Peds take home midterm review

Bullying can be common during the school-age years. The nurse should recognize that which applies to bullying? Select one: a. Can have a lasting effect on children b. Is rarely based on anything that is concrete c. Is not a significant threat to self-concept d. Is usually ignored by the child who is being bullied

A. Bullying in this age group is common and can have a long-lasting effect. Increasing awareness of differences, especially when accompanied by unkind comments and taunts from others, may make a child feel inferior and undesirable. Physical impairments such as hearing or visual defects, ears that "stick out," or birth marks assume great importance.

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

A. Children at this age may view illness or injury as a punishment for a real or imagined misdeed. The belief in divine punishment is common for an 8-year-old child.

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

A. Colic is multifactorial, and no single treatment is effective for all infants. The parent is verbalizing concern and worry. The nurse should allow the parent to put these feelings into words. An empathic, gentle, and reassuring attitude, in addition to suggestions about remedies, will help alleviate the parent's anxieties. The nurse should reassure the parent that he or she is not doing anything wrong. Colic is multifactorial. The infant with colic is experiencing spasmodic pain that is manifested by loud crying, in some cases up to 3 hours each day. Telling the parent that it will eventually go away does not help him or her through the current situation.

The nurse is planning to prepare a 4-year-old child for some diagnostic procedures. Guidelines for preparing this preschooler should include which action? Select one: a. Tell the child that procedures are never a form of punishment. b. Keep equipment out of the child's view. c. Use correct scientific and medical terminology in explanations. d. Plan for a short teaching session of about 30 minutes.

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

Which is usually the only symptom of pediculosis capitis (head lice)? Select one: a. Itching b. Vesicles c. Scalp rash d. Localized inflammatory response

A. Itching is generally the only manifestation of pediculosis capitis (head lice). Diagnosis is made by observation of the white eggs (nits) on the hair shaft. Vesicles, scalp rash, and localized inflammatory response are not symptoms of head lice.

In terms of fine motor development, what should the infant of 7 months be able to do? Select one: a. Hold a crayon between the fingers and make a mark on paper. b. Release cubes into a cup and build a tower of two blocks. c. Transfer objects from one hand to the other and bang cubes on a table. d. Use thumb and index finger in crude pincer grasp and release an object at will.

C. By age 7 months, infants can transfer objects from one hand to the other, crossing the midline, and bang objects on a hard surface. The crude pincer grasp is apparent at about age 9 months, and releasing an object at will is seen around 8 months. The child can scribble spontaneously at age 15 months. At age 12 months, the child can release cubes into a cup and build a small tower.

What is an appropriate nursing intervention to minimize separation anxiety in a hospitalized toddler? Select one: a. Encourage contact with children the same age b. Provide for privacy c. Explain procedures and routines d. Encourage parents to room in

D. A toddler experiences separation anxiety secondary to being separated from the parents. To avoid this, the parents should be encouraged to room in as much as possible. Maintaining routines and ensuring privacy are helpful interventions, but they would not substitute for the parents. Encouraging contact with children the same age would not substitute for having the parents present.

A nurse is planning a teaching session for parents of preschool children. Which statement explains why the nurse should include information about morbidity and mortality? Select one: a. It explains effectiveness of treatment. b. Life span statistics are included in the data. c. Cost-effective treatment is detailed for the general population. d. High-risk age groups for certain disorders or hazards are identified.

D. Analysis of morbidity and mortality data provides the parents with information about which groups of individuals are at risk for which health problems. Life span statistics is a part of the mortality data. Treatment modalities and cost are not included in morbidity and mortality data.

Which is descriptive of bulimia during adolescence? Select one: a. Profound lack of awareness that the eating pattern is abnormal b. Strong sense of control over eating behavior c. Feelings of elation after the binge-purge cycle d. Weight that can be normal, slightly above normal, or below normal

D. Individuals with bulimia are of normal or more commonly slightly above normal weight. Those who also restrict their intake can become severely underweight. The adolescent has a lack of control over eating during the episode. Patients with bulimia commonly have self-deprecating thoughts and a depressed mood after binge-purge cycles; they are also aware that the eating pattern is abnormal but are unable to stop.

