PEDS review questions

When teaching a 6-year-old child with sickle cell disease and his family about pain management, which of the following should the nurse discuss? Select all that apply. A When pain medications are used, all pain will be eliminated. B Nonpharmacologic methods of pain relief including heat, massage, physical therapy, humor, and distraction. C It is helpful to use a "passport card" that includes information about the diagnosis, any previous complications, and the pain regimen. D Only the physician can decide the best course of treatment, and the other health care providers follow that plan.

BCD

You are the nurse assigned to care for a child with a basilar skull fracture. Your most important nursing observation is change in level of consciousness. You will be highly alert for: A Alterations in vital signs that often appear before alterations in consciousness or focal neurologic signs B Bleeding from the ear, which is indicative of an anterior basal skull fracture C Seizures that are relatively uncommon in children at the time of head injury D Changes in posturing, such as any signs of extension or flexion posturing, unusual response to stimuli, and random versus purposeful movement

D

The newest nurse on the Pediatric unit is concerned about maintaining a professional distance in her relationship with a patient and the patient's family. Which comment indicates that she needs more mentoring regarding her patient-nurse relationship? A "I realize that caring for the child means I can visit them on my days off if they ask me." B "When the mother asks if I will care for her daughter every day, I explain that the assignments change based on the needs of the unit." C "When the mother asks me questions about my family, I answer politely, but I offer only pertinent information." D "I engage in multidisciplinary rounds and listen to the family's concerns."

A

When administering a medication to a child, the nurse knows that: A The most accurate means for measuring small amounts of medication is the plastic disposable calibrated oral syringe. B A teaspoon is often the unit of measurement for pediatric medication and is especially helpful when working with families. C Using a dropper is also acceptable, remembering that thick fluids are easier to measure than viscous fluids. D For more exact measuring, emptying dropper contents into a medicine cup can be helpful.

A

When assessing blood pressure in a child: A Knowledge of normal mean is important: newborn, 65/41; 1 month to 2 years, 95/58; and 2 to 5 years, 101/57 B Cuff size is the most important variable and should be measured using limb length C The child is considered normotensive if the blood pressure is below the 95th percentile D Check upper- and lower-extremity blood pressure to look for abnormalities such as aortic stenosis, which causes lower-extremity blood pressure to be higher than upper

A

When a preschool child is hospitalized without adequate preparation, the nurse should recognize that the child may likely see hospitalization as which of the following? Punishment Loss of parental love Threat to child's self-image Loss of companionship with friends

A If a preschool child is not prepared for hospitalization, a typical fantasy is to attribute the hospitalization to punishment for real or imagined misdeeds. School-age children may see hospitalization as loss of parental love and loss of companionship with friends. A threat to child's self image is a response characteristic of toddlers when threatened with loss of control.

A 3-year-old child has a fever. Her mother calls the nurse reporting a fever of 38.8º C (102º F) even though the child had acetaminophen 2 hours ago. The nurse's action should be based on which of the following? Fevers such as this are common with viral illnesses. Temperatures this high indicate greater severity of illness. Fevers over 102º F indicate a probable bacterial infection. Seizures are common in children when antipyretics are ineffective.

A Most fevers are of brief duration, with limited consequences, and are viral. Neither the increase in temperature nor its response to antipyretics indicates the severity or etiology of infection. Little evidence supports the use of antipyretic drugs to prevent febrile seizures.

A 2-year-old child is being admitted to the hospital for possible bacterial meningitis. When preparing for a lumbar puncture, the nurse should do which of the following? Place the child in a side-lying position. Set up a tray with equipment the same size as for adults. Apply EMLA to the puncture site 15 minutes before the procedure. Reassure the parents that the test is simple, painless, and risk free.

A Children are easiest to control in a side-lying position with the head and knees drawn up toward the chest. Pediatric spinal trays have smaller needles than do adult trays. EMLA should be applied approximately 60 minutes before the procedure. The emergency nature of the spinal tap precludes its use. The test is not simple, painless, or risk free. A spinal tap does have associated risks, and analgesia will be given for the pain.

When should clear liquids be stopped before scheduled surgery? Two hours before surgery Six hours before surgery The night before surgery at 8 PM The night before surgery at midnight

A Clear liquids can be given up to 2 hours before surgery to children of any age without risk of aspiration. Six hours is the recommended waiting time for infant formula, nonhuman milk, and light meals. Clear liquids can be given up to 2 hours before surgery to children of any age without risk of aspiration.

An 18-month-old child has just been admitted with croup. His parent is tearful and tells the nurse, "This is all my fault. I should have taken him to the doctor sooner so he wouldn't have to be here." Which of the following is appropriate in the care plan for this parent? Clarify misconception about the illness. Explain to the parent that the illness is not serious. Encourage the parent to maintain a sense of control. Assess further why the parent has excessive guilt feelings.

A Guilt is a common response of parents when a child is hospitalized. They may blame themselves for the child's illness or for not recognizing it soon enough. The nurse should clarify the nature of the problem and reassure parents that the child is being cared for. Croup is a potentially serious illness. The nurse should not minimize the parents' feelings. It would be difficult for the parents to maintain a sense of control while their child is seriously ill. No further assessment is indicated at this time; guilt is a common response for parents.

Which of the following is a clinical manifestation of increased intracranial pressure (ICP) in infants? Irritability Photophobia Vomiting and diarrhea Pulsating anterior fontanel

A Irritability is one of the changes that may indicate increased ICP. Photophobia is not indicative of increased ICP in infants. A pulsing anterior fontanel is normal. Vomiting is one of the signs of increased ICP in children, but when present with diarrhea, it is indicative of a gastrointestinal disturbance.

You are working with a family that brought their child into the pediatric clinic. The mother describes what may be a type of seizure. What subjective data will help you determine the type? Select all that apply. A The presence or absence of an aura B If the child appeared disoriented after the seizure C Presence of vomiting after the seizure D The duration of the seizure E If the seizure was related to certain foods or occurred after a certain activity

A B D

Nonpharmacologic strategies for pain management may reduce pain perception. make pharmacologic strategies unnecessary. usually take too long to implement. trick children into believing they do not have pain.

A Nonpharmacologic techniques provide coping strategies that may help reduce pain perception, make the pain more tolerable, decrease anxiety, and enhance the effectiveness of analgesics. Nonpharmacologic techniques should be learned before the pain occurs. It is best to use both pharmacologic and nonpharmacologic measures for pain control. The nonpharmacologic strategy should be matched with the child's pain severity and taught to the child before the onset of the painful experience. Some of the nonpharmacologic techniques may mitigate the child's experience with mild pain, but the child will still know the discomfort was present.

Physiologic measurements in children's pain assessment are not useful as the sole indicator for pain. the best indicator of pain in children of all ages. of most value when children also report having pain. essential to determine whether a child is telling the truth about pain.

A Physiologic manifestations of pain may vary considerably, so they do not provide a consistent measure of pain. Heart rate may increase or decrease. The same signs that may suggest fear, anxiety, or anger also indicate pain. In chronic pain, the body adapts, and these signs decrease or stabilize. Physiologic measurements are of limited value and must be viewed in the context of a pain rating scale, behavioral assessment, and parental report. When the child reports pain on an appropriate pain scale, the appropriate interventions should be used.

A young boy has just been diagnosed with pseudohypertrophic (Duchenne) muscular dystrophy. His care should include which of the following? Recommend genetic counseling. Explain that the disease is easily treated. Suggest ways to limit the use of muscles. Assist the family in finding a nursing facility to provide his care.

A Pseudohypertrophic (Duchenne) muscular dystrophy is inherited as an X-linked recessive gene. Genetic counseling is recommended for parents, female siblings, maternal aunts, and their female offspring. No effective treatment exists at this time for childhood muscular dystrophy. Maintaining optimum function of all muscles for as long as possible is the primary goal. It has been found that children who remain as active as possible are able to avoid the need for a wheelchair for a longer time. Finding a nursing facility is inappropriate at the time of diagnosis. When the child becomes increasingly incapacitated, the family may consider home-based care, a skilled nursing facility, or respite care to provide the necessary care.

