P2Q

After teaching the parents of a child with celiac disease about diet, which of the following, if stated by the parents to be avoided, indicates effective teaching? Select all that apply. 1. Chocolate candy. 2. Hot dogs. 3. Bologna on rye sandwich. 4. Corn tortillas. 5. White rice.

1, 2, 3. Children with celiac disease should avoid foods containing the protein gluten, which is found in wheat, oats, rye, and barley grains. Children are allowed to eat foods containing rice or corn. Labels need to be read carefully since these glutens are used as fi llers in many food items including many types of chocolate candy and hot dogs.

The nurse is caring for a newborn with esophageal atresia. When reviewing the mother ' s history, which would the nurse expect to fi nd? 1. Maternal polyhydramnios. 2. Pregnancy lasting more than 38 weeks. 3. Poor nutrition during pregnancy. 4. Alcohol consumption during pregnancy.

1. Maternal polyhydramnios is present because the infant cannot swallow and absorb the amniotic fl uid in utero

Which is an accurate description of a Kasai procedure? 1. A palliative procedure in which the bile duct is attached to a loop of bowel to assist with bile drainage. 2. A curative procedure in which a connection is made between the bile duct and a loop of bowel to assist with bile drainage. 3. A curative procedure in which the bile duct is banded to prevent bile leakage. 4. A palliative procedure in which the bile duct is banded to prevent bile leakage

1. The Kasai procedure is a palliative procedure in which the bile duct is attached to a loop of bowel to assist with bile drainage.

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

3. Rantadine (Zantac) decreases gastric acid secretion and should be administered 30 minutes before a feeding.

Which of the following would be an important assessment finding for an 8-month-old infant admitted with severe diarrhea? 1. Absent bowel sounds. 2. Pale yellow urine. 3. Normal skin elasticity. 4. Depressed anterior fontanel

4. An infant with severe diarrhea will experience some degree of dehydration. In an 8-month-old child, the anterior fontanel has not closed. Therefore, a depressed anterior fontanel would be an important fi nding. Additionally, the infant would exhibit dry mucous membranes, lethargy, hyperactive bowel sounds, dark urine, and sunken eyeballs. Skin turgor would be decreased or delayed (e.g., slow to return when pinched).

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

4. Cheese, banana slices, rice cakes, and whole milk do not contain gluten

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

4. The lip is repaired in the fi rst few weeks of life, but the palate is not usually repaired until the child is 18 months old.

A nursing instructor is teaching a group of students about the action of antipyretic agents in children. The instructor determines that the teaching has been successful when the students identify which of the following as the primary action? A) Cause vasodilation to promote heat loss B) Decrease the temperature set point C) Block release of histamine D) Promote prostaglandin production

B

Which of the following would be most important to include in the teaching plan for parents of a child with pinworm? A) "Seal the child's clothing in a plastic bag for at least 10 days." B) "Be sure your child wears shoes at all times." C) "Make sure the child washes his hands after using the bathroom." D) "After applying this special cream, leave it on for about 8 to 10 hours."

C

The nurse is caring for a 2-year-old child who was admitted to the pediatric unit for moderate dehydration due to vomiting and diarrhea. The child is restless with periods of irritability. The child is afebrile with a heart rate of 148 and a blood pressure of 90/42. Baseline laboratory tests reveal the following: Na 152, Cl 119, and glucose 115. The parents state that the child has not urinated in 12 hours. After establishing a saline lock, the nurse reviews the physician ' s orders. Which order should the nurse question? 1. Administer a saline bolus of 10 mL/kg, which may be repeated if the child does not urinate. 2. Recheck serum electrolytes in 12 hours. 3. After the saline bolus, begin maintenance fl uids of D5 ¼ NS with 10 mEq KCl/L. 4. Give clear liquid diet as tolerated.

3. Potassium is contraindicated because the child has not yet urinated. Potassium is not added to the maintenance fl uid until kidney function has been verifi ed.

The health care team wishes to establish a policy regarding sleep positions for infants with gastroesophageal refl ux (GER). The fi rst step should be to search for: 1. Policies from other hospitals. 2. Data from retrospective studies. 3. Published national standards. 4. Expert opinions

3. Published national standards are based on the best evidence and when available should serve as the foundation for nursing unit policies. Policies from other hospitals may or may not be evidence based. Retrospective studies and expert opinions should only be used to form policy when data from experimental studies or national standards are not available

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

3. Pyloric stenosis can run in families, and it is more common in males.

Which of the following would most likely alert the nurse to the possibility that a preschooler is experiencing moderate dehydration? 1. Deep, rapid respirations. 2. Diaphoresis. 3. Absence of tear formation. 4. Decreased urine specific gravity

3. The absence of tears is typically found when moderate dehydration is observed as the body attempts to conserve fl uids. Other typical fi ndings associated with moderate dehydration include a dry mouth, sunken eyes, poor skin turgor, and an increased pulse rate. Deep, rapid respirations are associated with severe dehydration. Decreased perspiration, not diaphoresis, would be seen with moderate dehydration. The specifi c gravity of urine increases with decreased output in the presence of dehydration.

A 4-month-old has had vomiting and diarrhea for 24 hours. The infant is fussy, and the anterior fontanel is sunken. The nurse notes the infant does not produce tears when crying. Which task will help confi rm the diagnosis of dehydration? 1. Urinalysis obtained by bagged specimen. 2. Urinalysis obtained by sterile catheterization. 3. Analysis of serum electrolytes. 4. Analysis of cerebrospinal fl uid.

3. The analysis of serum electrolytes offers the most information and assists with the diagnosis of dehydration.

Which of the following foods would be appropriate for a 12-month-old child with celiac disease? 1. Cheerios. 2. Pancakes. 3. Rice Chex. 4. Waffles.

3. The child with celiac disease should not eat foods containing wheat, oats, rye, or barley. Foods containing rice, such as Rice Chex cereal, or corn are appropriate. Because Cheerios are made from oats, this cereal should be avoided. Pancakes and waffl es are made from fl our that typically is derived from wheat and therefore should be avoided.

A mother asks, "How should I bathe my baby now that he's had surgery for his inguinal hernia?" Which of the following instructions should the nurse give the mother? 1. "Clean his face and diaper area for 2 weeks." 2. "Use sterile sponges to cleanse the inguinal incision." 3. "Give him a sponge bath daily for 1 week." 4. "Give the infant full tub baths every day."

3. The incision must be kept as clean and dry as possible. Therefore, daily sponge baths are given for about 1 week postoperatively. Cleaning the infant's face and diaper area should occur at least daily and continuously, not limited to a 2-week period. Because this type of surgery results in a wound that heals through primary intention, the skin will heal and cover the wound in 2 to 3 days. Therefore, it is not necessary to use sterile gauze to cleanse the incision; clean technique is acceptable. Because the incision must be kept as clean and dry, full tub baths are inappropriate.

The parent of an infant with a cleft lip and palate asks the nurse when the infant's cleft palate will be repaired. The nurse responds by stating that the first repair of a cleft palate is usually done at which of the following times? 1. Before the eruption of teeth. 2. When the child weighs approximately 10 kg (22 lb). 3. Before the development of speech. 4. After the child learns to drink from a cup

3. The optimal time for cleft palate repair depends on many factors. However, it is best done before speech develops and the child learns faulty speech habits as a result of the defect, usually before 12 to 15 months of age. Tooth eruption usually begins at about 6 months of age. The child should weigh about 10 kg (22 lb) at 6 months, but the important consideration is to schedule surgery before speech patterns begin to develop. An infant may learn to start drinking from a cup as early as 6 to 7 months of age, possibly up to the fi rst birthday.

After teaching the parents of an infant diagnosed with Hirschsprung's disease, the nurse determines that the parents understand the diagnosis when the father states which of the following? 1. "There is no rectal opening for stool to pass." 2. "There is a tube between the trachea and esophagus." 3. "The nerves at the end of the large colon are missing." 4. "The muscle below the stomach is too tight."

3. The primary defect in Hirschsprung's disease is an absence of autonomic parasympathetic ganglion cells in the distal portion of the colon. Thus, the nerves at the end of the large colon are missing. Absence of a rectal opening refers to an imperforate anus. A tube between the trachea and esophagus refers to a tracheoesophageal fi stula. Presence of a tight muscle below the stomach refers to pyloric stenosis.

When assessing a 4-month-old infant diagnosed with possible intussusception, the nurse should expect the mother to relate which of the following about the infant's crying and episodes of pain? 1. Constant accompanied by leg extension. 2. Intermittent with knees drawn to the chest. 3. Shrill during ingestion of solids. 4. Intermittent while being held in the mother's arms.

4. Following pyloromyotomy the infant should be positioned with the head elevated and slightly on the right side to promote gastric emptying; the parents have positioned their infant correctly. The infant should be positioned on the right side, not the left side. When the child is in a crib, the head can be elevated and the infant can be propped on the right side. The infant can use a pacifi er if needed.

Immediately after the first oral feeding after corrective surgery for pyloric stenosis, a 4-week-old infant is fussy and restless. Which of the following actions would be most appropriate at this time? 1. Encourage the parents to hold the infant. 2. Hang a mobile over the infant's crib. 3. Give the infant more to eat. 4. Give the infant a pacifier to suck on

4. Giving the infant a pacifi er would help meet non-nutritive sucking needs and ensure oral gratifi cation. Additionally, sucking aids in calming the infant. Holding the infant to decrease fussiness and restlessness is more effective in an older infant. Also, the reason for the infant's fussiness needs to be explored. Hanging a mobile over the crib frequently does not decrease fussiness. After surgery to correct pyloric stenosis, feeding the infant more formula would lead to vomiting, putting additional stress on the operative site

When teaching the mother of an infant who has undergone surgical repair of a cleft lip how to care for the suture line, the nurse demonstrates how to remove formula and drainage. Which of the following solutions should the nurse use? 1. Mouthwash. 2. Povidone-iodine (Betadine) solution. 3. A mild antiseptic solution. 4. Half-strength hydrogen peroxide.

