Peds final exam

The nurse is caring for a 6-month-old boy with Wiskott-Aldrich syndrome. The nurse teaches the parents which of the following: a) "Don't encourage a pacifier due to possible oral malformation" b) "Do not use a sponge bath for light cleaning" c) "Don't use a tub bath for daily cleansing" d) "Do not insert anything in the rectum"

"Do not insert anything in the rectum" Explanation: Children with Wiskott-Aldrich syndrome should not be given rectal suppositories or temperatures since these children are at a high risk for bleeding. Tub baths are not contraindicated. Pacifi ers are not contraindicated in Wiskott-Aldrich but should be kept as sanitary as possible to avoid oral infections.

A nurse is caring for an 11-year-old with an Ilizarov fixator and is providing teaching regarding pin care. The nurse should provide which instruction?

"Cleansing by showering should be sufficient." Explanation: The Ilizarov fixator uses wires that are thinner than ordinary pins, so simply cleansing by showering is usually sufficient to keep the pin site clean.

A 15-year-old adolescent is scheduled for a pelvic ultrasound to evaluate for a possible ovarian cyst. Which instruction by the nurse would be most appropriate?

"Drink plenty of fluids because you need to have a full bladder." Explanation: A full bladder is needed for an ultrasound of the pelvic region. The client needs to remain still for a computed tomography or magnetic resonance imaging scan, not an ultrasound. Water is withheld during a water deprivation test used to detect diabetes insipidus. Limiting stress and physical activity for 30 minutes before the test is required for the growth hormone stimulation test.

When evaluating parents' understanding of atopic dermatitis, which of the following statements would you want to hear them voice? a) "Flare-ups of lesions are not uncommon following therapy." b) "Hydrocortisone cream may lead to kidney disease." c) "Atopic dermatitis follows a streptococcal infection." d) "Atopic dermatitis turns to asthma later in life."

"Flare-ups of lesions are not uncommon following therapy." Explanation: Atopic dermatitis may recur when the child is re-exposed to the substance to which he or she is allergic.

A nurse is providing dietary interventions for a 12-year-old with a shellfish allergy. Which of the following responses indicates a need for further teaching? a) "Wheezing is a sign of a severe reaction" b) "We must order carefully when dining out" c) "He will likely outgrow this" d) "He must avoid lobster and shrimp"

"He will likely outgrow this" Correct Explanation: Older children and adolescents with allergic reactions to fish, shellfish, and nuts usually continue to have that concern as a life-long problem. The other statements are correct

The nursing is caring for a child recently admitted with an endocrine disorder. The child's mother asks the nurse what the term metabolism means. Which is the best response by the nurse?

"Metabolism refers to all physical and chemical reactions occurring in the body's cells that are necessary to sustain life."

The nurse is providing instructions to the parents of a child with a severe peanut allergy. Which of the following statements by the parents indicates a need for further teaching about the use of the EpiPen Jr.?

"The EpiPen Jr. should be jabbed into the upper arm" Correct Explanation: The EpiPen Jr. should be jabbed into the outer thigh, as this is a larger muscle, at a 90 degree angle, not into the upper arm. The other statements are correct.

The mother of a child with a possible food allergy asks the nurse for information about how to test for it. Which response by the nurse would be most appropriate? a) "We can inject an extract of the food under the skin and see if there is a reaction." b) "Skin testing using a patch is probably the easiest method." c) "The best way is to eliminate the food from the diet and then look for improvement." d) "We can check the level of antibodies in the blood to confirm the allergy.

"The best way is to eliminate the food from the diet and then look for improvement." Explanation: Food allergies are best identified by eliminating a suspected food from the diet and observing whether symptoms improve. After a time of improvement, the food is reintroduced and if the child is allergic to the food, the symptoms will return. Skin testing with either a patch or intracutaneous injection is ineffective for determining food allergies. Serum antibody levels can be measured but are not specific in helping to determine food allergies

The nurse is speaking with the parents of a child recently diagnosed with hypothyroidism. Which statement by a parent indicates an understanding of symptoms of this disorder?

"When they get my son's thyroid levels normal, he won't be so tired." Tiredness, fatigue, constipation, cold intolerance and weight gain are all symptoms of hypothyroidism. Nervousness, anxiety, heat intolerance, weight loss and smooth velvety skin are all symptoms of hyperthyroidism.

The nurse is caring for a 10-year-old boy who plays on two soccer teams. He practices four days a week and his team travels to tournaments once a month. He has been diagnosed with a stress fracture in one of his vertebrae. Which instruction is most important to emphasize to the boy and his parents?

"You and your coaches need to understand that you cannot play soccer for at least six weeks." Explanation: A child with an overuse injury needs to avoid the causative activity for six to eight weeks. The other suggestions are also important, but the nurse must emphasize to the boy and his parents that they must tell the coaches "no soccer for six weeks." In some situations, it is helpful to supply a written directive from the nurse or physician to help the parent avoid undue pressure from coaches.

The young girl has been diagnosed with JIA and has been prescribed methotrexate. Which of the following statements by the child's parent indicates that adequate learning has occurred? a) "She may start feeling better by next week." b) "She can take methotrexate with yogurt or chocolate milk." c) "Swimming sounds like a good exercise for her." d) "We'll need to bring her back in for some lab tests after she starts methotrexate." e) "A warm bath before bed might help her sleep better."

- "We'll need to bring her back in for some lab tests after she starts methotrexate." • "She may start feeling better by next week." Explanation: The child diagnosed with juvenile idiopathic arthritis should not take the oral form of methotrexate with dairy products. The approximate time to benefit from methotrexate is typically 3 to 6 weeks. The child will need blood tests to determine renal and liver function during treatment. Children with juvenile idiopathic arthritis usually find swimming to be auseful exercise for them because it helps maintain joint mobility without placing pressure on the joints. Sleep may be promoted by a warm bath at bedtime.

A child is undergoing skin testing for allergies. About 10 minutes after a scratch test with an allergen, the child develops signs and symptoms of anaphylaxis. The nurse prepares to administer epinephrine subcutaneously. The child weighs 88 pounds. The nurse would administer which dosage of epinephrine? a) 0.2 mg b) 0.4 mg c) 0.8 mg d) 1 mg

0.4 mg Explanation: The child weighs 88 pounds or 40 kg. The dose of epinephrine is 0.01 mg/kg. So for a child weighing 40 kg, the nurse would give 0.4 mg.

A nurse is providing care to a child diagnosed with cerebral palsy who is experiencing painful muscle spasms. The health care provider has prescribed baclofen 40 mg/day PO in three divided doses. How many milligrams should the nurse administer in each dose? Record your answer using one decimal place.

13.3 Explanation: The nurse will divide the number of doses per day into the total amount prescribed for each day. 40 mg ÷ 3 doses = 13.3 mg/dose

A child with HIV, weighing 25 kg, is about to receive an infusion of IVIG. The recommended dose is 400 mg/kg/dose. The medication is available in a concentration of 50 mg/mL. What is the proper amount of infusion that the child will receive?

200 mL Explanation: The dose is calculated as 25 x 400 = 10,000 mg. Because the concentration is 50 mg/mL, calculate the volume as 10,000/50 = 200 mL.

The nurse is caring for an infant exposed to HIV. The polymerase chain reaction (PCR) test was negative at birth. The nurse tells the mother that the child will most likely be tested again at what age? a) 8 to 10 weeks b) 2 to 3 months c) 12 months d) 4 to 7 weeks

4 to 7 weeks Explanation: Virologic testing for HIV-exposed infants should be done with the polymerase chain reaction test at birth, at 4 to 7 weeks, and again at 8 to 16 weeks. Serologic testing is done at approximately 12 months of age to document disappearance of the HIV-1 antibody

The nurse is caring for a group of children on the pediatric unit. The nurse should collect further data and explore the possibility of child abuse in which situation?

A 7-year-old with a spiral fracture of the humerus, which the caregiver reports as having been caused when the child was hit by a bat swung by a Little League teammate. Spiral fractures, which twist around the bone, are frequently associated with child abuse and are caused by a wrenching force. When a broken bone penetrates the skin, the fracture is called compound, or open. A simple, or closed, fracture is a single break in the bone without penetration of the skin. In a greenstick fracture, the bone bends and often just partially breaks.

The nurse is caring for a 4-year-old girl with HIV. The girl is taking nucleoside analogue reverse transcriptase inhibitors (NRTI) as part of a three-drug regimen. The nurse knows to monitor for signs of a fatal hypersensitivity reaction that can occur with which of the following medications? a) Abacavir b) Ritonavir c) Lamivudine d) Zidovudine

Abacavir Explanation: A fatal hypersensitivity reaction may occur with abacavir. Ritonavir is a protease inhibitor, not a nucleoside analogue reverse transcriptase inhibitor. This drug is not associated with a fatal hypersensitivity reaction. This drug is not associated with a fatal hypersensitivity reaction.

A school-aged child has a bee-sting allergy. When the child is stung by a bee during a school recess, assuming that all of the following interventions are covered by school protocol, which initial intervention by the school nurse would be most appropriate? a) Immediately transport the child to the local hospital. b) Administer epinephrine immediately. c) Apply a warm compress to the site of the bee sting. d) Notify the child's mother.

Administer epinephrine immediately. Explanation: Epinephrine counteracts histamine release to decrease bronchospasm and difficulty breathing.

Prior to discharging an infant with congenital hypothyroidism to home with the parents, what should the nurse emphasize regarding the care that this child will need going forward?

Administration of levothyroxine indefinitely

The nurse assists with the application of a full-body plaster cast to a child. The child immediately becomes diaphoretic and reports feeling hot. Which nursing intervention would be indicated?

Advise the child that this is to be expected. Explanation: Plaster becomes hot as it sets. Even with fiberglass casts, there will be a warm feeling inside the cast when it is drying. This is a normal expectation about which to educate the child before the application of the cast. If discomfort continues, the nurse should notify the health care provider. Infection would not present in this way with a cast application. A cast should not be moistened. If it does become wet, the cast should be dried with a hair dryer. There are some newer types of casts which can get wet but the nurse should know this before applying any moisture.

Susie is a 3-year-old with a history of neonatal transmission of HIV and recent diagnosis of AIDS, as manifested by M. tuberculosis infection. To date, Susie has been relatively healthy with few illnesses associated with high fever; she has been developing appropriately and is at the 5th percentile for height and weight. Susie is at risk for all of the following diagnoses. Prioritize the order of urgency of these diagnoses based on the scenario provided.

Altered family coping related to new presentation of significant illness Altered comfort related to severity of new illness Inadequate adherence to medication regimen related to side effects Inadequate nutrition related to side effects of medication Delayed growth and development related to frequent infections Explanation: Because Susie has been relatively healthy since she was diagnosed with HIV, the change in her status is likely to cause changes in family coping mechanisms and dynamics that will have implications for the entire family. Next, the nurse needs to address the specific symptoms of the child. With the increased degree of illness and altered coping strategies, the child may have more difficulty with medication adherence, as well as other complications of AIDS-related illness and treatment, such as poor nutritional intake and delayed growth and development

22. The nurse is providing care to a child experiencing shock. Which intravenous solution would the nurse expect to administer? A) Ringer lactate B) Dextrose 5% and water C) Dextrose 5% and normal saline D) Dextrose 10% and water

Ans: A Feedback: Isotonic fluids, such as Ringer lactate or normal saline, are the fluids of choice given rapidly to children experiencing shock. Dextrose solutions are contraindicated in shock because of the risk of complications such as osmotic diuresis, hypokalemia, hyperglycemia, and worsening of ischemic brain injury

11. A child weighing 51 lb (23.1 kg) requires defibrillation. How many joules would the nurse expect to give initially? A) 46 B) 92 C) 102 D) 204

Ans: A Feedback: The initial amount of energy or joules for defibrillation is 2 joules/kg. The child weighs 51 lb, which is 23 kg, so 46 joules would be used.

