Chapters 38 & 39 Pediatrics!

Which interventions should the nurse include when planning care for a child with acute glomerulonephritis? (Select all that apply.) A) Encourage ambulation several times a day B) Promote increased fluid intake C) Administer diuretics D) Administers antihypertensives E) Weighs the child every day using the same scale F) Dipstick the child's urine to test for protein

Ans: C, D, E, F Feedback: Fluid intake and urinary output should be carefully monitored and recorded. Special attention is needed to keep the intake within prescribed limits. The amount of fluid the child is allowed may be based on output, as well as on evidence of continued hypertension and oliguria. If hypertension develops, a diuretic may help reduce the blood pressure to normal levels. An antihypertensive drug may be added if the diastolic pressure is 90 mm Hg or higher. Weigh the child daily, at the same time, on the same scale, and in the same clothes. The urine must be tested regularly for protein and hematuria using dipstick tests. Bed rest should be maintained until acute symptoms and gross hematuria disappears.

When caring for a child who has a urinary tract infection, which nursing intervention would be most appropriate? (Select all that apply.) A) Encourage the child to void every 30 minutes B) Position the child on a bedpan rather than on the toilet C) Observe for signs of pain or burning on urination D) Monitor intake and output E) Administer pain medications each time the child voids F) Administer antipyretics as needed

Ans: C, D, F Feedback: Because of pain and burning on urination, the toilet-trained child may try to hold urine and not void. Encourage the child to void every three or four hours to prevent recurrent infection. Observe the child for signs of burning and pain when urinating. Monitor and measure urine output. Antipyretic medications may be ordered to reduce body temperature. A bedpan would not be necessary in most children with a UTI. Pain medications following each voiding would not be indicated.

A caregiver brings her 7-year-old son to the pediatrician's office, concerned about the child's bed-wetting after being completely toilet trained even at night for over two years. The caregiver further reports that the child has wet the bed every night since returning home from a one-week fishing trip. The child refuses to talk about the bed-wetting. The nurse notes the child is shy, skittish, and will not make eye contact. Further evaluation needs to be done to rule out which problem? A) The child has a urinary tract infection due to not bathing while on the fishing trip B) The child is out of the habit of waking himself up during the night to void C) The child did not want to go on the fishing trip and is now retaliating against being made to go D) The child has been sexually abused, may be on the fishing trip

Ans: D Feedback: Enuresis may have a physiologic or psychological cause and may indicate a need for further exploration and treatment. Enuresis in the older child may be an expression of resentment toward family caregivers or of a desire to regress to an earlier level of development to receive more care and attention. Emotional stress can be a precipitating factor. The health care team also needs to consider the possibility that enuresis can be a symptom of sexual abuse. Bruising, bleeding, or lacerations on the external genitalia, especially in the child who is extremely shy and frightened, may be a sign of child abuse and should be further explored. Enuresis is not associated with a lack of bathing.

The nurse is doing a training session with a group of peers on the genitourinary system. Which is a major function of the kidneys? A) Produce white blood cells B) Remove carbon dioxide C) Circulate cerebrospinal fluid D) Regulate blood pressure

Ans: D Feedback: Functions of the kidney include regulating blood pressure by making the enzyme renin and also making erythropoietin, which helps stimulate the production of red blood cells. The kidney also excretes excess water and waste products and maintains a balance of electrolytes and acid-base. White blood cells are formed in the bone marrow. Carbon dioxide is removed by the alveoli. Cerebrospinal fluid circulates through the brain and the spinal cord.

What does the nurse recognize as a physiologic cause for a child to have enuresis? A) Regression to get attention B) Stress and stressful situations C) Sexual abuse D) Sleeping too soundly

Ans: D Feedback: Physiologic causes may include a small bladder capacity, urinary tract infection, and lack of awareness of the signal to empty the bladder because of sleeping too soundly. Psychological causes might include rigorous toilet training, resentment toward family caregivers, or a desire to regress to an earlier level of development to receive more care and attention or emotional stress and stressful situations. Enuresis can be a symptom of sexual abuse.

The nurse is collecting data from the caregivers of a child who is suspected of having a food allergy. Which clinical manifestations would likely have been seen in this child? A) Restlessness and irritability B) Blinking and twitching of the mouth C) Nasal discharge and sneezing D) Urticaria and pruritus

Ans: D Feedback: Common symptoms of food allergies include urticaria (hives), pruritus (itching), stomach pains, and respiratory symptoms. Some of the symptoms may appear quickly after the child has eaten the offending food, but other foods may cause a delayed reaction. Restlessness and irritability may be seen in children with seizure disorders, blinking and twitching of the mouth are seen with absence seizures, and nasal discharge and sneezing are seen with allergic rhinitis.

The nurse is collecting data on a 2½-year-old child admitted with a diagnosis of gastroenteritis. When interviewing the caregivers, which question would be most important for the nurse to ask? A) "How many times a day does your child urinate?" B) "How long has your child been toilet trained?" C) "Tell me about the types of stools your child has been having." D) "What foods has your child eaten during the last few days."

Ans: D Feedback: For the child with gastroenteritis, the interview with the family caregiver must include specific information about the history of bowel patterns and the onset of diarrheal stools, with details on number and type of stools per day. Recent eating patterns, if the child is toilet trained, and how many times a day the child urinates are important questions, but the highest priority is gathering data regarding the stools and stool pattern.

The nurse is collecting data on a 6-year-old child admitted with acute glomerulonephritis. Which vital sign measurement would the nurse anticipate with this child's diagnosis? A) Pulse rate 112 bpm B) Pulse oximetry 93% on room air C) Respirations 24 per minute D) Blood pressure 136/84

Ans: D Feedback: Hypertension appears in 60% to 70% of patients during the first four or five days with a diagnosis of acute glomerulonephritis. The pulse of 112 bpm would be a little high for this age child, but not a concern with this diagnosis. The other vital signs are within normal limits for this age child.

When collecting data on a child diagnosed with diabetes mellitus, the nurse notes that the child has had weight loss and other symptoms of the disease. Which fasting blood glucose level would the nurse expect this child to have? A) 60 mg/dL B) 120 mg/dL C) 180 mg/dL D) 240 mg/dL

Ans: D Feedback: If the blood glucose level is elevated or ketonuria is present, a fasting blood sugar (FBS) is performed. An FBS result of 200 mg/dL or higher almost certainly is diagnostic for diabetes when other signs such as polyuria and weight loss, despite polyphagia, are present

The nurse is discussing the diagnosis of intussusception with a group of peers. Which statement is accurate regarding this disorder? A) There is a telescoping of the lower part of the bowel up over the upper part of the bowel B) The disorder is seen most often in female infants under the age of 3 months C) The infant is pale, cries weakly, and has spasms of pain continuously D) The stools of the infant are called currant jelly stools and consist of blood and mucus

Ans: D Feedback: In the child with intussusception, the stools consist of blood and mucus, thereby earning the name currant jelly stools. There is a telescoping of the upper portion of the bowel slipping over the lower portion. The condition occurs more often in boys than in girls and the highest incidence occurs in infants between the ages of 4 and 10 months. The infant who previously appeared healthy and happy suddenly becomes pale, cries out sharply, and draws up the legs in a severe colicky spasm of pain. This spasm may last for several minutes, after which the infant relaxes and appears well until the next episode, which may occur five, 10, or 20 minutes later.

The nurse is caring for a child with nephrotic syndrome. What will the nurse most likely assess in this child? A) Oliguria B) Amenorrhea C) Pyelonephritis D) Ascites

Ans: D Feedback: In the child with nephrotic syndrome the abdomen may be greatly enlarged with ascites, which is edema in the peritoneal cavity. Oliguria is a subnormal volume of urine. Amenorrhea is the absence of menstruation. Pyelonephritis is an inflammation of the kidney and renal pelvis.

