Peds Exam 1 and 2

Which condition in a child should alert a nurse for increased fluid requirements? A) Fever B) Mechanical ventilation C) Congestive heart failure D) Increased intracranial pressure (ICP)

A) Fever Fever leads to great insensible fluid loss in young children because of increased body surface area relative to fluid volume. Respiratory rate influences insensible fluid loss and should be monitored in the mechanically ventilated child. Congestive heart failure is a case of fluid overload in children. Increased ICP does not lead to increased fluid requirements in children.

A school nurse is performing hearing screening on school children. The nurse recognizes that the most common type of hearing loss resulting from interference of transmission of sound to the middle ear is characteristic of which type of hearing loss? A) Conductive B) Sensorineural C) Mixed conductive-sensorineural D) Central auditory imperceptive

A) Conductive Conductive or middle-ear hearing loss is the most common type. It results from interference of transmission of sound to the middle ear, most often from recurrent otitis media. Sensorineural, mixed conductive-sensorineural, and central auditory imperceptive are less common types of hearing loss.

A nurse is admitting a child with Crohn disease. Parents ask the nurse, "How is this disease different from ulcerative colitis?" Which statement should the nurse make when answering this question? A) "With Crohn's the inflammatory process involves the whole GI tract." B) "There is no difference between the two diseases." C) "The inflammation with Crohn's is limited to the colon and rectum." D) "Ulcerative colitis is characterized by skip lesions."

A) "With Crohn's the inflammatory process involves the whole GI tract" The chronic inflammatory process of Crohn disease involves any part of the GI tract from the mouth to the anus but most often affects the terminal ileum. Crohn disease involves all layers of the bowel wall in a discontinuous fashion, meaning that between areas of intact mucosa, there are areas of affected mucosa (skip lesions). The inflammation found with ulcerative colitis is limited to the colon and rectum, with the distal colon and rectum the most severely affected. Inflammation affects the mucosa and submucosa and involves continuous segments along the length of the bowel with varying degrees of ulceration, bleeding, and edema.

When both parents have sickle cell trait, which is the chance their children will have sickle cell anemia? A) 25% B) 50% C) 75% D) 100%

A) 25% Sickle cell anemia is inherited in an autosomal recessive pattern. If both parents have sickle cell trait (one copy of the sickle cell gene), then for each pregnancy, a 25% chance exists that their child will be affected with sickle cell disease. With each pregnancy, a 50% chance exists that the child will have sickle cell trait. Percentages of 75% and 100% are too high for the children of parents who have sickle cell trait.

The nurse is admitting a child with rheumatic fever. Which therapeutic management should the nurse expect to implement? A) Administering penicillin B) Avoiding salicylates (aspirin) C) Imposing strict bed rest for 4 to 6 weeks D) Administering corticosteroids if chorea develops

A) Administering penicillin The goal of medical management is the eradication of the hemolytic streptococci. Penicillin is the drug of choice. Salicylates can be used to control the inflammatory process, especially in the joints, and reduce the fever and discomfort. Bed rest is recommended for the acute febrile stage, but it does not need to be strict. The chorea is transient and will resolve without treatment.

A nurse in the emergency department is assessing a 5-year-old child with symptoms of pneumonia and a fever of 102° F. Which intervention can the nurse implement to promote a sense of control for the child? A) None, this is an emergency and the child should not participate in care. B) Allow the child to hold the digital thermometer while taking the child's blood pressure. C) Ask the child if it is OK to take a temperature in the ear. D) Have parents wait in the waiting room.

A) Allow the child to hold the digital thermometer while taking the child's blood pressure The nurse should allow the child to hold the digital thermometer while taking the child's blood pressure. Unless an emergency is life threatening, children need to participate in their care to maintain a sense of control. Because emergency departments are frequently hectic, there is a tendency to rush through procedures to save time. However, the extra few minutes needed to allow children to participate may save many more minutes of useless resistance and uncooperativeness during subsequent procedures. The child may not give permission, if asked, for a procedure that is necessary to be performed. It is better to give choices such as, "Which ear do you want me to do your temperature in?" instead of, "Can I take your temperature?" Parents should remain with their child to help with decreasing the child's anxiety.

In which of the conditions are all the formed elements of the blood simultaneously depressed? A) Aplastic anemia B) Sickle cell anemia C) Thalassemia major D) Iron deficiency anemia

A) Aplastic anemia Aplastic anemia refers to a bone marrow-failure condition in which the formed elements of the blood are simultaneously depressed. Sickle cell anemia is a hemoglobinopathy in which normal adult hemoglobin is partly or completely replaced by abnormal sickle hemoglobin. Thalassemia major is a group of blood disorders characterized by deficiency in the production rate of specific hemoglobin globin chains. Iron deficiency anemia results in a decreased amount of circulating red cells.

Teasing can be common during the school-age years. The nurse should recognize that which applies to teasing? A) Can have a lasting effect on children B) Is not a significant threat to self-concept C) Is rarely based on anything that is concrete D) Is usually ignored by the child who is being teased

A) Can have a lasting effect on children Teasing in this age group is common and can have a long-lasting effect. Increasing awareness of differences, especially when accompanied by unkind comments and taunts from others, may make a child feel inferior and undesirable. Physical impairments such as hearing or visual defects, ears that "stick out," or birth marks assume great importance.

An infant gains head control before sitting unassisted. The nurse recognizes that this is which type of development? A) Cephalocaudal B) Proximodistal C) Mass to specific D) Sequential

A) Cephalocaudal The pattern of development that is head-to-tail, or cephalocaudal, direction is described by an infant's ability to gain head control before sitting unassisted. The head end of the organism develops first and is large and complex, whereas the lower end is smaller and simpler, and development takes place at a later time. Proximodistal, or near to far, is another pattern of development. Limb buds develop before fingers and toes. Postnatally, the child has control of the shoulder before achieving mastery of the hands. Mass to specific is not a specific pattern of development. In all dimensions of growth, a definite, sequential pattern is followed.

Parents of a 3-year-old child with congenital heart disease are afraid to let their child play with other children because of possible overexertion. The nurse's reply should be based on which statement? A) Child needs opportunities to play with peers. B) Child needs to understand that peers' activities are too strenuous. C) Parents can meet all of the child's needs. D) Constant parental supervision is needed to avoid overexertion.

A) Child needs opportunities to play with peers The child needs opportunities for social development. Children usually limit their activities if allowed to set their own pace. The child will limit activities as necessary. Parents must be encouraged to seek appropriate social activities for the child, especially before kindergarten. The child needs to have activities that foster independence. The child will be able to regulate activities.

Which is the most commonly used method in completed suicides? A) Firearms B) Drug overdose C) Self-inflected laceration D) Carbon monoxide poisoning

A) Firearms Firearms are the most commonly used instruments in completed suicides among both males and females. For adolescent boys, firearms are followed by hanging and overdose. For adolescent females, overdose and strangulation are the next most common means of completed suicide. The most common method of suicide attempt is overdose or ingestion of potentially toxic substances such as drugs. The second most common method of suicide attempt is self-inflicted laceration. Carbon monoxide poisoning is not one of the more frequent forms of suicide completion.

A young child is brought to the emergency department with severe dehydration secondary to acute diarrhea and vomiting. Therapeutic management of this child should begin with: A) intravenous (IV) fluids. B) ORS. C) clear liquids, 1 to 2 ounces at a time. D) administration of antidiarrheal medication.

A) IV fluids In children with severe dehydration, IV fluids are initiated. ORS is acceptable therapy if the dehydration is not severe. Diarrhea is not managed by using clear liquids by mouth. These fluids have a high carbohydrate content, low electrolyte content, and high osmolality. Antidiarrheal medications are not recommended for the treatment of acute infectious diarrhea.

