Pediatrics Final Spring2015

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Which of the following should be included when educating patients/parents of early warning signs of an asthma attack? (Select all that apply.) Select one or more: a. Restlessness while trying to sleep b. Abdominal pain from severe coughing c. Extra effort to breathe d. Light wheezing e. Diaphoresis

A, C, D

In the United States, high rates of hospitalization and mortality from asthma occur in which of the following populations? (Select all that apply.) Select one or more: a. Native American children b. Asian American children c. African American children d. Children who attend public schools e. Children living in poverty

C, E

Bradycardia is a(n) _____ sign of increased intracranial pressure.

Late

The safe dose range for Drug A is 100-300 mg/kg/day. Ordered: 412 mg Q 6 hours. Child's weight: 9 pounds, 8 ounces Is the dose ordered appropriate?

A child weighs 6 pounds 5 ounces. How many grams is that?

2869 g

Which of the following are clinical manifestations of cystic fibrosis? Select one or more: a. deficiency in vitamin B 12 b. meconium ileus c. loose, watery stools d. altered absorption of vitamins A, D, E, & K

A child weighs 23 pounds 8 ounces. How many kilograms is that? AnswerCorrect kg

10.68

Ordered: D5 1/2 NS with 20 mEq KCl/L at 1/2 maintenance. Child weighs 6.4 kg. What is the appropriate hourly rate? AnswerCorrect mL/hour

13.3 6.4 kg * 100 mL/kg/day (since it's less than 10 kg) Maintenance for 24 hours: 640 mL Divided by 2 (or x by 0.5) to equal 1/2 maintenance : 320 320 ml/24 hr

A child weighs 11 pounds 12 ounces. Ordered: Gentamicin 2.5 mg/kg q 8 hours IV What dose will you administer in a single dose? ____ mg

13.4 11.75 lbs / 2.2 lbs/kg = 5.3409 kg * 2.5 mg/kg = 13.4 mg

Ordered: D10W at maintenance. Child weighs 3562 g. What is the appropriate hourly rate? AnswerCorrect mL/hour

14.8 3.562 kg = 356.2 ml/24 hours

Ordered: IV + PO to equal maintenance Child's weight: 6.3 kg IVF ran at full maintenance all night while the child slept. At 0800, child drinks 46 mL formula. Adjust the rate for the next four hours.

14.8 mL/hr 6.3 kg * 100ml/day = 630 ml/day = maintenance = 26.3 ml/hour 4 hours worth = 105.2 Minus the 46 the child took po = 59.2 to be made up with IVF/4 hours = 14.8 ml/hr

A child weighs 12 pounds 6 ounces. Ordered: Gentamicin 30.9 mg q 8 hours IV Available: Gentamicin 10 mg/mL What dose will you administer in a single dose? ____ mL

17.4

Ordered: IV + PO to equal maintenance Child's weight: 8.5 kg IVF ran at full maintenance all night while the child slept. At 0800, child drinks 53 mL apple juice. Adjust the rate for the next four hours.

22.2 8.5 kg * 100ml/day = 850 ml/day = maintenance = 35.4 ml/hour 4 hours worth = 141.6 Minus the 53 the child took po = 88.6 to be made up with IVF/4 hours = 22.15 ml/hr

A child weighs 5 pounds 8 ounces. How many grams is that?

2500

A nurse is doing a postop assessment on an infant who has just had a ventroperitoneal shunt placed for hydrocephalus. Which assessment would indicate a malfunction in the shunt? Select one: a. Bulging fontanelle b. Negative Brudzinski sign c. Incisional pain d. Movement of all extremities

Ordered: D5 1/2 NS with 20 mEq KCl/L at maintenance. Child weighs 7.2 kg. What is the appropriate hourly rate? AnswerCorrect mL/hour

30 100 mL/kg/day up to 10 kg 7.2 kg x 100 mL/kg/day = 720 mL/day = the maintenance for 24 hours 720 mL/24 hours = Hourly rate of 30 ml/hr

A child weighs 9 pounds 4 ounces. Ordered: Ampicillin 400 mg/kg/day in divided doses q 6 hours IV (Round to whole mg) Available: Ampicillin 100 mg/mL What dose will you administer in a single dose? ____ mL

A child with a myelomeningocele corrected at birth is now 5 years old. What is a priority nursing diagnosis for a child with corrected spina bifida at this age? Select one: a. Risk for altered urinary elimination b. Risk for altered comfort c. Risk for infection d. Risk for impaired tissue perfusion-cranial

A child weighs 9 pounds 3 ounces. How many grams is that? AnswerCorrect g

4176 9.1875 lbs/ 2.2 lbs/kg = 4.176 kg * 1000 g/kg = 4176 g

Ordered: D5 1/2 NS with 20 mEq KCl/L at maintenance. Child weighs 11.5 kg. What is the appropriate hourly rate? AnswerCorrect mL/hour

44.8 First 10 kg = 1000 mL/day Next 1.5 kg *50 mL/day = 75 ml/day Maintenance for 24 hours: 1075 ml Hourly rate: 44.8 ml/hr

A child weighs 9 pounds 12 ounces. How many grams is that?

4432

Ordered: D5 1/2 NS with 20 mEq KCl/L at maintenance. Child weighs 16.7 kg. What is the appropriate hourly rate? AnswerCorrect mL/hour

55.6 First 10 kg = 1000 mL/day Next 6.7 kg *50 mL/day = 335 ml/day Maintenance for 24 hours: 1335 ml Hourly rate: 55.625 ml/hr (55.6)

Ordered: D5 1/2 NS with 20 mEq KCl/L at maintenance. Child weighs 18 kg. What is the appropriate hourly rate? AnswerCorrect mL/hour

58.3 First 10 kg = 1000 mL/day Next 8 kg *50 mL/day = 400 ml/day Maintenance for 24 hours: 1400 ml Hourly rate: 58.3 ml/hr

Ordered: IV + PO to equal maintenance Child's weight: 3200 g IVF ran at full maintenance all night while the child slept. At 0800, child drinks 15 mL formula. Adjust the rate for the next four hours.

9.6 mL/hr 3200 g = 3.2 kg 3.2 kg * 100ml/day = 320 ml/day = maintenance = 13.3 ml/hour 4 hours worth = 53.2 Minus the 15 the child took po = 38.2 to be made up with IVF/4 hours = 9.55 (9.6) ml/hr

A 4-year-old is seen in the clinic for a sore throat. The most likely causative agent in the child's mind is that he: Select one: a. Yelled at his brother. b. Did not take his vitamins. c. Was exposed to someone else with a sore throat. d. Did not eat the right foods.

A child is admitted with infective endocarditis. Which of the following is the nurse's priority action? Select one: a. Start an intravenous line. b. Place the child on seizure precautions. c. Place the child in contact isolation. d. Assist with a lumbar puncture.

The nurse is planning postop care for an infant after a cleft lip repair. The plan should include: Select one: a. Supine or side-lying positioning. b. Prone positioning. c. Avoidance of soft elbow restraints. d. Suctioning with a Yankauer device.

The parents of a 10-year-old boy with cystic fibrosis restrict him from camping, sleepovers with friends, and school field trips. They time his respiratory treatments and log his diet, choosing most foods for him. They have him seen medically between scheduled appointments and call their physician frequently with concerns. The nurse considers these behaviors indicative of: Select one: a. Vulnerable child syndrome b. Parental depression c. Parental denial of the child's condition d. Need for respite care

When assessing the adolescent with anorexia, which of the following would the nurse expect to find? Select one: A. Murmur B. Fever C. Hypertension D. Tachycardia

A An adolescent with anorexia often exhibits a low body temperature, bradycardia, hypotension, and a murmur resulting from mitral valve prolapse.

A child with suspected sickle cell disease is scheduled for a hemoglobin electrophoresis. When reviewing the child's history, which of the following would the nurse identify as potentially interfering with the accuracy of the results? Select one: A. Blood transfusion 1 month ago B. History of recent infection C. Use of iron supplementation D. Lack of fasting for 12 hours

A Blood transfusion within the previous 12 weeks may alter the results of the hemoglobin electrophoresis. Iron supplements can increase serum ferritin levels. Children should fast for 12 hours before having a specimen obtained for iron levels. A history of infection might interfere with the white blood cell count results, not hemoglobin electrophoresis.

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? Select one: A. "Many people feel this way; I know someone who can help." B. "Are you using your medicine every day?" C. "If you have any scarring you can undergo dermabrasion." D. "Your condition will most likely improve in a year or two."

A 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.

When reviewing the medical record of a child, which of the following would the nurse interpret as the most sensitive indicator of intellectual disability? Select one: A. Language delay B. History of seizures C. Preterm birth D. Vision deficit

A Due to the extent of cognition required to understand and produce speech, the most sensitive early indicator of intellectual disability is delayed language development. A history of seizures, preterm birth, and vision deficit may be associated with intellectual disability but are not the most sensitive indicators.

An infant is diagnosed with infantile glaucoma. When developing the plan of care for the infant, the nurse would expect to prepare the infant and family for which of the following? Select one: A. Goniotomy B. Patching of affected eye C. Contact lenses D. Antibiotic therapy

A 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?

The nurse is teaching a couple about X-linked disorders. They are concerned that they might pass on hemophilia to their children. Which of the following responses indicates the need for further teaching? Select one: A. "If the father doesn't have it, then his kids won't either." B. "If the mother is a carrier, her daughter could be one too." C. "The father can't be a carrier if he doesn't have hemophilia." D. "If the mother is a carrier, her sons may have hemophilia."

A Hemophilia is an X-linked recessive disorder. This means that both the father and the mother must have the gene for hemophilia to pass it on to their children. Also, their male children will have hemophilia, while their female children have only a 50% chance of having the disorder. If the father has hemophilia and the mother has hemophilia, their children will have the disease. If the father has hemophilia and the mother is a carrier, all their children have a 50% chance of getting the disease.

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? Select one: A. Serum immunoglobulin E (IgE) level B. Wound culture C. Erythrocyte sedimentation rate D. Potassium hydroxide prep

A 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.

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 which of the following? Select one: A. "The infant has a lower risk for damage from ultraviolet radiation because the skin is more pigmented." B. "An infant's skin is thinner than an adult's, so substances placed on the skin are absorbed more readily." C. "An infant has less subcutaneous fat, which places the infant at a higher risk for heat loss." D. "The infant's epidermis is loosely connected to the dermis, increasing the risk for breakdown."

A 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.

A child with hypogammaglobulinemia is to receive intravenous immunoglobulin (IVIG). Which of the following would be least appropriate for the nurse to do? Select one: A. Shake the vial after reconstituting it B. Obtain preinfusion vital signs C. Premedicate the child with acetaminophen D. Check serum blood urea nitrogen and creatinine levels

A Many IVIG products are packed as two vials, one the IVIG powder and one the sterile diluents. Once reconstituted, the IVIG should not be shaken because this leads to foaming and may cause the immunoglobulin protein to degrade. The child can be premedicated with acetaminophen or diphenhydramine. Baseline serum blood urea nitrogen and creatinine should be assessed because acute renal insufficiency may occur as a serious adverse reaction.

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

A 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.

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

A 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.

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

A 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.

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 based on the understanding of which of the following? Select one: A. The condition is a surgical emergency. B. Renal failure is imminent. C. Intravenous antibiotics need to be initiated. D. The boy is at risk for sepsis.

A 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.

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? Select one: A. IgE B. IgM C. IgA D. IgG

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

The nurse identifies a nursing diagnosis of impaired social interaction related to altered social skills as evidenced by impulsivity and intrusive behavior. The nurse plans to identify factors that aggravate the child's behavior for which reason? Select one: A. Minimize stimuli that exacerbate the child's undesired behaviors B. Improve the child's ability to deal with external stressors C. Promote increased ability to follow through D. Encourage the child to adopt expectations into his routine

A The nurse identifies aggravating factors to help minimize stimuli that exacerbate the child's undesired behaviors. This must be accomplished first before any other interventions would be effective. Improving the child's ability to deal with external stressors is achieved by modifying the environment to decrease distracting stimuli. Actions such as speaking directly to the child and maintaining eye contact promote engagement and an increased ability to follow through. Providing positive feedback encourages the child to adopt expectations into his routine.

The nurse is providing care to a child with pancreatitis. When reviewing the child's laboratory test results, which of the following would the nurse expect to find? Select all answers that apply. Select one or more: A. Elevated serum amylase levels B. Leukocytosis C. Positive stool culture D. Decreased serum lipase levels E. Decreased C-reactive protein

A, B

The nurse is caring for a child who has been admitted for a sickle cell crisis. Which of the following would the nurse do first to provide adequate pain management? Select one: A. Initiate pain assessment with a standardized pain scale B. Administer a nonsteroidal anti-inflammatory drug (NSAID) as ordered. C. Administer meperidine as ordered. D. Use guided imagery and therapeutic touch.

A The nurse should first initiate pain assessment with a standardized pain scale upon admission and provide frequent evaluations of pain. Administering NSAIDs or meperidine and the use of nonpharmacologic pain management techniques are all appropriate. However, the first action is to assess the child's pain to provide a baseline for future comparison.

The nurse is developing a plan of care for a 7-year-old boy with diabetes insipidus. Which of the following would the nurse most likely identify as the priority nursing diagnosis? Select one: A. Deficient fluid volume related to dehydration B. Excess fluid volume related to edema C. Imbalanced nutrition, more than body requirements related to excess weight D. Deficient knowledge related to fluid intake regimen

A The priority nursing diagnosis most likely would be deficient fluid volume related to dehydration, due to a deficiency in the secretion of antidiuretic hormone (ADH). Excess fluid would result from a disorder that leads to water retention, such as syndrome of inappropriate antidiuretic hormone (SIADH). Deficient knowledge related to fluid intake regimen is a nursing diagnosis for this child, but a secondary one. Imbalanced nutrition, more than body requirements related to excess weight would be inappropriate for this child since he probably has lost weight secondary to the fluid loss.

A child is admitted to the hospital unit with physical injuries. The nurse is taking the child's history. Which statement by the parent is most suspicious for abuse? Select one: a. "The baby's 18-month-old brother was trying to pull the baby out of the crib and dropped the baby on the floor." The statement "The baby's 18-month-old brother was trying to pull the baby out of the crib and dropped the baby on the floor" is the most suspicious for abuse because developmentally, it would be very difficult for an 18-month-old child to pull an infant out of a crib. b. "I feel so bad. I was holding the baby in one arm and some towels in the other and did not see my toddler's toys on the floor. I tripped, and when I fell, the baby slipped out of my arms." c. "I placed the baby in the infant swing. His 6-year-old brother was running through the house and tripped over the swing, causing it to fall." d. "I did not realize that my baby was able to roll over yet, and I was just gone a minute to check on dinner when the baby rolled off of the couch and onto our tile floor."

