Lots of NCLEX Pediatrics questions

A mother brings her 2-month old child in for a well baby visit and reports concern that the child has its eyes crossed most of the time. What is the most appropriate response by the nurse? Select all that apply A. "It is ok for baby to cross her eyes at this age. After 4 months they will gain the ability to focus" B. "Sometimes infants need to have glasses to help them focus their eyes" C. "Babies can sometimes do this, but it is a completely normal thing for baby to do" D. "Well that is no good, we need to get her into see a pediatric opthamologist" E. "That seems a little harsh, you should love your baby no matter if they have crossed eyes or not"

A. "It is ok for baby to cross her eyes at this age. After 4 months they will gain the ability to focus" C. "Babies can sometimes do this, but it is a completely normal thing for baby to do"

The nurse is caring for a client with otitis media. Nursing interventions to treat this condition include which of the following? Select all that apply. A. Administer prescribed antibiotics B. Talk softly to the client C. Irrigate the ear daily D. Position on the affected side to facilitate drainage E. Use Q-tips to collect drainage

A. Administer prescribed antibiotics D. Position on the affected side to facilitate drainage

A nurse is caring for a client who is experiencing farsightedness. The nurse knows another name for this is which of the following? A. Hyperopia B. Myopia C. Ambylopia D. Strabismus

A. Hyperopia

The nurse is caring for a child with acute otitis media. Which of the following are appropriate nursing interventions for this child? Select all that apply. A. Instruct the parent to administer systemic antibiotics B. Instruct the parent to administer analgesics C. Instruct the parent to administer topical antibiotics D. Instruct the parent to monitor for drainage of the ear E. Instruct the parent in ear irrigation

A. Instruct the parent to administer systemic antibiotics B. Instruct the parent to administer analgesics D. Instruct the parent to monitor for drainage of the ear

2. The assessment that would lead the nurse to suspect that a newborn infant has a ventricular septal defect is: a. a loud, harsh murmur with a systolic tremor. b. cyanosis when crying. c. blood pressure higher in the arms than in the legs. d. a machinery-like murmur.

ANS: A A loud, harsh murmur combined with a systolic thrill is characteristic of a ventricular septal defect.

10. The nurse explained how to position an infant with tetralogy of Fallot if the infant suddenly becomes cyanotic. The nurse can determine the father understood the instructions when he states "If the baby turns blue, I will: a. hold him against my shoulder with his knees bent up toward his chest." b. lay him down on a firm surface with his head lower than the rest of his body." c. immediately put the baby upright in an infant seat." d. put the baby in supine position with his head elevated."

ANS: A In the event of a paroxysmal hypercyanotic or "tet" spell, the infant should be placed in a knee-chest position.

9. The nurse is caring for a child with a diagnosis of Kawasaki disease. The child's parent asks the nurse, "How does Kawasaki disease affect my child's heart and blood vessels?" The nurse's response is based on the understanding that: a. inflammation weakens blood vessels, leading to aneurysm. b. increased lipid levels lead to the development of atherosclerosis. c. untreated disease causes mitral valve stenosis. d. altered blood flow increases cardiac workload with resulting heart failure.

ANS: A Inflammation of vessels weakens the walls of the vessels and often results in aneurysm.

1. The nurse explains that a ventricular septal defect will allow: a. blood to shunt left to right, causing increased pulmonary flow and no cyanosis. b. blood to shunt right to left, causing decreased pulmonary flow and cyanosis. c. no shunting because of high pressure in the left ventricle. d. increased pressure in the left atrium, impeding circulation of oxygenated blood in the circulating volume.

ANS: A Pulmonary blood flow is increased when a ventricular septal defect exists. The blood shifts from left to right because of the higher pressure in the left ventricle. This particular shift does not cause cyanosis.

4. When a father asks why his child with tetralogy of Fallot seems to favor a squatting position, the nurse would explain that squatting: a. increases the return of venous blood back to the heart. b. decreases arterial blood flow away from the heart. c. is a common resting position when a child is tachycardic. d. increases the workload of the heart.

ANS: A The squatting position allows the child to breathe more easily because systemic venous return is increased.

5. An infant is experiencing dyspnea related to patent ductus arteriosus (PDA). The nurse understands dyspnea occurs because blood is: a. circulated through the lungs again, causing pulmonary circulatory congestion. b. shunted past the pulmonary circulation, causing pulmonary hypoxia. c. shunted past cardiac arteries, causing myocardial hypoxia. d. circulated through the ductus from the pulmonary artery to the aorta, bypassing the left side of the heart.

ANS: A When PDA is present, oxygenated blood recycles through the lungs, overburdening the pulmonary circulation.

A school-age child had an upper respiratory tract infection for several days and then began having a persistent dry, hacking cough that was worse at night. The cough has become productive in the past 24 hours. This is most suggestive of a. Bronchitis b. Bronchiolitis c. Viral-induced asthma d. Acute spasmodic laryngitis

ANS: A Feedback A Bronchitis is characterized by these symptoms and occurs in children older than 6 years. B Bronchiolitis is rare in children older than 2 years. C Asthma is a chronic inflammation of the airways that may be exacerbated by a virus. D Acute spasmodic laryngitis occurs in children between 3 months and 3 years.

A child has a chronic, nonproductive cough and diffuse wheezing during the expiratory phase of respiration. This suggests a. Asthma b. Pneumonia c. Bronchiolitis d. Foreign body in trachea

ANS: A Feedback A Children with asthma usually have these chronic symptoms. B Pneumonia appears with an acute onset and fever and general malaise. C Bronchiolitis is an acute condition caused by RSV. D Foreign body in the trachea will occur with an acute respiratory distress or failure and maybe stridor.

An infant's parents ask the nurse about preventing OM. What should be recommended? a. Avoid tobacco smoke. b. Use nasal decongestant. c. Avoid children with OM. d. Bottle feed or breastfeed in supine position.

ANS: A Feedback A Eliminating tobacco smoke from the child's environment is essential for preventing OM and other common childhood illnesses. B Nasal decongestants are not useful in preventing OM. C Children with uncomplicated OM are not contagious unless they show other upper respiratory infection (URI) symptoms. D Children should be fed in an upright position to prevent OM.

The nurse should assess a child who has had a tonsillectomy for a. Frequent swallowing b. Inspiratory stridor c. Rhonchi d. Elevated white blood cell count

ANS: A Feedback A Frequent swallowing is indicative of postoperative bleeding. B Inspiratory stridor is characteristic of croup. C Rhonchi are lower airway sounds indicating pneumonia. D Assessment of blood cell counts is part of a preoperative workup.

What sign is indicative of respiratory distress in infants? a. Nasal flaring b. Respiratory rate of 55 breaths/min c. Irregular respiratory pattern d. Abdominal breathing

ANS: A Feedback A Infants have difficulty breathing through their mouths; therefore nasal flaring is usually accompanied by extra respiratory efforts. It also allows more air to enter as the nares flare. B A respiratory rate of 55 breaths/min is a normal assessment for an infant. Tachypnea is a respiratory rate of 60 to 80 breaths/min. C Irregular respirations are normal in the infant. D Abdominal breathing is common because the diaphragm is the neonate's major breathing muscle.

The nurse expects the initial plan of care for a 9-month-old child with an acute otitis media infection to include a. symptomatic treatment and observation for 48 to 72 hours after diagnosis b. an oral antibiotic, such as amoxicillin, five times a day for 7 days c. pneumococcal conjugate vaccine d. myringotomy with tympanoplasty tubes

ANS: A Feedback A Select children 6 months of age or older with acute otitis media are treated by initiating symptomatic treatment and observation for 48 to 72 hours. B Acute otitis media may be treated with a 5- to 10-day course of oral antibiotics. When treatment is indicated, amoxicillin at a divided dose of 80 to 90 mg/kg/day given either every 8 or 12 hours for 5 to 10 days may be ordered. C Pneumococcal conjugate vaccine helps to prevent ear infections but is not included in the initial plan of care for a child with acute otitis media. D Surgical intervention is considered when the child has persistent ear infection despite antibiotic therapy or with otitis media with effusion that persists for more than 3 months and is associated with hearing loss.

Which classification of drugs is used to relieve an acute asthma episode? a. Short-acting beta2-adrenergic agonist b. Inhaled corticosteroids c. Leukotriene blockers d. Long-acting bronchodilators

ANS: A Feedback A Short-acting beta2-adrenergic agonist is the first medication administered. Later, systemic corticosteroids decrease airway inflammation in an acute asthma attack. They are given for short courses of 5 to 7 days. B Inhaled corticosteroids are used for long-term, routine control of asthma. C Leukotriene blockers diminish the mediator action of leukotrienes and are used for long-term, routine control of asthma in children older than 12 years. D A long-acting bronchodilator would not relieve acute symptoms.

The father of an infant calls the nurse to his son's room because he is "making a strange noise." A diagnosis of laryngomalacia is made. What does the nurse expect to find on assessment? a. Stridor b. High-pitched cry c. Nasal congestion d. Spasmodic cough

ANS: A Feedback A Stridor is usually present at birth but may begin as late as 2 months. Symptoms increase when the infant is supine or crying. B High-pitched cries are consistent with neurologic abnormalities and are not usually respiratory in nature. C Nasal congestion is nonspecific in relation to laryngomalacia. D Spasmodic cough is associated with croup; it is not a common symptom of laryngomalacia.

