Peds test 4

A boy with leukemia screams whenever he needs to be turned or moved. Which is the most probable cause of this pain? a. Edema b. Bone involvement c. Petechial hemorrhages d. Changes within the muscles

ANS: B The invasion of the bone marrow with leukemic cells gradually causes a weakening of the bone and a tendency toward fractures. As leukemic cells invade the periosteum, increasing pressure causes severe pain. Edema, petechial hemorrhages, and changes within the muscles would not cause severe pain.

20. A nurse is preparing a presentation for a parent group about musculoskeletal injuries. When describing a child's risk for this type of injury, the nurse integrates knowledge that bone growth occurs primarily in which area? A) Growth plate B) Epiphysis C) Physis D) Metaphysis

Ans: B Feedback: Growth of the bones occurs primarily in the epiphyseal region. This area is vulnerable and structurally weak. Traumatic force applied to the epiphysis during injury may result in fracture in that area of the bone. The growth plate refers to the combination of the epiphysis, the end of a long bone, and the physis, a cartilaginous area between the epiphysis and the metaphysis.

15. The nurse is assessing a child with a possible fracture. Which of the following would the nurse identify as the most reliable indicator? A) Lack of spontaneous movement B) Point tenderness C) Bruising D) Inability to bear weight

Ans: B Feedback: Point tenderness is one of the most reliable indicators of a fracture in a child. Neglect of an extremity, inability to bear weight, bruising, erythema, and pain may be present, but these findings can also suggest other conditions.

10. The nurse is caring for an infant with osteogenesis imperfecta and is providing instruction on how to reduce the risk of injury. Which response from the mother indicates a need for further teaching? A) "I need to avoid pushing or pulling on an arm or leg." B) "I must carefully lift the baby from under the armpits." C) "I should not bend an arm or leg into an awkward position." D) "We must avoid lifting the legs by the ankles to change diapers."

Ans: B Feedback: The nurse needs to emphasize that the mother must not lift a baby or young child with osteogenesis imperfecta from under the armpits as it may cause harm. Avoiding pushing or pulling, not bending an arm or leg into an awkward position, and avoiding lifting the legs by the ankles are appropriate responses.

23. A nurse is providing instructions to the parents of a 3-month-old with developmental dysplasia of the hip who is being treated with a Pavlik harness. Which statement by the parents demonstrates understanding of the instructions? Select all answers that apply. A) "We need to adjust the straps so that they are snug but not too tight." B) "We should change her diaper without taking her out of the harness." C) "We need to check the area behind her knees for redness and irritation." D) "We need to send the harness to the dry cleaners to have it cleaned." E) "We need to call the doctor if she is not able to actively kick her legs."

Ans: B, C, E Feedback: Instructions related to use of a Pavlik harness include changing the child's diaper while in the harness; checking the areas behind the knees and diaper area for redness, irritation, or breakdown; and calling the doctor if the child is unable to actively kick her legs. The straps are not to be adjusted without checking with the physician or nurse practitioner first. The harness can be washed with mild detergent by hand and air dried. A hair dryer can be used to dry the harness but only if the air fluffing setting is used.

26. The nurse is assessing an 11-year-old girl with scoliosis. Which of the following would the nurse expect to find? Select all answers that apply. A) Complaints of severe back pain B) Asymmetric shoulder elevation C) Even curve at the waistline D) Pronounced one-sided hump on bending over E) Diminished motor function F) Hyperactive reflexes

Ans: B, D Feedback: Assessment findings associated with scoliosis include asymmetric shoulder elevation, uneven curve at the waistline, rib hump on one side, and a pronounced hump on one side when bending over. Typically, only mild back discomfort is found and balance, motor strength, sensation, and reflexes are normal.

When reviewing the management of sickle cell anemia with a parent, the nurse understands further teaching would be needed if the parent said that which of the following circumstances contributed to a crisis? A. Excessive vomiting B. Fever C. Foods that are low in iron D. Emotional stress

C. Foods that are low in iron

A child is recently diagnosed with JIA. The most important priority for the child and family is promotion of: A. Optimum nutrition B. Anxiety reduction C. Growth and development D. Education

C. Growth and development

What kind of isolation would a hospitalized child with hand, foot, and mouth disease have? a. Droplet b. Contact c. Airborne d. No isolation

b. Contact

3. Which statemtent(s) about VWD are accurate? Select all that apply. a. VWD is an acquired bleeding disorder. b. Prolonged and excessive bleeding and menorrhagia are signs of VWD. c. The von Willebrand protein carries coagulation factor IX. d. VWD is sometimes treated with desmopressin acetate (DDAVP).

b. Prolonged and excessive bleeding and menorrhagia are signs of VWD. d. VWD is sometimes treated with desmopressin acetate (DDAVP).

All of the following are used to diagnosis osteomyelitis, except... a. Radiography b. MRI c. Echocardiogram d. Lab values: elevated ESR

c. Echocardiogram

All of the following are true statements regarding impetigo EXCEPT: a. The child's school should be notified of the diagnosis b. Scarring may occur if the child picks off the scar prematurely c. Most common during the dry winter months d. Commonly diagnosed by the appearance of the pustluar or crusty lesions

c. Most common during the dry winter months

In Retinoblastoma, what is Enucleation? a. A tumor in the lungs b. A yellow discharge in the eye c. Removal of the eye d. A form of cancer

c. Removal of the eye

A client with hemophilia has a very swollen knee after falling from bicycle riding. Which of the following is the first nursing action? a)initiate an IV site to begin administration of cryoprecipitate b) type and cross-match for possible transfusion c) monitor the client's vital signs for the first 5 minutes d) apply ice pack and compression dressings to the knee

d) apply ice pack and compression dressings to the knee

Impetigo is caused by all of the following EXCPET: a. S. aureus b. Group A beta-hemolytic streptococci c. Sarcoptes scabiei d. A combinations of S. aureus and group A beta-hemolytic streptococci

d. A combinations of S. aureus and group A beta-hemolytic streptococci

What special consideration should you teach parents when caring for a child with Atopic Dermatitis? a. Instruct parents to keep the child's skin dry b. Teach parents to keep child in water for a long period of time to promote hydration c. Instruct parents to dress child in heavy clothing to induce sweating d. Teach parents to use mild detergents and rinse the clothing twice after washing.

d. Teach parents to use mild detergents and rinse the clothing twice after washing.

True or False, In a hospital setting, children with Herpes Zoster should have their own private room and remain in isolation until infection is over

true

"Chemotherapy dosage is frequently based on total body surFace area (BSA), so it is important for the nurse to do which of the following before administering chemotherapy? "1. Measure abdominal girth 2. Claculate BMI 3. Ask the client about his/her height and weight 4. Weigh and measure the client on the day of medication administration"

"Answer: 4 To ensure that the client receives optimal doses of chemotherapy, dosing is usually based on the total Body surface area(BSA) which requires accurate height and weight before each med administration. Simply asking the client about height/weight may lead to inaccuracies in determining BSA. Calculating BMI and measuring abdominal girth does not provide the data needed."

"Which nursing diagnosis is highest-priority for a child undergoing chemotherapy and experiencing nausea and vomiting? "A. Fluid and Electrolyte Imbalance B. Alterations in Nutrition C. Alterations in Skin Integrity D. Body Image Disturbances"

"Correct Answer: A While all of the nursing diagnoses listed here are important, dehydration and fluid and electrolyte loss secondary to vomiting is the priority for this client."

"The mother of a child diagnosed with a potentially life-threatening form of cancer says to the nurse, ""I don't understand how this could happen to us. We have been so careful to make sure our child is healthy."" Which response by the nurse is most appropriate? "A. ""This must be a difficult time for you and your family. Would you like to talk about how you are feeling?"" B. ""Why do you say that? Do you think that you could have prevented this?"" C. ""You shouldn't feel that you could have prevented the cancer. It is not your fault."" D. ""Many children are diagnosed with cancer. It is not always life-threatening."""

"Correct Answer: A Parents of children diagnosed with cancer require major emotional support, and should be allowed to express their feelings. Prevention and blaming oneself is not supportive, nor is telling the parents that there are many other children with cancer."

"A preschool-age child undergoing chemotherapy experiences nausea and vomiting. Which of the following would be the best intervention to include in the child's plan of care? "a. Administer tube feedings. b. Offer small, frequent meals. c. Offer fluids only between meals. d. Allow the child to choose what to eat for meals."

