Exam 1 sellect all that apply

Question 1

1b. The nurse is teaching parents of preschool children consequences of inadequate sleep. What should the
nurse include in the teaching session? (Select all that apply.)

a. Behavior changes
b. Increased appetite
c. Difficulty concentrating
d. Poor control of emotions
e. Impaired learning ability

Answer 1

Consequences of inadequate sleep include daytime tiredness, behavior changes, hyperactivity, difficulty
concentrating, impaired learning ability, poor control of emotions and impulses, and strain on family
relationships. Increased appetite is not a consequence of inadequate sleep.

Question 2

2B. The nurse is administering activated charcoal to a preschool child with acetaminophen (Tylenol) poisoning. What potential complications from the use of activated charcoal should the nurse plan to assess for? (Select all
that apply.)

a. Diarrhea
b. Vomiting
c. Fluid retention
d. Intestinal obstruction

Answer 2

ANS: B, D

Potential complications from the use of activated charcoal include vomiting and possible aspiration, constipation, and intestinal obstruction. Diarrhea and fluid retention are not potential complications of
activated charcoal administration.

Question 3

3B. . What can the nurse suggest to families to reduce blood lead levels? (Select all that apply.)

a. Do not store food in open cans.
b. Ensure the child eats regular meals.
c. Mix formula with hot water from the tap.
d. Vacuum hard-surfaced floors and window wells.
e. Wash and dry the childs hands and face frequently.

Answer 3

ANS: A, B, E

To reduce blood lead levels, the family should ensure the child eats regular meals because more lead is
absorbed on an empty stomach. The childs hands and face should be washed and dried frequently, especially
before eating. Food should not be stored in open cans, particularly if cans are imported. Hot water dissolves
lead more quickly than cold water and thus contains higher levels of lead. Hot water should not be used to mix
formula. Hard-surfaced floors or window sills or wells should not be vacuumed because this spreads dust.

Question 4

4B. What are symptoms of abusive head trauma (AHT) in the more severe form that may be present?(Select all that apply.)

a. Seizures
b. Posturing
c. Tachypnea
d. Tachycardia
e. Altered level of consciousness

Answer 4

ANS: A, B, E

In more severe forms, presenting symptoms of abusive head trauma may include seizures, posturing, alterations in level of consciousness, apnea, bradycardia, or death.

Question 5

5B. 5. The nurse is teaching parents of preschool-aged children strategies to prevent sexual abuse. What should the nurse include in the teaching session? (Select all that apply.)

a. Back up a childs right to say no.
b. Dont take what your child says too seriously.
c. Take a second look at signals of potential danger.
d. Dont be too detailed about examples of sexual assault.
e. Remind children that even nice people sometimes do mean things

Answer 5

ANS: A, C, E

To provide protection and preparation from sexual abuse, parents should back up a childs right to say no, take a
second look at signals of potential danger, and remind children that even nice people sometimes do mean
things. Parents should take what children say seriously and they should give specific definitions and examples
of sexual assault.

Question 6

6B. A parent asks the nurse about the characteristics of a nightmare. What response should the nurse give to the parent? (Select all that apply.)

a. Nightmares are scary dreams.
b. The child can describe the nightmare.
c. The child is reassured by your presence.
d. Nightmares occur usually 1 to 4 hours after falling asleep.
e. Nightmares take place during nonrapid eye movement sleep

Answer 6

ANS: A, B, C

Nightmares are scary dreams, the child can describe the nightmare, and the child is reassured by a parents
presence. Sleep terrors occur usually 1 to 4 hours after falling asleep, but nightmares occur in the second half
of sleep. Sleep terrors occur during nonrapid eye movement sleep, but nightmares occur during rapid eye
movement sleep.

Question 7

7B. A parent asks the nurse about the characteristics of a sleep terror. What response should the nurse give to the
parent? (Select all that apply.)

a. The child screams during the sleep terror.
b. Return to sleep is delayed because of persistent fear.
c. The night terror occurs during the second half of night.
d. The child has no memory of the dream with a sleep terror.
e. The child is not aware of anothers presence during a sleep terror.

Answer 7

ANS: A, D, E

During sleep terrors, the child screams and has no memory of the dream. The child is not aware of anothers presence during a sleep terror. Return to sleep is usually rapid with a sleep terror, but it is delayed with a nightmare. The sleep terror occurs usually within 1 to 4 hours of sleep, but nightmares occur during the second
half of night.

Question 8

8B. What are classified as hydrocarbon poisons? (Select all that apply.)

a. Bleach
b. Gasoline
c. Turpentine
d. Lighter fluid
e. Oven cleaners

Answer 8

ANS: B, C, D

Gasoline, turpentine, and lighter fluid are classified as hydrocarbon poisons. Bleach and oven cleaners are classified as corrosive poisons.

