Unit II

A nurse is promoting the use of family-centered care in a local community clinic. Which of the following are advantages or disadvantages of this type of care provision? Select all answers that apply. A)Recovery times are longer. B)Anxiety is decreased. C)Communication is improved. D)Health care costs are increased. E)Pain management is enhanced. F)More health care resources are utilized.

B,C,E. When children's health care is provided through a family-centered approach, many positive outcomes are possible, including anxiety is decreased; children are calmer and pain management is enhanced; recovery times are shortened; families' confidence and problem-solving skills are improved; communication between the health care team and the family is also improved, leading to greater satisfaction for both the health care team and health care consumers (families); a decrease in health care costs is seen; and health care resources are used more effectively.

After assessing a 10-year-old girl, the nurse documents the appearance of breast buds, identifying this as which of the following? A)Menarche B)Thelarche C)Puberty D)Tanner stage 5

B. "Thelarche" is the term used to describe breast budding. Menarche refers to the first menstrual period. Puberty refers to the biological changes that occur during adolescence. Tanner stage 5 involves maturation of the breast tissue to adult configuration.

The nurse is conducting a physical examination of a 9-month-old baby with a flat, discolored area on the skin. The nurse documents this as which of the following? A)Papule B)Macule C)Vesicle D)Scaling

B. A macule is a flat, discolored area on the skin. A papule is a small, raised bump on the skin. A vesicle is a fluid-filled bump on the skin. Scaling is flaking of the skin.

A nurse is assessing the skin of a child with cellulitis. Which of the following would the nurse expect to find? A)Red raised hair follicles B)Warmth at skin disruption site C)Papules progressing to vesicles D)Honey-colored exudate

B. Cellulitis is manifested by erythema, pain, edema, and warmth at the site of skin disruption. Red raised hair follicles would indicate folliculitis. Papules progressing to vesicles and a honey-colored exudate would suggest nonbullous impetigo.

A group of nursing students are reviewing information about the variations in respiratory anatomy and physiology in children in comparison to adults. The students demonstrate understanding of the information when they identify which of the following? A)Children's demand for oxygen is lower than that of adults. B)Children develop hypoxemia more rapidly than adults do. C)An increase in oxygen saturation leads to a much larger decrease in pO2. D)Children's bronchi are wider in diameter than those of an adult.

B. Children develop hypoxemia more rapidly than adults do because they have a significantly higher metabolic rate and faster resting respiratory rates than adults do, which leads to a higher demand for oxygen. A smaller decrease in oxygen saturation reflects a disproportionately much larger decrease in pO2. The bronchi in children are narrower than in adults, placing them at higher risk for lower airway obstruction.

The nurse is teaching the parents of a 2-year-old toddler methods of dealing with their child's "negativism." Based on Erokson's theory of development, which of the following would be an appropriate intervention for this child? A)Discourage solitary play; encourage playing with other children. B)Encourage the child to pick out his own clothes. C)Use "time-outs" whenever the child says "no" inappropriately. D)Encourage the child to take turns when playing games.

B. Erikson defines the toddler period as a time of autonomy versus shame and doubt. It is a time of exerting independence. Allowing the child to choose his own clothes helps him to assert his independence. Negativism—always saying "no"—is a normal part of healthy development and is occurring as a result of the toddler's attempt to assert his or her independence. It should not be punished with "time-outs." The toddler should be encouraged to play alone and with other children. Toddlers cannot take turns in games until age 3.

The nurse is teaching the parents of a 12-year-old boy about appropriate approaches when raising an adolescent. Which of the following comments should be included in the discussion? A)"Find out if his friends are worthy of him." B)"Try to be open to his views." C)"Maintain a firm set of rules." D)"Remind him that he is still your little boy."

B. It is most important to be open to the child's views. This will encourage the child to consider parental concerns and promote communication. Being judgmental about his friends will make the child defensive about his choice of friends. Rules need to be flexible so they can apply to new situations. Avoid condescension. The child will appreciate being treated like a young man.

The school nurse is performing a physical examination on a 13-year-old boy who is on the soccer team. Which of the following is a physical quality that develops during these early adolescent years? A)Coordination B)Endurance C)Speed D)Accuracy

B. It is usually during early adolescence that teenagers begin to develop endurance. Their concentration has increased so they can follow complicated instructions. Coordination can be a problem because of the uneven growth spurts. During middle adolescence, speed and accuracy increase while coordination also improves.

The mother of a 5-year-old child with eczema is getting a check-up for her child before school starts. Which of the following will the nurse do during the visit? A)Change the bandage on a cut on the child's hand B)Assess the compliance with treatment regimens C)Discuss systemic corticosteroid therapy D)Assess the child's fluid volume

B. Maintaining proper therapy for eczema can be exhausting both physically and mentally. Therefore, it is essential that the nurse assess compliance and support the parents' ability to cope if necessary. Changing a bandage is not part of a health maintenance visit. Hydration is important for a child with eczema; however, fluid volume is not the focus at this visit. Systemic corticosteroid therapy is very rarely used and the success of the current therapy needs to be assessed first

The parents of a 2-year-old girl are frustrated by the frequent confrontations they have with their child. Which is the best anticipatory guidance the nurse can offer them? A)"Respond in a calm but firm manner." B)"You need to adhere to various routines." C)"Put her in time-out when she misbehaves." D)"It's important to toddler-proof your home."

B. Making expectations known through everyday routines helps to avoid confrontations. This helps the child know what to expect and how to behave. It is the best guidance to give these parents. Calm response and time-out are effective ways to discipline, but do not help to prevent confrontations. Toddler-proofing the house doesn't eliminate all the opportunities for confrontation.

The nurse is caring for an 8-year-old girl with an endocrine disorder involving the posterior pituitary gland. Which of the following would the nurse expect to implement? A)Instructing the parents to report adverse reactions to the growth hormone treatment B)Teaching the parents how to administer the desmopressin acetate C)Informing the parents that treatment stops when puberty begins D)Educating the parents to report signs of acute adrenal crisis

B. The nurse would teach the parents how to administer desmopressin acetate, which treats diabetes insipidus, a disorder related to the posterior pituitary gland. Instructing parents to report adverse reactions to growth hormone is an intervention for growth hormone deficiency. Informing the parents that treatment stops at the normal time of puberty is a teaching intervention for precocious puberty. Educating the parents to report signs of an acute adrenal crisis is an intervention for congenital adrenal hyperplasia. All three of these other disorders are related to the anterior pituitary.

After teaching a group of students about therapeutic play, the instructor determines that additional teaching is needed when the students identify which of the following as a characteristic? A)Focus on coping B)Use of a highly structured format C)Dramatization of emotions D)Expression of feelings

B. Therapeutic play is nondirected play, focused on helping the child cope with feelings and fears. Real-life stressors and emotions can be acted out or dramatized, allowing the child to express his or her feelings

Which food suggestion would be most appropriate for the mother of a preschooler to ensure an adequate intake of calcium? A)Spinach B)White beans C)Enriched bread D)Fortified cereal

B. To ensure an adequate intake of calcium, the nurse should suggest white beans, because 1 ounce of dried white beans when cooked provides 160 mg of calcium. Spinach, enriched bread, and fortified cereal are good sources of iron.

A nurse is performing a primary survey on a child who has sustained partial thickness burns over his upper body areas. Which of the following would the nurse do first? A)Inspect the child's skin color B)Assess for a patent airway C)Observe for symmetric breathing D)Palpate the child's pulse

B. When performing a primary survey, the nurse first assesses the child's airway for patency and then intervenes accordingly to ensure that the airway is patent. Next the nurse would evaluate the child's skin color, respiratory effort, and symmetry of breathing and breath sounds. Then the nurse would determine the pulse strength, perfusion status, and heart rate.

A nurse is preparing a presentation for a local parent group about burn prevention and care in children. Which of the following would the nurse be least likely to include in the presentation when describing how to care for a superficial burn? A)Using cool water over the burned area until the pain lessens B)Applying ice directly to the burned skin area C)Covering the burn with a clean, nonadhesive bandage D)Giving the child acetaminophen for pain relief

B. With a superficial burn, ice should not be applied to the skin. Using cool water over the burn area; covering with a clean, nonadhesive bandage; and using acetaminophen for pain relief are appropriate to include in the presentation.

The nurse is caring for an infant with suspected patent ductus arteriosus. Which of the following assessment findings would the nurse identify as helping to confirm this suspicion? A)Thrill at the base of the heart B)Harsh, continuous, machine-like murmur under the left clavicle C)Faint pulses D)Systolic murmur best heard along the left sternal border

B. With patent ductus arteriosus, a harsh, continuous, machine-like murmur (usually loudest under the left clavicle) is heard at the first and second intercostal spaces. A thrill at the base, faint pulses, and systolic murmur heard best along the left sternal border point to aortic stenosis.

The pediatric nurse is planning quiet activities for hospitalized 18-month-olds. Which of the following would be an appropriate activity for this age group? A)Painting by number B)Putting shapes into appropriate holes C)Stacking blocks D)Using crayons to color in a coloring book

C, At 18 months the child can stack four blocks. The 24-month-old can paint (but not by number), scribble, and color, and put round pegs into holes.

The nurse is consulting with a child life specialist (CLS) to help minimize the stress of hospitalization for a child. Which of the following services would the CLS provide? Select all answers that apply. A)Medical preparation for tests, surgeries, and other medical procedures B)Support before and after, but not during, medical procedures C)Activities to support normal growth and development D)Grief and bereavement support E)Emergency room interventions for children and families F)Only inpatient consultations with families

C,D,E. The CLS would provide activities to support normal growth and development, grief and bereavement support, and emergency room interventions for children and families. The CLS would also provide nonmedical preparation for tests, surgeries, and other medical procedures; support during medical procedures; and outpatient consultation with families.

The nurse is providing suggestions to a female adolescent about foods to help meet her nutritional requirements for iron. Which food would the nurse suggest as a good source of iron? A)Broccoli B)Yogurt C)Peanut butter D)White beans

C. Peanut butter is a good source of iron. Broccoli, yogurt, and white beans are good sources of calcium.

The nurse is conducting a physical examination of a child following a comprehensive health history. What should be the focus of the physical examination? A)The child B)The parents C)Chief complaint D)Developmental age

C. The next step after the health history is the physical examination. It should focus on the chief complaint or any of the systems that engaged the nurse's critical thinking while obtaining the history. The child and parents are involved in the assessment but the focus is on the health problem. The nurse should conduct a physical examination with the child's developmental age in mind.

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

D. 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.

The nurse is transporting a 6-month-old with a suspected blood disorder to the nursery. What is the most appropriate method of transporting the child by the nurse? A)A wagon with rails B)Cradle hold C)Football hold D)Over the shoulder

D. A 4-month-old should be carried in the "over-the-shoulder" method. A wagon with rails is for an older child. A cradle hold is for infants until 3 months of age. A football hold is for infants until 2 months of age

Which of the following would the nurse expect to find initially in a child with Guillain-Barré syndrome? A)Symmetric flaccid weakness B)Ataxia C)Sensory disturbances D)Lower extremity pain

D. Although symmetric flaccid weakness or paralysis, ataxia, and sensory disturbances may be assessed, pain, especially in the lower extremities, is commonly the initial presenting finding, preceding motor involvement.

A 6-month-old girl weighs 14.7 pounds during a scheduled check-up. Her birth weight was 8 pounds. Which of the following is the priority nursing intervention? A)Talking about solid food consumption B)Discouraging daily fruit juice intake C)Increasing the number of breastfeedings D)Discussing the child's feeding patterns

D. Assessing the current feeding pattern and daily intake is the priority intervention. Talking about solid food consumption may not be appropriate for this child yet. Discouraging daily fruit juice intake or increasing the number of breastfeedings may not be necessary until the situation is assessed.

An adolescent weighing 55 kg is admitted to the hospital experiencing a sickle cell crisis. Intravenous fluid therapy as well as increased oral fluids are ordered as part of his treatment plan. Based on the understanding of the amount of fluids needed to promote hemodilution, the nurse would expect the adolescent to receive how much total fluid in 24 hours? __________ mL

8,250 To promote hemodilution, the patient should receive 150 mL/kg/day. The patient weighs 55 kg; therefore, he should receive 150 × 55 = 8,250 mL.

Which of the following would be least effective in gaining the cooperation of a toddler during a physical examination? A)Tell the child that another child the same age wasn't afraid. B)Allow the child to touch and hold the equipment when possible. C)Permit the child to sit on the parent's lap during the examination. D)Offer immediate praise for holding still or doing what was asked.

A. Toddlers are egocentric, and telling the toddler how well another child behaved or cooperated probably will not help gain this child's cooperation. Allowing the child to touch and hold the equipment, permitting the child to sit on the parent's lap during the exam, and offering praise immediately for cooperating would foster cooperation.

The nurse is watching toddlers at play. Which of the following normal behaviors would the nurse observe? A)Toddlers engage in parallel play. B)Toddlers engage in solitary play. C)Toddlers engage in cooperative play. D)Toddlers do not engage in play outside the home.

A. Toddlers typically play alongside another child (parallel play) rather than cooperatively. Infants engage in solitary play.

18. A pregnant woman diagnosed with syphilis comes to the clinic for a visit. The nurse discusses the risk of transmitting the infection to her newborn, explaining that this infection is transmitted to the newborn through which of the following? A) Amniotic fluid B) Placenta C) Birth canal D) Breast milk

B. Antipyretics act to decrease the temperature set point in children with elevated temperatures by inhibiting the production of prostaglandins, which leads to heat loss through vasodilation and sweating. Antihistamines block the release of histamine.

The child life specialist (CLS) is preparing a 6-year-old child for a magnetic resonance imaging (MRI) scan. Which of the following statements reflects the use of atraumatic principles when explaining the procedure? A)"You will be taken to a magnetic resonance imaging machine for an x-ray of your liver." B)"You may hear some loud noises when you are lying in the machine, but they won't hurt you." C)"You have nothing to worry about; the MRI machine is safe and will not cause you any pain." D)"Let's just get you to the x-ray department for your test and you'll see how simple it is."

B. When using atraumatic principles, the CLS would explain any sensations, such as noises that will be experienced. The language should be simple and at the child's developmental age; using the technical term for the machine might frighten the child. Telling the child there is nothing to worry about does not allay the child's fears. Allowing the child to experience the machine without explaining the sensations does not follow atraumatic principles

The nurse is using pulse oximetry to measure oxygen saturation in a 3-year-old girl. The nurse understands that falsely high readings may be associated with which situation or condition? A)A nonsecure connection B)Cold extremities C)Hypovolemia D)Anemia

D. Falsely high readings may be associated with anemia. Falsely low readings may be associated with cold extremities, hypovolemia, and a nonsecure connection.

The nurse knows that the school-age child is in Erikson's stage of industry versus inferiority. Which of the following is the best example of a school-ager working toward accomplishing this developmental task? A)The child signs up for after-school activities. B)The child performs his bedtime preparations autonomously. C)The child becomes aware of the opposite sex. D)The child is developing a conscience.

A, Erikson (1963) describes the task of the school-age years to be a sense of industry versus inferiority. During this time, the child is developing his or her sense of self-worth by becoming involved in multiple activities at home, at school, and in the community, which develops his or her cognitive and social skills. Achieving independence is a task of the preschooler who also is developing a conscience at that age. Awareness of the opposite sex occurs in, but is not the focus of, the school-age child.

When observing a group of preschoolers at play in the clinic waiting room, which type of play would the nurse be least likely to note? A)Parallel play B)Cooperative play C)Dramatic play D)Fantasy play

A, Parallel play is associated with toddlers. Cooperative, dramatic, and fantasy play are commonly used by preschoolers.

An infant is diagnosed with a congenital cataract. Which of the following would the nurse expect to assess? A)Absent red reflex B)Rapid irregular eye movement C)Misalignment of the eyes D)Enlarged eye appearance

A. Assessment findings associated with congenital cataract include a history of lack of visual awareness; clouding of the cornea, which may or may not be visible; and no red reflex. Rapid irregular eye movement would suggest nystagmus. Misalignment of the eyes would suggest strabismus. Enlarged appearance of the eye is associated with infantile glaucoma

The nurse is caring for a 7-year-old girl who is scheduled for a hernia repair and is very scared. Which of the following fears would she also most likely have at this age? A)Fear of being kidnapped B)Fear of cutting her finger C)Fear of sudden loud noises D)Fear of the neighbor's dog

A. At this age, the child will be fearful of being kidnapped. She should have outgrown her fears of harm to her body, noises, and dogs, all of which are typical preschooler fears.

The nurse is caring for a 10-year-old with allergic conjunctivitis. The nurse would be alert to the child's increased risk for which of the following? A)Atopic dermatitis B)Insect bite sensitivity C)Acute otitis media D)Frequent sore throats

A. Atopic dermatitis is a risk factor specifically for allergic conjunctivitis because of repeated exposure to the particular allergens. Acute otitis media, insect bite sensitivity, and frequent sore throats can occur but are not related to the allergic conjunctivitis.

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

B,E. 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.

A 3-year-old child has sustained significant severe burns and is ordered to receive 100% oxygen. Which of the following would the nurse use to administer the oxygen? A)Nasal cannula B)Venturi mask C)Nonrebreather mask D)Oxygen hood

C. All children with severe burns should receive 100% oxygen via a nonrebreather mask or bag-valve-mask ventilation. A nasal cannula provides only low oxygen concentrations (22% to 44%); a Venturi mask provides only 24% to 50% oxygen concentrations. An oxygen hood is used for infants only.

A group of students are reviewing information about the anatomic differences in the eyes and ears of a child in comparison to an adult. The students demonstrate a need for additional study when they identify which of the following? A)Hearing is completely developed at the time of birth. B)Visual acuity develops from birth throughout childhood. C)Binocular vision is usually achieved by 2 months of age. D)The ability to discriminate colors is completed by birth.

D. The optic nerve is not completely myelinated at birth, so color discrimination is incomplete. Hearing is intact at birth and visual acuity develops from birth throughout childhood. Binocular vision is achieved by 4 months of age.

The nurse is discussing ways to promote discipline with parents who are becoming increasingly frustrated with their teenager. Which of the following would the nurse identify as most important? A)Establish rules and expectations. B)Collaborate to determine consequence. C)Make your responses consistent. D)Explain the rules to the adolescent.

C. Consistency and predictability are the cornerstones of discipline. Establishing rules and expectations, collaborating to determine the consequences, and explaining the rules are all important, but they are not as important as being consistent.

The nurse is providing anticipatory guidance to the parents of an 18-month-old girl. Which guidance will be most helpful for toilet teaching? A)Telling them either one may demonstrate toilet use B)Assuring them that bladder control occurs first C)Telling them that curiosity is a sure sign of readiness D)Advising them to use praise, not scolding

D. The most helpful guidance for toilet teaching is to urge the parents to use only praise, but never to scold, throughout the process. It is best for the same-sex parent to demonstrate toilet use. Bowel control will occur first. It may take additional months for nighttime bladder control to be achieved. Curiosity is a sign of readiness for toilet teaching, but by no means a sure sign.

The nurse is assessing the heart rate of a healthy school-age child. The nurse expects that the child's heart rate will be in which of the following ranges? A)80 to 150 bpm B)70 to 120 bpm C)65 to 110 bpm D)60 to 100 bpm

D. The normal heart rate for a school-age child is 60 to 100 bpm, for an infant is 80 to 150 bpm, for a toddler is 70 to 120 bpm, and for a preschooler is 65 to 110 bpm

The nurse is caring for a 2-year-old boy with hemophilia. His parents are upset by the possibility that he will become infected with hepatitis or HIV from the clotting factor replacement therapy. Which response by the nurse would be most appropriate? A)"Parents commonly fear the worst; however, the factor will help your child lead a normal life." B)"There are risks with any treatment including using blood products, but these are very minor." C)"Although factor replacement is expensive, there's more financial strain from missing work if he has a bleeding episode." D)"Since dry heat treatment of the factor began in 1986, there have been no reports of virus transmission."

D. The nurse needs to emphasize that since 1986, there have been no reports of virus transmission from factor infusion since the inception of heat treatment of the factor. Telling the parents that there is a minor risk does not teach. Telling the parents that factor is expensive or that it is common to worry does not teach, nor does it address their concerns.

The nurse is caring for a child recently diagnosed with glucose-6-phosphate dehydrogenase (G6PD) deficiency. The nurse is teaching the parents about triggers that may result in oxidative stress. Which of the following responses indicates a need for further teaching? A)"I doubt he will ever eat fava beans, but they could trigger hemolysis." B)"He must avoid exposure to naphthalene, an agent found in mothballs." C)"He must never take methylene blue for a urinary tract infection." D)"My son can never take penicillin for an infection."

D. The nurse should emphasize that penicillin is not a known trigger that may result in oxidative stress and hemolysis. Fava beans, naphthalene, and methylene blue can trigger oxidative stress.

The nurse is caring for a child who has been admitted for a sickle cell crisis. Which of the following would the nurse do first to provide adequate pain management? A)Administer a nonsteroidal anti-inflammatory drug as ordered. B)Use guided imagery and therapeutic touch. C)Administer meperidine as ordered. D)Initiate pain assessment with a standardized pain scale.

D. The nurse should first initiate pain assessment with a standardized pain scale upon admission and provide frequent evaluations of pain. Administering NSAIDs or meperidine and the use of nonpharmacologic pain management techniques are all appropriate. However, the first action is to assess the child's pain to provide a baseline for future comparison

A mother calls the school nurse and is concerned because her 13-year-old daughter's friends wear heavy makeup and black clothes. Which of the following is the best advice for the mother? A)"This can lead to piercings and tattoos." B)"The teen years are a time for experimenting." C)"Encourage her to socialize with the kids at church." D)"Teen appearance might not accurately reflect their actual values."

D. The nurse should inform the mother that the statements adolescents make with their dress and grooming may not indicate what their actual values are. Mentioning piercings and tattoos will only worry the mother more. Minimizing the situation as experimentation is of no value to the mother. Telling the mother to choose her daughter's friends for her will destroy trust between mother and daughter.

The nurse has developed a plan of care for a 12-month-old hospitalized with dehydration as a result of rotavirus. Which intervention would the nurse include in the plan of care? A)Encouraging consumption of fruit juice B)Offering Kool-Aid or popsicles as tolerated C)Encouraging milk products to boost caloric intake D)Maintaining the intravenous fluid rate as ordered

D. The nurse should maintain an intravenous line and administer the IV fluid as ordered to maintain fluid volume. High-carbohydrate fluids like fruit juice, Kool-Aid, and popsicles should be avoided as they are low in electrolytes, increase simple carbohydrate consumption, and can decrease stool transit time. Milk products should be avoided during the acute phase of illness as they may worsen diarrhea.

The nurse has developed a plan of care for a 6-year-old with muscular dystrophy. He was recently injured when he fell out of bed at home. Which intervention would the nurse suggest to prevent further injury? A)Recommend the bed's side rails be raised throughout the day and night. B)Suggest a caregiver be present continuously to prevent falls from bed. C)Encourage a loose restraint to be used when he is in bed. D)Recommend raising the bed's side rails when a caregiver is not present.

D. The nurse should recommend that side rails on the bed be elevated when a caregiver is not present. The use of restraints should be avoided if at all possible. Suggesting that a caregiver be present at all times places undue stress on the family. Close observation is more appropriate. Recommending side rails be elevated at all times may be upsetting to the child and make him feel like a "baby."

The nurse is caring for an 8-year-old girl who requires numerous venipunctures and injections daily. The nurse understands that the child is exhibiting signs of sensory overload and enlists the assistance of the child life specialist. What should the therapeutic play involve to best deal with the child's stressors? A)Puppets and dolls B)Drawing paper and crayons C)Wooden hammer and pegs D)Sewing puppets with needles

D. The nurse understands that the child may benefit from supervised needle play to assist the child undergoing frequent blood work, injections, or intravenous procedures. The child life specialist can determine what form of therapeutic play is best, but the nurse can recommend interventions based on his or her knowledge of the specific child.

A mother and her 4-week-old infant have arrived for a health maintenance visit. Which of the following activities will the nurse perform? A)Assess the child for an upper respiratory infection B)Take a health history for a minor injury C)Administer a varicella injection D)Plot the child's head circumference on a growth chart

D. The nurse will plot the head circumference of the child as part of developmental surveillance and screening. Assessing for an infection and taking a health history for an injury are not part of a health maintenance visit. Administering a vaccination for varicella would not occur until 12 months of age.

A nurse is teaching the parents of an infant with congenital adrenal hyperplasia about the signs and symptoms of adrenal crisis. The nurse determines that the teaching was successful when the parents identify which of the following? A)Bradycardia B)Constipation C)Fluid overload D)Persistent vomiting

D. Signs and symptoms of acute adrenal crisis include persistent vomiting, dehydration, hyponatremia, hyperkalemia, hypotension, tachycardia, and shock.

The parents of a child with congenital adrenal hyperplasia bring the child to the emergency department for evaluation because the child has had persistent vomiting. Which of the following would lead the nurse to suspect that the child is experiencing an acute adrenal crisis? A)Hypernatremia B)Bradycardia C)Hypertension D)Hyperkalemia

D. Signs and symptoms of an acute adrenal crisis include hyperkalemia, hyponatremia, tachycardia, hypotension, persistent vomiting, dehydration, and shock.

The nurse is performing an assessment of the reproductive system of a 17-year-old girl. Which of the following would alert the nurse to a developmental delay in this girl? A)Areola and papilla separate from the contour of the breast B)Mature distribution and coarseness of pubic hair C)Developed breast tissue D)Occurrence of first menstrual period

D. The first menstrual period usually begins between the ages of 9 and 15 years (average 12.8 years). Breast budding (thelarche) occurs at approximately ages 9 to 11 years and is followed by the growth of pubic hair.

The nurse is providing care to several children who have been brought to the clinic by the parents for complaints of cold-like symptoms. The nurse would most likely suspect sinusitis in which child? A)A 2-year-old with thin watery nasal discharge B)A 3-year-old with sneezing and coughing C)A 5-year-old with nasal congestion and sore throat D)A 7-year-old with halitosis and thick, yellow nasal discharge

D. The frontal sinuses, those most commonly associated with sinus infection, develop by age 6 to 8 years. Therefore, the 7-year-old would most likely experience sinusitis. In addition, this child also exhibits halitosis and a thick, yellow nasal discharge, other findings associated with sinusitis. Thin watery discharge in a 2-year-old is more likely to indicate allergic rhinitis. A 3-year-old with coughing and sneezing or a 5-year-old with nasal congestion and sore throat suggests the common cold.

The nurse assesses a child's level of consciousness, noting that the child falls asleep unless he is stimulated. The nurse documents this finding as: A)Confusion B)Obtunded C)Stupor D)Coma

B. Obtunded is a state in which the child has limited responses to the environment and falls asleep unless stimulation is provided. Confusion involves disorientation; the child may be alert but responds inappropriately to questions. Stupor exists when the child responds only to vigorous stimulation. Coma is a state in which the child cannot be aroused even with painful stimuli.

The nurse is obtaining a health history from parents whose 4-month-old boy has congenital hypothyroidism. Which of the following would the nurse most likely assess? A)The child has above-normal growth for his age. B)The child is active and playful. C)The skin is pink and healthy looking. D)It is difficult to keep the child awake.

D. The parents may state, during the health history, that it is difficult to keep the child awake. Physical examination would reveal that the child is below weight and height, that his skin is pale and mottled, and that he is lethargic and irritable.

The nurse is providing instructions to parents of a 2-year-old child with a fever. The child weighs 33 pounds. Based on the recommended dose for ibuprofen 5 to 10 mg/kg/dose, how much would the nurse instruct the parents to give as the lowest amount per dose?

75 mg The child weighs 33 pounds, which is equivalent to 15 kg. The recommendations for ibuprofen are 5 to 10 mg/kg/dose. The lowest dose would be 5 × 15 kg or 75 mg. The largest recommended dose would be 150 mg (10 mg/kg × 15 kg).

The nurse is providing anticipatory guidance to the mother of a 9-month-old girl during a well-baby visit. Which of the following topics would be most appropriate? A)Advising how to create a toddler-safe home B)Warning about small objects left on the floor C)Cautioning about putting the baby in a walker D)Telling about safety procedures during baths

A, The most appropriate topic for this mother would be advising her on how to create a toddler-safe home. The child will very soon be pulling herself up to standing and cruising the house. This will give her access to areas yet unexplored. Warning about small objects left on the floor, telling about safety procedures during baths, and cautioning about using baby walkers would no longer be anticipatory guidance as the child has passed these stages.

The nurse is assessing a child with aplastic anemia. Which of the following would the nurse expect to assess? Select all that apply. A)Ecchymoses B)Tachycardia C)Guaiac-positive stool D)Epistaxis E)Severe pain F)Warm tender joints

A,B,C,D. Assessment findings associated with aplastic anemia include ecchymoses, epistaxis, guaiac-positive stools, and tachycardia. Severe pain and warm tender joints are most often associated with sickle cell crisis.

The nurse is caring for preschoolers in a day care center. Of which of the following developmental milestones of this age group should the nurse be aware? Select all answers that apply. A)Counting 10 or more objects B)Correctly naming at least four colors C)Understanding the concept of time D)Knowing everyday objects E)Understanding the differences of others F)Forming concepts as logical as an adult's

A,B,C,D. The child in the intuitive phase can count 10 or more objects, correctly name at least four colors, and better understand the concept of time, and he or she knows about things that are used in everyday life, such as appliances, money, and food. The preschooler forms concepts that are not as complete or as logical as the adult's, and tolerates others' differences but doesn't understand them.

The nurse is teaching the parents of a child diagnosed with iron-deficiency anemia about ways to increase their child's intake of iron. The parents demonstrate understanding of the teaching when they identify which foods as good choices for the child? Select all that apply. A)Tuna B)Salmon C)Tofu D)Cow's milk E)Dried fruits

A,B,C,E. Foods high in iron include red meats, tuna, salmon, eggs, tofu, enriched grains, dried beans and peas, dried fruits, leafy green vegetables, and iron-fortified breakfast cereals.

The school nurse providing school health screenings knows that the 7- to 11-year-old is in Piaget's stage of concrete operational thoughts. Which of the following should this age group accomplish when developing operations? Select all answers that apply. A)Ability to assimilate and coordinate information about the world from different dimensions B)Ability to see things from another person's point of view and think through an action C)Ability to use stored memories of past experiences to evaluate and interpret present situations D)Ability to think about a problem from all points of view, ranking the possible solutions while solving the problem E)Ability to think outside of the present and incorporate into thinking concepts that do exist as well as concepts that might exist F)Ability to understand the principle of conservation—that matter does not change when its form changes

A,B,C,F. Piaget's stage of cognitive development for the 7- to 11-year-old is the period of concrete operational thoughts. In developing concrete operations, the child is able to assimilate and coordinate information about the world from different dimensions. He or she is able to see things from another person's point of view and think through an action, anticipating its consequences and the possibility of having to rethink the action. The school-age child is able to use stored memories of past experiences to evaluate and interpret present situations. Also, during concrete operational thinking, the school-age child develops an understanding of the principle of conservation—that matter does not change when its form changes.

The nurse is assessing the psychosocial development of a preschooler. Which of the following are normal activities characteristic of the preschooler? Select all answers that apply. A)Plans activities and makes up games B)Initiates activities with others C)Acts out roles of other people D)Engages in parallel play with peers E)Classifies or groups objects by their common elements F)Understands relationships among objects

A,B,C. The many activities of the preschooler include beginning to plan activities, making up games, initiating activities with others, and acting out the roles of other people (real and imaginary). Toddlers engage in parallel play; preschoolers engage in cooperative play. School-age children classify or group objects by common elements and understand relationships among objects.

The nurse is teaching the parents of a 4-year-old boy about the normal maturations of the child's organs during the preschool years and their effect on body functions. Which of the following statements accurately describe these changes? Select all answers that apply. A)Myelination of the spinal cord allows for bowel and bladder control to be complete in most children by age 3 years. B)The respiratory structures are continuing to grow in size, and the number of alveoli continues to increase, reaching the adult number at about 7 years of age. C)Heart rate increases and blood pressure decreases slightly during the preschool years; an innocent heart murmur may be heard upon auscultation. D)The bones continue to increase in length and the muscles continue to strengthen and mature; however, the musculoskeletal system is still not fully mature. E)The small intestine is continuing to grow in length, and stool passage usually occurs once or twice per day in the average preschooler. F)The urethra remains long in both boys and girls, making them more susceptible to urinary tract infections than adults.

A,B,D,E. Most of the body systems have matured by the preschool years. Myelination of the spinal cord allows for bowel and bladder control to be complete in most children by age 3 years. The respiratory structures are continuing to grow in size, and the number of alveoli continues to increase, reaching the adult number at about 7 years of age. The bones continue to increase in length and the muscles continue to strengthen and mature. However, the musculoskeletal system is still not fully mature. The small intestine is continuing to grow in length, and stool passage usually occurs once or twice per day in the average preschooler. The 4-year-old generally has adequate bowel control. Heart rate decreases and blood pressure increases slightly during the preschool years. An innocent heart murmur may be heard upon auscultation. The urethra remains short in both boys and girls, making them more susceptible to urinary tract infections than adults.

The nurse is questioning the parents of a 2-year-old child to obtain a functional history. Which of the following topics might the nurse include? Select all answers that apply. A)The child's toileting habits B)Use of car seats and other safety measures C)Problems with growth and development D)Prenatal and perinatal history E)The child's race and ethnicity F)Use of supplements and vitamins

A,B,F. The functional history should contain information about the child's daily routine, such as toileting habits, safety measures, and nutrition. Problems with growth and development would be covered in the developmental history. Prenatal and perinatal history is assessed in the past health history and the child's race and ethnicity is part of the demographics.

The school nurse is helping parents choose books for their preschoolers. What literacy skills present in the preschooler would the nurse consider when making choices? Select all answers that apply. A)Preschoolers enjoy books with pictures that tell stories. B)Preschoolers like stories with repeated phrases as they help keep their attention. C)Preschoolers like stories that describe experiences different from their own. D)Preschoolers demonstrate early literacy skills by reciting stories or portions of books. E)Preschoolers may retell the story from the book, pretend to read books, and ask questions about the story. F)Preschoolers do not have enough focus and expanded attention to notice when a page is skipped during reading.

A,B,D,E. Preschoolers enjoy books with pictures that tell stories. Stories with repeated phrases help to keep the child's attention. Also, children like stories that describe experiences similar to their own. The preschool child demonstrates early literacy skills by reciting stories or portions of books. He or she also may retell the story from the book, pretend to read books, and ask questions about the story. The preschool child has enough focus and expanded attention to notice when a page is skipped during reading and will call it to the parent's attention

A group of students are preparing for a class exam on skin disorders. As part of their preparation, they are reviewing information about acne vulgaris and its association with increased sebum production. The students demonstrate understanding of the information when they identify which areas as having the highest sebaceous gland activity? Select all answers that apply. A)Face B)Upper chest C)Neck D)Back E)Shoulders

A,B,D. The face, upper chest, and back are the areas of highest sebaceous activity and thus the most common areas for acne lesions to occur. The neck and shoulders are not typical areas involved with acne.

A nurse is developing a plan of care for a child who is admitted to the hospital for surgery. The child is visually impaired. Which of the following would be most appropriate for the nurse to include in the child's plan of care? Select all answers that apply. A)Explaining instructions using simple and specific terms the child understands B)Allowing the child to explore the postoperative equipment with his hands C)Touching the child on his shoulder before letting the child know someone is there D)Using the child's body parts to refer to the area where he may have postoperative pain E)Speaking to the child in a voice that is slightly louder than the usual tone of voice

A,B,D. When interacting with a visually impaired child, the nurse would make directions and instructions simple and specific, encourage exploration of objects such as postoperative equipment through touch, and use the parts of the child's body as reference points for the location of items or for this child, his postoperative pain. The nurse should identify him- or herself first before touching the child and speak in a tone of voice that is appropriate to the situation

27. A nurse suspects that an adolescent may have community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA). Which of the following would the nurse expect to assess? Select all answers that apply. A) Participation in contact sport B) Recent cut on the lower leg C) History of a recent sort throat D) Raised fluctuant lesions E) Erythematous rash over the trunk and face

A,B,D. With CAMRSA, skin and tissue infections are common, often appearing as a bump or skin area that is red, swollen, painful, and warm to the touch. There also may be fluctuance and purulent drainage. Participation in contact sports, openings in the skin such as abrasions and cuts, contact with contaminated items and surfaces, poor hygiene, and crowded living conditions are risk factors for CAMRSA. Recent sore throat and an erythematous rash on the trunk, face, and possibly the extremities are associated with scarlet fever

When assessing adolescents for health risks, the nurse must keep in mind the factors related to the prevalence of adolescent injuries. Which of the following accurately describe these factors? Select all answers that apply. A)Increased physical growth B)Insufficient psychomotor coordination C)Tiredness, lack of energy D)Lack of impulsivity E)Peer pressure F)Inexperience

A,B,E,F. Influencing factors related to the prevalence of adolescent injuries include increased physical growth, insufficient psychomotor coordination for the task, abundance of energy, impulsivity, peer pressure, and inexperience. Impulsivity, inexperience, and peer pressure may place the teen in a vulnerable situation between knowing what is right and wanting to impress peers. On the other hand, teens have a feeling of invulnerability, which may contribute to negative outcomes

The school nurse is teaching parents risk factors for suicide in adolescents. Which of the following would the nurse discuss? Select all answers that apply. A)Mental health changes B)History of previous suicide attempt C)Higher socioeconomic status D)Greatly improved school performance E)Family disorganization F)Substance abuse

A,B,E,F. Suicide is the third leading cause of death in adolescents 15 to 19 years of age. Risk factors for suicide include mental health changes, history of previous suicide attempt, family disorganization, and substance abuse. Other risk factors include poor school performance, crowded conditions/housing, low socioeconomic status, limited parental supervision, single-parent families/both parents in workforce, access to guns or cars, drug or alcohol use, low self-esteem, racism, peer or gang pressure, and aggression.

A 15-year-old adolescent is brought to the emergency department by his parents. The adolescent is febrile with chills that started suddenly. He states, "I had a sinus infection and sore throat a couple of days ago." The nurse suspects bacterial meningitis based on which of the following? Select all answers that apply. A)Complaints of stiff neck B)Photophobia C)Absent headache D)Negative Brudzinski sign E)Vomiting

A,B,E. In addition to the adolescent's complaints and history, other findings suggesting bacterial meningitis include complaints of a stiff neck, photophobia, headache, positive Brudzinski sign, and vomiting.

The school nurse is conducting a seminar for parents of adolescents on how to communicate with teenagers. Which of the following guidelines might the nurse recommend? Select all answers that apply. A)Talk face to face and be aware of body language. B)Ask questions to see why he or she feels that way. C)Do not give praise unless the adolescent deserves it. D)Speak to your child as an authority figure, not an equal. E)Don't admit that you make mistakes. F)Don't pretend you know all the answers.

A,B,F. In order to improve communication with teenagers, the parents should talk face to face and be aware of body language, ask questions to see why the teenager feels that way, not pretend they know all the answers, give praise and approval to the teenager often, speak to him or her as an equal (not talk down to him or her), and admit that they do make mistakes.

