Peds: Lots of questions

122 When taking a child's blood pressure, the nurse should select a cuff with a bladder width that is large enough to cover what percentage of the upper arm? 20% 40% 60% 80%

40% 2. The width of the cuff bladder ideally covers 40% of the arm circumference at the midpoint of the upper arm. 1. Twenty percent is too small and may give falsely elevated blood pressure values. 3. Sixty percent and 80% are too large and may give falsely low blood pressure values. 4. Sixty percent and 80% are too large and may give falsely low blood pressure values.

2 The parent of a child with cystic fibrosis calls the clinic nurse and describes signs and symptoms of tachypnea, tachycardia, dyspnea, pallor, and cyanosis. What does the nurse suspect the child is experiencing? A pneumothorax Bronchodilation Carbon dioxide retention Extremely thick sputum

A pneumothorax The child is exhibiting signs of increasing respiratory distress suggestive of a pneumothorax. The child needs to be seen as soon as possible. Bronchodilation would not produce the symptoms listed. Carbon dioxide retention would not produce the symptoms listed. An increased viscosity of sputum is characteristic of cystic fibrosis. The described change in respiratory status is potentially due to a pneumothorax.

3 Because absorption of fat-soluble vitamins is decreased in children with cystic fibrosis, the nurse reinforces the physician's orders. Teaching by the nurse is correct if which vitamin supplementation is explained? C, D A, E, K A, D, E, K C, folic acid

A, D, E, K A, D, E, and K are the fat-soluble vitamins that need to be supplemented. C and folic acid are not fat-soluble. C is not one of the fat-soluble vitamins. D also needs to be supplemented.

In taking care of a pediatric oncology patient, which diagnostic finding would indicate a critical concern for the development of infection? Absolute neutrophil count of 250 mm3 Temperature of 99.2 degrees Fahrenheit White blood cell count 7,000 mm3 Platelet count 100,000 mm3

Absolute neutrophil count of 250 mm3 An absolute neutrophil count of less than 500 mm3 is of critical concern as it indicates the potential for overwhelming infection. None of the other measurement parameters are reflective of this fact.

What is the most appropriate action to stop an occasional episode of epistaxis? Have the child sit up and lean forward. Apply ice under the nose and above the lip. Have the child lie down quietly with the feet elevated. Apply continuous pressure to the nose with the thumb and forefinger for at least 1 minute.

Have the child sit up and lean forward. Sitting up and leaning forward is the position used to prevent the child from aspirating blood. Pressure, not ice, is indicated for an occasional episode of epistaxis. Lying the child down with the feet elevated can potentially lead to aspiration. Continuous pressure for 10 minutes is recommended; 1 minute would not be long enough.

112 The nurse is explaining blood components to an 8-year-old child. The nurse's best description of platelets is that they do which of the following? Make up the liquid portion of blood Help keep germs from causing infection Carry the oxygen you breathe from your lungs to all parts of your body Help your body stop bleeding by forming a clot (scab) over the hurt area

Help your body stop bleeding by forming a clot (scab) over the hurt area Platelets are involved in hemostasis. Plasma makes up the liquid portion of blood. White blood cells help keep germs from causing infection. Red blood cells carry the oxygen you breathe from your lungs to all parts of your body.

77 Which statement best represents infectious mononucleosis? Human herpesvirus type 2 is the principal cause. Herpes-like Epstein-Barr virus is the principal cause. Diagnosis is established by a complete blood count, which reveals a characteristic leukopenia. Diagnosis is established by clinical manifestations because diagnostic tests cannot confirm the diagnosis.

Herpes-like Epstein-Barr virus is the principal cause. Herpes-like Epstein-Barr virus accounts for most cases of mononucleosis and is considered to be the principal cause. A complete blood count in an adolescent with mononucleosis would indicate a lymphocytic leukocytosis with atypical lymphs, not leukopenia. The monospot test is a highly specific test for mononucleosis.

74 What is the causative agent for erythema infectiosum (fifth disease)? Paramyxovirus Human parvovirus B19 Human herpesvirus type 6 Group A β-hemolytic streptococcus

Human parvovirus B19 Human parvovirus B19 is the causative agent of fifth disease. Paramyxovirus causes mumps. Human herpesvirus types 1 and 2 are the major causes of herpetic infections in humans. Group A β-hemolytic streptococcus is the causative agent for scarlet fever.

Which findings are consistent with tumor lysis syndrome? Hypercalcemia and hyperkalemia Hypochloremia and hypokalemia Hyponatremia and hyperphosphatemia Hyperuricemia and hyperkalemia

Hyperuricemia and hyperkalemia The hallmark characteristics of tumor lysis syndrome are: hyperuricemia, hypocalcemia, hyperphosphatemia, and hyperkalemia.

46 Which statement accurately expresses the genetic implications of cystic fibrosis (CF)? It is inherited as an autosomal dominant trait. It is a genetic defect found primarily in nonwhite population groups. If it is present in a child, both parents are carriers of the defective gene. There is a 50% chance that siblings of an affected child will also be affected.

If it is present in a child, both parents are carriers of the defective gene. CF is an autosomal recessive gene inherited from both parents. CF is inherited as an autosomal recessive, not autosomal dominant, trait. CF is found primarily in white populations. An autosomal recessive inheritance pattern means that there is a 25% chance a sibling will be infected but a 50% chance a sibling will be a carrier.

A child is status post hematopoietic stem cell transplantation (HSCT) and is preparing for discharge home. Based on the nurse's knowledge of HSCT, which concepts are important to include in the discharge teaching plan of care? (Select all that apply.) Preparing the child to return to school within 6 weeks Keeping the child on a high-calcium diet Avoiding live plants and fresh vegetables Avoiding influenza vaccinations Practicing good hygiene

Keeping the child on a high-calcium diet Avoiding live plants and fresh vegetables Practicing good hygiene Children should have a diet high in calcium or be placed on calcium supplements to reduce the risk of osteopenia. Live plants and fresh vegetables should be avoided because they carry bacteria. Practicing good hand hygiene is essential to prevent the spread of infection. Children cannot return to school for 6-12 months after HSCT. Either in-hospital or home schooling is required. Children and their families should be encouraged to get yearly influenza vaccination.

