common causes of respiratory arrest involving the upper airway? Select all that apply. a. Croup b. Asthma c. Pertussis d. Epiglottitis e. Pneumothorax

ANS: A, D Feedback: Common causes of respiratory arrest involving the upper airway include croup and epiglottitis. Asthma, pertussis, and pneumothorax are common causes involving the lower airway.

The parents bring their 4-year-old son to the emergency department. The child is receiving chemotherapy for acute lymphoblastic leukemia. The parents report that the child has become lethargic and has had significant episodes of vomiting and diarrhea. What findings would lead the nurse to suspect the child may be experiencing tumor lysis syndrome? Select all that apply. a. Hyperkalemia b. Hypophosphatemia c. Polyuria d. Hypocalcemia e. Hyperuricemia

ANS: A, D, E Feedback: Tumor lysis syndrome is characterized by hyperuricemia, hyperkalemia, hyperphosphatemia, decreased or absent urine output, and hypocalcemia.

The nurse is conducting a physical examination of a 9-month-old baby with a flat, discolored area on the skin. The nurse documents this as a: a. papule. b. macule. c. vesicle. d. scale.

ANS: B Feedback: A macule is a flat, discolored area on the skin. A papule is a small, raised bump on the skin. A vesicle is a fluid-filled bump on the skin. Scaling is flaking of the skin.

A 10-year-old boy is seen in the emergency department after falling down a flight of stairs and hitting his head. The child will be monitored overnight for complications. Which occurrence in the coming hours will warrant further assessment? a. The child reports a backache. b. The child is increasingly irritable with his mother and caregivers. c. The child refuses offers of snacks. d. The child reports his stomach is upset.

ANS: B Feedback: After a head injury the client should be closely observed for neurologic changes. Behavioral changes such as lethargy and irritability should be evaluated for the potential development of complications.

The nurse is assessing a 3-year-old boy whose parents brought him to the clinic when they noticed that the right side of his abdomen was swollen. What finding would suggest this child has a neuroblastoma? a. The child has a maculopapular rash on his palms. b. The parents report that their son is vomiting and not eating well. c. The parents report that their son is irritable and not gaining weight. d. Auscultation reveals wheezing with diminished lung sounds.

ANS: B Feedback: Along with the swollen abdomen on one side, the parents reporting that the child is vomiting and anorexic points to the possibility of a neuroblastoma. Observing a maculopapular rash on the child's palms is a sign of graft-versus-host disease. The parents reporting that the child is irritable and not gaining weight suggests a possible brain tumor as well as malabsorption problems. Auscultation revealing wheezing with diminished lung sounds would suggest other problems, not a neuroblastoma.

A nurse is inspecting the skin of a child with atopic dermatitis. What would the nurse expect to observe? a. Erythematous papulovesicular rash b. Dry, red, scaly rash with lichenification c. Pustular vesicles with honey-colored exudates d. Hypopigmented oval scaly lesions

ANS: B Feedback: Atopic dermatitis or eczema is characterized by a dry, red, scaly rash with lichenification and hypertrophy. An erythematous papulovesicular rash is associated with contact dermatitis. Pustules and vesicles with honey-colored exudates suggest nonbullous impetigo. Hypopigmented oval scaly lesions are associated with tinea versicolor.

A child with suspected sickle cell disease is scheduled for a hemoglobin electrophoresis. When reviewing the child's history, what would the nurse identify as potentially interfering with the accuracy of the results? a. Use of iron supplementation b. Blood transfusion 1 month ago c. Lack of fasting for 12 hours d. History of recent infection

ANS: B Feedback: Blood transfusion within the previous 12 weeks may alter the results of the hemoglobin electrophoresis. Iron supplements can increase serum ferritin levels. Children should fast for 12 hours before having a specimen obtained for iron levels. A history of infection might interfere with the white blood cell count results, not hemoglobin electrophoresis.

The nurse is caring for an 8-year-old girl who has been diagnosed with leukemia and will have a variety of tests, including a lumbar puncture, before beginning chemotherapy. What action would be the priority? A. Applying EMLA to the lumbar puncture site B. Educating the child and family about the testing procedures C. Administering promethazine as ordered for nausea D. Educating the family about chemotherapy and its side effects

ANS: B Feedback: Family should be educated on the procedure so they know what to expect and understand why the procedure is being performed

A 5-year-old child with type 1 diabetes is brought to the clinic by his mother for a follow-up visit after having his hemoglobin A1C level drawn. Which result would indicate to the nurse that the child is achieving long-term glucose control? a. 9.0% b. 8.2% c. 7.3% d. 6.9%

ANS: B Feedback: For a child 6 years of age and younger, the target HbA1C level should be less than 8.5% but greater than 7.5%. For children between the ages of 6 and 12 years, the target HbA1C level is less than 8%. For children and adolescents between 13 and 19 years of age, the target HbA1C level would be less than 7.5%.

A child is diagnosed with bacterial conjunctivitis and is prescribed topical antibiotic therapy. The child's mother asks when he can return to school. Which response by the nurse would be most appropriate? a. "You need to wait until you finish the entire prescription of antibiotic." b. "Once the drainage is gone, he can go back to school." c. "You can send him to school this afternoon after his first dose of antibiotic." d. "He needs to be symptom-free for at least 72 hours."

