Peds Final

What is the goal of the initial intervention for a child in cardiopulmonary arrest? a.Establishing a patent airway b.Determining a pulse rate c.Removing clothing d.Reassuring the parents

A A.The first intervention for a child in cardiopulmonary arrest, as for an adult, is to establish a patent airway. B.Assessment of pulse follows establishment of a patent airway. C.Clothing may be removed from the upper body for chest compressions after a patent airway is established. D.The first priority is to establish a patent airway.

A nurse routinely administers chemotherapy to hospitalized children with cancer. What safety measures does this nurse take as a routine part of practice? (Select all that apply.) a. Calculates child's body-surface area in meters squared b. Ensures a CBC is obtained within 72 hours of starting chemotherapy c. Double checks ordered doses against established protocols d. Obtains emergency equipment e. Monitors child based on provider orders

A, C, D The nurse providing chemotherapy has many responsibilities including calculating the child's body-surface area, double checking orders against protocols, and having emergency equipment available. A CBC should be obtained within 48 hours of administering chemotherapy. The nurse should monitor the child based on the child's condition and not just follow the orders left by the provider.

Which order should the nurse question when caring for a 5-year-old child after surgery for Hirschsprung disease? a. Monitor rectal temperature every 4 hours and report an elevation greater than 38.5° C. b. Assess stools after surgery. c. Keep the child NPO until bowel sounds return. d. Maintain IV fluids at ordered rate.

ANS: A Feedback A Rectal temperatures should not be taken after this surgery. Rectal temperatures are generally not the route of choice for children because of the route's traumatic nature. B This is an appropriate intervention postoperatively. Stools should be soft and formed. C This is an appropriate intervention postoperatively. D This is an appropriate postoperative order.

Which information should the nurse give to a child who is to have magnetic resonance imaging (MRI) of the brain? a. "Your head will be restrained during the procedure." b. "You will have to drink a special fluid before the test." c. "You will have to lie flat after the test is finished." d. "You will have electrodes placed on your head with glue."

ANS: A Feedback A To reduce fear and enhance cooperation during the MRI, the child should be made aware that the head will be restricted to obtain accurate information. B Drinking fluids is usually done for gastrointestinal procedures. C A child should lie flat after a lumbar puncture, not during an MRI. D Electrodes are attached to the head for an electroencephalogram.

Which play patterns does a 3-year-old child typically display? Select all that apply. a. Imaginary play b. Parallel play c. Cooperative play d. Structured play e. Associative play

ANS: A, B, C, E Feedback Correct Children between ages 3 and 5 years enjoy parallel and associative play. Children learn to share and cooperate as they play in small groups. Play is often imitative, dramatic, and creative. Imaginary friends are common around age 3 years. Incorrect Structured play is typical of school-age children.

Which interventions should the nurse include in the home care instructions for the parents of a child who has a cast applied to the left forearm? Select all that apply. a. Keep small toys away from the cast. b. Use a padded ruler to scratch the skin under the cast if it itches. c. Daily assess the cast for unusual odors. d. Elevate the extremity on pillows for the first 24 to 48 hours. e. Numbness and tingling in the extremity is expected.

ANS: A, C, D Feedback Correct Small toys should be kept away from the cast because they can become lodged inside the cast. The cast should be inspected daily for any unusual odors, which can indicate infection. The extremity should be elevated for the first 24 to 48 hours to decrease edema. Incorrect Nothing should be placed inside the cast. If numbness or tingling is experienced, the physician should be notified.

A nurse should expect which cerebral spinal fluid (CSF) laboratory results on a child diagnosed with bacterial meningitis? Select all that apply. a. Elevated white blood count (WBC) b. Decreased protein c. Decreased glucose d. Cloudy in color e. Increase in red blood cells (RBC)

ANS: A, C, D Feedback Correct The CSF laboratory results for bacterial meningitis include elevated WBC counts, cloudy or milky in color, and decreased glucose. Incorrect The protein is elevated and there should be no RBCs present. RBCs are present when the tap was traumatic.

A nurse working on the pediatric unit should be aware that children admitted with which of the following assessment findings are suggestive of physical child abuse? Select all that apply. a. Bruises in various stages of healing b. Bruises over the shins or bony prominences c. Burns on the palms of the hands d. A fracture of the right wrist from a sports accident e. Rib fractures in an infant

ANS: A, C, E Feedback Correct: Bruises in various stages of healing and burns on the palms of the hand may be indicative of physical abuse. Rib fractures in an infant are another indicator of physical abuse. Incorrect: Bruises over the shins or bony prominences are seen in children beginning to walk. A fracture of the right wrist can occur as the child begins to participate in sports activities.

The nurse is aware that suicide risk increases if the child displays which characteristics? Select all that apply. a. Previous suicide attempt b. No previous exposure to violence in the home c. Recent loss d. Effective social network e. History of physical abuse

ANS: A, C, E Feedback Correct: The risk of suicide increases if the child has had a previous suicide attempt, a recent loss, or a history of physical abuse. Incorrect: No previous violence in the home or having an effective social network decreases the risk of suicide.

Which interventions should the nurse implement to prevent complications of immobility for a child in skeletal traction? Select all that apply. a. Reposition the child every 2 hours. b. Avoid use of an egg-crate or sheepskin mattress. c. Limit fluid intake. d. Administer stool softeners as prescribed. e. Encourage coughing and deep breathing.

ANS: A, D, E Feedback Correct Complications of immobility can affect the skin, the gastrointestinal system, and the respiratory system. The child should be repositioned every 2 hours to prevent skin breakdown. Stool softeners should be administered to avoid constipation and the child should cough and deep breathe to maintain respiratory function. Incorrect Egg-crate or sheep skin mattresses can be useful in preventing skin breakdown, and fluids should be increased to prevent constipation, not decreased.

The nurse is teaching parents of a toddler about language development. Which statement best identifies the characteristics of language development in a toddler? a. Language development skills slow during the toddler period. b. The toddler understands more than he can express. c. Most of the toddler's speech is not easily understood. d. The toddler's vocabulary contains approximately 600 words.

ANS: B Feedback A Although language development varies in relationship to physical activity, language skills are rapidly accelerating by 15 to 24 months of age. B The toddler's ability to understand language (receptive language) exceeds the child's ability to speak it (expressive language). C By 2 years of age, 60% to 70% of the toddler's speech is understandable. D The toddler's vocabulary contains approximately 300 or more words.

Which is assessed with Tanner staging? a. Hormone levels b. Secondary sex characteristics c. Response to growth hormone secretion tests d. Hyperthyroidism

ANS: B Feedback A Hormone levels are assessed by their concentration in the blood. B Tanner stages are used to assess staging of secondary sex characteristics at puberty. C Growth hormone secretion tests are not associated with Tanner staging. D Tanner stages are not associated with hyperthyroidism.

According to Erikson, the psychosocial task of adolescence is to develop a. Intimacy b. Identity c. Initiative d. Independence

ANS: B Feedback A Intimacy is the developmental stage for early adulthood. B Traditional psychosocial theory holds that the developmental crises of adolescence lead to the formation of a sense of identity. C Initiative is the developmental stage for early childhood. D Independence is not one of Erikson's developmental stages.

What predisposes the adolescent to feel an increased need for sleep? a. An inadequate diet b. Rapid physical growth c. Decreased activity that contributes to a feeling of fatigue d. The lack of ambition typical of this age-group

ANS: B Feedback A Rapid physical growth, the tendency toward overexertion, and the overall increased activity of this age contributes to fatigue. B During growth spurts, the need for sleep is increased. C Rapid physical growth, the tendency toward overexertion, and the overall increased activity of this age contributes to fatigue. D Rapid physical growth, the tendency toward overexertion, and the overall increased activity of this age contributes to fatigue.

Which statement is the most appropriate advice to give parents of a 16-year-old who is rebellious? a. "You need to be stricter so that your teen stops trying to test the limits." b. "You need to collaborate with your daughter and set limits that are perceived as being reasonable." c. "Increasing your teen's involvement with her peers will improve her self-esteem." d. "Allow your teenager to choose the type of discipline that is used in your home."

ANS: B Feedback A Setting stricter limits typically does not decrease rebelliousness or decrease testing of parental limits. B Allowing teenagers to choose between realistic options and offering consistent and structured discipline typically enhances cooperation and decreases rebelliousness. Structure helps adolescents to feel more secure and assists them in the decision-making process. C Increasing peer involvement does not typically increase self-esteem. D Allowing teenagers to choose the method of discipline is not realistic and typically does not reduce rebelliousness.

Which tool measures body fat most accurately? a. Stadiometer b. Calipers c. Cloth tape measure d. Paper or metal tape measure

ANS: B Feedback A Stadiometers are used to measure height. B Calipers are used to measure skin-fold thickness, which is an indicator of body fat content. C Cloth tape measures should not be used because they can stretch. D Paper or metal tape measures can be used for recumbent lengths and other body measurements that must be made.

Which developmental assessment instrument is appropriate to assess a 5-year-old child? a. Brazelton Behavioral Scale b. Denver Developmental Screening Test II (DDST-II) c. Dubowitz Scale d. New Ballard Scale

ANS: B Feedback A The Brazelton Behavioral Scale is used for newborn assessment. B The DDST-II is used for infants and children between birth and 6 years of age. C The Dubowitz Scale is used for estimation of gestational age. D The New Ballard Scale is used for newborn screening.

Which child is most likely to be frightened by hospitalization? a. A 4-month-old infant admitted with a diagnosis of bronchiolitis b. A 2-year-old toddler admitted for cystic fibrosis c. A 9-year-old child hospitalized with a fractured femur d. A 15-year-old adolescent admitted for abdominal pain

ANS: B Feedback A Young infants are not as likely to be as frightened as toddlers by hospitalization because they are not as aware of the environment. B Toddlers are most likely to be frightened by hospitalization because their thought processes are egocentric, magical, and illogical. They feel very threatened by unfamiliar people and strange environments. C The 9-year-old child's cognitive ability is sufficient enough for the child to understand the reason for hospitalization. D The 15-year-old adolescent has the cognitive ability to interpret the reason for hospitalization.

An important consideration for the school nurse who is planning a class on bicycle safety is a. Most bicycle injuries involve collision with an automobile. b. Head injuries are the major causes of bicycle-related fatalities. c. Children should wear bicycle helmets if they ride on paved streets. d. Children should not ride double unless the bicycle has an extra-large seat.

ANS: B Feedback A Although motor vehicle collisions do cause injuries to bicyclists, most injuries result from falls. B The most important aspect of bicycle safety is to encourage the rider to use a protective helmet. Head injuries are the major cause of bicycle-related fatalities. C The child should always wear a properly fitted helmet approved by the U.S. Consumer Product Safety Commission. D Children should not ride double.

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 Feedback A 1.0 mg is too low a dose. B It has been estimated that a daily intake of 0.4 mg of folic acid in women of childbearing age has contributed to a reduction in the number of children with neural tube defects. C 1.5 mg is not the recommended dosage of folic acid. D 2.0 mg is not the recommended dosage of folic acid.

What is the appropriate priority nursing action for the infant with a CHD who has an increased respiratory rate, is sweating, and is not feeding well? a. Recheck the infant's blood pressure. b. Alert the physician. c. Withhold oral feeding. d. Increase the oxygen rate.

ANS: B Feedback A Although this may be indicated, it is not the priority action. B These are signs of early congestive heart failure, and the physician should be notified. C Withholding the infant's feeding is an incomplete response to the problem. D Increasing oxygen may alleviate symptoms, but medications such as digoxin and furosemide are necessary to improve heart function and fluid retention. Notifying the physician is the priority nursing action.

What are the nursing priorities for a child with sickle cell disease in vaso-occlusive crisis? a. Administration of antibiotics and nebulizer treatments b. Hydration and pain management c. Blood transfusions and an increased calorie diet d. School work and diversion

ANS: B Feedback A Antibiotics may be given prophylactically. Oxygen therapy rather than nebulizer treatments is used to prevent further sickling. B Hydration and pain management decrease the cells' oxygen demands and prevent sickling. C Although blood transfusions and increased calories may be indicated, they are not primary considerations for vaso-occlusive crisis. D School work and diversion are not major considerations when the child is in a vaso-occlusive crisis

Parents of a child with lice infestation should be instructed carefully in the use of antilice products because of which potential side effect? a. Nephrotoxicity b. Neurotoxicity c. Ototoxicity d. Bone marrow depression

ANS: B Feedback A Antilice products are not known to be nephrotoxic. B Because of the danger of absorption through the skin and potential for neurotoxicity, antilice treatment must be used with caution. A child with many open lesions can absorb enough to cause seizures. C Antilice products are not ototoxic. D Products that treat lice are not known to cause bone marrow depression.

When assessing a child for an upper extremity fracture, the nurse should know that these fractures most often result from a. Automobile accidents b. Falls c. Physical abuse d. Sports injuries

ANS: B Feedback A Automobile accidents result in fractures to any bones. Frequently, the femur is broken. B The major cause of children's fractures is falls. Because of the protection reflexes, the outstretched arm often receives the full force of the fall. C Physical abuse may result in fractures to any bone. D Sports injuries may result in fractures to any bone.

Which 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 Feedback A Coma is the state in which no motor or verbal response occurs to noxious (painful) stimuli. B Stupor exists when the child remains in a deep sleep, responsive only to vigorous and repeated stimulation. C Obtundation describes a level of consciousness in which the child is arousable with stimulation. D Persistent vegetative state describes the permanent loss of function of the cerebral cortex.

How should the nurse respond to a parent who asks, "How can I protect my baby from whooping cough?" a. "Don't worry; your baby will have maternal immunity to pertussis that will last until they are approximately 18 months old." b. "Make sure your child gets the pertussis vaccine." c. "See the doctor when the baby gets a respiratory infection." d. "Have your pediatrician prescribe erythromycin."

ANS: B Feedback A Infants do not receive maternal immunity to pertussis and are susceptible to pertussis. Pertussis is highly contagious and is associated with a high infant mortality rate. B Primary prevention of pertussis can be accomplished through administration of the pertussis vaccine. C Prompt evaluation by the primary care provider for respiratory illness will not prevent pertussis. D Erythromycin is used to treat pertussis. It will not prevent the disease.

The nurse is preparing a school-age child for computed tomography (CT scan) to assess cerebral function. Which statement should the nurse include when 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 Feedback A Pain medication is not required; however, sedation is sometimes necessary. 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. C The child will not be allowed to move and will be immobilized. D Someone is able to remain with the child during the procedure.

The infant with bronchopulmonary dysplasia (BPD) who has RSV bronchiolitis is a candidate for which treatment? a. Pancreatic enzymes b. Cool humidified oxygen c. Erythromycin intravenously d. Intermittent positive pressure ventilation

ANS: B Feedback A Pancreatic enzymes are used for patients with cystic fibrosis. B Humidified oxygen is delivered if the oxygen saturation level drops to less than 90%. C Antibiotics are ineffective against viral illnesses. Oxygen can be administered by hood, facemask, or nasal cannula. D Assisted ventilation is not necessary in the treatment of RSV infections.

Appropriate interventions to facilitate socialization of the cognitively impaired child include a. Providing age-appropriate toys and play activities b. Providing peer experiences, such as scouting, when older c. Avoiding exposure to strangers who may not understand cognitive development d. Emphasizing mastery of physical skills because they are delayed more often than verbal skills

ANS: B Feedback A Providing age-appropriate toys and play activities is important. However, peer interactions will better facilitate social development. B The acquisition of social skills is a complex task. Children of all ages need peer relationships. Parents should enroll the child in preschool. When older, they should have peer experiences similar to other children such as group outings, Boy and Girl Scouts, and Special Olympics. C Parents should expose the child to strangers so that the child can practice social skills. D Verbal skills are delayed more than physical skills.

The Glasgow Coma Scale consists of an assessment of a. Pupil reactivity and motor response b. Eye opening and verbal and motor responses c. Level of consciousness and verbal response d. ICP and level of consciousness

ANS: B Feedback A Pupil reactivity is not a part of the Glasgow Coma Scale but is included in the pediatric coma scale. B The Glasgow Coma Scale assesses eye opening, and verbal and motor responses. C Level of consciousness is not a part of the Glasgow Coma Scale. D Intracranial pressure and level of consciousness are not part of the Glasgow Coma Scale.

A nurse is explaining growth hormone deficiency to parents of a child admitted to rule out this problem. Which metabolic alteration that is related to growth hormone deficiency should the nurse explain to the parent? a. Hypocalcemia b. Hypoglycemia c. Diabetes insipidus. d. Hyperglycemia

ANS: B Feedback A Symptoms of hypocalcemia are associated with hypoparathyroidism. B Growth hormone helps maintain blood sugar at normal levels. C Diabetes insipidus is a disorder of the posterior pituitary. Growth hormone is produced by the anterior pituitary. D Hyperglycemia results from an insufficiency of insulin, which is produced by the beta cells in the islets of Langerhans in the pancreas.

Diabetes insipidus is a disorder of the a. Anterior pituitary b. Posterior pituitary c. Adrenal cortex d. Adrenal medulla

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

The school nurse observes an unkempt child dressed in inappropriate clothing who repeatedly asks for food. About which problem is the nurse concerned? a. Physical abuse b. Physical neglect c. Emotional abuse d. Sexual abuse

ANS: B Feedback A There are no physical indicators of actual abuse in this description. Behavioral indicators of physical abuse reflect an impaired relationship with parents and other adults. B These physical and behavioral indicators suggest that parental attention is not being given to the child's physical needs. The child is being neglected. C Emotional abuse is manifested by developmental problems or maladaptive behaviors. D Physical indicators of sexual abuse are focused on the genitourinary system. A variety of behavioral indicators range from bizarre sexual behavior to eating and sleeping disturbances.

Ringworm, frequently found in schoolchildren, is caused by a(n) a. Virus b. Fungus c. Allergic reaction d. Bacterial infection

ANS: B Feedback A These are not the causative organisms for ringworm. B Ringworm is caused by a group of closely related filamentous fungi, which invade primarily the stratum corneum, hair, and nails. They are superficial infections that live on, not in, the skin. C Ringworm is not an allergic response. D These are not the causative organisms for ringworm.

A boy who has fractured his forearm is unable to extend his fingers. The nurse knows that this a. Is normal following this type of injury b. May indicate compartmental syndrome c. May indicate fat embolism d. May indicate damage to the epiphyseal plate

ANS: B Feedback A This is not normal and indicates neurovascular compromise of some type. Paresthesia or numbness or loss of feeling can indicate a serious problem and can result in paralysis. B Swelling causes pressure to rise within the immobilizing device leading to compartmental syndrome. Signs include severe pain, often unrelieved by analgesics, and neurovascular impairment. It is not uncommon in the forearm, so the inability to extend the fingers may indicate compartmental syndrome. C The inability to extend the fingers often indicates neurovascular compromise. Fat embolism causes respiratory distress with hypoxia and respiratory acidosis. D This is not related to damage to the epiphyseal plate.

The nurse encourages the mother of a toddler with acute LTB to stay at the bedside as much as possible. The nurse's rationale for this action is primarily that 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 Feedback A This is true, but not the best answer. B The family's presence will decrease the child's distress. C Although true for toddlers, the main reason to keep parents at the child's bedside is to ease anxiety and therefore respiratory effort. D 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 adolescent being seen by the nurse practitioner for a sports physical is identified as having hypertension. On further testing, it is discovered the child has a cardiac abnormality. The initial treatment of secondary hypertension initially involves a. Weight control and diet b. Treating the underlying disease c. Administration of digoxin d. Administration of beta-adrenergic receptor blockers

ANS: B Feedback A Weight control and diet is a non-pharmacologic treatment for primary hypertension. B Identification of the underlying disease should be the first step in treating secondary hypertension. C Digoxin is indicated in the treatment of congestive heart failure. D Beta-adrenergic receptor blockers are indicated in the treatment of primary hypertension.

A hospitalized child has developed a methicillin-resistant Staphylococcus aureus (MRSA) infection. The nurse plans which interventions when caring for this child? Select all that apply. a. Airborne isolation b. Administration of vancomycin (Vancocin) c. Contact isolation d. Administration of mupirocin (Bactroban) ointment to the nares e. Administration of cefotaxime (Cefotetan)

ANS: B, C, D Feedback Correct: Vancomycin is used to treat MRSA along with mupirocin ointment to the nares. The patient is placed in contact isolation to prevent spread of the infection to other patients. Incorrect: The infection is not transmitted by the airborne route so only contact isolation is required. This infection is resistant to cephalosporins.

The prevalence of obesity in the United States has risen dramatically in both adults and children. The increase in the number of overweight children is addressed in Healthy People 2020. Strategies designed to approach this issue include (select all that apply) a. Decreased calcium and iron intake b. Increased fiber and whole grain intake c. Decreased use of sugar and sodium d. Increase fruit and vegetable intake e. Decrease the use of solid fats

ANS: B, C, D, E Feedback Correct Along with these recommendations, children at risk for being overweight should be screened beginning at age 2 years. Children with a family history of dyslipidemia or early cardiovascular disease development, children whose body mass index percentile exceeds the definition for overweight, and children who have high blood pressure should have a fasting lipid screen. Incorrect The nurse should instruct parents that calcium and iron intake should be increased as part of this strategy.

A school nurse is screening children for scoliosis. Which assessment findings should the nurse expect to observe for scoliosis? Select all that apply. a. Pain with deep palpation of the spinal column b. Unequal shoulder heights c. The trouser pant leg length appears shorter on one side d. Inability to bend at the waist e. Unequal waist angles

ANS: B, C, E Feedback Correct The assessment findings associated with scoliosis include unequal shoulder heights, trouser pant leg length appearing shorter on one side meaning unequal leg length, and unequal waist angles. Incorrect Scoliosis is a nonpainful curvature of the spine so pain is not expected and the child is able to bend at the waist adequately.

Which children admitted to the pediatric unit would the nurse monitor closely for development of SIADH? Select all who apply. a. A newly diagnosed preschooler with type 1 diabetes b. A school-age child returning from surgery for removal of a brain tumor c. An infant with suspected meningitis d. An adolescent with blunt abdominal trauma following a car accident e. A school-age child with head trauma

ANS: B, C, E Feedback Correct Childhood SIADH usually is caused by disorders affecting the central nervous system, such as infections (meningitis), head trauma, and brain tumors. Incorrect These conditions do not usually cause SIADH.

When is the most appropriate time to inspect the genital area during a well-child examination of a 14-year-old girl? a. It is not necessary to inspect the genital area. b. Examine the genital area first. c. After the abdominal assessment. d. Do the genital inspection last.

ANS: C Feedback A A visual inspection of all areas of the body is included in a physical examination. B Examination of the genital area can be embarrassing. It is not be appropriate to begin the examination of this area. C It is best to incorporate the genital assessment into the middle of the examination. This allows ample time for questions and discussion. If possible, proceed from the abdominal area to the genital area. D Assessing the genital area earlier in the examination allows more time for the adolescent to ask questions and engage in discussion.

What is the primary purpose of a transitional object? a. It helps the parents deal with the guilt they feel when they leave the child. b. It keeps the child quiet at bedtime. c. It is effective in decreasing anxiety in the toddler. d. It decreases negativism and tantrums in the toddler.

ANS: C Feedback A Decreased parental guilt (distress) is an indirect benefit of a transitional object. B A transitional object may be part of a bedtime ritual, but it may not keep the child quiet at bedtime. C Decreasing anxiety, particularly separation anxiety, is the function of a transitional object; it provides comfort to the toddler in stressful situations and helps make the transition from dependence to autonomy. D A transitional object does not significantly affect negativity and tantrums, but it can comfort a child after tantrums.

Frequent developmental assessments are important for which reason? a. Stable developmental periods during infancy provide an opportunity to identify any delays or deficits. b. Infants need stimulation specific to the stage of development. c. Critical periods of development occur during childhood. d. Child development is unpredictable and needs monitoring.

ANS: C Feedback A Infancy is a dynamic time of development that requires frequent evaluations to assess appropriate developmental progress. B Infants in a nurturing environment will develop appropriately and will not necessarily need stimulation specific to their developmental stage. C Critical periods are blocks of time during which children are ready to master specific developmental tasks. The earlier those delays in development are discovered and intervention initiated, the less dramatic their effect will be. D Normal growth and development is orderly and proceeds in a predictable pattern based on each individual's abilities and potentials.

An effective technique for communicating with toddlers is to a. Have the toddler make up a story from a picture. b. Involve the toddler in dramatic play with dress-up clothing. c. Use picture books. d. Ask the toddler to draw pictures of his fears.

ANS: C Feedback A Most toddlers do not have the vocabulary to make up stories. B Dramatic play is associated with older children. C Activities and procedures should be described as they are about to be done. Use picture books and play for demonstration. Toddlers experience the world through their senses. D Toddlers probably are not capable of drawing or verbally articulating their fears.

What is an appropriate preoperative teaching plan for a school-age child? a. Begin preoperative teaching the morning of surgery. b. Schedule a tour of the hospital a few weeks before surgery. c. Show the child books and pictures 4 days before surgery. d. Limit teaching to 5 minutes and use simple terminology.

ANS: C Feedback A Preoperative teaching a few hours before surgery is more appropriate for the preschool child. Preoperative materials should be introduced 1 to 5 days in advance for school-age children. B Preparation too far in advance of the procedure can be forgotten or cause undue anxiety for an extended period of time. C Preparatory material can be introduced to the school-age child several days (1 to 5) in advance of the event. Books, pictures, charts, and videos are appropriate. D A very short, simple explanation of the surgery is appropriate for a younger child such as a toddler.

The parent of 2-week-old Sarah asks the nurse whether Sarah needs fluoride supplements, because she is exclusively breastfed. The nurse's best response is a. "She needs to begin taking them now." b. "They are not needed if you drink fluoridated water." c. "She may need to begin taking them at age 6 months." d. "She can have infant cereal mixed with fluoridated water instead of supplements."

ANS: C Feedback A The recommendation is to begin supplementation at 6 months. B The amount of water that is ingested and the amount of fluoride in the water are considered when supplementation is being considered. C Fluoride supplementation is recommended by the American Academy of Pediatrics beginning at age 6 months if the child is not drinking adequate amounts of fluoridated water. D The amount of water that is ingested and the amount of fluoride in the water are considered when supplementation is being considered.

Which comments indicate that the mother of a toddler needs further teaching about dental care? a. "We use well water so I give my toddler fluoride supplements." b. "My toddler brushes his teeth with my help." c. "My child will not need a dental checkup until his permanent teeth come in." d. "I use a small nylon bristle brush for my toddler's teeth."

ANS: C Feedback A Toddlers need fluoride supplements when they use a water supply that is not fluorinated. B Toddlers need supervision with dental care. The parent should finish brushing areas not reached by the child. C Children should first see the dentist 6 months after the first primary tooth erupts and no later than age 30 months. D A small nylon bristle brush works best for cleaning toddlers' teeth.

Which type of fractures describes traumatic separation of cranial sutures? a. Basilar b. Linear c. Commuted d. Depressed

ANS: C Feedback A A basilar fracture involves the basilar portion of the frontal, ethmoid, sphenoid, temporal, or occipital bone. B A linear fracture includes a straight-line fracture without dura involvement. C Commuted skull fractures include fragmentation of the bone or a multiple fracture line. D A depressed fracture has the bone pushed inward, causing pressure on the brain.

Which statement best describes beta-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 Feedback A An overproduction of red cells occurs. Although numerous, the red cells are relatively unstable. B An overproduction of red cells occurs. Although numerous, the red cells are relatively unstable. C Individuals who live near the Mediterranean Sea and their descendants have the highest incidence of thalassemia. D Sickle cell disease is common in blacks of West African descent.

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 the knowledge that 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. The parents are better able to manage the disease.

ANS: C Feedback A Blood glucose monitoring is more expensive but provides improved management. B It is as accurate as equivalent testing done in laboratories. 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 sugar results. D 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 nurse is admitting a child who has been diagnosed with Kawasaki disease. What is the most serious complication for which the nurse should assess in Kawasaki disease? a. Cardiac valvular disease b. Cardiomyopathy c. Coronary aneurysm d. Rheumatic fever

ANS: C Feedback A Cardiac valvular disease can occur in rheumatic fever. B Cardiomyopathies are diseases of the heart muscle, which can occur as a result of congenital heart disease, coronary artery disease, or other systemic disease. C Coronary artery aneurysms are seen in 20% to 25% of children with untreated Kawasaki disease. D Rheumatic fever is not a complication of Kawasaki disease.

A common clinical manifestation of juvenile hypothyroidism is a. Insomnia b. Diarrhea c. Dry skin d. Accelerated growth

ANS: C Feedback A Children with hypothyroidism are usually sleepy. B Constipation is associated with hypothyroidism. C Thick, dry skin, mental decline, cold intolerance, and weight gain are associated with juvenile hypothyroidism. D Decelerated growth is common in juvenile hypothyroidism.

New parents ask the nurse, "Why is it necessary for our baby to have the newborn blood test?" The nurse explains that the priority outcome of mandatory newborn screening for inborn errors of metabolism is a. Appropriate community referral for affected infants b. Parental education about raising a special needs child c. Early identification of serious genetically transmitted metabolic diseases d. Early identification of electrolyte imbalances

ANS: C Feedback A Community referral is appropriate after a diagnosis is made. B With early identification and treatment, serious complications such as intellectual impairment are prevented. C Early identification of hypothyroidism is basic to the prevention of intellectual impairment in the child. D Although electrolyte imbalances could occur with some of the inborn errors of metabolism, this is not the priority outcome, nor would the newborn screen detect electrolyte imbalances.

What is a common trigger for asthma attacks in children? a. Febrile episodes b. Dehydration c. Exercise d. Seizures

ANS: C Feedback A Febrile episodes are consistent with other problems, for example, seizures. B Dehydration occurs as a result of diarrhea; it does not trigger asthma attacks. Viral infections are triggers for asthma. C Exercise is one of the most common triggers for asthma attacks, particularly in school-age children. D Seizures can result from a too-rapid intravenous infusion of theophylline—a therapy for asthma.

When infants are seen for fractures, which nursing intervention is a priority? a. No intervention is necessary. It is not uncommon for infants to fracture bones. b. Assess the family's safety practices. Fractures in infants usually result from falls. c. Assess for child abuse. Fractures in infants are often nonaccidental. d. Assess for genetic factors.

ANS: C Feedback A Fractures in infancy are not common. B Infants should be cared for in a safe environment and should not be falling. C Fractures in infants warrant further investigation to rule out child abuse. Fractures in children younger than 1 year are unusual because of the cartilaginous quality of the skeleton; a large amount of force is necessary to fracture their bones. D Fractures in infancy are usually nonaccidental rather than related to a genetic factor.

An appropriate nursing diagnosis for a child with a cognitive dysfunction who has a limited ability to anticipate danger is a. Impaired social interaction b. Deficient knowledge c. Risk for injury d. Ineffective coping

ANS: C Feedback A Impaired social interaction is indeed a concern for the child with a cognitive disorder but does not address the limited ability to anticipate danger. B Because of the child's cognitive deficit, knowledge will not be retained and will not decrease the risk for injury. C The nurse needs to know that limited cognitive abilities to anticipate danger lead to risk for injury. D Ineffective individual coping does not address the limited ability to anticipate danger.

A neonate is born with mild clubfeet. When the parents ask the nurse how this will be corrected, the nurse should explain that 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 Feedback A Serial casting is the preferred treatment. B Surgical intervention is done only if serial casting is not successful. 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. D Children do not improve without intervention.

Which parasite causes acute diarrhea? a. Shigella organisms b. Salmonella organisms c. Giardia lamblia d. Escherichia coli

ANS: C Feedback A Shigella is a bacterial pathogen. B Salmonella is a bacterial pathogen. C Giardiasis a parasite that represents 15% of nondysenteric illness in the United States. D E. coli is a bacterial pathogen.

What should the nurse teach parents about oral hygiene for the child receiving chemotherapy? a. Brush the teeth briskly to remove bacteria. b. Use a mouthwash that contains alcohol. c. Inspect the child's mouth daily for ulcers. d. Perform oral hygiene twice a day.

ANS: C Feedback A The teeth should be brushed with a soft-bristled toothbrush. Excessive force with brushing should be avoided because delicate tissue could be broken, causing infection or bleeding. B Mouthwashes containing alcohol may be drying to oral mucosa, thus breaking down the protective barrier of the skin. C The child's mouth is inspected regularly for ulcers. At the first sign of ulceration, an antifungal drug is initiated. D Oral hygiene should be performed four times a day.

A histamine-receptor antagonist such as cimetidine (Tagamet) or ranitidine (Zantac) is ordered for an infant with GER. The purpose of this is to a. Prevent reflux. b. Prevent hematemesis. c. Reduce gastric acid production. d. Increase gastric acid production.

ANS: C Feedback A These are not the modes of action of histamine-receptor antagonists. B These are not the modes of action of histamine-receptor antagonists. C The mechanism of action of histamine-receptor antagonists is to reduce the amount of acid present in gastric contents and to prevent esophagitis. D These are not the modes of action of histamine-receptor antagonists.

What should the nurse teach a child about using an albuterol metered-dose inhaler for exercise-induced asthma? a. Take two puffs every 6 hours around the clock. b. Use the inhaler only when the child is short of breath. c. Use the inhaler 30 minutes before exercise. d. Take one to two puffs every morning upon awakening.

ANS: C Feedback A This schedule will not relieve exercise-induced asthma. B Waiting until symptoms are severe is too late to begin using a metered-dose inhaler. C The appropriate time to use an inhaled beta2-agonist or cromolyn is before an event that could trigger an attack. D This may be the child's usual schedule for medication. If exercise causes symptoms, additional medication is indicated.

What is helpful to tell a mother who is concerned about preventing sleep problems in her 2-year-old child? a. Have the child always sleep in a quiet, darkened room. b. Provide high-carbohydrate snacks before bedtime. c. Communicate with the child's daytime caretaker about eliminating the afternoon nap. d. Use a nightlight in the child's room.

ANS: D Feedback A A dark, quiet room may be scary to a preschooler. B High-carbohydrate snacks increase energy and do not promote relaxation. C Most 2-year-olds take one nap each day. Many give up the habit by age 3 years. Insufficient rest during the day can lead to irritability and difficulty sleeping at night. D The preschooler has a great imagination. Sounds and shadows can have a negative effect on sleeping behavior. Nightlights provide the child with the ability to visualize the environment and decrease the fear felt in a dark room.

Which behavior is most likely to encourage open communication? a. Avoiding eye contact b. Folding arms across chest c. Standing with head bowed d. Soft stance with arms loose at the side

ANS: D Feedback A Avoiding eye contact does not facilitate communication. B Folding arms across the chest is a closed body posture, which does not facilitate communication. C Standing with head bowed is a closed body posture, which does not facilitate communication. D An open body stance and positioning such as loose arms at the side invite communication and interaction.

Which measurement is not indicated for a 4-year-old well-child examination? a. Blood pressure b. Weight c. Height d. Head circumference

ANS: D Feedback A Blood pressure measurements are taken on all children at every ambulatory visit. B Weight is measured at every well-child examination. C Height is measured at every well-child examination. D Head circumference is measured on all children from birth to 3 years. Children older than 3 years of age with questionable head size or a history of megalocephaly, hydrocephalus, or microcephaly should have their head circumference assessed at every visit. A 4-year-old without a history of these problems does not need his or her head circumference measured.

The school nurse has been asked to begin teaching sex education in the 5th grade. The nurse should recognize that a. Children in 5th 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 Feedback A Fifth graders are usually 10 to 11 years old. This age is not too young to speak about physiologic changes in their bodies. B They should be encouraged to ask questions. C Preadolescents need precise and concrete information. D When sexual information is presented to school-age children, sex should be treated as a normal part of growth and development.

In providing anticipatory guidance to parents, which parental behavior is the most important in fostering moral development? a. Telling the child what is right and wrong b. Vigilantly monitoring the child and her peers c. Weekly family meetings to discuss behavior d. Living as the parents say they believe

ANS: D Feedback A Telling the child what is right and wrong is not effective unless the child has experienced what she hears. Parents need to live according to the values they are teaching to their children. B Vigilant monitoring of the child and her peers is an inappropriate action for the parent to initiate. It does not foster moral development and reasoning in the child. C Weekly family meetings to discuss behaviors may or may not be helpful in the development of moral reasoning. D Parents living what they believe gives nonambivalent messages and fosters the child's moral development and reasoning.

What is the most important consideration for effectively communicating with a child? a. The child's chronologic age b. The parent-child interaction c. The child's receptiveness d. The child's developmental level

ANS: D Feedback A The child's age may not correspond with the child's developmental level; therefore it is not the most important consideration for communicating with children. B Parent-child interaction is useful in planning communication with children, but it is not the primary factor in establishing effective communication. C The child's receptiveness is a consideration in evaluating the effectiveness of communication. D The child's developmental level is the basis for selecting the terminology and structure of the message most likely to be understood by the child.

During examination of a toddler's extremities, the nurse notes that the child is bowlegged. The nurse should recognize that this finding is a. Abnormal, requiring further investigation b. Abnormal unless it occurs in conjunction with knock-knee c. Normal if the condition is unilateral or asymmetric d. Normal, because the lower back and leg muscles are not yet well developed

ANS: D Feedback A This is an expected finding in toddlers. B This is an expected finding in toddlers. C Further evaluation is needed if it persists beyond age 2 to 3 years, especially in African-American children. D Genu varum (bowlegged) is common in toddlers when they begin to walk. It usually persists until all of their lower back and leg muscles are well developed.

What is the goal of therapeutic management for a child diagnosed with ADHD? a. Administer stimulant medications. b. Assess the child for other psychosocial disorders. c. Correct nutritional imbalances. d. Reduce the frequency and intensity of unsocialized behaviors.

ANS: D Feedback A Although medications are effective in managing behaviors associated with ADHD, all families do not choose to give their child medication. Administering medication is not the primary goal. B Children with ADHD may have other psychosocial or learning problems; however, diagnosing these is not the primary goal. C Interventions to correct nutritional imbalances are the primary focus of care for eating disorders. D The primary goal of therapeutic management for the child with ADHD is to reduce the intensity and frequency of unsocialized behaviors.

The best setting for daytime care for a 5-year-old autistic child whose mother works is a. Private day care b. Public school c. His own home with a sitter d. A specialized program that facilitates interaction by use of behavioral methods

ANS: D Feedback A Daycare programs generally do not have resources to meet the needs of severely impaired children. B To best meet the needs of an autistic child, the public school may refer the child to a specialized program. C A sitter might not have the skills to interact with an autistic child. D Autistic children can benefit from specialized educational programs that address their special needs.

Nursing care for the child in congestive heart failure includes a. Counting the number of saturated diapers b. Putting the infant in the Trendelenburg position c. Removing oxygen while the infant is crying d. Organizing care to provide rest periods

ANS: D Feedback A Diapers must be weighed for an accurate record of output. B The head of the bed should be raised to decrease the work of breathing. C Oxygen should be administered during stressful periods such as when the child is crying. D Nursing care should be planned to allow for periods of undisturbed rest.

What is the priority in the discharge plan for a child with immune thrombocytopenic purpura (ITP)? a. Teaching the parents to report excessive fatigue to the physician b. Monitoring the child's hemoglobin level every 2 weeks c. Providing a diet that contains iron-rich foods d. Establishing a safe, age-appropriate home environment

ANS: D Feedback A Excessive fatigue is not a significant problem for the child with ITP. B ITP is associated with low platelet levels. C Increasing the child's intake of iron in the diet will not correct ITP. D Prevention of injury is a priority concern for a child with ITP.

The pediatric nurse understands that cellulitis is most often caused by a. Herpes zoster b. Candida albicans c. Human papillomavirus d. Streptococcus or Staphylococcus organisms

ANS: D Feedback A Herpes zoster is the virus associated with varicella and shingles. B Candida albicans is associated with candidiasis or thrush. C Human papillomavirus is associated with various types of human warts. D Streptococcus, Staphylococcus, and Haemophilus influenzae are the organisms usually responsible for cellulitis

What is the most appropriate nursing action when the nurse notes a reddened area on the forearm of a neutropenic child with leukemia? a. Massage the area. b. Turn the child more frequently. c. Document the finding and continue to observe the area. d. Notify the physician.

ANS: D Feedback A In a child with neutropenia, a reddened area may be the only sign of an infection. The area should never be massaged. B The forearm is not a typical pressure area; therefore the likelihood of the redness being related to pressure is very small. C The observation should be documented, but because it may be a sign of an infection and immunosuppression, the physician must also be notified. D Skin is the first line of defense against infection. Any signs of infection in a child who is immunosuppressed must be reported to the physician. When a child is neutropenic, pus may not be produced and the only sign of infection may be redness.

What should be included in the care for a neonate who was diagnosed with pertussis? a. Monitoring hemoglobin level b. Hearing test before discharge c. Serial platelet counts d. Treatment of all close contacts with a prophylactic antibiotic

ANS: D Feedback A Pertussis does not affect the hemoglobin level. B A complication of pertussis is not hearing impairment. C Pertussis does not affect platelets. D Erythromycin, azithromycin, or clarithromycin is given to all close contacts for the child diagnosed with pertussis.

Why do infants and young children quickly have respiratory distress in acute and chronic alterations of the respiratory system? a. They have a widened, shorter airway. b. There is a defect in their sucking ability. c. The gag reflex increases mucus production. d. Mucus and edema obstruct small airways

ANS: D Feedback A The airway in infants and young children is narrower, not wider. B Sucking is not necessarily related to problems with the airway. C The gag reflex is necessary to prevent aspiration. It does not produce mucus. D The airway in infants and young children is narrower, and respiratory distress can occur quickly because mucus and edema can cause obstruction to their small airways.

Which statement made by a parent indicates understanding of restrictions for a child after cardiac surgery? a. "My child needs to get extra rest for a few weeks." b. "My son is really looking forward to riding his bike next week." c. "I'm so glad we can attend religious services as a family this coming Sunday." d. "I am going to keep my child out of daycare for 6 weeks."

ANS: D Feedback A The child should resume his regular bedtime and sleep schedule after discharge. B Activities during which the child could fall, such as riding a bicycle, are avoided for 4 to 6 weeks after discharge. C Large crowds of people should be avoided for 4 to 6 weeks after discharge, including public worship. D Settings where large groups of people are present should be avoided for 4 to 6 weeks after discharge, including day care.

A child has a 2-day history of vomiting and diarrhea. He has hypoactive bowel sounds and an irregular pulse. Electrolyte values are sodium, 139 mEq/L; potassium, 3.3 mEq/L; and calcium, 9.5 mg/dL. This child is likely to have which of the following electrolyte imbalances? a. Hyponatremia b. Hypocalcemia c. Hyperkalemia d. Hypokalemia

ANS: D Feedback A The normal serum sodium level is 135 to 145 mEq/L. A level of 139 mEq/L is within normal limits. B A serum calcium level less than 8.5 mg/dL is considered hypocalcemia. C A serum potassium level greater than 5 mEq/L is considered hyperkalemia. D A serum potassium level less than 3.5 mEq/L is considered hypokalemia. Clinical manifestations of hypokalemia include muscle weakness, decreased bowel sounds, cardiac irregularities, hypotension, and fatigue.

Which statement made by a parent indicates an understanding about the management of a child with cellulitis? a. "I am supposed to continue the antibiotic until the redness and swelling disappear." b. "I have been putting ice on my son's arm to relieve the swelling." c. "I should call the doctor if the redness disappears." d. "I have been putting a warm soak on my son's arm every 4 hours."

ANS: D Feedback A The parent should not discontinue antibiotics when signs of infection disappear. To ensure complete healing, the parent should understand that the entire course of antibiotics should be given as prescribed. B A warm soak is indicated for the treatment of cellulitis. Ice will decrease circulation to the affected area and inhibit the healing process. C The disappearance of redness indicates healing and is not a reason to seek medical advice. D Warm soaks applied every 4 hours while the child is awake increase circulation to the infected area, relieve pain, and promote healing.

If a child has a concussion, a second concussion will have no further ill effects. Is this statement true or false?

ANS: F A second concussion may cause more harm to the brain and even lead to possible death. The parents of a child who has experienced a concussion should be encouraged to speak to their health care provider about whether the child can return to activities or sports. This condition is known as "second impact syndrome."

_________________________ is a chronic, multisystem, autoimmune disease characterized by inflammation of the connective tissue.

ANS: Systemic lupus erythematosus or SLE SLE varies in severity and is marked by remission and exacerbations. Although the etiology is unknown, genetic, hormonal, environmental, and immune response factors are likely to be responsible.

Which nursing action facilitates care being provided to a child in an emergency situation? a.Encourage the family to remain in the waiting room. b.Include parents as partners in providing care for the child. c.Always reassure the child and family. d.Give explanations using professional terminology.

B A.Allowing the parents to remain with the child may help calm the child. B.Include parents as partners in the childs treatments. Parents may need direct guidance in concrete terms to help distract the child. C.Telling the truth is the most important thing. False reassurance does not facilitate a trusting relationship. D.Professional terminology may not be understood. Speak to the child and family in language that they will understand.

A preschool child in the emergency department has a respiratory rate of 10 breaths per minute. How should the nurse interpret this finding? a.The child is relaxed. b.Respiratory failure is likely. c.This child is in respiratory distress. d.The childs condition is improving.

B A.Although the respiratory rate slows when an individual is relaxed, a rate of 10 breaths per minute in an ill preschool child is not a normal finding and is cause for concern. B.Very slow breathing in an ill child is an ominous sign, indicating respiratory failure. C.A rapid respiratory rate indicates respiratory distress. Other signs of respiratory distress may include retractions, grunting, and nasal flaring. D.A respiratory rate of 10 breaths per minute is not a normal finding for a preschool child. This conclusion is incorrect.

What condition does the nurse recognize as an early sign of distributive shock? a.Hypotension b.Skin warm and flushed c.Oliguria d.Cold, clammy skin

B A.Hypotension is a late sign of all types of shock. B.An early sign of distributive shock is extremities that are warm to the touch. The child with distributive shock may have hypothermia or hyperthermia. C.Oliguria is a manifestation of hypovolemic shock. D.Cold, clammy skin is a late sign of septic shock, which is a type of distributive shock.

A child has a brain tumor. What assessment finding leads the nurse to request a physical therapy consultation? a. Dizziness b. Ataxia c. Slurred speech d. Visual changes

B A child with ataxia would benefit from a physical therapy consultation to help regain coordination. Physical therapy would not help with dizziness, slurred speech, or visual changes.

What is an expected physical assessment finding for an adolescent with a diagnosis of Hodgkin disease? a. Protuberant, firm abdomen b. Enlarged, painless, firm cervical lymph nodes c. Soft tissue swelling d. Soft to hard, nontender mass in pelvic area

B Painless, firm, movable adenopathy (enlarged lymph nodes) palpated in the cervical region is an expected assessment finding in Hodgkin disease. Other systemic symptoms include unexplained fevers, weight loss, and night sweats. A protuberant, firm abdomen is present in many cases of neuroblastoma. Soft tissue swelling around the affected bone is a manifestation of Ewing sarcoma. A soft to hard, nontender mass can be palpated when rhabdomyosarcoma is present.

A child with a brain tumor is undergoing radiation therapy. What should the nurse include in the discharge instructions to the child's parents? (Select all that apply.) a. Apply over-the-counter creams to the area daily. b. Avoid excessive skin exposure to the sun. c. Use a washcloth when cleaning the area receiving radiation. d. Plan for adequate rest periods for the child. e. A darkening of the skin receiving radiation is expected.

B, D, E Children receiving cranial radiation are particularly affected by fatigue and an increased need for sleep during and shortly after completion of the course of radiation. Skin damage can include changes in pigmentation (darkening), redness, peeling, and increased sensitivity. Extra care must be taken to avoid excessive skin exposure to heat, sunlight, friction (such as rubbing with a towel or washcloth), and creams or moisturizers. Only topical creams and moisturizers prescribed by the radiation oncologist should be applied to the radiated skin.

What should the nurse teach parents about oral hygiene for the child receiving chemotherapy? a. Brush the teeth briskly to remove bacteria. b. Use a mouthwash that contains alcohol. c. Inspect the child's mouth daily for ulcers. d. Perform oral hygiene twice a day.

C The child's mouth is inspected regularly for ulcers. At the first sign of ulceration, an antifungal drug is initiated. The teeth should be brushed with a soft-bristled toothbrush. Excessive force with brushing should be avoided because delicate tissue could be broken, causing infection or bleeding. Mouthwashes containing alcohol may be drying to oral mucosa, thus breaking down the protective barrier of the skin. Oral hygiene should be performed four times a day.

A syndrome that leads to the deposition of platelets and fibrinogen plugs in the vasculature and the simultaneous depletion of platelets and clotting factor proteins is commonly known as DIC or _____________________.

disseminated intravascular coagulation The pathophysiology of DIC is complicated and not easily understood because both extreme bleeding and clotting occur at the same time.

A 10-year-old girl is brought to the emergency department manifesting the following physical symptoms: sweating, nausea, headache, abdominal cramps, cool moist skin, and an elevated temperature. The childs mother reports that since this was the first warm day of summer, they spent most of the day at the beach. This patient is experiencing ___________.

heat exhaustion This child is experiencing a heat-related illness known as heat exhaustion. Treatment includes moving the child to a cool environment and applying cool moist cloths to the skin, removing clothing or changing her to dry clothing, elevating her legs, and offering oral rehydration fluids if no altered mental status or vomiting is evident.

As a child with asthma struggles to get enough air, the respiratory rate increases (tachypnea). Tachypnea lowers the carbon dioxide levels in the blood. This is known as _____________.

hypocapnia As the child tires from the increased work of breathing, hyperventilation occurs and carbon dioxide levels increase. Increased levels of carbon dioxide in the blood (hypercapnia) during an asthma episode may be a sign of severe airway obstruction and impending respiratory failure.

____________________ is the leading cause of death in children of every age-group beyond 1 year of age. ANS: Unintentional injury

Children have a total of __________ primary (deciduous) teeth that they begin to lose when they are school age. ANS: 20 twenty

You are the nurse working triage in the emergency department. A school-age child is brought in for treatment, carried by her mother. What is part of a primary assessment that should be performed first on this child? a.Determine level of consciousness. b.Obtain a health history. c.Obtain a full set of vital signs. d.Evaluate for pain.

A A.A primary assessment consists of assessing the childs airway, breathing, circulation, level of consciousness, and exposure (ABCDEs). B.Obtaining the childs health history is a component of a secondary assessment. C.Vital signs are included in a secondary assessment, after the ABCDEs are assessed. D.Assessing for pain is a component of a secondary assessment.

Which is the most critical element of pediatric emergency care? a.Airway management b.Prevention of neurologic impairment c.Maintaining adequate circulation d.Supporting the childs family

A A.Airway management is the most critical element in pediatric emergency care. B.Prevention of neurologic impairment is certainly a concern in pediatric emergency care; however, it is not considered the most critical element. C.Maintaining adequate circulation is accomplished after a patent airway is established. D.The focus of emergency care is stabilizing the childs physiologic status. Supporting the family is important, but it is not considered to be the most critical element in pediatric emergency care.

What is the nurses immediate action when a child comes to the emergency department with sweating, chills, and fang bite marks on the thigh? a.Secure antivenin therapy. b.Apply a tourniquet to the leg. c.Ambulate the child. d.Reassure the child and parent.

A A.Antivenin therapy is essential to the childs survival because the child is showing signs of envenomation. B.The use of a tourniquet is no longer recommended. C.When a bite or envenomation is located on an extremity, the extremity should be immobilized. D.Envenomation is a potentially life-threatening condition. False reassurance is not helpful for building a trusting relationship.

The emergency department nurse notices that the mother of a young child is making a lot of phone calls and getting advice from her friends about what she should do. This behavior is an indication of a.Stress b.Healthy coping skills c.Attention-getting behaviors d.Low self-esteem

A A.Hyperactive behavior such as making a lot of phone calls and enlisting everyones opinions is a sign of stress. B.The behavior described is not a healthy coping skill. C.This may be an attention-getting behavior but is more likely an indicator of stress. D.This mother may have low self-esteem, but the immediate provocation is stress.