The nurse is doing a neurologic assessment on a child whose level of consciousness has been variable since sustaining a cervical neck injury 12 hours ago. Which of the following is the most essential in this assessment? Reactivity of pupils Doll's head maneuver Oculovestibular response Funduscopic examination to identify papilledema

A Pupil reactivity is an important indication of neurologic health. The pupils should be assessed for no reaction, unilateral reaction, and rate of reactivity. The doll's head maneuver should not be performed if there is a cervical spine injury. The oculovestibular response is a painful test that should not be done on a child who is having variable levels of consciousness. Papilledema does not develop until 24 to 48 hours into the course of unconsciousness.

Which of the following is an important nursing intervention when performing a bladder catheterization on a young boy? Insert 2% lidocaine lubricant into the urethra. Clean technique, not Standard Precautions, is needed. Lubricate the catheter with water-soluble lubricant such as K-Y Jelly. Delay catheterization for 20 minutes while anesthetic lubricant is absorbed.

A The anxiety, fear, and discomfort experienced during catheterization can be significantly decreased by preparing the child and parents, by selecting the correct catheter, and by using an appropriate technique for insertion. Generous lubrication of the urethra before catheterization and use of lubricant containing 2% lidocaine may reduce or eliminate the burning and discomfort associated with this procedure. Catheterization is a sterile procedure, and Standard Precautions for body-substance protection should be followed. Water-soluble lubricants do not provide appropriate local anesthesia. Catheterization should be delayed only 2 to 3 minutes. This provides sufficient local anesthesia for the procedure.

The nurse is preparing a 12-year-old girl for a bone marrow aspiration. She tells the nurse she wants her mother with her "like before." The most appropriate nursing action is to grant her request. explain why this is not possible. identify an appropriate substitute for her mother. offer to provide support to her during the procedure.

A The parents' preferences for assisting, observing, or waiting outside the room should be assessed, as well as the child's preference for parental presence. The child's choice should be respected. If the mother and child agree, then the mother is welcome to stay. An appropriate substitute for the mother is necessary only if the mother does not wish to stay. Support is offered to the child regardless of parental presence.

The nurses caring for a child are concerned about the child's frequent requests for pain medication. During a team conference, a nurse suggests they consider administering a placebo instead of the usual pain medication. The decision should be based on knowledge of which of the following? This practice is unjustified and unethical. This practice is effective to determine whether a child's pain is real. The absence of a response to a placebo means the child's pain has an organic basis. A positive response to a placebo will not occur if the child's pain has an organic basis.

A Use of placebos without the patient's consent is unethical. Use of placebos does not provide information about the presence or severity of the pain. Individuals may have a positive response to a placebo despite a significant organic cause for their pain.

The nurse wears gloves during a dressing change. When the gloves are removed, the nurse should do which of the following? Wash hands thoroughly. Check the gloves for leaks. Rinse gloves in disinfectant solution. Apply new gloves before touching the next patient.

A When gloves are worn, the hands are washed thoroughly after removing the gloves because both latex and vinyl gloves fail to provide complete protection. Gloves should be disposed of after use. Hands should be thoroughly washed before new gloves are applied.

These general approaches can be helpful when performing a physical exam. Select all that apply. A With toddlers restraint may be necessary, and requesting a parent's assistance is appropriate. B When examining a preschooler, giving a choice of which parts to examine may be helpful in gaining the child's cooperation. C With a school-age child, it is always best to have the parents present when examining. D Giving explanations about body systems can make adolescents nervous due to their egocentricities.

A B

Growth measurement is a key element in children of their health status. One measurement for height is linear growth measurement. What should the nurse do to perfect this technique? Select all that apply. A Understand the difference in measurement for children who can stand alone and for those who must lie recumbent. B Use a length board and footboard or a standiometer, which is the best technique, or use a tape measure. C Two measurers are usually required for a recumbent child, although one measurer may be sufficient for a cooperative child. D Reposition the child and repeat the procedure. Measure at least twice (ideally three times). Average the measurements for the final value. E Demonstrate competency when measuring the growth of infants, children, and adolescents. Refresher sessions should be taken when a lack of standardization occurs.

A D E

A family you are caring for on the Pediatric unit asks you about nutrition for their baby. What facts will you want to include in this nutritional information? Select all that apply. A Breastfeeding provides micronutrients and immunologic properties. B Eating preferences and attitudes related to food are established by family influences and culture. C Most children establish lifelong eating habits by age 18 months. D During adolescence, parental influence diminishes and adolescents make food choices related to peer acceptability and sociability. E Due to the stress of returning to work, most mothers use this as a time to stop breastfeeding.

A, B, D

During hospitalization there may be a reason to use restraints. Protocol for using restraints may include which of the following? Select all that apply. A One finger breadth should be left between the skin and the device, and knots should be tied to allow for quick release. B Elbow restraints fashioned from a variety of materials function well when a child's hands must be kept from his face—for example, after cleft lip or palate surgery. C A papoose board with straps or a mummy wrap effectively controls the child's movements when an infant or small child requires short-term restraint for examination or treatment that involves the head and neck. D Before initiating a behavioral restraint, the nurse should assess the patient's mental, behavioral, and physical status to determine the cause for the child's potentially harmful behavior. E Unless state law is more restrictive, behavioral restraints for children must be reordered every 2 hours for children under 9 years of age and every 3 hours for children 9 to 17 years old.

ABCD

Which of these statements accurately describes Duchenne muscular dystrophy? Select all that apply. A The absence of dystrophin leads to muscle fiber degeneration. B DMD is inherited as an X-linked recessive trait. C Cognitive and intellectual impairment are rare in children with DMD. D Affected children have a waddling gait and lordosis and fall frequently. E Ambulation usually becomes impossible by 12 years of age, and affected children are confined to a wheelchair. F Affected children must be hospitalized when ambulation becomes impossible.

ABDE

You tell the parent of a 4-year-old patient being admitted that you need to ask some questions. She asks, "Why do you have to ask so many questions?" Which explanations should you offer? Select all that apply. A "It is something we are required to do for every child who is hospitalized." B "By learning about your child's routines, we can try to minimize some of the changes he will be going through." C "Knowing more about your child can help predict how the hospital stay will go and will also help us choose a good roommate for him when more children arrive at the hospital." D "Gaining more information about your child, such as current medications she is taking, will help us provide the best care." E "This will give you an opportunity to ask questions as well."

ABE

When discharging the pediatric patient from the outpatient setting, the nurse knows which of the following responses indicate a need for more teaching? Select all that apply. A "The physician said my son can have clear liquids when we return home, which would include Jello, pudding, and apple juice." B "The other nurse explained that I can use other things to help with the pain, such as distraction (reading a book, music, or a movie), after the pain medication is given." C "I can get my child's prescription tomorrow, so I can go to my regular pharmacy where they can explain the medication to me." D "I am waiting for my husband to come so he can drive us, and I can watch my son in the car on the way home." E "I understand that I will be contacted tomorrow for follow-up on my child but that I should not hesitate to call if I have any concerns before then."

AC

Play is children's work, even in the hospital. Which of the following are functions of play? Select all that apply. A Provides diversion and brings about relaxation B Keeps the child occupied and directs concerns away from himself or herself C Helps the child feel more secure in a strange environment D Lessens the stress of separation and the feeling of homesickness E Provides a means for release of tension and expression of feelings F Allows the parents to have a break from the unit for a respite period

ACDE

Children and adolescents should be prepared for procedures according to their level of development and understanding. Which interventions by the nurse would be helpful? Select all that apply. A Explain procedure in relation to what child will see, hear, taste, smell, and feel. B Although older children may associate objects, places, or persons with prior painful experiences, infants will not have a memory of past experiences. C For school-age children, preparation can take several days in advance of the procedure to allow for processing of information. D Provide privacy; describe how the body will be covered and what will be exposed. E Allowing adolescents to talk with other adolescents who have had the same procedure may increase their level of anxiety and is not recommended.

