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Origin: Chapter 6, 7 7. The nurse explains to parents of school-age children that according to Kohlberg's theory of moral development, their child is at the conventional stage of moral development. What is the motivation for school-age children to follow rules? A) They follow rules out of a sense of being a 'good person.' B) They follow rules out of fear of being punished. C) They follow rules in order to receive praise from caretakers. D) They follow rules because it is in their nature to do so.

Ans: A Feedback: During the school-age years, the child's sense of morality is constantly being developed. According to Kohlberg, the school-age child is at the conventional stage of moral development. The 7- to 10-year-old usually follows rules out of a sense of being a "good person." He or she wants to be a good person to his or her parents, friends, and teachers and to himself or herself.

Origin: Chapter 6, 5 5. The nurse knows that the school-age child is in Erikson's stage of industry versus inferiority. Which best examplifies a school-ager working toward accomplishing this developmental task? A) The child signs up for after-school activities. B) The child performs his bedtime preparations autonomously. C) The child becomes aware of the opposite sex. D) The child is developing a conscience.

Ans: A Feedback: Erikson (1963) describes the task of the school-age years to be a sense of industry versus inferiority. During this time, the child is developing his or her sense of self-worth by becoming involved in multiple activities at home, at school, and in the community, which develops his or her cognitive and social skills. Achieving independence is a task of the preschooler who also is developing a conscience at that age. Awareness of the opposite sex occurs in, but is not the focus of, the school-age child.

Origin: Chapter 23, 17 17. The nurse is providing care to a child with folliculitis. What would the nurse expect to administer? A) Topical mupirocin B) Oral cephalosporin C) Intravenous oxacillin D) Topical Eucerin cream

Ans: A Feedback: For folliculitis, topical mupirocin is indicated in conjunction with aggressive hygiene and warm compresses. Oral cephalosporins are used for nonbullous impetigo if there are numerous lesions. Intravenous oxacillin is used for severe cases of staphylococcal scalded skin syndrome. Topical Eucerin cream is used for atopic dermatitis.

Origin: Chapter 6, 21 21. The mother of a 7-year-old girl tells the school nurse that her child is deathly afraid of going to school. What would be the best intervention the nurse could suggest in this situation? A) Return the child to school and investigate the cause of the fear. B) Have the child stay home from school until any issues causing this fear are resolved. C) Investigate a new school for the child to attend that the child will not be afraid of. D) Tell the child that privileges will be taken away if she does not return to school.

Ans: A Feedback: It is important to investigate specific causes of school refusal/school phobia and take appropriate action. The parents should return the child to school, investigate the cause of the fear, support the child, collaborate with teachers, and praise success in school attendance. This is not a situation for punishment, and changing schools would not solve the child's school phobia.

Origin: Chapter 23, 10 10. The nurse is caring for a child with widespread itching and has recommended bathing as a relief measure. After teaching the mother about this, which statement from the mother indicates a need for further instruction? A) "After bathing, I need to rub his skin everywhere to make sure he is completely dry." B) "I must make sure I use lukewarm water instead of hot water." C) "Oatmeal baths are helpful; we can add Aveeno skin relief bath treatment." D) "We should leave his skin moist before applying medication or moisturizer."

Ans: A Feedback: The nurse needs to emphasize to the mother that she must only pat the child dry and not rub his skin. Rubbing can cause further itching. Additionally, the skin should be left moist prior to applying medication or moisturizer. Lukewarm water and oatmeal baths are appropriate.

Origin: Chapter 22, 2 2. The nurse is providing postoperative care for a 14-month-old girl who has undergone a myelomeningocele repair. The girl's mother is extremely anxious and tells the nurse she is afraid she will never learn how to care for her daughter at home. Which response by the nurse would be most appropriate? A) "I will help you become comfortable in caring for your daughter." B) "You must learn how to care for your daughter at home." C) "You will need to learn to collaborate with all the caregivers." D) "There is a lot to learn, and you need a positive attitude."

Ans: A Feedback: The nurse needs to empower families to become the experts on their child's needs and conditions via education and participation in care. The most positive approach is to let the mother know the nurse will support her and help her become an expert on her daughter's care. Telling the mother that she must learn how to care for her daughter or that she must have a positive attitude is not helpful. Telling her that she needs to collaborate with the caregivers is true, but does not address her fears.

Origin: Chapter 22, 25 25. The nurse is caring for a 14-month-old boy with rickets who was recently adopted from overseas. His condition was likely a result of a diet very low in milk products. The nurse is providing teaching regarding treatment. Which response by the parents indicates a need for further teaching? A) "We must give him calcium and phosphorus with food every morning." B) "He must take vitamin D as prescribed and spend some time in the sunlight." C) "He must take calcium at breakfast and phosphorus at bedtime." D) "We should encourage him to have fish, dairy, and liver if he will eat it."

Ans: A Feedback: The nurse should emphasize that the calcium and phosphorus supplements should be administered at alternate times to promote proper absorption of both of these supplements. Taking vitamin D, spending time in the sun, and encouraging intake of fish, dairy, and liver are appropriate responses.

Origin: Chapter 22, 21 21. An 8-year-old girl was diagnosed with a closed fracture of the radius at approximately 2 p.m. The fracture was reduced in the emergency department and her arm placed in a cast. At 11 p.m. her mother brings her back to the emergency department due to unrelenting pain that has not been relieved by the prescribed narcotics. Which action would be the priority? A) Notifying the doctor immediately B) Applying ice C) Elevating the arm D) Giving additional pain medication as ordered

Ans: A Feedback: The nurse should notify the doctor immediately because the girl's symptoms are the classic sign of compartment syndrome. Immediate treatment is required to prevent excessive swelling and to detect neurovascular compromise as quickly as possible. The ice should be removed and the arm brought below the level of the heart to facilitate whatever circulation is present. Giving additional pain medication will not help in this situation.

Origin: Chapter 22, 24 24. The nurse is caring for a 10-year-old in traction. While performing a skin assessment, the nurse notices that the skin over the calcaneus appears slightly red and irritated. Which action would the nurse take first? A) Reposition the child's foot on a pressure-reducing device. B) Apply lotion to his foot to maintain skin integrity. C) Make sure the skin is clean and dry. D) Gently massage his foot to promote circulation.

Ans: A Feedback: The nurse's first action is to remove continuous pressure from this area. The other actions can help decrease the potential for skin breakdown, but the pressure must be relieved first.

Origin: Chapter 6, 6 6. The school nurse providing school health screenings knows that the 7- to 11-year-old is in Piaget's stage of concrete operational thoughts. What should this age group accomplish when developing operations? Select all that apply. A) Ability to assimilate and coordinate information about the world from different dimensions B) Ability to see things from another person's point of view and think through an action C) Ability to use stored memories of past experiences to evaluate and interpret present situations D) Ability to think about a problem from all points of view, ranking the possible solutions while solving the problem E) Ability to think outside of the present and incorporate into thinking concepts that do exist as well as concepts that might exist F) Ability to understand the principle of conservation—that matter does not change when its form changes

Ans: A, B, C, F Feedback: Piaget's stage of cognitive development for the 7- to 11-year-old is the period of concrete operational thoughts. In developing concrete operations, the child is able to assimilate and coordinate information about the world from different dimensions. He or she is able to see things from another person's point of view and think through an action, anticipating its consequences and the possibility of having to rethink the action. The school-age child is able to use stored memories of past experiences to evaluate and interpret present situations. Also, during concrete operational thinking, the school-age child develops an understanding of the principle of conservation—that matter does not change when its form changes. According to Piaget, the adolescent progresses from a concrete framework of thinking to an abstract one in the formal operational period. During this period, the adolescent is able to think about a problem from all points of view, ranking the possible solutions while solving the problem. The adolescent also develops the ability to think outside of the present; that is, he or she can incorporate into thinking concepts that do exist as well as concepts that might exist. His or her thinking becomes logical, organized, and consistent.

Origin: Chapter 22, 31 31. When teaching a group of students about the skeletal development in children, what information would the instructor include? A) The growth plate is made up of the epiphysis. B) A young child's bones commonly bend instead of break with an injury. C) The infant's skeleton has undergone complete ossification by birth. D) Children's bones have a thin periosteum and limited blood supply.

Ans: B Feedback: A young child's bones are more flexible and more porous with a lower mineral count than adults. Thus, bones will often bend rather than break when an injury occurs. The growth plate is composed of the epiphysis and physis. The infant's skeleton is not fully ossified at birth. Children's bones have a thick periosteum and an abundant blood supply.

Origin: Chapter 6, 8 8. The nurse is talking with a chatty 7-year-old girl during her regular check-up. Which behaviors would the child also be expected to exhibit? A) Showing no interest in what the nurse sees in her ears B) Explaining what is right and what is wrong C) Demonstrating independence from her mother D) Showing no concern when the nurse hurts her own finger

Ans: B Feedback: At this age, behavior is seen by the child as either completely right or wrong. The child will almost surely want to know why the nurse looks in her ears. The child depends heavily on parents for support and encouragement at this age. This is a time when children gain empathy, so the child would show concern for the nurse's injury.

Origin: Chapter 22, 8 8. The nurse is caring for a 2-month-old with cerebral palsy. The infant is limp and flaccid with uncontrolled, slow, worm-like, writhing, and twisting movements. What word would the nurse use when documenting these observations? A) Spastic B) Athetoid C) Ataxic D) Mixed

Ans: B Feedback: Athetoid cerebral palsy is characterized by abnormal, involuntary movement. It affects all four extremities with possible involvement of the face, neck, and tongue. The movements increase in periods of stress. Dysarthria and drooling may be present as well. Spastic cerebral palsy is characterized by poor control of posture, balance, and movement; exaggeration of deep tendon reflexes; and hypertonicity of affected extremities. Ataxic is characterized by poor coordination, unsteady gait, and wide-based gait.

Origin: Chapter 23, 13 13. A nurse is assessing the skin of a child with cellulitis. What would the nurse expect to find? A) Red, raised hair follicles B) Warmth at skin disruption site C) Papules progressing to vesicles D) Honey-colored exudate

Ans: B Feedback: Cellulitis is manifested by erythema, pain, edema, and warmth at the site of skin disruption. Red raised hair follicles would indicate folliculitis. Papules progressing to vesicles and a honey-colored exudate would suggest nonbullous impetigo.

Origin: Chapter 6, 13 13. The nurse is teaching the parents of a 9-year-old girl about the socialization that is occurring in their child through school contacts. Which information would the nurse include in her teaching plan? A) Teachers are the most influential people in the development of the school-age child's social network. B) Continuous peer relationships provide the most important social interaction for school-age children. C) Parents should establish norms and standards that signify acceptance or rejection. D) A characteristic of school-age children is their formation of groups with no rules and values involved.

Ans: B Feedback: Continuous peer relationships provide the most important social interaction for school-age children. Peer and peer-group identification are most essential to the socialization of the school-age child. Peer groups establish norms and standards that signify acceptance or rejection. Valuable lessons are learned from interactions with children their own age. A characteristic of school-age children is their formation of groups with rules and values.

Origin: Chapter 6, 16 16. What finding would the nurse most likely discover in a 10-year-old child in the period of concrete operational thought? A) Participation in abstract thinking B) Ability to classify similar objects C) Problem solving via the scientific method D) Ability to make independent decisions

Ans: B Feedback: During the period of concrete operational thought, children are able to classify or group objects based on their common elements. Abstract thinking, problem solving via the scientific method, and independent decision making are higher-level functions, typically seen in adolescents.

Origin: Chapter 22, 3 3. The nurse is conducting a physical examination of a child with a brachial plexus injury. Which finding would lead the nurse to be highly suspicious of Erb palsy? A) The child is unable to close one of his eyes. B) The involved extremity is adducted, prone, and internally rotated. C) Asymmetry of the face occurs when the child is crying. D) The mouth is drawn to the noninvolved side.

Ans: B Feedback: Erb palsy is an upper brachial plexus injury and the involved extremity usually presents as adducted, prone, and internally rotated. Inability to close one eye, facial asymmetry, or drawing of the mouth to the noninvolved side are associated with facial nerve palsy as a result of cranial nerve injuries.

Origin: Chapter 22, 13 13. What information would the nurse include in the preoperative plan of care for an infant with myelomeningocele? A) Positioning supine with a pillow under the buttocks B) Covering the sac with saline-soaked nonadhesive gauze C) Wrapping the infant snugly in a blanket D) Applying a diaper to prevent fecal soiling of the sac

Ans: B Feedback: For the infant with a myelomeningocele, saline-soaked nonadhesive gauze or antibiotic-soaked gauze is used to keep the sac moist. The infant is positioned prone, with a folded towel under the abdomen, so that the urine and feces flow away from the sac. A warmer or isolette is used to keep the infant warm. Blankets are avoided because they could place excess pressure on the sac. Diapering may be contraindicated to avoid placing pressure on the sac.

Origin: Chapter 6, 15 15. The nurse is performing a physical examination of an 11-year-old girl. What observations would be expected? A) The child has not gained weight since last year. B) The child has grown 2.5 inches since last year. C) The child breathes abdominally. D) The child's third molars are about to erupt.

Ans: B Feedback: From 6 to 12 years of age, children grow an average of 2.5 inches (6 to 7 cm) per year, increasing their height by at least 1 foot. An increase of 7 pounds (3 to 3.5 kg) per year in weight is expected. Abdominal breathing is typical of a preschooler and would have disappeared several years earlier. The third molars do not erupt until late adolescence.

Origin: Chapter 23, 2 2. The nurse is providing parental teaching about home care for an 8-year-old boy with widespread sunburn on his back and shoulders. Which response indicates a need for further teaching? A) "Cool compresses may help cool the burn." B) "He should manually peel off any flaking skin." C) "Nonsteroidal anti-inflammatory drugs like ibuprofen are helpful." D) "He should avoid hot showers or baths for a couple of days."

Ans: B Feedback: If skin flaking occurs, the child should be discouraged from manually "peeling" the flaked skin as it can cause further injury. Using cool compresses, taking nonsteroidal anti-inflammatory drugs, and avoiding hot showers or baths are appropriate measures.

Origin: Chapter 23, 1 1. The nurse is teaching the mother of a toddler about burn prevention. Which response by the mother indicates a need for further teaching? A) "We will leave fireworks displays to the professionals." B) "I will set our water heater at 130 degrees." C) "All sleepwear should be flame retardant." D) "The handles of pots on the stove should face inward."

Ans: B Feedback: If the temperature of the water heater is set at 130 degrees, a child can be burned significantly in only 30 seconds. The recommended maximal home hot water heater temperature is 120 degrees. Leaving fireworks to the professionals, using flame-retardant sleepwear, and turning the handles of pots on the stove inward are correct.

Origin: Chapter 23, 9 9. The nurse is caring for a 15-year-old boy who has sustained burn injuries. The nurse observes the burn developing a purplish color with discharge and a foul odor. The nurse suspects which infection? A) Burn wound cellulitis B) Invasive burn cellulitis C) Burn impetigo D) Staphylococcal scalded skin syndrome

Ans: B Feedback: Invasive burn cellulitis results in the burn developing a dark brown, black, or purplish color with a discharge and foul odor. In burn wound cellulitis, the area around the burn becomes increasingly red, swollen, and painful early in the course of burn management. Burn impetigo is characterized by multifocal, small, superficial abscesses. Staphylococcal scalded skin syndrome is not a burn infection; however, it is managed similarly to burns.

Origin: Chapter 23, 15 15. What would the nurse include when teaching an adolescent about tinea pedis? A) "Keep your feet moist and open to the air as much as possible." B) "Dry the area between your toes really well." C) "Wear nylon or synthetic socks every day." D) "Go barefoot when you are in the locker room at school."

Ans: B Feedback: Keeping the feet clean and dry is key for the child with tinea pedis. This includes rinsing the feet with water or a water/vinegar mixture and drying them well, especially between the toes. The adolescent should wear cotton socks and shoes that allow the feet to breathe. Going barefoot at home is allowed, but the adolescent should wear flip-flops around swimming pools and locker rooms.

Origin: Chapter 22, 36 36. A newborn is diagnosed with metatarsus adductus. The parents ask the nurse how this occurred. Which response by the nurse would be most appropriate? A) "This condition is due to a genetic defect in the bones." B) "It's most likely from how the baby was positioned in utero." C) "They really don't know what causes this condition." D) "There is probably an underlying deformity of the baby's hip."

Ans: B Feedback: Metatarsus adductus is a medial deviation of the forefoot that occurs as a result of in utero positioning. Osteogenesis imperfecta is a genetic bone disorder. The underlying cause of congenital clubfoot is not known. Developmental dysplasia of the hip involves a deformity of the newborn's hip.

Origin: Chapter 22, 9 9. The nurse is teaching a group of students about myelinization in a child. Which statement by the students indicates that the teaching was successful? A) Myelinization is completed by 4 years of age. B) The process occurs in a head-to-toe fashion. C) The speed of nerve impulses slows as myelinization occurs. D) Nerve impulses become less specific in focus with myelinization.

Ans: B Feedback: Myelinization occurs in a cephalocaudal, proximodistal manner and is completed by 2 years of age. As myelinization proceeds, nerve impulses become faster and more accurate.

Origin: Chapter 22, 33 33. The nurse is assessing a child with a possible fracture. What would the nurse identify as the most reliable indicator? A) Lack of spontaneous movement B) Point tenderness C) Bruising D) Inability to bear weight

Ans: B Feedback: Point tenderness is one of the most reliable indicators of a fracture in a child. Neglect of an extremity, inability to bear weight, bruising, erythema, and pain may be present, but these findings can also suggest other conditions.

Origin: Chapter 22, 29 29. The nurse is caring for an infant with osteogenesis imperfecta and is providing instruction on how to reduce the risk of injury. Which response from the mother indicates a need for further teaching? A) "I need to avoid pushing or pulling on an arm or leg." B) "I must carefully lift the baby from under the armpits." C) "I should not bend an arm or leg into an awkward position." D) "We must avoid lifting the legs by the ankles to change diapers."

Ans: B Feedback: The nurse needs to emphasize that the mother must not lift a baby or young child with osteogenesis imperfecta from under the armpits as it may cause harm. Avoiding pushing or pulling, not bending an arm or leg into an awkward position, and avoiding lifting the legs by the ankles are appropriate responses.

Origin: Chapter 22, 4 4. The nurse is caring for a 10-year-old with Duchenne muscular dystrophy. As part of the plan of care, the nurse focuses on maintaining his cardiopulmonary function. Which intervention would the nurse implement to best promote maximum chest expansion? A) Deep-breathing exercises B) Upright positioning C) Coughing D) Chest percussion

Ans: B Feedback: The nurse should emphasize that the child's position should be arranged to promote maximum chest expansion. This is usually in the upright position. Deep-breathing exercises are for strengthening/maintaining respiratory muscles. Coughing helps clear the airways. Chest percussion helps loosen secretions in lungs.

Origin: Chapter 23, 20 20. An instructor is developing a plan for a class of nursing students on various skin disorders. When describing urticaria, what would the instructor include? A) It is a type IV hypersensitivity reaction. B) Histamine release leads to vasodilation. C) Wheals appear first followed by erythema. D) The nonpruritic rash blanches with pressure.

Ans: B Feedback: Urticaria is a type I hypersensitivity reaction caused by an immunologically mediated antigen-antibody response of histamine release from the mast cells. Vasodilation and increased vascular permeability result, leading to erythema and then wheals. The rash is pruritic and blanches with pressure.

Origin: Chapter 23, 22 22. A nurse is performing a primary survey on a child who has sustained partial thickness burns over his upper body areas. What action should the nurse take first? A) Inspect the child's skin color. B) Assess for a patent airway. C) Observe for symmetric breathing. D) Palpate the child's pulse.

Ans: B Feedback: When performing a primary survey, the nurse first assesses the child's airway for patency and then intervenes accordingly to ensure that the airway is patent. Next the nurse would evaluate the child's skin color, respiratory effort, and symmetry of breathing and breath sounds. Then the nurse would determine the pulse strength, perfusion status, and heart rate.

Origin: Chapter 22, 40 40. A nurse is providing instructions to the parents of a 3-month-old with developmental dysplasia of the hip who is being treated with a Pavlik harness. Which statements by the parents demonstrate understanding of the instructions? Select all that apply. A) "We need to adjust the straps so that they are snug but not too tight." B) "We should change her diaper without taking her out of the harness." C) "We need to check the area behind her knees for redness and irritation." D) "We need to send the harness to the dry cleaners to have it cleaned." E) "We need to call the doctor if she is not able to actively kick her legs."