When treating allergies in a child, the nurse is aware that the classification for the drug of choice to control itching, sneezing, and rhinorrhea is which of the following? a) Antihistamines b) Decongestants c) Antibiotics d) Corticosteroids

Antihistamines Explanation: Antihistamines block histamine release and as a result control itching, sneezing, and rhinorrhea.

The parents of a child with juvenile idiopathic arthritis bring the child to the emergency department because the child is very drowsy and breathing heavily. The child also has been vomiting and complaining of ringing in her ears. The nurse suspects that the child is experiencing a toxic reaction to one of her medications. Which medication would the nurse suspect? a) Etanercept b) Aspirin c) Corticosteroid d) Methotrexate

Aspirin Explanation: The child is exhibiting signs and symptoms of aspirin toxicity. Corticosteroids would lead to signs and symptoms of Cushing syndrome as well as masking the signs of infection. Methotrexate would lead to changes in the white blood cell count, placing the child at risk for infection. Etanercept, like methotrexate, places the child at risk for infection. (less)

The nurse is providing teaching for the parents of a child with a latex allergy. The nurse tells the client to avoid which of the following foods? a) Blueberries b) Pomegranate c) Banana d) Pumpkin

Banana Explanation: The nurse should instruct children and their families to avoid foods with a known cross-reactivity to latex, such as bananas.

type 1 diabetes mellitus

Body does not have any insulin. Type 1 diabetes mellitus (DM) is a disorder in which the child's body has a deficiency of insulin; children with type 1 DM cannot produce insulin. Type 2 DM is controlled through diet, medicine, and exercise. Type 2 DM can be prevented through diet and exercise, but type 1 DM cannot. Resistance to insulin is not the primary factor in type 1 DM.

In understanding the development of the musculoskeletal system, the nurse recognizes that what is implanted in a gel-like substance during fetal life?

Cartilage Explanation: During fetal life, tissue called cartilage, which is a type of connective tissue consisting of cells implanted in a gel-like substance, gradually calcifies and becomes bone.

The nurse is caring for a 14-year-old boy in Buck traction for a slipped capital femoral epiphysis (SCFE). What information would the nurse include when completing a neurovascular assessment of the affected leg? Select all that apply.

Color Sensation Pulse Capillary refill Explanation: Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Assisting With Cast Application, p. 755.

The nurse caring for an infant with myelomeningocele before surgical intervention will prioritize care in what way?

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

A child with primary immune deficiency is about to receive an infusion of IVIG. Which of the following is the most appropriate premedication to minimize the reaction? a) Ibuprofen b) Solu-Medrol c) Ketorolac d) Diphenhydramine

Diphenhydramine Explanation: Diphenhydramine and acetaminophen are the most commonly used medications for this purpose. Nonsteroidals and steroids typically are not used for this indication.

A child with primary immune deficiency is about to receive an infusion of IVIG. Which of the following is the most appropriate premedication to minimize the reaction? a) Solu-Medrol b) Diphenhydramine c) Ketorolac d) Ibuprofen

Diphenhydramine Explanation: Diphenhydramine and acetaminophen are the most commonly used medications for this purpose. Nonsteroidals and steroids typically are not used for this indication.

The nurse is observing a 3-year-old boy who is sitting and playing in the waiting area of his pediatrician's office. The nurse calls the boy and his mother back for the boy's appointment. The boy rolls onto his stomach and pushes himself to his knees. Then he presses his hands against his ankles, knees, and thighs, walking up the front of his body, to stand. Which condition should the nurse suspect in this client?

Duchenne muscular dystrophy By age 3, children with: Duchenne muscular dystrophy = can rise from the floor only by rolling onto their stomachs and then pushing themselves to their knees. To stand, they press their hands against their ankles, knees, and thighs (they "walk up their front"); this is a Gower sign. Symptoms of facioscapulohumeral muscular dystrophy begin after the child is 10 years old, and the primary symptom is facial weakness. The child becomes unable to wrinkle the forehead and cannot whistle. Congenital myotonic dystrophy begins in utero and typically leads to death before age 1 year because of inability to sustain respiratory function. The symptoms of juvenile arthritis are primarily stiff and painful joints

Which of the following would best identify foods to which a child is allergic? a) Hyposensitivity testing b) Elimination diet c) Corticosteroid challenge testing d) Complete dietary protein restriction

Elimination diet Explanation: Elimination diets involve adding foods slowly to a child's diet so foods to which the child is allergic can be identified.

The nurse is assessing a 1-month-old girl who, according to the mother, doesn't eat well. Which assessment suggests the child has congenital hypothyroidism?

Enlarged tongue

Which of the following drugs should be available for emergency treatment of a child who goes into anaphylactic shock? a) Vistaril b) Morphine sulfate c) Meperidine d) Epinephrine

Epinephrine Explanation: Epinephrine (adrenaline) reverses the effects of histamine (severe bronchospasm and edema).

A 9-year-old girl has just been diagnosed with Graves disease. Which symptom should the nurse expect in this child? Select all that apply.

Exophthalmos (protruding eyes) Moist skin Nervousness Increased basal metabolic rate

Question: Place in correct order the steps in the anaphylactic response.

Exposure to allergen Rapid immune response Vasodilation Bronchoconstriction Circulatory collapse Explanation: Anaphylaxis typically is a very rapid response to exposure to an allergen. Vasodilation leads to potential circulatory collapse. Bronchospasm occurs simultaneously with other system reactions, also contributing to the life-threatening possibility.

The first time a child with hypersensitivity to stinging insects is stung, the reaction is usually anaphylactic shock and, if not immediately treated, death. a) True b) False

False Explanation: The first time a child is stung, the total reaction is probably only local edema at the site. The second time, generalized urticaria, pruritus, and edema may develop. The third time, symptoms may progress to wheezing and dyspnea. The next time, the reaction could be so severe that shock and death result. The progression of symptoms may be slower than this (involving 10 to 12 stings) if the stings occur far apart; if the stings are received close together (1 or 2 days apart, or even 3 weeks apart), the progression to fatal symptoms may occur as early as the second or third exposure

Question: The nurse instructs a school-aged child who has a bee-sting allergy and his parents on proper use of the EpiPen. What is the order of steps that should be taken if the child is bit by a bee?

Grasp the EpiPen with your fist, with black tip pointing down. Remove gray safety cap. Place EpiPen against child's thigh, injecting solution. Hold syringe in place for 10 seconds. Explanation: These are the necessary steps for injecting the EpiPen. First, make sure to hold the device correctly. Then remove the cap. Next, place the injection tip against the thigh, either directly on the skin or on the clothing. Finally, hold the syringe in place for 10 seconds to make sure the content is injected properly.

Question: The nurse is observing a child demonstrate the use of an Epipen. The nurse determines that the child has performed the procedure correctly. Place the steps below in the proper sequence that was demonstrated by the child.

Grasps Epipen with black tip pointing downward Forms a fist around the Epipen Pulls off the gray safety release Jabs the Epipen firmly into the outer thigh at a 90-degree angle Holds Epipen in place for 10 seconds Massages site for 10 seconds after removing Epipen Explanation: The steps to using an Epipen are as follows: Grasp the Epipen or Epipen Jr. with the black tip pointing downward, forming a fist; with the other hand, pull off the gray safety release; swing and jab the Epipen firmly into the outer thigh at a 90-degree angle and hold firmly there for 10 seconds; remove the Epipen and massage the thigh for 10 seconds

The nurse is administering the prescribed intravenous immunoglobulin to a 10-year-old boy. Which of the following would be most important for the nurse to do? a) Administer with food. b) Have epinephrine available. c) Monitor urine for glucose. d) Monitor for signs of Cushing syndrome.

Have epinephrine available. Explanation: The nurse should have epinephrine available during the infusion in case of an adverse reaction. Monitoring urine for glucose would be appropriate when corticosteroids are being given. Intravenous immunoglobulin does not need to be administered with food because it is being given as an intravenous infusion. Monitoring for signs of Cushing syndrome would be appropriate when corticosteroids are given

Through which mechanism is Duchenne muscular dystrophy acquired?

Heredity Explanation: Muscular dystrophy is hereditary and acquired through a recessive sex-linked trait. Therefore, it isn't caused by viral, autoimmune, or environmental factors.

The nurse is assessing a 16-year-old boy who has had long-term corticosteroid therapy. Which finding, along with the use of the corticosteroids, indicates Cushing disease?

History of rapid weight gain Explanation: Cushing disease= Rapid weight gain + long term corticosteroid therapy. -Confirm with adrenal suppresion test Cushings --OR-- Growth hormone deficiency= A round child-like face Growth hormone deficiency= A high weight-to-height ratio and delayed dentition

When describing anaphylaxis to a group of parents whose children have experienced anaphylaxis from insect stings, the nurse integrates knowledge that this response is related to which immunoglobulin? a) IgM b) IgE c) IgG d) IgA

IgE Explanation: Anaphylaxis is an acute IgE-mediated response to an allergen that involves many organ systems and may be life-threatening.

The nurse is caring for a 10-year-old child with growth hormone (GH) deficiency. Which therapy would you anticipate will be prescribed for the child?

Injections of GH

Which characteristic is true of cerebral palsy?

It appears at birth or during the first 2 years of life.

The nurse will teach parents of children with myelomeningocele to maintain an environment free of what element?

Latex Explanation: A latex-free environment is important because research shows that up to 73% of children with repeated surgeries for spina bifida are sensitive to latex. Those with known sensitivity must be managed in a latex-free environment in the health care setting and in the home, in the school, and beyond. Children at risk for latex sensitivity should wear medical alert identification. The other options may present risks to individual children but are not a threat to those with spina bifida as a group.

Question: The nursing instructor is describing the events of anaphylaxis. Place the assessment findings in the order that they would occur from first to last.

Nausea, vomiting, diarrhea Urticaria, angioedema Bronchospasm Hypoxia Seizures Explanation: Initially, a child may be nauseous, with vomiting and diarrhea, because of the sudden increase in gastrointestinal secretions produced by the stimulation of histamine. This is followed by urticaria and angioedema. Bronchospasm can become so severe the child becomes dyspneic and hypoxemic. Continued bronchospasm leads to hypoxia. As blood vessels dilate, the blood pressure and pulse rate fall. Seizures and death may follow as soon as 10 minutes after the allergen is introduced into the child's body.

An infant born to a mother who was HIV positive was tested at birth and found to be negative. The infant is scheduled for follow up testing. Which test would the nurse expect to be performed? a) Polymerase chain reaction (PCR) test b) CD4 counts c) Enzyme-linked immunosorbent assay (ELISA) d) Platelet count

Polymerase chain reaction (PCR) test Explanation: The PCR is the preferred test to determine HIV infection in infants over 1 month of age. The ELISA is positive in infants of HIV-infected mothers because of transplacentally received antibodies. These antibodies may persist and remain detectable up to 24 months of age, making the ELISA test less accurate at detecting HIV infection in infants and toddlers than the PCR. The platelet count would provide no information about the infant's HIV status. CD4 counts would be used to monitor HIV infection but not to confirm whether the infant is positive or negative for the virus

What will be the nurse's next action after noting dimpling and a tuft of hair located in the lumbosacral area of the preschool child during examination?

