Peds final review

A child has been diagnosed with hemophilia type A after experiencing excessive bleeding from a minor trauma. The mother states that the toddler being seen for the trauma is very active and is difficult, constantly saying no. What would be an appropriate response? 1 "Toddlers are curious, trying to make decisions and be independent." 2 "Saying no at this stage is a signal that the child may need some therapy." 3 "You must show the child from a young age that you are the boss and in charge." 4 "Responsible parenting means you must protect the child from all future injuries."

1 Toddlers are curious, trying to make decisions and being independent, and learning autonomy, which is a normal developmental stage for this age group. Saying no is the toddler's means of developing independence rather than a need for therapy. The developmental task according to Erikson is autonomy verses shame, so caregivers need to allow some independence. No person can protect absolutely another individual from all injuries.

A 7-year-old child with cerebral palsy who wears leg braces has a slight sensory loss in the lower extremities. What is the most essential information for the nurse to teach the child and parents? 1 Examine the skin for evidence of pressure points. 2 Keep the braces in good repair and pad them well. 3 Select shoes that have heels that are wide and low. 4 Check that the brace joints are aligned with body joints

1 When sensory perception is impaired, with resultant lack of effective specific motor responses, the child will be more vulnerable to skin irritation and trauma. Although it is important for the braces to be usable and well padded, the skin must be assessed daily when there is a sensory loss. Pressure may still occur even if the braces are well padded. Although this type of shoe will facilitate balance, assessing the skin for breakdown is the priority. Although alignment of brace joints to body joints is important in facilitating joint mobility, assessment for skin breakdown takes priority.

A nurse obtains a health history from the parents of a toddler who is admitted to the pediatric unit with the diagnosis of acute lymphocytic leukemia (ALL). What problems does the nurse expect the parents to report? Select all that apply. 1 Loss of appetite 2 Sores in the mouth 3 Paleness of the skin 4 Inability to fall asleep 5 Purplish spots on the skin

1,3,5 Anorexia, a presenting symptom of ALL, may be the result of enlarged lymph nodes, areas of inflammation in the intestinal tract, and catabolism. Pallor is another presenting sign of ALL; the number of red blood cells (RBCs) is decreased (anemia) because of bone marrow depression. Decreased platelet production results in bleeding tendencies; petechiae often are a presenting sign of ALL. Sores in the mouth are not a presenting sign of ALL but often result from chemotherapy. Because of bone marrow depression there is a reduced number of RBCs and therefore less oxygen being carried to body cells. The child will be lethargic and sleep excessively.

A nurse is obtaining a health history from the parents of a toddler who has recently been diagnosed with acute lymphocytic leukemia. Which early physiologic changes does the nurse expect the parents to report? Select all that apply. 1 Pale skin 2 Loss of hair 3 Eating less food 4 Sores in the mouth 5 Purplish spots on the skin

1,3,5 Pallor is a presenting sign of leukemia and reflects anemia because of decreased erythrocytes. Lack of appetite (anorexia) resulting in the consumption of less food is a presenting symptom of leukemia; it may be the result of enlarged lymph nodes and areas of inflammation in the intestinal tract. Decreased platelet production with petechiae and bleeding is a presenting sign of leukemia. Alopecia results from chemotherapy, not the leukemia. Sores in the mouth are not a presenting sign but often result from chemotherapy.

A ventroperitoneal shunt is inserted in a 4-month-old infant with hydrocephalus. Which signs of shunt failure should the nurse teach the parents during preparations for the infant's discharge? Select all that apply. 1 Vomiting 2 Dehydration 3 Sunken eyeballs 4 Distended fontanels 5 Abdominal distention

1,4 Vomiting is a sign of increased intracranial pressure in an infant; a malfunctioning shunt will produce the typical signs of hydrocephalus. Bulging fontanels indicate increased cerebrospinal fluid and increased intracranial pressure in an infant. Dehydration and sunken eyeballs are a sign of severe fluid volume deficit caused by prolonged vomiting or diarrhea; they are not associated with the projectile vomiting of increased intracranial pressure. Abdominal distention is a typical sign of gastroenteritis, not shunt failure.

Which of the following signs are indications of hydration status during a sickle cell crisis? Select all that apply. 1 Turgor of tissue 2 Edema of the ankles 3 Specific gravity of urine 4 Amount of urinary output 5 Texture of mucous membranes

1,5 Loss of tissue elasticity (decreased tissue turgor) indicates dehydration. Skin that takes 30 or more seconds to return to its original position after being pinched (tenting) is a sign of dehydration. Dry mucous membranes indicate inadequate hydration; moist mucous membranes indicate adequate hydration. The problem is dehydration, not retention of fluid; ankle edema is associated with interstitial fluid accumulation around the ankles. The amount and specific gravity of urine are not reliable indicators of hydration because the kidneys' ability to concentrate urine is impaired in sickle cell anemia.

What is the priority nursing intervention for an infant with a myelomeningocele before surgical correction? 1 Minimizing infection 2 Preventing trauma to the sac 3 Monitoring for increasing paralysis 4 Assessing the degree of bowel and bladder control

2 A meningomyelocele is thinly covered and fragile. Trauma to the sac can damage functioning neural tissue; an intact sac eliminates a potential portal of entry for microorganisms. Although minimizing infection is extremely important, it is not the priority; care of the sac is even more important, because an intact sac bars entry by microorganisms. Although observation for paralysis is an important nursing measure, it is not the priority. The extent of a meningomyelocele will influence the child's ability to control bowel and bladder function, but control is not developed until the toddler and preschool years.

A newborn is admitted to the neonatal intensive care unit with a myelomeningocele. What is the priority nursing intervention during the first 24 hours? 1 Using only disposable diapers for perineal care 2 Placing the infant in a prone or side-lying position 3 Washing the infant's genital area with an antiinfective 4 Performing neurologic checks above or at the site of the lesion

2 A prone or side-lying position will prevent pressure on the sac; if the sac ruptures, infection may occur. Diapers should not be applied, because they may irritate or contaminate the sac. Antiinfectives are too caustic. Assessment of the area below, not at or above, the defect is essential to determination of motor, urinary, and bowel function.

A 2-year-old child with previously diagnosed hemophilia is admitted to the pediatric unit for observation after a motor vehicle collision. The toddler has several bruises but no other apparent injuries. What is the nurse's specific concern regarding this child? 1 Risk for falls 2 Undetected injury 3 Deficient fluid volume 4 Development of infection

2 Although the child has no apparent injuries, internal bleeding may have occurred. The child should be monitored for internal bleeding in case there is an undetected injury. Although all 2-year-olds are at risk for falls, falls are not the greatest danger for this child at this time. Although all toddlers are at risk for fluid imbalances because of their larger percentage of body fluid to body mass, this is not a priority at this time. A child with hemophilia is at no greater risk for infection than any other child; the skin is intact, so this is not a priority.

A 10-year-old child with sickle cell anemia is admitted to the unit in vaso-occlusive crisis (VOC). After the child has been given the prescribed analgesic, which intervention is the priority to minimize the effects of the crisis? 1 Isotonic exercises 2 Intravenous fluids 3 Oxygen by nasal cannula 4 Cold compresses to affected areas

2 Because the kidneys of children with sickle cell anemia do not concentrate urine as well as do healthy kidneys, it is important to maintain adequate hydration. Hydration with IV fluids supplementing oral fluids can minimize the occurrence of a crisis because hemodilution helps prevent sickling. During a VOC bed rest is preferred, with the only exercise being passive range of motion. Oxygen may be used if the child has respiratory distress, but it does not help resolve a VOC because it decreases erythropoiesis. Cold compresses are contraindicated because cold causes vasoconstriction. Heat usually is applied to the affected areas.

An 8-year-old child with cerebral palsy is admitted to the hospital for a tendon-lengthening procedure. After the surgery the parents ask a nurse why their child must wear braces and shoes for at least 12 hours a day, even while in bed. What is the best response by the nurse? 1 "Ambulation should be encouraged as soon as possible." 2 "They maintain body alignment and help prevent foot drop." 3 "They stretch your child's ligaments and strengthen muscle tone." 4 "It helps your child accept the physical constraints of the condition.

2 Braces are worn to enable the spastic child to control movement. They also prevent deformities that can occur as a result of misalignment. Early ambulation is promoted by maintaining muscle strength and tone, but it is not the reason for applying braces. Exercises, not braces, are used to stretch ligaments and improve muscle strength and tone. Promoting acceptance is not the purpose of braces and shoes. The child is in Erikson's stage of industry versus inferiority, and the braces and shoes will promote independence.

A child is admitted to the pediatric intensive care unit with acute bacterial meningitis. What is the nurse's priority intervention? 1 Offering clear fluids whenever the child is awake 2 Checking the child's level of consciousness hourly 3 Assessing the child's blood pressure every four hours 4 Administering the prescribed oral antibiotic medication

2 Checking the level of consciousness is part of a total neurological check. It can reveal increasing intracranial pressure, which may occur as a result of cerebral inflammation. The child is too ill to ingest anything by mouth; also, vomiting is likely. Hydration is maintained intravenously. Taking the blood pressure and other vital signs every four hours is insufficient monitoring; many changes can occur in this time span. Intravenous antibiotics have a rapid systemic effect and are preferable to those administered by way of the oral route.

What nursing care to prevent a crisis is the same for school-aged children with sickle cell anemia and celiac disease? 1 Limiting activity 2 Protecting the child from infection 3 Documenting the color and consistency of stools 4 Offering a low-carbohydrate, high-protein, low-fat diet

2 Children with both illnesses have inadequate resistance to infection. Sickling results from a low oxygen level; celiac crisis results from malnourishment and immunologic defects. Activity need not be limited in celiac disease; strenuous activity should be limited in sickle cell anemia. Documenting the color and consistency of stools is important for children with celiac disease; it is not necessary for children with sickle cell anemia. A low-carbohydrate, high-protein, low-fat diet is not particularly helpful for children with sickle cell anemia or celiac disease.

A 3-year-old boy is found to have X-linked Duchenne muscular dystrophy. Neither parent has muscular dystrophy. Which statement indicates that the parents understand how the disorder is transmitted? 1 "Our sons or daughters may have the disease." 2 "Our daughters may be carriers of the disease." 3 "We each contributed a gene that gave our son the disease." 4 "We know that that our other son probably won't get the disease.

2 Duchenne muscular dystrophy follows an X-linked recessive inheritance pattern; when the father is unaffected and the mother is a carrier, there is a 50% chance that a son will be affected and a 50% chance that a daughter will be a carrier. Sex-linked transmission rarely results in females with the condition; males are predominantly affected, and females tend to be carriers. This sex-linked condition is transmitted by the recessive gene carried only by the mother. When the father is unaffected and the mother is a carrier, each son has a 50% chance of being affected.

A child is diagnosed with classic hemophilia. A nurse teaches the child's parents how to administer the plasma component factor VIII through a venous port. It is to be given three times a week. When should the parents administer this therapy? 1 Whenever a bleed is suspected 2 In the morning on scheduled days 3 At bedtime while the child is lying quietly in bed 4 On a regular schedule at the parents' convenience

2 Factor VIII has a short half-life; therefore prophylactic treatment involves administering the factor on the scheduled days in the morning so the child will get the most benefit during the day, while he is most active. Prophylactic treatment is administered on a scheduled basis to prevent bleeds from occurring. Administering the drug at bedtime will limit its effectiveness because bleeds are more common when the child is active. Administering the medicine on a regular schedule at the parents' convenience does not take into consideration the properties of the drug.

A child with sickle cell disease experiences a sequestration crisis. The parents ask how it differs from a painful episode (vaso-occlusive crisis). What is the best response by the nurse? 1 Peripheral ischemia occurs along with the pain. 2 Blood volume decreases and signs of shock appear. 3 Red blood cell (RBC) production diminishes with severe anemia. 4 Destruction of RBCs is accelerated and jaundice becomes evident.

2 In this type of episode there is pooling of blood in the liver and spleen, with subsequent decreased circulating blood volume and shock. Peripheral ischemia, along with the pain, is characteristic of a vaso-occlusive crisis. Decreased RBC production and the profound anemia that ensues are characteristics of aplastic crisis. Increased hemolysis and concomitant anemia, jaundice, and reticulocytosis are characteristics of hyperhemolytic crisis.

An infant is found to have hydrocephalus. Which assessment finding alerts the nurse to suspect increasing intracranial pressure? 1 Sunken eyes 2 Projectile vomiting 3 Depressed fontanels 4 Narrowing pulse pressur

2 Increased intracranial pressure exerts pressure on the vomiting center in the brain, resulting in projectile vomiting unrelated to feeding. The eyeballs will show signs of increased fluid volume in the skull and will be pushed forward, pulling the lids taut. The fontanels will show signs of increased fluid volume in the skull and therefore will bulge. With increased intracranial pressure the systolic pressure is increased and the diastolic pressure is the same or decreased, creating a widening, not narrowing, of pulse pressure.

During discharge planning the parents of an infant with spina bifida express concern about skin care and ask the nurse what can be done to avoid problems. What is the best response by the nurse? 1 Diapers should be changed at least every 4 hours. 2 Frequent diaper changes with cleansing are needed. 3 Medicated ointment should be applied six times a day. 4 Powder may be used in the perineal area when it becomes wet

2 Infants with spina bifida often exhibit dribbling of urine; they need meticulous skin care and frequent diaper changes to prevent skin breakdown. Changing diapers every 4 hours is insufficient and may result in skin breakdown. Medicated ointments are unnecessary; if a skin irritation develops and an ointment becomes necessary, it should be prescribed by the health care provider. Powder will not keep the skin dry; when powder mixes with urine, it forms a pastelike substance that promotes skin breakdown. Also, powder is toxic if inhaled and should be avoided.

A nurse is caring for an infant who has just undergone myelomeningocele repair. What should the nursing plan of care include? 1 Maintaining a supine position 2 Monitoring for cerebrospinal fluid leakage 3 Teaching clean catheterizations to parents 4 Applying sterile moist dressings to the incision

2 Leakage of cerebrospinal fluid indicates incomplete closure of the defect and must be reported. The supine position is contraindicated, because it places pressure on the surgical site. Teaching clean catheterization is not appropriate at this time. Moist dressings are applied before surgery, not after, to prevent drying of the sac.

A school nurse is screening children for scoliosis. In what age group is it usually identified? 1 Adolescence 2 Preadolescence 3 Early school years 4 Middle school years

2 Preadolescence is the time when scoliosis is most likely to become evident because of the growth spurt that occurs at this time. Although scoliosis may occur at any age, idiopathic scoliosis, the most common type, tends to become evident during the preadolescent growth spurt.

After an infant undergoes surgery for the repair of a myelomeningocele, diarrhea and metabolic acidosis develop, accompanied by decreased urine output. In light of the infant's status, what prescription does the nurse anticipate? 1 Isotonic saline 2 Sodium lactate 3 Serum albumin 4 Potassium chloride

2 Sodium lactate is converted to sodium bicarbonate; it helps correct the sodium deficiency and the metabolic acidosis. Normal saline solution results in the combination of the chloride with the hydrogen ion, intensifying the acidosis. Albumin is a colloid found in blood plasma; it is not used in the treatment of metabolic acidosis. Potassium is not administered until urine function has been restored.

During a routine physical examination, a 10-year-old girl is discovered to have scoliosis. The curve is diagnosed as mild and functional, and a daily exercise program is established. The next month at the follow-up visit, what statement made by the girl helps the nurse determine that the child is complying with the exercise program? 1 "I like doing my exercises with my brother so he can get stronger." 2 "I think my exercises will make me stronger when I practice soccer." 3 "I do my exercises every day while my mother stays with me and watches." 4 "I count out loud when I do my exercises so my mother can hear that I'm doing them all."

2 The child is anticipating improvement; this reflects positive internal motivation, which helps maintain the child's interest and willingness to continue with the program. Motivation may diminish if the focus is on the brother rather than on the child's need to do the exercises. Doing the exercises to please the mother, as evidenced by having the mother watch every day or listen to the daughter counting to show that the exercises are being done, is external motivation, which is not as desirable as internal motivation.

A nurse is teaching the parents of a toddler with a recent diagnosis of hemophilia about the disease. What area of the body should the nurse include as the most common site for bleeding? 1 Brain 2 Joints 3 Kidneys 4Abdomen

2 The joints are the most commonly involved areas because of weight bearing and constant movement. Neither the brain, nor the kidneys, nor the abdomen is the most common site; however, bleeding may occur in any of these areas.