Ans: B, C, E Feedback: Instructions related to use of a Pavlik harness include changing the child's diaper while in the harness; checking the areas behind the knees and diaper area for redness, irritation, or breakdown; and calling the doctor if the child is unable to actively kick her legs. The straps are not to be adjusted without checking with the physician or nurse practitioner first. The harness can be washed with mild detergent by hand and air dried. A hair dryer can be used to dry the harness but only if the air fluffing setting is used.

Origin: Chapter 6, 3 3. The pediatric nurse is aware of the maturation of organ systems in the school-age child. What accurately describes these changes? Select all that apply. A) The brain grows very slowly during the school-age years and growth is complete by the time the child is 12 years of age. B) Respiratory rates decrease, abdominal breathing disappears, and respirations become diaphragmatic in nature. C) The school-age child's blood pressure increases and the pulse rate decreases, and the heart grows more slowly during the middle years. D) The school-age child experiences more gastrointestinal upsets compared with earlier years since the stomach capacity increases. E) Bladder capacity increases, but varies among individual children, and girls generally have a greater bladder capacity than boys. F) Prepubescence typically occurs in the 2 years before the beginning of puberty and is characterized by the development of secondary sexual characteristics.

Ans: B, C, E, F Feedback: Respiratory rates decrease, abdominal breathing disappears, and respirations become diaphragmatic in nature. The school-age child's blood pressure increases and the pulse rate decreases. The heart grows more slowly during the middle years and is smaller in size in relation to the rest of the body than at any other development stage. Bladder capacity increases, but varies among individual children. Girls generally have a greater bladder capacity than boys. Prepubescence typically occurs in the 2 years before the beginning of puberty and is characterized by the development of secondary sexual characteristics. The brain and skull grow very slowly during the school-age years. Brain growth is complete by the time the child is 10 years of age. The school-age child experiences fewer gastrointestinal upsets compared with earlier years. Stomach capacity increases, which permits retention of food for longer periods of time.

Origin: Chapter 23, 28 28. The mother of a 15-year-old girl has contacted the clinic to report that her daughter has burned the back of her hand with a curling iron. The child's mother reports the burn is mild but states her daughter is complaining of pain. After consulting with the physician, what instructions can the nurse anticipate will be recommended? Select all that apply. A) Apply a thin film of protective cocoa butter. B) Run cool water over the injured area. C) Apply ice for 15 to 20 minutes each hour until the pain subsides. D) Take acetaminophen using the manufacturer's guidelines. E) Apply a thin layer of petroleum jelly to the burned area.

Ans: B, D Feedback: Mild burns may be cared for at home. Cool water may be run over the injured tissue. Acetaminophen or ibuprofen may be administered for pain. Ointments and creams including butter, margarine, cocoa butter, and petroleum jelly should not be applied.

Origin: Chapter 22, 19 19. A nursing instructor is preparing for a class discussion on spinal muscular atrophy (SMA). When describing type 2 SMA, which information would the instructor include? Select all answers that apply. A) Onset before 6 months of age B) Weakness most severe in shoulders and hips C) Difficulty with swallowing D) Slowly progressing condition E) Genetic disease with autosomal recessive inheritance

Ans: B, D, E Feedback: Any type of spinal muscular atrophy is a genetic motor neuron disease due to autosomal recessive inheritance. Type 2 SMA usually occurs between 6 and 18 months of age, with weakness that is most severe in the shoulders, hips, thighs, and upper back. It is slower in progression than type 1. Survival into adulthood is common if respiratory status is maintained appropriately. Type 1 SMA occurs before birth to 6 months of age and the child usually has difficulty swallowing, sucking, and breathing.

Origin: Chapter 22, 34 34. An 8-year-old boy with a fractured forearm is to have a fiberglass cast applied. What information would the nurse include when teaching the child about the cast? A) The cast will take a day or two to dry completely. B) The edges will be covered with a soft material to prevent irritation. C) The child initially may experience a very warm feeling inside the cast. D) The child will need to keep his arm down at his side for 48 hours.

Ans: C Feedback: A fiberglass cast usually takes only a few minutes to dry and will cause a very warm feeling inside the cast. Therefore, the nurse needs to warn the child that this will occur. Fiberglass casts usually have a soft fabric edge so they usually do not cause skin rubbing at the edges and don't require petaling. The child should be instructed to elevate his arm above the level of the heart for the first 48 hours.

Origin: Chapter 22, 43 43. An 18-month-old was brought to the emergency department by her mother, who states, "I think she broke her arm." The child is sent for a radiograph to confirm the fracture. Additional assessment of the child leads the nurse to suspect possible child abuse. Which type of fracture would the radiograph most likely reveal? A) Plastic deformity B) Buckle fracture C) Spiral fracture D) Greenstick fracture

Ans: C Feedback: A spiral fracture is very rare in children. A spiral femoral or humeral fracture, particularly in a child younger than 2 years of age, should always be thoroughly investigated to rule out the possibility of child abuse. Plastic, buckle, and greenstick fractures are common in children and do not usually suggest child abuse.

Origin: Chapter 22, 26 26. The nurse is caring for a 13-year-old boy in traction prior to surgery for slipped capital femoral epiphysis. He has been in an acute care setting for 2 weeks and will require an additional 10 days in the hospital. He is complaining that he feels isolated and is resisting further treatment. Which response by the nurse would be most appropriate? A) "I know it is boring, but you must remain immobile for 2 more weeks." B) "If there are no complications, you only have 2 more weeks here." C) "Let's come up with things to do like books, movies, games, and friends to visit." D) "If you resist your treatment, your condition will only get worse."

Ans: C Feedback: After 2 weeks in traction, a teenager can become easily bored and isolated from usual peer interaction. The most helpful intervention would be to engage the help of the child to develop a list of books, games, movies, and other activities that he would enjoy. The nurse should also encourage visitation and phone calls from friends. Telling the adolescent that he needs to remain immobile or telling him that he has only 2 more weeks do not address the adolescent's issue. Telling the adolescent that his condition will worsen if he resists is threatening and inappropriate.

Origin: Chapter 22, 30 30. The nurse is developing a teaching plan for a child who is to have his cast removed. What instruction would the nurse most likely include? A) Applying petroleum jelly to the dry skin B) Rubbing the skin vigorously to remove the dead skin C) Soaking the area in warm water every day D) Washing the skin with dilute peroxide and water

Ans: C Feedback: After a cast is removed, the child and family should be instructed to soak the area in warm water every day to help soften and remove the dry flaky skin. Moisturizing lotion, not petroleum jelly, should be applied to the skin. Vigorous rubbing would traumatize the skin and should be avoided. Warm soapy water, not dilute peroxide and water, should be used to wash the area.

Origin: Chapter 23, 23 23. A 3-year-old child has sustained severe burns and is ordered to receive 100% oxygen. What would the nurse use to administer the oxygen? A) Nasal cannula B) Venturi mask C) Nonrebreather mask D) Oxygen hood

Ans: C Feedback: All children with severe burns should receive 100% oxygen via a nonrebreather mask or bag-valve-mask ventilation. A nasal cannula provides only low oxygen concentrations (22% to 44%); a Venturi mask provides only 24% to 50% oxygen concentrations. An oxygen hood is used for infants only.

Origin: Chapter 23, 12 12. The nurse is preparing a class for a group of adolescents about reducing the risk of skin cancer. What information would the nurse include? A) Using a sunscreen with para-aminobenzoic acid (PABA) with an SPF of at least 10 B) Applying sunscreen at least 1 hour before going outside in the sun C) Avoiding sun exposure between the hours of 10 a.m. and 2 p.m. D) Using artificial ultraviolet (UV) tanning beds instead of sun exposure

Ans: C Feedback: Avoiding sun exposure between the hours of 10 a.m. and 2 p.m. is one method of reducing the risk for skin cancer. Sunscreens with an SPF of 15 or greater that are fragrance- and PABA-free should be used. Sunscreen should be applied at least 30 minutes before exposure and then reapplied at least every 2 hours while exposed. Artificial UV light, including tanning beds, should be avoided.

Origin: Chapter 22, 22 22. The nurse is caring for an active 14-year-old boy who has recently been diagnosed with scoliosis. He is dismayed that a "jock" like himself could have this condition, and is afraid it will impact his spot on the water polo team. Which response by the nurse would best address the boy's concerns? A) "If you wear your brace properly, you may not need surgery." B) "The good news is that you have very minimal curvature of your spine." C) "Let's talk to another boy with scoliosis, who is winning trophies for his swim team." D) "Let's talk to the doctor about your treatment options."

Ans: C Feedback: Because this boy is concerned about limiting his participation in water polo and perceives scoliosis as a disease that does not affect "jocks," putting the child in contact with someone with the same problem would be helpful. Telling the adolescent about not needing surgery if he wears his brace or that his curvature is minimal may or may not be true in his case and thus would be false reassurance. Although these suggestions and also the suggestion about talking to the doctor about treatment options could be helpful by engaging his input in the treatment, these do not address his specific concerns about his body image.

Origin: Chapter 22, 15 15. A child with spastic cerebral palsy is to receive botulin toxin. The nurse prepares the child for administration of this drug by which route? A) Oral B) Subcutaneous injection C) Intramuscular injection D) Intravenous infusion

Ans: C Feedback: Botulin toxin is administered by injection into the muscle. It may cause dry mouth. It is not administered orally, by subcutaneous injection, or by intravenous infusion.

Origin: Chapter 23, 27 27. The nurse is interviewing the mother of a 6-month-old being seen at a well-child visit. The mother reports she has used an over-the-counter topical ointment intended for adults on her child for a skin rash. What is the most appropriate response by the nurse? A) "This is dangerous so please do not do this again." B) "Why did you do that instead of contacting your doctor?" C) "Children have thin skin and can absorb medications differently than adults." D) "How often do you use this medication?"

Ans: C Feedback: Children have thinner skin than adults. They will absorb topical medications more rapidly than adults. Medications concentrated for adults should not be used on children. It is important to explain this to the parent. It is confrontational to tell her this is dangerous or to tell her to contact the physician. The frequency of use is information that should be obtained but the education is most important in this scenario.

Origin: Chapter 23, 5 5. A nurse is caring for a 5-year-old in Buck traction. When conducting a skin examination for signs of pressure ulcers, the nurse pays particular attention to which area? A) Sacral area B) Hip area C) Occiput D) Upper arm

Ans: C Feedback: Common sites of pressure ulcers in hospitalized children include the occiput and toes, while children who require wheelchairs for mobility demonstrate pressure ulcers in the sacral or hip areas more frequently. The upper arm is not a common site for pressure ulcers.

Origin: Chapter 22, 11 11. A nurse is preparing a program for a group of parents about injury prevention. What would the nurse include as an important contributing factor for cervical spine injury in a child? A) Exposure to teratogens while in utero B) Immaturity of the central nervous system C) Increased mobility of the spine D) Incomplete myelinization

Ans: C Feedback: Compared to the adult, a child's spine is very mobile, especially in the cervical spine region, resulting in a higher risk for cervical spine injury. Exposure to teratogens in utero may lead to altered growth and development of the brain or spinal cord. Immaturity of the central nervous system places the infant at risk for insults that may result in delayed motor skill attainment or cerebral palsy. Incomplete myelinization reflects the lack of motor control.

Origin: Chapter 23, 3 3. The nurse is providing care for a 14-year-old girl with severe acne. The girl expresses sadness and distress about her appearance. Which response by the nurse would be most appropriate? A) "Are you using your medicine every day?" B) "Your condition will most likely improve in a year or two." C) "Many people feel this way; I know someone who can help." D) "If you have any scarring you can undergo dermabrasion."

Ans: C Feedback: Depression can occur as a result of body image disturbances with severe acne. The nurse should provide emotional support to adolescents undergoing acne therapy and refer teens for counseling if necessary. Telling the girl that her condition is likely to improve in a year or two is not helpful. Asking the girl whether she uses her medicine every day or reminding her that her scars can be addressed with dermabrasion does not address her feelings of sadness and distress.

Origin: Chapter 23, 11 11. After teaching a class about the differences in the skin of infants and adults, the nurse determines that additional teaching is necessary when the class states: A) "An infant's skin is thinner than an adult's, so substances placed on the skin are absorbed more readily." B) "The infant's epidermis is loosely connected to the dermis, increasing the risk for breakdown." C) "The infant has a lower risk for damage from ultraviolet radiation because the skin is more pigmented." D) "An infant has less subcutaneous fat, which places the infant at a higher risk for heat loss."

Ans: C Feedback: Infants have less pigmentation in their skin, placing them at increased risk for skin damage from ultraviolet radiation. The infant's skin is thinner, the epidermis is loosely connected, and there is less subcutaneous fat.

Origin: Chapter 22, 32 32. The school nurse is presenting a class to a group of students about common overuse disorders. Which disorder would the school nurse include? A) Dislocated radial head B) Transient synovitis of the hip C) Osgood-Schlatter disease D) Scoliosis

Ans: C Feedback: Overuse syndromes refer to a group of disorders that result from repeated force applied to normal tissue. An example is Osgood-Schlatter disease. Dislocated radial head, transient synovitis of the hip, and scoliosis are not considered overuse syndromes.

Origin: Chapter 22, 5 5. A 6-year-old boy with cerebral palsy has been admitted to the hospital for some tests. His condition is stable. The boy's mother remains with her son, but she is obviously exhausted and stressed. Which response by the nurse would be most appropriate? A) "Would you like me to bring you a blanket and pillow?" B) "You are doing such a wonderful job with your son." C) "He's in good hands; consider going home to get some sleep." D) "Are you planning to spend the night or to go home?"

Ans: C Feedback: Providing daily, intense care can be quite demanding and tiring. When a child with cerebral palsy is admitted to the hospital, this may serve as a time of respite for family and primary caregivers. The nurse should remind the mother that her son is in good hands and urge her to go home. Asking her whether she is planning to stay might make the mother feel obligated to stay. Asking if she wants a blanket or pillow does not encourage the mother to leave the hospital. Telling the mother she is doing a good job is nice, but does not encourage her to take a break.

Origin: Chapter 22, 23 23. The nurse is caring for a female infant with torticollis and is providing instructions to the parents about how to help their daughter. Which statement by the parents indicates a need for further teaching? A) "We must encourage our daughter to turn her head both ways." B) "Flatness on one side of the head is a common side effect." C) "We must apply firm pressure and stretching every other day." D) "We will do a daily stretching regimen with multiple sessions."

Ans: C Feedback: The nurse needs to remind the parents that the stretching exercises should be done several times a day. The stretching is applied with gentle, not firm, pressure and should be done every day for multiple sessions. The statements about turning the head both ways, flatness on one side as common, and daily stretching with multiple sessions are correct.

Origin: Chapter 22, 27 27. The nurse is caring for a 2-year-old girl in a bilateral brace with tibia vara. Her parents are upset by their toddler's limited mobility. Which response by the nurse would be most appropriate? A) "If you don't follow the therapy, your daughter could develop severe bowing of her legs." B) "It's important to use the brace or your daughter may need surgery." C) "You are doing a great job. Let's put our heads together on how to keep her busy." D) "You'll need to accept this since treatment may be required for several years."

Ans: C Feedback: The nurse should support the parents by encouraging and praising their compliance with bracing. It is also important to work with the parents to help develop age-appropriate diversions to promote normal growth and development. Telling the parents that they must be compliant or their daughter could develop severe bowing does not teach, does not offer solutions, and does not address the parents' concerns. Telling the parents that they must simply accept this and that the treatment could take years is likely to upset them and does not teach. It also does not address their concerns.

Origin: Chapter 6, 19 19. The nurse has determined that an 8-year-old girl is at risk for being overweight. Which intervention would be a priority prior to developing the care plan? A) Determining the need for additional caloric intake B) Asking the parents who they want to work with the child C) Interviewing the parents about their eating habits D) Discussing the influence of peers on the child's diet

Ans: C Feedback: The nurse would need to find out what the parents' eating habits are like. It would not be necessary to determine the need for additional caloric intake. Developing a multidisciplinary plan is an intervention for a child with growth and development problems. Discussing the influence of peers is an intervention used for preventing injury.

Origin: Chapter 22, 18 18. A child with cerebral palsy has undergone surgery for placement of a baclofen pump. Which instruction would the nurse include when teaching the parents about caring for their child? A) Waiting 48 hours before allowing the child to take a tub bath B) Not allowing the child to sleep on his side for about 4 weeks C) Calling the physician if the child's temperature is over 100.5°F D) Discouraging the child from stretching or bending forward for 4 weeks

Ans: D Feedback: After insertion of a baclofen pump, the parents should discourage any twisting at the waist, reaching high overhead, stretching, or bending forward or backward for 4 weeks. The child would avoid tub baths for about 2 weeks and avoid sleeping on his stomach for 4 weeks. The parents should notify the physician or nurse practitioner if the child's temperature is greater than 101.5°F.

Origin: Chapter 23, 6 6. A 6-year-old boy has been admitted to the hospital with burns. The nurse notes carbonaceous sputum. What action would be the priority? A) Determining the burn depth B) Eliciting a description of the burn C) Estimating burn extent D) Ensuring a patent airway

Ans: D Feedback: Carbonaceous sputum is a sign of potential airway injury due to smoke inhalation. Therefore, the nurse should ensure a patent airway while obtaining a brief history and simultaneously evaluating the child and providing emergency care. If the burn does not pose an immediate, life-threatening risk, the nurse would obtain an in-depth history and elicit a description of the burn. Determining the burn depth and extent are part of the secondary survey.

Origin: Chapter 23, 7 7. A nurse is caring for a 14-year-old girl who received an electrical burn. The nurse would anticipate preparing the girl for which diagnostic tests as ordered? A) Pulse oximetry B) Fiberoptic bronchoscopy C) Xenon ventilation-perfusion scanning D) Electrocardiographic monitoring

Ans: D Feedback: Electrocardiographic monitoring is important for the child who has suffered an electrical burn to identify possible cardiac arrhythmias, which can be noted for up to 72 hours after a burn injury. Fiberoptic bronchoscopy and xenon ventilation-perfusion scanning may be ordered to evaluate an inhalation injury, not an electrical burn. Pulse oximetry is used to evaluate pulmonary function and would not be indicated in the case of an electrical burn.

Origin: Chapter 23, 24 24. As part of a clinical conference with a group of nursing students, the instructor is describing the burn classification. The instructor determines that the teaching has been successful when the group identifies what as characteristic of full thickness burns? A) Skin that is reddened, dry, and slightly swollen B) Skin appearing wet with significant pain C) Skin with blistering and swelling D) Skin that is leathery and dry with some numbness

Ans: D Feedback: Full thickness burns may be very painful, numb, or pain-free in some areas. They appear red, edematous, leathery, dry, or waxy and may display peeling or charred skin. Superficial burns are painful, red, dry, and possibly edematous. Partial thickness and deep partial thickness burns are very painful and edematous and have a wet appearance or blisters.

Origin: Chapter 22, 38 38. A group of nursing students are reviewing information about the type of skin and skeletal traction. The students demonstrate understanding of this information when they identify which of these as a type of skeletal traction? A) Russell traction B) Bryant traction C) Buck traction D) Side arm 90-90 traction

Ans: D Feedback: Side arm 90-90 traction is a type of skeletal traction with force applied through a pin in the distal femur. Russell traction, Bryant traction, and Buck traction are types of skin traction.

Origin: Chapter 19, 8 8. A nurse is reviewing the medical record of a child and finds that the child has a grade III murmur. After auscultating the child's heart sounds, how would the nurse document this murmur? A) Loud without a thrill B) Loud with a precordial thrill C) Soft and easily heard D) Loud, audible with a stethoscope

Ans: A Feedback: A grade III murmur is loud without a thrill. Grade II is soft and easily heard. Grade IV is loud with a precordial thrill. Grade V is characterized as loud, audible with a stethoscope.

Origin: Chapter 19, 12 12. After assessing a child's blood pressure, the nurse determines the pulse pressure and finds that it is narrowed. What would the nurse identify as associated with this finding? A) Aortic stenosis B) Patent ductus arteriosus C) Aortic insufficiency D) Complete heart block

Ans: A Feedback: A narrowed pulse pressure is associated with aortic stenosis. A widened pulse pressure is associated with patent ductus arteriosus, aortic insufficiency, fever, anemia, or complete heart block.