The nurse getting an end-of-shift report on a child with status asthmaticus should question which intervention? a. Administer oxygen by nasal cannula to keep oxygen saturation at 100%. b. Assess intravenous (IV) maintenance fluids and site every hour. c. Notify physician for signs of increasing respiratory distress. d. Organize care to allow for uninterrupted rest periods.

ANS: A Feedback A Supplemental oxygen should not be administered to maintain oxygen saturation at 100%. Keeping the saturation around 95% is adequate. Administration of too much oxygen to a child may lead to respiratory depression by decreasing the stimulus to breathe, leading to carbon dioxide retention. B When the child cannot take oral fluids because of respiratory distress, IV fluids are administered. The child with a continuous IV infusion must be assessed hourly to prevent complications. C A physician should be notified of any changes indicating increasing respiratory distress. D A child in respiratory distress is easily fatigued. Nursing care should be organized so the child can get needed rest without being disturbed.

What is the earliest recognizable clinical manifestation(s) of CF? a. Meconium ileus b. History of poor intestinal absorption c. Foul-smelling, frothy, greasy stools d. Recurrent pneumonia and lung infections

ANS: A Feedback A The earliest clinical manifestation of CF is a meconium ileus, which is found in about 10% of children with CF. Clinical manifestations include abdominal distention, vomiting, failure to pass stools, and rapid development of dehydration. B History of malabsorption is a later sign that manifests as failure to thrive. C Foul-smelling stools are a later manifestation of CF. D Recurrent respiratory infections are a later sign of CF.

What explanation should the nurse give to the parent of a child with asthma about using a peak flow meter? a. It is used to monitor the child's breathing capacity. b. It measures the child's lung volume. c. It will help the medication reach the child's airways. d. It measures the amount of air the child breathes in.

ANS: A Feedback A The peak flow meter is a device used to monitor breathing capacity in the child with asthma. B A child with asthma would have a pulmonary function test to measure lung volume. C A spacer used with a metered-dose inhaler prolongs medication transit so medication reaches the airways. D The peak flow meter measures the flow of air in a forced exhalation in liters per minute.

A 5-year-old child is brought to the emergency department with copious drooling and a croaking sound on inspiration. Her mother states that the child is very agitated and only wants to sit upright. What should be the nurse's first action in this situation? a. Prepare intubation equipment and call the physician. b. Examine the child's oropharynx and call the physician. c. Obtain a throat culture for respiratory syncytial virus (RSV). d. Obtain vital signs and listen to breath sounds.

ANS: A Feedback A This child has symptoms of epiglottitis, is acutely ill, and requires emergency measures. B If epiglottitis is suspected, the nurse should not examine the child's throat. Inspection of the epiglottis is only done by a physician, because it could trigger airway obstruction. C A throat culture could precipitate a complete respiratory obstruction. D Vital signs can be assessed after emergency equipment is readied.

Which assessment finding after tonsillectomy should be reported to the physician? a. Vomiting bright red blood b. Pain at surgical site c. Pain on swallowing d. The ability to only take small sips of liquids

ANS: A Feedback A Vomiting bright red blood and swallowing frequently are signs of bleeding postoperatively and should be reported to the physician. B It is normal for the child to have pain at the surgical site. C It is normal for the child to have pain on swallowing. D Only clear liquids are offered immediately after surgery, and small sips are preferred.

The nurse should teach parents of a child with cystic fibrosis to adjust enzyme dosage according to which indicator? a. Stool formation b. Vomiting c. Weight d. Urine output

ANS: A Feedback A When there is constipation, less enzyme is needed; with steatorrhea, more enzyme is needed for digestion of nutrients. B Vomiting does not affect enzyme dosaging. C The child's weight does not affect enzyme dosaging. D Urine output is not relevant to enzyme replacement.

What information should the nurse teach families about reducing exposure to pollens and dust? Select all that apply. a. Replace wall-to-wall carpeting with wood and tile floors. b. Use an air conditioner. c. Put dust-proof covers on pillows and mattresses. d. Keep humidity in the house above 60%. e. Keep pets outside.

ANS: A, B, C Feedback Correct: Carpets retain dust. To reduce exposure to dust, carpeting should be replaced with wood, tile, slate, or vinyl. These floors can be cleaned easily. For anyone with pollen allergies, it is best to keep the windows closed and to run the air conditioner. Covering mattresses and pillows with dust-proof covers will reduce exposure to dust. Incorrect: A humidity level above 60% promotes dust mites. It is recommended that household humidity be kept between 40% and 50% to reduce dust mites inside the house. Keeping pets outside will help to decrease exposure to dander, but will not affect exposure to pollen and dust.

21. What assessment(s) in a child with tetralogy of Fallot would indicate the child is experiencing a paroxysmal hypercyanotic episode? Select all that apply. a. Spontaneous cyanosis b. Dyspnea c. Weakness d. Dry cough e. Syncope

ANS: A, B, C, E Indicators of a paroxysmal hypercyanotic episode or a "tet" episode are spontaneous cyanosis, dyspnea, weakness, and syncope.

19. How would the nurse caring for an infant with congestive heart failure (CHF) modify feeding techniques to adapt for the child's weakness and fatigue? Select all that apply. a. Feeding more frequently with smaller feedings b. Using a soft nipple with enlarged holes c. Holding and cuddling the child during feeding d. Substituting glucose water for formula e. Offering high-caloric formula

ANS: A, B, C, E Infants with CHF fatigue easily. Feeding can be given more frequently in smaller amounts through a soft large-holed nipple. Formulas with a denser caloric content can be offered. The child may be encouraged to nurse if he or she is held.

A nurse is planning care for an asymptomatic child with a positive tuberculin test. What should the nurse include in the plan? Select all that apply. a. Administration of daily isoniazid (INH) b. Instructing family members about administration of INH to all close contacts of the child c. Administration of the Bacillus Calmette-Guérin vaccine d. Reporting the case to the health department e. Administration of INH and rifampin (Rifadin) simultaneously

ANS: A, B, D Feedback Correct: After a chest radiograph is obtained, asymptomatic children with positive tuberculin tests and no previous history of TB receive daily INH for 9 months. Asymptomatic contacts should receive INH for at least 8 to 10 weeks after contact has been broken or until a negative skin test can be confirmed (a second test is taken at least 10 weeks after the last exposure). Reporting cases of TB is required by law in all states in the United States. Incorrect: Bacillus Calmette-Guérin vaccine is the only anti-TB vaccine available, but it is given only to children who have negative test results. For asymptomatic TB, only INH is administered, not both isoniazid and rifampin together. Rifampin is used if the child has resistance to isoniazid.

20. The nurse uses a diagram to illustrate what four structural heart anomalies that comprise tetralogy of Fallot? Select the four that apply. a. Hypertrophied right ventricle b. Patent ductus arteriosus c. Ventral septal defect d. Narrowing of pulmonary artery e. Dextroposition of aorta

ANS: A, B, D, E The four anomalies that comprise tetralogy of Fallot are hypertrophied right ventricle, patent ductus arteriosus, stenosis of pulmonary artery, and dextroposition of the aorta.

The mother of a newborn asks the nurse what causes the baby to begin to breathe after delivery. What changes in the respiratory system stimulating respirations postnatally can the nurse explain to the mother? Select all that apply. a. Low oxygen levels in the infant's blood b. Rubbing the newborn with a towel or blanket c. Surfactant, a special lubricant in the lungs d. Increased blood flow to the infant's lungs e. Cold environment in the delivery room

ANS: A, B, E Feedback Correct: A postnatal change in the respiratory system is the stimulation of respiration by hypoxemia, hypercarbia, cold, tactile stimulation, and a possible decrease in the concentration of prostaglandin E2. Incorrect: Surfactant in the lungs lowers surface tension and facilitates lung expansion. It does not stimulate respirations. Pulmonary blood flow increases after birth, but this does not stimulate respirations in the newborn.

The nurse should implement which interventions for an infant experiencing apnea? Select all that apply. a. Stimulate the infant by gently tapping the foot. b. Shake the infant vigorously. c. Have resuscitative equipment available. d. Suction the infant. e. Maintain a neutral thermal environment.

ANS: A, C, E Feedback Correct: An infant with apnea should be stimulated by gently tapping the foot. Resuscitative equipment should be available and the infant should be maintained in a neutral thermal environment. Incorrect: The infant should not be shaken vigorously nor suctioned.

22. The nurse explains that which congenital cardiac defect(s) cause(s) increased pulmonary blood flow? Select all that apply. a. Atrial septal defects (ASDs) b. Tetralogy of Fallot c. Dextroposition of aorta d. Patent ductus arteriosus e. Ventricular septal defects (VSDs)

ANS: A, D, E The congenital heart defects that cause increased pulmonary blood flow are ASDs, VSDs, and patent ductus arteriosus.

