PEDs Final Combo

Nursing care of the child with Kawasaki disease is challenging because of which occurrence? a. The child's irritability b. Predictable disease course c. Complex antibiotic therapy d. The child's ongoing requests for food

ANS: A Patient irritability is a hallmark of Kawasaki disease and is the most challenging problem. A quiet environment is necessary to promote rest. The diagnosis is often difficult to make, and the course of the disease can be unpredictable. Intravenous gamma globulin and salicylates are the therapy of choice, not antibiotics. The child often is reluctant to eat. Soft foods and fluids should be offered to prevent dehydration.

An infant has tetralogy of Fallot. In reviewing the record, what laboratory result should the nurse expect to be documented? a. Leukopenia b. Polycythemia c. Anemia d. Increased platelet level

ANS: B Persistent hypoxemia that occurs with tetralogy of Fallot stimulates erythropoiesis, which results in polycythemia, an increased number of red blood cells.

After returning from cardiac catheterization, the nurse monitors the child's vital signs. The heart rate should be counted for how many seconds? a. 15 b. 30 c. 60 d. 120

ANS: C The heart rate is counted for a full minute to determine whether arrhythmias or bradycardia is present. Fifteen to 30 seconds are too short for accurate assessment. Sixty seconds is sufficient to assess heart rate and rhythm.

The parents of a young child with heart failure (HF) tell the nurse that they are nervous about giving digoxin. The nurse's response should be based on which knowledge? a. It is a safe, frequently used drug. b. Parents lack the expertise necessary to administer digoxin. c. It is difficult to either overmedicate or undermedicate with digoxin. d. Parents need to learn specific, important guidelines for administration of digoxin.

ANS: D Digoxin has a narrow therapeutic range. The margin of safety between therapeutic, toxic, and lethal doses is very small. Specific guidelines are available for parents to learn how to administer the drug safely and to monitor for side effects. Parents may lack the expertise to administer the drug at first, but with discharge preparation, they should be prepared to administer the drug safely.

A 6-month-old infant presents to the clinic with failure to thrive, a history of frequent respiratory infections, and increasing exhaustion during feedings. On physical examination, a systolic murmur is detected, no central cyanosis, and chest radiography reveals cardiomegaly. An echocardiogram is done that shows left-to-right shunting. This assessment data is characteristic of what? a. Tetralogy of Fallot b. Coarctation of the aorta c. Pulmonary stenosis d. Ventricular septal defect

ANS: D Heart failure is common with ventricular septal defect that causes failure to thrive, respiratory infections, and an increase in exhaustion during feedings. There is a characteristic murmur. The other defects do not have left-to-right shunting.

A 12-year-old child with Down syndrome is admitted to the hospital for surgical correction of a heart defect. The boy's mental age is that of a 3-year-old child. The nurse should prepare the child and family for surgery by what method? a. Extend preoperative teaching over several days. b. Explain the surgery to the child and the parents in detail. c. Exclude the child from preoperative teaching; teach only the parents. d. Provide teaching to the parents, keeping the information to the child simple.

ANS: D Important factors to consider in planning preparation strategies before cardiac surgery are the child's cognitive developmental level, previous hospital experiences, temperament and coping style, the timing of the preparation, and the involvement of the parents. The teaching should be provided to the parents, keeping the information simple to the child with a mental age of 3 years old.

Bacterial infective endocarditis (IE) should be treated with which protocol? a. Oral antibiotics for 6 months b. Oral antibiotics (penicillin) for 10 full days c. IV antibiotics, diuretics, and digoxin d. IV antibiotics (penicillin type) for 2 to 8 weeks

ANS: D Treatment for IE includes the administration of high-dose antibiotics given intravenously for 2 to 8 weeks to completely eradicate the infecting microorganism.

Because the absorption of fat-soluble vitamins is decreased in cystic fibrosis, which vitamin supplementation is necessary?

A, D, E, K A, D, E, and K are the fat-soluble vitamins, which need to be supplemented in higher doses for the child with cystic fibrosis. C is not one of the fat-soluble vitamins. D also needs to be supplemented in children with cystic fibrosis. C and folic acid are not fat-soluble vitamins.

2. A nurse is teaching a group of parents about preventing insect bites. Which of the following should the nurse include in the teaching? (Select all that apply.)

A. INCORRECT: Perfumes attract insects and should be avoided. B. CORRECT: Insects live in tall grasses; therefore, these areas should be avoided. C. INCORRECT: Bright colored clothing attracts insects and should be avoided. D. CORRECT: Insect repellent should be applied to prevent insect bites. E. CORRECT: House pets should be inspected and treated for insects to prevent exposing family members.

What condition is the leading cause of chronic illness in children? a. Asthma b. Pertussis c. Tuberculosis d. Cystic fibrosis

ANS: A Asthma is the most common chronic disease of childhood, the primary cause of school absences, and the third leading cause of hospitalization in children younger than the age of 15 years. Pertussis is not a chronic illness. Tuberculosis is not a significant factor in childhood chronic illness. Cystic fibrosis is the most common lethal genetic illness among white children.

The nurse is assisting with a growth hormone stimulation test for a child with short stature. What should the nurse monitor closely on this child during the test? a. Hypotension b. Tachycardia c. Hypoglycemia d. Nausea and vomiting

ANS: A Patients receiving clonidine (Catapres) for a growth hormone stimulation test require close blood pressure monitoring for hypotension. Tachycardia, hypoglycemia, and nausea and vomiting do not occur with Catapres administered for a growth hormone stimulation test.

What is the most significant factor in distinguishing those who commit suicide from those who make suicidal attempts or threats? a. Social isolation b. Level of stress c. Degree of depression d. Desire to punish others

ANS: A Social isolation is a significant factor in distinguishing adolescents who will kill themselves from those who will not. It is also more characteristic of those who complete suicide than of those who make attempts or threats.

The clinic nurse is assessing a child with central precocious puberty. What conditions can cause central precocious puberty? (Select all that apply.) a. Trauma b. Neoplasms c. Radiotherapy d. Exogenous sex hormones e. Primary hypothyroidism

ANS: A, B, C Trauma, neoplasms, and radiotherapy can be the cause of central precocious puberty. Exogenous sex hormones and primary hypothyroidism can cause peripheral precocious puberty.

The nurse has just collected blood by venipuncture in the antecubital fossa. Which of the following should the nurse do next? a. Keep arm extended while applying a bandage to the site. b. Keep arm extended, and apply pressure to the site for a few minutes. c. Apply a bandage to the site, and keep the arm flexed for 10 minutes. d. Apply a gauze pad or cotton ball to the site, and keep the arm flexed for several minutes.

ANS: B Applying pressure to the site of venipuncture stops the bleeding and aids in coagulation.

Which of the following is a clinical manifestation of acetaminophen poisoning? a. Hyperpyrexia b. Hepatic involvement c. Severe burning pain in stomach d. Drooling and inability to clear secretions

ANS: B Hepatic involvement is the third stage of acetaminophen poisoning.

The nurse is assessing a child with acute epiglottitis. Examining the child's throat by using a tongue depressor might precipitate which symptom or condition? a. Inspiratory stridor b. Complete obstruction c. Sore throat d. Respiratory tract infection

ANS: B If a child has acute epiglottitis, examination of the throat may cause complete obstruction and should be performed only when immediate intubation can take place. Stridor is aggravated when a child with epiglottitis is supine. Sore throat and pain on swallowing are early signs of epiglottitis. Epiglottitis is caused by H. influenzae in the respiratory tract.

The nurse is teaching a group of 10- to 12-year-old children about physical development during the school-age years. Which of the following statements, if made by a participant, would indicate the correct understanding of the teaching? a. "My body weight will be almost triple in the next few years." b. "I will grow an average of 2 inches per year from this point on." c. "There are not that many physical differences among school-age children." d. "I will have a gradual increase in fat, which may contribute to a heavier appearance."

ANS: B In middle childhood, growth in height and weight occurs at a slower pace. Between the ages of 6 and 12 years, children grow 2 inches per year.

Which of the following vitamins increases the absorption of iron? a. A b. C c. D d. Biotin

ANS: B Vitamin C increases the absorption of iron for hemoglobin formation.

Which of the following vitamins is administered prophylactically to all newborns to ensure adequate blood clotting? a. A b. K c. Niacin d. Folic acid

ANS: B Vitamin K is a catalyst for the production of prothrombin and the liver clotting factors II, VII, IX, and X.

The nurse is caring for a child with hypokalemia. The nurse evaluates the child for which signs and symptoms of hypokalemia? (Select all that apply.) a. Twitching b. Hypotension c. Hyperreflexia d. Muscle weakness e. Cardiac arrhythmias

ANS: B, D, E Signs and symptoms of hypokalemia are hypotension, muscle weakness, and cardiac arrhythmias. Twitching and hyperreflexia are signs of hyperkalemia.

A mother tells the clinic nurse that she often puts honey on her infant's pacifier to soothe the infant. What response should the nurse make to the mother? a. "That is a good way to soothe your baby." b. "Honey does not have any soothing effects." c. "There is still a risk for infant botulism from honey." d. "Honey is OK, but it should not be put on the pacifier."

ANS: C Although the precise source of Clostridium botulinum spores has not been identified as originating from honey in many cases of infant botulism in the United States, it is still recommended that honey not be given to infants younger than 12 months because the spores have been found in honey.

What medication used to treat heart failure (HF) is a diuretic? a. Captopril (Capten) b. Digoxin (Lanoxin) c. Hydrochlorothiazide (Diuril) d. Carvedilol (Coreg)

ANS: C Hydrochlorothiazide is a diuretic. Captopril is an ACE inhibitor, digoxin is a digital glycoside, and carvedilol is a beta-blocker.

The Allen test is performed as a precautionary measure before which one of the following procedures? a. Heel stick b. Venipuncture c. Arterial puncture d. Lumbar puncture

ANS: C The Allen test assesses the circulation of the radial, ulnar, or brachial arteries before arterial puncture.

Children who are taking long-term inhaled steroids should be assessed frequently for what potential complication? a. Cough b. Osteoporosis c. Slowed growth d. Cushing syndrome

ANS: C The growth of children on long-term inhaled steroids should be assessed frequently to evaluate systemic effects of these drugs. Cough is prevented by inhaled steroids. No evidence exists that inhaled steroids cause osteoporosis. Cushing syndrome is caused by long-term systemic steroids.

The nurse is preparing to admit a 7-year-old child with complex partial seizures. What clinical features of complex partial seizures should the nurse recognize? (Select all that apply.) a. They last less than 10 seconds. b. There is usually no aura. c. Mental disorientation is common. d. There is frequently a postictal state. e. There is usually an impaired consciousness.

ANS: C, D, E Clinical features of complex partial seizures include the following: it is common to have mental disorientation, there is frequently a postictal state, and there is usually an impaired consciousness. These seizures last longer than 10 seconds (usually longer than 60 seconds), and there is usually an aura.

Which is a common, serious complication of rheumatic fever? a. Seizures b. Cardiac arrhythmias c. Pulmonary hypertension d. Cardiac valve damage

ANS: D Cardiac valve damage is the most significant complication of rheumatic fever. Seizures, cardiac arrhythmias, and pulmonary hypertension are not common complications of rheumatic fever.

A child is admitted for minimal change nephrotic syndrome (MCNS). The nurse recognizes that the child's prognosis is related to what factor? a. Admission blood pressure b. Creatinine clearance c. Amount of protein in urine d. Response to steroid therapy

ANS: D Corticosteroids are the drugs of choice for MCNS. If the child has not responded to therapy within 28 days of daily steroid administration, the likelihood of subsequent response decreases. Blood pressure is normal or low in MCNS. It is not correlated with prognosis. Creatinine clearance is not correlated with prognosis. The presence of significant proteinuria is used for diagnosis. It is not predictive of prognosis

The nurse should instruct parents to administer a daily proton pump inhibitor to their child with gastroesophageal reflux at which time? a. Bedtime b. With a meal c. Midmorning d. 30 minutes before breakfast

ANS: D Proton pump inhibitors are most effective when administered 30 minutes before breakfast so that the peak plasma concentrations occur with mealtime. If they are given twice a day, the second best time for administration is 30 minutes before the evening meal.

Allergy with a hereditary tendency

Atopy

Normal Range for Uric Acid

Child 2.0 - 5.0 mg/dl

A disability that has existed since birth but may not be hereditary

Chronic illness

Anuria

Complete or almost complet absence of urine prodution by the kidney.

An infant with respiratory syncytial virus (RSV) is being admitted to the hospital. The nurse should plan to place the infant on which precaution?

Contact. (A patient with RSV is placed on contact precautions. The transmission of RSV is by contact of secretions, not by droplets or airborne. Enteric precautions are not required for RSV)

A nurse is reviewing the health care provider's documentation in the record of a child admitted with a diagnosis of intussusception. The nurse expects to note that the health care provider has documented which manifestation?

Currant jelly stools (In the child with intussusception, bright red blood and mucus are passed through the rectum, resulting in what is commonly described as currant jelly stools. The child classically presents with severe abdominal pain that is crampy and intermittent, causing the child to draw the knees in to the chest. Vomiting may be present, but not projectile. Options 1 and 4 are not manifestations of this disorder.)

A nurse is teaching the parent of a child who has strabismus. Which of the following should be included in the teaching? A. "Your child should be fitted for contact lenses." B. "Wearing glasses with convex lenses will correct this problem." C. "Placing a patch over the strong eye is needed." D. "Special lenses can correct the vision."

D. CORRECT: When performing a peripheral vision test, the nurse asks the child to focus on an object while bringing a pencil into the child's peripheral vision.

Any mental or physical disability that is manifested before the age of 18 years

Impairment

Innate immunity or resistance to infection or toxicity

Natural immunity

The nurse is planning how to prepare a 4-year-old child for some diagnostic procedures. Guidelines for preparing this preschooler should include which of the following?

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

In providing nourishment for a child with cystic fibrosis (CF), which of the following factors should the nurse keep in mind?

The diet should be high in calories and protein. Children with CF require a well-balanced, high-protein, high-calorie diet because of impaired intestinal absorption. Fats and proteins are a necessary part of a well-balanced diet. A well-balanced diet containing fruits and vegetables is important. Enzyme supplementation helps digest foods; other modifications are not necessary.

It is important that a child with acute streptococcal pharyngitis be treated with antibiotics to prevent

acute rheumatic fever. Children with group A β-hemolytic streptococci (GABHS) infection are at risk for acute rheumatic fever and acute glomerulonephritis. Otitis media is not a complication of acute streptococcal pharyngitis. Diabetes insipidus is not a complication of acute streptococcal pharyngitis. Children who have had acute streptococcal pharyngitis are at risk for acute glomerulonephritis, not nephrotic syndrome.

Uremia

excess of urea in the blood

The nurse is caring for a 1-month-old infant with respiratory syncytial virus (RSV) who is receiving 23% oxygen via a plastic hood. The child's SaO2 saturation is 88%, respiratory rate is 45 breaths/min, and pulse is 140 beats/min. Based on these assessments, what action should the nurse take? a. Withhold feedings. b. Notify the health care provider. c. Put the infant in an infant seat. d. Keep the infant in the plastic hood.

ANS: B The American Academy of Pediatrics practice parameter (2006) recommends the use of supplemental oxygen if the infant fails to maintain a consistent oxygen saturation of at least 90%. The health care provider should be notified of the saturation reading of 88%. Withholding the feedings or placing the infant in an infant seat would not increase the saturation reading. The infant should be kept in the hood, but because the saturation reading is 88%, the health care provider should be notified to obtain orders to increase the oxygen concentration.

Several types of long-term central venous access devices are used. Which of the following is considered an advantage of a Hickman-Broviac catheter? a. No need to keep exit site dry b. Easy to use for self-administered infusions c. Heparinized only monthly and after each infusion d. No limitations on regular physical activity, including swimming

ANS: B The Hickman-Broviac catheter has several benefits, including that it is easy to use for self-administered infusions.

A child is receiving total parenteral nutrition (TPN; hyperalimentation). At the end of 8 hours, the nurse observes the solution and notes that 200 ml/8 hr is being infused rather than the ordered amount of 300 ml/8 hr. The nurse should adjust the rate so that how much will infuse during the next 8 hours? a. 200 ml b. 300 ml c. 350 ml d. 400 ml

ANS: B The TPN infusion rate should not be increased or decreased without the practitioner being informed because alterations in rate can cause hyperglycemia or hypoglycemia.

A 4-year-old child is placed in Buck extension traction for Legg-Calvé-Perthes disease. He is crying with pain as the nurse assesses the skin of his right foot and sees that it is pale with an absence of pulse. What should the nurse do first? a. Reposition the child and notify the practitioner. b. Notify the practitioner of the changes noted. c. Give the child medication to relieve the pain. d. Chart the observations and check the extremity again in 15 minutes.

ANS: B The absence of a pulse and change in color of the foot must be reported immediately for evaluation by the practitioner. This is an emergency condition. Pain medication should be given after the practitioner is notified. The findings should be documented with ongoing assessment.

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

ANS: B The anxiety, fear, and discomfort experienced during catheterization can be significantly decreased by preparation of the child and parents, by selection of the correct catheter, and by appropriate technique of insertion. Generous lubrication of the urethra before catheterization and use of lubricant containing 2% lidocaine may reduce or eliminate the burning and discomfort associated with this procedure.

A 3-year-old child has a femoral shaft fracture. The nurse recognizes that the approximate healing time for this child is how long? a. 2 weeks b. 4 weeks c. 6 weeks d. 8 weeks

ANS: B The approximate healing times for a femoral shaft fracture are as follows: neonatal period, 2 to 3 weeks; early childhood, 4 weeks; later childhood, 6 to 8 weeks; and adolescence, 8 to 12 weeks.

Which should the nurse consider when preparing a school-age child and the family for heart surgery? a. Unfamiliar equipment should not be shown. b. Let child hear the sounds of an ECG monitor. c. Avoid mentioning postoperative discomfort and interventions. d. Explain that an endotracheal tube will not be needed if the surgery goes well.

ANS: B The child and family should be exposed to the sights and sounds of the intensive care unit (ICU). All positive, nonfrightening aspects of the environment are emphasized. The child should be shown unfamiliar equipment and its use demonstrated on a doll. Carefully prepare the child for the postoperative experience, including intravenous (IV) lines, incision, and endotracheal tube.

What preparation should the nurse consider when educating a school-age child and the family for heart surgery? a. Unfamiliar equipment should not be shown. b. Let the child hear the sounds of a cardiac monitor, including alarms. c. Explain that an endotracheal tube will not be needed if the surgery goes well. d. Discussion of postoperative discomfort and interventions is not necessary before the procedure.

ANS: B The child and family should be exposed to the sights and sounds of the intensive care unit (ICU). All positive, nonfrightening aspects of the environment are emphasized. The family and child should make the decision about a tour of the unit if it is an option. The child should be shown unfamiliar equipment and its use demonstrated on a doll. Carefully prepare the child for the postoperative experience, including intravenous lines, incision, endotracheal tube, expected discomfort, and management strategies.

The nurse is preparing an adolescent for discharge after a cardiac catheterization. Which statement by the adolescent would indicate a need for further teaching? a. "I should avoid tub baths but may shower." b. "I have to stay on strict bed rest for 3 days." c. "I should remove the pressure dressing the day after the procedure." d. "I may attend school but should avoid exercise for several days."

ANS: B The child does not need to be on strict bed rest for 3 days. Showers are recommended; children should avoid a tub bath. The pressure dressing is removed the day after the catheterization and replaced by an adhesive bandage to keep the area clean. Strenuous activity must be avoided for several days, but the child can return to school.

The parents of a 3-year-old child with congenital heart disease are afraid to let their child play with other children because of possible overexertion. How should the nurse reply to this concern? a. The parents should meet all the child's needs. b. The child needs opportunities to play with peers. c. Constant parental supervision is needed to avoid overexertion. d. The child needs to understand that peers' activities are too strenuous.

ANS: B The child needs opportunities for social development. Children are able to regulate and limit their activities based on their energy level. Parents must be encouraged to seek appropriate social activities for the child, especially before kindergarten. The child needs to have activities that foster independence.

A child in the terminal stage of cancer has frequent breakthrough pain. Nonpharmacologic methods are not helpful, and the child is exceeding the maximum safe dose for opiate administration. What approach should the nurse implement? a. Add acetaminophen for the breakthrough pain. b. Titrate the opioid medications to control the child's pain as specified in the protocol. c. Notify the practitioner that immediate hospitalization is indicated for pain management. d. Help the parents and child understand that no additional medication can be given because of the risk of respiratory depression.

ANS: B The child on long-term opioid management can become tolerant to the drugs. Also, increasing amounts of drugs may be necessary for disease progression. It is important to recognize that there is no maximum dosage that can be given to control pain. Acetaminophen will offer little additional pain control; it is useful for mild and moderate pain. Immediate hospitalization is not necessary; increased dosages of pain medications can be administered in the home environment. The principle of double effect allows for a positive intervention—relief of pain—even if there is a foreseeable possibility that death may be hastened.

A laboratory technician is performing a blood draw on a toddler. The toddler is holding still but crying loudly. The nurse should take which action? a. Have the lab technician stop the procedure until the child stops crying. b. Do nothing. It's Okay for a child to cry during a painful procedure. c. Tell the child to stop crying; it's only a small prick. d. Tell the child to stop crying because the procedure is almost over.

ANS: B The child should be allowed to express feelings of anger, anxiety, fear, frustration, or any other emotion. It is natural for children to strike out in frustration or to try to avoid stress-provoking situations. The child needs to know that it is all right to cry.

A 5-year-old boy is being prepared for surgery to remove a brain tumor. Nursing actions should be based on which statement? a. Removal of tumor will stop the various symptoms. b. Usually the postoperative dressing covers the entire scalp. c. He is not old enough to be concerned about his head being shaved. d. He is not old enough to understand the significance of the brain.

ANS: B The child should be told what he will look and feel like after surgery. This includes the size of the dressing. The nurse can demonstrate on a doll the expected size and shape of the dressing. Some of the symptoms may be alleviated by the removal of the tumor, but postsurgical headaches and cerebellar symptoms such as ataxia may be aggravated. Children should be prepared for the loss of their hair, and it should be removed in a sensitive, positive manner if the child is awake. Children at this age have poorly defined body boundaries and little knowledge of internal organs. Intrusive experiences are frightening, especially those that disrupt the integrity of the skin.

A 3-year-old child with Hirschsprung disease is hospitalized for surgery. A temporary colostomy will be necessary. How should the nurse prepare this child? a. It is unnecessary because of child's age. b. It is essential because it will be an adjustment. c. Preparation is not needed because the colostomy is temporary. d. Preparation is important because the child needs to deal with negative body image.

ANS: B The child's age dictates the type and extent of psychologic preparation. When a colostomy is performed, it is necessary to prepare the child who is at least preschool age by telling him or her about the procedure and what to expect in concrete terms, with the use of visual aids. The preschooler is not yet concerned with body image.

Which immunization should be given with caution to children infected with human immunodeficiency virus (HIV)? a. Influenza b. Varicella c. Pneumococcal d. Inactivated poliovirus (IPV)

ANS: B The children should be carefully evaluated before being given live viral vaccines such as varicella, measles, mumps, and rubella. The child must be immunocompetent and not have contact with other severely immunocompromised individuals. Influenza, pneumococcal, and inactivated poliovirus (IPV) are not live vaccines.

The nurse knows that parents need further teaching with regard to the treatment of congenital clubfoot when they state what? a. "We'll keep the cast dry." b. "We're happy this is the only cast our baby will need." c. "We'll watch for any swelling of the foot while the cast is on." d. "We're getting a special car seat to accommodate the cast."

ANS: B The common approach to clubfoot management and treatment is the Ponseti method. Serial casting is begun shortly after birth. Weekly gentle manipulation and stretching of the foot along with placement of serial long-leg casts allow for gradual repositioning of the foot. The extremity or extremities are casted until maximum correction is achieved, usually within 6 to 10 weeks. If parents state that this is the only cast the infant will need, they need further teaching.

A nurse is reviewing the laboratory results on a school-age child with hypoparathyroidism. Which results are consistent with this condition? a. Decreased serum phosphorus b. Decreased serum calcium c. Increased serum glucose d. Decreased serum cortisol level

ANS: B The diagnosis of hypoparathyroidism is made on the basis of clinical manifestations associated with decreased serum calcium and increased serum phosphorus. A decreased serum phosphorus would be seen in hyperparathyroidism, elevated glucose in diabetes, and a decreased serum cortisol level in adrenocortical insufficiency (Addison disease).

A nasal spray of desmopressin acetate (DDAVP) is used to treat which disorder? a. Hypopituitarism b. Diabetes insipidus c. Acute adrenocortical insufficiency d. Syndrome of inappropriate antidiuretic hormone

ANS: B The drug of choice for the treatment of diabetes insipidus is DDAVP, which is a synthetic analogue of vasopressin. DDAVP is not used to treat hypopituitarism, acute adrenocortical insufficiency, or syndrome of inappropriate antidiuretic hormone.

When taking the history of a child hospitalized with Reye syndrome, the nurse should not be surprised if a week ago the child had recovered from what? a. Measles b. Influenza c. Meningitis d. Hepatitis

ANS: B The etiology of Reye syndrome is not well understood, but most cases follow a common viral illness, typically influenza or varicella.

The nurse is teaching parents about administering digoxin (Lanoxin). What instructions should the nurse tell the parents? a. If the child vomits, give another dose. b. Give the medication at regular intervals. c. If a dose is missed, give a give an extra dose. d. Give the medication mixed with the child's formula.

ANS: B The family should be taught to administer digoxin at regular intervals. If a dose is missed, an extra dose should not be given; the same schedule should be maintained. If the child vomits, do not give a second dose. The drug should not be mixed with foods or other fluids because refusal to consume these would result in inaccurate intake of the drug.

The nurse encourages the mother of a toddler with acute laryngotracheobronchitis to stay at the bedside as much as possible. What is the primary rationale for this action? a. Mothers of hospitalized toddlers often experience guilt. b. The mother's presence will reduce anxiety and ease the child's respiratory efforts. c. Separation from the mother is a major developmental threat at this age. d. The mother can provide constant observations of the child's respiratory efforts.

ANS: B The family's presence will decrease the child's distress. It is true that mothers of hospitalized toddlers often experience guilt and that separation from mother is a major developmental threat for toddlers, but the main reason to keep parents at the child's bedside is to ease anxiety and therefore respiratory effort.

The nurse encourages the mother of a toddler with acute laryngotracheobronchitis (LTB) to stay at the bedside as much as possible. The nurse's rationale for this action is described primarily in which statement? a. Mothers of hospitalized toddlers often experience guilt. b. The mother's presence will reduce anxiety and ease child's respiratory efforts. c. Separation from mother is a major developmental threat at this age. d. The mother can provide constant observations of the child's respiratory efforts.

ANS: B The family's presence will decrease the child's distress. It is true that mothers of hospitalized toddlers often experience guilt but this is not the best answer. The main reason to keep parents at the child's bedside is to ease anxiety and therefore respiratory effort. The child should have constant monitoring by cardiorespiratory monitor and noninvasive oxygen saturation monitoring, but the parent should not play this role in the hospital.

An 8-month-old infant has a hypercyanotic spell while blood is being drawn. The nurse's first action should be to: a. assess for neurologic defects. b. place the child in the knee-chest position. c. begin cardiopulmonary resuscitation. d. prepare family for imminent death.

ANS: B The first action is to place the infant in the knee-chest position. Blow-by oxygen may be indicated. Neurologic defects are unlikely. The child should be assessed for airway, breathing, and circulation. Often, calming the child and administering oxygen and morphine can alleviate the hypercyanotic spell.

A child has had contact with some poison ivy. The school nurse understands that the full-blown reaction should be evident after how many days? a. 1 day b. 2 days c. 3 days d. 4 days

ANS: B The full-blown reaction to poison ivy is evident after about 2 days, with linear patches or streaks of erythemic, raised, fluid-filled vesicles; swelling; and persistent itching at the site of contact.

Glucocorticoids, mineralocorticoids, and sex steroids are secreted by which gland? a. Thyroid gland b. Adrenal cortex c. Anterior pituitary d. Parathyroid glands

ANS: B The glucocorticoids, mineralocorticoids, and sex steroids are secreted by the adrenal cortex. The thyroid gland produces thyroid hormone and thyrocalcitonin. The anterior pituitary produces hormones such as growth hormone, thyroid-stimulating hormone, adrenocorticotropic hormone, gonadotropin, prolactin, and melanocyte-stimulating hormone. The parathyroid glands produce parathyroid hormone.

What is a primary goal in caring for a child with cognitive impairment? a. Developing vocational skills b. Promoting optimum development c. Finding appropriate out-of-home care d. Helping child and family adjust to future care

ANS: B The goal for children with cognitive impairment is the promotion of optimum social, physical, cognitive, and adaptive development as individuals within a family and community. Vocational skills are only one part of that goal. The focus must also be on the family and other aspects of development. Out-of-home care is considered part of the child's development. Optimum development includes adjustment for both the family and child.

The parents of a 4-month-old infant cannot visit except on weekends. What action by the nurse indicates an understanding of the emotional needs of a young infant? a. Place her in a room away from other children. b. Assign her to the same nurse as much as possible. c. Tell the parents that frequent visiting is unnecessary. d. Assign her to different nurses so she will have varied contacts.

ANS: B The infant is developing a sense of trust. This is accomplished by the consistent, loving care of a nurturing person. If the parents are unable to visit, then the same staff nurses should be used as much as possible. Placing her in a room away from other children would isolate the child. The parents should be encouraged to visit. The nurse should describe how the staff will care for the infant in their absence.

What statement is descriptive of most cases of hemophilia? a. X-linked recessive deficiency of platelets causing prolonged bleeding b. X-linked recessive inherited disorder in which a blood clotting factor is deficient c. Autosomal dominant deficiency of a factor involved in the blood-clotting reaction d. Y-linked recessive inherited disorder in which the red blood cells become moon shaped

ANS: B The inheritance pattern in 80% of all the cases of hemophilia is X-linked recessive. The two most common forms of the disorder are factor VIII deficiency (hemophilia A, or classic hemophilia) and factor IX deficiency (hemophilia B, or Christmas disease). The disorder involves coagulation factors, not platelets. The disorder does not involve red blood cells or the Y chromosome.

A 7-year-old child has just had a cast applied for a fractured arm with the wrist and elbow immobilized. What information should be included in the home care instructions? a. No restrictions of activity are indicated. b. Elevate casted arm when both upright and resting. c. The shoulder should be kept as immobile as possible to avoid pain. d. Swelling of the fingers is to be expected. Notify a health professional if it persists more than 48 hours.

ANS: B The injured extremity should be kept elevated while resting and in a sling when upright. This will increase venous return. The child should not engage in strenuous activity for the first few days. Rest with elevation of the extremity is encouraged. Joints above and below the cast on the affected extremity should be moved. Swelling of the fingers may indicate neurovascular damage and should be reported immediately. Permanent damage can occur within 6 to 8 hours.

A school-age child has asthma. The nurse should teach the child that if a peak expiratory flow rate is in the yellow zone, this means that the asthma control is what? a. 80% of a personal best, and the routine treatment plan can be followed. b. 50% to 79% of a personal best and needs an increase in the usual therapy. c. 50 % of a personal best and needs immediate emergency bronchodilators. d. Less than 50% of a personal best and needs immediate hospitalization.

ANS: B The interpretation of a peak expiratory flow rate that is yellow (50%-79% of personal best) signals caution. Asthma is not well controlled. An acute exacerbation may be present. Maintenance therapy may need to be increased. Call the practitioner if the child stays in this zone.

A boy with leukemia screams whenever he needs to be turned or moved. Which is the most probable cause of this pain? a. Edema b. Bone involvement c. Petechial hemorrhages d. Changes within the muscles

ANS: B The invasion of the bone marrow with leukemic cells gradually causes a weakening of the bone and a tendency toward fractures. As leukemic cells invade the periosteum, increasing pressure causes severe pain. Edema, petechial hemorrhages, and changes within the muscles would not cause severe pain.

A school-age child has been bitten on the leg by a large snake that may be poisonous. During transport to an emergency facility, what should the care include? a. Apply ice to the snakebite. b. Immobilize the leg with a splint. c. Place a loose tourniquet distal to the bite. d. Apply warm compresses to the snakebite.

ANS: B The leg should be immobilized. Ice decreases blood flow to the area, which allows the venom to work more destruction and decreases the effect of antivenin on the natural immune mechanisms. A loose tourniquet is placed proximal, not distal, to the area of the bite to delay the flow of lymph. This can delay movement of the venom into the peripheral circulation. The tourniquet should be applied so that a pulse can be felt distal to the bite. Warmth increases circulation to the area and helps the toxin into the peripheral circulation

Identification and treatment of cryptorchid testes should be done by age 2 years. What is an important consideration? a. Medical therapy is not effective after this age. b. Treatment is necessary to maintain the ability to be fertile when older. c. The younger child can tolerate the extensive surgery needed. d. Sexual reassignment may be necessary if treatment is not successful.

ANS: B The longer the testis is exposed to higher body heat, the greater the likelihood of damage. To preserve fertility, surgery should be done at an early age. Surgical intervention is the treatment of choice. Simple orchiopexy is usually performed as an outpatient procedure. The surgical procedure restores the testes to the scrotum. This helps the boy to have both testes in the scrotum by school age. Sexual reassignment is not indicated when the testes are not descended.

A school-age child is admitted in vasoocclusive sickle cell crisis. The child's care should include: a. correction of acidosis. b. adequate hydration and pain management. c. pain management and administration of heparin. d. adequate oxygenation and replacement of factor VIII.

ANS: B The management of crises includes adequate hydration, minimization of energy expenditures, pain management, electrolyte replacement, and blood component therapy if indicated. Hydration and pain control are two of the major goals of therapy. The acidosis will be corrected as the crisis is treated. Heparin and factor VIII is not indicated in the treatment of vasoocclusive sickle cell crisis. Oxygen may prevent further sickling, but it is not effective in reversing sickling because it cannot reach the clogged blood vessels.

The nurse is preparing to administer a liquid medication by a nasogastric feeding tube. What is the first thing the nurse should do? a. Check placement of the tube. b. Check the pH of the gastric aspirate. c. Flush the tube with a small amount of water. d. Give the medication and then flush with a small amount of water.

ANS: B The most accurate way to check the position of the nasogastric tube is by checking the pH. Auscultation as a verification tool is reliable only 60% to 80% of the time and should not be used without additional methods. The tube should not be flushed or the medication administered until placement of the tube is checked.

A toddler is being sent to the operating room for surgery at 9 AM. As the nurse prepares the child, what is the priority intervention? a. Administering preoperative antibiotic b. Verifying that the child and procedure are correct c. Ensuring that the toddler has been NPO since midnight d. Informing the parents where they can wait during the procedure

ANS: B The most important intervention is to ensure that the correct child is going to the operating room for the identified procedure. It is the nurse's responsibility to verify identification of the child and what procedure is to be done. If an antibiotic is ordered, administering it is important, but correct identification is a priority. Clear liquids can be given up to 2 hours before surgery. If the child was NPO (taking nothing by mouth) since midnight, intravenous fluids should be administered. Parents should be encouraged to accompany the child to the preoperative area. Many institutions allow parents to be present during induction.

A child is recovering from Kawasaki disease (KD). The child should be monitored for which? a. Anemia b. Electrocardiograph (ECG) changes c. Elevated white blood cell count d. Decreased platelets

ANS: B The most serious complication of KD is the development of coronary artery aneurysms and the potential for myocardial infarction in children with aneurysm formation. The nurse should monitor any ECG changes.

A venipuncture will be performed on a 7-year-old girl. She wants her mother to hold her during the procedure. The nurse should recognize that this: a. is unsafe. b. may help child relax. c. is against hospital policy. d. is unnecessary because of child's age.

ANS: B The mother's preference for assisting, observing, or waiting outside the room should be assessed along with the child's preference for parental presence. The child's choice should be respected. This will most likely help the child through the procedure.

A bone marrow biopsy will be performed on a 7-year-old girl. She wants her mother to hold her during the procedure. How should the nurse respond? a. Holding your child is unsafe. b. Holding may help your child relax. c. Hospital policy prohibits this interaction. d. Holding your child is unnecessary given the child's age.

ANS: B The mother's preference for assisting, observing, or waiting outside the room should be assessed, as well as the child's preference for parental presence. The child's choice should be respected. This will most likely help the child through the procedure. If the mother and child agree, then the mother is welcome to stay. Her familiarity with the procedure should be assessed and potential safety risks identified (mother may sit in chair). Hospital policies should be reviewed to ensure that they incorporate family-centered care.

Guidelines for intramuscular administration of medication in school-age children include which of the following? a. Inject medication as rapidly as possible. b. Insert needle quickly, using a dartlike motion. c. Penetrate skin immediately after cleansing site, before skin has dried. d. Have child stand, if possible, and if child is cooperative.

ANS: B The needle should be inserted quickly in a dartlike motion at a 90-degree angle unless contraindicated.

Guidelines for intramuscular administration of medication in school-age children include what standard? a. Inject medication as rapidly as possible. b. Insert needle quickly, using a dartlike motion. c. Have the child stand if at all possible and if the child is cooperative. d. Penetrate the skin immediately after cleansing the site while the skin is moist.

ANS: B The needle should be inserted quickly in a dartlike motion at a 90-degree angle unless contraindicated. Inject medications slowly. Allow skin preparation to dry completely before the skin is penetrated. Place the child in a lying or sitting position.

The nurse is evaluating the laboratory results of a stool sample. What is a normal finding? a. The laboratory reports a stool pH of 5.0. b. The laboratory reports a negative guaiac. c. The laboratory reports low levels of enzymes. d. The laboratory reports reducing substances present.

ANS: B The normal stool finding is a negative guaiac. Stool pH should be 7.0 to 7.5. A stool pH <5.0 is suggestive of carbohydrate malabsorption; colonic bacterial fermentation produces short-chain fatty acids, which lower stool pH. There should be no enzymes or reducing substances present in a normal stool sample.

The nurse has received report on four children. Which child should the nurse assess first? a. A school-age child in a coma with stable vital signs b. A preschool child with a head injury and decreasing level of consciousness c. An adolescent admitted after a motor vehicle accident is oriented to person and place d. A toddler in a persistent vegetative state with a low-grade fever

ANS: B The nurse should assess the child with a head injury and decreasing level of consciousness first (LOC). Assessment of LOC remains the earliest indicator of improvement or deterioration in neurologic status. The next child the nurse should assess is a toddler in a persistent vegetative state with a low-grade fever. The school-age child in a coma with stable vital signs and the adolescent admitted to the hospital who is oriented to his surroundings would be of least worry to the nurse.

The primary nursing intervention to prevent bacterial endocarditis is to: a. institute measures to prevent dental procedures. b. counsel parents of high-risk children about prophylactic antibiotics. c. observe children for complications, such as embolism and heart failure. d. encourage restricted mobility in susceptible children.

ANS: B The objective of nursing care is to counsel the parents of high-risk children about both the need for prophylactic antibiotics for dental procedures and the necessity of maintaining excellent oral health. The child's dentist should be aware of the child's cardiac condition. Dental procedures should be done to maintain a high level of oral health. Prophylactic antibiotics are necessary. Children should be observed for complications such as embolism and heart failure and restricted mobility should be encouraged in susceptible children, but maintaining good oral health and prophylactic antibiotics is important.

Which of the following is an objective of care for the child with nephrosis? a. Reduce blood pressure. b. Reduce excretion of urinary protein. c. Increase excretion of urinary protein. d. Increase ability of tissues to retain fluid.

ANS: B The objectives of therapy for the child with nephrosis include reduction of the excretion of urinary protein, reduction of fluid retention, prevention of infection, and minimization of complications associated with therapy.

What test is never performed on a child who is awake? a. Doll's head maneuver b. Oculovestibular response c. Assessment of pyramidal tract lesions d. Funduscopic examination for papilledema

ANS: B The oculovestibular response (caloric test) involves the instillation of ice water into the ear of a comatose child. The caloric test is painful and is never performed on an awake child or one who has a ruptured tympanic membrane. The doll's head maneuver, assessment of pyramidal tract lesions, and funduscopic examination for papilledema are not considered painful and can be performed on awake children.

What blood flow pattern occurs in a ventricular septal defect? a. Mixed blood flow b. Increased pulmonary blood flow c. Decreased pulmonary blood flow d. Obstruction to blood flow from ventricles

ANS: B The opening in the septal wall allows for blood to flow from the higher pressure left ventricle into the lower pressure right ventricle. This left-to-right shunt creates increased pulmonary blood flow. The shunt is one way, from high pressure to lower pressure; oxygenated and unoxygenated blood do not mix. The outflow of blood from the ventricles is not affected by the septal defect.

The parents of a child hospitalized with sickle cell anemia tell the nurse that they are concerned about narcotic analgesics causing addiction. Which is appropriate for the nurse to explain about narcotic analgesics? a. Are often ordered but not usually needed b. Rarely cause addiction because they are medically indicated c. Are given as a last resort because of the threat of addiction d. Are used only if other measures, such as ice packs, are ineffective

ANS: B The pain of sickle cell anemia is best treated by a multidisciplinary approach. Mild to moderate pain can be controlled by ibuprofen and acetaminophen. When narcotics are indicated, they are titrated to effect and are given around the clock. Patient-controlled analgesia reinforces the patient's role and responsibility in managing the pain and provides flexibility in dealing with pain. Few, if any, patients who receive opioids for severe pain become behaviorally addicted to the drug. Narcotics are often used because of the severe nature of the pain of vasoocclusive crisis. Ice is contraindicated because of its vasoconstrictive effects.

A child is having tests done to determine parathyroid function. The clinic nurse knows that the parathyroid hormone (PTH) regulates the homeostasis of what in the serum? a. Sodium b. Calcium c. Potassium d. Magnesium

ANS: B The parathyroid glands secrete PTH. Along with vitamin D and calcitonin, PTH regulates the homeostasis of serum calcium concentrations.

An emergency department nurse is performing an assessment on a child with a suspected diagnosis of intussusception. Which assessment question for the parents will elicit the most specific data related to this disorder?

"Can you describe the type of pain that the child is experiencing?" (A report of severe colicky abdominal pain in a healthy, thriving child between 3 and 17 months of age is the classic presentation of intussusception. Typical behavior includes screaming and drawing the knees up to the chest. Options 1, 2, and 3 are important aspects of a health history but are not specific to the diagnosis of intussusception.)

A mother brings her 5-week-old infant to the health care clinic and tells the nurse that the child has been vomiting after meals. The mother reports that the vomiting is becoming more frequent and forceful. The nurse suspects pyloric stenosis and asks the mother which assessment question to elicit data specific to this condition?

"Does the vomit contain sour undigested food without bile, and is the infant constipated?" (Option 3 presents classic symptoms of pyloric stenosis. Stools that are ribbon-like and a child who is eating poorly are signs of congenital megacolon (Hirschsprung's disease). An infant who suddenly becomes pale, cries out, and draws the legs up to chest is demonstrating physical signs of intussusception. Crying during the evening hours, appearing to be in pain, eating well, and gaining weight are clinical manifestations of colic.)

A child has been diagnosed with scabies. Which statement by the parent indicates understanding of the nurse's teaching about scabies?

"Everyone who has been in close contact with my child will need to be treated." (Because of the length of time between infestation and physical symptoms (30 to 60 days), all persons who were in close contact with the affected child need treatment. Families need to know that although the mite will be killed, the rash and the itch will not be eliminated until the stratum corneum is replaced, which takes approximately 2 to 3 weeks. Aggressive housecleaning is not necessary, but surface vacuuming of heavily used rooms by a person with crusted scabies is recommended. The prescribed cream should be thoroughly and gently massaged into all skin surfaces (not just the areas that have a rash) from the head to the soles of the feet.)

The nurse is assessing the coping behaviors of the parents of a child recently diagnosed with a chronic illness. What behavior should the nurse consider an "approach behavior" that results in movement toward adjustment? a. Being unable to adjust to a progression of the disease or condition b. Anticipating future problems and seeking guidance and answers c. Looking for new cures without a perspective toward possible benefit d. Failing to recognize the seriousness of the child's condition despite physical evidence

ANS: B The parents who anticipate future problems and seek guidance and answers are demonstrating approach behaviors. These are positive actions in caring for their child. Being unable to adjust, looking for new cures, and failing to recognize the seriousness of the child's condition are avoidance behaviors. The parents are moving away from adjustment or exhibiting maladaptation to the crisis of a child with chronic illness or disability.

The nurse is preparing to admit a child to the hospital with a diagnosis of acute poststreptococcal glomerulonephritis. The nurse understands that the peak age at onset for this disease is what? a. 2 to 4 years b. 5 to 7 years c. 8 to 10 years d. 11 to 13 years

ANS: B The peak age at onset for acute poststreptococcal glomerulonephritis is 5 to 7 years of age.

What condition is the leading cause of death after heart transplantation? a. Infection b. Rejection c. Cardiomyopathy d. Heart failure

ANS: B The posttransplant course is complex. The leading cause of death after cardiac transplant is rejection. Infection is a continued risk secondary to the immunosuppression necessary to prevent rejection. Cardiomyopathy is one of the indications for cardiac transplant. Heart failure is not a leading cause of death.

Which is the leading cause of death after heart transplantation? a. Infection b. Rejection c. Cardiomyopathy d. Heart failure

ANS: B The posttransplant course is complex. The leading cause of death after cardiac transplantation is rejection. Infection is a continued risk secondary to the immunosuppression necessary to prevent rejection. Cardiomyopathy is one of the indications for cardiac transplant. Heart failure is not a leading cause of death.

An adolescent with a fractured femur is in Russell's traction. Surgical intervention to correct the fracture is scheduled for the morning. Nursing actions should include which action? a. Maintaining continuous traction until 1 hour before the scheduled surgery b. Maintaining continuous traction and checking position of traction frequently c. Releasing traction every hour to perform skin care d. Releasing traction once every 8 hours to check circulation

ANS: B When the muscles are stretched, muscle spasm ceases and permits realignment of the bone ends. The continued maintenance of traction is important during this phase because releasing the traction allows the muscle's normal contracting ability to again cause malpositioning of the bone ends. Continuous traction must be maintained to keep the bone ends in satisfactory realignment. Releasing at any time, either 1 hour before surgery, once every hour for skin care, or once every 8 hours would not keep the fracture in satisfactory alignment.

What are core principles of patient- and family-centered care? (Select all that apply.) a. Collaboration b. Empowering families c. Providing formal and informal support d. Maintaining strict policy and procedure routines e. Withholding information that is likely to cause anxiety

ANS: B, C Core principles of patent- and family-centered care include collaboration, empowerment, and providing formal and informal support. There should be flexibility in policy and procedures, and communication should be complete, honest, and unbiased, not withheld.

The nurse notices that a child is increasingly apprehensive and has tachycardia after heart surgery. The chest tube drainage is now 8 ml/kg/hr. What should be the nurse's initial intervention? a. Apply warming blankets. b. Notify the practitioner of these findings. c. Give additional pain medication per protocol. d. Encourage child to cough, turn, and deep breathe.

ANS: B The practitioner is notified immediately. Increases of chest tube drainage to more than 3 ml/kg/hr for more than 3 consecutive hours or 5 to 10 ml/kg in any 1 hour may indicate postoperative hemorrhage. Increased chest tube drainage with apprehensiveness and tachycardia may indicate cardiac tamponade—blood or fluid in the pericardial space constricting the heart—which is a life-threatening complication. Warming blankets are not indicated at this time. Additional pain medication can be given before the practitioner drains the fluid, but the notification is the first action. Encouraging the child to cough, turn, and deep breathe should be deferred until after evaluation by the practitioner.

A child with acute glomerulonephritis is in the playroom and experiences blurred vision and a headache. What action should the nurse take? a. Check the urine to see if hematuria has increased. b. Obtain the child's blood pressure and notify the health care provider. c. Obtain serum electrolytes and send urinalysis to the laboratory. d. Reassure the child and encourage bed rest until the headache improves.

ANS: B The premonitory signs of encephalopathy are headache, dizziness, abdominal discomfort, and vomiting. If the condition progresses, there may be transient loss of vision or hemiparesis, disorientation, and generalized tonic-clonic seizures. The health care provider should be notified of these symptoms.

The nurse is conducting a staff in-service on childhood endocrine disorders. Diabetes insipidus is a disorder of: a. anterior pituitary. b. posterior pituitary. c. adrenal cortex. d. adrenal medulla.

ANS: B The principal disorder of posterior pituitary hypofunction is diabetes insipidus. The anterior pituitary produces hormones such as GH, thyroid-stimulating hormone, adrenocorticotropic hormone, gonadotropin, prolactin, and melanocyte-stimulating hormone. The adrenal cortex produces aldosterone, sex hormones, and glucocorticoids. The adrenal medulla produces catecholamines.

Which should the nurse expect to find in the cerebral spinal fluid (CSF) results of a child with Guillain-Barré syndrome (GBS)? (Select all that apply.) a. Decreased protein concentration b. Normal glucose c. Fewer than 10 white blood cells (WBCs/mm3) d. Elevated red blood cell (RBC) count

ANS: B, C Diagnosis of GBS is based on clinical manifestations, CSF analysis, and EMG findings. CSF analysis reveals an abnormally elevated protein concentration, normal glucose, and fewer than 10 WBCs/mm3. CSF fluid should not contain RBCs.

A child is in the hospital for cystic fibrosis. What health care provider's prescription should the nurse clarify before implementing? a. Dornase alfa (Pulmozyme) nebulizer treatment bid b. Pancreatic enzymes every 6 hours c. Vitamin A, D, E, and K supplements daily d. Proventil (albuterol) nebulizer treatments tid

ANS: B The principal treatment for pancreatic insufficiency that occurs in cystic fibrosis is replacement of pancreatic enzymes, which are administered with meals and snacks to ensure that digestive enzymes are mixed with food in the duodenum. The enzymes should not be given every 6 hours, so this should be clarified before implementing this prescription. Dornase alfa (Pulmozyme) is given by nebulizer to decrease the viscosity of secretions, vitamin supplements are given daily, and Proventil nebulizer treatments are given to open the bronchi for easier expectoration.

What is a principle of palliative care that can be included in the care of children? a. Maintenance of curative therapy b. Child and family as the unit of care c. Exclusive focus on the spiritual issues the family faces d. Extensive use of opiates to ensure total pain control

ANS: B The principles of palliative care involve a multidisciplinary approach to the management of a terminal illness or the dying process that focuses on symptom control and support rather than on cure or life prolongation in the absence of the possibility of a cure. In pediatric palliative care, the focus of care is on the family. Palliative care requires the transition from curative to palliative care. The transition occurs when the likelihood of cure no longer exists. Spiritual issues are just one of the foci of palliative care. The multidisciplinary team focuses on physical, emotional, and social issues as well. Pain control is a priority in palliative care. The use of opiates is balanced with the side effects caused by this class of drugs.

The nurse is preparing to admit a 1-month-old infant with severe congenital neutropenia (Kostmann disease). What clinical features of severe congenital neutropenia should the nurse recognize? (Select all that apply.) a. Anemia is present. b. Neutropenia is present. c. The illness is severe. d. It has a dominant inheritance pattern. e. There are decreased eosinophils in the bone marrow.

ANS: B, C The clinical features of severe congenital neutropenia include anemia and neutropenia, and the illness is severe. It has an autosomal recessive inheritance pattern, and there are increased, not decreased, eosinophils in the bone marrow.

An 11-month-old hospitalized boy is restrained because he is receiving intravenous (IV) fluids. His grandmother has come to stay with him for the afternoon and asks the nurse if the restraints can be removed. What nurse's response is best? a. "Restraints need to be kept on all the time." b. "That is fine as long as you are with him." c. "That is fine if we have his parents' consent." d. "The restraints can be off only when the nursing staff is present."

ANS: B The restraints are necessary to protect the IV site. If the child has appropriate supervision, restraints are not necessary. The nurse should remove the restraints whenever possible. When parents or staff members are present, the restraints can be removed and the IV site protected. Parental permission is not needed for restraint removal.

Which of the following factors predisposes the urinary tract to infection? a. Increased fluid intake b. Short urethra in young girls c. Prostatic secretions in males d. Frequent emptying of the bladder

ANS: B The short urethra in females provides a ready pathway for invasion of organisms.

The most important nursing intervention when caring for an infant with myelomeningocele in the preoperative stage is which? a. Take vital signs every hour. b. Place the infant on the side to decrease pressure on the spinal sac. c. Watch for signs that might indicate developing hydrocephalus. d. Apply a heat lamp to facilitate drying and toughening of the sac.

ANS: B The spinal sac is protected from damage until surgery is performed. Early surgical closure is recommended to prevent local trauma and infection. Monitoring vital signs and watching for signs that might indicate developing hydrocephalus are important interventions, but preventing trauma to the sac is a priority. The sac is kept moist until surgical intervention is done.

The nurse is closely monitoring a child who is unconscious after a fall and notices that the child suddenly has a fixed and dilated pupil. The nurse should interpret this as: a. eye trauma. b. neurosurgical emergency. c. severe brainstem damage. d. indication of brain death.

ANS: B The sudden appearance of a fixed and dilated pupil(s) is a neurosurgical emergency. The nurse should immediately report this finding. Although a dilated pupil may be associated with eye trauma, this child has experienced a neurologic insult. Pinpoint pupils or bilateral fixed pupils for more than 5 minutes are indicative of brainstem damage. The unilateral fixed and dilated pupil is suggestive of damage on the same side of the brain. One fixed and dilated pupil is not suggestive of brain death.

The parents of a newborn with an umbilical hernia ask about treatment options. The nurse's response should be based on which knowledge? a. Surgery is recommended as soon as possible. b. The defect usually resolves spontaneously by 3 to 5 years of age. c. Aggressive treatment is necessary to reduce its high mortality. d. Taping the abdomen to flatten the protrusion is sometimes helpful.

ANS: B The umbilical hernia usually resolves by ages 3 to 5 years of age without intervention. Umbilical hernias rarely become problematic. Incarceration, where the hernia is constricted and cannot be reduced manually, is rare. Umbilical hernias are not associated with a high mortality rate. Taping the abdomen flat does not help heal the hernia; it can cause skin irritation.

Which of the following is the usual presenting symptom for testicular cancer? a. Hard, painful mass b. Hard, painless mass c. Epididymis easily palpated d. Scrotal swelling and pain

ANS: B The usual presenting symptom for testicular cancer is a heavy, hard, painless mass that is either smooth or nodular and palpated on the testes.

The nurse is talking with a 10-year-old boy who wears bilateral hearing aids. The left hearing aid is making an annoying whistling sound that the child cannot hear. What intervention is the most appropriate nursing action? a. Ignore the sound. b. Suggest he reinsert the hearing aid. c. Ask him to reverse the hearing aids in his ears. d. Suggest he raise the volume of the hearing aid.

ANS: B The whistling sound is acoustic feedback. The nurse should have the child remove the hearing aid and reinsert it, making sure no hair is caught between the ear mold and the ear canal. Ignoring the sound or suggesting he raise the volume of the hearing aid would be annoying to others. The hearing aids are molded specifically for each ear.

A recommendation to prevent neural tube defects (NTDs) is the supplementation of what? a. Vitamin A throughout pregnancy b. Folic acid for all women of childbearing age c. Folic acid during the first and second trimesters of pregnancy d. Multivitamin preparations as soon as pregnancy is suspected

ANS: B The widespread use of folic acid among women of childbearing age has decreased the incidence NTDs. In the United States, the rates of NTDs have declined from 1.3 per 1000 births in 1990 to 0.3 per 1000 after the introduction of mandatory folic acid supplementation in food in 1998. Vitamin A is not related to the prevention of NTDs. Folic acid supplementation is recommended for the preconceptual period, as well as during the pregnancy. The NTD is a failure of neural tube closure during early development, the first 3 to 5 weeks.

A child with sickle cell anemia (SCA) develops severe chest and back pain, fever, a cough, and dyspnea. What should be the first action by the nurse? a. Administer 100% oxygen to relieve hypoxia. b. Notify the practitioner because chest syndrome is suspected. c. Infuse intravenous antibiotics as soon as cultures are obtained. d. Give ordered pain medication to relieve symptoms of pain episode.

ANS: B These are the symptoms of chest syndrome, which is a medical emergency. Notifying the practitioner is the priority action. Oxygen may be indicated; however, it does not reverse the sickling that has occurred. Antibiotics are not indicated initially. Pain medications may be required, but evaluation by the practitioner is the priority.

The nurse notes that a child has lost 3.6 kg (8 lb) after 4 days of hospitalization for acute glomerulonephritis. What is the most likely cause of this weight loss? a. Poor appetite b. Reduction of edema c. Restriction to bed rest d. Increased potassium intake

ANS: B This amount of weight loss in this period is a result of the improvement of renal function and mobilization of edema fluid. Poor appetite and bed rest would not result in a weight loss of 8 lb in 4 days. Foods with substantial amounts of potassium are avoided until renal function is normalized.

A 10-year-old girl needs to have another intravenous (IV) line started. She keeps telling the nurse, "Wait a minute," and, "I'm not ready." How should the nurse interpret this behavior? a. IV insertions are viewed as punishment. b. This is expected behavior for a school-age child. c. Protesting like this is usually not seen past the preschool years. d. The child has successfully manipulated the nurse in the past.

ANS: B This school-age child is attempting to maintain some control over the hospital experience. The nurse should provide the girl with structured choices about when the IV line will be inserted. Preschoolers can view procedures as punishment; this is not typical behavior of a preschool-age child.

Which of the following would cause a nurse to suspect that an infection has developed under a cast? A Cold toes B Increased respirations C Complaint of paresthesia D "Hot spots" felt on the cast surface

"Hot spots" felt on the cast surface Correct If hot spots are felt on the cast surface, they usually indicate infection beneath the area. This should be reported so that a window can be made in the cast to observe the site. Cold toes may indicate too tight a cast and need further evaluation. Increased respirations may indicate a respiratory infection or pulmonary emboli. This should be reported, and the child should be evaluated. The five Ps of ischemia from a vascular injury include pain, pallor, pulselessness, paresthesia, and paralysis. Paresthesia is an indication of vascular injury, not infection.

The nurse is teaching a parent with a 2-month-old infant who has been diagnosed with colic about ways to relieve colic. Which statement by the parent indicates the need for additional teaching?

"I should let my infant cry for at least 30 minutes before I respond." (Because the infant has been diagnosed with colic, the parent should respond to the infant immediately or any type of interventions to relieve colic may not be effective. Also, the infant may develop a mistrust of the world if his or her needs are not met. The parent should swaddle the baby tightly with a soft blanket, massage the baby's abdomen, and place the infant in an upright seat after a feeding to help relieve colic.)

The nurse is teaching a nursing student about standard precautions. Which statement made by the student indicates a need for further teaching?

"I will use precautions when administering oral medications to a school-age child." (Standard precautions involve the use of barrier protection (personal protective equipment [PPE]), such as gloves, goggles, a gown, or a mask, to prevent contamination from (1) blood; (2) all body fluids, secretions, and excretions except sweat, regardless of whether they contain visible blood; (3) nonintact skin; and (4) mucous membranes. Precautions should be taken when giving oral care, when changing diapers, and when coming in contact with blood and body fluids. Further teaching is needed if the student indicates the need to use precautions when administering an oral medication to a school-age child.)

A 1-year-old child is diagnosed with intussusception, and the mother of the child asks the nurse to describe the disorder. Which statement is correct about intussusception?

"It is a condition in which a proximal segment of the bowel prolapses into a distal segment of the bowel." (Intussusception occurs when a proximal segment of the bowel prolapses into a distal segment of the bowel. It is not an acute bowel obstruction, but it is a common cause in infants and young children. It is not an inflammatory process.)

A nursing student is caring for a hospitalized child who has hypotonic dehydration. The nursing instructor asks the student to describe this type of dehydration. Which statement by the student indicates that the student understands the physiology associated with this type of dehydration?

"It occurs when the loss of electrolytes is greater than the loss of water." (Hypotonic dehydration occurs when the loss of electrolytes is greater than the loss of water; in this type of dehydration, the serum sodium level is less than 130 mEq/L. Isotonic dehydration occurs when water and electrolytes are lost in approximately the same proportion as they exist in the body. In this type of dehydration, the serum sodium levels remain normal (135 to 145 mEq/L). Options 1 and 4 describe hypertonic dehydration.)

A child is diagnosed with Hirschsprung's disease. The nurse is teaching the parents about the cause of the disease. Which statement, if made by the parent, supports that teaching was successful?

"Special cells are not present in the rectum, which caused the disease." (Hirschsprung's disease also is known as congenital aganglionosis or megacolon. It results from the absence of ganglion cells in the rectum and, to various degrees, up into the colon. Option 2 describes celiac disease. Option 3 describes irritable bowel syndrome. Option 4 describes lactose intolerance. )

A child is admitted to the pediatric intensive care unit for a submersion injury. The child's parents express guilt over the submersion injury to the nurse. The most appropriate response by the nurse is A "You will need to watch your child more closely in the future." B "Why did you let your child almost drown?" C "Your child will be fine, so don't worry." D "Tell me more about your feelings."

"Tell me more about your feelings." Correct The nurse needs to be nonjudgmental and provide the parents an opportunity to express their feelings. You will need to watch your child more closely in the future is a judgmental statement. Why did you let your child almost drown? is a judgmental question. Saying the child will be fine may not be true.

A child with β-thalassemia is receiving numerous blood transfusions. In addition, the child is receiving deferoxamine (Desferal) therapy. The child's parents ask the nurse what deferoxamine does. The most appropriate response by the nurse is "The medication helps to prevent blood transfusion reactions." "The medication stimulates red blood cell production." "The medication provides vitamin supplementation." "The medication helps to prevent iron overload."

"The medication helps to prevent iron overload." Correct A side effect of hypertransfusion therapy is often iron overload. Deferoxamine is an iron-chelating drug that binds excess iron; therefore, it can be excreted by the kidneys. Deferoxamine does not prevent blood transfusions. Deferoxamine does not stimulate red cell production. Deferoxamine is not a vitamin supplement.

A 3-year-old child is hospitalized after submersion injury. The child's mother complains to the nurse, "This seems unnecessary when he is perfectly fine." The nurse's best reply would be which of the following? A "He still needs a little extra oxygen." B "I'm sure he is fine, but the doctor wants to make sure." C "It is important to observe for possible physical reasons for the accident." D "The reason for hospitalization is that complications could still occur."

"The reason for hospitalization is that complications could still occur." Correct Complications such as respiratory compromise and cerebral edema can occur 24 hours after the incident. If the child needed oxygen, the mother would not state the child is perfectly fine. Telling the mother that the doctor wants to make sure the child is fine minimizes the role of the nurse and the need for observation for potential life-threatening complications. Physiologic causes may need to be identified in the case of a submersion injury, but it is not the reason for hospitalization.

A child is brought to the emergency department after experiencing a seizure at school. He has no history of seizures. The father tells the nurse that he cannot believe the child has epilepsy. The nurse's best response is which of the following? A "Epilepsy is easily treated." B "Very few children have actual epilepsy." C "The seizure may or may not mean that your child has epilepsy." D "Your child has had only one convulsion; it probably won't happen again."

"The seizure may or may not mean that your child has epilepsy." Correct A single seizure event is not classified as epilepsy and is generally not treated with long-term antiepileptic drugs. It can be the result of an acute medical or neurologic disease. True epilepsy is not easily treated, so saying that it is easily treated minimizes the father's concern. The statistics on epilepsy do not address the father's issues about his child. The seizure may or may not mean that a child has epilepsy, so it may not happen again. The nurse needs to provide the information to the parent that the diagnosis is not based on one seizure episode.

The parents of a child with sickle cell anemia (SCA) are concerned about subsequent children having the disease. Which response by the nurse is most accurate? "SCA is not inherited." "All siblings will have SCA." "There is a 25% chance of a sibling having SCA." "There is a 50% chance of a sibling having SCA."

"There is a 25% chance of a sibling having SCA." Correct SCA is inherited as an autosomal recessive disorder. In this inheritance pattern, there is a 25% chance that each subsequent child will have the disorder. SCA is an inherited hemoglobinopathy. In autosomal recessive disorders, there is a chance that 25% of the children will not have either SCA or sickle cell trait. There is a chance that 50% of the siblings will have sickle cell trait.

The nurse is teaching parents guidelines for feeding their 8-month-old infant with failure to thrive (FTT). Which statement by the parents indicates a need for further teaching?

"We will be sure to give our infant at least 8 oz of juice every day." (Juice intake in infants with FTT should be withheld until adequate weight gain has been achieved with appropriate milk sources; thereafter, no more than 4/oz day of juice should be given. Further teaching is needed if the parents indicate 8 oz of juice is allowed. For infants with FTT, 24-kcal/oz formulas may be provided to increase caloric intake. Because maladaptive feeding practices often contribute to growth failure, parents should follow specific step-by-step directions for formula preparation, as well as a written schedule of feeding times. Statements by the parents indicating they will use a 24-kcal/oz formula, follow directions for formula preparation, and feed their infant on schedule are accurate statements.)

The nurse is teaching parents about caring for their infant with seborrheic dermatitis (cradle cap). Which statement by the parents indicates understanding of the teaching?

"We will use a fine-tooth comb to help remove the loosened crusts from the strands of hair."(A fine-tooth comb or a soft facial brush helps remove the loosened crusts from the strands of hair after shampooing. This is an accurate statement. Shampoo should applied to the scalp and allowed to remain on the scalp until the crusts soften. Shampoo should not be rinsed off quickly. The crusts should be removed, and shampooing with antiseborrheic shampoo should be done daily, not every other day.)

The mother of a child with type 1 diabetes mellitus asks why her child cannot avoid all those "shots" and take pills as an uncle does. The most appropriate response by the nurse is A "The pills work with an adult pancreas only." B "The drugs affect fat and protein metabolism, not sugar." C "Your child needs to have insulin replaced, and the oral hypoglycemics only add to an existing supply of insulin." D "Perhaps when your child is older, the pancreas will produce its own insulin, and then your child can take oral hypoglycemics."

"Your child needs to have insulin replaced, and the oral hypoglycemics only add to an existing supply of insulin." Correct In type 1 diabetes, the beta cells have been destroyed. It is necessary to supply the insulin no longer produced by the beta cells. The oral medications have different modes of action that supplement insulin production by the pancreas, decreasing insulin resistance or affecting liver production of glucose. They are not insulin substitutes and are primarily used in type 2 diabetes mellitus. Oral hypoglycemics can supplement insulin production by the pancreas, decrease insulin resistance, or affect the liver production of glucose. In type 1 diabetes, the beta cells have been destroyed. Without a pancreatic beta cell transplant, it is unlikely that insulin would be produced.

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

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

A parent brings a 12-month-old infant into the emergency department and tells the nurse that the infant is allergic to peanuts and was accidentally given a cookie with peanuts in it. The infant is dyspneic, wheezing, and cyanotic. The health care provider has prescribed a dose of epinephrine to be administered. The infant weighs 24 lb. How many milligrams of epinephrine should be administered?

0.011 to 0.3 mg. (The correct dose of epinephrine to use in the emergency management of an anaphylactic reaction is 0.001 mg/kg up to a maximum of 0.3 mg, giving a range of 0.011 to 0.3 mg using a weight of 11 kg (24 lb).)

The hepatitis A vaccine is now recommended at which of the following ages?

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

The hepatitis A vaccine is now recommended at which of the following ages?

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

Pertussis vaccination should begin at which age?

2 months (The acellular pertussis vaccine is recommended by the American Academy of Pediatrics beginning at age 6 weeks. Infants are at greater risk for complications of pertussis. The vaccine is not given after age 7 years, when the risks of the vaccine become greater than those of pertussis. The first dose is usually given at the 2-month well-child visit. Infants are highly susceptible to pertussis, which can be a life-threatening illness in this age group.)

At a well-child check-up, the nurse notes that an infant with a previous diagnosis of failure to thrive (FTT) is now steadily gaining weight. The nurse should recommend that fruit juice intake be limited to no more than how much?

4 oz/day. (Restrict juice intake in children with FTT until adequate weight gain has been achieved with appropriate milk sources; thereafter, give no more than 4 oz/day of juice.)

Normal Range for BUN (Blood Urea Nitrogen)

4-18mg/dl in Newborn 5- 18mg/dl in Infant and Child

To prevent burns from hot water in the home, the nurse should recommend that families set their water heater thermostat to

49º C (120º F). The recommended temperature to set water heaters is 120º F. A water heater can be set 10 degrees higher and still be safe. Temperatures of 60º C (140º F) to 71º C (160º F) are too high. At 140º F, submersion for 5 seconds will cause a burn.

A 6-year-old child with acute renal failure (ARF) is being transferred out of the intensive care unit. Which children, considering their diagnoses, would be the most appropriate roommate for this child?

5-year-old child who has a fractured femur The 5-year-old orthopedic patient would be the best choice for a roommate. This child does not have an illness of viral or bacterial origin. A child with pneumonia has an illness of viral or bacterial origin and should not be placed in the same room as a child with ARF. A child with gastroenteritis has an illness of viral or bacterial origin and should not be placed in the same room as a child with ARF. A child who has had surgery for a ruptured appendix may have an illness of viral or bacterial origin and should not be placed in the same room as a child with ARF.

The nurse is collecting a stool sample from an infant with lactose intolerance. Which fecal pH should the nurse expect as the result?

5.5. (An acidic pH (5-5.5) indicates malabsorption, which occurs with lactose intolerance. The normal pH of the stool is 7.0 to 7.5. A finding of 8 would be alkaline.)

Which vitamin supplementation has been found to reduce both morbidity and mortality in measles?

A . (Evidence suggests that vitamin A supplementation reduces both morbidity and mortality in measles.)

. The nurse should recognize that when a child develops diabetic ketoacidosis, this is which of the following? A Expected outcome B Best treated at home C A life-threatening situation D Best treated at practitioner's office or clinic

A life-threatening situation Correct Diabetic ketoacidosis is the state of complete insulin deficiency. It is a medical emergency that must be diagnosed and treated. The child is usually admitted to an intensive care unit for assessment, insulin administration, and fluid and electrolyte replacement. Diabetic ketoacidosis is a medical emergency needing prompt assessment and intervention, usually in an intensive care environment.

Which statement best describes colic?

A paroxysmal abdominal pain or cramping manifested by episodes of loud crying. (Colic is described as paroxysmal abdominal pain or cramping that is manifested by loud crying and drawing up the legs to the abdomen. Weight loss is not part of the clinical picture. There are many theories about the cause of colic. Emotional stress or tension between the parent and child is one component. This is not consistent throughout all cases. Colic is most common in infants younger than 3 months of age.)

A mother tells the nurse that she does not want her infant immunized because of the discomfort associated with injections. What should the nurse explain?

A topical anesthetic can be applied before injections are given. (To minimize the discomfort associated with intramuscular injections, a topical anesthetic agent can be used on the injection site. These include EMLA (eutectic mixture of local anesthetic) and vapor coolant sprays. Pain associated with many procedures can be prevented or minimized by using the principles of atraumatic care. Infants have neural pathways that will indicate pain. Numerous research studies have indicated that infants perceive and react to pain in the same manner as do children and adults. The mother should be allowed to discuss her concerns and the alternatives available. This is part of the informed consent process.)

A nurse is assessing an infant. Which of the following are clinical manifestations of hypertrophic pyloric stenosis? (Select all that apply.) A.`Projectile vomiting B. Dry mucus membranes C. Currant jelly stools D. Sausage-shaped abdominal mass E. Constant hunger

A. CORRECT: A client who has a pyloric stricture has thickening of the pyloric sphincter, resulting in projectile vomiting. B. CORRECT: A client who has pyloric stricture is unable to consume adequate food and fluid, resulting in dehydration. Dry mucous membranes is a clinical manifestation of hypertrophic pyloric stenosis. E. CORRECT: A client who has pyloric stricture is unable to consume adequate food and fluid, resulting in constant hunger.

A nurse is assessing a client who has pertussis. Which of the following are clinical manifestations of pertussis? (Select all that apply.)

A. CORRECT: A client who has pertussis has coldlike symptoms, including runny nose, congestion, and mild fever. B. CORRECT: A client who has pertussis has coldlike symptoms, including runny nose, congestion, and mild fever. C. CORRECT: A client who has pertussis will experience coughing fits and a whooping sound.

A nurse is teaching a parent about posttraumatic stress disorder (PTSD). Which of the following should be included in the teaching? (Select all that apply.)

A. CORRECT: Children who have PTSD should be referred to psychotherapy to assist with resolution of the traumatic event. B. CORRECT: The child who is experiencing PTSD often has new phobias that can be related to the traumatic event. D. CORRECT: PTSD develops following a traumatic event such as assault, serious injury, or a life‑threatening episode.

A nurse is completing a physical assessment of a child with suspected glaucoma. Which of the following findings confirm this diagnosis? (Select all that apply.) A. Epiphora B. Absent red reflex C. Strabismus D. Blepharospasm E. Report of pain

A. CORRECT: Epiphora is a clinical manifestation of glaucoma. D. CORRECT: Blepharospasm is a clinical manifestation of glaucoma. E. CORRECT: Report of pain is a clinical manifestation of glaucoma.

A nurse is assessing a child who has a rotavirus infection. Which of the following are expected findings? (Select all that apply.) A. Fever B. Vomiting C. Watery stools D. Bloody stools E. Confusion

A. CORRECT: Fever is a clinical manifestation of rotavirus infection. B. CORRECT: Vomiting for approximately 2 days is a clinical manifestation of rotavirus infection. C. CORRECT: Foul-smelling, watery stools is a clinical manifestation of rotavirus infection.

A nurse is teaching a parent of an infant about gastrointestinal reflux disease (GERD). Which of the following should be included in the teaching? (Select all that apply.) A. Offer frequent feedings. B. Thicken formula with rice cereal. C. Use a bottle with a one-way valve. D. Position baby upright for 1 hr after feedings. E. Use a wide based nipple for feedings.

A. CORRECT: Frequent feeding will assist in decreasing the amount of vomiting episodes. B. CORRECT: Thickened formula will assist in decreasing the amount of vomiting episodes. an infant who has cleft lip and palate. D. CORRECT: Positioning the infant in an upright position for 1 hr following feedings will assist in decreasing the amount of vomiting episodes.

A nurse is assessing an infant who has eczema. Which of the following are clinical manifestations of eczema in an infant? (Select all that apply.)

A. CORRECT: Generalized distribution is a clinical manifestation found in infants who have eczema. B. CORRECT: Papules are a clinical manifestation found in infants who have eczema. C. INCORRECT: Clusters are a clinical manifestation found in children who have eczema. D. CORRECT: Crusting lesions are a clinical manifestation found in infants who have eczema. E. INCORRECT: Lichenification is a clinical manifestation found in children who have eczema.

A nurse is assessing a child. Which of the following are clinical manifestations of myopia? (Select all that apply.) A. Headaches B. Photophobia C. Difficult reading D. Difficulty focusing on close objects E. Poor school performance

A. CORRECT: Headaches are a clinical manifestation of myopia. C. CORRECT: Difficulty reading is a clinical manifestation of myopia. E. CORRECT: Poor school performance is a clinical manifestation of myopia.

A nurse is caring for a client who has major burns and suspected septic shock. Which of the following findings are consistent with septic shock? (Select all that apply.) A. Increased body temperature B. Altered sensorium C. Decreased capillary refill D. Decreased urine output E. Increased bowel sounds

A. CORRECT: Increased body temperature is a clinical manifestation of septic shock. B. CORRECT: Altered sensorium is a clinical manifestation of septic shock. D. CORRECT: Decreased urine output is a clinical manifestation of septic shock.

A nurse often cares children who are dying. Which of the following is an appropriate action for a nurse to take to maintain their effectiveness? (Select all that apply.) A. Remain in contact with the family after their loss. B. Develop a professional support system. C. Take time off from work. D. Suggest that a hospital representative attend the funeral. E. Demonstrate feelings of sympathy toward the family.

A. CORRECT: Maintaining contact with the family after their loss is an act of support for the family. B. CORRECT: Developing professional support systems is a strategy the nurse can use to maintain effectiveness when working with the client who is dying and their family. C. CORRECT: Taking time off from work is a strategy the nurse can use to maintain effectiveness when working with the client who is dying and their family.

A nurse is caring for a client who has a major burn and is experiencing severe pain. Which of the following is an appropriate nursing intervention to manage this client's pain? A. Administer morphine sulfate IV via continuous infusion. B. Administer meperidine (Demerol) IM as needed. C. Administer acetaminophen (Tylenol) PO every 4 hr. D. Administer hydrocodone (Vicodin) PO every 6 hr.

A. CORRECT: Opioids administered IV via continuous infusion are recommended for clients who have major burns.

A nurse is planning care for a child who has tinea capitis. Which of the following should the nurse include in the plan of care? (Select all that apply.)

A. CORRECT: Tinea capitis can be transmitted from household pets to persons. Therefore, pets should be treated, if infected. B. CORRECT: Selenium sulfide shampoo is recommended for use for children who have tinea capitis. C. INCORRECT: A topical antifungal medication is recommended for children who have tinea capitis. D. INCORRECT: Tinea capitis is a fungal infection. Therefore, antifungal medications are administered. E. INCORRECT: Moist, warm compresses are applied for bacterial skin infections and not recommended for children who have tinea capitis.

The nurse working with families of children with chronic diseases is concerned with helping the parents and siblings avoid compassion fatigue. Which activities would the nurse encourage for the families? (Select all that apply.)

A. Exercising C. Fostering social relationships in their community D. Developing a hobby, either individually or as a family

A nurse is assessing an infant who has scabies. Which of the following are expected findings? (Select all that apply.)

A. INCORRECT: Presence of nits on the hair shaft is a clinical manifestation of pediculosis capitis. B. CORRECT: Pencil-like marks on hands is a clinical manifestation of scabies. C. CORRECT: Blisters on the soles of the feet is a clinical manifestation of scabies. D. INCORRECT: Bluish-gray skin color is a clinical manifestation of pediculosis pubis. E. CORRECT: Pimples on the trunk is a clinical manifestation of scabies.

A nurse is caring for a child who has contact dermatitis due to poison ivy. Which of the following should be included in the plan of care? (Select all that apply.)

A.CORRECT: Removing the irritant from the skin will decrease the exposure. Therefore, removing the clothing over the rash should be included in the plan of care. E. CORRECT: Calamine lotion will assist in relieving discomfort and should be included in the plan of care.

The nurse enters a room and finds a 6-year-old child who is unconscious. After calling for help and before being able to use an automatic external defibrillator, which steps should the nurse take? Place in correct order. Provide answer using lowercase letters separated by commas (e.g., a, b, c, d, e, f). a. Place on a hard surface. b. Administer 30 chest compressions with two breaths. c. Feel carotid pulse while maintaining head tilt with the other hand. d. Use the head tilt-chin lift maneuver and check for breathing. e. Place heel of one hand on lower half of sternum with other hand on top. f. Give two rescue breaths.

ANS: a, d, f, c, e, b

An infant with an unrepaired tetralogy of Fallot defect is becoming extremely cyanotic during a routine blood draw. Which interventions should the nurse implement? Place in order from the highest-priority intervention to the lowest-priority intervention. Provide answer using lowercase letters separated by commas (e.g., a, b, c, d). a. Administer 100% oxygen by blow-by. b. Place infant in knee-chest position. c. Remain calm. d. Give morphine subcutaneously or by an existing intravenous line.

ANS: b, a, d, c Hypercyanotic spells, also referred to as blue spells or tet spells because they are often seen in infants with tetralogy of Fallot, may occur in any child whose heart defect includes obstruction to pulmonary blood flow and communication between the ventricles. The infant becomes acutely cyanotic and hyperpneic because sudden infundibular spasm decreases pulmonary blood flow and increases right-to-left shunting. Because profound hypoxemia causes cerebral hypoxia, hypercyanotic spells require prompt assessment and treatment to prevent brain damage or possibly death. The infant should first be placed in the knee-chest position to reduce blood returning to the heart. Next 100% oxygen is given to alleviate the hypoxemia. Morphine is next administered to reduce infundibular spasms. Last, the nurse should remain calm.

Place in order the correct sequence for emergency treatment of poisoning in a child. a. Locate the poison. b. Assess the child. c. Prevent absorption of poison. d. Terminate exposure to the toxic substance.

ANS: b, d, a, c b. The initial step in treating poisonings is to assess child, treat immediate life-threatening conditions, and initiate cardiopulmonary resuscitation (CPR) if indicated. d. Terminating the exposure to the toxic substance is the second step. a. Locating the poison for identification is the third step. c. Preventing absorption of poison is the fourth step.

A 6-year-old child is having a generalized seizure in the classroom at school. Place in order the interventions the school nurse should implement starting with the highest-priority intervention sequencing to the lowest-priority intervention. Provide answer using lowercase letters separated by commas (e.g., a, b, c, d, e). a. Take vital signs. b. Ease child to the floor. c. Allow child to rest. d. Turn child to the side. e. Integrate child back into the school environment.

ANS: b, d, a, c, e The nurse should ease the child to the floor immediately during a generalized seizure. During (and sometimes after) the generalized seizure, the swallowing reflex is lost, salivation increases, and the tongue is hypotonic. Therefore, the child is at risk for aspiration and airway occlusion. Placing the child on the side facilitates drainage and helps maintain a patent airway. Vital signs should be taken next and the child should be allowed to rest. When feasible, the child is integrated into the environment as soon as possible.

A child is brought to the emergency department experiencing an anaphylactic reaction to a bee sting. Once the airway is established, the nurse should do which action? Place in correct sequence. Provide answer using lowercase letters separated by commas (e.g., a, b, c). a. Administer epinephrine. b. Keep child warm and calm. c. Obtain vascular access.

ANS: c, a, b The correct sequence of actions is to obtain vascular access, administer epinephrine, and then to keep the child warm and calm.

he nurse is preparing to insert a nasogastric tube into a 4-year-old child for intermittent suctioning after abdominal surgery. Place in correct sequence the steps for inserting a nasogastric tube. a. Lubricate the nasogastric tube with water-soluble lubricant. b. Tape the nasogastric tube securely to the child's face. c. Check the placement of the tube by aspirating stomach contents. d. Place the child in the supine position with head slightly hyperflexed. e. Insert the nasogastric tube through the nares. f. Measure the tube from the tip of the nose to the ear lobe to midpoint between the xiphoid process and the umbilicus.

ANS: d, f, a, e, c, b This is the correct sequence for inserting a nasogastric tube.

Heart failure (HF) is a problem after the child has had a congenital heart defect repaired. The nurse knows a sign of HF is what? a. Wheezing b. Increased blood pressure c. Increased urine output d. Decreased heart rate

ANS: A A clinical manifestation of heart failure is wheezing from pulmonary congestion. The blood pressure decreases, urine output decreases, and heart rate increases.

Deficiency of which vitamin or mineral results in an inadequate inflammatory response? a. A b. B1 c. C d. Zinc

ANS: A A deficiency of vitamin A results in an inadequate inflammatory response. Deficiencies of vitamins B1 and C result in decreased collagen formation. A deficiency of zinc leads to impaired epithelialization.

The nurse is admitting a child with frostbite. What health care prescription should the nurse question and verify? a. Massage the injured tissue. b. Apply a loose dressing after rewarming. c. Avoid any application of dry heat to the area. d. Administer acetaminophen (Tylenol) for discomfort.

ANS: A A frostbite victim should not have injured tissue rubbed. It is contraindicated because it can cause damage by rupture of crystallized cells. After rewarming, a loose dressing is applied to the affected skin, and analgesia is administered if indicated. Dry heat is not applied.

A goiter is an enlargement or hypertrophy of which gland? a. Thyroid b. Adrenal c. Anterior pituitary d. Posterior pituitary

ANS: A A goiter is an enlargement or hypertrophy of the thyroid gland. Goiter is not associated with the adrenal, anterior pituitary, or posterior pituitary organs.

A goiter is an enlargement or hypertrophy of which gland? a. Thyroid b. Adrenal c. Anterior pituitary d. Posterior pituitary

ANS: A A goiter is an enlargement or hypertrophy of the thyroid gland. Goiter is not associated with the adrenal, anterior pituitary, or posterior pituitary secretory organs.

A 9-year-old child has just been diagnosed with recurrent abdominal pain (RAP). In preparing for discharge, the nurse should include what in the home care instructions to the parents? a. Following a high-fiber diet b. Using stimulant laxatives c. Using ice packs on the abdomen when pain occurs d. Sitting on the toilet for 30 minutes after each meal

ANS: A A high-fiber diet with possible addition of bulk laxatives is beneficial for children with RAP. Bulk-forming laxatives such as psyllium are recommended. Stimulant laxatives may produce painful cramping for the child. Warm packs, such as a heating pad, may help ease the discomfort. Bowel training is recommended to assist the child in establishing regular bowel habits. Thirty minutes is too long for the child to sit on the toilet. The time should be limited to 15 minutes.

A lumbar puncture (LP) is being done on an infant with suspected meningitis. The nurse expects which results for the cerebrospinal fluid that can confirm the diagnosis of meningitis? a. WBCs; glucose b. RBCs; normal WBCs c. glucose; normal RBCs d. Normal RBCs; normal glucose

ANS: A A lumbar puncture is the definitive diagnostic test. The fluid pressure is measured and samples are obtained for culture, Gram stain, blood cell count, and determination of glucose and protein content. The findings are usually diagnostic. The patient generally has an elevated white blood cell count, often predominantly polymorphonuclear leukocytes. The glucose level is reduced, generally in proportion to the duration and severity of the infection.

The nurse is planning care for a 3-year-old boy who has Down syndrome and is on continuous oxygen. He recently began walking around furniture. He is spoon fed by his parents and eats some finger foods. What goal is the most appropriate to promote normal development? a. Encourage mobility. b. Encourage assistance in self-care. c. Promote oral-motor development. d. Provide opportunities for socialization.

ANS: A A major principle for developmental support in children with complex medical issues is that it should be flexible and tailored to the individual child's abilities, interests, and needs. This child is exhibiting readiness for ambulation. It is an appropriate time to provide activities that encourage mobility, for example, longer oxygen tubing. Parents should provide decreasing amounts of assistance with self-care as he is able to develop these skills. The boy is receiving oral foods and is eating finger foods. He has acquired this skill. Mobility is a new developmental task. Opportunities for socialization should be ongoing.

The family and child have decided that hospice care best meets their needs during the terminal phase of illness. The nurse recognizes that the parents understand the principles of this care when they make which statement? a. "It will be good to be at home and care for our child." b. "What a relief it will be not to need any more medicines." c. "We are going to miss the support of the hospice team when our child dies." d. "We know that once hospice care starts, we will not be able to return to the hospital if the care is difficult."

ANS: A A major principle of hospice care is that the family members are the principal caregivers and are supported by a team of professionals. Pain and symptom management is a priority. The family and visiting nurses administer medications to keep the child as pain and symptom free as possible. The hospice team provides bereavement support to help the family in the postdeath adjustment. This may last for up to a year or more. If the family decides they can no longer care for the child at home, readmission to a freestanding hospice or hospital is possible.

Meperidine (Demerol) is not recommended for children in sickle cell crisis because it: a. may induce seizures. b. is easily addictive. c. is not adequate for pain relief. d. is given by intramuscular injection.

ANS: A A metabolite of meperidine, normeperidine, is a central nervous system stimulant that produces anxiety, tremors, myoclonus, and generalized seizures when it accumulates with repetitive dosing. Patients with sickle cell disease are particularly at risk for normeperidine-induced seizures. Meperidine is no more addictive than other narcotic agents. Meperidine is adequate for pain relief. It is available for IV infusion.

A young child with leukemia has anorexia and severe stomatitis. The nurse should suggest that the parents try which intervention? a. Relax any eating pressures. b. Firmly insist that child eat normally. c. Begin gavage feedings to supplement diet. d. Serve foods that are either hot or cold.

ANS: A A multifaceted approach is necessary for children with severe stomatitis and anorexia. First, the parents should relax eating pressures. The nurse should suggest that the parents try soft, bland foods; normal saline or bicarbonate mouthwashes; and local anesthetics. The stomatitis is a temporary condition. The child can resume good food habits as soon as the condition resolves.

A series of subdiaphragmatic abdominal thrusts (the Heimlich maneuver) is recommended for airway obstruction in children older than which age? a. 1 year b. 4 years c. 8 years d. 12 years

ANS: A A series of subdiaphragmatic abdominal thrusts (the Heimlich maneuver) is recommended for airway obstruction in children older than 1 year. For children younger than 1 year, back blows and chest thrusts are administered.

A child is being admitted to the hospital to be tested for cystic fibrosis (CF). Which tests should the nurse expect? a. Sweat chloride test, stool for fat, chest radiograph films b. Stool test for fat, gastric contents for hydrochloride, chest radiograph films c. Sweat chloride test, bronchoscopy, duodenal fluid analysis d. Sweat chloride test, stool for trypsin, biopsy of intestinal mucosa

ANS: A A sweat test result of greater than 60 mEq/L is diagnostic of CF, a high level of fecal fat is a gastrointestinal (GI) manifestation of CF, and a chest radiograph showing patchy atelectasis and obstructive emphysema indicates CF. Gastric contents contain hydrochloride normally; it is not diagnostic. Bronchoscopy and duodenal fluid are not diagnostic. Stool test for trypsin and intestinal biopsy are not helpful in diagnosing CF.

31. What tests aid in the diagnosis of cystic fibrosis (CF)? a. Sweat test, stool for fat, chest radiography b. Sweat test, bronchoscopy, duodenal fluid analysis c. Sweat test, stool for trypsin, biopsy of intestinal mucosa d. Stool for fat, gastric contents for hydrochloride, radiography

ANS: A A sweat test result of greater than 60 mEq/L is diagnostic of CF, a high level of fecal fat is a gastrointestinal manifestation of CF, and a chest radiograph showing patchy atelectasis and obstructive emphysema indicates CF. Bronchoscopy, duodenal fluid analysis, stool tests for trypsin, and intestinal biopsy are not helpful in diagnosing CF. Gastric contents normally contain hydrochloride; it is not diagnostic.

What type of seizure may be difficult to detect? a. Absence b. Generalized c. Simple partial d. Complex partial

ANS: A Absence seizures may go unrecognized because little change occurs in the child's behavior during the seizure. Generalized, simple partial, and complex partial all have clinical manifestations that are observable.

Which of the following types of seizures may be difficult to detect? a. Absence b. Generalized c. Simple partial d. Complex partial

ANS: A Absence seizures may go unrecognized because little change occurs in the child's behavior during the seizure. Generalized, simple partial, and complex partial seizures all have clinical manifestations that are observable.

When caring for the child with Reye syndrome, the priority nursing intervention should be to: a. monitor intake and output. b. prevent skin breakdown. c. observe for petechiae. d. do range-of-motion exercises.

ANS: A Accurate and frequent monitoring of intake and output is essential for adjusting fluid volumes to prevent both dehydration and cerebral edema. Preventing skin breakdown, observing for petechiae, and doing range-of-motion exercises are important interventions in the care of a critically ill or comatose child. Careful monitoring of intake and output is a priority.

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

ANS: A Administer the medication with a syringe without needle placed alongside of the infant's tongue. The contents are administered slowly in small amounts, allowing the child to swallow between deposits.

The continuous administration of mist, or aerosolized water, for the treatment of inflammatory conditions of the airways is a common practice that functions in which manner? a. Has no proven benefit b. Decreases the viscosity of mucus c. Decreases bronchoconstriction d. Reduces the inflammation of the lower airways

ANS: A Aerosol therapy or mist therapy with water is not a treatment of choice for inflammatory airway conditions. Some questionable benefit may occur in mild viral croup. The parent and child may experience a reduction in anxiety in a cool, humid environment. Upper airway secretions may be moistened; however, inhaled mist does not affect the viscosity of mucus. Humidity may worsen bronchospasm. Aerosolized medications are able to reduce inflammation of the lower airways, but water does not have this effect.

A 17-year-old patient is returning to the surgical unit after Luque instrumentation for scoliosis repair. In addition to the usual postoperative care, what additional intervention will be needed? a. Position changes are made by log rolling. b. Assistance is needed to use the bathroom. c. The head of the bed is elevated to minimize spinal headache. d. Passive range of motion is instituted to prevent neurologic injury.

ANS: A After scoliosis repair using a Luque procedure, the adolescent is turned by log rolling to prevent damage to the fusion and instrumentation. The patient is kept flat in bed for the first 12 hours and is not ambulatory until the second or third postoperative day. A urinary catheter is placed. The head of the bed is not elevated until the second postoperative day. Range of motion exercises are begun on the second postoperative day.

A 2-year-old child has to receive Rocephin IM injections every 12 hours. What nursing intervention should be implemented for the child? a. Hold the child while rocking in a chair after each injection. b. Prepare the child several hours before the injection is given. c. Allow the child to watch a younger child receive an injection. d. Encourage the child to draw a picture of the pain experienced when an injection is given.

ANS: A After the procedure, the child continues to need reassurance that he or she performed well and is accepted and loved. The other options are not appropriate for a toddler.

The nurse gives an injection in a patient's room. The nurse should do which of the following with the needle for disposal? a. Dispose of syringe and needle in a rigid, puncture-resistant container in patient's room. b. Dispose of syringe and needle in a rigid, puncture-resistant container in an area outside of patient's room. c. Cap needle immediately after giving injection and dispose of in proper container. d. Cap needle, break from syringe, and dispose of in proper container.

ANS: A All needles (uncapped and unbroken) are disposed of in a rigid, puncture-resistant container located near the site of use. Consequently, these containers should be installed in the patient's room.

The nurse is teaching parents of preschoolers about plants that are poisonous. What plant should the nurse include in the teaching session? a. Azalea b. Begonia c. Boston fern d. Asparagus fern

ANS: A All parts of the azalea are poisonous. Begonias, Boston ferns, and asparagus ferns are nonpoisonous plants.

The nurse is implementing care for a school-age child admitted to the pediatric intensive care in diabetic ketoacidosis (DKA). Which prescribed intervention should the nurse implement first? a. Begin 0.9% saline solution intravenously as prescribed. b. Administer regular insulin intravenously as prescribed. c. Place child on a cardiac monitor. d. Place child on a pulse oximetry monitor.

ANS: A All patients with DKA experience dehydration (10% of total body weight in severe ketoacidosis) because of the osmotic diuresis, accompanied by depletion of electrolytes, sodium, potassium, chloride, phosphate, and magnesium. The initial hydrating solution is 0.9% saline solution. Insulin therapy should be started after the initial rehydration bolus because serum glucose levels fall rapidly after volume expansion. The child should be placed on the cardiac and pulse oximetry monitor after the rehydrating solution has been initiated.

The nurse is caring for an adolescent with osteosarcoma being admitted to undergo chemotherapy. The adolescent had a right above-the-knee amputation 2 months ago and has been experiencing "phantom limb pain." Which prescribed medication is appropriate to administer to relieve phantom limb pain? a. Amitriptyline (Elavil) b. Hydrocodone (Vicodin) c. Oxycodone (OxyContin) d. Alprazolam (Xanax)

ANS: A Amitriptyline (Elavil) has been used successfully to decrease phantom limb pain. Opioids such as Vicodin or OxyContin would not be prescribed for this pain. A benzodiazepine, Xanax, would not be prescribed for this type of pain.

A 1-month-old infant is admitted to the hospital. The infant's mother is 17 years old and single and lives with her parents. Who signs the informed consent for the 1-month-old infant? a. The infant's mother b. The maternal grandparents of the infant c. The paternal grandparents of the infant d. Both the infant's mother and the maternal grandparents

ANS: A An emancipated minor is one who is legally under the age of majority but is recognized as having the legal capacity of an adult under circumstances prescribed by state law, such as pregnancy, marriage, high school graduation, independent living, or military service.

A child has an evulsed (knocked-out) tooth. The parents are reluctant to try to reimplant the tooth. Where should the tooth be placed for transport to the dentist? a. In cold milk b. In cold water c. In warm salt water d. In a dry, clean jar

ANS: A An evulsed tooth should be placed in a suitable medium for transplant, either cold milk or saliva (under the child or parent's tongue).

The nurse is caring for an adolescent with anorexia nervosa. What pituitary dysfunction should the nurse assess for in the adolescent? a. Hypopituitarism b. Pituitary hyperfunction c. Hyperplasia of the pituitary cells d. Overproduction of the anterior pituitary hormones

ANS: A Anorexia nervosa can cause hypopituitarism. It does not cause the hyperfunction of the pituitary, hyperplasia of the pituitary cells, or overproduction of the anterior pituitary hormones.

An infant has been diagnosed with staphylococcal pneumonia. Nursing care of the child with pneumonia includes which intervention? a. Administration of antibiotics b. Frequent complete assessment of the infant c. Round-the-clock administration of antitussive agents d. Strict monitoring of intake and output to avoid congestive heart failure

ANS: A Antibiotics are indicated for bacterial pneumonia. Often the child has decreased pulmonary reserve, and clustering of care is essential. The child's respiratory rate and status and general disposition are monitored closely, but frequent complete physical assessments are not indicated. Antitussive agents are used sparingly. It is desirable for the child to cough up some of the secretions. Fluids are essential to kept secretions as liquefied as possible.

An 18-month-old child is seen in the clinic with AOM. Trimethoprim-sulfamethoxazole (Bactrim) is prescribed. Which statement made by the parent indicates a correct understanding of the instructions? a. "I should administer all the prescribed medication." b. "I should continue medication until the symptoms subside." c. "I will immediately stop giving medication if I notice a change in hearing." d. "I will stop giving medication if fever is still present in 24 hours."

ANS: A Antibiotics should be given for their full course to prevent recurrence of infection with resistant bacteria. Symptoms may subside before the full course is given. Hearing loss is a complication of AOM. Antibiotics should continue to be given. Medication may take 24 to 48 hours to make symptoms subside. It should be continued.

An 18-month-old child is seen in the clinic with otitis media (OM). Oral amoxicillin is prescribed. What instructions should be given to the parent? a. Administer all of the prescribed medication. b. Continue medication until all symptoms subside. c. Immediately stop giving medication if hearing loss develops. d. Stop giving medication and come to the clinic if fever is still present in 24 hours.

ANS: A Antibiotics should be given for their full course to prevent recurrence of infection with resistant bacteria. Symptoms may subside before the full course is given. Hearing loss is a complication of OM; antibiotics should continue to be given. Medication may take 24 to 48 hours to make symptoms subside.

A 5-year-old child is admitted to the hospital in a sickle cell crisis. The child has been alert and oriented but in severe pain. The nurse notes that the child is complaining of a headache and is having unilateral hemiplegia. What action should the nurse implement? a. Notify the health care provider. b. Place the child on bed rest. c. Administer a dose of hydrocodone (Vicodin). d. Start O2 per the hospital's protocol.

ANS: A Any number of neurologic symptoms can indicate a minor cerebral insult, such as headache, aphasia, weakness, convulsions, visual disturbances, or unilateral hemiplegia. Loss of vision is usually the result of progressive retinopathy and retinal detachment. The nurse should notify the health care provider.

What cardiovascular defect results in obstruction to blood flow? a. Aortic stenosis b. Tricuspid atresia c. Atrial septal defect d. Transposition of the great arteries

ANS: A Aortic stenosis is a narrowing or stricture of the aortic valve, causing resistance to blood flow in the left ventricle, decreased cardiac output, left ventricular hypertrophy, and pulmonary vascular congestion. Tricuspid atresia results in decreased pulmonary blood flow. The atrial septal defect results in increased pulmonary blood flow. Transposition of the great arteries results in mixed blood flow.

In which condition are all the formed elements of the blood simultaneously depressed? a. Aplastic anemia b. Sickle cell anemia c. Thalassemia major d. Iron deficiency anemia

ANS: A Aplastic anemia refers to a bone marrow failure condition in which the formed elements of the blood are simultaneously depressed. Sickle cell anemia is a hemoglobinopathy in which normal adult hemoglobin is partly or completely replaced by abnormal sickled hemoglobin. Thalassemia major is a group of blood disorders characterized by deficiency in the production rate of specific hemoglobin chains. Iron-deficiency anemia results in a decreased amount of circulating red cells.

In which of the conditions are all the formed elements of the blood simultaneously depressed? a. Aplastic anemia b. Sickle cell anemia c. Thalassemia major d. Iron deficiency anemia

ANS: A Aplastic anemia refers to a bone marrow-failure condition in which the formed elements of the blood are simultaneously depressed. Sickle cell anemia is a hemoglobinopathy in which normal adult hemoglobin is partly or completely replaced by abnormal sickle hemoglobin. Thalassemia major is a group of blood disorders characterized by deficiency in the production rate of specific hemoglobin globin chains. Iron deficiency anemia results in a decreased amount of circulating red cells.

The nurse is talking to the parent of a child with special needs. The parent has expressed worry about how to support the siblings at home. What suggestion is appropriate for the nurse to give to the parent? a. "You should help the siblings see the similarities and differences between themselves and your child with special needs." b. "You should explain that your child with special needs should be included in all activities that the siblings participate in even if they are reluctant." c. "You should give the siblings many caregiving tasks for your child with special needs so the siblings feel involved." d. "You should intervene when there are differences between your child with special needs and the siblings."

ANS: A Appropriate information to give to a parent who wants to support the siblings of a child with special needs includes helping the siblings see the differences and similarities between themselves and the child with special needs to promote an understanding environment. The parent should be encouraged to allow the siblings to participate in activities that do not always include the child with special needs, to limit caregiving responsibilities, and to allow the children to settle their own differences rather than step in all the time.

The nurse is planning care for an adolescent with acquired immunodeficiency syndrome. What is the priority nursing goal? a. Prevent infection. b. Prevent secondary cancers. c. Identify source of infection. d. Restore immunologic defenses.

ANS: A As a result of the immunocompromise that is associated with human immunodeficiency virus (HIV) infection, the prevention of infection is paramount. Although certain precautions are justified in limiting exposure to infection, these must be balanced with the concern for the child's normal developmental needs. Preventing secondary cancers is not currently possible. Case finding is not a priority nursing goal in planning care for an individual. Current drug therapy is affecting the disease progression; although not a cure, these drugs can suppress viral replication, preventing further deterioration but not actually restoring immunologic defenses.

The thyroid-stimulating hormone (TSH) increases secretion in response to which hormone? a. Low levels of circulating thyroid hormone b. High levels of circulating thyroid hormone c. Low levels of circulating adrenocorticotropic hormone d. High levels of circulating adrenocorticotropic hormone

ANS: A As blood concentrations of the target hormones reach normal levels, a negative message is sent to the anterior pituitary to inhibit release of the tropic hormone. For example, TSH responds to low levels of circulating TH. As blood levels of TH reach normal concentrations, a negative feedback message is sent to the anterior pituitary, resulting in diminished release of TSH. Adrenocorticotropic stimulates the adrenals to secrete glucocorticoids.

A 12-year-old child with Guillain-Barré syndrome (GBS) is admitted to the pediatric intensive care unit. She tells you that yesterday her legs were weak and that this morning she was unable to walk. After the nurse determines the current level of paralysis, which should the next priority assessment be? a. Swallowing ability b. Parental involvement c. Level of consciousness d. Antecedent viral infections

ANS: A Assessment of swallowing is essential. Both pharyngeal involvement and respiratory function are usually involved at the same time. The child may require ventilatory support. The inability to swallow also contributes to aspiration pneumonia. Parental involvement is important after the physiologic assessment is complete. The child is answering questions and describing the onset of the illness, which demonstrates she is alert and oriented. Information regarding antecedent viral infections can be obtained after the child is assessed and stabilized.

A child has a chronic cough and diffuse wheezing during the expiratory phase of respiration. This suggests what condition? a. Asthma b. Pneumonia c. Bronchiolitis d. Foreign body in trachea

ANS: A Asthma may have these chronic signs and symptoms. Pneumonia appears with an acute onset, fever, and general malaise. Bronchiolitis is an acute condition caused by respiratory syncytial virus. Foreign body in the trachea occurs with acute respiratory distress or failure and maybe stridor.

A child is admitted to the hospital with asthma. Which assessment findings support this diagnosis? a. Nonproductive cough, wheezing b. Fever, general malaise c. Productive cough, rales d. Stridor, substernal retractions

ANS: A Asthma presents with a nonproductive cough and wheezing. Pneumonia appears with an acute onset, fever, and general malaise. A productive cough and rales would be indicative of pneumonia. Stridor and substernal retractions are indicative of croup.

The nurse is assessing a child after a cardiac catheterization. Which complication should the nurse be assessing for? a. Cardiac arrhythmia b. Hypostatic pneumonia c. Heart failure d. Rapidly increasing blood pressure

ANS: A Because a catheter is introduced into the heart, a risk exists of catheter-induced dysrhythmias occurring during the procedure. These are usually transient. Hypostatic pneumonia, heart failure, and rapidly increasing blood pressure are not risks usually associated with cardiac catheterization.

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

ANS: A Because of the urgency of the child's condition, conscious sedation should be used for the procedure.

The nurse is planning care for an adolescent with AIDS. Which is the priority nursing goal? a. Preventing infection b. Preventing secondary cancers c. Restoring immunologic defenses d. Identifying source of infection

ANS: A Because the child is immunocompromised in association with HIV infection, the prevention of infection is paramount. Although certain precautions are justified in limiting exposure to infection, these must be balanced with the concern for the child's normal developmental needs. Preventing secondary cancers is not currently possible. Current drug therapy is affecting the disease progression; although not a cure, these drugs can suppress viral replication, preventing further deterioration. Case finding is not a priority nursing goal.

A 10-year-old child, without a history of previous seizures, experiences a tonic-clonic seizure at school that lasts more than 5 minutes. Breathing is not impaired. Some postictal confusion occurs. What is the most appropriate initial action by the school nurse? a. Stay with child and have someone else call emergency medical services (EMS). b. Notify the parent and regular practitioner. c. Notify the parent that the child should go home. d. Stay with the child, offering calm reassurance.

ANS: A Because this is the child's first seizure and it lasted more than 5 minutes, EMS should be called to transport the child, and evaluation should be performed as soon as possible. The nurse should stay with the recovering child while someone else notifies EMS.

The management of a child who has just been stung by a bee or wasp should include applying what? a. Cool compresses b. Antibiotic cream c. Warm compresses d. Corticosteroid cream

ANS: A Bee or wasp stings are initially treated by carefully removing the stinger, cleansing with soap and water, applying cool compresses, and using common household agents such as lemon juice or a paste made with aspirin and baking soda. Antibiotic cream is unnecessary unless a secondary infection occurs. Warm compresses are avoided. Corticosteroid cream is not part of the initial therapy. If a severe reaction occurs, systemic corticosteroids may be indicated.

What condition can result from the bone demineralization associated with immobility? a. Osteoporosis b. Pooling of blood c. Urinary retention d. Susceptibility to infection

ANS: A Bone demineralization leads to a negative calcium balance, osteoporosis, pathologic fractures, extraosseous bone formation, and renal calculi. Pooling of blood is a result of the cardiovascular effects of immobilization. Urinary retention is secondary to the effect of immobilization on the urinary tract. Susceptibility to infection can result from the effects of immobilization on the respiratory and renal systems

Which can result from the bone demineralization associated with immobility? a. Osteoporosis b. Urinary retention c. Pooling of blood d. Susceptibility to infection

ANS: A Bone demineralization leads to a negative calcium balance, osteoporosis, pathologic fractures, extraosseous bone formation, and renal calculi. Urinary retention is secondary to the effect of immobilization on the urinary tract. Pooling of blood is a result of the cardiovascular effects of immobilization. Susceptibility to infection can result from the effects of immobilization on the respiratory and renal systems.

A school-age child had an upper respiratory tract infection for several days and then began having a persistent dry, hacking cough that was worse at night. The cough has become productive in the past 24 hours. This is most suggestive of which diagnosis? a. Bronchitis b. Bronchiolitis c. Viral-induced asthma d. Acute spasmodic laryngitis

ANS: A Bronchitis is characterized by these symptoms and occurs in children older than 6 years. Bronchiolitis is rare in children older than 2 years. Asthma is a chronic inflammation of the airways that may be exacerbated by a virus. Acute spasmodic laryngitis occurs in children between 3 months and 3 years.

A child with cystic fibrosis (CF) receives aerosolized bronchodilator medication. When should this medication be administered? a. Before chest physiotherapy (CPT) b. After CPT c. Before receiving 100% oxygen d. After receiving 100% oxygen

ANS: A Bronchodilators should be given before CPT to open bronchi and make expectoration easier. Aerosolized bronchodilator medications are not helpful when used after CPT. Oxygen administration is necessary only in acute episodes with caution because of chronic carbon dioxide retention.

Which clinical manifestations would suggest hydrocephalus in a neonate? a. Bulging fontanel and dilated scalp veins b. Closed fontanel and high-pitched cry c. Constant low-pitched cry and restlessness d. Depressed fontanel and decreased blood pressure

ANS: A Bulging fontanels, dilated scalp veins, and separated sutures are clinical manifestations of hydrocephalus in neonates. Closed fontanel and high-pitched cry, constant low-pitched cry and restlessness, and depressed fontanel and decreased blood pressure are not clinical manifestations of hydrocephalus, but all should be referred for evaluation.

What information should the nurse include when teaching an adolescent with Crohn disease (CD)? a. How to cope with stress and adjust to chronic illness b. Preparation for surgical treatment and cure of CD c. Nutritional guidance and prevention of constipation d. Prevention of spread of illness to others and principles of high-fiber diet

ANS: A CD is a chronic illness with a variable course and many potential complications. Guidance about living with chronic illness is essential for adolescents. Stress management techniques can help with exacerbations and possible limitations caused by the illness. At this time, there is no cure for CD. Surgical intervention may be indicated for complications that cannot be controlled by medical and nutritional therapy. Nutritional guidance is an essential part of management. Constipation is not usually an issue with CD. CD is not infectious, so transmission is not a concern. A low-fiber diet is indicated.

Parents of a child with cystic fibrosis ask the nurse about genetic implications of the disorder. Which statement, made by the nurse, expresses accurately the genetic implications? a. If it is present in a child, both parents are carriers of this defective gene. b. It is inherited as an autosomal dominant trait. c. It is a genetic defect found primarily in non-Caucasian population groups. d. There is a 50% chance that siblings of an affected child also will be affected.

ANS: A CF is an autosomal recessive gene inherited from both parents and is inherited as an autosomal recessive, not autosomal dominant, trait. CF is found primarily in Caucasian populations. An autosomal recessive inheritance pattern means that there is a 25% chance a sibling will be infected but a 50% chance a sibling will be a carrier.

A nurse is preparing to administer an angiotensin-converting enzyme (ACE) inhibitor. Which drug should the nurse be administering? a. Captopril (Capoten) b. Furosemide (Lasix) c. Spironolactone (Aldactone) d. Chlorothiazide (Diuril)

ANS: A Captopril is an ACE inhibitor. Furosemide is a loop diuretic. Spironolactone blocks the action of aldosterone. Chlorothiazide works on the distal tubules.

Latex allergy is suspected in a child with spina bifida. Appropriate nursing interventions include which action? a. Avoid using any latex product. b. Use only nonallergenic latex products. c. Administer medication for long-term desensitization. d. Teach family about long-term management of asthma.

ANS: A Care must be taken that individuals who are at high risk for latex allergies do not come in direct or secondary contact with products or equipment containing latex at any time during medical treatment. There are no nonallergenic latex products. At this time, desensitization is not an option. The child does not have asthma. The parents must be taught about allergy and the risk of anaphylaxis.

Which of the following describes a child who is abused by the parent(s)? a. Unintentionally contributes to the abusing situation b. Belongs to a low socioeconomic population c. Is healthier than the nonabused siblings d. Abuses siblings in the same way as child is abused by the parent(s)

ANS: A Child's temperament, position in the family, additional physical needs, activity level, or degree of sensitivity to parental needs unintentionally contributes to the abusing situation.

An 8-year-old girl tells the nurse that she has cancer because God is punishing her for "being bad." She shares her concern that if she dies, she will go to hell. The nurse should interpret this as being which of the following? a. A belief common at this age b. A belief that forms the basis for most religions c. Suggestive of excessive family pressure d. Suggestive of a failure to develop a conscience

ANS: A Children at this age may view illness or injury as a punishment for a real or imagined misdeed.

Samantha, age 5 years, tells the nurse that she "needs a Band-Aid" where she had an injection. Which of the following is the best nursing action? a. Apply a Band-Aid. b. Ask her why she wants a Band-Aid. c. Explain why a Band-Aid is not needed. d. Show her that the bleeding has already stopped.

ANS: A Children at this age-group still fear that their insides may leak out at the injection site. Provide the Band-Aid.

The nurse is teaching parents about the importance of iron in a toddler's diet. Which explains why iron deficiency anemia is common during toddlerhood? a. Milk is a poor source of iron. b. Iron cannot be stored during fetal development. c. Fetal iron stores are depleted by age 1 month. d. Dietary iron cannot be started until age 12 months.

ANS: A Children between the ages of 12 and 36 months are at risk for anemia because cow's milk is a major component of their diet and it is a poor source of iron. Iron is stored during fetal development, but the amount stored depends on maternal iron stores. Fetal iron stores are usually depleted by age 5 to 6 months. Dietary iron can be introduced by breastfeeding, iron-fortified formula, and cereals during the first 12 months of life.

What explanation provides the rationale for why iron-deficiency anemia is common during infancy? a. Cow's milk is a poor source of iron. b. Iron cannot be stored during fetal development. c. Fetal iron stores are depleted by 1 month of age. d. Dietary iron cannot be started until 12 months of age.

ANS: A Children between the ages of 12 and 36 months are at risk for anemia because cow's milk is a major component of their diet, and it is a poor source of iron. Iron is stored during fetal development, but the amount stored depends on maternal iron stores. Fetal iron stores are usually depleted by ages 5 to 6 months. Dietary iron can be introduced by breastfeeding, iron-fortified formula, and cereals during the first 12 months of life.

The nurse should expect a toddler to cope with the stress of a short period of separation from parents by displaying what? a. Regression b. Happiness c. Detachment d. Indifference

ANS: A Children in the toddler stage demonstrate goal-directed behaviors when separated from parents for short periods. They may demonstrate displeasure on the parents' return or departure by having temper tantrums; refusing to comply with the usual routines of mealtime, bedtime, or toileting; or regressing to more primitive levels of development. Detachment would be seen with a prolonged absence of parents, not a short one. Toddlers would not be indifferent or happy when experiencing short separations from parents.

A child, age 4 years, tells the nurse that she "needs a Band-Aid" where she had an injection. What nursing action should the nurse implement? a. Apply a Band-Aid. b. Ask her why she wants a Band-Aid. c. Explain why a Band-Aid is not needed. d. Show her that the bleeding has already stopped.

ANS: A Children in this age group still fear that their insides may leak out at the injection site. The nurse should be prepared to apply a small Band-Aid after the injection. No explanation should be required.

What is an effective strategy to reduce the stress of burn dressing procedures? a. Involve the child and give choices as feasible. b. Explain to the child why analgesics cannot be used. c. Reassure the child that dressing changes are not painful. d. Encourage the child to master stress with controlled passivity.

ANS: A Children who have an understanding of the procedure and some perceived control demonstrate less maladaptive behavior. They respond well to participating in decisions and should be given as many choices as possible. Analgesia and sedation can and should be used. The dressing change procedure is very painful and stressful. Misinformation should not be given to the child. Encouraging the child to master stress with controlled passivity is not a positive coping strategy.

A 1-year-old child has acute otitis media (AOM) and is being treated with oral antibiotics. What should the nurse include in the discharge teaching to the infant's parents? a. A follow-up visit should be done after all medicine has been given. b. After an episode of acute otitis media, hearing loss usually occurs. c. Tylenol should not be given because it may mask symptoms. d. The infant will probably need a myringotomy procedure and tubes.

ANS: A Children with AOM should be seen after antibiotic therapy is complete to evaluate the effectiveness of the treatment and to identify potential complications, such as effusion or hearing impairment. Hearing loss does not usually occur with acute otitis media. Tylenol should be given for pain, and the infant will not necessarily need a myringotomy procedure.

In providing nourishment for a child with cystic fibrosis (CF), which factor should the nurse keep in mind? a. Diet should be high in carbohydrates and protein. b. Diet should be high in easily digested carbohydrates and fats. c. Most fruits and vegetables are not well tolerated. d. Fats and proteins must be greatly curtailed.

ANS: A Children with CF require a well-balanced, high-protein, high-calorie diet because of impaired intestinal absorption. Enzyme supplementation helps digest foods; other modifications are not necessary. A well-balanced diet containing fruits and vegetables is important. Fats and proteins are a necessary part of a well-balanced diet.

A 5-year-old child is admitted with bacterial pneumonia. What signs and symptoms should the nurse expect to assess with this disease process? a. Fever, cough, and chest pain b. Stridor, wheezing, and ear infection c. Nasal discharge, headache, and cough d. Pharyngitis, intermittent fever, and eye infection

ANS: A Children with bacterial pneumonia usually appear ill. Symptoms include fever, malaise, rapid and shallow respirations, cough, and chest pain. Ear infection, nasal discharge, and eye infection are not symptoms of bacterial pneumonia.

Which of the following statements is true about smoking in adolescence? a. Smoking is related to other high-risk behaviors. b. Smoking will not continue unless peer pressure continues. c. Smoking is less common when the adolescent's parent(s) smokes. d. Smoking among adolescents is becoming more prevalent.

ANS: A Cigarettes are considered a gateway drug. Teenagers who smoke are 11.4 times more likely to use an illicit drug.

A nurse is interpreting the results of a tuberculin skin test (TST) on an adolescent who is HIV positive. Which induration size indicates a positive result for this child 48-72 hours after the test? a. 5 mm b. 10 mm c. 15 mm d. 20 mm

ANS: A Clinical evidence of a positive TST in children receiving immunosuppressive therapy, including immunosuppressive doses of steroids or who have immunosuppressive conditions, including HIV infection is an induration of 5 mm. Children younger than 4 years of age with: (a) other medical risk conditions, including Hodgkin disease, lymphoma, diabetes mellitus, chronic renal failure, or malnutrition; (b) born or whose parents were born in high-prevalence (TB) regions of the world; (c) frequently exposed to adults who are HIV infected, homeless, users of illicit drugs, residents of nursing homes, incarcerated or institutionalized, or migrant farm workers; and (d) who travel to high-prevalence (TB) regions of the world are positive when the induration is 10 mm. Children 4 years of age or older without any risk factors are positive when the induration is 20 mm.

What medication is contraindicated in children post tonsillectomy and adenoidectomy? a. Codeine b. Ondansetron (Zofran) b. Amoxil (amoxicillin) c. Acetaminophen (Tylenol)

ANS: A Codeine is contraindicated in pediatric patients after tonsillectomy and adenoidectomy. In 2012, the Food and Drug Administration issued a Drug Safety Communication that codeine use in certain children after tonsillectomy or adenoidectomy may lead to rare but life-threatening adverse events or death. Zofran, amoxicillin, and Tylenol are not contraindicated after tonsillectomy and adenoidectomy.

A parent of an infant with colic tells the nurse, "All this baby does is scream at me; it is a constant worry." The nurse's best action is which of the following? a. Encourage parent to verbalize feelings. b. Encourage parent not to worry so much. c. Assess parent for other signs of inadequate parenting. d. Reassure parent that colic rarely lasts past age 9 months.

ANS: A Colic is multifactorial, and no single treatment is effective for all infants. The parent is verbalizing concern and worry. The nurse should allow the parent to put these feelings into words. An empathic, gentle, and reassuring attitude, in addition to suggestions about remedies, will help alleviate the parent's anxieties.

What respiratory condition or disease results in both increased compliance and increased resistance? a. Asthma b. Atelectasis c. Surfactant deficiency d. Bronchopulmonary dysplasia

ANS: A Compliance is a measure of the relative ease with which the chest wall expands. Resistance is determined primarily by airway size. Asthma results in increased compliance and increased resistance, both of which increase the work of breathing. Atelectasis and surfactant deficiency both decrease compliance but do not affect resistance. Bronchopulmonary dysplasia increases resistance but does not affect compliance.

The health care provider suggests surgery be performed for ventricular septal defect to prevent what complication? a. Pulmonary hypertension b. Right-to-left shunt of blood c. Pulmonary embolism d. Left ventricular hypertrophy

ANS: A Congenital heart defects with a large left-to-right shunt (e.g., in ventricular septal defect, patent ductus arteriosus, or complete AV canal), which cause increased pulmonary blood flow, may result in pulmonary hypertension. If these defects are not repaired early, the high pulmonary flow will cause changes in the pulmonary artery vessels, and the vessels will lose their elasticity. The blood does not shunt right to left, a pulmonary embolism is not a complication of ventricular septal defect, and the left ventricle does not hypertrophy.

When caring for a child after a tonsillectomy, what intervention should the nurse do? a. Watch for continuous swallowing. b. Encourage gargling to reduce discomfort. c. Apply warm compresses to the throat. d. Position the child on the back for sleeping.

ANS: A Continuous swallowing, especially while sleeping, is an early sign of bleeding. The child swallows the blood that is trickling from the operative site. Gargling is discouraged because it could irritate the operative site. Ice compresses are recommended to reduce inflammation. The child should be positioned on the side or abdomen to facilitate drainage of secretions.

A 16-year-old girl comes to the pediatric clinic for information on birth control. The nurse knows that before this young woman can be examined, consent must be obtained from which source? a. Herself b. Her mother c. Court order d. Legal guardian

ANS: A Contraceptive advice is one of the conditions that is considered "medically emancipated." The adolescent is able to provide her own informed consent.

Why are cool-mist vaporizers rather than steam vaporizers recommended in the home treatment of respiratory infections? a. They are safer. b. They are less expensive. c. Respiratory secretions are dried by steam vaporizers. d. A more comfortable environment is produced.

ANS: A Cool-mist vaporizers are safer than steam vaporizers, and little evidence exists to show any advantages to steam. The cost of cool-mist and steam vaporizers is comparable. Steam loosens secretions, not dries them. Both cool-mist vaporizers and steam vaporizers may promote a more comfortable environment, but cool-mist vaporizers have decreased risk for burns and growth of organisms.

Which explains why cool-mist vaporizers rather than steam vaporizers are recommended in home treatment of childhood respiratory tract infections? a. They are safer. b. They are less expensive. c. Respiratory secretions are dried. d. A more comfortable environment is produced.

ANS: A Cool-mist vaporizers are safer than steam vaporizers, and little evidence exists to show any advantages to steam. The cost of cool-mist and steam vaporizers is comparable. Steam loosens secretions, not dries them. Both may promote a more comfortable environment, but cool-mist vaporizers present decreased risk for burns and growth of organisms.

Therapeutic management of nephrosis includes which of the following? a. Corticosteroids b. Antihypertensive agents c. Long-term diuretics d. Increased fluids to promote diuresis

ANS: A Corticosteroids are the first line of therapy for nephrosis. Response is usually seen within 7 to 21 days.

Which of the following should the nurse recommend to prevent urinary tract infections in young girls? a. Wear cotton underpants. b. Limit bathing as much as possible. c. Increase fluids; decrease salt intake. d. Cleanse perineum with water after voiding.

ANS: A Cotton underpants are preferable to nylon underpants.

Four-year-old Brian appears to be upset by hospitalization. Which of the following is an appropriate intervention? a. Let him know it is all right to cry. b. Give him time to gain control of himself. c. Show him how other children are cooperating. d. Tell him what a big boy he is to be so quiet.

ANS: A Crying is an appropriate behavior for the upset preschooler. The nurse provides support through physical presence.

A young child's parents call the nurse after their child is bitten by a raccoon in the woods. The nurse's recommendation should be based on what knowledge? a. Antirabies prophylaxis must be initiated immediately. b. The child should be hospitalized for close observation. c. No treatment is necessary if thorough wound cleaning is done. d. Antirabies prophylaxis must be initiated as soon as clinical manifestations appear.

