Exam, Elsevier and Book questions

Question 1

1. A nurse is selecting a family theory to assess a patient’s family dynamics. Which family theory best describes a series of tasks for the family throughout its life span?
Select one:
a. Duvall's Developmental Theory 
b. Family Systems Theory
c. Structural-functional theory
d. Interactional theory

Answer 1

a. Duvall’s Developmental Theory

Question 2

Which family theory explains how families react to stressful events and suggests factors that promote adaptation to these events?
Select one:
a. Family Stress Theory
b. Developmental Systems Theory
c. Duvall’s Developmental Theory
d. Interactional theory

Answer 2

a. Family Stress Theory

Question 3

Which is the term for a family in which the paternal grandmother, the parents, and two minor children live together?
Select one:
a. Blend
b. Traditional Nuclear
c. Binuclear
d. Extended

Answer 3

d. Extended

Question 4

A nurse is assessing a family’s structure. Which describes a family in which a mother, her children, and a stepfather live together?
Select one:
a. Extended
b. Nuclear
c. Blended
d. Binuclear

Answer 4

c. Blended

Question 5

The nurse is teaching a group of new parents about the experience of role transition. Which statement by a parent would indicate a correct understanding of the teaching?
Select one:
a. “Young parents can adjust to the new role easier than older parents.”
b. “My marital relationship can have a positive or negative effect on the role transition.”
c. “A parent’s previous experience with children makes the role transition more difficult.”
d. “If an infant has special care needs, the parents’ sense of confidence in their new role is strengthened.”

Answer 5

b. “My marital relationship can have a positive or negative effect on the role transition.”

Question 6

A mother brings 6-month-old Eric to the clinic for a well-baby checkup. She comments, “I want to go back to work, but I don’t want Eric to suffer because I’ll have less time with him.” The nurse’s most appropriate answer would be which statement?
Select one:
a. “You will need to stay home until Eric starts school.”
b. “You should go back to work so Eric will get used to being with others.”
c. “Let’s talk about the child care options that will be best for Eric.”.
d. “I’m sure he’ll be fine if you get a good babysitter.”

Answer 6

c. “Let’s talk about the child care options that will be best for Eric.”.

Question 7

Which term best describes a group of people who share a set of values, beliefs, practices, social relationships, law, politics, economics, and norms of behavior?
Select one:
a. Race
b. Social group
c. Culture 
d. Ethnicity

Answer 7

c. Culture

Question 8

A nurse is interviewing the parents of a toddler about use of complementary or alternative medical practices. The parents share several practices they use in their household. Which should the nurse document as complementary or alternative medical practices?
Select one or more:
a. Tylenol for fever
b. Cool air humidifier
c. Black tea at bedtime
d. Acupressure for headaches

Answer 8

d. Acupressure for headaches

Question 9

Which is the major cause of death for children older than 1 year?
Select one:
a. Heart disease
b. Congenital anomalies
c. Unintentional injuries 
d. Cancer

Answer 9

c. Unintentional injuries

Question 10

The nurse is teaching parents of toddlers about animal safety. Which should be included in the teaching session?
Select one:
a. Teach your toddler not to disturb an animal that is eating.
b. It is permissible for your toddler to feed treats to a dog.
c. The toddler is safe to approach an animal if the animal is chained.
d. Petting dogs in the neighborhood should be encouraged to prevent fear of dogs.

Answer 10

a. Teach your toddler not to disturb an animal that is eating.

Question 11

The school nurse is conducting a class on bicycle safety. Which statement made by a participant indicates a need for further teaching?
Select one:
a. Most bicycle injuries occur from a fall
b. I should replace my helmet every 5 years
c. Head injuries are the major cause of bicycle related fatalities
d. I can ride double with a friend on a bicycle if it has a large seat

Answer 11

d. I can ride double with a friend on a bicycle if it has a large seat

Question 12

Parents need further teaching about the use of car safety seats if they make which statement?
Select one:
a. “Even if our toddler helps buckle the straps, we will double-check the fastenings.”
b. “We will anchor the car seat to the car’s anchoring system.”
c. “We won’t start the car until everyone is properly restrained.”
d. “We won’t need to use the car seat on short trips to the store.”

Answer 12

d. “We won’t need to use the car seat on short trips to the store.”

Question 13

In providing a health promotion plan for new parents aimed at maintaining safety of children, which option should be stressed?
Select one:
a. Children’s anatomical proportions make them less likely to suffer traumatic brain injury.
b. Children should not be left alone in highchairs even if the chair is properly locked with the tray table secured.
c. As long as you provide firm directions and instructions, children typically will not get into trouble in their home environment.
d. Toddlers should be allowed to experiment with all types of foods as long as they are cut into two inch “bite size pieces.”

Answer 13

b. Children should not be left alone in highchairs even if the chair is properly locked with the tray table secured.

Question 14

After obtaining a health history, the nurse is charting information on the admission checklist for a child who was admitted to the pediatric unit for a respiratory infection. The nurse should include all of the following information under general appearance except: 
Select one:
a. Facial symmetry
b. Vital signs
c. Fine and Gross motor skills
d. Nutrition

Answer 14

b. Vital signs

Question 15

The nurse is doing a routine assessment on an 18-month-old child and notes that the anterior fontanel is closed. This should be interpreted as which of the following?
Select one:
a. Normal finding - indicates child is developing as expected
b. Abnormal finding – indicates need for immediate referral to practitioner
c. Abnormal finding – indicates need for neurological assessment
d. Questionable finding – indicates child should be checked in 1 month

Answer 15

a. Normal finding - indicates child is developing as expected

The posterior fontanelle is usually smaller and closes up by about 4 months of age.
The anterior fontanelle is usually bigger, starts getting smaller around 6 months, and doesn’t close up until 9-18 months of age (by 3 years at the latest).

Question 16

The student nurse is assessing the vital signs on a 7 month-old child who is crying while being held by the mother. The student nurse recognizes that the blood pressure is high for the child’s age. The next step the student nurse should take is:
Select one:
a. Report the blood pressure to the instructor
b. Repeat the blood pressure with the child in the crib
c. Repeat the blood pressure on the other leg
d. Repeat the blood pressure when the child is quiet

Answer 16

d. Repeat the blood pressure when the child is quiet

Question 17

The nurse is preparing to do a physical assessment on a 2 year-old child at a local clinic. The approach most likely to establish rapport and enable an accurate assessment is:
Select one:
a. Give the child a gown to wear
b. Insist the child sit on the examining table
c. Offer to let the child inspect the stethoscope
d. Use soft soothing sounds to communicate with the child

Answer 17

c. Offer to let the child inspect the stethoscope

Question 18

The nurse is discussing growth and development with a group of new parents. The nurse explains that the child’s physical development during the first year occurs primarily: 
Select one:
a. Cephalocaudal  
b. In length of legs 
c. In muscle size
d. Distal to proximal

Answer 18

a. Cephalocaudal\

Infant
-Head circ = chest circ
Toddler
-Squat, pot-bellied, bow-legged
-Growth in legs
-Taller/leaner after 2 years

Question 19

When recording a history which of the following fine motor skills would the nurse expect to be most recently achieved by a seven month-old infant?
Select one:
a. Voluntarily grasps an object.
b. Transfers object from one hand to the other.
c. Strong grasp reflex
d. Uses thumb and index finger in pincer grasp

Answer 19

b. Transfers object from one hand to the other.

Question 20

While discussing the progression of play with a group of parents, the nurse describes the play that is typical of a toddler as: 
Select one:
a. Associative
b. Solitary
c. Parallel 
d. Competative

Answer 20

c. Parallel

Question 21

The nurse is admitting a 4 month-old infant to the pediatric unit. The nurse recommends that hospital staff, nurses and parents hold the child during feedings in the plan of care to prevent all of the following common issues with hospitalization except for:
Select one:
a. Interrupted routine
b. Parental separation
c. Lack of stimulation 
d. Skin breakdown from prolonged bedrest

Answer 21

d. Skin breakdown from prolonged bedrest

Question 22

The nurse is observing parents playing with their 10-month-old daughter. Which of the following should the nurse recognize as an example that the child is developing object permanency?
Select one:
a. Looks for a toy that parent hides under a blanket.
b. Bangs two cubes held in her hands
c. Recognizes that a ball of clay is the same when flattened out.
d. Returns the blocks to the same spot on the table

Answer 22

a. Looks for a toy that parent hides under a blanket.

Question 23

The RN is preparing a four-year old child for surgery. Which intervention best demonstrates the RN understands the needs of the preschooler during hospitalization:
Select one:
a. Explaining to the child that surgery will involve just “first we will put you to sleep and then make a cut in your belly while you are asleep”
b. Pulling the curtain while the child changes to provide the child privacy.
c. Insist the child lay in the hospital bed instead of sitting on mom’s lap during preparation procedures
d. Asking the child, “Do you want to wear green or blue hospital socks?”

Answer 23

d. Asking the child, “Do you want to wear green or blue hospital socks?”

Question 24

The mother of a 3 year-old is upset because her child “has been acting like a baby since he was admitted to the hospital”. The nurse explains that:
Select one:
a. The child is experiencing stranger anxiety
b. Children this age really are babies
c. Children often demonstrate signs of regression in their behavior when they are hospitalized
d. The child is acting this way to get the mother’s attention

Answer 24

c. Children often demonstrate signs of regression in their behavior when they are hospitalized

Question 25

While reviewing for the NCLEX, the student nurse remembers that a preschool child: Select one or more: a. Are learning self control b. Have a fear of mutilation c. Believes their thoughts are powerful. d. Engage in ritualistic behaviors

Answer 25

b. Have a fear of mutilation | c. Believes their thoughts are powerful.

Question 26

While preparing medication to give to a 4 year-old child, remembers the 6 rights and 3 checks procedure for medication administration. The nurse recognizes a priority safety concern is: Select one: a. Teaching the child about the side effects of the medication b. Monitoring parental involvement in medication administration c. Calculating and administering safe doses . d. Determining which oral fluid to give with the medication

Answer 26

c. Calculating and administering safe doses .

Question 27

``` Which is probably the single most important influence on growth at all stages of development? Select one: a. Culture b. Environment c. Heredity d. Nutrition ```

Answer 27

d. Nutrition

Question 28

The nurse observes a mother with her 18-month-old child. In a period of just a few minutes the child has said "No" to her several times when she asks him to do something. The nurse recognizes that the child is: Select one: a. Trying to differentiate himself from his father b. Exhibiting attempts at autonomy c. Practicing domestic mimicry d. Trying to differentiate himself from his mother

Answer 28

b. Exhibiting attempts at autonomy

Question 29

``` The nurse is helping parents achieve a more nutritionally adequate vegetarian diet for their 4 year old child. Which is most likely lacking in their particular diet? Select one: a. Complete Protein. b. Fiber c. Carbohydrates d. Fat ```

Answer 29

a. Complete Protein.

Question 30

When a preschool child is hospitalized without adequate preparation, how does the child often react to the hospitalization? Select one: a. The child's self-image may be threatened b. Child may react to a potential loss of friends c. Child may exhibit regression d. Child may see hospitalization as a punishment

Answer 30

d. Child may see hospitalization as a punishment

Question 31

A 10-year-old girl needs to have another intravenous (IV) line started. She keeps telling the nurse, “Wait a minute” and “I’m not ready.” The nurse should recognize this as which description? Select one: a. The child thinks the nurse is punishing her. b. The child has successfully manipulated the nurse in the past. c. This is normal behavior for a school-age child. d. The behavior is not seen past the preschool years.

Answer 31

c. This is normal behavior for a school-age child.

Question 32

Samantha, age 4 years, tells the nurse that she “needs a Band-Aid” where she had an injection. Which is the best nursing action? Select one: a. Ask her why she wants a Band-Aid b. Explain why a Band-Aid is not needed c. Apply a Band-Aid d. Show her that the bleeding has already stopped.

Answer 32

c. Apply a Band-Aid

Question 33

``` A nurse is caring for four patients; three are toddlers and one is a preschooler. Which represents the major stressor of hospitalization for these four patients? Select one: a. Separation anxiety b. Loss of control c. Fear of pain d. Fear of bodily injury ```

Answer 33

a. Separation anxiety

Question 34

During the first 4 days of hospitalization, Eric, age 18 months, cried inconsolably when his parents left him, and he refused the staff’s attention. Now the nurse observes that Eric appears to be “settled in” and unconcerned about seeing his parents. The nurse should interpret this as which statement? Select one: a. Because he is "at home now in the hospital" seeing his mother again would only start the cycle of crying all over again b. He may be experiencing detachment, which is the third stage of separation anxiety c. He has transferred his trust to the nursing staff d. He has successfully adapted to the hospital environment

Answer 34

b. He may be experiencing detachment, which is the third stage of separation anxiety

Question 35

``` Families progress through various stages of reactions when a child is diagnosed with a chronic illness or disability. After the shock phase, a period of adjustment usually follows. This is often characterized by which of the following responses? Select one: a. Guilt and anger b. Acceptance of child's limitations c. Denial d. Social reintegration ```

Answer 35

a. Guilt and anger

Question 36

Amy, age 6 years, needs to be hospitalized again because of a chronic illness. The clinic nurse overhears her school-age siblings tell her, “We are sick of Mom always sitting with you in the hospital and playing with you. It isn’t fair that you get everything and we have to stay with the neighbors.” Which is the nurse’s best assessment of this situation? Select one: a. Siblings need to better understand their sister's illness and special needs b. Siblings are immature and probably spoiled c. Family has ineffective coping mechanisms to deal with chronic illness d. Jealousy and resentment are common reactions to the illness or hospitalization of a sibling with chronic illness

Answer 36

d. Jealousy and resentment are common reactions to the illness or hospitalization of a sibling with chronic illness

Question 37

The nurse is providing support to parents at the time their child is diagnosed with chronic disabilities. The nurse notices that the parents keep asking the same questions. What is the nurse’s best intervention? Select one: a. Recognize that some parents cannot understand explanations b. Kindly refer them to someone else for answering their questions c. Patiently continue to answer questions d. Suggest that they ask their questions when they are not upset

Answer 37

c. Patiently continue to answer questions

Question 38

A nurse plans therapeutic play time for a hospitalized child. What are the benefits of play? (Select all that apply.) Select one or more: a. Allows child a way to express feelings b. The child can deal with concerns and feelings c. The nurse can gain insight into the child's feelings and fears d. Gives the child a structured play environment e. Serves as a method to assist disturbed children

Answer 38

a. Allows child a way to express feelings b. The child can deal with concerns and feelings c. The nurse can gain insight into the child's feelings and fears

Question 39

``` A 12-year-old child enjoys collecting stamps, playing soccer, and participating in Boy Scout activities. The nurse recognizes that the child is displaying which developmental task? Select one: a. Identity b. Intimacy c. Integrity d. Industry ```

Answer 39

d. Industry

Question 40

Erickson’s psychosocial stages of development are listed below, match the stage associated with the age range. Trust vs Mistrust-> ________________ Autonomy vs Shame and Doubt-> ________________ Industry vs Inferiority-> ________________ Initiative vs Guilt -> ________________

Answer 40

Trust vs Mistrust-> infant to 18mo Autonomy vs Shame and Doubt-> 18mo to 3 yr Industry vs Inferiority-> 5-13 years Initiative vs Guilt -> 3-5 years

Question 41

``` According to Erikson, infancy is concerned with acquiring a sense of Select one: a. Industry b. Trust c. Initiative d. Separation ```

Answer 41

b. Trust

Question 42

Erickson’s psychosocial stages of development are listed below, match the stage associated with the age range. Trust vs Mistrust-> ________________ Autonomy vs Shame and Doubt-> ________________ Industry vs Inferiority-> ________________ Initiative vs Guilt -> ________________

Answer 42

Trust vs Mistrust-> infant to 12mo Autonomy vs Shame and Doubt-> 12mo to 3 yr Industry vs Inferiority-> 6-12 years Initiative vs Guilt -> 3-5 years

Question 43

A nurse is examining a toddler and is discussing with the mother psychosocial development according to Erikson’s theories. Based on the nurse’s knowledge of Erikson, the most age-appropriate activity to suggest to the mother at this stage is to Select one: a. Allow the toddler to play with a talking duck toy b. Allow the toddler to start making choices about what to wear. c. Feed lunch d. Turn on the TV with loud songs and bright colors

Answer 43

b. Allow the toddler to start making choices about what to wear.