The nurse is admitting a school-age child in acute renal failure with reduced glomerular filtration rate. Which urine test is the most useful clinical indication of glomerular filtration rate? Select one: a. pH b. Protein level c. Osmolality d. Creatinine

D. The most useful clinical indication of glomerular filtration is the clearance of creatinine. It is a substance that is freely filtered by the glomerulus and secreted by the renal tubule cells. The pH and osmolality are not estimates of glomerular filtration. Although protein in the urine demonstrates abnormal glomerular permeability, it is not a measure of filtration rate.

A nurse is teaching parents about caring for their child with chickenpox. The nurse should let the parents know that the child is considered to be no longer contagious when which occurs? Select one: a. 8 days after onset of illness b. 24 hours after lesions erupt c. When fever is absent d. When lesions are crusted

D. When the lesions are crusted, the chickenpox is no longer contagious. This may be a week after onset of disease. Chickenpox is still contagious when child has fever. Children are contagious after lesions erupt. If lesions are crusted at 8 days, the child is no longer contagious.

Although infants may be allergic to a variety of foods, the most common allergens are: Select one: a. fruit, vegetables, and wheat. b. cow's milk and green vegetables. c. fruit and eggs. d. eggs, cow's milk, and wheat.

D. Milk products, eggs, and wheat are three of the most common food allergens. Ingestion of these products can cause sensitization and, with subsequent exposure, an allergic reaction. Eggs are a common allergen, but fruit is not. Wheat is a common allergen, but fruit and vegetables are not. Cow's milk is a common allergen, but green vegetables are not.

The nurse is completing a pain assessment on a 4-year-old child. Which of the depicted pain scale tools should the nurse use with a child this age?

The pain scale appropriate for a 4-year-old child is the FACES pain scale. Numeric pain scales can be used on children as young as age 5 as long as they can count and have some concept of numbers and their values in relation to other numbers. Word graphic scales and visual analogue scales are used preferably for school-age children.

A nurse is admitting an infant with dehydration caused from water loss in excess of electrolyte loss. Which type of dehydration is this infant experiencing? Select one: a. Hypertonic b. Hypotonic c. Isotonic d. Isosmotic

a. Hypertonic dehydration results from water loss in excess of electrolyte loss. This is the most dangerous type of dehydration. It is caused by feeding children fluids with high amounts of solute. Isotonic dehydration occurs in conditions in which electrolyte and water deficits are present in balanced proportion and is another term for isomotic dehydration. Hypotonic dehydration occurs when the electrolyte deficit exceeds the water deficit, leaving the serum hypotonic.

A nurse is assessing a 12-month-old infant. Which statement best describes the infant's physical development a nurse should expect to find? Select one: a. Binocularity is well established by age 8 months. b. Maternal iron stores persist during the first 12 months of life. c. Birth weight doubles by age 5 months and triples by age 1 year. d. Anterior fontanel closes by age 6 to 10 months.

c. Growth is very rapid during the first year of life. The birth weight has approximately doubled by age 5 to 6 months and triples by age 1 year. The anterior fontanel closes at age 12 to 18 months. Binocularity is not established until age 15 months. Maternal iron stores are usually depleted by age 6 months.

A child has been admitted to the emergency department with an acetaminophen (Tylenol) poisoning. An antidote is being prescribed by the health care provider. Which antidote should the nurse prepare to administer? Select one: a. Flumazenil (Romazicon) b. Naloxone (Narcan) c. N-acetylcysteine (Mucomyst) d. Digoxin immune Fab (Digibind)

c. N-acetylcysteine (Mucomyst) Antidotes available to treat toxin ingestion include N-acetylcysteine for acetaminophen poisoning, naloxone for opioid overdose, flumazenil (Romazicon) for benzodiazepine (diazepam [Valium], midazolam [Versed]) overdose, and digoxin immune Fab (Digibind) for digoxin toxicity.