A The statement "The baby's 18-month-old brother was trying to pull the baby out of the crib and dropped the baby on the floor" is the most suspicious for abuse because developmentally, it would be very difficult for an 18-month-old child to pull an infant out of a crib.

A nurse is conducting a screening program for autism in infants and children. Which of the following would the nurse identify as a warning sign? Select one: A. Inability to say a single word by 16 months B. Lack of gestures by 8 months C. Inability to use two words by 18 months D. Lack of babbling by 6 months

A Warning signs of autism include no babbling by 12 months, no pointing or using gestures by 12 months, no single words by 16 months, no two-word utterances by 24 months, and loss of language or social skills at any age.

Which of the following are appropriate interventions in the management of severe brain injury? Select one or more: a. Seizure prevention/treatment b. Invasive ICP monitoring c. Mannitol administration d. Decreasing environmental stimulation e. Assisting with electromyography

A, B, C, D

Management of bronchiolitis focuses primarily on supportive care. Which of the following are appropriate treatment measures for an uncomplicated (i.e. not requiring ventilation) case? Select one or more: a. IV hydration b. nasopharyngeal suction c. chest tube placement d. supplemental oxygen

A, B, D

A group of nursing students are reviewing information about inflammatory bowel disease in preparation for a class discussion on the topic. The students demonstrate understanding of the material when they identify which of the following as characteristic of Crohn disease? Select all answers that apply. Select one or more: A. Elevated erythrocyte sedimentation rate B. Most common between the ages of 10 to 20 years C. Loss of haustra within bowel D. Low serum iron levels E. Tenesmus F. Distributed in a continuous fashion

A, B, D Crohn disease is most common between the ages of 10 and 20 years. Erythrocyte sedimentation rate is elevated and serum iron levels are low. Ulcerative colitis is distributed continuously distal to proximal, with tenesmus and loss of haustra within the bowel. Crohn disease is segmental, with disease-free skip areas common, and the bowel wall has a cobblestone appearance.

The nurse is assessing a child with aplastic anemia. Which of the following would the nurse expect to assess? Select all that apply. Select one or more: A. Ecchymoses B. Epistaxis C. Warm tender joints D. Severe pain E. Tachycardia F. Guaiac-positive stool

A, B, E, F Assessment findings associated with aplastic anemia include ecchymoses, epistaxis, guaiac-positive stools, and tachycardia. Severe pain and warm tender joints are most often associated with sickle cell crisis.

The nurse is developing a plan of care for a child with thalassemia. Which of the following would the nurse expect to include? Select all that apply. Select one or more: A. Packed RBC transfusions B. Opioid analgesics C. Deferoxamine therapy D. Platelet transfusions E. Heparin therapy F. Intravenous immunoglobulin

A, C RBC transfusions and deferoxamine for chelation are used to treat thalassemia. Heparin therapy is used for treating DIC. Opioid analgesics would be used to treat severe pain associated with sickle cell crisis. Platelet transfusions and intravenous immunoglobulin would be used to treat idiopathic thrombocytopenia purpura.

Which of the following findings are suggestive of congenital diaphragmatic hernia? (Select all that apply.) Select one or more: a. Absence of breath sounds on left side b. Delayed passage of meconium, >48 hours c. Barrel-shaped chest d. Retractions and cyanosis e. Current jelly stools

A, C, D

A child has sustained a traumatic brain injury, and is being monitored in the pediatric intensive care unit. The nurse is using the Glasgow Coma Scale to assess the child. Which assessments will be included? Select all that apply. Select one or more: a. Verbal response b. Head circumference c. Eye opening d. Pulse oximetry e. Motor response

A, C, E

A nurse is preparing a teaching session for a group of parents with children newly diagnosed with attention deficit/hyperactivity disorder (ADHD). When explaining this disorder to the parents, which of the following would the nurse include as being involved? Select all answers that apply. Select one or more: A. Impulsivity B. Anxiety C. Distractibility D. Defiance E. Inattention F. Hyperactivity

A, C, E, F ADHD is characterized by inattention, impulsivity, distractibility, and hyperactivity. Anxiety disorder and oppositional defiant disorder may be comorbidities associated with ADHD.

An infant with Tetralogy of Fallot is having a hypercyanotic episode. Which of the following nursing interventions should the nurse implement? Select all that apply. Select one or more: a. Administer oxygen. b. Administer demerol as ordered PRN. c. Administer diphenhydramamine (Benadryl) as ordered PRN. d. Place the child in knee-chest position. e. Draw blood for a serum hemoglobin.

A, D

When it presents in infancy, Arnold-Chiari type II malformation presents with which of the following symptoms? Select one or more: a. Stridor b. Prominant bony ridge c. Flattening of one side of the head d. Apnea

A, D

A nurse is developing a plan of care for a child who is admitted to the hospital for surgery. The child is visually impaired. Which of the following would be most appropriate for the nurse to include in the child's plan of care? Select all answers that apply. Select one or more: A. Allowing the child to explore the postoperative equipment with his hands B. Touching the child on his shoulder before letting the child know someone is there C. Speaking to the child in a voice that is slightly louder than the usual tone of voice D. Explaining instructions using simple and specific terms the child understands E. Using the child's body parts to refer to the area where he may have postoperative pain

A, D, E When interacting with a visually impaired child, the nurse would make directions and instructions simple and specific, encourage exploration of objects such as postoperative equipment through touch, and use the parts of the child's body as reference points for the location of items or for this child, his postoperative pain. The nurse should identify him- or herself first before touching the child and speak in a tone of voice that is appropriate to the situation.

A child is admitted with heart failure secondary to an AV canal. Which of the following should be included in the plan of care? Select one or more: a. Strict Intake & Output b. Antibiotics for treatment of Group A strep infection c. High dose aspirin therapy d. Cluster cares e. Anticipate IV access for at least 4 weeks f. Diuretics g. Offer small, frequent feeds

A, D, F, G

The nurse finds that an infant has stronger pulses in the upper extremities than in the lower extremities and higher blood pressure readings in the arms than in the legs. This could be indicative of which heart defect? Select one: a. Atrial septal defect b. Coarctation of the aorta c. Patent ductus arteriosus d. Transposition of the great vessels

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: Select one: a. "We'll watch for any swelling of the feet while the casts are on." b. "We're happy this is the only cast our baby will need." c. "We'll keep the casts dry." d. "We're getting a special car seat to accommodate the casts.

The nurse is performing a health assessment of a school-age child. Based on the child's developmental level, on which of the following problems would the nurse focus more attention? Select one: A. Risk-taking behaviors B. Accidents and injuries C. Infections D. Poisonings

The nurse is preparing to administer a medication to a 5-year-old who weighs 35 pounds. The prescribed single dose is 1 to 2 mg/kg/day. Which of the following is the appropriate dose range for this child? Select one: A. 70 to 140 mg B. 16 to 32 mg C. 8 to 16 mg D. 35 to 70 mg

The nurse is preparing to administer ampicillin to a child who weighs 40 kg. The safe dose for children is 50 to 100 mg/kg/day divided in doses administered every 6 hours. What would be the low single safe dose and high single safe dose per day for this child? Select one: A. 100 to 500 mg per dose B. 500 to 1,000 mg per dose C. 1,000 to 5,000 mg per dose D. 50 to 100 mg per dose

The nurse is providing family-centered care for a 12-year-old child with pertussis. The child has been ill for 3 weeks. Which of the following treatments are appropriate? Select one or more: a. IV ampicillin b. Oral azithromycin c. Oral gentamicin d. Chemoprophylaxis for household members e. Immunization

The nurse is teaching the parents of a newly diagnosed cystic fibrosis client how to administer the pancreatic enzymes. The nurse will advise the parents to administer the enzymes: Select one: a. b.i.d. (twice a day) b. With meals and large snacks. Pancreatic enzymes are administered with meals and large snacks. A scheduled time would not be appropriate because the enzymes are used to assist in digestion of nutrients. c. q.i.d. ( four times a day) d. Every 6 hours around the clock.

The nurse prepares a DTaP (diphtheria, tetanus toxoid, and acellular pertussis) immunization for a 6-month-old infant. To administer this injection safely, the nurse chooses which of the following needles (size and length), injection type, and injection site? Select one: a. 25 gauge ¾-inch needle, SQ (subcutaneous), deltoid b. 25 gauge 1-inch needle, IM (intramuscular), anterolateral thigh c. 25 gauge 1-inch needle, ID (intradermal), deltoid d. 22 gauge 1—2-inch needle, IM (intramuscular), ventrogluteal

Which clinical manifestation should the nurse expect when a child with sickle cell anemia experiences an acute vasoocclusive crisis? Select one: a. Cardiomegaly, systolic murmurs b. Painful swelling of hands and feet; painful joints c. Circulatory collapse d. Hepatomegaly, intrahepatic cholestasis

List 2 reasons why it is important for nurses to understand chronic sorrow.

Any 2 of the following would be acceptable. 1. Increasing numbers of chronically ill children attend school and are part of the greater community. 2. It is likely a nurse will encounter parents and caregivers who are experiencing chronic sorrow. 3. When nurses fail to recognize chronic sorrow, parents are often misunderstood and mislabeled as "difficult" or "in denial." 4. When nurses fail to recognize chronic sorrow, adversarial relationships develop between home, school, and the medical community. 5. When nurses fail to recognize chronic sorrow, nurses often provide inappropriate nursing interventions which may increase the families stress. 6. Research shows that more than 80% of caregivers experience chronic sorrow. 7. With greater understanding, nurses are better prepared to comfort, support, and help parents cope with chronic sorrow.

A newborn is diagnosed with patent ductus arteriosus. The nurse anticipates that the physician will most likely order which medication? Select one: A. Alprostadil B. Indomethacin C. Spironolactone D. Heparin

A newborn presents with gastroschisis. A single stage repair is scheduled for tomorrow morning. The nurse knows that a priority nursing intervention for this child is: Select one: a. Elevate head of bed to minimize risk of aspiration. b. Administer IV fluids and monitor intake and output. The child is at risk for fluid loss from the exposed bowel and the need to be in a warmer or isolette. Since the child is NPO preoperatively, fluid volume balance is maintained with intravenous fluids and monitoring of I&O. c. Ensure adequate calories are given before the child is made NPO. d. Begin teaching the parents about infant ostomy care.

A parent reports that her 5-year-old child, who has had all recommended immunizations, had a mild fever 1 week ago, and now has bright red cheeks and a lacy red rash on the trunk and arms. The nurse recognizes that this child might have: Select one: a. German measles (rubella). b. Fifth disease (Erythema infectiosum). c. Chickenpox (varicella). d. Roseola (Exanthem subitum).

A parent reports that her 5-year-old child, who has had all recommended immunizations, had a mild fever 1 week ago, and now has bright red cheeks and a lacy red rash on the trunk and arms. The nurse recognizes that this child might have: Select one: a. German measles (rubella). b. Fifth disease (Erythema infectiosum). correct c. Chickenpox (varicella). d. Roseola (Exanthem subitum).

Assessment of a 12-year-old who crashed his bicycle without a helmet reveals the following: temperature 99.2o, pulse 100 bpm, respiratory rate 24 breaths per minute with easy work of breathing, and BP 102/70 mm Hg. What is the priority action by the nurse? Select one: a. Administer IV fluid bolus of normal saline. b. Assess neurologic status while observing for obvious injuries. c. Remove the cervical collar if he complains that it bothers him. d. Listen for bowel sounds while assessing for pain.

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

B A tympanic temperature greater than 100.4°F (38°C) is defined as fever. An oral temperature of 99.5°F (greater than 37.5°C) would identify a fever. An axillary temperature of 99.1°F (greater than 37.3°C) would identify a fever.

After teaching a class about inborn errors of metabolism, the instructor determines that additional teaching is needed when the class identifies which of the following as an example of an inborn error of metabolism? Select one: A. Maple syrup urine disease B. Achondroplasia C. Galactosemia D. Tay-Sachs disease

B Achondroplasia is an autosomal dominant genetic disorder, not an inborn error of metabolism. Galactosemia, maple syrup urine disease, and Tay-Sachs are considered inborn errors of metabolism.

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? Select one: A. "He can't eat but he can drink fluids for the next 24 hours." B. "He should avoid taking a bath for about 3 days but he can shower." C. "It's normal if he says he feels like his heart skipped a beat." D. "This pressure dressing needs to stay on for 5 days from now."

B 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.

A nurse receives report on a 3-year-old child with a diagnosis of asthma exacerbation. The offgoing nurse reports that the child has been agitated and diaphoretic. She was very restless and would not lie down. Her oxygen need has increased in the past 24 hours. The child received Albuterol q 2 hours this shift. When the new nurse enters the room, the child is falling asleep in her mother's arms. Mother verbalizes relief that the child is finally able to sleep. On assessment, the child is no longer wheezing. She does not wake with assessment or VS. The nurse does which of the following? Select one: a. Tries to wake the child and administers albuterol b. Contacts the rapid response team for immediate assistance c. Lets the child rest for the time and reassesses in 2 hours d. Contacts the attending physician to request a chest x-ray

B Agitation, diaphoresis, restlessness and the inability to lie down are all signs of respiratory failure. The child has been experiencing these symptoms for an unknown period of time. Absence of breath sounds or wheezing is disturbing as it indicates that air flow is so diminished that it cannot even cause wheezing. When accompanied by confusion or drowsiness, respiratory arrest is imminent.

A nursing student is preparing an oral presentation about autosomal recessive inheritance. Which of the following must occur for an offspring to demonstrate signs and symptoms of the disorder with this type of inheritance? Select one: A. The father must be affected by the disease. B. Both parents must be heterozygous carriers. C. One parent must have the disease. D. The mother must be a carrier.

B Autosomal recessive inheritance occurs when two copies of the mutant or abnormal gene in the homozygous state are necessary to produce the phenotype. In other words, two abnormal genes are needed for the individual to demonstrate signs and symptoms of the disorder. Both parents of the affected person must be heterozygous carriers of the gene (clinically normal, but carriers of the gene).

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? Select one: A. Limb-girdle B. Duchenne C. Distal D. Myotonic

B 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.

The nurse is caring for a special needs infant. Which intervention will be most important in helping the child reach her maximum developmental potential? Select one: A. Monitoring her progress in elementary school B. Directing her parents to an early intervention program C. Serving on an individualized education program committee D. Preparing a plan for her to transition to college

B Early intervention is critical to maximizing the child's developmental potential by laying the foundation for health and development. While important, intervention in elementary or secondary school does not have the impact of early intervention. When the time arrives, it is important to have a written plan for transition to college, if this is a possibility for the grown child.

A child with growth hormone deficiency is receiving growth hormone. Which of the following would the nurse interpret as indicating effectiveness of this therapy? Select one: A. Complaints of headaches B. Height increase of 4 inches C. Growth plate closure D. Rapid weight gain

B Effectiveness of growth hormone therapy is indicated by at least a 3- to 5-inch increase in linear growth in the first year of treatment. Rapid weight gain and headaches are adverse reactions of this therapy. The drug is stopped when the epiphyseal growth plates close.

