Peds Last

A 62-pound child has a spinal cord injury and has completed the bolus dose of IV steroids. The nurse is preparing to hang an IV infusion of steroids for the next 23 hours. How much medication should this child get per hour? Record your answer using 1 decimal place. Administer _______ mg/hour.

152.2 (First calculate the child's weight in kilograms: 62/2.2 = 28.181818 kilograms. Next multiply the weight by the standard dose of 5.4 mg/kg/hour × 28.181818 = 152.181818. Last, round to 1 decimal place = 152.2 mg/hour.)

A 62-pound child has a spinal cord injury and is to receive steroid therapy. How much medication does the nurse draw up for the bolus dose? Record your answer in a whole number. Administer _____ mg.

845 (First calculate the child's weight in kilograms: 62/2.2 = 28.181818 kilograms. Next multiply the child's weight by the standard bolus dose: 28.181818 × 30 = 845.454545 mg. Round to the nearest whole number = 845 mg.)

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

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

During a presentation on behavioral disorders in children, the nurse is currently explaining the most commonly seen disorder. Which topic would the nurse be covering? A. Attention deficit-hyperactivity disorder B. Depression C. Eating disorders D. Sexual abuse

A (ADHD is the most common chronic behavioral disorder that emerges during childhood. Depression can occur, but it is not the most common chronic behavioral disorder that emerges during childhood. Eating disorders are not the most common chronic behavioral disorder that emerges during childhood. Sexual abuse is not a chronic behavioral disorder that emerges during childhood.)

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

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

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

A (The peak action for regular (short-acting) insulin is 2 to 3 hours after subcutaneous administration. The other times do not correspond to the peak action time.)

A limp, unresponsive 2-month-old is brought to the emergency room by her parents after she began "jerking." During the initial assessment the nurse notes no external head trauma, flat fontanels, and no marks on the baby's head. Which further assessments would the nurse expect to provide the most essential information? A. Ophthalmic B. Developmental C. Cardiac D. Respiratory

A (Abusive head trauma, formerly known as shaken baby syndrome/shaken infant syndrome, should be considered in any infant with signs of increased intracranial pressure, with retinal hemorrhage, seizures, subtle hydrocephalus, and papilledema. Shaken baby syndrome is a widely recognized form of physical child abuse that often is caused by vigorous shaking of the infant while the child is held by the extremities or shoulders. This type of physical abuse leads to whiplash-induced intracranial and retinal bleeding. There is generally no external sign of head trauma, which makes this syndrome difficult to detect. A developmental assessment cannot be done if the infant is limp and unresponsive. There is no data from the history or initial assessment that there is a cardiac or respiratory issue.)

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

A (During the "honeymoon" phase, which may last from a few weeks to a year or longer, the child is likely to need less insulin. Insulin requirements are generally higher during adolescence, growth spurts, and illnesses.)

A pre-teen is suspected of having bulimia nervosa by her parents. What findings would the nurse expect when doing an assessment on this patient? A. Erosion of the teeth B. States she feels full after eating a small amount. C. Slightly hypertensive D. Weight below normal parameters

A (Erosion of the teeth can occur because of the effects of the acidic stomach contents on the teeth from induced vomiting. Stating she feels full after eating a small amount is characteristic of anorexia nervosa. The patient could be hypotensive because of the loss of food and fluid. Weight would most likely be in within normal parameters.)

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

A (Headaches are a clinical manifestation of increased ICP in children. A change in the child's normal behavior pattern may be an important early sign of increased ICP. Bulging fontanel or increased head circumference is seen in infants. A change in respiratory pattern is a late sign of increased ICP. Cheyne-Stokes respiration may be evident. This refers to a pattern of increasing rate and depth of respirations followed by a decreasing rate and depth with a pause of variable length.)

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

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

The most common problem of children born with a myelomeningocele is a. bladder incontinence. b. intellectual impairment. c. respiratory compromise. d. cranioschisis.

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

A teenager suddenly develops a sudden onset of obsessive-compulsive disorder symptoms and is brought to the pediatrician by his father. What assessment would the nurse expect to be done to determine the actual problem? A. throat culture B. urinalysis C. electrocardiogram D. brain scan

A (Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) refer to the abrupt onset of OCD symptoms or tic disorder symptoms following a group A beta-hemolytic streptococcal infection. Research suggests that the disease is not caused by the bacteria but rather by the antibodies that attack neural tissue in the basal ganglia of the brain.)

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

A (Safety is the primary issue. School personnel need to be aware of the signs and symptoms of hypoglycemia and hyperglycemia and the appropriate interventions. While privacy is a concern, for the child's safety, key personnel need to know about the diagnosis and what to do in an emergency. The treatment of type 1 diabetes should not interfere with the school-age child's development of a sense of industry. Peer group acceptance, along with body image, are issues for the early adolescent with type 1 diabetes. This is not of greater priority than the child's safety.)

