Exam 3 - concentrated

The nurse is working in a hemodialysis center for children. During hemodialysis, the nurse notes that a 10-year-old becomes confused and restless. The child complains of a headache and nausea and has generalized muscle twitching. The nurse knows that this situation is called disequilibrium syndrome and may be prevented by which of the following? 1. Slowing the rate of solute removal during dialysis. 2. Ensuring the patient is warm during dialysis. 3. Administering antibiotics before dialysis. 4. Obtaining an accurate weight the night before dialysis.

1. The child is experiencing signs of disequilibrium syndrome, which is caused by free water shifting from intravascular spaces and can be prevented by slowing the rate of dialysis. TEST-TAKING HINT: The test taker should eliminate answers 2 and 3 because they are not associated with disequilibrium syndrome.

The nurse knows that the child with CRF is at risk for spontaneous fractures because of an electrolyte imbalance. Which of the following best describes the imbalance that occurs? 1. Decreased serum phosphorus and calcium levels. 2. Depletion of phosphorus and calcium stores from the bones. 3. Change in the structure of the bones, causing calcium to remain in the bones. 4. Nutritional needs are poorly met, leading to a decrease in many electrolytes such as calcium and phosphorus.

2. The calcium and phosphorus levels are drawn from the bones in response to low calcium levels. TEST-TAKING HINT: The test taker should eliminate answer 4 because dietary imbalances are not the primary cause of hypocalcemia in renal failure.

The nurse anticipates that the child who has had a kidney removed will have a high level of pain and will require invasive and noninvasive measures for pain relief. The nurse anticipates that the child will have pain because of which of the following? 1. The kidney is removed laparoscopically, and there will be residual pain from accumulated air in the abdomen. 2. There is a postoperative shift of fluids and organs in the abdominal cavity, leading to increased discomfort. 3. The chemotherapy makes the child more sensitive to pain. 4. The radiation therapy makes the child more sensitive to pain.

2. There is a postoperative shift of fluids and organs in the abdominal cavity, leading to increased discomfort. TEST-TAKING HINT: The test taker should eliminate answer 1 because the kidney is not removed laparoscopically.

The nurse is caring for a 10-kg toddler who is diagnosed with ARF. The toddler has a 24-hour urine output of 110 mL and is afebrile. After calculating daily fluid maintenance, which of the following would the nurse expect the toddler's daily allotment of fluids to be? 1. 1000 mL of oral and intravenous fluids. 2. 2000 mL of oral and intravenous fluids. 3. 350 mL of oral and intravenous fluids. 4. Sips of clear fluids and ice chips only

3. 350 mL is approximately a third of the daily fluid requirement and is recommended for the child in the oliguric phase of ARF. If the child were febrile, the fluid intake would be increased. TEST-TAKING HINT: The question specifies that the child is afebrile; therefore, the test taker can eliminate answers 1 and 2 because extra fluid is not required.

The nurse is caring for an 11-year-old diagnosed with ARF. The patient complains of "not feeling well," having "butterflies in the chest," and arms and legs "feeling like Jell-O." The nurse places the child on a cardiac monitor and notes that the QRS complex is wider than before and that an occasional premature ventricular contraction is seen. The nurse would expect to administer which of the following? 1. An isotonic saline solution with 20 mEq KCl/L. 2. Sodium bicarbonate via slow intravenous push. 3. Calcium gluconate via slow intravenous push. 4. Oral potassium supplements

3. Calcium gluconate is the drug of choice for cardiac irritability secondary to hyperkalemia. TEST-TAKING HINT: The test taker should eliminate answer 1 because the patient is already showing signs of increased potassium levels

The parents overhear the health-care team refer to their child's disease as in stage III. The parents ask the nurse what this means. The nurse responds, knowing which of the following? 1. The tumor is confined to the abdomen, but it has spread to the lymph nodes or peritoneal area; the prognosis is poor. 2. The tumor is confined to the abdomen, but it has spread to the lymph nodes or peritoneal area; the prognosis is still very good. 3. The tumor has been found in three other organs beyond the peritoneal area; the prognosis is poor. 4. The tumor has spread to other organs beyond the peritoneal area; the prognosis is poor.

2. The tumor is confined to the abdomen but has spread to the lymph nodes or peritoneal area. The prognosis is still very good. TEST-TAKING HINT: The test taker should be led to answer 2 because this represents stage III

The nurse is caring for a child who has just been diagnosed with a Wilms tumor. The child is scheduled for a magnetic resonance imaging of the lungs. The parents ask the nurse the reason for this test as a Wilms tumor involves the kidney, not the lung. What is the nurse's best response? 1. "I'm not sure why your child is going for this test. I will check and get back to you." 2. "It sounds like we made a mistake. I will check and get back to you." 3. "The test is done to check to see if the disease has spread to the lungs." 4. "We want to check the lungs to make sure your child is healthy enough to tolerate surgery."

3. The test is done to see if the disease has spread to the lungs. TEST-TAKING HINT: The test taker should be led to answer 3 because further testing evaluates metastasis to other organs.

The nurse is speaking to the parents of an infant with an inguinal hernia. The nurse knows the parents understand the teaching when they say which of the following? 1. "There are no risks associated with waiting to have the hernia reduced; surgery is done for cosmetic reasons." 2. "It is normal to see the bulge in the baby's groin decrease with a bowel movement." 3. "We will wait for surgery until the baby is older because narcotics for pain control will be required for several days." 4. "It is normal for the bulge in the baby's groin to look smaller when the baby is asleep."

4. The hernia often appears smaller when the child is asleep. TEST-TAKING HINT: The test taker can eliminate answer 1 because there are risks associated with waiting for the repair, and surgery is not done solely for cosmetic reasons.

64. Which of the following is not a feature of Benign Rolandic Epilepsy? 1. It is more common in girls than boys. 2. The child has twitching, numbness, or tingling in the face and tongue. The child also remains fully conscious. 3. Tonic-clonic seizures may occur during sleep. 4. The EEG has a specific pattern of spikes, called centrotemporal spikes.

ANS: 1 Feedback 1. Benign Rolandic Epilepsy, also called Benign Childhood Epilepsy with Centrotemporal Spikes or BCECTS, is more common in boys than in girls. 2. The symptoms are common in children. 3. Tonic-clonic seizures are common during sleep. 4. This is a symptom of Benign Rolandic Epilepsy.

47. Which cranial nerve may be assessed by noting the symmetry of the facial expression during crying or smiling? 1. Cranial nerve VII 2. Cranial nerve V 3. Cranial nerve III 4. Cranial nerve VI

ANS: 1 Feedback 1. Cranial nerve VII, the facial nerve, is responsible for symmetrical facial muscle movement. 2. Cranial nerve V, the Trigeminal nerve, controls mastication and facial sensation. 3. Cranial nerve III assesses oculomotor reflex. 4. Cranial nerve VI assesses the trochlear area.

14. A nurse is assessing a 6-month-old boys suture lines. The nurse notes that the baby has craniosynostosis. The nurse should be concerned because: 1. The suture line closure will not allow the brain to grow. 2. This can lead to hydrocephalus. 3. The child will have immediate developmental delays because of the lack of space for the brain to grow. 4. The child will not require surgery.

ANS: 1 Feedback 1. Early closure of the sutures will inhibit brain growth. 2. Fluid buildup is not a concern at this time. 3. A progression of developmental delay, rather than immediate delay, will occur. 4. Surgery may be needed to relieve pressure and allow for growth to occur.

23. An 18 month old is having a seizure when the nurse is assessing him. The nurse notes that the child is fluttering his eyes and smacking his lips. The nurse should document this seizure as: 1. An absence seizure. 2. A tonic-clonic seizure. 3. A myoclonic seizure. 4. A febrile seizure.

ANS: 1 Feedback 1. Eye fluttering and lip smacking are common characteristics of an absence seizure. 2. A tonic-clonic seizure has stiffening of the muscles. This child is not exhibiting this characteristic. 3. The child is not exhibiting muscle rigidity that is common with myoclonic seizures. 4. The child does not have a fever to cause the seizure.

59. What are the symptoms of increased intracranial pressure in infants and children? 1. Vomiting, sunsetting eyes, lethargy 2. Vomiting, irritability, decline in academic performance 3. Headache, diarrhea, insomnia 4. Excitability, anorexia, regression in language skills

ANS: 1 Feedback 1. Increased intracranial pressure causes depression of brain function, which results in lethargy. The sunsetting eyes phenomenon occurs when there is pressure on the nerves of the eyes from the increased cerebrospinal fluid, causing the eyes to look downward. The increased intracranial pressure sends signals to other body functions as well, causing vomiting. 2. Academic performance is not assessed for the increased intracranial pressure, as this can have a quick onset. 3. Diarrhea is not a symptom of increased intracranial pressure. 4. The depression of brain function decreases the excitability of the brain.

54. Which is true about microcephaly? 1. Microcephaly is defined as the condition when the circumference of the head is more than two standard deviations below normal. 2. Microcephaly is defined as the condition when the circumference of the head is more than three standard deviations below normal. 3. Microcephaly is defined as the condition when the circumference of the head is more than one standard deviation below normal. 4. Microcephaly is defined as the condition when the circumference of the head is more than two standard deviations above normal.

ANS: 1 Feedback 1. Microcephaly occurs when the brain has not developed properly or has stopped growing, and is often associated with cognitive, motor, and speech delays. 2. Microcephaly occurs when the brain has not developed properly or has stopped growing, and is often associated with cognitive, motor, and speech delays. 3. Microcephaly occurs when the brain has not developed properly or has stopped growing, and is often associated with cognitive, motor, and speech delays. 4. Microcephaly occurs when the brain has not developed properly or has stopped growing, and is often associated with cognitive, motor, and speech delays.

20. Which of the following types of epilepsy are photosensitive? 1. Juvenile myoclonic epilepsy 2. Temporal lobe epilepsy 3. Febrile seizures 4. Childhood absence epilepsy

ANS: 1 Feedback 1. Photosensitivity is common with Juvenile myoclonic epilepsy. 2. Photosensitivity does not usually occur in temporal lobe epilepsy. 3. Febrile seizures are triggered by fevers, not photosensitivity. 4. Childhood absence epilepsy is not influenced by photosensitivity.

13. A child with a diagnosis of schizencephaly is assigned to a new nurse on the pediatric floor. The new nurse has not worked with a child with this diagnosis before. A career nurse discusses the plan of care needed for the child with the new nurse. It will be important to: 1. Assess the side of the body that has paralysis for any lesions or sores. 2. Let the patient do as much as possible for activities of daily. 3. Discourage the patient to move the paralyzed side of the body. 4. Provide full care for the patient.

ANS: 1 Feedback 1. Skin breakdown can occur because of the lack of mobility for the affected side of the body. 2. The child may be lower functioning and not be able to understand how to do ADLs or have the physical ability to do them. 3. Movement is important, but not the priority. 4. Encouragement to do as much as possible is important for independence, but the child will need supervision.

62. Which of the following is not true about sleepwalking? 1. Sleepwalking occurs in REM sleep. 2. Sleepwalking tends to run in families. 3. When sleepwalking, a child looks awake and his/her eyes are open. 4. Sleepwalking is most common between the ages of 4 and 8.

ANS: 1 Feedback 1. Sleepwalking occurs in non-REM sleep. 2. Sleepwalking does run in families. 3. The childs eyes may be open and appear awake, or they may be closed during sleepwalking. 4. This range is the most common for sleepwalking.

2. The responsibilities of the central nervous system include: 1. Deciding to walk instead of run. 2. Helping to understand a math problem. 3. Digesting the food in the stomach. 4. Keeping the hand on a hot stove.

ANS: 1 Feedback 1. The brain is part of the CNS, which helps make decisions about body movements. 2. The CNS does not help with cognitive abilities. 3. Food digestion is part of the ANS. 4. The CNS would tell the hand to move.

67. Which of the following is a symptom of tension headaches? 1. A feeling of tightness or pressure around the head 2. Unilateral throbbing or pounding head pain 3. Nausea, vomiting, anorexia 4. Sensitivity to light and/or noise

ANS: 1 Feedback 1. The pain is usually mild to moderate and does not usually prevent children from participating in activities. 2. Tension headaches usually have a tightness or pressure around the head, not unilateral throbbing or pounding. 3. This is not noted in tension headaches. 4. This is not noted in tension headaches. This is more often noted in migraine headaches

22. A child with a known history of Benign Rolandic Epilepsy is having a seizure during lunch at the middle school. The school nurse is called to the cafeteria. What is the school nurses priority at this time? 1. Prevent a possible choking incident by checking the students mouth for food. 2. Lay the child down on the floor and make sure the area is safe. 3. Call the EMTs for help. 4. Notify the parents that their daughter is having a seizure.

ANS: 1 Feedback 1. This is the priority because the child is in the lunch room. The nurse must check for food to decrease the chance of choking. 2. Making the area safe is important, but not the priority at this time. 3. EMTs are not needed for this situation because this is a common occurrence for the diagnosis. 4. The parents should be notified after the child is safe.

26. Care for a child during status epilepticus should include all of the following except: 1. Turn the patient to the right side. 2. Loosen tight clothes. 3. Move toys out of the area to prevent injury. 4. Stay with the patient until the seizure has stopped.

ANS: 1 Feedback 1. Turning the patient to the right side increases the risk for aspiration because of the positioning of the bronchioles. 2. Loosening clothes helps the person move freely and reduces the chance of injury. 3. Moving objects out of the area decreases the chance for injury as the patient moves during the seizure. 4. It is important to make sure the patient stays safe.

42. A common treatment for a person with Guillain-Barre syndrome is: 1. Broad spectrum antibiotics. 2. Intravenous gamma globulins. 3. Antihistamines. 4. Acyclovir.

ANS: 2 Feedback 1. Broad spectrum antibiotics are not an effective treatment for the disease. 2. IGg is given to help the body naturally fight the syndrome. 3. Antihistamines are not an effective treatment for the disease. 4. Acyclovir will not treat the illness.

60. Which of the following is not a symptom of autism spectrum disorder? 1. Lack of expressive language 2. Enjoys change in routine 3. Lack of social skills 4. Engages in repetitive behavior

ANS: 2 Feedback 1. Children with autism spectrum disorder will exhibit this symptom. 2. Children with autistic spectrum disorder are disturbed or intolerant of changes in daily routines and rituals. 3. Children with autism spectrum disorder will exhibit this symptom. 4. Children with autism spectrum disorder will exhibit this symptom.

69. Which is the following is not a characteristic of Tourettes Syndrome? 1. Complex motor tics 2. The child is unaware of his/her behavior 3. Present for more than one year 4. Present before the 18th birthday

ANS: 2 Feedback 1. Common symptom of Tourettes syndrome 2. The child is aware of his/her behavior and often tries to suppress it unsuccessfully. 3. Tourettes Syndrome can be a life-long issue. 4. Tourettes Syndrome usually occurs in school-age children.

46. Which cranial nerve may be assessed by noting the strength of an infants suck? 1. Cranial nerve VII 2. Cranial nerve V 3. Cranial nerve III 4. Cranial nerve II

ANS: 2 Feedback 1. Cranial never VII assess acoustic ability. 2. Cranial nerve V, the Trigeminal nerve, controls mastication and facial sensation. 3. Cranial nerve III assesses oculomotor reflex. 4. Cranial nerve II assesses the optic area.

19. A mother is asking the nurse why her daughter continues to have temporal lobe seizures even though she is on medication. The nurse knows this is occurring because: 1. The medication may not be in the therapeutic range. 2. Temporal lobe seizures do not respond well to medications. 3. The daughter may be missing doses of her medication. 4. The food her daughter eats may have a negative reaction with the medication, causing more seizures.

ANS: 2 Feedback 1. Medication regulation is difficult with temporal lobe seizures. 2. Temporal lobe seizures have a poor response rate to medications. 3. Missing doses of medication can lead to seizures, but temporal lobe seizures dont respond well to medications. 4. Foods do not have an influence on temporal lobe seizures.

21. A child who had a seizure one hour ago is exhibiting signs of paralysis on the left side of the body. The nurse understands the child is exhibiting signs of: 1. Lethargy due to previous seizure activity. 2. Postictal paralysis. 3. Permanent paralysis of the left side of the body. 4. Major brain damage that is going to have long-term effects.

ANS: 2 Feedback 1. Neurological fatigue can occur after a seizure, but it is not the reason for the paralysis. 2. Postictal paralysis will resolve within the next few hours. 3. The paralysis caused by the seizure will resolve within the next few hours. 4. Serial seizures cause brain damage. One seizure will not.

58. Hydrocephalus occurs when cerebrospinal fluid collects in an abnormal pattern in the brain, causing an enlargement in the ventricles. What feature of young infants helps to compensate for the increased pressure caused by the collection of the cerebrospinal fluid? 1. They are too young to perceive pain. 2. They have open fontanels and sutures in the skull to allow for the expansion of the fluid. 3. Infants grow quickly, so the ventricles accommodate for the fluid. 4. All of the above

ANS: 2 Feedback 1. Pain is perceived at any age. 2. Open fontanels and sutures help to compensate for increases in intracranial pressure. The nurse should gently palpate the fontanel and be alert to changes, such as a tense and bulging fontanel. 3. Infant ventricle growth does not occur fast enough to compensate for the extra fluid. 4. One answer applies.

55. Which is not true about the assessment of primitive reflexes in infants? 1. Primitive reflexes are assessed immediately after the baby is born. 2. Primitive reflexes are assessed at every well-child visit until the age of 6 months. 3. Absent primitive reflexes can indicate prematurity or lesions in the motor neurons. 4. Some primitive reflexes remain throughout life, such as blinking.

ANS: 2 Feedback 1. Primitive reflexes are assessed immediately after birth in the APGAR scoring. 2. Assessment of primitive reflexes should continue through the age of 12 months in normal infants. 3. Absent reflexes can indicate prematurity or lesions in the motor neurons. 4. Some primitive reflexes remain for life.

68. Migraine headaches in children can be debilitating and can be triggered by all of the following except: 1. Too much or too little sleep. 2. Overhydration. 3. Skipping meals. 4. Unusual stress or the childs inability to cope with stressors.

ANS: 2 Feedback 1. Sleep is a factor for migraines in children. 2. Inadequate hydration is a factor for migraines in children, not overhydration. 3. Skipping meals is a factor in migraines for children. 4. Stress is a factor in migraines for children.

