PEDS Exam 2 (Ch. 6,14,15,21,22,23,31) Evolve Practices Questions

A parent tells the nurse, "I am worried about my 13-year-old son. He hasn't started puberty, and my daughter did when she was 11 years of age." The most appropriate explanation by the nurse is

"This is Normal Because The Onset Of Pubescence Is Usually Earlier In Girls Than It Is In Boys."! (Girls begin puberty on average approximately 2 years before boys. Puberty usually begins no earlier than age 12 years in boys, with an average age of onset of 14 years; therefore, no further evaluation is necessary at this time. The age of pubescence is gender related, with the average age of puberty onset being 12 years for girls and 14 years for boys. Puberty usually begins no earlier than age 12 years in boys, with an average age of onset of 14 years; therefore, her son is not having an abnormal onset of puberty.)

Which action would indicate a priority for the nurse in terms of health promotion safety?

4-year-old Child Wears Protective Equipment While On A Skateboard. (Skateboard use is not recommended for children aged 5 and younger regardless if they are wearing protective equipment. All of the other options indicate that attention has been placed on safety concerns and that the children are developmentally appropriate to handle the physical skill activity.)

A 4-year-old boy needs to use a metered-dose inhaler (MDI) of an inhaled cortocosteroid to treat his asthma. What should the nurse anticipate as being required to correctly adminster this type of medication?

A Spacer! (The medication in a metered-dose inhaler is sprayed into the spacer. The child can then inhale the medication without having to coordinate the spraying and breathing. A nebulizer is a mechanism to administer medications, but it cannot be used with metered-dose inhalers. Peak expiratory flow meters measure pulmonary function but are not related to medication administration. Chest physiotherapy is unrelated to medication administration.)

Because the absorption of fat-soluble vitamins is decreased in cystic fibrosis, which vitamin supplementation is necessary?

A,D,E,K! (A, D, E, and K are the fat-soluble vitamins, which need to be supplemented in higher doses for the child with cystic fibrosis. C and folic acid are not fat-soluble vitamins. D also needs to be supplemented in children with cystic fibrosis.)

It is important that a child with acute streptococcal pharyngitis be treated with antibiotics to prevent

Acute Rheumatic Fever! (Children with group A â-hemolytic streptococci (GABHS) infection are at risk for acute rheumatic fever and acute glomerulonephritis. Otitis media is not a complication of acute streptococcal pharyngitis. Diabetes insipidus is not a complication of acute streptococcal pharyngitis. Children who have had acute streptococcal pharyngitis are at risk for acute glomerulonephritis, not nephrotic syndrome.)

The school nurse is teaching a class on injury prevention. What should be included when discussing firearms?

Adolescence Is The Peak Age For Being Either A Victim Or An Offender In An Injury Involving A Firearm! (Gun carrying among adolescents is on the rise. The increase in gun availability is linked to increased gun injuries and deaths among children. Adolescents can be taught to safely use and store guns for hunting. Gun carrying is on the rise in adolescents and is not limited to stereotypical inner-city youth. Nonpowder guns, such as air rifles and BB guns, cause almost as many injuries as powder guns.)

What is an important consideration for the school nurse planning a class on injury prevention for adolescents?

Adolescents Need To Discharge Energy, Often At The Expense Of Logical Thinking! (The physical, sensory, and psychomotor development of adolescents provides a sense of strength and confidence. There is also an increase in energy coupled with risk taking that puts them at risk, because they often ignore logical thinking. Adolescents tend to be risk takers because of their feelings of indestructibility. The feelings of indestructibility that accompany adolescence interfere with understanding the consequences of their behavior, thus increasing their potential for injuries. Sports can be a useful way to discharge energy and should not be limited. Care must be taken to avoid overuse injuries and to use appropriate protective equipment.)

A nurse has been assigned to take care of a pediatric patient suspected of having chicken pox(varicella). Which type of precaution is required?

Airborne With Isolation Room! (When a pediatric patient is suspected of having chicken pox(varicella), airborne precautions should be taken and the patient placed in an isolation room.)

A nurse is providing instruction to a family concerning the care of an infant with bacterial conjunctivitis. Which observation indicates that additional teaching is needed?

An occlusive dressing is applied to the eye area.

Systematic clinical findings associated with bedbugs manifest as

Anaphylaxis! (This is an example of a systemic reaction. Folliculitis is an example of a secondary reaction whereas rash and wheal represent cutaneous symptoms.)

A parent with a toddler who has a respiratory infection wants to use the traditional method of topical vapor rub. Which statement by the parent indicates that additional teaching is needed with regard to administration of this treatment?

Application Of The Medication Will Be Given Orally To Avoid Potential Sneezing! (Topical vapor rubs should never be given orally or applied beneath the nose. All of the other options indicate appropriate action on the part of the parent in terms of medical asepsis, obtaining information by reading label and notifying the health care provider that a medication is being used in the current treatment plan.)

What should the nurse recognize as an early clinical sign of compensated shock in a child?

Apprehensiveness! (Apprehensiveness is indicative of compensated shock. Confusion is indicative of uncompensated shock. Sleepiness is not an indication of shock. Hypotension is a symptom of irreversible shock.)

A cardiac assessment is required to determine if a child's physical symptoms are related to possible heart disease. The nurse is proceeding to auscultation techniques. When observing the nursing student perform this assessment, which action would indicate that additional training was required?

Ascertaining Whether There Is Evidence Of Splenic Enlargement! (Evidence of splenic enlargement requires palpation as an assessment technique. All of the other options are in-line with auscultation techniques.)

A child with asthma is having pulmonary function tests. What explains the purpose of the peak expiratory flow rate (PEFR)?

