Comprehensive Exam

70. A newborn with suspected hydrocephalus is transferred to the intensive care unit for further evaluation and treatment. The infant ' s nurse knows which of the following? 1. To use sedation as needed to keep the baby from crying or being fussy. 2. To keep the crib in a fl at and neutral position. 3. To expect the infant to sleep more than an infant without hydrocephalus. 4. To not use any scalp veins for intravenous infusions.

(1. No products that interfere with levels of consciousness are used so as not to confuse assessment. 2. The head of the crib is slightly elevated to help decrease intracranial pressure. 3. Infants with hydrocephalus are often irritable and do not sleep well. 4. These may interfere with surgery and shunt placement.)

72. In preparing the patient and family for hospital discharge, which of the following signs and symptoms of shunt malfunction and infection should the nurse include in the teaching plan? Select all that apply. 1. Emesis, lethargy. 2. A change in neurological behavior. 3. Fever, irritability. 4. Diarrhea or constipation. 5. Redness along the shunt system.

1, 2, 3, 5. (1. Emesis and lethargy can be signs of increased intracranial pressure and may indicate an infectious process. 2. A change in behavior can be a sign of increased intracranial pressure and can be a sign of shunt malfunction. 3. Fever and irritability can be indications of a possible shunt infection. 4. Although diarrhea may be a sign of illness, it is usually not a shunt complication, nor is constipation. 5. Redness along the shunt system can be an indication of a possible infectious process.)

75. A 10-month-old has fallen out of the high chair and is brought to the emergency department (ED). Place the following components of the nurse ' s assessment into order of priority. 1. Airway 2. Bleeding 3. Appetite 4. Breathing 5. Circulation 6. Level of consciousness

1, 4, 5, 6, 2, 3. (1. Always fi rst priority to assess. 4. Second aspect of ABC priority. 5. Third aspect of ABC priority. 6. Important after stabilization of the "ABC." 2. Important but not fi rst priority. 3. Least important.)

89. When introducing solid foods into an infant ' s diet, it is important to introduce one food at a time in order to rule out ______________________.

Allergies. (Infants should be introduced to solid foods after 6 months of age. Iron-fortifi ed infant cereals are recommended fi rst, followed by the introduction of vegetables, then fruits. New foods should be introduced about every 3 to 5 days so the caregiver has the opportunity to identify any food allergies the baby may have.)

93. According to Freud, the most signifi cant achievement of toddlers is ______________________.

Toilet-training. (Freud believed that during the anal-urethral stage of psychosexual development, a child must achieve toilet-training. Freud believed that children may have long-lasting diffi culties if they do not master toilet-training.)

44. An infant with a lumbar myelomeningocele is admitted to the unit with an Arnold- Chiari malformation. The infant has which other diagnosis? 1. Hydrocephalus. 2. Anencephaly. 3. Tethering of the spinal cord. 4. Perinatal hemorrhage.

1 (1. Arnold-Chiari malformation is a herniation of the brainstem into the cervical spinal canal through the foramen magnum. 2. Anencephaly is absence of the brain. 3. Tethering of the spinal cord occurs when the tissue surrounding the cord adheres to the underlying bony or tissue structure of the spinal canal. 4. Perinatal hemorrhage is one cause of hydrocephalus but is not a brain malformation.)

18. A child assigned to the nurse ' s fl oor has a dysfl uency. The nurse should recognize what symptoms? 1. Stuttering. 2. Substitution of one sound for another. 3. Speaking in a monotone. 4. Hypernasal speech.

1 (1. Dysfl uency is speech with abnormal rhythms, such as repetitions in sounds or words. A stutter is described as tense repetitions of sounds or complete blockages of sounds. 2. Children who substitute or omit consonants have articulation errors. 3. A child who speaks in a monotone has a voice disorder. Hypernasal speech is prominent in children with palatal weakness and cleft palate repair. 4. Hypernasal speech is prominent in children with cleft repairs of the hard and soft palates)

60. A child is taking haloperidol (Haldol) for schizophrenia, and the family has been instructed to watch for extrapyramidal side effects. Which are characteristic of these side effects? 1. Abnormal movements and twitches. 2. Inappropriate behaviors. 3. Excessive aggressiveness. 4. Thoughts of suicide.

1 (1. Extrapyramidal symptoms are motor neuron responses that go from the brain to the spinal cord and present as tics, jerkiness, incoordination, and loss of involuntary muscle control. 2. The medication is given to control the inappropriate behaviors, such as aggressiveness. If the symptoms started with the medication, it would be important to report this to the provider. 3. The medication is given to control inappropriate behaviors, such as aggressiveness. If the symptoms started with the medication, it would be important to report this to the provider. 4. Thoughts of suicide would warrant further evaluation of the appropriate medication for treatment.)

81. Which is/are the most common, nonlethal complication(s) occurring from meningitis? 1. Cranial nerve defi cits. 2. Epilepsy. 3. Bleeding intracranially. 4. Cerebral palsy.

1 (1. If infection extends into the area of the cranial nerves, increased pressure may cause sensory defi cits. 2. Although this is a possible complication, it is not the most common. 3. Although there is often purpura and petechiae with meningitis, there is no intracranial bleeding. 4. This condition is usually an injury incurred during the neonatal period.)

12. Parents are told by the genetic counselor that they have a 1 : 4 probability of having a second child with cystic fi brosis (CF). They already have one child who is affected. The parents state their risk is lower now than when they had the previous child. What should the nurse tell the parents about the 1 : 4 probability? 1. Each pregnancy is an independent event. 2. The probability of having another child with CF is twice as likely as it was when they had the fi rst child. 3. The probability of having a healthy child is twice as likely with this pregnancy. 4. The probability of miscarrying is greater now than with the previous pregnancy.

1 (1. In a probability equation, each pregnancy is an independent event. 2. The probability of having a child with cystic fi brosis is 1 chance in 4, whether the fi rst or the fourth baby. 3. The probability of having a child with cystic fi brosis is 1 chance in 4, whether the fi rst or the fourth baby. 4. The probability of a miscarriage does not increase with this pregnancy.)

20. The nurse in the emergency department is caring for an 8-month-old who suffered a concussion from an automobile accident. The infant was in the car seat at the time. The nurse should assess the infant for which symptoms? 1. Sweating, irritability, and pallor. 2. Plethora and hyperthermia. 3. Crying with fear. 4. Negative Babinski refl ex.

1 (1. Post-concussion syndrome is a common fi nding in children who have suffered a head injury. Symptoms in the infant include pallor, sweating, irritability, and sleepiness. The symptoms begin within minutes to hours. 2. Plethora and hyperthermia may indicate a number of problems, such as being overdressed, crying, and stress. 3. Crying with fear in an 8-month-old is an expected behavior at this time. 4. Babies have a positive Babinski refl ex until they are walking, which means they have toe fanning; after that, it should be a negative fi nding.)

40. The nurse is working in a school health clinic, and a teen mentions that her older sister just had a baby born with a myelomeningocele. The teen is wondering if there is anything she can do to prevent this from happening to her baby when she decides to have children. Which is the best response? 1. Take a multivitamin with folic acid daily. 2. Eat more fruits and vegetables daily. 3. Have breakfast every morning. 4. There is nothing that can be done to decrease the risk

1 (1. The American Academy of Pediatrics recommends a daily intake of 0.4 mg of folic acid daily for all women of childbearing age. 2. Although eating fruits and vegetables is part of a healthy lifestyle, the young woman will not gain any additional folic acid in her diet through those foods. 3. Although eating breakfast is part of a healthy lifestyle, the young woman will not gain any additional folic acid in her diet. 4. The addition of folic acid at 0.4 mg daily to the diet will decrease the risk of having a baby with a neural tube defect by 50% to 70%.)

66. The nurse is caring for a child dying from leukemia. The parents want to know how comfortable the nurse is in giving doses of pain medication that are larger than customary. Which ethical principle of care are the parents asking about? 1. Double effect. 2. Justice 3. Honesty. 4. Benefi cence.

1 (1. The ethical principle of double effect states that an action has good intentions and that a bad intention is permissible if the action itself is good or neutral, the good effect must not be produced by the bad effect, and there is a compelling reason to allow the bad effect to occur if the good effect is the primary reason for the action. The child may require doses of pain relievers higher than is considered safe in order to relieve the pain. If the child dies during this treatment, the overwhelming reason for the excess medication was to make the child comfortable and decrease the intense pain. 2. Justice is the promotion of equity or fairness in every situation a nurse encounters, for example, fair allocation of resources, including appropriate staffi ng or mix of staff to all clients. 3. There is no principle of honesty. There is only acknowledgment of cultural differences in the dying process, honesty in dealing with the child and the family, and use of pain medication to relieve pain as indicated by the circumstances. 4. Benefi cence is doing or active promotion of good, balancing the benefi ts and risks of harm, taking positive action to help others, a desire to do good.)