82 Cystic fibrosis may affect one system or multiple systems of the body. What is the primary factor responsible for possible multiple clinical manifestations? Atrophic changes in the mucosal wall of the intestines Hypoactivity of the autonomic nervous system Hyperactivity of the apocrine glands Mechanical obstruction caused by increased viscosity of exocrine gland secretions 83 An immediate intervention to teach parents for while an infant is choking on a piece of food would be to have infant lie quietly while a call is placed for emergency help. position infant in a head-down, face-down position and administer five quick back slaps. Correct administer mouth-to-mouth resuscitation. give some water by a cup to relieve the obstruction. Positioning the infant head and face down while administering five quick blows between the shoulder blades is the correct initial sequence of actions for an infant with an obstructed airway. The infant needs to receive treatment immediately. Emergency help is called after attempting to remove the obstruction. Mouth-to-mouth resuscitation should not be used. This may push the object further into the child's respiratory system. If the child is obstructed, the water will not be able to pass. This will increase the risk of aspiration. 84 The school nurse is called to the cafeteria because a child "has eaten something he is allergic to." The child is in severe respiratory distress. The first action by the nurse is to determine what the child has eaten. administer diphenhydramine (Benadryl) PO stat. move the child to the nurse's office or hallway. have someone call for an ambulance and paramedic rescue squad or 9-1-1. Correct Because the child is in severe respiratory distress, the nurse should have someone call for a rescue squad or 9-1-1. Because severe respiratory distress is occurring, treatment of the response is indicated. What the child has eaten can be determined later. Diphenhydramine by mouth will not be effective for this type of emergency allergic reaction. The child should not be moved, unless the child is currently in a place that puts him or her at greater hazard. 85 In reviewing potential susceptibility to respiratory infections for children, which statement is based on supportive physiological evidence? Newborns are more likely to develop respiratory infections in the neonatal period due to changes from intrauterine to external environment. With advancing age, immunity decreases leading to greater chances of developing respiratory infections. There is an increase in infection rate between 3 to 6 months due to loss of protective effects of maternal antibodies. Correct Viral respiratory infections increase dramatically by 5 years of age. Newborns have immune protection that lasts from 3 to 6 months due to maternal antibody transfer and are therefore less likely to develop a respiratory infection. Development of respiratory infection is not related to transitioning from intrauterine to external environments. With advancing age, immunity increases rather than decreases. Viral respiratory infections occur less frequently by 5 years of age. 86 The nurse is interviewing the parents of a 4-month-old infant brought to the hospital emergency department. The infant is dead on arrival, and no attempt at resuscitation is made. The parents state that the baby was found in the crib with a blanket over the head, lying face down in bloody fluid from the nose and mouth. The parents indicate no problems when the infant was placed in the crib asleep. Which of the following causes of death does the nurse suspect? Suffocation Child abuse Infantile apnea Sudden infant death syndrome (SIDS) Correct Death is consistent with the appearance of SIDS. The infant is usually found in a disheveled bed; with blankets over the head; huddled into a corner and clutching the sheets; with frothy, blood-tinged fluid in the mouth and nose; and lying face down. The diaper is also usually full of stool, indicating a cataclysmic type of death. Although the child was found under the blanket, the other findings are consistent with SIDS. The findings as reported are consistent with SIDS, not child abuse. The history and physical findings are consistent with SIDS, not infantile apnea. 87 A parent with a toddler who has a respiratory infection wants to use the traditional method of topical vapor rub. Which statement by the parent indicates that additional teaching is needed with regard to administration of this treatment? The parent states that he will wash his hands before applying the medication. The parent will read the product label before administering the medication. The parent will inform the pediatrician that the medication is being used. Application of the medication will be given orally to avoid potential sneezing. Correct Topical vapor rubs should never be given orally or applied beneath the nose. All of the other options indicate appropriate action on the part of the parent in terms of medical asepsis, obtaining information by reading label and notifying the health care provider that a medication is being used in the current treatment plan. 88 A child is standing playing with toys and suddenly collapses. Attempts to engage the child in conversation are met with no response. Skin color indicates cyanosis. A preliminary assessment of the environment presents no specific issues. Based on this information, you would suspect that the child is? Experiencing seizure activity Potential aspiration of foreign body Correct Potential allergic reaction Traumatic injury A child who is in severe respiratory distress as a result of foreign body aspiration will not be able to speak, become cyanotic and collapse. This would be considered a medical emergency. Playing with a toy may potentially lead to aspiration if the toy parts are smaller than the child's airway. Within that age group, it is likely that the child may place items in his/her mouth. There is nothing to suggest seizure activity, allergic reaction or traumatic injury. 89 Treatment methods used for status asthmaticus focus on supportive oxygen therapy to maintain saturation at 90%. resolving acid-base disturbances that have led to alkalosis. restoring hydration. Correct decreasing airway compliance. Treatment methods for status asthmaticus are aimed at improving ventilation, decreasing airway resistance, relieving bronchospasm, correcting dehydration and acidosis, decreasing anxiety and treating any underlying concurrent infection. Oxygen saturation should be maintained at greater than 90%, typical acid-base disturbances result in acidosis, not alkalosis. 90 Asthma is classified into four categories: mild intermittent, mild persistent, moderate persistent, and severe persistent. Clinical features used to determine these categories include (Select all that apply.) lung function. Correct associated allergies. frequency of symptoms. Correct frequency and severity of exacerbations. Correct The peak expiratory flow rate is one of the diagnostic criteria for classifying severity. The frequency of symptoms is one of the diagnostic criteria for classifying severity. The frequency and severity of exacerbations are two of the diagnostic criteria for classifying severity. The clinical features that distinguish the categories of asthma do not include other allergies. 91 A 5-year-old child is brought the Emergency Department with abrupt onset of sore throat, pain with swallowing, fever, and sitting upright and forward. Acute epiglottitis is suspected. What are the most appropriate nursing interventions? (Select all that apply.) Vital signs Correct Throat culture Medical history Correct Assessment of breath sounds Correct Emergency airway equipment readily available Correct Vital signs should always be taken as a part of the assessment. Medical history is important in assisting with the diagnosis in addition to knowing immunization status. Assessment of breath sounds is important in assisting with the diagnosis. Suprasternal and substernal retractions may be noted. Emergency airway equipment must be readily available in case the airway becomes obstructed. Throat culture should never be done when diagnosis of epiglottis is suspected. Manipulation of the throat can stimulate the gag reflex in an already inflamed airway and cause laryngeal spasm that will cause occlusion of the airway. 92 A school-age child has undergone a tonsillectomy and is being cared for postoperatively in the hospital setting. The nurse assigned to the patient is developing a plan of care with regard to nutrition and hydration. What factors should be included in the postoperative plan of care for this patient? (Select all that apply.) Medicate for pain around the clock to ensure that the patient will be able to eat and maintain hydration. Restrict food and oral fluids initially making sure that the patient is fully alert and there is no evidence of bleeding. Correct Avoid giving fluids that are color tinged red or brown. Correct Provide milk to help maintain nutritional balance. Provide pudding to facilitate swallowing. 93 The most appropriate time to perform bronchial postural drainage is immediately before all aerosol therapy. before meals and at bedtime. Correct immediately on arising and at bedtime. 30 minutes after meals and at bedtime. The most effective time for bronchial drainage is before meals and before bedtime to prevent the interaction of excessive amounts of mucus and food intake, thereby increasing the risk of vomiting. Bronchial drainage is more effective after other respiratory therapies such as bronchodilator or nebulizer treatments. These treatments open the airways, facilitating the movement of mucus with the positioning of bronchial drainage. Bronchial drainage should be done three or four times each day to be effective. When bronchial drainage is completed after meals, it may cause the child to vomit. 94 It is important that a child with acute streptococcal pharyngitis be treated with antibiotics to prevent otitis media. diabetes insipidus. nephrotic syndrome. acute rheumatic fever. Correct Children with group A β-hemolytic streptococci (GABHS) infection are at risk for acute rheumatic fever and acute glomerulonephritis. Otitis media is not a complication of acute streptococcal pharyngitis. Diabetes insipidus is not a complication of acute streptococcal pharyngitis. Children who have had acute streptococcal pharyngitis are at risk for acute glomerulonephritis, not nephrotic syndrome. 95 If the mother of a child is hepatitis B surface antigen (HBsAg) negative, the nurse knows that the child should receive his or her first dose of the hepatitis B virus (HBV) vaccine at 2 months of age, at the first well-child visit. birth before discharge from the hospital. Correct 6 months of age, at the third well-child visit. no time (this vaccine is not currently recommended). It is recommended that newborns receive the hepatitis B vaccine before hospital discharge if the mother is HBsAg negative. The second dose of the vaccine is given at the first well-child visit. The third dose of the vaccine is given at the third well-child visit. The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention and the Committee on Infectious Diseases of the American Academy of Pediatrics govern the recommendations for immunization, which include the hepatitis B virus vaccine. 96 The Hib conjugate vaccines protect an infant against which of the following diseases? (Select all that apply.) Bacterial meningitis Correct Epiglottitis Correct Bacterial pneumonia Correct Septic arthritis Correct Sepsis Correct Hib conjugate vaccines protect against a number of serious infections caused by Haemophilus influenza type b, especially bacterial meningitis, epiglottitis, bacterial pneumonia, septic arthritis, and sepsis. 97 Which of the following is the appropriate site to administer an intramuscular (IM) vaccine to a newborn? The dorsal gluteal muscle The vastus lateralis muscle Correct The ventral gluteal muscle The biceps muscle If the vaccine is given intramuscularly, then it is given in the vastus lateralis in newborns or in the deltoid for older infants and children. Regardless of age, the dorsogluteal site should be avoided because it has been associated with low antibody seroconversion rates, indicating a reduced immune response, and it is no longer an acceptable evidence-based practice site for IM injections. The ventral gluteal muscle and the biceps muscle are not appropriate sites for IM injections. 98 The hepatitis A vaccine is now recommended at which of the following ages? 1 year Correct 1 month 12 years It is not recommended at any age. Hepatitis A has been recognized as a significant child health problem, particularly in communities with unusually high infection rates. Hepatitis A virus is spread by the fecal-oral route and from person-to-person contact, by ingestion of contaminated food or water, and rarely by blood transfusion, so the immunization is recommended at 1 year of age. 99 The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) and American College of Obstetricians and Gynecologists has recommended that pregnant adolescents and women who are not protected against pertussis receive the tetanus, diphtheria and pertussis (Tdap) vaccine optimally at which of the following times? Between 27 and 36 weeks of gestation or postpartum before discharge from the hospital Correct During the first pre-natal visit when pregnancy is confirmed The vaccine should be administered 24 hours prior to delivery This vaccine is only recommended during the first trimester The ACIP of the CDC and American College of Obstetricians and Gynecologists has recommended that pregnant adolescents and women who are not protected against pertussis receive the Tdap vaccine optimally between 27 and 36 weeks of gestation or postpartum before discharge from the hospital. The vaccine is not recommended during the first trimester. The vaccine is not recommended between 27 and 36 weeks to allot for antibody formation that will protect the mother and passive immunity to the infant.The vaccine is not recommended during the first trimester. 100 The nurse understands that respiratory hygiene and cough etiquette is recommended by the Centers for Disease Control and Prevention (CDC) to prevent which of the following? HBV, Hib, and pertussis HSV, influenza, and HBV RSV, influenza, and adenovirus Correct RSV, pertussis, and varicella The CDC (2007) recommends respiratory hygiene and etiquette to prevent the transmission of RSV, influenza, adenovirus, and other droplet-transmitted unknown viruses. HBV, HSV, and varicella are not transmitted via droplets. 101 What is the most common piece of medical equipment that can transmit harmful microorganisms among patients? Thermometer Stethoscope Correct Injection needle Disposable gloves A stethoscope is commonly used between patients, and if not correctly disinfected, it can be a dangerous source of spreading microorganisms. Thermometers of all types have barriers to prevent this. Needles are discarded immediately after injections and never reused, so they are not a common source of transmission. Disposable gloves are not reused, so they are not a common source of transmission. 102 A 12-month-old child presents to the clinic for a well visit after missing several appointments. The child began her immunization schedule but has missed several follow-up appointments and immunization doses. The nurse knows that the most appropriate action is what? The child must receive initial immunizations from the beginning. The child cannot receive missed immunizations if the schedule is not followed. The child should only receive the missed doses of immunizations. Correct The child should receive double-strength immunizations at this well visit. Children who began primary immunization at the recommended age but fail to receive all the doses do not need to begin the series again but instead should receive only the missed doses. The child may receive missed vaccinations on a catch-up schedule per CDC guidelines. 103 The change from the exclusive use of oral polio vaccine (OPV) to the exclusive use of inactivated poliovirus vaccine (IPV) related to the rare risk of vaccine-associated polio paralysis (VAPP) from OPV has resulted in which of the following? An increase in the risk of VAPP An increased number of injections and increased cost Correct A better antibody conversion than the oral formulation A measureable decrease in immunity in the community There is an increased number of injections and increased cost associated with IPV. The exclusive use of IPV eliminates the risk of VAPP. There is no increased antibody conversion from IPV. The same immunity is provided by both vaccines. 104 Which of the following vaccinations are included in health promotion during infancy? (Select all that apply.) Haemophilus influenzae type b (Hib) Correct Hepatitis C virus (HCV) Diphtheria, tetanus, and pertussis (DTaP) Correct Poliovirus Correct Hepatitis B virus (HBV) Correct The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention and the Committee on Infectious Diseases of the American Academy of Pediatrics govern the recommendations for immunization, which include diphtheria, tetanus, and pertussis (DTaP using acellular pertussis); poliovirus; measles, mumps, and rubella (MMR); Hib; HBV; hepatitis A virus (HAV); meningococcal; pneumococcal conjugate vaccine (PCV); and influenza (and H1N1) during infancy. There is no current vaccination to prevent the transmission of hepatitis C virus. 105 When hemoglobin levels fall sufficiently to produce clinical manifestations, the person's signs and symptoms are caused by phagocytosis. tissue hypoxia. Correct pulmonary hypertension. depressed bone marrow. The signs and symptoms (e.g., weakness, fatigue, and a waxy pallor in severe anemia) are caused by tissue hypoxia. Phagocytosis is a function of white blood cells used in prevention of infection. Pulmonary hypertension is not associated with anemia. Severe anemia may contribute to cardiac compensation. Depressed bone marrow may be the cause of the low hemoglobin. 106 The nurse suspects a child is having an adverse reaction to a blood transfusion. The first action by the nurse should be which of the following? Notify the physician. Take the vital signs and blood pressure and compare them with baseline levels. Dilute infusing blood with equal amounts of normal saline. Stop transfusion and maintain a patent intravenous line with normal saline and new tubing. Correct Stopping the transfusion and maintaining a patent intravenous line with normal saline and new tubing is the priority nursing action. If an adverse reaction is occurring, it is essential to minimize the amount of blood that is infused. Notifying a physician and taking vital signs and blood pressure should be performed after the blood transfusion is stopped and infusion of normal saline has begun. Blood should not be diluted; it should be returned to the blood bank if an adverse reaction has occurred. 107 An important nursing consideration when caring for a child with sickle cell anemia is which of the following? Refer the parents and child for genetic counseling. Teach the parents and child how to recognize the signs and symptoms of crises. Correct Help the child and family adjust to a short-term disease. Observe for complications of multiple blood transfusions. Parents need specific instructions on the need to watch for changes in the child's condition, including adequate hydration, and environmental concerns. Genetic counseling is important, but teaching care of the child is a priority. Sickle cell anemia is a long-term, chronic illness. Multiple blood transfusions are an option for some children with sickle cell disease. The priority for all children with this condition is properly preparing the parents to care for them. 108 The parents of a child hospitalized with sickle cell anemia tell the nurse that they are concerned about narcotic analgesics causing addiction. The nurse should explain which of the following concerning narcotic analgesics? They are often ordered but not usually needed. When they are medically indicated, children rarely become addicted. Correct They are given as a last resort because of the threat of addiction. They are used only if other measures, such as ice packs, are ineffective. Pain is the most common and debilitating symptom experienced by patients with sickle cell disease. The chronic nature of this pain can greatly affect the child's development. A multidisciplinary approach is best for its management. Patient-controlled analgesia or continuous intravenous administration is usually effective. Pharmacologic intervention is necessary for the pain of sickle cell crisis. 109 Chelation therapy is begun on a child with α-thalassemia major. The purpose of this therapy is to do which of the following? Treat the disease. Eliminate excess iron. Correct Decrease risk of hypoxia. Manage nausea and vomiting. Iron overload (hemosiderosis) is a complication of blood transfusions. Chelation therapy is necessary to minimize the development of hemosiderosis and hemochromatosis. Blood transfusions are the primary medical management. Chelation therapy removes iron; it does not affect the disease process. 110 The school nurse is caring for a child with hemophilia who fell on his arm during recess. Which of the following supportive measures should the nurse do until factor replacement therapy can be instituted? Apply warm, moist compresses. Apply a tourniquet for at least 5 minutes. Elevate the arm above the level of the heart. Correct Begin passive range of motion unless pain is severe. The initial response should include elevation. Cold should be applied to the arm. This will aid in vasoconstriction. Pressure is effective in small areas but would not work for an extremity. Passive range of motion is not recommended. The child can perform active range of motion after the bleeding episode has resolved. 111 The school nurse is discussing prevention of acquired immunodeficiency syndrome with some adolescents. Which of the following is appropriate to include? The virus is easily transmitted. It is only transmitted through blood. Condoms should be used if adolescents are homosexual. Recreational drug users should not share needles or other equipment. Correct Human immunodeficiency virus is spread through blood and body fluids. Intravenous needles that have been used should not be shared. They may be contaminated with the virus. The virus is not easily transmitted. It requires direct contact with blood or body fluids on a nonintact skin surface. Body fluids may also transmit the virus. Condoms should be used for both heterosexual and homosexual sex. 112 The nurse is explaining blood components to an 8-year-old child. The nurse's best description of platelets is that they do which of the following? Make up the liquid portion of blood Help keep germs from causing infection Carry the oxygen you breathe from your lungs to all parts of your body Help your body stop bleeding by forming a clot (scab) over the hurt area Correct Platelets are involved in hemostasis. Plasma makes up the liquid portion of blood. White blood cells help keep germs from causing infection. Red blood cells carry the oxygen you breathe from your lungs to all parts of your body. 113 Chemotherapeutic drugs to treat cancer are often given in combination because the drugs can be given by various routes. the drugs can be given at different times during the day. patients cannot tolerate extremely high doses of single drugs. the combinations allow for optimum cell destruction with minimum toxic effects. Correct Combining drugs allows for synergistic effects. Optimum cell cycle destruction with minimum toxic effects and decreased resistance by the cancer cells to the agent are possible. Routes of administration depend on the pharmacologic attributes of the drug. The routes do not influence interactions. Combination therapy usually has specific intervals to maximize synergistic effect. High doses of drugs are indicated in different regimens. 114 Which of the following pediatric oncologic emergencies is caused by the rapid release of intracellular metabolites during the initial treatment of some cancers? Hyperleukocytosis Overwhelming infection Acute tumor lysis syndrome Correct Superior vena cava syndrome Acute tumor lysis syndrome is caused by the rapid release of intracellular metabolites during the initial treatment of malignancies. Hyperleukocytosis, a white blood cell count greater than 100,000/mm3, can be present at diagnosis. It is not a result of the treatment. Infection may occur from bone marrow suppression that results from many chemotherapeutic agents. Superior vena cava syndrome can occur from compression of the mediastinal structures by Hodgkin disease and non-Hodgkin lymphoma. 115 The most common signs and symptoms of leukemia related to bone marrow involvement are which of the following? Petechiae, fever, and fatigue Correct Headache, papilledema, and irritability Muscle wasting, weight loss, and fatigue Decreased intracranial pressure, psychosis, and confusion Signs of infiltration of the bone marrow are petechiae from lowered platelet count, fever related to infection from the depressed number of effective leukocytes, and fatigue from the anemia. Headache, papilledema, irritability, muscle wasting, weight loss, fatigue, decreased intracranial pressure, psychosis, and confusion are not signs of bone marrow involvement. 116 A child with lymphoma is receiving extensive radiotherapy. Which of the following is the most common side effect of this treatment? Malaise Correct Seizures Neuropathy Lymphadenopathy Malaise is the most common side effect of radiotherapy. For children, the fatigue may be especially distressing because it means they cannot keep up with their peers. Seizures are unlikely because irradiation would not usually involve the cranial area for treatment of lymphoma. Neuropathy is a side effect of certain chemotherapeutic agents. Lymphadenopathy is one of the findings of lymphoma. 117 The postoperative care of a preschool child who has had a brain tumor removed should include which of the following? Colorless drainage is to be expected. Analgesics are contraindicated because of altered consciousness. Positioning is on the operative side in the Trendelenburg position. Carefully monitor fluids because of cerebral edema. Correct Because of cerebral edema and the danger of increased intracranial pressure postoperatively, fluids are carefully monitored. Colorless drainage may be leakage of cerebrospinal fluid from the incision site. This needs to be reported as soon as possible. Analgesics can be used for postoperative pain. The child should not be positioned in the Trendelenburg position postoperatively. 118 Which of the following best describes a neuroblastoma? The diagnosis is usually made after metastasis occurs. Correct It is the most common brain tumor in young children. Older children have an improved likelihood of survival. Early diagnosis is usually possible because of the obvious clinical manifestations. Neuroblastoma is considered a "silent" tumor. In more than 70% of cases, the diagnosis is made after metastasis occurs. The neuroblastoma is usually located in the abdomen. Children younger than 1 year of age have a 75% survival rate; those older than age 1 year, only 50%. The diagnosis is not usually made until other sites have been invaded by the tumor. 119 Which of the following is most descriptive of the therapeutic management of osteogenic sarcoma? Intensive irradiation is the primary treatment. Amputation of the affected extremity is rarely necessary. Treatment usually consists of surgery and chemotherapy. Correct Bone marrow transplantation offers the best chance of long-term survival. Optimum treatment of osteosarcoma is surgery and chemotherapy. Surgical biopsy is followed by either limb salvage or amputation and chemotherapy. Radiation and bone marrow transplantation are not part of the therapy for osteosarcoma. Amputation is often required when limb salvage is not possible. 120 Where are Wilms tumors (nephroblastomas) located? Bone Brain Kidney Correct Lymphatic system Wilms tumor, or nephroblastoma, is the most common intraabdominal and kidney tumor of childhood. Wilms tumors are encapsulated and are located in the abdom 121 Which of the following statements is true concerning the increased use of telephone triage by nurses? Health care costs have increased as a result. Emergency department visits are not recommended. Access to high-quality health care services has increased. Correct Home care is recommended when it is not appropriate. 3. With well-designed telephone triage programs, access to high-quality health care services and patient satisfaction have increased. 1. With the reduction in unnecessary emergency department and clinic visits, health care costs have decreased. 2. Emergency department visits are recommended based on the response to screening questions and when the child's condition is in doubt. 4. Guidelines are given for home management, if the triage assessment indicates that level of care. Parents are given instructions about changes in the child's condition to report. 122 When taking a child's blood pressure, the nurse should select a cuff with a bladder width that is large enough to cover what percentage of the upper arm? 20% 40% Correct 60% 80% 2. The width of the cuff bladder ideally covers 40% of the arm circumference at the midpoint of the upper arm. 1. Twenty percent is too small and may give falsely elevated blood pressure values. 3. Sixty percent and 80% are too large and may give falsely low blood pressure values. 4. Sixty percent and 80% are too large and may give falsely low blood pressure values. 123 Binocularity, the ability to fixate on one visual field with both eyes simultaneously, is normally present by what age? 1 month 3 to 4 months Correct 6 to 8 months 12 months 2. Binocularity is usually achieved by age 3 to 4 months. 1. One month is too young for binocularity. 3. If binocularity is not achieved by 6 to 12 months, the child must be observed for strabismus. 4. If binocularity is not achieved by 6 to 12 months, the child must be observed for strabismus. 124 The nurse has a 2-year-old boy sit in "tailor" position while palpating for the presence of the testes. What is the rationale for this position? It prevents cremasteric reflex. Correct Undescended testes can be palpated. Child has an inguinal hernia. Child does not yet have a need for privacy. 1. The tailor position stretches the muscle responsible for the cremasteric reflex. This prevents its contraction, which pulls the testes into the pelvic cavity. 2. Undescended testes cannot be predictably palpated. 3. Inguinal hernias are not detected by this method. This position is used for inhibiting the cremasteric reflex. 4. Privacy should always be provided for children. 125 Kimberly is having a checkup before starting kindergarten. The nurse asks her to do the "finger-to-nose test." The nurse is testing for which of the following? Deep tendon reflexes Cerebellar function Correct Sensory discrimination Ability to follow directions 2. The finger-to-nose test is an indication of cerebellar function. This test checks balance and coordination (p. 168). 1. Each deep tendon reflex is tested separately. 3. Each sense is tested separately. 4. Although performing this test can demonstrate the child's ability to follow directions, it is used primarily for cerebellar function. 126 The nurse is beginning to administer the Denver II to a small child when his mother says, "Can you tell me again what this Denver II is?" The nurse's best response is which of the following? "It's a simple intelligence test for young children." "It tells us what a child can do at a particular age." Correct "It's a test we give to measure a child's development." "It's an excellent way to see if a child's development is normal." 2. The Denver II is a developmental screening tool that assesses the child's abilities at different ages. 1. The Denver II is a screening tool for developmental milestones, not intelligence. 3. Children are not expected to perform each item on the Denver II. Most children will perform tasks in a range. It is used to provide an indication of the child's developmental level. 4. Children are not expected to perform each item on the Denver II. Most children will perform tasks in a range. It is used to provide an indication of the child's developmental level. 127 Which of the following is most likely to encourage parents to talk about their feelings related to their child's illness? Be sympathetic. Ask direct questions. Use open-ended questions. Correct Avoid periods of silence. 3. Open-ended questions require the parent to answer with more than a brief answer. Closed-ended questions should be avoided when attempting to elicit parents' feelings. 1. Sympathy is having feelings or emotions in common with another person rather than understanding those feelings (empathy). Sympathy is not therapeutic in the helping relationship. 2. Direct questions may obtain limited information. In addition, they may be considered threatening by the parent. 4. Silence can be an effective interviewing tool. It allows a sharing of feelings in which two or more people absorb the emotion in depth. Silence permits the interviewee to sort out thoughts and feelings and search for responses to questions. 128 What are some legal and ethical issues that arise for the nurse when using an interpreter? Direct questions to interpreter. Ask several questions at a time. The family should be fully informed of all aspects of procedures before consenting. Correct Discourage interpreter and client from discussing topics not included in interview. 3. In obtaining informed consent through interpreter, the nurse should fully inform the family of all aspects of the particular procedure to which they are consenting. 1. The communication is with the family members. The nurse directs the questions toward the family while observing nonverbal cues. 2. Questions are asked one at a time to allow the interpreter and family to translate, process, and answer the question. 4. The interpreter and client should build a rapport. Discussion of topics outside of the interview allows the two parties to become acquainted. 129 Which one of the following approaches would be best to use to ensure a receptive response from a toddler? Focus communication on the child and tell him or her how a procedure will feel. Correct Call the toddler's name while picking him or her up. Call the toddler's name and say, "I am your nurse." Stand by the toddler, addressing him or her by name. 1. Toddlers see things only in relation to themselves and from their point of view. 2. A stranger picking up a child up in an unfamiliar environment is very frightening for the toddler. 3. Toddlers will not know the meaning of "nurse." 4. Unknown adults who call the toddler by name can frighten the child. 130 When the nurse interviews an adolescent, which of the following is especially important? Focus the discussion on the peer group. Display a genuine interest in the adolescent. Correct Emphasize that confidentiality will always be maintained. Use the same type of language as the adolescent. 2. Adolescents accept anyone who shows a genuine interest in them. 1. Although peers are important to this age-group, the focus of the interview should be on the adolescent. 3. The nurse should clarify which information will be shared with other members of the health care team and any limits to confidentiality. 4. The nurse should maintain a professional relationship with adolescents. To avoid misinterpretation of words and phrases that the adolescent may use, the nurse should clarify terms frequently. 131 The nurse is taking a health history on a child. At the beginning of the interview a parent says, "I brought him here because he always has diarrhea." This should be recorded under which of the following headings? History Chief complaint Correct Review of systems Nutritional assessment 2. The mother has verbalized the specific reason for the child's visit to the health care provider. The chief complaint is the reason for which the child has been brought to the clinic, office, or hospital. 1. History refers to information that relates to previous aspects of the child's health, not the current. 3. The review of systems is a specific review of each body system. It usually begins with a statement similar to asking the parent to describe how the child's general health has been. 4. A nutritional assessment combines a nutrition history with physical examination. 132 Which of the following statements explains why it can be difficult to assess a child's dietary intake? No systematic assessment tool has been developed. Biochemical analysis for assessing nutrition is expensive. Families usually do not understand much about nutrition. Recall of food consumption is frequently unreliable. Correct 4. An individual's recall of food intake, especially amounts eaten, is frequently unreliable. 1. Systematic tools such as the 24-hour recall and detailed dietary history questionnaires are available. 2. Biochemical analysis is not necessary for assessing dietary intake. 3. Family knowledge of nutrition is not required. Detailed questions can elicit the child's patterns of eating and food intake. 133 Which of the following approaches is the most appropriate when performing a physical assessment on a toddler? Demonstrate use of equipment. Perform traumatic procedures first. Use minimum physical contact initially. Correct Always proceed in a head-to-toe direction. 3. Parents can remove clothing, and the child can remain on the parent's lap. The nurse should use minimum physical contact initially to gain the cooperation of the child. 1. The nurse should introduce the equipment slowly. The child can inspect the equipment, but demonstrations are usually too complex for this age-group. 2. Traumatic procedures should always be performed last. These will most likely upset the child and inhibit cooperation. 4. The head-to-toe assessment can be done in older children but usually must be adapted in younger children. 134 The nurse is assessing a 3-year-old African-American child who is being seen in the clinic for the first time. The child's height and weight are at the 20th percentile on the commonly used growth chart from the National Center for Health Statistics (NCHS). When interpreting these data, the nurse should recognize which of the following? The data suggest the child requires nutritional intervention. The NCHS charts are accurate for U.S. African-American children. Correct A correction factor is used when the NCHS chart is used for non-Caucasian ethnic groups. No assessment can be made until several measurements are plotted over time. 2. The NCHS growth charts can serve as reference guides for all racial or ethnic groups. U.S. African-American children were included in the sample population. 1. The 20th percentile for height and weight are not indicative of nutritional failure. 3. No correction factor exists. The growth chart can be used with the perspective that different groups of children have varying normal distributions on the growth curves. 4. Serial measurements are useful for longitudinal assessment of the child; single data points provide information about the child's current status. 135 Which of the following is associated with social drinking in adolescents? Heavy drinking as an adult Increasing rates of liver disease Significant morbidity and mortality Correct Use of stimulants to counter depressive effects of alcohol 3. Alcohol-related motor vehicle incidents result in 8000 adolescent deaths and 45,000 injuries each year and are the leading cause of unintentional injury and deaths among adolescents. 1. Heavy drinking as an adult and increasing rates of liver disease are associated with heavy drinking in adolescence. 2. Heavy drinking as an adult and increasing rates of liver disease are associated with heavy drinking in adolescence. 4. Adolescents who abuse alcohol may use sedatives as they become tolerant to the effects of the alcohol. 136 The nurse is caring for an adolescent brought to the hospital with acute drug toxicity. Cocaine is believed to be the drug involved. Initial data collection should include which of the following? Chemical content of drug Method of administration Correct Function the drug plays in the adolescent's life Adolescent's level of interest in rehabilitation 2. When the drug is questionable or unknown, every effort must be made to determine the type, amount of drug taken, the method and time of administration, and factors relating to the onset of presenting symptoms. 1. The actual content of most street drugs is highly questionable. Pharmacologic agents should be administered with caution, except for the narcotic antagonists in case of suspected opiate use. 3. The function the drug plays in the adolescent's life and the adolescent's level of interest in rehabilitation are important considerations in the long-term management in the nonacute stage. 4. The function the drug plays in the adolescent's life and the adolescent's level of interest in rehabilitation are important considerations in the long-term management in the nonacute stage. 137 Which of the following statements is true about adolescents who attempt suicide? Suicide attempts are rarely associated with mental health problems. The adolescent has mastered problem-solving skills. Gay and lesbian adolescents are at high risk for suicide. Correct They may have parents with idealistic expectations of academic performance. 3. Approximately four times as many gay, lesbian, and bisexual teens attempt suicide compared with others in this age-group. Gay and lesbian adolescents who live in families or communities that do not accept homosexuality are likely to suffer low self-esteem, self-loathing, depression, and hopelessness as a result of a lack of acceptance. 1. Retrospectively, 90% of adolescents who committed suicide met the criteria for at least one major psychiatric disorder. 2. Adolescents with developed problem-solving and social skills are less likely to commit suicide. 4. Many adolescents have parents with idealistic expectations. 138 Which of the following is the most commonly used method in completed suicides? Firearms Correct Drug overdose Self-inflicted laceration Carbon monoxide poisoning 1. Firearms are the most commonly used instruments in completed suicides among both males and females. For adolescent boys, firearms are followed by hanging and overdose. For adolescent females, overdose and strangulation are the next most common means of completed suicide. 2. The most common method of suicide attempt is overdose or ingestion of potentially toxic substances such as drugs. 3. The second most common method of suicide attempt is self-inflicted laceration. 4. Carbon monoxide poisoning is not one of the more frequent forms of suicide completion. 139 An adolescent girl tells the nurse that she thinks about death all of the time. The nurse asks her if she has a specific plan. This question should be considered which of the following? An essential part of the assessment Correct Suggesting that the adolescent needs a plan Inappropriate until parents are present for discussion A close-ended question that will inhibit assessment 1. Routine health assessments of adolescents should include questions that assess the presence of suicidal ideation or intent. It is essential if the child expresses thoughts about death. Questions such as "Have you ever developed a plan to hurt yourself or kill yourself" should be part of the assessment. 2. The information about having a plan is an essential part of the assessment and greatly affects the treatment plan. 3. Safety of the adolescent is of primary concern. The question needs to be addressed in an adolescent with suicidal ideation. 4. Asking about a specific plan is a close-ended question, requiring a yes or no answer. Adolescents who express suicidal feelings and have a specific plan are at particular risk and require further assessment and constant monitoring. 140 Nursing responsibilities in the management of adolescent obesity include which of the following? Plan a low-calorie, low-protein diet. Incorporate favorite foods into child's diet. Correct Encourage diversional activities during mealtimes. Use nutritious foods as a method of reward. 2. Incorporating favorite foods into the child's diet allows the adolescent control over the weight loss process. 1. Special diets are usually not used except in cases of severe obesity. Low-carbohydrate and moderate-protein diets may then be used. 3. Diversional activities (reading, television) are not encouraged during mealtimes. These can contribute to overeating. 4. Food should not be used as a reward. 141 Anorexia nervosa is best described as: easily diagnosed and treated. Emaciation from self-inflicted starvation. Correct resulting from a posterior pituitary disorder. occurring most frequently in adolescent males. 2. One of the criteria for diagnosis is the refusal to maintain body weight at a minimally normal weight for age and height. 1. Anorexia nervosa can be a difficult disorder to identify. The diagnosis depends on the person meeting certain diagnostic criteria. Without a known cause, treatment is difficult. Reversal of the severe malnutrition usually requires intense nutritional and behavioral-psychologic management. 3. Posterior pituitary disorders are not associated with anorexia nervosa. 4. Females account for 90% to 95% of the cases. 142 Which of the following symptoms would the nurse expect to observe during the physical assessment of an adolescent girl with severe weight loss and disrupted metabolism associated with anorexia nervosa? Tachycardia Dysmenorrhea Heat intolerance Lowered body temperature Correct 4. Symptoms of anorexia nervosa include low body temperature, severe weight loss, decreased blood pressure, dry skin, brittle nails, altered metabolic activity, and lanugo hair. 1. Bradycardia, rather than tachycardia, may be present. 2. Amenorrhea, rather than dysmenorrhea, is a manifestation of anorexia nervosa. 3. Cold intolerance is a manifestation of anorexia nervosa. 143 An adolescent with bulimia has a low potassium level. The nurse is aware of the potential for which of the following complications? Anemia Cardiac arrhythmias Correct Gastrointestinal reflux Heightened neurologic reflexes 2. A low potassium level places the adolescent at risk for cardiac arrhythmias. Hospitalization is recommended when the potassium level is less than 3.2 mmol/L. 1. Anemia is a potential problem when iron intake is not sufficient. This is not common with bulimia. 3. Esophageal tears, not gastrointestinal reflux, are a complication of bulimia. 4. Heightened neurologic reflexes are not an expected complication. 144 Which of the following is descriptive of bulimia during adolescence? Strong sense of control over eating behavior Feelings of elation after the binge-purge cycle Profound lack of awareness that the eating pattern is abnormal Consumption of large quantities of food used as a coping mechanism Correct 4. The individual with bulimia uses food as a means of control and coping. As the disease progresses, the adolescent loses the control aspect and continues the binge-purge cycle as a coping measure. 1. The adolescent has a lack of control over eating during the episode. 2. Patients with bulimia commonly have self-deprecating thoughts and a depressed mood after binge-purge cycles. 3. Individuals with bulimia are aware that the eating pattern is abnormal but are unable to stop. 145 Correct terminology is necessary in understanding substance abuse. Physical dependence is which of the following? Voluntary behavior based on psychosocial needs A problem that occurs in conjunction with addiction Culturally defined use of drugs for purposes other than accepted medical purposes Involuntary physiologic responses to the pharmacologic characteristics of drugs Correct 4. Physical dependence is an involuntary response to the pharmacologic characteristics of a drug such as an opiate or alcohol. 1. Dependence is a physiologic response; it is not culturally determined or subject to voluntary control. 2. A person can be physically dependent on a narcotic without being addicted; for example, patients who use an opiate to control pain need increasing doses to achieve the same effect. An individual can be addicted to a drug without being physically dependent. 3. Dependence is a physiologic response; it is not culturally determined or subject to voluntary control. 146 Drug abuse is suspected in an adolescent being seen in the emergency department. Which of the following physical signs is suggestive of barbiturate ingestion? Ataxia Correct Cyanosis Sweating Tachycardia 1. The physical signs of barbiturate ingestion include ataxia and slurred speech. 2. Cyanosis is indicative of opiate use. 3. Sweating may be suggestive of amphetamines administered by a parenteral route. 4. Cocaine use will produce tachycardia. 147 Which of the following statements is true about smoking in adolescence? Smoking among adolescents is becoming more prevalent. Smoking will not continue unless peer pressure continues. Adolescents with identified personality traits are more likely to smoke. Smoking is less common when an adolescent's parents disapprove of smoking. Correct 4. Teenagers who do not smoke usually have parents and friends who oppose smoking and who do not smoke. 1. The percentage of young people who reported current cigarette use and frequent cigarette use has declined significantly. 2. Teenagers begin smoking for a variety of reasons, such as imitation of adult behavior, peer pressure, a desire to imitate behaviors portrayed in movies and advertisements, and a desire to control weight. The absence of peer pressure alone will not stop smoking. 3. Research has not been able to identify significant differences in the personality traits of adolescents who smoke and those who do not. 148 Which of the following statements is correct about childhood obesity? Heredity is an important factor. Correct Most children have an underlying disease as a cause. The percentage of children who are obese is decreasing. Prevalence of childhood obesity is similar across socioeconomic groups. 1. Heredity is an important fact that contributes to obesity. Identical twins reared apart tend to resemble their biologic parents to a greater extent than their adoptive parent. It is difficult to distinguish between hereditary and environmental factors. 2. Underlying diseases such as hypothyroidism and hyperinsulinism account for only a small number of cases of childhood obesity. 3. The number of overweight and obese children is increasing in the United States. 4. In the United States, lower socioeconomic groups have a higher prevalence of obesity, especially among girls. 149 The nurse should make a referral for communication impairment in which of the following situations? Dysfluency occurring at any age First words not uttered before age 2 years Correct Speech largely unintelligible at 18 months Substitution of easily produced sounds for more difficult ones by age 3 years 2. Usually, children are able to assign meaning to words by the first year of life. A delay until the second birthday is an indication for referral. 1. A referral should be made if stuttering or other dysfluency persists past age 5 years. 3. Referral is indicated if the child is unintelligible at age 3 years. 4. The competency to substitute sounds is not expected until age 5 years. 150 When a child with mild cognitive impairment reaches the end of adolescence, which of the following characteristics would be expected? Achieves a mental age of 5 to 6 years Achieves a mental age of 8 to 12 years Correct Is unable to progress in functional reading or mathematics Acquires practical skills and useful reading and mathematics to an eighth-grade level 2. By the end of adolescence, the child with mild cognitive impairment can acquire practical skills and useful reading and math skills to a third- to sixth-grade level. A mental age of 8 to 12 years is obtainable, and the child can be guided toward social conformity. 1. A mental age of 5 to 12 years is characteristic of children with moderate cognitive impairment. 3. A mental age of 5 to 12 years is characteristic of children with moderate cognitive impairment. 4. Practical skills and useful reading and mathematics at an eighth-grade level are not descriptive of cognitive impairment. 151 When should children with cognitive impairment be referred for stimulation and educational programs? As young as possible Correct As soon as they have the ability to communicate in some way At age 3 years, when schools are required to provide services At age 5 or 6 years, when schools are required to provide services 1. The child's education should begin as soon as possible. Considerable evidence exists that early intervention programs for children with disabilities are valuable for cognitively impaired children. 2. The early intervention may facilitate the child's development of communication skills. 3. States are encouraged to provide early intervention programs from birth under Public Law 101-476, the Individuals with Disabilities Education Act. 4. States are encouraged to provide early intervention programs from birth under Public Law 101-476, the Individuals with Disabilities Education Act. 152 Parents of a child with cognitive impairment ask the nurse for guidance in toilet training. They have older children who were successfully toilet trained but do not know how to do this with the impaired child. The nurse's recommendation should include which of the following? Accidents cannot be ignored if toilet training is to be successful. Determine the child's readiness to begin toilet training. Correct Toilet training should not be initiated until the child has sufficient speech. A more punitive approach is needed because of the child's cognitive impairment. 2. The child's capabilities and readiness are essential to success. Parents must also be able to devote the time to a positive, consistent, individualized, nonpressured style of teaching. 1. Successful training occurs by focusing on the achievement of small goals. Feelings of comfort and adequacy are necessary. Calling undue attention to "accidents" impedes the program's success. 3. Speech fluency is an independent skill. 4. Positive reinforcement is needed, not negative feedback. 153 What is one of the major physical characteristics of the child with Down syndrome? Excessive height Spots on the palms Hypotonic musculature Correct Inflexibility of the joints 3. Hypotonic musculature is one of the major characteristics. 1. Children with Down syndrome have short stature. 2. Children with Down syndrome have a transverse palmar crease. 4. Hyperflexibility is a characteristic of Down syndrome. 154 The child with Down syndrome may be screened for which of the following before participating in some sports? Hyperflexibility Cutis marmorata Atlantoaxial instability Correct Speckling of iris (Brushfield spots) 3. Children with Down syndrome are at risk for atlantoaxial instability. Before they participate in sports that put stress on the head and neck, a radiologic examination should be done. 1. Hyperflexibility, cutis marmorata, and speckling of iris (Brushfield spots) are characteristic of Down syndrome, but they do not affect the child's ability to participate in sports. 2. Hyperflexibility, cutis marmorata, and speckling of iris (Brushfield spots) are characteristic of Down syndrome, but they do not affect the child's ability to participate in sports. 4. Hyperflexibility, cutis marmorata, and speckling of iris (Brushfield spots) are characteristic of Down syndrome, but they do not affect the child's ability to participate in sports. 155 Distortion of sound and problems in discrimination are characteristic of what type of hearing loss? Conductive Sensorineural Correct Central auditory imperceptive Mixed conductive-sensorineural 2. Sensorineural hearing loss, also known as perceptive or nerve deafness, involves damage to the inner ear structures or the auditory nerve. It results in distortion of sounds and problems in discrimination. 1. Conductive hearing loss involves mainly interference with loudness of sound. 3. Central auditory imperceptive hearing loss manifests as a combination of both sensorineural and conductive loss. 4. The mixed conductive-sensorineural category includes all hearing losses that do not demonstrate defects in the conduction or sensory structures. 156 A nurse would suspect possible visual impairment in a child who displays which of the following? Excessive rubbing of the eyes Correct Delay in speech development Rapid lateral movement of the eyes Lack of interest in casual conversation with peers 1. Excessive rubbing of the eyes is a clinical manifestation of visual impairment. 2. Delay in speech development, rapid lateral movement of the eyes, and lack of interest in casual conversation with peers are not associated with visual impairment. 3. Delay in speech development, rapid lateral movement of the eyes, and lack of interest in casual conversation with peers are not associated with visual impairment. 4. Delay in speech development, rapid lateral movement of the eyes, and lack of interest in casual conversation with peers are not associated with visual impairment. 157 Which of the following is a common clinical manifestation of autism? Deafness Tendency to overeat Early abnormal eye contact Correct Intense desire to be held and cuddled 3. The inability to maintain eye contact with another individual is a hallmark of autism. 1. The child with autism has spoken language delays, not deafness. 2. Children with autism may be picky eaters or willfully starve themselves or gag to prevent eating. They may also eat any available edible or inedible object. 4. A goal of nursing care is to decrease stimulation. Physical contact can be upsetting to children with autism. 158 A young child who has an intelligence quotient (IQ) of 45 would be described as which of the following? Mildly cognitively impaired but educable Moderately cognitively impaired but trainable Correct Within the lower limits of the range of normal intelligence Severely cognitively impaired and completely dependent on others for care 2. Children are considered trainable and moderately cognitively impaired if their IQ falls within range of 36 to 49. 1. Individuals with IQs of 50 to 75 are considered mildly cognitively but educable. 3. The lower limit of normal intelligence is approximately 70. 4. An IQ of 20 to 35 results in severe cognitive impairment. 159 Home care is being considered for a young child who is ventilator dependent. Which of the following factors is most important in deciding whether home care is appropriate? Level of education of parents Adequate family training Correct Presence of two parents in the home Family's ability to assume all health care costs 2. One of the essential elements is the family's preparation and ability to care for the child. The family must be able to demonstrate all aspects of care for the child, since in many areas nursing care may not be available on a continual basis. 1. The amount of formal education reached by the parents is not the important issue. The determinant is the family's ability to care adequately for the child in the home. 3. At least two family members should learn and demonstrate all aspects of the child's care in the hospital, but it does not have to be two parents. 4. Few families can assume all health care costs. Creative financial planning, including negotiating arrangements with the insurance company or public programs, may be required. 160 For case management to be the most effective, who is the most appropriate case manager? One nurse Correct A panel of experts The insurance company A multidisciplinary team 1. Nursing case managers are ideally suited to provide the care coordination necessary. Care coordination is most effective if a single person works with the family to accomplish the many tasks and responsibilities that are necessary. The family retains the role as primary decision maker. 2. It is preferable that the family have only one individual to work with. 3. Most likely the insurance company will have a case manager focusing on the financial aspects of care. This does not include coordination of care to assist the family. 4. It is preferable that the family have only one individual to work with. 161 The home health nurse is caring for a child who requires complex care. The family expresses frustration related to obtaining accurate information about their child's illness and its management. Which of the following is the best action for the nurse? Determine why family is easily frustrated. Refer family to child's primary care practitioner. Provide information family requests, being confident that every question can be answered by the nurse. Answer questions in a straightforward manner; get professional assistance when answer is unknown. Correct 4. The philosophic basis for family-centered practice is the recognition that the family is the constant in the child's life. It is essential that the family have complete and accurate information about their child's illness and management. The nurse may first have to clarify what information the family believes has not been communicated. 1. The family's frustration arises from their perception that they are not receiving information pertinent to their child's care. 2. It does not help the family to refer the family to the child's primary care practitioner. The home health nurse should have access to the necessary information. 3. Questions about what they need and want to know concerning their child's care should be addressed, but the nurse may not be able to answer every question. 162 A family wants to begin oral feeding of their 4-year-old son, who is ventilator dependent and currently tube-fed. They ask the home health nurse to feed him the baby food orally. The nurse recognizes a high risk of aspiration and an already compromised respiratory status. The most appropriate nursing action is which of the following? Refuse to feed him orally, since the risk is too high. Explain the risks involved and then let the family decide what should be done. Feed him orally because the family has the right to make this decision for their child. Acknowledge their request, explain the risks, and explore with the family the available options. Correct 4. Parents want to be included in the decision making for their child's care. The nurse should discuss the request with the family to ensure this is the issue of concern, and then potential options can be explored. 1. Refusing to feed him orally does not determine why the parents wish the oral feedings to begin and does not involve them in problem solving. 2. The decision to begin or not to change feedings should be a collaborative one, made in consultation with the family, nurse, and appropriate member of the health care team. 3. The decision to begin or not to change feedings should be a collaborative one, made in consultation with the family, nurse, and appropriate member of the health care team. 163 The home health nurse is planning care for a 3-year-old boy who has Down syndrome and is on continuous oxygen. He recently began walking around furniture. He is spoon-fed by his parents and eats some finger foods. Which of the following is the most appropriate goal to promote normal development? Encourage mobility. Correct Encourage assistance in self-care. Promote oral-motor development. Provide opportunities for socialization. 1. A major principle for developmental support in children with complex medical issues is

