WK6 Quiz

A nurse is teaching an adolescent who has DM about manifestations of hypoglycemia. Which of the following findings should the nurse include in the teaching? (SATA) A. Increased urination B. Hunger C. Signs of dehydration D. Irritability E. Sweating and pallor F. Kussmaul respirations

B. Hunger D. Irritability E. Sweating and pallor

An infant with congenital hypothyroidism may have what clinical symptoms?

poor feeding prolonged jaundice lethargy horse cry constipation heart murmur hypotonia enlarged tongue

Pituitary hyperfunction that occurs after epiphyseal closure?

Acromegaly

When are lupron injections discontinued from patients with precocious puberty?

At the age for normal pubertal changes to resume

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

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

A nurse is caring for a child who has type 1 dm. Which of the following are manifestations of diabetic ketoacidosis? (SATA) A. Blood glucose 58 mg/dL B. Weight gain C. Dehydration D. Mental confusion E. Fruity breath

C. Dehydration- osmotic diuresis b/c of electrolyte shift D. Mental confusion- mental confusion b/c of electrolyte shift E. Fruity breath- b/c of body's attempt to eliminate ketones

How are growth hormones administered? A. IM B. Intrathecal C. Subcutaneously Rectally

C. Subcutaneously

A pediatric oncology patient has developed a nose bleed. Which finding would account for this occurrence? A. Increased white blood cell count B. Increased neutrophils C. Decreased hemoglobin and hematocrit D. Decreased platelet count

D

An example of a disease process that is based on a "two-hit" hypothesis leading to a cancer diagnosis is: A. Fanconi anemia. B. Wiskott Aldrich syndrome. C. Klinefelter syndrome. D. Retinoblastoma.

D.

what is the most common type of juvenile hypothyroidism?

congenital hypoplastic thyroid gland (underdeveloped thyroid gland)

What is precocious puberty?

sexual development before age 9 years in boys or age 8 in girls (occurs more frequently in girls)

Why is prompt treatment necessary of congenital hypoplastic thyroid gland?

to prevent mental retardation related to inadequate brain growth in the infant

What nursing considerations are important with patients that have excessive GH?

treatment wont diminish growth already established treatment can prevent further growth increased work load of the heart can lead to cardiac problems

When are GH injections given? A. In the morning before breakfast B. The first of the month C. Every night before bed D. Every other week

C. Physiologic release of GH is normally at night.

A child is undergoing remission induction therapy to treat leukemia. Allopurinol is included in the regimen. The main reason for administering allopurinol as part of the client's chemotherapy regimen is to: a. Prevent metabolic breakdown of xanthine to uric acid b. Prevent uric acid from precipitating in the ureters c. Enhance the production of uric acid to ensure adequate excretion of urine d. Ensure that the chemotherapy doesn't adversely affect the bone marrow"

A (The massive cell destruction resulting from chemotherapy may place the client at risk for developing renal calculi; adding allopurinol decreases this risk by preventing the breakdown of xanthine to uric acid. Allopurinol doesn't act in the manner described in the other options.)

The mother of a 5-year-old child asks the nurse questions regarding the importance of vigilant use of sunscreen. Which information is most important for the nurse to convey to the mother? a.) Appropriate use of sunscreen decreases the risk of skin cancer. b.) Repeated exposure to the sun causes premature aging of the skin. c.) A child's skin is delicate, and burns easily. d.) In addition to causing skin cancer, repeated sun exposure predisposes the child to other forms of cancer.

A (While all of the answer choices are correct, recommending the use of sunscreen to decrease the incidence of skin cancer (a) is the best response.)

When would a child diagnosed with insulin-dependent diabetes mellitus most likely demonstrate a decreased need for insulin? A. During the honeymoon phase B. During adolescence C. During growth spurts D. During minor illnesses

A. During the honeymoon phase, which may last from a few weeks to a year or longer, the child is likely to need less insulin. During adolescence, physical growth and hormonal changes contribute to an increase in insulin requirements. Insulin requirements are typically increased during growth spurts. Stress either from illness or from events in the environment can cause hyperglycemia. Insulin requirements are increased during periods of minor illness.

A nurse is assessing a child who has short stature. Which of the following findings would indicate a growth hormone deficiency? A. Proportional height to weight B. Height proportionally greater than weight C. Weight proportionally greater than height D. BMI greater than height/weight ratio

A. Proportional height to weight- Children who have growth hormone deficiency present with short stature with proportional height and weight.

A nurse is reviewing sick day management with a parent of a child who has type 1 dm. Which of the following should the nurse include in the teaching? (SATA) A. Monitor blood glucose levels every 3 hr. B. Discontinue taking insulin until better. C. Drink 8 oz of fruit juice every hour. D. Test urine for ketones. E. Call the provider if blood glucose is greater than 240mg/dL.