Assesses The Severity Of Asthma! (The PEFR measures the maximum amount of air that can be forcefully exhaled in 1 minute. This can provide an objective measure of pulmonary function when compared with the child's baseline. The diagnosis of asthma is made on the basis of clinical manifestations, history, and physical examination, not pulmonary function tests such as the PEFR. The cause of asthma is inflammation, bronchospasm, and obstruction, which are not identified by the PEFR. Some of the triggers of asthma are identified with allergy testing, not with the PEFR.)

Which is most descriptive of the spiritual development of the older adolescent?

Beliefs Become More Internalized! (Because of their abstract thinking abilities, adolescents are able to interpret analogies and symbols related to their spiritual development. Rituals and practices become less important as the adolescent questions values and ideals of families. Strict observation of religious customs becomes less important as the adolescent questions values and ideals of families. Adolescents question external manifestations when not supported by adherence to supportive behaviors. The adolescent's spiritual development is more internally driven.)

A 4-year-old child has ingested a toxic dose of iron. The parent reports that the child vomited and complained of gastric pain an hour ago but "feels fine" now. The parent is not certain when the child ingested the iron tablets. The most appropriate recommendation by the nurse to the parent is to

Bring The Child To The Hospital Immediately! (The child should be transported to the hospital immediately for assessment and possible gastric lavage. The period of concern for complications of iron toxicity is from 30 minutes to 6 hours. Activated charcoal does not bind iron and, therefore, is not a course of treatment for this child. Ipecac is not recommended for poisonings.)

One of the goals for children with asthma is to prevent respiratory tract infection because infections

Can Trigger An Episode Or Aggravate Asthmatic State! (Respiratory tract infections can trigger an asthmatic attack. An annual influenza vaccine is recommended. All respiratory equipment should be kept clean. Respiratory tract infection affects the asthma, not the medications. Exercise-induced asthma is caused by vigorous activity, not a respiratory tract infection. Sensitivity to allergens is independent of respiratory tract infection.)

Apnea of infancy has been diagnosed in an infant scheduled for discharge with home monitoring. Part of the infant's discharge teaching plan should include?

Cardiopulmonary Resuscitation (CPR)! (CPR is essential for all parents and caregivers to know, especially when an infant has a history of apnea of infancy that is being monitored at home. Most likely, the child will not be receiving home IV therapy as part of the discharge care. The Heimlich maneuver is used to intervene when a child or an adult is experiencing a choking episode. It would not be necessary for the parents to learn the maneuver at this time. (Back slaps and chest thrusts are used on the responsive infant for choking.) The parents should arrange for other caregivers to help when possible. There is no reason that the infant cannot be left with capable and trained individuals. Anyone caring for the infant will need to be taught to use equipment and how to perform CPR.)

A 10-year-old child is riding a bicycle on the grounds of the school. Which finding if observed by the school nurse would require intervention?

Child's Shoes Are Ill Fitting! (Shoes that are ill fitting can result in potential injury as they can get caught up in gears and affect the ability of the child to navigate. All of the other observed behaviors are consistent with safe practice.)

A middle age child understands that with regards to a mathematical equation that 7 can be composed of 4+3 as well as 2+5. Based on this finding, the nurse documents that the development level of the child reflects?

Conservation! (Piaget's cognitive theory development describes conservation as the ability of the child to understand that the same concept may exist as identified by a different method. Numerical relationships are understood before substance conservation. Concrete operations is the term Piaget applies to the entire stage whereby children are able to use thought processes to experience events and actions. The latency period is described by Freud as the ability of the child to go from peer relationships to heterosexual relationships. Industry versus inferiority refers to Erikson's overview of this time frame whereby children if successful master the challenges between industry and inferiority.)

A school-age child with acute diarrhea and mild dehydration is being given oral rehydration solution (ORS). The child's mother calls the clinic nurse because the child is also occasionally vomiting. What should the nurse recommend?

Continue To Give ORS Frequently In Small Amounts! (Vomiting is not a contraindication to the use of ORS unless it is severe. The mother should continue to give the ORS in small amounts and at frequent intervals. For a school-age child with mild dehydration, rehydration can be safely done at home with oral solutions. Carbonated drinks should not be used. They may have a high carbohydrate content and contain caffeine, which is a diuretic and could exacerbate fluid loss and dehydration. NPO status is not indicated. Small, frequent intake of ORS is recommended.)

What information should the nurse include in a teaching plan for an adolescent with Crohn disease?

Coping With Stress & Adjusting To Chronic Illness! (Crohn disease is a chronic disease with life-altering complications. The nursing interventions include helping the child cope with stress and adjust to the illness. Nutritional guidance is necessary, but Crohn disease is not infectious. Adjustment to chronic illness is necessary, but Crohn disease is not infectious. Nutritional guidance is necessary, but constipation is not an issue.)

What is an important nursing responsibility when a dysrhythmia is suspected?

Count The Apical Pulse For 1 Full Minute, & Compare The Rate With The Radial Pulse Rate! (This is the nurse's first action. If a dysrhythmia is occurring, the radial pulse rate may be lower than the apical pulse rate. This may be indicated after conferring with the practitioner. The radial pulse rate needs to be compared with the apical pulse rate. It does not need to be counted for 1 minute five times. Only one nurse is needed to carry out this action.)

You are educating nursing student regarding fluid requirements for pediatric patients who present with comorbidities. Increased need for fluid requirements would be consistent with treatment management for which conditions? (Select all that apply.)

Diabetic Ketoacidosis (DKA), Burns, Diabetes Insipidus (DI)! (Increased fluid requirements would occur in response to DKA, DI and burns. CHF and SIADH would lead to decreased fluid requirements.)

The nurse should explain to the parents that their child is receiving furosemide (Lasix) for severe congestive heart failure because of its effects as

Diuretic! (Furosemide is a loop diuretic used to eliminate excess water and salt to prevent the accumulation of fluid associated with congestive heart failure.)