ANS: A Current therapy for a rabid animal bite consists of a thorough cleansing of the wound and passive immunization with human rabies immunoglobulin (HRIG) as soon as possible. Hospitalization is not necessary. The wound cleansing, passive immunization, and immunoglobulin administration can be done as an outpatient. The child needs to receive both HRIG and rabies vaccine.

Inflammation of the bladder is called: a. cystitis. b. urosepsis. c. urethritis. d. bacteriuria.

ANS: A Cystitis is an inflammation of the bladder.

What name is given to inflammation of the bladder? a. Cystitis b. Urethritis c. Urosepsis d. Bacteriuria

ANS: A Cystitis is an inflammation of the bladder. Urethritis is an inflammation of the urethra. Urosepsis is a febrile urinary tract infection with systemic signs of bacterial infection. Bacteriuria is the presence of bacteria in the urine.

The nurse is planning care for a child recently diagnosed with diabetes insipidus (DI). What intervention should be included? a. Encourage the child to wear medical identification. b. Discuss with the child and family ways to limit fluid intake. c. Teach the child and family how to do required urine testing. d. Reassure the child and family that this is usually not a chronic or life-threatening illness.

ANS: A DI is a potentially life-threatening disorder if the voluntary demand for fluid is suppressed or the child does not have access to fluids. Medical alert identification should be worn. Fluid intake is not restricted in children with DI. The child is unable to concentrate urine and can rapidly become dehydrated. Fluid intake may be limited during diagnosis, when the lack of intake will result in decreased urinary output and dehydration. Urine testing is not required in DI. Changes in body weight provide information about approximate fluid balance. This is a lifelong disorder that requires supplemental vasopressin throughout life.

The nurse is preparing to administer a dose of digoxin (Lanoxin) to a child in heart failure (HF). Which is a beneficial effect of administering digoxin (Lanoxin)? a. It decreases edema. b. It decreases cardiac output. c. It increases heart size. d. It increases venous pressure.

ANS: A Digoxin has a rapid onset and is useful for increasing cardiac output, decreasing venous pressure, and, as a result, decreasing edema. Cardiac output is increased by digoxin. Heart size and venous pressure are decreased by digoxin.

The parents of a child born with disabilities ask the nurse for advice about discipline. The nurse's response should be based on remembering that discipline is which? a. Essential for the child b. Not needed unless the child's behavior becomes problematic c. Best achieved with punishment for misbehavior d. Too difficult to implement with a special needs child

ANS: A Discipline is essential for the child. It provides boundaries on which she can test out her behavior and teaches her socially acceptable behaviors. The nurse should teach the parents ways to manage the child's behavior before it becomes problematic. Punishment is not effective in managing behavior.

A possible cause of acquired aplastic anemia in children is: a. drugs. b. injury. c. deficient diet. d. congenital defect.

ANS: A Drugs, such as chemotherapeutic agents and several antibiotics (e.g., chloramphenicol), can cause aplastic anemia. Injury, deficient diet, and congenital defect are not causative agents in acquired aplastic anemia.

A nurse is charting that a hospitalized child has labored breathing. Which describes labored breathing? a. Dyspnea b. Tachypnea c. Hypopnea d. Orthopnea

ANS: A Dyspnea is labored breathing. Tachypnea is rapid breathing. Hypopnea is breathing that is too shallow. Orthopnea is difficulty breathing except in upright position.

An infant's parents ask the nurse about preventing otitis media (OM). What information should be provided? a. Avoid tobacco smoke. b. Use nasal decongestants. c. Avoid children with OM. d. Bottle- or breastfeed in a supine position.

ANS: A Eliminating tobacco smoke from the child's environment is essential for preventing OM and other common childhood illnesses. Nasal decongestants are not useful in preventing OM. Children with uncomplicated OM are not contagious unless they show other symptoms of upper respiratory tract infection. Children should be fed in a semivertical position to prevent OM.

An infant's parents ask the nurse about preventing OM. Which should be recommended? a. Avoid tobacco smoke. b. Use nasal decongestant. c. Avoid children with OM. d. Bottle-feed or breastfeed in supine position.

ANS: A Eliminating tobacco smoke from the child's environment is essential for preventing OM and other common childhood illnesses. Nasal decongestants are not useful in preventing OM. Children with uncomplicated OM are not contagious unless they show other upper respiratory tract infection (URI) symptoms. Children should be fed in an upright position to prevent OM.

The nurse is caring for a child with suspected ingestion of some type of poison. What action should the nurse take next after initiating cardiopulmonary resuscitation (CPR)? a. Empty the mouth of pills, plants, or other material. b. Question the victim and witness. c. Place the child in a side-lying position. d. Call poison control.

ANS: A Emptying the mouth of any leftover pills, plants, or other ingested material is the next step after assessment and initiation of CPR if needed. Questioning the victim and witnesses, calling poison control, and placing the child in a side-lying position are follow-up steps.

During the summer many children are more physically active. What changes in the management of the child with diabetes should be expected as a result of more exercise? a. food intake b. food intake c. risk of hyperglycemia d. risk of insulin reaction

ANS: A Exercise is encouraged and never restricted unless indicated by other health conditions. Exercise lowers blood glucose levels, depending on the intensity and duration of the activity. Consequently, exercise should be included as part of diabetes management, and the type and amount of exercise should be planned around the child's interests and capabilities. However, in most instances, children's activities are unplanned, and the resulting decrease in blood glucose can be compensated for by providing extra snacks before (and, if the exercise is prolonged, during) the activity. In addition to a feeling of well-being, regular exercise aids in utilization of food and often results in a reduction of insulin requirements.

The parents of a child born with ambiguous genitalia tell the nurse that family and friends are asking what caused the baby to be this way. Tests are being done to assist in gender assignment. What should the nurse's intervention include? a. Explain the disorder so they can explain it to others. b. Help parents understand that this is a minor problem. c. Suggest that parents avoid family and friends until the gender is assigned. d. Encourage parents not to worry while the tests are being done.

ANS: A Explaining the disorder to parents so they can explain it to others is the most therapeutic approach while the parents await the gender assignment of their child. Ambiguous genitalia is a serious issue for the family. Careful testing and evaluation are necessary to aid in gender assignment to avoid lifelong problems for the child. Suggesting that parents avoid family and friends until the gender is assigned is impractical and would isolate the family from their support system while awaiting test results. The parents will be concerned. Telling them not to worry without giving them specific alternative actions would not be effective.

Nurses should be alert for increased fluid requirements in which circumstance? a. Fever b. Mechanical ventilation c. Congestive heart failure d. Increased intracranial pressure

ANS: A Fever leads to great insensible fluid loss in young children because of increased body surface area relative to fluid volume. The mechanically ventilated child has decreased fluid requirements. Congestive heart failure is a case of fluid overload in children. Increased intracranial pressure does not lead to increased fluid requirements in children.

Which of the following is the most commonly used method in completed suicides? a. Firearms b. Drug overdose c. Self-inflected laceration d. Carbon monoxide poisoning

ANS: A Firearms are the most commonly used instruments in completed suicides among both males and females. For adolescent boys, firearms are followed by hanging and overdose. For adolescent females, overdose and strangulation are the next most common means of completed suicide.

A 3-month-old infant is admitted to the pediatric unit for treatment of bronchiolitis. The infant's vital signs are T, 101.6° F; P, 106 beats/min apical; and R, 70 breaths/min. The infant is irritable and fussy and coughs frequently. IV fluids are given via a peripheral venipuncture. Fluids by mouth were initially contraindicated for what reason? a. Tachypnea b. Paroxysmal cough c. Irritability d. Fever

ANS: A Fluids by mouth may be contraindicated because of tachypnea, weakness, and fatigue. Therefore, IV fluids are preferred until the acute stage of bronchiolitis has passed. Infants with bronchiolitis may have paroxysmal coughing, but fluids by mouth would not be contraindicated. Irritability or fever would not be reasons for fluids by mouth to be contraindicated.

The nurse is preparing a school-age child for computed tomography (CT) scan to assess cerebral function. The nurse should include what statement in preparing the child? a. "The scan will not hurt." b. "Pain medication will be given." c. "You will be able to move once the equipment is in place." d. "Unfortunately no one can remain in the room with you during the test."

ANS: A For CT scans, the child must be immobilized. It is important to emphasize to the child that at no time is the procedure painful. Pain medication is not required; however, sedation is sometimes necessary. The child will not be allowed to move and will be immobilized. Someone is able to remain with the child during the procedure.

The nurse is teaching parents of a preschool child strategies to implement when the child delays going to bed. What strategy should the nurse recommend? a. Use consistent bedtime rituals. b. Give in to attention-seeking behavior. c. Take the child into the parent's bed for an hour. d. Allow the child to stay up past the decided bedtime.

ANS: A For children who delay going to bed, a recommended approach involves a consistent bedtime ritual and emphasizing the normalcy of this type of behavior in young children. Parents should ignore attention-seeking behavior, and the child should not be taken into the parents' bed or allowed to stay up past a reasonable hour.

A child has been admitted with status epilepticus. An emergency medication has been ordered. What medication should the nurse expect to be prescribed? a. Lorazepam (Ativan) b. Phenytoin (Dilantin) c. Topiramate (Topamax) d. Ethosuximide (Zarontin)

ANS: A For in-hospital management of status epilepticus, intravenous diazepam or lorazepam (Ativan) is the first-line drug of choice. Lorazepam is the preferred agent because of its rapid onset (2-5 minutes) and long half-life (12-24 hours) with few side effects.

Which drug should the nurse expect to administer to a preschool child who has increased intracranial pressure (ICP) resulting from cerebral edema? a. Mannitol (Osmitrol) b. Epinephrine hydrochloride (Adrenalin) c. Atropine sulfate (Atropine) d. Sodium bicarbonate (Sodium bicarbonate)

ANS: A For increased ICP, mannitol, an osmotic diuretic, administered intravenously, is the drug used most frequently for rapid reduction. Epinephrine hydrochloride, atropine sulfate, and sodium bicarbonate are not used to decrease ICP.

The nurse is teaching a mother how to perform chest physiotherapy and postural drainage on her 3-year-old child, who has cystic fibrosis. To perform percussion, the nurse should instruct her to: a. cover the skin with a shirt or gown before percussing. b. strike the chest wall with a flat-hand position. c. percuss over the entire trunk anteriorly and posteriorly. d. percuss before positioning for postural drainage.

ANS: A For postural drainage and percussion, the child should be dressed in a light shirt to protect the skin and placed in the appropriate postural drainage positions.

The nurse is selecting a site to begin an intravenous infusion on a 2-year-old child. The superficial veins on his hand and arm are not readily visible. What intervention should increase the visibility of these veins? a. Gently tap over the site. b. Apply a cold compress to the site. c. Raise the extremity above the level of the body. d. Use a rubber band as a tourniquet for 5 minutes.

ANS: A Gently tapping the site can sometimes cause the veins to be more visible. This is done before the skin is prepared. Warm compresses (not cold) may be useful. The extremity is held in a dependent position. A tourniquet may be helpful, but if too tight, it could cause the vein to burst when punctured. Five minutes is too long.

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

ANS: A Guilt is a common response of parents when a child is hospitalized. They may blame themselves for the child's illness or for not recognizing it soon enough. The nurse should clarify the nature of the problem and reassure parents that the child is being cared for.

What technique facilitates lip reading by a hearing-impaired child? a. Speak at an even rate. b. Avoid using facial expressions. c. Exaggerate pronunciation of words. d. Repeat in exactly the same way if child does not understand.

ANS: A Help the child learn and understand how to read lips by speaking at an even rate. Avoiding using facial expressions, exaggerating pronunciation of words, and repeating in exactly the same way if the child does not understand interfere with the child's understanding of the spoken word.

Which of the following statements is correct about childhood obesity? a. Heredity is an important factor in the development of obesity. b. Childhood obesity in the United States is decreasing. c. Childhood obesity is the result of inactivity. d. Childhood obesity can be attributed to an underlying disease in most cases.

ANS: A Heredity is an important fact that contributes to obesity. Identical twins reared apart tend to resemble their biologic parents to a greater extent than their adoptive parents. It is difficult to distinguish between hereditary and environmental factors.

A hospitalized child with nephrosis is receiving high doses of prednisone. Which of the following is an appropriate nursing goal related to this? a. Prevent infection. b. Stimulate appetite. c. Detect evidence of edema. d. Ensure compliance with prophylactic antibiotic therapy.

ANS: A High-dose steroid therapy has an immunosuppressant effect. These children are particularly vulnerable to upper respiratory tract infections. A priority nursing goal is to minimize the risk of infection by protecting the child from contact with infectious individuals.

The parents of a child on a ventilator tell the nurse that their insurance company wants the child to be discharged. They explain that they do not want the child home "under any circumstances." What principle should the nurse consider when working with this family? a. Desire to have the child home is essential to effective home care. b. Parents should not be expected to care for a technology-dependent child. c. Having a technology-dependent child at home is better for both the child and the family. d. Parents are not part of the decision-making process because of the costs of hospitalization.

ANS: A Home care requires the family to manage the child's illness, including providing daily hands-on care, monitoring the child's medical condition, and educating others to care for the child. The child's home environment with the child's family is perceived as the best place for the child to be cared for. If the family does not want to or is not able to assume these responsibilities, other arrangements need to be investigated. The family is an essential part of the decision-making process. Without family involvement and support, the technology-dependent child will not be well cared for at home.

An adolescent with osteosarcoma is scheduled for a leg amputation in 2 days. The nurse's approach should include which action? a. Answering questions with straightforward honesty b. Avoiding discussing the seriousness of the condition c. Explaining that, although the amputation is difficult, it will cure the cancer d. Assisting the adolescent in accepting the amputation as better than a long course of chemotherapy

ANS: A Honesty is essential to gain the child's cooperation and trust. The diagnosis of cancer should not be disguised with falsehoods. The adolescent should be prepared for the surgery so he or she has time to reflect on the diagnosis and subsequent treatment. This allows questions to be answered. To accept the need for radical surgery, the child must be aware of the lack of alternatives for treatment. Amputation is necessary, but it will not guarantee a cure. Chemotherapy is an integral part of the therapy with surgery. The child should be informed of the need for chemotherapy and its side effects before surgery.

The nurse is conducting a staff in-service on common problems associated with myelomeningocele. Which common problem is associated with this defect? a. Hydrocephalus b. Craniosynostosis c. Biliary atresia d. Esophageal atresia

ANS: A Hydrocephalus is a frequently associated anomaly in 80% to 90% of children. Craniosynostosis is the premature closing of the cranial sutures and is not associated with myelomeningocele. Biliary and esophageal atresia is not associated with myelomeningocele.

The nurse is planning a staff in-service on childhood spastic cerebral palsy. Spastic cerebral palsy is characterized by: a. hypertonicity and poor control of posture, balance, and coordinated motion. b. athetosis and dystonic movements. c. wide-based gait and poor performance of rapid, repetitive movements. d. tremors and lack of active movement.

ANS: A Hypertonicity and poor control of posture, balance, and coordinated motion are part of the classification of spastic cerebral palsy. Athetosis and dystonic movements are part of the classification of dyskinetic (athetoid) cerebral palsy. Wide-based gait and poor performance of rapid, repetitive movements are part of the classification of ataxic cerebral palsy. Tremors and lack of active movement may indicate other neurologic disorders.

An 18-month-old child is brought to the emergency department after being found unconscious in the family pool. What does the nurse identify as the primary problem in drowning incidents? a. Hypoxia b. Aspiration c. Hypothermia d. Electrolyte imbalance

ANS: A Hypoxia is the primary problem because it results in global cell damage, with different cells tolerating variable lengths of anoxia. Neurons sustain irreversible damage after 4 to 6 minutes of submersion. Severe neurologic damage occurs from hypoxia in 3 to 6 minutes. Aspiration of fluid does occur, resulting in pulmonary edema, atelectasis, airway spasm, and pneumonitis, which complicate the anoxia. Hypothermia occurs rapidly, except in hot tubs. Electrolyte imbalances do result, but they are not a major cause of morbidity and mortality.

What observation in a child should indicate the need for a referral to a specialist regarding a communication impairment? a. At 2 years of age, the child fails to respond consistently to sounds. b. At 3 years of age, the child fails to use sentences of more than five words. c. At 4 years of age, the child has impaired sentence structure. d. At 5 years of age, the child has poor voice quality.

ANS: A If a 2-year-old child fails to respond consistently to sounds, it is an indication for referral to a specialist regarding communication impairment. At age 3 years, the child failing to use sentences of three words would be an indication for referral; impaired sentence structure would be seen in a 5-year-old child and poor voice quality in an older child who has a communication impairment.

Which term is used to describe a type of fracture that does not produce a break in the skin? a. Simple b. Compound c. Complicated d. Comminuted

ANS: A If a fracture does not produce a break in the skin, it is called a simple, or closed, fracture. A compound, or open, fracture is one with an open wound through which the bone protrudes. A complicated fracture is one in which the bone fragments damage other organs or tissues. A comminuted fracture occurs when small fragments of bone are broken from the fractured shaft and lie in the surrounding tissue. These are rare in children.

When a preschool child is hospitalized without adequate preparation, the nurse should recognize that the child may likely see hospitalization as which of the following? a. Punishment b. Threat to child's self-image c. An opportunity for regression d. Loss of companionship with friends

ANS: A If a toddler is not prepared for hospitalization, a typical preschooler fantasy is to attribute the hospitalization to punishment for real or imagined misdeeds.

The nurse is administering an IV chemotherapeutic agent to a child with leukemia. The child suddenly begins to wheeze and have severe urticaria. Which is the most appropriate nursing action? a. Stop drug infusion immediately. b. Recheck rate of drug infusion. c. Observe child closely for next 10 minutes. d. Explain to child that this is an expected side effect.

ANS: A If an allergic reaction is suspected, the drug should be immediately discontinued. Any drug in the line should be withdrawn, and a normal saline infusion begun to keep the line open. Rechecking the rate of drug infusion, observing the child closely for next 10 minutes, and explaining to the child that this is an expected side effect can all be done after the drug infusion is stopped and the child is evaluated.

Surgery is performed on a child to correct cryptorchidism. The parents understand the reason for the surgery if they tell the nurse this was done to do what? a. "Prevent damage to the undescended testicle." b. "Prevent urinary tract infections." c. "Prevent prostate cancer." d. "Prevent an inguinal hernia."

ANS: A If the testes do not descend spontaneously, orchiopexy is performed before the child's second birthday, preferably between 1 and 2 years of age. Surgical repair is done to (1) prevent damage to the undescended testicle by exposure to the higher degree of body heat in the undescended location, thus maintaining future fertility; (2) decrease the incidence of malignancy formation, which is higher in undescended testicles; (3) avoid trauma and torsion; (4) close the processus vaginalis; and (5) prevent the cosmetic and psychologic disability of an empty scrotum. Parents understand the teaching if they respond the surgery is done to prevent damage.

The nurse is providing support to parents adapting to the hospitalization of their child to the pediatric intensive care unit. The nurse notices that the parents keep asking the same questions. What should the nurse do? a. Patiently continue to answer questions, trying different approaches. b. Kindly refer them to someone else for answering their questions. c. Recognize that some parents cannot understand explanations. d. Suggest that they ask their questions when they are not upset.

ANS: A In addition to a general pediatric unit, children may be admitted to special facilities such as an ambulatory or outpatient setting, an isolation room, or intensive care. Wherever the location, the core principles of patient and family-centered care provide a foundation for all communication and interventions with the patient, family, and health care team. The nurse should do the therapeutic action and patiently continue to answer questions, trying different approaches.

What intervention is contraindicated in a suspected case of appendicitis? a. Enemas b. Palpating the abdomen c. Administration of antibiotics d. Administration of antipyretics for fever

ANS: A In any instance in which severe abdominal pain is observed and appendicitis is suspected, the nurse must be aware of the danger of administering laxatives or enemas. Such measures stimulate bowel motility and increase the risk of perforation. The abdomen is palpated after other assessments are made. Antibiotics should be administered, and antipyretics are not contraindicated.

A nurse is conducting an in-service on asthma. Which statement is the most descriptive of bronchial asthma? a. There is heightened airway reactivity. b. There is decreased resistance in the airway. c. The single cause of asthma is an allergic hypersensitivity. d. It is inherited.

ANS: A In bronchial asthma, spasm of the smooth muscle of the bronchi and bronchioles causes constriction, producing impaired respiratory function. In bronchial asthma, there is increased resistance in the airway. There are multiple causes of asthma, including allergens, irritants, exercise, cold air, infections, medications, medical conditions, and endocrine factors. Atopy or development of an immunoglobulin E (IgE)-mediated response is inherited but is not the only cause of asthma.

Seventy-two hours after cardiac surgery, a young child has a temperature of 38.4° C (101.1° F). What action should the nurse perform? a. Report findings to the practitioner. b. Apply a hypothermia blanket. c. Keep the child warm with blankets. d. Record the temperature on the assessment flow sheet.

ANS: A In the first 24 to 48 hours after surgery, the body temperature may increase to 37.8° C (100° F) as part of the inflammatory response to tissue trauma. If the temperature is higher or fever continues after this period, it is most likely a sign of an infection, and immediate investigation is indicated. A hypothermia blanket is not indicated for this level of temperature. Blankets should be removed from the child to keep the temperature from increasing. The temperature should be recorded, but the practitioner must be notified for evaluation.

The nurse closely monitors the temperature of a child with nephrosis. The purpose of this is to detect an early sign of which of the following possible complications? a. Infection b. Hypertension c. Encephalopathy d. Edema

ANS: A Infection is a constant source of danger to edematous children and those receiving corticosteroid therapy. An increased temperature could be an indication of an infection.

A child with growth hormone (GH) deficiency is receiving GH therapy. When is the best time for the GH to be administered? a. At bedtime b. After meals c. Before meals d. After arising in morning

ANS: A Injections are best given at bedtime to more closely approximate the physiologic release of GH. After meals, before meals, and after arising in the morning do not parallel the physiologic release of the hormone.

A child with growth hormone (GH) deficiency is receiving GH therapy. When is the best time for the GH to be administered? a. At bedtime b. After meals c. Before meals d. On arising in the morning

ANS: A Injections are best given at bedtime to more closely approximate the physiologic release of GH. After or before meals and on arising in the morning do not mimic the physiologic release of the hormone.

An injury to which part of the brain will cause a coma? a. Brainstem b. Cerebrum c. Cerebellum d. Occipital lobe

ANS: A Injury to the brainstem results in stupor and coma. Signs of damage to the cerebrum are specific to the involved area. Individuals with frontal lobe injury may have impaired memory, personality changes, or altered intellectual functioning. Individuals with damage to the cerebellum have difficulties with coordination of muscle movements, including ataxia and nystagmus. Impaired vision and functional blindness result from injury to the occipital lobe.

A school-age child with diabetes gets 30 units of NPH insulin at 0800. According to when this insulin peaks, the child should be at greatest risk for a hypoglycemic episode between when? a. Lunch and dinner b. Breakfast and lunch c. 0830 to his midmorning snack d. Bedtime and breakfast the next morning

ANS: A Intermediate-acting (NPH and Lente) insulins reach the blood 2 to 6 hours after injection. The insulins peak 4 to 14 hours later and stay in the blood for about 14 to 20 hours.

A 4-year-old girl is admitted to outpatient surgery for removal of a cyst on her back. Her mother puts the hospital gown on her, but the child is crying because she wants to leave on her underpants. What is the most appropriate nursing action at this time?? a. Allow her to wear her underpants. b. Discuss with her mother why this is important to the child. c. Ask her mother to explain to her why she cannot wear them. d. Explain in a kind, matter-of-fact manner that this is hospital policy.

ANS: A It is appropriate for the child to leave her underpants on. If necessary, the underpants can be removed after she has received the initial medications for anesthesia. This allows her some measure of control in this procedure. The mother should not be required to make the child more upset. The child is too young to understand what hospital policy means.

Katie, 4 years old, is admitted to outpatient surgery for removal of a cyst on her foot. Her mother puts the hospital gown on her, but Katie is crying because she wants to leave on her underpants. The most appropriate nursing action is which of the following? a. Allow her to wear her underpants. b. Discuss with her mother why this is important to Katie. c. Ask her mother to explain to her why she cannot wear them. d. Explain in a kind, matter-of-fact manner that this is hospital policy.

ANS: A It is appropriate for the child to leave her underpants on. This allows her some measure of control in this procedure, foot surgery.

A child is in uncompensated respiratory alkalosis. What should the nurse expect the arterial blood gas to be? a. CO2, 30; pH, 7.50 b. CO2, 55; pH, 7.30 c. CO2, 35; pH, 7.28 d. CO2, 54; pH, 7.35

ANS: A Laboratory findings in respiratory alkalosis include reduced PCO2 (35?9?mm?9?Hg) and elevated plasma pH (>7.45).

Effective lone-rescuer CPR on a 5-year-old child should include a. two breaths to every 30 chest compressions. b. two breaths to every 15 chest compressions. c. reassessment of child after 50 cycles of compression and ventilation. d. reassessment of child every 10 minutes that CPR continues.

ANS: A Lone-rescuer CPR is two breaths to 30 compressions for all ages until signs of recovery occur. Reassessment of the child should take place after 20 cycles or 1 minute.

Mark, age 6 years, is hospitalized for intravenous (IV) antibiotic therapy. He eats little on his "regular diet" trays. He tells the nurse that all he wants to eat is pizza, tacos, and ice cream. Which of the following is the best nursing action? a. Request these favorite foods for him. b. Identify healthier food choices that he likes. c. Explain that he needs fruits and vegetables. d. Reward him with ice cream at end of every meal that he eats.

ANS: A Loss of appetite is a symptom common to most childhood illnesses. To encourage adequate nutrition, favorite foods should be requested for the child.

A 6-year-old boy is hospitalized for intravenous antibiotic therapy. He eats very little on his "regular diet" trays. He tells the nurse that all he wants to eat is pizza, tacos, and ice cream. What nursing action is the most appropriate? a. Request these favorite foods for him. b. Identify healthier food choices that he likes. c. Explain that he needs fruits and vegetables. d. Reward him with ice cream at the end of every meal that he eats.

ANS: A Loss of appetite is a symptom common to most childhood illnesses. To encourage adequate nutrition, the nurse should request favorite foods for the child. The foods he likes provide nutrition and can be supplemented with additional fruits and vegetables. Ice cream and other desserts should not be used as rewards or punishment.

The nurse is preparing an adolescent with scoliosis for a Luque-rod segmental spinal instrumentation procedure. Which consideration should the nurse include? a. Nasogastric intubation and urinary catheter may be required. b. Ambulation will not be allowed for up to 3 months. c. Surgery eliminates the need for casting and bracing. d. Discomfort can be controlled with nonpharmacologic methods.

ANS: A Luque-rod segmental spinal instrumentation is a surgical procedure. Nasogastric intubation and urinary catheterization may be required. Ambulation is allowed as soon as possible. Depending on the instrumentation used, most patients walk by the second or third postoperative day. Casting and bracing are required postoperatively. The child usually has considerable pain for the first few days after surgery. Intravenous opioids should be administered on a regular basis.

A child is admitted with a suspected diagnosis of Munchausen syndrome by proxy (MSBP). What is an important consideration in the care of this child? a. Monitoring the parents whenever they are with the child b. Reassuring the parents that the cause of the disorder will be found c. Teaching the parents how to obtain necessary specimens d. Supporting the parents as they cope with diagnosis of a chronic illness

ANS: A MSBP refers to an illness that one person fabricates or induces in another. The child must be continuously observed for development of symptoms to determine the cause. MSBP is caused by an individual harming the child for the purpose of gaining attention. Nursing staff should obtain all specimens for analyzing. This minimizes the possibility of the abuser contaminating the sample. The child must be supported through the diagnosis of MSBP. The abuser must be identified and the child protected from that individual.

A 10-year-old child requires daily medications for a chronic illness. Her mother tells the nurse that the child continually forgets to take the medicine unless reminded. What nursing action is most appropriate to promote adherence to the medication regimen? a. Establish a contract with her, including rewards. b. Suggest time-outs when she forgets her medicine. c. Discuss with her mother the damaging effects of her rescuing the child. d. Ask the child to bring her medicine containers to each appointment so they can be counted.

ANS: A Many factors can contribute to the child's not taking the medication. The nurse should resolve those issues such as unpleasant side effects, difficulty taking medicine, and time constraints before school. If these factors do not contribute to the issue, then behavioral contracting is usually an effective method to shape behaviors in children. Time-outs provide negative reinforcement. If part of a contract, negative consequences can work, but they need to be structured. Discussing with her mother the damaging effects of her rescuing the child is not the most appropriate action to encourage compliance. For a school-age child, parents should refrain from nagging and rescuing the child. This child is old enough to partially assume responsibility for her own care. If the child brings her medicine containers to each appointment so they can be counted, this will help determine if the medications are being taken, but it will not provide information about whether the child is taking them by herself.

Which of the following factors will decrease iron absorption and therefore should not be given at the same time as an iron supplement? a. Milk b. Multivitamin c. Fruit juice d. Meat, fish, poultry

ANS: A Many foods interfere with iron absorption and should be avoided when the iron is consumed. These foods include phosphates found in milk, phytates found in cereals, and oxalates found in many vegetables.

What statement best describes Hirschsprung disease? a. The colon has an aganglionic segment. b. It results in frequent evacuation of solids, liquid, and gas. c. The neonate passes excessive amounts of meconium. d. It results in excessive peristaltic movements within the gastrointestinal tract.

ANS: A Mechanical obstruction in the colon results from a lack of innervation. In most cases, the aganglionic segment includes the rectum and some portion of the distal colon. There is decreased evacuation of the large intestine secondary to the aganglionic segment. Liquid stool may ooze around the blockage. The obstruction does not affect meconium production. The infant may not be able to pass the meconium stool. There is decreased movement in the colon.

What pain medication is contraindicated in children with sickle cell disease (SCD)? a. Meperidine (Demerol) b. Hydrocodone (Vicodin) c. Morphine sulfate d. Ketorolac (Toradol)

ANS: A Meperidine (pethidine [Demerol]) is not recommended. Normeperidine, a metabolite of meperidine, is a central nervous system stimulant that produces anxiety, tremors, myoclonus, and generalized seizures when it accumulates with repetitive dosing. Patients with SCD are particularly at risk for normeperidine-induced seizures.

What condition is often associated with severe diarrhea? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis

ANS: A Metabolic acidosis results from the increased absorption of short-chain fatty acids produced in the colon. There is an increase in lactic acid from tissue hypoxia secondary to hypovolemia. Bicarbonate is lost through the stool. Ketosis results from fat metabolism when glycogen stores are depleted. Metabolic alkalosis and respiratory alkalosis do not occur from severe diarrhea.

The nurse is doing a neurologic assessment on a 2-month-old infant after a car accident. Moro, tonic neck, and withdrawal reflexes are present. How should the nurse interpret these findings? a. Neurologic health b. Severe brain damage c. Decorticate posturing d. Decerebrate posturing

ANS: A Moro, tonic neck, and withdrawal reflexes are three reflexes that are present in a healthy 2-month-old infant and are expected in this age group.

Kimberly, age 3 years, has a fever associated with a viral illness. Her mother calls the nurse, reporting a fever of 102° F even though she had acetaminophen 2 hours ago. The nurse's action should be based on which of the following? a. Fevers such as this are common with viral illnesses. b. Seizures are common in children when antipyretics are ineffective. c. Fever over 102° F indicates greater severity of illness. d. Fever over 102° F indicates a probable bacterial infection.

ANS: A Most fevers are of brief duration, with limited consequences, and are viral.

The nurse is teaching a group of nursing students about newborns born with the congenital defect of myelomeningocele. Which common problem is associated with this defect? a. Neurogenic bladder b. Mental retardation c. Respiratory compromise d. Cranioschisis

ANS: A Myelomeningocele is one of the most common causes of neuropathic (neurogenic) bladder dysfunction among children. Risk of mental retardation is minimized through early intervention and management of hydrocephalus. Respiratory compromise is not a common problem in myelomeningocele. Cranioschisis is a skull defect through which various tissues protrude. It is not associated with myelomeningocele.

A 5-month-old infant is in respiratory distress. What should the nurse expect to find? a. Nasal flaring b. Bradycardia c. Abdominal breathing d. Capillary refill of 2 seconds

ANS: A Nasal flaring is a sign of respiratory distress and a significant finding in an infant. The enlargement of the nostrils helps reduce nasal resistance and maintains airway patency. Nasal flaring may be intermittent or continuous and should be described as minimum or marked. The infant would have tachycardia, not bradycardia, in respiratory distress. Abdominal breathing and a capillary refill are normal findings in an infant.

A child is admitted with acute laryngotracheobronchitis (LTB). The child will most likely be treated with which? a. Racemic epinephrine and corticosteroids b. Nebulizer treatments and oxygen c. Antibiotics and albuterol d. Chest physiotherapy and humidity

ANS: A Nebulized epinephrine (racemic epinephrine) is now used in children with LTB that is not alleviated with cool mist. The beta-adrenergic effects cause mucosal vasoconstriction and subsequent decreased subglottic edema. The use of corticosteroids is beneficial because the anti-inflammatory effects decrease subglottic edema. Nebulizer treatments are not effective even though oxygen may be required. Antibiotics are not used because it is a viral infection. Chest physiotherapy would not be instituted.

The nurse is teaching the parents of a child recently diagnosed with ADHD who has been prescribed methylphenidate (Ritalin). Which of the following should the nurse include in teaching about the side effects of methylphenidate? a. "Your child may experience a sense of nervousness." b. "You may see an increase in your child's appetite." c. "Your child may experience daytime sleepiness." d. "You may see a decrease in your child's blood pressure."

ANS: A Nervousness is one of the common side effects of Ritalin.

The nurse is teaching nursing students about childhood nervous system tumors. Which best describes a neuroblastoma? a. Diagnosis is usually made after metastasis occurs. b. Early diagnosis is usually possible because of the obvious clinical manifestations. c. It is the most common brain tumor in young children. d. It is the most common benign tumor in young children.

ANS: A Neuroblastoma is a silent tumor with few symptoms. In more than 70% of cases, diagnosis is made after metastasis occurs, with the first signs caused by involvement in the nonprimary site. In only 30% of cases is diagnosis made before metastasis. Neuroblastomas are the most common malignant extracranial solid tumors in children. The majority of tumors develop in the adrenal glands or the retroperitoneal sympathetic chain. They are not benign but metastasize.

An infant with short bowel syndrome will be on total parenteral nutrition (TPN) for an extended period of time. What should the nurse monitor the infant for ? a. Central venous catheter infection, electrolyte losses, and hyperglycemia b. Hypoglycemia, catheter migration, and weight gain c. Venous thrombosis, hyperlipidemia, and constipation d. Catheter damage, red currant jelly stools, and hypoglycemia

ANS: A Numerous complications are associated with short bowel syndrome and long-term TPN. Infectious, metabolic, and technical complications can occur. Sepsis can occur after improper care of the catheter. The gastrointestinal tract can also be a source of microbial seeding of the catheter. The nurse should monitor for catheter infection, electrolyte losses, and hyperglycemia. Hypoglycemia, weight gain, constipation, or red currant jelly stools are not characteristics of short bowel syndrome with extended TPN.

The nurse is caring for a 10-year-old child who has an acute head injury, has a pediatric Glasgow Coma Scale score of 9, and is unconscious. What intervention should the nurse include in the child's care plan? a. Elevate the head of the bed 15 to 30 degrees with the head maintained in midline. b. Maintain an active, stimulating environment. c. Perform chest percussion and suctioning every 1 to 2 hours. d. Perform active range of motion and nontherapeutic touch every 8 hours.

ANS: A Nursing activities for children with head trauma and increased intracranial pressure (ICP) include elevating the head of the bed 15 to 30 degrees and maintaining the head in a midline position. The nurse should try to maintain a quiet, nonstimulating environment for a child with increased ICP. Chest percussion and suctioning should be performed judiciously because they can elevate ICP. Range of motion should be passive and nontherapeutic touch should be avoided because both of these activities can increase ICP.

For case management to be most effective, who should be recognized as the most appropriate case manager? a. Nurse b. Panel of experts c. Multidisciplinary team d. Insurance company

ANS: A Nursing case managers are ideally suited to provide the care coordination necessary. Care coordination is most effective if a single person works with the family to accomplish the many tasks and responsibilities that are necessary. The family retains the role as primary decision maker. Most likely the insurance company will have a case manager focusing on the financial aspects of care. This does not include coordination of care to assist the family.

Selective cholesterol screening is recommended for children older than the age of 2 years with which risk factor? a. Body mass index (BMI) = 95th percentile b. Blood pressure = 50th percentile c. Parent with a blood cholesterol level of 200 mg/dl d. Recently diagnosed cardiovascular disease in a 75-year-old grandparent

ANS: A Obesity is an indication for cholesterol screening in children. A BMI in the 95th percentile or higher is considered obese. Children who are hypertensive meet the criteria for screening, but blood pressure in the 50th percentile is within the normal range. A parent or grandparent with a cholesterol level of 240 mg/dl or higher places the child at risk. Early cardiovascular disease in a first- or second-degree relative is a risk factor. Age 75 years is not considered early.

Which of the following statements characterizes moral development in the older school-age child? a. They are able to judge an act by the intentions that prompted it rather than just by the consequences. b. Rules and judgments become more absolute and authoritarian. c. They view rule violations in an isolated context. d. They know the rules but cannot understand the reasons behind them.

ANS: A Older school-age children are able to judge an act by the intentions that prompted the behavior rather than just by the consequences.

A child is being admitted to the hospital with acute gastroenteritis. The health care provider prescribes an antiemetic. What antiemetic does the nurse anticipate being prescribed? a. Ondansetron (Zofran) b. Promethazine (Phenergan) c. Metoclopramide (Reglan) d. Dimenhydrinate (Dramamine)

ANS: A Ondansetron reduces the duration of vomiting in children with acute gastroenteritis. This would be the expected prescribed antiemetic. Adverse effects with earlier generation antiemetics (e.g., promethazine and metoclopramide) include somnolence, nervousness, irritability, and dystonic reactions and should not be routinely administered to children. For children who are prone to motion sickness, it is often helpful to administer an appropriate dose of dimenhydrinate (Dramamine) before a trip, but it would not be ordered as an antiemetic.

Clinical manifestations of nonorganic failure to thrive include which of the following? a. Avoidance of eye contact b. An associated malabsorption defect c. Weight that falls below the 15th percentile d. Normal achievement of developmental landmarks

ANS: A One of the clinical manifestations of nonorganic failure to thrive is the child's avoidance of eye contact with the health professional.

Which painful, tender, pea-sized nodules may appear on the pads of the fingers or toes in bacterial endocarditis? a. Osler nodes b. Janeway lesions c. Subcutaneous nodules d. Aschoff nodes

ANS: A Osler nodes are red, painful, intradermal nodes found on pads of the phalanges in bacterial endocarditis. Janeway lesions are painless hemorrhagic areas on palms and soles in bacterial endocarditis. Subcutaneous nodules are nontender swellings, located over bony prominences, commonly found in rheumatic fever. Aschoff nodules are small nodules composed of cells and leukocytes found in the interstitial tissues of the heart in rheumatic myocarditis.

A nurse is conducting a staff in-service on childhood cancers. Which is the primary site of osteosarcoma? a. Femur b. Humerus c. Pelvis d. Tibia

ANS: A Osteosarcoma is the most frequently encountered malignant bone cancer in children. The peak incidence is between ages 10 and 25 years. More than half occur in the femur. After the femur, most of the remaining sites are the humerus, tibia, pelvis, jaw, and phalanges.

What rationale explains why prolonged use of oxygen should be discouraged in a child with anemia? a. Prolonged use of oxygen can decrease erythropoiesis. b. Prolonged use of oxygen can interfere with iron production. c. Prolonged use of oxygen interferes with a child's appetite. d. Prolonged use of oxygen can affect the synthesis of hemoglobin.

ANS: A Oxygen administration is of limited value, because each gram of hemoglobin is able to carry a limited amount of the gas. In addition, prolonged use of supplemental oxygen can decrease erythropoiesis. Prolonged use of oxygen does not interfere with iron production, a child's appetite, or affect the synthesis of hemoglobin.

The nurse is giving discharge instructions to the parents of a 5-year-old child who had a tonsillectomy 4 hours ago. What statement by the parent indicates a correct understanding of the teaching? a. "I can use an ice collar on my child for pain control along with analgesics." b. "My child should clear the throat frequently to clear the secretions." c. "I should allow my child to be as active as tolerated." d. "My child should gargle and brush teeth at least three times per day."

ANS: A Pain control after a tonsillectomy can be achieved with application of an ice collar and administration of analgesics. The child should avoid clearing the throat or coughing and does not need to gargle and brush teeth a certain number of times per day and should avoid vigorous gargling and toothbrushing. Also, the child's activity should be limited to decrease the potential for bleeding, at least for the first few days.

What manifestation observed by the nurse is suggestive of parental overprotection? a. Gives inconsistent discipline b. Facilitates the child's responsibility for self-care of illness c. Persuades the child to take on activities of daily living even when not able d. Encourages social and educational activities not appropriate to the child's level of capability

ANS: A Parental overprotection is manifested when the parents fear letting the child achieve any new skill, avoid all discipline, and cater to every desire to prevent frustration. Overprotective parents do not allow the child to assume responsibility for self-care of the illness. The parents prefer to remain in the role of total caregiver. The parents do not encourage the child to participate in social and educational activities.

A child with asthma is having pulmonary function tests. What rationale explains the purpose of the peak expiratory flow rate? a. To assess severity of asthma b. To determine cause of asthma c. To identify "triggers" of asthma d. To confirm diagnosis of asthma

ANS: A Peak expiratory flow rate monitoring is used to monitor the child's current pulmonary function. It can be used to manage exacerbations and for daily long-term management. The cause of asthma is known. Asthma is caused by a complex interaction among inflammatory cells, mediators, and the cells and tissues present in the airways. The triggers of asthma are determined through history taking and immunologic and other testing. The diagnosis of asthma is made through clinical manifestations, history, physical examination, and laboratory testing.

The clinic nurse is assessing infant reflexes. What assessment indicates a persistence of primitive reflexes? a. Tonic neck reflex at 8 months of age b. Palmar grasp at 4 months of age c. Plantar grasp at 9 months of age d. Rooting reflex at 3 months of age

ANS: A Persistence of primitive reflexes is one of the earliest clues to CP (e.g., obligatory tonic neck reflex at any age or nonobligatory persistence beyond 6 months of age and the persistence or even hyperactivity of the Moro, plantar, and palmar grasp reflexes). The palmar grasp disappears by 6 months, the plantar grasp disappears by 12 months, and the rooting reflex disappears at 4 months, so these are normal findings.

What is the purpose in using cimetidine (Tagamet) for gastroesophageal reflux? a. The medication reduces gastric acid secretion. b. The medication neutralizes the acid in the stomach. c. The medication increases the rate of gastric emptying time. d. The medication coats the lining of the stomach and esophagus.

ANS: A Pharmacologic therapy may be used to treat infants and children with gastroesophageal reflux disease. Both H2-receptor antagonists (cimetidine [Tagamet], ranitidine [Zantac], or famotidine [Pepcid]) and proton pump inhibitors (esomeprazole [Nexium], lansoprazole [Prevacid], omeprazole [Prilosec], pantoprazole [Protonix], and rabeprazole [Aciphex]) reduce gastric hydrochloric acid secretion.

The nurse is teaching the family of an infant with cerebral palsy how to administer a diazepam (Valium) pill by gastrostomy tube. What should the nurse include in the teaching session? a. The pill should be crushed and mixed with a small amount of water. b. The pill should be crushed and mixed with the infant's formula. c. After administering the medication, flush the tube with air. d. Before administering the medication, check the placement of the tube.

ANS: A Pills may be crushed and mixed with small amounts of water but not other liquids, such as formula or elixir medications, because these may act together to form a sludge that can interfere with gastrostomy tube function. When crushed pills or tablets are administered, flush the feeding tube with more water after instilling the dissolved pill in water. The tube should not be flushed with air, and placement does not need to be checked because it is directly into the stomach.

The nurse is conducting a staff in-service on childhood-acquired heart diseases. Which is a major clinical manifestation of rheumatic fever? a. Polyarthritis b. Osler nodes c. Janeway spots d. Splinter hemorrhages of distal third of nails

ANS: A Polyarthritis, which is swollen, hot, red, and painful joints, is a major clinical manifestation of rheumatic fever. The affected joints will change every 1 to 2 days. Primarily the large joints are affected. Osler nodes, Janeway spots, and splinter hemorrhages are characteristic of infective endocarditis.

An adolescent whose leg was crushed when she fell off a horse is admitted to the emergency department. She has completed the tetanus immunization series, receiving the last tetanus toxoid booster 8 years ago. What care is necessary for therapeutic management of this adolescent to prevent tetanus? a. Tetanus toxoid booster is needed because of the type of injury. b. Human tetanus immunoglobulin is indicated for immediate prophylaxis. c. Concurrent administration of both tetanus immunoglobulin and tetanus antitoxin is needed. d. No additional tetanus prophylaxis is indicated. The tetanus toxoid booster is protective for 10 years.

ANS: A Protective levels of antibody are maintained for at least 10 years. Children with serious "tetanus-prone" wounds, including contaminated, crush, puncture, or burn wounds, should receive a tetanus toxoid booster prophylactically as soon as possible. This adolescent has circulating antibodies. The immunoglobulin is not indicated.

A 4-year-old child has just been diagnosed with pseudohypertrophic (Duchenne) muscular dystrophy. The management plan should include which action? a. Recommend genetic counseling. b. Explain that the disease is easily treated. c. Suggest ways to limit use of muscles. d. Assist family in finding a nursing facility to provide his care.

ANS: A Pseudohypertrophic (Duchenne) muscular dystrophy is inherited as an X-linked recessive gene. Genetic counseling is recommended for parents, female siblings, maternal aunts, and their female offspring. No effective treatment exists at this time for childhood muscular dystrophy. Maintaining optimal function of all muscles for as long as possible is the primary goal. It has been found that children who remain as active as possible are able to avoid wheelchair confinement for a longer time. Assisting the family in finding a nursing facility to provide his care is inappropriate at the time of diagnosis. When the child becomes increasingly incapacitated, the family may consider home-based care, a skilled nursing facility, or respite care to provide the necessary care.

What is the best explanation for using pulse oximetry on young children to determine oxygen saturation? a. Pulse oximetry is noninvasive. b. Pulse oximetry is better than capnography. c. Pulse oximetry is more accurate than arterial blood gases. d. Pulse oximetry provides intermittent measurements of oxygen.

ANS: A Pulse oximetry is a noninvasive measure of oxygen saturation of hemoglobin. Capnography measures carbon dioxide inhalation and exhalation. It does not provide information about oxygen saturation. Arterial blood gases provide additional clinical information, including pH, PCO2, bicarbonate, base excess, and PO2. An arterial puncture is required, which can be painful, and continuous monitoring cannot be done without an arterial line. Pulse oximetry can be either intermittent or continuous.

One of the supervisors for a home health agency asks the nurse to give a family of a child with a chronic illness a survey evaluating the nurses and other service providers. How should the nurse recognize this request? a. Appropriate to improve quality of care b. Improper because it is an invasion of privacy c. Inappropriate unless nurses and other providers agree to participate d. Not acceptable because the family lacks remembering necessary to evaluate professionals

ANS: A Quality assessment and improvement activities are essential for virtually all organizations. Family involvement in evaluating a home care plan can occur on several levels. The nurse can ask the family open-ended questions at regular intervals to assess their opinion of the effectiveness of care. Families should also be given an opportunity to evaluate the individual home care nurses, the home care agency, and other service providers periodically. Evaluation of the provision of care to the patient and family requires evaluation of the care provider, that is, the nurse. Quality-monitoring activities are required by virtually all health care agencies. During the evaluation process, the family is asked to provide their perceptions of care.

A child's parents ask the nurse many questions about their child's illness and its management. The nurse does not know enough to answer all the questions. What nursing action is most appropriate at this time? a. Tell them, "I don't know, but I will find out." b. Suggest that they ask the physician these questions. c. Explain that the nurse cannot be expected to know everything. d. Answer questions vaguely so they do not lose confidence in the nurse.

ANS: A Questions from parents should be answered in a straightforward manner. Stating "I don't know" or "I'll find out" is better than pretending to know or giving excuses. Suggesting that they ask the physician these questions is not supportive of the family. The nurse's role is to assist the parents in obtaining accurate information about their child's illness and its management. Although the nurse cannot be expected to know everything, it is an unprofessional attitude to state this. Nurses must provide accurate information to the extent possible. Vague answers are not helpful to the family.

Parents of a hospitalized child often question the skill of staff. The nurse interprets this behavior by the parents as what? a. Normal b. Paranoid c. Indifferent d. Wanting attention

ANS: A Recent research has identified common themes among parents whose children were hospitalized, including feeling an overall sense of helplessness, questioning the skills of staff, accepting the reality of hospitalization, needing to have information explained in simple language, dealing with fear, coping with uncertainty, and seeking reassurance from the health care team. The behavior does not indicate the parents are paranoid, indifferent, or wanting attention.

Which is the priority nursing intervention for an unconscious child after a fall? a. Establish adequate airway. b. Perform neurologic assessment. c. Monitor intracranial pressure. d. Determine whether a neck injury is present.

ANS: A Respiratory effectiveness is the primary concern in the care of the unconscious child. Establishment of an adequate airway is always the first priority. A neurologic assessment and determination of whether a neck injury is present will be performed after breathing and circulation are stabilized. Intracranial, not intercranial, pressure is monitored if indicated after airway, breathing, and circulation are maintained.

Respiratory failure can result from many causes. What condition is a specific primary cause of inefficient gas transfer? a. Anemia b. Pneumothorax c. Cystic fibrosis d. Laryngospasm

ANS: A Respiratory failure is defined as the inability of the respiratory system to maintain adequate oxygenation of the blood. In primary inefficient gas transfer, there is insufficient alveolar ventilation. Anemia, which is characterized by low hemoglobin levels, results in an inability to adequately oxygenate the blood. Pneumothorax and cystic fibrosis are examples of restrictive lung disease. Laryngospasm is an example of obstructive lung disease.

A child with acute gastrointestinal bleeding is admitted to the hospital. The nurse observes which sign or symptom as an early manifestation of shock? a. Restlessness b. Rapid capillary refill c. Increased temperature d. Increased blood pressure

ANS: A Restlessness is an indication of impending shock in a child. Capillary refill is slowed in shock. The child will feel cool. The blood pressure initially remains within the normal range and then declines.

An adolescent girl tells the nurse that she is very suicidal. The nurse asks her if she has a specific plan. Asking this should be considered which of the following? a. An appropriate part of the assessment b. Not a critical part of the assessment c. Suggesting that the adolescent needs a plan d. Encouraging the adolescent to devise a plan

ANS: A Routine health assessments of adolescents should include questions that assess the presence of suicidal ideation or intent. Questions such as "Have you ever developed a plan to hurt yourself or kill yourself" should be part of that assessment.

What statement is most descriptive of a school-age child's reaction to death? a. Very interested in funerals and burials b. Little understanding of words such as "forever" c. Imagine the deceased person to be still alive d. Can explain death from a religious or spiritual point of view

ANS: A School-age children are interested in naturalistic and physiologic explanations of why death occurs and what happens to the body. School-age children do have an established concept of forever and have a deeper understanding of death in a concrete manner. Adolescents may explain death from a religious or spiritual point of view.

Latasha, age 8 years, is being admitted to the hospital from the emergency department with an injury from falling off her bicycle. Which of the following will help her most in her adjustment to the hospital? a. Explain hospital schedules to her, such as mealtimes. b. Use terms such as "honey" and "dear" to show a caring attitude. c. Explain when parents can visit and why siblings cannot come to see her. d. Orient her parents, because she is young, to her room and hospital facility.

ANS: A School-age children need to have control of their environment. The nurse should offer explanations or prepare the child for those experiences that are unavailable.

An 8-year-old girl is being admitted to the hospital from the emergency department with an injury from falling off her bicycle. What intervention will help her most in her adjustment to the hospital? a. Explain hospital schedules to her, such as mealtimes. b. Use terms such as "honey" and "dear" to show a caring attitude. c. Explain when parents can visit and why siblings cannot come to see her. d. Orient her parents, because she is too young, to her room and hospital facility.

ANS: A School-age children need to have control of their environment. The nurse should offer explanations or prepare the child for what to expect. The nurse should refer to the child by the preferred name. Explaining when parents can visit and why siblings cannot come focuses on the limitations rather than helping her adjust to the hospital. At the age of 8 years, the child should be oriented to the environment along with the parents.

The nurse is conducting a staff in-service on inherited childhood blood disorders. Which statement describes severe combined immunodeficiency syndrome (SCIDS)? a. There is a deficit in both the humoral and cellular immunity with this disease. b. Production of red blood cells is affected with this disease. c. Adult hemoglobin is replaced by abnormal hemoglobin in this disease. d. There is a deficiency of T and B lymphocyte production with this disease.

ANS: A Severe combined immunodeficiency syndrome (SCIDS) is a genetic disorder that results in deficits of both humoral and cellular immunity. Wiskott-Aldrich is an X-linked recessive disorder with selected deficiencies of T and B lymphocytes. Fanconi syndrome is a hereditary disorder of red cell production. Sickle cell disease is characterized by the replacement of adult hemoglobin with an abnormal hemoglobin S.

A common characteristic of those who sexually abuse children is which of the following? a. Pressure victim into secrecy b. Are usually unemployed and unmarried c. Are unknown to victims and victims' families d. Have many victims that are each abused only once

ANS: A Sex offenders may pressure the victim into secrecy regarding the activity as a "secret between us" that other people may take away if they find out.

Ongoing fluid losses can overwhelm the child's ability to compensate, resulting in shock. What early clinical sign precedes shock? a. Tachycardia b. Slow respirations c. Warm, flushed skin d. Decreased blood pressure

ANS: A Shock is preceded by tachycardia and signs of poor tissue perfusion and decreased pulse oximetry values. Respirations are increased as the child attempts to compensate. As a result of the poor peripheral circulation, the child has skin that is cool and mottled with decreased capillary refilling after blanching. In children, lowered blood pressure is a late sign and may accompany the onset of cardiovascular collapse.

When both parents have sickle cell trait, which is the chance their children will have sickle cell anemia? a. 25% b. 50% c. 75% d. 100%

ANS: A Sickle cell anemia is inherited in an autosomal recessive pattern. If both parents have sickle cell trait (one copy of the sickle cell gene), then for each pregnancy, a 25% chance exists that their child will be affected with sickle cell disease. With each pregnancy, a 50% chance exists that the child will have sickle cell trait. Percentages of 75% and 100% are too high for the children of parents who have sickle cell trait.

Parents of a child with sickle cell anemia ask the nurse, "What happens to the hemoglobin in sickle cell anemia?" Which statement by the nurse explains the disease process?" a. Normal adult hemoglobin is replaced by abnormal hemoglobin. b. There is a lack of cellular hemoglobin being produced. c. There is a deficiency in the production of globulin chains. d. The size and depth of the hemoglobin are affected.

ANS: A Sickle cell anemia is one of a group of diseases collectively called hemoglobinopathies, in which normal adult hemoglobin is replaced by abnormal hemoglobin. Aplastic anemia is a lack of cellular elements being produced. Thalassemia major refers to a variety of inherited disorders characterized by deficiencies in production of certain globulin chains. Iron deficiency anemia affects the size and depth of the color.

An adolescent boy is brought to the emergency department after a motorcycle accident. His respirations are deep, periodic, and gasping. There are extreme fluctuations in blood pressure. Pupils are dilated and fixed. The nurse should suspect which type of head injury? a. Brainstem b. Skull fracture c. Subdural hemorrhage d. Epidural hemorrhage

ANS: A Signs of brainstem injury include deep, rapid, periodic or intermittent, and gasping respirations. Wide fluctuations or noticeable slowing of the pulse, widening pulse pressure, or extreme fluctuations in blood pressure are consistent with a brainstem injury. Skull fracture, subdural hemorrhage, and epidural hemorrhage are not consistent with brainstem injuries.

A 9-year-old girl often comes to the school nurse complaining of stomach pains. Her teacher says she is completing her school work satisfactorily, but lately has been somewhat aggressive and stubborn in the classroom. The school nurse should recognize this as which of the following? a. Signs of stress b. Developmental delay c. Physical problem causing emotional stress d. Lack of adjustment to school environment.

ANS: A Signs of stress include stomach pains or headache, sleep problems, bed-wetting, changes in eating habits, aggressive or stubborn behavior, reluctance to participate, or regression to early behaviors.

A child is upset because, when the cast is removed from her leg, the skin surface is caked with desquamated skin and sebaceous secretions. Which should the nurse suggest to remove this material? a. Soak in a bathtub. b. Vigorously scrub leg. c. Apply powder to absorb material. d. Carefully pick material off leg.

ANS: A Simple soaking in the bathtub is usually sufficient for the removal of the desquamated skin and sebaceous secretions. It may take several days to eliminate the accumulation completely. The parents and child should be advised not to scrub the leg vigorously or forcibly remove this material because it may cause excoriation and bleeding. Oil or lotion, but not powder, may provide comfort for the child.

A child is upset because, when the cast is removed from her leg, the skin surface is caked with desquamated skin and sebaceous secretions. What technique should the nurse suggest to remove this material? a. Soak in a bathtub. b. Vigorously scrub the leg. c. Carefully pick material off the leg. d. Apply powder to absorb the material.

ANS: A Simply soaking in the bathtub is usually sufficient for removal of the desquamated skin and sebaceous secretions. Several days may be required to eliminate the accumulation completely. The parents and child should be advised not to scrub the leg vigorously or forcibly remove this material because it may cause excoriation and bleeding. Oil or lotion, but not powder, may provide comfort for the child.

A young girl has just injured her ankle at school. In addition to notifying the child's parents, what is the most appropriate, immediate action by the school nurse? a. Apply ice. b. Observe for edema and discoloration. c. Encourage child to assume a position of comfort. d. Obtain parental permission for administration of acetaminophen or aspirin.

ANS: A Soft tissue injuries should be iced immediately. In addition to ice, the extremity should be rested, be elevated, and have compression applied. The nurse observes for the edema while placing a cold pack. The applying of ice can reduce the severity of the injury. Maintaining the ankle at a position elevated above the heart is important. The nurse helps the child be comfortable with this requirement. The nurse obtains parental permission for administration of acetaminophen or aspirin after ice and rest are assured.

A young girl has just injured her ankle at school. In addition to calling the child's parents, the most appropriate, immediate action by the school nurse is to: a. apply ice. b. observe for edema and discoloration. c. encourage child to assume a position of comfort. d. obtain parental permission for administration of acetaminophen or aspirin.

ANS: A Soft-tissue injuries should be iced immediately. In addition to ice, the extremity should be rested, be elevated, and have compression applied. Observing for edema and discoloration, encouraging the child to assume a position of comfort, and obtaining parental permission for administration of acetaminophen or aspirin are not immediate priorities. The application of ice can reduce the severity of the injury.

Therapeutic management of a 6-year-old child with hereditary spherocytosis (HS) should include which therapeutic intervention? a. Perform a splenectomy. b. Supplement the diet with calcium. c. Institute a maintenance transfusion program. d. Increase intake of iron-rich foods such as meat.

ANS: A Splenectomy corrects the hemolysis that occurs in HS. The splenectomy is generally reserved for children older than age 5 years with symptomatic anemia. Supplementation with calcium does not affect the HS. Additional folic acid can prevent deficiency caused by the rapid cell turnover. A maintenance transfusion program suppresses red blood cell formation. At this time, the risks of transfusion are greater than those of a splenectomy. Iron supplementation does not influence the course of HS.

A student athlete was injured during a basketball game. The nurse observes significant swelling. The player states he thought he "heard a pop," that the pain is "pretty bad," and that the ankle feels "as if it is coming apart." Based on this description, the nurse suspects what injury? a. Sprain b. Fracture c. Dislocation d. Stress fracture

ANS: A Sprains account for approximately 75% of all ankle injuries in children. A sprain results when the trauma is so severe that a ligament is either stretched or partially or completely torn by the force created as a joint is twisted or wrenched. Joint laxity is the most valid indicator of the severity of a sprain. A fracture involves the cross-section of the bone. Dislocations occur when the force of stress on the ligaments disrupts the normal positioning of the bone ends. Stress fractures result from repeated muscular contraction and are seen most often in sports involving repetitive weight bearing such as running, gymnastics, and basketball.

The mother of a young child with cognitive impairment asks for suggestions about how to teach her child to use a spoon for eating. The nurse should make which recommendation? a. Do a task analysis first. b. Do not expect this task to be learned. c. Continue to spoon feed the child until the child tries to do it alone. d. Offer only finger foods so spoon feeding is unnecessary.

ANS: A Successful teaching begins with a task analysis. The endpoint (self-feeding, toilet training, and so on) is broken down into the component steps. The child is then guided to master the individual steps in sequence. Depending on the child's functional level, using a spoon for eating should be an achievable goal. The child requires demonstration and then guided training for each component of the self-feeding. Feeding finger foods so spoon feeding is unnecessary eliminates some of the intermediate steps that are necessary to using a fork and spoon. For socialization purposes, it is desirable that a child use feeding implements.

What do the initial signs of respiratory syncytial virus (RSV) infection in an infant include? a. Rhinorrhea, wheezing, and fever b. Tachypnea, cyanosis, and apnea c. Retractions, fever, and listlessness d. Poor breath sounds and air hunger

ANS: A Symptoms such as rhinorrhea and a low-grade fever often appear first. OM and conjunctivitis may also be present. In time, a cough may develop. Wheezing is an initial sign as well. Progression of illness brings on the symptoms of tachypnea, retractions, poor breath sounds, cyanosis, air hunger, and apnea.

What structural defects constitute tetralogy of Fallot? a. Pulmonary stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy b. Aortic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy c. Aortic stenosis, ventricular septal defect, overriding aorta, left ventricular hypertrophy d. Pulmonary stenosis, ventricular septal defect, aortic hypertrophy, left ventricular hypertrophy

ANS: A Tetralogy of Fallot has these four characteristics: pulmonary stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy.

The nurse is conducting a staff in-service on congenital heart defects. Which structural defect constitutes tetralogy of Fallot? a. Pulmonic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy b. Aortic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy c. Aortic stenosis, atrial septal defect, overriding aorta, left ventricular hypertrophy d. Pulmonic stenosis, ventricular septal defect, aortic hypertrophy, left ventricular hypertrophy

ANS: A Tetralogy of Fallot has these four characteristics: pulmonic stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy. There is pulmonic stenosis but not atrial stenosis in tetralogy of Fallot. Right ventricular hypertrophy, not left ventricular hypertrophy, is present in tetralogy of Fallot. Tetralogy of Fallot has right ventricular hypertrophy, not left ventricular hypertrophy, and an atrial septal defect, not aortic hypertrophy.

What test should the nurse do as a precautionary measure before doing an arterial puncture to obtain an arterial blood sample? a. Allen test b. Smith test c. Venipuncture d. Cold compress

ANS: A The Allen test determines the adequacy of collateral circulation in the extremity distal to the proposed puncture site. If the child does not have satisfactory circulation when the proposed artery is occluded, that extremity is not used. The Smith test, venipuncture, and a cold compress are not done before arterial blood gas sampling.

A 10-year-old child, without a history of previous seizures, experiences a tonic-clonic seizure at school. Breathing is not impaired, but some postictal confusion occurs. The most appropriate initial action by the school nurse is to: a. stay with child and have someone call emergency medical service (EMS). b. notify parent and regular practitioner. c. notify parent that child should go home. d. stay with child, offering calm reassurance.

ANS: A The EMS should be called to transport the child because this is the child's first seizure. Because this is the first seizure, evaluation should be performed as soon as possible. The nurse should stay with the child while someone else notifies the EMS.

The Heimlich maneuver is recommended for airway obstruction in children older than _____ year(s). a. 1 b. 4 c. 8 d. 12

ANS: A The Heimlich maneuver is recommended for airway obstruction in children older than 1 year. Younger than 1 year, back blows and chest thrusts are administered. The Heimlich maneuver can be used in children older than 1 year.

Four-year-old David is placed in Buck extension traction for Legg-Calvé-Perthes disease. He is crying with pain as the nurse assesses that the skin of his right foot is pale with an absence of pulse. Which action should the nurse take first? a. Notify the practitioner of the changes noted. b. Give the child medication to relieve the pain. c. Reposition the child and notify physician. d. Chart the observations and check the extremity again in 15 minutes.

ANS: A The absence of a pulse and change in color of the foot must be reported immediately for evaluation by the practitioner. Pain medication should be given after the practitioner is notified. Legg-Calvé-Perthes disease is an emergency condition; immediate reporting is indicated. The findings should be documented with ongoing assessment.

The nurse should suspect a hearing impairment in an infant who fails to demonstrate which behavior? a. Babbling by age 12 months b. Eye contact when being spoken to c. Startle or blink reflex to sound d. Gesturing to indicate wants after age 15 months

ANS: A The absence of babbling or inflections in voice by at least age 7 months is an indication of hearing difficulties. Lack of eye contact is not indicative of a hearing loss. An infant with a hearing impairment might react to a loud noise but not respond to the spoken word. The child with hearing impairment uses gestures rather than vocalizations to express desires at this age.

What test is used to screen for carbohydrate malabsorption? a. Stool pH b. Urine ketones c. C urea breath test d. ELISA stool assay

ANS: A The anticipated pH of a stool specimen is 7.0. A stool pH of less than 5.0 is indicative of carbohydrate malabsorption. The bacterial fermentation of carbohydrates in the colon produces short-chain fatty acids, which lower the stool pH. Urine ketones detect the presence of ketones in the urine, which indicates the use of alternative sources of energy to glucose. The C urea breath test measures the amount of carbon dioxide exhaled. It is used to determine the presence of Helicobacter pylori. ELISA (enzyme-linked immunosorbent assay) detects the presence of antigens and antibodies. It is not useful for disorders of metabolism.

Parents of a 3-year-old child with congenital heart disease are afraid to let their child play with other children because of possible overexertion. The nurse's reply should be based on which statement? a. Child needs opportunities to play with peers. b. Child needs to understand that peers' activities are too strenuous. c. Parents can meet all of the child's needs. d. Constant parental supervision is needed to avoid overexertion.

ANS: A The child needs opportunities for social development. Children usually limit their activities if allowed to set their own pace. The child will limit activities as necessary. Parents must be encouraged to seek appropriate social activities for the child, especially before kindergarten. The child needs to have activities that foster independence. The child will be able to regulate activities.

A school-age child has been admitted with an acute asthma episode. The child is receiving oxygen by nasal prongs at 2 liters. How often should the nurse plan to monitor the child's pulse oximetry status? a. Continuous b. Every 30 minutes c. Every hour d. Every 2 hours

ANS: A The child on supplemental oxygen requires intermittent or continuous oxygenation monitoring, depending on severity of respiratory compromise and initial oxygenation status. The child in status asthmaticus should be placed on continuous cardiorespiratory (including blood pressure) and pulse oximetry monitoring.

A toddler fell out of a second-story window. She had a brief loss of consciousness and vomited four times. Since admission, she has been alert and oriented. Her mother asks why a computed tomography (CT) scan is required when she "seems fine." Which explanation should the nurse give? a. Your child may have a brain injury and the CT can rule one out. b. The CT needs to be done because of your child's age. c. Your child may start to have seizures and a baseline CT should be done. d. Your child probably has a skull fracture and the CT can confirm this diagnosis.

ANS: A The child's history of the fall, brief loss of consciousness, and vomiting four times necessitates evaluation of a potential brain injury. The severity of a head injury may not be apparent on clinical examination but will be detectable on a CT scan. The need for the CT scan is related to the injury and symptoms, not the child's age. The CT scan is necessary to determine whether a brain injury has occurred.

A sexually active female adolescent asks the nurse about the contraceptive Depo-Provera. The nurse should explain that it: a. requires injections every 3 months. b. requires daily administration of medication by mouth. c. provides long-term continuous protection, up to 5 years. d. prevents pregnancy if given within 72 hours of unprotected sex.

ANS: A The contraceptive Depo-Provera is administered by injection every 3 months.

What is the earliest recognizable clinical manifestation(s) of cystic fibrosis (CF)? a. Meconium ileus b. History of poor intestinal absorption c. Foul-smelling, frothy, greasy stools d. Recurrent pneumonia and lung infections

ANS: A The earliest clinical manifestation of CF is a meconium ileus, which is found in about 10% of children with CF. Clinical manifestations include abdominal distention, vomiting, failure to pass stools, and rapid development of dehydration. History of malabsorption is a later sign that manifests as failure to thrive. Foul-smelling stools and recurrent respiratory infections are later manifestations of CF.

A nurse is teaching nursing students about clinical manifestations of cystic fibrosis (CF). Which is/are the earliest recognizable clinical manifestation(s) of CF? a. Meconium ileus b. History of poor intestinal absorption c. Foul-smelling, frothy, greasy stools d. Recurrent pneumonia and lung infections

ANS: A The earliest clinical manifestation of CF is a meconium ileus, which is found in about 10% of children with CF. Clinical manifestations include abdominal distention, vomiting, failure to pass stools, and rapid development of dehydration. History of malabsorption is a later sign that manifests as failure to thrive. Foul-smelling stools are a later manifestation of CF. Recurrent respiratory tract infections are a later sign of CF.

What laboratory finding should the nurse expect in a child with an excess of water? a. Decreased hematocrit b. High serum osmolality c. High urine specific gravity d. Increased blood urea nitrogen

ANS: A The excess water in the circulatory system results in hemodilution. The laboratory results show a falsely decreased hematocrit. Laboratory analysis of blood that is hemodiluted reveals decreased serum osmolality and blood urea nitrogen. The urine specific gravity is variable relative to the child's ability to correct the fluid imbalance.

What urine test result is considered abnormal? a. pH 4.0 b. WBC 1 or 2 cells/ml c. Protein level absent d. Specific gravity 1.020

ANS: A The expected pH ranges from 4.8 to 7.8. A pH of 4.0 can be indicative of urinary tract infection or metabolic alkalosis or acidosis. Less than 1 or 2 white blood cells per milliliter is the expected range. The absence of protein is expected. The presence of protein can be indicative of glomerular disease. A specific gravity of 1.020 is within the anticipated range of 1.001 to 1.030. Specific gravity reflects level of hydration in addition to renal disorders and hormonal control such as antidiuretic hormone.

A 2-year-old child has a chronic history of constipation and is brought to the clinic for evaluation. What should the therapeutic plan initially include? a. Bowel cleansing b. Dietary modification c. Structured toilet training d. Behavior modification

ANS: A The first step in the treatment of chronic constipation is to empty the bowel and allow the distended rectum to return to normal size. Dietary modification is an important part of the treatment. Increased fiber and fluids should be gradually added to the child's diet. A 2-year-old child is too young for structured toilet training. For an older child, a regular schedule for toileting should be established. Behavior modification is part of the overall treatment plan. The child practices releasing the anal sphincter and recognizing cues for defecation.

The nurse is admitting a child with rheumatic fever. Which therapeutic management should the nurse expect to implement? a. Administering penicillin b. Avoiding salicylates (aspirin) c. Imposing strict bed rest for 4 to 6 weeks d. Administering corticosteroids if chorea develops

ANS: A The goal of medical management is the eradication of the hemolytic streptococci. Penicillin is the drug of choice. Salicylates can be used to control the inflammatory process, especially in the joints, and reduce the fever and discomfort. Bed rest is recommended for the acute febrile stage, but it does not need to be strict. The chorea is transient and will resolve without treatment.

A child with hemophilia A is scheduled for surgery. What precautions should the nurse institute with this child? a. Handle the child gently when transferring to a cart. b. Caution the child not to brush his teeth before surgery. c. Use tape sparingly on postoperative dressings. d. Do not administer analgesics before surgery.

ANS: A The goal of prevention of bleeding episodes is directed toward decreasing the risk of injury. The child should be handled carefully when transferring to a cart. Brushing teeth, use of tape, and giving analgesics will not risk a bleeding episode.

What is a major goal for the therapeutic management of juvenile idiopathic arthritis (JIA)? a. Control pain and preserve joint function. b. Minimize use of joint and achieve cure. c. Prevent skin breakdown and relieve symptoms. d. Reduce joint discomfort and regain proper alignment.

ANS: A The goals of therapy are to control pain, preserve joint range of motion and function, minimize the effects of inflammation, and promote normal growth and development. There is no cure for JIA at this time. Skin breakdown is not an issue for most children with JIA. Symptom relief and reduction in discomfort are important. When the joints are damaged, it is often irreversible.

Which of the following is described as the time interval between infection or exposure to disease and appearance of initial symptoms? a. Incubation period b. Prodromal period c. Desquamation period d. Period of communicability

ANS: A The incubation period is the interval between infection or exposure and appearance of symptoms.

The nurse is caring for an infant with congestive heart disease (CHD). The nurse should plan which intervention to decrease cardiac demands? a. Organize nursing activities to allow for uninterrupted sleep. b. Allow the infant to sleep through feedings during the night. c. Wait for the infant to cry to show definite signs of hunger. d. Discourage parents from rocking the infant

ANS: A The infant requires rest and conservation of energy for feeding. Every effort is made to organize nursing activities to allow for uninterrupted periods of sleep. Whenever possible, parents are encouraged to stay with their infant to provide the holding, rocking, and cuddling that help children sleep more soundly. To minimize disturbing the infant, changing bed linens and complete bathing are done only when necessary. Feeding is planned to accommodate the infant's sleep and wake patterns. The child is fed at the first sign of hunger, such as when sucking on fists, rather than waiting until he or she cries for a bottle because the stress of crying exhausts the limited energy supply. Because infants with CHD tire easily and may sleep through feedings, smaller feedings every 3 hours may be helpful.

Which of the following is an important nursing consideration when caring for an infant with failure to thrive? a. Establish a structured routine and follow it consistently. b. Maintain a nondistracting environment by not speaking to child during feeding. c. Place child in an infant seat during feedings to prevent overstimulation. d. Limit sensory stimulation and play activities to alleviate fatigue.

ANS: A The infant with failure to thrive should have a structured routine that is followed consistently. Disruptions in other activities of daily living can have a great impact on feeding behaviors. Bathing, sleeping, dressing, playing, and feeding are structured.

The nurse is administering an IM injection into a vastus lateralis muscle of a 6-month-old infant. What should the length of the needle and amount to be given be? a. 5/8 to 1 inch; 0.5 to 1.0 ml b. 1 inch to 1 1/2 inch; 1.0 to 2.0 ml c. 1 inch to 1 1/2 inch; 0.5 to 1.0 ml d. 5/8 to 1 inch; 0.75 to 2 ml

ANS: A The length of a needle for an infant should be 5/8 to 1 inch, and the amount of solution should not exceed 1 ml.

When teaching a mother how to administer eye drops, where should the nurse tell her to place them? a. In the conjunctival sac that is formed when the lower lid is pulled down b. Carefully under the eye lid while it is gently pulled upward c. On the sclera while the child looks to the side d. Anywhere as long as drops contact the eye's surface

ANS: A The lower lid is pulled down, forming a small conjunctival sac. The solution or ointment is applied to this area.

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

ANS: A The major stressor for children from infancy through the preschool years is separation anxiety, also called anaclitic depression. This is a major stressor of hospitalization.

A 14-year-old boy and his parents are concerned about bilateral breast enlargement. The nurse's discussion of this should be based on which of the following? a. This is usually benign and temporary. b. This is usually caused by Klinefelter syndrome. c. Administration of estrogen effectively reduces gynecomastia. d. Administration of testosterone effectively reduces gynecomastia.

ANS: A The male breast responds to hormonal changes. Some degree of bilateral or unilateral breast enlargement occurs frequently in boys during puberty.

A school-age child is admitted in vasoocclusive sickle cell crisis (pain episode). The child's care should include which therapeutic interventions? a. Hydration and pain management b. Oxygenation and factor VIII replacement c. Electrolyte replacement and administration of heparin d. Correction of alkalosis and reduction of energy expenditure

ANS: A The management of crises includes adequate hydration, pain management, minimization of energy expenditures, electrolyte replacement, and blood component therapy if indicated. Factor VIII is not indicated in the treatment of vasoocclusive sickle cell crisis. Oxygen may prevent further sickling, but it is not effective in reversing sickling because it cannot reach the clogged blood vessels. Also, prolonged oxygen can reduce bone marrow activity. Heparin is not indicated in the treatment of vasoocclusive sickle cell crisis. Electrolyte replacement should accompany hydration. The acidosis will be corrected as the crisis is treated. Energy expenditure should be minimized to improve oxygen utilization. Acidosis, not alkalosis, results from hypoxia, which also promotes sickling.

The nurse is talking to a parent of an infant with heart failure about feeding the infant. Which statement about feeding the child is correct? a. "You may need to increase the caloric density of your infant's formula." b. "You should feed your baby every 2 hours." c. "You may need to increase the amount of formula your infant eats with each feeding." d. "You should place a nasal oxygen cannula on your infant during and after each feeding."

ANS: A The metabolic rate of infants with heart failure is greater because of poor cardiac function and increased heart and respiratory rates. Their caloric needs are greater than those of the average infants, yet their ability to take in the calories is diminished by their fatigue. Infants with heart failure should be fed every 3 hours; a 2-hour schedule does not allow for enough rest, and a 4-hour schedule is too long. Fluids must be carefully monitored because of the heart failure. Infants do not require supplemental oxygen with feedings.

The mother of a 7-month-old infant newly diagnosed with cystic fibrosis is rooming in with her infant. She is breastfeeding and provides all the care except for the medication administration. What should the nurse include in the plan of care? a. Ensuring that the mother has time away from the infant b. Making sure the mother is providing all of the infant's care c. Determining whether other family members can provide the necessary care so the mother can rest d. Contacting the social worker because of the mother's interference with the nursing care

ANS: A The mother needs sufficient rest and nutrition so she can be effective as a caregiver. While the infant is hospitalized, the care is the responsibility of the nursing staff. The mother should be made comfortable with the care the staff provides in her absence. The mother has a right to provide care for the infant. The nursing staff and the mother should agree on the care division.

If an intramuscular (IM) injection is administered to a child who has Reye syndrome, the nurse should monitor for what? a. Bleeding b. Infection c. Poor absorption d. Itching at the injection site

ANS: A The nurse should watch for bleeding from the site. Because of related liver dysfunction with Reye syndrome, laboratory studies, such as prolonged bleeding time, should be monitored to determine impaired coagulation.

What primary nursing intervention should be implemented to prevent bacterial endocarditis? a. Counsel parents of high-risk children. b. Institute measures to prevent dental procedures. c. Encourage restricted mobility in susceptible children. d. Observe children for complications, such as embolism and heart failure.

ANS: A The objective of nursing care is to counsel the parents of high-risk children about the need for both prophylactic antibiotics for dental procedures and maintaining excellent oral health. The child's dentist should be aware of the child's cardiac condition. Dental procedures should be done to maintain a high level of oral health. Restricted mobility in susceptible children is not indicated. Parents are taught to observe for unexplained fever, weight loss, or change in behavior.

The nurse is taking care of a child who is alert but showing signs of increased intracranial pressure. Which test is contraindicated in this case? a. Oculovestibular response b. Doll's head maneuver c. Funduscopic examination for papilledema d. Assessment of pyramidal tract lesions

ANS: A The oculovestibular response (caloric test) involves the instillation of ice water into the ear of a comatose child. The caloric test is painful and is never performed on an awake child or one who has a ruptured tympanic membrane. Doll's head maneuver, funduscopic examination for papilledema, and assessment of pyramidal tract lesions can be performed on awake children.

An infant with a congenital heart defect is to receive a dose of palivizumab (Synagis). What is the purpose of this? a. Prevent RSV infection. b. Prevent secondary bacterial infection. c. Decrease toxicity of antiviral agents. d. Make isolation of infant with RSV unnecessary.

ANS: A The only product available in the United States for prevention of RSV is palivizumab, a humanized mouse monoclonal antibody, which is given once every 30 days (15 mg/kg) between November and March. It is given to high-risk infants, which includes an infant with a congenital heart defect.

The nurse is taking care of an adolescent with osteosarcoma. The parents ask the nurse about treatment. The nurse should make which accurate response about treatment for osteosarcoma? a. Treatment usually consists of surgery and chemotherapy. b. Amputation of affected extremity is rarely necessary. c. Intensive irradiation is the primary treatment. d. Bone marrow transplantation offers the best chance of long-term survival.

ANS: A The optimal therapy for osteosarcoma is a combination of surgery and chemotherapy. Intensive irradiation and bone marrow transplantation are usually not part of the therapeutic management.

The nurse is preparing a 12-year-old girl for a bone marrow aspiration. She tells the nurse she wants her mother with her "like before." The most appropriate nursing action is which of the following? a. Grant her request. b. Explain why this is not possible. c. Identify an appropriate substitute for her mother. d. Offer to provide support to her during the procedure.

ANS: A The parent's preferences for assisting, observing, or waiting outside the room should be assessed, along with the child's preference for parental presence. The child's choice should be respected.

A toddler is diagnosed with chronic benign neutropenia. The parents are being taught about caring for their child. What information is important to include? a. Avoid large indoor crowds and people who are ill. b. Parenteral antibiotics are necessary to control disease. c. Frequent rest periods are needed during the daytime. d. List the side effects of corticosteroids used to decrease inflammation.

ANS: A The parents are taught to minimize risk of infection by avoiding crowded areas and individuals who are ill. Parents are also cautioned about when to notify their practitioner and administration of granulocyte colony-stimulating factor, if indicated. Antibiotics are not needed unless the child has an infection. The toddler does not need any additional rest as a result of the neutropenia. Corticosteroids are not indicated.

The nurse is preparing to admit a child to the hospital with a diagnosis of minimal change nephrotic syndrome. The nurse understands that the peak age at onset for this disease is what? a. 2 to 3 years b. 4 to 5 years c. 6 to 7 years d. 8 to 9 years

ANS: A The peak age at onset for minimal change nephrotic syndrome is 2 to 3 years of age.

The nurse should monitor for which effect on the cardiovascular system when a child is immobilized? a. Venous stasis b. Increased vasopressor mechanism c. Normal distribution of blood volume d. Increased efficiency of orthostatic neurovascular reflexes

ANS: A The physiologic effects of immobilization, as a result of decreased muscle contraction, include venous stasis. This can lead to pulmonary emboli or thrombi. A decreased vasopressor mechanism results in orthostatic hypotension, syncope, hypotension, decreased cerebral blood flow, and tachycardia. An altered distribution of blood volume is found with decreased cardiac workload and exercise tolerance. Immobilization causes a decreased efficiency of orthostatic neurovascular reflexes with an inability to adapt readily to the upright position and with pooling of blood in the extremities in the upright position.

A mother calls the school nurse saying that her daughter has developed a school phobia. She has been out of school 3 days. The nurse's recommendations should include which of the following? a. Immediately return child to school. b. Explain to child that this is the last day she can stay home. c. Determine cause of phobia before returning child to school. d. Seek professional counseling before forcing child to return to school.

ANS: A The primary goal is to return the child to school. Parents must be convinced gently, but firmly, that immediate return is essential and that it is their responsibility to insist on school attendance.

Which of the following are the primary clinical manifestations of acute renal failure? a. Oliguria and hypertension b. Hematuria and pallor c. Proteinuria and muscle cramps d. Bacteriuria and facial edema

ANS: A The principal feature of acute renal failure is oliguria; hypertension is a nonspecific clinical manifestation.

A child, age 7 years, has a fever associated with a viral illness. She is being cared for at home. What is the principal reason for treating fever in this child? a. Relief of discomfort b. Reassurance that illness is temporary c. Prevention of secondary bacterial infection d. Avoidance of life-threatening complications

ANS: A The principal reason for treating fever is the relief of discomfort. Relief measures include pharmacologic and environmental intervention. The most effective is the use of pharmacologic agents to lower the set point. Although the nurse can reassure the child that the illness is temporary, the child is often uncomfortable and irritable. Intervention helps the child and family minimize the discomfort. Most fevers result from viral, not bacterial, infections. Few life-threatening events are associated with fever. The use of antipyretics does not seem to reduce the incidence of febrile seizures.

The nurse is caring for a neonate born with a myelomeningocele. Surgery to repair the defect is scheduled the next day. What is the most appropriate way to position and feed this neonate? a. Prone with the head turned to the side b. On the side c. Supine in an infant carrier d. Supine, with defect supported with rolled blankets

ANS: A The prone position with the head turned to the side for feeding is the optimum position for the infant. It protects the spinal sac and allows the infant to be fed without trauma. The side-lying position is avoided preoperatively. It can place tension on the sac and affect hip dysplasia if present. The infant should not be placed in a supine position.

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

ANS: A The rationale for preparing children for the hospital experience and related procedures is based on the principle that a fear of the unknown (fantasy) exceeds fear of the known. Preschool-age children see hospitalization as a punishment. Loss of parental love would be a toddler's reaction. Threat to the child's self-image would be a school-age child's reaction. Loss of companionship with friends would be an adolescent's reaction.

The nurse is planning care for a school-age child with bacterial meningitis. What intervention should be included? a. Keep environmental stimuli to a minimum. b. Have the child move her head from side to side at least every 2 hours. c. Avoid giving pain medications that could dull sensorium. d. Measure head circumference to assess developing complications.

ANS: A The room is kept as quiet as possible and environmental stimuli are kept to a minimum. Most children with meningitis are sensitive to noise, bright lights, and other external stimuli. The nuchal rigidity associated with meningitis would make moving the head from side to side a painful intervention. If pain is present, the child should be treated appropriately. Failure to treat can cause increased intracranial pressure. In this age group, the head circumference does not change. Signs of increased intracranial pressure would need to be assessed.

What nursing intervention is most appropriate in promoting normalization in a school-age child with a chronic illness? a. Give the child as much control as possible. b. Ask the child's peer to make the child feel normal. c. Convince the child that nothing is wrong with him or her. d. Explain to parents that family rules for the child do not need to be the same as for healthy siblings.

ANS: A The school-age child who is ill may be forced into a period of dependency. To foster normalcy, the child should be given as much control as possible. It is unrealistic for one individual to make the child feel normal. The child has a chronic illness, so it would be unacceptable to convince the child that nothing is wrong. The family rules should be similar for each of the children in a family. Resentment and hostility can arise if different standards are applied to each child.

When is bronchial (postural) drainage generally performed? a. Before meals and at bedtime b. Right before all aerosol therapy c. Immediately on arising and at bedtime d. Thirty minutes after meals and at bedtime

ANS: A The therapy should be done at bedtime and before meals or 1 to 1 1/2 hours after meals to avoid stomach upset. Postural drainage is most effective when it is performed after other respiratory therapy interventions, including bronchodilator and nebulizer treatments. Immediately on arising and at bedtime are appropriate times, but postural drainage is usually carried out at least three times each day. Thirty minutes after meals may induce vomiting.

Which of the following diagnostic tests allows visualization of renal parenchyma and renal pelvis without exposure to external beam radiation or radioactive isotopes? a. Renal ultrasound b. Computed tomography c. Intravenous pyelography d. Voiding cystourethrography

ANS: A The transmission of ultrasonic waves through the renal parenchyma allows visualization of the renal parenchyma and renal pelvis without exposure to external beam radiation or radioactive isotopes.

What diagnostic test allows visualization of renal parenchyma and renal pelvis without exposure to external-beam radiation or radioactive isotopes? a. Renal ultrasonography b. Computed tomography c. Intravenous pyelography d. Voiding cystourethrography

ANS: A The transmission of ultrasonic waves through the renal parenchyma allows visualization of the renal parenchyma and renal pelvis without exposure to external-beam radiation or radioactive isotopes. Computed tomography uses external radiation, and sometimes contrast media are used. Intravenous pyelography uses contrast medium and external radiation for radiography. Contrast medium is injected into the bladder through the urethral opening. External radiation for radiography is used before, during, and after voiding in voiding cystourethrography.

A child develops syndrome of inappropriate antidiuretic hormone secretion (SIADH) as a complication to meningitis. What action should be verified before implementing? a. Forcing fluids b. Daily weights with strict input and output (I and O) c. Strict monitoring of urine volume and specific gravity d. Close observation for signs of increasing cerebral edema

ANS: A The treatment of SIADH consists of fluid restriction until serum electrolytes and osmolality return to normal levels. SIADH often occurs in children who have meningitis. Monitoring weights, keeping I and O and specific gravity of urine, and observing for signs of increasing cerebral edema are all part of the nursing care for a child with SIADH.

A parent of a 7-year-old girl with a repaired ventricular septal defect (VSD) calls the cardiology clinic and reports that the child is just not herself. Her appetite is decreased, she has had intermittent fevers around 38° C (100.4° F), and now her muscles and joints ache. Based on this information, how should the nurse advise the mother? a. Immediately bring the child to the clinic for evaluation. b. Come to the clinic next week on a scheduled appointment. c. Treat the signs and symptoms with acetaminophen and fluids because it is most likely a viral illness. d. Recognize that the child is trying to manipulate the parent by complaining of vague symptoms.

ANS: A These are the insidious symptoms of bacterial endocarditis. Because the child is in a high-risk group for this disorder (VSD repair), immediate evaluation and treatment are indicated to prevent cardiac damage. With appropriate antibiotic therapy, bacterial endocarditis is successfully treated in approximately 80% of the cases. The child's complaints should not be dismissed. The low-grade fever is not a symptom that the child can fabricate.

A 12-year-old child has failed several courses of chemotherapy. An experimental drug is available that his parents want him to receive. He has told his parents and the oncologists that he is ready to die and does not want any more chemotherapy. The nurse recognizes what to be true? a. Parents and child both need support in the decision making. b. Twelve-year-olds are minors and cannot give consent or refuse treatments. c. The oncologists needs to make the decision because the parents and child disagree. d. The parents have the right and responsibility to make decisions for their children younger than age 18 years.

ANS: A This is a family issue that requires support to help both parents and child resolve the conflict. Because the child has little chance of survival, many institutions support the child's right to refuse or assent to therapy. The institution can obtain a court order to support the child's decision if verified by the oncologists. Twelve-year-olds can give consent for therapy under certain conditions, including being an emancipated minor and receiving therapy for birth control and sexually transmitted infections. Right to self-determination is also accepted if the child is fully aware of the consequences of the actions. The practitioners cannot take the responsibility for decision making from the parent or child. Parents have the responsibility for decision making, but certain circumstances do limit their authority.

A 10-year-old girl needs to have another intravenous (IV) line started. She keeps telling the nurse, "Wait a minute," and, "I'm not ready." The nurse should recognize that: a. this is normal behavior for a school-age child. b. this behavior is usually not seen past the preschool years. c. the child thinks the nurse is punishing her. d. the child has successfully manipulated the nurse in the past.

ANS: A This school-age child is attempting to maintain control. The nurse should provide the girl with structured choices about when the IV will be inserted.

What test measures the amount of air inhaled and exhaled during any respiratory cycle? a. Tidal volume b. Vital capacity c. Dynamic compliance d. Pulmonary resistance

ANS: A Tidal volume is defined as the amount of air inhaled and exhaled during any respiratory cycle. When it is multiplied by the respiratory rate, the minute volume is obtained. Forced vital capacity is the maximum amount of air that can be expired after maximum inspiration. It is used to monitor individuals with obstructive airway disease. Dynamic compliance is the relationship between the change in volume and pressure difference. Pulmonary resistance measures the changes in pressure with changes in flow on inspiration and expiration.

The nurse is teaching the parents of a 1-month-old infant with developmental dysplasia of the hip about preventing skin breakdown under the Pavlik harness. What statement by the parent would indicate a correct understanding of the teaching? a. "I should gently massage the skin under the straps once a day to stimulate circulation." b. "I will apply a lotion for sensitive skin under the straps after my baby has been given a bath to prevent skin irritation." c. "I should remove the harness several times a day to prevent contractures." d. "I will place the diaper over the harness, preferably using a superabsorbent disposable diaper that is relatively thin."

ANS: A To prevent skin breakdown with an infant who has developmental dysplasia of the hip and is in a Pavlik harness, the parent should gently massage the skin under the straps once a day to stimulate circulation. The parent should not apply lotions or powder because this could irritate the skin. The parent should not remove the harness, except during a bath, and should place the diaper under the straps.

The potential effects of chronic illness or disability on a child's development vary at different ages. What developmental alteration is a threat to a toddler's normal development? a. Hindered mobility b. Limited opportunities for socialization c. Child's sense of guilt that he or she caused the illness or disability d. Limited opportunities for success in mastering toilet training

ANS: A Toddlers are acquiring a sense of autonomy, developing self-control, and forming symbolic representation through language acquisition. Mobility is the primary tool used by toddlers to experiment with maintaining control. Loss of mobility can create a sense of helplessness. Toddlers do not socialize. They are sensitive to changes in family routines. A sense of guilt is more likely to occur in a preschooler. Toilet training is not usually mastered until the end of the toddler period.

Which of the following is an important nursing consideration when caring for a child with herpetic gingivostomatitis (HGS)? a. Apply topical anesthetics before eating. b. Drink from a cup, not a straw. c. Wait to brush teeth until lesions are sufficiently healed. d. Explain to parents how this is sexually transmitted.

ANS: A Treatment for HGS is aimed at relief of pain.

What form of diabetes is characterized by destruction of pancreatic beta cells, resulting in insulin deficiency? a. Type 1 diabetes b. Type 2 diabetes c. Gestational diabetes d. Maturity-onset diabetes of the young (MODY)

ANS: A Type 1 diabetes is characterized by the destruction of the pancreatic beta cells, which leads to absolute insulin deficiency. Type 2 diabetes results usually from insulin resistance. The pancreatic beta cells are not destroyed in gestational diabetes. MODY is an autosomal dominant monogenetic defect in beta cell function that is characterized by impaired insulin secretion with minimum or no defects in insulin action.

The school nurse is informed that a child with human immunodeficiency virus (HIV) infection will be attending school soon. What is an important nursing intervention to include in the plan of care? a. Carefully follow universal precautions. b. Inform the parents of the other children. c. Determine how the child became infected. d. Reassure other children that they will not become infected.

ANS: A Universal precautions are necessary to prevent further transmission of the disease. Informing the parents of the other children would violate the child's right to privacy. It is not within the role of the school nurse to determine how the child became infected. Reassuring other children that they will not become infected violates the child's privacy. General health classes can discuss prevention of HIV transmission.

The school nurse is informed that a child with human immunodeficiency virus (HIV) will be attending school soon. Which is an important nursing intervention? a. Carefully follow universal precautions. b. Determine how the child became infected. c. Inform the parents of the other children. d. Reassure other children that they will not become infected.

ANS: A Universal precautions are necessary to prevent further transmission of the disease. It is not the role of the nurse to determine how the child became infected. Informing the parents of other children and reassuring children that they will not become infected is a violation of the child's right to privacy.

When a child has chronic renal failure, the progressive deterioration produces a variety of clinical and biochemical disturbances that eventually are manifested in the clinical syndrome known as: a. uremia. b. oliguria. c. proteinuria. d. pyelonephritis.

ANS: A Uremia is the retention of nitrogenous products, producing toxic symptoms.

The parent of a child with cystic fibrosis (CF) calls the clinic nurse to report that the child has developed tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The nurse should tell the parent to bring the child to the clinic because these signs and symptoms are suggestive of what condition? a. Pneumothorax b. Bronchodilation c. Carbon dioxide retention d. Increased viscosity of sputum

ANS: A Usually the signs of pneumothorax are nonspecific. Tachypnea, tachycardia, dyspnea, pallor, and cyanosis are significant signs and symptoms and are indicative of respiratory distress caused by pneumothorax. If the bronchial tubes were dilated, the child would have decreased work of breathing and would most likely be asymptomatic. Carbon dioxide retention is a result of the chronic alveolar hypoventilation in CF. Hypoxia replaces carbon dioxide as the drive for respiration progresses. Increased viscosity would result in more difficulty clearing secretions.

Decongestant nose drops are recommended for a 10-month-old infant with an upper respiratory tract infection. Instructions for nose drops should include which information? a. Do not use for more than 3 days. b. Keep drops to use again for nasal congestion. c. Administer drops after feedings and at bedtime. d. Give two drops every 5 minutes until nasal congestion subsides.

ANS: A Vasoconstrictive nose drops such as Neo-Synephrine should not be used for more than 3 days to avoid rebound congestion. Drops should be discarded after one illness and not used for other children because they may become contaminated with bacteria. Drops administered before feedings are more helpful. Two drops are administered to cause vasoconstriction in the anterior mucous membranes. An additional two drops are instilled 5 to 10 minutes later for the posterior mucous membranes. No further doses should be given.

Decongestant nose drops are recommended for a 10-month-old infant with an upper respiratory tract infection. Instructions for nose drops should include which action? a. Avoid using for more than 3 days. b. Keep drops to use again for nasal congestion. c. Administer drops until nasal congestion subsides. d. Administer drops after feedings and at bedtime.

ANS: A Vasoconstrictive nose drops such as phenylephrine (Neo-Synephrine) should not be used for more than 3 days to avoid rebound congestion. Drops should be discarded after one illness because they may become contaminated with bacteria. Vasoconstrictive nose drops can have a rebound effect after 3 days of use. Drops administered before feedings are more helpful.

The nurse notes that the parents of a critically ill child spend a large amount of time talking with the parents of another child who is also seriously ill. They talk with these parents more than with the nurses. How should the nurse interpret this situation? a. Parent-to-parent support is valuable. b. Dependence on other parents in crisis is unhealthy. c. This is occurring because the nurses are unresponsive to the parents. d. This has the potential to increase friction between the parents and nursing staff.

ANS: A Veteran parents share experiences that cannot be supplied by other support systems. They have known the stress related to diagnosis, have weathered the many transition times, and have a practical remembering of resources. The parents can be mutually supportive during times of crisis. Nursing staff cannot provide the type of support that is realized from other parents who are experiencing similar situations. Friction should not exist between the nursing staff and the family of the child who is critically ill.

What statement is correct about young children who report sexual abuse? a. They may exhibit various behavioral manifestations. b. In more than half the cases, the child has fabricated the story. c. Their stories should not be believed unless other evidence is apparent. d. They should be able to retell the story the same way to another person.

ANS: A Victims of sexual abuse have no typical profile. The child may exhibit various behavioral manifestations, none of which is diagnostic for sexual abuse. When children report potentially sexually abusive experiences, their reports need to be taken seriously. Other children in the household also need to be evaluated. In children who are sexually abused, it is often difficult to identify other evidence. In one study, approximately 96% of children who were sexually abused had normal genital and anal findings. The ability to retell the story is partly dependent on the child's cognitive level. Children who repeatedly tell identical stories may have been coached.

What measure is important in managing hypercalcemia in a child who is immobilized? a. Provide adequate hydration. b. Change position frequently. c. Encourage a diet high in calcium. d. Provide a diet high in calories for healing.

ANS: A Vigorous hydration is indicated to prevent problems with hypercalcemia. Suggested intake for an adolescent is 3000 to 4000 ml/day of fluids. Diuretics are used to promote the removal of calcium. Changing position is important for skin and respiratory concerns. Calcium in the diet is restricted when possible. A high-protein diet served as frequent snacks with favored foods is recommended. A high-calorie diet without adequate protein will not promote healing.

Recent studies indicate that a deficiency of which of the following vitamins correlates with increased morbidity and mortality in children with measles? a. A b. C c. Niacin d. Folic acid

ANS: A Vitamin A deficiency is correlated with increased morbidity and mortality in children with measles. This vitamin deficiency also is associated with complications from diarrhea, and infections are often increased in infants and children with vitamin A deficiency.

A 4-month-old with significant head lag meets the criteria for floppy infant syndrome. A diagnosis of progressive infantile spinal muscular atrophy (Werdnig-Hoffmann disease) is made. What should be included in the nursing care for this child? a. Infant stimulation program b. Stretching exercises to decrease contractures c. Limited physical contact to minimize seizures d. Encouraging parents to have additional children

ANS: A Werdnig-Hoffmann disease (spinal muscular atrophy type 1) is the most common paralytic form of floppy infant syndrome (congenital hypotonia). An infant stimulation program is essential. Frequent position changes, including changes in environment, provide the child with more physical contacts. Verbal, tactile, and auditory stimulation are also included. Contractures do not occur because of muscular atrophy. Sensation is normal in children with this disorder. Frequent touch is necessary as part of the stimulation. Werdnig-Hoffmann disease is inherited as an autosomal recessive trait. Parents should be referred for genetic counseling.

What is important to incorporate in the plan of care for a child who is experiencing a seizure? a. Describe and record the seizure activity observed. b. Suction the child during a seizure to prevent aspiration. c. Place a tongue blade between the teeth if they become clenched. d. Restrain the child when seizures occur to prevent bodily harm.

ANS: A When a child is having a seizure, the priority nursing care is observation of the child and seizure. The nurse then describes and records the seizure activity. The child is not suctioned during the seizure. If possible, the child should be placed on the side, facilitating drainage to prevent aspiration.

An important nursing intervention when caring for a child who is experiencing a seizure would be to: a. describe and record the seizure activity observed. b. restrain the child when seizure occurs to prevent bodily harm. c. place a tongue blade between the teeth if they become clenched. d. suction the child during a seizure to prevent aspiration.

ANS: A When a child is having a seizure, the priority nursing care is observation of the child and seizure. The nurse then describes and records the seizure activity. The child should not be restrained, and nothing should be placed in the child's mouth. This may cause injury. To prevent aspiration, if possible, the child should be placed on the side, facilitating drainage.

What nursing intervention is most appropriate when providing comfort and support for a child when death is imminent? a. Limit care to essentials. b. Avoid playing music near the child. c. Whisper to the child instead of using a normal voice. d. Explain to the child the need for constant measurement of vital signs.

ANS: A When death is imminent, care should be limited to interventions for palliative care. Music may be used to provide comfort to the child. The nurse should speak to the child in a clear, distinct voice. Vital signs do not need to be measured frequently.

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

ANS: A When gloves are worn, the hands are washed thoroughly after removing the gloves because both latex and vinyl gloves fail to provide complete protection.

After surgery yesterday for gastroesophageal reflux, the nurse finds that the infant has somehow removed the nasogastric (NG) tube. What nursing action is most appropriate to perform at this time? a. Notify the practitioner. b. Insert the NG tube so feedings can be given. c. Replace the NG tube to maintain gastric decompression. d. Leave the NG tube out because it has probably been in long enough.

ANS: A When surgery is performed on the upper gastrointestinal tract, usually the surgical team replaces the NG tube because of potential injury to the operative site. The decision to replace the tube or leave it out is made by the surgical team. Replacing the tube is also usually done by the practitioner because of the surgical site.

The nurse is caring for an adolescent brought to the hospital with acute drug toxicity. Cocaine is believed to be the drug involved. Data collection should include which of the following? a. Mode of administration b. Drug's actual content c. Function the drug plays in the adolescent's life d. Adolescent's level of interest in rehabilitation

ANS: A When the drug is questionable or unknown, every effort must be made to determine the type, amount of drug taken, the mode and time of administration, and factors relating to the onset of presenting symptoms.

Lactose intolerance is diagnosed in a 14-month-old child. Which of the following should the nurse recommend as a substitute for milk? a. Yogurt b. Ice cream c. Fortified cereal d. Cow's milk formula

ANS: A Yogurt contains the inactive lactase enzyme, which is activated by the temperature and pH of the duodenum. This lactase activity substitutes for the lack of endogenous lactase.

Teasing can be common during the school-age years. The nurse should recognize that which of the following applies to teasing? a. Can have a lasting effect on children b. Is not a significant threat to self-concept c. Is rarely based on anything that is concrete d. Is usually ignored by the child who is being teased

ANS: A Teasing in this age-group is common and can have a long-lasting effect.

The nurse is caring for an infant with developmental dysplasia of the hip. Which clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Positive Ortolani click b. Unequal gluteal folds c. Negative Babinski sign d. Trendelenburg sign e. Telescoping of the affected limb f. Lordosis

ANS: A, B A positive Ortolani test and unequal gluteal folds are clinical manifestations of developmental dysplasia of the hip seen from birth to 2 to 3 months. Unequal gluteal folds, negative Babinski sign, and Trendelenburg sign are signs that appear in older infants and children. Telescoping of the affected limb and lordosis are not clinical manifestations of developmental dysplasia of the hip.

An adolescent with juvenile idiopathic arthritis (JIA) is prescribed abatacept (Orencia). Which should the nurse teach the adolescent regarding this medication? (Select all that apply.) a. Avoid receiving live immunizations while taking the medication. b. Before beginning this medication, a tuberculin screening test will be done. c. You will be getting a twice-a-day dose of this medication. d. This medication is taken orally.

ANS: A, B Abatacept reduces inflammation by inhibiting T cells and is given intravenously every 4 weeks. Possible side effects of biologics include an increased infection risk. Because of the infection risk, children should be evaluated for tuberculosis exposure before starting these medications. Live vaccines should be avoided while taking these agents.

A school-age child is diagnosed with systemic lupus erythematosus (SLE). The nurse should plan to implement which interventions for this child? (Select all that apply.) a. Instructions to avoid exposure to sunlight b. Teaching about body changes associated with SLE c. Preparation for home schooling d. Restricted activity

ANS: A, B Key issues for a child with SLE include therapy compliance; body-image problems associated with rash, hair loss, and steroid therapy; school attendance; vocational activities; social relationships; sexual activity; and pregnancy. Specific instructions for avoiding exposure to the sun and UVB light, such as using sunscreens, wearing sun-resistant clothing, and altering outdoor activities, must be provided with great sensitivity to ensure compliance while minimizing the associated feeling of being different from peers. The child should continue school attendance in order to gain interaction with peers and activity should not be restricted, but promoted.

The nurse is evaluating the laboratory results on cerebral spinal fluid (CSF) from a 3-year-old child with bacterial meningitis. Which findings confirm bacterial meningitis? (Select all that apply.) a. Elevated white blood cell (WBC) count b. Decreased glucose c. Normal protein d. Elevated red blood cell (RBC) count

ANS: A, B The cerebrospinal fluid analysis in bacterial meningitis shows elevated WBC count, decreased glucose, and increased protein content. There should not be RBCs evident in the CSF fluid.

What functional goal should the nurse expect for a child who has a T1 to T10 spinal cord injury? (Select all that apply.) a. May be braced for standing b. Able to drive automobile with hand controls c. Can manage adapted public transportation d. Some able to use regular public transportation e. Ambulates well, often with short leg braces with or without cane

ANS: A, B, C A child with a T1 to T10 spinal cord injury may be braced for standing, is able to drive an automobile with hand controls, and can manage adapted public transportation. The ability to use regular public transportation and ambulation with bilateral long braces using four-point or swing-through crutch gait are functional goals for individuals with a T10 to L2 injury.

The nurse is teaching the family with a child with cerebral palsy (CP) strategies to prevent constipation. What should the nurse include in the teaching session? (Select all that apply.) a. Increase fluid intake. b. Increase fiber in the diet. c. Administer stool softeners daily as prescribed. d. Increase the amount of dairy products in the diet. e. Allow the child to decide when to try to have a bowel movement.

ANS: A, B, C A variety of factors, including decreased mobility, decreased fluid intake, a fear of toileting, poor positioning on the toilet, and lack of fiber intake may be responsible for constipation for a child with CP. Stool softeners, laxatives, and a bowel management program may be required to prevent chronic constipation. The child should be placed on the toilet or encouraged to have a bowel movement at the same time each day. Dairy products can cause constipation.

The nurse is preparing to admit a 10-year-old child with appendicitis. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Fever b. Vomiting c. Tachycardia d. Flushed face e. Hyperactive bowel sounds

ANS: A, B, C Clinical manifestations of appendicitis include fever, vomiting, and tachycardia. Pallor is seen, not a flushed face, and the bowel sounds are hypoactive or absent, not hyperactive.

The nurse is preparing to assist with a growth hormone provocative test for a child with short stature. The nurse recognizes that which pharmacologics should be used to provoke the release of growth hormone (GH)? (Select all that apply.) a. Larodopa (levodopa) b. Clonidine (Catapres) c. Propranolol (Inderal) d. Cortisone (hydrocortisone) e. Biosynthetic growth hormone

ANS: A, B, C GH stimulation, or provocative testing, involves the use of pharmacologics to provoke the release of GH either directly or indirectly. Provocative testing involves the use of neuromodulators such as levodopa or agents such as clonidine, arginine, insulin, propranolol, or glucagon followed by the measurement GH blood levels. Cortisone is given to replace hormone deficiencies that can occur with GH deficiency. Biosynthetic GH is used to treat GH deficiency.

A parent asks the nurse about the "characteristics of a nightmare." What response should the nurse give to the parent? (Select all that apply.) a. Nightmares are scary dreams. b. The child can describe the nightmare. c. The child is reassured by your presence. d. Nightmares occur usually 1 to 4 hours after falling asleep. e. Nightmares take place during non-rapid eye movement sleep

ANS: A, B, C Nightmares are scary dreams, the child can describe the nightmare, and the child is reassured by a parent's presence. Sleep terrors occur usually 1 to 4 hours after falling asleep, but nightmares occur in the second half of sleep. Sleep terrors occur during non-rapid eye movement sleep, but nightmares occur during rapid eye movement sleep.

The nurse is caring for a child after cardiac surgery. What interventions should the nurse implement with regard to chest tubes placed to a water-seal drainage system? (Select all that apply.) a. Maintain sterility. b. Check for tube patency. c. Do not interrupt the water-seal drainage system. d. Clamp the chest tube when ambulating the child. e. Measure the drainage by emptying the collection chamber every shift.

ANS: A, B, C Nursing considerations with regard to chest tubes attached to a water-seal drainage system include (1) do not interrupt water-seal drainage unless the chest tube is clamped, (2) check for tube patency (fluctuation in the water-seal chamber), and (3) maintain sterility. The chest tube should not be clamped when ambulating the child and the drainage is measured in the collection chamber, not emptied.

The clinic nurse is teaching parents about when to call the office immediately for a child with a fever. What should the nurse include in the teaching session? (Select all that apply.) a. The child has a stiff neck. b. The fever is over 40.6° C (105° F). c. The child is younger than 2 months. d. The fever has lasted for more than 3 days. e. The fever went away for more than 24 hours and then returned.

ANS: A, B, C Parents should call the office immediately if a child has a fever over 40.6° C (105° F), the child is younger than 2 months, or the child has a stiff neck. Parents are to call within 24 hours if the fever went away for more than 24 hours and then returned or the fever has lasted for more than 3 days.

An adolescent is being placed on a beta-blocker. What should the nurse inform the adolescent with regard to this medication? (Select all that apply.) a. Medication may cause fatigue. b. Side effects may include impotence. c. Side effects may include bradycardia. d. Take the medication 1 hour before meals. e. Side effects may include peripheral edema.

ANS: A, B, C The adolescent should be instructed that the medication may cause fatigue, impotence, and bradycardia. The medications should be taken with meals and side effects do not include peripheral edema.

What are the advantages of an implanted port (Port-a-Cath)? (Select all that apply.) a. Reduced risk of infection b. Reduced cost for the family c. Placed completely under the skin d. Easy to use for self-administered infusions e. Removal does not require a surgical procedure

ANS: A, B, C The advantages of an implanted port include reduced risk of infection, reduced cost for the family, and placed completely under the skin. Because it is implanted and must be accessed, it is not easy to use for self-administered infusions, and removal does require a surgical procedure.

The nurse is preparing to admit a 5-year-old with an epidural hemorrhage. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Headache b. Vomiting c. Irritability d. Cephalhematoma e. Pallor with anemia

ANS: A, B, C The classic clinical picture of an epidural hemorrhage is a lucid interval (momentary unconsciousness) followed by a normal period for several hours, and then lethargy or coma due to blood accumulation in the epidural space and compression of the brain. The child may be seen with varying degrees of impaired consciousness depending on the severity of the traumatic injury. Common symptoms in a child with no neurologic deficit are irritability, headache, and vomiting. In infants younger than 1 year of age, the most common symptoms are irritability, pallor with anemia, and cephalhematoma.

The nurse is preparing to admit a 4-year-old child with chronic benign neutropenia. What clinical features of chronic benign neutropenia should the nurse recognize? (Select all that apply.) a. Gingivitis is present. b. Anemia is not present. c. Monocytosis is present. d. It has an autosomal recessive pattern. e. Treatment is by bone marrow transplantation.

ANS: A, B, C The clinical features of chronic benign neutropenia include gingivitis, no anemia, and monocytosis. It is not inherited, and because it is benign, it does not require treatment except antibiotics as indicated.

The nurse in the neonatal intensive care unit is caring for an infant with myelomeningocele scheduled for surgical repair in the morning. Which early signs of infection should the nurse monitor on this infant? (Select all that apply.) a. Temperature instability b. Irritability c. Lethargy d. Bradycardia e. Hypertension

ANS: A, B, C The nurse should observe an infant with unrepaired myelomeningocele for early signs of infection, such as temperature instability (axillary), irritability, and lethargy. Bradycardia and hypertension are not early signs of infection in infants.

In what condition should the nurse be alert for altered fluid requirements in children? (Select all that apply.) a. Oliguric renal failure b. Increased intracranial pressure c. Mechanical ventilation d. Compensated hypotension e. Tetralogy of Fallot f. Type 1 diabetes mellitus

ANS: A, B, C The nurse should recognize that conditions such as oliguric renal failure, increased intracranial pressure, and mechanical ventilation can cause an increase or a decrease in fluid requirements. Conditions such as hypotension, tetralogy of Fallot, and diabetes mellitus (type 1) do not cause an alteration in fluid requirements.

The nurse is preparing a presentation on compensated, decompensated, and irreversible shock in children. What clinical manifestations related to decompensated shock should the nurse include? (Select all that apply.) a. Tachypnea b. Oliguria c. Confusion d. Pale extremities e. Hypotension f. Thready pulse

ANS: A, B, C, D As shock progresses, perfusion in the microcirculation becomes marginal despite compensatory adjustments, and the signs are more obvious. Signs include tachypnea, oliguria, confusion, and pale extremities, as well as decreased skin turgor and poor capillary filling. Hypotension and a thready pulse are clinical manifestations of irreversible shock.

The nurse is preparing to admit a 2-year-old child with spina bifida occulta. What clinical manifestations of spina bifida occulta should the nurse expect to observe? (Select all that apply.) a. Dark tufts of hair b. Skin depression or dimple c. Port-wine angiomatous nevi d. Soft, subcutaneous lipomas e. Bladder and sphincter paralysis

ANS: A, B, C, D Clinical manifestations of spina bifida occulta include dark tufts of hair; skin depression or dimple; port-wine angiomatous nevi; and soft, subcutaneous lipomas. Bladder and sphincter paralysis are present with spina bifida cystica but not occulta.

The nurse is teaching coping strategies to parents of a child with a chronic illness. What coping strategies should the nurse include? (Select all that apply.) a. Listen to the child. b. Accept the child's illness. c. Establish a support system. d. Learn to care for the child's illness one day at a time. e. Do not share information with the child about the illness.

ANS: A, B, C, D Coping strategies for parents caring for a child with a chronic illness include listening to the child, accepting the child's illness, establishing a support system, and learning to care for the child's illness one day at a time. Information should be shared with the child about the illness.

The nurse is caring for a child with neurofibromatosis. What local manifestations does the nurse expect to assess in this child? (Select all that apply.) a. Pigmented nevi b. Axillary freckling c. Café-au-lait spots d. Slowly growing cutaneous neurofibromas e. Wheals that spread irregularly and fade within a few hours

ANS: A, B, C, D Local manifestations of neurofibromatosis include pigmented nevi, axillary freckling, café-au-lait spots, and slowly growing cutaneous neurofibromas. Wheals that spread irregularly and fade within a few hours are characteristic of urticaria.

What are some of the associated disabilities seen with cerebral palsy? (Select all that apply.) a. Visual impairment b. Hearing impairment c. Speech difficulties d. Intellectual impairment e. Associated heart defects

ANS: A, B, C, D Some of the disabilities associated with CP are visual impairment, hearing impairment, behavioral problems, communication and speech difficulties, seizures, and intellectual impairment. Additional sensory deficits such as hypersensitivity, hyposensitivity, and balance difficulties may occur in children with CP.

The school nurse is teaching a group of adolescents about avoiding contaminated water during a mission trip. What should the nurse include in the teaching? (Select all that apply.) a. Ice b. Meats c. Raw vegetables d. Unpeeled fruits e. Carbonated beverages

ANS: A, B, C, D The best measure during travel to areas where water may be contaminated is to allow children to drink only bottled water and carbonated beverages (from the container through a straw supplied from home). Children should also avoid tap water, ice, unpasteurized dairy products, raw vegetables, unpeeled fruits, meats, and seafood.

The nurse is caring for a 12-year-old child with -thalassemia. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Anorexia b. Unexplained fever c. Enlarged spleen or liver d. Bronzed, freckled complexion e. Precocious sexual development

ANS: A, B, C, D The clinical manifestations of -thalassemia include anorexia; unexplained fever; an enlarged spleen or liver; and a bronzed, freckled complexion. There is delayed sexual maturation, not precocious.

The nurse is conducting preoperative teaching to parents and their child about an external fixation device. What should the nurse include in the teaching session? (Select all that apply.) a. Pin care b. Crutch walking c. Modifications in activity d. Observing pin sites for infection e. Full weight bearing will be allowed after 24 hours

ANS: A, B, C, D The device is attached surgically by securing a series of external full or half rings to the bone with wires. Children and parents should be instructed in pin care, including observation for infection and loosening of pins. Partial weight bearing is allowed, and the child needs to learn to walk with crutches. Alterations in activity include modifications at school and in physical education. Full weight bearing is not allowed until the distraction is completed and bone consolidation has occurred.

The nurse recognizes that oxygen mist tents are rarely used for a child with respiratory distress. What are reasons for not using an oxygen mist tent? (Select all that apply.) a. Poor access to the child b. Cool and wet tent environment c. Oxygen levels fall when tent is entered d. Child may not tolerate it around the crib/bed e. Lower oxygen concentrations cannot be achieved

ANS: A, B, C, D The disadvantages of using a mist tent include poor access to the child, a cool and wet tent environment, oxygen levels fall when the tent is entered, and the child may not tolerate it around the crib or bed. Lower oxygen concentrations can be achieved in the tent and is an advantage.

What are supportive interventions that can assist a preschooler with a chronic illness to meet developmental milestones? (Select all that apply.) a. Encourage socialization. b. Encourage mastery of self-help skills. c. Provide devices that make tasks easier. d. Clarify that the cause of the child's illness is not his or her fault. e. Discuss planning for the future and how the condition can affect choices.

ANS: A, B, C, D To encourage initiative, mastery of self-help skills should be encouraged, and devices should be provided that make tasks easier. To develop peer relationships, socialization should be encouraged. To develop body image, the fact that the cause of the child's illness is not the fault of the child should be emphasized. Discussing planning for the future and how the condition can affect choices is appropriate for an adolescent.

What methods should the nurse use to measure compliance to a treatment plan? (Select all that apply.) a. Pill counts b. Chemical assays c. Direct observation d. Third-party reporting e. Monitoring therapeutic response

ANS: A, B, C, E Assessment of compliance must include direct measurement techniques. Pill counts, chemical assays, direct observation, and monitoring therapeutic response are direct measurement techniques. Third-party reporting would not always be available and would not be a method to measure compliance.

The nurse is assessing coping behaviors of a family with a child with a chronic illness. What indicates avoidance coping behaviors? (Select all that apply.) a. Refuses to agree to treatment b. Avoids staff, family members, or child c. Is unable to discuss possible loss of the child d. Recognizes own growth through a passage of time e. Makes no change in lifestyle to meet the needs of other family members

ANS: A, B, C, E Avoidance coping behaviors include refusing to agree to treatment; avoiding staff, family members, or child; unable to discuss possible loss of the child; and making no change in lifestyle to meet the needs of other family members. Recognizing one's own growth through a passage of time is an approach behavior.

The nurse is preparing to admit a neonate with bacterial meningitis. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Jaundice b. Cyanosis c. Poor tone d. Nuchal rigidity e. Poor sucking ability

ANS: A, B, C, E Clinical manifestations of bacterial meningitis in a neonate include jaundice, cyanosis, poor tone, and poor sucking ability. The neck is usually supple in neonates with meningitis, and there is no nuchal rigidity.

The nurse is preparing to admit an adolescent with bacterial meningitis. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Fever b. Chills c. Headache d. Poor tone e. Drowsiness

ANS: A, B, C, E Clinical manifestations of bacterial meningitis in an adolescent include, fever, chills, headache, and drowsiness. Hyperactivity is present, not poor tone.

The nurse is preparing to admit a 6-month-old infant with increased intracranial pressure (ICP). What clinical manifestations should the nurse expect to observe in this infant? (Select all that apply.) a. High-pitched cry b. Poor feeding c. Setting-sun sign d. Sunken fontanel e. Distended scalp veins f. Decreased head circumference

ANS: A, B, C, E Clinical manifestations of increased ICP in an infant include a high-pitched cry, poor feeding, setting-sun sign, and distended scalp veins. The infant would have a tense, bulging fontanel and an increased head circumference.

What interventions should the nurse implement to prevent a pressure ulcer in a critically ill child? (Select all that apply.) a. Nutrition consults b. Using skin moisturizers c. Turning the child every 2 hours d. Using plastic disposable underpads e. Using draw sheets to minimize shear

ANS: A, B, C, E Interventions found to prevent pressure ulcers in critically ill children include nutrition consults, using skin moisturizers, turning the child every 2 hours, and using draw sheets to minimize shear. Dryweave underpads, not underpads with plastic, should be used to reduce moisture

What play activities should the nurse implement to encourage fluid intake for a child? (Select all that apply.) a. Have a tea party. b. Use a crazy straw. c. Cut gelatin into fun shapes. d. Place liquid in large Styrofoam cups. e. Make ice pops using the child's favorite juice.

ANS: A, B, C, E Play activities to encourage fluid intake for a child include tea parties, crazy straws, cutting gelatin into fun shapes, and making ice pops using the child's favorite juice. Small cups, not large Styrofoam cups, should be used.

The nurse is administering a unit of blood to a child. What are signs and symptoms of a transfusion reaction? (Select all that apply.) a. Chills b. Shaking c. Flank pain d. Hypothermia e. Sudden severe headache

ANS: A, B, C, E Signs and symptoms of a transfusion reaction include chills, shaking, flank pain, and sudden severe headache. Hyperthermia, not hypothermia, occurs.

The nurse relates to parents that there are some beneficial effects of hospitalization for their child. What are beneficial effects of hospitalization? (Select all that apply.) a. Recovery from illness b. Improve coping abilities c. Opportunity to master stress d. Provide a break from school e. Provide new socialization experiences

ANS: A, B, C, E The most obvious benefit is the recovery from illness, but hospitalization also can present an opportunity for children to master stress and feel competent in their coping abilities. The hospital environment can provide children with new socialization experiences that can broaden their interpersonal relationships. Having a break from school is not a benefit of hospitalization.

What interventions can the nurse teach parents to do to ease respiratory efforts for a child with a mild respiratory tract infection? (Select all that apply.) a. Cool mist b. Warm mist c. Steam vaporizer d. Keep child in a flat, quiet position e. Run a shower of hot water to produce steam

ANS: A, B, C, E Warm or cool mist is a common therapeutic measure for symptomatic relief of respiratory discomfort. The moisture soothes inflamed membranes and is beneficial when there is hoarseness or laryngeal involvement. A time-honored method of producing steam is the shower. Running a shower of hot water into the empty bathtub or open shower stall with the bathroom door closed produces a quick source of steam. Keeping a child in this environment for 10 to 15 minutes may help ease respiratory efforts. A small child can sit on the lap of a parent or other adult. The child should be quiet but upright, not flat. The use of steam vaporizers in the home is often discouraged because of the hazards related to their use and limited evidence to support their efficacy.

