N131 Exam 3

2. Decreased wheezing Rationale: Asthma is a chronic inflammatory disease of the airways. Decreased wheezing in a child with asthma may be interpreted incorrectly as a positive sign when it may actually signal an inability to move air. A "silent chest" is an ominous sign during an asthma episode. With treatment, increased wheezing actually may signal that the child's condition is improving. Warm, dry skin indicates an improvement in the child's condition because the child is normally diaphoretic during exacerbation. The normal pulse rate in a 10-year-old is 70 to 110 beats/minute. The normal respiratory rate in a 10-year-old is 16 to 20 breaths/minute. Test-Taking Strategy: Note the word worsening in the question. Options 3 and 4 can be eliminated because they are comparable or alike in that they are normal vital signs. From the remaining options, recall that a "silent chest" is an ominous sign during an asthma episode and indicates severe bronchial spasm or obstruction. (NCLEX Ch 39 Respiratory Disorders)

A 10-year-old child with asthma is treated for acute exacerbation in the emergency department. The nurse caring for the child should monitor for which sign, knowing that it indicates a worsening of the condition? 1. Warm, dry skin 2. Decreased wheezing 3. Pulse rate of 90 beats/minute 4. Respirations of 18 breaths/minute

3. Intravenous infusion of factor VIII 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. Test-Taking Strategy: Focus on the child's diagnosis. Eliminate options 2 and 4 because they are comparable or alike. Recalling that a child with hemophilia A is missing clotting factor VIII will direct you to the correct option from those remaining. (NCLEX Ch 34 Hemolytic Disorders)

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

c. Children with a GABHS infection are at increased risk for the development of rheumatic fever and glomerulonephritis. (Wong Ch 28 The Child with Respiratory Dysfunction)

A 12-year-old child is in the urgent care clinic with a com- plaint of fever, headache, and sore throat. A diagnosis of group A beta hemolytic streptococcus (GABHS) pharyngitis is established with a rapid-strep test, and oral penicillin is prescribed. The nurse knows which of the following statements about GABHS is correct? a. Children with a GABHS infection are less likely to contract the illness again after the antibiotic regimen is completed. b. A follow-up throat culture is recommended following the completion of antibiotic therapy. c. Children with a GABHS infection are at increased risk for the development of rheumatic fever and glomerulonephritis. d. Children with a GABHS infection are at increased risk for the development of rheumatoid arthritis in adulthood.

a. Continue breastfeeding infant. c. Observe infant for labored breathing or apnea (cessation of breathing). d. Instill normal saline drops in both nares and suction thoroughly before feeding and before placing to sleep. f. Keep the infant out of day care or nursery. (Wong Ch 28 The Child with Respiratory Dysfunction)

A 2-month-old formerly healthy infant born at term is seen in the urgent care clinic with intercostal retractions, respiratory rate of 62, heart rate of 128, refusal to breastfeed, abundant nasal secretions, and a pulse oximeter reading of 88% in room air. The diagnosis of respiratory syncytial virus is made, and a bronchodilator is administered. The infant's oxygen saturation remains 95% in room air, and the respiratory rate is 54, with intercostal retractions; heart rate is 120 bpm. After 2 hours of observation and an intravenous bolus of fluids, the infant is being discharged home. The nurse provides which of the following home care instructions for this infant? Select all that apply. a. Continue breastfeeding infant. b. Discontinue breastfeeding and administer Pedialyte for 24 hours. c. Observe infant for labored breathing or apnea (cessation of breathing). d. Instill normal saline drops in both nares and suction thoroughly before feeding and before placing to sleep. e. Place infant to sleep on his side with the head of bed slightly elevated to facilitate breathing. f. Keep the infant out of day care or nursery.

a. Acute otitis media (AOM) (Wong Ch 28 The Child with Respiratory Dysfunction)

A 3-month-old infant is seen in the clinic with the following symptoms: irritability, crying, refusal to nurse for more than 2 to 3 minutes, rhinitis, and a rectal temperature of 101.8° F (38.8°C). The labor, delivery, and postpartum history for this term infant is unremarkable. The nurse anticipates a diagnosis of: a. Acute otitis media (AOM) b. Otitis media with effusion (OME) c. Otitis externa d. Respiratory syncitial virus (RSV)

2. Bone marrow biopsy showing blast cells Rationale: Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. The confirmatory test for leukemia is microscopic examination of bone marrow obtained by bone marrow aspirate and biopsy, which is considered positive if blast cells are present. An altered platelet count occurs as a result of the disease, but also may occur as a result of chemotherapy and does not confirm the diagnosis. The white blood cell count may be normal, high, or low in leukemia. A lumbar puncture may be done to look for blast cells in the spinal fluid that indicate central nervous system disease. Test-Taking Strategy: Focus on the subject, bone marrow biopsy and leukemia, and note the word confirms in the question. This word and knowledge that the bone marrow is affected in leukemia will direct you to the correct option. (NCLEX Ch 35 Oncological Disorders)

A 4-year-old child is admitted to the hospital for abdominal pain. The mother reports that the child has been pale and excessively tired and is bruising easily. On physical examination, lymphadenopathy and hepatosplenomegaly are noted. Diagnostic studies are being performed because acute lymphocytic leukemia is suspected. The nurse determines that which laboratory result confirms the diagnosis? 1. Lumbar puncture showing no blast cells 2. Bone marrow biopsy showing blast cells 3. Platelet count of 350,000 mm3 (350 × 109/L) 4. White blood cell count 4500 mm3 (4.5 × 109/L)

a. Observe the child for continuous swallowing. b. Encourage the child to take sips of cool, clear liquids. d. Observe the child for restlessness or difficulty breathing. f. Administer an analgesic such as acetaminophen for pain. (Wong Ch 28 The Child with Respiratory Dysfunction)

A 5-year-old is recovering from a tonsillectomy and adenoidectomy and is being discharged home with his mother. Home care instructions should include which of the following? Select all that apply. a. Observe the child for continuous swallowing. b. Encourage the child to take sips of cool, clear liquids. c. Administer codeine elixir as necessary for throat pain. d. Observe the child for restlessness or difficulty breathing. e. Encourage the child to cough every 4 to 5 hours to prevent pneumonia. f. Administer an analgesic such as acetaminophen for pain.

c. Acute epiglottitis (Wong Ch 28 The Child with Respiratory Dysfunction)

A 5-year-old is seen in the urgent care clinic with the following history and symptoms: sudden onset of severe sore throat after going to bed, drooling and difficulty swallowing, axillary temperature of 102.2° F (39.0° C), clear breath sounds, and absence of cough. The child appears anxious and is flushed. Based on these symptoms and history, the nurse anticipates a diagnosis of: a. Group A beta hemolytic streptococcus (GABHS) pharyngitis b. Acute tracheitis c. Acute epiglottitis d. Acute laryngotracheobronchitis

3. "The flowers from your garden are beautiful, but should not be placed in the child's room at this time." Rationale: Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing anemia from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production (thrombocytopenia). For a hospitalized neutropenic child, flowers or plants should not be kept in the room because standing water and damp soil harbor Aspergillus and Pseudomonas aeruginosa, to which the child is susceptible. In addition, fresh fruits and vegetables harbor molds and should be avoided until the white blood cell count increases. Test-Taking Strategy: Note that options 1 and 2 are comparable or alike and should be eliminated first; these options indicate that it is acceptable to place the flowers in the child's room. From the remaining options, select the correct option over option 4 because this response maintains the protective isolation procedures required. (NCLEX Ch 35 Oncological Disorders)

A 6-year-old child with leukemia is hospitalized and is receiving combination chemotherapy. Laboratory results indicate that the child is neutropenic, and protective isolation procedures are initiated. The grandmother of the child visits and brings a fresh bouquet of flowers picked from her garden, and asks the nurse for a vase for the flowers. Which response should the nurse provide to the grandmother? 1. "I have a vase in the utility room, and I will get it for you." 2. "I will get the vase and wash it well before you put the flowers in it." 3. "The flowers from your garden are beautiful, but should not be placed in the child's room at this time." 4. "When you bring the flowers into the room, place them on the bedside stand as far away from the child as possible."

4. Primary nocturnal enuresis is usually outgrown without therapeutic intervention. Rationale: Primary nocturnal enuresis occurs in a child who has never been dry at night for extended periods. The condition is common in children, and most children eventually outgrow bed-wetting without therapeutic intervention. The child is unable to sense a full bladder and does not awaken to void. The child may have delayed maturation of the central nervous system. The condition is not caused by a psychiatric problem. Test-Taking Strategy: Focus on the subject, the characteristics of primary nocturnal enuresis. Recall that the word enuresis refers to urinating, and the word nocturnal refers to nighttime. (NCLEX Ch 41 Renal and Urinary Disorders)

A 7-year-old child is seen in a clinic, and the health care provider documents a diagnosis of primary nocturnal enuresis. The nurse should provide which information to the parents? 1. Primary nocturnal enuresis does not respond to treatment. 2. Primary nocturnal enuresis is caused by a psychiatric problem. 3. Primary nocturnal enuresis requires surgical intervention to improve the problem. 4. Primary nocturnal enuresis is usually outgrown without therapeutic intervention.

a. D—Displacement: Check for endotracheal tube displacement c. O—Consider a possible obstruction of the endotracheal tube e. P—Consider a pneumothorax or chest trauma f. E—Equipment: Check equipment for malfunction (Wong Ch 27 Overview of Oxygen and Carbon Dioxide Exchange)

A 9-year-old who suffered severe closed head trauma is being transported from the pediatric intensive care unit to radiology for a computed tomography (CT) scan. He has been intubated, placed on a transport ventilator, and heavily sedated. On arrival to radiology, the nurse notes the pulse oximetry reading has decreased from 95% to 87%. The nurse uses the mnemonic DOPE to determine the reason for the sudden change in oxygenation. Which of the following actions does DOPE represent? Select all that apply. a. D—Displacement: Check for endotracheal tube displacement b. O—Observe the child's chest movements c. O—Consider a possible obstruction of the endotracheal tube d. P—Placement: Consider placing the child in a semi-Fowler position to enhance ventilation e. P—Consider a pneumothorax or chest trauma f. E—Equipment: Check equipment for malfunction g. E—Consider the environmental temperature as a cause for a sudden change in oxygenation

3. Capillary refill is less than 2 seconds. Rationale: Indicators that fluid volume deficit is resolving would be capillary refill less than 2 seconds, specific gravity of 1.003 to 1.030, urine output of at least 1 mL/kg/hour, and adequate tear production. A capillary refill time less than 2 seconds is the only indicator that the child is improving. Urine output of less than 1 mL/kg/hour, a specific gravity of 1.035, and no tears would indicate that the deficit is not resolving. Test-Taking Strategy: Focus on the subject, assessment findings indicating that fluid volume deficit is resolving. Recall the parameters that indicate adequate hydration status. The only option that indicates an improving fluid balance is option 3. The other options indicate fluid imbalance. (NCLEX Ch 36 Metabolic and Endocrine Disorders)

A child has fluid volume deficit. The nurse performs an assessment and determines that the child is improving and the deficit is resolving if which finding is noted? 1. The child has no tears. 2. Urine specific gravity is 1.035. 3. Capillary refill is less than 2 seconds. 4. Urine output is less than 1 mL/kg/hour.

c. Somnolence Rationale: Somnolence is a late sign indicating severe hypoxia. Tachypnea, tachycardia, and restlessness are cardinal signs of respiratory failure and are observed early. (Evolve Ch 27 Overview of Oxygen and Carbon Dioxide Exchange)

A child is developing respiratory failure. Signs that the hypoxia is becoming severe include a. tachypnea. b. tachycardia. c. somnolence. d. restlessness.

