PEDS EXAM 3 NCLEX - CH. 24-27

Which of the following is the best method to prevent the spread of infection to an immunosuppressed child? 1. Administer antibiotics prophylactically to the child. 2. Have people wash their hands prior to contact with the child. 3. Assign the same nurses to care for the child each day. 4. Limit visitors to family members only.

2. Have people wash their hands prior to contact with the child.

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

2. It can occur at any age but is seen most often between the ages of 2 and 5 years. 3. It can occur on its own or can be associated with many congenital anomalies.

The nurse is caring for a 6-month-old infant diagnosed with meningitis. When the child is placed in the supine position and flexes his neck, the nurse notes he flexes his knees and hips. This is referred to as: 1. Brudzinski sign. 2. Cushing triad. 3. Kernig sign. 4. Nuchal rigidity.

1. Brudzinski sign. Brudzinski sign occurs when the child responds to a flexed neck with an involuntary flexion of the hips and/or knees.

The diet that produces anticonvulsant effects from ketosis consists of: 1. High-fat and low-carbohydrate foods. 2. High-fat and high-carbohydrate foods. 3. Low-fat and low-carbohydrate foods. 4. Low-fat and high-carbohydrate foods.

1. High-fat and low-carbohydrate foods.

A school-age child comes in with a sore throat and fever. The child was recently diagnosed with Graves disease and is taking propylthiouracil. What concerns should the nurse have about this child? 1. The child must not be taking her medication. 2. The child may have leukopenia. 3. The child needs to start an antibiotic. 4. The child is not getting enough sleep.

2. The child may have leukopenia. Propylthiouracil is used to suppress thyroid function. One of the grave complications of the medication is leukopenia.

Which of the following will be abnormal in a child with the diagnosis of hemophilia? 1. Platelet count. 2. Hemoglobin level. 3. White blood cell count. 4. Partial thromboplastin time (PTT).

4. Partial thromboplastin time (PTT). The abnormal laboratory results in hemophilia are related to decreased clotting function. Partial thromboplastin time is prolonged.

A teen is seen in clinic for a possible diagnosis of Hodgkin disease. The nurse is aware that which of the following symptoms should make the health-care provider suspect Hodgkin disease? 1. Fever, fatigue, and pain in the joints. 2. Anorexia with weight loss. 3. Enlarged, painless, and movable lymph nodes in the cervical area. 4. Enlarged liver with jaundice.

3. Enlarged, painless, and movable lymph nodes in the cervical area.

An 8-year-old with type 1 diabetes mellitus is complaining of a headache and dizziness and is visibly perspiring. Which of the following should the nurse do first? 1. Administer glucagon intramuscularly. 2. Offer the child 8 oz of milk. 3. Administer rapid-acting insulin lispro (Humalog). 4. Offer the child 8 oz of water or calorie-free liquid.

2. Offer the child 8 oz of milk. Milk is best to give for mild hypoglycemia, which would present with the symptoms described.

A child recently diagnosed with epilepsy is being evaluated for anticonvulsant medication therapy. The child will likely be placed on which type of regimen? 1. Two to three oral anticonvulsant medications so that dosing can be low and side effects minimized. 2. One oral anticonvulsant medication to observe effectiveness and minimize side effects. 3. One rectal gel to be administered in the event of a seizure. 4. A combination of oral and intravenous anticonvulsant medications to ensure compliance.

2. One oral anticonvulsant medication to observe effectiveness and minimize side effects.

Which is the best action for the nurse to take during a child ' s seizure? 1. Administer the child ' s rescue dose of oral diazepam (Valium). 2. Loosen the child ' s clothing, and call for help. 3. Place a tongue blade in the child ' s mouth to prevent aspiration. 4. Carry the child to the infirmary to call 911 and start an intravenous line.

2. Loosen the child ' s clothing, and call for help. The nurse should remain with the child and observe the seizure. The child should be protected from his environment, and clothing should be loosened.

Which hormone(s) does the anterior pituitary secrete? Select all that apply. 1. Thyroxine. 2. Luteinizing hormone. 3. Prolactin (luteotropic hormone). 4. ACTH. 5. Epinephrine. 6. Cortisol.

2. Luteinizing hormone. 3. Prolactin (luteotropic hormone). 4. ACTH.

The nurse is assigned to care for a newborn with goiter. The nurse's primary concern is which of the following? 1. Reassuring the parents that the condition is only temporary and will be treated with medication. 2. Maintaining a patent airway and preparing for emergency ventilation. 3. Preparing the infant for surgery and initiating preoperative teaching with the parents. 4. Obtaining a detailed history, particularly of medications taken during the mother's pregnancy.

2. Maintaining a patent airway and preparing for emergency ventilation. Goiter in a newborn can cause tracheal compression, and positioning to help relieve pressure (i.e., neck hyperextension) is essential. Emergency precautions for ventilation and possible tracheostomy are also instituted.

The nurse is teaching the family about caring for their 7-year-old, who has been diagnosed with type 1 diabetes mellitus. What information should the nurse provide about this condition? 1. Best managed through diet, exercise, and oral medication. 2. Can be prevented by proper nutrition and monitoring blood glucose levels. 3. Characterized mainly by insulin resistance. 4. Characterized mainly by insulin deficiency.

4. Characterized mainly by insulin deficiency. Individuals with type 1 DM do not produce insulin. If one does not produce insulin, type 1 DM is the diagnosis.

Brain damage in a child who sustained a closed-head injury can be caused by which factor? 1. Increased perfusion to the brain and increased metabolic needs of the brain. 2. Decreased perfusion to the brain and decreased metabolic needs of the brain. 3. Increased perfusion to the brain and decreased metabolic needs of the brain. 4. Decreased perfusion of the brain and increased metabolic needs of the brain.

4. Decreased perfusion of the brain and increased metabolic needs of the brain.

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

3. A treatment option that will free the child from dialysis.

The nurse is caring for a 3-year-old with an altered state of consciousness. The nurse determines that the child is oriented by asking the child to: 1. Name the president of the United States. 2. Identify her parents and state her own name. 3. State her full name and phone number. 4. Identify the current month but not the date.

2. Identify her parents and state her own name.

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

2. Increased permeability of the glomeruli.

Which order would the nurse question for a child just admitted with the diagnosis of bacterial meningitis? 1. Maintain isolation precautions until 24 hours after receiving intravenous antibiotics. 2. Intravenous fluids at 1 1⁄2 times regular maintenance. 3. Neurological checks every hour. 4. Administer acetaminophen (Tylenol) for temperatures higher than 38°C (100.4°F).

2. Intravenous fluids at 1 1⁄2 times regular maintenance. Intravenous fluids at 11⁄2 times regular maintenance could cause fluid overload and lead to increased ICP.

Prednisone is given to children who are being treated for leukemia. Why is this medication given as part of the treatment plan? 1. Enhances protein metabolism. 2. Enhances sodium excretion. 3. Increases absorption of the chemotherapy. 4. Destroys abnormal lymphocytes.

4. Destroys abnormal lymphocytes. Prednisone is used in many of the treatment protocols for leukemia because there is abnormal lymphocyte production. Prednisone is thought to destroy abnormal lymphocytes.

The parents of a child with glomerulonephritis ask how they will know their child is improving after they go home. Which are the nurse's best responses? Select all that apply. 1. "Your child's urine output will increase, and the urine will become less tea-colored." 2. "Your child will have more energy as lab tests become more normal." 3. "Your child's appetite will decrease as urine output increases." 4. "Your child's laboratory values will become more normal." 5. "Your child's weight will increase as the urine becomes less tea-colored."

1. "Your child's urine output will increase, and the urine will become less tea-colored." 5. "Your child's weight will increase as the urine becomes less tea-colored." The child's weight will increase as the urine resumes a more normal color, indicating lab values are returning to normal and the child is better.

The nurse is caring for a child with leukemia. The nurse should be aware that children being treated for leukemia may experience which of the following complications? Select all that apply. 1. Anemia. 2. Infection. 3. Bleeding tendencies. 4. Bone deformities. 5. Polycythemia.