Question 9

9B. . What identified characteristics occur more frequently in parents who abuse their children? (Select all that
apply.)

a. Older parents
b. Socially isolated
c. Middle class parents
d. Single-parent families
e. Few supportive relationships

Answer 9

ANS: B, D, E

Abusive families are often socially isolated and have few supportive relationships. Single-parent families are at
higher risk for abuse. Younger parents more often are abusers of their children. Abusive parents have stressors
such as low-income circumstances, with little education, and are not middle class parents.

Question 10

10B. What are classified as corrosive poisons? (Select all that apply.)

a. Batteries
b. Paint thinner
c. Drain cleaners
d. Mineral seed oil
e. Mildew remover

Answer 10

ANS: A, C, E

Batteries, drain cleaners, and mildew removers are classified as corrosive poisons. Paint thinner and mineral
seed oil are classified as hydrocarbon poisons.

Question 11

1. The nurse is caring for a child who has a temperature of 30 C (86 F). What physical effects of hypothermia
   should the nurse expect to observe in this child? (Select all that apply.)

a. Reduced urinary output
b. Injury to peripheral tissue
c. Increased blood pressure
d. Tachycardia
e. Irritability with loss of consciousness
f. Rigid extremities

Answer 11

ANS: C, D, E

Hypothermia has varying physical effects depending on the childs core temperature. At 30 C (86 F), a child
would experience an increase in blood pressure, tachycardia, and irritability followed by a loss of
consciousness. Reduced urinary output from a decrease of blood flow to the kidneys, injury to peripheral
tissue, and rigid extremities are physical effects observed as the body temperature continues to decrease.

Question 12

2. The nurse is teaching a school-age child about factors that can delay wound healing. What factors should the nurse include in the teaching session? (Select all that apply.)
   a. Deficient vitamin C
   b. Deficient vitamin D
   c. Increased circulation
   d. Dry wound environment
   e. Increase in white blood cells

Answer 12

ANS: A, B, D

Factors that delay wound healing are a dry wound environment (allows epithelial cells to dry), deficient
vitamin C (inhibits formation of collagen fibers), and deficient vitamin D (regulates growth and differentiation
of cell types). Decreased, not increased, circulation delays healing. An increase in the white blood cell count
may occur but does not delay healing.

Question 13

3. The school nurse is assessing a childs severely scraped knee for infection. What are signs of a wound infection? (Select all that apply.)
   a. Odor
   b. Edema
   c. Dry scab
   d. Purulent exudate
   e. Decreased temperature

Answer 13

ANS: A, B, D

Signs of wound infection are odor, edema, and purulent exudate. Increased, not decreased, temperature
indicates infection. A dry scab over the wound is part of the healing process.

Question 14

4. The nurse is teaching parents of a school-age child how to cleanse small wounds. What should the nurse
   advise the parents to avoid using to cleanse a wound? (Select all that apply.)

a. Alcohol
b. Normal saline
c. Tepid water
d. Povidoneiodine
e. Hydrogen peroxide

Answer 14

ANS: A, D, E

Caution caregivers to avoid cleansing the wound with povidoneiodine, alcohol, and hydrogen peroxide because
these products disrupt wound healing. Normal saline and tepid water are safe to use when cleansing wounds.

Question 15

5. The emergency department nurse is admitting a child with a temperature of 35 C (95 F). What physical effects of hypothermia should the nurse expect to observe in this child? (Select all that apply.)
   a. Bradycardia
   b. Vigorous shivering
   c. Decreased respiratory rate
   d. Decreased intestinal motility
   e. Task performance is impaired

Answer 15

ANS: B, D, E

Hypothermia has varying physical effects depending on the childs core temperature. At 35 C (95 F), a child
would experience vigorous shivering, decreased intestinal motility, and task performance impairment. Bradycardia and decreased respiratory rate are physical effects observed as the body temperature continues to
decrease.

Question 16

6. The nurse is caring for a child with psoriasis. What local manifestations does the nurse expect to assess in
   this child? (Select all that apply.)

a. Development of wheals
b. First lesions appear in the scalp
c. Round, thick, dry reddish patches
d. Lesions appear in intergluteal folds
e. Patches are covered with coarse, silvery scales

Answer 16

ANS: B, C, E

Local manifestations of psoriasis include lesions that appear in the scalp initially and round, thick dry patches
covered with coarse, silvery scales. Development of wheals is seen in urticaria. Lesions in intergluteal folds are
characteristic of intertrigo.