6. An appropriate nursing action related to the administration of digoxin (Lanoxin) to an infant would be: a. counting the apical rate for 30 seconds before administering the medication. b. withholding a dose if the apical heart rate is less than 100 beats/min. c. repeating a dose if the child vomits within 30 minutes of the previous dose. d. checking respiratory rate and blood pressure before each dose.

ANS: B As a rule, if the pulse rate of an infant is below 100 beats/min, the medication is withheld and the physician is notified.

8. The comment made by a parent of a 1-month-old that would alert the nurse about the presence of a congenital heart defect is: a. "He is always hungry." b. "He tires out during feedings." c. "He is fussy for several hours every day." d. "He sleeps all the time."

ANS: B Fatigue during feeding or activity is common to most infants with congenital cardiac problems.

12. A child has an elevated antistreptolysin O (ASO) titer. Which combination of symptoms, in conjunction with this finding, would confirm a diagnosis of rheumatic fever? a. Subcutaneous nodules and fever b. Painful, tender joints and carditis c. Erythema marginatum and arthralgia d. Chorea and elevated sedimentation rate

ANS: B The presence of two major Jones' criteria would indicate a high probability of rheumatic fever.

7. A child develops carditis from rheumatic fever. The nurse knows that the areas of the heart affected by carditis are the: a. coronary arteries. b. heart muscle and the mitral valve. c. aortic and pulmonic valves. d. contractility of the ventricles.

ANS: B The tissues that cover the heart and heart valves are affected. The heart muscle may be involved and the mitral valve is frequently involved.

What is the best nursing response to the parent of a child with asthma who asks if his child can still participate in sports? a. "Children with asthma are usually restricted from physical activities." b. "Children can usually play any type of sport if their asthma is well controlled." c. "Avoid swimming because breathing underwater is dangerous for people with asthma." d. "Even with good asthma control, I would advise limiting the child to one athletic activity per school year."

ANS: B Feedback A Children with asthma should not be restricted from physical activity. B Sports that do not require sustained exertion, such as gymnastics, baseball, and weight lifting, are well tolerated. Children can usually play any type of sport if their asthma is well controlled. C Swimming is recommended as the ideal sport for children with asthma because the air is humidified and exhaling underwater prolongs exhalation and increases end-expiratory pressure. D If asthma is well controlled, the child can participate in any type of sport.

Which statement indicates that a parent of a toddler needs more education about preventing foreign body aspiration? a. "I keep objects with small parts out of reach." b. "My toddler loves to play with balloons." c. "I won't permit my child to have peanuts." d. "I never leave coins where my child could get them."

ANS: B Feedback A Keeping toys with small parts and other small objects out of reach can prevent foreign body aspiration. B Latex balloons account for a significant number of deaths from aspiration every year. C Peanuts are just one of the foods that pose a choking risk if given to young children. D Small objects, such as coins, need to be put out of the small child's reach.

Which type of croup is always considered a medical emergency? a. Laryngitis b. Epiglottitis c. Spasmodic croup d. Laryngotracheobronchitis (LTB)

ANS: B Feedback A Laryngitis is a common viral illness in older children and adolescents, with hoarseness and URI symptoms. B Epiglottitis is always a medical emergency that requires antibiotics and airway support for treatment. C Spasmodic croup is treated with humidity. D LTB may progress to a medical emergency in some children.

The nurse is caring for a child with acute respiratory distress syndrome (ARDS) associated with sepsis. Nursing actions should include: a. Forcing fluids b. Monitoring pulse oximetry c. Instituting seizure precautions d. Encouraging a high-protein diet

ANS: B Feedback A Maintenance of vascular volume and hydration is important and should be done parenterally. B Monitoring cardiopulmonary status is an important evaluation tool in the care of the child with ARDS. C Seizures are not a side effect of ARDS. D Adequate nutrition is necessary, but a high-protein diet is not helpful.

The infant with bronchopulmonary dysplasia (BPD) who has RSV bronchiolitis is a candidate for which treatment? a. Pancreatic enzymes b. Cool humidified oxygen c. Erythromycin intravenously d. Intermittent positive pressure ventilation

ANS: B Feedback A Pancreatic enzymes are used for patients with cystic fibrosis. B Humidified oxygen is delivered if the oxygen saturation level drops to less than 90%. C Antibiotics are ineffective against viral illnesses. Oxygen can be administered by hood, facemask, or nasal cannula. D Assisted ventilation is not necessary in the treatment of RSV infections.

Which statement made by a parent indicates an understanding about the genetic transmission of cystic fibrosis (CF)? a. "Only one parent carries the cystic fibrosis gene." b. "Both parents are carriers of the cystic fibrosis gene." c. "The presence of the disease is most likely the result of a genetic mutation." d. "The mother is usually the carrier of the cystic fibrosis gene."

ANS: B Feedback A The disease will not be present if only one parent is a carrier of the cystic fibrosis gene. B Cystic fibrosis follows a pattern of autosomal recessive transmission. Both parents must be carriers of the gene for the disease to be transmitted to the child. If both parents carry the CF gene, each pregnancy has a 25% chance of producing a CF-affected child. C Cystic fibrosis is known to have a definite pattern of transmission. It is transmitted as an autosomal recessive trait. D A carrier parent can transmit the carrier gene to the child. The disease is present when the carrier gene is transmitted from both parents.

The nurse encourages the mother of a toddler with acute LTB to stay at the bedside as much as possible. The nurse's rationale for this action is primarily that a. Mothers of hospitalized toddlers often experience guilt. b. The mother's presence will reduce anxiety and ease child's respiratory efforts. c. Separation from mother is a major developmental threat at this age. d. The mother can provide constant observations of the child's respiratory efforts.

ANS: B Feedback A This is true, but not the best answer. B The family's presence will decrease the child's distress. C Although true for toddlers, the main reason to keep parents at the child's bedside is to ease anxiety and therefore respiratory effort. D The child should have constant monitoring by cardiorespiratory monitor and noninvasive oxygen saturation monitoring, but the parent should not play this role in the hospital.

What intervention can be taught to the parents of a 3-year-old child with pneumonia who is not hospitalized? a. Offer the child only cool liquids. b. Offer the child her favorite warm liquid drinks. c. Use a warm mist humidifier. d. Call the physician for a respiratory rate less than 28 breaths/min.

ANS: B Feedback A Warm liquids are preferable because they help loosen secretions. B Offering the child fluids that she likes will facilitate oral intake. Warm liquids help loosen secretions. C Cool mist humidifiers are preferred to warm mist. Warm mist is a safety concern and could cause burns if touched by the child. D Typically parents are not taught to count their children's respirations and report abnormalities to the physician. Even if this were the case, a respiratory rate of less than 28 breaths/min is normal for a 3-year-old child. The expected respiratory rate for a 3-year-old child is 20 to 30 breaths/min.

The parent of a toddler calls the nurse, asking about croup. What is a distinguishing manifestation of spasmodic croup? a. Wheezing is heard audibly. b. It has a harsh, barky cough. c. It is bacterial in nature. d. The child has a high fever.

ANS: B Feedback A Wheezing is not a distinguishing manifestation of croup. It can accompany conditions such as asthma or bronchiolitis. B Spasmodic croup is viral in origin; is usually preceded by several days of symptoms of upper respiratory tract infection; often begins at night; and is marked by a harsh, metallic, barky cough; sore throat; inspiratory stridor; and hoarseness. C Spasmodic croup is viral in origin. D A high fever is not usually present.

15. When the child with rheumatic fever begins involuntary, purposeless movements of her limbs, the nurse recognizes that this is an indication of: a. seizure activity. b. hypoxia. c. Sydenham's chorea. d. decreasing level of consciousness.

ANS: C As the effects of rheumatic fever affect the central nervous system, the child may develop Sydenham's chorea manifested by involuntary, purposeless movements of the limbs.

16. The nurse clarifies to the parents of a 4-year-old child recovering from rheumatic fever that the child will need to receive monthly injections of penicillin G for a minimum of _____ year(s). a. 1 b. 2 c. 5 d. 10

ANS: C Children who recover from rheumatic fever should have a chemoprophylaxis protocol of penicillin G injections (about 200,000 units per dose) for a minimum of 5 years or up to the age of 18 to prevent further bouts of rheumatic fever.

17. The nurse is aware that the characteristics of high-density lipoproteins (HDLs) are that they: a. have high amounts of triglycerides. b. have only small amounts of protein. c. have little cholesterol. d. aid in steroid production.

ANS: C HDLs have low amounts of triglycerides, large amounts of proteins, low amount of cholesterol, and are excreted via the liver. They have no role in the production of steroids.

Teaching safety precautions with the administration of antihistamines is important because of what common side effect? a. Dry mouth b. Excitability c. Drowsiness d. Dry mucous membranes

ANS: C Feedback A A dry mouth is not a safety issue. B Excitability may affect rest or sleep, but drowsiness is the most important safety hazard. C Drowsiness is a safety hazard when alertness is needed, especially with a teenage driver. Nonsedating brands should be used. D Dry mucous membranes are not a safety issue.

Which intervention for treating croup at home should be taught to parents? a. Have a decongestant available to give the child when an attack occurs. b. Have the child sleep in a dry room. c. Take the child outside. d. Give the child an antibiotic at bedtime.