Record and refer the finding for follow-up to the pediatrician Dimpling and hair growth may signal spina bifida occulta, which usually is benign. However, some complications can be associated, and further investigation is warranted to prevent possible damage to the spinal cord. Magnetic resonance imaging (MRI) is often the diagnostic tool used. No hygienic concerns need prevail. These findings do not suggest development of precocious puberty or any other hormonal problem. The dimpling and hair tuft must be clearly explained to the parents.

A child who has type 1 diabetes mellitus is brought to the emergency department and diagnosed with diabetic ketoacidosis. What treatment would the nurse expect to administer?

Regular insulin Explanation: Insulin for diabetic ketoacidosis is given intravenously. Only regular insulin can be administered by this route.

The nurse is planning care for a school-age child diagnosed with growth hormone deficiency. Which diagnosis should the nurse select to help the child with this health problem?

Risk for situational low self-esteem related to short stature

The nurse is instructing a group of women of childbearing age about HIV during pregnancy. Which of the following should be a priority recommendation in this setting? a) Proper nutrition b) Screening for HIV c) Prophylactic treatment for HIV d) Screening for STIs

Screening for HIV Explanation: No screening mandate has been put forth for HIV, but all pregnant women should be encouraged to undergo this test. Prophylactic treatment would be initiated only once the woman has been screened. Screening for STIs and ensuring proper nutrition are also part of health promotion for women in this age group, but they are of lower priority than identifying HIV-positive individuals

A newborn is found to have Di George syndrome and has misshaped ears, a small mandible, and an absent thymus. The nurse recognizes that this condition is associated with which of the following types of immunodeficiency disorders? a) B-lymphocyte deficiency b) Combined T- and B-lymphocyte deficiency c) T-lymphocyte deficiency d) Secondary immunodeficiency

T-lymphocyte deficiency Explanation: T-lymphocyte immunodeficiencies involve inadequate numbers or inadequate functioning of one or more types of T lymphocytes; this affects cell-mediated immunity and also, because of helper T-lymphocyte function, possibly humoral immunity as well. Di George syndrome is a chromosomal disorder in which there is deletion of a small piece of chromosome 22. This leads to not only a T cell defect but misshaped or low-set ears, smaller than usual mandible, absent thymus, neonatal tetany, and congenital heart disease

The nurse is caring for a child with juvenile idiopathic arthritis (JIA). There is involvement of five or more small joints and it is affecting the body symmetrically. This tells the nurse which of the following? a) The child has polyarticular JIA b) The child has pauciarticular JIA c) The child is at risk for anaphylaxis d) The child has systemic JIA

The child has polyarticular JIA Explanation: Polyarticular JIA is defined by the involvement of five or more joints, frequently the small joints, and affects the body symmetrically. Pauciarticular JIAs is defined by the involvement of four or fewer joints. Systemic JIA presents with fever and rash in addition to join involvement at the time of diagnosis. The child with JIA is not at greater risk for anaphylaxis.

The nurse is caring for a child diagnosed with Legg-Calvé-Perthes disease (LCPD). What is the most important nursing intervention for the nurse to include in working with this child and his caregivers?

The nurse should help the caregivers to understand and help the child to effectively use the corrective devices. Explanation: Nursing care focuses on helping the child and caregivers to manage the corrective device and on the importance of compliance to promote healing and to avoid long-term disability.

In caring for a child in traction, which intervention is the highest priority for the nurse?

The nurse should monitor for decreased circulation every 4 hours. Explanation: Any child in traction must be carefully monitored to detect any signs of decreased circulation or neurovascular complications. Cleaning pin sites is appropriate for a child in skeletal traction to reduce the risk of infection. Providing age-appropriate activities and monitoring intake and output are important interventions for any ill child but would not be the highest priority interventions for the child in traction.

The young boy has fractured his left leg and has had a cast applied. The nurse educates the boy and his parents prior to discharge from the hospital. The parents should call the physician when which incidents occur? Select all that apply.

The parents should call the physician when the following things occur: The child has a temperature greater than 101.5F° (38.7° C) for more than 24 hours, there is drainage from the casted site, the site distal to the casted extremity is cyanotic, or severe edema is present.

A school-age child is diagnosed as having Cushing syndrome from long-term therapy with oral prednisone. What assessment finding is consistent with this child's diagnosis and treatment?

There are purple striae on the abdomen. Explanation: Cushing syndrome is caused by overproduction of the adrenal hormone cortisol. The overproduction of cortisol results in hyperpigmentation, which occurs from the melanin-stimulating properties of ACTH. Purple striae resulting from collagen deficit appear on the child's abdomen. The child will not be pale or fatigued. The child will not be excessively tall. The child will not be demonstrating signs of hypoglycemia.

To establish whether the problem is truly a milk allergy in a child who is suspected of having this condition, milk should be reintroduced every 6 to 12 months. a) True b) False

True Explanation: To establish whether the problem is truly a milk allergy, milk should be reintroduced every 6 to 12 months. If the problem is a true milk allergy, signs will recur

A 6-year-old boy has a moon-faced, stocky appearance but with thin arms and legs. His cheeks are unusually ruddy. He is diagnosed with Cushing syndrome. What is the most likely cause of this condition in this child?

Tumor of the adrenal cortex Explanation: Cushing syndrome is caused by overproduction of the adrenal hormone cortisol; this usually results from increased ACTH production due to either a pituitary or adrenal cortex tumor. The peak age of occurrence is 6 or 7 years. The overproduction of cortisol results in increased glucose production; this causes fat to accumulate on the cheeks, chin, and trunk, causing a moon-faced, stocky appearance. Cortisol is catabolic, so protein wasting also occurs. This leads to muscle wasting, making the extremities appear thin in contrast to the trunk, and loss of calcium in bones (osteoporosis). Other effects include hyperpigmentation (the child's face is unusually red, especially the cheeks).

A child presents to the primary care setting with enuresis, nocturia, increased hunger, weight loss, and increased thirst. What does the nurse suspect?

Type 1 diabetes mellitus

An elementary school child takes metformin three times each day. Which disorder would the school nurse expect the child to have?

Type 2 diabetes mellitus Explanation: Metformin is the common treatment to manage type 2 DM. Insulin, not oral medication, is the treatment of choice for type 1 DM. Metoclopramide is the treatment for GI reflux. Methylprednisolone is used to treat inflammatory bowel disease.

An infant on the pediatric floor has diabetes insipidus. Which assessment data are important for the nurse to monitor while the infant is on strict fluid precautions?

Urine output

A 13-year-old adolescent is being treated for scoliosis with a brace. During the first follow-up appointment after the brace was initiated, which statement by the adolescent indicates the need for further instruction?

When I get home from school, I look forward to taking off my brace for a few hours before I go to bed." Scoliosis refers to the lateral curvature of the spine. There are differing types of the condition. Mild-to-moderate curvatures can be managed by a brace. The brace is worn daily for all activities other than bathing. Clients should remove the brace for only 1 hour each day. Exceeding this time with the brace off will impair the therapeutic effects of the bracing treatment. During the time the brace is off, hygiene activities such as bathing should be done. It is important to check the brace for any damage daily to prevent injury. For comfort, a lightweight t-shirt may be worn under the brace.

A nurse is providing care to a child with HIV who is prescribed therapy with a nucleoside reverse transcriptase inhibitor. Which of the following would the nurse expect to administer? a) Nevirapine b) Ritonavir c) Efavirenz d) Zidovudine

Zidovudine Explanation: Zidovudine is a nucleoside reverse transcriptase inhibitor. Nevirapine and efavirenz are classified as nonnucleoside reverse transcriptase inhibitors. Ritonavir is a protease inhibitor.

A nurse should recognize that which laboratory result would be most consistent with a diagnosis of diabetes mellitus?

a fasting blood glucose greater than 126 mg/dl

A group of students are reviewing information about the skeletal development in children. The students demonstrate understanding of the information when they identify that ossification is complete by what age?

adolescence

A 5 year old is hospitalized after an asthma attack at school. The child tells the nurse that the janitor had been cleaning in the classroom prior to the attack and that a lot of dust was in the air. The dust that likely caused the attack is known as what? a) allergen b) macrophage c) immunogen d) antigen

allergen Explanation: Mediating substances that are released and cause tissue injury and allergic symptoms are called allergens. An antigen is any foreign substance capable of stimulating an immune response. An antigen that can be readily destroyed by an immune response is called an immunogen. Macrophages are mature white blood cells.

A nursing student correctly identifies the inability to distinguish self from nonself, causing the immune system to carry out immune responses against normal cells, as which of the following? a) autoimmunity b) allergen c) delayed hypersensitivity d) immunity

autoimmunity Explanation: Autoimmunity results from an inability to distinguish self from nonself, causing the immune system to carry out immune responses against normal cells and tissue. Delayed hypersensitivity is when T-lymphocyte activity occurs without an accompanying humoral response. Immunity is the ability to destroy like antigens. An allergen is any mediating substance that when released causes tissue injury and allergic symptoms.

An infant is placed in Bryant traction. For Bryant traction to be effective, the infant must be positioned on the:

back with hips up off the bed.

The nurse is caring for an 11-year-old presenting with tenderness in the shoulder. He is the pitcher for his baseball team and reports shoulder pain with active internal rotation but is able to continue past the pain with full range of motion. Based on these reported symptoms, the nurse is aware that the disorder is most likely to be:

epiphysiolysis of the proximal humerus.

When caring for a child experiencing anaphylactic shock, the most important nursing action would be to a) counteract hypertension. b) enhance the action of histamine. c) facilitate breathing. d) reverse sympathetic nervous system responses.

facilitate breathing. Explanation: The sudden release of histamine with an allergic reaction can cause severe bronchospasm, closing the airway.

A pediatric client has just been diagnosed with diabetes insipidus. What is the primary consideration for this client?

fluid replacement

The nurse is explaining to a parent some of the basic aspects of the immune system and its functions. She informs them that B cells, also known as _________ cells, will attack __________ antigens. a) humoral; viral b) humoral; bacterial c) killer; bacterial d) killer; viral

humoral; bacterial Explanation: B cells are also called humoral cells and typically attack bacterial organisms. Another term for T cells is killer cells, and they most commonly attack viral organisms.

The nurse is caring for a child with rickets. Which diagnostic test result would the nurse expect to find in the child's medical record?

low serum calcium levels

An adolescent wears a body brace for scoliosis. Which client education should the nurse provide?

to continue with age-appropriate activities

The nurse is caring for a child diagnosed with Duchenne muscular dystrophy and notes the presence of a Gower sign on the assessment form. What action by the child would support this assessment?

when on the floor, rising to the knees and pressing the hands against the ankles, knees, and thighs to stand A Gower sign is when children "walk up their front." When on the floor, the only way they can stand is to roll on their stomach and push themselves up to their knees. They then press their hands against their ankles, knees, and thighs. The presence of a waddling gait, difficulty climbing stairs, and a short heel cord are all present in Duchenne muscular dystrophy, but they are not the Gower sign. Meeting milestones late is also a symptom of this disorder, but it is not the Gower sign.