73. The parents of an infant with hydrocephalus ask about future activities in which their child can participate in school and as an adolescent. The nurse should tell the parents which of the following is appropriate? 1. A helmet should be worn during any activity that could lead to head injury. 2. Only non-contact sports should be pursued, such as swimming or tennis. 3. Because of the risk of shunt system infection, swimming is not a sports option. 4. The child should wear a MedicAlert bracelet; then there is no need to be concerned about the shunt.

1 (1. The risk of shunt breakage or obstruction is extremely low. 2. There is no reason why athletics need be restricted. Recent studies have shown little evidence of shunt injury or malfunction with sport participation. 3. The shunt is a sterile, closed system, without any external opening so there is no risk of infection from swimming. 4. Even with the alert bracelet, close contacts should be aware to provide care if necessary)

29. The nurse tells a parent which of the following data can be provided by a polysomnogram? Select all that apply. 1. Heart rate and respirations. 2. Brain waves. 3. Eye and body movements. 4. Cyanosis or plethora. 5. End-tidal carbon dioxide.

1, 2, 3, 5. (1. A polysomnogram can record heart rate and respirations. 2. A polysomnogram can record brain waves. 3. A polysomnogram can record eye movements and body movements. 4. Unless the child is being videotaped while asleep, the polysomnogram is not able to pick up cyanosis or plethora. 5. A polysomnogram can record end-tidal carbon dioxide.)

32. Parents express concern that their 5-year-old has started having more temper tantrums. The parents want to know if this is normal for this age. What should the nurse ask the parents about the tantrums? Select all that apply. 1. "Do you notice and praise your child when your child does something right?" 2. "Are the tantrums related to one specifi c aspect of life?" 3. "Are the tantrums causing any harm to self or others?" 4. "Have you consulted the Internet for any suggestions?" 5. "How do you handle your child during a tantrum?"

1, 2, 3, 5. (1. Many children who have diffi culty with temper tantrums are described by the family as "bad" or "diffi cult" in all aspects of their life. This description often carries over into all the activities and conversations that the family has with the child and degrades the positive aspects of the child ' s personality. 2. Tantrums are frequently associated with only one aspect of a child ' s life, and this should be identifi ed quickly so that changes can be instituted in the approach to the problem. 3. Tantrums that result in harm to the child or to others should be dealt with quickly; professional help may be needed. 4. The Internet is often a source of confl icting information, but families frequently seek help from it. Not all the information on the Internet is appropriate or correct. 5. Discipline and inappropriate behavior management techniques may worsen the temper tantrums.)

88. The nurse is doing discharge teaching for a 3-month-old with a new shunt placed for hydrocephalus. Which are signs and symptoms of hydrocephalus that the parents may see if the shunt malfunctions? Select all that apply. 1. Vomiting. 2. Irritability. 3. Poor feeding. 4. Headache. 5. Sunken fontanel. 6. Seizures. 7. Inability to wake up infant. 8. Hyperactivity.

1, 2, 3, 6, 7. (1. As the shunt malfunctions and cerebrospinal fl uid builds up, the child will exhibit symptoms of increased intracranial pressure. Vomiting is one of the possible signs of increased intracranial pressure. 2. As the shunt malfunctions and cerebrospinal fl uid builds up, the child will exhibit symptoms of increased intracranial pressure. Irritability and change in neurological status are two of the possible signs of increased intracranial pressure. 3. As the shunt malfunctions and cerebrospinal fl uid builds up, the child will exhibit symptoms of increased intracranial pressure. Poor feeding is one of the possible signs of increased intracranial pressure. 4. As the shunt malfunctions and cerebrospinal fl uid builds up, the child will exhibit symptoms of increased intracranial pressure. Headache is very diffi cult to assess in an infant. 5. A sunken fontanel is a sign of dehydration. With increased intracranial pressure, the brain is edematous and expands in size. This would result in an enlarged rather than a sunken fontanel. 6. As the shunt malfunctions and cerebrospinal fl uid builds up, the child will exhibit symptoms of increased intracranial pressure. Seizure is one possible sign of increased intracranial pressure. 7. As the shunt malfunctions and cerebrospinal fl uid builds up, the child will exhibit symptoms of increased intracranial pressure. A declining neurological status evidenced by the inability to wake a child up is one of the possible signs of increased intracranial pressure. 8. A declining neurological status is a sign of increased intracranial pressure. Hyperactivity is not a sign of a declining neurological status.)

53. A child returns from surgery, having had tonsils and adenoids removed. When the parents are getting ready for discharge, the nurse gives which of the following instructions about home care? Select all that apply. 1. Some secretions may be blood-tinged for a few days. 2. Run a cool-mist vaporizer in the bedroom. 3. Pain relief should be provided every 4 hours. 4. The child can resume a normal diet. 5. The child should blow the nose and cough every 4 hours.

1, 2, 3. (1. The nurse should alert the parents to the fact that the child may have some blood-tinged secretions for a few days afterward. 2. Using a cool mist vaporizer helps to decrease the viscosity of the secretions. 3. Pain relief every 4 hours is indicated. 4. The child should not be eating foods that are rough or fi brous but rather should stay on a soft or liquid diet for a few days to allow healing. 5. Blowing the nose and coughing are contraindicated because this may loosen the clot that has formed over the surgical site.)

6. A family is adopting a child from a foreign country. What suggestions can be given to the parents for incorporating the child into the family? Select all that apply. 1. Learn as much about the child as possible before adoption. 2. Expect confl ict and determine how to work through it with the child. 3. Do not discuss the biological parents with the child. 4. Discuss your expectations with the child. 5. Try to maintain a part of the child ' s original family name

1, 2, 4, 5. (1. Learn as much as possible about the child. 2. Expect to have some confl ict with cultural differences and age. 3. Children who are adopted when they are older than 2 years of age know their biological families and have feelings about their adoption. It is best to discuss this openly with the child. 4. Setting clear behavioral expectations for the child will aid in the assimilation into the family. 5. It is always good to retain some part of the child ' s original name, such as a middle name, to maintain the link with the previous family and culture.)

34. A 17-month-old is brought into the clinic, and the nurse notes the toddler has tooth decay on the maxillary upper incisors. Which tactic(s) would the nurse suggest to wean the toddler from the bottle? Select all that apply. 1. Hide the bottle and tell the toddler that it is not needed anymore. 2. Put only tap water in the bottle. 3. Give the bottle only at night. 4. Give the toddler a pacifi er and take the bottle away. 5. Do not give any bottles before bed.

1, 2, 5. (1. Hiding the bottle and offering a cup is a good way to start to wean a toddler. 2. Putting only drinking water in the bottle is a good way to start to wean a toddler. 3. Nighttime bottles should be discontinued as soon as the child is able to drink fl uids from the cup. Nighttime bottles allow the milk or formula to coat the teeth all night long, encouraging tooth decay. 4. Starting to use a pacifi er with a toddler who should be weaned from the bottle by 11 to 12 months of age is inappropriate. 5. Nighttime bottles should be discontinued as soon as the child is able to drink fl uids from the cup. Nighttime bottles allow the milk or formula to coat the teeth all night long, encouraging tooth decay.)

97. Which applies to cerebral palsy? Select all that apply. 1. It is the most common chronic disorder of childhood. 2. Hyperbilirubinemia increases the risk of cerebral palsy. 3. It is a progressive chronic disorder. 4. Most children do not experience any learning disabilities. 5. There is a familial tendency seen in children with cerebral palsy.

1, 2. (1. Cerebral palsy is the most common chronic disorder of childhood. 2. There is an increased risk of cerebral palsy in infants with hyperbilirubinemia. 3. Cerebral palsy is a nonprogressive chronic disorder. 4. Approximately 75% of children with cerebral palsy experience learning disabilities. 5. There is no familial tendency seen in children with cerebral palsy.)

54. A 2-year-old is brought to the emergency department for fever and ear pain. The parent reports the child has had many ear infections and that polyethylene tubes have been recommended, but the parent cannot afford surgery. The child is diagnosed with bilateral otitis media. The toddler is carrying a baby bottle full of juice, and the parent is carrying a pack of cigarettes. Which preventive measures could be taught to the parent to decrease the incidence of ear infections? Select all that apply. 1. Wean the toddler from the bottle. 2. Give the toddler a decongestant before bedtime. 3. Encourage the parent to smoke outside the house. 4. Counsel the parent to change his shirt and wash his hands after smoking. 5. Have the child ' s hearing checked.

1, 3, 4. (1. Most toddlers are weaned from the bottle at about 12 to 15 months. Children who continue to drink from a bottle while lying down have a higher incidence of colds and ear infections. 2. Giving the toddler a decongestant before bedtime is not recommended because the primary problem is obstruction of the eustachian tube due to intrinsic or extrinsic causes. Decongestants thicken and make passage of fl uid out of the middle ear more diffi cult. 3. Smoking outside the house is recommended as a way to prevent exposure of secondhand smoke to children, but the smoke still clings to the parents ' clothing and hands and continues to be a source of exposure. 4. Smokers should change their shirts and wash hands before handling a child to help prevent exposure to smoke. 5. Following treatment for otitis media, it is important to have the child ' s hearing checked because drainage from the middle ear may persist beyond the days of treatment. It will not prevent recurrence of the otitis media)

58. Which is assessed to diagnose pediculosis capitis? Select all that apply. 1. Crawling insects. 2. White fl akes in the hair. 3. Nits attached close to scalp. 4. Infl ammatory papules. 5. Dark brown hair.