5. Questions about neurological function are raised when a child: 1. Snores. 2. Shows aggression when previously none was shown. 3. Wants attention from a parent. 4. Refuses to follow adult instruction.

ANS: 2 Feedback 1. Snoring presents a concern for the airway, not neurological functioning. 2. Changes in personality are signs of abnormal behaviors and should be investigated. 3. Attention-seeking behaviors indicate psychosocial need, not a neurological change. 4. This is normal behavior for a child and does not qualify as a neurological issue.

41. What should the nurse anticipate when reviewing laboratory results of a patient with Guillain-Barre syndrome? 1. Elevated CBC 2. High protein in a cerebral spinal fluid tap 3. Creatinine phosphokinase elevated 4. Sensory nerve conduction time increased

ANS: 2 Feedback 1. The CBC should be within normal ranges. 2. The high protein in the cerebral spinal fluid is because of the inflammation to the area. 3. The laboratory results should be within normal limits. 4. The nerve conduction time is decreased

24. A 9 month old is admitted to the pediatric unit for seizures of unknown origin. The child has an EEG performed for several hours. The EEG notes several seizures occurring at different intervals. The nurse knows this child: 1. Will develop at the same rate as his peers. 2. May have severe mental and physical challenges due to the frequent seizure activity. 3. May exhibit a slight cognitive delay as he grows. 4. Will grow out of having seizures

ANS: 2 Feedback 1. The continual seizure activity can cause hypoxia to the brain. 2. The frequency of the seizures causes hypoxia to the brain, increasing the chance for mental and physical challenges. 3. The frequency of the seizures will increase the level of cognitive delays. 4. Because of the type of seizures, the child will not grow out of having seizures.

39. When assessing a 10-year-old child with myasthenia gravis, the nurse notes ptosis and drooping facial expressions. The nurse knows this disease will require all of the following except: 1. Supportive care, as there is no cure for the disease. 2. Administering beta blockers to improve the muscle tone. 3. Check the child for a depressive state due to body image issues. 4. Explain procedures to the child as needed and provide emotional support.

ANS: 2 Feedback 1. The lack of a cure will require education and support for the family and patient. 2. Administration of cholinesterase inhibitors is the common drug used to help keep the acetylcholine receptors from being blocked. 3. Because of the physical changes, an assessment of emotional and psychosocial issues is important. 4. Education and explanations will allow the child to feel involved in his/her care.

38. Brian, a 4-year-old boy, is demonstrating the Gowers sign, and his mother is wondering why her child is making this movement. The child is doing this because: 1. The weakness of his arms requires his legs to do more work. 2. The weakness in his hips and thighs requires help from his arms to stand. 3. Weakening trunk and back muscles require the legs and arms to help keep an upright position. 4. Weakening of the trunk requires this movement to help breath.

ANS: 2 Feedback 1. The weakness is in the hips and thighs, not the arms. 2. The weakness in the hips and thighs makes it difficult to stand, thus requiring the arms to help provide stability. 3. The trunk and back muscles are weak, but are not the reason for the Gowers sign. 4. The Gowers sign is seen when attempting to stand.

32. The assessment a nurse performed on a 12-year-old boy demonstrated a positive Kernigs sign and a Brudzinskis sign. Identify the priority for the nurses next action. 1. Document the findings and note as normal. 2. Further assess the neurological function of the child and call the doctor with a report. 3. Explain to the patient that the assessment was abnormal and there is no a cause for concern. 4. Prepare the child for a lumbar puncture.

ANS: 2 Feedback 1. These findings are abnormal and need further neurological testing. 2. Further assessment is needed because these signs should not be present in a 12-year-old child. 3. Explaining the situation to the patient is important, but there is s possible neurological issue that needs to be addressed with further diagnostic testing. 4. A lumbar puncture is invasive, and other tests should be done before the procedure.

29. A child that has rhythmic, repetitive, involuntary movements is exhibiting: 1. Tremors. 2. Dystonia. 3. Contractures. 4. Tics.

ANS: 2 Feedback 1. Tremors are involuntary and have random movements. 2. Twisting and repetitive, involuntary movements are common with dystonia. 3. Contractures can be a permanent placement of the body because of muscle and ligament rigidity. 4. Tics are not rhythmic in nature.

70. Meningitis is assessed by which of the following after blood tests and a physical assessment are completed? 1. Lumbar puncture 2. Urine tests 3. Kernigs sign and Brudzinskis sign 4. Physical examination

ANS: 2 Feedback 1. Usually done after blood tests and a physical assessment 2. Blood tests are done prior to the lumbar puncture. Urine tests are not. 3. Usually the second assessment done for the disease 4. Usually the first assessment done for the disease

25. A child has been status epileptics for the last 20 minutes. The child has Depakote, Valporic Acid, and Diazepam gel ordered. The nurse should prepare which medication for administration at this time? 1. Depakote 2. Valporic acid 3. Diazepam 4. None of the medications. The child will stop on his own.

ANS: 3 Feedback 1. The Depakote is needed on a regular, scheduled basis to help keep the level adequate in the body. 2. Valporic acid needs to be given on a regular schedule to keep the adequate levels in the body. 3. Diazepam can be used as needed to help stop the brain activity for seizures. 4. The seizure activity needs to be stopped because of the hypoxia that is occurring to the brain.

30. Identify a therapeutic management technique for a child with a tic disorder. 1. Behavioral modification to suppress the tics 2. Administer anti-psychotic medications to reduce the tics 3. Education and support for the child and the family 4. Genetic counseling for the family

ANS: 3 Feedback 1. Behavior modification does not aid in stopping tics form occurring. 2. Tics do not respond to antic-psychotic medications. 3. Support and education are important so that people understand that tics are involuntary. 4. There is little research to prove that tics are genetic in nature.

53. When measuring head circumference in an infant, what equipment should the nurse select to perform the task? 1. Cloth tape measure 2. Electronic measure 3. Paper tape measure 4. Metal tape measure

ANS: 3 Feedback 1. Cloth tape measures can stretch over time and yield an inaccurate measure of the infants head. 2. An electronic measure is not realistic for use with infants. 3. The nurse should use a paper tape measure because paper tape is more sanitary and can be discarded after each use. 4. A metal tape measure will not conform to the infants head to yield an accurate measurement.

44. A teenage boy has received a concussion while playing hockey. A cardinal sign of a concussion is: 1. Confusion. 2. Altered level of consciousness. 3. Loss of consciousness. 4. Fainting.

ANS: 3 Feedback 1. Confusion is not a cardinal sign, but may be present. 2. A change in the level of consciousness is not considered a cardinal sign. 3. A loss of consciousness is a cardinal sign for a concussion, and the child should be examined by a professional. 4. Fainting rarely occurs with a concussion.

33. Results from cerebrospinal fluid that was tested for meningitis have been received by the nurse. The results indicate bacterial meningitis. The nurse knows this because the results show: 1. A low protein count and a low glucose count. 2. A low red blood cell count. 3. An elevated protein count and a low glucose level. 4. A normal protein count and a high glucose count.

ANS: 3 Feedback 1. Does not indicate infection 2. Some red blood cells may show in the specimen if the lumbar puncture was not a clean catch. 3. Results indicate bacterial meningitis. 4. Results indicate viral meningitis.

35. The nurse is assessing a 6-month-old boy. Which of the following would be an abnormal finding, indicating possible cerebral palsy? 1. The infant can pull to a sitting position while holding onto an adults hand. 2. The infant does not exhibit a Moro reflex. 3. The infant does not exhibit a Babinskis reflex. 4. The infant has an obligatory tonic neck flexion

ANS: 4 Feedback 1. A 6-month-old should be able to pull up with aid from another person. 2. A Moro reflex should not be present after the newborn period. 3. The Babinskis reflex should not be present after the first few weeks of life. 4. A tonic neck flexion can indicate neurological damage because this is not a normal position for an infant.

43. After a seizure, a 2-year-old boy would exhibit what type of reaction with the Babinskis reflex? 1. Positive 2. Negative 3. Will be positive one time and negative the next 4. Not a reliable test at this age

ANS: 4 Feedback 1. A Babinskis reflex is not reliable at this age. It should only be done with infants. 2. A Babinskis reflex is not reliable at this age. It should only be done with infants. 3. There will not be accurate results 4. Because of the childs age, the results will not be accurate.

17. When speaking with a family about their 9-year-old daughters nightmares, it is important to ask: 1. If the child has a history of daytime napping. 2. What medications the child takes during the day. 3. How often the child consumes caffeine. 4. All of the above should be part of the assessment.

ANS: 4 Feedback 1. Daytime napping can cause a sleep disturbance pattern because the child is not reaching the REM cycle. 2. Medications can have a side effect of nightmares for children. 3. Caffeine causes sleep disturbance because it is a stimulant. 4. Daytime napping can cause a sleep disturbance pattern because the child is not reaching the REM cycle. Medications can have a side effect of nightmares for children. Caffeine causes sleep disturbance because it is a stimulant.

56. Developmental delay occurs when a child does not meet age appropriate milestones in which area(s) of development? 1. Fine motor skills 2. Gross motor skills 3. Language 4. All of the above

ANS: 4 Feedback 1. Delays can occur in this area and others as well. 2. Delays can occur in this area and others as well. 3. Delays can occur in this area and others as well. 4. Developmental delay, a descriptive term, can be related to an individual milestone delay or a mixed milestone delay.

16. Night terrors can occur in adolescents because of: 1. Emotional stress. 2. Alcohol use. 3. Bullying. 4. All of the above can trigger night terrors in adolescents.

ANS: 4 Feedback 1. Emotional stress can cause increased thoughts and trigger night terrors. 2. Alcohol causes a disturbance to the chemical balance in the brain, causing the night terrors. 3. Bullying can be an emotional stressor, causing the night terrors. 4. Emotional stress can cause increased thoughts and trigger night terrors. Alcohol causes a disturbance to the chemical balance in the brain, causing the night terrors. Bullying can be an emotional stressor, causing the night terrors.

15. A child that had a shunt placed four years ago for hydrocephalus is in the emergency room complaining of a rapid onset of vomiting and increased lethargy. The nurse knows that the child will need: 1. Nothing, as this is a normal complication and not an emergency. 2. To be placed on IV fluids to help maintain an electrolyte balance. 3. Small amounts of fluids until the vomiting has subsided. 4. To consider this a neurological medical emergency and check the childs head circumference.

ANS: 4 Feedback 1. This should be considered a neurological emergency, and the child should be checked. 2. Electrolyte imbalances are more apt to occur when fluid is removed. 3. The history of having a shunt needs to be addressed first to prevent any neurological damage. 4. Measuring the head circumference will give an indication as to the amount of fluid not draining with the shunt and should be considered a medical emergency.

71. Neurofibromatosis Type 1 is the most common neurofibromatosis in children. True or False

True 1. Neurofibromatosis Type 1 is the most common neurofibromatosis in children.

The nurse is working in the emergency department when an infant with a diagnosis of incarcerated hernia is brought in. The nurse would expect to hear the parents report a history of which of the following? 1. Acute onset of pain, abdominal distention, and a mass that cannot be reduced. 2. Gradual onset of pain, abdominal distention, and a mass that cannot be reduced. 3. Acute onset of pain, abdominal distention, and a mass that is easily reduced. 4. Gradual onset of pain, abdominal distention, and a mass that is easily reduced.

1. Signs of an incarcerated hernia include an acute onset of pain, abdominal distention, and a mass that cannot be reduced. Other signs are bloody stools, edema of the scrotum, and a history of poor feeding. TEST-TAKING HINT: The test taker can eliminate answers 2 and 4 because the onset of pain is not gradual

A 16-month-old with HUS has had blood and urine samples sent to the laboratory. Which of the following results are most consistent with his HUS? 1. Hematuria, massive proteinuria, elevated blood urea nitrogen, and creatinine. 2. Hematuria, mild proteinuria, decreased blood urea nitrogen, and creatinine. 3. Hematuria, mild proteinuria, increased blood urea nitrogen, and creatinine. 4. Ketonuria, proteinuria, elevated blood urea nitrogen, and creatinine.

3. Hematuria, mild proteinuria, increased BUN, and creatinine are all present in HUS. TEST-TAKING HINT: The test taker can eliminate answer 4 because ketonuria is not associated with HUS.

The nurse is caring for a 7-year-old who received a kidney transplant 1 week ago. The child complains to the nurse about abdominal pain, and the parents note that the child has been very irritable. The nurse notes a 10% weight gain and elevated blood urea nitrogen and creatinine levels. The nurse asks the parents if the child has been taking which of the following medications? 1. Codeine tablets. 2. Furosemide. 3. MiraLAX powder. 4. Corticosteroids

4. Corticosteroids are considered to be part of the antirejection regimen that is essential after a kidney transplant. TEST-TAKING HINT: The test taker should be led to answer 4 because it is the only listed answer that is part of an antirejection regimen.

9. A nurse is attempting to position a newborn with a myelomeningocele in the lower lumbar region. The best position for the newborn would be: 1. Prone. 2. Laying the newborn on his/her side with support provided to the myelomeningocele. 3. Supine. 4. Any position is acceptable for a neonate with a myelomeningocele.

ANS: 2 Feedback 1. Prone does not allow for support of the sac. 2. Laying the newborn on his/her side will provide support for the sac and decrease the chance of a rupture. 3. Supine places too much pressure on the sac and increases the risk for a rupture. 4. Laying the newborn on his/her side will provide the most support for the sac and decrease the chance of a rupture.

45. Tiagabine must be monitored when given to teens because: 1. It is less effective during puberty. 2. It has a high incidence of suicidal tendencies in teens. 3. It needs to be titrated with the teens growth pattern. 4. It is known to be sold as a street drug.

ANS: 2 Feedback 1. The drug can be effective during puberty. 2. The high level of suicidal rates makes monitoring the teens behavior a priority. 3. Titration to the growth is not a priority at this time. 4. The medication is not a common street drug.

40. Infantile spinal muscular atrophy contains all of the following characteristics except: 1. Muscle wasting of voluntary muscles. 2. Type 1 can begin in utero. 3. Inability to suck occurs early in life. 4. It is associated with children who are intellectually slower.

ANS: 3 Feedback 1. Muscle wasting is noted in these dystrophies. 2. Type 1 may start with the fetus. 3. Suckling is the strongest at the earliest points of life. As time progresses, the muscle weakens, making feeding difficult. 4. Children with the disease show cognitive delays.

36. A multidisciplinary meeting is being conducted for a 4-year-old boy with cerebral palsy. A goal for managing this childs condition would be: 1. Assistance with motor control of voluntary muscles. 2. Maximizing the childs capabilities. 3. Surgically correcting deformities. 4. Waiting to place the child in school.

ANS: 2 Feedback 1. It is important to have the child be as independent as possible to maintain optimum function. 2. Concentrating on the capabilities can help the child modify other areas of weakness to have a better quality of life. 3. Surgery is used only in extreme conditions. 4. Planning for school will be important, but the priority is to maximize the capabilities so the child is as independent in school as possible.

The nurse is caring for a 6-year-old with hepatitis. The child is hungry and wants to eat dinner. Which of the following foods should be offered? 1. A tuna sandwich on whole wheat bread and a cup of skim milk. 2. Clear liquids, such as broth, and Jell-O. 3. A hamburger, French fries, and a diet soda. 4. A peanut butter sandwich and a milkshake.

1. A diet that is high in protein and carbohydrates helps maintain caloric intake and protein stores while preventing muscle wasting. A low-fat diet prevents abdominal distention. TEST-TAKING HINT: The child with hepatitis is usually placed on a diet that is high in both protein and carbohydrates but low in fat.

A 5-year-old is hospitalized with MCNS. The nurse obtains a history from the parents. Which statement by the parents is most consistent with MCNS? 1. "Our child missed 2 days of school last week because of a really bad cold." 2. "We went camping last week, and our child's legs were covered in bug bites." 3. "Our child came home from school a week ago due to vomiting and stomach cramps." 4. "Our child has a pet turtle but does not wash hands after playing with the turtle."

1. An upper respiratory infection often precedes MCNS by a few days. TEST-TAKING HINT: The test taker should be led to answer 1 because MCNS is most often associated with upper respiratory infections.

A 13-month-old is being discharged following the repair of his epispadias. Which of the following statements made by the parents indicate that they understand the discharge teaching? 1. "If a mucous plug forms in the urinary drainage tube, we will irrigate it gently to prevent a blockage." 2. "If a mucous plug forms in the urinary drainage tube, we will allow it to pass on its own because this is a sign of healing." 3. "We will make sure the dressing is loosely applied to increase the toddler's comfort." 4. "If we notice any yellow drainage, we will know that everything is healing well."

1. Any mucous plugs should be removed by irrigation to prevent blockage of the urinary drainage system. TEST-TAKING HINT: The test taker can eliminate answer 2 and 4 because they have potential to cause injury to the child.

A 3-year-old is admitted to the pediatric unit with a diagnosis of HUS. The child is very pale and lethargic. Stools have progressed from watery to bloody diarrhea. Blood work indicates low hemoglobin and low hematocrit levels. The child has not had any urine output in 24 hours. The nurse expects which of the following to be added to the plan of care? 1. Administration of blood products and initiation of dialysis. 2. Administration of blood products and close observation of the child's hemodynamic status. 3. Administration of blood products followed by diuretic therapy to force urinary output. 4. Administration of clotting factors to diminish blood loss and continued monitoring of urinary output.

1. Blood products are given to control the anemia. Because the child is symptomatic, dialysis is the treatment of choice TEST-TAKING HINT: The test taker can eliminate answer 3 because diuretics will not cause a child in renal failure to produce urine.

A 4-month-old female is brought to the emergency department with severe dehydration. Her heart rate is 198, and her blood pressure is 68/38. The infant's anterior fontanel is sunken. The nurse notes that the infant does not cry when the intravenous line is inserted. The child's parents state that she has not "held anything down" in 18 hours. The nurse obtains a finger-stick blood sugar of 94. Which of the following would the nurse expect to do immediately? 1. Administer a bolus of normal saline. 2. Administer a bolus of D10W. 3. Administer a bolus of normal saline with 5% dextrose added to the solution. 4. Offer the child an oral rehydrating solution such as Pedialyte.

1. Dehydration is corrected with the administration of an isotonic solution, such as normal saline or lactated Ringer solution. TEST-TAKING HINT: The test taker should immediately eliminate answers 2 and 3 as they both suggest administering glucose in bolus form, which is always contraindicated in the pediatric population. Answer 4 should be eliminated as the infant is severely dehydrated and not responding to painful stimulation, which is suggested by the lack of a cry on intravenous insertion.