ANS: B Feedback: For the child with bacterial conjunctivitis, the child may safely return to school or day care when the mucopurulent drainage is no longer present, usually after 24 to 48 hours of treatment with the topical antibiotic. There is no need to wait until the prescription is finished. The antibiotic is being given topically, not systemically. One dose of antibiotic is not sufficient to eradicate the infection. Typically 24 to 48 hours of treatment is needed to stop the drainage, which, when no longer present, indicates that the child can return to school.

What information would the nurse include in the preoperative plan of care for an infant with myelomeningocele? a. Positioning supine with a pillow under the buttocks b. Covering the sac with saline-soaked nonadhesive gauze c. Wrapping the infant snugly in a blanket d. Applying a diaper to prevent fecal soiling of the sac

ANS: B Feedback: For the infant with a myelomeningocele, saline-soaked nonadhesive gauze or antibiotic-soaked gauze is used to keep the sac moist. The infant is positioned prone, with a folded towel under the abdomen, so that the urine and feces flow away from the sac. A warmer or isolette is used to keep the infant warm. Blankets are avoided because they could place excess pressure on the sac. Diapering may be contraindicated to avoid placing pressure on the sac.

When teaching a group of new parents about newborn care and development, which immunoglobulin would the nurse explain as being primarily responsible for the passive immunity exhibited by newborns? a. IgA b. IgG c. IgM d. IgE

ANS: B Feedback: IgG is acquired transplacentally, providing the newborn with passive immunity to antigens to which the mother had developed antibodies. IgA, IgD, IgE, and IgM do not cross the placenta and require an antigenic challenge for production.

The nurse is describing the phases of treatment to a child who was diagnosed with leukemia and his parents. How would the nurse describe the induction stage? a. Intense therapy to strengthen remission b. Rapid promotion of complete remission c. Elimination of all residual leukemic cells d. Reduction of risk for central nervous system (CNS) disease

ANS: B Feedback: Induction is done to rapidly produce a complete remission. Consolidation or intensification is the stage when remission is strengthened and leukemic cell burden is reduced. Maintenance attempts to eliminate all residual leukemic cells, and CNS prophylaxis is the stage that attempts to reduce the development of CNS disease.

The mother of a 5-year-old child with eczema is getting a check-up for her child before school starts. What will the nurse do during the visit? a. Change the bandage on a cut on the child's hand. b. Assess the compliance with treatment regimens. c. Discuss systemic corticosteroid therapy. d. Assess the child's fluid volume.

ANS: B Feedback: Maintaining proper therapy for eczema can be exhausting both physically and mentally. Therefore, it is essential that the nurse assess compliance and support the parents' ability to cope if necessary. Changing a bandage is not part of a health maintenance visit. Hydration is important for a child with eczema; however, fluid volume is not the focus at this visit. Systemic corticosteroid therapy is very rarely used and the success of the current therapy needs to be assessed first.

The nurse assesses a child's level of consciousness, noting that the child falls asleep unless he is stimulated. The nurse documents this finding as: a. Confusion b. Obtunded c. Stupor d. Coma

ANS: B Feedback: Obtunded is a state in which the child has limited responses to the environment and falls asleep unless stimulation is provided. Confusion involves disorientation; the child may be alert but responds inappropriately to questions. Stupor exists when the child responds only to vigorous stimulation. Coma is a state in which the child cannot be aroused even with painful stimuli.

What would be most appropriate to include in the plan of care for a child who has undergone surgery for removal of an astrocytoma? a. Elevating the foot of the bed b. Positioning the child on his unaffected side c. Raising the head of the bed at least 45 degrees d. Administering large volumes of intravenous fluids

ANS: B Feedback: Postoperatively, the nurse should position the child on his unaffected side, with the head of the bed flat or at the level prescribed by the neurosurgeon. The foot of the bed is not elevated to prevent increasing intracranial pressure and contributing to bleeding. Fluids are administered carefully to avoid excess fluid intake, which would cause or worsen cerebral edema.

The nurse is providing a class for a group of childcare providers. When discussing allergic reactions, which statement by a participant indicates the need for further instruction? a. "Most allergic reactions will happen within a few minutes of eating a problematic food." b. "If a child has previously eaten a food and not had a reaction they are not 'truly' allergic to it." c. "Allergic reactions can happen hours after eating something." d. "In addition to hives some children may also have vomiting and diarrhea when having an allergic reaction to a food."

ANS: B Feedback: Previous exposure with no incident does not mean an individual cannot develop a hypersensitivity to a food or other substance. An allergy may develop at any time. The remaining statements are correct.

The nurse is talking to the parents of a child who has been diagnosed with severe combined immune deficiency (SCID). Which statement by the parents best indicates that they understand their child's condition? a. "He'll need to receive intravenous immunoglobulin routinely." b. "We'll need to prepare him and ourselves for a bone marrow transplant." c. "He'll need to receive several different types of antiviral medications." d. "We'll make sure that he has his EpiPen with him at all times."

ANS: B Feedback: SCID is a potentially fatal disorder requiring emergency intervention at the time of diagnosis. Gene therapy provides some promise for the future treatment of SCID, but until then bone marrow or stem cell transplantation is necessary. IVIG may be used to help decrease the number of infections until bone marrow or stem cell transplantation can be done. Antiviral medications are used to treat HIV infection. An EpiPen is used for anaphylaxis.

A child with diabetes reports that he is feeling a little shaky. Further assessment reveals that the child is coherent but with some slight tremors and sweating. A fingerstick blood glucose level is 70 mg/dL. What would the nurse do next? a. Administer a sliding-scale dose of insulin. b. Give 10 to 15 g of a simple carbohydrate. c. Offer a complex carbohydrate snack. d. Administer glucagon intramuscularly.