After teaching a class of nursing students about acquired immunodeficiency, the instructor determines that the teaching was effective when the students identify which of the following as a contributing factor? Select all that apply. a) Immunosuppressive drugs b) Vitamin therapy c) Minor localized infection d) Malnutrition e) Cancer

• Cancer • Malnutrition • Immunosuppressive drugs Explanation: Factors contributing to secondary (acquired) immunodeficiency include severe systemic infection, cancer, renal disease, radiation therapy, severe stress, malnutrition, immunosuppressive therapy, and aging.

Which of the following treatments are common to both systemic lupus erythematosus and juvenile idiopathic arthritis? Select all that apply. a) Nonsteroidal antiinflammatories b) Corticosteroids c) Antipyretics d) Antirheumatics e) Antimalarial

• Corticosteroids • Nonsteroidal antiinflammatories Explanation: Antimalarials are specific to SLE; antirheumatics are specific to JIA. Antipyretics are not typically used for either disorder

30. Two nurses are driving to work and have just come upon the scene of a motor vehicle accident (MVA) involving a child being hit by a car. The nurses decide to stop and find that only the child was injured. One of the nurses begins providing care. What is the first question the other nurse should ask the witnesses of the accident? A) "Can I get your name and numbers in case someone needs to contact you later?" B) "How did the accident happen?" C) "Do you know if the children have any health history I should know about?" D) "How long ago did someone activate the EMS?"

Ans: B Feedback: The first question should be asking how the accident occurred in order to get an idea of the types of injuries the children may have sustained. All other questions can be asked after establishing this information; however, asking names and numbers of the witnesses would be the last question asked by the nurse, and would most likely be asked by someone else.

The nurse knows that disorders of the pituitary gland depend on the location of the physiologic abnormality. Caring for a child who has issues with the anterior pituitary, the nurse would expect the child to have issues with which hormone?

Growth hormone

After explaining the causes of hypothyroidism to the parents of a newly diagnosed infant, the nurse should recognize that further education is needed when the parents ask which question?

So, hypothyroidism can be treated by exposing our baby to a special light, right?" Congenital hypothyroidism can be permanent or transient and may result from a defective thyroid gland or an enzymatic defect in thyroxine synthesis. Only the last question, which refers to phototherapy for physiologic jaundice, indicates that the parents need more information.

A child has been prescribed Stimate (desmopressin) acetate for the treatment of diabetes insipidus. The client and the parents ask the nurse how this drug works. What is the correct response by the nurse?

Stimate (desmopressin acetate) is a synthetic antidiuretic hormone that will slow down your urine output

The nurse knows that which condition is caused by excessive levels of circulating cortisol?

Cushing syndrome

A 9-year-old male is coming into the office to be seen for possible precocious puberty. The nurse would expect that the lab will perform which test?

hCG test Laboratory testing may include different blood tests, depending on the sex of the client. In boys, the healthcare prescriber may order a serum human chorionic gonadotropin (hCG) test, which if elevated could indicate an hCG-secreting tumor. In girls, an elevated cortisol or ACTH level with no signs of Cushing syndrome (CS) could be caused by glucocorticoid resistance, evidenced by signs of precocious puberty. IGF-1 levels are assessed for growth hormone deficiency, not precocious puberty. FSH is measured to assess delayed puberty.

The nurse is assessing a child for signs of an endocrine disorder. Which statement by the parent would alert the nurse to further assess the child for an endocrine disorder?

have all of a sudden noticed my child is always thirsty...even at night." Explanation: Polydipsia (extreme thirst) is a sign of diabetes mellitus, an endocrine disorder. The other statements by the parent would indicate musculoskeletal, vision, or integumentary disorders. The nurse would further assess for polyuria, weight loss and polyphagia.

The nurse is caring for a child admitted with possible Legg-Calvé-Perthes disease. Which assessment question should the nurse ask the child's caregivers to help support this diagnosis?

"Does she/he report pain in the groin that results in a limp?" Symptoms first noticed in Legg-Calvé-Perthes disease are pain in the hip or groin and a limp accompanied by muscle spasms and limitation of motion.

To avoid anaphylactic reactions in children, which question would be most important to ask a parent before administering penicillin to her infant? a) "What do you give her to alleviate itching?" b) "Do you have a telephone to call us immediately if she develops trouble breathing?" c) "Is there any family history of allergy to penicillin?" d) "Has she ever had penicillin before?"

"Has she ever had penicillin before?" Explanation: Penicillin is a drug frequently involved in allergic reactions. The reaction occurs after the child has first been sensitized to the drug.

A nurse is conducting a physical examination of a 12-year-old girl with suspected systemic lupus erythematosus (SLE). How would the nurse best interview the girl? a) "Tell me if you have noticed any new bruising or different color patterns on your skin" b) "Have you noticed any hair loss or redness on your face?" c) "Do you notice any wheezing when you breathe or a runny nose?" d) "Do you have any shoulder pain or abdominal tenderness?"

"Have you noticed any hair loss or redness on your face?" Explanation: Alopecia and the characteristic malar rash (butterfly rash) on the face are common clinical manifestations of SLE. Rhinorrhea, wheezing, and an enlarged spleen are not hallmark manifestations of SLE. Petechiae and purpura are more commonly associated with hematological disorders, not SLE

The nurse is caring for a newborn with facial nerve palsy from birth trauma. The mother is very upset and concerned about the child's prognosis. Which response by the nurse would be most appropriate?

"In most cases treatment is not necessary, only observation." Explanation: The nurse should reassure the mother by reminding her that in most cases treatment is not necessary, only observation. Asking about signs of improvement might alarm the mother because in some cases it can take many months for the palsy to resolve. Asking whether this was a result of pressure from forceps does not address the mother's concerns about the child's prognosis. The mother may not understand or know why the condition occurred. Telling the mother that this is the most common facial nerve palsy does not address the mother's concerns about the child's prognosis.

A 13-year-old adolescent with hyperthyroidism who takes antithyroid medication has a sore throat and a fever. The parent calls the nurse and asks what to do. Which is the best response from the nurse?

"Please take your child straight to the emergency department." A side effect of antithyroid medications is leukopenia. Signs and symptoms that include fever and sore throat need to be seen immediately. These instructions should be reviewed with parents upon discharge. The question includes information about Graves disease, so ibuprofen would not be the treatment. The question centers around drug therapy, not the child's fluid status.

A parent, distressed to learn that her school-aged child is diagnosed with type 2 diabetes mellitus, asks the nurse how this could happen because no one in the family has diabetes. What instruction is most accurate?

"This disorder is associated with being overweight and eating a diet high in fats and carbohydrates." Type 2 diabetes is now seen in overweight adolescents and those who eat a diet high in fats and carbohydrates and do not exercise regularly. Type 2 diabetes is not caused by the pancreas not making enough insulin. This disorder is not linked to an inadequate ingestion of daily calories. This disorder may have a genetic link, but environmental factors such as obesity, diet, and exercise can influence its development.

A nurse is reinforcing the diagnosis of constitutional delay by the health provider to a 13-year-old male adolescent. Which is the best approach for this teen?

"You will not need medication because your hormone levels are normal. I would be glad to discuss these findings with you." This diagnosis of "short stature" or constitutional delay may cause self-esteem issues with male teens. The nurse should explore the teen's feelings. Teens with a delay in puberty usually experience puberty late, so there is no need for a second opinion. Hormone therapy is not given until after age 14.

A child and parents are being seen in the office after discharge from the hospital. The child was newly diagnosed with type 2 diabetes. When talking with the child and parents, which statement by the nurse would be most appropriate?

"Young people can usually be managed with an oral agent, meal planning, and exercise." Explanation: Treating type 2 diabetes in children may require insulin at the outset if the child is acidotic and acutely ill. More commonly, the child can be managed initially with oral agents, meal planning, and increasing activity. Telling the child that she is lucky she did not have to learn how to give a shot might scare her, so it will inhibit her from seeking future health care. Additionally, insulin may be used if good control is not achieved. The condition will not rectify itself if all orders are followed. A weight-loss program might need to be implemented but that is not always the case.

A 10-year-old child is newly diagnosed with type 1 diabetes. The child's hemoglobin A1C level is being monitored. The nurse determines that additional intervention is needed with the child based on which result?

8.5% Explanation: The goal for hemoglobin A1C in children between the ages of 6 and 12 years is less than 8%. Therefore, a result of 8.5% would indicate that additional intervention is needed to achieve the recommended goal.

6. The parents bring their 3-year-old son to the emergency department after he ingested some of his mother's medicine. Which assessment would be of critical importance for this child? A) Assessing mental status and skin moisture and color B) Evaluating the effectiveness of the child's breathing C) Noting the child's pulse rate and quality D) Auscultating all lung fields for signs of edema

Ans: A Feedback: In cases of poisoning, clinical manifestations vary widely depending on the medication or chemical ingested. Therefore, it is important to pay particular attention to the child's mental status, skin moisture and color, and bowel sounds. Evaluating the effectiveness of the child's breathing and noting the child's pulse rate and quality are basic to any rapid cardiopulmonary assessment. Auscultating all lung fields for signs of pulmonary edema would be critically important for a child who is a near-drowning victim.

14. What would lead the nurse to suspect that a 5-year-old child is experiencing supraventricular tachycardia? A) Heart rate 160 beats per minute B) Flattened P waves C) Normal QRS complex D) History of fever

Ans: B Feedback: Supraventricular tachycardia is manifested by flattened P waves, a heart rate greater than 180 beats per minute, a narrow QRS complex, and usually no significant history. A heart rate of 160 beats per minute, normal QRS complex, and history of fever, fluid loss, hypoxia, pain, or fear would suggest sinus tachycardia.

The school nurse notes that a child diagnosed with diabetes mellitus is experiencing an insulin reaction and is unable to eat or drink. Which action would be the most appropriate for the school nurse to take?

Administer subcutaneous glucagon. Explanation: If the child having an insulin reaction cannot take a sugar source orally, glucagon should be administered subcutaneously to bring about a prompt increase in the blood glucose level. This treatment prevents the long delay while waiting for a physician to administer IV glucose or for an ambulance to reach the child

A nurse in the emergency department is examining an 18-month-old with lip edema, urticaria, stridor, and tachycardia. The nurse immediately suspects: a) anaphylaxis. b) systemic lupus erythematosus. c) severe polyarticular juvenile idiopathic arthritis. d) severe combined immunodeficiency.

Anaphylaxis. Explanation: Lip edema, urticaria, stridor, and tachycardia are common clinical manifestations of anaphylaxis.

26. A child is undergoing rapid sequence intubation and is receiving atropine. The nurse understands that this agent is used to: A) lessen the vagal effects of intubation. B) reduce intracranial pressure. C) induce amnesia. D) provide short-term paralysis.

Ans: A Feedback: Atropine is used to decrease respiratory secretions and mitigate the vagal effects of intubation. Thiopental reduces intracranial pressure and oxygen demand. Midazolam causes amnesia. Rocuronium or other neuromuscular blocking agents provide short-term paralysis during intubation.

3. A 5-year-old girl is cyanotic, dusky, and anxious when she arrives in the emergency department. Which action would be most appropriate? A) Ventilating the child with a bag-valve-mask B) Estimating the child's weight using a Broselow tape C) Providing therapy using automated external defibrillation D) Using rescue breathing and chest compressions

Ans: A Feedback: The child is exhibiting signs of ineffective oxygenation and ventilation. Therefore, ventilating the child with a bag-valve-mask and 100% oxygen would be effective and efficient. Estimating the child's weight with a Broselow tape is typically done by ambulatory care providers. According to the American Heart Association, automated external defibrillators are recommended for use in children who are older than age 1 year who have no pulse and have suffered a sudden, witnessed collapse outside the hospital setting. Rescue breathing and chest compressions are implemented for children who are not breathing and do not have a pulse or when the pulse rate is less than 60 beats per minute.