Mechanical obstruction caused by increased viscosity of exocrine gland secretions

158 A young child who has an intelligence quotient (IQ) of 45 would be described as which of the following? Mildly cognitively impaired but educable Moderately cognitively impaired but trainable Within the lower limits of the range of normal intelligence Severely cognitively impaired and completely dependent on others for care

Moderately cognitively impaired but trainable 2. Children are considered trainable and moderately cognitively impaired if their IQ falls within range of 36 to 49. 1. Individuals with IQs of 50 to 75 are considered mildly cognitively but educable. 3. The lower limit of normal intelligence is approximately 70. 4. An IQ of 20 to 35 results in severe cognitive impairment.

66 Which method should the student nurse use to apply the principles of cough etiquette in the clinical setting to prevent the potential spread of infection? Wearing a surgical mask for all patient contacts even if the student nurse has not overt clinical symptoms of having a cold. Maintaining a perimeter of 10 feet from patient and visitors when coughing. Using tissues when coughing to catch secretions. Covering the nose when coughing.

Using tissues when coughing to catch secretions. Using a tissue when coughing to catch secretions is recommended. One does not have to wear a surgical mask if they do not have any cold type symptoms in the clinical environment unless the patient is neutropenic. Maintaining a space of 3 feet or more is recommended whereas 10 feet would be excessive. Covering one's mouth is recommended when coughing whereas the nose should be covered during sneezing.

115 The most common signs and symptoms of leukemia related to bone marrow involvement are which of the following? Petechiae, fever, and fatigue Headache, papilledema, and irritability Muscle wasting, weight loss, and fatigue Decreased intracranial pressure, psychosis, and confusion

Petechiae, fever, and fatigue Signs of infiltration of the bone marrow are petechiae from lowered platelet count, fever related to infection from the depressed number of effective leukocytes, and fatigue from the anemia. Headache, papilledema, irritability, muscle wasting, weight loss, fatigue, decreased intracranial pressure, psychosis, and confusion are not signs of bone marrow involvement.

A pediatric oncology patient has developed a nose bleed. Which testing parameter would be indicted in order to decide if medical treatment is needed? Chest x-ray CT of the nose Lumbar puncture Platelet count

Platelet count Pediatric oncology patients are at an increased risk for hemorrhage and bleeding. Evidence of a nose bleed may indicate thrombocytopenia and as such a platelet count should be obtained. Imaging studies such as CT and chest x-ray will not provide information related to hemostasis. An invasive procedure such as a lumbar puncture would be indicated if there was possibility of an infectious process.

56 What is described as the time interval between early manifestations of a disease and the overt clinical syndrome? Incubation period Prodromal period Desquamation period Period of communicability

Prodromal period The prodromal period is defined as the symptoms that occur between early manifestations of the disease and overt clinical symptoms. The incubation period is the time from exposure to the appearance of the first symptom. The desquamation period refers to the shedding of skin when applicable for a syndrome or disorder. The period of communicability describes the period when the child is infectious.

100 The nurse understands that respiratory hygiene and cough etiquette is recommended by the Centers for Disease Control and Prevention (CDC) to prevent which of the following? HBV, Hib, and pertussis HSV, influenza, and HBV RSV, influenza, and adenovirus RSV, pertussis, and varicella

RSV, influenza, and adenovirus The CDC (2007) recommends respiratory hygiene and etiquette to prevent the transmission of RSV, influenza, adenovirus, and other droplet-transmitted unknown viruses. HBV, HSV, and varicella are not transmitted via droplets.

111 The school nurse is discussing prevention of acquired immunodeficiency syndrome with some adolescents. Which of the following is appropriate to include? The virus is easily transmitted. It is only transmitted through blood. Condoms should be used if adolescents are homosexual. Recreational drug users should not share needles or other equipment.

Recreational drug users should not share needles or other equipment. Human immunodeficiency virus is spread through blood and body fluids. Intravenous needles that have been used should not be shared. They may be contaminated with the virus. The virus is not easily transmitted. It requires direct contact with blood or body fluids on a nonintact skin surface. Body fluids may also transmit the virus. Condoms should be used for both heterosexual and homosexual sex.

The nurse is assessing a pediatric oncology patient's nutritional status. Which diagnostic tests would provide best practice approach? Albumin, blood urea nitrogen (BUN) and daily weight Skinfold assessments and daily weight Intake and output with daily calorie count Serum prealbumin, albumin and transferrin

Serum prealbumin, albumin and transferrin No one diagnostic test or measurement provides enough evidence to evaluate the nutritional well-being of an individual patient. BUN provides evidence of hydration status but typically should be viewed using a BUN creatinine ratio to provide detailed information about a patient's renal status. Skinfold assessments while important again do not provide enough evidence even with the addition of a daily weight to evaluate one's nutritional status. Intake and output measurements in combination with daily calorie count are representative of hydration and nutritional support but do not provide information relative to nutritional body stores.

101 What is the most common piece of medical equipment that can transmit harmful microorganisms among patients? Thermometer Stethoscope Injection needle Disposable gloves

Stethoscope A stethoscope is commonly used between patients, and if not correctly disinfected, it can be a dangerous source of spreading microorganisms. Thermometers of all types have barriers to prevent this. Needles are discarded immediately after injections and never reused, so they are not a common source of transmission. Disposable gloves are not reused, so they are not a common source of transmission.

106 The nurse suspects a child is having an adverse reaction to a blood transfusion. The first action by the nurse should be which of the following? Notify the physician. Take the vital signs and blood pressure and compare them with baseline levels. Dilute infusing blood with equal amounts of normal saline. Stop transfusion and maintain a patent intravenous line with normal saline and new tubing.

Stop transfusion and maintain a patent intravenous line with normal saline and new tubing. Stopping the transfusion and maintaining a patent intravenous line with normal saline and new tubing is the priority nursing action. If an adverse reaction is occurring, it is essential to minimize the amount of blood that is infused. Notifying a physician and taking vital signs and blood pressure should be performed after the blood transfusion is stopped and infusion of normal saline has begun. Blood should not be diluted; it should be returned to the blood bank if an adverse reaction has occurred.

A child with lymphoma is receiving extensive radiotherapy. What is the most common side effect of this treatment? Fatigue Seizures Neuropathy Lymphadenopathy

Fatigue Fatigue is the most common side effect of radiotherapy. For children, the fatigue may be distressing because they cannot keep up with their peers. Seizures are unlikely, because irradiation would not usually be cranial for lymphoma. Neuropathy is a side effect of certain chemotherapeutic agents but not of radiotherapy. Lymphadenopathy is one of the findings of lymphoma, not a side effect of radiotherapy.

An example of a disease process with underlying immune adaptation l potentially leading to a cancer diagnosis is? Fanconi anemia Wiskott Aldrich syndrome Klinefelter syndrome Retinoblastoma

Wiskott Aldrich syndrome Wiskott Aldrich syndrome is an example of an immunodeficiency state may place the individual at increased risk to develop certain cancers. Fanconi anemia and Klinefelter syndrome are examples of chromosomal abnormalities which can potentially lead to development of cancer. Retinoblastoma is an example of "two-hit" hypothesis of inheritance leading to development of cancer states.

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

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

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

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

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

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

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

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

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

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

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

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

44 A child with asthma is having pulmonary function tests. The purpose of the peak expiratory flow rate (PEFR) is to: confirm the diagnosis of asthma. determine the cause of asthma. identify "triggers" of asthma. assess the severity of asthma.

assess the severity of asthma. Diagnosis of asthma is made on the basis of clinical manifestations, history, and physical examination. The causes of asthma are inflammation, bronchospasm, and obstruction. Some of the triggers of asthma are identified with allergy testing. The PEFR measures the maximum amount of air that can be forcefully exhaled in 1 minute. This can provide an objective measure of pulmonary function when compared to the child's baseline.

95 If the mother of a child is hepatitis B surface antigen (HBsAg) negative, the nurse knows that the child should receive his or her first dose of the hepatitis B virus (HBV) vaccine at 2 months of age, at the first well-child visit. birth before discharge from the hospital. 6 months of age, at the third well-child visit. no time (this vaccine is not currently recommended).

birth before discharge from the hospital. It is recommended that newborns receive the hepatitis B vaccine before hospital discharge if the mother is HBsAg negative. The second dose of the vaccine is given at the first well-child visit. The third dose of the vaccine is given at the third well-child visit. The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention and the Committee on Infectious Diseases of the American Academy of Pediatrics govern the recommendations for immunization, which include the hepatitis B virus vaccine.

Iron dextran is ordered for a young child with severe iron deficiency anemia. Nursing considerations include to: a.administer with meals. b.administer between meals. c.inject deeply into a large muscle. d.massage injection site for 5 minutes after administration of drug.

c.inject deeply into a large muscle. ANS: C Iron dextran is a parenteral form of iron. When administered intramuscularly, it must be injected into a large muscle. Iron dextran is for intramuscular or intravenous (IV) administration. The site should not be massaged to prevent leakage, potential irritation, and staining of the skin.

The nurse notes that a child has lost 8 pounds after 4 days of hospitalization for acute glomerulonephritis. This is most likely the result of: a.poor appetite. b.increased potassium intake. c.reduction of edema. d.restriction to bed rest.

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

81 One of the goals for children with asthma is to prevent respiratory tract infection because infections lessen effectiveness of medications encourage exercise-induced asthma increase sensitivity to allergens can trigger an episode or aggravate asthmatic state

can trigger an episode or aggravate asthmatic state

A child has frequent nose bleeds without warning producing varying amount of blood. Inspection of the nose area reveals irritated mucosa but no evidence of picking or trauma. The child has no history of allergic rhinitis or upper respiratory infections. Denies taking any medication, either prescribed or over the counter. Based on this information the nurse would: maintain wait full management as most nose bleeds originate from anterior portion of nose. suggest that the patient use humidification to prevent dryness of nasal passages. consider referral to ENT for evaluation for other comorbidities. increase fluid content to maintain humidification as this may be due to environmental dryness.

consider referral to ENT for evaluation for other comorbidities. Even though the majority of nose bleeds are considered to be from the anterior portion of the nose, the fact that the patient has frequent nose bleeds without warning in the absence of irritation or disease states alerts the nurse that there may be other underlying comorbidities such as vascular disorders, leukemia, thrombocytopenia, and clotting factor deficiencies. As such the patient should be referred for further evaluation.

Parents have understood teaching about prevention of childhood otitis media if they make which statement? a."We will only prop the bottle during the daytime feedings." b."Breastfeeding will be discontinued after 4 months of age." c."We will place the child flat right after feedings." d."We will be sure to keep immunizations up to date."

d."We will be sure to keep immunizations up to date." ANS: D Parents have understood the teaching about preventing childhood otitis media if they respond they will keep childhood immunizations up to date. The child should be maintained upright during feedings and after. Otitis media can be prevented by exclusively breastfeeding until at least 6 months of age. Propping bottles is discouraged to avoid pooling of milk while the child is in the supine position.

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

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

The nurse is caring for a 10-month-old infant with respiratory syncytial virus (RSV) bronchiolitis. Which intervention should be included in the child's care? (Select all that apply.) a.Place in a mist tent. b.Administer antibiotics. c.Administer cough syrup. d.Encourage to drink 8 ounces of formula every 4 hours. e.Cluster care to encourage adequate rest. f.Place on noninvasive oxygen monitoring.

d.Encourage to drink 8 ounces of formula every 4 hours. e.Cluster care to encourage adequate rest. f.Place on noninvasive oxygen monitoring. ANS: D, E, F Hydration is important in children with RSV bronchiolitis to loosen secretions and prevent shock. Clustering of care promotes periods of rest. The use of noninvasive oxygen monitoring is recommended. Mist tents are no longer used. Antibiotics do not treat illnesses with viral causes. Cough syrup suppresses clearing of respiratory secretions and is not indicated for young children.

Which is an appropriate nursing intervention when caring for an infant with an upper respiratory tract infection and elevated temperature? a.Give tepid water baths to reduce fever. b.Encourage food intake to maintain caloric needs. c.Have child wear heavy clothing to prevent chilling. d.Give small amounts of favorite fluids frequently to prevent dehydration.

d.Give small amounts of favorite fluids frequently to prevent dehydration. ANS: D Preventing dehydration by small frequent feedings is an important intervention in the febrile child. Tepid water baths may induce shivering, which raises temperature. Food should not be forced; it may result in the child vomiting. The febrile child should be dressed in light, loose clothing.

Which is a common side effect of short-term corticosteroid therapy? a.Fever b.Hypertension c.Weight loss d.Increased appetite

d.Increased appetite ANS: D Side effects of short-term corticosteroid therapy include an increased appetite. Fever is not a side effect of therapy. It may be an indication of infection. Hypertension is not usually associated with initial corticosteroid therapy. Weight gain, not weight loss, is associated with corticosteroid therapy.

Which explanation regarding cardiac catheterization is appropriate for a preschool child? a.Postural drainage will be performed every 4 to 6 hours after the test. b.It is necessary to be completely "asleep" during the test. c.The test is short, usually taking less than 1 hour. d.When the procedure is done, you will have to keep your leg straight for at least 4 hours.

d.When the procedure is done, you will have to keep your leg straight for at least 4 hours. ANS: D The child's leg will have to be maintained in a straight position for approximately 4 hours. Younger children can be held in the parent's lap with the leg maintained in the correct position. Postural drainage will not be performed unless the child has corresponding pulmonary problems. The child should be sedated to lie still, but being completely asleep is not necessary. The test will vary in length of time from start to finish.

68 The most important prevention method for the spread of any communicable disease is hand washing. immunizations as secondary prevention. use of appropriate broad spectrum antibiotics. isolation from infectious agents.

hand washing. Hand washing is the single most important prevention method for the spread of any communicable disease. Immunizations are considered to be a form of primary prevention. Use of appropriate broad spectrum antibiotics are not considered effective against all communicable diseases. Isolation from infectious agents may not be a realistic option.

75 An important nursing intervention in the care of a child with bacterial conjunctivitis is intermittent warm, moist compresses to remove crusts on the eye area. oral antihistamines to minimize itching. continuous warm compresses to relieve discomfort. application of optic corticosteroids to reduce inflammation.

intermittent warm, moist compresses to remove crusts on the eye area. The eye should be kept clean. Intermittent warm, moist compresses can soften the crusting for easier removal, maintaining the cleanliness of the eye. Antihistamines are not usually necessary for bacterial conjunctivitis. Continuous warm compresses would promote bacterial growth. Antibiotics are the treatment of choice for bacterial infections; optic corticosteroids are not warranted.

39 Asthma is classified into four categories: mild intermittent, mild persistent, moderate persistent, and severe persistent. Clinical features used to determine these categories include: (Select all that apply.) lung function. associated allergies. frequency of symptoms. frequency and severity of exacerbations.

lung function. frequency of symptoms. frequency and severity of exacerbations. The peak expiratory flow rate is one of the diagnostic criteria for classifying severity. The frequency of symptoms is one of the diagnostic criteria for classifying severity. The frequency and severity of exacerbations are two of the diagnostic criteria for classifying severity. The clinical features that distinguish the categories of asthma do not include other allergies.

90 Asthma is classified into four categories: mild intermittent, mild persistent, moderate persistent, and severe persistent. Clinical features used to determine these categories include (Select all that apply.) lung function. associated allergies. frequency of symptoms. frequency and severity of exacerbations.

lung function. frequency of symptoms. frequency and severity of exacerbations. The peak expiratory flow rate is one of the diagnostic criteria for classifying severity. The frequency of symptoms is one of the diagnostic criteria for classifying severity. The frequency and severity of exacerbations are two of the diagnostic criteria for classifying severity. The clinical features that distinguish the categories of asthma do not include other allergies.

76 The nurse is assessing a child with herpetic gingivostomatitis. The nurse wears gloves when examining the lesions. This nursing action is unnecessary because the virus is sexually transmitted. unnecessary because the virus is not easily spread. necessary only if the nurse touches his or her own mouth after touching the child's mouth. necessary because virus can easily enter breaks in the skin.

necessary because virus can easily enter breaks in the skin. HSV easily enters breaks in the skin and can cause herpetic whitlow on the fingers. Herpetic gingivostomatitis is usually caused by herpes simplex virus (HSV) HSV 2 is usually transmitted through sexual activity. Gloves are always necessary because the virus is easily spread.

Critical safety considerations that must be included if parenteral iron injections are used as part of therapy include (Select all that apply.) type and cross match. no massage following injection. multiple injections are preferred over intravenous route. no more than 1 ml should be given via injection. there is no need for a test dose administration if administered intravenously.

no massage following injection. no more than 1 ml should be given via injection. There is no need to perform a type and cross for iron replacement therapy. Administration via injection is done into a large muscle mass using Z track technique with no massage following. Preference is for intravenous route over intramuscular route if more than one injection is needed. No more than 1 ml is given via injection and a test dose is recommended if using intravenous route to high potential for allergic reaction.

58 A toddler has a deep laceration contaminated with dirt and sand. Before suturing, the nurse should irrigate the wound with alcohol. normal saline. hydrogen peroxide. povidone-iodine.

normal saline. Normal saline is the only acceptable fluid for irrigation from the choices given above. The nurse should cleanse the wound with a forced stream of normal saline or water. Alcohol, hydrogen peroxide or povidone-iodine should not be used as irrigation solutions, because they would be toxic to the wound.

A child with sickle cell anemia develops severe chest pain, fever, a cough, and dyspnea. The nurse's first action is to administer 100% oxygen to relieve hypoxia. administer pain medication to relieve symptoms. notify practitioner because chest syndrome is suspected. notify practitioner because child may be having a stroke.

notify practitioner because chest syndrome is suspected. Severe chest pain, fever, a cough, and dyspnea are the signs and symptoms of chest syndrome. The nurse must notify the practitioner immediately. Breathing 100% oxygen to relieve hypoxia may be ordered by the practitioner, but the first action is notification because these symptoms indicate a medical emergency. Pain medications may be indicated, but evaluation is necessary first. Severe chest pain, fever, cough, and dyspnea are not signs of a stroke.

31 A 3-year-old child is scheduled for surgery to remove a Wilms tumor from one kidney. The parents ask the nurse about what treatments, if any, will be necessary after recovery from surgery. What would be the most appropriate response from the nurse? "Radiation therapy may be necessary." "A kidney transplant will be planned." "No additional treatments are usually necessary." "Chemotherapy with or without radiation therapy is indicated."

"Chemotherapy with or without radiation therapy is indicated." This determination will be made on the basis of the histologic pattern of the tumor. Chemotherapy with or without radiation therapy is usually indicated. Radiation therapy may be necessary, but chemotherapy is first. Most children with Wilms tumor do not require renal transplants. Additional therapy is indicated after the tumor is removed.

126 The nurse is beginning to administer the Denver II to a small child when his mother says, "Can you tell me again what this Denver II is?" The nurse's best response is which of the following? "It's a simple intelligence test for young children." "It tells us what a child can do at a particular age." "It's a test we give to measure a child's development." "It's an excellent way to see if a child's development is normal."

"It tells us what a child can do at a particular age." 2. The Denver II is a developmental screening tool that assesses the child's abilities at different ages. 1. The Denver II is a screening tool for developmental milestones, not intelligence. 3. Children are not expected to perform each item on the Denver II. Most children will perform tasks in a range. It is used to provide an indication of the child's developmental level. 4. Children are not expected to perform each item on the Denver II. Most children will perform tasks in a range. It is used to provide an indication of the child's developmental level.

The nurse in an outpatient clinic is conducting a follow-up assessment on a child who had a severe streptococcal infection 1 week ago. The client is doing better, and the nurse is providing teaching to the parents about continuing to monitor the client for possible complications of the infection. Which information is most important for the nurse to discuss with the parents?

"Return immediately if acute flank or mid-abdominal pain occurs." Rationale: Acute glomerulonephritis is a major complication of streptococcal infections in children. The onset is often marked by a sudden occurrence of acute flank or mid-abdominal pain. The child may show signs of fluid retention, such as weight gain and edema.

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

"There is a 25% chance of a sibling having SCA." SCA is inherited as an autosomal recessive disorder. In this inheritance pattern, there is a 25% chance that each subsequent child will have the disorder. SCA is an inherited hemoglobinopathy. In autosomal recessive disorders, there is a chance that 25% of the children

98 The hepatitis A vaccine is now recommended at which of the following ages? 1 year 1 month 12 years It is not recommended at any age.

