Peds Exam 2

What is used to treat moderate to severe inflammatory bowel disease? a. Antacids b. Antibiotics c. Corticosteroids d. Antidiarrheal medications

ANS: C Feedback A These are not drugs of choice to treat the inflammatory process of inflammatory bowel disease. B Antibiotics may be used as adjunctive therapy to treat complications. C Corticosteroids, such as prednisone and prednisolone, are used in short bursts to suppress the inflammatory response in inflammatory bowel disease. D These are not drugs of choice to treat the inflammatory process of inflammatory bowel disease.

A group of teenage boys have just gotten on the basketball team and will be showering in the school's locker room after practice. What suggestions should the school nurse provide to these adolescents to decrease the chance of contracting athlete's foot (tinea pedis)? Select all that apply. A. Bring your own soap and towel, and don't share them with others. B. Dry your feet completely. C. Wear your practice shoes home. D. Change your socks every other day when not practicing. E. Use talcum powder or antifungal powder to keep your feet dry. F. Make sure your shoes are thoroughly dry before wearing them.

A, B, E, F Bringing their own soap and towel and not sharing them with others is necessary. They should dry their feet completely. Fungus likes moist, dark areas. Talcum powder or antifungal powder to keep feet dry as prevention of athlete's foot is appropriate. It is essential that their shoes be thoroughly dry before wearing them. They should not wear their practice shoes home because of the sweat moisture and the fact that their feet were just washed and dried. This would undo the positive actions the adolescents have taken. Changing socks every other day when not practicing is not often enough because of foot sweat and darkness. Socks should be changed at least daily.

A child who has measles and a compromised immune system needs to be watched for secondary infections or complications. Symptoms of which conditions should the nurse teach the parents to report immediately? Select all that apply. A. Bronchopneumonia B. Epiglottitis C. Laryngotracheobronchitis (croup) D. Otitis media E. Rheumatic fever F. Myocarditis

A, C, D, F Bronchopneumonia, otitis media and laryngotracheobronchitis (croup), and myocarditis can occur as complications of measles. Epiglottitis and rheumatic fever are not from measles.

The mother of a child with sickle cell disease calls the pediatrician's office because she thinks her son may have fifth disease. What information should the nurse give the mother? A. "Keep your child comfortable at home, but if you notice a major change in his activity level or behavior, call us immediately." B. "Use cool baths with oatmeal to decrease itching first thing in the morning and before going to bed at night." C. "Keep your child away from all of the other members of the household for the next three days." D. "Increase your son's intake of protein and fluids to help replace the liquid he is losing through his skin."

A. "Keep your child comfortable at home, but if you notice a major change in his activity level or behavior, call us immediately." Because the disease is mild, complications are not usually reported, especially in children. Patients with sickle cell disease or beta-thalassemia are at risk for anemia and aplastic crisis. A change in activity or energy could indicate anemia. Cool baths with oatmeal are not indicated for this illness. The child needs to be kept away from other family members for longer than 3 days. Increasing protein and fluids is not indicated for this child.

A mother calls the pediatrician's office and states that her 4-year-old son looks like "someone slapped his cheeks" and he's running a fever. What would the nurse suspect the child has based on the mother's description? A. Fifth disease B. Rubella C. Scarlet fever D. Roseola infantum

A. Fifth disease Fifth disease is a relatively mild systemic disease. Typically the child may appear well but has an intense, fiery red, edematous rash on the cheeks, which gives a "slapped cheek" appearance or a history of a rash that "comes and goes." Before the appearance of the rash, many children are asymptomatic or have nonspecific symptoms such as headache runny nose, malaise, and mild fever. Rubella often has the following signs and symptoms: Older children may report profuse nasal drainage, diarrhea, malaise, sore throat, headache, low-grade fever, polyarthritis, eye pain, aches, chills, anorexia, and nausea. Scarlet fever is known for the "strawberry tongue" and a fine red papular rash in the axillae, groin, and neck, which feels like sandpaper to the touch. Roseola infantum causes a sudden high fever (103 to 106° F [39.4 to 41.1° C]), malaise, and irritability, a mild cough, runny nose, abdominal pain, headache, vomiting, and diarrhea, and then several days later when the fever subsides a rash appears. The rash consists of rose-pink maculopapules or macules that blanch with pressure.

The nurse is caring for a 12-year-old boy who sustained major burns when putting charcoal lighter on a campfire. The nurse observes that boy is "very brave" and appears to accept pain with little or no response. Based on the nurse's knowledge of burns, pain, and age-specific development, what is the most appropriate nursing action? A. Talk with the health care provider about the possibility of requesting a psychological consultation. B. Spend time with the child to better understand why he doesn't seem to respond to pain. C. Praise the child frequently for his ability to deal with the pain. D. Encourage continued bravery as a coping strategy.

A. Talk with the health care provider about the possibility of requesting a psychological consultation. A psychological consultation will assist the child to verbalize fears. This age group is concerned with physical appearance. The psychologists can help integrate the issues that the child is facing. The nurse would talk with the health care provider and share the observations about this child, but ultimately the health care provider would be the one to decide if a consult is warranted. Further assessment is needed, but this child would probably benefit from the psychologist. It is likely that the child is having pain but not acknowledging it. If the child is feeling pain, the nurse should not praise him for hiding it. The nurse must act as an advocate and keep the child as comfortable as possible. Encouraging bravery may not be an effective coping strategy if the child is in severe pain.

Which drug is an angiotensin-converting enzyme (ACE) inhibitor? a. Captopril (Capoten) b. Furosemide (Lasix) c. Spironolactone (Aldactone) d. Chlorothiazide (Diuril)

ANS: A Feedback A Capoten is a drug in an ACE inhibitor. B Lasix is a loop diuretic. C Aldactone blocks the action of aldosterone. D Diuril works on the distal tubules.

A beneficial effect of administering digoxin (Lanoxin) is that it a. Decreases edema b. Decreases cardiac output c. Increases heart size d. Increases venous pressure

ANS: A Feedback A Digoxin has a rapid onset and is useful increasing cardiac output, decreasing venous pressure, and as a result, decreasing edema. B Cardiac output is increased by digoxin. C Heart size is decreased by digoxin. D Digoxin decreases venous pressure.

Unlike fragile X syndrome, which affects primarily males, __________ (RS) is almost exclusively linked to female gender.

ANS: Rett syndrome An estimated 1:10,000 to 1:15,000 females are affected. RS is characterized by an initial period of normal development with symptoms emerging between the ages of 6 and 18 months. Social and intellectual development stops and seizures along with physical disabilities emerge.

A new mother calls the pediatrician's office concerned because her newborn has developed a salmon colored, irregularly shaped spot between the eyes. The lesion becomes darker when the baby is crying. This skin lesion is called a(n) ____________.

ANS: salmon patch The nurse can reassure the mother that salmon patches are commonly known as "stork bites" or "angel kisses." These lesions are benign and usually fade during the first year of life. The only treatment necessary is parental education.

Elevated blood pressure in the blood vessels of the lungs is a condition known as PAH or _____________________ __________________ .

ANS: Pulmonary hypertension is diagnosed when the mean arterial pressure exceeds 20 mm Hg (normal is 15 mm Hg). The most common cause of pulmonary hypertension in children is congenital heart disease.

It is late winter when a 7-year-old child reports to the school nurse with fever, headache, myalgia, and glandular swelling. After assessment the nurse's preliminary diagnosis includes the viral infection most commonly known as ________.

ANS: mumps The classic indication of mumps is parotid glandular swelling, although a number of children will have no such swelling. This is often accompanied by fever. The parents should be notified and provided with educational information regarding care of the child with the mumps.

Which statement made by an adolescent girl indicates an understanding about the prevention of sexually transmitted diseases (STDs)? a. "I know the only way to prevent STDs is to not be sexually active." b. "I practice safe sex because I wash myself right after sex." c. "I won't get any kind of STD because I take the pill." d. "I only have sex if my boyfriend wears a condom."

ANS: A Feedback A Abstinence is the only foolproof way to prevent an STD. B STDs are transmitted through body fluids (semen, vaginal fluids, blood). Perineal hygiene will not prevent an STD. C Oral contraceptives do not protect women from contracting STDs. D A condom can reduce but not eliminate an individual's chance of acquiring an STD.

The earliest clinical manifestation of biliary atresia is a. Jaundice b. Vomiting c. Hepatomegaly d. Absence of stooling

ANS: A Feedback A Jaundice is the earliest and most striking manifestation of biliary atresia. It is first observed in the sclera, may be present at birth, but is usually not apparent until age 2 to 3 weeks. B Vomiting is not associated with biliary atresia. C Hepatomegaly and abdominal distention are common but occur later. D Stools are large and lighter in color than expected because of the lack of bile.

What is an expected outcome for the child with irritable bowel disease? a. Decreasing symptoms b. Adherence to a low-fiber diet c. Increasing milk products in the diet d. Adapting the lifestyle to the lifelong problems

ANS: A Feedback A Management of irritable bowel disease is aimed at identifying and decreasing exposure to triggers and decreasing bowel spasms, which will decrease symptoms. Management includes maintenance of a healthy, well-balanced, moderate-fiber, lower fat diet. B A moderate amount of fiber in the diet is indicated for the child with irritable bowel disease. C No modification in dairy products is necessary unless the child is lactose intolerant. D Irritable bowel syndrome is typically self-limiting and resolves by age 20 years.

An infant with imperforate anus has an anal plasty and temporary colostomy. Which statement by the infant's mother indicates that she understands how to care for the infant's colostomy at home? a. "I will call the doctor right away if my baby starts vomiting." b. "I'll call my home health nurse if the colostomy bag needs to be changed." c. "I'll call the doctor if I notice that the colostomy stoma is pink." d. "I'll have my mother help me with the care of the colostomy."

ANS: A Feedback A Parents are taught signs of strangulation; vomiting, pain, and an irreducible mass in the abdomen. The physician should be contacted immediately if strangulation is suspected. B The mother should be taught the basics of colostomy care, including how to change the appliance. C The colostomy stoma should be pink in color, not pale or discolored. D There is no evidence that her mother knows how to care for a colostomy. This also does not indicate the mother has understanding of caring for the infant's colostomy.

Which order should the nurse question when caring for a 5-year-old child after surgery for Hirschsprung disease? a. Monitor rectal temperature every 4 hours and report an elevation greater than 38.5° C. b. Assess stools after surgery. c. Keep the child NPO until bowel sounds return. d. Maintain IV fluids at ordered rate.

ANS: A Feedback A Rectal temperatures should not be taken after this surgery. Rectal temperatures are generally not the route of choice for children because of the route's traumatic nature. B This is an appropriate intervention postoperatively. Stools should be soft and formed. C This is an appropriate intervention postoperatively. D This is an appropriate postoperative order.

What food choice by the parent of a 2-year-old child with celiac disease indicates a need for further teaching? a. Oatmeal b. Rice cake c. Corn muffin d. Meat patty

ANS: A Feedback A The child with celiac disease is unable to fully digest gluten, the protein found in wheat, barley, rye, and oats. Oatmeal contains gluten and is not an appropriate food selection. B Rice is an appropriate choice because it does not contain gluten. C Corn is digestible because it does not contain gluten. D Meats do not contain gluten and can be included in the diet of a child with celiac disease.

Which intervention is appropriate for a hospitalized child who has crops of lesions on the trunk that appear as a macular rash and vesicles? a. Place the child in strict isolation; airborne and contact precautions. b. Continue to practice Standard Precautions. c. Pregnant women should avoid contact with the child. d. Screen visitors for immunity to measles.

ANS: A Feedback A The child's skin lesions are characteristic of varicella. Varicella is transmitted through direct contact, droplets, and airborne particles. In the hospital setting, children with varicella should be placed in strict isolation, and on Contact and Airborne Precautions. The purpose is to prevent transmission of microorganisms by inhalation of small-particle droplet nuclei and to protect other patients and health care providers from acquiring this disease. B The child's skin lesions are characteristic of varicella. Additional measures must be instituted to protect other patients and staff who may be susceptible to the disease. C Certain viral illnesses such as rubella and fifth disease are known to affect the fetus if the woman contracts the disease during pregnancy. This child appears to have varicella. Pregnancy is not a contraindication to caring for a child with varicella. D The child appears to have varicella. Screening visitors for immunity to measles is irrelevant. It is important to screen visitors for immunity to varicella.

What is the best response to parents who ask why their infant has a nasogastric tube to intermittent suction before abdominal surgery for hypertrophic pyloric stenosis? a. "The nasogastric tube decompresses the abdomen and decreases vomiting." b. "We can keep a more accurate measure of intake and output with the nasogastric tube." c. "The tube is used to decrease postoperative diarrhea." d. "Believe it or not, the nasogastric tube makes the baby more comfortable after surgery."

ANS: A Feedback A The nasogastric tube provides decompression and decreases vomiting. B A nursing responsibility when a patient has a nasogastric tube is measurement of accurate intake and output, but this is not why nasogastric tubes are inserted. C Nasogastric tube placement does not decrease diarrhea. D The presence of a nasogastric tube can be perceived as a discomfort by the patient.

The best chance of survival for a child with cirrhosis is a. Liver transplantation b. Treatment with corticosteroids c. Treatment with immune globulin d. Provision of nutritional support

ANS: A Feedback A The only successful treatment for end-stage liver disease and liver failure may be liver transplantation, which has improved the prognosis for many children with cirrhosis. B Liver transplantation has revolutionized the approach to cirrhosis. Liver failure and cirrhosis are indications for transplantation. Liver transplantation reflects the failure of other medical and surgical measures to prevent or treat cirrhosis. C Liver transplantation has revolutionized the approach to cirrhosis. Liver failure and cirrhosis are indications for transplantation. Liver transplantation reflects the failure of other medical and surgical measures to prevent or treat cirrhosis. D Liver transplantation has revolutionized the approach to cirrhosis. Liver failure and cirrhosis are indications for transplantation. Liver transplantation reflects the failure of other medical and surgical measures to prevent or treat cirrhosis.

The nurse notes on assessment that a 1-year-old child is underweight, with abdominal distention, thin legs and arms, and foul-smelling stools. The nurse suspects failure to thrive is associated with a. Celiac disease b. Intussusception c. Irritable bowel syndrome d. Imperforate anus

ANS: A Feedback A These are classic symptoms of celiac disease. B Intussusception is not associated with failure to thrive or underweight, thin legs and arms, and foul-smelling stools. Stools are like "currant jelly." C Irritable bowel syndrome is characterized by diarrhea and pain, and the child does not typically have thin legs and arms. D Imperforate anus is the incomplete development or absence of the anus in its normal position in the perineum. Symptoms are evident in early infancy.

Bismuth subsalicylate, clarithromycin, and metronidazole are prescribed for a child with a peptic ulcer to a. Eradicate Helicobacter pylori. b. Coat gastric mucosa. c. Treat epigastric pain. d. Reduce gastric acid production.

ANS: A Feedback A This combination of drug therapy is effective in the treatment of H. pylori. B This drug combination is prescribed to eradicate the H. pylori. C This drug combination is prescribed to eradicate the H. pylori. D This drug combination is prescribed to eradicate the H. pylori.

The nurse is caring for a neonate with a suspected tracheoesophageal fistula (TEF). Nursing care should include a. Elevating the head but give nothing by mouth b. Elevating the head for feedings c. Feeding glucose water only d. Avoiding suction unless infant is cyanotic

ANS: A Feedback A When a newborn is suspected of having TEF, the most desirable position is supine with the head elevated on an incline plane of at least 30 degrees. It is imperative that any source of aspiration be removed at once; oral feedings are withheld. B Feedings should not be given to infants suspected of having TEF. C Feedings should not be given to infants suspected of having TEF. D The oral pharynx should be kept clear of secretion by oral suctioning. This is to avoid cyanosis that is usually the result of laryngospasm caused by overflow of saliva into the larynx.

A nurse is teaching a group of parents about TEF. Which statement made by the nurse is accurate about TEF? a. This defect results from an embryonal failure of the foregut to differentiate into the trachea and esophagus. b. It is a fistula between the esophagus and stomach that results in the oral intake being refluxed and aspirated. c. An extra connection between the esophagus and trachea develops because of genetic abnormalities. d. The defect occurs in the second trimester of pregnancy.

ANS: A Feedback A When the foregut does not differentiate into the trachea and esophagus during the fourth to fifth week of gestation, a TEF occurs. B TEF is an abnormal connection between the esophagus and trachea. C There is no connection between the trachea and esophagus in normal fetal development. D This defect occurs early in pregnancy during the fourth to fifth week of gestation.

What is the nurse's first action when planning to teach the parents of an infant with a CHD? a. Assess the parents' anxiety level and readiness to learn. b. Gather literature for the parents. c. Secure a quiet place for teaching. d. Discuss the plan with the nursing team.

ANS: A Feedback A Any effort to organize the right environment, plan, or literature is of no use if the parents are not ready to learn or have high anxiety. Decreasing level of anxiety is often needed before new information can be processed. B A baseline assessment of prior knowledge should be taken into consideration before developing any teaching plan. C Locating a quiet place for meeting with parents is appropriate; however, an assessment should be done before any teaching is done. D Discussing a teaching plan with the nursing team is appropriate after an assessment of the parents' knowledge and readiness.

What intervention should be included in the plan of care for an infant with the nursing diagnosis of Excess Fluid Volume related to congestive heart failure? a. Weigh the infant every day on the same scale at the same time. b. Notify the physician when weight gain exceeds more than 20 g/day. c. Put the infant in a car seat to minimize movement. d. Administer digoxin (Lanoxin) as ordered by the physician.

