Exam 2 Flashcards
(278 cards)
1
Q
The parent of a child with cystic fibrosis calls the clinic nurse and describes signs and symptoms of tachypnea, tachycardia, dyspnea, pallor, and cyanosis. What does the
nurse suspect the child is experiencing?
A
Pneumothorax
2
Q
A type of dehydration that occurs when the electrolyte deficit exceeds the water deficit. Water transfers from ECF to the more concentrated ICF thus increasing the ECF fluid
loss resulting in shock.
A
Hypotonic dehydration
3
Q
What is the major health concern of children in the United States?
A
Chronic illness
4
Q
What should the nurse determine to be the priority intervention for a family with an infant who has a disability?
A
Foster feelings of competency by helping parents learn the special care needs of the infant.
5
Q
The potential effects of chronic illness or disability on a child’s development vary at different ages. What developmental alteration is a threat to a toddler’s normal development?
A
Hindered mobility
6
Q
A feeling of guilt that the child “caused” the disability or illness is especially common in which age group?
A
Preschooler
7
Q
What intervention is most appropriate for fostering the development of a school-age child with disabilities associated with cerebral palsy?
A
Encourage socialization with peers.
8
Q
A 16-year-old boy with a chronic illness has recently become rebellious and is taking risks such as missing doses of his medication. What should the nurse explain to his parents?
A
That this is a normal part of adolescence
9
Q
What nursing intervention is most appropriate in promoting normalization in a school-age child with a chronic illness?
A
Give the child as much control as possible.
10
Q
The nurse observes that a seriously ill child passively accepts all painful procedures. The nurse should recognize that this is most likely an indication that the child is experiencing what emotional response?
A
Belief that procedures are a deserved punishment
11
Q
The parents of a child born with disabilities ask the nurse for advice about discipline. The nurse’s response should be based on remembering that discipline is which?
A
Essential for the child
12
Q
Parents ask for help for their other children to cope with the changes in the family resulting from the special needs of their sibling. What strategy does the nurse recommend?
A
Invite the siblings to attend meetings to develop plans for the child with special needs.
13
Q
The nurse is assessing the coping behaviors of the parents of a child recently diagnosed with a chronic illness. What behavior should the nurse consider an “approach behavior” that results in movement toward adjustment?
A
Anticipating future problems and seeking guidance and answers
14
Q
What nursing intervention is especially helpful in assessing feelings of parental guilt when a disability or chronic illness is diagnosed?
A
Discuss the meaning of the parents’ religious and cultural background.
15
Q
What manifestation observed by the nurse is suggestive of parental overprotection?
A
Gives inconsistent discipline
16
Q
What finding by the nurse is most characteristic of chronic sorrow?
A
Periods of intensified sorrow at certain landmarks of the child’s development
17
Q
A 5-year-old child will be starting kindergarten next month. She has cerebral palsy, and it has been determined that she needs to be in a special education classroom. Her parents are tearful when telling the nurse about this and state that they did not realize her disability was so severe. What is the best interpretation of this situation?
A
This is a normal anticipated time of parental stress.
18
Q
The nurse is talking to the parent of a child with special needs. The parent has expressed worry about how to support the siblings at home. What suggestion is appropriate for the nurse to give to the parent?
A
“You should help the siblings see the similarities and differences between themselves and your child with special needs.”
19
Q
What is the single most prevalent cause of disability in children and responsible for the recent increase in childhood disability?
A
Asthma
20
Q
The parents of a child on a ventilator tell the nurse that their insurance company wants the child to be discharged. They explain that they do not want the child home “under any circumstances.” What principle should the nurse consider when working with this family?
A
Desire to have the child home is essential to effective home care.
21
Q
A child with a serious chronic illness will soon go home. The case manager requests that the family provide total care for the child for a couple of days while the child is still hospitalized. How should the request be viewed?
A
Important because it can be beneficial to the transition from hospital to home
22
Q
For case management to be most effective, who should be recognized as the most appropriate case manager?
A
Nurse
23
Q
An adolescent with long-term, complex health care needs will soon be discharged from the hospital. The nurse case manager has been assigned to the teen and family. The adolescent’s care involves physical therapy, occupational therapy, and speech therapy in addition to medical and nursing care. Who should be the decision maker in the adolescent’s care?
A
Adolescent and family
24
Q
The nurse has been assigned as a home health nurse for a child who is technology dependent. The nurse recognizes that the family’s background differs widely from the nurse’s own. The nurse believes some of their lifestyle choices are less than ideal. What nursing intervention is most appropriate to institute?
A
Respect the differences.
25
A child’s parents ask the nurse many questions about their child’s illness and its management. The nurse does not know enough to answer all the questions. What nursing action is most appropriate at this time?
Tell them, “I don’t know, but I will find out.”
26
The nurse outlines short- and long-term goals for a 10-year-old child with many complex health problems. Who should agree on these goals?
Child, family, and all professionals involved
27
When communicating with other professionals about a child with a chronic illness, what is important for nurses to do?
Restrict communication to clinically relevant information.
28
The nurse is planning care for a 3-year-old boy who has Down syndrome and is on continuous oxygen. He recently began walking around furniture. He is spoon fed by his parents and eats some finger foods. What goal is the most appropriate to promote normal development?
Encourage mobility.
29
What behavior seen in children should be addressed by the nurse who is providing care to a child with a chronic illness?
A preschooler who refuses to participate in self-care
30
The nurse asks the mother of a child with a chronic illness many questions as part of the assessment. The mother answers several questions, then stops and says, “I don’t know why you ask me all this. Who gets to know this information?” The nurse should respond in what manner?