ANS: B Feedback: The child is experiencing hypoglycemia as evidenced by the assessment findings and blood glucose level. Since the child is coherent, offering the child 10 to 15 g of a simple carbohydrate would be appropriate. Insulin is not used because the child is hypoglycemic. A complex carbohydrate snack would be used after offering the simple carbohydrate to maintain the glucose level. Intramuscular glucagons would be used if the child was not coherent.

The nurse is administering 10 units of NPH insulin to a child at 8 AM. The nurse would expect this insulin to begin acting at which time? a. By 8:15 AM b. Between 8:30 and 9 AM c. Between 9 and 11 AM d. Around 12 noon

ANS: C Feedback: NPH insulin has an onset of action of 1 to 3 hours, so the drug would begin to act between 9 and 11 AM. A rapid-acting insulin would begin to act by 8:15 AM; regular insulin would begin to act between 8:30 and 9 AM. No type of insulin would begin acting around 12 noon.

A nurse is preparing a plan of care for a child with a primary immunodeficiency. Which nursing diagnosis is the priority? a. Imbalanced nutrition, less than body requirements related to poor appetite b. Ineffective protection related to impaired humoral defenses c. Acute pain related to inflammatory processes d. Risk for delayed growth and development related to chronic illness

ANS: B Feedback: The child with a primary immunodeficiency lacks the necessary immune responses that provide protection from infection. Therefore, the priority nursing diagnosis would be ineffective protection. Imbalanced nutrition and risk for delayed growth and development may be appropriate, but these would not be the priority. Acute pain would be more appropriate for a child with juvenile idiopathic arthritis.

The nurse is caring for a 10-year-old with Duchenne muscular dystrophy. As part of the plan of care, the nurse focuses on maintaining his cardiopulmonary function. Which intervention would the nurse implement to best promote maximum chest expansion? a. Deep-breathing exercises b. Upright positioning c. Coughing d. Chest percussion

ANS: B Feedback: The nurse should emphasize that the child's position should be arranged to promote maximum chest expansion. This is usually in the upright position. Deep-breathing exercises are for strengthening/maintaining respiratory muscles. Coughing helps clear the airways. Chest percussion helps loosen secretions in lungs.

The nurse is caring for a child who is taking corticosteroids for systemic lupus erythematosus. The nurse closely monitors the child based on the understanding that corticosteroids exert which major action? a. They increase liver enzymes. b. They can mask signs of infection. c. They cause bone marrow suppression. d. They decrease renal function.

ANS: B Feedback: The nurse understands that corticosteroids may mask signs of infection. Cytotoxic drugs cause bone marrow suppression. Nonsteroidal anti-inflammatory drugs can increase liver enzymes and decrease renal function.

An instructor is developing a plan for a class of nursing students on various skin disorders. When describing urticaria, what would the instructor include? a. It is a type IV hypersensitivity reaction. b. Histamine release leads to vasodilation. c. Wheals appear first followed by erythema. d. The nonpruritic rash blanches with pressure.

ANS: B Feedback: Urticaria is a type I hypersensitivity reaction caused by an immunologically mediated antigen-antibody response of histamine release from the mast cells. Vasodilation and increased vascular permeability result, leading to erythema and then wheals. The rash is pruritic and blanches with pressure.

A nurse is performing a primary survey on a child who has sustained partial thickness burns over his upper body areas. What action should the nurse take first? a. Inspect the child's skin color. b. Assess for a patent airway. c. Observe for symmetric breathing. d. Palpate the child's pulse.

ANS: B Feedback: When performing a primary survey, the nurse first assesses the child's airway for patency and then intervenes accordingly to ensure that the airway is patent. Next the nurse would evaluate the child's skin color, respiratory effort, and symmetry of breathing and breath sounds. Then the nurse would determine the pulse strength, perfusion status, and heart rate.

The nurse is caring for an infant with candidal diaper rash. Which topical agent would the nurse expect the healthcare provider to order? a. Corticosteroids b. Antifungals c. Antibiotics d. Retinoids

ANS: B Feedback: Candidal diaper rash would require a fungicide. The nurse would expect to administer topical antifungals as ordered. Corticosteroids are not typically recommended for young infants and are used for atopic dermatitis and certain types of contact dermatitis. Antibiotics would be ineffective against fungal infections. Retinoids are indicated for moderate to severe acne.

What would the nurse include when teaching parents how to prevent otitis externa? a. Daily ear cleaning with cotton swabs b. Wearing earplugs when swimming c. Using a hair dryer on high to dry the ear canals d. Using hydrogen peroxide to dry the canal skin

ANS: B Feedback: To prevent otitis externa, the nurse would teach parents and children to wear earplugs when swimming and to avoid use of cotton swabs, headphones, and earphones. A hair dryer on a low setting can be used to dry the ear canals. A mixture of half rubbing alcohol and half vinegar can be used to dry the canal and alter the pH to discourage organism growth.

A 1-month-old infant admitted to the emergency department in respiratory distress exhibits a regular pattern of breathing followed by brief periods of apnea, then tachypnea for a short time, eventually returning to a normal respiratory rate. This type of breathing is: a. hypoventilation. b. hyperventilation. c. periodic breathing d. stridor.