A. Monitor blood glucose levels every 3 hr. A client who is experiencing illness can have waning blood glucose levels. Frequent monitoring of blood glucose levels is done to identify hyperglycemic or hypoglycemic episodes. D. Test urine for ketones. A client who is experiencing an illness should test her urine for ketone to assist in early detection of ketoacidosis. E. Call the provider if blood glucose is greater than 240mg/dL. A client who is experiencing illness should notify the provider of blood glucose levels greater than 240 mg/dL to obtain further instructions in caring for the hyperglycemia.

Which nursing intervention should not be included in the postoperative plan of care for a child undergoing surgery for a brain tumor? a. Place the child in Trendelenburg position. b. Perform neurologic assessments. c. Assess dressings for drainage. d. Monitor temperature.

ANS: A Feedback A The child is never placed in the Trendelenburg position because it increases intracranial pressure and the risk of bleeding. B Increased intracranial pressure is a risk in the postoperative period. The nurse would assess the child's neurologic status frequently. C Hemorrhage is a risk in the postoperative period. The child's dressing would be inspected frequently for bleeding. D Temperature is monitored closely because the child is at risk for infection in the postoperative period.

A 9-year old child with leukemia is in remission and has returned to school. The school nurse calls the mother of the child and tells the mother that a classmate has just been diagnosed with chickenpox. The mother immediately calls the clinic nurse because the leukemic child has never had chickenpox. The appropriate response by the clinic nurse to the mother is: A. There is no need to be concerned. B. Bring the child into the clinic for a vaccine. C. Keep the child out of school for 2 week period. D. Monitor the child for an elevated temperature, and call the clinic if this happens.

B (Rationale: immunocompromised children are unable to fight varicella adequately. Chickenpox can be deadly to the them. If the child who has not had chickenpox is exposed to someone with varicella, the child should receive varicella zoster immune globulin within 96hrs of exposure. Options 1,3,4, are incorrect because they do nothing to minimize the chances of developing the disease.)

Which symptom should be reported to the healthcare provider when a child is taking propylthiouracil? A. Nausea and vomiting B. Fever and sore throat C. Increased appetite and diarrhea D. Weight gain and mood swings

B. Propylthiouracil or methimazole is the treatment of choice for childhood hyperthyroidism. Fever and sore throat are clinical manifestations of neutropenia, a side effect of propylthiouracil. Nausea and vomiting are not common side effects of propylthiouracil. Increased appetite and diarrhea are clinical manifestations of Graves disease. Weight gain and mood swings are not considered side effects of propylthiouracil.

A school-age child is being seen in the oncology clinic for possible Hodgkin's disease. During the course of the nursing assessment, which findings would be expected? Select all that apply. a) fever. b) painless cervical nodes. c) painful cervical nodes. d) poor appetite. e) complaints of night sweats"

B, D (Painless cervical nodes are a hallmark sign of HD. In addition to this, night sweats also are characteristic. Fever, poor appetite, and painful cervical nodes are more characteristic of infection.")

A child is diagnosed with hypothyroidism. The nurse should expect to assess which symptoms associated with hypothyroidism? Select all that apply. A. weight loss B. Fatigue C. diarrhea D. dry, thick skin E. cold intolerance.

B, D, E A child with hypothyroidism will display fatigue, dry, thick skin, and cold intolerance. Weight loss and diarrhea are signs of hyperthyroidism.

Administration of colony stimulating agents for the pediatric oncology patient are used to: A.decrease nausea. B. shrink tumor size. C. increase bone marrow response. D. decrease production of stem cells.

C.

Which comment made by a 12-year-old child with insulin-dependent diabetes mellitus (IDDM) indicates a knowledge deficit? A. I rotate my insulin injection sites every time I give myself an injection. B. I keep records of my glucose levels and insulin sites and amounts. C. Ill be glad when I can take a pill for my diabetes like my uncle does. D. I keep Lifesavers in my school bag in case I have a low-sugar reaction.

C. Children with IDDM will require life-long insulin therapy. Rotating injection sites is appropriate because insulin absorption varies at different sites. Keeping records of serum glucose and insulin sites and amounts is appropriate. Prompt treatment of hypoglycemia reduces the possibility of a severe reaction. Keeping hard candy on hand is an appropriate action.

Which is the priority outcome of mandatory newborn screening for hypothyroidism? A. Appropriate community referral for affected families B. Parental education about raising a special needs child C. Early identification of the disorder D. Facilitation of parent-child bonding

C. Early identification of hypothyroidism is basic to the prevention of mental retardation in the child. Community referral is appropriate after a diagnosis is made. With early identification and treatment with thyroid hormone replacement, mental retardation is prevented. Facilitation of parentchild bonding is a consideration for all newborn infants.

Which is the best nursing action when a child with insulin-dependent diabetes mellitus is sweating, trembling, and pale? A. Offer the child a glass of water. B. Give the child 5 units of Regular insulin subcutaneously. C. Give the child a glass of orange juice. D. Give the child glucagon subcutaneously.

