Peds Test 3

Which of the following is the most descriptive of rhabdomyosarcoma? A. The most common sites are head and neck. B. It is a common hereditary neoplasm of childhood. C. It is the most common bone tumor of childhood. D. It is a benign tumor and unusual in children.

A. 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 is not known to be hereditary. Rhabdomyosarcoma arises from skeletal muscle tissue, not bone. Rhabdomyosarcoma is highly malignant.

In a non-potty-trained child with nephrotic syndrome, the best way to detect fluid retention is which of the following? A. Weigh child daily. B. Test urine for hematuria. C. Measure abdominal girth weekly. D. Count the number of wet diapers.

A. A daily weight at the same time, in the same clothing is the most accurate way to determine fluid gains and losses. The presence or absence of blood in the urine will not help with the determination of fluid retention. Abdominal girth will reflect edema, but weekly measurements are too infrequent. The number of wet diapers reflects how often they have been changed. The diapers should be weighed to reflect fluid balance.

A breast-fed newborn has just been diagnosed with galactosemia. The therapeutic management for this newborn includes which of the following nursing interventions? A. Stop breastfeeding infant. B. Add amino acids to the breast milk. C. Substitute a lactose-containing formula for breast milk. D. Give the appropriate enzyme along with breast milk.

A. All milk- and lactose-containing formulas, including breast milk, must be stopped during infancy. Soy protein is the formula of choice for newborns and infants with galactosemia. Breast milk should not be used in newborns and infants with galactosemia. The formula used for a newborn and infant with galactosemia cannot contain lactose. Breast milk should not be used in newborns and infants with galactosemia.

Which of the following should the nurse consider when providing support to a family whose infant has just been diagnosed with biliary atresia? A. Liver transplantation may be needed eventually. B. Death usually occurs by 6 months of age. C. Prognosis for full recovery is excellent. D. Children with surgical correction live normal lives.

A. Approximately 80% to 90% percent of children with biliary atresia will require liver transplantation. If the condition is untreated, death will usually occur by 2 years of age. Long-term survival is possible with surgical intervention. Liver transplantation is usually required for long-term survival. Even with surgical intervention, most children progress to liver failure and require transplantation.

The nurse is planning care for a child recently diagnosed with diabetes insipidus. Which of the following nursing interventions should be planned? A. Encourage child to wear medical identification. B. Discuss with the child and family ways to limit fluid intake. C. Teach the child and family how to do required urine testing. D. Reassure the child and family that diabetes insipidus is usually not a chronic or life-threatening illness.

A. Because of the unstable nature of the child's fluid and electrolyte balance, wearing a medical alert bracelet or carrying a medical identification card is an extremely important intervention. With diabetes insipidus the child should have unrestricted access to fluids, since the child will characteristically have polyuria due to a hyposecretion of antidiuretic hormone. No urine testing is required with diabetes insipidus. This disorder should not be confused with diabetes mellitus. Diabetes insipidus is both lifelong and life threatening. Medication must be taken and the effects monitored closely.

Nursing considerations related to the administration of chemotherapeutic drugs include which of the following? A. Many chemotherapeutic agents are vesicants that can cause severe cellular damage if the drug infiltrates. B. Good hand washing is essential when handling chemotherapeutic drugs, but gloves are not necessary. C. Infiltration will not occur unless superficial veins are used for the intravenous infusion. D. Anaphylaxis cannot occur, since the drugs are considered toxic to normal cells.

A. Chemotherapeutic agents can be extremely damaging to cells. Nurses experienced with the administration of vesicant drugs should be responsible for giving these drugs and prepared to treat extravasations if necessary. Gloves are worn to protect the nurse when handling the drugs, and the hands should be thoroughly washed afterward. Infiltration and extravasations are always a risk, especially with peripheral veins. Anaphylaxis is a possibility with some chemotherapeutic and immunologic agents, including asparaginase (Elspar).

The most important nursing consideration when caring for a child with sickle cell anemia is which of the following? A. Teach parents and child how to minimize crises. B. Refer parents and child for genetic counseling. C. Help the child and family to adjust to a short-term disease. D. Observe for complications of multiple blood transfusions.

A. Children and their families need specific instructions on how to minimize crises, including preventing infections; maintaining adequate hydration; and addressing environmental concerns, such as avoidance of extreme cold. Genetic counseling is important, but teaching care for 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 is that the child and the parents are properly prepared to manage the chronic disease.

Which of the following statements best describes Cushing syndrome? A. It is caused by excessive production of cortisol. B. The major clinical features are exophthalmia and pigmentary changes. C. Treatment involves replacement of cortisol. D. Diagnosis is suspected with findings of hypotension, hyperkalemia, and polyuria.

A. Cushing syndrome is a description of the clinical manifestations caused by too much circulating cortisol. Exophthalmia and pigmentary changes are manifestations of hyperthyroidism, not Cushing syndrome. The treatment for Cushing syndrome involves the reduction of circulating cortisol. If the cause is a pituitary tumor, surgery is indicated. Hypertension and hypokalemia-not hypotension, hyperkalemia, or polyuria-are expected findings with Cushing syndrome.

Which of the following best describes the 4-year-old's concept of death? A. Death is temporary. B. Death is permanent. C. Death is personified in various forms. D. Death is inevitable at some age.

A. Death is seen as a temporary departure, and the child assumes that the individual who has "died" will be back soon. The preschooler thinks of death as being an impermanent state. The 4-year-old believes that life and death can change places with each other. The concept of death as being personified in various forms is more typical of the beliefs of school-age children. The concept of the inevitability of death is more representative of the understanding of 9- and 10-year-olds.

The nurse is caring for a child hospitalized with acute adrenocortical insufficiency. The acute phase seems to be over when ascending flaccid paralysis occurs. The most appropriate nursing action is which of the following? A. Reassure the family that this condition is temporary. B. Reassure the family that flaccid paralysis is not problematic. C. Prepare the family for impending death. D. Prepare the family for the long-term consequences of paralysis.