A 13-year-old child with sickle cell anemia is experiencing a painful episode (vaso-occlusive crisis). The nurse assesses the child, obtains the child's vital signs, and reviews the child's laboratory test results. What is the priority nursing intervention? 1 Providing oxygen therapy 2 Administering an analgesic 3 Initiating a blood transfusion 4 Monitoring intravenous fluids

2 The pain experienced by the vaso-occlusive crisis is caused by sickle-shaped red blood cells that block blood flow through tiny blood vessels to the chest, abdomen, joints, and bones. Pain management is priority. If the client has evidence of hypoxia, then oxygen should be administered. Although a blood transfusion may be needed to treat the anemia and intravenous fluid reduce the viscosity of the sickled blood, it will not immediately relieve the pain.

A toddler with hemophilia A is receiving factor VIII. The mother asks the nurse, "If my child hurts himself or herself, I'll give 2 children's ibuprofen. Is that right?" How will the nurse respond? 1 "That's right. Ibuprofen will ease the pain." 2 "Give your child acetaminophen. Ibuprofen may cause bleeding." 3 "No. I'll explain why your child isn't allowed pain medications." 4 "You seem concerned about giving medications to your child."

2 The parent is asking a specific question that should be answered by the nurse. Ibuprofen is contraindicated because it interferes with platelet function and may cause more bleeding; therefore an analgesic such as acetaminophen should be administered because it does not interfere with coagulation. Analgesics are permitted, provided they do not have anticoagulant effects.

A client is seen in the clinic with sickle cell anemia. A nurse teaches the client about sickle cell anemia. Which information from the client indicates a correct understanding of the condition? 1 "I have abnormal platelets." 2 "I have abnormal hemoglobin." 3 "I have abnormal hematocrit." 4 "I have abnormal white blood cells.

2 The patient with sickle cell anemia has abnormal hemoglobin, hemoglobin S, causing the red blood cells to stiffen and elongate into a sickle. While it can affect hematocrit, it is really a result of the abnormal hemoglobin. The disorder affects hemoglobin rather than platelets or white blood cells.

A nurse is assessing an infant with talipes equinovarus (clubfoot) who has had a corrective boot cast applied. Which peripheral vascular assessment cannot be performed while the cast is in place? 1 Color 2 Pulse 3 Warmth 4 Blanching

2 The pedal pulse cannot be palpated under a boot cast. Assessments of the color, warmth, and blanching of the toes are all appropriate neurovascular checks.

An 8-year-old child who is experiencing a sickle cell pain episode is admitted to the child health unit. What is the most appropriate nursing care during this acute period? 1 Limiting fluids until the crisis ends 2 Administering prescribed analgesics 3 Applying cold compresses to painful joints 4 Performing range-of-motion exercises of affected joints

2 The priority is pain management; severe pain requires analgesics. Increased hydration is necessary to promote hemodilution, improve circulation, and prevent more sickling. Cold will constrict blood vessels, further depleting oxygenation to affected parts; warmth is preferable. There is too much swelling and pain in the joints during a crisis for the implementation of range-of-motion exercises.

An infant with a myelomeningocele is admitted to the pediatric intensive care unit. While the infant is awaiting surgical correction of the defect, what is the most appropriate nursing intervention? 1 Using disposable diapers 2 Placing the infant in the prone position 3 Performing neurologic checks above the site of the lesion 4 Washing the area below the defect with a nontoxic antiseptic

2 The prone position is the best position for preventing pressure on the sac. Diapers should not be applied because they may irritate or contaminate the sac. Assessment of the area below the defect is essential in determining motor and sensory function. There is no indication for the use of an antiseptic.

A child has been diagnosed with hemophilia type A after experiencing excessive bleeding from a minor trauma. The mother shares that she is 4 weeks pregnant and questions as to whether this pregnancy will result in a child with hemophilia. What is the best response by the nurse? 1 Probably not, because there is a 50% risk of a mother who is a carrier transmitting the disease, and one child already has the condition. 2 With each pregnancy, there is a 50% chance of a carrier transmitting the condition or being a carrier, depending on the gender of the child. 3 Definitely, because the one child has hemophilia, all future pregnancies will result in children with the condition. 4 If the father has the condition and the mother is a carrier, the child automatically will have hemophilia.

2 With each pregnancy, there is a 50% chance of a carrier transmitting the condition or being a carrier, depending on the gender of the child. The odds are the same with each pregnancy and do not change based upon a previous pregnancy. One child currently having the condition does not affect this pregnancy. A recessive trait will not automatically mean all future pregnancies will result in children with hemophilia.If the father has the condition and the mother is a carrier, this does not guarantee that the child will inherit the condition.

A nurse provides dietary instruction to a client who has iron deficiency anemia. Which food choices by the client does the nurse consider most desirable? Select all that apply. 1 Raw carrots 2 Boiled spinach 3 Dried cranberries 4 Brussel sprouts 5 Asparagus spears

2,3 According to the nutritional table, the food sources highest in iron are, "Liver and muscle meats, dried fruits, legumes, dark green leafy vegetables (which would include spinach), whole-grain and enriched bread and cereals, and beans." Although carrots, brussel sprouts, and asparagus spears contain some iron, they are not considered high sources of iron.

A school-aged child with sickle cell anemia is admitted to the pediatric unit in a vaso-occlusive crisis. The nurse's priority is to relieve the excruciating pain. What interventions should be implemented after the pain is under control? Select all that apply. 1 Antibiotics 2 Rehydration 3 Oxygen therapy 4 Nutritional supplements 5 Psychological counseling

2,3 During a sickle cell crisis the RBCs are sickled and interfere with the peripheral vascular circulation; fluids are needed to increase the circulating volume. Supplemental oxygen is beneficial to limit sickling. There is no indication of an infection that requires antibiotic therapy. There is no indication that the child is malnourished. Although counseling may be needed in the future, there is no indication that it is needed at this time

A nurse confers with the nutritionist about the diet of a 4-year-old child with spina bifida who spends many hours in a wheelchair. What should the nurse encourage the mother to increase in her child's diet? Select all that apply. 1 Fat 2 Fiber 3 Protein 4 Calories 5 Carbohydrates

2,3 Extra fiber is needed to combat constipation resulting from immobility. Extra protein is needed for maintaining muscle mass and to help prevent pressure ulcers. Of this child's dietary intake, 25% should consist of fat; this is the lowest recommended daily intake for fat. It should not be increased because more fat calories may lead to obesity in an immobilized child. Calories should be limited because energy needs are less for immobile children than for children who are active. Carbohydrates, especially simple sugars, should be limited to help prevent obesity.

Which iron-rich foods should the nurse recommend for a toddler-age client who is diagnosed with iron deficiency anemia? Select all that apply. 1 Carrots 2 Chicken 3 Broccoli 4 Lean steak 5 Whole milk

2,3,4 Parents should be encouraged to provide an iron-rich diet that includes heme and nonheme iron sources such as poultry (chicken), green leafy vegetables (broccoli), and red meats (lean steak). Carrots are not a source of iron in the diet. Whole milk consumption should be limited as it is a source of oxalates, which decrease the absorption of iron.

A 6-year-old child with sickle cell disease is admitted with a vaso-occlusive crisis (painful episode). What are the priority nursing concerns? Select all that apply. 1 Nutrition 2 Hydration 3 Pain management 4 Prevention of infection 5 Oxygen supplementation

2,3,5 The triad of treatment for a client experiencing a sickle cell crisis is: hydration, oxygenation, and pain management. Hydration will provide more circulating volume for the sickled cells to move through. Supplemental oxygen will provide more oxygen molecules to attach to the red cells, providing more oxygen to the tissue and joints. Pain management is typically the primary reason this client presents for treatment. The pain becomes unbearable. Other interventions such as nutrition and keeping the client safe from infection should be addressed but are not priorities.

A child in sickle cell crisis is admitted to the pediatric unit. Which actions will the nurse take? Select all that apply. 1 Place on strict isolation 2 Administer hydroxyurea 3 Administer acetylsalicylic acid 4 Apply oxygen via nasal cannula 5 Offer age-appropriate activities 6 Administer intravenous (IV) hydration

2,4,5,6 Hydroxyurea can reduce the number of sickling and pain episodes by stimulating fetal hemoglobin production. Providing oxygen via nasal cannula provides additional oxygen, which is necessary because of decreased hemoglobin, which carries oxygen. Age-appropriate activities can help alleviate boredom as the child begins to feel better. Providing intravenous hydration until the child is able to tolerate adequate by mouth fluids reduces sickle cell clotting. Strict isolation is not necessary. Aspirin should not be given to children because of risk of Reye syndrome.

A 16-year-old girl with sickle cell anemia is experiencing a painful episode (vaso-occlusive crisis) and has a patient-controlled analgesia (PCA) pump. She complains of pain (5 on a scale of 1 to 10) in her right elbow. The nurse observes that the pump is "locked out" for another 10 minutes. What action should the nurse implement? 1 Turning on the television for diversion 2 Calling the primary healthcare provider for another analgesic prescription 3 Placing the prescribed as-needed warm, wet compress on the elbow 4 Informing her gently that she must wait until the pump reactivates to get more medication

3

The nurse is providing care to the family of a preschool-age child who is diagnosed with sickle cell disease. Which statement made by the sibling would initiate a teaching session with the parents regarding discipline? 1"I really wish my brother wasn't sick all the time." 2"I am afraid that I caused my brother to get sick again because I was mad at him." 3"When I lied to my parents, I was punished for a week and my brother never gets punished." 4"I never get to go over to my friends' houses because we are always taking my brother to the doctor."

3 A critical component of any child's development is discipline. Applying appropriate discipline to the child who is chronically ill or disabled can also limit the resentment and hostility that can develop among siblings if parents apply different standards to each child. The nurse's responsibility is to help parents learn successful methods of guiding the child. The statements regarding wishing that the brother wasn't sick, fears of having caused the illness, and missing play dates may require further assessment and family teaching, but the teaching would not be related to discipline.

An infant has noncommunicating hydrocephalus, and a ventriculoperitoneal shunt is inserted. What should the nurse do when caring for the infant during the initial postoperative period? 1 Change the dressing when soiled. 2 Offer the infant fluids to increase fluid intake. 3 Place the infant flat with the head on the unaffected side. 4 Encourage the parents to hold their infant to help prevent crying.

3 A flat position helps prevent complications associated with too-rapid reduction of intracranial fluid. Lying on the unaffected side prevents pressure on the shunt valve. The dressing is not changed by the nurse; if there is drainage, the nurse should mark the area, reinforce the dressing, and notify the primary healthcare provider. Fluids are initially restricted to prevent fluid overload. Moving the infant will unintentionally raise the head; initially the infant is positioned flat, and the head should not be elevated at this time.

A preadolescent brings home a note from the school nurse informing the parents that the child should be evaluated for scoliosis. The mother calls the school nurse to ask for a description of scoliosis. Before responding, what does the nurse recall about scoliosis? 1 The concave lumbar curvature is exaggerated. 2 There are pathological changes in the vertebrae. 3 There is a rotary deformity of the lateral curvature of the spine. 4 The curvature of the thoracic spine has an increased convex angulation.

3 A rotary deformity of the lateral curvature of the spine is the correct definition of scoliosis. An exaggerated concave lumbar curvature is a description of lordosis. There are no pathological changes in the vertebrae with scoliosis. A curvature of the thoracic spine with an increased convex angulation is a description of kyphosis.

On the day after surgery for insertion of a ventriculoperitoneal shunt to treat hydrocephalus, an infant's temperature increases to 103.0° F (39.4° C). The nurse immediately notifies the practitioner. What is the next nursing action? 1 Covering the infant with a bath blanket 2 Sponging the infant with tepid alcohol 3 Removing excess clothing from the infant 4 Reassessing the infant's temperature in several hours

3 After the initial safety measures and notification of the practitioner have been addressed, excess clothing, which prevents heat loss, should be removed. Covering the infant will increase the temperature because heat loss will be reduced. Alcohol should never be used for infants or children; it causes severe chilling, which can lead to increased metabolic activity and a higher temperature. This high fever requires more frequent readings, usually at least every hour.

The nurse anticipates that the family of a child with cerebral palsy is at risk for difficult parenting issues. What does the nurse conclude is the probable basis for this difficulty? 1 Lack of social support 2 Unrealistic expectations 3 Loss of the expected healthy child 4 Having a child with cognitive impairment

3 All parents initially grieve over the loss of a healthy child, what could have been, and what may never be. Many families have support systems. Unrealistic expectations may be true of some, but not all, parents. Not all children with cerebral palsy are cognitively impaired; approximately 30% to 50% of children with cerebral palsy are mentally challenged.

A client who is receiving methotrexate for acute lymphocytic leukemia (ALL) develops a temperature of 101° F (38.3° C). The nurse notifies the primary healthcare provider. Aspirin 650 mg every 4 hours as needed for temperature equal to or greater than 101° F (38.3° C) is prescribed. What should the nurse do regarding this prescription? 1 Express concern about the dosage prescribed. 2 Request a prescription for an antacid. 3 Express concern about the type of antipyretic prescribed. 4 Ask if the frequency should be every 6 hours instead.

3 Aspirin is contraindicated in the presence of bleeding tendencies, which often occur with acute lymphocytic leukemia because of its inhibitory effect on platelet aggregation. Although expressing a concern about the dosage is within acceptable limits, this analgesic is contraindicated. Although an antacid will reduce the gastric irritation common with aspirin, this analgesic is contraindicated. Although the frequency is within acceptable limits, this analgesic is contraindicated.

The parent of a child with hemophilia asks the nurse, "If my son hurts himself, is it all right if I give him two baby aspirins?" What is the best response by the nurse? 1 "You seem concerned about giving drugs to your child." 2 "It's all right to give him baby aspirin when he hurts himself." 3 "Aspirin may cause more bleeding. Give him acetaminophen instead." 4 "He should be given acetaminophen every day. It'll prevent bleeding."

3 Aspirin, which has an anticoagulant effect, is contraindicated because it may harm a child with bleeding problems; in addition, aspirin is contraindicated for all children because of its relationship to Reye syndrome. Stating that the parent seems concerned about giving drugs to the child does not answer the mother's question and may cause the mother to feel defensive. Acetaminophen cannot prevent bleeding episodes; it is an analgesic.

A nurse is performing an assessment on a client with probable acute lymphocytic leukemia (ALL). Which clinical manifestation will the nurse expect to be present? 1 Alopecia 2 Insomnia 3 Ecchymosis 4 Hypertension

3 Bleeding tendencies occur because of bone marrow suppression and rapidly proliferating leukocytes. Alopecia is associated with chemotherapy; there is no change in hair with leukemia. The client more likely will be sleeping excessively. Hypertension is not a clinical manifestation of leukemia.

A 4-year-old child diagnosed with sickle cell anemia is at a high risk of acquiring pneumococcal diseases even after receiving one or two doses of the pneumococcal conjugate vaccine (PCV). Based on the immunization protocol, what dose of PCV should the nurse administer? 1Administer four more doses of PCV 2Administer three more doses of PCV 3Administer two more doses of PCV 4Administer one more dose of PCV

3 Children between the ages of 2 and 5 who are at a high risk of acquiring pneumococcal infections and have received anywhere from zero to two PCV doses should receive two additional doses within a span of 8 weeks.

A nurse is teaching the parents of an infant with cerebral palsy how to provide optimal care. What should the nurse include in the teaching? 1 Focusing on cognitive rather than motor skills 2 Maintaining immobility of the limbs with splints 3 Preserving muscle tone to prevent joint contractures 4 Continuing to offer a special formula to limit gagging

3 Children with cerebral palsy are especially prone to muscle tone disorders, including spasticity, which can lead to joint contractures. The therapy program must be balanced to promote progress in all areas of growth and development. Splinting of limbs is contraindicated because immobility promotes the development of joint contractures. Although these infants tend to gag and choke during feedings, a special formula is not necessary unless the child is allergic to dairy products.

While caring for a client with advanced muscular dystrophy who suffered respiratory distress, the nurse frequently repositions the client to prevent the development of pneumonia. Which other complication can be prevented through this nursing intervention? 1 Renal calculi 2 Disorientation 3 Pressure ulcers 4 Urinary infection

3 Clients in advanced stages of muscular dystrophy are immobile. A client who sustained respiratory distress should be frequently repositioned to prevent the development of pneumonia. The client is also at risk of developing pressure ulcers, which can be avoided by frequent repositioning of the client. Renal calculi can be prevented in this client by increasing fluid intake and decreasing dietary calcium. Urinary infection can be avoided by fluid intake to flush the renal system and measures to decrease urinary retention. Disorientation is a neurological complication that can be prevented by maintaining a proper sleep-wake schedule in accordance with day-night patterns and reorientation of the client to person, place, time, and control of sensory stimulation.