What would be the method of choice for obtaining a urine specimen from a 3-year-old child with a possible urinary tract infection? A) Performing a suprapubic aspiration B) Placing a cotton ball in the underwear to catch urine C) Placing an indwelling urinary catheter D) Obtaining a clean catch voided urine

Ans: D Feedback: In the cooperative, toilet-trained child, clean midstream urine may be used successfully to obtain a "clean catch" voided urine. If a culture is needed, the child may be catheterized, but this is usually avoided if possible. A suprapubic aspiration also may be done to obtain a sterile specimen. In the toilet-trained child, using a cotton ball to collect the urine would not be appropriate.

The nurse is caring for an infant with pyloric stenosis recovering from a pyloromyotomy. What is the most appropriate way for the nurse to position the infant during the recovery period? A) Allow the parents to hold the infant B) Place the infant on his back C) Lay the infant on his stomach D) Place on the side

Ans: D Feedback: Postoperatively the child should be placed on the side to prevent aspiration of mucus or vomitus, especially during the anesthesia recovery period. After fully waking from the surgery, the infant can be held by a family caregiver in a position that does not interfere with IV infusions and is comforting to both caregiver and child. The infant should not be placed on the back or the stomach

The nurse is planning care for a child with a diagnosis of pyloric stenosis during the preoperative phase. Which goal has the highest priority at this time? A) Preparing family for home care B) Promoting comfort C) Maintaining skin integrity D) Improving hydration

Ans: D Feedback: Preoperatively the highest priority for the child with pyloric stenosis is to improve nutrition and hydration. Maintaining mouth and skin integrity, and relieving family anxiety are important, but these are not the priority. The child will not likely have intense pain. Preparing the family for home care would be a postoperative goal.

What should the nurse teach a new mother about the role of the endocrine system? A) Regulates insulin B) Produces enzymes C) Absorbs nutrients D) Secretes hormones

Ans: D Feedback: The hormones secreted by the endocrine system are circulated through the bloodstream to control and regulate most of the activities and functions in the body. Regulating metabolism, growth, development, and reproduction are all functions of hormones. The pancreas secretes, not regulates, insulin. The liver and pancreas secrete enzymes and the GI tract absorbs nutrients.

The nurse is preparing an educational session for new parents on the gastrointestinal system of the newborn. Besides the stomach and intestines, which other organs will the nurse include in this teaching? A) A protective cushion lining the organs B) Nerves throughout the abdomen C) The brain and spinal cord D) The pharynx and esophagus

Ans: D Feedback: The main organs of the gastrointestinal (GI) or digestive system are the mouth, pharynx (throat), esophagus, stomach, small intestine, large intestine, rectum, and anal canal. The brain, spinal column, and nerves are part of the nervous system and there is a protective coating surrounding the nerves

The nurse arrives at a patient's home for a visit and sees one of the small children chewing several pieces of something white. The child is also drooling and crying and a container that looks like an empty pill bottle is on the floor. What should the nurse do first? A) Call 911 for emergency help B) Ask the poison control center about an antidote C) Give the child syrup of ipecac to induce vomiting D) Remove the substance from the child's mouth

Ans: D Feedback: Treatment steps in order of importance for poisoning: Remove the obvious remnants of the poison. Call 911 for emergency help if the child has collapsed or stopped breathing. If the child is conscious and alert, call the poison control center and follow their instructions. Administer the appropriate antidote if recommended. Administer general supportive and symptomatic care. The American Academy of Pediatrics no longer recommends administering syrup of ipecac because it has not been proven that inducing vomiting prevents poisoning. Because of the potential for misuse, the AAP also recommends safely disposing of any syrup of ipecac already in the home. In an emergency care setting, gastric lavage may be used to empty the stomach of toxic substances.

The nurse is teaching a group of nurses on the topic of gastrointestinal disorders. Which statement is most accurate related to the diagnosis of gastroesophageal reflux (GER)? A) A partial or complete intestinal obstruction occurs B) A thickened, elongated muscle causes an obstruction at the end of the stomach C) There are recurrent paroxysmal bouts of abdominal pain D) In this disorder the sphincter that leads into the stomach is relaxed

Ans: D Feedback: GER occurs when the sphincter in the lower portion of the esophagus, which leads into the stomach, is relaxed and allows gastric contents to be regurgitated back into the esophagus. Congenital aganglionic megacolon is characterized by persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin. Colic consists of recurrent paroxysmal bouts of abdominal pain. Pyloric stenosis is characterized by hypertrophy of the circular muscle fibers of the pylorus which leads to an obstruction at the distal end of the stomach.

The nurse is teaching a group of parents in the community about the steps that should be taken if a child is observed eating a poisonous. Place the following steps to be completed in the order of importance. A. Call 911 for emergency help if the child has collapsed or stopped breathing B. Follow instructions given by the Poison Help Line personnel C. Administer general supportive and symptomatic care D. Remove the obvious remnants of the poison E. Call the poison help line if child is conscious and alert F. Administer appropriate antidote if recommended

Ans: D, A, E, B, C, F Feedback: The treatment steps in order of importance are (1) remove the obvious remnants of the poison; (2) call 911 for emergency help if child has collapsed or stopped breathing; (3) call the Poison Help Line if the child is conscious and alert; the universal poison control number is (800) 222-1222; (4) follow instructions given by the Poison Help Line personnel; (5) administer appropriate antidote if recommended; and (6) administer general supportive and symptomatic care.

Gastroesophageal reflux (GER) occurs when the sphincter in the rectum is relaxed and allows regurgitation to occur.

False

Nephrotic syndrome is usually treated by the use of antibiotics, which are continued even after a remission occurs.

False

Rotating of insulin injection sites will help insulin act faster in the child with diabetes

False

The absence of menstruation is referred to as dysmenorrhea.

False

Wilms tumor is a tumor that arises from bits of embryonic tissue that remains after birth and causes a rapid cancerous growth in the area of the kidney.

False

Young children rarely ingest poisonous substances because their senses of taste and smell are fully developed and refined.

False

abnormal increase in the depth and rate of the respiratory movements.

Kussmaul breathing

syndrome occurring in infants and young children soon after weaning; results from severe deficiency of protein. Symptoms include a swollen abdomen, retarded growth with muscle wasting, edema, gastrointestinal changes, think dry hair with patchy alopecia, apathy, and irritability.

Kwashiorkor

Acute glomerulonephritis is a condition that appears to be an allergic reaction to a specific infection; most often group A beta-hemolytic streptococcal infection.

True

Children with lactose intolerance cannot digest the primary carbohydrate found in milk because of an inborn deficiency of the enzyme needed for this digestion.

True

In a child diagnosed with nephrotic syndrome, laboratory findings usually show increased levels of protein in the urine and a reduced level of blood serum protein.

True

Symptoms of appendicitis in the older child may be pain and tenderness in the right lower quadrant of the abdomen, nausea and vomiting, fever, and constipation.