ANS: C Feedback A Decongestants are inappropriate for croup, which affects the middle airway level. B A dry environment may contribute to symptoms. C Taking the child into the cool, humid, night air may relieve mucosal swelling and improve symptoms. D Croup is caused by a virus. Antibiotic treatment is not indicated.

What is a common trigger for asthma attacks in children? a. Febrile episodes b. Dehydration c. Exercise d. Seizures

ANS: C Feedback A Febrile episodes are consistent with other problems, for example, seizures. B Dehydration occurs as a result of diarrhea; it does not trigger asthma attacks. Viral infections are triggers for asthma. C Exercise is one of the most common triggers for asthma attacks, particularly in school-age children. D Seizures can result from a too-rapid intravenous infusion of theophylline—a therapy for asthma.

Which finding confirms a diagnosis of cystic fibrosis? a. Chest radiograph shows alveolar hyperinflation. b. Stool analysis indicates significant amounts of fecal fat. c. Sweat chloride is greater than 60 mEq/L. d. Liver function levels are abnormal.

ANS: C Feedback A Hyperinflation is one of the first findings on a chest radiograph of a child with cystic fibrosis. It does not confirm a diagnosis. B A 72-hour fecal fat determination may be included in a diagnostic workup. Inability to secrete digestive enzymes causes steatorrhea. C The diagnosis of cystic fibrosis requires a positive sweat test. A chloride level greater than 60 mEq/L is considered diagnostic for cystic fibrosis. D Liver function tests may be part of the diagnostic workup for cystic fibrosis.

A small child with cystic fibrosis cannot swallow pancreatic enzyme capsules. The nurse should teach parents to mix enzymes with: a. Macaroni and cheese b. Tapioca c. Applesauce d. Hot chocolate

ANS: C Feedback A Macaroni and cheese is not a good choice because enzymes are inactivated by heat and starchy foods. B Tapioca is not a good choice because enzymes are inactivated by starchy foods. C Enzymes can be mixed with a small amount of nonacidic foods. D Enzymes are less effective if mixed with foods that are hot.

Once an allergen is identified in a child with allergic rhinitis, the treatment of choice about which to educate the parents is a. Using appropriate medications b. Beginning desensitization injections c. Eliminating the allergen d. Removing the adenoids

ANS: C Feedback A Medications are not a first-line treatment but can be helpful in controlling allergic rhinitis. B Immunotherapy is usually the final component of controlling allergic rhinitis. C The first priority is to attempt to remove the causative agent from the child's environment. D Adenoids are tissues that can swell with constant rhinitis; however, a surgical procedure is not indicated for allergic rhinitis. Dealing with the cause is the first priority.

Which child requires a Mantoux test? a. The child who has episodes of nighttime wheezing and coughing b. The child who has a history of allergic rhinitis c. The child whose baby-sitter has received a tuberculosis diagnosis d. The premature infant who is being treated for apnea of infancy

ANS: C Feedback A Nighttime wheezing and coughing are consistent with a diagnosis of asthma. B Allergic rhinitis requires an allergy workup. C The Mantoux test is the initial screening mechanism for patients exposed to tuberculosis. D This infant requires a sleep study as part of the evaluation.

Which statement, if made by parents of a child with cystic fibrosis, indicates that they understood the nurse's teaching on pancreatic enzyme replacement? a. "Enzymes will improve my child's breathing." b. "I should give the enzymes 1 hour after meals." c. "Enzymes should be given with meals and snacks." d. "The enzymes are stopped if my child begins wheezing."

ANS: C Feedback A Pancreatic enzymes do not affect the respiratory system. B Pancreatic enzymes are taken within 30 minutes of eating all meals and snacks. Giving the medication 1 hour after meals is inappropriate and ineffective for absorption of nutrients. C Children with cystic fibrosis need to take enzymes with food for adequate absorption of nutrients. D Wheezing is not a reason to stop taking enzyme replacements.

Which statement made by a parent indicates an understanding about treatment of streptococcal pharyngitis? a. "I guess my child will need to have his tonsils removed." b. "A couple of days of rest and some ibuprofen will take care of this." c. "I should give the penicillin three times a day for 10 days." d. "I am giving my child prednisone to decrease the swelling of the tonsils."

ANS: C Feedback A Surgical removal of the tonsils is a controversial issue. It may be warranted in cases of recurrent tonsillitis. It is not indicated for the treatment of acute tonsillitis. B Comfort measures such as rest and analgesics are indicated, but these will not treat the bacterial infection. C Streptococcal pharyngitis is best treated with oral penicillin two to three times daily for 10 days. D Corticosteroids are not used in the treatment of streptococcal pharyngitis.

For which problem should the child with chronic otitis media with effusion be evaluated? a. Brain abscess b. Meningitis c. Hearing loss d. Perforation of the tympanic membrane

ANS: C Feedback A The infection of acute otitis media can spread to surrounding tissues, causing a brain abscess. B The infection of acute otitis media can spread to surrounding tissues, causing meningitis. C Chronic otitis media with effusion is the most common cause of hearing loss in children. D Inflammation and pressure from acute otitis media may result in perforation of the tympanic membrane.

What should the nurse teach a child about using an albuterol metered-dose inhaler for exercise-induced asthma? a. Take two puffs every 6 hours around the clock. b. Use the inhaler only when the child is short of breath. c. Use the inhaler 30 minutes before exercise. d. Take one to two puffs every morning upon awakening.

ANS: C Feedback A This schedule will not relieve exercise-induced asthma. B Waiting until symptoms are severe is too late to begin using a metered-dose inhaler. C The appropriate time to use an inhaled beta2-agonist or cromolyn is before an event that could trigger an attack. D This may be the child's usual schedule for medication. If exercise causes symptoms, additional medication is indicated.

18. The school nurse recommends a heart healthy diet that limits fats to no more than ____% of the total dietary intake. a. 10 b. 15 c. 20 d. 30

ANS: D

14. The nurse is aware that the infant born with hypoplastic left heart syndrome must acquire his or her oxygenated blood through: a. the patent ductus arteriosus. b. a ventricular septal defect. c. the closure of the foramen ovale. d. an atrial septal defect.

ANS: D Because the right side of the heart must take over pumping blood to both the lungs and systemic circulation, the ductus arteriosus must remain open to shunt the oxygenated blood from the lungs.

11. The parent of a 1-year-old child with tetralogy of Fallot asks the nurse, "Why do my child's fingertips look like that?" The nurse bases a response on the understanding that clubbing occurs as a result of: a. untreated congestive heart failure. b. a left-to-right shunting of blood. c. decreased cardiac output. d. chronic hypoxia.

ANS: D Clubbing of the fingers develops in response to chronic hypoxia.

13. An infant with congestive heart failure is receiving digoxin (Lanoxin). The nurse recognizes a sign of digoxin toxicity, which is: a. restlessness. b. decreased respiratory rate. c. increased urinary output. d. vomiting.

ANS: D Symptoms of digoxin toxicity include: nausea, vomiting, anorexia, irregularity in pulse rate and rhythm, and a sudden change in pulse.

3. The finding the nurse would expect when measuring blood pressure on all four extremities of a child with coarctation of the aorta is blood pressure that is: a. higher on the right side. b. higher on the left side. c. lower in the arms than in the legs. d. lower in the legs than in the arms.

ANS: D The characteristic symptoms of coarctation of the aorta are a marked difference in blood pressure and pulses between the upper and lower extremities. Pressure is increased proximal to the defect and decreased distal to the coarctation.

What information should the nurse teach workers at a daycare center about RSV? a. RSV is transmitted through particles in the air. b. RSV can live on skin or paper for up to a few seconds after contact. c. RSV can survive on nonporous surfaces for about 60 minutes. d. Frequent handwashing can decrease the spread of the virus.

ANS: D Feedback A RSV infection is not airborne. It is acquired mainly through contact with contaminated surfaces. B RSV can live on skin or paper for up to 1 hour. C RSV can live on cribs and other nonporous surfaces for up to 6 hours. D Meticulous handwashing can decrease the spread of organisms.

Why do infants and young children quickly have respiratory distress in acute and chronic alterations of the respiratory system? a. They have a widened, shorter airway. b. There is a defect in their sucking ability. c. The gag reflex increases mucus production. d. Mucus and edema obstruct small airways

ANS: D Feedback A The airway in infants and young children is narrower, not wider. B Sucking is not necessarily related to problems with the airway. C The gag reflex is necessary to prevent aspiration. It does not produce mucus. D The airway in infants and young children is narrower, and respiratory distress can occur quickly because mucus and edema can cause obstruction to their small airways.

What is an appropriate beverage for the nurse to give to a child who had a tonsillectomy earlier in the day? a. Chocolate ice cream b. Orange juice c. Fruit punch d. Apple juice

ANS: D Feedback A The child can have full liquids on the second postoperative day. B Citrus drinks are not offered because they can irritate the throat. C Red liquids are avoided because they give the appearance of blood if vomited. D The child can have clear, cool liquids when fully awake.