C. Four ounces of orange juice is an appropriate treatment for the conscious child who is exhibiting signs of hypoglycemia. A glass of water is not indicated in this situation. An easily digested carbohydrate is indicated when a child exhibits symptoms of hypoglycemia. Insulin would lower blood glucose and is contraindicated for a child with hypoglycemia. Subcutaneous injection of glucagon is used to treat hypoglycemia when the child is unconscious.

A nurse is teaching a child who has type 1 dm about self-care. Which of the following statements by the child indicates understanding of the teaching? A. I should skip breakfast when I am not hungry. B. I should increase my insulin with exercise. C. I should drink a glass of milk when I am feeling irritable. D. I should draw up the NPH insulin into the syringe before the regular insulin.

C. I should drink a glass of milk when I am feeling irritable. An early manifestation of hypoglycemia is irritability. Drinking a glass of milk, which is approximately 15g of carbohydrates, indicates understanding of the teaching.

A 4-year-old has a right nephrectomy to remove a Wilms tumor. The nurse knows that it is essential to: A. Request a low-salt diet B. Restrict fluids C. Educate the family regarding renal transplants D. Prevent urinary tract infections

D (Because the child has only one remaining kidney, it is important to prevent urinary tract infections. Answers A, B, and C are not necessary, so they are incorrect.)

In taking care of a pediatric oncology patient, which diagnostic finding would indicate a critical concern for the development of bleeding? A. Absolute neutrophil count of 1000 mm3 B. Temperature of 99.2° F C. White blood cell count 18,000 mm3 D. Platelet count 50,000 mm3

D.

A nurse is teaching a school age child who has dm about insulin administration. Which of the following should the nurse include in the teaching? A. You should inject the needle at a 30 degree angle B. You should combine your glargine and regular insulin in the same syringe. C. You should aspirate for blood before injecting the insulin. D. You should give four or five injections in one area before switching sites.

D. You should give four or five injections in one area before switching sites.--The nurse should instruct the client to administer four or five injections about 2.5 cm (1 in) apart before switching to another site.

A nurse is teaching the parent of a child who has a growth hormone deficiency. which of the following are complications of untreated growth hormone deficiency? (SATA) A. Delayed sexual development B. Premature aging C. Advanced bone age D. Short stature E Increased epiphyseal closure

A. Delayed sexual development B. Premature aging D. Short stature

A nurse determines that parents understood the teaching from the pediatric oncologist if the parents indicate that which test confirms the diagnosis of leukemia in children? a. Complete blood cell count (CBC) b. Lumbar puncture c. Bone marrow biopsy d. Computed tomography (CT) scan

ANS: C Feedback A A CBC may show blast cells that would raise suspicion of leukemia. It is not a confirming diagnostic study. B A lumbar puncture is done to check for central nervous system involvement in the child who has been diagnosed with leukemia. C The confirming test for leukemia is microscopic examination of bone marrow obtained by bone marrow aspiration and biopsy. D A CT scan may be done to check for bone involvement in the child with leukemia. It does not confirm a diagnosis.

Which finding if observed would warrant intervention regarding the administration of an antiemetic in a chemotherapy protocol for a pediatric patient? A.Providing the medication on a scheduled basis regardless of the patient's clinical symptoms. B. Administering the medication via the parenteral route prior to infusion of chemotherapy protocol. C. Providing medication with sips of water following clinical symptoms of nausea and/or vomiting. D.Administering 30 to 60 minutes prior to initiation of therapy.

C.

Which sign is the nurse most likely to assess in a child with hypoglycemia? A. Urine positive for ketones and serum glucose greater than 300 mg/dL B. Normal sensorium and serum glucose greater than 160 mg/dL C. Irritability and serum glucose less than 70 mg/dL D. Increased urination and serum glucose less than 120 mg/dL

C. Irritability and serum glucose less than 70 mg/dL are neuroglycopenic manifestations of hypoglycemia. Serum glucose greater than 300 mg/dL and urine positive for ketones are indicative of diabetic ketoacidosis. Normal sensorium and serum glucose greater than 160 mg/dL are associated with hyperglycemia. Increased urination is an indicator of hyperglycemia. A serum glucose level less than 120 mg/dL is within normal limits.

A nurse analyzes the lab values of a child with leukemia who is receiving chemotherapy. The nurse notices that the platelet count is 19,500 cell/mm3. Based on this lab value which intervention would the nurse document in her plan of care. A. Monitor closely for signs of infection. B. Temp every four hours. C. Isolation precautions D. Use a small toothbrush for mouth care"

D (Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production. If the platelet count is les than 20,000 than bleeding precautions need to be taken.)

A child with a brain tumor is undergoing radiation therapy. What should the nurse include in the discharge instructions to the child's parents? (Select all that apply.) a. Apply over-the-counter creams to the area daily. b. Avoid excessive skin exposure to the sun. c. Use a washcloth when cleaning the area receiving radiation. d. Plan for adequate rest periods for the child. e. A darkening of the skin receiving radiation is expected.