2. Notify the health care provider (HCP). Rationale: In the event of shock, the HCP is notified immediately before the nurse changes the child's position or increases intravenous fluids. After craniotomy, a child is never placed in the supine or Trendelenburg position because it increases intracranial pressure (ICP) and the risk of bleeding. The head of the bed should be elevated. Increasing intravenous fluids can cause an increase in ICP. Test-Taking Strategy: Focus on the subject, care for the child following craniotomy, and note the strategic words, most appropriate. Eliminate options 1 and 3 because these positions could increase ICP. Eliminate option 4 because increasing the flow rate could also increase ICP. In addition, the nurse should not increase intravenous fluids without an HCP's prescription. (NCLEX Ch 35 Oncological Disorders)

A child undergoes surgical removal of a brain tumor. During the postoperative period, the nurse notes that the child is restless, the pulse rate is elevated, and the blood pressure has decreased significantly from the baseline value. The nurse suspects that the child is in shock. Which is the most appropriate nursing action? 1. Place the child in a supine position. 2. Notify the health care provider (HCP). 3. Place the child in Trendelenburg position. 4. Increase the flow rate of the intravenous fluids.

1. Tell the mother that the child must stay in the tent. Rationale: Induration measuring 10 mm or more is considered to be a positive result in children younger than 4 years of age and in children with chronic illness or at high risk for exposure to tuberculosis. A reaction of 5 mm or more is considered to be a positive result for the highest risk groups, such as a child with an immunosuppressive condition or a child with human immunodeficiency virus (HIV) infection. A reaction of 15 mm or more is positive in children 4 years or older without any risk factors. Test-Taking Strategy: Options 3 and 4 are comparable or alike and can be eliminated first. From the remaining options, focus on the data in the question and note the child's age to assist in directing you to the correct option. (NCLEX Ch 39 Respiratory Disorders)

A child with laryngotracheobronchitis (croup) is placed in a cool mist tent. The mother becomes concerned because the child is frightened, consistently crying and trying to climb out of the tent. Which is the most appropriate nursing action? 1. Tell the mother that the child must stay in the tent. 2. Place a toy in the tent to make the child feel more comfortable. 3. Call the health care provider and obtain a prescription for a mild sedative. 4. Let the mother hold the child and direct the cool mist over the child's face.

a. On examination there is usually a mild to moderate elevation in blood pressure compared with normal values for age, although severe hypertension may be present. b. Urinalysis during the acute phase characteristically shows hematuria, proteinuria, and increased specific gravity. d. Assessment of the child's appearance for signs of cerebral complications is an important nursing function because the severity of the acute phase is variable and unpredictable. (Wong Ch 25 The Child with Renal Dysfunction)

A child with periorbital edema, decreased urine output, pallor, and fatigue is admitted to the pediatric unit. The child is being examined for acute glomerular nephritis. Which of the following nursing measures should be considered? Select all that apply. a. On examination there is usually a mild to moderate elevation in blood pressure compared with normal values for age, although severe hypertension may be present. b. Urinalysis during the acute phase characteristically shows hematuria, proteinuria, and increased specific gravity. c. The primary objective is to reduce the excretion of urinary protein and maintain protein-free urine. d. Assessment of the child's appearance for signs of cerebral complications is an important nursing function because the severity of the acute phase is variable and unpredictable. e. Because these children are particularly vulnerable to upper respiratory tract infection, protect them from contact with infected roommates, family, or visitors.

4. Normal saline infusion Rationale: Diabetic ketoacidosis is a complication of diabetes mellitus that develops when a severe insulin deficiency occurs. Hyperglycemia occurs with diabetic ketoacidosis. Rehydration is the initial step in resolving diabetic ketoacidosis. Normal saline is the initial IV rehydration fluid. NPH insulin is never administered by the IV route. Dextrose solutions are added to the treatment when the blood glucose level decreases to an acceptable level. Intravenously administered potassium may be required, depending on the potassium level, but would not be part of the initial treatment. Test-Taking Strategy: Focus on the subject, treatment for diabetic ketoacidosis. Eliminate option 3, knowing that dextrose would not be administered in a hyperglycemic state. Eliminate option 2 next, knowing that NPH insulin is not administered by the IV route. Recalling that hydration is the initial treatment in diabetic ketoacidosis will direct you to the correct option. (NCLEX Ch 36 Metabolic and Endocrine Disorders)

A child with type 1 diabetes mellitus is brought to the emergency department by the mother, who states that the child has been complaining of abdominal pain and has been lethargic. Diabetic ketoacidosis is diagnosed. Anticipating the plan of care, the nurse prepares to administer which type of intravenous (IV) infusion? 1. Potassium infusion 2. NPH insulin infusion 3. 5% dextrose infusion 4. Normal saline infusion

4. Deferoxamine 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. Test-Taking Strategy: Focus on the subject, chelation therapy. Specific knowledge regarding the antidote for iron toxicity is needed to answer this question. One way to remember this is to look at the prefix in the generic name of the medication used to treat iron overdose. Remember to associate defer- and removal of iron. (NCLEX Ch 34 Hemolytic Disorders)

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

4. The presence of Reed-Sternberg cells in the lymph nodes Rationale: Hodgkin's disease (a type of lymphoma) is a malignancy of the lymph nodes. The presence of giant, multinucleated cells (Reed-Sternberg cells) is the classic characteristic of this disease. Elevated levels of vanillylmandelic acid in the urine may be found in children with neuroblastoma. The presence of blast cells in the bone marrow indicates leukemia. Epstein-Barr virus is associated with infectious mononucleosis. Test-Taking Strategy: Focus on the subject, confirmatory diagnostic tests for Hodgkin's disease. Think about the pathophysiology associated with Hodgkin's disease. Remember that the Reed-Sternberg cell is characteristic of Hodgkin's disease. (NCLEX Ch 35 Oncological Disorders)

A diagnosis of Hodgkin's disease is suspected in a 12-year-old child. Several diagnostic studies are performed to determine the presence of this disease. Which diagnostic test result will confirm the diagnosis of Hodgkin's disease? 1. Elevated vanillylmandelic acid urinary levels 2. The presence of blast cells in the bone marrow 3. The presence of Epstein-Barr virus in the blood 4. The presence of Reed-Sternberg cells in the lymph nodes

4. Checks the amount of urine output Rationale: In hypotonic dehydration, electrolyte loss exceeds water loss. The priority assessment before administering potassium chloride intravenously would be to assess the status of the urine output. Potassium chloride should never be administered in the presence of oliguria or anuria. If the urine output is less than 1 to 2 mL/kg/hour, potassium chloride should not be administered. Although options 1, 2, and 3 are appropriate assessments for a child with dehydration, these assessments are not related specifically to the IV administration of potassium chloride. Test-Taking Strategy: Note the strategic word, priority. Focus on the IV prescription. Recalling that the kidneys play a key role in the excretion and reabsorption of potassium will direct you to the correct option. (NCLEX Ch 36 Metabolic and Endocrine Disorders)

A health care provider prescribes an intravenous (IV) solution of 5% dextrose and half-normal saline (0.45%) with 40 mEq of potassium chloride for a child with hypotonic dehydration. The nurse performs which priority assessment before administering this IV prescription? 1. Obtains a weight 2. Takes the temperature 3. Takes the blood pressure 4. Checks the amount of urine output

d. soothes inflamed mucous membranes. Rationale: Warm or cold mist is useful to soothe the inflamed mucous membranes. Humidification is most useful when hoarseness or laryngeal involvement occurs. Normal saline nose drops should be used to liquefy secretions. The mist particles do not penetrate in sufficient amounts to accomplish this. There is no additional oxygen in the mist therapy commonly used for respiratory tract infections. The primary effect of mist is to soothe the inflamed membranes. A reduction in swelling might ease ventilatory effort, but it is not the primary purpose of the therapy. (Evolve Ch 28 The Child with Respiratory Dysfunction)

A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because it a. liquefies secretions. b. improves oxygenation. c. promotes less labored ventilation. d. soothes inflamed mucous membranes.

2. It is negative. Rationale: Phenylketonuria is a genetic (autosomal recessive) disorder that results in central nervous system damage from toxic levels of phenylalanine (an essential amino acid) in the blood. It is characterized by blood phenylalanine levels greater than 20 mg/dL (12.1 mcmol/L); normal level is 0 to 2 mg/dL (0 to 121 mcmol/L). A result of 1 mg/dL is a negative test result. Test-Taking Strategy: Eliminate options 3 and 4 first because they are comparable or alike, indicating no definitive finding. Note that the level identified in the question is a low level; this should assist in directing you to the correct option. (NCLEX Ch 36 Metabolic and Endocrine Disorders)

A mother brings her 3-week-old infant to a clinic for a phenylketonuria rescreening blood test. The test indicates a serum phenylalanine level of 1 mg/dL (60.5 mcmol/L). The nurse reviews this result and makes which interpretation? 1. It is positive. 2. It is negative. 3. It is inconclusive. 4. It requires rescreening at age 6 weeks.