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

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

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

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

Which information should the nurse give to a child who is to have magnetic resonance imaging (MRI) of the brain? a. "You won't be able to move your head during the procedure." b. "You will have to drink a special fluid before the test." c. "You will have to lie flat after the test is finished." d. "You will have electrodes placed on your head with glue."

A (To reduce fear and enhance cooperation during the MRI, the child should be made aware that head movement will be restricted to obtain accurate information. The child does not need to drink special liquids, lie on the back afterward, or have electrodes placed.)

Latex allergy is suspected in a child with spina bifida. Appropriate nursing interventions include which of the following? a. Avoiding using any latex product b. Using only non-allergenic latex products c. Administering medication for long-term desensitization d. Teaching family about long-term management of allergic manifestations

A (Care must be taken that individuals who are at high risk for latex allergies do not come in direct or secondary contact with products or equipment containing latex at any time during medical treatment. Latex allergy is estimated to occur in 75% of this patient population. There are no non-allergenic latex products. At this time, desensitization is not an option. There are no treatment options for long-term management of allergic symptoms for latex allergy.)

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

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

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

A (Small red papules with peripheral scaling in a sharply demarcated area involving the anterior thighs, lower abdomen, and perineum are characteristic of primary candidiasis. C Intertrigo is identified by a red macerated area of sharp demarcation in the groin folds. It can also develop in the gluteal and neck folds.)

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

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

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

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

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

A (Impetigo tends to heal without scarring unless a secondary infection occurs. Hyperpigmentation may occur; however, only in dark-skinned children.)

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

A (Establishing and maintaining the child's airway is always the priority focus for assessment and care. )

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

A (Most children with atopic dermatitis have a family history of asthma, hay fever, or atopic dermatitis, and up to 80% of children with atopic dermatitis have asthma or allergic rhinitis.)

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

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

A 14-year-old is in the intensive care unit after a spinal cord injury 2 days ago. Nursing care for this child includes (Select all that apply.) a. monitoring and maintaining systemic blood pressure. b. administering corticosteroids. e. monitoring for respiratory complications.

A, B, E (Spinal cord injury patients are physiologically labile, and close monitoring is required. They may be unstable for the first few weeks after the injury. Corticosteroids are administered to minimize the inflammation present with the injury. Spinal cord injury is a catastrophic event. Discussion of long-term care should be delayed until the child is stable.)

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

A, B, E (Incorrect: Occlusion increases the risk of systemic absorption of a steroid; thus steroid creams are rarely used for diaper dermatitis because the diaper functions as an occlusive dressing. Rubber or plastic pants increase skin breakdown by holding in moisture and should be used infrequently. A steroid cream is not recommended.)

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

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

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

A, C, E (These lesions are not typically on the back or the buttocks.)

The nurse educator is explaining characteristics of sexually abused children during a special class for pediatric nurses. Which of the statements should the nurse educator include in the presentation? Select all that apply. A. Children who are sexually abused may deny that the abuse happened, even with direct questioning. B. Children were less likely to delay disclosure if they were younger than 7 years old, if they were boys, or if the abuse occurred within the family. C. Previously toilet-trained children may experience accidents with stool. D. Children of sexual abuse may experience sleep disturbances, decreased appetite or sudden refusal to participate in gym. E. Sexually abused adolescents may be promiscuous.

A, D, E (It is true that children who are sexually abused may deny that the abuse happened, even with direct questioning. Children of sexual abuse may experience sleep disturbances, decreased appetite, or sudden refusal to participate in gym. Sexually abused adolescents may be promiscuous. Children were more likely to delay disclosure if they were younger than 7 years old, were boys, or the abuse occurred within the family. Previously toilet-trained children may experience urinary accidents.)

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

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

Which statement best describes a subdural hematoma? a. Bleeding occurs between the dura and the skull. b. Bleeding occurs between the dura and the cerebrum. c. Bleeding is generally arterial, and brain compression occurs rapidly. d. The hematoma commonly occurs in the parietotemporal region.

B (A subdural hematoma is bleeding that occurs between the dura and the cerebrum as a result of a rupture of cortical veins that bridge the subdural space. An epidural hemorrhage occurs between the dura and the skull, is usually arterial with rapid brain concussion, and occurs most often in the parietotemporal region. An epidural hemorrhage occurs between the dura and the skull, is usually arterial with rapid brain concussion, and occurs most often in the parietotemporal region. An epidural hemorrhage occurs between the dura and the skull, is usually arterial with rapid brain concussion, and occurs most often in the parietotemporal region.)

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

B (Any indication of ICP such as double vision, headache, or vomiting should be promptly reported to the physician. Stabilizing the child's neck does not address the child's symptoms. Darkening the room and giving a cool cloth are comfort measures. A fluid restriction is not needed.)