ANS: B, D, E Feedback Correct: Children receiving cranial radiation are particularly affected by fatigue and an increased need for sleep during and shortly after completion of the course of radiation. Skin damage can include changes in pigmentation (darkening), redness, peeling, and increased sensitivity. Incorrect: Extra care must be taken to avoid excessive skin exposure to heat, sunlight, friction (such as rubbing with a towel or washcloth), and creams or moisturizers. Only topical creams and moisturizers prescribed by the radiation oncologist should be applied to the radiated skin.

Which statement, if made by a nurse to the parents of a child with leukemia, indicates an understanding of teaching related to home care associated with the disease? a. "Your son's blood pressure must be taken daily while he is on chemotherapy." b. "Limit your son's fluid intake just in case he has central nervous system involvement." c. "Your son must receive all of his immunizations in a timely manner." d. "Your son's temperature should be taken frequently."

ANS: D Feedback A The child's temperature must be taken daily because of the risk for infection, but it is not necessary to take a blood pressure daily. B Fluid is never withheld as a precaution against increased intracranial pressure. If a child had confirmed CNS involvement with increased intracranial pressure, this intervention might be more appropriate. C Children who are immunosuppressed should not receive any live virus vaccines. D An elevated temperature may be the only sign of an infection in an immunosuppressed child. Parents should be instructed to monitor their child's temperature as often as necessary.

A parent of a school age child who has GH deficiency asks the nurse how long the child will need to take injections for growth delay. Which of the following responses should the nurse make? A. Injections are usually continued until age 10 for girls and age 12 for boys. B. Injections continue until your child reaches the fifth percentile on the growth chart C. Injections should be continued until there is evidence of epiphyseal closure. D. The injections will need to be administered throughout your child's entire life.

C. Injections should be continued until there is evidence of epiphyseal closure.- Injections are continued until there is evidence of epiphyseal closure on radiographic tests.

You are working with the parents of a pediatric oncology patient who has successfully responded to therapy but is now experiencing body image changes as a result of hair loss due to chemotherapy regimen. The parents are upset about this change in their child's appearance. Which response would be appropriate with regard to the parent's concern? A. As the therapy has been successful, it is important to focus on that rather than body image changes. B. Tell the parents that the child's hair will grow back soon. C. Tell the parents that the child's hair will grow back stronger and healthier. D. Acknowledge the parent's concern and focus on available options that may be used to help with body image concerns.

D

A pediatric oncology patient is undergoing chemotherapy. Which observation would lead the nurse to suspect that the patient has developed sterile hemorrhagic cystitis? A. Absence of hematuria B. Presence of proteinuria C. Complaints by the patient that it burns upon urination D. Increased sensation of thirst.

B.

A diagnostic workup is being performed on a 1-year-old child with suspected neuroblastoma. The nurse reviews the results of the diagnostic tests and understands that which of the following findings is most specifically related to this type of tumor? A. Elevated vanillylmandelic acid (VMA) urinary levels B. Presence of blast cells in the bone marrow C. Projectile vomiting, usually in the morning D. Postive Babinski's sign"

A (Rationale: Neuroblastoma is a solid tumor found only in children. It arises from neural crest cells that develop into the sympathetic nervous system and the adrenal medulla. Typically, the tumor compresses adjacent normal tissue and organs. Neuroblastoma cells may excrete catecholamines and their metabolites. Urine samples will indicate elevated VMA levels. The presence of blast cells in the bone marrow occurs in leukemia. Projectile vomiting occurring most often in the morning and a positive Babinski's sign are clinical manifestations of a brain tumor.)

A child with cancer has the following lab result: WBC 10,000, RBC 5, and plts of 20,000. When planning this child's care, which risk should the nurse consider most significant? A. Hemorrage B. Anemia C. Infection D. Pain

A (The lab values presented all are normal except for the platelet count. Decreases in platelet counts place the child at greatest risk for hemorrhage.)

A 15-year-old has been admitted to the hospital with the diagnosis of acute lymphocytic leukemia. Which of the following signs and symptoms require the most immediate nursing intervention? A. Fatigue and Anorexia B. Fever and Petechiae C. Swollen lymph nodes in the neck and lethargy. D. Enlarged liver and spleen

B (Fever and petechiae associated with acute lymphocytic leukemia indicate a suppression of normal white blood cells and thrombocytes by the bone marrow and put the client at risk for other infections and bleeding. The nurse should initiate infection control and safety precautions to reduce these risks. Fatigue is a common symptom of leukemia due to red blood cell suppression. Although the client should be told about the need for rest and meal planning, such teaching is not the priority intervention. Swollen glands and lethargy may be uncomfortable but they do not require immediate intervention. An enlarged liver and spleen do require safety precautions that prevent injury to the abdomen; however, these precautions are not the priority.)

What is the primary concern for a 7-year-old child with insulin-dependent diabetes mellitus (IDDM) who asks his mother not to tell anyone at school that he has diabetes? A. The childs safety B. The privacy of the child C. Development of a sense of industry D. Peer group acceptance

A. Safety is the primary issue. School personnel need to be aware of the signs and symptoms of hypoglycemia and hyperglycemia and the appropriate interventions. Privacy is not a life-threatening concern. The treatment of IDDM should not interfere with the school-age childs development of a sense of industry. Peer group acceptance and body image are issues for the early adolescent with IDDM. This is not of greater priority than the childs safety.