7. What would the nurse do first for a 5-year-old girl with profound bradycardia? A) Provide oxygen at 100% B) Administer epinephrine as ordered C) Use warming blankets D) Perform gastric lavage

Ans: A Feedback: The most common cause of profound bradycardia is respiratory compromise, hypoxia, and shock; thus, oxygenation and ventilation are the priorities. If the bradycardia persists, the next step would be to administer epinephrine or atropine as ordered. Hypothermia or toxic ingestion can cause bradycardia. Treating the underlying problem will relieve the bradycardia.

13. The nurse is gathering the necessary equipment for tracheal intubation for a child who is 2 years old. Which tracheal tube size would the nurse obtain? A) 4.5 B) 5 C) 5.5 D) 6

Ans: A Feedback: To calculate tracheal tube size, divide the child's age by 4 and add 4. For a 2-year-old child, 2 divided by 4 equals 0.5 plus 4 equals 4.5. The nurse also should have one size smaller ready.

18. A child has a tracheal tube in place and will be receiving medications via this tube. Which medications would the nurse expect to be administered in this manner? Select all that apply. A) Lidocaine B) Adenosine C) Atropine D) Dopamine E) Epinephrine F) Naloxone

Ans: A, C, E, F Feedback: Medications that may be administered via a tracheal tube include lidocaine, epinephrine, atropine, and naloxone. Adenosine is given intravenously; dopamine is given intravenously or intraosseously.

19. A group of students are reviewing information about respiratory arrest in children. The students demonstrate understanding of this information when they identify what common causes of respiratory arrest involving the upper airway? Select all that apply. A) Croup B) Asthma C) Pertussis D) Epiglottitis E) Pneumothorax

Ans: A, D Feedback: Common causes of respiratory arrest involving the upper airway include croup and epiglottitis. Asthma, pertussis, and pneumothorax are common causes involving the lower airway.

5. A 9-year-old girl who has fallen from a second-story window is brought to the emergency department. Which assessment would be the priority? A) Evaluating pupils for equality and reactivity B) Monitoring oxygen saturation levels C) Asking the child if she knows where she is D) Using the appropriate pain assessment scale

Ans: B Feedback: Airway is always the priority in any emergency situation. Therefore, monitoring oxygen saturation levels, part of the rapid cardiopulmonary assessment, would be performed before any of the other assessments. Evaluating pupils for equality and reactivity, asking the child if she knows where she is, and using an appropriate pain assessment scale are assessments that would follow the ABCs.

2. The nurse is caring for a 7-year-old boy experiencing respiratory distress who is scheduled to have a chest radiograph. What would be most important for the nurse to include in the child's plan of care? A) Administering a sedative to help calm the child B) Assisting the child to lie still during the chest radiograph C) Accompanying the child to continue observation D) Informing the child that he might hear a loud banging noise

Ans: B Feedback: Chest radiographs that disclose alterations in normal anatomy or lung expansion, or evidence of pneumonia, tumor, or foreign body, are commonly performed for respiratory emergencies. Therefore, the nurse would need to assist the child in remaining still during the procedure. A sedative may be ordered for magnetic resonance imaging (MRI). Accompanying the child to continue observation would be necessary if the child was to undergo a computed tomography scan. Telling the child about a loud banging noise would be appropriate if the child was having an MRI.

10. The nurse is providing care to a 4-year-old boy with a broken arm and an infected laceration from a fall. The nurse notes a significant elevation in the child's heart rate. Which intervention would be least appropriate? A) Administering antipyretics as ordered for fever B) Using a defibrillator to reduce the heart rate C) Administering analgesics to reduce pain D) Allowing the parents to comfort the child

Ans: B Feedback: Fever, fear, and pain are common explanations for significant increases in the heart rate of a child. This normal elevation in heart rate is known as sinus tachycardia and can be managed by treating the underlying causes. Antipyretics, analgesics, and comfort from the parents would be appropriate. However, defibrillation should be avoided.

23. A child is brought to the emergency department with a suspected poisoning. What treatment would the nurse least likely expect to be used? A) Gastric lavage B) Syrup of ipecac C) Activated charcoal D) Whole bowel irrigation

Ans: B Feedback: Ipecac is rarely used in the health care setting to induce vomiting and is no longer recommended for use in the home setting. Gastric lavage, administration of activated charcoal (binds with the chemical substance in the bowel), or whole bowel irrigation with polyethylene glycol electrolyte solutions may be used.

29. A nurse has just transferred from an adult medical-surgical unit to a pediatric unit. When reviewing CPR skills, what it is important for the nurse to realize? A) The pediatric chain of survival and the adult chain of survival are the same B) Prevention of cardiac arrest and injuries is the first step in the chain of survival for children C) Integrated post-cardiac arrest care is not part of the chain of survival for children D) Early CPR should occur before any steps of the chain of survival are considered

Ans: B Feedback: Prevention of cardiac arrest and injuries is the first step in the chain of survival in children in contrast to early emergency medical system (EMS) activation in adults. Integrated post-cardiac arrest care is the last step in the chain for both adults and children. Early CPR is the second step in the chain for both adults and children.

21. The nurse is providing care to a child who is intubated and the child's condition is deteriorating. What would the nurse do first? A) Check if the tracheal tube is obstructed B) Assess for displacement of the tracheal tube C) Look for signs of a possible pneumothorax D) Check the equipment for malfunction

Ans: B Feedback: The PALS mnemonic "DOPE" is useful for troubleshooting when the status of a child who is intubated deteriorates: D = Displacement: the tracheal tube is displaced from the trachea; O = Obstruction: the tracheal tube is obstructed (e.g., with a mucus plug); P = Pneumothorax: usually a pneumothorax results in a sudden change in the child's assessment manifested by decreased breath sounds and decreased chest expansion on the side of the pneumothorax, possible subcutaneous emphysema over the chest (with a tension pneumothorax, there may be a sudden drop in heart rate and blood pressure); E = Equipment failure: relatively simple problems such as a disconnected oxygen supply, leaks in the ventilator circuit, and loss of power can cause the child to deteriorate.

28. The nurse is teaching a CPR course for a group of nursing students. Which responses indicate an understanding of the content provided regarding the AED? Select all that apply. A) "When considering the use of the AED, the child must weigh at least 30 pounds (13.6 kg)." B) "An AED must only be employed if the collapse is witnessed." C) "To use the device the child must be at least 1 year of age." D) "The AED can be used only if the victim is demonstrates no heart rate." E) "The AED is safe for use prehospital."

Ans: B, C, D, E Feedback: An AED is an alternative to manually defibrillating an individual. The AED device consists of electrodes that are applied to the chest. These electrodes are used to monitor the heart rhythm and deliver the electrical current. AED devices are readily available in a variety of locations, such as airports, sports facilities, and businesses. Additionally, the AHA has recommended that an AED be used for children who are older than age 1 year who have no pulse and have suffered a sudden, witnessed collapse.

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

Ans: C Feedback: Although septic, cardiogenic, hypovolemic, and distributive shock can occur in children, hypovolemic shock is the most common type of shock that occurs in children.

24. A group of students are working on a presentation for a local health fair about safety for children. When developing this presentation, the students would address what cause as the most common in pediatric injury? A) Sports B) Firearm use C) Falls D) Automobile accidents

Ans: C Feedback: Falls are the most common cause of pediatric injury. Automobile accidents continue to cause deaths of about five children daily. Childhood trauma also results from pedestrian accidents, sporting and bicycle injuries, and firearm use.

25. As part of their orientation to their pediatric clinical rotation, an instructor is teaching a group of students how to perform cardiopulmonary resuscitation (CPR) on a child. Two students return demonstrate the skill using an infant manikin. What action indicates the proper technique? A) Compressing 30 times for every 2 breaths B) Placing the heel of the hand on the midsternum C) Giving 2 breaths followed by 15 compressions D) Using two hands to perform chest compressions

Ans: C Feedback: For two-person CPR on an infant, the rescuers would perform 15 compressions to 2 breaths, with two thumbs encircling the chest at the nipple line. The ratio of 30 compressions to 2 breaths is used for one-person CPR with an infant. The heel of the hand on the sternum at the nipple line is used for a child; two hands would be used for an older child.

12. A 1-month-old infant admitted to the emergency department in respiratory distress exhibits a regular pattern of breathing followed by brief periods of apnea, then tachypnea for a short time, eventually returning to a normal respiratory rate. This type of breathing is: A) hypoventilation. B) hyperventilation. C) periodic breathing D) stridor.

Ans: C Feedback: Periodic breathing is regular breathing with occasional short pauses followed by rapid breathing for a short period, then eventually resumption of a normal respiratory rate. Hypoventilation refers to a decrease in the depth and rate of respirations. Hyperventilation refers to an increased depth and rate of respirations. Stridor refers to a high-pitched, easily audible inspiratory noise.

8. Which measure would be most appropriate for the nurse to do to ensure that a child's endotracheal (ET) tube is correctly positioned? A) Auscultate for abdominal breath sounds B) Mark the tracheal tube at the child's lip C) Watch for a yellow display on a CO2 monitor D) Inspect for water vapor in the tracheal tube

Ans: C Feedback: The best way to verify correct tracheal tube placement is to use a CO2 monitor. If the tube is properly placed, the monitor display will turn yellow with each exhalation. Auscultation for breath sounds and inspecting the tube for signs of water vapor are valid confirmations, but not as good as CO2 monitors. Marking the tube alerts the nurse if the tube becomes misplaced.

4. When caring for an 8-year-old boy injured in an automobile accident, the nurse demonstrates understanding of the principles of Pediatric Advanced Life Support (PALS) by which action? A) Assisting ventilation with a bag-valve-mask (BVM) device B) Treating ventricular fibrillation using a defibrillator C) Managing compensated shock to prevent decompensated shock D) Treating supraventricular tachycardia using cardioversion

Ans: C Feedback: The principles of PALS stress evaluating and managing compensated shock with the goal of preventing decompensated shock and thereby preventing cardiopulmonary arrest. Assisting ventilation with a BVM device, treating ventricular fibrillation using a defibrillator, and treating supraventricular tachycardia using cardioversion are interventions that may be used to treat both children and adults.

27. A nurse determines that a child is exhibiting compensated supraventricular tachycardia (SVT). What action would be attempted first? A) Adenosine B) Synchronized cardioversion C) Vagal maneuvers D) Amiodarone

Ans: C Feedback: With compensated supraventricular tachycardia, vagal maneuvers are attempted first and then adenosine is used if vagal maneuvers fail. Adenosine or synchronized cardioversion is used to treat uncompensated SVT; synchronized cardioversion and IV amiodarone are used to treat ventricular tachycardia.

9. Which intervention would be most helpful in preventing barotrauma when ventilating a 3-year-old girl with a bag-valve-mask? A) Choosing the correct size bag and face mask B) Setting the flow rate at exactly 10 L/minute C) Maintaining the airway in the open position D) Delivering one breath every 3 to 5 seconds

Ans: D Feedback: Barotrauma is often the result of physicians or nurse practitioners ventilating the child too rapidly using too much tidal volume. Therefore, delivering one breath every 3 to 5 seconds is the best way to prevent barotrauma. Choosing the correct size bag and face mask and setting the correct flow rate are important for effective ventilation, as is maintaining the airway in the open position. However, these actions would have little impact on preventing barotrauma.