What should be the emergency department nurses next action when a 6-year-old child has a systolic blood pressure of 58 mm Hg? a.Alert the physician about the systolic blood pressure. b.Comfort the child and assess respiratory rate. c.Assess the childs responsiveness to the environment. d.Alert the physician that the child may need intravenous fluids.

A A.Hypotension is a late sign of shock in children. The lower limit for systolic blood pressure for a child more than 1 year old is 70 mm Hg plus two times the childs age in years. A systolic blood pressure of 58 mm Hg calls for immediate action. The nurse should be direct in relaying the childs condition to the physician. B.This action does not address the problem of shock, which requires immediate intervention. C.Assessing the childs responsiveness is included in a neurologic assessment. It does not address the systolic blood pressure of 58 mm Hg. D.Although this child most likely requires intravenous fluids, the physician must be apprised of the systolic blood pressure so that appropriate intervention can be initiated.

A 2-year-old child is in the playroom. The nurse observes him picking up a small toy and putting it in his mouth. The child begins to choke. He is unable to speak. Which intervention is appropriate? a.Heimlich maneuver b.Abdominal thrusts c.Five back blows d.Five chest thrusts

A A.To clear a foreign body from the airway, the American Heart Association recommends the Heimlich maneuver for a conscious child older than 1 year of age. B.Abdominal thrusts are indicated when the child is unconscious. C.Back blows are indicated for an infant with an obstructed airway. D.Chest thrusts follow back blows for the infant with an obstructed airway.

Which clinical finding is an overt sign of retinoblastoma in children? a. Whitish reflex in the eye b. Lymphadenopathy c. Bone pain d. Change in gait

A A whitish reflex in the eye, leukocoria, is a common finding of retinoblastoma. It is an overt sign of cancer in children. Persistent lymphadenopathy is a manifestation of several forms of childhood cancers. It is a covert sign of cancer in children. Bone pain is not a sign of retinoblastoma and is considered a covert sign. A change in gait may be a sign of a brain tumor. It is considered a covert sign of cancer in children.

A child with acute myeloblastic leukemia is scheduled to have a bone marrow transplant (BMT). The donor is the child's own umbilical cord blood that had been previously harvested and banked. This type of BMT is termed a. autologous. b. allogeneic. c. syngeneic. d. stem cell.

A In an autologous transplant, the child's own marrow or previously harvested and banked cord blood is used. In an allogeneic BMT, histocompatibility has been matched with a related or an unrelated donor. In a syngeneic transplant, the child receives bone marrow from an identical twin. A stem cell transplantation uses a unique immature cell present in the peripheral circulation.

A child had surgery for a brain tumor. Which provider orders does the nurse question? a. Place the child in the Trendelenburg position. b. Perform neurologic assessments. c. Assess dressings for drainage. d. Monitor temperature.

A The child is never placed in the Trendelenburg position because it increases intracranial pressure and the risk of bleeding. Increased intracranial pressure is a risk in the postoperative period. The nurse would assess the child's neurologic status frequently. Hemorrhage is a risk in the postoperative period. The child's dressing would be inspected frequently for bleeding. Temperature is monitored closely because the child is at risk for infection in the postoperative period.

The nurse notes that a child's gums bleed easily and that the child has bruising and petechiae on his extremities. What laboratory values are consistent with these symptoms? a. Platelet count of 19,000/mm3 b. Prothrombin time of 11 to 15 seconds c. Hematocrit of 34 d. Leukocyte count of 14,000/mm3

A The normal platelet count is 150,000 to 400,000/mm3. This finding is very low, indicating an increased bleeding potential. The child should be monitored closely for signs of bleeding. The prothrombin time of 11 to 15 seconds is within normal limits. The normal hematocrit is 35 to 45, and although this finding is low, it would not create the symptoms presented. This value indicates the probable presence of infection, but it is not a reflection of bleeding tendency.

Which assessment should the nurse perform last when examining a 5-year-old child? a. Heart b. Lungs c. Abdomen d. Throat ANS: D

A The nurse may proceed from head to toe with preschool-age children. More invasive procedures should be saved until the end of the examination. Assessment of the heart is considered noninvasive. B For preschool children, invasive procedures should be left to the end of the examination. Assessment of the lungs is not considered to be frightening. C For preschool children, invasive procedures should be left to the end of the examination. Assessment of the abdomen is not considered to be frightening. D Examination of the mouth and throat is considered to be more invasive than other parts of a physical examination. For preschool children, invasive procedures should be left to the end of the examination.

When an adolescent with a new diagnosis of Ewing sarcoma asks the nurse about treatment, the nurse's response is based on the knowledge that (Select all that apply.) a. this type of tumor invades the bone. b. management includes chemotherapy, surgery, and radiation. c. Ewing sarcoma is usually not responsive to either chemotherapy or radiation. d. affected bones such as ribs and proximal fibula may be removed to excise the tumor. e. is the most common bone tumor seen in children.

A, B, D Ewing sarcoma invades the bone and is found most often in the midshaft of long bones, especially the femur, vertebrae, ribs, and pelvic bones. Treatment for Ewing sarcoma begins with chemotherapy to decrease tumor bulk, followed by surgical resection of the primary tumor. Local control of the tumor can be achieved with surgery or radiation. The affected bone may be removed if it will not affect the child's functioning. Ribs and the proximal fibula are considered expendable and may be removed to excise the tumor without affecting function. Ewing sarcoma is responsive to both chemotherapy and radiation. Osteosarcoma is the most common primary bone malignancy in children. The second most common bone tumor seen in children is Ewing sarcoma.

What should the nurse recognize as symptoms of a brain tumor in a school-age child? (Select all that apply.) a. Blurred vision b. Increased head circumference c. Vomiting when getting out of bed d. Intermittent headache e. Declining academic performance

A, C, D, E Visual changes such as nystagmus, diplopia, and strabismus are manifestations of a brain tumor. The change in position on awakening causes an increase in intracranial pressure, which is manifested as vomiting. Vomiting on awakening is considered a hallmark symptom of a brain tumor. Increased intracranial pressure resulting from a brain tumor is manifested as a headache. School-age children may exhibit declining academic performance, fatigue, personality changes, and symptoms of vague, intermittent headache. Other symptoms may include seizures or focal neurologic deficits. Manifestations of brain tumors vary with tumor location and the child's age and development. Infants with brain tumors may have increased head circumference with a bulging fontanel. School-age children have closed fontanels, and therefore their head circumferences do not increase with brain tumors.

An emergency department nurse is making a general appearance assessment on a preschool child just admitted to the emergency department. Which general assessment findings indicate the child looks bad? Select all that apply. a.Color pale b.Capillary refill less than 2 seconds c.Unwilling to separate from parents d.Cold extremities e.Lethargic

A, D, E Correct Signs of a child looking bad on a general appearance assessment include pale skin, cold extremities, and lethargy. Incorrect A capillary refill of less than 2 seconds is a good sign as well as a child who is unwilling to separate from parents (separation anxiety, expected).

You are caring for a 44-lb child who is hospitalized with vomiting and severe dehydration. The physician has ordered parenteral rehydration therapy to restore circulation. The order is for sodium chloride (0.9%) solution in a 20 mL/kg bolus. How much will you give?

ANS: 400 mL The child's weight must first be converted from pounds to kilograms (1 kg = 2.2 lb): 44 lb =20 kg. Next multiply 20 kg 20 mL = 400 mL. The bolus will be 400 mL.

Unlike fragile X syndrome, which affects primarily males, __________ (RS) is almost exclusively linked to female gender.

ANS: Rett syndrome An estimated 1:10,000 to 1:15,000 females are affected. RS is characterized by an initial period of normal development with symptoms emerging between the ages of 6 and 18 months. Social and intellectual development stops and seizures along with physical disabilities emerge.

In recent years the use of _____________ stem cell transplantation has become the accepted therapy for the treatment of several hematologic and oncologic disorders.

ANS: hematopoietic HSCT allows extremely high doses of chemotherapy, with or without radiation, to be given without regard for bone marrow recovery because hematopoiesis will be restored through transplantation. Stem cells are harvested from bone marrow, peripheral blood, and umbilical cord blood. HSCT is often used interchangeably with bone marrow transplantation in the clinical setting.

A girl with possible malabsorption syndrome is undergoing diagnostic testing for the condition. She is instructed to wear a facemask in order for expelled air to be collected. This test is known as the ________ breath test.

ANS: hydrogen A carbohydrate solution is given by mouth and exhaled. Inadequately digested carbohydrate produces hydrogen when acted on by the gastrointestinal flora. The hydrogen breath test will help confirm the diagnosis of malabsorption syndrome.

It is late winter when a 7-year-old child reports to the school nurse with fever, headache, myalgia, and glandular swelling. After assessment the nurse's preliminary diagnosis includes the viral infection most commonly known as ________.

ANS: mumps The classic indication of mumps is parotid glandular swelling, although a number of children will have no such swelling. This is often accompanied by fever. The parents should be notified and provided with educational information regarding care of the child with the mumps.

Tissue ischemia and nerve damage are serious complications that may result from immobilization in a cast or from traction. The five Ps of vascular impairment can be used as a guide when assessing for neurovascular problems. List the five Ps.

ANS: pain, pallor, pulselessness, paresthesia, paralysis Prompt referral to a physician and intervention is crucial if neurovascular impairment is to be prevented.

The rapid onset of physical, cognitive, and emotional symptoms that results in chest pain, shortness of breath, and the signs of impending doom is known as ________________.

ANS: panic disorder Also referred to as panic attacks. Before considering a diagnosis of panic disorder, organic causes should be ruled out. These may include hyperthyroidism, hyperglycemia, epilepsy, and mitral valve prolapse.

A less common malignancy of muscle or striated tissue is known as ______________.

ANS: rhabdomyosarcoma This sarcoma occurs periorbitally or in the head and neck of younger children and in the trunk and extremities of older children. Long-term survival rates are variable based upon the age of the child.

A new mother calls the pediatrician's office concerned because her newborn has developed a salmon colored, irregularly shaped spot between the eyes. The lesion becomes darker when the baby is crying. This skin lesion is called a(n) ____________.

ANS: salmon patch The nurse can reassure the mother that salmon patches are commonly known as "stork bites" or "angel kisses." These lesions are benign and usually fade during the first year of life. The only treatment necessary is parental education.

Bodily fluids are composed of two elements; water and _____.

ANS: solutes Water is the primary constituent of bodily fluids. An infant's weight is approximately 75% water compared to the adult's weight, which is 55% to 60% water. Solutes are composed of both electrolytes and nonelectrolytes. The body's solutes include sodium, potassium, chloride, calcium, and magnesium.

Prolonged seizure activity, in the form of either a single seizure lasting 30 minutes or recurrent seizures lasting more than 30 minutes, with no return to a normal level of consciousness is known as _________________.

ANS: status epilepticus The nurse caring for this patient should be aware that the causes of status epilepticus are many. Acute CNS injury from head trauma, meningitis, or electrolyte imbalance frequently precipitate status epilepticus.

The rise in the incidence of both overweight and obese children is directly related to the increase in the number of children diagnosed with _______________.

ANS: type 2 diabetes Type 2 diabetes is an emerging problem in the pediatric population. At the time of diagnoses, approximately 50% of the beta cells and the pancreas of type 2 diabetic children are still producing insulin. Education regarding healthy dietary choices and exercise are essential in managing these children.

Primary (deciduous) teeth are replaced by permanent teeth. By adulthood the child will have __________ permanent teeth.

ANS: 32 thirty-two

In assessing adolescents using Tanner staging, sexual maturity is rated using _________ distinct stages. (Your answer should appear as a number.)

ANS: 5 Tanner stages of adolescent sexual development describe five distinct stages of sexual maturity rating. There are separate rating scales for males and females, but both use five stages.

A nurse is planning a class for school-age children on obesity. Which percentile does the body mass index (BMI) need to exceed for a child to be assessed as obese?

ANS: 95 95th When intake of food exceeds expenditure, the excess is stored as fat. Obesity is an excessive accumulation of fat in the body and is assessed in children as a BMI that exceeds the 95th percentile for age.

Adolescent sexuality refers to the thoughts, feelings, and behaviors related to the teen's sexual identity. The most recent research (2009) indicates that 46% of all adolescents have been involved in some kind of sexual activity. The only complete protection from pregnancy and sexually transmitted diseases (STDs) is ____________.

ANS: abstinence Adolescents should be encouraged that there is nothing wrong with abstaining from sexual activity. Adolescents who engage in sexual activity at a young age are more likely to participate in other high-risk behaviors such as alcohol and drug use. Adolescents who demonstrate high self-esteem are more likely to delay sexual intercourse.

The nurse has just assisted in the delivery of a female infant to first-time parents. The infant is suctioned, dried, and placed skin-to-skin on her mother's chest. This allows for significant interaction between mother and baby and is known as _____________.

ANS: attachment Parent-infant attachment is one of the most important aspects of infant psychosocial development. Initiated immediately after birth, attachment is strengthened by many mutually satisfying interactions between parents and their infant during the first few months of life. Attachment is a sense of belonging or connection with each other.

A type of play that allows children to act out roles and experiences that may have happened to them, that they fear may happen, or that they have observed in others is known as ______ play.

ANS: dramatic This type of play can be spontaneous or guided and often includes medical or nursing equipment. It is especially valuable for children who have had or will have multiple procedures or hospitalizations

Adolescents' eyes and ears are fully developed and, with the exception of minor infections, the sensory system remains quite healthy during this period of development. The mother of a 12-year-old complains to the nurse that she is concerned that her daughter frequently needs changes to her corrective lenses. This is a condition known as ___________.

ANS: myopia Myopia (nearsightedness) occurs in early adolescence, between the ages of 11 and 13 and is a normal part of adolescent development.

A disturbance in the flow and time patterning of speech is known as ____________.

ANS: stuttering stammering During the preschool years, children often have experiences they want to share but had difficulty putting the words together. Children at this stage commonly repeat whole words or phrases and interject "um" into their speech. This may be more frequent during times of excitement or when formulating long and complex sentences. Parents can help their child by focusing on the idea that the child is expressing not on how the child is speaking. Parents should not complete the child's sentences or draw attention to the child's speech

Which is appropriate play for a 6-month-old infant? a. Pat-a-cake, peek-a-boo b. Ball rolling, hide-and-seek game c. Bright rattles and tactile toys d. Push and pull toys

ANS: A Feedback A Six-month-old children enjoy playing pat-a-cake and peek-a-boo. B Nine-month-old infants enjoy rolling a ball and playing hide-and-seek games. C Four-month-old infants enjoy bright rattles and tactile toys. D Twelve-month-old infants enjoy playing with push and pull toys.

The nurse palpated the anterior fontanel of a 14-month-old infant and found that it was closed. What does this finding indicate? a. This is a normal finding. b. This finding indicates premature closure of cranial sutures. c. This is abnormal and the child should have a developmental evaluation. d. This is an abnormal finding and the child should have a neurologic evaluation.

ANS: A Feedback A The anterior fontanel should be completely closed by 12 to 18 months of age. B A closed anterior fontanel at 14 months of age does not indicate premature closure of cranial sutures. C This finding is not abnormal and does not necessitate a developmental evaluation. D This finding is not abnormal and does not indicate the need for a neurologic examination.

Which activity is most appropriate for developing fine motor skills in the school-age child? a. Drawing b. Singing c. Soccer d. Swimming

ANS: A Feedback A Activities such as drawing, building models, and playing a musical instrument increase the school-age child's fine motor skills. B Singing is an appropriate activity for the school-age child, but it does not increase fine motor skills. C The school-age child needs to participate in group activities to increase both gross motor skills and social skills, but group activities do not increase fine motor skills. D Swimming is an activity that also increases gross motor skills.

The nurse is obtaining vital signs on a 1-year-old child. What is the most appropriate site for assessing the pulse rate? a. Apical b. Radial c. Carotid d. Femoral

ANS: A Feedback A Apical pulse rates are taken in children younger than 2 years. B Radial pulse rates may be taken in children older than 2 years. C It is difficult to palpate the carotid pulse in an infant. D The femoral pulse is palpated when comparing peripheral pulses, but it is not used to measure an infant's pulse rate.

The nurse advises the mother of a 3-month-old exclusively breastfed infant to a. Start giving the infant a vitamin D supplement. b. Start using an infant feeder and add rice cereal to the formula. c. Start feeding the infant rice cereal with a spoon at the evening feeding. d. Continue breastfeeding without any supplements.

ANS: A Feedback A Breast milk does not provide an adequate amount of dietary vitamin D. Infants who are exclusively breastfed need vitamin D supplements to prevent rickets. B An infant feeder is an inappropriate method of providing the infant with caloric intake. Solid foods are not recommended for a 3-month-old infant. C Rice cereal and other solid foods are contraindicated in a 3-month-old infant. Solid feedings do not typically begin before 4 to 6 months of age. D Because breast milk is not an adequate source of fluoride, infants need to be given a fluoride supplement in addition to a vitamin D supplement.

When a child broke her favorite doll during a hospitalization, her primary nurse bought the child a new doll and gave it to her the next day. What is the best interpretation of the nurse's behavior? a. The nurse is displaying signs of overinvolvement. b. The nurse is a kind and generous person. c. The nurse feels a special closeness to the child. d. The nurse wants to make the child happy.

ANS: A Feedback A Buying gifts for individual children is a warning sign of overinvolvement. B Nurses are kind and generous people, but buying gifts for individual children is unprofessional. C Nurses may feel closer to some patients and families. This does not make giving gifts to children or families acceptable from a professional standpoint. D Replacing lost items is not the nurse's responsibility. Becoming overly involved with a child can inhibit a healthy relationship.

The ability to mentally understand that 1 + 3 = 4 and 4 - 1 = 3 occurs in which stage of cognitive development? a. Concrete operations b. Formal operations c. Intuitive thought d. Preoperations

ANS: A Feedback A By 7 to 8 years of age, the child is able to retrace a process (reversibility) and has the skills necessary for solving mathematical problems. This stage is called concrete operations. B The formal operations stage deals with abstract reasoning and does not occur until adolescence. C Thinking in the intuitive stage is based on immediate perceptions. A child in this stage often solves problems by random guessing. D In preoperational thinking, the child is usually able to add 1 + 3 = 4 but is unable to retrace the process.

In terms of fine motor development, what should the 7-month-old infant be able to do? a. Transfer objects from one hand to the other. b. Use thumb and index finger in crude pincer grasp. c. Hold crayon and make a mark on paper. d. Release cubes into a cup.

ANS: A Feedback A By age 7 months, infants can transfer objects from one hand to the other, crossing the midline. B The crude pincer grasp is apparent at approximately age 9 months. C The child can scribble spontaneously at age 15 months. D At age 12 months, the child can release cubes into a cup.

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 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 Feedback A Children at this age may view illness or injury as a punishment for a real or imagined mystique. B The belief in divine punishment is common at this age. C The belief in divine punishment is common at this age. D The belief in divine punishment is common at this age.

According to Piaget, the adolescent is in the fourth stage of cognitive development, or period of what? a. Formal operations b. Concrete operations c. Conventional thought d. Postconventional thought

ANS: A Feedback A Cognitive thinking culminates with capacity for abstract thinking. This stage, the period of formal operations, is Piaget's fourth and last stage. B Concrete operations usually develops between ages 7 and 11 years. C Conventional and postconventional thought refer to Kohlberg's stages of moral development. D Conventional and postconventional thought refer to Kohlberg's stages of moral development.

Which statement best describes development in infants and children? a. Development, a predictable and orderly process, occurs at varying rates within normal limits. b. Development is primarily related to the growth in the number and size of cells. c. Development occurs in a proximodistal direction with fine muscle development occurring first. d. Development is more easily and accurately measured than growth.

ANS: A Feedback A Development, a continuous and orderly process, provides the basis for increases in the child's function and complexity of behavior. The increases in rate of function and complexity can vary normally within limits for each child. B An increase in the number and size of cells is a definition for growth. C Development proceeds in a proximodistal direction with fine muscle organization occurring as a result of large muscle organization. D Development is a more complex process that is affected by many factors; therefore, it is less easily and accurately measured. Growth is a predictable process with standard measurement methods.

A school nurse is teaching a health class for 5th grade children. The nurse plans to include which statement to best describe growth in the early school-age period? a. Boys grow faster than girls. b. Puberty occurs earlier in boys than in girls. c. Puberty occurs at the same age for all races and ethnicities. d. It is a period of rapid physical growth.

ANS: A Feedback A During the school-age developmental period, boys are approximately 1 inch taller and 2 pounds heavier than girls. B Puberty occurs 1 1/2 to 2 years later in boys, which is developmentally later than puberty in girls (not unusual in 9- or 10-year-old girls). C Puberty occurs approximately 1 year earlier in African-American girls than in white girls. D Physical growth is slow and steady during the school-age years.

A nurse is teaching adolescent boys about pubertal changes. The first sign of pubertal change seen with boys is a. Testicular enlargement b. Facial hair c. Scrotal enlargement d. Voice deepens

ANS: A Feedback A The first sign of pubertal changes in boys is testicular enlargement in response to testosterone secretion, which usually occurs in Tanner stage 2. Slight pubic hair is present and the smooth skin texture of the scrotum is somewhat altered. B During Tanner stages 4 and 5, facial hair appears at the corners of the upper lip and chin. C As testosterone secretion increases, the penis, testes, and scrotum enlarge. D During Tanner stages 4 and 5, rising levels of testosterone cause the voice to deepen.

The theorist who viewed developmental progression as a lifelong series of conflicts that need resolution is a. Erikson b. Freud c. Kohlberg d. Piaget

ANS: A Feedback A Erik Erikson viewed development as a series of conflicts affected by social and cultural factors. Each conflict must be resolved for the child to progress emotionally, with unsuccessful resolution leaving the child emotionally disabled. B Sigmund Freud proposed a psychosexual theory of development. He proposed that certain parts of the body assume psychological significance as foci of sexual energy. The foci shift as the individual moves through the different stages (oral, anal, phallic, latency, and genital) of development. C Lawrence Kohlberg described moral development as having three levels (preconventional, conventional, and postconventional). His theory closely parallels Piaget's. D Jean Piaget's cognitive theory interprets how children learn and think and how this thinking progresses and differs from adult thinking. Stages of his theory include sensorimotor, preoperations, concrete operations, and formal operations.

The most fatal type of burn in the toddler age-group is a. Flame burn from playing with matches b. Scald burn from high-temperature tap water c. Hot object burn from cigarettes or irons d. Electric burn from electrical outlets

ANS: A Feedback A Flame burns from matches and lighters represent one of the most fatal types of burns in the toddler age-group. B These are all significant causes of burn injury. The child should be protected from these causes by reducing the temperature on the hot water heater in the home, keeping objects such as cigarettes and irons away from children, and placing protective guards over electric outlets when not in use. C These are all significant causes of burn injury. The child should be protected from these causes by reducing the temperature on the hot water heater in the home, keeping objects such as cigarettes and irons away from children, and placing protective guards over electric outlets when not in use. D These are all significant causes of burn injury. The child should be protected from these causes by reducing the temperature on the hot water heater in the home, keeping objects such as cigarettes and irons away from children, and placing protective guards over electric outlets when not in use.

A 14-year-old male seems to be always eating, although his weight is appropriate for his height. The best explanation for this is that a. This is normal because of increase in body mass. b. This is abnormal and suggestive of future obesity. c. His caloric intake would have to be excessive. d. He is substituting food for unfilled needs.

ANS: A Feedback A In adolescence, nutritional needs are closely related to the increase in body mass. The peak requirements occur in the years of maximal growth. The caloric and protein requirements are higher than at almost any other time of life. B This describes the expected eating pattern for young adolescents; as long as weight and height are appropriate, obesity is not a concern. C This describes the expected eating pattern for young adolescents; as long as weight and height are appropriate, obesity is not a concern. D This describes the expected eating pattern for young adolescents; as long as weight and height are appropriate, obesity is not a concern.

The environment, both physical and psychosocial, is a significant determinate of growth and development outcomes before and after birth. Nurses can assist parents in preventing environmental injury for their 2-year-old toddler by teaching them to avoid the most common sources of exposure. This anticipatory guidance includes teaching related to a. Avoiding sun exposure, secondhand smoke, and lead b. Socioeconomic status, primarily poverty c. Maternal smoking and alcohol intake during pregnancy d. The passing of environmental toxins through breast milk

ANS: A Feedback A Lead can be present in the home and in toys made overseas. Environmental injury can also be the result of mercury, pesticides (flea and tick collars), radon, and exposure to the sun and secondhand smoke. It is important for the nurse to provide health teaching related to these factors. B The nurse is unable to influence socioeconomic status. C It is too late for the nurse to instruct the mother regarding smoking or alcohol intake during pregnancy. This should have been included in prenatal teaching. D It is unlikely that a 2-year-old child will still be breastfeeding.

A nurse is reviewing pediatric physical assessment techniques. Which statement about performing a pediatric physical assessment is correct? a. Physical examinations proceed systematically from head to toe unless developmental considerations dictate otherwise. b. The physical examination should be done with parents in the examining room for children of any age. c. Measurement of head circumference is done until the child is 5 years old. d. The physical examination is done only when the child is cooperative.

ANS: A Feedback A Physical assessment usually proceeds from head to toe; however, developmental considerations with infants and toddlers dictate that the least threatening assessments be done first to obtain accurate data. B Having parents in the examining room with adolescents is not appropriate. C Head circumference is routinely measured until 36 months of age. D Children will not always be cooperative during the physical examination. The examiner will need to incorporate communication and play techniques to facilitate cooperation.

Which toy is the most developmentally appropriate for an 18- to 24-month-old child? a. A push-and-pull toy b. Nesting blocks c. A bicycle with training wheels d. A computer

ANS: A Feedback A Push-and-pull toys encourage large muscle activity and are appropriate for toddlers. B Nesting blocks are more appropriate for a 12- to 15-month-old child. C A bicycle with training wheels is appropriate for a preschool or young school-age child. D A computer can be appropriate as early as the preschool years.

In terms of gross motor development, what would the nurse expect a 5-month-old infant to do? a. Roll from abdomen to back. b. Roll from back to abdomen. c. Sit erect without support. d. Move from prone to sitting position.

ANS: A Feedback A Rolling from abdomen to back is developmentally appropriate for a 5-month-old infant. B The ability to roll from back to abdomen usually occurs at 6 months old. C Sitting erect without support is a developmental milestone usually achieved by 8 months. D The 10-month-old infant can usually move from a prone to a sitting position.

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

ANS: A Feedback A Signs of stress include stomach pains or headache, sleep problems, bedwetting, changes in eating habits, aggressive or stubborn behavior, reluctance to participate, or regression to early behaviors. B This child is exhibiting signs of stress. C This child is exhibiting signs of stress. D This child is exhibiting signs of stress.

Which choice includes the components of a complete pediatric history? a. Statistical information, client profile, health history, family history, review of systems, lifestyle and life patterns b. Vital signs, chief complaint, and list of previous problems c. Chief complaint, including body location, quality, quantity, timeframe, and alleviating and aggravating factors d. Pertinent developmental and family information

ANS: A Feedback A The identified items are included in a complete pediatric history. B Vital signs, chief complaint, and list of previous problems do not constitute a complete history. C A problem-oriented history includes specific information about the chief complaint. D Pertinent developmental and family information are part of the complete history.

The parent of 16-month-old Chris asks, "What is the best way to keep Chris from getting into our medicines at home?" The nurse should advise that a. "All medicines should be locked away securely." b. "The medicines should be placed in high cabinets." c. "Chris just needs to be taught not to touch medicines." d. "Medicines should not be kept in the homes of small children."

ANS: A Feedback A The major reason for poisoning in the home is improper storage. Toddlers can climb, unlatch cabinets, and obtain access to high-security places. For medications, only a locked cabinet is safe. B Toddlers can climb by using furniture. High places are not a deterrent to an exploring toddler. C Toddlers are not able to generalize as dangerous all of the different forms of medications that may be available in the home. D This is not feasible. Many parents require medications for chronic illnesses. Parents must be taught safe storage for their home and when they visit other homes.

The nurse has a 2-year-old boy sit in "tailor" position during palpation for the testes. What is the rationale for this position? a. It prevents cremasteric reflex. b. Undescended testes can be palpated. c. This tests the child for an inguinal hernia. d. The child does not yet have a need for privacy.

ANS: A Feedback A The tailor position stretches the muscle responsible for the cremasteric reflex. This prevents its contraction, which pulls the testes into the pelvic cavity. B Undescended testes cannot be predictably palpated. C Inguinal hernias are not detected by this method. This position is used for inhibiting the cremasteric reflex. D Privacy should always be provided for children.

The nurse is performing a routine assessment on a 14-month-old infant and notes that the anterior fontanel is closed. This should be interpreted as a(n) a. Normal finding b. Questionable finding—infant should be rechecked in 1 month c. Abnormal finding—indicates need for immediate referral to practitioner d. Abnormal finding—indicates need for developmental assessment

ANS: A Feedback A This is a normal finding. The anterior fontanel closes between ages 12 and 18 months. The posterior fontanel closes between 2 and 3 months of age. B Because the anterior fontanel normally closes between ages 12 and 18 months, this is a normal finding, and no further intervention is required. C Because the anterior fontanel normally closes between ages 12 and 18 months, this is a normal finding, and no further intervention is required. D Because the anterior fontanel normally closes between ages 12 and 18 months, this is a normal finding, and no further intervention is required.

A 3-month-old infant born at 38 weeks of gestation will hold a rattle if it is put in her hands, but she will not voluntarily grasp it. The nurse should interpret this as a. Normal development b. Significant developmental lag c. Slightly delayed development as a result of prematurity d. Suggestive of a neurologic disorder such as cerebral palsy

ANS: A Feedback A This is indicative of normal development. Reflexive grasping occurs during the first 2 to 3 months and then gradually becomes voluntary. B The infant is expected to be able to perform this task by age 3 months. If the child's age is corrected because of being 2 weeks preterm, the child is at the midpoint of the range for this developmental task. C The infant is expected to be able to perform this task by age 3 months. If the child's age is corrected because of being 2 weeks preterm, the child is at the midpoint of the range for this developmental task. D The child is age-appropriate. No evidence of neurologic dysfunction is present.

The nurse percussing over an empty stomach expects to hear which sound? a. Tympany b. Resonance c. Flatness d. Dullness

ANS: A Feedback A Tympany is a high-pitched, loud-intensity sound heard over air-filled body parts such as the stomach and bowel. B Resonance is a low-pitched, low-intensity sound elicited over hollow organs such as the lungs. C Flatness is a high-pitched, soft-intensity sound elicited by percussing over solid masses such as bone or muscle. D Dullness is a medium-pitched, medium-intensity sound elicited when percussing over high-density structures such as the liver.

What is the nurse's first action when planning to teach the parents of an infant with a CHD? a. Assess the parents' anxiety level and readiness to learn. b. Gather literature for the parents. c. Secure a quiet place for teaching. d. Discuss the plan with the nursing team.

ANS: A Feedback A Any effort to organize the right environment, plan, or literature is of no use if the parents are not ready to learn or have high anxiety. Decreasing level of anxiety is often needed before new information can be processed. B A baseline assessment of prior knowledge should be taken into consideration before developing any teaching plan. C Locating a quiet place for meeting with parents is appropriate; however, an assessment should be done before any teaching is done. D Discussing a teaching plan with the nursing team is appropriate after an assessment of the parents' knowledge and readiness.

1. A nurse in a well-child clinic is teaching parents about their child's immune system. Which statement by the nurse is correct? a. The immune system distinguishes and actively protects the body's own cells from foreign substances. b. The immune system is fully developed by 1 year of age. c. The immune system protects the child against communicable diseases in the first 6 years of life. d. The immune system responds to an offending agent by producing antigens.1. A nurse in a well-child clinic is teaching parents about their child's immune system. Which statement by the nurse is correct?

ANS: A A The immune system responds to foreign substances, or antigens, by producing antibodies and storing information. Intact skin, mucous membranes, and processes such as coughing, sneezing, and tearing help maintain internal homeostasis. B. Children up to age 6 or 7 years have limited antibodies against common bacteria. The immunoglobulins reach adult levels at different ages. C. Immunization is the basis from which the immune system activates protection against some communicable diseases. D. Antibodies are produced by the immune system against invading agents, or antigens.

13. The nurse observes a red butterfly-shaped rash that spreads across the child's cheeks and nose. This assessment finding is characteristic of which condition? a. Systemic lupus erythematosus (SLE) b. Rheumatic fever c. Kawasaki disease d. Anaphylactic reaction

ANS: A A. A red, flat or raised malar "butterfly" rash over the cheeks and bridge of the nose is a clinical manifestation of SLE. B. A major manifestation of rheumatic fever is erythema marginatum, which appears as red skin lesions spread peripherally over the trunk. C. An erythematous rash, induration of the hands and feet, and erythema of the palms and soles are manifestations of Kawasaki disease. D. Initial symptoms of anaphylaxis include severe itching and rapid development of erythema.

18. The nurse is planning care for an adolescent with AIDS. The priority nursing goal is to a. Prevent infection. b. Prevent secondary cancers. c. Restore immunologic defenses. d. Identify source of infection.

ANS: A A. As a result of the immunocompromise that is associated 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. B. Preventing secondary cancers is not currently possible. C. Current drug therapy is affecting the disease progression; although not a cure, these drugs can suppress viral replication preventing further deterioration. D. Case finding is not a priority nursing goal.

4. Which statement is true regarding how infants acquire immunity? a. The infant acquires humoral and cell-mediated immunity in response to infections and immunizations. b. The infant acquires maternal antibodies that ensure immunity up to 12 months age. c. Active immunity is acquired from the mother and lasts 6 to 7 months. d. Passive immunity develops in response to immunizations.

ANS: A A. Infants acquire long-term active immunity from exposure to antigens and vaccines. Immunity is acquired actively and passively. B. The term infant's passive immunity is acquired from the mother and begins to dissipate during the first 6 to 8 months of life. C. Passive immunity is acquired from the mother. D. Active immunity develops in response to immunizations.

7. Which suggestion is appropriate to teach a mother who has a preschool child who refuses to take the medications for HIV infection? a. Mix medications with chocolate syrup or follow with chocolate candy. b. Mix the medications with milk or an essential food. c. Skip the dose of medication if the child protests too much. d. Mix the medication in a syringe, hold the child down firmly, and administer the medication.

ANS: A A. Liquid forms of HIV medications may be foul tasting or have a gritty texture. Chocolate will help to make these foods more palatable and is liked by most children. B. Medications should be mixed with nonessential foods. C. Doses of medication should never be skipped. D. Fighting with the child or using force should be avoided. A nonessential food that will make the taste of the medication more palatable for the child should be the correct action. The administration of medications for the child with HIV becomes part of the family's everyday routine for years.

8. What is the primary nursing concern for a hospitalized child with HIV infection? a. Maintaining growth and development b. Eating foods that the family brings to the child c. Consideration of parental limitations and weaknesses d. Resting for 2 to 3 hours twice a day

ANS: A A. Maintaining growth and development is a major concern for the child with HIV infection. Frequent monitoring for failure to thrive, neurologic deterioration, or developmental delay is important for HIV-infected infants and children. B. Nutrition, which contributes to a child's growth, is a nursing concern; however, it is not necessary for family members to bring food to the child. C. Although an assessment of parental strengths and weaknesses is important, it will be imperative for health care providers to focus on the parental strengths, not weaknesses. This is not as important as the frequent assessment of the child's growth and development. D. Rest is a nursing concern, but it is not as high a priority as maintaining growth and development. Rest periods twice a day for 2 to 3 hours may not be appropriate.

5. What is the most common mode of transmission of human immunodeficiency virus (HIV) in the pediatric population? a. Perinatal transmission b. Sexual abuse c. Blood transfusions d. Poor handwashing

ANS: A A. Perinatal transmission accounts for the highest percentage (91%) of HIV infections in children. Infected women can transmit the virus to their infants across the placenta during pregnancy, at delivery, and through breastfeeding. B. Cases of HIV infection from sexual abuse have been reported; however, perinatal transmission accounts for most pediatric HIV infections. C. Although in the past some children became infected with HIV through blood transfusions, improved laboratory screening has significantly reduced the probability of contracting HIV from blood products. D. Poor handwashing is not an etiology of HIV infection.

In caring for a child with a compound fracture, the nurse should carefully assess for a. Infection b. Osteoarthritis c. Epiphyseal disruption d. Periosteum thickening

ANS: A Feedback A Because the skin has been broken, the child is at risk for organisms to enter the wound. B The incidence of osteoarthritis does not increase with a compound fracture. C The chance of epiphyseal disruption is not increased with compound fracture. D Periosteum thickening is part of the healing process and not a complication.

A child who has symptoms of irritable mood, changes in sleep and appetite patterns, decreased self-esteem, and disengagement from family and friends lasting 3 weeks meets the criteria for which depressive disorder? a. Major depressive disorder b. Dysthymic disorder c. Cyclothymic disorder d. Panic disorder

ANS: A Feedback A A 2-week (or longer) episode of depressed or irritable mood in addition to disturbances in appetite, sleep, energy, or self-esteem meets the criteria for a major depressive disorder. B A dysthymic disorder is associated with a depressed or irritable mood for at least a year. C A cyclothymic or bipolar mood disorder is characterized by chronic, fluctuating mood disturbances between depressive lows and highs for a year. D A panic disorder is a type of anxiety disorder.

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

ANS: A Feedback A A goiter is an enlargement or hypertrophy of the thyroid gland. B Goiter is not associated with this secretory organ. C Goiter is not associated with this secretory organ. D Goiter is not associated with this secretory organ.

What should the nurse teach parents when the child is taking phenytoin (Dilantin) to control seizures? a. The child should use a soft toothbrush and floss the teeth after every meal. b. The child will require monitoring of renal function while taking this medication. c. Dilantin should be taken with food because it causes gastrointestinal distress. d. The medication can be stopped when the child has been seizure free for 1 month.

ANS: A Feedback A A side effect of Dilantin is gingival hyperplasia. Good oral hygiene will minimize this adverse effect. B The child should have liver function studies because this anticonvulsant may cause hepatic dysfunction, not renal dysfunction. C Dilantin has not been found to cause gastrointestinal upset. The medication can be taken without food. D Anticonvulsants should never be stopped suddenly or without consulting the physician. Such action could result in seizure activity.

Which clinical finding is an overt sign of retinoblastoma in children? a. Whitish reflex in the eye b. Lymphadenopathy c. Bone pain d. Change in gait

ANS: A Feedback A A whitish reflex in the eye, leukocoria, is a common finding of retinoblastoma. It is an overt sign of cancer in children. B Persistent lymphadenopathy is a manifestation of several forms of childhood cancer. It is a covert sign of cancer in children. C Bone pain is a covert symptom of cancer in children. D A change in gait may be a sign of a brain tumor. It is considered a covert sign of cancer in children.

A mother reports that her child has episodes where he appears to be staring into space. This behavior is characteristic of which type of seizure? a. Absence b. Atonic c. Tonic-clonic d. Simple partial

ANS: A Feedback A Absence seizures are very brief episodes of altered awareness. The child has a blank expression. B Atonic seizures cause an abrupt loss of postural tone, loss of consciousness, confusion, lethargy, and sleep. C Tonic-clonic seizures involve sustained generalized muscle contractions followed by alternating contraction and relaxation of major muscle groups. D There is no change in level of consciousness with simple partial seizures. Simple partial seizures consist of motor, autonomic, or sensory symptoms

Which statement made by an adolescent girl indicates an understanding about the prevention of sexually transmitted diseases (STDs)? a. "I know the only way to prevent STDs is to not be sexually active." b. "I practice safe sex because I wash myself right after sex." c. "I won't get any kind of STD because I take the pill." d. "I only have sex if my boyfriend wears a condom."

ANS: A Feedback A Abstinence is the only foolproof way to prevent an STD. B STDs are transmitted through body fluids (semen, vaginal fluids, blood). Perineal hygiene will not prevent an STD. C Oral contraceptives do not protect women from contracting STDs. D A condom can reduce but not eliminate an individual's chance of acquiring an STD.

A parent of a child with an anxiety disorder states, "I don't know how my child developed this problem." On what information should the nurse base a response? a. Genetic factors, hormonal imbalances, and societal influences all contribute to the development of anxiety disorders in children. b. Like many conditions affecting children, the etiology of anxiety disorders is unknown. c. The majority of anxiety disorders have a clear pattern of genetic inheritance. d. Dysfunctional family patterns are usually identified as the cause of an anxiety disorder.

ANS: A Feedback A Anxiety disorders are responses to stress and may be manifested as disturbances in feeling, body functions, behavior, or performance. Children with a history of verbal, physical, or sexual abuse; frequent separation from or loss of loved ones; drug use, incarceration, or lower socioeconomic status; homosexuality; chronic illness; behavioral disorders; and dysfunctional families are more likely than peers with healthy family patterns to have anxiety disorders. B The etiology of many anxiety disorders in children can be identified. C Some anxiety disorders are inheritable disorders. Others have been identified as having other origins. D Research consistently shows that psychosocial disorders are caused by a combination of predisposing or inherent factors and environmental or interactional factors.

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

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

Which diet would the nurse recommend to the mother of a child who is having mild diarrhea? a. Rice, potatoes, yogurt, cereal, and cooked carrots b. Bananas, rice, applesauce, and toast c. Apple juice, hamburger, and salad d. Whatever the child would like to eat

ANS: A Feedback A Bland but nutritious foods including complex carbohydrates (rice, wheat, potatoes, cereals), yogurt, cooked vegetables, and lean meats are recommended to prevent dehydration and hasten recovery. B These foods used to be recommended for diarrhea (BRAT diet). These foods are easily tolerated, but the BRAT diet is low in energy, density, fat, and protein. C Fatty foods, spicy foods, and foods high in simple sugars should be avoided. D The child should be offered foods he or she likes but should not be encouraged to eat fatty foods, spicy foods, and foods high in simple sugars.

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 a. Bronchitis b. Bronchiolitis c. Viral-induced asthma d. Acute spasmodic laryngitis

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

Which drug is an angiotensin-converting enzyme (ACE) inhibitor? a. Captopril (Capoten) b. Furosemide (Lasix) c. Spironolactone (Aldactone) d. Chlorothiazide (Diuril)

ANS: A Feedback A Capoten is a drug in an ACE inhibitor. B Lasix is a loop diuretic. C Aldactone blocks the action of aldosterone. D Diuril works on the distal tubules.

Latex allergy is suspected in a child with spina bifida. Appropriate nursing interventions include a. Avoiding using any latex product b. Using only nonallergenic latex products c. Administering medication for long-term desensitization d. Teaching family about long-term management of asthma

ANS: A Feedback 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. Latex allergy is estimated to occur in 75% of this patient population. B There are no nonallergic latex products. C At this time, desensitization is not an option. D The child does not have asthma. The parents must be taught about allergy and the risk of anaphylaxis.

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

ANS: A Feedback A Children with asthma usually have these chronic symptoms. B Pneumonia appears with an acute onset and fever and general malaise. C Bronchiolitis is an acute condition caused by RSV. D Foreign body in the trachea will occur with an acute respiratory distress or failure and maybe stridor.

When assessing the child with osteogenesis imperfecta, the nurse should expect to observe a. Discolored teeth b. Below-normal intelligence c. Increased muscle tone d. Above-average stature

ANS: A Feedback A Children with osteogenesis imperfecta have incomplete development of bones, teeth, ligaments, and sclerae. Teeth are discolored because of abnormal enamel. B Despite their appearance, children with osteogenesis imperfecta have normal or above-normal intelligence. C The child with osteogenesis imperfecta has weak muscles and decreased muscle tone. D Because of compression fractures of the spine, the child appears short.

Which sign or symptom is likely to be manifested by an adolescent with a depressive disorder? a. Abuse of alcohol b. Impulsivity and distractibility c. Carelessness and inattention to details d. Refusal to leave the house

ANS: A Feedback A Depression often manifests in conjunction with substance abuse, so children who abuse substances should be evaluated for depression as well. B Impulsivity and distractibility are manifestations of attention-deficit/hyperactivity disorder (ADHD). C A diminished ability to think or concentrate, carelessness, and inattention to details is a clinical manifestation of ADHD. D A refusal to leave the house, even to play with friends, is characteristic of separation anxiety disorder.

A beneficial effect of administering digoxin (Lanoxin) is that it a. Decreases edema b. Decreases cardiac output c. Increases heart size d. Increases venous pressure

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

When would a child diagnosed with type 1 diabetes mellitus most likely demonstrate a decreased need for insulin? a. During the "honeymoon" phase b. During adolescence c. During growth spurts d. During minor illnesses

ANS: A Feedback A During the "honeymoon" phase, which may last from a few weeks to a year or longer, the child is likely to need less insulin. B During adolescence, physical growth and hormonal changes contribute to an increase in insulin requirements. C Insulin requirements are typically increased during growth spurts. D Stress either from illness or from events in the environment can cause hyperglycemia. Insulin requirements are increased during periods of minor illness.

An infant's parents ask the nurse about preventing OM. What 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 Feedback A Eliminating tobacco smoke from the child's environment is essential for preventing OM and other common childhood illnesses. B Nasal decongestants are not useful in preventing OM. C Children with uncomplicated OM are not contagious unless they show other upper respiratory infection (URI) symptoms. D Children should be fed in an upright position to prevent OM.

What nursing assessment and care holds the highest priority in the initial care of a child with a major burn injury? a. Establishing and maintaining the child's airway b. Establishing and maintaining intravenous access c. Inserting a catheter to monitor hourly urine output d. Inserting a nasogastric tube into the stomach to supply adequate nutrition

ANS: A Feedback A Establishing and maintaining the child's airway is always the priority focus for assessment and care. B Establishing intravenous access is the second priority in this situation, after the airway has been established. C Inserting a catheter and monitoring hourly urine output is the third most important nursing intervention. D Nasogastric feedings are not begun initially on a child with major or severe burns. The initial assessment and care focus for a child with major burn injuries is the ABCs.

What intervention should be included in the plan of care for an infant with the nursing diagnosis of Excess Fluid Volume related to congestive heart failure? a. Weigh the infant every day on the same scale at the same time. b. Notify the physician when weight gain exceeds more than 20 g/day. c. Put the infant in a car seat to minimize movement. d. Administer digoxin (Lanoxin) as ordered by the physician.

ANS: A Feedback A Excess fluid volume may not be overtly visible. Weight changes may indicate fluid retention. Weighing the infant on the same scale at the same time each day ensures consistency. B An excessive weight gain for an infant is an increase of more than 50 g/day. C With fluid volume excess, skin will be edematous. The infant's position should be changed frequently to prevent undesirable pooling of fluid in certain areas. D Lanoxin is used in the treatment of congestive heart failure to improve cardiac function. Diuretics will help the body get rid of excess fluid.

The nurse should assess a child who has had a tonsillectomy for a. Frequent swallowing b. Inspiratory stridor c. Rhonchi d. Elevated white blood cell count

ANS: A Feedback A Frequent swallowing is indicative of postoperative bleeding. B Inspiratory stridor is characteristic of croup. C Rhonchi are lower airway sounds indicating pneumonia. D Assessment of blood cell counts is part of a preoperative workup.

What is a sign of increased intracranial pressure (ICP) in a 10-year-old child? a. Headache b. Bulging fontanel c. Tachypnea d. Increase in head circumference

ANS: A Feedback A Headaches are a clinical manifestation of increased ICP in children. A change in the child's normal behavior pattern may be an important early sign of increased ICP. B This is a manifestation of increased ICP in infants. A 10-year-old child would have a closed fontanel. C A change in respiratory pattern is a late sign of increased ICP. Cheyne-Stokes respiration may be evident. This refers to a pattern of increasing rate and depth of respirations followed by a decreasing rate and depth with a pause of variable length. D By 10 years of age, cranial sutures have fused so that head circumference will not increase in the presence of increased ICP.

The mother of a child with hemophilia asks the nurse how long her child will need to be treated for hemophilia. What is the best response to this question? a. "Hemophilia is a lifelong blood disorder." b. "There is a 25% chance that your child will have spontaneous remission and treatment will no longer be necessary." c. "Treatment is indicated until after your child has progressed through the toddler years." d. "It is unlikely that your child will need to be treated for his hemophilia because your first child does not have the disease."

ANS: A Feedback A Hemophilia is a lifelong hereditary blood disorder with no cure. Prevention by avoiding activities that induce bleeding and by treatment is lifelong. The management of hemophilia is highly individual and depends on the severity of the illness. B This is an untrue statement. Hemophilia is a lifelong hereditary blood disorder with no cure. Treatment is lifelong. C This is an untrue statement. Hemophilia is a lifelong hereditary blood disorder with no cure. Treatment is lifelong. D Because hemophilia has an X chromosome-linked recessive inheritance, there is a risk with each pregnancy that a child will either have the disease or be a carrier. Hemophilia is a life-long hereditary blood disorder with no cure. Treatment is lifelong.

In teaching family members about their child's von Willebrand disease, what is the priority outcome for the child that the nurse should discuss? a. Prevention of injury b. Maintaining adequate hydration c. Compliance with chronic transfusion therapy d. Prevention of respiratory infections

ANS: A Feedback A Hemorrhage as a result of injury is the child's greatest threat to life. B Fluid volume status becomes a concern when hemorrhage has occurred. C The treatment of von Willebrand disease is desmopressin acetate (DDAVP), which is administered intranasally or intravenously. D Respiratory infections do not constitute a major threat to the child with von Willebrand disease.

What is the priority nursing intervention for a child hospitalized with hemarthrosis resulting from hemophilia? a. Immobilization and elevation of the affected joint b. Administration of acetaminophen for pain relief c. Assessment of the child's response to hospitalization d. Assessment of the impact of hospitalization on the family system

ANS: A Feedback A Immobilization and elevation of the joint will prevent further injury until bleeding is resolved. B Although acetaminophen may help with pain associated with the treatment of hemarthrosis, it is not the priority nursing intervention. C Assessment of a child's response to hospitalization is relevant to all hospitalized children; however, in this situation, psychosocial concerns are secondary to physiologic concerns. A priority nursing concern for this child is the management of hemarthrosis. D Assessing the impact of hospitalization on the family system is relevant to all hospitalized children, but it is not the priority in this situation.

Impetigo ordinarily results in a. No scarring b. Pigmented spots c. Slightly depressed scars d. Atrophic white scars

ANS: A Feedback A Impetigo tends to heal without scarring unless a secondary infection occurs. B Hyperpigmentation may occur; however, only in dark skinned children. C No scarring usually occurs. D No scarring usually occurs

Which finding in an analysis of cerebrospinal fluid (CSF) is consistent with a diagnosis of bacterial meningitis? a. CSF appears cloudy. b. CSF pressure is decreased. c. Few leukocytes are present. d. Glucose level is increased compared with blood.

ANS: A Feedback A In acute bacterial meningitis, the CSF is cloudy to milky or yellowish in color. B The CSF pressure is usually increased in acute bacterial meningitis. C Many polymorphonuclear cells are present in CSF with acute bacterial meningitis. D The CSF glucose level is usually decreased compared with the serum glucose level.

A child with acute myeloblastic leukemia is scheduled to have a bone marrow transplant (BMT). The donor is the child's own umbilical cord blood that had been previously harvested and banked. This type of BMT is termed a. Autologous b. Allogeneic c. Syngeneic d. Stem cell

ANS: A Feedback A In an autologous transplant, the child's own marrow or previously harvested and banked cord blood is used. B In an allogeneic BMT, histocompatibility has been matched with a related or an unrelated donor. C In a syngeneic transplant, the child receives bone marrow from an identical twin. D A stem cell transplantation uses a unique immature cell present in the peripheral circulation.

What is true about the genetic transmission of sickle cell disease? a. Both parents must carry the sickle cell trait. b. Both parents must have sickle cell disease. c. One parent must have the sickle cell trait. d. Sickle cell disease has no known pattern of inheritance.

ANS: A Feedback A In this scenario, there is a 50% risk of having a child with sickle cell disease. B The sickle cell trait, not the disease itself, must be present in the parents for the child to have the disease. C An autosomal recessive pattern of inheritance means that both parents must be carriers of the sickle cell trait. D Sickle cell disease is known to have an autosomal recessive pattern of inheritance.