A nurse assessing a newborn elicits a positive response on the Ortolani test and as a result suspects that the newborn has developmental dysplasia of the hips (DDH). Which clinical finding supports this suspicion? 1 Legs are of equal length 2 Resistance to flexion of the hips 3 Limited ability to abduct either hip 4 Abduction of each hip to form a right angle

3 DDH limits abduction to less than 90 degrees. With DDH, the legs appear to be of unequal length. Flexion of the hips is not affected by DDH. Abduction of each hip to form a right angle is an expected finding in the newborn; maternal hormones cause loosening of ligaments, which allows abduction of each hip to a right angle (90 degrees).

A nurse is planning for the discharge of a child after a sickle cell vaso-occlusive crisis. What is most important for the nurse to emphasize? 1 A high-calorie diet 2 A rigorous exercise regimen 3 An increased intake of fluids 4 An increase in the hours spent sleeping

3 Dehydration promotes the sickling of erythrocytes. Increased fluid intake minimizes the chance that sickle cell pain will recur. A high-calorie diet is not necessary or helpful for a child with sickle cell anemia. Rigorous exercise is contraindicated because the decrease in oxygenation may cause sickling. An increase in the hours spent sleeping is not necessary.

A nurse is caring for an infant with a myelomeningocele. What does the nurse expect this infant to have that it is different from an infant with a meningocele? 1 Enlarged head 2 Sac over the lumbar area 3 Affected lower extremities 4 Infection of the spinal fluid

3 Failure of neural tube to close during the first 3 to 5 weeks of fetal development results in neural tube defects. Myelomeningocele is the most severe form; these children usually have lower extremity and bladder dysfunction. Hydrocephalus may occur after the repair of either a meningocele or a myelomeningocele. A saclike cyst containing meninges and spinal fluid may be present in either defect. Infection is possible with either defect because of the exposure of the meninges.

A toddler with a repaired myelomeningocele has urinary incontinence and some flaccidity of the lower extremities. What should the nurse teach the parents? 1 An ileal bladder will be necessary once the child is of school age. 2 An indwelling catheter offers the best hope for bladder management. 3 The child will probably require a program of intermittent straight catheterization. 4 The child will have to wear diapers for many years because bladder training is a slow process.

3 Most children with spinal cord damage resulting from spina bifida can be managed successfully with a program of intermittent straight catheterization. An ileal bladder is not necessary because most of these children can be managed successfully with intermittent straight catheterization. An indwelling catheter is the least desirable approach because of the risk for recurrent urinary tract infection. Stating that the child will have to wear diapers for many years is inaccurate and may be devastating to the parents.

A newborn is admitted to the neonatal intensive care unit with a myelomeningocele located at the fourth lumbar vertebra (L4). What is the priority nursing intervention while the infant is awaiting surgery? 1 Increasing nutritional intake 2 Promoting sensory stimulation 3 Providing meticulous skin care 4 Performing range-of-motion exercises

3 Skin care is essential to prevent rupture of the sac and subsequent infection. There is no need to increase nutrition; there are no data to confirm that the infant is malnourished. Although sensory stimulation is important, it is not the priority. Exercises are not indicated at this time; they may be implemented after surgery.

An adolescent who has sickle cell anemia is recovering from a painful episode. What does the nurse see as the priority issue for this adolescent? 1 Restriction of movement during periods of arthralgia 2 Separation from family during periods of hospitalization 3 Alteration in body image resulting from skeletal deformities 4 Interruption of education as a result of multiple hospitalizations

3 The adolescent is concerned with body image and fears change or mutilation of body parts. The occlusions in the microvasculature associated with sickle cell anemia can cause bone deformities. Restriction of movement is not a major problem because when the pain is relieved and the crisis is over, activity is resumed. Teenagers can tolerate extended periods of separation from the family. Although learning interruptions may be a concern for a teenager, altered body image is a more feared threat.

A nurse is planning to teach the four-point alternate crutch gait to a 9-year-old child with cerebral palsy. How does the nurse explain this choice to the parents? 1 The child has minimal step ability in the lower extremities. 2 It provides for two points of support on the floor at all times. 3 It provides for equal but partial weight bearing on each limb. 4 The child has more power in the upper extremities than in the lower extremities.

3 The four-point alternate crutch gait is a simple, slow, stable gait because there are always three points of support on the floor, with equal but partial weight bearing on each limb. The child has the ability to move, but the movement in the lower extremities is uncoordinated. The four-point gait provides for three points of support, not two, at all times. A four-point gait divides weight bearing equally among the limbs.

A 13-year-old adolescent is found to have idiopathic scoliosis. Because exercise and avoidance of fatigue are essential components of care, which sport should the nurse suggest as the most therapeutic for this preadolescent? 1 Golf 2 Bowling 3 Swimming 4 Badminton

3 The hyperextension required in swimming helps strengthen back muscles and necessitates deeper respirations, both of which are necessary before surgery and before wearing a brace or cast. The other options involve twisting the back muscles, which is not therapeutic for a child with this condition.

A nurse is concerned about helping the parents of an infant with cerebral palsy set long-term goals for the family. What is most important to understand when setting long-term goals? 1 Cognitive impairments require special education. 2 Progressive deterioration requires future institutionalization. 3 Unknown extent of the disability requires continual adjustments. 4 Diminished immune responses require protection from infection

3 The infant is too young for specific long-term plans; different problems may manifest as the child grows older. Children with cerebral palsy may or may not have cognitive impairments. Cerebral palsy does not get progressively worse; placement outside the home depends on the child's needs and the parents' abilities and desires. There is no relationship between cerebral palsy and a lowered immune response.

After surgery for repair of a myelomeningocele, the nurse places the infant in a side-lying position with the head slightly elevated. What is the main reason the nurse places the infant in this position after this particular surgery? 1 To prevent aspiration 2 To promote respiration 3 To reduce intracranial pressure 4 To maintain cleanliness of the suture site

3 The side-lying position with the head slightly elevated promotes venous return by gravity, which helps reduce intracranial pressure, a problem after myelomeningocele repair. Although preventing aspiration, promoting respiration, and maintaining cleanliness of the suture line are all important, the reason for this position that is unique with this type of surgery is that it minimizes intracranial pressure.

After closure of a newborn's myelomeningocele, what essential nursing intervention must be included in the plan of care? 1 Limiting leg movement 2 Decreasing environmental stimuli 3 Measuring head circumference daily 4 Monitoring for serous drainage from the nares

3 The surgical closure of the sac decreases the absorptive surface and eliminates a route by which the spinal fluid drains. Because the cranial sutures have not closed, the skull will expand if fluid increases, causing hydrocephalus. The lower extremities of most infants with myelomeningocele are partially or completely paralyzed; performing careful range-of-motion exercise is an important part of nursing care. There is no reason to decrease environmental stimuli for infants who have had surgical correction of a myelomeningocele unless they also have seizures. Observing for serous drainage from the nares is not expected, because damage to the meninges of the brain is not a factor in the surgical treatment of myelomeningocele.

A 4-year-old child is admitted to the pediatric unit with a tentative diagnosis of acute lymphocytic leukemia (ALL). The mother states that changes in her child's behavior and the "black and blue" marks were noticed several days ago. She blames herself for not bringing her child to the clinic sooner. On what information about the pathophysiology of leukemia should the nurse base a response? 1 The diagnosis can be certain only after a blood smear is analyzed. 2 If leukemia is diagnosed, the child's prognosis is probably guarded. 3 Early signs and symptoms of leukemia are similar to those of other mild illnesses of childhood. 4 The description of the clinical findings indicates that the child has been ill for longer than a single week.

3 To allay parental guilt and anxiety, it is important to acknowledge how difficult it is to recognize severe illness on the basis of changes in the child's behavior and ecchymoses that can result when a child bangs into an object, a common occurrence in young children. A bone marrow aspiration or biopsy is required for a definitive diagnosis. ALL in children has a favorable prognosis, depending on several factors, including the child's age at diagnosis, the white blood cell count, and the type of cell involved. Even if the mother missed the fact that her child was so ill, mentioning this may cause more anxiety and guilt and interfere with the development or a nurse-client rappor

The nurse is assessing a newborn for developmental dysplasia of the hip (DDH). Where does the nurse look for extra skinfolds? 1 Calf muscles 2 Popliteal area 3 Back of the thigh 4 Lower portion of the abdomen

3 With DDH there are extra skinfolds on the affected thigh, a result of the displacement of the head of the femur in the acetabulum. There are no extra folds in the calf muscles, popliteal area, or lower part of the abdomen in DDH.

A 4-month-old infant is being treated for talipes equinovarus (clubfoot). The infant has a cast change every 2 to 3 weeks. When the infant is brought to the well-baby clinic for a routine visit, a nurse evaluates the foot in the cast. Which assessments should the nurse include? Select all that apply. 1 Pedal pulses of both feet 2 Range of motion of the foot in the cast 3 Color of the toes of the foot in the cast 4 Movement of the toes of the foot in the cast 5 Knee flexion and extension of the affected leg

3,4 Skin color will indicate adequate (e.g., same color as the rest of the body's skin) or impaired (e.g., dusky, cyanotic) circulation in the foot in a cast. Movement will indicate unimpaired neural transmission in the foot. Pedal pulses will not be accessible on the foot in a cast. A foot cannot be put through its full range of motion with a cast in place. Knee flexion and extension are irrelevant; the knee is not involved with a foot in a cast.

While working in a neuromuscular clinic the nurse monitors infants for symptoms of cerebral palsy. Which statements by infants' mothers indicate the need for further evaluation for cerebral palsy? Select all that apply. 1 "My baby doesn't make eye contact." 2 "My baby seems to have a voracious appetite." 3 "My baby was able to turn from front to back by 2 months of age." 4 "I've noticed that this baby clings to me more than other children of the same age." 5 "All of my other children were sitting alone by this age. This baby doesn't seem to be anywhere near sitting alone."

3,5 An infant that turns from front to back at an early age will often be found to have spastic cerebral palsy; it is the spasticity that causes an unintentional turn from front to back. Cerebral palsy is a neurologic problem and is commonly recognized when the child fails to meet developmental norms. Failure to make eye contact is often associated with eye issues or autism. Neither anorexia nor a voracious appetite are associated with cerebral palsy. Personality traits are not related to a diagnosis of cerebral palsy.

A nurse is caring for an infant with developmental dysplasia of the hip. What is the priority intervention for this child? 1 Flexion of the hip 2 Extension of the hip 3 Adduction of the hip 4 Abduction of the hip

4 Abduction will enable the head of the femur to fit into the acetabulum, thereby correcting the dysplasia. Flexion causes the head of the femur to move away from the acetabulum. Extension causes the head of the femur to move away from the acetabulum. Adduction causes the head of the femur to move away from the acetabulum.

An adolescent with Duchenne muscular dystrophy has received care at the pediatric clinic since early childhood. Of which body system should the nurse perform a focused assessment to identify life-threatening complications as the child ages? 1 Neurologic 2 Gastrointestinal 3 Musculoskeletal 4 Cardiopulmonary

4 As muscular degeneration advances in the adolescent, the diaphragm, auxiliary muscles of respiration, and heart are affected, resulting in life-threatening respiratory infections and heart failure. Central nervous system functioning is not affected by Duchenne muscular dystrophy. Nutritional problems are less of a priority than cardiopulmonary problems. Although the musculoskeletal system will exhibit marked degeneration, it is second in priority to the cardiopulmonary changes.

A 1-month-old infant is being treated with sequential casts for bilateral clubfoot (talipes equinovarus); new casts have just been applied. The goal at this time is ensuring that circulation to the feet remains sufficient. How will the nurse determine that the goal is being met? 1 The cast is intact and there is no drainage. 2 There are no signs of pain in the extremities. 3 There is range of motion in the hips and knees. 4 The toes, when compressed, exhibit a quick return of circulation

4 Circulation to the feet can best be measured by applying pressure to the toes; a rapid return of color indicates adequate circulation. Both feet should be assessed and the responses compared for adequacy of circulation and symmetry. Drainage or no drainage on the cast is not an indicator of adequate circulation. An infant cannot express pain in a specific area; if the infant is uncomfortable, the infant will probably cry and be irritable. Flexion of the hips and knees does not indicate blood flow to the feet.

A mother whose infant was found to have cerebral palsy at 6 months of age asks why she was not told that her baby had cerebral palsy when the infant was born. How should the nurse respond? 1 "The neurological lesions changed as your baby matured." 2 "Joint deformities don't appear until after 6 months of age." 3 "The staff members didn't want to alarm you until it was necessary." 4 "Until there's control of voluntary movement, a diagnosis can't be confirmed."

4 Cortical control of voluntary muscles occurs between 2 and 4 months of age. The neurological lesions are fixed and will neither progress nor regress. Cerebral palsy is not diagnosed on the basis of the presence of joint deformities; these may develop later because of spastic muscle imbalance. Parents have a right to be informed of their child's diagnosis as soon as possible.

A client who has been diagnosed with acute lymphocytic leukemia will be receiving doxorubicin infusions as part of a chemotherapy regimen. The nurse monitors the client for signs and symptoms of doxorubicin toxicity. What clinical finding indicates that toxicity has occurred? 1 Alopecia 2 Dyspnea 3 Metallic taste to food 4 Cardiac rhythm abnormalities

4 Doxorubicin is cardiotoxic, which is manifested by transient ECG abnormalities. Alopecia is an expected side effect of doxorubicin, not a toxic effect. Dyspnea and a metallic taste to food are not effects of doxorubicin.

A 2½-year-old toddler is admitted with a fever of 103° F (39.4° C), stiffness of the neck, and general malaise. The diagnosis is acute bacterial meningitis. What is the priority nursing intervention for this child? 1 Increasing fluids 2 Administering oxygen 3 Giving a tepid sponge bath 4 Instituting droplet precaution

4 Droplet precautions prevent the spread of infection to others; isolation is a priority and should be implemented immediately. There is no indication that the child is dehydrated; fluid maintenance is a continuing goal. There is no indication that the child needs oxygen. Oxygen is not given routinely; it is given if the child has a decreased oxygen saturation level. A sponge bath is not given because these children are sensitive to stimuli, and movement causes increased discomfort.

A 2-year-old boy with hemophilia A is to start receiving prophylactic intravenous infusions of the recombinant form of factor VIII three times a week. The nurse will instruct the parents to administer the factor at what time on the designated days? 1 At bedtime 2 After lunch 3 Before dinner 4 Upon awakening

4 Factor VIII is administered once in the morning on designated days. The half-life of factor VIII is short. If factor VIII is administered later in the day (i.e., at bedtime, after lunch, or before dinner), protection will not be adequate during the day, when the child is most active and more vulnerable to bleeding.

An infant born with hydrocephalus will be discharged after insertion of a ventriculoperitoneal shunt. Which common complication should the nurse instruct the parents to report if it occurs at home? 1 Visibility of the sclerae above the irises 2 Violent involuntary muscle contractions 3 Excessive fluid accumulation in the abdomen 4 Fever accompanied by decreased responsiveness

4 Fever accompanied by decreased responsiveness is associated with infection. This is the greatest postoperative hazard for children with shunts for hydrocephalus. Eyes with sclerae visible above the irises occur with progressively increasing intracranial pressure, usually before shunt insertion. Violent involuntary muscle contractions may occur as the result of an infected shunt; however, it is not the most common sign of an infectious process. The peritoneum absorbs cerebrospinal fluid adequately; ascites is not a problem.

The parents of a child who is undergoing chemotherapy for acute lymphocytic leukemia (ALL) ask the nurse about the prognosis of children with this diagnosis. What does the nurse respond is the expected outcome for children with this type of leukemia? 1 Guarded, but the therapy keeps them pain-free 2 Limited to a few months in most of the children affected 3 Positive, with probable cure in 95% of the children affected 4 Extended to at least 5 years in more than 75% of the children treated

4 Five-year disease-free survival rates for children with ALL are currently 75% to 85%. The long-term prognosis of a 95% cure rate is too favorable, although this is the percentage of children who achieve the first remission. The other projected prognoses (guarded, limited to a few months) are too pessimistic.

After surgery for a myelomeningocele, an infant is being fed by means of gavage. When checking placement of the feeding tube, the nurse is unable to hear the air injected because of noisy breath sounds. What should the nurse do next? 1 Notify the provider. 2 Advance the tube 1 cm. 3 Insert 1 mL of formula slowly. 4 Try aspirating stomach contents.

