Pediatric Test 2

While performing a family assessment, the nurse identifies which symptoms associated with dysfunctional family coping strategies? Standard Text: Select all that apply. 1. Father acknowledges an addiction to alcohol. 2. The mother is a stay-at-home mother, and the father works two jobs to make ends meet. 3. The family has deep religious beliefs. 4. The father makes all of the decisions for the family, and the mother is compliant with the father's decisions. 5. Direct, open communication among family members is observed.

1,4

A ten-year-old boy with classic hemophilia is admitted to the hospital for hemorrhage into the knee joint. Treatment is instituted on admission. What would be an appropriate nursing diagnosis for this child? 1. Risk for impaired physical mobility related to joint stiffness and contractures 2. Risk for impaired tissue perfusion (cerebral) related to blood loss. 3. Activity intolerance related to bleeding 4. Disturbed body image related to swollen knee

1: A bleed into the joint can lead to permanent contracture of the joint. Bone changes can result from the immobility associated with the bleed.

A child with hemophilia comes to the emergency department following an automobile accident. The child presents with multiple injuries. When prioritizing care for the child, the nurse would be most concerned with which injury? 1. Occipital hematoma 2. Radial fracture 3. Dislocated shoulder 4. Abdominal abrasions

1: A potential intracranial bleed would receive highest priority because of the danger of increased intracranial pressure and potential neurologic damage.

Which nursing diagnosis would be most appropriate for an infant with acute bronchiolitis due to respiratory syncytial virus (RSV)? 1. Activity intolerance 2. Tissue perfusion, ineffective (peripheral) 3. Pain, acute 4. Decreased cardiac output

1: Activity intolerance is a problem because of the imbalance between oxygen supply and demand.

A seven-year-old client tells you, "Grandpa, Mommy, Daddy, and my brother live at my house." The nurse identifies this family type as a(n): 1. Extended family. 2. Traditional nuclear family. 3. Binuclear family. 4. Heterosexual cohabitating family.

1: An extended family contains a parent or a couple who share the house with their children and another adult relative.

When caring for a child diagnosed with aplastic anemia, the nurse would educate the parents regarding which common symptoms? 1. Fatigue and fever 2. Runny nose and cough 3. Nausea and vomiting 4. Cyanosis and bradycardia

1: Fatigue secondary to anemia and fever related to infection secondary to neutropenia are common symptoms.

The nurse is working with a child newly enrolled in an English as a Second Language class. The nurse wants to teach the child about the importance of hand washing before meals and to not eat food dropped on the exam room floor. The best way to evaluate the child's understanding of hygienic nutrition is to: 1. Have the child repeat his interpretation of the information that was taught. 2. Schedule a medical interpreter to accompany the patient to his next visit. 3. Provide written materials in English about hygiene and diet for the client to take home. 4. Have the nurse model proper hand washing before examining the child, and throw out the dropped cookie.

1: When an interpreter is not available, asking the client to repeat his understanding of what was taught reveals how he understood the concepts discussed.

The nurse is teaching parents of the child with sickle-cell disease how to avoid precipitating factors that can contribute to a sickle-cell crisis. Which are precipitating factors that could contribute to a sickle-cell crisis? Standard Text: Select all that apply. 1. Regular exercise 2. Fever 3. Dehydration 4. Altitude 5. Increased fluid intake

2,3,4

A new nurse takes a job in a clinic that works with immigrants from many different cultures. The nurse recognizes that to be culturally sensitive, the nurse will need to: Standard Text: Select all that apply. 1. Determine means to indoctrinate the patients in the American culture. 2. Gain knowledge about the cultural groups attending the clinic. 3. Avoid the use of interpreters to reduce the impression of a bias. 4. Honor the cultural variations of the patients at the clinic. 5. Acquire information and educational media, such as pamphlets and teaching videos, that use languages spoken by the cultural groups attending the clinic.

2,4,5

A school health nurse is screening for scoliosis. For what assessment findings would the nurse look? Standard Text: Select all that apply. 1. Lordosis 2. Prominent scapula 3. Pain 4. A one-sided rib hump 5. Uneven shoulders and hips

2,4,5

The nurse has taught a group of parents how to care for their children who have just had tympanostomy tubes inserted. The nurse will know the parents understand how to care for their child's tympanostomy tubes if they: Standard Text: Select all that apply. 1. Limit their diets to soft, bland foods. 2. Restrict the children to quiet activities after surgery. 3. Administer a decongestant for one to two weeks following surgery. 4. Encourage the children to drink generous amounts of fluids. 5. Avoid getting water in their ears during bath time.

2,4,5

The nurse is preparing to administer a blood transfusion to a child with a severe anemia. Which type of transfusion reaction may be within the nurse's realm of prevention? 1. Allergic 2. Hemolytic 3. Febrile 4. Septic

2: A hemolytic reaction results from mismatched blood, a preventable error. This error is most likely to occur at the bedside if the nurse does not carefully identify the unit of blood and the patient.

A toddler has had recurrent respiratory infections. The mother of the child expresses concern that her infant seems to be at increased risk for complications from respiratory infections in comparison with her older children. The best response from the nurse would be: 1. "You are incorrect in your assessment." 2. "The younger child's airways are smaller and more easily occluded." 3. "Air passages are more likely to become blocked with mucus because younger children make more mucus than older children." 4. "Toddlers do not breathe as deeply as do older children."

2: Airways are smaller in the younger child and are more easily occluded when mucus is produced.