Question 44

Based on Piaget’s theory of cognitive development, what is one basic concept a child is expected to attain during the first year of life? Select one: a. If an object is hidden, that does not mean that it is gone. b. Parents are not perfect. c. He or she cannot be fooled by changing shapes. d. Most procedures can be reversed.

Answer 44

a. If an object is hidden, that does not mean that it is gone.

Question 45

According to Kohlberg, children develop moral reasoning as they mature. Which statement is most characteristic of a preschooler’s stage of moral development? Select one: a. Actions are determined as good or bad in terms of their consequences. b. Obeying the rules of correct behavior is important. c. Behavior that pleases others is considered good. d. Showing respect for authority is important behavior.

Answer 45

a. Actions are determined as good or bad in terms of their consequences.

Question 46

A nurse is assessing a preschool-age child and notes the child exhibits magical thinking. According to Piaget, which describes magical thinking? Select one: a. Events have cause and effect b. God is like an imaginary friend c. If the skin is broken, the child’s insides will come out. d. Thoughts are all-powerful

Answer 46

d. Thoughts are all-powerful

Question 47

Zosyn IV is ordered to infuse over a ½ hour. The total volume that you want to infuse is 30 mls. What hourly rate (mL/hr) should you set the pump to run for this antibiotic to be delivered at the ordered rate? Answer: _______mL/hr

Answer 47

60 mL/hr

Question 48

An infant is having an anaphylactic reaction, and the nurse is preparing to administer epinephrine 0.001 mg/kg. The child weighs 22 pounds. What is the epinephrine dose the nurse should administer? (Record your answer using two decimal places.) Answer: _______ mg

Answer 48

0.01 mg

Question 49

Amoxicillin 600 mg, po, tid is ordered for a child with otitis media. Amoxicillin is supplied in a concentration of 200 mg/5 ml. How many mL(s) should be given per dose? Answer: _______ mL

Answer 49

15

Question 50

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

Answer 50

B. Culture

Question 51

``` Currently, the fastest-growing segment of the homeless population in the United States consists of which of the following? A. Families B. “Runaway” adolescents C. Migrant farm workers D. Individuals with mental disorders ```

Answer 51

A. Families

Question 52

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

Answer 52

C. She is experiencing cultural shock.

Question 53

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

Answer 53

A. Order the child a meatless tray as requested.

Question 54

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

Answer 54

A. They may be used to reinforce the treatment plan.

Question 55

When discussing oxygenation with colleagues on the pediatric unit, one nurse explains that the concept of oxygenation is: Select one: a. Increased as the child gets older b. Is the process of providing cells with oxygen through the respiratory system c. A reflection the child’s developmental status d. Presents problems primarily in children under the age of 5 years

Answer 55

b. Is the process of providing cells with oxygen through the respiratory system

Question 56

``` The nurse is reviewing information on medications to be used for children with respiratory distress. The nurse notes that medication that stimulates beta2 receptors include Select one: a. Mast cell stablizers b. Leukotriene modifiers c. Bronchodilators d. e. Corticosteroids ```

Answer 56

c. Bronchodilators

Question 57

``` When assessing the respiratory status of a child, the nurse should look for intercostal retractions during: Select one: a. Coughing b. Sneezing c. Expiration d. Inspiration ```

Answer 57

d. Inspiration

Question 58

``` While assessing a six-month-old child diagnosed with an upper respiratory infection, the nurse notes a heart rate of 116, abdominal breathing, a respiratory rate of 62, and capillary refill of < 2 seconds. Which finding is indicative of increasing respiratory distress? Select one: a. Heart rate of 116 b. Capillary refill less than 2 seconds c. Abdominal breathing d. Respiratory rate of 62 ```

Answer 58

d. Respiratory rate of 62

Question 59

The nurse caring for a toddler with acute laryngotracheobronchitis encourages the mother to stay at the bedside as much as possible. Which of the following is the primary rationale for this action? Select one: a. Mothers of hospitalized toddlers often experience guilt b. The mother can provide constant respiratory care for the child c. The mother’s presence will promote comfort and ease the child’s respiratory efforts d. Separation from the mother is a major developmental threat at this age

Answer 59

c. The mother’s presence will promote comfort and ease the child’s respiratory efforts

Question 60

``` The mother of a three week-old infant being admitted to the pediatric unit with RSV asks the nurse why the child is being hospitalized. The nurse explains that the child requires close monitoring and observation to prevent complications of RSV in infants this age such as: Select one: a. Fever b. tachycardia c. Apnea d. wheezing ```

Answer 60

c. Apnea

Question 61

``` The nurse recognizes that signs of respiratory distress in a 4-month old infant includes all of the following except: Select one: a. Nasal flaring b. Tripod positioning c. Restlessness d. Grunting ```

Answer 61

b. Tripod positioning

Question 62

An 18 month-old child was brought to the emergency department (ED) at 1:00 am with a barking cough and a low-grade fever. After several hours of treatment and observation, coughing has subsided, and the patient is ready for discharge to home. Which of the following should the nurse include in the discharge instructions? Select one: a. "Give the child extra fluids and suction his nose every 4 hours" b. "Administer antipyretics every 6 hours for the next 48 hours" c. "The child can return to daycare this morningat 9:00" d. "Bring the child back to the ED if he has difficulty breathing or starts to cough again"

Answer 62

d. "Bring the child back to the ED if he has difficulty breathing or starts to cough again"

Question 63

The nurse is discussing cystic fibrosis with the parents of a child newly diagnosed with CF. Which of the following statements by the parents indicates that they need more education? Select one: a. “CF causes thick mucus secretions of the respiratory and GI system” b. "CF is a self-limiting illness which will subside after puberty" c. “My child will be prone to more frequent respiratory infections” d. “My child will require frequent chest physiotherapy”

Answer 63

b. "CF is a self-limiting illness which will subside after puberty"

Question 64

The nurse is receiving report at 0700 on the four children she will be caring for today. The nurse determines that the child she should assess first is: Select one: a. A 4-year-old with cystic fibrosis and an fever b. A 10-year-old admitted this morning following an acute asthma exacerbation c. An 18-month-old with LTB admitted 48 hours ago d. A 3-week-old admitted at 0400 with RSV Bronchiolitis

Answer 64

d. A 3-week-old admitted at 0400 with RSV Bronchiolitis

Question 65

``` Respiratory illness in children may result in hypoxia. When providing care for children in respiratory distress, the nurse should know that which of the following would provide the best assessment of the child’s oxygenation status? Select one: a. Dietary intake b. Vital signs with O2 Sat c. Urine output d. Respiratory rate ```

Answer 65

b. Vital signs with O2 Sat

Question 66

The nurse is reviewing the plan of care for a newly admitted 2 year-old child with an acute respiratory infection. Which of the following nursing interventions would be appropriate respiratory care for this child? Select one: a. Keep child in the crib with mattress flat b. Start intravenous fluids c. CPT and suction every 4 hours d. Provide humidified oxygen prn as ordered by MD

Answer 66

d. Provide humidified oxygen prn as ordered by MD

Question 67

A nurse receives report on a 3 year-old boy with suspected epiglottitis. His temperature is 38.7 C, he has mild hypoxia, he is drooling and having intercostal retractions. On further examination, you note inspiratory stridor. The nurse's highest priority while taking care of this child is to: Select one: a. Monitor the child’s vital signs every 4 hours b. Use cool compresses to reduce the fever c. Provide a calm environment and allow the child to assume a position of comfort. d. Insist the child wear an O2 mask even if it agitates him

Answer 67

c. Provide a calm environment and allow the child to assume a position of comfort.

Question 68

A child brought to the emergency room with a severe asthma attack is being admitted to the pediatric unit. Which of the following is an appropriate nursing action to include in the plan of care? Select one: a. Maintain strict bedrest b. Restrict oral fluids to 50% of maintenance c. Calm nursing presence d. Sedate the child for adequate rest

Answer 68

c. Calm nursing presence

Question 69

The mother of a child with asthma asks the nurse why Singulair has been prescribed for her child. The nurse explains that Singulair is used to treat children with asthma because it Select one: a. Is a preventative medication for asthma b. Controls allergic rhinitis c. Decreases mucous production d. Is an anti-inflammatory

Answer 69

d. Is an anti-inflammatory

Question 70

``` The nurse mentioned in the previous question explains to the mother that Singulair is in a classification of drugs called Select one: a. Xanthine derivatives b. Nonselective beta-adrenergics c. Bronchodilators d. Leukotriene modifiers ```

Answer 70

d. Leukotriene modifiers

Question 71

The nurse is taking care of an infant with RSV bronchiolitis. The nurse explains to the parent that the benefits and actions of the Ribavirin medication are listed below with one exception which is: Select one: a. It is associated with decreased length of hospital stay b. Blocks viral replication c. Stabilization of cell membranes d. Enhances antiviral response genes

Answer 71

c. Stabilization of cell membranes

Question 72

``` A 1-day old neonate is suspected of having cystic fibrosis. The mother asks the nurse what symptoms led the physician to suspect cystic fibrosis. The nurse explains that the earliest clinical manifestation of cystic fibrosis is often: Select one: a. Rectal prolapse b. Steatorrheac stools c. Constipation d. Meconium ileus ```

Answer 72

d. Meconium ileus

Question 73

A child is undergoing diagnostic evaluation to confirm a diagnosis of cystic fibrosis. Which of the following would the nurse most likely identify as being used to confirm the diagnosis? Select one: a. Quantitative sweat chloride test b. Complete blood count with differential c. Anaerobic blood culture d. Arterial blood gas

Answer 73

a. Quantitative sweat chloride test

Question 74

``` A nurse is assessing a previously healthy 3-year-old child who was brought to the ED after a sudden episode of coughing, acute onset of stridor, followed by respiratory distress. The nurse understands the most probable cause of this child's respiratory distress is: Select one: a. Acute nasopharyngitis b. Asthma exacerbation c. Foreign body aspiration d. RSV bronchiolitis ```

Answer 74

c. Foreign body aspiration

Question 75

The nurse is receiving report at 0700 on the four children she will be caring for today. The nurse determines that the child she should assess first is: Select one: a. A four year-old with cystic fibrosis admitted last night with a fever b. A three week old admitted at 0400 with RSV c. A ten year-old admitted 16 hours ago following an acute asthma exacerbation d. An eighteen month-old admitted 2 days ago with LTB

Answer 75

b. A three week old admitted at 0400 with RSV

Question 76

The nurse is preparing to admit a 2 month-infant child with an acute respiratory infection. The nurse understands that this child is at increased risk for respiratory failure due to all of the following except: Select one: a. Younger children are at higher risk than older children b. The pharynx is larger in the infant than in the adult c. The epiglottis is floppier in an infant than an adult d. The infant airway is smaller than the adult airway

Answer 76

b. The pharynx is larger in the infant than in the adult

Question 77

The nurse enters the room of a 5 year old child, Molly, who has pneumonia. Molly has is working hard to breathe and her O2 Sat monitor reads 92%. The nurse raises the head of the bed and has Molly tilt her head back. Which of the following would the nurse do next? Select one: a. Provide oxygen therapy as ordered by MD b. Give Molly a drink of milk c. Take Molly’s temperature orally d. Tell her mother that Molly is fine and go get some lunch

Answer 77

a. Provide oxygen therapy as ordered by MD

Question 78

When assessing perfusion on a 6-month-old infant admitted to the pediatric unit, the nurse understands that perfusion: Select one: a. Is accomplished by pulmonary ventilation b. Is dependent on a functioning respiratory and cardiac system c. Presents problems primarily in children with chronic disorders d. Reflects the child’s heart rate during activities

Answer 78

b. Is dependent on a functioning respiratory and cardiac system

Question 79

Which heart defect and hemodynamic change pairing is correct? Select one: a. Tetrology of Fallot and increased pulmonary blood flow b. Aortic stenosis and obstruction to blood flow out of the heart c. Ventricular septal defect and decreased pulmonary blood flow d. Pulmonic stenosis and increased pulmonary blood flow

Answer 79

b. Aortic stenosis and obstruction to blood flow out of the heart

Question 80

The nurse is caring for a 2 year-old who is scheduled for repair of an uncomplicated ventricular-septal defect. When discussing the defect with the parents the nurse explains that: Select one: a. Blood is shunted from the aorta to the pulmonary system b. Blood is shunted from the right ventricle to the left ventricle c. The oxygen content in the right ventricle is higher than the left ventricle d. Blood is shunted from the left ventricle to the right ventricle

Answer 80

d. Blood is shunted from the left ventricle to the right ventricle The left to right shunting of blood through the VSD causes increased blood pressure in the right ventricle and heavy pulmonary blood flow. If untreated, this can cause irreversible changes in the pulmonary circulation

Question 81

``` An infant is admitted to the pediatric unit with a congenital heart defect caused by an outflow obstruction. The nurse understands that the child may have which of the following heart defects? Select one: a. Ventricular Septal Defect b. Pulmonary Stenosis c. Hypoplastic Left Heart d. Complete AV Canal ```

Answer 81

b. Pulmonary Stenosis

Question 82

``` When assessing 10-year-old child on the cardiac unit, the nurse notes cool mottled skin on the lower extremities, hypertension in the upper extremities, and decreased femoral pulses. The nurse understands that these assessment findings are indicative of: Select one: a. Aortic stenosis b. Tetralogy of Fallot c. Ventricular septal defect d. Coarctation of the aorta ```

Answer 82

d. Coarctation of the aorta - also called aortic narrowing, is a congenital condition whereby the aorta is narrow, usually in the area where the ductus arteriosus (ligamentum arteriosum after regression) inserts. ... Coarctations are most common in the aortic arch