Question 17

7. The nurse is caring for a child with erythema multiforme (Stevens-Johnson syndrome). What local
   manifestations does the nurse expect to assess in this child? (Select all that apply.)

a. Papular urticaria
b. Erythematous papular rash
c. Lesions absent in the scalp
d. Lesions enlarge by peripheral expansion
e. Firm papules that may be capped by vesicles

Answer 17

ANS: B, C, D

Local manifestations of erythema multiforme include an erythematous popular rash, lesions involving most
skin surfaces except the scalp and lesions that enlarge by peripheral expansion. Papular urticaria and firm papules capped by vesicles are characteristics of an insect bite.

Question 18

8. The nurse is caring for a child with neurofibromatosis. What local manifestations does the nurse expect to
   assess in this child? (Select all that apply.)

a. Pigmented nevi
b. Axillary freckling
c. Caf-au-lait spots
d. Slowly growing cutaneous neurofibromas
e. Wheals that spread irregularly and fade within a few hours

Answer 18

ANS: A, B, C, D

Local manifestations of neurofibromatosis include pigmented nevi, axillary freckling, caf-au-lait spots, and
slowly growing cutaneous neurofibromas. Wheals that spread irregularly and fade within a few hours are
characteristic of urticaria.

Question 19

1. What conditions are physical complications of obesity? (Select all that apply.)
   a. Type 2 diabetes mellitus
   b. QT interval prolongation
   c. Fatty liver disease
   d. Gastrointestinal dysfunction
   e. Abnormal growth acceleration
   f. Dental erosion

Answer 19

ANS: A, C, E

Physical complications of obesity include type 2 diabetes mellitus, which is reaching epidemic proportions in
children and adolescents; fatty liver disease not related to alcohol consumption; and abnormal growth
acceleration in which overweight children tend to be taller and mature earlier than children who are not
overweight. Prolonged QT intervals, gastrointestinal dysfunction, and dental erosion are physical
complications observed in children or adolescents who have eating disorders such as anorexia nervosa or
bulimia.

Question 20

2. The nurse is teaching an adolescent about the use of tretinoin (Retin-A). What should the nurse include in
   the teaching session? (Select all that apply.)

a. Begin with a pea-sized dot of medication.
b. Apply additional medication to the throat.
c. Use sunscreen daily and avoid the sun when possible.
d. Divide the medication into the three main areas of the face.
e. Apply the medication immediately after washing the face.

Answer 20

ANS: A, C, D

Tretinoin is available as a cream, gel, or liquid. This drug can be extremely irritating to the skin and requires
careful patient education for optimal usage. The patient should be instructed to begin with a pea-sized dot of medication, which is divided into the three main areas of the face and then gently rubbed into each area. The
avoidance of the sun and the daily use of sunscreen must be emphasized because sun exposure can result in
severe sunburn. The medication should not be applied for at least 20 to 30 minutes after washing to decrease
the burning sensation. The medication should not be applied to the throat.

Question 21

3. The clinic nurse is assessing an adolescent on a topical antibacterial agent. The nurse should assess for
   which side effects that can be seen with topical antibacterial agents? (Select all that apply.)

a. Burning
b. Dryness
c. Dry eyes
d. Erythema
e. Nasal irritation

Answer 21

ANS: A, B, D

Side effects of topical antibacterial medications include erythema, dryness, and burning; using the medications
every other day will decrease the adverse effects. Dry eyes and nasal irritation are seen with use of isotretinoin, 13-cis-retinoic acid (Accutane).

Question 22

4. What are risk factors of testicular cancer? (Select all that apply.)
   a. Hispanic
   b. Infertility
   c. Alcohol use
   d. Tobacco use
   e. Family history

Answer 22

ANS: B, D, E

Risk factors of testicular cancer include infertility, tobacco use, and a family history. White, not Hispanic, ethnicity is a high risk, and alcohol use is not a risk.

Question 23

5. The nurse is caring for an adolescent male with gynecomastia. What groups of drugs can induce
   gynecomastia in male adolescents? (Select all that apply.)

a. Oral antibiotics
b. Oral ketoconazoles
c. Calcium channel blockers
d. Histamine-2 receptor blockers
e. Cancer chemotherapeutic agents

Answer 23

ANS: B, C, D, E

Gynecomastia may be drug induced; calcium channel blockers, cancer chemotherapeutic agents, histamine-2
receptor blockers, and oral ketoconazoles have all been shown to cause the disorder. Oral antibiotics have not
been shown to cause gynecomastia.

Question 24

6. What menstrual disorders are indications for a pelvic examination? (Select all that apply.)
   a. Amenorrhea
   b. Dyspareunia
   c. Impaired fertility
   d. Irregular uterine or vaginal bleeding
   e. Dysmenorrhea unresponsive to therapy

Answer 24

ANS: A, D, E

Indications for a pelvic examination include amenorrhea, irregular uterine or vaginal bleeding, and
dysmenorrhea unresponsive to therapy. Impaired fertility is not an indication for a pelvic examination; it can
be a result of endometriosis. Dyspareunia (painful intercourse) is not an indication for a pelvic examination but
may be a sign of endometriosis.