The nurse is providing atraumatic care to children in a hospital setting. Which of the following are principles of this philosophy of care? Select all answers that apply. A)Avoid or reduce painful procedures B)Avoid or reduce physical distress C)Minimize parent-child interactions D)Provide child-centered care E)Minimize child control F)Use core primary nursing

A,B,F. When using atraumatic care, the nurse would avoid or reduce painful procedures, avoid or reduce physical distress, use core primary nursing, maximize parent-child interactions, provide family-centered care, and provide opportunities for control, such as participating in care, attempting to normalize daily schedule, and providing direct suggestions.

The nurse is developing a plan of care for a child with thalassemia. Which of the following would the nurse expect to include? Select all that apply. A)Packed RBC transfusions B)Deferoxamine therapy C)Heparin therapy D)Opioid analgesics E)Platelet transfusions F)Intravenous immunoglobulin

A,B. RBC transfusions and deferoxamine for chelation are used to treat thalassemia. Heparin therapy is used for treating DIC. Opioid analgesics would be used to treat severe pain associated with sickle cell crisis. Platelet transfusions and intravenous immunoglobulin would be used to treat idiopathic thrombocytopenia purpura.

The nurse is conducting a psychosocial assessment of a child with asthma brought to the physician's office for a check-up. Which of the following are psychosocial issues that might be assessed? Select all answers that apply. A)Health insurance coverage B)Transportation to health care facilities C)School's response to the chronic illness D)Past medical history E)Future treatment plans F)Health maintenance needs

A,B.C.Comprehensive health supervision includes frequent psychosocial assessments. Issues to be covered include health insurance coverage, transportation to health care facilities, financial stressors, family coping, and the school's response to the chronic illness. These are often stressful and emotionally charged issues. Past medical history, future treatment plans, and health maintenance needs would also be assessed; however, these are not psychosocial issues.

The nurse referring a child to home care discusses the advantages and disadvantages with the child's family. Which of the following are disadvantages of this method of health care? Select all answers that apply. A)The nurse is performing care of the child in the family's home. B)The home care nurse is not always equipped to perform technical care. C)The out-of-pocket cost of home care is more expensive. D)The technical procedures may be overwhelming for the family. E)The financial burden may cause more stress for the family. F)The child does not receive continuity of care provided in the hospital setting.

A,C,D,E. There are some disadvantages to home care. The presence of health care professionals in the home can be an intrusion on family privacy. Financial issues can become a large burden: families may have higher out-of-pocket costs if their insurance does not reimburse for home care. Having one parent at home full time and not earning an income can contribute to increased financial strain, not to mention social isolation of that parent. All of these can lead to increased stress on family members. Also, caring for children with complex medical needs can be overwhelming for some families. The home care nurse should arrange for continuity of care for the child.

The nurse is assessing a child who is suspected of having Guillain-Barré syndrome. Which assessment findings would the nurse correlate as supporting this diagnosis? Select all answers that apply. A)Recent cytomegalovirus infection B)Hyperactive deep tendon reflexes C)Numbness in the lower extremities D)Sustained clonus E)Difficulty swallowing

A,C,D. Guillain-Barré syndrome is often preceded by a viral or bacterial infection such as cytomegalovirus infection. Deep tendon reflexes are usually decreased or absent. Typically the disorder begins with muscle weakness and paresthesias such as numbness and tingling. Difficulty swallowing also may be present. Sustained clonus is more commonly associated with cerebral palsy.

A child is diagnosed with Kawasaki disease and is in the acute phase of the disorder. Which of the following would the nurse expect the physician to prescribe? Select all answers that apply. A)Intravenous immunoglobulin B)Ibuprofen C)Acetaminophen D)Aspirin E)Alprostadil

A,C,D. In the acute phase, high-dose aspirin in four divided doses daily and a single infusion of intravenous immunoglobulin are used. Acetaminophen is used to reduce fever. Nonsteroidal anti-inflammatory agents such as ibuprofen are avoided while the child is receiving aspirin therapy. Alprostadil is used to temporarily keep the ductus arteriosus patent in infants with ductal-dependent congenital heart defects.

The nurse is aware that the community affects the health of its members. Which of the following statements accurately reflect a community influence of health care? Select all answers that apply. A)A community can be a contributor to a child's health or be the cause of his or her illnesses. B)The child's health should be separated from the health of the surrounding community. C)Community support and resources are necessary for children with significant problems. D)Poverty has not been linked to an increase in health problems in communities. E)The breakdown of community and family support systems can lead to depression and violence. F)Ideally, the child's medical home is located outside the community.

A,C,E. A community can be a contributor to a child's health or be the cause of his or her illnesses. Community support and resources are necessary for children with significant problems since a close working relationship between the child's physician and community agencies is an enormous benefit to the child. Children from communities suffering the large-scale breakdown of family relationships and loss of support systems will be at increased risk for depression, violence and abuse, substance abuse, and HIV infection. The child's health cannot be totally separated from the health of the surrounding community. Poverty has been linked to low birthweight and premature birth, among other health problems. Ideally the child's medical home is within the family's community to reduce barriers such as lack of transportation, expense of travel, and time away from the parents' workplace.

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

A,C,E. 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.

The nurse is providing care to a child with pancreatitis. When reviewing the child's laboratory test results, which of the following would the nurse expect to find? Select all answers that apply. A)Leukocytosis B)Decreased C-reactive protein C)Elevated serum amylase levels D)Positive stool culture E)Decreased serum lipase levels

A,C. With pancreatitis, serum amylase and lipase levels are elevated and levels three times the normal values are extremely indicative of pancreatitis. Leukocytosis is common with acute pancreatitis. C-reactive protein levels may be elevated. Stool cultures are not used to evaluate this disorder. Positive stool cultures would indicate a bacterial cause of diarrhea.

The nurse caring for newborns knows that infants exhibit phenomenal increases in their gross motor skills over the first 12 months of life. Which of the following statements accurately describe the typical infant's achievement of these milestones? Select all answers that apply. A)At 1 month the infant lifts and turns the head to the side in the prone position. B)At 2 months the infant lifts head and looks around. C)At 6 months the infant pulls to stand up. D)At 7 months the infant sits alone with some use of hands for support. E)At 9 months the infant crawls with the abdomen off the floor. F)At 12 months the infant walks independently.

A,D,E,F. At 1 month the infant lifts and turns the head to the side in the prone position. At 7 months the infant sits alone with some use of hands for support. At 9 months the infant crawls with the abdomen off the floor. At 12 months the infant walks independently. At 4 months the infant lifts the head and looks around. At 10 months the infant pulls to stand up.

The nurse is assessing the respiratory system of a newborn. Which of the following anatomic differences place the infant at risk for respiratory compromise? Select all answers that apply. A)The nasal passages are narrower. B)The trachea and chest wall are less compliant. C)The bronchi and bronchioles are shorter and wider. D)The larynx is more funnel shaped. E)The tongue is smaller. F)There are significantly fewer alveoli.

A,D,F. In comparison with the adult, in the infant, the nasal passages are narrower, the trachea and chest wall are more compliant, the bronchi and bronchioles are shorter and narrower, the larynx is more funnel shaped, the tongue is larger, and there are significantly fewer alveoli. These anatomic differences place the infant at higher risk for respiratory compromise. The respiratory system does not reach adult levels of maturity until about 7 years of age.

The nurse is preparing a hospitalized 7-year-old girl for a lumbar puncture. Which of the following actions would help reduce her stress related to the procedure? Select all answers that apply. A)Pretend to perform the procedure on her doll. B)Explain the procedure to her in medical terms. C)Do not allow her to see or touch the equipment. D)Teach her the steps of the procedure. E)Tell her not to pay attention to any sounds she might hear. F)Introduce her to the health care personnel.

A,D,F. Useful techniques for reducing stress in children include the following: perform nursing care on stuffed animals or dolls and allow the child to do the same, teach the child the steps of the procedure or inform him or her exactly what will happen during the hospital stay, introduce the child to the health care personnel with whom he or she will come in contact, avoid the use of medical terms, allow the child to handle some equipment, show the child the room where he or she will be staying, explain the sounds the child may hear, and let the child sample the food that will be served.

The nurse is teaching the mother of a 5-year-old boy with a history of impaction how to administer enemas at home. Which of the following responses from the mother indicates a need for further teaching? A)"I should position him on his abdomen with knees bent." B)"He will require 250 to 500 mL of enema solution." C)"I should wash my hands and then wear gloves." D)"He should retain the solution for 5 to 10 minutes."

A. A 5-year-old child should lie on his left side with his right leg flexed toward the chest. An infant or toddler is positioned on his abdomen. Using 250 to 500 mL of solution, washing hands and wearing gloves, and retaining the solution for 5 to 10 minutes are appropriate responses.

A nurse is reviewing the medical record of a child and finds that the child has a grade III murmur. After auscultating the child's heart sounds, the nurse would document this murmur as which of the following? A)Loud without a thrill B)Loud with a precordial thrill C)Soft and easily heard D)Loud, audible with a stethoscope

A. A grade III murmur is loud without a thrill. Grade II is soft and easily heard. Grade IV is loud with a precordial thrill. Grade V is characterized as loud, audible with a stethoscope.

After assessing a child's blood pressure, the nurse determines the pulse pressure and finds that it is narrowed. Which of the following would the nurse identify as associated with this finding? A)Aortic stenosis B)Patent ductus arteriosus C)Aortic insufficiency D)Complete heart block

A. A narrowed pulse pressure is associated with aortic stenosis. A widened pulse pressure is associated with patent ductus arteriosus, aortic insufficiency, fever, anemia, or complete heart block

A child requires supplemental oxygen therapy at 8 liters per minute. Which delivery device would the nurse most likely expect to be used? A)Simple mask B)Venturi mask C)Nasal cannula D)Oxygen hood

A. A simple mask would be used to deliver a flow rate of 8 liters per minute. A Venturi mask would be used to deliver a specific percentage of oxygen, from 24% to 50%. A nasal cannula would be used to deliver no more than 4 liters per minute. An oxygen hood requires a liter flow of 10 to 15 liters per minute

The nurse is preparing to provide tracheostomy care to an infant. After gathering the necessary equipment, which of the following would the nurse do next? A)Position the infant supine with a towel roll under the neck B)Cut the new tracheostomy ties to the appropriate length C)Cut the tracheostomy ties from around the tracheostomy tube D)Cleanse around the site of the tracheostomy with the prescribed solution

A. After gathering the necessary equipment, the nurse would position the infant supine with a blanket or towel roll to extend the neck. Then the nurse would open all the packaging and cut the new tracheostomy ties to the appropriate length. This would be followed by cleaning the site with the appropriate solution and then rinsing it. After placing the precut sterile gauze under the tracheostomy tube, the nurse would cut the ties and remove them from the tube while an assistant holds the tube in place.

11. The nurse determines that it is necessary to implement airborne precautions for children with which of the following infections? A) Measles B) Streptococcus group A C) Rubella D) Scarlet fever

A. Airborne precautions are designed to reduce the risk of infectious agents transmitted by airborne droplet nuclei or dust particles such as for children with measles, varicella, or tuberculosis. Droplet precautions would be used for children with streptococcal group A infections, rubella, and scarlet fever

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

A. 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.

The nurse is preparing a class for a group of adolescents about promoting safety. Which of the following would the nurse plan to include as the leading cause of adolescent injuries? A)Car accidents B)Firearms C)Water D)Fires

A. Although firearms, water, and fires all pose a risk for injury for adolescents, most adolescent injuries are due to motor vehicle crashes.

The nurse is examining a 15-month-old child who was able to walk at the last visit and now can no longer walk. What would be the nurse's best intervention in this case? A)Schedule a full evaluation since this may indicate a neurologic disorder. B)Note the regression in the child's chart and recheck in another month. C)Document the findings as a developmental delay since this is a normal occurrence. D)Ask the parents if they have changed the child's schedule to a less active one.

A. Any child who "loses" a developmental milestone—for example, the child able to sit without support who now cannot—needs an immediate full evaluation, since this indicates a significant neurologic problem.

The nurse is teaching a new mother about the drastic growth and developmental changes her infant will experience in the first year of life. Which of the following describes a developmental milestone occurring in infancy? A)By 6 months of age the infant's brain weighs half that of the adult brain; at age 12 months, the brain weighs 2.5 times what it did at birth. B)Most infants triple their birthweight by 4 to 6 months of age and quadruple their birthweight by the time they are 1 year old. C)The head circumference increases rapidly during the first 6 months: the average increase is about 1 inch per month. D)The heart triples in size over the first year of life; the average pulse rate decreases from 120 to 140 in the newborn to about 100 in the 1-year-old.

A. By 6 months of age the infant's brain weighs half that of the adult brain; at age 12 months, the brain weighs 2.5 times what it did at birth. Most infants double their birthweight by 4 to 6 months of age and triple their birthweight by the time they are 1 year old. The head circumference increases rapidly during the first 6 months: the average increase is about 0.6 inch (1.5 cm) per month. The heart doubles in size over the first year of life. As the cardiovascular system matures, the average pulse rate decreases from 120 to 140 in the newborn to about 100 in the 1-year-old

The mother of a school-age child brings the child to the clinic for evaluation because he is having difficulty reading. His last visual screening was normal. He also complains of headaches and dizziness. Which of the following would the nurse suspect? A)Astigmatism B)Myopia C)Hyperopia D)Nystagmus

A. Children with astigmatism often have blurry vision and difficulty seeing letters as a whole, affecting their reading ability. They may have headaches and dizziness and often learn to tilt their heads slightly so that they can focus more effectively (which leads to normal vision screenings). Children with myopia can see well at close range but have difficulty focusing well on the blackboard or other objects at a distance. Hyperopia is characterized by blurriness at close range, with the ability to see at a distance. Nystagmus is manifested by a very rapid irregular eye movement

After teaching the parents of a 9-year-old girl about safety, which statement indicates the need for additional teaching? A)"She can ride in the front seat of the car once she is 10 years old." B)"We need to buy her a helmet so she can ride her scooter." C)"She should ride her bike with the traffic on the side of the road." D)"We signed her up for swim lesions at the local community center."

A. Children younger than 12 years of age must sit in the back seat of the car. Laws in most states require helmets for riding bicycles and scooters. When riding a bike, the child should ride on the side of the road traveling with the traffic. Children should know how to swim. If swimming skills are limited, the child must wear a life preserver at all times.

A group of students are reviewing information about gallbladder disease in children. The students demonstrate a need for additional review when they identify which of the following? A)Cholesterol gallstones are more frequently found in males. B)Pigment stones are found primarily in the common bile duct. C)Pancreatitis is a common complication of cholecystitis in children. D)Cholecystitis is due to chemical irritation from obstructed bile flow.

A. Cholesterol gallstones are seen more often in females than males and increased risk occurs with age and onset of puberty. Pigment stones are usually found in the common bile duct. Pancreatitis is a common complication in children with gallstone disease. Cholecystitis is an inflammation of the gallbladder that is caused by chemical irritation due to the obstruction of bile flow from the gallbladder into the cystic ducts

The nurse is caring for a hospitalized 13-year-old girl, who is questioning everything the medical staff is doing and is resistant to treatment. How should the nurse respond? A)"Let's work together to plan your day along with your treatments." B)"The sooner you cooperate, the sooner you are going to leave." C)"If you are more cooperative, perhaps we can arrange a visit from friends." D)"Please don't make me call your parents about this."

A. Collaborating with the adolescent will provide the teen with increased control. The nurse should work with the teen to provide a mutually agreeable schedule that allows for the teen's preferences while incorporating the required nursing care. Threatening to call the parents will most likely promote further resistance. The nurse should try to immediately engage the girl, rather than making the nurse's cooperation conditional upon the girl's cooperation. Telling the girl that the sooner she cooperates, the sooner she will leave is inappropriate. The nurse is incorrectly implying that her behavior, rather than her medical needs, is going to determine when she will be discharged from the hospital

A child with Duchenne muscular dystrophy is to receive prednisone as part of his treatment plan. After teaching the child's parents about this drug, which statement by the parents indicates the need for additional teaching? A)"We should give this drug before he eats anything." B)"We need to keep a close eye for possible infection." C)"The drug should not be stopped suddenly." D)"He might gain some weight with this drug."

A. Corticosteroids such as prednisone can cause gastric upset, so the medication should be given with food to reduce this risk. The drug may mask the signs of infection, so the parents need to monitor the child closely for any changes. Treatment with this drug should not be stopped abruptly due to the risk for acute adrenal insufficiency. Common side effects of this drug include weight gain, osteoporosis, and mood changes.

A nurse is preparing a teaching plan for the family of a child with allergic rhinitis. When describing the immune reaction that occurs, the nurse would identify the role of which immunoglobulin? A)IgA B)IgE C)IgG D)IgM

B. The immunoglobulin involved in the immune response associated with allergic rhinitis is IgE. IgA, IgG, and IgM are not involved in this response

The nurse is assessing the neuromusculoskeletal system of a newborn. Which of the following would the nurse identify as an abnormal finding? A)Sluggish deep tendon reflexes B)Full range of motion in extremities C)Absence of hypotonia D)Lack of purposeful muscular control

A. Deep tendon reflexes are present at birth and are initially brisk in the newborn and progress to average over the first few months. Sluggish deep tendon reflexes indicate an abnormality. The newborn is capable of spontaneous movement but lacks purposeful control. Full range of motion is present at birth. Healthy infants and children demonstrate normal muscle tone; hypertonia or hypotonia is an abnormal finding.

The nurse is preparing a teaching plan for the family and their 6-year-old son who has just been diagnosed with diabetes mellitus. Which of the following would the nurse identify as the initial goal for the teaching plan? A)Developing management and decision-making skills B)Educating the parents about diabetes mellitus type 1 C)Developing a nutritionally sound, 30-day meal plan D)Promoting independence with self-administration of insulin

A. Developing basic management and decision-making skills related to the diabetes is the initial goal of the teaching plan for this child and family. The nurse would have provided a basic description of the disorder after it was diagnosed. Development of a detailed monthly meal plan would come later, perhaps after consulting with a nutritionist. It is too soon to expect the boy to administer his own insulin.

The physician has ordered rectal diazepam (Valium) for a 2-year-old boy with status epilepticus. Which of the following instructions is essential for the nurse to teach the parents? A)Monitor their child's level of sedation. B)Watch for fever indicating infection. C)Gradually reduce the dosage as seizures stop. D)Monitor for an allergic reaction to the medication.

A. Diazepam is useful for home management of prolonged seizures and requires that the parents be educated on its proper administration. Monitoring the child's level of sedation is key when giving diazepam because it slows the central nervous system. Parents need to monitor the overall health of the child, including temperature when needed, but that has nothing to do with the diazepam. When the use of an anticonvulsant is stopped, gradual reduction of the dosage is necessary to prevent seizures or status epilepticus. This is not done without a physician's order. Monitoring for allergic reactions is necessary when any medications have been prescribed, but is not specific to diazepam

The nurse is assessing a 7-year-old boy with pharyngitis. The nurse would least likely expect to assess which of the following? A)Working hard to breathe B)Difficulty swallowing C)Rash on the abdomen D)Sore throat and headache

A. Disorders of the nose and throat do not result in increased work of breathing, so that would not be observed by the nurse. Difficulty swallowing, sore throat, and headache are consistent with pharyngitis, as is the rash, which would be fine, red, and sandpaper-like (called scarlatiniform)

A new mother expresses concern to the nurse that her baby is crying and grunting when passing stool. What is the nurse's best response to this observation? A)"This is normal behavior for infants unless the stool passed is hard and dry." B)"This is normal behavior for infants due to the immaturity of the gastrointestinal system." C)"This indicates a blockage in the intestine and must be reported to the physician." D)"This is normal behavior for infants unless the stool passed is black or green."

A. Due to the immaturity of the gastrointestinal system, newborns and young infants often grunt, strain, or cry while attempting to have a bowel movement. This is not of concern unless the stool is hard and dry. Stool color and texture may change depending on the foods that the infant is ingesting. Iron supplements may cause the stool to appear black or very dark green.

The nurse explains to parents of school-age children that according to Kohlberg's theory of moral development, their child is at the conventional stage of moral development. What is the motivation for school-age children to follow rules? A)They follow rules out of a sense of being a "good person." B)They follow rules out of fear of being punished. C)They follow rules in order to receive praise from caretakers. D)They follow rules because it is in their nature to do so.

A. During the school-age years, the child's sense of morality is constantly being developed. According to Kohlberg, the school-age child is at the conventional stage of moral development. The 7- to 10-year-old usually follows rules out of a sense of being a "good person." He or she wants to be a good person to his or her parents, friends, and teachers and to himself or herself.

16. After teaching a class on the role of white blood cells in infection, the instructor determines that the teaching was successful when the class identifies which type of white blood cells as important in combating bacterial infections? A)Neutrophils B)Eosinophils C)Basophils D)Lymphocytes

A. Elevations in certain portions of the white blood cell count reflect different processes occurring in the body. Neutrophils function to combat bacterial infection. Eosinophils function in allergic disorders and parasitic infections. Basophils combat parasitic infections and some allergic disorders. Lymphocytes function in viral infections.

The nurse observing toddlers in a day care center notes that they may be happy and pleasant one moment and overreact to limit setting the next minute by throwing a tantrum. What is the focus of the toddler's developmental task that is driving this behavior? A)The need for separation and control B)The need for love and belonging C)The need for safety and security D)The need for peer approval

A. Emotional development in the toddler years is focused on separation and individuation. The focus in infancy is on love and belonging, and the need for peer approval occurs in the adolescent. Safety and security are concerns in all levels of development, but not the primary focus.

The nurse working in community nursing uses epidemiology as a tool. What information can be obtained using this process? A)Health needs of a population B)Cultural needs of a population C)Income levels of a population D)Mortality rates of a population

A. Epidemiology can help determine the health and health needs of a population and assist in planning health services. Community health nurses perform epidemiologic investigations in order to help analyze and develop health policy and community health initiatives. The nurse provides culturally competent care but does not use epidemiology to determine culture, income levels, or mortality rates of children.

The nurse uses family-centered care to care for children in a pediatric office. Upon what concept is family-centered care based? A)The family is the constant in the child's life and the primary source of strength. B)The care provider is the constant in the child's life and the primary source of strength. C)The child must be prepared to be his or her own source of strength during times of crisis. D)The wishes of the family should direct the nursing care plan for the child.

A. Family-centered care involves a partnership between the child, family, and health care providers in planning, providing, and evaluating care. Family-centered care enhances parents' and caregivers' confidence in their own skills and also prepares children and young adults for assuming responsibility for their own health care needs. It is based on the concept that the family is the constant in the child's life and the primary source of strength and support for the child.

A nurse is caring for a 14-year-old girl scheduled for a barium swallow/upper gastrointestinal (GI) series. Before providing instructions, which of the following would be the priority? A)Screening the girl for pregnancy B)Reminding her to drink plenty of fluids after the procedure C)Ordering a bowel prep D)Reminding the girl about potential light-colored stools

A. Females of reproductive age must be screened for pregnancy prior to the test because radiography is used. A bowel prep is not necessary for a barium swallow/upper GI series. The reminders about fluids and light-colored stools are appropriate but are not the first priority.

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

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

The nurse is providing care to a child with folliculitis. Which of the following would the nurse expect to administer? A)Topical mupirocin B)Oral cephalosporin C)Intravenous oxacillin D)Topical Eucerin cream

A. For folliculitis, topical mupirocin is indicated in conjunction with aggressive hygiene and warm compresses. Oral cephalosporins are used for nonbullous impetigo if there are numerous lesions. Intravenous oxacillin is used for severe cases of staphylococcal scalded skin syndrome. Topical Eucerin cream is used for atopic dermatitis.

When assessing the vision of a 2-month-old, the nurse would use which of the following? A)Black-and-white checkerboard B)Red and blue circles C)Gray and blue animal drawings D)Green and yellow letters

A. For infants younger than 6 months of age, objects such as a black-and-white checkerboard or concentric circles are best because an infant's vision is more attuned to these high-contrast patterns than to colors. High-contrast animal figures such as pandas or Dalmatians also work well.

When providing care to a child with aplastic anemia, which nursing diagnosis most likely would be the priority? A)Risk for injury B)Imbalanced nutrition, less than body requirements C)Ineffective tissue perfusion D)Impaired gas exchange

A. For the child with aplastic anemia, safety is of the utmost concern, with injury prevention essential to prevent hemorrhage. Nutrition, tissue perfusion, and gas exchange may or may not be associated with the child's condition.

A group of students are reviewing information about glucose-6-phosphate dehydrogenase (G6PD) deficiency. The students demonstrate understanding of the material when they identify this disorder as due to which of the following? A)X-linked recessive inheritance B)Deficiency in clotting factors C)An excess supply of iron D)Autosomal recessive inheritance

A. G6PD deficiency is an X-linked recessive disorder that affects the functioning of the red blood cells. A deficiency in clotting factors is associated with disorders such as idiopathic thrombocytopenia purpura, DIC, or hemophilia. An excess supply of iron refers to hemosiderosis, a complication of thalassemia, an autosomal recessive disorder.

The mother of a 14-year-old girl complains to the nurse that her daughter is moody, shuts herself in her room, and fights with her younger sister. Which of the following comments is most valuable to the mother? A)"Calmly talk to her about your concerns." B)"This is normal for her age." C)"She may be hanging with a bad crowd." D)"Set some rules for family etiquette."

A. Getting the mother and daughter talking and sharing information is the most valuable advice. Telling the mother that this is normal does nothing for the family situation. Setting rules will alienate the child. Suggesting an underlying problem can cause a rift between the mother and daughter.

25. The parents of a 5-year-old have just found out that their child has head lice. Which statement by the parents would support the nursing diagnosis of deficient knowledge? A) "I can't believe it. We're not unclean, poor people." B) "We'll have to get that special shampoo." C) "Everybody in the house will need to be checked." D) "That explains his complaints of itching on his neck."

A. Head lice is not an indication of poor hygiene or poverty. It occurs in all socioeconomic groups. Thus, the parents' statement about being unclean and poor reflects a lack of knowledge about the infection. A pediculicide is used to wash the hair to treat the infestation. Household contacts need to be examined and treated if affected. Extreme pruritus is the most common symptom, with nits or lice especially behind the ears or at the nape of the neck.

The nurse is using the formula for bladder capacity to measure the bladder capacity of a 9-year-old girl. What number would the nurse document for this measurement? A)9 ounces B)10 ounces C)11 ounces D)12 ounces

C. The formula for bladder capacity is age in years plus 2 ounces. Therefore, the bladder capacity of the 9-year-old would be 11 ounces.

A child with increased intracranial pressure is being treated with hyperventilation. The nurse understands the need for this treatment is based on which of the following? A)PaCO2 levels decrease, causing vasoconstriction. B)Drainage of cerebrospinal fluid occurs. C)Activity is controlled via a stimulator. D)Hyperexcitability of the nerves is reduced.

A. Hyperventilation decreases PaCO2, which results in vasoconstriction and therefore decreases intracranial pressure. A shunt would allow for drainage of cerebrospinal fluid. A vagal nerve stimulator is used to provide an appropriate dose of stimulation to manage seizure activity. Anticonvulsants decrease the hyperexcitability of nerves

The mother of a hospitalized child reports that her daughter, who is having some difficulty eating, just had a 4-ounce cup of ice chips. The nurse documents this on the child's intake flow sheet as which of the following? A)2 ounces B)4 ounces C)6 ounces D)8 ounces

A. Ice chips are included as fluid intake, and the amount is approximately equivalent to half the same amount of water. Therefore, the nurse would document this fluid intake as 2 ounces.

The nurse is developing a plan of care for a 5-year-old child with a severe hearing impairment focusing on psychosocial interventions based on assessment findings. Which behavior would the nurse have most likely assessed? A)Immature emotional behavior B)Self-stimulatory actions C)Inattention and vacant stare D)Head tilt or forward thrust

A. Immature emotional behavior would be seen most frequently. The inability to hear impacts the socialization process and causes social problems for the child because the hearing impairment has inhibited normal development. Self-stimulatory actions, inattention, vacant stare, head tilt, or forward thrust may also cause problems with socialization, but they are typical of visually impaired children.

The nurse is preparing to assess the pulse of an 18-month-old child. Which pulse would be most difficult for the nurse to palpate? A)Radial B)Brachial C)Pedal D)Femoral

A. In a child younger than 2 years of age, the radial pulse is very difficult to palpate, whereas the pedal, brachial, and femoral pulses are usually easily palpated.

The nurse is taking a health history of an 11-year-old girl with recurrent abdominal pain. Which of the following responses would lead the nurse to suspect irritable bowel syndrome? A)"I always feel better after I have a bowel movement." B)"I don't take any medicine right now." C)"The pain comes and goes." D)"The pain doesn't wake me up in the middle of the night."

A. In cases of irritable bowel syndrome, the pain may be relieved by defecation. Use of medications and pain that comes and goes or wakes the person up in the middle of the night are all relevant findings pertinent to recurrent abdominal pain

The nurse performing a health history on a child asks the parents if their child has experienced increased appetite or thirst. What body system is the nurse assessing with this question? A)Endocrine B)Genitourinary C)Hematologic D)Neurologic

A. Indicators of problems with the endocrine system include increased thirst, excessive appetite, delayed or early pubertal changes, and problems with growth. For the genitourinary system the nurse would assess urinary patterns and genitals. For the hematologic system the nurse would assess lymph nodes, skin color, and bruising. Signs of neurologic problems include numbness, tingling, difficulty learning, altered mood or ability to stay alert, tremors, tics, and seizures.

The nurse is inspecting the genitals of a prepubescent girl. Which of the following are normal signs of the onset of puberty? A)Appearance of pubic hair around 11 to 13 years old B)Swelling or redness of the labia minora C)Presence of a small amount of downy pubic hair D)Lesions on the external genitalia

A. Infants and young girls (particularly those of dark-skinned races) may have a small amount of downy pubic hair. Otherwise, the appearance of pubic hair indicates the onset of pubertal changes, sometimes prior to breast changes. Pubic hair generally begins to appear by age 11 years, with age 13 being the latest. Redness or swelling of the labia may occur with infection, sexual abuse, or masturbation. Lesions on the external genitalia may indicate sexually transmitted infection.

The nurse is educating the parents of a 7-year-old boy with asthma about the medications that have been prescribed. Which of the following drugs would the nurse identify as an adjunct to a b2-adrenergic agonist for treatment of bronchospasm? A)Ipratropium B)Montelukast C)Cromolyn D)Theophylline

A. Ipratropium is an anticholinergic administered via inhalation to produce bronchodilation without systemic effects. It is generally used as an adjunct to a b2-adrenergic agonist. Montelukast decreases the inflammatory response by antagonizing the effects of leukotrienes. Cromolyn prevents release of histamine from sensitized mast cells. Theophylline provides for continuous airway relaxation

The mother of a 7-year-old girl tells the school nurse that her child is deathly afraid of going to school. What would be the best intervention the nurse could suggest in this situation? A)Return the child to school and investigate the cause of the fear. B)Have the child stay home from school until any issues causing this fear are resolved. C)Investigate a new school for the child to attend that the child will not be afraid of. D)Tell the child that privileges will be taken away if she does not return to school.

A. It is important to investigate specific causes of school refusal/school phobia and take appropriate action. The parents should return the child to school, investigate the cause of the fear, support the child, collaborate with teachers, and praise success in school attendance. This is not a situation for punishment, and changing schools would not solve the child's school phobia.

After teaching a group of parents about language development in toddlers, which of the following if stated by a member of the group indicates successful teaching? A)"When my 3-year-old asks 'why?' all the time, this is completely normal." B)"A 15-month-old should be able to point to his eyes when asked to do so." C)"At age 2 years, my son should be able to understand things like under or on." D)"An 18-month-old would most likely use words and gestures to communicate."

A. Language development occurs rapidly in a toddler. By age 3 years, the child asks "why?" Pointing to named body parts is characteristic of a 2-year-old. Understanding concepts such as on, under, or in is typical of a 3-year-old. A 1-year-old would communicate with words and gestures.

The parents of a 4-year-old who is a picky eater ask the nurse what foods to include in their child's diet to provide adequate iron consumption. Which of the following foods would the nurse recommend? A)Cooked lentils B)Whole milk C)Oranges D)Sweet potatoes

A. Lentils are a good source of iron. Whole milk, oranges, and sweet potatoes are good sources of calcium.

The nurse is caring for a 14-year-old boy with an osteosarcoma. Which of the following communication techniques would be least effective for him? A)Letting him choose juice or soda to take pills B)Seeking the teenager's input on all decisions C)Discussing the benefits of chemotherapy with him D)Avoiding undue criticism of noncompliance

A. Letting the child choose juice or soda to take pills is the least effective communication technique for an adolescent. It may provide some sense of control, but is not as effective as seeking his input on all care decisions, including him during discussions of the benefits of chemotherapy, and avoiding undue criticism of noncompliance.

When providing anticipatory guidance to parents about lying during the preschool period, which of the following would the nurse emphasize? A)"You need to determine the reason for lying before punishing the child." B)"Lying typically occurs because the child is afraid of being punished." C)"The misbehavior is usually more serious than the lying itself." D)"It is okay to become angry when dealing with the child's lying."

A. Lying is common in preschool children and occurs for a variety of reasons, such as fearing punishment, getting carried away by imagination, or imitating what another person has done. Regardless, the parent should ascertain the reason for the lying before punishing the child. The child also needs to learn that the lying is usually far worse than the misbehavior. Parents need to remain calm and serve as a role model of an even temper.

13. A mother brings her 8-year-old son for evaluation because of a rash on his lower leg. Which finding would support the suspicion that the child has Lyme disease? A) Playing in the woods about a week ago B) Rash is papular and vesicular C) High fever occurring about 4 days before the rash D) Complaints of extreme pruritus with visible nits

A. Lyme disease is caused by the bite of an infected tick, with a rash appearing 7 to 14 days after the tick bite. Ticks are commonly found in wooded areas. Therefore, reports of the child playing in the woods about 7 days ago would support the diagnosis of Lyme disease. A papular and vesicular rash is commonly associated with varicella (chickenpox). A high fever for 3 to 5 days before a rash suggests roseola. Extreme pruritus with visible nits would suggest pediculosis.

8. The nurse is performing a physical examination of an 8-year-old girl who was bitten by her kitten. Which of the following assessments would lead the nurse to suspect cat-scratch disease? A) Swollen lymph nodes B) Strawberry tongue C) Infected tonsils D) Swollen neck

A. Lymph nodes, especially under the arms, can become painful and swollen due to cat-scratch disease. Strawberry tongue is typical of scarlet fever. Infected tonsils and an edematous neck are symptoms of diphtheria

A nurse is preparing a presentation for a local health fair about meningitis and has developed a display that lists the following causes: Streptococcus group BHaemophilus influenzae type B Streptococcus pneumoniae Neisseria meningitidis Which of these would the nurse highlight as the most common cause of meningitis in newborns? A)Streptococcus group B B)Haemophilus influenzae type B C)Streptococcus pneumoniae D)Neisseria meningitides

A. Meningitis due to Streptococcus group B along with Escherichia coli is most common in newborns and infants. H. influenzae type B is a common cause in infants between the ages of 6 and 9 months. S. pneumoniae and N. meningitides are common causes in children older than 3 months and in adults

When developing the plan of care for a child with cerebral palsy, which treatment would the nurse expect as least likely? A)Skeletal traction B)Physical therapy C)Orthotics D)Occupational therapy

A. Skeletal traction would be the least likely treatment for a child with cerebral palsy. Physical therapy, orthotics and braces, and occupational therapy are all common treatments used for cerebral palsy.

The nurse in a community clinic is caring for a 6-month-old boy and his mother. Which of the following is the priority intervention to promote adequate growth? A)Monitoring the child's weight and height B)Encouraging a more frequent feeding schedule C)Assessing the child's current feeding pattern D)Recommending higher-calorie solid foods

A. Monitoring the child's weight and height is the priority intervention to promote adequate growth. Encouraging a more frequent feeding schedule, assessing the child's current feeding pattern, and recommending higher-calorie solid foods are interventions when the nursing diagnosis is that nutrition level does not meet body requirements.

The nurse is describing the maturation of various organ systems during toddlerhood to the parents. Which would the nurse correctly include in this description? A)Myelinization of the brain and spinal cord is complete at about 24 months. B)Alveoli reach adult numbers by 3 years of age. C)Urine output in a toddler typically averages approximately 30 mL/hour. D)Toddlers typically have strong abdominal muscles by the age of 2.

A. Myelinization of the brain and spinal cord continues to progress and is complete around 24 months of age. Alveoli reach adult numbers usually around the age of 7. Urine output in a toddler typically averages 1 mL/kg/hour. Abdominal musculature in a toddler is weak, resulting in a pot-bellied appearance.

A child with heart failure is receiving supplemental oxygen. The nurse understands that in addition to improving oxygen saturation, this intervention also helps to do which of the following? A)Cause vasodilation B)Increase pulmonary vascular resistance C)Promote diuresis D)Mobilize secretions

A. Oxygen improves oxygen saturation and also functions as a vasodilator and decreases pulmonary vascular resistance. Diuretics promote dieresis. Chest physiotherapy helps to mobilize secretions.

The nurse working in a community clinic attempts to establish a free vaccination program to refer low-income families. What is the key strategy for success when implementing a health promotion activity? A)Partnership development B)Funding for projects C)Finding an audience D)Adequate staffing

A. Partnership development is the key strategy for success when implementing a health promotion activity. Identifying key stakeholders from the community allows problems to be solved and provides additional venues for disseminating information. Funding, finding an audience, and staffing a project are elements of a public health promotion activity, but developing a partnership helps empower children and families at the individual and community levels to develop resources to optimize their health.

The nurse is caring for a child hospitalized with Reye syndrome who is in the acute stage of the illness. The nurse would assess the child most carefully for which of the following? A)Indications of increased intracranial pressure B)An increase in the blood glucose level C)A decrease in the liver enzymes D)A presence of protein in the urine

A. Reye syndrome is characterized by brain swelling, liver failure, and death in hours if treatment is not initiated. Therefore, increased intracranial pressure could occur. Liver enzyme levels typically increase. Blood glucose levels and protein in the urine are not characteristic of this illness

The nurse is conducting a well-child assessment for a 5-year-old boy in preparation for kindergarten. The boy's grandmother is his primary caregiver because the boy's mother has suffered from depression and substance abuse issues. The nurse understands that the child is at increased risk for which developmental problem? A)Lack of social and emotional readiness for school B)Stuttering C)Speech and language delays D)Fine motor skills delay

A. Risk factors for lack of social and emotional readiness for school include insecure attachment in the early years, maternal depression, parental substance abuse, and low socioeconomic status.

A child with diabetes insipidus is being treated with vasopressin. The nurse would assess the child closely for signs and symptoms of which of the following? A)Syndrome of inappropriate antidiuretic hormone (SIADH) B)Thyroid storm C)Cushing syndrome D)Vitamin D toxicity

A. SIADH, although rare in children, is a potential complication of excessive administration of vasopressin. Thyroid storm may result from over administration of levothyroxine (thyroid hormone replacement). Cushing syndrome is associated with corticosteroid use. Vitamin D toxicity may result from the use of vitamin D as treatment of hypoparathyroidism.