ANS: A Feedback A Excess fluid volume may not be overtly visible. Weight changes may indicate fluid retention. Weighing the infant on the same scale at the same time each day ensures consistency. B An excessive weight gain for an infant is an increase of more than 50 g/day. C With fluid volume excess, skin will be edematous. The infant's position should be changed frequently to prevent undesirable pooling of fluid in certain areas. D Lanoxin is used in the treatment of congestive heart failure to improve cardiac function. Diuretics will help the body get rid of excess fluid.

A child with pulmonary atresia exhibits cyanosis with feeding. On reviewing this child's laboratory values, the nurse is not surprised to notice which abnormality? a. Polycythemia b. Infection c. Dehydration d. Anemia

ANS: A Feedback A Polycythemia is a compensatory response to chronic hypoxia. The body attempts to improve tissue oxygenation by producing additional red blood cells and thereby increases the oxygen-carrying capacity of the blood. B Infection is not a clinical consequence of cyanosis. C Although dehydration can occur in cyanotic heart disease, it is not a compensatory mechanism for chronic hypoxia. It is not a clinical consequence of cyanosis. D Anemia may develop as a result of increased blood viscosity. Anemia is not a clinical consequence of cyanosis.

In which situation is there a risk that a newborn infant will have a congenital heart defect (CHD)? a. Trisomy 21 detected on amniocentesis b. Family history of myocardial infarction c. Father has type 1 diabetes mellitus d. Older sibling born with Turner syndrome

ANS: A Feedback A The incidence of congenital heart disease is approximately 50% in children with trisomy 21 (Down syndrome). B A family history of congenital heart disease, not acquired heart disease, increases the risk of giving birth to a child with CHD. C Infants born to mothers who are insulin dependent have an increased risk of CHD. D Infants identified as having certain genetic defects, such as Turner syndrome, have a higher incidence of CHD. A family history is not a risk factor.

Before giving a dose of digoxin (Lanoxin), the nurse checked an infant's apical heart rate and it was 114 bpm. What should the nurse do next? a. Administer the dose as ordered. b. Hold the medication until the next dose. c. Wait and recheck the apical heart rate in 30 minutes. d. Notify the physician about the infant's heart rate.

ANS: A Feedback A The infant's heart rate is above the lower limit for which the medication is held. The dose can be given. B A dose of Lanoxin is withheld for a heart rate less than 100 bpm in an infant. C The infant's heart rate is acceptable for administering Lanoxin. It is unnecessary to recheck the heart rate at a later time. D The infant's heart rate is acceptable. The physician should be notified for a heart rate less than 100 bpm in an infant.

What should the nurse include in discharge teaching as the highest priority for the child with a cardiac dysrhythmia? a. CPR instructions b. Repeating digoxin if the child vomits c. Resting if dizziness occurs d. Checking the child's pulse after digoxin administration

ANS: A Feedback A This could potentially be life-saving for the child. The parents and significant others in the child's life should have CPR training. B The digoxin dose is not repeated if the child vomits. C Dizziness is a symptom the child should be taught to report to adults so that the physician can be notified. It is not the priority intervention. D The child's pulse should be counted before the medication is given. The dose is withheld if the pulse is below the parameters set by the physician.

Which CHD results in increased pulmonary blood flow? a. Ventricular septal defect b. Coarctation of the aorta c. Tetralogy of Fallot d. Pulmonary stenosis

ANS: A Feedback A Ventricular septal defect causes a left-to-right shunting of blood, thus increasing pulmonary blood flow. B Coarctation of the aorta is a stenotic lesion that causes increased resistance to blood flow from the proximal to distal aorta. C The defects associated with tetralogy of Fallot result in a right-to-left shunting of blood, thus decreasing pulmonary blood flow. D Pulmonary stenosis causes obstruction of blood flow from the right ventricle to the pulmonary artery. Pulmonary blood flow is decreased.

1. A nurse in a well-child clinic is teaching parents about their child's immune system. Which statement by the nurse is correct? a. The immune system distinguishes and actively protects the body's own cells from foreign substances. b. The immune system is fully developed by 1 year of age. c. The immune system protects the child against communicable diseases in the first 6 years of life. d. The immune system responds to an offending agent by producing antigens.1. A nurse in a well-child clinic is teaching parents about their child's immune system. Which statement by the nurse is correct?

ANS: A A The immune system responds to foreign substances, or antigens, by producing antibodies and storing information. Intact skin, mucous membranes, and processes such as coughing, sneezing, and tearing help maintain internal homeostasis. B. Children up to age 6 or 7 years have limited antibodies against common bacteria. The immunoglobulins reach adult levels at different ages. C. Immunization is the basis from which the immune system activates protection against some communicable diseases. D. Antibodies are produced by the immune system against invading agents, or antigens.

13. The nurse observes a red butterfly-shaped rash that spreads across the child's cheeks and nose. This assessment finding is characteristic of which condition? a. Systemic lupus erythematosus (SLE) b. Rheumatic fever c. Kawasaki disease d. Anaphylactic reaction

ANS: A A. A red, flat or raised malar "butterfly" rash over the cheeks and bridge of the nose is a clinical manifestation of SLE. B. A major manifestation of rheumatic fever is erythema marginatum, which appears as red skin lesions spread peripherally over the trunk. C. An erythematous rash, induration of the hands and feet, and erythema of the palms and soles are manifestations of Kawasaki disease. D. Initial symptoms of anaphylaxis include severe itching and rapid development of erythema.

The primary treatment for warts is: a. Vaccination b. Local destruction c. Corticosteroids d. Specific antibiotic therapy

ANS: B Feedback A Vaccination is prophylaxis for warts and is not a treatment. B Topical treatments include chemical cautery, which is especially useful for the treatment of warts. Local destructive therapy individualized according to location, type, and number. Surgical removal, electrocautery, curettage, cryotherapy, caustic solutions, x-ray treatment, and laser therapies are used. C These are not effective in the treatment of warts. D These are not effective in the treatment of warts.

18. The nurse is planning care for an adolescent with AIDS. The priority nursing goal is to a. Prevent infection. b. Prevent secondary cancers. c. Restore immunologic defenses. d. Identify source of infection.

ANS: A A. As a result of the immunocompromise that is associated with HIV infection, the prevention of infection is paramount. Although certain precautions are justified in limiting exposure to infection, these must be balanced with the concern for the child's normal developmental needs. B. Preventing secondary cancers is not currently possible. C. Current drug therapy is affecting the disease progression; although not a cure, these drugs can suppress viral replication preventing further deterioration. D. Case finding is not a priority nursing goal.

4. Which statement is true regarding how infants acquire immunity? a. The infant acquires humoral and cell-mediated immunity in response to infections and immunizations. b. The infant acquires maternal antibodies that ensure immunity up to 12 months age. c. Active immunity is acquired from the mother and lasts 6 to 7 months. d. Passive immunity develops in response to immunizations.

ANS: A A. Infants acquire long-term active immunity from exposure to antigens and vaccines. Immunity is acquired actively and passively. B. The term infant's passive immunity is acquired from the mother and begins to dissipate during the first 6 to 8 months of life. C. Passive immunity is acquired from the mother. D. Active immunity develops in response to immunizations.

7. Which suggestion is appropriate to teach a mother who has a preschool child who refuses to take the medications for HIV infection? a. Mix medications with chocolate syrup or follow with chocolate candy. b. Mix the medications with milk or an essential food. c. Skip the dose of medication if the child protests too much. d. Mix the medication in a syringe, hold the child down firmly, and administer the medication.

ANS: A A. Liquid forms of HIV medications may be foul tasting or have a gritty texture. Chocolate will help to make these foods more palatable and is liked by most children. B. Medications should be mixed with nonessential foods. C. Doses of medication should never be skipped. D. Fighting with the child or using force should be avoided. A nonessential food that will make the taste of the medication more palatable for the child should be the correct action. The administration of medications for the child with HIV becomes part of the family's everyday routine for years.

8. What is the primary nursing concern for a hospitalized child with HIV infection? a. Maintaining growth and development b. Eating foods that the family brings to the child c. Consideration of parental limitations and weaknesses d. Resting for 2 to 3 hours twice a day

ANS: A A. Maintaining growth and development is a major concern for the child with HIV infection. Frequent monitoring for failure to thrive, neurologic deterioration, or developmental delay is important for HIV-infected infants and children. B. Nutrition, which contributes to a child's growth, is a nursing concern; however, it is not necessary for family members to bring food to the child. C. Although an assessment of parental strengths and weaknesses is important, it will be imperative for health care providers to focus on the parental strengths, not weaknesses. This is not as important as the frequent assessment of the child's growth and development. D. Rest is a nursing concern, but it is not as high a priority as maintaining growth and development. Rest periods twice a day for 2 to 3 hours may not be appropriate.

5. What is the most common mode of transmission of human immunodeficiency virus (HIV) in the pediatric population? a. Perinatal transmission b. Sexual abuse c. Blood transfusions d. Poor handwashing

ANS: A A. Perinatal transmission accounts for the highest percentage (91%) of HIV infections in children. Infected women can transmit the virus to their infants across the placenta during pregnancy, at delivery, and through breastfeeding. B. Cases of HIV infection from sexual abuse have been reported; however, perinatal transmission accounts for most pediatric HIV infections. C. Although in the past some children became infected with HIV through blood transfusions, improved laboratory screening has significantly reduced the probability of contracting HIV from blood products. D. Poor handwashing is not an etiology of HIV infection.

The management of a child who has just been stung by a bee or wasp should include the application of: a. Cool compresses b. Warm compresses c. Antibiotic cream d. Corticosteroid cream

ANS: A Feedback A Bee or wasp stings are initially treated by carefully removing the stinger, cleansing with soap and water, application of cool compresses, and the use of common household agents such as lemon juice or a paste made with aspirin and baking soda. B Warm compresses are avoided. C Antibiotic cream is unnecessary unless a secondary infection occurs. D Corticosteroid cream is not part of the initial therapy. If a severe reaction occurs, systemic corticosteroids may be indicated.

What nursing assessment and care holds the highest priority in the initial care of a child with a major burn injury? a. Establishing and maintaining the child's airway b. Establishing and maintaining intravenous access c. Inserting a catheter to monitor hourly urine output d. Inserting a nasogastric tube into the stomach to supply adequate nutrition

ANS: A Feedback A Establishing and maintaining the child's airway is always the priority focus for assessment and care. B Establishing intravenous access is the second priority in this situation, after the airway has been established. C Inserting a catheter and monitoring hourly urine output is the third most important nursing intervention. D Nasogastric feedings are not begun initially on a child with major or severe burns. The initial assessment and care focus for a child with major burn injuries is the ABCs.

Impetigo ordinarily results in: a. No scarring b. Pigmented spots c. Slightly depressed scars d. Atrophic white scars

ANS: A Feedback A Impetigo tends to heal without scarring unless a secondary infection occurs. B Hyperpigmentation may occur; however, only in dark skinned children. C No scarring usually occurs. D No scarring usually occurs

When assessing the child with atopic dermatitis, the nurse should ask the parents about a history of: a. Asthma b. Nephrosis c. Lower respiratory tract infections d. Neurotoxicity

ANS: A Feedback A Most children with atopic dermatitis have a family history of asthma, hay fever, or atopic dermatitis, and up to 80% of children with atopic dermatitis have asthma or allergic rhinitis. B Complications of atopic dermatitis relate to the skin. The renal system is not affected by atopic dermatitis. C There is no link between lower respiratory tract infections and atopic dermatitis. D Atopic dermatitis does not have a relationship to neurotoxicity.

A child experiences frostbite of the fingers after prolonged exposure to the cold. Which intervention should the nurse implement first?: a. Rapid rewarming of the fingers by placing in warm water b. Placing the hand in cool water c. Slow rewarming by wrapping in warm cloth d. Using an ice pack to keep cold until medical intervention is possible

ANS: A Feedback A Rapid rewarming is accomplished by immersing the part in well-agitated water at 37.8° C to 42.2° C (100° F to 108° F). B The frostbitten area should be rewarmed as soon as possible to avoid further tissue damage. C Rapid rewarming results in less tissue necrosis than slow thawing. D The frostbitten area should be rewarmed, as soon as possible, to avoid further tissue damage.

When changing an infant's diaper, the nurse notices small bright red papules with satellite lesions on the perineum, anterior thigh, and lower abdomen. This rash is characteristic of: a. Primary candidiasis b. Irritant contact dermatitis c. Intertrigo d. Seborrheic dermatitis

ANS: A Feedback A Small red papules with peripheral scaling in a sharply demarcated area involving the anterior thighs, lower abdomen, and perineum are characteristic of primary candidiasis. B A shiny, parchment-like erythematous rash on the buttocks, medial thighs, mons pubis, and scrotum, but not in the folds, is suggestive of irritant contact dermatitis. C Intertrigo is identified by a red macerated area of sharp demarcation in the groin folds. It can also develop in the gluteal and neck folds. D Seborrheic dermatitis is recognized by salmon-colored, greasy lesions with a yellowish scale found primarily in skin-fold areas or on the scalp.

What should be included in teaching a parent about the management of small red macules and vesicles that become pustules around the child's mouth and cheek? a. Keep the child home from school for 24 hours after initiation of antibiotic treatment. b. Clean the rash vigorously with Betadine three times a day. c. Notify the physician for any itching. d. Keep the child home from school until the lesions are healed.

ANS: A Feedback A To prevent the spread of impetigo to others, the child should be kept home from school for 24 hours after treatment is initiated. Good handwashing is imperative in preventing the spread of impetigo. B The lesions should be washed gently with a warm soapy washcloth three times a day. The washcloth should not be shared with other members of the family. C Itching is common and does not necessitate medical treatment. Rather, parents should be taught to clip the child's nails to prevent maceration of the lesions. D The child may return to school 24 hours after initiation of antibiotic treatment.

What should be the major consideration when selecting toys for a child with an intellectual or developmental disability? a. Safety b. Age appropriateness c. Ability to provide exercise d. Ability to teach useful skills

ANS: A Feedback A Safety is the primary concern in selecting recreational and exercise activities for all children. This is especially true for children who are intellectually disabled. B Age appropriateness should be considered in the selection of toys, but safety is of paramount importance. C Ability to provide exercise should be considered in the selection of toys, but safety is of paramount importance. D Ability to teach useful skills should be considered in the selection of toys, but safety is of paramount importance.

Parents have learned that their 6-year-old child has autism. The nurse may help the parents to cope by explaining that the child may a. Have an extremely developed skill in a particular area b. Outgrow the condition by early adulthood c. Have average social skills d. Have age-appropriate language skills

ANS: A Feedback A Some children with autism have an extremely developed skill in a particular area such as mathematics or music. B No evidence supports that autism is outgrown. C Autistic children have abnormal ways of relating to people (social skills). D Speech and language skills are usually delayed in autistic children.

A preschooler is diagnosed with helminthes. The child's mother is very upset and wants to know how her child could have contracted this illness. After obtaining a detailed history, the nurse identifies all possible transmission modes. Select all modes that apply. a. Playing in the backyard sandbox b. Not washing hands before eating c. Placing hands in the mouth and nail biting d. Skin-to-skin contact with other children e. Scratches from a neighborhood cat

ANS: A, B, C Feedback Correct Common helminthes include roundworm, pinworm, tapeworm, and hookworm. Children are frequently infected as the result of frequent hand-mouth activity (unwashed hands, nail biting, not washing hands after using the toilet) and the likelihood of fecal contamination from sandboxes (especially if dogs and cats deposit fecal material in them). Other causes include not adequately washing fruits and vegetables before eating them and drinking contaminated water. Incorrect Skin-to-skin contact with other children and scratches from a cat are not transmission modes for helminthes.

Which nursing interventions are significant for a child with cirrhosis who is at risk for bleeding? Select all that apply. a. Guaiac all stools b. Provide a safe environment c. Administer multivitamins with vitamins A, D, E, and K d. Inspect skin for pallor and cyanosis e. Monitor serum liver panels

ANS: A, B, C Feedback Correct Identification of bleeding includes stool guaiac testing, which can detect if blood is present in the stool; protecting the child from injury by providing a safe environment; administering vitamin K to prevent bleeding episodes; and avoiding injections. Incorrect A skin assessment would likely reveal jaundice. Pallor and cyanosis are associated with a cardiac problem. These may be late signs of a significant bleeding episode, but not significant in the prevention stage of the nursing process. Monitoring serum liver panels is important but would not provide information on coagulation status or risk factors associated with bleeding.

You are the nurse assessing a 3-year-old child who has characteristics of autism. Which observed behaviors are associated with autism? Select all that apply. a. The child flicks the light in the examination room on and off repetitiously. b. The child has a flat affect. c. The child demonstrates imitation and gesturing skills. d. Mother reports the child has no interest in playing with other children. e. The child is able to make eye contact.

ANS: A, B, D Feedback Correct Self-stimulation is common and generally involves repetition of a sensory stimulus. Autistic children generally show a fixed, unchanging response to a particular stimulus. Autistic children generally play alone or involve others only as mere objects. Incorrect Autistic children lack imitative skills. These children lack social ability and make poor eye contact.

A nurse is teaching parents about prevention of diaper dermatitis. Which should the nurse include in the teaching plan?( Select all that apply.): a. Clean the diaper area gently after every diaper change with a mild soap. b. Use a protective ointment to clean dry intact skin. c. Use a steroid cream after each diaper change. d. Use rubber or plastic pants over the diaper. e. Wash cloth diapers in hot water with a mild soap and double rinse.