4. Back rather than on the stomach Rationale: SIDS is the unexpected death of an apparently healthy infant younger than 1 year for whom an investigation of the death and a thorough autopsy fail to show an adequate cause of death. Several theories are proposed regarding the cause, but the exact cause is unknown. Nurses should encourage parents to place the infant on the back (supine) for sleep. Infants in the prone position (on the stomach) may be unable to move their heads to the side, increasing the risk of suffocation. The infant may have the ability to "turn to a prone position from the side-lying position. Test-Taking Strategy: Eliminate options 1, 2, and 3 because they are comparable or alike. Remember that the infant needs to be placed on his or her back. (NCLEX Ch 39 Respiratory Disorders)

A new parent expresses concern to the nurse regarding sudden infant death syndrome (SIDS). She asks the nurse how to position her new infant for sleep. In which position should the nurse tell the parent to place the infant? 1. Side or prone 2. Back or prone 3. Stomach with the face turned 4. Back rather than on the stomach

c. exercise is not restricted unless indicated by other health conditions. Rationale: Exercise is encouraged for children with diabetes because it lowers blood glucose levels. Insulin and meal requirements require careful monitoring to ensure that the child has sufficient energy for exercise. Exercise is highly encouraged. The decrease in blood glucose can be accommodated by having snacks available. The level of activity is not dependent on the type of insulin used. Long- and short-acting insulin both may be used to compensate for the effects of training and sporting events. Sports are encouraged to help regulate the insulin, and food should be adjusted according to the amount of exercise. The child needs to be cautioned to monitor responses to the exercise. (Evolve Ch 33 The Child with Endocrine Dysfunction)

A school-age child recently diagnosed with type 1 diabetes mellitus asks the nurse if he can still play soccer, play baseball, and swim. The nurse's response should be based on knowledge that a. exercise is contraindicated. b. the level of activity depends on the type of insulin required. c. exercise is not restricted unless indicated by other health conditions. d. soccer and baseball are too strenuous, but swimming is acceptable.

4. Eat a small box of raisins or drink a cup of orange juice before soccer practice. Rationale: Hypoglycemia is a blood glucose level less than 70 mg/dL (4 mmol/L) and results from too much insulin, not enough food, or excessive activity. An extra snack of 15 to 30 g of carbohydrates eaten before activities such as soccer practice would prevent hypoglycemia. A small box of raisins or a cup of orange juice provides 15 to 30 g of carbohydrates. The child or parents should not be instructed to adjust the amount or time of insulin administration. Meal amounts should not be doubled. Test-Taking Strategy: Use general medication guidelines to eliminate options 2 and 3 first, noting that they are comparable or alike and indicate changing the amount of insulin or time of administration. From the remaining options, recalling the definition of hypoglycemia and its manifestations and associated treatment will direct you to the correct option. (NCLEX Ch 36 Metabolic and Endocrine Disorders)

A school-age child with type 1 diabetes mellitus has soccer practice and the school nurse provides instructions regarding how to prevent hypoglycemia during practice. Which should the school nurse tell the child to do? 1. Eat twice the amount normally eaten at lunchtime. 2. Take half the amount of prescribed insulin on practice days. 3. Take the prescribed insulin at noontime rather than in the morning. 4. Eat a small box of raisins or drink a cup of orange juice before soccer practice.

c. recurrent urinary tract infections. Rationale: Reflux allows urine to flow back to the kidneys. When the urine is infected, this contributes to urinary tract infections and pyelonephritis. Incontinence may be associated with urinary tract infections. Reflux, when associated with vesicoureteral reflux, can cause renal scarring but not obstruction. Infarction of renal vessels does not occur. (Evolve Ch 25 The Child with Renal Dysfunction)

A young child is diagnosed with vesicoureteral reflux. The nurse should know that this usually results in a. incontinence. b. urinary obstruction. c. recurrent urinary tract infections. d. infarction of renal vessels.

4. Fruity breath odor and decreasing level of consciousness Rationale: Diabetic ketoacidosis is a complication of diabetes mellitus that develops when a severe insulin deficiency occurs. Hyperglycemia occurs with diabetic ketoacidosis. Signs of hyperglycemia include fruity breath odor and a decreasing level of consciousness. Hunger can be a sign of hypoglycemia or hyperglycemia, but hypertension is not a sign of diabetic ketoacidosis. Hypotension occurs because of a decrease in blood volume related to the dehydrated state that occurs during diabetic ketoacidosis. Cold clammy skin, irritability, sweating, and tremors all are signs of hypoglycemia. Test-Taking Strategy: Focus on the subject, the signs of diabetic ketoacidosis, and recall that in this condition the blood glucose level is elevated. Eliminate options 1, 2, and 3 because these signs do not occur with hyperglycemia. Recall that fruity breath odor and a change in the level of consciousness can occur during diabetic ketoacidosis. (NCLEX Ch 36 Metabolic and Endocrine Disorders)

An adolescent client with type 1 diabetes mellitus is admitted to the emergency department for treatment of diabetic ketoacidosis. Which assessment findings should the nurse expect to note? 1. Sweating and tremors 2. Hunger and hypertension 3. Cold, clammy skin and irritability 4. Fruity breath odor and decreasing level of consciousness

b. Monitor the respiratory status frequently. Rationale: The child's respiratory rate, status, oxygenation, general disposition, and level of activity are frequently monitored. Lying on the affected side may promote comfort by splinting the chest and reducing pleural rubbing. The child should be positioned with the unaffected side up to promote maximum expansion. Children should be placed in a semierect position or position of comfort. Antitussives are usually not indicated. (Evolve Ch 28 The Child with Respiratory Dysfunction)

An appropriate nursing intervention when caring for a child with pneumonia is which of the following? a. Avoid placing child on the affected side. b. Monitor the respiratory status frequently. c. Place in a Trendelenburg position. d. Administer antitussive agents around the clock.

d. Position the infant in a head-down, prone position and administer five quick blows between the shoulder blades. Rationale: Placing the infant in a head-down, prone position and administering five quick blows between the shoulder blades is the correct position and procedure for an infant who had choked on a piece of food or another object. Blowing into the infant's mouth might push the object into the lungs. Blind finger sweeps are avoided in infants and children younger than age 8 years. If the infant is choking, it is an emergency. Action must be taken. (Evolve Ch 27 Overview of Oxygen and Carbon Dioxide Exchange)

An immediate intervention when an infant chokes on a piece of food would be to do which of the following? a. Administer mouth-to-mouth resuscitation. b. Open the infant's mouth and perform a blind finger sweep. c. Have the infant lie quietly while a call is placed for emergency help. d. Position the infant in a head-down, prone position and administer five quick blows between the shoulder blades.

b. associated allergies. Rationale: Associated allergies are not part of the classification system used in the Guidelines for the Diagnosis and Management of Asthma. The clinical features that are assessed in the classification system are frequency of daytime and nighttime symptoms, frequency and severity of exacerbations, and lung function. (Evolve Ch 28 The Child with Respiratory Dysfunction)

Asthma is now classified into four categories: mild intermittent, mild persistent, moderate persistent, and severe persistent. Clinical features used to determine these categories include all of the following except a. lung function. b. associated allergies. c. frequency of symptoms. d. frequency and severity of exacerbations.

a. The kidneys conserve bicarbonate and excrete hydrogen ions. (Wong Ch 27 Overview of Oxygen and Carbon Dioxide Exchange)

Compensation in a child who has a respiratory acidosis (elevated carbonic acid) is accurately described by which of the following statements? a. The kidneys conserve bicarbonate and excrete hydrogen ions. b. The lungs increase ventilation efforts to excrete carbonic acid. c. The kidneys stop excreting sodium and potassium. d. The kidneys excrete excess carbonic acid.

d. glomerular filtration rate falls below 10% to 15% of normal. Rationale: Treatment with dialysis or transplantation is required when the glomerular filtration rate falls below 10% to 15% of normal. Anemia and acidosis may be present as part of the underlying disorder. The glomerular filtration rate determines the need for dialysis. The kidneys are able to maintain the chemical composition of fluids within normal limits until more than 50% of functional renal capacity is destroyed by disease or injury. (Evolve Ch 25 The Child with Renal Dysfunction)

Dialysis or transplantation becomes necessary for chronic renal failure when a. anemia develops. b. acidosis develops. c. glomerular filtration rate falls below 50% of normal. d. glomerular filtration rate falls below 10% to 15% of normal.

a. Respiratory acidosis (Wong Ch 27 Overview of Oxygen and Carbon Dioxide Exchange)

Identify the acid-base imbalance for the following arterial blood gases in a 1-month-old term infant on mechanical ventilation: pH: 7.32 PCO2: 68 PO2: 82 HCO3+: 21 a. Respiratory acidosis b. Respiratory alkalosis c. Metabolic acidosis d. Metabolic alkalosis

c. Dizziness Rationale: Acute and severe hypertension can cause the protective autoregulation of cerebral blood flow to fail, leading to hyperperfusion of the brain and cerebral edema. The premonitory signs of encephalopathy are headache, dizziness, abdominal discomfort, and vomiting. Seizures and transient loss of vision are signs that the condition is progressing. Psychosis is not an early warning sign of hypertensive encephalopathy. Seizures and transient loss of vision are signs that the condition is progressing. (Evolve Ch 25 The Child with Renal Dysfunction)

In acute glomerulonephritis, the nurse is aware that an early warning sign of encephalopathy is which of the following? a. Seizures b. Psychosis c. Dizziness d. Transient loss of vision

d. The diet should be high in calories and protein. Rationale: Children with CF require a well-balanced, high-protein, high-calorie diet because of impaired intestinal absorption. Fats and proteins are a necessary part of a well-balanced diet. A well-balanced diet containing fruits and vegetables is important. Enzyme supplementation helps digest foods; other modifications are not necessary. (Evolve Ch 28 The Child with Respiratory Dysfunction)

In providing nourishment for a child with cystic fibrosis (CF), which of the following factors should the nurse keep in mind? a. Fats and proteins must be greatly curtailed. b. The diet should be high in calories and protein. c. Most fruits and vegetables are not well tolerated. d. The diet should be high in easily digested carbohydrates and fats.

c. after taking antibiotics for 24 hours. Rationale: After children have taken antibiotics for 24 hours, they are no longer contagious to other children. Sore throat may persist longer than 24 hours of antibiotic therapy, but the child is no longer considered contagious. Complications may take days to weeks to develop. The time from throat culture does not affect the contagiousness of the infection. Antibiotics must be used. (Evolve Ch 28 The Child with Respiratory Dysfunction)

It is generally recommended that a child with acute streptococcal pharyngitis can return to school a. when his or her sore throat is better. b. if no complications develop. c. after taking antibiotics for 24 hours. d. 3 days after initial throat cultures.