The nurse is preparing to give digoxin (Lanoxin) to a 9-month-old infant. The nurse checks the dose; 4 ml of the drug is to be drawn up. Based on the nurse's knowledge of this medication and safe pediatric dosages, the most appropriate action by the nurse is

Do Not Draw-Up Dose; Suspect Dosage Error! (Digoxin is often prescribed in micrograms. Rarely is more than 1 ml administered to an infant. As a potentially dangerous drug, digoxin has precise administration guidelines. Some institutions require that digoxin dosages be checked with another professional before administration. The nurse has drawn up too much medication and should not give it to the child. Administration procedures as described are correct, but too much medication is prepared, so it should not be given to the child.)

After a patient returns from cardiac catheterization, the nurse notes that the pulse distal to the catheter insertion site is weaker (+1). The most appropriate nursing intervention is to

Document The Findings & Continue To Monitor! (The pulse distal to the catheter insertion site may be weaker for the first few hours after catheterization. It should gradually increase in strength. The extremity is kept straight and immobile, but elevation is not necessary. Because a weaker pulse is an expected finding, the nurse should document it and continue to monitor it. There is no need to notify the physician. The insertion site is kept dry. Warm compresses would increase the risk of bleeding from the insertion site.)

A physician suspects that a child may have congenital cardiac disease. Which noninvasive diagnostic procedure would help to confirm the possibility of heart disease?

Echocardiogram! (An echocardiogram is the most common test used to identify either a cardiac anomaly or evidence of heart disease. EKG provides evidence of electrical system conduction. Pulse oximetry provides information relative to perfusion. And a chest x-ray focuses on lungs and airway exchange, it may not be sensitive and specific to determine cardiac pathology.)

What procedure uses high-frequency sound waves obtained by a transducer to produce an image of cardiac structures?

Echocardiography! (Echocardiography uses high-frequency sound waves. The child must lie completely still. With the improvements in technology, a diagnosis can sometimes be made without cardiac catheterization. Electrocardiography is an electrical tracing of the depolarization of myocardial cells. Cardiac catheterization is an invasive procedure where a catheter is threaded into the heart, a contrast medium is injected, and the heart and its vessels are visualized. Electrophysiology is an invasive procedure where catheters with electrodes record the impulses of the heart directly from the conduction system.)

Evidence-based research shows that the most successful strategy for preventing smoking in teenagers is

Emphasis On Immediate Effects Of Smoking! (An emphasis on immediate effects of smoking has proven to be one of the most effective strategies for preventing smoking. Information focuses on tobacco smell and other aesthetic issues. Because this age-group is neither future oriented nor consequence oriented, emphasis on the long-term effects of smoking does not work as well as focusing on the immediate effects. Public campaigns can be effective when focused on the immediate effects of smoking, but they often focus on the more long-term effects of smoking. Threatening social norms in adolescents is not an effective strategy for the prevention of smoking.)

Which action would improve dental health in the school-age child?

Encouraging The Child To Floss. (Flossing is a critical activity that has been shown to improve dental health. Brushing teeth following meals as well as following snacks has also been shown to improve dental health. At this age, the child should be able to brush their own teeth. Whereas soda should be avoided, the use of fruit juice may contribute to dental caries as it is considered to be a sugar source and example of a fermentable carbohydrate. Water as a drink should be promoted to improve dental health.)

Which finding if observed by the nurse in a neonate immediately after birth should the should alert the nurse to suspect a tracheoesophageal fistula?

Excessive Amount Of Frothy Saliva In The Mouth! (Excessive salivation and drooling are indicative of tracheoesophageal fistulas. With a fistula, the child has difficulty managing the secretions, which may cause choking, coughing, and cyanosis. Jaundice is not usually associated with a tracheoesophageal fistula. Bile-stained vomitus is not usually associated with a tracheoesophageal fistula. The infant is able to suck with a tracheoesophageal fistula but is not able to manage the secretions.)

In performing a work up for a school aged child who reports frequent abdominal pain symptoms, what information would be critical to collect in order to make an accurate clinical diagnosis?

Find Out The Duration, Onset & Quality Characteristics Of The Symptoms! (School-age children typically relate recurrent abdominal pain. As such it is critical to obtain factors related to the pain characteristics, onset, duration and symptoms. This will help to correlate with potential organic and non-organic causes. Asking the parents' for detailed information may be needed but not at present to determine what type of pain the child is experiencing. Although it is important to denoted food allergies and food intolerance, the primary concern is abdominal pain presentation. Similarly, vital signs should be recorded but it is not the most critical piece of data that must be collected.)

When is the time frame for starting primary immunizations for a baby who was just born?

Following Birth Or Up To Two Weeks Of Age!

What clinical manifestations would the nurse expect to find in a newborn who has developed necrotizing enterocolitis (NEC)?

Gastric Residual & Melena! (The most prominent signs of NEC are abdominal distention, gastric residuals, and blood in the stools (melena). NEC resembles septicemia; the newborn may "not look well," in addition to having nonspecific signs such as lethargy, poor feeding, hypotension, hypothermia, bile-stained vomitus, and oliguria. The newborn with NEC is more likely to be seen with hypothermia, not hyperthermia. The passage of ribbon-like stools is seen in newborns and infants born with Hirschsprung disease. Projectile vomiting is seen in newborns and infants with pyloric stenosis.)

The most appropriate comfort intervention for a child with severe itching related to chickenpox is

Give an antipruritic medication such as diphenhydramine (Benadryl).

Girls experience an increase in weight and fat deposition during puberty. Nursing considerations related to this include

Giving Reassurance That These Changes Are Normal! (A certain amount of fat is increased along with lean body mass to fill the characteristic contours of the child's gender. A healthy balance must be achieved between expected healthy weight gain and obesity as related to these normal and expected physical changes. This should not be done unless weight gain is excessive. Eating disorders can develop in this group, and diet management should be considered only under a health care practitioner's care. Exercise is an important component in weight management but should never be done or encouraged in increased amounts or in excess to control weight gain that occurs normally during puberty. Some fat deposition is essential for normal hormonal regulation. Menarche is delayed in girls with body fat contents that are too low; therefore, a low-fat diet is not a recommended intervention.)