Question 83

``` The cardiologist is planning on meeting with the parents of a 3 month-old child to discuss the plan to medically close the child’s Patent Ductus Arteriosis. Which medication should the nurse have information on for the parents? Select one: a. Indomethacin b. Digoxin c. Amiodarone d. Prostaglandin ```

Answer 83

a. Indomethacin - When surgical ligation is not indicated, prostaglandin inhibitors (eg, nonsteroid antiinflammatory drugs [NSAIDs]) are used to close the ductus arteriosus. Intravenous (IV) indomethacin or IV ibuprofen is used to treat patent ductus arteriosus (PDA) in the neonate and in premature infants

Question 84

Two nurses are discussing the difference between hypoxemia and hypoxia. They determine that hypoxemia Select one: a. Is a result of reduction of oxygen supply to the tissues b. Results from left to right shunts c. Is seen as increased tissue perfusion d. Is associated with decreased partial pressure of oxygen in blood.

Answer 84

d. Is associated with decreased partial pressure of oxygen in blood.

Question 85

``` When reviewing heart failure in the pediatric population, the nurse understands that left sided heart failure in children is often seen as: Select one: a. Pulmonary edema b. Hepatomegaly c. Increased systemic venous congestion d. Decreased pulmonary venous pressure ```

Answer 85

a. Pulmonary edema

Question 86

``` A nurse caring for a child with heart failure due to a complex congenital heart defect understands that symptoms commonly seen include 1. Warm, pale extremities 2. Activity intolerance 3. Capillary refill > 2 secs 4. Developmental delay Choose from the following: Select one: a. 2,3,4 b. 2,4 c. 1,2,4 d. 2,3 ```

Answer 86

a. 2,3,4

Question 87

``` While assessing a child admitted with Tetralogy of Fallot, the nurse notes clubbing of the child’s fingers. The nurse understands that the cause of clubbing is usually due to: Select one: a. Chronic tissue hypoxemia b. Chronic activity intolerance c. Chronic low doses of Lasix d. Chronic low doses of Digoxin ```

Answer 87

a. Chronic tissue hypoxemia

Question 88

tetralogy of fallot

Answer 88

A heart defect that features four problems. They are: a hole between the lower chambers of the heart an obstruction from the heart to the lungs The aorta (blood vessel) lies over the hole in the lower chambers The muscle surrounding the lower right chamber becomes overly thickened

Question 89

A child with congestive heart failure has been admitted to the pediatric unit. The nurse would expect the child to exhibit which of the following? Select one: a. Weight loss and cold extremities b. Increased blood pressure and cyanosis c. Bradycardia and dyspnea d. Tachycardia and activity intolerance

Answer 89

d. Tachycardia and activity intolerance

Question 90

You are discharging a 10-week-old infant with CHD who will be going home on digoxin. Which of the following answers by the father indicate the need for more teaching? Select one: a. "Digoxin reduces the workload on the heart" b. "I know that this medication will improve the function of the heart muscle" c. "If I miss a dose because , then I should give 2 doses next time" d. "I know I should give the drug slowly directing it to the side and back of the mouth"

Answer 90

c. "If I miss a dose because , then I should give 2 doses next time"

Question 91

``` A 4-month-old child with a congenital heart defect has a hypercyanotic spell, the nurse’s priority action should be (which should be done first)? Select one: a. Administer oxygen b. Notify the child’s primary physician c. Put child in a knee-chest position d. Administer Lanoxin ```

Answer 91

c. Put child in a knee-chest position

Question 92

The nurse is discussing Rheumatic Heart Disease with the parents of a child in the clinic the nurse explains that rheumatic heart disease usually occurs Select one: a. Among un-immunized children b. In children attending day care c. As sequelae to a viral upper respiratory illness d. Following a Group A beta-hemolytic strep infection

Answer 92

d. Following a Group A beta-hemolytic strep infection

Question 93

``` The nurse is admitting a child diagnosed with Rheumatic Fever. The nurse explains to the parents that the most serious symptom of rheumatic fever is: Select one: a. Erythema marginatum b. Polyarthritis c. Carditis d. Carditis ```

Answer 93

c. Carditis

Question 94

While explaining Kawasaki disease to the parents of a 5 year-old child. The nurse explains that children are treated primarily to prevent: Select one: a. Fever from lasting longer than 5 days b. Development of erythematous rash c. Coronary artery aneurysms and thrombosis d. Edema of hands and feet

Answer 94

c. Coronary artery aneurysms and thrombosis

Question 95

``` During the assessment of a 3 year-old child admitted with Kawasaki Disease, the nurse notes bilateral conjunctivitis, thick nasal discharge, oral mucosal changes, and edema of the hands and feet. The nurse recognizes all findings are related to Kawasaki Disease except: Select one: a. Edema of the hands and feet b. Oral mucosal changes c. Thick nasal discharge d. Bilateral conjunctivitis ```

Answer 95

c. Thick nasal discharge

Question 96

Kawasaki Disease

Answer 96

Kawasaki disease is a rare childhood disease. It makes the walls of the blood vessels in the body become inflamed. It can affect any type of blood vessel, including the arteries, veins, and capillaries. No one knows what causes Kawasaki disease. Symptoms include High fever that lasts longer than 5 days Swollen lymph nodes in the neck A rash on the mid-section and genital area Red, dry, cracked lips and a red, swollen tongue Red, swollen palms of the hands and soles of the feet Redness of the eyes

Question 97

While assessing a 4-year-old child scheduled to receive Digoxin for heart failure, the nurse notes that the child has an apical heart rate of 68. The mother reports that the child was vomiting earlier. The nurse should: Select one: a. Give the medication with only a sip of water b. Ask if the child is still nauseous before giving the medication c. Recognize that these are possible signs of toxicity and withhold the medication d. Give half the dose and make a note that the pulse is lower than normal

Answer 97

c. Recognize that these are possible signs of toxicity and withhold the medication - features of digoxin toxicity are nausea, vomiting, abdominal pain, headache, dizziness, confusion, delirium, vision disturbance (blurred or yellow vision)

Question 98

The mother of a child with a heart defect is questioning the nurse about the child’s medication. The nurse explains that Aldactone: Select one: a. Promotes vascular relaxation b. Produces rapid diuresis c. Blocks reabsorption of sodium and water in the renal tubules d. Is a potassium sparing diuretic

Answer 98

d. Is a potassium sparing diuretic - Aldactone (spironolactone) is a potassium-sparing diuretic that prevents your body from absorbing too much salt and keeps your potassium levels from getting too low.

Question 99

The nurse is assessing a 3 year-old with congestive heart failure, weighing 10 kg, prior to administering the 10 mg Lasix IV. The nurse notes bilateral lung crackles, a blood pressure of 120/80, urine output of 350 ml over the last 24 hours, and a potassium level of 2.9. Which of these findings is a contraindication to giving the Lasix? Select one: a. Potassium level of 2.9 b. Blood pressure of 120/80 c. Bilateral lung crackles d. Urine output of 350 mL over the last 24 hours

Answer 99

a. Potassium level of 2.9

Question 100

The nurse is receiving morning shift report on the four children she will be caring for today. The nurse determines that the child she should assess first is: Select one: a. A two year-old admitted yesterday morning with bronchiolitis b. A three year-old child with Tetrology of Fallot who had 2 hypercyanotic spells since admission late last evening c. A five year-old with Kawasaki disease admitted three hours ago for IVIG infusion d. A fifteen month-old with a VSD scheduled for surgery tomorrow

Answer 100

b. A three year-old child with Tetrology of Fallot who had 2 hypercyanotic spells since admission late last evening

Question 101

When reviewing pediatric cardiac medications the student nurse notes that ACE inhibitors 1. Cause vasoconstriction and decreased sodium excretion 2. Block the conversion of angiotension I to angiotensin II 3. Enhance cardiac output 4. Reduce peripheral resistance Choose from the following: Select one: a. 2,3 b. 2,4 c. 1,2,4 d. 2,3,4

Answer 101

d. 2,3,4

Question 102

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

Answer 102

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

Question 103

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

Answer 103

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

Question 104

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

Answer 104

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

Question 105

``` Which of the following would be helpful word(s) to substitute for the word “shot” when working with a 4-year-old? A. Stick B. Bee sting C. Injection D. Medication under the skin ```

Answer 105

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

Question 106

When should clear liquids be stopped before scheduled surgery? A. Two hours before surgery \ B. Six hours before surgery C. The night before surgery at 8 PM D. The night before surgery at midnight

Answer 106

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

Question 107

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

Answer 107

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

Question 108

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

Answer 108

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

Question 109

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

Answer 109

C. Give high-quality foods and snacks whenever the child expresses hunger.

Question 110

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

Answer 110

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

Question 111

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

Answer 111

A. Wash hands thoroughly.

Question 112

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

Answer 112

A. Place the child in a side-lying position.

Question 113

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

Answer 113

A. Insert 2% lidocaine lubricant into the urethra.

Question 114

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

Answer 114

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

Question 115

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

Answer 115

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

Question 116

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

Answer 116

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

Question 117

``` The nurse is assessing a 6-month-old healthy infant who weighed 3.2 kg at birth. The nurse should expect the infant to now weigh approximately how many kilograms? A. 5.2 B. 6.3 C. 8.7 D. 9.6 ```

Answer 117

B. 6.3 Birth weight doubles at about ages 5 to 6 months. At 6 months, a child who weighed 3.2 kg at birth would weigh approximately 6.3 kg. The infant would have gone from the 50th percentile at birth to below the 5th percentile; 5.2 kg is too little. The infant would have tripled the birth weight by 6 months; 8.7 kg to 9.6 kg is too much.

Question 118

``` Which of the following reflexes appear at about 7 to 9 months of age? A. Moro B. Parachute C. Neck righting D. Labyrinth righting ```

Answer 118

B. Parachute The parachute reflex appears at 7 to 9 months of age and persists indefinitely. The Moro reflex is one of the primitive reflexes present at birth. Neck righting appears at 3 months of age and persists until 24 to 36 months. Labyrinth righting appears at 2 months and is strongest at 10 months

Question 119

In terms of fine motor development, what should an infant of 7 months be able to do? A. Transfer objects from one hand to the other. B. Use the thumb and index finger in crude pincer grasp. C. Hold a crayon and make a mark on paper. D. Release cubes into a cup.

Answer 119

A. Transfer objects from one hand to the other. The ability to transfer objects from one hand to another occurs at about age 7 months. The infant can use one hand for grasping and hold a cube in the other at the same time. A crude pincer grasp develops by ages 8 to 9 months. The ability to hold a crayon and mark on a piece of paper develops between ages 12 and 15 months. Infants can release a cube into a cup at ages 9 to 12 months.

Question 120

The nurse is assessing a 6-month-old infant who has head lag. The nurse should recognize which of the following? A. This is normal. B. The child is probably cognitively impaired. C. Developmental-neurologic evaluation is needed. D. The parent needs to work with the infant to stop head lag

Answer 120

C. Developmental-neurologic evaluation is needed. Most infants have only slight head lag when pulled from a lying to a sitting position at 4 months of age. By 6 months, head control should be well established. Developmental-neurologic evaluation is indicated to determine why the child is not achieving an expected milestone. The head lag is suggestive of a developmental delay. It does not provide information about cognitive status. As part of normal development, interventions cannot be done until a cause is identified.

Question 121

``` According to Erikson, infancy is concerned with acquiring a sense of which of the following? A. Trust B. Industry C. Initiative D. Autonomy ```

Answer 121

A. Trust During the first year of life, the infant focuses on the task of developing a sense of trust of self, of others, and of the world. This presents challenges for infants who are separated from parents or consistent caregivers. Industry is the focus of school-age children. Preschoolers are engaged in acquiring initiative. Autonomy is a developmental task during the toddler years.

Question 122

Which of the following behaviors indicates that an infant has developed object permanence? A. Secures objects by pulling on a string B. Actively searches for a hidden object C. Recognizes familiar face, such as mother D. Recognizes familiar object, such as bottle

Answer 122

B. Actively searches for a hidden object During the first 6 months of life, infants believe that objects exist only as long as they can see them. When infants search for an object that is out of sight, this signals the attainment of object permanence, whereby an infant knows an object exists even when it is not visible. The ability to understand cause and effect is part of secondary schema development, which is a later developmental task. Between ages 8 and 12 weeks, infants begin to respond differentially to their mothers. They cry, smile, vocalize, and show distinct preference for the mother. This preference is one of the stages that influences the attachment process but is too early for object permanence. Recognizing familiar objects is an important transition for the infant, but it does not signal object

Question 123

The parent of a 10-week-old infant tells the nurse, “She cries sometimes when nothing is wrong—for example, when she is dry and has recently been fed.” The most appropriate nursing intervention is which of the following? A. Reassure the parent that nothing is wrong. B. Explain how to better interpret infant cues. C. Evaluate for failure of the parent to bond with the infant. D. Reassure the parent that periods of “unexplained fussiness” are normal

Answer 123

D. Reassure the parent that periods of “unexplained fussiness” are normal A crying infant can be a source of great distress for parents. There is great variability in the amount of crying that can be expected from an infant. Parents should be reassured that some crying without apparent cause is normal. Persistent and inconsolable crying may need further attention. Reassuring the parent that nothing is wrong negates the parent’s concern about the child. The parent is responding to cues from the infant by feeding and changing diapers. There is no evidence that an attachment issue exists. The parent is seeking information about how to care for the infant.

Question 124

Sara, age 4 months, was born at 35 weeks of gestation. She seems to be developing normally, but her parents are concerned because she is a “more difficult” baby than their other child, who was full term. The nurse should explain that A. infants tend to become more difficult over time. B. infants become less difficult if they are kept on scheduled feedings and structured routines. C. Sara’s behavior is suggestive of failure to completely bond with her parents. D. Sara’s difficult temperament is the result of painful experiences in the neonatal period.

Answer 124

B. infants become less difficult if they are kept on scheduled feedings and structured routines. Children perceived as difficult may respond better to scheduled feedings and structured caregiving routines than to demand feedings and frequent changes in routines. Infant temperament has a strong biologic component. Together with interactions with the environment, primarily the family, the biologic component contributes to the infant’s unique temperament. Sara’s temperament has been created by both biologic and environmental factors. The nurse should provide guidance in parenting techniques that are best suited to Sara’s temperament.

Question 125

The nurse is guiding parents in selecting a daycare facility for their child. Which of the following is especially important to consider when making the selection? A. Health practices of the facility B. Structured learning environment C. Socioeconomic status of the children D. Cultural similarities of the children

Answer 125

A. Health practices of the facility Health practices should be most important. With the need for diaper changes and assistance with feeding, young children are at increased risk when hand washing and other hygienic measures are not consistently used. A structured learning environment is not the highest priority for a child this age. The socioeconomic status of the children should have little effect on the choice of facility. Cultural similarities may be important to some families, but the facility’s health care practices are more important.

Question 126

``` A mother tells the nurse that she is discontinuing breastfeeding her 5-month-old infant. The nurse should recommend that the infant be given A. skim milk. B. whole cow’s milk. C. commercial formula without iron. D. commercial iron-fortified formula ```

Answer 126

D. commercial iron-fortified formula For children younger than 1 year, the American Academy of Pediatrics recommends the use of breast milk. If breastfeeding has been discontinued, then iron-fortified commercial formula should be used. Cow’s milk should not be used in children younger than 12 months. Maternal iron stores are almost depleted by this age; the iron-fortified formula will help prevent the development of iron-deficiency anemia.