The nurse is caring for a child with acute renal failure. What laboratory findings should the nurse expect to find? (Select all that apply.) a. Hyponatremia b. Hyperkalemia c. Metabolic alkalosis d. Elevated blood urea nitrogen level e. Decreased plasma creatinine level

ANS: A, B, D A child with acute renal failure would have hyponatremia, hyperkalemia, and elevated blood urea nitrogen levels. The child would have metabolic acidosis, not alkalosis, and the plasma creatinine levels would be increased, not decreased.

The nurse is assessing coping behaviors of a family with a child with a chronic illness. What indicates approach coping behaviors? (Select all that apply.) a. Plans realistically for the future b. Verbalizes possible loss of the child c. Uses magical thinking and fantasy d. Realistically perceives the child's condition e. Does not share the burden of the disorder with others

ANS: A, B, D Approach coping behaviors include planning realistically for the future, verbalizing possible loss of a child, and realistically perceiving the child's behavior. Using magical thinking and fantasy is an avoidance behavior. The family should share the burden of the disorder with others as an approach behavior.

The nurse is planning to admit an 8-year-old child with hypoparathyroidism. What clinical manifestations should the nurse expect to observe in this child? (Select all that apply.) a. Muscle cramps b. Positive Chvostek sign c. Emotional lability d. Laryngeal spasms e. Short attention span

ANS: A, B, D Clinical manifestations of hypoparathyroidism include muscle cramps, positive Chvostek sign, and laryngeal spasms. Emotional lability and short attention span are signs of Graves disease.

The nurse is conducting discharge teaching to parents of a preschool child with myelomeningocele, repaired at birth, being discharged from the hospital after a urinary tract infection (UTI). Which should the nurse include in the discharge instructions related to management of the child's genitourinary function? (Select all that apply.) a. Continue to perform the clean intermittent catheterizations (CIC) at home. b. Administer the oxybutynin chloride (Ditropan) as prescribed. c. Reduce fluid intake in the afternoon and evening hours. d. Monitor for signs of a recurrent urinary tract infection. e. Administer furosemide (Lasix) as prescribed.

ANS: A, B, D Discharge teaching to prevent renal complications in a child with myelomeningocele include: (1) regular urologic care with prompt and vigorous treatment of infections; (2) a method of regular emptying of the bladder, such as clean intermittent catheterization (CIC) taught to and performed by parents and self-catheterization taught to children; (3) medications to improve bladder storage and continence, such as oxybutynin chloride (Ditropan) and tolterodine (Detrol). Fluids should not be limited and Lasix is not used to improve renal function for children with myelomeningocele.

The nurse is teaching a school-age child about factors that can delay wound healing. What factors should the nurse include in the teaching session? (Select all that apply.) a. Deficient vitamin C b. Deficient vitamin D c. Increased circulation d. Dry wound environment e. Increase in white blood cells

ANS: A, B, D Factors that delay wound healing are a dry wound environment (allows epithelial cells to dry), deficient vitamin C (inhibits formation of collagen fibers), and deficient vitamin D (regulates growth and differentiation of cell types). Decreased, not increased, circulation delays healing. An increase in the white blood cell count may occur but does not delay healing.

The nurse is caring for a child with secondary hypertension. What renal disorders are associated with secondary hypertension? (Select all that apply.) a. Renal tumor b. Hydronephrosis c. Vesicoureteral reflux d. Glomerulonephritis e. Urinary tract infection

ANS: A, B, D Renal disorders that can cause secondary hypertension include a renal tumor, hydronephrosis, and glomerulonephritis. Vesicoureteral reflux or urinary tract infections do not cause secondary hypertension.

The nurse is planning to admit a 12-year-old with Graves disease (GD). What clinical manifestations should the nurse expect to observe in this child? (Select all that apply.) a. Insomnia b. Irritability c. Tonic rigidity d. Hyperactivity e. Muscle cramps

ANS: A, B, D Signs and symptoms of hyperthyroidism develop gradually, with an interval between onset and diagnosis of approximately 6 to 12 months. Clinical features include irritability, hyperactivity, short attention span, tremors, insomnia, and emotional lability. Tonic rigidity and muscle cramps are signs of hypoparathyroidism.

The school nurse is assessing a child's severely scraped knee for infection. What are signs of a wound infection? (Select all that apply.) a. Odor b. Edema c. Dry scab d. Purulent exudate e. Decreased temperature

ANS: A, B, D Signs of wound infection are odor, edema, and purulent exudate. Increased, not decreased, temperature indicates infection. A dry scab over the wound is part of the healing process.

The nurse is preparing to admit an adolescent with encephalitis. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Malaise b. Apathy c. Lethargy d. Hypoactivity e. Hypothermia

ANS: A, B, D The clinical manifestations of encephalitis include malaise, apathy, and lethargy. There is hyperactivity, not hypoactivity, and hyperthermia, not hypothermia.

The clinic nurse is administering influenza vaccinations. Which children should not receive the live attenuated influenza vaccine (LAIV)? (Select all that apply.) a. A child with asthma b. A child with diabetes c. A child with hemophilia A d. A child with cancer receiving chemotherapy e. A child with gastroesophageal reflux disease

ANS: A, B, D The live attenuated influenza vaccine (LAIV) is an acceptable alternative to the IM vaccine (IIV) for ages 2 to 49 years. It is a live vaccine administered via nasal spray. Several groups are excluded from receiving it, including children with a chronic heart or lung disease (asthma or reactive airways disease), diabetes, or kidney failure; children who are immunocompromised or receiving immunosuppressants; children younger than 5 years of age with a history of recurrent wheezing; children receiving aspirin; patients who are pregnant; children who have a severe allergy to chicken eggs or who are allergic to any of the nasal spray vaccine components; or children with a history of Guillain-Barré Syndrome after a previous dose. A child with hemophilia A or gastroesophageal reflux disease would not be immunocompromised so they can receive the LAIV.

What are supportive interventions that can assist an infant with a chronic illness to meet developmental milestones? (Select all that apply.) a. Encourage consistent caregivers. b. Encourage periodic respite from demands of care. c. Encourage one family member to be the primary caretaker. d. Encourage parental "rooming in" during hospitalization. e. Withhold age-appropriate developmental tasks until the child is older.

ANS: A, B, D To develop trust, consistent caretakers and parents "rooming in" should be encouraged. To develop a sense of separateness from parents, periodic respites from caregiving should be encouraged. All members of the family, not one primary caretaker, should be encouraged to participate in care. Age-appropriate developmental tasks should be encouraged, not withheld until an older age.

The nurse is caring for an intubated child on mechanical ventilation. What interventions should the nurse implement to prevent ventilator-assisted pneumonia (VAP)? (Select all that apply.) a. Routine oral hygiene b. Appropriate hand hygiene c. Limit oropharyngeal suctioning of secretions d. Elevating the head of the bed 30 to 45 degrees e. Wearing gloves to handle respiratory secretions

ANS: A, B, D, E Critically ill children on mechanical ventilation are at risk for acquisition of VAP. To prevent VAP, recommendations for nurses working with mechanically ventilated patients include appropriate hand hygiene measures; wearing gloves to handle respiratory secretions or contaminated objects; elevating the head of the bed 30 to 45 degrees; and routine oral hygiene, which includes oropharyngeal suctioning of secretions.

What signs and symptoms are indicative of a urinary tract disorder in the infancy period (1-24 months)? (Select all that apply.) a. Pallor b. Poor feeding c. Hypothermia d. Excessive thirst e. Frequent urination

ANS: A, B, D, E Signs and symptoms of a urinary tract disorder in the infancy period are pallor, poor feeding, excessive thirst, and frequent urination. Hyperthermia is seen, not hypothermia.

The nurse is assisting with application of a synthetic cast on a child with a fractured humerus. What are the advantages of a synthetic cast over a plaster of Paris cast? (Select all that apply.) a. Less bulky b. Drying time is faster c. Molds readily to body part d. Permits regular clothing to be worn e. Can be cleaned with small amount of soap and water

ANS: A, B, D, E The advantages of synthetic casts over plaster of Paris casts are that they are less bulky, dry faster, permit regular clothes to be worn, and can be cleaned. Plaster of Paris casts mold readily to a body part, but synthetic casts do not mold easily to body parts.

The nurse is preparing to admit a 2-year-old child with rubella (German measles). Which clinical manifestations of rubella should the nurse expect to observe? (Select all that apply.) a. Sore throat b. Conjunctivitis c. Koplik spots d. Lymphadenopathy e. Discrete, pinkish red maculopapular exanthema

ANS: A, B, D, E The clinical manifestations of rubella include a sore throat; conjunctivitis; lymphadenopathy; and a discrete, pinkish red maculopapular exanthema. Koplik spots occur in measles but not rubella.

What are indications for a referral regarding a communication impairment in a school-age child? (Select all that apply.) a. Barely audible voice quality b. Vocal pitch inappropriate for age c. Intonation noted during speaking d. Maintains a rhythm while speaking e. Distortion of sounds after age 7 years

ANS: A, B, E Barely audible voice quality, vocal pitch inappropriate for age, and distortion of sounds after age 7 years are indications for a referral regarding a communication impairment. Intonation noted while speaking and maintaining a rhythm while speaking are normal characteristics of speech.

The nurse is preparing to admit a 6-year-old child with irritable bowel syndrome (IBS). What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Flatulence b. Constipation c. No urge to defecate d. Absence of abdominal pain e. Feeling of incomplete evacuation of the bowel

ANS: A, B, E Children with IBS often have alternating diarrhea and constipation, flatulence, bloating or a feeling of abdominal distention, lower abdominal pain, a feeling of urgency when needing to defecate, and a feeling of incomplete evacuation of the bowel.

The nurse is preparing to admit a 7-year-old child with ataxic cerebral palsy. What clinical manifestations of ataxic cerebral palsy should the nurse expect to observe? (Select all that apply.) a. Wide-based gait b. Rapid, repetitive movements performed poorly c. Slow, twisting movements of the trunk or extremities d. Hypertonicity with poor control of posture, balance, and coordinated motion e. Disintegration of movements of the upper extremities when the child reaches for objects

ANS: A, B, E Clinical manifestations of ataxic cerebral palsy include a wide-based gait; rapid, repetitive movements performed poorly; and disintegration of movements of the upper extremities when the child reaches for objects. Slow, twisting movements of the trunk are seen with dyskinetic cerebral palsy, and hypertonicity with poor control of posture, balance, and coordinated motion are seen with spastic cerebral palsy.

Which assessment findings should the nurse note in a school-age child with Duchenne muscular dystrophy (DMD)? (Select all that apply.) a. Lordosis b. Gower sign c. Kyphosis d. Scoliosis e. Waddling gait

ANS: A, B, E Difficulties in running, riding a bicycle, and climbing stairs are usually the first symptoms noted in Duchenne muscular dystrophy. Typically, affected boys have a waddling gait and lordosis, fall frequently, and develop a characteristic manner of rising from a squatting or sitting position on the floor (Gower sign). Lordosis occurs as a result of weakened pelvic muscles, and the waddling gait is a result of weakness in the gluteus medius and maximus muscles. Kyphosis and scoliosis are not assessment findings with DMD.

2. The nurse is caring for a child with a urinary tract infection who is on intravenous gentamicin (Garamycin). What interventions should the nurse plan for this child with regard to this medication? (Select all that apply.) a. Encourage fluids. b. Monitor urinary output. c. Monitor sodium serum levels. d. Monitor potassium serum levels. e. Monitor serum peak and trough levels.

ANS: A, B, E Garamycin can cause renal toxicity and ototoxicity. Fluids should be encouraged and urinary output and serum peak and trough levels monitored. It is not necessary to monitor potassium sodium levels for patients taking this medication.

What disease processes require airborne precautions? (Select all that apply.) a. Measles b. Varicella c. Pertussis d. Meningitis e. Tuberculosis

ANS: A, B, E In addition to Standard Precautions, use airborne precautions for patients known or suspected to have serious illnesses transmitted by airborne droplet nuclei. Examples of such illnesses include measles, varicella (including disseminated zoster), and tuberculosis. Pertussis and meningitis require droplet precautions.

What disease processes require contact isolation? (Select all that apply.) a. Rotavirus b. Hepatitis A c. Streptococcal pharyngitis d. Mycoplasmal pneumonia e. Respiratory syncytial virus

ANS: A, B, E In addition to Standard Precautions, use contact precautions for patients known or suspected to have serious illnesses easily transmitted by direct patient contact or by contact with items in the patient's environment. Examples of such illnesses include rotavirus, hepatitis A, and respiratory syncytial virus. Streptococcal pharyngitis and mycoplasmal pneumonia require droplet precautions.

What are symptoms of abusive head trauma (AHT) in the more severe form that may be present? (Select all that apply.) a. Seizures b. Posturing c. Tachypnea d. Tachycardia e. Altered level of consciousness

ANS: A, B, E In more severe forms, presenting symptoms of abusive head trauma may include seizures, posturing, alterations in level of consciousness, apnea, bradycardia, or death.

The nurse is caring for a child with a urinary tract infection who is on trimethoprim-sulfamethoxazole (Bactrim). What side effects of this medication should the nurse teach to the parents and the child? (Select all that apply.) a. Rash b. Urticaria c. Pneumonitis d. Renal toxicity e. Photosensitivity

ANS: A, B, E Side effects of Bactrim are rash, urticaria, and photosensitivity. Pneumonitis and renal toxicity are not side effects of Bactrim.

What are signs and symptoms of anemia? (Select all that apply.) a. Pallor b. Fatigue c. Dilute urine d. Bradycardia e. Muscle weakness

ANS: A, B, E Signs and symptoms of anemia include, pallor, fatigue, and muscle weakness. Tachycardia, not bradycardia, and dark urine, not dilute, are signs and symptoms of anemia.

A 14-year-old girl is in the intensive care unit after a spinal cord injury 2 days ago. Nursing care for this child includes which action(s)? (Select all that apply.) a. Monitoring and maintaining systemic blood pressure b. Administering corticosteroids c. Minimizing environmental stimuli d. Discussing long-term care issues with the family e. Monitoring for respiratory complications

ANS: A, B, E Spinal cord injury patients are physiologically labile, and close monitoring is required. They may be unstable for the first few weeks after the injury. Corticosteroids are administered to minimize the inflammation present with the injury. It is not necessary to minimize environmental stimuli for this type of injury. Discussing long-term care issues with the family is inappropriate. The family is focusing on the recovery of their child. It will not be known until the rehabilitation period how much function the child may recover.

The advantages of the ventrogluteal muscle as an injection site in young children include which of the following? (Select all that apply.) a. Less painful than vastus lateralis b. Free of important nerves and vascular structures c. Cannot be used when child reaches a weight of 20 pounds d. Increased subcutaneous fat, which increases drug absorption e. Easily identified by major landmarks

ANS: A, B, E These are advantages of the ventrogluteal. The major disadvantage is lack of familiarity by health professionals and controversy over whether the site can be used before weight bearing

What are supportive interventions that can assist a toddler with a chronic illness to meet developmental milestones? (Select all that apply.) a. Give choices. b. Provide sensory experiences. c. Avoid discipline and limit setting. d. Discourage negative and ritualistic behaviors. e. Encourage independence in as many areas as possible.

ANS: A, B, E To encourage autonomy, choices should be given and independence encouraged in as many areas as possible. Sensory experiences should be encouraged to help the toddler to learn through sensorimotor experiences. Age-appropriate discipline and limit setting should be initiated. Negative and ritualistic behaviors are normal and should be allowed.

What can the nurse suggest to families to reduce blood lead levels? (Select all that apply.) a. Do not store food in open cans. b. Ensure the child eats regular meals. c. Mix formula with hot water from the tap. d. Vacuum hard-surfaced floors and window wells. e. Wash and dry the child's hands and face frequently.

ANS: A, B, E To reduce blood lead levels, the family should ensure the child eats regular meals because more lead is absorbed on an empty stomach. The child's hands and face should be washed and dried frequently, especially before eating. Food should not be stored in open cans, particularly if cans are imported. Hot water dissolves lead more quickly than cold water and thus contains higher levels of lead. Hot water should not be used to mix formula. Hard-surfaced floors or window sills or wells should not be vacuumed because this spreads dust.

What are signs and symptoms of the stage of despair in relation to separation anxiety in young children? (Select all that apply.) a. Withdrawn from others b. Uncommunicative c. Clings to parents d. Physically attacks strangers e. Forms new but superficial relationships f. Regresses to early behaviors

ANS: A, B, F Manifestations of the stage of despair seen in children during a hospitalization may include withdrawing from others, being uncommunicative, and regressing to earlier behaviors. Clinging to parents and physically attacking a stranger should be seen during the stage of protest, and forming new but superficial relationships is seen during the stage of detachment.

In teaching a 16-year-old adolescent who was recently diagnosed with systemic lupus erythematosus (SLE), what statements should the nurse include? (Select all that apply.) a. "You should use a moisturizer with a sun protection factor (SPF) of 30." b. "You should avoid pregnancy because this can cause a flare-up." c. "You should not receive any immunizations in the future." d. "You may need to be on a low-protein, high-carbohydrate diet." e. "You should expect to lose weight while taking steroids." f. "You may need to modify your daily recreational activities."

ANS: A, B, F Teaching for an adolescent with SLE should foster adaptation and self-advocacy and include using a moisturizer with an SPF of 30, avoiding pregnancy because it can produce a flare-up, and modifying recreational activities but continuing with daily exercise as an essential part of the treatment plan. The adolescent should continue to receive immunizations as scheduled, should expect to gain weight while on steroid therapy, and would not have a specialized diet.

A 9-year-old child has just been diagnosed with recurrent abdominal pain (RAP). Which of the following should the nurse include in preparing the family for discharge? (Select all that apply.) a. "Your child should be on a high-fiber diet." b. "You may give your child a stimulant laxative once a week." c. "You should help your child with bowel training to establish regular bowel habits." d. "Your child may place ice packs on the abdomen when pain occurs."

ANS: A, C A high-fiber diet with possible addition of bulk laxatives is beneficial in children with RAP. Bowel training is recommended to assist the child in establishing regular bowel habits.

The nurse is planning to administer immunizations to a 6-month-old infant. Which interventions should the nurse implement to minimize local reactions from the vaccines? (Select all that apply.) a. Select a needle length of 1 inch. b. Administer in the deltoid muscle. c. Inject the vaccine into the vastus lateralis. d. Draw the vaccine up from a vial with a filter needle. e. Change the needle on the syringe after drawing up the vaccine and before injecting.

ANS: A, C To minimize local reactions from vaccines, the nurse should select a needle of adequate length (25 mm [1 inch] in infants) to deposit the antigen deep in the muscle mass and inject it into the vastus lateralis muscle. The deltoid may be used in children 18 months of age or older but not in a 6-month-old infant. A filter needle is not needed to draw the vaccine from a vial. Changing the needle on the syringe after drawing up the vaccine before injecting it has not been shown to decrease local reactions.

The nurse is teaching parents of a child with gastroesophageal reflux (GER) disease foods that can exacerbate acid reflux. What foods should be included in the teaching session? (Select all that apply.) a. Citrus b. Bananas c. Spicy foods d. Peppermint e. Whole wheat bread

ANS: A, C, D Avoidance of certain foods that exacerbate acid reflux (e.g., caffeine, citrus, tomatoes, alcohol, peppermint, spicy or fried foods) can improve mild GER symptoms. Bananas and whole wheat bread will not exacerbate acid reflux.

The clinic nurse is evaluating causes for iron deficiency caused by inadequate supply of iron. What should the nurse recognize as causes for iron deficiency caused by an inadequate iron supply? (Select all that apply.) a. Prematurity b. Slow growth rate c. Excessive milk intake d. Severe iron deficiency in the mother e. Exclusive breastfeeding of infant from birth to 3 months

ANS: A, C, D Causes for iron deficiency caused by an inadequate supply of iron include prematurity, excessive milk intake, and severe iron deficiency in the mother. Rapid growth rate, not slow, and exclusive breastfeeding of infant after 6 months, not from birth to 3 months, can be causes of inadequate supply of iron.

The nurse is preparing to admit a 5-year-old child with a lower motor neuron syndrome. What clinical manifestations of a lower motor neuron syndrome should the nurse expect to observe? (Select all that apply.) a. Loss of hair b. Babinski reflex present c. Skin and tissue changes d. Marked atrophy of atonic muscle e. Hyperreflexia with tendon reflexes exaggerated

ANS: A, C, D Clinical manifestations of a lower motor neuron syndrome include loss of hair, skin and tissue changes, and marked atrophy of atonic muscle. Babinski reflex present and hyperreflexia with tendon reflexes exaggerated are manifestations of an upper motor neuron syndrome.

What are common respiratory symptoms dying children experience? (Select all that apply.) a. Cough b. Eupnea c. Wheezing d. Shortness of breath e. Decrease in secretions

ANS: A, C, D Common respiratory symptoms dying children experience include cough, wheezing, and shortness of breath. Eupnea is normal breathing, and secretions increase not decrease.

The nurse is caring for a 5-year-old child who is scheduled for a tonsillectomy in 2 hours. Which action should the nurse include in the child's postoperative care plan? (Select all that apply.) a. Notify the surgeon if the child swallows frequently. b. Apply a heat collar to the child for pain relief. c. Place the child on the abdomen until fully wake. d. Allow the child to have diluted juice after the procedure. e. Encourage the child to cough frequently.

ANS: A, C, D Frequent swallowing is a sign of bleeding in children after a tonsillectomy. The child should be placed on the abdomen or the side to facilitate drainage. The child can drink diluted juice, cool water, or popsicles after the procedure. An ice collar should be used after surgery. Frequent coughing and nose blowing should be avoided.

The nurse is preparing to give oral care to a school-age child with mucositis secondary to chemotherapy administered to treat leukemia. Which preparations should the nurse use for oral care on this child? (Select all that apply.) a. Chlorhexidine gluconate (Peridex) b. Lemon glycerin swabs c. Antifungal troches (lozenges) d. Lip balm (Aquaphor) e. Hydrogen peroxide

ANS: A, C, D Preparations that may be used to prevent or treat mucositis include chlorhexidine gluconate (Peridex) because of its dual effectiveness against candidal and bacterial infections, antifungal troches (lozenges) or mouthwash, and lip balm (e.g., Aquaphor) to keep the lips moist. Agents that should not be used include lemon glycerin swabs (irritate eroded tissue and can decay teeth), hydrogen peroxide (delays healing by breaking down protein), and milk of magnesia (dries mucosa).

The nurse is assessing a family's use of complementary medicine practices. What practices are classified as mind-body control therapies? (Select all that apply.) a. Relaxation b. Acupuncture c. Prayer therapy d. Guided imagery e. Herbal medicine

ANS: A, C, D Relaxation, prayer therapy, and guided imagery are classified as mind-body control therapies. Acupuncture and herbal medicine are classified as traditional and ethnomedicine therapies.

The nurse is preparing to admit a 7-year-old child with type 2 diabetes. What clinical features of type 2 diabetes should the nurse recognize? (Select all that apply.) a. Oral agents are effective. b. Insulin is usually needed. c. Ketoacidosis is infrequent. d. Diet only is often effective. e. Chronic complications frequently occur.

ANS: A, C, D The clinical features of type 2 diabetes include the following: oral agents are effective, ketoacidosis is infrequent, and diet only is often effective. Insulin is only needed in 20% to 30% of cases and chronic complications occur infrequently.

What factors can negatively affect parents' reactions to their child's illness? (Select all that apply.) a. Additional stresses b. Previous coping abilities c. Lack of support systems d. Seriousness of the threat to the child e. Previous experience with hospitalization

ANS: A, C, D The factors that can negatively affect parents' reactions to their child's illness are additional stresses, lack of support systems, and the seriousness of the threat to the child. Previous coping abilities and previous experience with hospitalization would have a positive effect on coping.

What are supportive interventions that can assist an adolescent with a chronic illness to meet developmental milestones? (Select all that apply.) a. Encourage activities appropriate for age. b. Avoid discussing planning for the future. c. Provide instruction on interpersonal and coping skills. d. Emphasize good appearance and wearing of stylish clothes. e. Understand that the adolescent will not have the same sexual needs.

ANS: A, C, D To achieve independence from family, instruction on interpersonal and coping skills should be provided. To promote heterosexual relationships, activities appropriate for age should be encouraged, and a good appearance and wearing of stylish clothes should be emphasized. Plans for the future should be discussed, and the adolescent will have the same sexual needs as adolescents without a chronic illness.

What characterizes a preschooler's concept of death? (Select all that apply.) a. Belief their thoughts can cause death. b. They have a concrete understanding of death. c. Death is seen as temporary and gradual. d. Death is seen as a departure, a kind of sleep. e. They usually have some sense of the meaning of death.

ANS: A, C, D, E A preschool child's concept of death includes believing that his or her thoughts can cause death, seeing death as temporary and gradual and a kind of sleep, and having some sense of the meaning of death. Having a concrete understanding of death is a characteristic of a school-age child's concept of death.

The nurse is preparing to admit a 10-year-old child with Duchenne muscular dystrophy. What clinical features of Duchenne muscular dystrophy should the nurse recognize? (Select all that apply.) a. Calf muscle hypertrophy b. Late onset, usually between 6 and 8 years of age c. Progressive muscular weakness, wasting, and contractures d. Loss of independent ambulation by 9 to 12 years of age e. Slowly progressive, generalized weakness during adolescence

ANS: A, C, D, E Clinical features of Duchenne muscular dystrophy include calf muscle hypertrophy; progressive muscular weakness; wasting and contractures; loss of independent ambulation by 9 to 12 years of age; and slowly progressive, generalized weakness during adolescence. The onset is early, not late, usually between 3 and 5 years of age.

The nurse is preparing to admit a 6-month-old child with gastroesophageal reflux disease. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Spitting up b. Bilious vomiting c. Failure to thrive d. Excessive crying e. Respiratory problems

ANS: A, C, D, E Clinical manifestations of gastroesophageal reflux disease include spitting up, failure to thrive, excessive crying, and respiratory problems. Hematemesis, not bilious vomiting, is a manifestation.

The nurse is teaching parents of preschool children consequences of inadequate sleep. What should the nurse include in the teaching session? (Select all that apply.) a. Behavior changes b. Increased appetite c. Difficulty concentrating d. Poor control of emotions e. Impaired learning ability

ANS: A, C, D, E Consequences of inadequate sleep include daytime tiredness, behavior changes, hyperactivity, difficulty concentrating, impaired learning ability, poor control of emotions and impulses, and strain on family relationships. Increased appetite is not a consequence of inadequate sleep.

A child is diagnosed with active pulmonary tuberculosis. What medications does the nurse anticipate to be prescribed for the first 2 months? (Select all that apply.) a. Isoniazid (INH) b. Cefuroxime (Ceftin) c. Rifampin (Rifadin) d. Pyrazinamide (PZA) e. Ethambutol (Myambutol)

ANS: A, C, D, E For the child with clinically active pulmonary and extrapulmonary TB, the goal is to achieve sterilization of the tuberculous lesion. The American Academy of Pediatrics (2012) recommends a 6-month regimen consisting of INH, rifampin, ethambutol, and PZA given daily or twice weekly for the first 2 months followed by INH and rifampin given two or three times a week by DOT for the remaining 4 months (Mycobacterium tuberculosis). Cefuroxime is not part of the regimen.

Parents tell the nurse that siblings of their hospitalized child are feeling "left out." What suggestions should the nurse make to the parents to assist the siblings to adjust to the hospitalization of their brother or sister? (Select all that apply.) a. Arrange for visits to the hospital. b. Limit information given to the siblings. c. Encourage phone calls to the hospitalized child. d. Make or buy inexpensive toys or trinkets for the siblings. e. Identify an extended family member to be their support system.

ANS: A, C, D, E Strategies to support siblings during hospitalization include arranging for visits, encouraging phone calls, giving inexpensive gifts, and identifying a support person. Information should be shared with the siblings not limited.

The nurse is caring for a child with meningitis. What acute complications of meningitis should the nurse continuously assess the child for? (Select all that apply.) a. Seizures b. Cerebral palsy c. Cerebral edema d. Hydrocephalus e. Cognitive impairments

ANS: A, C, E Acute complications of meningitis include syndrome of inappropriate antidiuretic hormone (SIADH), subdural effusions, seizures, cerebral edema and herniation, and hydrocephalus. Long-term complications include cerebral palsy, cognitive impairments, learning disorder, attention deficit hyperactivity disorder, and seizures.

What are classified as corrosive poisons? (Select all that apply.) a. Batteries b. Paint thinner c. Drain cleaners d. Mineral seed oil e. Mildew remover

ANS: A, C, E Batteries, drain cleaners, and mildew removers are classified as corrosive poisons. Paint thinner and mineral seed oil are classified as hydrocarbon poisons.

The nurse is planning to admit a 14-year-old adolescent with Cushing syndrome. What clinical manifestations should the nurse expect to observe in this child? (Select all that apply.) a. Truncal obesity b. Decreased pubic hair c. Petechial hemorrhage d. Hyperpigmentation of elbows e. Facial plethora f. Headache and weakness

ANS: A, C, E Clinical manifestations of Cushing syndrome include truncal obesity, petechial hemorrhage, and facial plethora. Decreased pubic and axillary hair; hyperpigmentation of elbows, knees, and wrists; and headache and weakness are clinical manifestations of adrenocortical insufficiency.

The nurse is preparing to admit a 6-year-old child with celiac disease. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Steatorrhea b. Polycythemia c. Malnutrition d. Melena stools e. Foul-smelling stools

ANS: A, C, E Clinical manifestations of celiac disease include impaired fat absorption (steatorrhea and foul-smelling stools) and impaired nutrient absorption (malnutrition). Anemia, not polycythemia, is a manifestation, and melena stools do not occur.

A tonsillectomy or adenoidectomy is contraindicated in what conditions? (Select all that apply.) a. Cleft palate b. Seizure disorders c. Blood dyscrasias d. Sickle cell disease e. Acute infection at the time of surgery

ANS: A, C, E Contraindications to either tonsillectomy or adenoidectomy are (1) cleft palate because both tonsils help minimize escape of air during speech, (2) acute infections at the time of surgery because the locally inflamed tissues increase the risk of bleeding, and (3) uncontrolled systemic diseases or blood dyscrasias. Tonsillectomy or adenoidectomy is not contraindicated in sickle cell disease or seizure disorders.

Ryan has just been unexpectedly admitted to the intensive care unit after abdominal surgery. The nursing staff has completed the admission process, and Ryan's condition is beginning to stabilize. When speaking with the parents, the nurses should expect which of the following stressors to be evident? (Select all that apply.) a. Unfamiliar environment b. Usual day-night routine c. Strange smells d. Provision of privacy e. Inadequate knowledge of condition and routine

ANS: A, C, E Intensive care units, especially when the family is unprepared for the admission, are a strange and unfamiliar place with many pieces of unfamiliar equipment. The sights and sounds are much different from those of a general hospital unit. Also, with the child's condition being more precarious, it may be difficult to keep the parents updated and knowledgeable about what is happening.

What does the nurse recognize as physical signs of approaching death? (Select all that apply.) a. Mottling of skin b. Decreased sleeping c. Cheyne-Stokes respirations d. Loss of the sense of hearing e. Decreased appetite and thirst

ANS: A, C, E Physical signs of approaching death include mottling of skin, Cheyne-Stokes respirations, and decreased appetite and thirst. Sleeping increases, not decreases, and hearing is the last sense to fail.

The nurse is teaching an adolescent with hypertension foods recommended on the DASH diet. What foods should the nurse include in the teaching session? (Select all that apply.) a. Green beans b. Energy drinks c. Low-fat yogurt d. Chocolate milk e. Whole grain bread

ANS: A, C, E The DASH diet provides a lower salt diet that has been associated with improvement in BP and is believed to be beneficial for all patients with hypertension. DASH stands for Dietary Approaches to Stop Hypertension. The DASH diet is plentiful in vegetables, fruits, whole grains, and low-fat dairy products and low in sugar and salt. Energy drinks are high in sugar, and chocolate milk is high in fat.

An adolescent is being placed on an ACE inhibitor. What should the nurse inform the adolescent with regard to this medication? (Select all that apply.) a. Stay well hydrated. b. Increase intake of potassium. c. Avoid rapid position changes. d. Take the medication with meals. e. Side effects may include a cough.

ANS: A, C, E The adolescent should be instructed to stay well hydrated and avoid rapid position changes and that side effects may include a cough when on ACE inhibitors. ACE inhibitors do not deplete potassium, and they should be taken 1 hour before meals to increase absorption.

What are signs and symptoms of a possible kidney transplant rejection in a child? (Select all that apply.) a. Fever b. Hypotension c. Diminished urinary output d. Decreased serum creatinine e. Swelling and tenderness of graft area

ANS: A, C, E The child with a kidney transplant who exhibits any of the following should be evaluated immediately for possible rejection: fever, diminished urinary output, and swelling and tenderness of graft area. Hypertension, not hypotension, and increased, not decreased, serum creatinine are signs of rejection.

What are supportive interventions that can assist a school-age child with a chronic illness to meet developmental milestones? (Select all that apply.) a. Encourage socialization. b. Discourage sports activities. c. Encourage school attendance. d. Provide instructions on assertiveness. e. Educate teachers and classmates about the child's condition.

ANS: A, C, E To develop a sense of accomplishment, school attendance should be encouraged, and teachers and classmates should be educated about the child's condition. To form peer relationships, socialization should be encouraged. Sports activities should be encouraged (e.g., Special Olympics), not discouraged. Providing instructions on assertiveness is appropriate for adolescence.

The nurse is teaching parents of preschool-aged children strategies to prevent sexual abuse. What should the nurse include in the teaching session? (Select all that apply.) a. Back up a child's right to say no. b. Don't take what your child says too seriously. c. Take a second look at signals of potential danger. d. Don't be too detailed about examples of sexual assault. e. Remind children that even "nice" people sometimes do mean things.

ANS: A, C, E To provide protection and preparation from sexual abuse, parents should back up a child's right to say no, take a second look at signals of potential danger, and remind children that even "nice" people sometimes do mean things. Parents should take what children say seriously and they should give specific definitions and examples of sexual assault.

The treatment of brain tumors in children consists of which therapies? (Select all that apply.) a. Surgery b. Bone marrow transplantation c. Chemotherapy d. Stem cell transplantation e. Radiation f. Myelography

ANS: A, C, E Treatment for brain tumors in children may consist of surgery, chemotherapy, and radiotherapy alone or in combination. Bone marrow and stem cell transplantation therapies are used for leukemia, lymphoma, and other solid tumors where myeloablative therapies are used. Myelography is a radiographic examination after an intrathecal injection of contrast medium. It is not a treatment.

The nurse is preparing a community outreach program for adolescents about the characteristic differences between type 1 and type 2 diabetes mellitus (DM). What concepts should the nurse include? (Select all that apply.) a. Type 1 DM has an abrupt onset. b. Type 1 DM is often controlled with oral glucose agents. c. Type 1 DM occurs primarily in whites. d. Type 2 DM always requires insulin therapy. e. Type 2 DM frequently has a familial history. f. Type 2 DM occurs in people who are overweight.

ANS: A, C, E, F Characteristics of type 1 DM include having an abrupt onset, primarily occurring in whites, and not being controlled with oral glucose agents (insulin is required for therapy). Type 2 DM frequently has a familial history, occurs in people who are overweight, and does not always require insulin therapy (it is used in 20% to 30% of patients).

The nurse is caring for an infant with a suspected urinary tract infection. Which of the following clinical manifestations would be observed? (Select all that apply.) a. Vomiting b. Jaundice c. Failure to gain weight d. Swelling of the face e. Back pain f. Persistent diaper rash

ANS: A, C, F Vomiting, failure to gain weight, and persistent diaper rash are clinical manifestations observed in an infant with a UTI.

An infant has developed staphylococcal pneumonia. Nursing care of the child with pneumonia includes which interventions? (Select all that apply.) a. Cluster care to conserve energy b. Round-the-clock administration of antitussive agents c. Strict intake and output to avoid congestive heart failure d. Administration of antibiotics

ANS: A, D Antibiotics are indicated for a bacterial pneumonia. Often the child will have decreased pulmonary reserve, and the clustering of care is essential. Antitussive agents are used sparingly. It is desirable for the child to cough up some of the secretions. Fluids are essential to kept secretions as liquefied as possible.

The clinic nurse is reviewing the immunization guidelines for hepatitis B. Which are true of the guidelines for this vaccine? (Select all that apply.) a. The hepatitis B vaccination series should be begun at birth. b. The adolescent not vaccinated at birth does not have a need to be vaccinated. c. Any child not vaccinated at birth should receive two doses at least 4 months apart. d. An unimmunized 10-year-old child should receive three doses administered 4 weeks apart.

ANS: A, D Current immunization guidelines for hepatitis B vaccination recommend beginning the hepatitis B vaccine series at birth or, in unimmunized children, as soon as possible. Children younger than 11 years of age may be vaccinated with a three-dose series, administered 4 weeks apart. Children 11 years and older may receive the two-dose adult formulation given at least 4 months apart.

A nurse is planning interventions for a toddler with juvenile hypothyroidism. Which interventions should the nurse plan to implement for this child? (Select all that apply.) a. Moisturizer for dry skin b. Antidiarrheal medications c. Medications to help with insomnia d. Implementation of thyroxine therapy

ANS: A, D The presenting symptoms of juvenile hypothyroidism are myxedematous skin changes (dry skin, puffiness around the eyes, sparse hair), constipation, lethargy, and mental decline. The nurse should plan interventions for the dry skin and for the implementation of thyroxine therapy. The child is prone to constipation and sleepiness so antidiarrheal medication and medications to help with insomnia would not be appropriate.

4. The nurse is teaching parents of a school-age child how to cleanse small wounds. What should the nurse advise the parents to avoid using to cleanse a wound? (Select all that apply.) a. Alcohol b. Normal saline c. Tepid water d. Povidone-iodine e. Hydrogen peroxide

ANS: A, D, E Caution caregivers to avoid cleansing the wound with povidone-iodine, alcohol, and hydrogen peroxide because these products disrupt wound healing. Normal saline and tepid water are safe to use when cleansing wounds.

What activity should the school nurse recommend for a child with hemophilia A? (Select all that apply.) a. Golf b. Soccer c. Rugby d. Jogging e. Swimming

ANS: A, D, E Children and adolescents with severe hemophilia can participate in noncontact sports such as swimming, golf, walking, jogging, fishing, and bowling. Contact sports such as football, boxing, hockey, soccer, and rugby are strongly discouraged because the risk of injury outweighs the physical and psychosocial benefits of participating in these sports.

The nurse is teaching parents of a child with a cognitive impairment signs that indicate the child is developmentally ready for dressing training. What signs should the nurse include that indicate the child is developmentally ready for dressing training? (Select all that apply.) a. Can follow verbal commands b. Can sit quietly for 1 to 2 minutes c. Can master every task of dressing d. Can follow physical gestures or cues e. Can relate clothing to the appropriate body part

ANS: A, D, E Children are considered developmentally ready for dressing training if they can sit quietly for 3 to 5 minutes (not 1 to 2) while working on a task; can follow physical gestures or cues; can follow verbal commands; and can relate clothing to the appropriate body part, such as socks to feet. As with other self-help skills, the child may not be able to master every task but should be evaluated for evidence of willingness to participate at his or her level of readiness.

The nurse is preparing to admit a 10-year-old child with absence seizures. What clinical features of absence seizures should the nurse recognize? (Select all that apply.) a. There is no aura. b. There is a postictal state. c. They usually last longer than 30 seconds. d. There is a brief loss of consciousness. e. There is an occasional clonic movement.

ANS: A, D, E Clinical features of absence seizures include no auras, a brief loss of consciousness, and an occasional clonic movement. There is no postictal state, and the seizures rarely last longer than 30 seconds.

The nurse is caring for a 14-year-old child with systemic lupus erythematous (SLE). What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Arthralgia b. Weight gain c. Polycythemia d. Abdominal pain e. Glomerulonephritis

ANS: A, D, E Clinical manifestations of SLE include arthralgia, abdominal pain, and glomerulonephritis. Weight loss, not gain, and anemia, not polycythemia, are manifestations of SLE.

The nurse is planning to admit a 14-year-old adolescent with hyperparathyroidism. What clinical manifestations should the nurse expect to observe in this patient? (Select all that apply.) a. Polyuria b. Diarrhea c. Hypotension d. Vague bone pain e. Paresthesia in extremities

ANS: A, D, E Clinical manifestations of hyperparathyroidism include polyuria, vague bone pain, and paresthesia in the extremities. Constipation, not diarrhea, and hypertension, not hypotension, are manifestations of hyperparathyroidism.

The nurse is preparing to admit a 2-month-old child with hypertrophic pyloric stenosis. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Weight loss b. Bilious vomiting c. Abdominal pain d. Projectile vomiting e. The infant is hungry after vomiting

ANS: A, D, E Clinical manifestations of hypertrophic pyloric stenosis include weight loss, projectile vomiting, and hunger after vomiting. The vomitus is nonbilious, and there is no evidence of pain or discomfort, just chronic hunger.

A parent asks the nurse about the "characteristics of a sleep terror." What response should the nurse give to the parent? (Select all that apply.) a. The child screams during the sleep terror. b. Return to sleep is delayed because of persistent fear. c. The night terror occurs during the second half of night. d. The child has no memory of the dream with a sleep terror. e. The child is not aware of another's presence during a sleep terror.

ANS: A, D, E During sleep terrors, the child screams and has no memory of the dream. The child is not aware of another's presence during a sleep terror. Return to sleep is usually rapid with a sleep terror, but it is delayed with a nightmare. The sleep terror occurs usually within 1 to 4 hours of sleep, but nightmares occur during the second half of night.

The clinic nurse is assessing an infant. What are early signs of cognitive impairment the nurse should discuss with the health care provider? (Select all that apply.) a. Head lag at 11 months of age b. No pincer grasp at 4 months of age c. Colicky incidents at 3 months of age d. Unable to speak two to three words at 24 months of age e. Unresponsiveness to the environment at 12 months of age

ANS: A, D, E Early signs of cognitive impairment include gross motor delay (head lag should be established by 6 months, and head lag still present at 11 months is a delay), language delay (normal language development is speaking two to three words by age 12 months; if unable to speak two to three words at 24 months, that is a delay), and unresponsiveness to the environment at 12 months. No pincer grasp at 4 months of age is normal (palmar grasp is the expected finding), and colicky incidents at 3 months of age is a normal finding.

What conditions can produce hyperventilation? (Select all that apply.) a. Hysteria b. Narcotics c. Atelectasis d. Salicylate intoxication e. Mechanical ventilation

ANS: A, D, E Hysteria, salicylate intoxication, and mechanical ventilation can produce hyperventilation. Narcotics and atelectasis produce inadequate gas exchange, not hyperventilation.

The nurse should expect to assess which clinical manifestations in an adolescent with Cushing syndrome? (Select all that apply.) a. Hyperglycemia b. Hyperkalemia c. Hypotension d. Cushingoid features e. Susceptibility to infections

ANS: A, D, E In Cushing syndrome, physiologic disturbances seen are Cushingoid features hyperglycemia, susceptibility to infection, hypertension, and hypokalemia.

What are signs and symptoms of the stage of detachment in relation to separation anxiety in young children? (Select all that apply.) a. Appears happy b. Lacks interest in the environment c. Regresses to an earlier behavior d. Forms new but superficial relationships e. Interacts with strangers or familiar caregivers

ANS: A, D, E Manifestations of the stage of detachment seen in children during a hospitalization may include appearing happy, forming new but superficial relationships, and interacting with strangers or familiar caregivers. Lacking interest in the environment and regressing to an earlier behavior are manifestations seen in the stage of despair.

The school nurse recognizes that the adverse effects of performance-enhancing substances can include what? (Select all that apply.) a. Depression b. Dehydration c. Hypotension d. Aggressiveness e. Changes in libido

ANS: A, D, E Mood changes have been observed as adverse effects of using performance-enhancing substances, including aggressiveness, changes in libido, depression, anxiety, and psychosis. Fluid retention, not dehydration, and hypertension, not hypotension, are adverse effects of performance-enhancing substances

The nurse is caring for a child with increased intracranial pressure (ICP). What interventions should the nurse plan for this child? (Select all that apply.) a. Avoid jarring the bed. b. Keep the room brightly lit. c. Keep the bed in a flat position. d. Administer prescribed stool softeners. e. Administer a prescribed antiemetic for nausea.

ANS: A, D, E Other measures to relieve discomfort for a child with ICP include providing a quiet, dimly lit environment; limiting visitors; preventing any sudden, jarring movement, such as banging into the bed; and preventing an increase in ICP. The latter is most effectively achieved by proper positioning and prevention of straining, such as during coughing, vomiting, or defecating. An antiemetic should be administered to prevent vomiting, and stool softeners should be prescribed to prevent straining with bowel movements. The head of the bed should be elevated 15 to 30 degrees.

What signs and symptoms are indicative of a urinary tract disorder in the childhood period (2 to 14 years)? (Select all that apply.) a. Fatigue b. Dehydration c. Hypotension d. Growth failure e. Blood in the urine

ANS: A, D, E Signs and symptoms of a urinary tract disorder in the childhood period are fatigue, growth failure, and blood in the urine. Edema is noted, not dehydration, and hypertension is present, not hypotension.

The parents tell a nurse "our child is having some short-term negative outcomes since the hospitalization." The nurse recognizes that what can negatively affect short-term negative outcomes? (Select all that apply.) a. Parents' anxiety b. Consistent nurses c. Number of visitors d. Length of hospitalization e. Multiple invasive procedures

ANS: A, D, E The stressors of hospitalization may cause young children to experience short- and long-term negative outcomes. Adverse outcomes may be related to the length and number of admissions, multiple invasive procedures, and the parents' anxiety. Consistent nurses would have a positive effect on short-term negative outcomes. The number of visitors does not have an effect on negative outcomes.

The nurse is caring for a child immobilized because of Russel traction. What interventions should the nurse implement to prevent renal calculi? (Select all that apply.) a. Monitor output. b. Encourage the patient to drink apple juice. c. Encourage milk intake. d. Ensure adequate fluids. e. Encourage the patient to drink cranberry juice.

ANS: A, D, E To prevent renal calculi in a child who is immobilized, a nurse should monitor output; ensure adequate fluids; and encourage cranberry juice, which acidifies urine. Apple juice and milk alkalize the urine, so they should not be encouraged.

What characterizes a toddler's concept of death? (Select all that apply.) a. They are unable to comprehend an absence of life. b. They may recognize the fact of physical death. c. They understand the universality and inevitability of death. d. The are affected more by the change in lifestyle than the concept of death. e. They can only think about events in terms of their own frame of reference—living.

ANS: A, D, E Toddlers are egocentric and can only think about events in terms of their own frame of reference—living. Their egocentricity and vague separation of fact and fantasy make it impossible for them to comprehend absence of life. Instead of understanding death, this age group is affected more by any change in lifestyle. Toddlers do not understand the universality and inevitability of death and do not recognize the fact of physical death.

The nurse is caring for a 14-year-old child with disseminated intravascular coagulation (DIC). What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Petechiae b. Chronic diarrhea c. Hepatosplenomegaly d. Bleeding from openings in the skin e. Hypotension f. Purpura

ANS: A, D, E, F Some clinical manifestations of DIC are petechiae, bleeding from openings in the skin, hypotension, and purpura. Hepatosplenomegaly and chronic diarrhea are clinical manifestations of human immunodeficiency virus (HIV) infection in children.

Nursing care of a child diagnosed with a syndrome of inappropriate ADH should include which of the following? (Select all that apply.) a. Weigh daily b. Encourage fluids c. Turn frequently d. Maintain nothing by mouth (NPO) e. Restrict fluids

ANS: A, E Increased secretion of ADH causes the kidney to reabsorb water, which increases fluid volume and decreases serum osmolarity with a progressive reduction in sodium concentration. The immediate management of the child is to restrict fluids. The child should also be weighed at the same time each day. Encouraging fluids will worsen the child's condition. Turning frequently is not an appropriate intervention unless the child is unresponsive. Fluids, not food, should be restricted.

The nurse is caring for a 12-year-old child who is on fall precautions secondary to seizures. What interventions should be included in the child's care plan? (Select all that apply.) a. Place a call light and desired items within reach. b. Keep the bed in the highest position with the two side rails up. c. Turn off the lights and television at night. d. Keep personal belongings and clutter contained in one area of the floor. e. Have the child wear an appropriate-size gown and nonskid footwear.

ANS: A, E Prevention of falls requires alterations in the environment, including keeping call light and desired items within reach and having the child wear appropriate-size gowns and nonskid footwear. The bed should be in the lowest position possible with all the side rails up; at least a dim light should be left on at night; and personal belongings and clutter should not be on the floor—they should be in a cabinet.

An infant with hydrocephalus is hospitalized for surgical placement of a ventriculoperitoneal shunt. Which interventions should be included in the child's postoperative care? (Select all that apply.) a. Observe closely for signs of infection. b. Pump the shunt reservoir to maintain patency. c. Administer sedation to decrease irritability. d. Maintain Trendelenburg position to decrease pressure on the shunt. e. Maintain an accurate record of intake and output. f. Monitor for abdominal distention.

ANS: A, E, F Infection is a major complication of ventriculoperitoneal shunts. Observation for signs of infection is a priority nursing intervention. Intake and output should be measured carefully. Abdominal distention could be a sign of peritonitis or a postoperative ileus. Pumping of the shunt may cause obstruction or other problems and should not be performed unless indicated by the neurosurgeon. Pain management rather than sedation should be the goal of therapy. The child is kept flat to avoid too rapid a reduction of intracranial fluid.

-Adrenergic agonists and methylxanthines are often prescribed for a child with an asthma attack. Which describes their action? a. Liquefy secretions. b. Dilate the bronchioles. c. Reduce inflammation of the lungs. d. Reduce infection.

ANS: B -Adrenergic agonists and methylxanthines work to dilate the bronchioles in acute exacerbations. These medications do not liquefy secretions or reduce infection. Corticosteroids and mast cell stabilizers reduce inflammation in the lungs.

The nurse is explaining the purpose of using a vacuum-assisted closure (VAC) device to assist in the healing of a wound. What should the nurse explain as the purpose of using a VAC device? a. The device will decrease capillary flow. b. The device applies gentle continuous suction. c. The device will allow the wound to remain open. d. The device will prevent the formation of granulation tissue.

ANS: B A VAC device uses a technique that involves placing a foam dressing into the wound, covering it with an occlusive dressing, and applying gentle continuous suction. The negative pressure of the suction is applied from the foam dressing to the wound surfaces. The mechanical force removes excess fluids from the wound, stimulates formation of granulation tissue, restores capillary flow, and fosters closure of the wound.

Chelation therapy is begun on a child with -thalassemia major. The purpose of this therapy is to: a. treat the disease. b. eliminate excess iron. c. decrease risk of hypoxia. d. manage nausea and vomiting.

ANS: B A complication of the frequent blood transfusions in thalassemia is iron overload. Chelation therapy with deferoxamine (an iron-chelating agent) is given with oral supplements of vitamin C to increase iron excretion. Chelation therapy treats the side effect of the disease management. Decreasing the risk of hypoxia and managing nausea and vomiting are not the purposes of chelation therapy.

The nurse is teaching nursing students about childhood fractures. Which describes a compound skull fracture? a. Involves the basilar portion of the occipital bone b. Bone is exposed through the skin c. Traumatic separations of the cranial sutures d. Bone is pushed inward, causing pressure on the brain

ANS: B A compound fracture has the bone exposed through the skin. A basilar fracture involves the basilar portion of the frontal, ethmoid, sphenoid, temporal, or occipital bone. Diastatic skull fractures are traumatic separations of the cranial sutures. A depressed fracture has the bone pushed inward, causing pressure on the brain.

A child with heart failure is on Lanoxin (digoxin). The laboratory value a nurse must closely monitor is which? a. Serum sodium b. Serum potassium c. Serum glucose d. Serum chloride

ANS: B A fall in the serum potassium level enhances the effects of digoxin, increasing the risk of digoxin toxicity. Increased serum potassium levels diminish digoxin's effect. Therefore, serum potassium levels (normal range, 3.5-5.5 mmol/L) must be carefully monitored.

A school-age child has sustained a head injury and multiple fractures after being thrown from a horse. The child's level of consciousness is variable. The parents tell the nurse that they think their child is in pain because of periodic crying and restlessness. The most appropriate nursing action is to: a. discuss with parents the child's previous experiences with pain. b. discuss with practitioner what analgesia can be safely administered. c. explain that analgesia is contraindicated with a head injury. d. explain that analgesia is unnecessary when child is not fully awake and alert.

ANS: B A key nursing role is to provide sedation and analgesia for the child. Consultation with the appropriate practitioner is necessary to avoid conflict between the necessity to monitor the child's neurologic status and the promotion of comfort and relief of anxiety. Information on the child's previous experiences with pain should be obtained as part of the assessment, but because of the severity of injury, analgesia should be provided as soon as possible. Analgesia can be safely used in individuals who have sustained head injuries and can decrease anxiety and resultant increased ICP

A goal for children with spina bifida is to reduce the chance of allergy development. What is a priority nursing intervention? a. Recommend allergy testing. b. Provide a latex-free environment. c. Use only powder-free latex gloves. d. Limit use of latex products as much as possible.

ANS: B A latex-free environment is the goal. This includes eliminating the use of latex gloves and other medical devices containing latex. Allergy testing would provide information about whether the allergy has developed. It will not reduce the chances of developing the allergy. Although powder-free latex gloves are less allergenic, latex should not be used. Limiting the use of latex products is one component of providing a latex-free environment, but latex products should not be used.

The nurse is planning home care for a 2-year-old child with a tracheostomy. What recommendation should be included? a. Sterile technique is essential in home care of the tracheostomy. b. Parents are able to change the tracheostomy tube when needed. c. Play activities must be sedentary such as listening to music and working on puzzles. d. The child must wear a plastic bib when eating or drinking to prevent aspiration into the stoma.

ANS: B A plugged, clogged, or obstructed tracheostomy tube is a life-threatening circumstance. Parents are taught the signs and symptoms, how to suction, and how to change the tube. Clean technique and thorough hand washing are sufficient for suctioning, cleaning the tracheostomy site, and changing the tracheostomy tube. The child who is physically able can engage in activities appropriate to age. Young children who may spill food near the stoma should wear a fabric bib without a plastic lining or other device to prevent dribbled food and crumbs from being aspirated.

What measure of fluid balance status is most useful in a child with acute glomerulonephritis? a. Proteinuria b. Daily weight c. Specific gravity d. Intake and output

ANS: B A record of daily weight is the most useful means to assess fluid balance and should be kept for children treated at home or in the hospital. Proteinuria does not provide information about fluid balance. Specific gravity does not accurately reflect fluid balance in acute glomerulonephritis. If fluid is being retained, the excess fluid will not be included. Also proteinuria and hematuria affect specific gravity. Intake and output can be useful but are not considered as accurate as daily weights. In children who are not toilet trained, measuring output is more difficult.

The nurse needs to start an intravenous (IV) line on an 8-year-old child to begin administering intravenous antibiotics. The child starts to cry and tells the nurse, "Do it later, okay?" What action should the nurse take? a. Postpone starting the IV until the next shift. b. Start the IV line and then allow for expression of feelings. c. Change the route of the antibiotics to PO. d. Postpone starting the IV line until the child is ready.

ANS: B A school-age child may try to delay the procedure, but it is best to complete the procedure and allow time for the child to express his or her feelings. The nurse should not postpone administering the antibiotic, change it to PO, or wait to start the IV line until the child is ready.

Which of the following statements is true concerning adolescent suicide? a. A sense of hopelessness and despair are a normal part of adolescence. b. Gay and lesbian adolescents are at a particularly high risk for suicide. c. Problem-solving skills are of limited value to the suicidal adolescent. d. Previous suicide attempts are not an indication of risk for completed suicides.

ANS: B A significant number of teenage suicides occur among homosexual youths. Gay and lesbian adolescents who live in families or communities that do not accept homosexuality are likely to suffer low self-esteem, self-loathing, depression, and hopelessness as a result of a lack of acceptance from their family or community.

What statement best describes a subdural hematoma? a. Bleeding occurs between the dura and the skull. b. Bleeding occurs between the dura and the cerebrum. c. Bleeding is generally arterial, and brain compression occurs rapidly. d. The hematoma commonly occurs in the parietotemporal region.

ANS: B A subdural hematoma is bleeding that occurs between the dura and the cerebrum as a result of a rupture of cortical veins that bridge the subdural space. An epidural hemorrhage occurs between the dura and the skull, is usually arterial with rapid brain concussion, and occurs most often in the parietotemporal region.

Which statement best describes a subdural hematoma? a. Bleeding occurs between the dura and the skull. b. Bleeding occurs between the dura and the cerebrum. c. Bleeding is generally arterial, and brain compression occurs rapidly. d. The hematoma commonly occurs in the parietotemporal region.

ANS: B A subdural hematoma is bleeding that occurs between the dura and the cerebrum as a result of a rupture of cortical veins that bridge the subdural space. An epidural hemorrhage occurs between the dura and the skull, is usually arterial with rapid brain concussion, and occurs most often in the parietotemporal region.

A 6-year-old boy with very fair skin will be joining his family during a beach vacation. What should the nurse recommend? a. Keep him off the beach during the daytime hours. b. Use sunscreen with an SPF of at least 15 and reapply it every 2 to 3 hours. c. Apply a topical sunscreen product with an SPF of 30 in the morning. d. Dress him in long pants and long-sleeved shirt and keep him under a beach umbrella.

ANS: B A sunscreen with an SPF (sun protection factor) of at least 15 is recommended. The sunscreen should be reapplied every 2 to 3 hours and after the child is in the water or sweating excessively. During a beach vacation, avoiding the beach during daytime hours is impractical. The highest risk of sun exposure is from 10 AM to 3 PM. Sunlight exposure should be limited during this time. An SPF of 30 is good, but reapplying it is necessary every 2 to 3 hours and when the child gets wet. Long pants and a shirt are impractical. The beach umbrella can be used with the sunscreen to limit exposure to the sun.

The nurse is conducting a staff in-service on casts. Which is an advantage to using a fiberglass cast instead of a plaster of Paris cast? a. Cheaper b. Dries rapidly c. Molds closely to body parts d. Smooth exterior

ANS: B A synthetic casting material dries in 5 to 30 minutes as compared with a plaster cast, which takes 10 to 72 hours to dry. Synthetic casts are more expensive and have a rough exterior, which may scratch surfaces. Plaster casts mold closer to body parts.

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

ANS: B A toddler experiences separation anxiety secondary to being separated from the parents. To avoid this, the parents should be encouraged to room in as much as possible.

The nurse stops to assist an adolescent who has experienced severe trauma when hit by a motorcycle. The emergency medical system (EMS) has been activated. The first person who provided assistance applied a tourniquet to the child's leg because of arterial bleeding. What should the nurse do related to the tourniquet? a. Loosen the tourniquet. b. Leave the tourniquet in place. c. Remove the tourniquet and apply direct pressure if bleeding is still present. d. Remove the tourniquet every 5 minutes, leaving it off for 30 seconds each time.

ANS: B A tourniquet is applied only as a last resort, and then it is left in place and not loosened until definitive treatment is available. After the tourniquet is applied, skin and tissue necrosis occur below the site. Loosening or removing the tourniquet allows toxins from the tissue necrosis to be released into the circulation. This can induce systemic, deadly tourniquet shock.

Which of the following is descriptive of attention deficit hyperactivity disorder (ADHD)? a. Manifestations exhibited are so bizarre that the diagnosis is fairly easy. b. Manifestations affect every aspect of the child's life but are most obvious in the classroom. c. Learning disabilities associated with ADHD eventually disappear when adulthood is reached. d. Diagnosis of ADHD requires that all manifestations of the disorder be present.

ANS: B ADHD affects every aspect of the child's life, but the disruption is most obvious in the classroom.

The nurse is providing support to a family that is experiencing anticipatory grief related to their child's imminent death. What statement by the nurse is therapeutic? a. "Your other children need you to be strong." b. "You have been through a very tough time." c. "His suffering is over; you should be happy." d. "God never gives us more than we can handle."

ANS: B Acknowledging that the family has been through a very tough time validates the loss that the parents have experienced. It is nonjudgmental. After the death of a child, the parent recognizes the responsibilities to the rest of the family but needs to be able to experience the grief of the loss. Telling the parents what they should do is giving advice. The parent would not be happy that the child has died, and stating so is argumentative. The parents may be angry with God, or their religious beliefs may be unknown, so the nurse should not provide false reassurance by talking to them about God.

Which of the following best describes acute glomerulonephritis? a. Occurs after a urinary tract infection b. Occurs after a streptococcal infection c. Associated with renal vascular disorders d. Associated with structural anomalies of genitourinary tract

ANS: B Acute glomerulonephritis is an immune-complex disease that occurs after a streptococcal infection with certain strains of the group A â-hemolytic streptococcus.

Chronic adrenocortical insufficiency is also referred to as: a. Graves disease. b. Addison disease. c. Cushing syndrome. d. Hashimoto disease.

ANS: B Addison disease is chronic adrenocortical insufficiency. Graves and Hashimoto diseases involve the thyroid gland. Cushing syndrome is a result of excessive circulation of free cortisol.

A child with hypopituitarism is being started on growth hormone (GH) therapy. Nursing considerations should be based on which knowledge? a. Therapy is most successful if it is started during adolescence. b. Replacement therapy requires daily subcutaneous injections. c. Hormonal supplementation will be required throughout child's lifetime. d. Treatment is considered successful if children attain full stature by adolescence.

ANS: B Additional support is required for children who require hormone replacement therapy, such as preparation for daily subcutaneous injections and education for self-management during the school-age years. Young children, obese children, and those who are severely GH deficient have the best response to therapy. Replacement therapy is not needed after attaining final height. The children are no longer GH deficient. When therapy is successful, children can attain their actual or near-final adult height at a slower rate than their peers.

The middle school nurse is speaking to parents about prevention of injuries as a goal of the physical education program. How should the goal be achieved? a. Use of protective equipment at the family's discretion b. Education of adults to recognize signs that indicate a risk for injury c. Sports medicine program to help student athletes work through overuse injuries d. Arrangements for multiple sports to use same athletic fields to accommodate more children

ANS: B Adults close to sports activities need to be aware of the early warning signs of fatigue, dehydration, and risk for injury. School policy should require mandatory use of protective equipment. Proper sports medicine therapy does not support "working through" overuse injuries. Too many students involved in different activities create distractions, which contribute to the child losing focus. This is a contributing factor to injury.

What pathologic process is believed to be responsible for the development of postinfectious glomerulonephritis? a. Infarction of renal vessels b. Immune complex formation and glomerular deposition c. Bacterial endotoxin deposition on and destruction of glomeruli d. Embolization of glomeruli by bacteria and fibrin from endocardial vegetation

ANS: B After a streptococcal infection, antibodies are formed, and immune-complex reaction occurs. The immune complexes are trapped in the glomerular capillary loop. Infarction of renal vessels occurs in renal involvement in sickle cell disease. Bacterial endotoxin deposition on and destruction of glomeruli is not a mechanism for postinfectious glomerulonephritis. Embolization of glomeruli by bacteria and fibrin from endocardial vegetation is the pathology of renal involvement with bacterial endocarditis.

The nurse gives an injection in a patient's room. How should the nurse dispose of the needle? a. Remove the needle from the syringe and dispose of it in a proper container. b. Dispose of the syringe and needle in a rigid, puncture-resistant container in the patient's room. c. Close the safety cover on the needle and return it to the medication preparation area for proper disposal. d. Place the syringe and needle in a rigid, puncture-resistant container in an area outside of the patient's room.

ANS: B All needles (uncapped and unbroken) are disposed of in a rigid, puncture-resistant, tamper-proof container located near the site of use. Consequently, these containers should be installed in the patient's room. Needles and syringes are disposed of uncapped and unbroken. A used needle should not be transported to an area distant from use for disposal.

A young boy will receive a bone marrow transplant (BMT). This is possible because one of his older siblings is a histocompatible donor. Which is this type of BMT called? a. Syngeneic b. Allogeneic c. Monoclonal d. Autologous

ANS: B Allogeneic transplants are from another individual. Because he and his sibling are histocompatible, the BMT can be done. Syngeneic marrow is from an identical twin. There is no such thing as a monoclonal BMT. Autologous refers to the individual's own marrow.

An awake, alert 4-year-old child has just arrived at the emergency department after an ingestion of aspirin at home. The practitioner has ordered activated charcoal. The nurse administers charcoal in which manner? a. Giving half of the solution and then repeating the other half in 1 hour b. Mixing with a flavorful beverage in an opaque container with a straw c. Serving it in a clear plastic cup so the child can see how much has been drunk d. Administering it through a nasogastric tube because the child will not drink it because of the taste

ANS: B Although activated charcoal can be mixed with a flavorful sugar-free beverage, it will be black and resemble mud. When it is served in an opaque container, the child will not have any preconceived ideas about its being distasteful. The ability to see the charcoal solution may affect the child's desire to drink the solution. The child should be encouraged to drink the solution all at once. The nasogastric tube would be traumatic. It should be used only in children who cannot be cooperative or those without a gag reflex.

A young child with human immunodeficiency virus (HIV) is receiving several antiretroviral drugs. What is the purpose of these drugs? a. Cure the disease. b. Delay disease progression. c. Prevent spread of infection. d. Treat Pneumocystis carinii pneumonia.

ANS: B Although not a cure, these antiretroviral drugs can suppress viral replication, preventing further deterioration of the immune system, and delay disease progression. At this time, cure is not possible. Antiretroviral drugs do not prevent the spread of the disease. P. carinii prophylaxis is accomplished with antibiotics.

A young child with human immunodeficiency virus (HIV) is receiving several antiretroviral drugs. The purpose of these drugs is to: a. cure the disease. b. delay disease progression. c. prevent spread of disease. d. treat Pneumocystis carinii pneumonia.

ANS: B Although not a cure, these antiviral drugs can suppress viral replication, preventing further deterioration of the immune system and delaying disease progression. At this time, cure is not possible. These drugs do not prevent the spread of the disease. P. carinii prophylaxis is accomplished with antibiotics.

The nurse is notified that a 9-year-old boy with nephrotic syndrome is being admitted. Only semiprivate rooms are available. What roommate should be best to select? a. A 10-year-old girl with pneumonia b. An 8-year-old boy with a fractured femur c. A 10-year-old boy with a ruptured appendix d. A 9-year-old girl with congenital heart disease

ANS: B An 8-year-old boy with a fractured femur would be the best choice for a roommate. The boys are similar in age. The child with nephrotic syndrome most likely will be on immunosuppressive agents and susceptible to infection. The child with a fractured femur is not infectious. A girl should not be a good roommate for a school-age boy. In addition, the 10-year-old girl with pneumonia and the 10-year-old boy with a ruptured appendix have infections and could pose a risk for the child with nephrotic syndrome.

The nurse is caring for a child in respiratory distress. What is an early but less obvious sign of respiratory failure? a. Stupor b. Headache c. Bradycardia d. Somnolence

ANS: B An early but less obvious sign of respiratory failure is a headache. Stupor, bradycardia, and somnolence are signs of more severe hypoxia.

What is the major health concern of children in the United States? a. Acute illness b. Chronic illness c. Congenital disabilities d. Nervous system disorders

ANS: B An estimated 18% of children in the United States have a chronic illness or disability that warrants health care services beyond those usually required by children. Chronic illness has surpassed acute illness as the major health concern for children. Congenital disabilities exist from birth but may not be hereditary. These represent a portion of the number of children with chronic illnesses. Mental and nervous system disorders account for approximately 17% of chronic illnesses in children.

An infant is born with one lower limb deficiency. When is the optimum time for the child to be fitted with a functional prosthetic device? a. As soon as possible after birth b. When the infant is developmentally ready to stand up c. At about ages 12 to 15 months, when most children are walking d. At about 4 years, when the healthy limb is not growing so rapidly

ANS: B An infant should be fitted with a functional prosthetic leg when the infant is developmentally ready to pull to a standing position. When the infant begins limb exploration, a soft prosthesis can be used. The child should begin using the prosthesis as part of his or her normal development. This will match the infant's motor readiness.

The nurse is caring for a family whose infant was just born with anencephaly. What is the most important nursing intervention? a. Implement measures to facilitate the attachment process. b. Help the family cope with the birth of an infant with a fatal defect. c. Prepare the family for extensive surgical procedures that will be needed. d. Provide emotional support so the family can adjust to the birth of an infant with problems.

ANS: B Anencephaly is the most serious neural tube defect. The infants have an intact brainstem and, if born alive, may be able to maintain vital functions for a few hours to several weeks. The family requires emotional support and counseling to cope with the birth of an infant with a fatal defect. The parents should be encouraged to hold their infant and provide comfort measures. This facilitates the grieving process because the infant has a limited life expectancy. Infants with anencephaly do not have cerebral hemispheres. There is no surgical correction available for this defect. Emotional support is needed as the family adjusts to the birth of a child who has a fatal defect.

Care for the child with acute idiopathic thrombocytopenic purpura (ITP) includes which therapeutic intervention? a. Splenectomy b. Intravenous administration of anti-D antibody c. Use of nonsteroidal anti-inflammatory drugs (NSAIDs) d. Helping child participate in sports

ANS: B Anti-D antibody causes an increase in platelet count approximately 48 hours after administration. Splenectomy is reserved for chronic severe ITP not responsive to pharmacologic management. NSAIDs are not used in ITP. Both NSAIDs and aspirin interfere with platelet aggregation. The nurse works with the child and parents to choose quiet activities while the platelet count is below 100,000/mm3.

A toddler is admitted to the pediatric unit with presumptive bacterial meningitis. The initial orders include isolation, intravenous access, cultures, and antimicrobial agents. The nurse knows that antibiotic therapy will begin when? a. After the diagnosis is confirmed b. When the medication is received from the pharmacy c. After the child's fluid and electrolyte balance is stabilized d. As soon as the practitioner is notified of the culture results

ANS: B Antimicrobial therapy is begun as soon as a presumptive diagnosis is made. The choice of drug is based on the most likely infective agent. Drug choice may be adjusted when the culture results are obtained. Waiting for culture results to begin therapy increases the risk of neurologic damage. Although fluid and electrolyte balance is important, there is no indication that this child is unstable. Antibiotic therapy would be a priority intervention.

The nurse has just collected blood by venipuncture in the antecubital fossa. What should the nurse do next? a. Keep the child's arm extended while applying a Band-Aid to the site. b. Keep the child's arm extended and apply pressure to the site for a few minutes. c. Apply a Band-Aid to the site and keep the arm flexed for 10 minutes. d. Apply a gauze pad or cotton ball to the site and keep the arm flexed for several minutes.

ANS: B Applying pressure to the site of venipuncture stops the bleeding and aids in coagulation. Pressure should be applied before a bandage or gauze pad is applied.

The nurse is caring for a child with carbon monoxide (CO) poisoning associated with smoke inhalation. What intervention is essential in this child's care? a. Monitor pulse oximetry. b. Monitor arterial blood gases. c. Administer oxygen if respiratory distress develops. d. Administer oxygen if child's lips become bright, cherry-red in color.

ANS: B Arterial blood gases are the best way to monitor CO poisoning. Pulse oximetry is contraindicated in the case of CO poisoning because the PaO2 may be normal. One hundred percent oxygen should be given as quickly as possible, not only if respiratory distress or other symptoms develop.

The nurse is caring for a child with carbon monoxide poisoning associated with smoke inhalation. Which is essential in this child's care? a. Monitor pulse oximetry. b. Monitor arterial blood gases. c. Administer oxygen if respiratory distress develops. d. Administer oxygen if child's lips become bright, cherry red.

ANS: B Arterial blood gases are the best way to monitor carbon monoxide poisoning. Pulse oximetry is contraindicated in the case of carbon monoxide poisoning because the PaO2 may be normal. The child should receive 100% oxygen as quickly as possible, not only if respiratory distress or other symptoms develop.

Arterial blood gases have just been drawn on a child. What should the nurse do next? a. Take the sample to the laboratory immediately. b. Pack the sample in ice and take it to the laboratory immediately. c. Place the sample in a brown bag until it can be taken to laboratory. d. Refrigerate the sample until it can be taken to the laboratory.

ANS: B Arterial blood gases require careful handling for accurate results. Immediately after obtaining the specimen, the nurse packs it in ice to reduce cellular metabolism and takes it to the laboratory.

A cardiac defect that allows blood to shunt from the (high pressure) left side of the heart to the (lower pressure) right side can result in which condition? a. Cyanosis b. Heart failure c. Decreased pulmonary blood flow d. Bounding pulses in upper extremities

ANS: B As blood is shunted into the right side of the heart, there is increased pulmonary blood flow and the child is at high risk for heart failure. Cyanosis usually occurs in defects with decreased pulmonary blood flow. Bounding upper extremity pulses are a manifestation of coarctation of the aorta.

What is the single most prevalent cause of disability in children and responsible for the recent increase in childhood disability? a. Cancer b. Asthma c. Seizures d. Heart disease

ANS: B Asthma is the single most prevalent cause of disability in children and has been largely responsible for much of the recent increase in childhood disability.

The nurse is caring for a child after a parathyroidectomy. What medication should the nurse have available if hypocalcemia occurs? a. Insulin b. Calcium gluconate c. Propylthiouracil (PTU) d. Cortisone (hydrocortisone)

ANS: B Because hypocalcemia is a potential complication after a parathyroidectomy, observing for signs of tetany, instituting seizure precautions, and having calcium gluconate available for emergency use are part of the nursing care.

The nurse is caring for an infant with myelomeningocele scheduled for surgical closure in the morning. Which interventions should the nurse plan for the care of the myelomeningocele sac? a. Open to air b. Covered with a sterile moist nonadherent dressing c. Reinforcement of the original dressing if drainage noted d. A diaper secured over the dressing

ANS: B Before surgical closure, the myelomeningocele is prevented from drying by the application of a sterile, moist, nonadherent dressing over the defect. The moistening solution is usually sterile normal saline. Dressings are changed frequently (every 2 to 4 hours), and the sac is closely inspected for leaks, abrasions, irritation, and any signs of infection. The sac must be carefully cleansed if it becomes soiled or contaminated. The original dressing would not be reinforced but changed as needed. A diaper is not placed over the dressing because stool contamination can occur.

What is an advantage of the ventrogluteal muscle as an injection site in young children? a. Easily accessible from many directions b. Free of significant nerves and vascular structures c. Can be used until child reaches a weight of 9 kg (20 lb) d. Increased subcutaneous fat, which provides sustained drug absorption

ANS: B Being free of significant nerves and vascular structure is one of the advantages of the ventrogluteal site. In addition, it is considered less painful than the vastus lateralis. The major disadvantage is lack of familiarity by health professionals and controversy over whether the site can be used before weight bearing. The vastus lateralis is a more accessible site. The ventrogluteal muscle site has safely been used from newborn through adulthood. Clinical guidelines address the need for the child to be walking. The site has less subcutaneous tissue, which facilitates intramuscular deposition of the drug rather than subcutaneous.

The nurse is teaching nursing students about shock that occurs in children. One of the most frequent causes of hypovolemic shock in children is: a. sepsis. b. blood loss. c. anaphylaxis. d. congenital heart disease.

ANS: B Blood loss is the most frequent cause of hypovolemic shock in children. Sepsis causes septic shock, which is overwhelming sepsis and circulating bacterial toxins. Anaphylactic shock results from extreme allergy or hypersensitivity to a foreign substance. Congenital heart disease contributes to hypervolemia, not hypovolemia.

What is the most frequent cause of hypovolemic shock in children? a. Sepsis b. Blood loss c. Anaphylaxis d. Heart failure

ANS: B Blood loss is the most frequent cause of hypovolemic shock in children. Sepsis causes septic shock, which is overwhelming sepsis and circulating bacterial toxins. Anaphylactic shock results from extreme allergy or hypersensitivity to a foreign substance. Heart failure contributes to hypervolemia, not hypovolemia.

What statement is most descriptive of Meckel diverticulum? a. It is acquired during childhood. b. Intestinal bleeding may be mild or profuse. c. It occurs more frequently in females than in males. d. Medical interventions are usually sufficient to treat the problem.

ANS: B Bloody stools are often a presenting sign of Meckel diverticulum. It is associated with mild to profuse intestinal bleeding. Meckel diverticulum is the most common congenital malformation of the gastrointestinal tract and is present in 1% to 4% of the general population. It is more common in males than in females. The standard therapy is surgical removal of the diverticulum.

A child with cystic fibrosis (CF) receives aerosolized bronchodilator medication. When should this medication be administered? a. After chest physiotherapy (CPT) b. Before chest physiotherapy (CPT) c. After receiving 100% oxygen d. Before receiving 100% oxygen

ANS: B Bronchodilators should be given before CPT to open bronchi and make expectoration easier. These medications are not helpful when used after CPT. Oxygen is administered only in acute episodes, with caution, because of chronic carbon dioxide retention.

What clinical manifestations suggest hydrocephalus in an infant? a. Closed fontanel and high-pitched cry b. Bulging fontanel and dilated scalp veins c. Constant low-pitched cry and restlessness d. Depressed fontanel and decreased blood pressure

ANS: B Bulging fontanels, dilated scalp veins, and separated sutures are clinical manifestations of hydrocephalus in neonates. A closed fontanel, high-pitched cry, constant low-pitched cry, restlessness, a depressed fontanel, and decreased blood pressure are not clinical manifestations of hydrocephalus, but all should be referred for evaluation.

A child is admitted to the hospital with lesions on his abdomen that appear like cigarette burns. What should accurate documentation by the nurse include? a. Two unhealed lesions are on the child's abdomen. b. Two round 4-mm lesions are on the child's lower abdomen. c. Two round symmetrical lesions are on the child's lower abdomen. d. Two round lesions on the child's abdomen that appear to be cigarette burns.

ANS: B Burn documentation should include the location, pattern, demarcation lines, and presence of eschar or blisters. The option that includes the size of the lesions is the most accurate.

A toddler's mother calls the nurse because she thinks her son has swallowed a button type of battery. He has no signs of respiratory distress. The nurse's response should be based on which premise? a. An emergency laparotomy is very likely. b. The location needs to be confirmed by radiographic examination. c. Surgery will be necessary if the battery has not passed in the stool in 48 hours. d. Careful observation is essential because an ingested battery cannot be accurately detected.

ANS: B Button batteries can cause severe damage if lodged in the esophagus. If both poles of the battery come in contact with the wall of the esophagus, acid burns, necrosis, and perforation can occur. If the battery is in the stomach, it will most likely be passed without incident. Surgery is not indicated. The battery is metallic and is readily seen on radiologic examination.

The nurse is preparing a staff education in-service session for a group of new graduate nurses who will be working in a long-term care facility for children; many of the children have cerebral palsy (CP). What statement should the nurse include in the training? a. Children with dyskinetic CP have a wide-based gait and repetitive movements. b. Children with spastic pyramidal CP have a positive Babinski sign and ankle clonus. c. Children with hemiplegia CP have mouth muscles and one lower limb affected. d. Children with ataxic CP have involvement of pharyngeal and oral muscles with dysarthria.

ANS: B CP has a variety of clinical classifications. Spastic pyramidal CP includes manifestations such as a positive Babinski sign and ankle clonus; ataxic CP has a wide-based gait and repetitive movements; hemiplegia CP is characterized by motor dysfunction on one side of the body with upper extremity more affected than lower limbs; and dyskinetic CP involves the pharyngeal and oral muscles, causing drooling and dysarthria.

What drug is an angiotensin-converting enzyme (ACE) inhibitor? a. Furosemide (Lasix) b. Captopril (Capoten) c. Chlorothiazide (Diuril) d. Spironolactone (Aldactone)

ANS: B Captopril is an ACE inhibitor. Furosemide is a loop diuretic. Chlorothiazide works on the distal tubules. Spironolactone blocks the action of aldosterone and is a potassium-sparing diuretic.

The nurse is caring for a child with acute respiratory distress syndrome (ARDS) associated with sepsis. What nursing action should be included in the care of the child? a. Force fluids. b. Monitor pulse oximetry. c. Institute seizure precautions. d. Encourage a high-protein diet.

ANS: B Careful monitoring of oxygenation and cardiopulmonary status is an important evaluation tool in the care of the child with ARDS. Maintenance of vascular volume and hydration is important and should be done parenterally. Seizures are not a side effect of ARDS. Adequate nutrition is necessary, but a high-protein diet is not helpful.

Which of the following is descriptive of central nervous system stimulants? a. They produce strong physical dependence. b. They can result in strong psychologic dependence. c. Withdrawal symptoms are life threatening. d. Acute intoxication can lead to coma.

ANS: B Central nervous system stimulants such as amphetamines and cocaine produce a strong psychologic dependence.

Strict isolation is required for a child who is hospitalized with: a. mumps. b. chickenpox. c. exanthema subitum (roseola). d. erythema infectiosum (fifth disease).

ANS: B Chickenpox is communicable through direct contact, droplet spread, and contaminated objects.

What is the most common form of child maltreatment? a. Sexual abuse b. Child neglect c. Physical abuse d. Emotional abuse

ANS: B Child neglect, which is characterized by the failure to provide for the child's basic needs, is the most common form of child maltreatment. Sexual abuse, physical abuse, and emotional abuse are individually not as common as neglect.

The nurse is teaching nursing students about normal physiologic changes in the respiratory system of toddlers. Which best describes why toddlers have fewer respiratory tract infections as they grow older? a. The amount of lymphoid tissue decreases. b. Repeated exposure to organisms causes increased immunity. c. Viral organisms are less prevalent in the population. d. Secondary infections rarely occur after viral illnesses.

ANS: B Children have increased immunity after exposure to a virus. The amount of lymphoid tissue increases as children grow older. Viral organisms are not less prevalent, but older children have the ability to resist invading organisms. Secondary infections after viral illnesses include Mycoplasma pneumoniae and group A -hemolytic streptococcal infections.

What intervention should be included in the nursing care of a child with autism spectrum disorder (ASD)? a. Assign multiple staff to care for the child. b. Communicate with the child at his or her developmental level. c. Provide a wide variety of foods for the child to try. d. Place the child in a semiprivate room with a roommate of a similar age.

ANS: B Children with ASD require individualized care. The nurse needs to communicate with the child at the child's developmental level. Consistent caregivers are essential for children with ASD. The same staff members should care for the child as much as possible. Children with ASD do not adapt to changing situations. The same foods should be provided to allow the child to adjust. A private room is desirable for children with ASD. Stimulation is minimized.

The nurse is conducting discharge teaching with the parent of a 7-year-old child with minimal change nephrotic syndrome (MCNS). What statement by the parent indicates a correct understanding of the teaching? a. "My child needs to stay home from school for at least 1 more month." b. "I should not add additional salt to any of my child's meals." c. "My child will not be able to participate in contact sports while receiving corticosteroid therapy." d. "I should measure my child's urine after each void and report the 24-hour amount to the health care provider."

ANS: B Children with MCNS can be treated at home after the initial phase with appropriate discharge instructions, including a salt restriction of no additional salt to the child's meals. The child may return to school but should avoid exposure to infected playmates. Participation in contact sports is not affected by corticosteroid therapy. The parent does not need to measure the child's urine on a daily basis but may be instructed to test for albumin.

One of the goals for children with asthma is to maintain the child's normal functioning. What principle of treatment helps to accomplish this goal? a. Limit participation in sports. b. Reduce underlying inflammation. c. Minimize use of pharmacologic agents. d. Have yearly evaluations by a health care provider.

ANS: B Children with asthma are often excluded from exercise. This practice interferes with peer interaction and physical health. Most children with asthma can participate provided their asthma is under control. Inflammation is the underlying cause of the symptoms of asthma. By decreasing inflammation and reducing the symptomatic airway narrowing, health care providers can minimize exacerbations. Pharmacologic agents are used to prevent and control asthma symptoms, reduce the frequency and severity of asthma exacerbations, and reverse airflow obstruction. It is recommended that children with asthma be evaluated every 6 months.

A 13-year-old child with cystic fibrosis (CF) is a frequent patient on the pediatric unit. This admission, she is sleeping during the daytime and unable to sleep at night. What should be a beneficial strategy for this child? a. Administer prescribed sedative at night to aid in sleep. b. Negotiate a daily schedule that incorporates hospital routine, therapy, and free time. c. Have the practitioner speak with the child about the need for rest when receiving therapy for CF. d. Arrange a consult with the social worker to determine whether issues at home are interfering with her care.

ANS: B Children's response to the disruption of routine during hospitalization is demonstrated in eating, sleeping, and other activities of daily living. The lack of structure is allowing the child to sleep during the day, rather than at night. Most likely the lack of schedule is the problem. The nurse and child can plan a schedule that incorporates all necessary activities, including medications, mealtimes, homework, and patient care procedures. The schedule can then be posted so the child has a ready reference. Sedatives are not usually used with children. The child has a chronic illness and most likely knows the importance of rest. The parents and child can be questioned about changes at home since the last hospitalization.

A child is on phenytoin (Dilantin). What should the nurse encourage? a. Fluid restriction b. Good dental hygiene c. A decrease in vitamin D intake d. Taking the medication with milk

ANS: B Chronic treatment with phenytoin may cause gum hypertrophy. Children taking phenobarbital or phenytoin should receive adequate vitamin D and folic acid because deficiencies of both have been associated with these drugs. The medication should not be taken with milk, and fluids should be encouraged, not restricted.

The psychologic effects of being obese during adolescence include which of the following? a. Sexual promiscuity b. Poor body image c. Feelings of contempt for thin peers d. Accurate body image but self-deprecating attitude

ANS: B Common emotional consequences of obesity include poor body image, low self-esteem, social isolation, and feelings of depression and isolation.

A neonate born with ambiguous genitalia is diagnosed with congenital adrenogenital hyperplasia. Therapeutic management includes administration of: a. vitamin D. b. cortisone. c. stool softeners. d. calcium carbonate.

ANS: B Cortisone is administered to suppress the abnormally high secretions of adrenocorticotropic hormone (ACTH). This in turn inhibits the secretion of adrenocorticosteroid, which stems the progressive virilization. Vitamin D, stool softeners, and calcium carbonate have no role in the therapy of adrenogenital hyperplasia.

The parents of a 7-year-old boy tell the nurse that lately he has been cruel to their family pets and actually caused physical harm. The nurse's recommendation should be based on remembering what? a. This is an expected behavior at this age. b. This is a warning sign of a serious problem. c. This is harmless venting of anger and frustration. d. This is common in children who are physically abused.

ANS: B Cruelty to family pets is not an expected behavior. Hurting animals can be one of the earliest symptoms of a conduct disorder. Abusing animals does not dissipate violent emotions; rather, the acts may fuel the abusive behaviors. Referral for evaluation is essential. This behavior may be seen in emotional abuse or neglect, not physical abuse

Intranasal administration of desmopressin acetate (DDAVP) is used to treat which condition? a. Hypopituitarism b. Diabetes insipidus (DI) c. Syndrome of inappropriate antidiuretic hormone (SIADH) d. Acute adrenocortical insufficiency

ANS: B DDAVP is the treatment of choice for DI. It is administered intranasally through a flexible tube. The child's response pattern is variable, with effectiveness lasting from 6 to 24 hours.

Iron overload is a side effect of chronic transfusion therapy. What treatment assists in minimizing this complication? a. Magnetic therapy b. Infusion of deferoxamine c. Hemoglobin electrophoresis d. Washing red blood cells (RBCs) to reduce iron

ANS: B Deferoxamine infusions in combination with vitamin C allow the iron to remain in a more chelatable form. The iron can then be excreted more easily. Use of magnets does not remove additional iron from the body. Hemoglobin electrophoresis is used to confirm the diagnosis of hemoglobinopathies; it does not affect iron overload. Washed RBCs remove white blood cells and other proteins from the unit of blood; they do not affect the iron concentration.

The nurse should suspect a child has cerebral palsy (CP) if the parent says what? a. "My 6-month-old baby is rolling from back to prone now." b. "My 4-month-old doesn't lift his head when on his tummy." c. "My 8-month-old can sit without support." d. "My 10-month-old is not walking."

ANS: B Delayed gross motor development is a universal manifestation of CP. The child shows a delay in all motor accomplishments, and the discrepancy between motor ability and expected achievement tends to increase with successive developmental milestones as growth advances. The infant who does not lift his head when on the tummy is showing a gross motor delay, as that is seen at 0 to 3 months. The other statements are within normal growth and development expectations.

Kristin, age 10 years, sustained a fracture in the epiphyseal plate of her right fibula when she fell off of a tree. When discussing this injury with her parents, the nurse should consider which statement? a. Healing is usually delayed in this type of fracture. b. Growth can be affected by this type of fracture. c. This is an unusual fracture site in young children. d. This type of fracture is inconsistent with a fall.

ANS: B Detection of epiphyseal injuries is sometimes difficult, but fractures involving the epiphysis or epiphyseal plate present special problems in determining whether bone growth will be affected. Healing of epiphyseal injuries is usually prompt. The epiphysis is the weakest point of the long bones. This is a frequent site of damage during trauma.

The nurse is giving discharge instructions to the parent of a 6-year-old child who had a cardiac catheterization 4 hours ago. What statement by the parent indicates a correct understanding of the teaching? a. "My child should not attend school for the next 5 days." b. "I should change the bandage every day for the next 2 days." c. "My child can take a tub bath but should avoid taking a shower for the next 4 days." d. "I should expect the site to be red and swollen for the next 3 days."

ANS: B Discharge instructions for a parent of a child who recently had a cardiac catheterization should include changing the bandage every day for the next 2 days. The child should avoid strenuous exercise but can go back to school. The child should avoid a tub bath, but an older child could take a shower the first day after the catheterization. The site should not have swelling or redness; if there is, it should be reported to the health care practitioner.

As part of the treatment for heart failure, the child takes the diuretic furosemide (Lasix). As part of teaching home care, the nurse encourages the family to give the child foods such as bananas, oranges, and leafy vegetables. These foods are recommended because they are high in: a. chlorides. b. potassium. c. sodium. d. vitamins.

ANS: B Diuretics that work on the proximal and distal renal tubules contribute to increased losses of potassium. The child's diet should be supplemented with this electrolyte. With this type of diuretic, potassium must be monitored and supplemented as needed.

What consideration is most important in managing tuberculosis (TB) in children? a. Skin testing b. Chemotherapy c. Adequate rest d. Adequate hydration

ANS: B Drug therapy for TB includes isoniazid, rifampin, and pyrazinamide daily for 2 months and isoniazid and rifampin given two or three times a week by direct observation therapy for the remaining 4 months. Chemotherapy is the most important intervention for TB.

Which consideration is the most important in managing tuberculosis (TB) in children? a. Skin testing annually b. Pharmacotherapy c. Adequate nutrition d. Adequate hydration

ANS: B Drug therapy for TB includes isoniazid, rifampin, and pyrazinamide daily for 2 months and two or three times a week for the remaining 4 months. Pharmacotherapy is the most important intervention for TB.

A child has just returned from surgery for repair of a fractured femur. The child has a long-leg cast on. The toes on the leg with the cast are edematous, but they have color, sensitivity, and movement. What action should the nurse take? a. Call the health care provider to report the edema. b. Elevate the foot and leg on pillows. c. Apply a warm moist pack to the foot. d. Encourage movement of toes.

ANS: B During the first few hours after a cast is applied, the chief concern is that the extremity may continue to swell to the extent that the cast becomes a tourniquet, shutting off circulation and producing neurovascular complications (compartment syndrome). One measure to reduce the likelihood of this problem is to elevate the body part and thereby increase venous return. The health care provider does not need to be notified because edema is expected and warm moist packs will not decrease the edema. The child should move the toes, but that will not help reduce the edema.

Which one of the following statements best describes fear in the school-age child? a. They are increasingly fearful for body safety. b. Most of the new fears that trouble them are related to school and family. c. They should be encouraged to hide their fears to prevent ridicule by peers. d. Those who have numerous fears need continuous protective behavior by parents to eliminate these fears.

ANS: B During the school-age years, children experience a wide variety of fears, but new fears relate predominantly to school and family.

Which type of croup is always considered a medical emergency? a. Laryngitis b. Epiglottitis c. Spasmodic croup d. Laryngotracheobronchitis (LTB)

ANS: B Epiglottitis is always a medical emergency needing antibiotics and airway support for treatment. Laryngitis is a common viral illness in older children and adolescents, with hoarseness and URI symptoms. Spasmodic croup is treated with humidity. LTB may progress to a medical emergency in some children.

An adolescent is being seen in the clinic for evaluation of acromegaly. The nurse understands that which occurs with acromegaly? a. There is a lack of growth hormone (GH) being produced. b. There is excess growth hormone (GH) after closure of the epiphyseal plates. c. There is an excess of growth hormone (GH) before the closure of the epiphyseal plates. d. There is a lack of thyroid hormone being produced.

ANS: B Excess GH after closure of the epiphyseal plates results in acromegaly. A lack of growth hormone results in delayed growth or even dwarfism. Gigantism occurs when there is hypersecretion of GH before the closure of the epiphyseal plates. Cretinism is associated with hypothyroidism

Exophthalmos (protruding eyeballs) may occur in children with: a. hypothyroidism. b. hyperthyroidism. c. hypoparathyroidism. d. hyperparathyroidism.

ANS: B Exophthalmos is a clinical manifestation of hyperthyroidism. Hypothyroidism, hypoparathyroidism, and hyperparathyroidism are not associated with exophthalmos.

Exophthalmos (protruding eyeballs) may occur in children with which condition? a. Hypothyroidism b. Hyperthyroidism c. Hypoparathyroidism d. Hyperparathyroidism

ANS: B Exophthalmos is associated with hyperthyroidism. Hypothyroidism, hypoparathyroidism, and hyperparathyroidism are not associated with exophthalmos.

The nurse is preparing a school-age child for computed tomography (CT scan) to assess cerebral function. The nurse should include which statement in preparing the child? a. "Pain medication will be given." b. "The scan will not hurt." c. "You will be able to move once the equipment is in place." d. "Unfortunately, no one can remain in the room with you during the test."

ANS: B For CT scans, the child must be immobilized. It is important to emphasize to the child that at no time is the procedure painful. Pain medication is not required; however, sedation is sometimes necessary. Someone is able to remain with the child during the procedure

Families progress through various stages of reactions when a child is diagnosed with a chronic illness or disability. After the shock phase, a period of adjustment usually follows. This is often characterized by what response? a. Denial b. Guilt and anger c. Social reintegration d. Acceptance of the child's limitations

ANS: B For most families, the adjustment phase is accompanied by several responses, including guilt, self-accusation, bitterness, and anger. The initial diagnosis of a chronic illness or disability often is met with intense emotion and characterized by shock and denial. Social reintegration and acceptance of the child's limitations are the culmination of the adjustment process.

What description applies to fragile X syndrome? a. Chromosomal defect affecting only females b. Second most common genetic cause of cognitive impairment c. Most common cause of uninherited cognitive impairment d. Chromosomal defect that follows the pattern of X-linked recessive disorders

ANS: B Fragile X syndrome is the most common inherited cause of cognitive impairment and the second most common genetic cause of cognitive impairment after Down syndrome. Fragile X primarily affects males and follows the pattern of X-linked dominant inheritance with reduced penetrance.

What consideration is important for the nurse when changing dressings and applying topical medication to a child's abdomen and leg burns? a. Apply topical medication with clean hands. b. Wash hands and forearms before and after dressing change. c. If dressings have adhered to the wound, soak in hot water before removal. d. Apply dressing so that movement is limited during the healing process.

ANS: B Frequent hand and forearm washing is the single most important element of the infection-control program. Topical medications should be applied with a tongue blade or gloved hand. Dressings that have adhered to the wound can be removed with tepid water or normal saline. Dressings are applied with sufficient tension to remain in place but not so tightly as to impair circulation or limit motion.

A child with sickle cell disease is in a vasoocclusive crisis. What nonpharmacologic pain intervention should the nurse plan? a. Exercise as a distraction b. Heat to the affected area c. Elevation of the extremity d. Cold compresses to the affected area

ANS: B Frequently, heat to the affected area is soothing. Cold compresses are not applied to the area because doing so enhances vasoconstriction and occlusion. Bed rest is usually well tolerated during a crisis, although the actual rest obtained depends a great deal on pain alleviation and the use of organized schedules of nursing care. Although the objective of bed rest is to minimize oxygen consumption, some activity, particularly passive range of motion exercises, is beneficial to promote circulation. Usually the best course is to let children determine their activity tolerance. Elevating the extremity will not help in sickle cell disease.

Parents are concerned that their 6-year-old son continues to occasionally wet the bed. What does the nurse explain? a. This is likely because of increased stress at home. b. Enuresis usually ceases between 6 and 8 years of age. c. Drug therapy will be prescribed to treat the enuresis. d. Testing will be necessary to determine what type of kidney problem exists.

ANS: B Further data must be gathered before the diagnosis of enuresis is made. Enuresis is the inappropriate voiding of urine at least twice a week. This child does meet the age criterion, but the parents need to be questioned about and keep a diary on the frequency of events. If the bedwetting is infrequent, parents can be encouraged that the child may grow out of this behavior. Drug therapy will not be prescribed until a more complete evaluation is done. Additional assessment information must be gathered, but at this time, there is no indication of renal disease.

. When communicating with dying children, what should the nurse remember? a. Adolescent children tend to be concrete thinkers. b. Games, art, and play provide a good means of expression. c. When children can recite facts, they understand the implications of those facts. d. If children's questions direct the conversation, the assessment will be incomplete.

ANS: B Games, art, and play provide children a way to use their natural expressive means to stimulate dialogue. Adolescent children are abstract thinkers. Children may not understand the implication of facts just because they can recite them. The assessment is more complete when children's questions direct the conversation.

What should preoperative care of a newborn with an anorectal malformation include? a. Frequent suctioning b. Gastrointestinal decompression c. Feedings with sterile water only d. Supine position with head elevated

ANS: B Gastrointestinal decompression is an essential part of nursing care for a newborn with an anorectal malformation. This helps alleviate intraabdominal pressure until surgical intervention. Suctioning is not necessary for an infant with this type of anomaly. Feedings are not indicated until it is determined that the gastrointestinal tract is intact. Supine position with head elevated is indicated for infants with a tracheoesophageal fistula, not anorectal malformations.

What statement best identifies the cause of heart failure (HF)? a. Disease related to cardiac defects b. Consequence of an underlying cardiac defect c. Inherited disorder associated with a variety of defects d. Result of diminished workload imposed on an abnormal myocardium

ANS: B HF is the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures to meet the body's metabolic demands. HF is not a disease but rather a result of the inability of the heart to pump efficiently. HF is not inherited. HF occurs most frequently secondary to congenital heart defects in which structural abnormalities result in increased volume load or increased pressures on the ventricles.

Nursing strategies to improve the growth and development of the child with human immunodeficiency virus (HIV) infection should include what? a. Provide only those foods that the child feels like eating. b. Fortify foods with nutritional supplements to maximize quality of intake. c. Weigh the child and measure height and muscle mass on a daily basis. d. Provide high-fat and high-calorie meals and snacks to meet body requirements for growth.

ANS: B HIV infection often leads to marked failure to thrive and multiple nutritional deficiencies. Nutritional management may be difficult because of recurrent illness, diarrhea, and other physical problems. The nurse should implement intensive nutritional interventions if the child's growth begins to slow or weight begins to decrease. Fortifying foods with nutritional supplements will maximize quality of intake. The child does not need to be weighed daily, and high-fat meals and snacks should not be encouraged.

What finding is characteristic of fractures in children? a. Fractures rarely occur at the growth plate site because it absorbs shock well. b. Rapidity of healing is inversely related to the child's age. c. Pliable bones of growing children are less porous than those of adults. d. The periosteum of a child's bone is thinner, is weaker, and has less osteogenic potential compared to that of an adult.

ANS: B Healing is more rapid in children. The younger the child, the more rapid the healing process. Nonunion of bone fragments is uncommon except in severe injuries. The epiphyseal plate is the weakest point of long bones and a frequent site of injury during trauma. Children's bones are more pliable and porous than those of adults. This allows them to bend, buckle, and break. The greater porosity increases the flexibility of the bone and dissipates and absorbs a significant amount of the force on impact. The adult periosteum is thinner, is weaker, and has less osteogenic potential than that of a child.

The regulation of red blood cell (RBC) production is thought to be controlled by which physiologic factor? a. Hemoglobin b. Tissue hypoxia c. Reticulocyte count d. Number of RBCs

ANS: B Hemoglobin does not directly control RBC production. If there is insufficient hemoglobin to adequately oxygenate the tissue, then erythropoietin may be released. When tissue hypoxia occurs, the kidneys release erythropoietin into the bloodstream. This stimulates the marrow to produce new RBCs. Reticulocytes are immature RBCs. The "retic" count can be used to monitor hematopoiesis. The number of RBCs does not directly control production. In congenital cardiac disorders with mixed blood flow or decreased pulmonary blood flow, RBC production continues secondary to tissue hypoxia.

What is a clinical manifestation of acetaminophen poisoning? a. Hyperpyrexia b. Hepatic involvement c. Severe burning pain in stomach d. Drooling and inability to clear secretions

ANS: B Hepatic involvement is the third stage of acetaminophen poisoning. Hyperpyrexia is a severe elevation in body temperature and is not related to acetaminophen poisoning. Acetaminophen does not cause burning pain in stomach and does not pose an airway threat.

What type of dehydration occurs when the electrolyte deficit exceeds the water deficit? a. Isotonic dehydration b. Hypotonic dehydration c. Hypertonic dehydration d. Hyperosmotic dehydration

ANS: B Hypotonic dehydration occurs when the electrolyte deficit exceeds the water deficit, leaving the serum hypotonic. Isotonic dehydration occurs in conditions in which electrolyte and water deficits are present in balanced proportion. Hypertonic dehydration results from water loss in excess of electrolyte loss. This is the most dangerous type of dehydration. It is caused by feeding children fluids with high amounts of solute. Hyperosmotic dehydration is another term for hypertonic dehydration.

An 8-year-old child is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than _____ beats/min. a. 60 b. 70 c. 90 d. 100

ANS: B If a 1-minute apical pulse is less than 70 beats/min for an older child, the digoxin is withheld; 60 beats/min is the cut-off for holding the digoxin dose in an adult. A pulse below 90 to 110 beats/min is the determination for not giving a digoxin dose to infants and young children.

A 2-year-old child is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than which rate? a. 60 beats/min b. 90 beats/min c. 100 beats/min d. 120 beats/min

ANS: B If a 1-minute apical pulse is less than 90 beats/min for an infant or young child, the digoxin is withheld. Sixty beats/min is the cut-off for holding the digoxin dose in an adult. One hundred to 120 beats/min is an acceptable pulse rate for the administration of digoxin.

Which position should the nurse place a 10-year-old child after a large tumor was removed through a supratentorial craniotomy? a. On the inoperative side with the bed flat b. On the inoperative side with the head of bed elevated 20 to 30 degrees c. On the operative side with the bed flat and pillows behind the head d. On the operative side with the head of bed elevated 45 degrees

ANS: B If a large tumor was removed, the child is not placed on the operative side because the brain may suddenly shift to that cavity, causing trauma to the blood vessels, linings, and the brain itself. The child with an infratentorial procedure is usually positioned on either side with the bed flat. When a supratentorial craniotomy is performed, the head of bed is elevated 20 to 30 degrees with the child on either side or on the back. In a supratentorial craniotomy, the head elevation facilitates CSF drainage and decreases excessive blood flow to the brain to prevent hemorrhage. Pillows should be placed against the child's back, not head, to maintain the desired position.

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

ANS: B Illness and hospitalization may be viewed as punishment in preschoolers. Always state directly that procedures are never a form of punishment.

Immobilization causes what effect on metabolism? a. Hypocalcemia b. Decreased metabolic rate c. Positive nitrogen balance d. Increased levels of stress hormones

ANS: B Immobilization causes a decreased metabolic rate with slowing of all systems and a decreased food intake. Immobilization leads to hypercalcemia and a negative nitrogen balance secondary to muscle atrophy. Decreased production of stress hormones occurs with decreased physical and emotional coping capacity.

The nurse is caring for a preschool child immobilized by a spica cast. Which effect on metabolism should the nurse monitor on this child related to the immobilized status? a. Hypocalcemia b. Decreased metabolic rate c. Positive nitrogen balance d. Increased production of stress hormones

ANS: B Immobilization causes a decreased metabolic rate with slowing of all systems and a decreased food intake. Immobilization leads to hypercalcemia and causes a negative nitrogen balance secondary to muscle atrophy. A decreased production of stress hormones occurs with decreased physical and emotional coping capacity.

Cardiopulmonary resuscitation is begun on a toddler. What pulse is usually palpated because it is the most central and accessible? a. Radial b. Carotid c. Femoral d. Brachial

ANS: B In a toddler, the carotid pulse is palpated. The radial pulse is not considered a central pulse. The femoral pulse is not the most central and accessible. Brachial pulse is felt in infants younger than 1 year of age.

Cardiopulmonary resuscitation (CPR) is begun on a toddler. Which pulse is usually palpated because it is the most central and accessible? a. Radial b. Carotid c. Femoral d. Brachial

ANS: B In a toddler, the carotid pulse is palpated. The radial pulse is not considered a central pulse. The femoral pulse is not the most central and accessible. Brachial pulse is felt in infants younger than 1 year.

What statement is the most descriptive of asthma? a. It is inherited. b. There is heightened airway reactivity. c. There is decreased resistance in the airway. d. The single cause of asthma is an allergic hypersensitivity.

ANS: B In asthma, spasm of the smooth muscle of the bronchi and bronchioles causes constriction, producing impaired respiratory function. Atopy, or development of an immunoglobulin E (IgE)-mediated response, is inherited but is not the only cause of asthma. Asthma is characterized by increased resistance in the airway. Asthma has multiple causes, including allergens, irritants, exercise, cold air, infections, medications, medical conditions, and endocrine factors.

The nurse is caring for a child with persistent hypoxia secondary to a cardiac defect. The nurse recognizes that a risk exists of cerebrovascular accidents (strokes). Which is an important objective to decrease this risk? a. Minimize seizures. b. Prevent dehydration. c. Promote cardiac output. d. Reduce energy expenditure.

ANS: B In children with persistent hypoxia, polycythemia develops. Dehydration must be prevented in hypoxemic children because it potentiates the risk of strokes. Minimizing seizures, promoting cardiac output, and reducing energy expenditure will not reduce the risk of cerebrovascular accidents.

The nurse is caring for a child with persistent hypoxia secondary to a cardiac defect. The nurse recognizes the risk of cerebrovascular accidents (strokes) occurring. What strategy is an important objective to decrease this risk? a. Minimize seizures. b. Prevent dehydration. c. Promote cardiac output. d. Reduce energy expenditure.

ANS: B In children with persistent hypoxia, polycythemia develops. Dehydration must be prevented in hypoxemic children because it potentiates the risk of strokes. Minimizing seizures, promoting cardiac output, and reducing energy expenditure will not reduce the risk of cerebrovascular accidents.

In anticipation of the admission of a child with hereditary spherocytosis (HS) who is experiencing an aplastic crisis, what action should the nurse plan? a. Secure an isolation room. b. Prepare for a transfusion of packed red blood cells. c. Anticipate preoperative preparation for a splenectomy. d. Gather equipment and medication for treatment of shock.

ANS: B In hereditary spherocytosis, aplastic crisis results in a sudden cessation of RBC production by the bone marrow. Hemoglobin and hematocrit values drop rapidly, which results in severe anemia. Transfusion support may be needed, and close monitoring of the child's cardiovascular status is necessary. The nurse should prepare for a transfusion of packed red blood cells initially. An isolation room is not needed, splenectomy would not be done at this time, and the child will not be in shock.

The mother of a 20-month-old boy tells the nurse that he has a barking cough at night. His temperature is 37° C (98.6° F). The nurse suspects mild croup and should recommend which intervention? a. Admit to the hospital and observe for impending epiglottitis. b. Provide fluids that the child likes and use comfort measures. c. Control fever with acetaminophen and call if cough gets worse tonight. d. Try over-the-counter cough medicine and come to the clinic tomorrow if no improvement.

ANS: B In mild croup, therapeutic interventions include adequate hydration (as long as the child can easily drink) and comfort measures to minimize distress. The child is not exhibiting signs of epiglottitis. A temperature of 37° C is within normal limits. Although a return to the clinic may be indicated, the mother is instructed to return if the child develops noisy respirations or drooling.

A 2-year-old child comes to the emergency department with dehydration and hypovolemic shock. Which of the following best explains why an intraosseous infusion is started? a. It is less painful for small children. b. Rapid venous access is not possible. c. Antibiotics must be started immediately. d. Long-term central venous access is not possible.

ANS: B In situations in which rapid establishment of systemic access is vital and venous access is hampered, such as peripheral circulatory collapse and hypovolemic shock, intraosseous infusion provides a rapid, safe, lifesaving alternative.

The nurse is caring for a neonate born with a myelomeningocele. Surgery to repair the defect is scheduled the next day. The most appropriate way to position and feed this neonate is which position? a. Prone and tube-fed b. Prone, head turned to side, and nipple-fed c. Supine in an infant carrier and nipple-fed d. Supine, with defect supported with rolled blankets, and nipple-fed

ANS: B In the prone position, feeding is a problem. The infant's head is turned to one side for feeding. If the child is able to nipple-feed, tube feeding is not needed. Before surgery, the infant is kept in the prone position to minimize tension on the sac and risk of trauma.

Which occurs in septic shock? a. Hypothermia b. Increased cardiac output c. Vasoconstriction d. Angioneurotic edema

ANS: B Increased cardiac output, which results in warm, flushed skin, is one of the manifestations of septic shock. Fever and chills are characteristic of septic shock. Vasodilation is more common than vasoconstriction. Angioneurotic edema occurs as a manifestation in anaphylactic shock.

The nurse is preparing to give digoxin (Lanoxin) to a 9-month-old infant. The nurse checks the dose and draws up 4 ml of the drug. The most appropriate nursing action is which? a. Mix the dose with juice to disguise its taste. b. Do not give the dose; suspect a dosage error. c. Check the heart rate; administer digoxin if the rate is greater than 100 beats/min. d. Check the heart rate; administer digoxin if the rate is greater than 80 beats/min.

ANS: B Infants rarely receive more than 1 ml (50 mcg, or 0.05 mg) of digoxin in one dose; a higher dose is an immediate warning of a dosage error. To ensure safety, compare the calculation with that of another staff member before giving digoxin.

An adolescent with irritable bowel syndrome comes to see the school nurse. What information should the nurse share with the adolescent? a. A low-fiber diet is required. b. Stress management may be helpful. c. Milk products are a contributing factor. d. Pantoprazole (a proton pump inhibitor) is effective in treatment.

ANS: B Irritable bowel syndrome is believed to involve motor, autonomic, and psychologic factors. Stress management, environmental modification, and psychosocial intervention may reduce stress and gastrointestinal symptoms. A high-fiber diet with psyllium supplement is often beneficial. Milk products can exacerbate bowel problems caused by lactose intolerance. Antispasmodic drugs, antidiarrheal drugs, and simethicone are beneficial for some individuals. Proton pump inhibitors have no effect.

In preparing to give "enemas until clear" to a young child, the nurse should select which of the following? a. Tap water b. Normal saline c. Oil retention d. Fleet solution

ANS: B Isotonic solutions should be used in children. Saline is the solution of choice.

How much folic acid is recommended for women of childbearing age? a. 1.0 mg b. 0.4 mg c. 1.5 mg d. 2.0 mg

ANS: B It has been estimated that a daily intake of 0.4 mg of folic acid in women of childbearing age will prevent 50% to 70% of cases of neural tube defects; 1.0 mg is too low a dose; 1.5 to 2.0 mg are not the recommended dosages of folic acid.

The nurse is teaching the parent of a preschool child how to administer the child's insulin injection. The child will be receiving 2 units of regular insulin and 12 units of NPH insulin every morning. What should the parent be taught? a. Draw the insulin in separate syringes. b. Draw the regular insulin first and then the NPH into the same syringe. c. Draw the NPH insulin first and then the regular into the same syringe. d. Check blood sugar first, and if below 120, hold the regular insulin and give the NPH.

ANS: B To obtain maximum benefit from mixing insulins, the recommended practice is to (1) inject the measured amount of air (equivalent to the dosage) into the long-acting insulin; (2) inject the measured amount of air into the rapid-acting (clear) insulin and, without removing the needle; (3) withdraw the clear insulin; and (4) insert the needle (already containing the clear insulin) into the long-acting (cloudy) insulin and then withdraw the desired amount. The blood sugar may be checked before giving the insulin, but the prescribed dose should not be withheld if the blood sugar is 120.

A nurse must do a venipuncture on a 6-year-old child. What consideration is important in providing atraumatic care? a. Use an 18-gauge needle if possible. b. Show the child the equipment to be used before the procedure. c. If not successful after four attempts, have another nurse try. d. Restrain the child completely.

ANS: B To provide atraumatic care the child should be able to see the equipment to be used before the procedure begins. Use the smallest gauge needle that permits free flow of blood. A two-try-only policy is desirable, in which two operators each have only two attempts. If insertion is not successful after four punctures, alternative venous access should be considered. Restrain the child only as needed to perform the procedure safely; use therapeutic hugging.

An infant is diagnosed with transposition of the great vessels. Prostaglandin E1 is given intravenously. The parents ask how long the child will remain on the prostaglandin E1. What is the appropriate response by the nurse? a. Prostaglandin E1 will be given intermittently until corrective surgery is performed. b. Prostaglandin E1 will be given continuously until corrective surgery is performed. c. Prostaglandin E1 will be given continuously throughout the preoperative and postoperative periods until the child is stable. d. Prostaglandin E1 will be given intermittently throughout the preoperative and postoperative periods until the child is stable.

ANS: B To provide intracardiac mixing for a child with transposition of the great arteries, intravenous prostaglandin E1 is administered continuously to keep the ductus arteriosus open to temporarily increase blood mixing and provide an oxygen saturation of 75% or to maintain cardiac output until surgery. It is discontinued after surgery.

An 8-year-old girl has been uncooperative and angry since the diagnosis of cancer was made. Her parents tell the nurse that they do not know what to do "because she is always so mad at us." What nursing action is most appropriate at this time? a. Explain to child that anger is not helpful. b. Help the parents deal with her anger constructively. c. Ask the parents to find out what she is angry about. d. Encourage the parents to ignore the anger at this time.

ANS: B To school-age children, chronic illness and dying represent a loss of control. This threat to their sense of security and ego strength can be manifested by verbal uncooperativeness. The child can be viewed as impolite, insolent, and stubborn. The best intervention is to encourage children to talk about feelings and give control where possible. Verbal explanations would not be "heard" by the child. The child may not be cognizant of the anger. Ignoring the anger will not help the child gain some control over the events.

At which age should a nurse keep teaching time short (5 minutes)? a. Infant b. Toddler c. Preschool d. School age

ANS: B Toddlers have limited time concept, and teaching time should be kept short (5-10 minutes).

What is an appropriate nursing intervention when caring for a child in traction? a. Removing adhesive traction straps daily to prevent skin breakdown b. Assessing for tightness, weakness, or contractures in uninvolved joints and muscles c. Providing active range of motion exercises to affected extremity three times a day d. Keeping child prone to maintain good alignment

ANS: B Traction places stress on the affected bone, joint, and muscles. The nurse must assess for tightness, weakness, or contractures developing in the uninvolved joints and muscles. The adhesive straps should be released or replaced only when absolutely necessary. Active, passive, or active with resistance exercises should be carried out for the unaffected extremity only. Movement is expected with children. Each time the child moves, the nurse should check to ensure that proper alignment is maintained.

Which is an appropriate nursing intervention when caring for a child in traction? a. Remove adhesive traction straps daily to prevent skin breakdown. b. Assess for tightness, weakness, or contractures in uninvolved joints and muscles. c. Provide active range-of-motion exercises to affected extremity three times a day. d. Keep the child in one position to maintain good alignment.

ANS: B Traction places stress on the affected bone, joint, and muscles. The nurse must assess for tightness, weakness, or contractures developing in the uninvolved joints and muscles. The adhesive straps should be released or replaced only when absolutely necessary. Active, passive, or active with resistance exercises should be carried out for the unaffected extremity only. Movement is expected with children. Each time the child moves, the nurse should check to ensure that proper alignment is maintained.

The nurse is admitting a school-age child with suspected Guillain-Barré syndrome (GBS). Which is a priority in the care for this child? a. Monitoring intake and output b. Assessing respiratory efforts c. Placing on a telemetry monitor d. Obtaining laboratory studies

ANS: B Treatment of GBS is primarily supportive. In the acute phase, patients are hospitalized because respiratory and pharyngeal involvement may require assisted ventilation, sometimes with a temporary tracheotomy. Treatment modalities include aggressive ventilatory support in the event of respiratory compromise, intravenous (IV) administration of immunoglobulin (IVIG), and sometimes steroids; plasmapheresis and immunosuppressive drugs may also be used. Intake and output, telemetry monitoring and obtaining laboratory studies may be part of the plan of care but are not the priority.

Effective cardiopulmonary resuscitation (CPR) on a 5-year-old child should include what technique? a. Provide one breath to every five chest compressions. b. Provide two breaths to every 30 chest compressions. c. Reassess the child every 10 minutes while CPR continues. d. Evaluate the child after 50 cycles of compression and ventilation.

ANS: B Two breaths to 15 compressions is the standard for infants and children when two rescuers are present. One breath to every five chest compressions is not the appropriate ratio for CPR in this age group. Reassessment of the child should take place after 20 cycles or 1 minute.

One of the clinical manifestations of chronic renal failure is uremic frost. Which of the following best describes this term? a. Deposits of urea crystals in urine b. Deposits of urea crystals on skin c. Overexcretion of blood urea nitrogen d. Inability of body to tolerate cold temperatures

ANS: B Uremic frost is the deposition of urea crystals on the skin.

The nurse has been visiting an adolescent with recently acquired tetraplegia. The teen's mother tells the nurse, "I'm sick of providing all the care while my husband does whatever he wants to, whenever he wants to do it." What reaction should be the nurse's initial response? a. Refer the mother for counseling. b. Listen and reflect the mother's feelings. c. Ask the father in private why he does not help. d. Suggest ways the mother can get her husband to help.

ANS: B It is appropriate for the nurse to reflect with the mother about her feelings, exploring solutions such as an additional home health aide to help care for the child and provide respite for the mother. It is inappropriate for the nurse to agree with the mother that her husband is not helping enough. This judgment is beyond the role of the nurse and can undermine the family relationship. Counseling, if indicated, would be necessary for both parents. A support group for caregivers may be indicated. The nurse should not ask the father in private why he does not help or suggest way the mother can get her husband to help. These interventions are based on the mother's perceptions; the father may have a full-time job and other commitments. The parents may need an unbiased third person to help them through the negotiation of their new parenting responsibilities.

A child is admitted with acute glomerulonephritis. The nurse would expect the urinalysis during this acute phase to show which of the following? a. Bacteriuria, hematuria b. Hematuria, proteinuria c. Bacteriuria, increased specific gravity d. Proteinuria, decreased specific gravity `

ANS: B Urinalysis during the acute phase characteristically shows hematuria and proteinuria.

A child is admitted with acute glomerulonephritis. What should the nurse expect the urinalysis during this acute phase to show? a. Bacteriuria and hematuria b. Hematuria and proteinuria c. Bacteriuria and increased specific gravity d. Proteinuria and decreased specific gravity

ANS: B Urinalysis during the acute phase characteristically shows hematuria, proteinuria, and increased specific gravity. Proteinuria generally parallels the hematuria but is not usually the massive proteinuria seen in nephrotic syndrome. Gross discoloration of urine reflects its red blood cell and hemoglobin content. Microscopic examination of the sediment shows many red blood cells, leukocytes, epithelial cells, and granular and red blood cell casts. Bacteria are not seen, and urine culture results are negative.

The vector reservoir for agents causing viral encephalitis in the United States is: a. tarantula spiders. b. mosquitoes. c. carnivorous wild animals. d. domestic and wild animals.

ANS: B Viral encephalitis, not attributable to a childhood viral disease, is usually transmitted by mosquitoes. The vector reservoir for most agents pathogenic for humans and detected in the United States are mosquitoes and ticks; therefore, most cases of encephalitis appear during the hot summer months. Tarantula spiders, carnivorous wild animals, and domestic and wild animals are not reservoirs for the agents that cause viral encephalitis.

A nurse is admitting an infant with asthma. The nurse understands that asthma in infants is usually triggered by: a. medications. b. a viral infection. c. exposure to cold air. d. allergy to dust or dust mites.

ANS: B Viral illnesses cause inflammation that causes increased airway reactivity in asthma. Medications such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and antibiotics may aggravate asthma, but not frequently in infants. Exposure to cold air may exacerbate already existing asthma. Allergy is associated with asthma, but 20% to 40% of children with asthma have no evidence of allergic disease.

Parents phone the nurse and say that their child just knocked out a permanent tooth. What should the nurse's instructions to the parents include? a. Place the tooth in dry container for transport. b. Hold the tooth by the crown and not by the root area. c. Transport the child and tooth to a dentist within 18 hours. d. Take the child to hospital emergency department if his or her mouth is bleeding.

ANS: B It is important to avoid touching the root area of the tooth. The tooth should be held by the crown area; rinsed in milk, saline, or running water; and reimplanted as soon as possible. The tooth is kept moist during transport to maintain viability. Cold milk is the most desirable medium for transport. The child needs to be seen by a dentist as soon as possible. Tooth evulsion causes a large amount of bleeding. The child will need to be seen by a dentist because of the loss of a tooth, not the bleeding.

A father calls the clinic because he found his young daughter squirting Visine eyedrops into her mouth. What is the most appropriate nursing action? a. Reassure the father that Visine is harmless. b. Direct him to seek immediate medical treatment. c. Recommend inducing vomiting with ipecac. d. Advise him to dilute Visine by giving his daughter several glasses of water to drink.

ANS: B Visine is a sympathomimetic and if ingested may cause serious consequences. Medical treatment is necessary. Inducing vomiting is no longer recommended for ingestions. Dilution will not decrease risk.

A 2-year-old child starts to have a tonic-clonic seizure. The child's jaws are clamped. What is the most important nursing action at this time? a. Place a padded tongue blade between the child's jaws. b. Stay with the child and observe his respiratory status. c. Prepare the suction equipment. d. Restrain the child to prevent injury.

ANS: B It is impossible to halt a seizure once it has begun, and no attempt should be made to do so. The nurse must remain calm, stay with the child, and prevent the child from sustaining any harm during the seizure. The nurse should not move or forcefully restrain the child during a tonic-clonic seizure and should not place a solid object between the teeth. Suctioning may be needed but not until the seizure has ended.

The school nurse practitioner is consulted by a fifth-grade teacher about a student who has become increasingly inattentive and hyperactive in the classroom. The nurse notes that the child's weight has changed from the 50th percentile to the 30th percentile. The nurse is concerned about possible hyperthyroidism. What additional sign or symptom should the nurse anticipate? a. Skin that is cool and dry b. Blurred vision and loss of acuity c. Running and being active during recess d. Decreased appetite and food intake

ANS: B Visual disturbances such as loss of visual acuity and blurred vision are associated with hyperthyroidism. They may occur before the actual onset of other symptoms. The child's skin is usually warm, flushed, and moist. Although the signs of hyperthyroidism include excessive motion, irritability, hyperactivity, short attention span, and emotional lability, these children are easily fatigued and require frequent rest periods. Children with hyperthyroidism have increased food intake. Even with voracious appetites, weight loss occurs.