True

absence of menstruation

amenorrhea

massive edema

anasarca

swelling of the face, lips

angioedema

medication that expels intestinal worms; vermifuge

anthelmintic

Urinary tract infections are usually treated with _______________, such as amoxicillin.

antibiotic drugs

edema in the peritoneal cavity

ascites

an agent that binds with metal

chelating agent

________________ consists of recurrent paroxysmal bouts of abdominal pain and is commonly seen in young infants.

colic

episodes of crying in the infant, often associated with recurrent gastrointestinal disturbances that are common among young infants and that usually disappear around the age of 3 months.

colic

To relieve the obstruction in the bowel in the child with congenital aganglionic megacolon, usually a(n) ______________ is performed.

colostomy

softening of the occipital bones caused by reduction of mineralization of the skull.

craniotabes

stools that consist of blood and mucus.

currant jelly stools

A child with severe diarrhea can quickly become _______________ because of the amount of fluid they are losing in the stool.

dehydrated

characterized by drowsiness, dry skin, flushed cheeks, cherry-red lips, and acetone breath with a fruity smell as a result of excessive ketones in the blood in uncontrolled diabetes.

diabetic ketoacidosis

daytime loss of urinary control

diurnal enuresis

painful or difficult menses

dysmenorrhea

degenerative disease of the brain.

encephalopathy

Physiologic causes of _______________ may include a small bladder capacity, urinary tract infection, and lack of awareness of the signal to empty the bladder because of sleeping too soundly.

enuresis

continued incontinence of urine beyond the age when control of urination is commonly acquired

enuresis

Edema is usually the presenting symptom in nephrotic syndrome and appears first around the ________________ and ankles.

eyes

infectious diarrhea caused by infectious organisms, including salmonella, E Coli, dysentery bacilli, and various viruses, most notable rotaviruses.

gastroenteritis

________________ is a collection of peritoneal fluid that accumulates in the scrotum through a small passage, which is a fingerlike projection in the inguinal canal through which the testes usually descend.

hydrocele

increase in the level of cholesterol in the blood

hyperlipidemia

infection that occurs during the course of an already existing disease

intercurrent infections

________________ is the invagination or telescoping of one portion of the bowel into a distal portion of the bowel.

intussusception

telescoping; enfolding of one part of a structure into another.

invagination

a sugar found in milk, that, when hydrolyzed, yields glucose and galactose.

lactose

· inability to digest lactose because of an inborn deficiency of the enzyme lactase.

lactose intolerance

a leukocyte count less than 5,000 mm3

leukopenia

deficiency in calories as well as protein. The child suffers growth retardation and wasting of subcutaneous fat and muscle.

marasmus

the first menstrual period signifying the beginning of menstruation.

menarche

pain experienced midcycle in the menstrual cycle at the time of ovulation

mittelschmerz

nighttime bedwetting

nocturnal enuresis

decreased production of urine, especially in relation to fluid intake

oliguria

surgical procedure used to bring an undescended testis down into the scrotum and anchor it there.

orchiopexy

persistent ingestion of nonfood substances such as clay, laundry starch, freezer frost, or dirt.

pica

abnormal thirst

polydipsia

increased food consuption

polyphagia

a dramatic increase in urinary output, often with enuresis

polyuria

Symptoms such as edema, headache, increased anxiety, mild depression, and mood swings are often seen in the adolescent with ________________ syndrome.

premenstrual

symptoms occurring before menstruation, including edema (resulting in weight gain), headache, increased anxiety, mild depression or mood swings, premenstrual tension.

premenstrual syndrome (PMS)

ithcing

pruritus

infection of the kidneys

pyelonephritis

stretch marks

striae

hives

urticaria

inflammation of the vagina

vaginitis

The child with pyloric stenosis has frequent and forceful bouts of projectile ________________ because of the narrowing of the lumen of the pylorus.

vomiting

The nurse caring for the child diagnosed with type 2 diabetes mellitus recognizes that most often the disorder can be managed by which action? A) Taking oral hypoglycemic agents B) Increasing protein in the diet, especially in the evening C) Conserving energy with rest periods during the day D) Decreasing amounts of daily insulin

Ans: A Feedback: If the child presents with diabetic ketoacidosis, initial treatment is insulin administration, but then oral hypoglycemic agents such as metformin are often effective for controlling blood glucose levels. Lifestyle changes such as weight loss and increased exercise are important aspects of treatment for the child. Treatment of type 2 diabetes mellitus does not include adding protein during the evening meal, conserving energy, or decreasing the amount of daily insulin.

A mother is confused as to why her daughter develops urinary tract infections more frequently than her son when their diet and fluid intake is similar. What should the nurse respond to the mother? A) "A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily." B) "The position of the urethra in girls makes girls more susceptible than boys to UTIs." C) "Girls need more vitamin C than boys to keep their urinary tract healthy so your daughter may be deficient in vitamin C." D) "It is unlikely that your daughter is practicing good cleaning habits after she voids."

Ans: A Feedback: Many different bacteria may infect the urinary tract, and intestinal bacteria, particularly Escherichia coli, account for about 80% of acute episodes. The female urethra is shorter and straighter than the male urethra, so it is more easily contaminated with feces.

The nurse is reviewing genitourinary conditions associated with acute glomerulonephritis. Which condition occurs when there is a decreased volume of urine output? A) Oliguria B) Amenorrhea C) Pyelonephritis D) Ascites

Ans: A Feedback: Oliguria is a subnormal volume of urine. Amenorrhea is the absence of menstruation. Pyelonephritis is an inflammation of the kidney and renal pelvis. Ascites is edema in the peritoneal cavity

A 12-year-old girl who has not yet reached menarche comes to the pediatrician's office for her annual well-child check. As the nurse is weighing and measuring her, the child says emphatically that she does not want to get her period. Which response would be most appropriate for the nurse to make to this child? A) "What have you heard about it that makes you worried?" B) "But it's a good thing, having a period is a part of growing up." C) "Are you afraid of getting pregnant?" D) "Do you think it will hurt?"

Ans: A Feedback: The beginning of menstruation, called menarche, normally occurs between the ages of 9 and 16 years. For many girls this is a joyous affirmation of their womanhood, but others may have negative feelings about the event depending on how they have been prepared for menarche and for their roles as women. The nurse would need to explore the child's understanding of the implications of menarche

A child who is nutritionally deprived is diagnosed with beriberi. The nurse should focus teaching with the caregivers on which vitamin? A) Thiamine B) Vitamin C C) Niacin D) Iron

Ans: A Feedback: A severe lack of thiamine in the diet causes beriberi, a disease characterized by cardiac and neurologic symptoms. Beriberi does not occur when balanced diets that include whole grains are eaten. Lack of vitamin C causes scurvy, lack of niacin causes pellagra, and lack of iron causes anemia

A child is being admitted with the diagnosis of congenital aganglionic megacolon. What information should the nurse recall about this disorder before caring for the patient? A) It is a partial or complete intestinal obstruction B) A thickened, elongated muscle causes an obstruction at the end of the stomach C) There are recurrent paroxysmal bouts of abdominal pain D) In this disorder the sphincter that leads into the stomach is relaxed

Ans: A Feedback: Congenital aganglionic megacolon, also called Hirschsprung disease, is characterized by persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin. Pyloric stenosis is characterized by hypertrophy of the circular muscle fibers of the pylorus which leads to an obstruction at the distal end of the stomach. Colic consists of recurrent paroxysmal bouts of abdominal pain. Gastroesophageal reflux (GER) occurs when the sphincter in the lower portion of the esophagus is relaxed and allows gastric contents to be regurgitated back into the esophagus.

The nurse is collecting data on a 6-year-old child admitted with a possible urinary tract infection. Which vital sign measurement might indicate an infection? A) Pulse rate 135 bpm B) Pulse oximetry 93% on room air C) Respirations 22 per minute D) Blood pressure 100/70

Ans: A Feedback: Data to collect regarding the child includes temperature, pulse (be alert for tachycardia) and respiration rates; normal vital signs for a 6-year-old would be a pulse rate of 70 to 115 beats per minute, so this rate shows tachycardia. The other vital signs are all within normal limits for this age child.

In which body structure does the digestive process begin? A) Mouth B) Stomach C) Small intestine D) Large intestine

Ans: A Feedback: Food enters the mouth, and the digestive process begins. Digestion takes place by mechanical and chemical mechanisms. As the food continues through the stomach and intestines, digestion continues

A child with minimal change nephrotic syndrome (MCNS) is being discharged after a three-week hospitalization and her parents are planning a welcome-home party. What food should the nurse suggest as being appropriate for this child's diet? A) Banana splits B) Popcorn C) Potato chips D) Orange soda

Ans: A Feedback: For the child with nephrotic syndrome, the addition of salt is discouraged, and sometimes the child is put on a low-sodium diet. In addition the child may be placed on a high protein diet. Popcorn, potato chips, and orange soda all have higher sodium content than do banana splits. In addition the banana split would have higher protein content.