1, 3, 4. (1. The lice can be seen crawling about on the scalp. 2. The nits can be described as "looking like dandruff," but it could also be dandruff or seborrhea that is seen. 3. Nits can be seen, especially behind the ears, at the nape of the neck, and close to the hair shaft. 4. Often there are scratch marks and infl ammatory papules as a result of the itching and scratching of the scalp. 5. Head lice can be found in short and long hair and in coarse, curly hair.)

27. The nurse working in the newborn nursery has to draw a heel-stick blood sample before an infant ' s discharge. What can the nurse do to decrease the pain the infant feels from this procedure? Select all that apply. 1. Wrap the heel in a warm, damp cloth. 2. Use EMLA before doing the stick. 3. Swaddle the infant. 4. Have the infant do non-nutritive sucking. 5. Do the stick while the infant is asleep

1, 3, 4. (1. Wrapping the foot in a warm washcloth increases the vasodilation and makes obtaining the sample easier. 2. Using EMLA cream on the heel before the stick has not been shown to decrease the pain response of the infant. 3. Swaddling appears very effective in decreasing neonatal pain. 4. Non-nutritive sucking appears very effective in decreasing neonatal pain. 5. The baby will feel the pain whether asleep or awake.)

51. An innocent murmur has which characteristics? Select all that apply. 1. Short induration. 2. S 2 murmur. 3. Loudest in the pulmonic area. 4. Fixed and can be heard in many positions. 5. Grade III or less.

1, 3, 5. (1. An innocent murmur does not have an anatomical or physiological abnormality; it is a sound of short duration, grade III or less, and is best heard in the pulmonic area of the chest (second intercostal space close to the sternum). 2. An S 2 murmur is considered pathological until proved otherwise. 3. An innocent murmur does not have an anatomical or physiological abnormality; it is a sound of short duration, grade III or less, and is best heard in the left pulmonic area of the chest (second intercostal space close to the sternum). 4. Murmurs that are innocent or functional vary in their intensity and the position in which they can be heard. Pathological murmurs are fi xed and radiate throughout the chest. 5. An innocent murmur does not have an anatomical or physiological abnormality; it is a sound of short duration, grade III or less, and heard best in the pulmonic area of the chest (second intercostal space close to the sternum).)

65. Which should the nurse teach the child and parents about montelukast (Singulair) ordered for moderate persistent asthma? Select all that apply. 1. This is an add-on medication to the child ' s regular medications. 2. It can be given when the child needs it. 3. It is not to be used to treat acute episodes. 4. The parents will need to give up smoking. 5. The child will require chest physiotherapy in conjunction with the medication.

1, 3. (1. Leukotriene modifi ers such as montelukast are given orally and are indicated for add-on to low-dose inhaled corticosteroids in moderate persistent asthma. 2. The leukotriene modifi ers should be given on a daily basis for effectiveness. 3. The leukotriene modifi ers are not to be used for acute asthma attacks. 4. Although the parents should give up smoking for the sake of their child ' s asthma, it is not affected by the medication 5. Chest physiotherapy is used for children who have cystic fi brosis. It can help with respiratory distress by loosening mucus in the lungs.)

61. A sports physical examination is being performed on a 12-year-old male. He is evaluated as a Tanner stage II. Which physical characteristic would the nurse expect? Select all that apply. 1. Enlarging penis. 2. Height spurt. 3. Gynecomastia. 4. Deepening voice. 5. Enlarging scrotum.

1, 5. (1. A Tanner stage II male (early puberty) shows signs of an enlarging penis and loosening of scrotal skin. Puberty occurs from age 9½ to 14 years for typical growing boys. 2. Height spurts occur toward the end of mid-puberty. 3. Mid-puberty shows signs of breast enlargement (gynecomastia) due to elevated estrogen levels. This is temporary. 4. A deepening of the voice occurs with changes in the larynx toward the end of puberty. 5. Enlarging scrotum and penis are characteristics of a Tanner II male.)

9. Match each genetic term with its defi nition and function. 1. Congenital A. Mohogenic defect of an organ 2. FISH analysis B. Recognized pattern of malformation 3. Genome C. Present at birth 4. Malformation D. Clinically exhibited characteristic 5. Phenotype E. Fluorescent in situ hybridization 6. Syndrome F. Complete genetic information of organism

1, C; 2, E; 3, F; 4, A; 5, D; 6, B.

68. Parents of a 2-year-old with Down syndrome are told the child should be screened for atlantoaxial instability. The nurse tells the parents that which of the following are symptoms of this instability? 1. Mental retardation. 2. Neck pain and torticollis. 3. Vision and hearing loss. 4. Early onset of puberty.

2 (1. All children with Down syndrome have mental retardation. 2. Atlantoaxial instability is ligamentous laxity of the atlantoaxial joint. The symptoms of neck pain, torticollis, and loss of bowel and bladder control indicate that instability is already present. The purpose of the x-rays is to prevent symptoms by limiting activities if instability is present. 3. Children with Down syndrome may have vision and hearing loss and should be screened before 2 years of age for both. 4. Children with Down syndrome attain puberty at the same age as do nondisabled children.)

83. During the nurse ' s assessment, a child begins to have a generalized tonic-clonic seizure. The drug of choice and method of administration the nurse expects the health-care provider (HCP) to order are which of the following? 1. Lorazepam and diazepam, combined in an intravenous solution of D 5 W. 2. Lorazepam given intravenously or diazepam given directly into a vein. 3. Phenobarbital administered in an intravenous solution of D 5 W, 0.45 normal saline. 4. Phenytoin in a dextrose solution given intravenously over 1 hour.

2 (1. Although these are the correct drugs, they are not administered simultaneously. 2. These continue to be the drugs of choice for in-hospital management of tonic-clonic activity. These are the recommended methods of administration; diazepam compromises intravenous tubing. 3. Phenobarbital is not the drug of choice for in-hospital management of tonic-clonic activity. 4. Intravenous phenytoin is given by slow intravenous push. Dextrose causes phenytoin to precipitate.)

21. A parent tells the nurse that the 3-month-old infant is fussy, spits up constantly, and has a lot of gas, and there is a family history of allergies. These symptoms are related to which diagnosis? 1. Failure to thrive. 2. Sensitive to cow ' s milk. 3. Phenylketonuria. 4. Pancreatic insuffi ciency.

2 (1. Babies who have failure to thrive can tolerate a cows ' milk formula, but they need to have a diet modifi er to increase calories, such as polycose powder or medium-chain triglycerides oil. 2. The parent is describing symptoms of a cow ' s milk allergy and mentions there are many family members with allergies. 3. Phenylketonuria is an inborn error of metabolism presenting with growth failure, failure to thrive, and frequent vomiting. The infants are placed on a low phenylalanine formula, such as Lofenalac. 4. Portagen formula is used to nourish babies with pancreatic insuffi ciency or intestinal resections. Frequently these children are diagnosed with cystic fi brosis and present with failure to thrive, steatorrhea, bulky stools, and abdominal pain.)

57. Three preschool children and their foreign-born parents come to a homeless shelter. The family has been homeless for 3 months. The children appear somewhat unkempt but nourished. One of the children has several enlarged cervical lymph nodes and is running a low-grade fever. Which chronic infectious illness should be suspected in the child? 1. Chlamydial pneumonia. 2. Tuberculosis. 3. Pertussis (whooping cough). 4. Asthma.

2 (1. Chlamydial pneumonia is a sexually transmitted disease that would not be expected unless sexual abuse had occurred. 2. The chronic infectious illness for which this child is at risk is tuberculosis. The disease may present as asymptomatic or include fever, enlarged lymph nodes, anorexia, weight loss, night sweats, and, occasionally, hemoptysis. It is recommended that Mantoux skin tests be performed annually for at-risk populations such as the homeless, fi rst generation immigrants, and residents of correctional facilities. 3. Pertussis is an acute respiratory tract infection that lasts approximately 4 to 6 weeks. 4. Asthma is not contagious.)

74. While assisting with a lumbar puncture procedure on an infant or small child, the nurse should do which of the following? 1. Have the patient in a clean diaper to avoid contamination of the site. 2. Monitor the patient ' s cardiorespiratory status at all times. 3. Position the patient in the prone position with the head to the left. 4. Start an intravenous line to facilitate use of conscious sedation

2 (1. Diapers are kept rolled down and out of the way during a lumbar puncture. 2. Airway, breathing, and circulation are always the priority during procedures. 3. Positioning the patient should facilitate the opening of the vertebral spaces, either by a lateral or sitting-type position. 4. Conscious sedation is not utilized during a lumbar puncture.)