The nurse is conducting a physical examination of a child with a suspected cardiovascular disorder. Which of the following findings would the nurse most likely expect to assess if the child had transposition of the great vessels? A)Significant cyanosis without presence of a murmur B)Abrupt cessation of chest output with an increase in heart rate/filling pressure C)Soft systolic ejection D)Holosystolic murmur

A. Significant cyanosis without presence of a murmur is highly indicative of transposition. Abrupt cessation of chest output accompanied by an increase in heart rate and filling pressure is indicative of cardiac tamponade. A soft systolic ejection or holosystolic murmur can be found with other disorders, such as hypoplastic left heart syndrome, but is not highly suspicious of transposition

The nurse is caring for a premature baby in the NICU. The mother reports that the infant's normally happy and outgoing 5-year-old sister is acting sad and withdrawn. The nurse understands that due to her developmental stage, the girl is at risk of which of the following? A)Viewing her baby sister's illness as her fault B)Harming the baby C)Experiencing clinical depression D)Creating an imaginary friend to cope with the situation

A. Since the preschool child is facing the psychosocial task of initiative versus guilt, it is natural for the child to experience guilt when something goes wrong. The child may have a strong belief that if someone is ill or dying, he or she may be at fault and the illness or death is punishment. It is less likely that the girl would be at risk of harming the baby or experiencing clinical depression as a result of the baby's illness. The child may create an imaginary friend to cope with the illness, but would not withdraw or express sadness as a result of the imaginary friend.

The mother of a 5-year-old girl brings the child to the clinic for an evaluation. The mother tells the nurse, "She seems to be so tired and irritable lately. And she looks so pale." Further assessment reveals pale conjunctiva and oral mucous membranes. The nurse suspects iron-deficiency anemia. Which additional finding would help provide additional evidence for this suspicion? A)Spooned nails B)Negative splenomegaly C)Oxygen saturation: 99% D)Bradycardia

A. Spooning or concave shape of the nails suggests iron-deficiency anemia. Other findings would include decreased oxygen saturation levels, tachycardia, and possible splenomegaly.

The nurse is caring for a 7-year-old girl hospitalized in isolation. The nurse notices that she has begun sucking her thumb and changing her speech patterns to those of a toddler. What condition is the girl manifesting? A)Regression B)Suppression C)Repression D)Denial

A. Sucking the thumb and changing the speech pattern (such as to baby talk) are signs of regression, a defense mechanism used by children to deal with unpleasant experiences by returning to a previous stage that may be more comfortable to the child. Suppression is a conscious inhibition of an idea or desire. Repression is an unconscious inhibition of an idea or desire. Denial would be exhibited by expressions of resignation instead of true contentment, not thumb sucking or baby talk

The nurse is caring for a 3-year-old girl with a respiratory disorder. The nurse anticipates the need for providing supplemental oxygen to the child when performing which of the following? A)Suctioning a tracheostomy tube B)Administering drugs with a nebulizer C)Providing tracheostomy care D)Suctioning with a bulb syringe

A. Supplemental oxygenation may be necessary before, and is always performed after, suctioning a child with a tracheostomy tube. Providing tracheostomy care, administering drugs with a nebulizer, and suctioning with a bulb syringe do not require supplemental oxygen

The nurse is helping the parents and their underweight adolescent collaborate on planning a healthy menu. Of which of the following nutritional requirements of adolescents should the nurse be aware? A)Teenagers have a need for increased calories, zinc, calcium, and iron for growth. B)Teenage girls who are active require about 1,800 calories per day. C)Teenage boys who are active require between 2,000 and 2,500 calories per day. D)Adolescents require about 1,000 to 1,200 mg of calcium each day.

A. Teenagers have a need for increased calories, zinc, calcium, and iron for growth. However, the number of calories needed for adolescence depends on the teen's age and activity level as well as growth patterns. Teenage girls who are active require about 2,200 calories per day. Teenage boys who are active require between 2,500 and 3,000 calories per day. Adolescents require about 1,200 to 1,500 mg of calcium each day.

The nurse is interviewing a 3-year-old girl who tells the nurse: "Want go potty." The parents tell the nurse that their daughter often speaks in this type of broken speech. What would be the nurse's appropriate response to this concern? A)"This is a normal, common speech pattern in the 3-year-old and is called telegraphic speech." B)"This is considered a developmental delay in the 3-year-old and we should consult a speech therapist." C)"This is a condition known as echolalia and can be corrected if you work with your daughter on language skills." D)"This is a condition known as stuttering and it is a normal pattern of speech development in the toddler."

A. Telegraphic speech is common in the 3-year-old. Telegraphic speech refers to speech that contains only the essential words to get the point across, much like a telegram. In telegraphic speech the nouns and verbs are present and are verbalized in the appropriate order. Echolalia (repetition of words and phrases without understanding) normally occurs in toddlers younger than 30 months of age. "Why" and "what" questions dominate the older toddler's language. Stuttering usually has its onset at between 2 and 4 years of age. It occurs more often in boys than in girls. About 75% of all cases of stuttering resolve within 1 to 2 years after they start

The parents of a 1-year-old girl, both of whom have perfect teeth, are concerned about their child getting dental caries. Which is the best advice the nurse can provide? A)Tell the parents to limit the child's eating to meal and snack times. B)Urge the parents to take the child to a dentist for a check-up. C)Advise the parents to reduce carbohydrates in the child's diet. D)Advise the parents to use fluoride toothpaste.

A. Telling the parents to limit eating to meal and snack times is the best advice for preventing dental caries. This reduces the amount of exposure the child's teeth have to food. Urging them to take the child to see a dentist is sound advice but doesn't suggest actions they can take now to prevent caries. Carbohydrates react with oral bacteria to cause caries, but they should not be reduced from the diet. Avoiding fluoridated toothpaste may help prevent fluorosis.

During a physical assessment of a 5-month-old child, the nurse observes the first tooth has just erupted and uses the opportunity to advise the mother to schedule a dental examination for her baby. Which of the following is the correct time for the dentist visit? A)By the first birthday B)By the second birthday C)By entry into kindergarten D)By entry into first grade

A. The American Academy of Pediatric Dentistry recommends that a dentist examine the infant by his or her first birthday. Besides assessing routine oral health care, establishing a dental contact by the first birthday provides a resource for emergency dental care if it is needed.

The nurse is conducting a physical examination of a toddler with suspected lead poisoning. Lab results indicate blood lead level 52 g/dL. Which action would the nurse expect to happen next? A)Repeat testing within 2 days and prepare to begin chelation therapy as ordered B)Repeat testing within 1 week with education to decrease lead exposure C)Confirm with repeat testing in 1 month and referral to local health department D)Prepare to admit child to begin chelation therapy

A. The American Academy of Pediatrics' recommendation for blood lead levels of 45 to 69 g/dL is to confirm with repeat lab within 2 days and begin chelation therapy. The nurse should also expect to refer to the local health department for investigation of home lead reduction. Lead levels greater than 70 g/dL require immediate hospitalization. Repeat testing in 1 month and education would be appropriate for levels between 15 and 19 g/dL. Repeat testing in 1 week with parent education is appropriate for lead levels between 20 and 44 g/dL.

The nurse contacts a child life specialist (CLS) to work with children on a pediatric ward. What is the primary goal of the CLS? A)Decrease anxiety and fear during hospitalization and painful procedures B)Keep children who are hospitalized distracted from pain C)Perform medical procedures using atraumatic principles D)Act as a liaison between the nurse and the child

A. The CLS is a specially trained individual who provides programs that prepare children for hospitalization, surgery, and other procedures that could be painful (Child Life Council, 2010a, 2010b). The goal of the CLS is to decrease the anxiety and fear while improving and encouraging understanding and cooperation of the child. The CLS may use distraction techniques and act as a liaison, but that is not the primary goal of the CLS role. The CLS does not perform medical procedures.

The nurse teaches parents of adolescents that adolescents need the support of parents and nurses to facilitate healthy lifestyles. Which of the following should be a priority focus of this guidance? A)Reducing risk-taking behavior B)Promoting adequate physical growth C)Maximizing learning potential D)Teaching personal hygiene routines

A. The adolescent experiences drastic changes in the physical, cognitive, psychosocial, and psychosexual areas. With this rapid growth during adolescence, the development of secondary sexual characteristics, and interest in the opposite sex, the adolescent needs the support and guidance of parents and nurses to facilitate healthy lifestyles and to reduce risk-taking behaviors. Promoting physical growth, maximizing learning potential, and teaching hygiene are secondary to reducing risky behavior.

The nurse is explaining to parents that the preschooler's developmental task is focused on the development of initiative rather than guilt. Which of the following is a priority intervention the nurse might recommend for parents of preschoolers to stimulate initiative? A)Reward the child for initiative in order to build self-esteem. B)Change the routine of the preschooler often to stimulate initiative. C)Do not set limits on the preschooler's behavior as this results in low self-esteem. D)As a parent, decide how and with whom the child will play.

A. The building of self-esteem continues throughout the preschool period. It is of particular importance during these years, as the preschooler's developmental task is focused on the development of initiative rather than guilt. A sense of guilt will contribute to low self-esteem, whereas a child who is rewarded for his or her initiative will have increased self-confidence. Routine and ritual continue to be important throughout the preschool years, as they help the child to develop a sense of time as well as provide the structure for the child to feel safe and secure. Also, consistent limits provide the preschooler with expectation and guidance. Giving children opportunities to decide how and with whom they want to play also helps them develop initiative.

The nurse is performing an annual check-up for an 8-year-old child. Compared to the previous assessment of this child, which of the following characteristics would most likely be observed? A)Breathing is diaphragmatic. B)Pulse rate is increased. C)Secondary sex characteristics are present. D)Blood pressure has reached adult level.

A. The child's respiratory system is maturing, so abdominal breathing has been replaced by diaphragmatic breathing. Pulse rate will decrease, rather than increase, during this time. Secondary sex characteristics will not appear until the late school-age years. Blood pressure will not reach the adult level until adolescence

The nurse is caring for a 7-month-old girl during a well-child visit. Which of the following interventions is most appropriate for this child? A)Discussing the type of sippy cup to use B)Advising about increased caloric needs C)Explaining how to prepare table meats D)Describing the tongue extrusion reflex

A. The cup may be introduced at 6 to 8 months of age. Old-fashioned sippy cups are preferred compared to the new style. The nurse would not advise about increased caloric needs as caloric needs drop at this age. Transition to table meat will not take place until age 10 to 12 months. Tongue extrusion reflex has disappeared at age 4 to 6 months.

An 8-month-old infant is brought to the clinic for evaluation. The mother tells the nurse that she has noticed some white patches on the infant's tongue that look like curdled milk after breastfeeding. The nurse suspects oral candidiasis (thrush). Which question would the nurse use to help confirm this suspicion? A)"Are you having breast pain when you nurse the baby?" B)"Has he had any dairy problems recently?" C)"Is he experiencing any vomiting lately?" D)"How have his stools been this past week?"

A. The infant may develop thrush from the mother if the mother has a fungal infection of the breast. Asking the mother about breast pain would be important because this type of infection can cause the mother a great deal of pain with nursing. Dairy products are not associated with oral candidiasis but are associated with the development of infectious diarrhea in infants. Vomiting is unrelated to thrush. The infant also may have candidal diaper rash, but this would be manifested on the skin as a beefy-red rash with satellite lesions, not in his stools.

A 4-year-old boy has a history of seizures and has been started on a ketogenic diet. Which of the following food selections would be most appropriate for his lunch? A)Fried eggs, bacon, and iced tea B)A hamburger on a bun, French fries, and milk C)Spaghetti with meatballs, garlic bread, and a cola drink D)A grilled cheese sandwich, potato chips, and a milkshake

A. The ketogenic diet involves a high intake of fats, adequate protein intake, and a very low intake of carbohydrates, resulting in a state of ketosis. The child is kept in a mild state of dehydration. Eggs and bacon are high in fat; the tea does not contain any carbohydrates. Therefore, this is the best choice. The hamburger is fat and protein, the bun is a carbohydrate, and the French fries and the milk both contain fat and protein, but both contain a lot of carbohydrates. The pasta and the sauce for the spaghetti are carbohydrates, the meatballs are protein, and the garlic bread is a carbohydrate, as is the cola drink. The grilled cheese sandwich has the fat and protein from the cheese, but the bread and chips are primarily carbohydrates, and the milkshake has fat, protein, and carbohydrates. Only the selection in A contains a ketogenic meal

A group of students are reviewing information about head injuries in children. The students demonstrate understanding of this information when they identify which of the following as the most common type of skull fracture in children? A)Linear B)Depressed C)Diastatic D)Basilar

A. The most common type of skull fracture in children is a linear skull fracture, which can result from minor head injuries. Other, less common types of skull fractures in children include depressed, diastatic, and basilar.

The nurse is teaching the parents of an overweight 18-month-old girl about diet. Which intervention will be most effective for promoting proportionate growth? A)Remove high-calorie, low-nutrient foods from the diet. B)Ensure 30 minutes of unstructured activity per day. C)Avoid sharing your snacks and candy with the child. D)Reduce the amount of high-fat food the child eats.

A. The most effective intervention will be to remove high-calorie, low-nutrient foods from the diet in order to reduce the number of calories and increase the nutritional value. Exercise is also important, but a child this age should have 30 minutes of structured physical activity plus several hours of unstructured physical activity per day. The parents should set an example for good eating habits. Dietary fat should not be restricted for an 18-month-old child because it is necessary for nervous system development

The nurse is assessing heart rate for children on the pediatric ward. Which of the following is a normal finding based on developmental age? A)An infant's rate is 90 bpm. B)A toddler's rate is 150 bpm. C)A preschooler's rate is 130 bpm. D)A school-age child's rate is 50 bpm.

A. The normal heart rate for an infant is 80 to 150 bpm, for a toddler is 70 to 120 bpm, for a preschooler is 65 to 110 bpm, and for a school-age child is 60 to 100 bpm.

Community-based nursing provides opportunities that are quite different from acute care nursing. Which of the following job characteristics is unique to home care nursing? A)Experiencing a greater amount of independence B)Building a close relationship with the family C)Coordinating therapy services and reimbursements D)Focusing teaching on child independence

A. The nurse in the home care setting experiences a greater amount of independence due to the lack of co-workers, supervisors, or doctors. Building a close relationship with the family, coordinating services and reimbursement, and teaching self-care to the child are not unique to the home care setting

The nurse is conducting a routine health assessment of a 3-month-old boy and notices a flat occiput. The nurse provides teaching and emphasizes the importance of tummy time. Which of the following responses by the mother indicates a need for further teaching? A)"He must be positioned on his tummy as much as possible." B)"I need to watch him during his tummy time." C)"I need to change his head position while he is in an upright chair." D)"His head has flattened due to the pressure of his head position."

A. The nurse needs to emphasize that the boy must have tummy time while he is observed and awake, and to remind the mother that the baby should still sleep on his back. The other statements are correct.

The nurse is caring for a child with a spinal cord injury and providing instruction to the parents on promoting skin integrity. Which response from the mother indicates a need for further teaching? A)"I need to monitor his skin at least twice a week." B)"I must monitor skin affected by his adaptive equipment." C)"He must change positions frequently." D)"We must avoid harsh cleaning products."

A. The nurse needs to emphasize to the mother that she must monitor the condition of the entire surface of the skin several times daily to provide a baseline and allow for early identification of areas at risk. Monitoring the skin affected by adaptive equipment, changing positions frequently, and avoiding harsh cleaning products are appropriate.

The nurse is caring for a child with widespread itching and has recommended bathing as a relief measure. After teaching the mother about this, which statement from the mother indicates a need for further instruction? A)"After bathing, I need to rub his skin everywhere to make sure he is completely dry." B)"I must make sure I use lukewarm water instead of hot water." C)"Oatmeal baths are helpful; we can add Aveeno skin relief bath treatment." D)"We should leave his skin moist before applying medication or moisturizer."

A. The nurse needs to emphasize to the mother that she must only pat the child dry and not rub his skin. Rubbing can cause further itching. Additionally, the skin should be left moist prior to applying medication or moisturizer. Lukewarm water and oatmeal baths are appropriate.

The nurse is caring for a child with thalassemia who is receiving chelation therapy at home using a battery-operated pump. After teaching the parents about this treatment, which statement by the mother indicates a need for additional teaching? A)"I can have the nurse administer the chelation therapy if I am uncomfortable." B)"I must be very careful to strictly adhere to the chelation regimen." C)"The deferoxamine binds to the iron so it can be removed from the body." D)"The medication can be administered while my child is sleeping."

A. The nurse needs to emphasize to the mother that therapy must be maintained at home to continuously decrease the iron levels in the child's body. Family members need to be taught to administer deferoxamine subcutaneously with a small battery-powered infusion pump over a several-hour period each night (usually while the child is sleeping).

The nurse is providing postoperative care for a 14-month-old girl who has undergone a myelomeningocele repair. The girl's mother is extremely anxious and tells the nurse she is afraid she will never learn how to care for her daughter at home. Which response by the nurse would be most appropriate? A)"I will help you become comfortable in caring for your daughter." B)"You must learn how to care for your daughter at home." C)"You will need to learn to collaborate with all the caregivers." D)"There is a lot to learn, and you need a positive attitude."

A. The nurse needs to empower families to become the experts on their child's needs and conditions via education and participation in care. The most positive approach is to let the mother know the nurse will support her and help her become an expert on her daughter's care. Telling the mother that she must learn how to care for her daughter or that she must have a positive attitude is not helpful. Telling her that she needs to collaborate with the caregivers is true, but does not address her fears

The nurse is caring for a 3-year-old girl with short bowel syndrome as a result of trauma to the small intestine. The girl's mother is extremely anxious and tells the nurse she is afraid she will never learn how to care for her daughter at home. How should the nurse respond? A)"I will help you become an expert on your daughter's care." B)"You must learn how to care for your daughter at home." C)"You really need the support of your husband." D)"There is a lot to learn and you need a positive attitude."

A. The nurse needs to empower families to become the experts on their children's needs and conditions via education and participation in care. The most positive approach in this case is to let the mother know the nurse will support her and help her become an expert on her daughter's care. Telling the mother that she must learn how to care for her daughter or that she must have a positive attitude is not helpful. Telling her that she needs the support of her husband is irrelevant and unhelpful.

During a health check-up without his parents, a 17-year-old tells the nurse he is gay. Which of the following approaches should the nurse take? A)"Tell me what makes you think you are gay." B)"This puts you in an at-risk category." C)"We need to talk about safe sex." D)"You're not gay; you're confused."

A. The nurse needs to get more information from the teenager (assessment) before making any comment and then proceed in a sensitive and caring way. Comments about being at risk or needing to know about safe sex are negative and should be replaced with health promotion comments. Denying the statement shows the teenager that you are not an ally.

The nurse is enlisting the parents' assistance for therapeutic hugging prior to an otoscopic examination. What should the nurse emphasize to the parents? A)"You will need to keep his hands down and his head still." B)"If this does not work, we will have to apply restraints." C)"If you are not capable of this, let me know so I can get some assistance." D)"I may need you to leave the room if your son will not remain still."

A. The nurse needs to provide a specific explanation of the parents' role and what body parts to hold still in a safe manner. Implying that the parents may not be capable or may have to leave the room is inappropriate. Telling the parents that restraints may be required is not helpful, does not teach, and may be perceived as a threat

The nurse is caring for a 14-month-old boy with rickets who was recently adopted from overseas. His condition was likely a result of a diet very low in milk products. The nurse is providing teaching regarding treatment. Which response by the parents indicates a need for further teaching? A)"We must give him calcium and phosphorus with food every morning." B)"He must take vitamin D as prescribed and spend some time in the sunlight." C)"He must take calcium at breakfast and phosphorus at bedtime." D)"We should encourage him to have fish, dairy, and liver if he will eat it."

A. The nurse should emphasize that the calcium and phosphorus supplements should be administered at alternate times to promote proper absorption of both of these supplements. Taking vitamin D, spending time in the sun, and encouraging intake of fish, dairy, and liver are appropriate responses

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

A. 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

The nurse is caring for a 5-year-old girl post tonsillectomy. The girl looks out the window and tells the nurse that it is raining and says, "The sky is crying because it is sad that my throat hurts." The nurse understands that the girl is demonstrating which mental process? A)Magical thinking B)Centration C)Transduction D)Animism

A. The nurse understands that the girl is demonstrating magical thinking. Magical thinking is a normal part of preschool development. The preschool-age child believes her thoughts to be all-powerful. Transduction is reasoning by viewing one situation as the basis for another situation whether or not they are truly causally linked. Animism is attributing life-like qualities to inanimate objects. Centration is focusing on one aspect of a situation while neglecting others

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

A. 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

The nurse is teaching the student nurse the sequence for performing the assessment techniques during a physical examination. What is the appropriate order? A)Inspection, palpation, percussion, auscultation B)Inspection, percussion, palpation, auscultation C)Palpation, percussion, inspection, auscultation D)Inspection, auscultation, palpation, percussion

A. The physical examination of children, just as for adults, begins with a systematic inspection: checking color, warmth, characteristics, and texture visually and smelling for any odor. Palpation follows inspection to validate observations. Next percussion is used to determine the location, size, and density of organs or masses. The stethoscope is used last to auscultate the heart, lungs, and abdomen.

The nurse is developing a plan of care for a 7-year-old boy with diabetes insipidus. Which of the following would the nurse most likely identify as the priority nursing diagnosis? A)Deficient fluid volume related to dehydration B)Excess fluid volume related to edema C)Deficient knowledge related to fluid intake regimen D)Imbalanced nutrition, more than body requirements related to excess weight

A. The priority nursing diagnosis most likely would be deficient fluid volume related to dehydration, due to a deficiency in the secretion of antidiuretic hormone (ADH). Excess fluid would result from a disorder that leads to water retention, such as syndrome of inappropriate antidiuretic hormone (SIADH). Deficient knowledge related to fluid intake regimen is a nursing diagnosis for this child, but a secondary one. Imbalanced nutrition, more than body requirements related to excess weight would be inappropriate for this child since he probably has lost weight secondary to the fluid loss.

The nurse is providing teaching about accidental poisoning to the family of a 3-year-old. The nurse understands that a child of this age is at increased risk of accidental ingestion due to which sensory alteration? A)A less discriminating sense of taste B)A lack of fully developed hearing C)Visual acuity that has not fully developed D)A less discriminating sense of touch

A. The young preschooler may have a less discriminating sense of taste than the older child, making him or her at increased risk for accidental ingestion. A less discriminating sense of touch and developing visual acuity would not increase the risk. Hearing is intact at birth and it does not increase the child's risk for accidental ingestion.

An infant is diagnosed with infantile glaucoma. When developing the plan of care for the infant, the nurse would expect to prepare the infant and family for which of the following? A)Goniotomy B)Antibiotic therapy C)Contact lenses D)Patching of affected eye

A. Therapeutic management of infantile glaucoma is focused on surgical intervention via a goniotomy. Antibiotic therapy would be used to treat an infection. Contact lenses would be indicated for refractive errors and following removal of congenital cataracts. Patching of the affected eye is used for treating amblyopia and after surgery for congenital cataract

A mother brings her 6-year-old son in for a check-up because the child is complaining of stomachaches. It is the beginning of the school year. Which of the following might the mother also mention? A)The child cries before going to school. B)The child made friends the first day of school. C)The child fights with siblings more often. D)The child loves the crowds in the lunchroom.

A. This child has a slow-to-warm-up temperament. The child may also be crying before going to school. Making friends the first day of school and enjoying the crowds in the lunchroom are typical of a child with an easy temperament. Irritability is typical of a child with a difficult temperament.

When evaluating the hemogram of an 8-month-old infant, the nurse would identify which type of hemoglobin as being the predominant type? A)Hemoglobin A B)Hemoglobin F C)Hemoglobin A2 D)Hemoglobin S

A. Three types of normal hemoglobin are present at any given time in the blood: A, F, and A2. By 6 months of age, hemoglobin A is the predominant type. Hemoglobin S is associated with sickle cell disease.

The parent of a 6-month old infant asks the nurse for advice about his son's thumb sucking. What would be the nurse's best response to this parent? A)"Thumb sucking is a healthy self-comforting activity." B)"Thumb sucking leads to the need for orthodontic braces." C)"Caregivers should pay special attention to the thumb sucking to stop it." D)"Thumb sucking should be replaced with the use of a pacifier."

A. Thumb sucking is a healthy self-comforting activity. Infants who suck their thumbs or pacifiers often are better able to soothe themselves than those who do not. Studies have not shown that sucking either thumbs or pacifiers leads to the need for orthodontic braces unless the sucking continues well beyond the early school-age period. The infant who has become attached to thumb sucking should not have additional attention drawn to the issue, as that may prolong thumb sucking. Pacifiers should not be used to replace thumb sucking as this habit will also need to be discouraged as the child grows.

A nurse is preparing a school-aged child for a lumbar puncture. The nurse would expect to position the child in which manner? A)On her side with the head flexed forward and knees flexed to the abdomen B)Sitting upright with the head flexed forward to the chest C)Supine with arms and legs pronated and extended D)Prone with the arms flexed under the chest

A. When a lumbar puncture is performed on a child, the child is placed on his or her side with the head flexed forward and knees flexed to the abdomen. An infant would be positioned sitting upright with the head flexed forward. A supine position with the arms and legs pronated and extended suggests decerebrate posturing. A prone position is not used for a lumbar puncture

The nurse is implementing care for a hospitalized toddler. What communication technique would the nurse use with the child to reflect the child's developmental level? A)Allow the child extra time to complete thoughts. B)Communicate solely through play. C)Provide simple but honest and straightforward responses. D)Remain nonjudgmental to avoid alienation.

A. When working with toddlers and preschoolers, the nurse should allow them time to complete their thoughts. Though language acquisition at this age is exponential, it often takes longer for the young child to find the right words, particularly in response to a query. Infants communicate nonverbally and often through play. School-age children need simple but honest and straightforward responses, and nurses should be nonjudgmental with adolescents to avoid alienating them and to keep lines of communication open.

A 10-month-old is brought to the emergency department by her parents after they found her face down in the bathtub. The mother said, "I just left the bathroom to answer the phone. When I came back, I found her." Which of the following assessments would be the priority? A)Airway, breathing, and circulation B)Level of consciousness C)Vital signs D)Pupillary response

A. With a submersion injury, hypoxia is the primary problem. Therefore, assessment of airway, breathing, and circulation are the priority assessments for which the nurse would institute resuscitative measures. Other assessments such as level of consciousness, vital signs, and papillary response would be done once the child's airway, breathing, and circulation are assessed and emergency interventions are instituted.

When preparing to administer the polio vaccine to an infant, the nurse would expect to administer the vaccine by which route? A)Intramuscular B)Subcutaneous C)Oral D)Intradermal

B. The inactivated polio vaccine (IPV) is the only polio vaccine currently recommended in the United States, and it is administered subcutaneously. Up until the year 2000, the oral polio vaccine (OPV) was used. The polio vaccine is not administered intramuscularly or intradermally.

A child with spastic cerebral palsy is to receive botulin toxin. The nurse prepares the child for administration of this drug by which route? A)Oral B)Subcutaneous injection C)Intramuscular injection D)Intravenous infusion

C. Botulin toxin is administered by injection into the muscle. It may cause dry mouth. It is not administered orally, by subcutaneous injection, or by intravenous infusion.

A mother brings her child to the health care clinic because she thinks that the child has conjunctivitis. Which assessment finding would lead the nurse to suspect bacterial conjunctivitis? Select all answers that apply. A)Itching of the eyes B)Inflamed conjunctiva C)Stringy discharge D)Photophobia E)Mild pain F)Tearing

B,E. Bacterial conjunctivitis is manifested by inflamed conjunctiva, a purulent or mucoid discharge, mild pain, and occasional eyelid edema. Itching and a stringy discharge suggest allergic conjunctivitis. Photophobia and tearing suggest viral conjunctivitis.

A nursing instructor is preparing for a class discussion on spinal muscular atrophy (SMA). When describing type 2 SMA, which of the following would the instructor include? Select all answers that apply. A)Onset before 6 months of age B)Weakness most severe in shoulders and hips C)Difficulty with swallowing D)Slowly progressing condition E)Genetic disease with autosomal recessive inheritance

B, D, E. Any type of spinal muscular atrophy is a genetic motor neuron disease due to autosomal recessive inheritance. Type 2 SMA usually occurs between 6 and 18 months of age, with weakness that is most severe in the shoulders, hips, thighs, and upper back. It is slower in progression than type 1. Survival into adulthood is common if respiratory status is maintained appropriately. Type 1 SMA occurs before birth to 6 months of age and the child usually has difficulty swallowing, sucking, and breathing.

After teaching the parents of a child diagnosed with celiac disease about nutrition, the nurse determines that the teaching was effective when the parents identify which foods as appropriate for their child? Select all answers that apply. A)Wheat germ B)Peanut butter C)Carbonated drinks D)Shellfish E)Jelly F)Flavored yogurt

B,C,D,E. Foods allowed in a gluten-free diet include peanut butter, carbonated drinks, shellfish, and jelly. Wheat germ and flavored yogurt should be avoided.

The nurse observes an infant interacting with his parents. Which of the following are normal social behavioral developments for this age group? Select all answers that apply. A)Around 5 months the infant may develop stranger anxiety. B)Around 2 months the infant exhibits a first real smile. C)Around 3 months the infant smiles widely and gurgles when interacting with the caregiver. D)Around 3 months the infant will mimic the parent's facial movements, such as sticking out the tongue. E)Around 3 to 6 months of age the infant may enjoy socially interactive games such as patty-cake and peek-a-boo. F)Separation anxiety may also start in the last few months of infancy.

B,C,D,F. The infant exhibits a first real smile at age 2 months. By about 3 months of age the infant will start an interaction with a caregiver by smiling widely and possibly gurgling. The 3- to 4-month-old will also mimic the parent's facial movements, such as widening the eyes and sticking out the tongue. Separation anxiety may also start in the last few months of infancy. Around the age of 8 months the infant may develop stranger anxiety. At 6 to 8 months of age the infant may enjoy socially interactive games such as patty-cake and peek-a-boo

The nurse assesses the spirituality of an adolescent. Which of the following are normal moral and spiritual milestones in this age group? Select all answers that apply. A)Adolescents will base their actions on the avoidance of punishment and the attainment of pleasure. B)Adolescents develop their own set of morals and values and question the status quo. C)Adolescents undergo the process of developing their own set of morals at different rates. D)Adolescents are more interested in the spiritualism of their religion than in the actual practices of their religion. E)Adolescents can understand the concepts of right and wrong and are developing a conscience. F)Adolescents are able to understand and incorporate into their behavior the concept of the "golden rule."

B,C,D. It is during the adolescent years that teenagers develop their own set of values and morals at different rates. At the beginning of this stage, teenagers begin to question the status quo. The majority of their choices are based on emotions while they are questioning societal standards. Adolescents also begin to question their formal religious practices. As they progress through adolescence, teenagers become more interested in the spiritualism of their religion than in the actual practices of their religion. The toddler will base his or her actions on the avoidance of punishment and the attainment of pleasure. The preschool child can understand the concepts of right and wrong and is developing a conscience. The school-age child is able to understand and incorporate into his behavior the concept of the "golden rule."

The pediatric nurse is aware of the maturation of organ systems in the school-age child. Which of the following accurately describe these changes? Select all answers that apply. A)The brain grows very slowly during the school-age years and growth is complete by the time the child is 12 years of age. B)Respiratory rates decrease, abdominal breathing disappears, and respirations become diaphragmatic in nature. C)The school-age child's blood pressure increases and the pulse rate decreases, and the heart grows more slowly during the middle years. D)The school-age child experiences more gastrointestinal upsets compared with earlier years since the stomach capacity increases. E)Bladder capacity increases, but varies among individual children, and girls generally have a greater bladder capacity than boys. F)Prepubescence typically occurs in the 2 years before the beginning of puberty and is characterized by the development of secondary sexual characteristics.

B,C,E,F. Respiratory rates decrease, abdominal breathing disappears, and respirations become diaphragmatic in nature. The school-age child's blood pressure increases and the pulse rate decreases. The heart grows more slowly during the middle years and is smaller in size in relation to the rest of the body than at any other development stage. Bladder capacity increases, but varies among individual children. Girls generally have a greater bladder capacity than boys. Prepubescence typically occurs in the 2 years before the beginning of puberty and is characterized by the development of secondary sexual characteristics. The brain and skull grow very slowly during the school-age years. Brain growth is complete by the time the child is 10 years of age. The school-age child experiences fewer gastrointestinal upsets compared with earlier years. Stomach capacity increases, which permits retention of food for longer periods of time.

A group of students are reviewing information about neuromuscular disorders. The students demonstrate understanding of the information when they identify which of the following as examples of autoimmune neuromuscular disorders? Select all answers that apply. A)Cerebral palsy B)Guillain-Barré syndrome C)Myasthenia gravis D)Spinal muscular atrophy E)Dermatomyositis

B,C,E. Autoimmune neuromuscular disorders include Guillain-Barré syndrome, myasthenia gravis, and dermatomyositis. Cerebral palsy is associated with brain anoxia. Spinal muscle atrophy is a genetic motor neuron disease.

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."

B,C,E. 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.

The nurse is performing developmental surveillance for children at a medical home. Which of the following infants are most at risk for developmental delays? Select all answers that apply. A)A child whose birthweight was 1,600 g B)A child whose parent has a mental illness C)A child raised by a single parent D)A child with a lead level above 10 mg/dL E)A child with hypertonia or hypotonia F)A child with gestational age more than 33 weeks

B,C,E. Risk factors for developmental delays include having a single parent, a parent with developmental disability or mental illness, hypertonia or hypotonia, birthweight less than 1,500 g, lead level above 19 mg/dL, and gestational age less than 33 weeks.

The nurse is reviewing the medical record of a child with infective endocarditis. Which of the following would the nurse expect to find? Select all answers that apply. A)White blood cell count revealing leukopenia B)Microscopic hematuria with urinalysis C)Electrocardiogram with prolonged PR interval D)Lungs clear on auscultation E)Petechiae on palpebral conjunctiva

B,C,E. With infective endocarditis, leukocytosis, microscopic hematuria, prolonged PR interval, adventitious lung sounds, and petechiae on the palpebral conjunctiva are noted.

28. A child is diagnosed with a helminthic infection. Which of the following would the nurse expect to be prescribed? Select all answers that apply. A) Erythromycin B) Albendazole C) Pyrantel pamoate D) Acyclovir E) Metronidazole F) Permethrin

B,C. Drugs used to treat helminthic infections include albendazole and pyrantel pamoate. Erythromycin is used to treat bacterial infections. Acyclovir is used to treat viral infections. Metronidazole is used to treat trichomoniasis. Permethrin is used to treat pediculosis

A nurse is preparing a class for parents of infants about managing diaper dermatitis. Which of the following would the nurse include in the presentation? Select all answers that apply. A)Applying topical nystatin to the diaper area B)Using a blow dryer on warm to dry the diaper area C)Refraining from using rubber pants over diapers D)Using scented diaper wipes to clean the area E)Washing the diaper area with an antibacterial soap

B,C. For diaper dermatitis, topical products such as ointments or creams containing vitamins A, D, and E; zinc oxide; or petrolatum help to provide a barrier. Nystatin is an antifungal agent used for diaper candidiasis. Using a blow dryer on warm to dry the area, avoiding the use of rubber pants, and using unscented diaper wipes or ones free of preservatives are appropriate. The area should be washed with a soft cloth, without harsh soaps.

The nurse is preparing a nursing care plan for a child hospitalized for cardiac surgery. Which of the following are examples of interventions that nurses perform in the "building a trusting relationship" stage? Select all answers that apply. A)Gathering information about the child using the child's own toys B)Preparing the child for a procedure by playing games C)Explaining in simple terms what will happen during surgery D)Allowing the child to devise an exercise plan following surgery E)Praising the child for how well he is doing following instructions F)Giving the child a favorite toy to cuddle following a painful procedure

B,C. The introduction phase involves the initial contact with children and their families and it establishes the foundation for a trusting relationship. A trusting relationship can be built by using appropriate language, games, and play such as singing a song during a procedure, preparing the child adequately for procedures, and providing explanations and encouragement. In the decision-making phase, the nurse gives some control over to the child by allowing him to participate in making certain decisions, such as devising an exercise. Finally, the comfort and reassurance phase uses techniques such as praising the child and providing opportunities to cuddle with a favorite toy

The nurse is helping parents prepare a healthy meal plan for their toddler. Which of the following guidelines for promoting nutrition should be followed when planning meals? Select all answers that apply. A)The child younger than 2 years of age should have his or her fat intake restricted. B)Extending breastfeeding into toddlerhood is believed to be beneficial to the child. C)Weaning from the bottle should occur by 6 to 12 months of age. D)Adequate calcium intake and appropriate exercise lay the foundation for proper bone mineralization. E)The toddler requires an average intake of 500 mg calcium per day. F)Toddlers tend to have the highest daily iron intake of any age group.

B,D,E, Extending breastfeeding into toddlerhood is believed to be beneficial to the child as it is known to help prevent obesity. Adequate calcium intake and appropriate exercise lay the foundation for proper bone mineralization. The toddler requires an average intake of 500 mg calcium per day. The child younger than 2 years of age should not have his or her fat intake restricted, but this does not mean that unhealthy foods such as sweets should be eaten liberally. Weaning from the bottle should occur by 12 to 15 months of age. Prolonged bottle-feeding is associated with the development of dental caries. It is important for toddlers to consume adequate amounts of iron since they tend to have the lowest daily iron intake of any age group

The nurse is performing an admission of a 10-year-old boy. Which of the following actions will help the nurse establish a trusting and caring relationship with the child and his family? Select all answers that apply. A)The nurse should not minimize the child's fears by smiling. B)The nurse should initiate introductions. C)The nurse should not use formal titles at the introduction. D)The nurse should maintain eye contact at the appropriate level. E)The nurse should start communication with the child first and then move on to the family. F)The nurse should use age-appropriate communication with the child.

B,D,F. Regardless of the site of care, nursing care must begin by establishing a trusting, caring relationship with the child and family. The nurse should smile, start introductions, give his or her title, and let the child and family know what will happen and what is expected of them. The nurse should also maintain eye contact at the appropriate level, communicate with children at age-appropriate levels, and, with a younger child, start with the family first so the child can see that the family trusts you

The parents of a preschooler ask the nurse to help them choose a preschool for their child. Which of the following are recommended guidelines and goals for choosing a preschool? Select all answers that apply. A)The main goal of preschool is to improve reading and writing skills and readiness for entering into grade school. B)When selecting a preschool the parent may want to consider the accreditation of the school and the teachers' qualifications. C)The teachers should decide how focused on curriculum the school should be for each individual student. D)The parent should observe the classroom, evaluating the environment, noise level, and sanitary practices. E)The type of discipline used in the school is also an important factor. Parents should choose a preschool that uses corporal punishment. F)The parent should observe the classroom to determine how the children interact with each other and how the teachers interact with the children.

B,D,F. When selecting a preschool the parent may want to consider the accreditation of the school, the teachers' qualifications, and recommendations of other parents. The parent should observe the classroom, evaluating the environment, noise level, and sanitary practices, as well as how the children interact with each other and how the teachers interact with the children. The main goal of preschool is to foster the child's social skills and accustom him or her to the group environment. The parents must decide how focused on curriculum they want the school to be. The type of discipline used in the school is also an important factor. Parents should not choose a preschool that uses corporal punishment

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

B,D. 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.