1. Anemia. 2. Infection. 3. Bleeding tendencies.

The parent of a 4-year-old brings the child to the clinic and tells the nurse the child's abdomen is distended. After a complete examination, a diagnosis of Wilms tumor is suspected. Which of the following is most important when doing a physical examination on this child? 1. Avoid palpation of the abdomen. 2. Assess the urine for the presence of blood. 3. Monitor vital signs, especially the blood pressure. 4. Obtain an accurate height and weight.

1. Avoid palpation of the abdomen.

The parent of a teen with a diagnosis of Hodgkin disease asks what the child's prognosis will be with treatment. What information should the nurse give to the parent and child? 1. Clinical staging of Hodgkin disease will determine the treatment; long-term survival for all stages of Hodgkin disease is excellent. 2. There is a considerably better prognosis if the client is diagnosed early and is less than 5 years of age. 3. The prognosis for Hodgkin disease depends on the type of chemotherapy. 4. The only way to obtain a good prognosis is by chemotherapy and bone marrow transplant.

1. Clinical staging of Hodgkin disease will determine the treatment; long-term survival for all stages of Hodgkin disease is excellent.

Which of the following can be a manifestation of leukemia in a child? Select all that apply. 1. Leg pain. 2. Fever. 3. Excessive weight gain. 4. Bruising. 5. Enlarged lymph nodes.

1. Leg pain. 2. Fever. 4. Bruising. 5. Enlarged lymph nodes.

A child had a urinary tract infection (UTI) 3 months ago and was treated with an oral antibiotic. A follow-up urinalysis revealed normal results. The child has had no other problems until this visit when the child was diagnosed with another UTI. Which is the most appropriate plan? 1. Obtain urinalysis and urine culture. 2. Evaluate for renal failure. 3. Admit to the pediatric unit. 4. Send home on an antibiotic. 5. Schedule a VCUG.

1. Obtain urinalysis and urine culture. Urinalysis and urine culture are routinely used to diagnose UTIs. VCUG is used to determine the extent of urinary tract involvement when a renal ultrasound shows scaring or possible reflux. If the child has a UTI related to bubble baths, constipation, or wiping back to front, a VCUG would not be ordered.

Which of the following confi rms a diagnosis of Hodgkin disease in a 15-year-old? 1. Reed-Sternberg cells in the lymph nodes. 2. Blast cells in the blood. 3. Lymphocytes in the bone marrow. 4. VMA in the urine.

1. Reed-Sternberg cells in the lymph nodes. A lymph node biopsy is done to confirm a histological diagnosis and staging of Hodgkin disease. The presence of Reed-Sternberg cells is characteristic of the disease.

Which of the following activities should a nurse suggest for a client diagnosed with hemophilia? Select all that apply. 1. Swimming. 2. Golf. 3. Hiking. 4. Fishing. 5. Soccer.

1. Swimming. 2. Golf. 3. Hiking. 4. Fishing. Children with hemophilia should be encouraged to take part in noncontact activities that allow for social, psychological, and physical growth.

The nurse receives a call from a parent of a child with leukemia in remission. The parent says the child has been exposed to chickenpox and has never had it. Which of the following responses is most appropriate for the nurse? Select all that apply. 1. "You need to monitor the child's temperature frequently and call back if the temperature is greater than 101°F (38.3°C)." 2. "The child has had two varicella immunizations as an infant but is no longer immune after chemotherapy." 3. "You need to bring the child to the clinic for a varicella immunoglobulin vaccine." 4. "Your child will need to be isolated for the next 2 weeks." 5. "Your child may develop chicken pox lesions about 14 to 21 days after exposure."

2. "The child has had two varicella immunizations as an infant but is no longer immune after chemotherapy." 3. "You need to bring the child to the clinic for a varicella immunoglobulin vaccine."

A 10-year-old with severe factor VIII deficiency falls, injures an elbow, and is brought to the ED. The nurse should prepare which of the following? 1. An IM injection of factor VIII. 2. An IV infusion of factor VIII. 3. An injection of desmopressin. 4. An IV infusion of platelets.

2. An IV infusion of factor VIII. The child is treated with an IV infusion of factor VIII to replace the missing factor and help stop the bleeding.

A nurse instructs the parent of a child with sickle cell disease about factors that might precipitate a pain crisis in the child. Which of the following factors identified by the parent as being able to cause a pain crisis indicates a need for further instruction? 1. Infection. 2. Overhydration. 3. Stress at school. 4. Cold environment.

2. Overhydration. Overhydration does not cause a crisis.

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

3. "Because your child is losing so much protein, the liver is stimulated and makes more lipids."

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

3. An 8-year-old male presenting with a finger laceration; mother states he had surgical re-implantation of his ureters 2 years ago. Although this child has had a history of urinary infections, the child is currently not displaying any signs and therefore does not need a urinalysis at this time.

The nurse is taking care of a child with sickle cell disease. The nurse is aware that which of the following problems is (are) associated with sickle cell disease? Select all that apply. 1. Polycythemia. 2. Hemarthrosis. 3. Aplastic crisis. 4. Thrombocytopenia. 5. Vaso-occlusive crisis.

3. Aplastic crisis. 5. Vaso-occlusive crisis. Aplastic crisis, temporary cessation of red blood cell production, is associated with sickle cell anemia. Vaso-occlusive crisis is the most common problem in children with sickle cell disease.

A nurse is caring for a 5-year-old with sickle cell vaso-occlusive crisis. Which of the following orders should the nurse question? Select all that apply. 1. Position the child for comfort. 2. Apply hot packs to painful areas. 3. Give meperidine (Demerol) 25 mg intravenously every 4 hours as needed for pain. 4. Restrict oral fluids. 5. Apply oxygen per nasal cannula to keep oxygen saturations above 94%.

3. Give meperidine (Demerol) 25 mg intravenously every 4 hours as needed for pain. 4. Restrict oral fluids. 5. Apply oxygen per nasal cannula to keep oxygen saturations above 94%. Tissue hypoxia is very painful. Narcotics such as morphine are usually given for pain when the child is in a crisis. Meperidine (Demerol) should be avoided because of the risk of Demerol-induced seizures. The child should receive hydration because when the child is in crisis, the abnormal S-shaped red blood cells clump, causing tissue hypoxia and pain. Oxygen is of little value unless the tissue is hypoxic. The objective of treatment is to minimize hypoxia.

Select the best room assignment for a newly admitted child with bacterial meningitis. 1. Semiprivate room with a roommate who also has bacterial meningitis. 2. Semiprivate room with a roommate who has bacterial meningitis but has received intravenous antibiotics for more than 24 hours. 3. Private room that is dark and quiet with minimal stimulation. 4. Private room that is bright and colorful and has developmentally appropriate activities available.

3. Private room that is dark and quiet with minimal stimulation. A quiet private room with minimal stimulation is ideal because the child with meningitis should be in a quiet environment to avoid cerebral irritation.

The parent of a child diagnosed with Wilms tumor asks the nurse what the treatment plan will be. The nurse explains the usual protocol for this condition. Which information should the nurse give to the parent? 1. The child will have chemotherapy and, after that has been completed, radiation. 2. The child will need to have surgery to remove the tumor. 3. The child will go to surgery for removal of the tumor and the kidney and will then start chemotherapy. 4. The child will need radiation and later surgery to remove the tumor.

3. The child will go to surgery for removal of the tumor and the kidney and will then start chemotherapy.

Todd has some oral ulcers (stomatitis). His parents ask about oral hygiene. The nurse should suggest: A. avoid brushing teeth until ulcers heal. B. use frequent mouthwashes with normal saline. C. use frequent mouthwashes with hydrogen proxide. D. cleanse teeth with lemon glycerin swabs.

B. use frequent mouthwashes with normal saline. A. Oral care is important in the cancer patient to prevent infection; brushing the teeth with a toothbrush is discouraged only when the child has a low platelet count. B. Frequent saline mouthwashes promote healing of oral ulcers. C. Mouthwashes with hydrogen peroxide are avoided because this delays healing by breaking down protein. D. The use of lemon glycerin swabs is discouraged because this irritates eroded tissue and can decay teeth.

The school nurse is talking to a 14-year-old about managing type 1 diabetes mellitus. Which statement indicates the student's understanding of the disease? 1. "It really does not matter what type of carbohydrate I eat as long as I take the right amount of insulin." 2. "I should probably have a snack right after gym class." 3. "I need to cut back on my carbohydrate intake and increase my lean protein intake." 4. "Losing weight will probably help me decrease my need for insulin."