The caregivers of a child newly diagnosed with diabetes express concern that they won't remember the different signs and symptoms of hyperglycemia and hypoglycemia. What should the nurse do? A) Instruct them to treat the reaction as if it's hypoglycemia, which is more likely B) Repeat the signs and symptoms over and over until they seem to understand C) Suggest that the child wear an insulin pump for continuous insulin administration D) Give the caregivers educational pamphlets and videos about diabetes

Ans: A Feedback: Hypoglycemia is much more likely to occur than hyperglycemia; so if there is any doubt as to whether the child is having a hypoglycemic or hyperglycemic reaction, it should be treated as hypoglycemia. While the pump may offer continuous insulin, it does not sense blood glucose level; insulin reactions can still occur. Careful monitoring of blood glucose is still needed. While repeating signs and symptoms may be helpful, caregivers of a recently diagnosed child have lots of information to absorb and the repetition may create more anxiety. Assuming that the caregivers can read and understand them, written materials and videos may be helpful but they should not take the place of an initial teaching session with a nurse

The mother of a newborn asks why a baby needs small feedings at frequent intervals. What should the nurse explain to the mother? A) The enzymes secreted by the liver and pancreas are reduced B) Food moves more slowly through the GI tract C) The pylorus has not been fully formed D) Peristaltic action is absent in the lower portion of the bowel

Ans: A Feedback: In the newborn the enzymes secreted by the liver and pancreas are reduced. The infant cannot break down and use complex carbohydrates. Because of this, the newborn diet must be adjusted to allow for this immaturity. By the age of four to six months, the needed enzymes are usually sufficient in amount. The smaller capacity of the infant's stomach and the increased speed that food moves through the GI tract require feeding smaller amounts at more frequent intervals. In addition, the small capacity of the colon leads to a bowel movement after each feeding. The pyloric sphincter is formed, but is lax and does not have bearing on the frequency of feeding.

What is the most common source of lead poisoning in children? A) Paint used in older homes B) Juice stored in glass jars C) Water purchased in plastic jugs D) Toys painted with spray paint

Ans: A Feedback: Lead poisoning has other causes, but the most common cause has been the lead in paint, especially paint used on the outside or the inside of older houses. Other sources of lead are toys painted with lead-containing paint, drinking water contaminated by lead pipes or copper pipes with lead-soldered joints, and fruit juices or other food improperly stored in glazed earthenware.

The nurse is caring for an 8-year-old child with nephrotic syndrome. Which nursing intervention would be appropriate for this child? A) Measure the abdominal girth daily B) Weigh the child once a week C) Test the urine for ketones twice a day D) Administer antipyretics as needed

Ans: A Feedback: Measure the child's abdomen daily at the level of the umbilicus and make certain that all staff personnel measure at the same level. Weigh the child at the same time every day on the same scale in the same clothing. Test the urine regularly for albumin and specific gravity. Elevated temperature is not an issue with nephrotic syndrome.

The nurse is explaining the development of rickets to a group of new parents. In addition to a vitamin D deficiency which other nutrients should the nurse explain are also decreased? A) Calcium and phosphorus B) Vitamin C and thiamine C) Riboflavin and niacin D) Iron and potassium

Ans: A Feedback: Rickets, a disease affecting the growth and calcification of bones, is caused by a lack of vitamin D. The absorption of calcium and phosphorus is diminished because of the lack of vitamin D, which is needed to regulate the use of these minerals. The absorption of the other nutrients is not affected by the lack of vitamin D

The caregiver of a child with type 1 diabetes mellitus is concerned about the child's teaching complaining of the child needing to use the restroom often at school. What manifestation of diabetes is the teacher describing? A) Polyuria B) Pica C) Polyphagia D) Polydipsia

Ans: A Feedback: Symptoms of type 1 diabetes mellitus include polyphagia or increased hunger and food consumption, polyuria or a dramatic increase in urinary output, probably with enuresis, and polydipsia or increased thirst. Pica is eating nonfood substances.

The nurse is doing dietary teaching with the caregivers of a child diagnosed with idiopathic celiac disease. Of the following foods, which would most likely be appropriate in the child's diet? A) Bananas B) Toast C) Oatmeal D) Potatoes

Ans: A Feedback: The young child should be started on a starch-free, low-fat diet. Bananas contain invert sugar and are usually well tolerated. Products that contain wheat, rye, or oats should be excluded. Potatoes are not identified as a food that is well tolerated

The nurse is discussing the treatment of congenital aganglionic megacolon with the caregivers of a child diagnosed with this disorder. Which statement best explains the treatment for this diagnosis? A) "The treatment for the disorder will be a surgical procedure." B) "Your child will be treated with oral iron preparations to correct the anemia." C) "We will give enemas until clear and then teach you how to do these at home." D) "Your child will receive counseling so the underlying concerns will be addressed."

Ans: A Feedback: Treatment of congenital aganglionic megacolon involves surgery with the ultimate resection of the aganglionic portion of the bowel. Chronic anemia may be present, but iron will not correct the disorder. Enemas may be given to initially achieve bowel elimination, but they will not treat the disorder. Differentiation must be made between this condition and psychogenic megacolon because of coercive toileting or other emotional problems. The child with aganglionic megacolon does not withhold stools or defecate in inappropriate places, and no soiling occurs.

The nurse is determining which foods should be added to a child's diet to increase the intake of vitamin C. Which foods are high in vitamin C? (Select all that apply) A) Strawberries B) Potatoes C) Peas D) Fish sticks E) Cottage cheese F) Bagels

Ans: A, B, C Feedback: A variety of fresh vegetables and fruits supplies vitamin C for the older infant and child. Strawberries, potatoes, and peas are high in vitamin C content. Meat, dairy, and grain foods have little vitamin C content.

The nurse is teaching a new mother about food allergies. Which foods are frequently the cause of a food allergy? (Select all that apply.) A) Eggs B) Broccoli C) Corn D) Oranges E) Grapes F) Soybeans

Ans: A, C, D, F Feedback: Among the foods most likely to cause allergic reactions are milk, eggs, wheat, corn, legumes (including peanuts and soybeans), oranges, strawberries, and chocolate. Vegetables other than corn are less likely to cause allergies. Citric fruits are more often the cause of allergies.

The nurse is developing a plan of care for a child with nephrotic syndrome. What would be appropriate goals of treatment for this child? (Select all that apply.) A) Conserving energy B) Encouraging a high-salt diet C) Preventing infection D) Restricting protein intake E) Promoting coping

Ans: A, C, E Feedback: The major goals for the child with nephrotic syndrome are relieving edema, improving nutritional status, maintaining skin integrity, conserving energy, and preventing infection. The family goals include learning about the disease and treatments, as well as learning ways to cope with the child's long-term care. The child may be on a no-added-salt or lowsalt diet, but there are usually no food restrictions.

The nurse is discussing genitourinary conditions with a group of 16-year-old girls. One of the girls says she has heard about girls who have stopped taking birth control pills and now don't have periods. To what condition the girl is referring? A) Oliguria B) Amenorrhea C) Pyelonephritis D) Ascites

Ans: B Feedback: Amenorrhea is the absence of menstruation. Pyelonephritis is an inflammation of the kidney and renal pelvis. Oliguria is a subnormal volume of urine. Ascites is edema in the peritoneal cavity

A child being treated at home for acute glomerulonephritis has a convulsion. What should the nurse recommend the caregiver do at this time? A) Weigh the child in the same clothes she had been weighed in the day before and report the two weighs to the nurse B) Take the child's blood pressure and report the findings to the nurse C) Give the child a diuretic and report back to the nurse in a few hours D) Give the child fluids and report back to the nurse in a few hours

Ans: B Feedback: Blood pressure should be monitored regularly using the same arm and a properly fitting cuff. If hypertension develops, a diuretic may help reduce the blood pressure to normal levels. An antihypertensive drug may be added if the diastolic pressure is 90 mm Hg or higher. The concern is immediate so reporting the findings in a few hours could delay needed treatment. The child should be weighed daily in the same clothes and using the same scale, but the blood pressure is the priority in this situation.