The nurse understands that the clinical manifestations in hydronephrosis are due to which of the following? 1. A structural abnormality in the urinary system causes urine to back up and can cause pressure and cell death. 2. A structural abnormality causes urine to flow too freely through the urinary system, leading to fluid and electrolyte imbalances. 3. Decreased production of urine in one or both kidneys, resulting in an electrolyte imbalance. 4. Urine with an abnormal electrolyte balance and concentration leads to increased blood pressure and subsequent increased glomerular filtration rate.

1. Hydronephrosis is due to a structural abnormality in the urinary system, causing urine to back up, leading to pressure and potential cell death TEST-TAKING HINT: This question requires familiarity with the pathophysiology of hydronephrosis

The nurse is caring for an infant newly diagnosed with Hirschsprung disease. Which of the following does the nurse understand about this infant's condition? 1. There is a lack of peristalsis in the large intestine and an accumulation of bowel contents, leading to abdominal distention. 2. There is excessive peristalsis throughout the intestine, resulting in abdominal distention. 3. There is a small-bowel obstruction leading to ribbon-like stools. 4. There is inflammation throughout the large intestine, leading to accumulation of intestinal contents and abdominal distention.

1. In Hirschsprung disease, a portion of the large intestine has an area lacking in ganglion cells. This results in a lack of peristalsis as well as an accumulation of bowel contents and abdominal distention. TEST-TAKING HINT: The test taker should be familiar with the pathophysiology of Hirschsprung disease in order to select answer 1.

The nurse is caring for a newborn with esophageal atresia. When reviewing the mother's history, the nurse would expect to find which of the following? 1. A history of maternal polyhydramnios. 2. A pregnancy that lasted more than 38 weeks. 3. A history of poor nutrition during pregnancy. 4. A history of alcohol consumption during pregnancy.

1. Maternal polyhydramnios is present because the infant cannot swallow and absorb the amniotic fluid in utero. TEST-TAKING HINT: The test taker should select answer 1 because esophageal atresia prevents the infant from ingesting much, leading to increased amniotic fluid in utero

A newborn is diagnosed with bladder exstrophy that includes a malformed pelvis. Which of the following is a priority of care? 1. Change the diaper frequently and assess for skin breakdown. 2. Keep the exposed bladder open in a warm and dry environment to avoid any heat loss. 3. Immediately administer a dextrose-containing solution intravenously to avoid any possibility of hypoglycemia. 4. Cluster all care to allow the child to sleep, grow, and gain strength for the upcoming surgical repair

1. Preventing infection from stool contamination and skin breakdown is the top priority of care TEST-TAKING HINT: The test taker can eliminate answers 2 and 3 because they have potential to cause harm to the infant.

The nurse knows that which of the following causes the symptoms seen in testicular torsion? 1. Twisting of the spermatic cord interrupts the blood supply. 2. Swelling of the scrotal sac leads to testicular displacement. 3. Unmanaged undescended testes cause testicular displacement. 4. Microthrombi formation in the vessels of the spermatic cord causes interruption of the blood supply.

1. Testicular torsion is caused by an interruption of the blood supply due to twisting of the spermatic cord. TEST-TAKING HINT: This question depends on familiarity with the pathophysiology of testicular torsion.

The nurse is reviewing the pathophysiology of HUS. The manifestations of the disease are due primarily to which of the following events? 1. The swollen lining of the small blood vessels damages the red blood cells, which are then removed by the spleen, leading to anemia. 2. There is a disturbance of the glomerular basement membrane, allowing large proteins to pass through. 3. The red blood cell changes shape, causing it to obstruct microcirculation. 4. There is a depression in the production of all formed elements of the blood.

1. The swollen lining of the small blood vessels damages the red blood cells, which are then removed by the spleen. TEST-TAKING HINT: The question requires familiarity with the pathophysiology of HUS.

The nurse is caring for an infant diagnosed with Hirschsprung disease. The mother states she is pregnant with a male and wants to know if her new baby will likely have the disorder. Select the nurse's best response. 1. "Genetics play a small role in Hirschsprung disease, so there is a chance the baby will develop it as well." 2. "There is no evidence to support a genetic link, so it is very unlikely the baby will also have it." 3. "It is rarely seen in boys, so it is not likely your new baby will have Hirschsprung disease." 4. "Hirschsprung disease is seen only in girls, so your new baby will not be at risk."

1. There is a genetic component to Hirschsprung disease, so any future siblings are also at risk. TEST-TAKING HINT: The test taker can eliminate answers 3 and 4 as they are similar and therefore would not likely be the correct answer.

The parents of a child with glomerulonephritis ask how will they know that the condition is improving after they take their child home. What is the nurse's best response? 1. "Your child's urine output will increase, and the urine will become less tea-colored." 2. "Your child will rest more comfortably." 3. "Your child's appetite will decrease." 4. "Your child's laboratory test values will become more normal."

1. When glomerulonephritis is improving, urine output increases, and the urine becomes less tea-colored. These are signs that can be monitored at home by the child's parents. TEST-TAKING HINT: The test taker should be led to answer 1 because the manifestations represent improvement in the disease process that can be easily recognized by the parents.

The nurse is caring for an infant who has been diagnosed with SBS. The parents of the infant ask how the disease will affect their child. Select the nurse's best response. 1. "Because your child has a shorter intestine than most, your child will likely experience constipation and will need to be placed on a bowel regimen." 2. "Because your child has a shorter intestine than most, your child will not be able to absorb all the nutrients and vitamins in food and will need to get nutrients in alternative ways." 3. "Unfortunately, most children with this diagnosis do not do very well." 4. "The prognosis and course of the disease have changed because hyperalimentation is available.

2. Because the intestine is used for absorption, children with SBS usually need alternative forms of nutrition such as hyperalimentation. TEST-TAKING HINT: The test taker should eliminate answer 1 as it is false. Answer 3 can also be eliminated because it makes a generalization that should not be made without knowing the details of the child's diagnosis

The nurse is providing discharge teaching to the parents of an infant with an umbilical hernia. Which of the following should be included in the plan of care? 1. If the hernia has not resolved on its own by the age of 12 months, surgery is generally recommended. 2. If the hernia appears to be more swollen or tender, seek medical care immediately. 3. To help the hernia resolve, place a pressure dressing over the area gently. 4. If the hernia is repaired surgically, there is a strong likelihood that it will return

2. If the hernia appears larger, swollen, or tender, the intestine may be trapped, which is a surgical emergency TEST-TAKING HINT: The test taker should be led to select answer 2 because a change in the hernia indicates an incarcerated hernia, which is an emergency

The nurse is caring for a 7-week-old scheduled for a pyloromyotomy in 24 hours. Which of the following would the nurse expect to find in the plan of care? 1. Keep infant NPO; begin intravenous fluids at maintenance. 2. Keep infant NPO; begin intravenous fluids at maintenance; place NGT to low wall suction. 3. Obtain serum electrolytes; keep infant NPO; do not attempt to pass NGT due to obstruction from pylorus. 4. Offer infant small frequent feedings; keep NPO 6 to 8 hours before surgery.

2. In addition to giving fluids intravenously and keeping the infant NPO, an NGT is placed to decompress the stomach TEST-TAKING HINT: The test taker should consider the pathophysiology of pyloric stenosis and eliminate answers 1, 3, and 4.

The nurse is caring for a newborn who has just been diagnosed with tracheoesophageal atresia and is scheduled for surgery. Which of the following should the nurse expect to do in the preoperative period? 1. Keep the child in a monitored crib, obtain frequent vital signs, and allow the parents to visit but not hold their infant. 2. Administer intravenous fluids and antibiotics. 3. Place the infant on 100% oxygen via a non-rebreather mask. 4. Have the mother feed the infant slowly in a monitored area, stopping all feedings 4 to 6 hours before surgery.

2. Intravenous fluids are administered to prevent dehydration because the infant is NPO. Intravenous antibiotics are administered to prevent pneumonia because aspiration of secretions is likely. TEST-TAKING HINT: Infants with tracheoesophageal atresia are at great risk for aspiration and subsequent pneumonia. With this knowledge, the test taker should eliminate answer 4 and select answer 2.

The nurse is caring for a 6-week-old infant with cerebral palsy and GER. After two hospital admissions for aspiration, the child is scheduled for a Nissen fundoplication. The nurse knows that this procedure involves which of the following? 1. The fundus of the stomach is wrapped around the inferior stomach, mimicking a lower esophageal sphincter. 2. The fundus of the stomach is wrapped around the inferior esophagus, mimicking a cardiac sphincter. 3. The fundus of the stomach is wrapped around the middle portion of the stomach, decreasing the capacity of the stomach. 4. The fundus of the stomach is dilated, decreasing the likelihood of reflux.

2. The Nissen fundoplication involves wrapping the fundus of the stomach around the inferior esophagus, creating a lower esophageal sphincter or cardiac sphincter. TEST-TAKING HINT: The test taker needs to be familiar with surgical options for GER disease.

The nurse is caring for an infant with biliary atresia. The parents ask why the child is receiving cholestyramine. Select the nurse's best response. 1. To lower your child's cholesterol. 2. To relieve your child's itching. 3. To help your child gain weight. 4. To help feedings be absorbed in a more efficient manner

2. The primary reason cholestyramine is administered to the child with biliary atresia is to relieve pruritus. TEST-TAKING HINT: The test taker needs to consider the manifestations of the disease process when considering why medications are administered. The liver is unable to eliminate bile, which leads to intense pruritus.

The parents of a 6-week-old male ask the nurse if there is a difference between an inguinal hernia and a hydrocele. What is the nurse's best response? 1. "The terms are used interchangeably and mean the same thing." 2. "The symptoms are similar, but an inguinal hernia occurs when tissue protrudes into the groin, whereas a hydrocele is a fluid-filled mass in the groin." 3. "A hydrocele is the term used when an inguinal hernia occurs in females." 4. "A hydrocele presents in a manner similar to that of an inguinal hernia but causes increased concern because it is often malignant."

2. The symptoms are similar, but an inguinal hernia occurs when tissue protrudes into the groin, and a hydrocele is a fluid-filled mass in the groin. TEST-TAKING HINT: This question depends on knowledge of the definitions of inguinal hernia and hydrocele.

The nurse knows that which of the following need to be present to diagnose HUS? 1. Increased red blood cells with a low reticulocyte count, increased platelet count, and renal failure. 2. Decreased red blood cells with a high reticulocyte count, decreased platelet count, and renal failure. 3. Increased red blood cells with a high reticulocyte count, increased platelet count, and renal failure. 4. Decreased red blood cells with a low reticulocyte count, decreased platelet count, and renal failure.

2. The triad in HUS includes decreased red blood cells (with a high reticulocyte count as the body attempts to produce more red blood cells), decreased platelet count, and renal failure. TEST-TAKING HINT: The test taker can eliminate answers 1 and 3 because platelets are not increased in HUS.

The nurse is caring for a 3-year-old undergoing evaluation for celiac disease. Which of the following would the nurse expect to be included in the child's diagnostic workup? 1. Obtain complete blood count and serum electrolytes. 2. Obtain complete blood count and stool sample; keep child NPO. 3. Obtain stool sample and prepare child for jejunal biopsy. 4. Obtain complete blood count and serum electrolytes; monitor child's response to gluten-containing diet.

3. A stool sample for analysis of fat and a jejunal biopsy can confirm the diagnosis TEST-TAKING HINT: The test taker should eliminate answers 1, 2, and 4 because they do not include preparing the child for a jejunal biopsy, which is the key to a definitive diagnosis of celiac disease

A 7-year-old is being seen in the pediatric clinic. The child is diagnosed with chronic constipation that has been unresponsive to dietary and activity changes. Which of the following pharmacological measures is most appropriate? 1. Natural supplements and herbs. 2. A stimulant laxative. 3. A stool softener. 4. Pharmacological measures are not used in pediatric constipation.

3. A stool softener is the drug of choice because it will lead to easier evacuation. TEST-TAKING HINT: The test taker should eliminate answer 4 as it implies that medications are never given to the constipated child. In health care, there are very few cases of "never" and "always."

The nurse is caring for a newborn male with hypospadias. His parents ask if circumcision is an option. Which is the nurse's best response? 1. "Circumcision is a fading practice and is now contraindicated in most children." 2. "Circumcision in children with hypospadias is recommended because it helps prevent infection." 3. "Circumcision is an option, but it cannot be done at this time." 4. "Circumcision can never be performed in a child with hypospadias."

3. It is usually recommended that circumcision be delayed in the child with hypospadias because the foreskin may be needed for repair of the defect. TEST-TAKING HINT: The test taker can eliminate answer 4 because "never" is infrequently the case in health care.

At a well-child health screening, the parent of a 7-year-old voices concern over the child's continued bed-wetting at night. The parent, on going to bed, has tried getting the child up at 11:30 p.m., but the child still wakes up wet. What is the nurse's best response about what the parent should do next? 1. "There is a medication called DDAVP that decreases the volume of the urine. The physician thinks that will work for your child." 2. "When your child wakes up wet, be very firm, and indicate how displeased you are. Have your child change the sheets to see how much work is involved." 3. "Limit fluids in the evening, and start a reward system in which your child can choose a reward after a certain number of dry nights." 4. "Bed-wetting alarms are readily available, and most children do very well with them."

3. Limiting the child's fluids in the evening will help decrease the nocturnal urge to void. Providing positive reinforcement and allowing the child to choose a reward will increase the child's sense of control. TEST-TAKING HINT: The test taker can eliminate answer 2 because negative reinforcement is not recommended and is not helpful

The nurse is caring for a 7-year-old with glomerulonephritis. Which of the following combinations of signs is commonly associated with glomerulonephritis? 1. Massive proteinuria, hematuria, decreased urinary output, and lethargy. 2. Mild proteinuria, increased urinary output, and lethargy. 3. Mild proteinuria, hematuria, decreased urinary output, and lethargy. 4. Massive proteinuria, decreased urinary output, and hypotension.

3. Mild-to-moderate proteinuria, hematuria, decreased urinary output, and lethargy are common findings in glomerulonephritis. TEST-TAKING HINT: The test taker should eliminate answers 1and 4 because glomerulonephritis does not cause massive proteinuria. Answer 2 can be eliminated because increased urine output is not associated with glomerulonephritis.

The nurse is caring for an 18-month-old infant whose cleft palate was repaired 12 hours ago. Which of the following should be included in the plan of care? 1. Allow the infant to have familiar items of comfort such as a favorite stuffed animal and a pacifier. 2. Once liquids have been tolerated, encourage a bland diet such as soup, Jell-O, and saltine crackers. 3. Administer pain medication on a regular schedule, as opposed to an as-needed schedule. 4. Use a Yankauer suction catheter on the infant's mouth to decrease the risk of aspiration of oral secretions.

3. Pain medication should be administered regularly to avoid crying, which places stress on the suture line. TEST-TAKING HINT: The child who has had a cleft palate repair should have nothing in the mouth that could irritate the suture line. Answers 1, 2, and 4 can be eliminated

The nurse in the pediatric clinic receives a call from the parent of a 5-year-old and states that the child has been having diarrhea for 24 hours. The parent explains that the child vomited twice 2 hours ago and now claims to be thirsty. The parent asks what to offer the child because the child is refusing Pedialyte. Select the nurse's most appropriate response. 1. "You can offer clear diet soda such as Sprite and ginger ale." 2. "Pedialyte is really the best thing for your child, who, if thirsty enough, will eventually drink it." 3. "Pedialyte is really the best thing for your child. Allow your child some choicein the way to take it. Try offering small amounts in a spoon, medicine cup, or syringe." 4. "It really does not matter what your child drinks as long as it is kept down. Try offering small amounts of fluids in medicine cups."

3. Pedialyte is the first choice, as recommended by the American Academy of Pediatrics. Offering the child appropriate choices may allow the child to feel empowered and less likely to refuse the Pedialyte. Small, frequent amounts are usually better tolerated. TEST-TAKING HINT: The test taker should eliminate answer 2 because it offers an ultimatum to a child. The child is likely to refuse the Pedialyte, worsening the state of dehydration.

A 2-month-old male is brought to the pediatric clinic. The infant has had vomiting and diarrhea for 24 hours. The infant's anterior fontanel is sunken. The child is irritable, and the nurse notes that the infant does not produce tears when he cries. Which of the following tasks will help confirm the diagnosis of dehydration? 1. Urinalysis obtained by bagged specimen. 2. Urinalysis obtained by sterile catheterization. 3. Analysis of serum electrolytes. 4. Analysis of cerebrospinal fluid.

3. The analysis of serum electrolytes offers the most information and assists with the diagnosis of dehydration TEST-TAKING HINT: Infants have limited ability to concentrate urine, so answers 1 and 2 can be eliminated immediately.

At a well-child health screening, the parent of a 7-year-old voices concern over the child's continued bed-wetting at night. The parent, on going to bed, has tried getting the child up at 11:30 p.m., but the child still wakes up wet. What is the nurse's best response about what the parent should do next? 1. "There is a medication called DDAVP that decreases the volume of the urine. The physician thinks that will work for your child." 2. "When your child wakes up wet, be very firm, and indicate how displeased you are. Have your child change the sheets to see how much work is involved." 3. "Limit fluids in the evening, and start a reward system in which your child can choose a reward after a certain number of dry nights." 4. "Bed-wetting alarms are readily available, and most children do very well with them."

3. The child is having symptoms of testicular torsion, which is a surgical emergency and needs immediate attention. TEST-TAKING HINT: The test taker should be led to answer 3 because testicular torsion is a surgical emergency.

The nurse is caring for a newborn with an anorectal malformation and has had a colostomy placed. The nurse knows that more education is needed when the infant's parent states which of the following? 1. "I will make sure the stoma is red." 2. "There should not be any discharge or irritation around the outside of the stoma." 3. "I will keep a bag attached to avoid the contents of the small intestine coming in contact with the baby's skin." 4. "As my baby grows, a pattern will develop over time, and there should be predictable bowel movements."

3. The colostomy contains stool from the large intestine; an ileostomy contains the very irritating stool from the small intestine TEST-TAKING HINT: Although it is important to keep a bag attached to the colostomy, the contents are not the irritating effluent of an ileostomy

The mother of a newborn asks the nurse why she has to nurse so frequently. The nurse replies using which of the following principles? 1. Formula tends to be more calorically dense, and formula-fed babies require fewer feedings than breastfed babies. 2. The newborn's stomach capacity is small, and peristalsis is slow. 3. The newborn's stomach capacity is small, and peristalsis is more rapid than in older children. 4. Breastfed babies tend to take longer to complete a feeding than formula-fed babies.