A child has had cold symptoms for more than 2 weeks, a headache, nasal congestion with purulent nasal drainage, facial tenderness, and a cough that increases during sleep. The nurse recognizes that these symptoms are characteristic of which respiratory condition? a. Allergic rhinitis b. Bronchitis c. Asthma d. Sinusitis

ANS: D Feedback A The classic symptoms of allergic rhinitis are watery rhinorrhea, itchy nose, eyes, ears, and palate, and sneezing. Symptoms occur as long as the child is exposed to the allergen. B Bronchitis is characterized by a gradual onset of rhinitis and a cough that is initially nonproductive but may change to a loose cough. C The manifestations of asthma may vary, with wheezing being a classic sign. The symptoms presented in the question do not suggest asthma. D Sinusitis is characterized by signs and symptoms of a cold that do not improve after 14 days, a low-grade fever, nasal congestion and purulent nasal discharge, headache, tenderness, a feeling of fullness over the affected sinuses, halitosis, and a cough that increases when the child is lying down.

Which statement is characteristic of AOM? a. The etiology is unknown. b. Permanent hearing loss often results. c. It can be treated by intramuscular (IM) antibiotics. d. It is treated with a broad range of antibiotics.

ANS: D Feedback A The etiology of AOM may be Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, or a viral agent. Recent concerns about drug-resistant organisms have caused authorities to recommend judicious use of antibiotics and that antibiotics are not required for initial treatment. B Permanent hearing loss is not a frequent cause of properly treated AOM. C Intramuscular antibiotics are not necessary. Oral amoxicillin is the treatment of choice. D Historically AOM has been treated with a range of antibiotics, and it is the most common disorder treated with antibiotics in the ambulatory setting.

Which intervention is appropriate for the infant hospitalized with bronchiolitis? a. Position on the side with neck slightly flexed. b. Administer antibiotics as ordered. c. Restrict oral and parenteral fluids if tachypneic. d. Give cool, humidified oxygen.

ANS: D Feedback A The infant should be positioned with the head and chest elevated at a 30- to 40-degree angle and the neck slightly extended to maintain an open airway and decrease pressure on the diaphragm. B The etiology of bronchiolitis is viral. Antibiotics are only given if there is a secondary bacterial infection. C Tachypnea increases insensible fluid loss. If the infant is tachypneic, fluids are given parenterally to prevent dehydration. D Cool, humidified oxygen is given to relieve dyspnea, hypoxemia, and insensible fluid loss from tachypnea.

Which vitamin supplements are necessary for children with cystic fibrosis? a. Vitamin C and calcium b. Vitamin B6 and B12 c. Magnesium d. Vitamins A, D, E, and K

ANS: D Feedback A Vitamin C and calcium are not fat soluble. B B6 and B12 are not fat-soluble vitamins. C Magnesium is not a vitamin. D Fat-soluble vitamins are poorly absorbed because of deficient pancreatic enzymes in children with cystic fibrosis; therefore supplements are necessary.

The nurse is providing education related to "Safe Sleep" to the parents of a healthy newborn infant to help prevent sudden infant death syndrome (SIDS). The nurse instructs the parents that bed sharing is not recommended; however, they should put the infant in a safe bassinet or crib in the parent's room for sleeping. Is this statement true or false?

ANS: T The American Academy of Pediatrics (AAP) recommends the following actions to help prevent SIDS in infants: place healthy infants on their backs to sleep, use mattresses with a firm sleeping surface, avoid exposing the infant to secondhand smoke, and offer a pacifier for sleep. In addition, bed sharing is not recommended, and parents are advised to put the infant in a safe bassinet or crib in the parent's room for sleeping.

A client presents to the emergency department with a foreign object sticking out of the left eye. Which of the following is a priority intervention? Select all that apply. A. Begin a bowel regimen protocol B. Make the client NPO C. Administer IV antibiotics D. Prepare the client for X ray or CT scan of the eye E. Carefully remove the foreign object

B. Make the client NPO C. Administer IV antibiotics D. Prepare the client for X ray or CT scan of the eye

The nurse notes that the client has conductive hearing loss. Which of the following contribute to this type of hearing loss? Select all that apply. A. Meniere's disease B. Osteosclerosis C. Loud noises D. Cerumen E. Middle ear disease

B. Otosclerosis D. Cerumen E. Middle ear disease

A nurse is caring for a 71-year-old client who has demonstrated some hearing loss and started to use a hearing aid. Which findings would the nurse expect if the client is using the hearing aid correctly? Select all that apply. A. The client can hear everything perfectly once the hearing aid is in place B. The client does not have any whistling or extraneous noise with the device C. The client demonstrates knowledge of how to properly care for the device D. The client is able to insert the hearing aid properly E. The client responds when the nurse speaks to the client

B. The client does not have any whistling or extraneous noise with the device C. The client demonstrates knowledge of how to properly care for the device D. The client is able to insert the hearing aid properly E. The client responds when the nurse speaks to the client

A nurse is caring for a client who is experiencing eye movements that are out of sync with each other. Which of the following terms is appropriate for this finding? A. Myopia B. Amblyopia C. Strabismus D. Hyperopia

C. Strabismus

A child is brought to the emergency department after falling from a high swing and landing on the back. The nurse notes that the client also has hemophilia. Based on the client's history and the nature of the injury, which should the nurse assess for first? 1.Blood in the urine 2.Oxygen saturation 3.Presence of headache 4.Presence of slurred speech

Correct Answer: 1 Rationale: Because the kidneys are located in the flank region of the body, trauma to the back area can cause hematuria, particularly in the child with hemophilia. The nurse would be most concerned about the child's airway and respiratory rate if the child sustained an injury to the neck region. Headache and slurred speech are associated with head trauma.

A 2-year-old boy with a diagnosis of hemophilia is admitted to the hospital with bleeding into the joint of the right knee. Which intervention should the nurse plan to implement with this child? 1.Measure the injured knee joint every shift. 2.Take the temperature by rectal method only. 3.Administer acetylsalicylic acid for pain control. 4.Immobilize the joint and apply moist heat to the joint.

Correct Answer: 1 Rationale: Interventions for bleeding into the joint include measuring the injured joint to assess for progression of the bleeding. This provides objective rather than subjective data, which are needed to determine if the bleeding is increasing. Rectal temperatures can cause tissue trauma, causing further bleeding. The application of heat and the administration of acetylsalicylic acid will increase bleeding.

Oral iron is prescribed for a child with iron deficiency anemia. The nurse provides instructions to the mother regarding the administration of the iron. The nurse should instruct the mother to administer the medication in which way? 1.Between meals 2.Just before a meal 3.Just after the meal 4.With a fruit low in vitamin C

Correct Answer: 1 Rationale: The mother should be instructed to administer oral iron supplements between meals. The iron should be given with a citrus fruit or juice high in vitamin C because vitamin C increases the absorption of iron by the body.

The nurse is providing instructions to the mother of a 3-year-old child with hemophilia regarding care of the child. Which statement by the mother indicates a need for further teaching? 1."I need to cancel the upcoming dental appointment that I made for my child." 2."If my child gets a cut, I should hold pressure on it until the bleeding stops." 3."I should check the house and remove any household items that can easily fall over." 4."I should move furniture with sharp corners out of the way and pad the corners of the furniture."

Correct Answer: 1 Rationale: The nurse needs to stress the importance of immunizations, dental hygiene, and routine well-child care. The remaining options are appropriate care measures. The mother is instructed regarding actions in the event of blunt trauma, especially trauma involving the joints, and is told to apply prolonged pressure to superficial wounds until the bleeding has stopped.

The home care nurse is providing safety instructions to the mother of a child with hemophilia. Which instruction should the nurse include to promote a safe environment for the child? 1.Eliminate any toys with sharp edges from the child's play area. 2.Allow the child to use play equipment only when a parent is present. 3.Allow the child to play indoors only, and avoid any outdoor play or playgrounds. 4.Place a helmet and elbow pads on the child every day as soon as the child awakens.

Correct Answer: 1 Rationale: The nurse should instruct the mother to remove toys with sharp edges that may cause injury from the child's play area. It is not necessary to restrict play if safety measures have been implemented. It is not necessary that the child be restricted from outdoor play activity, but the activities that the child participates in should be monitored. Requiring that the child wear a helmet and elbow pads immediately on awakening and throughout the day is not necessary; however, these items should be worn during activities that could cause injury.

The nurse is conducting staff in-service training on von Willebrand's disease. Which should the nurse include as characteristics of von Willebrand's disease? Select all that apply. 1.Easy bruising occurs. 2.Gum bleeding occurs. 3.It is a hereditary bleeding disorder. 4.Treatment and care are similar to that for hemophilia. 5.It is characterized by extremely high creatinine levels. 6.The disorder causes platelets to adhere to damaged

Correct Answer: 1,2,3,4,6 Rationale: von Willebrand's disease is a hereditary bleeding disorder characterized by a deficiency of or a defect in a protein termed von Willebrand factor. The disorder causes platelets to adhere to damaged endothelium. It is characterized by an increased tendency to bleed from mucous membranes. Assessment findings include epistaxis, gum bleeding, easy bruising, and excessive menstrual bleeding. An elevated creatinine level is not associated with this disorder.