Explain who will have access to the information.
31
What is a principle of palliative care that can be included in the care of children?
Child and family as the unit of care
32
What factor is most important for parents implementing do not resuscitate (DNR) orders?
Acknowledgment by health care team that child has no realistic chance for cure
33
A 12-year-old child has failed several courses of chemotherapy. An experimental drug is available that his parents want him to receive. He has told his parents and the oncologists that he is ready to die and does not want any more chemotherapy. The nurse recognizes what to be true?
Parents and child both need support in the decision making.
34
What explanation best describes how preschoolers react to the death of a loved one?
Preschoolers may feel guilty and responsible for the death.
35
A preschooler is found digging up a pet bird that was recently buried after it died. What is the best explanation for this behavior?
He needs reassurance that the pet has not gone somewhere else.
36
At which age do most children have an adult concept of death as being inevitable, universal, and irreversible?
9 to 11 years
37
What statement is most descriptive of a school-age child’s reaction to death?
Very interested in funerals and burials
38
At which developmental period do children have the most difficulty coping with death, particularly if it is their own?
Adolescence
39
An 8-year-old girl has been uncooperative and angry since the diagnosis of cancer was made. Her parents tell the nurse that they do not know what to do “because she is always so mad at us.” What nursing action is most appropriate at this time?
Help the parents deal with her anger constructively.
40
A 7-year-old child is in the end stages of cancer. The parents ask you how they will know when death is imminent. What physical sign is indicative of approaching death?
Difficulty swallowing
41
The nurse is often the individual who is in the optimum position to suggest tissue donation to a family (after consultation with the practitioner). What will occur if a family chooses organ or tissue donation?
Written consent is required for tissue or organ donation.
42
When is an autopsy required?
In the case of a suspected suicide
43
The nurse is providing support to a family that is experiencing anticipatory grief related to their child’s imminent death. What statement by the nurse is therapeutic?
“You have been through a very tough time.”
44
The sibling of a 4-year-old girl dies from sudden infant death syndrome. The parents are concerned because the 4-year-old girl showed more outward grief when her cat died than now. How should the nurse explain this reaction to the parents?
The death may be so painful and threatening that the child must deny it for now.
45
How might the quality of life for a terminally ill child and his family be enhanced by nurses?
Advocate for and implement pain and symptom relief measures.
46
The nurse has attended a professional development program about palliative care for the pediatric population. What statement by the nurse should indicate a correct understanding of the program?
“Palliative care promotes the optimal functioning and quality of life.”
47
When communicating with dying children, what should the nurse remember?
Games, art, and play provide a good means of expression.
48
The nurse understands that a school-age child may react to death with what reaction?
Fearing the unknown
49
The American Association on Intellectual and Developmental Disabilities (AAIDD), formerly the American Association on Cognitive Impairment, classifies cognitive impairment based on what parameter?
Adaptive skill domains
50
What is a primary goal in caring for a child with cognitive impairment?
Promoting optimum development
51
One of the techniques that has been especially useful for learners having cognitive impairment is called fading. What description best explains this technique?
Gradually reduces the assistance given to the child so the child becomes more independent
52
The parents of a child with cognitive impairment ask the nurse for guidance with discipline. What should the nurse’s recommendation be based on?
Behavior modification is an excellent form of discipline.
53
What intervention is most appropriate to facilitate social development of a child with a cognitive impairment?
Provide peer experiences, such as infant stimulation and preschool programs.
54
The mother of a young child with cognitive impairment asks for suggestions about how to teach her child to use a spoon for eating. The nurse should make which recommendation?
Do a task analysis first.
55
Many of the clinical features of Down syndrome present challenges to caregivers. Based on these features, what intervention should be included in the child’s care?
Use a cool-mist vaporizer to keep the mucous membranes moist and secretions liquefied.
56
What description applies to fragile X syndrome?
Second most common genetic cause of cognitive impairment
57
The nurse should suspect a hearing impairment in an infant who fails to demonstrate which behavior?
Babbling by age 12 months
58
What technique facilitates lip reading by a hearing-impaired child?
Speak at an even rate.
59
A father calls the emergency department nurse saying that his daughter’s eyes burn after getting some dishwasher detergent in them. The nurse recommends that the child be seen in the emergency department or by an ophthalmologist. The nurse also should recommend which action before the child is transported?
Irrigate the eyes copiously with tap water for 20 minutes.
60
A 5-year-old child has bilateral eye patches in place after surgery yesterday morning. Today he can be out of bed. What nursing intervention is most important at this time?
Orient him to his immediate surroundings.
61
What observation in a child should indicate the need for a referral to a specialist regarding a communication impairment?
At 2 years of age, the child fails to respond consistently to sounds.
62
The nurse is performing a physical assessment on a 3-year-old child. The parents state that the child excessively rubs the eyes and often tilts the head to one side. What visual impairment should the nurse suspect?
Myopia, or nearsightedness
63
The community nurse is planning prevention measures designed to avoid conditions that can cause cognitive impairment. Taking folic acid supplements during pregnancy to prevent neural tube defects is which type of prevention strategy?
Primary
64
The nurse is teaching a preschool child with a cognitive impairment how to throw a ball overhand. What teaching strategy should the nurse use for this child?
Demonstrate how to throw a ball overhand.
65
The camp nurse is choosing a toy for a child with cognitive impairment to play with during swimming time. What toy should the nurse choose to encourage improvement of developmental skills?
A large beach ball
66
The nurse is teaching feeding strategies to a parent of a 12-month-old infant with Down syndrome. What statement made by the parent indicates a need for further teaching?