3. The small-stomach capacity and rapid movement of fluid through the digestive system account for the need for small frequent feedings. TEST-TAKING HINT: The test taker should eliminate answers 1 and 4 because they both form generalizations that are not supported by current literature.

The nurse is caring for a 4-month-old who has just had an isolated cleft lip repaired. Select the best position for the child in the immediate postoperative period. 1. Right side-lying. 2. Left side-lying. 3. Supine. 4. Prone.

3. The supine position is preferred because there is decreased risk of the infant rubbing the suture line. TEST-TAKING HINT: The test taker should be led to answer 3 because it is the only option in which the suture line is not at increased risk for injury.

The nurse is conducting an in-service lecture on NEC to a group of colleagues. The nurse knows that she needs to provide more education when one of the participants states which of the following? 1. "Encouraging the mother to pump her milk for the feedings helps prevent NEC." 2. "Some sources state that the occurrence of NEC has increased because so many preterm infants are surviving." 3. "When signs of sepsis appear, the infant will likely deteriorate quickly." 4. "NEC occurs only in preemies and low-birth-weight infants."

4. Although much more common in preterm and low-birth-weight infants, NEC is also seen in term infants as well. TEST-TAKING HINT: The test taker needs to be familiar with general concepts associated with NEC. Answer 4 contains the word "only," which is an absolute value that is rarely used in health care.

An 8-month-old is being evaluated for a UTI. A urinalysis and urine culture are ordered. Which of the following is the best way to obtain the urine sample? 1. Carefully cleanse the perineum from front to back, and apply a self-adhesive urine collection bag to the perineum. 2. Insert an indwelling Foley catheter and begin antibiotic administration. 3. Place a sterile cotton ball in the diaper, and immediately obtain the sample with a syringe after the first void. 4. Using a straight catheter, obtain the sample, and immediately remove the catheter without waiting for the results of the urine sample.

4. An in-and-out catheterization is the best way to obtain a urine culture in a child who is not yet toilet-trained. TEST-TAKING HINT: The test taker can eliminate answers 1 and 3 because they both lead to a contaminated sample.

The nurse is caring for a 14-year-old with celiac disease. The nurse knows that the patient understands the diet instructions by ordering which of the following meals? 1. Eggs, bacon, rye toast, and lactose-free milk. 2. Pancakes, orange juice, and sausage links. 3. Oat cereal, breakfast pastry, and nonfat skim milk. 4. Cheese, banana slices, rice cakes, and whole milk.

4. Cheese, banana slices, rice cakes, and whole milk do not contain gluten. TEST-TAKING HINT: The test taker needs to recall that children with celiac disease cannot tolerate gluten, which is found in wheat, barley, rye, and oats. Answers 1, 2, and 3 contain gluten.

A 3-year-old returns to the pediatric clinic after having had MCNS. His parents ask the nurse how to prevent the child from having it again. What is the nurse's best response? 1. "It is very rare for a child to have a relapse after having fully recovered." 2. "Unfortunately, many children have cycles of relapses, and there is very little that can be done to prevent it." 3. "Your child is much less likely to get sick again if sodium is avoided in his diet." 4. "Try to keep your child away from sick children because relapses have been associated with infectious illnesses."

4. Exposure to infectious illness has been linked to the relapse of nephrotic syndrome. TEST-TAKING HINT: The test taker can eliminate answers 1 and 2 because relapses are common and can be prevented.

The nurse is caring for a 2-month-old infant diagnosed with GER. Which of the following should the nurse include in the plan of care to decrease the incidence of symptoms of GER? 1. Place the infant in an infant seat immediately after feedings. 2. Place the infant in the prone position immediately after feeding to decrease the risk of aspiration. 3. Encourage the parents not to worry because most infants outgrow GER within the first year of life. 4. Encourage the parents to hold the infant in an upright position for 30 minutes following a feeding.

4. Keeping the infant in an upright position is the best way to decrease the symptoms of GER. The infant can also be placed in the supine position with the head of the crib elevated. A harness can be used to keep the child from sliding down. TEST-TAKING HINT: The test taker may be led to answers 3 and 4 as they are both correct. The question is looking for ways to decrease reflux. Although decreasing parental anxiety may help decrease reflux, the better answer is 4, as it more likely to be an effective management plan.

The nurse is teaching feeding techniques to new parents. The nurse emphasizes the importance of slowly warming the formula and testing the temperature prior to feeding the infant. The parent of a newborn asks, "Will my baby spit out the formula if it is too hot or too cold?" Select the nurse's best response. 1. "Babies have a tendency to reject hot fluids but not cold fluids, which could result in abdominal discomfort." 2. "Babies have a tendency to reject cold fluids but not hot fluids, which could result in esophageal burns." 3. "Your baby would most likely spit out formula that was too hot, but your baby could swallow some of it, which could result in a burn." 4. "Your baby is too young to be physically capable of spitting out fluids and will automatically swallow anything."

4. Swallowing is a reflex in infants younger than 6 weeks. TEST-TAKING HINT: Swallowing is a reflex that is present until the age of 6 weeks. The test taker should eliminate answers 1, 2, and 3 as they both suggest that the infant is capable of selectively rejecting fluids.

The parents of a newborn diagnosed with a cleft lip and palate ask the nurse when their child's lip and palate will most likely be repaired. Select the nurse's best response. 1. "The palate and the lip are usually repaired in the first few weeks of life so that the baby can grow and gain weight." 2. "The palate and the lip are usually not repaired until the baby is approximately 6 months old so that the mouth has had enough time to grow." 3. "The lip is repaired in the first few months of life, but the palate is not usually repaired until the child is 3 years old." 4. "The lip is repaired in the first few weeks of life, but the palate is not usually repaired until the child is 18 months old."

4. The lip is repaired in the first few weeks of life, but the palate is not usually repaired until the child is 18 months old. TEST-TAKING HINT: The test taker should consider the palate's involvement in the development of speech and therefore eliminate answer 3. The palate is usually given at least a year to grow sufficiently.

The nurse is caring for an infant with biliary atresia who is scheduled for a Kasai procedure. Which of the following is an accurate description of this surgery? 1. A palliative procedure in which a bile duct is attached to a loop of bowel to assist with bile drainage. 2. A curative procedure in which a connection is made between a bile duct and a loop of bowel to assist with bile drainage. 3. A curative procedure in which a bile duct is banded to prevent bile leakage. 4. A palliative procedure in which a bile duct is banded to prevent bile leakage.

1. The Kasai procedure is a palliative procedure in which a bile duct is attached to a loop of bowel to assist with bile drainage. TEST-TAKING HINT: The test taker should eliminate answers 2 and 3 as the majority of cases of biliary atresia require a liver transplant. The Kasai procedure is performed to give the child a few years to grow before requiring a transplant.

The nurse is administering Prilosec to a 3-month-old with GER. The child's parents ask the nurse how the medication works. Select the nurse's best response. 1. "Prilosec is a proton pump inhibitor that is commonly used for reflux in infants." 2. "Prilosec decreases stomach acid, so it will not be as irritating when your child spits up." 3. "Prilosec helps food move through the stomach quicker, so there will be less chance for reflux." 4. "Prilosec relaxes the pressure of the lower esophageal sphincter."

2. This accurate description gives the parents information that is clear and concise. TEST-TAKING HINT: The test taker should eliminate answers 1 and 4 because they do not communicate information in a manner that will be clear to many parents.

The nurse is caring for a 5-year-old who has just returned from having an appendectomy. Which of the following is the optimal way to manage pain? 1. Intravenous morphine as needed. 2. Liquid Tylenol with codeine as needed. 3. Morphine administered through a PCA pump. 4. Intramuscular morphine as needed.

3. Morphine administered through a PCA pump offers the child control over managing pain. The PCA pump also has the benefit of offering a basal rate as well as an as-needed rate for optimal pain management TEST-TAKING HINT: The test taker needs to recall that PCA analgesia is very effective, even in young children.

On reviewing information about glomerulonephritis, the nurse knows that which of the following children is at risk for developing the disease? 1. A 10-year-old recovering from viral pneumonia. 2. A 6-year-old with new-onset type 1 diabetes. 3. A 3-year-old who had impetigo 1 week ago. 4. A 5-year-old with a history of five UTIs in the previous year.

3. Impetigo is a skin infection caused by the streptococcal organism that is commonly associated with glomerulonephritis. TEST-TAKING HINT: The test taker may be distracted by answer 1 because streptococcal infections are associated with glomerulonephritis. However, answer 1 states that the illness is viral, so that answer is not a correct choice

The parents of a 6-year-old being evaluated for appendicitis tell the nurse the physician diagnosed their child as having a positive Rovsing sign. They ask the nurse what this means. Select the nurse's best response. 1. "Your child's physician should answer that question." 2. "A positive Rovsing sign means the child feels pain in the right side of the abdomen when the left side is palpated." 3. "A positive Rovsing sign means pain is felt when the physician removes the hand from the abdomen." 4. "A positive Rovsing sign means pain is felt in the right lower quadrant when the child coughs."

2. A positive Rovsing sign occurs when the left lower quadrant is palpated and pain is felt in the right lower quadrant. TEST-TAKING HINT: The test taker should immediately eliminate answer 1 because it is not therapeutic and is dismissive.

The nurse is providing discharge instructions to the parents of a 10-year-old who had an appendectomy for a ruptured appendix 5 days ago. The nurse knows that further education is required when the child's parent states: 1. "We will wait a few days before allowing our child to return to school." 2. "We will wait 2 weeks before allowing our child to return to sports." 3. "We will call the pediatrician's office if we notice any drainage around the wound." 4. "We will encourage our child to go for walks every day."

2. The child should wait 6 weeks before returning to any strenuous activity TEST-TAKING HINT: The test taker should note that the question is asking which of the answers indicate that more education is needed. Answer 2 should be selected because 2 weeks is too early to return to strenuous contact sports

The nurse is caring for a neonate with an anorectal malformation. The nurse notes that the infant has not passed any stool per rectum but that the infant's urine contains meconium. The nurse can make which of the following assumptions? 1. The child likely has a low anorectal malformation. 2. The child likely has a high anorectal malformation. 3. The child will not need a colostomy. 4. This malformation will be corrected with a nonoperative rectal pull-through.

2. The presence of stool in the urine indicates that the anorectal malformation is high. TEST-TAKING HINT: The test taker needs to consider that stool is present in the urine, indicating a fistula is present and a more complex anorectal malformation exists, so answers 1 and 4 can be eliminated.

The nurse is caring for a 9-month-old with diarrhea secondary to rotavirus. The child has not vomited and is mildly dehydrated. The nurse is sending the child home. Which of the following is likely to be included in the discharge teaching? 1. Administer Immodium as needed. 2. Administer Kaopectate as needed. 3. Continue breastfeeding per routine. 4. The infant may return to day care 24 hours after antibiotics have been started.

3. Breastfeeding is usually well tolerated and helps prevent death of intestinal villi and malabsorption. TEST-TAKING HINT: The test taker can eliminate answer 4 as antibiotics are not effective with viruses such as rotavirus. Answers 1 and 2 can be eliminated as antidiarrheal agents are not recommended in the pediatric population.

The nurse is caring for a 2-year-old hospitalized with MCNS. The edema has progressed from periorbital to generalized. The skin appears stretched, and areas of breakdown are noted over the bony prominences. The child has been receiving Lasix twice daily for several days. In order to reduce edema, which of the following does the nurse expect to be included in the treatment plan? 1. An increase in the amount and frequency of Lasix. 2. Addition of a second diuretic, such as mannitol. 3. Administration of intravenous albumin. 4. Elimination of all fluids and sodium from the child's diet.

3. In cases of severe edema, albumin is used to help return the fluid to the bloodstream from the subcutaneous tissue. TEST-TAKING HINT: The test taker can eliminate answer 2 because mannitol is used to treat edema of the central nervous system.

The nurse is caring for a 3-year-old who had an appendectomy 2 days ago. When taking the child's temperature, the nurse notes that the child has a fever of 101.8°F (38.8°C). The nurse notes the child's breath sounds are slightly diminished in the right lower lobe. Which of the following actions is most appropriate for this patient? 1. Teach the child how to use an incentive spirometer. 2. Encourage the child to blow bubbles. 3. Obtain an order for intravenous antibiotics. 4. Obtain an order for acetaminophen.

2. Blowing bubbles is a developmentally appropriate way to help the preschooler take deep breaths and cough. TEST-TAKING HINT: The test taker should be aware that a fever in the first few days after surgery is generally due to pulmonary complications, so that answer 3 can be eliminated. Remembering the developmental needs of the child, the test taker should select answer 2.

A 2-year-old is admitted to the pediatric floor with a diagnosis of HUS. Which of the following would the nurse likely find in the child's history? 1. The child has a history of frequent UTIs and possible VUR. 2. The child and parents had vomiting and diarrhea, but the parents believe it was due to "probably something that they ate." 3. The child was stung by a bee and experienced localized edema to the site for 3 days. 4. The child had previously been healthy and did not show any signs of illness until this admission.

2. HUS is often preceded by diarrhea that may be caused by E. coli present in undercooked meat. TEST-TAKING HINT: The test taker can eliminate answer 1 because there is no correlation between UTIs and HUS.

The nurse is teaching the family about MCNS and explains that the clinical manifestations are due to which of the following? 1. Chemical changes in the composition of albumin. 2. Increased permeability of the glomeruli. 3. Obstruction of the capillaries of the glomeruli because of antibody-antigen complex formation. 4. Loss of the kidney's ability to excrete waste and concentrate urine.

2. Increased permeability of the glomeruli in MCNS allows large substances such as protein to pass through and be excreted in the urine. TEST-TAKING HINT: The test taker should recognize the pathophysiology of MCNS.

The nurse is providing discharge instructions to the parents of an infant born with bladder exstrophy who had a continent urinary reservoir placed. Which of the following statements should be included? 1. "Allowing your child to sleep on the abdomen will provide comfort during the immediate postoperative period." 2. "As your child grows, be cautious around playgrounds because the surface could be a health hazard." 3. "As your child grows, be sure to encourage many different foods because it is not likely that food allergies will develop." 4. "In order to encourage your child's development, keep the environment stimulating by having brightly colored things around, such as balloons."

2. Many children with urological malformations are prone to latex allergies. The surfaces of playgrounds are often made of rubber, which contains latex. TEST-TAKING HINT: The test taker can eliminate answer 1 because infants should be placed to sleep on their backs to prevent sudden infant death syndrome

The parents of a 3-year-old are concerned that the child is having "more accidents" during the day. Which of the following questions would be appropriate for the nurse to ask in order to obtain more information? Select all that apply. 1. "Has there been a stressful event in the child's life, such as the birth of a sibling?" 2. "Has anyone else in the family had problems with accidents?" 3. "Does your child seem to be drinking more than usual?" 4. "Is your child more irritable, and does your child seem to be in pain when urinating?" 5. "Is your child having difficulties sharing at preschool?"

1, 2, 3, 4. 1. Stressors such as the birth of a sibling can lead to incontinence in a child who previously had bladder control. 2. A pattern of enuresis can often be seen in families. 3. Increased thirst and incontinence can be associated with diabetes. 4. Irritability and incontinence can be associated with UTIs. TEST-TAKING HINT: The test taker should be able to eliminate answer 5 by knowing lack of sharing is not unusual in preschoolers

A 3-year-old has a recurrent UTI. She had a UTI 3 months ago and was treated with an oral antibiotic. A follow-up urinalysis revealed results within normal range. The child has had no other problems until this visit. Choose the nurse's best response. 1. The nurse should prepare for the following tests: urinalysis, urine culture, and VCUG. 2. Signs and symptoms of renal failure should be evaluated. 3. The nurse should prepare the child for likely admission to the pediatric unit. 4. Send the child home on an antibiotic and instruct the parent to offer the child lots of fluids.

1. Urinalysis and urine culture are routinely used to diagnose UTIs. VCUG is used to determine the extent of urinary tract involvement when the child has a second UTI within 1 year. TEST-TAKING HINT: The test taker can eliminate answer 2 because it is the only answer that does not address the UTI. Answer 1 is the best choice because it will provide more data about the cause of the child's recurrent UTIs.

Which of the following is true of a Wilms tumor? Select all that apply. 1. It is also referred to as neuroblastoma. 2. It can occur at any age but is seen most often between the ages of 2 and 5 years. 3. It can occur on its own or can be associated with many congenital anomalies. 4. It is a slow-growing tumor. 5. It is associated with a very poor prognosis

2, 3. 2. It can occur at any age but is seen most often between the ages of 2 and 5 years. 3. It can occur on its own or can be associated with many congenital anomalies. TEST-TAKING HINT: The test taker would have to know about Wilms tumor to answer the question.

The parents of a child with glomerulonephritis ask the nurse why the urine is such a funny color. What is the nurse's best response? 1. "It is not uncommon for the urine to be discolored when children are receiving steroids and blood pressure medications." 2. "There is blood in your child's urine that causes it to be tea-colored." 3. "Your child's urine is very concentrated, so it appears to be discolored." 4. "A ketogenic diet often causes the urine to be tea-colored."

2. Blood in the child's urine causes it to be tea-colored. TEST-TAKING HINT: The test taker can immediately eliminate answer 4 because the child is not placed on a ketogenic diet.

The nurse on the pediatric unit is verifying that the patients have received the correct lunches. She knows that the child with CRF needs to receive which of the following diets? 1. A diet high in calories, protein, and all minerals and electrolytes. 2. A diet with high calories but low protein and minerals. 3. A diet high in calories, protein, and calcium and low in potassium and phosphorus. 4. A diet high in calories, protein, phosphorus, and calcium and low in potassium and sodium.

3. The child with CRF needs a diet high in calories, protein, and calcium and low in potassium and phosphorus. TEST-TAKING HINT: The test taker should eliminate answer 2 because it is important for the child to have a diet high in protein.

The nurse is caring for a 12-year-old receiving peritoneal dialysis. The nurse notes the return to be cloudy, and the child is complaining of abdominal pain. The child's parents ask what the next step will likely be. What is the nurse's best response? 1. "We will probably place antibiotics in the dialysis fluid before the next dwell time." 2. "Many children experience cloudy returns. We do not usually worry about it." 3. "We will probably give your child some oral antibiotics just to make sure nothing else develops." 4. "The abdominal pain is likely due to the fluid going in too slowly. We will increase the rate of administration with the next fill."

