TB Ch. 22, 23, 26, 31, 33

17. The nurse is recording vital signs in the client diagnosed with complications of anorexia nervosa. Which findings are consistent with the condition? Select all that apply. A. Hyperthermia B. Orthostatic hypotension C. Weak pulse D. Hypertension E. Hypothermia

ANS: B, C, E Rationale: Anorexia nervosa is a condition most commonly seen in adolescents. In this condition the individual is obsessed with body weight. There is a noted loss of weight. The vital signs frequently display orthostatic hypotension, irregular and decreased pulse, or hypothermia.

12. A 16-year-old child suffering from alopecia related to chemotherapy treatment is refusing to let friends visit. Which action by the nurse is most appropriate? A. Respect the child's wishes and document refusal B. Have the parents explain the importance of letting friends visit C. Provide opportunities for the child to discuss his or her body image changes D. Allow friends to visit because socialization is important for adolescents

ANS: C Rationale: Being able to discuss body image changes is a pathway toward providing insight on adaptive measures to minimize the appearance of hair loss. The nurse should respect the child's wishes not to have visitors, but the nurse should recognize that this may be a result of altered body image.

5. When describing the negative feedback system that controls endocrine function, the nurse explains that a decreased secretion of which correlates with a decrease in blood glucose levels? A. Insulin B. Glucagon C. Adrenocorticotropic hormone D. Glycogen

ANS; A Rationale: Feedback is seen in endocrine systems that regulate concentrations of blood components such as glucose. Glucose from the ingested lactose or sucrose is absorbed in the intestine and the level of glucose in blood rises. Elevation of blood glucose concentration stimulates endocrine cells in the pancreas to release insulin. Insulin has the major effect of facilitating entry of glucose into many cells of the body. As a result, blood glucose levels fall. When the level of blood glucose falls sufficiently, the stimulus for insulin release disappears and insulin is no longer secreted.

6. A child with attention deficit hyperactivity disorder (ADHD) is prescribed methylphenidate hydrochloride. What should the nurse instruct the parents regarding an adverse effect of this medication? A. Anorexia B. Sleepiness C. Garbled speech D. Rapid increase in height

ANS: A Rationale: An adverse effect of methylphenidate hydrochloride is anorexia. Sleepiness and garbled speech are not adverse effects of this medication. Children taking this medication can develop growth suppression and not accelerated growth in height.

10. Antiemetics are ordered to control nausea and vomiting in the child undergoing chemotherapy. How can the nurse most effectively use these medications? A. Administer the antiemetic before starting chemotherapy B. Provide the antiemetic as needed (PRN) when nausea and vomiting are reported C. Use the antiemetic after it is clear that nonpharmacologic methods are not effective D. Start the antiemetic on a scheduled basis when the chemotherapy begins to cause nausea

ANS: A Rationale: Antiemetics are most effective when given before chemotherapy begins and then on a regular schedule to prevent nausea and vomiting throughout administration of chemotherapy. Nonpharmacologic measures can be used in conjunction with antiemetics but not in place of them

17. The nurse is preparing to post a sign above the crib of an infant with a Wilms tumor. Which statement should the nurse post immediately? A. "Do not palpate abdomen." B. "No intramuscular injections." C. "No milk or milk products allowed." D. "No blood sampling in lower extremities."

ANS: A Rationale: It is important that the child's abdomen not be palpated any more than is necessary for diagnosis because handling appears to aid metastasis. Place a sign reading "No Abdominal Palpation" over the child's crib to help prevent this. Intramuscular injections, milk products, or blood sampling in the lower extremities are not contraindicated for this health problem.

7. A nurse suspects that a child is experiencing isotonic dehydration based on which assessment findings? Select all that apply. A. Extreme thirst B. Cool skin temperature C. Irritability D. Normal serum sodium level E. Clammy skin

ANS: B, C, D Rationale: Signs and symptoms of isotonic dehydration include mild thirst; poor skin turgor; cool, dry skin; decreased urine output; irritability; and normal serum sodium level. Extreme thirst suggests hypertonic dehydration. Cool, clammy skin suggests hypotonic dehydration

3. The nurse is preparing a discharge teaching plan for the parents of an 8-year-old girl with leukemia. Which instruction would be the priority? A. Calling the doctor if the child gets a sore throat B. Keeping a written copy of the treatment plan C. Writing down phone numbers and appointments D. Using acetaminophen if the child needs an analgesi

ANS: A Rationale: Calling the doctor if the child gets a sore throat is the priority. Because of the child's impaired immune system, any sign of potential infection, such as sore throat, must be evaluated by a physician. Using acetaminophen if the child needs an analgesic, writing down phone numbers and appointments, and keeping a written copy of the treatment plan are important teaching points but secondary to guarding against infection

6. A child is to receive an oral corticosteroid as part of the treatment regimen for leukemia. After teaching the child and family about this drug, the nurse determines the need for additional teaching when they state: A. "We should administer the drug on an empty stomach." B. "We should check our son's urine for glucose." C. "He might develop a rounded face from this drug." D. "We will need to gradually decrease the dosage."

ANS: A Rationale: Corticosteroids are commonly administered with food to decrease the risk for gastrointestinal upset. Corticosteroids can disrupt glucose balance, so urine should be checked for glucose. A moon face is an adverse effect of corticosteroids. Corticosteroids need to be tapered gradually to reduce the risk of adrenal insufficiency.

14. Which type of diet should be included in the plan of care for a child diagnosed with Addison disease? A. High-protein, low-carbohydrate, high-sodium diet B. High-protein, high-carbohydrate, low-sodium diet C. Low-calorie, low-carbohydrate, low-sodium diet D. Low-calorie, low-cholesterol, low-saturated fat diet

ANS: A Rationale: In Addison disease, the body produces inadequate hepatic glucagons. A high-protein, low-carbohydrate, and high-sodium diet prevents fatigue, hypoglycemia, and hyponatremia. The child with Cushing syndrome needs low calories, carbohydrates, and sodium. The child with hypothyroidism needs low calories, cholesterol, and saturated fat.

15. A nurse is providing care to a toddler with nephroblastoma and is being evaluated. Which nursing action would be most important? A. Restricting the child's visitors B. Placing a "no abdominal palpation" sign above the child's bed C. Ensuring that the child be allowed nothing by mouth D. Preparing the child for chemotherapy E. Preventing weight-bearing activities

ANS: B Rationale: Nephroblastoma (Wilms' tumor) metastasizes rapidly, so it is important that the child's abdomen not be palpated any more than necessary for diagnosis, because handling appears to aid metastasis. There is no need to restrict the child's visitors. Ensuring nothing by mouth would be appropriate prior to surgery. Preventing weight-bearing activities would be appropriate for a child with Ewing's sarcoma

6. The nurse is taking a health history for a 9-year-old with conjunctivitis. Which statement by the parents leads the nurse to suspect that the child is experiencing allergic conjunctivitis? A. "He recently helped clean the basement. B. "He was exposed to several family members with an infection. C. He just recovered from an upper respiratory infection. D. We have a family history of conjunctivitis.

ANS: A Rationale: Allergic conjunctivitis may be induced by animal dander, dust mites, or some other ever-present antigen. Exposure to infective agents is related to infectious conjunctivitis. Recent upper respiratory infection and a family history of conjunctivitis are not contributing factors for allergic conjunctivitis.

7. Diabetes insipidus a disorder of the posterior pituitary resulting in deficient secretion of which hormone? A. Antidiuretic hormone B. Adrenocorticotropic hormone C. Thyroid stimulating hormone D. Luteinizing hormone

ANS: A Rationale: Central diabetes insipidus (DI), also called neurogenic, vasopressin-sensitive, or hypothalamic DI, is a disorder of the posterior pituitary that results from deficient secretion of ADH. Nephrogenic DI is a result of the inability of the kidney to respond to ADH.

18. The nurse is caring for a child who is scheduled for bone scan. It is suspected that the child has a growth hormone deficiency. Which finding would support this medical diagnosis? A. The bone scan would show bone age would be two or more deviations below normal. B. The bone scan would show a brain tumor. C. The bone scan would show bone age would be three or more deviations above normal. D. The bone scan would a tumor on the child's kidney.