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

123 Binocularity, the ability to fixate on one visual field with both eyes simultaneously, is normally present by what age? 1 month 3 to 4 months 6 to 8 months 12 months

3 to 4 months 2. Binocularity is usually achieved by age 3 to 4 months. 1. One month is too young for binocularity. 3. If binocularity is not achieved by 6 to 12 months, the child must be observed for strabismus. 4. If binocularity is not achieved by 6 to 12 months, the child must be observed for strabismus.

18 The nurse is explaining the blood component platelets to an 8-year-old child with hemophilia. How should the nurse best describe platelets to this child? "Platelets help keep germs from causing infection." "They make up the liquid portion of blood." "These cells carry the oxygen you breathe from your lungs to all parts of your body." "Platelets help your body stop bleeding by forming a clot (scab) over the bleeding area."

"Platelets help your body stop bleeding by forming a clot (scab) over the bleeding area." Platelets are involved in homeostasis, and the explanation can be understood by an 8-year-old. White blood cells help keep germs from causing infection. Plasma makes up the liquid portion of blood. Red blood cells carry the oxygen you breathe from your lungs to all parts of your body.

12 The parent of a child receiving an iron preparation tells the nurse that the child's stools are a tarry greenish-black color. What should the nurse's response be? "This is a symptom of iron deficiency anemia." "What you are seeing is an adverse effect of the iron preparation." "This is an indicator of an iron preparation overdose." "You can expect this change in the stools caused by the iron preparation."

"You can expect this change in the stools caused by the iron preparation." An adequate dosage of iron turns the stools a tarry greenish-black color. A symptom of iron deficiency anemia is not relevant. If the stools do not become a tarry greenish-black color, it may indicate administration issues. An adverse effect of the iron preparation is not relevant. If the stools do not become a tarry greenish-black color, it may indicate administration issues. This does not indicate an iron preparation overdose. If the stools do not become a tarry greenish-black color, it may indicate administration issues.

154 The child with Down syndrome may be screened for which of the following before participating in some sports? Hyperflexibility Cutis marmorata Atlantoaxial instability Speckling of iris (Brushfield spots)

3. Children with Down syndrome are at risk for atlantoaxial instability. Before they participate in sports that put stress on the head and neck, a radiologic examination should be done. 1. Hyperflexibility, cutis marmorata, and speckling of iris (Brushfield spots) are characteristic of Down syndrome, but they do not affect the child's ability to participate in sports. 2. Hyperflexibility, cutis marmorata, and speckling of iris (Brushfield spots) are characteristic of Down syndrome, but they do not affect the child's ability to participate in sports. 4. Hyperflexibility, cutis marmorata, and speckling of iris (Brushfield spots) are characteristic of Down syndrome, but they do not affect the child's ability to participate in sports.

132 Which of the following statements explains why it can be difficult to assess a child's dietary intake? No systematic assessment tool has been developed. Biochemical analysis for assessing nutrition is expensive. Families usually do not understand much about nutrition. Recall of food consumption is frequently unreliable.

4. An individual's recall of food intake, especially amounts eaten, is frequently unreliable. 1. Systematic tools such as the 24-hour recall and detailed dietary history questionnaires are available. 2. Biochemical analysis is not necessary for assessing dietary intake. 3. Family knowledge of nutrition is not required. Detailed questions can elicit the child's patterns of eating and food intake.

9 A 4-year-old child needing to use a metered-dose inhaler to treat asthma cannot coordinate her breathing to use it effectively. The appropriate intervention by the nurse is to use which piece of respiratory equipment? A spacer A nebulizer A peak expiratory flowmeter An incentive spirometer

A spacer The medication in a metered-dose inhaler is sprayed into the spacer. The child can then inhale the medication without having to coordinate the spraying and breathing. A nebulizer is a mechanism used to administer medications, but it cannot be used with metered-dose inhalers. This is a measure of pulmonary function not related to medication administration. This item helps patients to increase their lung expansion and to be able to see their progress.

37 Because the absorption of fat-soluble vitamins is decreased in children with cystic fibrosis, supplementation of which vitamins is necessary? C, D A, E, K A, D, E, K C, folic acid

A, D, E, K C is not one of the fat-soluble vitamins. D also needs to be supplemented. A, D, E, and K are the fat-soluble vitamins that need to be supplemented in higher doses. C and folic acid are not fat soluble.

121 Which of the following statements is true concerning the increased use of telephone triage by nurses? Health care costs have increased as a result. Emergency department visits are not recommended. Access to high-quality health care services has increased. Home care is recommended when it is not appropriate.

Access to high-quality health care services has increased. 3. With well-designed telephone triage programs, access to high-quality health care services and patient satisfaction have increased. 1. With the reduction in unnecessary emergency department and clinic visits, health care costs have decreased. 2. Emergency department visits are recommended based on the response to screening questions and when the child's condition is in doubt. 4. Guidelines are given for home management, if the triage assessment indicates that level of care. Parents are given instructions about changes in the child's condition to report.

150 When a child with mild cognitive impairment reaches the end of adolescence, which of the following characteristics would be expected? Achieves a mental age of 5 to 6 years Achieves a mental age of 8 to 12 years Is unable to progress in functional reading or mathematics Acquires practical skills and useful reading and mathematics to an eighth-grade level

Achieves a mental age of 8 to 12 years 2. By the end of adolescence, the child with mild cognitive impairment can acquire practical skills and useful reading and math skills to a third- to sixth-grade level. A mental age of 8 to 12 years is obtainable, and the child can be guided toward social conformity. 1. A mental age of 5 to 12 years is characteristic of children with moderate cognitive impairment. 3. A mental age of 5 to 12 years is characteristic of children with moderate cognitive impairment. 4. Practical skills and useful reading and mathematics at an eighth-grade level are not descriptive of cognitive impairment.

114 Which of the following pediatric oncologic emergencies is caused by the rapid release of intracellular metabolites during the initial treatment of some cancers? Hyperleukocytosis Overwhelming infection Acute tumor lysis syndrome Superior vena cava syndrome

Acute tumor lysis syndrome Acute tumor lysis syndrome is caused by the rapid release of intracellular metabolites during the initial treatment of malignancies. Hyperleukocytosis, a white blood cell count greater than 100,000/mm3, can be present at diagnosis. It is not a result of the treatment. Infection may occur from bone marrow suppression that results from many chemotherapeutic agents. Superior vena cava syndrome can occur from compression of the mediastinal structures by Hodgkin disease and non-Hodgkin lymphoma.

The nurse in planning care for the pediatric oncology patient anticipates implementing which action with regard to the administration of an antiemetic in a chemotherapy protocol? Providing the medication on a prn basis based on patient's presenting symptoms of nausea and/or vomiting. Administering the medication via the oral route following infusion of chemotherapy protocol. Providing medication with sips of water following clinical symptoms of nausea and/or vomiting. Administering 30 to 60 minutes prior to initiation of therapy.

Administering 30 to 60 minutes prior to initiation of therapy. Anticipatory management of an antiemetic is part of chemotherapy and/or radiation protocols. It is typically given 30 to 60 minutes prior to the infusion and administered in a scheduled sequence rather than based on a prn or when the patient presents symptomatically. Preferred route of administration is via parenteral route especially if the anticipated risk for nausea and/or vomiting is increased.

139 An adolescent girl tells the nurse that she thinks about death all of the time. The nurse asks her if she has a specific plan. This question should be considered which of the following? An essential part of the assessment Suggesting that the adolescent needs a plan Inappropriate until parents are present for discussion A close-ended question that will inhibit assessment

An essential part of the assessment 1. Routine health assessments of adolescents should include questions that assess the presence of suicidal ideation or intent. It is essential if the child expresses thoughts about death. Questions such as "Have you ever developed a plan to hurt yourself or kill yourself" should be part of the assessment. 2. The information about having a plan is an essential part of the assessment and greatly affects the treatment plan. 3. Safety of the adolescent is of primary concern. The question needs to be addressed in an adolescent with suicidal ideation. 4. Asking about a specific plan is a close-ended question, requiring a yes or no answer. Adolescents who express suicidal feelings and have a specific plan are at particular risk and require further assessment and constant monitoring.

The parent states that he will wash his hands before applying the medication. The parent will read the product label before administering the medication. The parent will inform the pediatrician that the medication is being used. Application of the medication will be given orally to avoid potential sneezing.

Application of the medication will be given orally to avoid potential sneezing. Topical vapor rubs should never be given orally or applied beneath the nose. All of the other options indicate appropriate action on the part of the parent in terms of medical asepsis, obtaining information by reading label and notifying the health care provider that a medication is being used in the current treatment plan.

17 A school-age child with hemophilia falls on the playground and goes to the school nurse with superficial bleeding above the elbow. What is the most appropriate action by the nurse? Apply warm, moist compresses. Apply pressure for at least 15 minutes. Keep the affected extremity in a dependent position. Begin passive range of motion unless pain is severe.

Apply pressure for at least 15 minutes. Pressure should be applied for at least 15 minutes to help control superficial bleeding. The extremity should be immobilized and elevated. Passive range of motion is not recommended until the bleeding has resolved. Then the child can perform active range of motion as a prophylaxis for joint function. Cold compresses should be applied to the arm. This will aid in vasoconstriction and pain reduction.

61 When applying wet compresses or dressings to the skin, what should the nurse do? Apply the dressing so that the area is totally immobilized. Apply the dressing when it is saturated and dripping. Pour or syringe a new solution over a dressing that has become dry. Apply the desired solution on cotton gauze or soft cotton cloths, such as clean cloths.

Apply the desired solution on cotton gauze or soft cotton cloths, such as clean cloths. The desired solution should be applied to Kerlix gauze; soft cotton cloths; or strips from cloth diapers, sheets, or pillowcase material. The moist dressing should be laid flat on the area with an attempt to not restrict movement. After immersion in the solution, the dressings are wrung out to avoid dripping. The material should be moistened and then reapplied. When the solution dries, concentrated residue is left in the dressing. The addition of fluid may result in a more concentrated soak being placed on the sensitive tissue.

151 When should children with cognitive impairment be referred for stimulation and educational programs? As young as possible As soon as they have the ability to communicate in some way At age 3 years, when schools are required to provide services At age 5 or 6 years, when schools are required to provide services

As young as possible 1. The child's education should begin as soon as possible. Considerable evidence exists that early intervention programs for children with disabilities are valuable for cognitively impaired children. 2. The early intervention may facilitate the child's development of communication skills. 3. States are encouraged to provide early intervention programs from birth under Public Law 101-476, the Individuals with Disabilities Education Act. 4. States are encouraged to provide early intervention programs from birth under Public Law 101-476, the Individuals with Disabilities Education Act.

80 A child with asthma is having pulmonary function tests. What explains the purpose of the peak expiratory flow rate (PEFR)? Confirms the diagnosis of asthma Determines the cause of asthma Identifies the "triggers" of asthma Assesses the severity of asthma

Assesses the severity of asthma The PEFR measures the maximum amount of air that can be forcefully exhaled in 1 minute. This can provide an objective measure of pulmonary function when compared with the child's baseline. The diagnosis of asthma is made on the basis of clinical manifestations, history, and physical examination, not pulmonary function tests such as the PEFR. The cause of asthma is inflammation, bronchospasm, and obstruction, which are not identified by the PEFR. Some of the triggers of asthma are identified with allergy testing, not with the PEFR.

146 Drug abuse is suspected in an adolescent being seen in the emergency department. Which of the following physical signs is suggestive of barbiturate ingestion? Ataxia Cyanosis Sweating Tachycardia

Ataxia 1. The physical signs of barbiturate ingestion include ataxia and slurred speech. 2. Cyanosis is indicative of opiate use. 3. Sweating may be suggestive of amphetamines administered by a parenteral route. 4. Cocaine use will produce tachycardia.

32 The nurse is caring for a child with Wilms tumor. Which preoperative nursing intervention is the most important? Avoid palpating the abdomen. Closely monitor arterial blood gases. Prepare the child and family for long-term dialysis. Prepare the child and family for renal transplantation.

Avoid palpating the abdomen. Wilms tumors are encapsulated. It is extremely important to avoid any palpation of the mass to minimize the risk of dissemination of cancer cells to adjacent and other sites. Closely monitoring arterial blood gases is not indicated preoperatively for this abdominal surgery. Preparing the child and family for long-term dialysis is not indicated unless both kidneys have to be removed. This option is considered a last resort. If both kidneys are involved, preoperative chemotherapy or radiation are used to minimize the size of the tumor. Renal transplantation is planned if both kidneys need to be removed and a compatible living donor exists. Otherwise, dialysis is necessary until a donor organ can be obtained.

96 The Hib conjugate vaccines protect an infant against which of the following diseases? (Select all that apply.) Bacterial meningitis Epiglottitis Bacterial pneumonia Septic arthritis Sepsis

Bacterial meningitis Epiglottitis Bacterial pneumonia Septic arthritis Sepsis Hib conjugate vaccines protect against a number of serious infections caused by Haemophilus influenza type b, especially bacterial meningitis, epiglottitis, bacterial pneumonia, septic arthritis, and sepsis.

99 The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) and American College of Obstetricians and Gynecologists has recommended that pregnant adolescents and women who are not protected against pertussis receive the tetanus, diphtheria and pertussis (Tdap) vaccine optimally at which of the following times? Between 27 and 36 weeks of gestation or postpartum before discharge from the hospital During the first pre-natal visit when pregnancy is confirmed The vaccine should be administered 24 hours prior to delivery This vaccine is only recommended during the first trimester

Between 27 and 36 weeks of gestation or postpartum before discharge from the hospital The ACIP of the CDC and American College of Obstetricians and Gynecologists has recommended that pregnant adolescents and women who are not protected against pertussis receive the Tdap vaccine optimally between 27 and 36 weeks of gestation or postpartum before discharge from the hospital. The vaccine is not recommended during the first trimester. The vaccine is not recommended between 27 and 36 weeks to allot for antibody formation that will protect the mother and passive immunity to the infant.The vaccine is not recommended during the first trimester.

45 One of the goals for children with asthma is to prevent respiratory tract infection. This is because respiratory tract infection does which of the following? Increases sensitivity to allergens Causes exercise-induced asthma Lessens effectiveness of medications Can trigger an episode or aggravate asthmatic state

Can trigger an episode or aggravate asthmatic state Viral respiratory tract infections can exacerbate asthma, especially in young children, whose airways are mechanically smaller and more reactive than those of older children. Respiratory tract infections do not affect sensitivity to allergens. Exercise precipitates exercise-induced asthma. The respiratory tract infection does not lessen the effectiveness of the medications.

143 An adolescent with bulimia has a low potassium level. The nurse is aware of the potential for which of the following complications? Anemia Cardiac arrhythmias Gastrointestinal reflux Heightened neurologic reflexes

Cardiac arrhythmias 2. A low potassium level places the adolescent at risk for cardiac arrhythmias. Hospitalization is recommended when the potassium level is less than 3.2 mmol/L. 1. Anemia is a potential problem when iron intake is not sufficient. This is not common with bulimia. 3. Esophageal tears, not gastrointestinal reflux, are a complication of bulimia. 4. Heightened neurologic reflexes are not an expected complication.

117 The postoperative care of a preschool child who has had a brain tumor removed should include which of the following? Colorless drainage is to be expected. Analgesics are contraindicated because of altered consciousness. Positioning is on the operative side in the Trendelenburg position. Carefully monitor fluids because of cerebral edema.

Carefully monitor fluids because of cerebral edema. Because of cerebral edema and the danger of increased intracranial pressure postoperatively, fluids are carefully monitored. Colorless drainage may be leakage of cerebrospinal fluid from the incision site. This needs to be reported as soon as possible. Analgesics can be used for postoperative pain. The child should not be positioned in the Trendelenburg position postoperatively.

131 The nurse is taking a health history on a child. At the beginning of the interview a parent says, "I brought him here because he always has diarrhea." This should be recorded under which of the following headings? History Chief complaint Review of systems Nutritional assessment

Chief complaint 2. The mother has verbalized the specific reason for the child's visit to the health care provider. The chief complaint is the reason for which the child has been brought to the clinic, office, or hospital. 1. History refers to information that relates to previous aspects of the child's health, not the current. 3. The review of systems is a specific review of each body system. It usually begins with a statement similar to asking the parent to describe how the child's general health has been. 4. A nutritional assessment combines a nutrition history with physical examination.

With regard to incidence of childhood cancer, which statement is accurate? In children there is a high incidence of cancer. Despite a low incidence, there is high morbidity in children under the age of 15. Gender does not affect incidence of childhood cancers. Higher incidence in found in African American children as compared to Caucasians.

Despite a low incidence, there is high morbidity in children under the age of 15. Despite a lower incidence of childhood cancer, there is a higher morbidity associated with specific age groups. Different subtypes of cancer are affected by gender, age and ethnicity. A higher incidence of cancers are found in Caucasian children as compared to African American children.

64 What is most descriptive of atopic dermatitis (eczema) in the infant? Eczema is worse in summer months. Eczema is worse in humid climates. Eczema is associated with upper respiratory tract infections. Eczema is associated with hereditary allergies.

Eczema is associated with hereditary allergies. The majority of children with atopic dermatitis have a family history of eczema, asthma, food allergies, or allergic rhinitis. This suggests a genetic predisposition. Atopic dermatitis worsens in fall and winter months. Eczema improves in humid climates. Eczema is associated with allergies.

109 Chelation therapy is begun on a child with α-thalassemia major. The purpose of this therapy is to do which of the following? Treat the disease. Eliminate excess iron. Decrease risk of hypoxia. Manage nausea and vomiting.

Eliminate excess iron. Iron overload (hemosiderosis) is a complication of blood transfusions. Chelation therapy is necessary to minimize the development of hemosiderosis and hemochromatosis. Blood transfusions are the primary medical management. Chelation therapy removes iron; it does not affect the disease process.

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

Encourage mobility. 1. A major principle for developmental support in children with complex medical issues is that it should be flexible and tailored to the individual child's abilities, interests, and needs. This child is exhibiting readiness for ambulation. It is an appropriate time to take steps that encourage mobility (e.g., providing longer oxygen tubing). 2. Parents should provide decreasing amounts of assistance with self-care as he is able to develop these skills. 3. He is receiving oral foods and is eating finger foods. He has acquired this skill. Mobility is a new developmental task. 4. Opportunities for socialization should be ongoing.

51 Which of the following types of croup is always considered a medical emergency? Laryngitis Epiglottitis Spasmodic croup Laryngotracheobronchitis

Epiglottitis Epiglottitis is always a medical emergency needing antibiotics and airway support for treatment. Laryngitis is a common viral illness in older children and adolescents, with hoarseness and upper respiratory tract infection symptoms. Spasmodic croup is treated with humidity. Laryngotracheobronchitis may progress to a medical emergency in some children.

138 Which of the following is the most commonly used method in completed suicides? Firearms Drug overdose Self-inflicted laceration Carbon monoxide poisoning

Firearms 1. Firearms are the most commonly used instruments in completed suicides among both males and females. For adolescent boys, firearms are followed by hanging and overdose. For adolescent females, overdose and strangulation are the next most common means of completed suicide. 2. The most common method of suicide attempt is overdose or ingestion of potentially toxic substances such as drugs. 3. The second most common method of suicide attempt is self-inflicted laceration. 4. Carbon monoxide poisoning is not one of the more frequent forms of suicide completion.

104 Which of the following vaccinations are included in health promotion during infancy? (Select all that apply.) Haemophilus influenzae type b (Hib) Hepatitis C virus (HCV) Diphtheria, tetanus, and pertussis (DTaP) Poliovirus Hepatitis B virus (HBV)

Haemophilus influenzae type b (Hib) Diphtheria, tetanus, and pertussis (DTaP) Poliovirus Hepatitis B virus (HBV) The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention and the Committee on Infectious Diseases of the American Academy of Pediatrics govern the recommendations for immunization, which include diphtheria, tetanus, and pertussis (DTaP using acellular pertussis); poliovirus; measles, mumps, and rubella (MMR); Hib; HBV; hepatitis A virus (HAV); meningococcal; pneumococcal conjugate vaccine (PCV); and influenza (and H1N1) during infancy. There is no current vaccination to prevent the transmission of hepatitis C virus.

Which findings would the nurse suspect to be observed during a work up for in a pediatric patient suspected of having a brain tumor? (Select all that apply.) Vomiting following eating Headache upon arising that dissipates as the day progresses Correct Decreased pulse pressure Correct Abnormal cranial nerve examination Correct Negative Babinski sign

Headache upon arising that dissipates as the day progresses Decreased pulse pressure Abnormal cranial nerve examination The presence of brain tumor would cause a variety of clinical symptoms depending on the location and extent of the tumor. Expected physical findings are associated with headache upon arising that subsides as the day progresses, a decreased pulse pressure, abnormal neurological exam which includes cranial nerve abnormalities as well as a positive Babinski reflex. Vomiting specifically associated with eating is not directly correlated with a brain tumor. Vomiting can be present but may or not be associated with nausea or feeding.

A pediatric oncology patient is undergoing chemotherapy. Which treatment option would the nurse anticipate being included in the plan of care in order to prevent the development of sterile hemorrhagic cystitis? Restrictive fluid intake. Inclusion of dairy foods in the diet. Implementing a frequent voiding plan throughout the course of the day to the patient. Limiting mobility during course of chemotherapy.

Implementing a frequent voiding plan throughout the course of the day to the patient. Providing a frequent voiding plan to encourage the patient to void upon urge, immediately upon arising, before bedtime and one nighttime void will help to prevent possibility of urinary stasis. Encouraging fluid intake rather than restricting fluid is the mainstay of treatment. Dairy foods in the diet provide no effective treatment against the development of sterile hemorrhagic cystitis. Similarly, limiting mobility is not indicated.

The school nurse is discussing prevention of acquired immunodeficiency syndrome (AIDS) with some adolescents. Which statement is appropriate to include? The virus is easily transmitted. The virus is transmitted only through blood. Intravenous drug users should not share needles. Condoms should be used if a person is sexually active and homosexual.

Intravenous drug users should not share needles. Human immunodeficiency virus (HIV) is spread through blood and body fluids. Intravenous needles that have been used should not be shared. They may be contaminated with the virus. The virus is not easily transmitted. It requires direct contact with blood or body fluids on a nonintact skin surface. Body fluids may also transmit the virus. Condoms should be used for both heterosexual and homosexual sex.

124 The nurse has a 2-year-old boy sit in "tailor" position while palpating for the presence of the testes. What is the rationale for this position? It prevents cremasteric reflex. Undescended testes can be palpated. Child has an inguinal hernia. Child does not yet have a need for privacy.

It prevents cremasteric reflex. 1. The tailor position stretches the muscle responsible for the cremasteric reflex. This prevents its contraction, which pulls the testes into the pelvic cavity. 2. Undescended testes cannot be predictably palpated. 3. Inguinal hernias are not detected by this method. This position is used for inhibiting the cremasteric reflex. 4. Privacy should always be provided for children.

136 The nurse is caring for an adolescent brought to the hospital with acute drug toxicity. Cocaine is believed to be the drug involved. Initial data collection should include which of the following? Chemical content of drug Method of administration Function the drug plays in the adolescent's life Adolescent's level of interest in rehabilitation

Method of administration 2. When the drug is questionable or unknown, every effort must be made to determine the type, amount of drug taken, the method and time of administration, and factors relating to the onset of presenting symptoms. 1. The actual content of most street drugs is highly questionable. Pharmacologic agents should be administered with caution, except for the narcotic antagonists in case of suspected opiate use. 3. The function the drug plays in the adolescent's life and the adolescent's level of interest in rehabilitation are important considerations in the long-term management in the nonacute stage. 4. The function the drug plays in the adolescent's life and the adolescent's level of interest in rehabilitation are important considerations in the long-term management in the nonacute stage.

79 What clinical manifestation would the nurse expect when a pneumothorax occurs in a neonate who is undergoing mechanical ventilation? Barrel chest Wheezing Thermal instability Nasal flaring and retractions

Nasal flaring and retractions Nasal flaring, retractions, and grunting are signs of respiratory distress in a neonate. Barrel chest develops with chronic obstructive pulmonary disease, not with acute pneumothorax. Wheezing has a greater association with bronchopulmonary dysplasia or an obstruction in the airways than with an acute pneumothorax. An acute pneumothorax would not affect the neonate's thermal stability.

Pediatric oncology patients are affected by medical management of their respective disease process and yet it is critical to include health promotion measures as part of their overall care. Which health promotion is not indicated in the plan of care? Continuation of dental hygiene treatment plan consistent with developmental age of child. Family members should receive live measles, mumps and rubella vaccinations as warranted. No treatment should be given if the patient has been exposed to varicella. The patient should not receive live attenuated vaccines during the course of chemotherapy protocol.

No treatment should be given if the patient has been exposed to varicella. If a pediatric oncology patient has been exposed to varicella, dependent on the time frame either varicella immune zoster immunoglobulin should be administered (within 96 hours of exposure) and/or treatment with antiviral agents should be provided if the patient develops varicella. This treatment is indicated as the development of varicella can lead to increased morbidity and mortality. All of the other options should be included in a health promotion plan of care.