Question 25

7. The nurse is teaching an adolescent girl strategies to relieve dysmenorrhea. What should the nurse include in the teaching session? (Select all that apply.)
   a. Effleurage
   b. Diet high in fat
   c. Limiting exercise
   d. Use of a heating pad
   e. Massaging the lower back

Answer 25

ANS: A, D, E

Dysmenorrhea can be relieved by heat (heating pad or hot bath), which minimizes cramping by increasing
vasodilation and muscle relaxation and minimizing uterine ischemia. Also, massaging the lower back can
reduce pain by relaxing paravertebral muscles and increasing the pelvic blood supply. Soft, rhythmic rubbing
of the abdomen (effleurage) is useful because it provides a distraction and an alternative focal point. A low-fat, not a high-fat, diet can help with dysmenorrhea, and exercise should not be limited because exercise can be
beneficial.

Question 26

8. The nurse is preparing to administer danazol (Danocrine) to a patient with endometriosis. What are the side effects of this medication? (Select all that apply.)
   a. Insomnia
   b. Hot flashes
   c. Amenorrhea
   d. Increased libido
   e. Vaginal secretions

Answer 26

ANS: A, B, C

The side effects of danazol are amenorrhea, hot flashes, vaginal dryness, insomnia, and decreased libido.

Question 27

9. The nurse is teaching an adolescent female about the symptoms of premenstrual syndrome (PMS). What
   symptoms should the nurse include in the teaching session? (Select all that apply.)

a. Headaches
b. Fluid retention
c. Increased energy
d. Emotional changes
e. Premenstrual cravings

Answer 27

ANS: A, B, D, E

Symptoms of PMS include fluid retention (abdominal bloating, pelvic fullness, edema of the lower extremities, breast tenderness, and weight gain), behavioral or emotional changes (depression, crying spells, irritability, panic attacks, and impaired ability to concentrate), premenstrual cravings (sweets, salt, increased appetite, and
food binges), headache, and backache. Fatigue rather than increased energy occurs.

Question 28

10. The nurse is teaching an adolescent with premenstrual syndrome (PMS) dietary measures to relieve the symptoms of PMS. What should the nurse include in the teaching session? (Select all that apply.)
    a. Limit salt in the diet.
    b. Limit legumes in the diet.
    c. Include red meat in the diet.
    d. Include whole grains in the diet.
    e. Limit consumption of refined sugar

Answer 28

ANS: A, D, E

Dietary treatment for PMS includes limiting consumption of refined sugar, salt, red meat, alcohol, and
caffeinated beverages. Women can be encouraged to include whole grains, legumes, seeds, nuts, vegetables,
fruits, and vegetable oils in their diet.

Question 29

11. The nurse is teaching an adolescent female with primary dysmenorrhea foods that are natural diuretics. What foods should the nurse include in the teaching plan? (Select all that apply.)
    a. Peaches
    b. Asparagus
    c. Watermelon
    d. Wheat bread
    e. Dairy products

Answer 29

ANS: A, B, C

Natural diuretics such as asparagus, cranberry juice, peaches, parsley, or watermelon may help reduce edema
and related discomforts of primary dysmenorrhea. Wheat bread and dairy products are not natural diuretics.

Question 30

12. The school nurse is teaching a group of adolescent females which measures to take to prevent genital tract infections. What should the nurse include in the teaching session? (Select all that apply.)
    a. Use condoms.
    b. Douche once a week.
    c. Avoid tight-fitting clothing.
    d. Limit exposure to bubble baths.
    e. Avoid colored and scented toilet tissue

Answer 30

ANS: A, C, D, E

Measure to take to prevent genital tract infections include using condoms, avoiding tight-fitting clothing,
limiting exposure to bubble baths, and avoiding colored and scented toilet tissue. Douching should be avoided.

Question 31

1. The nurse is preparing a presentation on compensated, decompensated, and irreversible shock in children. What clinical manifestations related to decompensated shock should the nurse include? (Select all that apply.)
   a. Tachypnea
   b. Oliguria
   c. Confusion
   d. Pale extremities
   e. Hypotension
   f. Thready pulse

Answer 31

ANS: A, B, C, D

As shock progresses, perfusion in the microcirculation becomes marginal despite compensatory adjustments, and the signs are more obvious. Signs include tachypnea, oliguria, confusion, and pale extremities, as well as
decreased skin turgor and poor capillary filling. Hypotension and a thready pulse are clinical manifestations of
irreversible shock

Question 32

2. In what condition should the nurse be alert for altered fluid requirements in children? (Select all that apply.)
   a. Oliguric renal failure
   b. Increased intracranial pressure
   c. Mechanical ventilation
   d. Compensated hypotension
   e. Tetralogy of Fallot
   f. Type 1 diabetes mellitus

Answer 32

ANS: A, B, C

The nurse should recognize that conditions such as oliguric renal failure, increased intracranial pressure, and
mechanical ventilation can cause an increase or a decrease in fluid requirements. Conditions such as
hypotension, tetralogy of Fallot, and diabetes mellitus (type 1) do not cause an alteration in fluid requirements.