The nurse is preparing a teaching plan for the parents of a child who has been diagnosed with a congenital heart defect. Which of the following would the nurse be least likely to include? A)Daily weight assessment B)Maintenance of strict bed rest C)Prevention of infection D)Signs of complications

B. A child with congenital heart disease should be allowed to engage in activity as tolerated, with rest periods frequently throughout the day to prevent overexertion. Daily weights, infection prevention measures, and signs of complications are all appropriate to include when teaching parents of a child with a congenital heart defect.

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.

B. 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.

While auscultating the heart of a 5-year-old child, the nurse notes a murmur that is soft and quiet and heard each time the heart is auscultated. The nurse documents this finding as which of the following? A)Grade 1 B)Grade 2 C)Grade 3 D)Grade 4

B. A grade 2 murmur is soft and quiet and is heard each time the chest is auscultated. A grade 1 murmur is barely audible and is heard at some times and not at other times. A grade 3 murmur is audible with intermediate intensity. A grade 4 murmur is audible and accompanied by a palpable thrill.

A nurse is reviewing the medical record of a child with hearing loss and notes that the child's hearing loss is in the range 40 to 60 decibels (dB). The nurse interprets this as indicating which of the following? A)Mild loss B)Moderate loss C)Severe loss D)Profound loss

B. A hearing loss of 40 to 60 decibels (dB) indicates a moderate loss; 20 to 40 dB indicates a mild loss; 60 to 80 dB indicates a severe loss; and greater than 80 dB indicates a profound loss

A large portion of the nurse's efforts is dedicated to health supervision for children who use the facility as their primary medical contact. At which of the following facilities does the nurse work? A)An urgent care center B)A pediatric practice C)A mobile outreach immunization program D)A dermatology practice

B. A pediatric practice is most likely to fulfill the characteristics for primary care, also known as a medical home. An urgent care center does not provide preventative care activities. Mobile outreach would not provide for any care requiring hospitalization. A dermatology practice is unlikely to provide service outside its area of specialization.

After teaching the mother about follow-up immunizations for her daughter, who received the varicella vaccine at age 14 months, the nurse determines that the teaching was successful when the mother states that a follow-up dose should be given at which time? A)When the child is 20 to 36 months of age B)When the child is 4 to 6 years of age C)When the child is 11 to 12 years of age D)When the child is 13 to 15 years of age

B. A second dose of varicella vaccine should be given when the child is 4 to 6 years of age. Hepatitis A vaccine should be given to infants at age 12 months, with a repeat dose given in 6 to 12 months. The human papillomavirus (HPV) vaccine should be given to children beginning at age 11 to 12 years, with catch-up doses to begin at 13 to 14 years of age.

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.

B. 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.

Based on Erikson's developmental theory, which of the following is the major developmental task of the adolescent? A)Gaining independence B)Finding an identity C)Coordinating information D)Mastering motor skills

B. According to Erikson, it is during adolescence that teenagers achieve a sense of identity. The toddler developed a sense of trust in infancy and is ready to give up dependence and to assert his or her sense of control and autonomy. The psychosocial task of the preschool years is establishing a sense of initiative versus guilt by mastering skills. In the school-age years the child develops concrete operations and is able to assimilate and coordinate information about the world from different dimensions.

The school nurse is preparing a program on sexuality and birth control for a class of 14- to 16-year-olds. Which of the following behaviors will have the most influence on how the information is presented? A)Teens are adjusting to new body images. B)Adolescents tend to take risks. C)Teenagers are able to think in the abstract. D)Adolescents understand that actions have consequences.

B. Adolescents are risk takers. This tendency enables them to overcome common sense and their own better judgment. Although adolescents are capable of abstract thinking and understand that actions have consequences, they are not yet committed to these attributes. Changing body image would not have significant influence on the presentation.

The nurse is explaining a discharge plan to the parents of an infant being discharged from the hospital. Which of the following characteristics regarding adult learning should the nurse incorporate into her plan? A)Adults are dependent learners. B)Adults are problem focused. C)Adults are future focused. D)Adults do not value past learning.

B. Adults are problem focused and task oriented; they learn best when they perceive there is a gap in their knowledge base and want information and skills to fill the gap. Adults are self-directed; they value independence and want to learn on their own terms. Adults want an immediate need satisfied; they learn best at a time when learning meets an immediate need. Adults value past experiences and beliefs; they bring an accumulated wealth of experiences to each health care encounter

A group of nursing students are reviewing the medications used to treat asthma. The students demonstrate understanding of the information when they identify which agent as appropriate for an acute episode of bronchospasm? A)Salmeterol B)Albuterol C)Ipratropium D)Cromolyn

B. Albuterol is a short-acting b2-adrenergic agonist that is used for treatment of acute bronchospasm. Salmeterol is a long-acting b2-adrenergic agonist used for long-term control or exercise-induced asthma. Ipratropium is an anticholinergic agent used as an adjunct to b2-adrenergic agonists for treatment of bronchospasm. Cromolyn is a mast cell stabilizer used prophylactically but not to relieve bronchospasm during an acute wheezing episode.

The parents of a boy diagnosed with Hirschsprung disease are anxious and fearful of the upcoming surgery. The mother states, "I'm worried about having to care for our son's ostomy." Which intervention would be most helpful for the parents? A)Explaining to them about the diagnosis and surgery B)Having a wound, ostomy, and continence nurse meet with them C)Reinforcing that the ostomy will be temporary D)Teaching them about the medications used to slow stool output

B. Although explaining about the diagnosis and surgery, reinforcing that the ostomy will be temporary, and teaching them about medications would be appropriate, the parents are voicing concerns about caring for the ostomy. Therefore, having a wound, ostomy, and continence nurse meet with them would address these concerns and help them deal with the anxieties and care of a newly placed stoma.

When providing anticipatory guidance to a group of parents with school-aged children, which of the following would the nurse describe as the most important aspect of social interaction? A)School B)Peer relationships C)Family D)Temperament

B. Although school, family, and temperament are important influences on social interaction, peer relationships at this time provide the most important social interaction for school-age children.

The nurse is caring for a 7-year-old boy who needs his left leg immobilized. What is the priority nursing intervention? A)Enlist the assistance of a child life specialist. B)Explain to the boy that he must keep his leg very still. C)Apply a clove-hitch restraint to the boy's left leg. D)Explain that a restraint will be applied if he cannot hold still.

B. An explanation about the desired goal is necessary and appropriate for a 7-year-old child to understand what is required. In many cases, this will be all that is needed. Explaining that a restraint will be applied if the boy cannot hold still will likely be perceived as a threat or punishment. All alternative measures need to be tried before the use of restraints. Enlisting the assistance of the child life specialist is not a priority.

The nurse is talking with a chatty 7-year-old girl during her regular check-up. Which of the following behaviors would the child also be expected to exhibit? A)Showing no interest in what the nurse sees in her ears B)Explaining what is right and what is wrong C)Demonstrating independence from her mother D)Showing no concern when the nurse hurts her own finger

B. At this age, behavior is seen by the child as either completely right or wrong. The child will almost surely want to know why the nurse looks in her ears. The child depends heavily on parents for support and encouragement at this age. This is a time when children gain empathy, so the child would show concern for the nurse's injury.

The nurse is caring for a 2-month-old with cerebral palsy. The infant is limp and flaccid with uncontrolled, slow, worm-like, writhing, and twisting movements. Which of the following would the nurse use when documenting these observations? A)Spastic B)Athetoid C)Ataxic D)Mixed

B. Athetoid cerebral palsy is characterized by abnormal, involuntary movement. It affects all four extremities with possible involvement of the face, neck, and tongue. The movements increase in periods of stress. Dysarthria and drooling may be present as well. Spastic cerebral palsy is characterized by poor control of posture, balance, and movement; exaggeration of deep tendon reflexes; and hypertonicity of affected extremities. Ataxic is characterized by poor coordination, unsteady gait, and wide-based gait

A nurse is inspecting the skin of a child with atopic dermatitis. Which of the following would the nurse expect to observe? A)Erythematous papulovesicular rash B)Dry, red, scaly rash with lichenification C)Pustular vesicles with honey-colored exudates D)Hypopigmented oval scaly lesions

B. Atopic dermatitis or eczema is characterized by a dry, red, scaly rash with lichenification and hypertrophy. An erythematous papulovesicular rash is associated with contact dermatitis. Pustules and vesicles with honey-colored exudates suggest nonbullous impetigo. Hypopigmented oval scaly lesions are associated with tinea versicolor.

After teaching a class about the hemodynamic characteristics of congenital heart disease, the instructor determines that the teaching has been successful when the class identifies which defect as an example of a disorder involving increased pulmonary blood flow? A)Tetralogy of Fallot B)Atrial septal defect C)Hypoplastic left heart syndrome D)Transposition of the great vessels

B. Atrial septal defect is an example of a disorder involving increased pulmonary blood flow. Tetralogy of Fallot is a defect involving decreased pulmonary blood flow. Transposition of the great vessels and hypoplastic left heart syndrome are examples of mixed disorders.

The parents of a 10-year-old girl with a refractive error ask the nurse about the possibility of laser surgery to correct the vision. Which statement by the nurse would be most appropriate? A)"As she gets older, her vision will begin to correct itself." B)"Laser surgery typically is not done until she's 18 years old." C)"She looks so cute in her glasses; why put her through surgery?" D)"She can use contact lenses soon, so surgery isn't necessary."

B. Because of the continuing refractive development in the child's vision through adolescence, laser surgery for vision correction is not recommended by the American Academy of Ophthalmology until 18 years of age. The refractive error will continue to change as the child's vision continues to develop, making the refraction unstable. Thus, corrective lens prescription may change but the refraction error will not correct itself. Glasses still carry a stigma and the child may be teased or bullied. The statement about the child looking cute in her glasses ignores the parents' question and concerns and questions the parents' desire for information. The use of contact lenses does not negate the possibility of surgery. However, laser surgery would have to wait until the child is 18 years of age.

When preparing to apply a restraint to a child, which of the following would be most important for the nurse to do? A)Expect to keep the restraint on for at least 8 hours. B)Explain that safety, not punishment, is the reason for the restraint. C)Plan to use a square knot to secure the restraint to the side rails. D)Use a limb restraint rather than a jacket restraint for most issues.

B. Before applying a restraint, the nurse needs to explain the reason for the restraint to the child, emphasizing that the restraint is for safety, not to punish the child. The least restrictive type of restraint should be used, and it should be applied for the shortest time necessary. A clove-hitch knot is used to secure the restraint with ties to the bed or crib frame, not the side rails.

A child with suspected sickle cell disease is scheduled for a hemoglobin electrophoresis. When reviewing the child's history, which of the following would the nurse identify as potentially interfering with the accuracy of the results? A)Use of iron supplementation B)Blood transfusion 1 month ago C)Lack of fasting for 12 hours D)History of recent infection

B. Blood transfusion within the previous 12 weeks may alter the results of the hemoglobin electrophoresis. Iron supplements can increase serum ferritin levels. Children should fast for 12 hours before having a specimen obtained for iron levels. A history of infection might interfere with the white blood cell count results, not hemoglobin electrophoresis

The nurse is caring for an infant with candidal diaper rash. Which topical agent would the nurse expect the physician to order? A)Corticosteroids B)Antifungals C)Antibiotics D)Retinoids

B. Candidal diaper rash would require a fungicide. The nurse would expect to administer topical antifungals as ordered. Corticosteroids are not typically recommended for young infants and are used for atopic dermatitis and certain types of contact dermatitis. Antibiotics would be ineffective against fungal infections. Retinoids are indicated for moderate to severe acne.

The nurse is assessing a 2-year-old boy who has missed some developmental milestones. Which finding will point to the cause of motor skill delays? A)The mother is suffering from depression. B)The child is homeless and has no toys. C)The mother describes an inadequate diet. D)The child is unperturbed by a loud noise.

B. Children develop through play, so a child without any toys may have trouble developing the motor skills appropriate to his age. Maternal depression is a risk factor for poor cognitive development. Inadequate diet will cause growth deficiencies. A child who does not respond to a loud noise probably has hearing loss, which will lead to a language deficit.

The nurse is caring for a 10-year-old girl who is in an isolation room. Which of the following interventions would be a priority intervention for this child? A)Reduce noise as much as possible. B)Provide age-appropriate toys and games. C)Discourage visits from family members. D)Put on mask prior to entering the room.

B. Children in this setting may experience sensory deprivation due to the limited contact with others and the use of personal protective equipment such as gloves, masks, and gowns. The nurse should stimulate the child by playing with her with age-appropriate toys/games. Reducing noise would be appropriate for sensory overload. The nurse should encourage the family to visit often, introduce him- or herself before entering the room, and allow the child to view his or her face before applying a mask.

The nurse is observing a 24-month-old boy in a day care center. Which finding suggests delayed motor development? A)The child has trouble undressing himself. B)The child is unable to push a toy lawnmower. C)The child is unable to unscrew a jar lid. D)The child falls when he bends over.

B. Children with normal motor development are able to push toys with wheels at 24 months of age. He won't be ready to undress himself, unscrew a jar lid, or bend over without falling until about 36 months of age.

A nursing instructor is preparing a class on chronic lung disease. Which of the following would the instructor include when describing this disorder? A)It is a result of cystic fibrosis. B)It is seen most commonly in premature infants. C)It typically affects females more often than males. D)It is characterized by bradypnea.

B. Chronic lung disease, formerly known as bronchopulmonary dysplasia, is often diagnosed in infants who have experienced respiratory distress syndrome, most commonly seen in premature infants. Male gender is a risk factor for development. Tachypnea and increased work of breathing are characteristic of chronic lung disease.

The nurse is inspecting the fingernails of an 18-month-old girl. Which of the following findings indicates chronic hypoxemia? A)Nails that curve inward B)Clubbing of the nails C)Nails that curve outward D)Dry, brittle nails

B. Clubbing of the nails indicates chronic hypoxemia related to either respiratory or cardiac disease. Nails that curve inward or outward may be hereditary or linked with injury, infection, or iron-deficiency anemia. Dry, brittle nails may indicate a nutritional deficiency.

During a health history, the nurse explores the sleeping habits of a 3-yearold boy by interviewing his parents. Which of the following statements from the parents reflects a recommended guideline for promoting healthy sleep in this age group? A)"Our son sleeps through the night, and we insist that he takes two naps a day." B)"We keep a strict bedtime ritual for our son, which includes a bath and bedtime story." C)"Our son still sleeps in a crib because we feel it is the safest place for him at night." D)"Our son occasionally experiences night walking so we allow him to stay up later when this happens."

B. Consistent bedtime rituals help the toddler prepare for sleep; the parent should be advised to choose a bedtime and stick to it as much as possible. The nightly routine might include a bath followed by reading a story. A typical toddler should sleep through the night and take one daytime nap. Most children discontinue daytime napping at around 3 years of age. When the crib becomes unsafe (that is, when the toddler becomes physically capable of climbing over the rails), then he or she must make the transition to a bed. Attention during night waking should be minimized so that the toddler receives no reward for being awake at night.

The nurse is teaching the parents of a 9-year-old girl about the socialization that is occurring in their child through school contacts. Which of the following information would the nurse include in her teaching plan? A)Teachers are the most influential people in the development of the school-age child's social network. B)Continuous peer relationships provide the most important social interaction for school-age children. C)Parents should establish norms and standards that signify acceptance or rejection. D)A characteristic of school-age children is their formation of groups with no rules and values involved.

B. Continuous peer relationships provide the most important social interaction for school-age children. Peer and peer-group identification are most essential to the socialization of the school-age child. Peer groups establish norms and standards that signify acceptance or rejection. Valuable lessons are learned from interactions with children their own age. A characteristic of school-age children is their formation of groups with rules and values.

A group of nursing students are reviewing information about inflammatory bowel disease in preparation for a class discussion on the topic. The students demonstrate understanding of the material when they identify which of the following as characteristic of Crohn disease? Select all answers that apply. A)Distributed in a continuous fashion. B)Most common between the ages of 10 to 20 years C)Elevated erythrocyte sedimentation rate D)Low serum iron levels E)Tenesmus F)Loss of haustra within bowel

B. Crohn disease is most common between the ages of 10 and 20 years. Erythrocyte sedimentation rate is elevated and serum iron levels are low. Ulcerative colitis is distributed continuously distal to proximal, with tenesmus and loss of haustra within the bowel. Crohn disease is segmental, with disease-free skip areas common, and the bowel wall has a cobblestone appearance.

When conducting a physical examination of a child with suspected Kawasaki disease, which of the following would the nurse expect to assess? A)Hirsutism or striae B)Strawberry tongue C)Malar rash D)Café au lait spots

B. Dry, fissured lips and a strawberry tongue are common findings with Kawasaki disease. Acne, hirsutism, and striae are associated with anabolic steroid use. Malar rash is associated with lupus. Café au lait spots are associated with neurofibromatosis.

The parents of a 5-year-old boy tell the nurse that their son is having frequent episodes of night terrors. Which of the following statements would indicate that the boy is having nightmares instead of night terrors? A)"It usually happens about an hour after he falls asleep." B)"He will tell us about what happened in his dream." C)"He is completely unaware that we are there." D)"When we try to comfort him, he screams even more."

B. During a nightmare, a child will have a memory of the occurrence and may remember the dream and talk about it later. With night terrors, the child has no memory of the event. The other statements are indicative of night terrors.

Which of the following would the nurse most likely find in a 10-year-old child in the period of concrete operational thought? A)Participation in abstract thinking B)Ability to classify similar objects C)Problem solving via the scientific method D)Ability to make independent decisions

B. During the period of concrete operational thought, children are able to classify or group objects based on their common elements. Abstract thinking, problem solving via the scientific method, and independent decision making are higher-level functions, typically seen in adolescents.

The nurse is caring for an 8-year-old boy with myasthenia gravis and is teaching his parents about the signs of cholinergic crisis. Which of the following responses by the parents indicates a need for further teaching? A)"Low blood pressure is a sign of crisis." B)"He might have difficulty swallowing." C)"He may start to sweat a lot." D)"More saliva in the mouth is a common sign."

B. Dysphagia is a sign of myasthenic crisis. Increased salivation, hypotension, and increased sweating are signs and symptoms of cholinergic crisis.

Which of the following would the nurse include in the preoperative plan of care for an infant with myelomeningocele? A)Positioning supine with a pillow under the buttocks B)Covering the sac with saline-soaked nonadhesive gauze C)Wrapping the infant snugly in a blanket D)Applying a diaper to prevent fecal soiling of the sac

B. For the infant with a myelomeningocele, saline-soaked nonadhesive gauze or antibiotic-soaked gauze is used to keep the sac moist. The infant is positioned prone, with a folded towel under the abdomen, so that the urine and feces flow away from the sac. A warmer or isolette is used to keep the infant warm. Blankets are avoided because they could place excess pressure on the sac. Diapering may be contraindicated to avoid placing pressure on the sac.

The nurse is educating a first-time mother who has a 1-week-old boy. Which of the following is the most accurate anticipatory guidance? A)Describing the effect of neonatal teeth on breastfeeding B)Explaining that the stomach holds less than 1 ounce C)Informing that fontanels will close by 6 months D)Telling that the step reflex persists until the child walks

B. Explaining that the child's stomach holds less than 1 ounce gives the mother a reason for frequent, small feedings and is the most helpful and accurate anticipatory guidance. Telling that the step reflex persists until the child walks and informing that fontanels will close by 6 months are inaccurate. The step reflex disappears at about 2 months and fontanels close between 12 and 18 months. Neonatal teeth are highly unusual and need no explanation unless they occur

A nurse is caring for a 14-year-old girl following myelography. Which of the following would be the priority nursing action? A)Monitoring for a decrease in spasticity B)Observing for signs of meningeal irritation C)Assessing motor function D)Observing for mental confusion or hallucinations

B. Following myelography, the nurse should carefully observe for signs of meningeal irritation because of what is involved in this procedure. Monitoring for a decrease in muscle spasticity, assessing motor function, and observing for mental confusion or hallucinations is appropriate following an intrathecal test dose of baclofen.

A 5-year-old child with type 1 diabetes is brought to the clinic by his mother for a follow-up visit after having his hemoglobin A1C level drawn. Which result would indicate to the nurse that the child is achieving long-term glucose control? A)9.0% B)8.2% C)7.3% D)6.9%

B. For a child 6 years of age and younger, the target HbA1C level should be less than 8.5% but greater than 7.5%. For children between the ages of 6 to 12 years, the target HbA1C level is less than 8%. For children and adolescents between 13 to 19 years of age, the target HbA1C level would be less than 7.5%.

The nurse is teaching the student nurse how to perform a physical assessment based on the child's developmental stage. Which of the following statements accurately describes a recommended guideline for setting the tone of the examination for a school-age child? A)Keep up a running dialogue with the caregiver, explaining each step as you do it. B)Include the child in all parts of the examination; speak to the caregiver before and after the examination. C)Speak to the child using mature language and appeal to his or her desire for self-care. D)Address the child by name; speak to the caregiver and do the most invasive parts last.

B. For a school-age child, the nurse should include the child in all parts of the examination, and speak to the caregiver before and after the examination. For a newborn the nurse should keep up a running dialogue with the caregiver, explaining each step as it is done. The nurse should speak to the early teen using mature language and appeal to his or her desire for self-care. For an infant, the nurse should address the child by name, and speak to the caregiver and do the most invasive parts last.

A child is diagnosed with bacterial conjunctivitis and is prescribed topical antibiotic therapy. The child's mother asks when he can return to school. Which response by the nurse would be most appropriate? A)"You need to wait until you finish the entire prescription of antibiotic." B)"Once the drainage is gone, he can go back to school." C)"You can send him to school this afternoon after his first dose of antibiotic." D)"He needs to be symptom-free for at least 72 hours."

B. For the child with bacterial conjunctivitis, the child may safely return to school or day care when the mucopurulent drainage is no longer present, usually after 24 to 48 hours of treatment with the topical antibiotic. There is no need to wait until the prescription is finished. The antibiotic is being given topically, not systemically. One dose of antibiotic is not sufficient to eradicate the infection. Typically 24 to 48 hours of treatment is needed to stop the drainage, which, when no longer present, indicates that the child can return to school

The nurse is performing a physical assessment of a 10-year-old boy. The nurse notes that during last year's check-up the child weighed 80 pounds. According to average growth for this age group, what would be his expected current weight? A)83 pounds B)85 pounds C)87 pounds D)89 pounds

B. From 6 to 12 years of age, an increase of 4 to 6 pounds (2 to 3 kg) per year in weight is expected.

The nurse is performing a physical examination of an 11-year-old girl. Which of the following observations would be expected? A)The child has not gained weight since last year. B)The child has grown 3 inches since last year. C)The child breathes abdominally. D)The child's third molars are about to erupt.

B. From 6 to 12 years of age, children grow an average of 2 inches (5 cm) per year, increasing their height by at least 1 foot. An increase of 4 to 6 pounds (2 to 3 kg) per year in weight is expected. Abdominal breathing is typical of a preschooler and would have disappeared several years earlier. The third molars do not erupt until late adolescence.

7. After teaching a mother how to remove a tick from her 6-year-old boy's arm, the nurse determines that additional teaching is needed when the mother states which of the following? A) "I'll protect my fingers with a paper towel." B) "I'll grasp the tick and pull it away quickly." C) "I should put the tick in a plastic bag in the freezer." D) "I need to grasp the tick close to the child's skin."

B. Grasping the tick and pulling it away quickly would indicate the need for additional teaching. When removing a tick, the mother should use fine-tipped tweezers while protecting her fingers with a tissue, paper towel, or latex gloves. The mother should grasp the tick as close to the skin as possible and pull upward with steady, even pressure. Once removed, the mother should place the tick in a sealable plastic bag in the freezer in case the child becomes sick and identification of the tick is needed

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

B. 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.

The nurse is incorporating nonverbal communication with verbal communication when explaining the treatment plan for a child with juvenile diabetes. Which of the following should the nurse do to communicate effectively with this family? A)Relax; maintain an open posture, with the arms crossed. B)Sit opposite the family and lean forward slightly. C)Use eye contact sparingly to avoid embarrassment. D)Speak a verbal yes or no; do not use head nods.

B. Guidelines for appropriate nonverbal communication include the following: sit opposite the family and lean forward slightly; relax: maintain an open posture, with the arms uncrossed; maintain eye contact; and nod your head to demonstrate interest.

A 2-week-old child responds to a bell during an initial health supervision examination. The child's records do not show that a newborn hearing screening was done. Which of the following is the best action for the nurse to take? A)Do nothing because responding to the bell proves he does not have a hearing deficit. B)Immediately schedule the infant for a newborn hearing screening. C)Ask the mother to observe for signs that the infant is not hearing well. D)Screen again with the bell at the 2-month-old health supervision visit.

B. Guidelines for infant hearing screening recommend universal screening with an auditory brain stem response (ABR) or evoked otoacoustic emissions (EOAE) test by 1 month of age. All the other answers rely on behavioral observation. Studies have shown that behavioral observations are not a reliable method of screening for hearing loss.

The nurse is providing parental teaching about home care for an 8-year-old boy with widespread sunburn on his back and shoulders. Which of the following responses indicates a need for further teaching? A)"Cool compresses may help cool the burn." B)"He should manually peel off any flaking skin." C)"Nonsteroidal anti-inflammatory drugs like ibuprofen are helpful." D)"He should avoid hot showers or baths for a couple of days."

B. If skin flaking occurs, the child should be discouraged from manually "peeling" the flaked skin as it can cause further injury. Using cool compresses, taking nonsteroidal anti-inflammatory drugs, and avoiding hot showers or baths are appropriate measures.

The nurse is caring for a newborn and knows that his vision, unlike his hearing, is not fully developed. Which aspect of the child's vision would the nurse expect to be similar to his father's vision? A)Adequate color detection B)Visual acuity of 20/100 C)Nearsightedness D)Monocular vision

B. If the child's father has lost visual acuity, he and his new son could possibly have the same 20/100 vision. Poor color detection, nearsightedness, and monocular vision are characteristic of newborns and are the result of their lack of development.

The nurse is teaching the mother of a toddler about burn prevention. Which response by the mother indicates a need for further teaching? A)"We will leave fireworks displays to the professionals." B)"I will set our water heater at 130 degrees." C)"All sleepwear should be flame retardant." D)"The handles of pots on the stove should face inward."

B. If the temperature of the water heater is set at 130 degrees, a child can be burned significantly in only 30 seconds. The recommended maximal home hot water heater temperature is 120 degrees. Leaving fireworks to the professionals, using flame-retardant sleepwear, and turning the handles of pots on the stove inward are correct.

The mother of a 3-week-old infant old brings her daughter in for an evaluation. During the visit, the mother tells the nurse that her baby is spitting up after feedings. Which response by the nurse would be most appropriate? A)"We need to tell the doctor about this." B)"Infants this age commonly spit up." C)"Your daughter might have an allergy." D)"Don't worry; you're just feeding her too much."

B. In infants younger than 1 month of age, the lower esophageal sphincter is not fully developed, so infants younger than 1 month of age frequently regurgitate after feedings. Many children younger than 1 year of age continue to regurgitate for several months, but this usually disappears with age. The mother's report is not a cause for concern so the physician does not need to be notified. Additional information would be needed to determine if the infant had an allergy. Although the infant's stomach capacity is small, telling the mother not to worry does not address the mother's concern, and telling her that she is feeding the daughter too much implies that she is doing something wrong.

A nurse is leading a discussion with a group of new mothers about newborn nutrition and its importance for growth and development. One of the mothers asks, "Doesn't the baby get iron from me before birth?" Which response by the nurse would be most appropriate? A)"You give the baby some iron, but it is not enough to sustain him after birth." B)"Because the baby grows rapidly during the first months, he uses up what you gave him." C)"The iron you give him before birth is different from what he needs once he is born." D)"If the baby didn't use up what you gave him before birth, he excretes it soon after birth."

B. In the term infant, a period of physiologic anemia occurs between the age of 2 and 6 months. This is due to the fact that the infant demonstrates rapid growth and an increase in blood volume over the first several months of life, and maternally derived iron stores are depleted by age 4 to 6 months of age. Sufficient iron intake is critical for the appropriate development of hemoglobin and RBCs. Therefore, the infant must ingest adequate quantities of iron either from breast milk or from iron-fortified formula in early infancy and other food sources in later infancy.

A group of nursing students are reviewing the six links in the chain of infection and the nursing implications for each. The students demonstrate understanding of the information when they identify which precaution as helping to break the chain of infection to the susceptible host? A)Keeping linens dry and clean B)Maintaining skin integrity C)Washing hands frequently D)Coughing into a handkerchief

B. Maintaining the integrity of the child's skin and mucous membranes is a precaution that will break the chain of infection at the susceptible host. Keeping linens dry and clean is a precaution to take at the reservoir link. Washing hands frequently breaks the chain at the mode of transmission. Coughing into a handkerchief is a precaution for the portal of exit.

The nurse is examining a 3-year-old boy with acute otitis media who has a mild earache and a temperature of 38.5º C. Which of the following actions will be taken? A)Obtain a culture of the middle ear fluid. B)Instruct the parents to watch for worsening symptoms. C)Administer antibiotics. D)Administer antivirals.

B. In this case, the child will be continually observed. If the symptoms persist or become worse, antibiotics will be prescribed. This clinical practice guideline was developed by the American Academy of Pediatrics and the American Academy of Family Physicians in order to avoid overusing antibiotics or obtaining a middle ear fluid culture with every occurrence of acute otitis media. Administering antiviral agents would not be appropriate for this child. (Refer to Table 39.3 for treatment recommendations for acute otitis media.)

A nurse is providing care to a child with idiopathic thrombocytopenic purpura with a platelet count of 18,000/mm3. Which medication would the nurse most likely expect to be ordered? A)Folic acid B)Intravenous immune globulin C)Dimercaprol D)Deferoxamine

B. Intravenous immune globulin would be used to treat idiopathic thrombocytopenic purpura. Folic acid is used to treat folic acid deficiency anemia. Dimercaprol is used to remove lead from the soft tissue and bone to allow for excretion by the kidneys. Deferoxamine is used to treat iron toxicity.

The nurse is caring for a 15-year-old boy who has sustained burn injuries. The nurse observes the burn developing a violaceous color with discharge and a foul odor. The nurse suspects which of the following infections? A)Burn wound cellulitis B)Invasive burn cellulitis C)Burn impetigo D)Staphylococcal scalded skin syndrome

B. Invasive burn cellulitis results in the burn developing a violaceous, dark brown or black color with a discharge and foul odor. In burn wound cellulitis, the area around the burn becomes increasingly red, swollen, and painful early in the course of burn management. Burn impetigo is characterized by multifocal, small, superficial abscesses. Staphylococcal scalded skin syndrome is not a burn infection; however, it is managed similarly to burns.

The nurse is providing anticipatory guidance to a mother of a 5-month-old boy about introducing solid foods. Which statement by the mother indicates that effective teaching has occurred? A)"I'll start with baby oatmeal cereal mixed with low-fat milk." B)"The cereal should be a fairly thin consistency at first." C)"I can puree the meat that we are eating to give to my baby." D)"Once he gets used to the cereal, then we'll try giving him a cup."

B. Iron-fortified rice cereal mixed with a small amount of formula or breast milk to a fairly thin consistency is typically the first solid food used. As the infant gets older, a thicker consistency is appropriate. Strained, pureed, or mashed meats may be introduced at 10 to 12 months of age. A cup is typically introduced at 6 to 8 months of age regardless of what or how much solid food is being consumed.

The school nurse is working with a 10-year-old girl with recurrent abdominal pain. The girl's teacher has been less than understanding about the frequent absences and trips to the nurse's office. How should the nurse respond? A)"Be patient; she is trying some new medication." B)"The pain she is having is real." C)"The family is working toward improvement." D)"Please do not add to this family's stress."

B. It is important to educate the teacher that this recurrent abdominal pain is a true pain that the child feels and it is not "in her mind." Telling the teacher not to add to the family's stress or that the family is working toward improvement does not teach. The nurse must have the permission of the family to discuss the girl's medication.

Which of the following would the nurse include when teaching an adolescent about tinea pedis? A)"Keep your feet moist and open to the air as much as possible." B)"Dry the area between your toes really well." C)"Wear nylon or synthetic socks every day." D)"Go barefoot when you are in the locker room at school."

B. Keeping the feet clean and dry is key for the child with tinea pedis. This includes rinsing the feet with water or a water/vinegar mixture and drying them well, especially between the toes. The adolescent should wear cotton socks and shoes that allow the feet to breathe. Going barefoot at home is allowed, but the adolescent should wear flip-flops around swimming pools and locker rooms.

The nurse is caring for a 3-month-old with nasolacrimal duct obstruction. Which intervention would be most appropriate for the nurse to implement? A)Being careful to prevent spread of infection B)Teaching the parents how to gently massage the duct C)Applying hot, moist compresses to the affected eye D)Referring the child to an ophthalmologist

B. Massaging the nasolacrimal duct can cause it to open and drain. Teaching the parents how to do this would be part of the nurse's plan of care. Nasolacrimal duct obstruction is not infectious. Applying hot, moist compresses to the eye is an intervention for conjunctivitis. Nasolacrimal duct obstruction is often self-resolving, so there would be no need for a specialist's care.

A newborn is diagnosed with metatarsus adductus. The parents ask the nurse about how this occurred. Which response by the nurse would be most appropriate? A)"This condition is due to a genetic defect in the bones." B)"It's most likely from how the baby was positioned in utero." C)"They really don't know what causes this condition." D)"There is probably an underlying deformity of the baby's hip."

B. Metatarsus adductus is a medial deviation of the forefoot that occurs as a result of in utero positioning. Osteogenesis imperfecta is a genetic bone disorder. The underlying cause of congenital clubfoot is not known. Developmental dysplasia of the hip involves a deformity of the newborn's hip.

A child is diagnosed with hyperthyroidism. Which agent would the nurse expect the physician to prescribe? A)Mineralocorticoid B)Methimazole C)Levothyroxine D)Dexamethasone

B. Methimazole is an antithyroid drug that is used to treat hyperthyroidism. Mineralocorticoid (Florinef) is used to treat adrenal insufficiency. Levothyroxine is used to treat hypothyroidism. Dexamethasone is used to treat congenital adrenal hyperplasia

When instructing the parents of a toddler about appropriate nutrition, which of the following would the nurse recommend? A)About 12 to 16 ounces of fruit juice per day B)Approximately 16 to 24 ounces of milk per day C)Fat intake of 30% to 40% of total calories D)An average of 10 to 12 grams of fiber per day

B. Milk intake should be limited to 16 to 24 ounces per day, with fruit juice limited to 4 to 6 ounces per day. A toddler's total fat intake should be 20% to 30% of total calories. The daily recommended fiber intake is 19 grams.

A child is prescribed monthly injections of vitamin B12. When developing the teaching plan for the family, the nurse would focus on which type of anemia? A)Aplastic anemia B)Pernicious anemia C)Folic acid anemia D)Sickle cell anemia

B. Monthly injections of vitamin B12 are used to treat pernicious anemia. Aplastic anemia is characterized by a decrease in all blood cells necessitating a bone marrow transplant. Folic acid deficiency anemia is treated with dietary measures and possible folic acid supplementation. Sickle cell anemia is treated supportively with a focus on preventing sickling crisis, infection, and other complications.

The school nurse knows that dating is a milestone for adolescents. Which of the following statements accurately describes a trend in teen dating? A)Most late adolescents spend more time in activities with mixed-sex groups, such as dances and parties, than they do dating as a couple. B)Most teens have been involved in at least one romantic relationship by middle adolescence. C)Teens that date frequently report slightly lower levels of self-esteem and decreased autonomy. D)Homosexual behavior as a teen usually indicates that the adolescent will maintain a homosexual orientation.

B. Most teens have been involved in at least one romantic relationship by middle adolescence. Most early adolescents spend more time in activities with mixed-sex groups, such as dances and parties, than they do dating as a couple. Teens who date frequently report slightly higher levels of self-esteem and increased autonomy. Homosexual behavior as a teen does not necessarily indicate that the adolescent will maintain a homosexual orientation.

A child with myasthenia gravis is brought to the emergency department by his parents. The parents have noticed a sudden increase in respiratory difficulty. The nurse suspects myasthenic crisis based on which statement by the parents? A)"We gave him an extra dose of his medication earlier today." B)"He was coughing and had a slight fever yesterday and today." C)"Things have been pretty stress-free lately." D)"He's been resting when he gets tired."

B. Myasthenic crisis results from stress, exposure to extreme temperatures, and infections. Thus, the parents' statement about a cough and fever suggest an infection. An overdose of anticholinergic medication would lead to a cholinergic crisis. Resting when the child gets tired and lack of stress are appropriate and would not precipitate a myasthenic crisis.

The nurse is teaching a group of students about myelinization in a child. Which statement by the students indicates that the teaching was successful? A)Myelinization is completed by 4 years of age. B)The process occurs in a head-to-toe fashion. C)The speed of nerve impulses slows as myelinization occurs. D)Nerve impulses become less specific in focus with myelinization.

B. Myelinization occurs in a cephalocaudal, proximodistal manner and is completed by 2 years of age. As myelinization proceeds, nerve impulses become faster and more accurate.

At which age would the nurse expect to find the beginning of object permanence? A)1 month B)4 months C)8 months D)12 months

B. Object permanence begins to develop between 4 and 7 months of age and is solidified by approximately age 8 months. By age 12 months, the infant knows he or she is separate from the parent or caregiver.

The nurse strives to provide culturally competent care for children in a health clinic that follows the principles of health supervision. Which of the following nursing actions reflects this type of care? A)The nurse treats all children the same regardless of their culture. B)The nurse negotiates a care plan with the child and family. C)The nurse researches the child's culture and provides care based on the findings. D)The nurse provides future-based care for culturally diverse children.

B. Optimal wellness for the child requires the nurse and the family to negotiate a mutually acceptable plan of care. The nurse must consider the culture of children because if the goals of the health care plan are not consistent with the health belief system of the family, the plan has little chance for success. Researching the culture is helpful, but the nurse should not assume all children follow cultural directives and base the care plan solely on the research. Most health promotion and disease prevention strategies in the United States have a future-based orientation; however, significant numbers of children belong to cultures with a present-based orientation. For these children, health promotion activities need shorter-term goals and outcomes to be useful.

The nurse is explaining the difference between active and passive immunity to the student nurse. Which of the following statements accurately describes a characteristic of the process of immunity? A)Active immunity is produced when the immunoglobulins of one person are transferred to another. B)Passive immunity can be obtained by injection of exogenous immunoglobulins. C)Active immunity can be transferred from mothers to infants via colostrum or the placenta. D)Passive immunity is acquired when a person's own immune system generates the immune response.

B. Passive immunity can be obtained by injection of exogenous immunoglobulins. Passive immunity is produced when the immunoglobulins of one person are transferred to another. Passive immunity can also be transferred from mothers to infants via colostrum or the placenta. Active immunity is acquired when a person's own immune system generates the immune response.