AD

When the nurse interviews an adolescent, which of the following is especially important? Focus the discussion on the peer group. Display a genuine interest in the adolescent. Emphasize that confidentiality will always be maintained. Use the same type of language as the adolescent.

Adolescents accept anyone who shows a genuine interest in them. Although peers are important to this age group, the focus of the interview should be on the adolescent. The nurse should clarify which information will be shared with other members of the health care team and any limits to confidentiality. The nurse should maintain a professional relationship with adolescents. To avoid misinterpretation of words and phrases that the adolescent may use, the nurse should clarify terms frequently.

Which of the following statements explains why it can be difficult to assess a child's dietary intake? No systematic assessment tool has been developed. Biochemical analysis for assessing nutrition is expensive. Families usually do not understand much about nutrition. Recall of food consumption is frequently unreliable.

An individual's recall of food intake, especially amounts eaten, is frequently unreliable. Systematic tools such as the 24-hour recall and detailed dietary history questionnaires are available. Biochemical analysis is not necessary for assessing dietary intake. Family knowledge of nutrition is not required. Detailed questions can elicit the child's patterns of eating and food intake.

A 14-year-old male with a spinal cord injury is placed on a standing table and suddenly begins to sweat profusely and complain of a headache. The nurse takes a set of vital signs and notes a significant increase in systolic blood pressure and a heart rate of 50 bpm. The most helpful intervention in this situation would be for the nurse to: A Place the adolescent back in his wheelchair and take him to his room B Palpate the bladder for distention C Administer a routine analgesic for his headache and discontinue the therapy D Place the standing table in a horizontal position and allow the adolescent to rest for a few minutes

B

As the nurse is getting Nathan ready for surgery, his doctor asked you to explain preemptive analgesic to Nathan's mother. Which response leads you to believe his mother needs more teaching? A "I understand that preemptive analgesia is giving Nathan pain medication before he has pain and could be given before surgery." B "This medication will control Nathan's pain so he doesn't feel anything." C "Giving this medicine early may help prevent complications after surgery." D "By controlling Nathan's pain, he will be more comfortable and may be able to go home sooner."

B

Pain scales for infants and their uses include but are not limited to: A CRIES: Crying, Requiring increased oxygen, Inability to console, Expression, and Sleeplessness B FLACC: child's face, legs, activity, cry, and consolability C NCCPC: parent and health care giver questionnaire assessing acute and chronic pain D NPASS: neonatal pain, agitation, and sedation scale for infants from 3 to 6 months

B

The overriding goal of atraumatic care is: A Prevent or minimize the child's separation from the family B Do no harm C Promote a sense of control D Prevent or minimize bodily injury and pain

B

The primary risk factor for the development of cerebral palsy is: A Maternal chorioamnionitis B Premature birth C Birth asphyxia D Intraventricular hemorrhage

B

Urinary system distress (neurogenic bladder) in children with spina bifida is managed by: A DDAVP (1-deamino-8-D-arginine vasopressin) B Clean intermittent catheterization C Continuous urinary catheterization D Mitrofanoff procedure

B

When obtaining a heel stick for lab results: A The heel stick is performed because it is less invasive and less painful than a venipuncture. B Breastfeeding during a neonatal heel lance is effective in reducing pain and has been found to be more effective than sucrose in some studies. C While safe for use in preterm infants when applied correctly, EMLA has been found to be much more effective than placebo in preventing pain during heel lancing. D To avoid osteochondritis (underlying calcaneus bone, infection, and abscess of the heel), the puncture should be no deeper than 1 mm and should be made at the inner aspect of the heel.

B

You are working with a pediatric nurse who has just transferred to the pediatric clinic. You are role-playing phone triage related to a child with a head injury. You ascertain that the nurse needs more teaching based on what response? A "After initial physical exam, if there was no loss of consciousness with the head injury, the child can be observed at home." B "If there is a language barrier, written instructions can be given, followed by discharge." C "Another physical exam should take place in 1 or 2 days." D "Parents should call the doctor if their child has any of these signs: blurred vision, walking unsteadily, or is hard to awaken."

B

The nurse is caring for a 2-year-old girl who is unconscious but stable after a car accident. Her parents are staying at the bedside most of the time. Which of the following is an appropriate nursing intervention? Suggest that the parents go home until she is alert enough to know they are present. Encourage the parents to hold, talk, and sing to her as they usually would. Use ointment on her lips but do not attempt to cleanse her teeth until swallowing returns. Position her with proper body alignment and the head of the bed lowered 15 degrees.

B The parents should be encouraged to interact with their daughter. Senses of hearing and tactile perception may be intact, and stimulation of these senses is important. The daughter may be able to hear that they are present. Oral care is essential in an unconscious child. Mouth care should be done at least twice daily. The head of the bed should be elevated, not lowered.

An appropriate nursing intervention to minimize separation anxiety in a hospitalized toddler would be which of the following? Provide for privacy. Encourage parents to room-in. Explain procedures and routines. Encourage contact with children of the same age.

B A toddler experiences separation anxiety secondary to being separated from the parents. To avoid this, the parents should be encouraged to room-in as much as possible. Explaining routines and ensuring privacy are helpful interventions, but they would not substitute for the parents' presence. Encouraging contact with children of the same age would not substitute for having the parents present.

Which of the following is usually the greatest threat to a hospitalized adolescent? Fear of pain Fear of altered body image Restricted motor activity Separation from home and family

B Injury, pain, disability, and death are viewed primarily in terms of how each affects the adolescents' views of themselves in the present. Any change that differentiates them from their peers is regarded as a major tragedy. Pain is a concern because it affects body image. Adolescents are able to react with much more self-control than are younger children. Restricted motor activity would be an issue if it affected body image in the long term. Adolescents are able to tolerate separation from family.

A 6-month-old infant does not smile, has poor head control, has a persistent Moro reflex, and often gags and chokes while eating. These findings are most suggestive of hypotonia. cerebral palsy. spinal cord injury. neonatal myasthenia gravis.

B Poor head control, a persistent Moro reflex, and feeding difficulties in a 6-month-old infant are suggestive of cerebral palsy. Not smiling, poor head control, a persistent Moro reflect, and gagging and choking while eating are not consistent with hypotonia, spinal cord injury, or neonatal myasthenia gravis.

When administering a gavage feeding to a school-age child, the nurse should do which of the following? Administer feedings over 5 to 10 minutes. Position the child on the right side after administering the feeding. Check the placement of the tube by inserting 20 ml of sterile water. Lubricate the tip of the feeding tube with Vaseline to facilitate passage.

B Position the child with the head elevated about 30 degrees and on the right side or abdomen for at least 1 hour. This is in the same manner as after any infant feeding to minimize the possibility of regurgitation and aspiration. Feedings should be administered via gravity flow and take from 15 to 30 minutes to complete. With a syringe attached to the feeding tube, apply negative pressure. Aspiration of stomach contents indicates proper placement. Then inject a small amount of air into the tube while simultaneously listening with a stethoscope over the stomach area. Insert the tube that has been lubricated with sterile water or water-soluble lubricant.

Which of the following clinical manifestations in an infant would be suggestive of spinal muscular atrophy (Werdnig-Hoffmann disease)? Hypertonicity Lying in the frog position Hyperactive deep tendon reflexes Motor deficits on one side of body

B The infant lies in the frog position with the legs externally rotated, abducted and flexed at knees. The child has hypotonia and inactivity as the most prominent features. The deep tendon reflexes are absent. The motor deficits are bilateral.