ANS: A Rationale: Diagnostic testing used in children with suspected GH deficiency include bone age will be two or more deviations below normal. CT or MRI scans would be used to rule out tumors or structural abnormalities, not bone scans

10. The nurse is reviewing the history of an adolescent with peptic ulcer disease. Which client activity would the nurse identify as an associated contributing factor? Select all that apply. A. Use of acetaminophen B. Ingestion of diet colas C. High coffee intake D. Cigarette smoking E. High-fat diet

ANS: B, C, D Rationale: In adolescents, associated factors include a genetic tendency, use of nonsteroidal anti-inflammatory drugs, alcohol, caffeine and cigarettes

11. An 18-month-old child is admitted with signs of increased intracranial pressure. What should the nurse observe when assessing this patient? A. Numbness of fingers and decreased temperature B. Increased pulse rate and decreased blood pressure C. Increased temperature and decreased respiratory rate D. Decreased level of consciousness and increased respiratory rate

ANS: C Rationale: Manifestations of increased intracranial pressure include increased body temperature and decreased respiratory rate. Pulse rate slows, and the blood pressure increases

2. A school-aged girl with Crohn's disease will receive total parenteral nutrition (TPN) for the next 6 weeks. Which would best help her accept the treatment plan? A. Help her ambulate with the bottles. B. Provide some time to talk to her several times a day. C. Help her give the bottles nicknames and personalities. D. Explain that TPN substitutes for normal food.

ANS: B Rationale: Many children receiving alternative methods of feeding miss the conversation that goes with mealtime. Providing this helps them accept an alternative feeding method.

6. A 17-year-old adolescent is found wandering around. The adolescent is confused, sweaty, and pale. Which test would the nurse expect to be performed first? A. Blood glucose level B. CT scan C. Arterial blood gases D. Blood cultures

ANS: A Rationale: It is important to draw a blood glucose level on the adolescent because the client is exhibiting signs of hypoglycemia and needs to be treated as soon as possible. Once the adolescent is stabilized, a complete health history will need to be taken to determine the extent of the illness.

16. A child has been admitted to the acute care facility for the management of dehydration. The nurse is preparing to administer intravenous fluid replacement to the child. Which fluids are suitable for use? Select all that apply. A. Lactated Ringer B. Normal saline C. 5% dextrose in water D. 0.45% saline E. 10% dextrose in water

ANS: A, B Rationale: Intravenous fluids can be used to treat dehydration. The fluids used need to be isotonic. Examples of isotonic fluids include normal saline and ringer lactate solution

2. A 6-month-old girl is seen with retinoblastoma. When taking a health history from her father, which symptom would you expect him to report he has noticed? A. The infant always keeps her eyes tightly closed. B. He has noticed one pupil appears white. C. His daughter tugs and pulls at one ear. D. His daughter's eye appears to be protruding.

ANS: B Rationale: As the tumor grows against the retina of the eye, the red reflex is no longer visible; the pupil appears white.

5. A 10-year-old who is receiving chemotherapy has received ondansetron before this therapy session. About an hour later, the child tells the nurse that his mouth feels really dry. The child has urinated several times and his skin turgor is normal. Which response by the nurse would be most appropriate? A. "The drug you got to help with the nausea can cause dry mouth." B. "Let me increase your intravenous fluids." C. "You might be having a severe allergic reaction. Are you itchy?" D. "This indicates an infection. We need to start antibiotics."

ANS: A Rationale: Ondansetron is associated with dry mouth. Increasing IV fluids may or may not be appropriate. The child is urinating and his skin turgor is normal so it doesn't appear that he is dehydrated and in need of extra fluid. A severe allergic reaction would more likely be manifested by itching, hives, and increasing respiratory distress. Dry mouth is not an indicator of infection.

3. The nurse is preparing an 18-month-old for discharge following treatment for dehydration secondary to diarrhea. What instruction would the nurse most likely include in the discharge teaching? A. "Encourage a bland diet." B. "Implement clear liquids." C. "Provide plenty of 100% fruit juice." D. "Offer flavored gelatin if hungry."

ANS: A Rationale: After rehydration is achieved, it is important to encourage the child to consume a bland diet in order to maintain energy and growth. The solid foods presented are easily digested and age appropriate. The parents should avoid prolonged used of clear liquids in the child with diarrhea because "starvation stools" might result. Fluids high in glucose such as fruit juice, gelatin, and soda may worsen diarrhea. Gelatin is high in glucose and may worsen diarrhea.

8. A 9-year-old child with leukemia is scheduled to undergo an allogeneic hematopoietic stem cell transplant. When teaching the child and parents, what information would the nurse include? A. "We'll need to have a match to a donor." B. "The risk for rejection is much less with this type of transplant." C. "You won't need to receive the high doses of chemotherapy before the transplant." D. "You'll need to have an incision in your hip area to instill the cells."

ANS: A Rationale: An allogenic hematopoietic stem cell transplantation (HSCT) refers to transplantation using stem cells from another individual that are harvested from the bone marrow, peripheral blood, or umbilical cord blood. With this type of transplant, human leukocyte antibody (HLA) matching must occur. Therefore, the lesser the degree of HLA matching in the donor, the higher the risk for graft rejection and graft-versus-host disease (GVHD). Regardless of the type of transplant, a period of purging of abnormal cells in the child is necessary and accomplished through high-dose chemotherapy or irradiation. The procedure is accomplished by intravenously infusing hematopoietic stem cells into the child.

4. The nurse is assessing a 10-year-old girl with acute lymphoblastic leukemia. What information would lead the nurse to suspect that the cancer has infiltrated the central nervous system? A. Child reports of facial palsy and vision problems B. Observing petechiae, purpura, or unusual bruising C. Noting adventitious breath sounds during auscultation D. Palpation of abdomen reveals enlarged liver and spleen

ANS: A Rationale: The presence of facial palsy and vision problems indicates that the central nervous system has been infiltrated by leukemia cells. The petechiae, purpura, or unusual bruising results from decreased platelet levels and may be present regardless of metastasis. Adventitious breath sounds may indicate pneumonia, and may be present whether the disease has metastasized or not. Hepatomegaly and splenomegaly result from infection, not metastasis.

7. A child receiving chemotherapy is experiencing significant reduction in red blood cells secondary to myelosuppression. Which agent would the nurse most likely expect to be ordered? A. Epoetin alfa B. Filgrastim C. Sargramostim D. Gamma interferon

ANS: A Rationale: Epoetin alfa is a colony-stimulating factor used to stimulate production of red blood cells. Filgrastim is a colony-stimulating factor used to stimulate production of granulocytes. Sargramostim is a colony-stimulating factor used to stimulate production of granulocytes. Gamma interferon is used to stimulate macrophage production to fight bacteria and fungus.

20. During the assessment of a preschooler, the nurse notes that the child has abnormal dryness and thickening of the conjunctiva and dry and scaly skin. Which vitamin deficiency does the nurse suspect this child is experiencing? A. Vitamin A B. Vitamin B C. Vitamin D D. Vitamin E

ANS: A Rationale: A vitamin A deficiency manifests with night blindness, abnormal dryness and thickening of the conjunctiva and cornea (xerophthalmia), corneal ulcerations, dry and scaly skin, impaired immunity, infections, growth retardation. Manifestations of a vitamin B deficiency include stomatitis, glossitis, cheilosis, edema, anemia, ophthalmoplegia, tachycardia or bradycardia, peripheral neuropathy, fatigue, confusion, seizures. Manifestations of a vitamin D deficiency include rickets, short stature, bone fractures due to weakening or softening of the bones (osteomalacia), low calcium blood levels (which can also be associated with tetany and paresthesias). Manifestations of a vitamin E deficiency include paresthesias, tetany, ataxia, edema, depressed deep tendon reflexes, vision problems

8. A group of nursing students are reviewing information about neonatal screenings. The students demonstrate understanding of the information when the students identify which system of most consistently affected by metabolic disorders? \ A. Nervous system B. Cardiovascular system C. Gastrointestinal system D. Respiratory system

ANS: A Rationale: Although any system can be affected, the nervous system is most consistently affected by metabolic disorders. The physical examination should focus on evaluating neurodevelopmental functions. Abnormalities commonly revealed include impaired states of alertness and arousal, tremors, posturing, clonic jerking, tonic spasms, or seizures.

7. The mother of a 12-year-old with Reye syndrome approaches the nurse wanting to know how this happened to her child, saying, "I never give my kids aspirin!" Which response by the nurse would be most appropriate? A. "Sometimes it's hard to tell if a product contains aspirin." B. "Do you think that maybe your child took aspirin on his own?" C. "Don't worry; you're in good hands. We have it under control now." D. "Aspirin in combination with the virus will make the brain swell and the liver fail."

ANS: A Rationale: Although warning labels are placed on containers of salicylates, salicylates are in a wide variety of products, so consumers must read the small print very carefully or they will miss the warning. The parent needs to be receptive to further education. Don't state the obvious, but also don't minimize the situation. Encourage the mother to ask for information, and be sure to explain in terms she will understand.

15. The nurse is providing education to the parents of a female with hydrocephalus who has just had a shunt inserted. When discussing the child's condition with the parents, which of the following would be most appropriate? A. "Tell me your concerns about your child's shunt." B. "Be sure to call the doctor if she gets a persistent headache." C. "Her autoregulation mechanism to absorb spinal fluid has failed." D. "Always keep her head raised 30 degrees."