ANS: C Feedback: Periodic breathing is regular breathing with occasional short pauses followed by rapid breathing for a short period, then eventually resumption of a normal respiratory rate. Hypoventilation refers to a decrease in the depth and rate of respirations. Hyperventilation refers to an increased depth and rate of respirations. Stridor refers to a high-pitched, easily audible inspiratory noise.

A nurse is preparing a class for parents of infants about managing diaper dermatitis. What advice would the nurse include in the presentation? Select all that apply. a. Applying topical nystatin to the diaper area b. Using a blow dryer on warm to dry the diaper area c. Refraining from using rubber pants over diapers d. Using scented diaper wipes to clean the area e. Washing the diaper area with an antibacterial soap

ANS: B, C Feedback: For diaper dermatitis, topical products such as ointments or creams containing vitamins A, D, and E; zinc oxide; or petrolatum help to provide a barrier. Nystatin is an antifungal agent used for diaper candidiasis. Using a blow dryer on warm to dry the area, avoiding the use of rubber pants, and using unscented diaper wipes or ones free of preservatives are appropriate. The area should be washed with a soft cloth, without harsh soaps.

The community health nurse has just completed a presentation to a group of parents regarding drowning prevention. Which statements by the parents indicate understanding of the teaching? Select all that apply. a. "I am so glad our 6-year-old child had swim lessons. We really can't afford a fence around our pool." b. "Since we have a 16-year-old I am really concerned about supervision when our child is swimming in the ocean." c. "We always make sure our babysitter keeps her CPR training up to date." d. "It is scary to think that we have a pool and drowning is the second leading cause of accidental death in children." e. "We make sure to keep our bathroom door closed when our 10-month-old is walking around the house since the door handle is too high to reach."

ANS: B, C, D, E Feedback: In children older than 15 years of age, most drownings occur in natural water settings, such as oceans or lakes. Most incidents of drowning are accidental and result from inadequately supervising children of any age. It is important for any caregivers of children to be current on CPR in case of any accident. Children younger than 1 year old most often drown in bathtubs, buckets, or toilets, so keeping the bathroom door closed helps decrease the risk of drowning.

The mother of a 15-year-old girl has contacted the clinic to report that her daughter has burned the back of her hand with a curling iron. The child's mother reports the burn is mild but states her daughter is complaining of pain. After consulting with the healthcare provider, what instructions can the nurse anticipate will be recommended? Select all that apply. a. Apply a thin film of protective cocoa butter. b. Run cool water over the injured area. c. Apply ice for 15 to 20 minutes each hour until the pain subsides. d. Take acetaminophen using the manufacturer's guidelines. e. Apply a thin layer of petroleum jelly to the burned area.

ANS: B, D Feedback: Mild burns may be cared for at home. Cool water may be run over the injured tissue. Acetaminophen or ibuprofen may be administered for pain. Ointments and creams including butter, margarine, cocoa butter, and petroleum jelly should not be applied.

A mother brings her child to the healthcare clinic because she thinks that the child has conjunctivitis. Which assessment findings would lead the nurse to suspect bacterial conjunctivitis? Select all that apply. a. Itching of the eyes b. Inflamed conjunctiva c. Stringy discharge d. Photophobia e. Mild pain f. Tearing

ANS: B, E Feedback: Bacterial conjunctivitis is manifested by inflamed conjunctiva, a purulent or mucoid discharge, mild pain, and occasional eyelid edema. Itching and a stringy discharge suggest allergic conjunctivitis. Photophobia and tearing suggest viral conjunctivitis.

The nurse is caring for a newborn whose mother is HIV positive. The nurse would expect to administer a 6-week course of which medication? a. Lopinavir b. Ritonavir c. Nevirapine d. Zidovudine

ANS: D Feedback: Children born to HIV-positive mothers should receive a 6-week course of zidovudine therapy. Lopinavir, ritonavir, and nevirapine are medications used for treatment of HIV-1 infections as part of a three-drug regimen.

An 8-year-old boy with a fractured forearm is to have a fiberglass cast applied. What information would the nurse include when teaching the child about the cast? a. The cast will take a day or two to dry completely. b. The edges will be covered with a soft material to prevent irritation. c. The child initially may experience a very warm feeling inside the cast. d. The child will need to keep his arm down at his side for 48 hours.

ANS: C Feedback: A fiberglass cast usually takes only a few minutes to dry and will cause a very warm feeling inside the cast. Therefore, the nurse needs to warn the child that this will occur. Fiberglass casts usually have a soft fabric edge so they usually do not cause skin rubbing at the edges and don't require petaling. The child should be instructed to elevate his arm above the level of the heart for the first 48 hours.

An 18-month-old was brought to the emergency department by her mother, who states, "I think she broke her arm." The child is sent for a radiograph to confirm the fracture. Additional assessment of the child leads the nurse to suspect possible child abuse. Which type of fracture would the radiograph most likely reveal? a. Plastic deformity b. Buckle fracture c. Spiral fracture d. Greenstick fracture

ANS: C Feedback: A spiral fracture is very rare in children. A spiral femoral or humeral fracture, particularly in a child younger than 2 years of age, should always be thoroughly investigated to rule out the possibility of child abuse. Plastic, buckle, and greenstick fractures are common in children and do not usually suggest child abuse.

The nurse is caring for a 13-year-old boy in traction prior to surgery for slipped capital femoral epiphysis. He has been in an acute care setting for 2 weeks and will require an additional 10 days in the hospital. He is complaining that he feels isolated and is resisting further treatment. Which response by the nurse would be most appropriate? a. "I know it is boring, but you must remain immobile for 2 more weeks." b. "If there are no complications, you only have 2 more weeks here." c. "Let's come up with things to do like books, movies, games, and friends to visit." d. "If you resist your treatment, your condition will only get worse."