4. Half-strength hydrogen peroxide is recommended for cleaning the suture line after cleft lip repair. The bubbling action of the hydrogen peroxide is effective for removing debris. Normal saline also may be used. Mouthwashes frequently contain alcohol, which can be irritating. Also, mouthwashes are not as effective in removing debris as halfstrength peroxide solutions are. Povidone-iodine solution is not used because the iodine contained in the solution can be absorbed through the skin, leading to toxicity. A mild antiseptic solution has some antibacterial properties but is ineffective in removing suture-line debris

The nurse will soon receive a 4-month-old who has been diagnosed with intussusception. The infant is described as very lethargic with the following vital signs: T 101.8°F (38.7°C), HR 181, BP 68/38. The reporting nurse states the infant ' s abdomen is very rigid. Which is the most appropriate action for the receiving nurse? 1. Prepare to accompany the infant to a computed tomography scan to confi rm the diagnosis. 2. Prepare to accompany the infant to the radiology department for a reducing enema. 3. Prepare to start a second intravenous line to administer fl uids and antibiotics. 4. Prepare to get the infant ready for immediate surgical correction.

4. Intussusception with peritonitis is a surgical emergency, so preparing the infant for surgery is the nurse ' s top priority

Which should the nurse include in the plan of care to decrease symptoms of gastroesophageal refl ux (GER) in a 2-month-old? Select all that apply. 1. Place the infant in an infant seat immediately after feedings. 2. Place the infant in the prone position immediately after feeding to decrease the risk of aspiration. 3. Encourage the parents not to worry because most infants outgrow GER within the fi rst year of life. 4. Encourage the parents to hold the infant in an upright position for 30 minutes following a feeding. 5. Suggest that the parents burp the infant after every 1-2 ounces consumed.

4. Keeping the infant in an upright position is the best way to decrease the symptoms of GER. The infant can also be placed in the supine position with the head of the crib elevated. A harness can be used to keep the child from sliding down. 5. Burping the infant frequently may help decrease spitting up by expelling air from the stomach more often.

The nurse is caring for a child with osteomyelitis who will be receiving high-dose intravenous antibiotic therapy for 3 to 4 weeks. What should the nurse plan to monitor? 1. Blood glucose level. 2. Thrombin times. 3. Urine glucose level. 4. Urine specifi c gravity

4. Long-term, high-dose antibiotic therapy can adversely affect renal, hepatic, and hematopoietic function. Urine specifi c gravity would provide valuable information about the kidneys' ability to concentrate or dilute urine, thereby suggesting renal impairment. Blood glucose levels reveal how well the client's body is using glucose. Thrombin times reveal information about the clotting mechanism. Urine glucose levels reveal information about the body's use and excretion of glucose.

The mother of a child with celiac disease asks, "How long must he stay on this diet?" Which response by the nurse is best? 1. "Until the jejunal biopsy is normal." 2. "Until his stools appear normal." 3. "For the next 6 months." 4. "For the rest of his life."

4. Most children with celiac disease have a lifelong sensitivity to gluten, which requires that they maintain some type of diet restriction for the rest of their lives

The nurse receives a call from the parent of a 10-month-old who has vomited three times in the past 8 hours. The parent describes the baby as playful and wanting to drink. The parent asks the nurse what to give the child. Select the nurse ' s best response. 1. "Replace the next feeding with regular water, and see if that is better tolerated." 2. "Do not allow your baby to eat any solids; give half the normal formula feeding, and see if that is better tolerated." 3. "Do not let your baby eat or drink anything for 24 hours to give the stomach a chance to rest." 4. "Give your child ½ ounce of Pedialyte every 10 minutes. If vomiting continues, wait an hour, and then repeat what you previously gave."

4. Offering small amounts of clear liquids is usually well tolerated. If the child vomits, make NPO for an hour to allow the stomach to rest and then restart fl uids. The child in this scenario is described as playful and therefore does not appear to be at risk for dehydration.

After undergoing surgical correction of pyloric stenosis, an infant is returned to the room in stable condition. While standing by the crib, the mother says, "Perhaps if I had brought my baby to the hospital sooner, the surgery could have been avoided." Which of the following should be the nurse's best response? 1. "Surgery is the most effective treatment for pyloric stenosis." 2. "Try not to worry; your baby will be fi ne." 3. "Do you feel that this problem indicates that you are not a good mother?" 4. "Do you think that earlier hospitalization could have avoided surgery?"

4. Restating or rephrasing a mother's response provides the opportunity for clarifi cation and validation. It also helps to focus on what the mother is saying and address her concerns and feelings. Although surgery is the most effective treatment for pyloric stenosis, stating this ignores the mother's feelings and does not give her an opportunity to express them. Telling the mother not to worry also ignores the mother's feelings. Additionally, this type of statement gives the mother premature reassurance, which may turn out to be false. Asking the mother if she thinks the problem indicates that she is not a good mother implies such an idea. It does not allow her to express her concerns and feelings and therefore is not a therapeutic response.

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

4. The aganglionic portion needs to be removed. Although most children have a temporary colostomy placed, many infants are able to bypass the colostomy and have the bowel immediately reattached.

The pregnant mother of a child diagnosed with erythema infectiosum (fi fth disease) is crying, and says, "I am afraid. Will my unborn baby die? I have a planned cesarean section next week." Which statement would be the most therapeutic response? 1. "Let me get the physician to come and talk with you." 2. "I understand. I would be afraid, too." 3. "Would you like me to call your obstetrician to have you seen as soon as possible?" 4. "I understand you are afraid. Can we can talk about your concerns?"

4. There is less risk of fetal death in the second half of the pregnancy. It is more therapeutic to acknowledge a client ' s fears. After acknowledging her fears, the appropriate response would be to discuss concerns and clarify any misconceptions.

Which would be the most therapeutic response for the mother of a 6-month-old who tells the nurse she does not want her infant to have the DTaP vaccine because the infant had localized redness the last time she received the vaccine? 1. "I will let the physician know, and we will not administer the DTaP vaccination today." 2. "Every child has that allergic reaction, and your child will still get the DTaP today." 3. "I will let the physician know that you refuse further immunizations for your daughter." 4. "Would you mind if we discussed your concerns?"

4. This is the therapeutic response— discussing the mother ' s concerns about the immunizations and local reactions.

A group of students are reviewing information about gallbladder disease inchildren. The students demonstrate a need for additional review when they state: A) cholesterol gallstones are more frequently found in males. B) pigment stones are found primarily in the common bile duct. C) pancreatitis is a common complication of cholecystitis in children. D) cholecystitis is due to chemical irritation from obstructed bile flow.

A Cholesterol gallstones are seen more often in females than males and increasedrisk occurs with age and onset of puberty. Pigment stones are usually found in thecommon bile duct. Pancreatitis is a common complication in children with gallstonedisease. Cholecystitis is an inflammation of the gallbladder that is caused bychemical irritation due to the obstruction of bile flow from the gallbladder into thecystic ducts.

The nurse is taking a health history of an 11-year-old girl with recurrent abdominal pain. Which response would lead the nurse to suspect irritable bowelsyndrome? A) "I always feel better after I have a bowel movement." B) "I don't take any medicine right now." C) "The pain comes and goes." D) "The pain doesn't wake me up in the middle of the night.

A In cases of irritable bowel syndrome, the pain may be relieved by defecation. Use ofmedications and pain that comes and goes or wakes the person up in the middle ofthe night are all relevant findings pertinent to recurrent abdominal pain.

An 8-month-old infant is brought to the clinic for evaluation. The mother tellsthe nurse that she has noticed some white patches on the infant's tongue that looklike curdled milk after breastfeeding. The nurse suspects oral candidiasis (thrush).Which question would the nurse use to help confirm this suspicion? A) "Are you having breast pain when you nurse the baby?" B) "Has he had any dairy problems recently?" C) "Is he experiencing any vomiting lately?" D) "How have his stools been this past week?"

A The infant may develop thrush from the mother if the mother has a fungal infectionof the breast. Asking the mother about breast pain would be important because thistype of infection can cause the mother a great deal of pain with nursing. Dairyproducts are not associated with oral candidiasis but are associated with thedevelopment of infectious diarrhea in infants. Vomiting is unrelated to thrush. Theinfant also may have candidal diaper rash, but this would be manifested on the skinas a beefy-red rash with satellite lesions, not in his stools.

The parents of a boy diagnosed with Hirschsprung disease are anxious andfearful of the upcoming surgery. The mother states, "I'm worried about having tocare for our son's ostomy." Which intervention would be most helpful for theparents? A) Explaining to them about the diagnosis and surgery B) Having a wound, ostomy, and continence nurse meet with them C) Reinforcing that the ostomy will be temporary D) Teaching them about the medications used to slow stool output

B Although explaining about the diagnosis and surgery, reinforcing that the ostomywill be temporary, and teaching them about medications would be appropriate, theparents are voicing concerns about caring for the ostomy. Therefore, having awound, ostomy, and continence nurse meet with them would address theseconcerns and help them deal with the anxieties and care of a newly placed stoma.

The mother of a 3-week-old infant old brings her daughter in for anevaluation. During the visit, the mother tells the nurse that her baby is spitting upafter feedings. Which response by the nurse would be most appropriate? A) "We need to tell the healthcare provider about this." B) "Infants this age commonly spit up." C) "Your daughter might have an allergy." D) "Don't worry; you're just feeding her too much."

B In infants younger than 1 month of age, the lower esophageal sphincter is not fullydeveloped, so infants younger than 1 month of age frequently regurgitate afterfeedings. Many children younger than 1 year of age continue to regurgitate forseveral months, but this usually disappears with age. The mother's report is not acause for concern, so the healthcare provider does not need to be notified.Additional information would be needed to determine if the infant had an allergy.Although the infant's stomach capacity is small, telling the mother not to worrydoes not address the mother's concern, and telling her that she is feeding thedaughter too much implies that she is doing something wrong.

The nurse is conducting a physical examination of a child with suspectedCrohn disease. Which finding would be the most suspicious of Crohn disease? A) Normal growth patterns B) Perianal skin tags or fissures C) Poor growth patterns D) Abdominal tenderness

B Perianal skin tags and/or fissures are highly suspicious of Crohn disease. Poorgrowth patterns and abdominal tenderness are common to Crohn disease but arealso seen with many other conditions. Normal growth patterns would not point toCrohn disease because of problems with absorbing nutrients

The nurse is caring for a 2-month-old with a cleft palate. The child willundergo corrective surgery at age 3 months. The mother would like to continuebreastfeeding the baby after surgery and wonders if it is possible. How should thenurse respond? A) "There is a good chance that you will be able to breastfeed almostimmediately." B) "Breastfeeding is likely to be possible but check with the surgeon." C) "After the suture line heals, breastfeeding can resume." D) "We will have to wait and see what happens after the surgery."