A child with hypoparathyroidism is receiving vitamin D therapy. The parents should be advised to watch for which signs or symptoms of vitamin D toxicity? a. Headache and seizures b. Weakness and lassitude c. Anorexia and insomnia d. Physical restlessness, voracious appetite without weight gain

ANS: B Vitamin D toxicity can be a serious consequence of therapy. Parents are advised to watch for weakness, fatigue, lassitude, headache, nausea, vomiting, and diarrhea. Renal impairment is manifested through polyuria, polydipsia, and nocturia. Headaches may be a sign of vitamin D toxicity, but seizures are not. Anorexia and insomnia are not characteristic of vitamin D toxicity. Physical restlessness and a voracious appetite with weight loss are manifestations of hyperthyroidism.

What clinical manifestation is a common sign of digoxin toxicity? a. Seizures b. Vomiting c. Bradypnea d. Tachycardia

ANS: B Vomiting is a common sign of digoxin toxicity and is often unrelated to feedings. Seizures are not associated with digoxin toxicity. The child will have a slower (not faster) heart rate but not a slower respiratory rate.

The nurse is teaching parents about signs of digoxin (Lanoxin) toxicity. Which is a common sign of digoxin toxicity? a. Seizures b. Vomiting c. Bradypnea d. Tachycardia

ANS: B Vomiting is a common sign of digoxin toxicity. Seizures are not associated with digoxin toxicity. The child will have a slower heart rate, not respiratory rate. The heart rate will be slower, not faster.

What is the recommended drink for athletes during practice and competition? a. Sports drinks to replace carbohydrates b. Cold water for gastrointestinal tract rapid absorption c. Carbonated beverages to help with acid-base balance d. Enhanced performance carbohydrate-electrolyte drinks

ANS: B Water is recommended for most athletes, who should drink 4 to 8 oz every 15 to 20 minutes. Cold water facilitates rapid gastric emptying and intestinal absorption. Most carbohydrate sports drinks have 6% to 8% carbohydrate, which can cause gastrointestinal upset. Carbonated beverages are discouraged. There is no evidence that these drinks enhance function.

When teaching injury prevention during the school-age years, which of the following should the nurse include? a. Teach children to fear strangers. b. Teach basic rules of water safety. c. Avoid letting child cook in microwave ovens. d. Caution child against engaging in competitive sports.

ANS: B Water safety instruction is an important source of injury prevention at this age. The child should be taught to swim, select safe and supervised places to swim, swim with a companion, check for sufficient water depth before diving, and use an approved flotation device.

Congenital adrenal hyperplasia (CAH) is suspected in a newborn because of ambiguous genitalia. The parents are appropriately upset and concerned about their child's gender. In teaching the parents about CAH, what should the nurse explain? a. Reconstructive surgery as a female is preferred. b. Sexual assignment should wait until genetic sex is determined. c. Prenatal masculinization will strongly influence the child's development. d. The child should be raised as a boy because of the presence of a penis and scrotum.

ANS: B It is preferable to raise the child according to genetic sex. With hormone replacement and surgical intervention if needed, genetically female children achieve satisfactory results in reversing virilism and achieving normal puberty and ability to conceive. Reconstructive surgery as a female is only preferred for infants who are genetically female. Infants who are genetically male should be given hormonal supplementation. Sex assignment and rearing depend on psychosocial influences, not on genetic sex hormone influences during fetal life. It is not advised to raise the child as a boy because of the presence of a penis and scrotum unless the child is genetically male. If a genetic female, the child will be sterile and may never be able to function satisfactorily in a heterosexual relationship.

What is an approximate method of estimating output for a child who is not toilet trained? a. Have parents estimate output. b. Weigh diapers after each void. c. Place a urine collection device on the child. d. Have the child sit on a potty chair 30 minutes after eating.

ANS: B Weighing diapers will provide an estimate of urinary output. Each 1 g of weight is equivalent to 1 ml of urine. Having parents estimate output would be inaccurate. It is difficult to estimate how much fluid is in a diaper. The urine collection device would irritate the child's skin. It would be difficult for a toddler who is not toilet trained to sit on a potty chair 30 minutes after eating.

What is the nursing action related to the applying of biologic or synthetic skin coverings for a child with partial-thickness burns of both legs? a. Splint the legs to prevent movement. b. Observe wounds for signs of infection. c. Monitor closely for manifestations of shock. d. Examine dressings for indications of bleeding.

ANS: B When applied early to a superficial partial-thickness injury, biologic dressings stimulate epithelial growth and faster wound healing. If the dressing covers areas of heavy microbial contamination, infection occurs beneath the dressing. In the case of partial-thickness burns, such infection may convert the wound to a full-thickness injury. Infection is the primary concern when biologic dressings are used.

A child, age 3 years, has cerebral palsy (CP) and is hospitalized for orthopedic surgery. His mother says he has difficulty swallowing and cannot hold a utensil to feed himself. He is slightly underweight for his height. What is the most appropriate nursing action related to feeding this child? a. Bottle or tube feed him a specialized formula until he gains sufficient weight. b. Stabilize his jaw with caregiver's hand (either from a front or side position) to facilitate swallowing. c. Place him in a well-supported, semireclining position. d. Place him in a sitting position with his neck hyperextended to make use of gravity flow.

ANS: B Jaw control is compromised in many children with CP. More normal control is achieved if the feeder stabilizes the oral mechanisms from the front or side of the face. Bottle or tube feeding will not improve feeding without jaw support. The semireclining position and hyperextended neck position increase the chances of aspiration.

In which of these communicable diseases are Koplik spots present? a. Rubella b. Measles (rubeola) c. Chickenpox (varicella) d. Exanthema subitum (roseola)

ANS: B Koplik spots are small irregular red spots with a minute, bluish white center found on the buccal mucosa 2 days before systemic rash.

An infant with short bowel syndrome is receiving total parenteral nutrition (TPN). The practitioner has added continuous enteral feedings through a gastrostomy tube. The nurse recognizes this as important for which reason? a. Wean the infant from TPN the next day b. Stimulate adaptation of the small intestine c. Give additional nutrients that cannot be included in the TPN d. Provide parents with hope that the child is close to discharge

ANS: B Long-term survival without TPN depends on the small intestine's ability to increase its absorptive capacity. Continuous enteral feedings facilitate the adaptation. TPN is indicated until the child is able to receive all nutrition via the enteral route. Before this is accomplished, the small intestine must adapt and increase in cell number and cell mass per villus column. TPN is formulated to meet the infant's nutritional needs. Continuous enteral feedings through a gastrostomy tube is a positive sign, but the infant's ability to tolerate increasing amounts of enteral nutrition is only one factor that determines readiness for discharge.

A child who has cystic fibrosis is admitted to the pediatric unit with methicillin-resistant Staphylococcus aureus (MRSA) infection. The nurse recognizes that in addition to a private room, the child is placed on what precautions? a. Droplet b. Contact c. Airborne d. Standard

ANS: B MRSA is an increasingly significant source of hospital-acquired infections. This organism meets the criteria of being epidemiologically important and can be transmitted by direct contact. Gowns and gloves should be worn when exposed to potentially contagious materials, and meticulous hand washing is required. S. aureus is not an organism that is spread through airborne or droplet mechanisms. Additional precautions, beyond Standard Precautions, are needed to prevent spread of this organism.

Marasmus is which of the following? a. Deficiency of protein with an adequate supply of calories b. Not confined to geographic areas where food supplies are inadequate c. Syndrome that results solely from vitamin deficiencies d. Characterized by thin, wasted extremities and a prominent abdomen resulting from edema (ascites)

ANS: B Marasmus is a syndrome of emotional and physical deprivation. It is not confined to geographic areas were food supplies are inadequate.

A child is in uncompensated metabolic alkalosis. What should the nurse expect the arterial blood gas to be? a. HCO3, 24; pH, 7.35 b. HCO3, 28; pH, 7.50 c. HCO3, 20; pH, -7.30 d. HCO3, 26; pH, 7.40

ANS: B Metabolic alkalosis results in an elevated plasma pH (normal pH is 7.35-7.45) that occurs when there is an excess of bicarbonate (normal HCO3 is 22-26).

Gingivitis is a common problem in children with cerebral palsy (CP). What preventive measure should be included in the plan of care? a. High-carbohydrate diet b. Meticulous dental hygiene c. Minimum use of fluoride d. Avoidance of medications that contribute to gingivitis

ANS: B Meticulous oral hygiene is essential. Many children with CP have congenital enamel defects, high-carbohydrate diets, poor nutritional intake, and difficulty closing their mouths. These, coupled with the child's spasticity or clonic movements, make oral hygiene difficult. Children with CP have high carbohydrate intake and retention, which contribute to dental caries. Use of fluoride should be encouraged through fluoridated water or supplements and toothpaste. Certain medications such as phenytoin do contribute to gingival hyperplasia. If that is the drug of choice, then meticulous oral hygiene must be used.

What amount of fluid loss occurs with moderate dehydration? a. <50 ml/kg b. 50 to 90 ml/kg c. <5% total body weight d. >15% total body weight

ANS: B Moderate dehydration is defined as a fluid loss of between 50 and 90 ml/kg. Mild dehydration is defined as a fluid loss of less than 50 ml/kg. Weight loss up to 5% is considered mild dehydration. Weight loss over 15% is severe dehydration

The nurse is caring for a child with acute respiratory distress syndrome (ARDS) associated with sepsis. Nursing actions should include: a. forcing fluids. b. monitoring pulse oximetry. c. instituting seizure precautions. d. encouraging a high-protein diet.

ANS: B Monitoring cardiopulmonary status is an important evaluation tool in the care of the child with ARDS. Maintenance of vascular volume and hydration is important and should be done parenterally. Seizures are not a side effect of ARDS. Adequate nutrition is necessary, but a high-protein diet is not helpful.

Which is often administered to prevent or control hemorrhage in a child with cancer? a. Nitrosoureas b. Platelets c. Whole blood d. Corticosteroids

ANS: B Most bleeding episodes can be prevented or controlled with the administration of platelet concentrate or platelet-rich plasma. Nitrosoureas, whole blood, and corticosteroids would not prevent or control hemorrhage.

When taking the history of a child hospitalized with Reye syndrome, the nurse should not be surprised that a week ago the child had recovered from: a. measles. b. varicella. c. meningitis. d. hepatitis.

ANS: B Most cases of Reye syndrome follow a common viral illness such as varicella or influenza. Measles, meningitis, and hepatitis are not associated with Reye syndrome.

The nurse is analyzing an arterial blood gas of pH, 7.50; PCO2, 50; and HCO3, 29. What result should the nurse document for this blood gas? a. Fully compensated metabolic alkalosis b. Partially compensated metabolic alkalosis c. Fully compensated respiratory alkalosis d. Partially compensated respiratory alkalosis

ANS: B When the fundamental acid-base ratio is altered for any reason, the body attempts to correct the deviation. In a simple disturbance, a single primary factor affects one component of the acid-base pair and is usually accompanied by a compensatory or secondary change in the component that is not primarily affected. In metabolic alkalosis, the pH is high (?7?7.45), and the HCO3 is high (?7?26). When the pH is restored to normal, the disturbance is described as compensated. It is partially compensated because the pH remains abnormal, but the PCO2 is high (?7?45), indicating an attempt at compensation.

The nurse is analyzing an arterial blood gas of pH, 7.30; PCO2, 50; and HCO3, 29. What result should the nurse document for this blood gas? a. Fully compensated respiratory acidosis b. Partially compensated respiratory acidosis c. Fully compensated metabolic acidosis d. Partially compensated metabolic acidosis

ANS: B When the fundamental acid-base ratio is altered for any reason, the body attempts to correct the deviation. In a simple disturbance, a single primary factor affects one component of the acid-base pair and is usually accompanied by a compensatory or secondary change in the component that is not primarily affected. In respiratory acidosis, the pH is low (?6?7.35), and the PCO2 is high (?7?45). When the pH is restored to normal, the disturbance is described as compensated. It is partially compensated because the pH remains abnormal, but the HCO3 is high (?7?26), indicating an attempt at compensation.

When is a child with chickenpox considered to be no longer contagious? a. When fever is absent b. When lesions are crusted c. 24 hours after lesions erupt d. 8 days after onset of illness

ANS: B When the lesions are crusted, the chickenpox is no longer contagious. This may be a week after onset of disease.

A preadolescent has maintained good glycemic control of his type 1 diabetes through the school year. During summer vacation, he has had repeated episodes of hypoglycemia. What additional teaching is needed? a. Carbohydrates in the diet need to be replaced with protein. b. Additional snacks are needed to compensate for increased activity. c. The child needs to decrease his activity level to minimize episodes of hypoglycemia. d. Insulin dosage should be increased to compensate for a change in activity level.

ANS: B Most children have a different schedule during summer vacation. The increased activity and exercise reduce insulin resistance and increase glucose utilization. Additional snacks should be eaten before physical activity to increase carbohydrates and protein and compensate for increased activity. Physical activity should always be encouraged if the child is capable. The benefits include improved glucose utilization and decreased insulin requirements. In consultation with the practitioner, insulin dosage may need to be decreased because of improved glucose utilization.

The clinic nurse is evaluating lab results for a child. What recorded hematocrit (Hct) result is considered within the normal range? a. 30% b. 40% c. 50% d. 60%

ANS: B Normal hematocrit (Hct) is 35% to 45%.

A toddler has a deep laceration contaminated with dirt and sand. Before closing the wound, the nurse should irrigate with what solution? a. Alcohol b. Normal saline c. Povidone-iodine d. Hydrogen peroxide

ANS: B Normal saline is the only acceptable fluid for irrigation listed. The nurse should cleanse the wound with a forced stream of normal saline or water. Alcohol is not used for wound irrigation. Povidone-iodine is contraindicated for cleansing fresh, open wounds. Hydrogen peroxide can cause formation of subcutaneous gas when applied under pressure.

To facilitate the administration of an oral medication to a preschool-age child, what action should the nurse take? a. Dilute the medication in a large amount of favorite liquid and allow the child to hold the cup. b. Set limits about the need to take medication and offer praise immediately after the task is accomplished. c. Mix the medication in a moderate amount of the child's favorite food. d. Explain the purpose of the medication and allow the child time to express resistance before giving the medication.

ANS: B Nurses who approach children with confidence and who convey the impression that they expect to be successful are less likely to encounter difficulty. It is best to approach a child as though cooperation is expected. The medication should not be placed in a favorite liquid or food. Allowing the child time to express resistance will delay administration of the medication.

What statement is true concerning osteogenesis imperfecta (OI)? a. It is easily treated. b. It is an inherited disorder. c. Braces and exercises are of no therapeutic value. d. Later onset disease usually runs a more difficult course.

ANS: B OI is a heterogeneous, autosomal dominant disorder characterized by fractures and bone deformity. Treatment is primarily supportive. Several investigational therapies are being evaluated. The primary goal of therapy is rehabilitation. Lightweight braces and splints help support limbs, prevent fractures, and aid in ambulation. The disease is present at birth. Prognosis is affected by the type of OI.

A child with cystic fibrosis (CF) is receiving recombinant human deoxyribonuclease (DNase). Which is an adverse effect of this medication? a. Mucus thickens b. Voice alters c. Tachycardia d. Jitteriness

ANS: B One of the only adverse effects of DNase is voice alterations and laryngitis. DNase decreases viscosity of mucus, is given in an aerosolized form, and is safe for children younger than 12 years. 2 agonists can cause tachycardia and jitteriness.

A child with cystic fibrosis is receiving recombinant human deoxyribonuclease (DNase). What statement about DNase is true? a. Given subcutaneously b. May cause voice alterations c. May cause mucus to thicken d. Not indicated for children younger than age 12 years

ANS: B One of the only adverse effects of DNase is voice alterations and laryngitis. DNase is given in an aerosolized form, decreases the viscosity of mucus, and is safe for children younger than 12 years.

Calcium carbonate is given with meals to a child with chronic renal disease. The purpose of this is to: a. prevent vomiting. b. bind phosphorus. c. stimulate appetite. d. increase absorption of fat-soluble vitamins.

ANS: B Oral calcium carbonate preparations combine with phosphorus to decrease gastrointestinal absorption and the serum levels of phosphate. Serum calcium levels are increased by the calcium carbonate, and vitamin D administration is necessary to increase calcium absorption.

What is the rationale for orthopedic surgery for a child with cerebral palsy? a. To cure spasticity b. To improve function c. For cosmetic purposes d. To prevent the need of physical therapy

ANS: B Orthopedic surgery is used primarily to improve function rather than for cosmetic purposes and is followed by physical therapy. It will not cure spasticity.

The nurse has attended a professional development program about palliative care for the pediatric population. What statement by the nurse should indicate a correct understanding of the program? a. "Palliative care provides interventions that hasten death." b. "Palliative care promotes the optimal functioning and quality of life." c. "Palliative care does not provide pain and symptom management like hospice care." d. "Palliative care is not well received in hospitals that provide end-of-life care for children."

ANS: B Palliative care is designed to promote optimal functioning and quality of life during the time the child has remaining. Palliative care does not provide interventions that are intended to hasten death. The care does provide pain and symptom management and is well received in hospitals that provide end-of-life care for children.

A 5-year-old child will be starting kindergarten next month. She has cerebral palsy, and it has been determined that she needs to be in a special education classroom. Her parents are tearful when telling the nurse about this and state that they did not realize her disability was so severe. What is the best interpretation of this situation? a. This is a sign the parents are in denial. b. This is a normal anticipated time of parental stress. c. The parents need to learn more about cerebral palsy. d. The parents' expectations are too high.

ANS: B Parenting a child with a chronic illness can be stressful. At certain anticipated times, parental stress increases. One of these identified times is when the child begins school. Nurses can help parents recognize and plan interventions to work through these stressful periods. The parents are not in denial; rather, they are responding to the child's placement in school. The parents are not exhibiting signs of a remembering deficit; this is their first interaction with the school system with this child.

The parents of a child with spastic cerebral palsy (CP) state that their child seems to have significant pain. In addition to systemic pharmacologic management, the nurse includes which teaching? a. Patterning b. Positions to reduce spasticity c. Stretching exercises after meals d. Topical analgesics for muscle spasms

ANS: B Parents and children are taught positions to assume while sitting and recumbent that reduce spasticity. The American Academy of Pediatrics has stated that patterning should not be used for neurologically disabled children. Patterning attempts to alter abnormal tone and posture and elicit desired movements through positional manipulation or other means of modifying or augmenting sensory output. Stretching should be done after appropriate analgesic medication has been given and is effective. Topical analgesia is not effective for the muscle spasms of spastic CP.

The nurse should teach parents of a preschool child with type 1 diabetes that which can raise the blood glucose level? a. Exercise b. Steroids c. Decreased food intake d. Lantus insulin

ANS: B Parents should understand how to adjust food, activity, and insulin at the time of illness or when the child is treated for an illness with a medication known to raise the blood glucose level (e.g., steroids). Exercise, insulin, and decreased food intake can cause hypoglycemia.

What procedure is most appropriate for assessment of an abdominal circumference related to a bowel obstruction? a. Measuring the abdomen after feedings b. Marking the point of measurement with a pen c. Measuring the circumference at the symphysis pubis d. Using a new tape measure with each assessment to ensure accuracy

ANS: B Pen marks on either side of the tape measure allow the nurse to measure the same spot on the child's abdomen at each assessment. The child most likely will be kept NPO (nothing by mouth) if a bowel obstruction is present. If the child is being fed, the assessment should be done before feedings. The symphysis pubis is too low. Usually the largest part of the abdomen is at the umbilicus. Leaving the tape measure in place reduces the trauma to the child.

The narrowing of preputial opening of foreskin is called: a. chordee. b. phimosis. c. epispadias. d. hypospadias.

ANS: B Phimosis is the narrowing or stenosis of the preputial opening of the foreskin.

What is the narrowing of preputial opening of foreskin called? a. Chordee b. Phimosis c. Epispadias d. Hypospadias

ANS: B Phimosis is the narrowing or stenosis of the preputial opening of the foreskin. Chordee is the ventral curvature of the penis. Epispadias is the meatal opening on the dorsal surface of the penis. Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis.

Correct terminology is necessary in understanding substance abuse. Physical dependence is which of the following? a. Problem that occurs in conjunction with addiction b. Involuntary physiologic response to drug c. Culturally defined use of drugs for purposes other than accepted medical purposes d. Voluntary behavior based on psychosocial needs

ANS: B Physical dependence is an involuntary response to the pharmacologic characteristics of drugs such as opioids or alcohol.

The nurse is caring for a school-age child with severe anemia and activity intolerance. What diversional activity should the nurse plan for this child? a. Playing a musical instrument b. Playing board or card games c. Participating in a game of table tennis d. Participating in decorating the hospital room

ANS: B Plan diversional activities that promote rest but prevent boredom and withdrawal. Because short attention span, irritability, and restlessness are common in anemia and increase stress demands on the body, plan appropriate activities such as playing board or card games. Playing a musical instrument, participating in a game of table tennis, or decorating the hospital room would cause undue exertion.

Which of the following is descriptive of the play of school-age children? a. Individuality in play is better tolerated than at earlier ages. b. Knowing the rules of a game gives an important sense of belonging. c. They like to invent games, making up the rules as they go. d. Team play helps children learn the universal importance of competition and winning.

ANS: B Play involves increased physical skill, intellectual ability, and fantasy. Children form groups and cliques and develop a sense of belonging to a team or club. At this age, children begin to see the need for rules.

What sign/symptom is a major clinical manifestation of rheumatic fever (RF)? a. Fever b. Polyarthritis c. Osler nodes d. Janeway spots

ANS: B Polyarthritis, which is swollen, hot, red, and painful joints, is a major clinical manifestation. The affected joints will change every 1 or 2 days. The large joints are primarily affected. Fever is considered a minor manifestation of RF. Osler nodes and Janeway spots are characteristic of bacterial endocarditis.

What is a high-fiber food that the nurse should recommend for a child with chronic constipation? a. White rice b. Popcorn c. Fruit juice d. Ripe bananas

ANS: B Popcorn is a high-fiber food. Refined rice is not a significant source of fiber. Unrefined brown rice is a fiber source. Fruit juices are not a significant source of fiber. Raw fruits, especially those with skins and seeds, other than ripe bananas, have high fiber.

Which of the following foods should the nurse recommend as a good source of potassium for a child receiving diuretics? a. Carrots b. Bananas c. Dairy products d. Dark green vegetables

ANS: B Potassium supplementation is required with the use of some diuretics. Bananas, citrus fruits, bran, legumes, and peanut butter are some of the foods that are significant sources of potassium.

A 6-year-old child is scheduled for a cardiac catheterization. What consideration is most important in planning preoperative teaching? a. Preoperative teaching should be directed at his parents because he is too young to understand. b. Preoperative teaching should be adapted to his level of development so that he can understand. c. Preoperative teaching should be done several days before the procedure so he will be prepared. d. Preoperative teaching should provide details about the actual procedures so he will know what to expect.

ANS: B Preoperative teaching should always be directed to the child's stage of development. The caregivers also benefit from these explanations. The parents may ask additional questions, which should be answered, but the child needs to receive the information based on developmental level. This age group will not understand in-depth descriptions. School-age children should be prepared close to the time of the cardiac catheterization.

Using knowledge of child development, which of the following is the best approach when preparing a toddler for a procedure? a. Avoid asking the child to make choices. b. Demonstrate the procedure on a doll. c. Plan for teaching session to last about 20 minutes. d. Show necessary equipment without allowing child to handle it.

ANS: B Prepare toddlers for procedures by using play. Demonstrate on a doll, but avoid the child's favorite doll because the toddler may think the doll is really "feeling" the procedure.

A feeling of guilt that the child "caused" the disability or illness is especially common in which age group? a. Toddler b. Preschooler c. School-age child d. Adolescent

ANS: B Preschoolers are most likely to be affected by feelings of guilt that they caused the illness or disability or are being punished for wrongdoings. Toddlers are focused on establishing their autonomy. The illness fosters dependency. School-age children have limited opportunities for achievement and may not be able to understand limitations. Adolescents face the task of incorporating their disabilities into their changing self-concept.

What is a priority intervention for an infant with a temporary colostomy for Hirschsprung disease? a. Teaching how to irrigate the colostomy b. Protecting the skin around the colostomy c. Discussing the implications of a colostomy during puberty d. Using simple, straightforward language to prepare the child

ANS: B Protection of the peristomal skin is a major priority. Well-fitting appliances and skin protectants are used. Teaching how to irrigate a colostomy is not necessary because colostomies are not irrigated in infants. The colostomy is usually reversed within 6 months to 1 year. The parents, not the infant, need to be prepared for the surgery.

One of the major differences in clinical presentation between Crohn disease (CD) and ulcerative colitis (UC) is that UC is more likely to cause which clinical manifestation? a. Pain b. Rectal bleeding c. Perianal lesions d. Growth retardation

ANS: B Rectal bleeding is more common in UC than CD. Pain, perianal lesions, and growth retardation are common manifestations of CD.

Which of the following statements is descriptive of renal transplantation in children? a. It is an acceptable means of treatment after age 10 years. b. It is preferred means of renal replacement therapy in children. c. Children can receive kidneys only from other children. d. The decision for transplantation is difficult, since a relatively normal lifestyle is not possible.

ANS: B Renal transplant offers the opportunity for a relatively normal life and is the preferred means of renal replacement therapy in end-stage renal disease.

The nurse has been assigned as a home health nurse for a child who is technology dependent. The nurse recognizes that the family's background differs widely from the nurse's own. The nurse believes some of their lifestyle choices are less than ideal. What nursing intervention is most appropriate to institute? a. Change the family. b. Respect the differences. c. Assess why the family is different. d. Determine whether the family is dysfunctional.

ANS: B Respect for varied family structures and for racial, ethnic, cultural, and socioeconomic diversity among families is essential in home care. The nurse must assess and respect the family's background and lifestyle choices. It is not appropriate to attempt to change the family. The nurse is a guest in the home and care of the child. The family and the values held by the cultural group prevail. The nurse may assess why the family is different to help the nurse and other health professionals understand the differences. It is not appropriate to determine whether the family is dysfunctional.

A child is in uncompensated respiratory acidosis. What should the nurse expect the arterial blood gas to be? a. O2, 95; CO2, 45; pH, 7.40 b. O2, 88; CO2, 55; pH, 7.30 c. O2, 88; CO2, 35; pH, 7.28 d. O2, 92; CO2, 54; pH, 7.35

ANS: B Respiratory acidosis results from diminished or inadequate pulmonary ventilation that causes an elevation in plasma Pco2 and thus an increased concentration of dissolved carbonic acid, which leads to elevated carbonic acid and hydrogen ion concentration. This tends to lower the pH. CO2 of 55 is elevated (normal CO2 is 35-45), and a pH of 7.30 is low (normal pH is 7.35-7.45).

A 16-year-old boy with a chronic illness has recently become rebellious and is taking risks such as missing doses of his medication. What should the nurse explain to his parents? a. That he needs more discipline b. That this is a normal part of adolescence c. That he needs more socialization with peers d. That this is how he is asking for more parental control

ANS: B Risk taking, rebelliousness, and lack of cooperation are normal parts of adolescence, during which young adults are establishing independence. If the parents increase the amount of discipline, he will most likely be more rebellious. More socialization with peers does not address the problem of risk-taking behavior.

How much oxygen is contained in ambient air (room air)? a. 15% b. 21% c. 30% d. 42%

ANS: B Room air is composed of 21% oxygen, trace amounts of carbon dioxide, and 79% nitrogen.

The diet of a child with nephrosis usually includes: a. high protein. b. salt restriction. c. low fat. d. high carbohydrate.

ANS: B Salt is usually restricted (but not eliminated) during the edema phase.

The nurse is caring for an 11-year-old boy who has recently been diagnosed with diabetes. Which should be included in the teaching plan for daily injections? a. The parents do not need to learn the procedure. b. He is old enough to give most of his own injections. c. Self-injections will be possible when he is closer to adolescence. d. He can learn about self-injections when he is able to reach all injection sites.

ANS: B School-age children are able to give their own injections. Parents should participate in learning and giving the insulin injections. He is already old enough to administer his own insulin. The child is able to use thighs, abdomen, part of the hip, and arm. Assistance can be obtained if other sites are used.

The nurse is caring for a 10-year-old child during a long hospitalization. What intervention should the nurse include in the care plan to minimize loss of control and autonomy during the hospitalization? a. Allow the child to skip morning self-care activities to watch a favorite television program. b. Create a calendar with special events such as a visit from a friend to maintain a routine. c. Allow the child to sleep later in the morning and go to bed later at night to promote control. d. Create a restrictive environment so the child feels in control of sensory stimulation.

ANS: B School-age children may feel an overwhelming loss of control and autonomy during a longer hospitalization. One intervention to minimize this loss of control is to create a calendar with planned special events such as a visit from a friend. Maintaining the child's daily routine is another intervention to minimize the sense of loss of control; allowing the child to skip morning self-care activities, sleep later, or stay up later would work against this goal. Environments should be as nonrestrictive as possible to allow the child freedom to move about, thus allowing a sense of autonomy.

What is a significant secondary prevention nursing activity for lead poisoning? a. Chelation therapy b. Screening children for blood lead levels c. Removing lead-based paint from older homes d. Questioning parents about ethnic remedies containing lead

ANS: B Screening children for lead poisoning is an important secondary prevention activity. Screening does not prevent the initial exposure of the child to lead. It can lead to identification and treatment of children who are exposed. Chelation therapy is treatment, not prevention. Removing lead-based paints from older homes before children are affected is primary prevention. Questioning parents about ethnic remedies containing lead is part of the assessment to determine the potential source of lead.

A child has been admitted to the hospital with a blood lead level of 72 mcg/dL. What treatment should the nurse anticipate? a. Referral to social services b. Initiation of chelation therapy c. Follow-up testing within 1 month d. Aggressive environmental intervention

ANS: B Severe lead toxicity (lead level ?5=70 mcg/dL) requires immediate inpatient chelation treatment. Referral to social service and follow-up in 1 month are prescribed for lead levels of 15 to 19 mcg/dL. Aggressive environmental intervention would be initiated after chelation treatments.

A 3-month-old infant dies shortly after arrival to the emergency department. The infant has subdural and retinal hemorrhages but no external signs of trauma. What should the nurse suspect? a. Unintentional injury b. Shaken baby syndrome c. Congenital neurologic problem d. Sudden infant death syndrome (SIDS)

ANS: B Shaken baby syndrome causes internal bleeding but may have no external signs. Unintentional injury would not cause these injuries. With unintentional injuries, external signs are usually present. Congenital neurologic problems would usually have signs of abnormal neurologic anatomy. SIDS does not usually have identifiable injuries.

A 3-month-old infant dies shortly after arrival to the emergency department. The infant has subdural and retinal hemorrhages but no external signs of trauma. The nurse should suspect: a. unintentional injury. b. shaken-baby syndrome. c. sudden infant death syndrome (SIDS). d. congenital neurologic problem.

ANS: B Shaken-baby syndrome causes internal bleeding but may have no external signs.

An adolescent comes to the school nurse after experiencing shin splints during a track meet. What reassurance should the nurse offer? a. Shin splints are expected in runners. b. Ice, rest, and nonsteroidal antiinflammatory drugs (NSAIDs) usually relieve pain. c. It is generally best to run around and "work the pain out." d. Moist heat and acetaminophen are indicated for this type of injury.

ANS: B Shin splints result when the ligaments tear away from the tibial shaft and cause pain. Actions that have an antiinflammatory effect are indicated for shin splints. Ice, rest, and NSAIDs are the usual treatment. Shin splints are rarely serious, but they are not expected, and preventive measures are taken. Rest is important to heal the shin splints. Continuing to place stress on the tibia can lead to further damage.

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

ANS: B Siblings experience loneliness, fear, and worry, as well as anger, resentment, jealousy, and guilt. The siblings experience stress equal to that of the hospitalized child.

What condition occurs when the normal adult hemoglobin is partly or completely replaced by abnormal hemoglobin? a. Aplastic anemia b. Sickle cell anemia c. Thalassemia major d. Iron deficiency anemia

ANS: B Sickle cell anemia is one of a group of diseases collectively called hemoglobinopathies, in which normal adult hemoglobin is replaced by abnormal hemoglobin. Aplastic anemia is a lack of cellular elements being produced. Thalassemia major refers to a variety of inherited disorders characterized by deficiencies in production of certain globulin chains. Iron-deficiency anemia affects red blood cell size and depth of color but does not involve abnormal hemoglobin.

The nurse is caring for a child with a tracheostomy. What clinical manifestation should the nurse recognize as an early sign of impending respiratory distress or failure? a. Cyanosis b. Restlessness c. Audible stridor d. Crowing respirations

ANS: B Signs of hypoxemia are initially subtle. Cardinal signs of impending respiratory failure include restlessness, tachypnea, tachycardia, and diaphoresis. Cyanosis is a sign of severe hypoxia. Stridor and crowing respirations are indicative of inflammation. Sternal retractions are an early but less obvious sign.

What diagnostic test for allergies involves the injection of specific allergens? a. Phadiatop b. Skin testing c. Radioallergosorbent tests (RAST) d. Blood examination for total immunoglobulin E (IgE)

ANS: B Skin testing is the most commonly used diagnostic test for allergy. A specific allergen is injected under the skin, and after a suitable time, the size of the resultant wheal is measured to determine the patient's sensitivity. Phadiatop is a screening test that uses a blood sample to assess for IgE antibodies for a group of specific allergens. RAST determines the level of specific IgE antibodies. Blood examination for total IgE would not distinguish among allergens.

Smokeless tobacco is: a. not addicting. b. proven to be carcinogenic. c. easy to stop using. d. a safe alternative to cigarette smoking.

ANS: B Smokeless tobacco is a popular substitute for cigarettes and poses serious health hazards to children and adolescents. Smokeless tobacco is associated with cancer of the mouth and jaw.

Hydrotherapy is required to treat a child with extensive partial-thickness burn wounds. What is the purpose of hydrotherapy? a. Provide pain relief b. Débride the wounds c. Destroy bacteria on the skin d. Increase peripheral blood flow

ANS: B Soaking in a tub or showering once or twice a day acts to loosen and remove sloughing tissue, exudate, and topical medications. The hydrotherapy cleanses the wound and the entire body and helps maintain range of motion. Appropriate pain medications are necessary. Dressing changes are extremely painful. The total bacterial count of the skin is reduced by the hydrotherapy, but this is not the primary goal. There may be an increase in peripheral blood flow, but the primary purpose is for wound débridement.

The parents of a neonate with adrenogenital hyperplasia tell the nurse that they are afraid to have any more children. The nurse should explain which statement about adrenogenital hyperplasia? a. It is not hereditary. b. Genetic counseling is indicated. c. It can be prevented during pregnancy. d. All future children will have the disorder.

ANS: B Some forms of adrenogenital hyperplasia are hereditary and should be referred for genetic counseling. Affected offspring should also be referred for genetic counseling. There is an autosomal recessive form of adrenogenital hyperplasia. A prenatal treatment with glucocorticoids can be offered to the mother during pregnancy to avoid the sex ambiguity, but it does not affect the presence of the disease. If it is the heritable form, for each pregnancy, a 25% risk occurs that the child will be affected.

A 6-year-old child has had a tonsillectomy. The child is spitting up small amounts of dark brown blood in the immediate postoperative period. The nurse should take what action? a. Notify the health care provider. b. Continue to assess for bleeding. c. Give the child a red flavored ice pop. d. Position the child in a Trendelenburg position.

ANS: B Some secretions, particularly dried blood from surgery, are common after a tonsillectomy. Inspect all secretions and vomitus for evidence of fresh bleeding (some blood-tinged mucus is expected). Dark brown (old) blood is usually present in the emesis, as well as in the nose and between the teeth. Small amounts of dark brown blood should be further monitored. A red-flavored ice pop should not be given and the Trendelenburg position is not recommended.

What type of cerebral palsy (CP) is the most common type? a. Ataxic b. Spastic c. Dyskinetic d. Mixed type

ANS: B Spastic CP is the most common clinical type. Early manifestations are usually generalized hypotonia, or decreased tone that lasts for a few weeks or may extend for months or as long as 1 year. It is replaced by increased stretch reflexes, increased muscle tone, and weakness. Ataxic, dyskinetic, and mixed type are less common forms of CP.

A child with a hip spica cast is being prepared for discharge. Recognizing that caring for a child at home is complex, the nurse should include what instructions for the parents' discharge teaching? a. Turn every 8 hours. b. Specially designed car restraints are necessary. c. Diapers should be avoided to reduce soiling of the cast. d. Use an abduction bar between the legs to aid in turning.

ANS: B Standard seat belts and car seats may not be readily adapted for use by children in some casts. Specially designed car seats and restraints meet safety requirements. The child must have position changes much more frequently than every 8 hours. During feeding and play activities, the child should be moved for both physiologic and psychosocial benefit. Diapers and other strategies are necessary to maintain cleanliness. The abduction bar is never used as an aid for turning. Putting pressure on the bar may damage the integrity of the cast.

What term is used when a patient remains in a deep sleep, responsive only to vigorous and repeated stimulation? a. Coma b. Stupor c. Obtundation d. Persistent vegetative state

ANS: B Stupor exists when the child remains in a deep sleep, responsive only to vigorous and repeated stimulation. Coma is the state in which no motor or verbal response occurs to noxious (painful) stimuli. Obtundation describes a level of consciousness in which the child is arousable with stimulation. Persistent vegetative state describes the permanent loss of function of the cerebral cortex.

The nurse must suction a 6-month-old infant with a tracheostomy. What intervention should be included? a. Encourage the child to cough to raise the secretions before suctioning. b. Perform each pass of the suction catheter for no longer than 5 seconds. c. Allow the child to rest after every five times the suction catheter is passed. d. Select a catheter with a diameter three quarters of the diameter of the tracheostomy tube.

ANS: B Suctioning should require no longer than 5 seconds per pass. Otherwise, the airway may be occluded for too long. An infant would be unable to cooperate with instructions to cough up secretions. The child is allowed to rest for 30 to 60 seconds after each aspiration to allow oxygen tension to return to normal. Then the process is repeated until the trachea is clear. The catheter should have a diameter one half the size of the tracheostomy tube. If it is too large, it might block the child's airway.

The nurse is teaching the parent of a 4-year-old child with a cast on the arm about care at home. What statement by the parent indicates a correct understanding of the teaching? a. "I should have the affected limb hang in a dependent position." b. "I will use an ice pack to relieve the itching." c. "I should avoid keeping the injured arm elevated." d. "I will expect the fingers to be swollen for the next 3 days."

ANS: B Teaching the parent to use an ice pack to relieve the itching is an important aspect when planning discharge for a child with a cast. The affected limb should not be allowed to hang in a dependent position for more than 30 minutes. The affected arm should be kept elevated as much as possible. If there is swelling or redness of the fingers, the parent should notify the health care provider.

An adolescent tells the school nurse that she is pregnant. Her last menstrual period was 4 months ago. She has not received any medical care. She smokes but denies any other substance use. The priority nursing action is which of the following? a. Notify her parents. b. Refer for prenatal care. c. Explain the importance of not smoking. d. Discuss dietary needs for adequate fetal growth.

ANS: B Teenage girls and their unborn children are at greater risk for complications during pregnancy and delivery. With improved therapies, the mortality for teenage pregnancy is decreasing, but the morbidity is high.

A nurse is teaching nursing students the physiology of congenital heart defects. Which defect results in decreased pulmonary blood flow? a. Atrial septal defect b. Tetralogy of Fallot c. Ventricular septal defect d. Patent ductus arteriosus

ANS: B Tetralogy of Fallot results in decreased blood flow to the lungs. The pulmonic stenosis increases the pressure in the right ventricle, causing the blood to go from right to left across the ventricular septal defect. Atrial and ventricular septal defects and patent ductus arteriosus result in increased pulmonary blood flow.

What nursing interventions should the nurse plan for a hospitalized toddler to minimize fear of bodily injury? (Select all that apply.) a. Perform procedures slowly. b. Maintain parent-child contact. c. Use progressively smaller dressings on surgical incisions. d. Tell the child bleeding will stop after the needle is removed. e. Remove a dressing as quickly as possible from surgical incisions.

ANS: B, C Whenever procedures are performed on young children, the most supportive intervention to minimize the fear of bodily injury is to do the procedure as quickly as possible while maintaining parent-child contact. Because of toddlers' and preschool children's poorly defined body boundaries, the use of bandages may be particularly helpful. For example, telling children that the bleeding will stop after the needle is removed does little to relieve their fears, but applying a small Band-Aid usually reassures them. The size of bandages is also significant to children in this age group; the larger the bandage, the more importance is attached to the wound. Watching their surgical dressings become successively smaller is one way young children can measure healing and improvement. Prematurely removing a dressing may cause these children considerable concern for their well-being.

What functional goal should the nurse expect for a child who has a C7 spinal cord injury? (Select all that apply.) a. Able to drive automobile with hand controls b. Complete independence within limitations of a wheelchair c. Can roll over in bed, sit up in bed, and eat independently d. Requires some assistance in transfer and lower extremity dressing e. Ambulation with bilateral long braces using four-point or swing-through crutch gait

ANS: B, C, D A child with a C7 spinal cord injury can expect to be completely independent within the limitations of a wheelchair, can roll over in bed, sit up in bed, and eat independently, and will require some assistance in transfer and lower extremity dressing. The ability to drive an automobile with hand controls is a functional goal for a T1 to T10 spinal cord injury. Ambulation with bilateral long braces using four-point or swing-through crutch gait is a functional goal for a T10 to L2 injury.

What condition or disease decreases lung compliance? (Select all that apply.) a. Asthma b. Atelectasis c. Pneumothorax d. Pulmonary edema e. Lobar emphysema

ANS: B, C, D Atelectasis, pneumothorax, and pulmonary edema decrease lung compliance. Asthma and lobar emphysema increase lung compliance.

What findings should the nurse expect to observe in a 7-month-old infant with Werdnig-Hoffman disease? (Select all that apply.) a. Noticeable scoliosis b. Absent deep tendon reflexes c. Abnormal tongue movements d. Failure to thrive e. Prominent pectus excavatum f. Significant leg involvement

ANS: B, C, D Clinical manifestations of Werdnig-Hoffman disease in an infant include absent deep tendon reflexes, abnormal tongue movements, and failure to thrive. Scoliosis, prominent pectus excavatum, and significant leg involvement are findings observed in a child with intermediate spinal muscular atrophy

The nurse is admitting a 9-year-old child with hemolytic uremic syndrome. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Hematuria b. Anorexia c. Hypertension d. Purpura e. Proteinuria f. Periorbital edema

ANS: B, C, D Clinical manifestations of hemolytic uremic syndrome include anorexia; hypertension; and purpura, which persists for several days to 2 weeks. Gross hematuria is seen in acute glomerulonephritis. Substantial proteinuria and periorbital edema are common manifestations in nephrotic syndrome.

What clinical manifestations should be observed in a 2-year-old child with hypotonic dehydration? (Select all that apply.) a. Thick, doughy feel to the skin b. Slightly moist mucous membranes c. Absent tears d. Very rapid pulse e. Hyperirritability

ANS: B, C, D Clinical manifestations of hypotonic dehydration include slightly moist mucous membranes, absent tears, and a very rapid pulse. A thick, doughy feel to the skin and hyperirritability are signs of hypertonic dehydration.

What are classified as hydrocarbon poisons? (Select all that apply.) a. Bleach b. Gasoline c. Turpentine d. Lighter fluid e. Oven cleaners

ANS: B, C, D Gasoline, turpentine, and lighter fluid are classified as hydrocarbon poisons. Bleach and oven cleaners are classified as corrosive poisons.

The nurse is caring for a child with erythema multiforme (Stevens-Johnson syndrome). What local manifestations does the nurse expect to assess in this child? (Select all that apply.) a. Papular urticaria b. Erythematous papular rash c. Lesions absent in the scalp d. Lesions enlarge by peripheral expansion e. Firm papules that may be capped by vesicles

ANS: B, C, D Local manifestations of erythema multiforme include an erythematous popular rash, lesions involving most skin surfaces except the scalp and lesions that enlarge by peripheral expansion. Papular urticaria and firm papules capped by vesicles are characteristics of an insect bite.

The nurse is assessing a family's use of complementary medicine practices. What practices are classified as nutrition, diet, and lifestyle or behavioral health changes? (Select all that apply.) a. Reflexology b. Macrobiotics c. Megavitamins d. Health risk reduction e. Chiropractic medicine

ANS: B, C, D Macrobiotics, megavitamins, and health risk reduction are classified as nutrition, diet, and lifestyle or behavioral health changes. Reflexology and chiropractic medicine are classified as structural manipulation and energetic therapies.

The nurse is planning care for a school-age child admitted to the hospital with hemophilia. Which interventions should the nurse plan to implement for this child? (Select all that apply.) a. Finger sticks for blood work instead of venipunctures b. Avoidance of IM injections c. Acetaminophen (Tylenol) for mild pain control d. Soft tooth brush for dental hygiene e. Administration of packed red blood cells

ANS: B, C, D Nurses should take special precautions when caring for a child with hemophilia to prevent the use of procedures that may cause bleeding, such as IM injections. The subcutaneous route is substituted for IM injections whenever possible. Venipunctures for blood samples are usually preferred for these children. There is usually less bleeding after the venipuncture than after finger or heel punctures. Neither aspirin nor any aspirin-containing compound should be used. Acetaminophen is a suitable aspirin substitute, especially for controlling mild pain. A soft toothbrush is recommended for dental hygiene to prevent bleeding from the gums. Packed red blood cells are not administered. The primary therapy for hemophilia is replacement of the missing clotting factor. The products available are factor VIII concentrates.

A child is hospitalized in acute renal failure and has a serum potassium greater than 7 mEq/L. What temporary measures that will produce a rapid but transient effect to reduce the potassium should the nurse expect to be prescribed? (Select all that apply.) a. Dialysis b. Calcium gluconate c. Sodium bicarbonate d. Glucose 50% and insulin e. Sodium polystyrene sulfonate (Kayexalate)

ANS: B, C, D Several measures are available to reduce the serum potassium concentration, and the priority of implementation is usually based on the rapidity with which the measures are effective. Temporary measures that produce a rapid but transient effect are calcium gluconate, sodium bicarbonate, and glucose 50%, and insulin. Definitive but slower-acting measures are then implemented which include administration of a cation exchange resin such as sodium polystyrene sulfonate (Kayexalate), 1 g/kg, administered orally or rectally, and/or dialysis.

Parents of a child who will need hemodialysis ask the nurse, "What are the advantages of a fistula over a graft or external access device for hemodialysis?" What response should the nurse give? (Select all that apply.) a. It is ready to be used immediately. b. There are fewer complications with a fistula. c. There is less restriction of activity with a fistula. d. It produces dilation and thickening of the superficial vessels. e. The fistula does not require a needle insertion at each dialysis.

ANS: B, C, D The creation of a subcutaneous (internal) arteriovenous fistula by anastomosing a segment of the radial artery and brachiocephalic vein produces dilation and thickening of the superficial vessels of the forearm to provide easy access for repeated venipuncture. Fewer complications and less restriction of activity are observed with the use of a fistula. Both the graft and the fistula require needle insertion at each dialysis. The fistula cannot be used immediately.

1. The nurse is planning to use an interpreter with a non-English-speaking family. What should the nurse plan with regard to the use of an interpreter? (Select all that apply.) a. Use a family member. b. The nurse should speak slowly. c. Use an interpreter familiar with the family's culture. d. The nurse should speak only a few sentences at a time. e. The nurse should speak to the interpreter during interactions.

ANS: B, C, D When parents who do not speak English are informed of their child's chronic illness, interpreters familiar with both their culture and language should be used. The nurse should speak slowly and only use a few sentences at a time. Children, family members, and friends of the family should not be used as translators because their presence may prevent parents from openly discussing the issues. The nurse should speak to the family, not the interpreter.

What characterizes a school-aged child's concept of death? (Select all that apply.) a. Have a mature understanding of death b. Can respond to logical explanations of death c. Personify death as the devil or the bogeyman d. Have a deeper understanding of death in a concrete sense e. Fear the mutilation and punishment associated with death

ANS: B, C, D, E A school-aged child's concept of death includes responding to logical explanations of death, personifying death as the devil or bogeyman, having a deeper understanding of death in a concrete sense, and fearing mutilation and punishment associated with death. Adolescents' concept of death is a mature understanding of death.

A child has had a short-arm synthetic cast applied. What should the nurse teach to the child and parents about cast care? (Select all that apply.) a. Relieve itching with heat. b. Elevate the arm when resting. c. Observe the fingers for any evidence of discoloration. d. Do not allow the child to put anything inside the cast. e. Examine the skin at the cast edges for any breakdown.

ANS: B, C, D, E Cast care involves elevating the arm, observing the fingers for evidence of discoloration, not allowing the child to put anything inside the cast, and examining the skin at the edges of the cast for any breakdown. Ice, not heat, should be applied to relieve itching.

What influences a child's reaction to the stressors of hospitalization? (Select all that apply.) a. Gender b. Separation c. Support systems d. Developmental age e. Previous experience with illness

ANS: B, C, D, E Major stressors of hospitalization include separation, loss of control, bodily injury, and pain. Children's reactions to these crises are influenced by their developmental age; previous experience with illness, separation, or hospitalization; innate and acquired coping skills; seriousness of the diagnosis; and support systems available. Gender does not have an effect on a child's reaction to stressors of hospitalization.

The nurse is teaching parents the signs of a hearing impairment in a child. What should the nurse include as signs? (Select all that apply.) a. Outgoing behavior b. Yelling to express pleasure c. Asking to have statements repeated d. Foot stamping for vibratory sensation e. Failure to develop intelligible speech by age 24 months

ANS: B, C, D, E Signs of a hearing impairment in a child include yelling to express pleasure, asking to have statements repeated, foot stamping for vibratory sensation, and failure to develop intelligible speech by age 24 months. The child's behavior is shy, not outgoing

The clinic nurse is assessing a child with bacterial conjunctivitis (pink eye). Which assessment findings should the nurse expect? (Select all that apply.) a. Itching b. Swollen eyelids c. Inflamed conjunctiva d. Purulent eye drainage e. Crusting of eyelids in the morning

ANS: B, C, D, E The assessment findings in bacterial conjunctivitis include swollen eyelids, inflamed conjunctiva, purulent eye drainage, and crusting of eyelids in the morning. Itching is seen with allergic conjunctivitis but not with bacterial conjunctivitis.

What effects of an altered pituitary secretion in a child with meningitis indicates syndrome of inappropriate antidiuretic hormone (SIADH)? (Select all that apply.) a. Hypotension b. Serum sodium is decreased c. Urinary output is decreased d. Evidence of overhydration e. Urine specific gravity is increased

ANS: B, C, D, E The serum sodium is decreased, urinary output is decreased, evidence of overhydration is present, and urine specific gravity is increased in SIADH. Hypertension, not hypotension, occurs.

What strategies should the nurse implement to assist in feeding a sick child? (Select all that apply.) a. Serve large portions. b. Make mealtimes pleasant. c. Avoid foods that are highly seasoned. d. Provide finger foods for young children. e. Ensure a variety of foods, textures, and colors.

ANS: B, C, D, E To assist in feeding a sick child mealtimes should be pleasant; highly seasoned foods should be avoided; finger foods should be provided for young children; and a variety of foods, textures, and colors should be ensured. Small portions, not large, should be served.

The nurse is caring for a 14-year-old child with juvenile idiopathic arthritis (JIA). What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Erythema over joints b. Soft tissue contractures c. Swelling in multiple joints d. Morning stiffness of the joints e. Loss of motion in the affected joints

ANS: B, C, D, E Whether single or multiple joints are involved, stiffness, swelling, and loss of motion develop in the affected joints in JIA. The swelling results from soft tissue edema, joint effusion, and synovial thickening. The affected joints may be warm and tender to the touch, but it is not uncommon for pain not to be reported. The limited motion early in the disease is a result of muscle spasm and joint inflammation; later it is caused by ankylosis or soft tissue contracture. Morning stiffness of the joint(s) is characteristic and present on arising in the morning or after inactivity. Erythema is not typical, and a warm, painful, red joint is always suspect for infection.

An adolescent is being placed on a calcium channel blocker. What should the nurse inform the adolescent with regard to this medication? (Select all that apply.) a. The medication may cause fatigue. b. The medication may increase heart rate. c. The medication may cause constipation. d. The medication may cause cold extremities. e. The medication may cause peripheral edema.

ANS: B, C, E Calcium channel blockers may cause an increase in heart rate, constipation, and peripheral edema. Beta-blockers can cause fatigue and cold extremities, but calcium channel blockers do not cause these potential side effects.

The clinic nurse is evaluating causes for iron deficiency due to impaired iron absorption. What should the nurse recognize as causes for iron deficiency due to impaired iron absorption? (Select all that apply.) a. Gastric acidity b. Chronic diarrhea c. Lactose intolerance d. Absence of phosphates e. Inflammatory bowel disease

ANS: B, C, E Causes for iron deficiency due to impaired iron absorption include chronic diarrhea, lactose intolerance, and inflammatory bowel disease. Gastric alkalinity, not acidity, and the presence, not absence, of phosphates can be causes of impaired iron absorption.

The nurse is preparing to admit a 3-year-old child with acute spasmodic laryngitis. What clinical features of hepatitis B should the nurse recognize? (Select all that apply.) a. High fever b. Croupy cough c. Tendency to recur d. Purulent secretions e. Occurs sudden, often at night

ANS: B, C, E Clinical features of acute spasmodic laryngitis include a croupy cough, a tendency to recur, and occurring sudden, often at night. High fever is a feature of acute epiglottitis and purulent secretions are seen with acute tracheitis.

The nurse is caring for a child with Kawasaki disease in the acute phase. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Osler nodes b. Cervical lymphadenopathy c. Strawberry tongue d. Chorea e. Erythematous palms f. Polyarthritis

ANS: B, C, E Clinical manifestations of Kawasaki disease in the acute phase include cervical lymphadenopathy, a strawberry tongue, and erythematous palms. Osler nodes are a clinical manifestation of endocarditis. Chorea and polyarthritis are seen in rheumatic fever.

The nurse is preparing to admit a 7-year-old child with acute laryngotracheobronchitis (LTB). What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Dysphagia b. Brassy cough c. Low-grade fever d. Toxic appearance e. Slowly progressive

ANS: B, C, E Clinical manifestations of LTB include a brassy cough, low-grade fever, and slow progression. Dysphagia and a toxic appearance are characteristics of acute epiglottitis.

The nurse is preparing to admit a 7-year-old child with an upper motor neuron syndrome. What clinical manifestations of an upper motor neuron syndrome should the nurse expect to observe? (Select all that apply.) a. No flexor spasms b. Babinski reflex present c. No wasting of muscle mass d. Marked atrophy of atonic muscle e. Hyperreflexia with tendon reflexes exaggerated

ANS: B, C, E Clinical manifestations of an upper motor neuron syndrome include Babinski reflex present, no wasting of muscle mass, and hyperreflexia with tendon reflexes exaggerated. No flexor spasms and marked atrophy of atonic muscle are manifestations of a lower motor neuron syndrome.

The nurse is caring for a child with psoriasis. What local manifestations does the nurse expect to assess in this child? (Select all that apply.) a. Development of wheals b. First lesions appear in the scalp c. Round, thick, dry reddish patches d. Lesions appear in intergluteal folds e. Patches are covered with coarse, silvery scales

ANS: B, C, E Local manifestations of psoriasis include lesions that appear in the scalp initially and round, thick dry patches covered with coarse, silvery scales. Development of wheals is seen in urticaria. Lesions in intergluteal folds are characteristic of intertrigo.

The nurse is preparing to admit a 9-year-old child with syndrome of inappropriate antidiuretic hormone (SIADH). What interventions should the nurse include in the child's care plan? (Select all that apply.) a. Provide a low-sodium, low-fat diet. b. Initiate seizure precautions. c. Weigh daily at the same time each day. d. Encourage intake of 1 l of fluid per day. e. Measure intake and output hourly.

ANS: B, C, E Nursing care of the child with SIADH includes placing the child on seizure precautions, obtaining a daily weight at the same time each day, and accurately measuring the child's intake and output. The nurse does not need to provide a low-sodium, low-fat diet because there are no diet restrictions. The child would be on fluid precautions to avoid fluid overload, so 1 l of fluid would not be encouraged.

A nurse is caring for a school-age child with left unilateral pneumonia and pleural effusion. A chest tube has been inserted to promote continuous closed chest drainage. Which interventions should the nurse implement when caring for this child? (Select all that apply.) a. Positioning child on the right side b. Assessing the chest tube and drainage device for correct settings c. Administering prescribed doses of analgesia d. Clamping the chest tube when child ambulates e. Monitoring for need of supplemental oxygen

ANS: B, C, E Nursing care of the child with a chest tube requires close attention to respiratory status; the chest tube and drainage device used are monitored for proper function (i.e., drainage is not impeded, vacuum setting is correct, tubing is free of kinks, dressing covering chest tube insertion site is intact, water seal is maintained, and chest tube remains in place). Movement in bed and ambulation with a chest tube are encouraged according to the child's respiratory status, but children require frequent doses of analgesia. Supplemental oxygen may be required in the acute phase of the illness and may be administered by nasal cannula, face mask, flow-by, or face tent. The child should be positioned on the left side, not the right. Lying on the affected side if the pneumonia is unilateral ("good lung up") splints the chest on that side and reduces the pleural rubbing that often causes discomfort. The chest tube should never be clamped; this can cause a pneumothorax. The chest tube should be maintained to the underwater seal at all times.

The nurse is caring for a child with hypercalcemia. The nurse evaluates the child for which signs and symptoms of hypercalcemia? (Select all that apply.) a. Tetany b. Anorexia c. Constipation d. Laryngospasm e. Muscle hypotonicity

ANS: B, C, E Signs and symptoms of hypercalcemia are anorexia, constipation, and muscle hypotonicity. Tetany and laryngospasm are signs of hypocalcemia.

The nurse is caring for a child with hypernatremia. The nurse evaluates the child for which signs and symptoms of hypernatremia? (Select all that apply.) a. Apathy b. Lethargy c. Oliguria d. Intense thirst e. Dry, sticky mucos

ANS: B, C, E Signs and symptoms of hypernatremia are nausea; oliguria; and dry, sticky mucos. Apathy and lethargy are signs of hyponatremia.

A clinic nurse is conducting a staff in-service for other clinic nurses about signs and symptoms of a rhabdomyosarcoma tumor. Which should be included in the teaching session? (Select all that apply.) a. Bone fractures b. Abdominal mass c. Sore throat and ear pain d. Headache e. Ecchymosis of conjunctiva

ANS: B, C, E The initial signs and symptoms of rhabdomyosarcoma tumors are related to the site of the tumor and compression of adjacent organs. Some tumor locations, such as the orbit, manifest early in the course of the illness. Other tumors, such as those of the retroperitoneal area, only produce symptoms when they are relatively large and compress adjacent organs. Unfortunately, many of the signs and symptoms attributable to rhabdomyosarcoma are vague and frequently suggest a common childhood illness, such as "earache" or "runny nose." An abdominal mass, sore throat and ear pain, and ecchymosis of conjunctiva are signs of a rhabdomyosarcoma tumor. Bone fractures would be seen in osteosarcoma and a headache is a sign of a brain tumor.

Which should the nurse teach about prevention of sickle cell crises to parents of a preschool child with sickle cell disease? (Select all that apply.) a. Limit fluids at bedtime. b. Notify the health care provider if a fever of 38.5° C (101.3° F) or greater occurs. c. Give penicillin as prescribed. d. Use ice packs to decrease the discomfort of vasoocclusive pain in the legs. e. Notify the health care provider if your child begins to develop symptoms of a cold.

ANS: B, C, E The most important issues to teach the family of a child with sickle cell anemia are to (1) seek early intervention for problems, such as a fever of 38.5° C (101.3° F) or greater; (2) give penicillin as ordered; (3) recognize signs and symptoms of splenic sequestration, as well as respiratory problems that can lead to hypoxia; and (4) treat the child normally. The nurse emphasizes the importance of adequate hydration to prevent sickling and to delay the adhesion-stasis-thrombosis-ischemia cycle. It is not sufficient to advise parents to "force fluids" or "encourage drinking." They need specific instructions on how many daily glasses or bottles of fluid are required. Many foods are also a source of fluid, particularly soups, flavored ice pops, ice cream, sherbet, gelatin, and puddings. Increased fluids combined with impaired kidney function result in the problem of enuresis. Parents who are unaware of this fact frequently use the usual measures to discourage bedwetting, such as limiting fluids at night. Enuresis is treated as a complication of the disease, such as joint pain or some other symptom, to alleviate parental pressure on the child. Ice should not be used during a vasoocclusive pain crisis because it vasoconstricts and impairs circulation even more.

The parent of a child with a chronic illness tells the nurse, "I feel so hopeless in this situation." The nurse should take which actions to foster hopefulness for the family? (Select all that apply.) a. Avoid topics that are lighthearted. b. Convey a personal interest in the child. c. Be honest when reporting on the child's condition. d. Do not initiate any playful interaction with the child. e. Demonstrate competence and gentleness when delivering care.

ANS: B, C, E To foster hopefulness, the nurse should convey a personal interest in the child, be honest when reporting on a child's condition, and demonstrate competence and gentleness when delivering care. The nurse should introduce conversations on neutral, non-disease-related, or less sensitive topics (discuss the child's favorite sports, tell stories). The nurse should be lighthearted and initiate or respond to teasing or other playful interactions with the child.

The nurse is administering activated charcoal to a preschool child with acetaminophen (Tylenol) poisoning. What potential complications from the use of activated charcoal should the nurse plan to assess for? (Select all that apply.) a. Diarrhea b. Vomiting c. Fluid retention d. Intestinal obstruction

ANS: B, D Potential complications from the use of activated charcoal include vomiting and possible aspiration, constipation, and intestinal obstruction. Diarrhea and fluid retention are not potential complications of activated charcoal administration.

The nurse is caring for a child with celiac disease. The nurse understands that what may precipitate a celiac crisis? (Select all that apply.) a. Exercise b. Infections c. Fluid overload d. Electrolyte depletion e. Emotional disturbance

ANS: B, D, E A celiac crisis can be precipitated by infections, electrolyte depletion, and emotional disturbance. Exercise or fluid overload does not precipitate a crisis.

What identified characteristics occur more frequently in parents who abuse their children? (Select all that apply.) a. Older parents b. Socially isolated c. Middle class parents d. Single-parent families e. Few supportive relationships

ANS: B, D, E Abusive families are often socially isolated and have few supportive relationships. Single-parent families are at higher risk for abuse. Younger parents more often are abusers of their children. Abusive parents have stressors such as low-income circumstances, with little education, and are not middle class parents.

Parents of a school-age child with hemophilia ask the nurse, "Which sports are recommended for children with hemophilia?" Which sports should the nurse recommend? (Select all that apply.) a. Soccer b. Swimming c. Basketball d. Golf e. Bowling

ANS: B, D, E Because almost all persons with hemophilia are boys, the physical limitations in regard to active sports may be a difficult adjustment, and activity restrictions must be tempered with sensitivity to the child's emotional and physical needs. Use of protective equipment, such as padding and helmets, is particularly important, and noncontact sports, especially swimming, walking, jogging, tennis, golf, fishing, and bowling, are encouraged. Contact sport such as soccer and basketball are not recommended.

What are characteristics of diabetic ketoacidosis? (Select all that apply.) a. Pallor b. Acidosis c. Bradypnea d. Dehydration e. Electrolyte imbalance

ANS: B, D, E Characteristics of diabetic ketoacidosis include acidosis, dehydration, and electrolyte imbalance. Respirations are rapid (Kussmaul respirations), not slow, and flushing, not pallor, would occur.

The nurse is planning to admit a 10-year-old child with syndrome of inappropriate antidiuretic hormone (SIADH). What clinical manifestations should the nurse expect to observe in this child? (Select all that apply.) a. Polyuria b. Anorexia c. Polydipsia d. Irritability e. Stomach cramps

ANS: B, D, E Clinical signs of SIADH are directly related to fluid retention and hyponatremia. When cells in the brain are exposed to too much water as opposed to sodium, swelling occurs. When serum sodium levels are diminished to 120?9?mEq/l, affected children may display anorexia, nausea, vomiting, stomach cramps, irritability, and personality changes. Polyuria and polydipsia are manifestations of diabetes insipidus.

What dietary instructions should the nurse give to parents of a child undergoing chronic hemodialysis? (Select all that apply.) a. High protein b. Fluid restriction c. High phosphorus d. Sodium restriction e. Potassium restriction

ANS: B, D, E Dietary limitations are necessary in patients undergoing chronic dialysis to avoid biochemical complications. Fluid and sodium are restricted to prevent fluid overload and its associated symptoms of hypertension, cerebral manifestations, and congestive heart failure. Potassium is restricted to prevent complications related to hyperkalemia; phosphorus restriction helps prevent parathyroid hyperactivity and its attendant risk of abnormal calcification in soft tissues. Adequate protein, not high intake, is necessary to maximize growth potential. Fluid limitations are determined by residual urinary output and the need to limit intradialytic weight gain.

The emergency department nurse is admitting a child with a temperature of 35° C (95° F). What physical effects of hypothermia should the nurse expect to observe in this child? (Select all that apply.) a. Bradycardia b. Vigorous shivering c. Decreased respiratory rate d. Decreased intestinal motility e. Task performance is impaired

ANS: B, D, E Hypothermia has varying physical effects depending on the child's core temperature. At 35° C (95° F), a child would experience vigorous shivering, decreased intestinal motility, and task performance impairment. Bradycardia and decreased respiratory rate are physical effects observed as the body temperature continues to decrease.

The nurse is teaching the family of a child with type 1 diabetes about insulin. What should the nurse include in the teaching session? (Select all that apply.) a. Unopened vials are good for 60 days. b. Diabetic supplies should not be left in a hot environment. c. Insulin can be placed in the freezer if not used every day. d. After it has been opened, insulin is good for up to 28 to 30 days. e. Insulin bottles that have been opened should be stored at room temperature or refrigerated.

ANS: B, D, E Insulin bottles that have been "opened" (i.e., the stopper has been punctured) should be stored at room temperature or refrigerated for up to 28 to 30 days. After 1 month, these vials should be discarded. Unopened vials should be refrigerated and are good until the expiration date on the label. Diabetic supplies should not be left in a hot environment. Insulin need not be refrigerated but should be maintained at a temperature between 15° and 29.5° C (59° and 85° F). Freezing renders insulin inactive.

The nurse is monitoring an infant for signs of increased intracranial pressure (ICP). Which are late signs of increased intracranial pressure (ICP) in an infant? (Select all that apply.) a. Tachycardia b. Alteration in pupil size and reactivity c. Increased motor response d. Extension or flexion posturing e. Cheyne-Stokes respirations

ANS: B, D, E Late signs of ICP in an infant or child include bradycardia, alteration in pupil size and reactivity, decreased motor response, extension or flexion posturing, and Cheyne-Stokes respirations.

What cerebrospinal fluid (CSF) analysis should the nurse expect with viral meningitis? (Select all that apply.) a. Color is turbid. b. Protein count is normal. c. Glucose is decreased. d. Gram stain findings are negative. e. White blood cell (WBC) count is slightly elevated.

ANS: B, D, E The CSF analysis in viral meningitis shows a normal or slightly elevated protein count, negative Gram stain, and a slightly elevated WBC. The color is clear or slightly cloudy, and the glucose level is normal.

The nurse is caring for a child with an anterior pituitary tumor. What hormones are secreted by the anterior pituitary? (Select all that apply.) a. Oxytocin b. Luteinizing hormone c. Antidiuretic hormone d. Thyroid-stimulating hormone e. Adrenocorticotrophic hormone

ANS: B, D, E The anterior pituitary is responsible for secreting the following hormones: growth hormone, thyroid-stimulating hormone, adrenocorticotrophic hormone, follicle-stimulating hormone, luteinizing hormone, and prolactin. The posterior pituitary secretes antidiuretic hormone and oxytocin.

The nurse is preparing to admit a 5-year-old with spina bifida cystica that was below the second lumbar vertebra. What clinical manifestations of spina bifida cystica below the second lumbar vertebra should the nurse expect to observe? (Select all that apply.) a. No motor impairment b. Lack of bowel control c. Soft, subcutaneous lipomas d. Flaccid, partial paralysis of lower extremities e. Overflow incontinence with constant dribbling of urine

ANS: B, D, E The clinical manifestations of spina bifida cystica below the second lumbar vertebra include lack of bowel control, flaccid, partial paralysis of lower extremities, and overflow incontinence with constant dribbling of urine. No motor impairment occurs with spina bifida cystica that was below the third lumbar vertebra, and soft, subcutaneous lipomas occur with spina bifida occulta.

The nurse is preparing to admit a 5-year-old child who developed lesions of varicella (chickenpox) 3 days ago. Which clinical manifestations of varicella should the nurse expect to observe? (Select all that apply.) a. Nonpruritic rash b. Elevated temperature c. Discrete rose pink rash d. Vesicles surrounded by an erythematous base e. Centripetal rash in all three stages (papule, vesicle, and crust)

ANS: B, D, E The clinical manifestations of varicella include elevated temperature, vesicles surrounded by an erythematous base, and a centripetal rash in all three stages (papule, vesicle, and crust). The rash is pruritic, and a discrete pink rash is seen with exanthema subitum, not varicella.

The nurse is teaching parents the signs of a hearing impairment in infants. What should the nurse include as signs? (Select all that apply.) a. Lack of a fencing reflex b. Lack of a startle reflex to a loud sound c. Awakened by loud environmental noises d. Failure to localize a sound by 6 months of age e. Response to loud noises as opposed to the voice

ANS: B, D, E The fencing reflex is elicited when the infant is placed on his or her back; it does not indicate a hearing impairment. Awakening by a loud environmental noise is a normal response.

What interventions should the nurse anticipate being administered to a child with supraventricular tachycardia (SVT)? a. Bed rest b. Applying ice to the face c. Administration of atropine d. Administration of adenosine (Adenocor) e. Having the child perform a Valsalva maneuver

ANS: B, D, E The treatment of SVT depends on the degree of compromise imposed by the dysrhythmia. In some instances, vagal maneuvers, such as applying ice to the face, massaging the carotid artery (on one side of the neck only), or having an older child perform a Valsalva maneuver (e.g., exhaling against a closed glottis, blowing on the thumb as if it were a trumpet for 30 to 60 seconds), can reverse the SVT. When vagal maneuvers fail, adenosine may be used to end the episode of SVT by impairing AV node conduction. IV adenosine is the first-line pharmacologic measure for termination of SVT in infants and children in the emergency setting. Administration of atropine or bed rest will not resolve SVT.

The nurse is caring for a newborn with suspected congenital diaphragmatic hernia. What of the following findings would the nurse expect to observe? (Select all that apply.) a. Loud, harsh murmur b. Scaphoid abdomen c. Poor peripheral pulses d. Mediastinal shift e. Inguinal swelling f. Moderate respiratory distress

ANS: B, D, F Clinical manifestations of a congenital diaphragmatic hernia include a scaphoid abdomen, a mediastinal shift, and moderate to severe respiratory distress. The infant would not have a harsh, loud murmur or poor peripheral pulses. Inguinal swelling is indicative of an inguinal hernia.

. The nurse is preparing to admit a 3-year-old child with intussusception. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Absent bowel sounds b. Passage of red, currant jelly-like stools c. Anorexia d. Tender, distended abdomen e. Hematemesis f. Sudden acute abdominal pain

ANS: B, D, F Intussusception occurs when a proximal segment of the bowel telescopes into a more distal segment, pulling the mesentery with it and leading to obstruction. Clinical manifestations of intussusception include the passage of red, currant jelly-like stools; a tender, distended abdomen; and sudden acute abdominal pain. Absent bowel sounds, anorexia, and hematemesis are clinical manifestations observed in other types of gastrointestinal dysfunction.

The nurse is teaching a parent of a 6-month-old infant with gastroesophageal reflux (GER) before discharge. What instructions should the nurse include? (Select all that apply.) a. Elevate the head of the bed in the crib to a 90-degree angle while the infant is sleeping. b. Hold the infant in the prone position after a feeding. c. Discontinue breastfeeding so that a formula and rice cereal mixture can be used. d. The infant will require the Nissen fundoplication after 1 year of age. e. Prescribed cimetidine (Tagamet) should be given 30 minutes before feedings.

ANS: B, E Discharge instructions for an infant with GER should include the prone position (up on the shoulder or across the lap) after a feeding. Use of the prone position while the infant is sleeping is still controversial. The American Academy of Pediatrics recommends the supine position to decrease the risk of sudden infant death syndrome even in infants with GER. Prescribed cimetidine or another proton pump inhibitor should be given 30 minutes before the morning and evening feeding so that peak plasma concentrations occur with mealtime. The head of the bed in the crib does not need to be elevated. The mother may continue to breastfeed or express breast milk to add rice cereal if recommended by the health care provider; thickening breast milk or formula with cereal is not recommended by all practitioners. The Nissen fundoplication is only done on infants with GER in severe cases with complications.

After the introduction of the Back to Sleep campaign in 1992, an increased incidence has been noted of which of the following pediatric disorders? (Select all that apply.) a. SIDS b. Torticollis c. Failure to thrive d. Apnea of infancy e. Plagiocephaly

ANS: B, E Plagiocephaly is a misshapen head caused by the prolonged pressure on one side of the skull. If that side becomes misshapen, facial asymmetry may result. The sternocleidomastoid muscle may tighten on the affected side, causing torticollis.

Which neurologic diagnostic test gives a visualized horizontal and vertical cross-section of the brain at any axis? a. Nuclear brain scan b. Echoencephalography c. CT scan d. Magnetic resonance imaging (MRI)

ANS: C A CT scan provides a visualization of the horizontal and vertical cross-sections of the brain at any axis. A nuclear brain scan uses a radioisotope that accumulates where the blood-brain barrier is defective. Echoencephalography identifies shifts in midline structures of the brain as a result of intracranial lesions. MRI permits visualization of morphologic features of target structures and permits tissue discrimination that is unavailable with any other techniques.

A chest radiograph film is ordered for a child with suspected cardiac problems. The child's parent asks the nurse, "What will the radiograph show about the heart?" The nurse's response should be based on knowledge that the x-ray film will show: a. bones of chest but not the heart. b. measurement of electrical potential generated from heart muscle. c. permanent record of heart size and configuration. d. computerized image of heart vessels and tissues.

ANS: C A chest radiograph will provide information on the heart size and pulmonary blood-flow patterns. It will provide a baseline for future comparisons. The heart will be visible, as well as the sternum and ribs. Electrocardiography (ECG) measures the electrical potential generated from heart muscle. Echocardiography will produce a computerized image of the heart vessels and tissues by using sound waves.

The nurse is assessing a child's functional self-care level for feeding, bathing and hygiene, dressing, and grooming and toileting. The child requires assistance or supervision from another person and equipment or device. What code does the nurse assign for this child? a. I b. II c. III d. IV

ANS: C A code of III indicates the child requires assistance from another person and equipment or device. A code of I indicates use of equipment or device. A code of II indicates assistance or supervision from another person. A code of IV indicates the child is totally dependent.

The nurse is planning care for an 8-year-old child with a concussion. Which is descriptive of a concussion? a. Petechial hemorrhages cause amnesia. b. Visible bruising and tearing of cerebral tissue occur. c. It is a transient and reversible neuronal dysfunction. d. A slight lesion develops remotely from the site of trauma.

ANS: C A concussion is a transient, reversible neuronal dysfunction with instantaneous loss of awareness and responsiveness resulting from trauma to the head. Petechial hemorrhages along the superficial aspects of the brain along the point of impact are a type of contusion, but are not necessarily associated with amnesia. A contusion is visible bruising and tearing of cerebral tissue. Contrecoup is a lesion that develops remote from the site of trauma as a result of an acceleration-deceleration injury.

What statement is descriptive of a concussion? a. Petechial hemorrhages cause amnesia. b. Visible bruising and tearing of cerebral tissue occur. c. It is a transient and reversible neuronal dysfunction. d. It is a slight lesion that develops remote from the site of trauma.

ANS: C A concussion is a transient, reversible neuronal dysfunction with instantaneous loss of awareness and responsiveness resulting from trauma to the head. Petechial hemorrhages on the superficial aspects of the brain along the point of impact are a type of contusion but are not necessarily associated with amnesia. A contusion is visible bruising and tearing of cerebral tissue. Contrecoup is a lesion that develops remote from the site of trauma as a result of an acceleration-deceleration injury.

What intervention is necessary when weaning a child from the ventilator? a. Light sedation before scheduled extubation b. No suctioning before scheduled extubation c. Cool mist begun immediately after extubation d. Vigorous chest physiotherapy and suctioning performed immediately after extubation

ANS: C A cool mist or noninvasive oxygen therapy is initiated immediately after extubation. Steroids may be administered to minimize any laryngeal edema. Analgesics may be given, but sedation is not usually indicated. The child is suctioned just before extubation to ensure that the airway is clear. Chest physiotherapy and suctioning are performed before extubation.

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

ANS: C A draw sheet should be used to move the child in the bed or onto a gurney to reduce friction and shearing injuries. Do not drag the child from under the arms.

The practitioner has ordered a liquid oral antibiotic for a toddler with otitis media. The prescription reads 1 1/2 tsp four times per day. What should the nurse consider in teaching the mother how to give the medicine? a. A measuring spoon should be used, and the medication must be given every 6 hours. b. The mother is not able to handle this regimen. Long-acting intramuscular antibiotics should be administered. c. A hollow-handled medication spoon is advisable, and the medication should be equally spaced while the child is awake. d. A household teaspoon should be used and the medicine given when the child wakes up, around lunch time, at dinner time, and before bed.

ANS: C A hollow-handled medication spoon allows the mother to measure the correct amount of medication. The order is written for four times a day; every 6 hours dosing is not necessary. There is no indication that the mother is not able to adhere to the medication regimen. She is asking for clarification so she can properly care for her child. Long-acting intramuscular antibiotics are not indicated. Household teaspoons vary greatly and should not be used.

A school-age child has sustained a head injury and multiple fractures after being thrown from a horse. The child's level of consciousness is variable. The parents tell the nurse that they think their child is in pain because of periodic crying and restlessness. What is the most appropriate nursing action? a. Explain that analgesia is contraindicated with a head injury. b. Have the parents describe the child's previous experiences with pain. c. Consult with a practitioner about what analgesia can be safely administered. d. Teach the parents that analgesia is unnecessary when the child is not fully awake and alert.

ANS: C A key nursing role is to provide sedation and analgesia for the child. Consultation with the appropriate practitioner is necessary to avoid conflict between the necessity to monitor the child's neurologic status and to promote comfort and relieve anxiety. Analgesia can be safely used in individuals who have sustained head injuries. The child's previous experiences with pain should be obtained as part of the assessment, but because of the severity of the injury, analgesia should be provided as soon as possible. Analgesia can decrease anxiety and resultant increased intracranial pressure.

A child has been seizure free for 2 years. A father asks the nurse how much longer the child will need to take the antiseizure medications. How should the nurse respond? a. Medications can be discontinued at this time. b. The child will need to take the drugs for 5 years after the last seizure. c. A step-wise approach will be used to reduce the dosage gradually. d. Seizure disorders are a lifelong problem. Medications cannot be discontinued.

ANS: C A predesigned protocol is used to wean a child gradually off antiseizure medications, usually when the child is seizure free for 2 years. Medications must be gradually reduced to minimize the recurrence of seizures. The risk of recurrence is greatest within 6 months after discontinuation.

A child has been seizure-free for 2 years. A father asks the nurse how much longer the child will need to take the antiseizure medications. The nurse includes which intervention in the response? a. Medications can be discontinued at this time. b. The child will need to take the drugs for 5 years after the last seizure. c. A step-wise approach will be used to reduce the dosage gradually. d. Seizure disorders are a lifelong problem. Medications cannot be discontinued.

ANS: C A predesigned protocol is used to wean a child gradually off antiseizure medications, usually when the child is seizure-free for 2 years and has a normal electroencephalogram (EEG). Medications must be gradually reduced to minimize the recurrence of seizures. Seizure medications can be safely discontinued. The risk of recurrence is greatest within the first year.

A toddler with spastic cerebral palsy needs to be transported to the radiology department. What transportation method should the nurse use to take the toddler to the radiology department? a. A stretcher b. A wheelchair c. A wagon with pillows d. Carried in the nurse's arms

ANS: C A wagon with pillows would support the child with spastic cerebral palsy better than a stretcher or wheelchair. A wagon would give the child a "wheelchair" experience, so the nurse should not carry the child.

Which is caused by a virus that primarily infects a specific subset of T lymphocytes, the CD4+ T cells? a. Wiskott-Aldrich syndrome b. Idiopathic thrombocytopenic purpura c. Acquired immunodeficiency syndrome (AIDS) d. Severe combined immunodeficiency disease

ANS: C AIDS is caused by the human immunodeficiency virus (HIV), which primarily attacks the CD4+ T cells. Wiskott-Aldrich syndrome, idiopathic thrombocytopenic purpura, and severe combined immunodeficiency disease are not viral illnesses.

A 3-year-old child woke up in the middle of the night with a croupy cough and inspiratory stridor. The parents bring the child to the emergency department, but by the time they arrive, the cough is gone, and the stridor has resolved. What can the nurse teach the parents with regard to this type of croup? a. A bath in tepid water can help resolve this type of croup. b. Tylenol can help to relieve the cough and stridor. c. A cool mist vaporizer at the bedside can help prevent this type of croup. d. Antibiotics need to be given to reduce the inflammation.

ANS: C Acute spasmodic laryngitis (spasmodic croup, "midnight croup," or "twilight croup") is distinct from laryngitis and LTB and characterized by paroxysmal attacks of laryngeal obstruction that occur chiefly at night. The child goes to bed well or with some mild respiratory symptoms but awakens suddenly with characteristic barking; a metallic cough; hoarseness; noisy inspirations; and restlessness. However, there is no fever, and the episode subsides in a few hours. Children with spasmodic croup are managed at home. Cool mist is recommended for the child's room. A tepid water bath will not help, but steam provided by hot water may relieve the laryngeal spasm. The child will not need Tylenol, and antibiotics are not given for this type of croup.

The single parent of a 12-year-old child who has just been diagnosed with chickenpox tells the nurse that she cannot afford to stay home with the child and miss work. The parent asks the nurse if some medication will shorten the course of the illness. Which of the following is the most appropriate nursing intervention? a. Reassure the parent that it is not necessary to stay home with the child. b. Explain that no medication will shorten the course of the illness. c. Explain the advantages of the medication acyclovir to treat chickenpox. d. Explain the advantages of the medication varicella-zoster immune globulin (VZIG) to treat chickenpox.

ANS: C Acyclovir is effective in treating the number of lesions; shortening the duration of fever; and decreasing itching, lethargy, and anorexia.

A child with hypopituitarism is being started on growth hormone (GH) therapy. Nursing considerations should be based on which knowledge? a. Treatment is most successful if it is started during adolescence. b. Treatment is considered successful if children attain full stature by adulthood. c. Replacement therapy requires daily subcutaneous injections. d. Replacement therapy will be required throughout the child's lifetime.

ANS: C Additional support is required for children who require hormone replacement therapy, such as preparation for daily subcutaneous injections and education for self-management during the school-age years. Young children, obese children, and those who are severely GH deficient have the best response to therapy. When therapy is successful, children can attain their actual or near-final adult height at a slower rate than their peers. Replacement therapy is not needed after attaining final height. They are no longer GH deficient.

To help an adolescent deal with diabetes, the nurse needs to consider which characteristic of adolescence? a. Desire to be unique b. Preoccupation with the future c. Need to be perfect and similar to peers d. Awareness of peers that diabetes is a severe disease

ANS: C Adolescence is a time when the individual has a need to be perfect and similar to peers. Having diabetes makes adolescents different from their peers. Adolescents do not wish to be unique; they desire to fit in with the peer group. An adolescent is usually not future oriented. Awareness of peers that diabetes is a severe disease would further alienate the adolescent with diabetes. The peer group would focus on the differences

To help the adolescent deal with diabetes, the nurse must consider which characteristic of adolescence? a. Desire to be unique b. Preoccupation with the future c. Need to be perfect and similar to peers d. Need to make peers aware of the seriousness of hypoglycemic reactions

ANS: C Adolescence is a time when the individual wants to be perfect and similar to peers. Having diabetes makes adolescents different from their peers. Adolescents do not wish to be unique; they desire to fit in with the peer group and are usually not future oriented. Forcing peer awareness of the seriousness of hypoglycemic reactions would further alienate the adolescent with diabetes. The peer group would focus on the differences.

The nurse is discussing sexuality with the parents of an adolescent girl who has a moderate cognitive impairment. What factor should the nurse consider when dealing with this issue? a. Sterilization is recommended for any adolescent with cognitive impairment. b. Sexual drive and interest are very limited in individuals with cognitive impairment. c. Individuals with cognitive impairment need a well-defined, concrete code of sexual conduct. d. Sexual intercourse rarely occurs unless the individual with cognitive impairment is sexually abused.

ANS: C Adolescents with moderate cognitive impairment may be easily persuaded and lack judgment. A well-defined, concrete code of conduct with specific instructions for handling certain situations should be defined for the adolescent. Permanent contraception by sterilization presents moral and ethical issues and may have psychologic effects on the adolescent. It may be prohibited in some states. The adolescent needs to have practical sexual information regarding physical development and contraception. Cognitively impaired individuals may desire to marry and have families. The adolescent needs to be protected from individuals who may make intimate advances.

It is generally recommended that a child with acute streptococcal pharyngitis can return to school: a. when sore throat is better. b. if no complications develop. c. after taking antibiotics for 24 hours. d. after taking antibiotics for 3 days.

ANS: C After children have taken antibiotics for 24 hours, they are no longer contagious to other children. Sore throat may persist longer than 24 hours after beginning antibiotic therapy, but the child is no longer considered contagious. Complications may take days to weeks to develop.

A 10-year-old boy on a bicycle has been hit by a car in front of a school. The school nurse immediately assesses airway, breathing, and circulation. What should be the next nursing action? a. Place the child on his side. b. Take the child's blood pressure. c. Stabilize the child's neck and spine. d. Check the child's scalp and back for bleeding.

ANS: C After determining that the child is breathing and has adequate circulation, the next action is to stabilize the neck and spine to prevent any additional trauma. The child's position should not be changed until the neck and spine are stabilized. Blood pressure is a later assessment. A less urgent but important assessment is inspection of the scalp for bleeding.

A 10-year-old boy on a bicycle has been hit by a car in front of the school. The school nurse immediately assesses airway, breathing, and circulation. The next nursing action: should be to a. place on side. b. take blood pressure. c. stabilize neck and spine. d. check scalp and back for bleeding.

ANS: C After determining that the child is breathing and has adequate circulation, the next action is to stabilize the neck and spine to prevent any additional trauma. The child's position should not be changed until the neck and spine are stabilized. Blood pressure is a later assessment. Less urgent, but an important assessment, is inspection of the scalp for bleeding.

The parents of a 2-year-old boy who had a repair of exstrophy of the bladder at birth ask when they can begin toilet training their son. The nurse replies based on what knowledge? a. Most boys in the United States can be toilet trained at age 3 years. b. Training can begin when he has sufficient bladder capacity. c. Additional surgery may be necessary to achieve continence. d. They should begin now because he will require additional time.

ANS: C After repair of the bladder exstrophy, the child's bladder is allowed to increase capacity. Several surgical procedures may be necessary to create a urethral sphincter mechanism to aid in urination and ejaculation. With the lack of a urinary sphincter, toilet training is unlikely. The child cannot hold the urine in the bladder. Bladder capacity is one component of continence. A functional sphincter is also needed.

A child is brought to the emergency department experiencing an anaphylactic reaction to a bee sting. While an airway is being established, the nurse should prepare which medication for immediate administration? a. Diphenhydramine (Benadryl) b. Dobutamine (Dobutarex) c. Epinephrine (Adrenalin) d. Calcium chloride (calcium chloride)

ANS: C After the first priority of establishing an airway, administration of epinephrine is the drug of choice. Diphenhydramine, an antihistamine, is usually not used for severe reactions. Dobutamine and calcium chloride are not appropriate drugs for this type of reaction.

A 3-year-old child is hospitalized after a submersion injury. The child's mother complains to the nurse, "Being at the hospital seems unnecessary when he is perfectly fine." The nurse's best reply should be: a. "He still needs a little extra oxygen." b. "I'm sure he is fine, but the doctor wants to make sure." c. "The reason for this is that complications could still occur." d. "It is important to observe for possible central nervous system problems."

ANS: C All children who have a submersion injury should be admitted to the hospital for observation. Although many children do not appear to have suffered adverse effects from the event, complications such as respiratory compromise and cerebral edema may occur 24 hours after the incident. The mother would not think the child is fine if oxygen were still required. The nurse should clarify that different complications can occur up to 24 hours later and that observations are necessary.

A preschool child is scheduled for an echocardiogram. Parents ask the nurse whether they can hold the child during the procedure. The nurse should answer with which response? a. "You will be able to hold your child during the procedure." b. "Your child can be active during the procedure, but can't sit in your lap." c. "Your child must lie quietly; sometimes a mild sedative is administered before the procedure." d. "The procedure is invasive so your child will be restrained during the echocardiogram."

ANS: C Although an echocardiogram is noninvasive, painless, and associated with no known side effects, it can be stressful for children. The child must lie quietly in the standard echocardiographic positions; crying, nursing, or sitting up often leads to diagnostic errors or omissions. Therefore, infants and young children may need a mild sedative; older children benefit from psychological preparation for the test. The distraction of a video or movie is often helpful.

Urinary tract anomalies are frequently associated with what irregularities in fetal development? a. Myelomeningocele b. Cardiovascular anomalies c. Malformed or low-set ears d. Defects in lower extremities

ANS: C Although unexplained, there is a frequent association between malformed or low-set ears and urinary tract anomalies. During the newborn examination, the nurse should have a high suspicion about urinary tract structure and function if ear anomalies are present. Children who have myelomeningocele may have impaired urinary tract function secondary to the neural defect. When other congenital defects are present, there is an increased likelihood of other issues with other body systems. Cardiac and extremity defects do not have a strong association with renal anomalies.

A child is diagnosed with influenza, probably type A disease. Management includes which recommendation? a. Clear liquid diet for hydration b. Aspirin to control fever c. Amantadine hydrochloride (Symmetrel) to reduce symptoms d. Antibiotics to prevent bacterial infection

ANS: C Amantadine hydrochloride may reduce symptoms related to influenza A if administered within 24 to 48 hours of onset. It is ineffective against type B or C. A clear liquid diet is not necessary for influenza, but maintaining hydration is important. Aspirin is not recommended in children because of increased risk of Reye syndrome. Acetaminophen or ibuprofen is a better choice. Preventive antibiotics are not indicated for influenza unless there is evidence of a secondary bacterial infection.

What condition is defined as reduced visual acuity in one eye despite appropriate optical correction? a. Myopia b. Hyperopia c. Amblyopia d. Astigmatism

ANS: C Amblyopia, or lazy eye, is reduced visual acuity in one eye. Amblyopia is usually caused by one eye not receiving sufficient stimulation. The resulting poor vision in the affected eye can be avoided with the treatment of the primary visual defect such as strabismus. Myopia, or nearsightedness, refers to the ability to see objects clearly at close range but not a distance. Hyperopia, or farsightedness, is the ability to see objects at a distance but not at close range. Astigmatism is unequal curvatures in refractive apparatus.

A child with cyanide poisoning has been admitted to the emergency department. What antidote does the nurse anticipate being prescribed for the child? a. Atropine b. Glucagon c. Amyl nitrate d. Naloxone (Narcan)

ANS: C Amyl nitrate is the antidote for cyanide poisoning. Atropine is an antidote for organophosphate poisoning, glucagon is an antidote for a beta-blocker poisoning, and naloxone (Narcan) is an antidote for an opioid poisoning.

The nurse is caring for a child on oxygen being delivered by a nasal cannula. What is the advantage of delivering oxygen in this manner? a. It can deliver mist if desired. b. It is less likely to cause abdominal distention. c. The child is able to eat and talk while getting oxygen. d. This method can deliver a higher concentration of oxygen.

ANS: C An advantage of delivering oxygen by nasal cannula is that the child is able to eat and talk while getting oxygen. This method cannot deliver mist or higher concentrations of oxygen. A disadvantage of this method is that it may cause abdominal distention.

The test that provides the most reliable evidence of recent streptococcal infection is which? a. Throat culture b. Mantoux test c. Antistreptolysin O test d. Elevation of liver enzymes

ANS: C Antistreptolysin O (ASLO) titers measure the concentration of antibodies formed in the blood against this product. Normally, the titers begin to rise about 7 days after onset of the infection and reach maximum levels in 4 to 6 weeks. Therefore, a rising titer demonstrated by at least two ASLO tests is the most reliable evidence of recent streptococcal infection.

Decreasing the demands on the heart is a priority in care for the infant with heart failure (HF). In evaluating the infant's status, which finding is indicative of achieving this goal? a. Irritability when awake b. Capillary refill of more than 5 seconds c. Appropriate weight gain for age d. Positioned in high Fowler position to maintain oxygen saturation at 90%

ANS: C Appropriate weight gain for an infant is indicative of successful feeding and a reduction in caloric loss secondary to the HF. Irritability is a symptom of HF. The child also uses additional energy when irritable. Capillary refill should be brisk and within 2 to 3 seconds. The child needs to be positioned upright to maintain oxygen saturation at 90%. Positioning is helping to decrease respiratory effort, but the infant is still having difficulty with oxygenation.

A critically injured child has died and is being removed from a ventilator in the pediatric intensive care unit. What is a priority nursing intervention for the family at this time? a. Ensure that parents are in the waiting room while the ventilator is removed. b. Help the parents understand that the child is already dead and no further interventions are necessary. c. Control the environment around the child and family to provide privacy. d. Encourage them to wait to see their child until the funeral home has prepared the body.

ANS: C Around the time of death, nursing care can be invaluable to the parents. The nurse should attempt to control the environment to ensure that the family and child have privacy. Other individuals such as clergy can be present if the family wishes. Attention to religious and cultural rituals may be important to them. The family should decide where they would like to be during removal from the ventilator. The family should be allowed to be with the child if they wish rather than waiting until the funeral home has prepared the body. Explain all interventions used for the child before death.

What is a major premise of family-centered care? a. The child is the focus of all interventions. b. Nurses are the authorities in the child's care. c. Parents are the experts in caring for their child. d. Decisions are made for the family to reduce stress.

ANS: C As parents become increasingly responsible for their children, they are the experts. It is essential that the health care team recognize the family's expertise. In family-centered care, consistent attention is given to the effects of the child's chronic illness on all family members, not just the child. Nurses are adjuncts in the child's care. The nurse builds alliances with parents. Family members are involved in decision making about the child's physical care.

Which defect results in increased pulmonary blood flow? a. Pulmonic stenosis b. Tricuspid atresia c. Atrial septal defect d. Transposition of the great arteries

ANS: C Atrial septal defect results in increased pulmonary blood flow. Blood flows from the left atrium (higher pressure) into the right atrium (lower pressure) and then to the lungs via the pulmonary artery. Pulmonic stenosis is an obstruction to blood flowing from the ventricles. Tricuspid atresia results in decreased pulmonary blood flow. Transposition of the great arteries results in mixed blood flow.

A parent reports to the nurse that her child has inflamed conjunctivae of both eyes with purulent drainage and crusting of the eyelids, especially on awakening. These manifestations suggest: a. viral conjunctivitis. b. allergic conjunctivitis. c. bacterial conjunctivitis. d. conjunctivitis caused by foreign body.

ANS: C Bacterial conjunctivitis has these symptoms

What explanation best describes how preschoolers react to the death of a loved one? a. Grief is acute but does not last long at this age. b. Children this age are too young to have a concept of death. c. Preschoolers may feel guilty and responsible for the death. d. They express grief in the same way that the adults in the preschoolers' life are expressing grief.

ANS: C Because of egocentricity, the preschooler may feel guilty and responsible for the death. Preschoolers may need to distance themselves from the loss. Giggling or joking and regression to earlier behaviors may help them until they incorporate the loss. The preschooler's concept of death is more a special sleep or departure.

A 2-year-old child is being admitted to the hospital for possible bacterial meningitis. When preparing for a lumbar puncture, what should the nurse do? a. Set up a tray with equipment the same size as for adults. b. Apply EMLA to the puncture site 15 minutes before the procedure. c. Prepare the child for conscious sedation being used for the procedure. d. Reassure the parents that the test is simple, painless, and risk free.

ANS: C Because of the urgency of the child's condition, conscious sedation should be used for the procedure. Pediatric spinal trays have smaller needles than do adult trays. EMLA should be applied approximately 60 minutes before the procedure; the emergency nature of the spinal tap precludes its use. A spinal tap is not a simple procedure and does have associated risks; analgesia will be given for the pain.

The nurse is planning activity for a 4-year-old child with anemia. Which activity should the nurse plan for this child? a. Game of "hide and seek" in the children's outdoor play area b. Participation in dance activities in the playroom c. Puppet play in the child's room d. A walk down to the hospital lobby

ANS: C Because the basic pathologic process in anemia is a decrease in oxygen-carrying capacity, an important nursing responsibility is to assess the child's energy level and minimize excess demands. The child's level of tolerance for activities of daily living and play is assessed, and adjustments are made to allow as much self-care as possible without undue exertion. Puppet play in the child's room would not be overly tiring. Hide and seek, dancing, and walking to the lobby would not conserve the anemic child's energy.

A parent asks the nurse why self-monitoring of blood glucose is being recommended for her child with diabetes. The nurse should base the explanation on which knowledge? a. It is a less expensive method of testing. b. It is not as accurate as laboratory testing. c. Children are better able to manage the diabetes. d. Parents are better able to manage the disease.

ANS: C Blood glucose self-management has improved diabetes management and can be used successfully by children from the time of diagnosis. Insulin dosages can be adjusted based on blood glucose results. Blood glucose monitoring is more expensive but provides improved management. It is as accurate as equivalent testing done in laboratories. The ability to self-test allows the child to balance diet, exercise, and insulin. The parents are partners in the process, but the child should be taught how to manage the disease.

The parent of a child hospitalized with acute glomerulonephritis asks the nurse why blood pressure readings are being taken so often. What knowledge should influence the nurse's reply? a. The antibiotic therapy contributes to labile blood pressure values. b. Hypotension leading to sudden shock can develop at any time. c. Acute hypertension is a concern that requires monitoring. d. Blood pressure fluctuations indicate that the condition has become chronic.

ANS: C Blood pressure monitoring is essential to identify acute hypertension, which is treated aggressively. Antibiotic therapy is usually not indicated for glomerulonephritis. Hypertension, not hypotension, is a concern in glomerulonephritis. Blood pressure control is essential to prevent further renal damage. Blood pressure fluctuations do not provide information about the chronicity of the disease.

An adolescent will receive a bone marrow transplant (BMT). The nurse should explain that the bone marrow will be administered by which route? a. Bone grafting b. Bone marrow injection c. IV infusion d. Intra-abdominal infusion

ANS: C Bone marrow from a donor is infused intravenously, and the transfused stem cells will repopulate the marrow. Because the stem cells migrate to the recipient's marrow when given intravenously, this is the method of administration.

A preadolescent has been diagnosed with scoliosis. The planned therapy is the use of a thoracolumbosacral orthotic. The preadolescent asks how long she will have to wear the brace. What is the appropriate response by the nurse? a. "For as long as you have been told." b. "Most preadolescents use the brace for 6 months." c. "Until your vertebral column has reached skeletal maturity." d. "It will be necessary to wear the brace for the rest of your life."

ANS: C Bracing can halt or slow the progress of most curvatures. They must be used continuously until the child reaches skeletal maturity. Telling the child "for as long as you have been told" does not answer the child's question and does not promote involvement in care. Six months is unrealistic because skeletal maturity is not reached until adolescence. When skeletal growth is complete, bracing is no longer effective.

At which age do most children have an adult concept of death as being inevitable, universal, and irreversible? a. 4 to 5 years b. 6 to 8 years c. 9 to 11 years d. 12 to 16 years

ANS: C By age 9 or 10 years, children have an adult concept of death. They realize that it is inevitable, universal, and irreversible. Preschoolers and young school-age children are too young to have an adult concept of death. Adolescents have a mature understanding of death.

A school-age child with celiac disease asks for guidance about snacks that will not exacerbate the disease. What snack should the nurse suggest? a. Pizza b. Pretzels c. Popcorn d. Oatmeal cookies

ANS: C Celiac disease symptoms result from ingestion of gluten. Corn and rice do not contain gluten. Popcorn or corn chips will not exacerbate the intestinal symptoms. Pizza and pretzels are usually made from wheat flour that contains gluten. Also, in the early stages of celiac disease, the child may be lactose intolerant. Oatmeal contains gluten.

Parent guidelines for relieving colic in an infant include which of the following? a. Avoid touching abdomen. b. Avoid using a pacifier. c. Change infant's position frequently. d. Place infant where family cannot hear the crying.

ANS: C Changing the infant's position frequently may be beneficial. The parent can walk holding the child face down and with the child's chest across the parent's arm. The parent's hand can support the child's abdomen, applying gentle pressure.

The nurse is teaching the parents of a child who is receiving methimazole (Tapazole) for the treatment of hyperthyroidism (Graves disease). Which statement made by the parent indicates a correct understanding of the teaching? a. "I would expect my child to gain weight while taking this medication." b. "I would expect my child to experience episodes of ear pain while taking this medication." c. "If my child develops a sore throat and fever, I should contact the physician immediately." d. "If my child develops the stomach flu, my child will need to be hospitalized."

ANS: C Children being treated with Tapazole must be carefully monitored for the side effects of the medication. Parents must be alerted that sore throat and fever accompany the grave complication of leukopenia. These symptoms should be immediately reported. Weight gain, episodes of ear pain, and concern for hospitalization with the stomach flu are not concerns related to taking Tapazole.

A child is receiving propylthiouracil for the treatment of hyperthyroidism (Graves disease). The parents and child should be taught to recognize and report which sign or symptom immediately? a. Fatigue b. Weight loss c. Fever, sore throat d. Upper respiratory tract infection

ANS: C Children being treated with propylthiouracil must be carefully monitored for the side effects of the drug. Parents must be alerted that sore throat and fever accompany the grave complication of leukopenia. These symptoms should be immediately reported. Fatigue and weight loss are manifestations of hyperthyroidism. Their presence may indicate that the drug is not effective but does not require immediate evaluation. Upper respiratory tract infections are most likely viral in origin and not a sign of leukopenia.

The sibling of a 4-year-old girl dies from sudden infant death syndrome. The parents are concerned because the 4-year-old girl showed more outward grief when her cat died than now. How should the nurse explain this reaction to the parents? a. The child is not old enough to have a concept of death. b. This suggests maladaptive coping, and referral is needed for counseling. c. The death may be so painful and threatening that the child must deny it for now. d. The child is not old enough to have formed a significant attachment to her sibling.

ANS: C Children of this age believe that their thoughts can cause death. The child may feel guilty and responsible. The loss may be so deep, painful, and threatening that the child needs to deny it for a time. Denial is within the range of a normal response to the death of a sibling. Counseling is not indicated at this time. Denial is also characteristic of the child's developmental level. These children do have a concept of death, seeing it as a separation. The child also would have formed an attachment to the sibling, who was in the house and sharing the parents' time and attention.

Which of the following describes moral development in younger school-age children? a. The standards of behavior now come from within themselves. b. They do not yet experience a sense of guilt when they misbehave. c. They know the rules and behaviors expected of them but do not understand the reasons behind them. d. They no longer interpret accidents and misfortunes as punishment for misdeeds.

ANS: C Children who are ages 6 and 7 years know the rules and behaviors expected of them but do not understand the reasons for these rules and behaviors.

A 7-year-old is identified as being at risk for skin breakdown. What intervention should the nursing care plan include? a. Massaging reddened bony prominences b. Teaching the parents to turn the child every 4 hours c. Ensuring that nutritional intake meets requirements d. Minimizing use of extra linens, which can irritate the child's skin

ANS: C Children who are hospitalized and NPO (taking nothing by mouth) for several days are at risk for nutritional deficiencies and skin breakdown. If NPO status is prolonged, parenteral nutrition should be considered. Massaging bony prominences can cause deep tissue damage. This should be avoided. Although parents can participate, turning the child is the nurse's responsibility. If the child is alert and can move, position shifts should be done more frequently. If the child does not move, the nurse should reposition every 2 hours. The number of linens is not an issue. The child should not be dragged across the sheet. Children should be lifted and moved to avoid friction and shearing.

Two hospitalized adolescents are playing pool in the activity room. Neither of them seems enthusiastic about the game. How should the nurse interpret this situation? a. Playing pool requires too much concentration for this age group. b. Pool is an activity better suited for younger children. c. The adolescents may be enjoying themselves but have lower energy levels than healthy children. d. The adolescents' lack of enthusiasm is one of the signs of depression.

ANS: C Children who are ill and hospitalized typically have lower energy levels than healthy children. Therefore, children may not appear enthusiastic about an activity even when they are enjoying it. Pool is an appropriate activity for adolescents. They have the cognitive and psychomotor skills that are necessary. If the adolescents were significantly depressed, they would be unable to engage in the game.

A school-age child with acute diarrhea and mild dehydration is being given oral rehydration solutions (ORS). The child's mother calls the clinic nurse because he is also occasionally vomiting. The nurse should recommend which intervention? a. Bring the child to the hospital for intravenous fluids. b. Alternate giving ORS and carbonated drinks. c. Continue to give ORS frequently in small amounts. d. Keep child NPO (nothing by mouth) for 8 hours and resume ORS if vomiting has subsided.

ANS: C Children who are vomiting should be given ORS at frequent intervals and in small amounts. Intravenous fluids are not indicated for mild dehydration. Carbonated beverages are high in carbohydrates and are not recommended for the treatment of diarrhea and vomiting. The child is not kept NPO because this would cause additional fluid losses

In providing nourishment for a child with cystic fibrosis (CF), what factors should the nurse keep in mind? a. Fats and proteins must be greatly curtailed. b. Most fruits and vegetables are not well tolerated. c. Diet should be high in calories, proteins, and unrestricted fats. d. Diet should be low fat but high in calories and proteins.

ANS: C Children with CF require a well-balanced, high-protein, high-caloric diet, with unrestricted fat (because of the impaired intestinal absorption).

The parents of an infant with cerebral palsy (CP) ask the nurse if their child will have cognitive impairment. The nurse's response should be based on which knowledge? a. Affected children have some degree of cognitive impairment. b. Around 20% of affected children have normal intelligence. c. About 45% of affected children have normal intelligence. d. Cognitive impairment is expected if motor and sensory deficits are severe.

ANS: C Children with CP have a wide range of intelligence, and 40% to 50% are within normal limits. A large percentage of children with CP do not have mental impairment. Many individuals who have severely limiting physical impairment have the least amount of intellectual compromise.

In a child with sickle cell anemia (SCA), adequate hydration is essential to minimize sickling and delay the vasoocclusion and hypoxia-ischemia cycle. What information should the nurse share with parents in a teaching plan? a. Encourage drinking. b. Keep accurate records of output. c. Check for moist mucous membranes. d. Monitor the concentration of the child's urine.

ANS: C Children with SCA have impaired kidney function and cannot concentrate urine. Parents are taught signs of dehydration and ways to minimize loss of fluid to the environment. Encouraging drinking is not specific enough for parents. The nurse should give the parents and child a target fluid amount for each 24-hour period. Accurate monitoring of output may not reflect the child's fluid needs. Without the ability to concentrate urine, the child needs additional intake to compensate. Dilute urine and specific gravity are not valid signs of hydration status in children with SCA.

A child has a streptococcal throat infection and is being treated with antibiotics. What should the nurse teach the parents to prevent infection of others? a. The child can return to school immediately. b. The organism cannot be transmitted through contact. c. The child can return to school after taking antibiotics for 24 hours. d. The organism can only be transmitted if someone uses a personal item of the sick child.

ANS: C Children with streptococcal infection are noninfectious to others 24 hours after initiation of antibiotic therapy. It is generally recommended that children not return to school or daycare until they have been taking antibiotics for a full 24-hour period. The organism is spread by close contact with affected persons—direct projection of large droplets or physical transfer of respiratory secretions containing the organism.

Which of the following is a major complication in a child with chronic renal failure? a. Hypokalemia b. Metabolic alkalosis c. Water and sodium retention d. Excessive excretion of blood urea nitrogen

ANS: C Chronic renal failure leads to water and sodium retention, which contributes to edema and vascular congestion.

What major complication is associated with a child with chronic renal failure? a. Hypokalemia b. Metabolic alkalosis c. Water and sodium retention d. Excessive excretion of blood urea nitrogen

ANS: C Chronic renal failure leads to water and sodium retention, which contributes to edema and vascular congestion. Hyperkalemia, metabolic acidosis, and retention of blood urea nitrogen are complications of chronic renal failure.

What medication is classified as an antiretroviral? a. Dapsone (Aczone) b. Pentamidine (Pentam) c. Didanosine (Videx) d. Trimethoprim-sulfamethoxazole (Bactrim)

ANS: C Classes of antiretroviral agents include nucleoside reverse transcriptase inhibitors (e.g., zidovudine, didanosine, stavudine, lamivudine, abacavir), nonnucleoside reverse transcriptase inhibitors (e.g., nevirapine, delavirdine, efavirenz), and protease inhibitors (e.g., indinavir, saquinavir, ritonavir, nelfinavir, amprenavir, lopinavir, ritonavir). Dapsone, pentamidine, and Bactrim are anti-infectives.

What term refers to seizures that involve both hemispheres of the brain? a. Absence b. Acquired c. Generalized d. Complex partial

ANS: C Clinical observations of generalized seizures indicate that the initial involvement is from both hemispheres. Absence seizures have a sudden onset and are characterized by a brief loss of consciousness, a blank stare, and automatisms. Acquired seizure disorder is a result of a brain injury from a variety of factors; it is not a term that labels the type of seizure. Complex partial seizures are the most common seizures. They may begin with an aura and be manifested as repetitive involuntary activities without purpose, carried out in a dreamy state.

Which type of seizure involves both hemispheres of the brain? a. Focal b. Partial c. Generalized d. Acquired

ANS: C Clinical observations of generalized seizures indicate that the initial involvement is from both hemispheres. Focal seizures may arise from any area of the cerebral cortex, but the frontal, temporal, and parietal lobes are most commonly affected. Partial seizures are caused by abnormal electric discharges from epileptogenic foci limited to a circumscribed region of the cerebral cortex. A seizure disorder that is acquired is a result of a brain injury from a variety of factors; it does not specify the type of seizure.

The nurse asks the mother of a child with a chronic illness many questions as part of the assessment. The mother answers several questions, then stops and says, "I don't know why you ask me all this. Who gets to know this information?" The nurse should respond in what manner? a. Determine why the mother is so suspicious. b. Determine what the mother does not want to tell. c. Explain who will have access to the information. d. Explain that everything is confidential and that no one else will know what is said.

ANS: C Communication with the family should not be invasive. The nurse needs to explain the importance of collecting the information, its applicability to the child's care, and who will have access to the information. The mother is not being suspicious and is not necessarily withholding important information. She has a right to understand how the information she provides will be used. The nurse will need to share, through both oral and written communication, clinically relevant information with other involved health professionals.

Physiologically, the child compensates for fluid volume losses by which mechanism? a. Inhibition of aldosterone secretion b. Hemoconcentration to reduce cardiac workload c. Fluid shift from interstitial space to intravascular space d. Vasodilation of peripheral arterioles to increase perfusion

ANS: C Compensatory mechanisms attempt to maintain fluid volume. Initially, interstitial fluid moves into the intravascular compartment to maintain blood volume. Aldosterone is released to promote sodium retention and conserve water in the kidneys. Hemoconcentration results from the fluid volume loss. With less circulating volume, tachycardia results. Vasoconstriction of peripheral arterioles occurs to help maintain blood pressure.

A young child's parents call the nurse after their child was bitten by a raccoon in the woods. The nurse's recommendation should be based on which statement? a. Child should be hospitalized for close observation. b. No treatment is necessary if thorough wound cleaning is done. c. Antirabies prophylaxis must be initiated. d. Antirabies prophylaxis must be initiated if clinical manifestations appear.

ANS: C Current therapy for a rabid animal bite consists of a thorough cleansing of the wound and passive immunization with human rabies immune globulin (HRIG) as soon as possible. Hospitalization is not necessary. The wound cleansing, passive immunization, and immune globulin administration can be done as an outpatient. The child needs to receive both HRIG and rabies vaccine.

The nurse is monitoring a 7-year-old child post-surgical resection of an infratentorial brain tumor. Which vital sign findings indicate Cushing's triad? a. Increased temperature, tachycardia, tachypnea b. Decreased temperature, bradycardia, bradypnea c. Bradycardia, hypertension, irregular respirations d. Bradycardia, hypotension, tachypnea

ANS: C Cushing's triad is a hallmark sign of increased intracranial pressure (ICP). The triad includes bradycardia, hypertension, and irregular respirations. Increased or decreased temperature is not a sign of Cushing's triad.

The nurse is teaching a child with a cast about cast removal. What should the nurse teach the child about cast removal? a. "The cast cutter will be a quiet machine." b. "You will feel cold as the cast is removed." c. "You will feel a tickly sensation as the cast is removed." d. "The cast cutter cuts through the cast like a circular saw."

ANS: C Cutting the cast to remove it or to relieve tightness is frequently a frightening experience for children. They fear the sound of the cast cutter and are terrified that their flesh, as well as the cast, will be cut. Because it works by vibration, a cast cutter cuts only the hard surface of the cast. The oscillating blade vibrates back and forth very rapidly and will not cut when placed lightly on the skin. Children have described it as producing a "tickly" sensation

What statement best describes Duchenne (pseudohypertrophic) muscular dystrophy (DMD)? a. It has an autosomal dominant inheritance pattern. b. Onset occurs in later childhood and adolescence. c. It is characterized by presence of Gower sign, a waddling gait, and lordosis. d. Disease stabilizes during adolescence, allowing for life expectancy to approximately age 40 years.

ANS: C DMD is characterized by a waddling gait and lordosis. Gower sign is a characteristic way of rising from a squatting or sitting position on the floor. DMD is inherited as an X-linked recessive gene. Genetic counseling is recommended for parents, female siblings, maternal aunts, and their female offspring. Onset occurs usually between ages 3 and 5 years. DMD has a progressive and relentless loss of muscle function until death by respiratory or cardiac failure.

The diet of a child with chronic renal failure is usually characterized as which of the following? a. High in protein b. Low in vitamin D c. Low in phosphorus d. Supplemented with vitamins A, E, and K

ANS: C Dietary phosphorus is controlled by the reduction of protein and milk intake to prevent or control the calcium-phosphorus imbalance.

What diet is most appropriate for the child with chronic renal failure (CRF)? a. Low in protein b. Low in vitamin D c. Low in phosphorus d. Supplemented with vitamins A, E, and K

ANS: C Dietary phosphorus may need to be restricted by limiting protein and milk intake. Substances that bind phosphorus are given with meals to prevent its absorption, which enables a more liberal intake of phosphorus-containing protein. Protein is limited to the recommended daily allowance for the child's age. Further restriction is thought to negatively affect growth and neurodevelopment. Vitamin D therapy is administered in children with CRF to increase calcium absorption. Supplementation of vitamins A, E, and K, beyond normal dietary intake, is not advised in children with CRF. These fat-soluble vitamins can accumulate.

What finding is a clinical manifestation of increased intracranial pressure (ICP) in children? a. Low-pitched cry b. Sunken fontanel c. Diplopia, blurred vision d. Increased blood pressure

ANS: C Diplopia and blurred vision are signs of increased ICP in children. A high-pitched cry and a tense or bulging fontanel are characteristic of increased ICP. Increased blood pressure, common in adults, is rarely seen in children.

The parents of a child with cognitive impairment ask the nurse for guidance with discipline. What should the nurse's recommendation be based on? a. Discipline is ineffective with cognitively impaired children. b. Cognitively impaired children do not require discipline. c. Behavior modification is an excellent form of discipline. d. Physical punishment is the most appropriate form of discipline.

ANS: C Discipline must begin early. Limit-setting measures must be clear, simple, consistent, and appropriate for the child's mental age. Behavior modification, especially reinforcement of desired behavior and use of time-out procedures, is an appropriate form of behavior control. Aversive strategies should be avoided in disciplining the child.

The nurse is caring for a child with a decubiti on the buttocks. The nurse notes that the dressing covering the decubiti is loose. What action should the nurse implement? a. Retape the dressing. b. Remove the dressing. c. Change the dressing. d. Reinforce the dressing.

ANS: C Dressings should always be changed when they are loose or soiled. They should be changed more frequently in areas where contamination is likely (e.g., sacral area, buttocks, tracheal area). The dressing should not be retaped, removed, or reinforced.

The nurse understands that medications delivered by which route are more likely to cause a drug reaction? a. Oral b. Topical c. Intravenous d. Intramuscular

ANS: C Drugs administered by the intravenous route are more likely to cause a reaction than the oral, topical, or intramuscular route.

The nurse is admitting a toddler with the diagnosis of juvenile hypothyroidism. Which is a common clinical manifestation of this disorder? a. Insomnia b. Diarrhea c. Dry skin d. Accelerated growth

ANS: C Dry skin, mental decline, and myxedematous skin changes are associated with juvenile hypothyroidism. Children with hypothyroidism are usually sleepy. Constipation is associated with hypothyroidism. Decelerated growth is common in juvenile hypothyroidism.

What is a common clinical manifestation of juvenile hypothyroidism? a. Insomnia b. Diarrhea c. Dry skin d. Rapid growth

ANS: C Dry skin, mental decline, and myxedematous skin changes are associated with juvenile hypothyroidism. Children with hypothyroidism often have sleepiness, constipation, and decelerated growth.

What nursing intervention is most appropriate when caring for the child with osteomyelitis? a. Encourage frequent ambulation. b. Administer antibiotics with meals. c. Move and turn the child carefully and gently to minimize pain. d. Provide active range of motion exercises for the affected extremity.

ANS: C During the acute phase, any movement of the affected limb causes discomfort to the child. Careful positioning with the affected limb supported is necessary. Weight bearing is not permitted until healing is well under way to avoid pathologic fractures. Intravenous antibiotics are used initially. Food is not necessary with parenteral therapy. Active range of motion would be painful for the child.

The nurse is teaching a child experiencing severe edema associated with minimal change nephrotic syndrome about his diet. The nurse should discuss what dietary need? a. Consuming a regular diet b. Increasing protein c. Restricting fluids d. Decreasing calories

ANS: C During the edematous stage of active nephrosis, the child has restricted fluid and sodium intake. As the edema subsides, the child is placed on a diet with increased salt and fluids. A regular diet is not indicated. There is no evidence that a diet high in protein is beneficial or has an effect on the course of the disease. Calories sufficient for growth and tissue healing are essential. With the child having little appetite and the fluid and salt restrictions, achieving adequate nutrition is difficult.

After the acute stage and during the healing process, what is the primary complication from burn injury? a. Shock b. Asphyxia c. Infection d. Renal shutdown

ANS: C During the healing phase, local infection or sepsis is the primary complication. Respiratory problems, primarily airway compromise, and shock are the primary complications during the acute stage of burn injury. Renal shutdown is not a complication of the burn injury but may be a result of the profound shock.

An adolescent with a spinal cord injury is admitted to a rehabilitation center. Her parents describe her as being angry, hostile, and uncooperative. The nurse should recognize that this is suggestive of which psychosocial state? a. Normal phase of adolescent development b. Severe depression that will require long-term counseling c. Normal response to her situation that can be redirected in a healthy way d. Denial response to her situation that makes rehabilitative efforts more difficult

ANS: C During the rehabilitation phase, it is desirable for adolescents to begin to express negative feelings toward the situation. The rehabilitation team can redirect the negative energy toward learning a new way of life. The injury has interrupted the normal adolescent process of achieving independence, triggering these negative behaviors. Severe depression can occur, but it indicates that the child is no longer in denial. Long-term therapy is not indicated. Being angry, hostile, and uncooperative are behaviors that are indications that the adolescent understands the severity of the injury and need for rehabilitation.

In some genetically susceptible children, anesthetic agents can trigger malignant hyperthermia. The nurse should be alert in observing that, in addition to an increased temperature, an early sign of this disorder is which of the following? a. Apnea b. Bradycardia c. Muscle rigidity d. Decreased blood pressure

ANS: C Early signs of malignant hyperthermia include tachycardia, increasing blood pressure, tachypnea, mottled skin, and muscle rigidity.

Tepid water or sponge baths are indicated for hyperthermia in children. The nurse should do which of the following? a. Add isopropyl alcohol to the water. b. Direct a fan on the child in the bath. c. Stop the bath if the child begins to chill. d. Continue the bath for 5 minutes.

ANS: C Environmental measures such as sponge baths can be used to reduce temperature if tolerated by the child and if they do not induce shivering. Shivering is the body's way of maintaining the elevated set point. Compensatory shivering increases metabolic requirements above those already caused by the fever.

What medication is considered to be the most useful in treating cardiac arrest? a. Bretylium tosylate (Bretylium) b. Xylocaine (lidocaine) c. Adrenaline (epinephrine) d. Naloxone (Narcan)

ANS: C Epinephrine is considered one of the most useful drugs in treating cardiac arrest. As an adrenergic agent, it acts on both - and -receptors in the heart. Epinephrine is rapidly cleared from the bloodstream. Bretylium is no longer used in pediatric cardiac arrest management. Lidocaine is used for ventricular arrhythmias only. Naloxone is useful only to reverse effects of opioids.

Which drug is considered the most useful in treating childhood cardiac arrest? a. Bretylium tosylate (Bretylium) b. Lidocaine hydrochloride (Lidocaine) c. Epinephrine hydrochloride (Adrenaline) d. Naloxone (Narcan)

ANS: C Epinephrine works on alpha and beta receptors in the heart and is the most useful drug in childhood cardiac arrest. Bretylium is no longer used in pediatric cardiac arrest management. Lidocaine is used for ventricular arrhythmias only. Naloxone is useful only to reverse effects of opioids.

Vitamin A supplementation may be recommended for the young child who has which of the following? a. Mumps b. Rubella c. Measles (rubeola) d. Erythema infectiosum

ANS: C Evidence shows vitamin A decreases morbidity and mortality in measles.

The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. What effect does exercise have on a type 1 diabetic? a. Exercise increases blood glucose. b. Extra insulin is required during exercise. c. Additional snacks are needed before exercise. d. Excessive physical activity should be restricted.

ANS: C Exercise lowers blood glucose levels, decreasing the need for insulin. Extra snacks are provided to maintain the blood glucose levels. Exercise is encouraged and not restricted unless indicated by other health conditions.

The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. Which should the nurse explain about exercise in type 1 diabetes? a. Exercise will increase blood glucose. b. Exercise should be restricted. c. Extra snacks are needed before exercise. d. Extra insulin is required during exercise.

ANS: C Exercise lowers blood glucose levels, which can be compensated for by extra snacks. Exercise lowers blood glucose and is encouraged and not restricted, unless indicated by other health conditions. Extra insulin is contraindicated because exercise decreases blood glucose levels.

What parents should have the most difficult time coping with their child's hospitalization? a. Parents of a child hospitalized for juvenile arthritis b. Parents of a child hospitalized with a recent diagnosis of bronchiolitis c. Parents of a child hospitalized for sepsis resulting from an untreated injury d. Parents of a child hospitalized for surgical correction of undescended testicles

ANS: C Factors that affect parents' reactions to their child's illness include the seriousness of the threat to the child. The parents of a child hospitalized for sepsis resulting from an untreated injury would have more difficulty coping because of the seriousness of the illness and because the wound was not treated immediately.