1. "It really does not matter what type of carbohydrate I eat as long as I take the right amount of insulin." A carbohydrate is a carbohydrate, and insulin dosing is based on blood sugar level and carbohydrates to be eaten.

A child diagnosed with meningitis is having a generalized tonic-clonic seizure. Which should the nurse do first? 1. Administer blow-by oxygen and call for additional help. 2. Reassure the parents that seizures are common in children with meningitis. 3. Call a code and ask the parents to leave the room. 4. Assess the child ' s temperature and blood pressure.

1. Administer blow-by oxygen and call for additional help. The child experiencing a seizure usually requires more oxygen because the seizure increases the body's metabolic rate and demand for oxygen. The seizure may also affect the child's airway, causing the child to be hypoxic. It is always appropriate to give the child blow-by oxygen immediately. The nurse should remain with the child and call for additional help.

The nurse is caring for a child with a skull fracture who is unconscious and has severely increased intracranial pressure (ICP). The nurse notes the child's temperature to be 104°F (40°C). Which should the nurse do first? 1. Place a cooling blanket on the child. 2. Administer acetaminophen (Tylenol) via nasogastric tube. 3. Administer acetaminophen (Tylenol) rectally. 4. Place ice packs in the child ' s axillary areas.

1. Place a cooling blanket on the child.

A toddler is admitted to the pediatric fl oor for hypopituitarism following removal of a craniopharyngioma. The toddler has polyuria, polydipsia, and dehydration. Which area of the brain was most affected by the surgery? 1. Posterior pituitary. 2. Anterior pituitary. 3. Autonomic nervous system. 4. Sympathetic nervous system.

1. Posterior pituitary. The posterior pituitary is responsible for the secretion of ADH and control of the renal tubules. The symptoms are those of DI.

The most appropriate nursing diagnosis for a child with type 1 diabetes mellitus is which of the following? 1. Risk for infection related to reduced body defenses. 2. Impaired urinary elimination (enuresis). 3. Risk for injury related to medical treatment. 4. Anticipatory grieving.

1. Risk for infection related to reduced body defenses. Risk for infection is a correct nursing diagnosis. Understanding DM is understanding the effect it has on peripheral circulation and impairment of defense mechanisms.

Which of the following factors need(s) to be included in a teaching plan for a child with sickle cell disease? Select all that apply. 1. The child needs to be taken to a physician when sick. 2. The parent should make sure the child sleeps in an air-conditioned room. 3. Emotional stress should be avoided. 4. It is important to keep the child well hydrated. 5. It is important to make sure the child gets adequate nutrition.

1. The child needs to be taken to a physician when sick. 3. Emotional stress should be avoided. 4. It is important to keep the child well hydrated. 5. It is important to make sure the child gets adequate nutrition. Seek medical attention for illness to prevent the child from going into a crisis. Stress can cause a depressed immune system, making the child more susceptible to infection and crisis. Parents and children are advised to avoid stress. The child needs good hydration and nutrition to maintain good health. The child needs good hydration and nutrition to maintain good health.

A child with hemophilia A fell and injured a knee while playing outside. The knee is swollen and painful. Which of the following measures should be taken to stop the bleeding? Select all that apply. 1. The extremity should be immobilized. 2. The extremity should be elevated. 3. Warm moist compresses should be applied to decrease pain. 4. Passive range-of-motion exercises should be administered to the extremity. 5. Factor VIII should be administered.

1. The extremity should be immobilized. 2. The extremity should be elevated. 5. Factor VIII should be administered. Measures are needed to induce vasoconstriction and stop the bleeding, including immobilization of the extremity. Measures are needed to induce vasoconstriction and stop the bleeding. Treatment should include elevating the extremity. Hemophilia A is a deficiency in factor VIII, which causes delay in clotting when there is a bleed. Giving a dose of Factor VIII concentrate will assist in the clotting process.

Which of the following is correct regarding prognostic factors for determining survival for a child newly diagnosed with ALL? 1. The initial white blood cell count on diagnosis. 2. The race of the child. 3. The amount of time needed to initiate treatment. 4. Children aged 12 to 15 years.

1. The initial white blood cell count on diagnosis.

The nurse is aware that cloudy cerebrospinal fluid (CSF) most likely indicates: 1. Viral meningitis. 2. Bacterial meningitis. 3. No infection, because CSF is usually cloudy. 4. Sepsis.

2. Bacterial meningitis.

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

2. Decreased red blood cells with a high reticulocyte count, decreased platelet count, and renal failure.

Which is the most likely reason an adolescent with diabetes has problems with low self-esteem? 1. Managing diabetes decreases independence. 2. Managing diabetes complicates perceived ability to "fit in." 3. Obesity complicates perceived ability to "fit in." 4. Hormonal changes are exacerbated by fl uctuations in insulin levels.

2. Managing diabetes complicates perceived ability to "fit in." Because the desire to fi t in is so strong in adolescence, the need to manage one ' s diabetes can compromise the patient ' s perception of ability to do so. For example, an adolescent with type 1 DM has to plan meals and snacks, test blood sugar, limit choices of when and what to eat, and always be concerned with the immediate health consequences of actions as simple as eating. The fact that these limitations can negatively affect self-esteem is an essential concept for the nurse caring for adolescents with diabetes to understand.

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

3. "Circumcision is an option, but it cannot be done at this time." It is usually recommended that circumcision be delayed in the child with hypospadias because the foreskin may be needed for repair of the defect.

The nurse knows further education is needed about Reye syndrome when a mother states: 1. "I will have my children immunized against varicella and influenza." 2. "I will make sure not to give my child any products containing aspirin." 3. "I will give aspirin to my child to treat a headache." 4. "Children with Reye syndrome are admitted to the hospital."

3. "I will give aspirin to my child to treat a headache." The administration of aspirin or products containing aspirin has been associated with the development of Reye syndrome. A headache can be the first sign of a viral illness followed by other symptoms. It is best not to use aspirin or aspirin-containing products in children.

A 12-year-old comes to the clinic with a diagnosis of Graves disease. What information should the nurse discuss with the child? 1. Suggest weight loss. 2. Encourage attending school. 3. Emphasize that the disease will go into remission. 4. Encourage the child to take responsibility for daily medications.

4. Encourage the child to take responsibility for daily medications. Because the child is 12 years old, encouraging responsibility for health care is important. The child still needs family involvement and ongoing supervision but should not be completely dependent on family for care.

What key information should be explained to the family of a 3-year-old who has short stature and abnormal laboratory test results? 1. Because of the diurnal rhythm of the body, growth hormone levels are elevated following the onset of sleep. 2. Exercise can stimulate growth hormone secretion. 3. The initial screening tests need to be repeated for accuracy. 4. Growth hormone levels in children are so low that stimulation testing must be done.

4. Growth hormone levels in children are so low that stimulation testing must be done. The need for additional testing requires explanation. The abnormal IGF-1 and insulin-like growth factor binding protein require a definitive diagnosis when the levels are either abnormally high or low. Very young children do not secrete adequate levels of growth hormone to measure accurately and thus require challenge/stimulation testing.

A child with leukemia is receiving chemotherapy and is complaining of nausea. The nurse has been giving the scheduled antiemetic. Which of the following should the nurse do when the child is nauseated? 1. Encourage low-protein foods. 2. Encourage low-caloric foods. 3. Offer the child's favorite foods. 4. Offer cool, clear liquids.

4. Offer cool, clear liquids.

A father calls the pediatrician's office concerned about his 5-year-old type 1 diabetic child who has been ill. He reports that upon checking the child's urine, it was positive for ketones. What is the nurse's best response to this father? a. "Come to the office immediately." b. "Encourage the child to drink calorie-free liquids." c. "Hold the next dose of insulin." d. "Administer an extra dose of insulin now."

b. "Encourage the child to drink calorie-free liquids."