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

c. Thicken formula with rice cereal. Small, frequent feedings of formula combined with 1 teaspoon to 1 tablespoon of rice cereal per ounce of formula have been recommended. Milk-thickening agents have been shown to decrease the number of episodes of vomiting and to increase the caloric density of the formula. This may benefit infants who are underweight as a result of GER disease. Placing the child in a Trendelenburg position would increase the reflux. Continuous nasogastric feedings are reserved for infants with severe reflux and failure to thrive.

A mother asks the nurse what would be the first indication that acute glomerulonephritis is improving. What is the nurse's best response? Select one: a. Blood pressure will stabilize. b. The child will have more energy. c. Urinary output will increase. d. Urine will be free of protein.

c. Urinary output will increase. 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.

A nurse is assessing a family's structure. Which describes a family in which a mother, her children, and a stepfather live together? Select one: a. Binuclear b. Nuclear c. Extended d. Blended A blended family contains at least one stepparent, step-sibling, or half-sibling. The nuclear family consists of two parents and their children. No other relatives or nonrelatives are present in the household. In binuclear families, parents continue the parenting role while terminating the spousal unit. For example, when joint custody is assigned by the court, each parent has equal rights and responsibilities for the minor child or children. An extended family contains at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling.

d. A blended family contains at least one stepparent, step-sibling, or half-sibling. The nuclear family consists of two parents and their children. No other relatives or nonrelatives are present in the household. In binuclear families, parents continue the parenting role while terminating the spousal unit. For example, when joint custody is assigned by the court, each parent has equal rights and responsibilities for the minor child or children. An extended family contains at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling.

A nurse is preparing to accompany a medical mission's team to a third world country. Marasmus is seen frequently in children 6 months to 2 years in this country. Which symptoms should the nurse expect for this condition? Select one: a. Loose, wrinkled skin b. Depigmentation of the skin c. Dermatoses d. Edematous skin

A. Marasmus is characterized by gradual wasting and atrophy of body tissues, especially of subcutaneous fat. The child appears to be very old, with loose and wrinkled skin, unlike the child with kwashiorkor, who appears more rounded from the edema. Fat metabolism is less impaired than in kwashiorkor; thus, deficiency of fat-soluble vitamins is usually minimal or absent. In general, the clinical manifestations of marasmus are similar to those seen in kwashiorkor with the following exceptions: With marasmus, there is no edema from hypoalbuminemia or sodium retention, which contributes to a severely emaciated appearance; no dermatoses caused by vitamin deficiencies; little or no depigmentation of hair or skin; moderately normal fat metabolism and lipid absorption; and a smaller head size and slower recovery after treatment.

The nurse observes some children in the playroom. Which play situation exhibits the characteristics of parallel play? Select one: a. Brian playing with his truck next to Kristina playing with her truck b. Adam playing a board game with Kyle, Steven, and Erich c. Kimberly and Amanda sharing clay to each make things d. Danielle playing with a music box on her mother's lap

A. Playing with trucks next to each other but not together is an example of parallel play. Both children are engaged in similar activities in proximity to each other; however, they are each engaged in their own play. Sharing clay to make things is characteristic of associative play. Friends playing a board game together is characteristic of cooperative play. A child playing with something by herself on her mother's lap is an example of solitary play.

An infant experienced an apparent life-threatening event (ALTE) and is being placed on home apnea monitoring. Parents have understood the instructions for use of a home apnea monitor when they state? Select one: a. "We will check the monitor several times a day to be sure the alarm is working." b. "We can adjust the monitor to eliminate false alarms." c. "We will place the monitor in the crib with our infant." d. "We should sleep in the same bed as our monitored infant."