4 Gastric returns indicate correct placement of the feeding tube. Further assessment is necessary before the provider is notified. Advancing the tube even 1 cm may cause undue trauma, regardless of where the tube is located. Inserting even a small amount of formula is unsafe until correct placement is verified; formula may enter the lungs if the tube is not in the stomach.

A child has been diagnosed with hemophilia type A after experiencing excessive bleeding from a minor trauma. The parents ask how this could happen in addition to many other questions. Hemophilia A is linked to a deficiency in what? 1 Factor II 2 Factor III 3 Factor IX 4 Factor VII

4 Hemophilia type A, which is the most common type of hemophilia, is from a deficiency of Factor VIII. Factors II and III are distractors. Factor IX is associated with hemophilia type B.

A nurse is caring for an infant who has undergone surgery to correct a myelomeningocele. What assessment provides data about a potential major complication for this infant? 1 Daily weights 2 Fluid output every 8 hours 3 Blood pressure every 12 hours 4 Daily head circumference measurements

4 Hydrocephalus, which typically occurs after surgical correction, is a major complication of myelomeningocele. Measuring the head circumference daily provides an accurate basis for day-to-day comparisons. Although important, daily weights are not specific to monitoring for a developing hydrocephalus. An infant's output is unrelated to hydrocephalus. Vital signs should be taken every 2 to 4 hours after surgery.

A client is seen in the clinic with sickle cell anemia. The parents of the client ask how their child got sickle cell anemia. What is an accurate explanation? 1 Sickle cell anemia is a random condition with no known cause. 2 If one parent is a carrier and one is negative for the gene, the child will get the disease. 3 If both parents are carriers, all of their offspring will probably get this disease, and they should consider sterilization. 4 If both parents are carriers, the odds are one in four that an offspring will get the disease, and one in four that an offspring will be disease free.

4 If both parents are carriers, the odds are one in four an offspring will get the disease, two in four will be carriers, and one in four will be disease free. It is an autosomal recessive inherited condition. Sickle cell anemia is not random; the gene must come from both parents. One parent being a carrier and the other not having the gene would not cause the disease. If both parents are carriers there is the possibility of 25% with each pregnancy that the child may inherit the disease, and 50% of being a carrier.

An infant is found to have communicating hydrocephalus. The parents ask for clarification of the primary healthcare provider's explanation of the problem. How should the nurse respond? 1 "Too much spinal fluid is being produced within the spaces (ventricles) of the brain." 2 "The flow of spinal fluid through the brain cells does not empty effectively into the spinal cord." 3 "The spinal fluid is prevented from being adequately absorbed by a blockage in the spaces (ventricles) of the brain." 4 "There is a part of the brain surface that usually absorbs spinal fluid after its production that is not functioning adequately."

4 In communicating hydrocephalus, a part of the brain surface that usually absorbs spinal fluid after its production does not function adequately. Too much spinal fluid is often a result of a choroid plexus tumor. It does not interfere with the flow of cerebrospinal fluid through the ventricles. Stating that the flow of spinal fluid through the brain cells does not empty effectively into the spinal cord is inaccurate; brain cells and the spinal cord are not involved. Stating that the spinal fluid is prevented from being adequately absorbed by a blockage in the spaces (ventricles) of the brain reflects the pathophysiologic process of noncommunicating hydrocephalus.

An 8-year-old child is being discharged after recovery from a sickle cell vaso-occlusive (painful crisis) episode. The nurse teaches the parents the do's and don'ts of the child's care. What statement by the parents satisfies the nurse that they understand the principles of care? 1 Have the child schooled by a private tutor 2 Restrict the child's fluid intake during the night 3 Permit the child to play with just one peer at a time 4 Encourage the child to engage in low-intensity activities

4 Low-intensity activities should be encouraged, because strenuous exercise leads to increased cellular metabolism, resulting in tissue hypoxia, which can precipitate sickling. Hiring a tutor is detrimental to the child's developmental needs and may result in social isolation. Some parents restrict fluids at night to discourage bedwetting. However, fluids should not be restricted in this case because keeping the child well hydrated helps prevent sickling. Restricting the child's play activities is unnecessary unless the other children have an infectious disease; a variety of peer relationships should be encouraged.

For how long should a nurse maintain isolation of a child with bacterial meningitis? 1 For 12 hours after admission 2 Until the cultures are negative 3 Until antibiotic therapy is completed 4 For 48 hours after antibiotic therapy begins

4 Most children are no longer contagious after 24 to 48 hours of intravenous antibiotics. Twelve hours after admission is inadequate, even if antibiotics are started immediately. Keeping the child isolated until cultures are negative or antibiotic therapy is complete is an excessively long period and is unnecessary.

The parents of an infant born with a myelomeningocele are confused about what the primary healthcare provider has told them about the condition. What should the nurse consider before answering the parents' questions in language that they will understand? 1 It is a fusion failure of the vertebral arches without herniation of cord or meninges. 2 There is a defect in the base of the skull through which the brain and meninges have herniated. 3 A membrane-covered sac of meninges, filled with spinal fluid, is protruding through a defect in the spine. 4 A saclike cyst of meninges, containing a portion of spinal cord and fluid, is protruding through a defect in the spine.

4 Myelomeningocele is a neural tube defect in which the meninges and spinal nerves protrude through the opening in the spinal column. Nerve damage may occur at or below the level of the defect. A fusion failure of the vertebral arches without herniation of cord or meninges is spina bifida occulta; there is no break in the skin or protrusion of any structure. A defect in the base of the skull through which the brain and meninges have herniated is an encephalocele; the spinal cord is not involved. A membrane-covered sac of meninges, filled with spinal fluid and protruding through a defect in the spine, is a meningocele; usually there is no nerve damage, although affected individuals may have minor disabilities.

An infant who has undergone surgical correction of a myelomeningocele is to be discharged. What information should the nurse include when preparing the parents to care for their infant at home? 1 The need to limit the infant's fluid intake to formula 2 The need to provide a quiet environment to limit external stimuli 3 The positions to be avoided to help prevent the infant from turning 4 How to perform range-of-motion exercises for the lower extremities

4 Passive range of motion, positioning, and stretching may help decrease the risk of muscle contractures in the lower extremities. Fluid intake should be unrestricted to provide adequate kidney function and prevent constipation. The infant needs stimulation to develop mentally and socially. Development of mobility should be encouraged; the infant's movements should not be restricted.

What is most important for a nurse to teach the parents of a child with Duchenne muscular dystrophy to do for their school-aged child? 1 Maintain a high-calorie diet 2 Institute seizure precautions 3 Restrict the use of larger muscles 4 Perform range-of-motion exercises

4 Range-of-motion exercises are essential to help achieve the primary objectives of maintaining optimal muscle function for as long as possible and preventing the development of contractures. A high-calorie diet may result in obesity, which could cause the child to need a wheelchair sooner rather than as late as possible. Seizures are not associated with Duchenne muscular dystrophy. Restricting the use of large muscles could result in disuse atrophy and contractures.

A client develops hydrocephalus two weeks after cranial surgery for a ruptured cerebral aneurysm. The nurse concludes that the hydrocephalus probably is related to which physiologic response? 1 Vasospasm of adjacent cerebral arteries 2 Ischemic changes in the Broca speech center 3 Increased production of cerebrospinal fluid (CSF) 4 Blocked absorption of fluid from the arachnoid space

4 Residual blood from the ruptured aneurysm may have blocked the arachnoid villi, interrupting the flow of CSF, resulting in hydrocephalus. Vasospasm is a protective response during the active bleeding process; it does not cause hydrocephalus. The Broca center is not directly affected; even if it were, there is no relationship to the development of hydrocephalus. The production of cerebrospinal fluid is not increased in this situation; increased production may result when there is a tumor of the choroid plexus.

A nurse is caring for a client with scoliosis of the thoracic spine and lumbar spine. Which risk does the nurse suspect in the client? 1 Osteoarthritis 2 Muscle spasticity 3 Intervertebral disc prolapse 4 Cardiac function impairment

4 Scoliosis can lead to cardiac function impairment. A client with an S-shaped thoracic and lumbar spine, and unequal shoulder and scapula height, may have scoliosis. A thoracic rib prominence in the lumbar spine deformity of 45 degrees indicates that the client is at a risk of lung and cardiac function impairment. Osteoarthritis is an inflammatory joint condition that is uncommon in a client with scoliosis of the thoracic spine and lumbar spine. Muscle spasticity, an increased muscle tone that may interfere with gait, movement, and speech, is uncommon in the client with scoliosis of the thoracic and lumbar spine. Passively raising the client's leg 60 degrees or less during a straight-leg-raising test indicates nerve root irritation due to intervertebral disc prolapse.

A nurse in the pediatric clinic should be most observant for signs of cerebral palsy in a 6-month-old infant in which instance? 1 Has a 40-year-old mother 2 Was born exhibiting the Moro reflex 3 Was delivered by an elective cesarean birth 4 Was born during the 32nd week of gestation

4 Studies indicate that a large percentage of children with cerebral palsy had preterm births and weighed less than 3 lb 5 oz (1500 g) at birth. Studies do not indicate a greater incidence of cerebral palsy in children born to older women. There is no greater incidence of cerebral palsy in children born in cesarean births that are not performed because of fetal distress. The Moro reflex is expected at birth.

The nurse is caring for a client with iron deficiency anemia that has decreased hemoglobin and hematocrit levels. The nurse expects to identify what other abnormal laboratory level? 1 Macrocytic red blood cells (RBCs) 2 Thrombocytopenia 3 Decreased folate levels 4 Increased total iron-binding capacity (TIBC)

4 TIBC may be elevated from 350 to 500 mcg/dL (82 µmol/L) (expected range is 250 to 460 mcg/dL [45-82 mcmol/L]) because the RBCs are compensating for the iron deficiency. The RBCs are microcytic, not macrocytic, because of their low iron content. A low platelet count is not associated with iron deficiency anemia. Decreased folate levels often are noted in vitamin B12 anemias, such as occur with sprue and celiac diseases, as well as in folate deficiency anemia, but not in iron deficiency anemia.

A newborn has been diagnosed with developmental dysplasia of the hips and is placed in a Pavlik harness. The parents have been instructed that the infant is to wear the appliance full time except for bathing. What additional instruction should the nurse give the parents about the harness? 1 Avoid undershirts or diapers under the harness. 2 The harness may be adjusted as needed as the baby grows. 3 Apply lotion or baby powder under the harness to prevent skin breakdown. 4 Avoid using the legs to lift the infant's buttocks when changing the diaper at bath time.

4 The Pavlik harness abducts and flexes the hips. If the legs are used to lift the buttocks when the child is out of the harness, it may negate the harness position. Undershirts and diapers should be placed under the straps to reduce irritation. Parents should never adjust the harness; this is the responsibility of the primary healthcare provider. Lotion and powders may cake under the harness and cause skin irritation.

An infant is found to have cerebral palsy (CP) several months after birth. When the infant is 10 months old the mother comes to the pediatric clinic because the child has begun to exhibit slow writhing movements. The nurse explains that these movements are characteristically associated with what type of CP? 1 Ataxic 2 Spastic 3 Dystonic 4 Athetoid

4 The athetoid type of CP consists of slow, wormlike, writhing movements. The ataxic type of CP is characterized by rapid, repetitive movements. The spastic type of CP is characterized by hypertonicity of muscles. The dystonic type of CP is a combination of the spastic and athetoid types.

A 9-year-old child who has cerebral palsy and scoliosis also is mentally challenged and blind. The child is incontinent, has contractures of the elbows and wrists, and sits in a customized wheelchair most of the day. One goal of nursing care is for the child's skin integrity to remain intact. Which nursing action will best achieve this goal? 1 Padding the child's lower extremities 2 Repositioning the child every 4 hours 3 Replacing the bed linens with sterile linens 4 Changing disposable diapers every 2 to 3 hours

4 The buttocks are at greatest risk for excoriation because the child sits in a wheelchair most of the day. For skin integrity to be maintained, the diaper area must be kept dry; disposable diapers keep moisture away from the skin. Because the child is in a wheelchair, there is no pressure on the child's legs. The child should be repositioned every 1 to 2 hours. Replacing the bed linens is unnecessary; freshly laundered linens will not prevent the development of a pressure ulcer.

Six weeks after birth an infant is found to have developmental dysplasia of the hip. The nurse explains to the parents the benefits of early treatment. What is the rationale for the immediate institution of corrective measures? 1 Mobility will be delayed if correction is postponed. 2 Traction is effective if it is used before toddlerhood. 3 Infants are easier to manage in spica casts than are toddlers. 4 Infants' cartilaginous hip joints promote molding of the acetabulum

4 The cartilaginous hip joints are the basis for the use of abduction devices (e.g., Pavlik harness) and spica casts when the infant is very young. Congenital hip dysplasia does not limit ambulation for the young child, although the gait will be affected. Traction is not used to correct developmental dysplasia of the hip. Although casted infants are easier to manage than casted toddlers, this is not the reason for early treatment.

A 9-year-old child with cerebral palsy is to be taught the four-point alternate crutch gait. The parents ask why this gait was chosen. How should the nurse respond? 1 "Your child has more power in the arms than in the legs." 2 "Your child doesn't have power or step ability in the legs." 3 "It provides two points of support on the floor between steps." 4 "It provides for equal but partial weight-bearing on each limb."

4 The four-point alternate crutch gait is a simple and slow but stable gait because there are always three points of support on the floor, with equal but partial weight-bearing on each limb. Telling the parent that their child has more power in the arms than in the legs may or may not be true; the data are insufficient to justify this conclusion. Some power and step ability is required to use the four-point alternate crutch gait. The child has uncoordinated movement in the legs because of the cerebral palsy.

To prevent skin breakdown on the scalp of an infant with hydrocephalus, how should the nurse position the infant? 1 On either side and flat 2 Supine and Trendelenburg 3 Prone, with the legs elevated about 30 degrees 4 Supine, with the head elevated about 45 degrees

4 The head should be elevated, allowing gravity to minimize intracranial pressure. The Trendelenburg position is contraindicated because it can increase intracranial pressure. The infant may be positioned on the back or side to allow routine changes in head position.

An infant with hydrocephalus has a ventriculoperitoneal shunt surgically inserted. What nursing care is essential during the first 24 hours after this procedure? 1 Medicating the infant for pain 2 Placing the infant in a high Fowler position 3 Positioning the infant on the side that has the shunt 4 Monitoring the infant for increasing intracranial pressure

4 The shunt may become obstructed, leading to an accumulation of cerebrospinal fluid and increased intracranial pressure. Although providing pain relief for the infant is an important part of postsurgical care, monitoring for potentially severe complications such as increased intracranial pressure takes precedence. Positioning the infant flat helps prevent complications that may result from a too-rapid reduction of intracranial fluid. The infant is positioned off the shunt to prevent pressure on the valve and incision area.

The parents of a toddler with a right ventriculoperitoneal (VP) shunt for the treatment of hydrocephalus are taught about postoperative positioning. The nurse concludes that they understand the teaching when they state that they will place the toddler in what position? 1 In the position that provides the most comfort 2 On the back with a small support beneath the neck 3 On the abdomen with the head turned to the left side 4 Flat on the left side with the head and back supported

4 The side-lying position on the unaffected side and the use of supports help prevent pressure on the shunt; the horizontal position prevents too-rapid drainage of cerebrospinal fluid. Basing the toddler's placement in the immediate postoperative period solely on comfort is unsafe. Neck supports should not be used for toddlers because they flex the neck, which can cause airway occlusion. The prone position is contraindicated; turning the head to the side puts pressure on the shunt.

A nurse in the pediatric clinic is evaluating a 6-year-old child with sickle cell anemia whose spleen autoinfarcted by age 4. What is the priority nursing care at this time? 1 Monitoring for signs of jaundice 2 Assessing the abdomen frequently 3 Monitoring serial hematocrit readings 4 Determining parental knowledge about infection

4 The spleen plays a role in immunity. Initially the spleen enlarges and becomes congested with accumulated sickled red blood cells; in time, fibrous material replaces the tissue in the spleen, and by age 5 the spleen is obliterated. Without a spleen the child is prone to infection, which can precipitate a sickle cell crisis. Assessing the child for jaundice is not a priority, because jaundice is an expected adaptation that is not life threatening. Abdominal assessments are important but not required frequently in this situation. Serial hematocrit readings are necessary only if the child is in sickle cell crisis.

An infant with a myelomeningocele undergoes surgery and is returned to the pediatric unit. The father appears anxious and tends to avoid physical contact with the infant. Later he says to the nurse, "My wife seems so wrapped up with the baby; I hope she has time for me." What is the most therapeutic response by the nurse? 1 "Are you feeling that you'll have to fend for yourself?" 2 "Do you think maybe your parents will be able to help out?" 3 "You'll both be so busy, you won't even miss her attention." 4 "I can understand your concern about the changes you'll have to make."