ANS: C Feedback: After 2 weeks in traction, a teenager can become easily bored and isolated from usual peer interaction. The most helpful intervention would be to engage the help of the child to develop a list of books, games, movies, and other activities that he would enjoy. The nurse should also encourage visitation and phone calls from friends. Telling the adolescent that he needs to remain immobile or telling him that he has only 2 more weeks do not address the adolescent's issue. Telling the adolescent that his condition will worsen if he resists is threatening and inappropriate.

The nurse is developing a teaching plan for a child who is to have his cast removed. What instruction would the nurse most likely include? a. Applying petroleum jelly to the dry skin b. Rubbing the skin vigorously to remove the dead skin c. Soaking the area in warm water every day d. Washing the skin with dilute peroxide and water

ANS: C Feedback: After a cast is removed, the child and family should be instructed to soak the area in warm water every day to help soften and remove the dry flaky skin. Moisturizing lotion, not petroleum jelly, should be applied to the skin. Vigorous rubbing would traumatize the skin and should be avoided. Warm soapy water, not dilute peroxide and water, should be used to wash the area.

After teaching a group of nursing students about shock in children, the instructor determines that the teaching was successful when the students identify which type of shock as most common? a. Septic b. Cardiogenic c. Hypovolemic d. Distributive

ANS: C Feedback: Although septic, cardiogenic, hypovolemic, and distributive shock can occur in children, hypovolemic shock is the most common type of shock that occurs in children.

The school nurse is walking through the lunchroom when one of the children says she started to feel strange after trading lunches with a friend. Which assessment would be most important? a. Asking if she has a rash anywhere b. Checking if she has any nausea c. Determining if her throat itches d. Asking if she has abdominal pain

ANS: C Feedback: Asking if the child's throat itches is most important because this aids in determining airway patency, which is always the priority. Asking about a rash, nausea, or abdominal pain can be done after the nurse is certain the child's airway is not jeopardized.

The nurse is interviewing the mother of a 6-month-old being seen at a well-child visit. The mother reports she has used an over-the-counter topical ointment intended for adults on her child for a skin rash. What is the most appropriate response by the nurse? a. "This is dangerous so please do not do this again." b. "Why did you do that instead of contacting your healthcare provider?" c. "Children have thin skin and can absorb medications differently than adults." d. "How often do you use this medication?"

ANS: C Feedback: Children have thinner skin than adults. They will absorb topical medications more rapidly than adults. Medications concentrated for adults should not be used on children. It is important to explain this to the parent. It is confrontational to tell her this is dangerous or to tell her to contact the healthcare provider. The frequency of use is information that should be obtained but the education is most important in this scenario.

A nurse is caring for a 5-year-old in Bucks traction. When conducting a skin examination for signs of pressure ulcers, the nurse pays particular attention to which area? a. Sacral area b. Hip area c. Occiput d. Upper arm

ANS: C Feedback: Common sites of pressure ulcers in hospitalized children include the occiput and toes, while children who require wheelchairs for mobility demonstrate pressure ulcers in the sacral or hip areas more frequently. The upper arm is not a common site for pressure ulcers.

A nurse is preparing a program for a group of parents about injury prevention. What would the nurse include as an important contributing factor for cervical spine injury in a child? a. Exposure to teratogens while in utero b. Immaturity of the central nervous system c. Increased mobility of the spine d. Incomplete myelinization

ANS: C Feedback: Compared to the adult, a child's spine is very mobile, especially in the cervical spine region, resulting in a higher risk for cervical spine injury. Exposure to teratogens in utero may lead to altered growth and development of the brain or spinal cord. Immaturity of the central nervous system places the infant at risk for insults that may result in delayed motor skill attainment or cerebral palsy. Incomplete myelinization reflects the lack of motor control.

A 6-year-old boy with cerebral palsy has been admitted to the hospital for some tests. His condition is stable. The boy's mother remains with her son, but she is obviously exhausted and stressed. Which response by the nurse would be most appropriate? a. "Would you like me to bring you a blanket and pillow?" b. "You are doing such a wonderful job with your son." c. "He's in good hands; consider going home to get some sleep." d. "Are you planning to spend the night or to go home?"

ANS: C Feedback: Providing daily, intense care can be quite demanding and tiring. When a child with cerebral palsy is admitted to the hospital, this may serve as a time of respite for family and primary caregivers. The nurse should remind the mother that her son is in good hands and urge her to go home. Asking her whether she is planning to stay might make the mother feel obligated to stay. Asking if she wants a blanket or pillow does not encourage the mother to leave the hospital. Telling the mother she is doing a good job is nice, but does not encourage her to take a break.

A 4-year-old is brought to the emergency department with a burn. What would alert the nurse to the possibility of child abuse? a. Burn assessment correlates with mother's report of contact with a portable heater. b. Parents state that the injury occurred approximately 15 to 20 minutes ago. c. Clear delineations are noted between burned and nonburned skin areas. d. The burn area appears asymmetric and nonuniform.

ANS: C Feedback: Suggested signs of a burn resulting from possible child abuse include a uniform appearance of the burn with clear delineations of burned and nonburned areas. Abuse would also be suspected if the report of the injury was inconsistent with burn injury or there was a delay in seeking treatment. An asymmetric nonuniform burn often correlates with a splatter-type burn resulting from the child pulling a source of hot fluid onto himself or herself.