Origin: Chapter 18, 11 11. A child requires supplemental oxygen therapy at 8 liters per minute. Which delivery device would the nurse most likely expect to be used? A) Simple mask B) Venturi mask C) Nasal cannula D) Oxygen hood

Ans: A Feedback: A simple mask would be used to deliver a flow rate of 8 liters per minute. A Venturi mask would be used to deliver a specific percentage of oxygen, from 24% to 50%. A nasal cannula would be used to deliver no more than 4 liters per minute. An oxygen hood requires a liter flow of 10 to 15 liters per minute.

Origin: Chapter 18, 29 29. A child requires supplemental oxygen therapy at 8 liters per minute. Which delivery device would the nurse most likely expect to be used? A) Simple mask B) Venturi mask C) Nasal cannula D) Oxygen hood

Ans: A Feedback: A simple mask would be used to deliver a flow rate of 8 liters per minute. A Venturi mask would be used to deliver a specific percentage of oxygen, from 24% to 50%. A nasal cannula would be used to deliver no more than 4 liters per minute. An oxygen hood requires a liter flow of 10 to 15 liters per minute.

Origin: Chapter 21, 26 26. A child returns from surgery in which a stoma was created in the abdominal wall to the bladder. The nurse identifies this as a: A) vesicostomy. B) ureteral stent. C) continent urinary diversion. D) bladder augmentation.

Ans: A Feedback: A vesicostomy refers to a stoma created in the abdominal wall to the bladder. A ureteral stent is a thin catheter temporarily placed in the ureter to drain urine. A continent urinary diversion uses a piece of the intestine to create a bladder that can be catheterized. Bladder augmentation involves the use of a piece of the stomach or intestine to enlarge bladder capacity.

Origin: Chapter 18, 23 23. The nurse is preparing to provide tracheostomy care to an infant. After gathering the necessary equipment, what would the nurse do next? A) Position the infant supine with a towel roll under the neck. B) Cut the new tracheostomy ties to the appropriate length. C) Cut the tracheostomy ties from around the tracheostomy tube. D) Cleanse around the site of the tracheostomy with the prescribed solution.

Ans: A Feedback: After gathering the necessary equipment, the nurse would position the infant supine with a blanket or towel roll to extend the neck. Then the nurse would open all the packaging and cut the new tracheostomy ties to the appropriate length. This would be followed by cleaning the site with the appropriate solution and then rinsing it. After placing the precut sterile gauze under the tracheostomy tube, the nurse would cut the ties and remove them from the tube while an assistant holds the tube in place.

Origin: Chapter 18, 25 25. The nurse is preparing to provide tracheostomy care to an infant. After gathering the necessary equipment, which action would the nurse take next? A) Position the infant supine with a towel roll under the neck B) Cut the new tracheostomy ties to the appropriate length C) Cut the tracheostomy ties from around the tracheostomy tube D) Cleanse around the site of the tracheostomy with the prescribed solution

Ans: A Feedback: After gathering the necessary equipment, the nurse would position the infant supine with a blanket or towel roll to extend the neck. Then the nurse would open all the packaging and cut the new tracheostomy ties to the appropriate length. This would be followed by cleaning the site with the appropriate solution and then rinsing it. After placing the precut sterile gauze under the tracheostomy tube, the nurse would cut the ties and remove them from the tube while an assistant holds the tube in place.

Origin: Chapter 15, 10 10. The nurse determines that it is necessary to implement airborne precautions for children with which infection? A) Measles B) Streptococcus group A C) Rubella D) Scarlet fever

Ans: A Feedback: Airborne precautions are designed to reduce the risk of infectious agents transmitted by airborne droplet nuclei or dust particles such as for children with measles, varicella, or tuberculosis. Droplet precautions would be used for children with streptococcal group A infections, rubella, and scarlet fever.

Origin: Chapter 21, 6 6. The nurse is caring for a 4-year-old girl with vulvovaginitis. After explaining to the girl's mother how to help prevent subsequent episodes, which statement by the mother indicates a need for additional teaching? A) "She needs to wipe from front to back." B) "I will make sure she changes her underwear every day." C) "She should probably avoid bubble baths." D) "I will help supervise her wiping after bowel movements."

Ans: A Feedback: At the age of 4, the mother should not assume that the girl will wipe properly. The mother will need to supervise her wiping in order to train her properly. Making sure the child changes her underwear daily, avoiding bubble baths, and supervising her wiping after bowel movements indicate that the mother has understood the instructions.

Origin: Chapter 15, 15 15. 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

Ans: A Feedback: Elevations in certain portions of the white blood cell count reflect different processes occurring in the body. Neutrophils function to combat bacterial infection. Eosinophils function in allergic disorders and parasitic infections. Basophils combat parasitic infections and some allergic disorders. Lymphocytes function in viral infections.

Origin: Chapter 15, 23 23. 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."

Ans: A Feedback: Head lice is not an indication of poor hygiene or poverty. It occurs in all socioeconomic groups. Thus, the parents' statement about being unclean and poor reflects a lack of knowledge about the infection. A pediculicide is used to wash the hair to treat the infestation. Household contacts need to be examined and treated if affected. Extreme pruritus is the most common symptom, with nits or lice especially behind the ears or at the nape of the neck.

Origin: Chapter 18, 8 8. The nurse is educating the parents of a 7-year-old boy with asthma about the medications that have been prescribed. Which drug would the nurse identify as an adjunct to a b2-adrenergic agonist for treatment of bronchospasm? A) Ipratropium B) Montelukast C) Cromolyn D) Theophylline

Ans: A Feedback: Ipratropium is an anticholinergic administered via inhalation to produce bronchodilation without systemic effects. It is generally used as an adjunct to a b2-adrenergic agonist. Montelukast decreases the inflammatory response by antagonizing the effects of leukotrienes. Cromolyn prevents release of histamine from sensitized mast cells. Theophylline provides for continuous airway relaxation.

Origin: Chapter 21, 7 7. A nurse is caring for a 7-year-old girl scheduled for an intravenous pyelogram (IVP). Which action would be the priority before the test? A) Checking with the parents for any allergies B) Ensuring adequate hydration C) Giving the girl an enema D) Screening her for pregnancy

Ans: A Feedback: It is important to double-check whether the girl has any allergies. The test is contraindicated in children allergic to shellfish or iodine. Adequate hydration is also important, but the check for allergies is a priority. Only females of reproductive age must be screened for pregnancy. An enema is not necessary at all institutions.

Origin: Chapter 21, 10 10. The nurse is caring for a 12-year-old girl with nephrotic syndrome. The girl confides that she feels like a "freak" compared to her peers because of her weight, edema, and moon face. Which response by the nurse would be most appropriate? A) "Let's put you in touch with some other girls who are also having the same body changes." B) "Luckily, this is just a temporary, unfortunate part of your condition; you need to accept it." C) "Your real friends do not care about your appearance and just want you to get well." D) "You are beautiful in your own way; what matters is what is on the inside."

Ans: A Feedback: It is important to introduce the girl to other youngsters with chronic renal conditions so she does not feel so isolated. Adolescents need interaction with peers. Telling the girl that this is a temporary condition, her real friends don't care about her appearance, and she is beautiful in her own way dismisses the girl's concerns and does not offer solutions. Nephrotic syndrome is a chronic condition, so telling her the condition is temporary also is inaccurate.

Origin: Chapter 5, 19 19. The parents of a 4-year-old who is a picky eater ask the nurse what foods to include in their child's diet to provide adequate iron consumption. Which food would the nurse recommend? A) Cooked lentils B) Whole milk C) Oranges D) Sweet potatoes

Ans: A Feedback: Lentils are a good source of iron. Whole milk, oranges, and sweet potatoes are good sources of calcium.

Origin: Chapter 5, 27 27. When providing anticipatory guidance to parents about their preschool son who was caught in a lie, what would the nurse emphasize? A) "You need to determine the reason for lying before punishing the child." B) "Lying should never be tolerated and the child should be punished." C) "The misbehavior is usually more serious than the lying itself." D) "It is okay to become angry when dealing with the child's lying."

Ans: A Feedback: Lying is common in preschool children and occurs for a variety of reasons, such as fearing punishment, getting carried away by imagination, or imitating what another person has done. Regardless, the parent should ascertain the reason for the lying before punishing the child. The child also needs to learn that the lying is usually far worse than the misbehavior. Parents need to remain calm and serve as a role model of an even temper.

Origin: Chapter 15, 12 12. 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

Ans: A Feedback: Lyme disease is caused by the bite of an infected tick, with a rash appearing 7 to 14 days after the tick bite. Ticks are commonly found in wooded areas. Therefore, reports of the child playing in the woods about 7 days ago would support the diagnosis of Lyme disease. A papular and vesicular rash is commonly associated with varicella (chickenpox). A high fever for 3 to 5 days before a rash suggests roseola. Extreme pruritus with visible nits would suggest pediculosis.

Origin: Chapter 15, 7 7. The nurse is performing a physical examination of an 8-year-old girl who was bitten by her kitten. Which assessment would lead the nurse to suspect cat-scratch disease? A) Swollen lymph nodes B) Strawberry tongue C) Infected tonsils D) Swollen neck

Ans: A Feedback: Lymph nodes, especially under the arms, can become painful and swollen due to cat-scratch disease. Strawberry tongue is typical of scarlet fever. Infected tonsils and an edematous neck are symptoms of diphtheria.

Origin: Chapter 19, 20 20. A child with heart failure is receiving supplemental oxygen. The nurse understands that in addition to improving oxygen saturation, this intervention also has what effect? A) Cause vasodilation B) Increase pulmonary vascular resistance C) Promote diuresis D) Mobilize secretions

Ans: A Feedback: Oxygen improves oxygen saturation and also functions as a vasodilator and decreases pulmonary vascular resistance. Diuretics promote dieresis. Chest physiotherapy helps to mobilize secretions.

Origin: Chapter 5, 16 16. When observing a group of preschoolers at play in the clinic waiting room, which type of play would the nurse be least likely to note? A) Parallel play B) Cooperative play C) Dramatic play D) Fantasy play

Ans: A Feedback: Parallel play is associated with toddlers. Cooperative, dramatic, and fantasy play are commonly used by preschoolers.

Origin: Chapter 15, 25 25. An adolescent is diagnosed with gonorrhea. When developing the plan of care for this adolescent, the nurse would expect that she would also receive treatment for what? A) Chlamydia B) Syphilis C) Genital herpes D) Trichomoniasis

Ans: A Feedback: Patients with gonorrhea usually receive treatment for chlamydia as well because patients often are coinfected. Coinfection with syphilis, genital herpes, or trichomoniasis is uncommon.

Origin: Chapter 18, 1 1. The nurse is assessing a 7-year-old boy with pharyngitis. What assessment finding would suggest the child has developed a peritonsillar abscess? A) Palatal edema B) Difficulty swallowing C) Rash on the abdomen D) Sore throat and headache

Ans: A Feedback: Peritonsillar abscess may be noted by asymmetric swelling of the tonsils, shifting of the uvula to one side, and palatal edema. Difficulty swallowing, sore throat, and headache are consistent with pharyngitis, as is the rash, which would be fine, red, and sandpaper-like (called scarlatiniform) but do not indicate a peritonsillar abscess..

Origin: Chapter 5, 23 23. The nurse is conducting a well-child assessment for a 5-year-old boy in preparation for kindergarten. The boy's grandmother is his primary caregiver because the boy's mother has suffered from depression and substance abuse issues. The nurse understands that the child is at increased risk for which developmental problem? A) Lack of social and emotional readiness for school B) Stuttering C) Speech and language delays D) Fine motor skills delay

Ans: A Feedback: Risk factors for lack of social and emotional readiness for school include insecure attachment in the early years, maternal depression, parental substance abuse, and low socioeconomic status.

Origin: Chapter 19, 4 4. The nurse is conducting a physical examination of a child with a suspected cardiovascular disorder. Which finding would the nurse most likely expect to assess if the child had transposition of the great vessels? A) Significant cyanosis without presence of a murmur B) Abrupt cessation of chest output with an increase in heart rate/filling pressure C) Soft systolic ejection D) Holosystolic murmur

Ans: A Feedback: Significant cyanosis without presence of a murmur is highly indicative of transposition. Abrupt cessation of chest output accompanied by an increase in heart rate and filling pressure is indicative of cardiac tamponade. A soft systolic ejection or holosystolic murmur can be found with other disorders, such as hypoplastic left heart syndrome, but is not highly suspicious of transposition.

Origin: Chapter 5, 26 26. The nurse is caring for a premature baby in the NICU. The mother reports that the infant's normally happy and outgoing 5-year-old sister is acting sad and withdrawn. The nurse understands that due to her developmental stage, the girl is at risk of what happening? A) Viewing her baby sister's illness as her fault B) Harming the baby C) Experiencing clinical depression D) Creating an imaginary friend to cope with the situation

Ans: A Feedback: Since the preschool child is facing the psychosocial task of initiative versus guilt, it is natural for the child to experience guilt when something goes wrong. The child may have a strong belief that if someone is ill or dying, he or she may be at fault and the illness or death is punishment. It is less likely that the girl would be at risk of harming the baby or experiencing clinical depression as a result of the baby's illness. The child may create an imaginary friend to cope with the illness, but would not withdraw or express sadness as a result of the imaginary friend.

Origin: Chapter 18, 30 30. The nurse is caring for a 3-year-old girl with a respiratory disorder. The nurse anticipates the need for providing supplemental oxygen to the child when performing which intervention? A) Suctioning a tracheostomy tube B) Administering drugs with a nebulizer C) Providing tracheostomy care D) Suctioning with a bulb syringe

Ans: A Feedback: Supplemental oxygenation may be necessary before, and is always performed after, suctioning a child with a tracheostomy tube. Providing tracheostomy care, administering drugs with a nebulizer, and suctioning with a bulb syringe do not require supplemental oxygen.

Origin: Chapter 18, 9 9. The nurse is caring for a 3-year-old girl with a respiratory disorder. The nurse anticipates the need for providing supplemental oxygen to the child when performing which action? A) Suctioning a tracheostomy tube B) Administering drugs with a nebulizer C) Providing tracheostomy care D) Suctioning with a bulb syringe

Ans: A Feedback: Supplemental oxygenation may be necessary before, and is always performed after, suctioning a child with a tracheostomy tube. Providing tracheostomy care, administering drugs with a nebulizer, and suctioning with a bulb syringe do not require supplemental oxygen.

Origin: Chapter 21, 17 17. A 15-year-old boy comes to the emergency department accompanied by his parents. The boy reports an abrupt onset of sudden pain on the right side of his scrotum. When asked to rate his pain on a scale of 1 to 10, with 10 being the most severe, the boy states, "It's a 12." Further assessment reveals a blue-black swelling on the affected side. The nurse suspects testicular torsion and immediately notifies the physician because: A) the condition is a surgical emergency. B) the boy is at risk for sepsis. C) intravenous antibiotics need to be initiated. D) renal failure is imminent.

Ans: A Feedback: Testicular torsion is a surgical emergency that necessitates immediate surgical correction to prevent testicular necrosis and possible gangrene. There is no infection with testicular torsion, intravenous antibiotics are not used to treat this condition, and renal failure is not imminent.

Origin: Chapter 5, 11 11. The nurse is explaining to parents that the preschooler's developmental task is focused on the development of initiative rather than guilt. What is a priority intervention the nurse might recommend for parents of preschoolers to stimulate initiative? A) Reward the child for initiative in order to build self-esteem. B) Change the routine of the preschooler often to stimulate initiative. C) Do not set limits on the preschooler's behavior as this results in low self-esteem. D) As a parent, decide how and with whom the child will play.

Ans: A Feedback: The building of self-esteem continues throughout the preschool period. It is of particular importance during these years, as the preschooler's developmental task is focused on the development of initiative rather than guilt. A sense of guilt will contribute to low self-esteem, whereas a child who is rewarded for his or her initiative will have increased self-confidence. Routine and ritual continue to be important throughout the preschool years, as they help the child to develop a sense of time as well as provide the structure for the child to feel safe and secure. Also, consistent limits provide the preschooler with expectation and guidance. Giving children opportunities to decide how and with whom they want to play also helps them develop initiative.

Origin: Chapter 21, 1 1. The nurse is caring for a child who is experiencing an acute renal transplant rejection and is to receive muromonab-CD3. What would the nurse most likely expect to assess after the first dose is administered? A) Fever with chills, chest tightness B) Cough, hyperkalemia C) Photosensitivity, gastrointestinal (GI) upset D) Urinary retention, decreased appetite

Ans: A Feedback: The first dose of muromonab-CD3 can cause fever, chills, chest tightness, wheezing, nausea, and vomiting. Cough and hyperkalemia are associated with angiotensin-converting enzyme inhibitors. Photosensitivity and GI upset are often associated with diuretics. Urinary retention and decreased appetite are associated with imipramine.

Origin: Chapter 5, 4 4. The nurse is caring for a 5-year-old girl posttonsillectomy. The girl looks out the window and tells the nurse that it is raining and says, "The sky is crying because it is sad that my throat hurts." The nurse understands that the girl is demonstrating which mental process? A) Magical thinking B) Centration C) Transduction D) Animism

Ans: A Feedback: The nurse understands that the girl is demonstrating magical thinking. Magical thinking is a normal part of preschool development. The preschool-age child believes her thoughts to be all-powerful. Transduction is reasoning by viewing one situation as the basis for another situation whether or not they are truly causally linked. Animism is attributing life-like qualities to inanimate objects. Centration is focusing on one aspect of a situation while neglecting others.

Origin: Chapter 5, 22 22. The nurse is providing teaching about accidental poisoning to the family of a 3-year-old. The nurse understands that a child of this age is at increased risk of accidental ingestion due to which sensory alteration? A) A less discriminating sense of taste B) A lack of fully developed hearing C) Visual acuity that has not fully developed D) A less discriminating sense of touch

Ans: A Feedback: The young preschooler may have a less discriminating sense of taste than the older child, making him or her at increased risk for accidental ingestion. A less discriminating sense of touch and developing visual acuity would not increase the risk. Hearing is intact at birth and it does not increase the child's risk for accidental ingestion.

Origin: Chapter 5, 3 3. The nurse is assessing the psychosocial development of a preschooler. What are normal activities characteristic of the preschooler? Select all that apply. A) Plans activities and makes up games B) Initiates activities with others C) Acts out roles of other people D) Engages in parallel play with peers E) Classifies or groups objects by their common elements F) Understands relationships among objects

Ans: A, B, C Feedback: The many activities of the preschooler include beginning to plan activities, making up games, initiating activities with others, and acting out the roles of other people (real and imaginary). Toddlers engage in parallel play; preschoolers engage in cooperative play. School-age children classify or group objects by common elements and understand relationships among objects.

Origin: Chapter 5, 15 15. The nurse is caring for preschoolers in a day care center. For this age group, of what developmental milestones should the nurse be aware? Select all that apply. A) Counting 10 or more objects B) Correctly naming at least four colors C) Understanding the concept of time D) Knowing everyday objects E) Understanding the differences of others F) Forming concepts as logical as an adult's

Ans: A, B, C, D Feedback: The child in the intuitive phase can count 10 or more objects, correctly name at least four colors, and better understand the concept of time, and he or she knows about things that are used in everyday life, such as appliances, money, and food. The preschooler forms concepts that are not as complete or as logical as the adult's, and tolerates others' differences but doesn't understand them.

Origin: Chapter 15, 26 26. A nurse suspects that an adolescent may have community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA). What would the nurse expect to assess? Select all that apply. A) Participation in contact sport B) Recent cut on the lower leg C) History of a recent sore throat D) Raised fluctuant lesions E) Erythematous rash over the trunk and face

Ans: A, B, D Feedback: With CAMRSA, skin and tissue infections are common, often appearing as a bump or skin area that is red, swollen, painful, and warm to the touch. There also may be fluctuance and purulent drainage. Participation in contact sports, openings in the skin such as abrasions and cuts, contact with contaminated items and surfaces, poor hygiene, and crowded living conditions are risk factors for CAMRSA. Recent sore throat and an erythematous rash on the trunk, face, and possibly the extremities are associated with scarlet fever.