When caring for a child with nephrotic syndrome, the nurse is aware to monitor which of the following clinical manifestations? A. Hematuria, bacteriuria, weight gain B. Gross hematuria, albuminuria, fever C. Hypertension, weight loss, proteinuria D. Massive proteinuria, hypoalbuminemia, edema

D. Massive proteinuria, hypoalbuminemia, edema

A 7-year-old is diagnosed with central precocious puberty. The child is to receive a monthly intramuscular (IM) injection of leuprolide acetate (Lupron). The child has great fear of pain and needles and requires considerable stress reduction techniques each time an injection is due. What could the nurse suggest that might help manage the pain? 1. Apply a eutectic mixture of local anesthetics (EMLA) of lidocaine and prilocaine to the site at least 60 minutes before the injection. 2. Have extra help on hand to help hold the child down. 3. Apply cold to the area prior to injection. 4. Identify a reward to bribe the child to behave during the injection.

1. Apply a eutectic mixture of local anesthetics (EMLA) of lidocaine and prilocaine to the site at least 60 minutes before the injection. EMLA cream works well for skin and cutaneous pain. Having the child assist in putting on the EMLA patch involves the child in the pain-relieving process.

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

1. Change the diaper frequently and assess for skin breakdown. Preventing infection from stool contamination and skin breakdown is the top priority of care.

School-age children with cancer often have a body image disturbance related to hair loss, moon face, or debilitation. Which of the following interventions is (are) most appropriate? Select all that apply. 1. Encourage them to wear a wig similar to their own hairstyle. 2. Emphasize the benefits of the therapy they are receiving. 3. Have them play only with other children with cancer. 4. Use diversional techniques to avoid discussing changes in the body because of the chemotherapy. 5. Help them find a "special friend" who understands what they are experiencing.

1. Encourage them to wear a wig similar to their own hairstyle. 5. Help them find a "special friend" who understands what they are experiencing.

Which of the following measures should the nurse implement to help with the nausea and vomiting caused by chemotherapy? Select all that apply. 1. Give an antiemetic 30 minutes prior to the start of therapy. 2. Continue the antiemetic as ordered until 24 hours after the chemotherapy is complete. 3. Remove food that has a lot of odor. 4. Keep the child on a nothing-by-mouth status. 5. Wait until the nausea begins to start the antiemetic.

1. Give an antiemetic 30 minutes prior to the start of therapy. 2. Continue the antiemetic as ordered until 24 hours after the chemotherapy is complete. 3. Remove food that has a lot of odor.

A child diagnosed with leukemia is receiving allopurinol (Zyloprim) as part of the treatment plan. The parents ask why their child is receiving this medication. What information about the medication should the nurse provide? 1. Helps reduce the uric acid level caused by cell destruction. 2. Helps make the chemotherapy more effective. 3. Helps reduce the nausea and vomiting associated with chemotherapy. 4. Helps decrease pain in the bone marrow.

1. Helps reduce the uric acid level caused by cell destruction.

A nurse is caring for a 15-year-old who has just been diagnosed with non-Hodgkin lymphoma. Which of the following should the nurse include in teaching the parents about this lymphoma? Select all that apply. 1. The malignancy originates in the lymphoid system. 2. The presence of Reed-Sternberg cells in the biopsy is considered diagnostic. 3. Mediastinal involvement is typical. 4. The disease is diffuse rather than nodular. 5. Treatment includes chemotherapy and radiation.

1. The malignancy originates in the lymphoid system. 3. Mediastinal involvement is typical. 4. The disease is diffuse rather than nodular. 5. Treatment includes chemotherapy and radiation.

Which activity should an adolescent just diagnosed with epilepsy avoid? 1. Swimming, even with a friend. 2. Being in a car at night. 3. Participating in any strenuous activities. 4. Returning to school right away.

2. Being in a car at night. The rhythmic reflection of other car lights can trigger a seizure in some children.

The nurse is providing discharge teaching to the parents of a toddler who experienced a febrile seizure. The nurse knows clarification is needed when the mother says: 1. "My child will likely have another seizure." 2. "My child's 7-year-old brother is also at high risk for a febrile seizure." 3. "I'll give my child acetaminophen (Tylenol) when ill to prevent the fever from rising too high too rapidly." 4. "Most children with febrile seizures do not require seizure medicine."

2. "My child's 7-year-old brother is also at high risk for a febrile seizure." Most children over the age of 5 years do not have febrile seizures.

The nurse is caring for a 10-year-old with leukemia who is receiving chemotherapy. The child is on neutropenic precautions. Friends of the child come to the desk and ask for a vase for the flowers they have brought with them. Which of the following is the best response? 1. "I will get you a special vase that we use on this unit." 2. "The flowers from your garden are beautiful but should not be placed in the room at this time." 3. "As soon as I can wash a vase, I will put the flowers in it and bring it to the room." 4. "Get rid of the flowers immediately. You could harm the child."

2. "The flowers from your garden are beautiful but should not be placed in the room at this time." A neutropenic client should not have flowers in the room because the flowers may harbor Aspergillus or Pseudomonas aeruginosa. Neutropenic children are susceptible to infection. Precautions need to be taken so that the child does not come in contact with any potential sources of infection. Fresh fruits and vegetables can also harbor molds and should be avoided. Telling the friend that the flowers are beautiful but that the child cannot have them is a tactful way not to offend the friend.

Which medication should the nurse anticipate administering first to a child in status epilepticus? 1. Establish an intravenous line and administer intravenous lorazepam (Ativan). 2. Administer rectal diazepam (Valium). 3. Administer an oral glucose gel to the side of the child ' s mouth. 4. Administer oral diazepam (Valium).

2. Administer rectal diazepam (Valium). Rectal diazepam (Valium) is first administered in an attempt to stop the seizure long enough to establish an IV, and then IV medication is administered.

What are the clinical manifestations of non-Hodgkin lymphoma? 1. Basically the same as those in Hodgkin disease. 2. Depends on the anatomical site and extent of involvement. 3. Nausea, vomiting, abdominal pain. 4. Behavior changes, jaundice, dry mouth.

2. Depends on the anatomical site and extent of involvement.

A 6-year-old white girl comes with her mother for evaluation of her acne, breast buds, axillary hair, and body odor. What information should the nurse explain to them? 1. This is a typical age for girls to go into puberty. 2. Encourage the girl to dress and act appropriately for her chronological age. 3. She should be on birth control because she is fertile. 4. She may be short if her epiphyses close early.

2. Encourage the girl to dress and act appropriately for her chronological age. Dressing and acting appropriately for her chronological age should be encouraged for the well-being of the child.

The school nurse notices that a 14-year-old who used to be an excellent student and very active in sports is losing weight and acting very nervous. The teen was recently checked by the primary care provider (PCP), who noted the teen had a very low level of TSH. The nurse recognizes that the teen has which condition? 1. Hashimoto thyroid disease. 2. Graves disease. 3. Hypothyroidism. 4. Juvenile autoimmune thyroiditis.

2. Graves disease. Graves disease is hyperthyroidism and presents with low TSH levels, weight loss, and excessive nervousness.

The nurse is caring for a 10-year-old post parathyroidectomy. Discharge teaching should include which of the following? 1. How to administer injectable growth hormone. 2. The importance of supplemental calcium in the diet. 3. The importance of increasing iodine in the diet. 4. How to administer subcutaneous insulin.

2. The importance of supplemental calcium in the diet. The parathyroid is responsible for calcium reabsorption; therefore, supplemental calcium in the diet is the important point to be discussed in patient teaching.

A nurse is caring for an infant who is very fussy and has a diagnosis of diabetes insipidus (DI). Which parameters should the nurse monitor while the infant is on fluid restrictions? Select all that apply. 1. Oral intake. 2. Urine output. 3. Appearance of the mucous membranes. 4. Change in pulse and temperature. 5. Lethargy and pain.

2. Urine output. 5. Lethargy and pain. It is crucial to monitor and record urine output. The infant with DI has hyposecretion of ADH, and fluid restriction has little effect on urine formation. This infant is at risk for dehydration and for fluid and electrolyte imbalances. As a result of DI the infant may have behavior changes such as lethargy and pain.

A nurse is working with a child who has had a bone age evaluation. Which explanation of the test should the nurse give? 1. "The bone age will give you a diagnosis of your child ' s short stature." 2. "If the bone age is delayed, the child will continue to grow taller." 3. "The x-ray of the bones is compared with that of the age-appropriate, standardized bone age." 4. "If the bone age is not delayed, no further treatment is needed."

3. "The x-ray of the bones is compared with that of the age-appropriate, standardized bone age." The bone age is a method of evaluating the epiphyseal growth centers of the bone using standardized, age-appropriate tables.