What sign is indicative of respiratory distress in infants? a. Nasal flaring b. Respiratory rate of 55 breaths/min c. Irregular respiratory pattern d. Abdominal breathing

ANS: A Feedback A Infants have difficulty breathing through their mouths; therefore nasal flaring is usually accompanied by extra respiratory efforts. It also allows more air to enter as the nares flare. B A respiratory rate of 55 breaths/min is a normal assessment for an infant. Tachypnea is a respiratory rate of 60 to 80 breaths/min. C Irregular respirations are normal in the infant. D Abdominal breathing is common because the diaphragm is the neonate's major breathing muscle.

A child with GH deficiency is receiving GH therapy. What 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 Feedback A Injections are best given at bedtime to more closely approximate the physiologic release of GH. B This time does not mimic the physiologic release of the hormone. C This time does not mimic the physiologic release of the hormone. D This time does not mimic the physiologic release of the hormone.

The earliest clinical manifestation of biliary atresia is a. Jaundice b. Vomiting c. Hepatomegaly d. Absence of stooling

ANS: A Feedback A Jaundice is the earliest and most striking manifestation of biliary atresia. It is first observed in the sclera, may be present at birth, but is usually not apparent until age 2 to 3 weeks. B Vomiting is not associated with biliary atresia. C Hepatomegaly and abdominal distention are common but occur later. D Stools are large and lighter in color than expected because of the lack of bile.

The nurse knows that treatment of Osgood-Schlatter disease includes a. Limitation of knee bending or kneeling b. Increasing range of motion (ROM) of the knee c. Encouraging flexion of the hip d. Limitation of adduction of the hip

ANS: A Feedback A Limitation of knee bending or kneeling provides pain control and allows the knees to heal. B Increasing ROM of the knee increases pain and exacerbates the disease. C Encouraging flexion of the hip will have no effect on the process affecting the knees. D Limitation of hip adduction will not help the child with Osgood-Schlatter disease.

What is an expected outcome for the child with irritable bowel disease? a. Decreasing symptoms b. Adherence to a low-fiber diet c. Increasing milk products in the diet d. Adapting the lifestyle to the lifelong problems

ANS: A Feedback A Management of irritable bowel disease is aimed at identifying and decreasing exposure to triggers and decreasing bowel spasms, which will decrease symptoms. Management includes maintenance of a healthy, well-balanced, moderate-fiber, lower fat diet. B A moderate amount of fiber in the diet is indicated for the child with irritable bowel disease. C No modification in dairy products is necessary unless the child is lactose intolerant. D Irritable bowel syndrome is typically self-limiting and resolves by age 20 years.

What information provided by the nurse would be helpful to a 15-year-old adolescent taking methimazole three times a day? a. Pill dispensers and alarms on her watch can remind her to take the medication as ordered. b. She can take the medication when she is nervous and feels she needs it. c. She can take two pills before school and one pill at dinner, which will be easier for her to remember. d. Her mother can be responsible for reminding her when it is time to take her medication.

ANS: A Feedback A Methimazole is an antithyroid medication that should be taken three times a day. Reminders will facilitate taking medication as ordered. B This medication needs to be taken regularly, not on an as-needed basis. C The dosage cannot be combined to reduce the frequency of administration. D Because of the adolescent's school schedule and activities, she, rather than her mother, needs to be responsible for her medication.

When assessing the child with atopic dermatitis, the nurse should ask the parents about a history of a. Asthma b. Nephrosis c. Lower respiratory tract infections d. Neurotoxicity

ANS: A Feedback A Most children with atopic dermatitis have a family history of asthma, hay fever, or atopic dermatitis, and up to 80% of children with atopic dermatitis have asthma or allergic rhinitis. B Complications of atopic dermatitis relate to the skin. The renal system is not affected by atopic dermatitis. C There is no link between lower respiratory tract infections and atopic dermatitis. D Atopic dermatitis does not have a relationship to neurotoxicity.

The most common problem of children born with a myelomeningocele is a. Neurogenic bladder b. Intellectual impairment c. Respiratory compromise d. Cranioschisis

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

To assess the child with severe burns for adequate perfusion, the nurse monitors a. Distal pulses b. Skin turgor c. Urine output d. Mucous membranes

ANS: C Feedback A Distal pulses may be affected by many variables. Urine output is the most reliable indicator of end-organ perfusion. B Skin turgor is often difficult to assess on burn patients because the skin is not intact. C Urine output reflects the adequacy of end-organ perfusion. D Mucous membranes do not reflect end-organ perfusion.

What is the best response for the nurse to give a parent about contacting the physician regarding an infant with diarrhea? a. "Call your pediatrician if the infant has not had a wet diaper for 6 hours." b. "The pediatrician should be contacted if the infant has two loose stools in an 8-hour period." c. "Call the doctor immediately if the infant has a temperature greater than 100° F." d. "Notify the pediatrician if the infant naps more than 2 hours."

ANS: A Feedback A No urine output in 6 hours needs to be reported because it indicates dehydration. B Two loose stools in 8 hours is not a serious concern. If blood is obvious in the stool or the frequency increases to one bowel movement every hour for more than 8 hours, the physician should be notified. C A fever greater than 101° F should be reported to the infant's physician. D It is normal for the infant who is not ill to nap for 2 hours. The infant who is ill may nap longer than the typical amount.

An assessment of a 7-month-old infant with a hemoglobin level of 6.5 mg/dL is likely to reveal an infant who is a. Lethargic, pale, and irritable b. Thin, energetic, and sleeps little c. Anorexic, vomiting, and has watery stools d. Flushed, fussy, and tired

ANS: A Feedback A Pallor, lethargy, irritability, and tachycardia are clinical manifestations of iron deficiency anemia. A child with a hemoglobin level of 6.5 mg/dL has anemia. B A child with a hemoglobin level of 6.5 mg/dL has anemia. Infants with iron deficiency anemia are not typically thin and energetic but do tend to sleep a lot. C A child with a hemoglobin level of 6.5 mg/dL has anemia. Gastrointestinal symptoms are not clinical manifestations associated with iron deficiency anemia. D A child with a hemoglobin level of 6.5 mg/dL has anemia. Although the infant with iron deficiency anemia may be tired and fussy, pallor, rather than a flushed appearance, is characteristic of a low hemoglobin level.

An infant with imperforate anus has an anal plasty and temporary colostomy. Which statement by the infant's mother indicates that she understands how to care for the infant's colostomy at home? a. "I will call the doctor right away if my baby starts vomiting." b. "I'll call my home health nurse if the colostomy bag needs to be changed." c. "I'll call the doctor if I notice that the colostomy stoma is pink." d. "I'll have my mother help me with the care of the colostomy."

ANS: A Feedback A Parents are taught signs of strangulation; vomiting, pain, and an irreducible mass in the abdomen. The physician should be contacted immediately if strangulation is suspected. B The mother should be taught the basics of colostomy care, including how to change the appliance. C The colostomy stoma should be pink in color, not pale or discolored. D There is no evidence that her mother knows how to care for a colostomy. This also does not indicate the mother has understanding of caring for the infant's colostomy.

A nurse is teaching parents the difference between pediatric fractures and adult fractures. Which observation is true about pediatric fractures? a. They seldom are complete breaks. b. They are often compound fractures. c. They are often at the epiphyseal plate. d. They are often the result of decreased mobility of the bones

ANS: A Feedback A Pediatric fractures seldom are complete breaks. Rather, children's bones tend to bend or buckle. B Compound fractures are no more common than simple fractures in children. C Epiphyseal plate fractures are no more common than any other type of fracture. D Increased mobility of the bones prevents children from having complete fractures.

Which finding noted by the nurse on a physical assessment is most suggestive that a child has been sexually abused? a. Swelling of the genitalia and pain on urination b. Smooth philtrum and thin upper lip c. Speech and physical development delays d. History of constipation, drowsiness, and constricted pupils

ANS: A Feedback A Physical indicators of sexual abuse may include swelling or itching of the genitalia and pain on urination. Other indicators may include bruises, bleeding, or lacerations of the external genitalia, vagina, or anal area. B The infant with fetal alcohol syndrome may have microphthalmia or abnormally small eyes or short palpebral fissures, a thin upper lip, and a poorly developed philtrum. C Children who have been emotionally abused may exhibit speech disorders, lags in physical development, failure to thrive, or hyperactive and disruptive behaviors. Although there is a possibility for speech and developmental delays, these are not more suggestive of sexual abuse than swollen genitalia and pain on urination. D Opiates can cause detachment and apathy, drowsiness, constricted pupils, constipation, slurred speech, and impaired judgment.

A child with pulmonary atresia exhibits cyanosis with feeding. On reviewing this child's laboratory values, the nurse is not surprised to notice which abnormality? a. Polycythemia b. Infection c. Dehydration d. Anemia

ANS: A Feedback A Polycythemia is a compensatory response to chronic hypoxia. The body attempts to improve tissue oxygenation by producing additional red blood cells and thereby increases the oxygen-carrying capacity of the blood. B Infection is not a clinical consequence of cyanosis. C Although dehydration can occur in cyanotic heart disease, it is not a compensatory mechanism for chronic hypoxia. It is not a clinical consequence of cyanosis. D Anemia may develop as a result of increased blood viscosity. Anemia is not a clinical consequence of cyanosis.

A child experiences frostbite of the fingers after prolonged exposure to the cold. Which intervention should the nurse implement first? a. Rapid rewarming of the fingers by placing in warm water b. Placing the hand in cool water c. Slow rewarming by wrapping in warm cloth d. Using an ice pack to keep cold until medical intervention is possible

ANS: A Feedback A Rapid rewarming is accomplished by immersing the part in well-agitated water at 37.8° C to 42.2° C (100° F to 108° F). B The frostbitten area should be rewarmed as soon as possible to avoid further tissue damage. C Rapid rewarming results in less tissue necrosis than slow thawing. D The frostbitten area should be rewarmed, as soon as possible, to avoid further tissue damage.

What should be the major consideration when selecting toys for a child with an intellectual or developmental disability? a. Safety b. Age appropriateness c. Ability to provide exercise d. Ability to teach useful skills

ANS: A Feedback A Safety is the primary concern in selecting recreational and exercise activities for all children. This is especially true for children who are intellectually disabled. B Age appropriateness should be considered in the selection of toys, but safety is of paramount importance. C Ability to provide exercise should be considered in the selection of toys, but safety is of paramount importance. D Ability to teach useful skills should be considered in the selection of toys, but safety is of paramount importance.

What is the primary concern for a 7-year-old child with type 1 diabetes mellitus who asks his mother not to tell anyone at school that he has diabetes? a. The child's safety b. The privacy of the child c. Development of a sense of industry d. Peer group acceptance

ANS: A Feedback A Safety is the primary issue. School personnel need to be aware of the signs and symptoms of hypoglycemia and hyperglycemia and the appropriate interventions. B Privacy is not a life-threatening concern. C The treatment of type 1 diabetes should not interfere with the school-age child's development of a sense of industry. D Peer group acceptance, along with body image, are issues for the early adolescent with type 1 diabetes. This is not of greater priority than the child's safety.

The nurse expects the initial plan of care for a 9-month-old child with an acute otitis media infection to include a. symptomatic treatment and observation for 48 to 72 hours after diagnosis b. an oral antibiotic, such as amoxicillin, five times a day for 7 days c. pneumococcal conjugate vaccine d. myringotomy with tympanoplasty tubes

ANS: A Feedback A Select children 6 months of age or older with acute otitis media are treated by initiating symptomatic treatment and observation for 48 to 72 hours. B Acute otitis media may be treated with a 5- to 10-day course of oral antibiotics. When treatment is indicated, amoxicillin at a divided dose of 80 to 90 mg/kg/day given either every 8 or 12 hours for 5 to 10 days may be ordered. C Pneumococcal conjugate vaccine helps to prevent ear infections but is not included in the initial plan of care for a child with acute otitis media. D Surgical intervention is considered when the child has persistent ear infection despite antibiotic therapy or with otitis media with effusion that persists for more than 3 months and is associated with hearing loss.

Which classification of drugs is used to relieve an acute asthma episode? a. Short-acting beta2-adrenergic agonist b. Inhaled corticosteroids c. Leukotriene blockers d. Long-acting bronchodilators

ANS: A Feedback A Short-acting beta2-adrenergic agonist is the first medication administered. Later, systemic corticosteroids decrease airway inflammation in an acute asthma attack. They are given for short courses of 5 to 7 days. B Inhaled corticosteroids are used for long-term, routine control of asthma. C Leukotriene blockers diminish the mediator action of leukotrienes and are used for long-term, routine control of asthma in children older than 12 years. D A long-acting bronchodilator would not relieve acute symptoms.

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 should the nurse suggest to remove this material? a. Wash the area with warm water and soap. b. Vigorously scrub leg. c. Apply powder to absorb material. d. Carefully pick material off leg.

ANS: A Feedback A Simple soaking in the bathtub is usually sufficient for the removal of the desquamated skin and sebaceous secretions. B 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. C Oil or lotion, but not powder, may provide comfort for the child. D 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.

When changing an infant's diaper, the nurse notices small bright red papules with satellite lesions on the perineum, anterior thigh, and lower abdomen. This rash is characteristic of a. Primary candidiasis b. Irritant contact dermatitis c. Intertrigo d. Seborrheic dermatitis

ANS: A Feedback A Small red papules with peripheral scaling in a sharply demarcated area involving the anterior thighs, lower abdomen, and perineum are characteristic of primary candidiasis. B A shiny, parchment-like erythematous rash on the buttocks, medial thighs, mons pubis, and scrotum, but not in the folds, is suggestive of irritant contact dermatitis. C Intertrigo is identified by a red macerated area of sharp demarcation in the groin folds. It can also develop in the gluteal and neck folds. D Seborrheic dermatitis is recognized by salmon-colored, greasy lesions with a yellowish scale found primarily in skin-fold areas or on the scalp.

Parents have learned that their 6-year-old child has autism. The nurse may help the parents to cope by explaining that the child may a. Have an extremely developed skill in a particular area b. Outgrow the condition by early adulthood c. Have average social skills d. Have age-appropriate language skills

ANS: A Feedback A Some children with autism have an extremely developed skill in a particular area such as mathematics or music. B No evidence supports that autism is outgrown. C Autistic children have abnormal ways of relating to people (social skills). D Speech and language skills are usually delayed in autistic children.

Which statement by the mother of an adolescent being discharged after spinal fusion for severe scoliosis indicates the need for further teaching? a. "I am glad we chose surgery. Now it is all over and done." b. "I'll see you in a month; we'll be back fairly regularly." c. "I have to pick up some more T-shirts on the way home." d. "Those exercises the physical therapist showed us were not too hard."

ANS: A Feedback A Spinal fusion requires long-term follow-up to assess the stability of the spinal correction. B This statement indicates the mother's understanding of the need for long-term follow-up. C T-shirts are needed to protect the skin under the orthoplasty jacket, which is worn after fusion. D This statement indicates the mother received instructions and understands that continued interventions are needed.

The father of an infant calls the nurse to his son's room because he is "making a strange noise." A diagnosis of laryngomalacia is made. What does the nurse expect to find on assessment? a. Stridor b. High-pitched cry c. Nasal congestion d. Spasmodic cough

ANS: A Feedback A Stridor is usually present at birth but may begin as late as 2 months. Symptoms increase when the infant is supine or crying. B High-pitched cries are consistent with neurologic abnormalities and are not usually respiratory in nature. C Nasal congestion is nonspecific in relation to laryngomalacia. D Spasmodic cough is associated with croup; it is not a common symptom of laryngomalacia.

Which statement about suicide is correct? a. Children younger than 10 years of age do not attempt suicide. b. Suicide risk decreases with age. c. Suicide is usually an isolated event in a school community. d. The prevalence of suicide attempts is higher among males.

ANS: A Feedback A Suicide by children under the age of 10 is uncommon. B The risk of suicide increases with age. C It is common for suicide to occur in a cluster within a community (e.g., schools). D Males have a 4% rate of suicide attempts compared to 8% in females; however, males are more likely to die after a suicide attempt.

The nurse getting an end-of-shift report on a child with status asthmaticus should question which intervention? a. Administer oxygen by nasal cannula to keep oxygen saturation at 100%. b. Assess intravenous (IV) maintenance fluids and site every hour. c. Notify physician for signs of increasing respiratory distress. d. Organize care to allow for uninterrupted rest periods.

ANS: A Feedback A Supplemental oxygen should not be administered to maintain oxygen saturation at 100%. Keeping the saturation around 95% is adequate. Administration of too much oxygen to a child may lead to respiratory depression by decreasing the stimulus to breathe, leading to carbon dioxide retention. B When the child cannot take oral fluids because of respiratory distress, IV fluids are administered. The child with a continuous IV infusion must be assessed hourly to prevent complications. C A physician should be notified of any changes indicating increasing respiratory distress. D A child in respiratory distress is easily fatigued. Nursing care should be organized so the child can get needed rest without being disturbed.

The parents of a child with acid-base imbalance ask the nurse about mechanisms that regulate acid-base balance. Which statement by the nurse accurately explains the mechanisms regulating acid-base balance in children? a. The respiratory, renal, and chemical-buffering systems b. The kidneys balance acid; the lungs balance base c. The cardiovascular and integumentary systems d. The skin, kidney, and endocrine systems

ANS: A Feedback A The acid-base system is regulated by chemical buffering, respiratory control of carbon dioxide, and renal regulation of bicarbonate and secretion of hydrogen ions. B Both the kidneys and the lungs, along with the buffering system, contribute to acid-base balance. Neither system regulates acid or base balances exclusively. C The cardiovascular and integumentary systems are not part of acid-base regulation in the body. D Chemical buffers, the lungs, and the kidneys work together to keep the blood pH within normal range.

A priority nursing intervention when caring for a child in a Pavlik harness is a. Skin care b. Bowel function c. Feeding patterns d. Respiratory function

ANS: A Feedback A The child in a Pavlik harness needs special attention to skin care because the infant's skin is sensitive and the harness may cause irritation. B The harness should not affect normal bowel function in the infant. C Families are typically instructed on techniques for holding and feeding. The harness should not affect feeding patterns in the infant. D The harness should not affect normal respiratory function in the infant

Which nursing intervention should not be included in the postoperative plan of care for a child undergoing surgery for a brain tumor? a. Place the child in Trendelenburg position. b. Perform neurologic assessments. c. Assess dressings for drainage. d. Monitor temperature.

ANS: A Feedback A The child is never placed in the Trendelenburg position because it increases intracranial pressure and the risk of bleeding. B Increased intracranial pressure is a risk in the postoperative period. The nurse would assess the child's neurologic status frequently. C Hemorrhage is a risk in the postoperative period. The child's dressing would be inspected frequently for bleeding. D Temperature is monitored closely because the child is at risk for infection in the postoperative period.

The nurse should expect a child who has frequent tension type of headaches to describe headache pain as a. "There is a rubber-band squeezing my head." b. "It's a throbbing pain over my left eye." c. "My headaches are worse in the morning and get better later in the day." d. "I have a stomachache and a headache at the same time."

ANS: A Feedback A The child who has tension type of headaches may describe the pain as a bandlike tightness or pressure, tight neck muscles, or soreness in the scalp. B A common symptom of migraines is throbbing headache pain, typically on one side of the eye. C A headache that is worse in the morning and improves throughout the course of the day is typical of ICP. D Abdominal pain may accompany headache pain in migraines.

What food choice by the parent of a 2-year-old child with celiac disease indicates a need for further teaching? a. Oatmeal b. Rice cake c. Corn muffin d. Meat patty

ANS: A Feedback A The child with celiac disease is unable to fully digest gluten, the protein found in wheat, barley, rye, and oats. Oatmeal contains gluten and is not an appropriate food selection. B Rice is an appropriate choice because it does not contain gluten. C Corn is digestible because it does not contain gluten. D Meats do not contain gluten and can be included in the diet of a child with celiac disease.

What is the most appropriate intervention for an adolescent with a mild scoliosis? a. Long-term monitoring b. Surgical intervention c. Bracing d. No follow-up

ANS: A Feedback A The child with mild scoliosis requires long-term follow-up to determine whether the curve will progress or remain stable. B Surgical intervention is not needed for mild scoliosis. C Mild scoliosis is not braced if it is stable. D Follow-up to monitor the curve is important until skeletal maturity has occurred.

Which intervention is appropriate for a hospitalized child who has crops of lesions on the trunk that appear as a macular rash and vesicles? a. Place the child in strict isolation; airborne and contact precautions. b. Continue to practice Standard Precautions. c. Pregnant women should avoid contact with the child. d. Screen visitors for immunity to measles.

ANS: A Feedback A The child's skin lesions are characteristic of varicella. Varicella is transmitted through direct contact, droplets, and airborne particles. In the hospital setting, children with varicella should be placed in strict isolation, and on Contact and Airborne Precautions. The purpose is to prevent transmission of microorganisms by inhalation of small-particle droplet nuclei and to protect other patients and health care providers from acquiring this disease. B The child's skin lesions are characteristic of varicella. Additional measures must be instituted to protect other patients and staff who may be susceptible to the disease. C Certain viral illnesses such as rubella and fifth disease are known to affect the fetus if the woman contracts the disease during pregnancy. This child appears to have varicella. Pregnancy is not a contraindication to caring for a child with varicella. D The child appears to have varicella. Screening visitors for immunity to measles is irrelevant. It is important to screen visitors for immunity to varicella.

The primary clinical manifestation of scabies is a. Edema b. Redness c. Pruritus d. Maceration

ANS: C Feedback A Edema is not observed in scabies. B Redness is not observed in scabies. C Scabies is caused by the scabies mite. The inflammatory response and intense itching occur after the host has become sensitized to the mite. This occurs approximately 30 to 60 days after initial contact. In the previously sensitized person, the response occurs within 48 hours. D Maceration is not observed in scabies.

When a 2-week-old infant is seen for irritability, poor appetite, and rapid head growth with observable distended scalp veins, the nurse recognizes these signs as indicative of a. Hydrocephalus b. Syndrome of inappropriate antidiuretic hormone (SIADH) c. Cerebral palsy d. Reye's syndrome

ANS: A Feedback A The combination of signs is strongly suggestive of hydrocephalus. B SIADH would not manifest in this way. The child would have decreased urination, hypertension, weight gain, fluid retention, hyponatremia, and increased urine specific gravity. C The manifestations of cerebral palsy vary but may include persistence of primitive reflexes, delayed gross motor development, and lack of progression through developmental milestones. D Reye's syndrome is associated with an antecedent viral infection with symptoms of malaise, nausea, and vomiting. Progressive neurologic deterioration occurs.

What is 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 Feedback 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. B History of malabsorption is a later sign that manifests as failure to thrive. C Foul-smelling stools are a later manifestation of CF. D Recurrent respiratory infections are a later sign of CF.

A child with osteomyelitis asks the nurse, "What is a 'sed' rate?" What is the best response for the nurse? a. "It tells us how you are responding to the treatment." b. "It tells us what type of antibiotic you need." c. "It tells us whether we need to immobilize your extremity." d. "It tells us how your nerves and muscles are doing."

ANS: A Feedback A The erythrocyte sedimentation rate (ESR) indicates the presence of inflammation and infectious process and is one of the best indicators of the child's response to treatment. B Although the ESR indirectly identifies whether an antibiotic is needed, the organism involved dictates the type of antibiotic and the length of treatment. C The ESR does not direct whether the extremity will be immobilized. D An ESR rate will not evaluate neuromuscular status.

In which situation is there a risk that a newborn infant will have a congenital heart defect (CHD)? a. Trisomy 21 detected on amniocentesis b. Family history of myocardial infarction c. Father has type 1 diabetes mellitus d. Older sibling born with Turner syndrome

ANS: A Feedback A The incidence of congenital heart disease is approximately 50% in children with trisomy 21 (Down syndrome). B A family history of congenital heart disease, not acquired heart disease, increases the risk of giving birth to a child with CHD. C Infants born to mothers who are insulin dependent have an increased risk of CHD. D Infants identified as having certain genetic defects, such as Turner syndrome, have a higher incidence of CHD. A family history is not a risk factor.

Before giving a dose of digoxin (Lanoxin), the nurse checked an infant's apical heart rate and it was 114 bpm. What should the nurse do next? a. Administer the dose as ordered. b. Hold the medication until the next dose. c. Wait and recheck the apical heart rate in 30 minutes. d. Notify the physician about the infant's heart rate.

ANS: A Feedback A The infant's heart rate is above the lower limit for which the medication is held. The dose can be given. B A dose of Lanoxin is withheld for a heart rate less than 100 bpm in an infant. C The infant's heart rate is acceptable for administering Lanoxin. It is unnecessary to recheck the heart rate at a later time. D The infant's heart rate is acceptable. The physician should be notified for a heart rate less than 100 bpm in an infant.

What is the major concern guiding treatment for the child with Legg-Calvé-Perthes disease? a. Avoid permanent deformity. b. Minimize pain. c. Maintain normal activities. d. Encourage new hobbies.

ANS: A Feedback A The major concern related to Legg-Calvé-Perthes disease is to prevent an arthritic process resulting from the flattening of the femoral head of the femur when it protrudes outside the acetabulum. B The pain associated with Legg-Calvé-Perthes disease decreases with increased rest, making activity restriction an important factor for these children. The priority concern for treatment is to prevent deformity. C In Legg-Calvé-Perthes disease, the major concern is to prevent deformity through decreased activity. D Prevention of deformity is the major concern for children with Legg-Calvé-Perthes disease, and rest is a mandatory treatment. Selected hobbies that do not require physical activity are encouraged.

What is the best response to parents who ask why their infant has a nasogastric tube to intermittent suction before abdominal surgery for hypertrophic pyloric stenosis? a. "The nasogastric tube decompresses the abdomen and decreases vomiting." b. "We can keep a more accurate measure of intake and output with the nasogastric tube." c. "The tube is used to decrease postoperative diarrhea." d. "Believe it or not, the nasogastric tube makes the baby more comfortable after surgery."

ANS: A Feedback A The nasogastric tube provides decompression and decreases vomiting. B A nursing responsibility when a patient has a nasogastric tube is measurement of accurate intake and output, but this is not why nasogastric tubes are inserted. C Nasogastric tube placement does not decrease diarrhea. D The presence of a nasogastric tube can be perceived as a discomfort by the patient.

The nurse notes that a child's gums bleed easily and he has bruising and petechiae on his extremities. What laboratory values are consistent with these symptoms? a. Platelet count of 19,000/mm3 b. Prothrombin time of 11 to 15 seconds c. Hematocrit of 34 d. Leukocyte count of 14,000/mm3

ANS: A Feedback A The normal platelet count is 150,000 to 400,000/mm3. This finding is very low, indicating an increased bleeding potential. The child should be monitored closely for signs of bleeding. B The prothrombin time of 11 to 15 seconds is within normal limits. C The normal hematocrit is 35 to 45 and, although this finding is low, it would not create the symptoms presented. D This value indicates the probable presence of infection, but it is not a reflection of bleeding tendency.

A child has a total cholesterol level of 180 mg/dL. What dietary recommendations should the nurse make to the child and the child's parents? Select all that apply. a. Replace whole milk for 2% or 1% milk. b. Increase servings of red meat. c. Increase servings of fish. d. Avoid excessive intake of fruit juices. e. Limit servings of whole grain.

ANS: A, C, D Feedback Correct A low-fat diet includes using nonfat or low-fat dairy products, limiting red meat intake, and increasing intake of fish, vegetables, whole grains, and legumes. Incorrect Children should avoid excessive intake of fruit juices and other sweetened drinks, sugars, and saturated fats.

The best chance of survival for a child with cirrhosis is a. Liver transplantation b. Treatment with corticosteroids c. Treatment with immune globulin d. Provision of nutritional support

ANS: A Feedback A The only successful treatment for end-stage liver disease and liver failure may be liver transplantation, which has improved the prognosis for many children with cirrhosis. B Liver transplantation has revolutionized the approach to cirrhosis. Liver failure and cirrhosis are indications for transplantation. Liver transplantation reflects the failure of other medical and surgical measures to prevent or treat cirrhosis. C Liver transplantation has revolutionized the approach to cirrhosis. Liver failure and cirrhosis are indications for transplantation. Liver transplantation reflects the failure of other medical and surgical measures to prevent or treat cirrhosis. D Liver transplantation has revolutionized the approach to cirrhosis. Liver failure and cirrhosis are indications for transplantation. Liver transplantation reflects the failure of other medical and surgical measures to prevent or treat cirrhosis.

What is the best time for the nurse to assess the peak effectiveness of subcutaneously administered Regular insulin? a. Two hours after administration b. Four hours after administration c. Immediately after administration d. Thirty minutes after administration

ANS: A Feedback A The peak action for Regular (short-acting) insulin is 2 to 3 hours after subcutaneous administration. B The duration of Regular (short-acting) insulin is only 3 to 6 hours. Peak action occurs 2 to 3 hours after the insulin is administered. C Subcutaneously administered Regular (short-acting) insulin has an onset of action of 30 to 60 minutes after injection. The effectiveness of subcutaneously administered, short-acting insulin cannot be assessed immediately after administration. D Thirty minutes corresponds to the onset of action for Regular (short-acting) insulin.

What explanation should the nurse give to the parent of a child with asthma about using a peak flow meter? a. It is used to monitor the child's breathing capacity. b. It measures the child's lung volume. c. It will help the medication reach the child's airways. d. It measures the amount of air the child breathes in.

ANS: A Feedback A The peak flow meter is a device used to monitor breathing capacity in the child with asthma. B A child with asthma would have a pulmonary function test to measure lung volume. C A spacer used with a metered-dose inhaler prolongs medication transit so medication reaches the airways. D The peak flow meter measures the flow of air in a forced exhalation in liters per minute.

Which action is the primary concern in the treatment plan for a child with persistent vomiting? a. Detecting the cause of vomiting b. Preventing metabolic acidosis c. Positioning the child to prevent further vomiting d. Recording intake and output

ANS: A Feedback A The primary focus of managing vomiting is detection of the cause and then treatment of the cause. B Metabolic alkalosis results from persistent vomiting. Prevention of complications is the secondary focus of treatment. C The child with persistent vomiting should be positioned upright or side-lying to prevent aspiration. D Recording intake and output is a nursing intervention, but it is not the primary focus of treatment.

Discharge planning for the child with juvenile arthritis includes the need for a. Routine ophthalmologic examinations to assess for visual problems b. A low-calorie diet to decrease or control weight in the less mobile child c. Avoiding the use of aspirin to decrease gastric irritation d. Immobilizing the painful joints, which is the result of the inflammatory process

ANS: A Feedback A The systemic effects of juvenile arthritis can result in visual problems, making routine eye examinations important. B Children with juvenile arthritis do not have problems with increased weight and often are anorexic and in need of high-calorie diets. C Children with arthritis are often treated with aspirin. D Children with arthritis can immobilize their own joints. Range-of-motion exercises are important for maintaining joint flexibility and preventing restricted movement in the affected joints.

The nurse notes on assessment that a 1-year-old child is underweight, with abdominal distention, thin legs and arms, and foul-smelling stools. The nurse suspects failure to thrive is associated with a. Celiac disease b. Intussusception c. Irritable bowel syndrome d. Imperforate anus

ANS: A Feedback A These are classic symptoms of celiac disease. B Intussusception is not associated with failure to thrive or underweight, thin legs and arms, and foul-smelling stools. Stools are like "currant jelly." C Irritable bowel syndrome is characterized by diarrhea and pain, and the child does not typically have thin legs and arms. D Imperforate anus is the incomplete development or absence of the anus in its normal position in the perineum. Symptoms are evident in early infancy.

A 5-year-old child is brought to the emergency department with copious drooling and a croaking sound on inspiration. Her mother states that the child is very agitated and only wants to sit upright. What should be the nurse's first action in this situation? a. Prepare intubation equipment and call the physician. b. Examine the child's oropharynx and call the physician. c. Obtain a throat culture for respiratory syncytial virus (RSV). d. Obtain vital signs and listen to breath sounds.

ANS: A Feedback A This child has symptoms of epiglottitis, is acutely ill, and requires emergency measures. B If epiglottitis is suspected, the nurse should not examine the child's throat. Inspection of the epiglottis is only done by a physician, because it could trigger airway obstruction. C A throat culture could precipitate a complete respiratory obstruction. D Vital signs can be assessed after emergency equipment is readied.

Bismuth subsalicylate, clarithromycin, and metronidazole are prescribed for a child with a peptic ulcer to a. Eradicate Helicobacter pylori. b. Coat gastric mucosa. c. Treat epigastric pain. d. Reduce gastric acid production

ANS: A Feedback A This combination of drug therapy is effective in the treatment of H. pylori. B This drug combination is prescribed to eradicate the H. pylori. C This drug combination is prescribed to eradicate the H. pylori. D This drug combination is prescribed to eradicate the H. pylori.

Which assessment finding should the nurse expect in an infant with Hirschsprung disease? a. "Currant jelly" stools b. Constipation with passage of foul-smelling, ribbon-like stools c. Foul-smelling, fatty stools d. Diarrhea

ANS: B Feedback A "Currant jelly" stools are associated with intussusception. B Constipation results from absence of ganglion cells in the rectum and colon, and is present since the neonatal period with passage of frequent foul-smelling, ribbon-like, or pellet-like stools. C Foul-smelling, fatty stools are associated with cystic fibrosis and celiac disease. D Diarrhea is not typically associated with Hirschsprung disease but may result from impaction.

What should the nurse include in discharge teaching as the highest priority for the child with a cardiac dysrhythmia? a. CPR instructions b. Repeating digoxin if the child vomits c. Resting if dizziness occurs d. Checking the child's pulse after digoxin administration

ANS: A Feedback A This could potentially be life-saving for the child. The parents and significant others in the child's life should have CPR training. B The digoxin dose is not repeated if the child vomits. C Dizziness is a symptom the child should be taught to report to adults so that the physician can be notified. It is not the priority intervention. D The child's pulse should be counted before the medication is given. The dose is withheld if the pulse is below the parameters set by the physician.

What should be included in teaching a parent about the management of small red macules and vesicles that become pustules around the child's mouth and cheek? a. Keep the child home from school for 24 hours after initiation of antibiotic treatment. b. Clean the rash vigorously with Betadine three times a day. c. Notify the physician for any itching. d. Keep the child home from school until the lesions are healed.

ANS: A Feedback A To prevent the spread of impetigo to others, the child should be kept home from school for 24 hours after treatment is initiated. Good handwashing is imperative in preventing the spread of impetigo. B The lesions should be washed gently with a warm soapy washcloth three times a day. The washcloth should not be shared with other members of the family. C Itching is common and does not necessitate medical treatment. Rather, parents should be taught to clip the child's nails to prevent maceration of the lesions. D The child may return to school 24 hours after initiation of antibiotic treatment.

A mother whose 7-year-old child has been placed in a cast for a fractured right arm reports that he will not stop crying even after taking acetaminophen with codeine. He also will not straighten the fingers on his right arm. The nurse tells the mother to a. Take him to the emergency department. b. Put ice on the injury. c. Avoid letting him get so tired. d. Wait another hour; if he is still crying, call back.

ANS: A Feedback A Unrelieved pain and the child's inability to extend his fingers are signs of compartmental syndrome, which requires immediate attention. B Placing ice on the extremity is an inappropriate action for the symptoms. C This is an inappropriate response to give to a mother who is concerned about her child. D A child who has signs and symptoms of compartmental syndrome should be seen immediately. Waiting an hour could compromise the recovery of the child.

Which CHD results in increased pulmonary blood flow? a. Ventricular septal defect b. Coarctation of the aorta c. Tetralogy of Fallot d. Pulmonary stenosis

ANS: A Feedback A Ventricular septal defect causes a left-to-right shunting of blood, thus increasing pulmonary blood flow. B Coarctation of the aorta is a stenotic lesion that causes increased resistance to blood flow from the proximal to distal aorta. C The defects associated with tetralogy of Fallot result in a right-to-left shunting of blood, thus decreasing pulmonary blood flow. D Pulmonary stenosis causes obstruction of blood flow from the right ventricle to the pulmonary artery. Pulmonary blood flow is decreased.

Which assessment finding after tonsillectomy should be reported to the physician? a. Vomiting bright red blood b. Pain at surgical site c. Pain on swallowing d. The ability to only take small sips of liquids

ANS: A Feedback A Vomiting bright red blood and swallowing frequently are signs of bleeding postoperatively and should be reported to the physician. B It is normal for the child to have pain at the surgical site. C It is normal for the child to have pain on swallowing. D Only clear liquids are offered immediately after surgery, and small sips are preferred.

The nurse is caring for a neonate with a suspected tracheoesophageal fistula (TEF). Nursing care should include a. Elevating the head but give nothing by mouth b. Elevating the head for feedings c. Feeding glucose water only d. Avoiding suction unless infant is cyanotic

ANS: A Feedback A When a newborn is suspected of having TEF, the most desirable position is supine with the head elevated on an incline plane of at least 30 degrees. It is imperative that any source of aspiration be removed at once; oral feedings are withheld. B Feedings should not be given to infants suspected of having TEF. C Feedings should not be given to infants suspected of having TEF. D The oral pharynx should be kept clear of secretion by oral suctioning. This is to avoid cyanosis that is usually the result of laryngospasm caused by overflow of saliva into the larynx.

A nurse is teaching a group of parents about TEF. Which statement made by the nurse is accurate about TEF? a. This defect results from an embryonal failure of the foregut to differentiate into the trachea and esophagus. b. It is a fistula between the esophagus and stomach that results in the oral intake being refluxed and aspirated. c. An extra connection between the esophagus and trachea develops because of genetic abnormalities. d. The defect occurs in the second trimester of pregnancy.

ANS: A Feedback A When the foregut does not differentiate into the trachea and esophagus during the fourth to fifth week of gestation, a TEF occurs. B TEF is an abnormal connection between the esophagus and trachea. C There is no connection between the trachea and esophagus in normal fetal development. D This defect occurs early in pregnancy during the fourth to fifth week of gestation.

The nurse should teach parents of a child with cystic fibrosis to adjust enzyme dosage according to which indicator? a. Stool formation b. Vomiting c. Weight d. Urine output

ANS: A Feedback A When there is constipation, less enzyme is needed; with steatorrhea, more enzyme is needed for digestion of nutrients. B Vomiting does not affect enzyme dosaging. C The child's weight does not affect enzyme dosaging. D Urine output is not relevant to enzyme replacement.

You are working as the triage nurse in a pediatric emergency room. You receive a telephone call from the mother of an adolescent whose front tooth was completely knocked out of his mouth while he was playing soccer. The mother is seeking advice. Which is the appropriate response? Select all that apply. a. Rinse the tooth in lukewarm tap water. b. Place the tooth in saline, milk, or water. c. Scrub the tooth with a disinfectant, such as mouth wash. d. Bring the child to the emergency room within the next hour for the best prognosis.

ANS: A, B Feedback Correct Rinse the tooth in lukewarm tap water—this is a correct response. Place the tooth in saline, milk, or water—this is a correct response. Incorrect The tooth should not be scrubbed, and cleaning agents and disinfectants should be avoided. The prognosis is best if the injury is treated within 30 minutes.

Peer victimization is becoming a significant problem for school-age children and adolescents in the United States. Parents should be educated regarding signs that a child is being bullied. These might include (select all that apply) a. The child spends an inordinate amount of time in the nurse's office. b. Belongings frequently go missing or are damaged. c. The child wants to be driven to school. d. School performance improves. e. The child freely talks about his day.

ANS: A, B, C Feedback Correct Signs that may indicate a child is being bullied are similar to signs of other types of stress and include nonspecific illness or complaints, withdrawal, depression, school refusal, and decreased school performance. Children express fear of going to school or riding the school bus. Very often, children will not talk about what is happening to them. Incorrect These are not indications of bullying.

Which demonstrates the school-age child's developing logic in the stage of concrete operations? Select all that apply. a. The school-age child is able to recognize that 1 lb of feathers is equal to 1 lb of metal. b. The school-age child is able to recognize that he can be a son, brother, or nephew at the same time. c. The school-age child understands the principles of adding, subtracting, and reversibility. d. The school-age child has thinking that is characterized by egocentrism, animism, and centration.

ANS: A, B, C Feedback Correct The school-age child understands that the properties of objects do not change when their order, form, or appearance does. Conservation occurs in the concrete operations stage. Comprehension of class inclusion occurs as the school-age child's logic increases. The child begins to understand that a person can be in more than one class at the same time. This is characteristic of concrete thinking and logical reasoning. The school-age child is able to understand principles of adding and subtracting, as well as the process of reversibility, which occurs in the stage of concrete operations. Incorrect This type of thinking occurs in the intuitive thought stage, not the concrete operations stage of development.

What information should the nurse teach families about reducing exposure to pollens and dust? Select all that apply. a. Replace wall-to-wall carpeting with wood and tile floors. b. Use an air conditioner. c. Put dust-proof covers on pillows and mattresses. d. Keep humidity in the house above 60%. e. Keep pets outside.

ANS: A, B, C Feedback Correct: Carpets retain dust. To reduce exposure to dust, carpeting should be replaced with wood, tile, slate, or vinyl. These floors can be cleaned easily. For anyone with pollen allergies, it is best to keep the windows closed and to run the air conditioner. Covering mattresses and pillows with dust-proof covers will reduce exposure to dust. Incorrect: A humidity level above 60% promotes dust mites. It is recommended that household humidity be kept between 40% and 50% to reduce dust mites inside the house. Keeping pets outside will help to decrease exposure to dander, but will not affect exposure to pollen and dust.

A preschooler is diagnosed with helminthes. The child's mother is very upset and wants to know how her child could have contracted this illness. After obtaining a detailed history, the nurse identifies all possible transmission modes. Select all modes that apply. a. Playing in the backyard sandbox b. Not washing hands before eating c. Placing hands in the mouth and nail biting d. Skin-to-skin contact with other children e. Scratches from a neighborhood cat

ANS: A, B, C Feedback Correct: Common helminthes include roundworm, pinworm, tapeworm, and hookworm. Children are frequently infected as the result of frequent hand-mouth activity (unwashed hands, nail biting, not washing hands after using the toilet) and the likelihood of fecal contamination from sandboxes (especially if dogs and cats deposit fecal material in them). Other causes include not adequately washing fruits and vegetables before eating them and drinking contaminated water. Incorrect: Skin-to-skin contact with other children and scratches from a cat are not transmission modes for helminthes.

Which nursing interventions are significant for a child with cirrhosis who is at risk for bleeding? Select all that apply. a. Guaiac all stools b. Provide a safe environment c. Administer multivitamins with vitamins A, D, E, and K d. Inspect skin for pallor and cyanosis e. Monitor serum liver panels

ANS: A, B, C Feedback Correct: Identification of bleeding includes stool guaiac testing, which can detect if blood is present in the stool; protecting the child from injury by providing a safe environment; administering vitamin K to prevent bleeding episodes; and avoiding injections. Incorrect: A skin assessment would likely reveal jaundice. Pallor and cyanosis are associated with a cardiac problem. These may be late signs of a significant bleeding episode, but not significant in the prevention stage of the nursing process. Monitoring serum liver panels is important but would not provide information on coagulation status or risk factors associated with bleeding.

Which strategy is not always appropriate for pediatric physical examination? a. Take the history in a quiet, private place. b. Examine the child from head to toe. c. Exhibit sensitivity to cultural needs and differences. d. Perform frightening procedures last.

ANS: B Feedback A The nurse should collect the child's health history in a quiet, private area. B The classic approach to physical examination is to begin at the head and proceed through the entire body to the toes. When examining a child, however, the examiner must tailor the physical assessment to the child's age and developmental level. C The nurse should always be sensitive to cultural needs and differences among children. D When examining children, painful or frightening procedures should be left to the end of the examination.

While developing a care plan for a school-age child with a visual impairment, the nurse knows that which of the following actions are important in working with this special needs child? Select all that apply. a. Obtain a thorough assessment of the child's self-care abilities. b. Orient the child to various sounds in the environment. c. Mandate that the child's parents stay continuously with their child during hospitalization. d. Allow the child to handle equipment as procedures are explained. e. Encourage the child to use a dry erase board to write his needs.

ANS: A, B, D Feedback Correct These are correct responses that can be used for a school-age child with a visual impairment. Incorrect Mandating that the child's parents stay continuously with their child may not be possible and is not usually necessary if the school-age child is at the expected level of growth and development. Encouraging a child to write his needs on a dry erase board would be an appropriate intervention for a child who is aphonic, not for a child with a visual deficit.

You are the nurse assessing a 3-year-old child who has characteristics of autism. Which observed behaviors are associated with autism? Select all that apply. a. The child flicks the light in the examination room on and off repetitiously. b. The child has a flat affect. c. The child demonstrates imitation and gesturing skills. d. Mother reports the child has no interest in playing with other children. e. The child is able to make eye contact.

ANS: A, B, D Feedback Correct Self-stimulation is common and generally involves repetition of a sensory stimulus. Autistic children generally show a fixed, unchanging response to a particular stimulus. Autistic children generally play alone or involve others only as mere objects. Incorrect Autistic children lack imitative skills. These children lack social ability and make poor eye contact.

A nurse is planning care for an asymptomatic child with a positive tuberculin test. What should the nurse include in the plan? Select all that apply. a. Administration of daily isoniazid (INH) b. Instructing family members about administration of INH to all close contacts of the child c. Administration of the Bacillus Calmette-Guérin vaccine d. Reporting the case to the health department e. Administration of INH and rifampin (Rifadin) simultaneously

ANS: A, B, D Feedback Correct: After a chest radiograph is obtained, asymptomatic children with positive tuberculin tests and no previous history of TB receive daily INH for 9 months. Asymptomatic contacts should receive INH for at least 8 to 10 weeks after contact has been broken or until a negative skin test can be confirmed (a second test is taken at least 10 weeks after the last exposure). Reporting cases of TB is required by law in all states in the United States. Incorrect: Bacillus Calmette-Guérin vaccine is the only anti-TB vaccine available, but it is given only to children who have negative test results. For asymptomatic TB, only INH is administered, not both isoniazid and rifampin together. Rifampin is used if the child has resistance to isoniazid.

When an adolescent with a new diagnosis of Ewing sarcoma asks the nurse about treatment, the nurse's response is based on the knowledge that (select all that apply) a. This type of tumor invades the bone. b. Management includes chemotherapy, surgery, and radiation. c. Ewing sarcoma is usually not responsive to either chemotherapy or radiation. d. Affected bones such as ribs and proximal fibula may be removed to excise the tumor. e. Is the most common bone tumor seen in children.

ANS: A, B, D Feedback Correct: Ewing sarcoma invades the bone and is found most often in the midshaft of long bones, especially the femur, vertebrae, ribs, and pelvic bones. Treatment for Ewing sarcoma begins with chemotherapy to decrease tumor bulk, followed by surgical resection of the primary tumor. Local control of the tumor can be achieved with surgery or radiation. The affected bone may be removed if it will not affect the child's functioning. Ribs and the proximal fibula are considered expendable and may be removed to excise the tumor without affecting function. Incorrect: Ewing sarcoma is responsive to both chemotherapy and radiation. Osteosarcoma is the most common primary bone malignancy in children. The second most common bone tumor seen in children is Ewing sarcoma.

The nurse is assessing parental knowledge of temper tantrums. Which are true statements about temper tantrums? Select all that apply. a. Temper tantrums are a common response to anger and frustration in toddlers. b. Temper tantrums often include screaming, kicking, throwing things, and head banging. c. Parents can effectively manage temper tantrums by giving in to the child's demands. d. Children having temper tantrums should be safely isolated and ignored. e. Parents can learn to anticipate times when tantrums are more likely to occur.

ANS: A, B, D, E Feedback Correct Temper tantrums are a common response to anger and frustration in toddlers. They occur more often when toddlers are tired, hungry, bored, or excessively stimulated. A nap before fatigue or a snack if mealtime is delayed will be helpful in alleviating the times when tantrums are most likely to occur. Tantrums may include screaming, kicking, throwing things, biting themselves, or banging their head. Effective management of tantrums includes safely isolating and ignoring the child. Incorrect The child should learn that nothing is gained by having a temper tantrum. Giving in to the child's demands only increases the behavior.

Hearing seems to be relatively acute, even at birth, as shown by reflexive generalized reaction to noise. All newborns should undergo hearing screening at birth, before hospital discharge. In addition, assessment for hearing deficits should take place at every well-baby visit. Risk factors for hearing loss include (select all that apply) a. Structural abnormalities of the ear b. Family history of hearing loss c. Alcohol or drug use by the mother during pregnancy d. Gestational diabetes e. Trauma

ANS: A, B, E Feedback Correct Structural abnormalities of the ear, a family history of hearing loss, and trauma are risk factors for hearing loss. Other risk factors include persistent otitis media and developmental delay. The American Academy of Pediatrics suggests that infants who demonstrate hearing loss be eligible for early intervention and specialized hearing and language services. Incorrect Prenatal alcohol or drug intake and gestational diabetes are not risk factors for hearing loss in the infant.

Which nursing intervention is appropriate for a child with type 1 diabetes who is experiencing deficient fluid volume related to abnormal fluid losses through diuresis and emesis? Select all that apply. a. Initiate IV access. b. Begin IV fluid replacement with normal saline. c. Begin IV fluid replacement with D5 1/2NS. d. Weigh on arrival to the unit and then every other day. e. Maintain strict intake and output monitoring.

ANS: A, B, E Feedback Correct IV access should always be obtained on a hospitalized child with dehydration and a history of type 1 diabetes. Maintaining circulation is a priority nursing intervention. If the child is vomiting and unable to maintain adequate hydration, fluid volume replacement/rehydration is needed. Normal saline is the initial IV rehydration fluid, followed by half-normal saline. Maintaining strict intake and output is essential in calculating rehydration status. Incorrect D5 1/2NS is not the recommended fluid for rehydration of this patient. Weighing the patient on arrival is important, but following the initial weight, the child needs to be weighed more frequently than every other day. Comparison of admission weight and a weight every 8 hours provides an indication of hydration status.

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 (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 Feedback Correct 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. Incorrect Spinal cord injury is a catastrophic event. Discussion regarding long-term care should be delayed until the child is stable.

The mother of a newborn asks the nurse what causes the baby to begin to breathe after delivery. What changes in the respiratory system stimulating respirations postnatally can the nurse explain to the mother? Select all that apply. a. Low oxygen levels in the infant's blood b. Rubbing the newborn with a towel or blanket c. Surfactant, a special lubricant in the lungs d. Increased blood flow to the infant's lungs e. Cold environment in the delivery room

ANS: A, B, E Feedback Correct: A postnatal change in the respiratory system is the stimulation of respiration by hypoxemia, hypercarbia, cold, tactile stimulation, and a possible decrease in the concentration of prostaglandin E2. Incorrect: Surfactant in the lungs lowers surface tension and facilitates lung expansion. It does not stimulate respirations. Pulmonary blood flow increases after birth, but this does not stimulate respirations in the newborn.

A nurse is assessing a newborn for facial feature characteristics associated with fetal alcohol syndrome: Which characteristics should the nurse expect to assess? Select all that apply. a. Short palpebral fissures b. Smooth philtrum c. Low set ears d. Inner epicanthal folds e. Thin upper lip

ANS: A, B, E Feedback Correct: Infants with fetal alcohol syndrome may have characteristic facial features, including short palpebral fissures, a smooth philtrum (the vertical groove in the median portion of the upper lip), and a thin upper lip. Incorrect: Low set ears and inner epicanthal folds are associated with Down syndrome

A nurse is teaching parents about prevention of diaper dermatitis. Which should the nurse include in the teaching plan? Select all that apply. a. Clean the diaper area gently after every diaper change with a mild soap. b. Use a protective ointment to clean dry intact skin. c. Use a steroid cream after each diaper change. d. Use rubber or plastic pants over the diaper. e. Wash cloth diapers in hot water with a mild soap and double rinse.