A child with autism spectrum disorder (ASD) is admitted to the hospital with pneumonia. The nurse should plan which priority intervention when caring for the child? A) Maintain a structured routine and keep stimulation to a minimum. B) Place child in a room with a roommate of the same age. C) Maintain frequent touch and eye contact with the child. D) Take the child frequently to the playroom to play with other children.

A) Maintain a structured routine and keep stimulation to a minimum Providing a structured routine for the child to follow is a key in the management of ASD. Decreasing stimulation by using a private room, avoiding extraneous auditory and visual distractions, and encouraging the parents to bring in possessions the child is attached to may lessen the disruptiveness of hospitalization. Because physical contact often upsets these children, minimum holding and eye contact may be necessary to avoid behavioral outbursts. Children with ASD need to be introduced slowly to new situations, with visits with staff caregivers kept short whenever possible. The playroom would be too overwhelming with new people and situations and should not be a priority of care.

The nurse is teaching parents about the importance of iron in a toddler's diet. Which explains why iron deficiency anemia is common during toddlerhood? A) Milk is a poor source of iron. B) Iron cannot be stored during fetal development. C) Fetal iron stores are depleted by age 1 month. D) Dietary iron cannot be started until age 12 months.

A) Milk is a poor source of iron Children between the ages of 12 and 36 months are at risk for anemia because cow's milk is a major component of their diet and it is a poor source of iron. Iron is stored during fetal development, but the amount stored depends on maternal iron stores. Fetal iron stores are usually depleted by age 5 to 6 months. Dietary iron can be introduced by breastfeeding, iron-fortified formula, and cereals during the first 12 months of life.

Which term refers to the ability to see objects clearly at close range but not at a distance? A) Myopia B) Amblyopia C) Cataract D) Glaucoma

A) Myopia Myopia, or nearsightedness, refers to the ability to see objects clearly at close range but not a distance. Amblyopia, or lazy eye, is reduced visual acuity in one eye. A cataract is opacity of the lens of the eye. Glaucoma is a group of eye diseases characterized by increased intraocular pressure.

Parents of a child with sickle cell anemia ask the nurse, "What happens to the hemoglobin in sickle cell anemia?" Which statement by the nurse explains the disease process?" A) Normal adult hemoglobin is replaced by abnormal hemoglobin. B) There is a lack of cellular hemoglobin being produced. C) There is a deficiency in the production of globulin chains. D)The size and depth of the hemoglobin are affected.

A) Normal adult hemoglobin is replaced by abnormal hemoglobin Sickle cell anemia is one of a group of diseases collectively called hemoglobinopathies, in which normal adult hemoglobin is replaced by abnormal hemoglobin. Aplastic anemia is a lack of cellular elements being produced. Thalassemia major refers to a variety of inherited disorders characterized by deficiencies in production of certain globulin chains. Iron deficiency anemia affects the size and depth of the color.

The nurse is caring for an infant with congestive heart disease (CHD). The nurse should plan which intervention to decrease cardiac demands? A) Organize nursing activities to allow for uninterrupted sleep. B) Allow the infant to sleep through feedings during the night. C) Wait for the infant to cry to show definite signs of hunger. D) Discourage parents from rocking the infant

A) Organize nursing activities to allow for uninterrupted sleep The infant requires rest and conservation of energy for feeding. Every effort is made to organize nursing activities to allow for uninterrupted periods of sleep. Whenever possible, parents are encouraged to stay with their infant to provide the holding, rocking, and cuddling that help children sleep more soundly. To minimize disturbing the infant, changing bed linens and complete bathing are done only when necessary. Feeding is planned to accommodate the infant's sleep and wake patterns. The child is fed at the first sign of hunger, such as when sucking on fists, rather than waiting until he or she cries for a bottle because the stress of crying exhausts the limited energy supply. Because infants with CHD tire easily and may sleep through feedings, smaller feedings every 3 hours may be helpful.

The nurse is conducting a staff in-service on congenital heart defects. Which structural defect constitutes tetralogy of Fallot? A) Pulmonic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy B) Aortic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy C) Aortic stenosis, atrial septal defect, overriding aorta, left ventricular hypertrophy D) Pulmonic stenosis, ventricular septal defect, aortic hypertrophy, left ventricular hypertrophy

A) Pulmonic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy Tetralogy of Fallot has these four characteristics: pulmonic stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy. There is pulmonic stenosis but not atrial stenosis in tetralogy of Fallot. Right ventricular hypertrophy, not left ventricular hypertrophy, is present in tetralogy of Fallot. Tetralogy of Fallot has right ventricular hypertrophy, not left ventricular hypertrophy, and an atrial septal defect, not aortic hypertrophy.

When a preschool child is hospitalized without adequate preparation, the nurse should recognize that the child may likely see hospitalization as: A) punishment. B) threat to child's self-image. C) an opportunity for regression. D) loss of companionship with friends.

A) Punishment If a toddler is not prepared for hospitalization, a typical preschooler fantasy is to attribute the hospitalization to punishment for real or imagined misdeeds. Attributing the hospitalization to punishment for real or imagined misdeeds is a reaction typical of toddler and school-age children when threatened with loss of control.

Which is an important nursing consideration in the care of a child with celiac disease? A) Refer to a nutritionist for detailed dietary instructions and education. B) Help child and family understand that diet restrictions are usually only temporary. C) Teach proper hand washing and standard precautions to prevent disease transmission. D) Suggest ways to cope more effectively with stress to minimize symptoms.

A) Refer to a nutritionist for detailed dietary instructions and education The main consideration is helping the child adhere to dietary management. Considerable time is spent explaining to the child and parents about the disease process, the specific role of gluten in aggravating the condition, and foods that must be restricted. Referral to a nutritionist would help in this process. The most severe symptoms usually occur in early childhood and adult life. Dietary avoidance of gluten should be lifelong. Celiac disease is not transmissible or stress related.

A previously "potty-trained" 30-month-old child has reverted to wearing diapers while hospitalized. The nurse should reassure the parents that this is normal because of which reason? A) Regression is seen during hospitalization. B) Developmental delays occur because of the hospitalization. C) The child is experiencing urinary urgency because of hospitalization. D) The child was too young to be "potty-trained."

A) Regression is seen during hospitalization Regression is expected and normal for all age groups when hospitalized. Nurses should assure the parents this is temporary and the child will return to the previously mastered developmental milestone when back home. This does not indicate a developmental delay. The child should not be experiencing urinary urgency because of hospitalization and this would not be normal. Successful "potty-training" can be started at 2 years of age if the child is ready.

The nurse is administering an IV chemotherapeutic agent to a child with leukemia. The child suddenly begins to wheeze and have severe urticaria. Which is the most appropriate nursing action? A) Stop drug infusion immediately. B) Recheck rate of drug infusion. C) Observe child closely for next 10 minutes. D) Explain to child that this is an expected side effect.

A) Stop drug infusion immediately If an allergic reaction is suspected, the drug should be immediately discontinued. Any drug in the line should be withdrawn, and a normal saline infusion begun to keep the line open. Rechecking the rate of drug infusion, observing the child closely for next 10 minutes, and explaining to the child that this is an expected side effect can all be done after the drug infusion is stopped and the child is evaluated.

A 10-year-old girl needs to have another intravenous (IV) line started. She keeps telling the nurse, "Wait a minute" and "I'm not ready." The nurse should recognize this as which description? A) This is normal behavior for a school-age child. B) The behavior is not seen past the preschool years. C) The child thinks the nurse is punishing her. D) The child has successfully manipulated the nurse in the past.

A) This is normal behavior for a school-age child The 10-year-old girl is attempting to maintain control. The nurse should provide the girl with structured choices about when the IV will be inserted. Telling the nurse "Wait a minute" and "I'm not ready" can be characteristic behavior when an individual needs to maintain some control over a situation.