A nurse is conducting a health history for a 1-month-old with an infectious disorder. Which segment of the health history would be most helpful for the nurse when determining if the infant developed the infection from the mother? A)Family history B)Past medical history C)Home treatments D)Present illness history

B. Past medical history will provide information about the mother's pregnancy and delivery, giving insight into the possibility of maternal transmission of the infection. Family history would provide information about lack of immunizations or recent infectious or communicable diseases. Home treatments and present illness history would provide no information about the possibility of maternal transmission of infection

The nurse is conducting a physical examination of a child with suspected Crohn disease. Which of the following findings would be the most highly suspicious of Crohn disease? A)Normal growth patterns B)Perianal skin tags or fissures C)Poor growth patterns D)Abdominal tenderness

B. Perianal skin tags and/or fissures are highly suspicious of Crohn disease. Poor growth patterns 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.

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

B. 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.

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."

B. 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.

The nurse is providing anticipatory guidance for parents of a preschooler regarding sex education. Which of the following is a recommended guideline when dealing with this issue? A)Be prepared to thoroughly cover a topic before the child asks about it. B)Before answering questions, find out what the child thinks about the subject. C)Expand upon the topic when answering questions to prevent further confusion. D)Provide a less than honest response to shelter the child from knowledge that is too advanced.

B. Preschoolers are very inquisitive and want to learn about everything around them; therefore, they are very likely to ask questions about sex and where babies come from. Before attempting to answer questions, parents should try to find out first what the child is really asking and what the child already thinks about that subject. Then they should provide a simple, direct, and honest answer. The child needs only the information that he or she is requesting.

A new mother shows the nurse that her baby grasps her finger when she touches the baby's palm. How might the nurse respond to this information? A)"This is a primitive reflex known as the plantar grasp." B)"This is a primitive reflex known as the palmar grasp." C)"This is a protective reflex known as rooting." D)"This is a protective reflex known as the Moro reflex."

B. Primitive reflexes are subcortical and involve a whole-body response. Selected primitive reflexes present at birth include Moro, root, suck, asymmetric tonic neck, plantar and palmar grasp, step, and Babinski. During the palmar grasp, the infant reflexively grasps when the palm is touched. The plantar grasp occurs when the infant reflexively grasps with the bottom of the foot when pressure is applied to the plantar surface. The root reflex occurs when the infant's cheek is stroked and the infant turns to that side, searching with mouth. The Moro reflex is displayed when with sudden extension of the head, the arms abduct and move upward and the hands form a "C."

The nurse is counseling the mother of a newborn who is concerned about her baby's constant crying. What teaching would be appropriate for this mother? A)Carrying the baby may increase the length of crying. B)Reducing stimulation may decrease the length of crying. C)Using vibration, white noise, or swaddling may increase crying. D)Using a swing or car ride may increase the incidence of crying episodes.

B. Prolonged crying leads to increased stress among caregivers. Reducing stimulation may decrease the length of crying, and carrying the infant more may be helpful. Some infants respond to the motion of an infant swing or a car ride. Vibration, white noise, or swaddling may also help to decrease fussing in some infants. Parents should try one intervention at a time, taking care not to stimulate the infant excessively in the process of searching for solutions.

The nurse is examining an 8-year-old boy with tachycardia and tachypnea. The nurse anticipates which of the following as most helpful in determining the extent of the child's hypoxia? A)Pulmonary function test B)Pulse oximetry C)Peak expiratory flow D)Chest radiograph

B. Pulse oximetry is a useful tool for determining the extent of hypoxia. It can be used by the nurse for continuous or intermittent monitoring. Pulmonary function testing measures respiratory flow and lung volumes and is indicated for asthma, cystic fibrosis, and chronic lung disease. Peak expiratory flow testing is used to monitor the adequacy of asthma control. Chest radiographs can show hyperinflation, atelectasis, pneumonia, foreign bodies, pleural effusion, and abnormal heart or lung size.

The nurse is assessing a child with suspected infective endocarditis. Which of the following assessment findings would the nurse interpret as a sign of extracardiac emboli? A)Pruritus B)Roth spots C)Delayed capillary refill D)Erythema marginatum

B. Roth spots are splinter hemorrhages with pale centers on the sclerae, palate, buccal mucosa, chest, fingers, or toes, and are signs of extracardiac emboli. Delayed capillary refill time does not point to extracardiac emboli. Wheezing and pruritus are indicative of a hypersensitivity reaction. Erythema marginatum is a classic rash associated with acute rheumatic fever

The parents of an 11-year-old child ask the nurse for suggestions to promote good nutrition for their child. Which response by the nurse would be most appropriate? A)"Be sure to limit protein to one meal every day." B)"Use whole-grain or enriched breads and cereals." C)"Have eggs on the average of once a week." D)"Eat dark green leafy vegetables about twice a week."

B. The American Heart Association's dietary recommendations to promote good nutrition include using whole-grain or enriched breads and cereals, having a good-quality protein with every meal, and eating eggs approximately four times per week and dark green leafy or deep yellow vegetables at least four times per week.

The nurse is providing anticipatory guidance for parents of a school-age child on teaching the dangers of drugs and alcohol. Which of the following advice might be helpful for these parents? A)School-age children are not ready to absorb information that deals with drugs and alcohol. B)School-age children can think critically to interpret messages seen in advertising, media, and sports. C)Parents must prevent their child from being exposed to messages that are in conflict with their values. D)Discussions with children need to be based on facts and focused on the past and future.

B. School-age children can be taught how to think critically to interpret messages seen in advertising, media, sports, and entertainment personalities. School-age children are ready to absorb information that deals with drugs and alcohol and may be exposed to messages that are in conflict with their parents' values regarding smoking and alcohol. This may occur at school and cannot be prevented. Discussions with children need to be based on facts and focused on the present.

The nurse is performing a risk assessment of a 5-year-old and determines the child has a risk factor for cystic fibrosis. What type of screening would the nurse perform to confirm or rule out this disease? A)Universal screening B)Selective screening C)Hyperlipidemia screening D)Developmental screening

B. Selective screening is done when a risk assessment indicates the child has one or more risk factors for the disorder. In universal screening, an entire population is screened regardless of the child's individual risk. Selectively screening children at high risk for hyperlipidemia can reduce their lifelong risk of coronary artery disease; it does not screen for cystic fibrosis. Developmental screening is performed to detect developmental delays.

1. A 3-year-old boy has been on chemotherapy for cancer. He complains about a sore throat, is experiencing malaise, and has a temperature of 99.8°F orally. His mother calls the child's physician. What is the appropriate information for the nurse to tell his mother at this time? A) "Continue to watch the child, giving him aspirin and cool fluids for the fever." B) "Plan to bring the child into the physician's office today." C) "Monitor the temperature, but not to worry unless it gets above 104°F." D) "Keep the child warm and as comfortable as possible."

B. Some chemotherapy agents mask the signs of infection, so the child could be very ill. The child needs to be assessed. Aspirin is not used in children of this age because of the chance of Reye syndrome. Continuing to watch the child and giving cool fluids would be appropriate if the child was not receiving chemotherapy. The child should be dressed lightly and warm binding clothing should be avoided. In addition, for this situation, these actions are incorrect because they do not address the need for the child to be assessed

The school nurse is conducting vision screening for a 7-year-old girl and documents the condition "amblyopia." What would the nurse tell the parents about this condition? A)"Amblyopia is an uncorrected refractive error of the eye." B)"Amblyopia is reduced vision in an eye that has not been adequately used during early development." C)"Amblyopia is a malalignment of the eye, which occurs at birth." D)"Amblyopia is a clouding of the lens of the eye caused by trauma to the eye."

B. Some problems frequently identified in school-age children include amblyopia (lazy eye), uncorrected refractive errors or other eye defects, and malalignment of the eyes (called strabismus). Amblyopia is reduced vision in an eye that has not been adequately used during early development. Inadequate use can result from conditions such as strabismus, being cross-eyed, or one eye being more nearsighted, farsighted, or astigmatic than the other eye. Amblyopia is the leading cause of visual impairment in children (National Eye Institute, 2008) and if untreated can result in vision loss.

After teaching a group of students about acute rheumatic fever, the instructor determines that the teaching was successful when the students identify which of the following as an assessment finding? A)Janeway lesions B)Jerky movements of the face and upper extremities C)Black lines D)Osler nodes

B. Sydenham chorea is a movement disorder of the face and upper extremities associated with acute rheumatic fever. Janeway lesions, black lines, and Osler nodes are associated with infective endocarditis

The nurse is caring for a 4-week-old girl and her mother. Which of the following is the most appropriate subject for anticipatory guidance? A)Promoting the digestibility of breast milk B)Telling how and when to introduce rice cereal C)Describing root reflex and latching on D)Advising how to choose a good formula

B. Telling the mother how to introduce rice cereal is the most appropriate subject for anticipatory guidance. Since this mother is already breast- or bottle-feeding her baby, educating her about these subjects would not inform her about what to expect in the next phase of development.

The nurse is evaluating the laboratory test results of a 7-year-old child with a suspected hematologic disorder. Which finding would cause the nurse to be concerned? A)WBC: 5.6 × 103/mm3 B)RBC: 2.8 × 106/mm3 C)Hemoglobin: 11.4 mg/dL D)Hematocrit: 35%

B. The RBC listed is below the normal range for a child between the ages of 6 and 16 years (4.0 to 5.2 × 106/mm3). The WBC count, hemoglobin, and hematocrit are within acceptable parameters for a child this age.

The nurse is preparing to take a tympanic temperature reading of a 4-year-old. In order to get an accurate reading, what does the nurse need to do? A)Pull the earlobe back and down B)Direct the infrared sensor at the tympanic membrane C)Pull the earlobe down and forward D)Remove any visible cerumen from inside the ear canal

B. The accuracy of tympanic temperature reading is dependent upon appropriate technique. The nurse needs to be sure to direct the infrared sensor at the tympanic membrane. Since the child is older than age 3, the earlobe does not need to be pulled back and down. The nurse would not remove earwax from inside the ear canal

The nurse is conducting a well-child examination of a 5-year-old girl, who was 40 inches tall at her last examination at age 4. Which of the following height measurements would be within the normal range of growth expected for a preschooler? A)41 inches B)43 inches C)45 inches D)47 inches

B. The average preschool-age child will grow 2.5 to 3 inches (6.5 to 7.8 cm) per year. The average 3-year-old is 37 inches tall (96.2 cm), the average 4-year-old is 40.5 inches tall (103.7 cm), and the average 5-year-old is 43 inches tall (118.5 cm).

The nurse is assessing the temperature of a diaphoretic toddler who is crying and being uncooperative. What would be the best method to assess temperature in this child? A)Oral thermometer B)Axillary method C)Temporal scanning D)Rectal route

B. The axillary method may be used for children who are uncooperative, neurologically impaired, or immunosuppressed or have injuries or surgery to the oral cavity. Since the child is crying and uncooperative, the oral method would not be a good choice. The accuracy of the temporal method may be affected by excessive sweating. The rectal route is invasive, not well accepted by children or parents, and probably unnecessary with the modern alternative methods now available.

The nurse is assessing a 5-year-old girl who is anxious, has a high fever, speaks in a whisper, and sits up with her neck thrust forward. Based on these findings, which of the following would be least appropriate for the nurse to perform? A)Providing 100% oxygen B)Visualizing the throat C)Having the child sit forward D)Auscultating for lung sounds

B. The child is exhibiting signs and symptoms of epiglottitis, which can be life-threatening. Under no circumstances should the nurse attempt to visualize the throat. Reflex laryngospasm may occur, precipitating immediate airway occlusion. Providing 100% oxygen in the least invasive manner that is most acceptable to the child is a sound intervention, as is allowing the child to assume a position of sitting forward with the neck extended. Auscultation would reveal breath sounds consistent with an obstructed airway.

A child with diabetes reports that he is feeling a little shaky. Further assessment reveals that the child is coherent but with some slight tremors and sweating. A fingerstick blood glucose level is 70 mg/dL. Which of the following would the nurse do next? A)Administer a sliding-scale dose of insulin B)Give 10 to 15 grams of a simple carbohydrate C)Offer a complex carbohydrate snack D)Administer glucagon intramuscularly

B. The child is experiencing hypoglycemia as evidenced by the assessment findings and blood glucose level. Since the child is coherent, offering the child 10 to 15 grams of a simple carbohydrate would be appropriate. Insulin is not used because the child is hypoglycemic. A complex carbohydrate snack would be used after offering the simple carbohydrate to maintain the glucose level. Intramuscular glucagons would be used if the child was not coherent.

A group of nursing students are reviewing the components of the endocrine system. The students demonstrate understanding of the review when they identify which of the following as the primary function of this system? A)Regulation of water balance B)Hormonal secretion C)Cellular metabolism D)Growth stimulation

B. The endocrine system consists of various glands, tissues, or clusters of cells that produce and release hormones. Hormones are chemical messengers that stimulate and/or regulate the actions of other tissues, organs, or endocrine glands that have specific receptors to a hormone. Along with the nervous system, the endocrine milieu influences all physiologic effects such as growth and development, metabolic processes related to fluid and electrolyte balance and energy production, sexual maturation and reproduction, and the body's response to stress. The release patterns of the hormones vary, but the level in the body is maintained within specified limits to preserve health.

After teaching a group of new parents about their newborns' eyes and vision, which statement by the group indicates effective teaching? A)"Our newborn can see at distances of about 1 to 2 feet." B)"We won't know the baby's eye color until he's at least 6 months old." C)"A baby can easily distinguish colors, but they must be bright colors." D)"A newborn can focus with both eyes at the same time shortly after birth."

B. The eye color of an infant is determined by 6 to 12 months of age. A newborn sees best at distances of about 8 to 10 inches. The optic nerve is not completely myelinated, so color discrimination is incomplete. The rectus muscles are uncoordinated at birth and mature over time, so binocular vision may be achieved by 4 months of age.

The nurse is assessing a 4-month-old boy during a scheduled visit. Which of the following findings might suggest a developmental problem? A)The child does not coo or gurgle. B)The child does not babble or laugh. C)The child never squeals or yells. D)The child does not say dada or mama.

B. The fact that the child does not babble or laugh might suggest a developmental problem. At 4 to 5 months of age most children are making simple vowel sounds, laughing aloud, doing raspberries, and vocalizing in response to voices. The child should have developed past cooing or gurgling, but is too young to squeal, yell, or say dada or mama.

The nurse is preparing a presentation to a local parent group about pediatric health supervision. Which of the following would the nurse emphasize as the focus? A)Injury prevention B)Wellness C)Health maintenance D)Developmental surveillance

B. The focus of pediatric health supervision is wellness. Injury and disease prevention, health maintenance and promotion, and developmental surveillance are all critical components of wellness

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

B. 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.

The nurse knows that children have larger heads in relation to the body and a higher center of gravity. When developing a teaching plan for parents, the nurse includes information about an increased risk for which of the following problems? A)Febrile seizures B)Head trauma C)Caput succedaneum D)Posterior plagiocephaly

B. The larger head size in relation to the body, coupled with a higher center of gravity, causes children to hit their head more readily when involved in motor vehicle accidents, bicycle accidents, and falls. Febrile seizures are not related to anatomy or physiology. Caput succedaneum is an edematous area on the scalp caused by pressure of the uterus or vagina during head-first delivery. Posterior plagiocephaly is caused by early closure of the lamboid suture.

The nurse knows that barriers to the adolescent's health and successful achievement of the tasks of adolescence exist. Which of the following is the major barrier to health for this population? A)Cultural B)Socioeconomic C)Marital status D)Racial

B. The major barrier to the adolescent's health and successful achievement of the tasks of adolescence is socioeconomic status. Adolescents at a lower socioeconomic level are at higher risk for developing health care problems and risk-taking behaviors; this may be due to their inability to access health care and to obtain needed services. In caring for adolescents, the nurse should also recognize the influence of their culture, ethnicity, and race upon them.

The nurse is assessing a newborn who was delivered after a prolonged labor due to an abnormal presentation. The newborn sustained a cranial nerve injury. The nurse would most likely expect to assess deficits related to which cranial nerve? A)Optic B)Facial C)Acoustic D)Trigeminal

B. The most common cranial nerve injury occurring during birth trauma involves facial nerve palsy. The optic, acoustic, and trigeminal nerves are not typically injured during birth trauma.

The nurse is discussing vaccination for Haemophilus influenzae type B (Hib) with the mother of a 6-month-old child. Which of the following comments provides the most compelling reason to get the vaccination? A)"These bacteria live in every human." B)"Young children are especially susceptible to these bacteria." C)"You have a choice of two excellent vaccines." D)"Your child needs this final dose for protection."

B. The most compelling reason for vaccination is that the highest rate of illness from influenza is in children. The fact that Hib is an opportunistic bacterium that lives in humans and only causes disease when resistance is lowered may be difficult for the parent to understand. A choice of two vaccines conveys no benefits to the mother. Need for the final dose is vague.

The nurse is teaching good sleep habits for toddlers to the mother of a 2-year-old boy. Which response indicates the mother understands sleep requirements for her son? A)"I'll put him to bed at 7 p.m., except Friday and Saturday." B)"He needs 13 hours of sleep per day including his nap." C)"I need to put the side down on the crib so he can get out." D)"His father can give him a horseback ride into his bed."

B. The mother understands her child needs 13 hours of sleep and one nap per day. Routines, such as the same bedtime every night, promote good sleep. However, a horseback ride to bed may cause problems because it may not provide a calming transition from play to sleep. A bath and reading a book would be better. If the child can climb out of a crib, he needs to be in a youth bed or regular bed to avoid injury.

3The nurse is caring for a 12-year-old boy with idiopathic thrombocytopenia. The nurse is providing discharge instructions about home care and safety recommendations to the boy and his parents. Which response indicates a need for further teaching? A)"We should avoid aspirin and drugs like ibuprofen." B)"He can resume participation in football in 2 weeks." C)"Swimming would be a great activity." D)"Our son cannot take any antihistamines."

B. The nurse must emphasize to the parents that they need to prevent trauma to their son by avoiding activities that may cause injury. Participation in contact sports like football is not recommended. Aspirin, nonsteroidal anti-inflammatory drugs, and antihistamines should be avoided because they could precipitate anemia. Swimming, a noncontact sport, is an appropriate choice.

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."

B. 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

The mother of a 5-year-old boy calls the nurse and seeks advice on how to assist the child with the recent death of his paternal grandfather. The boy keeps asking when his grandpa is coming back. How should the nurse respond? A)"It is best to just ignore this and to not respond to his questions." B)"This is normal; children his age do not understand the permanence of death." C)"You have to keep repeating that his grandfather is never coming back." D)"He will eventually figure this out on his own."

B. The nurse needs to remind the mother that preschoolers do not completely understand the concept of death or its permanence. Telling the mother that it is best to ignore the boy's questions or that the boy will eventually figure this out on his own does not teach. Repeating that the grandfather is not coming back does not consider the developmental stage of the child and is inappropriate.

The nurse is caring for an 11-year-old girl preparing to undergo a magnetic resonance imaging (MRI) scan. Which of the following statements would best help prepare the girl for the test and decrease anxiety? A)"You won't hear a sound if you wear your headphones." B)"The machine makes a very loud rattle; however, headphones will help." C)"There are a variety of loud sounds you will hear." D)"The MRI scanner sounds like a machine gun."

B. The nurse should acknowledge that an MRI is loud and briefly describe the noises the machine makes. Then, the nurse should immediately offer a solution: headphones. Telling the girl she won't hear a sound is untrue. Telling her that there are loud sounds isn't enough and could increase anxiety. Comparing the MRI scanner to the sound of a machine gun is not appropriate imagery for a child.

The nurse is caring for an infant girl with a suspected cardiovascular disorder. Which of the following statements by the mother would warrant further investigation? A)"My baby does not make any grunting noises." B)"The baby seems more comfortable over my shoulder." C)"The baby usually drinks all of her bottle." D)"I don't notice any rapid breathing patterns."

B. The nurse should be alert to statements indicating that the baby seems to be more comfortable when she is sitting up or over her mother's shoulder than when she is lying flat. Grunting or rapid breathing would be a cause for concern. Drinking all of the bottle would be considered normal

The nurse is caring for an immunosuppressed 3-year-old girl and is providing teaching to the mother about proper oral hygiene. Which of the following responses from the mother indicates a need for further teaching? A)"I really need to carefully check for skin breakdown." B)"I must really scrub her teeth and gums well." C)"I must use a soft toothbrush." D)"I can use a soft gauze sponge to care for her gums."

B. The nurse should caution the mother that overly vigorous brushing should be avoided as it can injure or irritate the gums. The other statements are recommended guidelines for care.

The nurse is conducting a health history for a 9-year-old child with stomach pains. Which of the following is a recommended guideline when approaching the child for information? A)Wear a white examination coat when conducting the interview. B)Allow the child to control the pace and order of the health history. C)Use quick deliberate gestures to get your point across. D)Do not make physical contact with the child during the interview.

B. The nurse should elicit the child's cooperation by allowing him or her control over the pace and order of the health history, or anything else that the child can control while still allowing the nurse to obtain the information needed. A white examination coat or all-white uniform may be frightening to children, who may associate the uniform with painful experiences or find it too unfamiliar. The nurse should use slow deliberate gestures rather than very quick or grand ones, which may be frightening to shy children. The nurse should make physical contact with the child in a nonthreatening way at first by briefly cuddling newborns before returning them to caregivers, laying a hand on the head or arm of toddlers and preschoolers, and warmly shaking the hand of older children and teens to convey a gentle demeanor.

The nurse is caring for a 10-year-old with Duchenne muscular dystrophy. As part of the plan of care, the nurse focuses on maintaining his cardiopulmonary function. Which intervention would the nurse implement to best promote maximum chest expansion? A)Deep-breathing exercises B)Upright positioning C)Coughing D)Chest percussion

B. The nurse should emphasize that the child's position should be arranged to promote maximum chest expansion. This is usually in the upright position. Deep-breathing exercises are for strengthening/maintaining respiratory muscles. Coughing helps clear the airways. Chest percussion helps loosen secretions in lungs.

The nurse is caring for a 10-year-old boy who is in traction. The boy has a nursing diagnosis of deficient diversional activity related to confinement in bed that is evidenced by verbalization of boredom and lack of participation in play, reading, and schoolwork. Which of the following would be the best intervention? A)Offer the child reading materials. B)Enlist the aid of a child life specialist. C)Encourage the child to complete his homework. D)Ask for the parents' assistance.

B. The nurse should enlist the aid of a child life specialist to provide suggestions for appropriate activities. Offering the child reading materials or encouraging him to complete his homework would most likely be met with resistance as he has already verbalized his boredom and disinterest in play, reading, and schoolwork. The parents could offer the child life specialist ideas about the boy's likes and dislikes; however, the child life specialist could offer expertise in assisting hospitalized children

A child is brought to the emergency department after sustaining a concussion. The child is to be discharged home with his parents. Which of the following would the nurse include in the child's discharge instructions? A)"Expect his headache to get worse initially and then disappear." B)"Wake him every 2 hours to check his movement and responses." C)"Call your medical provider if he vomits more than five times." D)"Any watery fluid draining from his ears is normal."

B. The nurse should instruct the parents to wake the child every 2 hours to ensure that he moves normally and wakes enough to recognize and respond appropriately to them. The parents should be instructed to call the physician or nurse practitioner or bring the child back to the emergency department if he experiences a constant headache that gets worse, vomits more than two times, or has oozing of blood or watery fluid from his ears or nose

The nurse is measuring the blood pressure of a 12-year-old boy with an oscillometric device. The boy's reading is greater than the 90th percentile for gender and height. What is the appropriate nursing action? A)Repeat the reading with the oscillometric device. B)Repeat the blood pressure reading using auscultation. C)Measure the blood pressure in all four extremities. D)Measure the blood pressure with a Doppler.

B. The nurse should repeat the reading using auscultation. The nurse should not use the Doppler ultrasound method in this circumstance. The nurse would only measure the blood pressure in all four extremities with a child presenting with cardiac complaints.

The nurse is caring for an infant who had hyperbilirubinemia requiring exchange transfusion. Based on this information, this infant is at risk for what type of disorder? A)Vision loss B)Hearing loss C)Hypertension D)Hyperlipidemia

B. There are many conditions that place an infant at risk for hearing loss, including an exchange transfusion with hyperbilirubinemia. A risk factor for vision loss is history of ocular structural abnormalities. Risk factors for systemic hypertension include preterm birth, very low birthweight, renal disease, organ transplant, congenital heart disease, or other illnesses associated with hypertension. A risk factor for hyperlipidemia is family history.

The nurse is caring for an infant with a temporary ileostomy. As part of the plan of care, the nurse monitors for skin breakdown around the stoma. If redness occurs, which of the following would be most appropriate to promote healing and prevent further skin breakdown? A)Clean the area well with a scented diaper wipe. B)Apply a barrier/healing cream or paste on the skin. C)Use a barrier wafer (such as Stomahesive) to attach the appliance. D)Sanitize the area with an alcohol wipe after each diaper change.

B. The nurse should use a barrier/healing cream or paste on the skin around the stoma to promote healing and prevent further skin breakdown. Diaper wipes that contain fragrance or alcohol can sting if used on nonintact skin and can worsen skin breakdown. The barrier wafer would be helpful, but does not address the skin breakdown.

The nurse is assessing a child with suspected thalassemia. Which of the following would the nurse expect to assess? A)Dactylitis B)Frontal bossing C)Presence of clubbing D)Presence of spooning

B. The nurse would expect to find skeletal deformities such as frontal or maxillary bossing. Dactylitis is associated with sickle cell anemia. Clubbing and spooning are associated with chronic decreases in oxygen supply.

The nurse is caring for an 8-year-old girl with hyperpituitarism. Which of the following ordered treatments will the nurse expect to perform? A)Give desmopressin acetate intranasally B)Inject octreotide acetate C)Give 1 mg/kg/day of methimazole D)Administer glipizide orally

B. The nurse would give the child a subcutaneous injection of octreotide acetate every 12 hours as directed. Desmopressin is a synthetic antidiuretic hormone used to treat diabetes insipidus. Methimazole is an antithyroid drug used to treat hyperthyroidism. Glipizide is a hypoglycemic drug that assists insulin production in children with diabetes mellitus type 2.

The nurse is counseling parents of a picky eater on how to promote healthy eating habits in their child. Which of the following interventions would be appropriate advice? A)Allow the child to pick out his or her own foods for meals. B)Present the food matter-of-factly and allow the child to choose what to eat. C)Offer high-fat snacks if the child does not eat to get him or her to eat something. D)Offer the child a special treat if he or she eats all the food on the plate.

B. The parents should maintain a matter-of-fact approach, offer the meal or snack, and then allow the child to decide how much of the food, if any, he or she is going to eat. High-fat, nutrient-poor snacks should not be substituted for healthy foods just to coax the child to "eat something." If the preschooler is growing well, then the pickiness is not a cause for concern. A larger concern may be the negative relationship that can develop between the parent and child relating to mealtime. The more the parent coaxes, cajoles, bribes, and threatens, the less likely the child is to try new foods or even eat the ones he or she likes that are served. The child should be offered a healthy diet, with foods from all groups over the course of the day as recommended by the U.S. Department of Agriculture.

The parents of a 4-year-old ask the nurse when their child will be able to differentiate right from wrong and develop morals. What would be the best response of the nurse? A)"The preschooler has no sense of right and wrong." B)"The preschooler is developing a conscience." C)"The preschooler sees morality as internal to self." D)"The preschooler's morals are their own, right or wrong."

B. The preschool child can understand the concepts of right and wrong and is developing a conscience. Preschool children see morality as external to themselves; they defer to power (that of the adult). The child's moral standards are those of their parents or other adults who influence them, not necessarily their own.

For which of the following children would the nurse conduct an immediate comprehensive health history? A)A child who is brought to the emergency room with lacerations B)A child who is a new client in a pediatric office C)A child who is a routine client and presents with signs of a sinus infection D)A child whose condition is improving

B. The purpose of the examination will determine how comprehensive the history must be. A comprehensive history would be performed for a new child in a pediatric office or a child who is admitted to the hospital. Also, if the physician or nurse practitioner rarely sees the child or if the child is critically ill, a complete and detailed history is in order, no matter what the setting. The child who has received routine health care and presents with a mild illness may need only a problem-focused history. In critical situations, some of the history taking must be delayed until after the child's condition is stabilized.

A child with iron-deficiency anemia is prescribed ferrous fumarate, 3 mg/kg/day in two divided doses. The nurse interprets this order as indicating which of the following? A)The child requires a prophylactic dose of iron. B)The child has mild to moderate iron deficiency. C)The child has severe iron deficiency. D)The child is being prepared for packed red blood cell administration.

B. The recommended dosage for iron supplementation for a child with mild to moderate iron deficiency is 3 mg/kg/day of ferrous fumarate. A prophylactic dose is 1 to 2 mg/kg/day of up to a maximum of 15 mg elemental iron per day. Severe iron deficiency requires 4 to 6 mg/kg/day of elemental iron in three divided doses. Transfusion of packed red blood cells is reserved for the most severe cases. Prior to the transfusion of packed red blood cells, the nurse would follow specific blood bank guidelines.

The nurse is teaching a new mother about the development of sensory skills in her newborn. Which of the following would alert the mother to a sensory deficit in her child? A)The newborn's eyes wander and occasionally are crossed. B)The newborn does not respond to a loud noise. C)The newborn's eyes focus on near objects. D)The newborn becomes more alert with stroking when drowsy.

B. Though hearing should be fully developed at birth, the other senses continue to develop as the infant matures. The newborn should respond to noises. Sight, smell, taste, and touch all continue to develop after birth. The newborn's eyes wander and occasionally cross, and the newborn is nearsighted, preferring to view objects at a distance of 8 to 15 inches. Holding, stroking, rocking, and cuddling calm infants when they are upset and make them more alert when they are drowsy.

Which of the following would the nurse include when teaching parents how to prevent otitis externa? A)Daily ear cleaning with cotton swabs B)Wearing ear plugs when swimming C)Using a hair dryer on high to dry the ear canals D)Using hydrogen peroxide to dry the canal skin

B. To prevent otitis externa, the nurse would teach parents and children to wear earplugs when swimming and to avoid use of cotton swabs, headphones, and earphones. A hair dryer on a low setting can be used to dry the ear canals. A mixture of half rubbing alcohol and half vinegar can be used to dry the canal and alter the pH to discourage organism growth.

During a well-child visit, the nurse assesses an infant's ability to suck on a pacifier. The nurse is assessing which cranial nerve? A)Olfactory B)Trigeminal C)Facial D)Accessory

B. To test the trigeminal nerve, the nurse would note the strength of the infant's suck on a pacifier, thumb, or bottle. The olfactory nerve is not assessed in infants and young children. The facial nerve is assessed by noting the symmetry of facial expressions. For the infant, this would be assessed during spontaneous crying or smiling. The accessory nerve is assessed when the infant is in the sitting position and symmetry of the head position is noted

After teaching the parents of a daughter with central precocious puberty about medication therapy, which statement by the parents indicates successful teaching? A)"She needs to use the nasal spray once every day." B)"She'll start puberty again when the medication stops." C)"This medication will slow down the changes but not reverse them." D)"Once therapy is done, she'll need surgery."

B. Treatment for central precocious puberty involves administering a gonadotropin-releasing hormone (GnRH) analog. When it is stopped, puberty resumes according to the appropriate developmental stages. This analog can be given by depot injection every 3 to 4 weeks, a daily subcutaneous injection, or an intranasal spray two or three times per day. With GnRH analog treatment, secondary sexual development stabilizes or regresses. Surgery is indicated only if there is a tumor.

An instructor is developing a plan for a class of nursing students on the various skin disorders. When describing urticaria, which of the following would the instructor include? A)It is a type IV hypersensitivity reaction. B)Histamine release leads to vasodilation C)Wheals appear first followed by erythema. D)The nonpruritic rash blanches with pressure.

B. Urticaria is a type I hypersensitivity reaction caused by an immunologically mediated antigen-antibody response of histamine release from the mast cells. Vasodilation and increased vascular permeability result, leading to erythema and then wheals. The rash is pruritic and blanches with pressure.

The nurse is determining maintenance fluid requirements for a child who weighs 25 kg. How much fluid would the child need per day? A)1,560 mL B)1,600 mL C)1,650 mL D)1,700 mL

B. Using the following formula of 100 mL/kg for the first 10 kg, plus 50 mL/kg for the next 10 kg, and then 20 mL/kg for the remaining kg, the child would require (100 × 10) + (50 × 10) + (20 × 5) = 1,000 + 500 + 100 = 1,600 mL in 24 hours.

Assessment of a child leads the nurse to suspect viral conjunctivitis based on which of the following? A)Mild pain B)Photophobia C)Itching D)Watery discharge

B. Viral conjunctivitis is characterized by lymphadenopathy, photophobia, and tearing. Mild pain is associated with bacterial conjunctivitis. Itching and watery discharge are associated with allergic conjunctivitis.

The nurse is preparing to perform a physical examination of a child with asthma. Which of the following techniques would the nurse be least likely to perform? A)Inspection B)Palpation C)Percussion D)Auscultation

B. When examining the child with asthma, the nurse would inspect, auscultate, and percuss. Palpation would not be used.

The nurse is reviewing the laboratory test results of a child with Addison disease. Which of the following would the nurse expect to find? A)Hypernatremia B)Hyperkalemia C)Hyperglycemia D)Hypercalcemia

B. With Addison disease, the child would exhibit hyperkalemia, hyponatremia, and hypoglycemia. Hypercalcemia would be associated with hyperparathyroidism.

The parents of a 6-week-old boy come to the clinic for evaluation because the infant has been vomiting. The parents report that the vomiting has been increasing in frequency and forcefulness over the last week. The mother says, "Sometimes, it seems like it just bursts out of his mouth." A diagnosis of hypertrophic pyloric stenosis is suspected. When performing the physical examination, which of the following would the nurse most likely find? A)Sausage-shaped mass in the upper midabdomen B)Hard, moveable, olive-shaped mass in the right upper quadrant C)Tenderness over the McBurney point in the right lower quadrant D)Abdominal pain in the epigastric or umbilical region

B. With hypertrophic pyloric stenosis, a hard, moveable, olive-shaped mass would be palpated in the right upper quadrant. A sausage-shaped mass in the upper midabdomen would suggest intussusception. Tenderness over the McBurney point would be associated with appendicitis. Epigastric or umbilical pain would be associated with peptic ulcer disease.

The nurse is conducting a physical examination of a child with a ventricular septal defect. Which finding would the nurse expect to assess? A)Right ventricular heave B)Holosystolic harsh murmur along the left sternal border C)Fixed split-second heart sound D)Systolic ejection murmur

B. With ventricular septal defects, there is often a characteristic holosystolic harsh murmur along the left sternal border. Right ventricular heave, fixed split-second heart sound, and systolic ejection murmur are typically found with atrial septal defects.

An adolescent is scheduled for outpatient arthroscopic surgery on his knee next week. As part of preparing him for the procedure, which action would be most appropriate? A)Discussing the events with the adolescent and his mother upon arrival the morning of the procedure B)Providing detailed explanations of the procedure at least a week in advance of the procedure C)Encouraging the parent to stay with the adolescent as much as possible before the procedure D)Answering the adolescent's questions with simple answers, encouraging him to ask the surgeon

B. he adolescent needs a detailed explanation about the procedure at least 7 to 10 days beforehand. Waiting until the morning of the procedure would be inappropriate. However, information could be clarified and additional questions could be answered at this time. Having the parent stay with the adolescent is something that the adolescent would need to decide; he may or may not want a parent present. Referring the adolescent to the surgeon for his questions is inappropriate and ignores the adolescent's desire for control and information

Which reflex, if found in a 4-month-old infant, would cause the nurse to be concerned? A)Plantar grasp B)Step C)Babinski D)Neck righting

B.Appropriate appearance and disappearance of primitive reflexes, along with the development of protective reflexes, indicates a healthy neurologic system. The step reflex is a primitive reflex that appears at birth and disappears at 4 to 8 weeks of age. The plantar grasp reflex is a primitive reflex that appears at birth and disappears at about the age of 9 months. The Babinski reflex is a primitive reflex that appears at birth and disappears around the age of 12 months. The neck righting reflex is a protective reflex that appears around the age of 4 to 6 months and persists.

The nurse is performing a physical examination on a 9-year-old boy who has experienced a tick bite on his lower leg and is suspected of having Lyme disease. Which assessment finding would the nurse expect to find? A)Swelling in the neck B)Confusion and anxiety C)Ring-like rash on lower leg D)Hypersalivation

C. A ring-like rash at the site of the tick bite is characteristic for Lyme disease. Swelling in the neck is a symptom of mumps. Confusion, anxiety, and hypersalivation are symptoms of rabies.

When examining the abdomen of a child, which technique would the nurse use last? A)Auscultation B)Percussion C)Palpation D)Inspection

C, Palpation should be the last part of the abdominal examination. Inspection, auscultation, and percussion should be done before palpation.

The nurse is providing anticipatory guidance to a mother to help promote healthy sleep for her 3-week old baby. Which of the following recommended guidelines might be included in the teaching plan? A)Place the baby on a soft mattress with a firm flat pillow for the head. B)Place the head of the bed near the window to provide fresh air, weather permitting. C)Place the baby on his or her back when sleeping. D)If the baby sleeps through the night, wake him or her up for the night feeding.

C, Sudden infant death syndrome (SIDS) has been associated with prone positioning of newborns and infants, so the infant should be placed to sleep on the back. The baby should sleep on a firm mattress without pillows or comforters. The baby's bed should be placed away from air conditioner vents, open windows, and open heaters. By 4 months of age night waking may occur, but the infant should be capable of sleeping through the night and does not require a night feeding.

The nurse is examining the posture of a male toddler and notes the condition "lordosis." What would be the appropriate reaction of the nurse to this finding? A)Explain that the child will need a back brace. B)Refer the toddler to a physical therapist. C)Do nothing; this is a normal condition for toddlers. D)Notify the primary care physician about the condition.

C, The toddler demonstrates lordosis (swayback) and bowlegs, with a relatively large head and protuberant belly. This is a normal condition and requires no further attention.

A nurse is preparing a presentation for a group of parents with children diagnosed with diabetes type 1. The children are all adolescents. Which of the following issues would the nurse need to address? Select all that apply. A)Self-monitoring of blood glucose levels B)Feelings of being different C)Deficient decision-making skills D)Body image conflicts E)Struggle for independence

C,D,E. Adolescents are undergoing rapid physical, emotional, and cognitive growth. Working toward a separate identity from parents and the demands of diabetic care can hinder this. This struggle for independence can lead to nonadherence of the diabetic care regimen. Conflicts develop with self-management, body image, and peer group acceptance. Teens may acquire the skills to perform tasks related to diabetic care but may lack decision-making skills needed to adjust treatment plan. Teens do not always foresee the consequences of their activities. Self-monitoring of blood glucose levels and feelings of being different are issues common to school-age children.

The nurse suspects that a 4-year-old with type 1 diabetes is experiencing hypoglycemia based on which of the following? Select all that apply. A)Blurred vision B)Dry, flushed skin C)Diaphoresis D)Slurred speech E)Fruity breath odor F)Tachycardia

C,D,F. Manifestations of hypoglycemia include behavioral changes, confusion, slurred speech, belligerence, diaphoresis, tremors, palpitation, and tachycardia. Blurred vision; dry, flushed skin; and fruity breath odor suggest hyperglycemia.