While interviewing parents who have just arrived in the health care clinic, the nurse begins the interview. Which statement below involves therapeutic communication techniques? Select all that apply. A Allowing the parents to direct the conversation so they feel comfortable and in control B Using broad, open-ended questions so that parents can feel open to discuss issues C Redirecting by asking guided questions to keep the parents on task D Careful listening, which relies on the use of clues and verbal leads to help move the conversation along E Asking carefully worded, detailed questions to get accurate information

B, C, D

Because injuries are the most common cause of death and disability in children in the United States, which stage of development correctly determines the type of injury that may occur? Select all that apply. A A newborn may roll over and fall off an elevated surface. B The need to conform and gain acceptance from his peers may make a child accept a dare. C Toddlers who can run and climb may be susceptible to burns, falls, and collisions with objects. D A preschooler may ride her two-wheel bike in a reckless manner. E A crawling infant may aspirate due to the tendency to place objects in his mouth.

B, C, E

Duvall's Developmental Stages of the Family include which of the following? Select all that apply. A Stages an individual progresses through in their moral and spiritual development B Stages families progress through in adulthood C Stages that designate how parenting progresses as a child develops D Stages that designate appropriate discipline related to developmental stages E Stages that describe the journey a couple will take as their children mature

B, C, E

The National Children's Study is the largest prospective, long-term study of children's health and development in the United States. Which of these options are the goals of this study? Select all that apply. A Ensure that every child is immunized at the appropriate age. B Provide information for families to eradicate unhealthy diets, dental caries, and childhood obesity. C Enlist the help of school lunch programs to reach the goal of vegetables and fruits as 30% of each lunch. D Significantly reduce violence, substance abuse, and mental health disorders among the nation's children. E Decrease tardiness and truancy and increase the high school graduation rate in each state over the next 5 years.

B, D

Ways to integrate spiritual practices into nursing care include: A Explaining the religious practices you personally take part in B Realizing that young children have little understanding regarding their spirituality C Agreeing with children and their families when they explain their religious beliefs so they are not offended D Becoming knowledgeable about the religious worldviews of cultural groups found in the patients you care for

D

You are working with a new nurse to give an IM injection. Which principles do you want to include when doing this teaching? Select all that apply. A Usually 2 ml is the maximum volume that should be administered in a single site to small children and older infants. B New evidence suggests that immunizations at the ventrogluteal site have been found to have fewer local reactions and fever. C Distraction and prevention of unexpected movement may be more easily achieved by placing the child supine on a parent's lap for ventrogluteal site use. D The deltoid muscle advantages are less pain and fewer side effects from the injectate compared with the vastus lateralis. E Aspiration during intramuscular vaccine administration is always recommended.

BCD

Culture includes which of the following? Select all that apply. A Cultural competence, which includes building skills in the health care provider, such as offering lists of common foods, health care beliefs, and important rituals B Cultural humility, which requires that health care providers participate in a continual process of self-reflection and self-critique C Recognizing the power of the health care provider role that views the patient and family as full members of the health care team D A particular group with its values, beliefs, norms, patterns, and practices that are learned, shared, and transmitted from one generation to another E A complex whole in which each part is interrelated, including beliefs, tradition, lifeways, and heritage

BCDE

How can the nurse prepare a child for a painful procedure? Select all that apply. A Be honest and use correct terms so that the child trusts the nurse. B Involve the child in the use of distraction, such as using bubbles, music, or playing a game. C Kindly ask parents to leave the room so they don't have to watch the painful procedure. D Use positive self-talk such as "When I go home, I will feel better and be able to see my friends." E Use guided imagery that involves recalling a previous pleasurable event.

BDE

While orienting a new nurse to the ICU, she asks, "How do these children sleep and not become frightened with all the lights and noises?" How should you respond? Select all that apply. A "These children are sicker than those on the pediatric unit, so the noises and lights are necessary." B "We try to organize care into clusters so infants and children can sleep and we can turn down lights." C "We silence alarms to allow for periods of sleep, especially at night." D "When possible, we allow for uninterrupted sleep cycles—for infants 90 minutes and for older children 60 minutes." E "We encourage parents to sit with and touch their child as often as possible."

BE

Binocularity, the ability to fixate on one visual field with both eyes simultaneously, is normally present by what age? 1 month 3 to 4 months 6 to 8 months 12 months

Binocularity is usually achieved by age 3 to 4 months. One month is too young for binocularity. If binocularity is not achieved by 6 to 12 months, the child must be observed for strabismus.

A nurse looks over her assignment for the day that includes an infant, a preschool-age child, a third-grader, and a sophomore in high school. Which techniques take into consideration developmental stages when working with pediatric patients? A Being aware that infants will become agitated due to stranger anxiety around age 4 months B When a preschooler is getting blood drawn, giving a detailed explanation will be helpful C Explaining and demonstrating what the blood pressure machine does to the third-grader before taking her blood pressure D Using a single consistent approach with the adolescent will help allay anger and hostility

C

As the nurse assigned to a child diagnosed with bacterial meningitis, you know that: A The child will not need to be placed in isolation because antibiotics have been started B Enteric precautions will remain in place for up to 48 hours C Respiratory isolation will remain in place for 24 hours after antibiotics are started D Due to headache, the child will want the head of the bed elevated with two pillows

C

Family systems theory includes: A Direct causality, meaning each change affects the whole family B Family systems react to changes as they take place, not initiate it C A balance between morphogenesis and morphostasis is necessary D Theory is used primarily for family dysfunction and pathology

C

When caring for their infant, a parent asks you, "Is Emily in a lot of pain? How would you know since she can't really tell you?" The best answer to this question is: A "Infants don't feel pain as we do because their pain receptors are not fully developed yet." B "The nurses give pain medication before she really feels the pain." C "We assess her pain using an infant pain assessment tool and give the medicine as needed." D "Although we try to give her medicine before she feels pain, we watch her very closely and use different techniques to help relieve the pain."

D

Separation anxiety is something that affects children when they are hospitalized. Each developmental stage has a somewhat different reaction as they deal with this difficulty. Which stage corresponds to the adolescent stage? A May demonstrate separation anxiety by refusing to eat, experiencing difficulty in sleeping, crying quietly for their parents, continually asking when the parents will visit, or withdrawing from others B Separation anxiety comes in stages: protest, despair, detachment C Loss of peer group contact may pose a severe emotional threat because of loss of group status, inability to exert group control or leadership, and loss of group acceptance D May need and desire parental guidance or support from other adult figures but may be unable or unwilling to ask for it

C

The most common complication that should be anticipated and observed for in an infant with myelomeningocele after surgical repair of the defect is: A Urinary stress B Chiari malformation C Hydrocephalus D Latex allergy

C

The nurse is explaining the strategy of consequences to a parent he is working with. Which response by the parent indicates more teaching is needed when he describes the types of consequences? A Natural: Those that occur without any intervention B Logical: Those that are directly related to the rule C Transforming: Allowing the child to come to the conclusion on his or her own D Unrelated: Those that are imposed deliberately

C

You are caring for a child with hydrocephalus who is postoperative from a shunt revision. Which assessment finding is your priority for increased intercranial pressure? A Nausea and refusal to eat postoperatively B Complaint of a headache C Irritability and wanting to sleep D Decrease in heart rate over the last hour

D

A significant common side effect that occurs with opioid administration is euphoria. diuresis. constipation. allergic reactions.

C Constipation is one of the most common side effects of opioid administration. Preventive strategies should be implemented to minimize this problem. Sedation is a more common result than euphoria. Urinary retention, not diuresis, may occur with opiates. Rarely, some individuals may have pruritus.