The nurse is caring for a 1-month-old girl with low-set ears and severe hypotonia who was diagnosed with trisomy 18. Which nursing diagnosis would the nurse identify as most likely? Select one: A. Interrupted family process related to the child's diagnosis B. Grieving related to the child's poor prognosis C. Ineffective coping related to stress of providing care D. Deficient knowledge deficit related to the genetic disorder

B Grieving related to the child's prognosis is a diagnosis specific to this child's care. The prognosis for trisomy 18 is that the child will not survive beyond the first year of life. Ineffective coping related to the stress of providing care, deficient knowledge related to the genetic disorder, and interrupted family process due to the child's diagnosis could be appropriate for any family of a child with a genetic disorder.

As a result of seizure activity, a computed tomography (CT) scan was performed and showed that an 18-month-old child has intracranial arteriovenous malformation. When developing the child's plan of care, the nurse would expect to implement actions to prevent which of the following? Select one: A. Drug interactions B. Hemorrhagic stroke C. Developmental disabilities D. Respiratory paralysis

B Intracranial hemorrhage or hemorrhagic stroke is a risk for children with intracranial arteriovenous malformation. Drug interactions are a risk for children who are treated with combinations of anticonvulsants for epilepsy. Children with hydrocephalus are at an increased risk for developmental disabilities. Respiratory paralysis is a risk of botulism that typically affects infants younger than 6 months of age.

A 10-month-old with biliary atresia is being discharged after Kasai procedure. Which statement, if made by her parents, indicates that teaching with regard to her prognosis has been understood? Select one: a. "We are happy to be able to stop that special formula and all of those vitamins." b. "We know that even though surgery is over, she will likely need a liver transplant." c. "We are glad this problem was found so early; now everything will be fine." d. "We will stop her liver medicine now that she is being discharged."

B Kasai procedure is palliative, and prognosis is best if performed before 10 weeks of age. Its purpose is to achieve biliary drainage and avoid liver failure. A liver transplant is required in 80 to 90 percent of cases.

The nurse is reviewing the laboratory test results of a child diagnosed with disseminated intravascular coagulation (DIC). Which of the following would the nurse interpret as indicative of this disorder? Select one: A. Increased fibrinogen level B. Positive fibrin split products C. Shortened prothrombin time D. Increased platelets

B Laboratory test results associated with DIC include positive fibrin split products; prolonged prothrombin time, partial thromboplastin time, bleeding time, and thrombin time; decreased fibrinogen levels, platelets, clotting factors II, V, VIII, and X, and antithrombin III; and increased levels of fibrinolysin, fibrinopeptide A, and positive D-dimers.

The nurse is caring for a 3-month-old with nasolacrimal duct obstruction. Which intervention would be most appropriate for the nurse to implement? Select one: A. Being careful to prevent spread of infection B. Teaching the parents how to gently massage the duct C. Referring the child to an ophthalmologist D. Applying hot, moist compresses to the affected eye

B Massaging the nasolacrimal duct can cause it to open and drain. Teaching the parents how to do this would be part of the nurse's plan of care. Nasolacrimal duct obstruction is not infectious. Applying hot, moist compresses to the eye is an intervention for conjunctivitis. Nasolacrimal duct obstruction is often self-resolving, so there would be no need for a specialist's care.

The nurse assesses a child's level of consciousness, noting that the child falls asleep unless he is stimulated. The nurse documents this finding as: Select one: A. Confusion B. Obtunded C. Stupor D. Coma

B Obtunded is a state in which the child has limited responses to the environment and falls asleep unless stimulation is provided. Confusion involves disorientation; the child may be alert but responds inappropriately to questions. Stupor exists when the child responds only to vigorous stimulation. Coma is a state in which the child cannot be aroused even with painful stimuli.

A nurse is providing an in-service program on child abuse for a group of newly hired nurses. When evaluating the effectiveness of the teaching, the nurse determines a need for additional review when the group identifies which of the following as an indicator of possible child abuse? Select one: A. Consistent delays in seeking treatment for the child's injuries B. Sexual behavior that correlates with the child's developmental age C. Frequent changes in history information with visits D. Injuries that are inconsistent with the reported traumatic event

B Sexual behavior that correlates with the child's developmental age would be appropriate and not an indicator of child abuse. A delay in seeking medical treatment, a history that changes over time, or a history of trauma that is inconsistent with the observed injury all suggest child abuse.

Which of the following would lead the nurse to suspect that an adolescent has bulimia? Select one: A. Bradycardia B. Calluses on back of knuckles C. Nail pitting D. Body mass index less than 17

B The adolescent with bulimia would exhibit calluses on the back of the knuckles and split fingernails and would be of normal weight or slightly overweight. A body mass index of 17, nail pitting, and bradycardia would suggest anorexia.

A nurse is preparing a plan of care for a child with a primary immunodeficiency. Which nursing diagnosis would the nurse most likely identify as the priority? Select one: A. Risk for delayed growth and development related to chronic illness B. Ineffective protection related to impaired humoral defenses C. Acute pain related to inflammatory processes D. Imbalanced nutrition, less than body requirements related to poor appetite

B The child with a primary immunodeficiency lacks the necessary immune responses that provide protection from infection. Therefore, the priority nursing diagnosis would be ineffective protection. Imbalanced nutrition and risk for delayed growth and development may be appropriate, but these would not be the priority. Acute pain would be more appropriate for a child with juvenile idiopathic arthritis.

The nurse is discussing vaccination for Haemophilus influenzae type B (Hib) with the mother of a 6-month-old child. Which of the following comments provides the most compelling reason to get the vaccination? Select one: A. "Your child needs this final dose for protection." B. "Young children are especially susceptible to these bacteria." C. "These bacteria live in every human." D. "You have a choice of two excellent vaccines."

B The most compelling reason for vaccination is that the highest rate of illness from influenza is in children. The fact that Hib is an opportunistic bacterium that lives in humans and only causes disease when resistance is lowered may be difficult for the parent to understand. A choice of two vaccines conveys no benefits to the mother. Need for the final dose is vague.

The nurse is caring for a 2-year-old boy with hemophilia. His parents are upset by the possibility that he will become infected with hepatitis or HIV from the clotting factor replacement therapy. Which response by the nurse would be most appropriate? Select one: A. "Parents commonly fear the worst; however, the factor will help your child lead a normal life." B. "Since dry heat treatment of the factor began in 1986, there have been no reports of virus transmission." C. "There are risks with any treatment including using blood products, but these are very minor." D. "Although factor replacement is expensive, there's more financial strain from missing work if he has a bleeding episode."

B The nurse needs to emphasize that since 1986, there have been no reports of virus transmission from factor infusion since the inception of heat treatment of the factor. Telling the parents that there is a minor risk does not teach. Telling the parents that factor is expensive or that it is common to worry does not teach, nor does it address their concerns.

The nurse is caring for a 13-year-old girl with von Willebrand disease. After teaching the adolescent and her parents about this disorder and care, which response by the parents indicates a need for additional teaching? Select one: A. "We need to administer Stimate prior to dental work." B. "We should administer desmopressin as often as needed." C. "We should be aware that she may suffer from menorrhagia." D. "We understand that she may have frequent nosebleeds."

B The parents need to know that Stimate is the only brand of desmopressin spray that is used for controlling bleeding; the other brands are used for homeostasis and enuresis. Additionally, Stimate should only be used 3 days in a row as lessening of the response (tachyphylaxis) occurs with frequent use. Stimate should be used before dental work. Menorrhagia and nosebleeds may occur.

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? Select one: A. Fear related to infant's cardiac condition and need for ongoing care B. Interrupted family processes related to demands of caring for the ill child C. Risk for delayed growth and development related to necessary treatments D. Deficient knowledge related to the care of a child with congenital heart disease

B 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.

When evaluating the hemogram of an 8-month-old infant, the nurse would identify which type of hemoglobin as being the predominant type? Select one: A. Hemoglobin A2 B. Hemoglobin A C. Hemoglobin F D. Hemoglobin S

B Three types of normal hemoglobin are present at any given time in the blood: A, F, and A2. By 6 months of age, hemoglobin A is the predominant type. Hemoglobin S is associated with sickle cell disease.

A group of nursing students are reviewing information about the endocrine system in infants and children. The students demonstrate understanding of the information when they state which of the following? Select one: A. A child's endocrine system has little effect on growth and development. B. Infants have difficulty balancing glucose and electrolytes. C. Endocrine glands begin developing in the third trimester of gestation. D. At birth, the endocrine glands are completely functional.

B Typically, most endocrine glands begin to develop during the first trimester of gestation, but their development is incomplete at birth. Thus, complete hormonal control is lacking during the early years of life, and the infant cannot appropriately balance fluid concentration, electrolytes, amino acids, glucose, and trace substances.

A nurse is caring for a hospitalized 3 month old infant admitted following a motor vehicle accident. The child is being monitored for increased intracranial pressure. The nurse notes that the anterior fontanel bulges when the infant cries. Based on this assessment finding, which action would the nurse take? Select one: a. Lower the head of the bed b. Have the mother provide comfort measures and reassess. c. Place the infant on NPO status d. Notify the physician immediately

B When an infant cries intercranial pressure increases causing the fontanel to bulge. Since crying can occur because of hunger, thirst, pain, the nurse should attempt to decrease the crying by assessing the cause. Notifying the MD first would result in the MD asking the question, "What have you done to decrease the cause of the cry which is increasing the icp?

Chronic sorrow is the periodic recurrence of grief-related feelings associated with an ongoing disparity from a loss experience. Which of the following families are at high risk for developing chronic sorrow? Select one or more: a. Parents of a child who experienced pelvis and femur fractures in an automobile/bicycle accident who must spend 3 months in full spica cast. b. Parents of a child with Pierre-Robin sequence who is trach dependent c. Parents of a child admitted with pneumonia right before Christmas d. Parents of a child with spina bifida who is wheelchair bound

B, D

A child with persistent otitis media with effusion is to undergo insertion of pressure-equalizing tubes via a myringotomy. The child is to be discharged later that day. After teaching the parents about caring for their child after discharge, which statement indicates that the teaching was successful? Select one: A. "His chances for ear infections now have dramatically decreased." B. "He should wear earplugs when swimming in a pool or a lake." C. "We should keep the ears protected with cotton balls for the first 24 hours." D. "The tubes will stay in place for about a month and then fall out on their own."

B When pressure-equalizing tubes are inserted, the surgeon may recommend avoiding water entry into the ears. Therefore, earplugs are suggested when the child is in the bathtub or swimming. When swimming in a lake, earplugs are especially important because lake water is contaminated with bacteria and entry of that water into the middle ear must be avoided. Typically, the tubes remain in place for at least several months and generally fall out on their own. Placement of pressure-equalizing tubes does not prevent middle ear infection. Other than earplugs for bathing and swimming, nothing else is placed in the child's ear.

A mother brings her child to the health care clinic because she thinks that the child has conjunctivitis. Which assessment finding would lead the nurse to suspect bacterial conjunctivitis? Select all answers that apply. Select one or more: A. Itching of the eyes B. Mild pain C. Inflamed conjunctiva D. Stringy discharge E. Photophobia F. Tearing

B, C Bacterial conjunctivitis is manifested by inflamed conjunctiva, a purulent or mucoid discharge, mild pain, and occasional eyelid edema. Itching and a stringy discharge suggest allergic conjunctivitis. Photophobia and tearing suggest viral conjunctivitis.

A 2-month-old infant is admitted with suspected Spinal Muscular Atrophy. Which of the following findings is the nurse likely to assess? Select one or more: a. Scoliosis b. Generalized weakness c. Low weight-to-length ratio d. Weak cry

B, C, D

Which of the following activities are appropriate for an 8-year-old child with mild Cerebral Palsy? Select one or more: a. Participating in solitary or parallel play b. Participating in social groups such as Girl Scouts/Boy Scouts. c. Participating in physical therapy to promote gross motor skills d. Attending school

B, C, D

A 15-year-old adolescent is brought to the emergency department by his parents. The adolescent is febrile with chills that started suddenly. He states, "I had a sinus infection and sore throat a couple of days ago." The nurse suspects bacterial meningitis based on which of the following? Select all answers that apply. Select one or more: A. Absent headache B. Vomiting C. Photophobia D. Complaints of stiff neck E. Negative Brudzinski sign

B, C, D In addition to the adolescent's complaints and history, other findings suggesting bacterial meningitis include complaints of a stiff neck, photophobia, headache, positive Brudzinski sign, and vomiting.

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

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

The nurse suspects that a 4-year-old with type 1 diabetes is experiencing hypoglycemia based on which of the following? Select all that apply. Select one or more: A. Dry, flushed skin B. Slurred speech C. Tachycardia D. Fruity breath odor E. Diaphoresis F. Blurred vision

B, C, E Manifestations of hypoglycemia include behavioral changes, confusion, slurred speech, belligerence, diaphoresis, tremors, palpitation, and tachycardia. Blurred vision; dry, flushed skin; and fruity breath odor suggest hyperglycemia.

The nurse is caring for an infant with candidal diaper rash. Which topical agent would the nurse expect the physician to order? Select one: A. Corticosteroids B. Retinoids C. Antifungals D. Antibiotics

C 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.

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

B, D 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.

A child is diagnosed with Kawasaki disease and is in the acute phase of the disorder. Which of the following would the nurse expect the physician to prescribe? Select all answers that apply. Select one or more: A. Intravenous immunoglobulin B. Aspirin C. Alprostadil D. Acetaminophen E. Ibuprofen

B, D 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.

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 answers that apply. Select one or more: A. Back B. Neck C. Shoulders D. Upper chest E. Face

B, D, E 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.

A 4-year-old has acute glomerulonephritis, and is admitted to the hospital. Which is an appropriate nursing diagnosis for this child? Select one: a. Risk for infection related to hypertension b. Altered growth and development related to a chronic disease c. Fluid volume excess related to decreased plasma filtration d. Risk for injury related to loss of blood in urine

A 45-day-old infant weighing 4.2 kg is admitted with suspected Herpes encephalitis. He has an IV in place and is receiving compatible maintenance IV fluid and his first dose of Acyclovir 113 mg. The drug book information on dosing is as follows: Acyclovir Route/dosage Herpes Simplex Encephalitis IV (Adults): 10 mg/kg q 8 hr for 14-21 days. IV (Children 3 mo - 12 yr): 10 mg/kg q 8 hr for 14-21 days. IV (Children birth - 3 mo): 20 mg/kg q 8 hr for 14-21 days. IV (Neonates, premature): 10 mg/kg q 12 hr for 14-21 days. What is the priority nursing intervention at this point? Select one: a. Assess IV site for any sign of infiltration or phlebitis. b. Complete a full assessment, including evaluation of neurologic status. c. Stop the infusion & notify the physician. d. Increase the maintenance IV fluid to dilute the acyclovir infusion.