B Postoperatively, some surgeons allow breastfeeding to be resumed almostimmediately. However, the nurse needs to advise the mother to check with thesurgeon to determine when breastfeeding can resume. Telling the mother that shehas to wait until the suture line heals may be inaccurate. Telling her to wait and seedoes not answer her question.

The nurse is caring for an infant with a temporary ileostomy. As part of theplan of care, the nurse monitors for skin breakdown around the stoma. If rednessoccurs, what would be most appropriate to promote healing and prevent furtherskin breakdown? A) Clean the area well with a scented diaper wipe. B) Apply a barrier/healing cream or paste on the skin. C) Use a barrier wafer to attach the appliance. D) Sanitize the area with an alcohol wipe after each diaper change.

B The nurse should use a barrier/healing cream or paste on the skin around thestoma to promote healing and prevent further skin breakdown. Diaper wipes thatcontain fragrance or alcohol can sting if used on nonintact skin and can worsen skinbreakdown. The barrier wafer would be helpful but does not address the skinbreakdown.

The parents of a 6-week-old boy come to the clinic for evaluation becausethe infant has been vomiting. The parents report that the vomiting has beenincreasing in frequency and forcefulness over the last week. The mother says,"Sometimes, it seems like it just bursts out of his mouth." A diagnosis ofhypertrophic pyloric stenosis is suspected. When performing the physicalexamination, what would the nurse most likely find? A) Sausage-shaped mass in the upper midabdomen B) Hard, moveable, olive-shaped mass in the right upper quadrant C) Tenderness over the McBurney point in the right lower quadrant D) Abdominal pain in the epigastric or umbilical region

B With hypertrophic pyloric stenosis, a hard, moveable, olive-shaped mass would bepalpated in the right upper quadrant. A sausage-shaped mass in the uppermidabdomen would suggest intussusception. Tenderness over the McBurney pointwould be associated with appendicitis. Epigastric or umbilical pain would beassociated with peptic ulcer disease.

A child is diagnosed with a helminthic infection. Which of the following would the nurse expect to be prescribed? Select all answers that apply. A) Erythromycin B) Albendazole C) Pyrantel pamoate D) Acyclovir E) Metronidazole F) Permethrin

B, C

The nurse is caring for a 6-month-old with a cleft lip and palate. The motherof the child demonstrates understanding of the disorder with which statements?Select all that apply. A) "My smoking during pregnancy didn't have anything to do with thisdisorder. Smoking primarily causes low birth weight." B) "I know my baby takes a lot longer to feed than most children thisage." C) "It really worries me that my baby may have some other disordersthat haven't been detected yet." D) "I wonder if my baby will develop speech problems when languagedevelopment begins?" E) "Thankfully there are healthcare providers that specialize in correctingthis type of disorder.

B, C, D, E Feeding and speech are especially difficult for the child with cleft lip and palate untilthe defect is repaired. Cleft lip and palate occurs frequently in association withother anomalies and has been identified in more than 350 syndromes. Plasticsurgeons or craniofacial specialists, oral surgeons, dentists or orthodontists, andprosthodontists are some of the healthcare providers that specialize in repair of thisdisorder. The mother is incorrect in stating that smoking is not associated with cleftlip or palate. Maternal smoking during pregnancy is a major risk factor for thedisorder.

After teaching the parents of a child diagnosed with celiac disease aboutnutrition, the nurse determines that the teaching was effective when the parentsidentify which foods as appropriate for their child? Select all that apply. A) Wheat germ B) Peanut butter C) Carbonated drinks D) Shellfish E) Jelly F) Flavored yogurt

B, C, D, E Foods allowed in a gluten-free diet include peanut butter, carbonated drinks,shellfish, and jelly. Wheat germ and flavored yogurt should be avoided.

Which finding would lead the nurse to suspect that a child is experiencing moderate dehydration? A) Dusky extremities B) Tenting of skin C) Sunken fontanels D) Hypotension

C A child with moderate dehydration would exhibit sunken fontanels. Severedehydration would be characterized by dusky extremities, skin tenting, andhypotension.

The nurse is providing care to a child with an intussusception. The child has abowel movement and the nurse inspects the stool. The nurse would most likelydocument the stool's appearance as having what quality? A) Greasy B) Clay-colored C) Currant jelly-like D) Bloody

C The child with intussusception often exhibits currant jelly-like stools that may ormay not be positive for blood. Greasy stools are associated with celiac disease.Cay-colored stools are observed with biliary atresia. Bloody stools can be seen withseveral gastrointestinal disorders, such as inflammatory bowel disease.

A mother brings her 3-month-old child into the emergency department. The child is listless with dry mucous membranes, tenting of the skin on the forehead, a depressed fontanel, and a history of vomiting and diarrhea for the last 36 hours. In what order from first to last should the nurse implement the physician's orders? 1. Obtain vital signs 2. Insert an I.V. and infuse fluids. 3. Apply a urine collection bag. 4. Draw blood for laboratory tests.

1, 3, 2, 4 The nurse should fi rst obtain vital signs and evaluate the child for signs of shock or cardiac arrhythmias. The weight can also be obtained at this time to estimate the amount of fl uid lost. The nurse should next apply the urine collection bag. As soon as possible after these steps, the nurse should insert an I.V. to replace lost fl uids, electrolytes, and sugar to reduce the incidence of metabolic acidosis created by the lack of calorie intake and the loss of electrolytes. Blood should be drawn to assess the severity of electrolyte imbalance and other possible causes for the diarrhea and vomiting.

Which should be included in the plan of care for a 14-month-old whose cleft palate was repaired 12 hours ago? Select all that apply. 1. Allow the infant to have familiar items of comfort such as a favorite stuffed animal and a "sippy" cup. 2. Once liquids have been tolerated, encourage a bland diet such as soup, Jell-O, and saltine crackers. 3. Administer pain medication on a regular schedule, as opposed to an as-needed schedule. 4. Use a Yankauer suction catheter on the infant ' s mouth to decrease the risk of aspiration of oral secretions. 5. When discharged, remove elbow restraints.

1, 3. The child should not be allowed to use anything that creates suction in the mouth, such as pacifi ers or straws. "Sippy" cups are acceptable. Pain medication should be administered regularly to avoid crying, which places stress on the suture line

The nurse is caring for a child who has just returned from surgery for repair of a cleft lip. In which order, from first to last, should the nurse do the following? 1. Maintain clear and adequate airway 2. Maintain sufficient fluid and caloric intake. 3. Provide emotional comfort to the child. 4. Apply elbow restraints. 5. Teach the parents proper feeding methods

1, 4, 2, 3, 5 The nurse should fi rst ensure that the child has a patent airway, because swelling and secretions following surgery can block the airway. Next, the nurse should restrain the infant's arms to keep him from rubbing with his hands or fi ngers on the incision line, which could cause scarring and damage to the incision. The child will need adequate nourishment and fl uids as soon as he recovers from anesthesia. The nurse must comfort the child, and try to prevent him from crying as much as possible, because crying puts a strain on the suture line and can cause scarring. The nurse should involve the parents in the child's care and feeding as soon as possible after she has assessed the child's ability to safely ingest his feedings

The nurse is caring for an infant newly diagnosed with Hirschsprung disease. What does the nurse understand about this infant ' s condition? Select all that apply. 1. There is a lack of peristalsis in the large intestine and an accumulation of bowel contents, leading to abdominal distention. 2. There is excessive peristalsis throughout the intestine, resulting in abdominal distention. 3. There is a small-bowel obstruction, leading to ribbon-like stools. 4. There is infl ammation throughout the large intestine, leading to accumulation of intestinal contents and abdominal distention. 5. There is an accumulation of bowel contents, leading to non-passage of stools.

1, 5. In Hirschsprung disease, a portion of the large intestine has an area lacking in ganglion cells. This results in a lack of peristalsis as well as an accumulation of bowel contents and abdominal distention. There is accumulation of stool above the aganglionic bowel, which does not allow stool to pass through.

The stool culture of a child with profuse diarrhea reveals Salmonella bacilli. After teaching the mother about the course of Salmonella enteritidis, which of the following statements by the mother indicates effective teaching? 1. "Some people become carriers and stay infectious for a long time." 2. "After the acute stage passes, the organism is usually not present in the stool." 3. "Although the organism may be alive indefinitely, in time it will be of no danger to anyone." 4. "If my child continues to have the organism in the stool, an antitoxin can help destroy the organism."

1. After having Salmonella enteritidis, some clients become chronic carriers of the causative organism and remain infectious for a long time as the organism continues to be shed from the body. During this time, the child is still considered infectious. No antitoxin is available to treat or prevent Salmonella infections

Which of the following measures would be most effective in helping the infant with a cleft lip and palate to retain oral feedings? 1. Burp the infant at frequent intervals. 2. Feed the infant small amounts at one time. 3. Place the end of the nipple far to the back of the infant's tongue. 4. Maintain the infant in a lying position while feeding

1. An infant with a cleft lip and palate typically swallows large amounts of air while being fed and therefore should be burped frequently. The soft palate defect allows air to be drawn into the pharynx with each swallow of formula. The stomach becomes distended with air, and regurgitation, possibly with aspiration, is likely if the infant is not burped frequently. Feeding frequently, even in small amounts, would not prevent swallowing of large amounts of air. A nipple placed in the back of the mouth is likely to cause the infant to gag and aspirate. Holding the infant in a lying position during feedings can also lead to regurgitation and aspiration of formula. The infant should be fed in an upright position

Which of the following instructions should the nurse expect to include in the discharge teaching plan for the parent of an infant who has had an inguinal herniorrhaphy? 1. Change diapers as soon as they become soiled. 2. Apply an abdominal binder. 3. Keep the incision covered with a sterile dressing. 4. Restrain the infant's hands.

1. Changing a diaper as soon as it becomes soiled helps prevent wound infection, the most common complication after inguinal hernia repair in an infant secondary to possible wound contamination with urine and stool. Because the surgical wound is unlikely to separate, an abdominal binder is unnecessary. The incision may or may not be covered with a dressing. If a dressing is not used, the physician may apply a topical spray to protect the wound. Restraining the infant's hands is unnecessary if the diaper is applied snugly. The infant would be unable to get the hands into the diaper close to the surgical site

After surgery to correct pyloric stenosis, the nurse instructs the parents about the postoperative feeding schedule for their infant. The parents exhibit understanding of these instructions when they state that they can start feeding the child within which of the following time frames? 1. 6 hours. 2. 8 hours. 3. 10 hours. 4. 12 hours

1. Clear liquids containing glucose and electrolytes are usually prescribed 4 to 6 hours after surgery. If vomiting does not occur, formula or breast milk then can be gradually substituted for clear liquids until the infant is taking normal feedings.