4 Validating the father's feelings lets the father know that the nurse understands that adjustments will have to be made. Also, it is open-ended enough to let him talk about feelings. Stating that the father is afraid that he will have to fend for himself is a premature assumption and is not open-ended enough to foster expression of feelings about what is bothering the father. The father has not expressed his feelings enough for the nurse to offer any specific suggestions for help. Saying that the father may be too busy may compound the father's anxiety; also, it does not let him explore feelings.

A nurse is assessing an infant for developmental dysplasia of the hip. How does the nurse identify the Ortolani sign? 1 Unilateral droop of the hip 2 Broadening of the perineum 3 Apparent shortening of one leg 4 Audible click on hip manipulation

4. With specific manipulation an audible click may be heard as the femoral head slips into the acetabulum; this is known as the Ortolani sign. Unilateral droop of the hip is the Trendelenburg sign; it is associated with weight bearing. Broadening of the perineum is associated with bilateral dislocation. Apparent shortening of one leg is the Allis sign.

The nurse is conducting discharge teaching with an adolescent with hemophilia. Which statement by the client indicates a need for further teaching? 1 "I'll use a straight razor when I start shaving." 2 "I plan on trying out for the swim team next year." 3 "If I injure a joint, I'll keep it still, elevate it, and apply ice." 4 "If I get a little scratch, I can apply gentle pressure for 10 to 15 minutes."

1 A straight razor should not be used by the adolescent with hemophilia, so further teaching is required. The adolescent with hemophilia should be taught to use an electric razor for shaving. Contact sports should be avoided, but swimming is a recommended activity, so trying out for the swim team indicates that the adolescent understands the teaching. If a superficial injury occurs, gentle, prolonged pressure should be applied until the bleeding has stopped. If a muscle or joint injury occurs, the area should be immobilized, elevated, and iced. Both statements indicate that the adolescent has understood the teaching.

A 12-year-old child with sickle cell anemia is admitted during a vaso-occlusive crisis. What is the priority of care for this child? 1 Relieving pain 2 Exercising joints 3 Increasing urine output 4 Improving respirations

1 A vaso-occlusive crisis is accompanied by severe pain because the clumped red blood cells block small vessels. Swollen limbs are painful and should not be exercised during a pain episode. Although increased urine output, associated with appropriate hydration, is an important objective, pain relief is the priority. Improved respiratory function occurs as pain is relieved.

An infant who has been found to have developmental dysplasia of the hip (DDH) is being examined in the pediatric clinic. What clinical finding does the nurse expect to identify during the physical assessment? 1 Limited abduction of the affected hip 2 Downward and inward rotation of the affected hip 3 Inability to flex and extend the hip on the affected side 4 Free abduction of the affected hip when placed in the frog position

1 Abduction of the hip is limited infant with DDH, because the head of the femur slips out of the acetabulum and is unable to rotate. Rotation of the hip is unaffected. The hip can be flexed on the affected side. Free abduction of the affected hip is impossible; the frog position may be used in the treatment of DDH.

The school nurse is assessing a 10-year-old boy with hemophilia who has fallen while playing in the schoolyard. At which site does the nurse expect to find internal bleeding? 1 Joints 2 Abdomen 3 Cerebrum 4 Epiphyses

1 Activity can result in bleeding in children with hemophilia; therefore weight-bearing joints, especially the knees, are the most common site of bleeding. The abdomen is usually protected from the trauma of direct force. The cerebrum is protected by the skull and is not likely to be injured. Bleeding from bones themselves is not common without other associated trauma.

A child with recently diagnosed idiopathic scoliosis has a mild structural curve. The child's mother asks whether the problem can be corrected with exercise. What should the nurse tell the mother concerning an exercise program? 1 Exercise is used in conjunction with a brace. 2 Exercise can be used if the child appears highly motivated. 3 Exercise might exaggerate the curvature if the curve is severe. 4 Exercise is needed to correct the curvature without the need for a brace

1 An exercise program and a brace are the treatments of choice for mild structural scoliosis. Although compliance will affect the ultimate outcome of treatment, exercises alone are not helpful in this type of scoliosis. Exercises are to be encouraged, regardless of the type or extent of scoliosis. Exercises alone are used only with postural-related, not structural-related, scoliosis.

A child is admitted to the hospital with a tentative diagnosis of meningitis, and a lumbar puncture is performed to confirm the diagnosis. What finding from the spinal fluid report should lead the nurse to conclude that bacterial meningitis is present? 1 Increased protein 2 Increased glucose 3 Decreased specific gravity 4 Decreased white blood cell count

1 Bacterial meningitis causes increased permeability of the blood-cerebrospinal fluid barrier, resulting in increased protein in cerebrospinal fluid. The glucose level will be within the expected range. The specific gravity will be increased, as will the white blood cell count.

An infant with a myelomeningocele is scheduled for surgery to close the defect. Which nursing action best facilitates the parent-child relationship in the preoperative period? 1 Encouraging the parents to stroke their infant 2 Allowing the parents to hold their infant in their arms 3 Referring the parents to the Spina Bifida Association of America (Canada: Spina Bifida and Hydrocephalus Association of Canada) 4 Teaching the parents to use special techniques when feeding the infant

1 Because the infant cannot be held, tactile stimulation helps meet the infant's needs and fosters bonding with the parents. An infant with an unrepaired myelomeningocele cannot be held in the arms. Referrals will be more appropriate at a later time. Although special feeding techniques are important in the postoperative period, they may not improve the parent-infant relationship.

When planning long-term care for a 2-year-old child with cerebral palsy (CP), what is important for the nurse to consider? 1 CP is not progressively degenerative. 2 The effects of CP are unpredictable. 3 The child probably has some degree of cognitive impairment (CI). 4 The child should have genetic counseling before planning a family.

1 CP is a nonprogressive chronic condition and its effects are predictable. Although CI may be present in some children with CP, not all children with this disorder have CI. A variety of prenatal, perinatal, and postnatal factors contribute to the development of CP. It is estimated that the cause of CP is unknown in as many as 80% of people with the disorder.

The hypertonicity of the muscles in an infant with cerebral palsy causes scissoring of the legs. The nurse teaches the mother that the preferred way to carry the infant is in a sitting position in what way? 1 Astride one of her hips 2 Strapped in an infant seat 3 Wrapped tightly in a blanket 4 Under the arm in a football hold

1 Carrying the infant astride the parent's hip prevents scissoring by keeping the infant's legs abducted. An infant seat will not prevent scissoring. Tight wrapping maintains the infant's legs in a scissored position. When the football hold is used, the infant is carried in a supine position with the legs adducted, which promotes scissoring.

A nurse concludes that the teaching about sickle cell anemia has been understood when an adolescent with the disorder makes which statement? 1 "I'll start to have symptoms when I drink less fluid." 2 "I'll start to have symptoms when I have fewer platelets." 3 "I'll start to have symptoms when I decrease the iron in my diet." 4 "I'll start to have symptoms when I have fewer white blood cells."

1 Dehydration precipitates sickling of red blood cells and therefore is a major causative factor for painful episodes associated with sickle cell anemia. An inadequate number of platelets (thrombocytes) is unrelated to painful episodes associated with sickle cell anemia. Iron intake is unrelated to the sickling phenomenon. An inadequate number of white blood cells is unrelated to painful episodes associated with sickle cell anemia.

A nurse is caring for a 6-year-old child with sickle cell anemia. What is the priority nursing intervention to prevent thrombus formation? 1 Encouraging fluids 2 Encouraging bed rest 3 Administering oxygen 4 Administering prescribed anticoagulants

1 Dehydration, stress, infection, and electrolyte imbalance can trigger the sickling process. Red blood cells (RBCs) change to the sickle shape when deoxygenated because of polymerization of the abnormal hemoglobin. This process damages the RBC membrane, which causes the cells to become entangled in the blood vessels, depriving the tissues that are distal to the occlusion of oxygen, resulting in ischemia and infarction, which can in turn cause organ damage. The child's condition determines the activity level; although bed rest may be required during a pain episode, at other times it is not necessary. Administering oxygen will not prevent thrombus formation. Anticoagulants do not help prevent thrombus formation in sickle cell anemia.

A nurse places a school-aged child with bacterial meningitis in isolation with droplet precautions. What is the purpose of these precautions? 1 They keep the child away from uninfected people. 2 The infectious process is interrupted as quickly as possible. 3 The child is protected from contracting a secondary infection. 4 They prevent the development of a hospital-acquired infection.

1 Droplet precautions reduce the transmission of infection from the child to other individuals (cross-infection). The microorganisms are transmitted to others in respiratory droplets. Droplet precautions do not interrupt the infectious process; they protect those in contact with the child from contracting the infection. Droplet precautions do not protect the child from contracting secondary infections; they protect others from being exposed to the child's pathogens. Thorough hand washing and aseptic techniques, not droplet precautions, limit the spread of hospital-acquired infections.

After an infant who was born with talipes equinovarus (clubfoot) has the cast removed, the nurse teaches the mother how and when to exercise the baby's foot. The nurse concludes that the mother understands the instructions when she says that she will exercise the foot with what frequency? 1 With each diaper change 2 Once a day in the morning 3 Twice a day after each nap 4 Every 4 hours during the day

1 Exercises should be performed often; association with a specific activity makes it easier to incorporate it into the lifestyle. Once or twice a day is not frequent enough. Although every 4 hours is frequent enough, such a rigid schedule is difficult to follow with an infant, and compliance may falter.

A client is seen in the clinic with sickle cell crisis. Which hemoglobin range will the nurse expect to find? 1 6-8 g/100 mL (60-80 mmol/L) 2 10-12 g/100 mL (100-120 mmol/L) 3 12-14 g/100 mL (120-140 mmol/L) 4 16-18 g/100 mL (160-180 mmol/L)

1 In sickle cell crisis, hemoglobin values are low, usually in the 6-8 g/100 mL (60-80 mmol/L) range showing many sickle-shaped cells, and the client also will have a low oxygen level. A level of 10-12 g/100 mL (100-120 mmol/L) is too high. A range of 12-14 g/100 mL (120-140 mmol/L) is a normal finding. 16-18 g/100 mL (160-180 mmol/L) may be indicative of dehydration rather than anemia.

A 13-month-old child is admitted with a tentative diagnosis of bacterial meningitis, and the practitioner schedules a lumbar puncture. What is the most important action the nurse should take in preparation for the lumbar puncture? 1 Asking the parents what they were told about the test 2 Using a doll to demonstrate the procedure to the child 3 Obtaining a pacifier for the child to suck on during the procedure 4 Telling the parents that they may stay with their child during the test

1 Informed consent is required. The procedure should be explained to the parents by the practitioner, and the nurse should confirm the parents' comprehension and have them sign the consent form. The child is too young to comprehend a demonstration of the procedure. Although staying with the child may be important to the parents, it is not the priority. Although a pacifier may keep the child calm, this is not the priority, either.

Spinal fusion is performed in an adolescent with scoliosis. What postoperative nursing intervention is specifically related to surgery for scoliosis? 1 Log-rolling every 2 hours 2 Checking the dressing frequently 3 Supervising deep-breathing exercises 4 Maintaining the adolescent in the supine position for 3 days

1 Log-rolling is necessary to prevent movement of the newly aligned and instrumented vertebrae and should be done frequently to prevent skin breakdown. Dressings are checked frequently in all postoperative clients; this action is nonspecific. Coughing and deep-breathing are done by most postoperative clients; this action is nonspecific. The client who has had a spinal fusion may be turned and still be protected from injury with log-rolling. Remaining in one position for 3 days could lead to skin breakdown from unrelieved pressure.

An adolescent with acute lymphocytic leukemia (ALL) completes parenteral chemotherapy, and the healthcare provider prescribes mercaptopurine. The nurse teaches the adolescent about this medication. What statement indicates that the adolescent has understood the information? 1 "This will help prevent a relapse." 2 "I guess I'll need an intravenous line for this drug." 3 "I guess this drug is a substitute for brain radiation." 4 "This will stop the cancer from spreading to my stomach."

1 Mercaptopurine is given as maintenance therapy to prevent relapses. Mercaptopurine is an oral medication. Oral chemotherapy is an adjunct to other therapies in childhood leukemia, not an alternative for other therapies. The prime site of metastasis of ALL is the central nervous system.

An infant with a diagnosis of hydrocephalus has just had a ventriculoperitoneal shunt inserted. In what position should the nurse place the infant? 1 Supine on the unaffected side 2 Side-lying on the affected side 3 Head elevated at 45 degrees on the affected side 4 Head elevated at 90 degrees on the unaffected side

1 Placing the infant flat will prevent complications from too-rapid reduction of intracranial fluid; placing the infant on the unaffected side will prevent pressure on the shunt valve. Placing the infant on the affected side will put pressure on the shunt valve, which may cause it to become obstructed, interfering with the outflow of cerebrospinal fluid. Raising the head of the bed will allow a too-rapid reduction in cerebrospinal fluid, which may cause the cerebral cortex to pull away from the dura, resulting in a subdural hematoma. Placing the infant on the affected side will put pressure on the shunt valve. Elevating the head to 90 degrees will permit too rapid a reduction in cerebrospinal fluid.

After an uneventful pregnancy a client gives birth to an infant with a meningocele. The neonate has 1-minute and 5-minute Apgar scores of 9 and 10, respectively. What is the priority nursing care for this newborn? 1 Protecting the sac with moist sterile gauze 2 Removing buccal mucus and administering oxygen 3 Placing name bracelets on both the mother and infant 4 Transferring the newborn to the neonatal intensive care unit

1 Preventing infection and trauma is the priority; rupture of the sac may lead to meningitis. The Apgar scores are 9 and 10 at 1 and 5 minutes, respectively; oxygen is not needed. Placement of name bracelets on both mother and infant may be done before the infant leaves the birthing room; the priority is care of the infant's sac. The infant's sac must be protected before the infant is transferred to the neonatal intensive care unit.

The nurse is completing an assessment on a couple seeking genetic counseling for sickle cell anemia. Both prospective parents carry sickle cell traits. The nurse recognizes that the couple has what chance of having a child who develops the disease? 1 25% 2 50% 3 75% 4 100%

1 Sickle cell is an autosomal recessive genetic disorder. If both individuals have sickle cell traits, there is a 25% chance they will produce a child with the disease. Other options, such as 50%, 75%, and 100%, are not plausible. However, the children do have a 50% chance of being carriers.

Parents of a child with sickle cell anemia ask about their child taking iron supplements to help treat the anemia. What would be the best response? 1 Taking supplements will not help with this condition. 2 It is advised that iron be taken with orange juice to aid in absorption. 3 An over-the-counter multivitamin with iron should meet the needs of the child. 4 It is advised that liquid iron supplements be given through a straw to prevent staining the teeth.

1 Taking iron supplements will not help. Sickle cell anemia is not caused by too little iron in the blood; it's caused by not having enough red blood cells. Taking iron supplements could cause harm, because the extra iron builds up in the body and can damage organs. Although iron is better absorbed when taken with orange juice, in the case of sickle cell anemia supplements are not given. Using a straw when giving liquid iron supplements does prevent staining of the teeth; however, giving iron to this child may be detrimental. A multivitamin may be beneficial for this child; however, the addition of iron could build up in the body.

What should the nurse explain to the parents of a newborn with developmental dysplasia of the hip (DDH) will most likely will be part of the infant's treatment? 1 A fitted Pavlik harness 2 Tight swaddling in blankets 3 Periodic strapping to a cradleboard 4 Placement in an infant seat on a set schedule

1 The Pavlik harness promotes hip abduction and flexion. Swaddling or strapping the infant to a cradleboard limits hip abduction and puts stress on the hip joint. Although placing the infant in an infant seat allows movement in the flexed position, it does not promote abduction.

An infant has developmental dysplasia of the hip. What clinical finding should the nurse expect to note during an assessment? 1 Apparent shortening of one leg 2 Limited ability to adduct the affected leg 3 Narrowing of the perineum with an anal stricture 4 Inability to palpate movement of the femoral head

1 The affected leg appears to be shorter because the femoral head is displaced upward. The child's ability to abduct, not adduct, the affected leg is limited. Narrowing of the perineum with an anal stricture does not occur with hip dysplasia. When the femoral head slips out of the acetabulum, it is palpable.