A. The parents should check the monitor several times a day to be sure the alarm is working and that it can be heard from room to room. The parents should not adjust the monitor to eliminate false alarms. Adjustments could compromise the monitor's effectiveness. The monitor should be placed on a firm surface away from the crib and drapes. The parents should not sleep in the same bed as the monitored infant.

Which factor is most important in predisposing toddlers to frequent infections? Select one: a. Defense mechanisms are less efficient than those during infancy. b. Toddlers have a short, straight internal ear canal and large lymph tissue. c. Pulse and respiratory rates are slower than those in infancy. d. Respirations are abdominal.

B. Toddlers continue to have the short, straight internal ear canal of infants. The lymphoid tissue of the tonsils and adenoids continues to be relatively large. These two anatomic conditions combine to predispose the toddler to frequent infections. The abdominal respirations and lowered pulse and respiratory rate of toddlers do not affect their susceptibility to infection. The defense mechanisms are more efficient compared with those of infancy.

Which describes the cognitive abilities of school-age children? Select one: a. Have developed the ability to reason abstractly b. Are able to classify, to group and sort, and to hold a concept in their minds while making decisions based on that concept c. Progress from making judgments based on what they reason to making judgments based on what they see d. Are capable of scientific reasoning and formal logic

B. In Piaget's stage of concrete operations, children have the ability to group and sort and make conceptual decisions. Children cannot reason abstractly and logically until late adolescence. Making judgments based on what they reason to making judgments based on what they see is not a developmental skill.

Which therapeutic management should the nurse prepare to initiate first for a child with acute diarrhea and moderate dehydration? Select one: a. Clear liquids b. Oral rehydration solution (ORS) c. Adsorbents, such as kaolin and pectin d. Antidiarrheal medications such as paregoric

B. ORS is the first treatment for acute diarrhea. Clear liquids are not recommended because they contain too much sugar, which may contribute to diarrhea. Adsorbents are not recommended. Antidiarrheals are not recommended because they do not get rid of pathogens.

A previously "potty-trained" 30-month-old child has reverted to wearing diapers while hospitalized. The nurse should reassure the parents that this is normal because of which reason? Select one: a. The child is experiencing urinary urgency because of hospitalization. b. Regression is seen during hospitalization. c. Developmental delays occur because of the hospitalization. d. The child was too young to be "potty-trained."

B. Regression is expected and normal for all age groups when hospitalized. Nurses should assure the parents this is temporary and the child will return to the previously mastered developmental milestone when back home. This does not indicate a developmental delay. The child should not be experiencing urinary urgency because of hospitalization and this would not be normal. Successful "potty-training" can be started at 2 years of age if the child is ready.

The parents of a newborn say that their toddler "hates the baby; he suggested that we put him in the trash can so the trash truck could take him away." Which is the nurse's best reply? Select one: a. "Let's see if we can figure out why he hates the new baby." b. "That is a normal response to the birth of a sibling. Let's look at ways to deal with this." c. "That's a strong statement to come from such a small boy." d. "Let's refer him to counseling to work this hatred out. It's not a normal response."

B. The arrival of a new infant represents a crisis for even the best-prepared toddler. Toddlers have their entire schedule and routines disrupted because of the new family member. The nurse should work with parents on ways to involve the toddler in the newborn's care and to help focus attention on the toddler. The toddler does not hate the infant. This is an expected response to the changes in routines and attention that affect the toddler. The toddler can be provided with a doll to tend to the doll's needs at the same time the parent is performing similar care for the newborn.

Which is an important nursing consideration when caring for an infant with failure to thrive? Select one: a. Maintain a nondistracting environment by not speaking to child during feeding. b. Establish a structured routine and follow it consistently. The infant with failure to thrive should have a structured routine that is followed consistently. Disruptions in other activities of daily living can have a great impact on feeding behaviors. Bathing, sleeping, dressing, playing, and feeding are structured. The nurse should talk to the child by giving directions about eating. This will help the child maintain focus. Young children should be held while being fed, and older children can sit at a feeding table. The child should be fed in the same manner at each meal. The child can engage in sensory and play activities at times other than mealtime. c. Limit sensory stimulation and play activities to alleviate fatigue. d. Place child in an infant seat during feedings to prevent overstimulation.