"Correct answer: D While all options can be done to encourage nutrition, allowing the preschooler choices meets two issues: nutrition and developmental tasks."

"The pediatric nurse understands that the most common cancer found in children is: "1. Non-hodgkin's lymphoma 2. Acute lymphocytic leukemia 3. Chronic lymphocytic leukemia 4. Ewing's sarcoma"

"Correct: 2. 1. No - this is not a common cancer in children 2. YES! this is the most common form of cancer found in children is acute lymphocytic leukemia. 3. No - this is not a common cancer in children 4. No - this is not a common cancer in children"

"David, age 15 months, is recovering from surgery to remove Wilms' tumor. Which findings best indicates that the child is free from pain? "a. Decreased appetite b. Increased heart rate c. Decreased urine output d. Increased interest in play"

"Correct: D Answer D. One of the most valuable clues to pain is a behavior change: A child who's pain-free likes to play. A child in pain is less likely to consume food or fluids. An increased heart rate may indicate increased pain; decreased urine output may signify dehydration."

The mother of a 3-year-old child arrives at a clinic and tells the nurse that the child has been scratching the skin continuously and has developed a rash. The nurse assesses the child and suspects the presence of scabies. The nurse bases this suspicion on which finding noted on assessment of the child's skin? 1.Fine grayish red lines 2.Purple-colored lesions 3.Thick, honey-colored crusts 4.Clusters of fluid-filled vesicles

1. Fine grayish red lines Scabies is a parasitic skin disorder caused by an infestation of Sarcoptes scabiei (itch mite). Scabies appears as burrows or fine, grayish red, threadlike lines. They may be difficult to see if they are obscured by excoriation and inflammation. Purple-colored lesions may indicate various disorders, including systemic conditions. Thick, honey-colored crusts are characteristic of impetigo or secondary infection in eczema. Clusters of fluid-filled vesicles are seen in herpesvirus infection.

The clinic nurse is reviewing the health care provider's prescription for a child who has been diagnosed with scabies. Lindane has been prescribed for the child. The nurse questions the prescription if which is noted in the child's record? 1.The child is 18 months old. 2.The child is being bottle-fed. 3.A sibling is using lindane for the treatment of scabies. 4.The child has a history of frequent respiratory infections.

1. The child is 18 months old Lindane is a pediculicide product that may be prescribed to treat scabies. It is contraindicated for children younger than 2 years because they have more permeable skin, and high systemic absorption may occur, placing the children at risk for central nervous system toxicity and seizures. Lindane also is used with caution in children between the ages of 2 and 10 years. Siblings and other household members should be treated simultaneously

When assessing a child for developmental dysplasia of the hip, the nurse feels a "clunk" when the child's hip is abducted and relocated. Which of the following did the nurse perform? 1) Braxton's maneuver 2) Ortolani's sign 3) Trendelenburg's sign 4) Barlow's test

2) Barlow's is when the hip is adducted and dislocated.

A nurse has just finished providing discharge teaching to the family of a child going home with a cast that was applied 30 minutes prior. Which statement by the family indicates that further teaching is necessary? Select all that apply: 1) "For the next couple of days, we should keep the casted arm above the level of the heart and apply ice." 2) "If my child's arm starts to itch, we can apply lotion if we can reach into the cast." 3) "We will tape a plastic bag around his cast before he takes a bath." 4) "If my child gets his cast wet, we'll blow dry it with the lowest heat setting on our blow dryer." 5) "We will make sure we regularly press the skin back around the edge of the cast." 6) "We will make sure our child does not eat anything messy while he has this cast on."

2, 4, 6 Nothing should be inserted into the cast, and lotions and powders should not be used. If the cast gets wet, a blow dryer with COLD air should be used. There is no need to adjust the child's diet, but the cast should be covered while the child eats or drinks. See page 844

While caring for a 9-year-old female in Buck's traction, which of the following actions by the nurse is correct? 1) The nurse encourages the child's 3 year-old sibling to sit on the bed and visit with the child. 2) The nurse helps the child learn how to raise and lower the head of her bed so she can complete her homework. 3) The nurse checks the capillary refill on the child's extremities every 4 hours. 4) The nurse teaches the child's mother to place the weights on the bedside table before the child uses the bedpan.

3) Extra visitors should not be invited on the bed- especially a toddler who may think the weights at the end of the bed are toys. The head of the bed should only be raised or lowered with physician's orders, and this should be done minimally. The weights should ALWAYS be hanging freely.

The school nurse has provided an instructional session about impetigo to parents of the children attending the school. Which statement, if made by a parent, indicates a need for further instruction? 1."It is extremely contagious." 2."It is most common in humid weather." 3."Lesions most often are located on the arms and chest." 4."It might show up in an area of broken skin, such as an insect bite."

3. Lesions most often are located on the arms and chest." Impetigo is a contagious bacterial infection of the skin caused by b-hemolytic streptococci or staphylococci, or both. Impetigo is most common during hot, humid summer months. Impetigo may begin in an area of broken skin, such as an insect bite or atopic dermatitis. Impetigo is extremely contagious. Lesions usually are located around the mouth and nose, but may be present on the hands and extremities.

A concerned mother calls the and tells you the following pieces of information about her 2-year-old son. Which statement by the mother most concerns you? 1) "I noticed that when my son is standing, his knees touch but his feet seem really far apart." 2) "My son's feet are so flat, even though he's been waking for 9 months now." 3) "My baby really hates it when I try to feed him broccoli and keeps spitting it out onto his plate." 4) "This morning when I was trying to dress him, my son cried nonstop when I tried to put his shirt on."

4) This could indicate a sprain or fracture, and nursemaid's elbow is common in toddlers and preschoolers. This statement should be further investigated since it indicates pain/discomfort. It is not uncommon for infants to have flat feet, although the arch of the foot should begin to form after walking begins. However, some infants never develop an arch and have flat feet as adults. Genu valgum, or "knock knees", are commonly seen around the ages 2-3, and this will often resolve by ages 7-8. It is not uncommon for a toddler to dislike broccoli. Who does like broccoli.

A topical corticosteroid is prescribed by a health care provider for a child with atopic dermatitis (eczema). Which instruction should the nurse give the parent about applying the cream? 1.Apply the cream over the entire body. 2.Apply a thick layer of cream to affected areas only. 3.Avoid cleansing the area before application of the cream. 4.Apply a thin layer of cream and rub it into the area thoroughly.

4. Apply a thin layer of cream and rub it into the area thoroughly. Atopic dermatitis is a superficial inflammatory process involving primarily the epidermis. A topical corticosteroid may be prescribed and should be applied sparingly (thin layer) and rubbed into the area thoroughly. The affected area should be cleaned gently before application. A topical corticosteroid should not be applied over extensive areas. Systemic absorption is more likely to occur with extensive application.

Permethrin (Elimite) is prescribed for a child with a diagnosis of scabies. The nurse should give which instruction to the parents regarding the use of this treatment? 1.Apply the lotion to areas of the rash only. 2.Apply the lotion and leave it on for 6 hours. 3.Avoid putting clothes on the child over the lotion. 4.Apply the lotion to cool, dry skin at least 30 minutes after bathing.

4. Apply the lotion to cool, dry skin at least 30 minutes after bathing. Permethrin is massaged thoroughly and gently into all skin surfaces (not just the areas that have the rash) from the head to the soles of the feet. Care should be taken to avoid contact with the eyes. The lotion should not be applied until at least 30 minutes after bathing and should be applied only to cool, dry skin. The lotion should be kept on for 8 to 14 hours, and then the child should be given a bath. The child should be clothed during the 8 to 14 hours of treatment contact time.

The school nurse is conducting pediculosis capitis (head lice) assessments. Which finding indicates a child has a "positive" head check? 1.Maculopapular lesions behind the ears 2.Lesions in the scalp that extend to the hairline or neck 3.White flaky particles throughout the entire scalp region 4.White sacs attached to the hair shafts in the occipital area

4. White sacs attached to the hair shafts in the occipital area Pediculosis capitis is an infestation of the hair and scalp with lice. The nits are visible and attached firmly to the hair shaft near the scalp. The occiput is an area in which nits can be seen. Maculopapular lesions behind the ears or lesions that extend to the hairline or neck are indicative of an infectious process, not pediculosis. White flaky particles are indicative of dandruff.