17. A child who weighs 53 lb is receiving fluid volume replacement as part of the treatment for shock. The nurse is evaluating the child's hourly urinary output to determine if the child's condition is improving. Which output would the nurse interpret as most indicative of improvement? A) 12 mL B) 15 mL C) 22 mL D) 30 mL

Ans: D Feedback: Improved urinary output of 1 to 2 mL/kg/hour is the goal. The child weighs 53 pounds, which is equivalent to 24 kg. Thus, improvement in this child would be noted by an hourly urinary output between 24 and 48 mL/hour.

15. What would be most appropriate to use to help maintain a patent airway in an infant experiencing a respiratory emergency? A) Neck hyperextension B) Head tilt-chin lift technique C) Jaw-thrust maneuver D) Small towel under shoulders

Ans: D Feedback: The infant will benefit from a small sheet or towel folded under the shoulders. This facilitates keeping the infant's airway in the sniff position as recommended by the American Heart Association's Basic Cardiac Life Support guidelines. Neck hyperextension and flexion should be avoided because these may occlude the airway. The head tilt-chin lift technique is appropriate to open the airway of a child older than age 1 year if a cervical spine injury is not suspected. The jaw-thrust maneuver is used if there is concern about the cervical spine.

1. The nurse is caring for a 6-year-old girl who was injured in a bicycle accident. Which question would be most important for the nurse to ask during the health history? A) "Has she been diagnosed with any chronic disorders?" B) "Is your daughter currently taking any medications?" C) "Is she allergic to any medications or drugs?" D) "Tell me how the bicycle accident happened."

Ans: D Feedback: The priority inquiry is to determine the nature of the emergency so that appropriate interventions may be initiated. This will also provide direction for obtaining more in-depth information as time permits. Information about allergic reactions to drugs, medications being taken, and chronic disorders that may affect treatment will be gathered next.

20. The nurse is preparing the plan of care for a child experiencing respiratory distress. What action would be the top priority? A) Providing supplemental oxygen B) Monitoring for changes in status C) Assisting ventilation D) Maintaining a patent airway

Ans: D Feedback: The priority when caring for any child with respiratory distress is to maintain a patent airway. Although providing supplemental oxygen, monitoring for changes in status, and assisting with ventilation are important, these measures would be futile if the child's airway was not patent.

The parents of a child who was diagnosed with diabetes insipidus ask the nurse, "How does this disorder occur?" When responding to the parents, the nurse integrates knowledge that a deficiency of which hormone is involved?

Antidiuretic hormone Diabetes insipidus results from a deficiency in the secretion of antidiuretic hormone (ADH). This hormone, also known as vasopressin, is produced in the hypothalamus and stored in the pituitary gland. Hypopituitarism or dwarfism involves a growth hormone deficiency. Diabetes mellitus involves a disruption in insulin secretion. Thyroxine is a thyroid hormone that if deficient leads to hypothyroidism.

A mother brings her 4-month-old infant to the doctor's office due to vesicular lesions that have appeared on the child's scalp and face. The mother says that the child will not stop scratching at the lesions and that she is concerned that he is having some kind of allergic reaction. Which of the following should the nurse recommend to the mother to help reduce pruritus in this child? a) Put the child on elimination diets b) Have the child retested for PKU c) Have the child undergo skin testing d) Apply wet dressings for 15 to 20 minutes, followed by moisturizer

Apply wet dressings for 15 to 20 minutes, followed by moisturizer Explanation: A major consideration in treatment of atopic dermatitis is aimed at reducing pruritus so children do not irritate lesions and cause secondary infections by scratching. Hydrating the skin by bathing or applying wet dressings (wet with tap water or Burrow's solution) for 15 to 20 minutes, followed by application of moisturizer such as Eucerin is helpful. Skin testing is usually ineffective because, although the allergen causing infantile atopic dermatitis may be pollen, dust or a mold spore; it is often a food allergen. Elimination diets can help identify an allergen, but do not directly help reduce pruritus; in any case, a 4-month-old should not be eating solid foods. Because untreated phenylketonuria (PKU) can lead to atopic dermatitis, children with infantile atopic dermatitis need to have a repeat test for PKU to be certain this is ruled out—however, this intervention does not directly reduce pruritus, either.

The nurse is caring for a child who is beginning to show signs and symptoms of anaphylaxis. Which intervention would be the priority? a) Obtaining brief history of allergen exposure b) Assessing patency of the airway c) Administering IV diphenhydramine (Benadryl) d) Administering corticosteroids

Assessing patency of the airway Explanation: The priority nursing intervention is to assess patency of the airway and breathing. If the child is stable, the next step would be to obtain a brief history of allergen exposure. If epinephrine is required, it would be administered prior to diphenhydramine. Corticosteroids would be used to prevent late-onset reactions.

The nurse caring for a client diagnosed with muscular dystrophy would expect which laboratory values to be most abnormal?

Creatine kinase Explanation: Serum creatine kinase levels are elevated early in the disorder, when significant muscle wasting is actively occurring. Bilirubin is a by-product of liver function. Potassium and sodium levels can change due to various factors and aren't indicators of muscular dystrophy.

Why will it be necessary for the nurse to be very supportive of parents' attempts to feed the infant with recently repaired myelomeningocele?

Assuming the usual feeding position will be difficult. Explanation: Because the repaired area will need to be protected, having to use an alternate feeding position is likely. The infant may need to be fed prone with the head turned to the side and may not be able to be held. Being able to provide food for the infant is central to parenting the child. Difficulty nurturing a child can be very stressful. Little pain will be experienced and should easily be controlled owing to loss of sensation in the area. The sucking reflex should not be affected by the myelomeningocele or its repair. Nausea and vomiting are unlikely after recovery from the anesthetic.

An adolescent with scoliosis is refusing to wear the prescribed body brace. Which instruction is best to progress the adolescent to the treatment goals?

CORRECT: "It is important to wear the brace now to stabilize your spinal alignment, decreasing your symptoms." INCORRECT: "It is important to correct spinal curvature before it gets too bad, causing you problems." It is important to have the adolescent understand the treatment and how the treatment will benefit him or her. Body bracing helps to hold the spine in alignment and prevent further curvature, decreasing the symptoms. The brace will not correct the problem. Adolescents have a hard time being compliant with the brace due to body image disturbance and peer reaction. The brace can also cause discomfort and be hot to wear. Torticollis is tightened neck muscles causing the head to tilt downward. A herniated disc is related to the disc space between the vertebrae. It has no affect on the curvature of the spine.

A pediatric client has just been diagnosed with diabetes mellitus. What would the nurse do first?

Check blood glucose levels. Explanation: The nurse must check the insulin level before it can be administered. Once a need is established, then insulin administration becomes the priority intervention. Stress management, glucose checks, and nutritional consultation can all be implemented once therapy with insulin begins.

The nurse is working with a group of caregivers of school-aged children discussing fractures. The nurse explains that if the fragments of fractured bone are separated, the fracture is said to be:

Complete Explanation: If the fragments of fractured bone are separated, the fracture is said to be complete. If fragments remain partially joined, the fracture is termed incomplete. Greenstick fractures are one kind of incomplete fracture, caused by incomplete ossification, common in children. Spiral fractures twist around the bone.

Assessment of a newborn reveals that the child has hypothyroidism. How does the nurse document this finding?

Congenital hypothyroidism

A woman in her first trimester of pregnancy has just been diagnosed with acquired hypothyroidism. The nurse is alarmed because this condition can lead to which pregnancy complication?

Decreased cognitive development of the fetus Explanation: If acquired hypothyroidism exists in a woman during pregnancy, her infant can be born intellectually disabled, because there was not enough iodine present for fetal growth. It is important, therefore, that girls with this syndrome be identified before they reach childbearing age.

The nurse is assessing a child with spina bifida occulta. During the assessment, the parents say, "It's going to be so difficult taking care of our child. He'll never be able to walk." The nurse identifies which nursing diagnosis as the priority?

Deficient knowledge related to diagnosis and condition Explanation: The parents' statement indicates a lack of understanding about the condition. Spina bifida is a term that is often used to refer to all neural tube disorders that affect the spinal cord. This can be confusing and a cause of concern for parents. There are well-defined degrees of spinal cord involvement, and it is important for health care professionals to use the correct terminology. Spina bifida occulta is a defect of the vertebral bodies without protrusion of the spinal cord or meninges. This defect is not visible externally and in most cases has no adverse affects. In most cases, spina bifida occulta is benign and asymptomatic and produces no neurologic signs; it may be considered a normal variant. Mobility typically is not impaired with spina bifida occulta. The child is at no greater risk for injury as any other child. The parents demonstrate a lack of knowledge, not problems with coping.

A newborn is diagnosed with the salt-losing form of congenital adrenogenital hyperplasia. On what should the nurse focus when assessing this client?

Dehydration Explanation: If there is a complete blockage of cortisol formation, aldosterone production will also be deficient. Without adequate aldosterone, salt is not retained by the body, so fluid is not retained. Almost immediately after birth, affected infants begin to have vomiting, diarrhea, anorexia, loss of weight, and extreme dehydration. If these symptoms remain untreated, the extreme loss of salt and fluid can lead to collapse and death as early as 48 to 72 hours after birth. The salt-losing form must be detected before an infant reaches an irreversible point of salt depletion. This disorder does not cause hypoglycemia, excessive bleeding, or excessive cortisone secretion.

After teaching a group of students about endocrine disorders, the instructor determines that the teaching was successful when the students identify insulin deficiency, increased levels of counterregulatory hormones, and dehydration as the primary cause of which condition?

Diabetic ketoacidosis Explanation: Insulin deficiency, in association with increased levels of counterregulatory hormones (glucagon, growth hormone, cortisol, catecholamines) and dehydration, is the primary cause of diabetic ketoacidosis, a life-threatening form of metabolic acidosis that is a frequent complication of diabetes. Liver converts triglycerides (lipolysis) to fatty acids, which in turn change to ketone bodies. The accumulation and excretion of ketone bodies by the kidneys is called ketonuria. Glucosuria is glucose that is spilled into the urine.

A child with primary immune deficiency is about to receive an infusion of IVIG. Which of the following is the most appropriate premedication to minimize the reaction? a) Ketorolac b) Diphenhydramine c) Ibuprofen d) Solu-Medrol

Diphenhydramine Explanation: Diphenhydramine and acetaminophen are the most commonly used medications for this purpose. Nonsteroidals and steroids typically are not used for this indication.

A child is prescribed glargine insulin. What information would the nurse include when teaching the child and parents about this insulin?

Do not mix this insulin with other insulins.

A child is scheduled to undergo hyposensitization. The nurse understands that this therapy attempts to achieve which of the following? a) Blockage of histamine release b) An increased level of IgE c) Reduction in allergen exposure d) Increased concentration of IgG

Increased concentration of IgG Explanation: Hyposensitization works by increasing the plasma concentration of IgG antibodies. IgG acts to prevent or block IgE antibodies from coming into contact with the allergen. IgE levels are not increased. Antihistamines block the release of histamine. Environmental control helps to reduce exposure to potential allergens

A young patient comes to the clinic with multiple symptoms of an infection. The nurse realizes that the patient has been seen in the clinic every month for the last 6 months for the same problems. Which body system does the nurse suspect is malfunctioning in this patient? a) gastrointestinal b) cardiovascular c) respiratory d) immune

immune Explanation: Disorders of the immune system include deficiencies of immune substances and function that affect the body's ability to ward off infection.