4. Red blood cells that are microcytic and hypochromic 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. Test-Taking Strategy: Focus on the subject, laboratory findings. Eliminate options 1 and 3 first, knowing that the hemoglobin and red blood cell counts would be decreased. From the remaining options, select the correct option over option 2 because of the relationship between anemia and red blood cells. (NCLEX Ch 34 Hemolytic Disorders)

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

c. Ensure uninterrupted delivery of the appropriate oxygen concentration. Rationale: The nurse's responsibility is to ensure that the appropriate oxygen concentration is delivered uninterrupted. Oxygen delivery needs to be continued as ordered. Most children receiving oxygen will need the supplemental oxygen during the increased energy expenditure of eating. Ongoing assessment of the infant's respiratory status and oxygen saturation are necessary. Oxygen is a medication, and the amount is prescribed by the practitioner. Oxygen should not blow directly on the infant. Cold air applied to the face can result in the diving reflex, which causes bradycardia and shunting of blood from the periphery to central circulation. (Evolve Ch 27 Overview of Oxygen and Carbon Dioxide Exchange)

Nursing considerations related to the administration of oxygen in an infant include which of the following? a. Discontinue during feedings so child can be held. b. Assess infant to determine how much oxygen should be given. c. Ensure uninterrupted delivery of the appropriate oxygen concentration. d. Direct oxygen flow so that it blows directly into the infant's face in a hood.

d. Can trigger an episode or aggravate asthmatic state Rationale: Viral respiratory tract infections can exacerbate asthma, especially in young children, whose airways are mechanically smaller and more reactive than those of older children. Respiratory tract infections do not affect sensitivity to allergens. Exercise precipitates exercise-induced asthma. The respiratory tract infection does not lessen the effectiveness of the medications. (Evolve Ch 28 The Child with Respiratory Dysfunction)

One of the goals for children with asthma is to prevent respiratory tract infection. This is because respiratory tract infection does which of the following? a. Increases sensitivity to allergens b. Causes exercise-induced asthma c. Lessens effectiveness of medications d. Can trigger an episode or aggravate asthmatic state

d. periodically for children who are high-risk populations. Rationale: Children who are high risk for contracting the disease are monitored periodically. Annual testing is only indicated for children with human immunodeficiency virus infection and incarcerated adolescents. Testing is not necessary unless exposure is likely or an underlying medical risk factor is present. (Evolve Ch 28 The Child with Respiratory Dysfunction)

Skin testing for tuberculosis (TB) is recommended a. every year for all children older than 2 years. b. every year for all children older than 10 years. c. every 2 years for all children starting at age 1 year. d. periodically for children who are high-risk populations.

b. Narrowing of the upper airway (Wong Ch 27 Overview of Oxygen and Carbon Dioxide Exchange)

Stridor, a high-pitched, noisy respiration, is usually an indication of: a. Lower airway obstruction b. Narrowing of the upper airway c. A deficiency of pulmonary surfactant d. Imminent respiratory arrest

4. Fluid overload 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. Test-Taking Strategy: Note the strategic words, need for further instruction. These words indicate a negative event query and ask you to select an option that is an incorrect statement. Recalling that fluids are a main component of treatment in sickle cell anemia to prevent crisis will direct you to the correct option. Remember that fluids are required to prevent dehydration. (NCLEX Ch 34 Hemolytic Disorders)

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

2. "The child should not receive any hepatitis vaccines." Rationale: Epiglottitis is a bacterial form of croup. A primary concern is that it can progress to acute respiratory distress. Clinical manifestations suggestive of airway obstruction include tripod positioning (leaning forward while supported by arms, chin thrust out, mouth open), nasal flaring, the use of accessory muscles for breathing, and the presence of stridor. Option 4 is an incorrect position. Options 1 and 3 are incorrect because epiglottitis causes tachycardia and a high fever. Test-Taking Strategy: Focus on the subject, manifestations of airway obstruction in a child with epiglottitis. Eliminate option 1 first because tachycardia rather than bradycardia would occur in a child experiencing respiratory distress. Eliminate option 3 next, knowing that a high fever occurs with epiglottitis. From the remaining options, visualize the descriptions in each and determine which position would best assist a child experiencing respiratory distress. (NCLEX Ch 39 Respiratory Disorders)

The clinic nurse is providing instructions to a parent of a child with cystic fibrosis regarding the immunization schedule for the child. Which statement should the nurse make to the parent? 1. "The immunization schedule will need to be altered." 2. "The child should not receive any hepatitis vaccines." 3. "The child will receive all of the immunizations except for the polio series." 4. "The child will receive the recommended basic series of immunizations along with a yearly influenza vaccination."

3. Inconclusive Rationale: Laryngotracheobronchitis (croup) is the inflammation of the larynx, trachea, and bronchi and is the most common type of croup. It can be viral or bacterial. Antibiotics are not indicated in the treatment of croup unless a bacterial infection is present. Options 1, 2, and 4 are incorrect. In addition, no supporting data in the question indicate that the child may be allergic to antibiotics. Test-Taking Strategy: Focus on the subject, indications for the use of antibiotics. Eliminate option 1 because there are no supporting data in the question regarding the potential for allergies. Noting the word viral in the question and noting the age of the child will assist in eliminating options 2 and 4. (NCLEX Ch 39 Respiratory Disorders)

The clinic nurse reads the results of a tuberculin skin test (TST) on a 3-year-old child. The results indicate an area of induration measuring 10 mm. The nurse should interpret these results as which finding? 1. Positive 2. Negative 3. Inconclusive 4. Definitive and requiring a repeat test

d. Proteinuria, hypoalbuminemia, and edema Rationale: Edema, proteinuria, hypoalbuminemia, and hypercholesterolemia are the clinical manifestations of nephrotic syndrome in children. Bacteriuria is not a diagnostic criterion for nephrotic syndrome. Fever is not associated with nephrotic syndrome. Weight gain occurs secondary to the edema. (Evolve Ch 25 The Child with Renal Dysfunction)

The clinical manifestations of nephrotic syndrome include which of the following? a. Hematuria, bacteriuria, and weight gain b. Gross hematuria, albuminuria, and fever c. Hypertension, weight loss, and proteinuria d. Proteinuria, hypoalbuminemia, and edema

4. The child is leaning backward, supporting himself or herself with the hands and arms. Rationale: Laryngotracheobronchitis (croup) is the inflammation of the larynx, trachea, and bronchi and is the most common type of croup. Cool mist therapy may be prescribed to liquefy secretions and to assist in breathing. If the use of a tent or hood is causing distress, treatment may be more effective if the child is held by the parent and a cool mist is directed toward the child's face (blow-by). A mild sedative would not be administered to the child. Crying would increase hypoxia and aggravate laryngospasm, which may cause airway obstruction. Options 1 and 2 would not alleviate the child's fear. Test-Taking Strategy: Note the strategic words, most appropriate. Focus on the subject, the child's fear. Options 1, 2, and 3 are comparable or alike in that they do not address the fear. The correct option is the one that addresses the subject of the question. (NCLEX Ch 39 Respiratory Disorders)

The emergency department nurse is caring for a child diagnosed with epiglottitis. In assessing the child, the nurse should monitor for which indication that the child may be experiencing airway obstruction? 1. The child exhibits nasal flaring and bradycardia. 2. The child is leaning forward, with the chin thrust out. 3. The child has a low-grade fever and complains of a sore throat. 4. The child is leaning backward, supporting himself or herself with the hands and arms.

a. loss of hearing Rationale: Loss of hearing is the principal functional consequences of prolonged middle ear infections. Diminished hearing has an adverse effect on the development of speech, language, and cognition. During the active infection, loss of appetite typically occurs, and sucking or chewing tends to aggravate the pain. This is a short-term issue; when the otitis media resolves, the child resumes previous dietary intake. Ear infections do not have an effect on vision. Rupture of the eardrum may occur, but the loss of hearing and subsequent effect on speech are of greater concern. (Evolve Ch 28 The Child with Respiratory Dysfunction)

The most profound complication of prolonged middle ear disorders is a. loss of hearing. b. failure to thrive. c. visual impairment. d. tympanic membrane rupture.

1. Palpating the abdomen for a mass Rationale: Wilms' tumor is the most common intraabdominal and kidney tumor of childhood. If Wilms' tumor is suspected, the tumor mass should not be palpated by the nurse. Excessive manipulation can cause seeding of the tumor and spread of the cancerous cells. Hematuria, fever, and hypertension are clinical manifestations associated with Wilms' tumor. Test-Taking Strategy: Focus on the subject, the action to avoid. Knowledge that this tumor is an intraabdominal and kidney tumor will assist in eliminating options 2 and 4 because of the relationship of these options to renal function. Next, thinking about the effect of palpating the tumor will direct you to the correct option from the remaining options. (NCLEX Ch 35 Oncological Disorders)

The mother of a 4-year-old child tells the pediatric nurse that the child's abdomen seems to be swollen. During further assessment, the mother tells the nurse that the child is eating well and that the activity level of the child is unchanged. The nurse, suspecting the possibility of Wilms' tumor, should avoid which during the physical assessment? 1. Palpating the abdomen for a mass 2. Assessing the urine for the presence of hematuria 3. Monitoring the temperature for the presence of fever 4. Monitoring the blood pressure for the presence of hypertension

c. Reposition the LED electrode to another site and monitor the infant's oxygen saturation reading (Wong Ch 27 Overview of Oxygen and Carbon Dioxide Exchange)

The mother of a 6-month-old infant being given oxygen via a nasal cannula at 0.5 liters flow and 25% oxygen calls the nurse to the room because the pulse oximeter is reading 86%; the infant needs a diaper change and is acting hungry. The nurse notes the heart rate is 80 beats per minute on the pulse oximeter. She listens to the infant's apical heart rate and obtains a heart rate of 100 per minute. The nurse's priority intervention is to: a. Increase the nasal cannula flow to 1 liter per minute and 30% O2 b. Call the physician and request a chest radiograph for the infant c. Reposition the LED electrode to another site and monitor the infant's oxygen saturation reading d. Help the mother change the infant's soiled diaper and prepare a bottle of infant formula

3. Encourage the child to drink liquids. Rationale: When the child is sick, the mother should test for urinary ketones with each voiding. If ketones are present, liquids are essential to aid in clearing the ketones. The child should be encouraged to drink liquids. Bringing the child to the clinic immediately is unnecessary. Insulin doses should not be adjusted or changed. Test-Taking Strategy: Use general medication guidelines. Eliminate options 1 and 4, noting that they are comparable or alike. Recall that insulin doses should not be adjusted or changed. From the remaining options, note the words positive for ketones in the question. Recalling that liquids are essential to aid in clearing the ketones will direct you to the correct option. (NCLEX Ch 36 Metabolic and Endocrine Disorders)

The mother of a 6-year-old child who has type 1 diabetes mellitus calls a clinic nurse and tells the nurse that the child has been sick. The mother reports that she checked the child's urine and it was positive for ketones. The nurse should instruct the mother to take which action? 1. Hold the next dose of insulin. 2. Come to the clinic immediately. 3. Encourage the child to drink liquids. 4. Administer an additional dose of regular insulin.