A. During the recovery phase, paralysis may develop. It is a temporary, quickly reversible clinical manifestation. Flaccid paralysis is problematic if not reversible. Flaccidity can indicate impending death in a child with neurologic deficits but is not associated with adrenocortical insufficiency. Ascending flaccid paralysis is a reversible condition when associated with adrenocortical insufficiency. Paralysis is a temporary, quickly reversible clinical manifestation.

The most important nursing consideration related to congenital hypothyroidism is which of the following? A. Early identification of the disorder B. Facilitation of parent-infant attachment C. Initiation of referrals for mental retardation D. Help for parents in dealing with the child's future prospects

A. Early diagnosis of congenital hypothyroidism is imperative. Since brain growth is complete by 2 to 3 years of age, the thyroid hormone deficiency must be detected and replacement therapy begun as soon as possible to prevent long-term or life-threatening complications. The promotion of parent-infant attachment is important with all infants. With appropriate intervention, the child may not have any developmental deficit. With appropriate intervention, the child may not have any developmental deficit.

The nurse observes erythema, pain, and edema at a child's intravenous (IV) infusion site with streaking along the vein. Which of the following should the nurse do first? A. Immediately stop the infusion. B. Check for a good blood return. C. Ask another nurse to check the IV site. D. Increase IV drip with normal saline for 1 minute and recheck.

A. Erythema, pain, and edema at an IV site describe an extravasation or infiltration. The IV must be stopped to prevent further damage to the child. Blood return suggests that the IV catheter is still within the vein, but this does not address the immediacy of the assessment findings. Reassessment of the IV site by another nurse can be done once the IV has been stopped, which is the priority based on the assessment findings. The IV infusion should not be increased. It will add additional fluid to the child's tissue and could cause further damage.

An infant is born with ambiguous genitalia. Tests are being done to assist in gender assignment. The parents tell the nurse that family and friends are asking what caused the baby to be this way. The nurse's explanation should include which of the following? A. Explain the disorder so that parents can explain it to others. B. Help parents understand that no one knows how this occurs. C. Suggest that parents avoid family and friends until gender is assigned. D. Encourage parents not to worry while the tests are being done.

A. Explaining the disorder to the parents so that they can explain it to others is the most therapeutic approach while the parents await the gender assignment of their child. Ambiguous genitalia are caused by decreased enzyme activity required for adrenocortical production of cortisol. Avoidance of family and friends is impractical and would isolate the family from their support system while awaiting test results. The parents will be concerned. Telling the parents not to worry without giving them specific alternative actions will not be effective.

A child with lymphoma is receiving extensive radiotherapy. Which of the following is the most common side effect of this treatment? A. Fatigue B. Seizures C. Neuropathy D. Lymphadenopathy

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

During the summer many children are more physically active. What changes in the management of the child with type 1 diabetes mellitus should be expected as a result of more exercise? A. Increased food intake B. Decreased food intake C. Increased risk of hyperglycemia D. Decreased risk of insulin shock

A. Food intake should be increased in the summer when the child is more active. Races and other competitions may require more food than other practice times to maintain a balance between glucose and exogenously administered insulin. The child will require increased food on days of increased activity. The increased activity lowers blood glucose levels. Blood sugars must be monitored closely to avoid administering too much insulin during time of reduced need.

Which of the following statements best describes Hirschsprung disease? A. The colon has an aganglionic segment. B. There is a passage of excessive amounts of meconium in the neonate. C. It results in excessive peristaltic movements within the gastrointestinal tract. D. It results in frequent evacuation of solids, liquid, and gas.

A. Hirschsprung disease is a mechanical obstruction caused by a lack of motility of a segment of the intestine as a result of the lack of ganglionic cells; thus it is referred to as aganglionic megacolon. Hirschsprung disease is associated with a neonate's inability to pass meconium or an older child's inability to pass feces. There is a lack of peristalsis in the affected segment of the infant or child with Hirschsprung disease. The infant or child with Hirschsprung disease will be seen with constipation or the passage of ribbonlike stools.

Which of the following laboratory findings, in conjunction with the presenting symptoms, indicates nephrosis? A. Hypoalbuminemia B. Low specific gravity C. Decreased hemoglobin D. Decreased hematocrit

A. Hypoalbuminemia is a result of the large amounts of protein that leak through the glomerular membrane into the urine in a child with nephrosis. Specific gravity is increased due to the large amount of protein in a child with nephrosis. Hemoglobin would be elevated secondary to the hypovolemia in a child with nephrosis. Hematocrit would be elevated secondary to nephrosis.

Which of the following is an appropriate nursing intervention when caring for an infant with narcotic abstinence syndrome? A. Wrap infant snugly. B. Initiate early stimulation program. C. Place in infant seat for feedings. D. Teach mother how to provide tactile stimulation.

A. Infants with narcotic abstinence syndrome who are irritable respond to physical comforting and close contact. Wrapping the infant snugly minimizes self-stimulation, thus decreasing stimulation. Infants with narcotic abstinence syndrome require less stimulation. It is suggested that infants with narcotic abstinence syndrome be breast-fed if mother is human immunodeficiency virus (HIV) negative and not using illicit substances; thus feeding in an infant seat may be inappropriate. Infants with narcotic abstinence syndrome require less stimulation; thus the mother should be taught to limit tactile stimulation, not increase it.

The nurse notes that the parents of a critically ill child spend a large amount of time talking with the parents of another child who is also seriously ill. They talk with these parents more than with the nurses. The nurse should recognize that this behavior indicates: A. That parent-to-parent support is valuable. B. That parent-to-parent dependence is unhealthy. C. The situation has developed because the nurses are unresponsive to the parents. D. The situation is unusual and has the potential to increase friction between the parents and nursing staff.

A. Parent-to-parent support is unique and not available from other sources. Being with other parents who have shared similar experiences (such as hospitalization) allows a mutually supportive environment. Rather than being a dependent relationship, parents provide support for each other, and this is a healthy strategy for assisting parents in working through similar psychosocial issues related to their child's illness, treatment, and prognosis. The nurses cannot provide the same type of support as another parent who has had the "lived experience." There are no data to support that this type of relationship between parents occurs because of the nursing staff and their lack of responsiveness to the parents or child. It is increasingly common for hospitals to facilitate parent-to-parent interaction. Parental support groups often meet in hospital settings and are encouraged to provide care to parents in similar circumstances.