The nurse is caring for an 8-year-old boy who has chronic epilepsy. What would be most important to address when teaching the child and parents about living with this condition? a. Multiple corrective surgeries to slowly remove diseased parts of his brain b. Physical, occupational, and speech therapy to maximize his potential c. Support for maintaining self-esteem because of his altered lifestyle d. Hyperventilation therapy to counteract the periods of decreased oxygenation

ANS: C Feedback: The effects of living with a seizure disorder can be devastating, and it is essential for the child to receive support to maintain self-esteem. While corrective surgery is possible, it would only be performed once. Physical, occupational, speech, and hyperventilation therapy are not indicated for treatment of epilepsy.

After teaching a group of parents about ear infections in children, which statement indicates that the teaching was successful? a. Infants with congenital deformities have an increased risk for ear infections. b. Ear infections typically increase as the child gets older. c. The shorter and wider eustachian tubes of an infant increase the risk. d. Adenoids shrink as the child grows, allowing more bacteria to enter.

ANS: C Feedback: The infant has relatively short, wide, horizontally placed eustachian tubes, allowing bacteria and viruses to gain access to the middle ear and resulting in an increased number of infections as compared to adults. Congenital deformities of the ear are associated with other body system anomalies, but not necessarily an increase in ear infections. As the child matures, the eustachian tubes assume a more slanted position, so older children and adults have fewer infections. A child's adenoids are often enlarged, leading to obstruction of the eustachian tubes and infection.

The nurse is caring for a child who has undergone stem cell transplantation for severe combined immune deficiency. What finding would the nurse interpret as indicative of graft-versus-host disease? a. Presence of wheezing b. Splenomegaly c. Maculopapular rash d. Chronic or recurrent diarrhea

ANS: C Feedback: The nurse should monitor the stem cell transplant child closely for a maculopapular rash that usually starts on the palms and soles for indication that graft-versus-host disease is developing. Wheezing and recurrent diarrhea are not typical clinical manifestations of graft-versus-host disease. Splenomegaly is associated with hypogammaglobulinemia.

The nurse is caring for a child who is having an anaphylactic reaction with bronchospasm. The nurse would expect to administer what medication for bronchospasm as ordered? a. Epinephrine b. Corticosteroid c. Albuterol d. Diphenhydramine

ANS: C Feedback: The nurse would expect to administer bronchodilator inhalation treatment (albuterol) if bronchospasm is present. Epinephrine, diphenhydramine, and/or corticosteroids are administered to reverse the allergic process.

When caring for an 8-year-old boy injured in an automobile accident, the nurse demonstrates understanding of the principles of Pediatric Advanced Life Support (PALS) by which action? a. Assisting ventilation with a bag-valve-mask (BVM) device b. Treating ventricular fibrillation using a defibrillator c. Managing compensated shock to prevent decompensated shock d. Treating supraventricular tachycardia using cardioversion

ANS: C Feedback: The principles of PALS stress evaluating and managing compensated shock with the goal of preventing decompensated shock and thereby preventing cardiopulmonary arrest. Assisting ventilation with a BVM device, treating ventricular fibrillation using a defibrillator, and treating supraventricular tachycardia using cardioversion are interventions that may be used to treat both children and adults.

A group of nursing students are reviewing information about the endocrine system in infants and children. The students demonstrate understanding of the information when they state: a. Endocrine glands begin developing in the third trimester of gestation. b. At birth, the endocrine glands are completely functional. c. Infants have difficulty balancing glucose and electrolytes. d. A child's endocrine system has little effect on growth and development.

ANS: C Feedback: Typically, most endocrine glands begin to develop during the first trimester of gestation, but their development is incomplete at birth. Thus, complete hormonal control is lacking during the early years of life, and the infant cannot appropriately balance fluid concentration, electrolytes, amino acids, glucose, and trace substances.

A 4-year-old boy has a febrile seizure during a well-child visit. What action would be a priority? a. Hyperextending the child's head while placing him on his side b. Using a tongue blade to pry open the child's jaw c. Loosening the child's clothing to ensure a patent airway d. Protecting the child from harm during the seizure

ANS: D Feedback: During a seizure, the child should not be held down in a specific position. Protecting the child's head and body during the seizure is the priority. Ensuring a patent airway is an important intervention but is not accomplished by loosening the child's clothing or hyperextending his head. The child should be placed on his side and nothing should be inserted into his mouth to forcibly open the jaw.

A child with persistent otitis media with effusion is to undergo insertion of pressure-equalizing tubes via a myringotomy. The child is to be discharged later that day. After teaching the parents about caring for their child after discharge, which statement indicates that the teaching was successful? a. "The tubes will stay in place for about a month and then fall out on their own." b. "His chances for ear infections now have dramatically decreased." c. "He should wear earplugs when swimming in a pool or a lake." d. "We should keep the ears protected with cotton balls for the first 24 hours."

ANS: C Feedback: When pressure-equalizing tubes are inserted, the surgeon may recommend avoiding water entry into the ears. Therefore, earplugs are suggested when the child is in the bathtub or swimming. When swimming in a lake, earplugs are especially important because lake water is contaminated with bacteria and entry of that water into the middle ear must be avoided. Typically, the tubes remain in place for at least several months and generally fall out on their own. Placement of pressure-equalizing tubes does not prevent middle ear infection. Other than earplugs for bathing and swimming, nothing else is placed in the child's ear.