A nurse is assessing an infant with suspected developmental dysplasia of the hip. What does the nurse expect the infant's orthopedic status to reveal? 1 Apparent shortening of one leg 2 Limited ability to adduct the affected leg 3 Narrowing of the perineum with an anal stricture 4 Inability to palpate movement of the femoral head

1 The affected leg appears to be shorter because the femoral head is displaced upward. The infant's ability to abduct, not adduct, the affected leg is affected. An anal stricture is not expected with developmental dysplasia of the hip. When the femoral head slips out of the acetabulum, it is easily palpable.

A nurse is caring for an infant with hydrocephalus after the insertion of a shunt. How should the nurse evaluate the effectiveness of the shunt? 1 By palpating the anterior fontanel 2 By determining the frequency of voiding 3 By assessing the child for periorbital edema 4 By assessing the symmetry of the Moro reflex

1 A bulging fontanel is the most significant sign of increased intracranial pressure in an infant. Periorbital edema, the frequency of voiding, and the symmetry of the Moro reflex are not indicators of increased intracranial pressure.

A nurse is assessing a 3-week-old infant who has been admitted to the pediatric unit with hydrocephalus. What finding denotes a complication requiring immediate attention? 1 Tense anterior fontanel 2 Uncoordinated eye/muscle movement 3 Larger head circumference than chest circumference 4 Inability to support the head while in the prone position

1 A tense or bulging fontanel is indicative of increased intracranial pressure, which is caused by the fluid accumulation associated with hydrocephalus. Conjugate gaze does not occur until 3 to 4 months of age, once the eye muscles have matured. The head is the largest part of the body at this age; the head circumference should be about 1 inch (2.5 centimeters) larger than chest circumference. An infant cannot support the head before 1 to 1½ months of age.

A pregnant client tells the nurse in the prenatal clinic that although she and her husband do not have the disease, she has a 1-year-old daughter with sickle cell anemia. She asks the nurse, "Will this baby also have sickle cell anemia?" How should the nurse respond? 1 "The chance that another child will have sickle cell anemia is 25%." 2 "Only one child in a family is affected, so the others probably will be all right." 3 "The most likely conclusion is that your children will have sickle cell anemia." 4 "If your partner has the sickle cell gene, 50% of your children will have sickle cell anemia."

1 According to the Mendelian laws of inheritance, the sickle cell gene is recessive. If neither parent has the disease, both of them have the sickle cell trait; there is therefore a 25% chance that a child will have sickle cell anemia, a 50% chance that a child will have the sickle cell trait, and a 25% chance that a child will be unaffected. Saying that only one child in a family is affected and that the others probably will be all right is too vague. Stating that the children will have sickle cell anemia is not an accurate answer. The client should be told the probability of a child's inheriting the disease, but 50% is too high.

An 11-year-old child is found to have acute lymphocytic leukemia (ALL), and the healthcare provider discusses the diagnosis and treatment with the child and family. What age-appropriate behavior does the nurse expect from the child regarding the life-threatening diagnosis? 1 Expressing anger by being insolent 2 Saying that when people die they go to heaven 3 Being afraid to go to sleep for fear of not awakening 4 Telling the nurse that death is punishment for not being good

1 Anger is an appropriate response for an 11-year-old, who sees dying as loss of control over every aspect of living. The child may convey this emotion by physically attempting to run away or by pushing others away through rude behavior; it is a plea for some self-control and power. Saying that when people die they go to heaven is characteristic of the toddler, who is egocentric and has a vague separation of fact and fantasy, which makes it impossible to understand the absence of life. Being afraid of sleep is characteristic of the preschooler, who does not have logical thinking. Telling the nurse that death is a punishment is more typical of the preschool-aged child, who sees deviation from accepted behavior as the reason for becoming ill.

A 4-year-old child is admitted to the pediatric unit with the diagnosis of acute lymphocytic leukemia (ALL). A blood transfusion is ordered, and an intravenous line is started. What will the nurse do in regard to administering the transfusion? 1 Infuse the blood over no more than 4 hours. 2 Take the vital signs 3 hours after the transfusion. 3 Check the vital signs 15 minutes after starting the transfusion. 4 Have the blood warm at room temperature for 1 hour before administration

1 Blood should be administered within 4 hours; the risk for bacterial proliferation increases over time and exposure to room temperature. Taking the vital signs 3 hours after the transfusion is too long to wait; the vital signs should be checked every 5 minutes during the absorption of the first 50 mL of blood and then routinely thereafter (every 15 minutes to 1 hour, depending on hospital policy). Vital signs must be checked every 5 minutes during the administration of the first 50 mL of blood to detect a transfusion reaction. Blood should be used within 30 minutes after its arrival from the blood bank; the risk for bacterial proliferation increases over time and exposure to room temperature.

A cast is applied to the involved extremity of an infant with talipes equinovarus (clubfoot). How often does the nurse tell the parents to bring their baby back to the clinic for a cast change? 1 Each week 2 Once a month 3 When the cast edges fray 4 If the cast becomes soiled

1 Casts are changed weekly to accommodate the rapid growth of early infancy. Once a month is not frequent enough in early infancy; the cast may become too tight because of the infant's rapid growth. The cast is not on the foot long enough for fraying to occur. Soiling is usually not a problem, because casts for clubfoot do not extend to the perineal area.

A nurse is teaching a high school student about scoliosis treatment options. On what should the nurse focus? 1 Effect on body image 2 Least invasive treatment 3 Continuation with schooling 4 Maintenance of contact with peers

1 Establishing an identity, the major developmental task of the adolescent, is related to the affirmation of self-image. To achieve this task there is a need to conform to group norms, one of which is appearance. The type of treatment is not an issue. Although it is important to continue schooling and to maintain contact with peers, the effect on body image is more important.

A client is seen in the clinic with sickle cell anemia. The primary healthcare provider has prescribed an iron supplement to treat the client's anemia. What is the nurse's primary concern in regard to giving the supplement? 1 Giving iron with this condition is contraindicated. 2 Finding a straw is necessary to prevent staining of teeth. 3 When giving iron, orange juice is needed to improve absorption. 4 Warning about stools changing to black will prevent undue stress

1 Giving iron is contraindicated as sickled cells do not incorporate the iron, so it will build up in the body, causing pain rather than being absorbed. Liquid iron should be administered with a straw to prevent staining teeth, but not with this condition. Giving iron with orange juice is correct, but not to a person with sickle cell anemia. Feces will turn dark with iron supplements; however, this client should not be receiving iron.

Which observation during a developmental appraisal of a 6-month-old infant is most important to the nurse in light of a diagnosis of hydrocephalus? 1 Head lag 2 Babinski reflex 3 Inability to sit unsupported 4 Absence of the grasp reflex

1 Head lag in an infant who is 6 months old is abnormal and is frequently a sign of cerebral damage. The Babinski reflex may be present until 2 years of age. The ability to sit unsupported is achieved at 7 to 8 months. The grasp reflex usually disappears by 3 months.

A child has been diagnosed with hemophilia type A after experiencing excessive bleeding from a minor trauma. How is hemophilia inherited? 1 X-linked recessive trait 2 Y-linked recessive trait 3 X-linked dominant trait 4 Y-linked dominant trait

1 Hemophilia A is an X-linked recessive trait, not a dominant trait, meaning daughters who have the gene are carriers, and sons with the gene have the condition. The trait is not carried on the Y chromosome.

What safety instruction should a nurse teach a 10-year-old child with diminished sensation in the legs because of cerebral palsy? 1 Test the temperature of the water before a bath. 2 Tighten brace straps securely before ambulating. 3 Set the clock twice during the night to change position. 4 Look down at the legs when crutch-walking to check how they are positioned.

1 Individuals whose thermoreceptive senses are impaired are unable to detect changes or degrees of temperature. They must be taught to first test the temperature in any water-related activity to prevent scalding and burning. Overtightening of brace straps may lead to circulatory impairment or skin breakdown. The child with cerebral palsy has uncontrolled movement of voluntary muscles and does not need to change positions at night to prevent skin breakdown. Looking down at the legs when crutch-walking is dangerous because this action alters the center of gravity; with practice the child will be able to place the legs in the appropriate position for walking without looking down.

Which is a clinical manifestation of the Landouzy-Déjérine type of muscular dystrophy (MD)? 1 Loss of hearing 2 Cardiomyopathy 3 Respiratory failure 4 Mental impairment

1 Loss of hearing is the clinical manifestation of Landouzy-Déjérine MD. Cardiomyopathy and respiratory failure are the clinical manifestations of both Duchenne and Becker MD. Duchenne MD is clinically manifested by mental impairment.

A platelet transfusion is to be administered to a child with acute lymphocytic leukemia. What will the nurse do first? 1 Administer the platelets rapidly through the intravenous (IV) line 2 Set the IV pump to run for 8 hours 3 Flush the IV line with a dextrose solution 4 Check the vital signs every 2 hours during the transfusion

1 Platelets are fragile and should be administered as quickly as possible, within 1 hour, or as fast as the child can tolerate the infusion. There are minimal numbers of red blood cells (RBCs) and white blood cells contained within the infusion, which reduces the risk of a severe reaction. Platelets must be infused within 1 hour. They may be infused as rapidly as the child's cardiovascular status will tolerate. A dextrose solution is not appropriate for flushing a blood derivative line because it may cause hemolysis of RBCs. Two hours is too long an interval between checks of the child's vital signs. Vital signs should be obtained before the infusion, 15 minutes after initiation of the infusion, and at the end of the infusion.

A 1-month-old infant with hydrocephalus is scheduled to have surgery for the insertion of a ventriculoperitoneal shunt. What is the primary focus of nursing interventions for this infant? 1 Maintaining a satisfactory comfort level to limit crying 2 Applying bandages to the infant's head to protect it from injury 3 Establishing a fixed feeding schedule to ensure appropriate hydration 4 Providing play objects to maintain age-appropriate stimulation for the child

1 Preventing crying will avoid sudden increases in intracranial pressure. Applying head bandages is inappropriate and unnecessary. Young infants, especially those with hydrocephalus, tolerate a demand schedule better, and it may diminish the possibility of vomiting. Providing toys is inappropriate for a 1-month-old infant.

A nurse who works in a fertility clinic is discussing the inheritance pattern of sickle cell disease with the parents of a school-aged child with the disease. The parents are planning to have a second child. What does the nurse know is the parental genotypic makeup? 1 Father heterozygous (sickle trait), mother heterozygous (sickle trait) 2 Mother homozygous (no sickle trait), father heterozygous (sickle trait) 3 Father homozygous (no sickle trait), mother heterozygous (sickle trait) 4 Mother homozygous (has sickle cell disease), father is homozygous (no sickle trait)

1 Sickle cell disease is an autosomal recessive disorder; each parent contributes one affected gene. All children with a mother who is homozygous (has sickle cell disease) and a father who is homozygous (no sickle trait) will have the sickle cell trait but not sickle cell disease. There is a 50% chance that a child with a homozygous mother/heterozygous father, homozygous father/heterozygous mother, or homozygous mother/homozygous father will have the sickle cell trait, not sickle cell disease.

A 10-year-old child is admitted to the pediatric unit in vaso-occlusive sickle cell crisis. The nurse manager is planning to assign a room. Which child is the best roommate option for this client? 1 Child with thalassemia 2 Child with osteomyelitis 3 Child with viral pneumonia 4 Child with acute pharyngitis

1 Thalassemia is a hemolytic anemia that is not communicable; roommates with infectious diseases should be avoided because a child with sickle cell anemia is susceptible to infection. Osteomyelitis is an infection of the bone, pneumonia is an infection of the lung, and pharyngitis is an upper respiratory infection; therefore none of these children is a suitable roommate.

An orthopedic surgeon plans to have a school-aged child with cerebral palsy walk with crutches. What should the nurse determine before preparing this child for crutch-walking? 1 Weight-bearing ability of the child's four extremities 2 The power in the child's trunk to drag the legs forward when the child is erect 3 Whether the child's circulation can tolerate the body's being placed in an erect position 4 The ability of the child's shoulder girdle to support the body's weight when it leaves the floor

1 The choice of gait is based on the weight-bearing capabilities of each of the four extremities. Assessment of the extremities takes priority over assessment of the trunk. The child with cerebral palsy uses upper-extremity strength for crutch control and lower-extremity strength to facilitate some movement. The child with cerebral palsy is unlikely to have orthostatic circulatory impairment. Because of decreased muscle control, it is unlikely that the child is able to use a gait involving complete support of body weight off the floor.

An infant with talipes equinovarus has a plaster cast applied to the involved foot. How should the nurse move the infant while the cast is wet? 1 By handling the cast with just the palms 2 By touching the cast with just the fingertips 3 By turning the infant without touching the cast 4 By moving the infant's body while sliding the cast

1 The palm provides a wide base of support for the infant's body and the casted extremity. Touching the cast with the fingertips will cause indentations that may create pressure points; this may compromise the skin, neurovascular function, or both. The cast must be touched because the lower extremity and the cast must be supported.

The parents of an infant who has undergone surgical repair of a myelomeningocele express concern about skin care and ask what they can do to prevent problems. What should the nurse teach the parents about their infant's skin care? 1 Will require long-term multidisciplinary follow-up care 2 Should take prophylactic antibiotic therapy indefinitely 3 Must be kept dry by applying powder after each diaper change 4 Does not need anything more than routine cleansing and diaper changes

1 These infants need follow-up care with a variety of healthcare providers (e.g., neurologist, physical therapist) to manage the child's condition during growth and development. Taking prophylactic antibiotic therapy indefinitely is unnecessary. Powder should be avoided; it will create a pastelike substance when mixed with urine, and when aerosolized it is a respiratory irritant. These children require more frequent perineal care than just routine cleansing and diaper changes.

What is the most appropriate nursing intervention for an adolescent child with sickle cell anemia? 1 Teaching the family how to limit sickling episodes 2 Preparing the child for occasional blood transfusions 3 Educating the family about prophylactic medications 4 Explaining to the child how excess oxygen causes sickling

1 To help prevent a crisis, the child and family must be taught to try to prevent sickling by maintaining hydration, promoting adequate oxygenation, and avoiding strenuous exercise. Blood transfusions are a common treatment rather than a rare occurrence. There are no prophylactic medications to prevent sickle cell crisis. It is a lack, not an excess, of oxygen that contributes to sickling.

A nurse is teaching the parents of a school-aged child with sickle cell anemia about ways to prevent sickling. What should the nurse explain as the primary cause of sickling? 1 Hypoxia 2 Hemodilution 3 Hypocalcemia 4 Hemoglobin

1 Under conditions of decreased oxygen, the relatively insoluble hemoglobin S changes its molecular structure to form long, slender crystals and eventually the crescent, or sickled, shape. Hemodilution, accomplished with increased fluids, helps prevent sickling. Hypocalcemia will not influence the sickling process. Between 65% and 100% of hemoglobin F is found in individuals with thalassemia major (Cooley anemia).

A child has been diagnosed with hemophilia type A after experiencing excessive bleeding from a minor trauma. The parents ask what symptoms of bleeding they should be looking for in the future. What symptoms should the nurse list? Select all that apply. 1 Epistaxis 2 Hematuria 3 Hemarthrosis 4 Easy bruising 5 Frequent fevers 6 Fast clotting of injuries 7 Dark-colored tarry stools

1,2,3,4,7 Epistaxis, also known as nosebleeds, is a common symptom of a lack of clotting factor. Hematuria (blood in the urine) may be grossly apparent. The child may experience joint pain and deformities from bleeding into joints. Excessive bruising will occur from bleeding into tissue with seemingly minor injuries. Dark-colored tarry consistency stools are indicative of gastrointestinal bleeding. Frequent fevers are not associated with hemophilia. Prolonged clotting times occur with this condition.

A nurse is assessing a newborn with a myelomeningocele. What clinical findings prompt the nurse to suspect hydrocephalus? Select all that apply. 1 Bulging fontanels 2 High-pitched crying 3 Apgar score of less than 5 4 A defect in the lumbosacral area 5 Head circumference 2 cm greater than the chest circumference

1,2,4 An excessive amount of cerebrospinal fluid associated with hydrocephalus causes bulging fontanels. A shrill, high-pitched cry often accompanies progressive hydrocephalus and other neurologic problems. Hydrocephalus complicates approximately 80% of lumbosacral myelomeningoceles. Infants with hydrocephalus may or may not have low Apgar scores. Head circumference 2 cm greater than the chest circumference is expected in a newborn.

A 15-month-old child with the diagnosis of hydrocephalus is to undergo computed tomography (CT). What action should the nurse include when preparing the toddler for the CT scan? 1 Shaving the head 2 Administering the prescribed sedative 3 Starting the prescribed intravenous infusion 4 Giving the child a simple explanation of the procedure

2 A 15-month-old toddler will have difficulty complying with directions to remain still and may be extremely frightened by the equipment, so sedatives are usually prescribed. Shaving the head is not necessary; the head must remain still but need not be shaved. Starting the prescribed infusion is not necessary unless a contrast medium is being used. The child is too young to understand even a simple explanation of the procedure.