The nurse is caring for a boy with probable intussusception. He had diarrhea before admission, but while waiting for administration of air pressure to reduce the intussusception, he passed a normal brown stool. Which of the following is the most appropriate nursing action? A. Notify the physician. B. Measure the abdominal girth. C. Auscultate for bowel sounds. D. Take vital signs, including blood pressure.

A. Passage of a normal stool indicates that the intussusception has resolved. Notification of the physician is essential to determine whether a change in treatment plan is indicated. Measurement of the abdominal girth may be indicated, but notifying the physician is the priority. Auscultating for bowel sounds may be indicted, but notifying the physician is the priority.

Which of the following are the most common signs and symptoms of leukemia related to bone marrow involvement? A. Petechiae, infection, fatigue B. Headache, papilledema, irritability C. Muscle wasting, weight loss, fatigue D. Decreased intracranial pressure, psychosis, confusion

A. Petechiae, infection, and fatigue are signs of infiltration of the bone marrow. Petechiae occur from lowered platelet count, infection occurs from the depressed number of effective leukocytes, and fatigue occurs 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.

Which of the following urine tests would be considered abnormal? A. pH: 4 B. Specific gravity: 1.020 C. Protein level: absent D. Glucose level: absent

A. The expected pH of urine is 4.8 to 7.8. A specific gravity of 1.020 is within the normal specific gravity range of 1.015 to 1.030. Protein should not be present in the urine. It would indicate an abnormality in glomerular filtration. Glucose should not be present in the urine. If present, it could indicate diabetes mellitus, glomerulonephritis, or a response to infusion of fluids with high glucose concentrations.

The potential effects of chronic illness or disability on a child's development vary at different ages. Which of the following is a threat to a toddler's normal development? A. Hindered mobility B. Poorly defined body image C. Limited opportunities for socialization D. Limited opportunities to achieve and accomplish

A. The inability to move about and master the environment will inhibit the toddler's developing autonomy, the critical task of toddlerhood. A sense of body image begins to develop in the preschool years. The task of socialization occurs during the preschool years as the child begins to develop peer relationships. A child's sense of achievement and accomplishment begins to develop during the school-age years.

The nurse is caring for a toddler who has had surgery for a brain tumor. During an assessment the nurse notes that the child is becoming irritable and pupils are unequal and sluggish. The most appropriate nursing action is to: A. Notify the practitioner immediately. B. Assess for level of consciousness (LOC). C. Observe closely for signs of increased intracranial pressure (ICP). D. Administer pain medication and assess for response.

A. The worsening of symptoms may indicate that the ICP is increasing. The practitioner should be notified immediately, since this is considered a medical emergency. Assessing for LOC should be done as part of the assessment. The nurse is noting signs of potentially increased ICP as described; thus this has already been completed. Pain medication should not be given, since it can often mask the signs of increasing ICP. The priority nursing intervention is to consult with the practitioner immediately.

Which of the following statements is correct about young children who report sexual abuse by one of their parents? A. They may exhibit various behavioral manifestations. B. In most cases, the child has fabricated the story. C. Their stories are not believed unless other evidence is apparent. D. They should be able to retell the story the same way to another person.

A. There is no diagnostic profile of the child who is being sexually abused. Many different behavioral manifestations may be exhibited, from outward sexual behaviors with others to withdrawal and introversion. It is never appropriate to assume that a child has fabricated the story of sexual abuse. Adults are reluctant to believe children, and sexual abuse often goes unreported. Physical examination is normal in approximately 80% of abused children. The child will usually try to protect their parents and may accept responsibility for the act.

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

A. This 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.

Which of the following physiologic alterations is characterized by destruction of pancreatic beta cells that produce insulin? A. Type 1 diabetes B. Type 2 diabetes C. Impaired glucose tolerance D. Gestational diabetes

A. Type 1 diabetes is characterized by destruction of the insulin-producing pancreatic beta cells. Type 2 diabetes is a result of insulin resistance. The insulin-producing pancreatic beta cells are destroyed in type 1 diabetes and are not associated with impaired glucose tolerance. Gestational diabetes occurs during pregnancy and is not associated with the destruction of pancreatic beta cells that produce insulin.

The nurse is caring for a child with Wilms tumor. Which of the following is the most important nursing intervention preoperatively? A. Avoid abdominal palpation. B. Closely monitor arterial blood gases. C. Prepare child and family for long-term dialysis. D. Prepare child and family for renal transplantation.

A. 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. A sign should be placed over the bed indicating that no abdominal palpation should be conducted. Monitoring of arterial blood gases is not indicated preoperatively for this abdominal surgery. 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 radiation and/or chemotherapy is used to minimize the tumor size. Renal transplantation is a last resort if both kidneys need to be removed and a compatible living donor exists.

Denial is a common reaction to the diagnosis of a disability or chronic illness. Which of the following applies to denial as a defense mechanism? A. Denial is maladaptive. B. Denial is a necessary cushion to prevent disintegration of the family's psyche. C. Denial prevents a sense of hope. D. Denial prevents the mobilization of energies toward goal-directed, problem-solving behavior

B. Adaptive denial is effective as the family learns the impact that the diagnosis of a disability will have on their family. Denial is not maladaptive until it interferes with the treatment goals and regimen. Denial may allow a sense of hope while the family is overwhelmed by the diagnosis. Denial enables families to mobilize energies toward goal-directed problem solving.

Which of the following is the most common cause of secondary hyperparathyroidism? A. Diabetes mellitus B. Chronic renal disease C. Congenital heart disease D. Growth hormone deficiency

B. Chronic renal disease is the most common cause of secondary hyperparathyroidism. The parathyroid gland plays an integral role in the maintenance of calcium in the body, as do the kidneys. Diabetes mellitus does not contribute to secondary hypoparathyroidism. Congenital heart disease does not contribute to secondary hypoparathyroidism. Growth hormone deficiency does not contribute to secondary hypoparathyroidism.