A child has just returned from spinal fusion surgery. The nurse should check for signs of: Select one: a. Seizure activity. b. Impaired pupillary response during neurological checks. c. Impaired color, sensitivity, and movement to lower extremities. d. Increased intracranial pressure.

An infant has been born with an esophageal atresia and tracheoesophageal fistula. What is a priority preop nursing diagnosis? Select one: a. Ineffective tissue perfusion: gastrointestinal related to decreased circulation b. Acute pain related to esophageal defect c. Risk for aspiration related to regurgitation d. Ineffective infant feeding pattern related to uncoordinated suck and swallow

The nurse is planning care for a school-age child with bacterial meningitis. Which of the following should be included? Select one: a. Avoid giving pain medications that could dull sensorium. b. Measure head circumference to assess developing complications. c. Keep environmental stimuli at a minimum. d. Have the child move her head from side to side at least once every 2 hours.

The school nurse completes an assessment of a 6-year-old child to determine the services the child will need in the classroom. The child needs respiratory support with oxygen. The child also requires enteral tube feedings and intravenous medication during the school day. With these needs, the school nurse evaluates the child to be: Select one: a. Developmentally delayed. b. Socially withdrawn. c. Medically fragile d. Mentally handicapped.

A child has undergone surgery using steel bar placement to correct pectus excavatum. Which of the following would the nurse instruct the parents to avoid? Select one: A. High Fowler B. Supine C. Side-lying D. Semi-Fowler

C 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.

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? Select one: A. Transposition of the great vessels B. Hypoplastic left heart syndrome C. Atrial septal defect D. Tetralogy of Fallot

C 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.

The asthma action plan is developed using a child's personal best average peak expiratory flow readings (PEFR). At what percent of PEFR should the healthcare provider first be notified? Select one: a. 50-52% b. 88-90% c. 77-79% d. 25-27%

C Correct. Peak flow readings from 50 - 80% indicate asthma is worsening. Contact the healthcare provider to get guidance on additional medications. (See p. 1345 in your book.)

The nurse is preparing a teaching plan for the family and their 6-year-old son who has just been diagnosed with diabetes mellitus. Which of the following would the nurse identify as the initial goal for the teaching plan? Select one: A. Promoting independence with self-administration of insulin B. Educating the parents about diabetes mellitus type 1 C. Developing management and decision-making skills D. Developing a nutritionally sound, 30-day meal plan

C Developing basic management and decision-making skills related to the diabetes is the initial goal of the teaching plan for this child and family. The nurse would have provided a basic description of the disorder after it was diagnosed. Development of a detailed monthly meal plan would come later, perhaps after consulting with a nutritionist. It is too soon to expect the boy to administer his own insulin.

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? Select one: A. Administering antibiotics as ordered B. Keeping the drainage tube taped in an upright position C. Using a double-diapering technique D. Administering analgesics as prescribed

C 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.

The nurse is caring for an adolescent girl with anorexia nervosa. Which of the following findings would indicate to the nurse that the girl requires hospitalization? Select one: A. Body mass index of 18 B. Soft, sparse body hair and dry, sallow skin C. Food refusal D. Weight gain of one-half pound per week

C Food refusal, severe weight loss, unstable vital signs, arrested pubertal development, and the need for enteral nutrition warrant hospitalization. Soft, sparse body hair and dry, sallow skin are signs of anorexia, but do not warrant hospitalization. A weight gain of one-half pound per week indicates progress toward therapeutic goals. A body mass index of 18 is on the low end of the normal range of body mass.

When teaching the parents of a child with phenylketonuria, the nurse would instruct them to include which of the following foods in the child's diet? Select one: A. Eggs B. Meat C. Oranges D. Milk

C Foods that contain phenylalanine are to be avoided. These include milk, meat, and eggs. Foods such as oranges would be allowed.

A child with attention deficit/hyperactivity disorder is prescribed long-acting methylphenidate. Which of the following would the nurse include when teaching the child and his parents about this drug? Select one: A. "This drug may cause drowsiness, so be careful when doing things." B. "Some increase in appetite may occur, so watch how much you eat." C. "Take this drug every day in the morning when you wake up." D. "Give the drug three times a day: morning, midday, and after school."

C Long-acting methylphenidate is administered once daily in the morning, whereas the other forms are given three times a day. The drug typically causes difficulty sleeping and decreased appetite.

An infant has been diagnosed with Osteogenesis Imperfecta. (OI). The nurse is teaching the parents about how to care for their infant. What information is most important for the nurse to include in the instructions to the parents? Select one: a. Notify the health-care provider if your infant does not respond to sound because the infant's central nervous system fails to develop completely. b. Check the color of your infant's nail beds and mucous membranes for the signs of circulatory impairment c. Protect your infant from injury and handle your baby carefully because your infant's bones can break very easily d. If you note signs of infection bring your infant to the clinic because the infant has a significant immune dysfunction.

C OI is also known as brittle bone disease and the infant should be handled carefully and protected from injury. TTT "Osteo" refers to bone.

The parents of a 5-year-old bring their son to the emergency department because of significant eyelid edema. The mother states, "He scratched himself near his eye a couple of days ago while playing outside in the yard." The nurse suspects periorbital cellulitis based on which of the following? Select one: A. Evidence of discharge B. Altered visual acuity C. Purplish discoloration of eyelid D. Reddened conjunctiva

C Periorbital cellulitis is a bacterial infection of the eyelids and tissue surrounding the eye. The bacteria may gain entry into the skin via an abrasion, laceration, insect bite, foreign body, or impetiginous lesion. It may also result from a nearby bacterial infection such as sinusitis. Findings include marked eyelid edema, purplish or red color of the eyelid, clear conjunctivae, absence of discharge, and normal visual acuity.

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

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

A group of nursing students are reviewing information about neurocutaneous syndromes. The students demonstrate an understanding of these disorders when they identify which of the following as an example? Select one: A. Achondroplasia B. Apert syndrome C. Sturge-Weber syndrome D. Marfan syndrome

C Sturge-Weber syndrome is an example of a neurocutaneous syndrome. Marfan syndrome, Apert syndrome, and achondroplasia are autosomal dominantly inherited genetic disorders.

Which exercise would the nurse suggest as most helpful to maintain mobility in a child with juvenile idiopathic arthritis? Select one: A. Using a treadmill B. Jogging every other day C. Swimming D. Playing basketball

C Swimming is a particularly useful exercise to maintain joint mobility without placing pressure on the joints. Jogging, using a treadmill, and playing basketball would place pressure on the joints of the lower extremities.

The nurse has admitted a child with a cyanotic heart defect. Which initial lab result would the nurse expect to find? Select one: a. Low platelet count b. Low hematocrit c. High hemoglobin and hematocrit d. High white blood cell count

C The child's bone marrow responds to chronic hypoxemia by producing more red blood cells to increase the amount of hemoglobin available to carry oxygen to the tissues. This occurs in cases of cyanotic heart defects. Therefore, the hematocrit would not be low, the white blood cell count would not be high (unless an infection were present), and the platelets would be normal.

After teaching a group of parents about ear infections in children, which statement indicates that the teaching was successful? Select one: A. Infants with congenital deformities have an increased risk for ear infections. B. Ear infections typically increase as the child gets older. C. The shorter and wider eustachian tubes of an infant increase the risk D. Adenoids shrink as the child grows, allowing more bacteria to enter.

C The infant has relatively short, wide, horizontally placed eustachian tubes, allowing bacteria and viruses to gain access to the middle ear and resulting in an increased number of infections as compared to adults. Congenital deformities of the ear are associated with other body system anomalies, but not necessarily an increase in ear infections. As the child matures, the eustachian tubes assume a more slanted position, so older children and adults have fewer infections. A child's adenoids are often enlarged, leading to obstruction of the eustachian tubes and infection.

Which of the following findings are suggestive of congenital diaphragmatic hernia? (Select all that apply.) Select one or more: a. Delayed passage of meconium, >48 hours b. Current jelly stools c. Retractions and cyanosis d. Barrel-shaped chest e. Absence of breath sounds on one side

C, D, E

A nurse is preparing a presentation for a group of parents with children diagnosed with diabetes type 1. The children are all adolescents. Which of the following issues would the nurse need to address? Select all that apply. Select one or more: A. Self-monitoring of blood glucose levels B. Feelings of being different C. Deficient decision-making skills D. Body image conflicts E. Struggle for independence

C, D, E Adolescents are undergoing rapid physical, emotional, and cognitive growth. Working toward a separate identity from parents and the demands of diabetic care can hinder this. This struggle for independence can lead to nonadherence of the diabetic care regimen. Conflicts develop with self-management, body image, and peer group acceptance. Teens may acquire the skills to perform tasks related to diabetic care but may lack decision-making skills needed to adjust treatment plan. Teens do not always foresee the consequences of their activities. Self-monitoring of blood glucose levels and feelings of being different are issues common to school-age children.

The nurse works in a pediatric unit. In working with a parent who is suspected of Munchausen syndrome by proxy, it is very important for the nurse to: Select one: a. Confront the parent with concerns of possible abuse. b. Explain to the child that her parent is causing her illness, and that the health team will prevent her from being harmed. c. Try to keep the parent separated from the child as much as possible. d. Carefully document parent—child interactions.

A 15-year-old male had a tonsillectomy 10 days ago. Earlier in the day, he complained that his throat was very sore and it felt "like something was stuck there." His mother calls to report that he just vomited "quite a bit" of bright red blood. Which of the following is the most appropriate response by the nurse? Select one: a. "When did he last take pain medication and is he having any pain right now?" b. "Can you bring him to the clinic so we can check it? We'll squeeze him in anytime." c. "Have him wear an ice collar for 20 minutes. That should help decrease any swelling or bleeding." d. "Go to the nearest emergency room right away." e. "It's very common to vomit once or twice after tonsillectomy. Watch him and let us know in the morning how he is feeling."

A 4-month-old is brought to the Emergency Department for evaluation of constipation which began about a week ago. Mother states the child is not feeding well. On assessment, the nurse notes a weak cry, drooping eyelids, and overall floppy muscle tone. Which of the following is the priority nursing action? Select one: a. Place a feeding tube since the child will have a decreased gag reflex. b. Instruct the mother not to try feeding the child until the constipation is more fully evaluated. Airway safety must be the priority nursing intervention. This would follow shortly. c. Obtain stool and blood cultures and place an IV for antibiotics. d. Ensuring that airway managment equipment, including a bag & mask and intubation supplies, is readily available.

A lumbar puncture is done on an infant suspected to have meningitis. If the infant has bacterial meningitis, the nurse would expect the cerebral spinal fluid to show what result? Select one: a. An elevated red blood cell count b. A decreased white blood cell count c. Normal glucose d. An elevated white blood cell count

Parents are told by the gentic counselor that they have a 1:4 probability of having a second child with cystic fibrosis (CF). They already have one child who is affected. The parents state their risk is lower now than when they had the previous child. What should the nurse tell the parents about the 1:4 probability? Select one: a. The probability of miscarrying is greater now than with the previous pregnancy. b. The probability of having a healthy child is twice as likely with this pregnancy. c. The probability of having another child with CF is twice as likely as it was when they had the first child. d. Each pregnancy is an independent event

Supportive care for the family of an infant with sudden infant syndrome (SIDS) includes: Select one: a. Sheltering the parents from grief by not giving them any personal items of the infant's, such as footprints. b. Interviewing the parents to determine the cause of the SIDS incident. c. Advising the parents that an autopsy is not necessary. d. Allowing the parents to hold, touch, and rock the infant.

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: Select one: A. 140 beats per minute B. 120 beats per minute C. 100 beats per minute D. 80 beats per minute

A child has sustained a basilar skull fracture. For which complication should the nurse assess? Select one: a. Transient confusion b. Periorbital ecchymosis c. Headache d. Cerebral spinal fluid leakage from the nose or ears

D A fracture of the bones that form the base (floor) of the skull and results from severe blunt head trauma of significant force. A basilar skull fracture commonly connects to the sinus cavities. This connection may allow fluid or air entry into the inside of the skull and may cause infection. The key word is complication. While periorbital ecchymosis and CSF are both signs of a basilar skull fracture only the CSF leak is a complication because it involves an opening from the brain to the outside which provides a route for serious infection, primarily meningitis. A fracture of the bones that form the base (floor) of the skull and results from severe blunt head trauma of significant force. A basilar skull fracture commonly connects to the sinus cavities. This connection may allow fluid or air entry into the inside of the skull and may cause infection.

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? Select one: A. Swelling in the neck B. Hypersalivation C. Confusion and anxiety D. Ring-like rash on lower leg

D 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.

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? Select one: A. Salmeterol B. Ipratropium C. Cromolyn D. Albuterol

D Albuterol is a short-acting β2-adrenergic agonist that is used for treatment of acute bronchospasm. Salmeterol is a long-acting β2-adrenergic agonist used for long-term control or exercise-induced asthma. Ipratropium is an anticholinergic agent used as an adjunct to β2-adrenergic agonists for treatment of bronchospasm. Cromolyn is a mast cell stabilizer used prophylactically but not to relieve bronchospasm during an acute wheezing episode.

A group of nursing students are reviewing information about humoral and cellular immunity. The students demonstrate understanding of this material when they identify which of the following as involved in cellular immunity? Select one: A. B cells B. Antibodies C. Antigens D. T cells

D Cellular immunity involves T cells, which do not recognize antigens. B cells, antibodies, and antigens are involved in humoral immunity.

The nurse is caring for a 4-year-old boy who has undergone an appendectomy. The child is unwilling to use the incentive spirometer. Which approach would be most appropriate to elicit the child's cooperation? Select one: A. "If you don't try, I will have to get the doctor." B. "You must blow in this or you might get pneumonia." C. "Can you cough for me please?" D. "Can you blow this cotton ball across the tray?"

D Children are more likely to cooperate with interventions if play is involved. Encourage deep breathing by playing games. Asking the boy to cough is less likely to engage him. Telling the child he might get pneumonia is not age appropriate and is unhelpful. Threatening to call the doctor is unhelpful and inappropriate. Remember, however, that the incentive spirometer works on the principle of the amount of air inhaled, not exhaled. Having the child take a deep breath prior to blowing the cotton ball is a beginning step.