A toddler is repeatedly being seen by the pediatrician for a variety of ills, but nothing conclusive can ever be found on exam or in the blood work. When the toddler has been hospitalized, recovery has been rapid. What would the nurse case worker suspect is present in this family? A. Posttraumatic stress disorder B. Factitious disorder by proxy C. A bipolar disorder D. An obsessive-compulsive disorder

B (Factitious disorder by proxy, formerly Munchausen syndrome by proxy, is a psychiatric disorder where people feign illness to gain attention. Munchausen syndrome by proxy occurs when a person with Munchausen syndrome falsifies illness in a child. A bipolar disorder is a psychosocial disorder manifested in childhood but has other characteristics. Obsessive-compulsive disorder is a psychosocial disorder manifested in childhood but has other characteristics. Posttraumatic stress disorder is a psychosocial disorder manifested in childhood but has other characteristics.)

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

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

After a tonic-clonic seizure, it would not be unusual for a child to display a. iritability and hunger. b. lethargy and confusion. c. nausea and vomiting. d. nervousness and excitability.

B (In the period after a tonic-clonic seizure, the child may be confused and lethargic. Some children may sleep for a period of time. The other manifestations are not normally seen after a seizure.)

How much folic acid does the nurse tell female patients is recommended for women of childbearing age? a. 1.0 mg b. 0.4 mg c. 1.5 mg d. 2.0 mg

B (It has been estimated that a daily intake of 0.4 mg of folic acid in women of childbearing age has contributed to a reduction in the number of children with neural tube defects. The other doses are not the recommended dose.)

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

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

A 6-year-old male patient watches everything that is going on in his room and outside his room, and he sleeps very little. What might the nurse suspect the child is experiencing based on his behavior? A. Obsessive-compulsive disorder B. Post-traumatic stress disorder C. Bipolar behavior D. Separation anxiety

B (PTSD interferes with the child's ability to concentrate, may contribute to sleep problems, and may cause the child to be hypervigilant or agitated. Bipolar disorder is characterized by chronic, fluctuating, and extreme mood disturbances. Separation anxiety is disabling anxiety about being apart from one's parents or another significant person to whom the child is attached or anxiety about being away from home. Obsessive-compulsive disorder (OCD) manifests as repetitive unwanted thoughts (obsessions) or ritualistic actions (compulsions), or both. Obsessions are recurrent intrusive thoughts, feelings, and ideas. Compulsions are behaviors or actions that are repetitive and recurrent.)

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

B (Positioning the child on his side will prevent aspiration. It is inappropriate to leave the child during the seizure. Nothing should be inserted into the child's mouth during a seizure to prevent injury to the mouth, gums, or teeth. Restraints could cause injury. Sharp objects and furniture should be moved out of the way to prevent injury.)

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

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

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

B (Spastic cerebral palsy, the most common type of cerebral palsy, will manifest with hypertonicity and increased deep tendon reflexes. The child's muscles are very tight, and any stimuli may cause a sudden jerking movement. Tremulous movements, slow writhing movements, and loss of kinesthetic sense are not manifestations of spastic cerebral palsy.)

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

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

Which term is used when a patient remains in a deep sleep, responsive only to vigorous and repeated stimulation? a. Coma b. Stupor c. Obtundation d. Persistent vegetative state

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

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

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

Diabetes insipidus is a disorder of the a. anterior pituitary. b. posterior pituitary. c. adrenal cortex. d. adrenal medulla.

B (The principal disorder of posterior pituitary hypofunction is diabetes insipidus. ADH is produced in the hypothalamus and stored in the posterior pituitary gland. When ADH is not released appropriately by the posterior pituitary gland, DI occurs. The anterior pituitary produces hormones such as growth hormone, thyroid-stimulating hormone, adrenocorticotropic hormone, gonadotropin, prolactin, and melanocyte-stimulating hormone. The adrenal cortex produces aldosterone, sex hormones, and glucocorticoids. The adrenal medulla produces catecholamines.)

A preschooler tells his teacher that someone touched him "down there" pointing to his genitals. Which statement best explains young children who report sexual abuse? A. In most cases, the child has fabricated the story because of a busy imagination. B. Younger children may exhibit a variety of behavioral manifestations. C. Younger children's stories are not believed unless other evidence is apparent. D. Younger children should be able to retell the story the same way to another person.

B (There is no diagnostic profile of the child who is being sexually abused. Many different behavioral manifestations may be exhibited. Physical examination is normal in 80% of abused children. The child will usually try to protect parents and may accept responsibility for the act rather than tell. Knowing this, the nurse should teach the child that inappropriate touching should be reported to as many adults as it takes to be heard and believed. Adults are reluctant to believe children, and sexual abuse goes unreported. Children should be taught to tell as many adults as it takes until they are believed.)

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

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

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

B (Ringworm is caused by a group of closely related filamentous fungi, which invade primarily the stratum corneum, hair, and nails. They are superficial infections that live on, not in, the skin. Ringworm is not an allergic response.)

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

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

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

B (The vocabulary to classify the depth of a burn is superficial, partial thickness, or full thickness.)

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

B (Tretinoin causes photosensitivity, and sunscreen should be applied before sun exposure.)