The nurse should recognize that when a child develops diabetic ketoacidosis (DKA), treatment will be which of the following? A. No treatment is required, since DKA is an expected outcome of type 1 diabetes mellitus. B. Immediate treatment is required, since DKA is a life-threatening situation. C. DKA is best treated at home. D. DKA is best treated at practitioner's office or clinic.

B. DKA is the complete state of insulin deficiency. It is a medical emergency that must be diagnosed and treated immediately. The child is usually admitted to an intensive care unit for assessment, intravenous insulin administration, and fluid and electrolyte replacement. DKA is a medical emergency needing prompt assessment and intervention, usually in an intensive care environment. It is not an expected outcome of type 1 diabetes mellitus. DKA is a medical emergency that requires hospitalization, usually in an intensive care unit. DKA is a medical emergency that requires hospitalization, usually in an intensive care unit.

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

B. 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; thus 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.

The nurse is caring for a child dying from cancer. Physical signs that the child is approaching death include which of the following? A. Rapid pulse B. Change in respiratory pattern C. Sensation of cold although body feels hot D. Loss of hearing followed by loss of other senses

B. In the final hours of life, the respiratory pattern may become labored, with periods of apnea. In the hours nearing death, the pulse becomes weak and slowed, not rapid. When nearing death, the opposite is true; there is a sensation of heat, although the body feels cold. When nearing death, hearing is the last sense to fail.

Nursing responsibilities when caring for the suicidal adolescent include which of the following? A. Emphasize that a suicide attempt is an immature way of dealing with stress. B. Pay particular attention to children who are withdrawn and giving their personal belongings away. C. Ignore threats of suicide because they are usually bids for attention. D. Recognize a suicide attempt as an impulsive act resulting from a temporary crisis.

B. It is imperative that the nurse recognize warning signs of a potential suicide. For the depressed youngster, suicide may appear to be the only way out, and telling a child that he or she is immature in feelings or behavior will exacerbate an already crisis-laden situation. All threats of suicide must be taken seriously and should never be ignored. Even if the crisis is temporary, the child's perception may be that suicide is the only way out.

Which of the following is appropriate mouth care for a toddler with mucosal ulceration related to chemotherapy? A. Lemon glycerin swabs for cleansing B. Mouthwashes with normal saline C. Mouthwashes with hydrogen peroxide D. Local anesthetic such as viscous lidocaine before meals

B. Normal saline mouthwashes are the preferred mouth care for this age-group. The rinse will keep the mucosal surfaces clean without adverse effects on mucosa or problems if the child swallows the rinse. Lemon glycerin swabs can irritate eroded tissue and can decay teeth. Hydrogen peroxide delays healing by breaking down protein. Viscous lidocaine is not recommended for toddlers, since it depresses the gag reflex and the child may have resultant aspiration.

Several nurses tell their nursing supervisor that they want to be able to attend the funeral of a child for whom they had cared. They say they felt especially close to both the child and the family. The supervisor should recognize that attending the funeral is: A. Appropriate because families expect this expression of concern. B. Appropriate because it can assist in the resolution of personal grief. C. Inappropriate because it is considered unprofessional behavior on the part of the nurses. D. Inappropriate because it increases burnout of the nursing staff.

B. Nurses should attend the funeral of a child if they were close to the family. This will help the nurses grieve and gain closure. Families may or may not expect this expression of concern. The behavior is appropriate if a relationship existed between the nurses and family. Attending the funeral of a child they have developed a relationship with may provide nurses a means of grieving and thus may prevent burnout.

Management of the child with a peptic ulcer often includes which of the following? A. Milk at frequent intervals B. Proton pump inhibitors C. Antacids 1 and 3 hours before meals and at bedtime D. Coping with stress and adjusting to chronic illness

B. Proton pump inhibitors block the production of acid. They are well tolerated and have infrequent side effects. Milk is not beneficial in the management of peptic ulcer disease. Proton pump inhibitors are more effective than antacids. Coping with stress is beneficial, but peptic ulcer disease is treatable.

The postoperative care of a preschool child who has had a brain tumor removed should include which of the following? A. Recording of colorless drainage as normal on the nurse's notes B. Close supervision of the child while he or she is regaining consciousness C. Positioning the child on the right side in the Trendelenburg position D. No administration of analgesics

B. The child needs to be observed closely, with careful and frequent assessment of the vital signs and monitoring for signs of increasing intracranial pressure. Any changes should be reported immediately to the practitioner. Colorless drainage may be leakage of cerebrospinal fluid from the incision site. This needs to be reported to the practitioner immediately. The child should not be positioned in Trendelenburg position postoperatively. Analgesics can be used for postoperative pain as needed.

A 4-year-old child has ingested a toxic dose of iron. The parent reports that the child vomited and had gastric pain an hour ago but "feels fine" now. The parent is not certain when the child ingested the iron tablets. The nurse should instruct the parent to do which of the following? A. Observe the child closely for 2 more hours. B. Bring the child to the hospital immediately. C. Administer activated charcoal. D. Administer ipecac to induce vomiting if the child does not vomit again within 1 hour.

B. The child should be transported to hospital immediately for assessment and possible gastric lavage. The period of concern for complications of iron toxicity is from 30 minutes to 6 hours. Activated charcoal does not bind iron and thus is not a course of treatment for this child. Ipecac is not recommended for poisonings.

Which of the following clinical manifestations would the nurse expect to find in a newborn who has developed necrotizing enterocolitis (NEC)? A. Hyperthermia B. Gastric residual and melena C. The passage of ribbonlike stools D. Projectile vomiting

B. The most prominent signs of NEC are abdominal distention, gastric residuals, and blood in the stools (melena). NEC resembles septicemia; the newborn may "not look well," in addition to having nonspecific signs such as lethargy, poor feeding, hypotension, hypothermia, bile-stained vomitus, and oliguria. The newborn with NEC is more likely to be seen with hypothermia, not hyperthermia. The passage of ribbonlike stools is seen in newborns and infants born with Hirschsprung disease. Projectile vomiting is seen in newborns and infants with pyloric stenosis.