ANS: A, B, E Feedback Correct: Prompt, gentle cleaning with water and mild soap (e.g., Dove, Neutrogena Baby Soap) after each voiding or defecation rids the skin of ammonia and other irritants and decreases the chance of skin breakdown and infection. A bland, protective ointment (e.g., A&D, Balmex, Desitin, zinc oxide) can be applied to clean, dry, intact skin to help prevent diaper rash. If cloth diapers are laundered at home, the parents should wash them in hot water, using a mild soap and double rinsing. Incorrect: Occlusion increases the risk of systemic absorption of a steroid; thus steroid creams are rarely used for diaper dermatitis because the diaper functions as an occlusive dressing. Rubber or plastic pants increase skin breakdown by holding in moisture and should be used infrequently. A steroid cream is not recommended.

Trust is important in establishing and maintaining a therapeutic relationship. Maintaining the balance between appropriate involvement and professional separation is quite challenging. Which behaviors may indicate professional separation or underinvolvement? Select all that apply. a. Avoiding the child or his or her family b. Revealing personal information c. Calling in sick d. Spending less time with a particular child e. Asking to trade assignments

ANS: A, C, D, E Feedback Correct Whether nurses become too emotionally involved or find themselves at the other end of the spectrum—being underinvolved—they lose effectiveness as objective professional resources. These are all indications of the nurse who is underinvolved in a child's care. Incorrect Revealing personal information to a patient or his or her family is an indication of overinvolvement.

What should the nurse recognize as symptoms of a brain tumor in a school-age child for whom she is caring? Select all that apply. a. Blurred vision b. Increased head circumference c. Vomiting when getting out of bed d. Intermittent headache e. Declining academic performance

ANS: A, C, D, E Feedback Correct Visual changes such as nystagmus, diplopia, and strabismus are manifestations of a brain tumor. The change in position on awakening causes an increase in intracranial pressure, which is manifested as vomiting. Vomiting on awakening is considered a hallmark symptom of a brain tumor. Increased intracranial pressure resulting from a brain tumor is manifested as a headache. School-age children may exhibit declining academic performance, fatigue, personality changes, and symptoms of vague, intermittent headache. Other symptoms may include seizures or focal neurologic deficits. Incorrect Manifestations of brain tumors vary with tumor location and the child's age and development. Infants with brain tumors may have increased head circumference with a bulging fontanel. School-age children have closed fontanels and therefore their head circumferences do not increase with brain tumors.

A nurse has completed a teaching session for parents about "baby-proofing" the home. Which statements made by the parents indicate an understanding of the teaching? Select all that apply. a. "We will put plastic fillers in all electrical plugs." b. "We will place poisonous substances in a high cupboard." c. "We will place a gate at the top and bottom of stairways." d. "We will keep our household hot water heater at 130 degrees." e. "We will remove front knobs from the stove."

ANS: A, C, E Feedback Correct By the time babies reach 6 months of age, they begin to become much more active, curious, and mobile. Putting plastic fillers on all electrical plugs can prevent an electrical shock. Putting gates at the top and bottom of stairways will prevent falls. Removing front knobs form the stove can prevent burns. Incorrect Poisonous substances should be stored in a locked cabinet not in a cabinet that children can reach when they begin to climb. The household hot water heater should be turned down to 120 degrees or less.

Which interventions are appropriate for preventing childhood obesity? Select all that apply. a. Establish consistent times for meals and snacks. b. Eliminate all snacks. Eat three nutritious meals a day. c. Teach the family and child how to select foods and prepare foods. d. Encourage schools to provide snack machines with popcorn, cookies, and diet soda. e. Limit computer and television time.

ANS: A, C, E Feedback Correct Preventing obesity includes encouraging families to establish consistent times for meals and snacks and discouraging between-meal eating. Parents and children also need to be taught how to select and prepare healthful foods. Because snacks are an important aspect in childhood nutrition, nutritious snacks should be identified. School-age children usually require a healthful snack after school and in the evening. A child who spends time with social media has less interest in physical activity and going outdoors. Incorrect Snacks are an important aspect in childhood nutrition. Nutritious snacks should be identified, not eliminated. Healthy snack options include fruit, popcorn, nuts, and yogurt, not cookies and diet soda. In schools with snack machines, children may use their lunch money to purchase high-calorie snacks versus a nutritious lunch.

Motor vehicle injuries are a significant threat to young children. Knowing this, the nurse plans a teaching session with a toddler's parents on car safety. Which will she teach? Select all that apply. a. Secure in a rear-facing, upright car safety seat. b. Place the car safety seat in the rear seat, behind the driver's seat. c. Harness safety straps should fit snugly. d. Place the car safety seat in the front passenger seat equipped with an airbag. e. After the age of 2 years, toddlers can be placed in a forward-facing car seat.

ANS: A, C, E Feedback Correct Toddlers should be secured in a rear-facing, upright, approved car safety seat. Harness straps should be adjusted to provide a snug fit. Incorrect The car safety seat should be placed in the middle of the rear seat. Children younger than 13 years should not ride in a front passenger seat that is equipped with an airbag.

Which assessment findings indicate to the nurse that a child has excess fluid volume? Select all that apply. a. Weight gain b. Decreased blood pressure c. Moist breath sounds d. Poor skin turgor e. Rapid bounding pulse

ANS: A, C, E Feedback Correct: A child with fluid volume excess will have a weight gain, moist breath sounds due to the excess fluid in the pulmonary system, and a rapid bounding pulse. Other signs seen with fluid volume excess are increased blood pressure, edema, and fatigue. Incorrect: Decreased blood pressure and poor skin turgor are signs of fluid volume deficit.

The nurse should implement which interventions for an infant experiencing apnea? Select all that apply. a. Stimulate the infant by gently tapping the foot. b. Shake the infant vigorously. c. Have resuscitative equipment available. d. Suction the infant. e. Maintain a neutral thermal environment.

ANS: A, C, E Feedback Correct: An infant with apnea should be stimulated by gently tapping the foot. Resuscitative equipment should be available and the infant should be maintained in a neutral thermal environment. Incorrect: The infant should not be shaken vigorously nor suctioned.

Which statement is correct about toilet training? a. Bladder training is usually accomplished before bowel training. b. Wanting to please the parent helps motivate the child to use the toilet. c. Watching older siblings use the toilet confuses the child. d. Children must be forced to sit on the toilet when first learning.

ANS: B Feedback A Bowel training precedes bladder training. B Voluntary control of the anal and urethral sphincters is achieved some time after the child is walking. The child must be able to recognize the urge to let go and to hold on. The child must want to please the parent by holding on rather than pleasing himself or herself by letting go. C Watching older siblings provides role modeling and facilitates imitation for the toddler. D The child should be introduced to the potty chair or toilet in a nonthreatening manner.

Which interventions should a nurse implement when caring for a child with hepatitis? Select all that apply. a. Provide a well-balanced low-fat diet. b. Schedule playtime in the playroom with other children. c. Teach parents not to administer any over-the-counter medications. d. Arrange for home schooling because the child will not be able to return to school. e. Instruct parents on the importance of good handwashing.

ANS: A, C, E Feedback Correct: The child with hepatitis should be placed on a well-balanced low-fat diet. Parents should be taught to not give over-the-counter medications because of impaired liver function. Hand hygiene is the most important preventive measure for the spread of hepatitis. Incorrect: The child will be in contact isolation in the hospital so playtime with other hospitalized children is not scheduled. The child will be on contact isolation for a minimum of 1 week after the onset of jaundice. After that period, the child will be allowed to return to school.

Where do the lesions of atopic dermatitis most commonly occur in the infant? Select all that apply. a. Cheeks b. Buttocks c. Extensor surfaces of arms and legs d. Back e. Trunk

ANS: A, C, E Feedback Correct: The lesions of atopic dermatitis are generalized in the infant. They are most commonly on the cheeks, scalp, trunk, and extensor surfaces of the extremities. Incorrect: These lesions are not typically on the back or the buttocks.

A preschool age child is being admitted for some diagnostic tests and possible surgery. The nurse planning care should use which phrases when explaining procedures to the child? Select all that apply. a. Fluids will be given through tubing connected to a small tiny tube inserted into your arm. b. After surgery we will be doing dressing changes. c. You will get a shot before surgery. d. The doctor will give you medicine that will help you go into a deep sleep. e. We will take you to surgery on a bed on wheels.

ANS: A, D, E Feedback Correct A preschool child needs simple concrete explanations that cannot be misinterpreted. An IV should be explained as fluids going into a tube connected to a small tube in your hand; anesthesia can be explained as a medicine that will help you go into a deep sleep (put to sleep should be avoided); and a stretcher can be described as riding on a bed with wheels. Incorrect The term "dressing changes" is ambiguous and will not be understood by a preschooler. The term "get a shot" should not be used. A preschooler or young child is likely to misinterpret this information.

Injuries claim many lives during adolescence. Which factors contribute to early adolescents engaging in risk-taking behaviors? Select all that apply. a. Peer pressure b. A desire to master their environment c. Engagement in the process of separation from their parents d. A belief that they are invulnerable e. Impulsivity

ANS: A, D, E Feedback Correct Peer pressure (including impressing peers) is a factor contributing to adolescent injuries. During early to middle adolescence, children feel that they are exempt from the consequences of risk-taking behaviors; they believe that negative consequences only happen to others. Feelings of invulnerability ("It can't happen to me") are evident in adolescence. Impulsivity places adolescents in unsafe situations. Incorrect Mastering the environment is the task of young school-age children. Emancipation is a major issue for the older adolescent. The process is accomplished as the teenager gains an education or vocational training.

The nurse is caring for a child with iron-deficiency anemia. What should the nurse expect to find when reviewing the results of the complete blood count (CBC)? Select all that apply. a. Low hemoglobin levels b. Elevated red blood cell (RBC) levels c. Elevated mean cell volume (MCV) levels d. Low reticulocyte count e. Decreased MCV levels

ANS: A, D, E Feedback Correct The results of the complete blood count in a child with iron-deficiency anemia will show low hemoglobin levels (6 to 11 g/dL) and microcytic, hypochromic RBCs; this manifests as decreased MCV and decreased mean cell hemoglobin. The reticulocyte count is usually slightly elevated or normal. Incorrect The reticulocyte count is usually slightly elevated or normal, and mean cell volume levels are decreased, not increased.

The nurse should provide which information to parents about the prevention of parasitic infections? Select all that apply. a. Perform good handwashing. b. Diaper a child when swimming. c. Avoid cleaning the bathroom facilities with bleach. d. Shoes should be worn outside. e. Fruits and vegetables should be washed before eating.

ANS: A, D, E Feedback Correct: Children are more commonly infected with parasites than adults, primarily as a result of frequent hand-to-mouth activity and the likelihood of fecal contamination. Good handwashing can prevent the transmission. Shoes should be worn when outside to prevent transmission, and fruits and vegetables should be washed before eating. Incorrect: The child should not swim in a pool that allows diapered children. The bathroom facilities should be cleaned with bleach to decrease the chance of transmission.

A nurse should plan to implement which interventions for a child admitted with inorganic failure to thrive? Select all that apply. a. Observation of parent-child interactions b. Assignment of different nurses to care for the child from day to day c. Use of 28 calorie per ounce concentrated formulas d. Administration of daily multivitamin supplements e. Role modeling appropriate adult-child interactions

ANS: A, D, E Feedback Correct: The nurse should plan to assess parent-child interactions when a child is admitted for nonorganic failure to thrive. The observations should include how the child is held and fed, how eye contact is initiated and maintained, and the facial expressions of both the child and the caregiver during interactions. Role modeling and teaching appropriate adult-child interactions (including holding, touching, and feeding the child) will facilitate appropriate parent-child relationships, enhance parents' confidence in caring for their child, and facilitate expression by the parents of realistic expectations based on the child's developmental needs. Daily multivitamin supplements with minerals are often prescribed to ensure that specific nutritional deficiencies do not occur in the course of rapid growth. The nursing staff assigned to care for the child should be consistent. Incorrect: Providing a consistent caregiver from the nursing staff increases trust and provides the child with an adult who anticipates his or her needs and who is able to role model child care to the parent. Caloric enrichment of food is essential, and formula may be concentrated in titrated amounts up to 24 calories per ounce. Greater concentrations can lead to diarrhea and dehydration.

The mother of an HIV-positive infant who is 2 months old questions the nurse about which childhood immunizations her child will be able to receive. Which immunizations should an HIV-positive child be able to receive according to the American Academy of Pediatrics recommendation for immunizing infants who are HIV positive? Select all that apply. a. Hepatitis B b. DTaP c. MMR d. IPV e. HIB

ANS: A,B,D,E Correct Routine immunizations are appropriate. Incorrect The MMR vaccination is not given at 2 months of age. If it were indicated, CD4+ counts are monitored when deciding whether to provide live virus vaccines. If the child is severely immunocompromised, the MMR vaccine is not given. The varicella vaccine can be considered on the basis of the child's CD4+counts. Only IPV should be used for HIV-infected children.

Which home care instructions should the nurse provide to the parents of a child with acquired immunodeficiency syndrome (AIDS)? Select all that apply. a. Give supplemental vitamins as prescribed. b. Yearly influenza vaccination should be avoided. c. Administer trimethoprim-sulfamethoxazole (Bactrim) as prescribed. d. Notify the physician if the child develops a cough or congestion. e. Missed doses of antiretroviral medication do not need to be recorded.

ANS: A,C,D Correct The parents should be taught that supplemental vitamins will be prescribed to aid in nutritional status. Bactrim is administered to prevent the opportunistic infection of Pneumocystis pneumonia. The physician should be notified if the child with AIDS develops a cough and congestion. Incorrect The yearly influenza vaccination is recommended and any missed doses of antiretroviral medication need to be recorded and reported.

The mother of a 10-month-old infant tells the nurse that her infant "really likes cow's milk." What is the nurse's best response to this mother? a. "Milk is good for him." b. "It is best to wait until he is a year old before giving him cow's milk." c. "Limit cow's milk to his bedtime bottle." d. "Mix his cereal with cow's milk and give him formula in a bottle."

ANS: B Feedback A Although milk is a good source of calcium and protein for children after the first year of life, it is not the best source of nutrients for children younger than 1 year old. B It is best to wait until the infant is at least 1 year old before giving him cow's milk because of the risk of allergies and intestinal problems. Cow's milk protein intolerance is the most common food allergy during infancy. C Bedtime bottles of formula or milk are contraindicated because of their high sugar content, which leads to dental decay in primary teeth. D Cereal can be mixed with formula.

Approximately how much would a newborn who weighed 7 pounds 6 ounces at birth weigh at 1 year of age? a. 14 3/4 lb b. 22 1/8 lb c. 29 1/2 lb d. Unable to estimate weigh at 1 year

ANS: B Feedback A An infant doubles birth weight by 6 months of age. B An infant triples birth weight by 1 year of age. C An infant quadruples birth weight by 2 years of age. D Weight at 6 months, 1 year, and 2 years of age can be estimated from the birth weight.

Which statement made by a mother is consistent with a developmental delay? a. "I have noticed that my 9-month-old infant responds consistently to the sound of his name." b. "I have noticed that my 12-month-old child does not get herself to a sitting position or pull to stand." c. "I am so happy when my 1 1/2-month-old infant smiles at me." d. "My 5-month-old infant is not rolling over in both directions yet."

ANS: B Feedback A An infant who responds to his name at 9 months of age is demonstrating abilities to both hear and interpret sound. B Critical developmental milestones for gross motor development in a 12-month-old include standing briefly without support, getting to a sitting position, and pulling to stand. If a 12-month-old child does not perform these activities, it may be indicative of a developmental delay. C A social smile is present by 2 months of age. D Rolling over in both directions is not a critical milestone for gross motor development until the child reaches 6 months of age.

Which behavior by parents or teachers will best assist the child in negotiating the developmental task of industry? a. Identifying failures immediately and asking the child's peers for feedback b. Structuring the environment so that the child can master tasks c. Completing homework for children who are having difficulty in completing assignments d. Decreasing expectations to eliminate potential failures

ANS: B Feedback A Asking peers for feedback reinforces the child's feelings of failure. B The task of the caring teacher or parent is to identify areas in which a child is competent and to build on successful experiences to foster feelings of mastery and success. Structuring the environment to enhance self-confidence and to provide the opportunity to solve increasingly more complex problems will promote a sense of mastery. C When teachers or parents complete children's homework for them, it sends the message that you do not trust them to do a good job. Providing assistance and suggestions and praising their best efforts are more appropriate. D Decreasing expectations to eliminate failures will not promote a sense of achievement or mastery.

Which statement by a mother indicates that her 5-month-old infant is ready for solid food? a. "When I give my baby solid foods, she has difficulty getting it to the back of her throat to swallow." b. "She has just started to sit up without any support." c. "I am surprised that she weighs only 11 pounds. I expected her to have gained some weight." d. "I find that she really has to be encouraged to eat."

ANS: B Feedback A Children who are ready to manage solid foods are able to move food to the back of their throats to swallow. This child's extrusion reflex may still be present. B Sitting is a sign that the child is ready to begin with solid foods. C Infants who weigh less than 13 pounds and demonstrate a lack of interest in eating are not ready to be started on solid foods. D Infants who are difficult feeders and do not demonstrate an interest in solid foods are not ready to be started on them.

A 17-year-old tells the nurse that he is not having sex because it would make his parents very angry. This response indicates that the adolescent has a developmental lag in which area? a. Cognitive development b. Moral development c. Psychosocial development d. Psychosexual development

ANS: B Feedback A Cognitive development is related to moral development, but it is not the pivotal point in determining right and wrong behaviors. B The appropriate moral development for a 17-year-old would include evidence that the teenager has internalized a value system and does not depend on parents to determine right and wrong behaviors. Adolescents who remain concrete thinkers may never advance beyond conformity to please others and avoid punishment. C Identity formation is the psychosocial development task. Energy is focused within the adolescent, who exhibits behavior that is self-absorbed and egocentric. D Although a task during adolescence is the development of a sexual identity, the teenager's dependence on the parents' sanctioning of right or wrong behavior is more appropriately related to moral development.

The nurse inspecting the skin of a dark-skinned child notices an area that is a dusky red or violet color. This skin coloration is associated with what? a. Cyanosis b. Erythema c. Vitiligo d. Nevi

ANS: B Feedback A Cyanosis in a dark-skinned child appears as a black coloration of the skin. B In dark-skinned children, erythema appears as dusky red or violet skin coloration. C Vitiligo refers to areas of depigmentation. D Nevi are areas of increased pigmentation.

Which statement, made by a 4-year-old child's father, is true about the care of the preschooler's teeth? a. "Because the 'baby teeth' are not permanent, they are not important to the child." b. "My son can be encouraged to brush his teeth after I have thoroughly cleaned his teeth." c. "My son's 'permanent teeth' will begin to come in at 4 to 5 years of age." d. "Fluoride supplements can be discontinued when my son's 'permanent teeth' erupt."

ANS: B Feedback A Deciduous teeth are important because they maintain spacing and play an important role in the growth and development of the jaws and face and in speech development. B Toddlers and preschoolers lack the manual dexterity to remove plaque adequately, so parents must assume this responsibility. C Secondary teeth erupt at approximately 6 years of age. D If the family does not live in an area where fluoride is included in the water supply, fluoride supplements should be continued.

Kimberly is having a checkup before starting kindergarten. The nurse asks her to do the "finger-to-nose" test. The nurse is testing for a. Deep tendon reflexes b. Cerebellar function c. Sensory discrimination d. Ability to follow directions

ANS: B Feedback A Each deep tendon reflex is tested separately. B The finger-to-nose-test is an indication of cerebellar function. This test checks balance and coordination. C Each sense is tested separately. D Although this test enables the nurse to evaluate the child's ability to follow directions, it is used primarily for cerebellar function.

Which information should the nurse include when preparing a 5-year-old child for a cardiac catheterization? a. A detailed explanation of the procedure b. A description of what the child will feel and see during procedure c. An explanation about the dye that will go directly into his vein d. An assurance to the child that he and the nurse can talk about the procedure when it is over

ANS: B Feedback A Explaining the procedure in detail is probably more than the 5-year-old child can comprehend, and it will likely produce anxiety. B For a preschooler, the provision of sensory information about what to expect during the procedure will enhance the child's ability to cope with the events of the procedure and will decrease anxiety. C Using the word "dye" with a preschooler can be frightening for the child. D The child needs information before the procedure.

What is the most appropriate response for the nurse to make to the parent of a 3-year-old child found in a bed with the side rails down? a. "You must never leave the child in the room alone with the side rails down." b. "I am very concerned about your child's safety when you leave the side rails down. The hospital has guidelines stating that side rails need to be up if the child is in the bed." c. "It is hospital policy that side rails need to be up if the child is in bed." d. "When parents leave side rails down, they might be considered as uncaring."

ANS: B Feedback A Framing the communication in the negative does not facilitate effective communication. B To express concern and then choose words that convey a policy is appropriate. C Stating a policy to parents conveys the attitude that the hospital has authority over parents in matters concerning their children and may be perceived negatively. D This statement conveys blame and judgment to the parent.

A mother of a 2-month-old infant tells the nurse, "My child doesn't sleep as much as his older brother did at the same age." What is the best response for the nurse? a. "Have you tried to feed the baby more often?" b. "Infant sleep patterns vary widely, with some infants sleeping only 2 to 3 hours at a time." c. "It is helpful to keep a record of your baby's eating, waking, sleeping, and elimination patterns and to come back in a week to discuss them." d. "This infant is difficult. It is important for you to identify what is bothering the baby."

ANS: B Feedback A Infants typically do not need more caloric intake to improve sleep behaviors. B Newborn infants may sleep as much as 17 to 20 hours per day. Sleep patterns vary widely, with some infants sleeping only 2 to 3 hours at a time. C Keeping intake, output, waking, and sleeping data is not typically helpful to discuss differences among infants' behaviors. D Just because an infant may not sleep as much as a sibling did does not justify labeling the child as being difficult. Identifying an infant as difficult without identifying helpful actions is not a therapeutic response for a parent concerned about sleep.

Which expected outcome is developmentally appropriate for a hospitalized 4-year-old child? a. The child will be dressed and fed by the parents. b. The child will independently ask for play materials or other personal needs. c. The child will be able to verbalize an understanding of the reason for the hospitalization. d. The child will have a parent stay in the room at all times.

ANS: B Feedback A Parents need to foster appropriate developmental behavior in the 4-year-old child. Dressing and feeding the child do not encourage independent behavior. B Erikson identifies initiative as a developmental task for the preschool child. Initiating play activities and asking for play materials or assistance with personal needs demonstrates developmental appropriateness. C A 4-year-old child cannot be expected to cognitively understand the reason for hospitalization. Expecting the child to verbalize an understanding for hospitalization is an inappropriate outcome. D Parents staying with the child throughout a hospitalization is an inappropriate outcome. Although children benefit from parental involvement, parents may not have the support structure to stay in the room with the child at all times.

Many adolescents decide to follow a vegetarian diet during their teen years. The nurse can advise the adolescent and his or her parents that a. This diet will not meet the nutritional requirements of growing teens. b. A vegetarian diet is healthy for this population. c. An adolescent on a vegetarian diet is less likely to eat high-fat or low-nutrient foods. d. A vegetarian diet requires little extra meal planning.

ANS: B Feedback A Several dietary organizations have suggested that a vegetarian diet, if correctly followed, is healthy for this population. B A vegetarian diet is healthy for this population, and the low-fat aspect of the diet can prevent future cardiovascular problems. C As with any adolescent, nurses need to advise teens who follow a vegetarian eating plan to avoid low-nutrient, high-fat foods. D The nurse can assist with planning food choices that will provide sufficient calories and necessary nutrients. The focus is on obtaining enough calories for growth and energy from a variety of fruits and vegetables, whole grains, nuts, and soymilk.

A preschool aged child will be receiving immunizations. Which statement identifies an appropriate level of language development for a 4-year-old child? a. The child has a vocabulary of 300 words and uses simple sentences. b. The child uses correct grammar in sentences. c. The child is able to pronounce consonants clearly. d. The child uses language to express abstract thought.

ANS: B Feedback A Simple sentences and a 300-word vocabulary are appropriate for a 2-year-old child. B The 4-year-old child is able to use correct grammar in sentence structure. C The 4-year-old child typically has difficulty in pronouncing consonants. D The use of language to express abstract thought is developmentally appropriate for the adolescent.

An important consideration for the nurse who is communicating with a very young child is to a. Speak loudly, clearly, and directly. b. Use transition objects, such as a puppet. c. Disguise own feelings, attitudes, and anxiety. d. Initiate contact with child when parent is not present.

ANS: B Feedback A Speaking in this manner will tend to increase anxiety in very young children. B Using a transition object, such as a puppet or doll, allows the young child an opportunity to evaluate an unfamiliar person (the nurse). This will facilitate communication with a child of this age. C The nurse must be honest with the child. Attempts at deception will lead to a lack of trust. D Whenever possible, the parent should be present for interactions with young children.

A nurse is assessing an older school-age child recently admitted to the hospital. Which assessment indicates that the child is in an appropriate stage of cognitive development? a. The child's addition and subtraction ability b. The child's ability to classify c. The child's vocabulary d. The child's play activity

ANS: B Feedback A Subtraction and addition are appropriate cognitive activities for the young school-age child. B The ability to classify things from simple to complex and the ability to identify differences and similarities are cognitive skills of the older school-age child; this demonstrates use of classification and logical thought processes. C Vocabulary is not as valid an assessment of cognitive ability as is the child's ability to classify. D Play activity is not as valid an assessment of cognitive function as is the child's ability to classify.

Which chart should the nurse use to assess the visual acuity of an 8-year-old child? a. Lea chart b. Snellen chart c. HOTV chart d. Tumbling E chart

ANS: B Feedback A The Lea chart tests vision using four different symbols designed for use with preschool children. B The Snellen chart is used to assess the vision of children older than 6 years of age. C The HOTV chart tests vision by using graduated letters and is designed for use with children ages 3 to 6 years. D The tumbling E chart uses the letter E in various directions and is designed for use with children ages 3 to 6 years.

Which is the preferred site for administration of the Hib vaccine to an infant? a. Deltoid b. Anterolateral thigh c. Upper, outer aspect of the arm d. Dorsal gluteal region

ANS: B Feedback A The deltoid muscle is not used for infants. B The anterolateral thigh is the preferred site for intramuscular administration of vaccines for infants. C Subcutaneous injections can be given in the upper arm. The HIB vaccine is given by the intramuscular route. D The dorsal gluteal site is never used for vaccines.

Which strategy is the best approach when initiating the physical examination of a 9-month-old male infant? a. Undress the infant and do a head-to-toe examination. b. Have the parent hold the child on his or her lap. c. Put the infant on the examination table and begin assessments at the head. d. Ask the parent to leave because the infant will be upset.

ANS: B Feedback A The head-to-toe approach needs to be modified for the infant. Uncomfortable procedures, such as the otoscopic examination, should be left until last. B Infants 6 months and older feel stranger anxiety. It is easier to do most of the examination on the parent's lap to lessen anxiety. C The infant may feel less fearful if placed in the parent's lap or with the parent within visual range if placed on the examining table. The head-to-toe approach is modified for the infant. D There is no reason to ask a parent to leave when an infant is being examined. Having the parent with the infant will make the experience less upsetting for the infant.

Which behavior suggests appropriate psychosocial development in the adolescent? a. The adolescent seeks validation for socially acceptable behavior from older adults. b. The adolescent is self-absorbed and self-centered and has sudden mood swings. c. Adolescents move from peers and enjoy spending time with family members. d. Conformity with the peer group increases in late adolescence.

ANS: B Feedback A The peer group validates acceptable behavior during adolescence. B During adolescence, energy is focused within. Adolescents concentrate on themselves in an effort to determine who they are or who they will be. Adolescents are likely to be impulsive and impatient. Parents often describe their teenager as being "self-centered or lazy." C Adolescents move from family and enjoy spending time with peers. Adolescents also spend time alone; they need this time to think and concentrate on themselves. D Conformity becomes less important in late adolescence.

Which assessment finding is considered a neurologic soft sign in a 7-year-old child? a. Plantar reflex b. Poor muscle coordination c. Stereognostic function d. Graphesthesia

ANS: B Feedback A The plantar reflex is a normal response. When the lateral aspect of the sole of the foot is stroked in a movement curving medially from the heel to the ball, the response will be plantar flexion of the toes. B Poor muscle coordination is a neurologic soft sign. C Stereognostic function refers to the ability to identify familiar objects placed in each hand. D Graphesthesia is the ability to identify letters or numbers traced on the palm or back of the hand with a blunt point.

Which statement by a mother of a toddler indicates a correct understanding of the use of discipline? a. "I always include explanations and morals when I am disciplining my toddler." b. "I always try to be consistent when disciplining the children, and I correct my children at the time they are misbehaving." c. "I believe that discipline should be done by only one family member." d. "My rule of thumb is no more than one spanking a day."

ANS: B Feedback A The toddler's cognitive level of development precludes the use of explanations and morals as a part of discipline. B Consistent and immediate discipline for toddlers is the most effective approach. Unless disciplined immediately, the toddler will have difficulty connecting the discipline with the behavior. C Discipline for the toddler should be immediate; therefore the family member caring for the child should provide discipline to the toddler when it is necessary. D Discipline is required for unacceptable behavior, and the one-spanking-a-day rule contradicts the concept of a consistent response to inappropriate behavior. In addition, spanking is an inappropriate method of disciplining a child.

The nurse is assessing a 4-year-old child's visual acuity. He is planning to attend preschool next week. The results indicate a visual acuity of 20/40 in both eyes. The child's father asks the nurse about his son's results. Which response, if made by the nurse, is correct? a. "Your child will need a referral to the ophthalmologist before he can attend preschool next week." b. "Your child's visual acuity is normal for his age." c. "The results of this test indicate your child may be color blind." d. "Your child did not pass the screening test. He will need to return within the next few weeks to be reevaluated."

ANS: B Feedback A This is within the normal range for visual acuity at 4 years of age. The 4-year-old's acuity is usually 20/30 to 20/40. There is no need for evaluation by an ophthalmologist at this time. B This is the correct response. C The child's visual acuity is within normal range for his age. Color vision is evaluated by different methods than visual acuity. D This is within the normal range for visual acuity at 4 years of age. The 4-year-old's acuity is usually 20/30 to 20/40. There is no need for further evaluation at this time.

Which is an appropriate disciplinary intervention for the school-age child? a. Using time-out periods b. Using a consequence that is consistent with the inappropriate behavior c. Using physical punishment d. Using lengthy dialog about inappropriate behavior

ANS: B Feedback A Time-out periods are more appropriate for younger children. B A consequence that is related to the inappropriate behavior is the recommended discipline. C Physical intervention is an inappropriate form of discipline. It does not connect the discipline with the child's inappropriate behavior. D Lengthy discussions typically are not helpful.

The mother of a 14-month-old child is concerned because the child's appetite has decreased. The best response for the nurse to make to the mother is a. "It is important for your toddler to eat three meals a day and nothing in between." b. "It is not unusual for toddlers to eat less." c. "Be sure to increase your child's milk consumption, which will improve nutrition." d. "Giving your child a multivitamin supplement daily will increase your toddler's appetite."

ANS: B Feedback A Toddlers need small, frequent meals. Nutritious selection throughout the day, rather than quantity, is more important with this age-group. B Physiologically, growth slows and appetite decreases during the toddler period. C Milk consumption should not exceed 16 to 24 oz daily. Juice should be limited to 4 to 6 oz per day. Increasing the amount of milk will only further decrease solid food intake. D Supplemental vitamins are important for all children, but they do not increase appetite.

A mother asks when toilet training is most appropriately initiated. What is the nurse's best response? a. "When your child is 12 to 18 months of age." b. "When your child exhibits signs of physical and psychological readiness." c. "When your child has been walking for 9 months." d. "When your child is able to sit on the 'potty' for 10 to 15 minutes."

ANS: B Feedback A Toilet training is not arbitrarily started at 12 to 18 months of age. The child needs to demonstrate signs of bowel or bladder control before attempting toilet training. The average toddler is not ready until 18 to 24 months of age. Waiting until 24 to 30 months of age makes the task easier; toddlers are less negative, more willing to control their sphincters, and want to please their parents. B Neurologic development is completed at approximately 18 months of age. Parents need to know that both physical and psychological readiness are necessary for toilet training to be successful. C One of the physical signs of readiness for toilet training is that the child has been walking for 1 year. D The ability to sit on the "potty" for 10 to 15 minutes may demonstrate parental control rather than being a sign of developmental readiness for toilet training.

17. A young child with HIV is receiving several antiretroviral drugs. The purpose of these drugs is to a. Cure the disease. b. Delay disease progression. c. Prevent the spread of disease. d. Treat Pneumocystis carinii pneumonia.

ANS: B A. At this time, cure is not possible. B. Although not a cure, these antiviral drugs can suppress viral replication, preventing further deterioration of the immune system, and delay disease progression. C. These drugs do not prevent the spread of the disease. D. Pneumocystis carinii prophylaxis is accomplished with antibiotics.

14. What is the primary nursing concern for a child having an anaphylactic reaction? a. Identifying the offending allergen b. Ineffective breathing pattern c. Increased cardiac output d. Positioning to facilitate comfort

ANS: B A. Determining the cause of an anaphylactic reaction is important to implement the appropriate treatment, but the primary concern is the airway. B. Laryngospasms resulting in ineffective breathing patterns is a life-threatening manifestation of anaphylaxis. The primary action is to assess airway patency, respiratory rate and effort, level of consciousness, oxygen saturation, and urine output. C. During anaphylaxis, the cardiac output is decreased. D. During the acute period of anaphylaxis, the nurse's primary concern is the child's breathing. Positioning for comfort is not a primary concern during a crisis.

6. The Center for Disease Control (CDC, 2009) recommendation for immunizing infants who are HIV positive is a. Follow the routine immunization schedule. b. Routine immunizations are administered; assess CD4+ counts before administering the MMR and varicella vaccinations. c. Do not give immunizations because of the infant's altered immune status. d. Eliminate the pertussis vaccination because of the risk of convulsions

ANS: B A. Routine immunizations are appropriate; however, CD4+ cell counts should be assessed before administering the MMR and varicella vaccines to establish adequate immune system function. B. Routine immunizations are appropriate. CD4+ cells are monitored when deciding whether to provide live virus vaccines. If the child is severely immunocompromised, the MMR vaccine is not given. The varicella vaccine can be considered on the basis of the child's CD4+ counts. Only inactivated polio virus (IPV) should be used for HIV-infected children. C. Immunizations are given to infants who are HIV positive. D. The pertussis vaccination is not eliminated for an infant who is HIV positive.

10. Children receiving long-term systemic corticosteroid therapy are most at risk for a. Hypotension b. Dilation of blood vessels in the cheeks c. Growth delays d. Decreased appetite and weight loss

ANS: C A. Hypertension is a clinical manifestation of long-term systemic steroid administration. B. Dilation of blood vessels in the cheeks is associated with an excess of topically administered steroids. C. Growth delay is associated with long-term steroid use. D. Increased appetite and weight gain are clinical manifestations of excess systemic corticosteroid therapy.

A child with non-Hodgkin lymphoma will be starting chemotherapy. What intervention is initiated before chemotherapy to prevent tumor lysis syndrome? a. Insertion of a central venous catheter b. Intravenous (IV) hydration containing sodium bicarbonate c. Placement of an externalized ventriculoperitoneal (VP) shunt d. Administration of pneumococcal and Haemophilus influenzae type B vaccines

ANS: B Feedback A A central venous catheter is placed to assist in delivering chemotherapy. B Intensive hydration with an IV fluid containing bicarbonate alkalinizes the urine to help prevent the formation of uric acid crystals, which damage the kidney. C An externalized VP shunt may be placed to relieve intracranial pressure caused by a brain tumor. D If a splenectomy is necessary for a child with Hodgkin disease, the pneumococcal and Haemophilus influenzae vaccines are administered before the surgery.

What is an expected physical assessment finding for an adolescent with a diagnosis of Hodgkin disease? a. Protuberant, firm abdomen b. Enlarged, painless, firm cervical lymph nodes c. Soft tissue swelling d. Soft to hard, nontender mass in pelvic area

ANS: B Feedback A A protuberant, firm abdomen is present in many cases of neuroblastoma. B Painless, firm, movable adenopathy (enlarged lymph nodes) palpated in the cervical region is an expected assessment finding in Hodgkin disease. Other systemic symptoms include unexplained fevers, weight loss, and night sweats. C Soft tissue swelling around the affected bone is a manifestation of Ewing sarcoma. D A soft to hard, nontender mass can be palpated when rhabdomyosarcoma is present.

The nurse assessing a premature newborn infant auscultates a continuous machinery-like murmur. This finding is associated with which congenital heart defect? a. Pulmonary stenosis b. Patent ductus arteriosus c. Ventricular septal defect d. Coarctation of the aorta

ANS: B Feedback A A systolic ejection murmur that may be accompanied by a palpable thrill is a manifestation of pulmonary stenosis. B The classic murmur associated with patent ductus arteriosus is a machinery-like one that can be heard throughout both systole and diastole. C The characteristic murmur associated with ventricular septal defect is a loud, harsh, holosystolic murmur. D A systolic murmur that is accompanied by an ejection click may be heard on auscultation when coarctation of the aorta is present.

What is the most appropriate intervention for the parents of a 6-year-old child with precocious puberty? a. Advise the parents to consider birth control for their daughter. b. Explain the importance of having the child foster relationships with same-age peers. c. Assure the child's parents that there is no increased risk for sexual abuse because of her appearance. d. Counsel parents that there is no treatment currently available for this disorder.

ANS: B Feedback A Advising the parents of a 6-year-old to put their daughter on birth control is not appropriate and will not reverse the effects of precocious puberty. B Despite the child's appearance, the child needs to be treated according to her chronologic age and to interact with children in the same age-group. An expected outcome is that the child will adjust socially by exhibiting age-appropriate behaviors and social interactions. C Parents need to be aware that there is an increased risk of sexual abuse for a child with precocious puberty. D Treatment for precocious puberty is the administration of gonadotropin-releasing hormone blocker, which slows or reverses the development of secondary sexual characteristics and slows rapid growth and bone aging.

The nurse understands that the type of precautions needed for children receiving chemotherapy is based on which actions of chemotherapeutic agents? a. Gastrointestinal upset b. Bone marrow suppression c. Decreased creatinine level d. Alopecia

ANS: B Feedback A Although gastrointestinal upset may be an adverse effect of chemotherapy, it is not caused by all chemotherapeutic agents. No special precautions are instituted for gastrointestinal upset. B Chemotherapy agents cause bone marrow suppression, which creates the need to institute precautions related to reduced white blood cell, red blood cell, and platelet counts. These precautions focus on preventing infection and bleeding. C A decreased creatinine level is consistent with renal pathologic conditions, not chemotherapy. D Not all chemotherapeutic agents cause alopecia. No precautions are taken to prevent alopecia.

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 Feedback A 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. 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. C 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. D 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 nursing assessment is applicable to the care of a child with herpetic gingivostomatitis? a. Comparison of range of motion for the upper and lower extremities b. Urine output, mucous membranes, and skin turgor c. Growth pattern since birth d. Bowel elimination pattern

ANS: B Feedback A An oral herpetic infection does not affect joint function. B The child with herpetic gingivostomatitis is at risk for deficient fluid volume. Painful lesions on the mouth make drinking unpleasant and undesirable, with subsequent dehydration becoming a real danger. C Herpetic gingivostomatitis is not a chronic disorder that would affect the child's long-term growth pattern. D Although constipation could be caused by dehydration, it is more important to assess urine output, skin turgor, and mucous membranes to identify dehydration before constipation is a problem.

A child had an aortic stenosis defect surgically repaired 6 months ago. Which antibiotic prophylaxis is indicated for an upcoming tonsillectomy? a. No antibiotic prophylaxis is necessary. b. Amoxicillin is taken orally 1 hour before the procedure. c. Oral penicillin is given for 7 to 10 days before the procedure. d. Parenteral antibiotics are administered for 5 to 7 days after the procedure.

ANS: B Feedback A Antibiotic prophylaxis is indicated for the first 5 months after surgical repair. B The standard prophylactic agent is amoxicillin given orally 1 hour before the procedure. C Antibiotic prophylaxis is not given for this period of time. D The treatment for infective endocarditis involves parenteral antibiotics for 2 to 8 weeks.

What is the best response by the nurse to a parent asking about antidiarrheal medication for her 18-month-old child? a. "It is okay to give antidiarrheal medication to a young child as long as you follow the directions on the box for correct dosage." b. "Antidiarrheal medication is not recommended for young children because it slows the body's attempt to rid itself of the pathogen." c. "I'm sure your child won't like the taste, so give extra fluids when you give the medication." d. "Antidiarrheal medication will lessen the frequency of stools, but give your child Gatorade to maintain electrolyte balance."

ANS: B Feedback A Antidiarrheal medications are not recommended for children younger than 2 years old. B Antidiarrheal medications may actually prolong diarrhea because the body will retain the organism causing the diarrhea, further increasing fluid and electrolyte losses. The use of these medications is not recommended for children younger than 2 years old because of their binding nature and potential for toxicity. C This action is inappropriate because antidiarrheal medications should not be given to a child younger than 2 years old. D It is not appropriate to advise a parent to use antidiarrheal medication for a child younger than 2 years old. Education about appropriate oral replacement fluids includes avoidance of sugary drinks, apple juice, sports beverages, and colas.

A condition in which the normal adult hemoglobin is partly or completely replaced by abnormal hemoglobin is known as a. Aplastic anemia b. Sickle cell anemia c. Thalassemia major d. Iron-deficiency anemia

ANS: B Feedback A Aplastic anemia is a lack of cellular elements being produced. B Sickle cell anemia is one of a group of diseases collectively called hemoglobinopathies, in which normal adult hemoglobin is replaced by an abnormal hemoglobin. C Hemophilia refers to a group of bleeding disorders in which there is deficiency of one of the factors necessary for coagulation. D Iron-deficiency anemia affects size and depth of color and does not involve an abnormal hemoglobin.

A nurse is giving a parent information about autism. Which statement made by the parent indicates understanding of the teaching? a. Autism is characterized by periods of remission and exacerbation. b. The onset of autism usually occurs before 3 years of age. c. Children with autism have imitation and gesturing skills. d. Autism can be treated effectively with medication.

ANS: B Feedback A Autism does not have periods of remission and exacerbation. B The onset of autism usually occurs before 3 years of age. C Autistic children lack imitative skills. D Medications are of limited use in children with autism.

During a well-child visit, the nurse identifies that an 18-month-old infant is bowlegged. She is aware that this assessment is a. Common in children with nutritional deficiencies b. Common in infants and toddlers c. A serious condition needing further evaluation d. An indication of neurologic impairment

ANS: B Feedback A Bowlegs are not usually associated with nutritional deficiencies. B Bowlegs are common in infants and toddlers. C Bowlegs may need intervention but do not generally indicate serious abnormalities. D Bowlegs do not generally indicate a neurologic impairment.

During painful episodes of juvenile arthritis, a plan of care should include what nursing intervention? a. A weight-control diet to decrease stress on the joints b. Proper positioning of the affected joints to prevent musculoskeletal complications c. Complete bed rest to decrease stress to joints d. High-resistance exercises to maintain muscular tone in the affected joints

ANS: B Feedback A Children in pain often are anorexic and need high-calorie foods. B Proper positioning is important to support and protect affected joints. Isometric exercises and passive range-of-motion exercises will prevent contractures and deformities. C Children with juvenile arthritis need a combination of rest and exercise. D Children with juvenile arthritis need to avoid high-resistance exercises and they benefit from low-resistance exercises, such as swimming.

What is the best nursing response to the parent of a child with asthma who asks if his child can still participate in sports? a. "Children with asthma are usually restricted from physical activities." b. "Children can usually play any type of sport if their asthma is well controlled." c. "Avoid swimming because breathing underwater is dangerous for people with asthma." d. "Even with good asthma control, I would advise limiting the child to one athletic activity per school year."

ANS: B Feedback A Children with asthma should not be restricted from physical activity. B Sports that do not require sustained exertion, such as gymnastics, baseball, and weight lifting, are well tolerated. Children can usually play any type of sport if their asthma is well controlled. C Swimming is recommended as the ideal sport for children with asthma because the air is humidified and exhaling underwater prolongs exhalation and increases end-expiratory pressure. D If asthma is well controlled, the child can participate in any type of sport.

What is the priority nursing intervention for the child with ascending paralysis as a result of Guillain-Barré syndrome (GBS)? a. Immunosuppressive medications b. Respiratory assessment c. Passive range-of-motion exercises d. Anticoagulant therapy

ANS: B Feedback A Children with rapidly progressing paralysis are treated with intravenous immunoglobulins for several days. Administering this infusion is not the nursing priority. B Airway is always the number one priority. Special attention to respiratory status is needed because most deaths from GBS are attributed to respiratory failure. Respiratory support is necessary if the respiratory system becomes compromised and muscles weaken and become flaccid. C The child with GBS is at risk for complications of immobility. Performing passive range-of-motion exercises is an appropriate nursing intervention, but not the priority intervention. D Anticoagulant therapy may be initiated because the risk of pulmonary embolus as a result of deep vein thrombosis is always a threat. This is not the priority nursing intervention.

What should be included in health teaching to prevent Lyme disease? a. Complete the immunization series in early infancy. b. Wear long sleeves and pants tucked into socks while in wooded areas. c. Give low-dose antibiotics to the child before exposure. d. Restrict activities that might lead to exposure for the child.

ANS: B Feedback A Currently there is no vaccine available for Lyme disease. The Lyme disease vaccine had been approved for persons ages 15 to 70 years; however, was withdrawn from the market in 1992. B Wearing long sleeves and pants, and tucking the pants into socks keeps ticks on the clothing and prevents them from hiding on the body. C Antibiotics are used to treat, not prevent, Lyme disease. D Children should be allowed to maintain normal growth and development with activities such as hiking.

The primary nursing intervention to prevent bacterial endocarditis is 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 Feedback A Dental procedures should be done to maintain a high level of oral health. Prophylactic antibiotics are necessary. 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. C Observing children for complications should be done, but maintaining good oral health and prophylactic antibiotics is important. D Encouraging restricted mobility should be done, but maintaining good oral health and prophylactic antibiotics is important.

A parent asks the nurse why a developmental assessment is being conducted for a child during a routine well-child visit. The nurse answers based on the knowledge that routine developmental assessments during well-child visits are a. Not necessary unless the parents request them b. The best method for early detection of cognitive disorders c. Frightening to parents and children and should be avoided d. Valuable in measuring intelligence in children

ANS: B Feedback A Developmental assessment is a component of all well-child examinations. B Early detection of cognitive disorders can be facilitated through assessment of development at each well-child examination. C Developmental assessments are not frightening when the parent and child are educated about the purpose of the assessment. D Developmental assessments are not intended to measure intelligence.

A child with a head injury sleeps unless aroused, and when aroused responds briefly before falling back to sleep. What should the nurse chart for this child's level of consciousness? a. Disoriented b. Obtunded c. Lethargic d. Stuporous

ANS: B Feedback A Disoriented refers to lack of ability to recognize place or person. B Obtunded describes an individual who sleeps unless aroused and once aroused has limited interaction with the environment. C An individual is lethargic when he or she awakens easily but exhibits limited responsiveness. D Stupor refers to requiring considerable stimulation to arouse the individual.

Developmental delays, self-injury, fecal smearing, and severe temper tantrums in a preschool child are symptoms of a. Down syndrome b. Intellectual disability c. Psychosocial deprivation d. Separation anxiety

ANS: B Feedback A Down syndrome is often identified at birth by characteristic facial and head features, such as brachycephaly (disproportionate shortness of the head); flat profile; inner epicanthal folds; wide, flat nasal bridge; narrow, high-arched palate; protruding tongue; and small, short ears, which may be low set. Although intellectual impairment may be present, the symptoms listed are not the primary ones expected in the diagnosis of Down syndrome. B These are symptoms of intellectual disability. C Psychosocial deprivation may be a cause of mild intellectual disability. The symptoms listed are characteristic of severe intellectual disability. D Symptoms of separation anxiety include protest, despair, and detachment.

Which behavior verbalized by a school-age child should alert the school nurse to a problem of possible obsessive-compulsive disorder (OCD)? a. States feelings of worthlessness and sadness everyday b. Feels need to ride a bike around the tree in front of the house seven times every day before entering the house c. Recurrent episodes of chest pain, heart palpations, and shortness of breath when entering the computer classroom d. Deterioration of relationships with family members

ANS: B Feedback A Feelings of worthlessness and sadness are suggestive of a depressive disorder. B Obsessive-compulsive disorder (OCD) manifests repetitive unwanted thoughts (obsessions) or ritualistic actions (compulsions) or both. C Panic disorders often cause recurrent episodes of chest pain, heart palpations, and shortness of breath. These symptoms may be accompanied by a feeling of impending doom. D Deterioration of relationships with family members, irregular school attendance, low grades, rebellious or aggressive behavior, and excessive dependence on peer influence are behaviors that may indicate substance abuse.

What is an appropriate nursing action before surgery when caring for a child diagnosed with a Wilms' tumor? a. Limit fluid intake. b. Do not palpate the abdomen. c. Force oral fluids. d. Palpate the abdomen every 4 hours.

ANS: B Feedback A Fluids are not routinely limited in a child with a Wilms' tumor. However, intake and output are important because of the kidney involvement. B Excessive manipulation of the tumor area can cause seeding of the tumor and spread of the malignant cells. C Fluids are not forced on a child with a Wilms' tumor. Normal intake for age is usually maintained. D The abdomen of a child with a Wilms' tumor should never be palpated because of the danger of seeding the tumor and spreading malignant cells.

A child with autism hospitalized with asthma. The nurse should plan care so that the a. Parents' expectations are met. b. Child's routine habits and preferences are maintained. c. Child is supported through the autistic crisis. d. Parents need not be at the hospital.

ANS: B Feedback A Focus of care is on the child's needs rather than on the parent's desires. B Children with autism are often unable to tolerate even slight changes in routine. The child's routine habits and preferences are important to maintain. C Autism is a life-long condition. D The presence of the parents is almost always required when an autistic child is hospitalized.

Juvenile arthritis should be suspected in a child who exhibits a. Frequent fractures b. Joint swelling and pain lasting longer than 6 weeks c. Increased joint mobility d. Lurching and abnormal gait, limited abduction

ANS: B Feedback A Frequent fractures are indicative of osteogenesis imperfecta. B Intermittent joint pain lasting longer than 6 weeks is indicative of juvenile arthritis. C Increased joint mobility is indicative of osteogenesis imperfecta. D Lurching to the affected side causing an abnormal gait and limited abduction are associated with developmental dysplasia of the hip (DDH). PTS: 1 DIF: Cognitive Level: Comprehension REF:

Exophthalmos (protruding eyeballs) may occur in children with which condition? a. Hypothyroidism b. Hyperthyroidism c. Hypoparathyroidism d. Hyperparathyroidism

ANS: B Feedback A Hypothyroidism is not associated with exophthalmos. B Exophthalmos is a clinical manifestation of hyperthyroidism. C Hypoparathyroidism is not associated with exophthalmos. D Hyperparathyroidism is not associated with exophthalmos.

Which statement indicates that a parent of a toddler needs more education about preventing foreign body aspiration? a. "I keep objects with small parts out of reach." b. "My toddler loves to play with balloons." c. "I won't permit my child to have peanuts." d. "I never leave coins where my child could get them."

ANS: B Feedback A Keeping toys with small parts and other small objects out of reach can prevent foreign body aspiration. B Latex balloons account for a significant number of deaths from aspiration every year. C Peanuts are just one of the foods that pose a choking risk if given to young children. D Small objects, such as coins, need to be put out of the small child's reach.

Which type of croup is always considered a medical emergency? a. Laryngitis b. Epiglottitis c. Spasmodic croup d. Laryngotracheobronchitis (LTB)

ANS: B Feedback A Laryngitis is a common viral illness in older children and adolescents, with hoarseness and URI symptoms. B Epiglottitis is always a medical emergency that requires antibiotics and airway support for treatment. C Spasmodic croup is treated with humidity. D LTB may progress to a medical emergency in some children.