ANS: A Rationale: Always start by assessing the family's knowledge. Ask them what they feel they need to know. Knowing when to call the doctor and how to raise the child's head are important, but they might not be listening if they have another question on their minds. "Autoregulation" is too technical—base information on the parents' level of understanding

5. The nurse is assessing a 7-year-old with a hearing aid. His mother says he is losing his hearing again. Which finding would the nurse identify as contributing to this current complaint? A. Overproduction of cerumen B. Soreness of the outer ear C. History of a normal term birth D. The eardrum responds to a puff of air

ANS: A Rationale: Approximately 10% of children either produce larger than normal amounts or have difficulty with cerumen removal that results in hearing impairment. Cerumen impaction can affect hearing, even with a hearing aid. Soreness of the outer ear is a sign of otitis externa. Full-term birth would not play role in continued loss of hearing. Eardrum response to a puff of air indicates the absence of fluid in the middle ear.

12. An 8-year-old child is being treated for tonic-clonic seizures. What should the nurse emphasize when teaching the parents about this disorder? A. The child should maintain an active lifestyle. B. Immediately provide medication if a seizure begins. C. Have the child carry a padded tongue blade with her at all times. D. Ensure quiet time late in the day, when seizure activity is most likely to occur.

ANS: A Rationale: As a rule, children with seizures should attend regular school and participate in physical education classes and active sports. Antiseizure medication is ineffective during a seizure because most medication needs to achieve a therapeutic level to be effective. Padded tongue blades are not used in people with a seizure disorder. There is no specific time of day when a seizure can occur

3. An 11-year-old boy has recently been prescribed methylphenidate. The mother calls the pediatrician's office to speak with the advanced practice pediatric nurse practitioner. This mother has been extremely resistant to medication and insists that the medication is not working. How should the nurse respond? A. "Tell me what makes you think the medication is not working" B. "Do you want to try a different medication?" C. "Are you sure you are administering it properly" D. "Do you want to increase the dosage?"

ANS: A Rationale: Asking the mother to explain why she believes the medicine is not working will offer important insights to the mother's definition of effectiveness. It is important for both the mother and the advanced practice pediatric nurse practitioner to develop a shared definition of effectiveness and improvement. Once this is established, the nurse can suggest the next step in the treatment plan. Asking if the mother wants to try a different medication or increase the dosage does not provide any information about the child's response to the current medication. Asking the mother whether she is administering it properly could cause her to take offense and does not provide the necessary information.

20. The nurse is speaking with the parents of a school-aged child recently diagnosed with diabetes mellitus regarding the differences between hypoglycemia and hyperglycemia. Which statement by a parent indicates a need for further teaching? A. "If I notice changes in my son like tearfulness or irritability, his blood sugar may be high." B. "When my son's breath smells fruity, it almost always indicates high blood sugar." C. "If my son says he feels shaky, his blood sugar may be low." D. "Dry flushed skin may be a sign if high blood sugar."

ANS: A Rationale: Behavior changes such as tearfulness, irritability, confusion and slurred speech are indications of hypoglycemia, not hyperglycemia. Tremors and diaphoresis are also indications of low blood sugar. Dry flushed skin, fatigue, weakness, nausea, vomiting and fruity breath odor are all symptoms of hyperglycemia.

1. A 17-year-old girl has been diagnosed with bulimia nervosa. Which complication should the nurse carefully assess for in this client? A. Severe erosion of teeth B. Hypertension C. Diabetes mellitus D. Atherosclerosis

ANS: A Rationale: Bulimia refers to recurrent and episodic binge eating and purging by vomiting, accompanied by awareness that the eating pattern is abnormal yet the child is not able to stop the pattern. Adolescents with bulimia may develop severe erosion of their teeth because of the constant exposure to acidic gastrointestinal juices from vomiting. Esophageal tears may also result from forceful vomiting. Hypertension, diabetes mellitus, and atherosclerosis are not associated with bulimia nervosa.

20. An adolescent is recovering from surgery, radiation, and chemotherapy following a diagnosis of Ewing sarcoma. Which statement by the family indicates that reteaching is needed? A. "Our child is looking forward to playing football again." B. "We will remind our child to care for the skin following radiation." C. "Our child's friends shaved their heads in solidarity to show their support." D. "We will watch for signs of infection and report it to our health care provider."

ANS: A Rationale: Caution adolescents to continue to be careful about activities that cause stress on an extremity that has received radiation (for example, football or weightlifting) because it may not be as strong as usual afterward. The family will need reteaching because they say their child is looking forward to playing football again. Skin care, supportive friends, and reporting infections are all good for his recovery.

9. The nurse is preparing teaching materials for a family whose child has been prescribed somatropin for a growth hormone deficiency. What should the nurse instruct the parents about the administration of this medication? A. This medication must be given by injection. B. This medication must be given in the morning before school. C. Hip or knee pain is an expected adverse effect of this medication. D. This medication does not interact with any other types of medication.

ANS: A Rationale: Somatropin is administered by injection. It is best given at hour of sleep because that is when growth hormone is released. Hip or knee pain could indicate a slipped capital epiphysis and should be reported to the health care provider. The nurse should urge the parents to inform all health care providers that the child is receiving this medication to avoid medication interactions

11. The nurse is reviewing the medical record of a child with a mental health disorder and finds that the child is receiving cognitive behavioral therapy. How does the nurse interprets this information? A. Process that requires the individual to view a situation from a different perspective B. Interventions that address family dynamics and family coping C. Individual exploration of the person's conflicts and stressors D. Use of play to explore problems, issues, and conflicts

ANS: A Rationale: Cognitive behavioral therapy helps the individual reframe perceptions, change ideas about a situation, or view a situation from a different perspective. Next, the patient is helped to see the relations among his or her thoughts and beliefs and his or her emotional responses. Finally, the patient is encouraged to use problem solving to identify alternative solutions or ways of behaving. Individual therapy is an interpersonal process in which the patient and care provider together discover, explore, and resolve the patient's perceived and/or actual stressors, conflicts, behavioral responses, doubts, and anxieties. Family therapy focuses on family dynamics. Interventions may be designed to develop family-based coping strategies, such as problem solving or stress management. Play therapy involves the exploration of life's problems, developmental issues, and interpersonal conflicts.

4. A 19-year-old client with hypothyroidism asks the nurse if she will need to take thyroid medication if she becomes pregnant. The nurse integrates understanding of which of the following when responding to the client? A. Regulation of thyroid medication is more difficult because the thyroid gland increases in size during pregnancy B. There is no need to take a thyroid medication because the fetus's thyroid produces thyroid stimulating hormone C. It is more difficult to maintain thyroid regulation during pregnancy due to the slowing of metabolism D. Fetal growth is arrested if the thyroid medications are continued during pregnancy

ANS: A Rationale: During the pregnancy the thyroid gland triples in size which makes it more difficult to regulate thyroid medication. Thyroid function does not slow during pregnancy. The fetus might produce TSH but it does not reach the mother. Fetal growth is not arrested if medication is continued during the pregnancy.

9. A nurse is caring for a 3-year-old girl with microcephaly. Which of the following actions is appropriate for the nurse to take? A. Playfully ask the child to touch her nose B. Teach the parents about ventriculoperitoneal (VP) shunts C. Prepare the child for the experience of cranial surgery D. Administer antipyretics as ordered

ANS: A Rationale: Having the child touch her nose will assist the nurse in assessing probable neurologic and cognitive deficits. A VP shunt may be necessary for hydrocephaly. Surgery is often an intervention for craniosynostosis but cannot correct microcephaly. Hyperthermia is not a complication with microcephaly.

3. A child with Addison's disease has been admitted with a history of nausea and vomiting for the past 3 days. The client is receiving IV glucocorticoids. Which intervention would the nurse implement? A. Take glucometer readings as ordered B. Measure intake and output C. Monitor sodium and potassium levels D. Weigh daily

ANS: A Rationale: IV glucocorticoids raise the glucose levels and often require coverage with insulin. Measuring the intake and output at this time is not necessary. Sodium and potassium would be monitored when the client is receiving mineralcorticoids. Daily weights are not necessary at this time.

16. A nurse is communicating with a family about palliative care. Which of the following would be the best approach to take? A. Ask the family what they know, and what they wish to know and be prepared to repeat the information you give to them several times B. Give the family as much information as possible to promote better decision-making C. Provide information during a crisis when the parent's senses are heightened and memory is improved D. Avoid pushing the family by asking too many questions.

ANS: A Rationale: It is important to ask what the family knows, what they are ready to hear, and be prepared to repeat the information over the course of time. An essential component of communication is to realize that it is a dynamic ongoing process and that too much information can be delivered at one time. It is important to ask what the family knows, what they are ready to hear, and be prepared to repeat the information over the course of time. In times of crisis or stress, concentration and understanding may be impaired due to overwhelming feelings of loss and helplessness.