An infant has had surgery for repair of a myelomeningocele. For which early sign of impending hydrocephalus should the nurse monitor the infant? 1 Frequent crying 2 Bulging fontanels 3 Change in vital signs 4 Difficulty with feeding

2 After closure, spinal fluid may accumulate and reach the brain, increasing intracranial pressure (ICP) and causing the fontanels to bulge. Frequent crying may be a typical pattern for the neonate; it does not, in and of itself, indicate changes in ICP. Changes in vital signs are not among the early signs of increasing ICP in an infant. Difficulty with feeding can indicate changes in ICP but is not one of the initial signs.

The mother of a boy with recently diagnosed hemophilia is pregnant with her second child. She asks the nurse what the chances are that her baby will also have hemophilia. How should the nurse respond? 1 There is a 5% chance that the baby will be affected. 2 There is a 25% chance that the baby will be affected. 3 There is a 50% chance that the baby will be affected. 4 There is a 75% chance that the baby will be affected

2 Before the sex of the unborn child is known, the odds are 25%; 50% of pregnancies will result in boys, and each has a 50% chance of having hemophilia. Hemophilia is an X-linked recessive disorder. The mother is usually the carrier, and the father is unaffected. The laws of Mendelian genetics do not include a 5% probability of inheritance of hemophilia. A 50% or 75% chance is too high; there is only a 25% chance that the fetus will be affected.

While performing preoperative teaching a nurse explores a young adolescent's concern about changes in appearance after surgery to correct scoliosis. What is the most appropriate statement by the nurse? 1 "After surgery your back will be much straighter." 2 "You're concerned about how you'll look after surgery." 3 "Many teenagers who have this type of surgery do very well." 4 "Your parents think it's important for you to have this surgery.

2 By saying, "You're concerned about how you'll look after surgery," the nurse is using the technique of paraphrasing to encourage the adolescent to expand on personal concerns, which may relieve anxiety. Adolescents tend to be focused on the present, not the future; the nurse should focus on the adolescent's current concerns. Focusing on others is not client-centered care; the nurse should focus on the adolescent.

A 13-year-old is found to have idiopathic scoliosis. She is upset about the treatment regimen and is worried about being different from her friends. What should the nurse do to help the child maintain a positive self-image during treatment? 1 Remind her how crooked her back will be if she refuses treatment. 2 Help her investigate appropriate clothing to enhance her appearance. 3 Disregard her negative characteristics and focus on her positive attributes. 4 Refer her for psychological counseling until the treatment program is completed.

2 Clothes can be selected to minimize the appearance of a brace, especially if an effort is made to wear current styles. Reminding the child how she will look without treatment has a negative connotation that emphasizes the problem. Focusing only on positive attributes may be misinterpreted as unqualified praise; adults should give honest appraisals of both positive and negative attributes. There are no data to indicate that the child will not adjust to the treatment regimen.

A nurse is performing an assessment on a fifth-grader who has been admitted to the pediatric unit with the diagnosis of acute lymphocytic leukemia (ALL). What early clinical findings does the nurse expect to identify? 1 Nosebleeds and papilledema 2 Fatigue and ecchymotic areas 3 Abdominal pain and reddened complexion 4 Enlargement of the axillary and groin lymph nodes

2 Fatigue and ecchymoses are early clinical findings to ALL. They are caused by decreased white blood cell, red blood cell (RBC), and platelet production that results when the bone marrow is crowded with abnormal lymph cells. Although epistaxis does occur, papilledema is not a common presenting sign because the blood-brain barrier is an initial deterrent. Pain is not an early symptom of ALL. The skin will be pale, not reddened, because of a decreased RBC count. Enlargement of lymph nodes in the axillae and groin is a sign of lymphoma or a late, not early, sign of leukemia.

A 3-year-old child with mild iron deficiency anemia is seen by a nurse in the clinic. In addition to weakness and fatigue, what should the nurse expect the child to exhibit? 1 Cold, clammy skin 2 Increased pulse rate 3 Increased blood pressure 4 Cyanosis of the nail beds

2 Increased pulse rate (tachycardia) occurs as the body tries to compensate for hypoxia due to mild iron deficiency anemia. Severe anemia however can manifest as pale, cool, and clammy skin. Increased blood pressure is not a response associated with anemia. Cyanosis of the nail beds is a sign of carbon monoxide poisoning.

A nurse is assessing an adolescent child with the diagnosis of hemophilia. In what part of the body does the nurse expect bleeding to occur? 1 Brain 2 Joints 3 Intestines 4 Pericardium

2 Joints are the most commonly involved areas because they are subject to weight-bearing and constant movement. Neither the brain, intestines, nor the pericardium is the most common site of bleeding in hemophilia.

A 3-year-old is placed in a bilateral hip spica cast for the treatment of developmental dysplasia of the hip. The nurse should teach the parents to monitor their child and report to the practitioner the occurrence of what? 1 Warm toes 2 Leg numbness 3 Skin desquamation 4 Generalized discomfort

2 Numbness is a neurologic symptom that should be reported immediately because it indicates pressure on the nerves and blood vessels. Warm toes indicate intact circulation to the lower extremities. Peeling skin (desquamation) is the result of inadequate skin care, but can be managed easily with lotion or oil. Some degree of discomfort is expected after cast application.

A 2-month-old infant is being treated with sequential casts for bilateral clubfoot (talipes equinovarus). New casts have just been applied. What should the nurse evaluate to determine that circulation to the feet remains sufficient? 1 Alignment of legs on x-ray 2 Warmth of the toes of both feet 3 Mobility of the knees when flexed 4 Presence of posterior tibial pulses

2 Peripheral vascular assessment includes comparing temperature, color, sensation, mobility, capillary refill, and, if accessible, peripheral pulses. The posterior tibial pulse site is under the cast and is not accessible for palpation. Mobility of the knees when flexed is impossible, because the cast extends from the thigh to just above the toes. X-rays permit assessment of bones, not of circulation.

A nurse is caring for an infant born with a myelomeningocele who is scheduled for surgery. What is the priority preoperative goal for this infant? 1 Keeping the infant sedated 2 Keeping the infant infection free 3 Ensuring maintenance of leg movement 4 Ensuring development of a strong sucking reflex

2 Prevention of infection is the priority both before and after the repair of the sac. Sedatives are not indicated; analgesics are administered as needed. Leg movement may be a postoperative goal, although it may be unrealistic because these infants' lower bodies are usually paralyzed. The sucking reflex is not associated with myelomeningocele.

The parents of an infant who just underwent insertion of a ventriculoperitoneal shunt for hydrocephalus are concerned about the prognosis. What information should the nurse give the parents? 1 The prognosis is excellent, and the valve is permanent. 2 The shunt may need to be replaced as the child grows older. 3 If any brain damage has occurred, it is irreversible even after the first year of life. 4 Hydrocephalus usually is self-limiting by 2 years of age, and then the shunt is removed.

2 Shunts are updated, with the length of the tubing increased as the child grows. Although treatment of hydrocephalus with shunt replacement is quite successful, there is always a danger of malfunction and infection of the shunt. Some brain damage may be reversible during the first year of life. Hydrocephalus necessitates treatment for the life of the child.

A 2-year-old child with developmental dysplasia of the hip has a spica cast applied. The mother asks the nurse how to keep the cast clean. How should the nurse respond? 1 "Tuck a folded diaper above the perineal opening." 2 "Place plastic wrap or duct tape around the perineal edges of the cast." 3 "Wipe the cast with a wet cloth and sprinkle it with baby powder." 4 "Do the best you can because it will get soiled no matter what you do.

2 Suggesting the use of a protective nonabsorbent material is supportive, constructive, practical, and factual. Placing a diaper above the perineal area will not protect the area beneath the perineum. Although water may or may not cause dissolution of cast material, the infant may inhale the baby powder, which can cause respiratory difficulties. "Do the best you can" is a negative response that provides neither a suggestion nor support to the mother.

A 1-year-old infant has been admitted with a tentative diagnosis of bacterial meningitis. A lumbar puncture is performed to confirm the diagnosis. What laboratory report on the cerebrospinal fluid (CSF) supports this diagnosis? 1 Decreased cell count 2 Increased protein level 3 Increased glucose level 4 Low spinal fluid pressure

2 The blood-brain barrier is affected in bacterial meningitis, permitting the passage of protein into the CSF. The cell count will be increased. The glucose level is decreased in proportion to the duration of the disease. Spinal fluid pressure will be increased.

A 10-year-old child is found to have hemophilia. The nurse is explaining how hemophilia is inherited. What is the best explanation of the genetic factor that is involved? 1 It follows the Mendelian law of inherited disorders. 2 The mother is a carrier of the disorder but usually is not affected by it. 3 It is an autosomal dominant disorder in which the woman carries the trait. 4 A carrier may be male or female, but the disease occurs in the sex opposite that of the carrier.

2 The hemophilia gene is carried on the X chromosome but is recessive. Therefore, the female is the carrier (an unaffected XO and an affected XH). If the male receives the affected XH (XHYO), he will have the disorder. Hemophilia is carried by the female; the Mendelian laws of inheritance are not sex specific. Hemophilia is a sex-linked recessive disorder. Only females carry the trait; usually males are affected.

The parents of an infant who is to undergo insertion of a right ventriculoperitoneal shunt for hydrocephalus are taught about postoperative positioning that helps prevent pressure on the valve site. What statement indicates that they understand the teaching? 1 "We'll place her in the position that seems comfortable." 2 "The flat left side-lying position is the safest position for our baby." 3 "We should place her on her back with a small support under the neck." 4 "The right side-lying position with the head supported is the best position.

2 The side-lying position on the unaffected side helps prevent pressure against the valve; the flat position prevents too-rapid drainage of cerebrospinal fluid. Stating that they will place the baby in a comfortable position is inappropriate in the immediate postoperative period; the infant should be kept flat and off the affected side. Neck supports should not be used with infants; they may cause airway occlusion. The right side-lying position in this case puts the infant on the affected side, resulting in pressure on the valve that could cause it to close; this would heighten the risk for increased intracranial pressure.

The nurse is admitting an 8-month-old infant with suspected bacterial meningitis to the hospital. List in order of priority the nursing actions that should be taken. 1. Insert an intravenous access device 2. Institute respiratory isolation 3. Monitor for signs of increased intracranial pressure (ICP) 4. Assist with a lumbar puncture 5. Administer the prescribed antibiotics

2,1,4,5,3

A 9-year-old child is admitted to the pediatric unit with a tentative diagnosis of acute lymphocytic leukemia (ALL). What early signs and symptoms of leukemia does the nurse expect to identify? Select all that apply. 1 Flushing 2 Anorexia 3 Limb pain 4 Splenomegaly 5 Mouth lesions

2,3,4 Hypermetabolism associated with the leukemic process results in loss of appetite. Bone marrow dysfunction and invasion of the periosteum result in bone pain. Infiltration, enlargement, and fibrosis of the spleen occur early in the disease process as the excess white blood cells are trapped. Flushing is not expected. Bone marrow dysfunction results in anemia, and pallor accompanies the decreased erythrocyte count. Mouth lesions (stomatitis) occur later during the disease process or as a result of chemotherapy.

A pregnant client with sickle cell anemia visits the clinic each month for a routine examination. What additional assessment should be made during every visit? Select all that apply. 1 Signs of hypothyroidism 2 Evidence of urinary tract infection 3 Symptoms of hypoglycemia 4 Presence of hyperemesis gravidarum 5 Evidence of carpal tunnel syndrome

2,4 Pregnant clients with sickle cell anemia are particularly vulnerable to infections, especially of the genitourinary tract; urine specimens should be examined frequently. A client with sickle cell anemia should always be monitored for hydration, so assessment for dehydration from vomiting caused by hyperemesis gravidarum is of high concern. Hypothyroidism affects 1 in 1500 women during pregnancy; women with sickle cell anemia are not at any higher risk for hypothyroidism than the general population. Women with sickle cell anemia are not at an increased risk for carpal tunnel syndrome during pregnancy.

The nurse observes that a client with sickle cell anemia and on a blood transfusion regimen has cardiac dysrhythmias due to iron overdose toxicity. Which medication is most beneficial to this client? 1Deferasirox 2Deferiprone 3Deferoxamine 4Ferrous gluconate

3 A client with sickle cell anemia requires frequent blood transfusions and is at an increased risk for iron toxicity. Deferoxamine is an intravenous medication that chelates with the iron and reduces iron overload or hemochromatosis in the client in less time. Therefore it is the most beneficial drug in this situation. Deferasirox and deferiprone are oral chelating agents and, therefore, show delayed action compared to deferoxamine. Iron supplements such as ferrous gluconate should not be administered to the client as they further increase the risk of iron overload.

A 3-month-old infant with severe developmental dysplasia of the hip has a hip spica cast applied. Which instruction should the nurse give the parents to help prevent a serious complication? 1 Change diapers frequently. 2 Decrease the number of feedings per day. 3 Call the primary healthcare provider if a foul smell is detected. 4 Avoid turning the child from the prone to the supine position

3 A foul smell emanating from the cast may indicate the development of an infection and necessitates immediate intervention to prevent sepsis, which is a serious complication involving tissue infection that has worsened to become a bloodstream infection. Soiling of the cast with excreta, although problematic, is not a serious complication. Decreasing the number of feedings per day is not necessary or desirable. The infant's position should be changed frequently.

A 13-month-old child is undergoing lumbar puncture for confirmation of a diagnosis of bacterial meningitis. During the procedure the nurse notes that the spinal fluid is cloudy. What does this finding indicate? 1 Healthy spinal fluid 2 Increased glucose level 3 Increased white blood cell (WBC) count 4 Rising number of red blood cells (RBCs)

3 A high WBC count causes spinal fluid to appear cloudy and possibly milky white; it is a sign of infection. Healthy spinal fluid is clear. An increased glucose level does not affect the color or clarity of the spinal fluid. RBCs give the spinal fluid a sanguineous, not cloudy, appearance.

A 3-year-old child with sickle cell anemia is admitted to the child health unit during a painful episode. Splenomegaly is identified. What does the nurse explain to the parents about splenomegaly? 1 Common in infancy 2 Difficult to palpate in children 3 Triggered by a vasoocclusive crisis 4 Most common during late childhood

3 A vasoocclusive crisis (painful episode) often precipitates a pooling of blood in the liver and in the spleen, resulting in enlargement of the spleen (splenomegaly). Splenomegaly is not common during infancy. An enlarged spleen is easily palpable in a child. Splenomegaly is not common during late childhood; the spleen of a child with sickle cell anemia usually autoinfarcts by late childhood.

A newborn with a myelomeningocele is being transferred immediately from the birthing room to the neonatal intensive care unit (NICU). What is the initial nursing intervention? 1 Start antibiotic prophylaxis 2 Provide routine newborn care 3 Apply a sterile saline dressing 4 Assess the infant for paralysis

3 Applying a sterile saline dressing helps prevent infection while keeping the membranes moist. Although the infant should be assessed for paralysis, it is not the priority. Antibiotics are not given prophylactically. This newborn needs more than just routine care because of the outpouching of the meninges.

A school-aged child with newly diagnosed acute lymphocytic leukemia (ALL) is to undergo induction therapy with prednisone, vincristine, and asparaginase. After several days the child becomes constipated. What does the nurse suspect as the cause? 1 Diet, which lacks bulk 2 Inactivity, which results from illness 3 Vincristine, which decreases peristalsis 4 Prednisone, which causes gastric irritability

3 Constipation, which may progress to paralytic ileus, is a side effect of vincristine. Lack of bulk and inactivity each may contribute to constipation, but neither is the primary cause of this child's constipation. Prednisone may cause nausea and vomiting, but it does not cause constipation.

A parent whose infant is born with talipes equinovarus (clubfoot) tells the nurse, "I am afraid to have more children because they might have the same problem." What is the best response by the nurse? 1 Reassuring the parent that this problem is unlikely to occur again 2 Discussing the probability of the defect occurring in future children 3 Exploring the parent's understanding of the probable causes of this disorder 4 Explaining that there is no way of knowing whether the deformity will occur in a future child

3 Exploring the parent's understanding of the probable causes of this disorder allows the nurse to assess the parent's knowledge and fears. A discussion of the disorder's incidence, geographic variations, and familial tendency can follow. Stating that the deformity's recurrence is unlikely constitutes false reassurance; clubfoot may occur again in a future sibling. Discussing probabilities implies a known genetic mode of transmission. Although it is familial, its occurrence cannot be predicted. Explaining that there is no way of knowing whether the deformity will occur in a future child cuts off communication and does not explore the parent's concern.