Question 127

What information should the nurse give a mother regarding the introduction of solid foods during infancy? A. Fruits and vegetables should be introduced into the diet first. B. Foods should be introduced one at a time at intervals of 5 to 7 days. C. Solid foods can be mixed in a bottle to make the transition easier for the infant. D. Solid foods should not be introduced until 8 to 10 months when the extrusion reflex begins to disappear.

Answer 127

B. Foods should be introduced one at a time at intervals of 5 to 7 days.One food item is introduced at intervals of 5 to 7 days to allow the identification of food allergies. Iron-fortified cereal should be the first solid food introduced into the infant’s diet. Mixing solid foods in a bottle has no effect on the transition to solid food. Solid foods can be introduced earlier than 8 to 10 months. The extrusion reflex usually disappears by age 6 months.

Question 128

The parents of a 3-month-old girl complain to the nurse that they are exhausted because she still wakes up as often as every 1 to 2 hours during the night. When she awakens, they change her diaper, and her mother nurses her back to sleep. Which of the following should the nurse suggest to help them deal with this problem? A. Let her cry herself back to sleep. B. Put her in parents’ bed to cuddle. C. Start putting her to bed while still awake and while the parent is present. D. Give her a bottle of formula instead of breastfeeding her so often at night.

Answer 128

C. Start putting her to bed while still awake and while the parent is present. Current research suggests that parents be present at bedtime until the child is drowsy. The child should then be allowed to fall asleep alone. This encourages self-soothing behaviors. Children who learn to fall asleep on their own have longer sustained sleep periods than those who fall asleep with parents present. Letting the child cry herself back to sleep is difficult to implement for many parents. Co-bedding could be unsafe at this age. The type of feeding will not affect the child’s sleep pattern.

Question 129

``` Which of the following vaccines is recommended for administration at birth? A. MMR (measles, mumps, and rubella) B. Hepatitis B C. Hepatitis A D. Haemophilus influenzae type b (Hib) ```

Answer 129

B. Hepatitis B Hepatitis B immunization is recommended early. Hepatitis B virus infections that occur during childhood can lead to fatal consequences from cirrhosis or liver cancer during adulthood. MMR is recommended for children ages 12 to 15 months. The hepatitis A series should begin between 12 and 23 months. Hib is administered beginning at age 2 months.

Question 130

The clinic is loaning a federally approved car seat to a 10-lb (4.5-kg) infant’s family. The nurse should explain that the safest place to put the car seat is in the A. back seat facing forward. B. middle of the back seat facing rearward. C. front seat with airbags on passenger side. D. front seat if there is no air bag on the passenger side.

Answer 130

B. middle of the back seat facing rearward. The rear-facing car seat provides the best protection for an infant’s disproportionately heavy head and weak neck in the event of an accident. The middle of the back seat is the safest position for the child. Severe injuries and deaths in children have occurred from air bags deploying on impact in the front passenger seat

Question 131

Myelination of the spinal cord is almost complete by 2 years of age. As a result of this, which of the following can gradually be achieved? A. Visual acuity of 20/20 B. Throwing a ball without falling C. Respirations becoming diaphragmatic D. Control of anal and urethral sphincters

Answer 131

D. Control of anal and urethral sphincters With complete myelination of the spinal column, voluntary control of elimination occurs. Control of anal and urethral sphincters is gradually achieved. Visual acuity is acceptable at 20/40. Throwing a ball without falling is achieved by 18 months of age. Respirations remain abdominal in this age-group.

Question 132

Which of the following is descriptive of toddlers’ cognitive development at age 20 months? A. Realize that “out of sight” is not out of reach. B. Search for an object only if they see it hidden. C. Put objects into a container but cannot take them out. D. Understand the passage of time, such as “just a minute” and “in an hour.”

Answer 132

A. Realize that “out of sight” is not out of reach. At this age, children are in the final sensorimotor stage. They will now search for an object in several potential places even though they saw only the original hiding place. Children have a more developed sense of objective permanence. They will search for objects even if they have not seen them hidden. When a child is able to put objects into a container but cannot take them out, this is indicative of tertiary circular reactions, which appear between the ages of 13 and 18 months. An embryonic sense of time exists; although children may behave appropriately to time-oriented phrases, their sense of timing is exaggerated.

Question 133

Two toddlers are playing in a sandbox when one child suddenly grabs a toy from the other child. Which of the following is the best interpretation of this behavior? A. This is typical behavior because toddlers are aggressive. B. This is typical behavior because toddlers are egocentric. C. Toddlers should know that sharing toys is expected of them. D. Toddlers should have the cognitive ability to know right from wrong.

Answer 133

B. This is typical behavior because toddlers are egocentric. Play develops from the solitary play of infancy to the parallel play of toddlers. A toddler plays alongside other children, not with them. When a child grabs a toy from another child, it is typical behavior of the toddler and is not intentionally aggressive. Shared play is not within their cognitive development. Toddlers do not conceptualize shared play. Because a toddler cannot view the situation from the perspective of the other child, it is okay to take the toy. Therefore, no right or wrong is associated with taking a toy.

Question 134

A toddler’s parent asks the nurse for suggestions on dealing with temper tantrums. Which one of the following is the most appropriate recommendation? A. Punish the child. B. Explain to the child why the tantrum is wrong. C. Leave the child alone until the tantrum is over. D. Remain close by the child but ignore the behaviors.

Answer 134

D. Remain close by the child but ignore the behaviors. The best way to deal with temper tantrums is to ignore the behaviors, provided that the actions are not dangerous to the child. Tantrums are common during this age group as the child becomes more independent and overwhelmed by increasingly complex tasks. The parents and caregivers need to have consistent and developmentally appropriate expectations. Punishment and explanations will not be beneficial. The presence of the parent is necessary both for safety and to provide a feeling of control and security to the child when the tantrum is over.

Question 135

Which statement characterizes toddlers’ eating behavior? A. Food fads are common. B. They have increased appetite. C. They have few food preferences. D. Their table manners are predictable.

Answer 135

A. Food fads are common. Appetite and food preferences are sporadic during the toddler years. The child may enjoy the same food several days in a row and then refuse to eat it. It is difficult to change the food fad. At approximately 18 months of age, toddlers have decreased nutritional needs. This is labeled physiologic anorexia. Toddlers have distinct food preferences that may not be consistent or predictable. At the toddler age, sitting at a table for a meal may be more disruptive than functional.

Question 136

Recommendations for parents of toddlers to meet fluoride requirements include all of the following except A. supervise the use of toothpaste. B. supervise the use of fluoride rinses. C. store fluoride products out of reach. D. administer fluoride supplements if water fluoride content is low.

Answer 136

B. supervise the use of fluoride rinses. Fluoride rinses are only suggested for children at high risk for cavities or over the age of 6 years. Toothpaste supervision, storage of fluoride products out of reach, and administration of fluoride supplements if water fluoride content is low are all recommended for toddlers.

Question 137

A parent has a 2-year-old child in the clinic for a well-child checkup. Which of the following statements by the parent would indicate to the nurse that the parent needs more instruction regarding accident prevention? A. “We locked all the medicines in the bathroom cabinet.” B. “We turned the thermostat down on our hot water heater.” C. “We placed gates at the top and bottom of the basement steps.” D. “We stopped using the car seat now that our child is older.”

Answer 137

D. “We stopped using the car seat now that our child is older.” Convertible car seats are necessary until the child is at least 18 kg (40 lb). Booster seats are required until the child is 36.2 kg (80 lb). Locking medicines in the bathroom cabinet will help prevent the child from accidentally ingesting medicines. Decreasing the temperature on the water heater can help prevent burns. Gates are appropriate to keep the toddler from falling down the stairs.

Question 138

In terms of fine motor development, what could a 3-year-old child be expected to do? A. Tie shoelaces. B. Use scissors or a pencil very well. C. Draw a person with seven to nine parts. D. Draw single-line shapes such as circles.

Answer 138

D. Draw single-line shapes such as circles. Three-year-old children are able to draw single-line shapes such as circles. A 5-year-old child’s fine motor skills include the ability to tie shoelaces, use scissors or a pencil, and draw a person with seven to nine parts.

Question 139

Which of the following is descriptive of a preschooler’s concept of time? A. Has no understanding of time B. Associates time with events C. Can tell time on a clock D. Uses terms such as “yesterday” appropriately

Answer 139

B. Associates time with events In a preschooler’s understanding, time has a relation with events such as: “We’ll go outside after lunch.” Preschoolers develop an abstract sense of time at age 3 years. Children can tell time on a clock at age 7 years. Children do not fully understand use of time-oriented words until age 6 years.

Question 140

Imaginary playmates are beneficial to the preschool child because they do which of the following? A. Take the place of social interactions. B. Take the place of pets and other toys. C. Become friends in times of loneliness. D. Accomplish what the child has already successfully accomplished.

Answer 140

C. Become friends in times of loneliness. One purpose of an imaginary friend is to be a friend in times of loneliness. Imaginary friends do not take the place of social interaction but may encourage conversation. Imaginary friends do not take the place of pets or toys. Imaginary friends accomplish what the child is still attempting.

Question 141

When preparing parents to teach their children about human sexuality, the nurse should emphasize which of the following? A. Parents should determine exactly what the child knows and wants to know before answering a question about sex. B. A parent’s words may have a greater influence on the child’s understanding than the parent’s actions. C. Parents should avoid using correct anatomic terms because they are confusing to preschoolers. D. Parents should allow children to satisfy their sexual curiosity by “playing doctor.”

Answer 141

A. Parents should determine exactly what the child knows and wants to know before answering a question about sex. Parents should be told that there are two rules that should be followed: find out what the child knows and be honest. Parents should model sexual behavior that is consistent with what they are teaching their children. Anatomic terms, although sometimes difficult to pronounce, will lay the groundwork for honest discussions later. Parents should not condone or condemn “playing doctor,” which is an extension of curiosity.

Question 142

Preschoolers’ fears can best be dealt with by which of the following interventions? A. Actively involving them in finding practical methods to deal with the frightening experience B. Forcing them to confront the frightening object or experience in the presence of their parents C. Using logical persuasion to explain away their fears and help them recognize how unrealistic the fears are D. Ridiculing their fears so that they understand that there is no need to be afraid

Answer 142

A. Actively involving them in finding practical methods to deal with the frightening experience Actively involving preschoolers in finding methods to deal with frightening experiences is the best way to deal with fears. Forcing a child to confront fears may make the child more afraid. Preconceptual thought prevents logical understanding. Ridiculing fears does not make them go away.

Question 143

Which of the following statements accurately describes physical development during the school-age years? A. The child’s weight almost triples. B. The child grows an average of 5 cm (2 inches) per year. C. Few physical differences are apparent among children of different genders at the end of middle childhood. D. Fat gradually increases, which contributes to the child’s heavier appearance

Answer 143

B. The child grows an average of 5 cm (2 inches) per year. In middle childhood, growth in height and weight occurs at a slower pace. Between the ages of 6 and 12 years, children grow 5 cm (2 inches) per year. In middle childhood, children’s weight will almost double; they gain 3 kg (6.6 lb) per year. At the end of middle childhood, girls grow taller and gain more weight than boys. Children take on a slimmer look with longer legs in middle childhood.

Question 144

Which of the following is characteristic of the psychosocial development of school-age children? A. Peer approval is not yet a motivating power. B. A developing sense of initiative is very important. C. Motivation comes from extrinsic rather than intrinsic sources. D. Feelings of inferiority or lack of worth can be derived from children themselves or from the environment.

Answer 144

D. Feelings of inferiority or lack of worth can be derived from children themselves or from the environment. A sense of industry, or accomplishment, is achieved between the ages of 6 years and adolescence. Erikson labels this stage as industry versus inferiority. Interaction with peers is a source of satisfaction for school-age children. Initiative is the developmental task of the preschooler. Intrinsic motivation is associated with increased competence in mastering skills.

Question 145

Which of the following describes the cognitive abilities of school-age children? A. Have developed the ability to reason abstractly B. Become capable of scientific reasoning and formal logic C. Progress from making judgments based on what they reason to making judgments based on what they see D. Have the ability to place things in a logical order, to group and sort, and to hold a concept in their minds while making decisions based on that concept.

Answer 145

D. Have the ability to place things in a logical order, to group and sort, and to hold a concept in their minds while making decisions based on that concept. In Piaget’s stage of concrete operations, children have the ability to group and sort and make conceptual decisions. Children cannot reason abstractly until late adolescence. Scientific reasoning and formal logic are skills of adolescents. Progressing from making judgments based on what school-age children reason to making judgments based on what they see is not a developmental skill.

Question 146

Which of the following describes moral development in younger school-age children? A. The standards of behavior now come from within themselves. B. They do not yet experience a sense of guilt when they misbehave. C. They know the rules and behaviors expected of them but do not understand the reasons behind them. D. They no longer interpret accidents and misfortunes as punishment for misdeeds

Answer 146

C. They know the rules and behaviors expected of them but do not understand the reasons behind them. Children who are ages 6 and 7 years know the rules and behaviors expected of them but do not understand the reasons for these rules and behaviors. Young children do not believe that standards of behavior come from within themselves but that rules are established and set down by others. Younger school-age children learn standards for acceptable behavior, act according to these standards, and feel guilty when they violate them. Misfortunes and accidents are viewed as punishment for bad acts.

Question 147

A group of boys ages 9 and 10 have formed a “boys only” club that is open to neighborhood and school friends who have skateboards. This should be interpreted as which of the following? A. Behavior that encourages bullying and sexism B. Behavior that reinforces poor peer relationships C. Characteristic of social development of this age D. Characteristic of children who are later at risk for membership in gangs

Answer 147

C. Characteristic of social development of this age One of the outstanding characteristics of middle childhood is the creation of formalized groups or clubs. Peer-group identification and association are essential to a child’s socialization. Poor relationships with peers and a lack of group identification can contribute to bullying. Forming a boys-only club at this age does not have a direct correlation with later gang activity.

Question 148

Bullying can be common during the school-age years. The nurse should recognize that bullying A. can have a lasting effect on children. B. is not a significant threat to self-concept. C. is rarely based on anything that is concrete. D. is usually ignored by the child who is being teased.

Answer 148

A. can have a lasting effect on children. Bullying in this age-group is common and can have a long-lasting effect. Increasing awareness of differences, especially when accompanied by unkind comments and taunts from others, may make a child feel inferior and undesirable. Physical impairments such as hearing or visual defects, ears that “stick out,” or birth marks assume great importance.

Question 149

Which of the following should the nurse include when giving parents guidelines about helping their children in school? A. Punish children who fail to perform adequately. B. Help children as much as possible with their homework. C. Communicate with teachers if there appears to be a problem. D. Accept responsibility for children’s successes and failures.

Answer 149

C. Communicate with teachers if there appears to be a problem. Communication between the parent and teachers is essential. It demonstrates that parents consider school important and that education is a shared responsibility. Excessive pressure or lack of encouragement from parents can inhibit the development of the child’s maximum potential. Children need to be responsible for their schoolwork. By being responsible, children learn to meet deadlines and be successful.

Question 150

Sleep problems in school-age children are often demonstrated by A. night terrors that awaken them. B. delaying tactics because they do not wish to go to bed. C. somatic illness that awakens them. D. increasing need for sleep time as they get older.

Answer 150

B. delaying tactics because they do not wish to go to bed. Children in middle childhood must be reminded to go to sleep. Older children up to age 11 years are particularly resistant, and they may demonstrate delaying tactics because they do not wish to go to bed. Night terrors are common in the preschool-age child. If somatic illness is present, a thorough assessment is indicated. The amount of sleep needed decreases as children get older.

Question 151

The parents of an 8-year-old girl tell the nurse that their daughter wants to join a soccer team. The nurse’s suggestions regarding participation in sports at this age should include which of the following? A. Organized sports such as soccer are not appropriate at this age. B. Competition is detrimental to the establishment of a positive self-image. C. Sports participation is encouraged if the type of sport is appropriate to the child’s abilities. D. Girls should compete only against girls because at this age boys are larger and have more muscle mass.

Answer 151

C. Sports participation is encouraged if the type of sport is appropriate to the child’s abilities. Virtually every child is suited for some type of sport. Participation should be encouraged if the chosen sport and level are appropriate for the child’s abilities and her physical and emotional make-up. Organized sports can be very beneficial for this age-group. School-age children enjoy competition. With appropriate guidance, children can be taught the proper techniques and safety measures to avoid injuries. Before puberty, there is no essential difference in strength and size between boys and girls.

Question 152

The school nurse is discussing dental health with some children in first grade. Which of the following should be included? A. Teach how to floss teeth properly. B. Recommend a toothbrush with hard nylon bristles. C. Emphasize the importance of brushing before bedtime. D. Recommend nonfluoridated toothpaste approved by the American Dental Association.

Answer 152

C. Emphasize the importance of brushing before bedtime. Brushing before bedtime is especially important because there is more time overnight for interaction between bacteria and unremoved substrate on the tooth surfaces. Flossing is important, but most first graders do not have the manual dexterity to floss properly. Soft nylon bristles are recommended for school-age children. Fluoridated toothpastes are recommended.

Question 153

When teaching the adolescent about the management of acne, the nurse should include which of the following interventions? A. Clean face with an antibacterial soap twice a day. B. Clean face gently with a mild soap once or twice a day. C. Avoid foods with a high fat content such as French fries and chocolate. D. Express comedones by gentle squeezing them followed by cleansing with alcohol.

Answer 153

B. Clean face gently with a mild soap once or twice a day. Cleansing the face with mild soap and water will remove surface dirt and oil. Antibacterial soaps may be too drying when used in combination with topical medications. No relationship has been established between food intake and acne. Squeezing can break down the ductal walls of the lesions and cause the acne to worsen.

Question 154

The school nurse is discussing testicular self-examination with adolescent male students. Why is this important? A. Epididymitis is common during adolescence. B. Asymptomatic sexually transmitted infections may be present. C. Testicular tumors during adolescence are generally malignant. D. Testicular tumors, although usually benign, are common during adolescence.

Answer 154

C. Testicular tumors during adolescence are generally malignant. Tumors of the testes are not common, but when manifested in adolescence, they are generally malignant and demand immediate evaluation. Epididymitis is not common in adolescence. Asymptomatic sexually transmitted infections would not be evident during testicular self-examination. The focus of this examination is on testicular cancer. Testicular tumors are most commonly malignant.

Question 155

An adolescent asks the nurse what causes primary dysmenorrhea. The nurse’s response should include which of the following? A. It is an inherited problem. B. Excessive estrogen production causes uterine pain. C. There is no physiologic cause; it is a psychologic reaction. D. One factor is the onset of ovulatory cycles.

Answer 155

D. One factor is the onset of ovulatory cycles. The factor present in all instances of primary dysmenorrhea is the onset of ovulatory cycles. Primary dysmenorrhea is not known to be inherited. Excessive estrogen has not been implicated in the etiology. Primary dysmenorrhea has a physiologic cause. Women with dysmenorrhea have higher prostaglandin levels.

Question 156

An adolescent tells the school nurse that she is pregnant. Her last menstrual period was 4 months ago. She has not received any medical care. She smokes but denies any other substance use. The priority nursing action is which of the following? A. Notify her parents. B. Refer her for prenatal care. C. Explain the importance of not smoking. D. Discuss dietary needs for adequate fetal growth.

Answer 156

B. Refer her for prenatal care. Teenage girls and their unborn children are at greater risk for complications during pregnancy and delivery compared with older women. With improved therapies, the mortality rate for teenage pregnancy is decreasing, but the morbidity is high. A pregnant teenager needs careful assessment by the nurse to determine the level of social support available to her and possibly her partner. Guidance from the adults in her life would be invaluable, and the nurse should support the adolescent as she informs her parents. Although explaining the importance of not smoking and discussing the dietary needs for adequate fetal growth are important, because of the adolescent’s potential for having a high-risk pregnancy, she will need a comprehensive prenatal program to minimize maternal and fetal complications.

Question 157

In planning sex education and contraceptive teaching for adolescents, the nurse should consider which of the following? A. Both sexual activity and contraception require planning. B. Teenagers frequently lack a fundamental understanding of fertility. C. Most teenagers today are knowledgeable about reproductive anatomy and physiology. D. Most teenagers who become pregnant do so as an act of hostility, especially toward their parents.

Answer 157

B. Teenagers frequently lack a fundamental understanding of fertility. Adolescents may not have sufficient knowledge of reproductive anatomy and physiology. This can lead to misunderstanding about when pregnancy can occur and proper usage of contraceptives. Teenagers may avoid having contraceptives available because it removes the spontaneity of the sexual act. Although adolescents may be aware of their own sexuality, they often lack correct information about reproductive physiology. Some teenagers may become pregnant to be seen as adults.

Question 158

Home care is being considered for a young child who is ventilator dependent. Which of the following factors is most important in deciding whether home care is appropriate? A. Level of education of parents B. Adequate family training C. Presence of two parents in the home D. Family’s ability to assume all health care costs

Answer 158

B. Adequate family training One of the essential elements is the family’s preparation and ability to care for the child. The family must be able to demonstrate all aspects of care for the child because in many areas nursing care may not be available on a continual basis. The amount of formal education reached by the parents is not the important issue. The determinant is the family’s ability to care adequately for the child in the home. At least two family members should learn and demonstrate all aspects of the child’s care in the hospital, but it does not have to be two parents. Few families can assume all health care costs. Creative financial planning, including negotiating arrangements with the insurance company or public programs, may be required.

Question 159