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

B (The child with herpetic gingivostomatitis is at risk for deficient fluid volume. Painful lesions on the mouth make drinking unpleasant and undesirable, with subsequent dehydration becoming a real danger. D Although constipation could be caused by dehydration, it is more important to assess urine output, skin turgor, and mucous membranes to identify dehydration before constipation is a problem.)

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

B (Rocky Mountain spotted fever is caused by a tick. The tick must attach and feed for at least 1 to 2 hours to transmit the disease. The usual habitat of the tick is in heavily wooded areas.)

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

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

What nursing actions are indicated when the nurse is administering phenytoin (Dilantin) by the intravenous route to control seizures? (Select all that apply.) b. Occasional blood levels will be assessed. d. It must be given in normal saline. e. It must be filtered.

B, D, E (The child should have serum levels drawn to monitor for optimal therapeutic levels. In addition, liver function studies should be monitored because this anticonvulsant may cause hepatic dysfunction. The IV dose must be given in normal saline, not D51/2 NS. The IV dose must be filtered. The IV dose must be given in normal saline, not D51/2 NS. Dilantin has not been found to cause gastrointestinal upset, and since it is being given by the IV route, this is not a concern. The medication can be taken without food.)

Which neurologic diagnostic test gives a visualized horizontal and vertical cross section of the brain at any axis? a. Nuclear brain scan b. Echoencephalography c. CT scan d. MRI

C (A CT scan provides a visualization of the horizontal and vertical cross sections of the brain at any axis. A nuclear brain scan uses a radioisotope that accumulates where the blood-brain barrier is defective. Echoencephalography identifies shifts in midline structures of the brain as a result of intracranial lesions. MRI permits visualization of morphologic features of target structures and permits tissue discrimination that is unavailable with any other techniques.)

A parent asks the nurse why self-monitoring of blood glucose is being recommended for her child with diabetes. The nurse should base the explanation on the knowledge that a. it is a less expensive method of testing. b. it is not as accurate as laboratory testing. c. children are better able to manage the diabetes. d. the parents are better able to manage the disease.

C (Blood glucose self-management has improved diabetes management and can be used successfully by children from the time of diagnosis. Insulin dosages can be adjusted based on blood sugar results. The child learns to be in better control by utilizing blood glucose monitoring. Blood glucose monitoring may be more expensive but provides improved management. It is as accurate as equivalent testing done in laboratories. The ability to self-test allows the child to balance diet, exercise, and insuli n. The parents are partners in the process, but the child should be taught how to manage the disease.)

Which comment by a 12-year-old child with type 1 diabetes indicates deficient knowledge? a. "I rotate my insulin injection sites every time I give myself an injection." b. "I keep records of my glucose levels and insulin sites and amounts." c. "I'll be glad when I can take a pill for my diabetes like my uncle does." d. "I keep Lifesavers in my school bag in case I have a low-sugar reaction."

C (Children with type 1 diabetes will require life-long insulin therapy. Rotating sites may help with variable insulin absorption. Rotating spots within the same major site is important. Keeping records of serum glucose and insulin sites and amounts is appropriate. Prompt treatment of hypoglycemia reduces the possibility of a severe reaction. Keeping hard candy on hand is an appropriate action.)

Which type of seizure involves both hemispheres of the brain? a. Focal b. Partial c. Generalized d. Acquired

C (Clinical observations of generalized seizures indicate that the initial involvement is from both hemispheres. Focal seizures may arise from any area of the cerebral cortex, but the frontal, temporal, and parietal lobes are most commonly affected. Partial seizures are caused by abnormal electric discharges from epileptogenic foci limited to a circumscribed region of the cerebral cortex. A seizure disorder that is acquired is a result of a brain injury from a variety of factors; it does not specify the type of seizure.)

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

C (Comminuted skull fractures include fragmentation of the bone or a multiple fracture line. A basilar fracture involves the basilar portion of the frontal, ethmoid, sphenoid, temporal, or occipital bone. A linear fracture includes a straight-line fracture without dural involvement. A depressed fracture has the bone pushed inward, causing pressure on the brain.)

What is the best nursing action when a child with type 1 diabetes mellitus is sweating, trembling, and pale? a. Offer the child a glass of water. b. Give the child 5 units of regular insulin subcutaneously. c. Give the child a glass of orange juice. d. Give the child glucagon subcutaneously.

C (Four ounces of orange juice is an appropriate treatment for the conscious child who is exhibiting signs of hypoglycemia. This contains 15 grams of carbohydrate. A glass of water is not indicated in this situation. An easily digested carbohydrate is indicated when a child exhibits symptoms of hypoglycemia. Insulin would lower blood glucose and is contraindicated for a child with hypoglycemia. Subcutaneous injection of glucagon is used to treat hypoglycemia when the child is unconscious.)

Nursing care of the infant who has had a myelomeningocele repair should include a. securely fastening the diaper. b. measurement of pupil size. c. measurement of head circumference. d. administration of seizure medications.