B. The infant with failure to thrive should have a structured routine that is followed consistently. Disruptions in other activities of daily living can have a great impact on feeding behaviors. Bathing, sleeping, dressing, playing, and feeding are structured. The nurse should talk to the child by giving directions about eating. This will help the child maintain focus. Young children should be held while being fed, and older children can sit at a feeding table. The child should be fed in the same manner at each meal. The child can engage in sensory and play activities at times other than mealtime.

Which is the preferred site for intramuscular injections in infants? Select one: a. Deltoid b. Vastus lateralis c. Rectus femoris d. Dorsogluteal

B. The preferred site for infants is the vastus lateralis. The deltoid and dorsogluteal sites are used for older children and adults. The rectus femoris is not a recommended site.

The nurse is caring for a school-age child with a tinea capitis (ringworm) infection. What should the nurse expect the therapeutic management of this child to include? Select one: a. Administering topical or oral antibiotics b. Administering oral griseofulvin c. Applying topical sulfonamides d. Applying Burow solution compresses to affected area

B. Treatment with the antifungal agent griseofulvin is part of the treatment for the fungal disease ringworm. Oral griseofulvin therapy frequently continues for weeks or months. Antibiotics, sulfonamides, and Burow solution are not effective in fungal infections.

The nurse is examining 12-month-old Amy, who was brought to the clinic for persistent diaper rash. The nurse finds perianal inflammation with satellite lesions that cross the inguinal folds. What is most likely the cause of the diaper rash? Select one: a. Infrequent diapering b. Candida albicans c. Urine and feces d. Impetigo

B. C.albicans infection produces perianal inflammation and a maculopapular rash with satellite lesions that may cross the inguinal folds. Impetigo is a bacterial infection that spreads peripherally in sharply marginated, irregular outlines. Eruptions involving the skin in contact with the diaper, but sparing the folds, are likely to be caused by chemical irritation, especially urine and feces.

The nurse is caring for a 6-year-old girl who had surgery 12 hours ago. The child tells the nurse that she does not have pain, but a few minutes later she tells her parents that she does. Which should the nurse consider when interpreting this? Select one: a. Children use pain experiences to manipulate their parents. b. Truthful reporting of pain should occur by this age. c. Children may be experiencing pain even though they deny it to the nurse. d. Inconsistency in pain reporting suggests that pain is not present.

C. Children may deny pain to the nurse because they fear receiving an injectable analgesic or because they believe they deserve to suffer as a punishment for a misdeed. They may refuse to admit pain to a stranger but readily tell a parent. Truthfully reporting pain and inconsistency in pain reporting suggesting that pain is not present are common fallacies about children and pain. Pain is whatever the experiencing person says it is, whenever the person says it exists. Pain would not be questioned in an adult 12 hours after surgery.

Which is a major complication in a child with chronic renal failure? Select one: a. Hypokalemia b. Metabolic alkalosis c. Water and sodium retention d. Excessive excretion of blood urea nitrogen

C. Chronic renal failure leads to water and sodium retention, which contributes to edema and vascular congestion. Hyperkalemia, metabolic acidosis, and retention of blood urea nitrogen are complications of chronic renal failure.

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

C. School-age children need to have control of their environment. The nurse should offer explanations or prepare the child for those experiences that are unavailable. The nurse should refer to the child by the preferred name. Explaining when parents can visit and why siblings cannot come to see her is telling the child all of the limitations, not helping her adjust to the hospital. At the age of 8 years, the child should be oriented to the environment along with the parents.