Question 33

3. What clinical manifestations should be observed in a 2-year-old child with hypotonic dehydration? (Select
   all that apply.)

a. Thick, doughy feel to the skin
b. Slightly moist mucous membranes
c. Absent tears
d. Very rapid pulse
e. Hyperirritability

Answer 33

ANS: B, C, D

Clinical manifestations of hypotonic dehydration include slightly moist mucous membranes, absent tears, and a
very rapid pulse. A thick, doughy feel to the skin and hyperirritability are signs of hypertonic dehydration.

Question 34

4. The nurse is caring for a child with hypokalemia. The nurse evaluates the child for which signs and
   symptoms of hypokalemia? (Select all that apply.)

a. Twitching
b. Hypotension
c. Hyperreflexia
d. Muscle weakness
e. Cardiac arrhythmia

Answer 34

ANS: B, D, E

Signs and symptoms of hypokalemia are hypotension, muscle weakness, and cardiac arrhythmias. Twitching
and hyperreflexia are signs of hyperkalemia.

Question 35

5. The nurse is caring for a child with hypercalcemia. The nurse evaluates the child for which signs and
   symptoms of hypercalcemia? (Select all that apply.)

a. Tetany
b. Anorexia
c. Constipation
d. Laryngospasm
e. Muscle hypotonicity

Answer 35

ANS: B, C, E

Signs and symptoms of hypercalcemia are anorexia, constipation, and muscle hypotonicity. Tetany and
laryngospasm are signs of hypocalcemia.

Question 36

6. The nurse is caring for a child with hypernatremia. The nurse evaluates the child for which signs and
   symptoms of hypernatremia? (Select all that apply.)

a. Apathy
b. Lethargy
c. Oliguria
d. Intense thirst
e. Dry, sticky mucos

Answer 36

ANS: B, C, E

Signs and symptoms of hypernatremia are nausea; oliguria; and dry, sticky mucos. Apathy and lethargy are
signs of hyponatremia.

Question 37

1. The nurse is teaching a parent of a 6-month-old infant with gastroesophageal reflux (GER) before discharge. What instructions should the nurse include? (Select all that apply.)
   a. Elevate the head of the bed in the crib to a 90-degree angle while the infant is sleeping.
   b. Hold the infant in the prone position after a feeding.
   c. Discontinue breastfeeding so that a formula and rice cereal mixture can be used.
   d. The infant will require the Nissen fundoplication after 1 year of age.
   e. Prescribed cimetidine (Tagamet) should be given 30 minutes before feedings.

Answer 37

ANS: B, E

Discharge instructions for an infant with GER should include the prone position (up on the shoulder or across
the lap) after a feeding. Use of the prone position while the infant is sleeping is still controversial. The
American Academy of Pediatrics recommends the supine position to decrease the risk of sudden infant death
syndrome even in infants with GER. Prescribed cimetidine or another proton pump inhibitor should be given
30 minutes before the morning and evening feeding so that peak plasma concentrations occur with mealtime. The head of the bed in the crib does not need to be elevated. The mother may continue to breastfeed or express
breast milk to add rice cereal if recommended by the health care provider; thickening breast milk or formula
with cereal is not recommended by all practitioners. The Nissen fundoplication is only done on infants with
GER in severe cases with complications.

Question 38

2. The nurse is preparing to admit a 3-year-old child with intussusception. What clinical manifestations should
   the nurse expect to observe? (Select all that apply.)

a. Absent bowel sounds
b. Passage of red, currant jellylike stools
c. Anorexia
d. Tender, distended abdomen
e. Hematemesis
f. Sudden acute abdominal pain

Answer 38

ANS: B, D, F

Intussusception occurs when a proximal segment of the bowel telescopes into a more distal segment, pulling the mesentery with it and leading to obstruction. Clinical manifestations of intussusception include the passage
of red, currant jellylike stools; a tender, distended abdomen; and sudden acute abdominal pain. Absent bowel
sounds, anorexia, and hematemesis are clinical manifestations observed in other types of gastrointestinal
dysfunction

Question 39

3. The school nurse is teaching a group of adolescents about avoiding contaminated water during a mission
   trip. What should the nurse include in the teaching? (Select all that apply.)