The nurse is caring for a child admitted with diabetic ketoacidosis. Which clinical manifestation would the nurse most likely assess in this child? A) Pale and moist skin B) Red lips and fruity odor to breath C) Hyperactive and restless behavior D) Slow pulse and elevated blood pressure

Ans: B Feedback: Diabetic ketoacidosis is characterized by drowsiness, dry skin, flushed cheeks and cherry-red lips, acetone breath with a fruity smell, and Kussmaul breathing or an abnormal increase in the depth and rate of the respiratory movements. Nausea and vomiting may occur. If untreated, the child lapses into coma and exhibits dehydration, electrolyte imbalance, rapid pulse, and subnormal temperature and blood pressure.

The caregiver of a child with a urinary tract infection asks why it is important for the child to have so much fluid. What should the nurse explain about fluid intake with a urinary tract infection? A) Fills the bladder so a specimen can be obtained B) Dilutes the urine and flushes the bladder C) Prevents the child from developing a fever D) Decreases the pain of urination

Ans: B Feedback: Increasing the child's fluid intake is necessary to help dilute the urine and flush the bladder. An increase in fluid intake also helps decrease the pain experienced in urination, but this is not the most important reason the child needs increased fluids. Fluids may help decrease the chance of the child developing a fever, but this is not the most important reason fluids are given.

When treating the child with lead poisoning what is used to remove the lead from the child's system? A) Diuretics B) Chelating agents C) Laxatives D) Emetics

Ans: B Feedback: The use of a chelating agent or an agent that binds with metal increases the urinary excretion of lead. Diuretics, laxatives, and emetics are not used in the treatment of lead poisoning

What is used to treat urinary tract infections? A) Increasing fluids, such as cranberry juice B) Administering antibiotics C) Performing bladder irrigations D) Administering diuretics

Ans: B Feedback: UTIs may be treated with antibiotics (usually sulfisoxazole or ampicillin) at home. Fluids are encouraged, but they do not treat the infection. Bladder irrigations and diuretics are not used in the treatment of urinary tract infections.

A single male caregiver of a 14-year-old girl comments that the child is mean and miserable during her periods. What would be the most appropriate response by the nurse? A) "PMS is a problem for a lot of women, but sometimes it's worse in the beginning. She might outgrow it." B) "There are nutritional and medical things she can do to lessen the symptoms; I'll give both of you information about some strategies and we'll track her for a few months." C) "That must be hard on you especially because you are raising her by yourself." D) "There really isn't anything that can be done to lessen the symptoms."

Ans: B Feedback: Women of all ages are subject to the discomfort of premenstrual syndrome (PMS), but the symptoms may be alarming to the adolescent. Symptoms include edema resulting in weight gain, headache, increased anxiety, mild depression, and mood swings. Generally the discomforts of PMS are minor and can be relieved by reducing salt intake during the week before menstruation, taking mild analgesics, and applying local heat. When symptoms are more severe, the physician may prescribe a mild diuretic to be taken the week before menstruation to relieve edema; occasionally oral contraceptive pills are prescribed to prevent ovulation.

The nurse is teaching a group of nurses on the topic of children diagnosed with acute glomerulonephritis. In which age range is the peak incidence of this disorder noted? A) 2 to 4 years of age B) 6 to 7 years of age C) 12 to 13 years of age D) 15 to 17 years of age

Ans: B Feedback: Acute glomerulonephritis has a peak incidence in children 6 to 7 years of age and occurs twice as often in boys.

The nurse is reinforcing dietary teaching with the caregiver of a child diagnosed with celiac syndrome. Which statement indicates a need for further teaching regarding the dietary restrictions for the child with celiac syndrome? A) "The soup we eat at our house is all made from scratch." B) "She loves hotdogs, and we always cut hers up into small pieces." C) "I have learned to make my own bread with no gluten." D) "Even though milk and pudding are good for her we don't give her those foods."

Ans: B Feedback: Commercially canned creamed soups, cold cuts, frankfurters, and pudding mixes generally contain wheat products and should not be included in the diet of the child with celiac syndrome. This caregiver needs further teaching regarding giving her child hotdogs, even if they are cut into small pieces. The other choices show an understanding of the dietary restrictions

The nurse is caring for a child admitted with pyloric stenosis. Which clinical manifestation would the child most likely demonstrate with this health problem? A) Explosive diarrhea B) Projectile vomiting C) Severe abdominal pain D) Frequent urination

Ans: B Feedback: During the first weeks of life, the infant with pyloric stenosis often eats well and gains weight and then starts vomiting occasionally after meals. Within a few days the vomiting increases in frequency and force, becoming projectile. The child may have constipation, and peristaltic waves may be seen in the abdomen, but the child does not appear in severe pain. Urine output is decreased and urination is infrequent

An infant that is nutritionally deprived is weak and seems somewhat uninterested in food. How often should the nurse plan to feed this infant? A) Every hour B) Every two or three hours C) Every four hours D) On demand

Ans: B Feedback: For the child who is nutritionally deprived, scheduling feedings every two or three hours is best because most weak babies can handle frequent, small feedings better than feedings every four hours. Feeding every hour would not give the weak child an adequate amount of time to rest and sleep between feedings.

The nurse teaching the caregivers of toddler and preschool-age children. One caregiver says that her child had diarrhea caused by giardiasis. Which caregiver statement explains the most likely situation in which the child contacted the disorder? A) "My son went to the mountains to fish with my husband before he got sick." B) "He attends a day care center four days a week while I am at work." C) "I won't let his sister take bubble baths but I do let him take one a few times a week." D) "My mother is in a nursing home but I always make the kids wash their hands before we leave her."

Ans: B Feedback: Giardiasis is caused by the protozoan parasite Giardia lamblia. It is a common cause of diarrhea and is prevalent in children who attend day care centers and other types of residential facilities. It may be found in contaminated mountain streams or pools frequented by diapered infants. Bubble baths can lead to urinary tract infections, but are not the cause of Giardiasis infestations.

The nurse determines that a child has insufficient calcium in the diet and is at risk for hypocalcemia. What may be caused by hypocalcemia? A) Cardiac arrhythmias B) Neurologic damage C) Kidney failure D) Urinary tract disorders

Ans: B Feedback: Hypocalcemia causes neurologic damage, including mental retardation. Calcium is necessary for bone and tooth formation, and is also needed for proper nerve and muscle function. Hypokalemia can cause cardiac issues. Kidney and urinary disorders are not likely to be caused by insufficiencies in the diet

The school nurse notes that a child diagnosed with diabetes mellitus is experiencing an insulin reaction and is unable to eat or drink. Which actions would be the most appropriate for the school nurse to take at this time? A) Request that someone call 911 B) Administer subcutaneous glucagon C) Anticipate that the child will need intravenous glucose D) Dissolve a piece of candy in the child's mouth

Ans: B Feedback: If the child having an insulin reaction cannot take a sugar source orally, glucagon should be administered subcutaneously to bring about a prompt increase in the blood glucose level. This treatment prevents the long delay while waiting for a physician to administer IV glucose or for an ambulance to reach the child.

The nurse is teaching a program about children with nephrotic syndrome. Which statement is most accurate related to the diagnosis of nephrotic syndrome? A) "These children have such a big appetite and are always hungry." B) "Children may look chubby, but they really are malnourished." C) "When you look at the urine of these children it is smoky and bloody." D) "Their laboratory work shows a decreased level of cholesterol."