A child has recurrent abdominal pain (RAP) and a dairy-free diet has been prescribed for 2 weeks. Which explanation is the reason for prescribing a dairy-free diet? A) To rule out lactose intolerance B) To rule out celiac disease C) To rule out sensitivity to high sugar content D) To rule out peptic ulcer disease

A) To rule out lactose intolerance Treatment for RAP involves providing reassurance and reducing or eliminating symptoms. Dietary modifications may include removal of dairy products to rule out lactose intolerance. Fructose is eliminated to rule out sensitivity to high sugar content and gluten is removed to rule out celiac disease. A dairy-free diet would not rule out peptic ulcer disease.

To prevent plagiocephaly, the nurse should teach parents to: A) place infant prone for 30 to 60 minutes per day. B) buy a soft mattress. C) allow infant to nap in the car safety seat. D) have infant sleep with the parents.

A) place infant prone for 30-60 minutes per day Prevention of positional plagiocephaly may begin shortly after birth by implementing prone positioning or "tummy time" for approximately 30 to 60 minutes per day when the infant is awake. Soft mattresses or sleeping with parents (co-sleeping) are not recommended because they put the infant at a higher risk for a sudden infant death incident. To prevent plagiocephaly, prolonged placement in car safety seats should be avoided.

A 3-month-old infant dies shortly after arrival to the emergency department. The infant has subdural and retinal hemorrhages but no external signs of trauma. The nurse should suspect: A) unintentional injury. B) shaken-baby syndrome. C) sudden infant death syndrome (SIDS). D) congenital neurologic problem.

B) Shaken-baby syndrome Shaken-baby syndrome causes internal bleeding but may have no external signs. Unintentional injury would not cause these injuries. SIDS and congenital neurologic problems would not appear this way.

The nurse is caring for a hospitalized 4-year-old boy. His parents tell the nurse that they will be back to visit at 6 PM. When the child asks the nurse when his parents are coming, the nurse's best response is A) "They will be here soon." B) "They will come after dinner." C) "Let me show you on the clock when 6 PM is." D) "I will tell you every time I see you how much longer it will be."

B) "They will come after dinner" A 4-year-old child understands time in relation to events such as meals. Children perceive "soon" as a very short time. The nurse may lose the child's trust if his parents do not return in the time he perceives as "soon." Children cannot read or use a clock for practical purposes until age 7 years. I will tell you every time I see you how much longer it will be assumes the child understands the concepts of hours and minutes, which are not developed until age 5 or 6 years.

What is the best age for solid food to be introduced into the infant's diet? A) 3 months B) 6 months C) When birth weight has tripled D) after their 1st birthday

B) 6 months Physiologically and developmentally, the 4- to 6-month-old infant is in a transition period. The extrusion reflex has disappeared, and swallowing is a more coordinated process. In addition, the gastrointestinal tract has matured sufficiently to handle more complex nutrients and is less sensitive to potentially allergenic food. Infants of this age will try to help during feeding; 2 to 3 months is too young. The extrusion reflex is strong, and the child will push food out with the tongue. No research indicates that the addition of solid food to a bottle has any benefit. Infant birth weight doubles at 1 year. Solid foods can be started earlier. Tooth eruption can facilitate biting and chewing; most infant foods do not require this ability.

The nurse is meeting a 5-year-old child for the first time and would like the child to cooperate during a dressing change. The nurse decides to do a simple magic trick using gauze. This should be interpreted as: A) inappropriate, because of child's age. B) a way to establish rapport. C) too distracting, when cooperation is important. D) acceptable, if there is adequate time.

B) A way to establish rapport A magic trick or other simple game may help alleviate anxiety for a 5-year-old. It is an excellent method to build rapport and facilitate cooperation during a procedure. Magic tricks appeal to the natural curiosity of young children. The nurse should establish rapport with the child. Failure to do so may cause the procedure to take longer and be more traumatic.

The nurse should suspect a hearing impairment in an infant who demonstrates which behavior? A) Absence of the Moro reflex B) Absence of babbling by age 7 months C) Lack of eye contact when being spoken to D) Lack of gesturing to indicate wants after age 15 months

B) Absence of babbling by age 7 months The absence of babbling or inflections in voice by age 7 months is an indication of hearing difficulties. The absence of the Moro reflex and eye contact when being spoken to does not indicate a hearing impairment. The child with hearing impairment uses gestures rather than vocalizations to express desires at this age.

A school-age child is admitted in vasoocclusive sickle cell crisis. The child's care should include: A) correction of acidosis. B) adequate hydration and pain management. C) pain management and administration of heparin. D) adequate oxygenation and replacement of factor VIII.

B) Adequate hydration and pain management The management of crises includes adequate hydration, minimization of energy expenditures, pain management, electrolyte replacement, and blood component therapy if indicated. Hydration and pain control are two of the major goals of therapy. The acidosis will be corrected as the crisis is treated. Heparin and factor VIII is not indicated in the treatment of vasoocclusive sickle cell crisis. Oxygen may prevent further sickling, but it is not effective in reversing sickling because it cannot reach the clogged blood vessels.

The nurse is caring for a child admitted with acute abdominal pain and possible appendicitis. Which is appropriate to relieve the abdominal discomfort? A) Place in Trendelenburg position. B) Allow to assume position of comfort. C) Apply moist heat to the abdomen. D) Administer a saline enema to cleanse bowel.

B) Allow to assume position of comfort The child should be allowed to take a position of comfort, usually with the legs flexed. The Trendelenburg position will not help with the discomfort. In any instance in which appendicitis is a possibility, there is a danger in administering a laxative or enemas or applying heat to the area. Such measures stimulate bowel motility and increase the risk of perforation.

The school nurse is caring for a child with a penetrating eye injury. Emergency treatment includes which intervention? A) Apply a regular eye patch. B) Apply a Fox shield to affected eye and any type of patch to the other eye. C) Apply ice until the physician is seen. D) Irrigate eye copiously with a sterile saline solution.

B) Apply a fox shield to affected eye and any type of patch to the other eye The nurse's role in a penetrating eye injury is to prevent further injury to the eye. A Fox shield (if available) should be applied to the injured eye and a regular eye patch to the other eye to prevent bilateral movement. It may cause more damage to the eye to apply a regular eye patch, apply ice until the physician is seen, or irrigate the eye copiously with a sterile saline solution.

Parents of a firstborn child are asking whether it is normal for their child to be extremely competitive. The nurse should respond to the parents that studies about the ordinal position of children suggest that firstborn children tend to: A) be praised less often. B) be more achievement oriented. C) be more popular with the peer group. D) identify with peer group more than parents.

B) Be more achievement oriented Firstborn children, like only children, tend to be more achievement-oriented. Being praised less often, being more popular with the peer group, and identifying with peer groups more than parents are characteristics of later-born children.

Parents are asking about an early intervention program for their child who has special needs. The nurse relates that this program is for which age of child? A) Birth to 1 year of age B) Birth to 3 years of age C) Ages 1 to 4 D) Ages 4 and 5

B) Birth to 3 years of age A variety of supplemental programs have been designed in the school system to accommodate special needs, both at school age and younger, through early intervention, which consists of any sustained and systematic effort to assist children from birth to age 3 years with disabilities and those who are developmentally vulnerable.

The nurse observes some children in the playroom. Which play situation exhibits the characteristics of parallel play? A) Kimberly and Amanda sharing clay to each make things B) Brian playing with his truck next to Kristina playing with her truck C) Adam playing a board game with Kyle, Steven, and Erich D) Danielle playing with a music box on her mother's lap

B) Brian playing with his truck next to Kristina playing with her truck Playing with trucks next to each other but not together is an example of parallel play. Both children are engaged in similar activities in proximity to each other; however, they are each engaged in their own play. Sharing clay to make things is characteristic of associative play. Friends playing a board game together is characteristic of cooperative play. A child playing with something by herself on her mother's lap is an example of solitary play.