Origin: Chapter 5, 2 2. The nurse is teaching the parents of a 4-year-old boy about the normal maturation of the child's organs during the preschool years and their effect on body functions. Which statements accurately describe these changes? Select all that apply. A) Myelination of the spinal cord allows for bowel and bladder control to be complete in most children by age 3 years. B) The respiratory structures are continuing to grow in size, and the number of alveoli continues to increase, reaching the adult number at about 7 years of age. C) Heart rate increases and blood pressure decreases slightly during the preschool years; an innocent heart murmur may be heard upon auscultation. D) The bones continue to increase in length and the muscles continue to strengthen and mature; however, the musculoskeletal system is still not fully mature. E) The small intestine is continuing to grow in length, and stool passage usually occurs once or twice per day in the average preschooler. F) The urethra remains long in both boys and girls, making them more susceptible to urinary tract infections than adults.

Ans: A, B, D, E Feedback: Most of the body systems have matured by the preschool years. Myelination of the spinal cord allows for bowel and bladder control to be complete in most children by age 3 years. The respiratory structures are continuing to grow in size, and the number of alveoli continues to increase, reaching the adult number at about 7 years of age. The bones continue to increase in length and the muscles continue to strengthen and mature. However, the musculoskeletal system is still not fully mature. The small intestine is continuing to grow in length, and stool passage usually occurs once or twice per day in the average preschooler. The 4-year-old generally has adequate bowel control. Heart rate decreases and blood pressure increases slightly during the preschool years. An innocent heart murmur may be heard upon auscultation. The urethra remains short in both boys and girls, making them more susceptible to urinary tract infections than adults.

Origin: Chapter 5, 8 8. The school nurse is helping parents choose books for their preschoolers. What literacy skills present in the preschooler would the nurse consider when making choices? Select all that apply. A) Preschoolers enjoy books with pictures that tell stories. B) Preschoolers like stories with repeated phrases as they help keep their attention. C) Preschoolers like stories that describe experiences different from their own. D) Preschoolers demonstrate early literacy skills by reciting stories or portions of books. E) Preschoolers may retell the story from the book, pretend to read books, and ask questions about the story. F) Preschoolers do not have enough focus and expanded attention to notice when a page is skipped during reading.

Ans: A, B, D, E Feedback: Preschoolers enjoy books with pictures that tell stories. Stories with repeated phrases help to keep the child's attention. Also, children like stories that describe experiences similar to their own. The preschool child demonstrates early literacy skills by reciting stories or portions of books. He or she also may retell the story from the book, pretend to read books, and ask questions about the story. The preschool child has enough focus and expanded attention to notice when a page is skipped during reading and will call it to the parent's attention.

Origin: Chapter 15, 29 29. The parents of a 7-month-old child with an infection ask the nurse about how to treat their child's fever. After providing teaching, the parents voice understanding with which statements? Select all that apply. A) "Unless my child develops a fever over 102.2°F , I don't need to make an appointment with the physician." B) "Having a temperature over 38°C puts my child at risk for the infection spreading to the bloodstream." C) "I can use acetaminophen to help with the symptoms of the infection but it won't get rid of the infection." D) "Even though people get frightened, fevers are not a bad thing during an infection unless it gets too high." E) "Any fever is dangerous and can cause serious damage to brain cells if it goes on too long."

Ans: A, C, D Feedback: In infants older than 3 months of age, fever less than 39°C (102.2°F) usually does not require treatment by a physician. Antipyretics, such as acetaminophen, provide symptomatic relief but do not change the course of the infection. A fever can actually enhance various components of the immune response. Infants younger than 3 months of age with a rectal temperature greater than 38°C should be seen by a physician or nurse practitioner because of increased risk of sepsis.

Origin: Chapter 19, 23 23. A child is diagnosed with Kawasaki disease and is in the acute phase of the disorder. What would the nurse expect the physician to prescribe? Select all that apply. A) Intravenous immunoglobulin B) Ibuprofen C) Acetaminophen D) Aspirin E) Alprostadil

Ans: A, C, D Feedback: In the acute phase, high-dose aspirin in four divided doses daily and a single infusion of intravenous immunoglobulin are used. Acetaminophen is used to reduce fever. Nonsteroidal anti-inflammatory agents such as ibuprofen are avoided while the child is receiving aspirin therapy. Alprostadil is used to temporarily keep the ductus arteriosus patent in infants with ductal-dependent congenital heart defects.

Origin: Chapter 6, 29 29. A 12-year-old girl is experiencing prepubescence, and tells the school nurse that she feels "very out of place" in her school. What would be acceptable responses by the nurse? Select all that apply. A) "It must be difficult for you. Why don't you sit down and we can talk about it." B) "I would suggest that you talk to your parents about your feelings. This isn't something that I can talk to you about." C) "All of the girls and boys will be going through the same thing as you so that should make you feel a little better." D) "Tell me how this makes you feel. Talking about your feelings may help you feel better about school." E) "I went through the same thing when I was in school. I know it doesn't feel like it now but I promise it will get easier."

Ans: A, D Feedback: Prepubescence typically occurs in the 2 years before the beginning of puberty and is characterized by the development of secondary sexual characteristics, a period of rapid growth for girls, and a period of continued growth for boys. Acknowledging the student's feelings and encouraging her to talk about her feelings will likely help her to feel better about herself. She may not be comfortable with talking about her feelings with her parents at this point, and the nurse discussing this topic with the student is acceptable. Telling her that everyone goes through it and that it will "get easier" does not address the student's feelings and is nontherapeutic communication.

Origin: Chapter 19, 15 15. The nurse is preparing a teaching plan for the parents of a child who has been diagnosed with a congenital heart defect. What would the nurse be least likely to include? A) Daily weight assessment B) Maintenance of strict bed rest C) Prevention of infection D) Signs of complications

Ans: B Feedback: A child with congenital heart disease should be allowed to engage in activity as tolerated, with rest periods frequently throughout the day to prevent overexertion. Daily weights, infection prevention measures, and signs of complications are all appropriate to include when teaching parents of a child with a congenital heart defect.

Origin: Chapter 23, 4 4. The nurse is conducting a physical examination of a 9-month-old baby with a flat, discolored area on the skin. The nurse documents this as a: A) papule. B) macule. C) vesicle. D) scale.

Ans: B Feedback: A macule is a flat, discolored area on the skin. A papule is a small, raised bump on the skin. A vesicle is a fluid-filled bump on the skin. Scaling is flaking of the skin.

Origin: Chapter 18, 18 18. A group of nursing students are reviewing the medications used to treat asthma. The students demonstrate understanding of the information when they identify which agent as appropriate for an acute episode of bronchospasm? A) Salmeterol B) Albuterol C) Ipratropium D) Cromolyn

Ans: B Feedback: Albuterol is a short-acting b2-adrenergic agonist that is used for treatment of acute bronchospasm. Salmeterol is a long-acting b2-adrenergic agonist used for long-term control or exercise-induced asthma. Ipratropium is an anticholinergic agent used as an adjunct to b2-adrenergic agonists for treatment of bronchospasm. Cromolyn is a mast cell stabilizer used prophylactically but not to relieve bronchospasm during an acute wheezing episode.

Origin: Chapter 15, 17 17. 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 action 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

Ans: B Feedback: Antipyretics act to decrease the temperature set point in children with elevated temperatures by inhibiting the production of prostaglandins, which leads to heat loss through vasodilation and sweating. Antihistamines block the release of histamine.

Origin: Chapter 19, 16 16. After teaching a class about the hemodynamic characteristics of congenital heart disease, the instructor determines that the teaching has been successful when the class identifies which defect as an example of a disorder involving increased pulmonary blood flow? A) Tetralogy of Fallot B) Atrial septal defect C) Hypoplastic left heart syndrome D) Transposition of the great vessels

Ans: B Feedback: Atrial septal defect is an example of a disorder involving increased pulmonary blood flow. Tetralogy of Fallot is a defect involving decreased pulmonary blood flow. Transposition of the great vessels and hypoplastic left heart syndrome are examples of mixed disorders.

Origin: Chapter 21, 12 12. The nurse is preparing a teaching plan for the parents of a child with a urinary tract infection (UTI). What would the nurse encourage the parents to avoid? A) Liberal fluid intake B) Caffeine C) Cranberry juice D) Cotton underwear

Ans: B Feedback: Caffeine is an irritant to the bladder and should be avoided. Liberal fluid intake and cranberry juice should be encouraged. The child should wear cotton underwear to avoid perineal irritation.

Origin: Chapter 18, 12 12. A group of nursing students are reviewing information about the variations in respiratory anatomy and physiology in children in comparison to adults. The students demonstrate understanding of the information when they identify which finding? A) Children's demand for oxygen is lower than that of adults. B) Children develop hypoxemia more rapidly than adults do. C) An increase in oxygen saturation leads to a much larger decrease in pO2 D) Children's bronchi are wider in diameter than those of an adult.

Ans: B Feedback: Children develop hypoxemia more rapidly than adults do because they have a significantly higher metabolic rate and faster resting respiratory rates than adults do, which leads to a higher demand for oxygen. A smaller decrease in oxygen saturation reflects a disproportionately much larger decrease in pO2. The bronchi in children are narrower than in adults, placing them at higher risk for lower airway obstruction.

Origin: Chapter 18, 20 20. A nursing instructor is preparing a class on chronic lung disease. What information would the instructor include when describing this disorder? A) It is a result of cystic fibrosis. B) It is seen most commonly in premature infants. C) It typically affects females more often than males. D) It is characterized by bradypnea.

Ans: B Feedback: Chronic lung disease, formerly known as bronchopulmonary dysplasia, is often diagnosed in infants who have experienced respiratory distress syndrome, most commonly seen in premature infants. Male gender is a risk factor for development. Tachypnea and increased work of breathing are characteristic of chronic lung disease.

Origin: Chapter 18, 26 26. A nursing instructor is preparing a class on chronic lung disease. Which information would the instructor include when describing this disorder? A) It is a result of cystic fibrosis. B) It is seen most commonly in premature infants. C) It typically affects females more often than males. D) It is characterized by bradypnea.

Ans: B Feedback: Chronic lung disease, formerly known as bronchopulmonary dysplasia, is often diagnosed in infants who have experienced respiratory distress syndrome, most commonly seen in premature infants. Male gender is a risk factor for development. Tachypnea and increased work of breathing are characteristic of chronic lung disease.

Origin: Chapter 21, 27 27. The nurse is preparing an 8-year-old girl for a cystoscopy. Which instruction would be most appropriate to give to the child? A) "You need to make sure that you don't go to the bathroom before the test." B) "You might feel some burning when you go to the bathroom afterward." C) "I'm going to have to put a tube into your bladder to empty it." D) "I have to put a thick tight rubber band around your arm to get a blood specimen."

Ans: B Feedback: Cystoscopy is an endoscopic visualization of the urethra and bladder. The nurse would instruct the child that she might experience some burning when she voids after the procedure. A full bladder is needed for urodynamic studies. Putting a tube into the bladder describes a catheterization. Putting a thick tight rubber band suggests a tourniquet, which is used to obtain blood specimens.

Origin: Chapter 19, 6 6. When conducting a physical examination of a child with suspected Kawasaki disease, which finding would the nurse expect to assess? A) Hirsutism or striae B) Strawberry tongue C) Malar rash D) Café au lait spots

Ans: B Feedback: Dry, fissured lips and a strawberry tongue are common findings with Kawasaki disease. Acne, hirsutism, and striae are associated with anabolic steroid use. Malar rash is associated with lupus. Café au lait spots are associated with neurofibromatosis.

Origin: Chapter 5, 12 12. The parents of a 5-year-old boy tell the nurse that their son is having frequent episodes of night terrors. Which of the following statements would indicate that the boy is having nightmares instead of night terrors? A) "It usually happens about an hour after he falls asleep." B) "He will tell us about what happened in his dream." C) "He is completely unaware that we are there." D) "When we try to comfort him, he screams even more."

Ans: B Feedback: During a nightmare, a child will have a memory of the occurrence and may remember the dream and talk about it later. With night terrors, the child has no memory of the event. The other statements are indicative of night terrors.

Origin: Chapter 21, 21 21. A nurse is preparing a presentation for a local parent group about urinary tract infections (UTIs) in children. Which organism would the nurse incorporate into the presentation as the most common cause? A) Klebsiella B) Escherichia coli C) Staphylococcus aureus D) Pseudomonas

Ans: B Feedback: E. coli most commonly causes UTI. Other less common causative organisms include Klebsiella, S. aureus, and Pseudomonas.

Origin: Chapter 21, 16 16. A nurse is conducting a physical examination of an infant and observes the urethral opening on the dorsal side of the penis. The nurse documents this finding as: A) hypospadias. B) epispadias. C) varicocele. D) hydrocele.

Ans: B Feedback: Epispadias is a urethral defect in which the opening is on the dorsal surface of the penis. Hypospadias is a urethral defect in which the opening is on the ventral surface of the penis rather than at the end. Varicocele is a venous varicosity along the spermatic cord manifested as a scrotal swelling. Hydrocele is a benign condition in which fluid accumulates in the scrotal sac.

Origin: Chapter 22, 6 6. A nurse is caring for a 14-year-old girl following myelography. What is the priority nursing action? A) Monitoring for a decrease in spasticity B) Observing for signs of meningeal irritation C) Assessing motor function D) Observing for mental confusion or hallucinations

Ans: B Feedback: Following myelography, the nurse should carefully observe for signs of meningeal irritation because of what is involved in this procedure. Monitoring for a decrease in muscle spasticity, assessing motor function, and observing for mental confusion or hallucinations is appropriate following an intrathecal test dose of baclofen.

Origin: Chapter 15, 6 6. 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 makes what statement? 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."

Ans: B Feedback: Grasping the tick and pulling it away quickly would indicate the need for additional teaching. When removing a tick, the mother should use fine-tipped tweezers while protecting her fingers with a tissue, paper towel, or latex gloves. The mother should grasp the tick as close to the skin as possible and pull upward with steady, even pressure. Once removed, the mother should place the tick in a sealable plastic bag in the freezer in case the child becomes sick and identification of the tick is needed.

Origin: Chapter 21, 2 2. The nurse is visually inspecting a urine specimen from a 12-year-old boy. The nurse documents gross hematuria with a specimen of which color? A) Cloudy yellow B) Cola colored C) Pale to almost clear urine D) Light orange to moderately yellow colored

Ans: B Feedback: Gross hematuria causes the urine to appear tea, cola, or even dirty green colored. Cloudy urine is typically a sign of infection. Normal urine ranges from moderately yellow to pale or almost clear. Orange-colored urine can occur because of medication.

Origin: Chapter 21, 15 15. After teaching the parents of a child with a hydrocele about this condition, which statement indicates that the teaching was successful? A) "If this gets worse and we don't treat it, our son could become infertile." B) "This condition should gradually go away on its own." C) "The surgeon is going to operate on him immediately." D) "It's going to be difficult putting ice packs on his scrotum."

Ans: B Feedback: Hydrocele requires watchful waiting because it will usually resolve spontaneously on its own. Hydrocele is not associated with the development of infertility; a varicocele, if left untreated, can lead to infertility. Immediate surgery is warranted for testicular torsion. Ice packs to the scrotum are helpful in relieving pain associated with epididymitis.

Origin: Chapter 21, 25 25. While presenting a panel discussion to a group of parents about urinary tract infections (UTIs) in children, one of the parents asks the nurse, "Why would my daughter be more at risk than my son?" Which response by the nurse would be most accurate? A) "Girls have a smaller bladder size than boys do." B) "A girl's urethra is closer to the rectal opening." C) "A girl's urethra is longer than a boy's urethra." D) "Her kidneys are less well protected."

Ans: B Feedback: In females, the urethra is shorter, which allows bacteria to enter the bladder. It also is closer in physical proximity to the rectum, leading to possible contamination. Bladder size does not differ between boys and girls. The kidneys are less well protected in the abdomen, increasing the risk for injury but not UTIs.

Origin: Chapter 21, 9 9. The nurse is taking a health history of a child with suspected acute poststreptococcal glomerulonephritis. Which response would alert the nurse to a confirmed risk factor for this condition? A) "She has been very healthy up to now." B) "He just got over a head cold with laryngitis." C) "My child is just 18 months old." D) "My child has not been sick at all."

Ans: B Feedback: Known risk factors include a recent episode of pharyngitis or other streptococcal infection, age older than 2 years, and male sex.

Origin: Chapter 15, 8 8. 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

Ans: B Feedback: Maintaining the integrity of the child's skin and mucous membranes is a precaution that will break the chain of infection at the susceptible host. Keeping linens dry and clean is a precaution to take at the reservoir link. Washing hands frequently breaks the chain at the mode of transmission. Coughing into a handkerchief is a precaution for the portal of exit.

Origin: Chapter 6, 30 30. The mother of a 12-year-old boy is talking with the school nurse about her son's clumsiness. She reports that he seems to fall a lot, his writing is horrible, and as much as he practices he can't play his guitar very well. How should the nurse respond to the mother? A) "Boys tend to take a bit longer than girls to mature." B) "Have you spoken with your pediatrician about your observations?" C) "Boys tend to refine their fine motor skills by this age." D) "I will make a note of your observations and talk to his teachers."

Ans: B Feedback: Myelinization of the central nervous system is reflected by refinement of fine motor skills. The child between 10 and 12 years of age begins to exhibit manipulative skills comparable to adults. In order to determine if the child is delayed in fine motor skill development, the pediatrician should be made aware because further examination or testing may be warranted. Just stating the fact that his motor skills should be developed by this age, although true, does not address the mother's concerns. The teachers can be notified of the mother's observations, but the child should still be assessed by the pediatrician.

Origin: Chapter 15, 1 1. 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

Ans: B Feedback: Past medical history will provide information about the mother's pregnancy and delivery, giving insight into the possibility of maternal transmission of the infection. Family history would provide information about lack of immunizations or recent infectious or communicable diseases. Home treatments and present illness history would provide no information about the possibility of maternal transmission of infection.

Origin: Chapter 5, 28 28. The nurse is providing anticipatory guidance for parents of a preschooler regarding sex education. What is a recommended guideline when dealing with this issue? A) Be prepared to thoroughly cover a topic before the child asks about it. B) Before answering questions, find out what the child thinks about the subject. C) Expand upon the topic when answering questions to prevent further confusion. D) Provide a less than honest response to shelter the child from knowledge that is too advanced.

Ans: B Feedback: Preschoolers are very inquisitive and want to learn about everything around them; therefore, they are very likely to ask questions about sex and where babies come from. Before attempting to answer questions, parents should try to find out first what the child is really asking and what the child already thinks about that subject. Then they should provide a simple, direct, and honest answer. The child needs only the information that he or she is requesting.

Origin: Chapter 18, 3 3. The nurse is examining an 8-year-old boy with tachycardia and tachypnea. The nurse anticipates which test as most helpful in determining the extent of the child's hypoxia? A) Pulmonary function test B) Pulse oximetry C) Peak expiratory flow D) Chest radiograph

Ans: B Feedback: Pulse oximetry is a useful tool for determining the extent of hypoxia. It can be used by the nurse for continuous or intermittent monitoring. Pulmonary function testing measures respiratory flow and lung volumes and is indicated for asthma, cystic fibrosis, and chronic lung disease. Peak expiratory flow testing is used to monitor the adequacy of asthma control. Chest radiographs can show hyperinflation, atelectasis, pneumonia, foreign bodies, pleural effusion, and abnormal heart or lung size.

Origin: Chapter 19, 5 5. The nurse is assessing a child with suspected infective endocarditis. Which assessment finding would the nurse interpret as a sign of extracardiac emboli? A) Pruritus B) Roth spots C) Delayed capillary refill D) Erythema marginatum

Ans: B Feedback: Roth spots are splinter hemorrhages with pale centers on the sclerae, palate, buccal mucosa, chest, fingers, or toes, and are signs of extracardiac emboli. Delayed capillary refill time does not point to extracardiac emboli. Wheezing and pruritus are indicative of a hypersensitivity reaction. Erythema marginatum is a classic rash associated with acute rheumatic fever.

Origin: Chapter 6, 28 28. The nurse is providing anticipatory guidance for parents of a school-age child on teaching the dangers of drugs and alcohol. What advice might be helpful for these parents? A) School-age children are not ready to absorb information that deals with drugs and alcohol. B) School-age children can think critically to interpret messages seen in advertising, media, and sports. C) Parents must prevent their child from being exposed to messages that are in conflict with their values. D) Discussions with children need to be based on facts and focused on the past and future.