The nurse is caring for a hospitalized adolescent whose femur was fractured 18 hours ago. The adolescent suddenly develops chest pain and dyspnea. The nurse should suspect what complication? a. Sepsis b. Osteomyelitis c. Pulmonary embolism d. Acute respiratory tract infection

ANS: C Fat emboli are of greatest concern in individuals with fractures of the long bones. Fat droplets from the marrow are transferred to the general circulation, where they are transported to the lung or brain. This type of embolism usually occurs within the second 12 hours after the injury. Sepsis would manifest with fever and lethargy. Osteomyelitis usually is seen with pain at the site of infection and fever. A child with an acute respiratory tract infection would have nasal congestion, not chest pain.

Rickets is caused by a deficiency in: a. vitamin A. b. vitamin C. c. vitamin D and calcium. d. folic acid and iron.

ANS: C Fat-soluble vitamin D and calcium are necessary in adequate amounts to prevent the development of rickets.

A feeding technique the nurse can teach to parents of a child with cerebral palsy to improve use of the lips and the tongue to facilitate speech is which? a. Feeding pureed foods b. Placing food on the tongue c. Placing food at the side of the tongue d. Placing food directly into the mouth with a spoon

ANS: C Feeding techniques such as forcing the child to use the lips and tongue in eating facilitate speech. An example of this technique is placing food at the side of the tongue, first one side and then the other, and making the child use the lips to take food from a spoon rather than placing it directly on the tongue. Feeding pureed foods would not encourage use of the lips and tongue.

The nurse is teaching the parent of a child experiencing severe edema associated with acute glomerulonephritis about the child's diet. Which of the following information should the nurse include in the teaching? a. "You will need to decrease the number of calories in your child's diet." b. "Your child's diet will need an increased amount of protein." c. "You will need to avoid adding salt to your child's food." d. "Your child's diet will consist of low-fat, low carbohydrate foods."

ANS: C For most children, a regular diet is allowed, but it should contain no added salt.

What behavior should most likely be manifested in an infant experiencing the protest phase of separation anxiety? a. Inactivity b. Depression and sadness c. Inconsolable and crying d. Regression to earlier behavior

ANS: C For older infants, being inconsolable and crying is seen during the protest phase of separation anxiety. Inactivity is observed during the stage of despair. The child is much less active and withdraws from others. Depression, sadness, and regression to earlier behaviors are observed during the phase of despair.

What organism is a parasite that causes acute diarrhea? a. Shigella organisms b. Salmonella organisms c. Giardia lamblia d. Escherichia coli

ANS: C G. lamblia is a parasite that represents 10% of nondysenteric illness in the United States. Shigella, Salmonella, and E. coli are bacterial pathogens.

The mother of a child with cognitive impairment calls the nurse because her son has been gagging and drooling all morning. The nurse suspects foreign body ingestion. What physiologic occurrence is most likely responsible for the presenting signs? a. Gastrointestinal perforation may have occurred. b. The object may have been aspirated. c. The object may be lodged in the esophagus. d. The object may be embedded in stomach wall.

ANS: C Gagging and drooling may be signs of esophageal obstruction. The child is unable to swallow saliva, which contributes to the drooling. Signs of gastrointestinal (GI) perforation include chest or abdominal pain and evidence of bleeding in the GI tract. If the object was aspirated, the child would most likely have coughing, choking, inability to speak, or difficulty breathing. If the object was embedded in the stomach wall, it would not result in symptoms of gagging and drooling.

A girl, age 5 1/2 years, has been sent to the school nurse for urinary incontinence three times in the past 2 days. The nurse should recommend to her parent that the first action is to have the child evaluated for what condition? a. School phobia b. Glomerulonephritis c. Urinary tract infection (UTI) d. Attention deficit hyperactivity disorder (ADHD)

ANS: C Girls between the ages of 2 and 6 years are considered high risk for UTIs. This child is showing signs of a UTI, including incontinence in a toilet-trained child and possible urinary frequency or urgency. A physiologic cause should be ruled out before psychosocial factors are investigated. Glomerulonephritis usually manifests with decreased urinary output and fluid retention. ADHD can contribute to urinary incontinence because the child is distracted, but the first manifestation was incontinence, not distractibility.

Which of the following is the most appropriate nursing diagnosis for the child with acute glomerulonephritis? a. Risk for Injury related to malignant process and treatment b. Fluid Volume Deficit related to excessive losses c. Fluid Volume Excess related to decreased plasma filtration d. Fluid Volume Excess related to fluid accumulation in tissues and third spaces

ANS: C Glomerulonephritis has a decreased filtration of plasma, which results in an excessive accumulation of water and sodium that expands plasma and interstitial fluid volumes, leading to circulatory congestion and edema.

The most common clinical manifestation(s) of brain tumors in children is/are: a. irritability. b. seizures. c. headaches and vomiting. d. fever and poor fine motor control.

ANS: C Headaches, especially on awakening, and vomiting that is not related to feeding are the most common clinical manifestation(s) of brain tumors in children. Irritability, seizures, and fever and poor fine motor control are clinical manifestations of brain tumors, but headaches and vomiting are the most common.

The nurse at a summer camp recognizes the signs of heatstroke in an adolescent girl. Her temperature is 40° C (104° F). She is slightly confused but able to drink water. Nursing care while waiting for transport to the hospital should include what intervention? a. Administer antipyretics. b. Administer salt tablets. c. Apply towels wet with cool water. d. Sponge with solution of rubbing alcohol and water.

ANS: C Heatstroke is a failure of normal thermoregulatory mechanisms. The onset is rapid with initial symptoms of headache, weakness, and disorientation. Immediate care is relocation to a cool environment, removal of clothing, and applying of cool water (wet towels or immersion). Antipyretics are not used because they are metabolized by the liver, which is already not functioning. Salt tablets are not indicated and may be harmful by increasing dehydration. Rubbing alcohol is not used.

A hospitalized child with minimal change nephrotic syndrome is receiving high doses of prednisone. What nursing goal is appropriate for this child? a. Stimulate appetite. b. Detect evidence of edema. c. Minimize risk of infection. d. Promote adherence to the antibiotic regimen.

ANS: C High-dose steroid therapy has an immunosuppressant effect. These children are particularly vulnerable to upper respiratory tract infections. A priority nursing goal is to minimize the risk of infection by protecting the child from contact with infectious individuals. Appetite is increased with prednisone therapy. The amount of edema should be monitored as part of the disease process, not necessarily related to the administration of prednisone. Antibiotics would not be used as prophylaxis.

A pregnant woman asks about prenatal diagnosis of hydrocephalus. The nurse's response should be based on which knowledge? a. It can be diagnosed only after birth. b. It can be diagnosed by chromosome studies. c. It can be diagnosed with fetal ultrasonography. d. It can be diagnosed by measuring the lecithin-to-sphingomyelin ratio.

ANS: C Hydrocephalus can be diagnosed by fetal ultrasonography as early as 14 weeks of gestation. Most incidents of hydrocephalus are not chromosomal in origin. The lecithin-to-sphingomyelin ratio can be used to determine fetal lung maturity.

Spastic cerebral palsy (CP) is characterized by which clinical manifestations? a. Athetosis, dystonic movements b. Tremors, lack of active movement c. Hypertonicity; poor control of posture, balance, and coordinated motion d. Wide-based gait; poor performance of rapid, repetitive movements

ANS: C Hypertonicity and poor control of posture, balance, and coordinated motion are part of the classification of spastic CP. Athetosis and dystonic movements are part of the classification of dyskinetic or athetoid CP. Tremors and lack of active movement may indicate other neurologic disorders. A wide-based gait and poor performance of rapid, repetitive movements are part of the classification of ataxic CP.

A school nurse is conducting a staff in-service to other school nurses on idiopathic scoliosis. During which period of child development does idiopathic scoliosis become most noticeable? a. Newborn period b. When child starts to walk c. Preadolescent growth spurt d. Adolescence

ANS: C Idiopathic scoliosis is most noticeable during the preadolescent growth spurt. Idiopathic scoliosis is seldom apparent before age 10 years. Diagnosis usually occurs during the preadolescent growth spurt.

When does idiopathic scoliosis become most noticeable? a. In the newborn period b. When the child starts to walk c. During the preadolescent growth spurt d. During adolescence

ANS: C Idiopathic scoliosis is most noticeable during the preadolescent growth spurt. It is seldom apparent before age 10 years.

What condition is an acquired hemorrhagic disorder that is characterized by excessive destruction of platelets? a. Aplastic anemia b. Thalassemia major c. Idiopathic thrombocytopenic purpura d. Disseminated intravascular coagulation

ANS: C Idiopathic thrombocytopenic purpura is an acquired hemorrhagic disorder characterized by an excessive destruction of platelets, discolorations caused by petechiae beneath the skin, and normal bone marrow. Aplastic anemia refers to a bone marrow failure condition in which the formed elements of the blood are simultaneously depressed. Thalassemia major is a group of blood disorders characterized by deficiency in the production rate of specific hemoglobin chains. Disseminated intravascular coagulation is characterized by diffuse fibrin deposition in the microvasculature, consumption of coagulation factors, and endogenous generation of thrombin and plasma.

The nurse is assessing a child with croup in the emergency department. The child has a sore throat and is drooling. Examining the child's throat using a tongue depressor might precipitate what condition? a. Sore throat b. Inspiratory stridor c. Complete obstruction d. Respiratory tract infection

ANS: C If a child has acute epiglottitis, examination of the throat may cause complete obstruction and should be performed only when immediate intubation can take place. Sore throat and pain on swallowing are early signs of epiglottitis. Stridor is aggravated when a child with epiglottitis is supine. Epiglottitis is caused by Haemophilus influenzae in the respiratory tract.

The parent of an infant with nasopharyngitis should be instructed to notify the health professional if the infant shows signs or symptoms of which condition? a. Has a cough b. Becomes fussy c. Shows signs of an earache d. Has a fever higher than 37.5° C (99° F)

ANS: C If an infant with nasopharyngitis shows signs of an earache, it may indicate respiratory complications and possibly secondary bacterial infection. The health professional should be contacted to evaluate the infant. Cough can be a sign of nasopharyngitis. Irritability is common in an infant with a viral illness. Fever is common in viral illnesses.

An infant had a gastrostomy tube placed for feedings after a Nissen fundoplication and bolus feedings are initiated. Between feedings while the tube is clamped, the infant becomes irritable, and there is evidence of cramping. What action should the nurse implement? a. Burp the infant. b. Withhold the next feeding. c. Vent the gastrostomy tube. d. Notify the health care provider.

ANS: C If bolus feedings are initiated through a gastrostomy after a Nissen fundoplication, the tube may need to remain vented for several days or longer to avoid gastric distention from swallowed air. Edema surrounding the surgical site and a tight gastric wrap may prohibit the infant from expelling air through the esophagus, so burping does not relieve the distention. Some infants benefit from clamping of the tube for increasingly longer intervals until they are able to tolerate continuous clamping between feedings. During this time, if the infant displays increasing irritability and evidence of cramping, some relief may be provided by venting the tube. The next feeding should not be withheld, and calling the health care provider is not necessary.

The nurse is caring for a child after heart surgery. Which should the nurse do if evidence is found of cardiac tamponade? a. Increase analgesia. b. Apply warming blankets. c. Immediately report this to physician. d. Encourage child to cough, turn, and breathe deeply.

ANS: C If evidence is noted of cardiac tamponade, which is blood or fluid in the pericardial space constricting the heart, the physician is notified immediately of this life-threatening complication. Increasing analgesia may be done before the physician drains the fluid, but the physician must be notified. Warming blankets are not indicated at this time. Encouraging the child to cough, turn, and breathe deeply should be deferred till after the evaluation by the physician.

Which is an important nursing consideration when suctioning a young child who has had heart surgery? a. Perform suctioning at least every hour. b. Suction for no longer than 30 seconds at a time. c. Administer supplemental oxygen before and after suctioning. d. Expect symptoms of respiratory distress when suctioning.

ANS: C If suctioning is indicated, supplemental oxygen is administered with a manual resuscitation bag before and after the procedure to prevent hypoxia. Suctioning should be done only as indicated, not on a routine basis. The child should be suctioned for no more than 5 seconds at one time. Symptoms of respiratory distress are avoided by using appropriate technique.

A 6-month-old infant is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than _____ beats/min. a. 60 b. 70 c. 90 to 110 d. 110 to 120

ANS: C If the 1-minute apical pulse is below 90 to 110 beats/min, the digoxin should not be given to a 6-month-old. 60 beats/min is the cut-off for holding the digoxin dose in an adult. 70 beats/min is the determining heart rate to hold a dose of digoxin for an older child. 110 to 120 beats/min is an acceptable heart rate to administer digoxin to a 6-month-old.

A child is admitted in acute renal failure (ARF). Therapeutic management to rapidly provoke a flow of urine includes the administration of what medication? a. Propranolol (Inderal) b. Calcium gluconate c. Mannitol (Osmitrol) or furosemide (Lasix) (or both) d. Sodium, chloride, and potassium

ANS: C In ARF, if hydration is adequate, mannitol or furosemide (or both) is administered to provoke a flow of urine. If glomerular function is intact, an osmotic diuresis will occur. Propranolol is a beta-blocker; it will not produce a rapid flow of urine in ARF. Calcium gluconate is administered for its protective cardiac effect when hyperkalemia exists. It does not affect diuresis. Electrolyte measurements must be done before administration of sodium, chloride, or potassium. These substances are not given unless there are other large, ongoing losses. In the absence of urine production, potassium levels may be elevated, and additional potassium can cause cardiac dysrhythmias.

The nurse is caring for a child with Meckel diverticulum. What type of stool does the nurse expect to observe? a. Steatorrhea b. Clay colored c. Currant jelly-like d. Loose stools with undigested food

ANS: C In Meckel diverticulum the bleeding is usually painless and may be dramatic and occur as bright red or currant jelly-like stools, or it may occur intermittently and appear as tarry stools. The stools are not clay colored, steatorrhea, or loose with undigested food.

A 5-year-old child returns from the pediatric intensive care unit after abdominal surgery. The orders state to monitor vital signs every 2 hours. On assessment, the nurse observes that the child's heart rate is 20 beats/min less than it was preoperatively. What should be the nurse's next action? a. Follow the orders and check in 2 hours. b. Ask the parents if this is the child's usual heart rate. c. Recheck the pulse and blood pressure in 15 minutes. d. Notify the surgeon that the child is probably going into shock.

ANS: C In a 5-year-old child, this is a significant change in vital signs. The nurse should assess the child to see if his condition mirrors a drop in heart rate. The assessment and vital signs should be redone in 15 minutes to determine whether the child's condition is stable. When a disparity in vital signs or other assessment data is observed, the nurse should reassess sooner. Most parents will not know their child's heart rate. It is important to determine how the child is recovering from surgery. The nurse should collect additional information before notifying the surgeon. This includes blood pressure, respiratory rate, and pain status.

After spinal fusion surgery the nurse should check for signs of what? a. Seizure activity b. Increased intracranial pressure c. Impaired color, sensitivity, and movement to the lower extremities d. Impaired pupillary response during neurologic checks

ANS: C In addition to the usual postoperative assessments of wound, circulation, and vital signs, the neurologic status of the patient's extremities requires special attention. Prompt recognition of any neurologic impairment is imperative because delayed paralysis may develop that requires surgical intervention.

What is an appropriate nursing intervention for a child with minimal change nephrotic syndrome (MCNS) who has scrotal edema? a. Place an ice pack on the scrotal area. b. Place the child in an upright sitting position. c. Elevate the scrotum with a rolled washcloth. d. Place a warm moist pack to the scrotal area.

ANS: C In children hospitalized with MCNS, elevating edematous parts may be helpful to shift fluid to more comfortable distributions. Areas that are particularly edematous, such as the scrotum, abdomen, and legs, may require support. The scrotum can be elevated with a rolled washcloth. Ice or heat should not be used. Sitting the child in an upright position will not decrease the scrotal edema.

Parents of a toddler with hypopituitarism ask the nurse, "What can we expect with this condition?" The nurse should respond with which statement? a. Growth is normal during the first 3 years of life. b. Weight is usually more retarded than height. c. Skeletal proportions are normal for age. d. Most of these children have subnormal intelligence.

ANS: C In children with hypopituitarism, the skeletal proportions are normal. Growth is within normal limits for the first year of life. Height is usually more delayed than weight. Intelligence is not affected by hypopituitarism.

The nurse is teaching parents of an infant about the causes of iron deficiency anemia. Which statement best describes iron deficiency anemia in infants? a. It is caused by depression of the hematopoietic system. b. It is easily diagnosed because of an infant's emaciated appearance. c. Clinical manifestations are similar regardless of the cause of the anemia. d. Clinical manifestations result from a decreased intake of milk and the premature addition of solid foods.

ANS: C In iron deficiency anemia, the child's clinical appearance is a result of the anemia, not the underlying cause. Usually the hematopoietic system is not depressed in iron deficiency anemia. The bone marrow produces red cells that are smaller and contain less hemoglobin than normal red cells. Children who are iron deficient from drinking excessive quantities of milk are usually pale and overweight. They are receiving sufficient calories, but are deficient in essential nutrients. The clinical manifestations result from decreased intake of iron-fortified solid foods and an excessive intake of milk.

After a tonic-clonic seizure, what symptoms should the nurse expect the child to experience? a. Diarrhea and abdominal discomfort b. Irritability and hunger c. Lethargy and confusion d. Nervousness and excitability

ANS: C In the postictal phase, after a tonic-clonic seizure, the child may remain semiconscious and difficult to arouse. The average duration of the postictal phase is usually 30 minutes. The child may remain confused or sleep for several hours. He or she may have mild impairment of fine motor movements. The child may have visual and speech difficulties and may vomit or complain of headache.

The nurse is caring for a 4-year-old child with cerebral palsy (CP). The child, developmentally, is at an infant stage. Appropriate developmental stimulation for this child should be what? a. Playing "pat-a-cake" with the child b. None so the child does not become overstimulated c. Putting a colorful mobile with music on the bed d. Giving the child a coloring book and crayons

ANS: C Incorporating play into the therapeutic program for a child with CP often requires great ingenuity and inventiveness from those involved in the child's care. Objects and toys are chosen for the child's developmental stage to provide needed sensory input using a variety of shapes, forms, and textures. Nurses can help parents integrate therapy into play activities in natural ways.

What nursing care should be included for a child diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH)? a. Maintain the child NPO (nothing by mouth). b. Turn the child frequently. c. Restrict fluids. d. Encourage fluids.

ANS: C Increased secretion of ADH causes the kidney to reabsorb water, which increases fluid volume and decreases serum osmolarity with a progressive reduction in sodium concentration. The immediate management of the child is to restrict fluids but not food. Frequently turning the child is not necessary unless the child is unresponsive. Encouraging fluids will worsen the child's condition.

Which statement best describes -thalassemia major (Cooley anemia)? a. All formed elements of the blood are depressed. b. Inadequate numbers of red blood cells are present. c. Increased incidence occurs in families of Mediterranean extraction. d. Increased incidence occurs in persons of West African descent.

ANS: C Individuals who live near the Mediterranean Sea and their descendants have the highest incidence of thalassemia. An overproduction of red cells occurs. Although numerous, the red cells are relatively unstable. Sickle cell disease is common in persons of West African descent.

What statement best describes -thalassemia major (Cooley anemia)? a. It is an acquired hemolytic anemia. b. Inadequate numbers of red blood cells (RBCs) are present. c. Increased incidence occurs in families of Mediterranean extraction. d. It commonly occurs in individuals from West Africa.

ANS: C Individuals who live near the Mediterranean Sea and their descendants have the highest incidence of thalassemia. Thalassemia is inherited as an autosomal recessive disorder. An overproduction of RBCs occurs. Although numerous, the red blood cells are relatively unstable. Sickle cell disease is common in blacks of West African descent.

Young people with anorexia nervosa are often described as being which of the following? a. Independent b. Disruptive c. Conforming d. Low achieving

ANS: C Individuals with anorexia nervosa are described as perfectionist, academically high achievers, conforming, and conscientious.

The nurse is teaching infant care to parents with an infant who has been diagnosed with osteogenesis imperfecta (OI). What should the nurse include in the teaching session? a. "Bisphosphonate therapy is not beneficial for OI." b. "Physical therapy should be avoided as it may cause damage to bones." c. "Lift the infant by the buttocks, not the ankles, when changing diapers." d. "The infant should meet expected gross motor development without assistive devices."

ANS: C Infants and children with this disorder require careful handling to prevent fractures. They must be supported when they are being turned, positioned, moved, and held. Even changing a diaper may cause a fracture in severely affected infants. These children should never be held by the ankles when being diapered but should be gently lifted by the buttocks or supported with pillows. Bisphosphonate and physical therapy are beneficial for OI. Lightweight braces will be used when the child starts to ambulate.

Prevention of burn injury is important anticipatory guidance. In the infant and toddler period, which mode is the most common cause of burn? a. Matches b. Electrical cords c. Hot liquids in the kitchen d. Microwave-heated foods

ANS: C Infants and toddlers are most commonly injured by hot liquids in the kitchen and bathroom. This often occurs as a result of inadequate supervision of this curious and energetic age group. Matches and lighters are seen as toys by young children and should be kept out of reach. Older toddlers and preschool children are at risk of chewing on electrical cords and placing objects in outlets. Microwave-heated fluids and foods can become superheated, resulting in oral burns.

The nurse is teaching a family how to care for their infant in a Pavlik harness to treat developmental dysplasia of the hip. Which should be included? a. Apply lotion or powder to minimize skin irritation. b. Remove harness several times a day to prevent contractures. c. Return to clinic every 1 to 2 weeks. d. Place diaper over harness, preferably using a superabsorbent disposable diaper that is relatively thin.

ANS: C Infants have a rapid growth pattern. The child needs to be assessed by the practitioner every 1 to 2 weeks for possible adjustments. Lotions and powders should not be used with the harness. The harness should not be removed, except as directed by the practitioner. A thin disposable diaper can be placed under the harness.

A 2-week-old infant with Down syndrome is being seen in the clinic. His mother tells the nurse that he is difficult to hold, that "he's like a rag doll. He doesn't cuddle up to me like my other babies did." What is the nurse's best interpretation of this lack of clinging or molding? a. Sign of detachment and rejection b. Indicative of maternal deprivation c. A physical characteristic of Down syndrome d. Suggestive of autism associated with Down syndrome

ANS: C Infants with Down syndrome have hypotonicity of muscles and hyperextensibility of joints, which complicate positioning. The limp, flaccid extremities resemble the posture of a rag doll. Holding the infant is difficult and cumbersome, and parents may feel that they are inadequate. A lack of clinging or molding is characteristic of Down syndrome, not detachment. There is no evidence of maternal deprivation. Autism is not associated with Down syndrome, and it would not be evident at 2 weeks of age.

During a well-child visit, the mother tells the nurse that her 4-month-old infant is constipated, is less active than usual, and has a weak-sounding cry. The nurse suspects botulism and questions the mother about the child's diet. What factor should support this diagnosis? a. Breastfeeding b. Commercial formula c. Infant cereal with honey d. Improperly sterilized bottles

ANS: C Ingestion of honey is a risk factor for infant botulism in the United States. Honey should not be given to children younger than the age of 1 year. Botulism is not found with the use of commercial infant cereals. Although there is a slight increase in botulism in breastfed infants when compared with formula-fed infants, there is not sufficient evidence to support formula feeding as prevention. Thoroughly cleaning bottles used for formula feeding is sufficient for botulism prevention. Inadequate sterilization of home-canned foods can contribute to botulism.

42. What is the purpose of a high-protein diet for a child with major burns? a. Promote growth b. Improve appetite c. Minimize protein breakdown d. Diminish risk of stress-induced hyperglycemia

ANS: C Initially after major burns, there is a hypometabolic phase, which lasts for 2 or 3 days. A hypermetabolic phase follows, characterized by increased body temperature, oxygen and glucose consumption, carbon dioxide production, glycogenolysis, proteolysis, and lipolysis. This response continues for up to 9 months. A diet high in protein and calories is necessary. Healing, not growth, is the primary consideration. Many children have poor appetites, and supplementation is necessary. Hypoglycemia, not hyperglycemia, can occur from the stress of burn injury because the liver glycogen stores are rapidly depleted.

Parents bring a 7-year-old child to the clinic for evaluation of an injured wrist after a bicycle accident. The parents and child are upset, and the child will not allow an examination of the injured arm. What priority nursing intervention should occur at this time? a. Send the child to radiology so radiography can be performed. b. Initiate an intravenous line and administer morphine for the pain. c. Calmly ask the child to point to where the pain is worst and to wiggle fingers. d. Have the parents hold the child so that the nurse can examine the arm thoroughly.

ANS: C Initially, assessment is the priority. Because the child is alert but upset, the nurse should work to gain the child's trust. Initial data are gained by observing the child's ability to move the fingers and to point to the pain. Other important observations at this time are pallor and paresthesia. The child needs to be sent for radiography, but initial assessment data need to be obtained. Sending the child for radiography will increase the child's anxiety, making the examination difficult. It is inappropriate to ask parents to restrain their child. These parents are upset about the injury. If restraint is indicated, the nurse should obtain assistance from other personnel.

A nurse is teaching an adolescent how to use the peak expiratory flowmeter. The adolescent has understood the teaching if which statement is made? a. "I will record the average of the readings." b. "I should be sitting comfortably when I perform the readings." c. "I will record the readings at the same time every day." d. "I will repeat the routine two times."

ANS: C Instructions for use of a peak flowmeter include standing up straight before performing the reading, recording the highest of the three readings (not the average), measuring the peak expiratory flow rate (PEFR) close to the same time each day, and repeating the entire routine three times, waiting 30 seconds between each routine.

A preschool child needs a dressing change. To prepare the child, what strategy should the nurse implement? a. Explain the procedure using medical terminology. b. Plan a 30-minute teaching session. c. Give choices when possible but avoid delay. d. Allow time after the procedure for questions and discussion.

ANS: C Involving children helps to gain their cooperation. Permitting choices gives them some measure of control. The other options would not be appropriate for a preschool child.

Iron dextran is ordered for a young child with severe iron deficiency anemia. Nursing considerations include to: a. administer with meals. b. administer between meals. c. inject deeply into a large muscle. d. massage injection site for 5 minutes after administration of drug.

ANS: C Iron dextran is a parenteral form of iron. When administered intramuscularly, it must be injected into a large muscle. Iron dextran is for intramuscular or intravenous (IV) administration. The site should not be massaged to prevent leakage, potential irritation, and staining of the skin.

The nurse suspects fluid overload in an infant receiving intravenous fluids. What clinical manifestation is suggestive of water intoxication? a. Oliguria b. Weight loss c. Irritability and seizures d. Muscle weakness and cardiac dysrhythmias

ANS: C Irritability, somnolence, headache, vomiting, diarrhea, and generalized seizures are manifestations of water intoxication. Urinary output is increased as the child attempts to maintain fluid balance. Weight gain is usually associated with water intoxication. Muscle weakness and cardiac dysrhythmias are not associated with water intoxication.

Which is an important nursing consideration when chest tubes will be removed from a child? a. Explain that it is not painful. b. Explain that only a Band-Aid will be needed. c. Administer analgesics before procedure. d. Expect bright red drainage for several hours after removal.

ANS: C It is appropriate to prepare the child for the removal of chest tubes with analgesics. Short-acting medications can be used that are administered through an existing IV line. A sharp, momentary pain is felt. This should not be misrepresented to the child. A petroleum gauze, air-tight dressing will be needed, but it is not a pain-free procedure. Little or no drainage should be found on removal.

What term is used to describe an abnormally increased convex angulation in the curvature of the thoracic spine? a. Scoliosis b. Lordosis c. Kyphosis d. Ankylosis

ANS: C Kyphosis is an abnormally increased convex angulation in the curvature of the thoracic spine. Scoliosis is a complex spinal deformity usually involving lateral curvature, spinal rotation causing rib asymmetry, and thoracic hypokyphosis. Lordosis is an accentuation of the cervical or lumbar curvature beyond physiologic limits. Ankylosis is the immobility of a joint.

A child is in uncompensated metabolic acidosis. What should the nurse expect the arterial blood gas to be? a. HCO3, 24; pH, 7.35 b. HCO3, 28; pH, 7.50 c. HCO3, 20; pH, 7.30 d. HCO3, 26; pH, 7.40

ANS: C Laboratory findings of uncompensated metabolic acidosis include lowered plasma pH (<7.35) and diminished plasma bicarbonate concentration (normal HCO3 is 22-26).

Which of the following is the most frequent source of acute childhood lead poisoning? a. Folk remedies b. Unglazed pottery c. Lead-based paint d. Cigarette butts and ashes

ANS: C Lead-based paint in houses built before 1978 is the most frequent source of lead poisoning.

Which is most descriptive of the pathophysiology of leukemia? a. Increased blood viscosity occurs. b. Thrombocytopenia (excessive destruction of platelets) occurs. c. Unrestricted proliferation of immature white blood cells (WBCs) occurs. d. First stage of coagulation process is abnormally stimulated.

ANS: C Leukemia is a group of malignant disorders of the bone marrow and lymphatic system. It is defined as an unrestricted proliferation of immature WBCs in the blood-forming tissues of the body. Increased blood viscosity may occur secondary to the increased number of WBCs. Thrombocytopenia may occur secondary to the overproduction of WBCs in the bone marrow. The coagulation process is unaffected by leukemia.

What is the initial clinical manifestation of generalized seizures? a. Confusion b. Feeling frightened c. Loss of consciousness d. Seeing flashing lights

ANS: C Loss of consciousness is a frequent occurrence in generalized seizures and is the initial clinical manifestation. Being confused, feeling frightened, and seeing flashing lights are clinical manifestations of a complex partial seizure.

Which is the initial clinical manifestation of generalized seizures? a. Being confused b. Feeling frightened c. Losing consciousness d. Seeing flashing lights

ANS: C Loss of consciousness is a frequent occurrence in generalized seizures and is the initial clinical manifestation. Being confused, feeling frightened, and seeing flashing lights are clinical manifestations of a complex partial seizure.

The nurse is caring for an adolescent who had an external fixator placed after suffering a fracture of the wrist during a bicycle accident. Which of the following statements by the adolescent would be expected about separation anxiety? a. "I wish my parents could spend the night with me while I am in the hospital." b. "I think I would like for my siblings to visit me but not my friends." c. "I hope my friends don't forget about visiting me." d. "I will be embarrassed if my friends come to the hospital to visit."

ANS: C Loss of peer-group contact may pose a severe emotional threat to an adolescent because of loss of group status, so friends visiting are an important aspect of hospitalization for an adolescent.

The nurse should know what about Lyme disease? a. Very difficult to prevent b. Easily treated with oral antibiotics in stages 1, 2, and 3 c. Caused by a spirochete that enters the skin through a tick bite d. Common in geographic areas where the soil contains the mycotic spores that cause the disease

ANS: C Lyme disease is caused by Borrelia burgdorferi, a spirochete spread by ticks. The early characteristic rash is erythema migrans. Tick bites should be avoided by entering tick-infested areas with caution. Light-colored clothing should be worn to identify ticks easily. Long-sleeve shirts and long pants tucked into socks should be worn. Early treatment of the erythema migrans (stage 1) can prevent the development of Lyme disease. Lyme disease is caused by a spirochete, not mycotic spores.

A term infant is delivered, and before delivery, the medical team was notified that a congenital diaphragmatic hernia (CDH) was diagnosed on ultrasonography. What should be done immediately at birth if respiratory distress is noted? a. Give oxygen. b. Suction the infant. c. Intubate the infant. d. Ventilate the infant with a bag and mask.

ANS: C Many infants with a CDH require immediate respiratory assistance, which includes endotracheal intubation and GI decompression with a double-lumen catheter to prevent further respiratory compromise. At birth, bag and mask ventilation is contraindicated to prevent air from entering the stomach and especially the intestines, further compromising pulmonary function. Oxygen and suctioning may be used for mild respiratory distress.

An appropriate method for administering oral medications that are bitter to an infant or small child would be to mix them with which of the following? a. Bottle of formula or milk b. Any food the child is going to eat c. Small amount (1 teaspoon) of a sweet-tasting substance such as jam or ice cream d. Large amounts of water to dilute medication sufficiently

ANS: C Mix the drug with a small amount (about 1 teaspoon) of sweet-tasting substance. This will make the medication more palatable to the child.

An appropriate method for administering oral medications that are bitter to an infant or small child should be to mix them with which? a. Bottle of formula or milk b. Any food the child is going to eat c. One teaspoon of something sweet-tasting such as jam d. Carbonated beverage, which is then poured over crushed ice

ANS: C Mix the drug with a small amount (about 1 tsp) of sweet-tasting substance. This will make the medication more palatable to the child. The medication should be mixed with only a small amount of food or liquid. If the child does not finish drinking or eating, it is difficult to determine how much medication was consumed. Medication should not be mixed with essential foods and milk. The child may associate the altered taste with the food and refuse to eat this food in the future.

Brian, age 12 years, has short stature because of a constitutional growth delay. The nurse should be the most concerned about which of the following? a. Proper administration of thyroid hormone b. Proper administration of human growth hormones c. Child's self-esteem and sense of competence d. Helping child understand that his height is most likely caused by chronic illness and is not his fault

ANS: C Most cases of constitutional growth delay are caused by simple constitutional delay of puberty, and the child can be assured that normal development will eventually take place. Listening to distressed adolescents and conveying interest and concern are important interventions for these children and adolescents. They should be encouraged to focus on the positives aspects of their bodies and personalities.

A child with juvenile idiopathic arthritis (JIA) is started on a nonsteroidal antiinflammatory drug (NSAID). What nursing consideration should be included? a. Monitor heart rate. b. Administer NSAIDs between meals. c. Check for abdominal pain and bloody stools. d. Expect inflammation to be gone in 3 or 4 days.

ANS: C NSAIDs are the first-line drugs used in JIA. Potential side effects include gastrointestinal (GI), renal, and hepatic side effects. The child is at risk for GI bleeding and elevated blood pressure. The heart rate is not affected by this drug class. NSAIDs should be given with meals to minimize gastrointestinal problems. The antiinflammatory response usually takes 3 weeks before effectiveness can be evaluated

What action by the school nurse is important in the prevention of rheumatic fever (RF)? a. Encourage routine cholesterol screenings. b. Conduct routine blood pressure screenings. c. Refer children with sore throats for throat cultures. d. Recommend salicylates instead of acetaminophen for minor discomforts.

ANS: C Nurses have a role in prevention, primarily in screening school-age children for sore throats caused by group A streptococci. They can actively participate in throat culture screening or refer children with possible streptococcal sore throats for testing. Routine cholesterol screenings and blood pressure screenings do not facilitate the recognition and treatment of group A hemolytic streptococci. Salicylates should be avoided routinely because of the risk of Reye syndrome after viral illnesses.

Which action by the school nurse is important in the prevention of rheumatic fever? a. Encourage routine cholesterol screenings. b. Conduct routine blood pressure screenings. c. Refer children with sore throats for throat cultures. d. Recommend salicylates instead of acetaminophen for minor discomforts.

ANS: C Nurses have a role in prevention—primarily in screening school-age children for sore throats caused by group A -hemolytic streptococci. They can achieve this by actively participating in throat culture screening or by referring children with possible streptococcal sore throats for testing. Cholesterol and blood pressure screenings do not facilitate the recognition and treatment of group A -hemolytic streptococci. Salicylates should be avoided routinely because of the risk of Reye syndrome after viral illnesses.

The nurse is preparing to give acetaminophen (Tylenol) to a child who has a fever. What nursing action is appropriate? a. Retake the temperature in 15 minutes after giving the Tylenol. b. Place a warm blanket on the child so chilling does not occur. c. Check to be sure the Tylenol dose does not exceed 15 mg/kg. d. Use cold compresses instead of Tylenol to control the fever.

ANS: C Nurses must have an understanding of the safe dosages of medications they administer to children, as well as the expected actions, possible side effects, and signs of toxicity. The recommended doses of acetaminophen should never be exceeded.

The nurse is preparing to care for a newborn with an omphalocele. The nurse should understand that care of the infant should include what intervention? a. Initiating breast- or bottle-feedings to stabilize the blood glucose level b. Maintaining pain management with an intravenous opioid c. Covering the intact bowel with a nonadherent dressing to prevent injury d. Performing immediate surgery

ANS: C Nursing care of an infant with an omphalocele includes covering the intact bowel with a nonadherent dressing to prevent injury or placing a bowel bag or moist dressings and a plastic drape if the abdominal contents are exposed. The infant is not started on any type of feeding but has a nasogastric tube placed for gastric decompression. Pain management is started after surgery, but surgery is not done immediately after birth. The infant is medically stabilized before different surgical options are considered.

Chronic otitis media with effusion (OME) differs from acute otitis media (AOM) because it is usually characterized by which signs or symptoms? a. Severe pain in the ear b. Anorexia and vomiting c. A feeling of fullness in the ear d. Fever as high as 40° C (104° F)

ANS: C OME is characterized by a feeling of fullness in the ear or other nonspecific complaints. OME does not cause severe pain. This may be a sign of AOM. Vomiting, anorexia, and fever are associated with AOM.

What term is used to describe a child's level of consciousness when the child is arousable with stimulation? a. Stupor b. Confusion c. Obtundation d. Disorientation

ANS: C Obtundation describes a level of consciousness in which the child is arousable with stimulation. Stupor is a state in which the child remains in a deep sleep, responsive only to vigorous and repeated stimulation. Confusion is impaired decision making. Disorientation is confusion regarding time and place.

The nurse has documented that a child's level of consciousness is obtunded. Which describes this level of consciousness? a. Slow response to vigorous and repeated stimulation b. Impaired decision making c. Arousable with stimulation d. Confusion regarding time and place

ANS: C Obtunded describes a level of consciousness in which the child is arousable with stimulation. Stupor is a state in which the child remains in a deep sleep, responsive only to vigorous and repeated stimulation. Confusion is impaired decision making. Disorientation is confusion regarding time and place.

An occlusive dressing is applied to a large abrasion. This is advantageous because the dressing will accomplish what? a. Deliver vitamin C to the wound. b. Provide an antiseptic for the wound. c. Maintain a moist environment for healing. d. Promote mechanical friction for healing.

ANS: C Occlusive dressings, such as Acuderm, are not adherent to the wound site. They provide a moist wound surface and insulate the wound. The dressing does not have vitamin C or antiseptic capabilities. Acuderm protects against friction.

What nursing intervention is appropriate when caring for an unconscious child? a. Avoid using narcotics or sedatives to provide comfort and pain relief. b. Change the child's position infrequently to minimize the chance of increased intracranial pressure (ICP). c. Monitor fluid intake and output carefully to avoid fluid overload and cerebral edema. d. Give tepid sponge baths to reduce fevers above 38.3° C (101° F) because antipyretics are contraindicated.

ANS: C Often comatose patients cannot cope with the quantity of fluids that they normally tolerate. Overhydration must be avoided to prevent fatal cerebral edema. Narcotics and sedatives should be used as necessary to reduce pain and anxiety, which can increase ICP. The child's position should be changed frequently to avoid complications such as pneumonia and skin breakdown. Antipyretics are the method of choice for fever reduction.

An appropriate nursing intervention when caring for an unconscious child should be to: a. change the child's position infrequently to minimize the chance of increased ICP. b. avoid using narcotics or sedatives to provide comfort and pain relief. c. monitor fluid intake and output carefully to avoid fluid overload and cerebral edema. d. give tepid sponge baths to reduce fever because antipyretics are contraindicated.

ANS: C Often comatose patients cannot cope with the quantity of fluids that they normally tolerate. Overhydration must be avoided to prevent fatal cerebral edema. The child's position should be changed frequently to avoid complications such as pneumonia and skin breakdown. Narcotics and sedatives should be used as necessary to reduce pain and discomfort, which can increase ICP. Antipyretics are the method of choice for fever reduction.

The parents of a 3-year-old admitted for recurrent diarrhea are upset that the practitioner has not told them what is going on with their child. What is the priority intervention for this family? a. Answer all of the parents' questions about the child's illness. b. Immediately page the practitioner to come to the unit to speak with the family. c. Help the family develop a written list of specific questions to ask the practitioner. d. Inform the family of the time that hospital rounds are made so that they can be present.

ANS: C Often families ask general questions of health care providers and do not receive the information they need. The nurse should determine what information the family does want and then help develop a list of questions. When the questions are written, the family can remember which questions to ask or can hand the sheet to the practitioner for answers. The nurse may have the information the parents want, but they are asking for specific information from the practitioner. Unless it is an emergency, the nurse should not place a stat page for the practitioner. Being present is not necessarily the issue but rather the ability to get answers to specific questions.

A 6-year-old child needs to drink 1 L of GoLYTELY in preparation for a computed tomography scan of the abdomen. To encourage the child to drink, what should the nurse do? a. Give him a large cup with ice so it tastes better. b. Restrict him to his room until he drinks the GoLYTELY. c. Use little cups and make a game to reward him for each cup he drinks. d. Tell him that if he does not finish drinking by a set time, the practitioner will be angry.

ANS: C One liter of GoLYTELY is difficult for many children to drink. By using small cups, the child will find the amount less overwhelming. Then a game can be made in which some type of reward (sticker, reading another page of a book) is given for each cup. A large cup of ice would make it more difficult because the child would see it as too much and ice adds additional fluid to be consumed. Negative reinforcement may work if the child wishes to be out of his room. A practitioner may or may not be angry if he does not finish drinking by a set time; this is a threat that may or may not be true. If the child is having difficulty drinking, this would most likely not be effective.

Clinical manifestations of toxic shock syndrome include: a. severe hypertension. b. subnormal temperature. c. erythematous macular rash. d. papular rash over extremities.

ANS: C One of the diagnostic criteria for toxic shock syndrome is a diffuse macular erythroderma. Hypotension is one of the manifestations. Fever of 38.9° C or higher is a characteristic. Desquamation of the palms and soles of the feet occurs in about 1 to 2 weeks.

The nurse finds that a 6-month-old infant has an apical pulse of 166 beats/min during sleep. What nursing intervention is most appropriate at this time? a. Administer oxygen. b. Record data on the nurses' notes. c. Report data to the practitioner. d. Place the child in the high Fowler position.

ANS: C One of the earliest signs of HF is tachycardia (sleeping heart rate >160 beats/min) as a direct result of sympathetic stimulation. The practitioner needs to be notified for evaluation of possible HF. Although oxygen or a semiupright position may be indicated, the first action is to report the data to the practitioner.

A group of boys ages 9 and 10 years have formed a "boys-only" club that is open to neighborhood and school friends who have skateboards. This should be interpreted as which of the following? a. Behavior that encourages bullying and sexism b. Behavior that reinforces poor peer relationships c. Characteristic of social development at this age d. Characteristic of children who later are at risk for membership in gangs

ANS: C One of the outstanding characteristics of middle childhood is the creation of formalized groups or clubs.

The nurse is often the individual who is in the optimum position to suggest tissue donation to a family (after consultation with the practitioner). What will occur if a family chooses organ or tissue donation? a. The funeral will be delayed. b. Cremation is the preferred method of burial. c. Written consent is required for tissue or organ donation. d. An open casket cannot be used subsequent to this procedure.

ANS: C Organ and tissue donation cannot proceed without the family's written informed consent. There is usually no delay in the funeral. Organs are usually retrieved before actual death, and tissue must be removed soon after. No obvious disfigurement of the body occurs, and an open casket can be used for the funeral.

Which of the following is an important consideration when the nurse is discussing enuresis with the parents of a young child? a. Enuresis is more common in girls than in boys. b. Enuresis is neither inherited nor has a familial tendency. c. Organic causes that may be related to enuresis should be considered first. d. Psychogenic factors that cause enuresis persist into adulthood.

ANS: C Organic causes that may be related to enuresis should be ruled out before psychogenic factors are considered.

What is the primary method of treating osteomyelitis? a. Joint replacement b. Bracing and casting c. Intravenous antibiotic therapy d. Long-term corticosteroid therapy

ANS: C Osteomyelitis is an infection of the bone, most commonly caused by Staphylococcus aureus infection. The treatment of choice is antibiotics. Joint replacement, bracing and casting, and long-term corticosteroid therapy are not indicated for infectious processes.

The nurse is taking care of a 10-year-old child who has osteomyelitis. Which treatment plan is considered the primary method of treating osteomyelitis? a. Joint replacement b. Bracing and casting c. Intravenous antibiotic therapy d. Long-term corticosteroid therapy

ANS: C Osteomyelitis is an infection of the bone, most commonly caused by Staphylococcus aureus. The treatment of choice is antibiotics. Joint replacement, bracing and casting, and long-term corticosteroid therapy are not indicated for infectious processes.

Nursing considerations related to the administration of oxygen in an infant include which of the following? a. Humidify oxygen if infant can tolerate it. b. Assess infant to determine how much oxygen should be given. c. Ensure uninterrupted delivery of the appropriate oxygen concentration. d. Direct oxygen flow so that it blows directly into the infant's face in a hood.

ANS: C Oxygen is a prescribed medication. It is the nurses' responsibility to ensure that the ordered concentration is delivered and the effects of therapy are monitored.

Prevention of pelvic inflammatory disease (PID) in adolescents is important because it: a. is easily prevented by proper personal hygiene. b. is easily prevented by compliance with any form of contraception. c. can have devastating effects on the reproductive tract of affected adolescents. d. can cause life-threatening and serious defects in the future children of affected adolescents.

ANS: C PID is a major concern because of its devastating effects on the reproductive tract. Short-term complications include abscess formation in the fallopian tubes, whereas long-term complications include ectopic pregnancy, infertility, and dyspareunia.

Peripheral precocious puberty (PPP) differs from central precocious puberty (CPP) in which manner? a. PPP results from a central nervous system (CNS) insult. b. PPP occurs more frequently in girls. c. PPP may be viewed as a variation in sexual development. d. PPP results from hormonal stimulation of the hypothalamic gonadotropin-releasing hormone (Gn-RH).

ANS: C PPP may be viewed as a variation in sexual development. PPP results from hormone stimulation other than the hypothalamic Gn-RH. Isolated manifestations of secondary sexual development occur. PPP can be missed if these changes are viewed as variations in pubertal onset. CPP results from CNS insult, occurs more frequently in girls, and results from hormonal stimulation of the hypothalamic Gn-RH.

The nurse is teaching the family of a child, age 8 years, with moderate hemophilia about home care. What should the nurse tell the family to do to minimize joint injury? a. Administer nonsteroidal anti-inflammatory drugs (NSAIDs). b. Administer DDAVP (synthetic vasopressin). c. Provide intravenous (IV) infusion of factor VIII concentrates. d. Encourage elevation and application of ice to the involved joint.

ANS: C Parents are taught home infusion of factor VIII concentrate. For moderate and severe hemophilia, prompt IV administration is essential to prevent joint injury. NSAIDs are effective for pain relief. They must be given with caution because they inhibit platelet aggregation. A factor VIII level of 30% is necessary to stop bleeding. DDAVP can raise the factor VIII level fourfold. Moderate hemophilia is defined by a factor VIII activity of 4.9. A fourfold increase would not meet the 30% level. Ice and elevation are important adjunctive therapy, but factor VIII is necessary.

The nurse is teaching feeding strategies to a parent of a 12-month-old infant with Down syndrome. What statement made by the parent indicates a need for further teaching? a. "If the food is thrust out, I will reefed it." b. "I will use a small, long, straight-handled spoon." c. "I will place the food on the top of the tongue." d. "I know the tongue thrust doesn't indicate a refusal of the food."

ANS: C Parents of a child with Down syndrome need to know that the tongue thrust does not indicate refusal to feed but is a physiologic response. Parents are advised to use a small but long, straight-handled spoon to push the food toward the back and side of the mouth. If food is thrust out, it should be refed. If the parent indicates placing the food on the tongue, further teaching is needed.

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

ANS: C Parents should bring favorite items from home to be with the child. Young children associate inanimate objects with people who are significant in their lives. The favorite items will comfort and reassure the child. Since the parents left the objects, the preschooler knows the parents will return.

The nurse is teaching the parents of a 3-year-old child who has been diagnosed with tonic-clonic seizures. What statement by the parent should indicate a correct understanding of the teaching? a. "I should attempt to restrain my child during a seizure." b. "My child will need to avoid contact sports until adulthood." c. "I should place a pillow under my child's head during a seizure." d. "My child will need to be taken to the emergency department [ED] after each seizure."

ANS: C Parents should try to place a pillow or folded blanket under the child's head for protection. The parent should not try to restrain the child during the seizure. The child does not need to go to the ED with each seizures; the nurse can teach parents certain criteria for when their child would need to be seen. Discussing what will happen in adulthood is not appropriate at this time.

The nurse uses the five Ps to assess ischemia in a child with a fracture. What finding is considered a late and ominous sign? a. Petaling b. Posturing c. Paresthesia d. Positioning

ANS: C Paresthesia distal to the injury or cast is an ominous sign that requires immediate notification of the practitioner. Permanent muscle and tissue damage can occur within 6 hours. The other signs of ischemia that need to be reported are pain, pallor, pulselessness, and paralysis. Petaling is a method of placing protective or smooth edges on a cast. Posturing is not a sign of peripheral ischemia. Finding a position of comfort can be difficult with a fracture. It would not be an ominous sign unless pain was increasing or uncontrollable.

What intervention is most appropriate for fostering the development of a school-age child with disabilities associated with cerebral palsy? a. Provide sensory experiences. b. Help develop abstract thinking. c. Encourage socialization with peers. d. Give choices to allow for feeling of control.

ANS: C Peer interaction is especially important in relation to cognitive development, social development, and maturation. Cognitive development is facilitated by interaction with peers, parents, and teachers. The identification with those outside the family helps the child fulfill the striving for independence. Sensory experiences are beneficial, especially for younger children. School-age children are too young for abstract thinking. Giving school-age children choices is always an important intervention. Providing structured choices allows for a feeling of control.

Which is a clinical manifestation of the systemic venous congestion that can occur with heart failure? a. Tachypnea b. Tachycardia c. Peripheral edema d. Pale, cool extremities

ANS: C Peripheral edema, especially periorbital edema, is a clinical manifestation of systemic venous congestion. Tachypnea is a manifestation of pulmonary congestion. Tachycardia and pale, cool extremities are clinical manifestations of impaired myocardial function

What statement is an advantage of peritoneal dialysis compared with hemodialysis? a. Protein loss is less extensive. b. Dietary limitations are not necessary. c. It is easy to learn and safe to perform. d. It is needed less frequently than hemodialysis.

ANS: C Peritoneal dialysis is the preferred form of dialysis for parents, infants, and children who wish to remain independent. Parents and older children can perform the treatments themselves. Protein loss is not significantly different. The dietary limitations are necessary, but they are not as stringent as those for hemodialysis. Treatments are needed more frequently but can be done at home.

Which of the following is a characteristic of children with depression? a. Increased range of affective response b. Preoccupation with need to perform well in school c. Change in appetite, resulting in weight loss or gain d. Tendency to prefer play instead of schoolwork

ANS: C Physiologic characteristics of children with depression include change in appetite resulting in weight loss or gain, nonspecific complaints of not feeling well, alterations in sleeping pattern, insomnia or hypersomnia, and constipation.

What is a characteristic of children with depression? a. Increased range of affective response b. Tendency to prefer play instead of schoolwork c. Change in appetite resulting in weight loss or gain d. Preoccupation with need to perform well in school

ANS: C Physiologic characteristics of children with depression include changes in appetite resulting in weight loss or gain, nonspecific complaints of not feeling well, alterations in sleeping patterns, insomnia or hypersomnia, and constipation. Children who are depressed have sad facial expressions with absent or diminished range of affective response. These children withdraw from previously enjoyed activities and engage in solitary play or work with a lack of interest in play. They are uninterested in doing homework or achieving in school, resulting in lower grades.

Parents are being taught how to feed their infant using a newly placed gastrostomy tube (G-tube). What is essential information for the parents to receive? a. Verify placement before each feeding. b. Use a syringe with a plunger to give the infant bolus feedings. c. Position the infant on the right side during and after the feeding. d. Beefy red tissue around the G-tube site must be reported to the practitioner.

ANS: C Positioning on the right side during and after feedings helps minimize the risk of aspiration. It is not necessary to verify placement before each feeing. G-tubes are inserted into the stomach and sutured in place. If the tube is through the skin, it is in the stomach. Feedings should be given by gravity flow. The plunger may be used to initiate the feeding, but then the formula should be allowed to flow. Beefy red tissue around the G-tube site is normal granulation tissue that is expected.

Using knowledge of child development, what approach is best when preparing a toddler for a procedure? a. Avoid asking the child to make choices. b. Plan for a teaching session to last about 20 minutes. c. Demonstrate on a doll how the procedure will be done. d. Show the necessary equipment without allowing child to handle it.

ANS: C Prepare toddlers for procedures by using play. Demonstrate on a doll but avoid the child's favorite doll because the toddler may think the doll is really "feeling" the procedure. In preparing a toddler for a procedure, the child is allowed to participate in care and help whenever possible. Teaching sessions for toddlers should be about 5 to 10 minutes. Use a small replica of the equipment and allow the child to handle it.

Several blood tests are ordered for a preschool child with severe anemia. The child is crying and upset because of memories of the venipuncture done at the clinic 2 days ago. The nurse should explain: a. venipuncture discomfort is very brief. b. only one venipuncture will be needed. c. topical application of local anesthetic can eliminate venipuncture pain. d. most blood tests on children require only a finger puncture because a small amount of blood is needed.

ANS: C Preschool children are concerned with both pain and the loss of blood. When preparing the child for venipuncture, the nurse will use a topical anesthetic to eliminate any pain. This is a traumatic experience for preschool children. They are concerned about their bodily integrity. A local anesthetic should be used, and a bandage should be applied to maintain bodily integrity. The nurse should not promise one attempt in case multiple attempts are required. Both finger punctures and venipunctures are traumatic for children. Both require preparation.

What behavior seen in children should be addressed by the nurse who is providing care to a child with a chronic illness? a. An infant who is uncooperative b. A toddler who expresses loneliness c. A preschooler who refuses to participate in self-care d. An adolescent who is showing independence

ANS: C Preschoolers thrive on being independent and are in the phase of gaining autonomy, so they want to perform as many self-care tasks as possible. If a preschooler is refusing to participate in self-care activities, then the home health nurse should address this. Infants are uncooperative by nature, and toddlers do not understand the concept of loneliness, so these are not observations that would need to be addressed. Adolescents are always striving for independence, so this is a normal observation; if the adolescent were becoming more dependent on family, it might require intervention.

Generally, the earliest age at which puberty begins is: a. 13 years in girls, 13 years in boys. b. 11 years in girls, 11 years in boys. c. 10 years in girls, 12 years in boys. d. 12 years in girls, 10 years in boys.

ANS: C Puberty signals the beginning of the development of secondary sex characteristics. This begins earlier in girls than in boys. Usually a 2-year difference occurs in the age of onset.

What are quick, jerky, grossly uncoordinated, irregular movements that may disappear on relaxation called? a. Twitching b. Spasticity c. Choreiform movements d. Associated movements

ANS: C Quick, jerky, grossly uncoordinated, irregular movements that may disappear on relaxation are called choreiform movements. Twitching is defined as spasmodic movements of short duration. Spasticity is the prolonged and steady contraction of a muscle characterized by clonus (alternating relaxation and contraction of the muscle) and exaggerated reflexes. Associated movements are the voluntary movement of one muscle accompanied by the involuntary movement of another muscle.

What statement is descriptive of renal transplantation in children? a. It is an acceptable means of treatment after age 10 years. b. Children can receive kidneys only from other children. c. It is the preferred means of renal replacement therapy in children. d. The decision for transplantation is difficult because a relatively normal lifestyle is not possible.

ANS: C Renal transplantation offers the opportunity for a relatively normal life and is the preferred means of renal replacement therapy in end-stage renal disease. It can be done in children as young as age 6 months. Both children and adults can serve as donors for renal transplant purposes. Renal transplantation affords the child a more normal lifestyle than dependence on dialysis.

A nurse is caring for a child in acute respiratory failure. Which blood gas analysis indicates the child is still in respiratory acidosis? a. pH 7.50, CO2 48 b. pH 7.30, CO2 30 c. pH 7.32, CO2 50 d. pH 7.48, CO2 33

ANS: C Respiratory failure is a process that involves pulmonary dysfunction generally resulting in impaired alveolar gas exchange, which can lead to hypoxemia or hypercapnia. Acidosis indicates the pH is less than 7.35 and the CO2 is greater than 45. If the pH is less than 7.35 but the CO2 is low, it is metabolic acidosis. Alkalosis is when the pH is greater than 7.45. If the pH is high and the CO2 is high, it is metabolic alkalosis. When the pH is high and the CO2 is low, it is respiratory alkalosis.

A nurse must do a venipuncture on a 6-year-old child. Which of the following is an important consideration in providing atraumatic care? a. Use an 18-gauge needle if possible. b. If not successful after four attempts, have another nurse try. c. Restrain child only as needed to perform venipuncture safely. d. Show child equipment to be used before procedure.

ANS: C Restrain child only as needed to perform the procedure safely; use therapeutic hugging.

During a respiratory assessment, the nurse notes a sinking in of soft tissues relative to the cartilaginous and bony thorax. What is the term for this finding? a. Grunting b. Tachypnea c. Retractions d. Nasal flaring

ANS: C Retractions are defined as the sinking of soft tissue relative to the cartilaginous or bony thorax. Retractions can be extreme in severe airway obstruction as the work of breathing increases. Grunting can be a sign of pain in older children with respiratory issues. It serves to increase the end-respiratory pressure, which prolongs the period of oxygen and carbon dioxide exchange across the membrane. Tachypnea is an increase in the respiratory rate above the child's baseline. Nasal flaring, the enlargement of the nostrils, helps reduce nasal resistance and maintains airway patency.

Which type of traction uses skin traction on the lower leg and a padded sling under the knee? a. Dunlop b. Bryant c. Russell d. Buck extension

ANS: C Russell traction uses skin traction on the lower leg and a padded sling under the knee. The combination of longitudinal and perpendicular traction allows realignment of the lower extremity and immobilizes the hips and knees in a flexed position. Dunlop traction is an upper-extremity traction used for fractures of the humerus. Bryant traction is skin traction with the legs flexed at a 90-degree angle at the hip. Buck extension traction is a type of skin traction with the legs in an extended position. It is used primarily for short-term immobilization, preoperatively with dislocated hips, for correcting contractures, or for bone deformities such as Legg-Calvé-Perthes disease.

The parents of a child with sickle cell anemia (SCA) are concerned about subsequent children having the disease. What statement most accurately reflects inheritance of SCA? a. SCA is not inherited. b. All siblings will have SCA. c. Each sibling has a 25% chance of having SCA. d. There is a 50% chance of siblings having SCA.

ANS: C SCA is inherited as an autosomal recessive disorder. In this inheritance pattern, each child born to these parents has a 25% chance of having the disorder, a 25% chance of having neither SCA nor the trait, and a 50% chance of being heterozygous for SCA (sickle cell trait). SCA is an inherited hemoglobinopathy.

The nurse is admitting a 7-year-old child to the pediatric unit for abdominal pain. To determine what the child understands about the reason for hospitalization, what should the nurse do? a. Find out what the parents have told the child. b. Review the note from the admitting practitioner. c. Ask the child why he came to the hospital today. d. Question the parents about why they brought the child to the hospital.

ANS: C School-age children are able to answer questions. The only way for the nurse to know about the child's understanding of the reason for hospitalization is to ask the child directly. Finding out what the parents told the child and why they brought the child to the hospital or reading the admitting practitioner's description of the reason for admission will not provide information about what the child has heard and retained.

The nurse is preparing a 9-year-old boy before obtaining a blood specimen by venipuncture. The child tells the nurse he does not want to lose his blood. What approach is best by the nurse? a. Explain that it will not be painful. b. Suggest to him that he not worry about losing just a little bit of blood. c. Discuss with him how his body is always in the process of making blood. d. Tell the child that he will not even need a Band-Aid afterward because it is a simple procedure.

ANS: C School-age children can understand that blood can be replaced. Explain the procedure to him using correct scientific and medical terminology. The venipuncture will be uncomfortable. It is inappropriate to tell him it will not hurt. Even though the nurse considers it a simple procedure, the boy is concerned. Telling him not to worry will not allay his fears.

A child is brought to the emergency department after experiencing a seizure at school. There is no previous history of seizures. The father tells the nurse that he cannot believe the child has epilepsy. The nurse's best response is: a. "Epilepsy is easily treated." b. "Very few children have actual epilepsy." c. "The seizure may or may not mean that your child has epilepsy." d. "Your child has had only one convulsion; it probably won't happen again."

ANS: C Seizures are the indispensable characteristic of epilepsy; however, not every seizure is epileptic. Epilepsy is a chronic seizure disorder with recurrent and unprovoked seizures. The treatment of epilepsy involves a thorough assessment to determine the type of seizure the child is having and the cause, followed by individualized therapy to allow the child to have as normal a life as possible. The nurse should not make generalized comments regarding the incidence of epilepsy until further assessment is made

A neonate is born with bilateral mild talipes equinovarus (clubfoot). When the parents ask the nurse how this will be corrected, the nurse should give which explanation? a. Traction is tried first. b. Surgical intervention is needed. c. Frequent, serial casting is tried first. d. Children outgrow this condition when they learn to walk.

ANS: C Serial casting is begun shortly after birth before discharge from nursery. Successive casts allow for gradual stretching of skin and tight structures on the medial side of the foot. Manipulation and casting of the leg are repeated frequently (every week) to accommodate the rapid growth of early infancy. Serial casting is the preferred treatment. Surgical intervention is done only if serial casting is not successful. Children do not improve without intervention.

A neonate is born with mild clubfeet. When the parents ask the nurse how this will be corrected, what should the nurse explain? a. Traction is tried first. b. Surgical intervention is needed. c. Frequent, serial casting is tried first. d. Children outgrow this condition when they learn to walk.

ANS: C Serial casting is begun shortly after birth, before discharge from the nursery. Successive casts allow for gradual stretching of skin and tight structures on the medial side of the foot. Manipulation and casting of the leg are repeated frequently (every week) to accommodate the rapid growth of early infancy. Serial casting is the preferred treatment. Surgical intervention is done only if serial casting is not successful. Children do not improve without intervention.

A child with corrosive poisoning is being admitted to the emergency department. What clinical manifestation does the nurse expect to assess on this child? a. Nausea and vomiting b. Alterations in sensorium, such as lethargy c. Severe burning pain in the mouth, throat, and stomach d. Respiratory symptoms of acute pulmonary involvement

ANS: C Severe burning pain in the mouth, throat, and stomach is a clinical manifestation of corrosive poisoning. Nausea and vomiting; alterations in sensorium, such as lethargy; and respiratory symptoms of acute pulmonary involvement are clinical manifestations of hydrocarbon poisoning.

The nurse is teaching the girls' varsity sports teams about the "female athlete triad." What is essential information to include? a. They should take low to moderate calcium to avoid hypercalcemia. b. They have strong bones because of the athletic training. c. Pregnancy can occur in the absence of menstruation. d. A diet high in carbohydrates accommodates increased training.

ANS: C Sexually active teenagers, regardless of menstrual status, need to consider contraceptive precautions. Increased calcium (1500 mg) is recommended for amenorrheic athletes. The decreased estrogen in girls with the female athlete triad, coupled with potentially inadequate diet, leads to osteoporosis. Diets high in protein and calories are necessary to avoid potentially long-term consequences of intensive, prolonged exercise programs in pubertal girls.

In teaching the parent of a newly diagnosed 2-year-old child with pyelonephritis related to vesicoureteral reflux (VUR), the nurse should include which information? a. Limit fluids to reduce reflux. b. Give cranberry juice twice a day. c. Have siblings examined for VUR. d. Surgery is indicated to reverse scarring.

ANS: C Siblings are at high risk for VUR. The incidence of reflux in siblings is approximately 36%. The other children should be screened for early detection and to potentially reduce scarring. Fluids are not reduced. The efficacy of cranberry juice in reducing infection in children has not been established. Surgery may be necessary for higher grades of VUR, but the scarring is not reversible.

When caring for a child with probable appendicitis, the nurse should be alert to recognize which sign or symptom as a manifestation of perforation? a. Anorexia b. Bradycardia c. Sudden relief from pain d. Decreased abdominal distention

ANS: C Signs of peritonitis, in addition to fever, include sudden relief from pain after perforation. Anorexia is already a clinical manifestation of appendicitis. Tachycardia, not bradycardia, is a manifestation of peritonitis. Abdominal distention usually increases in addition to an increase in pain (usually diffuse and accompanied by rigid guarding of the abdomen).

A 14-year-old adolescent is hospitalized with cystic fibrosis. What nursing note entry represents best documentation of his breakfast meal? a. Tolerated breakfast well b. Finished all of breakfast ordered c. One pancake, eggs, and 240 ml OJ d. No documentation is needed for this age child.

ANS: C Specific information is necessary for hospitalized children. It is essential to be able to identify caloric intake and eating patterns for assessment and intervention purposes. That he tolerated breakfast well only provides information that the child did not become ill with the meal. Even if he finished all his breakfast, an evaluation cannot be completed unless the quantity of food ordered is known. Nutritional information is essential, especially for children with chronic illnesses.

A 14-year-old girl is in the intensive care unit after a spinal cord injury 2 days ago. What nursing intervention is a priority for this child? a. Minimizing environmental stimuli b. Administering immunoglobulin c. Monitoring and maintaining systemic blood pressure d. Discussing long-term care issues with the family

ANS: C Spinal cord injury patients are physiologically labile, and close monitoring is required. They may be unstable for the first few weeks after the injury. Increased blood pressure may be an indication of autonomic dysreflexia. It is not necessary to minimize environmental stimuli for this type of injury. Spinal cord injury is not an infectious process. Immunoglobulin is not indicated. Discussing long-term care issues with the family is inappropriate. The family is focusing on the recovery of their child. It will not be known until the rehabilitation period how much function the child may recover.

The nurse must suction a child with a tracheostomy. Interventions should include which of the following? a. Encourage child to cough to raise the secretions before suctioning. b. Select a catheter with diameter three fourths as large as the diameter of the tracheostomy tube. c. Each pass of the suction catheter should take no longer than 5 seconds. d. Allow child to rest after every five times the suction catheter is passed.

ANS: C Suctioning should require not longer than 5 seconds per pass. Otherwise the airway may be occluded for too long.

Parents of two school-age children with asthma ask the nurse, "What sports can our children participate in?" The nurse should recommend which sport? a. Soccer b. Running c. Swimming d. Basketball

ANS: C Swimming is well tolerated in children with asthma because they are breathing air fully saturated with moisture and because of the type of breathing required in swimming. Exercise-induced bronchospasm is more common in sports that involve endurance, such as soccer. Prophylaxis with medications may be necessary.

Which of the following statements regarding chlamydial infections is correct? a. Treatment of choice is oral penicillin. b. Treatment of choice is nystatin or miconazole. c. Clinical manifestations include dysuria and urethral itching in males. d. Clinical manifestations include small, painful vesicles on genital areas.

ANS: C Symptoms of chlamydial infection in males include meatal erythema, tenderness, itching, dysuria, and urethral discharge. Some infected males have no symptoms.

The nurse is teaching a group of female adolescents about toxic shock syndrome and the use of tampons. What statement by a participant indicates a need for additional teaching? a. "I can alternate using a tampon and a sanitary napkin." b. "I should wash my hands before inserting a tampon." c. "I can use a superabsorbent tampon for more than 6 hours." d. "I should call my health care provider if I suddenly develop a rash that looks like sunburn."

ANS: C Teaching female adolescents about the association between toxic shock syndrome and the use of tampons is important. The teaching should include not using superabsorbent tampons; not leaving the tampon in for longer than 4 to 6 hours; alternating the use of tampons with sanitary napkins; washing hands before inserting a tampon to decrease the chance of introducing pathogens; and informing a health care provider if a sudden high fever, vomiting, muscle pain, dizziness, or a rash that looks like a sunburn appears.

Parents tell the nurse they do not want to let their school-age child know his illness is terminal. What response should the nurse make to the parents? a. "Have you discussed this with your health care provider?" b. "I would do the same thing in your position; it is better the child doesn't know." c. "I understand you want to protect your child, but often children realize the seriousness of their illness." d. "I praise you for that decision; it can be so difficult to be truthful about the seriousness of your son's illness."

ANS: C Terminally ill children develop an awareness of the seriousness of their diagnosis even when protected from the truth. Acknowledging parents feelings but giving them truthful information is the appropriate response. Asking about discussing this with the health care provider is avoiding the issue. Sharing your own feelings by stating "I would do the same thing" and giving praise for the decision is nontherapeutic.

What statement is most accurate in describing tetanus? a. Inflammatory disease that causes extreme, localized muscle spasm. b. Disease affecting the salivary gland with resultant stiffness of the jaw. c. Acute infectious disease caused by an exotoxin produced by an anaerobic spore-forming, gram-positive bacillus. d. Acute infection that causes meningeal inflammation resulting in symptoms of generalized muscle spasm.

ANS: C Tetanus results from an infection by the anaerobic spore-forming, gram-positive bacillus Clostridium tetani. The organism forms two exotoxins that affect the central nervous system to produce the clinical manifestations of the disease. Tetanus is not an inflammatory process. The toxin acts at the neuromuscular junction to produce muscular stiffness and to lower the threshold for reflex excitability. It is usually a systemic disease. Initial symptoms are usually a progressive stiffness and tenderness of the muscles of the neck and jaw. The sustained contraction of the jaw-closing muscles provides the name lockjaw. Meningeal inflammation is not the cause of the muscle spasms.

What child has a cyanotic congenital heart defect? a. An infant with patent ductus arteriosus b. A 1-year-old infant with atrial septal defect c. A 2-month-old infant with tetralogy of Fallot d. A 6-month-old infant with repaired ventricular septal defect

ANS: C Tetralogy of Fallot is a cyanotic congenital heart defect. Patent ductus arteriosus, atrial septal defect, and ventricular septal defect are acyanotic congenital heart defects.

The American Association on Intellectual and Developmental Disabilities (AAIDD), formerly the American Association on Cognitive Impairment, classifies cognitive impairment based on what parameter? a. Age of onset b. Subaverage intelligence c. Adaptive skill domains d. Causative factors for cognitive impairment

ANS: C The AAIDD has categorized cognitive impairment into adaptive skill domains. The child must demonstrate functional impairment in at least two of the following adaptive skill domains: communication, self-care, home living, social skills, use of community resources, self-direction, health and safety, functional academics, leisure, and work. Age of onset before 18 years is part of the former criteria. Low intelligence quotient (IQ) alone is not the sole criterion for cognitive impairment. Etiology is not part of the classification.

What is a priority of care when a child has an external ventricular drain (EVD)? a. Irrigation of drain to maintain flow b. As-needed dressing changes if dressing becomes wet c. Frequent assessment of amount and color of drainage d. Maintaining the EVD below the level of the child's head

ANS: C The EVD is inserted into the child's ventricle. Frequent assessment is necessary to determine amount of drainage and whether an infection is present. The EVD is a closed system and is not opened for irrigation. Antibiotics may be administered through the drain, but this is usually done by the neuropractitioner. The dressing is not changed. If it becomes wet, then the practitioner should be notified that cerebrospinal fluid (CSF) may be leaking. Unless ordered, maintaining the EVD below the level of the child's head position will create too much pressure and potentially drain too much CSF.

A child has a nasogastric (NG) tube after surgery for Hirschsprung disease. What is the purpose of the NG tube? a. Prevent spread of infection. b. Monitor electrolyte balance. c. Prevent abdominal distention. d. Maintain accurate record of output.

ANS: C The NG tube is placed to suction out gastrointestinal secretions and prevent abdominal distention. The NG tube would not affect infection. Electrolyte content of the NG drainage can be monitored. Without the NG tube, there would be no drainage. After the NG tube is placed, it is important to maintain an accurate record of intake and output. This is not the reason for placement of the tube.

What intervention is most appropriate to facilitate social development of a child with a cognitive impairment? a. Provide age-appropriate toys and play activities. b. Avoid exposure to strangers who may not understand cognitive development. c. Provide peer experiences, such as infant stimulation and preschool programs. d. Emphasize mastery of physical skills because they are delayed more often than verbal skills.

ANS: C The acquisition of social skills is a complex task. Initially, an infant stimulation program should be used. Children of all ages need peer relationships. Parents should enroll the child in preschool. When older, they should have peer experiences similar to those of other children such as group outings, Boy and Girl Scouts, and Special Olympics. Providing age-appropriate toys and play activities is important, but peer interactions facilitate social development. Parents should expose the child to individuals who do not know the child. This enables the child to practice social skills. Verbal skills are delayed more often than physical skills.

A home care nurse is caring for an adolescent with a T1 spinal cord injury. The adolescent suddenly becomes flushed, hypertensive, and diaphoretic. Which intervention should the nurse perform first? a. Place the adolescent in a flat right side-lying position. b. Place a cool washcloth on the adolescent's forehead and continue to monitor the blood pressure. c. Implement a standing prescription to empty the bladder with a sterile in and out Foley catheter. d. Take a full set of vital signs and notify the health care provider.

ANS: C The adolescent is experiencing an autonomic dysreflexia episode. The paralytic nature of autonomic function is replaced by autonomic dysreflexia, especially when the lesions are above the mid-thoracic level. This autonomic phenomenon is caused by visceral distention or irritation, particularly of the bowel or bladder. Sensory impulses are triggered and travel to the cord lesion, where they are blocked, which causes activation of sympathetic reflex action with disturbed central inhibitory control. Excessive sympathetic activity is manifested by a flushing face, sweating forehead, pupillary constriction, marked hypertension, headache, and bradycardia. The precipitating stimulus may be merely a full bladder or rectum or other internal or external sensory input. It can be a catastrophic event unless the irritation is relieved. Placing a cool washcloth on the adolescent's forehead, continuing to monitor blood pressure and vital signs, and notifying the healthcare provider would not reverse the sympathetic reflex situation.

A child with diazepam (Valium) poisoning has been admitted to the emergency department. What antidote does the nurse anticipate being prescribed? a. Succimer (Chemet) b. EDTA (Versenate) c. Flumazenil (Romazicon) d. Octreotide acetate (Sandostatin)

ANS: C The antidote for diazepam (Valium) poisoning is flumazenil (Romazicon). Succimer (Chemet) and EDTA (Versenate) are antidotes for heavy metal poisoning. Octreotide acetate (Sandostatin) is an antidote for sulfonylurea poisoning.

A child has a central venous access device for intravenous (IV) fluid administration. A blood sample is needed for a complete blood count, hemogram, and electrolytes. What is the appropriate procedure to implement for this blood sample? a. Perform a new venipuncture to obtain the blood sample. b. Interrupt the IV fluid and withdraw the blood sample needed. c. Withdraw a blood sample equal to the amount of fluid in the device, discard, and then withdraw the sample needed. d. Flush the line and central venous device with saline and then aspirate the required amount of blood for the sample.

ANS: C The blood specimen obtained must reflect the appropriate hemodilution of the blood and electrolyte concentration. The nurse needs to withdraw the amount of fluid that is in the device and discard it. The next sample will come from the child's circulating blood. With a central venous device, the trauma of a separate venipuncture can be avoided. The blood sample will be diluted with either the IV fluid being administered or the saline.

A mother states that she brought her child to the clinic because the 3-year-old girl was not keeping up with her siblings. During physical assessment, the nurse notes that the child has pale skin and conjunctiva and has muscle weakness. The hemoglobin on admission is 6.4 g/dl. After notifying the practitioner of the results, what nursing priority intervention should occur next? a. Reduce environmental stimulation to prevent seizures. b. Have the laboratory repeat the analysis with a new specimen. c. Minimize energy expenditure to decrease cardiac workload. d. Administer intravenous fluids to correct the dehydration.

ANS: C The child has a critically low hemoglobin value. The expected range is 11.5 to 15.5 g/dl. When the oxygen-carrying capacity of the blood decreases slowly, the child is able to compensate by increasing cardiac output. With the increasing workload of the heart, additional stress can lead to cardiac failure. Reduction of environmental stimulation can help minimize energy expenditure, but seizures are not a risk. A repeat hemoglobin analysis is not necessary. The child does not have evidence of dehydration. If intravenous fluids are given, they can further dilute the circulating blood volume and increase the strain on the heart.

A school-age child is diagnosed with a life-threatening illness. The parents want to protect their child from knowing the seriousness of the illness. The nurse should provide which explanation? a. This attitude is helpful to give parents time to cope. b. This will help the child cope effectively by denial. c. Terminally ill children know when they are seriously ill. d. Terminally ill children usually choose not to discuss the seriousness of their illness.

ANS: C The child needs honest and accurate information about the illness, treatments, and prognosis. Because of the increased attention of health professionals, children, even at a young age, realize that something is seriously wrong and that it involves them. Thus, denial is ineffective as a coping mechanism. The nurse should help parents understand the importance of honesty. Parents may need professional support and guidance from a nurse or social worker in this process. Children will usually tell others how much information they want about their condition.

The emergency department nurse is cleaning multiple facial abrasions on 9-year-old Mike. His mother is present. He is crying and screaming loudly. The nurse should do which of the following? a. Ask him to be quieter. b. Have his mother tell him to relax. c. Tell him it is okay to cry and scream. d. Suggest he talk to his mother instead of crying.

ANS: C The child should be allowed to express feelings of anger, anxiety, fear, frustration, or any other emotion. The child needs to know it is all right to cry.

The nurse is caring for a child admitted with acute abdominal pain and possible appendicitis. What intervention is appropriate to relieve the abdominal discomfort during the evaluation? a. Place in the Trendelenburg position. b. Apply moist heat to the abdomen. c. Allow the child to assume a position of comfort. d. Administer a saline enema to cleanse the bowel.

ANS: C The child should be allowed to take a position of comfort, usually with the legs flexed. The Trendelenburg position will not help with the discomfort. If appendicitis is a possibility, administering laxative or enemas or applying heat to the area is dangerous. Such measures stimulate bowel motility and increase the risk of perforation.

An 8-year-old child is hit by a motor vehicle in the school parking lot. The school nurse notes that the child is responding to verbal stimulation but is not moving his extremities when requested. What is the first action the nurse should take? a. Wait for the child's parents to arrive. b. Move the child out of the parking lot. c. Have someone notify the emergency medical services (EMS) system. d. Help the child stand to return to play.

ANS: C The child was involved in a motor vehicle collision and at this time is not able to move his extremities. The child needs immediate attention at a hospital for assessment of the possibility of a spinal cord injury. Because the child cannot move his extremities, the child should not be moved until his cervical and vertebral spines are stabilized. The EMS team can appropriately stabilize the spinal column for transport. Although it is important to notify the parents, the EMS system should be activated and transport arranged for serious injuries. The only indication to move the child is to prevent further trauma.

A 3-year-old child with a tracheostomy will soon be discharged. What recommendation should the nurse share with the family? a. Tub baths cannot be given. b. The child cannot be allowed to play outdoors. c. Avoid exposure to noxious fumes such as paint or varnish. d. Cover the tracheostomy with a plastic bib when exposed to cold air.

ANS: C The child with a tracheostomy should not be exposed to noxious fumes such as paint, varnish, or hair spray or to substances such as talc. The parent and child must be cautioned about safety measures around bodies of water. Baths can be taken, but parents must observe the necessary safety precautions. The child may play outdoors with a scarf or other protection that allows air through.

The clinical manifestations of sickle cell anemia (SCA) are primarily the result of which physiologic alteration? a. Decreased blood viscosity b. Deficiency in coagulation c. Increased red blood cell (RBC) destruction d. Greater affinity for oxygen

ANS: C The clinical features of SCA are primarily the result of increased RBC destruction and obstruction caused by the sickle-shaped RBCs. When the sickle cells change shape, they increase the viscosity in the area where they are involved in the microcirculation. SCA does not have a coagulation deficit. Sickled red cells have decreased oxygen-carrying capacity and transform into the sickle shape in conditions of low oxygen tension.

The nurse is conducting a staff in-service on sickle cell anemia. Which describes the pathologic changes of sickle cell anemia? a. Sickle-shaped cells carry excess oxygen. b. Sickle-shaped cells decrease blood viscosity. c. Increased red blood cell destruction occurs. d. Decreased adhesion of sickle-shaped cells occurs.

ANS: C The clinical features of sickle cell anemia are primarily the result of increased red blood cell destruction and obstruction caused by the sickle-shaped red blood cells. Sickled red cells have decreased oxygen-carrying capacity and transform into the sickle shape in conditions of low oxygen tension. When the sickle cells change shape, they increase the viscosity in the area where they are involved in the microcirculation. Increased adhesion and entanglement of cells occurs.

A 3-day-old infant presents with abdominal distention, is vomiting, and has not passed any meconium stools. What disease should the nurse suspect? a. Pyloric stenosis b. Intussusception c. Hirschsprung disease d. Celiac disease

ANS: C The clinical manifestations of Hirschsprung disease in a 3-day-old infant include abdominal distention, vomiting, and failure to pass meconium stools. Pyloric stenosis would present with vomiting but not distention or failure to pass meconium stools. Intussusception presents with abdominal cramping and celiac disease presents with malabsorption.

Parents ask the nurse, "When should palliative care be initiated?" What is the best response by the nurse? a. "When curative care is not feasible." b. "When the child's prognosis is uncertain." c. "It should be included along the continuum of care." d. "It should begin when curative treatments are no longer appropriate."

ANS: C The current approach by palliative care experts promotes the inclusion of palliative care along the continuum of care from diagnosis through treatment, not merely at the end of life. It should not wait to be initiated when curative care is not feasible, the child's prognosis is uncertain, or curative treatments are no longer appropriate.

Which is best described as the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures? a. Pulmonary congestion b. Congenital heart defect c. Heart failure d. Systemic venous congestion

ANS: C The definition of heart failure is the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures to meet the body's metabolic demands. Pulmonary congestion is an excessive accumulation of fluid in the lungs. Congenital heart defect is a malformation of the heart present at birth. Systemic venous congestion is an excessive accumulation of fluid in the systemic vasculature.

An adolescent has just been brought to the emergency department with a spinal cord injury and paralysis from a diving accident. The parents keep asking the nurse, "How bad is it?" The nurse's response should be based on which knowledge? a. Families adjust better to life-threatening injuries when information is given over time. b. Immediate loss of function is indicative of the long-term consequences of the injury. c. Extent and severity of damage cannot be determined for several weeks or even months. d. Numerous diagnostic tests will be done immediately to determine extent and severity of damage.

ANS: C The extent and severity of damage cannot be determined initially. The immediate loss of function is caused by anatomic and impaired physiologic function, and improvement may not be evident for weeks or months. It is essential to provide information about the adolescent's status to the parents. Immediate treatment information should be provided. Long-term rehabilitation and prognosis can be addressed after the child is stabilized. During the immediate postinjury period, physiologic responses to the injury make an accurate assessment of damage difficult.

An adolescent with long-term, complex health care needs will soon be discharged from the hospital. The nurse case manager has been assigned to the teen and family. The adolescent's care involves physical therapy, occupational therapy, and speech therapy in addition to medical and nursing care. Who should be the decision maker in the adolescent's care? a. Adolescent b. Nurse case manager c. Adolescent and family d. Multidisciplinary health care team

ANS: C The extent to which children are involved in their own care and decision making depends on many factors, including the child's developmental age, level of interest, physical ability, and parental support. If the adolescent is developmentally age appropriate, then decision making should be the responsibility of child and family. Family needs to be involved because they will be caring for the adolescent in the home. Health care providers have necessary input into the care of the child, but ultimate decision making rests with the adolescent and family.

The school nurse is seeing a child who collected some poison ivy leaves during recess. He says only his hands touched it. What is the most appropriate nursing action? a. Soak his hands in warm water. b. Apply Burow's solution compresses. c. Rinse his hands in cold running water. d. Scrub his hands thoroughly with antibacterial soap.

ANS: C The first recommended action is to rinse his hands in cold running water within 15 minutes of exposure. This will neutralize the urushiol not yet bonded to the skin. Soaking his hands in warm water is effective for soothing the skin lesions after the dermatitis has begun. Antibacterial soap removes protective skin oils and dilutes the urushiol, allowing it to spread.

It is now recommended that children with asthma who are taking long-term inhaled steroids should be assessed frequently because which disease or assessment findings may develop? a. Cough b. Osteoporosis c. Slowed growth d. Cushing syndrome

ANS: C The growth of children on long-term inhaled steroids should be assessed frequently to assess for systemic effects of these drugs. Cough is prevented by inhaled steroids. No evidence exists that inhaled steroids cause osteoporosis. Cushing syndrome is caused by long-term systemic steroids.

Which is characteristic of the immune-mediated type 1 diabetes mellitus? a. Ketoacidosis is infrequent. b. Onset is gradual. c. Age at onset is usually younger than 20 years. d. Oral agents are often effective for treatment.

ANS: C The immune-mediated type 1 diabetes mellitus typically has its onset in children or young adults. Infrequent ketoacidosis, gradual onset, and effectiveness of oral agents for treatment are more consistent with type 2 diabetes.

A child with severe anemia requires a unit of red blood cells (RBCs). The nurse explains to the child that the transfusion is necessary for which reason? a. Allow her parents to come visit her. b. Fight the infection that she now has. c. Increase her energy so she will not be so tired. d. Help her body stop bleeding by forming a clot (scab).

ANS: C The indication for RBC transfusion is risk of cardiac decompensation. When the number of circulating RBCs is increased, tissue hypoxia decreases, cardiac function is improved, and the child will have more energy. Parental visiting is not dependent on transfusion. The decrease in tissue hypoxia will minimize the risk of infection. There is no evidence that the child is currently infected. Forming a clot is the function of platelets.

Which clinical manifestations in an infant would be suggestive of spinal muscular atrophy (Werdnig-Hoffmann disease)? a. Hyperactive deep tendon reflexes b. Hypertonicity c. Lying in the frog position d. Motor deficits on one side of body

ANS: C The infant lies in the frog position with the legs externally rotated, abducted, and flexed at knees. The deep tendon reflexes are absent. The child has hypotonia and inactivity as the most prominent features. The motor deficits are bilateral.

What factor predisposes an infant to fluid imbalances? a. Decreased surface area b. Lower metabolic rate c. Immature kidney functioning d. Decreased daily exchange of extracellular fluid

ANS: C The infant's kidneys are functionally immature at birth and are inefficient in excreting waste products of metabolism. Infants have a relatively high body surface area (BSA) compared with adults. This allows a higher loss of fluid to the environment. A higher metabolic rate is present as a result of the higher BSA in relation to active metabolic tissue. The higher metabolic rate increases heat production, which results in greater insensible water loss. Infants have a greater exchange of extracellular fluid, leaving them with a reduced fluid reserve in conditions of dehydration.

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

ANS: C The informed consent must include the nature of the procedure, benefits and risks, and alternatives to the procedure.

Parents of a hemophiliac child ask the nurse, "Can you describe hemophilia to us?" Which response by the nurse is descriptive of most cases of hemophilia? a. Autosomal dominant disorder causing deficiency in a factor involved in the blood-clotting reaction b. X-linked recessive inherited disorder causing deficiency of platelets and prolonged bleeding c. X-linked recessive inherited disorder in which a blood-clotting factor is deficient d. Y-linked recessive inherited disorder in which the red blood cells become moon-shaped

ANS: C The inheritance pattern in 80% of all of the cases of hemophilia is X-linked recessive. The two most common forms of the disorder are factor VIII deficiency, hemophilia A or classic hemophilia; and factor IX deficiency, hemophilia B or Christmas disease. The inheritance pattern is X-linked recessive. The disorder involves coagulation factors, not platelets, and does not involve red cells or the Y chromosomes.

A 20-kg (44-lb) child in ketoacidosis is admitted to the pediatric intensive care unit. What order should the nurse not implement until clarified with the physician? a. Weigh on admission and daily. b. Replace fluid volume deficit over 48 hours. c. Begin intravenous line with D5 0.45% normal saline with 20 mEq of potassium chloride. d. Give intravenous regular insulin 2 units/kg/hr after initial rehydration bolus.

ANS: C The initial hydrating solution is 0.9% normal saline. Potassium is not given until the child is voiding 25 ml/hr, demonstrating adequate renal function. After initial rehydration and insulin administration, then potassium is given. Dextrose is not given until blood glucose levels are between 250 and 300 mg/dl. An accurate, current weight is essential for determination of the amount of fluid loss and as a basis for medication dosage. Replacing fluid volume deficit over 48 hours is the current recommendation in diabetic ketoacidosis in children. Cerebral edema is a risk of more rapid administration. Intravenous regular insulin 2 units/kg/hr after initial rehydration bolus is the recommended insulin administration for a child of this weight. Only regular insulin can be given intravenously, and it is given after initial fluid volume expansion.

The nurse suspects shock in a child 1 day after surgery. What should be the initial nursing action? a. Place the child on a cardiac monitor. b. Obtain arterial blood gases. c. Provide supplemental oxygen. d. Put the child in the Trendelenburg position.

ANS: C The initial nursing action for a patient in shock is to establish ventilatory support. Oxygen is provided, and the nurse carefully observes for signs of respiratory failure, which indicates a need for intubation. Cardiac monitoring would be indicated to assess the child's status further, but ventilatory support comes first. Oxygen saturation monitoring should be begun. Arterial blood gases would be indicated if alternative methods of monitoring oxygen therapy were not available. The Trendelenburg position is not indicated and is detrimental to the child. The head-down position increases intracranial pressure and decreases diaphragmatic excursion and lung volume.

What is an important nursing consideration when a child is hospitalized for chelation therapy to treat lead poisoning? a. Maintain bed rest. b. Maintain isolation precautions. c. Keep an accurate record of intake and output. d. Institute measures to prevent skeletal fracture.

ANS: C The iron chelates are excreted though the kidneys. Adequate hydration is essential. Periodic measurement of renal function is done. Bed rest is not necessary. Often the chelation therapy is done on an outpatient basis. Chelation therapy is not infectious or dangerous. Isolation is not indicated. Skeletal weakness does not result from high levels of lead.

A toddler has a unilateral foul-smelling nasal discharge and frequent sneezing. The nurse should suspect what condition? a. Allergies b. Acute pharyngitis c. Foreign body in the nose d. Acute nasopharyngitis

ANS: C The irritation of a foreign body in the nose produces local mucosal swelling with foul-smelling nasal discharge, local obstruction with sneezing, and mild discomfort. Allergies would produce clear bilateral nasal discharge. Nasal discharge is usually not associated with pharyngitis. Acute nasopharyngitis would have bilateral mucous discharge.

What immunoglobulin pattern does the nurse expect in a child recently diagnosed with Wiskott-Aldrich syndrome? a. Diminished levels of IgG b. Diminished levels of IgA c. Diminished levels of IgM d. Diminished levels of IgE

ANS: C The level of IgM is diminished early in the course of the disease, but levels of IgG, IgA, and IgE may be elevated initially.

When teaching a mother how to administer eye drops, where should the nurse tell her to place them? a. At the lacrimal duct b. On the sclera while the child looks to the outside c. In the conjunctival sac when the lower eyelid is pulled down d. Carefully under the eyelid while it is gently pulled upward

ANS: C The lower eyelid is pulled down, forming a small conjunctival sac. The solution or ointment is applied to this area. The medication should not be administered directly on the eyeball. The lacrimal duct is not the appropriate placement for the eye medication. It will drain into the nasopharynx, and the child will taste the drug.

What is an important nursing consideration when caring for a child with juvenile idiopathic arthritis (JIA)? a. Apply ice packs to relieve acute swelling and pain. b. Administer acetaminophen to reduce inflammation. c. Teach the child and family correct administration of medications. d. Encourage range of motion exercises during periods of inflammation.

ANS: C The management of JIA is primarily pharmacologic. The family should be instructed regarding administration of medications and the value of a regular schedule of administration to maintain a satisfactory blood level in the body. They need to know that nonsteroidal antiinflammatory drugs should not be given on an empty stomach and to be alert for signs of toxicity. Warm, moist heat is best for relieving stiffness and pain. Acetaminophen does not have antiinflammatory effects. Range of motion exercises should not be done during periods of inflammation.

The nurse is caring for a school-age child diagnosed with juvenile idiopathic arthritis (JIA). Which intervention should be a priority? a. Apply ice packs to relieve stiffness and pain. b. Administer acetaminophen to reduce inflammation. c. Teach the child and family correct administration of medications. d. Encourage range-of-motion exercises during periods of inflammation.

ANS: C The management of JIA is primarily pharmacologic. The family should be instructed regarding administration of medications and the value of regular schedule of administration to maintain a satisfactory blood level in the body. They need to know that NSAIDs should not be given on an empty stomach and to be alert for signs of toxicity. Warm moist heat is best for relieving stiffness and pain. Acetaminophen does not have antiinflammatory effects. Range-of-motion exercises should not be done during periods of inflammation.

A school-age child with leukemia experienced severe nausea and vomiting when receiving chemotherapy for the first time. Which is the most appropriate nursing action to prevent or minimize these reactions with subsequent treatments? a. Encourage drinking large amounts of favorite fluids. b. Encourage child to take nothing by mouth (remain NPO) until nausea and vomiting subside. c. Administer an antiemetic before chemotherapy begins. d. Administer an antiemetic as soon as child has nausea.

ANS: C The most beneficial regimen to minimize nausea and vomiting associated with chemotherapy is to administer the antiemetic before the chemotherapy is begun. The goal is to prevent anticipatory symptoms. Drinking fluids will add to the discomfort of the nausea and vomiting. Remaining until nausea and vomiting subside will help with this episode, but the child will have the discomfort and be at risk for dehydration. Administering an antiemetic as soon as the child has nausea does not prevent anticipatory nausea.

What condition is the most common cause of acute renal failure in children? a. Pyelonephritis b. Tubular destruction c. Severe dehydration d. Upper tract obstruction

ANS: C The most common cause of acute renal failure in children is dehydration or other causes of poor perfusion that may respond to restoration of fluid volume. Pyelonephritis and tubular destruction are not common causes of acute renal failure. Obstructive uropathy may cause acute renal failure, but it is not the most common cause.

Which of the following urine tests of renal function is used to estimate glomerular filtration? a. pH b. Osmolality c. Creatinine d. Protein level

ANS: C The most useful clinical indication of glomerular filtration is the clearance of creatinine. It is a substance that is freely filtered by the glomerulus and secreted by the renal tubule cells.

When communicating with other professionals about a child with a chronic illness, what is important for nurses to do? a. Ask others what they want to know. b. Share everything known about the family. c. Restrict communication to clinically relevant information. d. Recognize that confidentiality is not possible in home care.

ANS: C The nurse needs to share, through both oral and written communication, clinically relevant information with other involved health professionals. Asking others what they want to know and sharing everything known about the family are inappropriate measures. Patients have a right to confidentiality. Confidentiality permits the disclosure of information to other health professionals on a need-to-know basis.

A 6-year-old is being discharged home, which is 90 miles from the hospital, after an outpatient hernia repair. In addition to explicit discharge instructions, what should the nurse provide? a. An ambulance for transport home b. Verbal information about follow-up care c. Prescribed pain medication before discharge d. Driving instructions for a route with less traffic

ANS: C The nurse should anticipate that the child will begin experiencing pain on the trip home. By providing a dose of oral analgesia, the nurse can ensure the child remains comfortable during the trip. Transport by ambulance is not indicated for a hernia repair. Discharge instructions should be written. The parents will be focusing on their child and returning home, which limits their ability to retain information. The parents should know the most expedient route home.

The nurse observes that a seriously ill child passively accepts all painful procedures. The nurse should recognize that this is most likely an indication that the child is experiencing what emotional response? a. Hopefulness b. Chronic sorrow c. Belief that procedures are a deserved punishment d. Understanding that procedures indicate impending death

ANS: C The nurse should be particularly alert to a child who withdraws and passively accepts all painful procedures. This child may believe that such acts are inflicted as deserved punishment for being less worthy. A child who is hopeful is mobilized into goal-directed actions. This child would actively participate in care. Chronic sorrow is the feeling of sorrow and loss that recurs in waves over time. It is usually evident in the parents, not in the child. The seriously ill child would actively participate in care. Nursing interventions should be used to minimize the pain.

What information should the nurse include when teaching the mother of a 9-month-old infant about administering liquid iron preparations? a. Give with meals. b. Stop immediately if nausea and vomiting occur. c. Adequate dosage will turn the stools a tarry green color. d. Allow preparation to mix with saliva and bathe the teeth before swallowing.

ANS: C The nurse should prepare the mother for the anticipated change in the child's stools. If the iron dose is adequate, the stools will become a tarry green color. A lack of color change may indicate insufficient iron. The iron should be given in two divided doses between meals when the presence of free hydrochloric acid is greatest. Iron is absorbed best in an acidic environment. Vomiting and diarrhea may occur with iron administration. If these occur, the iron should be given with meals, and the dosage reduced and gradually increased as the child develops tolerance. Liquid preparations of iron stain the teeth; they should be administered through a straw and the mouth rinsed after administration.

Which should the nurse include when teaching the mother of a 9-month-old infant about administering liquid iron preparations? a. They should be given with meals. b. They should be stopped immediately if nausea and vomiting occur. c. Adequate dosage will turn the stools a tarry green color. d. Allow preparation to mix with saliva and bathe the teeth before swallowing.

ANS: C The nurse should prepare the mother for the anticipated change in the child's stools. If the iron dose is adequate, the stools will become a tarry green color. The lack of the color change may indicate insufficient iron. The iron should be given in two divided doses between meals when the presence of free hydrochloric acid is greatest. Iron is absorbed best in an acidic environment. Vomiting and diarrhea may occur with iron administration. If these occur, the iron should be given with meals, and the dosage reduced, then gradually increased as the child develops tolerance. Liquid preparations of iron stain the teeth. They should be administered through a straw and the mouth rinsed after administration.

The nurse is teaching a parent of an infant to limit the amount of formula to encourage the intake of iron-rich food. What amount should the nurse teach to the parent? a. 500 ml b. 750 ml c. 1000 ml d. 1250 ml

ANS: C The nurse should teach the parent to limit the amount of formula to no more than 1 1/day to encourage intake of iron-rich solid foods.

What is the primary objective of care for the child with minimal change nephrotic syndrome (MCNS)? a. Reduce blood pressure. b. Lower serum protein levels. c. Minimize excretion of urinary protein. d. Increase the ability of tissue to retain fluid.

ANS: C The objectives of therapy for the child with MCNS include reducing the excretion of urinary protein, reducing fluid retention, preventing infection, and minimizing complications associated with therapy. Blood pressure is usually not elevated in minimal change nephrotic syndrome. Serum protein levels are already reduced as part of the disease process. This needs to be reversed. The tissue is already retaining fluid as part of the edema. The goal of therapy is to reduce edema.

A 5-year-old girl sustained a concussion when she fell out of a tree. In preparation for discharge, the nurse is discussing home care with her mother. Which statement made by the mother indicates a correct understanding of the teaching? a. "I should expect my child to have a few episodes of vomiting." b. "If I notice sleep disturbances, I should contact the physician immediately." c. "I should expect my child to have some behavioral changes after the accident." d. "If I notice diplopia, I will have my child rest for 1 hour."

ANS: C The parents are advised of probable posttraumatic symptoms that may be expected. These include behavioral changes and sleep disturbances. If the child has these clinical signs, they should be immediately reported for evaluation. Sleep disturbances are to be expected.

A 5-year-old girl sustained a concussion when she fell out of a tree. In preparation for discharge, the nurse is discussing home care with her mother. What sign or symptom is considered a manifestation of postconcussion syndrome and does not necessitate medical attention? a. Vomiting b. Blurred vision c. Behavioral changes d. Temporary loss of consciousness

ANS: C The parents are advised of probable posttraumatic symptoms that may be expected. These include behavioral changes, sleep disturbances, emotional lability, and alterations in school performance. If the child is vomiting, has blurred vision, or has temporary loss of consciousness, she should be seen for evaluation.

What needs to be included as essential teaching for adolescents with systemic lupus erythematosus (SLE)? a. High calorie diet because of increased metabolic needs b. Home schooling to decrease the risk of infections c. Protection from sun and fluorescent lights to minimize rash d. Intensive exercise regimen to build up muscle strength and endurance

ANS: C The photosensitive rash is a major concern for individuals with SLE. Adolescents who spend time outdoors need to use sunscreens with a high SPF, hats, and clothing. Uncovered fluorescent lights can also cause a photosensitivity reaction. The diet should be sufficient in calories and nutrients for growth and development. The use of steroids can cause increased hunger, resulting in weight gain. This can present additional emotional issues for the adolescent. Normal functions should be maximized. The individual with SLE is encouraged to attend school and participate in peer activities. A balance of rest and exercise is important; excessive exercise is avoided.

What is a physiologic effect of immobilization on children? a. Metabolic rate increases. b. Venous return improves because the child is in the supine position. c. Circulatory stasis can lead to thrombus and embolus formation. d. Bone calcium increases, releasing excess calcium into the body (hypercalcemia).

ANS: C The physiologic effects of immobilization, as a result of decreased muscle contraction, include venous stasis. This can lead to pulmonary emboli or thrombi. The metabolic rate decreases with immobilization. With the loss of muscle contraction, there is a decreased venous return to the heart. Calcium leaves the bone during immobilization, leading to bone demineralization and increasing the calcium ion concentration in the blood.

A preschooler is found digging up a pet bird that was recently buried after it died. What is the best explanation for this behavior? a. He has a morbid preoccupation with death. b. He is looking to see if a ghost took it away. c. He needs reassurance that the pet has not gone somewhere else. d. The loss is not yet resolved, and professional counseling is needed.

ANS: C The preschooler can recognize that the pet has died but has difficulties with the permanence. Digging up the bird gives reassurance that the bird is still present. This is an expected response at this age. If the behavior persists, intervention may be required.

After returning from cardiac catheterization, the nurse determines that the pulse distal to the catheter insertion site is weaker. How should the nurse respond? a. Elevate the affected extremity. b. Notify the practitioner of the observation. c. Record data on the assessment flow record. d. Apply warm compresses to the insertion site.

ANS: C The pulse distal to the catheterization site may be weaker for the first few hours after catheterization but should gradually increase in strength. Documentation of the finding provides a baseline. The extremity is maintained straight for 4 to 6 hours. This is an expected change. The pulse is monitored. If there are neurovascular changes in the extremity, the practitioner is notified. The site is kept dry. Warm compresses are not indicated.

An adolescent diabetic is admitted to the emergency department for treatment of hyperglycemia and pneumonia. What are characteristics of diabetic hyperglycemia? a. Cold, clammy skin and lethargy b. Hunger and hypertension c. Thirst, being flushed, and fruity breath d. Disorientation and pallor

ANS: C The signs of hyperglycemia are thirst, being flushed, and fruity breath. The skin is not cold or clammy, and there is not hunger and hypertension. Disorientation and pallor are signs of hypoglycemia.

A 3-year-old child is experiencing pain after a tonsillectomy. The child has not taken in any fluids and does not want to drink anything, saying, "My tummy hurts." The following health care prescriptions are available: acetaminophen (Tylenol) PO (orally) or PR (rectally) PRN, ice chips, clear liquids. What should the nurse implement to relieve the child's pain? a. Ice chips b. Tylenol PO c. Tylenol PR d. Popsicle

ANS: C The throat is very sore after a tonsillectomy. Most children experience moderate pain after a tonsillectomy and need pain medication at regular intervals for at least the first 24 hours. Analgesics may need to be given rectally or intravenously to avoid the oral route.

A nurse is conducting discharge teaching for parents of an infant with osteogenesis imperfecta (OI). Further teaching is indicated if the parents make which statement? a. "We will be very careful handling the baby." b. "We will lift the baby by the buttocks when diapering." c. "We're glad there is a cure for this disorder." d. "We will schedule follow-up appointments as instructed.".

ANS: C The treatment for OI is primarily supportive. Although patients and families are optimistic about new research advances, there is no cure. The use of bisphosphonate therapy with IV pamidronate to promote increased bone density and prevent fractures has become standard therapy for many children with OI; however, long bones are weakened by prolonged treatment. Infants and children with this disorder require careful handling to prevent fractures. They must be supported when they are being turned, positioned, moved, and held. Even changing a diaper may cause a fracture in severely affected infants. These children should never be held by the ankles when being diapered but should be gently lifted by the buttocks or supported with pillows. Follow-up appointments for treatment with bisphosphonate can be expected

A parent calls the clinic nurse because his 7-year-old child was bitten by a black widow spider. What action should the nurse advise the parent to take? a. Apply warm compresses. b. Carefully scrape off the stinger. c. Take the child to the emergency department. d. Apply a thin layer of corticosteroid cream.

ANS: C The venom of the black widow spider has a neurotoxic effect. The parent should take the child to the emergency department for treatment with antivenin and muscle relaxants as needed. Warm compresses increase the circulation to the area and facilitate the spread of the venom. The black widow spider does not have a stinger. Corticosteroid cream has no effect on the

What nursing consideration is most important in the care of a child on a mechanical ventilator? a. Humidification is not necessary. b. Respiratory assessment is done by the ventilator. c. Positioning the child for comfort and optimum ventilation is necessary. d. Support and reassurance are not as important because the child is unconscious.

ANS: C The ventilator will do the work of breathing, but the nurse must position the child with attention to achieving optimum gas exchange. The reason for mechanical ventilation and the child's comfort are part of the assessment. Mechanical ventilation is usually achieved by intubation or tracheostomy. These routes bypass the humidification that occurs in the upper airway. The ventilator provides some information about the work of breathing, but patient assessment must be done by the nurse. Support and reassurance are always important for both the child and family. Opioids and anxiolytics are often used to decrease the child's anxiety. Careful assessment is indicated.

6. The nurse is reviewing prenatal vitamin supplements with an expectant client. Which supplement should be included in the teaching? a. Vitamin A throughout pregnancy b. Multivitamin preparations as soon as pregnancy is suspected c. Folic acid for all women of childbearing age d. Folic acid during the first and second trimesters of pregnancy

ANS: C The widespread use of folic acid among women of childbearing age has decreased the incidence of spina bifida significantly. Vitamin A is not related to the prevention of spina bifida. Folic acid supplementation is recommended for the preconception period and during the pregnancy. Only 42% of women actually follow these guidelines.

A newborn assessment shows a separated sagittal suture, oblique palpebral fissures, a depressed nasal bridge, a protruding tongue, and transverse palmar creases. These findings are most suggestive of which condition? a. Microcephaly b. Cerebral palsy c. Down syndrome d. Fragile X syndrome

ANS: C These are characteristics associated with Down syndrome. An infant with microcephaly has a small head. Cerebral palsy is a diagnosis not usually made at birth; no characteristic physical signs are present. The infant with fragile X syndrome has increased head circumference; long, wide, or protruding ears; a long, narrow face with a prominent jaw; hypotonia; and a high-arched palate.

During the first 4 days of hospitalization, Eric, age 18 months, cried inconsolably when his parents left him, and he refused the staff's attention. Now the nurse observes that Eric appears to be "settled in" and unconcerned about seeing his parents. The nurse should interpret this as which of the following? a. He has successfully adjusted to the hospital environment. b. He has transferred his trust to the nursing staff. c. He may be experiencing detachment, which is the third stage of separation anxiety. d. Because he is "at home" in the hospital now, seeing his mother frequently will only start the cycle again.

ANS: C These are the behavior manifestations of the separation anxiety phase of detachment. Superficially it appears that the child has adjusted to the loss.

An infant is brought to the emergency department with the following clinical manifestations: poor skin turgor, weight loss, lethargy, tachycardia, and tachypnea. This is suggestive of which situation? a. Water excess b. Sodium excess c. Water depletion d. Potassium excess

ANS: C These clinical manifestations indicate water depletion or dehydration. Edema and weight gain occur with water excess or overhydration. Sodium or potassium excess would not cause these symptoms.

Glucocorticoids, mineralocorticoids, and sex steroids are secreted by the: a. thyroid gland. b. parathyroid glands. c. adrenal cortex. d. anterior pituitary.

ANS: C These hormones are secreted by the adrenal cortex. The thyroid gland produces thyroid hormone and thyrocalcitonin. The parathyroid gland produces parathyroid hormone. The anterior pituitary produces hormones such as GH, thyroid-stimulating hormone, adrenocorticotropic hormone, gonadotropin, prolactin, and melanocyte-stimulating hormone.

The nurse understands that a school-age child may react to death with what reaction? a. Joking b. Having no reaction c. Fearing the unknown d. Seeing it as a distant event

ANS: C They tend to fear the expectation of the event more than its realization. Their fear of the unknown is greater than that of the known. They would not joke or have no reaction. Adolescents see death as a distant event.

A parent of an infant with gastroesophageal reflux asks how to decrease the number and total volume of emesis. What recommendation should the nurse include in teaching this parent? a. Surgical therapy is indicated. b. Place in prone position for sleep after feeding. c. Thicken feedings and enlarge the nipple hole. d. Reduce the frequency of feeding by encouraging larger volumes of formula.

ANS: C Thickened feedings decrease the child's crying and increase the caloric density of the feeding. Although it does not decrease the pH, the number and volume of emesis are reduced. Surgical therapy is reserved for children who have failed to respond to medical therapy or who have an anatomic abnormality. The prone position is not recommended because of the risk of sudden infant death syndrome. Smaller, more frequent feedings are more effective than less frequent, larger volumes of formula.

The nurse notes that a child has lost 8 pounds after 4 days of hospitalization for acute glomerulonephritis. This is most likely the result of which of the following? a. Poor appetite b. Increased potassium intake c. Reduction of edema d. Restriction to bed rest

ANS: C This amount of weight loss in this period is a result of the improvement of renal function and mobilization of edema fluid.

A 14-year-old is admitted to the emergency department with a fracture of the right humerus epiphyseal plate through the joint surface. What information does the nurse know regarding this type of fracture? a. It will create difficulty because the child is left handed. b. It will heal slowly because this is the weakest part of the bone. c. This type of fracture requires different management to prevent bone growth complications. d. This type of fracture necessitates complete immobilization of the shoulder for 4 to 6 weeks.

ANS: C This type of fracture (Salter type III) can cause problems with growth in the affected limb. Early and complete assessment is essential to prevent angular deformities and longitudinal growth problems. The difficulty for the child does not depend on the location at the epiphyseal plate. Any fracture of the dominant arm presents obstacles for the individual. Healing is usually rapid in the epiphyseal plate area. Complete immobilization is not necessary. Often these injuries are surgically repaired with open reduction and internal fixation.

When checking the intravenous (IV) site on a child, the nurse should take which action? a. Look at the site. b. Ask the child if the site "hurts." c. Look at the site while palpating the area. d. Take all the tape off, assess the site, and redress.

ANS: C To appropriately check the intravenous (IV) site, the nurse should look at the site and palpate the area. The other options would not be adequate assessments of the site.

Frequent urine tests for specific gravity are required on a 6-month-old infant. What method is the most appropriate way to collect small amounts of urine for these tests? a. Apply a urine collection bag to the perineal area. b. Tape a small medicine cup inside of the diaper. c. Aspirate urine from cotton balls inside the diaper with a syringe without a needle. d. Use a syringe without a needle to aspirate urine from a superabsorbent disposable diaper.

ANS: C To obtain small amounts of urine, use a syringe without a needle to aspirate urine directly from the diaper. Diapers with superabsorbent gels absorb the urine; if these are used, place a small gauze dressing or cotton balls inside the diaper to collect the urine and aspirate the urine with a syringe. For frequent urine sampling, the collection bag would be too irritating to the child's skin. It is not feasible to tape a small medicine cup to the inside of the diaper; the urine will spill from the cup.

Frequent urine testing for specific gravity and glucose are required on a 6-month-old infant. Which of the following is the most appropriate way to collect small amounts of urine for these tests? a. Apply a urine-collection bag to perineal area. b. Tape a small medicine cup to inside of diaper. c. Aspirate urine from cotton balls inside diaper with a syringe. d. Aspirate urine from superabsorbent disposable diaper with a syringe.

ANS: C To obtain small amounts of urine, use a syringe without a needle to aspirate urine directly from the diaper. If diapers with absorbent material are used, place a small gauze dressing or cotton balls inside the diaper to collect the urine, and aspirate the urine with a syringe.

The nurse is assisting a child with celiac disease to select foods from a menu. What foods should the nurse suggest? a. Hamburger on a bun b. Spaghetti with meat sauce c. Corn on the cob with butter d. Peanut butter and crackers

ANS: C Treatment of celiac disease consists primarily of dietary management. Although a gluten-free diet is prescribed, it is difficult to remove every source of this protein. Some patients are able to tolerate restricted amounts of gluten. Because gluten occurs mainly in the grains of wheat and rye but also in smaller quantities in barley and oats, these foods are eliminated. Corn, rice, and millet are substitute grain foods. Corn on the cob with butter would be gluten free.

The school nurse is discussing testicular self-examination with adolescent boys. Why is this important? a. Epididymitis is common during adolescence. b. Asymptomatic sexually transmitted diseases may be present. c. Testicular tumors during adolescence are generally malignant. d. Testicular tumors, although usually benign, are common during adolescence.

ANS: C Tumors of the testes are not common, but when manifested in adolescence, they are generally malignant and demand immediate evaluation.

What statement is characteristic of type 1 diabetes mellitus? a. Onset is usually gradual. b. Ketoacidosis is infrequent. c. Peak age incidence is 10 to 15 years. d. Oral agents are available for treatment.

ANS: C Type 1 diabetes mellitus typically usually has its onset before the age of 20 years, with a peak incidence between ages 10 and 15 years. Type 1 has an abrupt onset, in contrast to type 2, which has a more gradual appearance. Ketoacidosis occurs when insulin is unavailable and the body uses sources other than glucose for cellular metabolism. Ketoacidosis is more common in type 1 diabetes than in type 2. At this time, oral agents are available only for type 2 diabetes.

A critically ill child has hyperthermia. The parents ask the nurse to give an antipyretic such as acetaminophen (Tylenol). The nurse should explain that antipyretics: a. may cause malignant hyperthermia. b. may cause febrile seizures. c. are of no value in treating hyperthermia. d. are of limited value in treating hyperthermia.

ANS: C Unlike with fever, antipyretics are of no value in hyperthermia because the set point is already normal. Cooling measures are used instead.

A critically ill child has hyperthermia. The parents ask the nurse to give an antipyretic such as acetaminophen. How should the nurse respond to the parents? a. Febrile seizures can result. b. Antipyretics may cause malignant hyperthermia. c. Antipyretics are of no value in treating hyperthermia. d. Liver damage may occur in critically ill children.

ANS: C Unlike with fever, antipyretics are of no value in hyperthermia because the set point is already normal. Cooling measures are used instead. Antipyretics do not cause seizures. Malignant hyperthermia is a genetic myopathy that is triggered by anesthetic agents. Antipyretic agents do not have this effect. Acetaminophen can result in liver damage if too much is given or if the liver is already compromised. Other antipyretics are available, but they are of no value in hyperthermia.

What should the nurse consider when providing support to a family whose infant has just been diagnosed with biliary atresia? a. The prognosis for full recovery is excellent. b. Death usually occurs by 6 months of age. c. Liver transplantation may be needed eventually. d. Children with surgical correction live normal lives.

ANS: C Untreated biliary atresia results in progressive cirrhosis and death usually by 2 years of age. Surgical intervention at 8 weeks of age is associated with somewhat better outcomes. Liver transplantation is also improving outcomes for 10-year survival. Even with surgical intervention, most children require supportive therapy. With early intervention, 10-year survival rates range from 27% to 75%.

The nurse is teaching a client to prevent future urinary tract infections (UTIs). What factor is most important to emphasize as the potential cause? a. Poor hygiene b. Constipation c. Urinary stasis d. Congenital anomalies

ANS: C Urinary stasis is the single most important host factor that influences the development of UTIs. Urine is usually sterile but at body temperature provides an excellent growth medium for bacteria. Poor hygiene can be a contributing cause, especially in females because their short urethras predispose them to UTIs. Urinary stasis then provides a growth medium for the bacteria. Intermittent constipation contributes to urinary stasis. A full rectum displaces the bladder and posterior urethra in the fixed and limited space of the bony pelvis, causing obstruction, incomplete micturition, and urinary stasis. Congenital anomalies can contribute to UTIs, but urinary stasis is the primary factor in many cases.

The nurse is caring for a 12-year-old child with a left leg below the knee amputation (BKA). The child had the surgery 1 week ago. Which intervention should the nurse plan to implement for this child? a. Elevate the left stump on a pillow. b. Place ice pack on the stump. c. Encourage the child to use an overhead bed trapeze when repositioning. d. Replace the ace wrap covering the stump with a gauze dressing.

ANS: C Use of the overhead bed trapeze should be encouraged to begin to build up the arm muscles necessary for walking with crutches. Stump elevation may be used during the first 24 hours, but after this time, the extremity should not be left in this position because contractures in the proximal joint will develop and seriously hamper ambulation. Ice would not be an appropriate intervention and would decrease circulation to the stump. Stump shaping is done postoperatively with special elastic bandaging using a figure-eight bandage, which applies pressure in a cone-shaped fashion. This technique decreases stump edema, controls hemorrhage, and aids in developing desired contours so the child will bear weight on the posterior aspect of the skin flap rather than on the end of the stump. This wrap should not be replaced with a gauze dressing.

The nurse is facilitating a conference between the teachers and parents of a 7-year-old child newly diagnosed with attention deficit hyperactivity disorder (ADHD). What does the nurse stress? a. Academic subjects should be taught in the afternoon. b. Low-interest activities in the classroom should be minimized. c. Visual references should accompany verbal instruction. d. The child's environment should be visually stimulating.

ANS: C Verbal instructions should always be accompanied by visual or written instructions. This provides the child with reinforcement and a reference to expectations. Academic subjects should be taught in the morning when the child is experiencing the effects of the morning dose of medication. Low-interest activities should be mixed with high-interest activities to maintain the child's attention. Environmental stimulation should be minimized to help eliminate distractions that can overexcite the child.

What is the best method to verify the placement of a nasogastric tube before each use? a. Radiologic confirmation b. Auscultation of injected air c. Aspiration of stomach contents d. Verification of tape placement on tube

ANS: C Visual inspection and pH check of stomach contents is a reliable method of determining placement before each use. Radiologic examination should be obtained after initial placement but would be too cumbersome to do before each use. Auscultation is an unreliable method to confirm tube placement because of the similarity of sounds produced by air in the bronchus, esophagus, or pleural space. Verification of tape placement on the tube can be inaccurate if the tube has moved within the tape or become dislodged from the stomach.

A child with hypoparathyroidism is receiving vitamin D therapy. The parents should be advised to watch for which sign of vitamin D toxicity? a. Headache and seizures b. Physical restlessness and voracious appetite without weight gain c. Weakness and lassitude d. Anorexia and insomnia

ANS: C Vitamin D toxicity can be a serious consequence of therapy. Parents are advised to watch for signs, including weakness, fatigue, lassitude, headache, nausea, vomiting, and diarrhea. Renal impairment is manifested through polyuria, polydipsia, and nocturia. Headaches may be a sign of vitamin D toxicity, but seizures are not. Physical restlessness and a voracious appetite with weight loss are manifestations of hyperthyroidism. Anorexia and insomnia are not characteristic of vitamin D toxicity.

The nurse is admitting a child with Werdnig-Hoffmann disease (spinal muscular atrophy type 1). Which signs and symptoms are associated with this disease? a. Spinal muscular atrophy b. Neural atrophy of muscles c. Progressive weakness and wasting of skeletal muscle d. Pseudohypertrophy of certain muscle groups

ANS: C Werdnig-Hoffmann disease (spinal muscular atrophy type 1) is the most common paralytic form of floppy infant syndrome (congenital hypotonia). It is characterized by progressive weakness and wasting of skeletal muscle caused by degeneration of anterior horn cells. Kugelberg-Welander disease is a juvenile spinal muscular atrophy with a later onset. Charcot-Marie-Tooth disease is a form of progressive neural atrophy of muscles supplied by the peroneal nerves. Progressive weakness is found of the distal muscles of the arms and feet. Duchenne muscular dystrophy is characterized by muscles, especially in the calves, thighs, and upper arms, which become enlarged from fatty infiltration and feel unusually firm or woody on palpation. The term pseudohypertrophy is derived from this muscular enlargement.

Where are Wilms tumors (nephroblastomas) located? a. Bone b. Brain c. Kidney d. Lymphatic system

ANS: C Wilms tumor, or nephroblastoma, is the most common malignant renal and intraabdominal tumor of childhood.

What most accurately describes bowel function in children born with a myelomeningocele? a. Incontinence cannot be prevented. b. Enemas and laxatives are contraindicated. c. Some degree of fecal continence can usually be achieved. d. Colostomy is usually required by the time the child reaches adolescence.

ANS: C With a combination of dietary modification, regular toilet habits, and prevention of constipation and impaction, some degree of fecal continence can usually be achieved. Incontinence can be minimized with the development of a regular bowel training program. A surgical intervention can assist with continence. Enemas and laxatives are part of a bowel training program. Colostomies are not indicated in children with myelomeningocele.

What explains physiologically the edema formation that occurs with burns? a. Vasoconstriction b. Reduced capillary permeability c. Increased capillary permeability d. Diminished hydrostatic pressure within capillaries

ANS: C With a major burn, capillary permeability increases, allowing plasma proteins, fluids, and electrolytes to be lost into the interstitial space, causing edema. Maximum edema in a small wound occurs about 8 to 12 hours after injury. In larger injuries, the maximum edema may not occur until 18 to 24 hours later. Vasodilation occurs, causing an increase in hydrostatic pressure.

An infant with bronchiolitis is hospitalized. The causative organism is respiratory syncytial virus (RSV). The nurse knows that a child infected with this virus requires what type of isolation? a. Reverse isolation b. Airborne isolation c. Contact Precautions d. Standard Precautions

ANS: C RSV is transmitted through droplets. In addition to Standard Precautions and hand washing, Contact Precautions are required. Caregivers must use gloves and gowns when entering the room. Care is taken not to touch their own eyes or mucous membranes with a contaminated gloved hand. Children are placed in a private room or in a room with other children with RSV infections. Reverse isolation focuses on keeping bacteria away from the infant. With RSV, other children need to be protected from exposure to the virus. The virus is not airborne.

The nurse is preparing to obtain a nasal washing from a child. What equipment should the nurse gather for the procedure? (Select all that apply.) a. Sterile water b. A sterile swab c. Syringe with tubing d. Sterile normal saline e. Tracheal suction catheter

ANS: C, D Nasal washings may be obtained to identify viral pathogens and guide therapy in some respiratory conditions. The child is placed supine, and 1 to 3 ml of sterile normal saline is instilled with a sterile syringe (without a needle) into one nostril. The contents are aspirated with a syringe with 5 cm (2 inches) of 18- to 20-gauge tubing. The saline is quickly instilled and then aspirated to recover the nasal specimen. A tracheal suction catheter would not trap the mucus. Normal saline is used, not sterile water. A sterile swab is used for a throat culture, not for nasal washings.

A nurse is planning care for a school-age child with type 1 diabetes. Which insulin preparations are rapid and short acting? (Select all that apply.) a. Novolin N b. Lantus c. NovoLog d. Novolin R

ANS: C, D Rapid-acting insulin (e.g., NovoLog) reaches the blood within 15 minutes after injection. The insulin peaks 30 to 90 minutes later and may last as long as 5 hours. Short-acting (regular) insulin (e.g., Novolin R) usually reaches the blood within 30 minutes after injection. The insulin peaks 2 to 4 hours later and stays in the blood for about 4 to 8 hours. Intermediate-acting insulins (e.g., Novolin N) reach the blood 2 to 6 hours after injection. The insulins peak 4 to 14 hours later and stay in the blood for about 14 to 20 hours. Long-acting insulin (e.g., Lantus) takes 6 to 14 hours to start working. It has no peak or a very small peak 10 to 16 hours after injection. The insulin stays in the blood between 20 and 24 hours.