Which of the following is the most important goal when caring for a youngster with anorexia nervosa? A. Encourage weight gain. B. Correct malnutrition. C. Limit fluid intake. D. Provide effective oral care.

B. This is the priority goal of treatment. The individual with anorexia nervosa would probably not be receptive to encouragement of weight gain because of the complex etiology of the disorder. Anorexics often have low self-esteem and have a need for control, which they meet by controlling their eating. Fluids are often restricted by the individual with anorexia. It is important to correct fluid and electrolyte imbalances if present and not restrict fluid intake. Oral and dental care is more of an issue with the bulimic nervosa patient secondary to the excessive purging or vomiting episodes.

What should the nurse include when teaching an adolescent with Crohn disease? A. Preventing the spread of illness to others and nutritional guidance B. Adjusting to chronic illness and preventing the spread of illness to others C. Coping with stress and adjusting to chronic illness D. Nutritional guidance and preventing constipation

C. Crohn disease is a chronic disease with life-altering complications. The nursing interventions include helping the child cope with stress and adjust to the illness. Nutritional guidance is necessary, but Crohn disease is not infectious. Adjustment to chronic illness is necessary, but Crohn disease is not infectious. Nutritional guidance is necessary, but constipation is not an issue.

Which of the following should the nurse include when discussing a child's precocious puberty with the parents? A. The child is not yet fertile. B. Sexual interest is usually advanced. C. Dress and activities should be appropriate to chronologic age. D. Appearance of secondary sex characteristics does not proceed in the usual order.

C. Because of the child's early sexual maturation, both the family and child require extensive teaching. Included in this teaching is the information that the child should be engaged in activities according to his or her chronologic age. Functioning sperm or ova may be produced, making the child fertile. Heterosexual interest is usually appropriate to chronologic age. Development of the secondary sex characteristics proceeds in the usual order.

Which one of the following strategies might be recommended to increase caloric intake in an infant with failure to thrive? A. Use developmental stimulation by a specialist during feedings. B. Avoid solids until after the bottle is well accepted. C. Be persistent through 10 to 15 minutes of food refusal. D. Vary schedule for routine activities on a daily basis.

C. Calm perseverance is important. Parents often cannot persist through the child's refusals, but they should be encouraged to do so and supported. Feeding times should have a nonstimulating environment so that the focus is on the feeding, thus enhancing the chances of increasing caloric intake. Solids should be introduced slowly to decrease dependence on the bottle beginning at 6 months of age. The feeding schedule should be structured for the infant to have consistency and develop a routine for feeding.

Which of the following diets would be appropriate for the child with celiac disease? A. Salt free B. Phenylalanine free C. Low gluten D. High calories, low protein, low fat

C. Celiac disease is characterized by intolerance of gluten, the protein found in wheat, barley, rye, and oats. A low-gluten diet is indicated for life. The diet for a child with celiac disease does not have to be salt free. Low-phenylalanine diet is indicated in phenylketonuria. The diet of a child with celiac disease should be high in calories and protein and low in fat, in addition to the low-gluten requirement.

When should clear liquids be stopped before scheduled surgery? A. 2 hours before surgery B. 6 hours before surgery C. Varies according to the surgical procedure to be done D. The night before surgery, at midnight

C. Each surgical procedure may have a different requirement for when nothing by mouth (NPO) status should be initiated. The nurse should follow the surgeon or anesthesiologist's order as to when clear liquids should be stopped. Although 2 hours before surgery is a common time for stopping clear liquids to reduce the risk of pulmonary aspiration in healthy patients, the timing may vary. Thus it should be clarified with the surgeon or anesthesiologist. Although a 6-hour time frame is often used for stopping milk and milk products before surgery, the timing may vary. Thus it should be clarified with the surgeon or anesthesiologist. Stopping clear liquids by midnight may be too long a period before surgery. Thus the timing should be clarified with the surgeon or anesthesiologist.

A school-age child recently diagnosed with type 1 diabetes mellitus asks the nurse if he can still play soccer, play baseball, and swim. The nurse's response should be based on knowledge that: A. Exercise is contraindicated in the type 1 diabetic child. B. Soccer and baseball are too strenuous, but swimming is acceptable. C. Exercise is not restricted unless indicated by other health conditions. D. The level of activity depends on the type of insulin required.

C. Exercise is encouraged for children with type 1 diabetes because it lowers blood glucose levels. Insulin and meal requirements require careful monitoring to ensure the child has sufficient energy for exercise. Exercise is highly encouraged. The decrease in blood glucose can be accommodated by having snacks available. Sports are encouraged, with insulin and food adjusted for the exercise. The child needs to be cautioned to monitor responses to the exercises. The level of activity does not depend on the type of insulin used. Long-acting and short-acting insulin may both be used to provide coverage for the training and sporting events.

The mother of a child with type 1 diabetes mellitus asks why her child cannot avoid all those "shots" and take pills the same as an uncle does. Which of the following is the nurse's best reply? A. "The pills work with an adult pancreas only." B. "The drugs affect fat and protein metabolism, not sugar." C. "Your child needs insulin replaced, and the oral hypoglycemics only add to an existing supply of insulin." D. "Perhaps when your child is older, the pancreas will produce its own insulin, and then your child can take oral hypoglycemics."

C. In type 1 diabetes the beta cells have been destroyed. It is necessary to supply the insulin no longer produced by the beta cells. The oral medications have different modes of action that supplement insulin production by the pancreas, decreasing insulin resistance or affecting liver production of glucose. They are not insulin substitutes and are primarily used in type 2 diabetes mellitus. Oral hypoglycemics can supplement insulin production by the pancreas, decrease insulin resistance, or affect the liver production of glucose. In type 1 diabetes, the beta cells are destroyed. Without a pancreatic beta cell transplant, it is unlikely that insulin would be produced.