The nurse is caring postoperatively for an 8-year-old child with multiple fractures and other trauma resulting from a motor vehicle injury. The child is experiencing severe pain. Which of the following is an important consideration in managing the child's pain? Give only an opioid analgesic at this time. Increase the dosage of analgesic until the child is adequately sedated. Plan a preventive schedule of pain medication around the clock. Give the child a clock and explain when she or he can have pain medications.

C For severe postoperative pain, a preventive around-the-clock schedule is necessary to prevent decreased plasma levels of medications. The opioid analgesic will help for the present but is not an effective strategy. Increasing the dosage requires an order. The nurse should give the drug on a regular schedule and evaluate the effectiveness. Giving the child a clock and explaining when she or he can have pain medications is counterproductive. It focuses the child's attention on how long he or she will need to wait for pain relief.

The nurse is caring for an unconscious 10-year-old child. Skin care should include which of the following? Avoid use of a pressure-reduction device on the bed. Massage reddened bony prominences to prevent deep tissue damage. Use a draw sheet to move the child in bed to reduce friction and shearing injuries. Avoid rinsing the skin after cleansing with mild antibacterial soap to provide a protective barrier.

C A draw sheet should be used to move the child in the bed or onto a gurney to reduce friction and shearing injuries. Do not drag the child from under the arms. Pressure-reduction devices should be used to redistribute weight. Bony prominences should not be massaged if reddened. Deep tissue damage can occur. Pressure-reduction devices should be used instead. The skin should be cleansed with mild nonalkaline soap or soap-free cleaning agents for routine bathing.

A child is brought to the emergency department after experiencing a seizure at school. He has no history of seizures. The father tells the nurse that he cannot believe the child has epilepsy. The nurse's best response is which of the following? "Epilepsy is easily treated." "Very few children have actual epilepsy." "The seizure may or may not mean that your child has epilepsy." "Your child has had only one convulsion; it probably won't happen again."

C A single seizure event is not classified as epilepsy and is generally not treated with long-term antiepileptic drugs. It can be the result of an acute medical or neurologic disease. True epilepsy is not easily treated, so saying that it is easily treated minimizes the father's concern. The statistics on epilepsy do not address the father's issues about his child. The seizure may or may not mean that a child has epilepsy, so it may not happen again. The nurse needs to provide the information to the parent that the diagnosis is not based on one seizure episode.

The nurse is admitting a young child to the hospital because bacterial meningitis is suspected. Which of the following is a priority of nursing care? Initiate isolation precautions as soon as diagnosis is confirmed. Provide environmental stimulation to keep the child awake. Administer antibiotic therapy as soon as it is available. Administer sedatives and analgesics on a preventive schedule to manage pain.

C Administering antibiotic therapy is the priority action. Antibiotics are begun as soon as possible to avoid resultant disabilities and to prevent death. Isolation should be instituted as soon as diagnosis is anticipated. It is important to decrease the external stimuli. The nurse should keep the room as quiet as possible. Antibiotics are the priority function; pain should be managed if it occurs.

Which of the following is a potential cause of a postoperative decrease in blood pressure? Shock (early sign) Carbon dioxide retention Vasodilating anesthetic agents Increased intracranial pressure

C Anesthetic agents and opioids can contribute to a decrease in blood pressure in the postoperative period. Decreased blood pressure is a late sign of shock. Carbon dioxide retention results in increased blood pressure. Increased intracranial pressure results in increased blood pressure.

The nurse is caring for a child with multiple injuries who is comatose. The nurse should recognize that pain cannot occur if the child is comatose. may occur if the child regains consciousness. requires astute nursing assessment and management. is best assessed by family members who are familiar with the child.

C Because the child cannot communicate pain through one of the standard pain rating scales, the nurse must focus on physiologic and behavioral manifestations. The child can be in pain while comatose. The family can provide insight into different responses, but the nurse should monitor physiologic and behavioral manifestations.

A common initial reaction of parents to illness or injury and hospitalization in their child is which of the following? Relief Anger Frustration Depression

C Fear, anxiety, and frustration are common initial responses of parents. Relief is not a common reaction to hospitalization. Anger or guilt is usually the second reaction stage. Parents may finally react with some form of depression related to the physical and emotional exhaustion associated with a hospitalized child.

The nurse working in an outpatient surgery center for children should understand that children's anxiety is minimal in such a center. waiting is not stressful for parents in such a center. families need to be prepared for what to expect after discharge. accurate and complete discharge teaching is the responsibility of the surgeon.

C Parents need explicit instructions when taking their child home. The guidelines should include what observations need to be made and when to call the practitioner about changes in the child's condition. Less stress will exist because of the shortened hospital stay, but the parents will still have anxiety related to the surgery setting. Families will still be waiting during the procedure. This is reported to be one of the most stressful times. The surgeon will provide prescriptions and instructions related to the surgical procedure. The nurse's role is to prepare the family with both written and verbal instructions before discharge.

A 3-year-old child is being admitted for about 1 week of hospitalization. Her parents tell the nurse that they are going to buy her "a lot of new toys because she will be in the hospital." The nurse's reply should be based on an understanding of which of the following? New toys make hospitalization easier. New toys are usually better than older ones for children of this age. At this age, children often need the comfort and reassurance of familiar toys from home. Buying new toys for a hospitalized child is a maladaptive way to cope with parental guilt.

C Parents should bring favorite items from home for the child. Young children associate inanimate objects with significant people, and they gain comfort and reassurance from these items. Because the parents leave the objects at the hospital, the preschooler knows the parents will return. New toys will not serve the purpose of familiar toys and objects from home. The parents may experience some guilt as a response to the hospitalization, but there is no evidence that it is maladaptive.

A 6-year-old child needs to be hospitalized again because of a chronic illness. The clinic nurse overhears her school-age siblings tell her that they are "sick of Mom always sitting with her in the hospital and playing with her. . . . It isn't fair that you get everything and we have to stay with the neighbors." Which of the following is the nurse's best assessment of this situation? The siblings are immature and probably spoiled. The siblings need to better understand their sister's illness and needs. Jealousy and resentment are common reactions to the illness and hospitalization of a sibling. The family has ineffective coping mechanisms to deal with chronic illness.

C Siblings experience loneliness, fear, and worry, as well as anger, resentment, jealousy, and guilt. The siblings experience stress equal to that of the hospitalized child. These comments are common responses by normal siblings. There is no evidence that the family has maladaptive coping.

An appropriate intervention to encourage food and fluid intake in a hospitalized child is which of the following? Force the child to eat to combat caloric losses. Administer large quantities of flavored fluids at frequent intervals. Give high-quality foods and snacks whenever the child expresses hunger. Discourage participation in noneating activities until caloric intake is sufficient.

C Small, frequent meals and nutritious snacks should be provided for the child. Favorite foods such as peanut butter and jelly sandwiches, fruit yogurt, cheese, pizza, and macaroni and cheese should be available. Forcing a child to eat only meets with rebellion and reinforces the behavior as a control mechanism. Large quantities of fluid may decrease the child's hunger and further inhibit food intake.

A 5-year-old has patient-controlled analgesia (PCA) for pain management after abdominal surgery. Your explanation to the parents should include the child will be pain free. only the child is allowed to push the button for a bolus. the pump allows for a continuous basal rate and delivers a constant amount of medication to control pain. there is a high risk of overdose, so monitoring is done every 15 minutes.

C The PCA prescription can be set for a basal rate for a continued infusion of pain medication to prevent pain from returning during sleep and when the patient cannot control the infusion. Although the goal of PCA is to have effective pain relief, a pain-free state may not be possible. With a child who is 5 years old, the parents and nurse must assess the child to ensure that adequate medication is being given. A child who is 5 years old may not be able to understand the concept of pushing a button. Evidence suggests that effective analgesia can be obtained with the parents and nurse giving boluses as necessary. The prescription for the PCA includes how much medication can be given in a defined period. Monitoring every 1 to 2 hours for patient response is sufficient.