A 4-month-old is brought to the emergency department with severe dehydration. The heart rate is 198, and her blood pressure is 68/38. The infant ' s anterior fontanel is sunken. The nurse notes that the infant does not cry when the intravenous line is inserted. The child ' s parents state that she has not "held anything down" in 18 hours. The nurse obtains a fi nger-stick blood sugar of 94. Which would the nurse expect to do immediately? 1. Administer a bolus of normal saline. 2. Administer a bolus of D 10W. 3. Administer a bolus of normal saline with 5% dextrose added to the solution. 4. Offer the child an oral rehydrating solution such as Pedialyte

1. Dehydration is corrected with the administration of an isotonic solution, such as normal saline or lactated Ringer solution.

A child undergoes rehydration therapy after having diarrhea and dehydration. A nurse is teaching the child's parents about dietary management. The nurse understands that the teaching plan has been successful when the parents tell the nurse that they will follow which type of diet? 1. Regular. 2. Clear liquid. 3. Full liquid. 4. Soft

1. Dietary management following rehydration for diarrhea and mild dehydration would include offering the child a regular diet. Following rehydration, there is no need for the child to be on a special diet, such as a clear liquid, full liquid, or soft diet.

To meet the developmental needs of an 8-year-old child who is confi ned to home with osteomyelitis, what should the nurse include in the care plan? 1. Encouraging the child to communicate with schoolmates. 2. Encouraging the parents to stay with the child. 3. Allowing siblings to visit freely throughout the day. 4. Talking to the child about his interests twice daily

1. Encouraging contact with schoolmates allows the school-age child to maintain and develop socialization with peers, an important developmental task of this age-group. Although having family visits and interacting with the child are important, they do not meet the child's developmental needs. Talking to the child about his interests is important, but encouraging contact with schoolmates is crucial to maintain and develop socialization with peers.

An infant is to be discharged after surgery for intussusception. In developing the discharge teaching plan, the nurse should tell the mother? 1. The infant will experience a change in the normal home routine. 2. The infant can return to the prehospital routine immediately. 3. The infant needs to ingest more calories at home than what was consumed in the hospital. 4. The infant will continue to experience abdominal cramping for a few days.

1. Infants who have had an interruption in their normal routine and experiences, such as hospitalization and surgery, typically manifest behavior changes when discharged. The infant's normal routine has been signifi cantly altered, so it will take time to reestablish another routine. Calorie requirements at home will continue to be the same as those in the hospital. The infant does not need more calories at home. The surgical procedure corrected the problems, so the infant should not continue to have abdominal cramping

An infant is admitted to the pediatric unit with a diagnosis of hypertrophic pyloric stenosis after vomiting for several days. Which of the following nursing diagnoses should be the priority? 1. Deficient fluid volume related to prolonged vomiting. 2. Ineffective airway clearance related to impaired swallowing. 3. Imbalanced nutrition: Less than body requirements related to prolonged vomiting. 4. Bowel incontinence related to abdominal pain

1. Infants with pyloric stenosis usually have some degree of dehydration because of vomiting of the stomach contents. Therefore, a priority nursing diagnosis would be Deficient fluid volume related to prolonged vomiting. A nursing priority would be to restore fluid and electrolyte balance. Pyloric stenosis involves the pyloric valve distal to the stomach, not the respiratory tract. In addition, swallowing is not impaired with pyloric stenosis. Even though vomiting occurs, a normal infant should be able to protect the airway. Therefore, Ineffective airway clearance would be inappropriate. Imbalanced nutrition: Less than body requirements could be applicable but would not be the priority diagnosis. Bowel incontinence and abdominal pain are not typically associated with pyloric stenosis.

A child with newly diagnosed osteomyelitis has nausea and vomiting. The parent wishes to give the child ginger snaps to help control the nausea. The nurse should tell the parent: 1. "You can try them and see how he does." 2. "I will need to get an order." 3. "Your child needs medication for the vomiting." 4. "We discourage the use of home remedies in children."

1. Some clients fi nd ginger snaps help relieve nausea. The National Center for Complimentary and Alternative Medicine has determined that ginger, in small dose such as would be found in the cookies, has few side effects. There is no reason that the parent should not try this dietary intervention, however, the nurse must monitor the client's response. If the child has a diet as tolerated order, there is no need for an additional order. Ultimately, the child may need an antiemetic medication, but dietary strategies are often successful in treating vomiting related to osteomyelitis. Making a universal statement disregarding home remedies is not a clientcentered approach.

The mother of a toddler hospitalized for episodes of diarrhea reports that when her toddler cannot have things the way she wants, she throws her legs and arms around, screams, and cries. The mother says, "I don't know what to do!" After teaching the mother about ways to manage this behavior, which of the following statements indicates that the nurse's teaching was successful? 1. "Next time she screams and throws her legs, I'll ignore the behavior." 2. "I'll allow her to have what she wants once in a while." 3. "I'll explain why she cannot have what she wants." 4. "When she behaves like this, I'll tell her that she is being a bad girl."

1. The child is demonstrating behavior associated with temper tantrums, which are relatively frequent normal occurrences during toddlerhood as the child attempts to develop a sense of autonomy. The development of autonomy requires opportunities for the child to make decisions and express individuality. Ignoring the outbursts is probably the best strategy. Doing so avoids rewarding the behavior and helps the child to learn limits, promoting the development of self-control. However, the mother should intervene in a temper tantrum if the child is likely to injure herself. Allowing the child to have what she wants occasionally would typically add to the problems associated with temper tantrums, because doing so rewards the behavior and prevents the child from developing self-control. Toddlers do not possess the capacity to understand explanations about behavior. Expressing disappointment in the child's behavior or telling her that she is being a bad girl reinforces feelings of guilt and shame, thus interfering the child's ability to develop a sense of autonomy.

Which manifestations should the nurse expect to fi nd in a child in the early stages of acute hepatitis? 1. Nausea, vomiting, and generalized malaise. 2. Nausea, vomiting, and pain in the left upper quadrant. 3. Generalized malaise and yellowing of the skin and sclera. 4. Yellowing of the skin and sclera without any other generalized complaints.

1. The early stage of acute hepatitis is referred to as the anicteric phase, during which the child usually complains of nausea, vomiting, and generalized malaise.

A nasogastric tube inserted during surgery to correct an infant's intussusception is no longer freely removing gastric secretions. Which of the following should the nurse do next? 1. Aspirate the tube with a syringe. 2. Irrigate the tube with distilled water. 3. Increase the level of suction. 4. Rotate the tube.

1. The fi rst action is to check the placement of the tube to ensure that it is in the correct position. To check tube position, the nurse should aspirate the tube with a syringe. A return of gastric contents indicates that the end of the tube is in the stomach. Another method is to inject a small amount of air while auscultating with a stethoscope over the epigastric area. The tube is irrigated with normal saline, not distilled water, and only after the position of the tube is confi rmed. The suction level should not be increased, because doing so could damage the mucosa. Rotating the tube could irritate or traumatize the nasal mucosa.

The parent of a child being evaluated for celiac disease asks the nurse why it is important to make dietary changes. Which is the nurse ' s best response? 1. "The body ' s response to gluten causes damage to the mucosal cells in the intestine, leading to absorption problems." 2. "The body ' s response to consumption of anything containing gluten is to create special cells called villi, which leads to more diarrhea." 3. "The body ' s response to gluten causes the intestine to become more porous and hang on to more of the fat-soluble vitamins, leading to vitamin toxicity." 4. "The body ' s response to gluten causes damage to the mucosal cells, leading to malabsorption of water and hard, constipated stools."

1. The inability to digest protein leads to an accumulation of an amino acid that is toxic to the mucosal cells and villi, leading to absorption problems.

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

1. The infant is displaying signs of intussusception. This is an emergency that needs to be evaluated to prevent ischemia and perforation

Which of the following should the nurse use to determine achievement of the expected outcome for an infant with severe diarrhea and a nursing diagnosis of Deficient fluid volume related to passage of profuse amounts of watery diarrhea? 1. Moist mucous membranes. 2. Passage of a soft, formed stool. 3. Absence of diarrhea for a 4-hour period. 4. Ability to tolerate intravenous fluids well.

1. The outcome of moist mucous membranes indicates adequate hydration and fl uid balance, showing that the problem of fl uid volume defi cit has been corrected. Although a normal bowel movement, ability to tolerate intravenous fl uids, and an increasing time interval between bowel movements are all positive signs, they do not specifi cally address the problem of defi cient fl uid volume

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

1. There is a genetic component to Hirschsprung disease, so any future siblings are also at risk.

After teaching the parent of an infant who has had a surgical repair for a cleft lip about the use of elbow restraints at home, the nurse determines that the teaching has been successful when the parent states which of the following? 1. "We will keep the restraints on continuously except when checking the skin under them for redness." 2. "We will keep the restraints on during the day while he is awake, but take them off when we put him to bed at night." 3. "After we get home, we won't have to use the restraints because our child does not suck on his hands or fingers." 4. "We will be sure to keep the restraints on all the time until we come to see the physician for a follow-up visit."

1. To keep the infant from disturbing the suture line by placing fi ngers or other objects in the mouth, either intentionally or accidentally, the restraints should be in place at all times. They should be removed for a short period, however, so that the underlying skin can be checked for any redness or breakdown. While the restraints are removed, the parents should be instructed to manually restrain the hands and arms.

Which of the following would be most appropriate for the nurse to teach the mother of a 6-month-old infant hospitalized with severe diarrhea to help her comfort her infant who is fussy? 1. Offering a pacifier. 2. Placing a mobile above the crib. 3. Sitting at crib side talking to the infant. 4. Turning the television on to cartoons.