Which cell is the site of origin for Non-Hodgkin Lymphoma? A) B or T lymphocyte B) Erythrocyte C) Epithelial cell D) Monocyte

A) B or T lymphocyte

For immunocompromised children with Herpes Zoster (Shingles), acyclovir is given B) Never, due to Reyes Syndrome C) Intramuscular D) Sublingual

A) Intravenously

SELECT ALL THAT APPLY What relieves itching for a child who has Herpes zoster (Shingles)? A) Oatmeal Baths B) Antihistamines C) Aspirin D) Epsin Salt Baths

A) Oatmeal Baths B) Antihistamines

The nurse has received in report that the client receiving chemotherapy has severe neutropenia. Which of the following does the nurse plan to implement? Select all that apply. A. Assess for fever. B. Observe for bleeding. C. Administer pegfilgrastim (Neulasta). D. Do not permit fresh flowers or plants in the room. E. Do not allow his 16-year-old son to visit. F. Teach the client to omit raw fruits and vegetables from his diet.

A,C,D,F: Any temperature elevation in a client with neutropenia is considered a sign of infection and should be reported immediately. Administration of biological response modifiers, such as filgrastim (Neupogen) and pegfilgrastim (Neulasta), is indicated in neutropenia to prevent infection and sepsis. All fruits and vegetables should be cooked well; raw fruits and vegetables may harbor organisms, as well as Flowers and plants. Thrombocytopenia cause bleeding, not low neutrophils.The client is at risk for infection, not the visitors, if they are well. However, very small children, who may get frequent colds and viral infections, may pose a risk.

A client newly diagnosed with acute leukemia asks why he is at such extreme risk for infection when his white blood cell count is so high. What is the nurse's best response? A. "Even though you have many white blood cells, they are too immature to fight infection." B. "For now, your risk is low; however, when the chemotherapy begins, your risk for infection will be high." C. "These white blood cells are cancerous and live longer than normal white blood cells, so they are too old to fight infection." D. "It is not the white blood cells that provide protection; it is the red blood cells, which are very low in your blood right now."

A. For clients who understand that white blood cells are a great protection against infection, being at great risk for infection even when WBC counts are sometimes ten times normal is confusing. These are leukemic cells that overgrow at a very immature level. Therefore even though there can be huge numbers of circulating WBCs, these cells are so immature that they are nonfunctional. In addition, the heavy production of immature leukemic cells prevents normal WBCs, RBCs, and platelets from forming and maturing into functional cells.

Which of the following are psychosocial outcomes associated with JIA? (Select all that apply) A. Positive body image B. Weight gain C. Freedom from pain D. Maintenance of joint mobility

A. Positive body image

A young child with leukemia has anorexia and severe stomatitis. The nurse should suggest that the parents try which intervention? a. Relax any eating pressures. b. Firmly insist that child eat normally. c. Begin lavage feedings to supplement diet. d. Serve foods that are either hot or cold.

ANS: A A multifaceted approach is necessary for children with severe stomatitis and anorexia. First, the parents should relax eating pressures. The nurse should suggest that the parents try soft, bland foods; normal saline or bicarbonate mouthwashes; and local anesthetics. The stomatitis is a temporary condition. The child can resume good food habits as soon as the condition resolves.

In which of the conditions are all the formed elements of the blood simultaneously depressed? a. Aplastic anemia b. Sickle cell anemia c. Thalassemia major d. Iron deficiency anemia

ANS: A Aplastic anemia refers to a bone marrowfailure condition in which the formed elements of the blood are simultaneously depressed. Sickle cell anemia is a hemoglobinopathy in which normal adult hemoglobin is partly or completely replaced by abnormal sickle hemoglobin. Thalassemia major is a group of blood disorders characterized by deficiency in the production rate of specific hemoglobin globin chains. Iron deficiency anemia results in a decreased amount of circulating red cells.

The nurse is preparing to give oral care to a school-age child with mucositis secondary to chemotherapy administered to treat leukemia. Which preparations should the nurse use for oral care on this child? (Select all that apply.) a. Chlorhexidine gluconate (Peridex) b. Lemon glycerin swabs c. Antifungal troches (lozenges) d. Lip balm (Aquaphor) e. Hydrogen peroxide

ANS: A, C, D Preparations that may be used to prevent or treat mucositis include chlorhexidine gluconate (Peridex) because of its dual effectiveness against candidal and bacterial infections, antifungal troches (lozenges) or mouthwash, and lip balm (e.g., Aquaphor) to keep the lips moist. Agents that should not be used include lemon glycerin swabs (irritate eroded tissue and can decay teeth), hydrogen peroxide (delays healing by breaking down protein), and milk of magnesia (dries mucosa).

A young child with human immunodeficiency virus (HIV) is receiving several antiretroviral drugs. The purpose of these drugs is to: a. cure the disease. b. delay disease progression. c. prevent spread of disease. d. treat Pneumocystis carinii pneumonia.

ANS: B Although not a cure, these antiviral drugs can suppress viral replication, preventing further deterioration of the immune system and delaying disease progression. At this time, cure is not possible. These drugs do not prevent the spread of the disease. P. carinii prophylaxis is accomplished with antibiotics.

Which immunization should be given with caution to children infected with human immunodeficiency virus (HIV)? a. Influenza b. Varicella c. Pneumococcal d. Inactivated poliovirus (IPV)

ANS: B The children should be carefully evaluated before being given live viral vaccines such as varicella, measles, mumps, and rubella. The child must be immunocompetent and not have contact with other severely immunocompromised individuals. Influenza, pneumococcal, and inactivated poliovirus (IPV) are not live vaccines.

The nurse is planning care for a school-age child admitted to the hospital with hemophilia. Which interventions should the nurse plan to implement for this child? (Select all that apply.) a. Finger sticks for blood work instead of venipunctures b. Avoidance of IM injections c. Acetaminophen (Tylenol) for mild pain control d. Soft tooth brush for dental hygiene e. Administration of packed red blood cells

ANS: B, C, D Nurses should take special precautions when caring for a child with hemophilia to prevent the use of procedures that may cause bleeding, such as IM injections. The subcutaneous route is substituted for IM injections whenever possible. Venipunctures for blood samples are usually preferred for these children. There is usually less bleeding after the venipuncture than after finger or heel punctures. Neither aspirin nor any aspirin-containing compound should be used. Acetaminophen is a suitable aspirin substitute, especially for controlling mild pain. A soft toothbrush is recommended for dental hygiene to prevent bleeding from the gums. Packed red blood cells are not administered. The primary therapy for hemophilia is replacement of the missing clotting factor. The products available are factor VIII concentrates.

Which should the nurse teach about prevention of sickle cell crises to parents of a preschool child with sickle cell disease? (Select all that apply.) a. Limit fluids at bedtime. b. Notify the health care provider if a fever of 38.5 C (101.3 F) or greater occurs. c. Give penicillin as prescribed. d. Use ice packs to decrease the discomfort of vasoocclusive pain in the legs. e. Notify the health care provider if your child begins to develop symptoms of a cold.

ANS: B, C, E The most important issues to teach the family of a child with sickle cell anemia are to (1) seek early intervention for problems, such as a fever of 38.5 C (101.3 F) or greater; (2) give penicillin as ordered; (3) recognize signs and symptoms of splenic sequestration, as well as respiratory problems that can lead to hypoxia; and (4) treat the child normally. The nurse emphasizes the importance of adequate hydration to prevent sickling and to delay the adhesionstasisthrombosisischemia cycle. It is not sufficient to advise parents to force fluids or encourage drinking. They need specific instructions on how many daily glasses or bottles of fluid are required. Many foods are also a source of fluid, particularly soups, flavored ice pops, ice cream, sherbet, gelatin, and puddings. Increased fluids combined with impaired kidney function result in the problem of enuresis. Parents who are unaware of this fact frequently use the usual measures to discourage bedwetting, such as limiting fluids at night. Enuresis is treated as a complication of the disease, such as joint pain or some other symptom, to alleviate parental pressure on the child. Ice should not be used during a vasoocclusive pain crisis because it vasoconstricts and impairs circulation even more.

Parents of a school-age child with hemophilia ask the nurse, Which sports are recommended for children with hemophilia? Which sports should the nurse recommend? (Select all that apply.) a. Soccer b. Swimming c. Basketball d. Golf e. Bowling

ANS: B, D, E Because almost all persons with hemophilia are boys, the physical limitations in regard to active sports may be a difficult adjustment, and activity restrictions must be tempered with sensitivity to the childs emotional and physical needs. Use of protective equipment, such as padding and helmets, is particularly important, and noncontact sports, especially swimming, walking, jogging, tennis, golf, fishing, and bowling, are encouraged. Contact sport such as soccer and basketball are not recommended.