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 Feedback A Maintenance of vascular volume and hydration is important and should be done parenterally. B Monitoring cardiopulmonary status is an important evaluation tool in the care of the child with ARDS. C Seizures are not a side effect of ARDS. D Adequate nutrition is necessary, but a high-protein diet is not helpful.

Which STD should the nurse suspect when an adolescent girl comes to the clinic because she has a vaginal discharge that is white with a fishy smell? a. Human papillomavirus b. Bacterial vaginosis c. Trichomonas d. Chlamydia

ANS: B Feedback A Manifestations of the human papillomavirus are anogenital warts that begin as small papules and grow into clustered lesions. B Bacterial vaginosis is characterized by a profuse, white, malodorous (fishy smelling) vaginal discharge that sticks to the vaginal walls. C Infections with Trichomonas are frequently asymptomatic. Symptoms in females may include dysuria, vaginal itching, burning, and a frothy, yellowish-green, foul-smelling discharge. D Many people with chlamydial infection have few or no symptoms. Urethritis with dysuria, urinary frequency, or mucopurulent discharge may indicate chlamydial infection.

After a tonic-clonic seizure, it would not be unusual for a child to display a. Irritability and hunger b. Lethargy and confusion c. Nausea and vomiting d. Nervousness and excitability

ANS: B Feedback A Neither irritability nor hunger is typical of the period after a tonic-clonic seizure. B In the period after a tonic-clonic seizure, the child may be confused and lethargic. Some children may sleep for a period of time. C Nausea and vomiting are not expected reactions in the postictal period. D The child will more likely be confused and lethargic after a tonic-clonic seizure.

A nurse is conducting a health education class for a group of school-age children. Which statement made by the nurse is correct about the body's first line of defense against infection in the innate immune system? a. Nutritional status b. Skin integrity c. Immunization status d. Proper hygiene practices

ANS: B Feedback A Nutritional status is an indicator of overall health, but it is not the first line of defense in the innate immune system. B The first lines of defense in the innate immune system are the skin and intact mucous membranes. C Immunizations provide artificial immunity or resistance to harmful diseases. D Practicing good hygiene may reduce susceptibility to disease, but it is not a component of the innate immune system.

Which assessment finding is the most significant to report to the physician for a child with cirrhosis? a. Weight loss b. Change in level of consciousness c. Skin with pruritus d. Black, foul-smelling stools

ANS: B Feedback A One complication of cirrhosis is ascites. The child needs to be assessed for increasing abdominal girth and edema. A child who is retaining fluid will not exhibit weight loss. B The child with cirrhosis must be assessed for encephalopathy, which is characterized by a change in level of consciousness. Encephalopathy can result from a buildup of ammonia in the blood from the incomplete breakdown of protein. C Biliary obstruction can lead to pruritus, which is a frequent finding. An alteration in the level of consciousness is of higher priority. D Black, tarry stools may indicate blood in the stool. This needs be reported to the physician. This is not a higher priority than a change in level of consciousness

A parent whose child has been diagnosed with a cognitive deficit should be counseled that intellectual impairment a. Is usually due to a genetic defect b. May be caused by a variety of factors c. Is rarely due to first trimester events d. Is usually caused by parental intellectual impairment

ANS: B Feedback A Only a small percentage of children with intellectual impairment are affected by a genetic defect. B There are a multitude of causes for intellectual impairment. In most cases, a specific cause has not been identified. C One third of children with intellectual impairment are affected by first trimester events. D Intellectual impairment can be transmitted to a child only if the parent has a genetic disorder.

Before preparing a teaching plan for the parents of an infant with ductus arteriosus, it is important that the nurse understands this condition. Which statement best describes patent ductus arteriosus? a. Patent ductus arteriosus involves a defect that results in a right-to-left shunting of blood in the heart. b. Patent ductus arteriosus involves a defect in which the fetal shunt between the aorta and the pulmonary artery fails to close. c. Patent ductus arteriosus is a stenotic lesion that must be surgically corrected at birth. d. Patent ductus arteriosus causes an abnormal opening between the four chambers of the heart.

ANS: B Feedback A Patent ductus arteriosus allows blood to flow from the high-pressure aorta to the low-pressure pulmonary artery, resulting in a left-to-right shunt. B Patent ductus arteriosus is failure of the fetal shunt between the aorta and the pulmonary artery to close. C Patent ductus arteriosus is not a stenotic lesion. Patent ductus arteriosus can be closed both medically and surgically. D Atrioventricular defect occurs when fetal development of the endocardial cushions is disturbed, resulting in abnormalities in the atrial and ventricular septa and the atrioventricular valves.

A 4-month-old infant has gastroesophageal reflux (GER) but is thriving without other complications. What should the nurse suggest to minimize reflux? a. Place in Trendelenburg position after eating. b. Thicken formula with rice cereal. c. Give continuous nasogastric tube feedings. d. Give larger, less frequent feedings

ANS: B Feedback A Placing the child in a Trendelenburg position increases the reflux. B Small frequent feedings of formula combined with 1 teaspoon to 1 tablespoon of rice cereal per ounce of formula has been recommended. Milk thickening agents have been shown to decrease the number of episodes of vomiting and to increase the caloric density of the formula. This may benefit infants who are underweight as a result of GERD. C Continuous nasogastric feedings are reserved for infants with severe reflux and failure to thrive. D Smaller, more frequent feedings are recommended in reflux.

Anticipatory guidance for the family of a preadolescent with a cognitive dysfunction should include information about a. Institutional placement b. Sexual development c. Sterilization d. Clothing

ANS: B Feedback A Preadolescence does not require the child to be institutionalized. B Preadolescents who have a cognitive dysfunction may have normal sexual development without the emotional and cognitive abilities to deal with it. It is important to assist the family and child through this developmental stage. C Sterilization is not an appropriate intervention when a child has a cognitive dysfunction. D By the time a child reaches preadolescence, the family should have received counseling on age-appropriate clothing.

What is the most important action to prevent the spread of gastroenteritis in a daycare setting? a. Administering prophylactic medications to children and staff b. Frequent handwashing c. Having parents bring food from home d. Directing the staff to wear gloves at all times

ANS: B Feedback A Prophylactic medications are not helpful in preventing gastroenteritis. B Handwashing is the most the important measure to prevent the spread of infectious diarrhea. C Bringing food from home will not prevent the spread of infectious diarrhea. D Gloves should be worn when changing diapers, soiled clothing, or linens. They do not need to be worn for interactions that do not involve contact with secretions. Handwashing after contact is indicated.

Which statement about Crohn disease is the most accurate? a. The signs and symptoms of Crohn disease are usually present at birth. b. Signs and symptoms of Crohn disease include abdominal pain, diarrhea, and often a palpable abdominal mass. c. Edema usually accompanies this disease. d. Symptoms of Crohn disease usually disappear by late adolescence.

ANS: B Feedback A Signs and symptoms are not usually present at birth. B Crohn disease can occur anywhere in the GI tract from the mouth to the anus and is most common in the terminal ileum. Signs and symptoms include abdominal pain, diarrhea (nonbloody), fever, palpable abdominal mass, anorexia, severe weight loss, fistulas, obstructions, and perianal and anal lesions. C Diarrhea and malabsorption from Crohn disease cause weight loss, anorexia, dehydration, and growth failure. Edema does not accompany this disease. D Crohn disease is a long-term health problem. Symptoms do not typically disappear by adolescence.

What is the best response to a parent of a 2-month-old infant who asks when the infant should first receive the measles vaccine? a. "Your baby can get the measles vaccine now." b. "The first dose is given any time after the first birthday." c. "She should be vaccinated between 4 and 6 years of age." d. "This vaccine is administered when the child is 11 years old."

ANS: B Feedback A Some immunizations are initiated at 2 months of age, but not the measles vaccine. B The first measles, mumps, rubella (MMR) vaccine is recommended routinely at 1 year of age. C The second dose of MMR is recommended at 4 to 6 years of age. D Children should receive their second MMR dose no later than 11 to 12 years of age.

What should be the nurse's first action when a child with a head injury complains of double vision and a headache, and then vomits? a. Immobilize the child's neck. b. Report this information to the physician. c. Darken the room and put a cool cloth on the child's forehead. d. Restrict the child's oral fluid intake.

ANS: B Feedback A Stabilizing the child's neck does not address the child's symptoms. B Any indication of ICP should be promptly reported to the physician. C This intervention may facilitate the child's comfort. It would not be the nurse's first action. D The child's episode of vomiting does not necessitate a fluid restriction.

What is an expected outcome for the parents of a child with encopresis? a. The parents will give the child an enema daily for 3 to 4 months. b. The family will develop a plan to achieve control over incontinence. c. The parents will have the child launder soiled clothes. d. The parents will supply the child with a low-fiber diet.

ANS: B Feedback A Stool softeners or laxatives, along with dietary changes, are typically used to treat encopresis. Enemas are indicated when a fecal impaction is present. B Parents of the child with encopresis often feel guilty and believe that encopresis is willful on the part of the child. The family functions effectively by openly discussing problems and developing a plan to achieve control over incontinence. C This action is a punishment and will increase the child's shame and embarrassment. The child should not be punished for an action that is not willful. D Increasing fiber in the diet and fluid intake results in greater bulk in the stool, making it easier to pass.

The nurse is teaching the parents of a child who has been diagnosed with irritable bowel syndrome about the pathophysiology associated with the symptoms their child is experiencing. Which response indicates to the nurse that her teaching has been effective? a. "My child has an absence of ganglion cells in the rectum causing alternating diarrhea and constipation." b. "The cause of my child's diarrhea and constipation is disorganized intestinal contractility." c. "My child has an intestinal obstruction; that's why he has abdominal pain." d. "My child has an intolerance to gluten, and this causes him to have abdominal pain."

ANS: B Feedback A The absence of ganglion cells in the rectum is associated with Hirschsprung disease. B Disorganized contractility and increased mucus production are precipitating factors of irritable bowel disease. C Intestinal obstruction is associated with pyloric stenosis. D Intolerance to gluten is the underlying cause of celiac disease.

Teaching safety precautions with the administration of antihistamines is important because of what common side effect? a. Dry mouth b. Excitability c. Drowsiness d. Dry mucous membranes

ANS: C Feedback A A dry mouth is not a safety issue. B Excitability may affect rest or sleep, but drowsiness is the most important safety hazard. C Drowsiness is a safety hazard when alertness is needed, especially with a teenage driver. Nonsedating brands should be used. D Dry mucous membranes are not a safety issue.

What is the most appropriate nursing action when a child is in the tonic phase of a generalized tonic-clonic seizure? a. Guide the child to the floor if standing and go for help. b. Turn the child's body on the side. c. Place a padded tongue blade between the teeth. d. Quickly slip soft restraints on the child's wrists.

ANS: B Feedback A The child should be placed on a soft surface if he is not in bed; however, it is inappropriate to leave the child during the seizure. B Positioning the child on his side will prevent aspiration. C Nothing should be inserted into the child's mouth during a seizure to prevent injury to the mouth, gums, or teeth. D Restraints could cause injury. Sharp objects and furniture should be moved out of the way to prevent injury.

What should a nurse advise the parents of a child with type 1 diabetes mellitus who is not eating as a result of a minor illness? a. Give the child half his regular morning dose of insulin. b. Substitute simple carbohydrates or calorie-containing liquids for solid foods. c. Give the child plenty of unsweetened, clear liquids to prevent dehydration. d. Take the child directly to the emergency department.

ANS: B Feedback A The child should receive his regular dose of insulin even if he does not have an appetite. B A sick-day diet of simple carbohydrates or calorie-containing liquids will maintain normal serum glucose levels and decrease the risk of hypoglycemia. C If the child is not eating as usual, he needs calories to prevent hypoglycemia. D During periods of minor illness, the child with type 1 diabetes mellitus can be managed safely at home.

Which interaction is part of the discharge plan for a school-age child with osteomyelitis who is receiving home antibiotic therapy? a. Instructions for a low-calorie diet b. Arrange for tutoring and school work c. Instructions for a high-fat, low-protein diet d. Instructions for the parent to return the child to team sports immediately

ANS: B Feedback A The child with osteomyelitis is on a high-calorie, high-protein diet. B Promoting optimal growth and development in the school-age child is important. It is important to continue school work and arrange for tutoring if indicated. C The child with osteomyelitis is on a high-calorie, high-protein diet. D The child with osteomyelitis may need time for the bone to heal before returning to full activities.

What is the most important factor in determining the rate of fluid replacement in the dehydrated child? a. The child's weight b. The type of dehydration c. Urine output d. Serum potassium level

ANS: B Feedback A The child's weight determines the amount of fluid needed, not the rate of fluid replacement. One milliliter of body fluid is equal to 1 g of body weight; therefore a loss of 1 kg (2.2 lb) is equal to 1 L of fluid. B Isonamtremic and hyponatremic dehydration resuscitation involves fluid replacement over 24 hours. Hypernatremic dehydration involves a slower replacement rate to prevent a sudden decrease in the sodium level. C Urine output is not a consideration for determining the rate of administration of replacement fluids. D Potassium level is not as significant in determining the rate of fluid replacement as the type of dehydration.

Which statement made by a parent indicates an understanding about the genetic transmission of cystic fibrosis (CF)? a. "Only one parent carries the cystic fibrosis gene." b. "Both parents are carriers of the cystic fibrosis gene." c. "The presence of the disease is most likely the result of a genetic mutation." d. "The mother is usually the carrier of the cystic fibrosis gene."

ANS: B Feedback A The disease will not be present if only one parent is a carrier of the cystic fibrosis gene. B Cystic fibrosis follows a pattern of autosomal recessive transmission. Both parents must be carriers of the gene for the disease to be transmitted to the child. If both parents carry the CF gene, each pregnancy has a 25% chance of producing a CF-affected child. C Cystic fibrosis is known to have a definite pattern of transmission. It is transmitted as an autosomal recessive trait. D A carrier parent can transmit the carrier gene to the child. The disease is present when the carrier gene is transmitted from both parents.

What is an expected outcome for a 1-month-old infant with biliary atresia? a. Correction of the defect with the Kasai procedure b. Adequate nutrition and age-appropriate growth and development c. Adherence to a salt-free diet with vitamin B12 supplementation d. Adequate protein intake

ANS: B Feedback A The goal of the Kasai procedure is to allow for adequate growth until a transplant can be done. It is not a curative procedure. B Adequate nutrition, preventing skin breakdown, adequate growth and development, and family education and support are expected outcomes in an infant with biliary atresia. C Vitamin B12 supplementation is not indicated. A salt-restricted diet is appropriate. D Protein intake may need to be restricted to avoid hepatic encephalopathy.

Which factor should the nurse include when teaching a parent about the care of a newborn in a Pavlik harness for hip dysplasia? a. The harness may be removed with every diaper change. b. The harness is used to maintain the infant's hips in flexion and abduction and external rotation. c. The harness is only the first step of treatment. d. The harness is worn for 2 weeks.

ANS: B Feedback A The harness must be worn for 23 hours per day and should be removed only according to the physician's recommendation. Hips that remain unstable become progressively more deformed as maturity takes place. B The harness is used to maintain the infant's hips in flexion and external rotation to allow the hips (femoral head and acetabulum) to mold and grow normally. C With early diagnosis and treatment, the Pavlik harness is often the only treatment necessary. D The length of treatment is determined by radiographic documentation of the maturity of the hips.

Which strategy is appropriate when feeding the infant with congestive heart failure? a. Continue the feeding until a sufficient amount of formula is taken. b. Limit feeding time to no more than 30 minutes. c. Always bottle feed every 4 hours. d. Feed larger volumes of concentrated formula less frequently.

ANS: B Feedback A The infant with congestive heart failure may tire easily. If the infant does not consume an adequate amount of formula in 30 minutes, gavage feedings should be considered. B The infant with congestive heart failure may tire easily, so the feeding should not continue beyond 30 minutes. If inadequate amounts of formula are taken, gavage feedings should be considered. C Infants with congestive heart failure may be breastfed. Feedings every 3 hours is a frequently used interval. If the infant were fed less frequently than every 3 hours, more formula would need to be consumed and would tire the infant. D The infant is fed smaller volumes of concentrated formula every 3 hours.

A newborn assessment shows separated sagittal suture, oblique palpebral fissures, depressed nasal bridge, protruding tongue, and transverse palmar creases. These findings are most suggestive of a. Microcephaly b. Down syndrome c. Cerebral palsy d. Fragile X syndrome

ANS: B Feedback A The infant with microcephaly has a small head. B These are characteristics associated with Down syndrome. C Cerebral palsy is a diagnosis not usually made at birth. No characteristic physical signs are present. D The infant with fragile X syndrome has increased head circumference; long, wide, and/or protruding ears; long, narrow face with prominent jaw; hypotonia; and high arched palate.

What should the nurse expect to observe in the prodromal phase of rubeola? a. Macular rash on the face b. Koplik spots c. Petechiae on the soft palate d. Crops of vesicles on the trunk

ANS: B Feedback A The macular rash with rubeola appears after the prodromal stage. B Koplik spots appear approximately 2 days before the appearance of a rash. C Petechiae on the soft palate occur with rubella. D Crops of vesicles on the trunk are characteristic of varicella.

An infant with short bowel syndrome will be discharged home on total parenteral nutrition (TPN) and gastrostomy feedings. Nursing care should include a. Preparing family for impending death b. Teaching family signs of central venous catheter infection c. Teaching family how to calculate caloric needs d. Securing TPN and gastrostomy tubing under the diaper to lessen risk of dislodgment

ANS: B Feedback A The prognosis for patients with short bowel syndrome depends in part on the length of residual small intestine. It has improved with advances in TPN. B During TPN therapy, care must be taken to minimize the risk of complications related to the central venous access device, such as catheter infections, occlusions, or accidental removal. This is an important part of family teaching. C Although parents need to be taught about nutritional needs, the caloric needs and prescribed TPN and rate are the responsibility of the health care team. D The tubes should not be placed under the diaper due to risk of infection.

Rocky Mountain spotted fever is caused by the bite of a a. Flea b. Tick c. Mosquito d. Mouse or rat

ANS: B Feedback A These organisms do not transmit Rocky Mountain spotted fever. B Rocky Mountain spotted fever is caused by a tick. The tick must attach and feed for at least 1 to 2 hours to transmit the disease. The usual habitat of the tick is in heavily wooded areas. C These organisms do not transmit Rocky Mountain spotted fever. D These organisms do not transmit Rocky Mountain spotted fever.

The depth of a burn injury may be classified as a. Localized or systemic b. Superficial, superficial partial thickness, deep partial thickness, or full thickness c. Electrical, chemical, or thermal d. Minor, moderate, or major

ANS: B Feedback A These terms refer to the effect of the burn injury. For example, is there a reaction in the area of the burn (localized) or throughout the body (systemic)? B The vocabulary to classify the depth of a burn is superficial, partial thickness, or full thickness. C These terms refer to the cause of the burn injury. D These terms refer to the severity of the burn injury.

What is a priority nursing diagnosis for the 4-year-old child newly diagnosed with leukemia? a. Ineffective Breathing Pattern related to mediastinal disease b. Risk for Infection related to immunosuppressed state c. Disturbed Body Image related to alopecia d. Impaired Skin Integrity related to radiation therapy

ANS: B Feedback A This nursing diagnosis applies to a child with non-Hodgkin lymphoma or any cancer involving the chest area. B Leukemia is characterized by the proliferation of immature white blood cells, which lack the ability to fight infection. C This is a nursing diagnosis related to chemotherapy, but it is not of the highest priority. Not all children have a body image disturbance as a result of alopecia, especially not preschoolers. This would be of more concern to an adolescent. D Radiation therapy is not a treatment for leukemia.

What is the best response by the nurse to a mother asking about the cause of her infant's bilateral cleft lip? a. "Did you use alcohol during your pregnancy?" b. "Do you know of anyone in your family or the baby's father's family who was born with cleft lip or palate problems?" c. "This defect is associated with intrauterine infection during the second trimester." d. "The prevalent of cleft lip is higher in Caucasians"

ANS: B Feedback A Tobacco during pregnancy has been associated with bilateral cleft lip. B Cleft lip and palate result from embryonic failure resulting from multiple genetic and environmental factors. A genetic pattern or familial risk seems to exist. C The defect occurred at approximately 6 to 8 weeks of gestation. Second-trimester intrauterine infection is not a known cause of bilateral cleft lip. D The prevalence of cleft lip and palate is higher in Asian and Native American populations.

What is the nurse's best response to a parent with questions about how her child's blood disorder will be treated? a. "Your child may be able to receive home care." b. "What did the physician tell you?" c. "Blood diseases are transient, so there is no need to worry." d. "Your child will be tired for awhile and then be back to her old self."

ANS: B Feedback A Treatment depends on the child's condition and the type of blood disorder. Although it is possible that the child could be treated in the home, the child may need to be treated as an outpatient or in the hospital. It is best to first assess what the parent has been told by the physician. B Providing the parent an opportunity to express what she was told by the physician allows the nurse to assess the parent's understanding and provide further information. C Minimizing the parent's concern is inappropriate. D The nurse needs to assess the parent's knowledge before teaching about the disease.

What finding should cause the nurse to suspect a diagnosis of spastic cerebral palsy? a. Tremulous movements at rest and with activity b. Sudden jerking movement caused by stimuli c. Writhing, uncontrolled, involuntary movements d. Clumsy, uncoordinated movements

ANS: B Feedback A Tremulous movements are characteristic of rigid/tremor/atonic cerebral palsy. B Spastic cerebral palsy, the most common type of cerebral palsy, will manifest with hypertonicity and increased deep tendon reflexes. The child's muscles are very tight and any stimuli may cause a sudden jerking movement. C Slow, writhing, uncontrolled, involuntary movements occur with athetoid or dyskinetic cerebral palsy. D Clumsy movements, loss of coordination, equilibrium, and kinesthetic sense occur in ataxic cerebral palsy.

What should the nurse teach an adolescent who is taking tretinoin (Retin-A) to treat acne? a. The medication should be taken with meals. b. Apply sunscreen before going outdoors. c. Wash with benzoyl peroxide before application. d. The effect of the medication should be evident within 1 week.

ANS: B Feedback A Tretinoin is a topical medication. Application is not affected by meals. B Tretinoin causes photosensitivity, and sunscreen should be applied before sun exposure. C If applied together, benzoyl peroxide and tretinoin have reduced effectiveness and a potentially irritant effect. D Optimal results from tretinoin are not achieved for 3 to 5 months.

Which laboratory finding confirms that a child with type 1 diabetes is experiencing diabetic ketoacidosis? a. No urinary ketones b. Low arterial pH c. Elevated serum carbon dioxide d. Elevated serum phosphorus

ANS: B Feedback A Urinary ketones, often in large amounts, are present when a child is in diabetic ketoacidosis. B Severe insulin deficiency produces metabolic acidosis, which is indicated by a low arterial pH. C Serum carbon dioxide is decreased in diabetic ketoacidosis. D Serum phosphorus is decreased in diabetic ketoacidosis.

The primary treatment for warts is a. Vaccination b. Local destruction c. Corticosteroids d. Specific antibiotic therapy

ANS: B Feedback A Vaccination is prophylaxis for warts and is not a treatment. B Topical treatments include chemical cautery, which is especially useful for the treatment of warts. Local destructive therapy individualized according to location, type, and number. Surgical removal, electrocautery, curettage, cryotherapy, caustic solutions, x-ray treatment, and laser therapies are used. C These are not effective in the treatment of warts. D These are not effective in the treatment of warts.

While completing an assessment on a 6-month-old infant, which finding should the nurse recognize as a symptom of a brain tumor in an infant? a. Blurred vision b. Increased head circumference c. Vomiting when getting out of bed d. Headache

ANS: B Feedback A Visual changes such as nystagmus, diplopia, and strabismus are manifestations of a brain tumor but would not be able to be verbalized by an infant. B Manifestations of brain tumors vary with tumor location and the child's age and development. Infants with brain tumors may be irritable or lethargic, feed poorly, and have increased head circumference with a bulging fontanel. C The change in position on awakening causes an increase in intracranial pressure, which is manifested as vomiting. Vomiting on awakening is considered a hallmark symptom of a brain tumor, but infants do not get themselves out of bed in the morning. D Increased intracranial pressure resulting from a brain tumor is manifested as a headache but could not be verbalized by an infant.

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 Feedback A Vitamin D has no role in the therapy of adrenogenital hyperplasia. B The most common biochemical defect with congenital adrenal hyperplasia is partial or complete 21-hydroxylase deficiency. With complete deficiency, insufficient amounts of aldosterone and cortisol are produced so that circulatory collapse occurs without immediate replacement. C Stool softeners have no role in the therapy of adrenogenital hyperplasia. D Calcium carbonate has no role in the therapy of adrenogenital hyperplasia

What intervention can be taught to the parents of a 3-year-old child with pneumonia who is not hospitalized? a. Offer the child only cool liquids. b. Offer the child her favorite warm liquid drinks. c. Use a warm mist humidifier. d. Call the physician for a respiratory rate less than 28 breaths/min.

ANS: B Feedback A Warm liquids are preferable because they help loosen secretions. B Offering the child fluids that she likes will facilitate oral intake. Warm liquids help loosen secretions. C Cool mist humidifiers are preferred to warm mist. Warm mist is a safety concern and could cause burns if touched by the child. D Typically parents are not taught to count their children's respirations and report abnormalities to the physician. Even if this were the case, a respiratory rate of less than 28 breaths/min is normal for a 3-year-old child. The expected respiratory rate for a 3-year-old child is 20 to 30 breaths/min.

The nurse teaches parents to alert their health care provider about which adverse effect when a child receives valproic acid (Depakene) to control generalized seizures? a. Weight loss b. Bruising c. Anorexia d. Drowsiness

ANS: B Feedback A Weight gain, not loss, is a side effect of valproic acid. B Thrombocytopenia is an adverse effect of valproic acid. Parents should be alert for any unusual bruising or bleeding. C Drowsiness is not a side effect of valproic acid, although it is associated with other anticonvulsant medications. D Anorexia is not a side effect of valproic acid.

The parent of a toddler calls the nurse, asking about croup. What is a distinguishing manifestation of spasmodic croup? a. Wheezing is heard audibly. b. It has a harsh, barky cough. c. It is bacterial in nature. d. The child has a high fever.

ANS: B Feedback A Wheezing is not a distinguishing manifestation of croup. It can accompany conditions such as asthma or bronchiolitis. B Spasmodic croup is viral in origin; is usually preceded by several days of symptoms of upper respiratory tract infection; often begins at night; and is marked by a harsh, metallic, barky cough; sore throat; inspiratory stridor; and hoarseness. C Spasmodic croup is viral in origin. D A high fever is not usually present.

A neonate is displaying mottled skin, has a large fontanel and tongue, is lethargic, and is having difficulty feeding. The nurse recognizes that this is most suggestive of a. Hypocalcemia b. Hypothyroidism c. Hypoglycemia d. Phenylketonuria (PKU)

ANS: B Feedback A When hypocalcemia is present, neonates may display twitching, tremors, irritability, jitteriness, electrocardiographic changes, and, rarely, seizures. B An infant with hypothyroidism may exhibit skin mottling, a large fontanel, a large tongue, hypotonia, slow reflexes, a distended abdomen, prolonged jaundice, lethargy, constipation, feeding problems, and coldness to touch. C Hypoglycemia causes the neonate to exhibit jitteriness, poor feeding, lethargy, seizures, respiratory alterations including apnea, hypotonia, high-pitched cry, bradycardia, cyanosis, and temperature instability. D Infants with PKU may initially have digestive problems with vomiting, and they may have a musty or mousy odor to the urine, infantile eczema, hypertonia, and hyperactive behavior.

The nurse discovers a heart murmur in an infant 1 hour after birth. She is aware that fetal shunts are closed in the neonate at what point? a. When the umbilical cord is cut b. Within several days of birth c. Within a month after birth d. By the end of the first year of life

ANS: B Feedback A With the neonate's first breath, gas exchange is transferred from the placenta to the lungs. The separation of the fetus from the umbilical cord does not contribute to the establishment of neonatal circulation. B In the normal neonate, fetal shunts functionally close in response to pressure changes in the systemic and pulmonary circulations and to increased oxygen content. This process may take several days to complete. C The fetal shunts normally close within several days of birth. D Fetal shunts normally close soon after birth but may take several days.

Tattoos have become increasingly popular among mainstream adolescents. Like clothing and hairstyles, tattoos serve to define one's identity. It is important for nurses to caution adolescents on the health risks of obtaining a tattoo. These include (select all that apply) a. Amateur tattoos are difficult to remove. b. Tattoos pose a risk for bloodborne and skin infections. c. Health care professionals must be notified of the existence of a tattoo before a magnetic resonance imaging (MRI) scan. d. Tattoo dyes may cause allergic reactions. e. Tattoo parlors are well regulated.

ANS: B, C, D Feedback Correct Tattoos carry the risk for contracting bloodborne diseases such as hepatitis B and HIV. Infection, allergic reaction to the dye, scarring, or keloid formation can occur. Should an MRI ever be required, it is important to notify the health care professionals, because the dyes can contain iron and other metals. Incorrect Amateur tattoos are easily removed; however, studio tattoos made with red and green dye are extremely difficult to remove. Very little regulation exists in the tattoo industry; therefore, the cleanliness of each tattoo parlor varies. Teens should be counseled to avoid making an impulsive decision to get a tattoo.

A nurse is planning care for a hospitalized toddler in the preoperational thinking stage. Which characteristics should the nurse expect in this stage? Select all that apply. a. Concrete thinking b. Egocentrism c. Animism d. Magical thought e. Ability to reason

ANS: B, C, D Feedback Correct The characteristics of preoperational thinking that occur for the toddler include egocentrism (views everything in relation to self), animism (believes that inert objects are alive), and magical thought (believes that thinking something causes that event). Incorrect Concrete thinking is seen in school-age children, and ability to reason is seen with adolescents.

The nurse is caring for a child with aplastic anemia. What nursing diagnoses are appropriate? Select all that apply. a. Acute Pain related to vaso-occlusion b. Risk for Infection related to inadequate secondary defenses or immunosuppression c. Ineffective Protection related to thrombocytopenia d. Ineffective Tissue Perfusion related to anemia e. Ineffective Protection related to abnormal clotting

ANS: B, C, D Feedback Correct These are appropriate nursing diagnosis for the nurse planning care for a child with aplastic anemia. Aplastic anemia is a condition in which the bone marrow ceases production of the cells it normally manufactures, resulting in pancytopenia. The child will have varying degrees of the disease depending on how low the values are for absolute neutrophil count (affecting the body's response to infection), platelet count (putting the child at risk for bleeding), and absolute reticulocyte count (causing the child to have anemia). Incorrect Acute pain related to vaso-occlusion is an appropriate nursing diagnosis for sickle cell anemia for the child in vaso-occlusive crisis, but it is not applicable to a child with aplastic anemia. Ineffective protection related to abnormal clotting is an appropriate diagnosis for von Willebrand disease.

You are the nurse caring for a child with celiac disease. Which food choices by the child's parent indicate understanding of teaching? Select all that apply. a. Oatmeal b. Steamed rice c. Corn on the cob d. Baked chicken e. Peanut butter and jelly sandwich on wheat bread

ANS: B, C, D Feedback Correct: Rice is an appropriate choice because it does not contain gluten. Corn is digestible because it does not contain gluten. Meats do not contain gluten and can be included in the diet of a child with celiac disease. Incorrect: The child with celiac disease is unable to fully digest gluten, the protein found in wheat, barley, rye, and oats. Oatmeal contains gluten and is not an appropriate food selection. Wheat bread is not appropriate.

As a nurse working in the newborn nursery, you notice an infant who is having circumoral cyanosis. Which CHD do you suspect the child may have? Select all that apply. a. Patent ductus arteriosus (PDA) b. Tetralogy of Fallot c. Pulmonary atresia d. Transposition of the great arteries e. Ventricular septal defect

ANS: B, C, D Feedback Correct: Tetralogy of Fallot is a cyanotic lesion with decreased pulmonary blood flow. The hypoxia results in baseline oxygen saturations as low as 75% to 85%. Even with oxygen administration, saturations do not reach the normal range. Pulmonary atresia is a cyanotic lesion with decreased pulmonary blood flow. The hypoxia results in baseline oxygen saturations as low as 75% to 85%. Even with oxygen administration, saturations do not reach the normal range. Transposition of the great arteries is a cyanotic lesion with increased pulmonary blood flow. Incorrect: PDA is failure of the fetal shunt between the aorta and the pulmonary artery to close. PDA is not classified as a cyanotic heart disease. Prostaglandin E1 is often given to maintain ductal patency in children with cyanotic heart diseases. VSD is the most common type of cardiac defect. The VSD is a left-to-right shunting defect; however, it may be accompanied by other defects.

Which strategies can a nurse teach to parents of a child experiencing uncomplicated school refusal? Select all that apply. a. The child should be allowed to stay home until the anxiety about going to school is resolved. b. Parents should be empathetic yet firm in their insistence that the child attends school. c. A modified school attendance may be necessary. d. Parents need to pick the child up at school whenever the child wants to come home. e. Parents need to communicate with the teachers about the situation.

ANS: B, C, E Feedback Correct In uncomplicated cases of school refusal, the parent needs to return the child to school as soon as possible. If symptoms are severe, a limited period of part-time or modified school attendance may be necessary. For example, part of the day may be spent in the counselor's or school nurse's office, with assignments obtained from the teacher. Parents should be empathetic yet firm and consistent in their insistence that the child attend school. Incorrect Parents should not pick the child up at school once the child is there. The principal and teacher should be told about the situation so that they can cooperate with the treatment plan.

A nurse is performing an assessment on a newborn. Which vital signs indicate a normal finding for this age group? Select all that apply. a. Pulse of 80-125 a minute b. B/P of systolic 65-95 and diastolic 30-60 c. Temperature of 36.5-37.3 Celsius (axillary) d. Temperature of 36.4-37 Celsius (axillary) e. Respirations of 30-60 a minute

ANS: B, C, E Feedback Correct The normal vital signs for a newborn are temperature 36.5 to 37.3 Celsius (axillary), pulse rate of 120-160 a minute, respiratory rate of 30-60 a minute, systolic B/P of 65-95, and diastolic B/P of 30-62. A temperature of 36.4-37 Celsius is normal for an older child. A pulse rate of 80-125 is normal for a 4-year-old child. Incorrect A pulse rate of 80-125 per minute and temperature of 36.4-37° C are both too low for a well-newborn.

In planning care for a preschool-age child, the nurse knows that which open body postures encourage positive communication? Select all that apply. a. Leaning away from the preschooler b. Frequent eye contact c. Hands on hips d. Conversing at eye level e. Asking the parents to stay in the room

ANS: B, D Feedback Correct Frequent eye contact and conversing at eye level are both open body postures that encourage positive communication. Incorrect Leaning away from the child and placing your hands on your hips are both closed body postures that do not facilitate effective communication. Asking the parents to stay in the room while the nurse is talking to the child is helpful but is not an open body posture.

Parents of a teenager ask the nurse what signs they should look for if their child is in a gang. The nurse should include which signs when answering? Select all that apply. a. Plans to try out for the debate team at school b. Skipping classes to go to the mall c. Hanging out with friends they have had since childhood d. Unexplained source of money e. Fear of the police

ANS: B, D, E Feedback Correct Signs of gang involvement include skipping classes, unexplained sources of money, and fear of the police. Associating with new friends while ignoring old friends is also a sign. A change in attitude toward participating in activities is another sign of gang involvement. Incorrect Plans to try out for the debate team at school are not a sign of gang involvement. Hanging out with friends he or she has had since childhood is not a sign of gang involvement.

What should the nurse recognize as a possible indicator of child abuse in a 4-year-old child being treated for ear pain at the emergency department on a chilly Christmas Day in New York State? Select all that apply. a. The child extends his arms to be hugged by the nurse. b. The child is wearing clean, baggy shorts, sandals, and an oversized T-shirt. c. The child answers all questions in complete sentences, and smiles afterward. d. The child has dirty, broken teeth. e. The child states "I'm so fat" when the nurse tells his mother he weighs 25 lb.

ANS: B, D, E Feedback Correct These clothes are inappropriate attire for December in New York State. Even though the clothes are clean, dressing inappropriately for the weather is a potential indicator of child abuse. Clothing that is too large or small for the child's size also requires further evaluation. Dirty, broken teeth are an indicator of potential child abuse. A child who is 4 years old and weighs only 25 lb is thin for his age. Body image distortion (being thin but describing self as fat) is a potential indicator of child abuse. A child who is too thin for his height should also be further evaluated. Incorrect Although it may be unusual for this child to want to hugged by the nurse, it is not an indicator of child abuse. Answering questions using complete sentences and smiling is appropriate for a 4-year-old.

A child is diagnosed with hypothyroidism. The nurse should expect to assess which symptoms associated with hypothyroidism? Select all that apply. a. Weight loss b. Fatigue c. Diarrhea d. Dry, thick skin e. Cold intolerance

ANS: B, D, E Feedback Correct A child with hypothyroidism will display fatigue, dry, thick skin, and cold intolerance. Incorrect Weight loss and diarrhea are signs of hyperthyroidism.

What nursing actions are indicated when the nurse is administering phenytoin (Dilantin) by the intravenous route to control seizures? Select all that apply. a. It must be given with D5 1/2NS. b. The child will require monitoring of therapeutic serum levels while taking this medication. c. Dilantin should be given with food because it causes gastrointestinal distress. d. It must be given in normal saline. e. It must be filtered.

ANS: B, D, E Feedback Correct The child should have serum levels drawn to monitor for optimal therapeutic levels. In addition, liver function studies should be monitored because this anticonvulsant may cause hepatic dysfunction. The IV dose must be given in normal saline, not D5 1/2NS. The IV dose must be filtered. Incorrect The IV dose must be given in normal saline, not D5 1/2NS. Dilantin has not been found to cause gastrointestinal upset, and since it is being given by the IV route, this is not a concern. The medication can be taken without food.

The nurse is providing home care instructions to the parents of an infant being discharged after repair of a bilateral cleft lip. Which instructions should the nurse include? Select all that apply. a. Acetaminophen (Tylenol) should not be given to your infant. b. Feed your infant in an upright position. c. Place your infant prone for a period of time each day. d. Burp your child frequently during feedings. e. Apply antibiotic ointment to the lip as prescribed.

ANS: B, D, E Feedback Correct: After cleft lip surgery the parents are taught to feed the infant in an upright position to decrease the chance of choking. The parents are taught to burp the infant frequently during feedings because excess air is often swallowed. Parents are taught to cleanse the suture line area with a cotton swab using a rolling motion and apply antibiotic ointment with the same technique. Incorrect: Tylenol is used for pain and the child should never be placed prone as this position can you damage the suture line.

A child with a brain tumor is undergoing radiation therapy. What should the nurse include in the discharge instructions to the child's parents? Select all that apply. a. Apply over-the-counter creams to the area daily. b. Avoid excessive skin exposure to the sun. c. Use a washcloth when cleaning the area receiving radiation. d. Plan for adequate rest periods for the child. e. A darkening of the skin receiving radiation is expected.

ANS: B, D, E Feedback Correct: Children receiving cranial radiation are particularly affected by fatigue and an increased need for sleep during and shortly after completion of the course of radiation. Skin damage can include changes in pigmentation (darkening), redness, peeling, and increased sensitivity. Incorrect: Extra care must be taken to avoid excessive skin exposure to heat, sunlight, friction (such as rubbing with a towel or washcloth), and creams or moisturizers. Only topical creams and moisturizers prescribed by the radiation oncologist should be applied to the radiated skin.

The parents of a teen suspect their child is using amphetamines. Manifestations of amphetamine use include (select all that apply) a. Weight gain b. Excessive talking and activity c. Excessive sleeping d. Insomnia e. Agitation

ANS: B, D, E Feedback Correct: Euphoria, hyperactivity, agitation, irritability, insomnia, weight loss, tachycardia, and hypertension are expected behaviors and effects of amphetamine abuse. Incorrect: The adolescent using amphetamines is likely to have weight loss not weight gain. Excessive sleeping may be associated with alcohol abuse or abuse of barbiturates.

Which milestone is developmentally appropriate for a 2-month-old infant? a. Pulled to a sitting position, head lag is absent. b. Pulled to a sitting position, the infant is able to support the head when the trunk is lifted. c. The infant can lift his or her head from the prone position and briefly hold the head erect. d. In the prone position, the infant is fully able to support and hold the head in a straight line.

ANS: C Feedback A A 2-month-old infant's neck muscles are stronger than those of a newborn; however, head lag is present when pulled to a sitting position. B A 2-month-old infant continues to have some head lag when pulled to a sitting position. C A 2-month-old infant is able to briefly hold the head erect when in a prone position. If a parent were holding the infant against the parent's shoulder, the infant would be able to lift his or her head briefly. D It is not until 4 months of age that the infant can easily lift his or her head and hold it steadily erect when in the prone position.

What term should be used in the nurse's documentation to describe auscultation of breath sounds that are short, popping, and discontinuous on inspiration? a. Pleural friction rub b. Bronchovesicular sounds c. Crackles d. Wheeze

ANS: C Feedback A A pleural friction rub has a grating, coarse, low-pitched sound. B Bronchovesicular sounds are auscultated over mainstem bronchi. They are clear, without any adventitious sounds. C Crackles are short, popping, discontinuous sounds heard on inspiration. D Wheezes are musical, high-pitched, predominant sounds heard on expiration.

Which children are at greater risk for not receiving immunizations? a. Children who attend licensed daycare programs b. Children entering school c. Children who are home schooled d. Young adults entering college

ANS: C Feedback A All states require immunizations for children in daycare programs. B All states require immunizations for children entering school. C Home-schooled children are at risk for being underimmunized and need to be monitored. D Most colleges require a record of immunizations as part of a health history.

Which action is appropriate when the nurse is assessing breath sounds of an 18-month-old crying child? a. Ask the parent to quiet the child so the nurse can listen. b. Auscultate breath sounds and chart that the child was crying. c. Encourage the child to play with the stethoscope to distract and to calm down before auscultating. d. Document that data are not available because of noncompliance.

ANS: C Feedback A Asking a parent to quiet the child may or may not work. B Auscultating while the child is crying typically results in less than optimal data. C Distracting the child with an interesting activity can assist the child to calm down so an accurate assessment can be made. D Documenting that the child is not compliant is not appropriate. An assessment needs to be completed.

Which statement is the most accurate about moral development in the 9-year-old school-age child? a. Right and wrong are based on physical consequences of behavior. b. The child obeys parents because of fear of punishment. c. The school-age child conforms to rules to please others. d. Parents are the determiners of right and wrong for the school-age child.

ANS: C Feedback A Children 4 to 7 years of age base right and wrong on consequences. B Consequences are the most important consideration for the child between 4 and 7 years of age. C The 7- to 12-year-old child bases right and wrong on a good-boy or good-girl orientation in which the child conforms to rules to please others and avoid disapproval. D Parents determine right and wrong for the child younger than 4 years of age.

A mother tells the nurse that she is discontinuing breastfeeding her 5-month-old infant. The nurse should recommend that the infant be given a. Skim milk b. Whole cow's milk c. Commercial iron-fortified formula d. Commercial formula without iron

ANS: C Feedback A Cow's milk should not be used in children younger than 12 months. B Cow's milk should not be used in children younger than 12 months. C For children younger than 1 year, the American Academy of Pediatrics recommends the use of breast milk. If breastfeeding has been discontinued, then iron-fortified commercial formula should be used. D Maternal iron stores are almost depleted by this age; the iron-fortified formula will help prevent the development of iron-deficiency anemia.

Which factor has the greatest influence on child growth and development? a. Culture b. Environment c. Genetics d. Nutrition

ANS: C Feedback A Culture is a significant factor that influences how children grow toward adulthood. Culture influences both growth and development but does not eliminate inborn genetic influences. B Environment has a significant role in determining growth and development both before and after birth. The environment can influence how and to which extent genetic traits are manifested, but environmental factors cannot eliminate the effect of genetics. C Genetic factors (heredity) determine each individual's growth and developmental rate. Although factors such as environment, culture, nutrition, and family can influence genetic traits, they do not eliminate the effect of the genetic endowment, which is permanent. D Nutrition is critical for growth and plays a significant role throughout childhood.

When interviewing the mother of a 3-year-old child, the nurse asks about developmental milestones such as the age of walking without assistance. This should be considered a. Unnecessary information, because the child is 3 years old b. An important part of the family history c. An important part of the child's past growth and development d. An important part of the child's review of systems

ANS: C Feedback A Developmental milestones provide important information about the child's physical, social, and neurologic health. B The developmental milestones are specific to this child. If pertinent, attainment of milestones by siblings should be included in the family history. C Information about the attainment of developmental milestones is important to obtain. It provides data about the child's growth and development that should be included in the history. D The review of systems does not include the developmental milestones.

Which is the most appropriate question to ask when interviewing an adolescent to encourage conversation? a. "Are you in school?" b. "Are you doing well in school?" c. "How is school going for you?" d. "How do your parents feel about your grades?"

ANS: C Feedback A Direct questions with "yes" or "no" answers do not encourage conversation. B Direct questions that can be interpreted as judgmental do not enhance communication. C Open-ended questions encourage communication. D Asking adolescents about their parents' feelings may block communication.

Why do peer relationships become more important during adolescence? a. Adolescents dislike their parents. b. Adolescents no longer need parental control. c. They provide adolescents with a feeling of belonging. d. They promote a sense of individuality in adolescents.

ANS: C Feedback A During adolescence, the parent/child relationship changes from one of protection-dependency to one of mutual affection and quality. B Parents continue to play an important role in the personal and health-related decisions. C The peer group serves as a strong support to teenagers, providing them with a sense of belonging and a sense of strength and power. D The peer group forms the transitional world between dependence and autonomy.

At what age is an infant first expected to locate an object hidden from view? a. 4 months of age b. 6 months of age c. 9 months of age d. 20 months of age

ANS: C Feedback A Four-month-old infants are not cognitively capable of searching out objects hidden from their view. Infants at this developmental level do not pursue hidden objects. B Six-month-old infants have not developed the ability to perceive objects as permanent and do not search out objects hidden from their view. C By 9 months of age, an infant will actively search for an object that is out of sight. D Twenty-month-old infants actively pursue objects not in their view and are capable of recalling the location of an object not in their view. They first look for hidden objects around age 9 months.

In general, the earliest age at which puberty begins is ____ years in girls and _____ years in boys. a. 13; 13 b. 11; 11 c. 10; 12 d. 12; 10

ANS: C Feedback A Girls and boys do not usually begin puberty at the same age; girls usually begin earlier than boys. B Girls and boys do not usually begin puberty at the same age; girls usually begin earlier than boys. C Puberty signals the beginning of the development of secondary sex characteristics. This begins in girls earlier than in boys. Usually, there is a 2-year difference in the age at onset. D Girls and boys do not usually begin puberty at the same age; girls usually begin earlier than boys.

The nurse is performing a comprehensive physical examination on a young child in the hospital. At what age can the nurse expect a child's head and chest circumferences to be almost equal? a. Birth b. 6 months c. 1 year d. 3 years

ANS: C Feedback A Head circumference is larger than chest circumference until approximately 12 months of age. B Chest circumference is smaller than head circumference until approximately 1 year of age. C Head and chest measurements are almost equal at 1 year of age. D By 3 years of age, the chest circumference exceeds the head circumference.

Which statement by the nurse is most appropriate to a 15-year-old whose friend has mentioned suicide? a. "Tell your friend to come to the clinic immediately." b. "You need to gather details about your friend's suicide plan." c. "Your friend's threat needs to be taken seriously, and immediate help for your friend is important." d. "If your friend mentions suicide a second time, you will want to get your friend some help."

ANS: C Feedback A Instructing a 15-year-old to tell a friend to come to the clinic immediately provides the teen with limited information and does not address the concern. B It is important to determine whether a person threatening suicide has a plan of action; however, the best information for the 15-year-old to have is that all threats of suicide should be taken seriously and immediate help is important. C Suicide is the third most common cause of death among American adolescents. A suicide threat from an adolescent serves as a dramatic message to others and should be taken seriously. Adolescents at risk should be targeted for supportive guidance and counseling before a crisis occurs. D It is imperative that help is provided immediately for a teenager who is talking about suicide. Waiting until the teen discusses it a second time may be too late.

The parents of a newborn infant state, "We will probably not have our baby immunized because we are concerned about the risk of our child being injured." What is the nurse's best response? a. "It is your decision." b. "Have you talked with your parents about this? They can probably help you think about this decision." c. "The risks of not immunizing your baby are greater than the risks from the immunizations." d. "You are making a mistake."

ANS: C Feedback A It is the parents' decision not to immunize the child; however, the nurse has a responsibility to inform parents about the risks to infants who are not immunized. B Grandparents can be supportive but are not the primary decision makers for the infant. C Although immunizations have been documented to have a negative effect in a small number of cases, an unimmunized infant is at greater risk for development of complications from childhood diseases than from the vaccines. D Telling parents that they are making a mistake is an inappropriate response.

A 2-month-old child has not received any immunizations. Which immunizations should the nurse give? a. DTaP, Hib, HepB, MCV, varicella b. DTaP, Hib, HepB, HPV, IPV, Rota c. DTaP, Hib, HepB, PCV, Rota d. DTaP, Hib, HepB, PCV, HepA

ANS: C Feedback A Meningococcal vaccine should be administered to children at 11 to 12 years of age. B Human papillomavirus vaccine is administered to adolescent girls only. C DTaP, Hib, HepB, PCV, IPV, and Rota are appropriate immunizations for an unimmunized 2-month-old child. D HepA is recommended for all children at 1 year of age.

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 a. Behavior that encourages bullying and sexism b. Behavior that reinforces poor peer relationships c. Characteristic of social development of this age d. Characteristic of children who later are at risk for membership in gangs

ANS: C Feedback A Peer-group identification and association are essential to a child's socialization. Poor relationships with peers and a lack of group identification can contribute to bullying. B Peer-group identification and association are essential to a child's socialization. Poor relationships with peers and a lack of group identification can contribute to bullying. C One of the outstanding characteristics of middle childhood is the creation of formalized groups or clubs. D A boys-only club does not have a direct correlation with later gang activity.

When meeting a toddler for the first time, the nurse initiates contact by a. Calling the toddler by name and picking the toddler up b. Asking the toddler for her first name c. Kneeling in front of the toddler and speaking softly to the child d. Telling the toddler that you are her nurse

ANS: C Feedback A Picking a toddler up at an initial meeting is a threatening action and will more likely result in a negative response from the child. B Toddlers are unlikely to respond to direct questions at a first meeting. C More positive interactions occur when the toddler perceives the meeting in a nonthreatening way. Placing yourself at the toddler's level and speaking softly can be less threatening for the child. D Telling the toddler you are the nurse is not likely to facilitate or encourage cooperation. The toddler perceives you as a stranger and will find the action threatening.

What does the nurse need to know when observing a chronically ill child at play? a. Play is not important to hospitalized children. b. Children need to have structured play periods. c. Children's play is a form of communication. d. Play is to be discouraged because it tires hospitalized children.

ANS: C Feedback A Play is important to all children in all environments. Play for children is a mechanism for mastering their environment. B Although children's play activities appear to be unorganized and at times chaotic, play has purpose and meaning. Imposing structure on play interferes with the tasks being worked on. C Play for all children is an activity woven with meaning and purpose. For chronically ill children, play can indicate their state of wellness and response to treatment. It is a way to express joy, fear, anxiety, and disappointments. D Children who have fewer energy reserves still require play. For these children, less-active play activities will be important.

The parents of a 14-year-old girl are concerned that their adolescent spends too much time looking in the mirror. Which statement is the most appropriate for the nurse to make? a. "Your teenager needs clearer and stricter limits about her behavior." b. "Your teenager needs more responsibility at home." c. "During adolescence this behavior is not unusual." d. "The behavior is abnormal and needs further investigation."

ANS: C Feedback A Stricter limits are not an appropriate response for a behavior that is part of normal development. B More responsibility at home is not an appropriate response for this situation. C Egocentric and narcissistic behavior is normal during this period of development. The teenager is seeking a personal identity. D The behavior is normal and needs no further investigation.