C (Head circumference measurement is essential because hydrocephalus can develop in these infants. A diaper should be placed under the infant but not fastened. Keeping the diaper open facilitates frequent cleaning and decreases the risk for skin breakdown. Pupil size measurement is usually not necessary. Seizure medications are not routinely given to infants who do not have seizures.)

Which sign is the nurse most likely to assess in a child with hypoglycemia? a. Urine positive for ketones and serum glucose greater than 300 mg/dL b. Normal sensorium and serum glucose greater than 160 mg/dL c. Irritability and serum glucose less than 60 mg/dL d. Increased urination and serum glucose less than 120 mg/dL

C (Irritability and serum glucose less than 60 mg/dL are manifestations of hypoglycemia. Serum glucose greater than 300 mg/dL and urine positive for ketones are indicative of diabetic ketoacidosis. Normal sensorium and serum glucose greater than 160 mg/dL are associated with hyperglycemia. Increased urination is an indicator of hyperglycemia. A serum glucose level less than 120 mg/dL is within normal limits.)

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

C (Mandatory genetic screening allows early identification of genetically transmitted metabolic disorders. These disorders can be managed best with early diagnosis and in some cases, early treatment prevents serious physical and cognitive delays. Community referral is appropriate after a diagnosis is made. Parental education will be important, but that is not the goal of screening. Although electrolyte imbalances could occur with some of the inborn errors of metabolism, this is not the priority outcome, nor would the newborn screen detect electrolyte imbalances.)

What is an appropriate nursing intervention for the child with a tension headache? a. Assess for an aura. b. Maintain complete bed rest. c. Administer mild pain medication. d. Assess for nausea and vomiting.

C (Mild pain relievers like acetaminophen or ibuprofen are appropriate for the child with a tension headache. The other measures are not warranted.)

The school nurse is giving a presentation to parents focusing on how to help their children in school. Information by the nurse is correct if which statement is made? A. "Help children as much as possible with their homework so it is complete." B. "Determine how to discipline children who fail to perform adequately." C. "Communicate immediately with teachers if there appears to be a problem." D. "Parents need to accept responsibility for their childrens' successes and failures."

C (Parents should communicate immediately with teachers if there is a problem and not wait for a scheduled conference. School-age children need to develop responsibility. This helps with keeping promises and meeting deadlines, thereby laying successful foundations for adulthood. Discipline should be used to help children control behaviors. School-age children can use reasoning skills. Children need to do their own homework. This cultivates responsibility. If there is difficulty accomplishing it because of difficulty, the teacher needs to know so further instruction can be provided. Homework should reinforce what has been taught.)

What should the nurse include in the teaching plan for parents of a child with diabetes insipidus who is receiving DDAVP? a. Increase the dosage of DDAVP as the urine specific gravity (SG) increases. b. Give DDAVP only if urine output decreases. c. The child should have free access to water and toilet facilities at school. d. Cleanse skin before administering the transdermal patch.

C (The child's teachers should be aware of the diagnosis and treatment plan, and the child should have free access to water and toilet facilities at school. DDAVP needs to be given as ordered by the physician. If the parents are monitoring urine SG at home, they would not increase the medication dose for increased SG; the physician may order an increased dosage for very dilute urine with decreased SG. DDAVP needs to be given continuously as ordered by the physician. DDAVP is typically given intranasally or by subcutaneous injection. For nocturnal enuresis, it may be given orally.)

What is the best response to a father who tells the nurse that his son "daydreams" at home and that his teacher has observed this behavior at school? a. "Your son must have an active imagination." b. "Can you tell me exactly how many times this occurs in one day?" c. "Tell me about your son's activity when you notice the daydreams." d. "He is probably overtired and needs more rest."

C (The daydream episodes are suggestive of absence seizures, and data about activity associated with the daydreams should be obtained. Describing an active imagination or an overtired child does not address the symptoms of the father's concern. Determining the number of times the behavior occurs is not as helpful as information about the behavior.)

A 5-year-old sustained a concussion after falling out of a tree. In preparation for discharge, the nurse is discussing home care with the parents. Which statement made by the parents indicates a correct understanding of the teaching? a. "I should expect my child to have a few episodes of vomiting." b. "If I notice sleep disturbances, I should contact the physician immediately." c. "I should expect my child to have some behavioral changes after the accident." d. "If I notice diplopia, I will have my child rest for 1 hour."

C (The parents are advised of probable posttraumatic symptoms. These include behavioral changes and sleep disturbances. Vomiting and diplopia should be reported immediately. Sleep disturbances may occur with postconcussive syndrome, but difficulty waking the child up should be reported.)

A recommendation to prevent neural tube defects is the supplementation of a. vitamin A throughout pregnancy. b. multivitamin preparations as soon as pregnancy is suspected. c. folic acid for all women of childbearing age. d. folic acid during the first and second trimesters of pregnancy.

C (The widespread use of folic acid among women of childbearing age is expected to decrease the incidence of spina bifida significantly. Vitamin A, multivitamins, and folic acid only during specific points during the pregnancy have not been shown to prevent neural tube defects.)