“I will place the food on the top of the tongue.”
67
The nurse is counseling a pregnant 35-year-old woman about estimated risk of Down syndrome. What is the estimated risk for a woman who is 35 years of age?
One in 350
68
The nurse is teaching parents of a child with cataracts about the upcoming treatment. The nurse should give the parents what information about the treatment of cataracts?
“Cataracts require surgery to remove the cloudy lens and replace it.”
69
A 6-year-old child is admitted to the pediatric unit and requires bed rest. Having art supplies available meets which purpose?
Lets the child express thoughts and feelings through pictures rather than words
70
The parents of a 3-year-old admitted for recurrent diarrhea are upset that the practitioner has not told them what is going on with their child. What is the priority intervention for this family?
Help the family develop a written list of specific questions to ask the practitioner.
71
The nurse is admitting a 7-year-old child to the pediatric unit for abdominal pain. To determine what the child understands about the reason for hospitalization, what should the nurse do?
Ask the child why he came to the hospital today.
72
The nurse is doing a prehospitalization orientation for a girl, age 7 years, who is scheduled for cardiac surgery. As part of the preparation, the nurse explains that after the surgery, the child will be in the intensive care unit. How might the explanation by the nurse be viewed?
An appropriate part of the child’s preparation
73
A 9-year-old boy has an unplanned admission to the intensive care unit (ICU) after abdominal surgery. The nursing staff has completed the admission process, and his condition is beginning to stabilize. When speaking with the parents, the nurse should expect what additional stressor to be evident?
Insufficient remembering of his condition and routine
74
A 6-year-old is being discharged home, which is 90 miles from the hospital, after an outpatient hernia repair. In addition to explicit discharge instructions, what should the nurse provide?
Prescribed pain medication before discharge
75
The nurse should expect a toddler to cope with the stress of a short period of separation from parents by displaying what?
Regression
76
The nurse is providing support to parents adapting to the hospitalization of their child to the pediatric intensive care unit. The nurse notices that the parents keep asking the same questions. What should the nurse do?
Patiently continue to answer questions, trying different approaches.
77
The nurse is instructing student nurses about the stress of hospitalization for children from middle infancy throughout the preschool years. What major stress should the nurse relate to the students?
Separation anxiety
78
When a preschool-age child is hospitalized without adequate preparation, the nurse should recognize that the child may likely see hospitalization as what?
Punishment
79
A parent needs to leave a hospitalized toddler for a short period of time. What action should the nurse suggest to the parent to ease the separation for the toddler?
Leave a favorite article from home with the child.
80
What choice of words or phrases would be inappropriate to use with a child?
“Catheter” for “intravenous”
81
The nurse is assessing a child’s functional self-care level for feeding, bathing and hygiene, dressing, and grooming and toileting. The child requires assistance or supervision from another person and equipment or device. What code does the nurse assign for this child?
III
82
A 4-year-old girl is admitted to outpatient surgery for removal of a cyst on her back. Her mother puts the hospital gown on her, but the child is crying because she wants to leave on her underpants. What is the most appropriate nursing action at this time?
Allow her to wear her underpants.
83
The nurse is preparing a 9-year-old boy before obtaining a blood specimen by venipuncture. The child tells the nurse he does not want to lose his blood. What approach is best by the nurse?
Discuss with him how his body is always in the process of making blood.
84
A bone marrow biopsy will be performed on a 7-year-old girl. She wants her mother to hold her during the procedure. How should the nurse respond?
Holding may help your child relax.
85
A 5-year-old child returns from the pediatric intensive care unit after abdominal surgery. The orders state to monitor vital signs every 2 hours. On assessment, the nurse observes that the child’s heart rate is 20 beats/min less than it was preoperatively. What should be the nurse’s next action?
Recheck the pulse and blood pressure in 15 minutes.
86
A 10-year-old child requires daily medications for a chronic illness. Her mother tells the nurse that the child continually forgets to take the medicine unless reminded. What nursing action is most appropriate to promote adherence to the medication regimen?
Establish a contract with her, including rewards.
87
A 6-year-old boy is hospitalized for intravenous antibiotic therapy. He eats very little on his “regular diet” trays. He tells the nurse that all he wants to eat is pizza, tacos, and ice cream. What nursing action is the most appropriate?
Request these favorite foods for him.
88
A child, age 7 years, has a fever associated with a viral illness. She is being cared for at home. What is the principal reason for treating fever in this child?
Relief of discomfort
89
A critically ill child has hyperthermia. The parents ask the nurse to give an antipyretic such as acetaminophen. How should the nurse respond to the parents?
Antipyretics are of no value in treating hyperthermia.
90
A nurse must do a venipuncture on a 6-year-old child. What consideration is important in providing atraumatic care?
Show the child the equipment to be used before the procedure.
91
What is an advantage of the ventrogluteal muscle as an injection site in young children?
Free of significant nerves and vascular structures
92
What is a priority intervention for an infant with a temporary colostomy for Hirschsprung disease?
Protecting the skin around the colostomy
93
The nurse on a pediatric unit is writing guidelines for age-specific preparation of children for procedures based on developmental characteristics. What guideline is accurate?
Use simple diagrams of anatomy and physiology to explain a procedure to a school-age child.
94
A laboratory technician is performing a blood draw on a toddler. The toddler is holding still but crying loudly. The nurse should take which action?
Do nothing. It’s Okay for a child to cry during a painful procedure.
95
At which age should a nurse keep teaching time short (5 minutes)?