43. The parent of a school-age child who is a paraplegic and uses a wheelchair states that the child is allergic to latex. Which is the most important intervention for this child? 1. Giving antihistamines and steroids after procedures. 2. Prevention of contact with latex products. 3. Doing a radioallergosorbent test before each procedure. 4. Using only latex-free gloves when doing procedures.

2 (1. Giving antihistamines and steroids before and after procedures will help to decrease the response to the exposure. 2. The most important intervention for any person with latex allergy or sensitivity is to prevent contact with latex products. 3. Once the radioallergosorbent test confi rms that a person is allergic to latex, the test does not need to be repeated 4. Using latex-free gloves is one way to decrease exposure to latex)

19. Parents confi de to the nurse that their child, who is 35 months old, does not talk and spends hours sitting on the fl oor watching the ceiling fan go around. They are concerned their child may have autism. The nurse should ask the parents which question? 1. "Does your child have brothers or sisters?" 2. "Does your child seek you out for comfort and love?" 3. "Do you have trouble getting babysitters for your child?" 4. "Does your child receive speech therapy?"

2 (1. It is important to discuss the fi ndings that the parents have presented and not peripheral information that may or may not be necessary to their concern. 2. Children with autistic-like features lack many social skills, such as seeking reciprocity and comfort from parents and maintaining eye contact when someone is speaking with them. They have an inability to develop peer relationships. 3. It is important to discuss the fi ndings that the parents have presented and not peripheral information that may or may not be necessary to their concern. 4. It is important to discuss the fi ndings that the parents have presented and not peripheral information that may or may not be necessary to their concern.)

50. A fi xed splitting of the S 2 heart sound is heard in an otherwise healthy child. This is a diagnostic sign of which cardiac defect? 1. Mitral regurgitation. 2. Atrial septal defect. 3. Functional murmur. 4. Pericardial friction rub.

2 (1. Mitral regurgitation is best heard between S 2 and the beginning of S 1 . It is accentuated by exercise. 2. The S 2 sound is caused by the closure of the pulmonic and aortic valves. A fi xed splitting of the S 2 sound is indicative of an atrial septal defect. 3. A functional murmur does not denote a cardiac defect but may indicate anemia or some other physiological abnormality. 4. The pericardial friction rub is a highpitched grating sound that is indicative of pericarditis.)

5. The parent of a newborn wants to know what the newborn screening test does. What is the nurse ' s best response? 1. "It detects a large number of congenital diseases." 2. "It screens after birth for some inherited and congenital conditions." 3. "Parents choose which diseases to screen for." 4. "It screens for congenital diseases that insurance companies cover."

2 (1. Newborn screening tests screen for a large number of congenital diseases. 2. It screens for some inherited and congenital conditions after birth. 3. Individual states determine which diseases are screened for, not the parents. 4. Insurance companies do not determine which newborn screening tests are conducted.)

15. The nurse is working in a clinic, and the next client is an infant with deaf parents. In addition to providing an interpreter for the deaf, the nurse should incorporate what additional aid in communicating with the family? 1. Talk just as with hearing families. 2. Maintain good eye contact to let them read the nurse ' s lips. 3. Explain procedures thoroughly. 4. Recommend a trained hearing dog.

2 (1. People tend to "do other things" while talking. The family does not hear well, so this will be inappropriate. 2. When communicating with parents who are hearing-impaired, maintain good eye contact and allow them to read lips. 3. It is best to talk in short but concrete ideas. For teaching complex material, drawings and charts should be used. Enunciate clearly and talk slowly. 4. The visit requires that the family be able to understand what is being said by the provider. A trained hearing dog is not part of this priority.)

23. The nurse is caring for a newborn with Erb palsy and a phrenic nerve paralysis. The most effective way to promote respiratory effort is for the nurse to position the newborn in what way? 1. Supine. 2. On the affected side. 3. On the unaffected side. 4. Prone.

2 (1. Placing the infant supine will compromise the function of the unaffected lung. 2. To optimize the baby ' s breathing, position the infant with the affected side down. In this way, the unaffected lung can expand fully. Infants are primarily thoracic breathers, so it is important to maximize use of the unaffected lung. The infant also has an Erb/brachial palsy, which further limits the function on the affected side. 3. Placing the infant on the unaffected side will decrease the ability to expand the unaffected lung maximally and increase the work of breathing. 4. Placing the infant prone compromises the function of the unaffected lung.)

48. What are the two organizations in the United States that make and govern the recommendations for immunization policies and procedures? 1. National Advisory Committee on Immunization and American Medical Association. 2. U.S. Public Health Service Centers for Disease Control and American Academy of Pediatrics. 3. National Immunization Program and Pediatric Infectious Disease Association. 4. National Institutes of Health and Minister of National Health and Welfare.

2 (1. The National Advisory Committee on Immunizations is a subgroup of the U.S. Public Health Service. The American Medical Association makes recommendations on adult care. 2. The two organizations in the United States that govern the recommendations on immunization practices are the Advisory Committee on Immunization Practices (ACIP) of the U.S. Public Health Service and the Committee on Infectious Diseases of the American Academy of Pediatrics. 3. The National Immunization Program is a part of the U.S. Public Health Service. Pediatric Infectious Disease Committee makes recommendations on treatment of known infectious diseases in children. 4. Canada has its own advisory committee called the National Advisory Committee on Immunization under the Minister of the National Health and Welfare Department)

24. A 2-day-old baby is being readied for discharge but looks jaundiced. The nurse reviews the baby ' s birth records and notes that the baby has A blood type, and the mother has O blood type. The nurse should check which blood test? 1. Hepatitis B titer. 2. Total bilirubin. 3. Complete blood count. 4. Sedimentation rate.

2 (1. The baby would not have a hepatitis B titer unless the mother was hepatitis B-positive. 2. This baby has an ABO blood incompatibility, with the mother being O + and the baby being A + . The total bilirubin is a value that combines the unconjugated and the conjugated bilirubin levels. The newborn would have an increase in the unconjugated bilirubin (lipid-soluble) as a result of the presence of antibodies to the mother ' s blood type. 3. The complete blood count does not necessarily explain the jaundice. 4. The sedimentation rate indicates infl ammation somewhere in the body.)

11. A pregnant teen is to have prenatal testing. She is afraid of needles and wants to know the least invasive way she can get the testing done. The nurse should suggest which testing procedure? 1. Triple marker screen. 2. Ultrasound examination. 3. Amniocentesis. 4. Chorionic villus sampling.

2 (1. The triple marker screen, amniocentesis, and chorionic villus sampling require either a venipuncture or uterine puncture. 2. The ultrasound is appropriate for a noninvasive procedure. It would detect multiple gestations and structural abnormalities, but it would not detect biochemical abnormalities. 3. The triple marker screen, amniocentesis, and chorionic villus sampling require either a venipuncture or uterine puncture. 4. The triple marker screen, amniocentesis, and chorionic villus sampling require either a venipuncture or uterine puncture.)

87. A 14-year-old sustained a grade III concussion while playing football. Which statement made by the parents indicates that further education is needed? 1. "Our child will not be able to play football until recovery is complete." 2. "Our child needs to get back to school quickly because there are midterms next week." 3. "Our child ' s headaches may continue for the next 6 months; we should call the physician if the headaches get worse." 4. "If our child suffers another concussion before recovery is complete, brain injury will be compounded."

2 (1. This statement indicates that the parents understand the potential severe consequences of receiving a second concussion while recovering from the fi rst one. Football is a contact sport in which there is an increased risk of concussion. The child should not participate in contact sports until cleared by the physician. 2. Short-term memory loss is a frequent side effect of concussions. Until effects of the concussion have subsided and the child is cleared by a physician, the child should not take school tests that often rely on short-term memory. 3. Headaches can occur for up to 6 months after the initial impact. Headaches that continue to worsen, however, could be indicative of the development of other injuries. 4. This statement indicates that the parents understand the potential severe consequences of receiving a second concussion while recovering from the fi rst one.)

36. Parents are interested in switching their child from a booster seat to a regular seat belt. The child is 7 years old and weighs 51 lb. What can the nurse tell the parents about switching the child to a seat belt? Select all that apply. 1. The safest place to ride in the car is in the front seat. 2. The child needs to weigh 60 lb and be 8 years old to qualify legally for a seat belt. 3. The seat belt should be worn low on the hips. 4. Use a shoulder belt only if it does not cross the child ' s neck. 5. Tether straps are optional.

2, 3, 4. (1. The safest place for a child to ride in a car is in the middle of the back seat. 2. Legally, a child must weigh 60 lb and be 8 years old to ride in a seat belt without a booster. 3. The seat belt, whether in a booster or on a seat, should be worn low on the hips and not across the abdomen. 4. The shoulder strap, for safety purposes, should be across the chest and not across the face or neck. 5. Tether straps help to secure the seat belt in position when using a car seat or booster seat and should not be optional)

7. When the parents of a 5-year-old tell the child they are divorcing, the parents need to be aware of which behaviors that the child may demonstrate? Select all that apply. 1. Increased self-esteem, bragging. 2. Changes in sleep and appetite. 3. Feelings of abandonment. 4. Develops dictatorial attitude. 5. Verbalizes feelings about divorce-related changes

2, 3, 5. (1. Young children who are experiencing a divorce have poor self-esteem and blame themselves for the separation. 2. They exhibit loss of appetite and poor sleep patterns. 3. Preschool and young school-age children feel the parent who is leaving the family is abandoning them. They also develop increased anxiety. 4. Older rather than young school-age children may become dictatorial and aggressive and show a decline in school performance. 5. The 5-year-old can verbalize feelings about divorce and the changes that are going to take place within the family.)