The most important prevention method for the spread of any communicable disease is

Hand Washing!

The school nurse is called to the cafeteria because a child "has eaten something he is allergic to." The child is in severe respiratory distress. The first action by the nurse is to

Have Someone Call For An Ambulance & Paramedic Rescue Squad OR 9-1-1! (Because the child is in severe respiratory distress, the nurse should have someone call for a rescue squad or 9-1-1. Because severe respiratory distress is occurring, treatment of the response is indicated. What the child has eaten can be determined later. Diphenhydramine by mouth will not be effective for this type of emergency allergic reaction. The child should not be moved, unless the child is currently in a place that puts him or her at greater hazard.)

What is the causative agent for erythema infectiosum (fifth disease)?

Human Parvovirus B19! (This the causative agent of fifth disease. Paramyxovirus causes mumps. Human herpesvirus types 1 and 2 are the major causes of herpetic infections in humans. Group A β-hemolytic streptococcus is the causative agent for scarlet fever.)

Which factor predisposes an infant to fluid imbalances?

Immature Kidney Functioning! (The infant's kidneys are unable to concentrate or dilute urine, to conserve or excrete sodium, and to acidify urine. The infant has a proportionately greater body surface area, which allows for greater insensible water loss. The infant has a higher metabolic rate. The infant has an increased amount of extracellular fluid. Approximately 60% of the fluid loss is from the extracellular space.)

A child has been diagnosed with hepatitis A and received treatment. Based on this information the nurse determines that

Immunity Has Been Acquired For This Type! (Once a patient has been exposed and treated, they develop immunity to this type but there is no crossover immunity to other hepatitis types. Hepatitis A if transmitted through fecal-oral route and is not blood borne. There is no carrier state for Hepatitis A.)

The nurse is concerned with the prevention of communicable disease. Primary prevention results from

Immunizations! (Communicable diseases are prevented through immunizations, which constitute primary prevention)

How does the onset of the pubertal growth spurt compare in girls and boys?

In Girls, It Occurs About 2 Years Before It Appears In Boys! (The average age of onset for puberty is 12 years in girls and 14 years in boys. Although this may be true for an individual, the average difference is approximately 2 years. Usually, girls begin puberty and their growth spurt earlier than boys.)

Surgical repair for patent ductus arteriosus (PDA) is done to prevent the complication of

Increased Pulmonary Vascular Congestion! (A PDA allows blood to flow from the aorta (high pressure) to the pulmonary artery (low pressure). If the PDA stays open, increased pulmonary vascular congestion can occur. The increased pulmonary vascular congestion is the primary complication; pulmonary infection may occur, but it is not the priority complication. A PDA involves a left-to-right shunt of blood. The decreased workload on the left side of the heart is not a priority complication of a PDA.)

Which behavior is most characteristic of the concrete operations stage of cognitive development?

Increasingly Logical & Coherent Thought Processes! (Increasingly logical and coherent thought processes are characteristic of concrete operations. Children in this stage are able to classify objects. Progression from reflex activity to imitative behavior is characteristic of the sensorimotor stage, which occurs from birth to 2 years of age. Inability to put oneself in another's place is characteristic of the preoperational stage, ages 2 to 7 years. Adolescents, in the formal operations stage, have the ability to think in abstract terms and draw logical conclusions.)

An important nursing intervention in the care of a child with bacterial conjunctivitis is

Intermittent warm, moist compresses to remove crusts on the eye area.

Sexual orientation as a concept related to the adolescent period is

Is Different For Each Individual Based On Their Own Preferences! (Sexual orientation is the pattern of sexual arousal or romantic attraction between individuals regardless of whether it is based on heterosexual, same sex of transgender identification. It is not measured by hormone levels and is correlated with sexual identity.)

During the adolescence period, what role does the school environment take on?

It Forms The Basis For Their Social Life! (The school environment becomes the focus of the adolescent's social life. While the school environment provides a site for education, the adolescent may also be receiving instruction at other areas or venues. The school environment is not based on peer group assignment and peer groups provide the transitional structure for adolescent's emerging autonomy.)

An adolescent boy tells the school nurse that he is gay. The nurse's response should be based on knowledge that

It Is Important To Provide A Nonthreatening Environment For Him To Discuss His Feelings! (The nurse needs to be open and nonjudgmental in interactions with adolescents who have questions about their sexual orientation. This will allow a safe environment for the adolescents to speak and receive guidance from a health care professional as warranted. Adolescence is when sexual identity develops; therefore, questions about sexual orientation often surface at this time. The nurse's own beliefs should not bias the interaction with this student and, therefore, are irrelevant. Homosexual adolescents have different challenges to growing up and their sexual identity than heterosexual adolescents, often related to societal, cultural, religious, and spiritual influences.)

What should the nurse consider when providing support to a family whose infant has just been diagnosed with biliary atresia?

Liver Transplantation May Be Needed Eventually! (Approximately 80% to 90% of children with biliary atresia will require liver transplantation. If the condition is untreated, death will usually occur by 2 years of age. Long-term survival is possible with surgical intervention. Liver transplantation is usually required for long-term survival. Even with surgical intervention, most children progress to liver failure and require transplantation.)

Which diet is most appropriate for the child with celiac disease?

Low-Gluten Diet! (Celiac disease is characterized by intolerance of gluten, the protein found in wheat, barley, rye, and oats. A low-gluten diet is indicated for life. The diet for a child with celiac disease does not have to be salt free. A low-phenylalanine diet is indicated in phenylketonuria. The diet of a child with celiac disease should be high in calories and protein and low in fat, in addition to the low-gluten requirement.)