A child is hospitalized after a serious motor vehicle crash and has developed increased urination. What action by the nurse takes priority? a. Weigh the child daily. b. Monitor the child's intake and output. c. Assess the daily serum sodium level. d. Restrict dietary sodium intake.

C (This child might have diabetes insipidus; being in a car crash has the potential for a head injury. That coupled with frequent urination leads the nurse to suspect DI. A high serum sodium and low urine specific gravity are hallmarks of this condition. The priority action for the nurse is to review the child's most recent serum sodium. Daily weights and I&O are also important for many children but is not as specific for this condition as assessing the sodium level. The child may or may not need a sodium restriction, but assessment comes first.)

A mother calls the pediatrician's office to talk about her 8-year-old daughter who complains of stomachaches or headaches almost every Tuesday morning an hour before she needs to leave for school. What question by the nurse would be most helpful? A. "Is there a chance your daughter is being bullied?" B. "On a 1 to 10 scale, how much pain does the child have?" C. "What activities occur either before, during, or after school on Tuesdays only?" D. "Who takes care of your daughter when school is over?"

C (This is the question that must be asked to obtain a full picture of what occurs on Tuesdays only, either before, during, or after school. Consideration of this diagnosis should rule out precipitating factors such as fear of bullying, fatigue, boredom, learning challenges, upsetting incidents that occur in the school setting, or upsets that are occurring in the home. There is no data that states the daughter is cared for by someone else when school is over. There is a chance the daughter is being bullied, but an open question needs to be used to obtain a full picture of what occurs on Tuesdays only, either before, during, or after school. The pain level is not as important as the precipitating factor(s).)

An important nursing consideration when caring for a child with impetigo contagiosa is to a. Apply topical corticosteroids to decrease inflammation. b. Carefully remove dressings so as not to dislodge undermined skin, crusts, and debris. c. Carefully wash hands and maintain cleanliness when caring for an infected child. d. Examine child under a Wood lamp for possible spread of lesions.

C (A major nursing consideration related to bacterial skin infections, such as impetigo contagiosa, is to prevent the spread of the infection and complications.)

Treatment for herpes simplex virus (types 1 or 2) includes a. Corticosteroids b. Oral griseofulvin c. Oral antiviral agent d. Topical and/or systemic antibiotic

C (Oral antiviral agents are effective for viral infections such as herpes simplex. Griseofulvin is an antifungal agent and not effective for viral infections.)

A mother calls the emergency department nurse because her child was stung by a scorpion. The nurse should recommend a. Administering antihistamine b. Cleansing with soap and water c. Keeping child quiet and come to emergency department d. Removing stinger and apply cool compresses

C (Venomous species of scorpions inject venom that contains hemolysins, endotheliolysins, and neurotoxins. The absorption of the venom is delayed by keeping the child quiet and the involved area in a dependent position. )

A father calls the clinic nurse because his 2-year-old child was bitten by a black widow spider. The nurse should advise the father to a. Apply warm compresses. b. Carefully scrape off stinger. c. Take child to emergency department. d. Apply a thin layer of corticosteroid cream.

C (The black widow spider has a venom that is toxic enough to be harmful. The father should take the child to the emergency department for immediate treatment. Warm compresses increase circulation to the area and facilitate the spread of venom. Corticosteroid cream will have no effect on the venom.)

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

C (Urine output reflects the adequacy of end-organ perfusion)

What best describes a full-thickness (third-degree) burn? a. Erythema and pain b. Skin showing erythema followed by blister formation c. Destruction of all layers of skin evident with extension into subcutaneous tissue d. Destruction injury involving underlying structures such as muscle, fascia, and bone

C (A third-degree or full-thickness burn is a serious injury that involves the entire epidermis and dermis and extends into the subcutaneous tissues. A Erythema and pain are characteristic of a first-degree burn or superficial burn. B Erythema with blister formation is characteristic of a second-degree or partial-thickness burn. D A fourth-degree burn is a full-thickness burn that also involves underlying structures such as muscle, fascia, and bone.)

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

C (Scabies is caused by the scabies mite. The inflammatory response and intense itching occur after the host has become sensitized to the mite. This occurs approximately 30 to 60 days after initial contact. In the previously sensitized person, the response occurs within 48 hours.)

With what beverage should the parents of a child with ringworm be taught to give griseofulvin? a. Water b. A carbonated drink c. Milk d. Fruit juice

C (A Griseofulvin is insoluble in water. B Carbonated drinks do not contain fat, which aids in the absorption of griseofulvin. C Griseofulvin is insoluble in water. Giving the medication with a high-fat meal or milk increases absorption. D Fruit juice does not contain any fat; fat aids absorption of the medication.)