The nurse is caring for a school-age child with hyperthyroidism (Graves disease). Which clinical manifestations should the nurse monitor that may indicate a thyroid storm? (Select all that apply.) a. Constipation b. Hypotension c. Hyperthermia d. Tachycardia e. Vomiting

ANS: C, D, E A child with a thyroid storm will have severe irritability and restlessness, vomiting, diarrhea, hyperthermia, hypertension, severe tachycardia, and prostration.

The nurse is interpreting a tuberculin skin test. If the nurse finds a result of an induration 5 mm or larger, in which child should the nurse document this finding as positive? (Select all that apply.) a. A child with diabetes mellitus b. A child younger than 4 years of age c. A child receiving immunosuppressive therapy d. A child with a human immunodeficiency virus (HIV) infection e. A child living in close contact with a known contagious case of tuberculosis

ANS: C, D, E A tuberculin skin test with an induration of 5 mm or larger is considered to be positive if the child is receiving immunosuppressive therapy, has an HIV infection, or is living in close contact with a known contagious case of tuberculosis. The test would be considered positive in a child who has diabetes mellitus or is younger than 4 years of age if the tuberculin skin test had an induration of 10 mm or larger.

The nurse should plan which actions to assist the stuttering child? (Select all that apply.) a. Ask the child to stop and start over. b. Promise a reward for proper speech. c. Set a good example by speaking clearly. d. Give the child plenty of time to finish sentences. e. Look directly at the child while he or she is speaking.

ANS: C, D, E Actions to be encouraged to help the stuttering child include setting a good example by speaking clearly, giving the child plenty of time to finish sentences, and looking directly at the child while he or she is speaking. Asking the child to stop and start over and promising a reward for proper speech are actions to be avoided with stuttering children.

The nurse is caring for a neonate with suspected meningitis. Which clinical manifestations should the nurse prepare to assess if meningitis is confirmed? (Select all that apply.) a. Headache b. Photophobia c. Bulging anterior fontanel d. Weak cry e. Poor muscle tone

ANS: C, D, E Assessment findings in a neonate with meningitis include bulging anterior fontanel, weak cry, and poor muscle tone. Headache and photophobia are signs seen in an older child.

The nurse is teaching parents of a child being discharged from the hospital after a splenectomy about the risk of infection. What should the nurse include in the teaching session? (Select all that apply.) a. Avoid obtaining the pneumococcal vaccination for the child. b. Avoid obtaining the meningococcal vaccination for the child. c. The child should receive prophylactic penicillin for certain procedures. d. Have the child immunized with the Haemophilus influenzae type b vaccination. e. Notify the health care provider if your child develops a fever of 38.5° C (101.3° F).

ANS: C, D, E Because of the risk of life-threatening bacterial infection after splenectomy, these children are immunized with the pneumococcal, meningococcal, and H. influenzae type b vaccines before surgery and receive prophylactic penicillin for several years after splenectomy. The parents should be instructed in the importance of seeking immediate medical attention if their child develops a fever of 38.5° C (101.3° F) or higher as a common sign of infection or postsplenectomy sepsis.

The nurse is assessing a child with Down syndrome. The nurse recognizes that which are possible comorbidities that can occur with Down syndrome? (Select all that apply.) a. Diabetes mellitus b. Hodgkin's disease c. Congenital heart defects d. Respiratory tract infections e. Acute megakaryoblastic leukemia

ANS: C, D, E Children with Down syndrome often have multiple comorbidities, contributing to numerous other conditions. Respiratory tract infections are prevalent; when combined with cardiac anomalies, they are the chief cause of death, particularly during the first year. The incidence of leukemia is several times more frequent than expected in the general population, and in about half of the cases, the type is acute megakaryoblastic leukemia.

The nurse is preparing to admit a 7-year-old child with pulmonary edema. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Fever b. Bradycardia c. Diaphoresis d. Pink frothy sputum e. Respiratory crackles

ANS: C, D, E Clinical manifestations of pulmonary edema include diaphoresis, pink frothy sputum, and respiratory crackles. Fever or bradycardia are not manifestations of pulmonary edema.

The nurse is caring for a child with an epidural hematoma. The nurse should assess for what signs that can indicate Cushing triad? (Select all that apply.) a. Fever b. Flushing c. Bradycardia d. Systemic hypertension e. Respiratory depression

ANS: C, D, E Cushing triad (systemic hypertension, bradycardia, and respiratory depression) is a late sign of impending brainstem herniation. Fever or flushing does not occur with Cushing triad.

The nurse is caring for a child with a subdural hematoma. The nurse should assess for what signs that can indicate brainstem compression? (Select all that apply.) a. Coma b. Lethargy c. Hemiplegia d. Hemiparesis e. Unequal pupils

ANS: C, D, E Hemiparesis, hemiplegia, and anisocoria (unequal pupils) are signs of brainstem compression and require emergency treatment targeted at decreasing increased intracranial pressure. Coma and lethargy are seen with a subdural hematoma but do not indicate a brainstem compression.

The nurse is caring for a child who has a temperature of 30° C (86° F). What physical effects of hypothermia should the nurse expect to observe in this child? (Select all that apply.) a. Reduced urinary output b. Injury to peripheral tissue c. Increased blood pressure d. Tachycardia e. Irritability with loss of consciousness f. Rigid extremities

ANS: C, D, E Hypothermia has varying physical effects depending on the child's core temperature. At 30° C (86° F), a child would experience an increase in blood pressure, tachycardia, and irritability followed by a loss of consciousness. Reduced urinary output from a decrease of blood flow to the kidneys, injury to peripheral tissue, and rigid extremities are physical effects observed as the body temperature continues to decrease.

The nurse is teaching an adolescent with elevated triglycerides foods that should be decreased. What foods should the nurse include in the teaching? (Select all that apply.) a. Avocados b. Canola oil c. White flour d. White rice e. Sugary cereals

ANS: C, D, E If triglycerides are elevated, dietary recommendations include decreasing the intake of foods high in simple carbohydrates such as white flour, white rice, white bread, white pasta, sugary cereals, juice, and soda. Avocados and canola oil have beneficial effects on HDL, which is the good cholesterol.

The nurse is caring for a preschool child with a cast applied recently for a fractured tibia. Which assessment findings indicate possible compartment syndrome? (Select all that apply.) a. Palpable distal pulse b. Capillary refill to extremity less than 3 seconds c. Severe pain not relieved by analgesics d. Tingling of extremity e. Inability to move extremity

ANS: C, D, E Indications of compartment syndrome are severe pain not relieved by analgesics, tingling of extremity, and inability to move extremity. A palpable distal pulse and capillary refill to the extremity less than 3 seconds are expected findings.

The nurse is teaching parents about high-fiber foods that can prevent constipation. What foods should the nurse include in the teaching? (Select all that apply.) a. Oranges b. Bananas c. Lima beans d. Baked beans e. Raisin bran cereal

ANS: C, D, E Lima beans have 13.2 g of fiber in 1 cup, baked beans have 10.4 g of fiber in 1 cup, and raisin bran cereal has 7.3 g of fiber in 1 cup. One orange has only 3.1 g of fiber, and 1 banana has only 3.1 g of fiber, so they are not recommended as high-fiber foods.

What signs and symptoms are indicative of a urinary tract disorder in the neonatal period (birth to 1 month)? (Select all that apply.) a. Edema b. Bradypnea c. Frequent urination d. Poor urinary stream e. Failure to gain weight

ANS: C, D, E Signs and symptoms of a urinary tract disorder in the neonatal period are frequent urination, poor urinary stream, and failure to gain weight. The respirations would be rapid, not slow, and dehydration, not edema, occurs.

The nurse is teaching the parents of a child with a seizure disorder about the triggers that can cause a seizure. What should the nurse include in the teaching session? (Select all that apply.) a. Cold b. Sugared drinks c. Emotional stress d. Flickering lights e. Hyperventilation

ANS: C, D, E The most common factors that may trigger seizures in children include emotional stress, sleep deprivation, fatigue, fever, and physical exercise. Other precipitating factors include sleep, flickering lights, menstrual cycle, alcohol, heat, hyperventilation, and fasting. Cold and sugared drinks are not triggers for seizures.

The nurse is conducting discharge teaching about signs and symptoms of heart failure to parents of an infant with a repaired tetralogy of Fallot. Which signs and symptoms should the nurse include? (Select all that apply.) a. Warm flushed extremities b. Weight loss c. Decreased urinary output d. Sweating (inappropriate) e. Fatigue

ANS: C, D, E The signs and symptoms of heart failure include decreased urinary output, sweating, and fatigue. Other signs include pale, cool extremities, not warm and flushed, and weight gain, not weight loss.

What factors influence the effects of a child's hospitalization on siblings? (Select all that apply.) a. Older siblings b. Experiencing minimal changes c. Receiving little information about their ill brother or sister d. Being cared for outside the home by care providers who are not relatives e. Perceiving that their parents treat them differently compared with before their sibling's hospitalization

ANS: C, D, E Various factors have been identified that influence the effects of a child's hospitalization on siblings. Factors that are related specifically to the hospital experience and increase the effects on the sibling are being cared for outside the home by care providers who are not relatives, receiving little information about their ill brother or sister, and perceiving that their parents treat them differently compared with before their sibling's hospitalization. Being younger, not older, and experiencing many changes, not minimal changes, are factors that influence the effects of a child's hospitalization on siblings.

Which clinical manifestation should the nurse expect to see as shock progresses in a child and becomes decompensated shock? (Select all that apply.) a. Thirst and diminished urinary output b. Irritability and apprehension c. Cool extremities and decreased skin turgor d. Confusion and somnolence e. Normal blood pressure and narrowing pulse pressure f. Tachypnea and poor capillary refill time

ANS: C, D, F Cool extremities, decreased skin turgor, confusion, somnolence, tachypnea, and poor capillary refill time are beginning signs of decompensated shock. Thirst, diminished urinary output, irritability, apprehension, normal blood pressure, and narrowing pulse pressure are signs of compensated shock.

What characterizes an infant's concept of death? (Select all that apply.) a. Death is seen as temporary. b. Death is seen as a departure, a kind of sleep. c. Death has no significance before 6 months of age. d. They believe that death is a consequence of their thoughts. e. Anxiety is not created by death but by loss, even temporary, of the parent.

ANS: C, E Infants have no concept of death before six months and anxiety is not created by death but by loss, even temporary, of the parent. Death seen as temporary, a departure, or a belief that death is a consequence of thoughts are characteristic of a preschool child's concepts of death.

Nursing interventions for the child after a cardiac catheterization should include which actions? (Select all that apply.) a. Allow ambulation as tolerated. b. Monitor vital signs every 2 hours. c. Assess the affected extremity for temperature and color. d. Check pulses above the catheterization site for equality and symmetry. e. Remove pressure dressing after 4 hours. f. Maintain a patent peripheral intravenous catheter until discharge.

ANS: C, F The extremity that was used for access for the cardiac catheterization must be checked for temperature and color. Coolness and blanching may indicate arterial occlusion. The child should have a patent peripheral intravenous line (PIV) to ensure adequate hydration. The child should remain on bed rest with the leg extended for a minimum of 4 hours. Initially vital signs are taken every 15 minutes, with emphasis on a heart rate counted for 1 minute. Pulses above the catheterization site should not be affected by the catheterization. Pulses distal to the site should be monitored. The pressure dressings should not be removed for 24 hours.

An important nursing responsibility when dealing with a family experiencing the loss of an infant from sudden infant death syndrome (SIDS) would be which of the following? a. Explain how SIDS could have been predicted and prevented. b. Interview parents in depth concerning the circumstances surrounding the child's death. c. Discourage parents from making a last visit with the infant. d. Make a follow-up home visit to parents as soon as possible after the child's death.

ANS: D A competent, qualified professional should visit the family at home as soon as possible after the death and provide the family with printed information about SIDS.

The presence of which pair of factors is a good predictor of a fluid deficit of at least 5% in an infant? a. Weight loss and decreased heart rate b. Capillary refill of less than 2 seconds and no tears c. Increased skin elasticity and sunken anterior fontanel d. Dry mucous membranes and generally ill appearance

ANS: D A good predictor of a fluid deficit of at least 5% is any two four factors: capillary refill of more than 2 seconds, absent tears, dry mucous membranes, and ill general appearance. Weight loss is associated with fluid deficit, but the degree needs to be quantified. Heart rate is usually elevated. Skin elasticity is decreased, not increased. The anterior fontanel is depressed.

What refers to a hernial protrusion of a saclike cyst of meninges, spinal fluid, and a portion of the spinal cord with its nerves through a defect in the vertebral column? a. Rachischisis b. Meningocele c. Encephalocele d. Myelomeningocele

ANS: D A myelomeningocele has a visible defect with an external saclike protrusion, containing meninges, spinal fluid, and nerves. Rachischisis is a fissure in the spinal column that leaves the meninges and the spinal cord exposed. Meningocele is a hernial protrusion of a saclike cyst of meninges with spinal fluid but no neural elements. Encephalocele is a herniation of brain and meninges through a defect in the skull, producing a fluid-filled sac.

The nurse is preparing to admit a newborn with myelomeningocele to the neonatal intensive care nursery. Which describes this newborn's defect? a. Fissure in the spinal column that leaves the meninges and the spinal cord exposed b. Herniation of the brain and meninges through a defect in the skull c. Hernial protrusion of a saclike cyst of meninges with spinal fluid but no neural elements d. Visible defect with an external saclike protrusion containing meninges, spinal fluid, and nerves

ANS: D A myelomeningocele is a visible defect with an external saclike protrusion, containing meninges, spinal fluid, and nerves. Rachischisis is a fissure in the spinal column that leaves the meninges and the spinal cord exposed. Encephalocele is a herniation of brain and meninges through a defect in the skull, producing a fluid-filled sac. Meningocele is a hernial protrusion of a saclike cyst of meninges with spinal fluid, but no neural elements.

The nurse is taking care of a child who had a thyroidectomy. The nurse recognizes what as a positive Chvostek sign? a. Paresthesia occurring in feet and toes b. Frequent sharp flexion of wrist and ankle joints c. Carpal spasm elicited by pressure applied to the nerves of the upper arm d. Facial muscle spasm elicited by tapping the facial nerve in the region of the parotid gland

ANS: D A positive Chvostek sign is a facial muscle spasm that is elicited by tapping the facial nerve in the region of the parotid gland. Paresthesia occurring in the feet and toes and frequent sharp flexion of the wrist and ankle joints can be signs of hypoparathyroidism but are not part of a positive Chvostek sign. Carpal spasm elicited by pressure applied to nerves of the upper arm is called a positive Trousseau sign.

The nurse needs to take the blood pressure of a preschool boy for the first time. What action would be best in gaining his cooperation? a. Tell him that this procedure will help him get well faster. b. Take his blood pressure when a parent is there to comfort him. c. Explain to him how the blood flows through the arm and why the blood pressure is important. d. Permit him to handle the equipment and see the cuff inflate and deflate before putting the cuff in place.

ANS: D A preschooler is at the stage of preoperational thought. The nurse needs to explain the procedure in simple terms and allow the child to see how the equipment works. This will help allay fears of bodily harm. Blood pressure measurement is used for assessment, not therapy, and will not help him get well faster. Although the parent will be able to support the child, he may still be uncooperative. Also, the assessment of blood pressure may be needed before the parent is available. Explaining to a preschooler how the blood flows through the artery and why the blood pressure is important is too complex.

The nurse is caring for a 3-year-old child during a long hospitalization. The parent is concerned about how to support the child's siblings during the hospitalization. What statement is appropriate for the nurse to make? a. "You should choose one parent to spend every night in the hospital while the other parent stays at home with the other children." b. "You could leave your hospitalized child for periods at night to be at home with the other children." c. "You should discourage the siblings from visiting because this could upset everyone in the family." d. "You could encourage a nightly phone call between the siblings as part of the bedtime routine."

ANS: D A supportive measure for siblings of a hospitalized child is to have a routine of a phone call at some point during the day or evening so the parent at the hospital can stay in touch and the children at home are involved and can hear that their sibling is doing well. Parents should alternate who stays at the hospital overnight to prevent burnout and to allow each parent time at home with the siblings. Encourage siblings to visit if appropriate to keep the family unit intact. Leaving the hospitalized child alone at night will not support the siblings at home and may cause problems with the hospitalized child.

Cystic fibrosis (CF) is suspected in a toddler. Which test is essential in establishing this diagnosis? a. Bronchoscopy b. Serum calcium c. Urine creatinine d. Sweat chloride test

ANS: D A sweat chloride test result greater than 60 mEq/L is diagnostic of CF. Bronchoscopy, although helpful for identifying bacterial infection in children with CF, is not diagnostic. Serum calcium is normal in children with CF. Urine creatinine is not diagnostic of CF.

Which clinical manifestation should the nurse expect when a child with sickle cell anemia experiences an acute vasoocclusive crisis? a. Circulatory collapse b. Cardiomegaly, systolic murmurs c. Hepatomegaly, intrahepatic cholestasis d. Painful swelling of hands and feet; painful joints

ANS: D A vasoocclusive crisis is characterized by severe pain in the area of involvement. If in the extremities, painful swelling of the hands and feet is seen; if in the abdomen, severe pain resembles that of acute surgical abdomen; and if in the head, stroke and visual disturbances occur. Circulatory collapse results from sequestration crises. Cardiomegaly, systolic murmurs, hepatomegaly, and intrahepatic cholestasis result from chronic vasoocclusive phenomena.

What type of drug reduces hypertension by interfering with the production of angiotensin II? a. Diuretics b. Vasodilators c. Beta-blockers d. Angiotensin-converting enzyme (ACE) inhibitors

ANS: D ACE inhibitors act by interfering with the production of angiotensin II, which is a potent vasoconstrictor. Diuretics lower blood pressure by increasing fluid output. Vasodilators act on the vascular smooth muscle. By causing arterial dilation, blood pressure is lowered. Beta-blockers interfere with beta stimulation and depress renin output.

What substance is released from the posterior pituitary gland and promotes water retention in the renal system? a. Renin b. Aldosterone c. Angiotensin d. Antidiuretic hormone (ADH)

ANS: D ADH is released in response to increased osmolality and decreased volume of intravascular fluid; it promotes water retention in the renal system by increasing the permeability of renal tubules to water. Renin release is stimulated by diminished blood flow to the kidneys. Aldosterone is secreted by the adrenal cortex. It enhances sodium reabsorption in renal tubules, promoting osmotic reabsorption of water. Renin reacts with a plasma globulin to generate angiotensin, which is a powerful vasoconstrictor. Angiotensin also stimulates the release of aldosterone.

Acute salicylate (ASA, aspirin) poisoning results in which of the following? a. Chemical pneumonitis b. Hepatic damage c. Retractions and grunting d. Disorientation and loss of consciousness

ANS: D ASA poisoning causes disorientation and loss of consciousness.

What recommendation should the nurse make to prevent urinary tract infections (UTIs) in young girls? a. Avoid public toilet facilities. b. Limit long baths as much as possible. c. Cleanse the perineum with water after voiding. d. Ensure clear liquid intake of 2 L/day.

ANS: D Adequate fluid intake minimizes urinary stasis. The recommended fluid intake is 50 ml/kg or 100 ml/lb per day. The average 5- to 6-year-old weighs approximately 18 kg (40 lb), so she should drink 2 L/day of fluid. There is no evidence that using public toilet facilities increases UTIs. Long baths are not associated with increased UTIs. Proper hand washing and perineal cleansing are important, but no evidence exists that these decrease UTIs in young girls.

Cognitive development influences response to pain. What age group is most concerned with the fear of losing control during a painful experience? a. Toddlers b. Preschoolers c. School-age children d. Adolescents

ANS: D Adolescents view illness as physiologic (an organ malfunction) and psychophysiologic (psychologic factors that affect health). Adolescents usually approach pain with self-control. They are concerned with remaining composed and feel embarrassed and ashamed of losing control. Toddlers and preschoolers react to pain primarily as a physical, concrete experience. Preschoolers may try to escape a procedure with verbal statements such as "go away." Young school-age children may view pain as punishment for wrongdoing. This age group fears bodily harm.

At which developmental period do children have the most difficulty coping with death, particularly if it is their own? a. Toddlerhood b. Preschool c. School age d. Adolescence

ANS: D Adolescents, because of their mature understanding of death, remnants of guilt and shame, and issues with deviations from normal, have the most difficulty coping with death. Toddlers and preschoolers are too young to have difficulty coping with their own death. They fear separation from their parents. School-age children fear the unknown such as the consequences of the illness and the threat to their sense of security.

A health care provider prescribes feedings of 1 to 2 oz Pedialyte every 3 hours and to advance to 1/2 strength Similac with iron as tolerated postoperatively for an infant who had a pyloromyotomy. The nurse should decide to advance the feeding if which occurs? a. The infant's IV line has infiltrated. b. The infant has not voided since surgery. c. The infant's mother states the infant is tolerating the feeding okay. d. The infant is taking the Pedialyte without vomiting or distention.

ANS: D After a pyloromyotomy, feedings are usually instituted within 12 to 24 hours, beginning with clear liquids. They are offered in small quantities at frequent intervals. Supervision of feedings is an important part of postoperative care. The feedings are advanced only if the infant is taking the clear liquids without vomiting or distention. Feedings would not be advanced if the infant has not voided, the IV line becomes infiltrated, or the mother states the infant is tolerating the feedings.

An 8-year-old girl with moderate cerebral palsy (CP) recently began joining a regular classroom for part of the day. Her mother asks the school nurse about joining the after-school Girl Scout troop. The nurse's response should be based on which knowledge? a. Most activities such as Girl Scouts cannot be adapted for children with CP. b. After-school activities usually result in extreme fatigue for children with CP. c. Trying to participate in activities such as Girl Scouts leads to lowered self-esteem in children with CP. d. Recreational activities often provide children with CP with opportunities for socialization and recreation.

ANS: D After-school and recreational activities serve to stimulate children's interest and curiosity. They help the children adjust to their disability, improve their functional ability, and build self-esteem. Increasing numbers of programs are adapted for children with physical limitations. Almost all activities can be adapted. The child should participate to her level of energy. Self-esteem increases as a result of the positive feedback the child receives from participation.

The nurse is caring for a 4-year-old child who is receiving 2 L of oxygen per nasal cannula. What disadvantage should the nurse consider when planning care for the child? a. The child may need to have high humidity administered with the oxygen. b. The child may not be able to eat and drink comfortably. c. A nasal cannula may cause an accumulation of moisture on the face. d. A nasal cannula may cause abdominal distention.

ANS: D All oxygen delivery systems have advantages and disadvantages. One disadvantage of a nasal cannula is possible abdominal distention and discomfort, which could lead to vomiting. The advantages include that the child is able to eat and drink more comfortably, there is no need for a high humidity environment, and there is no accumulation of moisture causing skin irritation.

A family requires home care teaching with regard to preventative measures to use at home to avoid an asthmatic episode. What strategy should the nurse teach? a. Use a humidifier in the child's room. b. Launder bedding daily in cold water. c. Replace wood flooring with carpet. d. Use an indoor air purifier with HEPA filter.

ANS: D Allergen control includes use of an indoor air purifier with HEPA filter. Humidity should be kept low, bedding laundered in hot water once a week, and carpet replaced with wood floors.

The nurse is preparing a child for possible alopecia from chemotherapy. Which should be included? a. Explain to child that hair usually regrows in 1 year. b. Advise child to expose head to sunlight to minimize alopecia. c. Explain to child that wearing a hat or scarf is preferable to wearing a wig. d. Explain to child that when hair regrows, it may have a slightly different color or texture.

ANS: D Alopecia is a side effect of certain chemotherapeutic agents. When the hair regrows, it may be a different color or texture. The hair usually grows back within 3 to 6 months after cessation of treatment. The head should be protected from sunlight to avoid sunburn. Children should choose the head covering they prefer.

A young child has just arrived at the emergency department after ingestion of aspirin at home. The practitioner has ordered activated charcoal. The nurse administers charcoal in which of the following ways? a. Administer through a nasogastric tube because the child will not drink it because of the taste. b. Serve in a clear plastic cup so the child can see how much has been drunk. c. Give half of the solution, and then give the other half in 1 hour. d. Serve in an opaque container with a straw.

ANS: D Although the activated charcoal can be mixed with a flavorful beverage, it will be black and resemble mud. When it is served in an opaque container, the child does not have any preconceived ideas about its being distasteful.

What intervention should be beneficial in reducing the risk of Reye syndrome? a. Immunization against the disease b. Medical attention for all head injuries c. Prompt treatment of bacterial meningitis d. Avoidance of aspirin for children with varicella or those suspected of having influenza

ANS: D Although the etiology of Reye syndrome is obscure, most cases follow a common viral illness, either varicella or influenza. A potential association exists between aspirin therapy and the development of Reye syndrome, so use of aspirin is avoided. No immunization currently exists for Reye syndrome. Reye syndrome is not correlated with head injuries or bacterial meningitis.

Which is beneficial in reducing the risk of Reye syndrome? a. Immunization against the disease b. Medical attention for all head injuries c. Prompt treatment of bacterial meningitis d. Avoidance of aspirin to treat fever associated with influenza

ANS: D Although the etiology of Reye syndrome is obscure, most cases follow a common viral illness, either varicella or influenza. A potential association exists between aspirin therapy and the development of Reye syndrome, so use of aspirin is avoided. No immunization currently exists for Reye syndrome. Reye syndrome is not correlated with head injuries or bacterial meningitis.

A child has a seizure disorder. What test should be done to gather the most specific information about the type of seizure the child is having? a. Sleep study b. Skull radiography c. Serum electrolytes d. Electroencephalogram (EEG)

ANS: D An EEG is obtained for all children with seizures and is the most useful tool for evaluating a seizure disorder. The EEG confirms the presence of abnormal electrical discharges and provides information on the seizure type and the focus. The EEG is carried out under varying conditions—with the child asleep, awake, awake with provocative stimulation (flashing lights, noise), and hyperventilating. Stimulation may elicit abnormal electrical activity, which is recorded on the EEG. Various seizure types produce characteristic EEG patterns: high-voltage spike discharges are seen in tonic-clonic seizures, with abnormal patterns in the intervals between seizures; a three-per-second spike and wave pattern is observed in an absence seizure; and absence of electrical activity in an area suggests a large lesion, such as an abscess or subdural collection of fluid.

A child with acetylsalicylic acid (aspirin) poisoning is being admitted to the emergency department. What early clinical manifestation does the nurse expect to assess on this child? a. Hematemesis b. Hematochezia c. Hyperglycemia d. Hyperventilation

ANS: D An early clinical manifestation of acetylsalicylic acid (aspirin) poisoning is hyperventilation. Hematemesis, hematochezia, and hyperglycemia are clinical manifestations of iron poisoning.

A child is admitted for revision of a ventriculoperitoneal shunt for noncommunicating hydrocephalus. What is a common reason for elective revision of this shunt? a. Meningitis b. Gastrointestinal upset c. Hydrocephalus resolution d. Growth of the child since the initial shunting

ANS: D An elective revision of a ventriculoperitoneal shunt would most likely be done to accommodate the child's growth. Meningitis would require an emergent replacement or revision of the shunt. Gastrointestinal upset alone would not indicate the need for shunt revision. Noncommunicating hydrocephalus will not resolve without surgical intervention.

The nurse is reviewing factors that affect lung development. What factor delays surfactant production and maturation of alveolar cells? a. Thyroxine b. Prolactin c. Glucocorticosteroids d. Excess of endogenous insulin

ANS: D An excess of endogenous insulin can delay surfactant production and delays maturation of alveolar cells. Glucocorticosteroids, thyroxine, and prolactin enhance lung development.

A mother asks the nurse what would be the first indication that acute glomerulonephritis is improving. The nurse's best response would be which of the following? a. Blood pressure will stabilize. b. Child will have more energy. c. Urine will be free of protein. d. Urinary output will increase.

ANS: D An increase in urinary output may signal resolution of the acute glomerulonephritis.

Parents bring their 15-month-old infant to the emergency department at 3:00 AM because the toddler has a temperature of 39° C (102.2° F), is crying inconsolably, and is tugging at the ears. A diagnosis of otitis media (OM) is made. In addition to antibiotic therapy, the nurse practitioner should instruct the parents to use what medication? a. Decongestants to ease stuffy nose b. Antihistamines to help the child sleep c. Aspirin for pain and fever management d. Benzocaine ear drops for topical pain relief

ANS: D Analgesic ear drops can provide topical relief for the intense pain of OM. Decongestants and antihistamines are not recommended in the treatment of OM. Aspirin is contraindicated in young children because of the association with Reye syndrome.

Which type of shock is characterized by a hypersensitivity reaction causing massive vasodilation and capillary leaks, which may occur with drug or latex allergy? a. Neurogenic b. Cardiogenic c. Hypovolemic d. Anaphylactic

ANS: D Anaphylactic shock results from extreme allergy or hypersensitivity to a foreign substance. Neurogenic shock results from loss of neuronal control, such as the interruption of neuronal transmission that occurs from a spinal cord injury. Cardiogenic shock is decreased cardiac output. Hypovolemic shock is a reduction in the size of the vascular compartment, decreasing blood pressure, and low central venous pressure.

What physiologic defect is responsible for causing anemia? a. Increased blood viscosity b. Depressed hematopoietic system c. Presence of abnormal hemoglobin d. Decreased oxygen-carrying capacity of blood

ANS: D Anemia is a condition in which the number of red blood cells or hemoglobin concentration is reduced below the normal values for age. This results in a decreased oxygen-carrying capacity of blood. Increased blood viscosity is usually a function of too many cells or of dehydration, not of anemia. A depressed hematopoietic system or abnormal hemoglobin can contribute to anemia, but the definition depends on the decreased oxygen-carrying capacity of the blood.

Which child should the nurse document as being anemic? a. 7-year-old child with a hemoglobin of 11.5 g/dl b. 3-year-old child with a hemoglobin of 12 g/dl c. 14-year-old child with a hemoglobin of 10 g/dl d. 1-year-old child with a hemoglobin of 13 g/dl

ANS: D Anemia is a condition in which the number of red blood cells, or hemoglobin concentration, is reduced below the normal values for age. Anemia is defined as a hemoglobin level below 10 or 11 g/dl. The child with a hemoglobin of 10 g/dl would be considered anemic. The normal hemoglobin for a child after 2 years of age is 11.5 to 15.5 g/dl.

What is the most common cause of cerebral palsy (CP)? a. Central nervous system (CNS) diseases b. Birth asphyxia c. Cerebral trauma d. Neonatal encephalopathy

ANS: D Approximately 80% of CP is caused by unknown prenatal causes. Neonatal encephalopathy in term and preterm infants is believed to play a significant role in the development of CP. CNS diseases such as meningitis or encephalitis can result in CP. Birth asphyxia does contribute to some cases of CP. Cerebral trauma, including shaken baby syndrome, can result in CP.

Which is a common clinical manifestation of Hodgkin disease? a. Petechiae b. Bone and joint pain c. Painful, enlarged lymph nodes d. Enlarged, firm, nontender lymph nodes

ANS: D Asymptomatic, enlarged, cervical or supraclavicular lymphadenopathy is the most common presentation of Hodgkin disease. Petechiae are usually associated with leukemia. Bone and joint pain are not likely in Hodgkin disease. The enlarged nodes are rarely painful.

The nurse is caring for a child with myasthenia gravis (MG). What health care prescription should the nurse verify before administering? a. Ceftizoxime (Cefizox) b. Cefotaxime (Claforan) c. Ceftriaxone (Rocephin) d. Garamycin (gentamicin)

ANS: D Avoid aminoglycoside antibiotics such as gentamicin because they potentiate MG symptoms. Cefizox, Claforan, and Rocephin are cephalosporin antibiotics.

The parents of a child with cerebral palsy ask the nurse whether any drugs can decrease their child's spasticity. The nurse's response should be based on which statement? a. Anticonvulsant medications are sometimes useful for controlling spasticity. b. Medications that would be useful in reducing spasticity are too toxic for use with children. c. Many different medications can be highly effective in controlling spasticity. d. Implantation of a pump to deliver medication into the intrathecal space to decrease spasticity has recently become available.

ANS: D Baclofen, given intrathecally, is best suited for children with severe spasticity that interferes with activities of daily living and ambulation. Anticonvulsant medications are used when seizures occur in children with cerebral palsy. The intrathecal route decreases the side effects of the drugs that reduce spasticity. Few medications are currently available for the control of spasticity.

The nurse is teaching an adolescent about giving insulin injections. The adolescent asks if the disposable needles and syringes can be used more than once. The nurse's response should be based on which knowledge? a. It is unsafe. b. It is acceptable for up to 24 hours. c. It is acceptable for families with very limited resources. d. It is suitable for up to 3 days if stored in the refrigerator.

ANS: D Bacterial counts are unaffected if insulin syringes are handled in an aseptic manner and stored in the refrigerator between use. The syringes can be used up to 3 days and result in a considerable cost savings. Bacterial counts remain low for up to 72 hours with proper technique. The family's resources are not an issue; if a practice is unsafe, the family should not be encouraged to endanger the child by reusing equipment.

The nurse is discussing long-term care with the parents of a child who has a ventriculoperitoneal shunt. What issues should be addressed? a. Most childhood activities must be restricted. b. Cognitive impairment is to be expected with hydrocephalus. c. Wearing head protection is essential until the child reaches adulthood. d. Shunt malfunction or infection requires immediate treatment.

ANS: D Because of the potentially severe sequelae, symptoms of shunt malfunction or infection must be assessed and treated immediately. Limits should be appropriate to the child's developmental age. Except for contact sports, the child will have few restrictions. Cognitive impairment depends on the extent of damage before the shunt was placed.

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

ANS: D Before the blood sample is taken, the heel is heated with warm moist compresses for 5 to 10 minutes to dilate the blood vessels in the area.

The nurse is recommending how to prevent iron deficiency anemia in a healthy, term, breast-fed infant. Which should be suggested? a. Iron (ferrous sulfate) drops after age 1 month b. Iron-fortified commercial formula by age 4 to 6 months c. Iron-fortified infant cereal by age 2 months d. Iron-fortified infant cereal by age 4 to 6 months `

ANS: D Breast milk supplies inadequate iron for growth and development after age 5 months. Supplementation is necessary at this time. The mother can supplement the breastfeeding with iron-fortified infant cereal. Iron supplementation or the introduction of solid foods in a breast-fed baby is not indicated. Providing iron-fortified commercial formula by age 4 to 6 months should be done only if the mother is choosing to discontinue breastfeeding

Which is a type of skin traction with legs in an extended position? a. Dunlop b. Bryant c. Russell d. Buck extension

ANS: D Buck extension traction is a type of skin traction with the legs in an extended position. It is used primarily for short-term immobilization, preoperatively with dislocated hips, for correcting contractures, or for bone deformities such as Legg-Calvé-Perthes disease. Dunlop traction is an upper-extremity traction used for fractures of the humerus. Bryant traction is skin traction with the legs flexed at a 90-degree angle at the hip. Russell traction uses skin traction on the lower leg and a padded sling under the knee. The combination of longitudinal and perpendicular traction allows realignment of the lower extremity and immobilizes the hips and knees in a flexed position.

How might the quality of life for a terminally ill child and his family be enhanced by nurses? a. Tell the family what is best. b. Leave the family alone to deal with their tragedy. c. Remain objective and uninvolved with family grieving. d. Advocate for and implement pain and symptom relief measures.

ANS: D By increasing personal remembering, the nurse can advocate for and provide the best possible care for the child and family. This is supportive for the family and helps the nurse reduce the stress of caregiving. If the nurse tells the family what is best, this removes the decision making from the parents. It also increases pressure on the nurse to be the expert. The nurse is in a supportive role. The nurse should not leave the family alone to deal with their tragedy. Becoming involved is an objective, deliberate choice. Ideally, the nurse achieves detached concern, which allows sensitive, understanding care because the nurse is sufficiently detached to make objective, rational decisions.

What term is defined as the volume of blood ejected by the heart in 1 minute? a. Afterload b. Cardiac cycle c. Stroke volume d. Cardiac output

ANS: D Cardiac output is defined as the volume of blood ejected by the heart in 1 minute. Cardiac output = Heart rate x Stroke volume. Afterload is the resistance against which the ventricles must pump when ejecting blood (ventricular ejection). A cardiac cycle is the sequential contraction and relaxation of both the atria and ventricles. Stroke volume is the amount of blood ejected by the heart in any one contraction.

Chelation therapy for lead poisoning is initiated when a child's blood level is: a. 10 to 14 g/dl. b. 15 to 19 g/dl. c. 20 to 44 g/dl. d. >45 g/dl.

ANS: D Chelation therapy is initiated if the child's blood level is greater than 45 g/dl.

A chest radiography examination is ordered for a child with suspected cardiac problems. The child's parent asks the nurse, "What will the x-ray show about the heart?" The nurse's response should be based on knowledge that the radiograph provides which information? a. Shows bones of the chest but not the heart b. Evaluates the vascular anatomy outside of the heart c. Shows a graphic measure of electrical activity of the heart d. Supplies information on heart size and pulmonary blood flow patterns

ANS: D Chest radiographs provide information on the size of the heart and pulmonary blood flow patterns. The bones of the chest are visible on chest radiographs, but the heart and blood vessels are also seen. Magnetic resonance imaging is a noninvasive technique that allows for evaluation of vascular anatomy outside of the heart. A graphic measure of electrical activity of the heart is provided by electrocardiography.

What choice of words or phrases would be inappropriate to use with a child? a. "Rolling bed" for "stretcher" b. "Special medicine" for "dye" c. "Make sleepy" for "deaden" d. "Catheter" for "intravenous"

ANS: D Children can grasp information only if it is presented on or close to their level of cognitive development. This necessitates an awareness of the words used to describe events or processes, and exploring family traditions or approaches to information sharing and creating patient specific language or context. Therefore, to prevent or alleviate fears, nurses must be aware of the medical terminology and vocabulary that they use every day and be sensitive to the use of slang or confusing terminology. "Catheter" is a medical term and would be confusing.

The nurse is assisting the family of a child with a history of encopresis. What should be included in the nurse's discussion with the family? a. Instruct the parents to sit the child on the toilet at twice-daily routine intervals. b. Instruct the parents that the child will probably need to have daily enemas. c. Suggest the use of stimulant cathartics weekly. d. Reassure the family that most problems are resolved successfully, with some relapses during periods of stress.

ANS: D Children may be unaware of a prior sensation and be unable to control the urge after it begins. They may be so accustomed to bowel accidents that they may be unable to smell or feel them. Family counseling is directed toward reassurance that most problems resolve successfully, although relapses during periods of stress are possible. Sitting the child on the toilet is not recommended because it may intensify the parent-child conflict. Enemas may be needed for impactions, but long-term use prevents the child from assuming responsibility for defecation. Stimulant cathartics may cause cramping that can frighten children.

The nurse is assisting the family of a child with a history of encopresis. Which one of the following should be included in the nurse's discussion with this family? a. Instruct the parents to sit the child on the toilet at twice-daily routine intervals. b. Instruct the parents that the child will probably need to have daily enemas. c. Suggest the use of stimulant cathartics weekly. d. Reassure the family that most problems are resolved successfully, with some relapses during periods of stress.

ANS: D Children may be unaware of a prior sensation and unable to control the urge once it begins. They may be so accustomed to bowel accidents that they are unable to smell or feel it. Family counseling is directed toward reassurance that most problems resolve successfully, although relapses during periods of stress are possible.

The school nurse is planning a class on bicycle safety. Which of the following statements, if made by a participant, would indicate a need for further teaching? a. "Most bicycle injuries occur from a fall off the bicycle." b. "Head injuries are the major causes of bicycle-related fatalities." c. "I should replace my helmet every 5 years." d. "I can ride double with a friend if the bicycle has an extra large seat."

ANS: D Children should not ride double.

What is the antiepileptic medication that requires monitoring of vitamin D and folic acid? a. Topiramate (Topamax) b. Valproic acid (Depakene) c. Gabapentin (Neurontin) d. Phenobarbital (Luminal)

ANS: D Children taking phenobarbital or phenytoin should receive adequate vitamin D and folic acid because deficiencies of both have been associated with these drugs.

Which frequency is recommended for childhood skin testing for tuberculosis (TB) using the Mantoux test? a. Every year for all children older than 2 years b. Every year for all children older than 10 years c. Every 2 years for all children starting at age 1 year d. Periodically for children who reside in high-prevalence regions

ANS: D Children who reside in high-prevalence regions for TB should be tested every 2 to 3 years. Annual testing is not necessary. Testing is not necessary unless exposure is likely or an underlying medical risk factor is present.

Which of the following clinical manifestations would be seen in a child with chronic renal failure? a. Hypotension b. Massive hematuria c. Hypokalemia d. Unpleasant "uremic" breath odor

ANS: D Children with chronic renal failure have a characteristic breath odor resulting from the retention of waste products.

What finding by the nurse is most characteristic of chronic sorrow? a. Lack of acceptance of child's limitation b. Lack of available support to prevent sorrow c. Periods of intensified sorrow when experiencing anger and guilt d. Periods of intensified sorrow at certain landmarks of the child's development

ANS: D Chronic sorrow is manifested by feelings of sorrow and loss that recur in waves over time. The sorrow is a response to the recognition of the child's limitations. The family should be assessed in an ongoing manner to provide appropriate support as their needs change. The sorrow is not preventable. The chronic sorrow occurs during the reintegration and acknowledgment stage.

Probably the most important criterion on which to base the decision to report suspected child abuse is which of the following? a. Inappropriate parental concern for the degree of injury b. Absence of parents for questioning about child's injuries c. Inappropriate response of child d. Incompatibility between the history and injury observed

ANS: D Conflicting stories about the "accident" are the most indicative red flags of abuse.

What is probably the most important criterion on which to base the decision to report suspected child abuse? a. Inappropriate response of child b. Inappropriate parental concern for the degree of injury c. Absence of parents for questioning about child's injuries d. Incompatibility between the history and injury observed

ANS: D Conflicting stories about the "accident" are the most indicative red flags of abuse. The child or caregiver may have an inappropriate response, but this is subjective. Parents should be questioned at some point during the investigation.

What clinical manifestation(s) should the nurse expect to see as shock progresses in a child and becomes decompensated shock? a. Thirst b. Irritability c. Apprehension d. Confusion and somnolence

ANS: D Confusion and somnolence are beginning signs of decompensated shock. Thirst, irritability, and apprehension are signs of compensated shock.

Which clinical manifestation should the nurse expect to see as shock progresses in a child and becomes decompensated shock? a. Thirst b. Irritability c. Apprehension d. Confusion and somnolence

ANS: D Confusion and somnolence are beginning signs of decompensated shock. Thirst, irritability, and apprehension are signs of compensated shock.

Children taking phenobarbital (phenobarbital sodium) and/or phenytoin (Dilantin) may experience a deficiency of: a. calcium. b. vitamin C. c. fat-soluble vitamins. d. vitamin D and folic acid.

ANS: D Deficiencies of vitamin D and folic acid have been reported in children taking phenobarbital and phenytoin. Calcium, vitamin C, and fat-soluble vitamin deficiencies are not associated with phenobarbital or phenytoin.

Hyperglycemia associated with diabetic ketoacidosis is defined as a blood glucose measurement equal to or greater than _____ mg/dl. a. 100 b. 120 c. 180 d. 200

ANS: D Diabetic ketoacidosis is a state of relative insulin insufficiency and may include the presence of hyperglycemia, a blood glucose level greater than or equal to 200 mg/dl. The values 100 mg/dl, 120 mg/dl, and 180 mg/dl are too low for the definition of ketoacidosis.

What blood glucose measurement is most likely associated with diabetic ketoacidosis? a. 185 mg/dl b. 220 mg/dl c. 280 mg/dl d. 330 mg/dl

ANS: D Diabetic ketoacidosis is a state of relative insulin insufficiency and may include the presence of hyperglycemia, a blood glucose level greater than or equal to 330 mg/dl; 185, 220, and 280 mg/dl are values that are too low for the definition of ketoacidosis.

The parents of a young child with heart failure tell the nurse that they are "nervous" about giving digoxin (Lanoxin). The nurse's response should be based on which statement? a. It is a safe, frequently used drug. b. It is difficult to either overmedicate or undermedicate with digoxin. c. Parents lack the expertise necessary to administer digoxin. d. Parents must learn specific, important guidelines for administration of digoxin.

ANS: D Digoxin has a narrow therapeutic range. The margin of safety between therapeutic, toxic, and lethal doses is very small. Specific guidelines are available for parents to learn how to administer the drug safely and to monitor for side effects. Digoxin is a frequently used drug, but it has a narrow therapeutic range. Small amounts of the liquid are given to infants, making it easy to overmedicate or undermedicate. Parents may lack the necessary expertise to administer the drug at first, but with discharge preparation, they should be prepared to administer the drug safely.

The most common initial reaction of parents to illness or injury and hospitalization in their child is which of the following? a. Anger b. Fear c. Depression d. Disbelief

ANS: D Disbelief is the most common initial response of parents. This is especially true if the illness is sudden and serious.

Clinical manifestations of sodium excess (hypernatremia) include which signs or symptoms? a. Hyperreflexia b. Abdominal cramps c. Cardiac dysrhythmias d. Dry, sticky mucous membranes

ANS: D Dry, sticky mucous membranes are associated with hypernatremia. Hyperreflexia is associated with hyperkalemia. Abdominal cramps, weakness, dizziness, nausea, and apprehension are associated hyponatremia. Cardiac dysrhythmias are associated with hypokalemia.

What type of diarrhea is associated with an inflammation of the mucosa and submucosa in the ileum and colon caused by infectious agents? a. Osmotic b. Secretory c. Cytotoxic d. Dysenteric

ANS: D Dysenteric diarrhea is associated with an inflammation of the mucosa and submucosa in the ileum and colon caused by infectious agents such as Campylobacter, Salmonella, or Shigella organisms. Edema, mucosal bleeding, and leukocyte infiltration occur. Osmotic diarrhea occurs when the intestine cannot absorb nutrients or electrolytes. It is commonly seen in malabsorption syndromes such as lactose intolerance. Secretory diarrhea is usually a result of bacterial enterotoxins that stimulate fluid and electrolyte secretion from the mucosal crypt cells, the principal secretory cells of the small intestine. Cytotoxic diarrhea is characterized by the viral destruction of the villi of the small intestine. This results in a smaller intestinal surface area, with a decreased capacity for fluid and electrolyte absorption.

What factor is most important for parents implementing do not resuscitate (DNR) orders? a. Parents' beliefs about euthanasia b. Presence of other children in the home c. Experiences of the health care team with other children in this situation d. Acknowledgment by health care team that child has no realistic chance for cure

ANS: D Earlier implementation of DNR orders, use of less aggressive therapies, and greater provision of palliative care measures are associated with an honest appraisal of the child's condition. Euthanasia involves an action carried out by a person other than the patient to end the life of the patient suffering from a terminal condition. DNR orders do not involve euthanasia but give permission for health care providers to allow the child to die without intervention. Parents state that regardless of the number of children they have, the death of a child is a new experience and nothing can prepare them for it. Health professionals may base their discussions with families on prior experiences, but families base their decision on an honest appraisal of their child's condition.

A school-age child with diarrhea has been rehydrated. The nurse is discussing the child's diet with the family. What food or beverage should be tolerated best? a. Clear fluids b. Carbonated drinks c. Applesauce and milk d. Easily digested foods

ANS: D Easily digested foods such as cereals, cooked vegetables, and meats should be provided for the child. Early reintroduction of nutrients is desirable. Continued feeding or reintroduction of a regular diet has no adverse effects and actually lessens the severity and duration of the illness. Clear fluids (e.g., fruit juices and gelatin) and carbonated drinks have high carbohydrate content and few electrolytes. Caffeinated beverages should be avoided because caffeine is a mild diuretic. In some children, lactose intolerance will develop with diarrhea, and cow's milk should be avoided in the recovery stage.

The nurse suspects that a child has ingested some type of poison. Which of the following clinical manifestations would be most suggestive that the poison was a corrosive product? a. Tinnitus b. Disorientation c. Stupor, lethargy, coma d. Edema of lips, tongue, pharynx

ANS: D Edema of lips, tongue, and pharynx indicates a corrosive ingestion.

The nurse suspects that a child has ingested some type of poison. What clinical manifestation would be most suggestive that the poison was a corrosive product? a. Tinnitus b. Disorientation c. Stupor, lethargy, and coma d. Edema of the lips, tongue, and pharynx

ANS: D Edema of the lips, tongue, and pharynx indicates a corrosive ingestion. Tinnitus is indicative of aspirin ingestion. Corrosives do not act on the central nervous system.

Which is the most effective pain-management approach for a child who is having a bone marrow aspiration? a. Relaxation techniques b. Administration of an opioid c. EMLA cream applied over site d. Conscious or unconscious sedation

ANS: D Effective pharmacologic and nonpharmacologic measures should be used to minimize pain associated with procedures. For bone marrow aspiration, conscious or unconscious sedation should be used. Relaxation, opioids, and EMLA can be used to augment the conscious or unconscious sedation.

Pancreatic enzymes are administered to the child with cystic fibrosis. What nursing consideration should be included in the plan of care? a. Give pancreatic enzymes between meals if at all possible. b. Do not administer pancreatic enzymes if the child is receiving antibiotics. c. Decrease the dose of pancreatic enzymes if the child is having frequent, bulky stools. d. Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal.

ANS: D Enzymes may be administered in a small amount of cereal or fruit at the beginning of a meal or swallowed whole. Enzymes should be given just before meals and snacks. Pancreatic enzymes are not a contraindication for antibiotics. The dose of enzymes should be increased if child is having frequent, bulky stools.

Pancreatic enzymes are administered to the child with cystic fibrosis (CF). Nursing considerations should include to: a. not administer pancreatic enzymes if child is receiving antibiotics. b. decrease dose of pancreatic enzymes if child is having frequent, bulky stools. c. administer pancreatic enzymes between meals if at all possible. d. pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal.

ANS: D Enzymes may be administered in a small amount of cereal or fruit at the beginning of a meal or swallowed whole. Pancreatic enzymes are not a contraindication for antibiotics. The dosage of enzymes should be increased if child is having frequent, bulky stools. Enzymes should be given just before meals and snacks.

What statement applies to the current focus of the dietary management of children with diabetes? a. Measurement of all servings of food is vital for control. b. Daily calculate specific amounts of carbohydrates, fats, and proteins. c. The number of calories for carbohydrates remains constant on a daily basis; protein and fat calories are liberal. d. The intake ensures day-to-day consistency in total calories, protein, carbohydrates, and moderate fat while allowing for a wide variety of foods.

ANS: D Essentially the nutritional needs of children with diabetes are no different from those of healthy children. Children with diabetes need no special foods or supplements. They need sufficient calories to balance daily expenditure for energy and to satisfy the requirement for growth and development.

The nurse is conducting reflex testing on infants at a well-child clinic. Which reflex finding should be reported as abnormal and considered as a possible sign of cerebral palsy? a. Tonic neck reflex at 5 months of age b. Absent Moro reflex at 8 months of age c. Moro reflex at 3 months of age d. Extensor reflex at 7 months of age

ANS: D Establishing a diagnosis of cerebral palsy (CP) may be confirmed with the persistence of primitive reflexes: (1) either the asymmetric tonic neck reflex or persistent Moro reflex (beyond 4 months of age) and (2) the crossed extensor reflex. The tonic neck reflex normally disappears between 4 and 6 months of age. The crossed extensor reflex, which normally disappears by 4 months, is elicited by applying a noxious stimulus to the sole of one foot with the knee extended. Normally, the contralateral foot responds with extensor, abduction, and then adduction movements. The possibility of CP is suggested if these reflexes occur after 4 months.

A child is admitted with extensive burns. The nurse notes burns on the child's lips and singed nasal hairs. The nurse should suspect what condition in the child? a. A chemical burn b. A hot-water scald c. An electrical burn d. An inhalation injury

ANS: D Evidence of an inhalation injury includes burns of the face and lips, singed nasal hairs, and laryngeal edema. Clinical manifestations may be delayed for up to 24 hours. Chemical burns, electrical burns, and burns associated with hot-water scalds would not produce singed nasal hair.

What is a condition that can result if hypersecretion of growth hormone (GH) occurs after epiphyseal closure? a. Cretinism b. Dwarfism c. Gigantism d. Acromegaly

ANS: D Excess GH after closure of the epiphyseal plates results in acromegaly. Cretinism is associated with hypothyroidism. Dwarfism is the condition of being abnormally small. Gigantism occurs when there is hypersecretion of GH before the closure of the epiphyseal plates.

The nurse is caring for a preschool child with suspected diabetes insipidus. Which clinical manifestation should the nurse expect to observe? a. Oliguria b. Glycosuria c. Nausea and vomiting d. Polyuria and polydipsia

ANS: D Excessive urination accompanied by insatiable thirst is the primary clinical manifestation of diabetes. These symptoms may be so severe that the child does little other than drink and urinate. Oliguria is decreased urine production and is not associated with diabetes insipidus. Glycosuria is associated with diabetes mellitus. Nausea and vomiting are associated with inappropriate antidiuretic hormone (ADH) secretion.

One of the techniques that has been especially useful for learners having cognitive impairment is called fading. What description best explains this technique? a. Positive reinforcement when tasks or behaviors are mastered b. Repeated verbal explanations until tasks are faded into the child's development c. Negative reinforcement for specific tasks or behaviors that need to be faded out d. Gradually reduces the assistance given to the child so the child becomes more independent

ANS: D Fading is physically taking the child through each sequence of the desired activity and gradually fading out the physical assistance so the child becomes more independent. Positive reinforcement when tasks or behaviors are mastered is part of behavior modification. An essential component is ignoring undesirable behaviors. Verbal explanations are not as effective as demonstration and physical guidance. Consistent negative reinforcement is helpful, but positive reinforcement that focuses on skill attainment should be incorporated.

Rickets is caused by a deficiency in what? a. Vitamin A b. Vitamin C c. Folic acid and iron d. Vitamin D and calcium

ANS: D Fat-soluble vitamin D and calcium are necessary in adequate amounts to prevent rickets. No correlation exists between rickets and folic acid, iron, or vitamins A and C.

An adolescent girl asks the school nurse for advice because she has dysmenorrhea. She says that a friend recommended she try an over-the-counter nonsteroidal antiinflammatory drug (NSAID). The nurse's response should be based on which of the following? a. Aspirin is the drug of choice for the treatment of dysmenorrhea. b. Over-the-counter NSAIDs are rarely strong enough to provide adequate pain relief. c. NSAIDs are effective because of their analgesic effect. d. NSAIDs are effective because they inhibit prostaglandins, leading to reduction in uterine activity.

ANS: D First-line therapy for adolescents with dysmenorrhea is NSAIDs. This group of drugs blocks the formation of prostaglandins.

The nurse is evaluating arterial blood gas results. What condition can cause an increase in HCO3? a. Renal failure b. Lactic acidosis c. Diabetic ketoacidosis d. Fluid loss from upper gastrointestinal tract

ANS: D Fluid loss from an upper gastrointestinal tract causes an increase in HCO3. Renal failure, lactic acidosis, and diabetic ketoacidosis cause a decrease in HCO3.

What should the nurse plan for an immobilized child in cervical traction to prevent deep vein thrombosis (DVT)? a. Elevate the child's legs. b. Place a foot cradle on the bed. c. Place a pillow under the child's knees. d. Assist the child to dorsiflex the feet and rotate the ankles.

ANS: D For a child who is immobilized, circulatory stasis and DVT development are prevented by instructing patients to change positions frequently, dorsiflex their feet and rotate the ankles, sit in a bedside chair periodically, or ambulate several times daily. Elevating the legs or placing a foot cradle on the bed will not prevent DVTs. A pillow under the knee would impair circulation, not improve it.

A child with leukemia is receiving triple intrathecal chemotherapy consisting of methotrexate, cytarabine, and hydrocortisone. The purpose of this is to prevent: a. infection. b. brain tumor. c. drug side effects. d. central nervous system (CNS) disease.

ANS: D For certain children, CNS prophylactic therapy is indicated. This drug regimen is used to prevent CNS leukemia and will not prevent infection or drug side effects. If the child has a brain tumor in addition to leukemia, additional therapy would be indicated.

The nurse needs to assess a 15-month-old child who is sitting quietly on his father's lap. What initial action by the nurse would be most appropriate? a. Ask the father to place the child on the exam table. b. Undress the child while he is still sitting on his father's lap. c. Talk softly to the child while taking him from his father. d. Begin the assessment while the child is in his father's lap.

ANS: D For young children, particularly infants and toddlers, preserving parent-child contact is a good way of decreasing stress or the need for physical restraint during an assessment. For example, much of a patient's physical examination can be done with the patient in a parent's lap with the parent providing reassuring and comforting contact. The initial action would be to begin the assessment while the child is in his father's lap.

Which of the following is the causative agent of scarlet fever? a. Enteroviruses b. Corynebacterium organisms c. Scarlet fever virus d. Group A β-hemolytic streptococci (GABHS)

ANS: D GABHS infection causes scarlet fever.

Parents of a newborn with ambiguous genitalia want to know how long they will have to wait to know whether they have a boy or a girl. The nurse answers the parents based on what knowledge? a. Chromosome analysis will be complete in 7 days. b. A physical examination will be able to provide a definitive answer. c. Additional laboratory testing is necessary to assign the correct gender. d. Gender assignment involves collaboration between the parents and a multidisciplinary team.

ANS: D Gender assignment is a complex decision-making process. Endocrine, genetic, social, psychologic, and ethical elements of sex assignment have been integrated into the process. Parent participation is included. The goal is to enable the affected child to grow into a well-adjusted, psychosocially stable person. Chromosome analysis usually takes 2 or 3 days. A physical examination reveals ambiguous genitalia, but additional testing is necessary. A "correct" gender may not be identifiable.

It is important that a child with acute streptococcal pharyngitis be treated with antibiotics to prevent which condition? a. Otitis media b. Diabetes insipidus (DI) c. Nephrotic syndrome d. Acute rheumatic fever

ANS: D Group A hemolytic streptococcal infection is a brief illness with varying symptoms. It is essential that pharyngitis caused by this organism be treated with appropriate antibiotics to avoid the sequelae of acute rheumatic fever and acute glomerulonephritis. The cause of otitis media is either viral or other bacterial organisms. DI is a disorder of the posterior pituitary. Infections such as meningitis or encephalitis, not streptococcal pharyngitis, can cause DI. Glomerulonephritis, not nephrotic syndrome, can result from acute streptococcal pharyngitis.

What nursing intervention is especially helpful in assessing feelings of parental guilt when a disability or chronic illness is diagnosed? a. Ask the parents if they feel guilty. b. Observe for signs of overprotectiveness. c. Talk about guilt only after the parents mention it. d. Discuss the meaning of the parents' religious and cultural background.

ANS: D Guilt may be associated with cultural or religious beliefs. Some parents are convinced that they are being punished for some previous misdeed. Others may see the disorder as a trial sent by God to test their religious beliefs. The nurse can help the parents explore their religious beliefs. On direct questioning, the parents may not be able to identify the feelings of guilt. It would be appropriate for the nurse to explore their adjustment responses. Overprotectiveness is a parental response during the adjustment phase. The parents fear letting the child achieve any new skill and avoid all discipline.

The mother of a 1-month-old infant tells the nurse she worries that her baby will get meningitis like the child's younger brother had when he was an infant. The nurse should base a response on which information? a. Meningitis rarely occurs during infancy. b. Often a genetic predisposition to meningitis is found. c. Vaccination to prevent all types of meningitis is now available. d. Vaccinations to prevent pneumococcal and Haemophilus influenzae type B meningitis are available.

ANS: D H. influenzae type B meningitis has been virtually eradicated in areas of the world where the vaccine is administered routinely. Bacterial meningitis remains a serious illness in children. It is significant because of the residual damage caused by undiagnosed and untreated or inadequately treated cases. The leading causes of neonatal meningitis are the group B streptococci and Escherichia coli organisms. Meningitis is an extension of a variety of bacterial infections. No genetic predisposition exists. Vaccinations are not available for all of the potential causative organisms.

When discussing hyperlipidemia with a group of adolescents, the nurse should explain that cardiovascular disease can be prevented by high levels of: a. cholesterol. b. triglycerides. c. low-density lipoproteins (LDLs). d. high-density lipoproteins (HDLs).

ANS: D HDLs contain very low concentrations of triglycerides, relatively little cholesterol, and high levels of proteins. It is thought that HDLs protect against cardiovascular disease. Cholesterol, triglycerides, and LDLs are not protective against cardiovascular disease.

Which is considered a cardinal sign of diabetes mellitus? a. Nausea b. Seizures c. Impaired vision d. Frequent urination

ANS: D Hallmarks of diabetes mellitus are glycosuria, polyuria, and polydipsia. Nausea and seizures are not clinical manifestations of diabetes mellitus. Impaired vision is a long-term complication of the disease.

A 12-year-old child is injured in a bicycle accident. When considering the possibility of renal trauma, the nurse should consider what factor? a. Flank pain rarely occurs in children with renal injuries. b. Few nonpenetrating injuries cause renal trauma in children. c. Kidneys are immobile, well protected, and rarely injured in children. d. The amount of hematuria is not a reliable indicator of the seriousness of renal injury.

ANS: D Hematuria is consistently present with renal trauma. It does not provide a reliable indicator of the seriousness of the renal injury. Flank pain results from bleeding around the kidney. Most injuries that cause renal trauma in children are of the nonpenetrating or blunt type and usually involve falls, athletic injuries, and motor vehicle accidents. In children, the kidneys are more mobile, and the outer borders are less protected than in adults.

What suggestion by the nurse for parents regarding stuttering in children is most helpful? a. Offer rewards for proper speech. b. Encourage the child to take it easy and go slow when stuttering. c. Help the child by supplying words when he or she is experiencing a block. d. Give the child plenty of time and the impression that you are not in a hurry.

ANS: D Hesitancy and dysfluency should be considered a normal part of speech development. An important approach is to allow the child plenty of time to speak. Promising rewards for proper speech places additional pressure on the child. Encouraging the child to take it easy and go slow when stuttering draws attention to the dysfluency. The child needs to complete a sentence and thought without being interrupted.

When caring for the child with Kawasaki disease, the nurse should know which information? a. A child's fever is usually responsive to antibiotics within 48 hours. b. The principal area of involvement is the joints. c. Aspirin is contraindicated. d. Therapeutic management includes administration of gamma globulin and aspirin.

ANS: D High-dose IV gamma globulin and aspirin therapy is indicated to reduce the incidence of coronary artery abnormalities when given within the first 10 days of the illness. The fever of Kawasaki disease is unresponsive to antibiotics and antipyretics. Mucous membranes, conjunctiva, changes in the extremities, and cardiac involvement are seen. Aspirin is part of the therapy.

31. When caring for the child with Kawasaki disease, what should the nurse know to provide safe and effective care? a. Aspirin is contraindicated. b. The principal area of involvement is the joints. c. The child's fever is usually responsive to antibiotics within 48 hours. d. Therapeutic management includes administration of gamma globulin and salicylates.

ANS: D High-dose intravenous gamma globulin and salicylate therapy are indicated to reduce the incidence of coronary artery abnormalities when given within the first 10 days of the illness. Aspirin is part of the therapy. Mucous membranes, conjunctiva, changes in the extremities, and cardiac involvement are seen. The fever of Kawasaki disease is unresponsive to antibiotics. It is responsive to anti-inflammatory doses of aspirin and antipyretics.

The nurse is caring for a child with acute renal failure. Which of the following clinical manifestations should the nurse recognize as a sign of hyperkalemia? a. Dyspnea b. Seizure c. Oliguria d. Cardiac arrhythmia

ANS: D Hyperkalemia is the most common threat to the life of the child. Signs of hyperkalemia include electrocardiograph anomalies such as prolonged QRS complex, depressed ST segments, peaked T waves, bradycardia, or heart block.

The clinic nurse is assessing a child with hypopituitarism. Hypopituitarism can lead to which disorder? a. Gigantism b. Hyperthyroidism c. Cushing syndrome d. Growth hormone deficiency

ANS: D Hypopituitarism can lead to a growth hormone deficiency. An overproduction of the anterior pituitary hormones can result in gigantism (caused by excess growth hormone production during childhood), hyperthyroidism, or hypercortisolism (Cushing syndrome).

Hypospadias refers to which of the following? a. Absence of a urethral opening b. Penis shorter than usual for age c. Urethral opening along dorsal surface of penis d. Urethral opening along ventral surface of penis

ANS: D Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis.

A 9-year-old boy has an unplanned admission to the intensive care unit (ICU) after abdominal surgery. The nursing staff has completed the admission process, and his condition is beginning to stabilize. When speaking with the parents, the nurse should expect what additional stressor to be evident? a. Usual day-night routine b. Calming influence of staff c. Adequate privacy and support d. Insufficient remembering of his condition and routine

ANS: D ICUs, especially when the family is unprepared for the admission, are strange and unfamiliar. There are many pieces of unfamiliar equipment, and the sights and sounds are much different from those of a general hospital unit. Also, with the child's condition being more precarious, it may be difficult to keep the parents updated on what is happening. Lights are usually on around the clock, seriously disrupting the diurnal rhythm. In most ICUs, the staff works with a sense of urgency. It is difficult for parents to ask questions about their child when staff is with other patients. Usually little privacy is available for families in ICUs.

The nurse is conducting a staff in-service on childhood blood disorders. Which describes the pathology of idiopathic thrombocytopenic purpura? a. Bone marrow failure in which all elements are suppressed b. Deficiency in the production rate of globin chains c. Diffuse fibrin deposition in the microvasculature d. An excessive destruction of platelets

ANS: D Idiopathic thrombocytopenic purpura is an acquired hemorrhagic disorder characterized by an excessive destruction of platelets, discolorations caused by petechiae beneath the skin, and a normal bone marrow. Aplastic anemia refers to a bone marrow-failure condition in which the formed elements of the blood are simultaneously depressed. Thalassemia major is a group of blood disorders characterized by deficiency in the production rate of specific hemoglobin globin chains. Disseminated intravascular coagulation is characterized by diffuse fibrin deposition in the microvasculature, consumption of coagulation factors, and endogenous generation of thrombin and plasma.

The nurse is reviewing first aid with a group of school nurses. Which statement made by a participant indicates a correct understanding of the information? a. "If a child loses a tooth due to injury, I should place the tooth in warm milk." b. "If a child has recurrent abdominal pain, I should send him or her back to class until the end of the day." c. "If a child has a chemical burn to the eye, I should irrigate the eye with normal saline." d. "If a child has a nosebleed, I should have the child sit up and lean forward."

ANS: D If a child has a nosebleed, the child should lean forward, not lie down. A tooth should be placed in cold milk or saliva for transporting to a dentist. Recurrent abdominal pain is a physiologic problem and requires further evaluation. If a chemical burn occurs in the eye, the eye should be irrigated with water for 20 minutes.

The parent of an infant with nasopharyngitis should be instructed to notify the health professional if the infant displays which clinical manifestation? a. Fussiness b. Coughing c. A fever over 99° F d. Signs of an earache

ANS: D If an infant with nasopharyngitis shows signs of an earache, it may mean a secondary bacterial infection is present and the infant should be referred to a practitioner for evaluation. Irritability is common in an infant with a viral illness. Cough can be a sign of nasopharyngitis. Fever is common in viral illnesses.

The nurse is caring for a school-age child who has had a cardiac catheterization. The child tells the nurse that the bandage is "too wet." The nurse finds the bandage and bed soaked with blood. The most appropriate initial nursing action is to: a. notify physician. b. apply new bandage with more pressure. c. place the child in Trendelenburg position. d. apply direct pressure above catheterization site.

ANS: D If bleeding occurs, direct continuous pressure is applied 2.5 cm (1 inch) above the percutaneous skin site to localize pressure over the vessel puncture. Notifying a physician and applying a new bandage can be done after pressure is applied. The nurse can have someone else notify the physician while the pressure is being maintained. It is not a helpful intervention to place the girl in the Trendelenburg position. It would increase the drainage from the lower extremities.

Which should cause a nurse to suspect that an infection has developed under a cast? a. Complaint of paresthesia b. Cold toes c. Increased respirations d. "Hot spots" felt on cast surface

ANS: D If hot spots are felt on the cast surface, they usually indicate infection beneath the area. This should be reported so that a window can be made in the cast to observe the site. The five Ps of ischemia from a vascular injury are pain, pallor, pulselessness, paresthesia, and paralysis. Paresthesia is an indication of vascular injury, not infection. Cold toes may be indicative of too tight a cast and need further evaluation. Increased respirations may be indicative of a respiratory tract infection or pulmonary emboli. This should be reported, and child should be evaluated.

Which of the following is an appropriate action when an infant becomes apneic? a. Shake vigorously. b. Roll head side to side. c. Hold by feet upside down with head supported. d. Gently stimulate trunk by patting or rubbing.

ANS: D If the infant is apneic, the infant's trunk should be gently stimulated by patting or rubbing. If the infant is prone, turn onto the back.

A parent needs to leave a hospitalized toddler for a short period of time. What action should the nurse suggest to the parent to ease the separation for the toddler? a. Bring a new toy when returning. b. Leave when the child is distracted. c. Tell the child when they will return. d. Leave a favorite article from home with the child.

ANS: D If the parents cannot stay with the child, they should leave favorite articles from home with the child, such as a blanket, toy, bottle, feeding utensil, or article of clothing. Because young children associate such inanimate objects with significant people, they gain comfort and reassurance from these possessions. They make the association that if the parents left this, the parents will surely return. Bringing a new toy would not help with the separation. The parent should not leave when the child is distracted, and toddlers would not understand when the parent should return because time is not a concept they understand

What do inflicted immersion burns often appear as? a. Partial-thickness, asymmetrical burns b. Splash pattern burns on hands or feet c. Any splash burn with dry linear marks d. Sharply demarcated, symmetrical burns

ANS: D Immersion burns are sharply demarcated symmetrical burns. Asymmetrical burns and splash burns are often accidental.

The physician suggests that surgery be performed for patent ductus arteriosus (PDA) to prevent which complication? a. Hypoxemia b. Right-to-left shunt of blood c. Decreased workload on the left side of the heart d. Pulmonary vascular congestion

ANS: D In PDA, blood flows from the higher pressure aorta into the lower pressure pulmonary vein, resulting in increased pulmonary blood flow. This creates pulmonary vascular congestion. Hypoxemia usually results from defects with mixed blood flow and decreased pulmonary blood flow. The shunt is from left to right in a PDA. The closure would stop this. There is increased workload on the left side of the heart with a PDA.

Which of the following describes the cognitive abilities of school-age children? a. Have developed the ability to reason abstractly b. Are capable of scientific reasoning and formal logic c. Progress from making judgments based on what they reason to making judgments based on what they see d. Are able to classify, to group and sort, and to hold a concept in their minds while making decisions based on that concept

ANS: D In Piaget's stage of concrete operations, children have the ability to group and sort and make conceptual decisions.

The nurse is caring for a child with tetanus during the acute phase. What should the nurse plan in the care for this child? a. Playing music on a radio b. Giving frequent back rubs c. Providing bright lighting in the room d. Clustering nursing care to limit distractions

ANS: D In caring for a child with tetanus during the acute phase, every effort should be made to control or eliminate stimulation from sound, light, and touch. Although a darkened room is ideal, sufficient light is essential so that the child can be carefully observed; light appears to be less irritating than vibratory or auditory stimuli. The infant or child is handled as little as possible, and extra effort is expended to avoid any sudden or loud noise to prevent seizures.

What statement best describes iron deficiency anemia in infants? a. It is caused by depression of the hematopoietic system. b. Diagnosis is easily made because of the infant's emaciated appearance. c. It results from a decreased intake of milk and the premature addition of solid foods. d. Clinical manifestations are related to a reduction in the amount of oxygen available to tissues.

ANS: D In iron-deficiency anemia, the child's clinical appearance is a result of the anemia, not the underlying cause. Usually the hematopoietic system is not depressed. The bone marrow produces red blood cells that are smaller and contain less hemoglobin than normal red blood cells. Children who have iron deficiency from drinking excessive quantities of milk are usually pale and overweight. They are receiving sufficient calories but are deficient in essential nutrients. The clinical manifestations result from decreased intake of iron-fortified solid foods and an excessive intake of milk.

A toddler sustains a minor burn on the hand from hot coffee. What is the first action in treating this burn? a. Apply burn ointment. b. Put ice on the burned area. c. Cover the hand with gauze dressing. d. Hold the hand under cool running water.

ANS: D In minor burns, the best method to stop the burning process is to hold the burned area under cool running water. Ointments are not applied to a new burn; the ointment will contribute to the burning. Ice is not recommended. Gauze dressings do not stop the burning process.

A 6-year-old child is admitted for revision of a ventriculoperitoneal shunt for noncommunicating hydrocephalus. What sign or symptom does the child have that indicates a revision is necessary? a. Tachycardia b. Gastrointestinal upset c. Hypotension d. Alteration in level of consciousness

ANS: D In older children, who are usually admitted to the hospital for elective or emergency shunt revision, the most valuable indicators of increasing intracranial pressure are an alteration in the child's level of consciousness, complaint of headache, and changes in interaction with the environment.

Seventy-two hours after cardiac surgery, a young child has a temperature of 101° F. Which action should the nurse take? a. Keep child warm with blankets. b. Apply a hypothermia blanket. c. Record temperature on nurses' notes. d. Report findings to physician.

ANS: D In the first 24 to 48 hours after surgery, the body temperature may increase to 37.7° C (100° F) as part of the inflammatory response to tissue trauma. If the temperature is higher or continues after this period, it is most likely a sign of an infection and immediate investigation is indicated. Blankets should be removed from the child to keep the temperature from increasing. Hypothermia blanket is not indicated for this level of temperature. The temperature should be recorded, but the physician must be notified for evaluation. Suctioning should be done only as indicated, not on a routine basis. The child should be suctioned for no more than 5 seconds at one time. Symptoms of respiratory distress are avoided by using appropriate technique.

The nurse outlines short- and long-term goals for a 10-year-old child with many complex health problems. Who should agree on these goals? a. Family and nurse b. Child, family, and nurse c. All professionals involved d. Child, family, and all professionals involved

ANS: D In the home, the family is a partner in each step of the nursing process. The family priorities should guide the planning process. Both short- and long-term goals should be outlined and agreed on by the child, family, and professionals involved. Elimination of any one of these groups can potentially create a care plan that does not meet the needs of the child and family.

It is important to make certain that sensory connectors and oximeters are compatible because incompatible wiring can cause which condition? a. Hyperthermia b. Electrocution c. Pressure necrosis d. Burns under sensors

ANS: D Incompatible wiring can generate considerable heat at the tip of the sensor, resulting in partial- and full-thickness burns. Heat may be generated at the site of the sensor, but it will not result in generalized hyperthermia. Electrocution is not a possibility with oximeters. Pressure necrosis can occur from improperly applied sensors but not from incompatible wiring.

What functional ability should the nurse expect in a child with a spinal cord lesion at C7? a. Complete respiratory paralysis b. No voluntary function of upper extremities c. Inability to roll over or attain sitting position d. Almost complete independence within limitations of wheelchair

ANS: D Individuals who sustain injuries at the C7 level are able to achieve a significant level of independence. Some assistance is needed with transfers and lower extremity dressing. Patients are able to roll over in bed and to sit and eat independently. Patients with injuries at C3 or higher have complete respiratory paralysis. Those with injuries at C4 or higher do not have voluntary function of higher extremities. Injuries at C5 or higher prevent rolling over or sitting.

Which of the following is descriptive of bulimia during adolescence? a. Strong sense of control over eating behavior b. Feelings of elation after the binge-purge cycle c. Profound lack of awareness that the eating pattern is abnormal d. Weight that can be normal, slightly above normal, or below normal

ANS: D Individuals with bulimia are of normal or more commonly slightly above normal weight. Those who also restrict their intake can become severely underweight.

What nutritional component should be altered in the infant with heart failure (HF)? a. Decrease in fats b. Increase in fluids c. Decrease in protein d. Increase in calories

ANS: D Infants with HF have a greater metabolic rate because of poor cardiac function and increased heart and respiratory rates. Their caloric needs are greater than those of average infants, yet their ability to take in calories is diminished by their fatigue. The diet should include increased protein and increased fat to facilitate the child's intake of sufficient calories. Fluids must be carefully monitored because of the HF.

A child with pyloric stenosis is having excessive vomiting. The nurse should assess for what potential complication? a. Hyperkalemia b. Hyperchloremia c. Metabolic acidosis d. Metabolic alkalosis

ANS: D Infants with excessive vomiting are prone to metabolic alkalosis from the loss of hydrogen ions. Potassium and chloride ions are lost with vomiting. Metabolic alkalosis, not acidosis, is likely.

Which of the following statements is correct regarding sports injuries during adolescence? a. The increase in strength and vigor during adolescence helps prevent injuries related to fatigue. b. Conditioning does not help prevent many sports injuries. c. More injuries occur during organized athletic competition than during recreational sports participation. d. Adolescents may not possess insight and judgment to recognize when a sports activity is beyond their capabilities.

ANS: D Injuries occur when the adolescent's body is not suited to the sport and/or when they lack the insight and judgment to recognize that an activity exceeds their physical abilities.

What statement is correct regarding sports injuries during adolescence? a. Conditioning does not help prevent many sports injuries. b. The increase in strength and vigor during adolescence helps prevent injuries related to fatigue. c. More injuries occur during organized athletic competition than during recreational sports participation. d. Adolescents may not possess insight and judgment to recognize when a sports activity is beyond their capabilities.

ANS: D Injuries occur when the adolescent's body is not suited to the sport or when he or she lacks the insight and judgment to recognize that an activity exceeds his or her physical abilities. More injuries occur when an adolescent's muscles and body systems (respiratory and cardiovascular) are not conditioned to endure physical stress. Injuries do not occur from fatigue but rather from overuse. All sports have the potential for injury to the participant, whether the youngster engages in serious competition or in sports for recreation. More injuries occur during recreational sports than during organized athletic competition.

What term describes invagination of one segment of bowel within another? a. Atresia b. Stenosis c. Herniation d. Intussusception

ANS: D Intussusception occurs when a proximal section of the bowel telescopes into a more distal segment, pulling the mesentery with it. The mesentery is compressed and angled, resulting in lymphatic and venous obstruction. Atresia is the absence or closure of a natural opening in the body. Stenosis is a narrowing or constriction of the diameter of a bodily passage or orifice. Herniation is the protrusion of an organ or part through connective tissue or through a wall of the cavity in which it is normally enclosed.

What should the nurse determine to be the priority intervention for a family with an infant who has a disability? a. Focus on the child's disabilities to understand care needs. b. Institute age-appropriate discipline and limit setting. c. Enforce visiting hours to allow parents to have respite care. d. Foster feelings of competency by helping parents learn the special care needs of the infant.

ANS: D It is important that the parents learn how to care for their infant so they feel competent. The nurse facilitates this by teaching special holding techniques, supporting breastfeeding, and encouraging frequent visiting and rooming in. The focus should be on the infant's capabilities and positive features. Infants do not usually require discipline. As the child gets older, this is necessary, but it is not a priority intervention at this time. The nursing staff negotiates with the family about the need for respite care.

It is important to make certain that sensory connectors and oximeters are compatible, since wiring that is incompatible can cause which of the following? a. Hyperthermia b. Electrocution c. Pressure necrosis d. Burns under sensors ANS: D It is important to make certain that sensor connectors and oximeters are compatible. Wiring that is incompatible can generate considerable heat at the tip of the sensor, causing second- and third-degree burns under the sensor. It is important to make certain that sensory connectors and oximeters are compatible, since wiring that is incompatible can cause which of the following? a. Hyperthermia b. Electrocution c. Pressure necrosis d. Burns under sensors

ANS: D It is important to make certain that sensor connectors and oximeters are compatible. Wiring that is incompatible can generate considerable heat at the tip of the sensor, causing second- and third-degree burns under the sensor.

For children who do not have a matched sibling bone marrow donor, the therapeutic management of aplastic anemia includes what intervention? a. Antibiotics b. Antiretroviral drugs c. Iron supplementation d. Immunosuppressive therapy

ANS: D It is thought that aplastic anemia may be an autoimmune disease. Immunosuppressive therapy, including antilymphocyte globulin, antithymocyte globulin, cyclosporine, granulocyte colony-stimulating factor, and methylprednisone, has greatly improved the prognosis for patients with aplastic anemia. Antibiotics are not indicated as the management. They may be indicated for infections. Antiretroviral drugs and iron supplementation are not part of the therapy.

The nurse is taking care of an adolescent diagnosed with kyphosis. Which describes this condition? a. Lateral curvature of the spine b. Immobility of the shoulder joint c. Exaggerated concave lumbar curvature of the spine d. Increased convex angulation in the curve of the thoracic spine

ANS: D Kyphosis is an abnormally increased convex angulation in the curve of the thoracic spine. Scoliosis is a complex spinal deformity usually involving lateral curvature, spinal rotation causing rib asymmetry, and thoracic hypokyphosis. Ankylosis is the immobility of a joint. Lordosis is an exaggerated concave lumbar curvature of the spine.

A young boy is found squirting lighter fluid into his mouth. His father calls the emergency department. The nurse taking the call should know that the primary danger is which of the following? a. Hepatic dysfunction b. Dehydration secondary to vomiting c. Esophageal stricture and shock d. Bronchitis and chemical pneumonia

ANS: D Lighter fluid is a hydrocarbon. The immediate danger is aspiration.

A young boy is found squirting lighter fluid into his mouth. His father calls the emergency department. The nurse taking the call should know that the primary danger is what? a. Hepatic dysfunction b. Dehydration secondary to vomiting c. Esophageal stricture and shock d. Bronchitis and chemical pneumonia

ANS: D Lighter fluid is a hydrocarbon. The immediate danger is aspiration. Acetaminophen overdose, not hydrocarbons, causes hepatic dysfunction. Dehydration is not the primary danger. Esophageal stricture is a late or chronic consequence of hydrocarbon ingestion.

What do the clinical manifestations of minimal change nephrotic syndrome include? a. Hematuria, bacteriuria, and weight gain b. Gross hematuria, albuminuria, and fever c. Hypertension, weight loss, and proteinuria d. Massive proteinuria, hypoalbuminemia, and edema

ANS: D Massive proteinuria, hypoalbuminemia, and edema are clinical manifestations of minimal change nephrotic syndrome. Hematuria and bacteriuria are not seen, and there is usually weight loss, not gain. The blood pressure is normal or hypotensive

The nurse should recommend medical attention if a child with a slight head injury experiences: a. sleepiness. b. vomiting, even once. c. headache, even if slight. d. confusion or abnormal behavior.

ANS: D Medical attention should be sought if the child exhibits confusion or abnormal behavior, loses consciousness, has amnesia, has fluid leaking from the nose or ears, complains of blurred vision, or has an unsteady gait. Sleepiness alone does not require evaluation. If the child is difficult to arouse from sleep, medical attention should be obtained. Vomiting more than three times requires medical attention. Severe or worsening headache or one that interferes with sleep should be evaluated.

Although infants may be allergic to a variety of foods, the most common allergens are: a. fruit and eggs. b. fruit, vegetables, and wheat. c. cow's milk and green vegetables. d. eggs, cow's milk, and wheat.

ANS: D Milk products, eggs, and wheat are three of the most common food allergens. Ingestion of these products can cause sensitization and, with subsequent exposure, an allergic reaction.

The majority of children in the United States with human immunodeficiency virus (HIV) infection acquired the disease by which means? a. Through sexual contact b. From a blood transfusion c. By using intravenous (IV) drugs d. Perinatally from their mothers

ANS: D More than 90% of the children with HIV under 13 years who were reported to the Centers for Disease Control and Prevention acquired the infection during the perinatal period. With intervention, the number of children infected can be decreased. Sexual contact and IV drug use are the leading causes of infection in the 14- to 19-year age group. This number is less than the number of cases in the under 13-year age group. Transfusion has accounted for 3% to 6% of all pediatric acquired immunodeficiency syndrome cases to date. Before 1985 and routine screening of donated blood products, children with hemophilia were at great risk from pooled plasma products.

Neuropathic bladder disorders are common among children with which disorder? a. Plagiocephaly b. Meningocele c. Craniosynostosis d. Myelomeningocele

ANS: D Myelomeningocele is one of the most common causes of neuropathic bladder dysfunction among children. Plagiocephaly is the flattening of a side of the child's head. This is not associated with neuropathic bladder. Children with meningocele usually do not have neuropathic bladder. Craniosynostosis is the premature closure of one or more cranial sutures. It is not associated with neuropathic bladder.

Which medication is usually tried first when a child is diagnosed with juvenile idiopathic arthritis (JIA)? a. Aspirin b. Corticosteroids c. Cytotoxic drugs such as methotrexate d. Nonsteroidal anti-inflammatory drugs (NSAIDs)

ANS: D NSAIDs are the first drugs used in JIA. Naproxen, ibuprofen, and tolmetin are approved for use in children. Aspirin, once the drug of choice, has been replaced by the NSAIDs because they have fewer side effects and easier administration schedules. Corticosteroids are used for life-threatening complications, incapacitating arthritis, and uveitis. Methotrexate is a second-line therapy for JIA.

A 12-year-old boy is in the final phase of dying from leukemia. He tells the nurse who is giving him opiates for pain that his grandfather is waiting for him. How should the nurse interpret this situation? a. The boy is experiencing side effects of the opiates. b. The boy is making an attempt to comfort his parents. c. He is experiencing hallucinations resulting from brain anoxia. d. He is demonstrating readiness and acceptance that death is near.

ANS: D Near the time of death, many children experience visions of "angels" or people and talk with them. The children mention that they are not afraid and that someone is waiting for them. If the child has built a tolerance to the opioids, side effects are not likely. At this time, many children do begin to comfort their families and tell them that they are not afraid and are ready to die, but the visions usually precede this stage. There is no evidence of tissue hypoxia.

What clinical manifestation(s) is associated with calcium depletion (hypocalcemia)? a. Nausea, vomiting b. Weakness, fatigue c. Muscle hypotonicity d. Neuromuscular irritability

ANS: D Neuromuscular irritability is a clinical manifestation of hypocalcemia. Nausea and vomiting occur with hypercalcemia and hypernatremia. Weakness, fatigue, and muscle hypotonicity are clinical manifestations of hypercalcemia.

The clinic nurse is evaluating lab results for a child. What recorded hemoglobin (Hgb) result is considered within the normal range? a. 9 g/dl b. 10 g/dl c. 11 g/dl d. 12 g/dl

ANS: D Normal hemoglobin (Hgb) determination is 11.5 to 15.5 g/dl.

A quantitative sweat chloride test has been done on an 8-month-old child. What value should be indicative of cystic fibrosis (CF)? a. Less than 18 mEq/L b. 18 to 40 mEq/L c. 40 to 60 mEq/L d. Greater than 60 mEq/L

ANS: D Normally sweat chloride content is less than 40 mEq/L, with a mean of 18 mEq/L. A chloride concentration greater than 60 mEq/L is diagnostic of CF; in infants younger than 3 months, a sweat chloride concentration greater than 40 mEq/L is highly suggestive of CF.

Chronic otitis media with effusion (OME) is differentiated from acute otitis media (AOM) because it is usually characterized by: a. a fever as high as 40° C (104° F). b. severe pain in the ear. c. nausea and vomiting. d. a feeling of fullness in the ear.

ANS: D OME is characterized by feeling of fullness in the ear or other nonspecific complaints. Fever is a sign of AOM. OME does not cause severe pain. This may be a sign of AOM. Nausea and vomiting are associated with otitis media.

A 23-month-old child is admitted to the hospital with a diagnosis of meningitis. She is lethargic and very irritable with a temperature of 102° F. What should the nurse's care plan include? a. Observing the child's voluntary movement b. Checking the Babinski reflex every 4 hours c. Checking the Brudzinski reflex every 1 hour d. Assessing the level of consciousness (LOC) and vital signs every 2 hours

ANS: D Observation of vital signs, neurologic signs, LOC, urinary output, and other pertinent data is carried out at frequent intervals on a child with meningitis. The nurse should avoid actions that cause pain or increase discomfort, such as lifting the child's head, so the Brudzinski reflex should not be checked hourly. Checking the Babinski reflex or child's voluntary movements will not help with assessing the child's status.

The nurse is evaluating arterial blood gas results. What condition can cause an increase in PCO2? a. Hypoxia b. Hyperventilation c. Pulmonary embolism d. Obstructive lung disease

ANS: D Obstructive lung disease causes an increase in PCO2. Hypoxia, hyperventilation, and pulmonary embolism cause a decrease in PCO2.

The nurse is caring for an adolescent who has just started dialysis. The child seems always angry, hostile, or depressed. The nurse should recognize that this is most likely related to which of the following? a. Neurologic manifestations that occur with dialysis b. Physiologic manifestations of renal disease c. Adolescents having few coping mechanisms d. Adolescents often resenting the control and enforced dependence imposed by dialysis

ANS: D Older children and adolescents need control. The necessity of dialysis forces the adolescent into a dependent relationship, which results in these behaviors.

The nurse is caring for an adolescent who has just started dialysis. The child always seems angry, hostile, or depressed. The nurse should recognize that this is most likely related to what underlying cause? a. Physiologic manifestations of renal disease b. The fact that adolescents have few coping mechanisms c. Neurologic manifestations that occur with dialysis d. Resentment of the control and enforced dependence imposed by dialysis

ANS: D Older children and adolescents need to feel in control. Dialysis forces the adolescent into a dependent relationship, which results in these behaviors. Being angry, hostile, or depressed are functions of the age of the child, not neurologic or physiologic manifestations of the dialysis.

Which of the following is characteristic of dishonest behavior in children ages 8 to 10 years? a. Cheating during games is now more common. b. Lying results from the inability to distinguish between fact and fantasy. c. They may steal because their sense of property rights is limited. d. They may lie to meet expectations set by others that they have been unable to attain.

ANS: D Older school-age children may lie to meet expectations set by others to which they have been unable to measure up.

What condition precipitates polycythemia? a. Dehydration b. Severe infections c. Immunosuppression d. Prolonged tissue hypoxia

ANS: D Oxygen transport depends on both the number of circulating RBCs and the amount of normal hemoglobin in the cell. This explains why polycythemia (increase in the number of erythrocytes) occurs in conditions characterized by prolonged tissue hypoxia, such as cyanotic heart defects. Dehydration, severe infections, or immunosuppression will not precipitate polycythemia.

What clinical manifestation should be the most suggestive of acute appendicitis? a. Rebound tenderness b. Bright red or dark red rectal bleeding c. Abdominal pain that is relieved by eating d. Colicky, cramping, abdominal pain around the umbilicus

ANS: D Pain is the cardinal feature. It is initially generalized, usually periumbilical. The pain becomes constant and may shift to the right lower quadrant. Rebound tenderness is not a reliable sign and is extremely painful to the child. Bright or dark red rectal bleeding and abdominal pain that is relieved by eating are not signs of acute appendicitis.

Parents have understood teaching about prevention of childhood otitis media if they make which statement? a. "We will only prop the bottle during the daytime feedings." b. "Breastfeeding will be discontinued after 4 months of age." c. "We will place the child flat right after feedings." d. "We will be sure to keep immunizations up to date."

ANS: D Parents have understood the teaching about preventing childhood otitis media if they respond they will keep childhood immunizations up to date. The child should be maintained upright during feedings and after. Otitis media can be prevented by exclusively breastfeeding until at least 6 months of age. Propping bottles is discouraged to avoid pooling of milk while the child is in the supine position.

Which clinical manifestation may occur in the child who is receiving too much methimazole (Tapazole) for the treatment of hyperthyroidism (Graves disease)? a. Seizures b. Enlargement of all lymph glands c. Pancreatitis or cholecystitis d. Lethargy and somnolence

ANS: D Parents should be aware of the signs of hypothyroidism that can occur from overdosage of the drug. The most common manifestations are lethargy and somnolence. Seizures and pancreatitis are not associated with the administration of Tapazole. Enlargement of the salivary and cervical lymph glands occurs.

The nurse is caring for a child with hemophilia A. The child's activity is as tolerated. What activity is contraindicated for this child? a. Ambulating to the cafeteria b. Active range of motion c. Ambulating to the playroom d. Passive range of motion exercises

ANS: D Passive range of motion exercises should never be part of an exercise regimen after an acute episode because the joint capsule could easily be stretched and bleeding could recur. Active range of motion exercises are best so that the patient can gauge his or her own pain tolerance. The child can ambulate to the playroom or the cafeteria.

What is the role of the peer group in the life of school-age children? a. Gives them an opportunity to learn dominance and hostility b. Allows them to remain dependent on their parents for a longer time c. Decreases their need to learn appropriate sex roles d. Provides them with security as they gain independence from their parents

ANS: D Peer-group identification is an important factor in gaining independence from parents.

The nurse is caring for a child with severe head trauma after a car accident. What is an ominous sign that often precedes death? a. Delirium b. Papilledema c. Flexion posturing d. Periodic or irregular breathing

ANS: D Periodic or irregular breathing is an ominous sign of brainstem (especially medullary) dysfunction that often precedes complete apnea. Delirium is a state of mental confusion and excitement marked by disorientation for time and place. Papilledema is edema and inflammation of the optic nerve. It is commonly a sign of increased intracranial pressure. Flexion posturing is seen with severe dysfunction of the cerebral cortex or of the corticospinal tracts above the brainstem.

The nurse is caring for a child with severe head trauma after a car accident. Which is an ominous sign that often precedes death? a. Papilledema b. Delirium c. Doll's head maneuver d. Periodic and irregular breathing

ANS: D Periodic or irregular breathing is an ominous sign of brainstem (especially medullary) dysfunction that often precedes complete apnea. Papilledema is edema and inflammation of optic nerve. It is commonly a sign of increased ICP. Delirium is a state of mental confusion and excitement marked by disorientation for time and place. The doll's head maneuver is a test for brainstem or oculomotor nerve dysfunction.

Which of the following is an advantage of peritoneal dialysis? a. Treatments are done in hospitals. b. Protein loss is less extensive. c. Dietary limitations are not necessary. d. Parents and older children can perform treatments.

ANS: D Peritoneal dialysis is the preferred form of dialysis for parents, infants, and children who wish to remain independent. Parents and older children can perform the treatments themselves.

A preschool child has asthma, and a goal is to extend expiratory time and increase expiratory effectiveness. What action should the nurse implement to meet this goal? a. Encourage increased fluid intake. b. Recommend increased use of a budesonide (Pulmicort) inhaler. c. Administer an antitussive to suppress coughing. d. Encourage the child to blow a pinwheel every 6 hours while awake.

ANS: D Play techniques that can be used for younger children to extend their expiratory time and increase expiratory pressure include blowing cotton balls or a ping-pong ball on a table, blowing a pinwheel, blowing bubbles, or preventing a tissue from falling by blowing it against the wall. Increased fluids, increased use of a Pulmicort inhaler, or suppressing a cough will not increase expiratory effectiveness.

Type 1 diabetes mellitus is suspected in an adolescent. Which clinical manifestation may be present? a. Moist skin b. Weight gain c. Fluid overload d. Poor wound healing

ANS: D Poor wound healing may be present in an individual with type 1 diabetes mellitus. Dry skin, weight loss, and dehydration are clinical manifestations of type 1 diabetes mellitus.

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

ANS: D Position the child with the head elevated about 30 degrees and on the right side or abdomen for at least 1 hour. This is in the same manner as after any infant feeding to minimize the possibility of regurgitation and aspiration.

A child will start treatment for central precocious puberty. What synthetic hormone will be injected? a. Thyrotropin b. Gonadotropins c. Somatotropic hormone d. Luteinizing hormone-releasing hormone

ANS: D Precocious puberty of central origin is treated with monthly subcutaneous injections of luteinizing hormone-releasing hormone, which regulates pituitary secretions. Thyrotropin, gonadotropins, and somatotropic hormone are not the appropriate therapies for precocious puberty.

A child will start treatment for precocious puberty. The nurse recognizes that this will involve the injection of which synthetic medication? a. Thyrotropin b. Gonadotropins c. Somatotropic hormone d. Luteinizing hormone-releasing hormone

ANS: D Precocious puberty of central origin is treated with monthly subcutaneous injections of luteinizing hormone-releasing hormone. Thyrotropin, gonadotropins, and somatotropic hormone are not the appropriate therapies for precocious puberty.

José is a 4-year-old child scheduled for a cardiac catheterization. Preoperative teaching should be: a. directed at his parents because he is too young to understand. b. detailed in regard to the actual procedures so he will know what to expect. c. done several days before the procedure so that he will be prepared. d. adapted to his level of development so that he can understand.

ANS: D Preoperative teaching should always be directed at the child's stage of development. The caregivers also benefit from the same explanations. The parents may ask additional questions, which should be answered, but the child needs to receive the information based on developmental level. Preschoolers will not understand in-depth descriptions and should be prepared close to the time of the cardiac catheterization.

Which is an appropriate nursing intervention when caring for an infant with an upper respiratory tract infection and elevated temperature? a. Give tepid water baths to reduce fever. b. Encourage food intake to maintain caloric needs. c. Have child wear heavy clothing to prevent chilling. d. Give small amounts of favorite fluids frequently to prevent dehydration.

ANS: D Preventing dehydration by small frequent feedings is an important intervention in the febrile child. Tepid water baths may induce shivering, which raises temperature. Food should not be forced; it may result in the child vomiting. The febrile child should be dressed in light, loose clothing.

The nurse is preparing a community outreach program about the prevention of iron-deficiency anemia in infants. What statement should the nurse include in the program? a. Whole milk can be introduced into the infant's diet in small amounts at 6 months. b. Iron supplements cannot be given until the infant is older than 1 year of age. c. Iron-fortified cereal should be introduced to the infant at 2 months of age. d. Breast milk or iron-fortified formula should be used for the first 12 months.

ANS: D Prevention, the primary goal in iron-deficiency anemia, is achieved through optimal nutrition and appropriate iron supplements. The American Academy of Pediatrics recommends feeding an infant only breast milk or iron-fortified formula for the first 12 months of life. Whole cow's milk should not be introduced until after 12 months, iron supplements can be given during the first year of life, and iron-fortified cereals should not be introduced until the infant is 4 to 6 months old.

Congenital defects of the genitourinary tract, such as hypospadias, are usually repaired as early as possible to accomplish what? a. Minimize separation anxiety. b. Prevent urinary complications. c. Increase acceptance of hospitalization. d. Promote development of normal body image.

ANS: D Promoting development of normal body image is extremely important. Surgery involving sexual organs can be upsetting to children, especially preschoolers, who fear mutilation and castration. Proper preprocedure preparation can facilitate coping with these issues. Preventing urinary complications is important for defects that affect function, but for all external defects, repair should be done as soon as possible.

An 8-year-old child is hospitalized with infectious polyneuritis (Guillain-Barré syndrome [GBS]). When explaining this disease process to the parents, what should the nurse consider? a. Paralysis is progressive with little hope for recovery. b. Disease is inherited as an autosomal, sex-linked, recessive gene. c. Disease results from an apparently toxic reaction to certain medications. d. Muscle strength slowly returns, and most children recover.

ANS: D Recovery usually begins within 2 to 3 weeks, and most patients regain full muscle strength. The paralysis is progressive with proximal muscle weakness occurring before distal weakness. The recovery of muscle strength occurs in the reverse order of onset of paralysis. Most individuals regain full muscle strength. Better outcomes are associated with younger ages. GBS is an immune-mediated disease often associated with a number of viral or bacterial infections or the administration of vaccines.

Which of the following terms refers to the return of undigested food from the stomach, usually accompanied by burping? a. Spitting up b. Vomiting c. Rumination d. Regurgitation

ANS: D Regurgitation is the return of undigested food from the stomach, usually accompanied by burping.

What finding is the most reliable guide to the adequacy of fluid replacement for a small child with burns? a. Absence of thirst b. Falling hematocrit c. Increased seepage from burn wound d. Urinary output of 1 to 2 ml/kg of body weight/hr

ANS: D Replacement fluid therapy is delivered to provide a urinary output of 30 ml/hr in older children or 1 to 2 ml/kg of body weight/hr for children weighing less than 30 kg (66 lb). Thirst is the result of a complex set of interactions and is not a reliable indicator of hydration. Thirst occurs late in dehydration. A falling hematocrit would be indicative of hemodilution. This may reflect fluid shifts and may not accurately represent fluid replacement therapy. Increased seepage from a burn wound would be indicative of increased output, not adequate hydration.

Which of the following is a common childhood communicable disease that may cause severe defects in the fetus when it occurs in its congenital form? a. Erythema infectiosum b. Roseola c. Rubeola d. Rubella

ANS: D Rubella causes teratogenic effects on the fetus.

Which is the most common causative agent of bacterial endocarditis? a. Staphylococcus albus b. Streptococcus hemolyticus c. Staphylococcus albicans d. Streptococcus viridans

ANS: D S. viridans is the most common causative agent in bacterial (infective) endocarditis. Staphylococcus albus, Streptococcus hemolyticus, and Staphylococcus albicans are not common causative agents.

What condition is an inherited immunodeficiency disorder characterized by absence of both humoral and cell-mediated immunity? a. Fanconi syndrome b. Wiskott-Aldrich syndrome c. Acquired immunodeficiency syndrome (AIDS) d. Severe combined immunodeficiency syndrome (SCIDS)

ANS: D SCIDS is a genetic disorder that results in deficits of both humoral and cellular immunity. Fanconi syndrome is a hereditary disorder of red blood cell production. Wiskott-Aldrich syndrome is an X-linked recessive disorder with selected deficiencies of T and B lymphocytes. AIDS is not inherited.

Secondary prevention for cognitive impairment includes what activity? a. Genetic counseling b. Avoidance of prenatal rubella infection c. Preschool education and counseling services d. Newborn screening for treatable inborn errors of metabolism

ANS: D Secondary prevention involves activities that are designed to identify the condition early and initiate treatment to avert cerebral damage. Inborn errors of metabolism such as hypothyroidism, phenylketonuria, and galactosemia can cause cognitive impairment. Genetic counseling and avoidance of prenatal rubella infections are examples of primary prevention strategies to preclude the occurrence of disorders that can cause cognitive impairment. Preschool education and counseling services are examples of tertiary prevention. These are designed to include early identification of conditions and provision of appropriate therapies and rehabilitation services.

An adolescent girl calls the nurse at the clinic because she had unprotected sex the night before and does not want to be pregnant. The nurse should explain that: a. it is too late to prevent an unwanted pregnancy. b. an abortion may be the best option if she is pregnant. c. Norplant can be administered to prevent pregnancy for up to 5 years. d. postcoital contraception is available to prevent implantation and therefore pregnancy.

ANS: D Several emergency methods of contraception are available.

Which drug is usually given first in the emergency treatment of an acute, severe asthma episode in a young child? a. Ephedrine b. Theophylline c. Aminophylline d. Short-acting 2 agonists

ANS: D Short-acting 2 agonists are the first treatment in an acute asthma exacerbation. Ephedrine is not helpful in acute asthma exacerbations. Theophylline is unnecessary for treating asthma exacerbations. Aminophylline is not helpful for acute asthma exacerbation.

What drug is usually given first in the emergency treatment of an acute, severe asthma episode in a young child? a. Ephedrine b. Theophylline c. Aminophylline d. Short-acting 2-agonists

ANS: D Short-acting 2-agonists are the first treatment in an acute asthma exacerbation. Ephedrine and aminophylline are not helpful in acute asthma exacerbations. Theophylline is unnecessary for treating asthma exacerbations.

Parents ask for help for their other children to cope with the changes in the family resulting from the special needs of their sibling. What strategy does the nurse recommend? a. Explain to the siblings that embarrassment is unhealthy. b. Encourage the parents not to expect siblings to help them care for the child with special needs. c. Provide information to the siblings about the child's condition only as requested. d. Invite the siblings to attend meetings to develop plans for the child with special needs.

ANS: D Siblings should be invited to attend meeting to be part of the care team for the child. They can learn about an individualized education plan and help design strategies that will work at home. Embarrassment may be associated with having a sibling with a chronic illness or disability. Parents must be able to respond in an appropriate manner without punishing the sibling. The parents may need assistance with the care of the child. Most siblings are positive about the extra responsibilities. Parents need to inform the siblings about the child's condition before a nonfamily member does so. The parents do not want the siblings to fantasize about what is wrong with the child.

Which of the following is a common side effect of corticosteroid therapy? a. Fever b. Hypertension c. Weight loss d. Increased appetite

ANS: D Side effects of corticosteroid therapy include an increased appetite.

Several complications can occur when a child receives a blood transfusion. Which is an immediate sign or symptom of an air embolus? a. Chills and shaking b. Nausea and vomiting c. Irregular heart rate d. Sudden difficulty in breathing

ANS: D Signs of air embolism are sudden difficulty breathing, sharp pain in the chest, and apprehension. Air emboli should be avoided by carefully flushing all tubing of air before connecting to patient. Chills, shaking, nausea, and vomiting are associated with hemolytic reactions. Irregular heart rate is associated with electrolyte disturbances and hypothermia.

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

ANS: D Small, frequent meals and nutritious snacks should be provided for the child. Favorite foods such as peanut butter and jelly sandwiches, fruit yogurt, cheese, pizza, and macaroni and cheese should be available.

Several nurses tell their nursing supervisor that they want to attend the funeral of a child for whom they had cared. They say they felt especially close to both the child and the family. The supervisor should recognize that attending the funeral serves what purpose? a. It is improper because it increases burnout. b. It is inappropriate because it is unprofessional. c. It is proper because families expect this expression of concern. d. It is appropriate because it can assist in the resolution of personal grief.

ANS: D Some nurses find shared remembrance rituals useful in resolving grief. Attending funeral services can be a supportive act for both the family and the nurse. Burnout is a state of physical, emotional, and mental exhaustion. It results from prolonged involvement with individuals in situations that are emotionally demanding. Attending the funeral of a child can be an effective coping measure. Attending funerals does not detract from the professionalism of care. Although it is important to consider the family's expectations, the act of attending the funeral provides a sense of closure with the family and facilitates the grief process for the nurse.

The nurse is caring for an 8-year-old child with type 1 diabetes. The nurse should teach the child to monitor for which manifestation of hypoglycemia? a. Lethargy b. Thirst c. Nausea and vomiting d. Shaky feeling and dizziness

ANS: D Some of the clinical manifestations of hypoglycemia include shaky feelings; dizziness; difficulty concentrating, speaking, focusing, or coordinating; sweating; and pallor. Lethargy, thirst, and nausea and vomiting are manifestations of hyperglycemia.

What clinical manifestation occurs with hypoglycemia? a. Lethargy b. Confusion c. Nausea and vomiting d. Weakness and dizziness

ANS: D Some of the clinical manifestations of hypoglycemia include weakness; dizziness; difficulty concentrating, speaking, focusing, and coordinating; sweating; and pallor. Lethargy, confusion, and nausea and vomiting are manifestations of hyperglycemia.

Adolescents with bulimia may experience which of the following complications as a result of the frequent vomiting? a. Diarrhea b. Amenorrhea c. Cold intolerance d. Erosion of tooth enamel

ANS: D Some of the signs of bulimia include erosion of tooth enamel, increased dental caries from vomited gastric acid, throat complaints, fluid and electrolyte disturbances, and abdominal complaints from laxative abuse.

What nursing consideration is most important when caring for a child with end-stage renal disease (ESRD)? a. Children with ESRD usually adapt well to minor inconveniences of treatment. b. Children with ESRD require extensive support until they outgrow the condition. c. Multiple stresses are placed on children with ESRD and their families until the illness is cured. d. Multiple stresses are placed on children with ESRD and their families because children's lives are maintained by drugs and artificial means.

ANS: D Stressors on the family are often overwhelming because of the progressive deterioration. The child progresses from renal insufficiency to uremia to dialysis and transplantation, each of which requires intensive therapy and supportive care. The treatment of ESRD is intense and requires multiple examinations, dietary restrictions, and medications. Adherence to the regimen is often difficult for children and families because of the progressive nature of the renal failure. ESRD has an unrelenting course that has no known cure. Children do not outgrow the renal failure.

For minimal change nephrotic syndrome (MCNS), prednisone is effective when what occurs? a. Appetite increases and blood pressure is normal b. Urinary tract infection is gone and edema subsides c. Generalized edema subsides and blood pressure is normal d. Diuresis occurs as urinary protein excretion diminishes

ANS: D Studies suggest that the duration of steroid treatment for the initial episode should be at least 3 months. In most patients, diuresis occurs as the urinary protein excretion diminishes within 7 to 21 days after the initiation of steroid therapy. The blood pressure is normal with MCNS, so remaining so is not an improvement. There is no urinary tract infection with MCNS.

A young adolescent experiences infrequent migraine episodes. What pharmacologic intervention is most likely to be prescribed? a. Opioid b. Lorazepam c. Ergotamine d. Sumatriptan

ANS: D Sumatriptan is a serotonin agonist at specific vascular serotonin receptor sites and causes vasoconstriction in large intracranial arteries. Opioids are used infrequently because they rarely work on the mechanism of pain. Lorazepam is a benzodiazepine that acts as an anxiolytic and sedative. It is not indicated for treatment of migraine episodes. Ergotamine, an -adrenergic blocker, is used for adult vascular headaches, but it is not used in adolescents because of the side effects.

Parents are considering treatment options for their 5-year-old child with Legg-Calvé-Perthes disease. Both surgical and conservative therapies are appropriate. They are able to verbalize the differences between the therapies when they make what statement? a. "All therapies require extended periods of bed rest." b. "Conservative therapy will be required until puberty." c. "Our child cannot attend school during the treatment phase." d. "Surgical correction requires a 3- to 4-month recovery period."

ANS: D Surgical correction involves additional risks of anesthesia, infection, and possibly blood transfusion. The recovery period is only 3 to 4 months rather than the 2 to 4 years of conservative therapies. The use of non-weight-bearing appliances and surgical intervention does not require prolonged bed rest. Conservative therapy is indicated for 2 to 4 years. The child is encouraged to attend school and engage in activities that can be adapted to therapeutic appliances.

Which of the following symptoms would the nurse expect to observe during the physical assessment of an adolescent girl with severe weight loss and disrupted metabolism associated with anorexia nervosa? a. Dysmenorrhea and oliguria b. Tachycardia and tachypnea c. Heat intolerance and increased blood pressure d. Lowered body temperature and brittle nails

ANS: D Symptoms of anorexia nervosa include lower body temperature, severe weight loss, decreased blood pressure, dry skin, brittle nails, altered metabolic activity, and presence of lanugo hair.

An infant has been diagnosed with bladder obstruction. What do symptoms of this disorder include? a. Renal colic b. Strong urinary stream c. Urinary tract infections d. Posturination dribbling

ANS: D Symptoms of bladder obstruction include poor force of urinary stream, intermittency of voided stream, feelings of incomplete bladder emptying, and posturination dribbling. They may also include urinary frequency, nocturia, nocturnal enuresis, and urgency. Renal colic is a symptom of upper urinary tract obstruction. Children with bladder obstruction have a weak urinary stream. Urinary tract infections are not associated with bladder obstruction.

A child eats some sugar cubes after experiencing symptoms of hypoglycemia. This rapid-releasing sugar should be followed by: a. fat. b. fruit juice. c. several glasses of water. d. complex carbohydrate and protein.

ANS: D Symptoms of hypoglycemia are treated with a rapid-releasing sugar source followed by a complex carbohydrate and protein. Fat, fruit juice, and several glasses of water do not provide the child with complex carbohydrate and protein necessary to stabilize the blood glucose.

A child eats some sugar cubes after experiencing symptoms of hypoglycemia. This rapid-releasing sugar should be followed by which dietary intervention? a. Sports drink and fruit b. Glucose tabs and protein c. Glass of water and crackers d. Milk and peanut butter on bread

ANS: D Symptoms of hypoglycemia are treated with a rapid-releasing sugar source followed by a complex carbohydrate and protein. Milk supplies lactose and a more prolonged action from the protein. The bread is a complex carbohydrate, which with the peanut butter provides a sustained action. The sports drink contains primarily simple carbohydrates. The fruit contains additional carbohydrates. A protein source is needed for sustained action. The glucose tabs are simple carbohydrates. Complex carbohydrates are needed with the protein. Crackers are a complex carbohydrate, but protein is needed to stabilize the blood sugar.

Therapeutic management of a child with tetanus includes the administration of: a. nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation. b. muscle stimulants to counteract muscle weakness. c. bronchodilators to prevent respiratory complications. d. tetanus immunoglobulin therapy.

ANS: D Tetanus immunoglobulin therapy, to neutralize toxins, is the most specific therapy for tetanus. Tetanus toxin acts at the myoneural junction to produce muscular stiffness and lowers the threshold for reflex excitability. NSAIDs are not routinely used. Sedatives or muscle relaxants are used to help reduce titanic spasm and prevent seizures. Respiratory status is carefully evaluated for any signs of distress because muscle relaxants, opioids, and sedatives that may be prescribed may cause respiratory depression. Bronchodilators would not be used unless specifically indicated.

The nurse is performing a Glasgow Coma Scale on a school-age child with a head injury. The child opens eyes spontaneously, obeys commands, and is oriented to person, time, and place. Which is the score the nurse should record? a. 8 b. 11 c. 13 d. 15

ANS: D The Glasgow Coma Scale (GCS) consists of a three-part assessment: eye opening, verbal response, and motor response. Numeric values of 1 through 5 are assigned to the levels of response in each category. The sum of these numeric values provides an objective measure of the patient's level of consciousness (LOC). A person with an unaltered LOC would score the highest, 15. The child who opens eyes spontaneously, obeys commands, and is oriented is scored at a 15.

A nurse is calculating the correlation of Pao2 with Sao2 according to the oxyhemoglobin dissociation curve. What parameter should indicate that the Pao2 is less than 50 to 60 mm Hg? a. Coarse lung sounds b. Temperature of 100° F c. Respiratory rate of 58 d. Pulse oximetry reading of 90% or less

ANS: D The Pao2 can be correlated with the Sao2 by means of the oxyhemoglobin dissociation curve, although changes in Pao2 do not cause identical (linear) changes in Sao2. The curve represents the relationship between Pao2 (measured in the blood) and Sao2 (measured by the pulse oximeter). When the Pao2 is 60?9?mm?9?Hg, the Sao2 is 90%. The oxyhemoglobin dissociation curve does not correlate with lung sounds, temperature, or respiratory rate.

The nurse is discussing with a child and family the various sites used for insulin injections. What site usually has the fastest rate of absorption? a. Arm b. Leg c. Buttock d. Abdomen

ANS: D The abdomen has the fastest rate of absorption but the shortest duration. The arm has a fast rate of absorption but a short duration. The leg has a slow rate of absorption but a long duration. The buttock has the slowest rate of absorption and the longest duration.

The nurse is discussing with a child and family the various sites used for insulin injections. Which site usually has the fastest rate of absorption? a. Arm b. Leg c. Buttock d. Abdomen

ANS: D The abdomen has the fastest rate of absorption but the shortest duration. The arm has a fast rate of absorption but short duration. The leg has a slow rate of absorption but a long duration. The buttock has the slowest rate of absorption and the longest duration.

A school-age child with cystic fibrosis takes four enzyme capsules with meals. The child is having four or five bowel movements per day. The nurse's action in regard to the pancreatic enzymes is based on the knowledge that the dosage is what? a. Adequate b. Adequate but should be taken between meals c. Needs to be increased to increase the number of bowel movements per day d. Needs to be increased to decrease the number of bowel movements per day

ANS: D The amount of enzyme is adjusted to achieve normal growth and a decrease in the number of stools to one or two per day.

A child with acetaminophen (Tylenol) poisoning has been admitted to the emergency department. What antidote does the nurse anticipate being prescribed? a. Carnitine (Carnitor) b. Fomepizole (Antizol) c. Deferoxamine (Desferal) d. N-acetylcysteine (Mucomyst)

ANS: D The antidote for acetaminophen (Tylenol) poisoning is N-acetylcysteine (Mucomyst). Carnitine (Carnitor) is an antidote for valproic acid (Depakote), fomepizole (Antizol) is the antidote for methanol poisoning, and deferoxamine (Desferal) is the antidote for iron poisoning.

A 6-year-old child is admitted to the pediatric unit and requires bed rest. Having art supplies available meets which purpose? a. Allows the child to create gifts for parents b. Provides developmentally appropriate activities c. Is essential for play therapy so the child can work on past problems d. Lets the child express thoughts and feelings through pictures rather than words

ANS: D The art supplies allow the child to draw images that come into the mind. This can help the child develop symbols and then verbalize reactions to illness and hospitalization. The child can make gifts and drawings for parents, but the goal is to allow expression of feelings. Although art is developmentally and situationally appropriate, the child benefits by being able to express feelings nonverbally. The art supplies are not therapeutic play but a mechanism for expressive play. The child will not work on past problems.

Homeostasis in the body is maintained by what is collectively known as the neuroendocrine system. What is the name of the nervous system that is involved? a. Central b. Skeletal c. Peripheral d. Autonomic

ANS: D The autonomic nervous system (composed of the sympathetic and parasympathetic systems) controls involuntary functions. In combination with the endocrine system, it maintains homeostasis. The central, skeletal, and peripheral subdivisions of the nervous system are not part of the neuroendocrine system.

A child with hemophilia A will have which abnormal laboratory result? a. PT (ProTime) b. Platelet count c. Fibrinogen level d. PTT (partial thromboplastin time)

ANS: D The basic defect of hemophilia A is a deficiency of factor VIII. The partial thromboplastin time measures abnormalities in the intrinsic pathway (abnormalities in factors I, II, V, VIII, IX, X, XII, HMK, and KAL). The prothrombin time measures abnormalities of the extrinsic pathway (abnormalities in factors I, II, V, VII, and X). Fibrinogen level is not dependent on the intrinsic pathway. Platelets are not affected with hemophilia A.

What statement best represents infectious mononucleosis? a. Herpes simplex type 2 is the principal cause. b. A complete blood count shows a characteristic leukopenia. c. A short course of ampicillin is used when pharyngitis is present. d. Clinical signs and symptoms and blood tests are both needed to establish the diagnosis.

ANS: D The characteristics of the disease—malaise, sore throat, lymphadenopathy, central nervous system manifestations, and skin lesions—are similar to presenting signs and symptoms in other diseases. Hematologic analysis (heterophil antibody and monospot) can help confirm the diagnosis. However, not all young children develop the expected laboratory findings. Herpes-like Epstein-Barr virus is the principal cause. Usually, an increase in lymphocytes is observed. Penicillin, not ampicillin, is indicated. Ampicillin is linked with a discrete macular eruption in infectious mononucleosis.

A 7-year-old child is in the end stages of cancer. The parents ask you how they will know when death is imminent. What physical sign is indicative of approaching death? a. Hunger b. Tachycardia c. Increased thirst d. Difficulty swallowing

ANS: D The child begins to have difficulty swallowing as he or she approaches death. The child's appetite will decrease, and he or she will take only small bites of favorite foods or sips of fluids in the final few days. The pulse rate will slow.

A 6-year-old child is in the hospital for status asthmaticus. Nursing care during this acute period includes which prescribed interventions? a. Prednisolone (Pediapred) PO every day, IV fluids, cromolyn (Intal) inhaler bid b. Salmeterol (Serevent) PO bid, vital signs every 4 hours, spot check pulse oximetry c. Triamcinolone (Azmacort) inhaler bid, continuous pulse oximetry, vital signs once a shift d. Methylprednisolone (Solumedrol) IV every 12 hours, continuous pulse oximetry, albuterol nebulizer treatments every 4 hours and prn

ANS: D The child in status asthmaticus should be placed on continuous cardiorespiratory (including blood pressure) and pulse oximetry monitoring. A systemic corticosteroid (oral, IV, or IM) may also be given to decrease the effects of inflammation. Inhaled aerosolized short-acting 2-agonists are recommended for all patients. Therefore, Solumedrol per IV, continuous pulse oximetry, and albuterol nebulizer treatments are the expected prescribed treatments. Oral medications would not be used during the acute stage of status asthmaticus. Vital signs once a shift and spot pulse oximetry checks would not be often enough.

The nurse approaches a group of school-age patients to administer medication to Sam Hart. To identify the correct child, the nurse should do which of the following? a. Ask the group, "Who is Sam Hart?" b. Call out to the group, "Sam Hart?" c. Ask each child, "What's your name?" d. Check the patient's identification name band.

ANS: D The child must be correctly identified before the administration of any medication. Children are not totally reliable in giving correct names on request; identification bracelet should always be checked.

When only one child is abused in a family, the abuse is usually a result of what? a. The child is the firstborn. b. The child is the same gender as the abusing parent. c. The parent abuses the child to avoid showing favoritism. d. The parent is unable to deal with the child's behavioral style.

ANS: D The child unintentionally contributes to the abuse. The "fit" or compatibility between the child's temperament and the parent's ability to deal with that behavior style is an important predictor. Birth order and gender can contribute to abuse, but there is not a specific birth order or gender relationship that is indicative of abuse. Being the firstborn or the same gender as the abuser is not linked to child abuse. Avoidance of favoritism is not usually a cause of abuse.

A nurse is evaluating the effectiveness of teaching regarding care of a child with minimal change nephrotic syndrome (MCNS) that is in remission after administration of prednisone. The nurse realizes further teaching is required if the parents state what? a. "We will keep our child away from anyone who is ill." b. "We will be sure to administer the prednisone as ordered." c. "We will encourage our child to eat a balanced diet, but we will watch his salt intake." d. "We understand our child will not be able to attend school, so we will arrange for home schooling."

ANS: D The child with MCNS in remission can attend school. The child needs socialization and will be socially isolated if home schooled. The other statements are accurate for home care for a child with MCNS.

Which explanation regarding cardiac catheterization is appropriate for a preschool child? a. Postural drainage will be performed every 4 to 6 hours after the test. b. It is necessary to be completely "asleep" during the test. c. The test is short, usually taking less than 1 hour. d. When the procedure is done, you will have to keep your leg straight for at least 4 hours.

ANS: D The child's leg will have to be maintained in a straight position for approximately 4 hours. Younger children can be held in the parent's lap with the leg maintained in the correct position. Postural drainage will not be performed unless the child has corresponding pulmonary problems. The child should be sedated to lie still, but being completely asleep is not necessary. The test will vary in length of time from start to finish.

Many of the clinical features of Down syndrome present challenges to caregivers. Based on these features, what intervention should be included in the child's care? a. Delay feeding solid foods until the tongue thrust has stopped. b. Modify the diet as necessary to minimize the diarrhea that often occurs. c. Provide calories appropriate to the child's mental age. d. Use a cool-mist vaporizer to keep the mucous membranes moist and secretions liquefied.

ANS: D The constant stuffy nose forces the child to breathe by mouth, drying the mucous membranes and increasing the susceptibility to upper respiratory tract infections. A cool-mist vaporizer will keep the mucous membranes moist and liquefy secretions. Respiratory tract infections combined with cardiac anomalies are the primary cause of death in the first years. The child has a protruding tongue, which makes feeding difficult. The parents must persist with feeding while the child continues the physiologic response of the tongue thrust. The child is predisposed to constipation. Calories should be appropriate to the child's weight and growth needs, not mental age.

Myelosuppression, associated with chemotherapeutic agents or some malignancies such as leukemia, can cause bleeding tendencies because of a(n): a. decrease in leukocytes. b. increase in lymphocytes. c. vitamin C deficiency. d. decrease in blood platelets.

ANS: D The decrease in blood platelets secondary to the myelosuppression of chemotherapy can cause an increase in bleeding. The child and family should be alerted to avoid risk of injury. Decrease in leukocytes, increase in lymphocytes, and vitamin C deficiency would not affect bleeding tendencies.