8. The mother of a 6-month-old is going back to work. The nurse should make which of the following suggestions for ways to evaluate day-care options? Select all that apply. 1. Size of day-care center. 2. Strict health and safety requirements. 3. Caretakers who are loving and kind. 4. Challenging activities for all the children. 5. Child-care ratios that maximize staff use. 6. Small class size

2, 3, 6. (1. Larger day care facilities do not necessarily have qualifi ed staff and age-appropriate activities for the child or infant. 2. In choosing a day care, it is important for parents to see that the health and safety requirements of the law are maintained. 3. Each child gets the attention that is required for maintaining a healthy, happy child. Caretakers should be loving and supportive of the children and parents. 4. Activities should be age-appropriate for the child. 5. Child-care ratios, as well as class size, should be small, and staff should not feel they have more work to do than they can manage. 6. Child-care ratios, as well as class size, should be small, and staff should not feel they have more work to do than they can manage.)

78. Which does the nurse include in discharge teaching for a 15-year-old with systemic lupus erythematosus? Select all that apply. 1. High-protein diet. 2. Low salt intake. 3. Exposure to the sun. 4. Killed-virus vaccines. 5. Systemic corticosteroids. 6. Antimalarials.

2, 4, 5, 6. (1. Low protein to keep BUN within normal range. 2. Low salt to help control blood pressure. 3. Worsens butterfl y rash. 4. More susceptible to infections and a lowered immune response. 5. Steroids are fi rst-line treatment because of the anti-infl ammatory effect. 6. Antimalarials are used in mild SLE to control symptoms of arthritis, mouth ulcers, fever, and fatigue.)

96. Which applies to brain tumors? Select all that apply. 1. Brain tumors are the most common malignancy in the United States. 2. Although an exact cause is unknown, an association has been linked to paints and radiation. 3. All children with brain tumors present with very similar manifestations. 4. Brain tumors in children usually occur below the cerebellum. 5. Symptoms of brain tumors always appear rapidly.

2, 4. (1. Brain tumors are the most common solid tumor. Leukemia is the most common malignancy in the United States. 2. Although an exact cause is unknown, an association has been linked to paints and radiation. 3. The manifestations can vary, depending on where the tumor is located. 4. Brain tumors in children usually occur below the cerebellum. Brain tumors in adults usually occur above the cerebellum. 5. Symptoms of brain tumors can appear rapidly or slowly, depending on whether the tumor is fast- or slow-growing.)

38. The clinic is doing a lead screening program for children in a low-income community. The nurse working in the program wants to tell the parents the reasons to have their children screened for lead poisoning. Select all that apply. 1. Young children absorb 10% of the lead to which they are exposed. 2. Homes built between 1900 and 1950 may contain lead-based paint. 3. The blood level of lead should be below12.8 mcg/dL. 4. Lead can affect any part of the body, but the brain and kidneys are at greatest risk. 5. Foods such as fruit, candy, and antacids contain lead.

2, 4. (1. Young children absorb most of the lead that enters their body. 2. Homes built between 1900 and 1950 most likely contain lead-based paints. 3. The acceptable blood level is 5.0 mcg/dL or less. 4. Lead can affect any part of the body, but the brain, nervous system, kidneys, and blood are likely to be most affected. 5. In Hispanic and Arabic cultures, some painted jars in which candy is stored are painted with lead paints. Some medicinals, such as azarcon, greta, paylooh, surma, and lozeena, are sources of lead.)

79. A 12-year-old cut a hand while climbing a barbed-wire fence. What should the nurse discuss with the parents regarding need for tetanus vaccine? Select all that apply. 1. No tetanus vaccine is necessary; it is too soon since the child ' s scheduled Tdap was given. 2. Tetanus is a potentially fatal disease. 3. Puncture wounds are less susceptible to tetanus. 4. There will be mild soreness at the injection site. 5. Tdap should be administered. 6. Td should be administered.

2, 5. (1. Required tetanus boosters are given at 5 years of age. If a "dirty" wound occurs before 10 years after the last dose, a booster is necessary. 2. Tetanus is a potentially fatal disease. 3. Puncture wounds are more susceptible to tetanus, especially in rural areas. 4. This is a possible side effect of tetanus vaccine. 5. Because of the increase in incidence of pertussis in adolescents and adults, this is the vaccine of choice. 6. Td is no longer the vaccine of choice; DTaP is the vaccine used to help control the growing incidence of pertussis.)

35. Parents are frustrated with toilet-training their 2-year-old. Both parents work fulltime and claim they do not have time to spend on toilet-training. How will the nurse respond to the parents ' concern? Select all that apply. 1. "You will have to invest some time if the child is to be toilet-trained." 2. "A child needs to be both physically and psychologically ready to learn the skills needed to be continent." 3. "Do you think your child is stubborn?" 4. "Have the child sit on the toilet until the child voids." 5. "If the child can stay dry for two hours, then he might be ready to toilet train."

2, 5. (1. The parents have indicated that neither one has the motivation or time to do the toilet-training. 2. The child is 2 years old and may not be physically, emotionally, or psychologically ready to toilet-train. 3. A toddler will say "no" to most questions; that does not make the child stubborn. 4. Having the child sit on the toilet for more than 2 or 3 minutes is inappropriate. 5. One of the indicators for a child to be ready to train is if the toddler stays dry for 2 hours.)

26. A baby is brought into the clinic for follow-up review of phenylketonuria. The baby is 9 months old and weighs 22 lb. If the recommendation is to limit the phenylalanine in the diet to 25 mg/kg/day, this infant should have no more than ______________________ of phenylalanine/day.

250 mg. (Convert the weight of 22 lb to kilograms. There are 2.2 lb per kilogram of body weight, so divide 22 lb by 2.2. The baby weighs 10 kg. By multiplying 10 kg by 25 mg/kg recommendation per day, the total intake of phenylalanine per day for this infant is 250 mg.)

82. Which should the nurse teach the parent of a child with suspected meningitis? 1. Antibiotics are not initiated until the cerebrospinal fl uid cultures are defi nitive for specifi city to prevent resistance. 2. Antibiotics are useless against viral infections, so they are not used for meningitis. 3. Antibiotics should be started before the cerebrospinal fl uid cultures are defi nitive; culture results may take up to 3 days. 4. Antibiotic initiation is based on the age, signs, and symptoms of the child, not on the causative agent.

3 (1. A delay in administering antibiotics can be fatal. 2. Cerebrospinal fl uid cultures may require up to 3 days to determine the causative agent. 3. Immediate antibiotic therapy is necessary to prevent death and avoid disabilities. 4. Antibiotic choice is based on the most likely causative agent for that particular age-group. If the culture indicates a resistant organism, the antibiotic can be changed.)

45. Which would the nurse assess in a 4-week-old infant who has developmental dysplasia of the hip and is wearing a Pavlik harness? 1. Diaper dermatitis. 2. Talipes equinovarus. 3. Leg shortening and limited abduction. 4. Pain.

3 (1. Diaper dermatitis should be assessed with the diaper change, but it is not specifi c to the risks of wearing a Pavlik harness. 2. Talipes equinovarus is congenital clubfeet and does not occur as a result of the harness. 3. An infant wearing a Pavlik harness is at risk of leg shortening on the affected side and limited abduction. The straps on the harness may need adjustment and lengthening frequently. 4. Pain of any kind warrants further assessment.)

71. Which is immediate postoperative care for shunt placement in an infant diagnosed with hydrocephalus? 1. Wet-to-dry dressing changes at both the shunt insertion site and the abdominal incision site. 2. Measure the child ' s head at least once a day. 3. Position the infant ' s head off the shunt site for the fi rst 2 postoperative days. 4. Complete vital signs and neurological checks every 4 hours

3 (1. Dressings should be dry and free of drainage. 2. Once a shunt is determined to be functioning properly, head measurements are done at offi ce visits 3. Position the head on the side opposite the surgical site to prevent pressure on the shunt and valve. This provides better visibility to watch for signs of bleeding or infection. 4. Vital signs and neurological checks will be performed much more frequently, usually every 1 to 2 hours initially.)

49. A nurse is working in a well-child clinic administering immunizations to preschoolers. Which procedure will minimize local reactions to the injections? 1. Apply EMLA cream 1 hour before. 2. Change the needle on the syringe after drawing up the biological drug. 3. Inject into the vastus lateralis or ventrogluteal muscle. 4. Use distraction such as telling the child to hold their breath.