What is the best time for the nurse to assess the peak effectiveness of subcutaneously administered Regular insulin? A. Two hours after administration B. Four hours after administration C. Immediately after administration D. Thirty minutes after administration

A. The peak action for Regular (short-acting) insulin is 2 to 3 hours after subcutaneous administration. The duration of Regular (short-acting) insulin is only 3 to 6 hours. Peak action occurs 2 to 3 hours after the insulin is administered. Subcutaneously administered Regular (short-acting) insulin has an onset of action of 30 to 60 minutes after injection. The effectiveness of subcutaneously administered, short-acting insulin cannot be assessed immediately after administration. Thirty minutes corresponds to the onset of action for Regular (short-acting) insulin.

A pediatric patient has been diagnosed with leukemia and presents with a white blood cell (WBC) count of 80,000 mm3. Which statement if provided by a nursing student indicates that additional teaching is needed with regard to pathophysiological mechanisms of leukemia? A. The increase in WBC provides protection against bacterial infections. B. Although the WBC count is elevated, there are increased blast cells which help to protect the patient against infection. C. The amount of white blood cells is greatly increased, which affords protection against viral infections. D. Increases in white blood cells are expected but associated with a low leukocyte count.

B.

A client is admitted to the hospital for a colon resection and in preparation for surgery the physician orders neomycin. The nurse understands the main reason why this antibiotic is especially useful before colon surgery is because it: A. Will not affect the kidneys B. Acts systemically without delay C. Has limited absorption from the GI tract. D. Is effective against many different organisms

C (Because neomycin is limited absorption form the GI tract, it exerts it antibiotic effect on the intestinal mucosa. In preparation of GI surgery, the level of microbial organisms will be reduced.)

A child being treated for Acute Lymphocytic Leukemia (ALL) has a white blood cell (WBC) count of 7,000/mm3. the nursing care plan lists risk for infection as a priority nursing diagnosis, and measures are being taken to reduce the child's exposure to infection. the nurse determines that the plan has been successful when which outcome has been met? A. child's WBC count goes up. B. child's WBC count goes down. C. child's temperature remains within normal range. D. parents demonstrate good hand washing technique."

C (In leukemia, the WBCs that are present are immature and incapable of fighting infection. increases or decreases in the number of WBCs can be related to the disease process and treatment, and not related to infection. the only value that indicates the child is infection-free is the temperature. the use of proper handwashing technique is a measure or intervention used to meet a goal. but is not a goal itself. STRATEGY: the core issue of the question is knowledge of an indicator of infection in a client who is immunosuppressed from leukemia. recall that temperature and WBC counts are frequently used as indicators of infection. recall that in leukemia the WBCs are abnormal so choose the option related to temperature.)

A nurse is teaching a client about the risk factors associated with colorectal cancer. The nurse determines that further teaching related to the colo-rectal cancer is necessary if the client identifies which of the following as an associated risk factor? A. Age younger than 50 years B. History of coloractal polyps C. Family history of colorectal cancer D. Chronic inflammatory bowel disease"

A (Colorectal cancer risk factors include age older than 50 years, a family history of the disease, colorectal polyps, and chronic inflammatory bowel disease.)

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

A (Malaise is the most common side effect of radiotherapy. For children, the fatigue may be especially distressing because it means they cannot keep up with their peers.)

What information provided by the nurse would be helpful to a 15-year-old adolescent taking propylthiouracil three times a day? A. Pill dispensers and alarms on her watch can remind her to take the medication as ordered. B. She can take the medication when she is nervous and feels she needs it. C. She can take two pills before school and one pill at dinner, which will be easier for her to remember. D. Her mother can be responsible for reminding her when it is time to take her medication.

A. Propylthiouracil is an antithyroid medication that should be taken three times a day. Reminders will facilitate taking medication as ordered. This medication needs to be taken regularly, not on an as-needed basis. The dosage cannot be combined to reduce the frequency of administration. Because of the adolescents school schedule and activities, she, rather than her mother, needs to be responsible for her medication.

A neonate is displaying tremors, twitching, and irritability. This is suggestive of: A. hypocalcemia B. hypothyroidism C. hypoglycemia D. phenylketonuria (PKU)

A. When hypocalcemia is present, neonates may display twitching, tremors, irritability, jitteriness, electrocardiographic changes, and, rarely, seizures. An infant with hypothyroidism may exhibit skin mottling, a large fontanel, a large tongue, hypotonia, slow reflexes, a distended abdomen, prolonged jaundice, lethargy, constipation, feeding problems, and coldness to touch. Hypoglycemia causes the neonate to exhibit jitteriness, poor feeding, lethargy, seizures, and respiratory alterations including apnea, hypotonia, high-pitched cry, bradycardia, cyanosis, and temperature instability. Infants with PKU may initially have digestive problems with vomiting, and they may have a musty or mousy odor to the urine, infantile eczema, hypertonia, and hyperactive behavior.