A 5-year-old child has been sent to the school nurse for urinary incontinence three times in the past 2 days. The nurse should recommend to her parent that the first action is to have the child evaluated for which of the following? A. School phobia B. Emotional causes C. Possible urinary tract infection D. Possible structural defects of urinary tract

C. Incontinence in a previously toilet trained child can be an indication of a urinary tract infection. A physical cause of the problem needs to be eliminated before a psychologic cause is considered. Emotional causes should be investigated only once a physical cause has been ruled out. Possible structural defects would be explored as a cause after a urinary tract infection is confirmed.

A young child is diagnosed with vesicoureteral reflux. The nurse should know that this usually associated with: A. Incontinence. B. Urinary obstruction. C. Recurrent kidney infections. D. Infarction of renal vessels.

C. Reflux allows urine to flow back to the kidneys. When the urine is infected, this contributes to kidney infections. Incontinence may be associated with urinary tract infections, but not directly with vesicoureteral reflux. Vesicoureteral reflux can cause renal scarring but not obstruction. Infarction of the renal vessels does not occur with vesicoureteral reflux.

The parents of a child with sickle cell anemia (SCA) are concerned about subsequent children having the disease. The nurse should explain to the parents that: A. SCA is not inherited. B. All siblings will have SCA. C. There is a 25% chance of a sibling having SCA. D. There is a 50% chance of a sibling having SCA.

C. 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 will not have either sickle cell anemia or sickle cell trait. There is a chance that 50% of the siblings will have sickle cell trait.

Several types of long-term central venous access devices are used in practice. Which of the following is a benefit of using an implanted port (e.g., port-a-cath)? A. Implanted ports are easy to use for self-administered infusions. B. Implanted ports do not require piercing the skin for access. C. Implanted ports do not require limiting regular physical activity, including swimming. D. Implanted ports cannot dislodge, even if child "plays" with the port site.

C. Since this device is totally implanted under the skin, there are no activity limitations for the child. The implantable port has to be accessed with a special needle, making it difficult to self-administer infusions. Since the implantable port is totally under the skin, a needle must be used to access the port; thus the skin must be pierced for access. The implantable port site is under the skin, so there is nothing for the child to play with.

A 6-year-old child with acute renal failure (ARF) is being transferred out of the intensive care unit. Which of the following children, considering their diagnoses, would be the most appropriate roommate for this child? A. 6-year-old child with pneumonia B. 4-year-old child with gastroenteritis C. 5-year-old child who has a fractured femur D. 7-year-old child who had surgery for a ruptured appendix

C. The 5-year-old orthopedic patient would be the best choice for a roommate. This child does not have an illness of viral or bacterial origin. A child with pneumonia has an illness of viral or bacterial origin and should not be placed in the same room as a child with ARF. A child with gastroenteritis has an illness of viral or bacterial origin and should not be placed in the same room as a child with ARF. A child who has had surgery for a ruptured appendix may have an illness of viral or bacterial origin and should not be placed in the same room as a child with ARF.

A 9-year-old boy has several physical disabilities. His father explains to the nurse that his son concentrates on what he can do, rather than what he cannot do, and is as independent as possible. The nurse's best interpretation of the child's behavior and father's attitude is which of the following? A. The father is experiencing denial. B. The father is expressing his own fears about his child's disability. C. The child is using an adaptive coping style. D. The child is using a maladaptive coping style.

C. The behaviors and attitude described are characteristic of a child using an adaptive coping style. The child learns to accept physical limitations, but finds achievements in a variety of compensatory motor and intellectual pursuits. The father is describing his child using adaptive coping strategies. The father is not expressing fear, but presents a positive view of his son's adaptive skills. The behaviors and attitude described are those of an adaptive coping style, not a maladaptive style.

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. The nurse's explanation should be based on knowledge that: A. No additional treatments are usually necessary. B. Chemotherapy is usually not necessary. C. Chemotherapy with or without radiotherapy is indicated. D. Kidney transplant will be indicated within the year.

C. The determination of chemotherapy and/or radiotherapy as treatment modalities will be made based on the histologic pattern of the tumor. Chemotherapy with or without radiotherapy is usually indicated. Additional therapy of some type is indicated after the tumor is removed. Chemotherapy, radiotherapy, or both may be indicated postsurgical interventions. Most children with Wilms tumor do not require renal transplants.

A neonate had corrective surgery 3 days ago for esophageal atresia. The nurse notices that after his gastrostomy feeding, there is often a backup of feeding into the tube. As a result, the nurse should do which of the following? A. Position the child in a supine position after feedings. B. Position the child on the left side after feedings. C. Leave the gastrostomy tube open and suspended after feedings. D. Leave the gastrostomy tube clamped after feedings.

C. The formula is backing up into the tube because of delayed emptying. By keeping the tube open to air, it will prevent the buildup of pressure on the operative site and the subsequent backup of feeding into the tube. The child should be positioned on the right side with head elevated approximately 30 degrees after feeding. The child should be positioned on the right side with head elevated approximately 30 degrees after feeding. Leaving the gastrostomy tube clamped after feedings will create pressure on the operative site and increase the risk of backup of the feedings.

A neonate with a goiter has just been admitted to the newborn nursery. A priority nursing intervention is to: A. Position the neonate on the left side. B. Explain to the parents how to place the dressing on the goiter. C. Have a tracheostomy set at bedside. D. Suction at least every 5 to 10 minutes.

C. The goiter puts the infant at risk for respiratory failure. Preparations are made for emergency ventilation, including tracheostomy set at the bedside. Placing the neonate in a side-lying position is not indicated. Hyperextension of the child's neck may facilitate breathing. No dressing is indicated in a neonate who has a goiter. There is no indication for suctioning in a neonate with goiter.

The school nurse is caring for a boy 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? A. Apply warm, moist compresses. B. Apply pressure for at least 1 minute. C. Elevate area above the level of the heart. D. Begin passive range of motion unless pain is severe.

C. The initial response should include elevation of the arm to minimize bleeding. Cold should be applied to the arm. This will aid in vasoconstriction, thus 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.

A 17-year-old boy with type 1 diabetes mellitus tells the school nurse that he has recently started drinking alcohol with his friends on weekends. The nurse should do which of the following? A. Tell him not to drink alcohol. B. Ask him why he is drinking alcohol. C. Teach him about effects of alcohol on type 1 diabetes mellitus and how to prevent problems associated with alcohol intake. D. Recommend counseling so that he understands the serious consequences of alcohol consumption.