Which is caused by a virus that primarily infects a specific subset of T lymphocytes, the CD4+ T cells? a. Wiskott-Aldrich syndrome b. Idiopathic thrombocytopenic purpura c. Acquired immunodeficiency syndrome (AIDS) d. Severe combined immunodeficiency disease

ANS: C AIDS is caused by the human immunodeficiency virus (HIV), which primarily attacks the CD4+ T cells. Wiskott-Aldrich syndrome, idiopathic thrombocytopenic purpura, and severe combined immunodeficiency disease are not viral illnesses.

An adolescent will receive a bone marrow transplant (BMT). The nurse should explain that the bone marrow will be administered by which route? a. Bone grafting b. Bone marrow injection c. IV infusion d. Intra-abdominal infusion

ANS: C Bone marrow from a donor is infused intravenously, and the transfused stem cells will repopulate the marrow. Because the stem cells migrate to the recipients marrow when given intravenously, this is the method of administration.

The nurse is preparing a child for possible alopecia from chemotherapy. Which should be included? a. Explain to child that hair usually regrows in 1 year. b. Advise child to expose head to sunlight to minimize alopecia. c. Explain to child that wearing a hat or scarf is preferable to wearing a wig. d. Explain to child that when hair regrows, it may have a slightly different color or texture.

ANS: D Alopecia is a side effect of certain chemotherapeutic agents. When the hair regrows, it may be a different color or texture. The hair usually grows back within 3 to 6 months after cessation of treatment. The head should be protected from sunlight to avoid sunburn. Children should choose the head covering they prefer.

Which is a common clinical manifestation of Hodgkin disease? a. Petechiae b. Bone and joint pain c. Painful, enlarged lymph nodes d. Enlarged, firm, nontender lymph nodes

ANS: D Asymptomatic, enlarged, cervical or supraclavicular lymphadenopathy is the most common presentation of Hodgkin disease. Petechiae are usually associated with leukemia. Bone and joint pain are not likely in Hodgkin disease. The enlarged nodes are rarely painful.

Which is the most effective pain-management approach for a child who is having a bone marrow aspiration? a. Relaxation techniques b. Administration of an opioi c. EMLA cream applied over site d. Conscious or unconscious sedation

ANS: D Effective pharmacologic and nonpharmacologic measures should be used to minimize pain associated with procedures. For bone marrow aspiration, conscious or unconscious sedation should be used. Relaxation, opioids, and EMLA can be used to augment the conscious or unconscious sedation.

The nurse is caring for a school age child with ringworm the nurse should expect that therapeutic management for this child includes

Administering oral griseofulvin

The 7 year old patient has had a cast on to heal his fracture of his arm. After the expected time period, the nurse is teaching a child about what to expect when removing his cast. Which of the following teaching points should the nurse include? Select All that Apply: A) "The cast could begin to feel really warm as the striker saw is taking the cast off" B) "The striker saw will be very loud" C) "Look, see, the saw won't be able to cut your skin" D) "Once the cast is removed we will soak your leg in warm water" E) "you will still need to keep your leg very still even after the cast is removed"

Answer: A, B, C, and D. The cast/extremity under the cast could begin to feel warm during the cast removal process. The saw could be loud, but the nurse should demonstrate on him/herself that the saw can't won't cut the child. Once the cast is removed, it will be soaked and washed in warm soapy water, and it should be soaked in warm water daily. All of these need to be communicated to the child on the level of their understanding. The child should be told to start increasing activity the limb to regain strength and range of motion.

The nurse is caring for the patient with Russel's traction. Which of the following should the nurse include in this patients plan of care? SATA: A) Weight should remain off of the floor at all times B) Place a foot support to prevent foot drop C) Release traction for 5 minutes of every hour to provide skin care D) Ensure heel is resting on bed at all times E) Assess neurovascular status q 4 hours

Answer: A, B, and E. With all traction, the weights should remain off of the floor at all times and should not be released periodically or stopped for any reason unless emergent. A foot support will be needed for this patient because foot drop could develop related to the heel being elevated without support. The heel should be off of the bed at all times, not resting on it. Neurovascular status should be assessed often on this patient (as often as vitals are done).

Which of the following clinical manifestations of developmental dysplasia of the hip would be seen in the newborn? A. Lordosis B. Ortolani sign C. Trendelenburg sign D. Telescoping of the affected limb

Answer: b. In the newborn period, the dysplasia usually appears as hip joint laxity. During the Ortolani test, the examiner places forward pressure and then backward pressure on the trochanter. If the femoral head is felt to slip, dysplasia may be present. This test is most reliable from birth to 2 to 3 months.

A newborn with congenital clubfoot is being treated with successive casts. The parents ask why so many casts are required. The nurse should explain that: A. casts are needed for the traction. B. each cast is good for only 6 weeks. C. surgical intervention will not be necessary. D. They allow for gradual stretching of tight structures.

Answer: d. Serial casting is begun shortly after birth and before discharge from nursery. Successive casts allow for gradual stretching of skin and tight structures on the medial side of the foot. Manipulation and casting of the leg are repeated frequently (every week) to accommodate the rapid growth of early infancy.

What is the primary treatment for children with Non-Hodgkin Lymphoma? A) Radiation B) Multiagent Chemotherapy C) Stem Cell Transplant D) Hyperthermia therapy Correct Answer: B

B) Multiagent Chemotherapy

The pediatric nurse understands that the most common cancer found in children is: A. Non-hodgkin's lymphoma B. Acute lymphocytic leukemia C. Chronic lymphocytic leukemia D. Ewing's sarcoma

B. Acute lymphocytic leukemia

A school nurse identifies head lice in an 8-year-old student. Which concept should be included when teaching the family about treating this condition? A. Daily washing of hair will prevent the recurrence of the lice. B. If the nit cannot be removed from the hair shaft, the hair shaft should be cut. C. Clothing and towels should be washed in cold water. D. Conditioner should be applied prior to lice treatment.

B. If the nit cannot be removed from the hair shaft, the hair shaft should be cut.

The client is treated for head lice with lindane (Kwell). Following treatment, the nurse reinforces instructions to: A. Remain isolated for 48 hours. B. Inspect hair shafts, checking for nits daily, for one week following treatment. C. Shampoo with Kwell three times per week. D. Wash linens with cold water and bleach.

B. Inspect hair shafts, checking for nits daily, for one week following treatment.

You palpate a large left intra-abdominal mass in an infant. The most likely diagnosis is: A. Wilm's tumor B. Neuroblastoma C. Autosomal recessive polycystic kidney disease (ARPKD)

B. Neuroblastoma

Which action is most important for the nurse to implement to prevent nausea and vomiting in a client who is prescribed to receive the first round of IV chemotherapy? A. Keep the client NPO during the time chemotherapy is infusing. B. Administer antiemetic drugs before administering chemotherapy. C. Ensure that the chemotherapy is infused over a 4- to 6-hour period. D. Assess the client for manifestations of dehydration hourly during the infusion period.

B. When emetogenic chemotherapy drugs are prescribed, the client should receive antiemetic drugs before the chemotherapy drugs are administered. This allows time for prevention of chemotherapy-associated nausea and vomiting; however, the antiemetic therapy cannot stop until all risks for nausea and vomiting have passed. Clients become nauseated and vomit even if they are NPO.

After a client is admitted to the pediatric unit with a diagnosis of acute lymphocytic leukemia, the laboratory test indicates that the client is neutropenic. The nurse should perform which of the following?" A. advise the client to rest and avoid exertion B. prevent client exposure ot infections C. monitor the blood pressure frequently D. observe for increased bruising

B. prevent client exposure ot infections

Which of the following findings would alarm the nurse when caring for a client receiving chemotherapy who has a platelet count of 17,000/mm3? A. Increasing shortness of breath B. Diminished bilateral breath sounds C. Change in mental status D. Weight gain of 4 pounds in 1 day

C. A change in mental status could result from spontaneous bleeding; in this case, a cerebral hemorrhage may have developed. Increasing shortness of breath is typically related to anemia, not to thrombocytopenia.

Which intervention will be most helpful for the client with mucositis? A. Administering a biological response modifier B. Encouraging oral care with commercial mouthwash C. Providing oral care with a disposable mouth swab D. Maintaining NPO until the lesions have resolved

C. Mouth swabs are soft and disposable and therefore clean. Commercial mouthwashes should be avoided because they may contain alcohol or other drying agents that may further irritate the mucosa.