16. The nurse is educating parents of a male infant with Chiari type II malformation about the condition. Which of the following would be most important for the nurse to include? A. Taking time to feed the infant B. Laying the infant down after a feeding C. Being able to see major difference after surgery D. Not needing to change diapers as often

ANS: A Rationale: One of the problems associated with Chiari type II malformation is poor gag and swallowing reflexes, so the infant must be fed slowly. There is a great risk of aspiration, requiring that the child be placed in an upright position after feeding. The goal of surgery is to prevent further symptoms rather than to relieve existing ones. Infrequent urination is a problem associated with type I malformations

14. The nurse is conducting an assessment of a 5-year-old client. During the assessment, the nurse notes that the child does not maintain eye contract or speak. The nurse suspects an autism spectrum disorder. Which additional finding would help support the nurse's suspicion? A. The child constantly opens and closes the hands. B. The child is highly active and inattentive. C. The child has a slight decrease in head circumference. D. The child has a long face and prominent jaw.

ANS: A Rationale: Repetitive motor mannerisms such as constantly opening and closing the hands are a typical behavior pattern for autism spectrum disorder. A high level of activity and inattentiveness are typical symptoms of intellectual disability. Decrease in head circumference suggests malnutrition or decelerating brain growth. A long face and prominent jaw are symptoms of fragile X syndrome

1. A 12-year-old boy arrives at the emergency room experiencing nausea, vomiting, headache, and seizures. He is diagnosed with bacterial meningitis. Other findings include a decrease in urine production, hyponatremia, and water intoxication. Which pituitary gland disorder would be most associated with these symptoms? A. Syndrome of inappropriate antidiuretic hormone B. Diabetes insipidus C. Hyposecretion of somatotropin D. Hypersecretion of somatotropin

ANS: A Rationale: Syndrome of inappropriate antidiuretic hormone (SIADH) is a rare condition in which there is overproduction of antidiuretic hormone by the posterior pituitary gland. This results in a decrease in urine production and water intoxication. As sodium levels fall in proportion to water, the child develops hyponatremia or a lowered sodium plasma level. It can be caused by central nervous system infections such as bacterial meningitis. As the hyponatremia grows more severe, coma or seizures occur from brain edema. Diabetes insipidus is characterized by polyuria, not decreased urine production. Hyposecretion of somatotropin, or growth hormone, results in undergrowth; hypersecretion results in overgrowth.

13. A 10-year-old child is newly diagnosed with type 1 diabetes. The child's hemoglobin A1C level is being monitored. The nurse determines that additional intervention is needed with the child based on which result? A. 8.5% B. 6.5% C. 7.5 % D. 7.0%

ANS: A Rationale: The goal for hemoglobin A1C in children between the ages of 6 and 12 years is less than 8%. Therefore, a result of 8.5% would indicate that additional intervention is needed to achieve the recommended goal.

8. The nurse is caring for a 3-year-old girl who has just undergone a ventriculostomy. Which of the following would the nurse include in this child's plan of care to manage increased intracranial pressure (ICP)? A. Use pillows to support the child when lying on her side B. Support the parents in starting a ketogenic diet C. Pad the side rails on the bed D. Teach her to do deep breathing techniques

ANS: A Rationale: The nurse should use pillows to prevent the child from sliding down in bed and to support the head in a neutral position when the child lies on his or her side. Beginning a ketogenic diet and padding the side rails for safety are interventions for a child with seizures. A 3-year-old is not likely to understand deep breathing techniques

4. A panicked mother calls the health care provider's office and reports that her 5-year-old has a high fever and just had a seizure. The mother asks the nurse what she should do. Which is the nurse's best response? A. Report to the emergency room for medical evaluation B. Immerse the child in a bathtub of tepid water C. Administer oral acetaminophen per package directions D. Remove any heavy clothing and cover with a thin sheet

ANS: A Rationale: When a child has a febrile seizure associated with a high fever, it is important to seek medical evaluation. Medical evaluation will identify the source of the high fever. If the fever is viral, the child may be able to be managed at home. Advise them not to put the child in a bathtub of water to do this because it would be easy for the child to slip under water should a second seizure occur. Caution them not to apply alcohol or cold water as extreme cooling causes shock to an immature nervous system. Parents should not attempt to give oral medications such as acetaminophen, because the child will be in a drowsy, or postictal, state after the seizure and might aspirate the medicine. It is appropriate to remove heavy clothing but not the best response

14. The nurse identifies the nursing diagnosis of risk for infection related to chemotherapy-induced immunosuppression. What would the nurse include in the teaching plan for the child and parents about reducing the child's risk? Select all that apply. A. Having the child sleep in a single bed and room B. Encouraging frequent, thorough handwashing C. Providing a low-carbohydrate, low-protein diet D. Encouraging frequent close contact with numerous visitors E. Cheering up the environment with fresh flowers and plants

ANS: A, B Rationale: To reduce the risk of infection, the nurse should teach the child and parents about minimizing the child's exposure to potentially infectious situations. The nurse should encourage the parents to arrange for the child to sleep in a single bed and room and, if possible, avoid close contact with other family members who may be developing upper respiratory tract infections. Thorough and frequent handwashing, especially after using the bathroom and before eating, is essential. A high-calorie, high-protein diet helps to rebuild white blood cells and should be encouraged. If possible, the child's exposure to large crowds and visitors should be limited because of the increased risk of infection from these individuals. Fresh flowers and plants should be avoided because they could harbor mold spores.

11. The nurse caring for a young adolescent with Crohn's disease. After teaching the adolescent and her family about this condition, the nurse determines that the teaching was successful when they identify which of the following as a possible complication? Select all that apply. A. Stricture B. Fistula C. Intra-abdominal abscess formation D. Gallstones E. Pancreatitis

ANS: A, B, C Rationale: Crohn's disease is a recurrent disease. Long-term complications may include stricture, fistula, and intra-abdominal abscess formation. Individuals with severe disease who require extensive resection of diseased bowel may be left with short bowel syndrome and long-term dependence on parenteral nutrition. Gallstones and pancreatitis are not complications associated with Crohn diseas

15. The adolescent has been diagnosed with gastroesophageal reflux disease (GERD). Which statements by the teen indicates that adequate learning has occurred? Select all that apply. A. "This famotidine may make me tired." B. "The omeprazole could give me a headache." C. "It sounds like the physician is reluctant to give me a prokinetic because of the side effects." D. "I will probably need a laxative because of the omeprazole." E. "I should try to lie down right after I eat."

ANS: A, B, C Rationale: Famotidine may cause fatigue. Omeprazole can cause headaches. Prokinetics use may result in side effects involving the central nervous system. Omeprazole use more likely will result in diarrhea, not constipation. Children with GERD should not lie down after meals.

4. A child is diagnosed with short bowel syndrome. What would the nurse expect to be included in the child's plan of care? Select all that apply. A. Antibiotics B. Vitamin supplements C. Total parenteral nutrition D. Laxatives E. Immunosuppressants

ANS: A, B, C Rationale: For the child with short bowel syndrome, typically, antibiotics, vitamin and mineral supplements, antidiarrheal agents, and total parenteral nutrition are prescribed. Laxatives and immunosuppressants are not used.

19. The nurse is caring for a teenager recently diagnosed with Addison disease. Which findings can be anticipated by the nurse? Select all that apply. A. Sodium level 128 mEq/L B. Potassium level 5.6 mEq/L C. Muscular weakness D. Rapid weight gain E. Facial acne

ANS: A, B, C Rationale: Hyponatermia, hyperkalemia and muscle weakness are all symptoms of Addison disease. Rapid weight gain and acne are present in Cushing disorder, not Addison

13. A nurse is teaching the parents of a child diagnosed with attention deficit/hyperactivity disorder about the condition. The nurse determines that the teaching was successful when the parents make which statements? Select all that apply. A. "We need to set clear limits for our child's behavior." B. "A reward system would be useful to give our child positive feedback." C. "We need to limit the number of choices our child has." D. "We need to give our child all directions at once in case the child gets distracted." E. "If the child acts out, we can explain that this is being bad."

ANS: A, B, C Rationale: The child with ADHD needs clear limits and a limited number of choices to prevent the child from becoming overwhelmed. Positive feedback is essential, such as with a reward or token system. Directions should be broken down into steps that are clear and short. Parents should avoid negative comments that label the child as bad.

10. The nurse caring for a neonate experiencing seizures asks the charge nurse: "How can I tell if a baby is having a seizure or is just crying for attention?" Which response would be most appropriate? Select all that apply. A. "You will not be able to stop a seizure with gentle restraint." B. "The baby experiencing a seizure will be tachycardic." C. "Stimulating the baby by singing to him will not stop a seizure." D. "There will be no changes in the baby's vital signs with a seizure" E. "The baby will become more active with sensory stimulation with a seizure." F. "The baby will stop the seizure activity when swaddled in a blanket."