3 (1. EMLA cream does not decrease local reactions. 2. EMLA cream does not decrease local reactions, and changing the needle has not been shown to decrease local reactions. 3. The vastus lateralis and the ventrogluteal muscles are recommended sites for a child of any age. 4. Using distraction will minimize pain but not minimize local reactions.)

13. A young woman tells a nurse she is pregnant and concerned that her boyfriend may be "slow" mentally. The nurse should do which activity fi rst? 1. Develop a pedigree. 2. Take a family history. 3. Inform the provider about the concern. 4. Refer the client for genetic counseling.

3 (1. It is appropriate to develop a pedigree once the provider has discussed this issue with the patient. 2. It is appropriate to take a family history once the provider has discussed this issue with the patient. 3. Working as a team with the provider and sharing this information enables the provider to make appropriate decisions. 4. It is appropriate to make a referral for genetic counseling once the provider has discussed this issue with the patient.)

1. Which outcome is expected in a breastfed newborn? 1. Voids spontaneously within 12 hours of life. 2. Loses 10% of body weight in the fi rst 5 days. 3. Regains birth weight by the 14th day of life. 4. Awakens spontaneously for all feedings

3 (1. Newborns may not void spontaneously in the fi rst 12 hours of life, but they void within the fi rst 24 hours of life. 2. Most, but not all, babies lose approximately 10% of their body weight in the fi rst 3 to 4 days of life. 3. Breastfed infants should regain their birth weight by the 14th day of life. 4. Many babies do not initially awaken spontaneously for nursing; initially, the mother may need to offer the baby the breast every 2 to 3 hours.)

31. Parents are concerned that their toddler refuses to sleep in the new toddler bed and wonder what to do. The nurse explains that the child is using "global organization." What does the nurse mean by this term? 1. The preoperational phase of developing cognitive thought starts around 3 years old. 2. The child is self-centered and does not want to learn. 3. The child sees changing to a toddler bed as changing the whole process of sleeping and going to bed. 4. The toddler may have a phobia to the bed.

3 (1. Preoperational thought starts around 2 years of age and continues until late in the third year. 2. Toddlers are self-centered but are curious and want to learn. They love to explore their environment and try new things. 3. Toddlers think in very broad terms; it is diffi cult for them to see that changing the bed will not change the entire process of sleeping. "Global organization" means that change in one part changes the whole process. 4. The toddler is globally afraid of changes but is not phobic about the bed.)

56. An 11-month-old was born at 28 weeks ' gestation and required 2 weeks of ventilation. The baby is currently well and is being seen in the clinic. The physician recommends that the baby receive preventive therapy for respiratory syncytial virus (RSV) for the next 5 months since winter is approaching. Which medication will be ordered? 1. Respiratory syncytial virus immune globulin (RespiGam). 2. Ribavirin. 3. Palivizumab (Synagis). 4. Pneumococcal vaccine.

3 (1. RespiGam is also a prophylactic for respiratory syncytial virus, but it is primarily an immunoglobulin G that provides neutralizing antibodies against subtypes A and B of the virus. It must be given intravenously monthly, which is more diffi cult in terms of administration. 2. Ribavirin is an antiviral agent and is given in a hospital for treatment of respiratory syncytial virus. 3. The American Academy of Pediatrics recommends that infants born before 32 weeks ' gestation and younger than 2 years who have chronic lung disease should receive palivizumab (Synagis) monthly as a prophylactic to prevent respiratory syncytial virus during the winter months. 4. The pneumococcal vaccine could be given during these 5 months but would not protect the infant from respiratory syncytial virus)

25. An infant at 12 hours of age has a positive Coombs test result and a bilirubin level of 18 mg/dL. The provider has ordered an exchange transfusion for the infant. As the transfusion is proceeding, the nurse should watch for which sign? 1. Increasing jaundice. 2. Lethargy. 3. Temperature instability. 4. Irritability

3 (1. The baby is already becoming increasingly jaundiced; if the bilirubin level is not controlled, there is the risk of kernicterus. 2. Lethargy is symptomatic of a number of risks that a newborn might encounter, such as sepsis, dehydration, and hypothermia 3. The signs of a blood exchange transfusion reaction are focused on an unstable temperature. If the newborn becomes too cool, the infant could develop respiratory distress or bradycardia. If the baby ' s temperature becomes too high, there would be a dramatic change in blood pressure, with either hypertension or hypotension causing vascular collapse. If the baby becomes hyperthermic, the donor red blood cells could also be damaged, further increasing the jaundice. 4. Irritability would be symptomatic of a number of risks that a newborn might encounter, such as sepsis, dehydration, or hypothermia.)

67. The parents of a 19-year-old ask the nurse what they should do in terms of longterm care placement for their severely disabled child. Which is the nurse ' s best response? 1. "How much care do you want?" 2. "Do you have other children who could take your child into their home?" 3. "Do you have a detailed plan of care?" 4. "Are you working with an agency or social worker about this matter?"

3 (1. The parents obviously want their son cared for in the best and safest manner possible. 2. The parents may not have other relatives who are able or willing to take care of the child. 3. It is always best to ask the parents what plan of care has already been instituted. 4. Many social service agencies have counselors who can assist parents with developing a specifi c plan and asking the right questions. Before offering this service it is important to ask if they already have a plan of care.)

16. A teenager is legally blind. The teen is wearing thick glasses and is carrying some schoolbooks. Which question should the nurse ask the teen? 1. "Just how blind are you?" 2. "Can you see enough to read those books?" 3. "Tell me what you can see in this room." 4. "Is your vision worse than 20/200 in either of your eyes?"

3 (1. The term "legally blind" means a person has a central visual acuity of 20/200 or less in the better eye using corrective lens. 2. This statement asks the teenager to tell if there is enough vision to read books, which may not be the case. 3. Having the teenager explain what can be seen will assist in learning the teen ' s visual capabilities. Asking the teenager to explain initiates rapport and builds trust. 4. This statement asks the teenager to tell you if there is enough vision to read books, which may not be the case.)

84. Parents of a child with generalized seizures ask the nurse for information to give their child ' s teachers. Which of the following should be included? 1. A soft-padded spoon should be kept nearby to put between the child ' s teeth at the onset of a seizure. 2. Roll the child onto the abdomen, with the head to the left, so any contents can fl ow from the mouth. 3. If a seizure lasts longer than 5 minutes, an ambulance should be called. 4. As the child grows, medication dosages may need to be adjusted to control seizure activity.

3 (1. Trying to insert something into a seizing person ' s mouth can lead to injury. 2. Anyone having a seizure should be rolled onto the side. 3. If a child has seizure activity at school, the parent should be called as soon as possible . 4. Growth spurts occur, and medications will need to be adjusted. Teachers should be made aware and notify a parent or guardian if they notice even mild seizure activity.)

63. Which is the nurse ' s best approach to teach high school students about smoking prevention? 1. Discuss health consequences of smoking. 2. Use scare tactics and point out the negative effects of smoking. 3. Offer alternatives to smoking such as chewing gum or doing activities that distract. 4. Have the adolescents talk with their parents about smoking.

3 (1. Using examples of short-term consequences, such as stained teeth, unpleasant odor, and stains on fi ngers, will emphasize the teens ' most immediate needs of being accepted by their peers. These unpleasant effects may appear attractive. 2. Teens feel they are "invincible" and safe from harm. 3. It is always best to focus on prevention of smoking and take a positive approach to how a teen might resist smoking. Peer support groups work well in redefi ning the teens ' peer groups and give them tactics to use against smoking. 4. Talking with parents is not always an option for a teen.)

80. A parent calls the nurse for dosing information for Pepto-Bismol and aspirin for children who are 8 and 9 years old and are ill. Which does the nurse advise? Select all that apply. 1. 15 mL of Pepto-Bismol after every diarrhea stool. 2. 81 mg baby aspirin every 4 hours. 3. No medications are necessary. 4. Pepto-Bismol contains aspirin. 5. Diet as tolerated. 6. Reye syndrome is associated with aspirin use.

3, 4, 5, 6. (1. Pepto-Bismol contains bismuth subsalicylate, an aspirin component, and is contraindicated in children. 2. Aspirin is contraindicated in children with viral symptoms because of the association with Reye syndrome. 3. Allow the body to rid itself of harmful agents. This is fi rst-line advice. 4. Pepto-Bismol contains bismuth subsalicylate, an aspirin component. 5. This is fi rst-line advice if there is no vomiting. 6. Reye syndrome is associated with aspirin use and viral illness in children.)

76. Which are associated with Guillain-Barré? Select all that apply. 1. Always fatal after 18 to 24 months. 2. Progresses cephalocaudally. 3. Complications are associated with immobility. 4. Respiratory support is a nursing priority. 5. Tube feedings or total parental nutrition may become necessary.

3, 4, 5. (1. Progressive but full recovery is possible, taking months to years. 2. Neuromuscular progression is from feet to head. 3. Because of the progressive paralysis, immobility is a major concern. 4. The respiratory tract muscles may become compromised with the progression. 5. Adequate calorie intake is essential to prevent catabolism.)