ANS: A, B, E Feedback Correct: Prompt, gentle cleaning with water and mild soap (e.g., Dove, Neutrogena Baby Soap) after each voiding or defecation rids the skin of ammonia and other irritants and decreases the chance of skin breakdown and infection. A bland, protective ointment (e.g., A&D, Balmex, Desitin, zinc oxide) can be applied to clean, dry, intact skin to help prevent diaper rash. If cloth diapers are laundered at home, the parents should wash them in hot water, using a mild soap and double rinsing. Incorrect: Occlusion increases the risk of systemic absorption of a steroid; thus steroid creams are rarely used for diaper dermatitis because the diaper functions as an occlusive dressing. Rubber or plastic pants increase skin breakdown by holding in moisture and should be used infrequently. A steroid cream is not recommended.

A nurse is assessing a newborn for facial feature characteristics associated with fetal alcohol syndrome: Which characteristics should the nurse expect to assess? Select all that apply. a. Short palpebral fissures b. Smooth philtrum c. Low set ears d. Inner epicanthal folds e. Thin upper lip

ANS: A, B, E Feedback Correct: Infants with fetal alcohol syndrome may have characteristic facial features, including short palpebral fissures, a smooth philtrum (the vertical groove in the median portion of the upper lip), and a thin upper lip. Incorrect: Low set ears and inner epicanthal folds are associated with Down syndrome

A child has a total cholesterol level of 180 mg/dL. What dietary recommendations should the nurse make to the child and the child's parents? Select all that apply. a. Replace whole milk for 2% or 1% milk. b. Increase servings of red meat. c. Increase servings of fish. d. Avoid excessive intake of fruit juices. e. Limit servings of whole grain.

ANS: A, C, D Feedback Correct A low-fat diet includes using nonfat or low-fat dairy products, limiting red meat intake, and increasing intake of fish, vegetables, whole grains, and legumes. Incorrect Children should avoid excessive intake of fruit juices and other sweetened drinks, sugars, and saturated fats.

Which interventions should a nurse implement when caring for a child with hepatitis? Select all that apply. a. Provide a well-balanced low-fat diet. b. Schedule playtime in the playroom with other children. c. Teach parents not to administer any over-the-counter medications. d. Arrange for home schooling because the child will not be able to return to school. e. Instruct parents on the importance of good handwashing.

ANS: A, C, E Feedback Correct The child with hepatitis should be placed on a well-balanced low-fat diet. Parents should be taught to not give over-the-counter medications because of impaired liver function. Hand hygiene is the most important preventive measure for the spread of hepatitis. Incorrect The child will be in contact isolation in the hospital so playtime with other hospitalized children is not scheduled. The child will be on contact isolation for a minimum of 1 week after the onset of jaundice. After that period, the child will be allowed to return to school.

Where do the lesions of atopic dermatitis most commonly occur in the infant? (Select all that apply.): a. Cheeks b. Buttocks c. Extensor surfaces of arms and legs d. Back e. Trunk

ANS: A, C, E Feedback Correct: The lesions of atopic dermatitis are generalized in the infant. They are most commonly on the cheeks, scalp, trunk, and extensor surfaces of the extremities. Incorrect: These lesions are not typically on the back or the buttocks.

The nurse should provide which information to parents about the prevention of parasitic infections? Select all that apply. a. Perform good handwashing. b. Diaper a child when swimming. c. Avoid cleaning the bathroom facilities with bleach. d. Shoes should be worn outside. e. Fruits and vegetables should be washed before eating.

ANS: A, D, E Feedback Correct Children are more commonly infected with parasites than adults, primarily as a result of frequent hand-to-mouth activity and the likelihood of fecal contamination. Good handwashing can prevent the transmission. Shoes should be worn when outside to prevent transmission, and fruits and vegetables should be washed before eating. Incorrect The child should not swim in a pool that allows diapered children. The bathroom facilities should be cleaned with bleach to decrease the chance of transmission.

A nurse should plan to implement which interventions for a child admitted with inorganic failure to thrive? Select all that apply. a. Observation of parent-child interactions b. Assignment of different nurses to care for the child from day to day c. Use of 28 calorie per ounce concentrated formulas d. Administration of daily multivitamin supplements e. Role modeling appropriate adult-child interactions

ANS: A, D, E Feedback Correct: The nurse should plan to assess parent-child interactions when a child is admitted for nonorganic failure to thrive. The observations should include how the child is held and fed, how eye contact is initiated and maintained, and the facial expressions of both the child and the caregiver during interactions. Role modeling and teaching appropriate adult-child interactions (including holding, touching, and feeding the child) will facilitate appropriate parent-child relationships, enhance parents' confidence in caring for their child, and facilitate expression by the parents of realistic expectations based on the child's developmental needs. Daily multivitamin supplements with minerals are often prescribed to ensure that specific nutritional deficiencies do not occur in the course of rapid growth. The nursing staff assigned to care for the child should be consistent. Incorrect: Providing a consistent caregiver from the nursing staff increases trust and provides the child with an adult who anticipates his or her needs and who is able to role model child care to the parent. Caloric enrichment of food is essential, and formula may be concentrated in titrated amounts up to 24 calories per ounce. Greater concentrations can lead to diarrhea and dehydration.

The mother of an HIV-positive infant who is 2 months old questions the nurse about which childhood immunizations her child will be able to receive. Which immunizations should an HIV-positive child be able to receive according to the American Academy of Pediatrics recommendation for immunizing infants who are HIV positive? Select all that apply. a. Hepatitis B b. DTaP c. MMR d. IPV e. HIB

ANS: A,B,D,E Correct Routine immunizations are appropriate. Incorrect The MMR vaccination is not given at 2 months of age. If it were indicated, CD4+ counts are monitored when deciding whether to provide live virus vaccines. If the child is severely immunocompromised, the MMR vaccine is not given. The varicella vaccine can be considered on the basis of the child's CD4+counts. Only IPV should be used for HIV-infected children.

Which home care instructions should the nurse provide to the parents of a child with acquired immunodeficiency syndrome (AIDS)? Select all that apply. a. Give supplemental vitamins as prescribed. b. Yearly influenza vaccination should be avoided. c. Administer trimethoprim-sulfamethoxazole (Bactrim) as prescribed. d. Notify the physician if the child develops a cough or congestion. e. Missed doses of antiretroviral medication do not need to be recorded.

ANS: A,C,D Correct The parents should be taught that supplemental vitamins will be prescribed to aid in nutritional status. Bactrim is administered to prevent the opportunistic infection of Pneumocystis pneumonia. The physician should be notified if the child with AIDS develops a cough and congestion. Incorrect The yearly influenza vaccination is recommended and any missed doses of antiretroviral medication need to be recorded and reported.

Which assessment finding should the nurse expect in an infant with Hirschsprung disease? a. "Currant jelly" stools b. Constipation with passage of foul-smelling, ribbon-like stools c. Foul-smelling, fatty stools d. Diarrhea

ANS: B Feedback A "Currant jelly" stools are associated with intussusception. B Constipation results from absence of ganglion cells in the rectum and colon, and is present since the neonatal period with passage of frequent foul-smelling, ribbon-like, or pellet-like stools. C Foul-smelling, fatty stools are associated with cystic fibrosis and celiac disease. D Diarrhea is not typically associated with Hirschsprung disease but may result from impaction.

What should be included in health teaching to prevent Lyme disease? a. Complete the immunization series in early infancy. b. Wear long sleeves and pants tucked into socks while in wooded areas. c. Give low-dose antibiotics to the child before exposure. d. Restrict activities that might lead to exposure for the child.

ANS: B Feedback A Currently there is no vaccine available for Lyme disease. The Lyme disease vaccine had been approved for persons ages 15 to 70 years; however, was withdrawn from the market in 1992. B Wearing long sleeves and pants, and tucking the pants into socks keeps ticks on the clothing and prevents them from hiding on the body. C Antibiotics are used to treat, not prevent, Lyme disease. D Children should be allowed to maintain normal growth and development with activities such as hiking.

How should the nurse respond to a parent who asks, "How can I protect my baby from whooping cough?" a. "Don't worry; your baby will have maternal immunity to pertussis that will last until they are approximately 18 months old." b. "Make sure your child gets the pertussis vaccine." c. "See the doctor when the baby gets a respiratory infection." d. "Have your pediatrician prescribe erythromycin."

ANS: B Feedback A Infants do not receive maternal immunity to pertussis and are susceptible to pertussis. Pertussis is highly contagious and is associated with a high infant mortality rate. B Primary prevention of pertussis can be accomplished through administration of the pertussis vaccine. C Prompt evaluation by the primary care provider for respiratory illness will not prevent pertussis. D Erythromycin is used to treat pertussis. It will not prevent the disease.

Which STD should the nurse suspect when an adolescent girl comes to the clinic because she has a vaginal discharge that is white with a fishy smell? a. Human papillomavirus b. Bacterial vaginosis c. Trichomonas d. Chlamydia

ANS: B Feedback A Manifestations of the human papillomavirus are anogenital warts that begin as small papules and grow into clustered lesions. B Bacterial vaginosis is characterized by a profuse, white, malodorous (fishy smelling) vaginal discharge that sticks to the vaginal walls. C Infections with Trichomonas are frequently asymptomatic. Symptoms in females may include dysuria, vaginal itching, burning, and a frothy, yellowish-green, foul-smelling discharge. D Many people with chlamydial infection have few or no symptoms. Urethritis with dysuria, urinary frequency, or mucopurulent discharge may indicate chlamydial infection.

A nurse is conducting a health education class for a group of school-age children. Which statement made by the nurse is correct about the body's first line of defense against infection in the innate immune system? a. Nutritional status b. Skin integrity c. Immunization status d. Proper hygiene practices

ANS: B Feedback A Nutritional status is an indicator of overall health, but it is not the first line of defense in the innate immune system. B The first lines of defense in the innate immune system are the skin and intact mucous membranes. C Immunizations provide artificial immunity or resistance to harmful diseases. D Practicing good hygiene may reduce susceptibility to disease, but it is not a component of the innate immune system.

Which assessment finding is the most significant to report to the physician for a child with cirrhosis? a. Weight loss b. Change in level of consciousness c. Skin with pruritus d. Black, foul-smelling stools

ANS: B Feedback A One complication of cirrhosis is ascites. The child needs to be assessed for increasing abdominal girth and edema. A child who is retaining fluid will not exhibit weight loss. B The child with cirrhosis must be assessed for encephalopathy, which is characterized by a change in level of consciousness. Encephalopathy can result from a buildup of ammonia in the blood from the incomplete breakdown of protein. C Biliary obstruction can lead to pruritus, which is a frequent finding. An alteration in the level of consciousness is of higher priority. D Black, tarry stools may indicate blood in the stool. This needs be reported to the physician. This is not a higher priority than a change in level of consciousness.

A 4-month-old infant has gastroesophageal reflux (GER) but is thriving without other complications. What 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.

ANS: B Feedback A Placing the child in a Trendelenburg position increases the reflux. B 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 GERD. C Continuous nasogastric feedings are reserved for infants with severe reflux and failure to thrive. D Smaller, more frequent feedings are recommended in reflux.

10. Children receiving long-term systemic corticosteroid therapy are most at risk for a. Hypotension b. Dilation of blood vessels in the cheeks c. Growth delays d. Decreased appetite and weight loss

ANS: C A. Hypertension is a clinical manifestation of long-term systemic steroid administration. B. Dilation of blood vessels in the cheeks is associated with an excess of topically administered steroids. C. Growth delay is associated with long-term steroid use. D. Increased appetite and weight gain are clinical manifestations of excess systemic corticosteroid therapy.

What is the most important action to prevent the spread of gastroenteritis in a daycare setting? a. Administering prophylactic medications to children and staff b. Frequent handwashing c. Having parents bring food from home d. Directing the staff to wear gloves at all times

ANS: B Feedback A Prophylactic medications are not helpful in preventing gastroenteritis. B Handwashing is the most the important measure to prevent the spread of infectious diarrhea. C Bringing food from home will not prevent the spread of infectious diarrhea. D Gloves should be worn when changing diapers, soiled clothing, or linens. They do not need to be worn for interactions that do not involve contact with secretions. Handwashing after contact is indicated.

Which statement about Crohn disease is the most accurate? a. The signs and symptoms of Crohn disease are usually present at birth. b. Signs and symptoms of Crohn disease include abdominal pain, diarrhea, and often a palpable abdominal mass. c. Edema usually accompanies this disease. d. Symptoms of Crohn disease usually disappear by late adolescence.

ANS: B Feedback A Signs and symptoms are not usually present at birth. B Crohn disease can occur anywhere in the GI tract from the mouth to the anus and is most common in the terminal ileum. Signs and symptoms include abdominal pain, diarrhea (nonbloody), fever, palpable abdominal mass, anorexia, severe weight loss, fistulas, obstructions, and perianal and anal lesions. C Diarrhea and malabsorption from Crohn disease cause weight loss, anorexia, dehydration, and growth failure. Edema does not accompany this disease. D Crohn disease is a long-term health problem. Symptoms do not typically disappear by adolescence.

What is the best response to a parent of a 2-month-old infant who asks when the infant should first receive the measles vaccine? a. "Your baby can get the measles vaccine now." b. "The first dose is given any time after the first birthday." c. "She should be vaccinated between 4 and 6 years of age." d. "This vaccine is administered when the child is 11 years old."

ANS: B Feedback A Some immunizations are initiated at 2 months of age, but not the measles vaccine. B The first measles, mumps, rubella (MMR) vaccine is recommended routinely at 1 year of age. C The second dose of MMR is recommended at 4 to 6 years of age. D Children should receive their second MMR dose no later than 11 to 12 years of age.

What is an expected outcome for the parents of a child with encopresis? a. The parents will give the child an enema daily for 3 to 4 months. b. The family will develop a plan to achieve control over incontinence. c. The parents will have the child launder soiled clothes. d. The parents will supply the child with a low-fiber diet.

ANS: B Feedback A Stool softeners or laxatives, along with dietary changes, are typically used to treat encopresis. Enemas are indicated when a fecal impaction is present. B Parents of the child with encopresis often feel guilty and believe that encopresis is willful on the part of the child. The family functions effectively by openly discussing problems and developing a plan to achieve control over incontinence. C This action is a punishment and will increase the child's shame and embarrassment. The child should not be punished for an action that is not willful. D Increasing fiber in the diet and fluid intake results in greater bulk in the stool, making it easier to pass.

The nurse is teaching the parents of a child who has been diagnosed with irritable bowel syndrome about the pathophysiology associated with the symptoms their child is experiencing. Which response indicates to the nurse that her teaching has been effective? a. "My child has an absence of ganglion cells in the rectum causing alternating diarrhea and constipation." b. "The cause of my child's diarrhea and constipation is disorganized intestinal contractility." c. "My child has an intestinal obstruction; that's why he has abdominal pain." d. "My child has an intolerance to gluten, and this causes him to have abdominal pain."

ANS: B Feedback A The absence of ganglion cells in the rectum is associated with Hirschsprung disease. B Disorganized contractility and increased mucus production are precipitating factors of irritable bowel disease. C Intestinal obstruction is associated with pyloric stenosis. D Intolerance to gluten is the underlying cause of celiac disease.

What is an expected outcome for a 1-month-old infant with biliary atresia? a. Correction of the defect with the Kasai procedure b. Adequate nutrition and age-appropriate growth and development c. Adherence to a salt-free diet with vitamin B12 supplementation d. Adequate protein intake

ANS: B Feedback A The goal of the Kasai procedure is to allow for adequate growth until a transplant can be done. It is not a curative procedure. B Adequate nutrition, preventing skin breakdown, adequate growth and development, and family education and support are expected outcomes in an infant with biliary atresia. C Vitamin B12 supplementation is not indicated. A salt-restricted diet is appropriate. D Protein intake may need to be restricted to avoid hepatic encephalopathy.

What should the nurse expect to observe in the prodromal phase of rubeola? a. Macular rash on the face b. Koplik spots c. Petechiae on the soft palate d. Crops of vesicles on the trunk

ANS: B Feedback A The macular rash with rubeola appears after the prodromal stage. B Koplik spots appear approximately 2 days before the appearance of a rash. C Petechiae on the soft palate occur with rubella. D Crops of vesicles on the trunk are characteristic of varicella.

An infant with short bowel syndrome will be discharged home on total parenteral nutrition (TPN) and gastrostomy feedings. Nursing care should include a. Preparing family for impending death b. Teaching family signs of central venous catheter infection c. Teaching family how to calculate caloric needs d. Securing TPN and gastrostomy tubing under the diaper to lessen risk of dislodgment

ANS: B Feedback A The prognosis for patients with short bowel syndrome depends in part on the length of residual small intestine. It has improved with advances in TPN. B During TPN therapy, care must be taken to minimize the risk of complications related to the central venous access device, such as catheter infections, occlusions, or accidental removal. This is an important part of family teaching. C Although parents need to be taught about nutritional needs, the caloric needs and prescribed TPN and rate are the responsibility of the health care team. D The tubes should not be placed under the diaper due to risk of infection.

A nurse is giving a parent information about autism. Which statement made by the parent indicates understanding of the teaching? a. Autism is characterized by periods of remission and exacerbation. b. The onset of autism usually occurs before 3 years of age. c. Children with autism have imitation and gesturing skills. d. Autism can be treated effectively with medication.

ANS: B Feedback A Autism does not have periods of remission and exacerbation. B The onset of autism usually occurs before 3 years of age. C Autistic children lack imitative skills. D Medications are of limited use in children with autism.