1. Cloudy returns and abdominal pain are signs of peritonitis and are usually treated with the administration of antibiotics in the dialysis fluid. TEST-TAKING HINT: The test taker can eliminate answer 2 because pain would be increased if the rate of administration were increased.

The nurse is working in the pediatric intensive care unit, caring for a child receiving peritoneal dialysis. The nurse notes that the child has not been having adequate volume in the return. The child is currently edematous and hypertensive. The nurse would anticipate the physician to do which of the following? 1. Increase the glucose concentration of the dialysate. 2. Decrease the glucose concentration of the dialysate. 3. Administer antihypertensives and diuretics but not change the dialysate concentration. 4. Decrease the dwell time of the dialysate.

1. Increasing the concentration of glucose will pull more fluid into the return. TEST-TAKING HINT: The test taker should eliminate answers 2 and 4 because they decrease the amount of return.

The nurse is caring for a 9-year-old diagnosed with CRF. The child's blood pressure has been consistently elevated. The nurse knows that chronic hypertension in the child who has CRF is due to which of the following? 1. Retention of sodium and water. 2. Obstruction of the urinary system. 3. Accumulation of waste products in the body. 4. Generalized metabolic alkalosis.

1. The retention of sodium and water leads to hypertension. TEST-TAKING HINT: The test taker should eliminate answer 4 because metabolic alkalosis is not associated with CRF.

The nurse is caring for a child due for surgery on a Wilms tumor. The nurse knows that the child's procedure will consist of which of the following? 1. Only the affected kidney will be removed. 2. Both the affected kidney and the other kidney will be removed in case of recurrence. 3. The mass will be removed from the affected kidney. 4. The mass will be removed from the affected kidney, and a biopsy of the tissue of the unaffected kidney will be done.

1. The treatment of a Wilms tumor involves removal of the affected kidney. TEST-TAKING HINT: The test taker should eliminate answers 3 and 4 because the entire kidney is removed, not only the mass.

The nurse is caring for a 9-year-old in the pediatric intensive care unit. The patient had a tonsillectomy 6 days ago and was seen in the emergency room 4 hours ago due to postoperative hemorrhage. The patient's parent noted that her child was "swallowing a lot and finally began vomiting large amounts of blood." The child's vital signs are as follows: T 99.5° F (37.5°C), HR 124, BP 84/48, and RR 26. The nurse knows that this patient is at risk for which type of renal failure? 1. CRF due to advanced disease process. 2. Prerenal failure due to dehydration. 3. Primary kidney damage due to a lack of urine flowing through the system. 4. Postrenal failure due to a hypotensive state.

2. Examples of causes of prerenal failure include dehydration and hemorrhage TEST-TAKING HINT: The test taker should eliminate answer 1 because there is no evidence of a chronic disease process.

The nurse is reviewing the discharge instructions of a child diagnosed with encopresis. Which of the following instructions should the nurse question? 1. Limit the intake of milk. 2. Encourage positive reinforcement for appropriate toileting habits. 3. Obtain a complete dietary log. 4. Follow up with a child psychologist or psychiatrist

2. Positive reinforcement is encouraged. The use of negative reinforcement is discouraged, however, as it may cause the child to attempt to be controlling by holding on to the stool. TEST-TAKING HINT: Recall the developmental needs of children and successful approaches to meet their needs.

The nurse is caring for a 5-month-old infant with a diagnosis of intussusception. The infant has periods of irritability during which the knees are brought to chest and the infant cries, alternating with periods of lethargy. Vital signs are stable and within age-appropriate limits. The physician elects to give an enema. The parents ask the purpose of is the enema. Select the nurse's most appropriate response. 1. "The enema will confirm the diagnosis. If the test result is positive, your child will need to have surgery to correct the intussusception." 2. "The enema will confirm the diagnosis. Although very unlikely, the enema may also help fix the intussusception so that your child will not immediately need surgery." 3. "The enema will help confirm diagnosis and has a good chance of fixing the intussusception." 4. "The enema will help confirm the diagnosis and may temporarily fix the intussusception. If the bowel returns to normal, there is a strong likelihood that the intussusception will recur."

3. In most cases of intussusception in young children, an enema is successful in reducing the intussusception TEST-TAKING HINT: The test taker needs to be aware that intussusceptions in young children respond well to reduction by enema.

The parent of a child diagnosed with ARF asks the nurse why peritoneal dialysis was selected instead of hemodialysis. What is the nurse's best response? 1. "Hemodialysis is not used in the pediatric population." 2. "Peritoneal dialysis has no complications, so it is a treatment used without hesitation." 3. "Peritoneal dialysis removes fluid at a slower rate than hemodialysis, so many complications are avoided." 4. "Peritoneal dialysis is much more efficient than hemodialysis."

3. Peritoneal dialysis removes fluid at a slower rate that is more easily controlled than that of hemodialysis. TEST-TAKING HINT: The test taker should eliminate answer 2 because very few treatments are without complications.

The nurse is caring for a 2-year-old child who was admitted to the pediatric unit for moderate dehydration due to vomiting and diarrhea. The child is noted to be restless, with periods of irritability. The child is afebrile with a heart rate of 148 and a blood pressure of 90/42. Baseline laboratory tests reveal the following: Na 152, Cl 119, and glucose 115.The parents state that the child has not urinated in 12 hours. After establishing a saline lock, the nurse reviews the physician's orders. Which of the following orders should the nurse question? 1. Administer a saline bolus of 10 mL/kg, which may repeat if child does not urinate. 2. Recheck serum electrolytes in 12 hours. 3. After the saline bolus, begin maintenance fluids of D5 1/4 NS with 10 mEq KCl/L. 4. Give clear liquid diet as tolerated.

3. Potassium is contraindicated because the child has not yet urinated. Potassium is not added to the maintenance fluid until kidney function has been verified. TEST-TAKING HINT: Be aware of the usual ways in which dehydration is treated. Answer 3 should be selected because the description states that the child has not urinated.

A 10-year-old with renal failure is scheduled to undergo renal transplantation. The nurse knows that this treatment option is which of the following? 1. A curative procedure that will free the patient from any more treatment modalities. 2. An ideal treatment option for families with a history of dialysis noncompliance. 3. A treatment option that will free the patient from dialysis. 4. A treatment option that is very new to the pediatric population.

3. Renal transplantation frees the patient from dialysis TEST-TAKING HINT: The test taker should eliminate answer 1 because transplantation is a treatment, not a cure.

51. Neural tube defects occur in the brain and spinal cord in the fetal period. When do these defects occur? 1. Within the first trimester 2. Within the first 6 weeks 3. When the egg is fertilized 4. Within the first 28 days after fertilization

ANS: 4 Feedback 1. This answer is not specific enough. 2. This is outside of the range. 3. Development of the neural tube is minimal at this point. 4. Neural tube defects occur within the first 28 days of fertilization, before the woman knows that she is pregnant.

The nurse is caring for a 4-year-old child with a Wilms tumor. Which of the following would the nurse expect to find on assessment? 1. Decreased blood pressure, increased temperature, and a firm mass located in one flank area. 2. Increased blood pressure, temperature within normal limits, and a firm mass located in one flank area. 3. Increased blood pressure, temperature within normal limits, and a firm mass located on one side or the other of the midline of the abdomen. 4. Decreased blood pressure, temperature within normal limits, and a firm mass located on one side or the other of the midline of the abdomen.

3. The blood pressure may be increased if there is renal damage. The mass will be located on one side or the other of the midline of the abdomen. There is no reason for the child's temperature to be affected. TEST-TAKING HINT: The test taker can eliminate answers 1 and 2 because the mass is felt in the abdomen, not the back.

The nurse is caring for an 8-year-old who has just returned to the pediatric unit after an appendectomy for a ruptured appendix. Which of the following is the best position for the child? 1. Semi-Fowler. 2. Prone. 3. Right side-lying. 4. Left side-lying.

3. The right side-lying position promotes comfort and allows the peritoneal cavity to drain TEST-TAKING HINT: The test taker should be led to answer 3 because lying on the same side as the abdominal incision is usually the most comfortable for the child.

18. A quality of a partial seizure is: 1. Status epilepticus. 2. Tonic movements. 3. Fluttering eyelids. 4. Clonic movements.

ANS: 4 Feedback 1. This occurs after a grand mal seizure. 2. Tonic movements occur with a grand mal seizure. 3. Fluttering eyelids are noted in grand mal seizures. 4. Clonic movements occur in partial seizures and can occur in grand mal seizures.

The parents of a 7-year-old tell the nurse they do not understand the difference between CRF and ARF. What is the nurse's best response? 1. "There really is not much a difference because the terms are used interchangeably." 2. "Most children experience ARF. It is highly unusual for a child to experience CRF. 3. CRF tends to occur suddenly and is irreversible. 4. ARF is often reversible, whereas CRF results in permanent deterioration of kidney function

4. ARF is often reversible, whereas CRF results in permanent deterioration of kidney function. TEST-TAKING HINT: The test taker should eliminate answer 1 because the terms "acute" and "chronic" are not used interchangeably.

The nurse is about to receive a 4-year-old from the recovery room after anappendectomy for a non-ruptured appendix. The parents have not seen the child since the surgery and ask what to expect. Select the nurse's best response. 1. "Your child will be very sleepy, have an intravenous line in the hand, and have a nasal tube to help drain the stomach. If your child needs pain medication, it will be given intravenously." 2. "Your child will be very sleepy, have an intravenous line in the hand, and have white stockings to help prevent blood clots. If your child needs pain medication, we will give it intravenously or provide a liquid to swallow." 3. "Your child will be wide awake and will have an intravenous line in the hand. If your child needs pain medication, we will give it intravenously or provide a liquid to swallow." 4. "Your child will be very sleepy and will have an intravenous line in the hand. If your child needs pain medication, we will give it intravenously."

4. In the immediate postoperative period, the child is usually sleepy but can be roused. The child usually has an intravenous line for hydration and pain medication. TEST-TAKING HINT: The test taker should eliminate answer 1 because NGTs are not used unless the appendix has ruptured. Answer 2 can also be eliminated because a 4-year-old who is post appendectomy is not at risk for blood clots.

The nurse is caring for a 1-year-old diagnosed with ARF. The patient's parent calls the nurse to the bedside and says "My child's eyes cannot open." Edema is noted throughout the child's body, and the liver is enlarged. The child's urine output is less than 0.5 mL/kg/hr, and vital signs are as follows: HR 146, BP 176/92, and RR 42. The child is noted to have nasal flaring and retractions with inspiration. The lung sounds are coarse throughout. Despite receiving oral Kayexalate, the child's serum potassium continues to rise. Which of the following treatments will provide the most benefit to the patient? 1. Additional rectal Kayexalate. 2. Intravenous furosemide. 3. Endotracheal intubation and ventilatory assistance. 4. Placement of a Tenckhoff catheter for peritoneal dialysis.

4. Placement of a Tenckhoff catheter for peritoneal dialysis is needed when the child's condition deteriorates despite medical treatment. TEST-TAKING HINT: The test taker should be led to answer 4 because dialysis is the treatment required to reverse the existing clinical manifestations

The nurse in the pediatric clinic is providing instructions to the parents of a 2-yearold child who has just been diagnosed with acute hepatitis. Which of the following would be an appropriate activity for the nurse to recommend? 1. Riding a bike in an enclosed area such as a basement. 2. Playing basketball. 3. Playing video games in bed. 4. Playing with puzzles in bed.

4. Playing with puzzles is a developmentally appropriate activity for a 3-yearold on bedrest. TEST-TAKING HINT: The test taker should incorporate developmentally appropriate activities for the child in the early stages of acute hepatitis. Answers 1 and 2 can be eliminated as they are not activities that can be done while resting. Answer 4 should be selected because it is a better activity for a 3-year-old.

The nurse is caring for a 10-year-old who is being evaluated for possible appendicitis. The child has been complaining of nausea and sharp abdominal pain in the rightlower quadrant. An abdominal ultrasound is scheduled, and a blood count has been obtained. The child vomits, finds the pain relieved, and calls the nurse. Which of the following should be the nurse's next action? 1. Cancel the ultrasound, and obtain an order for oral Zofran. 2. Cancel the ultrasound, and prepare to administer an intravenous bolus. 3. Prepare for the probable discharge of the patient. 4. Immediately notify the physician of the child's status.

4. The physician should be notified immediately, as a sudden change or loss of pain often indicates a perforated appendix. TEST-TAKING HINT: The test taker should eliminate answers 1 and 2 because there is no reason to cancel the ultrasound. The physician should always be notified of any changes in a patient's condition.

The parent of a 3-year-old is shocked to hear the diagnosis of Wilms tumor and says, "How could I have missed a lump this big?" What is the nurse's best response? 1. "Do not be hard on yourself. It's easy to overlook something that has probably been growing for months when we see our children on a regular basis." 2. "I understand you must be very upset. Your child would have had a better prognosis had you caught it earlier." 3. "It really takes a trained professional to recognize something like this." 4. "Do not blame yourself. This mass grows so fast that it was probably not noticeable a few days ago."

4. The tumor is fast-growing and could very easily not have been evident a few days earlier. TEST-TAKING HINT: The test taker can eliminate answer 2 because the nurse should never cause the parent to feel guilt and responsibility over any diagnosis.

The school nurse is present at a school assembly when a student falls to the floor with a seizure. Which intervention does the nurse initiate when providing care to the student during the seizure? 1. Protect the student from injury related to seizure movement. 2. Remove or loosen any tight clothing around the neck or waist. 3. Provide comfort and promote resting in a quiet environment. 4. If incontinent, cover the student with a blanket or sheet.

ANS 1 1 This is correct. During the seizure, the nurse needs to protect the student from injury caused by seizure movement. 2 This is incorrect. Tight clothing around the neck should be loosened to keep the airway unimpaired. The clothing around the waist is not loosened, and no clothing is removed. 3 This is incorrect. After the seizure, the student should be comforted, reoriented, and allowed to rest. 4 This is incorrect. The student may experience bladder or bowel incontinence during a seizure; however, the student should not be covered with any item that can become entangled from seizure activity. Once the seizure is over, the student can be assisted with cleaning up.

The nurse is assessing a 4-month-old infant during a routine well-baby visit. During the neurological assessment, which finding is a reason for concern? 1. When the cheek is brushed, the head is turned toward the stimuli. 2. Toes fan out when the sole of the food is stroked upward. 3. Placing a small object in the palm inconsistently elicits a grasp. 4. A light puff of air in the face causes the eyes to close.

ANS 1 1 This is correct. The nurse is assessing for the presence of the rooting reflex, which disappears by the age of 3 to 4 months. The presence of this reflex at 4 months is a reason for concern. 2 This is incorrect. The nurse is checking for the presence of the Babinski sign, which is elicited by stroking the sole of the foot upward, causing the toes to fan out. The sign should disappear between 9 and 12 months of age. 3 This is incorrect. The nurse is checking the presence of a palmer grasp reflex, which should weaken by 3 months and completely disappear by 6 months of age. The ability to elicit an inconsistent grasp is not a reason for concern. 4 This is incorrect. At birth, one permanent reflex is the blinking (glabellar) reflex. The reflex is elicited when a light puff of air hits the face.

A third-grade teacher discusses behavioral problems with a student. The teacher states, "He walks around class making horrible sucking noises. He does not respond to me." Which information does the nurse seek from the student's parents? 1. Ask if the student has been tested by a physician for seizure disorder. 2. Inquire if the student is either diagnosed or medicated for ADHD. 3. Ascertain if the student has experienced recent illness or a fever. 4. Suggest the student be screened for possible developmental delays.

ANS 1 1 This is correct. The student's behavior is commonly seen with complex partial seizures; the nurse needs to ask if the student has been tested for seizure disorder. Manifestations include automatisms such as lip smacking, chewing, sucking, repetitive and involuntary movements, walking, and restlessness. Consciousness is altered, but the person remains awake. 2 This is incorrect. The student's altered consciousness while remaining awake does not fit a diagnosis of ADHD. 3 This is incorrect. Complex partial seizures do not occur as a result of illness or fever; there is no identification of the cause. 4 This is incorrect. Certain conditions that cause seizure activity can also be the cause of developmental delay; however, not all seizure activity is caused by or results in developmental delays.

19. A parent brings an infant to the pediatric clinic and expresses concern about irritability and poor feeding, along with recent symptoms of flu lasting a few days. The nurse notices multiple raised mosquito bites on the infant. Which additional knowledge causes the nurse to suspect encephalitis? Select all that apply. 1. A recent local outbreak of West Nile fever 2. Bulging fontanels when in a quiet state 3. Signs of facial and eyelid weakness 4. Loss of deep tendon reflexes 5. Drooling instead of swallowing saliva

ANS 1,2 1. This is correct. Encephalitis is an acute infection of the brain related to viral infections such as the herpes simplex virus and West Nile virus. 2. This is correct. Symptoms of encephalitis in infants are irritability, poor feeding, bulging fontanels, vomiting, and body stiffness. 3. This is incorrect. Acute flaccid myelitis symptoms include weakness in the face or eyelids. 4. This is incorrect. Loss of deep tendon reflexes is associated with acute flaccid myelitis. 5. This is incorrect. Difficulty swallowing is associated with acute flaccid myelitis, which can be exhibited in an infant with drooling instead of swallowing their saliva.

18. The NICU nurse is providing care for a neonate exhibiting manifestations of congenital Zika syndrome. Which distinct features does the nurse associate with the syndrome? Select all that apply. 1. Partially collapsed skull 2. Decreased brain tissue 3. Damage to the back of the eyes 4. Multiple joint contractures 5. Agitated body movement

ANS 1,2,3,4,5 1. This is correct. A neonate with Zika virus syndrome will exhibit severe microcephaly in which the skull has partially collapsed. 2. This is correct. A neonate with Zika virus syndrome will have decreased brain tissue with a specific pattern of brain damage, including subcortical calcifications. 3. This is correct. A neonate with Zika syndrome will exhibit damage to the back of the eye, including macular scarring and focal pigmentary retinal mottling. 4. This is correct. A neonate with Zika virus syndrome will have congenital contractures such as clubfoot or arthrogryposis, a condition in which the infant is born with multiple joint contractures throughout the body. 5. This is incorrect. A neonate with Zika virus syndrome will exhibit hypertonia, which restricts body movement soon after birth.