What medication does a nurse expect to administer to control bleeding in a child with hemophilia A? 1 Albumin 2 Fresh frozen plasma 3 Factor VIII concentrate 4 Factors II, VII, IX, X complex

3 Factor VIII is the missing plasma component necessary to control bleeding in a child with hemophilia A. Factor VIII is not provided by albumin. Although fresh frozen plasma does contain factor VIII, there is an insufficient amount in a plasma transfusion; a higher volume is required. A complex of factors II, VII, IX, and X is not useful in this situation.

A 3-month-old infant with developmental dysplasia of the hip (DDH) is placed in a Pavlik harness. The home care nurse sees the infant sleeping without the harness. When asked about this, the parent explains that the baby will not sleep with the harness on. How should the nurse respond? 1 Assure the parent that the harness may be removed for a short nap. 2 Encourage the parent to reapply the harness after her baby falls asleep. 3 Explain to the parent the importance of wearing the harness continuously. 4 Instruct the parent to eliminate one of the infant's daily naps, thereby reducing the time spent out of the harness.

3 For an optimal outcome the harness should be worn continuously; some practitioners permit its removal for bathing. Application of the harness will probably awaken the sleeping infant. Naps should not be limited.

A 4-year-old child with acute lymphocytic leukemia (ALL) is to undergo bone marrow aspiration. While involving the child in therapeutic play before the procedure, what should the nurse help him understand? 1 He needs to have a positive attitude. 2 His parents are concerned about him. 3 He did nothing to cause his current illness. 4 His problem was caused by an environmental factor.

3 Preschoolers (ages 3 to 5 years) are in the preoperational stage of cognitive development; it consists of a preconceptual phase that involves egocentric thought and the phase of intuitive thought, which transitions to the more logical thought of school-age children. Four-year-old children often believe that they cause their own illnesses. Emphasizing that the child did not cause the illness will help elicit and eliminate any fantasy he might have; it helps the child understand that treatment is not a punishment. Telling a 4-year-old to have a positive attitude is inappropriate and does not elicit feelings. Although parental concern is important, it does not address the developmental concerns of a 4-year-old child. Environmental factors are not currently supported as a cause of ALL; it is an inappropriate discussion for a 4-year-old child.

A child with a surgically corrected myelomeningocele will be attending nursery school. Because of the child's problems, the parents call the school nurse. What guidance should the nurse provide in response to their concerns? 1 Have the child wear plastic pants when in school. 2 Provide an extra supply of diapers for the child's use. 3 See the nurse in person to discuss the child's needs more fully. 4 Suggest that the child's entrance into nursery school be delayed for a year

3 Seeing the nurse in person to discuss their child's needs allows the nurse to include the parents in assessing the child's specific needs and enables the nurse to observe how the parents manage their child. Plastic pants encourage bacterial growth and increase susceptibility to urinary tract infection. Extra diapers do not provide a solution to other problems that the child may have. Suggesting that their child's entrance into nursery school be delayed is not necessary; a personal discussion with the parents will help address the child's needs.

A 14-year-old girl in whom scoliosis has been diagnosed undergoes spinal fusion. On the first postoperative day her face is red, she is rigid, and she is crying because she is in pain. She has prescriptions for morphine sulfate for severe pain and an acetaminophen-codeine compound for moderate pain. What information should influence the nurse's choice of analgesic? 1 One dose of morphine may be given, but the drug should be restricted thereafter because it is addictive. 2 Adolescents tend to exaggerate their discomfort, particularly when they are immobilized by surgery or injury. 3 Spinal fusion causes considerable pain during the early postoperative days, and morphine is the more effective analgesic. 4 The acetaminophen-codeine compound is preferred because morphine can cause respiratory depression or respiratory arrest

3 Spinal fusion causes considerable pain for several days and requires a strong analgesic. The first postoperative day is too early to begin weaning the client from opiates. Adolescents are no more prone to exaggerating their discomfort than clients in any other age group. A more potent analgesic, such as morphine, is needed, and the prescribed dosage should not cause respiratory problems.

How does a nurse identify possible developmental dysplasia of the hip (DDH) during a newborn assessment? 1 Depressed dance reflex 2 Limited adduction of the leg 3 Asymmetry of the gluteal folds 4 Shortened leg on the unaffected side

3 The gluteal folds should be symmetric, as should all planes and folds of the body. An abnormality of the hips will cause asymmetry, a shorter leg on the affected side, or both. The dance reflex is not affected in DDH. With DDH, abduction of the leg is usually limited at the hip. The leg on the affected, not unaffected, side appears to be shorter with DDH.

An infant is being admitted to a pediatric unit with bacterial meningitis. What is the priority nursing action? 1 Assessing the infant's neurologic status 2 Beginning intravenous fluids and antibiotics 3 Implementing respiratory isolation precautions 4 Teaching the parents the importance of maintaining a quiet environment

3 The infant's illness is contagious, and the nurse, as well as other clients, must first be protected with the implementation of respiratory isolation precautions. Assessment of neurologic status would be performed after implementing isolation. Parental teaching and implementation of prescribed fluids and antibiotics may be done after assessment. Also, antibiotics are usually not administered until after all cultures have been obtained.

A 2-year-old toddler is admitted to the pediatric unit with a diagnosis of bacterial meningitis. What is the most important safety measure for the nurse to institute immediately after the child has a seizure? 1 Monitoring the child's vital signs 2 Padding the side rails of the toddler's crib 3 Placing the child in the side-lying position 4 Bringing suction equipment to the bedside

3 The side-lying position promotes a patent airway; the tongue can move away from the back of the pharynx, and saliva can flow out of the mouth by gravity. Although monitoring of vital signs is important, a patent airway is the priority. The crib sides should have been padded as a part of seizure precautions before the seizure. If the seizure was unexpected and seizure precautions were not previously instituted, they should be instituted after the immediate respiratory and safety needs of the toddler have been met. Suctioning may be unnecessary; the child should not be left alone while equipment is obtained.

During a newborn assessment for developmental dysplasia of the hip (DDH), the nurse elicits the Ortolani sign. How does the nurse explain this finding to the child's mother? 1 It is a broadening of the perineum. 2 It is shortening of the affected leg. 3 It is a clicking of the hip when it is manipulated. 4 It is drooping of the hip on one side of the body.

3 With specific manipulation, an audible click may be heard or felt as the femoral head slips into the acetabulum. Broadening of the perineum is associated with bilateral dislocation. The apparent shortening of one leg is the Allis sign. A unilateral droop of one hip is the Trendelenburg sign; it occurs in a child with developmental dysplasia of the hip when the child bears weight.

A 4-year-old child is admitted to the pediatric unit with a tentative diagnosis of acute lymphocytic leukemia (ALL). Which signs and symptoms does the nurse expect when obtaining the health history and performing a physical assessment? Select all that apply. 1 Edema 2 Alopecia 3 Anorexia 4 Insomnia 5 Petechiae

3,5 Anorexia occurs due to catabolic alterations of metabolism caused by the cancer. Bone marrow depression (also caused by the cancer) will reduce the platelet count, which results in bleeding tendencies, petechiae, and ecchymoses. The red blood cell count is also reduced due to bone marrow depression, so the child will be lethargic and sleep excessively. Edema is not expected during early stage ALL and alopecia occurs because of chemotherapy, not the disease process

The mother of a 10-year-old boy with mild scoliosis asks the nurse, "How long will my son have to continue his exercises before he's better?" How should the nurse respond? 1 "At your son's age the exercise program is done for several months." 2 "Wearing a brace daily will probably result in quicker improvement." 3 "Surgery may be necessary, but it will be less involved if the exercises are done." 4 "Even if he keeps doing the exercises, we won't know how much he's improved until he's fully grown."

4 As the child grows the curvature may progress despite the exercise program. The child should be checked often, because a brace or surgery may become necessary. The younger the child is, the longer he or she will need to exercise; the program should be continued until growth is complete. A brace or surgery may or may not be necessary; specific daily exercises may be all that are necessary to correct functional scoliosis. Maintaining the exercise program does not guarantee that if surgery becomes necessary, it will be less involved.

A nurse is planning a conference for parents of school-aged children with sickle cell anemia. Which common concern of most parents of children with sickle cell anemia should the nurse address at the conference? 1 Finding special school facilities 2 Planning to move to a more therapeutic climate 3 Choosing effective birth control measures in the future 4 Sharing feelings regarding the transmission of the disorder

4 Discussions with parents who have children with similar problems help ease their discomfort and feelings of guilt. This is especially true in regard to genetically transmitted diseases. Children with sickle cell anemia should be allowed to attend the same schools as their healthy peers. There is no recommended therapeutic climate for children with sickle cell anemia. Some parents do not choose to avoid future pregnancies, and they should not be encouraged to do so.

A nurse notes that a child is exhibiting signs of cerebral palsy. At what age are these signs usually first noticeable? 1 2 years 2 3 years 3 3 months 4 12 months

4 Early diagnosis of cerebral palsy may be made as early as 6 months of age, but usually the condition is diagnosed closer to 12 months of age, as motor control is established. The diagnosis usually is established before 2 years of age as the child's movements and behaviors are observed. Differences in muscle tone, gait, posture, and mobility are apparent before 3 years of age in children with cerebral palsy. Although motor dysfunction may be apparent during the first 3 months in severely affected infants, cerebral palsy is most frequently diagnosed by the end of the first year of life.

A nurse is teaching a pregnant client with sickle cell anemia about the importance of taking supplemental folic acid. How does folic acid help this client? 1Lessens sickling of red blood cells 2Prevents vaso-occlusive crises 3Decreases cellular oxygen need 4Promotes production of hemoglobin

4 Folic acid is needed to produce heme for hemoglobin. Supplementation with folic acid does not reduce sickling, and it will not prevent vaso-occlusive crisis. Adequate oxygenation and hydration help prevent vaso-occlusive crisis. It does not decrease cellular oxygenation need, although, through production of hemoglobin, it can improve oxygen supply.

A nurse is caring for an infant with bacterial meningitis. The parents ask how their baby could have contracted the illness. What does the nurse consider as the most likely route of transmission to the central nervous system? 1 Genitourinary tract 2 Gastrointestinal tract 3 Skin or mucous membranes 4 Cranial apertures or sinuses

4 Infections of cranial structures can cause meningitis because bacteria travel by way of direct anatomic route to the meninges and cerebrospinal fluid (CSF). The other parts of the body do not come into contact with CSF.

What should the plan of care include to minimize the potential for a sickling episode in a child with sickle cell anemia? 1 Providing an iron-rich diet 2 Ensuring hemoconcentration 3 Enforcing periods of quiet play 4 Promoting adequate oxygenation

4 Low oxygen tension may precipitate sickling; therefore adequate oxygenation is desirable. Oral intake of iron may contribute to iron overload. Some children with sickle cell anemia receive frequent transfusions to suppress the production of red blood cells containing the sickle hemoglobin. Hemoconcentration results in increased viscosity, which promotes thrombus formation and sickling. Quiet play is desirable during a painful episode, but it is not used routinely to prevent a crisis.

The mother of a 13-year-old child with sickle cell anemia tells the nurse that the family is going camping by a lake this summer. She asks what activities are appropriate for her child. Which activity should the nurse suggest? 1 Swimming in the lake 2 Soccer with the family 3 Climbing the mountain trails 4 Motorboat rides around the lake

4 Motorboating is a relatively passive activity that will not increase the child's oxygen demands, which can precipitate sickling and therefore a painful episode. Mountain lakes are usually cold; temperature extremes can contribute to sickling that may precipitate a painful episode. Playing soccer may lead to increased cellular metabolism and increased tissue hypoxia, which can precipitate sickling that could progress to a painful episode. High altitudes should be avoided because the lower oxygen concentration of the air might trigger a painful episode.

The nurse is counseling the parents of a 12-year-old child with Duchenne muscular dystrophy about problems that may develop during adolescence. What body system does the nurse expect will be affected? 1 Neurological 2 Integumentary 3 Gastrointestinal 4 Cardiopulmonary

4 Muscle degeneration is advanced in the adolescent with Duchenne muscular dystrophy. The disease process involves the diaphragm, auxiliary muscles of respiration, and the heart, resulting in life-threatening respiratory infections and heart failure. Central nervous system function is not affected by Duchenne muscular dystrophy; nor is the integumentary system. Nutritional problems related to the gastrointestinal system are less significant than cardiopulmonary problems.

An adolescent is admitted with an acute hemophilia episode. For what are rest, ice, compression, and elevation most helpful? 1 Encouraging immobilization 2 Decreasing swelling and inflammation 3 Providing pain relief and reducing anxiety 4 Controlling bleeding and retaining joint function

4 Rest, ice, compression, and elevation (RICE) therapy is implemented to support joints and prevent bleeding into joints. Reducing inflammation is not the goal of treatment for the hemophiliac process. Total immobilization is not required. Pain may be relieved to some degree but is not assured.

An infant is found to have developmental dysplasia of the hip (DDH) 6 weeks after birth. The parents ask a nurse at the clinic why their infant must be restrained in a harness at such an early age. How should the nurse respond? 1 Infants are easier to manage in a harness than are toddlers. 2 Mobility will be delayed if correction is postponed until later. 3 Adduction devices cannot be used as effectively after the toddler age. 4 Infants' hip joints are cartilaginous, allowing molding of the acetabulum

4 The cartilaginous nature of infants' hip joints is the basis for the use of abduction devices (e.g., Pavlik harness) when the infant is very young. Although an infant is easier to manage in a harness than is a toddler, the main reason for the use of a harness so early in life is the easy moldability of the bones at this age. Traction may be used before surgery to correct contractures; these treatments are more traumatic than the harness, which is applied before the infant can walk. Hip dysplasia is usually not painful and does not limit ambulation for the young child. Abduction, not adduction, devices are used; abduction devices are ineffective by the time the child reaches the toddler age.

A child with hip dysplasia has undergone a closed reduction surgery. The nurse assesses the child 2 days after the surgery and feels that the treatment and care provided for the child were not effective. The nurse made this conclusion based on what findings? 1 The child has a staggering gait. 2 The child is unable to walk independently. 3 The child has impaired muscle tone and flexibility. 4 The child's femoral head did not return to the hip socket

4 The nurse and health care professionals set realistic outcomes and evaluate them regularly to determine the quality and effectiveness of the treatment. During closed reduction surgery, the surgeon fits the femoral head into the hip socket. If the laboratory reports indicate that the femoral head did not return to the hip socket, it implies that the surgery was ineffective and useless. The child may have a staggering gait for a few weeks after the surgery; this does not indicate that the surgery was ineffective. The child may experience pain after the surgery and may require support to walk. The child will be in a spica cast for 6 months after the surgery and, because of this, the child may temporarily lose muscle tone and flexibility. Therefore these outcomes do not indicate that the treatment was ineffective or useless.

An adolescent child with sickle cell anemia is admitted to the pediatric unit during a vaso-occlusive crisis. What does the nurse identify as the reason that the crisis occurred? 1 Severe depression of the circulating thrombocytes 2 Diminished red blood cell (RBC) production by the bone marrow 3 Pooling of blood in the spleen with splenomegaly as a consequence 4 Blockage of small blood vessels as a result of clumping of RBCs

4 The red blood cells in sickle cell anemia are fragile. When hypoxia or dehydration occurs, the cells take on a crescent shape; they then clump together and occlude blood vessels. The platelet count is not severely depressed in vaso-occlusive crisis. Diminished RBC production by the bone marrow is an aplastic crisis resulting in severe anemia. Pooling of blood in the spleen that results in splenomegaly is known as a splenic sequestration crisis.

Hydrocephalus develops in an infant who was born with a meningomyelocele, and a ventriculoperitoneal shunt is inserted. What nursing intervention is most important in this infant's care during the first 24 hours after surgery? 1 Placing in the high Fowler position 2 Administering the prescribed sedative 3 Positioning on the same side as the shunt 4 Monitoring for increasing intracranial pressure

4 The shunt may become obstructed, leading to an accumulation of cerebrospinal fluid in the head; the accumulated fluid causes an increase in intracranial pressure, which in turn leads to brainstem hypoxia. Positioning the infant flat helps prevent complications resulting from too-rapid reduction of intracranial fluid. Although pain management is essential to minimize an increase in intracranial pressure, sedation is contraindicated because it will mask the infant's level of consciousness. The infant is positioned on the side opposite the shunt to prevent pressure on the valve and incision area.