a. Ice
b. Meats
c. Raw vegetables
d. Unpeeled fruits
e. Carbonated beverage

Answer 39

ANS: A, B, C, D

The best measure during travel to areas where water may be contaminated is to allow children to drink only
bottled water and carbonated beverages (from the container through a straw supplied from home). Children
should also avoid tap water, ice, unpasteurized dairy products, raw vegetables, unpeeled fruits, meats, and
seafood

Question 40

4. The nurse is teaching parents about high-fiber foods that can prevent constipation. What foods should the
   nurse include in the teaching? (Select all that apply.)

a. Oranges
b. Bananas
c. Lima beans
d. Baked beans
e. Raisin bran cerea

Answer 40

ANS: C, D, E

Lima beans have 13.2 g of fiber in 1 cup, baked beans have 10.4 g of fiber in 1 cup, and raisin bran cereal has 7.3 g of fiber in 1 cup. One orange has only 3.1 g of fiber, and 1 banana has only 3.1 g of fiber, so they are not
recommended as high-fiber foods.

Question 41

5. The nurse is teaching parents of a child with gastroesophageal reflux (GER) disease foods that can
   exacerbate acid reflux. What foods should be included in the teaching session? (Select all that apply.)

a. Citrus
b. Bananas
c. Spicy foods
d. Peppermint
e. Whole wheat bread

Answer 41

ANS: A, C, D

Avoidance of certain foods that exacerbate acid reflux (e.g., caffeine, citrus, tomatoes, alcohol, peppermint, spicy or fried foods) can improve mild GER symptoms. Bananas and whole wheat bread will not exacerbate
acid reflux.

Question 42

6. The nurse is preparing to admit a 6-year-old child with irritable bowel syndrome (IBS). What clinical
   manifestations should the nurse expect to observe? (Select all that apply.)

a. Flatulence
b. Constipation
c. No urge to defecate
d. Absence of abdominal pain
e. Feeling of incomplete evacuation of the bowel

Answer 42

ANS: A, B, E

Children with IBS often have alternating diarrhea and constipation, flatulence, bloating or a feeling of
abdominal distention, lower abdominal pain, a feeling of urgency when needing to defecate, and a feeling of
incomplete evacuation of the bowel.

Question 43

7. The nurse is caring for a child with celiac disease. The nurse understands that what may precipitate a celiac
   crisis? (Select all that apply.)

a. Exercise
b. Infections
c. Fluid overload
d. Electrolyte depletion
e. Emotional disturbance

Answer 43

ANS: B, D, E

A celiac crisis can be precipitated by infections, electrolyte depletion, and emotional disturbance. Exercise or
fluid overload does not precipitate a crisis.

Question 44

8. The nurse is preparing to admit a 6-year-old child with celiac disease. What clinical manifestations should
   the nurse expect to observe? (Select all that apply.)

a. Steatorrhea
b. Polycythemia
c. Malnutrition
d. Melena stools
e. Foul-smelling stools

Answer 44

ANS: A, C, E

Clinical manifestations of celiac disease include impaired fat absorption (steatorrhea and foul-smelling stools)
and impaired nutrient absorption (malnutrition). Anemia, not polycythemia, is a manifestation, and melena
stools do not occu

Question 45

9. The nurse is preparing to admit a 10-year-old child with appendicitis. What clinical manifestations should
   the nurse expect to observe? (Select all that apply.)

a. Fever
b. Vomiting
c. Tachycardia
d. Flushed face
e. Hyperactive bowel sounds

Answer 45

ANS: A, B, C

Clinical manifestations of appendicitis include fever, vomiting, and tachycardia. Pallor is seen, not a flushed
face, and the bowel sounds are hypoactive or absent, not hyperactive.

Question 46

10. The nurse is preparing to admit a 2-month-old child with hypertrophic pyloric stenosis. What clinical
    manifestations should the nurse expect to observe? (Select all that apply.)

a. Weight loss
b. Bilious vomiting
c. Abdominal pain
d. Projectile vomiting
e. The infant is hungry after vomiting

Answer 46

ANS: A, D, E

Clinical manifestations of hypertrophic pyloric stenosis include weight loss, projectile vomiting, and hunger
after vomiting. The vomitus is nonbilious, and there is no evidence of pain or discomfort, just chronic hunger.

Question 47

11. The nurse is preparing to admit a 6-month-old child with gastroesophageal reflux disease. What clinical
    manifestations should the nurse expect to observe? (Select all that apply.)

a. Spitting up
b. Bilious vomiting
c. Failure to thrive
d. Excessive crying
e. Respiratory problems

Answer 47

ANS: A, C, D, E

Clinical manifestations of gastroesophageal reflux disease include spitting up, failure to thrive, excessive
crying, and respiratory problems. Hematemesis, not bilious vomiting, is a manifestation.