A nurse is instructing parents on treatment of pediculosis (head lice). Which should the nurse include in the teaching plan? Select all that apply. a. Bedding should be washed in warm water and dried on a low setting. b. After treating the hair and scalp with a pediculicide, shampoo the hair with regular shampoo. c. Retreat the hair and scalp with a pediculicide in 7 to 10 days. d. Items that cannot be washed should be dry cleaned or sealed in plastic bags for 2 to 3 weeks. e. Combs and brushes should be boiled in water for at least 10 minutes.

C, D, E (The hair should not be shampooed for 24 hours after the treatment. Even though the kill rate is high and there is residual action, retreatment should occur after 7 to 10 days. Combs and brushes should be boiled or soaked in antilice shampoo or hot water (greater than 60° C [140° F]) for at least 10 minutes. Advise parents to wash clothing (especially hats and jackets), bedding, and linens in hot water and dry at a hot dryer setting.)

Type 1 diabetes mellitus is suspected in an adolescent. Which clinical manifestation may be present? a. Moist skin b. Weight gain c. Fluid overload d. Blurred vision

D (Blurred vision is one manifestation of diabetes mellitus type 1. Other manifestations include dehydration with dry skin and weight loss, polyuria, and polyphagia.)

Which is the nurse's best response to the parents of a 10-year-old child newly diagnosed with type 1 diabetes mellitus who are concerned about the child's continued participation in soccer? a. "Consider the swim team as an alternative to soccer." b. "Encourage intellectual activity rather than participation in sports." c. "It is okay to play sports such as soccer unless the weather is too hot." d. "Give the child an extra 15 to 30 g of carbohydrate snack before soccer practice."

D (Exercise lowers blood glucose levels. A snack with 15 to 30 g of carbohydrates before exercise will decrease the risk of hypoglycemia. Soccer is an appropriate sport for a child with type 1 diabetes as long as the child prevents hypoglycemia by eating a snack. Participation in sports is not contraindicated for a child with type 1 diabetes. The child with type 1 diabetes may participate in sports activities regardless of climate.)

An adolescent male realizes that he is developing strong homosexual feelings and is actually gay. When he tells his parents, they are worried about him more than they are about his sexual orientation. What is a major reason for their concern? A. He might decide to run away from home. B. His grades at school might deteriorate. C. He might get picked on by his friends. D. He is at a much greater risk for suicide.

D (Gay, lesbian, and bisexual, adolescents are two to seven times more likely to attempt suicide than are their heterosexual peers. It's true he might get picked on by his friends, but there's no evidence.)

A child is brought to the emergency department in status epilepticus. Which medication should the nurse expect to be given initially in this situation? a. Clorazepate dipotassium (Tranxene) b. Fosphenytoin (Cerebyx) c. Phenobarbital d. Lorazepam (Ativan)

D (Lorazepam (Ativan) or diazepam (Valium) is given intravenously to control generalized tonic-clonic status epilepticus and may also be used for seizures lasting more than 5 minutes. The other drugs are used for seizures but are not the first-line treatment for status.)

A nurse is explaining to parents how the central nervous system of a child differs from that of an adult. Which statement accurately describes these differences? a. The infant has 150 mL of CSF compared with 50 mL in the adult. b. Papilledema is a common manifestation of ICP in the very young child. c. The brain of a term infant weighs less than half of the weight of the adult brain. d. Coordination and fine motor skills develop as myelinization of peripheral nerves progresses.

D (Peripheral nerves are not completely myelinated at birth. As myelinization progresses, so does the child's coordination and fine muscle movements. An infant has about 50 mL of CSF compared with 150 mL in an adult. Papilledema rarely occurs in infancy because open fontanels and sutures can expand in the presence of ICP. The brain of the term infant is two thirds the weight of an adult's brain.)

Which statement by an adolescent indicates an understanding about factors that can trigger migraine headaches? a. "I should avoid loud noises because this is a common migraine trigger." b. "Exercise can cause a migraine. I guess I won't have to take gym anymore." c. "I think I'll get a migraine if I go to bed at 9 PM on week nights." d. "I am learning to relax because I get headaches when I am worried about stuff."

D (Stress can trigger migraines. Relaxation therapy can help the adolescent control stress and headaches. Other precipitating factors in addition to stress include poor diet, food sensitivities, and flashing lights. Visual stimuli, not auditory stimuli, are known to be a common trigger for migraines. Exercise is not a trigger for migraines. The adolescent needs regular physical exercise. Altered sleep patterns and fatigue are common triggers for migraine headaches. Going to bed at 9 PM should allow an adolescent plenty of sleep to prevent fatigue.)

How should the nurse explain positioning for a lumbar puncture to a 5-year-old child? a. "You will be on your knees with your head down on the table." b. "You will be able to sit up with your chin against your chest." c. "You will be on your side with the head of your bed slightly raised." d. "You will lie on your side and bend your knees so that they touch your chin."

D (The child should lie on her side with knees bent and chin tucked in to the knees. This position exposes the area of the back for the lumbar puncture. The other positions are not used for a lumbar puncture.)