At a follow-up visit for an 8-year-old who is being evaluated for short stature, the nurse measures and plots the child's height on the growth chart. Which explanation should the nurse give the child and family? 1. "We want to make sure you were measured accurately the last two visits." 2. "We need to calculate how tall you will be when you grow to adult height." 3. "We need to see how much you have grown since your last visit." 4. "We need to know your height so that a dosage of medication can be calculated for you."

3. "We need to see how much you have grown since your last visit." Height velocity is the most important aspect of a growth evaluation and can demonstrate deceleration in growth if it is present.

Which test(s) could be utilized to determine cortisol levels in a child with suspected Cushing syndrome? Select all that apply. 1. Fasting blood glucose. 2. Thyroid panel (TSH, T3, T4). 3. 24-hour urine for 17-hydroxycorticoids. 4. Radiographic studies of the bones. 5. Cortisone suppression test. 6. Urine culture. 7. Complete blood count.

3. 24-hour urine for 17-hydroxycorticoids. 5. Cortisone suppression test. A 24-hour urine for 17-hydroxycorticoids or a cortisone suppression test is used for diagnosing overproduction of cortisol by the body. A 24-hour urine for 17-hydroxycorticoids or a cortisone suppression test is used for diagnosing overproduction of cortisol by the body.

A 5-year-old is admitted to the hospital with complaints of leg pain and fever. On physical examination, the child is pale and has bruising over various areas of the body. The health-care provider suspects that the child has ALL. The nurse informs the parent that the diagnosis will be confirmed by which of the following? 1. Lumbar puncture. 2. White blood cell count. 3. Bone marrow aspirate. 4. Bone scan.

3. Bone marrow aspirate.

The family of a young child has been told the child has diabetes insipidus (DI). What information should the nurse emphasize to the family? 1. One caregiver needs to learn to give the injections of vasopressin. 2. Children should wear MedicAlert tags if they are over 5 years old. 3. Diabetes insipidus is different from diabetes mellitus. 4. Over time, the child may grow out of the need for medication.

3. Diabetes insipidus is different from diabetes mellitus. Explaining that DI is different from DM is crucial to the parents 'understanding of the management of the disease. DI is a rare condition that affects the posterior pituitary gland, whereas DM is a more common condition that affects the pancreas.

Which of the following is the most effective treatment for pain in a child with sickle cell crisis? Select all that apply. 1. Meperidine (Demerol). 2. Aspirin. 3. Morphine. 4. Behavioral techniques. 5. Acetaminophen (Tylenol) with codeine.

3. Morphine. 4. Behavioral techniques. 5. Acetaminophen (Tylenol) with codeine. 1. Meperidine (Demerol) should not be used because it may potentiate seizures. 2. Aspirin should not be used in children because of the risk for Reye syndrome. 3. Morphine is the drug of choice for a child with sickle cell crises. Usually the child is started on oral doses of acetaminophen (Tylenol) with codeine. When that is not suffi cient to alleviate pain, stronger narcotics are prescribed, such as morphine. Ketorolac (Toradol) may be indicated for short-term use for moderate-severe pain. 4. Behavioral techniques such as positive self-talk, relaxation, distraction, and guided imagery are helpful when pain is occurring. 5. Usually the child is started on oral doses of acetaminophen (Tylenol) with codeine when pain is described as mild to moderate.

Which is an important nursing intervention for a child with a diagnosis of hyperthyroidism? 1. Encourage an increase in physical activity. 2. Do preoperative teaching for thyroidectomy. 3. Promote opportunities for periods of rest. 4. Do dietary planning to increase caloric intake.

3. Promote opportunities for periods of rest. Because increased activity is characteristic of hyperthyroidism, providing opportunity for rest is a recommended nursing intervention.

The nurse is discharging a child who has just received chemotherapy for neuroblastoma. Which of the following statements made by the child's parent indicates a need for additional teaching? 1. "I will inspect the skin often for any lesions." 2. "I will do mouth care daily and monitor for any mouth sores." 3. "I will wash my hands before caring for my child." 4. "I will take a rectal temperature daily and report a temperature greater than 101°F (38.3°C) immediately to the health-care provider."

4. "I will take a rectal temperature daily and report a temperature greater than 101°F (38.3°C) immediately to the health-care provider." Monitoring the child's temperature and reporting it to the physician are important, but the temperature should not be taken rectally. The risk of injury to the mucous membranes is high. Rectal abscesses can occur in the damaged rectal tissue. The best method for taking the temperature is axillary, especially if the child has mouth sores.

The nurse caring for a client with type 1 diabetes mellitus is teaching how to self-administer insulin. Which is the proper injection technique? 1. Position the needle with the bevel facing downward before injection. 2. Spread the skin prior to intramuscular injection. 3. Aspirate for blood return prior to injection. 4. Elevate the subcutaneous tissue before injection.

4. Elevate the subcutaneous tissue before injection. Skin tissue is elevated to prevent injection into the muscle when giving a subcutaneous injection. Insulin is only given subcutaneously.

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

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

When caring for a child with acute renal failure, which nursing measure requires immediate attention? a. Serum potassium concentrations in excess of 7 mEq/L b. Sodium level of 135 c. Transfusion for hemoglobin of 8 d. Mannitol and furosemide for a urine output of 2 ml/kg/hr

a. Serum potassium concentrations in excess of 7 mEq/L

Which descriptive terms should be used to describe a school-age child with myxedematous skin/eyes/hair changes? 1. The skin is oily and scaly. 2. The skin has pale, thickened patches. 3. The skin is moist. 4. The eyes are puffy, the hair is sparse, and the skin is dry.

4. The eyes are puffy, the hair is sparse, and the skin is dry. Myxedema, associated with low serum thyroxine and raised thyrotropin levels, is characteristic of hypothyroid dysfunction and presents with swelling or puffi ness of the limbs and face, sparse hair, and very dry skin. These signs may be accompanied by slowness of movements and mental dullness.

At a visit to the pediatric clinic, a mother is concerned by her 4-year-old's symptoms over the last few weeks. Which of the following symptoms described by the mother would lead the nurse to be concerned about an oncologic disorder? Select all that apply. a. Bruising in various stages, mainly on the legs b. Frequent complaints of respiratory infections, while siblings remain healthy c. Enlarged, firm lymph nodes d. Asthma symptoms with increase in wheezing e. Fever for more than 1 week

b. Frequent complaints of respiratory infections, while siblings remain healthy c. Enlarged, firm lymph nodes e. Fever for more than 1 week

A 13-year-old girl is brought to the clinic with the complaint of emotional lability and restlessness. Other symptoms include gradual weight loss despite a good appetite; warm, moist skin; heat intolerance; and unusually fine hair. These manifestations are most suggestive of which of the following? A. Hypothyroidism B. Hyperthyroidism C. Hypoparathyroidism D. Hyperparathyroidism

B. Hyperthyroidism

You are working in the emergency department, and a 10-year-old child with type 1 diabetes mellitus (DM) has just been admitted. He has been diagnosed with diabetic ketoacidosis (DKA). Which assessment data will you expect to note in this child? a. Shallow or normal respirations, hypertension, and tachycardia b. Fruity breath odor and decreasing level of consciousness c. Headache, hunger, and excessive irritability d. Normal urine output with specific gravity less than 1.020 and a trace of ketones

b. Fruity breath odor and decreasing level of consciousness

Todd has recently had several upper respiratory tract infections. Which should the nurse recommend to decrease his risk of infection? A. Dress him warmly. B. Use good hand washing. C. Isolate him from others. D. Keep him inside as much as possible.

B. Use good hand washing. A. The child should be dressed comfortably; dressing the child too warmly can mimic the development of a temperature, a sign of infection. B. Good hand washing minimizes the child's exposure to infective organisms. C. Visitors should be screened for signs of infection and taught good hand washing techniques; however, the child with acute lymphoblastic leukemia should not be socially isolated because this minimizes the support needed by the child and family. D. Social isolation is not necessary in the prevention of illness; cautious isolation from crowded areas is sometimes recommended when the absolute neutrophil count falls below 500/mm3.