The nurse is caring for 3-day-old girl with Down syndrome whose mother had no prenatal care. Which of the following will be the priority nursing diagnosis? Select one: A. Impaired physical mobility related to poor muscle tone B. Delayed growth and development related to a cognitive impairment C. Deficient knowledge related to the presence of a genetic disorder D. Imbalanced nutrition, less than body requirements related to the effects of hypotonia

D Children with Down syndrome may have difficulty sucking and feeding due to lack of muscle tone and the structure of their mouths and tongues. This can lead to poor nutritional intake and makes this the priority diagnosis. This also uses the strategy that physiologic needs have priority using Maslow's hierarchy of needs. Deficient knowledge due to lack of information about the disorder is a close second in priority, as the mother did not know of her daughter's condition before birth and has much to learn now. This child is at risk for a number of complications such as infection, heart disease, and leukemia and will require frequent assessment. Most children with Down syndrome experience some degree of intellectual disability, but early intervention will allow the child maximum development within the limits of the disease. Mobility is delayed but should not be a problem at this time.

A newborn has been diagnosed with Hirschsprung's disease. The parents ask the nurse about the symptoms that lead to this diagnosis. The nurse should explain that common symptoms are: Select one: a. Currant jelly colored, gelatinous stools; pain. b. Projectile vomiting; altered electrolytes. c. Acute diarrhea; dehydration. d. Failure to pass meconium; abdominal distention.

D Correct. The child with Hirschsprung disease has a function bowel obstruction or near obstruction as the colon contracts, but fails to relax. Gas ans stool build behing the obstruction, creating distention. Nearly half of all infants with Hirschsprung disease have a history of delayed first passage of meconium, and nearly half of infants with delayed first passage of meconium have Hirschsprung disease.

The physician has ordered rectal diazepam (Valium) for a 2-year-old boy with status epilepticus. Which of the following instructions is essential for the nurse to teach the parents? Select one: A. Monitor for an allergic reaction to the medication. B. Watch for fever indicating infection. C. Gradually reduce the dosage as seizures stop. D. Monitor their child's level of sedation.

D Diazepam is useful for home management of prolonged seizures and requires that the parents be educated on its proper administration. Monitoring the child's level of sedation is key when giving diazepam because it slows the central nervous system. Parents need to monitor the overall health of the child, including temperature when needed, but that has nothing to do with the diazepam. When the use of an anticonvulsant is stopped, gradual reduction of the dosage is necessary to prevent seizures or status epilepticus. This is not done without a physician's order. Monitoring for allergic reactions is necessary when any medications have been prescribed, but is not specific to diazepam.

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

D 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.

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 which of the following? Select one: A. Hypospadias B. Varicocele C. Hydrocele D. Epispadias

D 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.

A child with depression is prescribed fluoxetine. The nurse identifies this as belonging to which class of drugs? Select one: A. Psychostimulant B. Tricyclic antidepressant C. Atypical antidepressant D. Selective serotonin reuptake inhibitor

D Fluoxetine (Prozac) is a selective serotonin reuptake inhibitor. Trazodone is an atypical antidepressant; amitriptyline, desipramine, imipramine, and nortriptyline are tricyclic antidepressants. Methylphenidate and the amphetamines are psychostimulants.

The nurse is developing a plan of care for a 5-year-old child with a severe hearing impairment focusing on psychosocial interventions based on assessment findings. Which behavior would the nurse have most likely assessed? Select one: A. Head tilt or forward thrust B. Self-stimulatory actions C. Inattention and vacant stare D. Immature emotional behavior

D Immature emotional behavior would be seen most frequently. The inability to hear impacts the socialization process and causes social problems for the child because the hearing impairment has inhibited normal development. Self-stimulatory actions, inattention, vacant stare, head tilt, or forward thrust may also cause problems with socialization, but they are typical of visually impaired children.

The nurse is counseling a couple who suspect that they could bear a child with a genetic abnormality. Which of the following would be most important for the nurse to incorporate into the plan of care when working with this family? Select one: A. Presenting the information in a nondirective manner B. Informing the family of the need for a wide range of information C. Maintaining the confidentiality of the information D. Gathering information from at least three generations

D It is essential to respect client autonomy and present information in a factual, nondirective manner. In these situations, the nurse needs to understand that the choice is the couple's to make. Gathering information for three generations obtains a broad overview of what has been seen in both sides of the family. Maintaining confidentiality of the information is as important as with any other client information gathered. Informing family of the need for information is necessary because of its personal nature.

A 2-year-old has a tonic-clonic seizure while in the hospital crib. The child's jaws are clamped. Which is the most important nursing action at this time? Select one: a. Place a padded tongue blade between the child's jaws. b. Restrain the child to prevent injury. c. Prepare the suction equipment. d. Stay with the child and observe his respiratory status

D It is important for the nurse to stay with the child to assess for any changes in the child's respiratory status. Place the child in side-lying position, if possible, to allow secretions to drain. Monitor for adequate oxygenation. The child is at risk for hypoxic injury if the respiratory status is compromised.

A child with diabetes insipidus is being treated with vasopressin. The nurse would assess the child closely for signs and symptoms of which of the following? Select one: A. Cushing syndrome B. Thyroid storm C. Vitamin D toxicity D. Syndrome of inappropriate antidiuretic hormone (SIADH)

D SIADH, although rare in children, is a potential complication of excessive administration of vasopressin. Thyroid storm may result from overadministration of levothyroxine (thyroid hormone replacement). Cushing syndrome is associated with corticosteroid use. Vitamin D toxicity may result from the use of vitamin D as treatment of hypoparathyroidism.

A nurse is teaching the parents of an infant with congenital adrenal hyperplasia about the signs and symptoms of adrenal crisis. The nurse determines that the teaching was successful when the parents identify which of the following? Select one: A. Constipation B. Fluid overload C. Bradycardia D. Persistent vomiting

D Signs and symptoms of acute adrenal crisis include persistent vomiting, dehydration, hyponatremia, hyperkalemia, hypotension, tachycardia, and shock.

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

D 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.

The nurse is providing care to a child with an intussusception. The child has a bowel movement and the nurse inspects the stool. The nurse would document the stool's appearance most likely as which of the following? Select one: A. Bloody B. Greasy C. Clay-colored D. Currant jelly-like

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

A 4-year-old boy has a history of seizures and has been started on a ketogenic diet. Which of the following food selections would be most appropriate for his lunch? Select one: A. A grilled cheese sandwich, potato chips, and a milkshake B. A hamburger on a bun, French fries, and milk C. Spaghetti with meatballs, garlic bread, and a cola drink D. Fried eggs, bacon, and iced tea

D The ketogenic diet involves a high intake of fats, adequate protein intake, and a very low intake of carbohydrates, resulting in a state of ketosis. The child is kept in a mild state of dehydration. Eggs and bacon are high in fat; the tea does not contain any carbohydrates. Therefore, this is the best choice. The hamburger is fat and protein, the bun is a carbohydrate, and the French fries and the milk both contain fat and protein, but both contain a lot of carbohydrates. The pasta and the sauce for the spaghetti are carbohydrates, the meatballs are protein, and the garlic bread is a carbohydrate, as is the cola drink. The grilled cheese sandwich has the fat and protein from the cheese, but the bread and chips are primarily carbohydrates, and the milkshake has fat, protein, and carbohydrates. Only the selection in A contains a ketogenic meal.

The nurse is providing home care instructions for a 13-year-old girl recently diagnosed with systemic lupus erythematosus. Which response by the girl indicates a need for further teaching? Select one: A. "I need an eye examination every year." B. "I need to be careful when it is cold; I should always wear gloves." C. "I need to eat a healthy diet, exercise, and get plenty of sleep." D. "I need to wear sunscreen in the summer to prevent rashes."

D The nurse needs to emphasize that the girl should apply sunscreen every day, not just in the summer, to prevent rashes resulting from photosensitivity. A healthy diet, sleep, yearly eye examinations, and protection from cold weather are appropriate measures.

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? Select one: A. "We should leave his skin moist before applying medication or moisturizer." 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. "After bathing, I need to rub his skin everywhere to make sure he is completely dry."

D 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.

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? Select one: A. "He must take calcium at breakfast and phosphorus at bedtime." B. "He must take vitamin D as prescribed and spend some time in the sunlight." C. "We should encourage him to have fish, dairy, and liver if he will eat it." D. "We must give him calcium and phosphorus with food every morning."

D 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.

The nurse is caring for a child who has undergone stem cell transplantation for severe combined immune deficiency. Which of the following would the nurse interpret as indicative of graft-versus-host disease? Select one: A. Presence of wheezing B. Chronic or recurrent diarrhea C. Splenomegaly D. Maculopapular rash

D The nurse should monitor the stem cell transplant child closely for a maculopapular rash that usually starts on the palms and soles for indication that graft-versus-host disease is developing. Wheezing and recurrent diarrhea are not typical clinical manifestations of graft-versus-host disease. Splenomegaly is associated with hypogammaglobulinemia.

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: Select one: a. Explaining playroom policies. b. Taking the child on a tour of the unit. c. Letting the child touch equipment that will be used during the hospitalization. d. Orienting the child to where furniture is placed in the room.

D 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. Policies, handling equipment, and tours can be done at a later time.

A group of students are reviewing information about fluid balance and losses in children in comparison to adults. The students demonstrate a need for additional review when they identify which of the following? Select one: A. Fever plays a greater role in insensible fluid losses in infants and children. B. Children have a proportionately greater amount of body water than do adults. C. A higher metabolic rate plays a major role in increased insensible fluid losses. D. The infant's immature kidneys have a tendency to overconcentrate urine more.

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

The nurse is caring for a newborn with micrognathia, cleft palate, and glossoptosis. The child is experiencing respiratory distress with severe retractions. What is the priority nursing intervention? Select one: a. Begin bag and mask ventilation b. Place an oxygen hood on the child c. Place an NG/OG to decompress the stomach d. Place the child in a prone position

D This child exhibits signs of Pierre Robin sequence (small chin, cleft palate, drooping tongue). The accompanying respiratory distress is related to the tongue occluding the airway. Positioning the child prone allows the tongue to fall forward, thereby relieving the obstruction, partially or completely. This is the priority intervention because it opens the airway, is fast, requires no order and will support the child while additional interventions are reviewed.

The nurse is caring for a previously healthy 3-month-old girl hospitalized with RSV Bronchiolitis. Which of the following treatments does the nurse expect to utilize during the course of this child's care? Select all that apply. Select one or more: A. Humidification via mask or nebulizer B. Intravenous antibiotics C. Oxygen via tent D. Suctioning with a bulb syringe E. Maintenance IV fluids F. Nasopharygeal suction

D, E, F

A nursing student is reviewing information about primary immunodeficiencies. The student demonstrates understanding of the material by identifying which of the following as affecting only males? Select all answers that apply. Select one or more: A. Selective IgA deficiency B. IgG subclass deficiency C. Severe combined immune deficiency D. X-linked agammaglobulinemia E. Wiskott-Aldrich syndrome F. X-linked hyper-IgM syndrome

D, E, F X-linked agammaglobulinemia, Wiskott-Aldrich syndrome, and X-linked hyper-IgM syndrome affect males only. Selective IgA deficiency, IgG subclass deficiency, and severe combined immune deficiency affect boys and girls.

Which of the following are important nursing interventions when caring for an infant with a myelomeningocele in the preop stage? 1. Place infant prone with knees slightly flexed 2. Apply a heat lamp to facilitate drying and toughening of the sac 3. Cover the sac with a sterile dressing, using betadine to prevent infection 4. Measure head circumference daily Select one: a. 2 and 3 only b. 1, 3, and 4 only c. 1 and 3 only d. 2, 3, and 4 only e. 1 and 4 only

E Early in the preop phase (>10 hours before surgery) the child could be fed with head turned to one side. Since the question did not specify where in the pre-op process we are, I accepted both answers.

Discuss the differences between fetal circulation and neonatal circulation, including structural, pressure, and blood flow changes.

In fetal circulation, mixed blood enters the right atrium from the IVC. Some (Part A) passes through the foramen ovale into the Left atrium, then to the Left ventricle and out the aorta. Some (Part B) continues through to the Right ventricle and out the Pulmonary Artery. From the Pulmonary Artery, blood (Part B) goes to the lungs and back to the Left Atrium, and some (Part C) shunts through the ductus arteriosus to the Aorta. In the fetal heart, pulmonary vascular resistence is high and pressure is relatively high in the right heart. With the child's first breaths, the lungs expand, decreasing pulmonary vascular resistance to blood flow. Blood flow to the lungs then increases as does blood return to the heart from the lungs. The increased flow to the left side of the heart results in an increase in pressure in the Left atrium. This allows the foramen ovale to close. Likewise, decreased pulmonary vascular resistance results in lower pressure in the PA and less flow through the ductus arteriosus, allowing it to close. There will no longer be mixed blood. The Right heart will contain deoxygenated blood, and the Left heart oxygenated.

A 10-month-old is brought to the emergency department by her parents after they found her face down in the bathtub. The mother said, "I just left the bathroom to answer the phone. I came right back, but she had fallen in the water. We brought her in to make sure everything was okay." The child is awake and appears alert. She is playing on the mother's lap. Explain to these parents why the child is being admitted.

The main issue in a near drowning incident is hypoxia. Although the child is awake and alert and looks like there was no damage done, serious complications such as cerebral edema and respiratory distress can take up to 12 hours after the near drowning incident to occur. It is crucial that they are in a hospital setting and monitored for atleast 24 hours so if either one of these conditions occur so they can be treated quickly and appropriately. All submersion victims should be admitted for 24 hour observation, even if asymptomatic. Respiratory distress and cerebral edema may not present for 12 hours. The anoxic event can lead to cerebral edema and increased ICP, resulting in secondary injury to the brain.

Ethan is a 5-week-old male admitted with a moderate size VSD. Discuss the findings in his health history may have led to this diagnosis. Then record what you would teach his parents about the pathophysiology of VSD.

With smaller VSD's it is common that they are asymptomatic and will go undiagnosed. However with a moderate-large size VSD you will see S/S of increased pulmonary blood flow which include Right Ventricular hypertophy and pulmonary hypertension. You will see a health history of poor feeding, dyspnea, and failure to thrive d/t inability to take in enough caloric intake, and the pt. will become cyanotic with02 levels ranging from 50-90% and an increase in C02 in blood. VSD will lead to increased pulmonary blood flow due to the shunting of blood from high to low pressure (Left Ventricle --> Right Ventricle). Over time as the R. Ventricle continues getting increased amount of blood the R. side of the heart will hypertrophy and the shunting will then occur R. ventricle to L. ventricle because they are able to overcome the pressure differences. Eventually this will develop into R. sided heart failure and pulmonary HTN. Health history expected answers (not physical assessment): Fatigue Sweating Color change with feeding Poor weight gain Pulmonary infections Edema Tachypnea (Not physical assessment & clubbing is unlikely in a 5-week-old. Patho (other teaching is good, but doesn't count for this question): Hole between ventricles. Left to right shunting Results in increased pulmonary flow. Lower resistance in PA means even more blood goes that direction than out the AO. Excess fluid can back up in the lungs, increasing the pressure in the PA. Pulmonary hypertension can develop. Followed by RV hypertrophy and heart failure.