1. Typically, an infant hospitalized with severe diarrhea receives fl uid replacement intravenously rather than orally. Oral fl uids and food are usually withheld. Although activities such as placing a mobile over the crib, speaking to the infant, or turning on the television may provide distraction for or help in calming the infant, a fussy infant receiving nothing by mouth is usually best comforted by providing a pacifi er to satisfy sucking needs

When an infant with pyloric stenosis is admitted to the hospital, which of the following should the nurse do first? 1. Weigh the infant. 2. Begin an intravenous infusion. 3. Switch the infant to an oral electrolyte solution. 4. Orient the mother to the hospital unit.

1. Unless the infant is in hypovolemic shock, obtaining a baseline weight is an important first action because the weight is used to calculate the child's fluid and electrolyte needs. The intravenous fluid rate and the amounts of electrolytes to be added to the fluid are based on the infant's weight. The weight also helps determine the infant's degree of dehydration. The intravenous infusion is initiated once the weight has been obtained. The child with pyloric stenosis typically experiences vomiting and is at risk for fluid volume deficit and metabolic acidosis. As a result, oral food and fluids are withheld and the infant is allowed nothing by mouth. Fluid replacement is given intravenously. Orientation can wait until treatment is under way

Which of the following would be the best activity for the nurse to include in the plan of care for an infant experiencing severe diarrhea? 1. Monitoring the total 8-hour formula intake. 2. Weighing the infant each day. 3. Checking the anterior fontanel every shift. 4. Monitoring abdominal skin turgor every shift.

2. Because an infant experiencing severe diarrhea is at high risk for Defi cient fl uid volume, the nurse needs to evaluate the infant's fl uid balance status by weighing the infant at least every day. Body weight is the best indicator of hydration status because a higher proportion of an infant's body weight is water, compared with an adult. Initially, the infant with severe diarrhea is not allowed liquids but is given fl uids intravenously. Therefore, monitoring the oral intake of formula is inappropriate. Although checking the anterior fontanel for depression or bulging provides information about hydration status, this method is not considered the best indicator of the infant's fl uid balance. Monitoring skin turgor can provide information about fl uid volume status. The abdomen is commonly used to assess skin turgor in an infant because it is a large surface area and can be accessed quickly. However, weight is the best indicator of fl uid balance.

Which of the following statements by a mother about her child would suggest to the nurse that the child may have celiac disease and should be referred to a health care provider? 1. "His urine is so dark in color." 2. "His stools are large and smelly." 3. "His belly is so small." 4. "He is so short."

2. Celiac disease is a disorder involving intolerance to the protein gluten, which is found in wheat, rye, oats, and barley. The stools of a child with celiac disease are characteristically malodorous, pale, large (bulky), and soft (loose). Excessive fl atus is common, and bouts of diarrhea may occur. Dark urine is commonly associated with concentrated urine, such as when a child has dehydration. The belly of a child with celiac disease, a malabsorption disorder, typically is protuberant. A small belly may be associated with a child who is thin. Short stature is not associated with this malabsorption disorde

A child is to receive I.V. antibiotics for osteomyelitis. Before the initial dose of antibiotics can be given, the nurse confi rms that a blood sample for which of the following tests has been drawn? 1. Creatinine. 2. Culture. 3. Hemoglobin. 4. White blood count

2. Cultures are used to determine exactly what organism is causing the infl ammation. From the culture, sensitivities to various antibiotics may be determined. If the antibiotics are given before obtaining the culture, the antibiotics may inhibit the growth of the organism in the culture medium. This may lead to a delay in the most appropriate treatment. Unless a child has a known renal problem, baseline creatinine levels are not typically needed. However, levels may be needed during treatment depending on the medication. A complete blood count (CBC) with hemoglobin and white blood cell count is typically ordered for any suspected infection, but these tests do not identify the causative organism

Which of the following assessments should be the priority for an infant who has had surgery to correct an intussusception and is now at risk for development of a paralytic ileus postoperatively? 1. Measurement of urine specific gravity. 2. Auscultation of bowel sounds. 3. Inspection of the first stool passed. 4. Measurement of gastric output

2. Development of a paralytic ileus postoperatively is a functional obstruction of the bowel. Bowel sounds initially may be hyperactive, but then they diminish and cease. Measurement of urine specifi c gravity provides information about fl uid and electrolyte status. The fi rst stool and the amount of gastric output provide information about the return of gastric function.

When developing the plan of care for an infant with pyloric stenosis, the nurse identifies a nursing diagnosis of Deficient fluid volume related to prolonged vomiting. Which of the following parameters should the nurse expect to use when evaluating the client outcome? 1. Abdominal distention. 2. Weight loss. 3. Vomiting. 4. Respiratory effort.

2. For the client with a nursing diagnosis of Defi cient fl uid volume related to vomiting, the outcome would focus on restoration of fl uid balance. Typically, the nurse would evaluate the client for evidence of dehydration. Parameters would include assessment of the client's weight for loss or decreased skin turgor. Abdominal distention is caused by the stenosis and is not relieved until the child has surgery. The child may have increased respiratory effort due to abdominal distention; however, to evaluate the outcome related to fl uid defi cit, the nurse should weigh the infant. The nurse should record the amount of emesis, but evaluation of the outcome is accomplished by weighing the infant

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

2. If the hernia appears larger, swollen, or tender, the intestine may be trapped, which is a surgical emergency.

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

2. In addition to giving fl uids intravenously and keeping the infant NPO, an NGT is placed to decompress the stomach.

During physical assessment of a 4-month-old infant with Hirschsprung's disease, the nurse should most likely note which of the following? 1. Scaphoid-shaped abdomen. 2. Weight less than expected for height and age. 3. Cyanosis of the fingers and toes. 4. Hyperactive deep tendon reflexes

2. Infants with Hirschsprung's disease typically display failure to thrive, with poor weight gain due to malabsorption of nutrients. Therefore, the nurse would expect to see a child who weighs less than that which is expected for height and age. A distended, rather than a scaphoid-shaped, abdomen would be noted. Cyanosis of fi ngers and toes is associated with congenital heart disease. Hyperactive deep tendon refl exes are associated with upper motor neuron problems, such as cerebral palsy.

The nurse knows that Nissen fundoplication involves which of the following? 1. The fundus of the stomach is wrapped around the inferior stomach, mimicking a lower esophageal sphincter. 2. The fundus of the stomach is wrapped around the inferior esophagus, mimicking a cardiac sphincter. 3. The fundus of the stomach is wrapped around the middle portion of the stomach, decreasing the capacity of the stomach. 4. The fundus of the stomach is dilated, decreasing the likelihood of refl ux.

2. The Nissen fundoplication involves wrapping the fundus of the stomach around the inferior esophagus, creating a lower esophageal, or cardiac, sphincter

Preoperatively, the nurse develops a plan to prepare a 7-month-old infant psychologically for a scheduled herniorrhaphy the next day. Which of the following should the nurse expect to implement to accomplish this goal? 1. Explaining the preoperative and postoperative procedures to the mother. 2. Having the mother stay with the infant. 3. Making sure the infant's favorite toy is available. 4. Allowing the infant to play with surgical equipment.

2. The best way to prepare a 7-month-old infant psychologically for surgery is to have the primary caretaker stay with the child. Infants in the second 6 months of life commonly develop separation anxiety. Therefore, the priority in this case is to support the child by having the parent present. Teaching the mother what to expect may decrease her anxiety; this is important because infants sense anxiety and distress in parents, but the priority in this case is to have the parent present. Actual play and acting out life experiences are appropriate for preschool-age children. Allowing an infant to play with surgical equipment would be inappropriate and dangerous.

An infant diagnosed with Hirschsprung's disease undergoes surgery with the creation of a temporary colostomy. Which of the following statements by the parent regarding the colostomy indicates the need for further teaching? 1. "The colostomy is only temporary." 2. "The colostomy will give time for the nerves to return to normal." 3. "The colostomy may include two separate abdominal openings." 4. "Right after the procedure the stoma may appear purple."

2. The goal of the surgery is to remove the aganglionic portion of the intestine. The remaining intestines should have normal innervation. Colostomies are used to relieve the obstruction and allow the remaining intestines to return to normal size. A temporary loop or double-barreled colostomy has stomas for both the proximal and distal portion of the bowel. The fi nal surgical repair is usually done when the infant is around 20 lb. A new stoma is frequently swollen and bruised after surgery

When obtaining the nursing history from the mother of an infant with suspected intussusception, which of the following questions would be most helpful? 1. "What do the stools look like?" 2. "When was the last time your child urinated?" 3. "Is your child eating normally?" 4. "Has your child had any episodes of vomiting?"

2. The infant with intussusception experiences acute episodes of colic-like abdominal pain. Typically, the infant screams and draws the knees to the chest. Between these episodes of acute abdominal pain, the infant appears comfortable and normal. Feeding does not precipitate episodes of pain. Additionally, a 4-month-old infant typically would not be ingesting solid foods. Pain exhibited by crying that occurs when the infant is placed in a reclining position, as in the mother's arms, is not associated with intussusception. This type of cry may indicate that the infant wants attention, wants to be held, or needs to have a diaper change.

During assessment of a child with celiac disease, the nurse should most likely note which of the following physical fi ndings? 1. Enlarged liver. 2. Protuberant abdomen. 3. Tender inguinal lymph nodes. 4. Periorbital edema

2. The intestines of a child with celiac disease fi ll with accumulated undigested food and fl atus, causing the characteristic protuberant abdomen. Celiac disease is not usually associated with any liver dysfunction, including poor liver functioning leading to liver enlargement. Tender inguinal lymph nodes are often associated with an infection. Periorbital edema, swelling around the eyes, is associated with nephritis

The mother of a toddler who has just been admitted with severe dehydration secondary to gastroenteritis says that she cannot stay with her child because she has to take care of her other children at home. Which of the responses by the nurse would be most appropriate? 1. "You really shouldn't leave right now. Your child is very sick." 2. "I understand, but feel free to visit or call anytime to see how your child is doing." 3. "It really isn't necessary to stay with your child. We'll take very good care of him." 4. "Can you fi nd someone to stay with your children? Your child needs you here."