10. Parents are concerned that Turner syndrome is suspected in their newborn. Which physical characteristics led to this suspicion? Select all that apply. 1. Cleft lip and palate. 2. Weak, high-pitched cry. 3. Webbed neck and lymphedema. 4. Long arms and small genitalia. 5. Coarctation of the aorta.

3, 5. (1. Cleft lip and palate occur in many syndromes such as trisomy 13 and VATER, but they are not associated with Turner syndrome. 2. A weak, high-pitched cry is seen in babies with cri du chat syndrome. 3. A low-set posterior hairline, webbing of the neck, and lymphedema of the hands and feet are characteristic of Turner syndrome. 4. Small genitalia and long, thin arms and legs are seen with Klinefelter syndrome; this is seen only in males. 5. Coarctation of the aorta or bicuspid atrial valve pose the most serious risks for children with Turner syndrome.)

33. Parents are told they should start taking their toddler to the dentist. They are concerned the dentist will be too rough with their child. The nurse suggests the parents do which of the following before the dental visit? Select all that apply. 1. Tell the child it will not hurt. 2. Warn that they will have the dentist give a needle in case of bad behavior. 3. Tell the child they will go along to the dentist so that they can model comfortable, safe behavior. 4. Offer the child a treat for good behavior. 5. The dentist will look in their child ' s mouth and count the teeth.

3, 5. (1. It would be more appropriate for the parents to tell the child what "might" happen at the visit rather than say the visit will not hurt. Often, children perceive simple activities such as looking in the mouth or touching the skin as invasive and hurtful. 2. Telling the child that there are consequences for having fear of something new is inappropriate. 3. Modeling appropriate behavior for the child by having the child go with a parent creates a positive preparation for visiting the dentist. 4. Bribing a child to "be good" sets up a negative approach to teaching a child. The child will then want a treat for every visit to the dentist. 5. The dentist will look in the child ' s mouth and count the teeth)

64. A child with moderate asthma is wheezing and coughing. Which test should the nurse perform before the health-care provider (HCP) sees the child? Select all that apply. 1. Skin testing for allergens. 2. P CO 2 levels. 3. Biox level. 4. Metered dose inhaler. 5. Peak fl ow.

3, 5. (1. Skin testing is done by an allergist to help determine triggers for the asthma. 2. Taking P CO 2 levels would be helpful but would require the provider to order a blood gas. 3. A Biox level tells you what the oxygen concentration in the blood is, which aids in determining the treatment plan. 4. A metered dose inhaler is the device that is used to administer the medications. 5. The Expert Panel recommends that peak fl ow monitoring be used in children with asthma to determine the severity of an exacerbation and to guide therapeutic decision making.)

17. The nurse is working in a school health clinic, and a child comes in complaining of "something in my eye." What should the nurse do fi rst? 1. Have the child wash hands. 2. Refer the child to an ophthalmologist. 3. Wash out the affected eye with tap water. 4. Examine the eye for a foreign body.

4 (1. Although washing the child ' s hands needs to occur, this is not the fi rst priority. 2. Many eye injuries require immediate care with follow-up by an ophthalmologist. 3. Irrigating the eye, unless there is a chemical injury, may further irritate the eye problem. With chemical injuries, time is of the essence in diluting the chemical. This injury is stated to be a foreign body. 4. Examine the eye and check for a foreign body before attempting to treat the injury or determining the plan of action.)

59. A child in a classroom is disruptive with loud talking, has a short attention span, and has diffi culty organizing work. Which is the most likely diagnosis for this child? 1. Enuresis. 2. Sexual abuse. 3. Learning disability. 4. Attention defi cit-hyperactivity disorder

4 (1. Enuresis is bed-wetting, which can have an array of causes. 2. It is important to rule out sexual abuse before deciding on the attention defi cithyperactivity disorder diagnosis. It is also important to have a health-care provider (HCP) do a complete physical examination and have both the teacher and the family complete behavioral checklists before making that diagnosis. 3. It is important to rule out a learning disability before deciding on the attention defi cit-hyperactivity disorder diagnosis. It is also important to have a health-care provider (HCP) do a complete physical examination and have both the teacher and the family complete behavioral checklists before making that diagnosis. 4. The most likely diagnosis is attention defi cit-hyperactivity disorder because the child has the classic symptoms.)

37. The nurse goes to the kindergarten classroom to evaluate a rash. A 5-year-old has patches of itchy vesicles on the chest and face. The teacher tells the nurse the child had a runny nose a couple of days ago. The nurse suspects that the rash is caused by which virus? 1. Fifth disease (parvovirus B-19). 2. Roseola (herpesvirus type 6). 3. Scarlet fever (group A beta-hemolytic Streptococcus ). 4. Chickenpox (varicella zoster).

4 (1. Fifth disease is caused by the parvovirus, and the rash is initially described as "slapped cheek," with this impression lasting 3 to 4 days. 2. Roseola is caused by herpesvirus type 6 and is usually seen in children from 6 months to 3 years of age. 3. Scarlet fever is a bacterial disease and has a rash that feels like sandpaper. 4. The most likely diagnosis for this child is chickenpox, which is caused by the varicella zoster virus. This is seen in young children and is highly contagious to others in the classroom and at home. It initially presents with a high fever for 3 to 4 days.)

3. The posture of a healthy term newborn is described as: 1. Hypotonic. 2. Asymmetric. 3. Extended. 4. Flexed.

4 (1. Hypotonia is of concern because a fl oppy, limp infant may have suffered a birth insult or has a genetic condition such as Down syndrome. 2. Babies have a symmetric appearance and do not develop hand preference (asymmetry) until 18 to 24 months. 3. A full-term, healthy newborn initially has a fl exed posture because it has been curled up in the uterus. 4. A full-term, healthy newborn initially has a fl exed posture because it has been curled up in the uterus.)

46. Which is the primary goal for a newborn with a cleft of the soft palate? 1. Prevent ear infections. 2. Help the mother bond with the baby. 3. Repair the cleft palate. 4. Establish feeding and sucking.

4 (1. Infants with clefts of the palate are at greater risk for ear infections once they are eating and sucking on a breast or bottle. 2. It is important to help the mother bond with the baby, but nursing or sucking on the bottle helps to create positive feelings between the baby and the mother. 3. The cleft palate is not repaired until the baby is closer to 9 to 15 months of age when speech begins. 4. The primary goal of any newborn with a cleft palate is to establish feeding and sucking.)

77. An adolescent is complaining of knees swelling and hurting, hands and feet being cold all the time, frequent headaches, and a red rash on the cheeks and nose. Which does the nurse suspect? 1. Multiple sclerosis. 2. Normal adolescent concerns. 3. Myasthenia gravis. 4. Systemic lupus erythematosus.

4 (1. Multiple sclerosis appears initially as a neurological disorder. 2. The offered signs and symptoms are not normal in any age-group. 3. Myasthenia gravis is a neuromuscular disorder. 4. Butterfl y rash, arthritic symptoms, Raynaud phenomenon (cold hands and feet), and headaches, when all are seen together, are indicative of systemic lupus erythematosus.)

55. For the past 2 nights, an 18-month-old who attends day care has been having a barking, hoarse-sounding cough that comes in spasms with very noisy respirations. The parent is concerned that the child has picked up an infection at day care. The day-care staff indicates the child does not cough during the day, has no fever, and is eating and drinking well. This description is most likely which condition? 1. Laryngotracheobronchitis. 2. Bacterial tracheitis. 3. Asthma. 4. Acute spasmodic laryngitis.

4 (1. RespiGam is also a prophylactic for respiratory syncytial virus, but it is primarily an immunoglobulin G that provides neutralizing antibodies against subtypes A and B of the virus. It must be given intravenously monthly, which is more diffi cult in terms of administration. 2. Ribavirin is an antiviral agent and is given in a hospital for treatment of respiratory syncytial virus. 3. The American Academy of Pediatrics recommends that infants born before 32 weeks ' gestation and younger than 2 years who have chronic lung disease should receive palivizumab (Synagis) monthly as a prophylactic to prevent respiratory syncytial virus during the winter months. 4. The pneumococcal vaccine could be given during these 5 months but would not protect the infant from respiratory syncytial virus(1. Laryngotracheobronchitis is seen in infants and young school-age children and is viral in origin with accompanying symptoms of brassy cough, low-grade fever, hoarseness, but otherwise well appearance. 310 PEDIATRIC SUCCESS 2. Bacterial tracheitis is caused by Staphylococcus and is characterized by a croupy cough, purulent secretions, high fever, and a need for antibiotics. 3. Asthma is a chronic infl ammatory disease of the airways. In susceptible children, infl ammation causes cough, wheezing, and chest tightness. 4. This is the history of a child with acute spasmodic laryngitis. Symptoms of infl ammation are absent or mild. Some children are thought to be predisposed to this, with allergy or psychogenic factors as an underlying cause.)