You are working with a nurse who is new to your endocrine unit and has never worked with an infant born with congenital adrenal hyperplasia (CAH). You want to make sure he has a full understanding of this diagnosis. Which statement by the nurse indicates a need for further teaching? a. "Definitive diagnosis is confirmed by evidence of increased 17-ketosteroid levels in most types of CAH." b. "Blood studies to identify elevated calcium and decreased phosphorus levels are routinely performed." c. "Another test that can be used to visualize the presence of pelvic structures, such as female reproductive organs is ultrasonography." d. "This deficiency is an autosomal recessive disorder that results in improper steroid hormone synthesis."

b. "Blood studies to identify elevated calcium and decreased phosphorus levels are routinely performed."

Discharge teaching for parents of a school-age patient with diabetes insipidus (DI) should include which of the following? Select all that apply. a. Education and support regarding the rationale for fluid restrictions b. Information for school personnel regarding the diagnosis so that they can grant children unrestricted use of the lavatory c. A thorough explanation regarding the condition with specific clarification that DI is a different condition from diabetes mellitus (DM) d. Understanding that treatment will only be needed until the child reaches puberty e. Knowing that school-age children may assume full responsibility for their care

b. Information for school personnel regarding the diagnosis so that they can grant children unrestricted use of the lavatory c. A thorough explanation regarding the condition with specific clarification that DI is a different condition from diabetes mellitus (DM) e. Knowing that school-age children may assume full responsibility for their care

A child is admitted to the pediatric unit. The mother reports that the doctor says her son is anemic. What laboratory findings/manifestations would the nurse expect to see to confirm iron deficiency anemia? a. Cyanosis, due to inadequate oxygen saturation of existing hemoglobin b. A decreased reticulocyte count c. A total iron-binding capacity (TIBC) that is elevated above the normal range d. Decreased blood pressure changes, which are an early sign because of the compensatory mechanisms

c. A total iron-binding capacity (TIBC) that is elevated above the normal range

A nurse working on a pediatric unit is assigned to an infant with hypothyroidism. She knows that the assessment may include: a. Thyroid function tests that are usually normal, although thyroid-stimulating hormone (TSH) levels may be slightly or moderately elevated b. Increased secretion of pituitary TSH in response to decreased circulating levels of thyroid hormone (TH) or from infiltrative neoplastic or inflammatory processes c. Dry skin, puffiness around the eyes, sparse hair, constipation, sleepiness, lethargy, and mental decline d. Clinical features, including irritability, hyperactivity, short attention span, tremors, insomnia, and emotional lability

c. Dry skin, puffiness around the eyes, sparse hair, constipation, sleepiness, lethargy, and mental decline

A preschooler has been having periods during which he suddenly falls and appears to be weak for a short time after the event. The preschool teacher asks what she should do. Select the nurse's best response. 1. "Have the parents follow up with his health-care provider because this is likely an atonic seizure." 2. "Find out if there have been any new stressors in his life because it could be attention-seeking behavior." 3. "Have the parents follow up with his health-care provider because this is likely an absence seizure." 4. "The preschool years are a time of rapid growth, and many children appear clumsy. It would be best to watch him and see if it continues."

1. "Have the parents follow up with his health-care provider because this is likely an atonic seizure." An atonic seizure is characterized by a loss of muscular tone, whereby the child may fall to the ground.

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

1. "My child missed 2 days of school last week because of a really bad cold." An upper respiratory infection often precedes MCNS by a few days.

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

1. A 3-year-old who had impetigo 1 week ago. Impetigo is a skin infection caused by the streptococcal organism that is commonly associated with glomerulonephritis.

The nurse is caring for a child with a diagnosis of ALL who is receiving chemotherapy. The nurse notes that the child's platelet count is 20,000/mm3. Based on this laboratory finding, what information should the nurse provide to the child and parents? 1. A soft toothbrush should be used for mouth care. 2. Isolation precautions should be started immediately. 3. The child's vital signs, including blood pressure, should be monitored every 4 hours. 4. All visitors should be discouraged from coming to see the family.

1. A soft toothbrush should be used for mouth care.

A child with a seizure disorder has been having episodes during which she drops her pencil and simply appears to be daydreaming. This is most likely a/an: 1. Absence seizure. 2. Akinetic seizure. 3. Non-epileptic seizure. 4. Simple spasm seizure.

1. Absence seizure. Absence seizures occur frequently and last less than 30 seconds. The child experiences a brief loss of consciousness during which she may have a change in activity. These children rarely fall, but they may drop an object. The condition is often confused with daydreaming.

The nurse is caring for a child who is receiving a transfusion of PRBCs. The nurse is aware that if the child has a hemolytic reaction to the blood, the signs and symptoms would include which of the following? Select all that apply. 1. Fever. 2. Rash. 3. Oliguria. 4. Hypotension. 5. Chills.

1. Fever. 3. Oliguria. 4. Hypotension. Hemolytic reactions include fever, pain at insertion site, hypotension, renal failure, tachycardia, oliguria, and shock.

The nurse is caring for a child with sickle cell disease who is scheduled to have an exchange transfusion. What information should the nurse teach the family? 1. The procedure is done to prevent further sickling during a vaso-occlusive crisis. 2. The procedure reduces side effects from blood transfusions. 3. The procedure is a routine treatment for sickle cell crisis. 4. Once the child ' s spleen is removed, it is not necessary to do exchange transfusions.

1. The procedure is done to prevent further sickling during a vaso-occlusive crisis. Exchange transfusion reduces the number of circulating sickle cells and slows down the cycle of hypoxia, thrombosis, and tissue ischemia.

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

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

When caring for a child with lymphoma, the nurse needs to be aware of which of the following? 1. The same staging system is used for lymphoma and Hodgkin disease. 2. Aggressive chemotherapy with central nervous system prophylaxis will give the child a good prognosis. 3. All children with lymphoma need a bone marrow transplant for a good prognosis. 4. Despite high-dose chemotherapy, the prognosis is very poor for most children.

2. Aggressive chemotherapy with central nervous system prophylaxis will give the child a good prognosis.

Which of the following is a reason to perform a lumbar puncture on a child with a diagnosis of leukemia? Select all that apply. 1. Rule out meningitis. 2. Assess the central nervous system for infiltration. 3. Give intrathecal chemotherapy. 4. Determine increased intracranial pressure. 5. Stage the leukemia.

2. Assess the central nervous system for infiltration. 3. Give intrathecal chemotherapy.

The nurse is caring for a child with sickle cell disease who is scheduled to have a splenectomy. What information should the nurse explain to the parents regarding the reason for a splenectomy? 1. To decrease potential for infection. 2. To prevent splenic sequestration. 3. To prevent sickling of red blood cells. 4. To prevent sickle cell crisis.

2. To prevent splenic sequestration. Splenic sequestration is a life-threatening situation in children with sickle cell disease. Once a child is considered to be at high risk of splenic sequestration or has had this in the past, the spleen will be removed.

Which would the nurse most likely find in the history of a child with hemolytic uremic syndrome (HUS)? Select all that apply. 1. Frequent UTIs and possible vesicoureteral reflux (VUR). 2. Vomiting and diarrhea before admission. 3. Bee sting and localized edema of the site for 3 days. 4. Previously healthy with no signs of illness. 5. Anorexia and bruising.

2. Vomiting and diarrhea before admission. 5. Anorexia and bruising.

Where is the primary site of origin of the tumor in children who have neuroblastoma? 1. Bone. 2. Kidney. 3. Abdomen. 4. Liver.

3. Abdomen. Neuroblastoma tumors originate from embryonic neural crest cells that normally give rise to the adrenal medulla and the sympathetic nervous system. The majority of the tumors arise from the adrenal gland or from the retroperitoneal sympathetic chain. Therefore, the primary site is within the abdomen.

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

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

An 18-month-old male is brought to the clinic by his mother. His height is in the 50th percentile, and his weight is in the 80th percentile. The child is pale. The physical examination is normal, but his hematocrit level is 20%. Which of the following questions should assist the nurse in making a diagnosis? Select all that apply. 1. "How many bowel movements a day does your child have?" 2. "How much did your baby weigh at birth?" 3. "What does your child eat every day?" 4. "Has the child been given any new medications?" 5. "How much milk does your child drink per day?"

3. "What does your child eat every day?" 5. "How much milk does your child drink per day?" A diet history is necessary to determine the nutritional status of the child and whether the child is getting sufficient sources of iron. By asking how much milk the child consumes, the nurse can determine whether the child is filling up on milk and then not wanting to take food.