Ans: B Feedback: School-age children can be taught how to think critically to interpret messages seen in advertising, media, sports, and entertainment personalities. School-age children are ready to absorb information that deals with drugs and alcohol and may be exposed to messages that are in conflict with their parents' values regarding smoking and alcohol. This may occur at school and cannot be prevented. Discussions with children need to be based on facts and focused on the present.

Origin: Chapter 19, 26 26. A nurse is caring for a newborn with congenital heart disease (CHD). Which finding would the nurse interpret as indicating distress? A) Reduced respiratory rate during feeding B) Subcostal retraction at the time of feeding C) Perspiration on body after feeding D) Feeding lasting for 15-20 minutes

Ans: B Feedback: Subcostal retraction during feeding is indicative of distress associated with feeding in newborn infants with CHD. Feeding can be a stress to newborns with CHD who are seriously compromised. Additional features indicating distress in infants with CHD include increased respiratory rate, perspiration along the hairline during feeding and feeding time longer than 30 minutes.

Origin: Chapter 19, 7 7. After teaching a group of students about acute rheumatic fever, the instructor determines that the teaching was successful when the students identify which assessment finding? A) Janeway lesions B) Jerky movements of the face and upper extremities C) Black lines D) Osler nodes

Ans: B Feedback: Sydenham chorea is a movement disorder of the face and upper extremities associated with acute rheumatic fever. Janeway lesions, black lines, and Osler nodes are associated with infective endocarditis.

Origin: Chapter 5, 1 1. The nurse is conducting a well-child examination of a 5-year-old girl, who was 40 inches tall at her last examination at age 4. Which height measurement would be within the normal range of growth expected for a preschooler? A) 41 inches B) 43 inches C) 45 inches D) 47 inches

Ans: B Feedback: The average preschool-age child will grow 2.5 to 3 inches (6.5 to 7.8 cm) per year. The average 3-year-old is 37 inches tall (96.2 cm), the average 4-year-old is 40.5 inches tall (103.7 cm), and the average 5-year-old is 43 inches tall (118.5 cm).

Origin: Chapter 18, 7 7. The nurse is assessing a 5-year-old girl who is anxious, has a high fever, speaks in a whisper, and sits up with her neck thrust forward. Based on these findings, what would be least appropriate for the nurse to perform? A) Providing 100% oxygen B) Visualizing the throat C) Having the child sit forward D) Auscultating for lung sounds

Ans: B Feedback: The child is exhibiting signs and symptoms of epiglottis, which can be life-threatening. Under no circumstances should the nurse attempt to visualize the throat. Reflex laryngospasm may occur, precipitating immediate airway occlusion. Providing 100% oxygen in the least invasive manner that is most acceptable to the child is a sound intervention, as is allowing the child to assume a position of sitting forward with the neck extended. Auscultation would reveal breath sounds consistent with an obstructed airway.

Origin: Chapter 21, 14 14. A child is diagnosed with hemolytic-uremic syndrome (HUS). Review of the child's laboratory test results would reveal which finding? A) Decreased blood urea nitrogen (BUN) and creatinine B) Decreased platelets and leukocytosis C) Hypernatremia and hypokalemia D) Respiratory acidosis and proteinuria

Ans: B Feedback: The child with HUS typically exhibits severe thrombocytopenia (decreased platelets) and leukocytosis. BUN and creatinine are elevated. Hyponatremia, hyperkalemia, metabolic acidosis, and proteinuria also may be noted.

Origin: Chapter 22, 44 44. A 10-year-old girl is brought to the emergency department by her father after tripping over a rock while running in the yard. She tells the nurse, "I think I twisted my ankle." When assessing the child, what would the nurse most likely assess? A) Bruising B) Edema C) Limited range of motion D) Absent pulse

Ans: B Feedback: The girl is describing a sprain, which is frequently accompanied by edema. Bruising may or may not be present. The nurse should not attempt to perform passive range of motion on the affected body part. A pulse should be present; if one is not, neurovascular compromise is present.

Origin: Chapter 18, 17 17. A nurse is preparing a teaching plan for the family of a child with allergic rhinitis. When describing the immune reaction that occurs, the nurse would identify the role of which immunoglobulin? A) IgA B) IgE C) IgG D) IgM

Ans: B Feedback: The immunoglobulin involved in the immune response associated with allergic rhinitis is IgE. IgA, IgG, and IgM are not involved in this response.

Origin: Chapter 18, 27 27. A nurse is preparing a teaching plan for the family of a child with allergic rhinitis. When describing the immune reaction that occurs, the nurse would identify the role of which immunoglobulin? A) IgA B) IgE C) IgG D) IgM

Ans: B Feedback: The immunoglobulin involved in the immune response associated with allergic rhinitis is IgE. IgA, IgG, and IgM are not involved in this response.

Origin: Chapter 5, 13 13. The mother of a 5-year-old boy calls the nurse and seeks advice on how to assist the child with the recent death of his paternal grandfather. The boy keeps asking when his grandpa is coming back. How should the nurse respond? A) "It is best to just ignore this and to not respond to his questions." B) "This is normal; children his age do not understand the permanence of death." C) "You have to keep repeating that his grandfather is never coming back." D) "He will eventually figure this out on his own."

Ans: B Feedback: The nurse needs to remind the mother that preschoolers do not completely understand the concept of death or its permanence. Telling the mother that it is best to ignore the boy's questions or that the boy will eventually figure this out on his own does not teach. Repeating that the grandfather is not coming back does not consider the developmental stage of the child and is inappropriate.

Origin: Chapter 21, 3 3. The nurse is caring for a 4-year-old with a suspected urinary tract infection. What would be most appropriate when obtaining a urine specimen from the child? A) "I will need a urine sample." B) "Let your mom help you tinkle in this cup." C) "Please tinkle in this cup right now." D) "Please void in this cup instead of the toilet."

Ans: B Feedback: The nurse needs to use familiar terms to explain to the child what is needed and to gain cooperation. The most positive approach would be to let the child's mother help rather than demanding that he tinkle right now. Using the terms "urine sample" or "void" is not appropriate for a 4-year-old.

Origin: Chapter 19, 10 10. The nurse is caring for an infant girl with a suspected cardiovascular disorder. Which statement by the mother would warrant further investigation? A) "My baby does not make any grunting noises." B) "The baby seems more comfortable over my shoulder." C) "The baby usually drinks all of her bottle." D) "I don't notice any rapid breathing patterns."

Ans: B Feedback: The nurse should be alert to statements indicating that the baby seems to be more comfortable when she is sitting up or over her mother's shoulder than when she is lying flat. Grunting or rapid breathing would be a cause for concern. Drinking all of the bottle would be considered normal.

Origin: Chapter 21, 5 5. The nurse is caring for an infant with bladder exstrophy. As part of the infant's preoperative plan of care, the nurse monitors for abdominal skin excoriation. Which action would be most appropriate for promoting healing and preventing further skin breakdown? A) Cleaning the area well with a scented diaper wipe B) Applying a barrier/healing cream or paste on skin C) Keeping the bladder moist and covered with a sterile bag D) Covering the area with sterile gauze pads after tub baths

Ans: B Feedback: The nurse should use a barrier/healing cream or paste on surrounding skin to promote healing and prevent further skin breakdown. Diaper wipes that contain fragrance or alcohol can sting if used on nonintact skin and can worsen skin breakdown. It is important to protect the bladder, but this will not address the skin excoriation. Meticulous attention to cleanliness is important, but the nurse should sponge-bathe the infant rather than immerse him in water to prevent pathogens from the water possibly entering the bladder.

Origin: Chapter 5, 20 20. The nurse is counseling parents of a picky eater on how to promote healthy eating habits in their child. Which intervention would be appropriate advice? A) Allow the child to pick out his or her own foods for meals. B) Present the food matter-of-factly and allow the child to choose what to eat. C) Offer high-fat snacks if the child does not eat to get them to eat something. D) Offer the child a special treat if he or she eats all the food on the plate.

Ans: B Feedback: The parents should maintain a matter-of-fact approach, offer the meal or snack, and then allow the child to decide how much of the food, if any, he or she is going to eat. High-fat, nutrient-poor snacks should not be substituted for healthy foods just to coax the child to "eat something." If the preschooler is growing well, then the pickiness is not a cause for concern. A larger concern may be the negative relationship that can develop between the parent and child relating to mealtime. The more the parent coaxes, cajoles, bribes, and threatens, the less likely the child is to try new foods or even eat the ones he or she likes that are served. The child should be offered a healthy diet, with foods from all groups over the course of the day as recommended by the U.S. Department of Agriculture.

Origin: Chapter 5, 5 5. The parents of a 4-year-old ask the nurse when their child will be able to differentiate right from wrong and develop morals. What would be the best response of the nurse? A) 'The preschooler has no sense of right and wrong.' B) 'The preschooler is developing a conscience.' C) 'The preschooler sees morality as internal to self.' D) 'The preschooler's morals are their own, right or wrong.'

Ans: B Feedback: The preschool child can understand the concepts of right and wrong and is developing a conscience. Preschool children see morality as external to themselves; they defer to power (that of the adult). The child's moral standards are those of their parents or other adults who influence them, not necessarily their own.

Origin: Chapter 5, 21 21. Which food suggestion would be most appropriate for the mother of a preschooler to ensure an adequate intake of calcium? A) Spinach B) White beans C) Enriched bread D) Fortified cereal

Ans: B Feedback: To ensure an adequate intake of calcium, the nurse should suggest white beans, because 1 ounce of dried white beans when cooked provides 160 mg of calcium. Spinach, enriched bread, and fortified cereal are good sources of iron.

Origin: Chapter 18, 19 19. The nurse is preparing to perform a physical examination of a child with asthma. Which technique would the nurse be least likely to perform? A) Inspection B) Palpation C) Percussion D) Auscultation

Ans: B Feedback: When examining the child with asthma, the nurse would inspect, auscultate, and percuss. Palpation would not be used.

Origin: Chapter 19, 30 30. The nurse is caring for a newborn diagnosed with an atrial septal defect (ASD). The parents voice concern and state, "I can't believe this is happening. Will our child be okay?" What is the nurse's best response? A) "If the defect isn't treated it can cause problems such as pulmonary hypertension, heart failure, atrial arrhythmias, or stroke." B) "While each case is different, the majority of these defects correct on their own. Let's see what the tests show, then speak with the doctor." C) "Since there are no symptoms being exhibited right now, your child will likely not require surgery until the age of 3 years." D) "Most children have no symptoms of this defect."

Ans: B Feedback: While all responses supply correct information about the disorder, the best response is, "While each case is different, the majority of these defects correct on their own. Let's see what the tests show, then speak with the doctor." This individualizes the response to this child, offers realistic hope, and verifies that the physician will need to be consulted to answer questions regarding prognosis.

Origin: Chapter 19, 3 3. The nurse is caring for an infant with suspected patent ductus arteriosus. Which assessment finding would the nurse identify as helping to confirm this suspicion? A) Thrill at the base of the heart B) Harsh, continuous, machine-like murmur under the left clavicle C) Faint pulses D) Systolic murmur best heard along the left sternal border

Ans: B Feedback: With patent ductus arteriosus, a harsh, continuous, machine-like murmur (usually loudest under the left clavicle) is heard at the first and second intercostal spaces. A thrill at the base, faint pulses, and systolic murmur heard best along the left sternal border point to aortic stenosis.

Origin: Chapter 19, 1 1. The nurse is conducting a physical examination of a child with a ventricular septal defect. Which finding would the nurse expect to assess? A) Right ventricular heave B) Holosystolic harsh murmur along the left sternal border C) Fixed split-second heart sound D) Systolic ejection murmur

Ans: B Feedback: With ventricular septal defects, there is often a characteristic holosystolic harsh murmur along the left sternal border. Right ventricular heave, fixed split-second heart sound, and systolic ejection murmur are typically found with atrial septal defects.

Origin: Chapter 15, 27 27. A child is diagnosed with a helminthic infection. Which treatments would the nurse expect to be prescribed? Select all that apply. A) Erythromycin B) Albendazole C) Pyrantel pamoate D) Acyclovir E) Metronidazole F) Permethrin

Ans: B, C Feedback: Drugs used to treat helminthic infections include albendazole and pyrantel pamoate. Erythromycin is used to treat bacterial infections. Acyclovir is used to treat viral infections. Metronidazole is used to treat trichomoniasis. Permethrin is used to treat pediculosis.

Origin: Chapter 21, 23 23. The nurse is assessing a child with acute poststreptococcal glomerulonephritis. What would the nurse expect to assess? Select all that apply. A) Irritability B) Abdominal pain C) Hypertension D) Crackles E) Polyphagia

Ans: B, C, D Feedback: Assessment findings associated with acute poststreptococcal glomerulonephritis include fatigue, lethargy, abdominal pain, hypertension, crackles, and anorexia.

Origin: Chapter 21, 28 28. The nurse is assessing a 5-year-old child's genitourinary system. Which findings would the nurse document as normal? Select all that apply. A) Labial fusion B) Round abdomen C) Positive bowel sounds D) Dullness over the spleen E) Undescended testicles

Ans: B, C, D Feedback: Normal findings include a round abdomen, positive bowel sounds, dullness over the spleen, and descended testicles. Labial fusion, a distended abdomen, and undescended testicles are abnormal findings.

Origin: Chapter 19, 29 29. The nurse is caring for a child that just returned from a coronary arteriogram in which the catheter was placed through the left femoral artery. Which nursing actions demonstrate knowledge of the procedure? Select all that apply. A) The nurse allows the patient up to the bathroom only. B) The nurse assesses the dorsalis pedis pulse in the left foot. C) The nurse assesses the puncture site frequently. D) The nurse tells the parents that the physician will discuss the results of the procedure with them. E) The nurse assesses the patient's vital signs every 8 hours.

Ans: B, C, D Feedback: The nurse must assess the pulse distal to the puncture site to determine that circulation remains adequate to the extremity. Assessing the puncture site ensures early recognition of bleeding from the site. The physician will be able to inform the parents regarding the results of the procedure after completion. The child should be kept on bedrest for a specified period of time, so they cannot be up to the bathroom. Vital signs will need to be taken more frequently than every 8 hours for early detection of complications.

Origin: Chapter 19, 19 19. The nurse is reviewing the medical record of a child with infective endocarditis. What would the nurse expect to find? Select all that apply. A) White blood cell count revealing leukopenia B) Microscopic hematuria with urinalysis C) Electrocardiogram with prolonged PR interval D) Lungs clear on auscultation E) Petechiae on palpebral conjunctiva

Ans: B, C, E Feedback: With infective endocarditis, leukocytosis, microscopic hematuria, prolonged PR interval, adventitious lung sounds, and petechiae on the palpebral conjunctiva are noted.

Origin: Chapter 22, 42 42. The nurse is assessing an 11-year-old girl with scoliosis. What would the nurse expect to find? Select all answers that apply. A) Complaints of severe back pain B) Asymmetric shoulder elevation C) Even curve at the waistline D) Pronounced one-sided hump on bending over E) Diminished motor function F) Hyperactive reflexes

Ans: B, D Feedback: Assessment findings associated with scoliosis include asymmetric shoulder elevation, uneven curve at the waistline, rib hump on one side, and a pronounced hump on one side when bending over. Typically, only mild back discomfort is found and balance, motor strength, sensation, and reflexes are normal.

Origin: Chapter 5, 9 9. The parents of a preschooler ask the nurse to help them choose a preschool for their child. What are recommended guidelines and goals for choosing a preschool? Select all that apply. A) The main goal of preschool is to improve reading and writing skills and readiness for entering into grade school. B) When selecting a preschool the parent may want to consider the accreditation of the school and the teachers' qualifications. C) The teachers should decide how focused on curriculum the school should be for each individual student. D) The parent should observe the classroom, evaluating the environment, noise level, and sanitary practices. E) The type of discipline used in the school is also an important factor. Parents should choose a preschool that uses corporal punishment. F) The parent should observe the classroom to determine how the children interact with each other and how the teachers interact with the children.

Ans: B, D, F Feedback: When selecting a preschool, the parent may want to consider the accreditation of the school, the teachers' qualifications, and recommendations of other parents. The parent should observe the classroom, evaluating the environment, noise level, and sanitary practices, as well as how the children interact with each other and how the teachers interact with the children. The main goal of preschool is to foster the child's social skills and accustom him or her to the group environment. The parents must decide how focused on curriculum they want the school to be. The type of discipline used in the school is also an important factor. Parents should not choose a preschool that uses corporal punishment.

Origin: Chapter 22, 41 41. When assessing a child for slipped capital femoral epiphysis, what would the nurse identify as possible risk factors? Select all answers that apply. A) Age younger than 8 years B) African American ethnicity C) History of cystic fibrosis D) Excessive activity E) Obesity

Ans: B, E Feedback: Risk factors associated with slipped capital femoral epiphysis include age between 9 and 16 years, African American race, sedentary lifestyle, and being overweight or obese. A history of cystic fibrosis may contribute to rickets.

Origin: Chapter 19, 11 11. Auscultation of a child's heart reveals a loud murmur with a precordial thrill. The nurse documents this as which grade? A) Grade II B) Grade III C) Grade IV D) Grade V

Ans: C Feedback: A grade IV murmur is loud with a precordial thrill. A grade II murmur is soft and easily heard. A grade III murmur is characterized as loud without a thrill. A grade V murmur is characterized as loud, audible without a stethoscope.

Origin: Chapter 15, 9 9. 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

Ans: C Feedback: A ring-like rash at the site of the tick bite is characteristic for Lyme disease. Swelling in the neck is a symptom of mumps. Confusion, anxiety, and hypersalivation are symptoms of rabies.

Origin: Chapter 15, 18 18. A nurse is instructing a parent on how to obtain a stool culture for ova and parasites from a child with diarrhea. What 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."

Ans: C Feedback: A stool specimen for culture must be free of urine, water, and toilet paper. Therefore, the parent needs to understand how to collect the specimen so that it does not come into contact with any these. In addition, the specimen should not be retrieved out of toilet water. Mineral oil, barium, and bismuth interfere with the detection of parasites. In such cases, specimen collection should be delayed for 7 to 10 days. Once the specimen is collected, it should be brought to the laboratory immediately.

Origin: Chapter 18, 5 5. A nurse is administering 100% oxygen to a child with a pneumothorax based on the understanding that this treatment is used primarily for which reason? A) Improve gas exchange B) Bypass the obstruction C) Hasten air reabsorption D) Prevent hypoxemia

Ans: C Feedback: Administration of 100% oxygen is used to treat pneumothorax primarily because it hastens the reabsorption of air. Generally this is used only for a few hours. Although the oxygen also improves gas exchange and prevents hypoxemia, these are not the reasons for its use in this situation. There is no obstruction with a pneumothorax.

Origin: Chapter 19, 13 13. A 9-year-old child has undergone a cardiac catheterization and is being prepared for discharge. The nurse is instructing the parents and child about postprocedure care. Which statement by the parents indicates that the teaching was successful? A) "This pressure dressing needs to stay on for 5 days from now." B) "He can't eat but he can drink fluids for the next 24 hours." C) "He should avoid taking a bath for about 3 days but he can shower." D) "It's normal if he says he feels like his heart skipped a beat."

Ans: C Feedback: After a cardiac catheterization, the child should avoid tub baths for about 3 days but he can shower or use sponge baths. The pressure dressing should be removed the day after the procedure and a dry sterile dressing or adhesive bandage is applied for the next several days. After the procedure, the child can resume his usual diet. Any reports of fluttering or the heart skipping a beat should be reported.

Origin: Chapter 19, 9 9. The nurse is caring for a 2-month-old infant who has been diagnosed with acute heart failure. The nurse is providing teaching about nutrition. Which statement by the mother indicates a need for further teaching? A) "The baby may need as much as 150 calories/kg/day." B) "Small, frequent feedings are best if tolerated." C) "I need to feed him every hour to make sure he eats enough." D) "Gavage feedings may be required for now."

Ans: C Feedback: Although offering small frequent feedings is appropriate if the infant tolerates them, feeding every hour is not necessary. During the acute phase, continuous or intermittent gavage feedings may be needed to help the infant maintain or gain weight. Due to the increased metabolic demands, the infant may require as much as 150 calories/kg/day.