16 The nurse is caring for a child with sickle cell disease experiencing severe chest pain, fever, a cough, and dyspnea. What is the nurse's priority action? Administer 100% oxygen to relieve hypoxia. Administer pain medication to relieve symptoms. Notify the health care practitioner because chest syndrome is suspected. Notify the health care practitioner because the child may be having a stroke.

Notify the health care practitioner because chest syndrome is suspected. Severe chest pain, fever, a cough, and dyspnea are the signs and symptoms of chest syndrome. The nurse must notify the practitioner immediately. Severe chest pain, fever, a cough, and dyspnea are not signs of a stroke. Administration of oxygen may be ordered by the practitioner, but the first action is notification also so orders can be obtained. Pain medications may be indicated, but evaluation is necessary first.

24 The nurse is caring for a preschool child after the removal of a brain tumor. What should the nurse include in the child's care? (Select all that apply.) Observe for colorless drainage at the operative site. Position the child side-lying in the Trendelenburg position. Avoid giving analgesics because of altered consciousness. Provide close supervision while the child is regaining consciousness. Allow unlimited visitors so that the child does not get lonely.

Observe for colorless drainage at the operative site. Provide close supervision while the child is regaining consciousness. Colorless drainage may be leakage of cerebrospinal fluid from the incision site. This needs to be reported as soon as possible. The child needs to be observed closely. Careful assessment of the vital signs and monitoring for signs of increasing intracranial pressure need to be done. The child should not be positioned in the Trendelenburg position postoperatively. Analgesics can be used for postoperative pain but generally not opioids. Only parents of the child should visit at designated times to prevent overstimulation and potential for increased intracranial pressure.

160 For case management to be the most effective, who is the most appropriate case manager? One nurse A panel of experts The insurance company A multidisciplinary team

One nurse 1. Nursing case managers are ideally suited to provide the care coordination necessary. Care coordination is most effective if a single person works with the family to accomplish the many tasks and responsibilities that are necessary. The family retains the role as primary decision maker. 2. It is preferable that the family have only one individual to work with. 3. Most likely the insurance company will have a case manager focusing on the financial aspects of care. This does not include coordination of care to assist the family. 4. It is preferable that the family have only one individual to work with.

The pediatric nurse is performing a well child assessment. Which finding if noted would require further investigation? Palpation of an abdominal mass without pain expression. No report of pain or tenderness in arms or legs. Buccal mucosa pink and intact. Grey appearance of tympanic membrane on otoscopic exam.

Palpation of an abdominal mass without pain expression. In a pediatric patient detection of an abdominal mass, regardless of pain expression requires further diagnostic work up as it may be evidence of Wilm's tumor. All of the other findings represent normal variations and as such do not require further investigation.

30 The nurse is caring for a child with myelosuppression from chemotherapeutic agents. What activities should the nurse include while giving care? Restriction of oral fluids Performing good hand hygiene Instituting strict isolation Giving immunizations appropriate for age

Performing good hand hygiene Good hand hygiene is the most effective means of preventing disease transmission. Strict isolation is not necessary. The child should not receive any live vaccines. The immune system is not capable of responding appropriately to the vaccine. There is no indication that fluids should be reduced.

29 A child with newly diagnosed leukemia has been admitted for the initial round of chemotherapy. What common signs and symptoms of leukemia related to bone marrow involvement would the nurse expect to find either in the child's history or during the assessment? Petechiae, infection, and fatigue Headache, papilledema, and irritability Muscle wasting, weight loss, and fatigue Decreased intracranial pressure, psychosis, and confusion

Petechiae, infection, and fatigue These are signs of infiltration of the bone marrow: petechiae from lowered platelet count, infection from the decreased number of effective leukocytes, and fatigue from the anemia. Headache, papilledema, and irritability are not signs of bone marrow involvement. Muscle wasting, weight loss, and fatigue are not signs of bone marrow involvement. Decreased intracranial pressure, psychosis, and confusion are not signs of bone marrow involvement.

What are the most common signs and symptoms of leukemia related to bone marrow involvement? Petechiae, infection, fatigue Headache, papilledema, irritability Muscle wasting, weight loss, fatigue Decreased intracranial pressure, psychosis, confusion

Petechiae, infection, fatigue Petechiae, infection, and fatigue are signs of infiltration of the bone marrow. Petechiae occur from a lowered platelet count, infection occurs from the depressed number of effective leukocytes, and fatigue occurs from the anemia. Headache, papilledema, irritability, muscle wasting, weight loss and fatigue are not signs of bone marrow involvement. Decreased intracranial pressure, psychosis, and confusion are not signs of bone marrow involvement.

88 A child is standing playing with toys and suddenly collapses. Attempts to engage the child in conversation are met with no response. Skin color indicates cyanosis. A preliminary assessment of the environment presents no specific issues. Based on this information, you would suspect that the child is? Experiencing seizure activity Potential aspiration of foreign body Potential allergic reaction Traumatic injury

Potential aspiration of foreign body A child who is in severe respiratory distress as a result of foreign body aspiration will not be able to speak, become cyanotic and collapse. This would be considered a medical emergency. Playing with a toy may potentially lead to aspiration if the toy parts are smaller than the child's airway. Within that age group, it is likely that the child may place items in his/her mouth. There is nothing to suggest seizure activity, allergic reaction or traumatic injury.

22 A child is receiving chemotherapy through a newly implanted Port-a-Cath. What information should the nurse share with the parents about the implanted access device? It is easy to use for self-administered infusions. The skin does not need to be pierced for access. Regular physical activity, including swimming, does not need to be limited. It cannot be dislodged from the port, even if child "plays" with the port site.

Regular physical activity, including swimming, does not need to be limited. Because this device is totally under the skin, there are no activity limitations for the child, except when the port is in use. The port site is under the skin, but a special needle is used to access it. There is a potential for dislodging the access needle, but not the port itself. Because the port is totally under the skin, a needle must be used to access the port. The port has to be accessed with a special needle.

10 One of the goals for children with asthma is to prevent respiratory infections. Why is this information important for the nurse to include when teaching parents whose children have asthma? Respiratory infections trigger exercise-induced asthma. Allergen sensitivity is increased in the presence of infection. Asthma medication becomes less effective when a respiratory infection is present. Respiratory infections can trigger an episode or aggravate the asthmatic state.

Respiratory infections can trigger an episode or aggravate the asthmatic state. Respiratory infections can trigger an asthmatic attack. Annual influenza vaccine is recommended. All respiratory equipment should be kept clean. Exercise-induced asthma is caused by vigorous activity. Sensitivity to allergens is independent of respiratory infection. The infection affects the asthma, not the medications.

92 A school-age child has undergone a tonsillectomy and is being cared for postoperatively in the hospital setting. The nurse assigned to the patient is developing a plan of care with regard to nutrition and hydration. What factors should be included in the postoperative plan of care for this patient? (Select all that apply.) Medicate for pain around the clock to ensure that the patient will be able to eat and maintain hydration. Restrict food and oral fluids initially making sure that the patient is fully alert and there is no evidence of bleeding. Avoid giving fluids that are color tinged red or brown. Provide milk to help maintain nutritional balance. Provide pudding to facilitate swallowing.

Restrict food and oral fluids initially making sure that the patient is fully alert and there is no evidence of bleeding. Avoid giving fluids that are color tinged red or brown.

Sickle cell disease (SCD) occurs through a genetic mutation. Based on the understanding of this genetic form of transmission, the nurse understands that there are no carrier states associated with this disease. the disease is transmitted as part of a sex-linked mutation. SCD refers to a group of congenital disease expressions. it is a relatively uncommon disease as it is expressed as an autosomal recessive gene trait.

SCD refers to a group of congenital disease expressions. SCD refers to a group of heredity disease states in which there is variants exhibited in both heterozygous and homozygous expressions. It is expressed as an autosomal recessive trait and as such there are carrier states. It is not transmitted as a sex-linked mutation. It is one of the most common genetic disorders globally.

155 Distortion of sound and problems in discrimination are characteristic of what type of hearing loss? Conductive Sensorineural Central auditory imperceptive Mixed conductive-sensorineural

Sensorineural 2. Sensorineural hearing loss, also known as perceptive or nerve deafness, involves damage to the inner ear structures or the auditory nerve. It results in distortion of sounds and problems in discrimination. 1. Conductive hearing loss involves mainly interference with loudness of sound. 3. Central auditory imperceptive hearing loss manifests as a combination of both sensorineural and conductive loss. 4. The mixed conductive-sensorineural category includes all hearing losses that do not demonstrate defects in the conduction or sensory structures.

135 Which of the following is associated with social drinking in adolescents? Heavy drinking as an adult Increasing rates of liver disease Significant morbidity and mortality Use of stimulants to counter depressive effects of alcohol

Significant morbidity and mortality 3. Alcohol-related motor vehicle incidents result in 8000 adolescent deaths and 45,000 injuries each year and are the leading cause of unintentional injury and deaths among adolescents. 1. Heavy drinking as an adult and increasing rates of liver disease are associated with heavy drinking in adolescence. 2. Heavy drinking as an adult and increasing rates of liver disease are associated with heavy drinking in adolescence. 4. Adolescents who abuse alcohol may use sedatives as they become tolerant to the effects of the alcohol.

The nurse suspects a child is having an adverse reaction to a blood transfusion. What should the nurse's first action be? Notify the physician. Take vital signs and blood pressure and compare them with baseline values. Dilute infusing blood with equal amounts of normal saline. Stop the transfusion and maintain a patent intravenous line with normal saline and new tubing.

Stop the transfusion and maintain a patent intravenous line with normal saline and new tubing. The priority nursing action is to stop the transfusion and maintain a patent intravenous line with normal saline and new tubing. If an adverse reaction is occurring, it is essential to minimize the amount of blood that is infused into the child. The physician should be notified after the blood transfusion is stopped and normal saline is infusing. Vital signs should be assessed after the blood transfusion is stopped and normal saline is infusing. Blood should not be diluted; it should be returned to the blood bank if an adverse reaction has occurred.

107 An important nursing consideration when caring for a child with sickle cell anemia is which of the following? Refer the parents and child for genetic counseling. Teach the parents and child how to recognize the signs and symptoms of crises. Help the child and family adjust to a short-term disease. Observe for complications of multiple blood transfusions.

Teach the parents and child how to recognize the signs and symptoms of crises. Parents need specific instructions on the need to watch for changes in the child's condition, including adequate hydration, and environmental concerns. Genetic counseling is important, but teaching care of the child is a priority. Sickle cell anemia is a long-term, chronic illness. Multiple blood transfusions are an option for some children with sickle cell disease. The priority for all children with this condition is properly preparing the parents to care for them.

A child is coming to the clinic with his parents for a sports physical. Upon reviewing the patient's history, there is a notation that the child has been recently treated six months ago for immune thrombocytopenia purpura (ITP). Based on this notation, the nurse would provide this recommendation? The child should not play any sports or participate in any physical activity while in school. The child should take art classes rather than participate in sporting events. The child will have to repeat blood work before any determination can be made. The child can play non-contact sports but will have to be monitored if any bruising or bleeding should occur.

The child can play non-contact sports but will have to be monitored if any bruising or bleeding should occur. Contact sports should be avoided in a patient who has had prior treatment for ITP. The nature of ITP being idiopathic, it is important to protect the patient from impending trauma related to contact. However, the child as part of normal growth and development should be able to engage in non-contact sports activities. Being that the treatment was recent and that ITP is idiopathic, prospective management and monitoring should be included in the plan of care at this time.

102 A 12-month-old child presents to the clinic for a well visit after missing several appointments. The child began her immunization schedule but has missed several follow-up appointments and immunization doses. The nurse knows that the most appropriate action is what? The child must receive initial immunizations from the beginning. The child cannot receive missed immunizations if the schedule is not followed. The child should only receive the missed doses of immunizations. The child should receive double-strength immunizations at this well visit.

The child should only receive the missed doses of immunizations. Children who began primary immunization at the recommended age but fail to receive all the doses do not need to begin the series again but instead should receive only the missed doses. The child may receive missed vaccinations on a catch-up schedule per CDC guidelines.

118 Which of the following best describes a neuroblastoma? The diagnosis is usually made after metastasis occurs. It is the most common brain tumor in young children. Older children have an improved likelihood of survival. Early diagnosis is usually possible because of the obvious clinical manifestations.

The diagnosis is usually made after metastasis occurs. Neuroblastoma is considered a "silent" tumor. In more than 70% of cases, the diagnosis is made after metastasis occurs. The neuroblastoma is usually located in the abdomen. Children younger than 1 year of age have a 75% survival rate; those older than age 1 year, only 50%. The diagnosis is not usually made until other sites have been invaded by the tumor.

47 In providing nourishment for a child with cystic fibrosis (CF), which of the following factors should the nurse keep in mind? Fats and proteins must be greatly curtailed. The diet should be high in calories and protein. Most fruits and vegetables are not well tolerated. The diet should be high in easily digested carbohydrates and fats.

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

33 The nurse educator is describing a rhabdomyosarcoma to a group of new nurses. Teaching by the nurse is correct if which explanation is provided? The most common sites are the head and neck. It is the most common bone tumor of childhood. It is a common hereditary neoplasm of childhood. It is a benign tumor that is not commonly found in children.

The most common sites are the head and neck. Although striated muscle fibers from which this tumor arises can be found anywhere in the body, the most common sites are the head and neck. Rhabdomyosarcoma arises from skeletal muscle tissue, not bone. Rhabdomyosarcoma is not known to be hereditary. Rhabdomyosarcoma is highly malignant.

23 The mother of a child receiving chemotherapy asks about the term, "nadir." Which explanation by the nurse is best? The nadir is the time of the greatest bone marrow suppression, when blood counts will be the lowest. The nadir occurs when the blood counts have returned to their pre-chemotherapy values. The nadir occurs 2 to 3 days after chemotherapy administration when the blood counts begin to drop. The nadir describes the first few hours after chemotherapy administration has finished.

The nadir is the time of the greatest bone marrow suppression, when blood counts will be the lowest. The nadir is the time of the greatest bone marrow suppression when blood counts will be the lowest and generally occurs 7 to 14 days after chemotherapy administration, depending on the specific agent used.

A pediatric oncology patient undergoing chemotherapy treatment is refusing to eat despite providing the child's "favorite foods" and allowing for alternate feeding patterns independent of meal time. What etiological theories might account for the child's loss of desire to eat? (Select all that apply.) The patient anticipates that he/she will be nauseous and/or vomit as part of the treatment sequence. The patient is refusing to eat in an attempt to gain control over his/her surroundings. The "correct" food has just not been found and more food selections should be offered. The patient is experiencing symptoms of depression. The patient is refusing to eat because his/her parents did not make the food.

The patient anticipates that he/she will be nauseous and/or vomit as part of the treatment sequence. The patient is refusing to eat in an attempt to gain control over his/her surroundings. The patient is experiencing symptoms of depression. Anorexia and/or a refusal to eat sometimes accompanies chemotherapy interventions in patients. Thus, even in the context of being offered "favorite foods," the child may not want to eat. Theories proposed for this persistent anorexia and/or refusal include but are not limited to: possible depression, attempts at control, gaining control over one's environment, a conditioned response reflecting aversion during treatment and/or stress.

7 An infant with a congenital heart defect is receiving palivizumab (Synagis). Teaching by the nurse is correct if what information is discussed with the parents? This medication should prevent respiratory syncytial virus (RSV) infection. Synagis is known to prevent secondary bacterial infection. This drug minimizes the side effects of antiviral agents. This medication makes isolation of the infant with RSV unnecessary.

This medication should prevent respiratory syncytial virus (RSV) infection. Synagis is a monoclonal antibody specific for RSV. Monthly administration is initiated to prevent infection with RSV. The antibody is specific to RSV but not bacterial infection. Synagis does not decrease the side effects of antiviral agents. This drug will not affect the need to isolate the infant if RSV develops.

133 Which of the following approaches is the most appropriate when performing a physical assessment on a toddler? Demonstrate use of equipment. Perform traumatic procedures first. Use minimum physical contact initially. Always proceed in a head-to-toe direction.

Use minimum physical contact initially. 3. Parents can remove clothing, and the child can remain on the parent's lap. The nurse should use minimum physical contact initially to gain the cooperation of the child. 1. The nurse should introduce the equipment slowly. The child can inspect the equipment, but demonstrations are usually too complex for this age-group. 2. Traumatic procedures should always be performed last. These will most likely upset the child and inhibit cooperation. 4. The head-to-toe assessment can be done in older children but usually must be adapted in younger children.

25 A child is being placed on long-term prednisone therapy as part of the treatment for her leukemia and will be going home on the regimen. What teaching about the steroid treatment should the nurse provide to the parents? (Select all that apply.) Weight gain happens because of increased appetite. Frequent urination because of fluid loss. Her blood pressure should be monitored. Sleep disturbances, such as dreaming, can occur. Calm behavioral patterns should be present. Facial fullness usually disappears when the prednisone therapy has stopped.

Weight gain happens because of increased appetite. Her blood pressure should be monitored. Sleep disturbances, such as dreaming, can occur. Facial fullness usually disappears when the prednisone therapy has stopped. Weight gain occurs because of increased appetite and salt/fluid retention. Her blood pressure should be monitored because of fluid retention. Sleep disturbances, such as dreaming, can occur. It is true that the facial fullness usually disappears when the prednisone therapy has stopped. It will take a while to resolve, just as it took a while to appear. Fluid retention is common, not fluid loss. Emotional lability (mood changes) is characteristic of this medication. The child can be happy one minute and angry several minutes later without a trigger for the anger.

108 The parents of a child hospitalized with sickle cell anemia tell the nurse that they are concerned about narcotic analgesics causing addiction. The nurse should explain which of the following concerning narcotic analgesics? They are often ordered but not usually needed. When they are medically indicated, children rarely become addicted. They are given as a last resort because of the threat of addiction. They are used only if other measures, such as ice packs, are ineffective.

When they are medically indicated, children rarely become addicted. Pain is the most common and debilitating symptom experienced by patients with sickle cell disease. The chronic nature of this pain can greatly affect the child's development. A multidisciplinary approach is best for its management. Patient-controlled analgesia or continuous intravenous administration is usually effective. Pharmacologic intervention is necessary for the pain of sickle cell crisis.

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

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

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

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

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

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

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

a.Incubation period . ANS: A The incubation period is the interval between infection or exposure and appearance of symptoms. The prodromal period is the interval between the time when early manifestations of disease appear and the overt clinical syndrome is evident. Desquamation refers to the shedding of skin. The period of communicability is the time or times during which an infectious agent may be transferred directly or indirectly from an infected person to another person.

41 It is important that a child with Group A ß-hemolytic streptococci (GABHS) infection be treated with antibiotics to prevent: otitis media. diabetes insipidus. nephrotic syndrome. acute rheumatic fever.

acute rheumatic fever. Otitis media and diabetes insipidus are not sequelae to GABHS. Otitis media and diabetes insipidus are not sequelae to GABHS. Children are at risk for glomerulonephritis, not nephritic syndrome. Children with Group A ß-hemolytic streptococci (GABHS) infection are at risk for acute rheumatic fever and acute glomerulonephritis.

Therapeutic management of the patient with systemic lupus erythematosus (SLE) includes application of cold salts to suppress the inflammatory process. a high-protein, low-salt diet. a rigorous exercise regimen to build up muscle strength and endurance. administration of corticosteroids to control inflammation.

administration of corticosteroids to control inflammation. Corticosteroid administration is the primary mode of therapy currently for SLE. The application of cold salts will not affect the inflammatory process associated with SLE. A balanced diet without exceeding caloric expenditures is recommended. Exercise should be done in moderation.

49 It is generally recommended that a child with acute streptococcal pharyngitis can return to school when his or her sore throat is better. if no complications develop. after taking antibiotics for 24 hours. 3 days after initial throat cultures.

after taking antibiotics for 24 hours. After children have taken antibiotics for 24 hours, they are no longer contagious to other children. Sore throat may persist longer than 24 hours of antibiotic therapy, but the child is no longer considered contagious. Complications may take days to weeks to develop. The time from throat culture does not affect the contagiousness of the infection. Antibiotics must be used.

71 Systematic clinical findings associated with bedbugs manifest as folliculitis. anaphylaxis. rash. wheal.

anaphylaxis. Anaphylaxis is an example of a systemic reaction. Folliculitis is an example of a secondary reaction whereas rash and wheal represent cutaneous symptoms.

A child has been diagnosed with aplastic anemia and undergoing therapeutic treatment. Therapeutic therapy would focus on palliative treatment to maintain comfort. initiation of steroid therapy. anticipation of bone marrow transplant. asking parents if they want to consider organ donation.

anticipation of bone marrow transplant. Although a clinical diagnosis of aplastic anemia can lead to increased morbidity and mortality treatment measures focusing on immunosuppressive therapy, removal of potential exacerbating etiology, and bone marrow replacement. Palliative treatment methods may be included but they are not the mainstay of therapeutic management. Steroid therapy is not indicated as that may lead to an increased susceptibility to infection. Asking the parents about organ donation at this time may cause considerable distress and anxiety.

β-Adrenergic agonists and methylxanthines are often prescribed for a child with an asthma attack. Which describes their action? a.Liquefy secretions. b.Dilate the bronchioles. c.Reduce inflammation of the lungs. d.Reduce infection.

b.Dilate the bronchioles. ANS: B β-Adrenergic agonists and methylxanthines work to dilate the bronchioles in acute exacerbations. These medications do not liquefy secretions or reduce infection. Corticosteroids and mast cell stabilizers reduce inflammation in the lungs.

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

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

63 When giving instructions to a parent whose child has scabies, the school nurse should tell the parent to treat all family members if symptoms develop. be prepared for symptoms to last 2 to 3 weeks. notify the practitioner so an antibiotic can be prescribed. carefully treat only those areas where there is a rash.

be prepared for symptoms to last 2 to 3 weeks. The mite responsible for scabies will most likely be killed with the administration of medications. It will take 2 to 3 weeks for the stratum corneum to heal. That is when the symptoms will abate. Only the affected child needs to be treated for scabies. A scabicide is used. Permethrin and lindane are currently used for topical administration. Permethrin is applied to all skin surfaces in the treatment of scabies.

The nurse is teaching the parent about the diet of a child experiencing severe edema associated with acute glomerulonephritis. Which information should the nurse include in the teaching? a."You will need to decrease the number of calories in your child's diet." b."Your child's diet will need an increased amount of protein." c."You will need to avoid adding salt to your child's food." d."Your child's diet will consist of low-fat, low-carbohydrate foods."

c."You will need to avoid adding salt to your child's food." ANS: C For most children, a regular diet is allowed, but it should contain no added salt. The child should be offered a regular diet with favorite foods. Severe sodium restrictions are not indicated.

Which child should the nurse document as being anemic? a.7-year-old child with a hemoglobin of 11.5 g/dl b.3-year-old child with a hemoglobin of 12 g/dl c.14-year-old child with a hemoglobin of 10 g/dl d.1-year-old child with a hemoglobin of 13 g/dl

c.14-year-old child with a hemoglobin of 10 g/dl ANS: C Anemia is a condition in which the number of red blood cells, or hemoglobin concentration, is reduced below the normal values for age. Anemia is defined as a hemoglobin level below 10 or 11 g/dl. The child with a hemoglobin of 10 g/dl would be considered anemic. The normal hemoglobin for a child after 2 years of age is 11.5 to 15.5 g/dl.

Which is a clinical manifestation of the systemic venous congestion that can occur with heart failure? a.Tachypnea b.Tachycardia c.Peripheral edema d.Pale, cool extremities

c.Peripheral edema ANS: C Peripheral edema, especially periorbital edema, is a clinical manifestation of systemic venous congestion. Tachypnea is a manifestation of pulmonary congestion. Tachycardia and pale, cool extremities are clinical manifestations of impaired myocardial function.

It is now recommended that children with asthma who are taking long-term inhaled steroids should be assessed frequently because which disease or assessment findings may develop? a.Cough b.Osteoporosis c.Slowed growth d.Cushing syndrome

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

A mother calls the outpatient clinic requesting information on appropriate dosing for over-the-counter medications for her 13-month-old who has symptoms of an upper respiratory tract infection and fever. The box of acetaminophen says to give 120 mg q4h when needed. At his 12-month visit, the nurse practitioner prescribed 150 mg. The nurse's best response is: a."The doses are close enough; it doesn't really matter which one is given." b."It is not appropriate to use dosages based on age because children have a wide range of weights at different ages." c."From your description, medications are not necessary. They should be avoided in children at this age." d."The nurse practitioner ordered the drug based on weight, which is a more accurate way of determining a therapeutic dose."

d."The nurse practitioner ordered the drug based on weight, which is a more accurate way of determining a therapeutic dose." ANS: D The method most often used to determine children's dosage is based on a specific dose per kilogram of body weight. The mother should be given correct information. For a therapeutic effect, the dosage should be based on weight, not age. Acetaminophen can be used to relieve discomfort in children at this age group.

The nurse is recommending how to prevent iron deficiency anemia in a healthy, term, breast-fed infant. Which should be suggested? a.Iron (ferrous sulfate) drops after age 1 month b.Iron-fortified commercial formula by age 4 to 6 months c.Iron-fortified infant cereal by age 2 months d.Iron-fortified infant cereal by age 4 to 6 months

d.Iron-fortified infant cereal by age 4 to 6 months ANS: D Breast milk supplies inadequate iron for growth and development after age 5 months. Supplementation is necessary at this time. The mother can supplement the breastfeeding with iron-fortified infant cereal. Iron supplementation or the introduction of solid foods in a breast-fed baby is not indicated. Providing iron-fortified commercial formula by age 4 to 6 months should be done only if the mother is choosing to discontinue breastfeeding.