C. The nurse is taking a proactive approach. The adolescent is provided with information to facilitate the management of his illness. Telling him not to drink will not help the adolescent should he choose to continue drinking. Asking the adolescent why he drinks will provide information to the nurse, but will not address the information that he needs to have about managing his disease. Counseling can be included in the teaching plan.

The nurse is caring for an 8-year-old child who has a chronic illness. The child has a tracheostomy, and a parent is rooming-in during this hospitalization. The parent insists on providing almost all of the child's care and tells the nurses how to care for the child. When planning the child's care, the primary nurse should recognize that the parent is: A. Controlling and demanding. B. Assuming the nurse's role. C. The expert in care of the child. D. Afraid to allow the nurses to function independently.

C. The nurse recognizes that the philosophy of family-centered care states that the parents are the experts in the care of their child. Since these parents care for their child with complex health needs at home, they are most familiar with the care requirements and routine that works best for their child. They are in no way being controlling or demanding. The nurse's role includes assessment and evaluation, not just the implementation phase; thus the parents are not assuming the nurse's role. In fact, they are participating in the care of the child in their role as parents. Afraid to allow the nurses to function independently. In family-centered care, it is critical that the nurse works collaboratively with the family in caring for the child. No evidence supports that the parents are afraid to allow the nurses to function in their role.

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

C. These are the signs and symptoms of chest syndrome. The nurse must notify the practitioner immediately. This may be ordered by the practitioner, but the first action is notification, since 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.

Nursing care of the child with myelosuppression from leukemia or chemotherapeutic agents should include which of the following? A. Restrict oral fluids. B. Institute strict isolation. C. Use good hand-washing technique. D. Give immunizations appropriate for age.

C. This 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. The immune system is not capable of responding appropriately to the vaccine.

Which of the following is an advantage to teach to the family about continuous cycling peritoneal dialysis (CCPD) or continuous ambulatory peritoneal dialysis (CAPD) for adolescents who require dialysis? A. Hospitalization is only required several nights per week. B. Dietary restrictions are no longer necessary. C. Adolescents can carry out procedures themselves. D. Insertion of catheter does not require surgical placement.

C. This type of dialysis provides the most independence for adolescents with end-stage renal disease and their families. Adolescents can carry out the procedure themselves, and the procedure is usually performed at night, enabling the adolescent to live life more normally during the day. CCPD and CAPD can be done at home. Dietary restrictions are still required, but are less strict when an adolescent is on CCPD or CAPD. The catheter is surgically implanted in the abdominal cavity for both CCPD and CAPD.

The parent of a child hospitalized with acute glomerulonephritis (AGN) asks the nurse why blood pressure readings are being taken so often. The nurse's reply should be based on knowledge of which of the following? A. Blood pressure fluctuations are a common side effect of antibiotic therapy. B. Blood pressure fluctuations are a sign that the condition has become chronic. C. Acute hypertension must be anticipated and identified. D. Hypotension leading to sudden shock can develop at any time.

C. Vital signs, in particular blood pressure, provide information about the severity of AGN and early signs of complications. Acute hypertension is anticipated and requires frequent monitoring for early intervention. Blood pressure does not commonly fluctuate with antibiotic therapy. Blood pressure fluctuations are not indicative of chronic disease. Most children with AGN fully recover. Hypertension, not hypotension, is more likely with AGN.

A 5-year-old girl's sibling dies from sudden infant death syndrome. The parents are concerned because the girl showed more outward grief when her cat died than for her sibling's death. The nurse should explain that: A. This behavior suggests maladaptive coping, and a referral is needed for counseling. B. The child is not old enough to have a concept of death. C. The child is not old enough to have formed a significant attachment to her sibling. D. The death may be so painful and threatening that the child must deny it for now to protect her psyche.

D. A child at this age has limited defense mechanisms. Often, the child will react with more overt grief to a less significant loss than to the loss of a significant person. The child's behavior is suggestive of limited defense mechanisms, not maladaptive coping. The child is beginning to understand the permanence of death. At age 5 years the child will have formed relationships, including with a sibling.

The parent of a child receiving an iron preparation tells the nurse that the child's stools are a tarry black color. The nurse should explain that this is: A. A symptom of iron deficiency anemia. B. An adverse effect of the iron preparation. C. An indicator of an iron preparation overdose. D. A normally expected change due to the iron preparation.

D. An adequate dosage of iron turns the stools a tarry black color. Tarry black stools are not a sign of iron deficiency anemia. Tarry black stools are not an adverse effect of the iron preparation, but an expected effect. Tarry black stools are not an indicator of iron preparation overdose.

Which of the following is an important nursing consideration when caring for a child with end-stage renal disease (ESRD)? A. Children with ESRD usually adapt well to the minor inconveniences of treatment. B. Children with ESRD require extensive support until they outgrow the condition. C. Multiple stresses are placed on children with ESRD and their families until the illness is cured. D. Multiple stresses are placed on children with ESRD and their families because their lives are maintained by drugs and artificial means.

D. ESRD is a chronic, progressive illness with dependence on technology. Families need to arrange for continuing examinations and procedures that are often painful and may require hospitalization. ESRD is a complex disease process that requires substantial medical intervention and is not minor in its treatment modalities. ESRD cannot be outgrown. Dialysis is necessary until renal transplantation is performed. ESRD cannot be cured. Dialysis is necessary until renal transplantation performed.

The nurse assesses the neonate immediately after birth. A tracheoesophageal fistula should be suspected if which of the following is present? A. Jaundice B. Bile-stained vomitus C. Absence of sucking D. Excessive amount of frothy saliva in the mouth

D. Excessive salivation and drooling are indicative of tracheoesophageal fistulas. With a fistula, the child has difficulty managing the secretions, causing choking, coughing, and cyanosis. Jaundice is not usually associated with a tracheoesophageal fistula. Bile-stained vomitus is not usually associated with a tracheoesophageal fistula. The infant is able to suck with tracheoesophageal fistula, but is not able to manage the secretions.