ANS: A, B, C Rationale: With seizure activity, the neonate experiences tachycardia and increased blood pressure, and movements are not suppressed by general restraint and are unchanged by sensory stimuli. With nonepileptic movements, there is no change in vital signs, the movement is suppressed easily with gentle restraint, and movements are enhanced with sensory stimuli.

2. A 9-year-old girl has just been diagnosed with Grave's disease. Which symptom should the nurse expect in this child? Select all that apply. A. Exophthalmos (protruding eyes) B. Moist skin C. Nervousness D. Increased basal metabolic rate E. Obesity F. Lethargy

ANS: A, B, C, D Rationale: In Graves disease, children gradually experience nervousness, tremors, loss of muscle strength, and easy fatigue. Their basal metabolic rate, blood pressure, and pulse all increase. Their skin feels moist and they perspire freely. An exophthalmos-producing pituitary substance causes the prominent-appearing eyes that accompany hyperthyroidism in some children. Obesity and lethargy are symptoms of hypothyroidism, not of Graves disease (hyperthyroidism).

2. The nurse is performing a physical examination of a 5-year-old boy. Which documented findings would most strongly indicate maltreatment of the child? Select all that apply. A. Cuts and bruises on the hands B. Burns on the dorsal surface of the hand C. A curved laceration on the back D. Linear lesions across the chest and abdomen E. A bruise on the child's knee F. A scab on the child's elbow

ANS: A, B, C, D Rationale: Several injuries in children clearly signal probable child maltreatment. Children who are maltreated have a higher incidence of hand injury. Children who are beaten with electrical cords, belts, or clotheslines have peculiar circular and linear lesions. Children who are beaten with a belt buckle may have additional curved lacerations from the imprint of the buckle; few other objects produce such contusions. When children burn their hand by accident, they usually burn the palm; burns from maltreatment are often on the dorsal surface. However, it is normal for preschoolers who actively play to have bruises on multiple bony spots (shin, elbows, knees, etc.)

10. During a routine well-child visit, the mother of a preadolescent patient asks the nurse to explain signs of sexual abuse. The mother is concerned because an older male neighbor has been making comments and overtly admiring the child when playing outdoors. What signs of sexual abuse should the nurse tell the mother to look out for? Select all that apply. A. Child reports abdominal pain. B. Child has a change in school performance. C. Child demonstrates anxiety or trouble sleeping. D. Child does not want to be left alone with a certain adult. E. Child spends a great deal of time with peer-group friends

ANS: A, B, C, D Rationale: Signs of sexual maltreatment include vague reports of abdominal pain, a change in school performance, anxiety or trouble sleeping, and not wanting to be left alone with a certain adult. Spending time with peer-group friends is an expected preadolescent behavior and is not a sign of sexual maltreatment.

13. The nurse is caring for a child with a gastrointestinal disorder and measuring intake and output. The nurse observes that the child is demonstrating symptoms of adequate hydration when she/he has which of the following? Select all that apply. A. Fontanelles with normal tension B. Adequate skin turgor C. Oral intake D. Pink and moist mucous membranes E. Loose stools

ANS: A, B, D Rationale: A child can have oral intake that is insufficient for his/her needs and still be dehydrated due to fluid losses. Loose stools lead to dehydration therefore would not be an indicator of adequate hydration. Adequate hydration in the child can be seen in fontanels having normal tension, adequate skin turgor and pink, moist mucous membranes.

17. The nurse is performing discharge teaching for a 16-year-old diagnosed with peptic ulcer disease. Which statements by the parents and client demonstrate learning has occurred? A. "I will need to make sure to take all of the antibiotic prescribed." B. "It's important to take my histamine agonist medication at the appropriate time." C. "My proton pump inhibitor should be taken when I feel discomfort." D. "The prednisone that I take for my rheumatoid arthritis may be a cause of my peptic ulcer disease." E. "My mom having peptic ulcer disease has nothing to do with my having it.

ANS: A, B, D Rationale: If Helicobacter pylori (H. pylori) was detected as a cause of the peptic ulcer disease (PUD), the client will be prescribed an antibiotic and should take all of the medication. Histamine agonists and/or proton pump inhibitors should be taken routinely as prescribed. Risk factors include a family history of PUD or other GI diseases, or chronic salicylate or prednisone use

12. A child aged 3 months has been spitting up regularly since birth and is somewhat underweight. The nurse suggests which interventions to the parents? Select all that apply. A. Thicken feedings with rice cereal. B. Feed smaller amounts more frequently. C. Feed the infant in the supine position. D. Burp well when feeding.

ANS: A, B, D Rationale: Thickened feedings are heavier than formula/breast milk, making them more difficult to spit up. The rice cereal also adds calories that this infant needs. Smaller, frequent feedings and burping well prevent distending the stomach and reduce the likelihood of reflux. The best position following feeding is upright. The supine position creates pressure on the lower esophageal sphincter, which promotes reflux.

9. After an assessment, the nurse is concerned that a school-age child is at risk for developing a mental health disorder. Which assessment data will the nurse use to develop an appropriate plan care? Select all that apply. A. The parents recently divorced B. The father is unemployed and mother is infrequently home C. The child is learning to play the clarinet in music class in school D. The child is expected to care for younger siblings while mother sleeps E. There is history of multiple injuries obtained from a motor vehicle crash

ANS: A, B, D, E Rationale: Various factors have been associated with an increased risk for mental health disorders in children, including trauma, poverty or neglect, difficult temperament or attachment problems, medical illness, or major losses to the family such as divorce. Learning to play the clarinet in school has not been associated with an increased risk for mental health disorders in children

19. The nurse is caring for a child who has been hospitalized for maltreatment. When reviewing the child's records which findings may have placed the child at an increased risk for abuse? Select all that apply. A. The child's mother has a history of substance use disorder. B. Both parents work outside of the home. C. The child was born prematurely. D. The child has cerebral palsy. E. The child's father is the primary care taker.

ANS: A, C, D Rationale: Although not every child abused or child abuser will fit a profile of characteristics, many will. Child abuse occurs across all socioeconomic levels, but the findings are more prevalent in those experiencing poverty. Additional risk factors include prematurity, chronic illnesses, parental substance use disorder, cerebral palsy and cognitive impairment. Parents working outside the home and paternal caregivers are not families facing increased risk for abuse

9. While observing the parents of a neonate with pyloric stenosis feeding the baby, the nurse notes that the parents are becoming frustrated. The nurse identifies a nursing diagnosis of risk for impaired parenting related to frustration and difficulty feeding neonate. Which would be appropriate for the nurse to include in the plan of care? Select all that apply A. Encouraging rooming in with the neonate B. Helping them understand their stress level contributes to the neonate's vomiting C. Assisting the parents in holding and feeding their neonate D. Pointing out positive aspects about their neonate E. Informing the parents that the condition will require them to adjust their lifestyles

ANS: A, C, D Rationale: For a nursing diagnosis of risk for impaired parented, appropriate interventions include encouraging the parents to room in with their neonate, helping them understand that the cause of the condition is a physical problem, not something they did, assisting the parents in holding and feeding their neonate, and pointing out positive aspects about their neonate.

14. The young child has been diagnosed with hepatitis B. Which of the following statements by the child's mother indicates that further education is required? A. "We went swimming in a local lake 2 months ago and I just knew she drank some of the lake water." B. "Could I have this virus in my body, too?" C. "The virus is the reason her skin looks a little yellowish." D. "The only way you can get this virus is from intravenous drug use." E. "Her fever and rash are probably related to this virus."

ANS: A, D Rationale: Hepatitis A virus is transmitted by contaminated food or water. Hepatitis B virus may be transmitted perinatally from mother to infant, intravenous drug use with contaminated needles, sexual contact with an infected person, and blood transfusions. The mother may have contracted the virus prior to giving birth to the child. Infection with the hepatitis B virus may result in jaundice, fever, and a rash.

18. The nurse is caring for a newborn with a cleft palate. Which findings in the maternal medical record are considered to be contributing factors? Select all that apply. A. Maternal tobacco use. B. Moderate maternal alcohol use prior to pregnancy. C. Maternal age less than 18 years. D. Anticonvulsant therapy used to manage a seizure disorder. E. Reports of marijuana use in early pregnancy.