A three-year-old child has been found to have a mild to moderate hearing loss. The mother tells the nurse: "The doctor told me I should put my child in day care but didn't tell me why. Do you know why the doctor recommends day care?" The nurse's response will be based on the knowledge that day care will: 1. Help the child recognize his hearing deficit. 2. Increase the child's socialization skills. 3. Improve the child's immunity by increased exposure to organisms. 4. Teach other children that children are different.

2: By increasing the interaction with other children, the hearing-impaired child will improve his socialization skills.

The camp nurse is assessing a group of children attending summer camp. Which child will be most likely to have problems perceiving a sense of belonging? 1. The child whose parents divorced recently 2. The child recently placed into foster care 3. The child whose mother remarried and who gained a stepparent recently 4. The child adopted as an infant

2: Children in foster care are more likely to have problems perceiving a sense of belonging.

A new pediatric hospital will open soon. While planning nursing care, the hospital administration is considering two models of providing health care: family-focused care and family-centered care. The best example of a nursing action in the family-centered care approach would be when the nurse: 1. Assumes the role of an expert professional to direct the health care. 2. Encourages the parents to stay with and comfort the child during an invasive procedure. 3. Assumes the role of a healthcare authority and intervenes for the child and family as a unit. 4. Tells the family what must be done for the family's health.

2: Encouraging parents to be present during procedures exemplifies family-centered care. The benefit of employing the family-centered care philosophy is that the priorities and needs as seen by the family are addressed as a partnership between a family and a nurse develops.

The nurse is working with a child whose religious beliefs differ from those of the general population. The best nursing intervention to use to meet the specific spiritual needs of this child and family is to: 1. Ask, "What do you think caused the child's illness?" 2. Show respect while allowing time and privacy for religious rituals. 3. Identify health care practices forbidden by religious or spiritual beliefs. 4. Ask, "How do the child and family's religious and spiritual beliefs impact their practices for health and illness?"

2:Showing respect while allowing time and privacy for religious rituals is an intervention.

Following a facial injury of a 12-year-old youth during a baseball game, a nurse speaks with the league administrators about first aid for teeth that may be lost. The nurse will instruct the administration that appropriate first aid will include: Standard Text: Select all that apply. 1. Not worrying about the tooth loss, as children this age still have their "baby" teeth. 2. Only handling the lost tooth by the roots and avoiding touching the crown of the tooth. 3. Rinsing the lost tooth with sterile saline. 4. Placing the tooth back into its socket and taking the child to an emergency dental facility. 5. Keeping the tooth clean and dry during transport to an emergency dental facility.

3,4

A child has epistaxis while at school. The school nurse appropriately intervenes by: 1. Lying the child down and applying a warm pack. 2. Tilting the child's head back, squeezing the bridge of the nose, and applying a warm moist pack to the nose. 3. Tilting the child's head forward, squeezing the nares below the nasal bone, and applying ice to the nose. 4. Immediately packing the nares with a cotton ball soaked with Neo-Synephrine.

3: The correct initial treatment for a nosebleed is to tilt the head forward, squeeze the nares below the nasal bone for 10-15 minutes, and apply ice to the nose or back of the head.

The nurse in the newborn nursery is doing the admission assessment on a neonate. Which assessment finding would lead the nurse to suspect unilateral congenital hip dysplasia? 1. Lordosis 2. Trendelenburg sign 3. Asymmetry of the gluteal and thigh fat folds 4. Telescoping of the affected limb

3: A sign of congenital hip dysplasia in the infant would be asymmetry of the gluteal and thigh fat folds.

During discharge teaching to parents of a child hospitalized with sickle-cell crisis, the nurse should emphasize which of the following as a priority home care intervention? 1. Rapid weaning of pain medications 2. Promotion of a diet high in protein 3. Encouraging adequate hydration 4. Restriction of activities

3: Adequate hydration will help prevent further sequestration and crisis.

After reading a magazine article on complementary medicine methods, a teenager diagnosed with cancer asks the nurse about the possibility of adding CAM to the medical treatment plan. The nurse would explain to the child that prior to deciding on a CAM method, the adolescent must discuss: 1. The cost of the CAM with her parents. 2. The availability of CAM leaders with the hospital social worker. 3. The safety of the chosen CAM modality with her primary physician. 4. Alternative CAM methods with the nurse.

3: The priority concern about CAM modalities must be safety and the reaction of the CAM with the current medical treatment

A child must wear a brace for correction of scoliosis. Which nursing diagnosis takes priority at this time? 1. Impaired gas exchange, risk for 2. Altered growth and development, risk for 3. Impaired skin integrity, risk for 4. Impaired mobility, risk for

3: The skin should be monitored for breakdown in any area where the brace might rub against the skin.

While screening children, the nurse notes that one child seems to have "crossed eyes." Which screening tool might the nurse utilize to further screen this child? 1. Examine the eye with an otoscope. 2. Check for the "red reflex" in the eyes. 3. Perform the cover-uncover test. 4. Use a tonometer to evaluate the eyes.

3: When one eye is covered while the child is looking at an object, the uncovered eye will deviate from the location; this tool is used to detect strabismus.

The nurse has completed postoperative discharge teaching to the parents of a child who has had a tonsillectomy. Which statement indicates the parents have understood the teaching? 1. "We will call the physician for any indication of ear pain." 2. "We will be sure to give our child adequate amounts of citrus juices." 3. "We will plan on administering acetaminophen (Tylenol) for pain." 4. "We will keep our child on bed rest for ten days after the surgery."

3:Acetaminophen (Tylenol) is recommended for pain after a tonsillectomy.