A child is scheduled to undergo hyposensitization. The nurse understands that this therapy attempts to achieve which of the following? a) Blockage of histamine release b) Increased concentration of IgG c) An increased level of IgE d) Reduction in allergen exposure

Increased concentration of IgG Explanation: Hyposensitization works by increasing the plasma concentration of IgG antibodies. IgG acts to prevent or block IgE antibodies from coming into contact with the allergen. IgE levels are not increased. Antihistamines block the release of histamine. Environmental control helps to reduce exposure to potential allergens.

A newborn is discovered to have congenital adrenogenital hyperplasia. What will the nurse most likely observe when assessing this client?

Enlarged clitoris Explanation: Congenital adrenal hyperplasia is a syndrome that is inherited as an autosomal recessive trait, which causes the adrenal glands to not be able to synthesize cortisol. Because the adrenal gland is unable to produce cortisol, the level of adrenocorticotropic hormone (ACTH) secreted by the pituitary in an attempt to stimulate the gland to increase function is increased. Although the adrenals enlarge under the effect of ACTH, they still cannot produce cortisol but rather overproduce androgen. Excessive androgen production during intrauterine life masculinizes the genital organs in a female fetus so that the clitoris is so enlarged it appears to be a penis. This disorder does not cause divergent vision. The child will not be born small for gestational age. This disorder does not cause abnormal facial features.

The caregivers of a child just diagnosed with diabetes express concern that they won't remember the different signs and symptoms of hyperglycemia and hypoglycemia. As a result, they are afraid they won't handle an emergency correctly. What is the best initial response by the nurse to help ensure the child's safety?

Instruct them to treat the reaction as if it's hypoglycemia, which is more likely.

The nurse is preparing to administer an intravenous immunoglobulin infusion. While reconstituting the product according the manufacturer's instructions, the nurse knows to take which step for proper preparation? a) Gently roll the vial to mix the medication. b) Reconstitute the medication 2 hours prior to administration. c) Shake the vial vigorously to disperse the diluent. d) Store the reconstituted medication no longer than 4 hours in the refrigerator

Gently roll the vial to mix the medication. Explanation: The nurse knows not the shake the intravenous immunoglobulin, as this may lead to foaming and may cause the immunoglobulin protein to degrade. Reconstituted intravenous immunoglobulin can be refrigerated overnight but should be brought to room temperature prior to administration. The nurse does not need to reconstitute the medication 2 hours prior to administration

A child is brought to the clinic experiencing symptoms of nervousness, tremors, fatigue, increased heart rate and blood pressure. Based on this assessment, the nurse would suspect a diagnosis of which condition?

Graves disease Children who develop Graves disease experience nervousness, tremors, and increased heart rate and blood pressure cause by overstimulation of the thyroid gland. Cushing syndrome, hypertension, and hypothyroidism are not associated with these symptoms.

A 12-year-old child has hyperthyroidism. The nurse understands that the most common cause of hyperthyroidism in children is:

Graves disease.

The type of fracture often seen in young children is one in which there is not complete ossification of the bone, and the bone bends and just partially breaks. What type of fracture is this?

Greenstick Explanation: Greenstick fractures are one kind of incomplete fracture, caused by incomplete ossification, common in children. The bone bends and often just partially breaks. Spiral fractures are seen when the fracture goes around the bone instead of through (i.e., looks like someone twisted the bone, and can occur in skiing injuries, falls, or abuse). A complete fracture is when the bone is actually broken in two pieces. An epiphyseal fracture occurs at the epiphyseal growth plate.

The nurse is caring for a child who has just had a plaster cast applied to the arm. The nurse is correct in performing which action with this child?

Handling the cast with open palms when moving the arm.

The nurse is administering the prescribed intravenous immunoglobulin to a 10-year-old boy. Which of the following would be most important for the nurse to do? a) Have epinephrine available. b) Administer with food. c) Monitor for signs of Cushing syndrome. d) Monitor urine for glucose.

Have epinephrine available. Explanation: The nurse should have epinephrine available during the infusion in case of an adverse reaction. Monitoring urine for glucose would be appropriate when corticosteroids are being given. Intravenous immunoglobulin does not need to be administered with food because it is being given as an intravenous infusion. Monitoring for signs of Cushing syndrome would be appropriate when corticosteroids are given.

A child is diagnosed with hypoparathyroidism. Which electrolyte imbalance would the nurse most likely expect to address?

Hypocalcemia

When describing anaphylaxis to a group of parents whose children have experienced anaphylaxis from insect stings, the nurse integrates knowledge that this response is related to which immunoglobulin? a) IgG b) IgE c) IgM d) IgA

IgE Explanation: Anaphylaxis is an acute IgE-mediated response to an allergen that involves many organ systems and may be life-threatening.

Nursing students demonstrate correct understanding when they identify which immunoglobin as occurring most frequently in plasma and the major one to be synthesized during secondary response? a) IgD b) IgM c) IgG d) IgA

IgG Explanation: IgG is the most frequent antibody in plasma and is the major immunoglobin to be synthesized during the secondary response.

A nursing instructor is preparing a teaching plan for a class about the immune response. When discussing the immune response, which of the following would the instructor describe as being primarily involved in a secondary immune response? a) IgE b) IgG c) IgA d) IgM

IgG Explanation: Only IgM and IgG are involved in primary and secondary immune responses. The main immunoglobulin produced in a secondary response is IgG. With a primary immune response, IgM antibodies peak at 14 days after an initial exposure to an antigen and then decline. This is followed by the production of IgG, which remains high for several weeks. IgE antibodies are involved in an immediate hypersensitivity reaction

When teaching about primary and secondary humoral responses, what should the nurse identify as the immunoglobin that is first to appear in the serum? a) IgM b) IgD c) IgE d) IgG

IgM Explanation: IgM is the first immunoglobin to appear in the serum with the primary and secondary humoral responses

Which results would indicate to the nurse the possibility that a neonate has congenital hypothyroidism?

Low T4 level and high TSH level Screening results that show a low T4 level and a high TSH level indicate congenital hypothyroidism and the need for further tests to determine the cause of the disease.

A group of nursing students are reviewing information about the immune system. The students demonstrate understanding of the information when they identify which of the following being produced by the thymus? a) Stem cells b) Lymphocyte T cells c) White blood cells d) Antibodies

Lymphocyte T cells Explanation: The thymus is responsible producing lymphocyte T cells. The bone marrow produces stem cells that are capable of differentiating into various blood cells. White blood cells arise from the stem cells in the bone marrow. Antibodies are formed by the B cells.

The nurse is caring for a child with systemic lupus erythematosus. The doctor will most likely order which test to monitor the child's progress? a) Immunoglobulin electrophoresis b) Lymphocyte immunophenotyping T-cell quantification c) IgG subclasses d) Complement assay (C3 and C4)

Lymphocyte immunophenotyping T-cell quantification Explanation: Lymphocyte immunophenotyping T-cell quantification is for ongoing monitoring of progressive depletion of CD4 T lymphocytes in HIV disease. The nurse would expect the physician to order a complement assay (C3 and C4) for ongoing monitoring of systemic lupus erythematosus. IgG subclasses measures the levels of the four subclasses of IgG and is used to determine immunodeficiencies. Immunoglobulin electrophoresis is ordered for immunodeficiency and autoimmune disorders, not to monitor systemic lupus erythematosus.

The nurse is caring for a child diagnosed with low functioning parathyroid. Which is a treatment goal of a child with hypoparathyroidism?

Maintain the child's calcium level at a normal level with calcium replacement as prescribed

A woman in her fourth month of pregnancy has recently learned that her sexual partner is HIV positive. She agrees to be tested for the virus but asks the nurse what early symptoms she should be looking for in herself. Which of the following should the nurse mention to the client? a) Mild, flu-like symptoms b) Genital warts c) Skin rash d) Vaginal discharge

Mild, flu-like symptoms Explanation: Unlike other sexually transmitted infections, HIV infection rarely begins with reproductive tract lesions. Instead, early symptoms are more subtle and often difficult to differentiate from those of other diseases or even from the symptoms of early pregnancy such as fatigue, anemia, diarrhea, and weight loss. The initial invasion of the virus may be accompanied by mild, flulike symptoms.

The nurse is preparing the care plan regarding medication therapy for a client with hyperpituitarism. The child is receiving Decadron (dexamethasone). What interventions should the nurse add to the care plan? Select all that apply.

Monitor client for edema Monitor client for high glucose levels Do not abruptly stop administering medication

What advice would be most appropriate for the child with a stinging-insect allergy?

Obtain a Medic-Alert bracelet so the presence of the allergy can be identified easily. Explanation: Stinging-insect allergy can lead to anaphylactic shock. Alerting health care personnel to the possibility of an insect sting is important

A 7-year-old child who has type 1 diabetes mellitus is at school reporting a headache and dizziness. The school nurse notices sweat on the child's face. What should the nurse do first?

Offer the child 8 ounces of juice or soda These are symptoms of hypoglycemia. Glucagon is given only for severe hypoglycemia. Juice or soda is the best choice to get the child an immediate source of carbohydrates. Insulin or water would be given for hyperglycemia.

The nurse is caring for a child recently diagnosed with hypoparathyroidism disorder. Which medication would the nurse expect to be ordered?

Oral calcium Explanation: Medical management for hypoparathyroidism includes intravenous calcium gluconate for acute or severe tetany, then intramuscular or oral calcium as prescribed. IV diuretics is used in treatment of hyperparathyroidism. Oral corticosteroids and oral potassium are not used in the treatment of hypoparathyroidism.

The most accurate screening test for the presence of HIV antigen in young children is a) Western blot b) PCR c) CD4 count d) ELISA

PCR Explanation: PCR tests directly for the HIV antigen. ELISA and the Western blot test detect the presence of HIV antibodies. The CD4 count is used as a measure of disease status and progression.

A mother, who is HIV positive, is distraught when she learns that her 6-month-old baby is also HIV positive. The child had undergone open heart surgery as a newborn and had received numerous blood transfusions. The nurse recognizes that which of the following is the most likely means of transmission of the disease to this child? a) Placental spread during pregnancy b) Blood transfusion products contaminated with the virus c) The mother kissing the baby on the forehead d) Breastfeeding

Placental spread during pregnancy Explanation: Although it is decreasing in incidence, transmission of HIV from mother to child by placental spread is still the most common reason for childhood HIV infection in the United States. Children with hemophilia no longer have a high incidence of the disease because blood products are now screened for the virus. HIV is not transmitted by animals or through usual casual contact, such as shaking hands or kissing, or in households, day care centers, or schools. Infection via breast milk is possible but less likely that via placental spread. (less)

Type 1 diabetes will have:

Polyuria Polydipsia Polyphagia Abrupt Weight loss

Which findings should the nurse expect to assess when completing the health history of a child admitted for possible type 2 diabetes? Select all that apply.

Polyuria Polydipsia Polyphagia Gradual onset Weight gain/obesity

The nurse is conducting a physical examination of a 9-month-old infant with a suspected neuromuscular disorder. Which finding would warrant further evaluation?

Presence of Moro reflex Explanation: The persistence of a primitive reflex in a 9-month-old would warrant further evaluation. Symmetrical spontaneous movement and absence of the Moro and tonic neck reflex are expected in a normally developing 9-month-old child.

The nurse is assessing a 4-year-old girl with ambiguous genitalia. Which finding suggests congenital adrenal hyperplasia?