The nurse is caring for children in a physician's office where health supervision is practiced. Which of the following is a key focus of health supervision? Select all answers that apply. A)Making referrals for all health care needs B)Monitoring disease incidence C)Optimizing level of functioning D)Monitoring quality of care provided E)Teaching parents to prevent injury F)Providing care developed from national guidelines

C,E,F. Health supervision involves providing services proactively, with the goal of optimizing the child's level of functioning. It ensures the child is growing and developing appropriately and it promotes the best possible health of the child by teaching parents and children about preventing injury and illness (e.g., proper immunizations and anticipatory guidance). The framework for the health supervision visit is developed from national guidelines available through the U.S. Department of Health and Human Services (DHHS), the American Medical Association (AMA), and the American Academy of Pediatrics (AAP). Making referrals and monitoring disease incidence and quality of care provided may occur with this model, but they are not key focal points.

The nurse is providing developmentally appropriate care for a toddler hospitalized for observation following a fall down the steps. Which of the following measures might the nurse consider when caring for this child? Select all answers that apply. A)Use the en face position when holding the toddler. B)Use a bed for toddlers who have an adult present. C)Avoid leaving small objects that can be swallowed in the bed. D)Explain activities in concrete, simple terms. E)Allow the child to select meals and activities. F)Encourage parents to stay to prevent separation anxiety.

C,F. For a toddler, the nurse would avoid leaving small objects that can be swallowed in the bed and encourage parents to stay to prevent separation anxiety. The nurse would use the en face position when holding an infant and use a bed only for the older toddler who has an adult present in the room at all times. The nurse would explain activities in concrete, simple terms for a preschooler and allow a school-age child to select meals and activities

Which finding would lead the nurse to suspect that a child is experiencing moderate dehydration? A)Dusky extremities B)Tenting of skin C)Sunken fontanels D)Hypotension

C. A child with moderate dehydration would exhibit sunken fontanels. Severe dehydration would be characterized by dusky extremities, skin tenting, and hypotension.

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.

C. 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.

Auscultation of a child's heart reveals a loud murmur with a precordial thrill. The nurse documents this as which of the following? A)Grade II B)Grade III C)Grade IV D)Grade V

C. A grade IV murmur is loud with a precordial thrill. A grade II murmur is soft and easily heard. A grade III murmur is characterized as loud without a thrill. A grade V murmur is characterized as loud, audible without a stethoscope.

The nurse is helping a new mother prepare for breastfeeding her infant. During which of the following newborn states of consciousness would the nurse recommended attempting the feeding? A)Light sleep B)Drowsiness C)Quiet alert state D)Active alert state

C. A normal newborn will ordinarily move through six states of consciousness: (1) deep sleep: the infant lies quietly without movement; (2) light sleep: the infant may move a little while sleeping and may startle to noises; (3) drowsiness: eyes may close; the infant may be dozing; (4) quiet alert state: the infant's eyes are open wide and the body is calm; (5) active alert state: the infant's face and body move actively; and (6) crying: the infant cries or screams and the body moves in a disorganized fashion. The quiet alert state is the optimal state in which to breastfeed an infant.

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

C. 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.

20. A nurse is instructing a parent on how to obtain a stool culture for ova and parasites from a child with diarrhea. Which of the following would the nurse include in the teaching plan? A) "Give the child bismuth and then collect the next specimen." B) "Obtain the specimen from the toilet after the child has a bowel movement." C) "Keep the specimen from coming into contact with any urine." D) "Bring the specimen to the laboratory on the third day."

C. A stool specimen for culture must be free of urine, water, and toilet paper. Therefore, the parent needs to understand how to collect the specimen so that it does not come into contact with any these. In addition, the specimen should not be retrieved out of toilet water. Mineral oil, barium, and bismuth interfere with the detection of parasites. In such cases, specimen collection should be delayed for 7 to 10 days. Once the specimen is collected, it should be brought to the laboratory immediately

The nurse working in the emergency room monitors the admission of children. Statistically, for which one of the following disorders would children younger than 5 years most commonly be admitted? A)Mental health problems B)Injuries C)Respiratory disorders D)Gastrointestinal disorders

C. According to Child Health USA 2008-2009, diseases of the respiratory system account for the majority of hospitalizations in children younger than 5 years of age, while diseases of the respiratory system, mental health problems, injuries, and gastrointestinal disorders lead to more hospitalizations in older children

A nurse is administering 100% oxygen to a child with a pneumothorax based on the understanding that this treatment is used primarily for which reason? A)Improve gas exchange B)Bypass the obstruction C)Hasten air reabsorption D)Prevent hypoxemia

C. Administration of 100% oxygen is used to treat pneumothorax primarily because it hastens the reabsorption of air. Generally this is used only for a few hours. Although the oxygen also improves gas exchange and prevents hypoxemia, these are not the reasons for its use in this situation. There is no obstruction with a pneumothorax.

The nurse is taking a health history for a 9-year-old girl. Which finding would alert the nurse to a possible risk factor specifically associated with visual impairment? A)Being born at 39 weeks' gestation B)Having several hours of homework daily C)Being of African American heritage D)Being active in sports

C. African American heritage is a risk factor specifically for visual impairment. Although family history of the disorder, genetic syndrome, and previous medication use are risk factors for visual impairment, they are also risk factors for hearing impairment.

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."

C. 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.

A 9-year-old child has undergone a cardiac catheterization and is being prepared for discharge. The nurse is instructing the parents and child about postprocedure care. Which statement by the parents indicates that the teaching was successful? A)"This pressure dressing needs to stay on for 5 days from now." B)"He can't eat but he can drink fluids for the next 24 hours." C)"He should avoid taking a bath for about 3 days but he can shower." D)"It's normal if he says he feels like his heart skipped a beat."

C. After a cardiac catheterization, the child should avoid tub baths for about 3 days but he can shower or use sponge baths. The pressure dressing should be removed the day after the procedure and a dry sterile dressing or adhesive bandage is applied for the next several days. After the procedure, the child can resume his usual diet. Any reports of fluttering or the heart skipping a beat should be reported.

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

C. 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.

The nurse is caring for a 2-month-old infant who has been diagnosed with acute heart failure. The nurse is providing teaching about nutrition. Which of the following statements by the mother indicates a need for further teaching? A)"The baby may need as much as 150 calories/kg/day." B)"Small, frequent feedings are best if tolerated." C)"I need to feed him every hour to make sure he eats enough." D)"Gavage feedings may be required for now."

C. Although offering small frequent feedings is appropriate if the infant tolerates them, feeding every hour is not necessary. During the acute phase, continuous or intermittent gavage feedings may be needed to help the infant maintain or gain weight. Due to the increased metabolic demands, the infant may require as much as 150 calories/kg/day.

A child with a suspected cardiovascular disorder is to undergo diagnostic testing and is scheduled for an echocardiogram. When explaining this test to the child, which of the following would the nurse most likely include? A)"This test will check the pattern of how your heart is beating." B)"They'll take a picture of your chest to look at the heart's size." C)"A special wand that picks up sound is used to check your heart." D)"Small patches are attached to your chest to check the heart rhythm."

C. An echocardiogram is a noninvasive ultrasound procedure using a gel-coated wand that assesses the heart wall thickness, the size of the chambers, valve and septal motion, and the relationship of the great vessels to other cardiac structures. An electrocardiogram reveals the pattern or rhythm of the heart's beating and involves small patches or electrodes attached to the chest. A chest radiograph involves a radiographic film of the chest to determine the size of the heart and its chambers.

During the health history, the mother of a 4-month-old child tells the nurse she is concerned that her baby is not doing what he should be at this age. What is the nurse's best response? A)"I'll be able to tell you more after I do his physical." B)"Fill out the questionnaire and then I can let you know." C)"Tell me what concerns you." D)"All mothers worry about their babies. I'm sure he's doing well."

C. Asking about the mother's concerns is assessment and is the first thing the nurse should do. The mother has intimate knowledge of the infant and can provide invaluable information that can help structure the nurse's assessment. Relying on the physical assessment ignores the value of the mother's input. A screening questionnaire is no substitute for a developmental assessment. Minimizing the mother's concerns reduces communication between the mother and the nurse.

The nurse is preparing a class for a group of adolescents about reducing the risk of skin cancer. Which of the following would the nurse include? A)Using a sunscreen with para-aminobenzoic acid (PABA) with an SPF of at least 10 B)Applying sunscreen at least 1 hour before going outside in the sun C)Avoiding sun exposure between the hours of 10 a.m. and 2 p.m. D)Using artificial UV tanning beds instead of sun exposure

C. Avoiding sun exposure between the hours of 10 a.m. and 2 p.m. is one method of reducing the risk for skin cancer. Sunscreens with an SPF of 15 or greater that are fragrance- and PABA-free should be used. Sunscreen should be applied at least 30 minutes before exposure and then reapplied at least every 2 hours while exposed. Artificial ultraviolet light, including tanning beds, should be avoided

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."

C. 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.

The nurse is teaching a new mother the proper techniques for breastfeeding her newborn. Which of the following is a recommended guideline that should be implemented? A)Wash the hands and breasts thoroughly prior to breastfeeding. B)Stroke the nipple against the baby's chin to stimulate wide opening of the baby's mouth. C)Bring the baby's wide-open mouth to the breast to form a seal around all of the nipple and areola. D)When finished the mother can break the suction by firmly pulling the baby's mouth away from the nipple.

C. Before each breastfeeding session, mothers should wash their hands, but it is not necessary to wash the breast in most cases. The mother should then stroke the nipple against the baby's cheek to stimulate opening of the mouth and bring the baby's wide-open mouth to the breast to form a seal around all of the nipple and areola When the infant is finished feeding, the mother can break the suction by inserting her finger into the baby's mouth.

The nurse is examining a 7-year-old boy with blepharitis. Which of the following would the nurse least likely expect to assess? A)Redness B)Scaling C)Pain D)Edema

C. Blepharitis has symptoms of redness, scaling, and edema, but not pain. Pain is typically associated with hordeolum

The nurse has seen a 15-year-old girl and a 16-year-old boy during health surveillance visits. Which of the following physical characteristics would be seen in both teenagers? A)Decreased respiratory rates of 15 to 20 breaths per minute B)Eruption of last four molars C)Increased shoulder, chest, and hip widths D)Fully functioning sweat and sebaceous glands

C. Both teenagers are in the middle state of adolescence, which is marked by an increase in shoulder, chest, and hip widths. Decreased respiratory rate occurs in early adolescence, as do fully functioning sweat and sebaceous glands. Eruption of the last four molars occurs in late adolescence.

An infant with congenital heart disease is to undergo surgery to correct the defect. The mother states, "I guess I'm going to have to stop breastfeeding her." Which response by the nurse would be most appropriate? A)"That's true, but we'll make sure she gets the best intravenous nutrition." B)"Unfortunately, your baby needs more nutrients than what breast milk can provide." C)"Breast milk may help to boost her immune system, so you can continue to use it." D)"She won't be able to suck, so we have to give her fortified formula through a tube."

C. Breastfeeding a child before and after cardiac surgery may boost the infant's immune system, which can help fight postoperative infection. If breastfeeding is not possible, mothers can pump milk and the breast milk may be given via bottle, dropper, or gavage feeding. In addition, breastfeeding is associated with decreased energy expenditure during the act of feeding.

The nurse is assessing the motor skills of a 5-year-old girl. Which finding would cause the nurse to be concerned? A)Can copy a square on another piece of paper B)Can dress and undress herself without help C)Draws a person with three body parts D)Is beginning to tie her own shoelaces

C. By the age of 5 years, the child should be able to draw a person with a body and at least six body parts. She should also be able to copy triangles and other geometric patterns and dress and undress herself and should be learning to tie her shoelaces.

The nurse knows that effective communication with children and their parents is critical to providing atraumatic quality nursing care. Which of the following statements accurately describes the communication patterns of children? A)Communication patterns are similar from one child to the next. B)Children often use more words than adults to describe their fears. C)Children rely more on nonverbal communication and silence. D)Parents more often require affective communication rather than neutral communication.

C. Children often use fewer words than adults and may rely more on nonverbal communication and silence. Communication patterns can vary greatly from one child to the next. Some children are very talkative, while others are quiet. Parents more often require neutral communication (i.e., verbal communication that is related to assessing and solving problems), whereas children more often desire affective communication (establishment of rapport and trust, giving comfort).

A school-aged child with an infectious disease is placed on transmission-based precautions. Which nursing diagnosis would most likely be a priority? A)Impaired skin integrity related to trauma secondary to pruritus and scratching B)Fluid volume deficit related to increased metabolic demands and insensible losses C)Social isolation related to infectivity and inability to go to the playroom D)Deficient knowledge related to how infection is transmitted

C. Children who are placed on transmission-based precautions are not allowed to leave their rooms and are not allowed to go to common areas such as the playroom or schoolroom. Thus, they are at risk for social isolation. Impaired skin integrity, fluid volume deficit, and deficient knowledge may be appropriate but would depend on the infectious disease diagnosed.

A nurse is caring for a 5-year-old in Buck traction. When conducting a skin examination for signs of pressure ulcers, the nurse pays particular attention to which area? A)Sacral area B)Hip area C)Occiput D)Upper arm

C. Common sites of pressure ulcers in hospitalized children include the occiput and toes, while children who require wheelchairs for mobility demonstrate pressure ulcers in the sacral or hip areas more frequently. The upper arm is not a common site for pressure ulcers.

The nurse is working as a community health care nurse. What would be the nurse's focus when providing care of the child? A)Providing care to the individual and family in acute care settings B)Providing care to the indigent in family care settings C)Providing care in geographically and culturally diverse settings D)Providing care for particular age groups or particular diagnoses

C. Community health nurses work in geographically and culturally diverse settings. They address current and potential health needs of the population or community. Community-based nursing focuses more on providing care to the individual or family (which, of course, impacts the community) in settings outside of acute care. They promote and preserve the health of a population and are not limited to particular age groups, income levels, or diagnoses.

A nurse is preparing a program for a group of parents about injury prevention. Which of the following would the nurse include as an important contributing factor for cervical spine injury in a child? A)Exposure to teratogens while in utero B)Immaturity of the central nervous system C)Increased mobility of the spine D)Incomplete myelinization

C. Compared to the adult, a child's spine is very mobile, especially in the cervical spine region, resulting in a higher risk for cervical spine injury. Exposure to teratogens in utero may lead to altered growth and development of the brain or spinal cord. Immaturity of the central nervous system places the infant at risk for insults that may result in delayed motor skill attainment or cerebral palsy. Incomplete myelinization reflects the lack of motor control.

The nurse is providing care for a 14-year-old girl with severe acne. The girl expresses sadness and distress about her appearance. Which response by the nurse would be most appropriate? A)"Are you using your medicine every day?" B)"Your condition will most likely improve in a year or two." C)"Many people feel this way; I know someone who can help." D)"If you have any scarring you can undergo dermabrasion."

C. Depression can occur as a result of body image disturbances with severe acne. The nurse should provide emotional support to adolescents undergoing acne therapy and refer teens for counseling if necessary. Telling the girl that her condition is likely to improve in a year or two is not helpful. Asking the girl whether she uses her medicine every day or reminding her that her scars can be addressed with dermabrasion does not address her feelings of sadness and distress.

When describing the various changes that occur in organ systems during adolescence, which of the following would the nurse include? A)Significant increase in brain size B)Ossification completed later in girls C)Decrease in heart rate D)Decrease in activity of sebaceous glands

C. During adolescence, the heart rate decreases while the systolic blood pressure increases. Brain growth continues, but the size of the brain does not increase significantly. Ossification is more advanced in girls and occurs at an earlier age. Sebaceous gland activity increases during adolescence.

A child with growth hormone deficiency is receiving growth hormone. Which of the following would the nurse interpret as indicating effectiveness of this therapy? A)Rapid weight gain B)Complaints of headaches C)Height increase of 4 inches D)Growth plate closure

C. Effectiveness of growth hormone therapy is indicated by at least a 3- to 5-inch increase in linear growth in the first year of treatment. Rapid weight gain and headaches are adverse reactions of this therapy. The drug is stopped when the epiphyseal growth plates close.

When performing the physical examination of a child with c, which of the following would the nurse expect to assess? A)Dullness over the lung fields B)Increased diaphragmatic excursion C)Decreased tactile fremitus D)Hyperresonance over the liver

C. Examination of a child with cystic fibrosis typically reveals decreased tactile fremitus over areas of atelectasis, hyperresonance over the lung fields from air trapping, decreased diaphragmatic excursion, and dullness over the liver when enlarged.

The nurse is preparing a teaching plan for a 10-year-old girl with hyperthyroidism. Which of the following would the nurse include in the plan? A)Describing surgery to remove an anterior pituitary tumor B)Teaching her parents to give injections of growth hormone C)Explaining about the radioactive iodine procedure D)Showing her parents how to give DDAVP intranasally

C. Explaining about the radioactive iodine procedure would be part of the teaching plan for a child with hyperthyroidism because this is a less invasive type of therapy for the disorder. Describing surgery to remove an anterior pituitary tumor would be included for a child with hyperpituitarism. Teaching a parent to give injections of growth hormone would be appropriate for a child with a growth hormone deficiency. Showing parents how to give DDAVP intranasally is appropriate for a child with diabetes insipidus.

The nurse is instructing a 7-year-old child and his parents about using his prescribed corrective lenses. Which of the following would the nurse include in these instructions? A)"Make sure to take your glasses off from time to time to allow your eyes to rest." B)"Remove your glasses with both hands and lay them with the lens upright on the surface." C)"Clean the glasses every day with a mild soap and water or commercial cleaning agent." D)"Use paper towels or tissues to dry and periodically clean the lenses.

C. Eyeglasses should be cleaned daily with mild soap and water or a commercial cleaning agent. The glasses should be worn at all times, but when removed, they should be removed with both hands and placed on their side (not directly on the lens on any surface). A soft cloth, not paper towels, tissues, or toilet paper, should be used to clean the lenses

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

C. 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

The nurse is reviewing the white blood cell differential of a 4-year-old girl. Which value would lead the nurse to be concerned? A)Bands: 8% B)Segs: 28% C)Eosinophils: 10% D)Basophils: 0%

C. For a 4-year-old, normally eosinophils range from 0% to 3%; therefore, a result of 10% would be abnormal and a cause for concern. Bands of 8%, segs of 28%, and basophils of 0% are normal values for this age.

The nurse is assessing the heart rate of a healthy 13-month-old child. The nurse knows to auscultate which of the following sites to obtain an accurate assessment? A)Radial pulse B)Brachial pulse C)Apical pulse at the third or fourth intercostal space D)Apical pulse at the fourth or fifth intercostal space at the midclavicular line

C. For children younger than 2 years of age, the nurse should auscultate the apical pulse with the stethoscope at the point of maximum intensity just above and outside of the left nipple at the third or fourth intercostal space. The radial pulse is difficult to palpate accurately on children younger than 2 years of age because the blood vessels lie so close to the skin surface and are easily obliterated. The brachial pulse is not the best point of auscultation. The point of maximum intensity (PMI) is heard best at the fourth or fifth intercostal space at the midclavicular line beginning around 7 years of age.

The nurse measures the head circumference of a 6-month-old infant. Which measurement would the nurse interpret as most appropriate? A)33 cm B)35 cm C)43.5 cm D)47 cm

C. Head circumference increases rapidly during the first 6 months. In a 6-month-old it is typically 42 to 44.5 cm (16.5 to 17.5 in); at birth it is usually 33 to 35 cm (13 to 14 in); and at 1 year of age it is usually 45 to 47.5 cm (17.7 to 18.7 in).

The nurse is testing the sensory development of a toddler brought to the clinic for a well visit. Which of the following might alert the nurse to a potential problem with the child's sensory development? A)The toddler places the nurse's stethoscope in his mouth. B)The toddler's vision tests at 20/50 in both eyes C)The toddler does not respond to commands whispered in his ear. D)The toddler's taste discrimination is not at adult levels yet.

C. Hearing should be at the adult level, as infants are ordinarily born with hearing intact. Therefore, the toddler should hear commands whispered in his ear. Toddlers examine new items by feeling them, looking at them, shaking them to hear what sound they make, smelling them, and placing them in their mouths. Toddler vision continues to progress and should be 20/50 to 20/40 in both eyes. Though taste discrimination is not completely developed, toddlers may exhibit preferences for certain flavors of foods.

Hydrocephalus is suspected in a 4-month-old infant. Which of the following would the nurse expect to assess? A)Sunken fontanels B)Diminished reflexes C)Lower extremity spasticity D)Skull symmetry

C. Hydrocephalus is manifested by spasticity of lower extremities, bulging fontanels, brisk reflexes, and skull asymmetry.

The nurse is assessing a 9-year-old girl with a history of tuberculosis at age 6 years. She has been losing weight and has no appetite. The nurse suspects Addison disease based on which of the following assessment findings? A)Arrested height and increased weight B)Thin, fragile skin and multiple bruises C)Hyperpigmentation and hypotension D)Blurred vision and enuresis

C. Hyperpigmentation and hypotension would point to Addison disease. Arrested height and increased weight are typical of acquired hypothyroidism; this girl has lost weight. Thin, fragile skin and multiple bruises are indicative of Cushing syndrome. Blurred vision, headaches, and enuresis would be complaints of a child with diabetes mellitus.

4. The nurse is caring for a neonate who is suspected of having sepsis. Which of the following assessment findings would the nurse interpret as most indicative of sepsis? A) Rash on face B) Edematous neck C) Hypothermia D) Coughing

C. Hypothermia is a sign of sepsis in neonates. A rash on the face is a symptom of scarlet fever. An edematous neck is a sign of diphtheria. Paroxysmal coughing is a symptom of pertussis

A child with a pneumothorax has a chest tube attached to a water seal system. When assessing the child, the nurse notices that the chest tube has become disconnected from the drainage system. Which of the following would the nurse do first? A)Notify the physician B)Apply an occlusive dressing C)Clamp the chest tube D)Perform a respiratory assessment

C. If a chest tube becomes disconnected from the water seal drainage system, the nurse would first clamp the chest tube to prevent air from entering the child's chest cavity. Then the nurse would perform a respiratory assessment and notify the physician. An occlusive dressing would be applied first if the chest tube became dislodged from the child's chest.

The nurse is providing care for children in a pediatric medical home. Which of the following is a characteristic of care in these types of facilities? A)All insurance except Medicaid is accepted. B)Ambulatory care is not provided C)A centralized database contains all child information. D)Continuity of care is provided from infancy through adulthood.

C. In a medical home a centralized database contains all pertinent information. All insurance including Medicaid is accepted in the medical home and ambulatory care is provided. Continuity of care is also provided from infancy to adolescence.

The nurse is promoting learning and school attendance to an 11-year-old girl. Which of the following factors will affect the child's attitude most? A)Her parents' values and desires B)The dramatic changes to her body C)Peer group behaviors and attitudes D)Desire for attention from boys

C. In this age group, children have a strong desire to conform to their peer group and to be accepted. It is important to know the peer group's attitude about school and learning. Early adolescence marks the beginning of separation from the family, including its values and desires. Physiologic changes and sexual attraction would not have significant or lasting influence in this matter.

A newborn is diagnosed with patent ductus arteriosus. The nurse anticipates that the physician will most likely order which medication? A)Alprostadil B)Heparin C)Indomethacin D)Spironolactone

C. Indomethacin is the drug typically ordered to close a patent ductus arteriosus. Alprostadil would be indicated to maintain the ductus arteriosus temporarily in infants with ductal-dependent congenital heart defects. Heparin would be used for prophylaxis and treatment of thromboembolic disorders, especially after surgery. Spironolactone would be used to manage edema due to heart failure and to treat hypertension.

After teaching a class about the differences in the skin of infants and adults, the nurse determines that additional teaching is necessary when the class states which of the following? A)"An infant's skin is thinner than an adult's, so substances placed on the skin are absorbed more readily." B)"The infant's epidermis is loosely connected to the dermis, increasing the risk for breakdown." C)"The infant has a lower risk for damage from ultraviolet radiation because the skin is more pigmented." D)"An infant has less subcutaneous fat, which places the infant at a higher risk for heat loss."

C. Infants have less pigmentation in their skin, placing them at increased risk for skin damage from ultraviolet radiation. The infant's skin is thinner, the epidermis is loosely connected, and there is less subcutaneous fat.

The nurse is assessing a 12-month-old boy with an English-speaking father and a Spanish-speaking mother. The boy does not say mama or dada yet. Which of the following is the priority intervention? A)Performing a developmental evaluation of the child B)Encouraging the parents to speak English to the child C)Asking the mother if the child uses Spanish words D)Referring the child to a developmental specialist

C. Infants in bilingual families may use some words from each language. Therefore, the priority intervention in this situation would be to ask the mother if the child uses Spanish words. There is not enough evidence to warrant performing a developmental evaluation or referring the child to a developmental specialist. Encouraging the parents to speak English to the child is unnecessary if the child is progressing with Spanish first.

As a result of seizure activity, a computed tomography (CT) scan was performed and showed that an 18-month-old child has intracranial arteriovenous malformation. When developing the child's plan of care, the nurse would expect to implement actions to prevent which of the following? A)Drug interactions B)Developmental disabilities C)Hemorrhagic stroke D)Respiratory paralysis

C. Intracranial hemorrhage or hemorrhagic stroke is a risk for children with intracranial arteriovenous malformation. Drug interactions are a risk for children who are treated with combinations of anticonvulsants for epilepsy. Children with hydrocephalus are at an increased risk for developmental disabilities. Respiratory paralysis is a risk of botulism that typically affects infants younger than 6 months of age

During a health maintenance visit, a 15-year-old girl mentions that she is not happy with how overweight she is. Which of the following approaches is best for the nurse to take? A)"Good observation. Let's talk about diet and exercise." B)"Don't worry; you are within the weight and height guidelines." C)"What specifically have you been noticing?" D)"Tell me about your parents. Are they overweight?"

C. It is best to find out what caused the teenager to make the comment so that you can work with her about the issue. This is an assessment and must be done first. Launching into a lecture on diet and exercise will be of no value if the teenager wants to talk about dealing with snide comments from her peers. Telling the teenager she is statistically in the normal range for weight and height may close the conversation prematurely. The focus is on the teenager, not her parents. Obtaining that information would be important, but not at this time.

The nurse is performing risk assessments on adolescents in the school setting. Which one of the following teens should the nurse screen for hypertension? A)An Asian female B)A white male C)An African American male D)A Jewish male

C. It is important for the nurse to recognize the ethnic background of each adolescent. Research has shown that certain ethnic groups are at higher risk for certain diseases. For example, adolescent African Americans are at higher risk for developing hypertension.

A nurse is preparing a teaching program for a parenting group about preventing foreign body aspiration. Which of the following would the nurse include? A)Avoid giving popcorn to children younger than the age of 2 years. B)Withhold peanuts from children until they are at least 5 years of age. C)If an object fits through a standard toilet paper roll, the child can aspirate it. D)Keep pennies and dimes out of the child's reach; quarters do not pose a problem.

C. Items smaller than 1.25 inches can be aspirated easily. A simple way for parents to estimate the safe size of a small item or toy piece is to gauge its size against a standard toilet paper roll, which is generally about 1.5 inches in diameter. If it fits through the roll, it can be aspirated. Popcorn and peanuts should not be given to children until they are at least 3 years old. All coins should be kept out of the reach of children.

The nurse is reviewing the laboratory test results of a child diagnosed with disseminated intravascular coagulation (DIC). Which of the following would the nurse interpret as indicative of this disorder? A)Shortened prothrombin time B)Increased fibrinogen level C)Positive fibrin split products D)Increased platelets

C. Laboratory test results associated with DIC include positive fibrin split products; prolonged prothrombin time, partial thromboplastin time, bleeding time, and thrombin time; decreased fibrinogen levels, platelets, clotting factors II, V, VIII, and X, and antithrombin III; and increased levels of fibrinolysin, fibrinopeptide A, and positive D-dimers.

The nurse is assessing the neck of an 8-year-old child with Down syndrome. Which of the following findings would the nurse expect during the examination? A)Webbing B)Excessive neck skin C)Lax neck skin D)Shortened neck

C. Lax neck skin may occur with Down syndrome. Webbing or excessive neck skin folds may be associated with Turner syndrome. A shortened neck is expected in a child younger than age 4.

The nurse is performing a health assessment of a 3-month-old Black American boy. For what condition should this infant be monitored based on his race? A)Jaundice B)Iron deficiency C)Lactose intolerance D)Gastroesophageal reflux disease (GERD)

C. Many dietary practices are affected by culture, both in the types of food eaten and in the approach to progression of infant feeding. Some ethnic groups tend to be lactose intolerant (particularly blacks, Native Americans, and Asians); therefore, alternative sources of calcium must be offered. Jaundice, iron deficiency, and GERD are not seen at a significantly higher rate in African American infants.

The parents of a preschooler express concern to the nurse about their son's new habit of masturbating. Which of the following is an appropriate response to this concern? A)Tell the child in a firm manner that this behavior is not acceptable. B)When the child displays this behavior, place him in a "time-out." C)Treat the action in a matter-of-fact manner emphasizing safety. D)Consult a psychotherapist to determine the reason for this behavior.

C. Masturbation is a healthy and natural part of normal preschool development if it occurs in moderation. If the parent overreacts to this behavior, then it may occur more frequently. Masturbation should be treated in a matter-of-fact way by the parent. The child needs to learn certain rules about this activity: nudity and masturbation are not acceptable in public. The child should also be taught safety: no other person can touch the private parts unless it is the parent, doctor, or nurse checking to see when something is wrong.

The nurse is administering 10 units of NPH insulin to a child at 8 a.m. The nurse would expect this insulin to begin acting at which time? A)By 8:15 a.m. B)Between 8:30 and 9 a.m. C)Between 9 and 11 a.m. D)Around 12 noon

C. NPH insulin has an onset of action of 1 to 3 hours, so the drug would begin to act between 9 and 11 a.m. A rapid-acting insulin would begin to act by 8:15 a.m.; regular insulin would begin to act between 8:30 and 9 a.m. No type of insulin would begin acting around 12 noon.

A nurse is conducting a physical examination of a 5-year-old with suspected iron-deficiency anemia. How would the nurse evaluate for changes in neurologic functioning? A)"Open your mouth so I can look inside your cheeks and lips." B)"Do you have any bruises on your feet or shins?" C)"Will you show me how you walk across the room?" D)"Let me see the palms of your hands and soles of your feet."

C. Neurologic effects of iron deficiency may be demonstrated when the child's ability to sit, stand, and walk are impaired. Inspecting the mouth, looking for bruises, and checking the hands and feet provide information about signs of petechiae, purpura, or pallor.

A nurse is working with an adolescent who is slightly overweight and was recently diagnosed with hypertension. They are discussing nutritional management. Which statement by the adolescent demonstrates understanding of the information? A)"I have to make sure that I don't eat a lot of salty foods." B)"I can eat any amount at a meal as long as I don't eat between meals." C)"I should eat plenty of fresh fruits and vegetables." D)"If I skip breakfast, I can eat a much bigger lunch."

C. Nutritional management includes controlling portion sizes, decreasing the intake of sugary beverages and snacks, eating more fresh fruits and vegetables, and eating a healthy breakfast. Salt restriction and potassium or calcium supplements have not been shown to decrease blood pressure in children.

A mother brings her 31/2-year-old daughter to the emergency department because the child has been vomiting and having diarrhea for the past 36 hours. When assessing this child's temperature, which method would be least appropriate? A)Oral B)Tympanic C)Rectal D)Axillary

C. Obtaining the child's temperature via the rectal route would be least appropriate because the child has diarrhea, and insertion of the thermometer might traumatize the rectal mucosa. Additionally, the rectal route is highly invasive and a child of this age fears body invasion. Using the oral route might be problematic due to the child's age and inability to cooperate, especially in light of the child's vomiting. However, it would not be as dangerous as obtaining a rectal temperature. The tympanic or axillary method would be the most appropriate method.

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

C. 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.

The school nurse is performing health assessments on students in middle school. Of which of the following developmental milestones should the nurse be aware? A)Height in girls increases rapidly after menarche and usually ceases immediately after menarche. B)Boys' growth spurt usually begins between the ages of 8 and 14 years and ends between the ages of 131/2 and 171/2 years. C)Peak height velocity (PHV) occurs at approximately 12 years of age in girls or about 6 to 12 months after menarche. D)Boys reach PHV and peak weight velocity (PWV) at about 16 years of age.

C. PHV occurs at approximately 12 years of age in girls or about 6 to 12 months after menarche. Height in girls increases rapidly after menarche and usually ceases 2 to 21/2 years after menarche. Boys' growth spurt occurs later than girls' and usually begins between the ages of 101/2 and 16 years and ends sometime between the ages of 131/2 and 171/2 years. Boys reach PHV at about 14 years of age. PWV occurs about 6 months after menarche in girls and at about 14 years of age in boys.

A nurse is examining a 7-year-old boy with hordeolum. Which of the following would the nurse expect to find? A)Redness B)Scaling C)Pain D)Edema

C. Pain is typical of hordeolum. Blepharitis has symptoms of redness, scaling, and edema but not pain

6. The nurse is developing a teaching plan for the mother of a 4-year-old girl with cold and fever. Which of the following would the nurse include in this teaching plan? A) Keeping the child covered and warm B) Calling the doctor if the child's fever lasts more than 36 hours C) Ensuring fluid intake to prevent dehydration D) Observing for changes in alertness resulting from brain damage

C. Teaching the mother to ensure fluid intake is important because fever can cause dehydration. The child should be dressed lightly. There is no need to call the doctor unless the child's fever lasts more than 3 to 5 days or the fever is greater than 105ºF. A rapid rise to a high fever can cause a febrile convulsion, but it does not lead to brain damage.

A nurse is providing teaching to the parents of a child who has had a shunt inserted as treatment for hydrocephalus. The parents demonstrate understanding of the teaching when they state which of the following? A)"Having the shunt put in decreases his risk for developmental problems." B)"If he doesn't get an infection in the first week, the risk is greatly reduced." C)"He will need more surgeries to replace the shunt as he grows." D)"The shunt will help to prevent any further complications from his disease."

C. Parents need to know that hydrocephalus is a chronic illness that requires lifelong follow-up and regular evaluations, including future surgeries as the child grows. The risk for infection is ever present, but is most common 1 to 2 months after shunt placement. The child with a shunt and hydrocephalus is at risk for potential growth and developmental disabilities as well as complications such as infection and malfunction of the shunt

12. A child is diagnosed with scarlet fever. The nurse is reviewing the child's medical record, expecting which medication to be prescribed for this child? A) Ibuprofen B) Acyclovir C) Penicillin V D) Doxycycline

C. Penicillin V is the antibiotic of choice for the treatment of scarlet fever. Ibuprofen is used to treat fever. Acyclovir is used to treat viral infections. Doxycycline, a tetracycline, is the drug of choice for treating Rocky Mountain spotted fever.

The parents of a 5-year-old bring their son to the emergency department because of significant eyelid edema. The mother states, "He scratched himself near his eye a couple of days ago while playing outside in the yard." The nurse suspects periorbital cellulitis based on which of the following? A)Evidence of discharge B)Reddened conjunctiva C)Purplish discoloration of eyelid D)Altered visual acuity

C. Periorbital cellulitis is a bacterial infection of the eyelids and tissue surrounding the eye. The bacteria may gain entry into the skin via an abrasion, laceration, insect bite, foreign body, or impetiginous lesion. It may also result from a nearby bacterial infection such as sinusitis. Findings include marked eyelid edema, purplish or red color of the eyelid, clear conjunctivae, absence of discharge, and normal visual acuity.

Bacterial pneumonia is suspected in a 4-year-old boy with fever, headache, and chest pain. Which assessment finding would most likely indicate the need for this child to be hospitalized? A)Fever B)Oxygen saturation level of 96% C)Tachypnea with retractions D)Pale skin color

C. Pneumonia is usually a self-limiting disease. Children with bacterial pneumonia can be successfully managed at home if the work of breathing is not severe and oxygen saturation is within normal limits. Hospitalization would most likely be required for the child with tachypnea, significant retractions, poor oral intake, or lethargy for the administration of supplemental oxygen, intravenous hydration, and antibiotics. Fever, although common in children with pneumonia, would not necessitate hospitalization. An oxygen saturation level of 96% would be within normal limits. Pallor (pale skin color) occurs as a result of peripheral vasoconstriction in an effort to conserve oxygen for vital functions; this finding also would not necessitate hospitalization

When providing care to a newborn infant who was born at 29 weeks' gestation, the nurse integrates knowledge of potential complications, being alert for signs and symptoms of which of the following? A)Neonatal conjunctivitis B)Facial deformities C)Intracranial hemorrhage D)Incomplete myelinization

C. Premature infants have more fragile capillaries in the periventricular area than term infants, which puts them at greater risk for intracranial hemorrhage. Neonatal conjunctivitis can occur in any newborn during birth and is caused by viruses, bacteria, or chemicals. Facial deformities are typical of babies of alcoholic mothers. Incomplete myelinization is present in all newborns

The nurse is caring for a 4-year-old girl who has been hospitalized for over a week with severe burns. Which of the following would be a priority intervention to help satisfy this preschool child's basic needs? A)Encourage friends to visit as often as possible. B)Suggest that a family member be present with her 24 hours a day. C)Explain necessary procedures in simple language that she will understand. D)Allow her to make choices about her meals and activities as much as permitted.

C. Preschoolers fear mutilation and are afraid of intrusive procedures since they do not understand the body's integrity. They interpret words literally and have an active imagination; therefore, procedures should be demonstrated and/or explained in simple terms. Adolescents typically do not experience separation anxiety from being away from their parents; instead, their anxiety comes from being separated from friends, and therefore encouraging friends to visit is a priority intervention. Toddlers are especially susceptible to separation anxiety and would benefit from a family member being present as much as possible. School-age children are accustomed to controlling self-care and typically are highly social; they would benefit from being involved in choices about meals and activities.

A nurse is caring for a 4-year-old girl. The mother says that the girl is afraid of cats and dogs and does not like to go to the playground anymore because she wants to avoid the dogs that are often being walked at the park. What should the nurse tell the mother? A)"It is best to avoid the playground until she outgrows the fear." B)"She needs to face her fears head-on; take her to the park as much as possible." C)"Acknowledge her fear and help her develop a strategy for dealing with it." D)"Try to minimize her fears and insist that she go to the park."

C. Preschoolers have vivid imaginations and experience a variety of fears. It is best to acknowledge the fear, rather than minimize it, and then collaborate with the child on strategies for dealing with the fear. Avoiding the playground will not address the child's fears. Forcing the child to face her fear without enlisting her input to help deal with the fear does not teach. It is also important for the mother to find out if an incident involving cats and dogs occurred without her knowledge

A child is scheduled for a lower endoscopy. Which of the following would the nurse include in the child's plan of care in preparation for this test? A)Explaining about the need to ingest barium B)Establishing an intravenous access for radionuclide administration C)Administering the prescribed bowel cleansing regimen D)Withholding prescribed proton pump inhibitors for 5 days before

C. Prior to a lower endoscopy, the child must undergo bowel cleansing to allow visualization of the lower gastrointestinal tract via a fiberoptic instrument. Barium is ingested for an upper gastrointestinal and/or small bowel series. Radionuclides are used with a hepatobiliary scan. Proton pump inhibitors are withheld for 5 days before a urea breath test.