A nurse is caring for a visually impaired 20-month-old who has not begun to walk. Which nursing diagnosis would be appropriate for this child? 1. Self-care deficit 2. Impaired physical mobility 3. Impaired home maintenance 4. Delayed growth and development

4: A 20-month-old child who is not walking is delayed in growth and development. Toddlers generally walk by 15 months of age.

An infant has acute otitis media. Which of the following would be the most important for the nurse to teach the parents? 1. Keep the baby in a flat position during sleep. 2. Administer a decongestant. 3. Place the baby to sleep with a pacifier. 4. Administer acetaminophen (Tylenol) to relieve discomfort.

4: An infant with a bulging tympanic membrane because of acute otitis media will have pain. Parents are taught to administer acetaminophen (Tylenol) to relieve the discomfort associated with acute otitis media.

The nurse has completed parent education related to treatment for a child with congenital clubfoot. The nurse knows that parents need further teaching when they state: 1. "We're getting a special car seat to accommodate the casts." 2. "We'll watch for any swelling of the feet while the casts are on." 3. "We'll keep the casts dry." 4. "We're happy this is the only cast our baby will need."

4: Serial casting is the treatment of choice for congenital clubfoot. The cast is changed every one to two weeks until the corrected foot position is achieved.

A Southern, nominally Pentecostal, African American pediatric client is being assessed during admission. He has braided, black, kinky hair, and he celebrates Kwanzaa. The nurse should document his ethnicity and race on the nursing admission form as: 1. Ethnicity African American, race Black 2. Ethnicity Black, race African American 3. Ethnicity Pentecostal, race African American 4. Ethnicity Southern, race Black

1: His ethnicity is African American and his race is Black because race refers to biological similarities.

A child who has undergone a hematopoietic stem cell transplantation (HSCT) is ready for discharge. Which concepts are important for the nurse to include in discharge education? Standard Text: Select all that apply. 1. Keeping the child on a high-calcium diet 2. Practicing good hand washing 3. Avoiding live plants and fresh vegetables 4. Avoiding influenza vaccinations 5. Returning the child to school within six weeks

1,2,3

A seven-year-old child is admitted in sickle-cell crisis. The nurse is concerned with reducing the child's pain. Recognizing that any activity that reduces the sickling will reduce the pain, nursing activities will include: Standard Text: Select all that apply. 1. Administration of narcotics. 2. Administration of NSAIDs. 3. Cold application. 4. Encouraging oral fluids. 5. Maintaining bed rest.

1,2,4,5

A 10-month-old infant has had numerous ear infections since birth. The nurse will discuss with the parents ways that might reduce the incidence of otitis media and will include which strategies? Standard Text: Select all that apply. 1. Prohibiting tobacco smoke in the home 2. Avoiding use of a pacifier while the child is sleeping 3. Breastfeeding the infant 4. Cleaning the child's ears nightly with peroxide 5. Avoiding use of wood-burning stoves

1,2,5

A child is being discharged from the hospital following treatment of asthma. Discharge medications include cromolyn sodium (a mast cell stabilizer). Nursing instructions to the parents about this medication would include explaining: Standard Text: Select all that apply. 1. The medication works to prevent exacerbations. 2. The medication should be administered at the first symptom of an asthmatic attack. 3. The medication should be taken on a daily basis. 4. Avoid taking the medication if the child has symptoms of a cold. 5. The medication desensitizes the child against specific allergens.

1,3

Which of the following are major risks during the post-transplant phase of hematopoietic stem cell transplantation (HSCT)? Standard Text: Select all that apply. 1. Bleeding 2. Thrombosis 3. Pancytopenia 4. Infection 5. Fluid volume overload

1,3,4

Access to health care often is less accessible to many groups of children and parents. Which factors can contribute to reducing access to health care? Standard Text: Select all that apply. 1. Transportation problems 2. Lack of community healthcare facilities 3. Lack of health insurance among low-income families 4. Overload of clients resulting in inability to be seen in a timely fashion 5. Communication difficulties if the family is unable to speak or read English

1,3,5

A nurse is working with a pediatric client who is overweight. Which diseases are associated with pediatric obesity? Standard Text: Select all that apply. 1. Cardiovascular disease 2. Asthma 3. Infant mortality 4. Diabetes

1,4

The nurse recommends to the mother of a 10-month-old child that cow's milk not be introduced into the diet until after 12 months of age. The mother asks why she can't switch to cow's milk earlier. The nurse explains that cow's milk can lead to iron deficiency anemia because: Standard Text: Select all that apply. 1. Cow's milk is a poor source of iron. 2. The child may be exposed to an antibiotic in processed milk. 3. Cow's milk has a high fat content. 4. In young children, cow's milk can lead to bleeding from the gastrointestinal tract. 5. Cow's milk contains no vitamin C, which is necessary for iron absorption.

1,4

A child has been admitted to the hospital for treatment of otitis media. When explaining to the mother that the child will be treated for an ear infection, the mother states: "Oh, it is important that my child receives hot foods to help my child." Recognizing that this is a cultural preference and that ear infections are "cold conditions," the nurse will include which of the following in the child's diet? 1. Cheese and eggs 2. Chicken and fish 3. Fresh fruits and vegetables 4. Goat meat and raisins

1: Cheese and eggs are considered "hot" foods in many cultures and are used to treat cold conditions.

A child with hemophilia plans on participating in a bicycling club. Which recommendation should the nurse give to the child? 1. Wear kneepads, elbow pads, and a helmet while bicycling. 2. Consider a swim club instead of the bicycling club. 3. Do not join the club. 4. Participate only in the social activities of the club.