20. A parent brings an adolescent who is 16 years of age to the pediatric clinic, because the patient is experiencing unusual sensations in the feet. The nurse learns the patient was diagnosed with type 1 diabetes mellitus as a toddler; glucose levels have always been erratic and difficult to control. Which assessment findings does the nurse expect based on the health history? Select all that apply. 1. Inability to identify a sharp or blunt sensation on the sole of the foot 2. Feet warm to the touch and capillary refill within normal limits 3. Problems with balance when standing without support 4. Toe nails smooth in appearance and nail beds pink in color 5. Signs of weakness during neuromuscular checks to the lower legs

ANS 1,3,5 1. This is correct. The nurse is likely to suspect neuropathy, which is a condition of peripheral nerve damage resulting from a metabolic or endocrine disorder such as diabetes. The inability to distinguish between a sharp or blunt sensation on the sole of the foot supports the nurse's suspicion. 2. This is incorrect. The nurse does not expect to find feet that are warm to the touch, and capillary refill to be normal with suspected diabetic neuropathy. Compromised circulation is most likely. 3. This is correct. When neuropathy of the feet is present, balance can be adversely affected by pain, tingling, and loss of sensation. This finding supports the nurse's suspicions. 4. This is incorrect. Smooth toe nails and nail beds that are pink in color indicate good circulation. 5. This is correct. The presence of neuropathy in the lower extremities can be manifested by weakness.

The nurse is gathering health information on a child who is 8 years of age. The parent reports the child is extremely difficult to wake in the morning. Which other information will prompt the nurse to recommend screening for a sleep disorder? 1. The bedroom is shared with a sibling. 2. The nurse validates the child is obese. 3. There is a TV in the child's bedroom. 4. It is difficult to get the child to bed.

ANS 2 1 This is incorrect. The fact that the patient's bedroom is shared with a sibling is an environment factor that can interrupt sleep. 2 This is correct. Obesity in a child can cause sleep apnea, which can result in heavy snoring or choking sounds during sleep, as well as daytime fatigue, irritability, or learning problems in school. This finding will prompt the nurse to recommend screening for sleep disorder. 3 This is incorrect. TV in the bedroom is a distraction that delays sleep; this is an environmental factor. 4 This is incorrect. Children who are difficult to get to bed are likely to have sleep deprivation because of resisting sleep or falling asleep late at night. This is a behavioral factor.

The nurse is collecting information about a school-age patient brought to a pediatric clinic by a parent. The parent reports several incidences of syncope. Which assessment question helps the nurse to identify a possible diagnosis of vasovagal syncope? 1. "Has your daughter been diagnosed with diabetes mellitus?" 2. "Did your child feel strange and faint after standing up?" 3. "Was your child in a stressful situation before fainting?" 4. "Does your daughter have any cardiac conditions?"

ANS 2 1 This is incorrect. This question rules out metabolic syncope, which is when a person faints in response to metabolic conditions such as hypoglycemia or hyperventilation. 2 This is correct. This question is appropriate for identifying vasovagal syncope, which is the most common type of syncope. Blood pressure drops quickly, reducing the blood flow to the brain. Standing results in a flow of blood in the lower extremities, and the autonomic nervous system needs to act in conjunction with the heart to normalize blood pressure. 3 This is incorrect. This question rules out psychogenic syncope, fainting in response to anxiety or panic. 4 This is incorrect. This question rules out cardiac syncope, a loss of consciousness because of a heart condition that interferes with blood flow to the brain.

The pediatric nurse is examining the skin of a young child and notices eight café-au-lait spots between 1.5 and 3 inches in diameter on the body, along with axillary freckling. Which recommendation does the nurse make to the parent? 1. Refrain from having additional children without counseling. 2. Make an appointment with a physician for testing and evaluation. 3. Agree to blood testing of the child to identify a defect in the NF1 gene. 4. Arrange for psychological therapy to address self-esteem problems.

ANS 2 1 This is incorrect. Without a valid diagnosis, it is not appropriate for the nurse to recommend the parents refrain from having additional children. 2 This is correct. The nurse may recognize that the child's skin manifestations are related to a strong possibility of neurofibromatosis. The nurse needs to recommend seeing a physician for testing and evaluation. 3 This is incorrect. Part of the routine testing on the child is likely to involve a blood test to evaluate for a defect in the NF1 gene. 4 This is incorrect. Once a valid diagnosis is obtained, the nurse will recommend that psychological therapy may become necessary for self-esteem issues from the presence of visible skin tumors.

4. The nurse is presenting a class to high school females about decreasing the developmental risks related to pregnancy. Which information does the nurse consider to be most important? 1. Young women should begin taking 600 mg of calcium twice a day. 2. All females of child-bearing age should take 0.4 mg of folic acid daily. 3. Early prenatal care is essential for a healthy pregnancy and baby. 4. Important fetal development occurs before pregnancy is suspected.

ANS 2 1 This is incorrect. Women at a young age should begin taking calcium supplements to promote lifelong bone health. However, calcium is not the most important information to decrease developmental risks during pregnancy. 2 This is correct. Because neural tube closure occurs before most women even know they are pregnant, it is important to teach adolescent girls to begin taking folic acid supplements before pregnancy occurs. Teen pregnancies are usually unplanned, which makes folic acid intake very important. 3 This is incorrect. It is true that early prenatal care is important for a healthy pregnancy and baby; however, the most important information is about folic acid and preventing neural tube defects. 4 This is incorrect. High school females need to be aware that all essential fetal development occurs before pregnancy is even suspected. Neural tube closure normally occurs around the 28th day after fertilization.

31. Identify a true statement about Tourettes Syndrome (TS) is that: 1. Manifestations rarely change once developed. 2. Children with TS do not have obsessive compulsive disorders. 3. The tics of TS can lead to mental deterioration. 4. The tics are involuntary, and the person cannot control the behavior.

ANS 4 1. Manifestations change related to the stress level and various other factors. 2. There is a strong correlation between TS and obsessive compulsive disorders. 3. The tics do not affect the cognitive ability of a child. 4. The tics are involuntary, and public education about this is important so that the child is not harassed about the behaviors.

17. The nurse in a pediatric unit is providing care for a 2-month-old infant just diagnosed with spinal muscle atrophy. Which characteristics of the condition does the nurse expect to find during physical assessment? Select all that apply. 1. Hyperreflexia in deep tendons 2. Few spontaneous movements 3. Deep, rapid respirations 4. Fasciculations of the tongue 5. Proximal muscle atrophy

ANS 2,4 1. This is incorrect. SMA type 1 begins in utero or early infancy and is the most serious type. The infant will exhibit a loss of deep tendon reflexes, not hyperreflexia. 2. This is correct. The infant with SMA type 1 will exhibit few spontaneous movements and will be unable to lift their head. 3. This is incorrect. The respiratory muscles are weak, and death occurs by age 3 years because of respiratory compromise. Infants who display symptoms at birth usually have a shorter life span and die before they are 12 months old. 4. This is correct. Fasciculations, or constant, wormlike movements of the tongue, are noted in the infant diagnosed with SMA type 1. 5. This is incorrect. Proximal muscle atrophy is seen in SMA type 3, a juvenile form of the disease. This manifestation is not seen with SMA type 1.

The nurse in the emergency department of a pediatric hospital is providing care for a toddler with a sudden high fever. The parent states, "She has been grumpy all day and I thought she just needed a nap." Which finding does the nurse recognize as an indication of an immediate medical emergency? 1. The toddler keeps eyes closed or covered at all times. 2. The nurse elicits a positive Brudzinski's sign. 3. A rash of scattered red bumps is found on the skin. 4. The toddler cries when head and neck are moved.

ANS 3 1 This is incorrect. Meningitis should always be suspected in acutely ill infants and children with fever and lethargy until proven otherwise; photophobia is a positive sign for meningitis. Meningitis can be a life-threatening infection and must be treated as a medical emergency; however, there is another finding that is more serious. 2 This is incorrect. Brudzinski's sign is positive for meningitis when flexion of the neck causes involuntary flexion of the knee and hip; however, there is another finding that is more serious. 3 This is correct. The scenario describes the existence of a specific bacterial infection such as Neisseria meningitides. This infection results in a purpuric rash, often combined with sepsis. Death can occur in hours after the rash appears. This finding is an immediate medical emergency. 4 This is incorrect. Meningitis is commonly associated with a stiff neck; crying when the head and neck is moved is indicative of pain.

The nurse is performing well-baby checks in a pediatric clinic. During physical examination of a 1-month-old infant, the nurse notices a dimple with a tuft of hair in the lumbar sacral area indicative of spina bifida. Which developmental delays does the nurse expect for this infant? 1. There may be issues related to bowel and bladder control. 2. Some degree of paralysis of the lower limbs is expected. 3. The infant is not expected to experience physical delays. 4. Muscles of the legs will be flaccid with some sensory loss.

ANS 3 1 This is incorrect. The infant is exhibiting the characteristics of spina bifida occulta. Issues related to bowel and bladder control are seen in spina bifida cystica or with a meningocele. 2 This is incorrect. Some degree of paralysis is common with spina bifida cystica or a meningocele. 3 This is correct. The infant is exhibiting the characteristics of spina bifida occulta, which occurs from a section of the spinal vertebrae being malformed, but the spinal cord and nerves are normal. No developmental delays are expected with this condition. 4 This is incorrect. Flaccid leg muscles and sensory loss are associated with spina bifida cystica or a meningocele.

The nurse is providing care for a pediatric patient who received a concussion while playing football. The patient had brief loss of consciousness and now reports a headache with a pain level of 6 on a 0 to 10 scale. The patient states, "My team plays again in five days and I should be better." Which information is vital for the patient and parents to understand? 1. A realistic timeframe regarding complete recovery 2. Type of equipment to prevent a second head injury 3. The risk of acquiring second impact syndrome 4. The potential for long-term headaches

ANS 3 1 This is incorrect. The nurse needs to inform the patient and parents that full recovery from a concussion may take days, weeks, or months. This information is important, but it is not considered vital. 2 This is incorrect. Information about the type of equipment is needed to avoid a second head injury is important; however, it is not vital. 3 This is correct. There is risk for a lethal condition known as second impact syndrome, in which the brain swells rapidly and the person succumbs quickly if a second concussion occurs before the first concussion has resolved. The patient's remark makes this information vitally important. 4 This is incorrect. Head injuries may or may not cause long-term headaches.

A parent brings a child who is 8 years of age to the pediatric clinic and tells the nurse, "I think he has Tourette's syndrome. He recently began some eye-blinking and grimacing actions." Which information does the nurse provide to help the parent distinguish between transient tic of childhood and Tourette's syndrome? 1. Vocal tics frequently become chronic in children with transient tic of childhood diagnosis. 2. Transient tic of childhood begins with a high level of tic activity and usually disappears completely by age 12. 3. Tourette's syndrome is a disorder of complex motor and vocal tics that have been present for more than 1 year. 4. Tourette's syndrome is a disorder of complex motor and vocal tics that develop between the ages of 3 to 8 years.

ANS 3 1 This is incorrect. Transient tic of childhood is typically a disorder of motor or vocal tics that may last for several months but not greater than 1 year. 2 This is incorrect. Transient tic of childhood occurs before the age of 10 years, may worsen around age 12 years, and usually disappears completely by age 18. 3 This is correct. Tourette's syndrome is a disorder of complex motor and vocal tics that have been present for more than 1 year and began before the child's 18th birthday. 4 This is incorrect. Transient tic of childhood is usually a simple tic that appears between the ages of 3 and 9 years and lasts for less than 1 year.

4. The first assessment a child receives to identify neurological development is: 1. APGAR scores. 2. Scoliosis testing. 3. The Denver II study. 4. Kindergarten testing.

ANS: 1 Feedback 1. APGAR stands for Appearance, Pulse, Grimace, Activity, Respiration, indicating responses of the neurological system. This testing is done right after birth. 2. Scoliosis testing does not occur until the child is a preteen. 3. The Denver II test is not used until the infant is older. 4. Kindergarten testing occurs later in the childs life.

The nurse in the newborn nursery is providing care for a neonate with an open spinal cord defect. The neonate will be transported to a pediatric surgery hospital as soon as possible. Which description of the nurse's care of the neonate is correct? 1. Using aseptic technique, place a sterile plastic bag around the defect and loosely tie it closed. 2. Place the newborn prone on a loose diaper and cover the defect with a second saline-moistened diaper. 3. Position the newborn on the side with a moistened dressing on the defect; wrap the defect and newborn in a blanket. 4. Cover the defect with a sterile dressing moistened with warm sterile normal saline, using aseptic technique.

ANS 4 1 This is incorrect. A sterile bag is not placed around the defect and loosely tied closed. 2 This is incorrect. The nurse will use aseptic technique; the defect is not covered by a second saline moistened diaper, which can be clean but is not likely to be sterile. 3 This is incorrect. The defect must remain as sterile as possible and the neonate is positioned to prevent any pressure on the defect. A side-lying position is not used, and the defect and neonate are not wrapped in a blanket. Body heat will be preserved by placing the newborn in a warmer. 4 This is correct. The nurse must exercise caution to keep the defect covered and protected until surgical correction can occur. Using aseptic technique, the nurse should cover the defect with a sterile dressing moistened with warm sterile normal saline. The neonate will be positioned prone and lying on an open diaper.

The nurse is performing a developmental assessment on a toddler at age 3 years. The nurse notices a variety of mixed developmental milestones that have been missed during the visit. Which delay does the nurse expect to be of greatest concern to the parent? 1. Difficulty putting small objects into a bottle 2. An inability to kick a ball back to the nurse 3. Difficulty with and reluctance to self-dress 4. An inability to express needs with language

ANS 4 1 This is incorrect. At the age of 3 years, it is expected that the child will have the fine motor control needed to place small objects in a bottle. The lack of this ability may or may not be the parent's greatest concern. 2 This is incorrect. At the age of 3 years, the inability to kick a ball back to the nurse is an indication of gross motor delay. This may or may not be the parent's greatest concern. 3 This is incorrect. Difficulty with and reluctance to self-dress indicates a delay in adaptive skills. This may or may not be the parent's greatest concern. 4 This is correct. Language is an important developmental milestone, and the inability to verbally express needs by the age of 3 years is a real concern. The most common parental concern is delayed development of expressive language.

The nurse is providing care for an infant at 3 months of age. The parent reports sudden flexor or extensor movements of the neck, trunk, and extremities occurring multiple times a day. The infant is diagnosed with infant spasms and is prescribed corticotropin (Acthar jell) therapy. Which instruction is most important for the nurse to provide for the parent? 1. Reason for weekly laboratory visits 2. Expected medication side effects 3. Signs and symptoms of infections 4. How to administer IM medication

ANS 4 1 This is incorrect. Corticotropin therapy requires weekly monitoring of glucose and electrolytes during therapy. The nurse will share the importance of keeping these appointments; however, another option is most important. 2 This is incorrect. The nurse will inform the parent of expected side effects, such as increased appetite, weight gain, irritability, edema, hypertension, and risk for infections. However, another option is most important. 3 This is incorrect. Because the infant on corticotropin therapy is at greater risk for infections, the nurse will instruct the parent about signs and symptoms and when to contact the physician. However, another option is most important. 4 This is correct. Corticotropin (Acthar jell) is administered IM, so the most important information for the nurse to provide to the parent is how to administer the medication.

____ 1. The nurse is assessing a 7-year-old child at a pediatric clinic. The nurse notices that several developmental milestones have been missed or are late during previous visits. The parent states, "I know she is a little slow, but she will catch up quickly." Which action by the nurse is warranted? 1. Explain to the parent that rapid development takes place in infancy and early childhood. 2. Suggest activities in the home that may improve mental and physical development. 3. Recommend that the child be placed in special classes aimed at promoting development. 4. Ask the parent detailed questions about the pregnancy, birth, and early childhood health.

ANS 4 1 This is incorrect. Explaining the expected periods and timeframes when development rapidly occurs is not beneficial to the parent. 2 This is incorrect. Suggesting home activities that improve mental and physical development may or may not be effective. Further assessment is needed to better define the findings. 3 This is incorrect. It is premature for the nurse to recommend special classes for the child. 4 This is correct. The nurse needs to further assess for possible contributing factors for the child's developmental delays. Along with information about the pregnancy, birth, and early childhood health, the nurse will explore the family health history and home environment.

The pediatric nurse in an acute care facility is providing care for a patient who is 12 years of age with a history of sickle cell anemia. During this hospitalization, it is determined that the patient has experienced a stroke. Which teaching is most important for the nurse to provide to the patient and parents? 1. A need for intensive physical and speech therapies 2. Reasons to have a designated social worker 3. The necessity for an individualized education plan 4. Manifestations of increased intracranial pressure

ANS 4 1 This is incorrect. The patient and family need teaching regarding physical, occupational, and speech therapies, which may be required for the patient's recovery. However, another need is most important. 2 This is incorrect. Caring for a child after a stroke is emotionally, physically, and financially exhausting, and the nurse needs to provide information about the benefit of having a designated social worker. However, another need is most important. 3 This is incorrect. After a pediatric patient experiences a stroke, an individualized education plan may be needed to assist the patient with academic achievement. However, another need is most important. 4 This is correct. Screening for the development of hydrocephalus in indicated, because it is a common complication of pediatric stroke. Important teaching for the patient and parents is related to the manifestations of increased intracranial pressure, which occurs with hydrocephalus.

3. The blood-brain barrier of an infant is: 1. Less permeable than that of an adult. 2. Impermeable for glucose. 3. Permeable for large proteins. 4. Permeable for large molecules

ANS: 4 Feedback 1. There is no difference between the adult and infant blood-brain barrier. 2. Glucose is permeable for the blood-brain barrier. 3. Large proteins are impermeable for the blood-brain barrier. 4. Large molecules are able to cross the blood-brain barrier.

12. A head circumference is being measured at a 4 month olds well-baby checkup. It is noted that the head circumference has not grown since the previous assessment. The nurse should: 1. Ask the mother about the childs nutrition. 2. Notify the doctor. 3. Re-measure the head circumference, check developmental milestones, assess the nutritional status, and discuss the findings with the doctor. 4. Document the normal findings.

ANS: 3 Feedback 1. Nutritional assessment is important, but not the priority intervention at this time. 2. The doctor will receive the information after a re-measurement is taken to validate the findings. 3. Re-measurement is needed to validate findings, and assessing milestones will indicate the cognitive and physical abilities of the child. Nutritional information will indicate if adequate nutrition is being given. The doctor will be able to prescribe the best course of action after this information is reported. 4. The findings are abnormal, and further investigation is needed.