What is an important consideration in the diagnosis of attention deficit hyperactivity disorder (ADHD)? a. Learning disabilities are apparent at an early age. b. The child will always be distracted by external stimuli. c. Parental observations of the child's behavior are most relevant. d. It must be determined whether the child's behavior is age appropriate or problematic.

ANS: D The diagnosis of ADHD is complex. A multidisciplinary evaluation should be done to determine whether the child's behavior is appropriate for the developmental age or whether it is problematic. Learning disabilities are usually not evident until the child enters school. Each child with ADHD responds differently to stimuli. Some children are distracted by internal stimuli and others by external stimuli. Parents can only provide one viewpoint of the child's behavior. Many observers should be asked to provide input with structured tools to facilitate the diagnosis.

The diagnosis of hypertension depends on accurate assessment of blood pressure (BP). What is the appropriate technique to measure a child's BP? a. Assess BP while the child is standing. b. Compare left arm with left leg BP readings. c. Use a narrow cuff to ensure that the readings are correct. d. Measure BP with the child in the sitting position on three separate occasions.

ANS: D The diagnosis of hypertension is made after the BP is elevated on three separate occasions. Take the BP in a quiet area with the appropriate size cuff and the child sitting. Although left arm and left leg BP readings may be compared, it is not the procedure to diagnose hypertension. The appropriate size cuff is indicated. The most common cause of inaccurate readings is the use of a cuff that is too small.

Surgical closure of the ductus arteriosus would: a. stop the loss of unoxygenated blood to the systemic circulation. b. decrease the edema in legs and feet. c. increase the oxygenation of blood. d. prevent the return of oxygenated blood to the lungs.

ANS: D The ductus arteriosus allows blood to flow from the higher-pressure aorta to the lower-pressure pulmonary artery, causing a right-to-left shunt. If this is surgically closed, no additional oxygenated blood (from the aorta) will return to the lungs through the pulmonary artery. The aorta carries oxygenated blood to the systemic circulation. Because of the higher pressure in the aorta, blood is shunted into the pulmonary artery and the pulmonary circulation. Edema in the legs and feet is usually a sign of heart failure. This repair would not directly affect the edema. Increasing the oxygenation of blood would not interfere with the return of oxygenated blood to the lungs.

Anorexia nervosa may best be described as which of the following? a. Occurs most frequently in adolescent males b. Occurs most frequently in adolescents from lower socioeconomic groups c. Results from a posterior pituitary disorder d. Results in severe weight loss in the absence of obvious physical causes

ANS: D The etiology of anorexia remains unclear, but a distinct psychologic component is present. The diagnosis is based primarily on psychologic and behavioral criteria.

An adolescent asks the nurse what causes primary dysmenorrhea. The nurse's response should be based on which of the following? a. It is an inherited problem. b. Excessive estrogen production causes uterine pain. c. There is no physiologic cause; it is a psychologic reaction. d. There is a relation between prostaglandins and uterine contractility.

ANS: D The exact etiology of primary dysmenorrhea is debated. Overproduction of uterine prostaglandins has been implicated, as has overproduction of vasopressin.

The nurse is doing a prehospitalization orientation for a girl, age 7 years, who is scheduled for cardiac surgery. As part of the preparation, the nurse explains that after the surgery, the child will be in the intensive care unit. How might the explanation by the nurse be viewed? a. Unnecessary b. The surgeon's responsibility c. Too stressful for a young child d. An appropriate part of the child's preparation

ANS: D The explanation is a necessary part of preoperative preparation and will help reduce the anxiety associated with surgery. If the child wakes in the intensive care unit and is not prepared for the environment, she will be even more anxious. This is a joint responsibility of nursing, medical staff, and child life personnel.

A 4-year-old child is newly diagnosed with Legg-Calvé-Perthes disease. Nursing considerations should include which action? a. Encouraging normal activity for as long as is possible b. Explaining the cause of the disease to the child and family c. Preparing the child and family for long-term, permanent disabilities d. Teaching the family the care and management of the corrective appliance

ANS: D The family needs to learn the purpose, function, application, and care of the corrective device and the importance of compliance to achieve the desired outcome. The initial therapy is rest and non-weight bearing, which helps reduce inflammation and restore motion. Legg-Calvé-Perthes is a disease with an unknown etiology. A disturbance of circulation to the femoral capital epiphysis produces an ischemic aseptic necrosis of the femoral head. The disease is self-limiting, but the ultimate outcome of therapy depends on early and efficient therapy and the child's age at onset.

A 3-month-old infant has a hypercyanotic spell. What should be the nurse's first action? a. Assess for neurologic defects. b. Prepare the family for imminent death. c. Begin cardiopulmonary resuscitation. d. Place the child in the knee-chest position.

ANS: D The first action is to place the infant in the knee-chest position. Blow-by oxygen may be indicated. Neurologic defects are unlikely. Preparing the family for imminent death or beginning cardiopulmonary resuscitation should be unnecessary. The child is assessed for airway, breathing, and circulation. Often, calming the child and administering oxygen and morphine can alleviate the hypercyanotic spell.

A parent asks the nurse what would be the first indication that acute glomerulonephritis was improving. What would be the nurse's best response? a. Blood pressure will stabilize. b. Your child will have more energy. c. Urine will be free of protein. d. Urine output will increase.

ANS: D The first sign of improvement in acute glomerulonephritis is an increase in urinary output with a corresponding decrease in body weight. With diuresis, the child begins to feel better, the appetite improves, and the blood pressure decreases to normal with the reduction of edema. Gross hematuria diminishes, in part because of dilution of the red blood cells in the more dilute urine. Renal function and hypocomplementemia usually normalize by 8 weeks.

An older school-age child asks the nurse, "What is the reason for this topical corticosteroid cream?" What rationale should the nurse give? a. The cream is used for an antifungal effect. b. The cream is used for an analgesic effect. c. The cream is used for an antibacterial effect. d. The cream is used for an anti-inflammatory effect.

ANS: D The glucocorticoids are the therapeutic agents used most widely for skin disorders. Their local anti-inflammatory effects are merely palliative, so the medication must be applied until the disease state undergoes a remission or the causative agent is eliminated. It does not have an antifungal, analgesic, or antibacterial effect.

What therapeutic intervention is most appropriate for a child with -thalassemia major? a. Oxygen therapy b. Supplemental iron c. Adequate hydration d. Frequent blood transfusions

ANS: D The goal of medical management is to maintain sufficient hemoglobin (>9.5 g/dl) to prevent bone marrow expansion. This is achieved through a long-term transfusion program. Oxygen therapy and adequate hydration are not beneficial in the overall management of thalassemia. The child does not require supplemental iron. Iron overload is a problem because of frequent blood transfusions, decreased production of hemoglobin, and increased absorption from the gastrointestinal tract.

What is a major goal of therapy for children with cerebral palsy (CP)? a. Cure the underlying defect causing the disorder. b. Reverse the degenerative processes that have occurred. c. Prevent the spread to individuals in close contact with the child. d. Recognize the disorder early and promote optimum development.

ANS: D The goals of therapy include early recognition and promotion of an optimum developmental course to enable affected children to attain their potential within the limits of their dysfunction. The disorder is permanent, and therapy is chiefly symptomatic and preventive. It is not possible at this time to reverse the degenerative processes. CP is not contagious.

The mother of a toddler yells to the nurse, "Help! He is choking to death on his food!" The nurse determines that lifesaving measures are necessary based on which finding? a. Gagging b. Coughing c. Pulse over 100 beats/min d. Inability to speak

ANS: D The inability to speak is indicative of a foreign body airway obstruction of the larynx. Abdominal thrusts are needed for treatment of the choking child. Gagging, not obstruction, indicates irritation at the back of the throat. Coughing does not indicate a complete airway obstruction. Tachycardia may be present for many reasons.

The mother of a toddler yells to the nurse, "Help! He is choking to death on his food." The nurse determines that lifesaving measures are necessary based on which symptom? a. Gagging b. Coughing c. Pulse over 100 beats/min d. Inability to speak

ANS: D The inability to speak is indicative of a foreign-body airway obstruction of the larynx. Abdominal thrusts are needed for treatment of the choking child. Gagging indicates irritation at the back of the throat, not obstruction. Coughing does not indicate a complete airway obstruction. Tachycardia may be present for many reasons.

What is a systemic response to severe burns in a child? a. Metabolic alkalosis b. Decreased metabolic rate c. Increased renal plasma flow d. Abrupt drop in cardiac output

ANS: D The initial physiologic response to a burn injury is a dramatic change in circulation. A precipitous drop in cardiac output precedes any change in circulating blood or plasma volumes. A circulating myocardial depressant factor associated with severe burn injury is thought to be the cause. Metabolic acidosis usually occurs secondary to the disruption of the body's buffering action resulting from fluid shifting to extravascular space. There is a greatly accelerated metabolic rate in burn patients, supported by protein and lipid breakdown. With the loss of circulating volume, there is decreased renal blood flow and depressed glomerular filtration.

The school nurse is reviewing the process of wound healing. What is the initial response at the site of injury? a. Contraction b. Maturation c. Fibroplasia d. Inflammation

ANS: D The initial response at the site of injury is inflammation, a vascular and cellular response that prepares the tissues for the subsequent repair process. Fibroplasia (granulation or proliferation), the second phase of healing, lasts from 5 days to 4 weeks. During contraction and maturation, the third and fourth phases of wound healing, collagen continues to be deposited and organized into layers, compressing the new blood vessels and gradually stopping blood flow across the wound.

The nurse is conducting teaching to parents of a 7-year-old child who fractured an arm and is being discharged with a cast. Which instruction should be included in the teaching? a. Swelling of the fingers is to be expected for the next 48 hours. b. Immobilize the shoulder to decrease pain in the arm. c. Allow the affected limb to hang down for 1 hour each day. d. Elevate casted arm when resting and when sitting up.

ANS: D The injured extremity should be kept elevated while resting and in a sling when upright. This will increase venous return. Swelling of the fingers may indicate neurovascular damage and should be reported immediately. Permanent damage can occur within 6 to 8 hours. Joints above and below the cast on the affected extremity should be moved. The affected limb should not hang down for any length of time.

The nurse is instructing student nurses about the stress of hospitalization for children from middle infancy throughout the preschool years. What major stress should the nurse relate to the students? a. Pain b. Bodily injury c. Loss of control d. Separation anxiety

ANS: D The major stress from middle infancy throughout the preschool years, especially for children ages 6 to 30 months, is separation anxiety.

A mother calls the outpatient clinic requesting information on appropriate dosing for over-the-counter medications for her 13-month-old who has symptoms of an upper respiratory tract infection and fever. The box of acetaminophen says to give 120 mg q4h when needed. At his 12-month visit, the nurse practitioner prescribed 150 mg. The nurse's best response is which of the following? a. "The doses are close enough; it doesn't really matter which one is given." b. "It is not appropriate to use dosages based on age because children have a wide range of weights at different ages." c. "From your description, medications are not necessary. They should be avoided in children at this age." d. "The nurse practitioner ordered the drug based on weight, which is a more accurate way of determining a therapeutic dose."

ANS: D The method most often used to determine children's dosage is based on a specific dose per kilogram of body weight.

Which of the following is the most common cause of acute renal failure in children? a. Pyelonephritis b. Tubular destruction c. Urinary tract obstruction d. Severe dehydration

ANS: D The most common cause of acute renal failure in children is dehydration or other causes of poor perfusion that may respond to restoration of fluid volume.

The nurse is assessing a child who was just admitted to the hospital for observation after a head injury. What clinical manifestation is the most essential part of the nursing assessment to detect early signs of a worsening condition? a. Posturing b. Vital signs c. Focal neurologic signs d. Level of consciousness

ANS: D The most important nursing observation is assessment of the child's level of consciousness. Alterations in consciousness appear earlier in the progression of an injury than do alterations of vital signs or focal neurologic signs. Neurologic posturing is indicative of neurologic damage.

The nurse is assessing a child who was just admitted to the hospital for observation after a head injury. Which is the most essential part of the nursing assessment to detect early signs of a worsening condition? a. Posturing b. Vital signs c. Focal neurologic signs d. Level of consciousness

ANS: D The most important nursing observation is assessment of the child's level of consciousness. Alterations in consciousness appear earlier in the progression of an injury than do alterations of vital signs or focal neurologic signs. Neurologic posturing is indicative of neurologic damage. Vital signs and focal neurologic signs are later signs of progression when compared with level-of-consciousness changes.

Cystic fibrosis (CF) may affect single or multiple systems of the body. What is the primary factor responsible for possible multiple clinical manifestations in CF? a. Hyperactivity of sweat glands b. Hypoactivity of autonomic nervous system c. Atrophic changes in mucosal wall of intestines d. Mechanical obstruction caused by increased viscosity of mucous gland secretions

ANS: D The mucous glands produce a thick mucoprotein that accumulates and results in dilation. Small passages in organs such as the pancreas and bronchioles become obstructed as secretions form concretions in the glands and ducts. The exocrine glands, not sweat glands, are dysfunctional. Although abnormalities in the autonomic nervous system are present, it is not hypoactive. Intestinal involvement in CF results from the thick intestinal secretions, which can lead to blockage and rectal prolapse.

The nurse is preparing to administer a unit of packed red blood cells to a hospitalized child. What is an appropriate action that applies to administering blood? a. Take the vital signs every 15 minutes while blood is infusing. b. Use blood within 1 hour of its arrival from the blood bank. c. Administer the blood with 5% glucose in a piggyback setup. d. Administer the first 50 ml of blood slowly and stay with the child.

ANS: D The nurse should administer the first 50 ml of blood or initial 20% of volume (whichever is smaller) slowly and stay with the child. Vitals signs should be taken 15 minutes after initiation and then every hour, not every 15 minutes. Blood should be used within 30 minutes, not 1 hour. Normal saline, not 5% glucose, should be the IV solution.

The nurse is caring for an intubated infant with botulism in the pediatric intensive care unit. Which health care provider prescriptions should the nurse clarify with the health care provider before implementing? a. Administer 250 mg botulism immune globulin intravenously (BIG-IV) one time. b. Provide total parenteral nutrition (TPN) at 25 ml/hr intravenously. c. Titrate oxygen to keep pulse oximetry saturations greater than 92. d. Administer gentamicin sulfate (Garamycin) 10 mg per intravenous piggyback every 12 hours.

ANS: D The nurse should clarify the administration of an aminoglycoside antibiotic. Antibiotic therapy is not part of the management of infant botulism because the botulinum toxin is an intracellular molecule, and antibiotics would not be effective; aminoglycosides in particular should not be administered because they may potentiate the blocking effects of the neurotoxin. Treatment consists of immediate administration of botulism immune globulin intravenously (BIG-IV) without delaying for laboratory diagnosis. Early administration of BIG-IV neutralizes the toxin and stops the progression of the disease. The human-derived botulism antitoxin (BIG-IV) has been evaluated and is now available nationwide for use only in infant botulism. Approximately 50% of affected infants require intubation and mechanical ventilation; therefore, respiratory support is crucial, as is nutritional support because these infants are unable to feed.

An 8-month-old infant is restrained to prevent interference with the IV infusion. The nurse should do which of the following? a. Remove the restraints once a day to allow movement. b. Keep the restraints on constantly. c. Keep the restraints secure so infant remains supine. d. Remove restraints whenever possible.

ANS: D The nurse should remove the restraints whenever possible. When parents or staff are present, the restraints can be removed and the IV site protected.

The school nurse is caring for a child with a penetrating eye injury. Emergency treatment includes what intervention? a. Place a cool compress on eye during transport to the emergency department. b. Irrigate the eye copiously with a sterile saline solution. c. Remove the object with a lightly moistened gauze pad. d. Apply a Fox shield to the affected eye and any type of patch to the other eye.

ANS: D The nurse's role in a penetrating eye injury is to prevent further injury to the eye. A Fox shield (if available) should be applied to the injured eye and a regular eye patch to the other eye to prevent bilateral movement. Placing cool compress on the eye during transport to emergency department, irrigating eye copiously with a sterile saline solution, or removing object with a lightly moistened gauze pad may cause more damage to the eye.

When caring for a child with an intravenous infusion, the nurse should do which of the following? a. Use a macrodropper to facilitate reaching the prescribed flow rate. b. Avoid restraining the child to prevent undue emotional stress. c. Change the insertion site every 24 hours. d. Observe the insertion site frequently for signs of infiltration.

ANS: D The nursing responsibility for IV therapy is to calculate the amount to be infused in a given length of time; set the infusion rate; and monitor the apparatus frequently (at least every 1 to 2 hours) to make certain that the desired rate is maintained, the integrity of the system remains intact, the site remains intact (free of redness, edema, infiltration, or irritation), and the infusion does not stop.

A child who has just had definitive repair of a high rectal malformation is to be discharged. What should the nurse address in the discharge preparation of this family? a. Safe administration of daily enemas b. Necessity of firm stools to keep suture line clean c. Bowel training beginning as soon as the child returns home d. Changes in stooling patterns to report to the practitioner

ANS: D The parents are taught to notify the practitioner if any signs of an anal stricture or other complications develop. Constipation is avoided because a firm stool will place strain on the suture line. Daily enemas are contraindicated after surgical repair of a rectal malformation. Fiber and stool softeners are often given to keep stools soft and avoid tension on the suture line. The child needs to recover from the surgical procedure. Then bowel training may begin, depending on the child's developmental and physiologic readiness.

The nurse is caring for a 4-year-old child immobilized by a fractured hip. Which complication should the nurse monitor related to the child's immobilization status? a. Metabolic rate increases b. Increased joint mobility leading to contractures c. Bone calcium increases, releasing excess calcium into the body (hypercalcemia) d. Venous stasis leading to thrombi or emboli formation

ANS: D The physiologic effects of immobilization, as a result of decreased muscle contraction, include venous stasis. This can lead to pulmonary emboli or thrombi. The metabolic rate decreases with immobilization. Loss of joint mobility leads to contractures. Bone demineralization with osteoporosis and hypercalcemia occur with immobilization.

Which of the following is the preferred site for intramuscular injections in infants? a. Deltoid b. Dorsogluteal c. Rectus femoris d. Vastus lateralis

ANS: D The preferred site for infants is the vastus lateralis.

The psychosexual conflicts of preschool children make them extremely vulnerable to which threat? a. Loss of control b. Loss of identity c. Separation anxiety d. Bodily injury and pain

ANS: D The psychosexual conflicts of children in this age group make them vulnerable to threats of bodily injury. Intrusive procedures, whether painful or painless, are threatening to preschoolers, whose concept of body integrity is still poorly developed. Loss of control, loss of identity, and separation anxiety are not related to psychosexual conflicts.

A spinal tap must be done on a 9-year-old boy. While he is waiting in the treatment room, the nurse observes that he seems composed. When the nurse asks him if he wants his mother to stay with him, he says, "I am fine." How should the nurse interpret this situation? a. This child is unusually brave. b. He has learned that support does not help. c. Nine-year-old boys do not usually want a parent present during the procedure. d. Children in this age group often do not request support even though they need and want it.

ANS: D The school-age child's visible composure, calmness, and acceptance often mask an inner longing for support. Children of this age have a more passive approach to pain and an indirect request for support. It is especially important to be aware of nonverbal cues such as facial expression, silence, and lack of activity. Usually when someone identifies the unspoken messages, the child will readily accept support.

An 8-year-old girl is receiving a blood transfusion when the nurse notes that she has developed precordial pain, dyspnea, distended neck veins, slight cyanosis, and a dry cough. These manifestations are most suggestive of what complication? a. Air embolism b. Allergic reaction c. Hemolytic reaction d. Circulatory overload

ANS: D The signs of circulatory overload include distended neck veins, hypertension, crackles, a dry cough, cyanosis, and precordial pain. Signs of air embolism are sudden difficulty breathing, sharp pain in the chest, and apprehension. Urticaria, pruritus, flushing, asthmatic wheezing, and laryngeal edema are signs and symptoms of allergic reactions. Hemolytic reactions are characterized by chills, shaking, fever, pain at infusion site, nausea, vomiting, tightness in chest, flank pain, red or black urine, and progressive signs of shock and renal failure.

An 8-year-old girl is receiving a blood transfusion when the nurse notes that she has developed precordial pain, dyspnea, distended neck veins, slight cyanosis, and a dry cough. These manifestations are most suggestive of: a. air emboli. b. allergic reaction. c. hemolytic reaction. d. circulatory overload.

ANS: D The signs of circulatory overload include distended neck veins, hypertension, crackles, dry cough, cyanosis, and precordial pain. Signs of air embolism are sudden difficulty breathing, sharp pain in the chest, and apprehension. Allergic reactions are manifested by urticaria, pruritus, flushing, asthmatic wheezing, and laryngeal edema. Hemolytic reactions are characterized by chills, shaking, fever, pain at infusion site, nausea, vomiting, tightness in chest, flank pain, red or black urine, and progressive signs of shock and renal failure.

The nurse is closely monitoring a child who is unconscious after a fall and notices that the child suddenly has a fixed and dilated pupil. How should the nurse interpret this? a. Eye trauma b. Brain death c. Severe brainstem damage d. Neurosurgical emergency

ANS: D The sudden appearance of a fixed and dilated pupil(s) is a neurosurgical emergency. The nurse should immediately report this finding. Although a dilated pupil may be associated with eye trauma, this child has experienced a neurologic insult. One fixed and dilated pupil is not suggestive of brain death. Pinpoint pupils or fixed, bilateral pupils for more than 5 minutes are indicative of brainstem damage. The unilateral fixed and dilated pupil is suggestive of damage on the same side of the brain.

What is characteristic of children with posttraumatic stress disorder (PTSD)? a. Denial as a defense mechanism is unusual. b. Traumatic effects cannot remain indefinitely. c. Previous coping strategies and defense mechanisms are not useful. d. Children often play out the situation over and over again.

ANS: D The third phase of adjustment to PTSD involves the children playing out the situation over and over to come to terms with their fears. Denial is frequently used as a defense mechanism during the second phase. For some children, traumatic effects can remain indefinitely. Coping is a learned response. During the third stage, the children can be helped to use their coping strategies to deal with their fears.

Which of the following statements is true about gonorrhea? a. It is caused by Treponema pallidum. b. Treatment is by multidose administration of penicillin. c. Treatment is by topical applications to lesions. d. Treatment of all sexual contacts is an essential part of treatment.

ANS: D The treatment plan should include finding and treating all sexual partners.

Which immunization should not be given to a child receiving chemotherapy for cancer? a. Tetanus vaccine b. Inactivated poliovirus vaccine c. Diphtheria, pertussis, tetanus (DPT) d. Measles, rubella, mumps

ANS: D The vaccine used for measles, mumps, and rubella is a live virus and can result in an overwhelming infection. Tetanus vaccine, inactivated poliovirus vaccine, and diphtheria, pertussis, tetanus (DPT) are not live virus vaccines.

The nurse is helping parents achieve a more nutritionally adequate vegetarian diet for their children. Which of the following is most likely lacking in their particular diet? a. Fat b. Protein c. Vitamins C and A d. Complete protein

ANS: D The vegetarian diet can be extremely healthy, meeting the overall nutrition objectives for Healthy People 2010. Parents should be taught about food preparation to ensure that complete proteins are available for growth. When parents use a strict vegetarian diet, likelihood exists of inadequate protein for growth and calories for energy.

Which of the following vitamins is recommended for all women of childbearing age to reduce the risk of neural tube defects such as spina bifida? a. A b. C c. Niacin d. Folic acid

ANS: D The vitamin supplement that is recommended for all women of childbearing age is a daily dose of 0.4 mg of folic acid. Folic acid taken before conception and during pregnancy can reduce the risk of neural tube defects by 70%.

When a child develops latex allergy, which food may also cause an allergic reaction? a. Yeast b. Wheat c. Peanuts d. Bananas

ANS: D There are cross-reactions between allergies to latex and to a number of foods such as bananas, avocados, kiwi, and chestnuts. Although yeast, wheat, and peanuts are potential allergens, currently they are not known to cross-react with latex allergy.

The nurse is talking to a parent with a child who has a latex allergy. Which statement by the parent would indicate a correct understanding of the teaching? a. "My child will have an allergic reaction if he comes in contact with yeast products." b. "My child may have an upset stomach if he eats a food made with wheat or barley." c. "My child will probably develop an allergy to peanuts." d. "My child should not eat bananas or kiwis."

ANS: D There are cross-reactions between latex allergies and a number of foods such as bananas, avocados, kiwi, and chestnuts. Children with a latex allergy will not develop allergies to other food products such as yeast, wheat, barley, or peanuts.

A 4-year-old girl is brought to the emergency department. She has a "froglike" croaking sound on inspiration, is agitated, and is drooling. She insists on sitting upright. The nurse should intervene in which manner? a. Make her lie down and rest quietly. b. Examine her oral pharynx and report to the physician. c. Auscultate her lungs and prepare for placement in a mist tent. d. Notify the physician immediately and be prepared to assist with a tracheostomy or intubation.

ANS: D This child is exhibiting signs of respiratory distress and possible epiglottitis. Epiglottitis is always a medical emergency requiring antibiotics and airway support for treatment. Sitting up is the position that facilitates breathing in respiratory disease. The oral pharynx should not be visualized. If the epiglottis is inflamed, there is the potential for complete obstruction if it is irritated further. Although lung auscultation provides useful assessment information, a mist tent would not be beneficial for this child. Immediate medical evaluation and intervention are indicated.

The father of 12-year-old Ryan tells the nurse that he is concerned about his son getting "fat." Ryan is at the 50th percentile for height and the 75th percentile for weight on the growth chart. The most appropriate nursing action is which of the following? a. Reassure father that Ryan is not fat. b. Reassure father that Ryan is just a growing child. c. Suggest a low-calorie, low-fat diet. d. Explain that this is typical of the growth pattern of boys at this age.

ANS: D This is a characteristic pattern of growth in preadolescent boys, where the growth in height has slowed in preparation for the pubertal growth spurt, but weight is still gained. The nurse should review this with both the father and Ryan and develop a plan to maintain physical exercise and a balanced diet.

The nurse is doing a prehospitalization orientation for Diana, age 7, who is scheduled for cardiac surgery. As part of the preparation, the nurse explains that she will not be able to talk because of an endotracheal tube but that she will be able to talk when it is removed. This explanation is: a. unnecessary. b. the surgeon's responsibility. c. too stressful for a young child. d. an appropriate part of the child's preparation.

ANS: D This is a necessary part of preoperative preparation. If the child wakes and is not prepared for the inability to speak, she will be even more anxious.

The nurse is teaching parents the proper use of a hip-knee-ankle-foot orthosis (HKAFO) for their 4-year-old child. The parents demonstrate basic essential knowledge by making what statement? a. "Alcohol will be used twice a day to clean the skin around the brace." b. "Weekly visits to the orthotist are scheduled to check screws for tightness." c. "Initially, a burning sensation is expected and the brace should remain in place." d. "Condition of the skin in contact with the brace should be checked every 4 hours."

ANS: D This type of brace has several contact points with the child's skin. To minimize the risk of skin breakdown and facilitate use of the brace, vigilant skin monitoring is necessary. Alcohol should not be used on the skin. It is drying. Parents are capable of checking and tightening the screws when necessary. If a burning sensation occurs, the brace should be removed. If several complaints of burning occur, the orthotist should be contacted.

A child with a serious chronic illness will soon go home. The case manager requests that the family provide total care for the child for a couple of days while the child is still hospitalized. How should the request be viewed? a. Improper because of legal issues b. Supportive because families are usually eager to get involved c. Unacceptable because the family will have to assume the care soon enough d. Important because it can be beneficial to the transition from hospital to home

ANS: D This type of groundwork is essential for the family. Adequate family training and preparation will assist in the child's transition home. The nursing staff in the hospital is responsible for the child's care. The family will provide the care with assistance as needed. Although parents are eager to be involved, the purpose of this intervention is the development of family competency and confidence that they are capable. Arrangements for respite care are important for the family both during hospitalizations and while the child is at home.

A 3-year-old is brought to the emergency department with symptoms of stridor, fever, restlessness, and drooling. No coughing is observed. Based on these findings, the nurse should be prepared to assist with what action? a. Throat culture b. Nasal pharynx washing c. Administration of corticosteroids d. Emergency intubation

ANS: D Three clinical observations that are predictive of epiglottitis are absence of spontaneous cough, presence of drooling, and agitation. Nasotracheal intubation or tracheostomy is usually considered for a child with epiglottitis with severe respiratory distress. The throat should not be inspected because airway obstruction can occur, and steroids would not be done first when the child is in severe respiratory distress.

The nurse on a pediatric unit is writing guidelines for age-specific preparation of children for procedures based on developmental characteristics. What guideline is accurate? a. Inform toddlers about an upcoming procedure 2 hours before the procedure is to be performed. b. Inform school-age children about an upcoming procedure immediately before the procedure is scheduled to occur. c. Discourage parent presence during procedures on infants and toddlers. d. Use simple diagrams of anatomy and physiology to explain a procedure to a school-age child.

ANS: D To assist the school-age child in meeting Erickson's developmental stage of industry, using simple diagrams of anatomy and physiology to explain a procedure is the accurate guideline. Toddlers should be told about a procedure right before the procedure. School-age children should know about the procedure in advance, not right before, and parents should be present for procedures for infants and toddlers.

The nurse is preparing to administer a prescribed dose of desmopressin acetate (DDAVP) intramuscularly (IM) to a child with diabetes insipidus. What action should the nurse take before drawing the medication into a syringe? a. Mix the medication with sterile water. b. Mix the medication with sterile normal saline. c. Have another nurse double-check the medication dose. d. Hold the medication under warm water for 10 to 15 minutes and then shake vigorously.

ANS: D To be effective, vasopressin must be thoroughly mixed in the oil by being held under warm running water for 10 to 15 minutes and shaken vigorously before being drawn into the syringe. If this is not done, the oil may be injected minus the antidiuretic hormone. Small brown particles, which indicate drug dispersion, must be seen in the suspension.

What laboratory finding, in conjunction with the presenting symptoms, indicates minimal change nephrotic syndrome? a. Low specific gravity b. Decreased hemoglobin c. Normal platelet count d. Reduced serum albumin

ANS: D Total serum protein concentrations are reduced, with the albumin fractions significantly reduced. Specific gravity is high and proportionate to the amount of protein in the urine. Hemoglobin and hematocrit are usually normal or elevated. The platelet count is elevated as a result of hemoconcentration.

The most common test for diagnosing pinworms in a child is which of the following? a. Lower gastrointestinal (GI) series b. Three stool specimens, at intervals of 4 days c. Observation for presence of worms after child defecates d. Tape placed in perianal area in the morning as soon as child awakens

ANS: D Transparent tape is used to collect pinworms and their eggs from the perianal area in the morning before the child defecates or bathes.

The nurse is caring for an immobilized preschool child. What intervention is helpful during this period of immobilization? a. Encourage wearing pajamas. b. Let the child have few behavioral limitations. c. Keep the child away from other immobilized children if possible. d. Take the child for a "walk" by wagon outside the room.

ANS: D Transporting the child outside of the room by stretcher, wheelchair, or wagon increases environmental stimuli and provides social contact. Street clothes are preferred for hospitalized children. This decreases the sense of illness and disability. The child needs appropriate limits for both adherence to the medical regimen and developmental concerns. It is not necessary to keep the child away from other immobilized children.

A woman who is 6 weeks pregnant tells the nurse that she is worried that, even though she is taking folic acid supplements, the baby might have spina bifida because of a family history. The nurse's response should be based on what? a. Prenatal detection is not possible yet. b. There is no genetic basis for the defect. c. Chromosome studies done on amniotic fluid can diagnose the defect prenatally. d. Open neural tube defects (NTDs) result in elevated concentrations of -fetoprotein in amniotic fluid.

ANS: D Ultrasound scanning and measurement of -fetoprotein may indicate the presence of anencephaly or myelomeningocele. The optimum time for performing this analyzing is between 16 and 18 weeks. Prenatal diagnosis is possible through amniocentesis. A multifactorial origin is suspected, including drugs, radiation, maternal malnutrition, chemicals, and possibly a genetic mutation. Chromosome abnormalities are not present in NTDs.

What is a nursing intervention to reduce the risk of increasing intracranial pressure (ICP) in an unconscious child? a. Suction the child frequently. b. Turn the child's head side to side every hour. c. Provide environmental stimulation. d. Avoid activities that cause pain or crying.

ANS: D Unrelieved pain, crying, and emotional stress all contribute to increasing the ICP. Disturbing procedures should be carried out at the same time as therapies that reduce ICP, such as sedation. Suctioning is poorly tolerated by children. When necessary, it is preceded by hyperventilation with 100% oxygen. Turning the head side to side is contraindicated for fear of compressing the jugular vein. This would block the flow of blood from the brain, raising ICP. Nontherapeutic touch and environmental stimulation increase ICP. Minimizing both touch and environmental stimuli noise reduces ICP.

The parent of a child with diabetes mellitus asks the nurse when urine testing will be necessary. The nurse should explain that urine testing is necessary for which? a. Glucose is needed before administration of insulin. b. Glucose is needed four times a day. c. Glycosylated hemoglobin is required. d. Ketonuria is suspected.

ANS: D Urine testing is still performed to detect evidence of ketonuria. Urine testing for glucose is no longer indicated because of the poor correlation between blood glucose levels and glycosuria. Glycosylated hemoglobin analysis is performed on a blood sample.

Which of the following may be given to high-risk children after exposure to chickenpox to prevent varicella? a. Acyclovir b. Varicella globulin c. Diphenhydramine hydrochloride d. VZIG

ANS: D VZIG is given to high-risk children to prevent the development of chickenpox.

A child is unconscious after a motor vehicle accident. The watery discharge from the nose tests positive for glucose. The nurse should recognize that this suggests: a. diabetic coma. b. brainstem injury. c. upper respiratory tract infection. d. leaking of cerebrospinal fluid (CSF).

ANS: D Watery discharge from the nose that is positive for glucose suggests leaking of CSF from a skull fracture and is not associated with diabetes or respiratory tract infection. The fluid is probably CSF from a skull fracture and does not signify whether the brainstem is involved.

The weight loss of anorexia nervosa is usually triggered by which of the following? a. Sexual abuse b. School failure c. Independence from family d. Traumatic interpersonal conflict

ANS: D Weight loss may be triggered by a typical adolescent crisis such as the onset of menstruation or a traumatic interpersonal incident; situations of severe family stress, such as parental separation or divorce; or circumstances in which the young person lacks personal control, such as being teased, changing schools, or entering college.

The nurse uses the palms of the hands when handling a wet cast for which reason? a. To assess dryness of the cast b. To facilitate easy turning c. To keep the patient's limb balanced d. To avoid indenting the cast

ANS: D Wet casts should be handled by the palms of the hands, not the fingers, to avoid creating pressure points. Assessing dryness, facilitating easy turning, and keeping the patient's limb balanced are not reasons for using the palms of the hand rather than the fingers when handling a wet cast.

Because of their striving for independence and productivity, which age group of children is particularly vulnerable to events that may lessen their feeling of control and power? a. Infants b. Toddlers c. Preschoolers d. School-age children

ANS: D When a child is hospitalized, the altered family role, physical disability, loss of peer acceptance, lack of productivity, and inability to cope with stress usurp individual power and identity. This is especially detrimental to school-age children, who are striving for independence and productivity and are now experiencing events that decrease their control and power. Infants, toddlers, and preschoolers, although affected by loss of power, are not as significantly affected as school-age children.

Because of their striving for independence and productivity, which age-group of children is particularly vulnerable to events that may lessen their feeling of control and power? a. Infants b. Toddlers c. Preschoolers d. School-age children

ANS: D When a child is hospitalized, the altered family role, physical disability, loss of peer acceptance, lack of productivity, and inability to cope with stress usurp individual power and identity. This is especially detrimental to school-age children, who are striving for independence and productivity and are now experiencing events that lessen their control and power.

The nurse is caring for a school-age girl who has had a cardiac catheterization. The child tells the nurse that her bandage is "too wet." The nurse finds the bandage and bed soaked with blood. What nursing action is most appropriate to institute initially? a. Notify the physician. b. Place the child in Trendelenburg position. c. Apply a new bandage with more pressure. d. Apply direct pressure above the catheterization site.

ANS: D When bleeding occurs, direct continuous pressure is applied 2.5 cm (1 inch) above the percutaneous skin site to localize pressure on the vessel puncture. The physician can be notified, and a new bandage with more pressure can be applied after pressure is applied. The nurse can have someone else notify the physician while the pressure is being maintained. Trendelenburg positioning would not be a helpful intervention. It would increase the drainage from the lower extremities.

Prolonged steroid therapy has caused a child to have Cushing syndrome. To lessen the cushingoid effects, the steroid should be administered at which time? a. In the PM b. After lunch c. QD in the AM d. QOD in the AM

ANS: D When cushingoid features are caused by steroid therapy, the effects may be lessened with administration of the drug early in the morning and on an alternate-day basis. Giving the drug early in the day maintains the normal diurnal pattern of cortisol secretion. If given during the evening, it is more likely to produce symptoms because endogenous cortisol levels are normally low and the additional supply exerts more pronounced effects. An alternate-day schedule allows the anterior pituitary an opportunity to maintain more normal hypothalamic-pituitary-adrenal control mechanisms.

The school nurse has been asked to begin teaching sex education in the fifth grade. The nurse should recognize that: a. children in fifth grade are too young for sex education. b. children should be discouraged from asking too many questions. c. correct terminology should be reserved for children who are older. d. sex can be presented as a normal part of growth and development.

ANS: D When sexual information is presented to school-age children, sex should be treated as a normal part of growth and development.

What nursing consideration is important when suctioning a young child who has had heart surgery? a. Perform suctioning at least every hour. b. Suction for no longer than 30 seconds at a time. c. Expect symptoms of respiratory distress when suctioning. d. Administer supplemental oxygen before and after suctioning.

ANS: D When suctioning is indicated, supplemental oxygen is administered with a manual resuscitation bag before and after the procedure to prevent hypoxia. Suctioning should be done only as indicated and very carefully to avoid vagal stimulation. The child should be suctioned for no more than 5 seconds at a time. Symptoms of respiratory distress are avoided by using appropriate technique.

The nurse is analyzing an arterial blood gas of pH, 7.29; PCO2, 30; and HCO3, 20. What result should the nurse document for this blood gas? a. Fully compensated respiratory acidosis b. Partially compensated respiratory acidosis c. Fully compensated metabolic acidosis d. Partially compensated metabolic acidosis

ANS: D When the fundamental acid-base ratio is altered for any reason, the body attempts to correct the deviation. In a simple disturbance, a single primary factor affects one component of the acid-base pair and is usually accompanied by a compensatory or secondary change in the component that is not primarily affected. In metabolic acidosis, the pH is low (?6?7.35), and the HCO3 is low (?6?22). When the pH is restored to normal, the disturbance is described as compensated. It is partially compensated because the pH remains abnormal, but the PCO2 is low (?6?35), indicating an attempt at compensation.

The nurse is analyzing an arterial blood gas of pH, 7.50; PCO2, 30; and HCO3, 20. What result should the nurse document for this blood gas? a. Fully compensated metabolic alkalosis b. Partially compensated metabolic alkalosis c. Fully compensated respiratory alkalosis d. Partially compensated respiratory alkalosis

ANS: D When the fundamental acid-base ratio is altered for any reason, the body attempts to correct the deviation. In a simple disturbance, a single primary factor affects one component of the acid-base pair and is usually accompanied by a compensatory or secondary change in the component that is not primarily affected. In respiratory alkalosis, the pH is high (?7?7.45), and the PCO2 is low (?6?35). When the pH is restored to normal, the disturbance is described as compensated. It is partially compensated because the pH remains abnormal, but the HCO3 is low (?6?22), indicating an attempt at compensation.

What dietary instructions should the nurse give to parents of a child in the oliguria phase of acute glomerulonephritis with edema and hypertension? (Select all that apply.) a. High fat b. Low protein c. Encouragement of fluids d. Moderate sodium restriction e. Limit foods high in potassium

ANS: D, E Dietary restrictions depend on the stage and severity of acute glomerulonephritis, especially the extent of edema. A regular diet is permitted in uncomplicated cases, but sodium intake is usually limited (no salt is added to foods). Moderate sodium restriction is usually instituted for children with hypertension or edema. Foods with substantial amounts of potassium are generally restricted during the period of oliguria. Protein restriction is reserved only for children with severe azotemia resulting from prolonged oliguria. A low-protein, high-fat diet with encouragement of fluids would not be recommended.

Which are clinical manifestations of increased intracranial pressure (ICP) in infants? (Select all that apply.) a. Low-pitched cry b. Sunken fontanel c. Diplopia and blurred vision d. Irritability e. Distended scalp veins f. Increased blood pressure

ANS: D, E Diplopia and blurred vision, irritability, and distended scalp veins are signs of increased ICP in infants. Diplopia and blurred vision is indicative of ICP in children. A high-pitched cry and a tense or bulging fontanel are characteristics of increased ICP. Increased blood pressure, common in adults, is rarely seen in children.

What dietary instructions should the nurse give to parents of a child with minimal change nephrotic syndrome with massive edema? (Select all that apply.) a. Soft diet b. High protein c. Fluid restricted d. No salt added at the table e. Restriction of foods high in sodium

ANS: D, E The child with minimal change nephrotic syndrome maintains a regular diet, not soft. However, salt is restricted during periods of massive edema and while the patient is on corticosteroid therapy; no salt is added at the table, and foods with very high salt content are excluded. Although a low-sodium diet will not remove edema, its rate of increase may be reduced. Water is seldom restricted. A diet generous in protein is logical, but there is no evidence that it is beneficial or alters the outcome of the disease.

The nurse is preparing a staff education program about pediatric asthma. What concepts should the nurse include when discussing the asthma severity classification system? (Select all that apply.) a. Children with mild persistent asthma have nighttime signs or symptoms less than two times a month. b. Children with moderate persistent asthma use a short-acting -agonist more than two times per week. c. Children with severe persistent asthma have a peak expiratory flow (PEF) of 60% to 80% of predicted value. d. Children with mild persistent asthma have signs or symptoms more than two times per week. e. Children with moderate persistent asthma have some limitations with normal activity. f. Children with severe persistent asthma have frequent nighttime signs or symptoms.

ANS: D, E, F Children with mild persistent asthma have signs or symptoms more than two times per week and nighttime signs or symptoms three or four times per month. Children with moderate persistent asthma have some limitations with normal activity and need to use a short-acting -agonist for sign or symptom control daily. Children with severe persistent asthma have frequent nighttime signs or symptoms and have a PEF of less than 60%.

The nurse is caring for a 10-month-old infant with respiratory syncytial virus (RSV) bronchiolitis. Which intervention should be included in the child's care? (Select all that apply.) a. Place in a mist tent. b. Administer antibiotics. c. Administer cough syrup. d. Encourage to drink 8 ounces of formula every 4 hours. e. Cluster care to encourage adequate rest. f. Place on noninvasive oxygen monitoring.

ANS: D, E, F Hydration is important in children with RSV bronchiolitis to loosen secretions and prevent shock. Clustering of care promotes periods of rest. The use of noninvasive oxygen monitoring is recommended. Mist tents are no longer used. Antibiotics do not treat illnesses with viral causes. Cough syrup suppresses clearing of respiratory secretions and is not indicated for young children.

When a child with mild cognitive impairment reaches the end of adolescence, which of the following characteristics would be expected?

Achieves a mental age of 8 to 12 years (By the end of adolescence, the child with mild cognitive impairment can acquire practical skills and useful reading and math skills to a third- to sixth-grade level. A mental age of 8 to 12 years is obtainable, and the child can be guided toward social conformity. A mental age of 5 to 12 years is characteristic of children with moderate cognitive impairment. Practical skills and useful reading and mathematics at an eighth-grade level are not descriptive of cognitive impairment.)

A family wants to begin oral feeding of their 4-year-old son, who is ventilator dependent and currently tube fed. They ask the home health nurse to feed him the baby food orally. The nurse recognizes a high risk of aspiration and an already compromised respiratory status. The most appropriate nursing action is which of the following?

Acknowledge their request, explain the risks, and explore with the family the available options (Parents want to be included in the decision making for their child's care. The nurse should discuss the request with the family to ensure this is the issue of concern, and then potential options can be explored. Refusing to feed the child orally does not determine why the parents want oral feedings to begin and does not involve them in problem solving. The decision to begin oral feedings or not to change the feedings should be a collaborative one, made in consultation with the family, the nurse, and an appropriate member of the health care team.)

Immunity from exposure to the invading agent, which is a bacteria, virus, or toxin

Acquired immunity

A state in which immune bodies are actively formed against specific antigens, either naturally by having had the disease or artificially

Active immunity

Which statement is most accurate in describing tetanus? Acute infectious disease caused by an exotoxin produced by an anaerobic, gram-positive bacillus Inflammatory disease that causes extreme, localized muscle spasm Acute infection that causes meningeal inflammation, resulting in symptoms of generalized muscle spasm Disease affecting the salivary gland with resultant stiffness of the jaw

Acute infectious disease caused by an exotoxin produced by an anaerobic, gram-positive bacillus Correct Tetanus is an acute, preventable disease caused by an exotoxin produced by an anaerobic spore-forming, gram-positive bacillus, Clostridium tetani. Tetanus is caused by the effect of the exotoxins becoming fixed on nerve cells and is not an inflammatory disorder that causes muscle spasms. Tetanus is not an acute infection that leads to generalized muscle spasms. Tetanus is not a disease that affects the salivary glands, with resultant stiffness of the jaw.

Home care is being considered for a young child who is ventilator dependent. Which of the following factors is most important in deciding whether home care is appropriate?

Adequate family training (One of the essential elements is the family's preparation and ability to care for the child. The family must be able to demonstrate all aspects of care for the child because in many areas nursing care may not be available on a continual basis. The amount of formal education reached by the parents is not the important issue. The determinant is the family's ability to care adequately for the child in the home. At least two family members should learn and demonstrate all aspects of the child's care in the hospital, but it does not have to be two parents. Few families can assume all health care costs. Creative financial planning, including negotiating arrangements with the insurance company or public programs, may be required.)

What is an appropriate nursing intervention while the child with nephrotic syndrome is confined to bed?

Adjust activities to the child's tolerance level. The child will have a variable level of tolerance for activity. The activity tolerance will also be affected by the labile moods associated with steroid administration. The nurse should assist the family in adjusting activities for the child that are age appropriate. Restraints should not be used to confine children to bed, unless they are a potential threat to themselves or others. Parents should be encouraged to hold the child. The child should be encouraged to move all extremities while in bed to prevent the potential complications of immobility.

Which of the following is an important nursing consideration when chest tubes will be removed from a child? Explain that it is not painful. Administer analgesics before procedure. Explain that only a Band-Aid will be needed. Expect bright red drainage for several hours after removal.

Administer analgesics before procedure. Removal of chest tubes can be an uncomfortable, frightening experience. Analgesics should be used. Children are forewarned that they will feel a sharp, momentary pain. A petrolatum-covered gauze dressing is immediately applied over the wound and securely taped to the skin on all four sides to form an airtight seal. No drainage is anticipated on the dressing.

The nurse is admitting a young child to the hospital because bacterial meningitis is suspected. Which of the following is a priority of nursing care? A Initiate isolation precautions as soon as diagnosis is confirmed. B Provide environmental stimulation to keep the child awake. C Administer antibiotic therapy as soon as it is available. D Administer sedatives and analgesics on a preventive schedule to manage pain.

Administer antibiotic therapy as soon as it is available. Correct Administering antibiotic therapy is the priority action. Antibiotics are begun as soon as possible to avoid resultant disabilities and to prevent death. Isolation should be instituted as soon as diagnosis is anticipated. It is important to decrease the external stimuli. The nurse should keep the room as quiet as possible. Antibiotics are the priority function; pain should be managed if it occurs.

The nurse is admitting a young child to the hospital because bacterial meningitis is suspected. What is the major priority of nursing care? A Initiate isolation precautions as soon as the diagnosis is confirmed. B Initiate isolation precautions as soon as the causative agent is identified. C Administer antibiotic therapy as soon as it is ordered. D Administer sedatives and analgesics on a preventive schedule to manage pain.

Administer antibiotic therapy as soon as it is ordered. Correct Initiation of antibiotic therapy is the priority action. Antibiotics are begun as soon as possible to prevent death and to avoid resultant disabilities. Isolation should be instituted as soon as a diagnosis is anticipated and should remain in effect until bacterial or viral origin is determined. If bacterial meningitis is ruled out, then isolation precautions can be discontinued. Isolation should be instituted as soon as a diagnosis is anticipated and should remain in effect until bacterial or viral origin is determined. If bacterial meningitis is ruled out, then isolation precautions can be discontinued. Initiation of antibiotics is the priority nursing intervention. Pain should be managed on an as-needed basis.

When giving liquid medication to a crying 10-month-old infant, which approach minimizes the possibility of aspiration?

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

Which of the following is an advantage of continuous cycling peritoneal dialysis or continuous ambulatory peritoneal dialysis for adolescents who require dialysis?

Adolescents can carry out procedures themselves Continuous cycling peritoneal dialysis or continuous ambulatory peritoneal dialysis provide the most independence for adolescents with end-stage renal disease and their families. Adolescents can carry out the procedure themselves. Dietary restrictions are still required but are less strict. The procedure can be done at home. The catheter is surgically implanted in the abdominal cavity.

What is an advantage to teach to the family about continuous cycling peritoneal dialysis (CCPD) or continuous ambulatory peritoneal dialysis (CAPD) for adolescents who require dialysis?

Adolescents can carry out procedures themselves. This type of dialysis provides the most independence for adolescents with end-stage renal disease and their families. Adolescents can carry out the procedure themselves, and the procedure is usually performed at night, enabling the adolescent to live life more normally during the day. CCPD and CAPD can be done at home. Dietary restrictions are still required but are less strict when an adolescent is on CCPD or CAPD. The catheter is surgically implanted in the abdominal cavity for both CCPD and CAPD.

Which of the following statements is correct regarding sports injuries during adolescence? A Rapidly growing bones, muscles, joints, and tendons offer some protection from unusual strain. B The increase in strength and vigor during adolescence helps prevent injuries related to fatigue. C More injuries occur during organized athletic competition than during recreational sports participation. D Adolescents may not possess the insight and judgment to recognize when an activity is beyond their capabilities.

Adolescents may not possess the insight and judgment to recognize when an activity is beyond their capabilities. Correct Children and adolescents may not possess the insight and judgment to recognize when an activity is beyond their capabilities. Rapidly growing bones, muscles, joints, and tendons are especially vulnerable to unusual strain. The increase in strength and vigor in adolescence may tempt adolescents to overextend themselves. More injuries occur during recreational sports participation than in organized athletic competition.

The nurse is administering the first hepatitis A vaccine to an 18-month-old child. When should the child return to the clinic for the second dose of hepatitis A vaccination?

After 6 months. (Hepatitis A vaccine is now recommended for all children beginning at age 1 year (i.e., 12 months to 23 months). The second dose in the two-dose series may be administered no sooner than 6 months after the first dose.)

Which serious reaction should the nurse be alert for when administering vaccines?

Allergic reaction (Each vaccine administration carries the risk of an allergic reaction. The nurse must be prepared to intervene if the child demonstrates signs of a severe reaction. Mild febrile reactions do occur after administration. The nurse includes management of fever in the parent teaching. Local skin irritation may occur at the injection site after administration. Parents are informed that this is expected. The injection can be painful. The nurse can minimize the discomfort with topical analgesics and nonpharmacologic measures.)

The change from the exclusive use of oral polio vaccine (OPV) to the exclusive use of inactivated poliovirus vaccine (IPV) related to the rare risk of vaccine-associated polio paralysis (VAPP) from OPV has resulted in which of the following?

An increased number of injections and increased cost

The change from the exclusive use of oral polio vaccine (OPV) to the exclusive use of inactivated poliovirus vaccine (IPV) related to the rare risk of vaccine-associated polio paralysis (VAPP) from OPV has resulted in which of the following?

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

The home health nurse is caring for a child who requires complex care. The family expresses frustration related to obtaining accurate information about their child's illness and its management. Which of the following is the best action for the nurse?

Answer questions in a straightforward manner and get professional assistance when an answer is unknown. (The philosophic basis for family-centered practice is the recognition that the family is the constant in the child's life. It is essential that the family have complete and accurate information about their child's illness and management. The nurse may first have to clarify what information the family believes has not been communicated. The family's frustration arises from their perception that they are not receiving information pertinent to their child's care. It does not help the family to refer the family to the child's primary care practitioner. The home health nurse should have access to the necessary information. Questions about what they need and want to know concerning their child's care should be addressed, but the nurse may not be able to answer every question.)

Which of the following best describes the cause of most cases of acute glomerulonephritis?

Antecedent streptococcal infection Most cases are postinfectious and have been associated with pneumococcal, streptococcal, or viral infections. Renal vascular anomalies are not associated with acute glomerulonephritis. Urinary tract infections and structural anomalies can result in progressive renal injury, not acute glomerulonephritis.

Therapeutic management of a child with tetanus includes the administration of which of the following? Nonsteroidal antiinflammatory drugs (NSAIDs) to reduce inflammation Muscle stimulants to counteract muscle weakness Bronchodilators to prevent respiratory complications Antibiotics to control bacterial proliferation at the site of injury

Antibiotics to control bacterial proliferation at the site of injury Correct Antibiotics are administered to control the proliferation of the vegetative forms of the organism at the site of infection. Tetanus toxin acts at the myoneural junction to produce muscular stiffness and lowers the threshold for reflex excitability. NSAIDs are not routinely used. Sedatives or muscle relaxants are used to help reduce titanic spasm and prevent seizures. Respiratory status is carefully evaluated for any signs of distress because muscle relaxants, opioids, and sedatives that may be prescribed may cause respiratory depression. Bronchodilators would not be used unless specifically indicated.

A diagnosis of rheumatic fever is being ruled out for a child. Which lab test(s) is/are the most reliable? (Select all that apply.) Throat culture C-reactive protein (CRP) Antistreptolysin-O titer (ASO) titer Elevated white blood count (WBC) Erythrocyte sedimentation rate (ESR)

Antistreptolysin-O titer (ASO) titer

Parents bring their child to the emergency department and tell the nurse that the child has been complaining of colicky abdominal pain located in the lower right quadrant of the abdomen. The nurse suspects that the child has which disorder?

Appendicitis (The most common symptom of appendicitis is a colicky, periumbilical, or lower abdominal pain located in the right quadrant. Peritonitis is a complication that can follow organ perforation or intestinal obstruction. The classic signs and symptoms of intussusception are acute, colicky abdominal pain with currant jelly-like stools. Clinical manifestations of Hirschsprung's disease include constipation, abdominal distention, and ribbon-like, foul-smelling stools. )

When applying wet compresses or dressings to the skin, the nurse should do which of the following?

Apply desired solution on cotton gauze or soft cotton cloths, such as clean handkerchiefs (The desired solution should be applied to Kerlix gauze; soft cotton cloths; or strips from cloth diapers, sheets, handkerchiefs, or pillowcase material. The moist dressing should be laid flat on the area with an attempt to avoid restriction of movement. After immersion in the solution, the dressings are wrung out to avoid dripping. The dry dressing should be removed, moistened again, and then reapplied. When the solution dries, concentrated residue is left in the dressing. The addition of fluid may result in a more concentrated soak being placed on the sensitive tissue)

Which of the following should the nurse recognize as an early clinical sign of compensated shock in a child?

Apprehension (Early signs are vague and subtle, including apprehension, irritability, normal blood pressure, narrowing pulse pressure, thirst, pallor, and diminished urinary output. Confusion, sleepiness, and hypotension are later signs of shock.)

What should the nurse recognize as an early clinical sign of compensated shock in a child? Confusion Sleepiness Hypotension Apprehensiveness

Apprehensiveness Apprehensiveness is indicative of compensated shock. Confusion is indicative of uncompensated shock. Sleepiness is not an indication of shock. Hypotension is a symptom of irreversible shock.

Nursing interventions for the child after a cardiac catheterization would include which of the following? Allow ambulation as tolerated. Monitor vital signs every 2 hours. Assess the affected extremity for temperature and color. Check pulses above the catheterization site for equality and symmetry.

Assess the affected extremity for temperature and color. The involved extremity is carefully assessed for signs of complications. Pulses below the catheterization site are monitored for equality and symmetry. Temperature and color are also monitored. The child is maintained on bed rest or in parent's lap for 4 to 6 hours after the procedure. Initially, vital signs are taken every 15 minutes. Pulses are checked distal to the catheterization site.

What is the first step in the emergency treatment of poisoning in a child?

Assess the child (The initial step in treating a poisoning is to assess the child. Then treat immediate life-threatening conditions and initiate cardiopulmonary resuscitation if indicated. Locating the poison, preventing absorption of the poison, and terminating exposure to the toxic substance are important but none of these is the first step.)

A child with asthma is having pulmonary function tests. What explains the purpose of the peak expiratory flow rate (PEFR)?

Assesses the severity of asthma The PEFR measures the maximum amount of air that can be forcefully exhaled in 1 minute. This can provide an objective measure of pulmonary function when compared with the child's baseline. The diagnosis of asthma is made on the basis of clinical manifestations, history, and physical examination, not pulmonary function tests such as the PEFR. The cause of asthma is inflammation, bronchospasm, and obstruction, which are not identified by the PEFR. Some of the triggers of asthma are identified with allergy testing, not with the PEFR.

What is most descriptive of atopic dermatitis (AD) (eczema) in an infant?

Associated with hereditary allergies. (AD is a type of pruritic eczema that usually begins during infancy and is associated with allergy with a hereditary tendency. Approximately 50% of children with AD develop asthma. AD can be controlled but not cured. Manifestations of the disease are worse when environmental humidity is lower. AD is not associated with respiratory tract infections.)

. A nurse is caring for an infant with developmental dysplasia of the hip (DDH). Based on the nurses knowledge of DDH, which clinical manifestation should the nurse expect to observe? (Select all that apply.) A Lordosis B Negative Babinski sign C Asymmetric thigh and gluteal folds D Positive Ortolani and Barlow tests Shortening of limb on affected side

Asymmetric thigh and gluteal foldsCorrect Positive Ortolani and Barlow testsCorrect Shortening of limb on affected sideCorrect

A 3-year-old child is being admitted for about 1 week of hospitalization. Her parents tell the nurse that they are going to buy her "a lot of new toys because she will be in the hospital." The nurse's reply should be based on an understanding of which of the following?

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

A child with Down syndrome may be screened for which of the following before participating in some sports?

Atlantoaxial instability (Children with Down syndrome are at risk for atlantoaxial instability. Before they participate in sports that put stress on the head and neck, a radiologic examination should be done. Hyperflexibility, cutis marmorata, and speckling of the iris (Brushfield spots) are characteristic of Down syndrome, but they do not affect the child's ability to participate in sports.)

The nurse is caring for a child with a Wilms' tumor. What is the most important nursing intervention preoperatively?

Avoid abdominal palpation. Wilms' tumors are encapsulated. It is extremely important to avoid any palpation of the mass to minimize the risk of dissemination of cancer cells to adjacent and other sites. A sign should be placed over the bed indicating that no abdominal palpation should be conducted. Monitoring of arterial blood gases is not indicated preoperatively for this abdominal surgery. Long-term dialysis is not indicated, unless both kidneys have to be removed. This option is considered a last resort. If both kidneys are involved, preoperative irradiation and/or chemotherapy is used to minimize the tumor size. Renal transplantation is a last resort if both kidneys need to be removed and a compatible living donor exists.

What nursing intervention is used to prevent increased intracranial pressure (ICP) in an unconscious child? A Suction the child frequently. B Provide environmental stimulation. C Turn the head side to side every hour. D Avoid activities that cause pain or crying.

Avoid activities that cause pain or crying. Correct Nursing interventions should focus on assessment and interventions to minimize pain. These activities can cause the ICP to increase. Suctioning is a distressing procedure. In addition, the resultant decrease in carbon dioxide can increase ICP. Environmental stimulation should be minimized because it can increase ICP. The child's head should not be turned side to side. If the jugular vein is compressed, the ICP can rise.

The nurse is planning care for an infant with eczema. Which interventions should the nurse include in the care plan? (Select all that apply.)

Avoid giving the infant a bubble bath, Avoid overdressing the infant. (Guidelines for care of an infant with eczema include avoiding a bubble bath and harsh soaps and avoiding overdressing the infant to prevent perspiration, which can cause a flare-up. The care plan should include using a humidifier in the infant's room, topical steroids, and wet compresses on the most affected areas.)

A nurse is caring for a child who has Hirschsprung disease. Which of the following is an appropriate action for the nurse to take? A. Encourage a high-fiber, low-protein, low-calorie diet. B. Prepare the family for surgery. C. Place an NG for decompression. D. Initiate bedrest.

B. CORRECT: A client who has Hirschsprung disease requires surgery to remove the affected segment of the intestine. Preparing the family for surgery is an appropriate action for the nurse to take.

A nurse is teaching a parent about complicated grief. Which of the following statements by the nurse is appropriate? A. "It is considered complicated grief if you are still grieving 6 months after your loss." B. "Personal activities are affected when experiencing complicated grief." C. "Parents will experience complicated grief together." D. "Complicated grief self-resolves in 12 months."

B. CORRECT: A parent who is experiencing complicated grief experiences intense emotions that affect personal activities.

A nurse is providing instruction to the teacher of a child who has attention-deficit/hyperactivity disorder (ADHD). Which of the following classroom strategies should be included in the teaching? (Select all that apply.)

B. CORRECT: Allowing for regular breaks will assist the client who has ADHD to focus on the required tasks. C. CORRECT: Combining verbal instruction with visual cues will assist the client who has ADHD with learning information. D. CORRECT: Providing consistent classroom rules will assist the client who has ADHD to become successful. E. CORRECT: Stimuli in the environment distract the client who has ADHD, so they should be decreased.

A nurse is caring for a client who has a superficial partial thickness burn. Which of the following is an appropriate action for the nurse to take? A. Administer an IV infusion of 0.9% sodium chloride. B. Apply cool, wet compresses to affected area. C. Clean the affected area using a soft-bristle brush. D. Administer morphine sulfate.

B. CORRECT: Applying cool, wet compresses stops the burn process. Therefore, this is an appropriate action for the nurse to take.

A nurse is teaching a group of parents about complications of communicable diseases. Which of the following communicable diseases may lead to pneumonia? (Select all that apply.)

B. CORRECT: Complications of rubeola include ear infections, pneumonia, diarrhea, encephalitis, and death. C. CORRECT: Complications of pertussis include: infants and children - pneumonia, convulsions, apnea, encephalopathy, and death; teens and adults - weight loss, loss of bladder control, passing out, and rib fractures. D. CORRECT: Complications of varicella include dehydration, pneumonia, bleeding problems, bacterial infection of the skin, sepsis, toxic shock syndrome, bone or joint infections, and death.

A nurse is caring for an adolescent client who has mononucleosis. The nurse assesses fever, fatigue, swollen lymph nodes, sore throat, and a sore upper abdomen. Which of the following instructions should the nurse discuss with the adolescent and her parents? (Select all that apply.)

B. CORRECT: Fluids are encouraged to prevent dehydration with illness. C. CORRECT: The spleen could rupture as a result of injury. Therefore, strenuous activities should be avoided. D. CORRECT: Fatigue is common in clients who have mononucleosis. Therefore, allowing for periods of rest facilitates healing. F. CORRECT: It can soothe discomfort associated with a sore throat.

A nurse is providing teaching to the parent of a child who has attention-deficit/hyperactivity disorder. The nurse should include which of the following as a characteristic of impulsivity?

B. CORRECT: Frequently interrupting is a characteristic of impulsivity.

A nurse is teaching a parent of a preschool child about factors that affect the child's perception of death. Which of the following should be included in the teaching? A. Preschool children have no concept of death. B. Preschool children perceive death as temporary. C. Preschool children often regress to an earlier stage of behavior. D. Preschool children experience fear related to the disease process.

B. CORRECT: Preschool children perceive death as temporary because they have no concept of time.

A nurse is caring for a preschooler. Which of the following is an expected behavior of a preschool‑age child?

B. CORRECT: Preschool-age children are egocentric and relate fears to magical thinking.

A nurse on a pediatric unit is caring for a toddler. Which of the following toddler behaviors is an effect of hospitalization? (Select all that apply.)

B. CORRECT: Separation anxiety is a potential effect of hospitalization in a toddler. C. CORRECT: Intense emotions are a potential impact of hospitalization in a toddler. D. CORRECT: Behavior regression is a potential impact of hospitalization in a toddler.

A nurse is assessing a toddler for possible hearing loss. Which of the following are clinical manifestations of a hearing impairment? (Select all that apply.) A. Uses telegraphic speech B. Speaks loudly C. Repeats sentences D. Appears shy E. Is overly attentive to the surroundings

B. CORRECT: Speaking loudly is a clinical manifestation of a hearing impairment. D. CORRECT: Shyness or withdrawn behavior are clinical manifestations of a hearing impairment.

A nurse is caring for a child who has depression. Which of the following findings are associated with this diagnosis? (Select all that apply.)

B. CORRECT: Weight loss or gain are findings associated with depression. C. CORRECT: Low self-esteem is a finding associated with depression. D. CORRECT: Sleeping more than usual is a finding associated with depression.

The Hib conjugate vaccines protect an infant against which of the following diseases? (Select all that apply.)

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

The Hib conjugate vaccines protect an infant against which of the following diseases? (Select all that apply.)

Bacterial meningitis Correct B. Epiglottitis Correct C. Bacterial pneumonia Correct D. Septic arthritis Correct E. Sepsis Correct (Hib conjugate vaccines protect against a number of serious infections caused by Haemophilus influenza type b, especially bacterial meningitis, epiglottitis, bacterial pneumonia, septic arthritis, and sepsis)

A child in renal failure has hyperkalemia. Which foods should be avoided?

Bananas, carrots, and green leafy vegetables Bananas, carrots, and green leafy vegetables are high in potassium. Cold cuts, chips, and canned foods are high in sodium but not necessarily in potassium. A hamburger on a bun and lime Jell-O is an acceptable choice for a low-potassium diet. Spaghetti with meat sauce and breadsticks is an acceptable choice for a low-potassium diet.

The nurse is providing support to a family who is experiencing anticipatory grief related to their child's imminent death. Which of the following is an appropriate nursing intervention?

Be available to the family (One of the most important nursing interventions around the time of death is the availability of the nurse for the family. Attempting to "lighten the mood" or suggesting activities to cheer up the family would be highly inappropriate. The parents are in engaged in the grieving process and should be encouraged to express their feelings appropriately.)

Which one of the following strategies might be recommended for an infant with failure to thrive (FTT) to increase caloric intake?

Be persistent through 10 to 15 minutes of food refusal. (Calm perseverance through 10 to 15 minutes of food refusal will eventually diminish negative behavior. Children with FTT need a structured routine to help establish rhythmicity in their activities of daily living. Many children with FTT are fed exclusively from a bottle. Solids should be fed first. Stimulation is reduced during mealtimes to maintain the focus on eating.)

The nurse is preparing to feed a 10-month-old child diagnosed with failure to thrive (FTT). Which actions should the nurse plan to implement? (Select all that apply.)

Be persistent, Introduce new foods slowly, Maintain a calm, even temperament. (Feeding strategies for children with FTT should include persistence; introducing new foods slowly; and maintaining a calm, even temperament. The environment should be unstimulating, and a structured routine should be developed with regard to feeding, not just when the infant shows signs of hunger.)

When giving instructions to a parent whose child has scabies, what should the nurse include?

Be prepared for symptoms to last 2 to 3 weeks. (The mite responsible for the scabies will most likely be killed with the administration of medications. It will take 2 to 3 weeks for the stratum corneum to heal. That is when the symptoms will abate. Initiation of therapy does not wait for clinical symptom development. All individuals in close contact with the affected child need to be treated. Permethrin, a scabicide, is the preferred treatment and is applied to all skin surfaces.)

The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) and American College of Obstetricians and Gynecologists has recommended that pregnant adolescents and women who are not protected against pertussis receive the tetanus, diphtheria and pertussis (Tdap) vaccine optimally at which of the following times?

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

The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) and American College of Obstetricians and Gynecologists has recommended that pregnant adolescents and women who are not protected against pertussis receive the tetanus, diphtheria and pertussis (Tdap) vaccine optimally at which of the following times?

Between 27 and 36 weeks of gestation or postpartum before discharge from the hospital .(The ACIP of the CDC and American College of Obstetricians and Gynecologists has recommended that pregnant adolescents and women who are not protected against pertussis receive the Tdap vaccine optimally between 27 and 36 weeks of gestation or postpartum before discharge from the hospital.)

The nurse is preparing an adolescent girl for surgery to treat scoliosis. Which of the following should the nurse include? A Blood administration may be an option. B Ambulation will not be allowed for up to 3 months. C Surgery eliminates the need for casting and bracing. D Discomfort can be controlled with nonpharmacologic methods

Blood administration may be an option. Correct Spinal surgery usually involves considerable blood loss. Several options are considered for blood replacement. Ambulation is allowed as soon as possible. Depending on the instrumentation used, most patients are walking by the second or third postoperative day. Casting and bracing are required postoperatively. The child usually has considerable pain for the first few days after surgery. Intravenous opioids should be administered on a regular basis.

A child, age 10 years, sustained a fracture in the epiphyseal plate of her right fibula when she fell out of a tree. When discussing this injury with her parents, the nurse should consider which of the following? A This type of fracture is inconsistent with a fall. B Bone growth can be affected by this type of fracture. C This is an unusual fracture site in young children. D Healing is usually delayed in this type of fracture.

Bone growth can be affected by this type of fracture. Correct Detection of epiphyseal injuries is sometimes difficult, but fractures involving the epiphysis or epiphyseal plate present special problems in determining whether bone growth will be affected. The epiphysis is the weakest point of the long bones. This is a frequent site of damage during trauma. Healing of epiphyseal injuries is usually prompt.

The nurse is preparing to care for a child with a diagnosis of intussusception. The nurse reviews the child's record and expects to note which symptom of this disorder documented?

Bright red blood and mucus in the stools (Intussusception is a telescoping of one portion of the bowel into another. The condition results in an obstruction to the passage of intestinal contents. A child with intussusception typically has severe abdominal pain that is crampy and intermittent, causing the child to draw in the knees to the chest. Vomiting may be present, but is not projectile. Bright red blood and mucus are passed through the rectum and commonly are described as currant jelly-like stools. Watery diarrhea and ribbon-like stools are not manifestations of this disorder.)

A 7-year-old child has ingested a toxic dose of iron. The parent reports that the child vomited and had gastric pain an hour ago but "feels fine" now. The parent is not sure when the child ingested the iron tablets. The nurse should recommend which of the following?

Bring the child to the hospital immediately (The critical period for observation after the ingestion of iron is 30 minutes to 6 hours. The child has had gastric pain, which may be symptomatic of toxicity, and needs to be monitored and possibly receive medical intervention. Although activated charcoal may be necessary, evaluation is indicated first. The child needs to be evaluated immediately. Ipecac is not recommended after the ingestion of toxic substances)

A nurse is caring for a client who has a moderate burn. Which of the following is an appropriate action for the nurse to take? A. Maintain immobilization of the affected area. B. Expose affected area to the air. C. Initiate a high-protein, high-calorie diet. D. Implement contact isolation.

C. CORRECT: A high-protein, high-calorie diet is initiated to meet increased metabolic demands and promote healing.

A nurse is teaching a parent of a child who has pediculosis capitis. Which of the following should the nurse include in the teaching?

C. CORRECT: Pediculosis capitis is treated with 1% permethrin, which can be purchased over the counter.

A nurse is caring for an adolescent who has acne and is prescribed isotretinoin 13-cis-retinoic acid (Amnesteem). Which of the following laboratory findings should be monitored?

CORRECT: Adverse effects of 13-cis-retinoic acid include elevated cholesterol and triglycerides; therefore, these laboratory findings should be monitored.

A nurse is caring for an infant who has diaper dermatitis. Which of the following should be included in the plan of care? (Select all that apply.)

CORRECT: Allowing the buttocks to air dry facilitates thorough drying of the skin and should be included in the plan of care. CORRECT: Zinc oxide ointment protects the skin from moisture and irritation and should be included in the plan of care.

A nurse is teaching the parent of a child who has hand, foot, and mouth disease. Which of the following should be included in the teaching?

CORRECT: Children are most contagious the first week of illness. However, they can be contagious even when symptoms are gone.

A nurse is caring for a child who has cellulitis on the hand. Which of the following is an appropriate action for the nurse to take?

CORRECT: Hot compresses increase circulation and promote healing, and are an appropriate action for the nurse to take. B. INCORRECT: Cleansing with Burow's solution is recommended for impetigo contagiosa or herpes simplex virus. C. INCORRECT: Cryotherapy is recommended for human papillomavirus. D. INCORRECT: Cellulitis is a bacterial infection and requires antibiotic therapy.

A nurse is teaching a group of parents about communicable diseases. Which of the following is the most appropriate method to prevent a communicable disease?

CORRECT: Obtaining immunizations has decreased the rate of communicable diseases and is the best method to prevent further spread of illness.

A nurse is teaching the parent of an infant who has seborrheic dermatitis. Which of the following should be included in the teaching?

CORRECT: The cause of seborrheic dermatitis is unknown. The condition is not contagious; therefore, this should be included in the teaching.

One of the goals for children with asthma is to prevent respiratory tract infection. This is because respiratory tract infection does which of the following?

Can trigger an episode or aggravate asthmatic state Viral respiratory tract infections can exacerbate asthma, especially in young children, whose airways are mechanically smaller and more reactive than those of older children. Respiratory tract infections do not affect sensitivity to allergens. Exercise precipitates exercise-induced asthma. The respiratory tract infection does not lessen the effectiveness of the medications.

The nurse is examining an infant, age 10 months, who was brought to the clinic for persistent diaper rash. The nurse finds perianal inflammation with satellite lesions. What is the most likely cause?

Candida albicans infection. (C. albicans infection produces perianal inflammation and a maculopapular rash with satellite lesions that may cross the inguinal folds. Impetigo is a bacterial infection that spreads peripherally in sharply marginated, irregular outlines. Eruptions involving the skin in contact with the diaper but sparing the folds are likely to be caused by chemical irritation, especially urine and feces, and may be related to infrequent diapering.)

The nurse is planning care for an infant with candidiasis (moniliasis) diaper dermatitis. Which topical ointments may be prescribed for the patient? (Select all that apply.)

Candidiasis diaper dermatitis skin lesions are treated with topical nystatin, miconazole, and clotrimazole. Bactroban and Neosporin are used to treat bacterial dermatitides.

Which of the following is defined as the forces that favor filtration from the capillary?

Capillary hydrostatic pressure and interstitial oncotic pressure (Capillary hydrostatic pressure and interstitial oncotic pressure are forces that favor filtration from the capillary. Diffusion is the random movement of molecules from a region of greater concentration to regions of lower concentration, and osmosis is the physical force created by a solution of higher concentration across a semipermeable membrane. Active transport is movement of a substance against a pressure gradient from an area of lesser or equal concentration to an area of greater or equal concentration. A carrier substance is needed. Hydrostatic pressure is the pressure in the arterial portion of the circulatory system, which can push fluid through the capillary walls.)

A child has fluid volume deficit. The nurse performs an assessment and determines that the child is improving and the deficit is resolving if which finding is noted?

Capillary refill is less than 2 seconds. (Indicators that fluid volume deficit is resolving would be capillary refill less than 2 seconds, specific gravity of 1.002 to 1.025, urine output of at least 1 mL/kg/hour, and adequate tear production. A capillary refill time less than 2 seconds is the only indicator that the child is improving. Urine output of less than 1 mL/kg/hour, a specific gravity of 1.030, and no tears would indicate that the deficit is not resolving.)

Apnea of infancy has been diagnosed in an infant scheduled for discharge with home monitoring. Part of the infant's discharge teaching plan should include?

Cardiopulmonary resuscitation (CPR) CPR is essential for all parents and caregivers to know, especially when an infant has a history of apnea of infancy that is being monitored at home. Most likely, the child will not be receiving home IV therapy as part of the discharge care. The Heimlich maneuver is used to intervene when a child or an adult is experiencing a choking episode. It would not be necessary for the parents to learn the maneuver at this time. (Back slaps and chest thrusts are used on the responsive infant for choking.) The parents should arrange for other caregivers to help when possible. There is no reason that the infant cannot be left with capable and trained individuals. Anyone caring for the infant will need to be taught to use equipment and how to perform CPR.

When determining the etiology of a skin problem, which of the following is essential to the diagnosis of the lesions?

Careful inspection (One of the more advantageous aspects of skin lesions is that the diagnosis is usually readily established by simple, careful inspection. Types of skin products and laundry detergents are important if the lesions appear to be a result of contact dermatitis. If a contagious origin is suspected after inspection, siblings having similar lesions would be part of the history)

Which of the following is a characteristic of children with depression?

Change in appetite, resulting in weight loss or gain (Physiologic characteristics of children with depression include a change in appetite resulting in weight loss or gain, nonspecific complaints of not feeling well, alterations in sleeping pattern (insomnia or hypersomnia), and constipation. Children who are depressed have sad facial expressions with an absence or diminished range of affective response. Children who are depressed lack interest in doing homework or achieving in school, resulting in lower grades. These children withdraw from previously enjoyed activities and engage in solitary play or work. Schoolwork is not replaced by play)

The nurse is caring for a child dying from cancer. The parents ask how they will know that the child is approaching death. The nurse's answer should include which of the following?

Change in respiratory pattern (The respiratory pattern will become slower and shallower with periodic deep sighs, followed by Cheyne-Stokes respirations and the "death rattle." The pulse rate will slow. The child may have sensations of heat, while the body feels cool. Hearing is the last sense to fail.)

An infant is seen in the health care provider's office for complaints of frequent vomiting and spitting up after feedings. Findings indicate that the infant is not gaining weight and gastroesophageal reflux is suspected. Which would the nurse anticipate being prescribed initially in the care of this child?

Change the formula to predigested formula and feed small, frequent feedings. (For infants with frequent vomiting and spitting up, the diagnosis of gastroesophageal reflux should be considered. The initial action is to alter the formula. After the formula is changed, the family will be instructed to keep a log of feedings and any reflux with the new formula. Medication is not started until after the formula is changed. A prone position increases the risk of reflux and thus aspiration.)

Parent guidelines for relieving colic in an infant include which of the following?

Change the infant's position frequently. (Changing the infant's position frequently may be beneficial. The parent can walk holding the child face down and with the child's abdomen across the parent's arm. The parent's hand can support the child's abdomen, applying gentle pressure. Pacifiers can be used for meeting additional sucking needs. Gently massaging the abdomen is effective in some children. The child should not be placed where he or she cannot be monitored. The child can be placed in the crib and allowed to cry. Periodically, the child should be picked up and comforted.)

Where do eczematous lesions most commonly occur in an infant?

Cheeks and extensor surfaces of the arms and legs. (The lesions of atopic dermatitis are generalized in infants. They are most common on the cheeks, scalp, trunk, and extensor surfaces of the extremities. The abdomen and buttocks are not common sites of lesions. The back and flexor surfaces are not usually involved.)

The nurse is planning care for a child with chickenpox (varicella). Which prescribed supportive measures should the nurse plan to implement? (Select all that apply.)

Chickenpox is a virus, and acyclovir is ordered to lessen the symptoms. Benadryl and Tylenol are prescribed as supportive treatments. Vitamin A supplementation is used for treating rubeola. Zithromax is an antibiotic prescribed for bacterial infections such as pertussis.

Mandatory requests for organ and tissue donation have been instituted in several states. The nurse recognizes that which of the following children would most likely be acceptable as a transplant donor?

Child who died from a motor vehicle collision (A child who died from a motor vehicle collision is most suitable for both organ and tissue donation. Infections and cancer usually preclude individuals from being donors. Prolonged cardiac arrest will limit the use of organs for transplant, but bones, skin, and corneas may be usable.)

The parent of a 10-year-old child with diabetes asks the nurse why home blood glucose monitoring is being recommended. The nurse should base the explanation on which of the following? A It is an easier method of testing. B Parents are better able to manage the diabetes. C Children have a greater sense of control over the diabetes. D Fewer visits to the primary care provider will be necessary.

Children have a greater sense of control over the diabetes. Correct Blood glucose monitoring affords the child a greater sense of control. The immediate feedback allows for regulation of insulin doses. Home blood glucose monitoring provides a more accurate assessment of control than urine testing. Although the parents are involved in the management, a 10-year-old child should take responsibility for testing. The same number of visits will be necessary, but the blood glucose monitoring will enable better control.

The community health nurse is reviewing risk factors for vitamin D deficiency. Which children are at high risk for vitamin D deficiency? (Select all that apply.)

Children who are overweight or obese, Children with diets low in sources of vitamin D, Children of families who use milk products not supplemented with vitamin D. (Populations at risk for vitamin D deficiency include overweight or obese children, children with diets low in sources of vitamin D, and children of families who use milk products not supplemented with vitamin D. Children with dark, not fair, pigmentation and children who are exclusively breast fed, not bottle fed, are also at risk.)

The nurse reviews the record of a newborn infant and notes that a diagnosis of esophageal atresia with tracheoesophageal fistula is suspected. The nurse expects to note which most likely sign of this condition documented in the record?

Choking with feedings (In esophageal atresia and tracheoesophageal fistula, the esophagus terminates before it reaches the stomach, ending in a blind pouch, and a fistula is present that forms an unnatural connection with the trachea. Any child who exhibits the "3 C's"-coughing and choking with feedings and unexplained cyanosis-should be suspected to have tracheoesophageal fistula. Options 1, 2, and 4 are not specifically associated with tracheoesophageal fistula.)

What is the most common cause of secondary hyperparathyroidism? A Diabetes mellitus B Chronic renal disease C Congenital heart disease D Growth hormone deficiency

Chronic renal disease Correct Chronic renal disease is the most common cause of secondary hyperparathyroidism. The parathyroid gland plays an integral role in the maintenance of calcium in the body, as do the kidneys. Diabetes mellitus does not contribute to secondary hypoparathyroidism. Congenital heart disease does not contribute to secondary hypoparathyroidism. Growth hormone deficiency does not contribute to secondary hypoparathyroidism.

An 18-month-old child has just been admitted with croup. His parent is tearful and tells the nurse, "This is all my fault. I should have taken him to the doctor sooner so he wouldn't have to be here." Which of the following is appropriate in the care plan for this parent?

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

A child has an evulsed (knocked out) tooth. The parents are reluctant to try to reimplant the tooth. What should the tooth be placed in for transport to the dentist?

Cold milk (An evulsed tooth should be placed in a suitable medium, either cold milk or saliva (under the child or parent's tongue), for transport. Cold milk is a more suitable medium than water. The tooth should be maintained in a wet environment)

Which of the following is a measure of chest wall and lung distensibility?

Compliance Compliance is a measure of chest wall and lung distensibility. Resistance increases the work of breathing. Three major sources of resistance are airway size, tissue resistance in lung, and flow resistance in the airways. Ventilation is the exchange of gases in the lungs. Alveolar surface tension is one of several contributory factors to compliance.

The nurse should recommend medical attention if a child with a slight head injury experiences which of the following? A Vomiting B Sleepiness C Headache, even if slight D Confusion or abnormal behavior

Confusion or abnormal behavior Correct Altered mental status is a clinical manifestation that the damage from the head injury is progressing. Medical evaluation is necessary. Vomiting may occur after a minor head injury. Observation is required for changes in behavior or vital signs that indicate progression. Sleepiness may occur after a minor head injury. Observation is required to ensure that the child is arousable. Headache is common after a head injury and does not require medical evaluation unless accompanied by other signs of progression.

A long-lasting or recurrent condition that interferes with daily functioning that persists for more than 3 months

Congenital disability

An infant has been diagnosed with failure to thrive (FTT) classified according to the pathophysiology of defective utilization. The nurse understands that the reason for the FTT is most likely related to what?

Congenital infection. (FTT classified according to the pathophysiology of defective utilization is related to a genetic anomaly, congenital infection of metabolic storage disease. Cystic fibrosis would be related to the pathophysiology of inadequate absorption, hyperthyroidism would be related to the pathophysiology of increased metabolism, and breastfeeding problems are related to inadequate caloric intake.)

A 2-year-old child with acute diarrhea has been diagnosed with mild dehydration. Which rehydration methods would the nurse expect the health care provider to prescribe?

Consume oral rehydration fluid, advancing to a regular diet. (Mild dehydration is usually treated at home and consists of age-appropriate diet along with oral rehydration fluids. The BRAT diet does not provide the rehydration needed in a child who is dehydrated. Water does not provide electrolyte fluid replacement, a need during dehydration. Hospitalization is not required with mild dehydration.)

A young child has recently been fitted with a knee, ankle, and foot orthosis (brace). Care of the skin should include which of the following? A Apply lotion or cream to soften the skin. B Contact a practitioner or orthotist if skin redness does not disappear. C Place padding between the skin and brace if the child experiences a burning sensation under the brace. D If a small blister develops, apply rubbing alcohol and place padding between the skin and the brace.

Contact a practitioner or orthotist if skin redness does not disappear. Correct Redness is a sign of skin irritation from the brace. The brace needs to be adjusted to be functional. The skin should not be softened. The brace is specially designed for the child. Padding may alter the alignment of the brace. Rubbing alcohol would be painful. If the brace causes blisters, it needs to be adjusted.

An adolescent girl is cooking on a gas stove when her bathrobe catches fire. Her father smothers the flames with a rug and calls an ambulance. She has sustained major burns over much of her body. Which of the following is also important in her immediate care?

Cool with a single application of tepid water. (In major burns, additional applications of cool water lead to a drop in body temperature and potential circulatory collapse. Nothing is given by mouth because of the risk of aspiration in the presence of a paralytic ileus. As much of her clothing should be removed as possible.)

Therapeutic management of nephrotic syndrome includes which of the following?

Corticosteroids Most children with nephrotic syndrome respond to corticosteroids, making this group the drug of choice. Corticosteroid therapy is begun as soon as the diagnosis has been determined. Children with nephrotic syndrome usually do not respond to diuretics. Furosemide, in combination with metolazone, is useful for severe edema. Antihypertensive agents are not indicated in the management. Fluids are rarely restricted. The child is placed on a no-added-salt diet.

What is an important nursing responsibility when a dysrhythmia is suspected? Order an immediate electrocardiogram. Count the radial pulse every 1 minute for five times. Count the apical pulse for 1 full minute, and compare the rate with the radial pulse rate. Have someone else take the radial pulse simultaneously with the apical pulse.

Count the apical pulse for 1 full minute, and compare the rate with the radial pulse rate. This is the nurse's first action. If a dysrhythmia is occurring, the radial pulse rate may be lower than the apical pulse rate. This may be indicated after conferring with the practitioner. The radial pulse rate needs to be compared with the apical pulse rate. It does not need to be counted for 1 minute five times. Only one nurse is needed to carry out this action.

Which of the following is an important nursing responsibility when a dysrhythmia is suspected? Order an immediate electrocardiogram. Count the radial rate every 1 minute for 5 minutes. Count the apical rate for 1 full minute and compare with radial rate. Have someone else take the radial rate simultaneously with the apical rate.

Count the apical rate for 1 full minute and compare with radial rate. Counting the apical rate for 1 full minute and compare with radial rate is the nurse's first action. If a dysrhythmia is occurring, the radial pulse may be lower than the apical rate. Ordering an immediate electrocardiogram may be indicated after conferring with the practitioner. Radial pulse needs to be compared with the apical. It is the nurse's responsibility to check both rates, radial and apical.

Which of the following urine tests of renal function is used to estimate glomerular filtration?

Creatinine The most useful clinical estimation of glomerular filtration is the clearance of creatinine. The production and secretion of creatinine remain relatively constant from day to day, and its appearance in the urine is determined by the serum level. The pH is a measure of alkalinity, not glomerular filtration. Osmolality is a measure of concentration. The presence of protein is indicative of abnormal glomerular permeability.

A nurse is teaching a group of parents about infants who have failure to thrive. Which of the following characteristics should be included in the teaching?

D. CORRECT: Infants who have failure to thrive exhibit developmental delays as a result of decreased nutritional intake needed for brain development.

A nurse is caring for a child who has a terminal illness and reviews palliative care with an assistive personnel (AP). Which of the following statements by the AP indicates understanding of this review? A. "I'm sure the family is hopeful that the new medication will stop the illness." B. "I'll miss working with this client, now that only nurses will be caring for him." C. "I will get all the client's personal objects out of his room." D. "I will listen and respond as the family talks about their child's life."

D. CORRECT: Palliative care focuses on the process of dying and grieving, which includes using therapeutic communication.

A nurse is teaching a parent about parallel play in children. Which of the following statements by the nurse should be included in the teaching?

D. CORRECT: Parallel play is when the toddler plays independently but is among other children in a group.

A nurse is teaching a group of parents about separation anxiety. Which of the following should be included in the teaching?

D. CORRECT: Physical aggression toward strangers is a behavior seen in the protest stage of separation anxiety.

Which statement best describes pseudohypertrophic (Duchenne) muscular dystrophy (DMD)? DMD is inherited as an autosomal dominant disorder. DMD is characterized by weakness of the proximal muscles of both the pelvic and shoulder girdles. DMD is characterized by muscle weakness, usually beginning at about age 3 years. The onset of DMD occurs in later childhood and adolescence.

DMD is characterized by muscle weakness, usually beginning at about age 3 years. Correct Usually, children with DMD reach the early developmental milestones, but the muscular weakness is usually observed in the third year of life. DMD is inherited as an X-linked recessive disorder. Weakness in a child with DMD is usually first noted in walking. Progressive muscle weakness in other muscle groups then follows. DMD usually develops in the third year of life

A 4-month-old infant comes to the clinic for a well-infant checkup. Immunizations she should receive are DTaP (diphtheria, tetanus, acellular pertussis) and IPV (inactivated poliovirus vaccine). She is recovering from a cold but is otherwise healthy and afebrile. Her older sister has cancer and is receiving chemotherapy. Nursing considerations should include which?

DTaP and IPV can be safely given. (These immunizations can be given safely. Serious illness is a contraindication. A mild illness with or without fever is not a contraindication. These are not live vaccines, so they do not pose a risk to her sister.)

Which of the following best describes a 4-year-old child's concept of death?

Death is temporary (Preschool-age children view death as a type of departure. It is temporary and reversible. Older school-age children recognize the permanence and inevitability of death. Young school-age children personify death as the devil, God, or a bogeyman.)

The nurse is assessing a child with a cardiac problem. The child's extremities are cool with thready pulses, and urinary output is diminished. This is most suggestive of which of the following? Increased afterload Decreased contractility Increased stroke volume Decreased cardiac output

Decreased contractility Decreased contractility is suspected if the extremities are cool with thready pulses and urinary output is diminished. Certain states (e.g., hypoxia, acidosis) are known to depress contractility. Increased blood pressure is indicative of higher afterload. Increased stroke volume and decreased cardiac output will not produce the symptoms described.

What is a secondary effect when a child experiences decreased muscle strength, tone, and endurance from immobilization? A Increased metabolism B Increased venous return C Increased cardiac output D Decreased exercise tolerance

Decreased exercise tolerance Correct Muscle disuse leads to tissue breakdown and loss of muscle mass or muscle atrophy. It may take weeks or months to recover. Metabolism decreases during periods of immobility. There is decreased venous return due to decreased muscle activity secondary to immobility. There is decreased cardiac output secondary to immobility

Parents of a child with cognitive impairment ask the nurse for guidance in toilet training. They have older children who were successfully toilet trained but do not know how to do this with the impaired child. The nurse's recommendation should include which of the following?

Determine the child's readiness to begin toilet training.

A loss or abnormality of structure or function

Developmental disability

Which term refers to the relative lactase deficiency observed in preterm infants of less than 34 weeks of gestation?

Developmental lactase deficiency. (Developmental lactase deficiency refers to the relative lactase deficiency observed in preterm infants of less than 34 weeks of gestation. Congenital lactase deficiency occurs soon after birth after the newborn has consumed lactose-containing milk. Primary lactase deficiency, sometimes referred to as late-onset lactase deficiency, is the most common type of lactose intolerance and is manifested usually after 4 or 5 years of age. Secondary lactase deficiency may occur secondary to damage of the intestinal lumen, which decreases or destroys the enzyme lactase.)

The nurse is administering an oral antihistamine at bedtime to a child with atopic dermatitis (eczema). Which antihistamine should the nurse expect to be prescribed at bedtime?

Diphenhydramine (Benadryl) (Oral antihistamine drugs such as hydroxyzine or diphenhydramine usually relieve moderate or severe pruritus. Nonsedating antihistamines such as cetirizine (Zyrtec), loratadine (Claritin), or fexofenadine (Allegra) may be preferred for daytime pruritus relief. Because pruritus increases at night, a mildly sedating antihistamine such as Benadryl is prescribed.)

In acute glomerulonephritis, the nurse is aware that an early warning sign of encephalopathy is which of the following?

Dizziness Acute and severe hypertension can cause the protective autoregulation of cerebral blood flow to fail, leading to hyperperfusion of the brain and cerebral edema. The premonitory signs of encephalopathy are headache, dizziness, abdominal discomfort, and vomiting. Seizures and transient loss of vision are signs that the condition is progressing. Psychosis is not an early warning sign of hypertensive encephalopathy. Seizures and transient loss of vision are signs that the condition is progressing.

The nurse is teaching an adolescent, newly diagnosed with type I diabetes, ways to minimize discomfort with insulin injections. Which interventions are helpful in minimizing injection discomfort? (Select all that apply.) A Do not reuse needles B Inject insulin when it is cold C Flex or tense the muscle during injection D Remove all bubbles from the syringe prior to injection Do not move the direction of the needle-syringe during insertion or withdrawal

Do not reuse needlesCorrect Remove all bubbles from the syringe prior to injectionCorrect Do not move the direction of the needle-syringe during insertion or withdrawalCorrect

Which muscle is contraindicated for the administration of immunizations in infants and young children?

Dorsogluteal (The dorsogluteal site is avoided in children because of the location of nerves and veins. The deltoid is recommended for 12 months and older. The ventrogluteal and anterolateral thigh sites can safely be used for the administration of vaccines to infants.)

Which of the following should the nurse include when discussing a child's precocious puberty with the parents? A The child is not yet fertile. B Heterosexual interest is usually advanced. C Dress and activities should be appropriate to chronologic age. D Appearance of secondary sexual characteristics does not proceed in the usual order.

Dress and activities should be appropriate to chronologic age. Correct Because of the early sexual maturation of the child, both the family and child require extensive teaching. Included in this is the information that the child should be engaged in activities according to chronologic age. Functioning sperm or ova may be produced, thereby making the child fertile at an early age. Heterosexual interest is usually appropriate to chronologic age. Development of the secondary sexual characteristics proceeds in the usual order.

What statement should the nurse include when discussing a child's precocious puberty with the parents? A The child is not yet fertile. B Sexual interest is usually advanced. C Dress and activities should be appropriate to the chronologic age. D The appearance of secondary sex characteristics does not proceed in the usual order.

Dress and activities should be appropriate to the chronologic age. Correct Development of the secondary sex characteristics proceeds in the usual order. Functioning sperm or ova may be produced, making the child fertile. Heterosexual interest is usually appropriate to the chronologic age. Because of the child's early sexual maturation, both the family and child require extensive teaching. Included in this teaching is the information that the child should be engaged in activities according to his or her chronologic age.

Which of the following is a common clinical manifestation of autism?

Early abnormal eye contact (The inability to maintain eye contact with another individual is a hallmark of autism. The child with autism has spoken language delays, not deafness. Children with autism may be picky eaters or willfully starve themselves or gag to prevent eating. They may also eat any available edible or inedible object. A goal of nursing care is to decrease stimulation. Physical contact can be upsetting to children with autism.)

What is the most important nursing consideration related to congenital hypothyroidism? A Early identification of the disorder B Facilitation of parent-infant attachment C Initiation of referrals for mental retardation D Help for parents in dealing with the child's future prospects

Early identification of the disorder Correct Early diagnosis of congenital hypothyroidism is imperative. Because brain growth is complete by 2 to 3 years of age, the thyroid hormone deficiency must be detected and replacement therapy begun as soon as possible to prevent long-term or life-threatening complications. The promotion of parent-infant attachment is important with all infants. With appropriate intervention, the child may not have any developmental deficit. With appropriate intervention, the child may not have any developmental deficit.

Several types of long-term central venous access devices are used. Which of the following is a benefit of using an implanted port (e.g., Port-a-Cath)?

Easy access for blood work

What procedure uses high-frequency sound waves obtained by a transducer to produce an image of cardiac structures? Echocardiography Electrocardiography Cardiac catheterization Electrophysiology

Echocardiography Echocardiography uses high-frequency sound waves. The child must lie completely still. With the improvements in technology, a diagnosis can sometimes be made without cardiac catheterization. Electrocardiography is an electrical tracing of the depolarization of myocardial cells. Cardiac catheterization is an invasive procedure where a catheter is threaded into the heart, a contrast medium is injected, and the heart and its vessels are visualized. Electrophysiology is an invasive procedure where catheters with electrodes record the impulses of the heart directly from the conduction system.

Which of the following procedures uses high-frequency sound waves obtained by a transducer to produce an image of cardiac structures? Echocardiography Electrophysiology Electrocardiography Cardiac catheterization

Echocardiography Echocardiography uses high-frequency sound waves. The child must lie completely still. With the improvements in technology, diagnosis can sometimes be made without cardiac catheterization. Electrophysiology is an invasive procedure in which catheters with electrodes are used to record the impulses of the heart directly from the conduction system. Electrocardiography is a tracing of the electrical path of the depolarization action of myocardial cells. Cardiac catheterization is an invasive procedure in which a catheter is threaded into the heart.

The school nurse is caring for a boy with hemophilia who fell on his arm during recess. What supportive measures should the nurse use until factor replacement therapy can be instituted? Apply warm, moist compresses. Apply pressure for at least 1 minute. Elevate the area above the level of the heart. Begin passive range-of-motion unless the pain is severe.

Elevate the area above the level of the heart. Correct The initial response should include elevation of the arm to minimize bleeding. Cold should be applied to the arm. This will aid in vasoconstriction, minimizing blood loss. Pressure is effective in small areas but would not be as effective for an extremity. Passive range-of-motion is not recommended. The child can perform active range-of-motion after the bleeding episode has resolved.

The school nurse is caring for a child with hemophilia who fell on his arm during recess. Which of the following supportive measures should the nurse do until factor replacement therapy can be instituted? Apply warm, moist compresses. Apply a tourniquet for at least 5 minutes. Elevate the arm above the level of the heart. Begin passive range of motion unless pain is severe.

Elevate the arm above the level of the heart. Correct The initial response should include elevation. Cold should be applied to the arm. This will aid in vasoconstriction. Pressure is effective in small areas but would not work for an extremity. Passive range of motion is not recommended. The child can perform active range of motion after the bleeding episode has resolved.

Azotemia

Elevation of Blood urea nitrogen and Creatinine.

What is the rationale for elevating an extremity after a soft tissue injury such as a sprained ankle? A Elevation increases the pain threshold. B Elevation increases metabolism in the tissues. C Elevation produces deep tissue vasodilation. D Elevation reduces edema formation.

Elevation reduces edema formation. Correct Elevating the extremity uses gravity to facilitate venous return to reduce edema. Elevation should have no significant effect on the pain threshold. Elevation should not affect metabolism. Venous return to the heart, not vasodilation, is facilitated by elevation.

Chelation therapy is begun on a child with α-thalassemia major. The purpose of this therapy is to do which of the following? Treat the disease. Eliminate excess iron. Decrease risk of hypoxia. Manage nausea and vomiting.

Eliminate excess iron. Correct Iron overload (hemosiderosis) is a complication of blood transfusions. Chelation therapy is necessary to minimize the development of hemosiderosis and hemochromatosis. Blood transfusions are the primary medical management. Chelation therapy removes iron; it does not affect the disease process.

The home health nurse is planning care for a 3-year-old boy who has Down syndrome and is on continuous oxygen. He recently began walking around furniture. He is spoon fed by his parents and eats some finger foods. Which of the following is the most appropriate goal to promote normal development?

Encourage mobility (A major principle for developmental support in children with complex medical issues is that it should be flexible and tailored to the individual child's abilities, interests, and needs. This child is exhibiting readiness for ambulation. It is an appropriate time to take steps that encourage mobility (e.g., providing longer oxygen tubing). The parents should provide decreasing amounts of assistance with self-care as the child is able to develop these skills. He is receiving oral foods and is eating finger foods; therefore, he has already acquired oral-motor skills. Mobility is a new developmental task. Opportunities for socialization should be ongoing.)

An appropriate nursing intervention to minimize separation anxiety in a hospitalized toddler would be which of the following?

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

The nurse is planning care for a child recently diagnosed with diabetes insipidus. Which nursing intervention should be planned? A Encourage the child to wear medical identification. B Discuss with the child and family ways to limit fluid intake. C Teach the child and family how to do required urine testing. D Reassure the child and family that diabetes insipidus is usually not a chronic or life-threatening illness.

Encourage the child to wear medical identification. Correct Because of the unstable nature of the child's fluid and electrolyte balance, wearing a medical alert bracelet or carrying a medical identification card is an extremely important intervention. With diabetes insipidus, the child should have unrestricted access to fluids because the child will characteristically have polyuria due to a hyposecretion of antidiuretic hormone. No urine testing is required with diabetes insipidus. This disorder should not be confused with diabetes mellitus. Diabetes insipidus is both lifelong and life-threatening. Medication must be taken and the effects monitored closely.

The parent of an infant with colic tells the nurse, "All this baby does is scream at me; it is a constant worry." What is the nurse's best action?

Encourage the parent to verbalize feelings.(Colic is multifactorial, and no single treatment is effective for all infants. The parent is verbalizing concern and worry. The nurse should allow the parent to put these feelings into words. An empathetic, gentle, and reassuring attitude, in addition to suggestions about remedies, will help alleviate the parent's anxiety. The nurse should reassure the parent that he or she is not doing anything wrong. The infant with colic is experiencing spasmodic pain that is manifested by loud crying, in some cases up to 3 hours each day. Telling the parent that it will eventually go away does not help him or her through the current situation.)

The nurse is caring for a 2-year-old child who is unconscious but stable after a car accident. The child's parents are staying at the bedside most of the time. What is an appropriate nursing intervention? A Suggest that the parents go home until the child is alert enough to know they are present. B Use ointment on the lips but do not attempt to cleanse the teeth until swallowing returns. C Encourage the parents to hold, talk to, and sing to the child as they usually would. D Position the child with proper body alignment and the head of the bed lowered 15 degrees.

Encourage the parents to hold, talk to, and sing to the child as they usually would. Correct The parents should be encouraged to interact with the child. Senses of hearing and tactile perception may be intact, and stimulation is important in the child's recovery. Suggesting that the parents go home until the child is awake is not recommended. The child may be able to hear that they are present, and this stimulation may assist in recovery. Oral care is essential in the unconscious child. Mouth care should be done at least twice daily to prevent oral infections. The head of the bed should be elevated, not lowered, in a child with neurologic involvement.

The nurse is caring for a 2-year-old girl who is unconscious but stable after a car accident. Her parents are staying at the bedside most of the time. Which of the following is an appropriate nursing intervention? A Suggest that the parents go home until she is alert enough to know they are present. B Encourage the parents to hold, talk, and sing to her as they usually would. C Use ointment on her lips but do not attempt to cleanse her teeth until swallowing returns. D Position her with proper body alignment and the head of the bed lowered 15 degrees.

Encourage the parents to hold, talk, and sing to her as they usually would. Correct The parents should be encouraged to interact with their daughter. Senses of hearing and tactile perception may be intact, and stimulation of these senses is important. The daughter may be able to hear that they are present. Oral care is essential in an unconscious child. Mouth care should be done at least twice daily. The head of the bed should be elevated, not lowered.

The nurse is teaching parents strategies to manage their child's refusal to go to sleep. Which should the nurse include in the teaching session? (Select all that apply.)

Enforce consistent limits, Use a reward system with the child, Have a consistent before bedtime routine.(Strategies to manage a child's refusal to go to sleep include enforcement of consistent limits, using a reward system, and having a consistent before bedtime routine. An evaluation of whether the hour of sleep is too early should be considered because an early bedtime could cause the child to resist sleep if not tired.)

When planning care for a 4-month-old child admitted with respiratory distress caused by respiratory syncytial virus (RSV) and bronchiolitis, it is essential to include which of the following?

Ensure adequate hydration. When respiratory distress is present, hydration is an essential consideration. Usually infants cannot take fluids by the oral route because of the difficulty breathing. Intravenous fluid administration may be necessary. RSV is a virus, so antibiotics are not beneficial. Cough syrup is not routinely used in RSV. Although fluid and calories are important, an infant with respiratory distress is usually unable to drink this amount of fluid.

Nursing considerations related to the administration of oxygen in an infant include which of the following?

Ensure uninterrupted delivery of the appropriate oxygen concentration. The nurse's responsibility is to ensure that the appropriate oxygen concentration is delivered uninterrupted. Oxygen delivery needs to be continued as ordered. Most children receiving oxygen will need the supplemental oxygen during the increased energy expenditure of eating. Ongoing assessment of the infant's respiratory status and oxygen saturation are necessary. Oxygen is a medication, and the amount is prescribed by the practitioner. Oxygen should not blow directly on the infant. Cold air applied to the face can result in the diving reflex, which causes bradycardia and shunting of blood from the periphery to central circulation.

Which of the following types of croup is always considered a medical emergency?

Epiglottitis Epiglottitis is always a medical emergency needing antibiotics and airway support for treatment. Laryngitis is a common viral illness in older children and adolescents, with hoarseness and upper respiratory tract infection symptoms. Spasmodic croup is treated with humidity. Laryngotracheobronchitis may progress to a medical emergency in some children.

Which of the following is an important nursing consideration when caring for an infant with failure to thrive?

Establish a structured routine, which is followed consistently.(An infant with failure to thrive should have a structured routine that is followed consistently. Disruptions in other activities of daily living can have a great impact on feeding behaviors. Bathing, sleeping, dressing, playing, and feeding are structured. The child can engage in sensory and play activities at times other than mealtimes. Young children should be held while being fed, and older children can sit at a feeding table. The child should be fed in the same manner at each meal. The nurse should talk to the child by giving directions about eating. This will help the child maintain focus.)

A nurse would suspect possible visual impairment in a child who displays which of the following?

Excessive rubbing of the eyes (Excessive rubbing of the eyes is a clinical manifestation of visual impairment. A delay in speech development, rapid lateral movement of the eyes, and lack of interest in casual conversation with peers are not associated with visual impairment.)

A new parent relates to the nurse that the family has many known food allergies. Which is considered a primary strategy for feeding the infant with many family food allergies?

Exclusive breastfeeding for 4 to 6 months. (Exclusive breastfeeding for 4 to 6 months is now considered a primary strategy for avoiding atopy in families with known food allergies; however, there is no evidence that maternal avoidance (during pregnancy or lactation) of cow's milk protein or other dietary products known to cause food allergy will prevent food allergy in children. Researchers indicate that delaying the introduction of highly allergenic foods past 4 to 6 months of age may not be as protective for food allergy as previously believed. Likewise, studies have shown that soy formula does not prevent allergic disease in infants.)

A school-age child recently diagnosed with type 1 diabetes mellitus asks the nurse if playing soccer, playing baseball, and swimming are still possible. The nurse's response should be based on knowledge that A Exercise is contraindicated in the type 1 diabetic child B Soccer and baseball are too strenuous, but swimming is acceptable C Exercise is not restricted unless indicated by other health conditions D The level of activity depends on the type of insulin required

Exercise is not restricted unless indicated by other health conditions Correct Exercise is encouraged for children with type 1 diabetes because it lowers blood glucose levels. Insulin and meal requirements require careful monitoring to ensure the child has sufficient energy for exercise. Exercise is highly encouraged. The decrease in blood glucose can be accommodated by having snacks available. Sports are encouraged, with insulin and food adjusted for the exercise. The child needs to be cautioned to monitor responses to the exercise. The level of activity does not depend on the type of insulin used. Long-acting and short-acting insulin may both be used to provide coverage for the training and sporting events.

Parents tell the nurse that their 7-year-old daughter wants to see her brother's body and attend the funeral. Which of the following should the nurse do?

Explain that the child's parents or another significant person should provide support during these experiences. (For children of this age and older, attendance at funerals is both useful and meaningful. It helps the child acknowledge the death, honor the deceased, and receive comfort and support from a parent or significant person. If an open coffin is used for the funeral, the child should be prepared for how her brother will look. The child is asking to attend. Children who participate in the funeral planning and attend the services have higher self-esteem than those who are excluded.)

An infant is born with ambiguous genitalia. Tests are being done to assist in gender assignment. The parents tell the nurse that family and friends are asking what caused the baby to be this way. What should the nurse's explanation include? A Explain the disorder so that the parents can explain it to others. B Help the parents understand that no one knows how this occurs. C Suggest that the parents avoid family and friends until the gender is assigned. D Encourage the parents not to worry while the tests are being done.

Explain the disorder so that the parents can explain it to others. Correct Explaining the disorder to the parents so that they can explain it to others is the most therapeutic approach while the parents await the gender assignment of their child. Ambiguous genitalia are caused by decreased enzyme activity required for adrenocortical production of cortisol. Avoidance of family and friends is impractical and would isolate the family from their support system while awaiting test results. The parents will be concerned. Telling the parents not to worry without giving them specific alternative actions will not be effective.

At the time of a child's death, the nurse tells his mother, "We will miss him so much." The best interpretation of this is that the nurse is doing which of the following?

Expressing personal feelings of loss (The death of a patient is one of the most stressful aspects of being a critical care or oncology nurse. Nurses experience reactions similar to those of family members because of their involvement with the child and family during the illness. Nurses often have feelings of personal loss when a patient dies. There is no implication that the mother's loss is minimized. The nurse is experiencing a normal grief response to the death of a patient. The nurse is validating the worth of the child.)

Which of the following situations places infants at risk for developing vitamin D-deficiency rickets?

Families using yogurt as primary source of milk.(Yogurt does not contain adequate amounts of vitamins A and D. Commercial formulas have recommended amounts of vitamin D. Lack of sunlight is a causative factor. Individuals who follow a lacto-ovovegetarian diet use dairy products and can obtain sufficient vitamin D.)

Rickets is caused by a deficiency in what?

Fat-soluble vitamin D and calcium are necessary in adequate amounts to prevent rickets

A child with lymphoma is receiving extensive radiotherapy. What is the most common side effect of this treatment? Fatigue Seizures Neuropathy Lymphadenopathy

Fatigue Fatigue is the most common side effect of radiotherapy. For children, the fatigue may be distressing because they cannot keep up with their peers. Seizures are unlikely, because irradiation would not usually be cranial for lymphoma. Neuropathy is a side effect of certain chemotherapeutic agents but not of radiotherapy. Lymphadenopathy is one of the findings of lymphoma, not a side effect of radiotherapy.

Which of the following is usually the greatest threat to a hospitalized adolescent?

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

A 3-year-old child has a fever. Her mother calls the nurse reporting a fever of 38.8º C (102º F) even though the child had acetaminophen 2 hours ago. The nurse's action should be based on which of the following?

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

The nurse should make a referral for communication impairment in which of the following situations?

First words not uttered before age 2 years (Usually, children are able to assign meaning to words by the first year of life. A delay until the second birthday is an indication for referral. A referral should be made if stuttering or other dysfluency persists past age 5 years. Referral is indicated if the child is unintelligible at age 3 years. The competency to substitute sounds is not expected until age 5 years.)

Specific components of food or ingredients in food that are recognized by allergen-specific immune cells eliciting an immune reaction

Food allergen

An adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food

Food allergy

A food elicits a reproducible adverse reaction but does not have an established immunologic mechanism

Food intolerance

The clinic nurse reviews the record of an infant and notes that the health care provider has documented a diagnosis of suspected Hirschsprung's disease. The nurse reviews the assessment findings documented in the record, knowing that which symptom most likely led the mother to seek health care for the infant?

Foul-smelling ribbon-like stools (Hirschsprung's disease is a congenital anomaly also known as congenital aganglionosis or aganglionic megacolon. It occurs as the result of an absence of ganglion cells in the rectum and other areas of the affected intestine. Chronic constipation beginning in the first month of life and resulting in pellet-like or ribbon-like stools that are foul-smelling is a clinical manifestation of this disorder. Delayed passage or absence of meconium stool in the neonatal period is also a sign. Bowel obstruction especially in the neonatal period, abdominal pain and distention, and failure to thrive are also clinical manifestations. Options 1, 2, and 3 are not associated specifically with this disorder.)

Ringworm, frequently found in schoolchildren, is caused by which of the following?

Fungus (Ringworm is a dermatophytosis, which is an infection caused by closely related fungi. They cause superficial infections that invade the stratum corneum, hair, and nails. Viruses, allergic reactions, and bacterial infections do not cause ringworm)

An appropriate intervention to encourage food and fluid intake in a hospitalized child is which of the following?

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

What is an appropriate nursing intervention when caring for an infant with an upper respiratory tract infection and elevated temperature?

Give small amounts of favorite fluids frequently to prevent dehydration. Preventing dehydration by small, frequent feedings is an important intervention in a febrile child. Tepid water baths may induce shivering, which raises temperature. Food should not be forced; it may result in the child vomiting. A febrile child should be dressed in light, loose clothing.

Which of the following foods should the nurse recommend as a good source of potassium for a child receiving diuretics?

Grains and legumes .(One combination of foods that provides the appropriate amounts of essential amino acids is grains (cereal, rice, pasta) and legumes (beans, peas, lentils, peanuts). Grains alone do not provide the appropriate amounts of essential amino acids. Dairy products and dark green vegetables do not provide the appropriate amounts of essential amino acids.)

Which of the following food combinations will generally provide the appropriate amounts of essential amino acids for someone who is a vegetarian?

Grains and legumes.(Eating grains (cereal, rice, and pasta) and legumes (beans, peas, lentils, and peanuts) at the same meal provides the appropriate amount of essential amino acids. Grains and vegetables, legumes and vegetables, and milk products and fruit are combinations that do not provide the appropriate amounts of essential amino acids.)

The nurse is caring for a child who has just died. The parents ask to be left alone so that they can rock their child one more time. Which of the following should the nurse do?

Grant their request. (The parents should be allowed to remain with their child after the death. This is an important part of the grieving process and should be allowed if the parents desire. The nurse can remove all the tubes and equipment and offer the parents the option of preparing the body. It is important for the nurse to ascertain whether the family has any special needs.)

Which of the following vaccinations are included in health promotion during infancy? (Select all that apply.)

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

Which of the following vaccinations are included in health promotion during infancy? (Select all that apply.)

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

A young child is being treated for giardiasis. Which of the following should the nurse recommend to the child's parent?

Handwashing will be important to prevent transmission to other family members. (Proper handwashing technique is important to prevent transmission of the parasite to other family members. If a child with giardiasis is in a pool, contamination of the entire pool is a possibility. Treatment may be indicated for up to 1 month to treat parasites that have hatched since treatment began. It is imperative to promote fluid intake to prevent dehydration in the child, so withholding fluids is not an appropriate recommendation)

Which of the following is most descriptive of kwashiorkor?

Has a multifactorial etiology. (Current evidence suggests a multifactorial causation, including cultural, psychologic, and infective factors that interact to place the child at risk. Kwashiorkor appears in infants after being weaned from the breast after the birth of another child. No correlation exists between vitamin K and kwashiorkor. Protein deficiency exists in children with kwashiorkor.)

What is the most appropriate action to stop an occasional episode of epistaxis? Have the child sit up and lean forward. Apply ice under the nose and above the lip. Have the child lie down quietly with the feet elevated. Apply continuous pressure to the nose with the thumb and forefinger for at least 1 minute.

Have the child sit up and lean forward. Correct Sitting up and leaning forward is the position used to prevent the child from aspirating blood. Pressure, not ice, is indicated for an occasional episode of epistaxis. Lying the child down with the feet elevated can potentially lead to aspiration. Continuous pressure for 10 minutes is recommended; 1 minute would not be long enough.

The nurse is explaining blood components to an 8-year-old child. The nurse's best description of platelets is that they do which of the following? Make up the liquid portion of blood Help keep germs from causing infection Carry the oxygen you breathe from your lungs to all parts of your body Help your body stop bleeding by forming a clot (scab) over the hurt area

Help your body stop bleeding by forming a clot (scab) over the hurt area Correct Platelets are involved in hemostasis. Plasma makes up the liquid portion of blood. White blood cells help keep germs from causing infection. Red blood cells carry the oxygen you breathe from your lungs to all parts of your body.

A majority of the population is vaccinated, and the spread of certain diseases is stopped

Herd immunity

What is associated with infant botulism? Contaminated soil Honey and corn syrup Commercial infant cereals Improperly sterilized bottles

Honey and corn syrup Correct Unlike adult botulism, infant botulism is caused by ingesting spores of Clostridium botulinum, with the subsequent release of the toxin. The bacterium has been found in honey and corn syrup that were fed to affected infants. Contaminated soil is not associated with infants who develop infant botulism. Commercial infant cereals are not associated with the development of infant botulism. Improperly sterilized bottles are not associated with the development of infant botulism.

Which of the following is the causative agent for erythema infectiosum (fifth disease)?

Human parvovirus B19. (The human parvovirus B19 is the causative agent. Mumps is caused by paramyxovirus organisms. The human herpesvirus type 6 is the virus responsible for exanthema subitum (roseola). Group A α-hemolytic streptococci infection causes scarlet fever)

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

Hyperthyroidism These symptoms are suggestive of hyperthyroidism. Other symptoms include academic difficulties resulting from a short attention span and an inability to sit still, unexplained fatigue and sleeplessness, and difficulty with fine motor skills. Hypothyroidism is seen with decelerated growth from chronic deprivation of thyroid hormone. Other manifestations are myxedematous skin changes (dry skin, puffiness around the eyes, sparse hair), constipation, sleepiness, and mental decline. Early manifestations of hypoparathyroidism may be anxiety and mental depression followed by paresthesia and evidence of heightened neuromuscular excitability. Hyperparathyroidism results in hypercalcemia, which can be manifested by a change in behavior, gastrointestinal symptoms, and cardiac irregularities.

Rapid replacement of fluid is essential in the treatment of which of the following types of dehydration?

Hypertonic, hypotonic (In moderate to severe dehydration, rapid expansion of the intravascular space is necessary. Rapid replacement is indicated in isotonic dehydration. Osmotic is not a type of dehydration. Rapid replacement is contraindicated in hypertonic dehydration.)

In addition to presenting symptoms, what laboratory finding indicates nephrosis?

Hypoalbuminemia Hypoalbuminemia is a result of the large amounts of protein that leak through the glomerular membrane into the urine in a child with nephrosis. The specific gravity is increased due to the large amount of protein in a child with nephrosis. The hematocrit would be elevated secondary to nephrosis. The hemoglobin would be elevated secondary to the hypovolemia in a child with nephrosis.

What is one of the major physical characteristics of a child with Down syndrome?

Hypotonic musculature (Hypotonic musculature is one of the major characteristics. Children with Down syndrome have short stature. Children with Down syndrome have a transverse palmar crease. Hyperflexibility is a characteristic of Down syndrome.)

Which statement accurately expresses the genetic implications of cystic fibrosis (CF)?

If it is present in a child, both parents are carriers of the defective gene. CF is an autosomal recessive gene inherited from both parents. CF is inherited as an autosomal recessive, not autosomal dominant, trait. CF is found primarily in white populations. An autosomal recessive inheritance pattern means that there is a 25% chance a sibling will be infected but a 50% chance a sibling will be a carrier.

The nurse should recognize that when a child develops diabetic ketoacidosis (DKA), treatment will be instituted as described in which of the following statements? A No treatment is required, because DKA is an expected outcome of type 1 diabetes mellitus B Immediate treatment is required because DKA is a life-threatening situation C DKA is best treated at home D DKA is best treated at a practitioner's office or clinic

Immediate treatment is required because DKA is a life-threatening situation Correct DKA is the complete state of insulin deficiency. It is a medical emergency that must be diagnosed and treated immediately. The child is usually admitted to an intensive care unit for assessment, intravenous insulin administration, and fluid and electrolyte replacement. DKA is a medical emergency needing prompt assessment and intervention, usually in an intensive care environment. It is not an expected outcome of type 1 diabetes mellitus. DKA is a medical emergency that requires hospitalization, usually in an intensive care unit. DKA is a medical emergency that requires hospitalization, usually in an intensive care unit.

A mother calls the school nurse saying that her daughter has developed school phobia. She has been out of school for 3 days. The nurse's recommendations should include which of the following?

Immediately return the child to school (he primary goal is to return the child to school. Parents must be convinced gently, but firmly, that immediate return is essential and that it is their responsibility to insist on school attendance. The longer the child is permitted to stay out of school, the more difficult it will be for the child to reenter. This will only delay the return to school and inhibit the child's ability to cope. Professional counseling is recommended if the problem persists, but the child's return to school should not wait for the counseling.)

The parents of a child with cerebral palsy ask the nurse if any drugs can decrease their child's spasticity. The nurse's response should be based on which of the following? Anticonvulsant medications are sometimes useful for controlling spasticity. Medications that would be useful in reducing spasticity are too toxic for use with children. Many different medications can be highly effective in controlling spasticity. Implantation of a pump to deliver medication into the intrathecal space decreases spasticity.

Implantation of a pump to deliver medication into the intrathecal space decreases spasticity. Correct Baclofen, given intrathecally, is best suited for children with severe spasticity that interferes with activities of daily living and ambulation. Anticonvulsant medications are used when seizures occur in children with cerebral palsy. The intrathecal route decreases the side effects of the drugs that reduce spasticity. Few medications are currently available for the control of spasticity.

An infant has been diagnosed with failure to thrive (FTT) classified according to the pathophysiology of inadequate caloric intake. The nurse understands that the reason for the FTT is most likely related to what?

Incorrect formula preparation. (FTT classified according to the pathophysiology of inadequate caloric intake is related to incorrect formula preparation, neglect, food fads, excessive juice poverty, breastfeeding problems, behavioral problems affecting eating, parental restriction of caloric intake, or central nervous system problems affecting intake consumption. Cow's milk allergy would be related to the pathophysiology of inadequate absorption, congenital heart disease would be related to the pathophysiology of increased metabolism, and metabolic storage disease is related to defective utilization.)

During the summer, many children are more physically active. What changes in the management of the child with type 1 diabetes mellitus should be expected as a result of more exercise? A Increased food intake B Decreased food intake C Increased risk of hyperglycemia D Decreased risk of insulin shock

Increased food intake Correct Food intake should be increased in the summer when the child is more active. During races and other competitions, more food may be required than at other practice times to maintain a balance between glucose and exogenously administered insulin. The child will require increased food on days of increased activity. The increased activity lowers blood glucose levels. Blood sugars must be monitored closely to avoid administering too much insulin during a time of reduced need.

In which of the following conditions is the fluid requirement for children decreased?

Increased intracranial pressure (When there is a risk of increased intracranial pressure, the child's fluid balance is carefully monitored to ensure that only required fluids are given. With burns, fever, and vomiting, the child loses fluids at a greater than expected rate. Supplemental fluids need to be given to avoid the risk of dehydration.)

Normal Range for Creatinine

Infant 0.2 - 0.4mg/ dl Child 0.3 - 0.7mg/dl Adolescent 0.5 - 1.0mg/dl

Which of the following helps nurses understand how the respiratory tract in children is different from that in adults?