Which immunization should not be given to a child receiving chemotherapy for cancer? a.Tetanus vaccine b.Inactivated poliovirus vaccine c.Diphtheria, pertussis, tetanus (DPT) d.Measles, rubella, mumps

d.Measles, rubella, mumps ANS: D The vaccine used for measles, mumps, and rubella is a live virus and can result in an overwhelming infection. Tetanus vaccine, inactivated poliovirus vaccine, and diphtheria, pertussis, tetanus (DPT) are not live virus vaccines.

Which clinical manifestation should the nurse expect when a child with sickle cell anemia experiences an acute vasoocclusive crisis? a.Circulatory collapse b.Cardiomegaly, systolic murmurs c.Hepatomegaly, intrahepatic cholestasis d.Painful swelling of hands and feet; painful joints

d.Painful swelling of hands and feet; painful joints ANS: D A vasoocclusive crisis is characterized by severe pain in the area of involvement. If in the extremities, painful swelling of the hands and feet is seen; if in the abdomen, severe pain resembles that of acute surgical abdomen; and if in the head, stroke and visual disturbances occur. Circulatory collapse results from sequestration crises. Cardiomegaly, systolic murmurs, hepatomegaly, and intrahepatic cholestasis result from chronic vasoocclusive phenomena.

Chronic otitis media with effusion (OME) is differentiated from acute otitis media (AOM) because it is usually characterized by: a.a fever as high as 40° C (104° F). b.severe pain in the ear. c.nausea and vomiting. d.a feeling of fullness in the ear.

d.a feeling of fullness in the ear. ANS: D OME is characterized by feeling of fullness in the ear or other nonspecific complaints. Fever is a sign of AOM. OME does not cause severe pain. This may be a sign of AOM. Nausea and vomiting are associated with otitis media.

73 The most appropriate comfort intervention for a child with itching related to chickenpox is encourage frequent warm baths. give aspirin or acetaminophen (Tylenol). apply thick coat of pramoxine (Caladryl) lotion over open lesions. give an antipruritic medication such as diphenhydramine (Benadryl). apply thick coat of pramoxine (Caladryl) lotion over open lesions.

give an antipruritic medication such as diphenhydramine (Benadryl). Antipruritic medicines such as diphenhydramine are useful for severe itching, which interferes with sleep and may contribute to secondary infection. Cool baths, not warm ones, are recommended for relief of itching secondary to chickenpox. Neither drug provides antipruritic effects, nor should aspirin ever be given to children with chickenpox, because there is an increased risk of developing Reye syndrome. Caladryl lotion, which contains diphenhydramine, should be applied sparingly, not in thick coats, over open lesions to minimize absorption.

The nurse is explaining blood components to an 8-year-old child. Based on the nurse's knowledge of child development, the most appropriate description of platelets is that they help keep germs from causing infection. make up the liquid portion of blood. carry the oxygen you breathe from your lungs to all parts of your body. help your body stop bleeding by forming a clot (scab) over the hurt area.

help your body stop bleeding by forming a clot (scab) over the hurt area. Platelets are involved in homeostasis. White blood cells help protect the body from infection. The liquid portion of blood id known as plasma. Red blood cells are involved in oxygenation of tissues in the body.

The best approach that would facilitate improved outcomes when using surgical treatment for operable cancers is when there is evidence of adjacent tissue involvement. performing amputation rather than attempting resection. using multiple excisions to remove the tumor. if the tumor is encapsulated and localized.

if the tumor is encapsulated and localized. Tumors that are localized and encapsulated represent the best approach for improved outcomes for the surgical cancer patient as this indicates that the tumor is not showing evidence of metastasis. Evidence of adjacent tissue involvement means that the tumor has already metastasized. Resection of bone rather than amputation is associated with improved outcomes. Minimal incision surgical approach is favored to improve functioning and help maintain cosmoses.

43 A 4-year-old girl is brought to the emergency room. She has a "froglike" croaking sound on inspiration, is agitated, and is drooling. She insists on sitting upright. The nurse should: examine her oral pharynx and report to the physician. make her lie down and rest quietly. auscultate her lungs and make preparations for placement in a mist tent. notify the physician immediately and be prepared to assist with a tracheostomy or intubation.

notify the physician immediately and be prepared to assist with a tracheostomy or intubation. Examination of the oral pharynx may cause total obstruction. The child assumes a tripod position to facilitate breathing. Forcing the child to lie down will increase the respiratory distress and anxiety. Preparation should be made to care for her if an obstruction occurs. Sitting upright, drooling, agitation, and a froglike cough indicate epiglottitis. This is a medical emergency, and tracheostomy or intubation may be necessary.

38 An immediate intervention when an infant chokes on a piece of food would be to: have infant lie quietly while a call is placed for emergency help. position the infant in a head-down, face-down position and administer five quick blows between the shoulder blades. administer mouth-to-mouth resuscitation. give water by cup to relieve the obstruction.

position the infant in a head-down, face-down position and administer five quick blows between the shoulder blades. The infant needs to receive treatment immediately. Emergency help is called after attempting to remove the obstruction. This is the correct initial sequence of actions for an infant with an obstructed airway. Mouth-to-mouth resuscitation should not be used. This may push the object further into the child's respiratory system. If the child's airway is obstructed, the water will not be able to pass. This will increase the risk of aspiration.

60 A child is being seen in the emergency department with multiple facial abrasions and lacerations. A combination agent containing lidocaine, adrenaline, and tetracaine (LAT gel) is applied topically to the wounds. The purpose of this combination therapy is to cleanse the wound. promote scab formation. prevent infection of the wound. provide anesthesia to the wound.

provide anesthesia to the wound. The combination of lidocaine, adrenaline, and tetracaine (LAT) provides anesthesia within 10 to 15 minutes of application. LAT does not have a cleansing effect or antibacterial effect and does not influence scab formation.

34 A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because this environment facilitates: liquefying secretions. improving oxygenation. promoting ventilation. soothing inflamed mucous membrane.

soothing inflamed mucous membrane. The size of the droplets is too large to liquefy secretions. No additional oxygen is provided with humidified air. The humidity has no effect on ventilation. By humidifying the inspired air, the membranes inflamed by the infection and dry air are soothed.

113 Chemotherapeutic drugs to treat cancer are often given in combination because the drugs can be given by various routes. the drugs can be given at different times during the day. patients cannot tolerate extremely high doses of single drugs. the combinations allow for optimum cell destruction with minimum toxic effects.

the combinations allow for optimum cell destruction with minimum toxic effects. Combining drugs allows for synergistic effects. Optimum cell cycle destruction with minimum toxic effects and decreased resistance by the cancer cells to the agent are possible. Routes of administration depend on the pharmacologic attributes of the drug. The routes do not influence interactions. Combination therapy usually has specific intervals to maximize synergistic effect. High doses of drugs are indicated in different regimens.

105 When hemoglobin levels fall sufficiently to produce clinical manifestations, the person's signs and symptoms are caused by phagocytosis. tissue hypoxia. pulmonary hypertension. depressed bone marrow.

tissue hypoxia. The signs and symptoms (e.g., weakness, fatigue, and a waxy pallor in severe anemia) are caused by tissue hypoxia. Phagocytosis is a function of white blood cells used in prevention of infection. Pulmonary hypertension is not associated with anemia. Severe anemia may contribute to cardiac compensation. Depressed bone marrow may be the cause of the low hemoglobin.

42 When caring for a child after a tonsillectomy, the nurse should: watch for continuous swallowing. encourage gargling to reduce discomfort. position the child on the back for sleeping. apply warm compresses to the throat.

watch for continuous swallowing. This is the most obvious early sign of bleeding from the operative site. Gargling should be avoided because of potential trauma to the suture line. The child should be positioned on the side or abdomen to facilitate drainage. Cold is preferred. Ice collars and cold liquids are encouraged.

162 A family wants to begin oral feeding of their 4-year-old son, who is ventilator dependent and currently tube-fed. They ask the home health nurse to feed him the baby food orally. The nurse recognizes a high risk of aspiration and an already compromised respiratory status. The most appropriate nursing action is which of the following? Refuse to feed him orally, since the risk is too high. Explain the risks involved and then let the family decide what should be done. Feed him orally because the family has the right to make this decision for their child. Acknowledge their request, explain the risks, and explore with the family the available options.

Acknowledge their request, explain the risks, and explore with the family the available options. 4. Parents want to be included in the decision making for their child's care. The nurse should discuss the request with the family to ensure this is the issue of concern, and then potential options can be explored. 1. Refusing to feed him orally does not determine why the parents wish the oral feedings to begin and does not involve them in problem solving. 2. The decision to begin or not to change feedings should be a collaborative one, made in consultation with the family, nurse, and appropriate member of the health care team. 3. The decision to begin or not to change feedings should be a collaborative one, made in consultation with the family, nurse, and appropriate member of the health care team.

159 Home care is being considered for a young child who is ventilator dependent. Which of the following factors is most important in deciding whether home care is appropriate? Level of education of parents Adequate family training Presence of two parents in the home Family's ability to assume all health care costs

Adequate family training 2. One of the essential elements is the family's preparation and ability to care for the child. The family must be able to demonstrate all aspects of care for the child, since in many areas nursing care may not be available on a continual basis. 1. The amount of formal education reached by the parents is not the important issue. The determinant is the family's ability to care adequately for the child in the home. 3. At least two family members should learn and demonstrate all aspects of the child's care in the hospital, but it does not have to be two parents. 4. Few families can assume all health care costs. Creative financial planning, including negotiating arrangements with the insurance company or public programs, may be required.

103 The change from the exclusive use of oral polio vaccine (OPV) to the exclusive use of inactivated poliovirus vaccine (IPV) related to the rare risk of vaccine-associated polio paralysis (VAPP) from OPV has resulted in which of the following? An increase in the risk of VAPP An increased number of injections and increased cost A better antibody conversion than the oral formulation A measureable decrease in immunity in the community

An increased number of injections and increased cost There is an increased number of injections and increased cost associated with IPV. The exclusive use of IPV eliminates the risk of VAPP. There is no increased antibody conversion from IPV. The same immunity is provided by both vaccines.

161 The home health nurse is caring for a child who requires complex care. The family expresses frustration related to obtaining accurate information about their child's illness and its management. Which of the following is the best action for the nurse? Determine why family is easily frustrated. Refer family to child's primary care practitioner. Provide information family requests, being confident that every question can be answered by the nurse. Answer questions in a straightforward manner; get professional assistance when answer is unknown.

Answer questions in a straightforward manner; get professional assistance when answer is unknown. 4. The philosophic basis for family-centered practice is the recognition that the family is the constant in the child's life. It is essential that the family have complete and accurate information about their child's illness and management. The nurse may first have to clarify what information the family believes has not been communicated. 1. The family's frustration arises from their perception that they are not receiving information pertinent to their child's care. 2. It does not help the family to refer the family to the child's primary care practitioner. The home health nurse should have access to the necessary information. 3. Questions about what they need and want to know concerning their child's care should be addressed, but the nurse may not be able to answer every question.

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

Cerebellar function 2. The finger-to-nose test is an indication of cerebellar function. This test checks balance and coordination (p. 168). 1. Each deep tendon reflex is tested separately. 3. Each sense is tested separately. 4. Although performing this test can demonstrate the child's ability to follow directions, it is used primarily for cerebellar function.

65 When teaching the adolescent about the management of acne, the nurse should include what instructions? Clean the face with an antibacterial soap twice each day. Clean the face gently with a mild soap once or twice each day. Avoid foods with a high-fat content such as French fries and chocolate. Express comedones by gentle squeezing; then cleanse with alcohol.

Clean the face gently with a mild soap once or twice each day. Cleansing the face with mild soap and water will remove surface dirt and oil, which is essential in the management of acne. Antibacterial soaps may be too drying when used in combination with topical medications and may exacerbate acne. No relationship has been established between food intake and acne. Squeezing the acne can break down the ductal walls of the lesions and cause the acne to worsen.

144 Which of the following is descriptive of bulimia during adolescence? Strong sense of control over eating behavior Feelings of elation after the binge-purge cycle Profound lack of awareness that the eating pattern is abnormal Consumption of large quantities of food used as a coping mechanism

Consumption of large quantities of food used as a coping mechanism 4. The individual with bulimia uses food as a means of control and coping. As the disease progresses, the adolescent loses the control aspect and continues the binge-purge cycle as a coping measure. 1. The adolescent has a lack of control over eating during the episode. 2. Patients with bulimia commonly have self-deprecating thoughts and a depressed mood after binge-purge cycles. 3. Individuals with bulimia are aware that the eating pattern is abnormal but are unable to stop.

13 The parents of a 6-year-old girl with newly diagnosed idiopathic thrombocytopenia purpura (ITP) are very frightened about the seriousness of the condition. What information can the nurse give the parents that would help to calm them? (Select all that apply.) A splenectomy is done on most children with acute ITP. Low-dose aspirin is very effective in the treatment of ITP. Contact sports must be avoided to decrease the chance of bleeding. Some children respond to therapy faster than others. This is not an illness that causes the child to "feel bad." Normal activities such as school can often resume after treatment.

Contact sports must be avoided to decrease the chance of bleeding. Some children respond to therapy faster than others. This is not an illness that causes the child to "feel bad." Normal activities such as school can often resume after treatment. Contact sports must be avoided to decrease the chance of bleeding. Each child's response is individual regarding time to improve. Most often, children with ITP do not "feel bad." Normal activities such as school can often resume after IVIG and steroid treatment has been administered. A splenectomy is done on children with chronic ITP who do not respond to medical management. Low-dose aspirin is contraindicated in patients with ITP because of interfering with clotting

You are reviewing information relative to a patient's medical history for treatment of leukemia. Patient is exhibiting no clinical symptoms at this point in the treatment plan. In comparing bone marrow reports prior to and 6 months following chemotherapy, what information do you hope to obtain that would assist in evaluating the plan of care? Expectation that the results will be consistent indicating that goals have been met. Increased likelihood that atypical cells will be present suggesting a revision of the plan of care. Pancytopenic response indicating that chemotherapy treatment was successful. Determination of response to clinical therapy comparing pre and post procedure that will provide evidence to interpret whether medical treatment has been effective.

Determination of response to clinical therapy comparing pre and post procedure that will provide evidence to interpret whether medical treatment has been effective. Bone marrow biopsies are used both to diagnose as well as evaluate clinical response to chemotherapy (therapeutic management) used in the treatment of leukemia. While one would hope that the intervention was successful, until the results are compared and read by the pathologist, there is no way to state equivocally what the results will be at the histological level. Consistent findings pre and post treatment would indicate that treatment goals have not been met. Similarly, if clinical response is favorable, then one would not expect to see atypical cells. As the patient is not experiencing any symptoms, a diagnosis of pancytopenia would not be expected as this would indicate bone marrow failure.

152 Parents of a child with cognitive impairment ask the nurse for guidance in toilet training. They have older children who were successfully toilet trained but do not know how to do this with the impaired child. The nurse's recommendation should include which of the following? Accidents cannot be ignored if toilet training is to be successful. Determine the child's readiness to begin toilet training. Toilet training should not be initiated until the child has sufficient speech. A more punitive approach is needed because of the child's cognitive impairment.

Determine the child's readiness to begin toilet training. 2. The child's capabilities and readiness are essential to success. Parents must also be able to devote the time to a positive, consistent, individualized, nonpressured style of teaching. 1. Successful training occurs by focusing on the achievement of small goals. Feelings of comfort and adequacy are necessary. Calling undue attention to "accidents" impedes the program's success. 3. Speech fluency is an independent skill. 4. Positive reinforcement is needed, not negative feedback.

20 The parents of a toddler with a hematologic alteration ask about how to promote the child's growth and development needs. With which area will the parents need major assistance? Nutrition Discipline Education Sleep

Discipline Discipline can be a challenge for the parents of a child who bleeds easily. Verbal discipline with other techniques will need to be used. Parents cannot grab the child too tightly, since bruising can occur. Physical force should be avoided. Education should not be a problem. Sleep needs are basically the same for the child unless anemia is present and the child is fatigued more than usual. Nutrition follows basically the same guidelines except if the child needs more iron in the diet.

130 When the nurse interviews an adolescent, which of the following is especially important? Focus the discussion on the peer group. Display a genuine interest in the adolescent. Emphasize that confidentiality will always be maintained. Use the same type of language as the adolescent.

Display a genuine interest in the adolescent. 2. Adolescents accept anyone who shows a genuine interest in them. 1. Although peers are important to this age-group, the focus of the interview should be on the adolescent. 3. The nurse should clarify which information will be shared with other members of the health care team and any limits to confidentiality. 4. The nurse should maintain a professional relationship with adolescents. To avoid misinterpretation of words and phrases that the adolescent may use, the nurse should clarify terms frequently.

157 Which of the following is a common clinical manifestation of autism? Deafness Tendency to overeat Early abnormal eye contact Intense desire to be held and cuddled

Early abnormal eye contact 3. The inability to maintain eye contact with another individual is a hallmark of autism. 1. The child with autism has spoken language delays, not deafness. 2. Children with autism may be picky eaters or willfully starve themselves or gag to prevent eating. They may also eat any available edible or inedible object. 4. A goal of nursing care is to decrease stimulation. Physical contact can be upsetting to children with autism.

The school nurse is caring for a boy with hemophilia who fell on his arm during recess. What supportive measures should the nurse use until factor replacement therapy can be instituted? Apply warm, moist compresses. Apply pressure for at least 1 minute. Elevate the area above the level of the heart. Begin passive range-of-motion unless the pain is severe.

Elevate the area above the level of the heart. The initial response should include elevation of the arm to minimize bleeding. Cold should be applied to the arm. This will aid in vasoconstriction, minimizing blood loss. Pressure is effective in small areas but would not be as effective for an extremity. Passive range-of-motion is not recommended. The child can perform active range-of-motion after the bleeding episode has resolved.

110 The school nurse is caring for a child with hemophilia who fell on his arm during recess. Which of the following supportive measures should the nurse do until factor replacement therapy can be instituted? Apply warm, moist compresses. Apply a tourniquet for at least 5 minutes. Elevate the arm above the level of the heart. Begin passive range of motion unless pain is severe.

Elevate the arm above the level of the heart. The initial response should include elevation. Cold should be applied to the arm. This will aid in vasoconstriction. Pressure is effective in small areas but would not work for an extremity. Passive range of motion is not recommended. The child can perform active range of motion after the bleeding episode has resolved.

141 Anorexia nervosa is best described as: easily diagnosed and treated. Emaciation from self-inflicted starvation. resulting from a posterior pituitary disorder. occurring most frequently in adolescent males.

Emaciation from self-inflicted starvation. 2. One of the criteria for diagnosis is the refusal to maintain body weight at a minimally normal weight for age and height. 1. Anorexia nervosa can be a difficult disorder to identify. The diagnosis depends on the person meeting certain diagnostic criteria. Without a known cause, treatment is difficult. Reversal of the severe malnutrition usually requires intense nutritional and behavioral-psychologic management. 3. Posterior pituitary disorders are not associated with anorexia nervosa. 4. Females account for 90% to 95% of the cases.

52 When planning care for a 4-month-old child admitted with respiratory distress caused by respiratory syncytial virus (RSV) and bronchiolitis, it is essential to include which of the following? Give antibiotics. Ensure adequate hydration. Administer cough syrup. Feed 4 oz of formula every 4 hours.

Ensure adequate hydration. When respiratory distress is present, hydration is an essential consideration. Usually infants cannot take fluids by the oral route because of the difficulty breathing. Intravenous fluid administration may be necessary. RSV is a virus, so antibiotics are not beneficial. Cough syrup is not routinely used in RSV. Although fluid and calories are important, an infant with respiratory distress is usually unable to drink this amount of fluid.

156 A nurse would suspect possible visual impairment in a child who displays which of the following? Excessive rubbing of the eyes Delay in speech development Rapid lateral movement of the eyes Lack of interest in casual conversation with peers

Excessive rubbing of the eyes 1. Excessive rubbing of the eyes is a clinical manifestation of visual impairment. 2. Delay in speech development, rapid lateral movement of the eyes, and lack of interest in casual conversation with peers are not associated with visual impairment. 3. Delay in speech development, rapid lateral movement of the eyes, and lack of interest in casual conversation with peers are not associated with visual impairment. 4. Delay in speech development, rapid lateral movement of the eyes, and lack of interest in casual conversation with peers are not associated with visual impairment.

28 A child with lymphoma is receiving extensive radiation therapy. The nurse should be familiar about the most common side effect of this treatment? Fatigue Seizures Neuropathy Lymphadenopathy

Fatigue Fatigue is the most common side effect of radiation therapy. For children, the fatigue may be especially distressing, because it means they cannot keep up with their peers. Seizures are unlikely, because cranial irradiation is not usually involved in the treatment of lymphoma. Neuropathy is a side effect of certain chemotherapeutic agents. Lymphadenopathy is one of the findings of lymphoma.

149 The nurse should make a referral for communication impairment in which of the following situations? Dysfluency occurring at any age First words not uttered before age 2 years Speech largely unintelligible at 18 months Substitution of easily produced sounds for more difficult ones by age 3 years

First words not uttered before age 2 years 2. Usually, children are able to assign meaning to words by the first year of life. A delay until the second birthday is an indication for referral. 1. A referral should be made if stuttering or other dysfluency persists past age 5 years. 3. Referral is indicated if the child is unintelligible at age 3 years. 4. The competency to substitute sounds is not expected until age 5 years.

129 Which one of the following approaches would be best to use to ensure a receptive response from a toddler? Focus communication on the child and tell him or her how a procedure will feel. Call the toddler's name while picking him or her up. Call the toddler's name and say, "I am your nurse." Stand by the toddler, addressing him or her by name.

Focus communication on the child and tell him or her how a procedure will feel. 1. Toddlers see things only in relation to themselves and from their point of view. 2. A stranger picking up a child up in an unfamiliar environment is very frightening for the toddler. 3. Toddlers will not know the meaning of "nurse." 4. Unknown adults who call the toddler by name can frighten the child.

137 Which of the following statements is true about adolescents who attempt suicide? Suicide attempts are rarely associated with mental health problems. The adolescent has mastered problem-solving skills. Gay and lesbian adolescents are at high risk for suicide. They may have parents with idealistic expectations of academic performance.

Gay and lesbian adolescents are at high risk for suicide. 3. Approximately four times as many gay, lesbian, and bisexual teens attempt suicide compared with others in this age-group. Gay and lesbian adolescents who live in families or communities that do not accept homosexuality are likely to suffer low self-esteem, self-loathing, depression, and hopelessness as a result of a lack of acceptance. 1. Retrospectively, 90% of adolescents who committed suicide met the criteria for at least one major psychiatric disorder. 2. Adolescents with developed problem-solving and social skills are less likely to commit suicide. 4. Many adolescents have parents with idealistic expectations.

You are working with the parents of a pediatric oncology patient who has successfully responded to therapy. The parents have questions regarding what to expect as the child continues to grow and develop throughout the life cycle. Which response would be appropriate with regard to the parent's concern? As the therapy has been successful, growth and development should proceed along a normal sequence. It may be a good idea to schedule your child for repeat imaging studies on a yearly basis so as to make sure that the child remains in remission. There may be anticipated growth and developmental delays associated with chemotherapy treatments but they are typically self-limiting in nature. Genetic counseling may be something to consider as the child reaches adulthood and is considering having children his/herself if the type of cancer that the child had was inherited.

Genetic counseling may be something to consider as the child reaches adulthood and is considering having children his/herself if the type of cancer that the child had was inherited. Even though medical treatment has been noted as being successful, continued observation and medical follow up is indicated. Growth and development should be monitored in accordance with recommended pediatric screening guidelines. Although imaging studies may be required at some point in time for follow up, yearly imaging studies may not be needed. Genetic counseling when the child reaches adulthood should be considered especially if the type of cancer was inherited. Growth and developmental delays are not considered to be normal and may not be self-limiting.

48 What is an appropriate nursing intervention when caring for an infant with an upper respiratory tract infection and elevated temperature? Give tepid water baths to reduce fever. Encourage food intake to maintain caloric needs. Have the child wear heavy clothing to prevent chilling. Give small amounts of favorite fluids frequently to prevent dehydration.

Give small amounts of favorite fluids frequently to prevent dehydration. Preventing dehydration by small, frequent feedings is an important intervention in a febrile child. Tepid water baths may induce shivering, which raises temperature. Food should not be forced; it may result in the child vomiting. A febrile child should be dressed in light, loose clothing.

148 Which of the following statements is correct about childhood obesity? Heredity is an important factor. Most children have an underlying disease as a cause. The percentage of children who are obese is decreasing. Prevalence of childhood obesity is similar across socioeconomic groups.

Heredity is an important factor. 1. Heredity is an important fact that contributes to obesity. Identical twins reared apart tend to resemble their biologic parents to a greater extent than their adoptive parent. It is difficult to distinguish between hereditary and environmental factors. 2. Underlying diseases such as hypothyroidism and hyperinsulinism account for only a small number of cases of childhood obesity. 3. The number of overweight and obese children is increasing in the United States. 4. In the United States, lower socioeconomic groups have a higher prevalence of obesity, especially among girls.