1: Children with hemophilia should be encouraged to participate in non-contact sports activities. Bicycling is an excellent option, and is recommended, along with swimming. However, the child should always use kneepads, elbow pads, and a helmet when participating in any physical sport.

For which complication(s) should the nurse observe during administration of Factor VIII to a child with hemophilia? 1. Fever and chills 2. Fat emboli 3. Nausea and vomiting 4. Congestive heart failure

1: Fever and chills are common symptoms of transfusion reactions, which can occur with the administration of any blood product. Factor VIII is a blood product.

The nurse is working with a family who has recently immigrated to this country. The nurse has recently studied Purnell's Model for Cultural Competence (2002) and wants to respond to the family in a culturally acceptable manner. The most appropriate assessment question(s) would be: 1. "In what places have you lived?" and "What do you miss about your native land?" 2. "When I discuss your child's problem with you, how close to you should I stand?" 3. "What is the school system like in your native land?" 4. "What does eye contact indicate?" and "When do you want me to make eye contact?"

1: Identification of information about the native land is the beginning component of Purnell's Model for Cultural Competence.

A school-age child with hemophilia falls on the playground and goes to the nurse's office with superficial bleeding above the knee. The nurse should: 1. Apply pressure to the area for at least 15 minutes. 2. Apply a warm, moist pack to the area. 3. Perform some passive range-of-motion to the affected leg. 4. Keep the affected extremity in a dependent position.

1: If a hemophiliac child experiences a bleeding episode, superficial bleeding should be controlled by applying pressure to the area for at least 15 minutes, and ice should be applied.

Immediately after delivery, the nurse prepares to give the newborn a vitamin K injection. The new father is watching and asks the nurse why the baby is receiving a "shot." The nurse would explain that vitamin K injections are given to newborn infants to: 1. Activate clotting factors. 2. Break up blood clots. 3. Promote red blood cell function and assist in gas exchange. 4. Promote the production of hemoglobin.

1: Levels of clotting factors are lower in infants, so vitamin K is given prophylactically to activate essential clotting factors.

A child with meningococcemia is being admitted to the pediatric intensive care unit. This child should be placed in which type of room? 1. Private room, in respiratory isolation 2. Private room, in protective isolation 3. Private room, but not in isolation 4. Semiprivate room

1: Meningococcemia follows an infection with Neisseria meningitidis. N. Meningitidis is transmitted through airborne droplets; thus, the child should be placed in a private room in respiratory isolation.

The nurse is caring for four clients in the neonatal intensive care unit. Which infant has the greatest risk of developing retinopathy of prematurity (ROP)? 1. 28-weeks'-gestation infant who has been on long-term oxygen and weighed 1,400 grams 2. 32-weeks'-gestation infant of African heritage with a congenital heart defect who needed no oxygen and weighed 1,850 grams 3. 28-weeks'-gestation female infant who was on short-term oxygen, weighed 1,420 grams, and was treated with phototherapy 4. 36-weeks'-gestation, small-for-gestational-age infant who was in an oxyhood for 12 hours and weighed 1,800 grams

1: The 28-weeks'-gestation infant on oxygen weighing 1,400 grams has the greatest risk of retinopathy of prematurity because of gestational age (28 weeks or less), weight (less than 1,600 g), and oxygen therapy.

A nurse is planning to provide education for a family who has a child with sickle-cell anemia. For the prevention of a sickle-cell crisis, the nurse teaches the family the importance of avoiding which condition? 1. Respiratory infection and dehydration 2. Midrange altitudes 3. Weight loss without dehydration 4. Overhydration

1: The child with sickle-cell disease is at risk for infection, and dehydration can precipitate crisis.

The nurse is caring for a young child with otitis media. The parent asks the nurse why children seem to get otitis media frequently but adults do not. The nurse would explain that younger children get otitis media more often because: 1. The eustachian tube is shorter, wider, and horizontal in younger children. 2. The eustachian tube is shorter, more narrow, and horizontal in younger children. 3. The eustachian tube is longer, wider, and vertical in younger children. 4. The eustachian tube is longer, more narrow, and vertical in younger children.

1: The eustachian tube, which connects the nasopharynx to the middle ear, is proportionately shorter, wider, and more horizontal in infants and young children than in older children or adults. This promotes an increase in the incidence of ear infections.

The nurse can assist a child who has a mild hearing loss and reads lips to adapt to hospitalization by: 1. Touching the child lightly before speaking. 2. Using a picture board as the main means of communication. 3. Speaking in a loud voice while facing the child. 4. Speaking directly to the parents for communication.

1: The nurse can facilitate hospital adaptation of a child who has a hearing loss and can lip-read by obtaining the child's visual attention by lightly touching the child before communicating.

The school nurse is screening all second graders for tonsillitis and pharyngitis. Which finding is a normal finding in this age group? 1. Tonsils are large and seem to fill the throat. 2. Child is complaining of sore throat and drooling 3. White patches are observed on the tonsils. 4. Throat appears red, and child has a low-grade fever

1: This is a normal finding as the tonsilar material grows faster than the child and reaches adult size in this age group. It is not a reason to refer the child for follow-up.

A two-month-old infant is a direct admission to the pediatric unit with a diagnosis of ALTE (apparent life-threatening event). The physician is to see the infant to write medical orders. The nurse completes the nursing history and performs an assessment and finds no abnormal findings. While waiting on the physician, which activity can the nurse perform independently? 1. Place the child on an apnea monitor. 2. Place the child on nasal cannula oxygen. 3. Draw blood for arterial blood gases. 4. Place the child on contact isolation.