Origin: Chapter 19, 18 18. A child with a suspected cardiovascular disorder is to undergo diagnostic testing and is scheduled for an echocardiogram. When explaining this test to the child, what would the nurse most likely include? A) "This test will check the pattern of how your heart is beating." B) "They'll take a picture of your chest to look at the heart's size." C) "A special wand that picks up sound is used to check your heart." D) "Small patches are attached to your chest to check the heart rhythm."

Ans: C Feedback: An echocardiogram is a noninvasive ultrasound procedure using a gel-coated wand that assesses the heart wall thickness, the size of the chambers, valve and septal motion, and the relationship of the great vessels to other cardiac structures. An electrocardiogram reveals the pattern or rhythm of the heart's beating and involves small patches or electrodes attached to the chest. A chest radiograph involves a radiographic film of the chest to determine the size of the heart and its chambers.

Origin: Chapter 19, 28 28. The mother of a 4 week old infant is tearful. She reports the physician has told her that her son has a small atrial septal defect. She reports she is worried and asks the nurse more about the condition. Which statement by the parents best indicates an understanding of the nurse's teaching? A) "This greatly places my son at risk for cardiac failure." B) "If this does not resolve by the time my child is 1 year old he will likely need surgery." C) "Most of the time this condition spontaneously resolves." D) "Since the surgery to correct this condition can be risky my son will need to be at least 40 pounds."

Ans: C Feedback: Atrial septal defects in children most likely resolve without treatment. Those that are not corrected by the age of 18 months will likely require surgical intervention. When planned, surgery is not usually performed until the child is at least 3 years of age. There is no indication other problems are present so the child is not at an increased risk for cardiac failure.

Origin: Chapter 19, 24 24. An infant with congenital heart disease is to undergo surgery to correct the defect. The mother states, "I guess I'm going to have to stop breastfeeding her." Which response by the nurse would be most appropriate? A) "That's true, but we'll make sure she gets the best intravenous nutrition." B) "Unfortunately, your baby needs more nutrients than what breast milk can provide." C) "Breast milk may help to boost her immune system, so you can continue to use it." D) "She won't be able to suck, so we have to give her fortified formula through a tube."

Ans: C Feedback: Breastfeeding a child before and after cardiac surgery may boost the infant's immune system, which can help fight postoperative infection. If breastfeeding is not possible, mothers can pump milk and the breast milk may be given via bottle, dropper, or gavage feeding. In addition, breastfeeding is associated with decreased energy expenditure during the act of feeding.

Origin: Chapter 5, 7 7. The nurse is assessing the motor skills of a 5-year-old girl. Which finding would cause the nurse to be concerned? A) Can copy a square on another piece of paper B) Can dress and undress herself without help C) Draws a person with three body parts D) Is beginning to tie her own shoelaces

Ans: C Feedback: By the age of 5 years, the child should be able to draw a person with a body and at least six body parts. She should also be able to copy triangles and other geometric patterns and dress and undress herself and should be learning to tie her shoelaces.

Origin: Chapter 15, 30 30. The mother of a 4-year-old boy has contacted the physician's office. She reports her son was exposed to someone with chickenpox. She has inquired about when her son may show if he has gotten the disease. What information should be provided? A) The illness should be seen in a week if he has been exposed. B) Symptoms of the disease should show up within 24 to 48 hours of exposure. C) The incubation period for the disease is between 10 and 21 days. D) Younger children will have longer periods of incubation.

Ans: C Feedback: Chickenpox is the common name for varicella. This condition has an incubation period of 10 to 21 days.

Origin: Chapter 15, 21 21. A school-aged child with an infectious disease is placed on transmission-based precautions. Which nursing diagnosis would be the 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

Ans: C Feedback: Children who are placed on transmission-based precautions are not allowed to leave their rooms and are not allowed to go to common areas such as the playroom or schoolroom. Thus, they are at risk for social isolation. Impaired skin integrity, fluid volume deficit, and deficient knowledge may be appropriate but would depend on the infectious disease diagnosed.

Origin: Chapter 21, 13 13. The mother of a child with end-stage renal disease asks the nurse why her son is getting an injection of erythropoietin. When responding to the mother, the nurse explains this as the rationale. A) To treat low calcium levels B) To stimulate growth in stature C) To stimulate red blood cell growth D) To correct acidosis

Ans: C Feedback: Erythropoietin is given to stimulate red blood cell growth. Vitamin D and calcium are used to correct hypocalcemia. Growth hormone is used to stimulate growth in stature. Bicitra or sodium bicarbonate tablets are used to correct acidosis.

Origin: Chapter 18, 22 22. When performing the physical examination of a child with cystic fibrosis, what would the nurse expect to assess? A) Dullness over the lung fields B) Increased diaphragmatic excursion C) Decreased tactile fremitus D) Hyperresonance over the liver

Ans: C Feedback: Examination of a child with cystic fibrosis typically reveals decreased tactile fremitus over areas of atelectasis, hyperresonance over the lung fields from air trapping, decreased diaphragmatic excursion, and dullness over the liver when enlarged.

Origin: Chapter 15, 3 3. The nurse is caring for a neonate who is suspected of having sepsis. Which assessment findings would the nurse interpret as most indicative of sepsis? A) Rash on face B) Edematous neck C) Hypothermia D) Coughing

Ans: C Feedback: Hypothermia is a sign of sepsis in neonates. A rash on the face is a symptom of scarlet fever. An edematous neck is a sign of diphtheria. Paroxysmal coughing is a symptom of pertussis.

Origin: Chapter 18, 16 16. A child with a pneumothorax has a chest tube attached to a water seal system. When assessing the child, the nurse notices that the chest tube has become disconnected from the drainage system. What would the nurse do first? A) Notify the physician. B) Apply an occlusive dressing. C) Clamp the chest tube. D) Perform a respiratory assessment.

Ans: C Feedback: If a chest tube becomes disconnected from the water seal drainage system, the nurse would first clamp the chest tube to prevent air from entering the child's chest cavity. Then the nurse would perform a respiratory assessment and notify the physician. An occlusive dressing would be applied first if the chest tube became dislodged from the child's chest.

Origin: Chapter 19, 14 14. A newborn is diagnosed with patent ductus arteriosus. The nurse anticipates that the physician will most likely order which medication? A) Alprostadil B) Heparin C) Indomethacin D) Spironolactone

Ans: C Feedback: Indomethacin is the drug typically ordered to close a patent ductus arteriosus. Alprostadil would be indicated to maintain the ductus arteriosus temporarily in infants with ductal-dependent congenital heart defects. Heparin would be used for prophylaxis and treatment of thromboembolic disorders, especially after surgery. Spironolactone would be used to manage edema due to heart failure and to treat hypertension.

Origin: Chapter 18, 4 4. The nurse is discussing discharge instructions with the parents of a 6-year-old who had a tonsillectomy. What is the most important thing to stress? A) Administer analgesics. B) Encourage the child to drink liquids. C) Inspect the throat for bleeding. D) Apply an ice collar.

Ans: C Feedback: Inspecting the throat for bleeding is the most important discharge information to give the parents. Hemorrhage is unusual postoperatively but may occur any time from the immediate postoperative period to as late as 10 days after surgery. The nurse should inspect the throat for bleeding. Mucus tinged with blood may be expected, but fresh blood in the secretions indicates bleeding. Administering analgesics, encouraging fluids and applying an ice color are important but not as important as assessing for bleeding.

Origin: Chapter 18, 15 15. A nurse is preparing a teaching program for a parenting group about preventing foreign body aspiration. What information would the nurse include? A) Avoid giving popcorn to children younger than the age of 2 years. B) Withhold peanuts from children until they are at least 5 years of age. C) If an object fits through a standard toilet paper roll, the child can aspirate it. D) Keep pennies and dimes out of the child's reach; quarters do not pose a problem.

Ans: C Feedback: Items smaller than 1.25 inches (3.2 cm) can be aspirated easily. A simple way for parents to estimate the safe size of a small item or toy piece is to gauge its size against a standard toilet paper roll, which is generally about 1.5 inches in diameter. If it fits through the roll, it can be aspirated. Popcorn and peanuts should not be given to children until they are at least 3 years old. All coins should be kept out of the reach of children.

Origin: Chapter 5, 29 29. The parents of a preschooler express concern to the nurse about their son's new habit of masturbating. What is an appropriate response to this concern? A) Tell the child in a firm manner that this behavior is not acceptable. B) When the child displays this behavior, place him in a 'time-out.' C) Treat the action in a matter-of-fact manner emphasizing safety. D) Consult a psychotherapist to determine the reason for this behavior.

Ans: C Feedback: Masturbation is a healthy and natural part of normal preschool development if it occurs in moderation. If the parent overreacts to this behavior, then it may occur more frequently. Masturbation should be treated in a matter-of-fact way by the parent. The child needs to learn certain rules about this activity: nudity and masturbation are not acceptable in public. The child should also be taught safety: no other person can touch the private parts unless it is the parent, doctor, or nurse checking to see when something is wrong.

Origin: Chapter 19, 22 22. A nurse is working with an adolescent who is slightly overweight and was recently diagnosed with hypertension. They are discussing nutritional management. Which statement by the adolescent demonstrates understanding of the information? A) "I have to make sure that I don't eat a lot of salty foods." B) "I can eat any amount at a meal as long as I don't eat between meals." C) "I should eat plenty of fresh fruits and vegetables." D) "If I skip breakfast, I can eat a much bigger lunch."

Ans: C Feedback: Nutritional management includes controlling portion sizes, decreasing the intake of sugary beverages and snacks, eating more fresh fruits and vegetables, and eating a healthy breakfast. Salt restriction and potassium or calcium supplements have not been shown to decrease blood pressure in children.

Origin: Chapter 21, 30 30. The nurse is caring for a client with hemolytic-uremic syndrome (HUS). The client is demonstrating oliguria. What does the nurse expect to find when reviewing the client's records? A) A pattern of below-normal blood pressure B) Higher fluid output than fluid intake C) Elevated BUN and creatinine levels D) Increased glomerular filtration rate (GFR)

Ans: C Feedback: Oliguria is the result of acute renal failure associated with HUS. The BUN and creatinine level are indications of kidney function and are elevated with acute renal failure. Hypertension is associated with HUS. Output is decreased with renal failure, as is GFR.

Origin: Chapter 15, 11 11. 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) Doxycycline

Ans: C Feedback: Penicillin V is the antibiotic of choice for the treatment of scarlet fever. Ibuprofen is used to treat fever. Acyclovir is used to treat viral infections. Doxycycline, a tetracycline, is the drug of choice for treating Rocky Mountain spotted fever.

Origin: Chapter 18, 6 6. Bacterial pneumonia is suspected in a 4-year-old boy with fever, headache, and chest pain. Which assessment finding would most likely indicate the need for this child to be hospitalized? A) Fever B) Oxygen saturation level of 96% C) Tachypnea with retractions D) Pale skin color

Ans: C Feedback: Pneumonia is usually a self-limiting disease. Children with bacterial pneumonia can be successfully managed at home if the work of breathing is not severe and oxygen saturation is within normal limits. Hospitalization would most likely be required for the child with tachypnea, significant retractions, poor oral intake, or lethargy for the administration of supplemental oxygen, intravenous hydration, and antibiotics. Fever, although common in children with pneumonia, would not necessitate hospitalization. An oxygen saturation level of 96% would be within normal limits. Pallor (pale skin color) occurs as a result of peripheral vasoconstriction in an effort to conserve oxygen for vital functions; this finding also would not necessitate hospitalization.

Origin: Chapter 5, 24 24. A nurse is caring for a 4-year-old girl. The mother says that the girl is afraid of cats and dogs and does not like to go to the playground anymore because she wants to avoid the dogs that are often being walked at the park. What should the nurse tell the mother? A) "It is best to avoid the playground until she outgrows the fear." B) "She needs to face her fears head-on; take her to the park as much as possible." C) "Acknowledge her fear and help her develop a strategy for dealing with it." D) "Try to minimize her fears and insist that she go to the park."

Ans: C Feedback: Preschoolers have vivid imaginations and experience a variety of fears. It is best to acknowledge the fear, rather than minimize it, and then collaborate with the child on strategies for dealing with the fear. Avoiding the playground will not address the child's fears. Forcing the child to face her fear without enlisting her input to help deal with the fear does not teach. It is also important for the mother to find out if an incident involving cats and dogs occurred without her knowledge.

Origin: Chapter 21, 22 22. A nurse is interviewing the parents of a child diagnosed with obstructive uropathy. Which statement by the parents would the nurse identify as significant? A) "She's been constipated quite a few times." B) "We've noticed that her bed is wet in the morning." C) "She had surgery to repair a problem with her anus." D) "She had a bacterial skin infection about a week ago."

Ans: C Feedback: Risk factors associated with obstructive uropathy include prune belly syndrome, chromosome abnormalities, anorectal malformations, and ear defects. The statement about surgery to repair an anal problem suggests an anorectal malformation. Constipation is a risk factor for urinary tract infections. Bedwetting suggests enuresis. A bacterial skin infection is associated with acute glomerulonephritis.

Origin: Chapter 15, 22 22. A group of nursing students are reviewing information about childhood infectious diseases. The students demonstrate understanding of this information when they identify which disease as a common childhood exanthema? A) Mumps B) Rabies C) Rubella D) West Nile virus

Ans: C Feedback: Rubella is a common childhood exanthema. Mumps is a viral infection. Rabies is a zoonotic infection. West Nile virus is a vector-borne disease.

Origin: Chapter 15, 5 5. The nurse is developing a teaching plan for the mother of a 4-year-old girl with cold and fever. What would the nurse include in this teaching plan? A) Keeping the child covered and warm B) Calling the doctor if the child's fever lasts more than 36 hours C) Ensuring fluid intake to prevent dehydration D) Observing for changes in alertness resulting from brain damage

Ans: C Feedback: Teaching the mother to ensure fluid intake is important because fever can cause dehydration. The child should be dressed lightly. There is no need to call the doctor unless the child's fever lasts more than 3 to 5 days or the fever is greater than 105°F. A rapid rise to a high fever can cause a febrile convulsion, but it does not lead to brain damage.

Origin: Chapter 6, 18 18. The nurse is teaching parents to plan nutritional meals for their 7-year-old son who is overweight. Which guideline might the nurse include in the teaching plan? A) School-age children with an average body weight of 20 to 35 kg need approximately 90 calories per kilogram daily. B) The average water requirement for a school-age child per 24 hours ranges from 2,000 to 2,500 mL per day. C) The school-age child needs 28 g of protein and 800 mg of calcium for maintenance of growth and good nutrition. D) In the school-age child, calories needed to sustain weight increase, while the appetite decreases.

Ans: C Feedback: The 4- to 8-year-old child needs 28 g of protein and 800 mg of calcium for maintenance of growth and good nutrition. School-age children with an average body weight of 20 to 35 kg need approximately 70 calories per kilogram daily (1,400 to 2,100 calories per day). The average water requirement per 24 hours ranges from 1,800 to 2,200 mL per day. Growth, body composition, and body shape remain constant during the late school-age years. Needed calories decrease while the appetite increases.

Origin: Chapter 5, 30 30. The parents of a 5-year-old are concerned that their son is too short for his age. The nurse measures the child's height at 40 inches (101.6 cm). How should the nurse respond? A) "Some children are short for their age during the preschool years but usually catch up during early childhood." B) "Are most of the adults in your family short? It may be hereditary that your child will be shorter than average." C) "The average height for a 5-year-old is 43 inches tall (118.5cm), so your son is within the normal range for height." D) "I am sure his height is a concern, but if you start choosing nutrient-dense foods he will likely catch up to normal in height."

Ans: C Feedback: The average preschool-age child will grow 2.5 to 3 inches (6.5 to 7.8 cm) per year. The average 3-year-old is 37 inches tall (96.2 cm), the average 4-year-old is 40.5 inches tall (103.7 cm), and the average 5-year-old is 43 inches tall (118.5 cm).

Origin: Chapter 18, 14 14. A parent asks the nurse about immunizing her 7-month-old daughter against the flu. Which response by the nurse would be most appropriate? A) "She really doesn't need the vaccine until she reaches 1 year of age." B) "She will probably receive it the next time she is to get her routine shots." C) "Since your daughter is older than 6 months, she should get the vaccine every year." D) "The vaccine has many side effects, so she wouldn't get it until she's ready to go to school."

Ans: C Feedback: The current recommendations are for all children older than 6 months of age to be immunized yearly against influenza.

Origin: Chapter 21, 24 24. A nurse identifies a nursing diagnosis of impaired urinary elimination related to urinary tract infection. When developing the plan of care, what would be most important for the nurse to do first? A) Develop a schedule for bladder emptying. B) Encourage fluid intake. C) Assess usual voiding patterns. D) Monitor intake and output.

Ans: C Feedback: The first action would be to assess the child's usual voiding patterns to establish a baseline to develop an appropriate schedule for bladder emptying. Encouraging fluid intake and monitoring intake and output would be appropriate, but these would not be the first action.

Origin: Chapter 6, 4 4. The nurse is using the formula for bladder capacity to measure the bladder capacity of a 9-year-old girl. What number would the nurse document for this measurement? A) 9 ounces B) 10 ounces C) 11 ounces D) 12 ounces

Ans: C Feedback: The formula for bladder capacity is age in years plus 2 ounces. Therefore, the bladder capacity of the 9-year-old would be 11 ounces.

Origin: Chapter 15, 13 13. What 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."

Ans: C Feedback: The most effective measure to prevent pinworms or a recurrence is good hand hygiene, especially after using the bathroom and before eating. Sealing the child's clothing in a plastic bag is appropriate for pediculosis capitis. Having the child wear shoes at all times is helpful in preventing hookworm. Use of a cream that remains on for a specified time is associated with scabies.

Origin: Chapter 6, 25 25. The nurse is counseling the parents of a 10-year-old child who was caught stealing at school. Which topic should the nurse cover? A) Having the child return the property in front of his or her class B) Discussing ways for the child to save face C) Finding out what is currently going on at home D) Reminding the child daily that stealing is wrong

Ans: C Feedback: The parents need to understand the child's behavior. The reason for stealing at age 10 may be that the child wants the item or is trying to impress peers, or it may be a sign of anxiety. More information is needed before the nurse can effectively work with the family. The parents should work together with the child to decide how the item will be returned. The child will lose face but gain integrity by returning the stolen item. Reminding the child about stealing on a daily basis may ruin the child's self-esteem.

Origin: Chapter 21, 8 8. A 6-year-old child has undergone a renal transplant and is receiving cyclosporine. The nurse instructs the parents to be especially alert for which complication? A) Weight loss B) Hypotension C) Signs of infection D) Hair loss

Ans: C Feedback: The parents should be especially alert for signs of infection as cyclosporine is an immunosuppressant drug. Weight gain instead of weight loss, hypertension instead of hypotension, and increased facial hair instead of hair loss are some other potential side effects.

Origin: Chapter 5, 17 17. The nurse is supervising lunch time for children on a pediatric ward. Which observation is considered abnormal for this age group? A) The child has a full set of primary teeth. B) The child has no difficulty chewing and swallowing meat. C) The child uses his fingers and refuses to use a fork. D) The child is a picky eater.

Ans: C Feedback: The preschool child has learned to use utensils fairly effectively to feed himself or herself, has a full set of primary teeth, and is able to chew and swallow competently. Preschool children may be picky eaters. They may eat only a limited variety of foods or foods prepared in certain ways and may not be very willing to try new things.

Origin: Chapter 15, 28 28. The client has a heavily draining wound for which there is an order to change the dressing every 4 hours. The nurse becomes busy and does not change the dressing as ordered. Which link in the chain of infection has the nurse allowed to flourish? A) Susceptible host B) Portal of exit C) Reservoir D) Mode of transmission

Ans: C Feedback: The reservoir is the area where a pathogen grows and reproduces. Leaving the dressing unchanged allows for a dark, warm, nutrient rich, and moist environment where many organisms will thrive. A susceptible host is a person who cannot fight off an infection. The portal of exit is the way a pathogen exits the host. The mode of transmission is the way the pathogen travels.