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

3. "Your child will be contagious for approximately another 10 days, so it is best to not allow a return just yet." Children with HUS are considered contagious for up to 17 days after the resolution of diarrhea and should be placed on contact isolation.

To treat a common manifestation of Reye syndrome, which medication would the nurse expect to have readily available? 1. Furosemide (Lasix). 2. Insulin. 3. Glucose. 4. Morphine.

3. Glucose. A common manifestation is hypoglycemia, which is treated with the administration of intravenous glucose.

Which signs best indicate increased intracranial pressure (ICP) in an infant? Select all that apply. 1. Sunken anterior fontanel. 2. Complaints of blurred vision. 3. High-pitched cry. 4. Increased appetite. 5. Sleeping more than usual.

3. High-pitched cry. 5. Sleeping more than usual.

Which of the following should be done to protect the central nervous system from the invasion of malignant cells in a child newly diagnosed with leukemia? 1. Cranial and spinal radiation. 2. Intravenous steroid therapy. 3. Intrathecal chemotherapy. 4. High-dose intravenous chemotherapy.

3. Intrathecal chemotherapy.

The nurse is caring for a child who has been in a motor vehicle accident (MVA). The child falls asleep unless her name is called or she is gently shaken. This state of consciousness is referred to as: 1. Coma. 2. Delirium. 3. Obtunded. 4. Confusion.

3. Obtunded. "Obtunded" describes a state of consciousness in which the child has a limited response to the environment and can be aroused by verbal or tactile stimulation.

The nurse is caring for a child who is receiving extensive radiation as part of the treatment for Hodgkin disease. Which intervention should be implemented? 1. Administer pain medication prior to the child's going to radiation therapy. 2. Assess the child for neuropathy since this is a common side effect. 3. Provide adequate rest, because the child may experience excessive malaise and lack of energy. 4. Encourage the child to eat a low-protein diet while on radiation therapy.

3. Provide adequate rest, because the child may experience excessive malaise and lack of energy. The most common side effect is extensive malaise, which may be from damage to the thyroid gland, causing hypothyroidism.

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

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

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

4. "Try to keep your child away from sick children because relapses have been associated with infectious illnesses."

A child with a ventriculoperitoneal (VP) shunt complains of headache and blurry vision and now experiences irritability and sleeping more than usual. The parents ask the nurse what they should do. Select the nurse ' s best response. 1. "Give her some acetaminophen (Tylenol), and see if her symptoms improve. If they do not improve, bring her to the health-care provider's office." 2. "It is common for girls to have these symptoms, especially prior to beginning their menstrual cycle. Give her a few days, and see if she improves." 3. "You are probably worried that she is having a problem with her shunt. This is very unlikely because it has been working well for 9 years." 4. "You should immediately take her to the emergency department because these may be symptoms of a shunt malfunction."

4. "You should immediately take her to the emergency department because these may be symptoms of a shunt malfunction."

Which intervention should be implemented after a bone marrow aspiration? 1. Ask the child to remain in a supine position. 2. Place the child in an upright position for 4 hours. 3. Keep the child nothing by mouth for 6 hours. 4. Administer analgesics as needed for pain.

4. Administer analgesics as needed for pain.

Which of the following measures should the nurse teach the parent of a child with hemophilia to do fi rst if the child sustains an injury to a joint causing bleeding? 1. Give the child a dose of acetaminophen (Tylenol). 2. Immobilize the joint and elevate the extremity. 3. Apply heat to the area. 4. Administer factor per the home-care protocol.

4. Administer factor per the home-care protocol. Administration of factor should be the first intervention if home-care transfusions have been initiated.

A child is being admitted with the diagnosis of meningitis. Select the procedure the nurse should do first: 1. Administration of intravenous antibiotics. 2. Administration of maintenance intravenous fluids. 3. Placement of a Foley catheter. 4. Send the spinal fluid and blood samples to the laboratory for cultures.

4. Send the spinal fluid and blood samples to the laboratory for cultures. Cultures of spinal fluid and blood should be obtained, followed by administration of intravenous antibiotics.

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

4. Using a straight catheter, obtain the sample and immediately remove the catheter without waiting for the results of the urine sample. An in-and-out catheterization is the best way to obtain a urine culture in a child who is not yet toilet-trained. CATHETER INVASIVE THOUGH?? but according to rationale sterile cotton ball wouldn't remain sterile, urine bag would get microorganisms from skin

The chemotherapeutic agents that Todd is receiving usually cause nausea and vomiting. Which is an appropriate nursing intervention related to this? A. Discourage oral intake of fluids. B. Administer an antiemetic before chemotherapy begins. C. Administer an antiemetic as soon as symptoms begin. D. Explain to Todd and his parents that nausea and vomiting cannot be prevented.

B. Administer an antiemetic before chemotherapy begins. A. Frequent intake of fluids in small amounts should be encouraged to maintain hydration and because smaller portions are better tolerated. B. An initial dose of antiemetic should be given before chemotherapy to prevent the child from ever experiencing nausea and vomiting, thus preventing an anticipatory response. C. The nurse should anticipate a nausea and vomiting response to the chemotherapy and prevent this response by administering the antiemetic before symptoms occur. D. Nausea and vomiting can be prevented by providing an antiemetic before administering chemotherapy and around the clock for as long as nausea and vomiting typically last.

Todd is a 3-year-old child who has acute lymphoblastic leukemia. He is being seen in the oncology clinic for chemotherapy. Todd's mother asks the nurse, "What is wrong with my child's blood?" Based on the nurse's knowledge of leukemia and developmental stages, the most appropriate response is to tell the mother that Todd's blood has more: A. platelets. B. red blood cells. C. older-mature white blood cells. D. young-immature white blood cells.

D. young-immature white blood cells. •A. Bone-marrow dysfunction causes a proliferation of immature cells, which depress bone marrow production of the formed elements of the blood by competing for and depriving the normal cells of the essential nutrients for metabolism; thus, platelet production is decreased. •B. Bone-marrow dysfunction causes a proliferation of immature cells, which depress bone marrow production of the formed elements of the blood by competing for and depriving the normal cells of the essential nutrients for metabolism; thus, red blood cell production is decreased. •C. Bone-marrow dysfunction causes a proliferation of immature cells, which depress bone marrow production of the formed elements of the blood by competing for and depriving the normal cells of the essential nutrients for metabolism; thus, mature white blood cells production is decreased. •D. Bone-marrow dysfunction causes a proliferation of immature cells; thus young-immature white blood cell production is increased.

When giving discharge instructions to a parent post hypospadias repair, the nurse recognizes a need for more teaching when the mother says which of the following? Select all that apply. a. "I know that I should never clamp off the catheter." b. "My child can take a tub bath when we arrive home because it will soothe the area." c. "An antibacterial ointment may be applied to the penis daily for infection control." d. "Fluids should be monitored and rationed to prevent fluid overload." e. "My child should avoid straddle toys, sandboxes, swimming, and rough activities until allowed by the surgeon."

a. "I know that I should never clamp off the catheter." c. "An antibacterial ointment may be applied to the penis daily for infection control." e. "My child should avoid straddle toys, sandboxes, swimming, and rough activities until allowed by the surgeon."

You are working with a new graduate and explaining prevention of infection for a child with acute lymphocytic leukemia. Which statement by this new nurse indicates understanding? a. "Prophylaxis against Pneumocystis pneumonia is routinely given to most children during treatment for cancer." b. "If blood is drawn, firm pressure should be applied to the area for a minimum of 10 minutes." c. "Having a roommate with a routine surgery would be acceptable for this child." d. "The child should be vaccinated completely to avoid childhood diseases."

a. "Prophylaxis against Pneumocystis pneumonia is routinely given to most children during treatment for cancer."