``` For case management to be most effective, who is the most appropriate case manager? A. One nurse B. A panel of experts C. The insurance company D. A multidisciplinary team ```

Answer 159

A. One nurse Nursing case managers are ideally suited to provide the care coordination necessary. Care coordination is most effective if a single person works with the family to accomplish the many tasks and responsibilities that are necessary. The family retains the role as primary decision maker. It is preferable that the family have only one individual to work with. Most likely, the insurance company will have a case manager focusing on the financial aspects of care. This does not include coordination of care to assist the family.

Question 160

The home health nurse is caring for a child who requires complex care. The family expresses frustration related to obtaining accurate information about their child’s illness and its management. Which of the following is the best action for the nurse? A. Determine why the family is easily frustrated. B. Refer the family to the child’s primary care practitioner. C. Provide the information the family requests, being confident that every question can be answered by the nurse. D. Answer questions in a straightforward manner and get professional assistance when an answer is unknown.

Answer 160

D. Answer questions in a straightforward manner and get professional assistance when an answer is unknown. The philosophic basis for family-centered practice is the recognition that the family is the constant in the child’s life. It is essential that the family have complete and accurate information about their child’s illness and management. The nurse may first have to clarify what information the family believes has not been communicated. The family’s frustration arises from their perception that they are not receiving information pertinent to their child’s care. It does not help the family to refer the family to the child’s primary care practitioner. The home health nurse should have access to the necessary information. Questions about what they need and want to know concerning their child’s care should be addressed, but the nurse may not be able to answer every question.

Question 161

A family wants to begin oral feeding of their 4-year-old son, who is ventilator dependent and currently tube fed. They ask the home health nurse to feed him the baby food orally. The nurse recognizes a high risk of aspiration and an already compromised respiratory status. The most appropriate nursing action is which of the following? A. Refuse to feed the child orally because the risk is too high. B. Explain the risks involved and then let the family decide what should be done. C. Feed the child orally because the family has the right to make this decision for him. D. Acknowledge their request, explain the risks, and explore with the family the available options.

Answer 161

D. Acknowledge their request, explain the risks, and explore with the family the available options. Parents want to be included in the decision making for their child’s care. The nurse should discuss the request with the family to ensure this is the issue of concern, and then potential options can be explored. Refusing to feed the child orally does not determine why the parents want oral feedings to begin and does not involve them in problem solving. The decision to begin oral feedings or not to change the feedings should be a collaborative one, made in consultation with the family, the nurse, and an appropriate member of the health care team

Question 162

The home health 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. Which of the following is the most appropriate goal to promote normal development? A. Encourage mobility. B. Encourage assistance in self-care. C. Promote oral-motor development. D. Provide opportunities for socialization.

Answer 162

A. Encourage mobility. A major principle for developmental support in children with complex medical issues is that it should be flexible and tailored to the individual child’s abilities, interests, and needs. This child is exhibiting readiness for ambulation. It is an appropriate time to take steps that encourage mobility (e.g., providing longer oxygen tubing). The parents should provide decreasing amounts of assistance with self-care as the child is able to develop these skills. He is receiving oral foods and is eating finger foods; therefore, he has already acquired oral-motor skills. Mobility is a new developmental task. Opportunities for socialization should be ongoing.

Question 163

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

Answer 163

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

Question 164

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

Answer 164

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

Question 165

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

Answer 165

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

Question 166

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

Answer 166

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

Question 167

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

Answer 167

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

Question 168

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

Answer 168

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

Question 169

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

Answer 169

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

Question 170

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

Answer 170

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

Question 171

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

Answer 171

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

Question 172

``` A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because it A. liquefies secretions. B. improves oxygenation. C. promotes less labored ventilation. D. soothes inflamed mucous membranes. ```

Answer 172

D. soothes inflamed mucous membranes. Warm or cold mist is useful to soothe the inflamed mucous membranes. Humidification is most useful when hoarseness or laryngeal involvement occurs. Normal saline nose drops should be used to liquefy secretions. The mist particles do not penetrate in sufficient amounts to accomplish this. There is no additional oxygen in the mist therapy commonly used for respiratory tract infections. The primary effect of mist is to soothe the inflamed membranes. A reduction in swelling might ease ventilatory effort, but it is not the primary purpose of the therapy.

Question 173

What is an appropriate nursing intervention when caring for an infant with an upper respiratory tract infection and elevated temperature? A. Give tepid water baths to reduce fever. B. Encourage food intake to maintain caloric needs. C. Have the child wear heavy clothing to prevent chilling. D. Give small amounts of favorite fluids frequently to prevent dehydration.

Answer 173

D. Give small amounts of favorite fluids frequently to prevent dehydration. Preventing dehydration by small, frequent feedings is an important intervention in a febrile child. Tepid water baths may induce shivering, which raises temperature. Food should not be forced; it may result in the child vomiting. A febrile child should be dressed in light, loose clothing

Question 174

It is generally recommended that a child with acute streptococcal pharyngitis can return to school A. when his or her sore throat is better. B. if no complications develop. C. after taking antibiotics for 24 hours. D. 3 days after initial throat cultures.

Answer 174

C. after taking antibiotics for 24 hours. After children have taken antibiotics for 24 hours, they are no longer contagious to other children. Sore throat may persist longer than 24 hours of antibiotic therapy, but the child is no longer considered contagious. Complications may take days to weeks to develop. The time from throat culture does not affect the contagiousness of the infection. Antibiotics must be used.

Question 175

``` The most profound complication of prolonged middle ear disorders is A. loss of hearing. B. failure to thrive. C. visual impairment. D. tympanic membrane rupture. ```

Answer 175

A. loss of hearing. Loss of hearing is the principal functional consequences of prolonged middle ear infections. Diminished hearing has an adverse effect on the development of speech, language, and cognition. During the active infection, loss of appetite typically occurs, and sucking or chewing tends to aggravate the pain. This is a short-term issue; when the otitis media resolves, the child resumes previous dietary intake. Ear infections do not have an effect on vision. Rupture of the eardrum may occur, but the loss of hearing and subsequent effect on speech are of greater concern.

Question 176

``` Which of the following types of croup is always considered a medical emergency? A. Laryngitis B. Epiglottitis C. Spasmodic croup D. Laryngotracheobronchitis ```

Answer 176

B. Epiglottitis Epiglottitis is always a medical emergency needing antibiotics and airway support for treatment. Laryngitis is a common viral illness in older children and adolescents, with hoarseness and upper respiratory tract infection symptoms. Spasmodic croup is treated with humidity. Laryngotracheobronchitis may progress to a medical emergency in some children.

Question 177

``` When planning care for a 4-month-old child admitted with respiratory distress caused by respiratory syncytial virus (RSV) and bronchiolitis, it is essential to include which of the following? A. Give antibiotics. B. Ensure adequate hydration. C. Administer cough syrup. D. Feed 4 oz of formula every 4 hours. ```

Answer 177

B. Ensure adequate hydration. When respiratory distress is present, hydration is an essential consideration. Usually infants cannot take fluids by the oral route because of the difficulty breathing. Intravenous fluid administration may be necessary. RSV is a virus, so antibiotics are not beneficial. Cough syrup is not routinely used in RSV. Although fluid and calories are important, an infant with respiratory distress is usually unable to drink this amount of fluid.

Question 178

An appropriate nursing intervention when caring for a child with pneumonia is which of the following? A. Avoid placing child on the affected side. B. Monitor the respiratory status frequently. C. Place in a Trendelenburg position. D. Administer antitussive agents around the clock.

Answer 178

B. Monitor the respiratory status frequently. The child’s respiratory rate, status, oxygenation, general disposition, and level of activity are frequently monitored. Lying on the affected side may promote comfort by splinting the chest and reducing pleural rubbing. The child should be positioned with the unaffected side up to promote maximum expansion. Children should be placed in a semierect position or position of comfort. Antitussives are usually not indicated.

Question 179

Skin testing for tuberculosis (TB) is recommended A. every year for all children older than 2 years. B. every year for all children older than 10 years. C. every 2 years for all children starting at age 1 year. D. periodically for children who are high-risk populations.

Answer 179

D. periodically for children who are high-risk populations. Children who are high risk for contracting the disease are monitored periodically. Annual testing is only indicated for children with human immunodeficiency virus infection and incarcerated adolescents. Testing is not necessary unless exposure is likely or an underlying medical risk factor is present.