When developing the plan of care for a child with burns requiring fluid replacement therapy, what information would the nurse expect to include? a. Administration of colloid initially followed by a crystalloid b. Determination of fluid replacement based on the type of burn c. Administration of most of the volume during the first 8 hours d. Monitoring of hourly urine output to achieve less than 1 mL/kg/hr

ANS: C Feedback: With fluid replacement therapy, most of the volume is administered during the first 8 hours. Crystalloids (such as Ringer lactate) are administered for the first 24 hours, and then colloids are used once capillary permeability is less of a concern. Fluid replacement is determined by the amount of body surface area burned. Hourly urine output is expected to be at least 1 mL/kg/hr.

A preschooler presents to emergency department with history of vomiting, diarrhea, and fever over the past 3 days. She is receiving 100% oxygen via non-rebreather mask? Vital signs are temperature 104.5F, pulse 144 BPM, respiratory rate 30 BPM and BP 70/50 mm Hg. She is listless and difficult to arouse and has weak peripheral pulses with prolonged capillary refills. A. Administering acetaminophen rectally for the high fever. B. Administering IV antibiotics for the infection. C. Preparing the child for endotracheal intubation. D. Giving an IV bolus of lactated Ringers 20 ml/kg

ANS: D

A child has undergone surgery using steel bar placement to correct pectus excavatum. What position would the nurse instruct the parents to avoid? a. Semi-Fowler b. Supine c. High Fowler d. Side-lying

ANS: D Feedback: After surgery to correct pectus excavatum, the nurse would instruct the parents to avoid positioning the child on either side because this could disrupt the bar's position. Semi- or high Fowler's position and the supine position would be appropriate.

A 6-year-old boy has been admitted to the hospital with burns. The nurse notes carbonaceous sputum. What action would be the priority? a. Determining the burn depth b. Eliciting a description of the burn c. Estimating burn extent d. Ensuring a patent airway

ANS: D Feedback: Carbonaceous sputum is a sign of potential airway injury due to smoke inhalation. Therefore, the nurse should ensure a patent airway while obtaining a brief history and simultaneously evaluating the child and providing emergency care. If the burn does not pose an immediate, life-threatening risk, the nurse would obtain an in-depth history and elicit a description of the burn. Determining the burn depth and extent are part of the secondary survey.

A nurse is caring for a 14-year-old girl who received an electrical burn. The nurse would anticipate preparing the girl for which diagnostic tests as ordered? a. Pulse oximetry b. Fiberoptic bronchoscopy c. Xenon ventilation-perfusion scanning d. Electrocardiographic monitoring

ANS: D Feedback: Electrocardiographic monitoring is important for the child who has suffered an electrical burn to identify possible cardiac arrhythmias, which can be noted for up to 72 hours after a burn injury. Fiberoptic bronchoscopy and xenon ventilation-perfusion scanning may be ordered to evaluate an inhalation injury, not an electrical burn. Pulse oximetry is used to evaluate pulmonary function and would not be indicated in the case of an electrical burn.

A nurse develops a plan of care for a child that includes patching the eye. This plan of care would be most appropriate for which condition? a. Astigmatism b. Hyperopia c. Myopia d. Amblyopia

ANS: D Feedback: Eye patching is used for amblyopia or any condition that results in one eye being weaker than the other. Corrective lenses would be appropriate for astigmatism, hyperopia, and myopia.

A child is diagnosed with atopic dermatitis. Which laboratory test would the nurse expect the child to undergo to provide additional evidence for this condition? a. Erythrocyte sedimentation rate b. Potassium hydroxide prep c. Wound culture d. Serum immunoglobulin E (IgE) level

ANS: D Feedback: IgE levels are often used to evaluate for atopic dermatitis. IgE levels are elevated in this condition. Erythrocyte sedimentation rate may be used but this test is nonspecific and only indicates infection or inflammation. Potassium hydroxide prep is used to identify fungal infections. Wound culture would be done to identify a specific organism if an infection occurs with atopic dermatitis.

The nurse is caring for a 7-year-old girl who is undergoing a stem cell transplant. What information would the nurse include in the child's postoperative plan of care? a. Assessing for petechiae, purpura, bruising, or bleeding b. Limiting blood draws to the minimum volume required c. Administering antiemetics around the clock as ordered d. Monitoring for severe diarrhea and maculopapular rash

ANS: D Feedback: In the posttransplant phase, monitor closely for symptoms of graft-versus-host disease (GVHD) such as severe diarrhea and maculopapular rash progressing to redness or desquamation of the skin (especially on the palms of the hands or soles of the feet). During chemotherapy in the pretransplant phase, assess for petechiae, purpura, bruising, or bleeding to prevent hemorrhage; administer antiemetics around the clock as ordered to prevent the cycle of nausea, vomiting, and anorexia; and limit blood draws to the minimum volume required to prevent anemia.

A group of nursing students are reviewing information about the types of skin and skeletal traction. The students demonstrate understanding of this information when they identify which of these as a type of skeletal traction? a. Russell traction b. Bryant traction c. Buck traction d. Knee 90-90 traction

ANS: D Feedback: Knee 90-90 traction is a type of skeletal traction with force applied through a pin in the distal femur. Russell traction, Bryant traction, and Buck traction are types of skin/external traction.