2. The nurse's best course of action would be to support the mother. This is best done by conveying understanding and encouraging the mother to visit or call. Telling the mother that she shouldn't leave and that the child is very sick is critical and insensitive. Additionally, it implies guilt should the mother leave. Commenting that the child does not need anyone is not appropriate or true. Toddlers, in particular, need family members present because of the stresses associated with hospitalization. They experience separation anxiety, a normal aspect of development, and need constancy in their environment. Asking the mother to fi nd someone else to stay with her children is inappropriate. The children at home also need the support of the mother and/or other family members to minimize the disruptions in family life resulting from the toddler's hospitalization and to maintain consistency

Which of the following behaviors exhibited by the parents of an infant with pyloric stenosis should the nurse correctly interpret as a positive indication of parental coping? 1. Telling the nurse that they have to get away for a while. 2. Discussing the infant's care realistically. 3. Repeatedly asking if their child is normal. 4. Exhibiting fear that they will disturb the infant.

2. The parents' ability to verbalize the infant's care realistically indicates that they are working through their fears and concerns. This behavior demonstrates an understanding of the infant's condition and needs. Without further data, the fact that the parents have to get away could be interpreted as ineffective coping, possibly suggesting that they are unable to handle the situation. Continuing to ask about the child's general condition even after answers have been given does not suggest effective coping. The parents are demonstrating that they are unsure of themselves as parents or are hoping for positive information. Exhibiting fear that they will disturb the infant does not suggest effective coping. This behavior indicates that they are uncertain or lack knowledge about infants.

An 18-month-old is discharged from the hospital after having a febrile seizure secondary to exanthem subitum (roseola). On discharge, the mother asks the nurse if her 6-year-old twins will get sick. Which teaching about the transmission of roseola would be most accurate? 1. The child should be isolated in the home until the vesicles have dried. 2. The child does not need to be isolated from the older siblings. 3. Administer acetaminophen to the older siblings to prevent seizures. 4. Monitor older children for seizure development.

2. The route of roseola transmission is unknown, and the disease is more commonly seen in children 6 months to 3 years of age, so siblings do not need to be isolated.

What would be the priority nursing action on fi nding the varicella vaccine at room temperature on the shelf in the medication room? 1. Ensure the varicella vaccine ' s integrity is intact; if intact, follow the fi ve rights of medication administration. 2. Do not administer this batch of vaccine. 3. Ensure the varicella vaccine ' s integrity is intact; if intact, give the vaccine after verifying proper physician orders. 4. Ask the mother if the child has had any prior reactions to varicella.

2. The varicella vaccine integrity cannot be assured if the vaccine is at room temperature, so do not administer

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

2. This accurate description gives the parents information that is clear and concise.

An infant with Hirschsprung's disease is to be discharged 1 or 2 days after surgery to create a colostomy. After teaching the infant's parents about the overall effects of their infant's surgery, the nurse determines that the teaching has been effective when the parents state which of the following? 1. "His abdomen will be large for awhile." 2. "When he's ready, toilet training may be difficult." 3. "We need to limit his intake of dairy products." 4. "We will give him vitamin supplements until he is an adolescent."

2. Toilet-training is commonly more diffi cult for children who have undergone surgery for Hirschsprung's disease than it is for other children. This is because of the trauma to the area and the associated psychological implications. Abdominal distention is an early sign of infection and therefore the parents need to report it to the physician. Typically, dietary restrictions are not required. Usually the infant is placed on an age-appropriate diet. Vitamin supplementation is not necessary if the infant's dietary intake is adequate.

When teaching the mother of an infant who has received a temporary colostomy for treatment of Hirschsprung's disease about how the stoma should normally appear, which of the following descriptions about the stoma's appearance should the nurse include in the teaching? 1. Becoming dark brown in 2 months. 2. Staying deep red in color. 3. Changing to several shades of pink. 4. Turning almost purple in color.

2. Typically, the stoma should remain deep red in color as long as the infant has the colostomy. A dark-red to purplish color may indicate impaired circulation to the stoma

Which would be the priority intervention for a child suspected of having varicella (chickenpox)? 1. Contact precautions. 2. Contact and droplet respiratory precautions. 3. Droplet respiratory precautions. 4. Universal precautions and standard precautions.

2. Varicella (chickenpox) is highly contagious. Contact and droplet respiratory precautions should be started immediately because the primary source of transmission is secretions of the respiratory tract (droplet) and also by contaminated objects.

When developing the plan of care for an infant with a cleft lip before corrective surgery is performed, which of the following should be a priority? 1. Maintaining skin integrity in the oral cavity. 2. Using techniques to minimize crying. 3. Altering the usual method of feeding. 4. Preventing the infant from putting fingers in the mouth.

3. Before corrective surgery for a cleft lip, the infant needs to consume formula. Methods for feeding may need to be adjusted to fi t the infant's needs, because the infant with a cleft lip experiences a decreased ability to suck, which interferes with the infant's ability to compress the nipple. A special feeder may be used to feed the infant to ensure adequate caloric intake. Problems with infection and skin integrity in the mouth are uncommon because the areas of the defect are not open areas. Although crying may cause the infant to swallow more air because of the defect, crying poses no harm to the infant. There is no need to keep the infant's fi ngers out of the mouth preoperatively. The fi ngers will not harm the defect or cause an infection.

Which would the nurse expect to be included to make the diagnosis of celiac disease in a child? 1. Obtain complete blood count and serum electrolytes. 2. Obtain complete blood count and stool sample; keep child NPO. 3. Obtain stool sample and prepare child for jejunal biopsy. 4. Obtain complete blood count and serum electrolytes; monitor child ' s response to gluten-containing diet.

3. A stool sample for analysis of fat and a jejunal biopsy can confi rm the diagnosi

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

3. All vital signs need to be evaluated because the child with enterocolitis can quickly progress to a state of shock. A quick head-to-toe assessment will allow the nurse to evaluate the child ' s circulatory system.

A male adolescent who underwent repair of an inguinal hernia earlier today and is getting ready to go home receives instructions about resuming physical activities. Which of the following statements would indicate that he has understood the instructions? 1. "I can start riding my bike next week." 2. "I have to skip physical education classes for 2 weeks." 3. "I can start wrestling again in 3 weeks." 4. "I can return to my weight-lifting class in 2 weeks.

3. Because of possible stress on the suture line, physical activities such as bicycle riding, physical education classes, weight-lifting, and wrestling are contraindicated for about 3 weeks.

When developing the preoperative plan of care for an infant with Hirschsprung's disease, which of the following should the nurse include? 1. Administering a tap water enema. 2. Inserting a gastrostomy tube. 3. Restricting oral intake to clear liquids. 4. Using povidone-iodine solution to prepare the perineum

3. Before intestinal surgery, dietary intake is limited to clear liquids for 24 to 48 hours. A clear liquid diet meets the child's fl uid needs and avoids the formation of fecal material in the intestine. Typically, repeated saline enemas, not tap water enemas, are given to empty the bowel. Soapsuds enemas are contraindicated for infants, as are tap water enemas. A nasogastric tube may be inserted for gastric decompression. Insertion of a gastrostomy tube is outside the scope of nursing practice. Because the perineal area is not involved in the surgery, it does not need to be prepared.

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

3. Breastfeeding is usually well tolerated and helps prevent death of intestinal villi and malabsorption.

An infant diagnosed with Hirschsprung's disease is scheduled to receive a temporary colostomy. When initially discussing the diagnosis and treatment with the parents, which of the following would be most appropriate? 1. Assessing the adequacy of their coping skills. 2. Reassuring them that their child will be fine. 3. Encouraging them to ask questions. 4. Giving them printed material on the procedure.

3. By encouraging parents to ask questions during information-sharing sessions, the nurse can clarify misconceptions and determine the parents' understanding of information. A better understanding of what is happening allows the parents to feel some control over the situation. Assessing the adequacy of the parents' coping skills is important but secondary to encouraging them to express their concerns. The questions they ask and their interactions with the nurse may provide clues to the adequacy of their coping skills. The nurse should never give false reassurance to parents. At this point, there is no way for the nurse to know whether the child will be fi ne. Written materials are appropriate for augmenting the nurse's verbal communication. However, these are secondary to encouraging questions.

After teaching the mother of a child with celiac disease about dietary management, which of the following statements by the mother indicates successful teaching? 1. "I will feed my child foods that contain wheat products." 2. "I will be sure to give my child lots of milk." 3. "I will plan to feed my child foods that contain rice." 4. "I will be sure my child gets oatmeal every day."

3. Damage to intestinal mucosa in celiac disease is caused by gliadin, a part of the protein found in wheat, rye, barley, and oats. Foods containing these grains must be eliminated entirely from the diet of children with celiac disease. Foods containing rice and corn are a good substitute. Although an adequate intake of milk is important for any child, children with celiac disease do not need an increased milk intake

When obtaining a history from the parents of a child diagnosed with diarrhea due to Salmonella, the nurse should ask the parents if the child has been exposed to which of the following possible sources of infection? 1. Nonrefrigerated custard. 2. A pet canary. 3. Undercooked eggs. 4. Unwashed fruit.

3. Diarrhea related to Salmonella bacilli is commonly spread by raw or undercooked fowl and eggs, pet turtles, and kittens. Food poisoning caused by Staphylococcus species is commonly spread by inadequately cooked or refrigerated custards, cream fi llings, or mayonnaise. Psittacosis, a respiratory illness, may be spread by canaries. Contaminated, unwashed fruit is associated with typhoid fever (caused by Salmonella typhi), a disorder rarely seen in the United States.

During the initial assessment of a child admitted to the pediatric unit with osteomyelitis of the left tibia, when assessing the area over the tibia, which is an expected fi nding? 1. Diffuse tenderness. 2. Decreased pain. 3. Increased warmth. 4. Localized edema.

3. Findings associated with osteomyelitis commonly include pain over the area, increased warmth, localized tenderness, and diffuse swelling over the involved bone. The area over the affected bone is red.

The physician is able to reduce an infant's hernia and schedules the infant for a herniorrhaphy in 2 days. The mother asks the nurse why the surgery is not performed now. Which of the following responses indicates that the nurse understands the rationale for delaying the surgery? 1. "Delaying the surgery ensures that your infant will receive the proper preoperative preparation." 2. "We need to make sure that your infant receives nothing by mouth for at least 24 hours before the surgery." 3. "Waiting these 2 days helps to allow any edema and inflammation in the area to subside." 4. "Your infant needs to wear a truss for at least 24 hours before any surgery can be attempted."

3. If nonoperative reduction is successful, delaying surgery for 2 to 3 days allows the edema and infl ammation in the inguinal area to subside. Thus, the area to be operated will appear more normal, helping to decrease the risk of complications. The preoperative preparation for a herniorrhaphy is minimal and is not the reason for delaying the surgery. Typically, the infant is fed until a few hours before surgery to prevent dehydration. Trusses do not prevent incarceration, and there is no reason to use a truss preoperatively.