What is the best response by the nurse to a mother asking about the cause of her infant's bilateral cleft lip? a. "Did you use alcohol during your pregnancy?" b. "Do you know of anyone in your family or the baby's father's family who was born with cleft lip or palate problems?" c. "This defect is associated with intrauterine infection during the second trimester." d. "The prevalent of cleft lip is higher in Caucasians"

ANS: B Feedback A Tobacco during pregnancy has been associated with bilateral cleft lip. B Cleft lip and palate result from embryonic failure resulting from multiple genetic and environmental factors. A genetic pattern or familial risk seems to exist. C The defect occurred at approximately 6 to 8 weeks of gestation. Second-trimester intrauterine infection is not a known cause of bilateral cleft lip. D The prevalence of cleft lip and palate is higher in Asian and Native American populations.

The nurse assessing a premature newborn infant auscultates a continuous machinery-like murmur. This finding is associated with which congenital heart defect? a. Pulmonary stenosis b. Patent ductus arteriosus c. Ventricular septal defect d. Coarctation of the aorta

ANS: B Feedback A A systolic ejection murmur that may be accompanied by a palpable thrill is a manifestation of pulmonary stenosis. B The classic murmur associated with patent ductus arteriosus is a machinery-like one that can be heard throughout both systole and diastole. C The characteristic murmur associated with ventricular septal defect is a loud, harsh, holosystolic murmur. D A systolic murmur that is accompanied by an ejection click may be heard on auscultation when coarctation of the aorta is present.

What is the appropriate priority nursing action for the infant with a CHD who has an increased respiratory rate, is sweating, and is not feeding well? a. Recheck the infant's blood pressure. b. Alert the physician. c. Withhold oral feeding. d. Increase the oxygen rate.

ANS: B Feedback A Although this may be indicated, it is not the priority action. B These are signs of early congestive heart failure, and the physician should be notified. C Withholding the infant's feeding is an incomplete response to the problem. D Increasing oxygen may alleviate symptoms, but medications such as digoxin and furosemide are necessary to improve heart function and fluid retention. Notifying the physician is the priority nursing action.

A child had an aortic stenosis defect surgically repaired 6 months ago. Which antibiotic prophylaxis is indicated for an upcoming tonsillectomy? a. No antibiotic prophylaxis is necessary. b. Amoxicillin is taken orally 1 hour before the procedure. c. Oral penicillin is given for 7 to 10 days before the procedure. d. Parenteral antibiotics are administered for 5 to 7 days after the procedure.

ANS: B Feedback A Antibiotic prophylaxis is indicated for the first 5 months after surgical repair. B The standard prophylactic agent is amoxicillin given orally 1 hour before the procedure. C Antibiotic prophylaxis is not given for this period of time. D The treatment for infective endocarditis involves parenteral antibiotics for 2 to 8 weeks.

The primary nursing intervention to prevent bacterial endocarditis is a. Institute measures to prevent dental procedures. b. Counsel parents of high-risk children about prophylactic antibiotics. c. Observe children for complications, such as embolism and heart failure. d. Encourage restricted mobility in susceptible children.

ANS: B Feedback A Dental procedures should be done to maintain a high level of oral health. Prophylactic antibiotics are necessary. B The objective of nursing care is to counsel the parents of high risk children about both the need for prophylactic antibiotics for dental procedures and the necessity of maintaining excellent oral health. The child's dentist should be aware of the child's cardiac condition. C Observing children for complications should be done, but maintaining good oral health and prophylactic antibiotics is important. D Encouraging restricted mobility should be done, but maintaining good oral health and prophylactic antibiotics is important.

Before preparing a teaching plan for the parents of an infant with ductus arteriosus, it is important that the nurse understands this condition. Which statement best describes patent ductus arteriosus? a. Patent ductus arteriosus involves a defect that results in a right-to-left shunting of blood in the heart. b. Patent ductus arteriosus involves a defect in which the fetal shunt between the aorta and the pulmonary artery fails to close. c. Patent ductus arteriosus is a stenotic lesion that must be surgically corrected at birth. d. Patent ductus arteriosus causes an abnormal opening between the four chambers of the heart.

ANS: B Feedback A Patent ductus arteriosus allows blood to flow from the high-pressure aorta to the low-pressure pulmonary artery, resulting in a left-to-right shunt. B Patent ductus arteriosus is failure of the fetal shunt between the aorta and the pulmonary artery to close. C Patent ductus arteriosus is not a stenotic lesion. Patent ductus arteriosus can be closed both medically and surgically. D Atrioventricular defect occurs when fetal development of the endocardial cushions is disturbed, resulting in abnormalities in the atrial and ventricular septa and the atrioventricular valves.

Which strategy is appropriate when feeding the infant with congestive heart failure? a. Continue the feeding until a sufficient amount of formula is taken. b. Limit feeding time to no more than 30 minutes. c. Always bottle feed every 4 hours. d. Feed larger volumes of concentrated formula less frequently.

ANS: B Feedback A The infant with congestive heart failure may tire easily. If the infant does not consume an adequate amount of formula in 30 minutes, gavage feedings should be considered. B The infant with congestive heart failure may tire easily, so the feeding should not continue beyond 30 minutes. If inadequate amounts of formula are taken, gavage feedings should be considered. C Infants with congestive heart failure may be breastfed. Feedings every 3 hours is a frequently used interval. If the infant were fed less frequently than every 3 hours, more formula would need to be consumed and would tire the infant. D The infant is fed smaller volumes of concentrated formula every 3 hours.

An adolescent being seen by the nurse practitioner for a sports physical is identified as having hypertension. On further testing, it is discovered the child has a cardiac abnormality. The initial treatment of secondary hypertension initially involves a. Weight control and diet b. Treating the underlying disease c. Administration of digoxin d. Administration of beta-adrenergic receptor blockers

ANS: B Feedback A Weight control and diet is a non-pharmacologic treatment for primary hypertension. B Identification of the underlying disease should be the first step in treating secondary hypertension. C Digoxin is indicated in the treatment of congestive heart failure. D Beta-adrenergic receptor blockers are indicated in the treatment of primary hypertension.

The nurse discovers a heart murmur in an infant 1 hour after birth. She is aware that fetal shunts are closed in the neonate at what point? a. When the umbilical cord is cut b. Within several days of birth c. Within a month after birth d. By the end of the first year of life

ANS: B Feedback A With the neonate's first breath, gas exchange is transferred from the placenta to the lungs. The separation of the fetus from the umbilical cord does not contribute to the establishment of neonatal circulation. B In the normal neonate, fetal shunts functionally close in response to pressure changes in the systemic and pulmonary circulations and to increased oxygen content. This process may take several days to complete. C The fetal shunts normally close within several days of birth. D Fetal shunts normally close soon after birth but may take several days.

17. A young child with HIV is receiving several antiretroviral drugs. The purpose of these drugs is to a. Cure the disease. b. Delay disease progression. c. Prevent the spread of disease. d. Treat Pneumocystis carinii pneumonia.

ANS: B A. At this time, cure is not possible. B. Although not a cure, these antiviral drugs can suppress viral replication, preventing further deterioration of the immune system, and delay disease progression. C. These drugs do not prevent the spread of the disease. D. Pneumocystis carinii prophylaxis is accomplished with antibiotics.

14. What is the primary nursing concern for a child having an anaphylactic reaction? a. Identifying the offending allergen b. Ineffective breathing pattern c. Increased cardiac output d. Positioning to facilitate comfort

ANS: B A. Determining the cause of an anaphylactic reaction is important to implement the appropriate treatment, but the primary concern is the airway. B. Laryngospasms resulting in ineffective breathing patterns is a life-threatening manifestation of anaphylaxis. The primary action is to assess airway patency, respiratory rate and effort, level of consciousness, oxygen saturation, and urine output. C. During anaphylaxis, the cardiac output is decreased. D. During the acute period of anaphylaxis, the nurse's primary concern is the child's breathing. Positioning for comfort is not a primary concern during a crisis.

6. The Center for Disease Control (CDC, 2009) recommendation for immunizing infants who are HIV positive is a. Follow the routine immunization schedule. b. Routine immunizations are administered; assess CD4+ counts before administering the MMR and varicella vaccinations. c. Do not give immunizations because of the infant's altered immune status. d. Eliminate the pertussis vaccination because of the risk of convulsions

ANS: B A. Routine immunizations are appropriate; however, CD4+ cell counts should be assessed before administering the MMR and varicella vaccines to establish adequate immune system function. B. Routine immunizations are appropriate. CD4+ cells are monitored when deciding whether to provide live virus vaccines. If the child is severely immunocompromised, the MMR vaccine is not given. The varicella vaccine can be considered on the basis of the child's CD4+ counts. Only inactivated polio virus (IPV) should be used for HIV-infected children. C. Immunizations are given to infants who are HIV positive. D. The pertussis vaccination is not eliminated for an infant who is HIV positive.

Which nursing assessment is applicable to the care of a child with herpetic gingivostomatitis? a. Comparison of range of motion for the upper and lower extremities b. Urine output, mucous membranes, and skin turgor c. Growth pattern since birth d. Bowel elimination pattern

ANS: B Feedback A An oral herpetic infection does not affect joint function. B The child with herpetic gingivostomatitis is at risk for deficient fluid volume. Painful lesions on the mouth make drinking unpleasant and undesirable, with subsequent dehydration becoming a real danger. C Herpetic gingivostomatitis is not a chronic disorder that would affect the child's long-term growth pattern. D Although constipation could be caused by dehydration, it is more important to assess urine output, skin turgor, and mucous membranes to identify dehydration before constipation is a problem.

Parents of a child with lice infestation should be instructed carefully in the use of antilice products because of which potential side effect? a. Nephrotoxicity b. Neurotoxicity c. Ototoxicity d. Bone marrow depression

ANS: B Feedback A Antilice products are not known to be nephrotoxic. B Because of the danger of absorption through the skin and potential for neurotoxicity, antilice treatment must be used with caution. A child with many open lesions can absorb enough to cause seizures. C Antilice products are not ototoxic. D Products that treat lice are not known to cause bone marrow depression.

Ringworm, frequently found in schoolchildren, is caused by a(n): a. Virus b. Fungus c. Allergic reaction d. Bacterial infection

ANS: B Feedback A These are not the causative organisms for ringworm. B Ringworm is caused by a group of closely related filamentous fungi, which invade primarily the stratum corneum, hair, and nails. They are superficial infections that live on, not in, the skin. C Ringworm is not an allergic response. D These are not the causative organisms for ringworm.

Rocky Mountain spotted fever is caused by the bite of a: a. Flea b. Tick c. Mosquito d. Mouse or rat

ANS: B Feedback A These organisms do not transmit Rocky Mountain spotted fever. B Rocky Mountain spotted fever is caused by a tick. The tick must attach and feed for at least 1 to 2 hours to transmit the disease. The usual habitat of the tick is in heavily wooded areas. C These organisms do not transmit Rocky Mountain spotted fever. D These organisms do not transmit Rocky Mountain spotted fever.

The depth of a burn injury may be classified as: a. Localized or systemic b. Superficial, superficial partial thickness, deep partial thickness, or full thickness c. Electrical, chemical, or thermal d. Minor, moderate, or major

ANS: B Feedback A These terms refer to the effect of the burn injury. For example, is there a reaction in the area of the burn (localized) or throughout the body (systemic)? B The vocabulary to classify the depth of a burn is superficial, partial thickness, or full thickness. C These terms refer to the cause of the burn injury. D These terms refer to the severity of the burn injury.

What should the nurse teach an adolescent who is taking tretinoin (Retin-A) to treat acne? a. The medication should be taken with meals. b. Apply sunscreen before going outdoors. c. Wash with benzoyl peroxide before application. d. The effect of the medication should be evident within 1 week.

ANS: B Feedback A Tretinoin is a topical medication. Application is not affected by meals. B Tretinoin causes photosensitivity, and sunscreen should be applied before sun exposure. C If applied together, benzoyl peroxide and tretinoin have reduced effectiveness and a potentially irritant effect. D Optimal results from tretinoin are not achieved for 3 to 5 months.

A parent asks the nurse why a developmental assessment is being conducted for a child during a routine well-child visit. The nurse answers based on the knowledge that routine developmental assessments during well-child visits are a. Not necessary unless the parents request them b. The best method for early detection of cognitive disorders c. Frightening to parents and children and should be avoided d. Valuable in measuring intelligence in children

ANS: B Feedback A Developmental assessment is a component of all well-child examinations. B Early detection of cognitive disorders can be facilitated through assessment of development at each well-child examination. C Developmental assessments are not frightening when the parent and child are educated about the purpose of the assessment. D Developmental assessments are not intended to measure intelligence.

Developmental delays, self-injury, fecal smearing, and severe temper tantrums in a preschool child are symptoms of a. Down syndrome b. Intellectual disability c. Psychosocial deprivation d. Separation anxiety

ANS: B Feedback A Down syndrome is often identified at birth by characteristic facial and head features, such as brachycephaly (disproportionate shortness of the head); flat profile; inner epicanthal folds; wide, flat nasal bridge; narrow, high-arched palate; protruding tongue; and small, short ears, which may be low set. Although intellectual impairment may be present, the symptoms listed are not the primary ones expected in the diagnosis of Down syndrome. B These are symptoms of intellectual disability. C Psychosocial deprivation may be a cause of mild intellectual disability. The symptoms listed are characteristic of severe intellectual disability. D Symptoms of separation anxiety include protest, despair, and detachment.

A child with autism hospitalized with asthma. The nurse should plan care so that the a. Parents' expectations are met. b. Child's routine habits and preferences are maintained. c. Child is supported through the autistic crisis. d. Parents need not be at the hospital.

ANS: B Feedback A Focus of care is on the child's needs rather than on the parent's desires. B Children with autism are often unable to tolerate even slight changes in routine. The child's routine habits and preferences are important to maintain. C Autism is a life-long condition. D The presence of the parents is almost always required when an autistic child is hospitalized.

A parent whose child has been diagnosed with a cognitive deficit should be counseled that intellectual impairment a. Is usually due to a genetic defect b. May be caused by a variety of factors c. Is rarely due to first trimester events d. Is usually caused by parental intellectual impairment

ANS: B Feedback A Only a small percentage of children with intellectual impairment are affected by a genetic defect. B There are a multitude of causes for intellectual impairment. In most cases, a specific cause has not been identified. C One third of children with intellectual impairment are affected by first trimester events. D Intellectual impairment can be transmitted to a child only if the parent has a genetic disorder.

Anticipatory guidance for the family of a preadolescent with a cognitive dysfunction should include information about a. Institutional placement b. Sexual development c. Sterilization d. Clothing

ANS: B Feedback A Preadolescence does not require the child to be institutionalized. B Preadolescents who have a cognitive dysfunction may have normal sexual development without the emotional and cognitive abilities to deal with it. It is important to assist the family and child through this developmental stage. C Sterilization is not an appropriate intervention when a child has a cognitive dysfunction. D By the time a child reaches preadolescence, the family should have received counseling on age-appropriate clothing.

Appropriate interventions to facilitate socialization of the cognitively impaired child include a. Providing age-appropriate toys and play activities b. Providing peer experiences, such as scouting, when older c. Avoiding exposure to strangers who may not understand cognitive development d. Emphasizing mastery of physical skills because they are delayed more often than verbal skills

ANS: B Feedback A Providing age-appropriate toys and play activities is important. However, peer interactions will better facilitate social development. B The acquisition of social skills is a complex task. Children of all ages need peer relationships. Parents should enroll the child in preschool. When older, they should have peer experiences similar to other children such as group outings, Boy and Girl Scouts, and Special Olympics. C Parents should expose the child to strangers so that the child can practice social skills. D Verbal skills are delayed more than physical skills.

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

ANS: B Feedback A The infant with microcephaly has a small head. B These are characteristics associated with Down syndrome. C Cerebral palsy is a diagnosis not usually made at birth. No characteristic physical signs are present. D 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.

You are the nurse caring for a child with celiac disease. Which food choices by the child's parent indicate understanding of teaching? Select all that apply. a. Oatmeal b. Steamed rice c. Corn on the cob d. Baked chicken e. Peanut butter and jelly sandwich on wheat bread

ANS: B, C, D Feedback Correct Rice is an appropriate choice because it does not contain gluten. Corn is digestible because it does not contain gluten. Meats do not contain gluten and can be included in the diet of a child with celiac disease. Incorrect The child with celiac disease is unable to fully digest gluten, the protein found in wheat, barley, rye, and oats. Oatmeal contains gluten and is not an appropriate food selection. Wheat bread is not appropriate.

The mother of an infant with multiple anomalies tells the nurse that she had a viral infection in the beginning of her pregnancy. Which viral infection is associated with fetal anomalies? a. Measles b. Roseola c. Rubella d. Herpes simplex virus (HSV)

ANS: C Feedback A Measles is not associated with congenital defects. B Most cases of roseola occur in children 6 to 18 months old. C The rubella virus can cross the placenta and infect the fetus, causing fetal anomalies. D HSV can be transmitted to the newborn infant during vaginal delivery, causing multisystem disease. It is not transmitted transplacentally to the fetus during gestation.

As a nurse working in the newborn nursery, you notice an infant who is having circumoral cyanosis. Which CHD do you suspect the child may have? Select all that apply. a. Patent ductus arteriosus (PDA) b. Tetralogy of Fallot c. Pulmonary atresia d. Transposition of the great arteries e. Ventricular septal defect

ANS: B, C, D Feedback Correct Tetralogy of Fallot is a cyanotic lesion with decreased pulmonary blood flow. The hypoxia results in baseline oxygen saturations as low as 75% to 85%. Even with oxygen administration, saturations do not reach the normal range. Pulmonary atresia is a cyanotic lesion with decreased pulmonary blood flow. The hypoxia results in baseline oxygen saturations as low as 75% to 85%. Even with oxygen administration, saturations do not reach the normal range. Transposition of the great arteries is a cyanotic lesion with increased pulmonary blood flow. Incorrect PDA is failure of the fetal shunt between the aorta and the pulmonary artery to close. PDA is not classified as a cyanotic heart disease. Prostaglandin E1 is often given to maintain ductal patency in children with cyanotic heart diseases. VSD is the most common type of cardiac defect. The VSD is a left-to-right shunting defect; however, it may be accompanied by other defects.