The nurse is explaining Tanner staging to an adolescent and her mother. Which statement best describes Tanner staging? a. Predictable stages of puberty that are based on chronologic age b. Staging of puberty based on the initiation of menarche and nocturnal emissions c. Predictable stages of puberty that are based on primary and secondary sexual characteristics d. Staging of puberty based on the initiation of primary sexual characteristics

ANS: C Feedback A Tanner stages are not based on chronologic age. The age at which an adolescent enters puberty is variable. B The puberty stage in girls begins with breast development. Puberty stage in boys begins with genital enlargement. C Tanner sexual-maturing ratings are based on the development of stages of primary and secondary sexual characteristics. D Primary sexual characteristics are not the basis of Tanner staging.

In providing anticipatory guidance to parents whose child will soon be entering kindergarten, which is a critical factor in preparing a child for kindergarten entry? a. The child's ability to sit still b. The child's sense of learned helplessness c. The parent's interactions and responsiveness to the child d. Attending a preschool program

ANS: C Feedback A The child's ability to sit still is important to learning; however, parental responsiveness and involvement are more important factors. B Learned helplessness is the result of a child feeling that he or she has no effect on the environment and that his or her actions do not matter. Parents who are actively involved in a supportive learning environment will demonstrate a more positive approach to learning. C Interactions between the parent and child are an important factor in the development of academic competence. Parental encouragement and support maximize a child's potential. D Preschool and daycare programs can supplement the developmental opportunities provided by parents at home, but they are not critical in preparing a child for entering kindergarten.

Which is a priority in counseling parents of a 6-month-old infant? a. Increased appetite from secondary growth spurt b. Encouraging the infant to smile c. Securing a developmentally safe environment for the infant d. Strategies to teach infants to sit up

ANS: C Feedback A The infant's appetite and growth velocity decrease in the second half of infancy. B Although a social smile should be present by 6 months of age, encouraging this is not of higher priority than ensuring environmental safety. C Safety is a primary concern as an infant becomes increasingly mobile. D Unless the infant has a neuromuscular deficit, strategies for teaching a normally developing infant to sit up are not necessary.

An 8-year-old girl asks the nurse how the blood pressure apparatus works. The most appropriate nursing action is to a. Ask her why she wants to know. b. Determine why she is so anxious. c. Explain in simple terms how it works. d. Tell her she will see how it works as it is used.

ANS: C Feedback A The nurse should respond positively for requests for information about procedures and health information. By not responding, the nurse may be limiting communication with the child. B The child is not exhibiting anxiety, just requesting clarification of what will be occurring. C School-age children require explanations and reasons for everything. They are interested in the functional aspect of all procedures, objects, and activities. It is appropriate for the nurse to explain how equipment works and what will happen to the child. D The nurse must explain how the blood pressure cuff works so that the child can then observe during the procedure.

The nurse is planning a teaching session for a young child and her parents. According to Piaget's theory, the period of cognitive development in which the child is able to distinguish between concepts related to fact and fantasy, such as human beings are incapable of flying like birds, is the _______ period of cognitive development. a. Sensorimotor b. Formal operations c. Concrete operations d. Preoperational

ANS: C Feedback A The sensorimotor stage occurs in infancy and is a period of reflexive behavior. During this period, the infant's world becomes more permanent and organized. The stage ends with the infant demonstrating some evidence of reasoning. B Formal operations is a period in development in which new ideas are created through previous thoughts. Analytic reason and abstract thought emerge in this period. C Concrete operations is the period of cognitive development in which children's thinking is shifted from egocentric to being able to see another's point of view. They develop the ability to distinguish fact from fantasy. D The preoperational stage is a period of egocentrism in which the child's judgments are illogical and dominated by magical thinking and animism.

According to Piaget, the 6-month-old infant is in what stage of the sensorimotor phase? a. Use of reflexes b. Primary circular reactions c. Secondary circular reactions d. Coordination of secondary schemata

ANS: C Feedback A The use of reflexes is primarily during the first month of life. B Primary circular reaction stage marks the replacement of reflexes with voluntary acts. The infant is in this stage from age 1 month to 4 months. C Infants are usually in the secondary circular reaction stage from age 4 months to 8 months. This stage is characterized by a continuation of the primary circular reaction because of the response that results. Shaking is performed to hear the noise of the rattle, not just for shaking. D The fourth sensorimotor stage is coordination of secondary schemata. This is a transitional stage in which increasing motor skills enable greater exploration of the environment.

What heart sound is produced by vibrations within the heart chambers or in the major arteries from the back-and-forth flow of blood? a. S1, S2 b. S3, S4 c. Murmur d. Physiologic splitting

ANS: C Feedback A These are normal heart sounds. S1 is the closure of the tricuspid and mitral valves, and S2 is the closure of the pulmonic and aortic valves. B S3 is a normal heart sound sometimes heard in children. S4 is rarely heard as a normal heart sound. If heard, medical evaluation is required. C Murmurs are the sounds that are produced in the heart chambers or major arteries from the purulence of blood flow. Murmurs create a blowing and swooshing sound. D Physiologic splitting is the distinction of the two sounds in S2, which widens on inspiration. It is a significant normal finding.

15. What is the drug of choice the nurse should administer in the acute treatment of anaphylaxis? a. Diphenhydramine b. Histamine inhibitor (cimetidine) c. Epinephrine d. Albuterol

ANS: C A. Although diphenhydramine may be indicated, epinephrine is the first drug of choice in the immediate treatment of anaphylaxis. B. Although a histamine inhibitor such as cimetidine may be indicated, epinephrine is the first drug of choice in immediate treatment of anaphylaxis. C. Epinephrine is the first drug of choice in immediate treatment of anaphylaxis. Treatment must be initiated immediately because it may only be a matter of minutes before shock occurs. D. Albuterol is not usually indicated for treatment of anaphylaxis.

11. Which statement by a mother about antiretroviral agents for the management for her 5-year-old child with acquired immunodeficiency syndrome (AIDS) indicates that she has a good understanding? a. "When my child's pain increases, I double the recommended dosage of antiretroviral medication." b. "Addiction is a risk, so I only use the medication as ordered." c. "Doses of the antiretroviral medication are selected on the basis of my child's age and growth." d. "By the time my child is an adolescent she will not need her antiretroviral medications any longer."

ANS: C A. Antiretroviral medications are not administered for pain relief. Doubling the recommended dosage of any medication is not appropriate without an order from the physician. B. Addiction is not a realistic concern with antiretroviral medications. C. Doses of antiretroviral medication to treat HIV infection for infants and children are based on individualized age and growth considerations. D. Antiretroviral medications are still needed during adolescence. Doses for adolescents are based on pubertal status by Tanner staging.

12. Which intervention is appropriate for a child receiving high doses of steroids? a. Limit activity and receive home schooling. b. Decrease the amount of potassium in the diet. c. Substitute a killed virus vaccine for live virus vaccines. d. Monitor for seizure activity.

ANS: C A. Limiting activity and home schooling are not routine for a child receiving high doses of steroids. B. The child receiving steroids is at risk for hypokalemia and needs potassium in the diet. C. The child on high doses of steroids should not receive live virus vaccines because of immunosuppression. D. Children on steroids are not typically at risk for seizures.

9. What should the nurse include in a teaching plan for the mother of a toddler who will be taking prednisone for several months? a. The medication should be taken between meals. b. The medication needs to be discontinued because of the risks associated with long-term usage. c. The medication should not be stopped abruptly. d. The medication may lower blood glucose, so the mother needs to observe for signs of hypoglycemia.

ANS: C A. Prednisone should be taken with food to minimize or prevent gastrointestinal bleeding. B. Although there are adverse effects from long-term steroid use, the medication must not be discontinued without consulting a physician. Acute adrenal insufficiency can occur if the medication is withdrawn abruptly. The dosage needs to be tapered. C. The dosage must be tapered before the drug is discontinued to allow the gradual return of function in the pituitary-adrenal axis. D. The medication puts the child at risk for hyperglycemia.

16. What 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 A. Wiskott-Aldrich syndrome is not a viral illness. B. Idiopathic thrombocytopenic purpura is not a viral illness. C. Acquired immune deficiency is caused by the human immunodeficiency virus (HIV), which primarily attacks the CD4+ T cells. D. Severe combined immunodeficiency disease is not a viral illness.

What is the best nursing action when a child with type 1 diabetes mellitus is sweating, trembling, and pale? a. Offer the child a glass of water. b. Give the child 5 units of regular insulin subcutaneously. c. Give the child a glass of orange juice. d. Give the child glucagon subcutaneously.

ANS: C Feedback A A glass of water is not indicated in this situation. An easily digested carbohydrate is indicated when a child exhibits symptoms of hypoglycemia. B Insulin would lower blood glucose and is contraindicated for a child with hypoglycemia. C Four ounces of orange juice is an appropriate treatment for the conscious child who is exhibiting signs of hypoglycemia. D Subcutaneous injection of glucagon is used to treat hypoglycemia when the child is unconscious.

What is the best response to a parent who asks the nurse whether her 5-month-old infant can have cow's milk? a. "You need to wait until she is 8 months old and eating solids well." b. "Yes, if you think that she will eat enough meat to get the iron she needs." c. "Infants younger than 12 months need iron-rich formula to get the iron they need." d. "Try it and see how she tolerates it."

ANS: C Feedback A A 5-month-old infant cannot get adequate iron without drinking an iron-fortified formula or taking an iron supplement. B The American Academy of Pediatrics recommends beginning solid foods at 4 to 6 months of age. Meats are typically introduced in later infancy. Iron-fortified formula is still recommended. C Infants younger than 12 months need iron-fortified formula or breast milk. Infants who drink cow's milk do not get adequate iron and are at risk for iron deficiency anemia. D Counseling a parent to give a 5-month-old infant cow's milk is inappropriate.

A nurse determines that parents understood the teaching from the pediatric oncologist if the parents indicate that which test confirms the diagnosis of leukemia in children? a. Complete blood cell count (CBC) b. Lumbar puncture c. Bone marrow biopsy d. Computed tomography (CT) scan

ANS: C Feedback A A CBC may show blast cells that would raise suspicion of leukemia. It is not a confirming diagnostic study. B A lumbar puncture is done to check for central nervous system involvement in the child who has been diagnosed with leukemia. C The confirming test for leukemia is microscopic examination of bone marrow obtained by bone marrow aspiration and biopsy. D A CT scan may be done to check for bone involvement in the child with leukemia. It does not confirm a diagnosis.

What goal has the highest priority for a child with malabsorption associated with lactose intolerance? a. The child will experience no abdominal spasms. b. The child will not experience constipation associated with malabsorption syndrome. c. The child will not experience diarrhea associated with malabsorption syndrome. d. The child will receive adequate nutrition as evidenced by a weight gain of 1 kg/day

ANS: C Feedback A A child usually has abdominal cramping pain and distention rather than spasms. B The child usually has diarrhea, not constipation. C This goal is correct for a child with malabsorption associated with lactose intolerance. D One kilogram a day is too much weight gain with no time parameters.

Which statement is accurate concerning a child's musculoskeletal system and how it may be different from an adult's? a. Growth occurs in children as a result of an increase in the number of muscle fibers. b. Infants are at greater risk for fractures because their epiphyseal plates are not fused. c. Because soft tissues are resilient in children, dislocations and sprains are less common than in adults. d. Their bones have less blood flow.

ANS: C Feedback A A child's growth occurs because of an increase in size rather than an increase in the number of the muscle fibers. B This is not a true statement. Fractures in children younger than 1 year are unusual because a large amount of force is necessary to fracture their bones. C Because soft tissues are resilient in children, dislocations and sprains are less common than in adults. This is an accurate statement. D A child's bones have greater blood flow than an adult's bones.

Nursing care of the infant who has had a myelomeningocele repair should include a. Securely fastening the diaper b. Measurement of pupil size c. Measurement of head circumference d. Administration of seizure medications

ANS: C Feedback A A diaper should be placed under the infant but not fastened. Keeping the diaper open facilitates frequent cleaning and decreases the risk for skin breakdown. B Pupil size measurement is usually not necessary. C Head circumference measurement is essential because hydrocephalus can develop in these infants. D Seizure medications are not routinely given to infants who do not have seizures.

What fluid is the best choice when a child with mucositis asks for something to drink? a. Hot chocolate b. Lemonade c. Popsicle d. Orange juice

ANS: C Feedback A A hot beverage can be irritating to mouth ulcers. B Citrus products may be very painful to an ulcerated mouth. C Cool liquids are soothing and ice pops are usually well tolerated. D Citrus products may be very painful to an ulcerated mouth

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. MRI

ANS: C Feedback A A nuclear brain scan uses a radioisotope that accumulates where the blood-brain barrier is defective. B Echoencephalography identifies shifts in midline structures of the brain as a result of intracranial lesions. C A CT scan provides a visualization of the horizontal and vertical cross sections of the brain at any axis. D MRI permits visualization of morphologic features of target structures and permits tissue discrimination that is unavailable with any other techniques.

What maternal assessment is related to an infant's diagnosis of TEF? a. Maternal age more than 40 years b. First term pregnancy for the mother c. Maternal history of polyhydramnios d. Complicated pregnancy

ANS: C Feedback A Advanced maternal age is not a risk factor for TEF. B The first term pregnancy is not a risk factor for an infant with TEF. C A maternal history of polyhydramnios is associated with TEF. D Complicated pregnancy is not a risk factor for TEF.

In counseling an adolescent who is abusing alcohol, the nurse explains that alcohol abuse primarily affects which organ of the body? a. Heart b. Liver c. Brain d. Lungs

ANS: C Feedback A Although an excessive amount of a chemical can cause cardiac abnormalities, the brain is the most commonly affected organ. B Long-term alcohol use is known to impair the liver; however, brain function is decreased by any amount of alcohol intake. C The primary effect of substance abuse is on the brain and residually on the rest of the body. Alcohol affects the entire brain by decreasing its responsiveness. D The pulmonary system is not the primary target; however, one commonly abused drug known to cause pulmonary problems is tobacco.

The child with Down syndrome should be evaluated for which condition before participating in some sports? a. Hyperflexibility b. Cutis marmorata c. Atlantoaxial instability d. Speckling of iris (Brushfield spots)

ANS: C Feedback A Although hyperflexibility is characteristic of Down syndrome, it does not affect the child's ability to participate in sports. B Although cutis marmorata is characteristic of Down syndrome, it does not affect the child's ability to participate in sports. C Children with Down syndrome are at risk for atlantoaxial instability. Before participating in sports that put stress on the head and neck, a radiologic examination should be done. D Although Brushfield spots are characteristic of Down syndrome, they do not affect the child's ability to participate in sports.

What is an appropriate nursing intervention for the child with a tension headache? a. Assess for an aura. b. Maintain complete bed rest. c. Administer pharmacologic headache relief measures. d. Assess for nausea and vomiting.

ANS: C Feedback A An aura is associated with migraines but not with tension headaches. B Complete bed rest is not required. C Administration of pharmacologic techniques is appropriate to assist in the management of a tension headache. D Nausea and vomiting are associated with a migraine but not with tension headaches.

What is a priority concern for a 14-year-old child with inflammatory bowel disease? a. Compliance with antidiarrheal medication therapy b. Long-term complications c. Dealing with the embarrassment and stress of diarrhea d. Home schooling

ANS: C Feedback A Antidiarrheal medications are not typically ordered for a child with inflammatory bowel disease. B Long-term complications are not a priority concern for the adolescent with inflammatory bowel disease. C Embarrassment and stress from chronic diarrhea are real concerns for the adolescent with inflammatory bowel disease. D Exacerbations may interfere with school attendance, but home schooling is not a usual consideration for the adolescent with inflammatory bowel disease.

A mother calls the emergency department nurse because her child was stung by a scorpion. The nurse should recommend a. Administering antihistamine b. Cleansing with soap and water c. Keeping child quiet and come to emergency department d. Removing stinger and apply cool compresses

ANS: C Feedback A Antihistamines are not effective against scorpion venom. B The wound will have intense local pain. Emergency treatment is indicated. C Venomous species of scorpions inject venom that contains hemolysins, endotheliolysins, and neurotoxins. The absorption of the venom is delayed by keeping the child quiet and the involved area in dependent position. D The wound will have intense local pain. Emergency treatment is indicated.

When providing education for the parents of a child with Duchenne muscular dystrophy, the nurse plans to include a. Testing all female children for the disease b. Testing the father for the presence of the trait on the Y chromosome c. Genetic counseling for all female children d. Testing the parents to determine the carrier

ANS: C Feedback A Because it is a recessive X-linked disorder, females can only be carriers and do not have the disease. B The disease is an X-linked recessive disorder and would not be found on the Y chromosome. C Duchenne muscular dystrophy is a recessive sex-linked disease carried on the X chromosome, so only males are affected with the disease. D The disease is a recessive X-linked disease and is always carried by the mother.

When assessing a child for possible congenital heart defects (CHDs), where should the nurse measure blood pressure? a. The right arm b. The left arm c. All four extremities d. Both arms while the child is crying

ANS: C Feedback A Blood pressure measurements for upper and lower extremities are compared during an assessment for CHDs. B Discrepancies in blood pressure between the upper and lower extremities cannot be determined if blood pressure is not measured in all four extremities. C When a CHD is suspected, the blood pressure should be measured in all four extremities while the child is quiet. Discrepancies between upper and lower extremities may indicate cardiac disease. D Blood pressure measurements when the child is crying are likely to be elevated; thus the readings will be inaccurate. Also, all four extremities need to be measured.

Which assessment is most relevant to the care of an infant with dehydration? a. Temperature, heart rate, and blood pressure. b. Respiratory rate, oxygen saturation, and lung sounds. c. Heart rate, sensorium, and skin color. d. Diet tolerance, bowel function, and abdominal girth.

ANS: C Feedback A Children can compensate and maintain an adequate cardiac output when they are hypovolemic. Blood pressure is not as reliable an indicator of shock as are changes in heart rate, sensorium, and skin color. B Respiratory assessments will not provide data about impending hypovolemic shock. C Changes in heart rate, sensorium, and skin color are early indicators of impending shock in the child. D Diet tolerance, bowel function, and abdominal girth are not as important indicators of shock as heart rate, sensorium, and skin color.

How should the nurse respond when asked by the mother of a child with beta-thalassemia why the child is receiving deferoxamine? a. "To improve the anemia." b. "To decrease liver and spleen swelling." c. "To eliminate excessive iron being stored in the organs." d. "To prepare your child for a bone marrow transplant."

ANS: C Feedback A Chronic transfusion therapy is the treatment for anemia. Deferoxamine is administered to prevent complications from repeated transfusions. B Deferoxamine is used to prevent organ damage, not as a treatment for existing conditions such as hepatosplenomegaly. C Multiple transfusions result in hemosiderosis. Deferoxamine is given to chelate iron and prevent organ damage. D Preparation for a bone marrow transplant does not include administration of deferoxamine.

Therapeutic management of the child with acute diarrhea and dehydration usually begins with a. Clear liquids b. Adsorbents, such as kaolin and pectin c. Oral rehydration solution (ORS) d. Antidiarrheal medications such as paregoric

ANS: C Feedback A Clear liquids are not recommended because they contain too much sugar, which may contribute to diarrhea. B Adsorbents are not recommended. C Orally administered rehydration solution is the first treatment for acute diarrhea. D Antidiarrheals are not recommended because they do not get rid of pathogens.

What is the most important information to be included in the discharge planning for an infant with gastroesophageal reflux? a. Teach parents to position the infant on the left side. b. Reinforce the parents' knowledge of the infant's developmental needs. c. Teach the parents how to do infant cardiopulmonary resuscitation (CPR). d. Have the parents keep an accurate record of intake and output.

ANS: C Feedback A Correct positioning minimizes aspiration. The correct position for the infant is on the right side after feeding and supine for sleeping. B Knowledge of developmental needs should be included in discharge planning for all hospitalized infants, but it is not the most important in this case. C Risk of aspiration is a priority nursing diagnosis for the infant with gastroesophageal reflux. The parents must be taught infant CPR. D Keeping a record of intake and output is not a priority and may not be necessary.

Treatment for herpes simplex virus (types 1 or 2) includes a. Corticosteroids b. Oral griseofulvin c. Oral antiviral agent d. Topical and/or systemic antibiotic

ANS: C Feedback A Corticosteroids are not effective for viral infections. B Griseofulvin is an antifungal agent and not effective for viral infections. C Oral antiviral agents are effective for viral infections such as herpes simplex. D Antibiotics are not effective in viral diseases.

An important nursing consideration when caring for a child with impetigo contagiosa is to a. Apply topical corticosteroids to decrease inflammation. b. Carefully remove dressings so as not to dislodge undermined skin, crusts, and debris. c. Carefully wash hands and maintain cleanliness when caring for an infected child. d. Examine child under a Wood lamp for possible spread of lesions.

ANS: C Feedback A Corticosteroids are not indicated in bacterial infections. B Dressings are usually not indicated. The undermined skin, crusts, and debris are carefully removed after softening with moist compresses. C A major nursing consideration related to bacterial skin infections, such as impetigo contagiosa, is to prevent the spread of the infection and complications. This is done by thorough handwashing before and after contact with the affected child. D A Wood lamp is used to detect fluorescent materials in the skin and hair. It is used in certain disease states, such as tinea capitis.

What should the nurse include in the teaching plan for parents of a child with diabetes insipidus who is receiving DDAVP? a. Increase the dosage of DDAVP as the urine specific gravity (SG) increases. b. Give DDAVP only if urine output decreases. c. The child should have free access to water and toilet facilities at school. d. Cleanse skin before administering the transdermal patch.

ANS: C Feedback A DDAVP needs to be given as ordered by the physician. If the parents are monitoring urine SG at home, they would not increase the medication dose for increased SG; the physician may order an increased dosage for very dilute urine with decreased SG. B DDAVP needs to be given continuously as ordered by the physician. C The child's teachers should be aware of the diagnosis, and the child should have free access to water and toilet facilities at school. D DDAVP is typically given intranasally or by subcutaneous injection. For nocturnal enuresis, it may be given orally.

What is a priority intervention in planning care for the child with disseminated intravascular coagulation (DIC)? a. Hospitalization at the first sign of bleeding b. Teaching the child relaxation techniques for pain control c. Management in the intensive care unit d. Provision of adequate hydration to prevent complications

ANS: C Feedback A DIC typically develops in a child who is already hospitalized. B Relaxation techniques and pain control are not high priorities for the child with DIC. C The child with DIC is seriously ill and needs to be monitored in an intensive care unit. D Hydration is not the major concern for the child with DIC.

Which intervention for treating croup at home should be taught to parents? a. Have a decongestant available to give the child when an attack occurs. b. Have the child sleep in a dry room. c. Take the child outside. d. Give the child an antibiotic at bedtime.

ANS: C Feedback A Decongestants are inappropriate for croup, which affects the middle airway level. B A dry environment may contribute to symptoms. C Taking the child into the cool, humid, night air may relieve mucosal swelling and improve symptoms. D Croup is caused by a virus. Antibiotic treatment is not indicated.

A nurse has admitted a child to the hospital with a diagnosis of "rule out" peptic ulcer disease. Which test will the nurse expect to be ordered to confirm the diagnosis of a peptic ulcer? a. A dietary history b. A positive Hematest result on a stool sample c. A fiberoptic upper endoscopy d. An abdominal ultrasound

ANS: C Feedback A Dietary history may yield information suggestive of a peptic ulcer, but the diagnosis is confirmed through endoscopy. B Blood in the stool indicates a gastrointestinal abnormality, but it does not conclusively confirm a diagnosis of peptic ulcer. C Endoscopy provides direct visualization of the stomach lining and confirms the diagnosis of peptic ulcer. D An abdominal ultrasound is used to rule out other gastrointestinal alterations such as gallstones, tumor, or mechanical obstruction.

What best describes a full-thickness (third-degree) burn? a. Erythema and pain b. Skin showing erythema followed by blister formation c. Destruction of all layers of skin evident with extension into subcutaneous tissue d. Destruction injury involving underlying structures such as muscle, fascia, and bone

ANS: C Feedback A Erythema and pain are characteristic of a first-degree burn or superficial burn. B Erythema with blister formation is characteristic of a second-degree or partial-thickness burn. C A third-degree or full-thickness burn is a serious injury that involves the entire epidermis and dermis and extends into the subcutaneous tissues. D A fourth-degree burn is a full-thickness burn that also involves underlying structures such as muscle, fascia, and bone.

What assessment should the nurse make before initiating an intravenous (IV) infusion of dextrose 5% in 0.9% normal saline solution with 10 mEq of potassium chloride for a child hospitalized with dehydration? a. Fluid intake b. Number of stools c. Urine output d. Capillary refill

ANS: C Feedback A Fluid intake does not give information about renal function. B Stool count sheds light on intestinal function. Renal function is the concern before potassium chloride is added to an IV solution. C Potassium chloride should never be added to an IV solution in the presence of oliguria or anuria (urine output less than 0.5 mL/kg/hr). D Assessment of capillary refill does not provide data about renal function.

Which type of seizures involves both hemispheres of the brain? a. Focal b. Partial c. Generalized d. Acquired

ANS: C Feedback A Focal seizures may arise from any area of the cerebral cortex, but the frontal, temporal, and parietal lobes are most commonly affected. B Partial seizures are caused by abnormal electric discharges from epileptogenic foci limited to a circumscribed region of the cerebral cortex. C Clinical observations of generalized seizures indicate that the initial involvement is from both hemispheres. D 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.

Which statement best describes Fragile X syndrome? a. Chromosomal defect affecting only females b. Chromosomal defect that follows the pattern of X-linked recessive disorders c. Second most common genetic cause of cognitive impairment d. Most common cause of noninherited cognitive impairment

ANS: C Feedback A Fragile X primarily affects males. B Fragile X follows the pattern of X-linked dominant with reduced manifestation of the syndrome in female and moderate to severe dysfunction in males. C Fragile X syndrome is the most common inherited cause of cognitive impairment and the second most common cause of cognitive impairment after Down syndrome. D Fragile X is inherited.

Which viral pathogen frequently causes acute diarrhea in young children? a. Giardia organisms b. Shigella organisms c. Rotavirus d. Salmonella organisms

ANS: C Feedback A Giardia is a bacterial pathogen that causes diarrhea. B Shigella is a bacterial pathogen that is uncommon in the United States. C Rotavirus is the most frequent viral pathogen that causes diarrhea in young children. D Salmonella is a bacterial pathogen that causes diarrhea

With what beverage should the parents of a child with ringworm be taught to give griseofulvin? a. Water b. A carbonated drink c. Milk d. Fruit juice

ANS: C Feedback A Griseofulvin is insoluble in water. B Carbonated drinks do not contain fat, which aids in the absorption of griseofulvin. C Griseofulvin is insoluble in water. Giving the medication with a high-fat meal or milk increases absorption. D Fruit juice does not contain any fat; fat aids absorption of the medication.

Which finding confirms a diagnosis of cystic fibrosis? a. Chest radiograph shows alveolar hyperinflation. b. Stool analysis indicates significant amounts of fecal fat. c. Sweat chloride is greater than 60 mEq/L. d. Liver function levels are abnormal.

ANS: C Feedback A Hyperinflation is one of the first findings on a chest radiograph of a child with cystic fibrosis. It does not confirm a diagnosis. B A 72-hour fecal fat determination may be included in a diagnostic workup. Inability to secrete digestive enzymes causes steatorrhea. C The diagnosis of cystic fibrosis requires a positive sweat test. A chloride level greater than 60 mEq/L is considered diagnostic for cystic fibrosis. D Liver function tests may be part of the diagnostic workup for cystic fibrosis.

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 Feedback A If the child has these clinical signs, they should be immediately reported for evaluation. B If the child has these clinical signs, they should be immediately reported for evaluation. C The parents are advised of probable posttraumatic symptoms. These include behavioral changes and sleep disturbances. D If the child has these clinical signs, they should be immediately reported for evaluation.

A small child with cystic fibrosis cannot swallow pancreatic enzyme capsules. The nurse should teach parents to mix enzymes with: a. Macaroni and cheese b. Tapioca c. Applesauce d. Hot chocolate

ANS: C Feedback A Macaroni and cheese is not a good choice because enzymes are inactivated by heat and starchy foods. B Tapioca is not a good choice because enzymes are inactivated by starchy foods. C Enzymes can be mixed with a small amount of nonacidic foods. D Enzymes are less effective if mixed with foods that are hot.

The mother of an infant with multiple anomalies tells the nurse that she had a viral infection in the beginning of her pregnancy. Which viral infection is associated with fetal anomalies? a. Measles b. Roseola c. Rubella d. Herpes simplex virus (HSV)

ANS: C Feedback A Measles is not associated with congenital defects. B Most cases of roseola occur in children 6 to 18 months old. C The rubella virus can cross the placenta and infect the fetus, causing fetal anomalies. D HSV can be transmitted to the newborn infant during vaginal delivery, causing multisystem disease. It is not transmitted transplacentally to the fetus during gestation.

Once an allergen is identified in a child with allergic rhinitis, the treatment of choice about which to educate the parents is a. Using appropriate medications b. Beginning desensitization injections c. Eliminating the allergen d. Removing the adenoids

ANS: C Feedback A Medications are not a first-line treatment but can be helpful in controlling allergic rhinitis. B Immunotherapy is usually the final component of controlling allergic rhinitis. C The first priority is to attempt to remove the causative agent from the child's environment. D Adenoids are tissues that can swell with constant rhinitis; however, a surgical procedure is not indicated for allergic rhinitis. Dealing with the cause is the first priority.

What is the major focus of the therapeutic management for a child with lactose intolerance? a. Compliance with the medication regimen. b. Providing emotional support to family members. c. Teaching dietary modifications. d. Administration of daily normal saline enemas.

ANS: C Feedback A Medications are not typically ordered in the management of lactose intolerance. B Providing emotional support to family members is not specific to this medical condition. C Simple dietary modifications are effective in management of lactose intolerance. Symptoms of lactose intolerance are usually relieved after instituting a lactose-free diet. D Diarrhea is a manifestation of lactose intolerance. Enemas are contraindicated for this alteration in bowel elimination.

The nurse caring for a child with suspected appendicitis should question which order from the physician? a. Keep patient NPO. b. Start IV of D5/0.45 normal saline at 60 mL/hr. c. Apply K-pad to abdomen prn for pain. d. Obtain CBC on admission to nursing unit.

ANS: C Feedback A NPO status is appropriate for the potential appendectomy patient. B An IV is appropriate both as a preoperative intervention and to compensate for the short-term NPO status. C A K-pad (moist heat device) is contraindicated for suspected appendicitis because it may contribute to the rupture of the appendix. D Because appendicitis is frequently reflected in an elevated WBC, laboratory data are needed.

Which child requires a Mantoux test? a. The child who has episodes of nighttime wheezing and coughing b. The child who has a history of allergic rhinitis c. The child whose baby-sitter has received a tuberculosis diagnosis d. The premature infant who is being treated for apnea of infancy

ANS: C Feedback A Nighttime wheezing and coughing are consistent with a diagnosis of asthma. B Allergic rhinitis requires an allergy workup. C The Mantoux test is the initial screening mechanism for patients exposed to tuberculosis. D This infant requires a sleep study as part of the evaluation.

Throughout their life span, cognitively impaired children are less capable of managing environmental challenges and are at risk for a. Nutritional deficits b. Visual impairments c. Physical injuries d. Psychiatric problems

ANS: C Feedback A Nutritional deficits are related more to dietary habits and the caregivers' understanding of nutrition. B Visual impairments are unrelated to cognitive impairment. C Safety is a challenge for cognitively impaired children. Decreased capability to manage environmental challenges may lead to physical injuries. D Psychiatric problems may coexist with cognitive impairment; however, they are not environmental challenges.

The nurse is aware that an abdominal mass found in a 10-month-old infant corresponds with which childhood cancer? a. Osteogenic sarcoma b. Rhabdomyosarcoma c. Neuroblastoma d. Non-Hodgkin lymphoma

ANS: C Feedback A Osteogenic sarcoma is a bone tumor. Bone tumors typically affect older children. B Rhabdomyosarcoma is a malignancy of muscle, or striated tissue. It occurs most often in the periorbital area, in the head and neck in younger children, or in the trunk and extremities in older children. C Neuroblastoma is found exclusively in infants and children. In most cases of neuroblastoma, a primary abdominal mass and protuberant, firm abdomen are present. D Non-Hodgkin lymphoma is a neoplasm of lymphoid cells. Painless, enlarged lymph nodes are found in the cervical or axillary region. Abdominal signs and symptoms do not include a mass.

A nurse is conducting a class for nursing students about fetal circulation. Which statement is accurate about fetal circulation and should be included in the teaching session? a. Oxygen is carried to the fetus by the umbilical arteries. b. Blood from the inferior vena cava is shunted directly to the right ventricle through the foramen ovale. c. Pulmonary vascular resistance is high because the lungs are filled with fluid. d. Blood flows from the ductus arteriosus to the pulmonary artery.

ANS: C Feedback A Oxygen and nutrients are carried to the fetus by the umbilical vein. B The inferior vena cava empties blood into the right atrium. The direction of blood flow and the pressure in the right atrium propel most of this blood through the foramen ovale into the left atrium. C Resistance in the pulmonary circulation is very high because the lungs are collapsed and filled with fluid. D Most of the blood in the pulmonary artery flows though the ductus arteriosus into the descending aorta.

Which statement, if made by parents of a child with cystic fibrosis, indicates that they understood the nurse's teaching on pancreatic enzyme replacement? a. "Enzymes will improve my child's breathing." b. "I should give the enzymes 1 hour after meals." c. "Enzymes should be given with meals and snacks." d. "The enzymes are stopped if my child begins wheezing."

ANS: C Feedback A Pancreatic enzymes do not affect the respiratory system. B Pancreatic enzymes are taken within 30 minutes of eating all meals and snacks. Giving the medication 1 hour after meals is inappropriate and ineffective for absorption of nutrients. C Children with cystic fibrosis need to take enzymes with food for adequate absorption of nutrients. D Wheezing is not a reason to stop taking enzyme replacements.

What clinical manifestation should a nurse be alert for when suspecting a diagnosis of esophageal atresia? a. A radiograph in the prenatal period indicates abnormal development. b. It is visually identified at the time of delivery. c. A nasogastric tube fails to pass at birth. d. The infant has a low birth weight

ANS: C Feedback A Prenatal radiographs do not provide a definitive diagnosis. B The defect is not externally visible. Bronchoscopy and endoscopy can be used to identify this defect. C Atresia is suspected when a nasogastric tube fails to pass 10 to 11 cm beyond the gum line. Abdominal radiographs will confirm the diagnosis. D Infants with esophageal atresia may have been born prematurely and with a low birth weight, but neither is suggestive of the presence of an esophageal atresia.

A nurse is teaching an adolescent about primary hypertension. Which statement made by the adolescent indicates an understanding of primary hypertension? a. Primary hypertension should be treated with diuretics as soon as it is detected. b. Congenital heart defects are the most common cause of primary hypertension. c. Primary hypertension may be treated with weight reduction. d. Primary hypertension is not affected by exercise.

ANS: C Feedback A Primary hypertension is usually treated with weight reduction and exercise. If ineffective, pharmacologic intervention may be needed. B Primary hypertension is considered to be an inherited disorder. C Primary hypertension in children may be treated with weight reduction and exercise programs. D An exercise program in conjunction with weight reduction can be effective in managing primary hypertension in children.

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 Feedback A Pulmonic stenosis is an obstruction to blood flowing from the ventricles. B Tricuspid atresia results in decreased pulmonary blood flow. C The 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. D Transposition of the great arteries results in mixed blood flow.

Which description of a stool is characteristic of intussusception? a. Ribbon-like stools b. Hard stools positive for guaiac c. "Currant jelly" stools d. Loose, foul-smelling stools

ANS: C Feedback A Ribbon-like stools are characteristic of Hirschsprung disease. B With intussusception, passage of bloody mucus stools occurs. Stools will not be hard. C Pressure on the bowel from obstruction leads to passage of "currant jelly" stools. D Loose, foul-smelling stools may indicate infectious gastroenteritis

Which comment by a 12-year-old child with type 1 diabetes indicates deficient knowledge? a. "I rotate my insulin injection sites every time I give myself an injection." b. "I keep records of my glucose levels and insulin sites and amounts." c. "I'll be glad when I can take a pill for my diabetes like my uncle does." d. "I keep Lifesavers in my school bag in case I have a low-sugar reaction."

ANS: C Feedback A Rotating injection sites is appropriate because insulin absorption varies at different sites. B Keeping records of serum glucose and insulin sites and amounts is appropriate. C Children with type 1 diabetes will require life-long insulin therapy. D Prompt treatment of hypoglycemia reduces the possibility of a severe reaction. Keeping hard candy on hand is an appropriate action.

Which sign is the nurse most likely to assess in a child with hypoglycemia? a. Urine positive for ketones and serum glucose greater than 300 mg/dL b. Normal sensorium and serum glucose greater than 160 mg/dL c. Irritability and serum glucose less than 60 mg/dL d. Increased urination and serum glucose less than 120 mg/dL

ANS: C Feedback A Serum glucose greater than 300 mg/dL and urine positive for ketones are indicative of diabetic ketoacidosis. B Normal sensorium and serum glucose greater than 160 mg/dL are associated with hyperglycemia. C Irritability and serum glucose less than 60 mg/dL are neuroglycopenic manifestations of hypoglycemia. D Increased urination is an indicator of hyperglycemia. A serum glucose level less than 120 mg/dL is within normal limits.

What 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 red blood cell destruction occurs

ANS: C Feedback A Sickled red cells have decreased oxygen-carrying capacity and transform into the sickle shape in conditions of low oxygen tension. B When the sickle cells change shape, they increase the viscosity in the area where they are involved in the microcirculation. 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. D Increased red blood cell destruction occurs.

Which statement made by a parent indicates an understanding about treatment of streptococcal pharyngitis? a. "I guess my child will need to have his tonsils removed." b. "A couple of days of rest and some ibuprofen will take care of this." c. "I should give the penicillin three times a day for 10 days." d. "I am giving my child prednisone to decrease the swelling of the tonsils."

ANS: C Feedback A Surgical removal of the tonsils is a controversial issue. It may be warranted in cases of recurrent tonsillitis. It is not indicated for the treatment of acute tonsillitis. B Comfort measures such as rest and analgesics are indicated, but these will not treat the bacterial infection. C Streptococcal pharyngitis is best treated with oral penicillin two to three times daily for 10 days. D Corticosteroids are not used in the treatment of streptococcal pharyngitis.

Children with non-Hodgkin lymphoma are at risk for complications resulting from tumor lysis syndrome (TLS). The nurse should assess for a. Liver failure b. CNS deficit c. Kidney failure d. Respiratory distress

ANS: C Feedback A TLS is related to intracellular electrolytes overloading the kidney as a response to the rapid lysis of tumor cells. This does not affect the liver. B TLS does not affect the CNS. C In TLS, the tumor's intracellular contents are dumped into the child's extracellular fluid as the tumor cells are lysed in response to chemotherapy. Because of the large volume of these cells, their intracellular electrolytes overload the kidneys and, if not monitored, can cause kidney failure. D TLS does not affect the lungs and cause respiratory distress.

Which manifestation is atypical of ADHD? a. Talking incessantly b. Blurting out the answers to questions before the questions have been completed c. Acting withdrawn in social situations d. Fidgeting with hands or feet

ANS: C Feedback A Talking excessively is a characteristic of impulsivity/hyperactivity. B Blurting out the answers to questions before the questions have been completed is an indication of the impulse control that is often lacking in children with ADHD. C The child with ADHD tends to be talkative, often interrupting conversations, rather than withdrawn in social situations. D Fidgeting is typical of the overactivity that is associated with ADHD.

What is the priority nursing goal for a 14-year-old with Graves' disease? a. Relieving constipation b. Allowing the adolescent to make decisions about whether or not to take medication c. Verbalizing the importance of adherence to the medication regimen d. Developing alternative educational goals

ANS: C Feedback A The adolescent with Graves' disease is not constipated. B Adherence to the medication schedule is important to ensure optimal health and wellness. Medications should not be skipped and dose regimens should not be tapered by the child without consultation with the child's medical provider. C To adhere to the medication schedule, children need to understand that the medication must be taken two or three times per day. D The management of Graves' disease does not interfere with school attendance and does not require alternative educational plans.

Which statement indicates that a father understands the treatment for his child who has scarlet fever? a. "I can stop the medicine when my child feels better." b. "I will apply antibiotic cream to her rash twice a day." c. "I will give the penicillin for the full 10 days." d. "My child can go back to school when she has been on the antibiotic for a week."

ANS: C Feedback A The bacteria will not be eradicated if a partial course of antibiotics is given. B Treatment of scarlet fever does not include topical antibiotic cream. C It is necessary to give the entire course of antibiotic for 10 to 14 days. Penicillin is the preferred treatment for any streptococcal infection. D The child is no longer contagious after 24 hours of antibiotic therapy and can return to daycare or school.

What should the nurse keep in mind when planning to communicate with a child who has autism? a. The child has normal verbal communication. b. Expect the child to use sign language. c. The child may exhibit monotone speech and echolalia. d. The child is not listening if she is not looking at the nurse.

ANS: C Feedback A The child has impaired verbal communication and abnormalities in the production of speech. B Some autistic children may use sign language, but it is not assumed. C Children with autism have abnormalities in the production of speech such as a monotone voice or echolalia, or inappropriate volume, pitch, rate, rhythm, or intonation. D Children with autism often are reluctant to initiate direct eye contact.

A 4-year-old child with a long leg cast complains of "fire" in his cast. The nurse should a. Notify the physician on his next rounds. b. Note the complaint in the nurse's notes. c. Notify the physician immediately. d. Report the complaint to the next nurse on duty.

ANS: C Feedback A The child's symptom requires immediate attention. Notifying the physician on the next rounds is inappropriate. B Charting the complaint in the nurse's notes is an inappropriate action. Careful notation of symptoms is important, but the priority action is to contact the physician. C A burning sensation under the cast is an indication of tissue ischemia. It may be an early indication of serious neurovascular compromise, such as compartmental syndrome, that requires immediate attention. D Communication across shifts is important to the continuing assessment of the child; however, this symptom requires immediate evaluation, and the physician should be contacted.

Which factor is important to include in the teaching plan for parents of a child with Legg-Calvé-Perthes disease? a. It is an acute illness lasting 1 to 2 weeks. b. It affects primarily adolescents. c. There is a disturbance in the blood supply to the femoral epiphysis. d. It is caused by a virus.

ANS: C Feedback A The disease process usually lasts between 1 and 2 years and is a disorder of growth. B Legg-Calvé-Perthes disease is seen in children between 2 and 12 years of age. Most cases occur between 4 and 9 years of age. C Legg-Calvé-Perthes disease is a self-limiting disease that affects the blood supply to the femoral epiphysis. The most serious problem associated is the risk of permanent deformity. D The etiology is unknown.

What is the nurse's best response to a mother whose child has a diagnosis of acute lymphoblastic leukemia and is expressing guilt about not having responded sooner to her boy's symptoms? a. "You should always call the physician when your child has a change in what is normal for him." b. "It is better to be safe than sorry." c. "It is not uncommon for parents not to notice subtle changes in their children's health." d. "I hope this delay does not affect the treatment plan."

ANS: C Feedback A The goal is to relieve the mother's guilt and build trust so that she can talk about her feelings. This statement will only reinforce her guilt. B This response is flippant and reinforces that the mother was negligent, which will only increase her guilt. C This statement minimizes the role the mother played in not seeking early medical attention. It also displays empathy, which helps to build trust, thereby enabling the mother to talk about her feelings. Identifying concerns and clarifying misconceptions will help families cope with the stress of chronic illness. D This statement shows a total lack of empathy and would increase the mother's feelings of guilt.

Which statement best characterizes hepatitis A? a. Incubation period is 6 weeks to 6 months. b. Principal mode of transmission is through the parenteral route. c. Onset is usually rapid and acute. d. There is a persistent carrier state.

ANS: C Feedback A The incubation period is approximately 3 weeks for hepatitis A. B The principal mode of transmission for hepatitis A is the fecal-oral route. C Hepatitis A is the most common form of acute hepatitis in most parts of the world. It is characterized by a rapid acute onset. D Hepatitis A does not have a carrier state.

What information should the nurse include when teaching the parents of a 5-week-old infant about pyloromyotomy? a. The infant will be in the hospital for a week. b. The surgical procedure is routine and "no big deal." c. The prognosis for complete correction with surgery is good. d. They will need to ask the physician about home care nursing.

ANS: C Feedback A The infant will remain in the hospital for a day or two postoperatively. B Although the prognosis for surgical correction is good, telling the parents that surgery is "no big deal" minimizes the infant's condition. C Pyloromyotomy is the definitive treatment for pyloric stenosis. Prognosis is good with few complications. These comments reassure parents. D Home care nursing is not necessary after a pyloromyotomy.

Which comment is most developmentally typical of a 7-year-old boy? a. "I am a Power Ranger, so don't make me angry." b. "I don't know whether I like Mary or Joan better." c. "My mom is my favorite person in the world." d. "Jimmy is my best friend."

ANS: D Feedback A Magical thinking is developmentally appropriate for the preschooler. B Opposite-sex friendships are not typical for the 7-year-old child. C Seven-year-old children socialize with their peers, not their parents. D School-age children form friendships with peers of the same sex, those who live nearby, and other children who have toys that they enjoy.

The postoperative care plan for an infant with surgical repair of a cleft lip includes a. A clear liquid diet for 72 hours b. Nasogastric feedings until the sutures are removed c. Elbow restraints to keep the infant's fingers away from the mouth d. Rinsing the mouth after every feeding

ANS: C Feedback A The infant's diet is advanced from clear liquid to soft foods within 48 hours of surgery. B After surgery, the infant can resume preoperative feeding techniques. C Keeping the infant's hands away from the incision reduces potential complications at the surgical site. D Rinsing the mouth after feeding is an inappropriate intervention. Feeding a small amount of water after feedings will help keep the mouth clean. A cleft lip repair site should be cleansed with a wet sterile cotton swab after feedings.

For which problem should the child with chronic otitis media with effusion be evaluated? a. Brain abscess b. Meningitis c. Hearing loss d. Perforation of the tympanic membrane

ANS: C Feedback A The infection of acute otitis media can spread to surrounding tissues, causing a brain abscess. B The infection of acute otitis media can spread to surrounding tissues, causing meningitis. C Chronic otitis media with effusion is the most common cause of hearing loss in children. D Inflammation and pressure from acute otitis media may result in perforation of the tympanic membrane.

What is descriptive of most cases of hemophilia? a. Autosomal dominant disorder causing deficiency is 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 Feedback A The inheritance pattern is X-linked recessive. B The disorder involves coagulation factors, not platelets. 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. D The disorder does not involve red cells or the Y chromosome.

What is an appropriate statement for the nurse to make to parents of a child who has had a barium enema to correct an intussusception? a. "I will call the physician when the baby passes his first stool." b. "I am going to dilate the anal sphincter with a gloved finger to help the baby pass the barium." c. "I would like you to save all the soiled diapers so I can inspect them." d. "Add cereal to the baby's formula to help him pass the barium."

ANS: C Feedback A The physician does not need to be notified when the infant passes the first stool. B Dilating the anal sphincter is not appropriate for the child after a barium enema. C The nurse needs to inspect diapers after a barium enema because it is important to document the passage of barium and note the characteristics of the stool. D After reduction, the infant is given clear liquids and the diet is gradually increased.

A 6-year-old patient who has been placed in skeletal traction has pain, edema, and fever. The nurse should suspect a. Meningitis b. Crepitus c. Osteomyelitis d. Osteochondrosis

ANS: C Feedback A The symptoms of meningitis include headache, photophobia, fever, nausea, and vomiting. B Crepitus is the "sandy" or "gravelly" feeling noted when a broken bone is palpated. C The most serious complication of skeletal traction is osteomyelitis. Clinical manifestations include complaints of localized pain, swelling, warmth, tenderness, or unusual odor. An elevated temperature may accompany the symptoms. D Osteochondrosis is a disorder of the epiphyses involving an interruption of the blood supply.

At what age is sexual development in boys and girls considered to be precocious? a. Boys, 11 years; girls, 9 years b. Boys, 12 years; girls, 10 years c. Boys, 9 years; girls, 8 years d. Boys, 10 years; girls, 9 1/2 years

ANS: C Feedback A These ages fall within the expected range of pubertal onset. B These ages fall within the expected range of pubertal onset. C Manifestations of sexual development before age 9 in boys and age 8 in girls is considered precocious and should be investigated. D These ages fall within the expected range of pubertal onset.

What is used to treat moderate to severe inflammatory bowel disease? a. Antacids b. Antibiotics c. Corticosteroids d. Antidiarrheal medications

ANS: C Feedback A These are not drugs of choice to treat the inflammatory process of inflammatory bowel disease. B Antibiotics may be used as adjunctive therapy to treat complications. C Corticosteroids, such as prednisone and prednisolone, are used in short bursts to suppress the inflammatory response in inflammatory bowel disease. D These are not drugs of choice to treat the inflammatory process of inflammatory bowel disease.

What is the best response to a father who tells the nurse that his son "daydreams" at home and his teacher has observed this behavior at school? a. "Your son must have an active imagination." b. "Can you tell me exactly how many times this occurs in one day?" c. "Tell me about your son's activity when you notice the daydreams." d. "He is probably overtired and needs more rest."

ANS: C Feedback A This response does not address the child's symptoms or the father's concern. B This behavior is consistent with absence seizures, which can occur one after the other several times a day. Determining an exact number of absence seizures is not as useful as learning about behavior before the seizure that might have precipitated seizure activity. C The daydream episodes are suggestive of absence seizures, and data about activity associated with the daydreams should be obtained. D This response ignores both the child's symptoms and the father's concern about the daydreaming behavior.

What action is contraindicated when a child with Down syndrome is hospitalized? a. Determine the child's vocabulary for specific body functions. b. Assess the child's hearing and visual capabilities. c. Encourage parents to leave the child alone for extended periods of time. d. Have meals served at the child's usual meal times.

ANS: C Feedback A To communicate effectively with the child, it is important to know the child's particular vocabulary for specific body functions. B Children with Down syndrome have a high incidence of hearing loss and vision problems and should have hearing and vision assessed whenever they are in a health care facility. C The child with Down syndrome needs routine schedules and consistency. Having familiar people present, especially parents, helps to decrease the child's anxiety. D Routine schedules and consistency are important to children.

A recommendation to prevent neural tube defects is the supplementation of 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 Feedback A Vitamin A does not have a relation to the prevention of spina bifida. B Folic acid supplementation is recommended for the preconceptual period, as well as during the pregnancy. C The widespread use of folic acid among women of childbearing age is expected to decrease the incidence of spina bifida significantly. D Folic acid supplementation is recommended for the preconceptual period, as well as during the pregnancy.

A father calls the clinic nurse because his 2-year-old child was bitten by a black widow spider. The nurse should advise the father to a. Apply warm compresses. b. Carefully scrape off stinger. c. Take child to emergency department. d. Apply a thin layer of corticosteroid cream.

ANS: C Feedback A Warm compresses increase the circulation to the area and facilitate the spread of the venom. B The black widow spider does not have a stinger. C The black widow spider has a venom that is toxic enough to be harmful. The father should take the child to the emergency department for immediate treatment. D Corticosteroid cream will have no effect on the venom.

Which sign, when exhibited by a hospitalized child, should the nurse recognize as a characteristic of diabetes insipidus? a. Weight gain b. Increased urine specific gravity c. Increased urination d. Serum sodium level of 130 mEq/L

ANS: C Feedback A Weight gain results from retention of water when there is an excessive production of antidiuretic hormone; in diabetes insipidus there is a decreased production of antidiuretic hormone. B Concentrated urine is a sign of the syndrome of inappropriate antidiuretic hormone (SIADH), in which there is an excessive production of antidiuretic hormone. C The deficiency of antidiuretic hormone associated with diabetes insipidus causes the body to excrete large volumes of dilute urine. D A deficiency of antidiuretic hormone, as with diabetes insipidus, results in an increased serum sodium concentration (greater than 145 mEq/L).