A child with periorbital edema, decreased urine output, pallor, and fatigue is admitted to the pediatric unit. The child is being examined for acute glomerular nephritis. Which of the following nursing measures should be considered? Select all that apply. a. On examination, there is usually a mild to moderate elevation in blood pressure compared with normal values for age, although severe hypertension may be present. b. Urinalysis during the acute phase characteristically shows hematuria, proteinuria, and increased specific gravity. c. The primary objective is to reduce the excretion of urinary protein and maintain protein-free urine. d. Assessment of the child's appearance for signs of cerebral complications is an important nursing function because the severity of the acute phase is variable and unpredictable. e. Because these children are particularly vulnerable to upper respiratory tract infection, protect them from contact with infected roommates, family, or visitors.

a. On examination, there is usually a mild to moderate elevation in blood pressure compared with normal values for age, although severe hypertension may be present. b. Urinalysis during the acute phase characteristically shows hematuria, proteinuria, and increased specific gravity. d. Assessment of the child's appearance for signs of cerebral complications is an important nursing function because the severity of the acute phase is variable and unpredictable.

The parents of a child with Hodgkin disease ask how the physician will know what type of cancer their child has. Which of the following definitive signs and symptoms should the nurse describe? Select all that apply. a. The most common finding is enlarged, firm, nontender, movable nodes in the supraclavicular or cervical area. b. Tests include complete blood count, prothrombin time and glucose-6-phosphate dehydrogenase (G6PD), erythropoietin, and sedimentation rate. c. Generally a bone marrow biopsy is done to look for the presence of blast cells. d. The presence of Sternberg-Reed cells is considered diagnostic of Hodgkin disease. e. The presence of a white reflection as opposed to the normal red pupillary reflex in the pupil of a child's eye is a classic sign.

a. The most common finding is enlarged, firm, nontender, movable nodes in the supraclavicular or cervical area. d. The presence of Sternberg-Reed cells is considered diagnostic of Hodgkin disease.

You are working with a family that brought their child into the pediatric clinic. The mother describes what may be a type of seizure. What subjective data will help you determine the type? Select all that apply. a. The presence or absence of an aura b. If the child appeared disoriented after the seizure c. Presence of vomiting after the seizure d. The duration of the seizure e. If the seizure was related to certain foods or occurred after a certain activity

a. The presence or absence of an aura b. If the child appeared disoriented after the seizure d. The duration of the seizure

The nurse is caring for a 4-year-old girl with a history of frequent urinary tract infections (UTIs). What should the nurse be aware of before obtaining a urine sample? Select all that apply. a. To obtain a clean-catch urine specimen, have the child sit on the toilet facing backward toward the tank. b. Because children who have a UTI will have painful urination, have the child drink a large amount of fluid before obtaining the sample. c. The specimen must be fresh—less than 1 hour after voiding with storage at room temperature or less than 4 hours after voiding with refrigeration. d. If a urinalysis obtained by a bag specimen is negative, a specimen still needs to be obtained by catheterization or suprapubic aspiration. e. The key to distinguishing a true UTI from asymptomatic bacteriuria is the presence of pyuria. f. Because the child is febrile, the nurse should immediately start an antimicrobial and then obtain a urine culture.

a. To obtain a clean-catch urine specimen, have the child sit on the toilet facing backward toward the tank. c. The specimen must be fresh—less than 1 hour after voiding with storage at room temperature or less than 4 hours after voiding with refrigeration. e. The key to distinguishing a true UTI from asymptomatic bacteriuria is the presence of pyuria (cloudy urine from WBC and pus).

You are discharging a patient with hemophilia. Which of the following responses by the parents indicate an understanding of this disorder? Select all that apply. a. "My child should remain active to decrease joint problems, and most children with hemophilia can participate in the same activities as peers." b. "Care should be taken to avoid bleeding of gums, and softening the toothbrush in warm water before brushing or using a sponge-tipped disposable toothbrush may be helpful." c. "Signs of internal bleeding should be recognized, such as headache, slurred speech, loss of consciousness (from cerebral bleeding), and black, tarry stools (from gastrointestinal bleeding)." d. "If there is bleeding in a joint, elevation, ice, and rest should help and may prevent the need for factor VIII replacement." e. "All of my son's teachers need to be aware of what to do if he gets a bloody nose."

b. "Care should be taken to avoid bleeding of gums, and softening the toothbrush in warm water before brushing or using a sponge-tipped disposable toothbrush may be helpful." c. "Signs of internal bleeding should be recognized, such as headache, slurred speech, loss of consciousness (from cerebral bleeding), and black, tarry stools (from gastrointestinal bleeding)." e. "All of my son's teachers need to be aware of what to do if he gets a bloody nose."

You are working with a pediatric nurse who has just transferred to the pediatric clinic. You are role-playing phone triage related to a child with a head injury. You ascertain that the nurse needs more teaching based on what response? a. "After initial physical exam, if there was no loss of consciousness with the head injury, the child can be observed at home." b. "If there is a language barrier, written instructions can be given, followed by discharge." c. "Another physical exam should take place in 1 or 2 days." d. "Parents should call the doctor if their child has any of these signs: blurred vision, walking unsteadily, or is hard to awaken."

b. "If there is a language barrier, written instructions can be given, followed by discharge."

The nurse taking care of a 5-year-old cancer patient with ulcerative stomatitis is getting ready to perform mouth care. Which of the following principles should be followed? Select all that apply. a. Due to pain of the stomatitis, viscous lidocaine should be used to swish the mouth three times per day. b. A soft, bland diet, although not the favorite of the child, will help with the pain. c. Lemon glycerin swabs are helpful because they remind children of lemon drops. d. Using a soft sponge-type toothbrush will decrease the tendency for gums to bleed. e. A solution of 1 tsp of baking soda and tsp of table salt in 1 quart of water is helpful for mouth rinse.

b. A soft, bland diet, although not the favorite of the child, will help with the pain. d. Using a soft sponge-type toothbrush will decrease the tendency for gums to bleed. e. A solution of 1 tsp of baking soda and tsp of table salt in 1 quart of water is helpful for mouth rinse.

A child with sickle cell anemia (SCA) is admitted in a vasoocclusive crisis (VOC). Which of the following interventions should the nurse expect to see ordered? Select all that apply. a. Cold compresses to painful joints b. IV fluids started, and oral fluids encouraged c. Meperidine ordered every 4 hours for pain d. High-calorie, high-protein diet e. Antibiotics ordered for any existing infection

b. IV fluids started, and oral fluids encouraged d. High-calorie, high-protein diet e. Antibiotics ordered for any existing infection

Which is the most accurate genetic explanation for a family with hemophilia? a. It is a Y-linked dominant disorder. b. It is equally distributed among males and females. c. It is an X-linked recessive disorder. d. It is an autosomal recessive disorder.

c. It is an X-linked recessive disorder.

As the nurse assigned to a child diagnosed with bacterial meningitis, you know that: a. The child will not need to be placed in isolation because antibiotics have been started. b. Enteric precautions will remain in place for up to 48 hours. c. Respiratory isolation will remain in place for 24 hours after antibiotics are started. d. Due to headache, the child will want the head of the bed elevated with two pillows.

c. Respiratory isolation will remain in place for 24 hours after antibiotics are started.

You are the nurse assigned to care for a child with a basilar skull fracture. Your most important nursing observation is change in level of consciousness (LOC). You will be highly alert for: a. Alterations in vital signs that often appear before alterations in consciousness or focal neurologic signs b. Bleeding from the ear, which is indicative of an anterior basal skull fracture c. Seizures, which are relatively uncommon in children at the time of head injury d. Changes in posturing, such as any signs of extension or flexion posturing, unusual response to stimuli, and random versus purposeful movement

d. Changes in posturing, such as any signs of extension or flexion posturing, unusual response to stimuli, and random versus purposeful movement

You are caring for a child with hydrocephalus who is postoperative from a shunt revision. Which assessment finding is your priority for increased intracranial pressure (ICP)? a. Nausea and refusal to eat postoperatively b. Complaint of a headache c. Irritability and wanting to sleep d. Decrease in heart rate over the last hour

d. Decrease in heart rate over the last hour

You are caring for a child on the pediatric unit with a suspected abdominal tumor. Which criteria would lead you to determine this tumor is a neuroblastoma rather than a Wilms tumor? a. Most children present with neuroblastoma around age 4. b. Neuroblastoma is a firm, nontender, irregular mass confined to one side, generally deep in the flank. c. Hypertension is often noted due to secretion of excess amounts of rennin by the tumor. d. Most tumors develop in the adrenal gland or the retroperitoneal sympathetic chain.

d. Most tumors develop in the adrenal gland or the retroperitoneal sympathetic chain.