Which of the following self-report pain rating scales can be used in children as young as 3 years of age? Poker Chip Tool Visual Analog Scale FACES Pain Rating Scale Word-Graphic Rating Scale

C The Poker Chip Tool has been validated for children 4 years of age who have been determined to have the cognitive ability to identify the larger of two numbers. The Visual Analog Scale can be used for children older than 4 years of age but is most appropriate for ages 7 and older. The FACES Pain Rating Scale is for children as young as 3 years of age. The Word-Graphic Rating Scale uses descriptive words and is recommended for children 4 to 17 years of age.

Which of the following represents the major stressor of hospitalization for children from middle infancy throughout the preschool years? Fear of pain Loss of control Separation anxiety Fear of bodily injury

C The major stressor of hospitalization for children from infancy through the preschool years is separation anxiety, also called anaclitic depression. Fear of pain, loss of control, and fear of bodily injury are all stressors associated with hospitalization. However, separation from family is a primary stressor in this age group.

The Glasgow Coma Scale consists of an assessment of pupil reactivity and motor response. level of consciousness and verbal response. eye opening and verbal and motor response. intracranial pressure and level of consciousness.

C The scale is a three-part assessment that includes eye opening, verbal response, and motor response. It is an observational tool to detect a life-threatening complication such as cerebral edema. Pupil reactivity, level of consciousness, and intracranial pressure are not included in the scale.

Maria is a Spanish-speaking 5-year-old girl who has started kindergarten in an English-speaking school. Crying most of the time, she appears helpless and unable to function in this new situation. What is the best explanation for this behavior? She lacks adequate maturity for attending school. She lacks the knowledge needed in school. She is experiencing cultural shock. She is experiencing minority group discrimination.

Cultural shock is the helpless feeling and state of disorientation felt by an outsider attempting to adapt to a different culture group. Maria's inability to speak English inhibits her ability to interact. This would explain Maria's inability to function in this new situation. There is no evidence that the child lacks the maturity or knowledge needed in school or is experiencing minority group discrimination.

Which of the following terms best describes a group of people who share a set of values, beliefs, practices, social relationships, laws, politics, economics, and norms of behavior? Race Culture Ethnicity Social group

Culture is a pattern of assumptions, beliefs, and practices that unconsciously frames the outlook and decisions of a group of people. Race is defined as a division of humankind possessing traits that are genetically transmissible. Ethnicity is the affiliation of a set of persons who share a unique cultural, social, and linguistic heritage. A social group consists of a system of roles carried out in both primary and secondary groups. Socialization is the process by which individuals learn the roles that are expected of them.

Which of the following is the most consistent and commonly used indicator of pain in infants? Increased respirations Increased heart rate Thrashing of arms and legs Facial expression of discomfort

D Facial expression has consistently been validated as an indicator of pain in infants. Behavioral pain measures are most reliable for sharp procedural pain in infants. Increased heart rate and respirations are indicative of a generalized and complex response to stress. They are not specific for pain in infants. Thrashing of arms and legs is a reliable indicator in young children, not infants.

The nurse needs to do a heel stick on an ill neonate to obtain a blood sample. Which of the following is recommended to facilitate this? Elevate the foot for 5 minutes. Apply a tourniquet to the ankle. Apply cool, moist compresses. Wrap the foot in a warm washcloth.

D Before the blood sample is taken, the heel is heated with warm moist compresses for 5 to 10 minutes to dilate the blood vessels in the area. Elevating the foot will decrease the blood in the foot available for collection. A tourniquet is used to constrict superficial veins. It will have an insignificant effect on capillaries. Cooling causes vasoconstriction, making blood collection more difficult.

Which of the following would be helpful word(s) to substitute for the word "shot" when working with a 4-year-old? Stick Bee sting Injection Medication under the skin

D "Medication under the skin" clearly and simply describes what will be occurring. A 4-year-old child is in the stage of preoperational thought. The child may literally think the nurse is going to use a stick. This could be frightening to a child at this age. Most likely, there would be no prior experience with a bee sting. "Injection" is a technical term that the child may not understand. It could add additional anxiety.

. When giving liquid medication to a crying 10-month-old infant, which approach minimizes the possibility of aspiration? Keep the child upright with the nasal passages blocked for 1 minute after administration. Mix the medication with the infant's regular formula or juice and administer by bottle. Administer the medication with a cup as rapidly as possible with the infant securely restrained. Administer the medication with a syringe (without needle) placed along the side of the infant's tongue.

D Administering the medication with a syringe (without a needle) placed along the side of the infant's tongue allows the contents to be administered slowly in small amounts. The child is able to swallow between deposits. Holding the child's nasal passages will increase the risk of aspiration. The medication should be mixed with only a small amount of food or liquid. If the child does not finish drinking or eating, it is difficult to determine how much medication was consumed. Essential foods also should not be used. Medications should be given slowly to avoid aspiration.

The nurse should recommend medical attention if a child with a slight head injury experiences which of the following? Vomiting Sleepiness Headache, even if slight Confusion or abnormal behavior

D Altered mental status is a clinical manifestation that the damage from the head injury is progressing. Medical evaluation is necessary. Vomiting may occur after a minor head injury. Observation is required for changes in behavior or vital signs that indicate progression. Sleepiness may occur after a minor head injury. Observation is required to ensure that the child is arousable. Headache is common after a head injury and does not require medical evaluation unless accompanied by other signs of progression.

Therapeutic management of a child with tetanus includes the administration of which of the following? Nonsteroidal antiinflammatory drugs (NSAIDs) to reduce inflammation Muscle stimulants to counteract muscle weakness Bronchodilators to prevent respiratory complications Antibiotics to control bacterial proliferation at the site of injury

D Antibiotics are administered to control the proliferation of the vegetative forms of the organism at the site of infection. Tetanus toxin acts at the myoneural junction to produce muscular stiffness and lowers the threshold for reflex excitability. NSAIDs are not routinely used. Sedatives or muscle relaxants are used to help reduce titanic spasm and prevent seizures. Respiratory status is carefully evaluated for any signs of distress because muscle relaxants, opioids, and sedatives that may be prescribed may cause respiratory depression. Bronchodilators would not be used unless specifically indicated.

The parents of a child with cerebral palsy ask the nurse if any drugs can decrease their child's spasticity. The nurse's response should be based on which of the following? Anticonvulsant medications are sometimes useful for controlling spasticity. Medications that would be useful in reducing spasticity are too toxic for use with children. Many different medications can be highly effective in controlling spasticity. Implantation of a pump to deliver medication into the intrathecal space decreases spasticity.

D Baclofen, given intrathecally, is best suited for children with severe spasticity that interferes with activities of daily living and ambulation. Anticonvulsant medications are used when seizures occur in children with cerebral palsy. The intrathecal route decreases the side effects of the drugs that reduce spasticity. Few medications are currently available for the control of spasticity.

A 3-year-old child is hospitalized after submersion injury. The child's mother complains to the nurse, "This seems unnecessary when he is perfectly fine." The nurse's best reply would be which of the following? "He still needs a little extra oxygen." "I'm sure he is fine, but the doctor wants to make sure." "It is important to observe for possible physical reasons for the accident." "The reason for hospitalization is that complications could still occur."

D Complications such as respiratory compromise and cerebral edema can occur 24 hours after the incident. If the child needed oxygen, the mother would not state the child is perfectly fine. Telling the mother that the doctor wants to make sure the child is fine minimizes the role of the nurse and the need for observation for potential life-threatening complications. Physiologic causes may need to be identified in the case of a submersion injury, but it is not the reason for hospitalization.

An intravenous line is needed in a school-age child. The most appropriate action to provide analgesia during this procedure is to apply TAC (tetracaine, epinephrine [Adrenalin], cocaine) 15 minutes before the procedure. a transdermal fentanyl (Duragesic) patch at the site of venipuncture. EMLA (eutectic mixture of local anesthetics) immediately before the procedure. LMX (4% liposomal lidocaine cream) 30 minutes before the procedure.