Toddler
96
The nurse is preparing to give acetaminophen (Tylenol) to a child who has a fever. What nursing action is appropriate?
Check to be sure the Tylenol dose does not exceed 15 mg/kg.
97
The nurse needs to start an intravenous (IV) line on an 8-year-old child to begin administering intravenous antibiotics. The child starts to cry and tells the nurse, “Do it later, okay?” What action should the nurse take?
Start the IV line and then allow for expression of feelings.
98
When checking the intravenous (IV) site on a child, the nurse should take which action?
Look at the site while palpating the area.
99
What substance is released from the posterior pituitary gland and promotes water retention in the renal system?
Antidiuretic hormone (ADH)
100
Nurses should be alert for increased fluid requirements in which circumstance?
Fever
101
What factor predisposes an infant to fluid imbalances?
Immature kidney functioning
102
An infant is brought to the emergency department with the following clinical manifestations: poor skin turgor, weight loss, lethargy, tachycardia, and tachypnea. This is suggestive of which situation?
Water depletion
103
What clinical manifestation(s) is associated with calcium depletion (hypocalcemia)?
Neuromuscular irritability
104
What type of dehydration occurs when the electrolyte deficit exceeds the water deficit?
Hypotonic dehydration
105
What amount of fluid loss occurs with moderate dehydration?
50 to 90 ml/kg
106
Physiologically, the child compensates for fluid volume losses by which mechanism?
Fluid shift from interstitial space to intravascular space
107
The presence of which pair of factors is a good predictor of a fluid deficit of at least 5% in an infant?
Dry mucous membranes and generally ill appearance
108
The nurse suspects fluid overload in an infant receiving intravenous fluids. What clinical manifestation is suggestive of water intoxication?
Irritability and seizures
109
What physiologic state(s) produces the clinical manifestations of nervous system stimulation and excitement, such as over-excitability, nervousness, and tetany?
Metabolic and respiratory alkalosis
110
What is an approximate method of estimating output for a child who is not toilet trained?
Weigh diapers after each void.
111
The nurse is selecting a site to begin an intravenous infusion on a 2-year-old child. The superficial veins on his hand and arm are not readily visible. What intervention should increase the visibility of these veins?
Gently tap over the site.
112
The nurse determines that a child’s intravenous infusion has infiltrated. The infused solution is a vesicant. What is the most appropriate nursing action?
End the infusion and notify the practitioner.
113
Several types of long-term central venous access devices are used. What is a benefit of using an implanted port (e.g., Port-a-Cath)?
The patient does not need to limit regular physical activity, including swimming.
114
The nurse is teaching the family of a child with a long-term central venous access device about signs and symptoms of bacteremia. What finding indicates the presence of bacteremia?
Fever and general malaise
115
What type of diarrhea is associated with an inflammation of the mucosa and submucosa in the ileum and colon caused by infectious agents?
Dysenteric
116
What condition is often associated with severe diarrhea?
Metabolic acidosis
117
What organism is a parasite that causes acute diarrhea?
Giardia lamblia
118
A school-age child with diarrhea has been rehydrated. The nurse is discussing the child’s diet with the family. What food or beverage should be tolerated best?
Easily digested foods
119
A school-age child with acute diarrhea and mild dehydration is being given oral rehydration solutions (ORS). The child’s mother calls the clinic nurse because he is also occasionally vomiting. The nurse should recommend which intervention?
Continue to give ORS frequently in small amounts.
120
A 7-year-old child with acute diarrhea has been rehydrated with oral rehydration solution (ORS). The nurse should recommend that the child’s diet be advanced to what kind of diet?
Regular diet
121
What is the most frequent cause of hypovolemic shock in children?
Blood loss
122
What clinical manifestation(s) should the nurse expect to see as shock progresses in a child and becomes decompensated shock?
Confusion and somnolence
123
The nurse suspects shock in a child 1 day after surgery. What should be the initial nursing action?
Provide supplemental oxygen.
124
What is a systemic response to severe burns in a child?
Abrupt drop in cardiac output
125
A child is admitted with extensive burns. The nurse notes burns on the child’s lips and singed nasal hairs. The nurse should suspect what condition in the child?
An inhalation injury
126
What is the most immediate threat to life in children with thermal injuries?
Shock
127
After the acute stage and during the healing process, what is the primary complication from burn injury?
Infection
128
What sign is one of the first to indicate overwhelming sepsis in a child with burn injuries?
Disorientation
129
A toddler sustains a minor burn on the hand from hot coffee. What is the first action in treating this burn?
Hold the hand under cool running water.
130
What finding is the most reliable guide to the adequacy of fluid replacement for a small child with burns?
Urinary output of 1 to 2 ml/kg of body weight/hr
131
What is the purpose of a high-protein diet for a child with major burns?
Minimize protein breakdown
132
Hydrotherapy is required to treat a child with extensive partial-thickness burn wounds. What is the purpose of hydrotherapy?
Debride the wounds
133
What is an effective strategy to reduce the stress of burn dressing procedures?
Involve the child and give choices as feasible.
134
What consideration is important for the nurse when changing dressings and applying topical medication to a child’s abdomen and leg burns?
Wash hands and forearms before and after dressing change.
135
What is a strategy used to minimize scarring with burn injury in a child?
Limitation of period without pressure to areas of scarring
136
The nurse is teaching a group of female adolescents about toxic shock syndrome and the use of tampons. What statement by a participant indicates a need for additional teaching?
“I can use a superabsorbent tampon for more than 6 hours.”
137
What urine test result is considered abnormal?
pH 4.0
138
What diagnostic test allows visualization of renal parenchyma and renal pelvis without exposure to external-beam radiation or radioactive isotopes?