A nurse is caring for a child who has short stature. Which of the following diagnostic tests should be completed to confirm growth hormone (GH) deficiency? (SATA) A. CT scan of the head B. Bone age scan C. GH stimulation test D. Serum IGF -1 E. DNA testing

A. CT scan of the head- to determine whether there is a structural component to the short stature B. Bone age scan- To determine the development of the bones C. GH stimulation test- confirm dx of GH deficiency D. Serum IGF -1- a preliminary test to determine GH deficiency

The nurse notes that a child's gums bleed easily and he has bruising and petechiae on his extremities. What laboratory values are consistent with these symptoms? a. Platelet count of 19,000/mm3 b. Prothrombin time of 11 to 15 seconds c. Hematocrit of 34 d. Leukocyte count of 14,000/mm3

ANS: A Feedback A The normal platelet count is 150,000 to 400,000/mm3. This finding is very low, indicating an increased bleeding potential. The child should be monitored closely for signs of bleeding. B The prothrombin time of 11 to 15 seconds is within normal limits. C The normal hematocrit is 35 to 45 and, although this finding is low, it would not create the symptoms presented. D This value indicates the probable presence of infection, but it is not a reflection of bleeding tendency.

What should the nurse recognize as symptoms of a brain tumor in a school-age child for whom she is caring? (Select all that apply.) a. Blurred vision b. Increased head circumference c. Vomiting when getting out of bed d. Intermittent headache e. Declining academic performance

ANS: A, C, D, E Feedback Correct Visual changes such as nystagmus, diplopia, and strabismus are manifestations of a brain tumor. The change in position on awakening causes an increase in intracranial pressure, which is manifested as vomiting. Vomiting on awakening is considered a hallmark symptom of a brain tumor. Increased intracranial pressure resulting from a brain tumor is manifested as a headache. School-age children may exhibit declining academic performance, fatigue, personality changes, and symptoms of vague, intermittent headache. Other symptoms may include seizures or focal neurologic deficits. Incorrect Manifestations of brain tumors vary with tumor location and the child's age and development. Infants with brain tumors may have increased head circumference with a bulging fontanel. School-age children have closed fontanels and therefore their head circumferences do not increase with brain tumors.

Children with non-Hodgkin lymphoma are at risk for complications resulting from tumor lysis syndrome (TLS). The nurse should assess for: a. Liver failure b. CNS deficit c. Kidney failure d. Respiratory distress

ANS: C Feedback A TLS is related to intracellular electrolytes overloading the kidney as a response to the rapid lysis of tumor cells. This does not affect the liver. B TLS does not affect the CNS. C In TLS, the tumor's intracellular contents are dumped into the child's extracellular fluid as the tumor cells are lysed in response to chemotherapy. Because of the large volume of these cells, their intracellular electrolytes overload the kidneys and, if not monitored, can cause kidney failure. D TLS does not affect the lungs and cause respiratory distress.

The nurse should base a response to a parent's question about the prognosis of acute leukemia (ALL) on the knowledge that: a. Leukemia is a fatal disease, although chemotherapy provides increasingly longer periods of remission. b. Research to find a cure for childhood cancers is very active. c. The majority of children go into remission and remain symptom free when treatment is completed. d. It usually takes several months of chemotherapy to achieve a remission.

ANS: C Feedback A With the majority of children surviving 5 years or longer, it is inappropriate to refer to leukemia as a fatal disease. B This statement is true, but it does not address the parent's concern. C Children diagnosed with the most common form of leukemia, ALL, can almost always achieve remission, with a 5-year disease-free survival rate approaching 85%. D About 95% of children achieve remission within the first month of chemotherapy. If a significant number of blast cells are still present in the bone marrow after a month of chemotherapy, a new and stronger regimen is begun.

A preschool-aged child is to undergo several painful procedures. Which of the following techniques is most-appropriate for the nurse to use in preparing the child? A. Allow the child to practice injections on a favorite doll. B. Explain the procedure in simple terms. C. Allow a family member to explain the procedure to the child. D. Allow the child to watch an educational video.

B (Preschoolers have the cognitive ability to understand simple terms. Use of a favorite doll is contraindicated because it is ""part"" of that child and he/she might perceive the doll is experiencing pain.)

After a client is admitted to the pediatric unit with a diagnosis of acute lymphocytic leukemia, the laboratory test indicates that the client is neutropenic. The nurse should perform which of the following? a. Advise the client to rest and avoid exertion b. Prevent client exposure to infections c. Monitor the blood pressure frequently d. Observe for increased bruising

B (Rationale: Neutropenia is a decreased number of neutrophil cells in the blood which are responsible for the body's defense against infection. Rest and avoid exertion would be related to erythrocytes and oxygen carrying properties. Monitoring the blood pressure, and observing for bruising would be related to platelets and sign and symptoms of bleeding.)