D LMX is an effective analgesic agent when applied to the skin 30 minutes before a procedure. It eliminates or reduces the pain from most procedures involving skin puncture. TAC provides skin anesthesia about 15 minutes after application to nonintact skin. The gel can be placed on the wound for suturing. It is not useful for intact skin. Transdermal fentanyl patches are useful for continuous pain control, not rapid pain control. For maximum effectiveness, EMLA must be applied approximately 60 minutes in advance.

A school-age child with cancer is being prepared for a procedure. The child says, "I have had one of these. They hurt." The nurse's response should be based on knowledge that children often lie about experiencing pain. tolerate pain better than adults. become accustomed to painful procedures. commonly experience treatment-related moderate to severe pain when they have cancer.

D Pain is reported by approximately 84% of children with cancer. Of these, most report it as moderate to severe, and half report the pain as highly distressing. There are no data to support that children misrepresent pain experiences. Pain tolerance is a complex phenomenon that is not based on age. Children do not become accustomed to painful procedures.

An adolescent has sustained a spinal cord injury. The first stage, known as spinal shock syndrome, is characterized by increasing spasticity. spinal reflex activity. symptoms of hypertension. flaccid paralysis below level of damage.

D Reflexes are absent at or below the cord lesion. There is flaccidity or limpness of the involved muscles. Spinal reflex activity occurs in the second stage. Symptoms of hypotension occur.

Why are infants particularly vulnerable to acceleration-deceleration head injuries? The anterior fontanel is not yet closed. The nervous tissue is not well developed. The scalp of the head has extensive vascularity. Musculoskeletal support of the head is insufficient.

D The relatively large head size coupled with insufficient musculoskeletal support increases the risk to infants. The anterior fontanel, nervous tissue, and scalp of the head do not have an effect on this type of injury.

Currently, the fastest-growing segment of the homeless population in the United States consists of which of the following? Families "Runaway" adolescents Migrant farm workers Individuals with mental disorders

Homeless individuals lack the resources and community ties necessary to provide for their own adequate shelter. One of the most pressing problems in the United States is the rapidly increasing number of homeless families, which currently account for 50% of the nation's homeless. "Runaway" or throwaway adolescents are often victims of physical and social abuse. Although it is a significant issue, these adolescents do not represent the fastest-growing segment of the homeless population. Migrant farm workers are some of the most severely disadvantaged in the United States. They have a mobile existence that is detrimental for children. They do not constitute the fastest-growing segment of the homeless population. Individuals with mental disorders may be homeless. They do not constitute the fastest-growing segment of the homeless population.

What are some legal and ethical issues that arise for the nurse when using an interpreter? Direct the questions to the interpreter. Ask several questions at a time. The family should be fully informed of all aspects of procedures before consenting. Discourage the interpreter and client from discussing topics not included in the interview.

In obtaining informed consent through an interpreter, the nurse should fully inform the family of all aspects of the particular procedure to which they are consenting. The communication is with the family members. The nurse directs the questions toward the family while observing nonverbal cues. Questions are asked one at a time to allow the interpreter and family to translate, process, and answer the question. The interpreter and client should build a rapport. Discussion of topics outside of the interview allows the two parties to become acquainted.

The father of a hospitalized child tells the nurse, "He can't have meat. We are Buddhist and vegetarians." What is the nurse's best intervention? Order the child a meatless tray as requested. Ask a Buddhist priest to visit the family. Explain that hospital patients are exempt from dietary rules. Help the parent understand that meat provides protein needed for healing.

It is essential for the nurse to respect the religious practices of the child and family. The nurse should arrange a dietary consult to ensure that nutritionally complete vegetarian meals are prepared by the hospital kitchen. It is not necessary to ask a Buddhist priest to visit. The nurse should be able to arrange for a vegetarian tray. The nurse should not encourage the child and parent to go against their religious beliefs. Nutritionally complete, acceptable vegetarian meals should be provided.

What do morbidity rates measure? Life span statistics Acute illness, chronic disease, or disability Cost-effective treatment for the general population Prevalence of a specific illness in a population

Morbidity measures prevalence of a specific illness in a population over a specific period. Life span statistics are included in mortality data. Acute illness, chronic disease, and disability are factors that give morbidity statistics. Cost is not included in morbidity rates.

What is the leading cause of death from unintentional injuries in children? Poisoning Drowning Motor vehicles Fires and burns

Motor vehicle-related injuries are responsible for more than half of the injury-related deaths in children. Half of all poisonings occur in children younger than the age of 4 years, and it is the third leading cause of injury in those 15 to 24 years of age. Drowning and burns are among the top three causes of death for boys and girls throughout childhood.

Which of the following is most likely to encourage parents to talk about their feelings related to their child's illness? Be sympathetic. Ask direct questions. Use open-ended questions. Avoid periods of silence.

Open-ended questions require the parent to answer with more than a brief answer. Closed-ended questions should be avoided when attempting to elicit parents' feelings. Sympathy is having feelings or emotions in common with another person rather than understanding those feelings (empathy). Sympathy is not therapeutic in the helping relationship. Direct questions may obtain limited information. In addition, they may be considered threatening by the parent. Silence can be an effective interviewing tool. It allows a sharing of feelings in which two or more people absorb the emotion in depth. Silence permits the interviewee to sort out thoughts and feelings and search for responses to questions.

A child who has been receiving morphine intravenously will now start receiving it orally. The nurse should anticipate that to achieve equianalgesia (equal analgesic effect), the oral dose will be which of the following? Same as the intravenous dose Greater than the intravenous dose One half of the intravenous dose One fourth of the intravenous dose

Oral morphine undergoes significant metabolism from the first-pass effect. For this reason, a higher oral dose is necessary to achieve the same effect as parenteral morphine. The same dose given orally will provide less pain relief. A dose larger than the intravenous dose must be given to achieve an equianalgesic effect.

Which of the following approaches is the most appropriate when performing a physical assessment on a toddler? Demonstrate use of equipment. Perform traumatic procedures first. Use minimum physical contact initially. Always proceed in a head-to-toe direction.

Parents can remove clothing, and the child can remain on the parent's lap. The nurse should use minimum physical contact initially to gain the cooperation of the child. The nurse should introduce the equipment slowly. The child can inspect the equipment, but demonstrations are usually too complex for this age group. Traumatic procedures should always be performed last. These will most likely upset the child and inhibit cooperation. The head-to-toe assessment can be done in older children but usually must be adapted in younger children.

What nursing intervention is most descriptive of atraumatic care of children? Preparing a child before any unfamiliar treatment or procedure Preparing a child for separation from parents during hospitalization Helping a child accept pain that is associated with a treatment or procedure Helping a child accept the loss of control associated with hospitalization

Proper preparation of a child before any unfamiliar procedure is an essential component of atraumatic care. A major principle of atraumatic care is to minimize the separation from parents. Interventions are used to reduce and eliminate bodily injury and pain whenever possible. Children should be allowed choices and control whenever possible.

The nurse is beginning to administer the Denver II to a small child when his mother asks, "Can you tell me again what this Denver II is?" The nurse's best response is which of the following? "It's a simple intelligence test for young children." "It tells us what a child can do at a particular age." "It's a test we give to measure a child's development." "It's an excellent way to see if a child's development is normal."

The Denver II is a developmental screening tool that assesses the child's abilities at different ages. The Denver II is a screening tool for developmental milestones, not intelligence. Children are not expected to perform each item on the Denver II. Most children will perform tasks in a range. The Denver II is used to provide an indication of the child's developmental level.