Ans: B Feedback: In children with nephrotic syndrome, malnutrition may become severe. The generalized edema masks the loss of body tissue, causing the child to present a chubby appearance and to double his or her weight. After diuresis, the malnutrition becomes quite apparent. Anorexia, irritability, and loss of appetite develop. Hematuria is not usually present, although a few red blood cells may appear in the urine. There is an increase in the level of cholesterol in the blood.

The nurse is teaching a group of caregivers with children who have been diagnosed with diabetes mellitus about insulin shock. Which statement indicates that teaching has been effective? A) "If my child's eats as much as her older brother eats she could have an insulin reaction." B) "He measures his own medication but we watch closely to make sure he gets the correct amount so he doesn't have an insulin reaction." C) "She monitors her glucose levels because when it goes too high she has an insulin reaction." D) "On the weekends we encourage him to participate in lots of sports activities and stay busy so he doesn't have an insulin reaction."

Ans: B Feedback: Insulin reaction-insulin shock or hypoglycemia-is caused by insulin overload, resulting in too rapid metabolism of the body's glucose. This may be attributable to a change in the body's requirement, carelessness in diet such as failing to eat proper amounts of food, an error in insulin measurement, or excessive exercise.

The nurse provides teaching to a group of nurses on the topic of children diagnosed with Kwashiorkor. Which statement is most accurate related to the diagnosis of Kwashiorkor? A) "These children have a severe deficiency of vitamin D." B) "It is important to increase the intake of protein for these children." C) "The highest incidence of this disease is seen in children who are adolescents." D) "The cause of this disease can be treated very simply."

Ans: B Feedback: Kwashiorkor results from severe deficiency of protein with an adequate caloric intake. It accounts for most of the malnutrition in the world's children today. The highest incidence is in children of 4 months to 5 years of age. Although strenuous efforts are being made around the world to prevent this condition, its causes are complex.

What is the purpose of the accessory organs with gastrointestinal system function? A) To secrete liquids that helps the food to be tasted as a person eats B) To aid in and to produce substances that aid in the digestive process C) To cushion and protect the digestive organs D) To decrease the secretion of acids in the digestive organs

Ans: B Feedback: Other organs, called accessory organs, include structures that aid in the digestive process, as well as glands that secrete substances that further aid in digestion. These accessory organs include the teeth, tongue, gallbladder, appendix, salivary glands, liver, and pancreas. These organs do not affect the taste of food. The cerebral spinal fluid cushions and protects the nerve cells. These organs do not decrease the secretion of acids.

A child is scheduled for tests to diagnose pyloric stenosis. What is the pathophysiology of this disorder? A) A partial or complete intestinal obstruction occurs B) A thickened, elongated muscle causes an obstruction at the end of the stomach C) There are recurrent paroxysmal bouts of abdominal pain D) In this disorder the sphincter that leads into the stomach is relaxed

Ans: B Feedback: Pyloric stenosis is characterized by hypertrophy of the circular muscle fibers of the pylorus, with a severe narrowing of its lumen. The pylorus is thickened to as much as twice its size, is elongated, and has a consistency resembling cartilage. As a result of this obstruction at the distal end of the stomach, the stomach becomes dilated. Congenital aganglionic megacolon is characterized by persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin. Colic consists of recurrent paroxysmal bouts of abdominal pain. Gastroesophageal reflux (GER) occurs when the sphincter in the lower portion of the esophagus is relaxed and allows gastric contents to be regurgitated back into the esophagus.

The nurse is caring for a child admitted with acute appendicitis. Prior to the child going to the operating room for emergency surgery, which nursing intervention should the nurse perform? A) The nurse gives the child laxatives to evacuate the colon B) The nurse encourages the child and family to express their fears C) The nurse administers oral fluids to prevent dehydration D) The nurse applies a heating pad to the abdomen to manage pain

Ans: B Feedback: The child facing an emergency surgery may be extremely frightened and also may be in considerable pain. The family caregiver may be apprehensive about impending surgery. Explain to the child and the family what is happening and why, and encourage them to express their fears. Laxatives and enemas are contraindicated because they increase peristalsis, which increases the possibility of rupturing an inflamed appendix. Oral fluids are withheld and the child is NPO before surgery. A heating pad is contraindicated because of the danger of rupture of the appendix.

The location of the kidneys in the child in relationship to the location of the kidneys in the adult makes what occurrence a greater likelihood in the child? A) The adult has less fat to cushion the kidney B) The child has a greater risk for trauma to the kidney C) The child has more frequent urges to empty the bladder D) The adult has a greater chance of retaining fluids than the child

Ans: B Feedback: The kidneys in children are located lower in relationship to the ribs than in adults. This placement and the fact that the child has less of a fat cushion around the kidneys cause the child to be at greater risk for trauma to the kidneys. The location of the kidneys does not affect the urges to empty the bladder nor the retaining of fluids.

The nurse is collecting data on a 2-year-old child admitted with a diagnosis of urinary tract infection. When interviewing the caregivers, which question would be most important for the nurse to ask? A) "Is your child potty trained?" B) "Has your child complained of pain?" C) "How often do you bathe your child?" D) "Do any of your other children have a temperature?"

Ans: B Feedback: The nurse should gather information about the current illness which includes any complaints of pain. Toilet training and bathing habits would be of importance, but they are not the most important to ask. Temperatures in other children in the family would not be related to this child's current situation.

The nurse is caring for a child with acute glomerulonephritis. Which manifestations would the nurse most likely assess in this child? A) Loose, dark stools B) Smoky-colored urine C) Strawberry red tongue D) Jaundiced skin

Ans: B Feedback: The presenting symptom in acute glomerulonephritis is grossly bloody urine. The caregiver may describe the urine as smoky or bloody. Periorbital edema may accompany or precede hematuria. Loose stools are seen in diarrhea. A strawberry-colored tongue is a symptom seen in the child with Kawasaki disease. Jaundiced skin is noted in hepatitis.

The nurse has admitted a child with a diagnosis of severe gastroenteritis. What should the nurse do to prevent the risk of transmitting infection to other patients? A) Wear a mask when handling articles contaminated with feces B) Follow standard precautions C) Discourage anyone from visiting D) Sterilize thermometers between patients

Ans: B Feedback: To prevent the spread of possibly infectious organisms to other pediatric patients, follow standard precautions issued by the Centers for Disease Control. Gloves should be worn when handling items contaminated with feces, but masks are not necessary. Visitor should be limited to family only. Take the temperature with a thermometer that is used only for that child

The nurse is discussing urinary tract infections (UTIs) in children with a group of peers. Which statement is the most accurate regarding UTI in children? A) UTIs are rarely seen after toilet training B) The most common age for UTIs in children is 2 to 6 years of age C) Males between the ages of 10 and 12 years of age commonly get UTIs D) Girls who have gone through puberty most commonly get UTIs

Ans: B Feedback: UTIs are fairly common in the "diaper age," in infancy, and again between the ages of 2 and 6 years. Older school-age and adolescent girls are not as prone to UTIs.

The nurse is caring for a child who is being evaluated for a possible nephroblastoma. Which nursing intervention would be important for this child? A) Monitor for protein in the urine at each voiding B) Protect the child from having the abdomen palpated C) Check blood pressure every two hours D) Measure the child's intake and output every hour

Ans: B Feedback: When the child is being evaluated and treated, abdominal palpation should be avoided because cells may break loose and spread the tumor. Monitoring for urine protein, blood pressure, and intake and output are not as important as making sure this child's abdomen is not palpated.