The registered nurse would correct the nursing student when caring for a client with neutropenia secondary to chemotherapy in which circumstance? A. Student scrubs the hub of IV tubing before administering an antibiotic. B. Nurse overhears the student explaining to the client the importance of handwashing. C. Student teaches the client that symptoms of neutropenia include fatigue and weakness. D. The nurse observes the student providing oral hygiene and perineal care.

C. Symptoms of neutropenia include low neutrophil count, fever, and signs and symptoms of infection; the student should be corrected.

A pregnant woman has a child at home who has been diagnosed with neurofibromatosis She asks the nurse what she should look for in the new baby that would indicate that it also has neurofibromatosis. What sign should the nurse instruct the woman to look for in the new baby? a) Projectile vomiting b) Café-au-lait spots c) Xanthoma d) Increased urination

Café-au-lait spots Correct Explanation: Physical assessment may provide clues that a particular genetic condition is present in a person and family. Family history assessment may offer initial guidance regarding the particular area for physical assessment. For example, a family history of neurofibromatosis type 1, an inherited condition involving tumors of the central nervous system, would prompt the nurse to carry out a detailed assessment of closely related family members. Skin findings such as café-au-lait spots, axillary freckling, or tumors of the skin (neurofibromas) would warrant referral for further evaluation, including genetic evaluation and counseling. A family history of familial hypercholesterolemia would alert the nurse to assess family members for symptoms of hyperlipidemias (xanthomas, corneal arcus, abdominal pain of unexplained origin). As another example, increased urination could indicate type 1 diabetes. Projectile vomiting is indicative of pyloric stensosis.

A 12 year old boy seen in the clinic, and a diagnosis of Hodgkin's disease is suspected . Which diagnostic test results confirm the diagnosis of Hodgkin's disease? 1 . Elevated vanillylmandelic acid urinary level. 2. The presence of blast cells in the bone marrow 3. The presence of Epsetin-Barr virus in the blood. 4. The presence of Reed-Sternberg cells in the lymph nodes

Correct Answer 4 . Hodgkin's disease is a neoplasm of lymphatic tissue. The presence of gaint multinucleated cells ( Reed- Sternbergs cells) is the hallmark of this disease. The presence of blast cells in the bone marrow indicates leukemia. The Epstein-Barr virus is associated with infectious mononucleosis . Elevated levels of vanillylmandelic acid in the urine may be found in children with neroblastoma.

The nurse is caring for an adult client with Down syndrome who reports fatigue and shortness of breath. Which type of cancer has been identified in clients with Down syndrome? A. Breast cancer B. Colorectal cancer C. Malignant melanoma D. Leukemia

D. Leukemia is associated with Down syndrome and Turner syndrome.

The nurse is caring for a child whose parents are both African Americans. The child exhibits swelling of their hands and feet, fever, and signs of blocked capillaries. What is the likely cause? A. Hodgkin's disease B. Diabetic ketoacidosis C. Hyperthyroidism D. Sickle cell anemia

D. Sickle cell anemia

The mother of a child with JIA asks the nurse what activities the child can enjoy. Based on knowledge of the physiologic aspects of JIA, which of the following would be the most appropriate? A. Running B. Boxing C. Skiing D. Swimming

D. Swimming

A diagnosis of Hodgkin's disease is suspected in a 13 year old child seen in a clinic. Several diagnostic studies are performed to determine the presence of this disease. Which diagnostic test results confirm the diagnosis of Hodgkin's disease? A. Elevated vanillylmandelic acid urinary levels. B. The presence of blast cells in the bone marrow. C. The presence of Epstein-Barr virus in the blood. D. The presence of Reed-Sternberg cells in the lymph nodes"

D. The presence of Reed-Sternberg cells in the lymph nodes"

A client diagnosed with widespread lung cancer asks the nurse why he must be careful to avoid crowds and people who are ill. What is the nurse's best response? A. "With lung cancer, you are more likely to develop pneumonia and could pass this on to other people who are already ill." B. "When lung cancer is in the bones, it becomes a bone marrow malignancy, which stops producing immune system cells." C. "The large amount of mucus produced by the cancer cells is a good breeding ground for bacteria and other microorganisms." D. "When lung cancer is in the bones, it can prevent production of immune system cells, making you less resistant to infection."

D. Tumor cells that enter the bone marrow reduce the production of healthy white blood cells (WBCs), which are needed for normal immune function. Therefore clients who have cancer, especially leukemia, are at an increased risk for infection. Other people are not at risk for becoming infected as a result of contact with a person who has lung cancer. Lung cancer that has spread to the bone is still lung cancer; it is not a bone marrow malignancy. It is true that the person with lung cancer may produce more mucus, which can harbor microorganisms, but this is not the main reason why the client should avoid crowds and people who are ill.

The nurses taking care of a two-year-old child with a macule skin lesion which clinical findings should the nurse expect to assess with this type of lesion

Flat brown more less than 1 cm in diameter

The nurses taking care of a seven-year-old child with a skin rash called a papule which clinical findings should the nurse expect to assess with this type of skin rash

Illusion that is elevated, palpable, firm and circumscribed, less than 1 cm in diameter

An African American couple presents for a genetic counseling appointment. They are pregnant and are concerned about their child. What would a patient of African American heritage have genetic carrier testing for? a) Sickle cell anemia b) Asthma c) Rubella d) Meckel's diverticulum

Sickle cell anemia Correct Explanation: Assessing ancestry and ethnicity is important to help identify individuals and groups who could benefit from genetic testing for carrier identification, such as African Americans routinely offered testing for sickle cell anemia. The other answers are incorrect because they are not identified with the African American race

Cellulitis is often caused by

Streptococcus or Staphylococcus organisms.

A woman with both heart disease and osteoarthritis has come to the genetics clinic for genetic screening. What would the nurse know about these two diseases? a) They are direct result of the patient's lifestyle b) They are multifactorial c) They do not have a genetic basis d) They are caused by a single gene

They are multifactorial Correct Explanation: Genomic or multifactorial influences involve interactions among several genes (gene-gene interactions) and between genes and the environment (gene-environment interactions), as well as the individual's lifestyle.

The nurse is teaching nursing students about childhood skin lesions which an elevated circumscribed skin lesion that is less than 1 cm diameter and filled with serous fluid

Vesicle

A nurse is teaching the parent of a child who has hand, foot, and mouth disease. Which of the following should be included in the teaching? a. "Your child can be contagious when the symptoms are gone." b. "The incubation period is 10 to 21 days." c. "It is transmitted by droplet." d. "Once infected, your child will be a lifetime carrier."

a. "Your child can be contagious when the symptoms are gone."

A nurse is performing a neonatal assessment. Which assessment should the nurse use to assess for developmental dysplasia of the hip? (Select all that apply) a. Barlow Test b. Trendelenburg sign c. Manipulation of foot and ankle d. Ortolani test

a. Barlow Test d. Ortolani test

2. A child with hemophilia states that he wants to participate in sports. Which sport should the nurse recommend as most appropriate for the child? a)Running b)Swimming c)Biking d)Baseball

b) Swimming

\When caring for a male client with severe impetigo, the nurse should include which intervention in the plan of care? a. Placing mitts on the client's hands b. Administering systemic antibiotics as prescribed c. Applying topical antibiotics as prescribed d. Continuing to administer antibiotics for 21 days as prescribed

b. Administering systemic antibiotics as prescribed

A nurse is caring for a child after spinal fusion for scoliosis treatment. The child complains of abdominal discomfort and begins to have episodes of vomiting. On further assessment, the nurse notes abdominal distention. Based on these findings, the nurse should take which action? a. Notify the physician. b. Administer an antiemetic. c. Increase the intravenous fluids. d. Place the child in a Sims' position.

a. Notify the physician.

22. The nurse is providing care to a child with a long-leg hip spica cast. Which of the following would be a priority nursing diagnosis? A) Risk for impaired skin integrity due to cast and location B) Deficient knowledge related to cast care C) Risk for delayed development related to immobility D) Self-care deficit related to immobility

Ans: A Feedback: Although deficient knowledge, risk for delayed development, and self-care deficit may be applicable, the child is at increased risk for skin breakdown due to the size of the cast and its location. In addition, the cast has an opening, which allows for elimination. Soiling of cast edges or leakage of urine or stool can lead to skin breakdown.