The outpatient nurse understands that the phase of substance abuse characterized by a 14-year-old child admitting to using marijuana every day with friends after attending school is a. Experimentation b. Early drug use c. True drug addiction d. Severe drug addiction

ANS: C Feedback A With experimentation, the individual tries the drug to see what it is like or to satisfy peers. B Early drug use is identified as using drugs with some degree of regularity for their desirable effects. C True drug addiction is identified as regular use of drugs. Physical dependence may be present. Social functioning has a drug focus. D In severe drug addiction, the physical condition of the individual deteriorates and all activities are related to drug use.

The nurse should base a response to a parent's question about the prognosis of acute lymphoblastic leukemia (ALL) on the knowledge that a. Leukemia is a fatal disease, although chemotherapy provides increasingly longer periods of remission. b. Research to find a cure for childhood cancers is very active. c. The majority of children go into remission and remain symptom free when treatment is completed. d. It usually takes several months of chemotherapy to achieve a remission.

ANS: C Feedback A With the majority of children surviving 5 years or longer, it is inappropriate to refer to leukemia as a fatal disease. B This statement is true, but it does not address the parent's concern. C Children diagnosed with the most common form of leukemia, ALL, can almost always achieve remission, with a 5-year disease-free survival rate approaching 85%. D About 95% of children achieve remission within the first month of chemotherapy. If a significant number of blast cells are still present in the bone marrow after a month of chemotherapy, a new and stronger regimen is begun.

A nurse is teaching home care instructions to parents of a child with sickle cell disease. Which instructions should the nurse include? Select all that apply. a. Limit fluid intake. b. Administer aspirin for fever. c. Administer penicillin as ordered. d. Avoid cold and extreme heat. e. Provide for adequate rest periods.

ANS: C, D, E Feedback Correct Parents should be taught to avoid cold, which can increase sickling, and extreme heat, which can cause dehydration. Adequate rest periods should be provided. Penicillin should be administered daily as ordered. Incorrect The use of aspirin should be avoided; acetaminophen or ibuprofen should be used as an alternative. Fluids should be encouraged and an increase in fluid intake is encouraged in hot weather or when there are other risks for dehydration.

What actions should the nurse perform while caring for a school-age child who sprained his ankle playing football? Select all that apply. a. Turn the child every 1 to 2 hours. b. Assist with range-of-motion exercises every 2 hours. c. Apply ice to the affected ankle. d. Wrap the ankle with an Ace bandage. e. Elevate the affected extremity.

ANS: C, D, E Feedback Correct The child with a soft tissue injury in the first 6 to 12 hours is treated by controlling the swelling and reducing muscle damage. The acronym "RICE" summarizes the care needed: rest, ice, compression, and elevation. Incorrect During the acute phase of the injury, the child is not moved frequently and range-of-motion exercises would not be done. The child with a soft tissue injury in the first 6 to 12 hours is treated by controlling the swelling and reducing muscle damage.

A nurse is instructing parents on treatment of pediculosis (head lice). Which should the nurse include in the teaching plan? Select all that apply. a. Bedding should be washed in warm water and dried on a low setting. b. After treating the hair and scalp with a pediculicide, shampoo the hair with regular shampoo. c. Retreat the hair and scalp with a pediculicide in 7 to 10 days. d. Items that cannot be washed should be dry cleaned or sealed in plastic bags for 2 to 3 weeks. e. Combs and brushes should be boiled in water for at least 10 minutes.

ANS: C, D, E Feedback Correct: An over-the-counter pediculicide, permethrin 1% (Nix, Elimite, Acticin), kills head lice and eggs with one application and has residual activity (i.e., it stays in the hair after treatment) for 10 days. Nix crème rinse is applied to the hair after it is washed with a conditioner-free shampoo. The product should be rinsed out after 10 minutes. Incorrect: The hair should not be shampooed for 24 hours after the treatment. Even though the kill rate is high and there is residual action, retreatment should occur after 7 to 10 days. Combs and brushes should be boiled or soaked in antilice shampoo or hot water (greater than 60° C [140° F]) for at least 10 minutes. Advise parents to wash clothing (especially hats and jackets), bedding, and linens in hot water and dry at a hot dryer setting.

A nurse is conducting discharge teaching to parents about the care of their infant after cardiac surgery. The nurse instructs the parents to notify the physician if what condition occurs? Select all that apply. a. Respiratory rate of 36 at rest b. Appetite slowly increasing c. Temperature above 37.7° C (100° F) d. New, frequent coughing e. Turning blue or bluer than normal

ANS: C, D, E Feedback Correct: The parents should be instructed to notify the physician after their infant's cardiac surgery for a temperature above 37.7° C; new, frequent coughing; and any episodes of the infant turning blue or bluer than normal. Incorrect: A respiratory rate of 36 at rest for an infant is within normal expectations, and it is expected that the appetite will increase slowly.

What should the nurse evaluate before administering the Denver Developmental Screening Test II (DDST-II)? Select all that apply. a. The child's height and weight b. The parent's ability to comprehend the results c. The child's mood d. The parent-child interaction e. The child's chronologic age

ANS: C, E Feedback Correct The results of the screening test are valid if the child acted in a normal and expected manner. The child's chronologic age in years, months, and days must be calculated in order to draw the age line. This is necessary in order to perform an accurate DDST-II. Reliability and validity of the test can be altered if the child is not feeling well or is under the influence of medications. Incorrect The child's height and weight are not relevant to the DDST-II screening process. The parent's ability to understand the results of the screening is not relevant to the validity of the test. The parent-child interaction is not significantly relevant to the test results.

Which assessment finding in a preschooler suggests the need for further investigation? a. The child is able to dress independently. b. The child rides a tricycle. c. The child has an imaginary friend. d. The child has a 2-lb weight gain in 12 months.

ANS: D Feedback A A preschool child should be able to dress independently. B A preschool child should be able to ride a tricycle. C Imaginary friends are common for preschoolers. D Preschool children gain an average of 5 pounds a year. A gain of only 2 pounds is less than half of the expected weight gain and should be investigated.

When counseling parents and children about the importance of increased physical activity, the nurse can emphasize a. Anaerobic exercise should comprise a major component of the child's daily exercise. b. All children should be physically active for at least 2 hours per day. c. It is not necessary to participate in physical education classes at school if a student is taking part in other activities. d. Making exercise fun and a habitual activity.

ANS: D Feedback A Aerobic exercise should comprise a major component of children's daily exercise; however, physical activity should also include muscle and bone strengthening activities. B Children and adolescents should be physically active for at least 1 hour daily. C Encourage all student to participate fully in any physical education classes. D It is important to make exercise a fun and a habitual activity. Encourage parents to investigate their community's different activity programs. This includes recreation centers, parks, and the YMCA.

A school nurse is conducting a class on safety for a group of school-age children. Which statement indicates that the children may need further teaching? a. "My sister and I know two different ways to get out of the house." b. "I can dial 911 if there is a fire or a burglar in the house." c. "My mother has told us that if we have a fire, we have to meet at the neighbor's house." d. "If there is a fire I will have to go back in for my cat Fluffy because she will be scared."

ANS: D Feedback A All children should know two different escape routes from the house, in case one is blocked. B It is important for children to be taught how to call 911 in an emergency. C All families should have a predetermined meeting place away from the house. D Children should be taught never to return to a burning house, not even for a pet.

Which is the priority concern in developing a teaching plan for the parents of a 15-month-old child? a. Toilet training guidelines b. Guidelines for weaning children from bottles c. Instructions on preschool readiness d. Instructions on a home safety assessment

ANS: D Feedback A Although it is appropriate to give parents of a 15-month-old child toilet training guidelines, the child is not usually ready for toilet training, so it is not the priority teaching intervention. B Parents of a 15-month-old child should have been advised to beginning weaning from the breast or bottle at 6 to 12 months of age. C Educating a parent about preschool readiness is important and can occur later in the parents' educational process. The priority teaching intervention for the parents of a 15-month-old child is the importance of a safe environment. D Accidents are the major cause of death in children, including deaths caused by ingestion of poisonous materials. Home and environmental safety assessments are priorities in this age-group because of toddlers' increased motor skills and independence, which puts them at greater risk in an unsafe environment.

The mother of a 9-month-old infant is concerned because the infant cries when approached by an unknown shopper at the grocery store. What is the best response for the nurse to make to the mother? a. "You could consider leaving the infant more often with other people so he can adjust." b. "You might consider taking him to the doctor because he may be ill." c. "Have you noticed whether the baby is teething?" d. "This is a sign of stranger anxiety and demonstrates healthy attachment."

ANS: D Feedback A An infant who manifests stranger anxiety is showing a normal sign of healthy attachment. This behavior peaks at 7 to 9 months and is developmentally appropriate. The mother leaving the child more often will not change this developmental response to new strangers. B Assessing developmental needs is appropriate before taking an infant to a physician. C Pain from teething expressed by the infant's cries would not occur only when the mother left the room. D The nurse can reassure parents that healthy attachment is manifested by stranger anxiety in late infancy.

A parent asks the nurse about negativism in toddlers. The most appropriate recommendation is to a. Punish the child b. Provide more attention c. Ask the child to not always say "no" d. Reduce the opportunities for a "no" answer

ANS: D Feedback A Negativism is not an indication of stubbornness or insolence and should not be punished. B The negativism is not a function of attention; the child is testing limits to gain an understanding of the world. C The toddler is too young for this approach. D The nurse should suggest to the parent that questions should be phrased with realistic choices rather than yes or no answers. This provides a sense of control for the toddler and reduces the opportunity for negativism.

A mother asks the nurse, "When should I begin to clean my baby's teeth?" What is the best response for the nurse to make? a. "You can begin when all her baby teeth are in." b. "You can easily begin now. Just put some toothpaste on a gauze pad to clean the teeth." c. "I don't think you have to worry about that until she can handle a toothbrush." d. "You can begin as soon as your child has a tooth. The easiest way is to take cotton swabs or a face cloth and just wipe the teeth. Toothpaste is not necessary."

ANS: D Feedback A An infant's teeth need to be cleaned as soon as they erupt. Waiting until all the baby teeth are in is inappropriate and prolongs cleaning until 2 years of age. B Because toothpaste contains fluoride and infants will swallow the toothpaste, parents should avoid its use. C The infant's teeth need to be cleaned by the parent as soon as they erupt. Even when a child has the ability to hold a toothbrush, the parent should continue cleaning the child's teeth. D An infant's teeth need to be cleaned as soon as they erupt. Cleaning the teeth with cotton swabs or a face cloth is appropriate.

What is the best response a nurse can make to a 15-year-old girl who has verbalized a desire to have a baby? a. "Have you talked with your parents about this?" b. "Do you have plans to continue school?" c. "Will you be able to support the baby?" d. "Can you tell me how your life will be if you have an infant?"

ANS: D Feedback A Asking the teenager whether she has talked to her parents is not particularly helpful to the teen or the nurse and may terminate the communication. B A direct question about continuing school will not facilitate communication. Open-ended questions encourage communication. C Asking the teenager about how she will support the child will not facilitate communication. Open-ended questions encourage communication. D Having the teenager describe how the infant will affect her life will allow the teen to think more realistically. Her description will allow the nurse to assess the teen's perception and reality orientation.

The mother of a 10-month-old infant asks the nurse about beginning to wean her child from his bottle. Which statement by the mother suggests that the child is not ready to be weaned? a. "My son is frequently throwing his bottle down." b. "The baby takes a few ounces of formula from the bottle." c. "He is constantly chewing on the nipple. It concerns me." d. "He consistently is sucking."

ANS: D Feedback A Decreased interest in the bottle starts between 6 and 12 months. Throwing the bottle down is a sign of a decreased interest in the bottle. B When the child is taking more fluids from a cup and decreasing amounts from the bottle, the child is demonstrating a readiness for weaning. C Chewing on the nipple is another sign that the infant is ready to be weaned. D Consistent sucking is a sign that the child is not ready to be weaned.

What do parents of preschool children need to understand about discipline? a. Both parents and the child should agree on the method of discipline. b. Discipline should involve some physical restriction. c. The method of discipline should be consistent with the discipline methods of the child's peers. d. Discipline should include positive reinforcement of desired behaviors.

ANS: D Feedback A Discipline does not need to be agreed on by the child. Preschoolers feel secure with limits and appropriate, consistent discipline. Both parents should be in agreement so that the discipline is consistently applied. B Discipline does not necessarily need to include physical restriction. C Discipline does not need to be consistent with that of the child's peers. D Effective discipline strategies should involve a comprehensive approach that includes consideration of the parent-child relationship, reinforcement of desired behaviors, and consequences for negative behaviors.

You are the nurse admitting a toddler to the pediatric infectious disease unit. What is the single most important component of the child's physical examination? a. Assessment of heart and lungs b. Measurement of height and weight c. Documentation of parental concerns d. Obtaining an accurate history

ANS: D Feedback A Heart and lung assessment is not as important as an accurate history. B A single measurement of height and weight is not as significant as determining growth over time. The child's growth pattern can be elicited from the history. C Documentation of parental concerns is not as relevant to the physical examination as an accurate history. D An accurate history is most helpful in identifying problems and potential problems.

Which immunizations should be used with caution in children with an allergy to eggs? a. HepB b. DTaP c. Hib d. MMR

ANS: D Feedback A HepB is safe for children with an egg allergy. B DTaP is safe for children with an egg allergy. C Hib is safe for children with an egg allergy. D Live measles vaccine is produced by using chick embryo cell culture, so there is a remote possibility of anaphylactic hypersensitivity in children with egg allergies. Most reactions are actually the result of other components in the vaccine.

The nurse is discussing with a parent group the importance of fluoride for healthy teeth. What should the nurse recommend? a. Use fluoridated mouth rinses in children older than 1 year. b. Brush teeth with fluoridated toothpaste unless fluoride content of water supply is adequate. c. Give fluoride supplements to breastfed infants beginning at age 1 month. d. Determine whether water supply is fluoridated.

ANS: D Feedback A It is difficult to teach this age-group to spit out the mouthwash. Swallowing fluoridated mouthwashes can contribute to fluorosis. B Fluoridated toothpaste is still indicated, but very small amounts are used. C Fluoride supplementation is not recommended until after age 6 months. D The decision about fluoride supplementation cannot be made until it is known whether the water supply contains fluoride and the amount.

Communication entails much more than words going from one person's mouth to another person's ears. A positive, supportive technique that is effective from birth throughout adulthood is a. Listening b. Physical proximity c. Environment d. Touch

ANS: D Feedback A Listening is an essential component of the communication process. By practicing active listening skills, nurses can be effective listeners. Listening is a component of verbal communication. B Individuals have different comfort zones for physical distance. The nurse should be aware of these differences and move cautiously when meeting new children and families. C It is important to create a supportive and friendly environment for children including the use of child-sized furniture, posters, developmentally appropriate toys, and art displayed at a child's eye level. D Touch can convey warmth, comfort, reassurance, security, caring, and support. In infancy, messages of security and comfort are conveyed when they are being held. Toddlers and preschoolers find it soothing and comforting to be held and rocked. School-aged children and adolescents appreciate receiving a hug or pat on the back (with permission).

Examination of the abdomen is performed correctly by the nurse in which order? a. Inspection, palpation, and auscultation b. Palpation, inspection, and auscultation c. Palpation, auscultation, and inspection d. Inspection, auscultation, and palpation

ANS: D Feedback A Palpation is always performed last because it may distort the normal abdominal sounds. B Palpation is always performed last because it may distort the normal abdominal sounds. C Palpation is always performed last because it may distort the normal abdominal sounds. D The correct order of abdominal examination is inspection, auscultation, and palpation.

Which strategy is most likely to encourage a child to express his feelings about the hospital experience? a. Avoiding periods of silence b. Asking direct questions c. Sharing personal experiences d. Using open-ended questions

ANS: D Feedback A Periods of silence can serve to facilitate communication. B Direct questions can threaten and block communication. C Talking about yourself shifts the focus of the conversation away from the child. D Open-ended questions encourage conversation.

Which behavior is not demonstrated in the 8-year-old child? a. Understands that his or her point of view is not the only one b. Enjoys telling riddles and silly jokes c. Understands that pouring liquid from a small to large container does not change the amount d. Engages in fantasy and magical thinking

ANS: D Feedback A School-age children enter the stage of concrete operations. They learn that their point of view is not the only one. B The school-age child has a sense of humor. The child's increased language mastery and increased logic allow for appreciation of plays on words, jokes, and incongruities. C The school-age child understands that properties of objects do not change when their order, form, or appearance does. D The preschool-age child engages in fantasy and magical thinking. The school-age child moves away from this type of thinking and becomes more skeptical and logical. Belief in Santa Claus or the Easter Bunny ends in this period of development.

Which statement made by a mother of a school-age boy indicates a need for further teaching? a. "My child is playing soccer this year." b. "He is always busy with his friends playing games. He is very active." c. "I limit his television watching to about 2 hours a day." d. "I am glad his coach is a good role model. He emphasizes the importance of winning in today's society. The kids really are disciplined."

ANS: D Feedback A Team sports such as soccer are appropriate for exercise and refinement of motor skills. B School-age children need to participate in physical activities, which contribute to their physical fitness skills and well-being. C Limiting television to 2 hours a day is an appropriate restriction. School-age children should be encouraged to participate in physical activities. D Team sports are important for the development of sportsmanship and teamwork and for exercise and refinement of motor skills. A coach who emphasizes winning and strict discipline is not appropriate for children in this age-group.

When planning care for adolescents, the nurse should a. Teach parents first, and they, in turn, will teach the teenager. b. Provide information for their long-term health needs because teenagers respond best to long-range planning. c. Maintain the parents' role by providing explanations for treatment and procedures to the parents only. d. Give information privately to adolescents about how they can manage the specific problems that they identify.

ANS: D Feedback A Teenagers are socially and cognitively at the developmental stage where the health care provider can teach them. B Teenagers are more interested in immediate health care needs than in long-term needs. C Teenagers are at the developmental level that allows them to receive explanations about health care directly from the nurse. D Problems that teenagers identify and are interested in are typically the problems that they are the most willing to address. Confidentiality is important to adolescents. Adolescents prefer to confer privately (without parents) with the nurse and health care provider.

Which statement concerning physiologic factors is true? a. The infant has a slower metabolic rate than an adult. b. An infant has an inability to digest protein and lactase. c. Infants have a slower circulatory response than adults do. d. The kidneys of an infant are less efficient in concentrating urine than an adult's kidneys.

ANS: D Feedback A The infant's metabolic rate is faster, not slower, than an adult's. B Although the newborn infant's gastrointestinal system is immature, it is capable of digesting protein and lactase, but the ability to digest and absorb fat does not reach adult levels until approximately 6 to 9 months of age. C Circulation is faster in infants than in adults. D The infant's kidneys are not as effective at concentrating urine compared with an adult's because of immaturity of the renal system and slower glomerular filtration rates. This puts the infant at greater risk for fluid and electrolyte imbalance.

The parents of a newborn say that their toddler "hates the baby...he suggested that we put him in the trash can so the trash truck could take him away." The nurse's best reply is a. "Let's see if we can figure out why he hates the new baby." b. "That's a strong statement to come from such a small boy." c. "Let's refer him to counseling to work this hatred out. It's not a normal response." d. "That is a normal response to the birth of a sibling. Let's look at ways to deal with this."

ANS: D Feedback A The toddler does not hate the infant. This is an expected response to the changes in routines and attention that affect the toddler. B This is a normal response. The toddler can be provided with a doll to care for and tend to the doll's needs at the same time the parent is performing similar care for the newborn. C The toddler does not hate the infant. This is an expected response to the changes in routines and attention that affect the toddler. D The arrival of a new infant represents a crisis for even the best-prepared toddler. Toddlers have their entire schedule and routines disrupted because of the new family member. The nurse should work with parents on ways to involve the toddler in the newborn's care and to help focus attention on the toddler.

In girls, the initial indication of puberty is a. Menarche b. Growth spurt c. Growth of pubic hair d. Breast development

ANS: D Feedback A The usual sequence of secondary sexual characteristic development in girls is breast changes, rapid increase in height and weight, growth of pubic hair, appearance of axillary hair, menstruation, and abrupt deceleration of linear growth. B The usual sequence of secondary sexual characteristic development in girls is breast changes, rapid increase in height and weight, growth of pubic hair, appearance of axillary hair, menstruation, and abrupt deceleration of linear growth. C The usual sequence of secondary sexual characteristic development in girls is breast changes, rapid increase in height and weight, growth of pubic hair, appearance of axillary hair, menstruation, and abrupt deceleration of linear growth. D In most girls, the initial indication of puberty is the appearance of breast buds, an event known as thelarche.

A father tells the nurse that his daughter wants the same plate and cup used at every meal, even if they go to a restaurant. The nurse should explain that this is a. A sign the child is spoiled b. A way to exert unhealthy control c. Regression, common at this age d. Ritualism, common at this age

ANS: D Feedback A This is not indicative of a child who has unreasonable expectations, but rather normal development. B Toddlers use ritualistic behaviors to maintain necessary structure in their lives. C This is not regression, which is a retreat from a present pattern of functioning. D The child is exhibiting the ritualism that is characteristic at this age. Ritualism is the need to maintain the sameness and reliability. It provides a sense of comfort to the toddler. It will dictate certain principles in feeding practices, including rejecting a favorite food because it is served in a different container.

Which cranial nerve is assessed when the child is asked to imitate the examiner's wrinkled frown, wrinkled forehead, smile, and raised eyebrow? a. Accessory b. Hypoglossal c. Trigeminal d. Facial

ANS: D Feedback A To assess the accessory nerve, the examiner palpates and notes the strength of the trapezius and sternocleidomastoid muscles against resistance. B To assess the hypoglossal nerve, the examiner asks the child to stick out the tongue. C To assess the trigeminal nerve, the child is asked to identify a wisp of cotton on the face. The corneal reflex and temporal and masseter muscle strength are evaluated. D The facial nerve is assessed as described in the question.

A 17-month-old child is expected to be in what stage according to Piaget? a. Trust b. Preoperations c. Secondary circular reaction d. Sensorimotor period

ANS: D Feedback A Trust is Erikson's first stage. B Preoperations is the stage of cognitive development usually present in older toddlers and preschoolers. C Secondary circular reactions last from approximately ages 4 to 8 months. D The 17-month-old is in the fifth stage of the sensorimotor phase, tertiary circular reactions. Learning in this stage occurs mainly by trial and error.

Which parameter correlates best with measurements of the body's total muscle-mass to fat ratio? a. Height b. Weight c. Skin-fold thickness d. Mid arm circumference

ANS: D Feedback A Height is reflective of past nutritional status. B Weight is indicative of current nutritional status. C Skin-fold thickness is a measurement of the body's fat content. D Mid arm circumference is correlated with measurements of total muscle mass. Muscle serves as the body's major protein reserve and is considered an index of the body's protein stores.

When palpating the child's cervical lymph nodes, the nurse notes that they are tender, enlarged, and warm. What is the best explanation for this? a. Some form of cancer b. Local scalp infection common in children c. Infection or inflammation distal to the site d. Infection or inflammation close to the site

ANS: D Feedback A Tender lymph nodes are not usually indicative of cancer. B A scalp infection usually does not cause inflamed lymph nodes. C The lymph nodes close to the site of inflammation or infection would be inflamed. D Small nontender nodes are normal. Tender, enlarged, and warm lymph nodes may indicate infection or inflammation close to their location.

3. Which organs and tissues control the two types of specific immune functions? a.The spleen and mucous membranes b. Upper and lower intestinal lymphoid tissue c. The skin and lymph nodes d. The thymus and bone marrow

ANS: D A. Both the spleen and mucous membranes are secondary organs of the immune system that act as filters to remove debris and antigens and foster contact with T lymphocytes. B. Gut-associated lymphoid tissue is a secondary organ of the immune system. This tissue filters antigens entering the gastrointestinal tract. C. The skin and lymph nodes are secondary organs of the immune system. D. The thymus controls cell-mediated immunity (cells that mature into T lymphocytes). The bone marrow controls humoral immunity (stem cells for B lymphocytes).

2. A nurse is teaching parents about the importance of immunizations for infants because of immaturity of the immune system. The parents demonstrate that they understand the teaching if they make which statement? a. "The spleen reaches full size by 1 year of age." b. "IgM, IgE, and IgD levels are high at birth." c. "IgG levels in the newborn infant are low at birth." d. "Absolute lymphocyte counts reach a peak during the first year."

ANS: D A: The spleen reaches its full size during adulthood. B: IgM, IgE, and IgD are normally in low concentration at birth. IgM, IgE, IgA, and IgD do not cross the placenta. C: The term newborn infant receives an adult level of IgG as a result of transplacental transfer from the mother. D: Absolute lymphocyte counts reach a peak during the first year.

Which term is used to describe an abnormally increased convex angulation in the curvature of the thoracic spine? a. Scoliosis b. Ankylosis c. Lordosis d. Kyphosis

ANS: D Feedback A Scoliosis is a complex spinal deformity usually involving lateral curvature, spinal rotation causing rib asymmetry, and thoracic hypokyphosis. B Ankylosis is the immobility of a joint. C Lordosis is an accentuation of the cervical or lumbar curvature beyond physiologic limits. D Kyphosis is an abnormally increased convex angulation in the curve of the thoracic spine.

What should the nurse teach a school-age child and his parents about the management of ulcer disease? a. Eat a bland, low-fiber diet in small, frequent meals. b. Eat three balanced meals a day with no snacking between meals. c. The child needs to eat alone to avoid stress. d. Do not give antacids 1 hour before or after antiulcer medications.

ANS: D Feedback A A bland diet is not indicated for ulcer disease. The diet should be a regular diet that is low in caffeine, and the child should eat a meal or snack every 2 to 3 hours. B The child should eat every 2 to 3 hours. C Eating alone is not indicated. D Antacids can interfere with antiulcer medication if given less than 1 hour before or after antiulcer medications.

What action is not appropriate for a 14-month-old child with iron deficiency anemia? a. Decreasing the infant's daily milk intake to 24 oz or less b. Giving oral iron supplements between meals with orange juice c. Including apricots, dark-green leafy vegetables, and egg yolk in the infant's diet d. Allowing the infant to drink the iron supplement from a small medicine cup

ANS: D Feedback A A daily milk intake in toddlers of less than 24 oz will encourage the consumption of iron-rich solid foods. B Because food interferes with the absorption of iron, iron supplements are taken between meals. Administering this medication with foods rich in vitamin C facilitates absorption of iron. C Apricots, dark-green leafy vegetables, and egg yolks are rich sources of iron. Other iron-rich foods include liver, dried beans, Cream of Wheat, iron-fortified cereal, and prunes. D Iron supplements should be administered through a straw or by a medicine dropper placed at the back of the mouth because iron temporarily stains the teeth.

An infant is born and the nurse notices that the child has herniation of abdominal viscera into the base of the umbilical cord. What will the nurse document on her or his assessment of this condition? a. Diaphragmatic hernia b. Umbilical hernia c. Gastroschisis d. Omphalocele

ANS: D Feedback A A diaphragmatic hernia is the protrusion of part of the abdominal organs through an opening in the diaphragm. B An umbilical hernia is a soft skin protrusion of abdominal stricture through the esophageal hiatus. C Gastroschisis is the protrusion of intraabdominal contents through a defect in the abdominal wall lateral to the umbilical ring. There is no peritoneal sac. D Omphalocele is the herniation of the abdominal viscera into the base of the umbilical cord.

Which type of hernia has an impaired blood supply to the herniated organ? a. Hiatal hernia b. Incarcerated hernia c. Omphalocele d. Strangulated hernia

ANS: D Feedback A A hiatal hernia is the intrusion of an abdominal structure, usually the stomach, through the esophageal hiatus. B An incarcerated hernia is a hernia that cannot be reduced easily. C Omphalocele is the protrusion of intraabdominal viscera into the base of the umbilical cord. The sac is covered with peritoneum and not skin. D A strangulated hernia is one in which the blood supply to the herniated organ is impaired.

When a child with a musculoskeletal injury on the foot is assessed, what is most indicative of a fracture? a. Increased swelling after the injury is iced b. The presence of localized tenderness distal to the site c. The presence of an elevated temperature for 24 hours d. The inability of the child to bear weight

ANS: D Feedback A Although edema is often present with a fracture, it would be unusual for swelling to increase after application of ice, and this would not be most indicative of a fracture. Swelling after icing does not identify the degree of the injury. B Localized tenderness along with limited joint mobility may indicate serious injury, but inability to bear weight on the extremity is a more reliable sign. Tenderness is not a usual complaint distal to the affected site. C Elevated temperature is associated with infection, but not a fracture. D An inability to bear weight on the affected extremity is indicative of a more serious injury. With a fracture, general manifestations include pain or tenderness at the site, immobility or decreased range of motion, deformity of the extremity, edema, and inability to bear weight

A nurse is explaining to parents how the central nervous system of a child differs from that of an adult. Which statement accurately describes these differences? a. The infant has 150 mL of CSF compared with 50 mL in the adult. b. Papilledema is a common manifestation of ICP in the very young child. c. The brain of a term infant weighs less than half of the weight of the adult brain. d. Coordination and fine motor skills develop as myelinization of peripheral nerves progresses

ANS: D Feedback A An infant has about 50 mL of CSF compared with 150 mL in an adult. B Papilledema rarely occurs in infancy because open fontanels and sutures can expand in the presence of ICP. C The brain of the term infant is two thirds the weight of an adult's brain. D Peripheral nerves are not completely myelinated at birth. As myelinization progresses, so does the child's coordination and fine muscle movements.

A common, serious complication of rheumatic fever is a. Seizures b. Cardiac dysrhythmias c. Pulmonary hypertension d. Cardiac valve damage

ANS: D Feedback A Seizures are not common complications of rheumatic fever. B Cardiac dysrhythmias are not common complications of rheumatic fever. C Pulmonary hypertension is not a common complication of rheumatic fever. D Cardiac valve damage is the most significant complication of rheumatic fever.

Which statement best describes why infants are at greater risk for dehydration than older children? a. Infants have an increased ability to concentrate urine. b. Infants have a greater volume of intracellular fluid. c. Infants have a smaller body surface area. d. Infants have an increased extracellular fluid volume.

ANS: D Feedback A Because the kidneys are immature in early infancy, there is a decreased ability to concentrate the urine. B Infants have a larger proportion of fluid in the extracellular space. C Infants have proportionately greater body surface area in relation to body mass, which creates the potential for greater fluid loss through the skin and gastrointestinal tract. D The larger ratio of extracellular fluid to intracellular fluid predisposes the infant to dehydration.

Which nursing diagnosis has the highest priority for the toddler with celiac disease? a. Disturbed Body Image related to chronic constipation b. Risk for Disproportionate Growth related to obesity c. Excess Fluid Volume related to celiac crisis d. Imbalanced Nutrition: Less than Body Requirements related to malabsorption

ANS: D Feedback A Body Image disturbances are not usually apparent in toddlers. This is more common in adolescents. It is not the priority nursing diagnosis. B Celiac disease causes disproportionate growth and development associated with malnutrition, not obesity. C Celiac crisis causes deficient fluid volume. D Imbalanced Nutrition: Less than Body Requirements is the highest priority nursing diagnosis because celiac disease causes gluten enteropathy, a malabsorption condition.

A child taking oral corticosteroids for asthma is exposed to varicella. The child has not had the varicella vaccine and has never had the disease. What intervention should be taken to prevent varicella from developing? a. No intervention is needed unless varicella develops. b. Administer the varicella vaccine as soon as possible. c. The child should begin a course of oral antibiotics. d. The child should be prescribed acyclovir.

ANS: D Feedback A Children taking oral corticosteroids are immunosuppressed and are at high risk for serious complications. Intervention must be taken to prevent the disease when exposure occurs. B The varicella vaccine is a live virus vaccine and is contraindicated for an immunosuppressed child. C An antibiotic is not effective in treating varicella zoster, which is a virus. D For children receiving short-term corticosteroid treatment, acyclovir is often used in the treatment plan.

Which clinical manifestation should the nurse expect when a child with sickle cell anemia experiences an acute vaso-occlusive crisis? a. Circulatory collapse b. Cardiomegaly, systolic murmurs c. Hepatomegaly, intrahepatic cholestasis d. Painful swelling of hands and feet; painful joints

ANS: D Feedback A Circulatory collapse results from sequestration crises. B Cardiomegaly, systolic murmurs, hepatomegaly, and intrahepatic cholestasis result from chronic vaso-occlusive phenomena. C Cardiomegaly, systolic murmurs, hepatomegaly, and intrahepatic cholestasis result from chronic vaso-occlusive phenomena. D A vaso-occlusive 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.

What procedure is contraindicated in the care of a child with a minor partial-thickness burn injury wound? a. Cleaning the affected area with mild soap and water b. Applying antimicrobial ointment to the burn wound c. Changing dressings daily d. Leaving all loose tissue or skin intact

ANS: D Feedback A Cleaning with mild soap and water are important to the healing process. B Antimicrobial ointment is used on the burn wound to fight infection. C Clean dressings are applied daily to prevent wound infection. When dressings are changed, the condition of the burn wound can be assessed. D All loose skin and tissue should be debrided, because it can become a breeding ground for infectious organisms.

A school-age child with diarrhea has been rehydrated. The nurse is discussing the child's diet with the family. Which statement by the parent indicates a correct understanding of the teaching? a. "I will keep my child on a clear liquid diet for the next 24 hours." b. "I should encourage my child to drink carbonated drinks but avoid food for the next 24 hours." c. "I will offer my child bananas, rice, applesauce, and toast for the next 48 hours." d. "I should have my child eat a normal diet with easily digested foods for the next 48 hours."

ANS: D Feedback A Clear liquids and carbonated drinks have high carbohydrate content and few electrolytes. Caffeinated beverages should be avoided because caffeine is a mild diuretic. B Clear liquids and carbonated drinks have high carbohydrate content and few electrolytes. Caffeinated beverages should be avoided because caffeine is a mild diuretic. C In some children, lactose intolerance will develop with diarrhea, and cow's milk should be avoided in the recovery stage. 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.

A child is brought to the emergency department in generalized tonic-clonic status epilepticus. Which medication should the nurse expect to be given initially in this situation? a. Clorazepate dipotassium (Tranxene) b. Fosphenytoin (Cerebyx) c. Phenobarbital d. Lorazepam (Ativan)

ANS: D Feedback A Clorazepate dipotassium (Tranxene) is indicated for cluster seizures. It can be given orally. B Fosphenytoin can be given intravenously as a second round of medication if seizures continue. C Phenobarbital can be given intravenously as a second round of medication if seizures continue. D Lorazepam (Ativan) or diazepam (Valium) is given intravenously to control generalized tonic-clonic status epilepticus and may also be used for seizures lasting more than 5 minutes.

A nurse is teaching parents about diarrhea. Which statement by the parents indicates understanding of the teaching? a. Diarrhea results from a fluid deficit in the small intestine. b. Organisms destroy intestinal mucosal cells, resulting in an increased intestinal surface area. c. Malabsorption results in metabolic alkalosis. d. Increased motility results in impaired absorption of fluid and nutrients.

ANS: D Feedback A Diarrhea results from fluid excess in the small intestine. B Destroyed intestinal mucosal cells result in decreased intestinal surface area. C Loss of electrolytes in the stool from diarrhea results in metabolic acidosis. D Increased motility and rapid emptying of the intestines result in impaired absorption of nutrients and water. Electrolytes are drawn from the extracellular space into stool, and dehydration results.

Which statement made by a parent indicates incorrect information about intervention for a child's fever? a. "I should keep her covered lightly when she has a fever." b. "I'll give her plenty of liquids to keep her hydrated." c. "I can give her acetaminophen for a fever." d. "I'll look for over-the-counter preparations that contain aspirin."

ANS: D Feedback A Dressing the child in light clothing and using lightweight covers will help reduce fever and promote the child's comfort. B Adequate hydration will help maintain a normal body temperature. C Acetaminophen or ibuprofen should be used as directed for fever control. D Aspirin products are avoided because of the possibility of development of Reye's syndrome. The parent should check labels on all over-the-counter products to be sure they do not contain aspirin.

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. Blurred vision

ANS: D Feedback A Dry skin, weight loss, and dehydration are clinical manifestations of type 1 diabetes mellitus. B Dry skin, weight loss, and dehydration are clinical manifestations of type 1 diabetes mellitus. C Dry skin, weight loss, and dehydration are clinical manifestations of type 1 diabetes mellitus. D Fatigue and blurred vision are clinical manifestations of type 1 diabetes mellitus.

What discharge information should the nurse give to the parents of a male adolescent who has been diagnosed with the Epstein-Barr virus? a. It is particularly important to protect the adolescent's head during physical activities. b. The teen will feel like himself and be back to his usual routines in a week. c. The treatment of the Epstein-Barr virus is prolonged bed rest, usually lasting several months. d. Fatigue may persist, and the adolescent may need to increase school activities gradually.

ANS: D Feedback A During the acute and recovery phases, activity restrictions, which include no contact sports or roughhousing, are implemented to protect the child's enlarged spleen from rupture. B The recovery process from infectious mononucleosis is a slow and gradual one. C Bed rest is indicated during the acute stage of the illness, usually lasting 2 to 4 weeks. D The recovery period is often lengthy and fatigue may continue, necessitating a gradual return to school activities.

Which behavior demonstrated by an adolescent should alert the school nurse to a problem of substance abuse? a. States feelings of worthlessness b. Increased desire for social conformity c. Does not feel need for peer approval d. Deterioration of relationships with family members

ANS: D Feedback A Feelings of worthlessness are suggestive of a depressive disorder. An adolescent with a substance abuse problem may be depressed, but this behavior is not a manifestation of substance abuse. B The clinical manifestations of substance abuse are marked by an increase in antisocial behavior as the desire for social conformity decreases and the need for the substance increases. C The adolescent with a substance abuse problem may demonstrate an excessive dependence on peer influence. D Deterioration of relationships with family members, irregular school attendance, low grades, rebellious or aggressive behavior, and excessive dependence on peer influence are behaviors that may indicate substance abuse.

The nurse is providing counseling to the mother of a child diagnosed with fragile X syndrome. She explains to the mother that fragile X syndrome is a. Most commonly seen in girls b. Acquired after birth c. Usually transmitted by the male carrier d. Usually transmitted by the female carrier

ANS: D Feedback A Fragile X syndrome is most common in males. B Fragile X syndrome is congenital. C Fragile X syndrome is not transmitted by a male carrier. D The gene causing fragile X syndrome is transmitted by the mother.

Which postoperative intervention should be questioned for a child after a cardiac catheterization? a. Continue intravenous (IV) fluids until the infant is tolerating oral fluids. b. Check the dressing for bleeding. c. Assess peripheral circulation on the affected extremity. d. Keep the affected leg flexed and elevated.

ANS: D Feedback A IV fluid administration continues until the child is taking and retaining adequate amounts of oral fluids. B The insertion site dressing should be observed frequently for bleeding. The nurse should also look under the child to check for pooled blood. C Peripheral perfusion is monitored after catheterization. Distal pulses should be palpable, although they may be weaker than in the contralateral extremity. D The child should be positioned with the affected leg straight for 4 to 6 hours after the procedure.

An accurate description of anemia is a. Increased blood viscosity b. Depressed hematopoietic system c. Presence of abnormal hemoglobin d. Decreased oxygen-carrying capacity of blood

ANS: D Feedback A Increased blood viscosity is usually a function of too many cells or of dehydration, not of anemia. B A depressed hematopoietic system or abnormal hemoglobin can contribute to anemia, but the definition is dependent on the deceased oxygen-carrying capacity of the blood. C A depressed hematopoietic system or abnormal hemoglobin can contribute to anemia, but the definition is dependent on the decreased oxygen-carrying capacity of the blood. 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.

What is the priority nursing intervention for a 6-month-old infant hospitalized with diarrhea and dehydration? a. Estimating insensible fluid loss b. Collecting urine for culture and sensitivity c. Palpating the posterior fontanel d. Measuring the infant's weight

ANS: D Feedback A Infants have a greater total body surface area and therefore a greater potential for fluid loss through the skin. It is not possible to measure insensible fluid loss. B Urine for culture and sensitivity is not usually part of the treatment plan for the infant who is dehydrated from diarrhea. C The posterior fontanel closes by 2 months of age. The anterior fontanel can be palpated during an assessment of an infant with dehydration. D Weight is a crucial indicator of fluid status. It is an important criterion for assessing hydration status and response to fluid replacement.

What should the discharge plan for a school-age child with sickle cell disease include? a. Restricting the child's participation in outside activities b. Administering aspirin for pain or fever c. Limiting the child's interaction with peers d. Administering penicillin daily as ordered

ANS: D Feedback A Sickle cell disease does not prohibit the child from outdoor play. Active and passive exercises help promote circulation. B Aspirin use should be avoided. Acetaminophen or ibuprofen should be administered for fever or pain. C The child needs to interact with peers to meet his developmental needs. D Children with sickle cell disease are at a high risk for pneumococcal infections and should receive long-term penicillin therapy and preventive immunizations.

The infant with Down syndrome is closely monitored during the first year of life for what serious condition? a. Thyroid complications b. Orthopedic malformations c. Dental malformation d. Cardiac abnormalities

ANS: D Feedback A Infants with Down syndrome are not known to have thyroid complications. B Orthopedic malformations may be present, but special attention is given to assessment for cardiac and gastrointestinal abnormalities. C Dental malformations are not a major concern compared with the life-threatening complications of cardiac defects. D The high incidence of cardiac defects in children with Down syndrome makes assessment for signs and symptoms of these defects important during the first year. Clinicians recommend the child be monitored frequently throughout the first 12 months of life, including a full cardiac workup.

The skin condition commonly known as "warts" is the result of an infection by which organism? a. Bacteria b. Fungus c. Parasite d. Virus

ANS: D Feedback A Infection with these organisms does not result in warts. B Infection with these organisms does not result in warts. C Infection with these organisms does not result in warts. D Human warts are caused by the human papillomavirus.

Careful handwashing before and after contact can prevent the spread of which condition in daycare and school settings? a. Irritable bowel syndrome b. Ulcerative colitis c. Hepatic cirrhosis d. Hepatitis A

ANS: D Feedback A Irritable bowel syndrome is the result of increased intestinal motility and is not contagious. B Ulcerative colitis is not infectious. C Cirrhosis is not infectious. D Hepatitis A is spread person to person, by the fecal-oral route, and through contaminated food or water. Good handwashing is critical in preventing its spread. The virus can survive on contaminated objects for weeks.

A nurse knows that which exercise is best for a child with juvenile arthritis? a. Jogging b. Tennis c. Gymnastics d. Swimming in a heated pool

ANS: D Feedback A Jogging jars the hip, knee, and ankle joints and can cause joint damage. B Tennis also jars the joints and can cause joint damage. C Gymnastics does not protect the joints from injury. D The warmth of the water, coupled with mild resistance, makes swimming the perfect medium for strengthening and range-of-motion exercises while protecting the joints.

What should the parents of an infant with thrush (oral candidiasis) be taught about medication administration? a. Give nystatin suspension with a syringe without a needle. b. Apply nystatin cream to the affected area twice a day. c. Give nystatin before the infant is fed. d. Swab nystatin suspension onto the oral mucous membranes after feedings.

ANS: D Feedback A Medication may not reach the affected areas when it is squirted into the infant's mouth. Rubbing the suspension onto the gum ensures contact with the affected areas. B Nystatin cream is used for diaper rash caused by Candida. C To prolong contact with the affected areas, the medication should be administered after a feeding. D It is important to apply the nystatin suspension to the affected areas, which is best accomplished by rubbing it onto the gums and tongue, after feedings, every 6 hours, until 3 to 4 days after symptoms have disappeared.

The nurse is assessing a child who was just admitted to the hospital for observation after a head injury. The most essential part of nursing assessment to detect early signs of a worsening condition is a. Posturing b. Vital signs c. Focal neurologic signs d. Level of consciousness

ANS: D Feedback A Neurologic posturing is indicative of neurologic damage. B Vital signs and focal neurologic signs are later signs of progression when compared with level-of-consciousness changes. C Vital signs and focal neurologic signs are later signs of progression when compared with level-of-consciousness changes. D The most important nursing observation is assessment of the child's level of consciousness. Alterations in consciousness appear earlier in the progression of head injury than do alterations of vital signs or focal neurologic signs.

The father of a child recently diagnosed with developmental delay is very rude and hostile toward the nurses. This father was cooperative during the child's evaluation a month ago. What is the best explanation for this change in parental behavior? a. The father is exhibiting symptoms of a psychiatric illness. b. The father may be abusing the child. c. The father is resentful of the time he is missing from work for this appointment. d. The father is experiencing a symptom of grief.

ANS: D Feedback A One cannot determine that a parent is exhibiting symptoms of a psychiatric illness on the basis of a single situation. B The scenario does not give any information to suggest child abuse. C Although the father may have difficulty balancing his work schedule with medical appointments for his child, a more likely explanation for his behavior change is that he is grieving the loss of a normal child. D After a child is diagnosed with a developmental delay, families typically experience a cycle of grieving that is repeated when developmental milestones are not met.

What is an expected assessment finding in a child with coarctation of the aorta? a. Orthostatic hypotension b. Systolic hypertension in the lower extremities c. Blood pressure higher on the left side of the body d. Disparity in blood pressure between the upper and lower extremities

ANS: D Feedback A Orthostatic hypotension is not present with coarctation of the aorta. B Systolic hypertension may be detected in the upper extremities. C The left arm may not accurately reflect systolic hypertension because the left subclavian artery can be involved in the coarctation. D The classic finding in children with coarctation of the aorta is a disparity in pulses and blood pressures between the upper and lower extremities.

When taking a history on a child with a possible diagnosis of cellulitis, what should be the priority nursing assessment to help establish a diagnosis? a. Any pain the child is experiencing b. Enlarged, mobile, and nontender lymph nodes c. Child's urinalysis results d. Recent infections or signs of infection

ANS: D Feedback A Pain is important, but the history of recent infections is more relevant to the diagnosis. B Lymph nodes may be enlarged (lymphadenitis), but they are not mobile and are nontender. Lymphangitis may be seen with red "streaking" of the surrounding area. C An abnormal urinalysis result is not usually associated with cellulitis. D Cellulitis may follow an upper respiratory infection, sinusitis, otitis media, or a tooth abscess. The affected area is red, hot, tender, and indurated.

During a 14-year-old's physical examination, the nurse identifies that he plays soccer and football and is complaining of knee pain when he rises from a squatting position, and difficulty with weight bearing. The nurse should suspect a. Legg-Calvé-Perthes disease b. Osteomyelitis c. Duchenne muscular dystrophy d. Osgood-Schlatter disease

ANS: D Feedback A Pain on activity that decreases with rest is indicative of Legg-Calvé-Perthes disease. B Preexisting pain, favoring the affected limb, erythema, and tenderness are associated with osteomyelitis. C Duchenne muscular dystrophy causes progressive generalized weakness and muscle wasting. D Knee pain and tenderness aggravated by activity that requires kneeling, running, climbing stairs, and rising from a squatting position is highly significant for Osgood-Schlatter disease. The cause is believed to be related to repetitive stress from sports-related activities combined with overuse of immature muscles and tendons.

The nurse is admitting a child to the hospital for a cardiac workup. What is the first step in a cardiac assessment? a. Percussion b. Palpation c. Auscultation d. History and inspection

ANS: D Feedback A Percussion of the chest is usually deferred. B Palpation can be threatening to the child because it requires a significant amount of physical contact. For this reason it is not the initial step in a cardiac assessment. C Auscultation requires touching the child and is not the initial step in a cardiac assessment. D The assessment should begin with the least threatening interventions—the history and inspection. Assessment progression includes inspection, auscultation, and palpation because each step includes more touching.

A nurse is assigned to care for an infant with an unrepaired tetralogy of Fallot. What should the nurse do first when the baby is crying and becomes severely cyanotic? a. Place the infant in a knee-chest position. b. Administer oxygen. c. Administer morphine sulfate. d. Calm the infant.

ANS: D Feedback A Placing the infant in a knee-chest position will decrease venous return so that smaller amounts of highly saturated blood reach the heart. This should be done after calming the infant. B Administering oxygen is indicated after placing the infant in a knee-chest position. C Administering morphine sulfate calms the infant. It may be indicated some time after the infant has been calmed. D Calming the crying infant is the first response. An infant with unrepaired tetralogy of Fallot who is crying and agitated may eventually lose consciousness.

Therapeutic management of most children with Hirschsprung disease is primarily a. Daily enemas b. Low-fiber diet c. Permanent colostomy d. Surgical removal of the affected section of the bowel

ANS: D Feedback A Preoperative management may include enemas and a low-fiber, high-calorie, high-protein diet, until the child is physically ready for surgery. B Preoperative management may include enemas and low-fiber, high-calorie, high-protein diet, until the child is physically ready for surgery. C The colostomy that is created in Hirschsprung disease is usually temporary. D Most children with Hirschsprung disease require surgical rather than medical management. Surgery is done to remove the aganglionic portion of the bowel, relieve obstruction, and restore normal bowel motility and function of the internal anal sphincter.

For what reason might a newborn infant with a cardiac defect, such as coarctation of the aorta, that results in a right-to-left shunt receive prostaglandin E1? a. To decrease inflammation b. To control pain c. To decrease respirations d. To improve oxygenation

ANS: D Feedback A Prostaglandin E1 is used to maintain a patent ductus arteriosus, thus increasing pulmonary blood flow. B Prostaglandin E1 is administered to infants with a right-to-left shunt to keep the ductus arteriosus patent, thus increasing pulmonary blood flow. C Prostaglandin E1 is given to infants with a right-to-left shunt to keep the ductus arteriosus patent to increase pulmonary blood flow. D Prostaglandin E1 is given to infants with a right-to-left shunt to keep the ductus arteriosus patent. This will improve oxygenation.

A stool specimen from a child with diarrhea shows the presence of neutrophils and red blood cells. This is most suggestive of a. Protein intolerance b. Parasitic infection c. Fat malabsorption d. Bacterial gastroenteritis

ANS: D Feedback A Protein intolerance is suspected in the presence of eosinophils. B Parasitic infection is indicated by eosinophils. C Fat malabsorption is indicated by foul-smelling, greasy, bulky stools. D Neutrophils and red blood cells in stool indicate bacterial gastroenteritis.

What information should the nurse teach workers at a daycare center about RSV? a. RSV is transmitted through particles in the air. b. RSV can live on skin or paper for up to a few seconds after contact. c. RSV can survive on nonporous surfaces for about 60 minutes. d. Frequent handwashing can decrease the spread of the virus.

ANS: D Feedback A RSV infection is not airborne. It is acquired mainly through contact with contaminated surfaces. B RSV can live on skin or paper for up to 1 hour. C RSV can live on cribs and other nonporous surfaces for up to 6 hours. D Meticulous handwashing can decrease the spread of organisms.

Which change in status should alert the nurse to increased intracranial pressure (ICP) in a child with a head injury? a. Rapid, shallow breathing b. Irregular, rapid heart rate c. Increased diastolic pressure with narrowing pulse pressure d. Confusion and altered mental status

ANS: D Feedback A Respiratory changes occur with ICP. One pattern that may be evident is Cheyne-Stokes respiration. This pattern of breathing is characterized by increasing rate and depth, then decreasing rate and depth, with a pause of variable length. B Temperature elevation may occur in children with ICP. C Changes in blood pressure occur, but the diastolic pressure does not increase, nor is there a narrowing of pulse pressure. D The child with a head injury may have confusion and altered mental status, a change in vital signs, retinal hemorrhaging, hemiparesis, and papilledema.

What is the most common causative agent of bacterial endocarditis? a. Staphylococcus albus b. Streptococcus hemolyticus c. Staphylococcus albicans d. Streptococcus viridans

ANS: D Feedback A S. albus is not a common causative agent. B Streptococcus hemolyticus is not a common causative agent. C S. albicans is not a common causative agent. D S. viridans and S. aureus are the most common causative agents in bacterial (infective) endocarditis

Which is the nurse's best response to the parents of a 10-year-old child newly diagnosed with type 1 diabetes mellitus who are concerned about the child's continued participation in soccer? a. "Consider the swim team as an alternative to soccer." b. "Encourage intellectual activity rather than participation in sports." c. "It is okay to play sports such as soccer unless the weather is too hot." d. "Give the child an extra 15 to 30 g of carbohydrate snack before soccer practice."