3. "Antibiotics are not indicated unless a bacterial infection is present." Rationale: Laryngotracheobronchitis (croup) is the inflammation of the larynx, trachea, and bronchi and is the most common type of croup. It can be viral or bacterial. Antibiotics are not indicated in the treatment of croup unless a bacterial infection is present. Options 1, 2, and 4 are incorrect. In addition, no supporting data in the question indicate that the child may be allergic to antibiotics. Test-Taking Strategy: Focus on the subject, indications for the use of antibiotics. Eliminate option 1 because there are no supporting data in the question regarding the potential for allergies. Noting the word viral in the question and noting the age of the child will assist in eliminating options 2 and 4. (NCLEX Ch 39 Respiratory Disorders)

The mother of a hospitalized 2-year-old child with viral laryngotracheobronchitis (croup) asks the nurse why the health care provider did not prescribe antibiotics. Which response should the nurse make? 1. "The child may be allergic to antibiotics." 2. "The child is too young to receive antibiotics." 3. "Antibiotics are not indicated unless a bacterial infection is present." 4. "The child still has the maternal antibodies from birth and does not need antibiotics."

4. Encourage the child to lie on the right side. Rationale: Pneumonia is an inflammation of the pulmonary parenchyma or alveoli, or both, caused by a virus, mycoplasmal agents, bacteria, or aspiration of foreign substances. Splinting of the affected side by lying on that side may decrease discomfort. It would be inappropriate to advise the mother to increase the dose or frequency of the ibuprofen. Lying on the left side would not be helpful in alleviating discomfort. Test-Taking Strategy: Options 1 and 2 can be eliminated because they are comparable or alike. Recall that the nurse does not adjust the dose or frequency of medications. Recalling the principles related to splinting an incision in the postoperative client will assist in directing you to the correct option because these principles can be applied in this situation. (NCLEX Ch 39 Respiratory Disorders)

The mother of an 8-year-old child being treated for right lower lobe pneumonia at home calls the clinic nurse. The mother tells the nurse that the child complains of discomfort on the right side and that ibuprofen is not effective. Which instruction should the nurse provide to the mother? 1. Increase the dose of ibuprofen. 2. Increase the frequency of ibuprofen. 3. Encourage the child to lie on the left side. 4. Encourage the child to lie on the right side.

4. Partial thromboplastin time 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. Test-Taking Strategy: Focus on the subject, laboratory tests used to monitor hemophilia, and note the strategic words, most likely. Recalling the pathophysiology associated with this disorder and recalling that it results from a deficiency of specific coagulation proteins will direct you to the correct option. (NCLEX Ch 34 Hemolytic Disorders)

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

1. Initiate bleeding precautions. Rationale: Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing anemia from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production (thrombocytopenia). If a child is severely thrombocytopenic and has a platelet count less than 20,000 mm3 (20.0 × 109/L), bleeding precautions need to be initiated because of the increased risk of bleeding or hemorrhage. 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. In addition, suppositories, enemas, and rectal temperatures are avoided. Options 2, 3, and 4 are related to the prevention of infection rather than bleeding. Test-Taking Strategy: Note that the platelet count is low and recall that a low platelet count places the child at risk for bleeding. In addition, note that options 2, 3, and 4 are comparable or alike because they relate to prevention of and monitoring for infection. (NCLEX Ch 35 Oncological Disorders)

The nurse analyzes the laboratory values of a child with leukemia who is receiving chemotherapy. The nurse notes that the platelet count is 19,500 mm3 (19.5 × 109/L). On the basis of this laboratory result, which intervention should the nurse include in the plan of care? 1. Initiate bleeding precautions. 2. Monitor closely for signs of infection. 3. Monitor the temperature every 4 hours. 4. Initiate protective isolation precautions.

3. Bacteriuria Rationale: Epispadias is a congenital defect involving abnormal placement of the urethral orifice of the penis. The urethral opening is located anywhere on the dorsum of the penis. This anatomical characteristic facilitates entry of bacteria into the urine. Options 1, 2, and 4 are not characteristically noted in this condition. Test-Taking Strategy: Note the strategic words, most likely. Visualize the anatomical characteristics of epispadias to answer the question. Options 1, 2, and 4 do not relate to the potential for infection, which can be associated with epispadias. (NCLEX Ch 41 Renal and Urinary Disorders)

The nurse collects a urine specimen preoperatively from a child with epispadias who is scheduled for surgical repair. When analyzing the results of the urinalysis, which should the nurse most likely expect to note? 1. Hematuria 2. Proteinuria 3. Bacteriuria 4. Glucosuria

4. Remove excess clothing and blankets from the child. Rationale: After administering ibuprofen, excess clothing and blankets should be removed. The child can be sponged with tepid water but not cold water, because the cold water can cause shivering, which increases metabolic requirements above those already caused by the fever. Aspirin is not administered to a child with fever because of the risk of Reye's syndrome. Fluids should be encouraged to prevent dehydration, so oral fluids should not be withheld. Test-Taking Strategy: Focus on the subject, interventions for an elevated temperature. Remember that cooling measures such as removing excess clothing and blankets should be done when a child has a fever. Options 1, 2, and 3 are not interventions for a child with a fever." (NCLEX Ch 36 Metabolic and Endocrine Disorders)

The nurse has just administered ibuprofen to a child with a temperature of 102 °F (38.8 °C). The nurse should also take which action? 1. Withhold oral fluids for 8 hours. 2. Sponge the child with cold water. 3. Plan to administer salicylate in 4 hours. 4. Remove excess clothing and blankets from the child.

a. To obtain a clean-catch urine specimen, have the child sit on the toilet facing backward toward the tank. c. The specimen must be fresh—less than 1 hour after voiding with storage at room temperature or less than 4 hours after voiding with refrigeration. distinguishing a true UTI from asymptomatic bacteriuria is the presence of pyuria. (Wong Ch 25 The Child with Renal Dysfunction)

The nurse is caring for a 4-year-old girl with a history of frequent urinary tract infections. What should the nurse be aware of before obtaining a urine sample? Select all that apply. a. To obtain a clean-catch urine specimen, have the child sit on the toilet facing backward toward the tank. b. Since children who have a UTI will have painful urina- tion, have the child drink a large amount of fluid before obtaining the sample. c. The specimen must be fresh—less than 1 hour after voiding with storage at room temperature or less than 4 hours after voiding with refrigeration. d. If a urinalysis obtained by a bag specimen is negative, a specimen still needs to be obtained by catheterization or suprapubic aspiration. e. The key to distinguishing a true UTI from asymptomatic bacteriuria is the presence of pyuria. f. Because the child is febrile, the nurse should immediately start an antimicrobial and then obtain a urine culture.

2. Cover the bladder with a nonadhering plastic wrap. Rationale: In bladder exstrophy, the bladder is exposed and external to the body. In this disorder, one must take care to protect the exposed bladder tissue from drying, while allowing the drainage of urine. This is accomplished best by covering the bladder with a nonadhering plastic wrap. The use of petroleum jelly gauze should be avoided because this type of dressing can dry out, adhere to the mucosa, and damage the delicate tissue when removed. Dry sterile dressings and dressings soaked in solutions (that can dry out) also damage the mucosa when removed. Test-Taking Strategy: Focus on the subject, treatment for bladder exstrophy, and visualize this disorder. Noting the word nonadhering in the correct option will direct you to select this one. (NCLEX Ch 41 Renal and Urinary Disorders)

The nurse is caring for an infant with a diagnosis of bladder exstrophy. To protect the exposed bladder tissue, the nurse should plan which intervention? 1. Cover the bladder with petroleum jelly gauze. 2. Cover the bladder with a nonadhering plastic wrap. 3. Apply sterile distilled water dressings over the bladder mucosa. 4. Keep the bladder tissue dry by covering it with dry sterile gauze.

d. Try inserting a smaller tube. Rationale: If the same size tube cannot be inserted, the nurse should try to insert a smaller tube. This will keep the stoma open. The priority is to reinsert a new tracheostomy as soon as possible. The stoma is maintained open until the practitioner can evaluate it. The nurse should attempt to keep the tracheostomy stoma open. A smaller tube is required. (Evolve Ch 27 Overview of Oxygen and Carbon Dioxide Exchange)

The nurse is caring for an infant with a tracheostomy when accidental decannulation occurs. The nurse is unable to reinsert the tube. Which of the following should be the nurse's next action? a. Notify the surgeon. b. Perform oral intubation. c. Try inserting a larger tube. d. Try inserting a smaller tube.

2. Move the infant to a room with another child with RSV. Rationale: RSV is a highly communicable disorder and is not transmitted via the airborne route. The virus usually is transferred by the hands. Use of contact and standard precautions during care is necessary. Using good hand-washing technique and wearing gloves and gowns are also necessary. Masks are not required. An infant with RSV is isolated in a single room or placed in a room with another child with RSV. Enteric precautions are unnecessary. Test-Taking Strategy: Note the strategic words, most appropriate. Focus on the subject, the method of transmission of RSV. Remember that the virus is not transmitted via the airborne route and is usually transferred by the hands. An infant with RSV is isolated in a single room or placed in a room with another child with RSV." (NCLEX Ch 39 Respiratory Disorders)

The nurse is caring for an infant with bronchiolitis, and diagnostic tests have confirmed respiratory syncytial virus (RSV). On the basis of this finding, which is the most appropriate nursing action? 1. Initiate strict enteric precautions. 2. Move the infant to a room with another child with RSV. 3. Leave the infant in the present room because RSV is not contagious. 4. Inform the staff that they must wear a mask, gloves, and a gown when caring for the child.

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. 6. The disorder causes platelets to adhere to damaged endothelium. 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. Test-Taking Strategy: Focus on the subject, assessment findings, and on the child's diagnosis. Recalling that this disorder is characterized by an increased tendency to bleed from mucous membranes will direct you to the correct options. (NCLEX Ch 34 Hemolytic Disorders)

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 endothelium.

2. Administer the iron through a straw. 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. Test-Taking Strategy: Eliminate options 3 and 4 first because they are comparable or alike and because medication should not be added to formula and food. Next, note the word liquid in the question. This should assist you in recalling that iron in liquid form stains teeth. (NCLEX Ch 34 Hemolytic Disorders)

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.