The nurse is reinforcing dietary teaching with the caregiver of a child diagnosed with celiac syndrome. Which foods would be permitted in the diet of the child with celiac syndrome? (Select all that apply.) A) Corn flakes B) Bananas C) Skim milk D) Rye bread E) Oatmeal F) Applesauce

Ans: B, C, F Feedback: The child is usually started on a gluten-free, low-fat diet. Skim milk, banana flakes, and bananas are usually well tolerated. Lean meats, pureed vegetables, and fruits are gradually added to the diet. Wheat, rye, oat products, corn flour, and cornmeal are not included in the diet.

A young child is diagnosed with enterobiasis. Of what will this child most likely have a history? A) Bed-wetting B) Restlessness C) Perianal itching D) Malnutrition

Ans: C Feedback: Intense perianal itching is the primary symptom of pinworm infection or enterobiasis. Young children who cannot clearly verbalize their feelings may be restless, sleep poorly, or have episodes of bed-wetting. Pinworm infestation is as common as an infection or cold, making a history of malnutrition less likely. Chronic hookworm infestation can cause malnutrition.

A child with a history of ear infections has dark urine, a headache, and puffy eyes. The child had a fever a few days ago but the body temperature is now 100°F. What should the nurse suspect is occurring with this child? A) A urinary tract infection B) Lipoid nephrosis (idiopathic nephrotic syndrome) C) Acute glomerulonephritis D) Rheumatic fever

Ans: C Feedback: Acute glomerulonephritis is a condition that appears to be an allergic reaction to specific infections; most often group A beta-hemolytic streptococcal infections such as rheumatic fever. Presenting symptoms appear one to three weeks after the onset of a streptococcal infection such as strep throat, otitis media, tonsillitis, or impetigo. Usually the presenting symptom is grossly bloody urine. Periorbital edema may accompany or precede hematuria. Fever may be 103°F to 104°F at the onset but decreases in a few days to about 100°F. Slight headache and malaise are usual, and vomiting may occur. The child's manifestations are not consistent with a urinary tract infection, idiopathic nephrotic syndrome, or rheumatic fever.

What is the cause for most urinary tract infections in children? A) Hereditary causes B) Fungal infections C) Intestinal bacteria D) Dietary insufficiencies

Ans: C Feedback: Although many different bacteria may infect the urinary tract, intestinal bacteria, particularly Escherichia coli, account for about 80% of acute episodes. Hereditary and dietary concerns are not causes of urinary tract infections.

The nurse is teaching the mother of an infant about colic. What should the nurse explain as the cause of this health problem? A) A partial or complete intestinal obstruction occurs B) A thickened, elongated muscle causes an obstruction at the end of the stomach C) There are recurrent paroxysmal bouts of abdominal pain D) In this disorder the sphincter that leads into the stomach is relaxed

Ans: C Feedback: Colic consists of recurrent paroxysmal bouts of abdominal pain and is fairly common in young infants. Congenital aganglionic megacolon is characterized by persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin. Pyloric stenosis is characterized by hypertrophy of the circular muscle fibers of the pylorus which leads to an obstruction at the distal end of the stomach. Gastroesophageal reflux (GER) occurs when the sphincter in the lower portion of the esophagus is relaxed and allows gastric contents to be regurgitated back into the esophagus.

The nurse is caring for a child admitted with congenital aganglionic megacolon. Which clinical manifestation would the child most likely demonstrate with this health problem? A) Prolonged bleeding B) Chronic cough C) Persistent constipation D) Irregular breathing

Ans: C Feedback: Congenital aganglionic megacolon, also called Hirschsprung disease, is characterized by persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin. Prolonged bleeding is a manifestation of hemophilia. A chronic cough is noted in the child with cystic fibrosis. Irregular breathing occurs in children with seizures.

The nurse is caring for a child with a urinary tract infection. In addition to foul smelling urine, what other manifestation will the nurse most likely assess in this child? A) Weight gain B) Decreased urination C) Vomiting D) Increased appetite

Ans: C Feedback: In children, the symptoms or a urinary tract infection may be fever, nausea, vomiting, foul-smelling urine, weight loss, and increased urination. Occasionally there is little or no fever. Vomiting is common, and diarrhea may occur

What should the nurse include when teaching a new mother about the gastrointestinal system of a child? A) The child's gastrointestinal system is fully matured when the child is born B) The enzymes secreted by the child's liver and pancreas are much greater in amount than in the adult C) The child cannot break down and use complex carbohydrates in the same way the adult can D) The speed with which food passes through the gastrointestinal tract in the child is much slower than in the adult

Ans: C Feedback: In the GI tract of the newborn the enzymes secreted by the liver and pancreas are reduced. The infant cannot break down and use complex carbohydrates. In the infant, food moves through the GI tract with increased speed. The GI tract matures and the capacity of the GI tract increases as the child gets older.

The nurse is collecting data for a child diagnosed with acute glomerulonephritis. What would the nurse likely find in this child's history? A) A sibling with the same diagnosis B) A congenital heart defect C) A recent ear infection D) Treatment for asthma

Ans: C Feedback: In the child with acute glomerulonephritis presenting symptoms appear one to three weeks after the onset of a streptococcal infection, such as strep throat, otitis media, tonsillitis, or impetigo. There is not a family history of the disorder, a history of congenital concerns or defects, or asthma in children with acute glomerulonephritis.

.If a newborn is following a normal development process, how much urine will be in the bladder when the child voids? A) 3 mL B) 6 mL C) 15 mL D) 25 mL

Ans: C Feedback: In the newborn, the bladder empties when about 15 mL of urine is present.

The nurse is collecting data for a child with idiopathic celiac disease. The caregiver tells the nurse that the child has bulky and greasy stools. What should the nurse suspect the child is experiencing? A) Pica B) Invagination C) Steatorrhea D) Polyuria

Ans: C Feedback: Intestinal malabsorption with steatorrhea or fatty stools is a condition brought about by various causes, one being idiopathic celiac disease. Pica is the ingestion of nonfood substances, invagination is the telescoping of a portion of the bowel, and polyuria is a dramatic increase in the urinary output.

The school nurse is working with a group of teachers who teach in classrooms of children who are nutritionally deprived. Which statement indicates a problem related to decreased nutrition? A) "One of my students is taller than several of the other children in the class." B) "I am really glad that during this quarter the absence rate in my classroom has dropped." C) "Several of the children in my class have such a hard time concentrating." D) "The grades of the children in my class are higher than in the classroom next to me."

Ans: C Feedback: Malnourished children grow at a slower rate, have a higher rate of illness and infection, and have more difficulty concentrating and achieving in school. The other statements do not indicate a problem with decreased nutrition.

.What should the nurse teach a group of community members as being a cause of marasmus? A) Deficiency of vitamin C and iron B) Excess of vitamin C and iron C) Deficiency of protein and calories D) Excess of protein and calories

Ans: C Feedback: Marasmus is a deficiency in calories as well as protein. Scurvy is caused by inadequate intake of vitamin C, and anemia is caused by lack of iron. Excess calories add to the concern of obesity in children. Excess vitamin C is excreted, and it is unusual to have an excess of iron or protein in the diet of children; those nutrients are more often inadequate in children's diets

A group of nursing students is discussing terminology related to the genitourinary system during a postconference setting. One student asks "what is mittelschmerz?" How should this question be answered? A) A symptom of premenstrual syndrome B) The beginning of menstruation C) A dull, aching abdominal pain at ovulation D) A medication given to treat dysmenorrhea

Ans: C Feedback: Mittelschmerz is a dull, aching abdominal pain at the time of ovulation. The beginning of menstruation is called menarche. Premenstrual syndrome symptoms include edema, headache, increased anxiety, mild depression, and mood swings. Nonsteroidal antiinflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) inhibit prostaglandins and are the treatment of choice for primary dysmenorrhea.

The nurse is discussing the disease known as pellagra with a new mother. Which vitamin deficiency should the nurse teach as being the cause of this disorder? A) Thiamine B) Vitamin C C) Niacin D) Iron

Ans: C Feedback: Niacin insufficiency in the diet causes a disease known as pellagra, which presents with GI and neurologic symptoms. A diet deficient in thiamine causes beriberi. Lack of vitamin C causes scurvy, and lack of iron causes anemia.