Mark, a 9-year-old with Down syndrome, is mainstreamed into a regular third-grade class for part of the school day. His mother asks the school nurse about programs, such as Cub Scouts, that he might join. The nurse's recommendation should be based on which statement? A) Programs like Cub Scouts are inappropriate for children who are mentally retarded. B) Children with Down syndrome have the same need for socialization as other children. C) Children with Down syndrome socialize better with children who have similar disabilities. D) Parents of children with Down syndrome encourage programs, such as scouting, because they deny that their children have disabilities.

B) Children with down syndrome have the same need for socialization as other children. Children of all ages need peer relationships. Children with Down syndrome should have peer experiences similar to those of other children, such as group outings, Cub Scouts, and Special Olympics. Programs such as Cub Scouts can help children with cognitive impairment develop socialization skills. Although all children should have an opportunity to form a close relationship with someone of the same developmental level, it is appropriate for children with disabilities to develop relationships with children who do not have disabilities. The parents are acting as advocates for their child.

The nurse is caring for an infant whose cleft lip was repaired. Important aspects of this infant's postoperative care include: A) arm restraints, postural drainage, mouth irrigations. B) cleansing the suture line, supine and side-lying positions, arm restraints. C) mouth irrigations, prone position, cleansing suture line. D) supine and side-lying positions, postural drainage, arm restraints.

B) Cleansing the suture line, supine and side lying positions, arm restraints The suture line should be cleansed gently after feeding. The child should be positioned on the back, on the side, or in an infant seat. Elbows are restrained to prevent the child from accessing the operative site. Postural drainage is not indicated. This would increase the pressure on the operative site when the child is placed in different positions. There is no reason to perform mouth irrigations, and the child should not be placed in the prone position where injury to the suture site can occur.

A newborn assessment shows separated sagittal suture, oblique palpebral fissures, depressed nasal bridge, protruding tongue, and transverse palmar creases. These findings are most suggestive of: A) microcephaly. B) Down syndrome. C) cerebral palsy. D) fragile X syndrome.

B) Down Syndrome These are characteristics associated with Down syndrome. The infant with microcephaly has a small head. Cerebral palsy is a diagnosis not usually made at birth. No characteristic physical signs are present. The infant with fragile X syndrome has increased head circumference; long, wide, and/or protruding ears; long, narrow face with prominent jaw; hypotonia; and high arched palate.

Chelation therapy is begun on a child with β-thalassemia major. The purpose of this therapy is to: A) treat the disease. B) eliminate excess iron. C) decrease risk of hypoxia. D) manage nausea and vomiting.

B) Eliminate excess iron A complication of the frequent blood transfusions in thalassemia is iron overload. Chelation therapy with deferoxamine (an iron-chelating agent) is given with oral supplements of vitamin C to increase iron excretion. Chelation therapy treats the side effect of the disease management. Decreasing the risk of hypoxia and managing nausea and vomiting are not the purposes of chelation therapy.

A nurse is teaching nursing students the physiology of congenital heart defects. Which defect results in decreased pulmonary blood flow? A) Atrial septal defect B) Tetralogy of Fallot C) Ventricular septal defect D) Patent ductus arteriosus

B) Tetralogy of fallot Tetralogy of Fallot results in decreased blood flow to the lungs. The pulmonic stenosis increases the pressure in the right ventricle, causing the blood to go from right to left across the ventricular septal defect. Atrial and ventricular septal defects and patent ductus arteriosus result in increased pulmonary blood flow.

A mother who intended to breastfeed has given birth to an infant with a cleft palate. Nursing interventions should include: A) giving medication to suppress lactation. B) encouraging and helping mother to breastfeed. C) teaching mother to feed breast milk by gavage. D) recommending use of a breast pump to maintain lactation until infant can suck.

B) Encouraging and helping mother to breastfeed The mother who wishes to breastfeed may need encouragement and support because the defect does present some logistical issues. The nipple must be positioned and stabilized well back in the infant's oral cavity so that the tongue action facilitates milk expression. Because breastfeeding is an option, if the mother wishes to breastfeed, medications should not be given to suppress lactation. Because breastfeeding can usually be accomplished, gavage feedings are not indicated. The suction required to stimulate milk, absent initially, may be useful before nursing to stimulate the let-down reflex.

A newborn was admitted to the nursery with a complete bilateral cleft lip and palate. The physician explained the plan of therapy and its expected good results. However, the mother refuses to see or hold her baby. Initial therapeutic approach to the mother should be: A) restating what the physician has told her about plastic surgery. B) encouraging her to express her feelings. C) emphasizing the normalcy of her baby and the baby's need for mothering. D) recognizing that negative feelings toward the child continue throughout childhood.

B) Encouraging her to express her feelings For parents, cleft lip and cleft palate deformities are particularly disturbing. The nurse must place emphasize not only the infant's physical needs but also the parents' emotional needs. The mother needs to be able to express her feelings before she can accept her child. Although the nurse will restate what the physician has told the mother about plastic surgery, it is not part of the initial therapeutic approach. As the mother expresses her feelings, the nurse's actions should convey to the parents that the infant is a precious human being. The nurse emphasizes the child's normalcy and helps the mother recognize the child's uniqueness. Maternal-infant attachment was not negatively affected at age 1 year.

Which information should the nurse give a mother regarding the introduction of solid foods during infancy? A) Solid foods should not be introduced until 8 to 10 months, when the extrusion reflex begins to disappear. B) Foods should be introduced one at a time, at intervals of 4 to 7 days. C) Solid foods can be mixed in a bottle to make the transition easier for the infant. D) Fruits and vegetables should be introduced into the diet first.

B) Foods should be introduced one at a time, at intervals of 4-7 days One food item is introduced at intervals of 4 to 7 days to allow the identification of food allergies. Solid foods can be introduced earlier. The extrusion reflex usually disappears by age 6 months. Mixing solid foods in a bottle has no effect on the transition to solid food. Iron-fortified cereal should be the first solid food introduced into the infant's diet.

Pyloric stenosis can best be described as: A) dilation of the pylorus. B) hypertrophy of the pyloric muscle. C) hypotonicity of the pyloric muscle. D) reduction of tone in the pyloric muscle.

B) Hypertrophy of the pyloric muscle Hypertrophic pyloric stenosis occurs when the circumferential muscle of the pyloric sphincter becomes thickened, resulting in elongation and narrowing of the pyloric channel. Dilation of the pylorus, hypotonicity of the pyloric muscle, and reduction of tone in the pyloric muscle are not the definition of pyloric stenosis.

According to Erikson, the psychosocial task of adolescence is developing: A) intimacy. B) identity. C) initiative. D) independence.

B) Identity Traditional psychosocial theory holds that the developmental crises of adolescence lead to the formation of a sense of identity. Intimacy is the developmental stage for early adulthood. Independence is not one of Erikson's developmental stages.

A nurse is assessing a child and notes Koplik spots. In which of these communicable diseases are Koplik spots present? A) Rubella B) Measles (rubeola) C) Chickenpox (varicella) D) Exanthema subitum (roseola)

B) Measles (rubeola) Koplik spots are small irregular red spots with a minute, bluish white center found on the buccal mucosa 2 days before systemic rash. Rubella occurs with rash on the face, which rapidly spreads downward. Varicella appears with highly pruritic macules, followed by papules and vesicles. Roseola is seen with rose-pink macules on the trunk, spreading to face and extremities.