A hospitalized child has developed a methicillin-resistant Staphylococcus aureus (MRSA) infection. The nurse plans which interventions when caring for this child? Select all that apply. a. Airborne isolation b. Administration of vancomycin (Vancocin) c. Contact isolation d. Administration of mupirocin (Bactroban) ointment to the nares e. Administration of cefotaxime (Cefotetan)

ANS: B, C, D Feedback Correct Vancomycin is used to treat MRSA along with mupirocin ointment to the nares. The patient is placed in contact isolation to prevent spread of the infection to other patients. Incorrect The infection is not transmitted by the airborne route so only contact isolation is required. This infection is resistant to cephalosporins.

The nurse is providing home care instructions to the parents of an infant being discharged after repair of a bilateral cleft lip. Which instructions should the nurse include? Select all that apply. a. Acetaminophen (Tylenol) should not be given to your infant. b. Feed your infant in an upright position. c. Place your infant prone for a period of time each day. d. Burp your child frequently during feedings. e. Apply antibiotic ointment to the lip as prescribed.

ANS: B, D, E Feedback Correct After cleft lip surgery the parents are taught to feed the infant in an upright position to decrease the chance of choking. The parents are taught to burp the infant frequently during feedings because excess air is often swallowed. Parents are taught to cleanse the suture line area with a cotton swab using a rolling motion and apply antibiotic ointment with the same technique. Incorrect Tylenol is used for pain and the child should never be placed prone as this position can you damage the suture line.

What goal has the highest priority for a child with malabsorption associated with lactose intolerance? a. The child will experience no abdominal spasms. b. The child will not experience constipation associated with malabsorption syndrome. c. The child will not experience diarrhea associated with malabsorption syndrome. d. The child will receive adequate nutrition as evidenced by a weight gain of 1 kg/day.

ANS: C Feedback A A child usually has abdominal cramping pain and distention rather than spasms. B The child usually has diarrhea, not constipation. C This goal is correct for a child with malabsorption associated with lactose intolerance. D One kilogram a day is too much weight gain with no time parameters.

What maternal assessment is related to an infant's diagnosis of TEF? a. Maternal age more than 40 years b. First term pregnancy for the mother c. Maternal history of polyhydramnios d. Complicated pregnancy

ANS: C Feedback A Advanced maternal age is not a risk factor for TEF. B The first term pregnancy is not a risk factor for an infant with TEF. C A maternal history of polyhydramnios is associated with TEF. D Complicated pregnancy is not a risk factor for TEF.

What is a priority concern for a 14-year-old child with inflammatory bowel disease? a. Compliance with antidiarrheal medication therapy b. Long-term complications c. Dealing with the embarrassment and stress of diarrhea d. Home schooling

ANS: C Feedback A Antidiarrheal medications are not typically ordered for a child with inflammatory bowel disease. B Long-term complications are not a priority concern for the adolescent with inflammatory bowel disease. C Embarrassment and stress from chronic diarrhea are real concerns for the adolescent with inflammatory bowel disease. D Exacerbations may interfere with school attendance, but home schooling is not a usual consideration for the adolescent with inflammatory bowel disease.

What is the most important information to be included in the discharge planning for an infant with gastroesophageal reflux? a. Teach parents to position the infant on the left side. b. Reinforce the parents' knowledge of the infant's developmental needs. c. Teach the parents how to do infant cardiopulmonary resuscitation (CPR). d. Have the parents keep an accurate record of intake and output.

ANS: C Feedback A Correct positioning minimizes aspiration. The correct position for the infant is on the right side after feeding and supine for sleeping. B Knowledge of developmental needs should be included in discharge planning for all hospitalized infants, but it is not the most important in this case. C Risk of aspiration is a priority nursing diagnosis for the infant with gastroesophageal reflux. The parents must be taught infant CPR. D Keeping a record of intake and output is not a priority and may not be necessary.

A nurse has admitted a child to the hospital with a diagnosis of "rule out" peptic ulcer disease. Which test will the nurse expect to be ordered to confirm the diagnosis of a peptic ulcer? a. A dietary history b. A positive Hematest result on a stool sample c. A fiberoptic upper endoscopy d. An abdominal ultrasound

ANS: C Feedback A Dietary history may yield information suggestive of a peptic ulcer, but the diagnosis is confirmed through endoscopy. B Blood in the stool indicates a gastrointestinal abnormality, but it does not conclusively confirm a diagnosis of peptic ulcer. C Endoscopy provides direct visualization of the stomach lining and confirms the diagnosis of peptic ulcer. D An abdominal ultrasound is used to rule out other gastrointestinal alterations such as gallstones, tumor, or mechanical obstruction.

Which viral pathogen frequently causes acute diarrhea in young children? a. Giardia organisms b. Shigella organisms c. Rotavirus d. Salmonella organisms

ANS: C Feedback A Giardia is a bacterial pathogen that causes diarrhea. B Shigella is a bacterial pathogen that is uncommon in the United States. C Rotavirus is the most frequent viral pathogen that causes diarrhea in young children. D Salmonella is a bacterial pathogen that causes diarrhea.

What is the major focus of the therapeutic management for a child with lactose intolerance? a. Compliance with the medication regimen. b. Providing emotional support to family members. c. Teaching dietary modifications. d. Administration of daily normal saline enemas.

ANS: C Feedback A Medications are not typically ordered in the management of lactose intolerance. B Providing emotional support to family members is not specific to this medical condition. C Simple dietary modifications are effective in management of lactose intolerance. Symptoms of lactose intolerance are usually relieved after instituting a lactose-free diet. D Diarrhea is a manifestation of lactose intolerance. Enemas are contraindicated for this alteration in bowel elimination.

The nurse caring for a child with suspected appendicitis should question which order from the physician? a. Keep patient NPO. b. Start IV of D5/0.45 normal saline at 60 mL/hr. c. Apply K-pad to abdomen prn for pain. d. Obtain CBC on admission to nursing unit.

ANS: C Feedback A NPO status is appropriate for the potential appendectomy patient. B An IV is appropriate both as a preoperative intervention and to compensate for the short-term NPO status. C A K-pad (moist heat device) is contraindicated for suspected appendicitis because it may contribute to the rupture of the appendix. D Because appendicitis is frequently reflected in an elevated WBC, laboratory data are needed.

What clinical manifestation should a nurse be alert for when suspecting a diagnosis of esophageal atresia? a. A radiograph in the prenatal period indicates abnormal development. b. It is visually identified at the time of delivery. c. A nasogastric tube fails to pass at birth. d. The infant has a low birth weight.

ANS: C Feedback A Prenatal radiographs do not provide a definitive diagnosis. B The defect is not externally visible. Bronchoscopy and endoscopy can be used to identify this defect. C Atresia is suspected when a nasogastric tube fails to pass 10 to 11 cm beyond the gum line. Abdominal radiographs will confirm the diagnosis. D Infants with esophageal atresia may have been born prematurely and with a low birth weight, but neither is suggestive of the presence of an esophageal atresia.

Which description of a stool is characteristic of intussusception? a. Ribbon-like stools b. Hard stools positive for guaiac c. "Currant jelly" stools d. Loose, foul-smelling stools

ANS: C Feedback A Ribbon-like stools are characteristic of Hirschsprung disease. B With intussusception, passage of bloody mucus stools occurs. Stools will not be hard. C Pressure on the bowel from obstruction leads to passage of "currant jelly" stools. D Loose, foul-smelling stools may indicate infectious gastroenteritis.

Which parasite causes acute diarrhea? a. Shigella organisms b. Salmonella organisms c. Giardia lamblia d. Escherichia coli

ANS: C Feedback A Shigella is a bacterial pathogen. B Salmonella is a bacterial pathogen. C Giardiasis a parasite that represents 15% of nondysenteric illness in the United States. D E. coli is a bacterial pathogen.

Which statement indicates that a father understands the treatment for his child who has scarlet fever? a. "I can stop the medicine when my child feels better." b. "I will apply antibiotic cream to her rash twice a day." c. "I will give the penicillin for the full 10 days." d. "My child can go back to school when she has been on the antibiotic for a week."

ANS: C Feedback A The bacteria will not be eradicated if a partial course of antibiotics is given. B Treatment of scarlet fever does not include topical antibiotic cream. C It is necessary to give the entire course of antibiotic for 10 to 14 days. Penicillin is the preferred treatment for any streptococcal infection. D The child is no longer contagious after 24 hours of antibiotic therapy and can return to daycare or school.

Which statement best characterizes hepatitis A? a. Incubation period is 6 weeks to 6 months. b. Principal mode of transmission is through the parenteral route. c. Onset is usually rapid and acute. d. There is a persistent carrier state.

ANS: C Feedback A The incubation period is approximately 3 weeks for hepatitis A. B The principal mode of transmission for hepatitis A is the fecal-oral route. C Hepatitis A is the most common form of acute hepatitis in most parts of the world. It is characterized by a rapid acute onset. D Hepatitis A does not have a carrier state.

What information should the nurse include when teaching the parents of a 5-week-old infant about pyloromyotomy? a. The infant will be in the hospital for a week. b. The surgical procedure is routine and "no big deal." c. The prognosis for complete correction with surgery is good. d. They will need to ask the physician about home care nursing.

ANS: C Feedback A The infant will remain in the hospital for a day or two postoperatively. B Although the prognosis for surgical correction is good, telling the parents that surgery is "no big deal" minimizes the infant's condition. C Pyloromyotomy is the definitive treatment for pyloric stenosis. Prognosis is good with few complications. These comments reassure parents. D Home care nursing is not necessary after a pyloromyotomy.

The postoperative care plan for an infant with surgical repair of a cleft lip includes a. A clear liquid diet for 72 hours b. Nasogastric feedings until the sutures are removed c. Elbow restraints to keep the infant's fingers away from the mouth d. Rinsing the mouth after every feeding

ANS: C Feedback A The infant's diet is advanced from clear liquid to soft foods within 48 hours of surgery. B After surgery, the infant can resume preoperative feeding techniques. C Keeping the infant's hands away from the incision reduces potential complications at the surgical site. D Rinsing the mouth after feeding is an inappropriate intervention. Feeding a small amount of water after feedings will help keep the mouth clean. A cleft lip repair site should be cleansed with a wet sterile cotton swab after feedings.

What is an appropriate statement for the nurse to make to parents of a child who has had a barium enema to correct an intussusception? a. "I will call the physician when the baby passes his first stool." b. "I am going to dilate the anal sphincter with a gloved finger to help the baby pass the barium." c. "I would like you to save all the soiled diapers so I can inspect them." d. "Add cereal to the baby's formula to help him pass the barium."

ANS: C Feedback A The physician does not need to be notified when the infant passes the first stool. B Dilating the anal sphincter is not appropriate for the child after a barium enema. C The nurse needs to inspect diapers after a barium enema because it is important to document the passage of barium and note the characteristics of the stool. D After reduction, the infant is given clear liquids and the diet is gradually increased.

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.

ANS: C Feedback A These are not the modes of action of histamine-receptor antagonists. B These are not the modes of action of histamine-receptor antagonists. C The mechanism of action of histamine-receptor antagonists is to reduce the amount of acid present in gastric contents and to prevent esophagitis. D These are not the modes of action of histamine-receptor antagonists.

When assessing a child for possible congenital heart defects (CHDs), where should the nurse measure blood pressure? a. The right arm b. The left arm c. All four extremities d. Both arms while the child is crying

ANS: C Feedback A Blood pressure measurements for upper and lower extremities are compared during an assessment for CHDs. B Discrepancies in blood pressure between the upper and lower extremities cannot be determined if blood pressure is not measured in all four extremities. C When a CHD is suspected, the blood pressure should be measured in all four extremities while the child is quiet. Discrepancies between upper and lower extremities may indicate cardiac disease. D Blood pressure measurements when the child is crying are likely to be elevated; thus the readings will be inaccurate. Also, all four extremities need to be measured.

The nurse is admitting a child who has been diagnosed with Kawasaki disease. What is the most serious complication for which the nurse should assess in Kawasaki disease? a. Cardiac valvular disease b. Cardiomyopathy c. Coronary aneurysm d. Rheumatic fever

ANS: C Feedback A Cardiac valvular disease can occur in rheumatic fever. B Cardiomyopathies are diseases of the heart muscle, which can occur as a result of congenital heart disease, coronary artery disease, or other systemic disease. C Coronary artery aneurysms are seen in 20% to 25% of children with untreated Kawasaki disease. D Rheumatic fever is not a complication of Kawasaki disease.

Therapeutic management of the child with acute diarrhea and dehydration usually begins with a. Clear liquids b. Adsorbents, such as kaolin and pectin c. Oral rehydration solution (ORS) d. Antidiarrheal medications such as paregoric

ANS: C Feedback A Clear liquids are not recommended because they contain too much sugar, which may contribute to diarrhea. B Adsorbents are not recommended. C Orally administered rehydration solution is the first treatment for acute diarrhea. D Antidiarrheals are not recommended because they do not get rid of pathogens.

A nurse is conducting a class for nursing students about fetal circulation. Which statement is accurate about fetal circulation and should be included in the teaching session? a. Oxygen is carried to the fetus by the umbilical arteries. b. Blood from the inferior vena cava is shunted directly to the right ventricle through the foramen ovale. c. Pulmonary vascular resistance is high because the lungs are filled with fluid. d. Blood flows from the ductus arteriosus to the pulmonary artery.

ANS: C Feedback A Oxygen and nutrients are carried to the fetus by the umbilical vein. B The inferior vena cava empties blood into the right atrium. The direction of blood flow and the pressure in the right atrium propel most of this blood through the foramen ovale into the left atrium. C Resistance in the pulmonary circulation is very high because the lungs are collapsed and filled with fluid. D Most of the blood in the pulmonary artery flows though the ductus arteriosus into the descending aorta.

A nurse is teaching an adolescent about primary hypertension. Which statement made by the adolescent indicates an understanding of primary hypertension? a. Primary hypertension should be treated with diuretics as soon as it is detected. b. Congenital heart defects are the most common cause of primary hypertension. c. Primary hypertension may be treated with weight reduction. d. Primary hypertension is not affected by exercise.

ANS: C Feedback A Primary hypertension is usually treated with weight reduction and exercise. If ineffective, pharmacologic intervention may be needed. B Primary hypertension is considered to be an inherited disorder. C Primary hypertension in children may be treated with weight reduction and exercise programs. D An exercise program in conjunction with weight reduction can be effective in managing primary hypertension in children.

Which defect results in increased pulmonary blood flow? a. Pulmonic stenosis b. Tricuspid atresia c. Atrial septal defect d. Transposition of the great arteries

ANS: C Feedback A Pulmonic stenosis is an obstruction to blood flowing from the ventricles. B Tricuspid atresia results in decreased pulmonary blood flow. C The 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. D Transposition of the great arteries results in mixed blood flow.

15. What is the drug of choice the nurse should administer in the acute treatment of anaphylaxis? a. Diphenhydramine b. Histamine inhibitor (cimetidine) c. Epinephrine d. Albuterol

ANS: C A. Although diphenhydramine may be indicated, epinephrine is the first drug of choice in the immediate treatment of anaphylaxis. B. Although a histamine inhibitor such as cimetidine may be indicated, epinephrine is the first drug of choice in immediate treatment of anaphylaxis. C. Epinephrine is the first drug of choice in immediate treatment of anaphylaxis. Treatment must be initiated immediately because it may only be a matter of minutes before shock occurs. D. Albuterol is not usually indicated for treatment of anaphylaxis.

11. Which statement by a mother about antiretroviral agents for the management for her 5-year-old child with acquired immunodeficiency syndrome (AIDS) indicates that she has a good understanding? a. "When my child's pain increases, I double the recommended dosage of antiretroviral medication." b. "Addiction is a risk, so I only use the medication as ordered." c. "Doses of the antiretroviral medication are selected on the basis of my child's age and growth." d. "By the time my child is an adolescent she will not need her antiretroviral medications any longer."

ANS: C A. Antiretroviral medications are not administered for pain relief. Doubling the recommended dosage of any medication is not appropriate without an order from the physician. B. Addiction is not a realistic concern with antiretroviral medications. C. Doses of antiretroviral medication to treat HIV infection for infants and children are based on individualized age and growth considerations. D. Antiretroviral medications are still needed during adolescence. Doses for adolescents are based on pubertal status by Tanner staging.

12. Which intervention is appropriate for a child receiving high doses of steroids? a. Limit activity and receive home schooling. b. Decrease the amount of potassium in the diet. c. Substitute a killed virus vaccine for live virus vaccines. d. Monitor for seizure activity.

ANS: C A. Limiting activity and home schooling are not routine for a child receiving high doses of steroids. B. The child receiving steroids is at risk for hypokalemia and needs potassium in the diet. C. The child on high doses of steroids should not receive live virus vaccines because of immunosuppression. D. Children on steroids are not typically at risk for seizures.

9. What should the nurse include in a teaching plan for the mother of a toddler who will be taking prednisone for several months? a. The medication should be taken between meals. b. The medication needs to be discontinued because of the risks associated with long-term usage. c. The medication should not be stopped abruptly. d. The medication may lower blood glucose, so the mother needs to observe for signs of hypoglycemia.