ANS: D Feedback A Soccer is an appropriate sport for a child with type 1 diabetes as long as the child prevents hypoglycemia by eating a snack. B Participation in sports is not contraindicated for a child with type 1 diabetes. C The child with type 1 diabetes may participate in sports activities regardless of climate. D Exercise lowers blood glucose levels. A snack with 15 to 30 g of carbohydrates before exercise will decrease the risk of hypoglycemia.

A child with a history of fever of unknown origin, excessive bruising, lymphadenopathy, anemia, and fatigue is exhibiting symptoms most suggestive of a. Ewing sarcoma b. Wilms' tumor c. Neuroblastoma d. Leukemia

ANS: D Feedback A Symptoms of Ewing sarcoma involve pain and soft tissue swelling around the affected bone. B Wilms' tumor usually manifests as an abdominal mass with abdominal pain and may include renal symptoms, such as hematuria, hypertension, and anemia. C Neuroblastoma manifests primarily as an abdominal, chest, bone, or joint mass. Symptoms are dependent on the extent and involvement of the tumor. D These symptoms reflect bone marrow failure and organ infiltration, which occur in leukemia.

A parent asks the nurse how she will know whether her child has fifth disease. The nurse should advise the parent to be alert for which manifestation? a. Bull's-eye rash at the site of a tick bite b. Lesions in various stages of development on the trunk c. Maculopapular rash on the trunk that lasts for 2 days d. Bright red rash on the cheeks that looks like slapped cheeks

ANS: D Feedback A The bull's-eye rash at the site of a tick bite is a manifestation of Lyme disease. B Varicella is manifested as lesions in various stages of development—macule, papule, then vesicle, first appearing on the trunk and scalp. C Roseola manifests as a maculopapular rash on the trunk that can last for hours or up to 2 days. D Fifth disease manifests with an intense, fiery red, edematous rash on the cheeks, which gives a "slapped cheek" appearance.

What is an appropriate beverage for the nurse to give to a child who had a tonsillectomy earlier in the day? a. Chocolate ice cream b. Orange juice c. Fruit punch d. Apple juice

ANS: D Feedback A The child can have full liquids on the second postoperative day. B Citrus drinks are not offered because they can irritate the throat. C Red liquids are avoided because they give the appearance of blood if vomited. D The child can have clear, cool liquids when fully awake.

Many of the physical characteristics of Down syndrome present feeding problems. Care of the infant should include a. Delaying feeding solid foods until the tongue thrust has stopped b. Modifying diet as necessary to minimize the diarrhea that often occurs c. Providing calories appropriate to child's age d. Using special bottles that may assist the infant with feeding

ANS: D Feedback A 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. B The child is predisposed to constipation. C Calories should be appropriate to the child's weight and growth needs, not age. D Breastfeeding may not be possible if the infant's muscle tone or sucking reflex is immature. Mothers should be encouraged to pump breast milk and use special bottles for assistance with feeding. Some children with Down syndrome can breastfeed adequately.

The nurse caring for a child diagnosed with acute rheumatic fever should assess the child for a. Sore throat b. Elevated blood pressure c. Desquamation of the fingers and toes d. Tender, warm, inflamed joints

ANS: D Feedback A The child may have had a sore throat previously associated with a group A beta-hemolytic streptococcal infection a few weeks earlier. A sore throat is not a manifestation of rheumatic fever. B Hypertension is not associated with rheumatic fever. C Desquamation of the fingers and toes is a manifestation of Kawasaki syndrome. D Arthritis, characterized by tender, warm, erythematous joints, is one of the major manifestations of acute rheumatic fever in the first 1 to 2 weeks of the illness.

The child with lactose intolerance is most at risk for which electrolyte imbalance? a. Hyperkalemia b. Hypoglycemia c. Hyperglycemia d. Hypocalcemia

ANS: D Feedback A The child with lactose intolerance is not at risk for hyperkalemia. B Lactose intolerance does not affect glucose metabolism. C Hyperglycemia does not result from ingestion of a lactose-free diet. D The child between 1 and 10 years requires a minimum of 800 mg of calcium daily. Because high-calcium dairy products containing lactose are restricted from the child's diet, alternative sources such as egg yolk, green leafy vegetables, dried beans, and cauliflower must be provided to prevent hypocalcemia.

Which statement, if made by a nurse to the parents of a child with leukemia, indicates an understanding of teaching related to home care associated with the disease? a. "Your son's blood pressure must be taken daily while he is on chemotherapy." b. "Limit your son's fluid intake just in case he has central nervous system involvement." c. "Your son must receive all of his immunizations in a timely manner." d. "Your son's temperature should be taken frequently."

ANS: D Feedback A The child's temperature must be taken daily because of the risk for infection, but it is not necessary to take a blood pressure daily. B Fluid is never withheld as a precaution against increased intracranial pressure. If a child had confirmed CNS involvement with increased intracranial pressure, this intervention might be more appropriate. C Children who are immunosuppressed should not receive any live virus vaccines. D An elevated temperature may be the only sign of an infection in an immunosuppressed child. Parents should be instructed to monitor their child's temperature as often as necessary.

Which intervention is appropriate for the infant hospitalized with bronchiolitis? a. Position on the side with neck slightly flexed. b. Administer antibiotics as ordered. c. Restrict oral and parenteral fluids if tachypneic. d. Give cool, humidified oxygen.

ANS: D Feedback A The infant should be positioned with the head and chest elevated at a 30- to 40-degree angle and the neck slightly extended to maintain an open airway and decrease pressure on the diaphragm. B The etiology of bronchiolitis is viral. Antibiotics are only given if there is a secondary bacterial infection. C Tachypnea increases insensible fluid loss. If the infant is tachypneic, fluids are given parenterally to prevent dehydration. D Cool, humidified oxygen is given to relieve dyspnea, hypoxemia, and insensible fluid loss from tachypnea.

A child has had cold symptoms for more than 2 weeks, a headache, nasal congestion with purulent nasal drainage, facial tenderness, and a cough that increases during sleep. The nurse recognizes that these symptoms are characteristic of which respiratory condition? a. Allergic rhinitis b. Bronchitis c. Asthma d. Sinusitis

ANS: D Feedback A The classic symptoms of allergic rhinitis are watery rhinorrhea, itchy nose, eyes, ears, and palate, and sneezing. Symptoms occur as long as the child is exposed to the allergen. B Bronchitis is characterized by a gradual onset of rhinitis and a cough that is initially nonproductive but may change to a loose cough. C The manifestations of asthma may vary, with wheezing being a classic sign. The symptoms presented in the question do not suggest asthma. D Sinusitis is characterized by signs and symptoms of a cold that do not improve after 14 days, a low-grade fever, nasal congestion and purulent nasal discharge, headache, tenderness, a feeling of fullness over the affected sinuses, halitosis, and a cough that increases when the child is lying down.

A child who has been in good health has a platelet count of 45,000/mm3, petechiae, and excessive bruising that covers the body. The nurse is aware that these signs are clinical manifestations of a. Erythroblastopenia b. von Willebrand disease c. Hemophilia d. Immune thrombocytopenic purpura (ITP)

ANS: D Feedback A The clinical manifestations of erythroblastopenia are pallor, lethargy, headache, fainting, and a history of upper respiratory infection. B The clinical manifestations of von Willebrand disease are bleeding from the gums or nose, prolonged bleeding from cuts, and excessive bleeding after surgery or trauma. C Bleeding is the clinical manifestation of hemophilia and results from a deficiency of normal factor activity necessary to produce blood clotting. D Excessive bruising and petechiae, especially involving the mucous membranes and gums in a child who is otherwise healthy, are the clinical manifestations of ITP, resulting from decreased platelets. The etiology of ITP is unknown, but it is considered to be an autoimmune process.

Which information should be included in the nurse's discharge instructions for a child who underwent a cardiac catheterization earlier in the day? a. Pressure dressing is changed daily for the first week. b. The child may soak in the tub beginning tomorrow. c. Contact sports can be resumed in 2 days. d. The child can return to school on the third day after the procedure.

ANS: D Feedback A The day after the cardiac catheterization, the pressure dressing is removed and replaced with a Band-Aid. The catheter insertion site is assessed daily for healing. Any bleeding or sign of infection, such as drainage, must be reported to the cardiologist. B Bathing is limited to a shower, a sponge bath, or a brief tub bath (no soaking) for the first 1 to 3 days after the procedure. C Strenuous exercise such as contact sports, swimming, or climbing trees is avoided for up to 1 week after the procedure. D The child can return to school on the third day after the procedure. It is important to emphasize follow-up with the cardiologist.

Which nursing intervention is appropriate to assess for neurovascular competency in a child who fell off the monkey bars at school and hurt his arm? a. The degree of motion and ability to position the extremity b. The length, diameter, and shape of the extremity c. The amount of swelling noted in the extremity and pain intensity d. The skin color, temperature, movement, sensation, and capillary refill of the extremity

ANS: D Feedback A The degree of motion in the affected extremity and ability to position the extremity are incomplete assessments of neurovascular competency. B The length, diameter, and shape of the extremity are not assessment criteria in a neurovascular evaluation. C Although the amount of swelling is an important factor in assessing an extremity, it is not a criterion for a neurovascular assessment. D A neurovascular evaluation includes assessing skin color and temperature, ability to move the affected extremity, degree of sensation experienced, and speed of capillary refill in the extremity.

Which statement is characteristic of AOM? a. The etiology is unknown. b. Permanent hearing loss often results. c. It can be treated by intramuscular (IM) antibiotics. d. It is treated with a broad range of antibiotics.

ANS: D Feedback A The etiology of AOM may be Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, or a viral agent. Recent concerns about drug-resistant organisms have caused authorities to recommend judicious use of antibiotics and that antibiotics are not required for initial treatment. B Permanent hearing loss is not a frequent cause of properly treated AOM. C Intramuscular antibiotics are not necessary. Oral amoxicillin is the treatment of choice. D Historically AOM has been treated with a range of antibiotics, and it is the most common disorder treated with antibiotics in the ambulatory setting.

What is the most appropriate nursing response to the father of a newborn infant with myelomeningocele who asks about the cause of this condition? a. "One of the parents carries a defective gene that causes myelomeningocele." b. "A deficiency in folic acid in the father is the most likely cause." c. "Offspring of parents who have a spinal abnormality are at greater risk for myelomeningocele." d. "There may be no definitive cause identified."

ANS: D Feedback A The exact cause of most cases of neural tube defects is unknown. There may be a genetic predisposition, but no pattern has been identified. B Folic acid deficiency in the mother has been linked to neural tube defect. C There is no evidence that children who have parents with spinal problems are at greater risk for neural tube defects. D The etiology of most neural tube defects is unknown in most cases. There may be a genetic predisposition or a viral origin, and the disorder has been linked to maternal folic acid deficiency; however, the actual cause has not been determined.

The process of burn shock continues until what physiologic mechanism occurs? a. Heart rate returns to normal. b. Airway swelling decreases. c. Body temperature regulation returns to normal. d. Capillaries regain their seal.

ANS: D Feedback A The heart rate will be increased throughout the healing process because of increased metabolism. B Airway swelling subsides over a period of 2 to 5 days after injury. C Body temperature regulation will not be normal until healing is well under way. D Within minutes of the burn injury, the capillary seals are lost with a massive fluid leakage into the surrounding tissue, resulting in burn shock. The process of burn shock continues for approximately 24 to 48 hours, when capillary seals are restored.

How should the nurse explain positioning for a lumbar puncture to a 5-year-old child? a. "You will be on your knees with your head down on the table." b. "You will be able to sit up with your chin against your chest." c. "You will be on your side with the head of your bed slightly raised." d. "You will lie on your side and bend your knees so that they touch your chin."

ANS: D Feedback A The knee-chest position is not appropriate for a lumbar puncture. B An infant can be placed in a sitting position with the infant facing the nurse and the head steadied against the nurse's body. C A side-lying position with the head of the bed elevated is not appropriate for a lumbar puncture. D The child should lie on her side with knees bent and chin tucked in to the knees. This position exposes the area of the back for the lumbar puncture.

Hematopoietic stem cell transplantation (HSCT) is the standard treatment for a child in his or her first remission with what cancer? a. ALL b. Non-Hodgkin lymphoma c. Wilms' tumor d. Acute myeloblastic leukemia (AML)

ANS: D Feedback A The standard treatment for ALL is combination chemotherapy. B Standard treatment for non-Hodgkin lymphoma is chemotherapy. Bone marrow transplantation is used to treat non-Hodgkin lymphoma that is resistant to conventional chemotherapy and radiation. C The treatment for Wilms' tumor consists of surgery and chemotherapy alone or in combination with radiation therapy. D HSCT is often used interchangeably with bone marrow transplantation and is currently standard treatment for children in their first remission with AML.

The long-term treatment plan for an adolescent with an eating disorder focuses on a. Managing the effects of malnutrition b. Establishing sufficient caloric intake c. Improving family dynamics d. Restructuring perception of body image

ANS: D Feedback A The treatment of eating disorders is initially focused on reestablishing physiologic homeostasis. B Once body systems are stabilized, the next goal of treatment for eating disorders is maintaining adequate caloric intake. C Although family therapy is indicated when dysfunctional family relationships exist, the primary focus of therapy for eating disorders is to help the adolescent cope with complex issues. D The focus of treatment in individual therapy for an eating disorder involves restructuring cognitive perceptions about the individual's body image.

The best response for the nurse to make to an adolescent who states, "I am very sad. I wish I was not alive." is a. "Everyone feels sad once in a while." b. "You are just trying to escape your problems." c. "Have you told your parents how you feel?" d. "Have you thought about hurting yourself?"

ANS: D Feedback A This is a judgmental response that ignores the adolescent's obvious statement indicating a need for professional help. B This is a judgmental response that could increase the adolescent's sense of isolation and rejection. C The parents should be made aware of an adolescent's precarious mental state; however, this response does not address the adolescent's statement. D This response acknowledges the adolescent's suicide gesture and further assesses the adolescent's condition.

Which statement suggests that a parent understands how to correctly administer digoxin? a. "I measure the amount I am supposed to give with a teaspoon." b. "I put the medicine in the baby's bottle." c. "When she spits up right after I give the medicine, I give her another dose." d. "I give the medicine at 8 in the morning and evening every day."

ANS: D Feedback A To ensure the correct dosage, the medication should be measured with a syringe. B The medication should not be mixed with formula or food. It is difficult to judge whether the child received the proper dose if the medication is placed in food or formula. C To prevent toxicity, the parent should not repeat the dose without contacting the child's physician. D For maximum effectiveness, the medication should be given at the same time every day.

Which intervention should be included in the nurse's plan of care for a 7-year-old child with encopresis who has cleared the initial impaction? a. Have the child sit on the toilet for 30 minutes when he gets up in the morning and at bedtime. b. Increase sugar in the child's diet to promote bowel elimination. c. Use a Fleets enema daily. d. Give the child a choice of beverage to mix with a laxative.

ANS: D Feedback A To facilitate bowel elimination, the child should sit on the toilet for 5 to 10 minutes after breakfast and dinner. B Decreasing the amount of sugar in the diet will help keep stools soft. C Daily Fleets enemas can result in hypernatremia and hyperphosphatemia, and are used only during periods of fecal impaction. D Offering realistic choices is helpful in meeting the school-age child's sense of control.

Patient and parent education for the child who has a synthetic cast should include a. Applying a heating pad to the cast if the child has swelling in the affected extremity b. Wrapping the outer surface of the cast with an Ace bandage c. Splitting the cast if the child complains of numbness or pain d. Covering the cast with plastic and waterproof tape to keep it dry while bathing or showering

ANS: D Feedback A To prevent swelling, elevate the extremity and apply bagged ice to the casted area. B Wrapping the outer surface with an Ace bandage is not indicated. C If the child complains of numbness or pain, the child should return immediately to the clinic or emergency department for an evaluation of neurovascular status. D Damp skin is more susceptible to breakdown. Cast should be kept clean and dry.

Which action is initiated when a child has been scratched by a rabid animal? a. No intervention unless the child becomes symptomatic b. Administration of immune globulin around the wound c. Administration of rabies vaccine on days 3, 7, 14, and 28 d. Administration of both immune globulin and vaccine as soon as possible after exposure

ANS: D Feedback A Transmission of rabies can occur from bites with contaminated saliva, scratches from the claws of infected animals, airborne transmission in bat-infested caves, or in a laboratory setting. Rabies is fatal if no intervention is taken to prevent the disease. B Human rabies immune globulin is infiltrated locally around the wound and the other half of the dose is given intramuscularly. This is only part of the treatment after rabies exposure. C The rabies vaccine is given within 48 hours of exposure and again on days 3, 7, 14, and 28. D Human rabies immune globulin and the first dose of the rabies vaccine are given after exposure

What should the nurse stress in a teaching plan for the mother of an 11-year-old boy with ulcerative colitis? a. Preventing the spread of illness to others b. Nutritional guidance and preventing constipation c. Teaching daily use of enemas d. Coping with stress and avoiding triggers

ANS: D Feedback A Ulcerative colitis is not infectious. B Although nutritional guidance is a priority teaching focus, diarrhea is a problem with ulcerative colitis, not constipation. C This is not part of the therapeutic plan of care. D Coping with the stress of chronic illness and the clinical manifestations associated with ulcerative colitis (diarrhea, pain) are important teaching foci. Avoidance of triggers can help minimize the impact of the disease and its effect on the child.

Which statement by an adolescent indicates an understanding about factors that can trigger migraine headaches? a. "I should avoid loud noises because this is a common migraine trigger." b. "Exercise can cause a migraine. I guess I won't have to take gym anymore." c. "I think I'll get a migraine if I go to bed at 9 PM on week nights." d. "I am learning to relax because I get headaches when I am worried about stuff."

ANS: D Feedback A Visual stimuli, not auditory stimuli, are known to be a common trigger for migraines. B Exercise is not a trigger for migraines. The adolescent needs regular physical exercise. C Altered sleep patterns and fatigue is a common migraine trigger for migraine headaches. Going to bed at 9 PM should allow an adolescent plenty of sleep to prevent fatigue. D Stress can trigger migraines. Relaxation therapy can help the adolescent control stress and headaches. Other precipitating factors in addition to stress include poor diet, food sensitivities, and flashing lights.

Which vitamin supplements are necessary for children with cystic fibrosis? a. Vitamin C and calcium b. Vitamin B6 and B12 c. Magnesium d. Vitamins A, D, E, and K

ANS: D Feedback A Vitamin C and calcium are not fat soluble. B B6 and B12 are not fat-soluble vitamins. C Magnesium is not a vitamin. D Fat-soluble vitamins are poorly absorbed because of deficient pancreatic enzymes in children with cystic fibrosis; therefore supplements are necessary.

You are preparing immunizations for a 12-month-old child who is immunocompromised. Which immunizations cannot be given? Select all that apply. a. DTaP b. HepA c. IPV d. Varicella e. MMR

ANS: D, E Feedback Correct Children who are immunologically compromised should not receive live viral vaccines. Varicella is a live vaccine and should not be given except in special circumstances. MMR is a live vaccine and should not be given to immunologically compromised children. Incorrect DTaP, HepA, and IPV can be given safely.

It is important for the parents of a child who has had a severe allergic reaction to either peanuts or tree nuts to talk to their health care provider about whether the child should have medication available at school in case of an unanticipated exposure to nuts. Epinephrine is now available and easy to use in a device known as the ____________.

ANS: EpiPen The EpiPen is an auto-inject that can be given through the child's clothing. After the injection is given, the pen should be held in place for 10 seconds so that all medication can be delivered.

The number of hours spent sleeping decreases as the child grows older. Children ages 6 and 7 years require approximately 9 or 10 hours of sleep per night. Is this statement true or false?

ANS: F Children ages 6 and 7 actually need approximately 12 hours of sleep per night. Some children also continue to need an afternoon nap or quiet time to restore energy levels. The 12-year-old needs approximately 9 to 10 hours of sleep at night. Adequate sleep is important for school performance and physical growth. Inadequate sleep can cause irritability, inability to concentrate, and poor school performance.

For the child who speaks another language, the nurse must identify an interpreter who is proficient in both languages. The patient's 12-year-old brother has accompanied him to the hospital and would be an ideal candidate to interpret before any treatment or surgical procedure. Is this statement true or false?

ANS: F Other children should not be used as interpreters under any circumstances. An adult family member, a friend of the family, or an interpreter service should be used whenever possible. This is necessary in order to explain procedures, teach new skills, and assess patient needs.

The CDC recommends that all health care providers use the World Health Organization (WHO) growth standards to monitor growth for infants and children aged 0-2 years. For children ages 2 and older the CDC growth chart should be used. These charts are standardized and appropriate for all children. Is this statement true or false?

ANS: F There are special growth charts available for premature or very low birth weight infants, and children with specific conditions that may affect size and growth (i.e., Down syndrome).

The rate of Sudden Infant Death Syndrome (SIDS), now the third leading cause of death in infants, has increased despite international efforts and the Back to Sleep campaign. Is this statement true or false?

ANS: F This statement is incorrect. SIDS, which for a long time was the second leading cause of infant deaths, has decreased in part because of the Back to Sleep program. It is important for both hospital and clinic nurses to educate parents on safe sleep strategies for their infant.

Bipolar disorder is characterized by chronic, fluctuating, and extreme mood disturbances. Onset for this disorder occurs most often during the late preschool to early school-age stage of development. Is this statement true or false?

ANS: F Bipolar disorder occurs most often in late adolescence or early adulthood. Depression and lowered mood, alternate with episodes of the elation and aggression. Impaired social relationships are common.

Clostridium difficile (C-difficile) is a gram-positive anaerobic bacteria known to cause diarrhea, abdominal cramps, and fever. The CDC has reported that children are at minimal risks as this infection affects primarily the elderly or patients who are immunocompromised. Is this statement true or false?

ANS: F In 2005, the CDC reported an increase in the number of cases of Clostridium difficile in children who were previously thought to be at minimal risk. Children ages 1 to 4 are primarily affected.

The nurse who provides care for young children with fluid and electrolyte imbalance understands that they are more vulnerable to changes in fluid balance than adults. Under normal conditions the amount of fluid ingested during the day should equal the amount of fluid lost. Sensible water loss is that which occurs through the respiratory tract and skin. Is this statement true or false?

ANS: F Sensible water loss occurs through urine output. Insensible water loss occurs through the skin and respiratory tract. Insensible water loss per unit of body weight is significantly higher in infants and young children due to the faster respiratory rate and higher evaporative water losses.

The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding, or provision of breast milk by bottle, for the first 4 to 6 months of life, preferably until the child reaches 1 year of age or beyond. This does not include infants with congenital heart disease who have difficulty maintaining breastfeeding due to poor oxygenation and fatigue. Is this statement true or false?

ANS: F The AAP states that breastfeeding should not be precluded for most high-risk neonates and infants, including those with congenital heart disease. The benefits of breastfeeding these infants includes; higher and more stable oxygen saturation measurements, improved weight gain, and shorter hospital stays.

The nurse is evaluating lab results to determine if her patient is experiencing a diagnosis of DIC. The nurse should anticipate the following results: increased red blood cell count, low platelet counts, and an increased fibrinogen level. Is this statement true or false?

ANS: F The results indicate a decreased red blood cell count, low platelets, red blood cell fragments, prolonged prothrombin time, and a decreased fibrinogen level with an increased D-dimer.

An important part of the physical exam is the otoscopic examination of the ear. The ear canal should be straightened prior to visualization. If the child is younger than 3, this is accomplished when the nurse pulls the pinna of the ear down and back. Is this the correct procedure?

ANS: T If the child is older than 3, the pinna is pulled up and back. As much of the ear canal as possible should be visible before the speculum is inserted into the auditory meatus.

Parents are often concerned about their toddler's interest in and curiosity about gender differences. Sex play and masturbation are common among toddlers. Is this statement true or false?

ANS: T Nurses can reassure parents that self-exploration and exploration of another toddler's body is normal behavior during early childhood. Parents should respect the child's curiosity as normal and not judge them as being "bad."

The use of electronic or digital media for communication has had a negative effect on the language development of adolescents. Is this statement true or false?

ANS: T Text messaging, instant messaging, blogs, and Twitter all contribute to abbreviated communication techniques, which eliminate not only grammar and sentence construction, but also word development (e.g., using ur, for you are).

Breastfeeding is the ideal method for providing nutrition to the human infant and is recommended by the American Heart Association, the American Academy of Pediatrics, and the World Health Organization. Infants should be exclusively breastfed for a minimum of 4 months and preferably 6 months. Is this statement true or false?

ANS: T This statement is correct. Solid food should not be introduced until 4 to 6 months of age. Breastfeeding should accompany solid food introduction until 1 year of age.

Alterations in acid-base balance can affect cellular metabolism and enzymatic processes. When alterations in pH become too much for buffer systems to handle, compensatory mechanisms are activated. If the pH drops below normal than acidosis will occur. Is this statement true or false?

ANS: T Acidosis is the result of a drop in blood pH. The respiratory rate and depth will increase, removing carbon dioxide and raising blood pH. Conversely in the presence of alkalosis, respiratory rate and depth decrease, lowering blood pH.

Human cytomegalovirus (CMV) infection is a common cause of congenital infection and is the leading cause of hearing loss and intellectual disability in the United States. The neonate may be infected during the prenatal, perinatal, or postnatal period. Only infections acquired in utero cause permanent infection. Is this statement true or false?

ANS: T Approximately one third of women with primary CMV infection transmit the virus to the fetus. The prevalence is one in 150 live births. Only 10% of infected newborns go on to manifest symptoms. These include jaundice, lethargy, seizures, petechiae, respiratory distress, enlarged liver, and microcephaly.

Complementary and alternative medical therapies (CAM) are those that are scientifically proven or are not proven; however, they are deemed to be useful as an adjunct to treatment. It is not uncommon for families to try CAM without disclosing this information to the health care team. Is this statement true or false?

ANS: T Families should be asked about CAM therapies by the nurse in a nonthreatening manner. This is important information because some therapies can potentially decrease the efficacy of chemotherapy (such as folate in a child receiving methotrexate).

The nurse is providing education related to "Safe Sleep" to the parents of a healthy newborn infant to help prevent sudden infant death syndrome (SIDS). The nurse instructs the parents that bed sharing is not recommended; however, they should put the infant in a safe bassinet or crib in the parent's room for sleeping. Is this statement true or false?

ANS: T The American Academy of Pediatrics (AAP) recommends the following actions to help prevent SIDS in infants: place healthy infants on their backs to sleep, use mattresses with a firm sleeping surface, avoid exposing the infant to secondhand smoke, and offer a pacifier for sleep. In addition, bed sharing is not recommended, and parents are advised to put the infant in a safe bassinet or crib in the parent's room for sleeping.

Electric injury to a child often results in instant death because the electric current disrupts the rhythm of the heart. Is this statement true or false?

ANS: T The child who does not die instantly after an electrical injury is at risk for cardiac arrest or dysrhythmia, tissue damage, myoglobinuria, and metabolic acidosis.

Munchausen syndrome by proxy occurs when a person falsifies illness in their child. The pediatric nurse who is admitting a preschooler with this potential diagnosis understands that this is the most difficult form of child abuse to diagnose. Is this statement true or false?

ANS: T This is correct. The most common reasons these caretakers give for seeking treatment for the child include: bleeding, seizures, central nervous system depression, apnea, vomiting, diarrhea, fever, and rash. The parent's behavior reflects a serious psychiatric disturbance that requires both psychiatric treatment and removal of the child from their care.

A frequent parental concern is children's leg length inequality. Asymptomatic leg length inequality is relatively common in children. Is this statement true or false?

ANS: T This statement is correct. Causes may be congenital or acquired. Treatment ranges from no intervention to extensive reconstruction or prosthetic fitting.

Type 1 diabetes, the most common childhood endocrine disease, presents challenges to the nurse in the areas of teaching, management, and adherence. Due to recent changes in health care delivery systems, meeting the needs of a type 1 diabetic child has become even more complicated. Unless the newly diagnosed child is in diabetic ketoacidosis, the child may not be hospitalized. Is this statement true or false?

ANS: T This statement is correct. Therefore the nurse must develop a plan of care that involves child and family education and supports them in either an inpatient or in outpatient setting.

What is an appropriate nursing action before surgery when caring for a child diagnosed with a Wilms' tumor? a. Limit fluid intake. b. Do not palpate the abdomen. c. Force oral fluids. d. Palpate the abdomen every 4 hours.

B Excessive manipulation of the tumor area can cause seeding of the tumor and spread of the malignant cells. Fluids are not routinely limited in a child with a Wilms' tumor. However, intake and output are important because of the kidney involvement. Fluids are not forced on a child with a Wilms' tumor. Normal intake for age is usually maintained. The abdomen of a child with a Wilms' tumor should never be palpated because of the danger of seeding the tumor and spreading malignant cells.

How should the nurse instruct the mother who calls the emergency department because her 9-year-old child has just fallen on his face and one of his front teeth fell out? a.Put the tooth back in the childs mouth and call the dentist right away. b.Place the tooth in milk or water and go directly to the emergency department. c.Gently place the tooth in a plastic zippered bag until she makes a dental appointment. d.Clean the tooth and call the dentist for an immediate appointment.

B A.The parent may replace the tooth incorrectly, so it is best not to advise the parent to do this. B.The parent should be told to keep the tooth moist by placing it in a saline solution, water, milk, or a commercial tooth-preserving solution and get the child evaluated as soon as possible. C.The tooth should be kept moist, not dry. The child should be evaluated as soon as possible. D.Cleaning or scrubbing the tooth could damage it. It is essential for the child to have an immediate dental evaluation.

The nurse understands that the types of precautions needed for children receiving chemotherapy are based on which action of chemotherapeutic agents? a. Gastrointestinal upset b. Bone marrow suppression c. Decreased creatinine level d. Alopecia

B Chemotherapy agents cause bone marrow suppression, which creates the need to institute precautions related to reduced white blood cell, red blood cell, and platelet counts. These precautions focus on preventing infection and bleeding. Although gastrointestinal upset may be an adverse effect of chemotherapy, it is not caused by all chemotherapeutic agents. No special precautions are instituted for gastrointestinal upset. A decreased creatinine level is consistent with renal pathologic conditions, not chemotherapy. Not all chemotherapeutic agents cause alopecia. No precautions are taken to prevent alopecia.

You are the nurse caring for a child who is diagnosed with septic shock. He begins to develop an dysrhythmia and hemodynamic instability. Endotracheal intubation is necessary. The physician feels that cardiac arrest may soon develop. What drug do you anticipate the physician will order? a.Atropine sulfate b.Epinephrine c.Sodium bicarbonate d.Inotropic agents

B A.Atropine sulfate is used to treat symptomatic bradycardia. B.Epinephrine is the drug of choice for the management of cardiac arrest, dysrhythmias, and hemodynamic instability. C.Sodium bicarbonate is given to treat severe acidosis associated with cardiac arrest. D.Inotropic agents are indicated for hypotension or poor peripheral circulation in a child.

Assessment of a child with a submersion injury focuses on which system? a.Cardiovascular b.Respiratory c.Neurologic d.Gastrointestinal

B A.Cardiovascular assessment is secondary to the airway and breathing. B.Assessment of the child with a submersion injury focuses on the respiratory system. The airway and breathing are the priorities. C.Preventing neurologic impairment is a goal of intervention. Because the primary problem in submersion injuries is hypoxia, the focus of assessment is the respiratory system. D.Gastrointestinal assessment is less of a priority than assessment of other body systems.

Which action should the nurse working in the emergency department implement in order to decrease fear in a 2-year-old child? a.Keep the child physically restrained during nursing care. b.Allow the child to hold a favorite toy or blanket. c.Direct the parents to remain outside the treatment room. d.Let the child decide whether to sit up or lie down for procedures.

B A.It may be necessary to restrain the toddler for some nursing care or procedures. Because toddlers need autonomy and do not respond well to restrictions, the nurse should remove any restriction or restraint as soon as safety permits. B.Allowing a child to hold a favorite toy or blanket is comforting. C.Parents should remain with the child as much as possible to calm and reassure her. D.The toddler should not be given the overwhelming choice of deciding which position she prefers.

Which observations made by an emergency department nurse raises the suspicion that a 3-year-old child has been maltreated? a.The parents are extremely calm in the emergency department. b.The injury is unusual for a child of that age. c.The child does not remember how he got hurt. d.The child was doing something unsafe when the injury occurred.

B A.The nurse should observe the parents reaction to the child but must keep in mind that people behave very differently depending on culture, ethnicity, experience, and psychological makeup. B.An injury that is rarely found in children or is inconsistent with the age and condition of the child should raise suspicion of child maltreatment. C.The child may not remember what happened as a result of the injury itself, for example, sustaining a concussion. Also, a 3-year-old child may not be a reliable historian. D.The fact that the child was not supervised might be an area for health teaching. The nurse needs to gather more information to determine whether the parents have been negligent in the care of their child.

A child with non-Hodgkin lymphoma will be starting chemotherapy. What intervention is initiated before chemotherapy to prevent tumor lysis syndrome? a. Insertion of a central venous catheter b. Intravenous (IV) hydration containing sodium bicarbonate c. Placement of an externalized ventriculoperitoneal (VP) shunt d. Administration of pneumococcal and Haemophilus influenzae type B vaccines

B Intensive hydration with an IV fluid containing bicarbonate alkalinizes the urine to help prevent the formation of uric acid crystals, which damage the kidney. A central venous catheter is placed to assist in delivering chemotherapy. An externalized VP shunt may be placed to relieve intracranial pressure caused by a brain tumor. If a splenectomy is necessary for a child with Hodgkin disease, the pneumococcal and Haemophilus influenzae vaccines are administered before the surgery.

What is a priority nursing diagnosis for the 4-year-old child newly diagnosed with leukemia? a. Ineffective Breathing Pattern related to mediastinal disease b. Risk for Infection related to immunosuppressed state c. Disturbed Body Image related to alopecia d. Impaired Skin Integrity related to radiation therapy

B Leukemia is characterized by the proliferation of immature white blood cells, which lack the ability to fight infection. Ineffective Breathing Pattern applies to a child with non-Hodgkin lymphoma or any cancer involving the chest area. Disturbed Body Image relates to children taking chemotherapy or radiation therapy and does not occur for all children. It would not be the highest priority even if the child had the diagnosis. Radiation therapy is not a treatment for leukemia.

While completing an assessment on a 6-month-old infant, which finding should the nurse recognize as a symptom of a brain tumor? a. Blurred vision b. Increased head circumference c. Vomiting when getting out of bed d. Headache

B Manifestations of brain tumors vary with tumor location and the child's age and development. Infants with brain tumors may be irritable or lethargic, feed poorly, and have increased head circumference with a bulging fontanel. Visual changes such as nystagmus, diplopia, and strabismus are manifestations of a brain tumor but would not be able to be verbalized by an infant. The change in position on awakening causes an increase in intra- cranial pressure, which is manifested as vomiting. Vomiting on awakening is considered a hallmark symptom of a brain tumor, but infants do not get themselves out of bed in the morning. Increased intracranial pressure resulting from a brain tumor is manifested as a headache but could not be verbalized by an infant.

What may cause hypovolemic shock in children? Select all that apply. a.Hyperthermia b.Burns c.Vomiting or diarrhea d.Hemorrhage e.Skin abscess that cultures positive for methicillin-resistant Staphylococcus aureus (MRSA)

B, C, D Correct These are all causes of hypovolemic shock, which is characterized by an overall decrease in circulating blood or fluid volumes. Incorrect Neither of these is a cause of hypovolemic shock.

The nurse observes abdominal breathing in a 2-year-old child. What does this finding indicate? a.Imminent respiratory failure b.Hypoxia c.Normal respiration d.Airway obstruction

C A.A very slow respiration rate is an indicator of respiratory failure. B.Nasal flaring with inspiration and grunting on expiration occurs when hypoxia is present. C.Young children normally exhibit abdominal breathing. When measuring respiratory rate, the nurse should observe the rise and fall of the abdomen. D.The child with an airway obstruction will use accessory muscles to breathe.

Which action should the nurse incorporate into a care plan for a 14-year-old child in the emergency department? a.Limit the number of choices to be made by the adolescent. b.Insist that parents remain with the adolescent. c.Provide clear explanations and encourage questions. d.Give rewards for cooperation with procedures.

C A.Because adolescents are capable of abstract thinking, they should be allowed to make decisions about their care. B.Adolescents should have the choice of whether parents remain with them. They are very modest, and this modesty should be respected. C.Adolescents are capable of abstract thinking and can understand explanations. They should be offered the opportunity to ask questions. D.Giving rewards such as stickers for cooperation with treatments or procedures is more appropriate for the younger child.

A child is brought to the emergency department. When he is called to triage, which vital sign should be measured first? a.Temperature b.Heart rate c.Respiratory rate d.Blood pressure

C A.Temperature should be measured after other vital signs because it can be upsetting for children. B.Heart rate is not the first vital sign measured in children. C.When taking childrens vital signs, the nurse observes the respiratory rate first. D.Blood pressure is taken after other vital signs because it can be upsetting for children.

Parents of a child with acute lymphoblastic leukemia (ALL) ask about their child's prognosis. The nurse should base the response on the knowledge that a. leukemia is a fatal disease, although chemotherapy provides increasingly longer periods of remission. b. research to find a cure for childhood cancers is very active. c. the majority of children go into remission and remain symptom free when treatment is completed. d. it usually takes several months of chemotherapy to achieve a remission.

C Children diagnosed with the most common form of leukemia, ALL, can almost always achieve remission, with a 5-year disease-free survival rate approaching 85%. With the majority of children surviving 5 years or longer, it is inappropriate to refer to leukemia as a fatal disease. Telling parents about current research to answer their question does not address their concern. About 95% of children achieve remission within the first month of chemotherapy.

What fluid is the best choice when a child with mucositis asks for something to drink? a. Hot chocolate b. Lemonade c. Popsicle d. Orange juice

C Cool liquids are soothing, and ice pops are usually well tolerated. A hot beverage can be irritating to mouth ulcers. Citrus products may be very painful to an ulcerated mouth.

Children with non-Hodgkin lymphoma are at risk for complications resulting from tumor lysis syndrome (TLS). What findings would the nurse assess for to identify this complication early? a. Increased ALT, AST b. Change in level of consciousness c. Elevated BUN and creatinine d. Oxygen saturation of 93%

C In TLS, the tumor's intracellular contents are dumped into the child's extracellular fluid as the tumor cells are lysed in response to chemotherapy. Because of the large volume of these cells, their intracellular electrolytes overload the kidneys and, if not monitored, can cause kidney failure. Kidney failure would manifest in rising BUN and creatinine. This does not affect the liver so increased ALT and AST are not related. Changes in level of consciousness would not help identify this specific complication. An oxygen saturation of 93% is related to the lungs.

The nurse is aware that an abdominal mass found in a 10-month-old infant corresponds with which childhood cancer? a. Osteogenic sarcoma b. Rhabdomyosarcoma c. Neuroblastoma d. Non-Hodgkin lymphoma

C Neuroblastoma is found exclusively in infants and children. In most cases of neuroblastoma, a primary abdominal mass and protuberant, firm abdomen are present. Osteogenic sarcoma is a bone tumor. Bone tumors typically affect older children. Rhabdomyosarcoma is a malignancy of muscle or striated tissue. It occurs most often in the periorbital area, in the head and neck in younger children, or in the trunk and extremities in older children. Non-Hodgkin lymphoma is a neoplasm of lymphoid cells. Painless, enlarged lymph nodes are found in the cervical or axillary region. Abdominal signs and symptoms do not include a mass.

A nurse has taught parents about diagnostic testing for their child who is suspected of having leukemia. What test described by the parents shows good understanding of this information? a. Complete blood cell count (CBC) b. Lumbar puncture c. Bone marrow biopsy d. Computed tomography (CT) scan

C The confirming test for leukemia is microscopic examination of bone marrow obtained by bone marrow aspiration and biopsy. A CBC may show blast cells that would raise suspicion of leukemia. It is not a confirming diagnostic study. A lumbar puncture is done to check for central nervous system involvement in the child who has been diagnosed with leukemia. A CT scan may be done to check for bone involvement in the child with leukemia. It does not confirm a diagnosis.

A child has just been diagnosed with acute lymphoblastic leukemia, and the mother is expressing guilt about not taking the child to the doctor right away. What response by the nurse is best? a. "Always call the physician when your child has a change in what is normal for him." b. "It is better to be safe than sorry." c. "It is common for parents not to notice subtle changes in their children's health." d. "I hope this delay does not affect the treatment plan."

C This statement is not only true, but it will also help minimize the mother's guilt and help establish a therapeutic relationship with the nurse. Identifying concerns and clarifying misconceptions will help families cope with the stress of chronic illness.

What is the leading cause of unintentional death in children younger than 19 years of age in the United States? a.Drowning b.Airway obstruction c.Pedestrian injury d.Motor vehicle injuries

D A.Drowning is the second leading cause of unintentional death for children under 19 years of age. B.Airway obstruction is the third leading cause of unintentional death for children under 19 years of age. C.Pedestrian injuries are not the leading cause of unintentional death in children. It is a significant problem, with most injuries occurring in children between 1 and 4 years. D.The Centers for Disease Control and Prevention (CDC) has consistently found that motor vehicle injuries are the leading cause of unintentional death in children younger than 19 years of age in the United States.

A 3-year-old is brought to the emergency department by ambulance after her body was found submerged in the family pool. The child has altered mental status and shallow respirations. She did not require resuscitative interventions. Which condition should the nurse monitor first in this child? a.Neurologic status b.Hypothermia c.Hypoglycemia d.Hypoxia

D A.Although a neurologic assessment will be required, it is not the area of primary assessment. The airway is always assessed first. B.Hypothermia offers protection to the brain. It is a concern, but not the area of primary concern. C.Although the child may have electrolyte imbalances, this is not the primary assessment area. D.Hypoxia is responsible for the injury to organ systems during submersion injuries. Hypoxia can progress to cardiopulmonary arrest. Monitoring the airway is always the number one concern.

What is an appropriate nursing intervention for a 6-month-old infant in the emergency department? a.Distract the infant with noise or bright lights. b.Avoid warming the infant. c.Remove any pacifiers from the baby. d.Encourage the parent to hold the infant.

D A.Distraction with noise or bright lights is most appropriate for a preschool-age child. B.In an emergency health care facility, it is important to keep infants warm. C.Infants use pacifiers to comfort themselves; therefore the pacifier should not be taken away. D.Parents should be encouraged to hold the infant as much as possible while in the emergency department. Having the parent hold the infant may help to calm the child.

In which situation is the administration of milk or water indicated after ingestion? a.The child is suspected of ingesting lead paint chips. b.The child ingested approximately 15 tablets of baby aspirin. c.The child ingested an over-the-counter product containing acetaminophen. d.The child ingested an acid or alkali.

D A.Ingestion of leaded paint chips does not indicate treatment with administration of water or milk. B.Ingestion of aspirin is not treated with administration of water or milk. The treatment may involve gastric lavage with activated charcoal, IV fluids with various additives to decrease absorption, treatment of electrolyte imbalances, and vitamin K for bleeding tendencies. C.Ingestion of acetaminophen is not treated with administration of milk or water. Gastric lavage within 1 hour and administration of the antidote N-acetylcysteine (Mucomyst) is indicated. D.Administering water or milk can dilute the toxic effects of acid or alkali ingestion.

Which initial assessment made by the triage nurse suggests that a child requires immediate intervention? a.The child has thick yellow rhinorrhea. b.The child has a frequent nonproductive cough. c.The childs oxygen saturation is 95% by pulse oximeter. d.The child is grunting.

D A.Nasal discharge indicates that the child has a respiratory condition but does not mean the child needs immediate attention. B.A productive cough is not a finding that indicates that the child requires immediate attention. C.An oxygen saturation of 95% is a normal finding. D.One of the initial observations for triage is respiratory rate and effort. Grunting is a sign of hypoxemia and represents the bodys attempt to improve oxygenation by generating positive end-expiratory pressure.

Which nursing action is most appropriate to assist a preschool-age child in coping with the emergency department experience? a.Explain procedures and give the child at least 1 hour to prepare. b.Remind the child that she is a big girl. c.Avoid the use of bandages. d.Use positive terms and avoid terms such as shot and cut

D A.Preschool-age children should be told about procedures immediately before they are done. Allowing 1 hour of time to prepare only allows time for fantasies and increased anxiety. B.Children should not be shamed into cooperation. C.Bandages are important to preschool-age children. Children in this age-group believe that their insides can leak out and that bandages stop this from happening. D.Using positive terms and avoiding words that have frightening connotations assist the child in coping.

The father of a child in the emergency department is yelling at the physician and nurses. Which action is contraindicated in this situation? a.Provide a nondefensive response. b.Encourage the father to talk about his feelings. c.Speak in simple, short sentences. d.Tell the father he must wait in the waiting room.

D A.When dealing with parents who are upset, it is important not to be defensive or attempt to justify anyones actions. B.Encouraging the father to talk about his feelings may assist him to acknowledge his emotions and may defuse his angry reaction. C.People who are upset need to be spoken to with simple words (no longer than five letters) and short sentences (no more than five words). D.Because a parent who is upset may be aggravated by observers, he should be directed to a quiet area.

A nurse has taught the parents about home care of their child who has leukemia. Which statement made by the parents indicates an understanding of this teaching? a. "We will take our child's blood pressure daily." b. "We will restrict fluids in case there is central nervous system involvement." c. "We will make sure our child gets all immunizations in a timely manner." d. "We will take our child's temperature frequently."

D An elevated temperature may be the only sign of an infection in an immunosuppressed child. Parents should be instructed to monitor their child's temperature as often as necessary. It is not necessary to monitor blood pressure daily. Fluids are never withheld as a precautionary measure. Children who are immunosuppressed should not receive live virus vaccines.

A child is in the hospital receiving chemotherapy, and the nurse suspects the child has an infection. What action by the nurse takes priority? a. Monitor the child's temperature. b. Assess the daily white blood cell count. c. Administer antibiotics. d. Obtain blood and urine cultures.

D For a child with a suspected infection, cultures are taken to determine the site and type of infection. Often these include blood and urine but may include sputum or wound drainage. Antibiotics are only started after cultures have been obtained. Monitoring temperature and WBCs is important, but cultures are the only way to specifically identify an organism so it can be effectively treated.

Hematopoietic stem cell transplantation (HSCT) is the standard treatment for a child in his or her first remission with what cancer? a. Acute lymphocytic leukemias b. Non-Hodgkin lymphoma c. Wilms' tumor d. Acute myeloblastic leukemia (AML)

D HSCT is often used interchangeably with bone marrow transplantation and is currently standard treatment for children in their first remission with AML. Transplantation is standard treatment for a specific type of ALL (Philadelphia chromosome positive). Standard treatment for non-Hodgkin lymphoma is chemotherapy. Bone marrow transplantation is used to treat non-Hodgkin lymphoma that is resistant to conventional chemotherapy and radiation. The treatment for Wilms' tumor consists of surgery and chemotherapy alone or in combination with radiation therapy.

The nurse notes a reddened area on the forearm of a neutropenic child with leukemia. What action by the nurse is most appropriate? a. Massage the area. b. Turn the child more frequently. c. Document the finding and continue to observe the area. d. Notify the provider.

D Skin is the first line of defense against infection. Any signs of infection in a child who is immunosuppressed must be reported. When a child is neutropenic, pus may not be produced, and the only sign of infection may be redness. The area should never be massaged. The forearm is not a typical pressure area; therefore the likelihood of the redness being related to pressure is very small. The observation should be documented, but because it may be a sign of an infection and immunosuppression, the physician must also be notified.

A child with a history of fever of unknown origin, excessive bruising, lymphadenopathy, anemia, and fatigue is exhibiting symptoms most suggestive of which of the following? a. Ewing sarcoma b. Wilms' tumor c. Neuroblastoma d. Leukemia

D These symptoms reflect bone marrow failure and organ infiltration, which occur in leukemia. Symptoms of Ewing sarcoma involve pain and soft tissue swelling around the affected bone. Wilms' tumor usually manifests as an abdominal mass with abdominal pain and may include renal symptoms, such as hematuria, hypertension, and anemia. Neuroblastoma manifests primarily as an abdominal, chest, bone, or joint mass. Symptoms are dependent on the extent and involvement of the tumor.

The childhood vaccine ____________________ has dramatically reduced the incidence of epiglottitis.

H. influenzae type B (HIB) vaccine The nurse should encourage parents of young children to have their children immunized against H. influenzae to decrease the risk for contracting epiglottitis. Prophylaxis with rifampin is given to underimmunized contacts or family members younger than 4 years old and to any child contact who is immune depressed.

Automatic external defibrillators (AEDs) are becoming increasingly more available in community settings. They are very effective for correcting serious rhythm disturbances in adults; however, they are not recommended for use in children.

F It is now recommended that AEDs be used for infants and children as well. AEDs with high specificity in recognizing pediatric shockable rhythms and a system to decrease or attenuate delivery of shock are best used in children under 8 years of age.

The most common cause of death in the adolescent age-group involves a. Drownings b. Firearms c. Drug overdoses d. Motor vehicles

Feedback A Drownings are major concerns in adolescence but do not cause the majority of deaths. B Firearms are major concerns in adolescence but do not cause the majority of deaths. C Drug overdoses are major concerns in adolescence but do not cause the majority of deaths. D Risk taking behaviors play a major role in the high incidence of motor vehicle injuries and death among teenagers i.e. alcohol use, failure to wear a seatbelt, and inexperience.

. In which section of the health history should the nurse record that the parent brought the infant to the clinic today because of frequent diarrhea? a. Review of systems b. Chief complaint c. Lifestyle and life patterns d. Health history

Feedback A The review of systems includes past health functions of body systems. B The chief complaint is documented using the child's or parent's words for the reason the child was brought to the health care center. C Lifestyle and life patterns include the child's interaction with the social, psychological, physical, and cultural environment. D Health history includes birth history, growth and development, common childhood illnesses, immunizations, hospitalizations, injuries, and allergies.

Which statement about performing a pediatric physical assessment is correct for a school-age child? Select all that apply. a. Physical examinations proceed systematically from head to toe. b. The physical examination should be done with parents in the waiting room. c. Measurement of head circumference is obtained. d. The physical examination is done only when the child is cooperative. e. Remove clothing and have the child put on an examination gown.

Feedback Correct Physical assessment usually proceeds from head to toe; however if developmental delays exist, considerations dictate that the least threatening assessments be done first to obtain accurate data. School-age children are at a developmental stage when they should be cooperative for the physical examination. Children of this age are usually modest, and an examination gown should be provided. Incorrect Having parents in the examining room with adolescents is not appropriate, but is appropriate for children of other age-groups. Parents usually are not kept in the waiting room. Measurement of head circumference is obtained on children 36 months of age or less.

Elevated blood pressure in the blood vessels of the lungs is a condition known as PAH or _____________________ __________________ .

Pulmonary hypertension Pulmonary hypertension is diagnosed when the mean arterial pressure exceeds 20 mm Hg (normal is 15 mm Hg). The most common cause of pulmonary hypertension in children is congenital heart disease.

Regardless of the cause of traumatic injury, most children do well unless the injuries are extremely severe. Even children with traumatic brain injuries (TBI) have far more favorable chances of recovery than most adults. Is this statement true or false?

T Children up to 4 years old sustain TBIs 30% more often than any other age-group, but make up the lowest number of TBI hospitalizations and deaths.

The parents of a preschool child ask the nurse why their child needs to have her "eyes tested." The nurse explains that although evaluating the visual acuity in a young child can be difficult, the American Academy of Pediatric recommends that visual acuity testing be assessed on all children beginning no later than age _________ years.

three The American Academy of Pediatric recommends that visual acuity testing be assessed on all children beginning no later than age 3 years. Tools available for testing the visual acuity of preschool children include Lea cards, tumbling Es, and the HOTV chart.