Examination of a child's mouth reveals that teeth do not line up properly upon attempts to have the child bite down. This finding is noted as?

Malocclusion! (Malocclusion occurs when upper and lower teeth do not approximate when a child bites down. Gingivitis refers to inflammation of the gums. Evidence of dental caries would refer to the presence of a cavity. Dental injury refers to evidence of chipping or dislocation as a result of trauma.)

Cystic fibrosis may affect one system or multiple systems of the body. What is the primary factor responsible for possible multiple clinical manifestations?

Mechanical Obstruction Caused By Increased Viscosity Of Exocrine Gland Secretions! (Children with cystic fibrosis have thick exocrine gland secretions. The viscous secretions obstruct small passages in organs such as the lungs and pancreas. Thick mucous secretions are the probable cause of the multiple body system involvement, not atrophic changes in the intestinal mucosal walls. There is an identified autonomic nervous system anomaly, but it is not hypoactivity. The apocrine, or sweat, glands are not hyperactive. The child loses a greater amount of salt due to abnormal chloride movement.)

The most likely source of injury, whether intentional or unintentional in adolescents is associated with?

Motor Vehicle Accidents! (Motor vehicle accidents are the most common cause of injury and death in adolescents. Homicide is the second leading cause.)

What clinical manifestation would the nurse expect when a pneumothorax occurs in a neonate who is undergoing mechanical ventilation?

Nasal Flaring & Retractions! (Nasal flaring, retractions, and grunting are signs of respiratory distress in a neonate. Barrel chest develops with chronic obstructive pulmonary disease, not with acute pneumothorax. Wheezing has a greater association with bronchopulmonary dysplasia or an obstruction in the airways than with an acute pneumothorax. An acute pneumothorax would not affect the neonate's thermal stability.)

The nurse is assessing a child with herpetic gingivostomatitis. The nurse wears gloves when examining the lesions. This nursing action is

Necessary because virus can easily enter breaks in the skin.

In reviewing information about a school-age child, the nurse notes that the child goes to after school activities each day as the parents do not get home until considerably later in the day. Based on this description, the nurse would document

No Further Action Is Needed! (Many children have working parents and do not exhibit any adverse outcomes if they attend after school activities each day following release from school. There is no need for referral to a social worker. A latchkey child by definition is one that has no parental or supervision contact following the school day and are responsible for their own care until the parent comes home.)

While caring for hospitalized adolescents, the nurse observes that sometimes they are skeptical of their parents' religious beliefs and practices. The nurse should recognize that this is

Normal In Spiritual Development! (The behavior described occurs in stage 4 in spiritual development. Adolescents attempt to determine which of their parents' standards and beliefs to incorporate into their own. The behavior described is not abnormal. The behavior described is not applicable only during times of crisis. The behavior described is not related to the parents' inability to explain their beliefs and practices.)

A 13-year-old boy is concerned about bilateral breast enlargement. The most appropriate explanation by the nurse is based on knowing that this is

Normal Occurrence During Puberty! (Gynecomastia, or enlargement of the breast tissue, is common during midpuberty in about one third of boys. For most boys, the breast enlargement disappears within 2 years. Although overweight boys may have excess body weight in the breast area, in boys of normal body weight, gynecomastia is a normal occurrence during puberty. If gynecomastia persists beyond 2 years, then a hormonal cause may need to be investigated. Precocious puberty is the early onset of puberty, before age 9 years in boys, and is not related to the gynecomastia.)

A 4-year-old child is brought to the emergency department. The child has a "froglike" croaking sound on inspiration, is agitated, and is drooling. The child insists on sitting upright. The priority action by the nurse is to

Notify The Health Care Provider Immediately & Be Prepared To Assist With A Tracheostomy Or Intubation! (Sitting upright, drooling, agitation, and a froglike cough are indicative of epiglottitis. This is a medical emergency, and tracheostomy or intubation may be necessary. Examination of the oropharynx may cause total obstruction and should not be done when a child manifests signs indicating potential epiglottitis. The child assumes a tripod position to facilitate breathing. Forcing the child to lie down will increase the respiratory distress and anxiety. Interventions should be planned once the diagnosis of epiglottitis has been made or ruled out.)

The nurse is caring for a child with probable intussusception. The child had diarrhea before admission, but while waiting for administration of air pressure to reduce the intussusception, the child passed a normal brown stool. What is the most appropriate nursing action?

Notify The Physician! (Passage of a normal stool indicates that the intussusception has resolved. Notification of the physician is essential to determine whether a change in the treatment plan is indicated. Measurement of the abdominal girth may be indicated, but notifying the physician is the priority. Auscultating for bowel sounds may be indicted, but notifying the physician is the priority. Taking the vital signs, including the blood pressure, may be indicated, but notifying the physician is the priority.)

A group of nurses are reviewing potential health environmental for the spread of noscomial infections in the hosptial. Which equipment should the nurse include as having a high risk potential for transmission? (Select all that apply.)

Nurse's Station Desktop! Stethoscope! Computer Keyboard!

Which benchmark serves as the ending period for the middle year period of development?

Onset Of Puberty! (The onset of puberty signals the end of the middle year period. Beginning school and loss of deciduous teeth are associated with the beginning of the middle year period. Appearance of wisdom teeth occurs later on in life.)

Nursing care of the infant and child with congestive heart failure includes

Organize Activities To Allow For Uninterrupted Sleep! (The child needs to be well rested before feeding. The child's needs should be met to minimize crying. The nurse must organize care to decrease energy expenditure. The child in congestive heart failure has an excess of fluid, so forcing fluids is contraindicated. Monitoring of vital signs is appropriate, but minimizing energy expenditure is a priority. The child often cannot tolerate larger feedings; small, frequent feedings should be given to the child in congestive heart failure.)