14. A parent who is Jehovah ' s Witness has a child with leukemia and a very low RBC count. The nurse should recognize that the family faces which dilemma? 1. Numerous dietary kosher laws exist. 2. A belief that only Allah cures illness. 3. Desire for anointing of the sick. 4. Opposition to transfusions and vaccines.

4 (1. Some Jewish sects, not Jehovah ' s Witnesses, believe in numerous dietary kosher laws that they must follow. 2. Muslims, not Jehovah ' s Witnesses, believe that Allah cures but sometimes works through humans to provide treatment. 3. Catholics, not Jehovah ' s Witnesses, encourage anointing of the sick. 4. Jehovah ' s Witnesses are opposed to transfusions, and many are opposed to albumin, globulin, and factor replacement. Generally, they are not opposed to non-blood plasma expanders.)

99. Which approach gives the most support to parents grieving over a terminally ill newborn? 1. State, "You are both still young and will be able to have more children." 2. Avoid the parents; let them ask you questions. 3. Offer rationalizations for the child ' s terminal illness. 4. State, "You are still feeling all the pain of your child ' s illness

4 (1. Support to grieving families varies with the needs of the family. General guidelines in support of grieving families are to deal openly with their feelings and accept the family ' s grief response. Do not avoid them and avoid judgmental or rationalizing statements. Focus on their feelings. Provide referral to self-help groups or professional help if appropriate. 2. Support to grieving families varies with the needs of the family. General guidelines in support of grieving families are to deal openly with their feelings and accept the family ' s grief response. Do not avoid them and avoid judgmental or rationalizing statements. Focus on their feelings. Provide referral to self-help groups or professional help if appropriate. 3. Support to grieving families varies with the needs of the family. General guidelines in support of grieving families are to deal openly with their feelings and accept the family ' s grief response. Do not avoid them and avoid judgmental or rationalizing statements. Focus on their feelings. Provide referral to self-help groups or professional help if appropriate. 4. Support to grieving families varies with the needs of the family. General guidelines in support of grieving families are to deal openly with their feelings and accept the family ' s grief response. Do not avoid them and avoid judgmental or rationalizing statements. Focus on their feelings. Provide referral to selfhelp groups or professional help if appropriate.)

4. The nurse is working in the newborn nursery and accidentally bumps the crib of one of the babies. This baby demonstrates a Moro refl ex. The nurse sees this baby in which posture? 1. Trunk extended upward and head lifted. 2. When placed on abdomen, crawling movement occurs. 3. A "fencing" posture. 4. Extremities extended and abducted and fi ngers fanned.

4 (1. The Landau refl ex occurs when the infant is suspended prone; the infant will raise the head and extend the trunk upward. 2. Clonus is elicited by a brisk dorsifl exion of the foot that elicits oscillating movements of the ankles and knees. 3. This refl ex is the asymmetric tonic neck. When an infant ' s head turns to one side, the arm and leg on the same side extend, and the opposite arm and leg fl ex. 4. The Moro refl ex is another name for the startle refl ex.)

28. The nurse ' s unit is using the POPS pain scale for measuring pain in infants. The nurse knows this tool is which of the following? 1. Pain Assessment Tool for infants 27 weeks to term gestation. 2. The Neonatal Infant Pain Scale for infants 3 to 12 months. 3. Premature Infant Pain Profi le for infants 32 weeks to term gestation. 4. Post-Operative Pain Score for infants 1 to 7 months.

4 (1. The Pain Assessment Tool would not likely be used on an inpatient unit other than a neonatal intensive care unit. 2. The Neonatal Infant Pain Scale would not likely be used on an inpatient unit other than a neonatal intensive care unit. 3. The Premature Infant Pain Profi le would not likely be used on an inpatient unit other than a neonatal intensive care unit. 4. The acronym POPS stands for Post- Operative Pain Score.)

69. Which are early signs and symptoms of hydrocephalus in infants? 1. Confusion, headache, diplopia. 2. Rapid head growth, poor feeding, confusion. 3. Papilledema, irritability, headache. 4. Full fontanels, poor feeding, rapid head growth.

4 (1. These are signs of increased intracranial pressure in an older child. 2. Confusion is not easily assessed in an infant. 3. These are signs of increased intracranial pressure in an older child. 4. Previously undiagnosed, one of the fi rst signs of hydrocephalus is a bulging fontanel, followed by irritability, poor feeding, and overall rapid head growth.)

22. The nurse on the previous shift charted that a newborn demonstrated cutis marmorata. The nurse now caring for the baby should check which vital sign? 1. Blood pressure. 2. Respirations. 3. Skin color. 4. Temperature.

4 (1. This is an important vital sign to assess, but it is not specifi c to cutis marmorata. 2. This is an important vital sign to assess, but it is not specifi c to cutis marmorata. 3. This is an important vital sign to assess, but it is not specifi c to cutis marmorata. 4. Cutis marmorata is transient mottling of the body when the infant is exposed to cold. It is important to check the baby ' s temperature. Cutis marmorata is a change in the color of the skin.)

98. Which applies to encephalitis? Select all that apply. 1. Usually caused by a bacterial infection. 2. A chronic disease. 3. Most commonly seen after a varicella infection in the newborn population. 4. Newborns diagnosed with encephalitis often have extensive neurological problems. 5. Can be seen with meningitis.

4, 5. (1. Although it can be caused by a variety of organisms, encephalitis is usually a viral infection. 2. Encephalitis is an acute disease. 3. Encephalitis is most commonly seen after a herpes infection in the newborn population. It is often seen after a varicella infection in older children. 4. Newborns diagnosed with encephalitis often have extensive neurological problems. 5. Encephalitis can be seen with meningitis.)

2. The average newborn weighs 3400 g. The nurse will tell the parents that the baby weighs ______________________ lb.

7.5. (Change 3400 g to kg, and then multiply by 2.2 lb/kg. Divide 3400 g by 1000 g/kg = 3.4 kg. Multiply 3.4 kg by 2.2 lb/kg = 7.48 lb. Round up to 7.5 lb.)

62. A 15-year-old girl who is an avid basketball player comes to the clinic for menstrual irregularities. She skips meals and has lost some weight. She mentions that she has menstrual periods every 2 weeks. Women who have menstrual periods more often than every 21 days are ______________________.

Anovulatory. (Young women who have periods more frequently than every 21 days, after ruling out sexually transmitted diseases, are anovulatory. These young women have adequate estrogen levels but inadequate progesterone levels. Unopposed estrogen can place a young woman at risk for endometrial carcinoma.)

42. A 12-year-old girl with a thoracic myelomeningocele has had numerous urinary tract infections and has diffi culty doing her clean intermittent self-catheterization. She and her parents are seeking an alternative way to empty her bladder. The surgeon has offered to do a Mitrofanoff procedure. The surgeon will use the ______________________ to create a continent conduit between the bladder and the abdominal wall.

Appendix. (The appendix is used to create the stoma between the bladder and the abdominal wall. The abdominal stoma allows the young woman to perform the clean intermittent catheterization comfortably with less dexterity required.)

30. Parents tell the nurse that their 18-month-old is always curious about the environment and is learning new words every day. The toddler is entering a phase of rapid ______________________development.

Cognitive. (Piaget ' s late phase of sensorimotor development occurs between 12 and 24 months and is a time when cognitive development occurs rapidly. Reasoning skills are still very primitive. The main cognitive skill of early childhood is language acquisition.)

92. According to Piaget, the school-age child is in the ______________________ stage of cognitive development

Concrete operations. (During the concrete operations stage of cognitive development, the school-age child is able to take into account another person ' s point of view. School-age children are also able to classify, sort, and organize facts in order to use them for problem-solving.)

47. When an infant is born with a herniation of the abdominal wall with intestine present and the peritoneal sac absent, it is called ______________________.

Gastroschisis. (Gastroschisis is a herniation of the abdominal wall without a peritoneal sac and intestines outside the abdominal cavity.)

95. The term ______________________ is commonly defi ned as stiffness of the neck

Nuchal rigidity. (Nuchal rigidity is assessed when a child has a fever or appears septic.)

94. Seizures that originate in one hemisphere are called ______________________.

Partial or focal seizures. (Seizures originating in both hemispheres are called generalized seizures.)

91. Infants should ride in a ______________________ car seat until 2 years of age.

Rear-facing. (An infant should always ride in a rear-facing car seat until 2 years of age.)

90. The injection site of choice for a 6-month-old receiving immunizations is the ______________________.

Vastus lateralis. (The vastus lateralis muscle can be used for immunizations of children of all ages. It is a particularly good choice for infants because it is the most developed muscle for this age-group. This area is also appealing because it has few major nerves and blood vessels.)

52. A child is giggling and laughing, and the nurse gently places one hand on the child ' s front and the other on the back of the chest. The sounds can be felt through the skin. This fi nding is called ______________________.

Vocal fremitus. (The conduction of voice sounds through the chest and respiratory tract is called vocal fremitus. The decrease in fremitus indicates obstruction in the airways, as would occur with asthma or pneumothorax. The increase in fremitus occurs with pneumonia.)