Which is the most common cause of acute renal failure in children? Select one: a. Tubular destruction b. Urinary tract obstruction c. Inadequate perfusion d. Pyelonephritis

C. The most common cause of acute renal failure in children is poor perfusion that may respond to restoration of fluid volume. Pyelonephritis and tubular destruction are not common causes of acute renal failure. Obstructive uropathy may cause acute renal failure, but it is not the most common cause.

The nurse is caring for an infant whose cleft lip was repaired. What important aspects of this infant's postoperative care should be included? Select one: a. Arm restraints, postural drainage, mouth irrigations b. Mouth irrigations, prone position, cleansing the suture line c. Cleansing the suture line, supine and side-lying positions, arm restraints The suture line should be cleansed gently after feeding. The child should be positioned on the back, on the side, or in an infant seat. Elbows are restrained to prevent the child from accessing the operative site. Postural drainage is not indicated. This would increase the pressure on the operative site when the child is placed in different positions. There is no reason to perform mouth irrigations, and the child should not be placed in the prone position where injury to the suture site can occur. d. Supine and side-lying positions, postural drainage, arm restraints

C. The suture line should be cleansed gently after feeding. The child should be positioned on the back, on the side, or in an infant seat. Elbows are restrained to prevent the child from accessing the operative site. Postural drainage is not indicated. This would increase the pressure on the operative site when the child is placed in different positions. There is no reason to perform mouth irrigations, and the child should not be placed in the prone position where injury to the suture site can occur.

The nurse is observing parents playing with their 10-month-old child. Which should the nurse recognize as evidence that the child is developing object permanence? Select one: a. Bangs two cubes held in her hands b. Returns the blocks to the same spot on the table c. Recognizes that a ball of clay is the same when flattened out d. Looks for the toy that parents hide under the blanket

D. Object permanence is the realization that items that leave the visual field still exist. When the infant searches for the toy under the blanket, it is an indication that object permanence has developed. Returning the blocks to the same spot on the table is not an example of object permanence. Recognizing that a ball of clay is the same when flattened out is an example of conservation, which occurs during the concrete operations stage from 7 to 11 years. Banging two cubes together is a simple repetitive activity characteristic of developing a sense of cause and effect.

Frequent urine testing for specific gravity and glucose are required on a 6-month-old infant. Which is the most appropriate way to collect small amounts of urine for these tests? Select one: a. Aspirate urine from a superabsorbent disposable diaper with a syringe. b. Tape a small medicine cup to the inside of the diaper. c. Apply a urine-collection bag to the perineal area. d. Aspirate urine from cotton balls inside the diaper with a syringe.

D. To obtain small amounts of urine, use a syringe without a needle to aspirate urine directly from the diaper. If diapers with absorbent material are used, place a small gauze dressing or cotton balls inside the diaper to collect the urine, and aspirate the urine with a syringe. For frequent urine sampling, the collection bag would be too irritating to the child's skin. It is not feasible to tape a small medicine cup to the inside of the diaper; the urine will spill from the cup. Diapers with superabsorbent gels absorb the urine, so there is nothing to aspirate.

The parents of a 9-month-old infant tell the nurse that they have noticed foods such as peas and corn are not completely digested and can be seen in their infant's stools. The nurse's explanation of this is based on which statement? Select one: a. Child should not be given fibrous foods until digestive tract matures at age 4 years. b. Child should not be given any solid foods until this digestive problem is resolved. c. This is abnormal and requires further investigation. d. This is normal because of the immaturity of digestive processes at this age.

D. The immaturity of the digestive tract is evident in the appearance of the stools. Solid foods are passed incompletely broken down in the feces. An excess quantity of fiber predisposes the child to large, bulky stools. This is normal for the child and is a normal part of the maturational process; no further investigation is necessary.

A clinic nurse is assessing a child with erythema infectiosum (fifth disease). Which figure depicts the rash the nurse should expect to assess?

Erythema infectiosum rash appears in three stages: erythema on face, chiefly on cheeks "slapped face' appearance