Origin: Chapter 19, 25 25. During a follow-up visit, the parents of a 5-month-old infant diagnosed with congenital heart disease tell the nurse, "We're just so tired and emotionally spent. All these tests and examinations are overwhelming. We just want to have a normal life. We're so focused on the baby that it seems like our 3-year-old is lost in the shuffle." Which nursing diagnosis would the nurse identify as most appropriate? A) Risk for delayed growth and development related to necessary treatments B) Deficient knowledge related to the care of a child with congenital heart disease C) Interrupted family processes related to demands of caring for the ill child D) Fear related to infant's cardiac condition and need for ongoing care

Ans: C Feedback: The statements by the parents indicate that there is disruption in the family resulting from the demands of caring for the ill infant and they verbalized concern about their older child. The child may be at risk for delayed growth and development, but this is not indicated by the parents' statements. The parents may lack knowledge about their infant's condition and they may be experiencing fear about the infant's condition, but the statements reflect issues related to the family functioning.

Origin: Chapter 18, 2 2. The nurse hears wheezing when auscultating a 4-year-old. Which condition would the nurse most likely rule out based on the assessment findings? A) Bronchiolitis B) Asthma C) Influenza D) Cystic fibrosis

Ans: C Feedback: Wheezing typically is not associated with influenza. Wheezing is caused by an obstruction of the bronchioles that may be caused by bronchiolitis, asthma, cystic fibrosis, or chronic lung disease. In addition, if the bronchiolitis is due to influenza, wheezing may be heard.

Origin: Chapter 21, 19 19. The nurse is applying a urine bag to a 15-month-old boy to collect a urine specimen. Which action would the nurse take first? A) Apply benzoin to the scrotal area. B) Tuck the bag downward inside the diaper. C) Pat the perineal area dry after cleaning. D) Apply the narrow portion of the bag on the perineal space.

Ans: C Feedback: When applying a urine bag, the nurse would first cleanse the perineal area well and pat it dry. If a culture was to be obtained, the nurse would cleanse the genital area with povidone-iodine or according to institutional protocol. Next the nurse would apply benzoin around the scrotum and allow it to dry. Then the nurse would apply the urine bag, making sure that the penis is fully inside the bag, tucking it downward inside the diaper to discourage leaking.

Origin: Chapter 15, 24 24. While obtaining a health history from a male adolescent during a well check-up, the nurse assesses his sexual behavior and risk for sexually transmitted infections. Based on the information, the nurse plans to teach the adolescent about using a condom. What would the nurse include in the teaching plan? A) "You can reuse a condom if it's within 3 hours." B) "Store your condoms in your wallet so they are ready for use." C) "Put the condom on before engaging in any genital contact." D) "Use petroleum jelly with a latex condom for extra lubrication."

Ans: C Feedback: When teaching an adolescent about condom use, the nurse should tell the adolescent to put the condom on before any genital contact. A new condom should be used with each act of sexual intercourse; a condom should never be reused. Condoms should be stored in a cool, dry place away from direct sunlight and never stored in wallets, automobiles, or anywhere they could be exposed to extreme temperatures. Only water-soluble lubricants should be used with latex condoms. Oil-based or petroleum-based lubricants such as Vaseline can weaken latex condoms.

Origin: Chapter 21, 18 18. The nurse is reviewing the laboratory test results of a child with nephrotic syndrome. What would the nurse least likely expect to find? A) Hyperlipidemia B) Hypoalbuminemia C) Decreased blood urea nitrogen (BUN) D) Hypoproteinemia

Ans: C Feedback: With nephrotic syndrome, proteinuria, hyperlipidemia, decreased serum protein levels (hypoproteinemia), and decreased serum albumin levels (hypoalbuminemia) are present. BUN typically becomes elevated.

Origin: Chapter 21, 29 29. The nurse is providing instruction to the parents of a newborn boy. The parents have decided not to circumcise the child. What information should be included in the discussion? Select all answers that apply. A) The foreskin should be pulled back for cleaning at least once per day. B) The foreskin should be pulled back gently with each diaper change. C) Clean the penis gently with soap and water. D) If the foreskin is not retractable do not force it. E) When the foreskin is retracted, gently replace it prior to completing diapering.

Ans: C, D, E Feedback: The newborn's foreskin does not normally retract. This may not be possible until later in infancy. If the foreskin does not retract do not force it. If the foreskin is able to be retracted, do so gently. Return the foreskin to place prior to applying the diaper. Soap and water should be used several times per day to clean the penis and perineal area.

Origin: Chapter 19, 27 27. A child with suspected dyslipidemia undergoes laboratory testing. The nurse is reviewing the results. Which finding would the nurse interpret as supporting the diagnosis? Select all that apply. A) Total cholesterol level of 150 mg/dL B) Total cholesterol level of 180 mg/dL C) Total cholesterol level of 220 mg/dL D) LDL level of 90 mg/dL E) LDL level of 120 mg/dL F) LDL level of 140 md/dL

Ans: C, F Feedback: A total cholesterol level over 200 mg/dL and LDL level above 130 mg/dL are considered high and would support the diagnosis of dyslipidemia. Total cholesterol levels between 170 to 199 mg/dL and LDL levels between 110 to 129 mg/dL are considered borderline. Total cholesterol levels less than 170 mg/dL and LDL levels less than 110 mg/dL are acceptable in children.

Origin: Chapter 5, 25 25. The nurse is providing teaching about car safety to the parents of a 5-year-old girl who weighs 45 pounds. What should the nurse instruct the parents to do? A) "Place her in a booster seat with lap and shoulder belts in the front seat." B) "Place her in the back seat with the lap and shoulder belts in place." C) "Place her in a forward-facing car seat with a harness and top tether." D) "Place her in a booster seat with lap and shoulder belts in the back seat."

Ans: D Feedback: A child who weighs between 40 and 80 pounds should ride in a booster seat that utilizes both the lap and shoulder belts in the back seat. When a child is large enough to sit up straight with the knees bent at the front edge of the seat, then he or she may sit directly on the seat of the car with lap/shoulder belt securely and appropriately attached. The back seat of the car is the safest place for a child to ride. A forward-facing car seat with harness and top tether is for a preschooler who weighs less than 40 pounds.

Origin: Chapter 18, 24 24. A child is brought to the emergency department by his parents because he suddenly developed a barking cough. Further assessment leads the nurse to suspect that the child is experiencing croup. What would the nurse have most likely assessed? A) High fever B) Dysphagia C) Toxic appearance D) Inspiratory stridor

Ans: D Feedback: A child with croup typically develops a bark-like cough often at night. This may be accompanied by inspiratory stridor and suprasternal retractions. Temperature may be normal or slightly elevated. A high fever, dysphagia, and toxic appearance are associated with epiglottitis.

Origin: Chapter 19, 17 17. A 7-year-old child with a family history of cardiovascular disease is being screened for hyperlipidemia. When reviewing the child's laboratory test results, which total cholesterol level would be of significant concern? A) 120 mg/dL B) 150 mg/dL C) 180 mg/dL D) 210 mg/dL

Ans: D Feedback: A total cholesterol level greater than 200 mg/dL is considered high and would be of the greatest concern. Levels of 120 mg/dL and 150 mg/dL are considered within the normal range. A level of 180 mg/dL would be considered borderline and significant. However, a level greater than 200 mg/dL would be of greater concern.

Origin: Chapter 15, 20 20. The nurse is assessing the tympanic temperature of several children. The nurse documents that the child with which temperature reading has a fever? A) 98.2° F (36.8° C) B) 99.2° F (37.3° C) C) 100° F (37.8° C) D) 100.8° F (38.2° C)

Ans: D Feedback: A tympanic temperature greater than 100.4° F (greater than 38° C) is defined as fever. An oral temperature of 100° F (greater than 37.8° C) would identify a fever. An axillary temperature of 99° F (greater than 37.2° C) would identify a fever.

Origin: Chapter 21, 20 20. A group of students are reviewing information about renal failure in children. The students demonstrate a need for additional teaching when they identify which agent as a potential contributor to renal failure? A) Vancomycin B) Gentamicin C) Co-trimoxazole D) Amoxicillin

Ans: D Feedback: Amoxicillin is a penicillin and is not associated with nephrotoxicity leading to renal failure. Vancomycin, gentamicin (an aminoglycoside), and co-trimoxazole (a sulfonamide) are nephrotoxic.

Origin: Chapter 15, 2 2. 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. What 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.

Ans: D Feedback: Antipyretics provide symptomatic relief by increasing comfort in the child and decreasing fluid requirements, which helps to prevent dehydration. Fever has been shown to slow the growth of bacteria, increase neutrophil production, and encourage T-cell proliferation.

Origin: Chapter 5, 10 10. The mother of a 4-year-old boy tells the nurse that her son occasionally wets his pants during the day. How should the nurse respond? A) "Is there a family history of diabetes?" B) 'Suddenly having accidents can be a sign of diabetes." C) "That's normal; don't worry about it." D) "Tell me about the circumstances when this occurs."

Ans: D Feedback: Bladder control is present in 4- and 5-year-olds, but an occasional accident may occur, particularly in stressful situations or when the child is absorbed in an interesting activity. The nurse needs to ask an open-ended question to determine the circumstances when the child has had accidents. Simply telling the mother that it is normal does not address the mother's concerns. The nurse does need to gather more information, because accidents in a previously potty-trained child can be a sign of diabetes.

Origin: Chapter 6, 27 27. The school nurse is teaching parents about the effects of bullying on school children. What accurately describes this developmental concern? A) Children who bully are those who report themselves as being lonely and having difficulty in forming friendships. B) Children with health issues, such as, disabilities, obesity and food allergies, are at a decreased risk of being bullied. C) In general, about 20% of all children attending school are frightened and afraid most of the day. D) Both boys and girls are bullied; boys usually bully boys and use force more often.

Ans: D Feedback: Both boys and girls are bullied and can bully others. Boys usually bully boys and use force more often, and boys are twice as likely to be victims of bullying. Bullied children are those who report themselves as being lonely and having difficulty in forming friendships. Children with health issues, such as disabilities, obesity, and food allergies, are at an increased risk of being bullied. In general, about 10% of all children attending school are frightened and afraid most of the day.

Origin: Chapter 15, 14 14. 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

Ans: D Feedback: Children with chickenpox (varicella zoster) can return to school once the lesions have crusted.

Origin: Chapter 19, 2 2. The nurse is administering digoxin as ordered and the child vomits the dose. What should the nurse do next? A) Contact the physician. B) Offer a snack and administer another dose. C) Immediately administer another dose. D) Administer next dose as ordered in 12 hours.

Ans: D Feedback: Digoxin should be administered at regular intervals, every 12 hours, 1 hour before or 2 hours after feeding. If the child vomits digoxin, the nurse should not give a second dose and should wait until the next scheduled dose. It is not necessary to contact the physician.

Origin: Chapter 21, 4 4. The nurse is providing postsurgical care for an infant who has undergone a hypospadias repair. Which action by the nurse would be most important to help keep the area clean while maintaining proper position of the drainage tubing? A) Keeping the drainage tube taped in an upright position B) Administering antibiotics as ordered C) Administering analgesics as prescribed D) Using a double-diapering technique

Ans: D Feedback: Double diapering is a method used to protect a child's urethra and stent or catheter after surgery and additionally helps to keep the area clean and free from infection. Keeping the drainage tube taped in an upright position, administering antibiotics, and administering analgesics are also important, but double diapering keeps the area clean and helps prevent infection.

Origin: Chapter 22, 20 20. After teaching a class of nursing students about muscular dystrophy, the instructor determines that the teaching was successful when the students identify which type of muscular dystrophy as demonstrating an X-linked recessive pattern of inheritance? A) Limb-girdle B) Myotonic C) Distal D) Duchenne

Ans: D Feedback: Duchenne muscular dystrophy follows an X-linked recessive inheritance pattern. Limb-girdle muscular dystrophy is believed to be autosomal or X-linked inherited. Myotonic and distal muscular dystrophy follow an autosomal dominant inheritance pattern.

Origin: Chapter 23, 16 16. A child is diagnosed with atopic dermatitis. Which laboratory test would the nurse expect the child to undergo to provide additional evidence for this condition? A) Erythrocyte sedimentation rate B) Potassium hydroxide prep C) Wound culture D) Serum immunoglobulin E (IgE) level

Ans: D Feedback: IgE levels are often used to evaluate for atopic dermatitis. IgE levels are elevated in this condition. Erythrocyte sedimentation rate may be used but this test is nonspecific and only indicates infection or inflammation. Potassium hydroxide prep is used to identify fungal infections. Wound culture would be done to identify a specific organism if an infection occurs with atopic dermatitis.

Origin: Chapter 19, 21 21. The nurse is developing a plan of care for an infant with heart failure who is receiving digoxin. The nurse would hold the dose of digoxin and notify the physician if the infant's apical pulse rate was: A) 140 beats per minute. B) 120 beats per minute. C) 100 beats per minute. D) 80 beats per minute.

Ans: D Feedback: In an infant, if the apical pulse rate is less than 90 beats per minute, the dose is held and the physician should be notified.

Origin: Chapter 5, 6 6. Which activity would the nurse least likely include as exemplifying the preconceptual phase of Piaget's preoperational stage? A) Displays of animism B) Use of active imaginations C) Understanding of opposites D) Beginning questioning of parents' values

Ans: D Feedback: In the intuitive phase of Piaget's preoperational stage, the child begins to question parents' values. Animism, active imaginations, and an understanding of opposites would characterize the preconceptual phase of Piaget's preoperational stage.

Origin: Chapter 18, 21 21. A nurse is teaching the parents of a child diagnosed with cystic fibrosis about medication therapy. Which would the nurse instruct the parents to administer orally? A) Recombinant human DNase B) Bronchodilators C) Anti-inflammatory agents D) Pancreatic enzymes

Ans: D Feedback: Pancreatic enzymes are administered orally to promote adequate digestion and absorption of nutrients. Recombinant human DNase, bronchodilators, and anti-inflammatory agents are typically administered by inhalation.

Origin: Chapter 18, 10 10. The nurse is examining a 5-year-old boy. Which sign or symptom is a reliable first indication of respiratory illness in children? A) Slow, irregular breathing B) A bluish tinge to the lips C) Increasing lethargy D) Rapid, shallow breathing

Ans: D Feedback: Tachypnea, or increased respiratory rate, is often the first sign of respiratory illness in infants and children. Slow, irregular breathing and increasing listlessness are signs that the child's condition is worsening. Cyanosis (a bluish tinge to the lips) or the degree of cyanosis present is not always an accurate indication of the severity of respiratory involvement.

Origin: Chapter 18, 13 13. The nurse is providing care to several children who have been brought to the clinic by the parents reporting cold-like symptoms. The nurse would most likely suspect sinusitis in which child? A) A 2-year-old with thin watery nasal discharge B) A 3-year-old with sneezing and coughing C) A 5-year-old with nasal congestion and sore throat D) A 7-year-old with halitosis and thick, yellow nasal discharge

Ans: D Feedback: The frontal sinuses, those most commonly associated with sinus infection, develop by age 6 to 8 years. Therefore, the 7-year-old would most likely experience sinusitis. In addition, this child also exhibits halitosis and a thick, yellow nasal discharge, other findings associated with sinusitis. Thin watery discharge in a 2-year-old is more likely to indicate allergic rhinitis. A 3-year-old with coughing and sneezing or a 5-year-old with nasal congestion and sore throat suggests the common cold.

Origin: Chapter 18, 28 28. The nurse is providing care to several children who have been brought to the clinic by the parents reporting cold-like symptoms. The nurse would most likely suspect sinusitis in which child? A) A 2-year-old with thin watery nasal discharge B) A 3-year-old with sneezing and coughing C) A 5-year-old with nasal congestion and sore throat D) A 7-year-old with halitosis and thick, yellow nasal discharge

Ans: D Feedback: The frontal sinuses, those most commonly associated with sinus infection, develop by age 6 to 8 years. Therefore, the 7-year-old would most likely experience sinusitis. In addition, this child also exhibits halitosis and a thick, yellow nasal discharge, other findings associated with sinusitis. Thin watery discharge in a 2-year-old is more likely to indicate allergic rhinitis. A 3-year-old with coughing and sneezing or a 5-year-old with nasal congestion and sore throat suggests the common cold.

Origin: Chapter 21, 11 11. An 8-year-old girl is scheduled for a renal ultrasound. What would the nurse include in the plan of care when preparing the child for this test? A) Withholding food and fluids after midnight B) Checking the child for allergies to shellfish C) Ensuring the child has a full bladder D) Informing the child she should feel no discomfort

Ans: D Feedback: The nurse should inform the child that she should feel no discomfort during the test. No fasting is required and no dye is used, so allergies are not a concern. A full bladder is needed for urodynamic studies.

Origin: Chapter 5, 14 14. The nurse is developing a nursing care plan for a hospitalized 6-year-old. Which behavior would warrant nursing intervention? A) The child pretends he is talking to an imaginary friend when the nurse addresses the child. B) The child states that her fairy godmother is going to come and take her home. C) The child starts talking about his grandmother and then quickly changes the subject to a new toy he received. D) The child does not want to play games with other children on the hospital ward.

Ans: D Feedback: The preschooler begins to plan activities, make up games, and initiate activities with others. Not wanting to play games with other children is a sign of a developmental delay and nursing intervention is recommended. The preschooler often has an imaginary friend who serves as a creative way for the preschooler to sample different activities and behaviors and practice conversational skills. Through make-believe and magical thinking, preschool children satisfy their curiosity about differences in the world around them. The preschooler uses transduction when reasoning: he or she extrapolates from a particular situation to another, even though the events may be unrelated.

Origin: Chapter 5, 18 18. The nurse of a preschool child is helping parents develop a healthy meal plan for their child. What nutritional requirements for this age group should the nurse consider? A) The 3- to 5-year-old requires 300 to 500 mg calcium and 10 mg iron daily. B) The 3-year-old should consume 10 mg dietary fiber daily. C) The 4- to 8-year-old requires 15 mg dietary fiber per day. D) The typical preschooler requires about 85 kcal/kg of body weight.

Ans: D Feedback: The typical preschooler requires about 85 kcal/kg of body weight. The 3- to 5-year-old requires 500 to 800 mg calcium and 10 mg iron daily. The 3-year-old should consume 19 mg dietary fiber daily, while the 4- to 8-year-old requires 25 mg dietary fiber per day.

Origin: Chapter 15, 16 16. A woman gives birth to a healthy newborn. As part of the newborn's care, the nurse instills erythromycin ophthalmic ointment as a preventive measure for which sexually transmitted infection (STI)? A) Genital herpes B) Hepatitis B C) Syphilis D) Gonorrhea

Ans: D Feedback: To prevent gonococcal ophthalmia neonatorum, erythromycin or tetracycline ophthalmic ointment is instilled into the eyes of all newborns. This action is required by law in most states. The ointment is not used to prevent conditions related to genital herpes, hepatitis B, or syphilis.

Origin: Chapter 15, 4 4. The nurse is preparing a plan of care for a 5-year-old boy with chickenpox. Which nursing intervention 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.

Ans: D Feedback: Treatments such as sponging the child with alcohol or cold water are not appropriate interventions for fever management. Rather, the nurse would use tepid sponge baths and cool compresses. Administering antipyretics, keeping the child's fingernails short, and monitoring intake and output are appropriate.

Origin: Chapter 15, 19 19. The nurse is preparing to obtain a blood specimen via capillary heel puncture. Which action would be most appropriate for the nurse to do? A) Apply a cool compress for several minutes before collection. B) Elevate the extremity used after puncturing it. C) Squeeze the area to facilitate specimen collection. D) Wipe away the first drop of blood with dry gauze.

Ans: D Feedback: When obtaining a blood specimen by capillary puncture, the nurse should wipe away the first drop of blood with a cotton ball or dry gauze pad and then collect the sample without squeezing the foot to prevent possible hemolysis. Prior to the puncture, the nurse can apply a commercial heel warmer or warm compress for several minutes to promote vasodilation. The extremity being used should be placed in the dependent position after puncturing the heel.

Origin: Chapter 22, 39 39. The nurse is providing care to a child with a long-leg hip spica cast. What is the priority nursing diagnosis? A) Risk for impaired skin integrity due to cast and location B) Deficient knowledge related to cast care C) Risk for delayed development related to immobility D) Self-care deficit related to immobility

Ans: A Feedback: Although deficient knowledge, risk for delayed development, and self-care deficit may be applicable, the child is at increased risk for skin breakdown due to the size of the cast and its location. In addition, the cast has an opening, which allows for elimination. Soiling of cast edges or leakage of urine or stool can lead to skin breakdown.