Question 48

12. The nurse is preparing to admit a 5-year-old child with hepatitis A. What clinical features of hepatitis A
    should the nurse recognize? (Select all that apply.)

a. The onset is rapid.
b. Fever occurs early.
c. There is usually a pruritic rash.
d. Nausea and vomiting are common.
e. The mode of transmission is primarily by the parenteral route.

Answer 48

ANS: A, B, D

Clinical features of hepatitis A include a rapid onset, fever occurring early, and nausea and vomiting. A rash is
rare, and the mode of transmission is by the fecaloral route, rarely by the parenteral route

Question 49

13. The nurse is preparing to admit a 7-year-old child with hepatitis B. What clinical features of hepatitis B
    should the nurse recognize? (Select all that apply.)

a. The onset is rapid.
b. Rash is common.
c. Jaundice is present
d. No carrier state exists
e. The mode of transmission is principally by the parenteral route.

Answer 49

ANS: B, C, E

Clinical features of hepatitis B include a rash, jaundice, and the mode of transmission principally by the
parenteral route. The onset is insidious, not rapid, and a carrier state does exist

Question 50

14. The nurse is preparing to admit a 7-year-old child with Crohn disease. What clinical manifestations should
    the nurse expect to observe? (Select all that apply.)

a. Pain is common.
b. Weight loss is severe.
c. Rectal bleeding is common.
d. Diarrhea is moderate to severe.
e. Anal and perianal lesions are rare

Answer 50

ANS: A, B, D

Clinical manifestations of Crohn disease include pain, severe weight loss, and moderate to severe diarrhea. Rectal bleeding is rare, but anal and perianal lesions are common.

Question 51

1. The nurse is preparing a staff education program about pediatric asthma. What concepts should the nurse
   include when discussing the asthma severity classification system? (Select all that apply.)

a. Children with mild persistent asthma have nighttime signs or symptoms less than two times a
month.

b. Children with moderate persistent asthma use a short-acting b-agonist more than two times per
week.

c. Children with severe persistent asthma have a peak expiratory flow (PEF) of 60% to 80% of
predicted value.

d. Children with mild persistent asthma have signs or symptoms more than two times per week.
e. Children with moderate persistent asthma have some limitations with normal activity
f. Children with severe persistent asthma have frequent nighttime signs or symptoms.

Answer 51

ANS: D, E, F

Children with mild persistent asthma have signs or symptoms more than two times per week and nighttime
signs or symptoms three or four times per month. Children with moderate persistent asthma have some
limitations with normal activity and need to use a short-acting b-agonist for sign or symptom control daily. Children with severe persistent asthma have frequent nighttime signs or symptoms and have a PEF of less than
60%

Question 52

2. The nurse is caring for a newborn with suspected congenital diaphragmatic hernia. What of the following
   findings would the nurse expect to observe? (Select all that apply.)

a. Loud, harsh murmur
b. Scaphoid abdomen
c. Poor peripheral pulses
d. Mediastinal shift
e. Inguinal swelling
f. Moderate respiratory distress

Answer 52

ANS: B, D, F

Clinical manifestations of a congenital diaphragmatic hernia include a scaphoid abdomen, a mediastinal shift, and moderate to severe respiratory distress. The infant would not have a harsh, loud murmur or poor peripheral
pulses. Inguinal swelling is indicative of an inguinal hernia.

Question 53

3. What interventions can the nurse teach parents to do to ease respiratory efforts for a child with a mild
   respiratory tract infection? (Select all that apply.)

a. Cool mist
b. Warm mist
c. Steam vaporizer
d. Keep child in a flat, quiet position
e. Run a shower of hot water to produce steam

Answer 53

ANS: A, B, C, E

Warm or cool mist is a common therapeutic measure for symptomatic relief of respiratory discomfort. The
moisture soothes inflamed membranes and is beneficial when there is hoarseness or laryngeal involvement. A
time-honored method of producing steam is the shower. Running a shower of hot water into the empty bathtub
or open shower stall with the bathroom door closed produces a quick source of steam. Keeping a child in this
environment for 10 to 15 minutes may help ease respiratory efforts. A small child can sit on the lap of a parent
or other adult. The child should be quiet but upright, not flat. The use of steam vaporizers in the home is often
discouraged because of the hazards related to their use and limited evidence to support their efficacy.