1. Vomiting Rationale: The brain, although well protected by the solid bony cranium, is highly susceptible to pressure that may accumulate within the enclosure. Volume and pressure must remain constant within the brain. A change in the size of the brain, such as occurs with edema or increased volume of intracranial blood or cerebrospinal fluid without a compensatory change, leads to an increase in ICP, which may be life-threatening. Vomiting, an early sign of increased ICP, can become excessive as pressure builds up and stimulates the medulla in the brainstem, which houses the vomiting center. Children with open fontanels (posterior fontanel closes at 2 to 3 months; anterior fontanel closes at 12 to 18 months) compensate for ICP changes by skull expansion and subsequent bulging fontanels. When the fontanels have closed, nausea, excessive vomiting, diplopia, and headaches become pronounced, with headaches becoming more prevalent in older children. Test-Taking Strategy: Note the strategic word, early; focus on the age of the child, and use age as the key to principles of growth and development. Knowing when the fontanels close and focusing on the child's age as 3 years eliminates options 2 and 3. The subjective symptom of headache in option 4 is unreliable in a 3 year old, so eliminate this option. (NCLEX Ch 35 Oncological Disorders)

The nurse is monitoring a 3-year-old child for signs and symptoms of increased intracranial pressure (ICP) after a craniotomy. The nurse plans to monitor for which early sign or symptom of increased ICP? 1. Vomiting 2. Bulging anterior fontanel 3. Increasing head circumference 4. Complaints of a frontal headache

2. Notify the health care provider (HCP). Rationale: Colorless drainage on the dressing in a child after craniotomy indicates the presence of cerebrospinal fluid and should be reported to the HCP immediately. Options 1, 3, and 4 are not the immediate nursing intervention because they do not address the need for immediate intervention to prevent complications. Test-Taking Strategy: Note the strategic word, immediately. Eliminate options 3 and 4 because they are comparable or alike and delay necessary intervention. Also, note the words colorless drainage. This should alert you quickly to the possibility of the presence of cerebrospinal fluid and direct you to the correct option. (NCLEX Ch 35 Oncological Disorders)

The nurse is monitoring a child for bleeding after surgery for removal of a brain tumor. The nurse checks the head dressing for the presence of blood and notes a colorless drainage on the back of the dressing. Which intervention should the nurse perform immediately? 1. Reinforce the dressing. 2. Notify the health care provider (HCP). 3. Document the findings and continue to monitor. 4. Circle the area of drainage and continue to monitor.

1. Abdominal pain 5. Painless, firm, and movable adenopathy in the cervical area "Rationale: Hodgkin's disease (a type of lymphoma) is a malignancy of the lymph nodes. Specific clinical manifestations associated with Hodgkin's disease include painless, firm, and movable adenopathy in the cervical and supraclavicular areas and abdominal pain as a result of enlarged retroperitoneal nodes. Hepatosplenomegaly also is noted. Although fever, malaise, anorexia, and weight loss are associated with Hodgkin's disease, these manifestations are seen in many disorders. Test-Taking Strategy: Note the words specifically characteristic in the question. Eliminate options 2 and 3 first because these symptoms are comparable or alike in that they are general and vague. Recalling that painless adenopathy is associated with Hodgkin's disease and abdominal pain will direct you to the correct options. (NCLEX Ch 35 Oncological Disorders)

The nurse is performing an assessment on a 10-year-old child suspected to have Hodgkin's disease. Which assessment findings are specifically characteristic of this disease? Select all that apply. 1. Abdominal pain 2. Fever and malaise 3. Anorexia and weight loss 4. Painful, enlarged inguinal lymph nodes 5. Painless, firm, and movable adenopathy in the cervical area

1. Pallor 2. Edema 3. Anorexia 4. Proteinuria Rationale: Nephrotic syndrome is a kidney disorder characterized by massive proteinuria, hypoalbuminemia, edema, elevated serum lipids, anorexia, and pallor. The child gains weight. Test-Taking Strategy: Focus on the subject, the characteristics of nephrotic syndrome. Thinking about the pathophysiology associated with this disorder and recalling the assessment findings for nephrotic syndrome will direct you to the correct options. (NCLEX Ch 41 Renal and Urinary Disorders)

The nurse is performing an assessment on a child admitted to the hospital with a probable diagnosis of nephrotic syndrome. Which assessment findings should the nurse expect to observe? Select all that apply. 1. Pallor 2. Edema 3. Anorexia 4. Proteinuria 5. Weight loss 6. Decreased serum lipids

1. Restrict fluids as prescribed. Rationale: Hemolytic-uremic syndrome is thought to be associated with bacterial toxins, chemicals, and viruses that result in acute kidney injury in children. Clinical manifestations of the disease include acquired hemolytic anemia, thrombocytopenia, renal injury, and central nervous system symptoms. A child with hemolytic-uremic syndrome undergoing peritoneal dialysis because of anuria would be on fluid restriction. Pain is not associated with hemolytic-uremic syndrome, and potassium would be restricted, not encouraged, if the child is anuric. Peritoneal dialysis does not require an arteriovenous fistula (only hemodialysis). Test-Taking Strategy: Note the subject, anuria. Focus on the child's diagnosis and recall knowledge about the care of a client with acute kidney injury. Also focus on the data in the question. Noting the word peritoneal will assist in eliminating option 2. From the remaining options, remember that because the child is anuric, fluids will be restricted. (NCLEX Ch 41 Renal and Urinary Disorders)

The nurse is planning care for a child with hemolytic-uremic syndrome who has been anuric and will be receiving peritoneal dialysis treatment. The nurse should plan to implement which measure? 1. Restrict fluids as prescribed. 2. Care for the arteriovenous fistula. 3. Encourage foods high in potassium. 4. Administer analgesics as prescribed.

1. Place the infant in a private room. 6. Ensure that nurses caring for the infant with RSV do not care for other high-risk children. Rationale: RSV is a highly communicable disorder and is not transmitted via the airborne route. The virus usually is transferred by the hands. Use of contact and standard precautions during care (wearing gloves and a gown) reduces nosocomial transmission of RSV. A mask is unnecessary. In addition, it is important to ensure that nurses caring for a child with RSV do not care for other high-risk children to prevent the transmission of the infection. An infant with RSV should be isolated in a private room or in a room with another infant with RSV infection. The infant should be positioned with the head and chest at a 30- to 40-degree angle and the neck slightly extended to maintain an open airway and decrease pressure on the diaphragm. Cool humidified oxygen is delivered to relieve dyspnea, hypoxemia, and insensible water loss from tachypnea. Test-Taking Strategy: Focus on the subject, care of the child with bronchiolitis and RSV. Recalling the mode of transmission of RSV will assist in answering correctly. Remember that RSV is highly communicable and is transmitted via contact such as by the hands. (NCLEX Ch 39 Respiratory Disorders)

The nurse is preparing for the admission of an infant with a diagnosis of bronchiolitis caused by respiratory syncytial virus (RSV). Which interventions should the nurse include in the plan of care? Select all that apply. 1. Place the infant in a private room. 2. Ensure that the infant's head is in a flexed position. 3. Wear a mask at all times when in contact with the infant. 4. Place the infant in a tent that delivers warm humidified air. 5. Position the infant on the side, with the head lower than the chest. 6. Ensure that nurses caring for the infant with RSV do not care for other high-risk children.

3. Swimming 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. Test-Taking Strategy: Focus on the subject, a safe activity. Recalling that bleeding is a major concern in this condition, eliminate options 1, 2, and 4 because these activities are comparable or alike in that they present the potential for injury. (NCLEX Ch 34 Hemolytic Disorders)

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

1. Restrict fluid intake. 6. Give meperidine, 25 mg intravenously, every 4 hours for pain. 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. Test-Taking Strategy: Focus on the subject, identifying the prescriptions that need to be questioned and on the pathophysiology that occurs in sickle cell disease. Recalling that fluids are an important component of the treatment plan will assist in identifying that a fluid restriction prescription would need to be questioned. Also, recalling the effects of meperidine will assist in identifying that this prescription needs to be questioned. (NCLEX Ch 34 Hemolytic Disorders)

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.

4. "Circumcision has been delayed to save tissue for surgical repair." "Rationale: Hypospadias is a congenital defect involving abnormal placement of the urethral orifice of the penis. In hypospadias, the urethral orifice is located below the glans penis along the ventral surface. The infant should not be circumcised because the dorsal foreskin tissue will be used for surgical repair of the hypospadias. Options 1, 2, and 3 are unrelated to this disorder. Test-Taking Strategy: Focus on the subject, treatment for hypospadias. Note the words indicates their understanding. Recalling that hypospadias is a congenital defect involving abnormal placement of the urethral orifice of the penis will direct you to the correct option. (NCLEX Ch 41 Renal and Urinary Disorders)

The nurse is reviewing a treatment plan with the parents of a newborn with hypospadias. Which statement by the parents indicates their understanding of the plan? 1. "Caution should be used when straddling the infant on a hip." 2. "Vital signs should be taken daily to check for bladder infection." 3. "Catheterization will be necessary when the infant does not void." 4. "Circumcision has been delayed to save tissue for surgical repair."

d. cover the skin with a shirt or gown before percussing. Rationale: The child should wear a light shirt to protect the skin from the percussion. The hand is cupped when the child's chest wall is struck. Percussion is done after the position change. There are identified positions and sequence for postural drainage. (Evolve Ch 27 Overview of Oxygen and Carbon Dioxide Exchange)

The nurse is teaching a mother how to perform chest physiotherapy and postural drainage on her 3-year-old child, who has cystic fibrosis. To perform percussion, the nurse should instruct her to a. strike the chest wall with a flat-hand position. b. percuss before and after positioning for postural drainage. c. percuss over the entire trunk anteriorly and posteriorly. d. cover the skin with a shirt or gown before percussing.