An 8-month-old infant has a hypercyanotic spell while blood is being drawn. The nurse's first action should be to: A) assess for neurologic defects. B) place the child in the knee-chest position. C) begin cardiopulmonary resuscitation. D) prepare family for imminent death.

B) Place the child in the knee-chest position The first action is to place the infant in the knee-chest position. Blow-by oxygen may be indicated. Neurologic defects are unlikely. The child should be assessed for airway, breathing, and circulation. Often, calming the child and administering oxygen and morphine can alleviate the hypercyanotic spell.

As part of the treatment for heart failure, the child takes the diuretic furosemide (Lasix). As part of teaching home care, the nurse encourages the family to give the child foods such as bananas, oranges, and leafy vegetables. These foods are recommended because they are high in: A) chlorides. B) potassium. C) sodium. D) vitamins.

B) Potassium Diuretics that work on the proximal and distal renal tubules contribute to increased losses of potassium. The child's diet should be supplemented with this electrolyte. With this type of diuretic, potassium must be monitored and supplemented as needed.

The nurse is preparing an in-service education to staff about atraumatic care for pediatric patients. Which intervention should the nurse include? A) Prepare the child for separation from parents during hospitalization by reviewing a video. B) Prepare the child before any unfamiliar treatment or procedure by demonstrating on a stuffed animal. C) Help the child accept the loss of control associated with hospitalization. D) Help the child accept pain that is connected with a treatment or procedure.

B) Prepare the child before any unfamiliar treatment or procedure by demonstrating on a stuffed animal. Preparing the child for any unfamiliar treatments, controlling pain, allowing privacy, providing play activities for expression of fear and aggression, providing choices, and respecting cultural differences are components of atraumatic care. In the provision of atraumatic care, the separation of child from parents during hospitalization is minimized. The nurse should promote a sense of control for the child. Preventing and minimizing bodily injury and pain are major components of atraumatic care.

A 4-month-old infant has gastroesophageal reflux (GER) but is thriving without other complications. Which should the nurse suggest to minimize reflux? A) Place in Trendelenburg position after eating. B) Thicken formula with rice cereal. C) Give continuous nasogastric tube feedings. D) Give larger, less frequent feedings.

B) Thicken formula with rice cereal Small, frequent feedings of formula combined with 1 teaspoon to 1 tablespoon of rice cereal per ounce of formula has been recommended. Milk-thickening agents have been shown to decrease the number of episodes of vomiting and to increase the caloric density of the formula. This may benefit infants who are underweight as a result of GER disease. Placing the child in a Trendelenburg position would increase the reflux. Continuous nasogastric feedings are reserved for infants with severe reflux and failure to thrive.

The nurse should teach parents that which age is safe to give infants whole milk instead of commercial infant formula? A) 6 months B) 9 months C) 12 months D) 18 months

C) 12 months The American Academy of Pediatrics does not recommend the use of cow's milk for children younger than 12 months. At 6 and 9 months, the infant should be receiving commercial infant formula or breast milk. At age 18 months, milk and formula are supplemented with solid foods, water, and some fruit juices.

Which should the nurse include when teaching the mother of a 9-month-old infant about administering liquid iron preparations? A) They should be given with meals. B) They should be stopped immediately if nausea and vomiting occur. C) Adequate dosage will turn the stools a tarry green color. D) Allow preparation to mix with saliva and bathe the teeth before swallowing.

C) Adequate dosage will turn the stools a tarry green color The nurse should prepare the mother for the anticipated change in the child's stools. If the iron dose is adequate, the stools will become a tarry green color. The lack of the color change may indicate insufficient iron. The iron should be given in two divided doses between meals when the presence of free hydrochloric acid is greatest. Iron is absorbed best in an acidic environment. Vomiting and diarrhea may occur with iron administration. If these occur, the iron should be given with meals, and the dosage reduced, then gradually increased as the child develops tolerance. Liquid preparations of iron stain the teeth. They should be administered through a straw and the mouth rinsed after administration.

A school-age child with leukemia experienced severe nausea and vomiting when receiving chemotherapy for the first time. Which is the most appropriate nursing action to prevent or minimize these reactions with subsequent treatments? A) Encourage drinking large amounts of favorite fluids. B) Encourage child to take nothing by mouth (remain NPO) until nausea and vomiting subside. C) Administer an antiemetic before chemotherapy begins. D) Administer an antiemetic as soon as child has nausea.

C) Administer an antiemetic before chemotherapy begins The most beneficial regimen to minimize nausea and vomiting associated with chemotherapy is to administer the antiemetic before the chemotherapy is begun. The goal is to prevent anticipatory symptoms. Drinking fluids will add to the discomfort of the nausea and vomiting. Remaining until nausea and vomiting subside will help with this episode, but the child will have the discomfort and be at risk for dehydration. Administering an antiemetic as soon as the child has nausea does not prevent anticipatory nausea.

The child with Down syndrome should be evaluated for which condition before participating in some sports? A) hyperflexibility B) Cutis marmorata C) Atlantoaxial instability D) Speckling of iris (Brushfield spots)

C) Atlantoaxial instability Children with Down syndrome are at risk for atlantoaxial instability. Before participating in sports that put stress on the head and neck, a radiologic examination should be done. Hyperflexibility, cutis marmorata, and speckling of iris (Brushfield spots) are characteristic of Down syndrome, but they do not affect the child's ability to participate in sports.

Which defect results in increased pulmonary blood flow? A) Pulmonic stenosis B) Tricuspid atresia C) Atrial septal defect D) Transposition of the great arteries

C) Atrial septal defect Atrial septal defect results in increased pulmonary blood flow. Blood flows from the left atrium (higher pressure) into the right atrium (lower pressure) and then to the lungs via the pulmonary artery. Pulmonic stenosis is an obstruction to blood flowing from the ventricles. Tricuspid atresia results in decreased pulmonary blood flow. Transposition of the great arteries results in mixed blood flow.

Which of the following is the most common clinical manifestation of retinoblastoma? A) Glaucoma B) Amblyopia C) Cat's eye reflex D) Sunken eye socket

C) Cat's eye reflex When the eye is examined, the light will reflect off the tumor, giving the eye a whitish appearance. This is called a cat's eye reflex. A late sign of retinoblastoma is a red, painful eye with glaucoma. Amblyopia, or lazy eye, is reduced visual acuity in one eye. The eye socket is not sunken.

When caring for a newborn with Down syndrome, the nurse should be aware that the most common congenital anomaly associated with Down syndrome is: A) hypospadias. B) pyloric stenosis. C) congenital heart disease. D) congenital hip dysplasia.

C) Congenital heart disease Congenital heart malformations, primarily septal defects, are the most common congenital anomaly in Down syndrome. Hypospadias, pyloric stenosis, and congenital hip dysplasia are not frequent congenital anomalies associated with Down syndrome.

An infant who weighs 7 pounds at birth would be expected to weigh how many pounds at age 1 year? A) 14 B) 16 C) 18 D) 21

D) 21 In general, birth weight triples by the end of the first year of life. For an infant who was 7 pounds at birth, 21 pounds would be the anticipated weight at the first birthday; 14, 16, or 18 pounds is below what would be expected for an infant with a birth weight of 7 pounds.

A child is brought to the emergency department experiencing an anaphylactic reaction to a bee sting. While an airway is being established, the nurse should prepare which medication for immediate administration? A) Diphenhydramine (Benadryl) B) Dobutamine (Dobutarex) C) Epinephrine (Adrenalin) D) Calcium chloride (calcium chloride)

C) Epinephrine (Adrenalin) After the first priority of establishing an airway, administration of epinephrine is the drug of choice. Diphenhydramine, an antihistamine, is usually not used for severe reactions. Dobutamine and calcium chloride are not appropriate drugs for this type of reaction.