Question 180

Asthma is now classified into four categories: mild intermittent, mild persistent, moderate persistent, and severe persistent. Clinical features used to determine these categories include all of the following except A. lung function. B. associated allergies. C. frequency of symptoms. D. frequency and severity of exacerbations.

Answer 180

B. associated allergies. Associated allergies are not part of the classification system used in the Guidelines for the Diagnosis and Management of Asthma. The clinical features that are assessed in the classification system are frequency of daytime and nighttime symptoms, frequency and severity of exacerbations, and lung function.

Question 181

One of the goals for children with asthma is to prevent respiratory tract infection. This is because respiratory tract infection does which of the following? A. Increases sensitivity to allergens B. Causes exercise-induced asthma C. Lessens effectiveness of medications D. Can trigger an episode or aggravate asthmatic state.

Answer 181

D. Can trigger an episode or aggravate asthmatic state. Viral respiratory tract infections can exacerbate asthma, especially in young children, whose airways are mechanically smaller and more reactive than those of older children. Respiratory tract infections do not affect sensitivity to allergens. Exercise precipitates exercise-induced asthma. The respiratory tract infection does not lessen the effectiveness of the medications.

Question 182

Which statement accurately expresses the genetic implications of cystic fibrosis (CF)? A. It is inherited as an autosomal dominant trait. B. It is a genetic defect found primarily in nonwhite population groups. C. If it is present in a child, both parents are carriers of the defective gene. D. There is a 50% chance that siblings of an affected child will also be affected.

Answer 182

C. If it is present in a child, both parents are carriers of the defective gene. CF is an autosomal recessive gene inherited from both parents. CF is inherited as an autosomal recessive, not autosomal dominant, trait. CF is found primarily in white populations. An autosomal recessive inheritance pattern means that there is a 25% chance a sibling will be infected but a 50% chance a sibling will be a carrier.

Question 183

In providing nourishment for a child with cystic fibrosis (CF), which of the following factors should the nurse keep in mind? A. Fats and proteins must be greatly curtailed. B. The diet should be high in calories and protein. C. Most fruits and vegetables are not well tolerated. D. The diet should be high in easily digested carbohydrates and fats.

Answer 183

B. The diet should be high in calories and protein. Children with CF require a well-balanced, high-protein, high-calorie diet because of impaired intestinal absorption. Fats and proteins are a necessary part of a well-balanced diet. A well-balanced diet containing fruits and vegetables is important. Enzyme supplementation helps digest foods; other modifications are not necessary.

Question 184

Which of the following helps nurses understand how the respiratory tract in children is different from that in adults? A. Infants rely almost entirely on diaphragmatic-abdominal breathing. B. Smooth muscle development in the airways increases until about age 12 years. C. The configuration of the chest at birth is not as round as it becomes by adulthood. D. With age there is a decrease in both number of alveoli and branching of terminal bronchioles.

Answer 184

A. Infants rely almost entirely on diaphragmatic-abdominal breathing. The ribs of an infant articulate with the vertebrae and sternum at a more horizontal angle. This contributes to the infant using primarily diaphragmatic-abdominal breathing. Smooth muscle development at approximately 4 months of age is sufficient to respond to irritating stimuli. The chest of an infant is more rounded than that of an adult. Alveoli steadily increase in number. By age 12 years, there are nine times as many alveoli as at birth.

Question 185

``` Which of the following is a measure of chest wall and lung distensibility? A. Resistance B. Ventilation C. Compliance D. Alveolar surface tension ```

Answer 185

C. Compliance Compliance is a measure of chest wall and lung distensibility. Resistance increases the work of breathing. Three major sources of resistance are airway size, tissue resistance in lung, and flow resistance in the airways. Ventilation is the exchange of gases in the lungs. Alveolar surface tension is one of several contributory factors to compliance.

Question 186

Which of the following blood oxygenation tests is the photometric measurement of oxygen saturation? A. Oximetry B. Capnography C. Arterial puncture D. Transcutaneous oxygen and carbon dioxide monitoring

Answer 186

A. Oximetry Oximetry provides continuous noninvasive measurements of hemoglobin saturation. Photometric measurements are used to determine the oxygen saturation. Capnography measures carbon dioxide during inhalation and exhalation. Arterial puncture is the sampling method to obtain blood for gas analysis. Transcutaneous oxygen and carbon dioxide monitoring provides a continuous and reliable trend of arterial oxygen and carbon dioxide

Question 187

Nursing considerations related to the administration of oxygen in an infant include which of the following? A. Discontinue during feedings so child can be held. B. Assess infant to determine how much oxygen should be given. C. Ensure uninterrupted delivery of the appropriate oxygen concentration. D. Direct oxygen flow so that it blows directly into the infant’s face in a hood.

Answer 187

C. Ensure uninterrupted delivery of the appropriate oxygen concentration. The nurse’s responsibility is to ensure that the appropriate oxygen concentration is delivered uninterrupted. Oxygen delivery needs to be continued as ordered. Most children receiving oxygen will need the supplemental oxygen during the increased energy expenditure of eating. Ongoing assessment of the infant’s respiratory status and oxygen saturation are necessary. Oxygen is a medication, and the amount is prescribed by the practitioner. Oxygen should not blow directly on the infant. Cold air applied to the face can result in the diving reflex, which causes bradycardia and shunting of blood from the periphery to central circulation.

Question 188

The nurse is teaching a mother how to perform chest physiotherapy and postural drainage on her 3-year-old child, who has cystic fibrosis. To perform percussion, the nurse should instruct her to A. strike the chest wall with a flat-hand position. B. percuss before and after positioning for postural drainage. C. percuss over the entire trunk anteriorly and posteriorly. D. cover the skin with a shirt or gown before percussing.

Answer 188

D. cover the skin with a shirt or gown before percussing. The child should wear a light shirt to protect the skin from the percussion. The hand is cupped when the child’s chest wall is struck. Percussion is done after the position change. There are identified positions and sequence for postural drainage.

Question 189

``` The nurse is caring for an infant with a tracheostomy when accidental decannulation occurs. The nurse is unable to reinsert the tube. Which of the following should be the nurse’s next action? A. Notify the surgeon. B. Perform oral intubation. C. Try inserting a larger tube. D. Try inserting a smaller tube. ```

Answer 189

D. Try inserting a smaller tube. If the same size tube cannot be inserted, the nurse should try to insert a smaller tube. This will keep the stoma open. The priority is to reinsert a new tracheostomy as soon as possible. The stoma is maintained open until the practitioner can evaluate it. The nurse should attempt to keep the tracheostomy stoma open. A smaller tube is required.

Question 190

``` A child is developing respiratory failure. Signs that the hypoxia is becoming severe include A. tachypnea. B. tachycardia. C. somnolence. D. restlessness. ```

Answer 190

C. somnolence. Somnolence is a late sign indicating severe hypoxia. Tachypnea, tachycardia, and restlessness are cardinal signs of respiratory failure and are observed early.

Question 191

An immediate intervention when an infant chokes on a piece of food would be to do which of the following? A. Administer mouth-to-mouth resuscitation. B. Open the infant’s mouth and perform a blind finger sweep. C. Have the infant lie quietly while a call is placed for emergency help. D. Position the infant in a head-down, prone position and administer five quick blows between the shoulder blades.

Answer 191

D. Position the infant in a head-down, prone position and administer five quick blows between the shoulder blades. Placing the infant in a head-down, prone position and administering five quick blows between the shoulder blades is the correct position and procedure for an infant who had choked on a piece of food or another object. Blowing into the infant’s mouth might push the object into the lungs. Blind finger sweeps are avoided in infants and children younger than age 8 years. If the infant is choking, it is an emergency. Action must be taken.

Question 192

``` The nurse is assessing a child with a cardiac problem. The child’s extremities are cool with thready pulses, and urinary output is diminished. This is most suggestive of which of the following? A. Increased afterload B. Decreased contractility C. Increased stroke volume D. Decreased cardiac output ```

Answer 192

B. Decreased contractility Decreased contractility is suspected if the extremities are cool with thready pulses and urinary output is diminished. Certain states (e.g., hypoxia, acidosis) are known to depress contractility. Increased blood pressure is indicative of higher afterload. Increased stroke volume and decreased cardiac output will not produce the symptoms described.

Question 193

``` Which of the following procedures uses high-frequency sound waves obtained by a transducer to produce an image of cardiac structures? A. Echocardiography B. Electrophysiology C. Electrocardiography D. Cardiac catheterization ```

Answer 193

A. Echocardiography Echocardiography uses high-frequency sound waves. The child must lie completely still. With the improvements in technology, diagnosis can sometimes be made without cardiac catheterization. Electrophysiology is an invasive procedure in which catheters with electrodes are used to record the impulses of the heart directly from the conduction system. Electrocardiography is a tracing of the electrical path of the depolarization action of myocardial cells. Cardiac catheterization is an invasive procedure in which a catheter is threaded into the heart.

Question 194

Nursing interventions for the child after a cardiac catheterization would include which of the following? A. Allow ambulation as tolerated. B. Monitor vital signs every 2 hours. C. Assess the affected extremity for temperature and color. D. Check pulses above the catheterization site for equality and symmetry.

Answer 194

C. Assess the affected extremity for temperature and color. The involved extremity is carefully assessed for signs of complications. Pulses below the catheterization site are monitored for equality and symmetry. Temperature and color are also monitored. The child is maintained on bed rest or in parent’s lap for 4 to 6 hours after the procedure. Initially, vital signs are taken every 15 minutes. Pulses are checked distal to the catheterization site.

Question 195

``` Which of the following is an early sign of heart failure that the nurse should recognize? A. Tachypnea B. Bradycardia C. Inability to sweat D. Increased urinary output ```

Answer 195

A. Tachypnea Tachypnea is one of the early signs that should be identified. Tachycardia at rest, dyspnea, retractions, and activity intolerance are other physical signs and symptoms. Tachycardia, not bradycardia, is one of the symptoms suggestive of congestive heart failure. The child may be diaphoretic. Urinary output usually will be decreased.

Question 196

Nursing care of the infant and child with heart failure would include which of the following? A. Force fluids appropriate to age. B. Monitor respirations during active periods. C. Organize activities to allow for uninterrupted sleep. D. Give larger feedings less often to conserve energy

Answer 196

C. Organize activities to allow for uninterrupted sleep. The child needs to be well rested before feeding. The child’s needs should be met as quickly as possible to minimize crying. The nurse must organize care to minimize the child’s energy expenditure. The child who has heart failure has an excess of fluid. Monitoring vital signs is appropriate, but minimizing energy expenditure is a priority. The child often cannot tolerate larger feedings.

Question 197

``` Which of the following heart defects causes hypoxemia and cyanosis because desaturated venous blood is entering the systemic circulation? A. Coarctation of the aorta B. Atrial septal defect C. Patent ductus arteriosus D. Tetralogy of Fallot ```

Answer 197

D. Tetralogy of Fallot Tetralogy of Fallot is a cardiac defect that has a mixed blood circulation. Coarctation of the aorta is an obstructive defect. There is no mixing of oxygenated and unoxygenated blood. Atrial septal defect and patent ductus arteriosus have increased flow of blood to the pulmonary system. The pressure gradient allows for oxygenated blood to return to the lungs.

Question 198

Nurses counseling parents regarding the home care of the child with a cardiac defect before corrective surgery should stress which of the following? A. Be extremely concerned about cyanotic spells. B. Relax discipline and limit setting to prevent crying. C. Reduce caloric intake to decrease cardiac demands. D. Promote normality within the limits of the child’s condition.

Answer 198

D. Promote normality within the limits of the child’s condition. The child needs to have social interactions, discipline, and appropriate limit setting. Parents need to be encouraged to promote as normal a life as possible for their child. Because cyanotic spells occur in children with some defects, the parents need to be taught how to manage these. The child needs discipline and appropriate limits. The child needs increased caloric intake.

Question 199

Which of the following is an important nursing consideration when chest tubes will be removed from a child? A. Explain that it is not painful. B. Administer analgesics before procedure. C. Explain that only a Band-Aid will be needed. D. Expect bright red drainage for several hours after removal.

Answer 199

B. Administer analgesics before procedure. Removal of chest tubes can be an uncomfortable, frightening experience. Analgesics should be used. Children are forewarned that they will feel a sharp, momentary pain. A petrolatum-covered gauze dressing is immediately applied over the wound and securely taped to the skin on all four sides to form an airtight seal. No drainage is anticipated on the dressing.

Question 200

Therapeutic management of the child with rheumatic fever includes A. administration of penicillin. B. avoidance of salicylates (aspirin). C. strict bed rest for 4 to 6 weeks. D. administration of corticosteroids if chorea develops.

Answer 200

A. administration of penicillin. Penicillin remains the drug of choice (oral or intramuscular injections), with macrolides or cephalosporins as a substitute in penicillin-sensitive children. Initial therapy includes a full 10-day course of penicillin or an alternative antibiotic. Salicylates may be used to reduce the inflammatory process after diagnosis. Bed rest is not indicated. Children can resume regular activities after the febrile stage is over. The chorea is transient, and pharmacologic intervention is not indicated.

Question 201

``` The primary therapy for secondary hypertension in children is A. a low-salt diet. B. weight reduction. C. increased exercise and fitness. D. treatment of underlying cause. ```

Answer 201

D. treatment of underlying cause. Secondary hypertension is a result of an underlying disease process or structural abnormality. It is usually necessary to treat the problem before the hypertension will be resolved. A low-salt diet, weight reduction, and increased exercise and fitness therapies are usually effective for essential hypertension.

Question 202

Which of the following is an important nursing responsibility when a dysrhythmia is suspected? A. Order an immediate electrocardiogram. B. Count the radial rate every 1 minute for 5 minutes. C. Count the apical rate for 1 full minute and compare with radial rate. D. Have someone else take the radial rate simultaneously with the apical rate.

Answer 202

C. Count the apical rate for 1 full minute and compare with radial rate. Counting the apical rate for 1 full minute and compare with radial rate is the nurse’s first action. If a dysrhythmia is occurring, the radial pulse may be lower than the apical rate. Ordering an immediate electrocardiogram may be indicated after conferring with the practitioner. Radial pulse needs to be compared with the apical. It is the nurse’s responsibility to check both rates, radial and apical.

Question 203

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

Answer 203

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

Question 204

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

Answer 204

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

Question 205

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

Answer 205

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

Question 206

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

Answer 206

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

Question 207

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

Answer 207

D. LMX (4% liposomal lidocaine cream) 30 minutes before the procedure. LMX is an effective analgesic agent when applied to the skin 30 minutes before a procedure. It eliminates or reduces the pain from most procedures involving skin puncture. TAC provides skin anesthesia about 15 minutes after application to nonintact skin. The gel can be placed on the wound for suturing. It is not useful for intact skin. Transdermal fentanyl patches are useful for continuous pain control, not rapid pain control. For maximum effectiveness, EMLA must be applied approximately 60 minutes in advance.