Renal ultrasonography
139
What name is given to inflammation of the bladder?
Cystitis
140
The nurse is teaching a client to prevent future urinary tract infections (UTIs). What factor is most important to emphasize as the potential cause?
Urinary stasis
141
What recommendation should the nurse make to prevent urinary tract infections (UTIs) in young girls?
Ensure clear liquid intake of 2 L/day.
142
In teaching the parent of a newly diagnosed 2-year-old child with pyelonephritis related to vesicoureteral reflux (VUR), the nurse should include which information?
Have siblings examined for VUR.
143
The nurse notes that a child has lost 3.6 kg (8 lb) after 4 days of hospitalization for acute glomerulonephritis. What is the most likely cause of this weight loss?
Reduction of edema
144
What measure of fluid balance status is most useful in a child with acute glomerulonephritis?
Daily weight
145
The parent of a child hospitalized with acute glomerulonephritis asks the nurse why blood pressure readings are being taken so often. What knowledge should influence the nurse’s reply?
Acute hypertension is a concern that requires monitoring.
146
What is the primary objective of care for the child with minimal change nephrotic syndrome (MCNS)?
Minimize excretion of urinary protein.
147
A hospitalized child with minimal change nephrotic syndrome is receiving high doses of prednisone. What nursing goal is appropriate for this child?
Minimize risk of infection.
148
What condition is the most common cause of acute renal failure in children?
Severe dehydration
149
What diet is most appropriate for the child with chronic renal failure (CRF)?
Low in phosphorus
150
What nursing consideration is most important when caring for a child with end-stage renal disease (ESRD)?
Multiple stresses are placed on children with ESRD and their families because children’s lives are maintained by drugs and artificial means.
151
What statement is an advantage of peritoneal dialysis compared with hemodialysis?
It is easy to learn and safe to perform.
152
What statement is descriptive of renal transplantation in children?
It is the preferred means of renal replacement therapy in children.
153
The nurse is conducting discharge teaching with the parent of a 7-year-old child with minimal change nephrotic syndrome (MCNS). What statement by the parent indicates a correct understanding of the teaching?
“I should not add additional salt to any of my child’s meals.”
154
What is the narrowing of preputial opening of foreskin called?
Phimosis
155
Congenital defects of the genitourinary tract, such as hypospadias, are usually repaired as early as possible to accomplish what?
Promote development of normal body image.
156
The parents of a 2-year-old boy who had a repair of exstrophy of the bladder at birth ask when they can begin toilet training their son. The nurse replies based on what knowledge?
Additional surgery may be necessary to achieve continence.
157
The parents of a child born with ambiguous genitalia tell the nurse that family and friends are asking what caused the baby to be this way. Tests are being done to assist in gender assignment. What should the nurse’s intervention include?
Explain the disorder so they can explain it to others
158
Parents of a newborn with ambiguous genitalia want to know how long they will have to wait to know whether they have a boy or a girl. The nurse answers the parents based on what knowledge?
Gender assignment involves collaboration between the parents and a multidisciplinary team.
159
Surgery is performed on a child to correct cryptorchidism. The parents understand the reason for the surgery if they tell the nurse this was done to do what?
“Prevent damage to the undescended testicle.”
160
What is an appropriate nursing intervention for a child with minimal change nephrotic syndrome (MCNS) who has scrotal edema?
Elevate the scrotum with a rolled washcloth.
161
A nurse is evaluating the effectiveness of teaching regarding care of a child with minimal change nephrotic syndrome (MCNS) that is in remission after administration of prednisone. The nurse realizes further teaching is required if the parents state what?
“We understand our child will not be able to attend school, so we will arrange for home schooling.”
162
A child is admitted with acute glomerulonephritis. What should the nurse expect the urinalysis during this acute phase to show?
Hematuria and proteinuria
163
A child with acute glomerulonephritis is in the playroom and experiences blurred vision and a headache. What action should the nurse take?
Obtain the child’s blood pressure and notify the health care provider.
164
The nurse is preparing to admit a child to the hospital with a diagnosis of acute poststreptococcal glomerulonephritis. The nurse understands that the peak age at onset for this disease is what?
5 to 7 years
165
The nurse is preparing to admit a child to the hospital with a diagnosis of minimal change nephrotic syndrome. The nurse understands that the peak age at onset for this disease is what?
2 to 3 years
166
What test is used to screen for carbohydrate malabsorption?
Stool pH
167
A toddler’s mother calls the nurse because she thinks her son has swallowed a button type of battery. He has no signs of respiratory distress. The nurse’s response should be based on which premise?
The location needs to be confirmed by radiographic examination.
168
The mother of a child with cognitive impairment calls the nurse because her son has been gagging and drooling all morning. The nurse suspects foreign body ingestion. What physiologic occurrence is most likely responsible for the presenting signs?
The object may be lodged in the esophagus.
169
What is a high-fiber food that the nurse should recommend for a child with chronic constipation?
Popcorn
170
A 2-year-old child has a chronic history of constipation and is brought to the clinic for evaluation. What should the therapeutic plan initially include?
Bowel cleansing
171
What statement best describes Hirschsprung disease?
The colon has an aganglionic segment.
172
A 3-year-old child with Hirschsprung disease is hospitalized for surgery. A temporary colostomy will be necessary. How should the nurse prepare this child?
It is essential because it will be an adjustment.
173
A child has a nasogastric (NG) tube after surgery for Hirschsprung disease. What is the purpose of the NG tube?
Prevent abdominal distention.