The nurse is reviewing a health care provider's prescriptions for a child with sickle cell anemia who was admitted to the hospital for the treatment of vaso-occlusive crisis. Which prescriptions documented in the child's record should the nurse question? Select all that apply. 1.Restrict fluid intake. 2.Position for comfort. 3.Avoid strain on painful joints. 4.Apply nasal oxygen at 2 L/minute. 5.Provide a high-calorie, high-protein diet. 6.Give meperidine, 25 mg intravenously, every 4 hours for pain.

Correct Answer: 1,6 Rationale:Sickle cell anemia is one of a group of diseases termed hemoglobinopathies, in which hemoglobin A is partly or completely replaced by abnormal sickle hemoglobin S. It is caused by the inheritance of a gene for a structurally abnormal portion of the hemoglobin chain. Hemoglobin S is sensitive to changes in the oxygen content of the red blood cell; insufficient oxygen causes the cells to assume a sickle shape, and the cells become rigid and clumped together, obstructing capillary blood flow. Oral and intravenous fluids are an important part of treatment. Meperidine is not recommended for a child with sickle cell disease because of the risk for normeperidine-induced seizures. Normeperidine, a metabolite of meperidine, is a central nervous system stimulant that produces anxiety, tremors, myoclonus, and generalized seizures when it accumulates with repetitive dosing. The nurse would question the prescription for restricted fluids and meperidine for pain control. Positioning for comfort, avoiding strain on painful joints, oxygen, and a high-calorie and high-protein diet are also important parts of the treatment plan.

A child is brought to the emergency department after being accidentally struck in the lower back region with a baseball bat. When gathering assessment data, the nurse discovers that the child has hemophilia. The nurse should immediately assess for which data? 1. Slurred speech 2. Presence of hematuria 3. Complaints of headache 4. Change in respiratory rate

Correct Answer: 2 Rationale: Because the kidneys are located in the flank region of the body, trauma to the back area can cause hematuria, particularly in a child with hemophilia. The nurse would be most concerned about the child's airway and respiratory rate if the child had sustained an injury to the neck region. Slurred speech and headache are associated with head trauma.

An 11-year-old child is admitted to the hospital in vaso-occlusive sickle cell crisis. The nurse plans for which priority treatments in the care of the child? 1.Splenectomy, correction of acidosis 2.Adequate hydration, pain management 3.Frequent ambulation, oxygen administration 4.Passive range-of-motion exercises, adequate hydration

Correct Answer: 2 Rationale: During vaso-occlusive sickle cell crisis, the care focuses on adequate hydration and pain management. Adequate hydration with intravenous normal saline and oral fluids maintains blood flow and decreases the severity of the vaso-occlusive crisis. Analgesics for pain management are necessary during a vaso-occlusive crisis. Splenectomy would not be done with a vaso-occlusive crisis. Acidosis is not present. Oxygen can be administered to increase tissue perfusion but is not the priority treatment for a vaso-occlusive crisis. Passive range of motion is not recommended; bed rest is prescribed initially.

The nurse is providing home care instructions to the mother of an infant who has just been found to have hemophilia. The nurse should tell the mother that care of the infant should include which appropriate measure? 1.Use aspirin for pain relief. 2.Pad crib rails and table corners. 3.Use a soft toothbrush for dental hygiene. 4.Use a generous amount of lubricant when taking a temperature rectally.

Correct Answer: 2 Rationale: Establishment of an age-appropriate, safe environment is of paramount importance for hemophiliacs. Providing a safe environment for an infant includes padding table corners and crib rails, providing extra padding on clothes to protect the joints, observing a mobile infant at all times, and keeping items that can be pulled down onto the infant out of reach. Use of a soft toothbrush is an appropriate measure for a child with hemophilia but is not typically necessary for an infant. Rectal temperature measurements and the use of aspirin are contraindicated in hemophiliacs because of the risk of bleeding.

The nursing student is assigned to care for a child with hemophilia. The nursing instructor reviews the plan of care with the student. Which intervention on the student written plan of care requires correction? 1.Measure circumference of injured joints. 2.Blood transfusion of packed red blood cells. 3.Monitor temperature with oral thermometers. 4.Intravenous administration of recombinant factor.

Correct Answer: 2 Rationale: Hemophilia is a lifelong hereditary blood disorder associated with deficiency of clotting factors. It is inherited in a recessive manner via a genetic defect on the X chromosome. Hemophilia A results from a deficiency of factor VIII. Hemophilia B (Christmas disease) is a deficiency of factor IX. Blood product transfusion is not the treatment of choice over administering recombinant factors intravenously. Measuring circumference of injured joints is appropriate to assess for enlarging hematomas or bleeding under the skin. The nurse should avoid taking rectal temperatures to decrease the risk for injury.

The nurse is instructing the parents of a child with iron deficiency anemia regarding the administration of a liquid oral iron supplement. Which instruction should the nurse tell the parents? 1.Administer the iron at mealtimes. 2.Administer the iron through a straw. 3.Mix the iron with cereal to administer. 4.Add the iron to formula for easy administration.

Correct Answer: 2 Rationale: In iron deficiency anemia, iron stores are depleted, resulting in a decreased supply of iron for the manufacture of hemoglobin in red blood cells. An oral iron supplement should be administered through a straw or medicine dropper placed at the back of the mouth because the iron stains the teeth. The parents should be instructed to brush or wipe the child's teeth or have the child brush the teeth after administration. Iron is administered between meals because absorption is decreased if there is food in the stomach. Iron requires an acid environment to facilitate its absorption in the duodenum. Iron is not added to formula or mixed with cereal or other food items.

A child with sickle cell anemia who is in vaso-occlusive crisis is admitted to the hospital. Which health care provider prescription would assist in reversing the vaso-occlusive crisis? 1.Monitor pulse oximetry. 2.Begin intravenous fluids. 3.Administer oxygen by face mask. 4.Monitor vital signs and respiratory status.

Correct Answer: 2 Rationale: Increased fluid volume reduces the viscosity of the blood, preventing further vascular occlusion and further sickling caused by dehydration. Pulse oximetry and vital sign monitoring may be components of care, but they are actions that relate to monitoring the client versus treating. The intravenous fluids, however, will treat the condition. Vaso-occlusive crisis treatment includes analgesic and fluid administration. Oxygen may help relieve symptoms of respiratory distress, but analgesics and fluids treat the condition.

The pediatric nursing instructor asks a nursing student to prioritize care for a child diagnosed with sickle cell disease. Which student response correctly identifies the priority of care? 1.Fatigue 2.Hypoxia 3.Delayed growth 4.Avascular necrosis

Correct Answer: 2 Rationale: Sickle cell disease is a group of diseases termed hemoglobinopathies, in which hemoglobin A is partly or completely replaced by abnormal sickle hemoglobin S. It is caused by the inheritance of a gene for a structurally abnormal portion of the hemoglobin chain. Hemoglobin S is sensitive to changes in the oxygen content of the red blood cell. Hypoxia causes the cells to assume a sickle shape, and the cells become rigid and clumped together, obstructing capillary blood flow and leading to a vaso-occlusive crisis. All the clinical manifestations of sickle cell anemia result from the sickled cells being unable to flow easily through the microvasculature, and their clumping obstructs blood flow. With reoxygenation most of the sickled red blood cells resume their normal shape. Fatigue is a result of hypoxia; hypoxia should be addressed first. Avascular necrosis of the hips and shoulders and delayed growth are general manifestations of sickle cell disease.

The nursing student is presenting a clinical conference and discusses the cause of β-thalassemia. The nursing student informs the group that a child at greatest risk of developing this disorder is which of these? 1.A child of Mexican descent 2.A child of Mediterranean descent 3.A child whose intake of iron is extremely poor 4.A breast-fed child of a mother with chronic anemia

Correct Answer: 2 Rationale: β-Thalassemia is an autosomal recessive disorder characterized by the reduced production of 1 of the globin chains in the synthesis of hemoglobin (both parents must be carriers to produce a child with β-thalassemia major). This disorder is found primarily in individuals of Mediterranean descent. Options 1, 3, and 4 are incorrect.

The nurse is collecting data on a 12-month-old child with iron deficiency anemia. Which finding should the nurse expect to note in this child? 1.Cyanosis 2.Bronze skin 3.Tachycardia 4.Hyperactivity

Correct Answer: 3 Rationale: Clinical manifestations of iron deficiency anemia will vary with the degree of anemia but usually include extreme pallor with a porcelain-like skin, tachycardia, lethargy, and irritability.

The nurse is providing home care instructions to the parents of a 10-year-old child with hemophilia. Which sport activity should the nurse suggest for this child? 1.Soccer 2.Basketball 3.Swimming 4.Field hockey

Correct Answer: 3 Rationale: Hemophilia refers to a group of bleeding disorders resulting from a deficiency of specific coagulation proteins. Children with hemophilia need to avoid contact sports and to take precautions such as wearing elbow and knee pads and helmets with other sports. The safe activity for them is swimming.