1: This is appropriate monitoring of the infant.

A two-year-old male child arrived in the emergency department with complaints of sore throat, difficulty swallowing, and suspected diagnosis of acute epiglottitis. Which of the following interventions should not be included in the child's immediate care and assessment? 1. Throat culture 2. Medical history 3. Vital signs 4. Assessment of breath sounds

1: Throat cultures should never be done when a diagnosis of epiglottis is suspected. Manipulation of the throat can stimulate the gag reflex in an already inflamed airway and can cause complete occlusion of the airway.

A nurse is caring for a visually impaired 10-year-old child. The nursing intervention with the highest priority for this child during the admission process would be: 1. Explaining playroom policies. 2. Orienting the child to where furniture is placed in the room. 3. Taking the child on a tour of the unit. 4. Letting the child touch equipment that will be used during the hospitalization.

2: The priority intervention is to orient the child to furniture placement in the room. This is priority because it addresses basic safety for a visually impaired client.

The nurse working in a family-centered hospital sees families at all stages of the family life cycle. Place each of the following families along the continuum of the family life cycle, beginning with the earliest stage and proceeding to the last stage. Standard Text: Click and drag the options below to move them up or down. Choice 1. The husband who retired from his job four years ago. He has been widowed six months. Choice 2. Newlyweds Choice 3. Family with three children, ages 17, 13, and 9 Choice 4. Family taking their first child home from the birth hospital Choice 5. Family with grown children. Both parents hold full time jobs. Choice 6. Family whose oldest child will start kindergarten next year and whose third child will be born shortly

2,4,6,3,5,1

A premature infant develops acute respiratory distress syndrome (ARDS). How will the nurse position the baby? Standard Text: Select all that apply. 1. Upright 2. Semi-Fowler's position 3. Prone position 4. With his head hyperextended 5. With his head in a sniffing position

2,5

Two hours after admission for asthma exacerbation, the 10-year-old boy is lethargic with mottled skin color. He has increased the use of accessory muscles and demonstrates nasal flaring. He is unable to speak and his respiratory rate has increased. The nurse would suspect: 1. Improvement in his condition is imminent. 2. Respiratory failure is imminent. 3. The medical diagnosis is incorrect and the child should be diagnosed with pneumonia. 4. The child may be receiving too much oxygen, which is a respiratory depressant.

2: These are symptoms of impending failure. Intervention is necessary.

A nurse is working with the family of a pediatric client. The nurse is planning to obtain an accurate family assessment. The initial step would be to: 1. Select the most relevant family assessment tool. 2. Establish a trusting relationship with the family. 3. Focus primarily on the mother, learning her greatest concern. 4. Observe the family in the home setting, since this step always proves indispensable.

2: Establishment of a trusting relationship between the family and the nurse is the essential preliminary step in obtaining an accurate family assessment.

The oncology nurse is working with patients from many cultural backgrounds. When assessing pain, the nurse should recall that members of which cultural group are more likely to remain quiet when experiencing severe pain? 1. Hispanic 2. Asian 3. Italian 4. Jewish

2: Individuals from Asian cultures are more likely to remain quiet when experiencing pain.

A child who has Beta-thalassemia is receiving numerous blood transfusions. The child is also receiving deferoxamine (Desferal) therapy. The parents ask how the deferoxamine will help their child. Which is an action of deferoxamine that the nurse should convey? 1. Stimulates red blood cell production 2. Prevents iron overload 3. Provides vitamin supplementation 4. Prevents blood transfusion reactions

2: Iron overload can be a side effect of a hypertransfusion therapy. Deferoxamine (Desferal) is an iron-chelating drug that binds excess iron so it can be excreted by the kidneys. It does not prevent blood transfusion reactions, stimulate red blood cell production, or provide vitamin supplementation.

The community health nurse is making an initial visit to a family. The most effective and efficient way for the nurse to assess the parenting style in use is to: 1. Ask the parents, "What rule is hardest for your child to obey?" 2. Ask the children what happens when they break the rules. 3. Ask the parents, "How often do you hug or kiss your children?" 4. Observe the parent interacting with the child for five minutes.

2: Parental styles are assessed while the family explains how it handles situations that require limit setting.

A child is on rifampin (Rimactane) for treatment of tuberculosis. The parents call the clinic and report that the child's urine is orange. The nurse should advise the parents to: 1. Encourage the child to drink cranberry juice. 2. Expect orange-colored urine while the child is on rifampin. 3. Bring the child to the clinic for a urinalysis. 4. Bring the child to the clinic for a radiograph of the kidneys.

2: Rifampin can color the urine orange, so the parents and child should be taught that this is an expected side effect.

Unhappy with the treatment progress for their child with cancer, the parents choose to add dietary supplements, including megavitamins, as complementary medicine to the treatment plan. What would be the priority nursing diagnosis for this child? 1. Impaired gas exchange 2. Risk for injury 3. Altered family processes 4. Altered parenting

2: Risk for injury is the priority nursing diagnosis when complementary therapies are used. The nurse must be concerned for the child's safety with respect to side effects, risks, and other implications of complementary therapy used with traditional Western medical treatments.

The nurse is taking care of a child who had a tonsillectomy. During the postoperative period, the nurse should observe the child for which clinical manifestation? 1. Arrhythmias 2. Dehydration 3. Increased blood sugar 4. Increased urinary output

2: The child is at risk for dehydration due to deficient fluid volume related to inadequate intake after surgery. The child will anticipate having pain if she tries to swallow.