Which of the following are characteristics of Von Willebrand's Disease? Select all that apply. a. Easy bruising occurs b. Gum bleeding occurs c. It is a hereditary bleeding disorder d. Its characterized by extremely high creatinine levels

a. Easy bruising occurs b. Gum bleeding occurs c. It is a hereditary bleeding disorder

A child with Atopic Dermatitis has higher-than-normal colonization of which bacteria? a. Staphylococcus aureus b. Escherichia coli c. streptococci d. Neisseria

a. Staphylococcus aureus

The parents of a pediatric client who has sickle cell anemia ask about the cause of the disorder. Which response by the nurse would best describe the cause? A. "It is caused by a recessive trait the primarily affects African-Americans." B. "It is a rare, malignant disorder of the lymphatic system." C. "It is an inherited disorder caused by the abnormal hemoglobin synthesis." D. "It is caused by an increased demand for iron in the blood stream."

A. "It is caused by a recessive trait the primarily affects African-Americans."

A client that has just been diagnosed with Hodgkin's disease asks the nurse, "How did this happen to me?" What is the correct response by the nurse? A. "The cause of Hodgkin's disease is unknown, but it could be a possibility of having a viral illness, such as mono." B. "That doesn't matter." C. "Hodgkin's disease is caused by trauma to the body." D. "This disease is caused by immunizations."

A. "The cause of Hodgkin's disease is unknown, but it could be a possibility of having a viral illness, such as mono."

Which of the following laboratory values could indicate that a child has leukemia? A. WBCs 32,000/mm3 B. Platelets 300,000/mm3 C. Hemoglobin 15g/dL D. Blood pH of 7.35

A. WBCs 32,000/mm3

The parents of a child with ASD (autism spectrum disorder) often express concerns that their child: A. does not seek physical comfort or cuddling B. wants to constantly be cuddled C. is "clingy" with friends and siblings D. is always asking for hugs

A. does not seek physical comfort or cuddling

John's mother just noticed that John has lumps around his neck while bathing him that she has never seen before. What would the doctor associate with the manifestations of Hodgkin's disease? A. Painful, non-moveable lymph nodes B. Bone pain C. Painless, firm, moveable lymph nodes D. Generalized edema

C. Painless, firm, moveable lymph nodes

A nurse is asked to provide education for a 15-year-old who requires surgical treatment for scoliosis. Which should be an appropriate explanation for the adolescent? "The goal of surgery is to": A. Allow you to be taller B. Prevent pain C. Prevent problems with breathing D. Allow clothes to fit you better

C. Prevent problems with breathing

The best way to communicate to a child with ASD about a preocedure they are going to have would be: A. smile to let them know everything is going to be ok. B. tell them they are going to have a shot C. Show them pictures of the procedure that include few simple words D. Explain the procedure in great detail

C. Show them pictures of the procedure that include few simple words

A school nurse plans to reinforce information about the most effective methods to prevent the spread of head lice in school age children at a teacher's conference. The most appropriate information to give would be that: A. The classroom should be sprayed with an insecticide at the end of each day B. Hand washing should be done before and after each break by each child C. The children are not to share hats and scarves D. The heads of children are to be checked weekly for lice

C. The children are not to share hats and scarves

Indicators for ASD include all the following except A. lack of verbalization B. lack of social ability C. smiling all the time D. lack of response to verbal interactions

C. smiling all the time

The nurse is talking with the family of an 18 month-old newly diagnosed with retinoblastoma. A priority in communicating with the parents is. a. Discuss the need for genetic counseling b. Inform them that combined therapy is seldom effective c. Prepare for the child's permanent disfigurement d. Suggest that totally blindness may follow surgery.

a. Discuss the need for genetic counseling

When planning a screening clinic for scoliosis, the nurse would anticipate targeting which of the following groups? a. Preadolescents at the beginning of a growth spurt. b. Toddlers who have diets low in calcium and vitamin D. c. Preschoolers who are entering kindergarten. d. Infants whose mothers have had no prenatal care.

a. Preadolescents at the beginning of a growth spurt.

What is the most common bacteria that causes osteomyelitis? a. staphylococcus aureus b. kingella kingae c. escherichia coli d. group B streptococci

a. staphylococcus aureus

What are the most common findings of Retinoblastoma? a. Pain and discharge b. Leukocoria and strabismus c. Photosensitivity and cataracts d. Glaucoma and colored blindness

b. Leukocoria and strabismus

A nurse is caring for a child who is in Bryant traction. Which of the following is an appropriate action for the nurse to take? a. Place the client in bed with the head of the bed flat and the legs elevated b. Maintain the hips at a 90* angle to the body c. Place the patient in the prone position d. Place the weights on the floor

b. Maintain the hips at a 90* angle to the body

The mother of a child with hemophilia asks the nurse which over-the-counter medication is suitable for her child's joint discomfort. The nurse should tell the mother to purchase: a. Advil (ibuprofen) b. Tylenol (acetaminophen) c. Aspirin (acetylsalicytic acid) d. Naproxen (naprosyn)

b. Tylenol (acetaminophen)

A nurse is caring for a toddler who is diagnosed with hip dysplasia and has been placed in a hip spica cast. The child's mother asks the nurse why a Pavlik harness is not being used. Which of the following responses by the nurse appropriately addresses the mother's question? a. "The Pavlik harness is used for children with scholiosis, not hip dysplasia." b. "The Pavlik harness is used for school-age children." c. "The Pavlik harness cannot be used for your child because her condition is too severe." d. "The Pavlik harness is used for infants less than 6 months of age."

d. "The Pavlik harness is used for infants less than 6 months of age."

The nurse is planning activity for a 4-year-old child with anemia. Which activity should the nurse plan for this child? a. Game of hide and seek in the childrens outdoor play area b. Participation in dance activities in the playroom c. Puppet play in the childs room d. A walk down to the hospital lobby

ANS: C Because the basic pathologic process in anemia is a decrease in oxygen-carrying capacity, an important nursing responsibility is to assess the childs energy level and minimize excess demands. The childs level of tolerance for activities of daily living and play is assessed, and adjustments are made to allow as much self-care as possible without undue exertion. Puppet play in the childs room would not be overly tiring. Hide and seek, dancing, and walking to the lobby would not conserve the anemic childs energy.

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

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

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

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

The nurse is administering an IV chemotherapeutic agent to a child with leukemia. The child suddenly begins to wheeze and have severe urticaria. Which is the most appropriate nursing action? a. Stop drug infusion immediately. b. Recheck rate of drug infusion. c. Observe child closely for next 10 minutes. d. Explain to child that this is an expected side effect.

ANS: A If an allergic reaction is suspected, the drug should be immediately discontinued. Any drug in the line should be withdrawn, and a normal saline infusion begun to keep the line open. Rechecking the rate of drug infusion, observing the child closely for next 10 minutes, and explaining to the child that this is an expected side effect can all be done after the drug infusion is stopped and the child is evaluated.

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

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

A young boy will receive a bone marrow transplant (BMT). This is possible because one of his older siblings is a histocompatible donor. Which is this type of BMT called? a. Syngeneic b. Allogeneic c. Monoclonal d. Autologous

ANS: B Allogeneic transplants are from another individual. Because he and his sibling are histocompatible, the BMT can be done. Syngeneic marrow is from an identical twin. There is no such thing as a monoclonal BMT. Autologous refers to the individuals own marrow.

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

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

The parents of a child hospitalized with sickle cell anemia tell the nurse that they are concerned about narcotic analgesics causing addiction. Which is appropriate for the nurse to explain about narcotic analgesics? a. Are often ordered but not usually needed b. Rarely cause addiction because they are medically indicated c. Are given as a last resort because of the threat of addiction d. Are used only if other measures, such as ice packs, are ineffective

ANS: B The pain of sickle cell anemia is best treated by a multidisciplinary approach. Mild to moderate pain can be controlled by ibuprofen and acetaminophen. When narcotics are indicated, they are titrated to effect and are given around the clock. Patient-controlled analgesia reinforces the patients role and responsibility in managing the pain and provides flexibility in dealing with pain. Few, if any, patients who receive opioids for severe pain become behaviorally addicted to the drug. Narcotics are often used because of the severe nature of the pain of vasoocclusive crisis. Ice is contraindicated because of its vasoconstrictive effects.

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

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

15. Which exercise would the nurse suggest as most helpful to maintain mobility in a child with juvenile idiopathic arthritis? A) Jogging every other day B) Using a treadmill C) Swimming D) Playing basketball

Ans: C Feedback: Swimming is a particularly useful exercise to maintain joint mobility without placing pressure on the joints. Jogging, using a treadmill, and playing basketball would place pressure on the joints of the lower extremities.