Which is the most frequent source of acute childhood lead poisoning? A) Folk remedies B) Unglazed pottery C) Lead-based paint D) Cigarette butts and ashes

C) Lead-based paint Lead-based paint in houses built before 1978 is the most frequent source of lead poisoning. Some folk remedies and unglazed pottery may contain lead, but they are not the most frequent source. Cigarette butts and ashes do not contain lead.

A chest radiograph film is ordered for a child with suspected cardiac problems. The child's parent asks the nurse, "What will the radiograph show about the heart?" The nurse's response should be based on knowledge that the x-ray film will show: A) bones of chest but not the heart. B) measurement of electrical potential generated from heart muscle. C) permanent record of heart size and configuration. D) computerized image of heart vessels and tissues.

C) Permanent record of heart size and configuration A chest radiograph will provide information on the heart size and pulmonary blood-flow patterns. It will provide a baseline for future comparisons. The heart will be visible, as well as the sternum and ribs. Electrocardiography (ECG) measures the electrical potential generated from heart muscle. Echocardiography will produce a computerized image of the heart vessels and tissues by using sound waves.

An infant is brought to the emergency department with dehydration. Which physical assessment finding does the nurse expect? A) Weight gain B) Bradycardia C) Poor skin turgor D) Brisk capillary refill

C) Poor skin turgor Clinical manifestations of dehydration include poor skin turgor, weight loss, lethargy, and tachycardia. The infant would have prolonged capillary refill, not brisk.

A 4-year-old child tells the nurse that she does not want another blood sample drawn because "I need all my insides, and I don't want anyone taking them out." Which is the nurse's best interpretation of this? A) Child is being overly dramatic. B) Child has a disturbed body image. C) Preschoolers have poorly defined body boundaries. D) Preschoolers normally have a good understanding of their bodies.

C) Preschoolers have poorly defined body boundaries Preschoolers have little understanding of body boundaries, which leads to fears of mutilation. The child is not capable of being dramatic at 4 years of age. She truly has fear. Body image is just developing in the school-age child. Preschoolers do not have good understanding of their bodies.

A nurse on a pediatric unit is practicing family-centered care. Which is most descriptive of the care the nurse is delivering? A) Taking over total care of the child to reduce stress on the family B) Encouraging family dependence on health care systems C) Recognizing that the family is the constant in a child's life D) Excluding families from the decision-making process

C) Recognizing that the family is the constant in a child's life The three key components of family-centered care are respect, collaboration, and support. Family-centered care recognizes the family as the constant in the child's life. Taking over total care does not include the family in the process and may increase stress instead of reducing stress. The family should be enabled and empowered to work with the health care system. The family is expected to be part of the decision-making process.

A histamine-receptor antagonist such as cimetidine (Tagamet) or ranitidine (Zantac) is ordered for an infant with GER. The purpose of this is to: A) prevent reflux. B) prevent hematemesis. C) reduce gastric acid production. D) increase gastric acid production.

C) Reduce gastric acid production The mechanism of action of histamine-receptor antagonists is to reduce the amount of acid present in gastric contents and perhaps prevent esophagitis. Preventing reflux or hematemesis and increasing gastric acid production are not the modes of action of histamine-receptor antagonists.

Which action by the school nurse is important in the prevention of rheumatic fever? A) Encourage routine cholesterol screenings. B) Conduct routine blood pressure screenings. C) Refer children with sore throats for throat cultures. D) Recommend salicylates instead of acetaminophen for minor discomforts.

C) Refer children with sore throats for throat cultures Nurses have a role in prevention primarily in screening school-age children for sore throats caused by group A β-hemolytic streptococci. They can achieve this by actively participating in throat culture screening or by referring children with possible streptococcal sore throats for testing. Cholesterol and blood pressure screenings do not facilitate the recognition and treatment of group A β-hemolytic streptococci. Salicylates should be avoided routinely because of the risk of Reye syndrome after viral illnesses.

When caring for a child with probable appendicitis, the nurse should be alert to recognize that which condition or symptom is a sign of perforation? A) Bradycardia B) Anorexia C) Sudden relief from pain D) Decreased abdominal distention

C) Sudden relief from pain Signs of peritonitis, in addition to fever, include sudden relief from pain after perforation. Tachycardia, not bradycardia, is a manifestation of peritonitis. Anorexia is already a clinical manifestation of appendicitis. Abdominal distention usually increases.

A school-age child is diagnosed with a life-threatening illness. The parents want to protect their child from knowing the seriousness of the illness. The nurse should explain that: A) this will help the child cope effectively by denial. B) this attitude is helpful to give parents time to cope. C) terminally ill children know when they are seriously ill. D) terminally ill children usually choose not to discuss the seriousness of their illness.

C) Terminally ill children know when they are seriously ill The child needs honest and accurate information about the illness, treatments, and prognosis. Children, even at a young age, realize that something is seriously wrong and that it involves them. The nurse should help the parents understand the importance of honesty.

What is the single most important factor to consider when communicating with children? A) The child's physical condition B) Presence or absence of the child's parent C) The child's developmental level D) The child's nonverbal behaviors

C) The child's developmental level The nurse must be aware of the child's developmental stage to engage in effective communication. The use of both verbal and nonverbal communication should be appropriate to the developmental level. Although the child's physical condition is a consideration, developmental level is much more important. The parents' presence is important when communicating with young children but may be detrimental when speaking with adolescents. Nonverbal behaviors will vary in importance, based on the child's developmental level.

Which is the major cause of death for children older than 1 year? A) Cancer B) Heart disease C) Unintentional injuries D) Congenital anomalies

C) Unintentional injuries Unintentional injuries (accidents) are the leading cause of death after age 1 year through adolescence. Congenital anomalies are the leading cause of death in those younger than 1 year. Cancer ranks either second or fourth, depending on the age group, and heart disease ranks fifth in the majority of the age groups.

Which is most descriptive of the pathophysiology of leukemia? A) Increased blood viscosity occurs. B) Thrombocytopenia (excessive destruction of platelets) occurs. C) Unrestricted proliferation of immature white blood cells (WBCs) occurs. D) First stage of coagulation process is abnormally stimulated.

C) Unrestricted proliferation of immature white blood cells occurs Leukemia is a group of malignant disorders of the bone marrow and lymphatic system. It is defined as an unrestricted proliferation of immature WBCs in the blood-forming tissues of the body. Increased blood viscosity may occur secondary to the increased number of WBCs. Thrombocytopenia may occur secondary to the overproduction of WBCs in the bone marrow. The coagulation process is unaffected by leukemia.

Rickets is caused by a deficiency in: A) vitamin A. B) vitamin C. C) vitamin D and calcium. D) folic acid and iron.

C) Vitamin D and calcium Fat-soluble vitamin D and calcium are necessary in adequate amounts to prevent the development of rickets. No correlation exists between vitamins A, C, folic acid, or iron and rickets.

Parents of a hemophiliac child ask the nurse, "Can you describe hemophilia to us?" Which response by the nurse is descriptive of most cases of hemophilia? A) Autosomal dominant disorder causing deficiency in a factor involved in the blood-clotting reaction B) X-linked recessive inherited disorder causing deficiency of platelets and prolonged bleeding C) X-linked recessive inherited disorder in which a blood-clotting factor is deficient D) Y-linked recessive inherited disorder in which the red blood cells become moon-shaped

C) X-linked recessive inherited disorder in which a blood-clotting factor is deficient The inheritance pattern in 80% of all of the cases of hemophilia is X-linked recessive. The two most common forms of the disorder are factor VIII deficiency, hemophilia A or classic hemophilia; and factor IX deficiency, hemophilia B or Christmas disease. The inheritance pattern is X-linked recessive. The disorder involves coagulation factors, not platelets, and does not involve red cells or the Y chromosomes

Several blood tests are ordered for a preschool child with severe anemia. The child is crying and upset because of memories of the venipuncture done at the clinic 2 days ago. The nurse should explain: A) venipuncture discomfort is very brief. B) only one venipuncture will be needed. C) topical application of local anesthetic can eliminate venipuncture pain. D) most blood tests on children require only a finger puncture because a small amount of blood is needed.