A symptom often seen in acute glomerulonephritis is edema. What is the most common site for edema to be noted? A) Ankles B) Hands C) Eyes D) Sacrum

Ans: C Feedback: Periorbital edema may accompany or precede hematuria in children with acute glomerulonephritis. Edema in the ankles, hands, and sacrum are not noted in acute glomerulonephritis

The caregiver tells the nurse that her child eats things such as laundry starch, clay, paper, and paint. What does the child's behavior indicate to the nurse? A) Pica B) Invagination C) Steatorrhea D) Polyuria

Ans: C Feedback: Pica is the ingestion of nonfood substances, such as laundry starch, clay, paper, and paint. Invagination is the telescoping of a portion of the bowel. Steatorrhea is a condition seen in idiopathic celiac disease, and polyuria is a dramatic increase in the urinary output.

The nurse is preparing a teaching session on genitourinary conditions. Which condition occurs when there is an inflammation of the kidney and renal pelvis? A) Oliguria B) Amenorrhea C) Pyelonephritis D) Ascites

Ans: C Feedback: Pyelonephritis is an inflammation of the kidney and renal pelvis. Oliguria is a subnormal volume of urine. Amenorrhea is the absence of menstruation. Ascites is edema in the peritoneal cavity.

The nurse is caring for a 3-year-old with diabetes mellitus who has unpredictable eating patterns. One day the child will eat almost nothing, the next day the child eats everything on her tray. Which type of insulin would most likely be used to treat this child? A) Long-acting insulin B) Regular insulin C) Rapid-acting insulin D) Intermediate-acting insulin

Ans: C Feedback: Rapid-acting insulin can even be used after a meal in children with unpredictable eating habits. Regular, intermediate, and long-acting insulin all have a longer onset, peak, and duration than rapid-acting insulin, and are more difficult to regulate in the child with unpredictable eating patterns.

The nurse is providing a presentation on menstrual disorders. Which statement is the most accurate regarding the cause of secondary amenorrhea? A) "It is caused from taking birth control pills when a girl is younger than 13 years old." B) "This disorder is usually seen after a girl has had a spontaneous abortion." C) "Emotional stress can be a cause of this disorder." D) "This is what happens if a 16-year-old girl has never had any periods at all."

Ans: C Feedback: Secondary amenorrhea can be the result of discontinuing contraceptives, a sign of pregnancy, the result of physical or emotional stress, or a symptom of an underlying medical condition. A complete physical examination, including gynecologic screening, is necessary to help determine the cause. Primary amenorrhea occurs when a girl has had no previous menstruation. A spontaneous abortion does not cause secondary amenorrhea.

The caregiver of a 1-year-old son is upset to learn that the child is being given hormones. What should the nurse respond to the caregiver regarding the child's treatment? A) "Without the hormone your son will have fluid that will collect in his scrotum." B) "Without the treatment your child's gonads will not reach normal size." C) "The doctor is hoping that the hormone will cause your son's undescended testes to move into their proper place." D) "Your child's testes have not dropped, so the hormone is being administered to avoid causing degeneration until they do."

Ans: C Feedback: Shortly before or soon after birth, the male gonads (testes) descend from the abdominal cavity into their normal position in the scrotum. Occasionally one or both of the testes do not descend. This is called cryptorchidism. A surgical procedure called orchiopexy is used to bring the testes down into the scrotum and anchor them there. Some physicians prefer to try medical treatment such as injections of human chorionic gonadotropic hormone before doing surgery. If this is unsuccessful in bringing down the testes, orchiopexy is performed. If both testes remain undescended, the male will be sterile. Fluid will not collect in the scrotum if the hormone is not given.

The caregiver of a child with type 1 diabetes mellitus states that the child is always hungry and eating but continues to lose weight. What is the caregiver describing to the nurse? A) Polyuria B) Pica C) Polyphagia D) Polydipsia

Ans: C Feedback: Symptoms of type 1 diabetes mellitus include polyphagia or increased hunger and food consumption, polyuria or a dramatic increase in urinary output, probably with enuresis, and polydipsia or increased thirst. Pica is eating nonfood substances.

The health care provider orders prednisolone 2 mg/kg/day to be given every eight hours for a child diagnosed with nephrotic syndrome. The child weighs 44 lb. The medication is available in a solution of 3 mg/mL. What is the amount per dosage in mL for this child? A) 1.2 mL B) 3.8 mL C) 4.3 mL D) 12.6 mL

Ans: C Feedback: The child weighs 20 kg. The total daily dose would be 40 mg of medication per day or 13.3 mg per dose. To determine the amount per dose solve the equation 13.3 mg/3 mg × 1 mL = 4.3 mL. One dose would be 4.3 mL.

A 9-year-old is complaining of pain in the lower right quadrant of the abdomen, nausea, and constipation. The child has a fever of 101°F. Which nursing action should the nurse perform first? A) Give a laxative to alleviate constipation B) Place a heating pad or hot water bottle on the abdomen C) Help to find a comfortable position D) Give an analgesic such as acetaminophen

Ans: C Feedback: The child's symptoms indicate possible appendicitis. When appendicitis is suspected, laxatives and enemas are contraindicated because they increase peristalsis, which increases the possibility of rupturing an inflamed appendix. Heat to the abdomen is also contraindicated because of the danger of rupture of the appendix. Preoperatively analgesics are not given because they may conceal signs of tenderness that are important for diagnosis. Comfort can be provided through positioning.

If a child follows a normal development process, at which age will a child's kidneys reach their full size and function? A) 5 years of age B) 8 years of age C) 13 years of age D) 17 years of age

Ans: C Feedback: The kidneys reach their full size and function by the time the child is an adolescent.

The nurse is caring for a 7-year-old diagnosed with pinworms. The nurse teaches the child's caregiver about proper treatment and prevention of future infections. Which caregiver statement indicates a need for further teaching? A) "I always have to remind him to wash his hands before eating." B) "We just bought a washer and dryer, and the hot water works well." C) "Thank goodness my other children and I are not sick too." D) "He hates having his nails trimmed but I will insist they are kept short."

Ans: C Feedback: The life cycle of pinworms is six to eight weeks. Clothing, bedding, food, toilet seats, and other articles become infected, and the infestation spreads to other members of the family. Pinworm eggs also can float in the air and be inhaled. Family members may be infected and not realize it. Because pinworms are so easily transmitted, the nurse should encourage all family members to be treated as well. Washing hands before eating and after using the toilet, frequent laundering of bedding and underclothes in hot water, and short, clean fingernails are all ways to prevent subsequent infections.

Which classification of medication will the nurse most likely provide to a child with a pinworm infection? A) Anticoagulants B) Anticonvulsants C) Anthelmintics D) Antipyretics

Ans: C Feedback: Treatment consists of the use of an anthelmintic or vermifugal which is a medication that expels intestinal worms. Anticoagulants are used to prevent clot formation and extension. Anticonvulsants are used for seizure disorders. Antipyretics are used to treat elevated temperatures.

The incidence of vitamin D deficiency in the United States is lesser than in many countries. What is the most likely reason for this? A) Many children in US take daily vitamin supplements B) The water in many towns and cities in US has vitamin D added C) Some foods in US have been fortified with vitamin D D) The amount of ultraviolet sunlight each day in US is adequate to provide needed vitamin D

Ans: C Feedback: Whole milk and evaporated milk fortified with 400 Units of vitamin D per quart are available throughout the United States, which decreases the vitamin D deficiency of children in the United States. Vitamin D can be administered orally in the form of fish liver oil or synthetic vitamin, but this is not common for children in US. Water is not fortified with vitamin D, and some communities in US do not get adequate sunshine to meet vitamin D needs