Immediately on return to the nursing unit after surgical repair of a cleft palate, in which of the following positions should the nurse place the child? 1. On the back with the head in a position of comfort. 2. In low Fowler's position with the head turned to the side. 3. Lying on the abdomen with the head turned to the side. 4. In reverse Trendelenburg with the head tilted forward.

3. Immediately after a surgical repair of a cleft palate, the child is placed on the abdomen with the head turned to the side to lessen the chance of aspiration by allowing secretions to drain out. Positioning the child on the back places the child at risk for aspiration should any regurgitation or vomiting occur, even in low Fowler's position with the head to the side or in reverse Trendelenburg position with the head tilted forward.

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

3. In most cases of intussusception in young children, an enema is successful in reducing the intussusception.

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

3. Increasing fl uid consumption helps to decrease the hardness of the stool.

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

3. Infants with pyloric stenosis are always hungry and often appear malnourished.

A newborn admitted with pyloric stenosis is lethargic and has poor skin turgor. The primary care provider has ordered I.V. fluids of dextrose water with sodium and potassium. The baby's admission potassium level is 3.4 Meq/L. The nurse should: 1. Notify the primary care provider. 2. Administer the ordered fluids. 3. Verify that the infant has urinated. 4. Have the potassium level redrawn.

3. Normal serum potassium levels are 3.5 to 4.5 Meq/L. Elevated potassium levels can cause life threatening cardiac arrhythmias. The nurse must verify that the client has the ability to clear potassium through urination before administering the drug. Infants with pyloric stenosis frequently have low potassium levels due to vomiting. A level of 3.4 Meq/L is not unexpected and should be corrected with the ordered fl uids. The lab value does not need to be redrawn as the fi ndings are consistent with the infant's condition.

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

3. Pedialyte is the fi rst choice, as recommended by the American Academy of Pediatrics. Offering the child appropriate choices may allow the child to feel empowered and less likely to refuse the Pedialyte. Small, frequent amounts are usually better tolerated

While reviewing various studies about the use of antipyretics possibly prolonging illness, the nurse notes that there are benefits to their use for the child with fever. Which of the following would the nurse identify as the best explanation related to the benefit of antipyretics? A) They slow the growth of bacteria. B) They increase neutrophil production. C) They encourage T-cell proliferation. D) They help decrease fluid requirements

D

After teaching the parents of a 6-year-old how to administer an enema, thenurse determines that the teaching was successful when they state that they willgive how much solution to their child? A) 100 to 200 mL B) 200 to 300 mL C) 250 to 500 mL D) 500 to 1,000 mL

D For a school-age child, typically 500 to 1,000 mL of enema solution is given. For aninfant, 250 mL or less is used; for a toddler or preschooler, 250 to 500 mL is used.

The parents of a child diagnosed with celiac disease ask the nurse what typesof food they can offer their child. What recommendation would the nurse include inthe teaching plan? A) Frozen yogurt B) Rye bread C) Creamed spinach D) Fruit juice

D For the child with celiac disease, foods containing gluten such as frozen yogurt, ryebread, and creamed vegetables should be avoided. Fruit juice would be anappropriate suggestion in a gluten-free diet.

The nurse has developed a plan of care for a 12-month-old hospitalized withdehydration as a result of rotavirus. Which intervention would the nurse include inthe plan of care? A) Encouraging consumption of fruit juice B) Offering Kool-Aid or popsicles as tolerated C) Encouraging milk products to boost caloric intake D) Maintaining the intravenous (IV) fluid rate as ordered

D The nurse should maintain an IV line and administer the IV fluid as ordered tomaintain fluid volume. High-carbohydrate fluids like fruit juice, Kool-Aid, andpopsicles should be avoided as they are low in electrolytes, increase simplecarbohydrate consumption, and can decrease stool transit time. Milk productsshould be avoided during the acute phase of illness as they may worsen diarrhea.

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

1, 2, 3, 4. The lights in phototherapy increase insensible fl uid loss, requiring the nurse to monitor fl uid status closely. The infant with pyloric stenosis is likely to be dehydrated as a result of persistent vomiting. A 2-year-old with pneumonia may have increased insensible fl uid loss as a result of tachypnea associated with respiratory illness. The nurse needs to monitor fl uid status cautiously because fl uid overload can result in increased respiratory distress. The child with a burn experiences extensive extracellular fl uid loss and is at great risk for dehydration. The younger child is at greater risk because of greater proportionate body surface area.

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

1, 2, 3, 4. Hypothyroidism can be a causative factor in constipation. Weakened abdominal muscles can be seen in muscular dystrophy and can lead to constipation. Myelomeningocele affects the innervation of the rectum and can lead to constipation. Excessive milk consumption can lead to constipation.

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

3. The supine position is preferred because there is decreased risk of the infant rubbing the suture line

Which signs and symptoms would the nurse expect to assess in a child with rheumatic fever? 1. Ankle and knee joint pain. 2. Negative group A beta streptococcal culture. 3. Large red "bulls eye"-appearing rash. 4. Stiff neck with photophobia.

1. Joint pain or arthritis is the most common symptom of acute rheumatic fever (60% to 80% of fi rst attacks). The joint pain usually occurs in two or more large joints (ankle, knee, wrist, or elbow).

A 9-month-old is admitted because of dehydration. How should the nurse go about accurately monitoring fl uid intake and output? Select all that apply. 1. Weighing and recording all wet diapers. 2. Obtaining a urine specifi c gravity measure. 3. Obtaining an accurate daily weight. 4. Restricting fl uids prior to weighing the child. 5. Obtaining an accurate stool count

1, 2, 3, 5. Accurate intake and output recording includes noting all intake, including I.V. fl uids; noting output, such as emesis and stool; weighing diapers; measuring weight daily; measuring urine specifi c gravity; monitoring serum electrolytes; and monitoring for signs of dehydration. Children who are dehydrated must receive suffi cient fl uid intake. Restricting fl uids just prior to weighing the child will not alter the accuracy of the weight, and the nurse should continue to encourage fl uids for this dehydrated child

On the second postoperative day after repair of a cleft palate, which of the following should the nurse use to feed a toddler? 1. Cup. 2. Straw. 3. Rubber-tipped syringe. 4. Large-holed nipple.

1. A cup is the preferred drinking or eating utensil after repair of a cleft palate. At the age when repair is done, the child is ordinarily able to drink from a cup. Use of a cup avoids having to place a utensil in the mouth, which would increase the potential for injury to the suture lines

Which foods should be offered to a child with hepatitis? 1. A tuna sandwich on whole wheat bread and a cup of skim milk. 2. Clear liquids, such as broth, and Jell-O. 3. A hamburger, French fries, and a diet soda. 4. A peanut butter sandwich and a milkshake.

1. A diet that is high in protein and carbohydrates helps maintain caloric intake and protein stores while preventing muscle wasting. A low-fat diet prevents abdominal distention

Eight hours ago, an infant with Hirschsprung's disease had surgery to create a colostomy. Which of the following fi ndings should alert the nurse to notify the physician immediately? 1. A 3-cm increase in abdominal circumference. 2. Periods of occasional fussiness. 3. Absence of bowel sounds since surgery. 4. Evidence of the infant's returning appetite

1. Abdominal circumference is measured to monitor for abdominal distention. An increase of 3 cm in 8 hours would require notifi cation of the physician; it would indicate a substantial degree of abdominal distention, possibly from fl uid or gas accumulation. Normally, after surgery, an infant experiences occasional periods of fussiness. However, as long as the infant is able to be quiet by himself or with the aid of a pacifi er, the physician does not need to be contacted. Absence of bowel sounds would be expected after surgery because of the effects of anesthesia. It takes approximately 48 hours for gastric motility to resume. Even if the infant displays evidence that he is hungry, fl uids will not be offered until bowel sounds are heard, indicating a functioning gastrointestinal tract.

When assessing an infant with suspected inguinal hernia, which of the following findings would be most significant? 1. The inguinal swelling is reddened, and the abdomen is distended. 2. The infant is irritable, and a thickened spermatic cord is palpable. 3. The inguinal swelling can be reduced, and the infant has a stool in the diaper. 4. The infant's diaper is wet with urine, and the abdomen is nontender

1. Abdominal distention and a redness of the inguinal swelling are signifi cant fi ndings. Their presence in conjunction with area tenderness and inability to reduce the hernia indicate an incarcerated hernia. An incarcerated hernia can lead to strangulation, necrosis, and gangrene of the bowel. Other fi ndings associated with strangulation include irritability, anorexia, and diffi culty in defecation. Irritability is nonspecifi c and could be caused by various factors. A palpable, thickened spermatic cord on the affected side is diagnostic of inguinal hernia and would be an expected fi nding. A wet diaper indicates that urine is being excreted, a fi nding unrelated to inguinal hernia

After teaching the mother of an infant with pyloric stenosis about the disease, which of the following, if stated by the mother as a cause, indicates effective teaching? 1. "An enlarged muscle below the stomach sphincter." 2. "A telescoping of the large bowel into the smaller bowel." 3. "A result of giving the baby more formula than is necessary." 4. "A result of my baby taking the formula too quickly."

1. Pyloric stenosis involves hypertrophy of the pylorus muscle distal to the stomach and obstruction of the gastric outlet resulting in vomiting, metabolic acidosis, and dehydration. Telescoping of the bowel is called intussusception. Overfeeding, feeding too quickly, or underfeeding is not associated with pyloric stenosis.

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

1. The infant with biliary atresia usually has an enlarged liver and spleen. The stools appear clay-colored because of the absence of bile pigments. The urine is tea-colored because of the excretion of bile salts.

Which child can be discharged without further evaluation? 1. A 2-year-old who has had 24 hours of watery diarrhea that has changed to bloody diarrhea in the past 12 hours. 2. A 3-year-old who had a relapse of one diarrhea episode after restarting a normal diet. 3. A 6-year-old who has been having vomiting and diarrhea for 2 days and has decreased urine output. 4. A 10-year-old who has just returned from a Scout camping trip and has had several episodes of diarrhea.