C) topical application of local anesthetic can eliminate venipuncture pain Preschool children are concerned with both pain and the loss of blood. When preparing the child for venipuncture, the nurse will use a topical anesthetic to eliminate any pain. This is a traumatic experience for preschool children. They are concerned about their bodily integrity. A local anesthetic should be used, and a bandage should be applied to maintain bodily integrity. The nurse should not promise one attempt in case multiple attempts are required. Both finger punctures and venipunctures are traumatic for children. Both require preparation.

At what age should the nurse expect the anterior fontanel to close? A) 2 months B) 2 to 4 months C) 6 to 8 months D) 12 to 18 months

D) 12-18 months The anterior fontanel normally closes between ages 12 and 18 months. Two to 8 months is too early. The expected closure of the anterior fontanel occurs between ages 12 and 18 months; if it closes between ages 2 and 8 months, the child should be referred for further evaluation

Which clinical manifestation would be the most suggestive of acute appendicitis? A) Rebound tenderness B) Bright red or dark red rectal bleeding C) Abdominal pain that is relieved by eating D) Abdominal pain that is most intense at McBurney point

D) Abdominal pain that is most intense at McBurney point Pain is the cardinal feature. It is initially generalized, usually periumbilical. The pain localizes to the right lower quadrant at McBurney point. Rebound tenderness is not a reliable sign and is extremely painful to the child. Bright red or dark red rectal bleeding and abdominal pain that is relieved by eating are not signs of acute appendicitis.

José is a 4-year-old child scheduled for a cardiac catheterization. Preoperative teaching should be: A) directed at his parents because he is too young to understand. B) detailed in regard to the actual procedures so he will know what to expect. C) done several days before the procedure so that he will be prepared. D) adapted to his level of development so that he can understand.

D) Adapted to his level of development so that he can understand Preoperative teaching should always be directed at the child's stage of development. The caregivers also benefit from the same explanations. The parents may ask additional questions, which should be answered, but the child needs to receive the information based on developmental level. Preschoolers will not understand in-depth descriptions and should be prepared close to the time of the cardiac catheterization.

The nurse is conducting a staff in-service on childhood blood disorders. Which describes the pathology of idiopathic thrombocytopenic purpura? A) Bone marrow failure in which all elements are suppressed B) Deficiency in the production rate of globin chains C) Diffuse fibrin deposition in the microvasculature D) An excessive destruction of platelets

D) An excessive destruction of platelets Idiopathic thrombocytopenic purpura is an acquired hemorrhagic disorder characterized by an excessive destruction of platelets, discolorations caused by petechiae beneath the skin, and a normal bone marrow. Aplastic anemia refers to a bone marrow-failure condition in which the formed elements of the blood are simultaneously depressed. Thalassemia major is a group of blood disorders characterized by deficiency in the production rate of specific hemoglobin globin chains. Disseminated intravascular coagulation is characterized by diffuse fibrin deposition in the microvasculature, consumption of coagulation factors, and endogenous generation of thrombin and plasma.

The nurse is caring for a school-age child who has had a cardiac catheterization. The child tells the nurse that the bandage is "too wet." The nurse finds the bandage and bed soaked with blood. The most appropriate initial nursing action is to: A) notify physician. B) apply new bandage with more pressure. C) place the child in Trendelenburg position. D) apply direct pressure above catheterization site.

D) Apply direct pressure above catheterization site If bleeding occurs, direct continuous pressure is applied 2.5 cm (1 inch) above the percutaneous skin site to localize pressure over the vessel puncture. Notifying a physician and applying a new bandage can be done after pressure is applied. The nurse can have someone else notify the physician while the pressure is being maintained. It is not a helpful intervention to place the girl in the Trendelenburg position. It would increase the drainage from the lower extremities.

In girls, the initial indication of puberty is: A) menarche. B) growth spurt. C) growth of pubic hair. D) breast development.

D) Breast development In most girls, the initial indication of puberty is the appearance of breast buds, an event known as thelarche. The usual sequence of secondary sex characteristic development in girls is breast changes, rapid increase in height and weight, growth of pubic hair, appearance of axillary hair, menstruation, and abrupt deceleration of linear growth.

Which is a common, serious complication of rheumatic fever? A) Seizures B) Cardiac arrhythmias C) Pulmonary hypertension D) Cardiac valve damage

D) Cardiac valve damage Cardiac valve damage is the most significant complication of rheumatic fever. Seizures, cardiac arrhythmias, and pulmonary hypertension are not common complications of rheumatic fever.

An adolescent teen has bulimia. Which assessment finding should the nurse expect to assess? A) Diarrhea B) Amenorrhea C) Cold intolerance D) Erosion of tooth enamel

D) Erosion of tooth enamel Some of the signs of bulimia include erosion of tooth enamel, increased dental caries from vomited gastric acid, throat complaints, fluid and electrolyte disturbances, and abdominal complaints from laxative abuse. Diarrhea is not a result of the vomiting. It may occur in patients with bulimia who also abuse laxatives. Amenorrhea and cold intolerance are characteristics of anorexia nervosa, which some bulimics have. These symptoms are related to the extreme low weight.

Which is an appropriate action when an infant becomes apneic? A) Shake vigorously. B) Roll head side to side. C) Hold by feet upside down with head supported. D) Gently stimulate trunk by patting and or rubbing the soles of their feet

D) Gently stimulate trunk by patting and or rubbing the soles of their feet If the infant is apneic, the infant's trunk should be gently stimulated by patting or rubbing. If the infant is prone, turn onto the back. The infant should not be shaken vigorously, the head rolled side to side, or held by the feet upside down with the head supported. These can cause injury.

Invagination of one segment of bowel within another is called: A) atresia. B) stenosis. C) herniation. D) intussusception.

D) Intussusception Intussusception occurs when a proximal section of the bowel telescopes into a more distal segment, pulling the mesentery with it. The mesentery is compressed and angled, resulting in lymphatic and venous obstruction. Invagination of one segment of bowel within another is the definition of intussusception, not atresia, stenosis, or herniation.

Several complications can occur when a child receives a blood transfusion. Which is an immediate sign or symptom of an air embolus? A) Chills and shaking B) Nausea and vomiting C) Irregular heart rate D) Sudden difficulty in breathing

D) Sudden difficulty in breathing Signs of air embolism are sudden difficulty breathing, sharp pain in the chest, and apprehension. Air emboli should be avoided by carefully flushing all tubing of air before connecting to patient. Chills, shaking, nausea, and vomiting are associated with hemolytic reactions. Irregular heart rate is associated with electrolyte disturbances and hypothermia

The nurse is recommending how to prevent iron deficiency anemia in a healthy, term, breast-fed infant. Which should be suggested? A) Iron (ferrous sulfate) drops after age 1 month B) Iron-fortified commercial formula by age 4 to 6 months C) Iron-fortified infant cereal by age 2 months D) Iron-fortified infant cereal by age 4 to 6 months

D) Iron-fortified infant cereal by age 4 to 6 months Breast milk supplies inadequate iron for growth and development after age 5 months. Supplementation is necessary at this time. The mother can supplement the breastfeeding with iron-fortified infant cereal. Iron supplementation or the introduction of solid foods in a breast-fed baby is not indicated. Providing iron-fortified commercial formula by age 4 to 6 months should be done only if the mother is choosing to discontinue breastfeeding.