A 10-year-old child with hemophilia A has slipped on the ice and bumped his knee. The nurse should prepare to administer which prescription? 1.Injection of factor X 2.Intravenous infusion of iron 3.Intravenous infusion of factor VIII 4.Intramuscular injection of iron using the Z-track method

Correct Answer: 3 Rationale: Hemophilia refers to a group of bleeding disorders resulting from a deficiency of specific coagulation proteins. The primary treatment is replacement of the missing clotting factor; additional medications, such as agents to relieve pain, may be prescribed depending on the source of bleeding from the disorder. A child with hemophilia A is at risk for joint bleeding after a fall. Factor VIII would be prescribed intravenously to replace the missing clotting factor and minimize the bleeding. Factor X and iron are not used to treat children with hemophilia A.

The nurse is caring for a child with a diagnosis of hemophilia, and hemarthrosis is suspected because the child is complaining of pain in the joints. Which measure should the nurse expect to be prescribed for the child? 1.Range-of-motion exercises to the affected joint 2.Application of a heating pad to the affected joint 3.Application of a bivalved cast for joint immobilization 4.Nonsteroidal antiinflammatory drugs for the pain

Correct Answer: 3 Rationale: In an acute period, immobilization of the joint would be prescribed. Range-of-motion exercise during the acute period can increase the bleeding and would be avoided at this time. Heat will increase blood flow to the area, so it would promote increased bleeding to the area. Nonsteroidal antiinflammatory drugs (NSAIDs) can prolong bleeding time and would not be prescribed for the child.

A child with a diagnosis of sickle cell disease is being admitted for the treatment of vaso-occlusive crisis. The nurse prepares for the admission anticipating which prescription for the child? 1.NPO status 2.Meperidine for pain 3.Intravenous fluids 4.Intubation to administer oxygen

Correct Answer: 3 Rationale: Intravenous fluid and increased oral fluids are a component of the treatment plan for the child with vaso-occlusive crisis. Management of the severe pain that occurs with vaso-occlusive crisis includes the use of opioid analgesics, such as morphine sulfate and hydromorphone. Meperidine is contraindicated because of its side effects and the increased risk of seizures with its use. Oxygen is administered when hypoxia is present and the oxygen saturation level is less than 95%. Intubation is not necessary to treat vaso-occlusive crisis.

A nursing student is assigned to care for a child with sickle cell disease (SCD). The nursing instructor asks the student to describe the causative factors related to this disease. Which statement by the student indicates a need for further research? 1.SCD is an autosomal recessive disease. 2.Children with the HbS (sickle cell hemoglobin) trait are not symptomatic. 3.If each parent carries the trait, the child will carry the trait, and the probability of the child having the disease is 75%. 4.If one parent has the HbS trait and the other parent is normal, there is a 50% chance that each offspring will inherit the trait.

Correct Answer: 3 Rationale: SCD is an autosomal recessive disease. Children with the HbS trait are not symptomatic. If one parent has the HbS trait and the other parent is normal, there is a 50% chance that each offspring will inherit the trait. If each parent carries the trait, there is a 25% chance that their child will be normal, a 50% chance that the child will carry the trait, and a 25% chance that each child will have the disease.

A child arrives at the emergency department with a nosebleed. On assessment, the nurse is told by the mother that the nosebleed began suddenly and for no apparent reason. What is the initial nursing action? 1.Insert nasal packing. 2.Prepare a nasal balloon for insertion. 3.Ask the child to sit down and lean forward, and apply pressure to the nose. 4.Place the child in a semi Fowler's position, and apply ice packs to the nose.

Correct Answer: 3 Rationale: The initial nursing action for a child with a nosebleed is to have him or her sit down, ask the child to lean forward, and apply pressure to the nose for 5 to 10 minutes. Ice or cool compresses may also be applied to the nose and face. Placing the child in semi Fowler's position would cause swallowing of blood. Inserting nasal packing and preparing a nasal balloon are not appropriate initial interventions. A nasal packing or nasal balloon may be used if conservative measures fail.

The nurse is reviewing the laboratory results of a child with aplastic anemia and notes that the white blood cell count is 2000 mm3 (2 × 109/L) and that the platelet count is 150,000 mm3 (150 × 109/L). Which intervention should the nurse incorporate into the plan of care? 1.Avoid unnecessary injections. 2.Encourage quiet play activities. 3.Maintain strict neutropenic precautions. 4.Encourage the child to use a soft toothbrush.

Correct Answer: 3 Rationale: The normal white blood cell (WBC) count ranges from 5000 to 10,000 mm3 (5 to 10 × 109/L)and the normal platelet count ranges from 150,000 to 400,000 mm3 (150 to 400 × 109/L). Strict neutropenic procedures would be required if the WBC count were low to protect the child from infection. Precautionary measures to prevent bleeding should be taken when a child has a low platelet count. These include no injections, no rectal temperatures, use of a soft toothbrush, and abstinence from contact sports or activities that could cause an injury.

The nurse provides instructions regarding home care to the parents of a 3-year-old child hospitalized with hemophilia. Which statement, if made by the parent, indicates a need for further instructions? 1."We will supervise our child closely." 2."We will pad corners of the furniture." 3."We will avoid having our child receive immunizations." 4."We will remove household items that can easily fall over."

Correct Answer: 3 Rationale: The nurse needs to stress the importance of immunizations, dental hygiene, and routine well-child care. The remaining options are appropriate. The parents also are instructed in the measures to implement in the event of blunt trauma, especially trauma involving the joints, and taught to apply prolonged pressure to superficial wounds until the bleeding has stopped.

A child is seen in the health care clinic for complaints of fever. On data collection, the nurse notes that the child is pale, tachycardic, and has petechiae. Aplastic anemia is suspected. The nurse should prepare the child to obtain which specimen that will confirm the diagnosis? 1.Platelet count 2.Granulocyte count 3.Red blood cell count 4.Bone marrow biopsy

Correct Answer: 4 Rationale: Although the diagnosis of aplastic anemia may be suspected from the child's history and from the results of a complete blood count, a bone marrow biopsy must be performed to confirm the diagnosis.

A 12-year-old child with newly diagnosed thalassemia is brought to the clinic exhibiting delayed sexual maturation, fatigue, anorexia, pallor, and complaints of headache. The child seems listless and small for age and has frontal bossing. What should the nurse expect to note on review of the results of the laboratory tests? 1.Macrocytosis and hyperchromia 2.Excessive red blood cell production 3.Excessive mature erythrocyte proliferation 4.Deficient production of functional hemoglobin

Correct Answer: 4 Rationale: Defective hemoglobin is produced as a result of genetically deficient beta-polypeptide. This hemoglobin is unstable, disintegrates, and damages the erythrocytes. Rapid destruction of the red cells stimulates rapid production of immature red cells, and the net gain is less than optimally functioning red cells. Iron from the red blood cell destruction is stored in the tissues, causing multiple problems. In thalassemia, immature erythrocytes proliferate, not mature ones. This is a progressive anemia. The nurse also would note microcytosis and hypochromia.

The pediatric nurse educator provides a teaching session to the nursing staff regarding hemophilia. Which statement regarding this disorder should the nurse plan to include in the discussion? 1.Males inherit hemophilia from their fathers. 2.Hemophilia is a Y-linked hereditary disorder. 3.Females inherit hemophilia from their mothers. 4.Hemophilia A results from deficiency of factor VIII.

Correct Answer: 4 Rationale: Hemophilia refers to a group of bleeding disorders resulting from a deficiency of specific coagulation proteins. Hemophilia A results from a deficiency of factor VIII. Males inherit hemophilia from their mothers, and females inherit the carrier status from their fathers. Hemophilia is inherited in a recessive manner via a genetic defect on the X chromosome. Hemophilia B (Christmas disease) is a deficiency of factor IX.

The nurse analyzes the laboratory results of a child with hemophilia. The nurse understands that which result will most likely be abnormal in this child? 1.Platelet count 2.Hematocrit level 3.Hemoglobin level 4.Partial thromboplastin time

Correct Answer: 4 Rationale: Hemophilia refers to a group of bleeding disorders resulting from a deficiency of specific coagulation proteins. Results of tests that measure platelet function are normal; results of tests that measure clotting factor function may be abnormal. Abnormal laboratory results in hemophilia indicate a prolonged partial thromboplastin time. The platelet count, hemoglobin level, and hematocrit level are normal in hemophilia.

The nurse is monitoring the laboratory values of a child with leukemia who is receiving chemotherapy. The nurse prepares to implement bleeding precautions if the child becomes thrombocytopenic and the platelet count is less than how many cells/mm3? 1.200,000 mm3 (200 × 109/L) 2.180,000 mm3 (180 × 109/L) 3.160,000 mm3 (160× 109/L) 4.150,000 mm3 (150 × 109/L)

Correct Answer: 4 Rationale: If a child is thrombocytopenic, precautions need to be taken because of the increased risk of bleeding. The precautions include limiting activity that could result in head injury, using soft toothbrushes, checking urine and stools for blood, and administering stool softeners to prevent straining with constipation. Additionally, suppositories and rectal temperatures are avoided. The normal platelet count ranges from 150,000 to 400,000 mm3 (150 to 400 × 109/L).