Infants rely almost entirely on diaphragmatic-abdominal breathing. The ribs of an infant articulate with the vertebrae and sternum at a more horizontal angle. This contributes to the infant using primarily diaphragmatic-abdominal breathing. Smooth muscle development at approximately 4 months of age is sufficient to respond to irritating stimuli. The chest of an infant is more rounded than that of an adult. Alveoli steadily increase in number. By age 12 years, there are nine times as many alveoli as at birth.

Pyelonenephritis

Inflammation of Upper Urinary Tract and Kidney

Glomerulonephritis

Inflammation of the glomerulus of nephron

An adolescent girl dies in the emergency department after a car accident. Her family arrives at the hospital shortly after the death. They request to see her body. Because she is disfigured from the accident, the most appropriate nursing action is which of the following?

Inform them of what to expect and then let them see their daughter. (Prepare the family before viewing by telling them what to expect. Include bodily changes from the accident, tubes, and cold skin. The parents can be asked if they would like a clergyperson present. Requesting to see their daughter is not a problem. Encouraging the parents to delay or to not see their daughter are not appropriate interventions. The parents should be accompanied by a staff member with bereavement training.)

Which of the following is an important nursing intervention when performing a bladder catheterization on a young boy?

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

A 2-year-old child is admitted to a hospital burn unit with partial- and full-thickness burns involving 35% of body surface area. After admission assessment and review of the health care provider's prescriptions, the priority nursing intervention should focus on which action?

Inserting a Foley catheter (A Foley catheter is inserted into the child's bladder so that urine output can be measured accurately each hour. A nasogastric tube may or may not be required, but this is not the priority intervention. Although pain medication may be required, the child should not be sedated. Intravenously administered fluids are not restricted and are administered at a rate sufficient to keep the child's urine output at 1 mL/kg of body mass per hour, thus reflecting adequate tissue perfusion.)

The school nurse is discussing prevention of acquired immunodeficiency syndrome (AIDS) with some adolescents. Which statement is appropriate to include? The virus is easily transmitted. The virus is transmitted only through blood. Intravenous drug users should not share needles. Condoms should be used if a person is sexually active and homosexual.

Intravenous drug users should not share needles. Correct Human immunodeficiency virus (HIV) is spread through blood and body fluids. Intravenous needles that have been used should not be shared. They may be contaminated with the virus. The virus is not easily transmitted. It requires direct contact with blood or body fluids on a nonintact skin surface. Body fluids may also transmit the virus. Condoms should be used for both heterosexual and homosexual sex.

The nurse is helping parents achieve a more nutritionally adequate vegetarian diet for their children. Which is most likely lacking in their particular diet?

Iron and calcium. (Deficiencies can occur when various substances in the diet interact with minerals. For example, iron, zinc, and calcium can form insoluble complexes with phytates or oxalates (substances found in plant proteins), which impair the bioavailability of the mineral. This type of interaction is important in vegetarian diets because plant foods such as soy are high in phytates. Fat and vitamins C and A are readily available from vegetable sources. Plant proteins are available)

What may a clinical manifestations of failure to thrive (FTT) in a 13-month-old include?

Irregularity in activities of daily living. (One of the clinical manifestations of children with FTT is irregularity or low rhythmicity in activities of daily living. Children with FTT often refuse to switch from liquids to solid foods. Weight below the fifth percentile is indicative of FTT. Developmental delays, including social, motor, adaptive, and language, exist.)

Which of the following is a clinical manifestation of increased intracranial pressure (ICP) in infants? A Irritability B Photophobia C Vomiting and diarrhea D Pulsating anterior fontanel

Irritability Irritability is one of the changes that may indicate increased ICP. Photophobia is not indicative of increased ICP in infants. A pulsing anterior fontanel is normal. Vomiting is one of the signs of increased ICP in children, but when present with diarrhea, it is indicative of a gastrointestinal disturbance.

What type of dehydration is defined as "dehydration that occurs in conditions in which electrolyte and water deficits are present in approximately balanced proportion?"

Isotonic dehydration (Isotonic dehydration is the correct term for this definition and is the most frequent form of dehydration in children. Hypotonic dehydration occurs when the electrolyte deficit exceeds the water deficit, leaving the serum hypotonic. Hypertonic dehydration results from water loss in excess of electrolyte loss and is usually caused by a proportionately larger loss of water or a larger intake of electrolytes. "Dehydration that occurs in conditions in which electrolyte and water deficits are present in approximately balanced proportion" is a definition specific to isotonic dehydration.)

Which statement best describes Cushing syndrome? A It is caused by excessive production of cortisol. B The major clinical features are exophthalmia and pigmentary changes. C Treatment involves replacement of cortisol. D Diagnosis is suspected with findings of hypotension, hyperkalemia, and polyuria.

It is caused by excessive production of cortisol. Correct Cushing syndrome is a description of the clinical manifestations caused by too much circulating cortisol. Exophthalmia and pigmentary changes are manifestations of hyperthyroidism, not Cushing syndrome. The treatment for Cushing syndrome involves the reduction of circulating cortisol. If the cause is a pituitary tumor, surgery is indicated. Hypertension and hypokalemia—not hypotension, hyperkalemia, or polyuria—are expected findings with Cushing syndrome.

Which of the following statements best describes Cushing syndrome? A It is caused by excessive production of cortisol. B Treatment involves replacement of cortisol. C The major clinical features are exophthalmia and pigmentary changes. D The diagnosis is suspected with findings of hypotension, hyperkalemia, and polyuria.

It is caused by excessive production of cortisol. Correct Cushing syndrome is a description of the clinical manifestations caused by too much circulating cortisol. In children, this is caused by a tumor or excessive and prolonged steroid therapy. The treatment is reduction of circulating cortisol. If the cause is a pituitary tumor, surgery is indicated. Exophthalmia is a manifestation of hyperthyroidism, not Cushing syndrome. Hypertension and hypokalemia are expected findings.

The mother of an infant diagnosed with Hirschsprung's disease asks the nurse about the disorder. What should the nurse tell the mother about the disease?

It is congenital aganglionosis or megacolon. (Hirschsprung's disease is also known as congenital aganglionosis or megacolon. It is the result of an absence of ganglion cells in the rectum and to varying degrees upward in the colon. The remaining options are incorrect descriptions.)

Which is usually the only symptom of pediculosis capitis (head lice)?

Itching .(Itching is generally the only manifestation of pediculosis capitis (head lice). Diagnosis is made by observation of the white eggs (nits) on the hair shaft. Vesicles, scalp rash, and localized inflammatory response are not symptoms of head lice.)

A 6-year-old child needs to be hospitalized again because of a chronic illness. The clinic nurse overhears her school-age siblings tell her that they are "sick of Mom always sitting with her in the hospital and playing with her. . . . It isn't fair that you get everything and we have to stay with the neighbors." Which of the following is the nurse's best assessment of this situation?

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

The nurse is planning care for a school-age child with bacterial meningitis. Which nursing intervention should be included? A Keep environmental stimuli to a minimum. B Avoid giving pain medications that could dull the sensorium. C Measure the head circumference to assess developing complications. D Have the child move the head side to side at least every 2 hours.

Keep environmental stimuli to a minimum. Correct Children with meningitis are sensitive to noise, bright lights, and other external stimuli because of the irritation on the meningeal nerves. The nurse should keep the room as quiet as possible with a minimum of external stimuli, including lighting. After consultation with the practitioner, pain medications can be used on an as-needed basis. A school-age child will have closed sutures; therefore, the head circumference cannot change. The head circumference is not relevant to a child of this age. The child is placed in a side-lying position, with the head of the bed slightly elevated. The nurse should avoid measures such as lifting the child's head that increase discomfort and put tension on the neck.

The nurse is discussing the management of atopic dermatitis (eczema) with a parent. What should be included?

Keep the infant's fingernails and toenails cut short and clean.(The infant's nails should be kept short and clean and have no sharp edges. Gloves or cotton socks can be placed over the child's hands and pinned to the shirt sleeves. Heat and humidity increase perspiration, which can exacerbate the eczema. The child should be dressed properly for the climate. Synthetic material (not wool) should be used for the child's clothing during cold months. Baths are given as prescribed with tepid water, and emollients such as Aquaphor, Cetaphil, and Eucerin are applied within 3 minutes. Soap (except as indicated), bubble bath oils, and powders are avoided. Fabric softener should be avoided because of the irritant effects of some of its components.)

A child is status post hematopoietic stem cell transplantation (HSCT) and is preparing for discharge home. Based on the nurse's knowledge of HSCT, which concepts are important to include in the discharge teaching plan of care? (Select all that apply.) Preparing the child to return to school within six weeks Keeping the child on a high-calcium diet Avoiding live plants and fresh vegetables Avoiding influenza vaccinations Practicing good hygiene

Keeping the child on a high-calcium dietCorrect Avoiding live plants and fresh vegetablesCorrect Practicing good hygieneCorrect

Which of the following is the most frequent source of symptomatic lead poisoning in children?

Lead-based paint. (Lead-based paint in houses built before 1978 is the most frequent source of lead poisoning. Some folk remedies and unglazed pottery may contain lead, but they are not the most frequent source. Cigarette butts and ashes do not contain lead.)

Which of the following is a major complication of total parenteral nutrition in children?

Liver disease (Liver disease is the most important gastrointestinal complication of total parenteral nutrition. If present, anemia and asthma are not directly related to the total parenteral nutrition. Renal function is monitored to ensure electrolyte balance, but impairment is not an expected complication.)

What are risk factors for sudden infant death syndrome? (Select all that apply.)

Low Apgar scores, Recent viral illness, Native American infants. (Infant risk factors for sudden infant death syndrome include those with low Apgar scores and recent viral illness and Native American infants. Preterm, not postterm, birth and male, not female, gender are other risk factors.)

Which of the following clinical manifestations in an infant would be suggestive of spinal muscular atrophy (Werdnig-Hoffmann disease)? Hypertonicity Lying in the frog position Hyperactive deep tendon reflexes Motor deficits on one side of body

Lying in the frog position Correct The infant lies in the frog position with the legs externally rotated, abducted and flexed at knees. The child has hypotonia and inactivity as the most prominent features. The deep tendon reflexes are absent. The motor deficits are bilateral.

What is an important nursing responsibility when dealing with a family experiencing the loss of an infant from sudden infant death syndrome (SIDS)?

Make a follow-up home visit to the parents as soon as possible after the child's death. (A competent, qualified professional should visit the family at home as soon as possible after the death. Printed information about SIDS should be provided to the family. Parents should be allowed and encouraged to make a last visit with their child. SIDS cannot always be prevented or predicted, but parents can take steps to reduce the risk (e.g., supine sleeping, removing blankets and pillows from the crib, and not smoking). Discussions about the cause only increase parental guilt. The parents should be asked only factual questions to determine the cause of death.)

An 18-month-old child has been diagnosed with pediculosis capitis (head lice). Which prescription should the nurse question if ordered for the child?

Malathion (Ovide) .(The nurse should question malathion for an 18-month-old child. Malathion contains flammable alcohol, must remain in contact with the scalp for 8 to 12 hours, and is not recommended for children younger than 2 years of age. The drug of choice for infants and children is permethrin 1% cream rinse (Nix) or pyrethrin with piperonyl butoxide, which kill adult lice and nits. Benzyl alcohol 5% lotion has been approved by the Food and Drug Administration for the treatment of head lice in children as young as 6 months.)

Which of the following is descriptive of attention-deficit/hyperactivity disorder (ADHD)?

Manifestations affect every aspect of the child's life but are most obvious in the classroom. (ADHD affects every aspect of the child's life, but the disruption is most obvious in the classroom. The behaviors exhibited by the child with ADHD are not unusual aspects of behavior. The difference lies in the quality of motor activity and developmentally inappropriate inattention, impulsivity, and hyperactivity that the child displays. Some children experience decreased symptoms during late adolescence and adulthood, but a significant number carry their symptoms into adulthood. Any given child will not have every symptom of the condition. The manifestations may be numerous or few and mild or severe, and they vary with the child's developmental level.)

Nursing considerations related to the administration of chemotherapeutic drugs include Many chemotherapeutic agents are vesicants that can cause severe cellular damage if the drug infiltrates Good hand washing is essential when handling chemotherapeutic drugs, but gloves are not necessary Infiltration will not occur, unless superficial veins are used for the intravenous infusion Anaphylaxis cannot occur, because the drugs are considered toxic to normal cells

Many chemotherapeutic agents are vesicants that can cause severe cellular damage if the drug infiltrates Correct Chemotherapeutic agents can be extremely damaging to cells. Nurses experienced with the administration of vesicant drugs should be responsible for giving these drugs and prepared to treat extravasations if necessary. Gloves are worn to protect the nurse when handling the drugs, and the hands should be thoroughly washed afterward. Infiltration and extravasations are always a risk, especially with peripheral veins. Anaphylaxis is a possibility with some chemotherapeutic and immunologic agents, including asparaginase (Elspar).

Which factors will decrease iron absorption and should not be given at the same time as an iron supplement?

Many foods interfere with iron absorption and should be avoided when iron is consumed. These foods include phosphates found in milk, phytates found in cereals, and oxalates found in many vegetables.

What is marasmus?

Marasmus is a syndrome of emotional and physical deprivation. It is not confined to geographic areas were food supplies are inadequate. Marasmus is characterized by gradual wasting and atrophy of body tissues, especially of subcutaneous fat. The child appears old, with flabby and wrinkled skin. Marasmus is a deficiency of both protein and calories

Which of the following occurs in septic shock?

Massive vasodilation (In septic shock, an infection triggers an inflammatory response, which results in massive vasodilation and increased capillary permeability. Respirations are not affected. Capillary permeability is increased. Vasodilation results in decreased systemic vascular resistance.)

What is important when caring for a child with myelomeningocele in the preoperative stage? Place the child on one side to decrease pressure on the spinal cord. Apply a heat lamp to facilitate drying and toughening of the sac. Keep the skin clean and dry to prevent irritation from diarrheal stools. Measure the head circumference and examine the fontanels for signs that might indicate developing hydrocephalus.

Measure the head circumference and examine the fontanels for signs that might indicate developing hydrocephalus. Correct Obstructive hydrocephalus is frequently associated with myelomeningocele. Assessment of the fontanels and daily measurements of the head circumference will aid in early detection of associated increased intracranial pressure. Preoperatively, the child is kept in a prone position to decrease tension on the sac and reduce the risk of trauma or sac tearing. The sac must be kept moist. Sterile, moist, nonadherent dressings are placed over the sac as prescribed by the physician. Most infants do not have diarrheal stools. The sac area, though, should be kept clean and dry and out of contact with urine and stools.

Cystic fibrosis may affect one system or multiple systems of the body. What is the primary factor responsible for possible multiple clinical manifestations?

Mechanical obstruction caused by increased viscosity of exocrine gland secretions Children with cystic fibrosis have thick exocrine gland secretions. The viscous secretions obstruct small passages in organs such as the lungs and pancreas. Thick mucous secretions are the probable cause of the multiple body system involvement, not atrophic changes in the intestinal mucosal walls. There is an identified autonomic nervous system anomaly, but it is not hypoactivity. The apocrine, or sweat, glands are not hyperactive. The child loses a greater amount of salt due to abnormal chloride movement.

Which of the following would be helpful word(s) to substitute for the word "shot" when working with a 4-year-old?

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

The nurse is reviewing the laboratory results for an infant with suspected hypertrophic pyloric stenosis. What should the nurse expect to note as the most likely finding in this infant?

Metabolic alkalosis (Laboratory findings in an infant with hypertropic pyloric stenosis include metabolic alkalosis as a result of the vomiting that occurs in this disorder. Additional findings include decreased serum potassium and sodium levels, increased pH and bicarbonate level, and decreased chloride level. Options 1, 3, and 4 are incorrect.)

A child is hospitalized because of persistent vomiting. The nurse should monitor the child closely for which problem?

Metabolic alkalosis (Vomiting causes the loss of hydrochloric acid and subsequent metabolic alkalosis. Metabolic acidosis would occur in a child experiencing diarrhea because of the loss of bicarbonate. Diarrhea might or might not accompany vomiting. Hyperactive bowel sounds are not associated with vomiting.)

Depression of the central nervous system (CNS), manifested by lethargy, delirium, stupor, and coma, is observed in which of the following?

Metabolic and respiratory acidosis (Hydrogen ion imbalances result in CNS involvement. Depression of the CNS, as manifested by lethargy, delirium, diminished mental capacity, stupor, and coma, is found in acidosis that is either metabolic or respiratory in origin. Respiratory acidosis can also manifest these clinical findings. Respiratory and metabolic alkalosis are reflected clinically by CNS excitation and stimulation, nervousness, tingling sensations, and tetany that may progress to seizures.)

A 12-month-old infant has been diagnosed with failure to thrive (FTT). Which assessment findings does the nurse expect to be documented with this infant? (Select all that apply.)

Minimal smiling, Avoidance of eye contact,Wide-eyed gaze and continual scan of the environment. (Signs and symptoms of FTT include minimal smiling, avoidance of eye contact, and a wide-eyed gaze and continual scan of the environment ("radar gaze"). There is no fear of strangers, and there are developmental delays, including social, motor, adaptive, and language.)

A child admitted to the hospital with a diagnosis of gastroenteritis and dehydration weighs 17 pounds 2 ounces. The parents state that his preadmission weight was 18 pounds 4 ounces. Based on weight alone, what type of dehydration does the nurse expect?

Moderate dehydration (Mild dehydration is a weight loss of 3% to 5%; moderate dehydration is 6% to 10%; severe dehydration is greater than 10% weight loss. All types of dehydration are acute situations. The answer can be determined by calculating the percent of weight loss in dehydration. Because the math calculation determines more than a 5% weight loss but less than 10% weight loss, the correct answer is moderate dehydration. By calculating the percent of weight loss, the correct answer can be determined.)

The nurse is caring for a child diagnosed with Down's syndrome. In describing the disorder to the parents, what characteristics are most closely associated with the syndrome and serve as the basis for the nurse's explanation?

Moderate to severe retardation and linkage to an extra chromosome 21, group G (Down's syndrome is a form of mental retardation and is a congenital condition that results in moderate to severe mental retardation. Most cases are attributable to an extra chromosome (group G)-hence the name trisomy 21. Options 1, 2, and 4 are incorrect characteristics of this syndrome.)

Which of the following factors promote(s) wound healing?

Moist, crust-free wound environment (moist, crust-free wound environment enhances the migration of epithelial cells across the wound and facilitates healing. Antiseptics, such as hydrogen peroxide and povidone-iodine, have a cytotoxic effect on healthy cells and little effect on controlling infections. )

A nursing student is caring for an infant with a respiratory infection and is monitoring for signs of dehydration. The nursing instructor asks the student to identify the most reliable method of determining fluid loss. Which statement by the student indicates an understanding of the method to determine fluid loss?

Monitor body weight. (Body weight is the most reliable method of measuring body fluid loss or gain. One kilogram of weight change represents 1 L of fluid loss or gain. Options 2, 3, and 4 are also appropriate measures to assess for dehydration, but the most reliable method is to monitor body weight.)

An appropriate nursing intervention when caring for a child with pneumonia is which of the following?

Monitor the respiratory status frequently. The child's respiratory rate, status, oxygenation, general disposition, and level of activity are frequently monitored. Lying on the affected side may promote comfort by splinting the chest and reducing pleural rubbing. The child should be positioned with the unaffected side up to promote maximum expansion. Children should be placed in a semierect position or position of comfort. Antitussives are usually not indicated.

An infant has been diagnosed with an allergy to milk. In teaching the parent how to meet the infant's nutritional needs, the nurse states that

Most children will grow out of the allergy. (Approximately 80% of children with cow's milk allergy develop tolerance by the fifth birthday. The child can have eggs. Any food that has milk as a component or filler is eliminated. These foods include processed meats, salad dressings, soups, and milk chocolate. Having the entire family follow the special diet would provide support for the child, but the nutritional needs of other family members must be addressed. Antihistamines are not used for food allergies.)

What is appropriate mouth care for a toddler with mucosal ulceration related to chemotherapy? Lemon glycerin swabs for cleansing Mouthwashes with normal saline Mouthwashes with hydrogen peroxide Local anesthetic such as viscous lidocaine before meals

Mouthwashes with normal saline Correct Normal saline mouthwashes are the preferred mouth care for this age group. The rinse will keep the mucosal surfaces clean without adverse effects on mucosa or problems if the child swallows the rinse. Lemon glycerin swabs can irritate eroded tissue and can decay teeth. Hydrogen peroxide delays healing by breaking down protein. Viscous lidocaine is not recommended for toddlers, because it depresses the gag reflex and the child may have resultant aspiration.

What is an appropriate nursing intervention when caring for the child with chronic osteomyelitis? A Provide active range-of-motion exercises of the affected extremity. B Administer pain medication with meals. C Encourage frequent ambulation. D Move and turn the child carefully and gently to minimize pain.

Move and turn the child carefully and gently to minimize pain. Correct Osteomyelitis is extremely painful. Movement is carried out only as needed and then carefully and gently. Active range-of-motion exercises are contraindicated until pain has subsided. Pain medication should be administered as needed. Ambulation is contraindicated until pain has subsided.

What is an important nursing consideration when caring for a child with end-stage renal disease (ESRD)?

Multiple stresses are placed on children with ESRD and their families because their lives are maintained by drugs and artificial means. ESRD is a chronic, progressive illness with dependence on technology. Families need to arrange for continuing examinations and procedures that are often painful and may require hospitalization. ESRD is a complex disease process that requires substantial medical intervention and is not minor in its treatment modalities. ESRD cannot be outgrown. Dialysis is necessary until renal transplantation is performed. ESRD cannot be cured. Dialysis is necessary until renal transplantation is performed.

An 8-year-old child is hospitalized with infectious polyneuritis (Guillain-Barré syndrome). When explaining this disease process to the parents, what should the nurse consider? Paralysis is progressive, with little hope for recovery. Muscle function will gradually return, and recovery is possible in most children. Guillain-Barré syndrome results from an apparently toxic reaction to certain medications. Guillain-Barré syndrome is inherited as an autosomal recessive, sex-linked gene.

Muscle function will gradually return, and recovery is possible in most children. Correct Most patients regain full muscle strength following recovery from Guillain-Barré syndrome. The return of function is in reverse order of onset. Onset occurs as ascending paralysis; recovery occurs as descending return of function. The paralysis is progressive in Guillain-Barré syndrome, but most children have full recovery. Supportive nursing care is essential. Guillain-Barré syndrome is an immune-mediated disease most often associated with viral infections. During the history, the parents should be asked about the child's having a cold or viral infection within the past 2 weeks. Guillain-Barré syndrome is an immune-mediated disease most often associated with viral infections. Awarded 0.0 points out of 1.0 possible points.

Why are infants particularly vulnerable to acceleration-deceleration head injuries? A The anterior fontanel is not yet closed. B The nervous tissue is not well developed. C The scalp of the head has extensive vascularity. D Musculoskeletal support of the head is insufficient.

Musculoskeletal support of the head is insufficient. Correct The relatively large head size coupled with insufficient musculoskeletal support increases the risk to infants. The anterior fontanel, nervous tissue, and scalp of the head do not have an effect on this type of injury.

What clinical manifestation would the nurse expect when a pneumothorax occurs in a neonate who is undergoing mechanical ventilation?

Nasal flaring and retractions Nasal flaring, retractions, and grunting are signs of respiratory distress in a neonate. Barrel chest develops with chronic obstructive pulmonary disease, not with acute pneumothorax. Wheezing has a greater association with bronchopulmonary dysplasia or an obstruction in the airways than with an acute pneumothorax. An acute pneumothorax would not affect the neonate's thermal stability.

The nurse has administered a dose of epinephrine to a 12-month-old infant. For which adverse reactions of epinephrine should the nurse monitor? (Select all that apply.)

Nausea,Tremors,Irritability. (Epinephrine increases activation of the sympathetic nervous system. Adverse effects include nausea, tremors, and irritability. Tachycardia would occur, not bradycardia, and hypertension, not hypotension, would occur.)

The nurse is monitoring a child with burns during treatment for burn shock. The nurse understands that which assessment provides the most accurate guide to determine the adequacy of fluid resuscitation?

Neurological assessment (Sensorium is an accurate guide to determine the adequacy of fluid resuscitation. The burn injury itself does not affect the sensorium, so the child should be alert and oriented. Any alteration in sensorium should be evaluated further. A neurological assessment would determine the level of sensorium in the child. Options 1, 3, and 4 would not provide an accurate assessment of the adequacy of fluid resuscitation.)

What does impetigo ordinarily results in?

No scarring. (Impetigo tends to heal without scarring unless a secondary infection occurs.)

Which statement is true concerning osteogenesis imperfecta (OI)? A OI is easily treated. B OI is an inherited disorder. C With a later onset, the disease usually runs a more difficult course. D Braces and exercises are of no therapeutic value.

OI is an inherited disorder. Correct OI is an autosomal dominant inherited disorder. OI is a lifelong problem caused by defective bone mineralization, abnormal bone architecture, and increased susceptibility to fracture. OI has a predictable course that is determined by the pathophysiologic processes, not the time of onset. Lightweight braces and splints can help support limbs and fractures.

The nurse has provided dietary instructions to the mother of a child with celiac disease. The nurse determines that further instruction is needed if the mother states that she will include which food item in the child's nutritional plan?

Oatmeal (Dietary management is the mainstay of treatment for the child with celiac disease. All wheat, rye, barley, and oats should be eliminated from the diet and replaced with corn and rice. Vitamin supplements, especially fat-soluble vitamins and folate, may be needed in the early period of treatment to correct deficiencies.)

When caring for a child with an intravenous infusion, the nurse should do which of the following?

Observe the insertion site frequently for signs of infiltration (The nursing responsibility for intravenous therapy is to calculate the amount to be infused in a given length of time; set the infusion rate; and monitor the apparatus frequently, at least every 1 to 2 hours, to make certain that the desired rate is maintained, the integrity of the system remains intact, the site remains intact (free of redness, edema, infiltration, or irritation), and the infusion does not stop. Insertion sites do not need to be changed every 24 hours unless a problem is found with the site. This exposes the child to significant trauma. If an infusion pump is not used, a minidropper (60 drops/ml) is the recommended intravenous tubing in children. The intravenous site should be protected. This may require soft restraints on the child.)

Which of the following is the primary clinical manifestation of acute renal failure?

Oliguria Oliguria is the primary clinical symptom of acute renal failure. Generally, urinary output is less than 1 ml/kg/hr. Hematuria, proteinuria, and bacteriuria may be present in renal disease, but they are not the primary manifestations of acute renal failure.

The clinic nurse is assessing a child for dehydration. The nurse determines that the child is moderately dehydrated if which finding is noted on assessment?

Oliguria (In moderate dehydration, the fontanels would be slightly sunken, the mucous membranes would be dry, and the skin color would be dusky. Also, oliguria would be present.)

Oliguria

Oliguria is defined as a urine output that is less than 1 mL/kg/h in infants, less than 0.5 mL/kg/h in children.

For case management to be most effective, who is the most appropriate case manager?

One nurse (Nursing case managers are ideally suited to provide the care coordination necessary. Care coordination is most effective if a single person works with the family to accomplish the many tasks and responsibilities that are necessary. The family retains the role as primary decision maker. It is preferable that the family have only one individual to work with. Most likely, the insurance company will have a case manager focusing on the financial aspects of care. This does not include coordination of care to assist the family. )

Nursing care of the infant and child with heart failure would include which of the following? Force fluids appropriate to age. Monitor respirations during active periods. Organize activities to allow for uninterrupted sleep. Give larger feedings less often to conserve energy.

Organize activities to allow for uninterrupted sleep. The child needs to be well rested before feeding. The child's needs should be met as quickly as possible to minimize crying. The nurse must organize care to minimize the child's energy expenditure. The child who has heart failure has an excess of fluid. Monitoring vital signs is appropriate, but minimizing energy expenditure is a priority. The child often cannot tolerate larger feedings.

The nurse is teaching parents about potential causes of colic in infancy. Which should the nurse include in the teaching session? (Select all that apply.)

Overeating, Parental smoking, Swallowing excessive air. (Potential causes of colic include too rapid feeding, overeating, swallowing excessive air, improper feeding technique (especially in positioning and burping), emotional stress or tension between the parent and child, parental smoking, and overstimulation.)

Which of the following blood oxygenation tests is the photometric measurement of oxygen saturation?

Oximetry Oximetry provides continuous noninvasive measurements of hemoglobin saturation. Photometric measurements are used to determine the oxygen saturation. Capnography measures carbon dioxide during inhalation and exhalation. Arterial puncture is the sampling method to obtain blood for gas analysis. Transcutaneous oxygen and carbon dioxide monitoring provides a continuous and reliable trend of arterial oxygen and carbon dioxide.

A nurse is caring for an infant with gastroenteritis who is being treated for dehydration. The nurse reviews the health record and notes that the health care provider has documented that the infant is mildly dehydrated. Which assessment finding should the nurse expect to note in mild dehydration?

Pale skin color (In mild dehydration the skin color is pale. Options 1 and 3 are assessment characteristics of severe dehydration. Option 4 is an assessment characteristic of moderate dehydration. )

Which of the following terms best describes a multidisciplinary approach to the management of a terminal illness that focuses on symptom control and support?

Palliative care (A multidisciplinary approach to the management of a terminal illness that focuses on symptom control and support is one of the definitions of palliative care. The goal of palliative care is the achievement of the best possible quality of care for patients and their families. Dying care is what is provided when death is imminent. Curative care is aimed at illnesses for which cure is still a possibility. The goal of restorative care is to regain health and strength.)

Temporary immunity from the mother to the fetus via the placenta

Passive immunity

The nurse is teaching parents about foods that are hyperallergenic. Which foods should the nurse include? (Select all that apply.)

Peanuts, Egg noodles, Tomato juice. (Hyperallergenic foods include peanuts, egg noodles, and tomato juice. Bananas and potatoes are not hyperallergenic.)

A 3-year-old child is status post shunt revision for hydrocephaly. Part of the discharge teaching plan for the parents is signs of shunt malformation. Which signs are of shunt malformation? (Select all that apply.) A Personality change B Bulging anterior fontanel C Vomiting D Dizziness E Fever

Personality changeCorrect VomitingCorrect FeverCorrect

What are the most common signs and symptoms of leukemia related to bone marrow involvement? Petechiae, infection, fatigue Headache, papilledema, irritability Muscle wasting, weight loss, fatigue Decreased intracranial pressure, psychosis, confusion

Petechiae, infection, fatigue Correct Petechiae, infection, and fatigue are signs of infiltration of the bone marrow. Petechiae occur from a lowered platelet count, infection occurs from the depressed number of effective leukocytes, and fatigue occurs from the anemia. Headache, papilledema, and irritability are not signs of bone marrow involvement. Muscle wasting, weight loss, and fatigue are not signs of bone marrow involvement. Decreased intracranial pressure, psychosis, and confusion are not signs of bone marrow involvement.

A 2-year-old child is being admitted to the hospital for possible bacterial meningitis. When preparing for a lumbar puncture, the nurse should do which of the following?

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

A 12-year-old girl is admitted to the hospital with suspected appendicitis. What nursing interventions should be implemented preoperatively?

Placing the adolescent in a fetal position, side-lying with legs drawn up to chest (A client with appendicitis is more comfortable when lying in what is traditionally known as the fetal position, with the legs drawn up toward the chest. This flexed positioning assists in decreasing the pain that comes with appendicitis by decreasing the pressure on the abdominal area. Option 1 describes an intervention that is contraindicated because heat can lead to a ruptured appendix. Option 2 is incorrect. Pain medications are not given to the client with acute appendicitis because they may mask the symptoms that accompany a ruptured appendix. Option 4 describes a nursing intervention that may be necessary postoperatively. )

After the introduction of the Back to Sleep campaign in 1992, an increased incidence has been noted of which pediatric issues?

Plagiocephaly. (Plagiocephaly is a misshapen head caused by the prolonged pressure on one side of the skull. If that side becomes misshapen, facial asymmetry may result. SIDS has decreased by more than 40% with the introduction of the Back to Sleep campaign. Apnea of infancy and failure to thrive are unrelated to the Back to Sleep campaign.)

. Which of the following is the primary clinical manifestation of diabetes insipidus? A Oliguria B Glycosuria C Nausea, vomiting D Polyuria, polydipsia

Polyuria, polydipsia Correct Diabetes insipidus results from the hyposecretion of antidiuretic hormone. Because insufficient amounts are produced, excessive amounts of urine are produced. When allowed access to fluids, the child maintains balance with an almost insatiable thirst. Oliguria is diminished urinary output. Children with diabetes insipidus have increased urinary output. Glycosuria is not a manifestation of diabetes insipidus. It may be a manifestation of diabetes mellitus. Nausea and vomiting are not manifestations of diabetes insipidus. They can occur with oversecretion of antidiuretic hormone.

When administering a gavage feeding to a school-age child, the nurse should do which of the following?

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

An immediate intervention when an infant chokes on a piece of food would be to do which of the following?

Position the infant in a head-down, prone position and administer five quick blows between the shoulder blades. Placing the infant in a head-down, prone position and administering five quick blows between the shoulder blades is the correct position and procedure for an infant who had choked on a piece of food or another object. Blowing into the infant's mouth might push the object into the lungs. Blind finger sweeps are avoided in infants and children younger than age 8 years. If the infant is choking, it is an emergency. Action must be taken.

Herpes zoster is caused by the varicella virus and has an affinity for which?

Posterior root ganglia and posterior horn of the spinal cord. (The herpes zoster virus has an affinity for posterior root ganglia, the posterior horn of the spinal cord, and the skin. The zoster virus does not involve the nerve fibers listed)

A bottle-fed infant has been diagnosed with cow's milk allergy. Which formula should the nurse expect to be prescribed for the infant?

Pregestimil. (For infants with cow's milk allergy, the formula will be changed to a casein hydrolysate milk formula (Pregestimil, Nutramigen, or Alimentum) in which the protein has been broken down into its amino acids through enzymatic hydrolysis. Similac, Enfamil with iron, and Gerber Good Start are cow's milk-based formulas.)

The nurse is caring for a child hospitalized with acute adrenocortical insufficiency. Because of the sudden, severe nature of the disease, the family needs a great deal of emotional support. The most appropriate nursing action is which of the following? A Prepare the family for the child's impending death. B Prepare the family for each procedure. C Prepare the family for the long-term consequences of paralysis. D Reassure the family that flaccid paralysis is not problematic.

Prepare the family for each procedure. Correct By preparing the family for each procedure, the nurse is showing sensitivity to the family's emotional needs. Acute adrenocortical insufficiency is a reversible condition when associated with adrenocortical insufficiency. Flaccid paralysis is problematic if not reversible.

An infant is seen in the health care provider's office for complaints of projectile vomiting after feeding. Findings indicate that the child is fussy and is gaining weight but seems to never get enough to eat. Pyloric stenosis is suspected. Which prescription would the nurse anticipate having the highest priority in the care of this child?

Prepare the family for surgery for the child. (Infants with projectile vomiting after feeding that are fussy should be suspected of pyloric stenosis. The treatment for this diagnosis is surgery. The other options are treatment measures that may be prescribed for gastroesophageal reflux.)

A common characteristic of those who sexually abuse children is which of the following?

Pressure victim into secrecy . (Sex offenders may pressure the victim into secrecy, referring to the activity as a "secret between us" that other people may take away if they find out. The offender may be anyone, from a family member to a stranger at any level of society. Sex offenders are usually trusted acquaintances of the victims and victims' families. Many victims are abused many times over a long period)

A Boy Scout sustains frostbite to his feet while out hiking in the mountains. Before he is transported to the nearest emergency treatment center, which of the following is important in managing his care?

Prevent him from walking any farther (The feet must be protected from further injury until definitive treatment occurs. This includes keeping the child from walking. The child should be transported as quickly as possible to the nearest emergency treatment center. Injured body parts are handled gently. Recommended rewarming is by immersion in well-agitated warm water)

What are considered major goals of the therapeutic management of juvenile rheumatoid arthritis (JRA)? A Prevent joint discomfort; regain proper alignment. B Prevent loss of joint function; achieve cure. C Prevent physical deformity; preserve joint function. D Prevent skin breakdown; relieve symptoms.

Prevent physical deformity; preserve joint function. Correct The goals of treatment for JRA include the prevention of physical deformity, the preservation of joint function, and the control of pain. Once the joint is damaged from the physiologic processes of JRA, it may not be possible to regain proper alignment. Children with JRA may be cured of the disease. Skin breakdown is usually not an issue in JRA.

Nursing care of the infant with atopic dermatitis (eczema) should focus on which of the following?

Preventing infection of lesions .(The lesions of atopic dermatitis are itchy. New lesions develop when the skin is scratched. This cycle leads to the possibility of infection. Although keeping the baby content and maintaining adequate nutrition are important, decreasing the amount of scratching is a primary aim. Antibiotics are not the primary treatment of atopic dermatitis.)

An important role of the nurse in ambulatory settings and schools is the identification of communicable diseases for treatment and the prevention of spread. An important component is the recognition of which of the following aspects of the disease?

Prodromal stage (The prodromal period is the interval between the early manifestations of the disease and the time when the overt clinical syndrome is evident. Most communicable diseases are contagious during this time. Although the source and causative agent of the disease are important, recognizing the early signs can help the nurse prevent spread and refer the child for medical therapy when indicated. Constitutional symptoms occur during the active disease phase. The child has been contagious, and the time for early intervention may have passed)

Which of the following results when ice is applied immediately after a soft tissue injury, such as a sprained ankle? A Increases the pain threshold B Increases metabolism in the tissues C Produces deep tissue vasodilation D Leads to release of more histamine-like substances

Produces deep tissue vasodilation Correct Nine to 15 minutes of ice exposure produces deep tissue vasodilation without increased metabolism. Ice has a rapid cooling effect on tissues that reduces pain. The decreased temperature slows metabolism, thus reducing tissue oxygen requirements. Fewer histamine-like substances are released.

The nurse admits a child to the hospital with a diagnosis of pyloric stenosis. On assessment, which data would the nurse expect to obtain when asking the mother about the child's symptoms?

Projectile vomiting (In pyloric stenosis, hypertrophy of the circular muscles of the pylorus causes narrowing of the pyloric canal between the stomach and the duodenum. Clinical manifestations of pyloric stenosis include projectile vomiting, irritability, hunger and crying, constipation, and signs of dehydration including a decrease in urine output.)

Which measure is important in managing hypercalcemia in a child who is immobilized? A Promote adequate hydration B Change position frequently C Encourage a diet high in calcium D Provide a diet high in protein and calories

Promote adequate hydration Correct Hydration is extremely important to help remove the excess calcium from the body. This can help prevent hypercalcemia. Changing the child's position frequently will help with managing skin integrity but will not affect calcium levels. The calcium will not be incorporated into bone because of the lack of weight bearing. The child is at risk of developing hypercalcemia. The child's metabolism is slower because of the immobilization. A diet with sufficient calories and nutrients for healing is important.

Nurses counseling parents regarding the home care of the child with a cardiac defect before corrective surgery should stress which of the following? Be extremely concerned about cyanotic spells. Relax discipline and limit setting to prevent crying. Reduce caloric intake to decrease cardiac demands. Promote normality within the limits of the child's condition.

Promote normality within the limits of the child's condition. The child needs to have social interactions, discipline, and appropriate limit setting. Parents need to be encouraged to promote as normal a life as possible for their child. Because cyanotic spells occur in children with some defects, the parents need to be taught how to manage these. The child needs discipline and appropriate limits. The child needs increased caloric intake.

The clinical manifestations of nephrotic syndrome include which of the following?

Proteinuria, hypoalbuminemia, and edema Edema, proteinuria, hypoalbuminemia, and hypercholesterolemia are the clinical manifestations of nephrotic syndrome in children. Bacteriuria is not a diagnostic criterion for nephrotic syndrome. Fever is not associated with nephrotic syndrome. Weight gain occurs secondary to the edema.

When a preschool child is hospitalized without adequate preparation, the nurse should recognize that the child may likely see hospitalization as which of the following?

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

The nurse understands that respiratory hygiene and cough etiquette is recommended by the Centers for Disease Control and Prevention (CDC) to prevent which of the following?

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

The nurse understands that respiratory hygiene and cough etiquette is recommended by the Centers for Disease Control and Prevention (CDC) to prevent which of the following?

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

The nurse stops to assist a child who has been hit by a car while riding a bicycle. Someone has activated the emergency medical system. Until paramedics arrive, the nurse should consider which of the following in caring for this child who has experienced severe trauma? A Rapid assessment should begin with ABC status: airway, breathing, and circulation. B Assessment should begin with the area injured; assessment of other areas can wait. C The possibility of spinal cord injury should be ruled out before transporting the child to the hospital. D Temperature maintenance is more difficult than in adults because young children have a larger surface area related to body mass.

Rapid assessment should begin with ABC status: airway, breathing, and circulation. Correct The first priority is always airway, breathing, and circulation. Assessment of the injured area occurs after the child's cardiopulmonary status has been addressed. Transport can occur by immobilizing the cervical spine. The head is maintained in a neutral position, and movement of the head or body is not allowed in any direction. Infants have the greatest discrepancy in body surface areas. Children old enough to ride bikes have similar body proportions to adults.

What is characteristic of fractures in children? A Fractures rarely occur at the growth plate site because it absorbs shock well. B Rapidity of healing is inversely related to the child's age. C Pliable bones of growing children are less porous than those of adults. D The periosteum of a child's bone is thinner, is weaker, and has less osteogenic potential compared with that of the adult.

Rapidity of healing is inversely related to the child's age. Correct Fractures heal in less time in children than in adults. As the child ages, the healing time increases. The cartilage epiphyseal plate is the weakest point of the long bone. Therefore, it is a frequent site of damage and fractures. The periosteum is thickened, and there is a great production of osteoclasts when a bone injury occurs. Bone healing in children is rapid due to the thickened periosteum and generous blood supply.

. The nurse is doing a neurologic assessment on a child whose level of consciousness has been variable since sustaining a cervical neck injury 12 hours ago. What is the priority assessment for this child? A Reactivity of pupils B Doll's head maneuver C Oculovestibular response D Funduscopic examination to identify papilledema

Reactivity of pupils Correct Pupil reactivity is an important indication of neurologic health. The pupils should be assessed for no reaction, unilateral reaction, and rate of reactivity. The doll's head maneuver should not be performed if there is a cervical spine injury. Assessing for an oculovestibular response is a painful test that should not be done for a child who is having variable levels of consciousness. Papilledema does not develop for 24 to 48 hours in the course of unconsciousness.

The nurse is doing a neurologic assessment on a child whose level of consciousness has been variable since sustaining a cervical neck injury 12 hours ago. Which of the following is the most essential in this assessment? A Reactivity of pupils B Doll's head maneuver C Oculovestibular response D Funduscopic examination to identify papilledema

Reactivity of pupils Correct Pupil reactivity is an important indication of neurologic health. The pupils should be assessed for no reaction, unilateral reaction, and rate of reactivity. The doll's head maneuver should not be performed if there is a cervical spine injury. The oculovestibular response is a painful test that should not be done on a child who is having variable levels of consciousness. Papilledema does not develop until 24 to 48 hours into the course of unconsciousness.

The nurse is caring for a child hospitalized with acute adrenocortical insufficiency. The acute phase seems to be over when ascending flaccid paralysis occurs. What is the most appropriate nursing action? A Reassure the family that this condition is temporary. B Reassure the family that flaccid paralysis is not problematic. C Prepare the family for impending death. D Prepare the family for the long-term consequences of paralysis

Reassure the family that this condition is temporary. Correct During the recovery phase, paralysis may develop. It is a temporary, quickly reversible clinical manifestation. Flaccid paralysis is problematic if not reversible. Flaccidity can indicate impending death in a child with neurologic deficits but is not associated with adrenocortical insufficiency. Ascending flaccid paralysis is a reversible condition when associated with adrenocortical insufficiency. Paralysis is a temporary, quickly reversible clinical manifestation.

A young boy has just been diagnosed with pseudohypertrophic (Duchenne) muscular dystrophy. His care should include which of the following? Recommend genetic counseling. Explain that the disease is easily treated. Suggest ways to limit the use of muscles. Assist the family in finding a nursing facility to provide his care.

Recommend genetic counseling. Correct Pseudohypertrophic (Duchenne) muscular dystrophy is inherited as an X-linked recessive gene. Genetic counseling is recommended for parents, female siblings, maternal aunts, and their female offspring. No effective treatment exists at this time for childhood muscular dystrophy. Maintaining optimum function of all muscles for as long as possible is the primary goal. It has been found that children who remain as active as possible are able to avoid the need for a wheelchair for a longer time. Finding a nursing facility is inappropriate at the time of diagnosis. When the child becomes increasingly incapacitated, the family may consider home-based care, a skilled nursing facility, or respite care to provide the necessary care.

The school nurse is discussing prevention of acquired immunodeficiency syndrome with some adolescents. Which of the following is appropriate to include? The virus is easily transmitted. It is only transmitted through blood. Condoms should be used if adolescents are homosexual. Recreational drug users should not share needles or other equipment.

Recreational drug users should not share needles or other equipment. Correct Human immunodeficiency virus is spread through blood and body fluids. Intravenous needles that have been used should not be shared. They may be contaminated with the virus. The virus is not easily transmitted. It requires direct contact with blood or body fluids on a nonintact skin surface. Body fluids may also transmit the virus. Condoms should be used for both heterosexual and homosexual sex.

Which of the following should the nurse include when explaining how to manage pediculosis capitis?

Remove nits with a fine-tooth comb or tweezers (Daily removal of nits from a child's hair with a metal nit or flea comb is an essential control measure after treatment with a pediculicide. Cutting the child's hair short does not prevent infestation. Lice will infest short hair as readily as long hair. Regular shampoo will not remove nits. Using a fine-tooth comb or tweezers is necessary to remove the nits. It is not possible to tell viable and nonviable nits apart.)

The nurse is caring for a 12-year-old boy who sustained major burns when he put charcoal lighter on a campfire. The nurse observes that he is "very brave" and appears to accept pain with little or no response. The most appropriate nursing action related to this is which of the following?

Request a psychologic consultation (A psychologic consultation will help the child verbalize fears. Children in this age group are concerned with physical appearance. The psychologists can help integrate the issues that the child is facing. It is likely that the child is having pain but not acknowledging the pain. If the child is feeling pain, the nurse should not praise him for hiding it. Encouraging continued bravery may not be an effective coping strategy if the child is in severe pain.)

The nurse provides home care instructions to the parents of a child with celiac disease. The nurse should teach the parents to include which food item in the child's diet?

Rice (Celiac disease also is known as gluten enteropathy or celiac sprue and refers to an intolerance to gluten, the protein component of wheat, barley, rye, and oats. The important factor to remember is that all wheat, rye, barley, and oats should be eliminated from the diet and replaced with corn, rice, or millet. Vitamin supplements-especially the fat-soluble vitamins, iron, and folic acid-may be needed to correct deficiencies. Dietary restrictions are likely to be lifelong.)

A child falls on the playground and has a small laceration on the forearm. The school nurse should do which of the following to cleanse the wound?

Rinse the wound with sterile water or saline using a syringe to generate mild pressure (Normal saline and sterile water are the only acceptable fluids for irrigation listed. The nurse should cleanse the wound with a forced stream of normal saline or water. Hydrogen peroxide, water and soap, and a povidone-iodine solution should not be used because they are toxic to the wound.)

What is an appropriate action when an infant becomes apneic?

Roll the infant's head to the side.

Matt's mother tells the nurse that he keeps scratching the areas where he has poison ivy. The nurse's response should be based on which of the following?

Scratching the lesions may cause them to become secondarily infected. (Comfort measures should be used to minimize scratching. Irritating the lesions can result in secondary infection. The contact dermatitis is in response to the oil urushiol present in the poison ivy plant. The oozing from the skin irritation does not result in the development of further lesions. Poison ivy can be extremely itchy, and comfort measures should be used.)

Initial exposure to an allergen resulting in an immune response; subsequent exposure induces a much stronger response

Sensitization

Distortion of sound and problems in discrimination are characteristic of what type of hearing loss?

Sensorineural (Sensorineural hearing loss, also known as perceptive or nerve deafness, involves damage to the inner ear structures or the auditory nerve. It results in distortion of sounds and problems in discrimination. Conductive hearing loss involves mainly interference with loudness of sound. Central auditory imperceptive hearing loss manifests as a combination of both sensorineural and conductive loss. The mixed conductive-sensorineural category includes all hearing losses that do not demonstrate defects in the conduction or sensory structures.)

Which of the following represents the major stressor of hospitalization for children from middle infancy throughout the preschool years?

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

Which of the following factors predisposes the urinary tract to infection?

Short urethra in girls The short urethra, which measures approximately 2 cm (0.8 in) in girls and 4 cm (1.6 in) in mature women, provides a ready pathway for invasion of organisms. Increased fluid intake results in frequent emptying of the bladder, preventing urinary stasis. Urine is bacteriostatic at pH of 5.0. This is not achievable by ingestion of juice. Frequent emptying of the bladder helps prevent urinary tract infections.

What is a clinical manifestation of increased intracranial pressure (ICP) in infants? A Shrill, high-pitched cry B Photophobia C Pulsating anterior fontanel D Vomiting and diarrhea

Shrill, high-pitched cry Correct A shrill, high-pitched cry is a common clinical manifestation of increased ICP in infants. The characteristic cry occurs secondary to the pressure being placed on the meningeal nerves, causing pain. Photophobia is not indicative of increased ICP in infants. A pulsating anterior fontanel is normal in infants. The infant with increased ICP would be seen with a bulging anterior fontanel. Vomiting is one of the signs of increased ICP in children, but when present with diarrhea, it is more indicative of a gastrointestinal disturbance.

Which of the following statements best describes hypopituitarism? A Skeletal proportions are normal for age. B Weight is usually more retarded than height. C Growth is normal during the first 3 years of life. D Most of these children have subnormal intelligence.

Skeletal proportions are normal for age. Correct Skeletal proportions are normal for age, but these children appear young for their age. Growth in height is usually more delayed than in weight. Growth is normal for the first year of age, and then these children follow a slowed growth curve. Most of the children have normal intelligence. Often they are considered precocious because their educational ability seems to exceed their size. Emotional problems are common because of their small stature.

Autism is a complex developmental disorder. Diagnostic criteria for autism include delayed or abnormal functioning in which area(s) before 3 years of age? (Select all that apply.)

Social interaction Inability to maintain eye contact Language as used in social communication

What most accurately describes bowel function in children born with a myelomeningocele? Incontinence cannot be prevented. Enemas and laxatives are contraindicated. Some degree of fecal continence can usually be achieved. A colostomy is usually required by the time the child reaches adolescence.

Some degree of fecal continence can usually be achieved. Correct With diet modification and regular toilet habits (bowel training) to prevent constipation and impaction, some degree of fecal continence can be achieved. Although a lengthy process, continence can be achieved with modification of diet, use of stool softeners, and/or enemas. Enemas and stool softeners are part of the strategy to achieve continence. Laxatives should be used only as a last resort, although they may be used in some instances. A colostomy is not indicated for the child with myelomeningocele.

A condition requiring assistance for disabilities that may be medical, mental, or psychological

Special needs

A 3-year-old has cerebral palsy (CP) and is hospitalized for orthopedic surgery. The child's mother states the child has difficulty swallowing and cannot hold a utensil to self-feed. The child is slightly underweight for height. What is the most appropriate nursing action related to feeding? Bottle-feed or tube-feed the child with a specialized formula until sufficient weight is gained. Stabilize the child's jaw with one hand (either from a front or side position) to facilitate swallowing. Place the child in a well-supported, semireclining position to make use of gravity flow. Place the child in a sitting position with the neck hyperextended to make use of gravity flow.

Stabilize the child's jaw with one hand (either from a front or side position) to facilitate swallowing. Correct Because the jaw is compromised, more normal control can be achieved if the feeder provides stability. Manual jaw controls assist with head control, correction of neck and trunk hyperextension, and jaw stabilization. The child is too old to be bottle-fed. The neuromuscular compromise of the jaw interferes with the child's ability to eat. The child should be sitting up for meals to prevent aspiration. For swallowing, the neck should not be hyperextended.

What is the most common piece of medical equipment that can transmit harmful microorganisms among patients?

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

The nurse suspects a child is having an adverse reaction to a blood transfusion. What should the nurse's first action be? Notify the physician. Take vital signs and blood pressure and compare them with baseline values. Dilute infusing blood with equal amounts of normal saline. Stop the transfusion and maintain a patent intravenous line with normal saline and new tubing.

Stop the transfusion and maintain a patent intravenous line with normal saline and new tubing. Correct The priority nursing action is to stop the transfusion and maintain a patent intravenous line with normal saline and new tubing. If an adverse reaction is occurring, it is essential to minimize the amount of blood that is infused into the child. The physician should be notified after the blood transfusion is stopped and normal saline is infusing. Vital signs should be assessed after the blood transfusion is stopped and normal saline is infusing. Blood should not be diluted; it should be returned to the blood bank if an adverse reaction has occurred.

The nurse suspects a child is having an adverse reaction to a blood transfusion. The first action by the nurse should be which of the following? Notify the physician. Take the vital signs and blood pressure and compare them with baseline levels. Dilute infusing blood with equal amounts of normal saline. Stop transfusion and maintain a patent intravenous line with normal saline and new tubing.

Stop transfusion and maintain a patent intravenous line with normal saline and new tubing. Correct Stopping the transfusion and maintaining a patent intravenous line with normal saline and new tubing is the priority nursing action. If an adverse reaction is occurring, it is essential to minimize the amount of blood that is infused. Notifying a physician and taking vital signs and blood pressure should be performed after the blood transfusion is stopped and infusion of normal saline has begun. Blood should not be diluted; it should be returned to the blood bank if an adverse reaction has occurred.

What often causes cellulitis?

Streptococci or staphylococci. (Streptococci, staphylococci, and Haemophilus influenzae are the organisms usually responsible for cellulitis. Herpes zoster is the virus associated with varicella and shingles. C. albicans is associated with candidiasis, or thrush. Human papillomavirus is associated with various types of human warts.)

Which of the following phrases describes a characteristic of most neonatal seizures? A Generalized seizure B Tonic-clonic seizure C Well-organized seizure D Subtle and barely discernible seizure

Subtle and barely discernible seizure Correct Signs of seizures in newborns are subtle. They include symptoms such as lip smacking, tongue thrusting, eye rolling, and arching of the back. The newborn's central nervous system is not sufficiently developed to maintain a generalized seizure. The newborn's central nervous system is not sufficiently developed to maintain a tonic-clonic (generalized) seizure. The newborn's central nervous system is not sufficiently developed to maintain a well-organized seizure.

The nurse is interviewing the parents of a 4-month-old infant brought to the hospital emergency department. The infant is dead on arrival, and no attempt at resuscitation is made. The parents state that the baby was found in the crib with a blanket over the head, lying face down in bloody fluid from the nose and mouth. The parents indicate no problems when the infant was placed in the crib asleep. Which of the following causes of death does the nurse suspect?

Sudden infant death syndrome (SIDS) Death is consistent with the appearance of SIDS. The infant is usually found in a disheveled bed; with blankets over the head; huddled into a corner and clutching the sheets; with frothy, blood-tinged fluid in the mouth and nose; and lying face down. The diaper is also usually full of stool, indicating a cataclysmic type of death. Although the child was found under the blanket, the other findings are consistent with SIDS. The findings as reported are consistent with SIDS, not child abuse. The history and physical findings are consistent with SIDS, not infantile apnea.

The nurse is interviewing the parents of a 4-month-old boy brought to the hospital emergency department. The infant is dead, and no attempt at resuscitation is made. The parents state that the baby was found in his crib with a blanket over his head, lying face down in bloody fluid from his nose and mouth. The nurse might initially suspect his death was caused by what?

Sudden infant death syndrome (SIDS). (The description of how the child was found in the crib is suggestive of SIDS. The nurse is careful to tell the parents that a diagnosis cannot be confirmed until an autopsy is performed.)

A child is receiving cyclosporine following a kidney transplant. The child's parents ask the nurse the reason for the cyclosporine. The nurse's response is based on the knowledge that the medication's purpose is to

Suppress rejection Cyclosporine is given to suppress rejection. Cyclosporine does not decrease pain, boost immunity, or improve circulation.

The nurse is assessing an infant brought to the clinic with diarrhea. He is lethargic and has dry mucous membranes. Which of the following should the nurse recognize as an early sign of dehydration?

Tachycardia (Tachycardia is the earliest manifestation of dehydration. Fever and infection can also result in tachycardia, so these should be included in the assessment data. A bulging fontanel may be indicative of increased intracranial pressure, not dehydration. Decreased blood pressure is a late sign of dehydration. Capillary refill is slowed and more than 3 seconds in dehydration.)

What is an early sign of congestive heart failure that the nurse should recognize? Tachypnea Bradycardia Inability to sweat Increased urinary output

Tachypnea Tachypnea is one of the early signs of congestive heart failure that should be identified. Tachycardia at rest, dyspnea, retractions, and activity intolerance are other physical signs and symptoms. Tachycardia, not bradycardia, is one of the symptoms suggestive of congestive heart failure. The child may be diaphoretic if experiencing congestive heart failure. There will usually be decreased urinary output in a child experiencing congestive heart failure.

Which of the following is an early sign of heart failure that the nurse should recognize? Tachypnea Bradycardia Inability to sweat Increased urinary output

Tachypnea Tachypnea is one of the early signs that should be identified. Tachycardia at rest, dyspnea, retractions, and activity intolerance are other physical signs and symptoms. Tachycardia, not bradycardia, is one of the symptoms suggestive of congestive heart failure. The child may be diaphoretic. Urinary output usually will be decreased.

The nurse is caring for an immobilized preschool child. What is helpful during this period of immobilization? A Encourage the child to wear pajamas. B Let the child have few behavioral limitations. C Keep the child away from other immobilized children if possible. D Take the child for a "walk" by wagon outside the room.

Take the child for a "walk" by wagon outside the room. Correct It is important for children to have activities outside of the room if possible. This can give them opportunities to meet their normal growth and developmental needs. The child should be encouraged to wear street clothes during the day. Limit setting is necessary with all children. There is no reason to segregate children who are immobilized unless there are other medical issues that need to be addressed.

An important nursing consideration when caring for a child with juvenile idiopathic arthritis is which of the following? A Apply ice packs to relieve stiffness and pain. B Administer acetaminophen to reduce inflammation. C Teach the child and family the correct administration of medications. D Encourage range of motion exercises during periods of inflammation.

Teach the child and family the correct administration of medications. Correct The management of juvenile idiopathic arthritis is primarily pharmacologic. The family should be instructed regarding administration of medications and the value of a regular schedule of administration to maintain a satisfactory blood level in the body. They need to know that nonsteroidal antiinflammatory drugs should not be given on an empty stomach and to be alert for signs of toxicity. Warm, moist heat is best for relieving stiffness and pain. Acetaminophen does not have antiinflammatory effects. Range of motion exercises should not be done during periods of inflammation.

A 6-year-old child born with a myelomeningocele has a neurogenic bladder. The parents have been performing clean intermittent catheterization. What should the nurse recommend? Teach the child to do self-catheterization. Teach the child appropriate bladder control. Continue having the parents do the catheterization. Encourage the family to consider urinary diversion.

Teach the child to do self-catheterization. Correct At 6 years of age, this child should have the dexterity to perform the intermittent catheterization. This will give the child more control and mastery over the disability. Bladder control cannot be taught in a child with a neurogenic bladder. School-age children, even as young as 6 years, should be able to begin self-catheterization. A urinary diversion is not necessary for a neurogenic bladder.

. A 4-year-old child is newly diagnosed with Legg-Calvé-Perthes disease. Nursing considerations include which of the following? A Encourage normal activity for as long as possible. B Explain the cause of the disease to the child and family. C Prepare the child and family for long-term, permanent disabilities. D Teach the family the care and management of the corrective appliance.

Teach the family the care and management of the corrective appliance. Correct The family needs to learn the purpose, function, application, and care of the corrective device and the importance of compliance to achieve the desired outcome. The initial therapy is rest and non-weight-bearing activity, which help reduce inflammation and restore motion. Legg-Calvé-Perthes is a disease of unknown etiology. A disturbance of circulation to the femoral capital epiphysis produces an ischemic aseptic necrosis of the femoral head. The disease is self-limiting, but the ultimate outcome depends on early and efficient therapy and the age of the child at onset.

What is the most important nursing consideration when caring for a child with sickle cell anemia? Teach the parents and child how to minimize crises. Refer the parents and child for genetic counseling. Help the child and family to adjust to a short-term disease. Observe for complications of multiple blood transfusions.

Teach the parents and child how to minimize crises. Correct Children and their families need specific instructions on how to minimize crises, including preventing infections; maintaining adequate hydration; and addressing environmental concerns, such as avoidance of extreme cold. Genetic counseling is important, but teaching care for the child is a priority. Sickle cell anemia is a long-term, chronic illness. Multiple blood transfusions are an option for some children with sickle cell disease. The priority is that the child and the parents are properly prepared to manage the chronic disease.

An important nursing consideration when caring for a child with sickle cell anemia is which of the following? Refer the parents and child for genetic counseling. Teach the parents and child how to recognize the signs and symptoms of crises. Help the child and family adjust to a short-term disease. Observe for complications of multiple blood transfusions.

Teach the parents and child how to recognize the signs and symptoms of crises. Correct Parents need specific instructions on the need to watch for changes in the child's condition, including adequate hydration, and environmental concerns. Genetic counseling is important, but teaching care of the child is a priority. Sickle cell anemia is a long-term, chronic illness. Multiple blood transfusions are an option for some children with sickle cell disease. The priority for all children with this condition is properly preparing the parents to care for them.

Which of the following heart defects causes hypoxemia and cyanosis because desaturated venous blood is entering the systemic circulation? Coarctation of the aorta Atrial septal defect Patent ductus arteriosus Tetralogy of Fallot

Tetralogy of Fallot Tetralogy of Fallot is a cardiac defect that has a mixed blood circulation. Coarctation of the aorta is an obstructive defect. There is no mixing of oxygenated and unoxygenated blood. Atrial septal defect and patent ductus arteriosus have increased flow of blood to the pulmonary system. The pressure gradient allows for oxygenated blood to return to the lungs.

The school reviewed the pediculosis capitis (head lice) policy and removed the "no nit" requirement. The nurse explains that now, when a child is found to have nits, the parents must do which before the child can return to school?

The child can remain in school with treatment done at home. (Many children have missed significant amounts of school time with "no nit" policies. The child should be appropriately treated with a pediculicide and a fine-tooth comb. The environment needs to be treated to prevent reinfestation. The treatment with the pediculicide will kill the lice and leave nit casings. Cutting the child's hair is not recommended; lice infest short hair as well as long. With a "no nit" policy, treating the child with a shampoo to treat lice and combing the hair with a fine-tooth comb every day until nits are eliminated is the correct treatment. The policy change recognizes that most nits do not become lice.)

The nurse is preparing to administer a measles, mumps, rubella, and varicella (MMRV) vaccine. Which is a contraindication associated with administering this vaccine?

The child has a disorder that causes a deficient immune system. (The MMRV (measles, mumps, rubella, and varicella) vaccine is an attenuated live virus vaccine. Children with deficient immune systems should not receive the MMRV vaccine because of a lack of evidence of its safety in this population. Exposure to an infectious disease, symptoms of a cold, or intermittent episodes of diarrhea are not contraindications to receiving a live vaccine.)

Which of the following is an important consideration when the nurse is discussing enuresis with the parents of a young child?

The child should be encouraged to take charge of treatment interventions(Because any treatment involves and requires the child's active participation, the child is in charge of the interventions, and the parents should learn to support the child rather than intervene. Enuresis is more common in boys than in girls, and it has a strong family tendency. Psychogenic factors may influence enuresis, but it is doubtful that they are causative)

A 12-month-old child presents to the clinic for a well visit after missing several appointments. The child began her immunization schedule but has missed several follow-up appointments and immunization doses. The nurse knows that the most appropriate action is what?

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

A 12-month-old child presents to the clinic for a well visit after missing several appointments. The child began her immunization schedule but has missed several follow-up appointments and immunization doses. The nurse knows that the most appropriate action is what?

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

The nurse is preparing to admit a 1-year-old child with pertussis (whooping cough). Which clinical manifestations of pertussis should the nurse expect to observe? (Select all that apply.) a. Earache b. Coryza c. Conjunctivitis d. Low-grade fever e. Dry hacking cough ANS: B, D, E

The clinical manifestations of pertussis include coryza, a low-grade fever, and a dry hacking cough. The child does not have an earache or conjunctivitis.

A woman who is 6 weeks pregnant tells the nurse that she is worried her baby might have spina bifida because of a family history. What should the nurse's response be based on? There is no genetic basis for the defect. Prenatal detection is not possible yet. Chromosomal studies done on amniotic fluid can diagnose the defect prenatally. The concentration of α-fetoprotein in amniotic fluid can potentially indicate the presence of the defect prenatally.

The concentration of α-fetoprotein in amniotic fluid can potentially indicate the presence of the defect prenatally. Correct Fetal ultrasound and elevated concentrations of α-fetoprotein in amniotic fluid many indicate the presence of anencephaly, myelomeningocele, or other neural tube defects. The origin of neural tube defects is unknown but appears to have a multifactorial inheritance pattern. Prenatal detection is possible through amniotic fluid or chorionic villi sampling. There are no chromosomal studies currently that can diagnose spina bifida prenatally.

What should nurses stress when counseling parents regarding the home care of the child with a cardiac defect before corrective surgery? The importance of reducing caloric intake to decrease cardiac demands The importance of relaxing discipline and limit setting to prevent crying The need to be extremely concerned about cyanotic spells The desirability of promoting normalcy within the limits of the child's condition

The desirability of promoting normalcy within the limits of the child's condition The child needs to have social interactions, discipline, and appropriate limit setting. Parents need to be encouraged to promote as normal a life as possible for their child. The child needs increased caloric intake after cardiac surgery. The child needs discipline and appropriate limit setting, as would be done with any other child his or her age. Because cyanotic spells will occur in children with some defects, the parents need to be taught how to assess for and manage them appropriately, thereby decreasing their anxiety and concern.

A cure is no longer possible for a young child with cancer. The nursing staff recognizes that the goal of treatment must shift from cure to palliation. Which of the following is an important consideration at this time?

The family is included in the decision to shift the goals of treatment (When the child reaches the terminal stage, the nurse and physician should explore the family's wishes. The family should help decide what interventions will occur as they plan for their child's death. Palliative care can occur in different locations. The health care team will be able to make the determination that the terminal phase of care has arrived. The family must be included in the decision to shift the goals of therapy. They are responsible for the decision making about the care of their child.)

Which statement is the most descriptive of rhabdomyosarcoma? A The most common sites are the head and neck. B It is a common hereditary neoplasm of childhood. C It is the most common bone tumor of childhood. D It is a benign tumor and unusual in children.

The most common sites are the head and neck. Correct Although striated muscle fibers from which this tumor arises can be found anywhere in the body, the most common sites are the head and neck. Rhabdomyosarcoma is not known to be hereditary. Rhabdomyosarcoma arises from skeletal muscle tissue, not bone. Rhabdomyosarcoma is highly malignant.

Which of the following statements regarding burn injuries in children is correct?

The prognosis for a burned child is directly related to the amount of tissue destroyed (The prognosis of a child with a burn is directly related to the amount of tissue destroyed. The location of the wounds, age of the child, causative agent, respiratory involvement, general health of the child, and other injuries are also considered. Burned clothing is removed to prevent further damage from smoldering fabric and hot beads of synthetic fabric. Jewelry is removed to stop the transfer of heat from the metal to the skin. Burn and fire injuries are the third leading cause of unintentional injury-related death in children younger than the age of 14 years. The body proportions of the child are different from those of an adult. Use of the standard adult rule of nines will give an inaccurate estimate of the burn area. Physiologic factors, including greater relative percentage body water, minimum protein stores, and an immature immune response, contribute to a significantly higher mortality in children younger than age 2 years.)

Which of the following should the nurse consider when having informed consent forms signed for surgery and procedures on children?

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

The school nurse is called to the cafeteria because a child "has eaten something he is allergic to." The child is in severe respiratory distress. The first action by the nurse is to

The school nurse is called to the cafeteria because a child "has eaten something he is allergic to." The child is in severe respiratory distress. The first action by the nurse is to Because the child is in severe respiratory distress, the nurse should have someone call for a rescue squad or 9-1-1. Because severe respiratory distress is occurring, treatment of the response is indicated. What the child has eaten can be determined later. Diphenhydramine by mouth will not be effective for this type of emergency allergic reaction. The child should not be moved, unless the child is currently in a place that puts him or her at greater hazard.

Which of the following is the appropriate site to administer an intramuscular (IM) vaccine to a newborn?

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

Which of the following is the appropriate site to administer an intramuscular (IM) vaccine to a newborn?

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

The nurse is talking with the parents of a child who died 6 months ago. They sometimes still "hear" the child's voice and have trouble sleeping. They describe feeling empty and depressed. The nurse should recognize which of the following?

These are normal grief responses. (Hearing the child, trouble sleeping, and feeling empty and depressed are normal grief responses. The grief response is lengthy. The resolution of grief may take years, with an intensification of grief during the early years. The child will never be forgotten by the parents.)

The nurse provides feeding instructions to a parent of an infant diagnosed with gastroesophageal reflux disease. Which instruction should the nurse give to the parent to assist in reducing the episodes of emesis?

Thicken the feedings by adding rice cereal to the formula. (Gastroesophageal reflux is backflow of gastric contents into the esophagus as a result of relaxation or incompetence of the lower esophageal or cardiac sphincter. Small, more frequent feedings with frequent burping often are prescribed in the treatment of gastroesophageal reflux. Feedings thickened with rice cereal may reduce episodes of emesis. If thickened formula is used, cross-cutting of the nipple may be required.)

The parents of a 3-month-old infant report that their infant sleeps supine (face up) but is often prone (face down) while awake. The nurse's response should be based on remembering what?

This is acceptable to encourage head control and turning over. (These parents are implementing the guidelines to reduce the risk of SIDS. Infants should sleep on their backs to reduce the risk of SIDS and then be placed on their abdomens when awake to enhance achievement of milestones such as head control. These position changes encourage gross motor, not fine motor, development.)

The nurse is assessing a child with herpetic gingivostomatitis. In determining whether to wear gloves, the nurse bases the decision on which of the following?

This virus easily enters breaks in the skin(The herpes simplex virus is highly contagious and can easily enter breaks in the skin of the hands. Although the nurse can decide not to wear gloves, this is a violation of universal precautions because contact with the oral mucosa may take place. Herpetic gingivostomatitis is present in the lesions and is easily spread. )

Which of the following is an important nursing consideration when caring for a child with impetigo contagiosa?

Thoroughly wash hands and maintain cleanliness when caring for an infected child (Preventing the spread of inspection is a prime consideration when caring for children with bacterial skin infections. Thorough hand washing and cleanliness will help achieve this goal. Topical corticosteroids are contraindicated in bacterial infections. A Wood lamp is used for diagnosis of some fungal and bacterial skin infections. Dressings are not used in impetigo.)

What is considered a mixed cardiac defect? Pulmonic stenosis Atrial septal defect Patent ductus arteriosus Transposition of the great arteries

Transposition of the great arteries Transposition of the great arteries allows the mixing of both oxygenated and unoxygenated blood in the heart. Pulmonic stenosis is classified as an obstructive defect. Atrial septal defect is classified as a defect with increased pulmonary blood flow. Patent ductus arteriosus is classified as a defect with increased pulmonary blood flow.

The nurse is caring for an infant with a tracheostomy when accidental decannulation occurs. The nurse is unable to reinsert the tube. Which of the following should be the nurse's next action?

Try inserting a smaller tube If the same size tube cannot be inserted, the nurse should try to insert a smaller tube. This will keep the stoma open. The priority is to reinsert a new tracheostomy as soon as possible. The stoma is maintained open until the practitioner can evaluate it. The nurse should attempt to keep the tracheostomy stoma open. A smaller tube is required.

When should clear liquids be stopped before scheduled surgery?

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

Which physiologic alteration is characterized by destruction of pancreatic beta cells that produce insulin? A Type 1 diabetes B Type 2 diabetes C Impaired glucose tolerance D Gestational diabetes

Type 1 diabetes Correct Type 1 diabetes is characterized by destruction of the insulin-producing pancreatic beta cells. Type 2 diabetes is a result of insulin resistance. The insulin-producing pancreatic beta cells are destroyed in type 1 diabetes and are not associated with impaired glucose tolerance. Gestational diabetes occurs during pregnancy and is not associated with the destruction of pancreatic beta cells that produce insulin.

The nurse is caring for an unconscious 10-year-old child. Skin care should include which of the following?

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

An immunocompromised child has been exposed to chickenpox. What should the nurse anticipate to be prescribed to the exposed child?

Varicella-zoster immune globulin. (The use of varicella-zoster immune globulin or immune globulin intravenous (IGIV) is recommended for children who are immunocompromised, who have no previous history of varicella, and who are likely to contract the disease and have complications as a result. The antiviral agent acyclovir (Zovirax) or valacyclovir may be used to treat varicella infections in susceptible immunocompromised persons. It is effective in decreasing the number of lesions; shortening the duration of fever; and decreasing itching, lethargy, and anorexia. Symmetrel is an antiviral used to treat influenza)

The nurse is preparing an airborne infection isolation room for a patient. Which communicable disease does the patient likely have?

Varicella. (An airborne infection isolation room is the isolation for persons with a suspected or confirmed airborne infectious disease transmitted by the airborne route such as measles, varicella, or tuberculosis. Pertussis, influenza, and scarlet fever require droplet transmission precautions.)

Which of the following is a potential cause of a postoperative decrease in blood pressure?

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

Immobilization causes which of the following effects on the cardiovascular system? A Venous stasis B Increased vasopressor mechanism C Normal distribution of blood volume D Increased efficiency of orthostatic neurovascular reflexes

Venous stasis Correct The physiologic effects of immobilization, as a result of decreased muscle contraction, include venous stasis. This can lead to pulmonary emboli or thrombi. A decreased vasopressor mechanism results in orthostatic hypotension, syncope, decreased cerebral blood flow, and tachycardia. An altered distribution of blood volume is found with decreased cardiac workload and exercise tolerance. Immobilization causes a decreased efficiency of orthostatic neurovascular reflexes with an inability to adapt readily to the upright position and with pooling of blood in the extremities in the upright position.

Which is described as an elevated, circumscribed skin lesion that is less than 1 cm in diameter and filled with serous fluid?

Vesicle. (A vesicle is elevated, circumscribed, superficial, smaller than 1 cm in diameter, and filled with serous fluid. A cyst is elevated, circumscribed, palpable, encapsulated, and filled with liquid or semisolid material. A papule is elevated; palpable; firm; circumscribed; smaller than 1 cm in diameter; and brown, red, pink, tan, or bluish red. A pustule is elevated, superficial, and similar to a vesicle but filled with purulent fluid. )

A 5-year-old child is brought the Emergency Department with abrupt onset of sore throat, pain with swallowing, fever, and sitting upright and forward. Acute epiglottitis is suspected. What are the most appropriate nursing interventions? (Select all that apply.)

Vital signs Medical history Assessment of breath sounds Emergency airway equipment readily available

Deficiency of which of the following vitamins correlates with increased morbidity and mortality in children with measles and increased complications from diarrhea and infections?

Vitamin A deficiency contributes to increased morbidity in measles, diarrhea, and infections. The American Academy of Pediatrics recommends that supplementation be considered in children with measles and related disorders. No correlation exists between vitamin C, niacin, and folic acid and increased morbidity and mortality with measles.

Which of the following vitamins increases the absorption of iron?

Vitamin C. (Vitamin C increases the absorption of iron for hemoglobin formation. No correlation exists between vitamins B12, D, and biotin and iron absorption.)

A 1-year-old child is on a pure vegetarian (vegan) diet. This diet requires supplementation with what?

Vitamins D and B12. (Pure vegetarian (vegan) diets eliminate any food of animal origin, including milk and eggs. These diets require supplementation with many vitamins, especially vitamin B6, vitamin B12, riboflavin, vitamin D, iron, and zinc)

A nurse is caring for an infant with a suspected urinary tract infection (UTI). Based on the nurse's knowledge of UTIs, which clinical manifestation would be observed? (Select all that apply)

Vomiting Persistent diaper rash Failure to gain weight

Which of the following is an important nursing intervention in the care of a child with bacterial conjunctivitis?

Warm, moist compresses to remove crusts (Keeping the eye clean is a priority nursing goal for a child with bacterial conjunctivitis. The crusts are removed with a warm, moist compress, wiping the eye from the inner canthus downward and away from the opposite eye. Oral antihistamines are not indicated. Continuous compresses are not used. The warm, moist environment promotes bacterial growth. Topical corticosteroids are avoided because they reduce ocular resistance to bacteria.)

The nurse wears gloves during a dressing change. When the gloves are removed, the nurse should do which of the following?

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

A toddler is hospitalized with acute renal failure (ARF) secondary to severe dehydration. The nurse should assess the child for what possible complications?

Water intoxication The child with acute renal failure has the tendency to develop water intoxication with hyponatremia. Control of water balance requires careful monitoring of intake, output, body weight, and electrolytes. The child needs to be monitored for hypertension, not hypotension, when hospitalized with acute renal failure. Hyperkalemia, not hypokalemia, is a concern in acute renal failure. Hyponatremia, not hypernatremia, may develop in acute renal failure as the sodium is diluted in large amounts of water.

In a non-potty-trained child with nephrotic syndrome, what is the best way to detect fluid retention?

Weigh the child daily. A daily weight taken at the same time every day, with the child wearing the same clothing, is the most accurate way to determine fluid gains and losses. The presence or absence of blood in the urine will not help with the determination of fluid retention. The abdominal girth will reflect edema, but weekly measurements are too infrequent. The number of wet diapers reflects how often the diapers have been changed. The diapers should be weighed to reflect the fluid balance.

An infant is born with one lower limb deficiency. When is the optimum time for the child to be fitted with a prosthetic device? A As soon as possible after birth B When the infant is developmentally ready to stand up C At about age 12 to 15 months, when most children are walking D At about 4 years, when the healthy limb is not growing so rapidly

When the infant is developmentally ready to stand up Correct The optimum time for the child to be fitted with a prosthetic device is when he or she is developmentally ready to stand up. The prosthetic device will be integrated into the child's capabilities. Fitting the infant for a prosthesis as soon as possible after birth will not be useful, because the child is not ready to use the leg. Waiting until age 12 to 15 months to fit the child for a prosthesis may be too late. The fitting should be provided when the child is showing readiness to stand. Waiting until age 4 years to fit the child for a prosthesis may be too late. The fitting should be provided when the child is showing readiness to stand.

The parents of a child hospitalized with sickle cell anemia tell the nurse that they are concerned about narcotic analgesics causing addiction. The nurse should explain which of the following concerning narcotic analgesics? They are often ordered but not usually needed. When they are medically indicated, children rarely become addicted. They are given as a last resort because of the threat of addiction. They are used only if other measures, such as ice packs, are ineffective.

When they are medically indicated, children rarely become addicted. Correct Pain is the most common and debilitating symptom experienced by patients with sickle cell disease. The chronic nature of this pain can greatly affect the child's development. A multidisciplinary approach is best for its management. Patient-controlled analgesia or continuous intravenous administration is usually effective. Pharmacologic intervention is necessary for the pain of sickle cell crisis.

A new parent asks the nurse, "How can diaper rash be prevented?" What should the nurse recommend?

Wipe stool from the skin using water and a mild cleanser.(Change the diaper as soon as it becomes soiled. Gently wipe stool from the skin with water and mild soap. The skin should be thoroughly dried after washing. Applying oil does not create an effective barrier. Over washing the skin should be avoided, especially with perfumed soaps or commercial wipes, which may be irritating. Baby powder should not be used because of the danger of aspiration.)

The nurse needs to do a heel stick on an ill neonate to obtain a blood sample. Which of the following is recommended to facilitate this?

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

Lactose intolerance is diagnosed in an 11-month-old infant. Which should the nurse recommend as a milk substitute?

Yogurt. (Yogurt contains the inactive lactase enzyme, which is activated by the temperature and pH of the duodenum. This lactase activity substitutes for the lack of endogenous lactase. Ice cream and cow's milk-based formula contain lactose, which will probably not be tolerated by the child. Fortified cereal does not have the nutritional equivalents of milk.)

The nurse should explain to the parents that their child is receiving furosemide (Lasix) for severe congestive heart failure because of its effects as a diuretic. a beta blocker. a form of digitalis. an ACE inhibitor.

a diuretic. Furosemide is a diuretic used to eliminate excess water and salt to prevent the accumulation of fluid associated with congestive heart failure. Furosemide is not a beta blocker. Furosemide is not a form of digitalis. Furosemide is not an ACE inhibitor.

The parent of a child receiving an iron preparation tells the nurse that the child's stools are a tarry black color. The nurse should explain that this is a symptom of iron deficiency anemia. an adverse effect of the iron preparation. an indicator of an iron preparation overdose. a normally expected change due to the iron preparation.

a normally expected change due to the iron preparation. Correct An adequate dosage of iron turns the stools a tarry black color. Tarry black stools are not a sign of iron deficiency anemia. Tarry black stools are not an adverse effect of the iron preparation but an expected effect. Tarry black stools are not an indicator of iron preparation overdose.

The parent of a child hospitalized with acute glomerulonephritis (AGN) asks the nurse why blood pressure readings are being taken so often. Based on the nurse's knowledge of AGN, the most appropriate response by the nurse is

acute hypertension must be anticipated and identified Vital signs, in particular the blood pressure, provide information about the severity of AGN and early signs of complications. Acute hypertension is anticipated and requires frequent monitoring for early intervention. Blood pressure does not commonly fluctuate with antibiotic therapy. Blood pressure fluctuations are not indicative of chronic disease. Most children with AGN fully recover. Hypertension, not hypotension, is more likely with AGN.

Therapeutic management of the patient with systemic lupus erythematosus (SLE) includes application of cold salts to suppress the inflammatory process. a high-protein, low-salt diet. a rigorous exercise regimen to build up muscle strength and endurance. administration of corticosteroids to control inflammation.

administration of corticosteroids to control inflammation. Correct Corticosteroid administration is the primary mode of therapy currently for SLE. The application of cold salts will not affect the inflammatory process associated with SLE. A balanced diet without exceeding caloric expenditures is recommended. Exercise should be done in moderation

Therapeutic management of the patient with systemic lupus erythematosus (SLE) includes A application of cold salts to suppress the inflammatory process. B a high-protein, low-salt diet. C a rigorous exercise regimen to build up muscle strength and endurance. D administration of corticosteroids to control inflammation.

administration of corticosteroids to control inflammation. Correct Corticosteroid administration is the primary mode of therapy currently for SLE. The application of cold salts will not affect the inflammatory process associated with SLE. A balanced diet without exceeding caloric expenditures is recommended. Exercise should be done in moderation.

Therapeutic management of the child with rheumatic fever includes administration of penicillin. avoidance of salicylates (aspirin). strict bed rest for 4 to 6 weeks. administration of corticosteroids if chorea develops

administration of penicillin. Penicillin remains the drug of choice (oral or intramuscular injections), with macrolides or cephalosporins as a substitute in penicillin-sensitive children. Initial therapy includes a full 10-day course of penicillin or an alternative antibiotic. Salicylates may be used to reduce the inflammatory process after diagnosis. Bed rest is not indicated. Children can resume regular activities after the febrile stage is over. The chorea is transient, and pharmacologic intervention is not indicated.

It is generally recommended that a child with acute streptococcal pharyngitis can return to school

after taking antibiotics for 24 hours. After children have taken antibiotics for 24 hours, they are no longer contagious to other children. Sore throat may persist longer than 24 hours of antibiotic therapy, but the child is no longer considered contagious. Complications may take days to weeks to develop. The time from throat culture does not affect the contagiousness of the infection. Antibiotics must be used.

An 8-year-old has been diagnosed with moderate cerebral palsy (CP). The child recently began participation in a regular classroom for part of the day. The child's mother asks the school nurse about joining the after-school Scout troop. The nurse's response should be based on knowledge that most activities such as Scouts cannot be adapted for children with CP. after-school activities usually result in extreme fatigue for children with CP. trying to participate in activities such as Scouts leads to lowered self-esteem in children with CP. after-school activities often provide children with CP with opportunities for socialization and recreation.

after-school activities often provide children with CP with opportunities for socialization and recreation. Correct Recreational outlets and after-school activities should be considered for the child who is unable to participate in athletic programs in order to promote socialization opportunities. Most activities can be adapted for children with CP. The child, family, and activity director should assess the degree of activity to ensure it matches the child's capabilities. A supportive environment associated with after-school activities will add to the child's self-esteem

The temperature of an unconscious adolescent is 105º F (40.5º C). The priority nursing intervention is to A continue to monitor temperature. B initiate a pain assessment. C apply a hypothermia blanket. D administer aspirin stat.

apply a hypothermia blanket. Correct Brain damage can occur at temperatures as high as 105º F (40.5º C). It is extremely important to institute temperature-lowering interventions such as hypothermia blankets and tepid water baths immediately. The temperature needs to be monitored, but lowering the temperature is the priority. Pain assessments should be ongoing, but this is not the priority at this time. Lowering the body temperature is the priority. Aspirin should never be administered to a child, because of the risk of Reye syndrome. Antipyretics, such as acetaminophen or ibuprofen, usually are not effective with temperatures as high as 105º F (40. 5ºC).

Asthma is now classified into four categories: mild intermittent, mild persistent, moderate persistent, and severe persistent. Clinical features used to determine these categories include all of the following except

associated allergies. Associated allergies are not part of the classification system used in the Guidelines for the Diagnosis and Management of Asthma. The clinical features that are assessed in the classification system are frequency of daytime and nighttime symptoms, frequency and severity of exacerbations, and lung function.

Children are often undermedicated for pain during the terminal phase of illness. A factor that contributes to the lack of treatment is

balancing of effective dosage with side effects. (Moderate to severe pain requires opiates for effective treatment. Side effects of these drugs include decreased level of alertness and physical effects such as constipation, which may make the child more uncomfortable. Pain assessment tools are available for all ages of children. Education is necessary to help parents realize that addiction is an unnecessary concern. Effective pain management can be through the oral and transdermal routes.)

The most appropriate time to perform bronchial postural drainage is

before meals and at bedtime. The most effective time for bronchial drainage is before meals and before bedtime to prevent the interaction of excessive amounts of mucus and food intake, thereby increasing the risk of vomiting. Bronchial drainage is more effective after other respiratory therapies such as bronchodilator or nebulizer treatments. These treatments open the airways, facilitating the movement of mucus with the positioning of bronchial drainage. Bronchial drainage should be done three or four times each day to be effective. When bronchial drainage is completed after meals, it may cause the child to vomit.

If the mother of a child is hepatitis B surface antigen (HBsAg) negative, the nurse knows that the child should receive his or her first dose of the hepatitis B virus (HBV) vaccine at

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

If the mother of a child is hepatitis B surface antigen (HBsAg) negative, the nurse knows that the child should receive his or her first dose of the hepatitis B virus (HBV) vaccine at

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

One of the goals for children with asthma is to prevent respiratory tract infection because infections

can trigger an episode or aggravate asthmatic state. Respiratory tract infections can trigger an asthmatic attack. An annual influenza vaccine is recommended. All respiratory equipment should be kept clean. Respiratory tract infection affects the asthma, not the medications. Exercise-induced asthma is caused by vigorous activity, not a respiratory tract infection. Sensitivity to allergens is independent of respiratory tract infection.

A 6-month-old infant does not smile, has poor head control, has a persistent Moro reflex, and often gags and chokes while eating. These findings are most suggestive of hypotonia. cerebral palsy. spinal cord injury. neonatal myasthenia gravis.

cerebral palsy. Correct Poor head control, a persistent Moro reflex, and feeding difficulties in a 6-month-old infant are suggestive of cerebral palsy. Not smiling, poor head control, a persistent Moro reflect, and gagging and choking while eating are not consistent with hypotonia, spinal cord injury, or neonatal myasthenia gravis.

A 3-year-old has just returned from surgery in a hip spica cast. The priority nursing intervention is to A elevate the head of the bed. B offer sips of water. C check circulation, sensation, and motion of toes. D turn the child to the right side, then the left side every 4 hours.

check circulation, sensation, and motion of toes. Correct The chief concern is that the extremity may continue to swell. The circulation, sensation, and motion of the toes must be assessed to ensure that the cast does not become a tourniquet and cause complications. Elevating the head of the bed might help with comfort, but it is not a priority. The nurse must be observant to the risk of increased swelling in the extremities. Offering sips of water is acceptable once assessment of the extremities has been completed. The child's position should be changed every 2 hours. Positioning a child with a spica cast is important to prevent injury.

A 3-year-old child is scheduled for surgery to remove a Wilms' tumor from one kidney. The parents ask the nurse about what treatments, if any, will be necessary after recovery from surgery. The nurse's explanation should be based on knowledge that

chemotherapy with or without radiotherapy is indicated. The determination of chemotherapy and/or radiotherapy as treatment modalities will be made based on the histologic pattern of the tumor. Chemotherapy with or without radiotherapy is usually indicated. Additional therapy of some type is indicated after the tumor is removed. Chemotherapy or radiotherapy, or both, may be indicated as a postsurgical intervention. Most children with Wilms' tumor do not require renal transplants.

Strict isolation is required for a child who is hospitalized with

chickenpox (Chickenpox is communicable through direct contact, droplet spread, and contaminated objects. Mumps is transmitted from direct contact with the saliva of the infected person and is most communicable before the onset of swelling. The transmission and source of the viral infection exanthema subitum (roseola) is unknown. Erythema infectiosum is communicable before the onset of symptoms)

. The postoperative care of a preschool child who has had a brain tumor removed should include A recording of colorless drainage as normal on the nurse's notes. B close supervision of the child while he or she is regaining consciousness. C positioning the child on the right side in the Trendelenburg position. D no administration of analgesics.

close supervision of the child while he or she is regaining consciousness. Correct The child needs to be observed closely, with careful and frequent assessment of the vital signs and monitoring for signs of increasing intracranial pressure. Any changes should be reported immediately to the practitioner. Colorless drainage may be leakage of cerebrospinal fluid from the incision site. This needs to be reported to the practitioner immediately. The child should not be positioned in the Trendelenburg position postoperatively. Analgesics can be used for postoperative pain as needed.

The nurse is teaching a mother how to perform chest physiotherapy and postural drainage on her 3-year-old child, who has cystic fibrosis. To perform percussion, the nurse should instruct her to

cover the skin with a shirt or gown before percussing. The child should wear a light shirt to protect the skin from the percussion. The hand is cupped when the child's chest wall is struck. Percussion is done after the position change. There are identified positions and sequence for postural drainage.

The most appropriate nursing intervention when caring for a child experiencing a seizure is to A restrain the child when a seizure occurs to prevent bodily harm. B place a padded tongue between the teeth if they become clenched. C suction the child during the seizure to prevent aspiration. D described and document the seizure activity observed.

described and document the seizure activity observed. Correct The priority nursing intervention is to observe the child and seizure and document the activity observed. The child should not be restrained, because this may cause an injury. Nothing should be placed in the child's mouth, because this may cause an injury not only to the child but to the nurse. To prevent aspiration, the child should be placed on the side if possible to facilitate drainage.

External defects of the genitourinary tract, such as hypospadias, are usually repaired as early as possible to ensure

development of normal body image. Promotion of a normal body image is extremely important. Surgery involving sexual organs can be upsetting to children, especially preschoolers, who fear mutilation and castration. Surgical intervention for external defects of the genitourinary system should be done as soon as possible. Prevention of urinary tract complications is important for defects that affect function, but for all external defects, repair should be done as soon as possible. Proper preprocedure preparation can help prevent or at least reduce separation anxiety. Acceptance of hospitalization is important but not the reason for early surgical intervention of external defects of the genitourinary system.

The nurse is preparing to give digoxin (Lanoxin) to a 9-month-old infant. The nurse checks the dose; 4 mL of the drug is to be drawn up. Based on the nurse's knowledge of this medication and safe pediatric dosages, the most appropriate action by the nurse is do not draw-up dose; suspect dosage error. mix dose with juice to disguise its taste. check heart rate; administer dose by placing it to the back and side of mouth. check heart rate; administer dose by letting infant suck it through a nipple.

do not draw-up dose; suspect dosage error. Digoxin is often prescribed in micrograms. Rarely is more than 1 mL administered to an infant. As a potentially dangerous drug, digoxin has precise administration guidelines. Some institutions require that digoxin dosages be checked with another professional before administration. The nurse has drawn up too much medication and should not give it to the child. This is a correct procedure, but too much medication is prepared, so it should not be given to the child. This is a correct procedure, but too much medication is prepared, so it should not be given to the child.

After a patient returns from cardiac catheterization, the nurse notes that the pulse distal to the catheter insertion site is weaker (+1). The most appropriate nursing intervention is to elevate the affected extremity. document the findings and continue to monitor. notify the healthcare provider of the finding. apply warm compresses to the insertion site.

document the findings and continue to monitor The pulse distal to the catheter insertion site may be weaker for the first few hours after catheterization. It should gradually increase in strength. The extremity is kept straight and immobile, but elevation is not necessary. Because a weaker pulse is an expected finding, the nurse should document it and continue to monitor it. There is no need to notify the physician. The insertion site is kept dry. Warm compresses would increase the risk of bleeding from the insertion site.

Although infants may be allergic to a variety of foods, the most common allergens are

eggs, cow's milk, and peanuts. (Milk products, eggs, and peanuts are three of the most common food allergens. Ingestion of these products can cause sensitization and, with subsequent exposure, an allergic reaction. Eggs are a common allergen but not fruit or rice. Wheat is a common allergen but not fruit and vegetables. Cow's milk is a common allergen but not green vegetables)

A school-age child recently diagnosed with type 1 diabetes mellitus asks the nurse if he can still play soccer, play baseball, and swim. The nurse's response should be based on knowledge that A exercise is contraindicated. B the level of activity depends on the type of insulin required. C exercise is not restricted unless indicated by other health conditions. D soccer and baseball are too strenuous, but swimming is acceptable.

exercise is not restricted unless indicated by other health conditions. Correct Exercise is encouraged for children with diabetes because it lowers blood glucose levels. Insulin and meal requirements require careful monitoring to ensure that the child has sufficient energy for exercise. Exercise is highly encouraged. The decrease in blood glucose can be accommodated by having snacks available. The level of activity is not dependent on the type of insulin used. Long- and short-acting insulin both may be used to compensate for the effects of training and sporting events. Sports are encouraged to help regulate the insulin, and food should be adjusted according to the amount of exercise. The child needs to be cautioned to monitor responses to the exercise.

The Glasgow Coma Scale consists of an assessment of A pupil reactivity and motor response. B level of consciousness and verbal response. C eye opening and verbal and motor response. D intracranial pressure and level of consciousness.

eye opening and verbal and motor response. Correct The scale is a three-part assessment that includes eye opening, verbal response, and motor response. It is an observational tool to detect a life-threatening complication such as cerebral edema. Pupil reactivity, level of consciousness, and intracranial pressure are not included in the scale.

The nurse working in an outpatient surgery center for children should understand that

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

An adolescent has sustained a spinal cord injury. The first stage, known as spinal shock syndrome, is characterized by increasing spasticity. spinal reflex activity. symptoms of hypertension. flaccid paralysis below level of damage.

flaccid paralysis below level of damage. Correct Reflexes are absent at or below the cord lesion. There is flaccidity or limpness of the involved muscles. Spinal reflex activity occurs in the second stage. Symptoms of hypotension occur.

Dialysis or transplantation becomes necessary for chronic renal failure when

glomerular filtration rate falls below 10% to 15% of normal Treatment with dialysis or transplantation is required when the glomerular filtration rate falls below 10% to 15% of normal. Anemia and acidosis may be present as part of the underlying disorder. The glomerular filtration rate determines the need for dialysis. The kidneys are able to maintain the chemical composition of fluids within normal limits until more than 50% of functional renal capacity is destroyed by disease or injury.

The nurse is preparing a 12-year-old girl for a bone marrow aspiration. She tells the nurse she wants her mother with her "like before." The most appropriate nursing action is to

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

. A neonate with a goiter has just been admitted to the newborn nursery. A priority nursing intervention is to A position the neonate on the left side. B explain to the parents how to place the dressing on the goiter. C have a tracheostomy set at bedside. D suction at least every 5 to 10 minutes.

have a tracheostomy set at bedside. Correct The goiter puts the infant at risk for respiratory failure. Preparations are made for emergency ventilation, including having a tracheostomy set at the bedside. Placing the neonate in a side-lying position is not indicated. Hyperextension of the child's neck may facilitate breathing. No dressing is indicated in a neonate who has a goiter. There is no indication for suctioning in a neonate with goiter.

A young child with tetralogy of Fallot may assume a posturing position as a compensatory mechanism. The position automatically assumed by the child is the low Fowler position. the prone position. the supine position. the squatting position.

he squatting position The squatting or knee-chest position increases the return of blood flow to the heart for oxygenation in a child with a defect that consists of decreased pulmonary blood flow. The low Fowler position does not offer any physiologic advantage to the child related to cardiac compensation. The prone position does not offer any physiologic advantage to the child related to cardiac compensation. The supine position does not offer any physiologic advantage to the child related to cardiac compensation.

The nurse is explaining blood components to an 8-year-old child. Based on the nurse's knowledge of child development, the most appropriate description of platelets is that they help keep germs from causing infection. make up the liquid portion of blood. carry the oxygen you breathe from your lungs to all parts of your body. help your body stop bleeding by forming a clot (scab) over the hurt area.

help your body stop bleeding by forming a clot (scab) over the hurt area. Correct Platelets are involved in homeostasis. This is the function of white blood cells. This is a definition of plasma. This is the function of the red blood cells.

Surgical repair for patent ductus arteriosus (PDA) is done to prevent the complication of pulmonary infection. right-to-left shunt of blood. decreased workload on left side of heart. increased pulmonary vascular congestion.

increased pulmonary vascular congestion. A PDA allows blood to flow from the aorta (high pressure) to the pulmonary artery (low pressure). If the PDA stays open, increased pulmonary vascular congestion can occur. The increased pulmonary vascular congestion is the primary complication; pulmonary infection may occur, but it is not the priority complication. A PDA involves a left-to-right shunt of blood. The decreased workload on the left side of the heart is not a priority complication of a PDA.

The most profound complication of prolonged middle ear disorders is

loss of hearing. Loss of hearing is the principal functional consequences of prolonged middle ear infections. Diminished hearing has an adverse effect on the development of speech, language, and cognition. During the active infection, loss of appetite typically occurs, and sucking or chewing tends to aggravate the pain. This is a short-term issue; when the otitis media resolves, the child resumes previous dietary intake. Ear infections do not have an effect on vision. Rupture of the eardrum may occur, but the loss of hearing and subsequent effect on speech are of greater concern.

Asthma is classified into four categories: mild intermittent, mild persistent, moderate persistent, and severe persistent. Clinical features used to determine these categories include (Select all that apply)

lung function. frequency of symptoms. frequency and severity of exacerbations.

The callus that develops at a fracture site is important because it provides A use of the injured part. B sufficient support for weight bearing. C means for adequate blood supply. D means for holding bone fragments together

means for holding bone fragments together. Correct New bone cells are formed in large numbers and stimulated to maximum activity. They are found at the site of the injury. In time, calcium salts are absorbed to form the callus. Functional use cannot occur until the fracture site is stable. Sufficient support for weight bearing cannot occur until the fracture site is stable. The callus does not provide an adequate blood supply.

The newborn diagnosed with phenylketonuria (PKU) will require long-term follow-up to assess for the development of A obesity. B diabetes insipidus. C respiratory distress. D mental retardation

mental retardation. Correct PKU, an inborn error of metabolism, may lead to mental retardation if early intervention is not performed. Obesity is not associated with PKU. Diabetes insipidus is not associated with PKU. Respiratory distress is not associated with PKU.

A 15 year-old is admitted to the intensive care unit (ICU) with a spinal cord injury. The most appropriate nursing interventions for this adolescent are (select all that apply) monitoring neurologic status. administering corticosteroids. monitoring for respiratory complications. discussing long-term care issues with the family. monitoring and maintaining hemodynamic status.

monitoring neurologic status.Correct administering corticosteroids.Correct monitoring for respiratory complications.Correct discussing long-term care issues with the family. monitoring and maintaining hemodynamic status.Correct

The nurse is instructing a group of parents about head injuries in children. The nurse should explain that infants are particularly vulnerable to acceleration-deceleration head injuries because the A anterior fontanel is not yet closed. B nervous tissue is not well developed. C scalp of head has extensive vascularity. D musculoskeletal support of head is insufficient.

musculoskeletal support of head is insufficient. Correct The relatively large head size coupled with insufficient musculoskeletal support increases the risk to infants of acceleration-deceleration head injuries. The lack of closure of the anterior fontanel is not relevant to the development of acceleration-deceleration head injuries in infants. The lack of well-developed nervous tissue is not relevant to the development of acceleration-deceleration head injuries in infants. The vascularity of the scalp is not relevant to the development of acceleration-deceleration injuries in infants.

The nurse is performing a neurologic assessment of a 2-month-old infant after a car accident. Moro, tonic neck, and withdrawal reflexes are present. The nurse should recognize that these reflexes suggest A neurologic health B severe brain damage C decorticate posturing D decerebrate posturing

neurologic health Correct The Moro, tonic neck, and withdrawal reflexes are usually present in infants under 3 to 4 months of age. Therefore, the presence of these reflexes indicates neurologic health. The presence of the Moro, tonic neck, and withdrawal reflexes does not indicate severe brain damage. Decorticate posturing is indicative of severe dysfunction of the cerebral cortex and is not related to the presence of the Moro, tonic neck, or withdrawal reflexes. Decerebrate posturing is indicative of dysfunction at the level of the midbrain and is not related to the presence of the Moro, tonic neck, or withdrawal reflexes.

An adolescent has had a lower leg amputation secondary to a motorcycle accident and is complaining of pain in the missing extremity. The nurse should recognize that this is A indicative of narcotic addiction B indicative of the need for psychological counseling C abnormal and suggests nerve damage D normal and called phantom limb sensation

normal and called phantom limb sensation Correct Phantom limb sensation is an expected experience because the nerve-brain connections are still present. They gradually fade. This should be discussed preoperatively with the child. There is no indication of narcotic addiction by the adolescent complaining of pain in the amputated extremity. Phantom limb pain is expected after an amputation; psychological counseling is not required for the adolescent experiencing it. Phantom limb pain is expected after an amputation and is not suggestive of nerve damage.

The parent of a child receiving an iron preparation tells the nurse that the child's stools are a tarry green color. The nurse should explain that this is a(n) symptom of iron deficiency anemia. adverse effect of the iron preparation. indicator of an iron preparation overdose. normally expected change resulting from the iron preparation.

normally expected change resulting from the iron preparation. Correct An adequate dosage of iron turns the stools a tarry green color. Descriptions of iron-deficiency anemia, iron preparation, and iron preparation overdose are not relevant. If the stools do not become tarry green, it may be indicative of administration issues.

A child with sickle cell anemia develops severe chest pain, fever, a cough, and dyspnea. The nurse's first action is to administer 100% oxygen to relieve hypoxia. administer pain medication to relieve symptoms. notify practitioner because chest syndrome is suspected. notify practitioner because child may be having a stroke.

notify practitioner because chest syndrome is suspected. Correct Severe chest pain, fever, a cough, and dyspnea are the signs and symptoms of chest syndrome. The nurse must notify the practitioner immediately. Breathing 100% oxygen to relieve hypoxia may be ordered by the practitioner, but the first action is notification because these symptoms indicate a medical emergency. Pain medications may be indicated, but evaluation is necessary first. Severe chest pain, fever, cough, and dyspnea are not signs of a stroke.

A 4-year-old child is brought to the emergency department. The child has a "froglike" croaking sound on inspiration, is agitated, and is drooling. The child insists on sitting upright. The priority action by the nurse is to

notify the healthcare provider immediately and be prepared to assist with a tracheostomy or intubation. Sitting upright, drooling, agitation, and a froglike cough are indicative of epiglottitis. This is a medical emergency, and tracheostomy or intubation may be necessary. Examination of the oropharynx may cause total obstruction and should not be done when a child manifests signs indicating potential epiglottitis. The child assumes a tripod position to facilitate breathing. Forcing the child to lie down will increase the respiratory distress and anxiety. Interventions should be planned once the diagnosis of epiglottitis has been made or ruled out.

The nurse is caring for a toddler who has had surgery for a brain tumor. During an assessment, the nurse notes that the child is becoming irritable and the pupils are unequal and sluggish. The most appropriate nursing action is to A notify the practitioner immediately. B assess for level of consciousness (LOC). C observe closely for signs of increased intracranial pressure (ICP). D administer pain medication and assess for response.

notify the practitioner immediately. Correct The worsening of symptoms may indicate that the ICP is increasing. The practitioner should be notified immediately because this is considered a medical emergency. Assessing for the LOC should be done as part of the assessment. The nurse is noting signs of potentially increased ICP as described; therefore, this has already been completed. Pain medication should not be given, because it can often mask the signs of increasing ICP. The priority nursing intervention is to consult with the practitioner immediately.

Nursing care of the infant and child with congestive heart failure includes force fluids appropriate to age. monitor respirations during active periods. organize activities to allow for uninterrupted sleep. give larger feedings less often to conserve energy.

organize activities to allow for uninterrupted sleep. The child needs to be well rested before feeding. The child's needs should be met to minimize crying. The nurse must organize care to decrease energy expenditure. The child in congestive heart failure has an excess of fluid, so forcing fluids is contraindicated. Monitoring of vital signs is appropriate, but minimizing energy expenditure is a priority. The child often cannot tolerate larger feedings; small, frequent feedings should be given to the child in congestive heart failure.

A 5-year-old has bilateral eye patches in place after surgery one day earlier. Today, the child can be out of bed. The most appropriate nursing intervention is to

orient the child to the immediate surroundings

Which urine test would be considered abnormal?

pH: 4 The expected pH of urine is 4.8 to 7.8. A specific gravity of 1.020 is within the normal specific gravity range of 1.015 to 1.030. Protein should not be present in the urine. It would indicate an abnormality in glomerular filtration. Glucose should not be present in the urine. If present, it could indicate diabetes mellitus, glomerulonephritis, or a response to infusion of fluids with high glucose concentrations.

The term used to describe an abnormal sensation such as burning or prickling is

paresthesia (An abnormal sensation such as burning or prickling describes paresthesia. Hyperesthesia is excessive sensitiveness, hypesthesia is diminished sensation, and anesthesia is absence of sensation)

Skin testing for tuberculosis (TB) is recommended

periodically for children who are high-risk populations. Children who are high risk for contracting the disease are monitored periodically. Annual testing is only indicated for children with human immunodeficiency virus infection and incarcerated adolescents. Testing is not necessary unless exposure is likely or an underlying medical risk factor is present.

The parent of a child with cystic fibrosis calls the clinic nurse to report that the child has developed tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The nurse should tell the parent to bring the child to the clinic because these symptoms are suggestive of

pneumothorax The child is exhibiting signs of increasing respiratory distress suggestive of a pneumothorax. The child needs to be seen as soon as possible. Bronchodilation would not produce the described symptoms. Carbon dioxide retention would not produce the described symptoms. The increased viscosity of sputum is characteristic of cystic fibrosis. The change in respiratory status is potentially due to a pneumothorax.

An immediate intervention to teach parents for when an infant chokes on a piece of food would be to

position infant in a head-down, face-down position and administer five quick back slaps. Positioning the infant head and face down while administering five quick blows between the shoulder blades is the correct initial sequence of actions for an infant with an obstructed airway. The infant needs to receive treatment immediately. Emergency help is called after attempting to remove the obstruction. Mouth-to-mouth resuscitation should not be used. This may push the object further into the child's respiratory system. If the child is obstructed, the water will not be able to pass. This will increase the risk of aspiration.

A 5-year-old child has been sent to the school nurse for urinary incontinence three times in the past 2 days. The nurse should recommend to the child's parent that the first action is to have the child evaluated for

possible urinary tract infection. Incontinence in a previously toilet-trained child can be an indication of a urinary tract infection. A physical cause of the problem needs to be eliminated before a psychological cause is considered. Emotional causes should be investigated only once a physical cause has been ruled out. Possible structural defects would be explored as a cause after a urinary tract infection is confirmed.

Cerebral palsy (CP) may result from a variety of causes. It is now known that the most common cause of CP is birth asphyxia neonatal diseases cerebral trauma prenatal brain abnormalities

prenatal brain abnormalities Correct The most common currently identifiable cause of CP is existing brain abnormalities during the prenatal period. Birth asphyxia had previously been thought of as a factor in the development of CP. Neonatal diseases have previously been thought of as factors in the development of CP. Cerebral trauma has previously been thought of as a factor in the development of CP.

An infant with a congenital heart defect is receiving palivizumab (Synagis). Based on the nurse's knowledge of medication, the purpose of this medication is to

prevent respiratory syncytial virus (RSV) infection. Palivizumab is a monoclonal antibody specifically used in the prevention of RSV. Monthly administration is expected to prevent infection with RSV. The goal of this drug is prevention of RSV. It will not affect the need to isolate the child if RSV develops. Palivizumab is specific to RSV, not bacterial infections. Palivizumab will have no effect on antiviral agents.

Congenital heart defects have traditionally been divided into acyanotic or cyanotic defects. Based on the nurse's knowledge of congenital heart defects, this system in clinical practice is helpful, because it explains the hemodynamics involved. helpful, because children with cyanotic defects are easily identified. problematic, because cyanosis is rarely present in children. problematic, because children with acyanotic heart defects may develop cyanosis.

problematic, because children with acyanotic heart defects may develop cyanosis. This classification is problematic. Children with traditionally named acyanotic defects may become cyanotic, and children with traditionally classified cyanotic defects may be pink at times. The classification does not reflect the blood flow within the heart. Cardiac defects are best described by using the actual pathophysiologic process and mechanism. Children with cyanosis may be easily identified, but that does not help with the diagnosis. Cyanosis is present when children have defects where there is mixing of oxygenated blood with unoxygenated blood.

A child with spina bifida has developed a latex allergy from numerous bladder catheterizations and surgeries. A priority nursing intervention is to recommend allergy testing. provide a latex-free environment. use only powder-free latex gloves. limit the use of latex products as much as possible.

provide a latex-free environment. Correct The most important nursing intervention is to provide a latex-free environment. From birth on, limitation of exposure to latex is essential in an attempt to minimize sensitization. Latex-free catheters for self-catheterization are available. Allergy testing may expose the child to the allergen and, therefore, is not recommended. The gloves contain latex and will contribute to sensitization. No latex products should be used with children who have latex allergies. Latex products should be avoided at all times.

The major goal of therapy for children with cerebral palsy (CP) is reversing degenerative processes that have occurred. curing the underlying defect causing the disorder. preventing spread to individuals in close contact with the children. recognizing the disorder early and promoting optimal development.

recognizing the disorder early and promoting optimal development. Correct Because CP is currently a permanent disorder, the goal of therapy is to promote optimal development. This is done through early recognition and beginning of therapy. It is difficult to reverse the degenerative processes associated with CP. The underlying defect(s) associated with the development of CP cannot be cured. CP is not contagious.

A young child is diagnosed with vesicoureteral reflux. The nurse should know that this is usually associated with

recurrent kidney infections. Reflux allows urine to flow back to the kidneys. When the urine is infected, this contributes to kidney infections. Incontinence may be associated with urinary tract infections but not directly with vesicoureteral reflux. Vesicoureteral reflux can cause renal scarring but not obstruction. Infarction of the renal vessels does not occur with vesicoureteral reflux.

A young child is diagnosed with vesicoureteral reflux. The nurse should know that this usually results in

recurrent urinary tract infections Reflux allows urine to flow back to the kidneys. When the urine is infected, this contributes to urinary tract infections and pyelonephritis. Incontinence may be associated with urinary tract infections. Reflux, when associated with vesicoureteral reflux, can cause renal scarring but not obstruction. Infarction of renal vessels does not occur.

The nurse is caring for a comatose child with multiple injuries. The nurse should recognize that pain A cannot occur if the child is comatose. B may occur if the child regains consciousness. C requires astute nursing assessment and management. D is best assessed by family members who are familiar with the child.

requires astute nursing assessment and management. Correct Because the child cannot communicate pain through one of the standard pain rating scales, the nurse must focus on physiologic and behavioral manifestations to accurately assess pain. Pain can occur in the comatose child. The child can be in pain while comatose. The family can provide insight into the child's different responses, but the nurse should be monitoring physiologic and behavioral manifestations.

The nurse is caring for a child with multiple injuries who is comatose. The nurse should recognize that pain A cannot occur if the child is comatose. B may occur if the child regains consciousness. C requires astute nursing assessment and management. D is best assessed by family members who are familiar with the child.

requires astute nursing assessment and management. Correct Because the child cannot communicate pain through one of the standard pain rating scales, the nurse must focus on physiologic and behavioral manifestations. The child can be in pain while comatose. The family can provide insight into different responses, but the nurse should monitor physiologic and behavioral manifestations.

Which of the following is descriptive of a parent who is an abuser?

s likely a single parent or from a young parent family.(Younger parents and single parents are at higher risk to be abusers. Abusive families are often socially isolated and have few support systems. They often have additional stressors such as low-income circumstances and little education)

The nurse is discussing long-term care with the parents of a child who has a ventriculoperitoneal shunt to correct hydrocephalus. An important part of the discussion with the parents is that A parental protection is essential until the child reaches adulthood. B mental retardation is to be expected with hydrocephalus. C shunt malfunction or infection requires immediate treatment. D most usual childhood activities must be restricted.

shunt malfunction or infection requires immediate treatment. Correct Because of the potentially severe sequelae, symptoms of shunt malfunction or infection must be assessed and treated immediately if present. Limits should be appropriate to the child's developmental age. Except for contact sports, the child will have few restrictions. The development of mental retardation depends on the extent of damage before the shunt was placed. Limits should be appropriate to the child's developmental age. Except for contact sports, the child will have few restrictions.

A child is developing respiratory failure. Signs that the hypoxia is becoming severe include

somnolence Somnolence is a late sign indicating severe hypoxia. Tachypnea, tachycardia, and restlessness are cardinal signs of respiratory failure and are observed early.

A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because it

soothes inflamed mucous membrane. Humidified inspired air soothes the membranes inflamed by the infection and dry air. The size of the droplets in humidified air is too large to liquefy secretions. No additional oxygen is provided with humidified air. The humidity has no effect on ventilation.

A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because it

soothes inflamed mucous membranes. Warm or cold mist is useful to soothe the inflamed mucous membranes. Humidification is most useful when hoarseness or laryngeal involvement occurs. Normal saline nose drops should be used to liquefy secretions. The mist particles do not penetrate in sufficient amounts to accomplish this. There is no additional oxygen in the mist therapy commonly used for respiratory tract infections. The primary effect of mist is to soothe the inflamed membranes. A reduction in swelling might ease ventilatory effort, but it is not the primary purpose of the therapy.

A 4-year-old boy needs to use a metered-dose inhaler to treat asthma. He cannot coordinate the breathing to use it effectively. The nurse should suggest that he use a

spacer The medication in a metered-dose inhaler is sprayed into the spacer. The child can then inhale the medication without having to coordinate the spraying and breathing. A nebulizer is a mechanism to administer medications, but it cannot be used with metered-dose inhalers. Peak expiratory flow meters measure pulmonary function but are not related to medication administration. Chest physiotherapy is unrelated to medication administration.

A neural tube defect that is not visible externally in the lumbosacral area would be called meningocele. myelomeningocele. spina bifida cystica. spina bifida occulta.

spina bifida occulta. Correct Spina bifida occulta is completely enclosed. Often, this disorder will not be noticed. A clue to the presence of this internal disorder will be a dimple or tuft of hair on the lumbosacral area. A meningocele contains meninges and spinal fluid but no neural tissue and is evident at birth as a sac in the lumbosacral area. Transillumination of light will be present. A myelomeningocele is a neural tube defect that contains meninges, spinal fluid, and nerves and is evident at birth as a sac in the lumbosacral area. Transillumination of light will not be present. Spina bifida cystica is a cystic formation with an external saclike protrusion.

A young child is having a seizure that has lasted 35 minutes. There is a loss of consciousness. Based on the nurse's knowledge of seizures, the nurse recognizes this as A absence seizure. B generalized seizure. C status epilepticus. D simple partial seizure.

status epilepticus. Correct Status epilepticus is a generalized seizure that lasts more than 30 minutes. This is considered a medical emergency and requires immediate treatment. Absence seizures are generalized seizures that are characterized by brief losses of consciousness, blank staring, and fluttering of the eyelids. Generalized seizures are the most common form of seizures. They include tonic-clonic (grand mal) seizures and absence (petit mal) seizures. Tonic-clonic seizures have tonic-clonic activity and loss of consciousness and involve both hemispheres of the brain. Simple partial seizures are characterized by varying sensations and motor behaviors.

. A breastfed newborn has just been diagnosed with galactosemia. The therapeutic management for this newborn is to A stop breastfeeding. B add amino acids to the breast milk. C substitute a lactose-containing formula for breast milk. D give the appropriate enzyme along with breast milk.

stop breastfeeding. Correct All milk- and lactose-containing formulas, including breast milk, must be stopped during infancy. Soy protein is the formula of choice for newborns and infants with galactosemia. Breast milk should not be used in newborns and infants with galactosemia. The formula used for a newborn and infant with galactosemia cannot contain lactose. Breast milk should not be used in newborns and infants with galactosemia.

A 17-year-old with type 1 diabetes mellitus tells the school nurse about recently starting to drink alcohol with friends on weekends. The most appropriate intervention by the nurse is to A tell the adolescent not to drink alcohol. B ask the adolescent about the reasons for drinking alcohol. C teach the adolescent about the effects of alcohol on type 1 diabetes mellitus and how to prevent problems associated with alcohol intake. D recommend counseling so that the adolescent understands the serious consequences of alcohol consumption.

teach the adolescent about the effects of alcohol on type 1 diabetes mellitus and how to prevent problems associated with alcohol intake. Correct The nurse is taking a proactive approach. The adolescent is provided with information to facilitate the management of the illness. Telling someone not to drink will not help should the person choose to continue drinking. Asking the adolescent why the drinking is occurring will provide information to the nurse but will not address the information that the adolescent needs to have about managing the disease. Counseling can be included in the teaching plan.

The school nurse is explaining to a child's kindergarten teacher that the child is allergic to peanuts. The nurse should include information that the child will most likely outgrow the allergy soon. the child should have an injectable epinephrine cartridge available at all times. the child allergic to peanuts can usually have peanut butter, but not whole peanuts. the child usually only shows skin signs such as hives when allergic.

the child should have an injectable epinephrine cartridge available at all times. Correct Exposure to peanuts can result in a severe allergic, potentially life-threatening reaction, such as anaphylaxis and shock. Immediate treatment to prevent such reactions includes the injection of epinephrine; therefore, this should be available at all times wherever the child is within the school premises. Peanut allergies may be lifelong. Children allergic to peanuts are allergic to all peanut products, whole and processed. They should have no peanut-containing products at all. The signs and symptoms of an allergic reaction to peanuts may vary from individual to individual.

An important component of hospice care is

the needs of the family are considered as important as those of the child (The child and family are cared for as a unit in the hospice philosophy. Family members are often the principal caregivers and are supported by a team of professional volunteer staff. Care can be provided in the home or in an inpatient facility that follows hospice philosophy. Medical therapies for comfort and pain control are continued. No extraordinary efforts are made to achieve a cure. Family care may continue for a year or more after the death.)

A school-age child with cancer is beginning to feel better now that the necessary medical procedures and treatments are not so traumatic. The child has also become very uncooperative with the parents. The nurse should explain that

this is a common reaction and a way to express anger (Children of this age-group are likely to exhibit fears through verbal uncooperativeness. It is the child's attempt to have some control over what is happening. The child recognizes the seriousness of the illness and is attempting to exercise control. Stricter discipline will not help with the child's behavior. It is necessary to allow the child to communicate feelings and provide outlets for aggression. The child needs to have the support of the family and health care team. Structure is necessary with opportunities for communication and control when feasible.)

When hemoglobin falls sufficiently to produce clinical manifestations, the signs and symptoms are caused by phagocytosis. tissue hypoxia. pulmonary hypertension. depressed bone marrow.

tissue hypoxia. Correct The signs and symptoms (e.g., weakness, fatigue, and a waxy pallor in severe anemia) are caused by tissue hypoxia. Phagocytosis is a function of white blood cells used in prevention of infection. Pulmonary hypertension is not associated with anemia. Severe anemia may contribute to cardiac compensation. Depressed bone marrow may be the cause of the low hemoglobin.

The primary therapy for secondary hypertension in children is a low-salt diet. weight reduction. increased exercise and fitness. treatment of underlying cause.

treatment of underlying cause. Secondary hypertension is a result of an underlying disease process or structural abnormality. It is usually necessary to treat the problem before the hypertension will be resolved. A low-salt diet, weight reduction, and increased exercise and fitness therapies are usually effective for essential hypertension.

The primary therapy for secondary hypertension in children is weight reduction. low-salt diet. increased exercise and fitness. treatment of underlying cause.

treatment of underlying cause. Secondary hypertension is a result of an underlying disease process or structural abnormality. It is usually necessary to treat the problem before the hypertension will be resolved. Weight reduction is usually effective in managing essential hypertension. A low-salt diet is usually effective in managing essential hypertension. Increased exercise and fitness are usually effective in managing essential hypertension

The mother of a 20-month-old tells the nurse that the child has a barking cough at night. The child's temperature is 37ºC (98.6ºF). The mother states the child is not having difficulty breathing. The nurse suspects croup and should recommend

trying a cool-mist vaporizer at night and watching for signs of difficulty breathing. Because the child is not having difficulty breathing, the nurse should teach the parents the signs of respiratory distress and tell them to come to the emergency department if they develop. Cool mist is recommended to provide relief because this therapy will assist in opening up the child's airways. The child does not have a temperature and, therefore, does not need management with acetaminophen. Cough suppressants are not indicated by symptom, and the American Pediatrics Association no longer recommends over-the-counter cough medicines for children under the age of 2 years. A barking cough is characteristic of laryngotracheobronchitis, not epiglottitis.

Nursing care of the child with myelosuppression from leukemia or chemotherapeutic agents should include to restrict oral fluids. institute strict isolation. use good hand-washing technique. give immunizations appropriate for age.

use good hand-washing technique. Correct Good hand-washing technique is the most effective means to prevent disease transmission in children with myelosuppression. There is no indication to reduce fluids in children with myelosuppression. Strict isolation is not necessary in children with myelosuppression. The child should not receive any live vaccines, because the immune system is not capable of responding appropriately to them.

The most appropriate nursing intervention for a child following a tonsillectomy is to

watch for continuous swallowing. Frequent swallowing is the most obvious early sign of bleeding from the operative site in a child who has had a tonsillectomy. Gargling should be avoided after a tonsillectomy because of potential trauma to the suture line. The child should be positioned on the side or abdomen to facilitate drainage after a tonsillectomy. Ice collars and cold liquids are encouraged for the child who has had a tonsillectomy. Cold therapy soothes and anesthetizes the area, decreasing the pain. Heat or warmth would increase the risk of bleeding.

A 1-year-old has been admitted for complete repair of a tetralogy of Fallot. What assessment finding should the nurse expect to be documented? a. Weight gain b. Pale skin color c. Increasing cyanosis d. Decrease in hemoglobin and hematocrit

ANS: C Elective repair of tetralogy of Fallot is usually performed in the first year of life. Indications for repair include increasing cyanosis and the development of hypercyanotic spells. The child would not have a weight gain, pale skin color, or decrease in hemoglobin and hematocrit.