ANS: C A. Prednisone should be taken with food to minimize or prevent gastrointestinal bleeding. B. Although there are adverse effects from long-term steroid use, the medication must not be discontinued without consulting a physician. Acute adrenal insufficiency can occur if the medication is withdrawn abruptly. The dosage needs to be tapered. C. The dosage must be tapered before the drug is discontinued to allow the gradual return of function in the pituitary-adrenal axis. D. The medication puts the child at risk for hyperglycemia.

16. What is caused by a virus that primarily infects a specific subset of T lymphocytes, the CD4+ T cells? a. Wiskott-Aldrich syndrome b. Idiopathic thrombocytopenic purpura c. Acquired immunodeficiency syndrome (AIDS) d. Severe combined immunodeficiency disease

ANS: C A. Wiskott-Aldrich syndrome is not a viral illness. B. Idiopathic thrombocytopenic purpura is not a viral illness. C. Acquired immune deficiency is caused by the human immunodeficiency virus (HIV), which primarily attacks the CD4+ T cells. D. Severe combined immunodeficiency disease is not a viral illness.

A mother calls the emergency department nurse because her child was stung by a scorpion. The nurse should recommend: a. Administering antihistamine b. Cleansing with soap and water c. Keeping child quiet and come to emergency department d. Removing stinger and apply cool compresses

ANS: C Feedback A Antihistamines are not effective against scorpion venom. B The wound will have intense local pain. Emergency treatment is indicated. C Venomous species of scorpions inject venom that contains hemolysins, endotheliolysins, and neurotoxins. The absorption of the venom is delayed by keeping the child quiet and the involved area in dependent position. D The wound will have intense local pain. Emergency treatment is indicated.

Treatment for herpes simplex virus (types 1 or 2) includes: a. Corticosteroids b. Oral griseofulvin c. Oral antiviral agent d. Topical and/or systemic antibiotic

ANS: C Feedback A Corticosteroids are not effective for viral infections. B Griseofulvin is an antifungal agent and not effective for viral infections. C Oral antiviral agents are effective for viral infections such as herpes simplex. D Antibiotics are not effective in viral diseases.

An important nursing consideration when caring for a child with impetigo contagiosa is to: a. Apply topical corticosteroids to decrease inflammation. b. Carefully remove dressings so as not to dislodge undermined skin, crusts, and debris. c. Carefully wash hands and maintain cleanliness when caring for an infected child. d. Examine child under a Wood lamp for possible spread of lesions.

ANS: C Feedback A Corticosteroids are not indicated in bacterial infections. B Dressings are usually not indicated. The undermined skin, crusts, and debris are carefully removed after softening with moist compresses. C A major nursing consideration related to bacterial skin infections, such as impetigo contagiosa, is to prevent the spread of the infection and complications. This is done by thorough handwashing before and after contact with the affected child. D A Wood lamp is used to detect fluorescent materials in the skin and hair. It is used in certain disease states, such as tinea capitis.

To assess the child with severe burns for adequate perfusion, the nurse monitors: a. Distal pulses b. Skin turgor c. Urine output d. Mucous membranes

ANS: C Feedback A Distal pulses may be affected by many variables. Urine output is the most reliable indicator of end-organ perfusion. B Skin turgor is often difficult to assess on burn patients because the skin is not intact. C Urine output reflects the adequacy of end-organ perfusion. D Mucous membranes do not reflect end-organ perfusion.

The primary clinical manifestation of scabies is: a. Edema b. Redness c. Pruritus d. Maceration

ANS: C Feedback A Edema is not observed in scabies. B Redness is not observed in scabies. C Scabies is caused by the scabies mite. The inflammatory response and intense itching occur after the host has become sensitized to the mite. This occurs approximately 30 to 60 days after initial contact. In the previously sensitized person, the response occurs within 48 hours. D Maceration is not observed in scabies.

What best describes a full-thickness (third-degree) burn? a. Erythema and pain b. Skin showing erythema followed by blister formation c. Destruction of all layers of skin evident with extension into subcutaneous tissue d. Destruction injury involving underlying structures such as muscle, fascia, and bone

ANS: C Feedback A Erythema and pain are characteristic of a first-degree burn or superficial burn. B Erythema with blister formation is characteristic of a second-degree or partial-thickness burn. C A third-degree or full-thickness burn is a serious injury that involves the entire epidermis and dermis and extends into the subcutaneous tissues. D A fourth-degree burn is a full-thickness burn that also involves underlying structures such as muscle, fascia, and bone.

With what beverage should the parents of a child with ringworm be taught to give griseofulvin? a. Water b. A carbonated drink c. Milk d. Fruit juice

ANS: C Feedback A Griseofulvin is insoluble in water. B Carbonated drinks do not contain fat, which aids in the absorption of griseofulvin. C Griseofulvin is insoluble in water. Giving the medication with a high-fat meal or milk increases absorption. D Fruit juice does not contain any fat; fat aids absorption of the medication.

A father calls the clinic nurse because his 2-year-old child was bitten by a black widow spider. The nurse should advise the father to: a. Apply warm compresses. b. Carefully scrape off stinger. c. Take child to emergency department. d. Apply a thin layer of corticosteroid cream.

ANS: C Feedback A Warm compresses increase the circulation to the area and facilitate the spread of the venom. B The black widow spider does not have a stinger. C The black widow spider has a venom that is toxic enough to be harmful. The father should take the child to the emergency department for immediate treatment. D Corticosteroid cream will have no effect on the venom.

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)

ANS: C Feedback A Although hyperflexibility is characteristic of Down syndrome, it does not affect the child's ability to participate in sports. B Although cutis marmorata is characteristic of Down syndrome, it does not affect the child's ability to participate in sports. C 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. D Although Brushfield spots are characteristic of Down syndrome, they do not affect the child's ability to participate in sports.

Which statement best describes Fragile X syndrome? a. Chromosomal defect affecting only females b. Chromosomal defect that follows the pattern of X-linked recessive disorders c. Second most common genetic cause of cognitive impairment d. Most common cause of noninherited cognitive impairment

ANS: C Feedback A Fragile X primarily affects males. B Fragile X follows the pattern of X-linked dominant with reduced manifestation of the syndrome in female and moderate to severe dysfunction in males. C Fragile X syndrome is the most common inherited cause of cognitive impairment and the second most common cause of cognitive impairment after Down syndrome. D Fragile X is inherited.

An appropriate nursing diagnosis for a child with a cognitive dysfunction who has a limited ability to anticipate danger is a. Impaired social interaction b. Deficient knowledge c. Risk for injury d. Ineffective coping

ANS: C Feedback A Impaired social interaction is indeed a concern for the child with a cognitive disorder but does not address the limited ability to anticipate danger. B Because of the child's cognitive deficit, knowledge will not be retained and will not decrease the risk for injury. C The nurse needs to know that limited cognitive abilities to anticipate danger lead to risk for injury. D Ineffective individual coping does not address the limited ability to anticipate danger.

Throughout their life span, cognitively impaired children are less capable of managing environmental challenges and are at risk for a. Nutritional deficits b. Visual impairments c. Physical injuries d. Psychiatric problems

ANS: C Feedback A Nutritional deficits are related more to dietary habits and the caregivers' understanding of nutrition. B Visual impairments are unrelated to cognitive impairment. C Safety is a challenge for cognitively impaired children. Decreased capability to manage environmental challenges may lead to physical injuries. D Psychiatric problems may coexist with cognitive impairment; however, they are not environmental challenges.

What should the nurse keep in mind when planning to communicate with a child who has autism? a. The child has normal verbal communication. b. Expect the child to use sign language. c. The child may exhibit monotone speech and echolalia. d. The child is not listening if she is not looking at the nurse.

ANS: C Feedback A The child has impaired verbal communication and abnormalities in the production of speech. B Some autistic children may use sign language, but it is not assumed. C Children with autism have abnormalities in the production of speech such as a monotone voice or echolalia, or inappropriate volume, pitch, rate, rhythm, or intonation. D Children with autism often are reluctant to initiate direct eye contact.

What action is contraindicated when a child with Down syndrome is hospitalized? a. Determine the child's vocabulary for specific body functions. b. Assess the child's hearing and visual capabilities. c. Encourage parents to leave the child alone for extended periods of time. d. Have meals served at the child's usual meal times.

ANS: C Feedback A To communicate effectively with the child, it is important to know the child's particular vocabulary for specific body functions. B Children with Down syndrome have a high incidence of hearing loss and vision problems and should have hearing and vision assessed whenever they are in a health care facility. C The child with Down syndrome needs routine schedules and consistency. Having familiar people present, especially parents, helps to decrease the child's anxiety. D Routine schedules and consistency are important to children.

A nurse is conducting discharge teaching to parents about the care of their infant after cardiac surgery. The nurse instructs the parents to notify the physician if what condition occurs? Select all that apply. a. Respiratory rate of 36 at rest b. Appetite slowly increasing c. Temperature above 37.7° C (100° F) d. New, frequent coughing e. Turning blue or bluer than normal

ANS: C, D, E Feedback Correct The parents should be instructed to notify the physician after their infant's cardiac surgery for a temperature above 37.7° C; new, frequent coughing; and any episodes of the infant turning blue or bluer than normal. Incorrect A respiratory rate of 36 at rest for an infant is within normal expectations, and it is expected that the appetite will increase slowly.

A nurse is instructing parents on treatment of pediculosis (head lice). Which should the nurse include in the teaching plan? (Select all that apply.): a. Bedding should be washed in warm water and dried on a low setting. b. After treating the hair and scalp with a pediculicide, shampoo the hair with regular shampoo. c. Retreat the hair and scalp with a pediculicide in 7 to 10 days. d. Items that cannot be washed should be dry cleaned or sealed in plastic bags for 2 to 3 weeks. e. Combs and brushes should be boiled in water for at least 10 minutes.

ANS: C, D, E Feedback Correct: An over-the-counter pediculicide, permethrin 1% (Nix, Elimite, Acticin), kills head lice and eggs with one application and has residual activity (i.e., it stays in the hair after treatment) for 10 days. Nix crème rinse is applied to the hair after it is washed with a conditioner-free shampoo. The product should be rinsed out after 10 minutes. Incorrect: The hair should not be shampooed for 24 hours after the treatment. Even though the kill rate is high and there is residual action, retreatment should occur after 7 to 10 days. Combs and brushes should be boiled or soaked in antilice shampoo or hot water (greater than 60° C [140° F]) for at least 10 minutes. Advise parents to wash clothing (especially hats and jackets), bedding, and linens in hot water and dry at a hot dryer setting.

What should the nurse teach a school-age child and his parents about the management of ulcer disease? a. Eat a bland, low-fiber diet in small, frequent meals. b. Eat three balanced meals a day with no snacking between meals. c. The child needs to eat alone to avoid stress. d. Do not give antacids 1 hour before or after antiulcer medications.

ANS: D Feedback A A bland diet is not indicated for ulcer disease. The diet should be a regular diet that is low in caffeine, and the child should eat a meal or snack every 2 to 3 hours. B The child should eat every 2 to 3 hours. C Eating alone is not indicated. D Antacids can interfere with antiulcer medication if given less than 1 hour before or after antiulcer medications.

An infant is born and the nurse notices that the child has herniation of abdominal viscera into the base of the umbilical cord. What will the nurse document on her or his assessment of this condition? a. Diaphragmatic hernia b. Umbilical hernia c. Gastroschisis d. Omphalocele

ANS: D Feedback A A diaphragmatic hernia is the protrusion of part of the abdominal organs through an opening in the diaphragm. B An umbilical hernia is a soft skin protrusion of abdominal stricture through the esophageal hiatus. C Gastroschisis is the protrusion of intraabdominal contents through a defect in the abdominal wall lateral to the umbilical ring. There is no peritoneal sac. D Omphalocele is the herniation of the abdominal viscera into the base of the umbilical cord.

Which type of hernia has an impaired blood supply to the herniated organ? a. Hiatal hernia b. Incarcerated hernia c. Omphalocele d. Strangulated hernia

ANS: D Feedback A A hiatal hernia is the intrusion of an abdominal structure, usually the stomach, through the esophageal hiatus. B An incarcerated hernia is a hernia that cannot be reduced easily. C Omphalocele is the protrusion of intraabdominal viscera into the base of the umbilical cord. The sac is covered with peritoneum and not skin. D A strangulated hernia is one in which the blood supply to the herniated organ is impaired.

Which nursing diagnosis has the highest priority for the toddler with celiac disease? a. Disturbed Body Image related to chronic constipation b. Risk for Disproportionate Growth related to obesity c. Excess Fluid Volume related to celiac crisis d. Imbalanced Nutrition: Less than Body Requirements related to malabsorption

ANS: D Feedback A Body Image disturbances are not usually apparent in toddlers. This is more common in adolescents. It is not the priority nursing diagnosis. B Celiac disease causes disproportionate growth and development associated with malnutrition, not obesity. C Celiac crisis causes deficient fluid volume. D Imbalanced Nutrition: Less than Body Requirements is the highest priority nursing diagnosis because celiac disease causes gluten enteropathy, a malabsorption condition.

A child taking oral corticosteroids for asthma is exposed to varicella. The child has not had the varicella vaccine and has never had the disease. What intervention should be taken to prevent varicella from developing? a. No intervention is needed unless varicella develops. b. Administer the varicella vaccine as soon as possible. c. The child should begin a course of oral antibiotics. d. The child should be prescribed acyclovir.

ANS: D Feedback A Children taking oral corticosteroids are immunosuppressed and are at high risk for serious complications. Intervention must be taken to prevent the disease when exposure occurs. B The varicella vaccine is a live virus vaccine and is contraindicated for an immunosuppressed child. C An antibiotic is not effective in treating varicella zoster, which is a virus. D For children receiving short-term corticosteroid treatment, acyclovir is often used in the treatment plan.

A school-age child with diarrhea has been rehydrated. The nurse is discussing the child's diet with the family. Which statement by the parent indicates a correct understanding of the teaching? a. "I will keep my child on a clear liquid diet for the next 24 hours." b. "I should encourage my child to drink carbonated drinks but avoid food for the next 24 hours." c. "I will offer my child bananas, rice, applesauce, and toast for the next 48 hours." d. "I should have my child eat a normal diet with easily digested foods for the next 48 hours."

ANS: D Feedback A Clear liquids and carbonated drinks have high carbohydrate content and few electrolytes. Caffeinated beverages should be avoided because caffeine is a mild diuretic. B Clear liquids and carbonated drinks have high carbohydrate content and few electrolytes. Caffeinated beverages should be avoided because caffeine is a mild diuretic. C In some children, lactose intolerance will develop with diarrhea, and cow's milk should be avoided in the recovery stage. D Easily digested foods such as cereals, cooked vegetables, and meats should be provided for the child. Early reintroduction of nutrients is desirable. Continued feeding or reintroduction of a regular diet has no adverse effects and actually lessens the severity and duration of the illness.

Which statement made by a parent indicates incorrect information about intervention for a child's fever? a. "I should keep her covered lightly when she has a fever." b. "I'll give her plenty of liquids to keep her hydrated." c. "I can give her acetaminophen for a fever." d. "I'll look for over-the-counter preparations that contain aspirin."

ANS: D Feedback A Dressing the child in light clothing and using lightweight covers will help reduce fever and promote the child's comfort. B Adequate hydration will help maintain a normal body temperature. C Acetaminophen or ibuprofen should be used as directed for fever control. D Aspirin products are avoided because of the possibility of development of Reye's syndrome. The parent should check labels on all over-the-counter products to be sure they do not contain aspirin.

What discharge information should the nurse give to the parents of a male adolescent who has been diagnosed with the Epstein-Barr virus? a. It is particularly important to protect the adolescent's head during physical activities. b. The teen will feel like himself and be back to his usual routines in a week. c. The treatment of the Epstein-Barr virus is prolonged bed rest, usually lasting several months. d. Fatigue may persist, and the adolescent may need to increase school activities gradually.

ANS: D Feedback A During the acute and recovery phases, activity restrictions, which include no contact sports or roughhousing, are implemented to protect the child's enlarged spleen from rupture. B The recovery process from infectious mononucleosis is a slow and gradual one. C Bed rest is indicated during the acute stage of the illness, usually lasting 2 to 4 weeks. D The recovery period is often lengthy and fatigue may continue, necessitating a gradual return to school activities.

Careful handwashing before and after contact can prevent the spread of which condition in daycare and school settings? a. Irritable bowel syndrome b. Ulcerative colitis c. Hepatic cirrhosis d. Hepatitis A

ANS: D Feedback A Irritable bowel syndrome is the result of increased intestinal motility and is not contagious. B Ulcerative colitis is not infectious. C Cirrhosis is not infectious. D Hepatitis A is spread person to person, by the fecal-oral route, and through contaminated food or water. Good handwashing is critical in preventing its spread. The virus can survive on contaminated objects for weeks.

What should be included in the care for a neonate who was diagnosed with pertussis? a. Monitoring hemoglobin level b. Hearing test before discharge c. Serial platelet counts d. Treatment of all close contacts with a prophylactic antibiotic

ANS: D Feedback A Pertussis does not affect the hemoglobin level. B A complication of pertussis is not hearing impairment. C Pertussis does not affect platelets. D Erythromycin, azithromycin, or clarithromycin is given to all close contacts for the child diagnosed with pertussis.

Therapeutic management of most children with Hirschsprung disease is primarily a. Daily enemas b. Low-fiber diet c. Permanent colostomy d. Surgical removal of the affected section of the bowel

ANS: D Feedback A Preoperative management may include enemas and a low-fiber, high-calorie, high-protein diet, until the child is physically ready for surgery. B Preoperative management may include enemas and low-fiber, high-calorie, high-protein diet, until the child is physically ready for surgery. C The colostomy that is created in Hirschsprung disease is usually temporary. D 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.