An infant with neurologic impairment and delay is receiving several medications. A proton pump inhibitor is one of the medications the infant is receiving. Which medication(s) is/are proton pump inhibitor(s)? (Select all that apply.)

Pantoprazole (Protonix), Omeprazole (Prilosec)! (Omeprazole (Prilosec) utilizes a proton pump inhibitor that blocks the action of acid- producing cells. Pantoprazole (Protonix) utilizes a proton pump inhibitor that blocks the action of acid- producing cells. Ranitidine (Zantac) is a histamine-2 (H2) receptor blocker, not a proton pump inhibitor. Ranitidine (Zantac) inhibits the action of histamine at the H2 receptor site in the stomach that results in the inhibition of gastric acid secretion. Glycopyrrolate (Robinul) is an anticholinergic agent that is used to inhibit excessive salivation. Bethanechol (Urecholine) is a prokinetic drug and remains controversial in use.)

The parent of a child with cystic fibrosis calls the clinic nurse to report that the child has developed tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The nurse should tell the parent to bring the child to the clinic because these symptoms are suggestive of

Pneumothorax! (The child is exhibiting signs of increasing respiratory distress suggestive of a pneumothorax. The child needs to be seen as soon as possible. Bronchodilation would not produce the described symptoms. Carbon dioxide retention would not produce the described symptoms. The increased viscosity of sputum is characteristic of cystic fibrosis. The change in respiratory status is potentially due to a pneumothorax.)

An immediate intervention to teach parents for when an infant chokes on a piece of food would be to

Position Infant In A Head-Down, Face-Down Position & Administer Five Quick Back Slaps! (Positioning the infant head and face down while administering five quick blows between the shoulder blades is the correct initial sequence of actions for an infant with an obstructed airway. The infant needs to receive treatment immediately. Emergency help is called after attempting to remove the obstruction. Mouth-to-mouth resuscitation should not be used. This may push the object further into the child's respiratory system. If the child is obstructed, the water will not be able to pass. This will increase the risk of aspiration)

A child is standing playing with toys and suddenly collapses. Attempts to engage the child in conversation are met with no response. Skin color indicates cyanosis. A preliminary assessment of the environment presents no specific issues. Based on this information, you would suspect that the child is?

Potential Aspiration Of Foreign Body! (A child who is in severe respiratory distress as a result of foreign body aspiration will not be able to speak, become cyanotic and collapse. This would be considered a medical emergency. Playing with a toy may potentially lead to aspiration if the toy parts are smaller than the child's airway. Within that age group, it is likely that the child may place items in his/her mouth. There is nothing to suggest seizure activity, allergic reaction or traumatic injury.)

When conducting a class on sex and sexual activities with adolescents, the most appropriate approach by the nurse is to

Present Normal Body Functions In A Straightforward Manner! (The nurse should provide accurate and complete information using correct terminology that is understandable to the adolescent. Dolls are appropriate for teaching a younger age-group of children. Using the correct terminology is more appropriate for a group of adolescents. Parents are important for conveying the morals and values surrounding sexual activities, but nurses may provide adolescents with accurate, complete information. Adolescents should have information before they become sexually active about the potential consequences of sex, including the practice of safe sex to prevent pregnancy and the transmission of sexually transmitted diseases.)

An infant with a congenital heart defect is receiving palivizumab (Synagis). Based on the nurse's knowledge of medication, the purpose of this medication is to

Prevent Respiratory Syncytial Virus (RSV) Infection! (Palivizumab is a monoclonal antibody specifically used in the prevention of RSV. Monthly administration is expected to prevent infection with RSV. The goal of this drug is prevention of RSV. It will not affect the need to isolate the child if RSV develops. Palivizumab is specific to RSV, not bacterial infections. Palivizumab will have no effect on antiviral agents.)

Congenital heart defects have traditionally been divided into acyanotic or cyanotic defects. Based on the nurse's knowledge of congenital heart defects, this system in clinical practice is

Problematic, Because Children With Acyanotic Heart Defects May Develop Cyanosis! (This classification is problematic. Children with traditionally named acyanotic defects may become cyanotic, and children with traditionally classified cyanotic defects may be pink at times. The classification does not reflect the blood flow within the heart. Cardiac defects are best described by using the actual pathophysiologic process and mechanism. Children with cyanosis may be easily identified, but that does not help with the diagnosis. Cyanosis is present when children have defects where there is mixing of oxygenated blood with unoxygenated blood.)

What is described as the time interval between early manifestations of a disease and the overt clinical syndrome?

Prodromal Period! (This period is defined as the symptoms that occur between early manifestations of the disease and overt clinical symptoms. The incubation period is the time from exposure to the appearance of the first symptom. The desquamation period refers to the shedding of skin when applicable for a syndrome or disorder. The period of communicability describes the period when the child is infectious.)

Management of the child with a peptic ulcer often includes

Proton Pump Inhibitors! (Proton pump inhibitors block the production of acid. They are well tolerated and have infrequent side effects. Milk is not beneficial in the management of peptic ulcer disease. Proton pump inhibitors are more effective than antacids. Coping with stress is beneficial, but peptic ulcer disease is treatable.)

A child has sustained an injury and lost a primary tooth. Which priority action should be taken by the nurse at this time?

Provide Comfort Measures & Assess For Bleeding! (Avulsed primary teeth are usually not reimplanted. Therefore the nurse should focus on assessment of the site and comfort measures. All of the other options would be indicated if an avulsed tooth were to be reimplanted.)

When considering Crohn's and Ulcerative Colitis (UC) as disease states, which clinical symptoms may appear to be common presentations in both?

Rashes & Joint Pain! (Rashes and joint pain are common presentations in both Crohn's and UC. Rectal bleeding is more common in UC. Growth restriction, fistulas and strictures are more common in Crohn's.)