ANS: A, D Rationale: Infants born with a cleft palate may have mother's with risk factors. These include maternal smoking, prenatal infection, advanced maternal age, use of anticonvulsants or steroids

17. A nurse is obtaining the history from a parent of a child who experiences absence seizures. Which of the following would the nurse expect the mother to describe? A. Brief, sudden onset with muscles that become tense B. Loss of motor activity accompanied by a blank stare C. Sudden, brief jerking motions of a muscle group D. Loss of muscle tone and loss of consciousness

ANS: B Rationale: An absence seizure consists of a sudden, brief arrest of the child's motor activity accompanied by a blank stare and loss of awareness. A tonic seizure consists of a brief onset of increased tone. A myoclonic seizure is characterized by sudden, brief jerks of muscle groups. An atonic seizure involves a sudden loss of muscle tone and loss of consciousness

19. A child receiving chemotherapy wants to have a large birthday party and invite all the classmates. When the parent asks the nurse about this, what is the nurse's best response? A. "That will be a good way to cheer your child up!" B. "It is better to avoid large groups right now." C. "What about taking your child to a movie instead?" D. "We can have the party here in the hospital play room."

ANS: B Rationale: A child receiving chemotherapy is particularly susceptible to contracting an infection and thus should be kept away from people with known infections. Therefore, having the child avoid large groups right now is best. Although it would possibly cheer up the client, it is not best for the client's health. Going to a movie would not be a good idea because it could lead to exposure to someone who is ill. A party in the hospital play room is a possibility for the children in the hospital, but it would not be possible to invite the child's entire class.

1. A nurse manages the interdisciplinary care for an infant born with an omphalocele. What is an accurate description of the care for an omphalocele? A. At birth, protect the exposed bowel by gently manipulating it back into the abdominal cavity. B. Obtain IV access to give fluid resuscitation and correct any electrolyte abnormalities. C. Administer corticosteroids as prescribed—either oral prednisone or prednisolone or as IV methylprednisolone. D. Insert an NG tube to decompress the stomach and to prevent gastric distention.

ANS: B Rationale: For an omphalocele, protect the bowel by wrapping the exposed viscera with warm saline-soaked gauze and cover and seal with a plastic wrap or place in a "bowel bag" which will contain the defect, torso, and legs, to prevent heat and fluid loss from the exposed viscera. Obtain IV access. Give fluid resuscitation and correct any electrolyte abnormalities. Oral prednisone or prednisolone, or IV methylprednisolone, are administered for irritable bowel syndrome. An NG tube may be placed to decompress the stomach to prevent gastric distention when severe emesis is present with pancreatitis.

18. A 6-year-old is dealing with the death of a sibling. Which action should the nurse suggest to the family to best support the child with the grieving process? A. Having the child stay with a family friend instead of attending the funeral B. Assisting the child in drawing a picture to be placed in the sibling's casket C. Having the sibling stand in the receiving line with the parents at the funeral home D. Discouraging the child from interacting with family and friends while they express their sympathy

ANS: B Rationale: It is difficult for a 6-year-old child to understand the death of a sibling. Research supports having the presence of the sibling at the funeral and encouraging a token of love such as a drawing or note. Allowing the child to interact with others who provide comfort helps the child in this difficult time.

5. The nurse is conducting a physical examination of a child with suspected Crohn disease. Which finding would be the most suspicious of Crohn disease? A. Normal growth patterns B. Perianal skin tags or fissures C. Increased hunger D. Abdominal tenderness

ANS: B Rationale: Perianal skin tags and/or fissures are highly suspicious of Crohn disease. Poor growth pattern, hunger and abdominal tenderness are common to Crohn disease but are also seen with many other conditions. Normal growth patterns would not point to Crohn disease because of problems with absorbing nutrients.

6. The nurse is caring for a 2-month-old with a cleft palate. The child will undergo corrective surgery at age 3 months. The mother would like to continue breastfeeding the baby after surgery and wonders if it is possible. How should the nurse respond? A. "There is a good chance that you will be able to breastfeed almost immediately." B. "Breastfeeding is likely to be possible, but check with the surgeon." C. "After the suture line heals, breastfeeding can resume." D. "We will have to wait and see what happens after the surgery."

ANS: B Rationale: Postoperatively, some surgeons allow breastfeeding to be resumed almost immediately. However, the nurse needs to advise the mother to check with the surgeon to determine when breastfeeding can resume. Telling the mother that she has to wait until the suture line heals may be inaccurate. Telling her to wait and see does not answer her question

20. A 4-month-old infant is seen at the ambulatory care clinic and diagnosed with nasolacrimal duct obstruction. The mother asks what can be done. What information should be included in the information provided to the parent? A. Once the child is 6 to 9 months old a specialist will be able to drain the duct. B. Most of these conditions will spontaneously resolve. C. Antiviral therapy can be prescribed to manage this condition. D. Over-the-counter drops can be used sparingly.

ANS: B Rationale: Stenosis or simple obstruction of the nasolacrimal duct is a common disorder of infancy, occurring in about 6% to 20% of newborns and infants. It is unilateral in about 65% of cases. Chronic tearing occurs and buildup in the lacrimal sac causes a mucoid or mucopurulent drainage. Over 90% of all cases resolve spontaneously by 1 year of age.

19. A 7-month-old is scheduled for surgical correction of strabismus. The child's mother says to the nurse, "I'm glad my child will never have to wear that patch again." Which of these responses would be most appropriate for the nurse to make? A. "Your child will never need to wear the patch again." B. "Your child will need to wear the patch for a few days to keep him/her from rubbing or putting pressure on the eye." C. "Your child will need to wear the patch for several months to keep the eye in alignment." D. "Your child will have to be in restraints for a week to keep him/her from rubbing the eye."

ANS: B Rationale: Strabismus refers to a misalignment of the eyes, if the strabismus persists past 6 months of age this warrants referral to an ophthalmologist for further evaluation. Clinical therapy involves occlusion therapy (patching of the good eye) for 1-2 hours a day to force use of the weak eye. The child may have to wear the patch intermittently, no restraints are needed if the patch is left in place, and the surgery on the muscle is what puts the eye back into alignment.

18. The school nurse is educating the parents of a child with infectious conjunctivitis. Which of the following statements by the nurse would be most helpful for the parents related to prevention? A. "Use all the medication as directed." B. "Don't use anything that touches her face." C. "This could have started with a head cold." D. "Place the ointment inside the lower eyelid."

ANS: B Rationale: Warning the parents how infectious conjunctivitis is spread is most valuable for preventing infection within the family. Directing the parents to use a full course of medication is very important to help prevent a recurrence in the child but is not the most valuable for prevention. Telling of a possible cause or proper administration of medication has little preventive value.

4. A nurse is assessing a 5-year-old boy and suspects that the child may have an autism spectrum disorder. Which assessments would help support the nurse's suspicions? Select all that apply. A. Inability to make eye contact B. Hypersensitivity to touch C. Lack of facial expression D. Distinct interest in others around him E. Easily distracted from playing

ANS: B, C Rationale: Symptoms associated with autism spectrum disorder include deficits in nonverbal communicative behaviors such as abnormalities in eye contact and lack of facial expression and hyper- or hyposensitivity to sensory input such as touch. In addition, children, and stereotyped or repetitive motor movement, use of object or speech.

8. A nurse is developing a teaching plan for an adolescent diagnosed with gastroesophageal reflux disease. Which would the nurse include? Select all that apply. A. "Try sitting upright for an hour after eating." B. "You need to avoid acidic foods like oranges and grapefruits." C. "Eating smaller portions might be helpful." D. "You'll need to take your prescribed medications for about 6 to 8 weeks." E. "Try sleeping with your upper body elevated on a foam wedge."

ANS: B, C, E Rationale: Adolescents with gastroesophageal reflux disease should avoid lying down until 3 hours after a meal and should sleep at night with the upper body elevated on a foam wedge. Acidic foods such as citrus fruits and tomatoes should be avoided. Eating smaller portions may be helpful. Medications typically are prescribed for 6 to 8 months until esophageal healing is complete.

13. A child is receiving chemotherapy and develops stomatitis. The nurse identifies a nursing diagnosis of impaired oral mucous membranes related to the effects of chemotherapy. What instructions would the nurse include in the child's plan of care? Select all that apply. A. Vigorously rub the child's gums with gauze to clean them. B. Provide various soft and bland foods to minimize further irritation. C. Have the child rinse the mouth with lukewarm water three times a day. D. Give the child acidic foods (e.g., orange juice) to cleanse the mouth. E. Apply a lip balm or petroleum jelly to prevent cracking.

ANS: B, C, E Rationale: For the child with stomatitis, the nurse should provide soft foods to prevent further abrasions, have the child rinse the mouth three times a day with lukewarm water to promote comfort and healing, avoid giving the child acidic foods that would further irritate the tissue, and apply a lip balm or petroleum jelly to prevent cracking of the lips. The nurse should offer a soft toothbrush to minimize discomfort.