27. The nurse is identifying the difference between primary headaches to secondary headaches. Secondary headaches can occur: 1. Because of stress. 2. In relation to low blood pressure. 3. Because of concussions. 4. Because of migraines.

ANS: 3 Feedback 1. Stress is a primary cause for headaches. 2. Low blood pressure is a primary cause for headaches. 3. Concussions are a cause of secondary headaches because an injury has previously occurred to the brain tissue. 4. Migraines are a primary cause for headaches.

50. The brain is divided into two sections, called hemispheres. The hemispheres behave in a particular fashion in sending messages to the body. How do the hemispheres communicate information to the body? 1. The hemispheres relay messages in a direct route. 2. The hemispheres relay messages in a random fashion. 3. The hemispheres relay messages in a contralateral fashion. 4. The hemispheres relay messages in a unilateral route.

ANS: 3 Feedback 1. The hemispheres relay messages in a contralateral fashion. 2. The hemispheres relay messages in a contralateral fashion. 3. The hemispheres relay messages in a contralateral fashion. The right hemisphere sends messages to the left side of the body, and the left hemisphere sends messages to the right side of the body. 4. The hemispheres relay messages in a contralateral fashion.

34. Identify the false statement about bacterial meningitis. 1. Bacterial meningitis can be fatal if not treated. 2. Bacterial meningitis can spread quickly. 3. Bacterial meningitis cannot be effectively treated with antibiotics. 4. Bacterial meningitis can cause hearing loss in children.

ANS: 3 Feedback 1. The illness can cause death if not treated. 2. The illness can spread quickly and be fatal without treatment. 3. Antibiotic therapy can stop the progression of the illness. 4. Because of the bacteria, the illness attacks the ear drum, creating hearing loss in children if not treated early.

6. A neonate is born with anencephaly. The prognosis for a neonate with this condition is: 1. A normal outcome. 2. A high risk for hydrocephaly. 3. Can be death. 4. Mental handicap.

ANS: 3 Feedback 1. The neonate will not have a brain, thus this is not a normal outcome. 2. The child lacks brain tissue, and hydrocephaly is not common. 3. Death is inevitable for a neonate with anencephaly because of the lack of brain structure. 4. A child with anencephaly has a very short life span, and evaluation for mental handicap is not needed.

10. A neonate was born to a 28-year-old mother with an uneventful pregnancy two hours ago. The baby was delivered via cesarean section and taken directly to the neonatal intensive care unit because of an encephalocele. The mother is coming to see the baby. The nurse should: 1. Be prepared to answer questions about the babys care and condition. 2. Leave the room and give the family time with the neonate. 3. Prepare the mother prior to entering the room about the dysmorphic features and discuss the supportive care being provided. 4. Not let the mother see the child at this point.

ANS: 3 Feedback 1. The nurse should be ready to answer questions and needs to prepare the mother for the appearance of her neonate. 2. Time with the neonate is important, but support is the priority for parents at this time. 3. Prior information before seeing the child can help reduce the shock and foster more acceptance of the neonate. 4. The mother needs to see the neonate to help create a bond.

65. When a child suffers generalized seizures, it is important for the nurse to do all of the following except: 1. Turn the child on his/her side in order to allow fluid to flow from his/her mouth. 2. Time the seizure length 3. Monitor his/her airway and placing a plastic airway or padded tongue blade in his/her mouth if necessary to keep the airway open. 4. Protect the child from injury as the body convulses.

ANS: 3 Feedback 1. The nurse should monitor the airway and place the child on his/her side, but should never place anything in the airway of a child having a seizure. 2. The nurse should monitor the airway and time the seizure, but should never place anything in the airway of a child having a seizure. 3. Do not place anything in a childs mouth during a seizure. 4. Protecting the child from injury is important during a seizure.

37. A common trait of Beckers Muscular Dystrophy is: 1. Progressive weakness in the trunk and arms over time. 2. A quick rate of deterioration of the body. 3. Cardiomyopathy. 4. Usually diagnosed by the age of 3.

ANS: 3 Feedback 1. This type of dystrophy has weakening in the legs and pelvis areas. 2. This particular type of muscular dystrophy has a longer life expectancy than most other types of muscular dystrophy. 3. Cardiomyopathy occurs because of abnormality in the protein dystrophin in the body. 4. First diagnosis usually does not occur until between the ages 5 and 15.

28. Cyclic vomiting may: 1. Last for days. 2. Require SSRIs to stop hurting. 3. Not be associated with a headache. 4. Requires pain medication and Zofran.

ANS: 3 Feedback 1. Usually short lived 2. SSRIs are not an effective method of pain control for the vomiting. 3. The vomiting can occur for random reasons, but a headache is not a symptom. 4. Pain medication is not usually required to stop the vomiting.

48. Which cranial nerves are involved in sending impulses that are responsible for autonomic functions, like heart beat and the gag reflex? 1. Cranial nerves VII and IX 2. Cranial nerves IX, X, and XI 3. Cranial nerves IX and X 4. Cranial nerves X and XII

ANS: 3 Feedback1.Cranial nerves IX, the Glossopharyngeal, and X, the Vagus, send impulses to the heart and throat.2.Cranial nerve XI assesses the Spinal Accessory.3.Cranial nerve X assesses the Vagus.4.Cranial Nerve X assesses the Vagus, and Cranial Nerve XII assesses the Hypoglossal.

11. A child born with Dandy Walker malformation is receiving palliative care in the pediatric unit. A nurse should: 1. Provide the parents, patient, and family members with supportive care during this time. 2. Ask the parents to be part of the plan of care as much as possible. 3. Attempt to provide a primary nurse for this particular patient on each shift. 4. All of the above are correct.

ANS: 4 Feedback 1. Family support is important in order to provide a high quality of life in a limited amount of time. 2. Parental involvement will create a bond with the child and empower the parents. 3. A primary nurse is able to form a bond with the family and understand the needs of the child because of frequent interactions. 4. Family support is important in order to provide a high quality of life in a limited amount of time. Parental involvement will create a bond with the child and empower the parents. A primary nurse is able to form a bond with the family and understand the needs of the child because of frequent interactions.

7. A child with severe mental and physical handicaps is at risk for: 1. Developing neurocutaneous lesions. 2. A dysmorphic nose and ears. 3. Abnormal cranial nerve function. 4. All of the above are correct.

ANS: 4 Feedback 1. Neurocutaneous lesions occur because of high risk for lack of physical movement. 2. Bone structure may be dysmorphic because of chronic abnormal muscle movements and contractures. 3. Because of neurological dysfunction, cranial nerve function will be abnormal. 4. Neurocutaneous lesions occur because of high risk for lack of physical movement. Bone structure may be dysmorphic because of chronic abnormal muscle movements and contractures. Because of neurological dysfunction, cranial nerve function will be abnormal.

66. Headaches and migraines are common in children and adolescents. In assessing the severity of the headaches in children, the nurse must understand the ability of the child to describe his/her symptoms. What would be an incorrect step for a nurse to take when assessing headache pain in a young child? 1. Use an approved pain scale, such as the Wong-Baker Faces Pain Rating Scale. 2. Note the mother or caregivers report. 3. Note the childs behavior. 4. Note the nurses own beliefs about childrens perception of pain.

ANS: 4 Feedback 1. Pain scales enable the patient to describe the level of pain for documentation and therapy purposes. 2. Caregivers and parents of children are the best sources for information because they know the child the best and can more accurately assess the pain. 3. A child in pain will exhibit irritability and want to pull away from any painful stimulus. 4. Pain is a subjective phenomenon. Young children are often unable to verbalize their symptoms and must be helped when describing their feelings by use of approved pain scales and words that they can understand.

61. What are characteristics of a seizure? 1. Loss of awareness 2. Twitching movements of a part of the body 3. Rhythmic jerking movements of an extremity 4. All of the above

ANS: 4 Feedback 1. Symptom of a seizure 2. Symptom of a seizure 3. Symptom of a seizure 4. Seizures can take many forms, including staring, blinking, twitching, drooling, rigidity, atonic muscles, eye deviation and convulsions.

1. The autonomic nervous system is responsible for: 1. Digesting a meal of hotdogs and chips. 2. Monitoring the heart rate while running. 3. Causing the body to perspire in the hot sun. 4. All of the above are part of the autonomic nervous system.

ANS: 4 Feedback 1. The ANS helps with the digestion of food. 2. The heart is regulated by the ANS. 3. Perspiration occurs because of the ANS for the purpose of thermoregulation. 4. The ANS helps with the digestion of food. The heart is regulated by the ANS. Perspiration occurs because of the ANS for the purpose of thermoregulation.

49. Which, if any is not true about the brainstem? 1. It contributes to the regulation of the heart rate and respirations, as well as the bodys ability to manage consciousness and sleep patterns. 2. It controls autonomic behaviors necessary for the body to survive. 3. It connects with the spinal cord and houses the connections between the motor and sensory portions of the brain to the rest of the body. 4. It houses the cranial nerves.

ANS: 4 Feedback 1. The brainstem aids in the regulation of patterns in the body. 2. The brainstem is responsible for controlling the autonomic behaviors of the body. 3. The brainstem connects the spinal cord to the motor-sensory portions of the brain. 4. The brainstem houses 10 of the 12 pairs of cranial nerves.

57. When assessing for a developmental delay, which element(s) of the childs history would have a significant impact on reaching developmental milestones? 1. Poverty 2. Neglectful parenting 3. Cultural differences 4. All of the above

ANS: 4 Feedback 1. The childs socioeconomic status has a direct impact on the childs ability to meet developmental milestones. 2. Lack of parental interaction has a direct impact on the childs ability to meet developmental milestones. 3. Cultures each have a set of norms and values which have a direct impact on the childs ability to meet developmental milestones. 4. The childs socioeconomic status, parental connections, and culture have a direct impact on the childs ability to meet developmental milestones.

63. Which of the following statements about temporal lobe epilepsy are true? 1. Temporal lobe epilepsy is the most common partial seizure epilepsy. 2. Temporal lobe seizures are often resistant to treatment. 3. Temporal lobe epilepsy is often associated with a specific lesion in the temporal lobe, called hippocampal sclerosis. 4. All of the above

ANS: 4 Feedback 1. The most common partial seizure for epilepsy is temporal lobe. 2. Temporal lobe seizures have a high rate of resistance to treatment. 3. The hippocampal sclerosis can sometimes be surgically removed, which can stop or diminish seizure activity. 4. The hippocampal sclerosis can sometimes be surgically removed, which can stop or diminish seizure activity.

52. In the neural tube defect spina bifida, which of the following problems can the nurse expect the child to exhibit? 1. Problems walking 2. Partial or complete paralysis of the legs 3. Problems with bowel or bladder control 4. All of the above

ANS: 4 Feedback 1. There are different types of spina bifida, and the degree of severity will depend on how severely the child is affected. 2. There are different types of spina bifida, and the degree of severity will depend on how severely the child is affected. 3. There are different types of spina bifida, and the degree of severity will depend on how severely the child is affected. 4. There are different types of spina bifida, and the degree of severity will depend on how severely the child is affected.

8. Neural tube defects can be linked to: 1. A mothers drug habit while pregnant. 2. A mothers lack of folic acid while pregnant. 3. A fetuss exposure to environmental toxins. 4. A mothers alcohol consumption while pregnant.

NS: 2 Feedback 1. Drug habits can be linked to neurological damage and growth retardation. 2. Folic acid is needed for neural tube closure and should be taken as a prenatal vitamin. 3. Exposure to toxins can cause various cognitive and physical anomalies. 4. Alcohol can cause cognitive and physical anomalies if taken while pregnant.

Which of the following manifestations suggests that an infant is developing NEC? 1. The infant absorbs bolus orogastric feedings at a faster rate than previous feedings. 2. The infant has bloody diarrhea. 3. The infant has increased bowel sounds. 4. The infant appears hungry right before a scheduled feeding

2. Bloody diarrhea can indicate that the infant has NEC TEST-TAKING HINT: The test taker needs to be familiar with manifestations of NEC and be led to select answer 2.

The nurse in a diabetic clinic sees a 10-year-old who is a new diabetic and has had trouble maintaining blood glucose levels within normal limits. The patient's parent states the child has had several daytime "accidents." The nurse knows that this is referred to as which of the following? 1. Primary enuresis. 2. Secondary enuresis. 3. Diurnal enuresis. 4. Nocturnal enuresis.

2. Secondary enuresis refers to urinary incontinence in a child who previously had bladder control TEST-TAKING HINT: The test taker should be led to answer 2 because a disease process causes the child's enuresis.

The parents of a 4-year-old ask the nurse how to manage their child's constipation. Select the nurse's best response. 1. "Add 2 ounces of apple or pear juice to the child's diet." 2. "Be sure your child eats a lot of fresh fruit such as apples and bananas." 3. "Encourage your child to drink more fluids." 4. "Decrease bulky foods such as whole-grain breads and rice."

3. Increasing fluid consumption helps to decrease the hardness of the stool. TEST-TAKING HINT: Answer 1 decreases constipation in the infant but not in the preschooler.

The nurse is caring for an 8-week-old infant being evaluated for pyloric stenosis. Which of the following statements made by the parents would be typical of a child with this diagnosis? 1. "The baby is a very fussy eater and just does not want to eat." 2. "The baby tends to have a very forceful vomiting episode approximately 30 minutes after most feedings." 3. "The baby is always hungry." 4. "The baby is happy in spite of getting really upset on spitting up."

3. Infants with pyloric stenosis are always hungry and often appear malnourished. TEST-TAKING HINT: Recall the dynamics of pyloric stenosis. Because feedings are not absorbed, the infant is irritable and hungry. The test taker can eliminate answers 1 and 4 and select answer 3.

The nurse is caring for a 1-month-old term infant who experienced an anoxic episode at birth. The health-care team suspects that the infant is developing NEC. Which of the following would the nurse expect to be included in the plan of care? 1. Immediately remove the feeding NGT from the infant. 2. Obtain vital signs every 4 hours. 3. Prepare to administer antibiotics intravenously. 4. Change feedings to half-strength and administer slowly via a feeding pump.

3. Intravenous antibiotics are administered to prevent or treat sepsis. TEST-TAKING HINT: The test taker needs to consider the plan of care for an infant with NEC. This child is at risk for becoming critically ill, so feedings are stopped and vital signs are monitored very closely

The nurse is caring for an infant with pyloric stenosis. The parents ask if any future children will likely have pyloric stenosis. Select the nurse's best response. 1. "You seem worried; would you like to discuss your concerns?" 2. "It is very rare for a family to have more than one child with pyloric stenosis." 3. "Pyloric stenosis can run in families. It is more common among males." 4. "Although there can be a genetic link, it is very unusual for girls to have pyloric stenosis."

3. Pyloric stenosis can run in families, and it is more common in males. TEST-TAKING HINT: The test taker needs to be familiar with pyloric stenosis.

The nurse is giving discharge instructions to the parents of a 1-month-old infant with tracheoesophageal atresia. The infant is being discharged with a GT. The nurse knows that the parents understand the discharge teaching when the mother states: 1. "I will give my baby feedings through the GT but place liquid medications in the corner of the mouth to be absorbed." 2. "I will flush the GT with 2 ounces of water after each feeding to prevent the GT from clogging." 3. "I will clean the area around the GT with soap and water every day." 4. "I will place petroleum jelly around the GT if any redness develops."

3. The area around the GT should be cleaned with soap and water to prevent an infection. TEST-TAKING HINT: The test taker should immediately eliminate answer 1 because medications and feedings can be placed in the GT. The test taker should recall that 2 ounces of water after each feeding is a large amount (recalling that infants are typically fed at least every 4 hours).

A nurse working in an emergency room of a large pediatric hospital receives a transfer call from a reporting nurse at a local community hospital. The nurse will soon receive a 4-month-old who has been diagnosed with an intussusception. The infant is described as very lethargic with the following vital signs, T 101.8°F (38.7°C), HR 181, BP 68/38. The reporting nurse states the infant's abdomen is very rigid. Which of the following is the most appropriate action for the receiving nurse? 1. Prepare to accompany the infant to a computed tomography scan to confirm the diagnosis. 2. Prepare to accompany the infant to the radiology department for a reducing enema. 3. Prepare to start a second intravenous line to administer fluids and antibiotics. 4. Prepare to get the infant ready for immediate surgical correction.

4. Intussusception with peritonitis is a surgical emergency, so preparing the infant for surgery is the nurse's top priority. TEST-TAKING HINT: The child has already been diagnosed and is displaying signs of shock and peritonitis. The nurse must act quickly and get the child the surgical attention needed to avoid disastrous consequences.

Which of the following medications would most likely be included in the postoperative care of a child with repair of bladder exstrophy? 1. Lasix. 2. Mannitol. 3. Meperidine. 4. Oxybutynin.

4. Oxybutynin is used to control bladder spasms. TEST-TAKING HINT: The test taker can eliminate answer 2 because mannitol is a diuretic that is used for central nervous system edema.

The nurse is caring for an 8-week-old male who has just been diagnosed with Hirschsprung disease. The parents ask what they should expect. Select the nurse's best response. 1. "It is really an easy disease to manage. Most children are placed on stool softeners to help with constipation until the constipation resolves." 2. "A permanent stool diversion, called a colostomy, will be placed by the surgeon to bypass the narrowed area." 3. "Daily bowel irrigations will help your child maintain regular bowel habits." 4. "Although your child will require surgery, there are different ways to manage the disease, depending on how much of your child's bowel is involved."

4. The aganglionic portion needs to be removed. Although most children have a temporary colostomy placed, many infants are able to bypass the colostomy and have the bowel immediately reattached. TEST-TAKING HINT: The test taker should be led to answer 4 as it is the least restrictive of all answers and is the only one that states that the child will require surgery. All children with Hirschsprung disease are managed surgically.

The nurse is reviewing the basic anatomy and physiology of the genitourinary system. The nurse knows that the bladder capacity of a 3-year-old could be estimated to be approximately how much? 1. 1.5 oz. 2. 3 oz. 3. 4 oz. 4. 5 oz.

4. The capacity of the bladder can be estimated by adding 2 to the child's age in years. TEST-TAKING HINT: The test taker can eliminate answer 1 because 1.5 oz represents a very small bladder capacity.