2. It is common for children to have a relapse of diarrhea after resuming a regular diet

Which instructions for a child diagnosed with encopresis should the nurse question? Select all that apply. 1. Limit the intake of milk. 2. Offer a diet high in protein. 3. Obtain a complete dietary log. 4. Follow up with a child psychologist. 5. After dinner, have the child sit on the toilet for 10 minutes.

2, 4. A diet high in protein will cause more constipation. The child and family would not be encouraged initially to seek counseling unless a psychological component to the encopresis had been identifi ed.

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

2. Some mothers are able to breastfeed their infants who have a cleft lip and palate. The breast can help fi ll in the cleft and help the infant create suction.

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

2. The primary reason cholestyramine is administered to the child with biliary atresia is to relieve pruritus.

A child is diagnosed with chronic constipation that has been unresponsive to dietary and activity changes. Which pharmacological measure is most appropriate? 1. Natural supplements and herbs. 2. Stimulant laxative. 3. Osmotic agent. 4. Pharmacological measures are not used in pediatric constipation.

3. A stool softener (osmotic agent) is the drug of choice because it will lead to easier evacuation.

A 4-week-old infant admitted with the diagnosis of hypertrophic pyloric stenosis presents with a history of vomiting. The nurse should anticipate that the infant's vomitus would contain gastric contents and which of the following? 1. Bile and streaks of blood. 2. Mucus and bile. 3. Mucus and streaks of blood. 4. Stool and bile.

3. The vomitus of an infant with hypertrophic pyloric stenosis contains gastric contents, mucus, and streaks of blood. The vomitus does not contain bile or stool because the pyloric constriction is proximal to the ampulla of Vater.

When teaching the parent of an infant with Hirschsprung's disease who received a temporary colostomy about the types of foods the infant will be able to eat, which of the following would the nurse recommend? 1. High-fi ber diet. 2. Low-fat diet. 3. High-residue diet. 4. Regular diet.

4. A regular diet would be recommended for the child with a colostomy; no special diet is needed. High-fi ber foods, such as fruits and vegetables, should be minimized because they increase the bulk in the stool. Fat is necessary for brain growth in the fi rst year of life. A high-residue diet would result in bulkier stools and increased gas production, which will collect in the colostomy bag. Therefore, a high-residue diet is not indicated.

Which would be an appropriate activity for the nurse to recommend to the parent of a preschooler just diagnosed with acute hepatitis? 1. Climbing in a "playscape." 2. Kicking a ball. 3. Playing video games in bed. 4. Playing with puzzles in bed.

4. Playing with puzzles is a developmentally appropriate activity for a preschooler on bedrest

An expectant mother asks the nurse if her new baby will have an umbilical hernia. The nurse bases the response on the fact that it occurs: 1. More often in large infants. 2. In white infants more often than in African American infants. 3. Twice as often in male infants. 4. More often in premature infants.

4. Umbilical hernias occur more often in premature infants.

A mother brings her 8-year-old son for evaluation because of a rash on his lower leg. Which finding would support the suspicion that the child has Lyme disease? A) Playing in the woods about a week ago B) Rash is papular and vesicular C) High fever occurring about 4 days before the rash D) Complaints of extreme pruritus with visible nits

A

After teaching a class on the role of white blood cells in infection, the instructor determines that the teaching was successful when the class identifies which type of white blood cells as important in combating bacterial infections? A) Neutrophils B) Eosinophils C) Basophils D) Lymphocytes

A

The nurse determines that it is necessary to implement airborne precautions for children with which of the following infections? A) Measles B) Streptococcus group A C) Rubella D) Scarlet fever

A

The nurse is performing a physical examination of an 8-year-old girl who was bitten by her kitten. Which of the following assessments would lead the nurse to suspect cat-scratch disease? A) Swollen lymph nodes B) Strawberry tongue C) Infected tonsils D) Swollen neck

A

The parents of a 5-year-old have just found out that their child has head lice. Which statement by the parents would support the nursing diagnosis of deficient knowledge? A) "I can't believe it. We're not unclean, poor people." B) "We'll have to get that special shampoo." C) "Everybody in the house will need to be checked." D) "That explains his complaints of itching on his neck."

A

The nurse is providing care to a child with pancreatitis. When reviewing thechild's laboratory test results, what would the nurse expect to find? Select all thatapply. A) Leukocytosis B) Decreased C-reactive protein C) Elevated serum amylase levels D) Positive stool culture E) Decreased serum lipase levels

A, C With pancreatitis, serum amylase and lipase levels are elevated and levels threetimes the normal values are extremely indicative of pancreatitis. Leukocytosis iscommon with acute pancreatitis. C-reactive protein levels may be elevated. Stoolcultures are not used to evaluate this disorder. Positive stool cultures wouldindicate a bacterial cause of diarrhea.

After teaching a mother how to remove a tick from her 6-year-old boy's arm, the nurse determines that additional teaching is needed when the mother states which of the following? A) "I'll protect my fingers with a paper towel." B) "I'll grasp the tick and pull it away quickly." C) "I should put the tick in a plastic bag in the freezer." D) "I need to grasp the tick close to the child's skin."

B

A group of nursing students are reviewing information about inflammatorybowel disease in preparation for a class discussion on the topic. The studentsdemonstrate understanding of the material when they identify which characteristicsof Crohn disease? Select all that apply. A) Distributed in a continuous fashion B) Most common between the ages of 10 and 20 years C) Elevated erythrocyte sedimentation rate D) Low serum iron levels E) Tenesmus F) Loss of haustra within bowel

Ans: B, C, D Crohn disease is most common between the ages of 10 and 20 years. Erythrocytesedimentation rate is elevated, and serum iron levels are low. Ulcerative colitis isdistributed continuously distal to proximal, with tenesmus and loss of haustrawithin the bowel. Crohn disease is segmental, with disease-free skip areascommon, and the bowel wall has a cobblestone appearance.

The nurse is performing a gastrointestinal assessment on a 7-year-old boy.The parents are assisting with the history. Which assessment findings are indicativeof constipation? Select all that apply. A) "Our child only has 3 to 4 bowel movements per week." B) "Our child complains of pain because his bowel movements are sohard." C) "Our child tells us that his belly hurts a lot of the time." D) "I can tell he holds his bowel movement much of the time because ofthe way he stands." E) "I find smears of stool in his underwear almost every day."

Ans: B, C, D, E Pain, stool withholding behavior (retentive posturing), and encopresis (soiling offecal contents into the underwear beyond the age of expected toilet training) are allsigns of chronic functional constipation. Less than 3 bowel movements is consideredconstipation.

A group of nursing students are reviewing the six links in the chain of infection and the nursing implications for each. The students demonstrate understanding of the information when they identify which precaution as helping to break the chain of infection to the susceptible host? A) Keeping linens dry and clean B) Maintaining skin integrity C) Washing hands frequently D) Coughing into a handkerchief

B

A nurse is conducting a health history for a 1-month-old with an infectious disorder. Which segment of the health history would be most helpful for the nurse when determining if the infant developed the infection from the mother? A) Family history B) Past medical history C) Home treatments D) Present illness history

B

A child is diagnosed with scarlet fever. The nurse is reviewing the child's medical record, expecting which medication to be prescribed for this child? A) Ibuprofen B) Acyclovir C) Penicillin V D) Doxycyclin

C

A group of nursing students are reviewing information about childhood infectious diseases. The students demonstrate understanding of this information when they identify which of the following as a common childhood exanthema? A) Mumps B) Rabies C) Rubella D) West Nile virus

C

A nurse is instructing a parent on how to obtain a stool culture for ova and parasites from a child with diarrhea. Which of the following would the nurse include in the teaching plan? A) "Give the child bismuth and then collect the next specimen." B) "Obtain the specimen from the toilet after the child has a bowel movement." C) "Keep the specimen from coming into contact with any urine." D) "Bring the specimen to the laboratory on the third day."

C

A school-aged child with an infectious disease is placed on transmission-based precautions. Which nursing diagnosis would most likely be a priority? A) Impaired skin integrity related to trauma secondary to pruritus and scratching B) Fluid volume deficit related to increased metabolic demands and insensible losses C) Social isolation related to infectivity and inability to go to the playroom D) Deficient knowledge related to how infection is transmitted

C

The nurse is performing a physical examination on a 9-year-old boy who has experienced a tick bite on his lower leg and is suspected of having Lyme disease. Which assessment finding would the nurse expect to find? A) Swelling in the neck B) Confusion and anxiety C) Ring-like rash on lower leg D) Hypersalivation

C

After teaching the parents of a child with varicella zoster, the nurse determines that the parents have understood the teaching when they state that their child can return to school at which time? A) After day 5 of the rash B) When the rash is completely healed C) Once the rash appears D) After the lesions have crusted

D

The nurse is assessing the tympanic temperature of several children. The nurse documents that the child with which temperature reading has a fever? A) 99.5°F B) 99.2°F C) 100.0°F D) 100.8°F

D

The nurse is preparing a plan of care for a 5-year-old boy with chickenpox. Which of the following nursing interventions should be questioned? A) Administer antipyretics as ordered. B) Keep the child's fingernails short. C) Monitor fluid intake and output. D) Provide alcohol baths as needed.

D

A group of students are reviewing information about fluid balance and lossesin children in comparison to adults. The students demonstrate a need for additionalreview when they state that: A) children have a proportionately greater amount of body water than doadults. B) fever plays a greater role in insensible fluid losses in infants andchildren. C) a higher metabolic rate plays a major role in increased insensible fluidlosses. D) the infant's immature kidneys have a tendency to overconcentrateurine.

D The young infant's renal immaturity does not allow the kidneys to concentrate urineas well as in older children and adults, placing them at risk for dehydration oroverhydration. Children do have a proportionately greater amount of body waterthan adults, and fever is important in promoting insensible fluid losses in infantsand children because children become febrile more readily and their fevers arehigher than those in adults. Children also experience a higher metabolic rate, whichaccounts for increased insensible fluid losses and increased need for water forexcretory function.

A nursing instructor is developing a class presentation about the medicationsused to treat peptic ulcer disease. Which drug class would the instructor be leastlikely to include in the presentation? A) Antibiotics B) Proton pump inhibitors C) Histamine antagonists D) Prokinetics

D Treatment for peptic ulcer disease includes antibiotics if Helicobacter pylori areverified, histamine antagonists, and/or proton pump inhibitors. Prokinetics are usedto stimulate the gastrointestinal tract to help empty the stomach faster andpromote intestinal motility. They are not used for peptic ulcer disease.