The nurse is assessing a 3-year-old African American child who is being seen in the clinic for the first time. The child's height and weight are at the 20th percentile on the commonly used growth chart from the National Center for Health Statistics (NCHS). When interpreting these data, the nurse should recognize which of the following? The data suggest the child requires nutritional intervention. The NCHS charts are accurate for U.S. African American children. A correction factor is used when the NCHS chart is used for nonwhite ethnic groups. No assessment can be made until several measurements are plotted over time.

The NCHS growth charts can serve as reference guides for all racial or ethnic groups. U.S. African American children were included in the sample population. The 20th percentile for height and weight are not indicative of nutritional failure. No correction factor exists. The growth chart can be used with the perspective that different groups of children have varying normal distributions on the growth curves. Serial measurements are useful for longitudinal assessment of the child; single data points provide information about the child's current status.

Which of the following is most suggestive that a nurse has a nontherapeutic relationship with a patient or family? Staff members are concerned about the nurse's actions with the patient or family. Staff assignments allow the nurse to care for the same patient or family over an extended time. The nurse uses teaching skills to instruct the patient or family rather than doing everything for them. The nurse is able to withdraw emotionally when emotional overload occurs but still remain committed.

The concern of other staff members may indicate that the nurse is exhibiting negative behaviors and may be involved in a nontherapeutic relationship. Consistent staff assignments are important to provide continuity of care and contribute to therapeutic relationships. Using teaching skills to instruct the patient or family rather than doing everything for them empowers the family and facilitates their caring for the child. In therapeutic relationships, the nurse must recognize and maintain professional boundaries. The ability to recognize when these are being eroded is essential.

Kimberly is having a checkup before starting kindergarten. The nurse asks her to do the "finger-to-nose test." The nurse is testing for which of the following? Deep tendon reflexes Cerebellar function Sensory discrimination Ability to follow directions

The finger-to-nose test is an indication of cerebellar function. This test checks balance and coordination. Each deep tendon reflex is tested separately. Each sense is tested separately. Although performing this test can demonstrate the child's ability to follow directions, it is used primarily for cerebellar function.

The nurse is taking a health history on a child. At the beginning of the interview, a parent says, "I brought him here because he always has diarrhea." This should be recorded under which of the following headings? History Chief complaint Review of systems Nutritional assessment

The mother has verbalized the specific reason for the child's visit to the health care provider. The chief complaint is the reason for which the child has been brought to the clinic, office, or hospital. History refers to information that relates to previous aspects of the child's health, not the current health. The review of systems is a specific review of each body system. It usually begins with a statement similar to asking the parent to describe how the child's general health has been. A nutritional assessment combines a nutrition history with a physical examination.

Which of the following is descriptive of nursing diagnoses? They provide the basis for the selection of nursing interventions. They should describe everything for which nursing is responsible. The cause of the problem must be identified before a nursing diagnosis can be made. The cause of the problem implies a cause-and-effect relationship in the nursing diagnosis.

The nursing diagnosis is the clinical judgment about the client's response to actual or potential health problems. The outcome statement guides the necessary interventions. Nursing diagnoses do not describe all areas of nursing practice. An actual problem may not exist. There may be risk factors that predispose a child or family to dysfunctional health patterns. There may not be a direct cause-and-effect relationship expressed in the diagnostic statement.

The nurse has a 2-year-old boy sit in "tailor" position while palpating for the presence of the testes. What is the rationale for this position? It prevents the cremasteric reflex. Undescended testes can be palpated. The child has an inguinal hernia. The child does not yet have a need for privacy.

The tailor position stretches the muscle responsible for the cremasteric reflex. This prevents its contraction, which pulls the testes into the pelvic cavity. Undescended testes cannot be predictably palpated. Inguinal hernias are not detected by this method. Privacy should always be provided for children.

When taking a child's blood pressure, the nurse should select a cuff with a bladder width that is large enough to cover what percentage of the upper arm? 20% 40% 60% 80%

The width of the cuff bladder ideally covers 40% of the arm circumference at the midpoint of the upper arm. Twenty percent is too small and may give falsely elevated blood pressure values. Sixty percent and 80% are too large and may give falsely low blood pressure values.

In 1935 Title V of the Social Security Act was passed. This was significant in the evolution of child health care in the United States because it established what? Medicaid Children's Bureau Child Welfare Services White House Conferences on Children

This legislation provided for federal grants to be given to states for three major programs, Maternal Child Health, Crippled Children's Services, and Child Welfare Services. Medicaid was created in 1965 to reduce financial barriers to health care for poor individuals. The Children's Bureau was established in 1912 and was placed under the Department of Health, Education and Welfare. The White House Converences on Children was first convened in 1909.

Which one of the following approaches would be best to use to ensure a receptive response from a toddler? Focus communication on the child and tell him or her how a procedure will feel. Call the toddler's name while picking up him or her. Call the toddler's name and say, "I am your nurse." Stand by the toddler, addressing him or her by name.

Toddlers see things only in relation to themselves and from their point of view. A stranger picking up a child up in an unfamiliar environment is very frightening for the toddler. Toddlers will not know the meaning of "nurse." Unknown adults who call the toddler by name can frighten the child.

The health promotion interventions that have the greatest impact on injury prevention are which of the following? Utilization of auditory learning strategies for all families Including the nutritional counseling for the food pyramid Integrating Maslow's hierarchy of needs in the lesson Using a developmental approach to safety counseling

Utilizing a developmental approach to safety counseling will ensure that the parents are taught risks associated with developmental age and increased risk factors for that population. Family members may have different learning styles, so the nurse should include several strategies in the health promotion teaching session. Although nutritional counseling is important, it is not an injury prevention health promotion priority for preventing injury. Maslow's hierarchy of needs is a theoretical model to assist in assuring all the needs of an individual are met, but it is not the theoretical model of choice in this scenario.

Which of the following statements is true concerning folk remedies? They may be used to reinforce the treatment plan. They are incompatible with modern medical regimens. They are a leading cause of death in some cultural groups. They are not a part of the culture in large, developed countries.

Whenever folk remedies are compatible, they should be used to reinforce the treatment plan. This will assist in establishing a caring environment. Depending on the folk remedy, it may not be incompatible with modern medical regimens. Occasionally, a folk remedy can lead to death, but this varies with the remedy and its use. The roles that folk remedies have in large, developed countries vary depending on the remedies and the country's cultures.

Which of the following statements is true concerning the increased use of telephone triage by nurses? Health care costs have increased as a result. Emergency department visits are not recommended. Access to high-quality health care services has increased. Home care is recommended when it is not appropriate.

With well-designed telephone triage programs, access to high-quality health care services and patient satisfaction have increased. With the reduction in unnecessary emergency department and clinic visits, health care costs have decreased. Emergency department visits are recommended based on the response to screening questions and when the child's condition is in doubt. Guidelines are given for home management if the triage assessment indicates that level of care. Parents are given instructions about changes in the child's condition to report.

The nurse is planning how to prepare a 4-year-old child for some diagnostic procedures. Guidelines for preparing this preschooler should include which of the following? Keep equipment out of the child's view. Plan for a short teaching session of about 30 minutes. Tell the child procedures are never a form of punishment. Use correct scientific and medical terminology in explanations.

c Preschoolers may view illness and hospitalization as punishment. Always state directly that procedures are never a form of punishment. Demonstrate the use of equipment and allow the child to play with miniature or actual equipment. Teaching sessions for this age group should be 10 to 15 minutes in length. Explain the procedure and how it affects the child in simple terms.

Which of the following should the nurse consider when having informed consent forms signed for surgery and procedures on children? Only a parent or legal guardian can give consent. The person giving consent must be at least 18 years old. The risks and benefits of a procedure are part of the consent process. A mental age of 7 years or older is required for a consent to be considered "informed."

c The informed consent must include the nature of the procedure, benefits and risks, and alternatives to the procedure. In special circumstances, such as emancipated minors, the consent can be given by someone younger than age 18 years without the parent or legal guardian. A mental age of 7 years is too young for consent to be informed.