174
A parent of an infant with gastroesophageal reflux asks how to decrease the number and total volume of emesis. What recommendation should the nurse include in teaching this parent?
Thicken feedings and enlarge the nipple hole.
175
After surgery yesterday for gastroesophageal reflux, the nurse finds that the infant has somehow removed the nasogastric (NG) tube. What nursing action is most appropriate to perform at this time?
Notify the practitioner.
176
What clinical manifestation should be the most suggestive of acute appendicitis?
Colicky, cramping, abdominal pain around the umbilicus
177
The nurse is caring for a child admitted with acute abdominal pain and possible appendicitis. What intervention is appropriate to relieve the abdominal discomfort during the evaluation?
Allow the child to assume a position of comfort.
178
What statement is most descriptive of Meckel diverticulum?
Intestinal bleeding may be mild or profuse
179
Nutritional management of the child with Crohn disease includes a diet that has which component?
Increased protein
180
What information should the nurse include when teaching an adolescent with Crohn disease (CD)?
How to cope with stress and adjust to chronic illness
181
A child with pyloric stenosis is having excessive vomiting. The nurse should assess for what potential complication?
Metabolic alkalosis
182
What term describes invagination of one segment of bowel within another?
Intussusception
183
A school-age child with celiac disease asks for guidance about snacks that will not exacerbate the disease. What snack should the nurse suggest?
Popcorn
184
An infant with short bowel syndrome is receiving total parenteral nutrition (TPN). The practitioner has added continuous enteral feedings through a gastrostomy tube. The nurse recognizes this as important for which reason?
Stimulate adaptation of the small intestine
185
A child with acute gastrointestinal bleeding is admitted to the hospital. The nurse observes which sign or symptom as an early manifestation of shock?
Restlessness
186
What signs or symptoms are most commonly associated with the prodromal phase of acute viral hepatitis?
Anorexia and malaise
187
The nurse is discussing home care with a mother whose 6-year-old child has hepatitis A. What information should the nurse include?
Teach infection control measures to family members.
188
The nurse observes that a newborn is having problems after birth. What should indicate a tracheoesophageal fistula?
Excessive frothy saliva
189
The nurse is caring for an infant who had surgical repair of a tracheoesophageal fistula 24 hours ago. Gastrostomy feedings have not been started. What do nursing actions related to the gastrostomy tube include?
Leave the tube open to gravity drainage.
190
What should preoperative care of a newborn with an anorectal malformation include?
Gastrointestinal decompression
191
A child who has just had definitive repair of a high rectal malformation is to be discharged. What should the nurse address in the discharge preparation of this family?
Changes in stooling patterns to report to the practitioner
192
The nurse is preparing to care for a newborn with an omphalocele. The nurse should understand that care of the infant should include what intervention?
Covering the intact bowel with a nonadherent dressing to prevent injury
193
What should the nurse consider when providing support to a family whose infant has just been diagnosed with biliary atresia?
Liver transplantation may be needed eventually.
194
A 3-day-old infant presents with abdominal distention, is vomiting, and has not passed any meconium stools. What disease should the nurse suspect?
Hirschsprung disease
195
A 6-month-old infant with Hirschsprung disease is scheduled for a temporary colostomy. What should postoperative teaching to the parents include?
Assessing bowel function
196
An infant is born with a gastroschisis. Care preoperatively should include which priority intervention?
Covering the defect with a sterile bowel bag
197
What is the purpose in using cimetidine (Tagamet) for gastroesophageal reflux?
The medication reduces gastric acid secretion.
198
A health care provider prescribes feedings of 1 to 2 oz Pedialyte every 3 hours and to advance to 1/2 strength Similac with iron as tolerated postoperatively for an infant who had a pyloromyotomy. The nurse should decide to advance the feeding if which occurs?
The infant is taking the Pedialyte without vomiting or distention.
199
The nurse is assisting a child with celiac disease to select foods from a menu. What foods should the nurse suggest?
Corn on the cob with butter
200
A child is being admitted to the hospital with acute gastroenteritis. The health care provider prescribes an antiemetic. What antiemetic does the nurse anticipate being prescribed?
Ondansetron (Zofran)
201
The nurse should instruct parents to administer a daily proton pump inhibitor to their child with gastroesophageal reflux at which time?
30 minutes before breakfast
202
An infant had a gastrostomy tube placed for feedings after a Nissen fundoplication and bolus feedings are initiated. Between feedings while the tube is clamped, the infant becomes irritable, and there is evidence of cramping. What action should the nurse implement?
Vent the gastrostomy tube.
203
What intervention is contraindicated in a suspected case of appendicitis?
Enemas
204
The nurse is caring for a child with Meckel diverticulum. What type of stool does the nurse expect to observe?
Currant jelly–like
205
The nurse is evaluating the laboratory results of a stool sample. What is a normal finding?
The laboratory reports a negative guaiac.
206
What respiratory condition or disease results in both increased compliance and increased resistance?
Asthma
207
How much oxygen is contained in ambient air (room air)?
21%
208
During a respiratory assessment, the nurse notes a sinking in of soft tissues relative to the cartilaginous and bony thorax. What is the term for this finding?
Retractions
209
What test measures the amount of air inhaled and exhaled during any respiratory cycle?
Tidal volume
210
It is important to make certain that sensory connectors and oximeters are compatible because incompatible wiring can cause which condition?
Burns under sensors
211
What test should the nurse do as a precautionary measure before doing an arterial puncture to obtain an arterial blood sample?
Allen test
212
Arterial blood gases have just been drawn on a child. What should the nurse do next?