What should a nurse suggest to the parent of a child with insulin-dependent diabetes mellitus (IDDM) who is not eating as a result of a minor illness? A. Give the child half his regular morning dose of insulin. B. Substitute calorie-containing liquids for solid food to maintain normal serum glucose levels. C. Give the child plenty of unsweetened, clear liquids to prevent dehydration. D. Take the child directly to the emergency department.

B. Calorie-containing liquids will maintain normal serum glucose levels and decrease the risk of hypoglycemia. The child should receive his regular dose of insulin even if he does not have an appetite. If the child is not eating as usual, he needs calories to prevent hypoglycemia. During periods of minor illness, the child with IDDM can be managed safely at home.

Which is the most appropriate intervention for the parents of a 6-year-old child with precocious puberty? A. Advise the parents to consider birth control for their daughter. B. Explain the importance of having the child foster relationships with same-age peers. C. Assure the childs parents that there is no increased risk for sexual abuse because of her appearance. D. Counsel parents that there is no treatment currently available for this disorder.

B. Despite the childs appearance, the child needs to be treated according to her chronological age and to interact with children in the same age group. An expected outcome is that the child will adjust socially by exhibiting age-appropriate behaviors and social interactions. Advising the parents of a 6-year-old to put their daughter on birth control is not appropriate. Parents need to be aware that there is an increased risk of sexual abuse for a child with precocious puberty. Treatment for precocious puberty is the administration of gonadotropin-releasing hormone blocker, which slows or reverses the development of secondary sexual characteristics and slows rapid growth and bone aging.

A nurse is explaining growth hormone deficiency to parents of a child admitted to rule out this problem. Which metabolic alteration should the nurse explain to the parent that is related to growth hormone deficiency? A. Hypocalcemia B. Hypoglycemia C. Diabetes insipidus D. Hyperglycemia

B. Growth hormone helps maintain blood sugar at normal levels. Symptoms of hypocalcemia are associated with hypoparathyroidism. Diabetes insipidus is a disorder of the posterior pituitary. Growth hormone is produced by the anterior pituitary. Hyperglycemia results from an insufficiency of insulin, which is produced by the beta cells in the islets of Langerhans in the pancreas.

Which laboratory findings would confirm that a child with insulin-dependent diabetes mellitus (IDDM) is experiencing diabetic ketoacidosis? A. No urinary ketones B. Low arterial pH C. Elevated serum carbon dioxide D. Elevated serum phosphorus

B. Severe insulin deficiency produces metabolic acidosis, which is indicated by a low arterial pH. Urinary ketones, often in large amounts, are present when a child is in diabetic ketoacidosis. Serum carbon dioxide is decreased in diabetic ketoacidosis. Serum phosphorus is decreased in diabetic ketoacidosis.

A child is admitted to the hospital with a diagnosis of Wilm's tumor, Stage II. Which of the following statements most accurately describes this stage? A. The tumor is less than 3 cm. in size and requires no chemotherapy. B. The tumor did not extend beyond the kidney and was completely resected. C. The tumor extended beyond the kidney but was completely resected. D. The tumor has spread into the abdominal cavity and cannot be resected.

C (The staging of Wilm's tumor is confirmed at surgery as follows: Stage I, the tumor is limited to the kidney and completely resected; stage II, the tumor extends beyond the kidney but is completely resected; stage III, residual nonhematogenous tumor is confined to the abdomen; stage IV, hematogenous metastasis has occurred with spread beyond the abdomen; and stage V, bilateral renal involvement is present at diagnosis.)

A pediatric oncology patient has been discharged home following a course of chemotherapy. Which information should be included as part of discharge planning with regard to health promotion? A. No further treatments are needed and the patient can resume routine health assessments as developmentally appropriate. B. There are no restrictions based on activity and/or contacts with friends and family members. C. Certain restrictions will be in place related to immunizations that can be administered. D. The patient should limit fluid intake for several months in order to prevent overhydration from occurring.

C.

What should the nurse include in the teaching plan for parents of a child with diabetes insipidus who is receiving DDAVP intranasally? A. Increase the dosage of DDAVP as the urine specific gravity (SG) increases. B. Give DDAVP only if the urine output decreases. C. Child should have free access to water and toilet facilities at school. D. Cleanse the skin before administering the transdermal patch.

C. The childs teachers should be aware of the diagnosis and the child should have free access to water and toilet facilities at school. DDAVP needs to be given as ordered by the physician. If the parents are monitoring urine SG at home, they would not increase the medication dose for increased SG; the physician may order an increased dosage for very dilute urine with decreased SG. DDAVP needs to be given continuously as ordered by the physician. DDAVP is typically given intranasally or by subcutaneous injection. For nocturnal enuresis, it may be given orally.