1 Apnea of infancy has been diagnosed in an infant who will soon be discharged with home monitoring. What should be part of the discharge teaching by the nurse for the parents? Having the infant in the same room with adults at all times How to perform infant cardiopulmonary resuscitation Reassurance that the infant cannot be electrocuted during monitoring Advising that the infant not be left with other caretakers, such as babysitters

How to perform infant cardiopulmonary resuscitation CPR is essential for parents and caregivers to know. The monitor is insulated and grounded. The parents should arrange for other caregivers to help out. All need to be taught how to use the monitoring equipment and how to perform CPR. The infant should be nearby, with the monitored alarm loud enough to always be heard.

153 What is one of the major physical characteristics of the child with Down syndrome? Excessive height Spots on the palms Hypotonic musculature Inflexibility of the joints

Hypotonic musculature 3. Hypotonic musculature is one of the major characteristics. 1. Children with Down syndrome have short stature. 2. Children with Down syndrome have a transverse palmar crease. 4. Hyperflexibility is a characteristic of Down syndrome.

140 Nursing responsibilities in the management of adolescent obesity include which of the following? Plan a low-calorie, low-protein diet. Incorporate favorite foods into child's diet. Encourage diversional activities during mealtimes. Use nutritious foods as a method of reward.

Incorporate favorite foods into child's diet. 2. Incorporating favorite foods into the child's diet allows the adolescent control over the weight loss process. 1. Special diets are usually not used except in cases of severe obesity. Low-carbohydrate and moderate-protein diets may then be used. 3. Diversional activities (reading, television) are not encouraged during mealtimes. These can contribute to overeating. 4. Food should not be used as a reward.

145 Correct terminology is necessary in understanding substance abuse. Physical dependence is which of the following? Voluntary behavior based on psychosocial needs A problem that occurs in conjunction with addiction Culturally defined use of drugs for purposes other than accepted medical purposes Involuntary physiologic responses to the pharmacologic characteristics of drugs

Involuntary physiologic responses to the pharmacologic characteristics of drugs 4. Physical dependence is an involuntary response to the pharmacologic characteristics of a drug such as an opiate or alcohol. 1. Dependence is a physiologic response; it is not culturally determined or subject to voluntary control. 2. A person can be physically dependent on a narcotic without being addicted; for example, patients who use an opiate to control pain need increasing doses to achieve the same effect. An individual can be addicted to a drug without being physically dependent. 3. Dependence is a physiologic response; it is not culturally determined or subject to voluntary control.

8 A teenager with asthma is having pulmonary function tests and asks about the phrase, forced expiratory volume, that the physician used. Which response by the nurse most accurately explains the purpose of the forced expiratory volume (FEV1)? It confirms the diagnosis of asthma. It determines whether allergy is causing the asthma. It identifies what part of the lung is affected by the asthma. It assesses the severity of asthma.

It assesses the severity of asthma. The forced expiratory volume measures the maximum amount of air that can be forcefully exhaled in the first second. This can provide an objective measure of pulmonary function compared with the child's baseline. Diagnosis of asthma is made on the basis of clinical manifestations, history, and physical examination. The cause of asthma is inflammation, bronchospasm, and obstruction but not allergy. The FEV does not identify specific structures affected by the asthma.

When treating nausea and vomiting as a side effect of chemotherapy and/or radiotherapy, ondansetron (Zofran) is the preferred drug of choice because? It has a shorter onset of action. It can be administered via several different routes. It does not cause extrapyramidal side effects. It has no adverse side effects if administered appropriately.

It does not cause extrapyramidal side effects. Zofran is a 5-hydroxytryptamine-3 receptor antagonist and is considered the antiemetic of choice for oncology patients as it produces no extrapyramidal side effects. Pharmacodynamics and pharmacokinetic features aside, the preference for this medication is due to producing no extrapyramidal side effects. Any medication even if administered properly has the potential to cause side effects. The ability to administer via different routes does not indicate a preferred drug choice.

5 The mother of a child with acute streptococcal pharyngitis being treated with antibiotics asks why all of the antibiotic needs to be taken. What is the best response by the nurse? It decreases the chance of acquiring otitis media. It prevents diabetes insipidus. It decreases the chance of nephrotic syndrome. It prevents the child from getting acute rheumatic fever.

It prevents the child from getting acute rheumatic fever. Children with group A beta-hemolytic streptococcus (GABHS) infection are at risk for acute rheumatic fever and acute glomerulonephritis. Otitis media is not a sequela to group A beta hemolytic streptococcus (GABHS). Diabetes insipidus is not a sequela to GABHS. Children are at risk for glomerulonephritis and not nephrotic syndrome.

4 The parents ask why a humidified atmosphere is recommended for their infant with an upper respiratory tract infection. What is the best response by the nurse? It liquefies secretions. It improves oxygenation. It promotes ventilation. It soothes inflamed mucous membranes.

It soothes inflamed mucous membranes. By humidifying the inspired air, the membranes inflamed by the infection and dry air are soothed. The size of the droplets is too large to liquefy secretions. No additional oxygen is provided with humidified air. The humidity has no effect on ventilation.

120 Where are Wilms tumors (nephroblastomas) located? Bone Brain Kidney Lymphatic system

Kidney Wilms tumor, or nephroblastoma, is the most common intraabdominal and kidney tumor of childhood. Wilms tumors are encapsulated and are located in the abdom

142 Which of the following symptoms would the nurse expect to observe during the physical assessment of an adolescent girl with severe weight loss and disrupted metabolism associated with anorexia nervosa? Tachycardia Dysmenorrhea Heat intolerance Lowered body temperature

Lowered body temperature 4. Symptoms of anorexia nervosa include low body temperature, severe weight loss, decreased blood pressure, dry skin, brittle nails, altered metabolic activity, and lanugo hair. 1. Bradycardia, rather than tachycardia, may be present. 2. Amenorrhea, rather than dysmenorrhea, is a manifestation of anorexia nervosa. 3. Cold intolerance is a manifestation of anorexia nervosa.

70 An adolescent patient is admitted to the emergency room with complaints of pain in her right knee. The knee is swollen and warm to the touch. No exudate is noted. Patient is febrile. Which disease process would be included as part of the patient's differential diagnosis? Juvenile diabetes Lyme disease Congestive heart failure Rheumatoid arthritis

Lyme disease Final stages of Lyme disease include a variety of presentations in cardiac, neurological and musculoskeletal systems. Lyme arthritis is often seen in the knee. Cardiac complications can cause heart block. Endocrine abnormalities do not typically present with effusion of a joint.

A critical concept that needs to be maintained during intravenous administration of chemotherapy for a pediatric patient is? Positioning the patient in a semi-fowler's position. Not use an infusion device but rather allow for a free-flow line. Continue the infusion regardless if the patient develops a rash. Maintaining the integrity of the parenteral access line.

Maintaining the integrity of the parenteral access line. Administration of chemotherapy via parenteral access requires that the integrity of the access line be maintained and monitored by the nurse. If there is any indication that the site as infiltrated, then the infusion must be immediately stopped. Patient positioning is variable depending on patient comfort. An infusion device must be used as this is considered to be a titratable infusion. If the patient develops a rash in response to chemotherapy, this may be an indication of a hypersensitivity reaction. Intervention is required with notification of health care provider and discontinuing the infusion.

116 A child with lymphoma is receiving extensive radiotherapy. Which of the following is the most common side effect of this treatment? Malaise Seizures Neuropathy Lymphadenopathy

Malaise Malaise is the most common side effect of radiotherapy. For children, the fatigue may be especially distressing because it means they cannot keep up with their peers. Seizures are unlikely because irradiation would not usually involve the cranial area for treatment of lymphoma. Neuropathy is a side effect of certain chemotherapeutic agents. Lymphadenopathy is one of the findings of lymphoma.

26 The nurse is preparing to administer chemotherapeutic drugs. Which statement would most govern how the nurse administers the drugs? Many chemotherapeutic agents are vesicants that can cause severe cellular damage if the drug infiltrates. Good handwashing is essential when handling chemotherapeutic drugs, but gloves are not necessary. Infiltration will not occur unless superficial veins are used for the intravenous infusion. Anaphylaxis cannot occur because the drugs are considered toxic to normal cells.

Many chemotherapeutic agents are vesicants that can cause severe cellular damage if the drug infiltrates. Chemotherapeutic agents can be extremely damaging to cells. Nurses experienced with the administration of vesicant drugs should be responsible for giving these drugs and be prepared to treat extravasation if necessary. Gloves are worn to protect the nurse when handling the drugs, and the hands should be thoroughly washed both before and afterward. Infiltration and extravasation are always a risk, especially with peripheral veins. Anaphylaxis is a possibility with some chemotherapeutic and immunologic agents.

82 Cystic fibrosis may affect one system or multiple systems of the body. What is the primary factor responsible for possible multiple clinical manifestations? Atrophic changes in the mucosal wall of the intestines Hypoactivity of the autonomic nervous system Hyperactivity of the apocrine glands Mechanical obstruction caused by increased viscosity of exocrine gland secretions

Mechanical obstruction caused by increased viscosity of exocrine gland secretions Children with cystic fibrosis have thick exocrine gland secretions. The viscous secretions obstruct small passages in organs such as the lungs and pancreas. Thick mucous secretions are the probable cause of the multiple body system involvement, not atrophic changes in the intestinal mucosal walls. There is an identified autonomic nervous system anomaly, but it is not hypoactivity. The apocrine, or sweat, glands are not hyperactive. The child loses a greater amount of salt due to abnormal chloride movement.

11 The parents of a child who is newly diagnosed with cystic fibrosis ask what is happening within the body that is causing effects in multiple organ systems. Which response by the nurse is most accurate? Mechanical obstruction is caused by increased viscosity of mucous gland secretions. Atrophic changes occurs in the mucosal wall of intestines and alveoli. There is decreased activity of the autonomic nervous system. The hyperactivity of sweat glands causes major fluid loss.

Mechanical obstruction is caused by increased viscosity of mucous gland secretions. Children with cystic fibrosis have thick mucous gland secretions. The viscous secretions obstruct small passages in organs such as the pancreas. Thick mucous secretions are the probable cause of the multi-system involvement. There is an identified autonomic nervous system anomaly, but it is not decreased. The sweat glands are not hyperactive. The child loses a greater amount of salt because of abnormal chloride movement.

57 Which factor promotes wound healing? Antiseptics Eschar formation Dry wound environment Moist, crust-free wound environment

Moist, crust-free wound environment This environment enhances the migration of epithelial cells across the wound and facilitates healing. Antiseptics, such as hydrogen peroxide and povidone-iodine, have a cytotoxic effect on healthy cells and little effect on controlling infections. Eschar formation does not promote wound healing. Eschar is burn crust or dead tissue that inhibits wound healing. A dry wound environment does not facilitate wound healing.

53 An appropriate nursing intervention when caring for a child with pneumonia is which of the following? Avoid placing child on the affected side. Monitor the respiratory status frequently. Place in a Trendelenburg position. Administer antitussive agents around the clock.

Monitor the respiratory status frequently. The child's respiratory rate, status, oxygenation, general disposition, and level of activity are frequently monitored. Lying on the affected side may promote comfort by splinting the chest and reducing pleural rubbing. The child should be positioned with the unaffected side up to promote maximum expansion. Children should be placed in a semierect position or position of comfort. Antitussives are usually not indicated.

27 A toddler with mucosal ulceration related to chemotherapy is not eating because of pain. The nurse would expect to administer which solution to ease the child's discomfort? Lemon glycerin swabs for cleansing Mouthwashes with hydrogen peroxide Mouthwashes with normal saline solution Local anesthetic such as viscous lidocaine before meals

Mouthwashes with normal saline solution Normal saline solution mouthwashes are the preferred mouth care for this age group. The rinse will keep the mucosal surfaces clean without risking adverse effects on the mucosa or adverse effects caused by the child swallowing the rinse. Viscous lidocaine is not recommended for toddlers because it depresses the gag reflex. Lemon glycerin swabs can irritate eroded tissue and cause tooth decay. Hydrogen peroxide delays healing by breaking down protein.

19 A 4-year-old preschooler with a low platelet count received intravenous immunoglobulin (IVIG). What part of routine health maintenance would the nurse explain to the parents should be delayed? The administration of live-virus vaccines The yearly routine dental examination Assessing the child blood pressure Checking the child's visual acuity

The administration of live-virus vaccines The American Academy of Pediatrics (AAP) recommends delaying the administration of routine measles immunization for a minimum of 8 to 10 months after a child receives an immune globulin preparation because it may block the replication of live-virus vaccine. The yearly routine dental examination can be performed. Assessing the child's blood pressure is appropriate. Checking the child's visual acuity is fine.

147 Which of the following statements is true about smoking in adolescence? Smoking among adolescents is becoming more prevalent. Smoking will not continue unless peer pressure continues. Adolescents with identified personality traits are more likely to smoke. Smoking is less common when an adolescent's parents disapprove of smoking.

Smoking is less common when an adolescent's parents disapprove of smoking. 4. Teenagers who do not smoke usually have parents and friends who oppose smoking and who do not smoke. 1. The percentage of young people who reported current cigarette use and frequent cigarette use has declined significantly. 2. Teenagers begin smoking for a variety of reasons, such as imitation of adult behavior, peer pressure, a desire to imitate behaviors portrayed in movies and advertisements, and a desire to control weight. The absence of peer pressure alone will not stop smoking. 3. Research has not been able to identify significant differences in the personality traits of adolescents who smoke and those who do not.

86 The nurse is interviewing the parents of a 4-month-old infant brought to the hospital emergency department. The infant is dead on arrival, and no attempt at resuscitation is made. The parents state that the baby was found in the crib with a blanket over the head, lying face down in bloody fluid from the nose and mouth. The parents indicate no problems when the infant was placed in the crib asleep. Which of the following causes of death does the nurse suspect? Suffocation Child abuse Infantile apnea Sudden infant death syndrome (SIDS)

Sudden infant death syndrome (SIDS) Death is consistent with the appearance of SIDS. The infant is usually found in a disheveled bed; with blankets over the head; huddled into a corner and clutching the sheets; with frothy, blood-tinged fluid in the mouth and nose; and lying face down. The diaper is also usually full of stool, indicating a cataclysmic type of death. Although the child was found under the blanket, the other findings are consistent with SIDS. The findings as reported are consistent with SIDS, not child abuse. The history and physical findings are consistent with SIDS, not infantile apnea. 87 A parent with a toddler who has a respiratory infection wants to use the traditional method of topical vapor rub. Which statement by the parent indicates that additional teaching is needed with regard to administration of this treatment?

15 A child is having his normal health check at the pediatrician's office. What is the most important nursing consideration when preparing to teach parents of a child with sickle cell disease? Teach the parents and the child how to minimize sickle cell crises. Refer the parents for genetic counseling once the child is well. Help the child and family adjust generally to a chronic disease. Observe for complications of multiple blood transfusions.

Teach the parents and the child how to minimize sickle cell crises. Parents need instructions on watching for specific triggers such as stress, infection, dehydration, and low oxygen concentration that can cause changes in the child's condition. The physiologic aspects have priority over the psychological aspects. Genetic counseling is important, but teaching about the care of the child is the priority. Multiple blood transfusions are an option for some children with sickle cell disease. The priority for all children with this condition is having parents who are properly prepared to care for them. Sickle cell disease is a life-long chronic illness, but caring for the child's current health issues and teaching the parents how to avoid sickle cell triggers are priority.

69 Which clinical finding would alert the nurse to the possibility that the pediatric patient has conjunctivitis as a result of a foreign object body? Bilateral swollen lids Tearing of the right eye Crusting of eyelids Inflamed conjunctiva of both eyes

Tearing of the right eye Conjunctivitis as a result of a foreign object body typically presents with clinical symptoms in the affected eye. Bilateral presentation of symptoms rules is seen in conjunctivitis occurring from other sources such as viral, allergic or bacterial. Crusting of eyelids is typically seen with bacterial etiology.

134 The nurse is assessing a 3-year-old African-American child who is being seen in the clinic for the first time. The child's height and weight are at the 20th percentile on the commonly used growth chart from the National Center for Health Statistics (NCHS). When interpreting these data, the nurse should recognize which of the following? The data suggest the child requires nutritional intervention. The NCHS charts are accurate for U.S. African-American children. A correction factor is used when the NCHS chart is used for non-Caucasian ethnic groups. No assessment can be made until several measurements are plotted over time.

The NCHS charts are accurate for U.S. African-American children. 2. The NCHS growth charts can serve as reference guides for all racial or ethnic groups. U.S. African-American children were included in the sample population. 1. The 20th percentile for height and weight are not indicative of nutritional failure. 3. No correction factor exists. The growth chart can be used with the perspective that different groups of children have varying normal distributions on the growth curves. 4. Serial measurements are useful for longitudinal assessment of the child; single data points provide information about the child's current status.

128 What are some legal and ethical issues that arise for the nurse when using an interpreter? Direct questions to interpreter. Ask several questions at a time. The family should be fully informed of all aspects of procedures before consenting. Discourage interpreter and client from discussing topics not included in interview.

The family should be fully informed of all aspects of procedures before consenting. 3. In obtaining informed consent through interpreter, the nurse should fully inform the family of all aspects of the particular procedure to which they are consenting. 1. The communication is with the family members. The nurse directs the questions toward the family while observing nonverbal cues. 2. Questions are asked one at a time to allow the interpreter and family to translate, process, and answer the question. 4. The interpreter and client should build a rapport. Discussion of topics outside of the interview allows the two parties to become acquainted.

14 A child is diagnosed with sickle cell disease. The parents are unsure of how their child contracted the disease. What is the most appropriate explanation by the nurse? The mother has the trait, but the father does not. The father has the trait, but the mother does not. The mother has the disease, but the father has neither the trait nor the disease. The mother and father have the trait; therefore the child has a 25% chance for having the disease.

The mother and father have the trait; therefore the child has a 25% chance for having the disease. Sickle cell disease is an autosomal recessive disorder; therefore both parents must have the trait for the child to have the disease. Sickle cell disease is an autosomal recessive disorder; therefore both parents must have the trait for the child to have the disease. Both parents must have the trait for the child to have the disease. Both parents must have the trait for the child to have the disease.

A young pediatric oncology patient has stomatitis. Which intervention if observed by the charge nurse would warrant immediate action? The nurse assigned to the patient was offering mouth care using a sponge toothbrush. The nurse offers the patient frequent mouth rinses. The nurse is preparing to use viscous lidocaine to offer pain relief. The nurse administers sucralfate as ordered.

The nurse is preparing to use viscous lidocaine to offer pain relief. Use of viscous lidocaine is contraindicated in mucosal alterations as it can lead to potential aspiration and seizure activity. All of the other interventions are appropriate and can be used for symptomatic relief of stomatitis.

97 Which of the following is the appropriate site to administer an intramuscular (IM) vaccine to a newborn? The dorsal gluteal muscle The vastus lateralis muscle The ventral gluteal muscle The biceps muscle

The vastus lateralis muscle If the vaccine is given intramuscularly, then it is given in the vastus lateralis in newborns or in the deltoid for older infants and children. Regardless of age, the dorsogluteal site should be avoided because it has been associated with low antibody seroconversion rates, indicating a reduced immune response, and it is no longer an acceptable evidence-based practice site for IM injections. The ventral gluteal muscle and the biceps muscle are not appropriate sites for IM injections.

A pediatric patient has been diagnosed with leukemia and presents with a white blood cell (WBC) count of 80,000 mm3. In teaching a group of nursing students about the disease process, how would the nursing instructor describe the proliferation of white blood cells and their ability to fight off infection? The increase in WBC provides protection against viral infections but not bacterial infections. Although the WBC count is elevated, there are limited blast cells which leads to an increased likelihood that the patient will develop an infection. There is an increase in immature cells which reduce the body's ability to fight off infection. Although the WBC count is elevated, they are overwhelmed with mature cells that predispose the individual to develop an infection.

There is an increase in immature cells which reduce the body's ability to fight off infection. In leukemia, WBC count is elevated with an increase in blast or immature cells which limit the functional ability of WBCs being able to fight off infection.

85 In reviewing potential susceptibility to respiratory infections for children, which statement is based on supportive physiological evidence? Newborns are more likely to develop respiratory infections in the neonatal period due to changes from intrauterine to external environment. With advancing age, immunity decreases leading to greater chances of developing respiratory infections. There is an increase in infection rate between 3 to 6 months due to loss of protective effects of maternal antibodies. Viral respiratory infections increase dramatically by 5 years of age.

There is an increase in infection rate between 3 to 6 months due to loss of protective effects of maternal antibodies. Newborns have immune protection that lasts from 3 to 6 months due to maternal antibody transfer and are therefore less likely to develop a respiratory infection. Development of respiratory infection is not related to transitioning from intrauterine to external environments. With advancing age, immunity increases rather than decreases. Viral respiratory infections occur less frequently by 5 years of age.

21 The parents of a child with newly diagnosed beta-thalassemia asks for clarification about what the treatment is. Which explanation by the nurse is best? Treatment focuses on plasma transfusions and administration of clotting factors. Transfusions of red blood cells and medication to remove excessive iron from the blood are used. Splenectomy and medications to suppress the immune system are the recommended treatment. Liver transplantation and administration of intravenous vitamin regimens are used.

Transfusions of red blood cells and medication to remove excessive iron from the blood are used. This explanation uses simpler words to explain the erythrocyte transfusions and the chelation therapy. The management of beta-thalassemia centers on three techniques: (1) erythrocyte transfusions, (2) chelation therapy, and (3) splenectomy. The management of beta-thalassemia centers on three techniques: (1) erythrocyte transfusions, (2) chelation therapy, and (3) splenectomy. Bone marrow transplantation is the only cure for beta-thalassemia. The management of beta-thalassemia centers on three techniques: (1) erythrocyte transfusions, (2) chelation therapy to remove excessive iron overload, and (3) splenectomy.

119 Which of the following is most descriptive of the therapeutic management of osteogenic sarcoma? Intensive irradiation is the primary treatment. Amputation of the affected extremity is rarely necessary. Treatment usually consists of surgery and chemotherapy. Bone marrow transplantation offers the best chance of long-term survival.

Treatment usually consists of surgery and chemotherapy. Optimum treatment of osteosarcoma is surgery and chemotherapy. Surgical biopsy is followed by either limb salvage or amputation and chemotherapy. Radiation and bone marrow transplantation are not part of the therapy for osteosarcoma. Amputation is often required when limb salvage is not possible.

6 The mother of a 20-month-old child tells the nurse that the child has a barking cough at night and has a temperature of 37° C (98.6° F). Suspecting the child has croup, what should the nurse instruct the mother to do? Control the fever with acetaminophen, and call if the cough gets worse tonight. Try a cool-mist vaporizer at night and watch for signs of difficulty breathing. Try over-the-counter cough medicine, and come to the clinic tomorrow if there is no improvement. Take the child to the hospital in case epiglottitis occurs.

Try a cool-mist vaporizer at night and watch for signs of difficulty breathing. Because the child is not having difficulty breathing, the nurse should teach the parents the signs of respiratory distress and tell them to come to the emergency department if they develop. Cool mist is recommended to provide relief. Cough suppressants are not indicated. A barking cough and temperature of 37° C are characteristic of laryngotracheobronchitis (croup) and not epiglottitis. The child does not have a fever that needs to be managed.

127 Which of the following is most likely to encourage parents to talk about their feelings related to their child's illness? Be sympathetic. Ask direct questions. Use open-ended questions. Avoid periods of silence.

Use open-ended questions. 3. Open-ended questions require the parent to answer with more than a brief answer. Closed-ended questions should be avoided when attempting to elicit parents' feelings. 1. Sympathy is having feelings or emotions in common with another person rather than understanding those feelings (empathy). Sympathy is not therapeutic in the helping relationship. 2. Direct questions may obtain limited information. In addition, they may be considered threatening by the parent. 4. Silence can be an effective interviewing tool. It allows a sharing of feelings in which two or more people absorb the emotion in depth. Silence permits the interviewee to sort out thoughts and feelings and search for responses to questions.

40 A 5-year-old child is brought to the Emergency Department with abrupt onset of sore throat, pain with swallowing, fever, and sitting upright and forward. Acute epiglottitis is suspected. What are the most appropriate nursing interventions? (Select all that apply.) Vital signs Throat culture Medical history Assessment of breath sounds Emergency airway equipment readily available

Vital signs Medical history Assessment of breath sounds Emergency airway equipment readily available Vital signs should always be taken as a part of the assessment. Medical history is important in assisting with the diagnosis in addition to knowing immunization status. Assessment of breath sounds is important in assisting with the diagnosis. Suprasternal and substernal retractions may be noted. Emergency airway equipment must be readily available in case the airway becomes obstructed. Throat culture should never be done when diagnosis of epiglottis is suspected. Manipulation of the throat can stimulate the gag reflex in an already inflamed airway and cause laryngeal spasm that will cause occlusion of the airway.