Pack the sample in ice and take it to the laboratory immediately.
213
The continuous administration of mist, or aerosolized water, for the treatment of inflammatory conditions of the airways is a common practice that functions in which manner?
Has no proven benefit
214
When is bronchial (postural) drainage generally performed?
Before meals and at bedtime
215
What intervention is necessary when weaning a child from the ventilator?
Cool mist begun immediately after extubation
216
The nurse must suction a 6-month-old infant with a tracheostomy. What intervention should be included?
Perform each pass of the suction catheter for no longer than 5 seconds.
217
The nurse is planning home care for a 2-year-old child with a tracheostomy. What recommendation should be included?
Parents are able to change the tracheostomy tube when needed.
218
Respiratory failure can result from many causes. What condition is a specific primary cause of inefficient gas transfer?
Anemia
219
Effective cardiopulmonary resuscitation (CPR) on a 5-year-old child should include what technique?
Provide two breaths to every 30 chest compressions.
220
A series of subdiaphragmatic abdominal thrusts (the Heimlich maneuver) is recommended for airway obstruction in children older than which age?
1 year
221
The nurse is caring for a 4-year-old child who is receiving 2 L of oxygen per nasal cannula. What disadvantage should the nurse consider when planning care for the child?
A nasal cannula may cause abdominal distention.
222
A 5-month-old infant is in respiratory distress. What should the nurse expect to find?
Nasal flaring
223
A child is in uncompensated respiratory alkalosis. What should the nurse expect the arterial blood gas to be?
CO2, 30; pH, 7.50
224
A child is in uncompensated metabolic alkalosis. What should the nurse expect the arterial blood gas to be?
HCO3, 28; pH, 7.50
225
A nurse is calculating the correlation of Pao2 with Sao2 according to the oxyhemoglobin dissociation curve. What parameter should indicate that the Pao2 is less than 50 to 60 mm Hg?
Pulse oximetry reading of 90% or less
226
The nurse is reviewing factors that affect lung development. What factor delays surfactant production and maturation of alveolar cells?
Excess of endogenous insulin
227
The nurse is caring for a child in respiratory distress. What is an early but less obvious sign of respiratory failure?
Headache
228
The nurse is caring for a child on oxygen being delivered by a nasal cannula. What is the advantage of delivering oxygen in this manner?
The child is able to eat and talk while getting oxygen.
229
The nurse is evaluating arterial blood gas results. What condition can cause an increase in HCO3?
Fluid loss from upper gastrointestinal tract
230
The nurse is analyzing an arterial blood gas of pH, 7.30; PCO2, 50; and HCO3, 29. What result should the nurse document for this blood gas?
Partially compensated respiratory acidosis
231
The nurse is analyzing an arterial blood gas of pH, 7.50; PCO2, 50; and HCO3, 29. What result should the nurse document for this blood gas?
Partially compensated metabolic alkalosis
232
The nurse is analyzing an arterial blood gas of pH, 7.29; PCO2, 30; and HCO3, 20. What result should the nurse document for this blood gas?
Partially compensated metabolic acidosis
233
Why are cool-mist vaporizers rather than steam vaporizers recommended in the home treatment of respiratory infections?
They are safer.
234
It is important that a child with acute streptococcal pharyngitis be treated with antibiotics to prevent which condition?
Acute rheumatic fever
235
When caring for a child after a tonsillectomy, what intervention should the nurse do?
Watch for continuous swallowing.
236
What statement best represents infectious mononucleosis?
Clinical signs and symptoms and blood tests are both needed to establish the diagnosis.
237
Parents bring their 15-month-old infant to the emergency department at 3:00 AM because the toddler has a temperature of 39° C (102.2° F), is crying inconsolably, and is tugging at the ears. A diagnosis of otitis media (OM) is made. In addition to antibiotic therapy, the nurse practitioner should instruct the parents to use what medication?
Benzocaine ear drops for topical pain relief
238
An 18-month-old child is seen in the clinic with otitis media (OM). Oral amoxicillin is prescribed. What instructions should be given to the parent?
Administer all of the prescribed medication.
239
An infant’s parents ask the nurse about preventing otitis media (OM). What information should be provided?
Avoid tobacco smoke.
240
A 4-year-old girl is brought to the emergency department. She has a “froglike” croaking sound on inspiration, is agitated, and is drooling. She insists on sitting upright. The nurse should intervene in which manner?
Notify the physician immediately and be prepared to assist with a tracheostomy or intubation.
241
The nurse is assessing a child with croup in the emergency department. The child has a sore throat and is drooling. Examining the child’s throat using a tongue depressor might precipitate what condition?
Complete obstruction
242
The mother of a 20-month-old boy tells the nurse that he has a barking cough at night. His temperature is 37° C (98.6° F). The nurse suspects mild croup and should recommend which intervention?
Provide fluids that the child likes and use comfort measures.
243
The nurse encourages the mother of a toddler with acute laryngotracheobronchitis to stay at the bedside as much as possible. What is the primary rationale for this action?
The mother’s presence will reduce anxiety and ease the child’s respiratory efforts.
244
An infant with bronchiolitis is hospitalized. The causative organism is respiratory syncytial virus (RSV). The nurse knows that a child infected with this virus requires what type of isolation?
Contact Precautions
245
An infant has been diagnosed with staphylococcal pneumonia. Nursing care of the child with pneumonia includes which intervention?
Administration of antibiotics
246
What consideration is most important in managing tuberculosis (TB) in children?
Chemotherapy
247
A toddler has a unilateral foul-smelling nasal discharge and frequent sneezing. The nurse should suspect what condition?