The nursing receives report on the following patients: A 3-month-old infant with bronchiolitis who has expiratory wheezing in the upper lobes, decreased lung sounds in the bases and a respiratory rate of 25. A 6-month-old infant with Respiratory Syncitial Virus who has expiratory wheezing a respiratory rate of 71 breaths per minute. A 2-year-old with pneumonia who has expiratory wheezing and a respiratory rate of 55. A 3-year-old with croup who has a barking cough and a respiratory rate is 32. Which patient should the nurse see first?

1 The 3-month-old is demonstrating signs of respiratory failure and should be assessed first. As the youngest, this child will have the least reserves and is demonstrating diminished lung sounds and a respiratory rate lower than expected for age and condition. The 6-month-old would likely be assessed next due to the high respiratory rate and the potential for additional compromise.

The nurse uses family-centered care to care for children in a pediatric office. Upon what concept is family-centered care based? Select one: A. The family is the constant in the child's life and the primary source of strength. B. The wishes of the family should direct the nursing care plan for the child. C. The child must be prepared to be his or her own source of strength during times of crisis. D. The care provider is the constant in the child's life and the primary source of strength.

A Family-centered care involves a partnership between the child, family, and health care providers in planning, providing, and evaluating care. Family-centered care enhances parents' and caregivers' confidence in their own skills and also prepares children and young adults for assuming responsibility for their own health care needs. It is based on the concept that the family is the constant in the child's life and the primary source of strength and support for the child.

A 5-month-old child comes to the clinic for a well-child check and catch-up immunizations. Family has low income, but child's weight and length are appropriate for age. What teaching can the nurse provide to promote good oral health? Select all that apply. Select one or more: a. As soon as the baby's teeth come in, brush them every day. b. Baby teeth are important for speech development and good nutrition. c. Wipe the gums every day with a clean cloth or gauze. d. Start brushing the child's teeth every day when the first molars come in. e. Baby bottle tooth decay rarely occurs in infants under 18 months of age, so the child should stop using a bottle at one year old.

A, B, C

When caring for a child with a ventricular septal defect (VSD), the nurse should monitor for which clinical manifestations of hemodynamic alterations (Choose all that apply.) Select one or more: a. Fatigue b. Tachypnea c. Dyspnea d. Bradycardia e. Pulmonic murmur

A, B, C VSD is an abnormal connection between the right and left ventricles. Tachypnea, dyspnea, and fatige are clinical manifestations that may inddicate worseneing hemodynamics and possible congestive heart failure. Pulmonic murmur, bradycardia, and anxiety are not manifestations of hemodynamic changes in bentricular septal defects. Application and assessment.

The nurse is preparing to administer medication to a child with a gastrostomy tube in place. Which of the following are recommended for this procedure? Select all answers that apply. Select one or more: A. Flush the tube with water after administering medications. B. Verify medications can be crushed/opened and can be given via tube. C. Mix liquid medications with a small amount of water and add directly into the tube. D. Open up capsules and mix the contents with warm water E. Crush tablets and mix with warm water to prevent tube occlusion. F. Mix powdered medications well with cold water first.

A, B, D, E

A nurse is instituting neutropenic precautions for a child. Which of the following would the nurse most likely include? Select all answers that apply. Select one or more: A. Placing a mask on the child when outside the room B. Placing the child in a semiprivate room C. Avoiding rectal exams, suppositories, and enemas D. Discouraging fresh flowers in the child's room E. Encouraging an intake of raw fruits and vegetables

A, C, D Generally, neutropenic precautions include placing the child in a private room; avoiding rectal suppositories, enemas, and examinations; placing a mask on the child when outside the room; avoiding the intake of raw fruits and vegetables; and not permitting fresh flowers or live plants in the room.

The nurse is teaching the parents of a child diagnosed with iron-deficiency anemia about ways to increase their child's intake of iron. The parents demonstrate understanding of the teaching when they identify which foods as good choices for the child? Select all that apply. Select one or more: A. Salmon B. Cow's milk C. Tuna D. Tofu E. Dried fruits

A, C, D, E Foods high in iron include red meats, tuna, salmon, eggs, tofu, enriched grains, dried beans and peas, dried fruits, leafy green vegetables, and iron-fortified breakfast cereals.

The mother of an 8-year-old girl with a broken arm is the nurturer in the family. Which nursing activity should be focused on her? Select one: A. Transmitting information to family members B. Teaching proper care procedures C. Determining success of treatment D. Dealing with insurance coverage

The nurse is assessing a toddler for temperament and documents a "difficult" temperament. Which of the following is a trait of this type of personality? Select one: A. Moodiness B. Irritability C. Overly active D. Even-temperedness

When assessing the adolescent with anorexia, which of the following would the nurse expect to find? Select one: A. Hypertension B. Murmur C. Tachycardia D. Fever

B An adolescent with anorexia often exhibits a low body temperature, bradycardia, hypotension, and a murmur resulting from mitral valve prolapse.

The nurse is examining a 15-month-old child who was able to walk at the last visit and now can no longer walk. What would be the nurse's best intervention in this case? Select one: A. Document the findings as a developmental delay since this is a normal occurrence. B. Schedule a full evaluation since this may indicate a neurologic disorder. C. Note the regression in the child's chart and recheck in another month. D. Ask the parents if they have changed the child's schedule to a less active one.

B Any child who "loses" a developmental milestone—for example, the child able to sit without support who now cannot—needs an immediate full evaluation, since this indicates a significant neurologic problem.

The nurse is caring for a 3-year-old boy with encephalitis. Which of the following actions would demonstrate atraumatic care? Select one: A. Explaining, in medical terms, what will happen B. Providing EMLA (lidocaine) prior to lumbar puncture C. Starting the child's IV in his room D. Having his anxious mother stay in the waiting room

B Atraumatic care is a philosophy of providing therapeutic care through interventions that minimize physical and psychological distress for children and their families. Providing EMLA (lidocaine) prior to lumbar puncture is an example of atraumatic care. An anxious mother does not need to stay in the waiting room. The presence of a parent during procedures is supportive to the child and should be encouraged because it can reduce stress. The explanation of what will happen should be on the child's level, and the child should be removed from his or her hospital room for an IV insertion in order to keep the child's room a "safe haven."

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 of the following? Select one: 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.

B 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.

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? Select one: A. Once the rash appears B. After the lesions have crusted C. When the rash is completely healed D. After day 5 of the rash

B Children with chickenpox (varicella zoster) can return to school once the lesions have crusted.

The nurse is teaching a couple about X-linked disorders. They are concerned that they might pass on hemophilia to their children. Which of the following responses indicates the need for further teaching? Select one: A. "If the mother is a carrier, her sons may have hemophilia." B. "If the father doesn't have it, then his kids won't either." C. "If the mother is a carrier, her daughter could be one too." D. "The father can't be a carrier if he doesn't have hemophilia."

B Hemophilia is an X-linked recessive disorder. This means that both the father and the mother must have the gene for hemophilia to pass it on to their children. Also, their male children will have hemophilia, while their female children have only a 50% chance of having the disorder. If the father has hemophilia and the mother has hemophilia, their children will have the disease. If the father has hemophilia and the mother is a carrier, all their children have a 50% chance of getting the disease.

The nurse is working with a hospitalized preschool-age child. The nurse is planning activities to reduce anxiety in this child. Which is the most appropriate action by the nurse? Select one: a. Use an anatomically correct doll to teach the child about the illness. b. Provide the child with a doll and safe medical equipment to manipulate. c. Talk to the child about the hospitalization. d. Read a story to the child.

B Manipulation of equipment decreases stress in a preschool child.

Prior to administering morphine to a 10-year-old child, the nurse reviews the adverse effects of the drug. Which system is primarily affected by the drug causing most of the adverse effects? Select one: A. Peripheral nervous system B. Central nervous system C. Digestive system D. Musculoskeletal system

B Opioid agonists, such as morphine, are associated with numerous adverse effects, resulting primarily from their depressant action on the central nervous system.

The nurse working with children in a hospital setting notes that they are being discharged earlier and earlier. Which of the following is a primary reason for this trend? Select one: A. National health care initiatives B. Cost containment C. Increased funding for home care D. Nursing shortages

B Over the past century changes in health care, such as strained health care funding, shorter hospital stays, and cost containment, have led to a shift in responsibilities of care for children from the hospital to homes and communities. Nursing shortages influence the delivery of health care. National health care initiatives may or may not affect earlier discharge to home health care.

The nurse is counseling the parents of a 9-year-old boy who is receiving morphine for postoperative pain. Which of the following statements from the nurse accurately reflects the pain experience in children? Select one: A. "Your child will learn to adapt to the pain he is experiencing." B. "You can expect that your child will tell you when he is experiencing pain." C. "It is very rare that children become addicted to narcotics." D. "Your child will experience more adverse effects to narcotics than adults."

C Addiction to narcotics when used in children is very rare. Often children deny pain to avoid a painful situation or procedure, embarrassment, or loss of control. Repeated exposure to pain or painful procedures can result in an increase in behavioral manifestations. The risk of adverse effects of narcotic analgesics is the same for children as for adults.

The nurse is examining a 2-year-old child who was adopted from Guatemala. Which of the following would be a priority screening for this child? Select one: A. Screening for childhood illnesses B. Screening for abuse C. Screening for infectious diseases D. Screening for congenital defects

C Although all the screenings are important, health supervision of the internationally adopted child must include comprehensive screening for infectious disease. In 2008, approximately 19,600 children were adopted from countries outside the United States, many from areas with a high prevalence of infectious diseases (Intercountry Adoption, Office of Children's Issues, U.S. Department of State, 2010a, 2010b). Guatemala, China, and Russia supplied about half of all international adoptees in 2008, followed by Ethiopia, South Korea, and Vietnam. Proper screening is important not only to the child's health but also to the adopting family and the larger community.

The nurse is caring for children who are receiving IV therapy in the hospital setting. For which of the following children would a central venous device be indicated? Select one: A. A child who is receiving IV fluids for dehydration B. A child who is receiving a one-time dose of a medication C. A child who is receiving chemotherapy for leukemia D. A child who is receiving an IV push

C Although central venous access devices can be used short term, the majority are used for moderate- to long-term therapy, such as chemotherapy. Central venous access devices are indicated when the child lacks suitable peripheral access, requires IV fluid or medication for more than 3 to 5 days, or is to receive specific treatments, such as the administration of highly concentrated solutions or irritating drugs that require rapid dilution. Peripheral IV devices are used for most other IV therapies.

A 10-year-old girl is living with a foster family. Which intervention is the priority for the child in this family structure? Select one: A. Determining if the child is being bullied at school B. Establishing who is the child's actual caretaker C. Performing a comprehensive health assessment D. Dealing with mixed expectations of parents

C Because the child may have lived with several different families and may not have complete medical files, performing a comprehensive health assessment will be important. Determining if the child is being bullied at school is not specific to any one family structure. Assessing for problems related to mixed expectations of parents is common to a blended family. Establishing the identity of the caretaker is necessary with a communal family.

The nurse is taking a health history of a 6-week-old boy with a suspected cardiovascular disorder. Which of the following responses by the mother would lead the nurse to suspect that the child is experiencing heart failure? Select one: a. "He does not seem sick." b. "He seems to have a normal appetite." c. "He gets sweaty when he eats." d. "He does not seem short of breath."

C Diaphoresis with nipple feeding indicates heart failure. Shortness of breath would suggest heart failure. Children with heart failure experience subtle signs that suggest that something is wrong. Children with heart failure often display subtle signs such as difficulty feeding

The nurse is functioning in the primary role to care for a 12-year-old boy with metastatic cancer in the liver. Which of the following activities is typical of advocacy? Select one: A. Telling parents about clinical guidelines B. Teaching the family about types of cancers C. Educating the family about choices they have D. Instructing parents about proper home care

C Educating the family about choices they have regarding therapies for the cancer in the child's liver is an example of advocacy, in which the nurse advances the interests of the child and family by informing them of options and assisting them to make informed decisions. Telling parents about proper home care, clinical guidelines, and the types of cancers are all done in the primary role of educator.

The nurse knows that the emancipated minor is considered to have the legal capacity of an adult and may make his or her own health care decisions. Which of the following children would potentially be considered an emancipated minor? Select one: A. A child older than 13 years of age who asks for emancipation B. A minor with financial independence who is living with his parents C. A minor who is pregnant D. A minor who puts his or her medical decisions in writing

C Emancipation may be considered in any of the following situations, depending on the state's laws: membership in a branch of the armed services, marriage, court-determined emancipation, financial independence and living apart from parents, college attendance, pregnancy, mother younger than 18 years of age, and a runaway.

A parent of four children being interviewed by the nurse states: "Whatever my husband and I say goes and the kids need to follow our rules without complaining about them." What type of parenting style does this attitude represent? Select one: A. Rejecting-neglecting B. Permissive C. Authoritative D. Authoritarian

C Four major parenting styles seen in our society are authoritarian, authoritative, permissive, and rejecting-neglecting. The authoritarian parent expects obedience from the child and discourages the child from questioning the family's rules. The authoritative or democratic parent shows some respect for the child's opinions. Permissive or laissez-faire parents have little control over the behavior of their children. Rejecting or neglecting parents are indifferent or uninvolved.

The nurse is caring for a 12-year-old child hospitalized for internal injuries following a motor vehicle accident. For which of the following medical treatments would the nurse need to obtain an informed consent beyond the one signed at admission? Select one: A. Diagnostic imaging B. Cardiac monitoring C. Blood testing D. Spinal tap

D Most care given in a health care setting is covered by the initial consent for treatment signed when the child becomes a patient at that office or clinic or by the consent to treatment signed upon admission to the hospital or other inpatient facility. Certain procedures, however, require a specific process of informed consent, including major and minor surgery; invasive procedures such as lumbar puncture or bone marrow aspiration; treatments placing the child at higher risk, such as chemotherapy or radiation therapy; procedures or treatments involving research; photography involving children; and applying restraints to children.

For which of the following children would nonopioid analgesics be recommended? Select one: A. A child with end-stage cancer B. A child with severe postoperative pain C. A child with a broken arm D. A child with juvenile arthritis

D Nonopioid analgesics may be used to treat mild to moderate pain, often for conditions such as arthritis; joint, bone, and muscle pain; headache; dental pain; and menstrual pain. Opioid analgesics are typically used for moderate to severe pain as can occur with cancer, broken bones, and postoperative healing.

The nurse is caring for a 9-year-old boy who is having chemotherapy. The nurse is developing a teaching plan for the child and family about nutrition. Which of the following would the nurse be least likely to include? Select one: A. Featuring high-fiber foods if opioid analgesics are being taken B. Emphasizing the intake of grains, fruits, and vegetables C. Concentrating on consuming primarily high-calorie shakes and puddings D. Avoiding milk products if diarrhea is a problem

C Providing high-calorie shakes and puddings with diet restrictions can help with weight gain, if that is a problem. However, concentrating on high-calorie shakes and puddings is not a good strategy. It is best to provide a balanced diet emphasizing grains, fruits, and vegetables. If pain is being treated with opioid analgesics, featuring high-fiber foods is important to help relieve constipation. Avoiding milk products is a good idea if diarrhea is a problem because lactose can make diarrhea worse.