Origin: Chapter 6, 24 24. The nurse is caring for a 7-year-old girl who is scheduled for a hernia repair and is very scared. Which fear would she also most likely have at this age? A) Fear of being kidnapped B) Fear of cutting her finger C) Fear of sudden loud noises D) Fear of the neighbor's dog

Ans: A Feedback: At this age, the child will be fearful of being kidnapped. She should have outgrown her fears of harm to her body, noises, and dogs, all of which are typical preschooler fears.

Origin: Chapter 6, 17 17. After teaching the parents of a 9-year-old girl about safety, which statement indicates the need for additional teaching? A) "She can ride in the front seat of the car once she is 10 years old." B) "We need to buy her a helmet so she can ride her scooter." C) "She should ride her bike with the traffic on the side of the road." D) "We signed her up for swim lesions at the local community center."

Ans: A Feedback: Children younger than 12 years of age must sit in the back seat of the car. Laws in most states require helmets for riding bicycles and scooters. When riding a bike, the child should ride on the side of the road traveling with the traffic. Children should know how to swim. If swimming skills are limited, the child must wear a life preserver at all times.

Origin: Chapter 22, 12 12. A child with Duchenne muscular dystrophy is to receive prednisone as part of his treatment plan. After teaching the child's parents about this drug, which statement by the parents indicates the need for additional teaching? A) "We should give this drug before he eats anything." B) "We need to watch carefully for possible infection." C) "The drug should not be stopped suddenly." D) "He might gain some weight with this drug."

Ans: A Feedback: Corticosteroids such as prednisone can cause gastric upset, so the medication should be given with food to reduce this risk. The drug may mask the signs of infection, so the parents need to monitor the child closely for any changes. Treatment with this drug should not be stopped abruptly due to the risk for acute adrenal insufficiency. Common side effects of this drug include weight gain, osteoporosis, and mood changes.

Origin: Chapter 22, 16 16. The nurse is assessing the neuromusculoskeletal system of a newborn. What is an abnormal assessment finding? A) Sluggish deep tendon reflexes B) Full range of motion in extremities C) Absence of hypotonia D) Lack of purposeful muscular control

Ans: A Feedback: Deep tendon reflexes are present at birth and are initially brisk in the newborn and progress to average over the first few months. Sluggish deep tendon reflexes indicate an abnormality. The newborn is capable of spontaneous movement but lacks purposeful control. Full range of motion is present at birth. Healthy infants and children demonstrate normal muscle tone; hypertonia or hypotonia is an abnormal finding.

Origin: Chapter 22, 10 10. When developing the plan of care for a child with cerebral palsy, which treatment would the nurse expect as least likely? A) Skeletal traction B) Physical therapy C) Orthotics D) Occupational therapy

Ans: A Feedback: Skeletal traction would be the least likely treatment for a child with cerebral palsy. Physical therapy, orthotics and braces, and occupational therapy are all common treatments used for cerebral palsy.

Origin: Chapter 6, 2 2. The nurse is performing an annual check-up for an 8-year-old child. Compared to the previous assessment of this child, which characteristic would most likely be observed? A) Breathing is diaphragmatic. B) Pulse rate is increased. C) Secondary sex characteristics are present. D) Blood pressure has reached adult level.

Ans: A Feedback: The child's respiratory system is maturing, so abdominal breathing has been replaced by diaphragmatic breathing. Pulse rate will decrease, rather than increase, during this time. Secondary sex characteristics will not appear until the late school-age years. Blood pressure will not reach the adult level until adolescence.

Origin: Chapter 6, 12 12. A mother brings her 6-year-old son in for a check-up because the child is reporting stomachaches. It is the beginning of the school year. What might the mother also mention? A) The child cries before going to school. B) The child made friends the first day of school. C) The child fights with siblings more often. D) The child loves the crowds in the lunchroom.

Ans: A Feedback: This child has a slow-to-warm-up temperament. The child may also be crying before going to school. Making friends the first day of school and enjoying the crowds in the lunchroom are typical of a child with an easy temperament. Irritability is typical of a child with a difficult temperament.

Origin: Chapter 23, 29 29. The nurse is caring for a school-age child with tinea captitis. The child has open lesions from the disease and has lost hair in the areas affected. Which nursing diagnoses would be a part of this patient's care plan? Select all that apply. A) Impaired skin integrity B) Risk for infection C) Disturbed body image D) Bathing, self-care deficit E) Altered nutrition

Ans: A, B, C Feedback: Tinea is a fungal disease of the skin occurring on any part of the body, in this case the head (scalp, eyebrows, or eyelashes). Since this child has open lesions and hair loss from affected areas, there is impairment of skin integrity (which makes the areas at risk for infection. Body image is disturbed since the hair loss is visible. There is no indication of bathing deficit or altered nutrition.

Origin: Chapter 23, 19 19. A group of students are preparing for a class exam on skin disorders. As part of their preparation, they are reviewing information about acne vulgaris and its association with increased sebum production. The students demonstrate understanding of the information when they identify which areas as having the highest sebaceous gland activity? Select all that apply. A) Face B) Upper chest C) Neck D) Back E) Shoulders

Ans: A, B, D Feedback: The face, upper chest, and back are the areas of highest sebaceous activity and thus the most common areas for acne lesions to occur. The neck and shoulders are not typical areas involved with acne.

Origin: Chapter 23, 30 30. A teenage girl with psoriasis tells the nurse that she is so embarrassed by the plaque on her skin that she doesn't want to go to school. What is the best response by the nurse? A) "Have you been applying your medication and emollients to your skin as directed by your physician?" B) "It must be really difficult for you. Tell me how you are taking care of your skin on a daily basis." C) "Sunlight really helps the plaque areas heal. Maybe going to a tanning bed routinely will help." D) "You can't miss school because of your skin. Can you wear clothes that will cover the areas?"

Ans: B Feedback: "It must be really difficult for you. Tell me how you are taking care of your skin on a daily basis" shows empathy and allows the nurse to determine how the girl is taking care of the psoriasis and if any suggestions to the treatment plan can be helpful. Questioning the client if she is doing what the physician has prescribed may make her defensive and does not show empathy. Suggesting tanning can cause too much exposure to unwanted UV rays. Telling the girl that she can't miss school and to cover the areas does not elicit open discussion and does not promote self-esteem.

Origin: Chapter 22, 28 28. The nurse is conducting a physical examination of a child with suspected developmental dysplasia of the hip. Which finding would help confirm this diagnosis? A) Abduction occurs to 75 degrees and adduction to within 30 degrees (with stable pelvis). B) A distinct "clunk" is heard with Barlow and Ortolani maneuvers. C) A high-pitched "click" is heard with hip flexion or extension. D) The thigh and gluteal folds are symmetric.

Ans: B Feedback: A distinct "clunk" while performing Barlow and Ortolani maneuvers is caused as the femoral head dislocates or reduces back in to the acetabulum. A higher-pitched "click" may occur with flexion or extension of the hip. This is a benign, adventitious sound that should not be confused with a true "clunk" when assessing for developmental dysplasia of the hip. Abduction to 75 degrees, adduction within 30 degrees, and symmetric thigh and gluteal folds are normal findings.

Origin: Chapter 6, 26 26. When providing anticipatory guidance to a group of parents with school-aged children, what would the nurse describe as the most important aspect of social interaction? A) School B) Peer relationships C) Family D) Temperament

Ans: B Feedback: Although school, family, and temperament are important influences on social interaction, peer relationships at this time provide the most important social interaction for school-age children.

Origin: Chapter 23, 21 21. A nurse is inspecting the skin of a child with atopic dermatitis. What would the nurse expect to observe? A) Erythematous papulovesicular rash B) Dry, red, scaly rash with lichenification C) Pustular vesicles with honey-colored exudates D) Hypopigmented oval scaly lesions

Ans: B Feedback: Atopic dermatitis or eczema is characterized by a dry, red, scaly rash with lichenification and hypertrophy. An erythematous papulovesicular rash is associated with contact dermatitis. Pustules and vesicles with honey-colored exudates suggest nonbullous impetigo. Hypopigmented oval scaly lesions are associated with tinea versicolor.

Origin: Chapter 23, 8 8. The nurse is caring for an infant with candidal diaper rash. Which topical agent would the nurse expect the physician to order? A) Corticosteroids B) Antifungals C) Antibiotics D) Retinoids

Ans: B Feedback: Candidal diaper rash would require a fungicide. The nurse would expect to administer topical antifungals as ordered. Corticosteroids are not typically recommended for young infants and are used for atopic dermatitis and certain types of contact dermatitis. Antibiotics would be ineffective against fungal infections. Retinoids are indicated for moderate to severe acne.

Origin: Chapter 22, 37 37. A nurse is preparing a presentation for a parent group about musculoskeletal injuries. When describing a child's risk for this type of injury, the nurse integrates knowledge that bone growth occurs primarily in which area? A) Growth plate B) Epiphysis C) Physis D) Metaphysis

Ans: B Feedback: Growth of the bones occurs primarily in the epiphyseal region. This area is vulnerable and structurally weak. Traumatic force applied to the epiphysis during injury may result in fracture in that area of the bone. The growth plate refers to the combination of the epiphysis, the end of a long bone, and the physis, a cartilaginous area between the epiphysis and the metaphysis.

Origin: Chapter 6, 10 10. The school nurse is conducting vision screening for a 7-year-old girl and documents the condition 'amblyopia.' What would the nurse tell the parents about this condition? A) 'Amblyopia is an uncorrected refractive error of the eye.' B) 'Amblyopia is reduced vision in an eye that has not been adequately used during early development.' C) 'Amblyopia is a malalignment of the eye, which occurs at birth.' D) 'Amblyopia is a clouding of the lens of the eye caused by trauma to the eye.'

Ans: B Feedback: Some problems frequently identified in school-age children include amblyopia (lazy eye), uncorrected refractive errors or other eye defects, and malalignment of the eyes (called strabismus). Amblyopia is reduced vision in an eye that has not been adequately used during early development. Inadequate use can result from conditions such as strabismus, being cross-eyed, or one eye being more nearsighted, farsighted, or astigmatic than the other eye. Amblyopia is the leading cause of visual impairment in children (National Eye Institute, 2008) and if untreated can result in vision loss.

Origin: Chapter 22, 14 14. The nurse is assessing a newborn who was delivered after a prolonged labor due to an abnormal presentation. The newborn sustained a cranial nerve injury. The nurse would most likely expect to assess deficits related to which cranial nerve? A) Optic B) Facial C) Acoustic D) Trigeminal

Ans: B Feedback: The most common cranial nerve injury occurring during birth trauma involves facial nerve palsy. The optic, acoustic, and trigeminal nerves are not typically injured during birth trauma.

Origin: Chapter 23, 26 26. A nurse is preparing a presentation for a local parent group about burn prevention and care in children. What would the nurse be least likely to include in the presentation when describing how to care for a superficial burn? A) Using cool water over the burned area until the pain lessens B) Applying ice directly to the burned skin area C) Covering the burn with a clean, nonadhesive bandage D) Giving the child acetaminophen for pain relief

Ans: B Feedback: With a superficial burn, ice should not be applied to the skin. Using cool water over the burn area; covering with a clean, nonadhesive bandage; and using acetaminophen for pain relief are appropriate to include in the presentation.

Origin: Chapter 23, 18 18. A nurse is preparing a class for parents of infants about managing diaper dermatitis. What advice would the nurse include in the presentation? Select all that apply. A) Applying topical nystatin to the diaper area B) Using a blow dryer on warm to dry the diaper area C) Refraining from using rubber pants over diapers D) Using scented diaper wipes to clean the area E) Washing the diaper area with an antibacterial soap

Ans: B, C Feedback: For diaper dermatitis, topical products such as ointments or creams containing vitamins A, D, and E; zinc oxide; or petrolatum help to provide a barrier. Nystatin is an antifungal agent used for diaper candidiasis. Using a blow dryer on warm to dry the area, avoiding the use of rubber pants, and using unscented diaper wipes or ones free of preservatives are appropriate. The area should be washed with a soft cloth, without harsh soaps.

Origin: Chapter 6, 1 1. The nurse is performing a physical assessment of a 10-year-old boy. The nurse notes that during last year's check-up the child weighed 80 pounds. According to average growth for this age group, what would be his expected current weight? A) 81 pounds B) 85 pounds C) 87 pounds D) 89 pounds

Ans: C Feedback: From 6 to 12 years of age, an increase of 7 pounds (3 to 3.5 kg) per year in weight is expected.

Origin: Chapter 23, 25 25. A 4-year-old is brought to the emergency department with a burn. What would alert the nurse to the possibility of child abuse? A) Burn assessment correlates with mother's report of contact with a portable heater. B) Parents state that the injury occurred approximately 15 to 20 minutes ago. C) Clear delineations are noted between burned and nonburned skin areas. D) The burn area appears asymmetric and nonuniform.

Ans: C Feedback: Suggested signs of a burn resulting from possible child abuse include a uniform appearance of the burn with clear delineations of burned and nonburned areas. Abuse would also be suspected if the report of the injury was inconsistent with burn injury or there was a delay in seeking treatment. An asymmetric nonuniform burn often correlates with a splatter-type burn resulting from the child pulling a source of hot fluid onto himself or herself.

Origin: Chapter 22, 1 1. The nurse is teaching the mother of a 5-year-old boy with a myelomeningocele who has developed a sensitivity to latex. Which response from his mother indicates a need for further teaching? A) "He needs to get a medical alert identification." B) "I will need to discuss this with his caregivers." C) "A product's label indicates whether it is latex-free." D) "He must avoid all contact with latex."

Ans: C Feedback: The Food and Drug Administration (FDA) requires that all medical supplies be labeled if they contain latex, but this is not the case with consumer products. The mother must be familiar with products that contain latex. The Spina Bifida Association of America maintains an updated list of latex-containing products. Getting a medical alert identification, talking with his caregivers, and avoiding all contact with latex are correct.

Origin: Chapter 6, 9 9. The nurse is assessing the gross motor skills of an 8-year-old boy. Which of interview question would facilitate this assessment? A) 'Do you like to do puzzles?' B) 'Do play any instruments?' C) 'Do you participate in any sports?' D) 'Do you like to construct models?'

Ans: C Feedback: To assess the gross motor skills of school-age children, the nurse should ask questions about participation in sports and after-school activities. For fine motor skills, the nurse could ask questions about band membership, constructing models, and writing skills.

Origin: Chapter 23, 14 14. When developing the plan of care for a child with burns requiring fluid replacement therapy, what information would the nurse expect to include? A) Administration of colloid initially followed by a crystalloid B) Determination of fluid replacement based on the type of burn C) Administration of most of the volume during the first 8 hours D) Monitoring of hourly urine output to achieve less than 1 mL/kg/hour

Ans: C Feedback: With fluid replacement therapy, most of the volume is administered during the first 8 hours. Crystalloids (such as Ringer lactate) are administered for the first 24 hours, and then colloids are used once capillary permeability is less of a concern. Fluid replacement is determined by the amount of body surface area burned. Hourly urine output is expected to be at least 1 mL/kg/hour.

Origin: Chapter 22, 35 35. A child has undergone surgery using steel bar placement to correct pectus excavatum. What position would the nurse instruct the parents to avoid? A) Semi-Fowler B) Supine C) High Fowler D) Side-lying

Ans: D Feedback: After surgery to correct pectus excavatum, the nurse would instruct the parents to avoid positioning the child on either side because this could disrupt the bar's position. Semi- or high Fowler's position and the supine position would be appropriate.

Origin: Chapter 6, 22 22. Two working parents are discussing with the school nurse the possibility of their 12-year-old girl going home alone after school. What suggestion should the nurse make? A) Provide entertainment until the parents come home. B) Allow the child to go to a friend's house. C) Teach her how to take a message if someone calls. D) Purchase caller ID for the phone.

Ans: D Feedback: Having caller ID allows the child to answer the phone if Mom or Dad calls while ignoring all other calls. Rather than entertaining the child, this would be a better time for homework, age-appropriate chores, and limited entertainment. If the child goes to a friend's house, it should be prearranged between the parents, not spur of the moment. It is safer if the child does not answer the phone instead of taking a message.

Origin: Chapter 6, 11 11. The school nurse knows that school-age children are developing metalinguistic awareness. Which is an example of this skill? A) The child enjoys reading books. B) The child enjoys conversations with peers. C) The child enjoys speaking on the phone. D) The child enjoys telling jokes.

Ans: D Feedback: Language skills continue to accelerate during the school-age years. School-age children develop metalinguistic awareness—an ability to think about language and comment on its properties. This enables them to enjoy jokes and riddles due to their understanding of double meanings and play on words and sounds.

Origin: Chapter 6, 20 20. The school nurse is preparing a talk on the influence of the media on school-age children to present at the next PTO meeting. Which fact might the nurse include in the introduction? A) Children in the United States spend about 6 hours a day either watching TV or playing video games. B) A child will see 2,000 murders by the end of grade school and 20,000 commercials a year. C) A school-age child cannot determine what is real from what is fantasy; therefore, TV and video games can lead to aggressive behavior. D) Parents should limit television watching and video-game playing to 2 hours per day.

Ans: D Feedback: Parents should limit television watching and video-game playing to 2 hours per day. Children in the United States spend about 4 hours a day either watching TV or playing video games. A child will see 8,000 murders by the end of grade school and 40,000 commercials a year. Although school-age children can determine what is real from what is fantasy, research has shown that this amount of time in front of the TV—watching it or playing video games—can lead to aggressive behavior, less physical activity, and altered body image.

Origin: Chapter 6, 14 14. During a well-child check-up, the parents of a 9-year-old boy tell the nurse that their son's friends told him that soccer is a stupid game, and now he wants to play baseball. Which comment by the nurse best explains the effects of peer groups? A) "The child's best friends will continue playing soccer." B) "The children will cheer for each other regardless of the sport being played." C) "Your child will rarely talk to you about his friends." D) "Acceptance by friends, especially of the same sex, is very important at this age."

Ans: D Feedback: Peer relationships, especially of the same sex, are very important and can influence the child's relationship with his parents. They can provide enough support that he can risk parental conflict and stand his ground about playing soccer. At this age, peer groups are made up of the child's best friends, and they happen to be playing baseball. Peer groups have rules and take up sides against the soccer player. Peers are an authority, so the child will let his parents know their opinions.

Origin: Chapter 6, 23 23. The parents of an 8-year-old boy are interested in promoting learning through reading to their son. Which suggestion by the nurse would best promote this goal? A) Have the parents choose what he should read initially. B) Tell the child to read instead of watching TV with his parents. C) Tell the parents that reading is for the child to do by himself. D) Take the child to the library to check out some books.

Ans: D Feedback: Taking the child to the library can be a positive start to the reading experience. It is best to let the librarian recommend books that will be appropriate for the child, but let the child choose from recommended materials. Set an example by reading instead of watching TV while the child is not in bed. Reading to the child is a valuable parent-child activity that can expose the child to classic works that are beyond the child's present reading ability.

Origin: Chapter 22, 7 7. The nurse has developed a plan of care for a 6-year-old with muscular dystrophy. He was recently injured when he fell out of bed at home. Which intervention would the nurse suggest to prevent further injury? A) Recommend the bed's side rails be raised throughout the day and night. B) Suggest a caregiver be present continuously to prevent falls from bed. C) Encourage a loose restraint to be used when he is in bed. D) Recommend raising the bed's side rails when a caregiver is not present.

Ans: D Feedback: The nurse should recommend that side rails on the bed be elevated when a caregiver is not present. The use of restraints should be avoided if at all possible. Suggesting that a caregiver be present at all times places undue stress on the family. Close observation is more appropriate. Recommending side rails be elevated at all times may be upsetting to the child and make him feel like a "baby."

Origin: Chapter 22, 17 17. The nurse is developing a teaching plan for the parents of a child with a myelomeningocele who will require clean intermittent catheterization. What information would the nurse include? A) Applying petroleum jelly to lubricate the catheter B) Cleaning the reusable catheter with peroxide after each use C) Storing the reusable cleaned catheter in a brown paper bag D) Soaking the catheter in a vinegar and water solution to sterilize

Ans: D Feedback: When teaching parents how to perform clean intermittent catheterization, the nurse would instruct the parents to apply a water-based lubricant to the catheter, clean the reusable catheter with soap and water after each use, store the reusable clean catheter in a zip-top bag or other clean storage container, and soak the catheter in a 1:1 vinegar and water solution for about 30 minutes weekly, rinsing well before the next use or placing the catheter in boiling water for 10 minutes.