Foreign body in the nose
248
The nurse is caring for a child with acute respiratory distress syndrome (ARDS) associated with sepsis. What nursing action should be included in the care of the child?
Monitor pulse oximetry.
249
What diagnostic test for allergies involves the injection of specific allergens?
Skin testing
250
What statement is the most descriptive of asthma?
There is heightened airway reactivity.
251
What condition is the leading cause of chronic illness in children?
Asthma
252
A child has a chronic cough and diffuse wheezing during the expiratory phase of respiration. This suggests what condition?
Asthma
253
A child with asthma is having pulmonary function tests. What rationale explains the purpose of the peak expiratory flow rate?
To assess severity of asthma
254
Children who are taking long-term inhaled steroids should be assessed frequently for what potential complication?
Slowed growth
255
One of the goals for children with asthma is to maintain the child’s normal functioning. What principle of treatment helps to accomplish this goal?
Reduce underlying inflammation.
256
What drug is usually given first in the emergency treatment of an acute, severe asthma episode in a young child?
Short-acting B2-agonists
257
Cystic fibrosis (CF) may affect single or multiple systems of the body. What is the primary factor responsible for possible multiple clinical manifestations in CF?
Mechanical obstruction caused by increased viscosity of mucous gland secretions
258
What is the earliest recognizable clinical manifestation(s) of cystic fibrosis (CF)?
Meconium ileus
259
What tests aid in the diagnosis of cystic fibrosis (CF)?
Sweat test, stool for fat, chest radiography
260
A child with cystic fibrosis (CF) receives aerosolized bronchodilator medication. When should this medication be administered?
Before chest physiotherapy (CPT)
261
The parent of a child with cystic fibrosis (CF) calls the clinic nurse to report that the child has developed tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The nurse should tell the parent to bring the child to the clinic because these signs and symptoms are suggestive of what condition?
Pneumothorax
262
Pancreatic enzymes are administered to the child with cystic fibrosis. What nursing consideration should be included in the plan of care?
Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal.
263
The nurse is giving discharge instructions to the parents of a 5-year-old child who had a tonsillectomy 4 hours ago. What statement by the parent indicates a correct understanding of the teaching?
“I can use an ice collar on my child for pain control along with analgesics.”
264
A 6-year-old child has had a tonsillectomy. The child is spitting up small amounts of dark brown blood in the immediate postoperative period. The nurse should take what action?
Continue to assess for bleeding.
265
A 3-year-old child is experiencing pain after a tonsillectomy. The child has not taken in any fluids and does not want to drink anything, saying, “My tummy hurts.” The following health care prescriptions are available: acetaminophen (Tylenol) PO (orally) or PR (rectally) PRN, ice chips, clear liquids. What should the nurse implement to relieve the child’s pain?
Tylenol PR
266
What do the initial signs of respiratory syncytial virus (RSV) infection in an infant include?
Rhinorrhea, wheezing, and fever
267
The nurse is caring for a 1-month-old infant with respiratory syncytial virus (RSV) who is receiving 23% oxygen via a plastic hood. The child’s SaO2 saturation is 88%, respiratory rate is 45 breaths/min, and pulse is 140 beats/min. Based on these assessments, what action should the nurse take?
Notify the health care provider.
268
A 5-year-old child is admitted with bacterial pneumonia. What signs and symptoms should the nurse expect to assess with this disease process?
Fever, cough, and chest pain
269
An infant with a congenital heart defect is to receive a dose of palivizumab (Synagis). What is the purpose of this?
Prevent RSV infection.
270
A 3-year-old child woke up in the middle of the night with a croupy cough and inspiratory stridor. The parents bring the child to the emergency department, but by the time they arrive, the cough is gone, and the stridor has resolved. What can the nurse teach the parents with regard to this type of croup?
A cool mist vaporizer at the bedside can help prevent this type of croup.
271
A 3-month-old infant is admitted to the pediatric unit for treatment of bronchiolitis. The infant’s vital signs are T, 101.6° F; P, 106 beats/min apical; and R, 70 breaths/min. The infant is irritable and fussy and coughs frequently. IV fluids are given via a peripheral venipuncture. Fluids by mouth were initially contraindicated for what reason?
Tachypnea
272
In providing nourishment for a child with cystic fibrosis (CF), what factors should the nurse keep in mind?
Diet should be high in calories, proteins, and unrestricted fats.
273
A quantitative sweat chloride test has been done on an 8-month-old child. What value should be indicative of cystic fibrosis (CF)?
Greater than 60 mEq/L
274
A preschool child has asthma, and a goal is to extend expiratory time and increase expiratory effectiveness. What action should the nurse implement to meet this goal?
Encourage the child to blow a pinwheel every 6 hours while awake.
275
A school-age child has asthma. The nurse should teach the child that if a peak expiratory flow rate is in the yellow zone, this means that the asthma control is what?
50% to 79% of a personal best and needs an increase in the usual therapy.
276
A family requires home care teaching with regard to preventative measures to use at home to avoid an asthmatic episode. What strategy should the nurse teach?
Use an indoor air purifier with HEPA filter.
277
A school-age child with cystic fibrosis takes four enzyme capsules with meals. The child is having four or five bowel movements per day. The nurse’s action in regard to the pancreatic enzymes is based on the knowledge that the dosage is what?
Needs to be increased to decrease the number of bowel movements per day
278
A term infant is delivered, and before delivery, the medical team was notified that a congenital diaphragmatic hernia (CDH) was diagnosed on ultrasonography. What should be done immediately at birth if respiratory distress is noted?
Intubate the infant.