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

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

Which is most descriptive of the pathophysiology of leukemia? a. Increased blood viscosity occurs. b. Thrombocytopenia (excessive destruction of platelets) occurs. c. Unrestricted proliferation of immature white blood cells (WBCs) occurs. d. First stage of coagulation process is abnormally stimulated.

ANS: C Leukemia is a group of malignant disorders of the bone marrow and lymphatic system. It is defined as an unrestricted proliferation of immature WBCs in the blood-forming tissues of the body. Increased blood viscosity may occur secondary to the increased number of WBCs. Thrombocytopenia may occur secondary to the overproduction of WBCs in the bone marrow. The coagulation process is unaffected by leukemia.

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

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

Parents of a hemophiliac child ask the nurse, Can you describe hemophilia to us? Which response by the nurse is descriptive of most cases of hemophilia? a. Autosomal dominant disorder causing deficiency in a factor involved in the blood-clotting reaction b. X-linked recessive inherited disorder causing deficiency of platelets and prolonged bleeding c. X-linked recessive inherited disorder in which a blood-clotting factor is deficient d. Y-linked recessive inherited disorder in which the red blood cells become moon-shaped

ANS: C The inheritance pattern in 80% of all of the cases of hemophilia is X-linked recessive. The two most common forms of the disorder are factor VIII deficiency, hemophilia A or classic hemophilia; and factor IX deficiency, hemophilia B or Christmas disease. The inheritance pattern is X-linked recessive. The disorder involves coagulation factors, not platelets, and does not involve red cells or the Y chromosomes.

A school-age child with leukemia experienced severe nausea and vomiting when receiving chemotherapy for the first time. Which is the most appropriate nursing action to prevent or minimize these reactions with subsequent treatments? a. Encourage drinking large amounts of favorite fluids. b. Encourage child to take nothing by mouth (remain NPO) until nausea and vomiting subside. c. Administer an antiemetic before chemotherapy begins. d. Administer an antiemetic as soon as child has nausea.

ANS: C The most beneficial regimen to minimize nausea and vomiting associated with chemotherapy is to administer the antiemetic before the chemotherapy is begun. The goal is to prevent anticipatory symptoms. Drinking fluids will add to the discomfort of the nausea and vomiting. Remaining until nausea and vomiting subside will help with this episode, but the child will have the discomfort and be at risk for dehydration. Administering an antiemetic as soon as the child has nausea does not prevent anticipatory nausea.

Which should the nurse include when teaching the mother of a 9-month-old infant about administering liquid iron preparations? a. They should be given with meals. b. They should be stopped immediately if nausea and vomiting occur. c. Adequate dosage will turn the stools a tarry green color. d. Allow preparation to mix with saliva and bathe the teeth before swallowing.

ANS: C The nurse should prepare the mother for the anticipated change in the childs stools. If the iron dose is adequate, the stools will become a tarry green color. The lack of the color change may indicate insufficient iron. The iron should be given in two divided doses between meals when the presence of free hydrochloric acid is greatest. Iron is absorbed best in an acidic environment. Vomiting and diarrhea may occur with iron administration. If these occur, the iron should be given with meals, and the dosage reduced, then gradually increased as the child develops tolerance. Liquid preparations of iron stain the teeth. They should be administered through a straw and the mouth rinsed after administration.

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

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

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

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

A child with leukemia is receiving triple intrathecal chemotherapy consisting of methotrexate, cytarabine, and hydrocortisone. The purpose of this is to prevent: a. infection. b. brain tumor. c. drug side effects. d. central nervous system (CNS) disease.

ANS: D For certain children, CNS prophylactic therapy is indicated. This drug regimen is used to prevent CNS leukemia and will not prevent infection or drug side effects. If the child has a brain tumor in addition to leukemia, additional therapy would be indicated.

The nurse is conducting a staff in-service on childhood blood disorders. Which describes the pathology of idiopathic thrombocytopenic purpura? a. Bone marrow failure in which all elements are suppressed b. Deficiency in the production rate of globin chains c. Diffuse fibrin deposition in the microvasculature d. An excessive destruction of platelets

ANS: D Idiopathic thrombocytopenic purpura is an acquired hemorrhagic disorder characterized by an excessive destruction of platelets, discolorations caused by petechiae beneath the skin, and a normal bone marrow. Aplastic anemia refers to a bone marrowfailure condition in which the formed elements of the blood are simultaneously depressed. Thalassemia major is a group of blood disorders characterized by deficiency in the production rate of specific hemoglobin globin chains. Disseminated intravascular coagulation is characterized by diffuse fibrin deposition in the microvasculature, consumption of coagulation factors, and endogenous generation of thrombin and plasma.

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

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

13. A nurse is assessing a child with suspected osteomyelitis. Which finding would help support this suspicion? A) Swelling and point tenderness B) Decreased erythrocyte sedimentation rate C) Coolness of the affected site D) Increased range of motion

Ans: A Feedback: Findings associated with osteomyelitis include swelling, point tenderness, warmth over the site, decreased range of motion, and an elevated sedimentation rate.

1. An 8-year-old girl was diagnosed with a closed fracture of the radius at approximately 2 p.m. The fracture was reduced in the emergency department and her arm placed in a cast. At 11 p.m. her mother brings her back to the emergency department due to unrelenting pain that has not been relieved by the prescribed narcotics. Which action would be the priority? A) Notifying the doctor immediately B) Applying ice C) Elevating the arm D) Giving additional pain medication as ordered

Ans: A Feedback: The nurse should notify the doctor immediately because the girl's symptoms are the classic sign of compartment syndrome. Immediate treatment is required to prevent excessive swelling and to detect neurovascular compromise as quickly as possible. The ice should be removed and the arm brought below the level of the heart to facilitate whatever circulation is present. Giving additional pain medication will not help in this situation.

4. The nurse is caring for a 10-year-old in traction. While performing a skin assessment, the nurse notices that the skin over the calcaneus appears slightly red and irritated. Which action would the nurse do first? A) Reposition the child's foot on a pressure-reducing device B) Apply lotion to his foot to maintain skin integrity C) Make sure the skin is clean and dry D) Gently massage his foot to promote circulation

Ans: A Feedback: The nurse's first action is to remove continuous pressure from this area. The other actions can help decrease the potential for skin breakdown, but the pressure must be relieved first.

25. The nurse is reviewing the medical record of a child diagnosed with septic arthritis. Which of the following would the nurse expect to find? Select all answers that apply. A) Elevated neutrophil count B) Decreased C-reactive protein level C) Joint fluid with increased white blood cells D) Decreased joint space with radiograph E) Increased erythrocyte sedimentation rate

Ans: A, C, E Feedback: Laboratory and diagnostic test findings associated with septic arthritis include white blood cell count that is normal or elevated with elevated neutrophil counts, elevated erythrocyte sedimentation rate and C-reactive protein levels, joint aspiration fluid demonstrating increased white blood cell count, and an increased joint space with joint x-ray.

9. The nurse is conducting a physical examination of a child with suspected developmental dysplasia of the hip. Which of the following findings would help confirm this diagnosis? A) Abduction occurs to 75 degrees and adduction to within 30 degrees (with stable pelvis). B) A distinct "clunk" is heard with Barlow and Ortolani maneuvers. C) A high-pitched "click" is heard with hip flexion or extension. D) The thigh and gluteal folds are symmetric.

Ans: B Feedback: A distinct "clunk" while performing Barlow and Ortolani maneuvers is caused as the femoral head dislocates or reduces back in to the acetabulum. A higher-pitched "click" may occur with flexion or extension of the hip. This is a benign, adventitious sound that should not be confused with a true "clunk" when assessing for developmental dysplasia of the hip. Abduction to 75 degrees, adduction within 30 degrees, and symmetric thigh and gluteal folds are normal findings.

12. When teaching a group of students about the skeletal development in children, which of the following would the instructor include? A) The growth plate is made up of the epiphysis. B) A young child's bones commonly bend instead of break with an injury. C) The infant's skeleton has undergone complete ossification by birth. D) Children's bones have a thin periosteum and limited blood supply.

Ans: B Feedback: A young child's bones are more flexible and more porous with a lower mineral count than adults. Thus, bones will often bend rather than break when an injury occurs. The growth plate is composed of the epiphysis and physis. The infant's skeleton is not fully ossified at birth. Children's bones have a thick periosteum and an abundant blood supply.