The nurse is interviewing the parents of a 6-year-old who has been experiencing constipation. Which of the following could be a causative factor? Select all that apply. 1. Hypothyroidism. 2. Muscular dystrophy. 3. Myelomeningocele. 4. Drinks a lot of milk. 5. Active in sports

1, 2, 3, 4. 1. Hypothyroidism can be a causative factor in constipation. 2. Weakened abdominal muscles can be seen in muscular dystrophy and can lead to constipation. 3. Myelomeningocele affects the innervation of the rectum and can lead to constipation. 4. Excessive milk consumption can lead to constipation TEST-TAKING HINT: The test taker has to know which of these conditions can cause constipation.

The parents of a child being evaluated for celiac disease ask the nurse why it is important to make dietary changes. Select the nurse's best response. 1. "The body's response to gluten causes damage to the mucosal cells in the intestine, leading to absorption problems." 2. "When the child with celiac disease consumes anything containing gluten, the body responds by creating specials cells called villi, which leads to more diarrhea." 3. "The body's response to gluten causes the intestine to become more porous and hang on to more of the fat-soluble vitamins, leading to vitamin toxicity." 4. "The body's response to gluten causes damage to the mucosal cells, leading to malabsorbtion of water and hard, constipated stools."

1. The inability to digest protein leads to an accumulation of an amino acid that is toxic to the mucosal cells and villi, leading to absorption problems TEST-TAKING HINT: The test taker needs to recall the pathophysiology of celiac disease in order to select answer 1. By recalling that the child with celiac usually appears malnourished and experiences diarrhea, the test taker can eliminate answers 3 and 4.

The nurse is caring for a 7-year-old with glomerulonephritis. Which of the following findings requires immediate attention? 1. The child sleeps most of the day and is very "cranky" when awake; blood pressure is 170/90. 2. The child's urine output is 190 mL in an 8-hour period and is the color of Coca Cola. 3. The child complains of a severe headache and photophobia. 4. The child refuses breakfast and lunch and states that he "just is not hungry."

3. A severe headache and photophobia can be signs of encephalopathy due to hypertension, and the child needs immediate attention TEST-TAKING HINT: The test taker should eliminate answers 1, 2, and 4 because they are manifestations of glomerulonephritis

The nurse is working in the pediatric clinic and is seeing many children with diarrhea. Which of the following children can most likely be discharged without further evaluation? 1. A 2-year-old who has had 24 hours of watery diarrhea that has changed to bloody diarrhea in the past 12 hours. 2. A 10-year-old who has just returned from a Scout camping trip. 3. A 2-year-old who had a relapse of one diarrhea episode after restarting a normal diet. 4. A 6-year-old who has been having vomiting and diarrhea for 2 days and has decreased urine output.

3. It is common for children to have a relapse of diarrhea after resuming a regular diet. TEST-TAKING HINT: The test taker should eliminate answers 1 and 4 because they describe children who may have altered electrolytes and blood counts due to prolonged diarrhea.

The nurse is caring for a 3-month-old infant who has SBS and has been receiving TPN. The parents ask if their child will ever be able to eat. Select the nurse's best response. 1. "Children with SBS are never able to eat and must receive all of their nutrition in intravenous form." 2. "You will have to start feeding your child because children cannot be on TPN longer than 6 months." 3. "We will start feeding your child soon so that the bowel continues to receive stimulation." 4. "Your child will start receiving tube feedings soon but will never be able to eat by mouth."

3. It is important to begin feedings as soon as the bowel is healed so that it receives stimulation and does not atrophy TEST-TAKING HINT: The test taker could eliminate answers 1 and 4 as they contain the word "never," which is rarely used in health-care scenarios.

The nurse receives a call from the parent of a 10-month-old who has vomited three times in the past 8 hours. The parent describes the baby as playful and wanting to drink. The parent asks the nurse what to give the child. Select the nurse's best response. 1. "Replace the next feeding with regular water, and see if that is better tolerated." 2. "Do not allow your baby to eat any solids; give half the normal formula feeding, and see if that is better tolerated." 3. "Do not allow your baby to eat or drink anything for 24 hours to give the stomach a chance to rest." 4. "Give your child a very small amount of Pedialyte. If vomiting continues, wait a half hour, and then give half of what you previously gave."

4. Offering small amounts of clear liquids is usually well tolerated. The amount can be halved if the child vomits as long as the child does not appear to be dehydrated. The child in this scenario is described as playful and therefore does not appear to be at risk for dehydration. TEST-TAKING HINT: The test taker should eliminate answers 1 and 3 because they could cause harm to the infant.

Which of the following children may need extra fluids to prevent dehydration? Select all that apply. 1. A 7-day-old receiving phototherapy. 2. A 6-month-old with newly diagnosed pyloric stenosis. 3. A 2-year-old with pneumonia. 4. A 13-year-old who has just started her menses. 5. A 2-year-old with full-thickness burns to the chest, back, and abdomen.

1, 2, 3, 5. 1. The lights in phototherapy increase insensible fluid loss, requiring the nurse to monitor fluid status closely. 2. The infant with pyloric stenosis is likely to be dehydrated due to persistent vomiting. 3. A 2-year-old with pneumonia may have increased insensible fluid loss due to tachypnea associated with respiratory illness. The nurse needs to monitor fluid status cautiously because fluid overload can result in increased respiratory distress. 5. The child with a burn experiences extensive extracellular fluid loss and is at great risk for dehydration. The younger child is at greater risk due to greater proportionate body surface area. TEST-TAKING HINT: The test taker needs to know that an infant needing phototherapy, an infant with persistent vomiting, a child with pneumonia, and a child with burns require more fluids because of the risk of dehydration.

The nurse is caring for a 6-year-old in the early stages of acute hepatitis. Which of the following manifestations should the nurse expect to find? 1. Nausea, vomiting, and generalized malaise. 2. Nausea, vomiting, generalized malaise, and pain in the left upper quadrant. 3. Nausea, vomiting, generalized malaise, and yellowing of the skin and sclera. 4. Yellowing of the skin and sclera without any other generalized complaints.

1. The early stages of acute hepatitis are referred to as the anicteric phase, during which the child usually complains of nausea, vomiting, and generalized malaise. TEST-TAKING HINT: The test taker needs to be familiar with the manifestations of acute hepatitis. Knowing that the early stage is referred to as the anicteric phase, answers 3 and 4 can be eliminated.

A 16-month-old is admitted to the pediatric unit with a diagnosis of hydronephrosis. Which of the following should be included in the plan of care? 1. Intake and output as well as vital signs should be strictly monitored. 2. Fluids and sodium in the diet should be limited. 3. Steroids should be administered as ordered. 4. The child's contact with other people should be limited to avoid infectio

1. Fluid status is monitored to ensure adequate urinary output. Assessing blood pressure monitors kidney function. TEST-TAKING HINT: The test taker can eliminate answer 2 because fluids and sodium are not eliminated from the child's diet.

The nurse receives a call from the mother of a 6-month-old who describes her child as sleepy and fussy. She states that her infant vomited once this morning and had two episodes of diarrhea. The last episode contained mucus and a small amount of blood. She asks the nurse what she should do. Select the nurse's best response. 1. "Your infant will need to have some tests in the emergency room to determine if anything serious is going on." 2. "Try feeding your infant in about 30 minutes; in the event of repeat vomiting, bring the infant to the emergency room for some tests and intravenous rehydration." 3. "Many infants display these symptoms when they develop an allergy to the formula they are receiving; try switching to a soy-based formula." 4. "Do not worry about the blood and mucus in the stool; it is not unusual for infants to have blood in their stools because their intestines are more sensitive."

1. The infant is displaying signs of intussusception. This is an emergency that needs to be evaluated to prevent ischemia and perforation. TEST-TAKING HINT: The child is described as lethargic and is having diarrhea and vomiting. This child needs to be seen to rule out an intussusception. At the very least, the mother should be told to bring the child to the emergency room because the described signs could also be seen in severe dehydration. The test taker should be led to select answer 1.

The nurse is providing discharge instructions to the parents of an infant who has had surgery to open a low imperforate anus. The nurse knows that the discharge instructions have been understood when the child's parents say which of the following? 1. "We will use an oral thermometer because we cannot use a rectal one." 2. "We will call the physician if the stools change in consistency." 3. "Our infant will never be toilet-trained." 4. "We understand that it is not unusual for our infant's urine to contain stool."

2. A change in stool form is important to report because it could indicate stenosis of the rectum TEST-TAKING HINT: The test taker should eliminate answer 3 as it contains the word "never." There are very few circumstances in health care in which "never" is the case

The nurse is working in a pediatric urgent care clinic. Which of the following patients can be discharged without the need for a urinalysis to evaluate for a UTI? 1. A 4-month-old female who presents with a 2-day history of fussiness and poor appetite; her current vital signs include T 100.8°F (38.2°C) (axillary) and heart rate 120 beats per minute. 2. An 8-year-old male who presents with a finger laceration; his mother states he had surgical reimplantation of his ureters 2 years ago. 3. A 12-year-old female complaining of pain to her lower right back; she denies any burning or frequency at this time; she has an oral temperature of 101.5°F (38.6°C). 4. A 4-year-old female who states "it hurts when I pee"; her parent states that she has been asking to urinate every 30 minutes; vital signs are within normal range.

2. Although this child has had a history of urinary infections, the child is currently not displaying any signs and therefore does not need a urinalysis at this time. TEST-TAKING HINT: The test taker should be led to answer 2 because it states that the child is not currently having any manifestations of a UTI.

The nurse is caring for a 3-week-old female diagnosed with an inguinal hernia. The nurse knows that which of the following protruding into the groin most likely caused the inguinal hernia? 1. Bowel. 2. Fallopian tube. 3. Large thrombus formation. 4. Muscle tissue

2. Fallopian tube or an ovary is the most common tissue to protrude into the groin in females. TEST-TAKING HINT: The test taker should be led to answer 2 because the question specifically states that the child is a female

The nurse is caring for a newborn with a cleft lip and palate. The mother states, "I will not be able to breastfeed my baby." Select the nurse's best response. 1. "It sounds like you are feeling discouraged. Would you like to talk about it?" 2. "Sometimes breastfeeding is still an option for babies with a cleft lip and palate. Would you like more information?" 3. "Although breastfeeding is not an option, you have the option of pumping your milk and then feeding it to your baby with a special nipple." 4. "We usually discourage breastfeeding babies with cleft lip and palate as it puts them at an increased risk for aspiration."

2. Some mothers are able to breastfeed their infants who have a cleft lip and palate. The breast can help fill in the cleft and help the infant create suction TEST-TAKING HINT: The test taker should be led to select answer 2 because the breast can sometimes act to fill in the cleft.

The nurse is caring for a 3-month-old male who is being evaluated for possible Hirschsprung disease. His parents call the nurse and state that his diaper contains a large amount of mucus and bloody diarrhea. The nurse notes that the infant is irritable and his abdomen appears very distended. Which of the following should be the nurse's next action? 1. Reassure the parents that this is an expected finding and not uncommon. 2. Call a code for a potential cardiac arrest, and stay with the infant. 3. Immediately obtain all vital signs with a quick head-to-toe assessment. 4. Obtain a stool sample for occult blood.

3. All vital signs need to be evaluated because the child with enterocolitis can quickly progress to a state of shock. A quick head-to-toe assessment will allow the nurse to evaluate the child's circulatory system. TEST-TAKING HINT: The test taker should select answer 3 because there is not enough information to determine the status of the child. Obtaining vital signs will help the nurse to assess the situation.

A 5-year-old is being discharged from the hospital following the diagnosis of HUS. The child has been free of diarrhea for 1 week, and renal function has returned. The parent asks the nurse when the child can return to school. What is the nurse's best response? 1. "Immediately, as your child is no longer contagious." 2. "It would be best to keep your child home for a few more weeks because the immune system is weak, and there could be a relapse of HUS." 3. "Your child will be contagious for approximately another 10 days, so it is best to not allow a return just yet." 4. "It would be best to keep your child home to monitor urinary output."

3. Children with HUS are considered contagious for up to 17 days after the resolution of diarrhea and should be placed on contact isolation. TEST-TAKING HINT: The test taker can eliminate answer 1 because the child is still considered contagious.

The parents of a child hospitalized with MCNS ask why the last blood test revealed elevated lipids. What is the nurse's best response? 1. "If your child had just eaten a fatty meal, the lipids may have been falsely elevated." 2. "It's not unusual to see elevated lipids in children because of the dietary habits of today." 3. "Since your child is losing so much protein, the liver is stimulated and ends up making more lipids." 4. "Your child's blood is very concentrated because of the edema, so the lipids are falsely elevated."

3. In MCNS, the lipids are truly elevated. Lipoprotein production is increased because of the increased stimulation of the liver hypoalbuminemia. TEST-TAKING HINT: The test taker can eliminate answers 1 and 2 because they do not represent changes associated with a disease process.

The nurse is caring for a 4-year-old who weighs 15 kg. At the end of a 10-hour period, the nurse notes the urine output to be 150 mL. What action does the nurse take? 1. The nurse notifies the physician because this urine output is too low. 2. The nurse encourages the patient to increase oral intake in order to increase urine output. 3. The nurse records the patient's urine output in the chart. 4. The nurse administers isotonic fluid intravenously to help with the rehydration process.

3. Recording the patient's urine output in the chart is the appropriate action because the urine output is within the expected range of 0.5-1 mL/kg/hr. TEST-TAKING HINT: The test taker can eliminate answers 1, 2, and 4 because they address strategies for caring for a dehydrated child

The nurse is caring for a 4-month-old with GER. The infant is due to receive Reglan (metoclopramide). Based on the medication's mechanism of action, whenshould this medication be administered? 1. Immediately before a feeding. 2. 30 minutes after the feeding. 3. 30 minutes before the feeding. 4. At bedtime.

3. Reglan increases gastric emptying and should be administered 30 minutes TEST-TAKING HINT: The test taker needs to be familiar with the administration of Reglanbefore a feeding.

A 6-week-old male is scheduled for a hypospadias and chordee repair. The parent tells the nurse, "I understand why the hypospadias repair is necessary, but do they have to fix the chordee as well?" What is the nurse's best response? 1. "I understand your concern. Parents do not want their children to undergo extra surgery." 2. "The chordee repair is done strictly for cosmetic reasons that may affect your son as he ages." 3. "The repair is done to optimize his sexual function when he is older." 4. "This is the best time to repair the chordee because he will be having surgery anyway."

3. Releasing the chordee surgically is necessary for future sexual function. TEST-TAKING HINT: The test taker should be led to answer 3 because it provides the parents with a simple, accurate explanation.

The nurse is instructing a group of girls and parents about the importance of preventing UTIs. Which of the following should the nurse teach? 1. Avoiding constipation has no effect on the occurrence of UTIs. 2. After urinating, always wipe from back to front to prevent fecal contamination. 3. Hygiene is an important preventive measure and can be accomplished with frequent tub baths. 4. Increasing fluids will help prevent and treat UTIs.

4. Increasing fluids will help flush the bladder of any organism, encouraging urination and preventing stasis of urine. TEST-TAKING HINT: The test taker can eliminate answers 1, 2, and 3 because they do not provide accurate information.

A 20-month-old is admitted with hydronephrosis. The nurse notes which of the following findings? 1. Increased blood pressure, metabolic alkalosis, polydipsia, and polyuria. 2. Increased blood pressure, metabolic acidosis, and bacterial growth in the urine. 3. Increased blood pressure, metabolic alkalosis, and bacterial growth in the urine. 4. Increased blood pressure, metabolic acidosis, polydipsia, polyuria, and bacterial growth in the urine

4. The blood pressure is increased as the body attempts to compensate for the decreased glomerular filtration rate. Metabolic acidosis is caused by a reduction in hydrogen ion secretion from the distal nephron. Polydipsia and polyuria occur as the kidney's ability to concentrate urine decreases. There is bacterial growth in the urine due to the urinary stasis caused by the obstruction. TEST-TAKING HINT: The test taker can eliminate answers 1 and 3 because hydronephrosis does not lead to metabolic alkalosis.

The day surgery nurse knows that the parent of a 13-year-old male understands postoperative teaching for a repair of testicular torsion by saying which the following? 1. "We will encourage him to rest for a few days, but he can return to football practice in a week." 2. "We will keep him in bed for 4 days and let him gradually increase his activity after that." 3. "We will seek therapy as he ages because he is now infertile." 4. "We will make sure he knows how to do testicular self-examination on a monthly basis."

4. The child and family should be taught the importance of testicular selfexamination. TEST-TAKING HINT: The test taker can eliminate answer 1 because this activity could place the postoperative child at risk for injury

The nurse is in the room while a mother of a newborn is feeding her infant for the first time. The baby immediately begins coughing and choking. The nurse notes that the baby is extremely cyanotic. Which of the following should be the nurse's immediate action? 1. Call the physician, and inform the physician of the situation. 2. Have the mother stop feeding the infant, and observe to see if the choking episode resolves on its own. 3. Immediately determine the infant's oxygen saturation, and have the mother stop feeding the infant. 4. Take the infant from the mother, and administer blow-by oxygen while obtaining the infant's oxygen saturation.

4. The infant should be taken from the mother and placed in the crib where the nurse can assess the baby. Oxygen should be administered immediately, and vital signs should be obtained. TEST-TAKING HINT: The test taker should be led to answer 4 because the baby is cyanotic and needs oxygen.

The nurse is caring for a 4-week-old infant with biliary atresia. Which of the following manifestations would the nurse expect to see? 1. Abdominal distention, enlarged liver, enlarged spleen, clay-colored stool, and tea-colored urine. 2. Abdominal distention, multiple bruises, bloody stools, and hematuria. 3. Yellow sclera and skin tones, excessively oily skin, and prolonged bleeding times. 4. No manifestations until the disease has progressed to the advanced stage

1. The infant with biliary atresia usually has an enlarged liver and spleen. The stools appear clay-colored due to the absence of bile pigments. The urine is teacolored due to the excretion of bile salts. TEST-TAKING HINT: The test taker needs to be familiar with the manifestations of biliary atresia and should be led to select answer 1.

An expectant mother asks the nurse if her new baby will likely have an umbilical hernia. The nurse bases the response on which of the following? 1. Umbilical hernias occur more often in large infants. 2. Umbilical hernias occur more often in white infants than in African-American infants. 3. Umbilical hernias occur twice as often in male infants. 4. Umbilical hernias occur more often in premature infants.

4. Umbilical hernias occur more often in premature infants. TEST-TAKING HINT: The test taker needs to be familiar with the occurrence of umbilical hernias.