A stool specimen from a child with diarrhea shows the presence of neutrophils and red blood cells. This is most suggestive of a. Protein intolerance b. Parasitic infection c. Fat malabsorption d. Bacterial gastroenteritis

ANS: D Feedback A Protein intolerance is suspected in the presence of eosinophils. B Parasitic infection is indicated by eosinophils. C Fat malabsorption is indicated by foul-smelling, greasy, bulky stools. D Neutrophils and red blood cells in stool indicate bacterial gastroenteritis.

A parent asks the nurse how she will know whether her child has fifth disease. The nurse should advise the parent to be alert for which manifestation? a. Bull's-eye rash at the site of a tick bite b. Lesions in various stages of development on the trunk c. Maculopapular rash on the trunk that lasts for 2 days d. Bright red rash on the cheeks that looks like slapped cheeks

ANS: D Feedback A The bull's-eye rash at the site of a tick bite is a manifestation of Lyme disease. B Varicella is manifested as lesions in various stages of development—macule, papule, then vesicle, first appearing on the trunk and scalp. C Roseola manifests as a maculopapular rash on the trunk that can last for hours or up to 2 days. D Fifth disease manifests with an intense, fiery red, edematous rash on the cheeks, which gives a "slapped cheek" appearance.

The child with lactose intolerance is most at risk for which electrolyte imbalance? a. Hyperkalemia b. Hypoglycemia c. Hyperglycemia d. Hypocalcemia

ANS: D Feedback A The child with lactose intolerance is not at risk for hyperkalemia. B Lactose intolerance does not affect glucose metabolism. C Hyperglycemia does not result from ingestion of a lactose-free diet. D The child between 1 and 10 years requires a minimum of 800 mg of calcium daily. Because high-calcium dairy products containing lactose are restricted from the child's diet, alternative sources such as egg yolk, green leafy vegetables, dried beans, and cauliflower must be provided to prevent hypocalcemia.

Which intervention should be included in the nurse's plan of care for a 7-year-old child with encopresis who has cleared the initial impaction? a. Have the child sit on the toilet for 30 minutes when he gets up in the morning and at bedtime. b. Increase sugar in the child's diet to promote bowel elimination. c. Use a Fleets enema daily. d. Give the child a choice of beverage to mix with a laxative.

ANS: D Feedback A To facilitate bowel elimination, the child should sit on the toilet for 5 to 10 minutes after breakfast and dinner. B Decreasing the amount of sugar in the diet will help keep stools soft. C Daily Fleets enemas can result in hypernatremia and hyperphosphatemia, and are used only during periods of fecal impaction. D Offering realistic choices is helpful in meeting the school-age child's sense of control.

Which action is initiated when a child has been scratched by a rabid animal? a. No intervention unless the child becomes symptomatic b. Administration of immune globulin around the wound c. Administration of rabies vaccine on days 3, 7, 14, and 28 d. Administration of both immune globulin and vaccine as soon as possible after exposure

ANS: D Feedback A Transmission of rabies can occur from bites with contaminated saliva, scratches from the claws of infected animals, airborne transmission in bat-infested caves, or in a laboratory setting. Rabies is fatal if no intervention is taken to prevent the disease. B Human rabies immune globulin is infiltrated locally around the wound and the other half of the dose is given intramuscularly. This is only part of the treatment after rabies exposure. C The rabies vaccine is given within 48 hours of exposure and again on days 3, 7, 14, and 28. D Human rabies immune globulin and the first dose of the rabies vaccine are given after exposure.

What should the nurse stress in a teaching plan for the mother of an 11-year-old boy with ulcerative colitis? a. Preventing the spread of illness to others b. Nutritional guidance and preventing constipation c. Teaching daily use of enemas d. Coping with stress and avoiding triggers

ANS: D Feedback A Ulcerative colitis is not infectious. B Although nutritional guidance is a priority teaching focus, diarrhea is a problem with ulcerative colitis, not constipation. C This is not part of the therapeutic plan of care. D Coping with the stress of chronic illness and the clinical manifestations associated with ulcerative colitis (diarrhea, pain) are important teaching foci. Avoidance of triggers can help minimize the impact of the disease and its effect on the child.

Nursing care for the child in congestive heart failure includes a. Counting the number of saturated diapers b. Putting the infant in the Trendelenburg position c. Removing oxygen while the infant is crying d. Organizing care to provide rest periods

ANS: D Feedback A Diapers must be weighed for an accurate record of output. B The head of the bed should be raised to decrease the work of breathing. C Oxygen should be administered during stressful periods such as when the child is crying. D Nursing care should be planned to allow for periods of undisturbed rest.

Which postoperative intervention should be questioned for a child after a cardiac catheterization? a. Continue intravenous (IV) fluids until the infant is tolerating oral fluids. b. Check the dressing for bleeding. c. Assess peripheral circulation on the affected extremity. d. Keep the affected leg flexed and elevated.

ANS: D Feedback A IV fluid administration continues until the child is taking and retaining adequate amounts of oral fluids. B The insertion site dressing should be observed frequently for bleeding. The nurse should also look under the child to check for pooled blood. C Peripheral perfusion is monitored after catheterization. Distal pulses should be palpable, although they may be weaker than in the contralateral extremity. D The child should be positioned with the affected leg straight for 4 to 6 hours after the procedure.

What is an expected assessment finding in a child with coarctation of the aorta? a. Orthostatic hypotension b. Systolic hypertension in the lower extremities c. Blood pressure higher on the left side of the body d. Disparity in blood pressure between the upper and lower extremities

ANS: D Feedback A Orthostatic hypotension is not present with coarctation of the aorta. B Systolic hypertension may be detected in the upper extremities. C The left arm may not accurately reflect systolic hypertension because the left subclavian artery can be involved in the coarctation. D The classic finding in children with coarctation of the aorta is a disparity in pulses and blood pressures between the upper and lower extremities.

The nurse is admitting a child to the hospital for a cardiac workup. What is the first step in a cardiac assessment? a. Percussion b. Palpation c. Auscultation d. History and inspection

ANS: D Feedback A Percussion of the chest is usually deferred. B Palpation can be threatening to the child because it requires a significant amount of physical contact. For this reason it is not the initial step in a cardiac assessment. C Auscultation requires touching the child and is not the initial step in a cardiac assessment. D The assessment should begin with the least threatening interventions—the history and inspection. Assessment progression includes inspection, auscultation, and palpation because each step includes more touching.

A nurse is assigned to care for an infant with an unrepaired tetralogy of Fallot. What should the nurse do first when the baby is crying and becomes severely cyanotic? a. Place the infant in a knee-chest position. b. Administer oxygen. c. Administer morphine sulfate. d. Calm the infant.

ANS: D Feedback A Placing the infant in a knee-chest position will decrease venous return so that smaller amounts of highly saturated blood reach the heart. This should be done after calming the infant. B Administering oxygen is indicated after placing the infant in a knee-chest position. C Administering morphine sulfate calms the infant. It may be indicated some time after the infant has been calmed. D Calming the crying infant is the first response. An infant with unrepaired tetralogy of Fallot who is crying and agitated may eventually lose consciousness.

For what reason might a newborn infant with a cardiac defect, such as coarctation of the aorta, that results in a right-to-left shunt receive prostaglandin E1? a. To decrease inflammation b. To control pain c. To decrease respirations d. To improve oxygenation

ANS: D Feedback A Prostaglandin E1 is used to maintain a patent ductus arteriosus, thus increasing pulmonary blood flow. B Prostaglandin E1 is administered to infants with a right-to-left shunt to keep the ductus arteriosus patent, thus increasing pulmonary blood flow. C Prostaglandin E1 is given to infants with a right-to-left shunt to keep the ductus arteriosus patent to increase pulmonary blood flow. D Prostaglandin E1 is given to infants with a right-to-left shunt to keep the ductus arteriosus patent. This will improve oxygenation.

What is the most common causative agent of bacterial endocarditis? a. Staphylococcus albus b. Streptococcus hemolyticus c. Staphylococcus albicans d. Streptococcus viridans

ANS: D Feedback A S. albus is not a common causative agent. B Streptococcus hemolyticus is not a common causative agent. C S. albicans is not a common causative agent. D S. viridans and S. aureus are the most common causative agents in bacterial (infective) endocarditis.

A common, serious complication of rheumatic fever is a. Seizures b. Cardiac dysrhythmias c. Pulmonary hypertension d. Cardiac valve damage

ANS: D Feedback A Seizures are not common complications of rheumatic fever. B Cardiac dysrhythmias are not common complications of rheumatic fever. C Pulmonary hypertension is not a common complication of rheumatic fever. D Cardiac valve damage is the most significant complication of rheumatic fever.

The nurse caring for a child diagnosed with acute rheumatic fever should assess the child for a. Sore throat b. Elevated blood pressure c. Desquamation of the fingers and toes d. Tender, warm, inflamed joints

ANS: D Feedback A The child may have had a sore throat previously associated with a group A beta-hemolytic streptococcal infection a few weeks earlier. A sore throat is not a manifestation of rheumatic fever. B Hypertension is not associated with rheumatic fever. C Desquamation of the fingers and toes is a manifestation of Kawasaki syndrome. D Arthritis, characterized by tender, warm, erythematous joints, is one of the major manifestations of acute rheumatic fever in the first 1 to 2 weeks of the illness.

Which statement made by a parent indicates understanding of restrictions for a child after cardiac surgery? a. "My child needs to get extra rest for a few weeks." b. "My son is really looking forward to riding his bike next week." c. "I'm so glad we can attend religious services as a family this coming Sunday." d. "I am going to keep my child out of daycare for 6 weeks."

ANS: D Feedback A The child should resume his regular bedtime and sleep schedule after discharge. B Activities during which the child could fall, such as riding a bicycle, are avoided for 4 to 6 weeks after discharge. C Large crowds of people should be avoided for 4 to 6 weeks after discharge, including public worship. D Settings where large groups of people are present should be avoided for 4 to 6 weeks after discharge, including day care.

The process of burn shock continues until what physiologic mechanism occurs? a. Heart rate returns to normal. b. Airway swelling decreases. c. Body temperature regulation returns to normal. d. Capillaries regain their seal.

ANS: D Feedback A The heart rate will be increased throughout the healing process because of increased metabolism. B Airway swelling subsides over a period of 2 to 5 days after injury. C Body temperature regulation will not be normal until healing is well under way. D Within minutes of the burn injury, the capillary seals are lost with a massive fluid leakage into the surrounding tissue, resulting in burn shock. The process of burn shock continues for approximately 24 to 48 hours, when capillary seals are restored.

Which information should be included in the nurse's discharge instructions for a child who underwent a cardiac catheterization earlier in the day? a. Pressure dressing is changed daily for the first week. b. The child may soak in the tub beginning tomorrow. c. Contact sports can be resumed in 2 days. d. The child can return to school on the third day after the procedure.

ANS: D Feedback A The day after the cardiac catheterization, the pressure dressing is removed and replaced with a Band-Aid. The catheter insertion site is assessed daily for healing. Any bleeding or sign of infection, such as drainage, must be reported to the cardiologist. B Bathing is limited to a shower, a sponge bath, or a brief tub bath (no soaking) for the first 1 to 3 days after the procedure. C Strenuous exercise such as contact sports, swimming, or climbing trees is avoided for up to 1 week after the procedure. D The child can return to school on the third day after the procedure. It is important to emphasize follow-up with the cardiologist.

Which statement suggests that a parent understands how to correctly administer digoxin? a. "I measure the amount I am supposed to give with a teaspoon." b. "I put the medicine in the baby's bottle." c. "When she spits up right after I give the medicine, I give her another dose." d. "I give the medicine at 8 in the morning and evening every day."

ANS: D Feedback A To ensure the correct dosage, the medication should be measured with a syringe. B The medication should not be mixed with formula or food. It is difficult to judge whether the child received the proper dose if the medication is placed in food or formula. C To prevent toxicity, the parent should not repeat the dose without contacting the child's physician. D For maximum effectiveness, the medication should be given at the same time every day.

3. Which organs and tissues control the two types of specific immune functions? a.The spleen and mucous membranes b. Upper and lower intestinal lymphoid tissue c. The skin and lymph nodes d. The thymus and bone marrow

ANS: D A. Both the spleen and mucous membranes are secondary organs of the immune system that act as filters to remove debris and antigens and foster contact with T lymphocytes. B. Gut-associated lymphoid tissue is a secondary organ of the immune system. This tissue filters antigens entering the gastrointestinal tract. C. The skin and lymph nodes are secondary organs of the immune system. D. The thymus controls cell-mediated immunity (cells that mature into T lymphocytes). The bone marrow controls humoral immunity (stem cells for B lymphocytes).

2. A nurse is teaching parents about the importance of immunizations for infants because of immaturity of the immune system. The parents demonstrate that they understand the teaching if they make which statement? a. "The spleen reaches full size by 1 year of age." b. "IgM, IgE, and IgD levels are high at birth." c. "IgG levels in the newborn infant are low at birth." d. "Absolute lymphocyte counts reach a peak during the first year."

ANS: D A: The spleen reaches its full size during adulthood. B: IgM, IgE, and IgD are normally in low concentration at birth. IgM, IgE, IgA, and IgD do not cross the placenta. C: The term newborn infant receives an adult level of IgG as a result of transplacental transfer from the mother. D: Absolute lymphocyte counts reach a peak during the first year.

What procedure is contraindicated in the care of a child with a minor partial-thickness burn injury wound? a. Cleaning the affected area with mild soap and water b. Applying antimicrobial ointment to the burn wound c. Changing dressings daily d. Leaving all loose tissue or skin intact

ANS: D Feedback A Cleaning with mild soap and water are important to the healing process. B Antimicrobial ointment is used on the burn wound to fight infection. C Clean dressings are applied daily to prevent wound infection. When dressings are changed, the condition of the burn wound can be assessed. D All loose skin and tissue should be debrided, because it can become a breeding ground for infectious organisms.

The pediatric nurse understands that cellulitis is most often caused by: a. Herpes zoster b. Candida albicans c. Human papillomavirus d. Streptococcus or Staphylococcus organisms

ANS: D Feedback A Herpes zoster is the virus associated with varicella and shingles. B Candida albicans is associated with candidiasis or thrush. C Human papillomavirus is associated with various types of human warts. D Streptococcus, Staphylococcus, and Haemophilus influenzae are the organisms usually responsible for cellulitis

The skin condition commonly known as "warts" is the result of an infection by which organism? a. Bacteria b. Fungus c. Parasite d. Virus

ANS: D Feedback A Infection with these organisms does not result in warts. B Infection with these organisms does not result in warts. C Infection with these organisms does not result in warts. D Human warts are caused by the human papillomavirus.

What should the parents of an infant with thrush (oral candidiasis) be taught about medication administration? a. Give nystatin suspension with a syringe without a needle. b. Apply nystatin cream to the affected area twice a day. c. Give nystatin before the infant is fed. d. Swab nystatin suspension onto the oral mucous membranes after feedings.

ANS: D Feedback A Medication may not reach the affected areas when it is squirted into the infant's mouth. Rubbing the suspension onto the gum ensures contact with the affected areas. B Nystatin cream is used for diaper rash caused by Candida. C To prolong contact with the affected areas, the medication should be administered after a feeding. D It is important to apply the nystatin suspension to the affected areas, which is best accomplished by rubbing it onto the gums and tongue, after feedings, every 6 hours, until 3 to 4 days after symptoms have disappeared.

When taking a history on a child with a possible diagnosis of cellulitis, what should be the priority nursing assessment to help establish a diagnosis? a. Any pain the child is experiencing b. Enlarged, mobile, and nontender lymph nodes c. Child's urinalysis results d. Recent infections or signs of infection

ANS: D Feedback A Pain is important, but the history of recent infections is more relevant to the diagnosis. B Lymph nodes may be enlarged (lymphadenitis), but they are not mobile and are nontender. Lymphangitis may be seen with red "streaking" of the surrounding area. C An abnormal urinalysis result is not usually associated with cellulitis. D Cellulitis may follow an upper respiratory infection, sinusitis, otitis media, or a tooth abscess. The affected area is red, hot, tender, and indurated.

Which statement made by a parent indicates an understanding about the management of a child with cellulitis? a. "I am supposed to continue the antibiotic until the redness and swelling disappear." b. "I have been putting ice on my son's arm to relieve the swelling." c. "I should call the doctor if the redness disappears." d. "I have been putting a warm soak on my son's arm every 4 hours."

ANS: D Feedback A The parent should not discontinue antibiotics when signs of infection disappear. To ensure complete healing, the parent should understand that the entire course of antibiotics should be given as prescribed. B A warm soak is indicated for the treatment of cellulitis. Ice will decrease circulation to the affected area and inhibit the healing process. C The disappearance of redness indicates healing and is not a reason to seek medical advice. D Warm soaks applied every 4 hours while the child is awake increase circulation to the infected area, relieve pain, and promote healing.

The best setting for daytime care for a 5-year-old autistic child whose mother works is a. Private day care b. Public school c. His own home with a sitter d. A specialized program that facilitates interaction by use of behavioral methods

ANS: D Feedback A Daycare programs generally do not have resources to meet the needs of severely impaired children. B To best meet the needs of an autistic child, the public school may refer the child to a specialized program. C A sitter might not have the skills to interact with an autistic child. D Autistic children can benefit from specialized educational programs that address their special needs.