Treatment methods used for status asthmaticus focus on

Restoring Hydration! (Treatment methods for status asthmaticus are aimed at improving ventilation, decreasing airway resistance, relieving bronchospasm, correcting dehydration and acidosis, decreasing anxiety and treating any underlying concurrent infection. Oxygen saturation should be maintained at greater than 90%, typical acid-base disturbances result in acidosis, not alkalosis.)

A child is exhibiting signs of clinical dehydration. Which laboratory value would support a diagnosis of hypertonic dehydration?

Serum Sodium Level of 150 mEq/dL! (Hypertonic dehydration would result in an increase in serum sodium levels in proportion to fluid loss. Normal serum sodium level ranges between 135 and 145 mEq/dL. Normal plasma osmolality is within the 275 to 295 mOsm/L. Calculation of loss of body fluid weight in terms of moderate loss would be at 50 mL/kg with 100 mL/kg being severe.)

What is an important consideration related to childhood stress?

Some Children Are More Vulnerable To Stress Than Others! (Children's age, temperament, life situation, and state of health affect their vulnerability, reactions, and ability to handle stress. It is not feasible to protect children from all stress. Children can be taught coping strategies. Supportive interpersonal relationships are essential to the psychological well-being of children. Adults need to recognize signs of stress before they become overwhelming. Providing children with interpersonal security helps them develop coping strategies for dealing with stress.)

A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because it

Soothes Inflamed Mucous Membrane! (Humidified inspired air soothes the membranes inflamed by the infection and dry air. The size of the droplets in humidified air is too large to liquefy secretions. No additional oxygen is provided with humidified air. The humidity has no effect on ventilation.)

Which observation if noted by the school nurse would pose a priority concern?

Student Is Looking At Risque Image Of Another Student On Her Phone While Seated At The Cafeteria Table! (This observation would be an example of sexting which is illegal and associated with risky sexual actions according to recent evidenced based practice. The use of social media within the school setting to post a picture of a student taken in class while not the best practice would not cause a concern unless the image was provocative or offensive. Texting information to advise parents that a student would be late would be considered to be appropriate. Use of mobile phones in the school setting may not pose a problem unless that activity is restricted by school policy.)

The nurse is interviewing the parents of a 4-month-old infant brought to the hospital emergency department. The infant is dead on arrival, and no attempt at resuscitation is made. The parents state that the baby was found in the crib with a blanket over the head, lying face down in bloody fluid from the nose and mouth. The parents indicate no problems when the infant was placed in the crib asleep. Which of the following causes of death does the nurse suspect?

Sudden Infant Death Syndrome (SIDS)! (Death is consistent with the appearance of SIDS. The infant is usually found in a disheveled bed; with blankets over the head; huddled into a corner and clutching the sheets; with frothy, blood-tinged fluid in the mouth and nose; and lying face down. The diaper is also usually full of stool, indicating a cataclysmic type of death. Although the child was found under the blanket, the other findings are consistent with SIDS. The findings as reported are consistent with SIDS, not child abuse. The history and physical findings are consistent with SIDS, not infantile apnea.)

An adolescent teen has confided to the school nurse that he is bisexual and asks the school nurse for advice in "coming out" top his peers. What would be the best response to the student's request?

Suggest That The Individual Have Form A Safety Plan First Before Disclosing Information! (It is important to have a safety plan in place first before "coming out" as individuals may not be able to cope with the information and as such the adolescent teen maybe exposed to potential rejection, violence or misunderstanding. The nurse has no legal authority to violate confidentiality by notifying the teen's parents without his consent. And although it may be best to tell one's parents first, the priority is to have a safety plan in place prior to disclosure of this type of information. Similarly, the teen is the best person to determine when the time is right but safety and support are a priority.)

What is an early sign of congestive heart failure that the nurse should recognize?

Tachypnea! (Tachypnea is one of the early signs of congestive heart failure that should be identified. Tachycardia at rest, dyspnea, retractions, and activity intolerance are other physical signs and symptoms. Tachycardia, not bradycardia, is one of the symptoms suggestive of congestive heart failure. The child may be diaphoretic if experiencing congestive heart failure. There will usually be decreased urinary output in a child experiencing congestive heart failure.)

The nurse is discussing home care with the mother of a 6-year-old child with hepatitis A. Part of the discharge teaching plan should include?

Teach Infection Control Measures To Family Members! (Hepatitis A is a contagious disease, transmitted through the fecal-oral route. The nurse should teach infection control measures to family members. Hepatitis A does not usually have an icteric phase and often is subclinical. The period of communicability for hepatitis A is the latter half of the incubation period to 1 week after the onset of clinical illness; therefore, the child can return to school after that time frame. Hepatitis A is infectious through the fecal-oral route; therefore, family members may be susceptible to acquiring the disease if they fail to institute proper infection control measures.)

Which clinical finding would alert the nurse to the possibility that the pediatric patient has conjunctivitis as a result of a foreign object body?

Tearing of the right eye!

The onset of puberty in boys is characterized by

Testicular Enlargement! (This is the first change that signals puberty in boys during Tanner stage 2 of sexual development. Voice changes occur between Tanner stages 3 and 4 of sexual development. Fine pubic hair may occur at the base of the penis early in puberty, but darker hair occurs during Tanner stage 3 of sexual development. The penis enlarges during Tanner stage 3 of sexual development.)

Which statement best describes Hirschsprung disease?

The Colon Has An Aganglionic Segment! (Hirschsprung disease is a mechanical obstruction caused by a lack of motility of a segment of the intestine as a result of the lack of ganglionic cells; therefore, it is referred to as aganglionic megacolon. Hirschsprung disease is associated with a neonate's inability to pass meconium or an older child's inability to pass feces. There is a lack of peristalsis in the affected segment of the infant or child with Hirschsprung disease. The infant or child with Hirschsprung disease will be seen with constipation or the passage of ribbon-like stools.)