A group of students are reviewing information about the various types of insulin used to treat type 1 diabetes. The students demonstrate understanding of the information when they identify which of these insulins as having the longest duration? a. Lispro b. Regular c. NPH d. Glargine

ANS: D Feedback: Of the insulins listed, glargine (Lantus) has the longest duration of action, that is, 12 to 24 hours. Lispro lasts approximately 3 to 5 hours; regular lasts 5 to 8 hours; and NPH lasts approximately 10 to 16 hours.

A 16-year-old boy reports to the school nurse reporting headaches and a stiff neck. Which sign or symptom would alert the nurse that the child may have bacterial meningitis? a. Fixed and dilated pupils b. Frequent urination c. Sunset eyes d. Sunlight is "too bright"

ANS: D Feedback: Photophobia, or intolerance of light, is another symptom of bacterial meningitis. Fixed and dilated pupils are a symptom of head trauma and warrant prompt intervention. Frequent urination is a symptom of a type I Arnold-Chiari malformation. Sunset eyes indicate increased intracranial pressure typical of hydrocephalus.

What finding would lead the nurse to suspect that a child is beginning to develop increased intracranial pressure? a. Bradycardia b. Cheyne-Stokes respirations c. Fixed, dilated pupils d. Projectile vomiting

ANS: D Feedback: Projectile vomiting is an early sign of increased intracranial pressure. Bradycardia, Cheyne-Stokes respirations, and fixed dilated pupils are late signs of increased intracranial pressure.

The nurse is caring for a 3-year-old boy with amblyopia. Which intervention would be most appropriate to include in the child's plan of care? a. Rinsing the eye with cool water b. Educating the family about the disease c. Encouraging frequent hand washing d. Promoting eye safety

ANS: D Feedback: Promoting eye safety is extremely important for the child with amblyopia; if the better eye suffers a serious injury, both eyes may become blind. Rinsing the eye with cool water, educating the family about the disorder, and encouraging frequent hand washing are interventions for infectious conjunctivitis.

The nurse inspects the eyes of a child and observes that the sclera is showing over the top of the iris. The nurse documents this finding as: a. Decorticate posturing b. Nystagmus c. Doll's eye d. Sunsetting

ANS: D Feedback: Sunsetting is when the sclera of the eyes is showing over the top of the iris. Decorticate posturing includes adduction of the arms, flexion at the elbows with the arms held over the chest, and flexion of the wrists with both hands fisted and the lower extremities adducted and extended. Nystagmus is manifested by involuntary rapid rhythmic eye movements. Doll's eye is a maneuver that tests for symmetric eye movement to the opposite side when the head is turned in the other direction.

A nurse is preparing a presentation for an expectant parent group about neural tube defects and how to prevent them. Which would the nurse emphasize? a. Smoking cessation b. Aerobic exercise c. Increased calcium intake d. Folic acid supplementation

ANS: D Feedback: The cause of neural tube defects is unknown, but there is strong evidence to support the use of folic acid supplementation for prevention. Smoking cessation and aerobic exercise are general health recommendations unrelated to neural tube defects. Increased calcium intake is important for fetal growth and development, but it is not linked to preventing neural tube defects.

What would be most appropriate to use to help maintain a patent airway in an infant experiencing a respiratory emergency? a. Neck hyperextension b. Head tilt-chin lift technique c. Jaw-thrust maneuver d. Small towel under shoulders

ANS: D Feedback: The infant will benefit from a small sheet or towel folded under the shoulders. This facilitates keeping the infant's airway in the sniff position as recommended by the American Heart Association's Basic Cardiac Life Support guidelines. Neck hyperextension and flexion should be avoided because these may occlude the airway. The head tilt-chin lift technique is appropriate to open the airway of a child older than age 1 year if a cervical spine injury is not suspected. The jaw-thrust maneuver is used if there is concern about the cervical spine.

The nurse is caring for a child who has been admitted for a sickle cell crisis. What would the nurse do first to provide adequate pain management? a. Administer a nonsteroidal anti-inflammatory drug (NSAID) as ordered. b. Use guided imagery and therapeutic touch. c. Administer meperidine as ordered. d. Initiate pain assessment with a standardized pain scale.

ANS: D Feedback: The nurse should first initiate pain assessment with a standardized pain scale upon admission and provide frequent evaluations of pain. Administering NSAIDs or meperidine and the use of nonpharmacologic pain management techniques are all appropriate. However, the first action is to assess the child's pain to provide a baseline for future comparison.

The nurse has developed a plan of care for a 6-year-old with muscular dystrophy. He was recently injured when he fell out of bed at home. Which intervention would the nurse suggest to prevent further injury? a. Recommend the bed's side rails be raised throughout the day and night. b. Suggest a caregiver be present continuously to prevent falls from bed. c. Encourage a loose restraint to be used when he is in bed. d. Recommend raising the bed's side rails when a caregiver is not present.

ANS: D Feedback: The nurse should recommend that side rails on the bed be elevated when a caregiver is not present. The use of restraints should be avoided if at all possible. Suggesting that a caregiver be present at all times places undue stress on the family. Close observation is more appropriate. Recommending side rails be elevated at all times may be upsetting to the child and make him feel like a "baby."

The nurse is preparing the plan of care for a child experiencing respiratory distress. What action would be the top priority? a. Providing supplemental oxygen b. Monitoring for changes in status c. Assisting ventilation d. Maintaining a patent airway

ANS: D Feedback: The priority when caring for any child with respiratory distress is to maintain a patent airway. Although providing supplemental oxygen, monitoring for changes in status, and assisting with ventilation are important, these measures would be futile if the child's airway was not patent.