Laboratory studies are performed for a child suspected to have iron deficiency anemia. The nurse reviews the laboratory results, knowing that which result indicates this type of anemia? 1.Elevated hemoglobin level 2.Decreased reticulocyte count 3.Elevated red blood cell count 4.Red blood cells that are microcytic and hypochromic

Correct Answer: 4 Rationale: In iron deficiency anemia, iron stores are depleted, resulting in a decreased supply of iron for the manufacture of hemoglobin in red blood cells. The results of a complete blood cell count in children with iron deficiency anemia show decreased hemoglobin levels and microcytic and hypochromic red blood cells. The red blood cell count is decreased. The reticulocyte count is usually normal or slightly elevated.

A child with a diagnosis of sickle cell anemia and vaso-occlusive crisis is complaining of severe pain, selecting number 8 on the 1 to 10 pain scale. Which medication would the nurse expect to be prescribed for pain control? 1.Ibuprofen 2.Meperidine 3.Acetaminophen 4.Morphine sulfate

Correct Answer: 4 Rationale: Morphine sulfate is the medication of choice for severe pain for the child with sickle cell anemia. Opioids such as morphine sulfate provide systemic relief. Ibuprofen decreases inflammation locally. Meperidine has neurological adverse effects and can cause seizures and should be avoided. Acetaminophen would not provide adequate pain relief.

The nurse is caring for a child with hemophilia and is reviewing the results that were sent from the laboratory. Which result should the nurse expect in this child? 1.Shortened prothrombin time (PT) 2.Prolonged PT 3.Shortened partial thromboplastin time (PTT) 4.Prolonged PTT

Correct Answer: 4 Rationale: PTT measures the activity of thromboplastin, which is dependent on intrinsic factors. In hemophilia, the intrinsic clotting factor VIII (antihemophilic factor) is deficient, resulting in a prolonged PTT. The results in the remaining options are incorrect. The PT may not necessarily be affected in this disorder.

A child in whom sickle cell anemia is suspected is seen in a clinic, and laboratory studies are performed. The nurse checks the laboratory results, knowing that which value would be increased in this disease? 1.Platelet count 2.Hematocrit level 3.Hemoglobin level 4.Reticulocyte count

Correct Answer: 4 Rationale: Sickle cell anemia is a group of diseases termed hemoglobinopathies, in which hemoglobin A is partly or completely replaced by abnormal sickle hemoglobin S. It is caused by the inheritance of a gene for a structurally abnormal portion of the hemoglobin chain. Hemoglobin S is sensitive to changes in the oxygen content of the red blood cell. Insufficient oxygen causes the cells to assume a sickle shape, and the cells become rigid and clumped together, obstructing capillary blood flow. A diagnosis is established on the basis of a complete blood count, examination for sickled red blood cells in the peripheral smear, and hemoglobin electrophoresis. Laboratory studies will show decreased hemoglobin level and hematocrit, a decreased platelet count, an increased reticulocyte count, and the presence of nucleated red blood cells. Reticulocyte counts are increased in children with sickle cell disease because the life span of their sickled red blood cells is shortened.

The clinic nurse instructs parents of a child with sickle cell anemia about the precipitating factors related to sickle cell crisis. Which, if identified by the parents as a precipitating factor, indicates the need for further instruction? 1.Stress 2.Trauma 3.Infection 4.Fluid overload

Correct Answer: 4 Rationale: Sickle cell crises are acute exacerbations of the disease, which vary considerably in severity and frequency; these include vaso-occlusive crisis, splenic sequestration, hyperhemolytic crisis, and aplastic crisis. Sickle cell crisis may be precipitated by infection, dehydration, hypoxia, trauma, or physical or emotional stress. The mother of a child with sickle cell disease should encourage fluid intake of 1½ to 2 times the daily requirement to prevent dehydration.

The pediatric nurse educator is providing a teaching session to nursing staff about hemophilia. Which statement should the nurse educator include? 1."Acetylsalicylic acid is given for pain control." 2."Hemarthrosis is the result of synovial cavity aspiration." 3."Total joint rest along with ice pack application continues for 72 hours after factor VIII is administered." 4."Affected prepubescent girls should be counseled concerning menorrhagia, which may be life-threatening."

Correct Answer: 4 Rationale: The female offspring of an affected male and a carrier female is at risk for hemorrhage once puberty is attained and menstrual cycles begin, and depending on the severity of the hemophilia, a hysterectomy or ablation may be performed. The remaining options are incorrect statements. Aspirin is not routinely given to young children and would not be given to a child with a bleeding disorder because of its effects on platelet aggregation. Hemarthrosis is the result of bleeding into the joint cavity, not of aspiration. Seventy-two hours is too long for the joint to be rested because maintenance of mobility is a primary concern once the bleeding episode has been arrested.

The nurse provides instructions to the mother of a child with sickle cell disease. Which statement by the mother indicates a need for further teaching? 1."I need to be sure that my child has adequate rest periods." 2."I will take my child's temperature and watch for a fever." 3."I need to encourage my child to drink large amounts of fluids." 4."I know my child must spend as much time as possible in the sun."

Correct Answer: 4 Rationale: The nurse should instruct the mother to encourage fluid intake 1.5 to 2 times the daily requirements. Adequate rest periods should be provided, and the child should not be exposed to cold or heat stress. The mother should be taught how to take the child's body temperature and how to use a thermometer properly. Sources of infection should be avoided, as should prolonged exposure to the sun.

Oral iron supplements are prescribed for a 6-year-old child with iron deficiency anemia. Which beverage is the best option to recommend with iron administration? 1.Milk 2.Water 3.Apple juice 4.Orange juice

Correct Answer: 4 Rationale: Vitamin C (ascorbic acid) increases the absorption of iron by the body. The mother should be instructed to administer the medication with a citrus fruit or juice high in vitamin C. From the options presented, the correct option is the only one that identifies the food highest in vitamin C.

The nurse on the pediatric unit is caring for a child with hemophilia who has been in a motor vehicle crash. Which assessment finding, if noted in the child, indicates the need for follow-up? 1.The child maintains affected joints in an immobilized position and denies pain at this time. 2.The child's urine is noted to be clear and light yellow and is negative for red blood cells. 3.The child maintains bruised joints in an elevated position; the bruises noted are beginning to turn yellow. 4.The child is drowsy and difficult to arouse; previously the child was able to respond to questions effectively.

Correct Answer: 4 Rationale: When caring for a child with hemophilia who has sustained injuries, the nurse should monitor for signs of internal bleeding. One sign of internal bleeding is change in level of consciousness, which could indicate intracranial hemorrhage. Additional signs of bleeding include pain, tenderness, and bruising of the affected area and hematuria. Denial of pain of affected joints, clear and light yellow urine that is negative for red blood cells, and bruises that are beginning to turn yellow are not signs of internal or external bleeding.

A child with β-thalassemia is receiving long-term blood transfusion therapy for the treatment of the disorder. Chelation therapy is prescribed as a result of too much iron from the transfusions. Which medication should the nurse anticipate to be prescribed? 1.Fragmin 2.Meropenem 3.Metoprolol 4.Deferoxamine

Correct Answer: 4 Rationale: β-Thalassemia is an autosomal recessive disorder characterized by the reduced production of 1 of the globin chains in the synthesis of hemoglobin (both parents must be carriers to produce a child with β-thalassemia major). The major complication of long-term transfusion therapy is hemosiderosis. To prevent organ damage from too much iron, chelation therapy with either Exjade or deferoxamine may be prescribed. Deferoxamine is classified as an antidote for acute iron toxicity. Fragmin is an anticoagulant used as prophylaxis for postoperative deep vein thrombosis. Meropenem is an antibiotic. Metoprolol is a beta blocker used to treat hypertension.

A nurse is helping a client to remove dentures from the top of the mouth. Which best describes how the nurse should assist? A. Move the dentures from side to side until a popping sound is heard, then remove B. Gently pull the dentures forwards straight out of the mouth C. Wiggle the dentures from front to back and pull straight down D. Grasp the denture with the thumb and index finger to break the seal from the palate

D. Grasp the denture with the thumb and index finger to break the seal from the palate

A patient complains that he has developed a chronically dry mouth after taking his daily medication. What information can the nurse provide that would most likely help him to manage this condition? A. Have the patient swish his mouth with a mouthwash of viscous lidocaine after taking the medication B. Provide a lubricating ointment that the patient can use on his lips and gums C. Encourage the patient to brush and floss the teeth several times per day D. Tell the patient to routinely suck on hard candies and chew gum that contains xylitol

D. Tell the patient to routinely suck on hard candies and chew gum that contains xylitol

The childhood vaccine ____________________ has dramatically reduced the incidence of epiglottitis.

H. influenzae type B (HIB) vaccine The nurse should encourage parents of young children to have their children immunized against H. influenzae to decrease the risk for contracting epiglottitis. Prophylaxis with rifampin is given to underimmunized contacts or family members younger than 4 years old and to any child contact who is immune depressed.

As a child with asthma struggles to get enough air, the respiratory rate increases (tachypnea). Tachypnea lowers the carbon dioxide levels in the blood. This is known as _____________.

hypocapnia As the child tires from the increased work of breathing, hyperventilation occurs and carbon dioxide levels increase. Increased levels of carbon dioxide in the blood (hypercapnia) during an asthma episode may be a sign of severe airway obstruction and impending respiratory failure.