19. The nurse is caring for a pediatric client newly diagnosed with Crohn's disease. When reviewing the client's subjective and objective data, which is consistent with the diagnostic criteria? Select all that apply. A. Severe bloody diarrhea B. Significant weight loss C. Perianal lesions D. Lesions limited to the colon and rectum E. Cobblestone appearance of intestinal surface

ANS: B, C, E Rationale: With Crohn's disease, the child experiences moderate diarrhea, severe weight loss, and perianal lesions. The lesions can affect any part of the gastrointestinal tract but most commonly the terminal ileum. The wall of the colon becomes thickened and the surface is inflamed, leading to a "cobblestone" appearance of the mucosa

20. The nurse is completing the physical assessment of a 12-year-old child who has a series of bruises in various stages of healing. When asked about the bruises the child appears frightened and offers inconsistent accounts about how the child got the bruises. The nurse suspects abuse. Which initial action of the nurse is most appropriate? A. Take photographs of the bruises. B. Ask the child to provide a written statement of how he or she got the bruises. C. Document the bruises and any statements made by the child relating to them. D. Interview the child's parents about the origin of the bruises. E. Interview the child's parents about the origin of the bruises.

ANS: C Rationale: Nurses in each state have a legal requirement to report suspicions of child abuse or maltreatment. The nurse must document all findings. The medical record will be of importance in establishing the findings. Once the findings are documented, the nurse will need to closely follow the agency policies regarding the reporting process. The nursing supervisor will need to also be involved but that will take place after the documentation has been completed. The child cannot be photographed without appropriate approvals. The child may indeed be asked to provide a more detailed reporting of the bruising, but it is not the role of the nurse to request it. The child's parents will also become a part of the investigation but the interviewing process does not come before the documentation of the findings.

1. A high-school football player has been diagnosed as having osteosarcoma of the femur. The parents are angry because they told the adolescent not to play football. Which health teaching points would the nurse include in the teaching plan for the adolescent and parents? A. Osteosarcoma often follows trauma, such as a football injury. B. You can expect some discoloration of the leg following chemotherapy. C. Football injuries do not contribute to the development of a tumor. D. Tumor growth is related to your dislike of milk.

ANS: C Rationale: Osteosarcoma is the most malignant form of bone cancer. It is caused from the embryonic mecenchymal tissue that forms in the bones. A football injury may predispose more scrutiny of a lesion but it will not be the cause of the cancer, nor will the dislike of milk. Osteosarcoma may be treated with chemotherapy and radiation. It may also involve an amputation. The parents who state they are angry at their adolescent for playing football is more likely projecting their fears of the diagnosis and the future for their adolescent.

3. The parents of a child with a history of seizures who has been taking phenytoin (Dilantin) ask the nurse why it's difficult to maintain therapeutic plasma levels of this medication. Which statement by the nurse would be most accurate? A. "A drop in the plasma drug level will lead to a toxic state." B. "The capacity to metabolize the drug becomes overwhelmed over time." C. "Small increments in dosage lead to sharp increases in plasma drug levels." D. "Large increments in dosage lead to a more rapid stabilizing therapeutic effect."

ANS: C Rationale: Within the therapeutic range for phenytoin, small increments in dosage produce sharp increases in plasma drug levels. The capacity of the liver to metabolize phenytoin is affected by slight changes in the dosage of the drug, not necessarily the length of time the client has been taking the drug. Large increments in dosage will greatly increase plasma levels, leading to drug toxicity

2. A 6-month-old infant is admitted with a diagnosis of bacterial meningitis. The nurse would place the infant in which room? A. A room with a 12-month-old infant with a urinary tract infection B. A room with an 8-month-old infant with failure to thrive C. A private room near the nurses' station D. A two-bed room in the middle of the hall

ANS: C Rationale: A child who has the diagnosis of bacterial meningitis will need to be placed in a private room until that child has received I.V. antibiotics for 24 hours because the child is considered contagious. Additionally, bacterial meningitis can be quite serious; therefore, the child should be placed near the nurses' station for close monitoring and easier access in case of a crisis

1. An otherwise healthy 18-month-old child with a history of febrile seizures is in the well-child clinic. Which statement by the father would indicate to the nurse that additional teaching should be done? A. "I have ibuprofen available in case it's needed." B. "My child will likely outgrow these seizures by age 5." C. "I always keep phenobarbital with me in case of a fever." D. "The most likely time for a seizure is when the fever is rising."

ANS: C Rationale: Anticonvulsants, such as phenobarbital, are administered to children with prolonged seizures or neurologic abnormalities. Ibuprofen, not phenobarbital, is given for fever. Febrile seizures usually occur after age 6 months and are unusual after age 5. Treatment is to decrease the temperature because seizures occur as the temperature rises

5. An extremely thin preadolescent is being assessed by the nurse. Which client statement should the nurse identify as being consistent with that of a person with anorexia nervosa? A. "I'd like to grow up to be a model." B. "I'd like to gain weight but just can't." C. "I feel chubby no matter what I wear." D. "I'm afraid that someone is poisoning my food."

ANS: C Rationale: Characteristics of a child with anorexia nervosa include a severely distorted body image with an intense fear of gaining weight or becoming fat. The goal to be a model is not consistent with that of anorexia nervosa. The inability to gain weight is not a characteristic of anorexia nervosa. The fear of food being poisoned is a characteristic of paranoid behavior.

15. What should be included in the teaching plan for a child with type 1 diabetes mellitus who is going home on insulin therapy? A. Children show an increased need for insulin during the first months after glucose control is established. B. Once glucose control is established, there will never be a need for an increase in the amount of insulin administered. C. It is absolutely normal for the growing child to require an increase in insulin; this does not mean his/her condition is getting worse. D. All children should be on at least two types of insulin to establish glucose control.

ANS: C Rationale: Children show a decreased need for insulin shortly after glucose control has been established, which is referred to by some as the "honeymoon phase" and should be described to parents so that they do not get any false hope that the child does not need insulin. As children grow, they will require increased doses of insulin to maintain glucose control, and not all children need to receive two types of insulin. Insulin treatment should be based on each individual child.

13. The nurse instructs a hearing-impaired school-age child on to how self-inject a prescribed medication. Which observation indicates to the nurse that additional teaching is required? A. The child pinches the skin together before inserting the needle. B. The child injects the appropriate amount of air into the vial before withdrawing medication. C. The child places the filled syringe and uncapped needle on the bed to open the alcohol wipe. D. The child slowly pushes on the plunger to inject the medication before withdrawing the needle

ANS: C Rationale: Children who are unable to hear may need additional time for explanations and support. By placing the syringe and uncapped needle on the bed, the child is contaminating the needle. This would indicate that additional teaching is necessary. Pinching the skin, injecting air, and slowly pushing on the plunger all indicate that teaching has been effective.

11. The nurse realizes that the chemotherapy agents and radiation that a child is receiving are likely to irritate the bladder. What are the best measures that the nurse can take to diminish this risk? A. Administer chemotherapy during sleep periods, including naps and overnight B. Have the child wait to void until the bladder becomes full C. Keep intravenous (IV) fluids running to maintain excellent hydration and frequent voids D. Promote drinking of cranberry juice, making it an attractive oral fluid option

ANS: C Rationale: IV fluids are given before, during, and after radiation and chemotherapy drugs; bladder irritation results from the need to dilute and remove them from the body. This reduces the need for the child to drink large quantities. Administering the drug during sleep and having the child retain urine would cause irritating chemicals to be kept in contact with the bladder mucosa. No benefit is associated with providing cranberry juice.

12. A nurse is assessing a child for possible obsessive-compulsive disorder. Which question would be most helpful for obtaining information from the child? A. "Are you having any recurring dreams about the trauma you experienced?" B. "Has anything happened at home recently that has upset you?" C. "Is there anything that you do over and over again and can't resist doing?" D. "Do you have times when you wake up during the night without any reason?"

ANS: C Rationale: Obsessive-compulsive disorder is characterized by obsessions--unwanted, unrealistic, irrational recurring or persistent thoughts, impulses, or images beyond excessive worry and compulsions--repetitive behaviors, rituals, or mental acts. Thus, asking the child about doing anything over and over again would be more effective in obtaining additional information. Asking about recurring dreams related to a trauma might be appropriate for assessing posttraumatic stress disorder. Asking about home issues might help to shed light on possible separation anxiety. Asking about waking up at night without a reason provides information about sleep disorders.