Several children arrived at the emergency department accompanied only by their fathers. The nurse knows that the father who legally may sign emergency medical consent for treatment is: 1. The non-biologic one from the heterosexual cohabitating family. 2. The divorced one from the binuclear family. 3. The divorced one when the single-parent mother has custody. 4. The stepfather from the blended or reconstituted family.

2: The divorced father from the binuclear family may sign informed consent because he has equal legal rights with the mother under joint custody arrangements.

The nurse is reviewing the charts from a multicultural health clinic. The nurse needs to know that for three cultures, the listed first name is actually the family name, while the individual's given name is placed last. The three cultures with this variation are: 1. French, German, and Irish. 2. Cambodian, Filipino, and Korean. 3. Canadian, Egyptian, and Haitian. 4. Brazilian, English, and Jewish.

2: The listed first name is in fact the family name in Cambodian, Filipino, and Korean cultures.

The family rushes a four-month-old infant to the hospital after finding the infant not breathing. The child is diagnosed as a victim of sudden infant death syndrome. Supportive care for this family would include: 1. Sheltering parents from the grief by not giving them any personal items of the infant, such as footprints. 2. Allowing parents to hold, touch, and rock the dead infant. 3. Advising parents that an autopsy is not necessary. 4. Interviewing parents to determine the cause of the SIDS incident.

2: The parents should be allowed to hold, touch, and rock the infant, giving them a chance to say good-bye to their baby.

The nurse is beginning to obtain information about the present illness and medical history from the child's family. The "zone" of space that the nurse should plan to use include the: 1. Public zone. 2. Personal zone. 3. Intimate zone. 4. Social zone.

2: The personal zone, 18 inches to three feet, is used when talking to individuals during interviewing and history taking.

After a routine vaginal delivery, the infant transitions with the mother in the recovery room without difficulty. Prior to being discharged from the recovery room, it is noted that the infant's respiratory rate is 102 and the lungs are clear to auscultation. Based on these findings, an appropriate transfer for this infant would be to: 1. The newborn nursery for the first bath. 2. The NICU and placed under an over-bed warmer for observation. 3. To the mother's room to promote bonding with the parents. 4. The newborn nursery for its first feeding.

2: This infant needs to remain under constant observation due to the respiratory rate.

As a component of the family assessment, the family assists the nurse in developing an ecomap. Prior to beginning the ecomap, the nurse explains that the ecomap: 1. Provides information about the family structure including family life events, health, and illness. 2. Illustrates family relationships and interactions with community activities including school, parental jobs, and children's activities. 3. Is a short questionnaire of five questions that measures family growth, affection, and resolve. 4. Is a family assessment that consists of three categories of information about the family's strengths and problems.

2: This is the description of the ecogram.

The nurse is working in the respiratory clinic. In assessing children for cystic fibrosis, the nurse recognizes that children from which genetic and biologic racial background are more likely to have assessment findings characteristic of cystic fibrosis? 1. Asian 2. White 3. Hispanic 4. Black

2: White children of certain geographic origins are more likely to manifest diseases such as cystic fibrosis and celiac disease.

A newborn who is 24 hours old is suspected of having cystic fibrosis. As the child is being prepared for transfer to a pediatric hospital, the mother asks the nurse what symptoms made the physician suspect cystic fibrosis. The nurse would reply that the clinical manifestation of cystic fibrosis that is seen first is: 1. Rectal prolapse. 2. Constipation. 3. Steatorrheic stools. 4. Meconium ileus.

4: Newborns with cystic fibrosis might present in the first 48 hours with meconium ileus.

The physician has ordered the child to receive a unit of packed red blood cells. In preparing to administer the blood, the nurse will initiate an intravenous line and hang what fluid? 1. D5W 2. D5LR 3. D5 1/4NS 4. NS

4: Normal saline is appropriate to hang prior to initiating blood.

A nurse who is planning to teach school-age children about the "common cold" should include what information? 1. Aspirin should be taken for alleviation of fever if the common cold is contracted. 2. Antibiotics will eliminate the nasopharyngitis virus. 3. Vaccinations can prevent contraction of a nasopharyngitis virus. 4. Proper hand washing can prevent the spread of the common cold.

4: Proper hand washing should be taught to school-age children to reduce the spread of the "common cold" virus.

The nurse is administering packed red blood cells to a child with sickle-cell disease (SCD). The nurse knows that a transfusion reaction will most likely occur: 1. Six hours after the transfusion is given. 2. At the end of the administration of the transfusion. 3. Within the first 20 minutes of administration of the transfusion. 4. Never; children with SCD do not have reactions.

3: Blood reactions can occur as soon as the blood transfusion begins or within the first 20 minutes. The nurse should remain with the child during the first 20 minutes of the transfusion.

A mother of a three-year-old tells the nurse that her child often puts small toys in his mouth and she is concerned about choking. She asks the nurse what she should do if the child chokes. In addition to recommending the mother take a CPR course, the best response by the nurse would be to: 1. Show the mother how to do cardiac compressions and rescue breathing. 2. Recommend the mother perform back blows and chest thrusts. 3. Teach the mother how to perform abdominal thrusts. 4. Tell the mother to do nothing until the child loses consciousness.

3: Giving abdominal thrusts is the correct intervention for a choking child.

A child is admitted to the hospital and diagnosed with aplastic anemia. The parents ask the nurse what aplastic anemia is. Which would be the best description of aplastic anemia? 1. Causes a proliferation of white blood cells 2. Is characterized by abnormally shaped red blood cells 3. Is characterized by failure of the bone marrow to produce adequate numbers of cells 4. Is a disorder that occurs following a viral illness

3: In aplastic anemia, the bone marrow does not produce sufficient numbers of circulating blood cells.