2. Generalized edema Rationale: Nephrotic syndrome is defined as massive proteinuria, hypoalbuminemia, hyperlipemia, and edema. Other manifestations include weight gain; periorbital and facial edema that is most prominent in the morning; leg, ankle, labial, or scrotal edema; decreased urine output and urine that is dark and frothy; abdominal swelling; and blood pressure that is normal or slightly decreased. Test-Taking Strategy: Note the strategic word, most. Recall the pathophysiology associated with nephrotic syndrome. Associate edema with nephrotic syndrome. This will help you to answer questions similar to this one. (NCLEX Ch 41 Renal and Urinary Disorders)

The nurse performing an admission assessment on a 2-year-old child who has been diagnosed with nephrotic syndrome notes that which most common characteristic is associated with this syndrome? 1. Hypertension 2. Generalized edema 3. Increased urinary output 4. Frank, bright red blood in the urine

4. "I'll let him decide when to return to his play activities." Rationale: Cryptorchidism is a condition in which 1 or both testes fail to descend through the inguinal canal into the scrotal sac. Surgical correction may be necessary. All vigorous activities should be restricted for 2 weeks after surgery to promote healing and prevent injury. This prevents dislodging of the suture, which is internal. Normally, 2-year-olds want to be active; allowing the child to decide when to return to his play activities may prevent healing and cause injury. The parents should be taught to monitor the temperature, provide analgesics as needed, and monitor the urine output. Test-Taking Strategy: Note the strategic words, need for further instruction. These words indicate a negative event query and ask you to select an option that is an incorrect statement. Option 1 is an important action to recognize signs of infection. Option 2 is appropriate to keep pain to a minimum. Option 3 monitors voiding pattern, which is also important after this type of surgery. (NCLEX Ch 41 Renal and Urinary Disorders)

The nurse provided discharge instructions to the parents of a 2-year-old child who had an orchiopexy to correct cryptorchidism. Which statement by the parents indicates the need for further instruction? 1. "I'll check his temperature." 2. "I'll give him medication so he'll be comfortable." 3. "I'll check his voiding to be sure there's no problem." 4. "I'll let him decide when to return to his play activities."

2. "The child does not experience pain at the primary tumor site." Rationale: Osteosarcoma is the most common bone cancer in children. Cancer usually is found in the metaphysis of long bones, especially in the lower extremities, with most tumors occurring in the femur. Osteosarcoma is manifested clinically by progressive, insidious, and intermittent pain at the tumor site. By the time these children receive medical attention, they may be in considerable pain from the tumor. Options 1, 3, and 4 are accurate regarding osteosarcoma. Test-Taking Strategy: Note the strategic words, need for information. These words indicate a negative event query and ask you to select an option that is an incorrect statement. Knowledge that osteosarcoma is a malignant tumor of the bone will direct you to the correct option. (NCLEX Ch 35 Oncological Disorders)

The nurse provides a teaching session to the nursing staff regarding osteosarcoma. Which statement by a member of the nursing staff indicates a need for information? 1. "The femur is the most common site of this sarcoma." 2. "The child does not experience pain at the primary tumor site." 3. "Limping, if a weight-bearing limb is affected, is a clinical manifestation." 4. "The symptoms of the disease in the early stage are almost always attributed to normal growing pains."

2. "I noticed his urine was the color of coca-cola lately." Rationale: Glomerulonephritis refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. Gross hematuria, resulting in dark, smoky, cola-colored or brown-colored urine, is a classic symptom of glomerulonephritis. Blood urea nitrogen levels and serum creatinine levels may be elevated, indicating that kidney function is compromised. A mild to moderate elevation in protein in the urine is associated with glomerulonephritis. Hypertension is also common due to fluid volume overload secondary to the kidneys not working properly. Test-Taking Strategy: Focus on the subject, the manifestations of glomerulonephritis. Eliminate options 1 and 3 first because hypertension from fluid volume overload and proteinuria are most likely to occur in this kidney disorder. Recalling that this is a renal disorder and that blood urea nitrogen levels and serum creatinine levels increase in these type of disorders will assist in directing you to the correct option. (NCLEX Ch 41 Renal and Urinary Disorders)

The nurse reviews the record of a child who is suspected to have glomerulonephritis. Which statement by the child's parent should the nurse expect that is associated with this diagnosis? 1. "I'm so glad they didn't find any protein in his urine." 2. "I noticed his urine was the color of coca-cola lately." 3. "His health care provider said his kidneys are working well." 4. "The nurse who admitted my child said his blood pressure was low."

3. Give the child a teaspoon of honey. 6. Prepare to administer glucagon subcutaneously if unconsciousness occurs. Rationale: Hypoglycemia is defined as a blood glucose level less than 70 mg/dL (4 mmol/L). Hypoglycemia occurs as a result of too much insulin, not enough food, or excessive activity. If possible, the nurse should confirm hypoglycemia with a blood glucose reading. Glucose is administered orally immediately; rapid-releasing glucose is followed by a complex carbohydrate and protein, such as a slice of bread or a peanut butter cracker. An extra snack is given if the next meal is not planned for more than 30 minutes or if activity is planned. If the child becomes unconscious, cake frosting or glucose paste is squeezed onto the gums, and the blood glucose level is retested in 15 minutes; if the reading remains low, additional glucose is administered. If the child remains unconscious, administration of glucagon may be necessary, and the nurse should be prepared for this intervention. Encouraging the child to ambulate and administering regular insulin would result in a lowered blood glucose level. Providing electrolyte replacement therapy intravenously is an intervention to treat diabetic ketoacidosis. Waiting 30 minutes to confirm the blood glucose level delays necessary intervention. Test-Taking Strategy: Focus on the subject, a low blood glucose level, and on the information in the question. Think about the pathophysiology associated with hypoglycemia and how it is treated. Recalling that a blood glucose level of 60 mg/dL (3.4 mmol/L) indicates hypoglycemia will assist in determining the correct interventions. (NCLEX Ch 36 Metabolic and Endocrine Disorders)

The nurse should implement which interventions for a child older than 2 years with type 1 diabetes mellitus who has a blood glucose level of 60 mg/dL (3.4 mmol/L)? Select all that apply. 1. Administer regular insulin. 2. Encourage the child to ambulate. 3. Give the child a teaspoon of honey. 4. Provide electrolyte replacement therapy intravenously. 5. Wait 30 minutes and confirm the blood glucose reading. 6. Prepare to administer glucagon subcutaneously if unconsciousness occurs.

c. A life-threatening situation Rationale: Diabetic ketoacidosis is the state of complete insulin deficiency. It is a medical emergency that must be diagnosed and treated. The child is usually admitted to an intensive care unit for assessment, insulin administration, and fluid and electrolyte replacement. Diabetic ketoacidosis is a medical emergency needing prompt assessment and intervention, usually in an intensive care environment. (Evolve Ch 33 The Child with Endocrine Dysfunction)

The nurse should recognize that when a child develops diabetic ketoacidosis, this is which of the following? a. Expected outcome b. Best treated at home c. A life-threatening situation d. Best treated at practitioner's office or clinic

2. A child of Mediterranean descent 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. Test-Taking Strategy: Focus on the subject, the child at greatest risk for β-thalassemia major. Think about the pathophysiology of the disorder. Remember that this disorder occurs primarily in individuals of Mediterranean descent. (NCLEX Ch 34 Hemolytic Disorders)

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

c. Children have a greater sense of control over the diabetes. Rationale: Blood glucose monitoring affords the child a greater sense of control. The immediate feedback allows for regulation of insulin doses. Home blood glucose monitoring provides a more accurate assessment of control than urine testing. Although the parents are involved in the management, a 10-year-old child should take responsibility for testing. The same number of visits will be necessary, but the blood glucose monitoring will enable better control. (Evolve Ch 33 The Child with Endocrine Dysfunction)

The parent of a 10-year-old child with diabetes asks the nurse why home blood glucose monitoring is being recommended. The nurse should base the explanation on which of the following? a. It is an easier method of testing. b. Parents are better able to manage the diabetes. c. Children have a greater sense of control over the diabetes. d. Fewer visits to the primary care provider will be necessary.

a. Corticosteroids Rationale: Most children with nephrotic syndrome respond to corticosteroids, making this group the drug of choice. Corticosteroid therapy is begun as soon as the diagnosis has been determined. Children with nephrotic syndrome usually do not respond to diuretics. Furosemide, in combination with metolazone, is useful for severe edema. Antihypertensive agents are not indicated in the management. Fluids are rarely restricted. The child is placed on a no-added-salt diet. (Evolve Ch 25 The Child with Renal Dysfunction)

Therapeutic management of nephrotic syndrome includes which of the following? a. Corticosteroids b. Long-term diuretics c. Antihypertensive agents d. Fluid and salt restrictions

d. Give small amounts of favorite fluids frequently to prevent dehydration. Rationale Preventing dehydration by small, frequent feedings is an important intervention in a febrile child. Tepid water baths may induce shivering, which raises temperature. Food should not be forced; it may result in the child vomiting. A febrile child should be dressed in light, loose clothing. (Evolve Ch 28 The Child with Respiratory Dysfunction)

What is an appropriate nursing intervention when caring for an infant with an upper respiratory tract infection and elevated temperature? a. Give tepid water baths to reduce fever. b. Encourage food intake to maintain caloric needs. c. Have the child wear heavy clothing to prevent chilling. d. Give small amounts of favorite fluids frequently to prevent dehydration.

b. 1740 ml/day (Wong Ch 25 The Child with Renal Dysfunction)

What is the 24-hour fluid requirement for a child weighing 32 kg? a. 1920 ml/day b. 1740 ml/day c. 1840 ml/day d. 1620 ml/day

a. Serum potassium concentrations in excess of 7 mEq/L (Wong Ch 25 The Child with Renal Dysfunction)

When caring for a child with acute renal failure, which nursing measure requires immediate attention? a. Serum potassium concentrations in excess of 7 mEq/L b. Sodium level of 135 c. Transfusion for hemoglobin of 8 d. Mannitol and furosemide for a urine output of 2 ml/kg/hr

a. "I know I should never clamp off the catheter." c. "An antibacterial ointment may be applied to the penis daily for infection control." e. "My child should avoid straddle toys, sandboxes, swimming, and rough activities until allowed by the surgeon." (Wong Ch 25 The Child with Renal Dysfunction)

When giving discharge instructions to a parent post hypospadias repair, the nurse recognizes a need for more teaching when the mother says which of the following? Select all that apply. a. "I know I should never clamp off the catheter." b. "My child can take a tub bath when we arrive home because it will soothe the area." c. "An antibacterial ointment may be applied to the penis daily for infection control." d. "Fluids should be monitored and rationed to prevent fluid overload." e. "My child should avoid straddle toys, sandboxes, swimming, and rough activities until allowed by the surgeon."

b. Ensure adequate hydration. Rationale: When respiratory distress is present, hydration is an essential consideration. Usually infants cannot take fluids by the oral route because of the difficulty breathing. Intravenous fluid administration may be necessary. RSV is a virus, so antibiotics are not beneficial. Cough syrup is not routinely used in RSV. Although fluid and calories are important, an infant with respiratory distress is usually unable to drink this amount of fluid. (Evolve Ch 28 The Child with Respiratory Dysfunction)