A 6-year-old boy with cerebral palsy has been admitted to the hospital for some tests. His condition is stable. The boy's mother remains with her son, but she is obviously exhausted and stressed. Which response by the nurse would be most appropriate? A)"Would you like me to bring you a blanket and pillow?" B)"You are doing such a wonderful job with your son." C)"He's in good hands; consider going home to get some sleep." D)"Are you planning to spend the night or to go home?"

C. Providing daily, intense care can be quite demanding and tiring. When a child with cerebral palsy is admitted to the hospital, this may serve as a time of respite for family and primary caregivers. The nurse should remind the mother that her son is in good hands and urge her to go home. Asking her whether she is planning to stay might make the mother feel obligated to stay. Asking if she wants a blanket or pillow does not encourage the mother to leave the hospital. Telling the mother she is doing a good job is nice, but does not encourage her to take a break.

24. A group of nursing students are reviewing information about childhood infectious diseases. The students demonstrate understanding of this information when they identify which of the following as a common childhood exanthema? A) Mumps B) Rabies C) Rubella D) West Nile virus

C. Rubella is a common childhood exanthema. Mumps is a viral infection. Rabies is a zoonotic infection. West Nile virus is a vector-borne disease.

When speaking to a group of parents at a local elementary school, the nurse describes school nursing as a specialized practice of nursing based on the fact that a healthy child has a better chance to succeed in school. Which of the following best describes the strategy school nurses use to achieve student success? A)They coordinate all school health programs. B)They link community health services. C)They work to minimize health-related barriers to learning. D)They promote student health and safety.

C. School nurses work to remove or minimize health barriers to learning to give students the best opportunity for academic success. Coordinating school health programs, linking community health programs, and promoting health and safety are individual components within the ultimate goal of removing or minimizing health barriers

A 4-year-old is brought to the emergency department with a burn. Which of the following would alert the nurse to the possibility of child abuse? A)Burn assessment correlates with mother's report of contact with a portable heater. B)Parents state that the injury occurred approximately 15 to 20 minutes ago. C)Clear delineations are noted between burned and nonburned skin areas. D)The burn area appears asymmetric and nonuniform.

C. Suggested signs of a burn resulting from possible child abuse include a uniform appearance of the burn with clear delineations of burned and nonburned areas. Abuse would also be suspected if the report of the injury was inconsistent with burn injury or there was a delay in seeking treatment. An asymmetric nonuniform burn often correlates with a splatter-type burn resulting from the child pulling a source of hot fluid onto himself or herself

The nurse is providing guidance after observing a mother interact with her negative 2-year-old boy. For which interaction will the nurse advise the mother that she is handling the negativism properly? A)Telling the child to stop tearing pages from magazines B)Asking the child if he would please quit throwing toys C)Telling the child firmly that we don't scream in the office D)Saying, "Please come over here and sit in this chair. OK?"

C. Telling the child firmly that we don't scream in the office gets the point across to the child that his behavior is unacceptable while role modeling appropriate communication. Telling the child to stop tearing up magazines does not give him direction for appropriate behavior. Asking the child if he would quit throwing toys gives him an opportunity to say "no," and is the same as asking "OK?" at the end of a direction.

The nurse is performing a vision screening for a 4-year-old child. Which of the following screening charts would be best for determining the child's visual acuity? A)Snellen B)Ishihara C)Allen figures D)Color Vision Testing Made Easy (CVTME)

C. The Allen figures chart is reliable for assessing visual acuity for a preschool child. The Snellen chart requires that the child has a good knowledge of the alphabet. This is not an expectation for a 4-year-old child. The Ishihara and CVTME charts are designed to assess color vision discrimination and not visual acuity.

The nurse is teaching the mother of a 5-year-old boy with a myelomeningocele who has developed a sensitivity to latex. Which of the following responses from his mother indicates a need for further teaching? A)"He needs to get a medical alert identification." B)"I will need to discuss this with his caregivers." C)"A product's label indicates whether it is latex-free." D)"He must avoid all contact with latex."

C. The Food and Drug Administration (FDA) requires that all medical supplies be labeled if they contain latex, but this is not the case with consumer products. The mother must be familiar with products that contain latex. The Spina Bifida Association of America maintains an updated list of latex-containing products. Getting a medical alert identification, talking with his caregivers, and avoiding all contact with latex are correct.

The nurse is screening a 6-year-old child for mental ability. Which of the following tests would the nurse use to assess intelligence? A)Denver Articulation Screening B)Denver PRQ C)Goodenough-Harris Drawing Test D)Parents' Evaluation of Developmental Status (PEDS.

C. The Goodenough-Harris Drawing Test is a nonverbal screen for mental ability (intelligence). The Denver Articulation Screening screens for articulation disorders. The Denver PRQ assesses personal-social, fine motor-adaptive, language, and gross motor skills, and the PEDS screens for a wide range of developmental, behavioral, and family issues.

The nurse is performing a physical assessment of a 3-year-old girl. Which of the following would be a concern for the nurse? A)The toddler gained 4 pounds in weight since last year. B)The toddler gained 3 inches in height since last year. C)The toddler's anterior fontanel is not fully closed. D)The circumference of the child's head increased 1 inch since last year.

C. The anterior fontanel should be closed by the time the child is 18 months old. The average toddler weight gain is 3 to 5 pounds per year. Length/height increases by an average of 3 inches per year. Head circumference increases about 1 inch from when the child is between 1 and 2 years of age, and then increases an average of a half-inch per year until age 5.

The nurse is providing care to a child with an intussusception. The child has a bowel movement and the nurse inspects the stool. The nurse would document the stool's appearance most likely as which of the following? A)Greasy B)Clay-colored C)Currant jelly-like D)Bloody

C. The child with intussusception often exhibits currant jelly-like stools that may or may not be positive for blood. Greasy stools are associated with celiac disease. Clay-colored stools are observed with biliary atresia. Bloody stools can be seen with several gastrointestinal disorders, such as inflammatory bowel disease.

The nurse is examining a 10-month-old boy who was born 10 week early. Which of the following findings is cause for concern? A)The child has doubled his birthweight. B)The child exhibits plantar grasp reflex. C)The child's head circumference is 19.5 inches. D)No primary teeth have erupted yet.

C. The child's head size is large for his adjusted age (7.5 months), which would be cause for concern. Birth weight doubles by about 6 months of age. Plantar grasp reflex does not disappear until 9 months adjusted age. Primary teeth may not erupt until 8 months adjusted age.

A parent asks the nurse about immunizing her 7-month-old daughter against the flu. Which response by the nurse would be most appropriate? A)"She really doesn't need the vaccine until she reaches 1 year of age." B)"She will probably receive it the next time she is to get her routine shots." C)"Since your daughter is older than 6 months, she should get the vaccine every year." D)"The vaccine has many side effects, so she wouldn't get it until she's ready to go to school."

C. The current recommendations are for all children older than 6 months of age to be immunized yearly against influenza.

The nurse is caring for an 8-year-old boy who has chronic epilepsy. Which of the following would be most important to address when teaching the child and parents about living with this condition? A)Multiple corrective surgeries to slowly remove diseased parts of his brain B)Physical, occupational, and speech therapy to maximize his potential C)Support for maintaining self-esteem because of his altered lifestyle D)Hyperventilation therapy to counteract the periods of decreased oxygenation

C. The effects of living with a seizure disorder can be devastating, and it is essential for the child to receive support to maintain self-esteem. While corrective surgery is possible, it would only be performed once. Physical, occupational, speech, and hyperventilation therapy are not indicated for treatment of epilepsy.

After teaching a group of parents about ear infections in children, which statement indicates that the teaching was successful? A)Infants with congenital deformities have an increased risk for ear infections. B)Ear infections typically increase as the child gets older. C)The shorter and wider eustachian tubes of an infant increase the risk. D)Adenoids shrink as the child grows, allowing more bacteria to enter.

C. The infant has relatively short, wide, horizontally placed eustachian tubes, allowing bacteria and viruses to gain access to the middle ear and resulting in an increased number of infections as compared to adults. Congenital deformities of the ear are associated with other body system anomalies, but not necessarily an increase in ear infections. As the child matures, the eustachian tubes assume a more slanted position, so older children and adults have fewer infections. A child's adenoids are often enlarged, leading to obstruction of the eustachian tubes and infection

A rapid strep test has confirmed that a 5-year-old girl has a group A Streptococcus infection. When teaching the parents about measures to implement, which of the following would be the least immediate concern? A)Using a cool mist humidifier B)Encouraging the child to drink liquids C)Discarding the child's toothbrush D)Administering antibiotic therapy

C. The least immediate concern would be to discard the child's toothbrush so that she does not reinfect herself. Usually this is accomplished after 24 hours of antibiotic therapy. Immediate care measures would include using a cool mist humidifier in the child's room and encouraging her to drink liquids or eat ice chips. In addition, antibiotic therapy would be initiated immediately and continue until the entire prescription is complete.

After teaching a group of students about visual disorders, the instructor determines that the teaching was successful when the students identify which of the following as the most common cause of visual difficulties in children? A)Astigmatism B)Strabismus C)Refractive errors D)Nystagmus

C. The most common cause of visual difficulties in children is refractive errors. Astigmatism, strabismus, and nystagmus are other common visual disorders in children but are less common than refractive errors.

14. Which of the following would be most important to include in the teaching plan for parents of a child with pinworm? A) "Seal the child's clothing in a plastic bag for at least 10 days." B) "Be sure your child wears shoes at all times." C) "Make sure the child washes his hands after using the bathroom." D) "After applying this special cream, leave it on for about 8 to 10 hours."

C. The most effective measure to prevent pinworms or a recurrence is good hand hygiene, especially after using the bathroom and before eating. Sealing the child's clothing in a plastic bag is appropriate for pediculosis capitis. Having the child wear shoes at all times is helpful in preventing hookworm. Use of a cream that remains on for a specified time is associated with scabies.

The nurse is caring for a 13-year-old girl hospitalized for complications from type 1 diabetes. The girl has a nursing diagnosis of powerlessness related to lack of control of multiple demands associated with hospitalization, procedures, treatments, and changes in usual routine. How can the nurse help promote control? A)Ask the child to identify her areas of concern. B)Encourage participation of parents in care activities. C)Offer the girl as many choices as possible. D)Enlist the family's assistance in creating a time schedule.

C. The nurse needs to offer the girl as many choices as possible, such as options for food and drink (as her diet allows), hygiene, activities, or clothing options to promote feelings of individuality and control. Two of the other options engage the parents in the process. A 13-year-old girl is capable of making her own choices regarding activities, schedules, and routine, but she may not be able to identify her areas of concern.

The nurse is caring for a female infant with torticollis and is providing instructions to the parents about how to help their daughter. Which statement by the parents indicates a need for further teaching? A)"We must encourage our daughter to turn her head both ways." B)"Flatness on one side of the head is a common side effect." C)"We must apply firm pressure and stretching every other day." D)"We will do a daily stretching regimen with multiple sessions."

C. The nurse needs to remind the parents that the stretching exercises should be done several times a day. The stretching is applied with gentle, not firm, pressure and should be done every day for multiple sessions. The statements about turning the head both ways, flatness on one side as common, and daily stretching with multiple sessions are correct.

The nurse is implementing interventions to prevent physical stressors for a 9-year-old child receiving chemotherapy in the hospital. Which of the following is an example of using atraumatic care for this child? A)Use restraint or "holding down" of the child during the procedure to prevent injury. B)Have the parent stand near and/or rub the child's feet during the procedure. C)Insert a saline lock if the child will require multiple doses of parenteral medications. D)Avoid using numbing techniques for multiple blood draws or IV insertion.

C. The nurse should insert a saline lock if the child will require multiple doses of parenteral medications. During painful or invasive procedures, the nurse should avoid traditional restraint or "holding down" of the child and use alternative positioning such as "therapeutic hugging." If therapeutic hugging is not an option, the nurse could have the parent stand near the child's head to provide comfort. The nurse should also use numbing techniques for blood draws or IV insertion

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."

C. 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.

The parents of a 2-day-old girl are concerned because her feet and hands are slightly blue. How should the nurse respond? A)"Your daughter has acrocyanosis; this is causing her blue hands and feet." B)"Let's watch her carefully to make sure she does not have a circulatory problem." C)"This is normal; her circulatory system will take a few days to adjust." D)"This is a vasomotor response caused by cooling or warming."

C. The nurse should tell the parents that this is normal and that the baby's circulatory system is adjusting to extrauterine life. Using the technical term "acrocyanosis" would most likely scare the parents. Telling the parents that the child may have a circulatory problem is inaccurate as this is a normal variation. Acrocyanosis and the mottling caused by cooling and warming are two different variations.

The nurse has determined that an 8-year-old girl is at risk for being overweight. Which of the following interventions would be a priority prior to developing the care plan? A)Determining the need for additional caloric intake B)Asking the parents who they want to work with the child C)Interviewing the parents about their eating habits D)Discussing the influence of peers on the child's diet

C. The nurse would need to find out what the parents' eating habits are like. It would not be necessary to determine the need for additional caloric intake. Developing a multidisciplinary plan is an intervention for a child with growth and development problems. Discussing the influence of peers is an intervention used for preventing injury.

The nurse is caring for a 13-year-old girl with von Willebrand disease. After teaching the adolescent and her parents about this disorder and care, which response by the parents indicates a need for additional teaching? A)"We need to administer Stimate prior to dental work." B)"We should be aware that she may suffer from menorrhagia." C)"We should administer desmopressin as often as needed." D)"We understand that she may have frequent nosebleeds."

C. The parents need to know that Stimate is the only brand of desmopressin spray that is used for controlling bleeding; the other brands are used for homeostasis and enuresis. Additionally, Stimate should only be used 3 days in a row as lessening of the response (tachyphylaxis) occurs with frequent use. Stimate should be used before dental work. Menorrhagia and nosebleeds may occur

The nurse is counseling the parents of a 10-year-old child who was caught stealing at school. Which of the following topics should the nurse cover? A)Having the child return the property in front of his or her class B)Discussing ways for the child to save face C)Finding out what is currently going on at home D)Reminding the child daily that stealing is wrong

C. The parents need to understand the child's behavior. The reason for stealing at age 10 may be that the child wants the item or is trying to impress peers, or it may be a sign of anxiety. More information is needed before the nurse can effectively work with the family. The parents should work together with the child to decide how the item will be returned. The child will lose face but gain integrity by returning the stolen item. Reminding the child about stealing on a daily basis may ruin the child's self-esteem

The nurse is supervising lunch time for children on a pediatric ward. Which of the following observations is considered abnormal for this age group? A)The child has a full set of primary teeth. B)The child has no difficulty chewing and swallowing meat. C)The child uses his fingers and refuses to use a fork. D)The child is a picky eater.

C. The preschool child has learned to use utensils fairly effectively to feed himself or herself, has a full set of primary teeth, and is able to chew and swallow competently. Preschool children may be picky eaters. They may eat only a limited variety of foods or foods prepared in certain ways and may not be very willing to try new things.

The nurse is caring for a 10-year-old boy with hyperpituitarism due to a tumor on the anterior pituitary gland. Which of the following would be a priority for this child? A)Promoting a healthy body image B)Encouraging effective family coping C)Providing pre- and postoperative care D)Promoting knowledge about treatment options

C. The priority intervention will be providing pre- and postoperative care. Promoting a healthy body image for the boy and encouraging effective family coping are secondary interventions appropriate after the surgery. Promoting knowledge about proper treatment options would be more of the physician's responsibility than the nurse's

During a follow-up visit, the parents of a 5-month-old infant diagnosed with congenital heart disease tell the nurse, "We're just so tired and emotionally spent. All these tests and examinations are overwhelming. We just want to have a normal life. We're so focused on the baby that it seems like our 3-year-old is lost in the shuffle." Which nursing diagnosis would the nurse identify as most appropriate? A)Risk for delayed growth and development related to necessary treatments B)Deficient knowledge related to the care of a child with congenital heart disease C)Interrupted family processes related to demands of caring for the ill child D)Fear related to infant's cardiac condition and need for ongoing care

C. The statements by the parents indicate that there is disruption in the family resulting from the demands of caring for the ill infant and they verbalized concern about their older child. The child may be at risk for delayed growth and development, but this is not indicated by the parents' statements. The parents may lack knowledge about their infant's condition and they may be experiencing fear about the infant's condition, but the statements reflect issues related to the family functioning.

The nurse is educating a 16-year-old girl who has just been diagnosed with acute myelogenous leukemia. Which of the following statements best demonstrates therapeutic communication? A)Discussing the treatment plan in detail for the next few weeks B)Using medical terms when describing the disease C)Assessing the adolescent's emotional status in private D)Talking about clothing and the stores where she shops

C. Therapeutic communication is goal directed and purposeful. Assessing the child's emotional status in private is goal directed and purposeful. Talking about clothing and shopping is not therapeutic communication unless its purpose is to find head coverings or wigs to mask hair loss and that information was not presented. Discussing the treatment plan for the next few weeks in detail is too much information for someone who has just been diagnosed. Using medical terms when describing the disease does not promote understanding.

The nurse is choosing foods for a toddler's diet that are high in vitamin A. Which of the following could be added to the menu? Select all answers that apply. A)Applesauce B)Avocados C)Broccoli D)Sweet potatoes E)Spinach F)Carrots

D,E,F Foods that are high in vitamin A include apricots, cantaloupe, carrots, mangos, spinach and dark greens, and sweet potatoes. Applesauce is high in fiber, and avocados and broccoli are high in folate.

The nurse is preparing a child and his family for a lumbar puncture. Which of the following would be a primary intervention instituted by the CLS to keep the child safe? A)Distraction methods B)Stimulation methods C)Therapeutic hugging D)Therapeutic touch

C. Therapeutic hugging (a holding position that promotes close physical contact between the child and a parent or caregiver) may be used for certain procedures or treatments where the child must remain still. Alternatively, distraction or stimulation (such as with a toy) can help to gain the child's cooperation, but therapeutic hugging would be used to keep the child safe during the procedure. Therapeutic touch is an energy therapy used to promote healing and decrease anxiety and stress and is not related to safety.

The nurse is teaching the parents of a child with a hematologic disorder about the functions of the various blood cells. The nurse determines that the teaching was successful when the parents state which blood cell as being primarily responsible for blood clotting? A)Granulocytes B)Erythrocytes C)Thrombocytes D)Leukocytes

C. Thrombocytes or platelets are responsible for blood clotting. Granulocytes are a type of white blood cell or leukocyte, both of which are involved in fighting infection. Erythrocytes or red blood cells are responsible for transporting nutrients and oxygen to body tissues and waste products from the tissues.

The nurse is assessing the gross motor skills of an 8-year-old boy. Which of the following interview questions would facilitate this assessment? A)"Do you like to do puzzles?" B)"Do play any instruments?" C)"Do you participate in any sports?" D)"Do you like to construct models?"

C. To assess the gross motor skills of school-age children, the nurse should ask questions about participation in sports and after-school activities. For fine motor skills, the nurse could ask questions about band membership, constructing models, and writing skills.

The nurse is teaching the student nurse how to communicate effectively with children. Which one of the following methods would the nurse recommend? A)Position self above the child's level to denote authority. B)If possible, communicate with the child apart from the parent. C)Direct questions and explanations to the child. D)Use the medical terms for body parts and medical care.

C. To communicate effectively with children, the nurse should direct questions and explanations to the child; position self at the child's level; allow the child to remain near the parent if needed, so the child can remain comfortable and relaxed; and use the child's or family's terms for body parts and medical care when possible.

Which of the following would the nurse expect to find in an 18-month-old? A)Standing on tiptoes B)Pedaling a tricycle C)Climbing stairs with assistance D)Carrying a large toy while walking

C. Toddlers continue to progress with motor skills. An 18-month-old should be able to climb stairs with assistance. A 24-month-old should be able to stand on his or her tiptoes and carry a large toy while walking. A 36-month-old would be able to pedal a tricycle.

The nurse is teaching parents interventions appropriate to the emotional development of their toddlers. Which of the following is a recommended intervention for this age group? A)Remove children's security blankets at this stage to help them assert their autonomy. B)Distract toddlers from exploring their own body parts, particularly their genitals. C)Do not blame toddlers for aggressive behavior; instead, point out the results of their behavior. D)Offer toddlers many choices to foster control over their environment.

C. Toddlers should not be blamed for their aggressive behavior; adults can assist the toddler in building empathy by pointing out when someone is hurt and explaining what happened. Adults should allow toddlers to rely upon a security item to self-soothe as this is a function of autonomy and is viewed as a sign of a nurturing environment, rather than one of neglect. Toddlers may question parents about the difference between male and female body parts and may begin to explore their own genitals. This is normal behavior in this age group. Offering limited choices is one way of allowing toddlers some control over their environment and helping them to establish a sense of mastery.

A group of nursing students are reviewing information about the endocrine system in infants and children. The students demonstrate understanding of the information when they state which of the following? A)Endocrine glands begin developing in the third trimester of gestation. B)At birth, the endocrine glands are completely functional. C)Infants have difficulty balancing glucose and electrolytes. D)A child's endocrine system has little effect on growth and development.

C. Typically, most endocrine glands begin to develop during the first trimester of gestation, but their development is incomplete at birth. Thus, complete hormonal control is lacking during the early years of life, and the infant cannot appropriately balance fluid concentration, electrolytes, amino acids, glucose, and trace substances.

The nurse is assessing a 13-year-old boy with type 2 diabetes mellitus. Which of the following would the nurse correlate with disorder? A)The parents report that their child had "a cold or flu" recently. B)Blood pressure is decreased when checking vital signs. C)The parents report that their son "can't drink enough water." D)Auscultation reveals Kussmaul breathing.

C. Unquenchable thirst (polydipsia) is a common finding associated with diabetes mellitus, type 1 and 2. However, reports of flu-like illness and Kussmaul breathing are more commonly associated with type 1 diabetes. Blood pressure is normal with type 1 diabetes and elevated with type 2 diabetes.

The nurse hears wheezing when auscultating a 4-year-old. Which of the following conditions would the nurse most likely rule out based on the assessment findings? A)Bronchiolitis B)Asthma C)Influenza D)Cystic fibrosis

C. Wheezing typically is not associated with influenza. Wheezing is caused by an obstruction of the bronchioles that may be caused by bronchiolitis, asthma, cystic fibrosis, or chronic lung disease. In addition, if the bronchiolitis is due to influenza, wheezing may be heard

A 5-year-old girl is diagnosed with iron-deficiency anemia and is to receive iron supplements. The child has difficulty swallowing tablets, so a liquid formulation is prescribed. After teaching the parents about administering the iron supplement, which statement indicates the need for additional teaching? A)"She needs to eat foods that are high in fiber so she doesn't get constipated." B)"We'll try to get her to drink lots of fluids throughout the day." C)"We will place the liquid in the front of her gums, just below her teeth." D)"We need to measure the liquid carefully so that we give her the correct amount."

C. When giving liquid iron supplements, the liquid should be placed behind the teeth because it can stain the teeth. Iron can lead to constipation, so increased fluid and fiber intake is appropriate. The dosage needs to be measured carefully to prevent overdosing the child, leading to iron toxicity.

The nurse is caring for a 6-year-old visually impaired boy and is about to begin the physical examination. Which intervention would be most appropriate to promote effective communication with the child? A)Show him the stethoscope. B)Describe the examination room. C)Use his name before touching him. D)Allow him to explore the exam room.

C. When interacting with a visually impaired child, it is a good communication technique to use his name to gain his attention before touching him. Letting him listen to his heart with the stethoscope, describing the examination room, and promoting exploration by touch are sound ways to interact, but are not specific to communicating with the child at the beginning of the assessment.

A child with persistent otitis media with effusion is to undergo insertion of pressure-equalizing tubes via a myringotomy. The child is to be discharged later that day. After teaching the parents about caring for their child after discharge, which statement indicates that the teaching was successful? A)"The tubes will stay in place for about a month and then fall out on their own." B)"His chances for ear infections now have dramatically decreased." C)"He should wear earplugs when swimming in a pool or a lake." D)"We should keep the ears protected with cotton balls for the first 24 hours."

C. When pressure-equalizing tubes are inserted, the surgeon may recommend avoiding water entry into the ears. Therefore, earplugs are suggested when the child is in the bathtub or swimming. When swimming in a lake, earplugs are especially important because lake water is contaminated with bacteria and entry of that water into the middle ear must be avoided. Typically, the tubes remain in place for at least several months and generally fall out on their own. Placement of pressure-equalizing tubes does not prevent middle ear infection. Other than earplugs for bathing and swimming, nothing else is placed in the child's ear.

26. While obtaining a health history from a male adolescent during a well check-up, the nurse assesses his sexual behavior and risk for sexually transmitted infections. Based on the information, the nurse plans to teach the adolescent about using a condom. Which of the following would the nurse include in the teaching plan? A) "You can reuse a condom if it's within 3 hours." B) "Store your condoms in your wallet so they are ready for use." C) "Put the condom on before engaging in any genital contact." D) "Use Vaseline with a latex condom for extra lubrication."

C. When teaching an adolescent about condom use, the nurse should tell the adolescent to put the condom on before any genital contact. A new condom should be used with each act of sexual intercourse; a condom should never be reused. Condoms should be stored in a cool, dry place away from direct sunlight and never stored in wallets, automobiles, or anywhere they could be exposed to extreme temperatures. Only water-soluble lubricants should be used with latex condoms. Oil-based or petroleum-based lubricants such as Vaseline can weaken latex condoms

When developing the plan of care for a child with burns requiring fluid replacement therapy, which of the following would the nurse expect to include? A)Administration of colloid initially followed by a crystalloid B)Determination of fluid replacement based on the type of burn C)Administration of most of the volume during the first 8 hours D)Monitoring of hourly urine output to achieve less than 1 mL/kg/hour

C. With fluid replacement therapy, most of the volume is administered during the first 8 hours. Crystalloids (such as Ringer lactate) are administered for the first 24 hours, and then colloids are used once capillary permeability is less of a concern. Fluid replacement is determined by the amount of body surface area burned. Hourly urine output is expected to be at least 1 mL/kg/hour.

The nurse is teaching parents to plan nutritional meals for their son who is overweight. Which of the following guidelines might the nurse include in the teaching plan? A)School-age children with an average body weight of 20 to 35 kg need approximately 90 calories per kilogram daily. B)The average water requirement for a school-age child per 24 hours ranges from 2,000 to 2,500 mL per day. C)The school-age child needs 28 g of protein and 800 mg of calcium for maintenance of growth and good nutrition. D)In the school-age child, calories needed to sustain weight increase, while the appetite decreases.

C. he school-age child needs 28 g of protein and 800 mg of calcium for maintenance of growth and good nutrition. School-age children with an average body weight of 20 to 35 kg need approximately 70 calories per kilogram daily (1,400 to 2,100 calories per day). The average water requirement per 24 hours ranges from 1,800 to 2,200 mL per day. Growth, body composition, and body shape remain constant during the late school-age years. Needed calories decrease while the appetite increases.

Assessment reveals that a child weighs 73 lb and is 4 ft 1 in. tall. The nurse calculates this child's body mass index as: A)19.1 B)20.7 C)21.4 D)24.5

C.Body mass index is determined by dividing the child's weight (in pounds) by the child's height (in inches) squared and then multiplying this figure by 703. Thus, 73 lb divided by (49 inches × 49 inches) equals 0.0304 multiplied by 703 equals 21.37 or 21.4.

15. After teaching the parents of a child with varicella zoster, the nurse determines that the parents have understood the teaching when they state that their child can return to school at which time? A) After day 5 of the rash B) When the rash is completely healed C) Once the rash appears D) After the lesions have crusted

D. Children with chickenpox (varicella zoster) can return to school once the lesions have crusted.

The nurse is assessing a 3-year-old boy's development during a well-child visit. Which response by the child indicates the need for further assessment? A)He says a swear word when he hurts himself playing. B)He says "pew" when his sister has soiled her diaper. C)He laughs when his brother cries getting vaccinated. D)He constantly asks "why?" whenever he is told a fact.

C.Laughing when his brother cries when being vaccinated indicates that the child hasn't yet developed a sense of empathy or that there may be psychosocial issues, such as sibling rivalry, that should be assessed. The child may repeat a word even if it is out of context. This is called echolalia. Older toddlers have a well-developed sense of smell and will comment if they don't like a smell. The incessant "why" is very common to toddlers' speech.

The nurse is ordered to apply restraints to a toddler who keeps pulling at the tubes in his arm. Which of the following criteria must occur to ensure proper use of these restraints? Select all answers that apply. A)The nurse must check the restraints every 15 minutes while they are in place. B)Secure the restraints with ties to the side rails, not the bed or crib frame. C)Assess the temperature of the affected extremities, pulses, and capillary refill every 15 minutes after placement. D)Use a clove-hitch type of knot to secure the restraints with ties. E)Remove the restraint every 2 hours to allow for range of motion and repositioning. F)Encourage parent participation, providing continuous explanations about the reasons and time frame for restraints.

D,E,F. The nurse should use a clove-hitch type of knot to secure the restraints with ties, remove the restraint every 2 hours to allow for range of motion and repositioning, and encourage parent participation, providing continuous explanations about the reasons and time frame for the restraints. The nurse must check restraints 15 minutes following initial placement and then every hour for proper placement and secure the restraints with ties to the bed or crib frame, not the side rails. The nurse should also assess the temperature of the affected extremities, pulses, and capillary refill, initially after 15 minutes and then every hour after placement.

The nurse is providing teaching about car safety to the parents of a 5-year-old girl who weighs 45 pounds. What should the nurse instruct the parents to do? A)"Place her in a booster seat with lap and shoulder belts in the front seat." B)"Place her in the back seat with the lap and shoulder belts in place." C)"Place her in a forward-facing car seat with a harness and top tether." D)"Place her in a booster seat with lap and shoulder belts in the back seat."

D. A child who weighs between 40 and 80 pounds should ride in a booster seat that utilizes both the lap and shoulder belts in the back seat. When a child is large enough to sit up straight with the knees bent at the front edge of the seat, then he or she may sit directly on the seat of the car with lap/shoulder belt securely and appropriately attached. The back seat of the car is the safest place for a child to ride. A forward-facing car seat with harness and top tether is for a preschooler who weighs less than 40 pounds.

A child is brought to the emergency department by his parents because he suddenly developed a barking cough. Further assessment leads the nurse to suspect that the child is experiencing croup. Which of the following would the nurse have most likely assessed? A)High fever B)Dysphagia C)Toxic appearance D)Inspiratory stridor

D. A child with croup typically develops a barking-like cough often at night. This may be accompanied by inspiratory stridor and suprasternal retractions. Temperature may be normal or slightly elevated. A high fever, dysphagia, and toxic appearance are associated with epiglottitis.

A nurse is examining a child who has sustained blunt trauma to the eye area. The nurse suspects a simple contusion based on which of the following? A)Pain in the eye B)Impaired visual acuity C)Blurred vision D)Intact extraocular movements

D. A simple contusion of the eye area is manifested by bruising and edema of the lids or surrounding eye area, intact extraocular eye movement, intact visual acuity, absence of diplopia or blurred vision, pain surrounding the eye but not within the eye, and pupils that are equal, are round, and react to light and accommodation

A 7-year-old child with a family history of cardiovascular disease is being screened for hyperlipidemia. When reviewing the child's laboratory test results, which total cholesterol level would be of significant concern? A)120 mg/dL B)150 mg/dL C)180 mg/dL D)210 mg/dL

D. A total cholesterol level greater than 200 mg/dL is considered high and would be of the greatest concern. Levels of 120 mg/dL and 150 mg/dL are considered within the normal range. A level of 180 mg/dL would be considered borderline and significant. However, a level greater than 200 mg/dL would be of greater concern.

22. The nurse is assessing the tympanic temperature of several children. The nurse documents that the child with which temperature reading has a fever? A) 99.5°F B) 99.2°F C) 100.0°F D) 100.8°F

D. A tympanic temperature greater than 100.4°F (38°C) is defined as fever. An oral temperature of 99.5°F (greater than 37.5°C) would identify a fever. An axillary temperature of 99.1°F (greater than 37.3°C) would identify a fever

A child with cerebral palsy has undergone surgery for placement of a baclofen pump. Which of the following would the nurse include when teaching the parents about caring for their child? A)Waiting 48 hours before allowing the child to take a tub bath B)Not allowing the child to sleep on his side for about 4 weeks C)Calling the physician if the child's temperature is over 100.5°F D)Discouraging the child from stretching or bending forward for 4 weeks

D. After insertion of a baclofen pump, the parents should discourage any twisting at the waist, reaching high overhead, stretching, or bending forward or backward for 4 weeks. The child would avoid tub baths for about 2 weeks and avoid sleeping on his stomach for 4 weeks. The parents should notify the physician or nurse practitioner if the child's temperature is greater than 101.5°F.

A child has undergone surgery using steel bar placement to correct pectus excavatum. Which of the following would the nurse instruct the parents to avoid? A)Semi-Fowler B)Supine C)High Fowler D)Side-lying

D. After surgery to correct pectus excavatum, the nurse would instruct the parents to avoid positioning the child on either side because this could disrupt the bar's position. Semi- or high Fowler's position and the supine position would be appropriate.

The nurse is examining a 2-year-old child who was adopted from Guatemala. Which of the following would be a priority screening for this child? A)Screening for congenital defects B)Screening for abuse C)Screening for childhood illnesses D)Screening for infectious diseases

D. Although all the screenings are important, health supervision of the internationally adopted child must include comprehensive screening for infectious disease. In 2008, approximately 19,600 children were adopted from countries outside the United States, many from areas with a high prevalence of infectious diseases (Intercountry Adoption, Office of Children's Issues, U.S. Department of State, 2010a, 2010b). Guatemala, China, and Russia supplied about half of all international adoptees in 2008, followed by Ethiopia, South Korea, and Vietnam. Proper screening is important not only to the child's health but also to the adopting family and the larger community.

3. While reviewing various studies about the use of antipyretics possibly prolonging illness, the nurse notes that there are benefits to their use for the child with fever. Which of the following would the nurse identify as the best explanation related to the benefit of antipyretics? A) They slow the growth of bacteria. B) They increase neutrophil production. C) They encourage T-cell proliferation. D) They help decrease fluid requirements.

D. Antipyretics provide symptomatic relief by increasing comfort in the child and decreasing fluid requirements, which helps to prevent dehydration. Fever has been shown to slow the growth of bacteria, increase neutrophil production, and encourage T-cell proliferation

The nurse is providing anticipatory guidance to an obese teenager. Which of the following interventions would be most likely to promote healthy weight in teenagers? A)Make the focus of the program weight centered. B)Begin directly advising children about their weight at age 6. C)Focus physical activity on competitive sports and activities. D)Obtain nutritional histories directly from the school-age child and adolescent.

D. Before providing education to school-age and teenage children, it is important to obtain nutritional histories directly from them because increasingly they are eating meals away from the family table. The focus of healthy weight promotion should be health centered, not weight centered. Linking success to numbers on a scale increases the possibility of developing eating disorders, nutritional deficiencies, and body hatred. The nurse can begin directly advising children on healthy foods starting at age 3. The focus of physical activity should be on noncompetitive, fun activities.

The mother of a 4-year-old boy tells the nurse that her son occasionally wets his pants during the day. How should the nurse respond? A)"Is there a family history of diabetes?" B)"Suddenly having accidents can be a sign of diabetes." C)"That's normal; don't worry about it." D)"Tell me about the circumstances when this occurs."

D. Bladder control is present in 4- and 5-year-olds, but an occasional accident may occur, particularly in stressful situations or when the child is absorbed in an interesting activity. The nurse needs to ask an open-ended question to determine the circumstances when the child has had accidents. Simply telling the mother that it is normal does not address the mother's concerns. The nurse does need to gather more information, because accidents in a previously potty-trained child can be a sign of diabetes.

The parents of a 7-year-old girl with type 1 diabetes has been recording her blood glucose measurements before meals and at bedtime for the past 4 days; they are as follows: Monday Tuesday B: 120 mg/dL 135 mg/dL L: 110 mg/dL 120 mg/dL D: 90 mg/dL 140 mg/dL Bed: 110 mg/dL 110 mg/dL Wednesday Thursday B:124 mg/dL 200 mg/dL L:140 mg/dL 220 mg/dL D:130 mg/dL 200 mg/d Bed: 160 mg/dL 240 mg/dL The parents bring the child in for a follow-up visit and show the nurse the results. Based on the results, the nurse would need to obtain additional information from the parents and child about which day? A)Monday B)Tuesday C)Wednesday D)Thursday

D. Blood glucose levels for a child who is 7 years of age should range from 90 to 180 mg/dL before meals and from 100 to 180 mg/dL before bedtime. On Thursday, the results for each testing were above normal. Therefore, the nurse needs to gather additional information about this day.

The school nurse is teaching parents about the effects of bullying on school children. Which of the following accurately describes this developmental concern? A)Children who bully are those who report themselves as being lonely and having difficulty in forming friendships. B)Children who are bullied are reported to have low self-esteem, poor grades, and poor interpersonal skills. C)In general, about 20% of all children attending school are frightened and afraid most of the day. D)Both boys and girls are bullied; boys usually bully boys and use force more often.

D. Both boys and girls are bullied; boys usually bully boys and use force more often. Bullied children are those who report themselves as being lonely and having difficulty in forming friendships. The children who perform the bullying are those children who are reported to have low self-esteem, poor grades, and poor interpersonal skills. In general, about 10% of all children attending school are frightened and afraid most of the day.

A 6-year-old boy has been admitted to the hospital with burns. The nurse notes carbonaceous sputum. Which of the following would be the priority? A)Determining the burn depth B)Eliciting a description of the burn C)Estimating burn extent D)Ensuring a patent airway

D. Carbonaceous sputum is a sign of potential airway injury due to smoke inhalation. Therefore, the nurse should ensure a patent airway while obtaining a brief history and simultaneously evaluating the child and providing emergency care. If the burn does not pose an immediate, life-threatening risk, the nurse would obtain an in-depth history and elicit a description of the burn. Determining the burn depth and extent are part of the secondary survey.

The nurse is performing a health history on a 6-year-old boy who is having trouble adjusting to school. Which of the following questions would be most likely to elicit valuable information? A)"Do you like your new school?" B)"Are you happy with your teacher?" C)"Do you enjoy reading a book?" D)"What are your new classmates like?"

D. Careful conversation and interview with the child and/or the caregiver will provide important information about the child's health. Depending on the intent of the health assessment, many of the questions will be direct, and many will require the caregiver or child to answer simply "yes" or "no." In other than emergency situations, though, asking open-ended questions such as "What are your classmates like?" offers an excellent opportunity to learn more about the child's life.

The nurse is instructing the parents of a school-age child with an eye disorder how to care for her eye. Which of the following conditions would the nurse explain as resolving by itself without the use of antibiotics? A)Blepharitis B)Hordeolum C)Corneal abrasion D)Chalazion

D. Chalazion usually resolves spontaneously but may require surgical drainage. Therapeutic management of blepharitis, hordeolum, and corneal abrasion may require antibiotic ointment.