The nurse is caring for a 7-year-old girl hospitalized in isolation. The nurse notices that she has begun sucking her thumb and changing her speech patterns to those of a toddler. What condition is the girl manifesting? Select one: A. Suppression B. Repression C. Regression D. Denial

C Sucking the thumb and changing the speech pattern (such as to baby talk) are signs of regression, a defense mechanism used by children to deal with unpleasant experiences by returning to a previous stage that may be more comfortable to the child. Suppression is a conscious inhibition of an idea or desire. Repression is an unconscious inhibition of an idea or desire. Denial would be exhibited by expressions of resignation instead of true contentment, not thumb sucking or baby talk.

The nurse is administering a number of therapeutic interventions for neonates, infants, and children on the pediatric unit. Which of these interventions contributes to an increase in chronic illness seen in early childhood? Select one: A. Using corticosteroids as a treatment for asthma B. Administering antibiotics to prevent lethal infections C. Using mechanical ventilation for premature infants D. Vaccinating children to prevent childhood diseases

C Using mechanical ventilation and medications to foster lung development in premature infants increases their survival rate. Yet the infants who survive are often faced with myriad chronic illnesses. Administering antibiotics to prevent lethal infections, vaccinating children to prevent childhood diseases, and using corticosteroids as a treatment for asthma may cause side effects, but do not contribute to chronic illness in children.

The nurse is assessing the "resilience" of a 16-year-old boy. Which of the following is an example of an external protective factor that may help to promote resiliency in this child? Select one: A. His ability to accept his own limitations B. His knowledge of when to continue or stop with goal achievement C. His ability to take control of his own decisions D. His caring relationship with members of his family

The nurse is caring for four clients. The client with the highest risk of developing retinopathy of prematurity is the: Select one: a. 28-weeks'-gestation infant who was on short-term oxygen and weighed 1420 g. b. 32-weeks'-gestation infant who needed no oxygen and weighed 1850 g. c. 30-weeks'-gestation infant who was in an Oxy-Hood for 12 hours and weighed 1800 g. d. 28-weeks'-gestation infant who has been on long-term oxygen and weighed 1400 g.

The nurse is monitoring a child who has received epidural analgesia with morphine. The nurse is careful to monitor for which of the following adverse effects of the medication? Select one: A. Epidural hematoma B. Spinal headache C. Arachnoiditis D. Respiratory depression

A 28-day-old infant with a fever is admitted to rule out sepsis. Blood, urine, and CSF cultures are drawn and the child is placed on IV antibiotics. The following day the urine culture comes back positive. The nurse knows that a common cause of UTI in a child this age is: Select one: a. Ureteral pelvic junction obstruction b. Nephrotic syndrome c. Hypospadias d. Vesicoureteral reflux

D 70% of young children diagnosed with UTI have vesicoureteral reflux, a condition in which urine from the bladder flows back up the ureters. This reflux of urine occurs during bladder contraction with voiding.

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. Which of the following would the nurse have most likely assessed? Select one: A. Toxic appearance B. Dysphagia C. High fever D. Inspiratory stridor

D A child with croup typically develops a barking-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.

The nurse is planning care for a child with hemolytic uremic syndrome. The child has been anuric and is scheduled for a peritoneal dialysis catheter insertion. While waiting for the catheter insertion to be scheduled, the nurse plans to: Select one: a. Give stool softners to prevent constipation. b. Administer analgesics. c. Encourage foods high in potassium. d. Restrict fluids as prescribed.

D Children in renal failure would have fluid restrictons while waiting for dialysis.

The nurse is caring for a newborn infant who has Down syndrome. Which of the following nursing actions reflects the nurse's use of the ethical principle of nonmaleficence? Select one: A. The nurse speaks truthfully to the parents regarding their child's prognosis. B. The nurse fairly allocates resources for caring for newborns in a facility. C. The nurse involves the parents in making health care decisions for their child. D. The nurse provides safe, competent nursing care to avoid harming the infant.

D Ethics includes the basic principles of autonomy, beneficence, nonmaleficence, justice, veracity, and fidelity. Nonmaleficence means avoiding causing harm, intentionally or unintentionally. One example is providing safe, competent nursing care. Speaking truthfully to the parents is an example of veracity. Generally, parents have the autonomy to make health care decisions for their child. Justice refers to acting fairly, and also involves allocating resources fairly.

A 2-week-old child responds to a bell during an initial health supervision examination. The child's records do not show that a newborn hearing screening was done. Which of the following is the best action for the nurse to take? Select one: A. Screen again with the bell at the 2-month-old health supervision visit. B. Ask the mother to observe for signs that the infant is not hearing well. C. Do nothing because responding to the bell proves he does not have a hearing deficit. D. Immediately schedule the infant for a newborn hearing screening.

D Guidelines for infant hearing screening recommend universal screening with an auditory brain stem response (ABR) or evoked otoacoustic emissions (EOAE) test by 1 month of age. All the other answers rely on behavioral observation. Studies have shown that behavioral observations are not a reliable method of screening for hearing loss.

A 5-year-old is in the playroom when the respiratory therapist arrives on the Pediatric Unit to give the child a scheduled breathing treatment. Which action should the nurse take? Select one: a. Show the respiratory therapist to the playroom so that the treatment can be performed. b. Postpone the treatment until the next scheduled time. c. Reschedule the treatment for a later time. d. Assist the child to the treatment room for the treatment, but reassure him that he may return when the procedure is completed.

D In pediatrics we often allow children to sleep rather than to wake them for procedures or feedings. However, play cannot be the priority over administration of medications. In addition, the playroom would provide a not private place for a treatment or medication administration which violates HIPAA; treatments in the playroom could also increase the spread pathogens. We do not do any traumatic treatment in the child's bed or hospital room rather they should be taken to the treatment room. In this case we don't know if the 5 y/o child finds his respitory treatment traumatic so the answer has you take him to the treatment room. For most 5 year olds this treatment could probably be done in their hospital room without causing stress.

The nurse is caring for a toddler with special needs. Which of the following developmental tasks related to toddlerhood might be delayed in the child with special needs? Select one: A. Learning through sensorimotor exploration B. Developing peer relationships C. Developing body image D. Developing language and motor skills

D In special needs children developmental delays may occur in all stages. In particular, motor and language skill development may be delayed if the toddler is not given adequate opportunities to test his or her limits and abilities. Development of body image may be hindered in the preschooler due to painful exposures and anxiety. Development of peer relationships may be delayed in the school-age and adolescent child. The infant's ability to learn through sensorimotor exploration may be impaired due to lack of appropriate stimulation, confinement to a crib, or increased contact with painful experiences.

The nurse is conducting a pain assessment of a 10-year-old boy who has been taking acetaminophen for chronic knee pain. The assessment indicates that the recommended dose is no longer providing adequate relief. What is the appropriate nursing action? Select one: A. Increase the dosage of the acetaminophen. B. Use guided imagery to help his pain. C. Tell the child he is experiencing the ceiling effect. D. Obtain an order for a different medication.

D Increasing the dose of the acetaminophen will not help his pain because he has reached as high a dose of that medication that will work. This is known as the ceiling effect, but explaining that to him will not help his pain. Additionally, acetaminophen is toxic to the liver and increasing the dose could be dangerous. Guided imagery is not the best therapy for his pain, so the physician needs to order a different medication to manage his pain.

Ordered: D5 1/2 NS with 20 mEq KCl/L at maintenance. Child weighs 7.6 kg. What is the appropriate hourly rate? Answer____ mL/hour

31.7 100 mL/kg/day up to 10 kg: 7.6 x 100 = 760 Maintenance for 24 hours: 760 ml

The caregiver of a child diagnosed with celiac disease tells the nurse that the child has large amounts of bulky stools and what looks like fat in his stools. The clinical manifestation this caregiver is describing is which of the following? Select one: a. Steatorrhea b. Current jelly stools c. Severe diarrhea d. Projectile stools

A Celiac disease/syndrome is used to designate the complex of malabsorptive disorders. Intestinal malabsorption with steatorrhea (fatty stools) is a condition brought about by various causes.

A nurse has just administered medication via an orogastric tube. What is the priority nursing action following administration? Select one: A. Flush the tube. B. Remove the tube. C. Retape the tube. D. Check tube placement.

An 8-year-old boy with Duchenne muscular dystrophy is being seen in the clinic for a routine health visit. An appropriate nursing diagnosis for this client would be: Select one: a. Risk for injury related to muscle weakness. b. Risk for impaired skin integrity related to paresthesia to lower extremities. c. Risk for infection related to altered immune system. d. Risk for altered comfort related to effects of muscular dystrophy disease.

The physician has ordered rectal diazepam (Valium) for a 2-year-old boy with status epilepticus. Which of the following instructions is essential for the nurse to teach the parents? Select one: A. Monitor their child's level of sedation. B. Watch for fever indicating infection. C. Gradually reduce the dosage as seizures stop. D. Monitor for an allergic reaction to the medication.

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. Which of the following would the nurse have most likely assessed? Select one: A. Inspiratory stridor B. High fever C. Toxic appearance D. Dysphagia

A A child with croup typically develops a barking-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.

The nurse working in the emergency room monitors the admission of children. Statistically, for which one of the following disorders would children younger than 5 years most commonly be admitted? Select one: A. Respiratory disorders B. Mental health problems C. Injuries D. Gastrointestinal disorders

A According to Child Health USA 2008-2009, diseases of the respiratory system account for the majority of hospitalizations in children younger than 5 years of age, while diseases of the respiratory system, mental health problems, injuries, and gastrointestinal disorders lead to more hospitalizations in older children.

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

A 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.

The nurse is caring for a child brought to the emergency department by a babysitter. The child needs emergency treatment and the parents cannot be contacted. What would be the nurse's best response to this situation? Select one: A. Document failed attempts to obtain consent to allow emergency care without consent. B. Have the primary care physician for the child sign the consent form. C. Delay medical care until the child's next of kin can be contacted. D. Have the babysitter sign the consent form even if she does not have signed papers to do so.

A Health care providers can provide emergency treatment to a child without consent if they have made reasonable attempts to contact the child's parent or legal guardian (American Academy of Pediatrics, Committee on Pediatric Emergency Medicine, 2007). If the parent is not available, then the person in charge may give consent for emergency treatment if that person has a signed form from the parent or legal guardian allowing him or her to do so. During an emergency situation, a verbal consent via the telephone may be obtained. In urgent or emergent situations, appropriate medical care never should be delayed or withheld due to an inability to obtain consent.

The nurse caring for an infant with myelomeningocele pre-operatively will prioritize care in what way? Select one: a. Cover the sac with a saline-moistened dressing b. Protect the infant from infection by irrigating the sac with betadine c. Prevent cold stress using an isolette and blankets d. Change position from side to side hourly e. Keep the mass uncovered and dry

A Protection of exposed neural tissue is of high priority. Keeping the cystic mass moist prevents damage to neural elements from drying. Blankets may cause trauma to the sac. An Isolette can be used for warmth, but much attention will have to be directed toward keeping the sac moist. Side-to-side hourly position changes increase the risk of damage to protruding nervous tissue. Unnecessary handling should be avoided.

The nurse is examining a 5-year-old boy. Which of the following signs or symptoms is a reliable first indication of acute respiratory illness in children? Select one: A. Rapid, shallow breathing B. Increasing lethargy C. A bluish tinge to the lips D. Slow, irregular breathing

A 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.

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, which of the following would be least appropriate for the nurse to perform? Select one: A. Visualizing the throat B. Providing 100% oxygen C. Having the child sit forward D. Auscultating for lung sounds

A 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.

The nurse is providing care to a child with an intussusception. The child has a bowel movement and the nurse inspects the stool. The nurse would document the stool's appearance most likely as which of the following? Select one: A. Currant jelly-like B. Greasy C. Clay-colored D. Bloody

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

The nurse is caring for an 8-year-old girl who requires medication that is only available in an enteric tablet form. The nurse is teaching the mother how to help the girl swallow the medication. Which of the following statements indicates a need for further teaching? Select one: A. "I can pinch her nose to make it easier to swallow." B. "We cannot crush this type of pill as it will affect the delivery of the medication." C. "I can encourage her to place it on the back of her tongue." D. "We can place the tablet in a spoonful of applesauce."

A The mother should be advised to never pinch the child's nose as it increases the risk for aspiration. The other statements are correct.

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? Select one: A. "I must carefully lift the baby from under the armpits." B. "I need to avoid pushing or pulling on an arm or leg." C. "We must avoid lifting the legs by the ankles to change diapers." D. "I should not bend an arm or leg into an awkward position."

A 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.

The charge nurse on a hospital unit is developing plans of care related to separation anxiety. The charge nurse recognizes that which hospitalized child is at greatest risk to experience separation anxiety when parents cannot stay? Select one: a. 18-month-old b. 3-year-old c. 4-year-old d. 6-month-old

A While all of these children can experience separation anxiety, the young toddler is at greatest risk. Toddlers are the group at greatest risk for a stressful experience when hospitalized. Separation from parents increases this risk greatly.

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? Select one: A. Fever B. Tachypnea with retractions C. Oxygen saturation level of 96% D. Pale skin color

B 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.

A child needs a consent form signed for a minor surgical procedure. Which of the following statements accurately describes the responsibilities of the health care providers when obtaining the consent? Select one: A. The physician is responsible for ensuring that the consent form is completed with signatures from the parents or legal guardians. B. The nurse is responsible for determining that the parents or legal guardians understand what they are signing by asking them pertinent questions. C. The physician is responsible for serving as a witness to the signature process. D. The nurse is responsible for informing the child and family about the procedure and obtaining consent.

B The nurse's responsibility related to informed consent includes the following: determining that the parents or legal guardians understand what they are signing by asking them pertinent questions, ensuring that the consent form is completed with signatures from the parents or legal guardians, and serving as a witness to the signature process. The physician or advanced practitioner providing or performing the treatment and/or procedure is responsible for informing the child and family about the procedure and obtaining consent by providing a detailed description of the procedure or treatment, the potential risks and benefits, and alternative methods available.

A 5-year-old is hospitalized with a fractured femur. Which of the following assessment tools are appropriate for this age child? Select all that apply. Select one or more: a. Visual analog scale b. Faces pain scale c. Poker chip tool d. Oucher scale e. CRIES scale

B, C, D

A nurse is preparing a class for parents of infants about managing diaper dermatitis. Which of the following would the nurse include in the presentation? Select all answers that apply. Select one or more: A. Applying topical nystatin to the diaper area B. Refraining from using rubber pants over diapers C. Using unscented diaper wipes to clean the area D. Use a barrier cream containing vitamins A, D, and E; zinc oxide; or petrolatum. E. Washing the diaper area with an antibacterial soap

B, C, D 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.