Which change in status should alert the nurse to increased intracranial pressure (ICP) in a child with a head injury? a. Rapid, shallow breathing b. Irregular, rapid heart rate c. Increased diastolic pressure with narrowing pulse pressure d. Confusion and altered mental status

D (The child with a head injury may have confusion and altered mental status, a change in vital signs, retinal hemorrhaging, hemiparesis, and papilledema. Respiratory changes occur with ICP. One pattern that may be evident is Cheyne-Stokes respiration. This pattern of breathing is characterized by increasing rate and depth, then decreasing rate and depth, with a pause of variable length. Temperature elevation may occur in children with ICP. Changes in blood pressure occur, but the diastolic pressure does not increase, nor is there a narrowing of pulse pressure.)

The father of a newborn infant with myelomeningocele asks about the cause of this condition. What response by the nurse is most appropriate? a. "One of the parents carries a defective gene that causes myelomeningocele." b. "A deficiency in folic acid in the father is the most likely cause." c. "Offspring of parents who have a spinal abnormality are at greater risk for myelomeningocele." d. "There may be no definitive cause identified."

D (The etiology of most neural tube defects is unknown in most cases. There may be a genetic predisposition or a viral origin, and the disorder has been linked to maternal folic acid deficiency; however, the actual cause has not been determined. There may be a genetic predisposition, but no pattern has been identified. Folic acid deficiency in the mother has been linked to neural tube defect. There is no evidence that children who have parents with spinal problems are at greater risk for neural tube defects.)

The nurse is assessing a child who was just admitted to the hospital for observation after a head injury. What is the most essential part of nursing assessment to detect early signs of a worsening condition? a. Posturing b. Vital signs c. Focal neurologic signs d. Level of consciousness

D (The most important nursing observation is assessment of the child's level of consciousness. Alterations in consciousness appear earlier in the progression of head injury than do alterations of vital signs or focal neurologic signs. Neurologic posturing is indicative of neurologic damage. Vital signs and focal neurologic signs are later signs of progression when compared with level-of-consciousness changes. Vital signs and focal neurologic signs are later signs of progression when compared with level-of-consciousness changes.)

What procedure is contraindicated in the care of a child with a minor partial-thickness burn injury wound? a. Cleaning the affected area with mild soap and water b. Applying antimicrobial ointment to the burn wound c. Changing dressings daily d. Leaving all loose tissue or skin intact

D (All loose skin and tissue should be debrided, because it can become a breeding ground for infectious organisms.)

The skin condition commonly known as "warts" is the result of an infection by which organism? a. Bacteria b. Fungus c. Parasite d. Virus

D (Human warts are caused by the human papillomavirus.)

The process of burn shock continues until what physiologic mechanism occurs? a. Heart rate returns to normal. b. Airway swelling decreases. c. Body temperature regulation returns to normal. d. Capillaries regain their seal.

D (Within minutes of the burn injury, the capillary seals are lost with a massive fluid leakage into the surrounding tissue, resulting in burn shock. The process of burn shock continues for approximately 24 to 48 hours, when capillary seals are restored. A The heart rate will be increased throughout the healing process because of increased metabolism. B Airway swelling subsides over a period of 2 to 5 days after injury. C Body temperature regulation will not be normal until healing is well under way. )

What should the parents of an infant with thrush (oral candidiasis) be taught about medication administration? a. Give nystatin suspension with a syringe without a needle. b. Apply nystatin cream to the affected area twice a day. c. Give nystatin before the infant is fed. d. Swab nystatin suspension onto the oral mucous membranes after feedings.

D (A Medication may not reach the affected areas when it is squirted into the infant's mouth. Rubbing the suspension onto the gum ensures contact with the affected areas. B Nystatin cream is used for diaper rash caused by Candida. C To prolong contact with the affected areas, the medication should be administered after a feeding. D It is important to apply the nystatin suspension to the affected areas, which is best accomplished by rubbing it onto the gums and tongue, after feedings, every 6 hours, until 3 to 4 days after symptoms have disappeared.)

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

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

When taking a history on a child with a possible diagnosis of cellulitis, what should be the priority nursing assessment to help establish a diagnosis? a. Any pain the child is experiencing b. Enlarged, mobile, and nontender lymph nodes c. Child's urinalysis results d. Recent infections or signs of infection

D (Cellulitis may follow an upper respiratory infection, sinusitis, otitis media, or a tooth abscess. The affected area is red, hot, tender, and indurated. A Pain is important, but the history of recent infections is more relevant to the diagnosis. B Lymph nodes may be enlarged (lymphadenitis), but they are not mobile and are nontender. Lymphangitis may be seen with red "streaking" of the surrounding area.)

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

D (Streptococcus, Staphylococcus, and Haemophilus influenzae are the organisms usually responsible for cellulitis)

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

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

TRUE OR FALSE Electric injury to a child often results in instant death because the electric current disrupts the rhythm of the heart.

true (The child who does not die instantly after an electrical injury is at risk for cardiac arrest or dysrhythmia, tissue damage, myoglobinuria, and metabolic acidosis.)