28. A 10-year-old girl is brought to the emergency department by her father after tripping over a rock while running in the yard. She tells the nurse, "I think I twisted my ankle." When assessing the child, which of the following would the nurse most likely assess? A) Bruising B) Edema C) Limited range of motion D) Absent pulse

Ans: B Feedback: The girl is describing a sprain, which is frequently accompanied by edema. Bruising may or may not be present. The nurse should not attempt to perform passive range of motion on the affected body part. A pulse should be present; if one is not, neurovascular compromise is present.

24. When assessing a child for slipped capital femoral epiphysis, which of the following would the nurse identify as a possible risk factor? Select all answers that apply. A) Age younger than 8 years B) African American ethnicity C) History of cystic fibrosis D) Excessive activity E) Obesity

Ans: B, E Feedback: Risk factors associated with slipped capital femoral epiphysis include age between 9 and 16 years, African American race, sedentary lifestyle, and being overweight or obese. A history of cystic fibrosis may contribute to rickets.

17. An 8-year-old boy with a fractured forearm is to have a fiberglass cast applied. Which of the following would the nurse include when teaching the child about the cast? A) The cast will take a day or two to dry completely. B) The edges will be covered with a soft material to prevent irritation. C) The child initially may experience a very warm feeling inside the cast. D) The child will need to keep his arm down at his side for 48 hours.

Ans: C Feedback: A fiberglass cast usually takes only a few minutes to dry and will cause a very warm feeling inside the cast. Therefore, the nurse needs to warn the child that this will occur. Fiberglass casts usually have a soft fabric edge so they usually do not cause skin rubbing at the edges and don't require petaling. The child should be instructed to elevate his arm above the level of the heart for the first 48 hours.

27. An 18-month old was brought to the emergency department by her mother, who states, "I think she broke her arm." The child is sent for a radiograph to confirm the fracture. Additional assessment of the child leads the nurse to suspect possible child abuse. Which type of fracture would the radiograph most likely reveal? A) Plastic deformity B) Buckle fracture C) Spiral fracture D) Greenstick fracture

Ans: C Feedback: A spiral fracture is very rare in children. A spiral femoral or humeral fracture, particularly in a child younger than 2 years of age, should always be thoroughly investigated to rule out the possibility of child abuse. Plastic, buckle, and greenstick fractures are common in children and do not usually suggest child abuse.

6. The nurse is caring for a 13-year-old boy in traction prior to surgery for slipped capital femoral epiphysis. He has been in an acute care setting for 2 weeks and will require an additional 10 days in the hospital. He is complaining that he feels isolated and is resisting further treatment. Which response by the nurse would be most appropriate? A) "I know it is boring, but you must remain immobile for 2 more weeks." B) "If there are no complications, you only have 2 more weeks here." C) "Let's come up with things to do like books, movies, games, and friends to visit." D) "If you resist your treatment, your condition will only get worse."

Ans: C Feedback: After 2 weeks in traction, a teenager can become easily bored and isolated from usual peer interaction. The most helpful intervention would be to engage the help of the child to develop a list of books, games, movies, and other activities that he would enjoy. The nurse should also encourage visitation and phone calls from friends. Telling the adolescent that he needs to remain immobile or telling him that he has only 2 more weeks do not address the adolescent's issue. Telling the adolescent that his condition will worsen if he resists is threatening and inappropriate.

11. The nurse is developing a teaching plan for a child who is to have his cast removed. Which of the following would the nurse most likely include? A) Applying petroleum jelly to the dry skin B) Rubbing the skin vigorously to remove the dead skin C) Soaking the area in warm water every day D) Washing the skin with dilute peroxide and water

Ans: C Feedback: After a cast is removed, the child and family should be instructed to soak the area in warm water every day to help soften and remove the dry flaky skin. Moisturizing lotion, not petroleum jelly, should be applied to the skin. Vigorous rubbing would traumatize the skin and should be avoided. Warm soapy water, not dilute peroxide and water, should be used to wash the area.

2. The nurse is caring for an active 14-year-old boy who has recently been diagnosed with scoliosis. He is dismayed that a "jock" like himself could have this condition, and is afraid it will impact his spot on the water polo team. Which response by the nurse would best address the boy's concerns? A) "If you wear your brace properly, you may not need surgery." B) "The good news is that you have very minimal curvature of your spine." C) "Let's talk to another boy with scoliosis, who is winning trophies for his swim team." D) "Let's talk to the doctor about your treatment options."

Ans: C Feedback: Because this boy is concerned about limiting his participation in water polo and perceives scoliosis as a disease that does not affect "jocks," putting the child in contact with someone with the same problem would be helpful. Telling the adolescent about not needing surgery if he wears his brace or that his curvature is minimal may or may not be true in his case and thus would be false reassurance. Although these suggestions and also the suggestion about talking to the doctor about treatment options could be helpful by engaging his input in the treatment, these do not address his specific concerns about his body image.

7. A nurse is caring for a 10-year-old girl following joint fluid aspiration. The nurse would expect to perform which of the following immediately after the procedure? A) Transporting the aspirated fluid to the lab within 30 minutes B) Encouraging the child to drink fluids postprocedure C) Applying cold therapy and a pressure dressing to the site D) Elevating the extremity on a heating pad with several pillows

Ans: C Feedback: Following joint fluid aspiration, the nurse should use cold therapy to decrease swelling and apply a pressure dressing to prevent hematoma formation or fluid recollection. Transporting the specimen to the lab is a priority for the erythrocyte sedimentation rate and blood culture. Encouraging fluids is a priority intervention for tests performed with contrast medium. Heat therapy is contraindicated.

14. The school nurse is presenting a class to a group of students about common overuse disorders. Which of the following would the school nurse include? A) Dislocated radial head B) Transient synovitis of the hip C) Osgood-Schlatter disease D) Scoliosis

Ans: C Feedback: Overuse syndromes refer to a group of disorders that result from repeated force applied to normal tissue. An example is Osgood-Schlatter disease. Dislocated radial head, transient synovitis of the hip, and scoliosis are not considered overuse syndromes.

8. The nurse is caring for a 2-year-old girl in a bilateral brace with tibia vara. Her parents are upset by their toddler's limited mobility. Which response by the nurse would be most appropriate? A) "If you don't follow the therapy, your daughter could develop severe bowing of her legs." B) "It's important to use the brace or your daughter may need surgery." C) "You are doing a great job. Let's put our heads together on how to keep her busy." D) "You'll need to accept this since treatment may be required for several years."

Ans: C Feedback: The nurse should support the parents by encouraging and praising their compliance with bracing. It is also important to work with the parents to help develop age-appropriate diversions to promote normal growth and development. Telling the parents that they must be compliant or their daughter could develop severe bowing does not teach, does not offer solutions, and does not address the parents' concerns. Telling the parents that they must simply accept this and that the treatment could take years is likely to upset them and does not teach. It also does not address their concerns.

21. A group of nursing students are reviewing information about the type of skin and skeletal traction. The students demonstrate understanding of this information when they identify which of the following as a type of skeletal traction? A) Russell traction B) Bryant traction C) Buck traction D) 90-90 traction

Ans: D Feedback: 90-90 traction is a type of skeletal traction with force applied through a pin in the distal femur. Russell traction, Bryant traction, and Buck traction are types of skin traction.

16. A child is diagnosed with juvenile idiopathic arthritis and is receiving several different medications listed in the medication administration record. Which agent would the nurse identify as being used to prevent disease progression? A) Aspirin B) Prednisone C) Ibuprofen D) Methotrexate

Ans: D Feedback: Disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, are necessary to prevent disease progression. Other agents, such as aspirin and ibuprofen, are helpful with pain relief. Prednisone helps for relief of inflammation.

16. Which of the following would the nurse be least likely to assess in a 6-year-old with septic arthritis of the hip? A) Moderate to severe pain of the affected hip B) Previous otitis media infection C) Refusal to straighten the affected extremity D) Full range of motion of the hip

Ans: D Feedback: The child with septic arthritis of the hip typically has limited range of motion, maintains the joint in flexion, and does not allow the leg to be straightened. Moderate to severe pain is usually noted and there is a history of a previous infection, such as a respiratory infection or otitis media.

Which child is at the highest risk for osteomyelitis? a. a female 13 year old who likes playing soccer b. a male 10 year old with the flu c. a female 4 month old who was small for gestational age d. a male preschooler who likes climbing trees

d. a male preschooler who likes climbing trees