A neonate has been diagnosed with a herpes simplex viral infection of the eye. Which medication will the nurse prepare to administer? 1. Oral erythromycin 2. Fluoroquinolone eyedrops or ointment 3. Parenteral acyclovir (Zovirax) and vidarabine (VIRA-A) ophthalmic ointment 4. Intravenous penicillin

3: Neonatal herpes simplex virus is treated vigorously with parenteral acyclovir for 14 days or longer and topical ophthalmic medication (trifluridine, iododeoxyuridine, or vidarabine).

The charge nurse is reviewing the care plans written by the unit's staff nurses. The charge nurse recognizes that the NANDA nursing diagnosis most likely to be construed as culturally biased and possibly offensive is: 1. Interrupted family processes related to shift in family roles secondary to demands of illness. 2. Fear related to separation from support system during hospitalization. 3. Noncompliance related to impaired verbal communication secondary to recent immigration from a non-English-speaking area. 4. Spiritual distress related to discrepancy between beliefs and prescribed treatment.

3: Noncompliance carries a negative bias. The inability to communicate effectively due to language differences does not mean the patient and/or family are noncompliant.

The nurse is teaching the parents of a patient who is newly diagnosed with cystic fibrosis how to administer the pancreatic enzymes. The nurse will advise the parents to administer the enzymes: 1. qid (four times daily). 2. bid (twice daily). 3. With meals and snacks. 4. Every six hours around the clock.

3: Pancreatic enzymes are administered with meals and large snacks.

A child is admitted to the hospital with pneumonia. The child's oximetry reading is 88% upon admission to the pediatric floor. The priority nursing activity for this child would be to: 1. Begin administration of intravenous fluids. 2. Obtain a blood sample to send to the lab for electrolyte analysis. 3. Begin oxygen per nasal cannula at 1 liter. 4. Medicate for pain.

3: Pulse oximetry reading should be 92 or greater. Oxygen by nasal cannula at 1 liter should be started initially.

Following treatment for iron deficiency anemia, the physician orders lab tests. Which lab value would indicate an improvement in the child's condition? 1. Low hemoglobin 2. Normal platelet count 3. High reticulocyte count 4. Low hematocrit

3: Reticulocytes are immature red blood cells and indicate new cells are being produced.

Which of the following parental demonstrations indicates that the parents understand the nurse's teaching with regard to prevention of iron-deficiency anemia? 1. The parents feed their infant with a formula that is not iron-fortified. 2. The child's vitamin C consumption is limited after one year of age. 3. The parents start iron-fortified infant cereal at four to six months of age. 4. Cow's milk is introduced into the child's diet at six months of age.

3: Starting iron-fortified infant cereal at four to six months of age is recommended for prevention of iron deficiency in children.

The nurse is working with a mother of three children on parenting skills. The nurse demonstrates a strategy that uses reward to increase positive behavior. This strategy is called: 1. Time-out. 2. Experiencing consequences of misbehavior. 3. Reasoning. 4. Behavior modification.

4: Behavior modification reinforces good behavior by giving rewards for desired behaviors.

The nurse is assigned to a child in a spica cast for a fractured femur suffered in an automobile accident. The child's teenage brother was driving the car, which was totaled. The nurse learns that the father lost his job three weeks ago and that the mother has just accepted a temporary waitress job. An appropriate diagnosis for this family is: 1. Interrupted Family Processes related to a child with significant disability requiring alteration in family functioning. 2. Risk for Caregiver Role Strain related to a child with a newly acquired disability and the associated financial burden. 3. Impaired Social Interaction (parent and child) related to the lack of family or respite support. 4. Compromised Family Coping related to multiple simultaneous stressors.

4: Compromised Family Coping related to multiple simultaneous stressors.

The nurse is evaluating the parent's understanding of teaching related to environmental control for their child's asthma management. Which statement by the parents indicates that they understand the teaching? 1. "We're glad the dog can continue to sleep in our child's room." 2. "We'll keep the plants in our child's room dusted." 3. "We'll be sure to use the fireplace often to keep the house warm in the winter." 4. "We will replace the carpet in our child's bedroom with tile."

4: Control of dust in the child's bedroom is an important aspect of environmental control for asthma management.

During a hurricane emergency, a child with hemophilia is injured and bleeding internally. The child is transported to the hospital. Due to the emergency, the appropriate factor is not available. What blood product would be the next best option to promote clotting? 1. Platelets 2. Whole blood 3. Packed cells 4. Fresh or fresh frozen plasma

4: Factors are located in the plasma. Fresh or fresh frozen plasma will provide the best source of factor available.

Which of the following is a priority nursing diagnosis for the child with idiopathic thrombocytopenic purpura (ITP)? 1. Ineffective breathing pattern 2. Nausea 3. Fluid-volume deficit 4. Risk for injury

4: ITP is the most common bleeding disorder in children, so risk for injury and subsequent bleeding is the priority nursing diagnosis.

The nurse is caring for a child with disseminated intravascular coagulation (DIC). Which would be a priority nursing intervention for this child? 1. Preparation for radiograph procedures 2. Monitoring of fluid restriction 3. Frequent ambulation 4. Monitoring of oxygen saturation and vital signs

4: In a child who has a bleeding and clotting disorder, the priority nursing intervention would be monitoring for life-threatening complications.