What should nurses stress when counseling parents regarding the home care of the child with a cardiac defect before corrective surgery?

The Desirability Of Promoting Normalcy Within The Limits Of The Child's Condition! (The child needs to have social interactions, discipline, and appropriate limit setting. Parents need to be encouraged to promote as normal a life as possible for their child. The child needs increased caloric intake after cardiac surgery. The child needs discipline and appropriate limit setting, as would be done with any other child his or her age. Because cyanotic spells will occur in children with some defects, the parents need to be taught how to assess for and manage them appropriately, thereby decreasing their anxiety and concern.)

A parent is concerned as her 6-year-old child "cheats" when playing games with other children. The parent is concerned that this behavior will affect future behaviors as the child gets older. The nurse understands the parent's anxiety about the described behavior and provides the following assurance

This Type Of Behavior Occurs Around This Age Period & Is Due To The Child Not Being Able To Understand What It Means To Lose! (Cheating as a behavior occurs primarily between the ages of 5 and 6. It is almost at times displayed as an automatic behavior as the child does not understand about winning and losing. The behavior typically goes away as the child matures. Ignoring the behavior without some direction is not advised as it is best to address the situation and help the child to begin understanding of the concept.)

When evaluating the extent of an infant's dehydration, the nurse should recognize that the symptoms of severe dehydration (15%) are

Trachycardia, Parched Mucous Membranes, Sunken Eyes & Fontanels! (Symptoms of severe dehydration include tachycardia, parched mucous membranes, and sunken eyes and fontanels. In severe dehydration, there is a 15% weight loss in infants, not 5%, although the infant will exhibit tachycardia and decreased tears. Tachycardia, orthostatic hypotension and shock, and intense thirst would be expected in an infant with severe dehydration. The infant would be extremely irritable, with sunken eyes and fontanels, if severely dehydrated.)

What is considered a mixed cardiac defect?

Transposition Of The Great Arteries! (Transposition of the great arteries allows the mixing of both oxygenated and unoxygenated blood in the heart. Pulmonic stenosis is classified as an obstructive defect. Atrial septal defect and patent ductus arteriosus are classified as defects with increased pulmonary blood flow.)

The primary therapy for secondary hypertension in children is

Treatment Of Underlying Cause! (Secondary hypertension is a result of an underlying disease process or structural abnormality. It is usually necessary to treat the problem before the hypertension will be resolved. Weight reduction and a low-salt diet are usually effective in managing essential hypertension. Increased exercise and fitness are usually effective in managing essential hypertension.)

The mother of a 20-month-old tells the nurse that the child has a barking cough at night. The child's temperature is 37° C (98.6° F). The mother states the child is not having difficulty breathing. The nurse suspects croup and should recommend

Trying A Cool-Mist Vaporizer At Night & Watching For Signs Of Difficulty Breathing! (Because the child is not having difficulty breathing, the nurse should teach the parents the signs of respiratory distress and tell them to come to the emergency department if they develop. Cool mist is recommended to provide relief because this therapy will assist in opening up the child's airways. The child does not have a temperature and, therefore, does not need management with acetaminophen. Cough suppressants are not indicated by symptom, and the American Pediatrics Association no longer recommends over-the-counter cough medicines for children under the age of 2 years. A barking cough is characteristic of laryngotracheobronchitis, not epiglottitis.)

An example of indirect bullying would be if

Using Social Media To Make Offensive Comments About An Individual! (Indirect bullying are actions that are taken that are meant to cause harm to an individual or group. The use of social media to make offensive comments about an individual is not the place for professing feelings. One must take into account that offensive comments by definition are offensive. Telling an individual that you don't like them as a result of their exhibited behavior is an example of direct communication. Taking a toy away from someone because you want to see it may not be the best approach but it does involve direct action.)

Which method should the student nurse use to apply the principles of cough etiquette in the clinical setting to prevent the potential spread of infection?

Using Tissues When Coughing To Catch Secretions! (Using a tissue when coughing to catch secretions is recommended. One does not have to wear a surgical mask if they do not have any cold type symptoms in the clinical environment unless the patient is neutropenic. Maintaining a space of 3 feet or more is recommended whereas 10 feet would be excessive. Covering one's mouth is recommended when coughing whereas the nose should be covered during sneezing.)

A finding that is consistent with prepubescence is

Variation In Physical Appearance Between Boys & Girls! (During the period of prepubescence there is a variation in physical appearance between boys and girls. The age of onset of these appearances also varies with girls exhibiting changes earlier than their male counterparts. The changes occur during the preadolescence period. Secondary sex characteristics also present at different times for boys and girls.)

The school nurse is concerned about an outbreak of chickenpox because two children at the school have cancer and are immunodeficient from chemotherapy. The most appropriate recommendation by the school nurse is that

Varicella-zoster immune globulin (VZIG) to prevent chickenpox.

Dietary management of a child with inflammatory bowel disease (IBD) should include

Vitamin Supplements! (Multivitamins, iron, and folic acid supplementation are recommended for the child with IBD. A high-protein, high-calorie diet is needed to help correct nutritional deficits. A high-fiber diet is not recommended for IBD. Even small amounts of bran have been associated with a worsening of the child's condition.)

The most appropriate nursing intervention for a child following a tonsillectomy is to

Watch For Continuous Swallowing! (Frequent swallowing is the most obvious early sign of bleeding from the operative site in a child who has had a tonsillectomy. Gargling should be avoided after a tonsillectomy because of potential trauma to the suture line. The child should be positioned on the side or abdomen to facilitate drainage after a tonsillectomy. Ice collars and cold liquids are encouraged for the child who has had a tonsillectomy. Cold therapy soothes and anesthetizes the area, decreasing the pain. Heat or warmth would increase the risk of bleeding.)