A 6-month-old is admitted for suspected Kawsaki Disease. Which of the following treatments and nursing interventions are appropriate for this patient? Select one or more: a. Antibiotic administration b. IVIG administration c. Fever management d. Strict intake and output e. High dose aspirin

B, C, D, E

The nurse is performing developmental surveillance for children at a medical home. Which of the following infants are most at risk for developmental delays? Select all answers that apply. Select one or more: A. A child with gestational age more than 33 weeks B. A child whose parent has a mental illness C. A child raised by a single parent D. A child whose birthweight was 1,800 g E. A child with a lead level above 20 mg/dL F. A child with hypertonia or hypotonia

B, C, E, F Risk factors for developmental delays include having a single parent, a parent with developmental disability or mental illness, hypertonia or hypotonia, birthweight less than 1,500 g, lead level above 19 mg/dL, and gestational age less than 33 weeks.

The nurse is providing atraumatic care to children in a hospital setting. Which of the following are principles of this philosophy of care? Select all answers that apply. Select one or more: A. Minimize child control B. Avoid or reduce painful procedures C. Use core primary nursing D. Provide child-centered care E. Minimize parent-child interactions F. Avoid or reduce physical distress

B, C, F When using atraumatic care, the nurse would avoid or reduce painful procedures, avoid or reduce physical distress, use core primary nursing, maximize parent-child interactions, provide family-centered care, and provide opportunities for control, such as participating in care, attempting to normalize daily schedule, and providing direct suggestions.

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

B, D 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.

A 2-year-old child recently diagnosed with epiglottitis will be discharged home on an antibiotic. Which action by the mother best demonstrates understanding of how to give the medication? The mother: Select one: a. Verbalizes how to give the medication. b. Observes the nurse draw up the medication and administer it to the child. c. Draws up the medication correctly in an oral syringe and administers it to the child. d. Acknowledges understanding of written instruction.

A child has been admitted to the hospital unconscious. The child has a history of insulin-dependent diabetes mellitus, and according to the child's mother, he took a normal dose of insulin this morning with breakfast. At school, the child had two pieces of birthday cake and some ice cream at a class birthday party. What is the likely reason for this child's unconscious state? Select one: a. Insulin shock b. Metabolic alkalosis c. Metabolic ketoacidosis d. Insulin reaction

After teaching a group of nursing students about shock in children, the instructor determines that the teaching was successful when the students identify which type of shock as most common? Select one: A. Septic B. Cardiogenic C. Hypovolemic D. Distributive

An unresponsive toddler is brought to the emergency department. Rapid assessment reveals mottled skin color, respiratory rate of 10 breaths per minute, and a brachial pulse of 52 bpm. What is the priority nursing action? Select one: a. Start chest compressions and provide 100% oxygen via non-rebreather mask. b. Prepare the defibrillator and draw up code medications. c. Start chest compressions and provide 100% oxygen with a bag-valve-mask device. d. Begin an IV fluid infusion and administer epinephrine IV.

Parents are told by the gentic counselor that they have a 1:4 probability of having a second child with cystic fibrosis (CF). They already have one child who is affected. The parents state their risk is lower now than when they had the previous child. What should the nurse tell the parents about the 1:4 probability? Select one: a. The probability of having another child with CF is twice as likely as it was when they had the first child. b. The probability of having a healthy child is twice as likely with this pregnancy. c. Each pregnancy is an independent event. d. The probability of miscarrying is greater now than with the previous pregnancy.

The nurse is assessing a small-for-gestational-age newborn who had an older sibling who died of sudden infant death syndrome. Knowing this, the nurse must include which in the plan of care for the newborn? Select one: a. Encourage the parents to place the infant on his abdomen to sleep. b. Encourage the parents to sleep with the infant for close observation. c. Encourage the parents to place the infant in a crib with a tight-fitting, firm mattress. d. Encourage the parents to place the infant in a crib with a soft mattress with extra blankets.

The nurse is caring for a 2-year-old girl who is wheezing and has difficulty breathing. Which interview question would provide the most useful information related to the symptoms of the child? Select one: A. Asking about the child's diet B. Asking about the temperament of the child C. Asking the parents if they smoke in the home D. Inquiring about child safety in the home C

After teaching a group of parents about ear infections in children, which statement indicates that the teaching was successful? Select one: A. Adenoids shrink as the child grows, allowing more bacteria to enter. B. Ear infections typically increase as the child gets older. C. The shorter and wider eustachian tubes of an infant increase the risk. D. Infants with congenital deformities have an increased risk for ear infections.

A 34-day-old infant weighing 3.4 kg is admitted with suspected Herpes encephalitis. He has an IV in place and is receiving compatible maintenance IV fluid and his first dose of Acyclovir 60 mg. The drug book information on dosing is as follows: Acyclovir Route/dosage Herpes Simplex Encephalitis IV (Adults): 10 mg/kg q 8 hr for 14-21 days. IV (Children 3 mo - 12 yr): 10 mg/kg q 8 hr for 14-21 days. IV (Children birth - 3 mo): 20 mg/kg q 8 hr for 14-21 days. IV (Neonates, premature): 10 mg/kg q 12 hr for 14-21 days. What is the priority nursing intervention at this point? Select one: a. Increase the maintenance IV fluid rate to dilute the acyclovir infusion. b. Assess IV site for any sign of infiltration or phlebitis. c. Complete a full assessment, including evaluation of neurologic status. d. Stop the infusion & notify the physician.

C The maximum recommended dose for a child this weight is 68 mg. Renal failure, seizures, and other life-threatening sequelae may occur with overdose, but this dose is within safe range. Assessment is the first priority.

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

C 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.

The nurse is preparing to administer ear drops to a 6-year-old. To ensure that the medication is instilled properly, the nurse does which of the following? Select one: A. Pulls the pinna downward and back B. Pulls the pinna upward C. Pulls the pinna upward and back D. Pulls the pinna downward

C The nurse should pull the pinna upward and back for children 3 years of age and older. The nurse should pull the pinna downward and back for children younger than 3 years of age.

The nurse is caring for a child who is receiving total parenteral nutrition (TPN) for failure to thrive. Which of the following nursing actions might the nurse take to prevent complications from this therapy? Select one: A. Secure all connections and open the catheter during tubing and cap changes. B. Ensure that the system remains an open system at all times. C. Use occlusive dressings and chlorhexidine-impregnated sponge (Biopatch) dressings. D. Adhere to clean technique when caring for the catheter and administering TPN.

C The nurse should use occlusive dressings and chlorhexidine-impregnated sponge (Biopatch) dressings to help prevent infection. The nurse should always follow agency or institution policy and procedures, adhere to strict aseptic technique when caring for the catheter and administering TPN, ensure that the system remains a closed system at all times, and secure all connections and clamp the catheter or have the child perform the Valsalva maneuver during tubing and cap changes.

The nurse has applied EMLA cream as ordered. How does the nurse assess that the cream has achieved its purpose? Select one: A. Assess the skin for redness. B. Gently poke the child with a needle. C. Lightly tap the area where the cream is. D. Note any blanching of skin.

C The nurse should verify that sensation is absent by lightly tapping or scratching the area. Blanching or redness indicates that the medication has penetrated the skin adequately but does not indicate that sensation is absent. Using a needle to poke the skin would likely frighten the child.

The nurse is providing care to an ill child and his family. Which of the following activities reflects the use of the assessment step of the nursing process when providing care for children? Select one: A. Developing a care plan that incorporates child goals B. Evaluating care provided by the interdisciplinary team C. Collecting data about the child and family D. Analyzing data to make judgments about the child's health state

C The nursing process is applicable to all health care settings and consists of five steps: assessment, nursing diagnosis, outcome identification and planning, implementation, and outcome evaluation. Collecting data about the child and family occurs in the assessment step of the nursing process. Analyzing data to make judgments about the child's health state involves nursing diagnosis, evaluating care provided by the interdisciplinary team is performed in the outcome evaluation, and developing a care plan that incorporates child goals occurs in the planning stage.

The nurse is preparing to administer an intramuscular injection to an 8-month-old infant. Which site would the nurse select? Select one: A. Rectus femoris B. Dorsogluteal muscle C. Vastus lateralis D. Deltoid

C The preferred injection site in infants is the vastus lateralis muscle. An alternative site is the rectus femoris. The dorsogluteal site is not used in children until the child has been walking for at least 1 year. The deltoid muscle is used as a site in children after the age of 4 or 5 years.

A 4-month-old is brought to the Emergency Department for evaluation of constipation which began about a week ago. Mother states the child is not feeding well. On assessment, the nurse notes a weak cry, drooping eyelids, and overall floppy muscle tone. Which of the following is the priority nursing action? Select one: a. Obtain stool and blood cultures and place an IV for antibiotics. b. Place a feeding tube since the child will have a decreased gag reflex. c. Ensuring that airway managment equipment, including a bag & mask and intubation supplies, is readily available. d. Instruct the mother not to try feeding the child until the constipation is more fully evaluated.

C This child has many signs and symptoms of infantile botulism. He could lose the ability to manage his airway at an moment. These children are unstable and will require airway management at some point. This is the priority nursing intervention.

The nurse is assessing a family to determine if they have access to adequate health care. Which of the following statements accurately describes how certain families are affected by common barriers to health care? Select one: A. The overall health care plan of working families may improve access to specialty care but limit access to preventive services. B. The proportion of children between the ages of 6 and 18 who are overweight is decreasing, but a large increase is occurring in African American females. C. White, non-Hispanic children overall are more likely than African American and Hispanic children to be in very good or excellent health. D. After a decade of escalation, the percentage of children living in low-income families has been on the decline since 2000.

C White, non-Hispanic children overall are more likely than African American and Hispanic children to be in very good or excellent health. After a decade of decline, the percentage of children living in low-income families has been on the rise since 2000. In 2005, 39% of children were living in low-income families and 18% were living in poor families (Douglas-Hall & Chau, 2008). The proportion of children between the ages of 6 and 18 who are overweight is increasing, but the largest increase is occurring in African American females (ChildStats.gov Forum on Child and Family Statistics, 2010). The overall plan may improve access to preventive services but may limit the access to specialty care, which has a major impact on children with chronic or long-term illnesses.

A nurse is assessing an adolescent admitted for a severe ventroperitoneal shunt infection. Which of the following assessment findings would the nurse expect to see? Select one or more: a. Bulging fontanel b. Positive Babinski sign c. Vomiting d. Loss of coordination or balance e. Redness along the shunt tract

C, D, E Shunt infections present with signs of infection, such as fever or redness near the site, and signs of shunt malfunction as the shunt becomes clogged with WBCs in the CSF. (CSF should be free of WBCs normally.) Signs of shunt malfunction include those associated with increased intracranial pressure.

A community health nurse has been asked to talk about preventing accidental drowning at a child safety day for parents of toddlers. Which of the following would the nurse emphasize? Select one or more: A. Children this age are most likely to drown in artificial pools, toilets, and liquid-filled buckets. B. Water wings or "floaties" are not a substitute for personal flotation devices or adult supervision. C. Children this age should ride in a rear facing car seat until 2 years of age. D. Children this age are at increased risk for accidental poisoning due to their natural curiosity and increased mobility.

Children this age are most likely to drown in artificial pools, toilets, and liquid-filled buckets., Water wings or "floaties" are not a substitute for personal flotation devices or adult supervision.

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? Select one: A. Oxygen saturation level of 96% B. Pale skin color C. Fever D. Tachypnea with retractions

D 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.

The nurse is caring for a 1-year-old boy who was a premature infant. What must the nurse do to attain accurate developmental assessment data? Select one: a. Compare the child to his siblings. b. Use open-ended questions when discussing the child with his parents. c. Screen with the Denver II using the child's chronological age. d. Assess for developmental progress based on the child's corrected or adjusted age.

D Premature infants should be compared to developmental norms using their corrected age through 3 years' chronological age. Using the child's chronological age when the screening tool is the Denver II will yield inaccurate results. Comparing the child to his siblings will not provide accurate assessment data. Open-ended questions will give parents opportunity to share comprehensive data and may be an aid to gathering better parent assessment of their premature child, but this is not the key to accurate assessment of children born prematurely.

The nurse is caring for a child who has been sedated for a painful procedure. The priority nursing activity for this child is: Select one: a. Monitoring pulse oximetry. b. Allowing parents to stay with the child. c. Placing the child on a cardiac monitor. d. Assessing the child's respiratory effort.

D Shallow breathing is the first indication of oversedation. Respiratory effort decreases before hypoxemia.

When teaching a class about trisomy 21, the instructor would identify this disorder as due to which of the following? Select one: A. Genomic imprinting B. X-linked recessive inheritance C. Autosomal dominant inheritance D. Nondisjunction

D Trisomy 21 is an example of a genetic disorder involving an abnormality in chromosomal number due to nondisjunction. X-linked recessive inheritance disorders, such as hemophilia and Duchenne muscular dystrophy, involve altered genes on the X chromosome. Genomic imprinting disorders, such as Prader-Willi syndrome, involve expression of only the maternal or paternal allele, with the other being inactive. Autosomal dominant inheritance disorders, such as neurofibromatosis and achondroplasia, involve a single gene in the heterozygous state that is capable of producing the phenotype, thus overshadowing the normal gene.

A child is being discharged from the hospital after a 3-week stay following a motor vehicle accident. The mother expresses concern about caring for the child's wounds at home. She has demonstrated appropriate technique with medication administration and wound care. Which is the priority nursing diagnosis? Select one: a. Knowledge deficit of home care b. Altered family processes related to hospitalization c. Risk for infection related to presence of healing wounds d. Parental anxiety related to care of the child at home

D While all of the diagnoses might have been appropriate at some point, the current focus is the mother's anxiety about caring for the child at home. The priority is to develop a plan to assist in relieving the anxiety.

The nurse is administering pain medication for a child with continuous pain from internal injuries. Which of the following methods would be ordered to dispense the medication? Select one: A. Administer the medication when the child complains of pain. B. Administer the medication PRN (as needed). C. Administer the mediation when pain has peaked. D. Administer the medication around the clock at timed intervals

D With any medication administered for pain management, the timing of administration is vital. Timing depends on the type of pain. For continuous pain, the current recommendation is to administer analgesia around the clock at scheduled intervals to achieve the necessary effect. As-needed or PRN dosing is not recommended for continuous pain. This method can lead to inadequate pain relief because of the delay before the drug reaches its peak effectiveness. For pain that can be predicted or considered temporary, such as with a procedure, analgesia is administered so that the peak action of the drug matches the time of the painful event. It is not recommended to wait until the child complains of pain because therapeutic levels will be difficult to reach at this point.

Pediatrics Final Spring2015

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