A nurse is assessing a child with diabetes insipidus. Which sign should the nurse expect to note? A. Weight gain B. Increased urine specific gravity C. Increased urination D. Serum sodium level of 130 mEq/L

C. The deficiency of antidiuretic hormone associated with diabetes insipidus causes the body to excrete large volumes of dilute urine. Weight gain results from retention of water when there is an excessive production of antidiuretic hormone; in diabetes insipidus there is a decreased production of antidiuretic hormone. Concentrated urine is a sign of the syndrome of inappropriate antidiuretic hormone (SIADH), in which there is an excessive production of antidiuretic hormone. A deficiency of antidiuretic hormone, as with diabetes insipidus, results in an increased serum sodium concentration (greater than 145 mEq/L).

What is a nursing goal for a 12-year-old child with Graves disease? A. Relief of constipation B. Allowing the adolescent to make decisions about taking her medication C. Verbal demonstration of an understanding about the medication regimen D. Development of alternative educational goals

C. To adhere to the medication schedule, children need to understand that the medication must be taken two or three times per day. The adolescent with Graves disease is not constipated. Making decisions about her medication is not appropriate for a 12-year-old child. The management of Graves disease does not interfere with school attendance and does not require alternative educational plans.

Which statement made by a 14-year-old adolescent who is newly diagnosed with insulin-dependent diabetes mellitus (IDDM) indicates a need for further teaching? A. I should eat meals and snack at the same time every day. B. Exercise will decrease my insulin requirements. C. It is okay to drink chocolate milk with meals. D. I need to check my sugars before meals and at bedtime.

C. Chocolate milk is high in carbohydrates. Carbohydrates raise blood glucose levels. A beverage low in carbohydrates is a better choice. Meals and snacks should be eaten at regular times. Exercise decreases insulin requirements. Checking serum glucose before breakfast and dinner is appropriate.

The nurse is completing a care plan for a client diagnosed with leukemia. Which independent problem should be addressed? A. Infection. B. Anemia. C. Nutrition. D. Grieving.

D (Grieving is an independent problem, and the nurse can assess and treat this problem with or without collaboration)

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

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

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

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

A nurse is preparing to administer 10 units of Regular insulin and 5 units of Lente insulin. Place in order the steps the nurse should follow to administer the total dosage of 15 units of insulin. Place the initial step first and end with the final step. Use the following format for your answers: A, B, C, D A. Inject 5 units of air into the Lente insulin vial. B. Draw up the 5 units of Lente insulin. C. Inject 10 units of air into the Regular insulin vial. D. Cleanse the insulin vials with alcohol wipes. E. Draw up the 10 units of Regular insulin.

D, A, C, E, B Cleanse the insulin vials with alcohol wipes initially. When mixing two different types of insulin, inject the appropriate amount of air into both vials and then withdraw the short-acting (clear) insulin first. So the steps should be to cleanse the insulin vials, inject air into the Lente, inject air into the Regular insulin vial, then draw the Regular (clear) insulin, and lastly draw the Lente (cloudy) insulin.

Which is the nurses best response to the parents of a 10-year-old child newly diagnosed with insulin-dependent diabetes mellitus (IDDM) who are concerned about the childs continued participation in soccer? A. Consider the swim team as an alternative to soccer. B. Encourage intellectual activity rather than participation in sports. C. It is okay to play sports such as soccer when the weather is moderate. D. Give the child an extra 15 to 30 grams of carbohydrate snack before soccer practice.

D. Exercise lowers blood glucose levels. A snack with 15 to 30 grams of carbohydrates before exercise will decrease the risk of hypoglycemia. Soccer is an appropriate sport for a child with IDDM as long as the child prevents hypoglycemia by eating a snack. Participation in sports is not contraindicated for a child with IDDM. The child with IDDM may participate in sports activities regardless of climate.

A nurse is describing the endocrine system to a nursing student. Which statement best describes the negative feedback system of the pituitary gland? B. Target organs stimulate the hypothalamus, which in turn produces hormones. C. The anterior pituitary stimulates the production of posterior pituitary hormones. D. The pituitary gland secretes hormones that stimulate target organs to produce specific hormones. As hormonal secretions of the target organs increase, the pituitary gland decreases the secretion of the stimulating hormone.

D. The pituitary stimulates target organs to produce specific hormones. When enough hormone is produced, the target organ signals the pituitary to stop secretion of the stimulating hormone. There are six hormones secreted by the anterior pituitary; they are not interdependent. The anterior pituitary gland stimulates target organs to produce specific hormones and does not control production of posterior pituitary hormones.

Pituitary hyperfunction that occurs prior to epiphyseal closure?

Gigantism

Why are patients who have excessive growth hormone secretion at risk for developing DM?

Increased insulin resistance

What type of formula should be avoided in children who are taking levothyroxine for congenital hypothyroidism?

Soy because it prevents the absorption of the medication

What portions of the pituitary gland secretes TSH?

anterior pituitary

What is the therapeutic management for patients that have precocious puberty?

monthly subcutaneous injection of lupron Lupron regulates pituitary secretion

Excess GH prior to the closure of the epiphyseal shafts results in?

overgrowth of the long bones