Question 208

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

Answer 208

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

Question 209

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

Answer 209

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

Question 210

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

Answer 210

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

Question 211

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

Answer 211

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

Question 212

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

Answer 212

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

Question 213

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

Answer 213

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

Question 214

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

Answer 214

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

Question 215

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

Answer 215

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

Question 216

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

Answer 216

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

Question 217

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

Answer 217

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

Question 218

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

Answer 218

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

Question 219

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

Answer 219

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

Question 220

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

Answer 220

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

Question 221

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

Answer 221

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

Question 222

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

Answer 222

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

Question 223

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

Answer 223

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

Question 224

The nurse stops to assist a child who has been hit by a car while riding a bicycle. Someone has activated the emergency medical system. Until paramedics arrive, the nurse should consider which of the following in caring for this child who has experienced severe trauma? A. Rapid assessment should begin with ABC status: airway, breathing, and circulation. B. Assessment should begin with the area injured; assessment of other areas can wait. C. The possibility of spinal cord injury should be ruled out before transporting the child to the hospital. D. Temperature maintenance is more difficult than in adults because young children have a larger surface area related to body mass.

Answer 224

A. Rapid assessment should begin with ABC status: airway, breathing, and circulation. The first priority is always airway, breathing, and circulation. Assessment of the injured area occurs after the child’s cardiopulmonary status has been addressed. Transport can occur by immobilizing the cervical spine. The head is maintained in a neutral position, and movement of the head or body is not allowed in any direction. Infants have the greatest discrepancy in body surface areas. Children old enough to ride bikes have similar body proportions to adults

Question 225

Immobilization causes which of the following effects on the cardiovascular system? A. Venous stasis B. Increased vasopressor mechanism C. Normal distribution of blood volume D. Increased efficiency of orthostatic neurovascular reflexes

Answer 225

A. Venous stasis The physiologic effects of immobilization, as a result of decreased muscle contraction, include venous stasis. This can lead to pulmonary emboli or thrombi. A decreased vasopressor mechanism results in orthostatic hypotension, syncope, decreased cerebral blood flow, and tachycardia. An altered distribution of blood volume is found with decreased cardiac workload and exercise tolerance. Immobilization causes a decreased efficiency of orthostatic neurovascular reflexes with an inability to adapt readily to the upright position and with pooling of blood in the extremities in the upright position.

Question 226

A young child has recently been fitted with a knee, ankle, and foot orthosis (brace). Care of the skin should include which of the following? A. Apply lotion or cream to soften the skin. B. Contact a practitioner or orthotist if skin redness does not disappear. C. Place padding between the skin and brace if the child experiences a burning sensation under the brace. D. If a small blister develops, apply rubbing alcohol and place padding between the skin and the brace.

Answer 226

B. Contact a practitioner or orthotist if skin redness does not disappear. Redness is a sign of skin irritation from the brace. The brace needs to be adjusted to be functional. The skin should not be softened. The brace is specially designed for the child. Padding may alter the alignment of the brace. Rubbing alcohol would be painful. If the brace causes blisters, it needs to be adjusted.

Question 227

A child, age 10 years, sustained a fracture in the epiphyseal plate of her right fibula when she fell out of a tree. When discussing this injury with her parents, the nurse should consider which of the following? A. This type of fracture is inconsistent with a fall. B. Bone growth can be affected by this type of fracture. C. This is an unusual fracture site in young children. D. Healing is usually delayed in this type of fracture.

Answer 227

B. Bone growth can be affected by this type of fracture. Detection of epiphyseal injuries is sometimes difficult, but fractures involving the epiphysis or epiphyseal plate present special problems in determining whether bone growth will be affected. The epiphysis is the weakest point of the long bones. This is a frequent site of damage during trauma. Healing of epiphyseal injuries is usually prompt.

Question 228

Which of the following would cause a nurse to suspect that an infection has developed under a cast? A. Cold toes B. Increased respirations C. Complaint of paresthesia D. “Hot spots” felt on the cast surface

Answer 228

D. “Hot spots” felt on the cast surface If hot spots are felt on the cast surface, they usually indicate infection beneath the area. This should be reported so that a window can be made in the cast to observe the site. Cold toes may indicate too tight a cast and need further evaluation. Increased respirations may indicate a respiratory infection or pulmonary emboli. This should be reported, and the child should be evaluated. The five Ps of ischemia from a vascular injury include pain, pallor, pulselessness, paresthesia, and paralysis. Paresthesia is an indication of vascular injury, not infection.

Question 229

Which of the following statements is correct regarding sports injuries during adolescence? A. Rapidly growing bones, muscles, joints, and tendons offer some protection from unusual strain. B. The increase in strength and vigor during adolescence helps prevent injuries related to fatigue. C. More injuries occur during organized athletic competition than during recreational sports participation. D. Adolescents may not possess the insight and judgment to recognize when an activity is beyond their capabilities.

Answer 229

D. Adolescents may not possess the insight and judgment to recognize when an activity is beyond their capabilities. Children and adolescents may not possess the insight and judgment to recognize when an activity is beyond their capabilities. Rapidly growing bones, muscles, joints, and tendons are especially vulnerable to unusual strain. The increase in strength and vigor in adolescence may tempt adolescents to overextend themselves. More injuries occur during recreational sports participation than in organized athletic competition.

Question 230

Which of the following results when ice is applied immediately after a soft tissue injury, such as a sprained ankle? A. Increases the pain threshold B. Increases metabolism in the tissues C. Produces deep tissue vasodilation D. Leads to release of more histamine-like substances

Answer 230

C. Produces deep tissue vasodilation Nine to 15 minutes of ice exposure produces deep tissue vasodilation without increased metabolism. Ice has a rapid cooling effect on tissues that reduces pain. The decreased temperature slows metabolism, thus reducing tissue oxygen requirements. Fewer histamine-like substances are released.

Question 231

A 4-year-old child is newly diagnosed with Legg-Calvé-Perthes disease. Nursing considerations include which of the following? A. Encourage normal activity for as long as possible. B. Explain the cause of the disease to the child and family. C. Prepare the child and family for long-term, permanent disabilities. D. Teach the family the care and management of the corrective appliance.

Answer 231

D. Teach the family the care and management of the corrective appliance. The family needs to learn the purpose, function, application, and care of the corrective device and the importance of compliance to achieve the desired outcome. The initial therapy is rest and non–weight-bearing activity, which help reduce inflammation and restore motion. Legg-Calvé-Perthes is a disease of unknown etiology. A disturbance of circulation to the femoral capital epiphysis produces an ischemic aseptic necrosis of the femoral head. The disease is self-limiting, but the ultimate outcome depends on early and efficient therapy and the age of the child at onset.

Question 232

The nurse is preparing an adolescent girl for surgery to treat scoliosis. Which of the following should the nurse include? A. Blood administration may be an option. B. Ambulation will not be allowed for up to 3 months. C. Surgery eliminates the need for casting and bracing. D. Discomfort can be controlled with nonpharmacologic methods.

Answer 232

A. Blood administration may be an option. Spinal surgery usually involves considerable blood loss. Several options are considered for blood replacement. Ambulation is allowed as soon as possible. Depending on the instrumentation used, most patients are walking by the second or third postoperative day. Casting and bracing are required postoperatively. The child usually has considerable pain for the first few days after surgery. Intravenous opioids should be administered on a regular basis.

Question 233

An important nursing consideration when caring for a child with juvenile idiopathic arthritis is which of the following? A. Apply ice packs to relieve stiffness and pain. B. Administer acetaminophen to reduce inflammation. C. Teach the child and family the correct administration of medications. D. Encourage range of motion exercises during periods of inflammation.

Answer 233

C. Teach the child and family the correct administration of medications. The management of juvenile idiopathic arthritis is primarily pharmacologic. The family should be instructed regarding administration of medications and the value of a regular schedule of administration to maintain a satisfactory blood level in the body. They need to know that nonsteroidal antiinflammatory drugs should not be given on an empty stomach and to be alert for signs of toxicity. Warm, moist heat is best for relieving stiffness and pain. Acetaminophen does not have antiinflammatory effects. Range of motion exercises should not be done during periods of inflammation.

Question 234

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

Answer 234

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

Question 235

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

Answer 235

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

Question 236

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

Answer 236

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

Question 237

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

Answer 237

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

Question 238

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

Answer 238

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

Question 239

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

Answer 239

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

Question 240

Which of the following is defined as the forces that favor filtration from the capillary? A. Diffusion and osmosis B. Active transport C. Capillary hydrostatic pressure and interstitial oncotic pressure D. Hydrostatic pressure

Answer 240

C. Capillary hydrostatic pressure and interstitial oncotic pressure Capillary hydrostatic pressure and interstitial oncotic pressure are forces that favor filtration from the capillary. Diffusion is the random movement of molecules from a region of greater concentration to regions of lower concentration, and osmosis is the physical force created by a solution of higher concentration across a semipermeable membrane. Active transport is movement of a substance against a pressure gradient from an area of lesser or equal concentration to an area of greater or equal concentration. A carrier substance is needed. Hydrostatic pressure is the pressure in the arterial portion of the circulatory system, which can push fluid through the capillary walls.

Question 241

``` In which of the following conditions is the fluid requirement for children decreased? A. Burns B. Fever C. Vomiting D. Increased intracranial pressure ```

Answer 241

D. Increased intracranial pressure When there is a risk of increased intracranial pressure, the child’s fluid balance is carefully monitored to ensure that only required fluids are given. With burns, fever, and vomiting, the child loses fluids at a greater than expected rate. Supplemental fluids need to be given to avoid the risk of dehydration.

Question 242

What type of dehydration is defined as “dehydration that occurs in conditions in which electrolyte and water deficits are present in approximately balanced proportion?” A. Isotonic dehydration B. Hypotonic dehydration C. Hypertonic dehydration D. All types of dehydration in infants and small children

Answer 242

A. Isotonic dehydration Isotonic dehydration is the correct term for this definition and is the most frequent form of dehydration in children. Hypotonic dehydration occurs when the electrolyte deficit exceeds the water deficit, leaving the serum hypotonic. Hypertonic dehydration results from water loss in excess of electrolyte loss and is usually caused by a proportionately larger loss of water or a larger intake of electrolytes. “Dehydration that occurs in conditions in which electrolyte and water deficits are present in approximately balanced proportion” is a definition specific to isotonic dehydration.

Question 243

``` Rapid replacement of fluid is essential in the treatment of which of the following types of dehydration? A. Isotonic, osmotic B. Hypotonic, isotonic C. Osmotic, hypertonic D. Hypertonic, hypotonic ```

Answer 243

B. Hypotonic, isotonic In moderate to severe dehydration, rapid expansion of the intravascular space is necessary. Rapid replacement is indicated in isotonic dehydration. Osmotic is not a type of dehydration. Rapid replacement is contraindicated in hypertonic dehydration.

Question 244

``` Depression of the central nervous system (CNS), manifested by lethargy, delirium, stupor, and coma, is observed in which of the following? A. Metabolic acidosis B. Respiratory alkalosis C. Metabolic and respiratory acidosis D. Metabolic and respiratory alkalosis ```

Answer 244

C. Metabolic and respiratory acidosis Hydrogen ion imbalances result in CNS involvement. Depression of the CNS, as manifested by lethargy, delirium, diminished mental capacity, stupor, and coma, is found in acidosis that is either metabolic or respiratory in origin. Respiratory acidosis can also manifest these clinical findings. Respiratory and metabolic alkalosis are reflected clinically by CNS excitation and stimulation, nervousness, tingling sensations, and tetany that may progress to seizures.

Question 245

The nurse is assessing an infant brought to the clinic with diarrhea. He is lethargic and has dry mucous membranes. Which of the following should the nurse recognize as an early sign of dehydration? A. Tachycardia B. Bulging, tense fontanel C. Decreased blood pressure D. Capillary refill of less than 3 seconds

Answer 245

A. Tachycardia Tachycardia is the earliest manifestation of dehydration. Fever and infection can also result in tachycardia, so these should be included in the assessment data. A bulging fontanel may be indicative of increased intracranial pressure, not dehydration. Decreased blood pressure is a late sign of dehydration. Capillary refill is slowed and more than 3 seconds in dehydration.

Question 246

When caring for a child with an intravenous infusion, the nurse should do which of the following? A. Change the insertion site every 24 hours. B. Use a macrodropper to facilitate the prescribed flow rate. C. Observe the insertion site frequently for signs of infiltration. D. Avoid restraining the child to prevent undue emotional stress

Answer 246

C. Observe the insertion site frequently for signs of infiltration. The nursing responsibility for intravenous therapy is to calculate the amount to be infused in a given length of time; set the infusion rate; and monitor the apparatus frequently, at least every 1 to 2 hours, to make certain that the desired rate is maintained, the integrity of the system remains intact, the site remains intact (free of redness, edema, infiltration, or irritation), and the infusion does not stop. Insertion sites do not need to be changed every 24 hours unless a problem is found with the site. This exposes the child to significant trauma. If an infusion pump is not used, a minidropper (60 drops/ml) is the recommended intravenous tubing in children. The intravenous site should be protected. This may require soft restraints on the child.

Question 247

Several types of long-term central venous access devices are used. Which of the following is a benefit of using an implanted port (e.g., Port-a-Cath)? A. Accessed without piercing skin B. Easy to use for self-administered infusions C. Easy access for blood work D. Catheter unable to dislodge from port even if the child “plays” with the port site

Answer 247

C. Easy access for blood work The port is completely under the skin. Other advantages include cosmetic appearance and easy access for blood work and fluid and medication administration. The skin must be accessed with a special needle before the infusion can begin. Placement in the chest makes it difficult to use for self-administered injections. The catheter can be dislodged from the port if the child rubs the port site.

Question 248

``` Which of the following is a major complication of total parenteral nutrition in children? A. Anemia B. Asthma C. Liver disease D. Renal impairment ```

Answer 248

C. Liver disease Liver disease is the most important gastrointestinal complication of total parenteral nutrition. If present, anemia and asthma are not directly related to the total parenteral nutrition. Renal function is monitored to ensure electrolyte balance, but impairment is not an expected complication.