A nurse is preparing to feed a 12-month-old infant with failure to thrive. Which intervention should the nurse implement? A) Provide stimulation during feeding. B) Avoid being persistent during feeding time. C) Limit feeding time to 10 minutes. D) Maintain a face-to-face posture with the infant during feeding.

D) Maintain a face to face posture with the infant during feeding The nurse preparing to feed an infant with failure to thrive should maintain a face-to-face posture with the infant when possible. Encourage eye contact and remain with the infant throughout the meal. Stimulation is not recommended; a quiet, unstimulating atmosphere should be maintained. Persistence during feeding may need to be implemented. Calm perseverance through 10 to 15 minutes of food refusal will eventually diminish negative behavior. Although forced feeding is avoided, "strictly encouraged" feeding is essential. The length of the feeding should be established (usually 30 minutes); limiting the feeding to 10 minutes would make the infant feel rushed.

The most common cause of death in the adolescent age group involves: A) drownings. B) firearms. C) drug overdoses. D) motor vehicles.

D) Motor vehicles Forty percent of all adolescent deaths in the United States are the result of motor vehicle accidents. Drownings, firearms, and drug overdoses are major concerns in adolescence but are not the most common cause of death.

Which clinical manifestation should the nurse expect when a child with sickle cell anemia experiences an acute vasoocclusive crisis? A) Circulatory collapse B) Cardiomegaly, systolic murmurs C) Hepatomegaly, intrahepatic cholestasis D) Painful swelling of hands and feet; painful joints

D) Painful swelling of hands and feet; painful joints A vasoocclusive crisis is characterized by severe pain in the area of involvement. If in the extremities, painful swelling of the hands and feet is seen; if in the abdomen, severe pain resembles that of acute surgical abdomen; and if in the head, stroke and visual disturbances occur. Circulatory collapse results from sequestration crises. Cardiomegaly, systolic murmurs, hepatomegaly, and intrahepatic cholestasis result from chronic vasoocclusive phenomena.

Which term best describes a multidisciplinary approach to the management of a terminal illness that focuses on symptom control and support? A) Dying care B) Curative care C) Restorative care D) Palliative care

D) Palliative care This is one of the definitions of palliative care. The goal of palliative care is the achievement of the highest possible quality of life for patients and their families.

Caring for the newborn with a cleft lip and palate before surgical repair includes: A) gastrostomy feedings. B) keeping infant in near-horizontal position during feedings. C) allowing little or no sucking. D) providing satisfaction of sucking needs.

D) Providing satisfaction of sucking needs Using special or modified nipples for feeding techniques helps meet the infant's sucking needs. Gastrostomy feedings are usually not indicated. Feeding is best accomplished with the infant's head in an upright position. The child requires both nutritive and nonnutritive sucking.

A parent asks the nurse about negativism in toddlers. Which is the most appropriate recommendation? A) Punish the child. B) Provide more attention. C) Ask child not always to say "no." D) Reduce the opportunities for a "no" answer.

D) Reduce the opportunities for a "no" answer The nurse should suggest to the parent that questions be phrased with realistic choices rather than yes or no answers. This provides the toddler with a sense of control and reduces the opportunity for negativism. Negativism is not an indication of stubbornness or insolence and should not be punished. The negativism is not a function of attention; the child is testing limits to gain an understanding of the world. The toddler is too young to be asked to not always say "no."

Anorexia nervosa may best be described as: A) occurring most frequently in adolescent males. B) occurring most frequently in adolescents from lower socioeconomic groups. C) resulting from a posterior pituitary disorder. D) resulting in severe weight loss in the absence of obvious physical causes.

D) Resulting in severe weight loss in the absence of obvious physical causes. The etiology of anorexia remains unclear, but a distinct psychological component is present. The diagnosis is based primarily on psychological and behavioral criteria. Females account for 90% to 95% of the cases. No relation has been identified between socioeconomic groups and anorexia. Posterior pituitary disorders are not associated with anorexia nervosa.

A father tells the nurse that his daughter wants the same plate and cup used at every meal, even if they go to a restaurant. The nurse should explain that this is: A) a sign the child is spoiled. B) a way to exert unhealthy control. C) regression, common at this age. D) ritualism, common at this age.

D) Ritualism, common at this age The child is exhibiting the ritualism that is characteristic at this age. Ritualism is the need to maintain sameness and reliability. It provides a sense of comfort to the toddler. It will dictate certain principles in feeding practices, including rejecting a favorite food because it is served in a different container. Ritualism is not indicative of a child who has unreasonable expectations, but rather normal development. Toddlers use ritualistic behaviors to maintain necessary structure in their lives. This is not regression, which is a retreat from a present pattern of functioning.

Which is the most common causative agent of bacterial endocarditis? A) Staphylococcus albus B) Streptococcus hemolyticus C) Staphylococcus albicans D) Streptococcus viridans

D) Streptococcus viridans S. viridans is the most common causative agent in bacterial (infective) endocarditis. Staphylococcus albus, Streptococcus hemolyticus, and Staphylococcus albicans are not common causative agents.

Nursing interventions to help the siblings of a child with special needs cope include: A) explaining to the siblings that embarrassment is unhealthy. B) encouraging the parents not to expect siblings to help them care for the child with special needs. C) providing information to the siblings about the child's condition only as they request it. D) suggesting to the parents ways of showing gratitude to the siblings who help care for the child with special needs.

D) Suggesting to the parents ways of showing gratitude to the siblings who help care for the child with special needs. The presence of a child with special needs in a family will change the family dynamic. Siblings may be asked to take on additional responsibilities to help the parents to care for the child. The parents should show gratitude, such as an increase in allowance, special privileges, and verbal praise. Embarrassment may be associated with having a sibling with a chronic illness or disability. Parents must be able to respond in an appropriate manner without punishing the sibling. The parents may need assistance with the care of the child. Most siblings are positive about the extra responsibilities. The siblings need to be informed about the child's condition before a nonfamily member does so. The parents do not want the siblings to fantasize about what is wrong with the child.

Which therapeutic management treatment is implemented for children with Hirschsprung disease? A) Daily enemas B) Low-fiber diet C) Permanent colostomy D) Surgical removal of affected section of bowel

D) Surgical removal of affected section of bowel Most children with Hirschsprung disease require surgical rather than medical management. Surgery is done to remove the aganglionic portion of the bowel, relieve obstruction, and restore normal bowel motility and function of the internal anal sphincter. Preoperative management may include enemas and low-fiber, high-calorie, high-protein diet, until the child is physically ready for surgery. The colostomy that is created in Hirschsprung disease is usually temporary.

Which immunization should not be given to a child receiving chemotherapy for cancer? A) Tetanus vaccine B) Inactivated poliovirus vaccine C) Diphtheria, pertussis, tetanus (DPT) D) Measles, rubella, mumps

D) measles, rubella, mumps The vaccine used for measles, mumps, and rubella is a live virus and can result in an overwhelming infection. Tetanus vaccine, inactivated poliovirus vaccine, and diphtheria, pertussis, tetanus (DPT) are not live virus vaccines.

When caring for the child with Kawasaki disease, the nurse should know which information? A) A child's fever is usually responsive to antibiotics within 48 hours. B) The principal area of involvement is the joints. C) Aspirin is contraindicated. D) Therapeutic management includes administration of gamma globulin and aspirin.

D) therapeutic management includes administration of gamma globulin and aspirin High-dose IV gamma globulin and aspirin therapy is indicated to reduce the incidence of coronary artery abnormalities when given within the first 10 days of the illness. The fever of Kawasaki disease is unresponsive to antibiotics and antipyretics. Mucous membranes, conjunctiva, changes in the extremities, and cardiac involvement are seen. Aspirin is part of the therapy.