Question 54

4. A tonsillectomy or adenoidectomy is contraindicated in what conditions? (Select all that apply.)
   a. Cleft palate
   b. Seizure disorders
   c. Blood dyscrasias
   d. Sickle cell disease
   e. Acute infection at the time of surgery

Answer 54

ANS: A, C, E

Contraindications to either tonsillectomy or adenoidectomy are (1) cleft palate because both tonsils help
minimize escape of air during speech, (2) acute infections at the time of surgery because the locally inflamed
tissues increase the risk of bleeding, and (3) uncontrolled systemic diseases or blood dyscrasias. Tonsillectomy
or adenoidectomy is not contraindicated in sickle cell disease or seizure disorders.

Question 55

5. The clinic nurse is administering influenza vaccinations. Which children should not receive the live
   attenuated influenza vaccine (LAIV)? (Select all that apply.)

a. A child with asthma
b. A child with diabetes
c. A child with hemophilia A
d. A child with cancer receiving chemotherapy
e. A child with gastroesophageal reflux disease

Answer 55

The live attenuated influenza vaccine (LAIV) is an acceptable alternative to the IM vaccine (IIV) for ages 2 to
49 years. It is a live vaccine administered via nasal spray. Several groups are excluded from receiving it,
including children with a chronic heart or lung disease (asthma or reactive airways disease), diabetes, or kidney
failure; children who are immunocompromised or receiving immunosuppressants; children younger than 5
years of age with a history of recurrent wheezing; children receiving aspirin; patients who are pregnant;
children who have a severe allergy to chicken eggs or who are allergic to any of the nasal spray vaccine
components; or children with a history of Guillain-Barr Syndrome after a previous dose. A child with
hemophilia A or gastroesophageal reflux disease would not be immunocompromised so they can receive the
LAIV.

Question 56

6. The nurse is preparing to admit a 7-year-old child with acute laryngotracheobronchitis (LTB). What clinical manifestations should the nurse expect to observe? (Select all that apply.)
   a. Dysphagia
   b. Brassy cough
   c. Low-grade fever
   d. Toxic appearance
   e. Slowly progressive

Answer 56

ANS: B, C, E

Clinical manifestations of LTB include a brassy cough, low-grade fever, and slow progression. Dysphagia and
a toxic appearance are characteristics of acute epiglottitis.

Question 57

7. The nurse is preparing to admit a 3-year-old child with acute spasmodic laryngitis. What clinical features of
   hepatitis B should the nurse recognize? (Select all that apply.)

a. High fever
b. Croupy cough
c. Tendency to recur
d. Purulent secretions
e. Occurs sudden, often at night

Answer 57

ANS: B, C, E

Clinical features of acute spasmodic laryngitis include a croupy cough, a tendency to recur, and occurring
sudden, often at night. High fever is a feature of acute epiglottitis and purulent secretions are seen with acute
tracheitis

Question 58

8. A child is diagnosed with active pulmonary tuberculosis. What medications does the nurse anticipate to be
   prescribed for the first 2 months? (Select all that apply.)

a. Isoniazid (INH)
b. Cefuroxime (Ceftin)
c. Rifampin (Rifadin)
d. Pyrazinamide (PZA)
e. Ethambutol (Myambutol)

Answer 58

ANS: A, C, D, E

For the child with clinically active pulmonary and extrapulmonary TB, the goal is to achieve sterilization of the
tuberculous lesion. The American Academy of Pediatrics (2012) recommends a 6-month regimen consisting of
INH, rifampin, ethambutol, and PZA given daily or twice weekly for the first 2 months followed by INH and
rifampin given two or three times a week by DOT for the remaining 4 months (Mycobacterium tuberculosis). Cefuroxime is not part of the regimen.

Question 59

9. The nurse is interpreting a tuberculin skin test. If the nurse finds a result of an induration 5 mm or larger, in
   which child should the nurse document this finding as positive? (Select all that apply.)

a. A child with diabetes mellitus
b. A child younger than 4 years of age
c. A child receiving immunosuppressive therapy
d. A child with a human immunodeficiency virus (HIV) infection
e. A child living in close contact with a known contagious case of tuberculosi

Answer 59

ANS: C, D, E

A tuberculin skin test with an induration of 5 mm or larger is considered to be positive if the child is receiving
immunosuppressive therapy, has an HIV infection, or is living in close contact with a known contagious case
of tuberculosis. The test would be considered positive in a child who has diabetes mellitus or is younger than 4
years of age if the tuberculin skin test had an induration of 10 mm or larger.

Question 60

10. The nurse is preparing to admit a 7-year-old child with pulmonary edema. What clinical manifestations
    should the nurse expect to observe? (Select all that apply.)

a. Fever
b. Bradycardia
c. Diaphoresis
d. Pink frothy sputum
e. Respiratory crackles

Answer 60

ANS: C, D, E

Clinical manifestations of pulmonary edema include diaphoresis, pink frothy sputum, and respiratory crackles. Fever or bradycardia are not manifestations of pulmonary edema.