The nurse in a multicultural health clinic recognizes that many cultures use non-Western means in combination with Western health care prescriptions to treat illness. The nurse needs to recognize that the individuals most likely to combine curanderismo with Western health care prescriptions are: 1. African Americans 2. Native Americans 3. Asian Americans 4. Mexican Americans

4: Mexican Americans are most likely to combine curanderismo with Western health care prescriptions.

A child is admitted to the hospital with the diagnosis of laryngotracheobronchitis (LTB). The nurse should be prepared to perform which intervention? 1. Administer antibiotics and assist with possible intubation. 2. Obtain a sputum specimen. 3. Swab the throat for a throat culture. 4. Administer nebulized epinephrine and oral or IM dexamethasone.

4: Nebulized epinephrine and dexamethasone are given for LTB.

A child has been diagnosed with sickle-cell disease. Both parents deny having the disease themselves. The parents ask the nurse how their child got this disease. The nurse recognizes that the only possible explanation of the etiology is: 1. The father is not the biological father of the infant. 2. The mother of the child has the trait, but the father doesn't. 3. The father of the child has the trait, but the mother doesn't. 4. The mother and the father of the child have the sickle-cell trait.

4: Sickle-cell disease is an autosomal recessive disorder; both parents must have the trait in order for a child to have a 25% chance of having this disease.

An infant was born at 34 weeks' gestation and is being treated in the NICU for apnea of prematurity. The infant is in an isolette with an apnea monitor and intravenous fluids. The apnea monitor sounds, and the nurse checks the infant to find the infant is not breathing. The initial intervention by the nurse would be to: 1. Administer oxygen. 2. Perform back blows and chest thrusts. 3. Call a code. 4. Stroke the infant's back.

4: Tactile stimulation is often sufficient to restart the infant's respirations. Apnea of prematurity is due to immaturity of the respiratory center.

The nurse is teaching a group of mothers of infants about the benefits of immunization. The nurse will explain that the life-threatening disease epiglottitis can be prevented by immunization against: 1. Hepatitis B. 2. Polio. 3. Measles, mumps, and rubella (MMR). 4. Haemophilus influenzae type B (HIB).

4: The Haemophilus influenzae type B (HIB) immunization can assist in prevention of epiglottitis.

The nurse is working on parenting skills with a group of mothers. Which style of parenting tends to produce adolescents who tend to be self-reliant and socially competent? 1. Authoritarian 2. Permissive 3. Indifferent 4. Authoritative

4: The authoritative parenting style is one that results in positive outcomes for the behavior and learning of children. Nurses have observed that children from homes using this parental style more frequently have personalities manifesting self-reliance, self-control, and social competence. These parents should be praised for using the preferred approach.

During assessment of a child's biological family history, it is especially important that the nurse asking the mother for information uses the term "child's father" instead of "your husband" in the situation of a: 1. Traditional nuclear family. 2. Two-income nuclear family. 3. Traditional extended family. 4. Heterosexual cohabitating family.

4: The couple in a heterosexual cohabitating family is not married, so no husband exists; the nurse should be asking about the child's father.

A pediatric clinic serves several children who were adopted. The clinic nurse recognizes that the adopted child who is most likely to blame himself for being "given away" by the biologic parents is the: 1. Adopted child entering high school. 2. Child under three who was adopted as an infant. 3. Preschooler whose skin color is different from the adopted parents. 4. Child entering kindergarten.

4: The five-year-old child is most likely to shoulder the blame for being "given up" by the biologic parents.

During the assessment, the nurse notices that a Black baby has a darker, slightly bluish-hued patch about 5 × 7 cm on the buttocks and lower back. What is the nurse's next action? 1. Ask the mother about the cause of the bruise. 2. Call the Department of Social Services (DSS) to report this as a sign of abuse. 3. Confer with the physician the possibility of a bleeding tendency. 4. Chart the presence of a Mongolian spot.

4: The nurse will chart the presence of a Mongolian spot, as this may be observed in races with dark skin tones.

The community health nurse is assessing several families for various strengths and needs in regard to afterschool and backup child care arrangements. The family type that typically will benefit most from this assessment and subsequent interventions is the: 1. Traditional nuclear family. 2. Extended family. 3. Binuclear family. 4. Single-parent family.

4: The single-parent family most typically lacks social, emotional, and financial resources. Nursing considerations for such families should include referrals to options that will enable the parent to fulfill work commitments while providing the child with access to resources that can support the child's growth and development.

The nurse is reviewing discharge instructions for a child who has received a cochlear implant. In addition to encouraging speech therapy for the child, the nurse will instruct the parents to monitor the child for signs of: 1. Ringing in the ears. 2. Pharyngitis. 3. Hearing loss. 4. Bacterial meningitis.

4: There is an increased risk of bacterial meningitis following insertion of a cochlear implant.

The nurse stops at the scene of an accident and finds a child conscious but with a sucking wound of the chest. The immediate action by the nurse would be to: 1. Place the child in trendelenburg. 2. Begin rescue breathing. 3. Begin cardiac resuscitation. 4. Cover the wound with an air occlusive dressing.

4: This prevents more air from entering the chest and is appropriate.

The nurse working in a multicultural clinic recognizes that when the purpose of teaching is to promote the health of individual children, this effort should be directed to the authority responsible for the health care decisions. In certain cultural groups, health care decisions typically are made by the father. Therefore, the nurse should direct teaching efforts to the fathers in which cultures? 1. European American 2. African American 3. Native American 4. Appalachian

4:Family dominance patterns in some Appalachian cultures are more likely to be patriarchal.