Emergency care for the child who has ingested a cleaning product with bleach includes which of the following interventions? A. Induce vomiting to remove poisonous agent. B. Give activated charcoal to decontaminate stomach. Activated charcoal is not effective with strong acid or alkali agents. C. Administer N-acetylcysteine (Mucomyst) to child immediately. D. Have child drink 3 to 4 ounces of water to dilute the poisonous agent.

D. Having the child drink approx 120 ml of water is recommended for dilution of the poisonous agent. Vomiting is never induced. Strong acids or alkalis can cause additional damage during regurgitation. N-acetylcysteine is the antidote for acetaminophen poisoning.

The nurse is discussing home care with a mother whose 6-year-old child has hepatitis A. Which of the following should the nurse include? A. Bed rest is important until 1 week after the icteric phase. B. The child should not return to school until 3 weeks after the icteric phase. C. Reassure the mother that hepatitis A cannot be transmitted to other family members. D. Teach infection control measures to family members.

D. Hepatitis A is a contagious disease, transmitted through the fecal-oral route. The nurse should teach infection control measures to family members. Hepatitis A does not usually have an icteric phase and often is subclinical. The period of communicability for hepatitis A is the later half of the incubation period to 1 week after onset of clinical illness; thus the child can return to school after that time frame. Hepatitis A is infectious through fecal-oral route; thus family members may be susceptible to acquiring the disease if they fail to institute proper infection control measures.

Therapeutic management of the child with inflammatory bowel disease (IBD) includes a diet that has which of the following components? A. Low protein B. Low calorie C. High fiber D. Vitamin supplements

D. Multivitamins, iron, and folic acid supplementation are recommended for the child with IBD. A high-protein, high-calorie diet is needed to help correct nutritional deficits. A high-calorie, high-protein diet is needed to help correct nutritional deficits. A high-fiber diet is not recommended for IBD. Even small amounts of bran have been associated with a worsening of the child's condition.

The newborn diagnosed with phenylketonuria (PKU) will require long-term follow-up to assess for the development of: A. Obesity. B. Diabetes insipidus. C. Respiratory distress. D. Mental retardation.

D. PKU, an inborn error of metabolism, may lead to mental retardation if early intervention is not performed. Obesity is not associated with PKU Diabetes insipidus is not associated with PKU. Respiratory distress is not associated with PKU.

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? A. Help keep germs from causing infection B. Make up the liquid portion of blood C. Carry the oxygen you breathe from your lungs to all parts of your body D. Help your body stop bleeding by forming a clot (scab) over the hurt area

D. Platelets are involved in homeostasis. This is the function of white blood cells. This is a definition of plasma. This is the function of the red blood cells.

External defects of the genitourinary tract, such as hypospadias, are usually repaired as early as possible to ensure which of the following? A. Prevention of urinary tract complications B. Prevention of separation anxiety C. Acceptance of hospitalization D. Development of normal body image

D. Promotion of a normal body image is extremely important. Surgery involving sexual organs can be upsetting to children, especially preschoolers who fear mutilation and castration. Surgical intervention for external defects of the genitourinary system should be done as soon as possible. Prevention of urinary tract complications is important for defects that affect function, but for all external defects repair should be done as soon as possible. Proper preprocedure preparation can help prevent or at least reduce separation anxiety. Acceptance of hospitalization is important but not the reason for early surgical intervention of external defects of the genitourinary system.

A child has a nasogastric (NG) tube after surgery for acute appendicitis. The purpose of the NG tube is which of the following? A. Maintain electrolyte balance B. Maintain accurate record of output C. Prevent spread of infection D. Prevent abdominal distention

D. The NG tube is used to maintain gastric decompression until intestinal activity returns. The NG tube may adversely affect electrolyte balance by removing stomach secretions. NG drainage is one part of the child's output. The nurse would need to incorporate the NG drainage with other output. There is no relationship between the NG tube and prevention of the spread of infection.

What is an appropriate nursing intervention while the child with nephrotic syndrome is confined to bed? A. Restrain child as necessary. B. Discourage parents from holding child. C. Do passive range-of-motion exercises once a day. D. Adjust activities to child's tolerance level.

D. The child will have variable level of tolerance for activity. The activity tolerance will also be affected by the labile moods associated with steroid administration. The nurse should assist the family in adjusting activities for the child that are age appropriate. Restraints should not be used to confine children to bed, unless they are a potential threat to themselves or others. Parents should be encouraged to hold the child. The child should be encouraged to move all extremities while in bed to prevent the potential complications of immobility.

A toddler is hospitalized with acute renal failure secondary to severe dehydration. The nurse should assess the child for which of the following possible complications? A. Hypotension B. Hypokalemia C. Hypernatremia D. Water intoxication

D. The child with acute renal failure has the tendency to develop water intoxication with hyponatremia. Control of water balance requires careful monitoring of intake, output, body weight, and electrolytes. The child needs to be monitored for hypertension, not hypotension, when hospitalized with acute renal failure. Hyperkalemia, not hypokalemia, is a concern in acute renal failure. Hyponatremia, not hypernatremia, may develop in acute renal failure as the sodium is diluted in large amounts of water.

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

D. The priority nursing action is to stop the transfusion and maintain a patent intravenous (IV) 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. This should be done after the blood is stopped and normal saline is infusing. Vital signs should be assessed after the blood is stopped and normal saline is infusing. Blood should not be diluted; it should be returned to the blood bank if an adverse reaction occurred.

Which of the following is characteristic of children with posttraumatic stress disorder (PTSD)? A. Denial as a defense mechanism is unusual. B. Traumatic effects cannot remain indefinitely. C. Previous coping strategies and defense mechanisms are not useful. D. Children often play out the situation over and over again in an attempt to come to terms with their fear.

D. This is an expected response by a child to a traumatic event. Play is often the safest means of communication for children and should be encouraged as a means of expression with a child experiencing PTSD. Denial is a commonly used defense mechanism by children and adolescents. Professional help is indicated if the stages of response are prolonged. Coping strategies and defense mechanisms that have been effective previously may be effective for PTSD.