7. For which child's behavior should the nurse identify as being characteristic of separation anxiety disorder? A. An 8-month-old who cries when left with strangers B. A 7-year-old who withdraws from contact with all strangers C. An 8-year-old who will not stay overnight at a friend's house D. A 10-year-old who reports headaches if there is to be a test in school

ANS: C Rationale: Separation anxiety is considered a disorder when an older child shows excessive anxiety about separation or the possibility of separation from parents. They experience acute distress and perhaps frequent nightmares about separation and, when separated, show symptoms of nausea or vomiting or crying to such a degree it prevents them from visiting at friends' houses. For an 8-month-old, crying when being left with strangers is a normal behavior. A 7-year-old who withdraws from contact with strangers might have been instructed to do this as a form of safety or might be shy. A 10-year-old who reports headaches when a test is scheduled in school is demonstrating some other type of behavior. Separation anxiety would not occur just when a test is scheduled in school.

16. A child has been prescribed Stimate (esmopressin) acetate for the treatment of diabetes insipidus. The client and the parents ask the nurse how this drug works. What is the correct response by the nurse? A. Stimate (esmopressin) acetate works on your pancreas to stimulate insulin production B. Stimate (esmopressin) acetate is a synthetic form of insulin used to lower your blood sugar C. Stimate (esmopressin) acetate is a synthetic antidiuretic hormone that will slow down your urine output D. Stimate (esmopressin) acetate works to help your kidneys work more efficiently

ANS: C Rationale: Stimate (esmopressin) acetate is a synthetic antidiuretic hormone that promotes reabsorption of water by action on renal tubules; it is used to control diabetes insipidus by decreasing the amount of urine produced.

10. A 2-year-old client and the parents are at the office for a follow-up visit. The client has had excessive hormone levels in the recent blood work, and the parents question why this was not found sooner. Which response by the nurse would be most appropriate? A. "It takes time to determine the level of functioning of endocrine glands." B. "Have there been signs and symptoms that you should have reported to the doctor?" C. "As endocrine functions become more stable throughout childhood, alterations become more apparent." D. "Endocrine disorders are hard to detect and you are lucky that we have found it when we did."

ANS: C Rationale: The endocrine glands are all present at birth; however, endocrine functions are immature. As these functions mature and become stabilized during the childhood years, alterations in endocrine function become more apparent. Thus, endocrine disorders may arise at any time during childhood development.

9. A preschooler who received chemotherapy in the pediatric oncology outpatient department 1 week ago now has a temperature of 101.5°F (38.6°C). Which is the most appropriate response by the nurse? A. Tell the parent to administer acetaminophen every 4 hours until the fever dissipates. B. Ask whether any family members or other close associates are ill. C. Have the parent bring the child to the pediatric oncology clinic as soon as possible. D. Instruct the parent to immediately obtain and give the antibiotic that the oncologist will order.

ANS: C Rationale: The preschooler is considered immune suppressed following recent chemotherapy. A fever can mean sepsis, which would require immediate investigation of blood and other body fluids to identify the organism, plus prompt treatment with an IV antibiotic. This can be accomplished only by seeing the pediatric oncologist and is likely to result in hospitalization.

14. The nurse is caring for a child recovering from surgery to correct strabismus. Which interventions should the nurse include when planning this child's care? Select all that apply. A. Apply an eye patch. B. Maintain on bed rest for 3 days. C. Support for nausea and vomiting. D. Provide pain medication as prescribed. E. Apply antibiotic ointment as prescribed

ANS: C, D, E Rationale: After eye surgery for strabismus, the patient may experience nausea and vomiting and pain on eye movement. The patient will also be prescribed antibiotic ointment. An eye patch is not usually required. The child will not need to be on bed rest for 3 days

12. The nurse is examining a child with hypoparathyroidism. The nurse would expect to assess which signs and symptoms? Select all that apply. A. Capillary refill B. Polyphagia C. Chvostek D. Babinski E. Trousseau

ANS: C, E Rationale: A child with hypoparathyroidism would have a positive Chvostek or Trousseau sign, both of which indicate hypocalcemia. To test for the Chvostek sign, tap sharply over the facial nerve below the temple and anteriorly to the ear. The sign is positive when the mouth twitches (contraction of the lateral facial muscles). To check for the Trousseau sign, apply a blood pressure cuff to the child's upper arm. Inflate the cuff until the blood supply is occluded. If doing so causes carpal spasm (the fingers contract and the child is unable to open the hand), the Trousseau sign is positive. Capillary refill helps to evaluate tissue oxygenation. Polyphagia refers to excessive eating or hunger. Babinski refers to the Babinski reflex, which suggest neurologic dysfunction.

8. The nurse is caring for a 12-month-old child diagnosed with an autism spectrum disorder. What information from the mother during the health history should the nurse identify as being consistent with the disorder? A. The child speaks in complete sentences. B. The child sleeps at least 12 out of every 24 hours. C. The child responds warmly to the father but not to the mother. D. The child constantly stares at a rotating wheel on the crib mobile.

ANS: D Rationale: A manifestation of an autism spectrum disorder is an abnormal response to sensory stimuli such as staring at a rotating wheel on the crib mobile. A child with an autism spectrum disorder will demonstrate repetitive words and failure to develop social relationships. The number of hours of sleep is not used to help identify an autism spectrum disorder.

18. The nurse is assessing a 30-month-old child during a routine well-child visit. Which statement by the parent would alert the nurse to further assess for a learning disorder? A. "My child seems to prefer playing with certain toys and will not play with other toys very much." B. "My child likes a certain type of food and does not want to try new foods very often." C. "My child gets restless when we go to a restaurant to eat and we have to wait for our food. D. "My child does not say more than one or two words and grunts to indicate needs."

ANS: D Rationale: Delayed language is often a first sign of an intellectual/learning disorder in a child. The nurse would expect the 30-month-old child to be a picky eater, prefer some toys over others and to be restless when required to sit for an extended period of time

11. The nurse knows that disorders of the pituitary gland depend on the location of the physiologic abnormality. Caring for a child who has issues with the anterior pituitary, the nurse would expect the child to have issues with which hormone? A. Vasopressin B. Antidiuretic hormone C. Oxytocin D. Growth hormone

ANS: D Rationale: Disorders of the pituitary gland depend on the location of the physiologic abnormality. The anterior pituitary, or adenohypophysis, is made up of endocrine glandular tissue and secretes growth hormone (GH), adrenocorticotropic hormone (ACTH), TSH, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin. The posterior lobe is called the neurohypophysis because it is formed of neural tissue. It secretes antidiuretic hormone (ADH; vasopressin) and oxytocin. Usually, several target organs are affected when there is a disorder of the pituitary gland, especially the adenohypophysis

15. The nurse is educating the parents of a 6-year-old boy about his learning disorder. Which of the following facts would the nurse integrate into the discussion? A. Learning disorders indicate lower intelligence. B. Learning disorders are synonymous with learning deficits. C. The disorder requires comprehensive special education. D. The disorder is caused by a difference in brain architecture.

ANS: D Rationale: In most cases, the etiology of learning disorders is not known. However, it is believed that the brain architecture is different from that of children without a learning disorder. Children with a learning disability process information differently than children who respond to traditional teaching methods. The "wiring" or architecture of the brain differs from that of a child without a learning disorder, and the biochemical balance may differ as well. Learning disorders do not predict intelligence. They should not be considered deficits but rather different responses to information. Likewise, they can be limited to one area, allowing the child to excel in other areas.

17. A child is admitted to the pediatric medical unit with the diagnosis of syndrome of inappropriate antidiuretic hormone (SIADH). Based on the typical signs and symptoms of this disorder, which nursing diagnosis will the nurse identify as relating to this client? A. Delayed growth and development B. Imbalanced nutrition: More than body requirements C. Noncompliance D. Excess fluid volume

ANS: D Rationale: Syndrome of inappropriate antidiuretic hormone (SIADH) occurs when ADH (vasopressin) is secreted in the presence of low serum osmolality because the feedback mechanism that regulates ADH does not function properly. ADH continues to be released, and this leads to water retention, decreased serum sodium due to hemodilution, and extracellular fluid volume expansion; thus, Excess fluid volume from edema is the highest priority.

16. The mother of a 2-month-old infant questions the nurse about autism. She reports a close family member has a child with this disorder and she is concerned about her child. What information can be provided to the child's mother? Select all that apply. A. "The cause of autism is largely considered to be related to immunizations administered in infancy." B. "Concerns are often noted as early as 3 to 6 months of age." C. "Once your child begins to speak it will be easier to make a determination." D. "In infancy a lack of loving behaviors such as cuddling is concerning." E. "Infants who are on the autism spectrum may have difficulty establishing or maintaining eye contact."

ANS: D, E Rationale: The spectrum of autism disorder ranges from mild (e.g., Asperger syndrome) to severe. Autistic behaviors may be first noticed in infancy as developmental delays or between the age of 12 and 36 months when the child regresses or loses previously acquired skills. The exact etiology of autism continues to elude scientists, but it may be due to genetic makeup, brain abnormalities, altered chemistry, a virus, or toxic chemicals. Children with ASD display impaired social interactions and communication. They may fail to develop interpersonal relationships and experience social isolation.