91 A 5-year-old child is brought the Emergency Department with abrupt onset of sore throat, pain with swallowing, fever, and sitting upright and forward. Acute epiglottitis is suspected. What are the most appropriate nursing interventions? (Select all that apply.) Vital signs Throat culture Medical history Assessment of breath sounds Emergency airway equipment readily available

Vital signs Medical history Assessment of breath sounds Emergency airway equipment readily available Vital signs should always be taken as a part of the assessment. Medical history is important in assisting with the diagnosis in addition to knowing immunization status. Assessment of breath sounds is important in assisting with the diagnosis. Suprasternal and substernal retractions may be noted. Emergency airway equipment must be readily available in case the airway becomes obstructed. Throat culture should never be done when diagnosis of epiglottis is suspected. Manipulation of the throat can stimulate the gag reflex in an already inflamed airway and cause laryngeal spasm that will cause occlusion of the airway.

78 The school nurse is conducting an assessment for pediculosis capitis (head lice) on a group of school-age children. Which describes a child with a positive head check? Maculopapular lesions behind the ears White, flaky particles throughout the entire scalp area Lesions in the scalp extending from the hairline to the neck White sacs attached to the hair shafts in the occipital area

White sacs attached to the hair shafts in the occipital area Evidence of pediculosis capitis includes white sacs (nits) attached to the hair shafts and usually located in the occipital area. Lesions may be present from itching, but the positive sign is evidence of the nits. White flaky particles appear with dandruff, and lice nits must be distinguished from dandruff. Lesions may be present from itching, but the positive sign is evidence of the nits.

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

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

Decongestant nose drops are recommended for a 10-month-old infant with an upper respiratory tract infection. Instructions for nose drops should include which action? a.Avoid using for more than 3 days. b.Keep drops to use again for nasal congestion. c.Administer drops until nasal congestion subsides. d.Administer drops after feedings and at bedtime.

a.Avoid using for more than 3 days. ANS: A Vasoconstrictive nose drops such as phenylephrine (Neo-Synephrine) should not be used for more than 3 days to avoid rebound congestion. Drops should be discarded after one illness because they may become contaminated with bacteria. Vasoconstrictive nose drops can have a rebound effect after 3 days of use. Drops administered before feedings are more helpful.

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

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

An infant has developed staphylococcal pneumonia. Nursing care of the child with pneumonia includes which interventions? (Select all that apply.) a.Cluster care to conserve energy b.Round-the-clock administration of antitussive agents c.Strict intake and output to avoid congestive heart failure d.Administration of antibiotics

a.Cluster care to conserve energy d.Administration of antibiotics ANS: A, D Antibiotics are indicated for a bacterial pneumonia. Often the child will have decreased pulmonary reserve, and the clustering of care is essential. Antitussive agents are used sparingly. It is desirable for the child to cough up some of the secretions. Fluids are essential to kept secretions as liquefied as possible.

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

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

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

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

Which condition in a child should alert a nurse for increased fluid requirements? a.Fever b.Mechanical ventilation c.Congestive heart failure d.Increased intracranial pressure (ICP)

a.Fever ANS: A Fever leads to great insensible fluid loss in young children because of increased body surface area relative to fluid volume. Respiratory rate influences insensible fluid loss and should be monitored in the mechanically ventilated child. Congestive heart failure is a case of fluid overload in children. Increased ICP does not lead to increased fluid requirements in children.

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

a.Fevers such as this are common with viral illnesses. ANS: A Most fevers are of brief duration, with limited consequences, and are viral. Little evidence supports the use of antipyretic drugs to prevent febrile seizures. Neither the increase in temperature nor its response to antipyretics indicates the severity or etiology of infection.

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

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

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

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

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

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

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

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

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

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

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

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

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

a.cover the skin with a shirt or gown before percussing. ANS: A For postural drainage and percussion, the child should be dressed in a light shirt to protect the skin and placed in the appropriate postural drainage positions. The chest wall is struck with a cupped-hand, not a flat-hand position. The procedure should be done over the rib cage only. Positioning precedes the percussion.

94 It is important that a child with acute streptococcal pharyngitis be treated with antibiotics to prevent otitis media. diabetes insipidus. nephrotic syndrome. acute rheumatic fever.

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

55 Asthma is now classified into four categories: mild intermittent, mild persistent, moderate persistent, and severe persistent. Clinical features used to determine these categories include all of the following except lung function. associated allergies. frequency of symptoms. frequency and severity of exacerbations.

associated allergies. Associated allergies are not part of the classification system used in the Guidelines for the Diagnosis and Management of Asthma. The clinical features that are assessed in the classification system are frequency of daytime and nighttime symptoms, frequency and severity of exacerbations, and lung function.

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

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

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

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

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

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

Which best describes acute glomerulonephritis? a.Occurs after a urinary tract infection b.Occurs after a streptococcal infection c.Associated with renal vascular disorders d.Associated with structural anomalies of genitourinary tract

b.Occurs after a streptococcal infection ANS: B Acute glomerulonephritis is an immune-complex disease that occurs after a streptococcal infection with certain strains of the group A â-hemolytic streptococcus. Acute glomerulonephritis usually follows streptococcal pharyngitis and is not associated with renal vascular disorders or genitourinary tract structural anomalies.

The nurse is teaching nursing students about normal physiologic changes in the respiratory system of toddlers. Which best describes why toddlers have fewer respiratory tract infections as they grow older? a.The amount of lymphoid tissue decreases. b.Repeated exposure to organisms causes increased immunity. c.Viral organisms are less prevalent in the population. d.Secondary infections rarely occur after viral illnesses.

b.Repeated exposure to organisms causes increased immunity. ANS: B Children have increased immunity after exposure to a virus. The amount of lymphoid tissue increases as children grow older. Viral organisms are not less prevalent, but older children have the ability to resist invading organisms. Secondary infections after viral illnesses include Mycoplasma pneumoniae and group A β-hemolytic streptococcal infections.

A nurse is teaching nursing students the physiology of congenital heart defects. Which defect results in decreased pulmonary blood flow? a.Atrial septal defect b.Tetralogy of Fallot c.Ventricular septal defect d.Patent ductus arteriosus

b.Tetralogy of Fallot ANS: B Tetralogy of Fallot results in decreased blood flow to the lungs. The pulmonic stenosis increases the pressure in the right ventricle, causing the blood to go from right to left across the ventricular septal defect. Atrial and ventricular septal defects and patent ductus arteriosus result in increased pulmonary blood flow.

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

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

The nurse is teaching parents about signs of digoxin (Lanoxin) toxicity. Which is a common sign of digoxin toxicity? a.Seizures b.Vomiting c.Bradypnea d.Tachycardia

b.Vomiting ANS: B Vomiting is a common sign of digoxin toxicity. Seizures are not associated with digoxin toxicity. The child will have a slower heart rate, not respiratory rate. The heart rate will be slower, not faster.

A nurse is admitting an infant with asthma. The nurse understands that asthma in infants is usually triggered by: a.medications. b.a viral infection. c.exposure to cold air. d.allergy to dust or dust mites.

b.a viral infection. ANS: B Viral illnesses cause inflammation that causes increased airway reactivity in asthma. Medications such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and antibiotics may aggravate asthma, but not frequently in infants. Exposure to cold air may exacerbate already existing asthma. Allergy is associated with asthma, but 20% to 40% of children with asthma have no evidence of allergic disease.

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

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

A child is admitted with acute glomerulonephritis. The nurse should expect the urinalysis during this acute phase to show: a.bacteriuria, hematuria. b.hematuria, proteinuria. c.bacteriuria, increased specific gravity. d.proteinuria, decreased specific gravity.

b.hematuria, proteinuria. ANS: B Urinalysis during the acute phase characteristically shows hematuria and proteinuria. Bacteriuria and changes in specific gravity are not usually present during the acute phase.

93 The most appropriate time to perform bronchial postural drainage is immediately before all aerosol therapy. before meals and at bedtime. immediately on arising and at bedtime. 30 minutes after meals and at bedtime.

before meals and at bedtime. The most effective time for bronchial drainage is before meals and before bedtime to prevent the interaction of excessive amounts of mucus and food intake, thereby increasing the risk of vomiting. Bronchial drainage is more effective after other respiratory therapies such as bronchodilator or nebulizer treatments. These treatments open the airways, facilitating the movement of mucus with the positioning of bronchial drainage. Bronchial drainage should be done three or four times each day to be effective. When bronchial drainage is completed after meals, it may cause the child to vomit.

A child is diagnosed with influenza, probably type A disease. Management includes which recommendation? a.Clear liquid diet for hydration b.Aspirin to control fever c.Amantadine hydrochloride (Symmetrel) to reduce symptoms d.Antibiotics to prevent bacterial infection

c.Amantadine hydrochloride (Symmetrel) to reduce symptoms ANS: C Amantadine hydrochloride may reduce symptoms related to influenza A if administered within 24 to 48 hours of onset. It is ineffective against type B or C. A clear liquid diet is not necessary for influenza, but maintaining hydration is important. Aspirin is not recommended in children because of increased risk of Reye syndrome. Acetaminophen or ibuprofen is a better choice. Preventive antibiotics are not indicated for influenza unless there is evidence of a secondary bacterial infection.

The nurse is teaching parents of an infant about the causes of iron deficiency anemia. Which statement best describes iron deficiency anemia in infants? a.It is caused by depression of the hematopoietic system. b.It is easily diagnosed because of an infant's emaciated appearance. c.Clinical manifestations are similar regardless of the cause of the anemia. d.Clinical manifestations result from a decreased intake of milk and the premature addition of solid foods.

c.Clinical manifestations are similar regardless of the cause of the anemia. ANS: C In iron deficiency anemia, the child's clinical appearance is a result of the anemia, not the underlying cause. Usually the hematopoietic system is not depressed in iron deficiency anemia. The bone marrow produces red cells that are smaller and contain less hemoglobin than normal red cells. Children who are iron deficient from drinking excessive quantities of milk are usually pale and overweight. They are receiving sufficient calories, but are deficient in essential nutrients. The clinical manifestations result from decreased intake of iron-fortified solid foods and an excessive intake of milk.

The nurse is conducting discharge teaching about signs and symptoms of heart failure to parents of an infant with a repaired tetralogy of Fallot. Which signs and symptoms should the nurse include? (Select all that apply.) a.Warm flushed extremities b.Weight loss c.Decreased urinary output d.Sweating (inappropriate) e.Fatigue

c.Decreased urinary output d.Sweating (inappropriate) e.Fatigue ANS: C, D, E The signs and symptoms of heart failure include decreased urinary output, sweating, and fatigue. Other signs include pale, cool extremities, not warm and flushed, and weight gain, not weight loss.

The nurse is conducting a staff in-service on sickle cell anemia. Which describes the pathologic changes of sickle cell anemia? a.Sickle-shaped cells carry excess oxygen. b.Sickle-shaped cells decrease blood viscosity. c.Increased red blood cell destruction occurs. d.Decreased adhesion of sickle-shaped cells occurs.

c.Increased red blood cell destruction occurs. ANS: C The clinical features of sickle cell anemia are primarily the result of increased red blood cell destruction and obstruction caused by the sickle-shaped red blood cells. Sickled red cells have decreased oxygen-carrying capacity and transform into the sickle shape in conditions of low oxygen tension. When the sickle cells change shape, they increase the viscosity in the area where they are involved in the microcirculation. Increased adhesion and entanglement of cells occurs.

Which action by the school nurse is important in the prevention of rheumatic fever? a.Encourage routine cholesterol screenings. b.Conduct routine blood pressure screenings. c.Refer children with sore throats for throat cultures. d.Recommend salicylates instead of acetaminophen for minor discomforts.

c.Refer children with sore throats for throat cultures. ANS: C Nurses have a role in prevention—primarily in screening school-age children for sore throats caused by group A β-hemolytic streptococci. They can achieve this by actively participating in throat culture screening or by referring children with possible streptococcal sore throats for testing. Cholesterol and blood pressure screenings do not facilitate the recognition and treatment of group A β-hemolytic streptococci. Salicylates should be avoided routinely because of the risk of Reye syndrome after viral illnesses.

Parents of two school-age children with asthma ask the nurse, "What sports can our children participate in?" The nurse should recommend which sport? a.Soccer b.Running c.Swimming d.Basketball

c.Swimming ANS: C Swimming is well tolerated in children with asthma because they are breathing air fully saturated with moisture and because of the type of breathing required in swimming. Exercise-induced bronchospasm is more common in sports that involve endurance, such as soccer. Prophylaxis with medications may be necessary.

It is generally recommended that a child with acute streptococcal pharyngitis can return to school: a.when sore throat is better. b.if no complications develop. c.after taking antibiotics for 24 hours. d.after taking antibiotics for 3 days.

c.after taking antibiotics for 24 hours. ANS: C After children have taken antibiotics for 24 hours, they are no longer contagious to other children. Sore throat may persist longer than 24 hours after beginning antibiotic therapy, but the child is no longer considered contagious. Complications may take days to weeks to develop.

When caring for a newborn with Down syndrome, the nurse should be aware that the most common congenital anomaly associated with Down syndrome is: a.hypospadias. b.pyloric stenosis. c.congenital heart disease. d.congenital hip dysplasia.

c.congenital heart disease. ANS: C Congenital heart malformations, primarily septal defects, are the most common congenital anomaly in Down syndrome. Hypospadias, pyloric stenosis, and congenital hip dysplasia are not frequent congenital anomalies associated with Down syndrome.

Several blood tests are ordered for a preschool child with severe anemia. The child is crying and upset because of memories of the venipuncture done at the clinic 2 days ago. The nurse should explain: a.venipuncture discomfort is very brief. b.only one venipuncture will be needed. c.topical application of local anesthetic can eliminate venipuncture pain. d.most blood tests on children require only a finger puncture because a small amount of blood is needed.

c.topical application of local anesthetic can eliminate venipuncture pain. ANS: C Preschool children are concerned with both pain and the loss of blood. When preparing the child for venipuncture, the nurse will use a topical anesthetic to eliminate any pain. This is a traumatic experience for preschool children. They are concerned about their bodily integrity. A local anesthetic should be used, and a bandage should be applied to maintain bodily integrity. The nurse should not promise one attempt in case multiple attempts are required. Both finger punctures and venipunctures are traumatic for children. Both require preparation.

The parent of an infant with nasopharyngitis should be instructed to notify the health professional if the infant displays which clinical manifestation? a.Fussiness b.Coughing c.A fever over 99° F d.Signs of an earache

d.Signs of an earache ANS: D If an infant with nasopharyngitis shows signs of an earache, it may mean a secondary bacterial infection is present and the infant should be referred to a practitioner for evaluation. Irritability is common in an infant with a viral illness. Cough can be a sign of nasopharyngitis. Fever is common in viral illnesses.

Cystic fibrosis (CF) is suspected in a toddler. Which test is essential in establishing this diagnosis? a.Bronchoscopy b.Serum calcium c.Urine creatinine d.Sweat chloride test

d.Sweat chloride test ANS: D A sweat chloride test result greater than 60 mEq/L is diagnostic of CF. Bronchoscopy, although helpful for identifying bacterial infection in children with CF, is not diagnostic. Serum calcium is normal in children with CF. Urine creatinine is not diagnostic of CF.

Many of the physical characteristics of Down syndrome present nursing problems. Care of the child should include which intervention? a.Delay feeding solid foods until the tongue thrust has stopped. b.Modify diet as necessary to minimize the diarrhea that often occurs. c.Provide calories appropriate to child's age. d.Use a cool-mist vaporizer to keep mucous membranes moist.

d.Use a cool-mist vaporizer to keep mucous membranes moist. ANS: D The constant stuffy nose forces the child to breathe by mouth, drying the mucous membranes and increasing the susceptibility to upper respiratory tract infections. A cool-mist vaporizer will keep the mucous membranes moist and liquefy secretions. The child has a protruding tongue, which makes feeding difficult. The parents must persist with feeding while the child continues the physiologic response of the tongue thrust. The child is predisposed to constipation. Calories should be appropriate to the child's weight and growth needs, not age.

Pancreatic enzymes are administered to the child with cystic fibrosis (CF). Nursing considerations should include to: a.not administer pancreatic enzymes if child is receiving antibiotics. b.decrease dose of pancreatic enzymes if child is having frequent, bulky stools. c.administer pancreatic enzymes between meals if at all possible. d.pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal.

d.pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal. ANS: D Enzymes may be administered in a small amount of cereal or fruit at the beginning of a meal or swallowed whole. Pancreatic enzymes are not a contraindication for antibiotics. The dosage of enzymes should be increased if child is having frequent, bulky stools. Enzymes should be given just before meals and snacks.

A mother asks the nurse what would be the first indication that acute glomerulonephritis is improving. The nurse's best response should be that the: a.blood pressure will stabilize. b.the child will have more energy. c.urine will be free of protein. d.urinary output will increase.

d.urinary output will increase. ANS: D An increase in urinary output may signal resolution of the acute glomerulonephritis. If blood pressure is elevated, stabilization usually occurs with the improvement in renal function. The child having more energy and the urine being free of protein are related to the improvement in urinary output.

84 The school nurse is called to the cafeteria because a child "has eaten something he is allergic to." The child is in severe respiratory distress. The first action by the nurse is to determine what the child has eaten. administer diphenhydramine (Benadryl) PO stat. move the child to the nurse's office or hallway. have someone call for an ambulance and paramedic rescue squad or 9-1-1.

have someone call for an ambulance and paramedic rescue squad or 9-1-1. Because the child is in severe respiratory distress, the nurse should have someone call for a rescue squad or 9-1-1. Because severe respiratory distress is occurring, treatment of the response is indicated. What the child has eaten can be determined later. Diphenhydramine by mouth will not be effective for this type of emergency allergic reaction. The child should not be moved, unless the child is currently in a place that puts him or her at greater hazard.

67 The nurse is concerned with the prevention of communicable disease. Primary prevention results from immunizations. early diagnosis. strict isolation. treatment of disease.

immunizations. Communicable diseases are prevented through immunizations, which constitute primary prevention. Early diagnosis can prevent the spread of communicable disease by initiating treatment and isolation if necessary; this would be considered secondary prevention. Strict isolation would be considered part of the treatment regimen and would constitute tertiary prevention, which is the prevention of complications or sequelae. Treatment of disease would not prevent communicable disease.

Administration of colony stimulating agents for the pediatric oncology patient are based on the fact that increase the time frame for genetic adaptation. delays the onset of cellular regeneration. it will stimulate production of blood cell components. increase bone marrow recovery time.

it will stimulate production of blood cell components. Colony stimulating agents used in the treatment of pediatric oncology patients help to restore functional integrity of the bone marrow leading to decreased likelihood of infections. They decrease bone marrow recovery time and stimulate bone marrow growth of specific cellular components.

50 The most profound complication of prolonged middle ear disorders is loss of hearing. failure to thrive. visual impairment. tympanic membrane rupture.

loss of hearing. Loss of hearing is the principal functional consequences of prolonged middle ear infections. Diminished hearing has an adverse effect on the development of speech, language, and cognition. During the active infection, loss of appetite typically occurs, and sucking or chewing tends to aggravate the pain. This is a short-term issue; when the otitis media resolves, the child resumes previous dietary intake. Ear infections do not have an effect on vision. Rupture of the eardrum may occur, but the loss of hearing and subsequent effect on speech are of greater concern.

59 An occlusive dressing, is applied to a large abrasion. This is advantageous because the dressing will provide an antiseptic for the wound. deliver vitamin C to wound. maintain a moist environment for healing. promote mechanical friction for healing.

maintain a moist environment for healing. Occlusive dressings such as Acuderm do not adhere to the wound site. They provide a moist wound surface and insulate the wound. Occlusive dressings do not have antiseptic capabilities, contain vitamin C or protect against friction.

35 Cystic fibrosis may affect singular or multiple systems of the body. The primary factor responsible for possible multiple clinical manifestations is: atrophic changes in the mucosal wall of intestines. hypoactivity of the autonomic nervous system. hyperactivity of the sweat glands. mechanical obstruction caused by increased viscosity of mucous gland secretions.

mechanical obstruction caused by increased viscosity of mucous gland secretions. Thick mucous secretions are the probable cause of the multiple body system involvement. There is an identified autonomic nervous system anomaly, but it is not hypoactivity. The sweat glands are not hyperactive. The child loses a greater amount of salt because of abnormal chloride movement. Children with cystic fibrosis have thick mucous gland secretions. The viscous secretions obstruct small passages in organs such as the pancreas.

54 Skin testing for tuberculosis (TB) is recommended every year for all children older than 2 years. every year for all children older than 10 years. every 2 years for all children starting at age 1 year. periodically for children who are high-risk populations.

periodically for children who are high-risk populations. Children who are high risk for contracting the disease are monitored periodically. Annual testing is only indicated for children with human immunodeficiency virus infection and incarcerated adolescents. Testing is not necessary unless exposure is likely or an underlying medical risk factor is present.

36 The parent of a child with cystic fibrosis calls the clinic nurse to report that the child has developed tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The nurse should tell the parent to bring the child to the clinic because these symptoms are suggestive of: pneumothorax. bronchodilation. carbon dioxide retention. increased viscosity of sputum.

pneumothorax. The child is exhibiting signs of increasing respiratory distress suggestive of a pneumothorax. He or she needs to be seen as soon as possible. Bronchodilation and carbon dioxide retention would not produce the symptoms listed. Bronchodilation and carbon dioxide retention would not produce the symptoms listed. The increased viscosity of sputum is characteristic of cystic fibrosis. The change in respiratory status is potentially caused by a pneumothorax.

83 An immediate intervention to teach parents for while an infant is choking on a piece of food would be to have infant lie quietly while a call is placed for emergency help. position infant in a head-down, face-down position and administer five quick back slaps. administer mouth-to-mouth resuscitation. give some water by a cup to relieve the obstruction.

position infant in a head-down, face-down position and administer five quick back slaps. Positioning the infant head and face down while administering five quick blows between the shoulder blades is the correct initial sequence of actions for an infant with an obstructed airway. The infant needs to receive treatment immediately. Emergency help is called after attempting to remove the obstruction. Mouth-to-mouth resuscitation should not be used. This may push the object further into the child's respiratory system. If the child is obstructed, the water will not be able to pass. This will increase the risk of aspiration.

89 Treatment methods used for status asthmaticus focus on supportive oxygen therapy to maintain saturation at 90%. resolving acid-base disturbances that have led to alkalosis. restoring hydration. decreasing airway compliance.

restoring hydration. Treatment methods for status asthmaticus are aimed at improving ventilation, decreasing airway resistance, relieving bronchospasm, correcting dehydration and acidosis, decreasing anxiety and treating any underlying concurrent infection. Oxygen saturation should be maintained at greater than 90%, typical acid-base disturbances result in acidosis, not alkalosis.

62 A nurse should explain that ringworm is a noncontagious disorder. a sign of uncleanliness. expected to resolve spontaneously. spread by direct and indirect contact.

spread by direct and indirect contact. Ringworm is spread by both direct and indirect contact and is considered to be an infectious disorder. Children should wear protective caps at night to avoid transfer of ringworm to bedding. Because ringworm is easily transmitted, it is not a sign of uncleanliness. It can be acquired from theater seats or gym mats and by animal-to-human transmission. The drug griseofulvin (Fulvicin) is indicated for a prolonged course, possibly several months.

The school nurse is explaining to a child's kindergarten teacher that the child is allergic to peanuts. The nurse should include information that the child will most likely outgrow the allergy soon. the child should have an injectable epinephrine cartridge available at all times. the child allergic to peanuts can usually have peanut butter, but not whole peanuts. the child usually only shows skin signs such as hives when allergic.

the child should have an injectable epinephrine cartridge available at all times. Exposure to peanuts can result in a severe allergic, potentially life-threatening reaction, such as anaphylaxis and shock. Immediate treatment to prevent such reactions includes the injection of epinephrine; therefore, this should be available at all times wherever the child is within the school premises. Peanut allergies may be lifelong. Children allergic to peanuts are allergic to all peanut products, whole and processed. They should have no peanut-containing products at all. The signs and symptoms of an allergic reaction to peanuts may vary from individual to individual.

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

the medication helps to prevent iron overload. A side effect of hypertransfusion therapy is often iron overload. Deferoxamine is an iron-chelating drug that binds excess iron; therefore, it can be excreted by the kidneys. It does not prevent blood transfusions nor stimulate red bell production. It is not a vitamin supplement.

Nursing care of the child with myelosuppression from leukemia or chemotherapeutic agents should include to restrict oral fluids. institute strict isolation. use good hand washing technique. give immunizations appropriate for age.

use good hand washing technique. Good hand washing technique is the most effective means to prevent disease transmission in children with myelosuppression. There is no indication to reduce fluids in children with myelosuppression. Strict isolation is not necessary in children with myelosuppression. The child should not receive any live vaccines, because the immune system is not capable of responding appropriately to them.

72 The school nurse is concerned about an outbreak of chickenpox because two children at the school have cancer and are immunodeficient from chemotherapy. The most appropriate recommendation by the school nurse is that no precautions necessary. acyclovir (Zovirax) should be taken to minimize the symptoms of chickenpox. varicella-zoster immune globulin (VZIG) to prevent chickenpox. temporarily stopping chemotherapy will allow the immune system to recover.

varicella-zoster immune globulin (VZIG) to prevent chickenpox. VZIG is an antibody to the virus that causes chickenpox. Administration of VZIG can prevent development of the disease in immunocompromised children secondary to chemotherapy. Chickenpox can be a life-threatening event for a child who is immunocompromised and must be addressed. Acyclovir is effective in reducing the number of lesions from chickenpox, but in immunodeficient children the disease itself should be prevented. The administration of VZIG does not place the child at any greater risk; therefore, there is no need to stop chemotherapy.