The nurse is providing counseling to the mother of a child diagnosed with fragile X syndrome. She explains to the mother that fragile X syndrome is a. Most commonly seen in girls b. Acquired after birth c. Usually transmitted by the male carrier d. Usually transmitted by the female carrier

ANS: D Feedback A Fragile X syndrome is most common in males. B Fragile X syndrome is congenital. C Fragile X syndrome is not transmitted by a male carrier. D The gene causing fragile X syndrome is transmitted by the mother.

The infant with Down syndrome is closely monitored during the first year of life for what serious condition? a. Thyroid complications b. Orthopedic malformations c. Dental malformation d. Cardiac abnormalities

ANS: D Feedback A Infants with Down syndrome are not known to have thyroid complications. B Orthopedic malformations may be present, but special attention is given to assessment for cardiac and gastrointestinal abnormalities. C Dental malformations are not a major concern compared with the life-threatening complications of cardiac defects. D The high incidence of cardiac defects in children with Down syndrome makes assessment for signs and symptoms of these defects important during the first year. Clinicians recommend the child be monitored frequently throughout the first 12 months of life, including a full cardiac workup.

The father of a child recently diagnosed with developmental delay is very rude and hostile toward the nurses. This father was cooperative during the child's evaluation a month ago. What is the best explanation for this change in parental behavior? a. The father is exhibiting symptoms of a psychiatric illness. b. The father may be abusing the child. c. The father is resentful of the time he is missing from work for this appointment. d. The father is experiencing a symptom of grief.

ANS: D Feedback A One cannot determine that a parent is exhibiting symptoms of a psychiatric illness on the basis of a single situation. B The scenario does not give any information to suggest child abuse. C Although the father may have difficulty balancing his work schedule with medical appointments for his child, a more likely explanation for his behavior change is that he is grieving the loss of a normal child. D After a child is diagnosed with a developmental delay, families typically experience a cycle of grieving that is repeated when developmental milestones are not met.

Many of the physical characteristics of Down syndrome present feeding problems. Care of the infant should include a. Delaying feeding solid foods until the tongue thrust has stopped b. Modifying diet as necessary to minimize the diarrhea that often occurs c. Providing calories appropriate to child's age d. Using special bottles that may assist the infant with feeding

ANS: D Feedback A The child has a protruding tongue, which makes feeding difficult. The parents must persist with feeding while the child continues the physiologic response of the tongue thrust. B The child is predisposed to constipation. C Calories should be appropriate to the child's weight and growth needs, not age. D Breastfeeding may not be possible if the infant's muscle tone or sucking reflex is immature. Mothers should be encouraged to pump breast milk and use special bottles for assistance with feeding. Some children with Down syndrome can breastfeed adequately.

It is important for the parents of a child who has had a severe allergic reaction to either peanuts or tree nuts to talk to their health care provider about whether the child should have medication available at school in case of an unanticipated exposure to nuts. Epinephrine is now available and easy to use in a device known as the ____________.

ANS: EpiPen The EpiPen is an auto-inject that can be given through the child's clothing. After the injection is given, the pen should be held in place for 10 seconds so that all medication can be delivered.

Clostridium difficile (C-difficile) is a gram-positive anaerobic bacteria known to cause diarrhea, abdominal cramps, and fever. The CDC has reported that children are at minimal risks as this infection affects primarily the elderly or patients who are immunocompromised. Is this statement true or false?

ANS: F In 2005, the CDC reported an increase in the number of cases of Clostridium difficile in children who were previously thought to be at minimal risk. Children ages 1 to 4 are primarily affected.

The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding, or provision of breast milk by bottle, for the first 4 to 6 months of life, preferably until the child reaches 1 year of age or beyond. This does not include infants with congenital heart disease who have difficulty maintaining breastfeeding due to poor oxygenation and fatigue. Is this statement true or false?

ANS: F The AAP states that breastfeeding should not be precluded for most high-risk neonates and infants, including those with congenital heart disease. The benefits of breastfeeding these infants includes; higher and more stable oxygen saturation measurements, improved weight gain, and shorter hospital stays.

_________________________ is a chronic, multisystem, autoimmune disease characterized by inflammation of the connective tissue.

ANS: Systemic lupus erythematosus or SLE SLE varies in severity and is marked by remission and exacerbations. Although the etiology is unknown, genetic, hormonal, environmental, and immune response factors are likely to be responsible.

Human cytomegalovirus (CMV) infection is a common cause of congenital infection and is the leading cause of hearing loss and intellectual disability in the United States. The neonate may be infected during the prenatal, perinatal, or postnatal period. Only infections acquired in utero cause permanent infection. Is this statement true or false

ANS: T Approximately one third of women with primary CMV infection transmit the virus to the fetus. The prevalence is one in 150 live births. Only 10% of infected newborns go on to manifest symptoms. These include jaundice, lethargy, seizures, petechiae, respiratory distress, enlarged liver, and microcephaly.

Electric injury to a child often results in instant death because the electric current disrupts the rhythm of the heart. Is this statement true or false?

ANS: T The child who does not die instantly after an electrical injury is at risk for cardiac arrest or dysrhythmia, tissue damage, myoglobinuria, and metabolic acidosis.

The camp nurse is telling a group of campers and their counselors how to avoid insect and tick bites. What information should the nurse include? Select all that apply. A. Dark, long-sleeved shirts should be worn. B. A hat is helpful when in wooded and grassy areas. C. Try to stay on paths rather than walking through dense areas. D. Apply insect repellent lightly on the hands. E. Ticks should be scraped off the skin. F. Shirts should be tucked into the pants.

B, C, F A hat is very helpful to protect the head from insects getting in the hair when in wooded and grassy areas. Trying to stay on paths rather than walking through dense areas is true. Shirts should be tucked into the pants to prevent insects and ticks getting to the skin. Light, long sleeved shirts should be worn because of being able to see insects and ticks. Insect repellent should not be applied on the hands because the hands often touch the eyes and mouth. Ticks should be removed with tweezers. The tick should be removed as close to the skin as possible using steady upward pressure. Ensure that all mouthparts are removed from the skin.

The parents of a young boy with burns covering 40% of the total body surface area (TBSA) ask why he is receiving enteral feedings at night while he is sleeping and is eating during the day. Which response by the nurse is best? A. "His appetite is really poor right now and he needs more fluid." B. "Your son needs more protein and calories than he can eat while awake." C. "Your child needs a large quantity of high carbohydrate and low protein." D. "His intestinal activity is slow right now, and this is easier on his system."

B. "Your son needs more protein and calories than he can eat while awake." Enteral feedings can supply the protein, carbohydrate, and calories that the child cannot ingest. The feedings are stopped during the day so the child is able to eat basically whatever he wants, and then the minimum amount of nutrition can be ensured by the enteral feedings at night. A diet high in protein, carbohydrate, and calories is recommended. The combination of eating and enteral feedings allows the child to eat "kid food" during the day and receive the nutrients he needs at night. The hourly amount of the enteral feeding will also depend on how the child tolerates the feeding. It is often true that appetites are diminished because of pain. Oral feedings are not contraindicated. This is encouraged; however, most children with burns are unable to consume sufficient calories by mouth.

The nurse is reviewing the orders for a child with cellulitis. What would the nurse expect to see ordered for this patient? A. Damp to dry compresses using Burow's solution B. Administration of oral or parenteral antibiotics for several days C. Topical application of an antibiotic cream to the involved area D. Incision and drainage of cellulitis lesions covering a wide area

B. Administration of oral or parenteral antibiotics for several days Oral or parenteral antibiotics are indicated because of the need to have the antibiotic infused systemically. The antibiotic needs to be administered systemically. Incision and drainage of severe cellulitis lesions is done only if it is determined that the cellulitis is localized enough. If this is done, there is a risk of spreading infection or making the lesion worse. Warmed sterile water or sterile saline dressings may be indicated for limited cellulitis.

The pediatric office nurse is giving instructions to a parent whose child has scabies. What information should the school nurse include? A. Treat all of the family members if symptoms develop. B. Be prepared for symptoms to last 2 to 3 weeks. C. Notify your health care practitioner so an antibiotic can be prescribed. D. Carefully treat only those areas where there is a rash.

B. Be prepared for symptoms to last 2 to 3 weeks. The mite responsible for the scabies will most likely be killed with the administration of medications. It will take 2 to 3 weeks for the stratum corneum to heal. That is when the symptoms will abate. A scabicide is used. Permethrin (Nix) and Lindane (Kwell) are currently used for topical administration. Permethrin (Nix) is applied to all skin surfaces. Only the affected individuals need to be treated.

The nurse is teaching adolescents about the management of acne. What should the nurse include in the discussion? A. Clean the face with an antibacterial soap twice each day. B. Clean the face gently with a mild soap once or twice each day. C. Avoid foods with a high fat content, such as French fries and chocolate. D. Express comedones by gentle squeezing; then cleanse with alcohol.

B. Clean the face gently with a mild soap once or twice each day. Cleansing the face with mild soap and water will remove surface dirt and oil. No relationship has been established between food intake and acne. Squeezing comedones and then cleansing with alcohol can break down the ductal walls of the lesions and cause the acne to worsen. Antibacterial soaps may be too drying when used in combination with topical medications.

A child with a depressed immune system due to chemotherapy for cancer has been admitted to the pediatric unit because of possible measles. What would the nurse expect to assess if the child is in the prodrome period of the disease? A. Confusion, chorea, and conjunctivitis B. Coryza, cough, and conjunctivitis C. Coordination problems, clubbing, and contractures D. Croup, congestion, and crying

B. Coryza, cough, and conjunctivitis Typically, children have a prodrome period with fever that rises gradually and the "three Cs" ([coryza or profuse runny nose], cough, and conjunctivitis) that lasts between 1 and 4 days. There are no coordination problems, clubbing of the digits, or contractures. Croup is a collection of problems and is not seen with measles. Crying is very vague, but there is some congestion. Confusion doesn't occur unless the fever is very high. There are no uncoordinated movements, but conjunctivitis is present.

A school-age child is recovering from infectious mononucleosis. What information should the nurse give the mother about activities when he returns to school? A. The child should eat away from the other children in the lunchroom. B. Participation in his physical education class should be limited to non-contact sports. C. Allow the child to rest until he returns to school without worrying about homework. D. He will be able to return to school full-time when he has his medical release.

B. Participation in his physical education class should be limited to non-contact sports. Participation in his physical education class should be limited to non-contact sports and quiet activities to protect the child's enlarged spleen from rupture. Allowing the child to postpone homework until he returns to school could put the child behind and cause additional stress. He might need to return to school part-time when he has his medical release. There is no reason he needs to eat away from the other children in the lunchroom. However, he should not share any of his lunch or anything saliva has touched.

The nurse is explaining the time interval between early manifestations of disease and the overt clinical syndrome to a parent calling about her sick child. Which word would the nurse use? A. The incubation period B. The prodromal period C. The desquamation period D. The period of communicability

B. The prodromal period The definition of prodromal period is the interval between early manifestations of the disease and the appearance of overt clinical symptoms. The "desquamation period" refers to the shedding of skin. The period of communicability is the time when the child is infectious. The incubation period is the time from exposure to appearance of first symptom.

During the rehabilitative phase of care, the nurse applies pressure dressings to the patient's severely burned areas. This activity is used to accomplish which goal? A. To relieve as much pain as possible B. To decrease the development of scar tissue C. To promote motion during the healing process D. To protect underlying tissue by encouraging scar formation

B. To decrease the development of scar tissue Uniform pressure to the scar decreases blood supply. The use of pressure garments serves to decrease the blood supply to the hypertrophic tissue. This is done to prevent scarring and contractures. Motion is encouraged because it prevents contractures, but this has nothing to do with the pressure dressing application. The goal of the pressure dressing is to minimize the development of scar tissue. The goal of the pressure dressing is to improve the appearance of scars.

A mother calls the pediatrician's office to find out how to provide comfort for her son who is itching from chickenpox. Information from the nurse is correct if which information is shared with the mother? A. "Encourage frequent warm baths." B. "Give acetaminophen (Tylenol)." C. "Give diphenhydramine (Benadryl)." D. "Apply a thick coat of Caladryl lotion over open lesions."

C. "Give diphenhydramine (Benadryl)." Antipruritic medicines such as diphenhydramine (Benadryl) are useful for severe itching, which interferes with sleep and may contribute to secondary infection. Caladryl lotion (contains Benadryl) should be applied sparingly over open lesions to minimize absorption. Cool baths are recommended for relief of itching. Acetaminophen (Tylenol) has no anti-itching effects.

The office nurse is taking a history on a child's illness from the parents. The nurse notes that the parents treated their 7-year-old child appropriately for a fever when they report that they provided what care? A. Gave baby aspirin (ASA) B. Bathed the child in cold water C. Gave fluids at frequent intervals D. Gave alternating dosages of acetaminophen (Tylenol) and ibuprofen (Motrin)

C. Gave fluids at frequent intervals Providing fluids at frequent intervals helps to meet the body's need for fluids during a febrile illness. Alternating acetaminophen (Tylenol) and ibuprofen (Motrin) might result in an overdose and has no real benefit. Aspirin is associated with Reye's syndrome and should not be given to children with a fever. The cold bath will chill the child and cause shivering, which is a response that will increase the body temperature.

The nurse is using Standard Precautions while caring for her patients. Nursing care is correct if which procedures are used to promote infection control? A. Gloves are worn any time a patient is touched. B. Needles are capped immediately after use and disposed of in a special container. C. Gloves are worn to change diapers when there are loose or explosive stools. D. Masks are used only when caring for patients with airborne infections.

C. Gloves are worn to change diapers when there are loose or explosive stools. Changing a diaper with loose or explosive stools has the greatest risk for exposure to body substances. Masks are a component of Transmission-Based Precautions and not Standard Precautions. Gloves are not indicated unless there is potential for contact with body substances. Used needles should never be capped. They should be immediately disposed of in a rigid puncture-proof container.

The school nurse is seeing a child who brought poison ivy to school in his leaf collection. The child says, "It only touched my hands." What is the initial nursing action? A. Apply compresses using Burow's solution. B. Soak the child's hands in warm water. C. Rinse the child's hands in cold, running water. D. Scrub the child's hands thoroughly with antibacterial soap.

C. Rinse the child's hands in cold, running water. Rinsing the child's hands in cold, running water is the recommended first action. Once contact has been made, it is desirable to flush the skin with cold, running water within 15 minutes of exposure. This will neutralize the urushiol not yet bonded to the skin. The antibacterial soap removes protective skin oils and dilutes the urushiol, allowing it to spread. Application of Burow's solution compresses is effective for soothing the skin lesions once the dermatitis has begun. Cold, running water, not warm, is effective in removing the oil.

The nurse is caring for an infant with recurrent atopic dermatitis (eczema). What information would the nurse expect to see in the infant's history? A. It last happened in the summer. B. The infant recently traveled to a humid climate. C. The infant has several allergies similar to her mother. D. The infant had an upper respiratory infection a week ago.

C. The infant has several allergies similar to her mother. The majority of children with atopic dermatitis have a family history of eczema, asthma, food allergies, or allergic rhinitis. This suggests a genetic predisposition. It is associated with allergies and not upper respiratory infections. Atopic dermatitis worsens in fall and winter. It improves in humid climates.

The school nurse is educating a group of elementary school teachers about ringworm (tinea capitis). Which explanation of the condition by the nurse is best? A. It is self-limiting and not contagious. B. It is a sign of uncleanliness. C. The patient should recover spontaneously without interventions. D. It is spread by direct and indirect contact.

D. It is spread by direct and indirect contact. Ringworm is spread by both direct and indirect contact. Children should wear protective caps at night to avoid transfer of ringworm to bedding. Ringworm is infectious and not self-limiting. Because ringworm is easily transmitted, it is not a sign of uncleanliness. It can be transmitted by theater seats, gym mats, and animal-to-human transmission. Treatment is required with the drug griseofulvin (Grisactin), which is indicated for a prolonged course, possibly several months.

An occlusive dressing, Acu-Derm, is applied to a large abrasion. What is the reason the nurse would use this type of dressing? A. It delivers vitamin C to the wound. B. It provides an antiseptic for the wound. C. It promotes mechanical friction for healing. D. It maintains a moist environment for healing.

D. It maintains a moist environment for healing. Occlusive dressings, such as Acu-Derm, provide a dressing that is non-adherent to the wound site. It provides a moist wound surface and insulates the wound. The dressing does not have vitamin C, does not have antiseptic capabilities, and protects

The nurse is applying wet dressings on the skin. What procedure would be correct for the nurse to use? A. Apply the dressing when it is saturated and dripping. B. Apply the dressing so that the area is totally immobilized. C. Pour new solution over a dressing that has become dry, or apply solution with a syringe. D. Pour the desired solution on soft gauze and then squeeze the gauze to remove excess liquid prior to putting it on the skin.

D. Pour the desired solution on soft gauze and then squeeze the gauze to remove excess liquid prior to putting it on the skin. The desired solution should be applied to soft gauze or soft cotton cloths, but the excess fluid must be removed, or the desired effects will not occur. After immersion in the solution, the dressings are wrung out to avoid dripping. The moist dressing should be laid flat on the area with an attempt to avoid restriction of movement. As the evaporation begins to dry them, the dressings are removed, immersed in the solution again, and reapplied by using aseptic technique. When the solution dries, concentrated residue is left in the dressing. The addition of fluid may result in a more concentrated soak being placed on the sensitive tissue.

A girl with possible malabsorption syndrome is undergoing diagnostic testing for the condition. She is instructed to wear a facemask in order for expelled air to be collected. This test is known as the ________ breath test.

hydrogen A carbohydrate solution is given by mouth and exhaled. Inadequately digested carbohydrate produces hydrogen when acted on by the gastrointestinal flora. The hydrogen breath test will help confirm the diagnosis of malabsorption syndrome.