Pubic hair and hirsutism

A 12-year-old boy arrives at the emergency room experiencing nausea, vomiting, headache, and seizures. He is diagnosed with bacterial meningitis. Other findings include a decrease in urine production, hyponatremia, and water intoxication. Which pituitary gland disorder would be most associated with these symptoms?

Syndrome of inappropriate antidiuretic hormone Explanation: Syndrome of inappropriate antidiuretic hormone (SIADH) is a rare condition in which there is overproduction of antidiuretic hormone by the posterior pituitary gland. This results in a decrease in urine production and water intoxication. As sodium levels fall in proportion to water, the child develops hyponatremia or a lowered sodium plasma level. It can be caused by central nervous system infections such as bacterial meningitis. As the hyponatremia grows more severe, coma or seizures occur from brain edema. Diabetes insipidus is characterized by polyuria, not decreased urine production. Hyposecretion of somatotropin, or growth hormone, results in undergrowth; hypersecretion results in overgrowth.

The nurse is caring for a 12-year-old girl with hypothyroidism. Which information should be part of the nurse's teaching plan for the child and family?

Reporting irritability or anxiety Explanation: Side effects of hypothyroidism are restlessness, inability to sleep, or irritability. These should be reported to the physician. Educating how to recognize vitamin D toxicity is necessary for a child with hypoparathyroidism. Teaching parents how to maintain fluid intake regimens is important for a child with diabetes insipidus. Teaching the child and parents to administer methimazole with meals is necessary for hyperthyroidism.

Which nursing diagnosis will the nurse prepare for the infant who is placed prone to protect the myelomeningocele repair site?

Risk for impaired skin integrity Explanation: The skin of the infant's knees and elbows is exposed to both pressure and friction. Leakage of urine and stool makes skin cleanliness a challenge. Should voluntary movement of the legs be affected, they become more vulnerable to skin integrity problems. The neuromuscular dysfunction the infant experiences is neither peripheral nor vascular. Disorganized infant behavior does not reflect the reality of the situation, and risk for activity intolerance is not appropriate because little activity occurs.

The nurse is explaining patterns of incidence and transmission of HIV to a group of adolescent girls. She explains that the risks for this population are much higher because of the possibility of both vertical and horizontal transmission. Horizontal transmission refers to transmission of the disease during which of the following? a) Pregnancy b) The birthing process c) Feeding with breast milk d) Sexual contac

Sexual contact Explanation: Horizontal transmission refers to person-to-person transfer of the virus. Transmission by feeding with breast milk, birthing, and pregnancy are all examples of vertical transmission

A client is being treated for hyperthyroidism with propylthiouracil. The nurse suspects the client's dose of medication is inadequate when assessing which signs and/or symptoms? Select all that apply.

Tachycardia Diarrhea Fever Irritability

The nurse is caring for a child who is scheduled for bone scan. It is suspected that the child has a growth hormone deficiency. Which finding would support this medical diagnosis?

The bone scan would show bone age would be two or more deviations below normal. Diagnostic testing used in children with suspected GH deficiency include bone age will be two or more deviations below normal. CT or MRI scans would be used to rule out tumors or structural abnormalities, not bone scans.

A 9-year-old child with Graves disease is seen at the pediatrician's office reporting sore throat and fever. The nurse notes in the history that the child is taking propylthiouracil. Which of the following would concern the nurse?

The child may have developed leukopenia. Explanation: Graves disease is defined as an overproduction of thyroid hormones. Propylthiouracil is used to suppress thyroid function. A complication of Graves disease is leukopenia

The nurse is caring for a 3-year-old boy with a fracture of the humerus. His chart indicates "fracture is partially through the physis extending into the metaphysis." The nurse identifies this as which Salter-Harris classification?

Type II Explanation: According to the Salter-Harris classification........... a type II fracture= partially through the physis extending into the metaphysis. A type I fracture is through the physis, widening it. A type IV fracture is through the metaphysis, physis, and epiphysis. A type V fracture is a crushing injury to the physis.

A nurse is taking care of an infant with diabetes insipidus. Which assessment data are most important for the nurse to monitor while the infant has a prescription for fluid restriction?

Urine output Explanation: An infant with the diagnosis of diabetes insipidus has decreased secretion of antidiuretic hormone (ADH). The infant is at risk for dehydration so monitoring urinary output is the most important intervention. The child's oral intake has been ordered. Monitoring a child who is under fluid restriction includes assessing the oral mucosa; however, urine output is the most important assessment for this patient. Vital signs are part of a basic assessment.

A 6-month-old boy has been admitted to the hospital with severe bloody diarrhea. The nurse notes petechiae and eczema with signs of secondary infection. As the nurse documents the boy's history, the parents report easy bruising and prolonged bleeding after circumcision. Based on these findings, the nurse suspects a diagnosis of which of the following? a) Severe combined immunodeficiency b) von Willebrand's disease c) Wiskott-Aldrich syndrome d) Beta-thalassemia major

Wiskott-Aldrich syndrome Explanation: Severe bloody diarrhea, petechiae, bruising, eczema with secondary infection, and prolonged bleeding episodes are signs and symptoms of Wiskott-Aldrich syndrome. Beta-thalassemia major would be manifested by signs of bleeding. von Willebrand's disease would be manifested by signs of bleeding. Severe combined immunodeficiency would be manifested by chronic diarrhea and failure to thrive, persistent thrush, and a history of severe infections beginning in infancy. (less)

The nurse is interpreting the negative feedback system that controls endocrine function. What secretion will the nurse correlate as decreasing while blood glucose levels decrease?

insulin Explanation: Feedback is seen in endocrine systems that regulate concentrations of blood components such as glucose. Glucose from the ingested lactose or sucrose is absorbed in the intestine and the level of glucose in blood rises. Elevation of blood glucose concentration stimulates endocrine cells in the pancreas to release insulin. Insulin has the major effect of facilitating entry of glucose into many cells of the body; as a result, blood glucose levels fall. When the level of blood glucose falls sufficiently, the stimulus for insulin release disappears and insulin is no longer secreted. Glycogen is stored in the liver and muscles. It is released to provide energy when the blood glucose levels fall. Glucagon is also produced by the pancreas. Its job is to force the liver to release stored insulin when the body has a need for more insulin. The adrenocorticotropic hormone is produced by the anterior pituitary. Its function is to regulate cortisol. This is needed so the adrenal glands can function properly. It also helps the body respond to stress.

The nursing diagnosis you anticipate that would best apply to a child with allergic rhinitis is a) risk for infection related to blocked eustachian tubes. b) disturbed self-esteem related to inherited tendency for illness. c) pain related to sinus edema and headache. d) ineffective tissue perfusion related to frequent nosebleeds.

pain related to sinus edema and headache. Correct Explanation: Many children with allergic rhinitis develop sinus headaches from edema of the upper airway

The nurse is preparing to administer intravenous immunoglobulin (IVIG) for a child who has not had an IVIG infusion in over 10 weeks. The nurse knows to first: a) obtain baseline physical assessment. b) begin infusion slowly increasing to prescribed rate. c) assess for adverse reaction. d) premedicate with acetaminophen or diphenhydramine.

premedicate with acetaminophen or diphenhydramine. Explanation: Premedication with diphenhydramine or acetaminophen may be indicted in children who have never received intravenous immunoglobulin (IVIG), have not had an infusion in over 8 weeks, have had a recent bacterial infection, or have history of serious infusion-related adverse reactions. The nurse should first premedicate, and then obtain a baseline physical assessment. Once the infusion begins, the nurse should continually assess for adverse reaction

Food allergies have become more and more common in the last few decades. Which of the following are common food allergies of childhood? Select all that apply. a) Milk b) Eggs c) Cheerios d) Apples e) Peanuts

• Eggs • Milk • Peanuts Explanation: Allergies to eggs, peanuts, and milk are common in childhood. Cheerios are made of oats and are not known to be allergenic. Apples also are not allergenic, unlike bananas, which can cause problems for children who have latex allergies.

A nurse is preparing a presentation for a group of new parents and is planning to discuss nutrition during the first year. As part of the presentation, the nurse is planning to address foods that should be avoided to reduce the risk of possible food allergies. Which of the following would the nurse most likely include? Select all that apply.

• Eggs • Peanuts • Shrimp Explanation: Foods that should be avoided in children younger than 1 year of age include: cow's milk, eggs, peanuts, tree nuts, sesame seeds, kiwi fruit, and fish and shellfish (ie, shrimp). Carrots, potatoes, and oranges are not considered problematic. (less)

Nursing students are reviewing the events involved in humoral immunity. They demonstrate understanding of the information when they identify which of the following as occurring with complement activation? Select all that apply. a) Smooth muscle relaxation b) Decreased vascular permeability c) Lysis of the foreign antigen d) Phagocytosis e) Chemotaxis

• Lysis of the foreign antigen • Chemotaxis • Phagocytosis Explanation: Complement activation results in increased vascular permeability, smooth muscle contraction, chemotaxis, phagocytosis, and lysis of the foreign antigen

The nurse is reviewing the medical history of a 4-year-old child. Which of the following would the nurse identify as potentially indicative of a primary immunodeficiency? Select all that apply. a) Recurrent deep abscess of the thigh b) Pneumonia last spring; resolved with antibiotics c) Oral thrush, persistent over the past 6 to 7 months d) Acute otitis media, one episode every 3 to 4 weeks over the past year. e) Infected laceration requiring IV antibiotic 2 months ago; healed

• Recurrent deep abscess of the thigh • Oral thrush, persistent over the past 6 to 7 months • Acute otitis media, one episode every 3 to 4 weeks over the past year. Explanation: Warning signs associated with primary immunodeficiency include eight or more episodes of acute otitis media in 1 year (one episode every 3 to 4 weeks results in at least 12 episodes in the past year), recurrent deep skin or organ abscesses, persistent oral thrush or skin candidiasis after 1 year of age. A history of infections that do not clear with IV antibiotics or two or more episodes of pneumonia in 1 year would be considered warning signs.

The child has a peanut allergy and accidentally ate food that contained peanuts. Which of the following findings are clinical manifestations of anaphylaxis? Select all that apply. a) The child's pulse is 52 beats per minute b) The child states that his tongue feels "too big" for his mouth c) The child has developed hives on his face and trunk d) The child states that he feels like he might faint e) The child states he feels might "throw up"

• The child states he feels might "throw up" • The child states that his tongue feels "too big" for his mouth • The child states that he feels like he might faint • The child has developed hives on his face and trunk Explanation: The following are common signs and symptoms of anaphylaxis: tongue edema, urticaria, nausea, vomiting, and syncope. Typically, the child who has developed anaphylaxis will be tachycardic.

The nurse is preparing to administer the child's dose of intravenous immune globulin (IVIG). Which of the following activities by the nurse indicates the need for further education? Select all that apply. a) The nurse is prepared to give acetaminophen to the child b) The nurse is prepared to give diphenhydramine to the child c) The nurse is preparing to administer the medication ventrogluteal site as an intramuscular injection d) The nurse takes baseline vital signs and will monitor the vital signs during the infusion e) The nurse has mixed the medication with the child's intravenous antibiotic

• The nurse is preparing to administer the medication ventrogluteal site as an intramuscular injection • The nurse has mixed the medication with the child's intravenous antibiotic Explanation: IVIG should be given only intravenously and should not be given as an intramuscular injection. IVIG cannot be mixed with other medications. The nurse should closely monitor the child's vital signs during the infusion of the IVIG. The child may require an antipyretic and/or an antihistamine during infusion to help with fever and chills.