When planning care for a 4-month-old child admitted with respiratory distress caused by respiratory syncytial virus (RSV) and bronchiolitis, it is essential to include which of the following? a. Give antibiotics. b. Ensure adequate hydration. c. Administer cough syrup. d. Feed 4 oz of formula every 4 hours.

b. Antecedent streptococcal infection Rationale: Most cases are postinfectious and have been associated with pneumococcal, streptococcal, or viral infections. Renal vascular anomalies are not associated with acute glomerulonephritis. Urinary tract infections and structural anomalies can result in progressive renal injury, not acute glomerulonephritis. (Evolve Ch 25 The Child with Renal Dysfunction)

Which of the following best describes the cause of most cases of acute glomerulonephritis? a. Renal vascular anomalies b. Antecedent streptococcal infection c. Results from a urinary tract infection d. Structural anomalies of genitourinary tract

a. Oximetry Rationale: Oximetry provides continuous noninvasive measurements of hemoglobin saturation. Photometric measurements are used to determine the oxygen saturation. Capnography measures carbon dioxide during inhalation and exhalation. Arterial puncture is the sampling method to obtain blood for gas analysis. Transcutaneous oxygen and carbon dioxide monitoring provides a continuous and reliable trend of arterial oxygen and carbon dioxide. (Evolve Ch 27 Overview of Oxygen and Carbon Dioxide Exchange)

Which of the following blood oxygenation tests is the photometric measurement of oxygen saturation? a. Oximetry b. Capnography c. Arterial puncture d. Transcutaneous oxygen and carbon dioxide monitoring

b. Short urethra in girls Rationale: The short urethra, which measures approximately 2 cm (0.8 in) in girls and 4 cm (1.6 in) in mature women, provides a ready pathway for invasion of organisms. Increased fluid intake results in frequent emptying of the bladder, preventing urinary stasis. Urine is bacteriostatic at pH of 5.0. This is not achievable by ingestion of juice. Frequent emptying of the bladder helps prevent urinary tract infections. (Evolve Ch 25 The Child with Renal Dysfunction)

Which of the following factors predisposes the urinary tract to infection? a. Increased fluid intake b. Short urethra in girls c. Ingestion of highly acidic juices d. Frequent emptying of the bladder

a. Infants rely almost entirely on diaphragmatic-abdominal breathing. Rationale: The ribs of an infant articulate with the vertebrae and sternum at a more horizontal angle. This contributes to the infant using primarily diaphragmatic-abdominal breathing. Smooth muscle development at approximately 4 months of age is sufficient to respond to irritating stimuli. The chest of an infant is more rounded than that of an adult. Alveoli steadily increase in number. By age 12 years, there are nine times as many alveoli as at birth. (Evolve Ch 27 Overview of Oxygen and Carbon Dioxide Exchange)

Which of the following helps nurses understand how the respiratory tract in children is different from that in adults? a. Infants rely almost entirely on diaphragmatic-abdominal breathing. b. Smooth muscle development in the airways increases until about age 12 years. c. The configuration of the chest at birth is not as round as it becomes by adulthood. d. With age there is a decrease in both number of alveoli and branching of terminal bronchioles.

c. Compliance Rationale: Compliance is a measure of chest wall and lung distensibility. Resistance increases the work of breathing. Three major sources of resistance are airway size, tissue resistance in lung, and flow resistance in the airways. Ventilation is the exchange of gases in the lungs. Alveolar surface tension is one of several contributory factors to compliance. (Evolve Ch 27 Overview of Oxygen and Carbon Dioxide Exchange)

Which of the following is a measure of chest wall and lung distensibility? a. Resistance b. Ventilation c. Compliance d. Alveolar surface tension

c. Adolescents can carry out procedures themselves. Rationale: Continuous cycling peritoneal dialysis or continuous ambulatory peritoneal dialysis provide the most independence for adolescents with end-stage renal disease and their families. Adolescents can carry out the procedure themselves. Dietary restrictions are still required but are less strict. The procedure can be done at home. The catheter is surgically implanted in the abdominal cavity. (Evolve Ch 25 The Child with Renal Dysfunction)

Which of the following is an advantage of continuous cycling peritoneal dialysis or continuous ambulatory peritoneal dialysis for adolescents who require dialysis? a. Dietary restrictions are no longer necessary. b. Hospitalization is only required several nights per week. c. Adolescents can carry out procedures themselves. d. Insertion of a catheter does not require surgical placement.

a. Oliguria Rationale: Oliguria is the primary clinical symptom of acute renal failure. Generally, urinary output is less than 1 ml/kg/hr. Hematuria, proteinuria, and bacteriuria may be present in renal disease, but they are not the primary manifestations of acute renal failure. (Evolve Ch 25 The Child with Renal Dysfunction)

Which of the following is the primary clinical manifestation of acute renal failure? a. Oliguria b. Hematuria c. Proteinuria d. Bacteriuria

d. Polyuria, polydipsia Rationale: Diabetes insipidus results from the hyposecretion of antidiuretic hormone. Because insufficient amounts are produced, excessive amounts of urine are produced. When allowed access to fluids, the child maintains balance with an almost insatiable thirst. Oliguria is diminished urinary output. Children with diabetes insipidus have increased urinary output. Glycosuria is not a manifestation of diabetes insipidus. It may be a manifestation of diabetes mellitus. Nausea and vomiting are not manifestations of diabetes insipidus. They can occur with oversecretion of antidiuretic hormone. (Evolve Ch 33 The Child with Endocrine Dysfunction)

Which of the following is the primary clinical manifestation of diabetes insipidus? a. Oliguria b. Glycosuria c. Nausea, vomiting d. Polyuria, polydipsia

c. Dress and activities should be appropriate to chronologic age. Rationale: Because of the early sexual maturation of the child, both the family and child require extensive teaching. Included in this is the information that the child should be engaged in activities according to chronologic age. Functioning sperm or ova may be produced, thereby making the child fertile at an early age. Heterosexual interest is usually appropriate to chronologic age. Development of the secondary sexual characteristics proceeds in the usual order. (Evolve Ch 33 The Child with Endocrine Dysfunction)

Which of the following should the nurse include when discussing a child's precocious puberty with the parents? a. The child is not yet fertile. b. Heterosexual interest is usually advanced. c. Dress and activities should be appropriate to chronologic age. d. Appearance of secondary sexual characteristics does not proceed in the usual order.

b. Epiglottitis Rationale: Epiglottitis is always a medical emergency needing antibiotics and airway support for treatment. Laryngitis is a common viral illness in older children and adolescents, with hoarseness and upper respiratory tract infection symptoms. Spasmodic croup is treated with humidity. Laryngotracheobronchitis may progress to a medical emergency in some children. (Evolve Ch 28 The Child with Respiratory Dysfunction)

Which of the following types of croup is always considered a medical emergency? a. Laryngitis b. Epiglottitis c. Spasmodic croup d. Laryngotracheobronchitis

b. Creatinine Rationale: The most useful clinical estimation of glomerular filtration is the clearance of creatinine. The production and secretion of creatinine remain relatively constant from day to day, and its appearance in the urine is determined by the serum level. The pH is a measure of alkalinity, not glomerular filtration. Osmolality is a measure of concentration. The presence of protein is indicative of abnormal glomerular permeability. (Evolve Ch 25 The Child with Renal Dysfunction)

Which of the following urine tests of renal function is used to estimate glomerular filtration? a. pH b. Creatinine c. Osmolality d. Protein level

4. "Has the child had a sore throat or a throat infection in the last few weeks?" Rationale: Glomerulonephritis refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. Group A β-hemolytic streptococcal infection is a cause of glomerulonephritis. Often, a child becomes ill with streptococcal infection of the upper respiratory tract and then develops symptoms of acute poststreptococcal glomerulonephritis after an interval of 1 to 2 weeks. The assessment data in options 1, 2, and 3 are unrelated to a diagnosis of glomerulonephritis. Test-Taking Strategy: Note the subject, a question that will elicit information specific to the diagnosis of glomerulonephritis. Option 1 relates to a kidney injury, not an infectious process. From the remaining options, recalling that a streptococcal infection 1 to 2 weeks before the development of glomerulonephritis is the classic assessment finding will assist in directing you to the correct option. (NCLEX Ch 41 Renal and Urinary Disorders)

Which question should the nurse ask the parents of a child suspected of having glomerulonephritis? 1. "Did your child fall off a bike onto the handlebars?" 2. "Has the child had persistent nausea and vomiting?" 3. "Has the child been itching or had a rash anytime in the last week?" 4. "Has the child had a sore throat or a throat infection in the last few weeks?"

2. Reduce exposure to environmental organisms. 3. Use strict aseptic technique for all procedures. 4. Ensure that anyone entering the child's room wears a mask. Rationale: Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing anemia from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production (thrombocytopenia). A common complication of treatment for leukemia is overwhelming infection secondary to neutropenia. Measures to prevent infection include the use of a private room, strict aseptic technique, restriction of visitors and health care personnel with active infection, strict hand washing, ensuring that anyone entering the child's room wears a mask, and reducing exposure to environmental organisms by eliminating raw fruits and vegetables from the diet and fresh flowers from the child's room and by not leaving standing water in the child's room. Applying firm pressure to a needle-stick area for at least 10 minutes is a measure to prevent bleeding. Test-Taking Strategy: Focus on the subject, preventing infection. Reading each intervention carefully and keeping this subject in mind will assist in answering the question. A semiprivate room places the child at risk for infection. Applying firm pressure to a needle-stick area is related to preventing bleeding. (NCLEX Ch 35 Oncological Disorders)

Which specific nursing interventions are implemented in the care of a child with leukemia who is at risk for infection? Select all that apply. 1. Maintain the child in a semiprivate room. 2. Reduce exposure to environmental organisms. 3. Use strict aseptic technique for all procedures. 4. Ensure that anyone entering the child's room wears a mask. 5. Apply firm pressure to a needle-stick area for at least 10 minutes.

c. If it is present in a child, both parents are carriers of the defective gene. Rationale: CF is an autosomal recessive gene inherited from both parents. CF is inherited as an autosomal recessive, not autosomal dominant, trait. CF is found primarily in white populations. An autosomal recessive inheritance pattern means that there is a 25% chance a sibling will be infected but a 50% chance a sibling will be a carrier. (Evolve Ch 28 The Child with Respiratory Dysfunction)

Which statement accurately expresses the genetic implications of cystic fibrosis (CF)? a. It is inherited as an autosomal dominant trait. b. It is a genetic defect found primarily in nonwhite population groups. c. If it is present in a child, both parents are carriers of the defective gene. d. There is a 50% chance that siblings of an affected child will also be affected.