The nurse is caring for a 4-year-old boy who has undergone an appendectomy. The child is unwilling to use the incentive spirometer. Which approach would be most appropriate to elicit the child's cooperation? A)"Can you cough for me please?" B)"You must blow in this or you might get pneumonia." C)"If you don't try, I will have to get the doctor." D)"Can you blow this cotton ball across the tray?"

D. Children are more likely to cooperate with interventions if play is involved. Encourage deep breathing by playing games. Asking the boy to cough is less likely to engage him. Telling the child he might get pneumonia is not age appropriate and is unhelpful. Threatening to call the doctor is unhelpful and inappropriate. Remember, however, that the incentive spirometer works on the principle of the amount of air inhaled, not exhaled. Having the child take a deep breath prior to blowing the cotton ball is a beginning step.

A 15-month-old girl is having her first health visit at a clinic. The mother has no immunization record but says the child was immunized 3 months ago at the local health department. Which of the following is the best action for the nurse to take? A)Ask the mother to bring the records to the next health maintenance visit. B)Start the catch-up schedule since there are no immunization records. C)Keep the child at the facility while the mother returns home for the records. D)Call the local health department and verify the child's immunization status.

D. Contacting the health department will provide a copy of the child's immunization record for the permanent records. It also avoids repeating vaccinations unnecessarily. Accepting the mother's recollection of the infant's immunization status puts the infant at risk of not being fully immunized. Since the health department may be contacted, there is no need to start the catch-up schedule. It is inappropriate to leave her child at the facility.

The nurse is caring for a 13-year-old girl with delayed puberty. Based on the nurse's knowledge of this condition, the nurse would include which nursing diagnosis in the child's plan of care? A)Disabled family coping related to the child's disorder B)Imbalanced nutrition, less than body requirements related to the child's short stature C)Noncompliance related to the need for lifelong hormone therapy D)Deficient knowledge related to the administration of estradiol

D. Deficient knowledge related to the administration of estradiol is an appropriate nursing diagnosis for this child. There are oral, transdermal, topical, injectable, and vaginal preparations available. Disabled family coping due to the child's disorder and noncompliance due to long-term therapy are not likely diagnoses because of the simplicity and brevity of the treatment for this disorder. Imbalanced nutrition evidenced by short stature would be appropriate for a child with growth hormone deficiency

The nurse is caring for a 4-year-old boy with Ewing sarcoma who is scheduled for a computed axial tomography (CAT) scan tomorrow. Which of the following is the best example of therapeutic communication? A)Telling him he will get a shot when he wakes up tomorrow morning B)Telling him how cool he looks in his baseball cap and pajamas C)Using family-familiar words and soft words when possible D)Describing what it is like to get a CAT scan using words he understands

D. Describing what it is like to get a CAT scan using age-appropriate words is the best example of therapeutic communication. It is goal-directed, focused, and purposeful communication. Using family-familiar words and soft words is a good teaching technique. Telling him how cool he looks in his baseball cap and pajamas is not goal-directed communication. Telling the child he will get a shot when he wakes up could keep him awake all night.

The nurse is administering digoxin as ordered and the child vomits the dose. What should the nurse do next? A)Contact the physician B)Offer a snack and administer another dose C)Immediately administer another dose D)Administer next dose as ordered in 12 hours

D. Digoxin should be administered at regular intervals, every 12 hours, 1 hour before or 2 hours after feeding. If the child vomits digoxin, the nurse should not give a second dose and should wait until the next scheduled dose. It is not necessary to contact the physician.

The nurse is promoting a healthy diet to guide a mother when feeding her 2-week-old girl. Which of the following is the most effective anticipatory guidance? A)Encouraging breastfeeding until the sixth month B)Advocating iron supplements with bottle-feeding C)Advising fluid intake per feeding of 5 or 6 ounces D)Discouraging the addition of fruit juice to the diet

D. Discouraging the addition of fruit juice to the child's diet is the most effective anticipatory guidance. Fruit juice can displace important nutrients from breast milk or formula. Encouraging breastfeeding until the sixth month is only halfway to the Healthy People goal of breastfeeding for the first year. Advising fluid intake per feeding of 5 or 6 ounces is too much for this neonate, but is typical for an infant 4 to 6 months of age. Advocating iron supplements with bottle-feeding is unnecessary so long as the formula is fortified with iron.

After teaching a class of nursing students about muscular dystrophy, the instructor determines that the teaching was successful when the students identify which type of muscular dystrophy as demonstrating an X-linked recessive pattern of inheritance? A)Limb-girdle B)Myotonic C)Distal D)Duchenne

D. Duchenne muscular dystrophy follows an X-linked recessive inheritance pattern. Limb-girdle muscular dystrophy is believed to be autosomal or X-linked inherited. Myotonic and distal muscular dystrophy follow an autosomal dominant inheritance pattern.

A 4-year-old boy has a febrile seizure during a well-child visit. Which of the following would be a priority? A)Hyperextending the child's head while placing him on his side B)Using a tongue blade to pry open the child's jaw C)Loosening the child's clothing to ensure a patent airway D)Protecting the child from harm during the seizure

D. During a seizure, the child should not be held down in a specific position. Protecting the child's head and body during the seizure is the priority. Ensuring a patent airway is an important intervention but is not accomplished by loosening the child's clothing or hyperextending his head. The child should be placed on his side and nothing should be inserted into his mouth to forcibly open the jaw.

A nurse is caring for a 14-year-old girl who received an electrical burn. The nurse would anticipate preparing the girl for which diagnostic tests as ordered? A)Pulse oximetry B)Fiberoptic bronchoscopy C)Xenon ventilation-perfusion scanning D)Electrocardiographic monitoring

D. Electrocardiographic monitoring is important for the child who has suffered an electrical burn to identify possible cardiac arrhythmias, which can be noted for up to 72 hours after a burn injury. Fiberoptic bronchoscopy and xenon ventilation-perfusion scanning may be ordered to evaluate an inhalation injury, not an electrical burn. Pulse oximetry is used to evaluate pulmonary function and would not be indicated in the case of an electrical burn.

The nurse has developed a teaching plan for the family of a 2-year-old boy who holds his breath when he gets frustrated. Which of the following will be most important to include in this plan? A)Provide cuddle time whenever the child begins to act out. B)Explain the child's behavior to the parents. C)Encourage the parents to interact more with the child. D)Stay close to prevent injury when he gets frustrated.

D. Encourage the parents to maintain a safe environment when an episode is occurring, but to avoid giving extra attention to the child after the event since this could encourage repetition of the behavior. It is important for the parents to understand what is happening, but rewarding the child with cuddle time when he is misbehaving provides incorrect reinforcement of behaviors. Encouraging the parents to interact more with the child may be helpful, but the priority is safety for the child.

A nurse develops a plan of care for a child that includes patching the eye. This plan of care would be most appropriate for which condition? A)Astigmatism B)Hyperopia C)Myopia D)Amblyopia

D. Eye patching is used for amblyopia or any condition that results in one eye being weaker than the other. Corrective lenses would be appropriate for astigmatism, hyperopia, and myopia.

A group of nursing students are reviewing information related to seizures that occur in infants and children. The students demonstrate a need for additional review when they identify which type as common in neonates? A)Tonic B)Focal clonic C)Multifocal clonic D)Myoclonic

D. Five major types of seizures have been recognized in the neonatal period: subtle, tonic, focal clonic, multifocal clonic, and myoclonic. Of these, myoclonic seizures rarely occur during the neonatal period. Subtle seizures affect preterm and full-term neonates. Tonic seizures primarily occur in preterm neonates. Focal clonic and multifocal clonic are more common in full-term neonates

After teaching the parents of a 6-year-old how to administer an enema, the nurse determines that the teaching was successful when they state that they will give how much solution to their child? A)100 to 200 mL B)200 to 300 mL C)250 to 500 mL D)500 to 1,000 mL

D. For a school-age child, typically 500 to 1,000 mL of enema solution is given. For an infant, 250 mL or less is used; for a toddler or preschooler, 250 to 500 mL is used.

A 3-year-old child is scheduled for a hearing screening. The nurse would prepare the child for screening by which method? A)Auditory brain stem response B)Evoked otoacoustic emissions C)Visual reinforcement audiometry D)Conditioned play audiometry

D. For children between the ages of 2 and 4 years, conditioned play audiometry would be an appropriate method for hearing screening. Auditory brain stem response and evoked otoacoustic emissions are appropriate hearing screening methods for newborns through age 6 months. Visual reinforcement audiometry is appropriate for children ages 6 months to 2 years.

The parents of a child diagnosed with celiac disease ask the nurse what types of food they can offer their child. Which of the following would the nurse include in the teaching plan? A)Frozen yogurt B)Rye bread C)Creamed spinach D)Fruit juice

D. For the child with celiac disease, foods containing gluten such as frozen yogurt, rye bread, and creamed vegetables should be avoided. Fruit juice would be an appropriate suggestion in a gluten-free diet.

As part of a clinical conference with a group of nursing students, the instructor is describing the burn classification. The instructor determines that the teaching has been successful when the group identifies which of the following as characteristic of full thickness burns? A)Skin that is reddened, dry, and slightly swollen B)Skin appearing wet with significant pain C)Skin with blistering and swelling D)Skin that is leathery and dry with some numbness

D. Full thickness burns may be very painful, numb, or pain-free in some areas. They appear red, edematous, leathery, dry, or waxy and may display peeling or charred skin. Superficial burns are painful, red, dry, and possibly edematous. Partial thickness and deep partial thickness burns are very painful and edematous and have a wet appearance or blisters.

The nurse is using verbal skills to explain the nursing care plan to parents of a 10-year-old child with cancer. Which of the following describes a guideline the nurse should follow to provide appropriate verbal communication? A)Use closed-ended questions that do not restrict the child's or parent's answers. B)Allow the focus to change without redirecting the conversation. C)Restate the child's and parents comments in your own words. D)Paraphrase the child's or parent's feelings to demonstrate empathy.

D. General guidelines for appropriate verbal communication include the following: paraphrase the child's or parent's feelings to demonstrate empathy, use open-ended questions that do not restrict the child's or parent's answers, redirect the conversation to maintain focus, and demonstrate active listening by using the child's or family's own words.

Two working parents are discussing with the school nurse the possibility of their 12-year-old girl going home alone after school. Which of the following suggestions should the nurse make? A)Provide entertainment until the parents come home. B)Allow the child to go to a friend's house. C)Teach her how to take a message if someone calls. D)Purchase caller ID for the phone.

D. Having caller ID allows the child to answer the phone if Mom or Dad calls while ignoring all other calls. Rather than entertaining the child, this would be a better time for homework, age-appropriate chores, and limited entertainment. If the child goes to a friend's house, it should be prearranged between the parents, not spur of the moment. It is safer if the child does not answer the phone instead of taking a message.

The nurse is promoting nutrition to a 13-year-old boy who is overweight. Which of the following comments should the nurse expect to include in the discussion? A)"You need to go on a low-fat diet." B)"Eat what your parents eat." C)"Go out for a sport at school." D)"Keep a food diary."

D. Having the boy keep a detailed food diary for 1 week will determine current patterns of eating. This can then be used to show him how to make small changes with results, especially if eating is done before periods of inactivity such as before going to bed or when he is bored. Speaking and thinking in terms of diet are negative and can lead to poor body image. If the parents have poor eating habits, telling the child to eat what his parents eat could be bad advice. The child could too easily choose the wrong sport or do poorly. It is best to offer solutions with more variety.

The nurse is teaching the parents of a 2-year-old girl how to deal with common toddler situations. Which is the best advice? A)Discipline the child for regressive behavior. B)Scold the child for public thumb sucking. C)Tell the older sibling to not act like a baby. D)Have the child help clean up a bowel accident.

D. Having the child help clean up a bowel accident is the best advice. Toddlers should never be punished for bowel or bladder "accidents," but gently reminded about toileting. Regressive behavior is best ignored, while appropriate behavior should be praised. Telling the older sibling to not act like a baby is a negative approach. It would be better to have the child be mother's helper. Calmly telling the child that thumb sucking is something that is done at home is better than scolding the child.

Which of the following would the nurse expect to assess in a child with hypothyroidism? A)Nervousness B)Heat intolerance C)Smooth velvety skin D)Weight gain

D. Hypothyroidism is manifested by weight gain, fatigue, cold intolerance, and dry skin. Nervousness, heat intolerance, and smooth velvety skin are associated with hyperthyroidism.

The nurse is performing a physical examination on a sleeping newborn. Which of the following body systems should the nurse examine last? A)Heart B)Abdomen C)Lungs D)Throat

D. If the infant is asleep, the nurse should auscultate the heart, lungs, and abdomen first while the baby is quiet. The nurse performs the assessment in a head-to-toe manner, leaving the most traumatic procedures, such as examination of the ears, nose, mouth, and throat, until last.

The nurse is developing a plan of care for an infant with heart failure who is receiving digoxin. The nurse would hold the dose of digoxin and notify the physician if the infant's apical pulse rate was: A)140 beats per minute B)120 beats per minute C)100 beats per minute D)80 beats per minute

D. In an infant, if the apical pulse rate is less than 90 beats per minute, the dose is held and the physician should be notified.

During class, a student states, "I didn't think children could have strokes. I thought this only occurred in older adults." When responding to the student, which of the following would be most important for the instructor to integrate into the response? A)Strokes in children often have an identifiable cause. B)The signs and symptoms in children are different from an adult. C)Research has identified specific treatments for children. D)Ischemic strokes are more common than hemorrhagic strokes.

D. In children, ischemic strokes are more common than hemorrhagic strokes. However, the cause of the stroke in many children remains unidentified. Signs and symptoms are similar to those in adults and will vary based on age; underlying cause, if known; and location of the stroke. Historically, children have been excluded from adult stroke studies and thus, many treatments used have had to be adapted from adult studies.

Which activity would the nurse least likely include as exemplifying the preconceptual phase of Piaget's preoperational stage? A)Displays of animism B)Use of active imaginations C)Understanding of opposites D)Beginning questioning of parents' values

D. In the intuitive phase of Piaget's preoperational stage, the child begins to question parents' values. Animism, active imaginations, and an understanding of opposites would characterize the preconceptual phase of Piaget's preoperational stage.

A nurse is assessing the fontanels of a crying newborn and notes that the posterior fontanel pulsates and briefly bulges. What do these findings indicate? A)Increased intracranial pressure B)Overhydration C)Dehydration D)These are normal findings.

D. It is common to see the fontanel pulsate or briefly bulge if a baby cries. Overhydration or increased intracranial pressure would cause a persistent bulging. Dehydration would cause the fontanel to be sunken.

The school nurse is planning to teach a segment on smoking during the freshman health classes. The nurse is aware that this needs to be a forum rather than a lecture. Which of the following techniques will also help deliver a "don't smoke" message? A)Showing a command of the facts on smoking B)Speaking with a tone of authority C)Keeping your personal experiences out of it D)Listening to all comments nonjudgmentally

D. It is very important to listen to the students' comments without judgment to avoid creating a resistance to information. Spouting too many facts too often and taking on an authoritative tone will show the audience that their opinions don't matter. Using personal experiences and admitting mistakes you have made can be helpful to communication.

A mother is concerned about her infant's spitting up. Which suggestion would be most appropriate? A)"Put the infant in an infant seat after eating." B)"Limit burping to once during a feeding." C)"Feed the same amount but space out the feedings." D)"Keep the baby sitting up for about 30 minutes afterward."

D. Keeping the baby upright for 30 minutes after the feeding, burping the baby at least two or three times during feedings, and feeding smaller amounts on a more frequent basis may help to decrease spitting up. Positioning the infant in an infant seat compresses the stomach and is not recommended.

The school nurse knows that school-age children are developing metalinguistic awareness. Which of the following is an example of this skill? A)The child enjoys reading books. B)The child enjoys conversations with peers. C)The child enjoys speaking on the phone. D)The child enjoys telling jokes.

D. Language skills continue to accelerate during the school-age years. School-age children develop metalinguistic awareness—an ability to think about language and comment on its properties. This enables them to enjoy jokes and riddles due to their understanding of double meanings and play on words and sounds.

The neonatal nurse assesses newborns for iron-deficiency anemia. Which of the following newborns is at highest risk for this disorder? A)A postterm newborn B)A term newborn with jaundice C)A newborn born to a diabetic mother D)A premature newborn

D. Maternal iron stores are transferred to the fetus throughout the last trimester of pregnancy. Infants born prematurely miss all or at least a portion of this iron store transfer, placing them at increased risk for iron-deficiency anemia compared with term infants. An infant having jaundice, having been born to a mother with diabetes, or have been born postterm does not significantly place the infant at risk for iron-deficiency anemia.

A group of students are reviewing information about the various types of insulin used to treat type 1 diabetes. The students demonstrate understanding of the information when they identify which insulin listed below as having the longest duration? A)Lispro B)Regular C)NPH D)Glargine

D. Of the insulins listed, glargine (Lantus) has the longest duration of action, that is, 12 to 24 hours. Lispro lasts approximately 3 to 5 hours; regular lasts 5 to 8 hours; and NPH lasts approximately 10 to 16 hours.

The nurse working with children in a hospital setting notes that they are being discharged earlier and earlier. Which of the following is a primary reason for this trend? A)Nursing shortages B)Increased funding for home care C)National health care initiatives D)Cost containment

D. Over the past century changes in health care, such as strained health care funding, shorter hospital stays, and cost containment, have led to a shift in responsibilities of care for children from the hospital to homes and communities. Nursing shortages influence the delivery of health care. National health care initiatives may or may not affect earlier discharge to home health care.

A nurse is teaching the parents of a child diagnosed with cystic fibrosis about medication therapy. Which of the following would the nurse instruct the parents to administer orally? A)Recombinant human DNase B)Bronchodilators C)Anti-inflammatory agents D)Pancreatic enzymes

D. Pancreatic enzymes are administered orally to promote adequate digestion and absorption of nutrients. Recombinant human DNase, bronchodilators, and anti-inflammatory agents are typically administered by inhalation

A nurse is talking with the parents of a child who has had a febrile seizure. The nurse would integrate an understanding of which of the following into the discussion? A)The child's risk for cognitive problems is greatly increased. B)Structural damage occurs with febrile seizure. C)The child's risk for epilepsy is now increased. D)Febrile seizures are benign in nature.

D. Parents need reassurance that febrile seizures, although frightening, are benign in nature. Children who experience one or more febrile seizures are at no greater risk of developing epilepsy than the general population. No evidence exists that febrile seizures cause structural damage or cognitive declines

The nurse is providing discharge planning for a 12-year-old boy with multiple medical conditions. Which of the following would be the best teaching method for this child and his family? A)Demonstrate the care and ask for a return demonstration. B)Provide and review educational booklets and materials. C)Provide a written schedule for the child's care. D)Provide a trial period of home care.

D. Parents of children with multiple medical needs may benefit from a trial period of home care. This occurs while the child is still in the hospital, but the parents or caregivers provide all of the care that the child requires. The other options are also important teaching methods, but a trial period is the best solution for a child with multiple medical conditions.

The school nurse is preparing a talk on the influence of the media on school-age children to present at the next PTO meeting. Which of the following facts might the nurse include in the introduction? A)Children in the United States spend about 6 hours a day either watching TV or playing video games. B)A child will see 2,000 murders by the end of grade school and 20,000 commercials a year. C)A school-age child cannot determine what is real from what is fantasy; therefore, TV and video games can lead to aggressive behavior. D)Parents should limit television watching and video-game playing to 2 hours per day.

D. Parents should limit television watching and video-game playing to 2 hours per day. Children in the United States spend about 4 hours a day either watching TV or playing video games. A child will see 8,000 murders by the end of grade school and 40,000 commercials a year. Although school-age children can determine what is real from what is fantasy, research has shown that this amount of time in front of the TV—watching it or playing video games—can lead to aggressive behavior, less physical activity, and altered body image.

During a well-child check-up, the parents of a 9-year-old boy tell the nurse that their son's friends told him that soccer is a stupid game, and now he wants to play baseball. Which comment by the nurse best explains the effects of peer groups? A)"The child's best friends will continue playing soccer." B)"The children will cheer for each other regardless of the sport being played." C)"Your child will rarely talk to you about his friends." D)"Acceptance by friends, especially of the same sex, is very important at this age."

D. Peer relationships, especially of the same sex, are very important and can influence the child's relationship with his parents. They can provide enough support that he can risk parental conflict and stand his ground about playing soccer. At this age, peer groups are made up of the child's best friends, and they happen to be playing baseball. Peer groups have rules and take up sides against the soccer player. Peers are an authority, so the child will let his parents know their opinions.

A 16-year-old boy complains to the school nurse of headaches and a stiff neck. Which of the following signs and symptoms would alert the nurse that the child may have bacterial meningitis? A)Fixed and dilated pupils B)Frequent urination C)Sunset eyes D)Sunlight is "too bright"

D. Photophobia, or intolerance of light, is another symptom of bacterial meningitis. Fixed and dilated pupils are a symptom of head trauma and warrant prompt intervention. Frequent urination is a symptom of a type I Arnold-Chiari malformation. Sunset eyes indicate increased intracranial pressure typical of hydrocephalus.

Which of the following would lead the nurse to suspect that a child is beginning to develop increased intracranial pressure? A)Bradycardia B)Cheyne-Stokes respirations C)Fixed, dilated pupils D)Projectile vomiting

D. Projectile vomiting is an early sign of increased intracranial pressure. Bradycardia, Cheyne-Stokes respirations, and fixed dilated pupils are late signs of increased intracranial pressure

The nurse is caring for a 4-year-old boy with infectious conjunctivitis. Which intervention would be least appropriate to include in the child's plan of care? A)Rinsing the eye with cool water B)Educating the family about the disease C)Encouraging frequent hand washing D)Promoting eye safety

D. Promoting eye safety would be appropriate if the child had an eye injury. Rinsing the eye with cool water, educating the family about the disorder, and encouraging frequent hand washing are interventions for infectious conjunctivitis.

The nurse is providing discharge teaching regarding formula preparation for a new mother. Which of the following guidelines would the nurse include in the teaching plan? A)Always wash bottles and nipples in hot soapy water and rinse well; do not wash them in the dishwasher. B)Store tightly covered ready-to-feed formula can after opening in refrigerator for up to 24 hours. C)Warm bottle of formula by placing bottle in a container of hot water, or microwaving formula. D)Do not add cereal to the formula in the bottle or sweeten the formula with honey.

D. Proper formula preparation includes the following: wash nipples and bottles in hot soapy water and rinse well or run nipples and bottles through the dishwasher; store tightly covered ready-to-feed formula can after opening in refrigerator for up to 48 hours; after mixing concentrate or powdered formula, store tightly covered in refrigerator for up to 48 hours; do not reheat and reuse partially used bottles; throw away the unused portion after each feeding; do not add cereal to the formula in the bottle; do not sweeten formula with honey; warm formula by placing bottle in a container of hot water; and do not microwave formula.

The nurse is administering a hepatitis B vaccine to a child. What is the classification of this type of vaccine? A)Killed vaccines B)Toxoid vaccines C)Conjugate vaccines D)Recombinant vaccines

D. Recombinant vaccines use genetically engineered organisms. The hepatitis B vaccine is produced by splicing a gene portion of the virus into a gene of a yeast cell. The yeast cell is then able to produce hepatitis B surface antigen to use for vaccine production. Killed vaccines contain whole dead organisms; they are incapable of reproducing but are capable of producing an immune response. Toxoid vaccines contain protein products produced by bacteria called toxins. The toxin is heat-treated to weaken its effect, but it retains its ability to produce an immune response. Conjugate vaccines are the result of chemically linking the bacterial cell wall polysaccharide (sugar-based) portions with proteins.

The nurse is developing a teaching plan for toddler safety to present at a parenting seminar. Which of the following are safety interventions that the nurse should address? A)Encourage parents to enroll toddlers in swimming classes to avoid the need for constant supervision around water. B)Advise parents to keep pot handles on stoves turned outward to avoid accidental burns. C)Encourage parents to smoke only in designated rooms in the house or outside the house. D)Advise parents to use a forward-facing car seat with harness straps and a clip, placed in the backseat of the car.

D. Safety is of prime concern throughout the toddler period. The safest place for the toddler to ride is in the back seat of the car. Parents should use the appropriate size and style of car seat for the child's weight and age as required by the state. At a minimum, all children over 20 pounds and up to 40 pounds should be in a forward-facing car seat with harness straps and a clip. Parents who want to enroll a toddler in a swimming class should be aware that a water safety skills class would be most appropriate. However, even toddlers who have completed a swimming program still need constant supervision in the water. Pot handles on stoves should be turned inward to avoid accidental burn. Nurses should counsel parents to stop smoking (optimal), but if they continue smoking never to smoke inside the home or car with children present.

The nurse is preparing a presentation for a local parent-teacher organization about the growth and development of school-age children. Which of the following would the nurse include? A)Boys mature much more quickly than girls of the same age during this time. B)From 6 to 12 years of age, children grow an average of 4 inches per year. C)The child's body size is in direct correlation with his or her maturity level. D)Secondary sex characteristics are often embarrassing for both sexes.

D. Secondary sex characteristics are often a source of embarrassment for both sexes because preadolescent boys and girls do not want to be different from their peers of the same or opposite sex. In the later school years, girls begin to surpass boys in both height and weight. During this time, children grow an average of 2 inches (5 cm) per year. Physical maturity is not necessarily associated with emotional or social maturity.

The adolescent continues to develop self-concept and self-esteem. Which of the following is most important to a teen's self-esteem? A)Strong authority figures B)Spirituality C)Morals and values D)Body image

D. Self-concept and self-esteem are tied to body image many times. Adolescents who perceive their body as being different than peers or as less than ideal may view themselves negatively. Sexual characteristics are important to the adolescent's self-concept and body image. Authority figures, spirituality, and morals and values play a role in development of self-esteem, but body image is most influential in the development of self-concept/self-esteem.

The nurse is caring for an 8-year-old boy hospitalized for a bone marrow transplant. His parents are in and out of his room throughout the day. Which of the following behaviors of the child would alert the nurse that he is in the second stage of separation anxiety? A)He ignores his parents when they return to his room. B)He cries uncontrollably whenever they leave. C)He forms superficial relationships with his caregivers. D)He sits quietly and is uninterested in playing and eating.

D. Separation anxiety consists of three stages—protest, despair, and detachment. In the protest stage, the child reacts aggressively to separation and exhibits great distress by crying, expressing agitation, and rejecting others who attempt to offer comfort. In the despair phase the child displays hopelessness by withdrawing from others, becoming quiet without crying, and exhibiting apathy, depression, lack of interest in play and food, and overall feelings of sadness. In the detachment stage the child shows interest in the environment, starts to play again, and forms superficial relationships with the nurses and other children. If the parents return, the child ignores them. A child in this phase of separation anxiety exhibits resignation, not contentment

A child is diagnosed with atopic dermatitis. Which laboratory test would the nurse expect the child to undergo to provide additional evidence for this condition? A)Erythrocyte sedimentation rate B)Potassium hydroxide prep C)Wound culture D)Serum immunoglobulin E level

D. Serum immunoglobulin E (IgE) levels are often used to evaluate for atopic dermatitis. IgE levels are elevated in this condition. Erythrocyte sedimentation rate may be used but this test is nonspecific and only indicates infection or inflammation. Potassium hydroxide prep is used to identify fungal infections. Wound culture would be done to identify a specific organism if an infection occurs with atopic dermatitis.

The nurse emphasizes that a toddler younger than the age of 18 months should never be spanked primarily for which reason? A)Spanking in a child this age predisposes the child to a pro-violence attitude. B)The child will become resentful and angry, leading to more outbursts. C)Spanking demonstrates a poor model for problem-solving skills. D)There is an increased risk for physical injury in this age group.

D. Spanking should never be used with toddlers younger than 18 months of age because there is an increased possibility of physical injury. Although spanking or other forms of corporal punishment lead to a pro-violence attitude, create resentment and anger in the child, and are a poor model for learning effective problem-solving skills, the risk of physical injury in this age group is paramount.

The nurse inspects the eyes of a child and observes that the sclera is showing over the top of the iris. The nurse documents this finding as: A)Decorticate posturing B)Nystagmus C)Doll's eye D)Sunsetting

D. Sunsetting is when the sclera of the eyes is showing over the top of the iris. Decorticate posturing includes adduction of the arms, flexion at the elbows with the arms held over the chest, and flexion of the wrists with both hands fisted and the lower extremities adducted and extended. Nystagmus is manifested by involuntary rapid rhythmic eye movements. Doll's eye is a maneuver that tests for symmetric eye movement to the opposite side when the head is turned in the other direction

The nurse is teaching the student nurse about abnormal findings when assessing the breasts of children. Which of the following may be associated with renal disorders? A)Swollen nipples upon inspection of a newborn's breasts B)Tender nodule palpated under the nipple of a 10-year-old C)Observation of enlarged breast tissue in a male adolescent D)Observation of a supernumerary nipple along the mammary ridge

D. Supernumerary nipples are usually of no concern as they do not change over time, but they may be associated with renal disorders. Newborns of both genders may have swollen nipples from the influence of maternal estrogen, but by several weeks of age the nipples should be flat. A tender nodule palpated just under the nipple confirms pubertal changes and is a normal finding. Adolescent boys may develop gynecomastia (enlargement of the breast tissue) due to hormonal pubertal changes. When the hormone levels stabilize, male adolescents then have flat nipples.

The nurse is examining a 5-year-old boy. Which of the following signs or symptoms is a reliable first indication of respiratory illness in children? A)Slow, irregular breathing B)A bluish tinge to the lips C)Increasing lethargy D)Rapid, shallow breathing

D. Tachypnea, or increased respiratory rate, is often the first sign of respiratory illness in infants and children. Slow, irregular breathing and increasing listlessness are signs that the child's condition is worsening. Cyanosis (a bluish tinge to the lips) or the degree of cyanosis present is not always an accurate indication of the severity of respiratory involvement

The parents of an 8-year-old boy are interested in promoting learning through reading to their son. Which of the following suggestions by the nurse would best promote this goal? A)Have the parents choose what he should read initially. B)Tell the child to read instead of watching TV with his parents. C)Tell the parents that reading is for the child to do by himself. D)Take the child to the library to check out some books.

D. Taking the child to the library can be a positive start to the reading experience. It is best to let the librarian recommend books that will be appropriate for the child, but let the child choose from recommended materials. Set an example by reading instead of watching TV while the child is not in bed. Reading to the child is a valuable parent-child activity that can expose the child to classic works that are beyond the child's present reading ability.

The nurse is performing a cognitive assessment of a 2-year-old. Which of the following behaviors would alert the nurse to a developmental delay in this area? A)The child cannot say name, age, and gender. B)The child cannot follow a series of two independent commands. C)The child has a vocabulary of 40 to 50 words. D)The child does not point to named body parts.

D. The 2-year-old can point to named body parts and has a vocabulary of 40 to 50 words. At 30 months old a child can follow a series of two independent commands and at 3 years old a child can say name, age, and gender.

A nurse is preparing a presentation for an expectant parent group about neural tube defects and prevention. Which of the following would the nurse emphasize? A)Smoking cessation B)Aerobic exercise C)Increased calcium intake D)Folic acid supplementation

D. The cause of neural tube defects is unknown, but there is strong evidence to support the use of folic acid supplementation for prevention. Smoking cessation and aerobic exercise are general health recommendations unrelated to neural tube defects. Increased calcium intake is important for fetal growth and development, but it is not linked to preventing neural tube defects

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

D. 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.

The nurse is developing a nursing care plan for a hospitalized 6-year-old. Which of the following behaviors would warrant nursing intervention? A)The child pretends he is talking to an imaginary friend when the nurse addresses the child. B)The child states that her fairy godmother is going to come and take her home. C)The child starts talking about his grandmother and then quickly changes the subject to a new toy he received. D)The child does not want to play games with other children on the hospital ward.

D. The preschooler begins to plan activities, make up games, and initiate activities with others. Not wanting to play games with other children is a sign of a developmental delay and nursing intervention is recommended. The preschooler often has an imaginary friend who serves as a creative way for the preschooler to sample different activities and behaviors and practice conversational skills. Through make-believe and magical thinking, preschool children satisfy their curiosity about differences in the world around them. The preschooler uses transduction when reasoning: he or she extrapolates from a particular situation to another, even though the events may be unrelated.

The nurse is caring for a toddler who is in Piaget's sensorimotor stage of cognitive development. Which of the following tasks would the nurse expect the toddler to be able to perform? A)Completing puzzles with four pieces B)Winding up a mechanical toy C)Playing make-believe with dolls D)Knowing which are his or her toys

D. The toddler in Piaget's sensorimotor stage of cognitive development (18 to 24 months) understands requests, is capable of following simple directions, and has a sense of ownership (knowing which toys are his). The other tasks are accomplished by the child in the preoperational stage (2 to 7 years).

The nurse of a preschool child is helping parents develop a healthy meal plan for their child. Which of the following nutritional requirements for this age group should the nurse consider? A)The 3- to 5-year-old requires 300 to 500 mg calcium and 10 mg iron daily. B)The 3-year-old should consume 10 mg dietary fiber daily. C)The 4- to 8-year-old requires 15 mg dietary fiber per day. D)The typical preschooler requires about 85 kcal/kg of body weight.

D. The typical preschooler requires about 85 kcal/kg of body weight. The 3- to 5-year-old requires 500 to 800 mg calcium and 10 mg iron daily. The 3-year-old should consume 19 mg dietary fiber daily, while the 4- to 8-year-old requires 25 mg dietary fiber per day.

A group of students are reviewing information about fluid balance and losses in children in comparison to adults. The students demonstrate a need for additional review when they identify which of the following? A)Children have a proportionately greater amount of body water than do adults. B)Fever plays a greater role in insensible fluid losses in infants and children. C)A higher metabolic rate plays a major role in increased insensible fluid losses. D)The infant's immature kidneys have a tendency to overconcentrate urine more.

D. The young infant's renal immaturity does not allow the kidneys to concentrate urine as well as in older children and adults, placing them at risk for dehydration or overhydration. Children do have a proportionately greater amount of body water than adults, and fever is important in promoting insensible fluid losses in infants and children because children become febrile more readily and their fevers are higher than those in adults. Children also experience a higher metabolic rate, which accounts for increased insensible fluid losses and increased need for water for excretory function.

17. A woman gives birth to a healthy newborn. As part of the newborn's care, the nurse instills erythromycin ophthalmic ointment as a preventive measure for which sexually transmitted infection (STI)? A) Genital herpes B) Hepatitis B C) Syphilis D) Gonorrhea

D. To prevent gonococcal ophthalmia neonatorum, erythromycin or tetracycline ophthalmic ointment is instilled into the eyes of all newborns. This action is required by law in most states. The ointment is not used to prevent conditions related to genital herpes, hepatitis B, or syphilis.

A nursing instructor is developing a class presentation about the medications used to treat peptic ulcer disease. Which drug class would the instructor be least likely to include in the presentation? A)Antibiotics B)Proton pump inhibitors C)Histamine antagonists D)Prokinetics

D. Treatment for peptic ulcer disease includes antibiotics if Helicobacter pylori is verified, histamine antagonists, and/or proton pump inhibitors. Prokinetics are used to stimulate the gastrointestinal tract to help empty the stomach faster and promote intestinal motility. They are not used for peptic ulcer disease.

5. The nurse is preparing a plan of care for a 5-year-old boy with chickenpox. Which of the following nursing interventions should be questioned? A) Administer antipyretics as ordered. B) Keep the child's fingernails short. C) Monitor fluid intake and output. D) Provide alcohol baths as needed.

D. Treatments such as sponging the child with alcohol or cold water are not appropriate interventions for fever management. Rather, the nurse would use tepid sponge baths and cool compresses. Administering antipyretics, keeping the child's fingernails short, and monitoring intake and output are appropriate.

The nurse teaching safety to teens knows that which of the following is the leading cause of death among adolescents? A)Drowning B)Poisoning C)Diseases D)Unintentional injuries

D. Unintentional injuries are the leading causes of death in adolescents (U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, 2008). Injuries kill more adolescents than all diseases combined, with 46% of injury-related deaths due to motor vehicle accidents (U.S. Department of Health and Human Services, 2007). Unintentional injury accounts for about 48% of adolescent injury deaths, violence and homicide for 15.2%, and suicide for 11.8% of adolescent injury deaths (U.S. Department of Health and Human Services, 2007). Males are more likely than females to die of any type of injury.

The mother of a 15-month-old child is questioning the nurse about the need for the hepatitis B vaccination. Which of the following comments provides the most compelling reason for the vaccine? A)"The most common side effect is injection site soreness." B)"This is a recombinant or genetically engineered vaccine." C)"Immunizations are needed to protect the general population." D)"This protects your child from infection that can cause liver disease."

D. Up to 90% of neonates infected with hepatitis B develop chronic carrier status and will be predisposed to cirrhosis and hepatic cancer. The mother is not questioning side effects, safety, or disease prevention in general. Therefore, it is best to speak to her concerns.

21. The nurse is preparing to obtain a blood specimen via capillary heel puncture. Which of the following would be most appropriate for the nurse to do? A) Apply a cool compress for several minutes before collection B) Elevate the extremity used after puncturing it C) Squeeze the area to facilitate specimen collection D) Wipe away the first drop of blood with dry gauze

D. When obtaining a blood specimen by capillary puncture, the nurse should wipe away the first drop of blood with a cotton ball or dry gauze pad and then collect the sample without squeezing the foot to prevent possible hemolysis. Prior to the puncture, the nurse can apply a commercial heel warmer or warm compress for several minutes to promote vasodilation. The extremity being used should be placed in the dependent position after puncturing the heel.

The nurse is developing a teaching plan for the parents of a child with a myelomeningocele who will require clean intermittent catheterization. Which of the following would the nurse include? A)Applying petroleum jelly to lubricate the catheter B)Cleaning the reusable catheter with peroxide after each use C)Storing the reusable cleaned catheter in a brown paper bag D)Soaking the catheter in a vinegar and water solution to sterilize

D. When teaching parents how to perform clean intermittent catheterization, the nurse would instruct the parents to apply a water-based lubricant to the catheter, clean the reusable catheter with soap and water after each use, store the reusable clean catheter in a zip-top bag or other clean storage container, and soak the catheter in a 1:1 vinegar and water solution for about 30 minutes weekly, rinsing well before the next use or placing the catheter in boiling water for 10 minutes.

The nurse is designing a nursing care plan for a toddler with lymphoma, who is hospitalized for treatment. Which of the following is a priority intervention that the nurse should include in this child's nursing plan? A)Limiting visitors to scheduled visiting hours B)Planning physical therapy for the child C)Introducing the toddler to other toddlers in the unit D)Monitoring the toddler for developmental delays

D. When the toddler is hospitalized, growth and development may be altered. The toddler's primary task is establishing autonomy, and the toddler's focus is mobility and language development. The nurse caring for the hospitalized toddler must use knowledge of normal growth and development to be successful in interactions with the toddler, promote continued development, and recognize delays. Parents should be encouraged to stay with the toddler to avoid separation anxiety. Planning activities and socialization of the toddler is important, but the priority intervention is monitoring for, and addressing, developmental delays that may occur in the hospital.