Question 249

``` Which of the following should the nurse recognize as an early clinical sign of compensated shock in a child? A. Confusion B. Sleepiness C. Hypotension D. Apprehension ```

Answer 249

D. Apprehension Early signs are vague and subtle, including apprehension, irritability, normal blood pressure, narrowing pulse pressure, thirst, pallor, and diminished urinary output. Confusion, sleepiness, and hypotension are later signs of shock.

Question 250

Which of the following occurs in septic shock? A. Massive vasodilation B. Increased respiratory rate C. Decreased capillary permeability D. Increased systemic vascular resistance

Answer 250

A. Massive vasodilation In septic shock, an infection triggers an inflammatory response, which results in massive vasodilation and increased capillary permeability. Respirations are not affected. Capillary permeability is increased. Vasodilation results in decreased systemic vascular resistance.

Question 251

Which of the following statements regarding burn injuries in children is correct? A. Burns are the most frequent cause of accidental death during childhood. B. The prognosis for a burned child is directly related to the amount of tissue destroyed. C. The standard “rule of nines” chart is typically used for assessing the size of a burn in small children. D. Children younger than age 2 years have significantly lower mortality rates than older children with similar burns.

Answer 251

B. The prognosis for a burned child is directly related to the amount of tissue destroyed. The prognosis of a child with a burn is directly related to the amount of tissue destroyed. The location of the wounds, age of the child, causative agent, respiratory involvement, general health of the child, and other injuries are also considered. Burned clothing is removed to prevent further damage from smoldering fabric and hot beads of synthetic fabric. Jewelry is removed to stop the transfer of heat from the metal to the skin. Burn and fire injuries are the third leading cause of unintentional injury-related death in children younger than the age of 14 years. The body proportions of the child are different from those of an adult. Use of the standard adult rule of nines will give an inaccurate estimate of the burn area. Physiologic factors, including greater relative percentage body water, minimum protein stores, and an immature immune response, contribute to a significantly higher mortality in children younger than age 2 years

Question 252

An adolescent girl is cooking on a gas stove when her bathrobe catches fire. Her father smothers the flames with a rug and calls an ambulance. She has sustained major burns over much of her body. Which of the following is also important in her immediate care? A. Cool with a single application of tepid water. B. Encourage her to drink clear liquids. C. Remove her burned clothing and jewelry. D. Leave the rug in place until the ambulance arrives.

Answer 252

A. Cool with a single application of tepid water. In major burns, additional applications of cool water lead to a drop in body temperature and potential circulatory collapse. Nothing is given by mouth because of the risk of aspiration in the presence of a paralytic ileus. As much of her clothing should be removed as possible.

Question 253

The nurse is caring for a 12-year-old boy who sustained major burns when he put charcoal lighter on a campfire. The nurse observes that he is “very brave” and appears to accept pain with little or no response. The most appropriate nursing action related to this is which of the following? A. Request a psychologic consultation. B. Ask the child why he doesn’t have pain. C. Praise the child for ability to withstand pain. D. Encourage continued bravery as a coping strategy.

Answer 253

A. Request a psychologic consultation. A psychologic consultation will help the child verbalize fears. Children in this age group are concerned with physical appearance. The psychologists can help integrate the issues that the child is facing. It is likely that the child is having pain but not acknowledging the pain. If the child is feeling pain, the nurse should not praise him for hiding it. Encouraging continued bravery may not be an effective coping strategy if the child is in severe pain.

Question 254

``` To prevent burns from hot water in the home, the nurse should recommend that families set their water heater thermostat to A. 38º C (100º F). B. 49º C (120º F). C. 60º C (140º F). D. 71º C (160º F). ```

Answer 254

B. 49º C (120º F). The recommended temperature to set water heaters is 120º F. A water heater can be set 10 degrees higher and still be safe. Temperatures of 60º C (140º F) to 71º C (160º F) are too high. At 140º F, submersion for 5 seconds will cause a burn.

Question 255

Chemotherapeutic drugs to treat cancer are often given in combination because A. the drugs can be given by various routes. B. the drugs can be given at different times during the day. C. patients cannot tolerate extremely high doses of single drugs. D. he drugs allow for optimum cell destruction with minimum toxic effects.

Answer 255

D. he drugs allow for optimum cell destruction with minimum toxic effects. Combining drugs allows for synergistic effects. Optimum cell cycle destruction with minimum toxic effects and decreased resistance by the cancer cells to the agent are possible. Routes of administration depend on the pharmacologic attributes of the drug. The routes do not influence interactions. Combination therapy usually has specific intervals to maximize synergistic effect. High doses of drugs are indicated in different regimens.

Question 256

Nursing considerations related to the administration of chemotherapeutic drugs include which of the following? A. Anaphylaxis cannot occur because the drugs are considered toxic to normal cells. B. Infiltration will not occur unless superficial veins are used for the intravenous infusion. C. Many chemotherapeutic agents are vesicants that can cause severe cellular damage if drug infiltrates. D. Good hand washing is essential when handling chemotherapeutic drugs, but gloves are not necessary.

Answer 256

C. Many chemotherapeutic agents are vesicants that can cause severe cellular damage if drug infiltrates. Chemotherapeutic agents can be extremely damaging to cells. Nurses experienced with the administration of vesicant drugs should be responsible for giving these drugs and be prepared to treat extravasations if necessary. Anaphylaxis is a possibility with some chemotherapeutic and immunologic agents. Infiltration and extravasations are always a risk, especially with peripheral veins. Gloves are worn to protect the nurse when handling the drugs, and the hands should be thoroughly washed afterward.

Question 257

``` Which of the following pediatric oncologic emergencies is caused by the rapid release of intracellular metabolites during the initial treatment of some cancers? A. Hyperleukocytosis B. Overwhelming infection C. Acute tumor lysis syndrome D. Superior vena cava syndrome ```

Answer 257

C. Acute tumor lysis syndrome Acute tumor lysis syndrome is caused by the rapid release of intracellular metabolites during the initial treatment of malignancies. Hyperleukocytosis, a white blood cell count greater than 100,000/mm3, can be present at diagnosis. It is not a result of the treatment. Infection may occur from bone marrow suppression that results from many chemotherapeutic agents. Superior vena cava syndrome can occur from compression of the mediastinal structures by Hodgkin disease and non-Hodgkin lymphoma.

Question 258

The most common signs and symptoms of leukemia related to bone marrow involvement are which of the following? A. Petechiae, fever, and fatigue B. Headache, papilledema, and irritability C. Muscle wasting, weight loss, and fatigue D. Decreased intracranial pressure, psychosis, and confusion

Answer 258

A. Petechiae, fever, and fatigue Signs of infiltration of the bone marrow are petechiae from lowered platelet count, fever related to infection from the depressed number of effective leukocytes, and fatigue from the anemia. Headache, papilledema, irritability, muscle wasting, weight loss, fatigue, decreased intracranial pressure, psychosis, and confusion are not signs of bone marrow involvement.

Question 259

``` A child with lymphoma is receiving extensive radiotherapy. Which of the following is the most common side effect of this treatment? A. Malaise B. Seizures C. Neuropathy D. Lymphadenopathy ```

Answer 259

A. Malaise Malaise is the most common side effect of radiotherapy. For children, the fatigue may be especially distressing because it means they cannot keep up with their peers. Seizures are unlikely because irradiation would not usually involve the cranial area for treatment of lymphoma. Neuropathy is a side effect of certain chemotherapeutic agents. Lymphadenopathy is one of the findings of lymphoma.

Question 260

The postoperative care of a preschool child who has had a brain tumor removed should include which of the following? A. Colorless drainage is to be expected. B. Analgesics are contraindicated because of altered consciousness. C. Positioning is on the operative side in the Trendelenburg position. D. Carefully monitor fluids because of cerebral edema.

Answer 260

D. Carefully monitor fluids because of cerebral edema. Because of cerebral edema and the danger of increased intracranial pressure postoperatively, fluids are carefully monitored. Colorless drainage may be leakage of cerebrospinal fluid from the incision site. This needs to be reported as soon as possible. Analgesics can be used for postoperative pain. The child should not be positioned in the Trendelenburg position postoperatively.

Question 261

Which of the following best describes a neuroblastoma? A. The diagnosis is usually made after metastasis occurs. B. It is the most common brain tumor in young children. C. Older children have an improved likelihood of survival. D. Early diagnosis is usually possible because of the obvious clinical manifestations.

Answer 261

A. The diagnosis is usually made after metastasis occurs. Neuroblastoma is considered a “silent” tumor. In more than 70% of cases, the diagnosis is made after metastasis occurs. The neuroblastoma is usually located in the abdomen. Children younger than 1 year of age have a 75% survival rate; those older than age 1 year, only 50%. The diagnosis is not usually made until other sites have been invaded by the tumor.

Question 262

Which of the following is most descriptive of the therapeutic management of osteogenic sarcoma? A. Intensive irradiation is the primary treatment. B. Amputation of the affected extremity is rarely necessary. C. Treatment usually consists of surgery and chemotherapy. D. Bone marrow transplantation offers the best chance of long-term survival.

Answer 262

C. Treatment usually consists of surgery and chemotherapy. Optimum treatment of osteosarcoma is surgery and chemotherapy. Surgical biopsy is followed by either limb salvage or amputation and chemotherapy. Radiation and bone marrow transplantation are not part of the therapy for osteosarcoma. Amputation is often required when limb salvage is not possible.

Question 263

``` Where are Wilms tumors (nephroblastomas) located? A. Bone B. Brain C. Kidney D. Lymphatic system ```

Answer 263

C. Kidney Wilms tumor, or nephroblastoma, is the most common intraabdominal and kidney tumor of childhood. Wilms tumors are encapsulated and are located in the abdomen.

Question 264

The nurse is explaining blood components to an 8-year-old child. The nurse’s best description of platelets is that they do which of the following? A. Make up the liquid portion of blood B. Help keep germs from causing infection C. Carry the oxygen you breathe from your lungs to all parts of your body D. Help your body stop bleeding by forming a clot (scab) over the hurt area

Answer 264

D. Help your body stop bleeding by forming a clot (scab) over the hurt area Platelets are involved in hemostasis. Plasma makes up the liquid portion of blood. White blood cells help keep germs from causing infection. Red blood cells carry the oxygen you breathe from your lungs to all parts of your body.

Question 265

``` When hemoglobin falls sufficiently to produce clinical manifestations, the signs and symptoms are caused by A. phagocytosis. B. tissue hypoxia. C. pulmonary hypertension. D. depressed bone marrow. ```

Answer 265

B. tissue hypoxia. The signs and symptoms (e.g., weakness, fatigue, and a waxy pallor in severe anemia) are caused by tissue hypoxia. Phagocytosis is a function of white blood cells used in prevention of infection. Pulmonary hypertension is not associated with anemia. Severe anemia may contribute to cardiac compensation. Depressed bone marrow may be the cause of the low hemoglobin.

Question 266

The nurse suspects a child is having an adverse reaction to a blood transfusion. The first action by the nurse should be which of the following? A. Notify the physician. B. Take the vital signs and blood pressure and compare them with baseline levels. C. Dilute infusing blood with equal amounts of normal saline. D. Stop transfusion and maintain a patent intravenous line with normal saline and new tubing.

Answer 266

D. Stop transfusion and maintain a patent intravenous line with normal saline and new tubing. Stopping the transfusion and maintaining a patent intravenous line with normal saline and new tubing is the priority nursing action. If an adverse reaction is occurring, it is essential to minimize the amount of blood that is infused. Notifying a physician and taking vital signs and blood pressure should be performed after the blood transfusion is stopped and infusion of normal saline has begun. Blood should not be diluted; it should be returned to the blood bank if an adverse reaction has occurred.

Question 267

The parent of a child receiving an iron preparation tells the nurse that the child’s stools are a tarry green color. The nurse should explain that this is a(n) A. symptom of iron deficiency anemia. B. adverse effect of the iron preparation. C. indicator of an iron preparation overdose. D. normally expected change resulting from the iron preparation.

Answer 267

D. normally expected change resulting from the iron preparation. An adequate dosage of iron turns the stools a tarry green color. Descriptions of iron-deficiency anemia, iron preparation, and iron preparation overdose are not relevant. If the stools do not become tarry green, it may be indicative of administration issues.

Question 268

An important nursing consideration when caring for a child with sickle cell anemia is which of the following? A. Refer the parents and child for genetic counseling. B. Teach the parents and child how to recognize the signs and symptoms of crises. C. Help the child and family adjust to a short-term disease. D. Observe for complications of multiple blood transfusions.

Answer 268

B. Teach the parents and child how to recognize the signs and symptoms of crises. Parents need specific instructions on the need to watch for changes in the child’s condition, including adequate hydration, and environmental concerns. Genetic counseling is important, but teaching care of the child is a priority. Sickle cell anemia is a long-term, chronic illness. Multiple blood transfusions are an option for some children with sickle cell disease. The priority for all children with this condition is properly preparing the parents to care for them.

Question 269

The parents of a child hospitalized with sickle cell anemia tell the nurse that they are concerned about narcotic analgesics causing addiction. The nurse should explain which of the following concerning narcotic analgesics? A. They are often ordered but not usually needed. B. When they are medically indicated, children rarely become addicted. C. They are given as a last resort because of the threat of addiction. D. They are used only if other measures, such as ice packs, are ineffective

Answer 269

B. When they are medically indicated, children rarely become addicted. Pain is the most common and debilitating symptom experienced by patients with sickle cell disease. The chronic nature of this pain can greatly affect the child’s development. A multidisciplinary approach is best for its management. Patient-controlled analgesia or continuous intravenous administration is usually effective. Pharmacologic intervention is necessary for the pain of sickle cell crisis.

Question 270

``` Chelation therapy is begun on a child with α-thalassemia major. The purpose of this therapy is to do which of the following? A. Treat the disease. B. Eliminate excess iron. C. Decrease risk of hypoxia. D. Manage nausea and vomiting. ```

Answer 270

B. Eliminate excess iron. Iron overload (hemosiderosis) is a complication of blood transfusions. Chelation therapy is necessary to minimize the development of hemosiderosis and hemochromatosis. Blood transfusions are the primary medical management. Chelation therapy removes iron; it does not affect the disease process.

Question 271

The school nurse is caring for a child with hemophilia who fell on his arm during recess. Which of the following supportive measures should the nurse do until factor replacement therapy can be instituted? A. Apply warm, moist compresses. B. Apply a tourniquet for at least 5 minutes. C. Elevate the arm above the level of the heart. D. Begin passive range of motion unless pain is severe.

Answer 271

C. Elevate the arm above the level of the heart. The initial response should include elevation. Cold should be applied to the arm. This will aid in vasoconstriction. Pressure is effective in small areas but would not work for an extremity. Passive range of motion is not recommended. The child can perform active range of motion after the bleeding episode has resolved.

Question 272

The school nurse is discussing prevention of acquired immunodeficiency syndrome with some adolescents. Which of the following is appropriate to include? A. The virus is easily transmitted. B. It is only transmitted through blood. C. Condoms should be used if adolescents are homosexual. D. Recreational drug users should not share needles or other equipment.

Answer 272

D. Recreational drug users should not share needles or other equipment. Human immunodeficiency virus is spread through blood and body fluids. Intravenous needles that have been used should not be shared. They may be contaminated with the virus. The virus is not easily transmitted. It requires direct contact with blood or body fluids on a nonintact skin surface. Body fluids may also transmit the virus. Condoms should be used for both heterosexual and homosexual sex.

Question 273

``` Which of the following types of diarrhea is commonly seen in malabsorption syndromes because the intestine cannot absorb nutrients or electrolytes? A. Chronic B. Secretory C. Acute D. Intractable diarrhea of infancy ```

Answer 273

A. Chronic Chronic diarrhea is commonly seen in malabsorption syndromes. In disorders such as lactose intolerance, the intestine cannot absorb nutrients or electrolytes. Secretory diarrhea is usually caused by bacterial enterotoxins that stimulate fluid and electrolyte secretion. Acute diarrhea is caused by infectious agent in the gastrointestinal tract. Intractable diarrhea of infancy is a syndrome that occurs in the first few months of life and persists longer than 2 weeks with no recognized pathogens.

Question 274

``` Which of the following is the viral pathogen that frequently causes acute diarrhea in young children? A. Giardia organisms B. Shigella organisms C. Rotavirus D. Salmonella organisms ```

Answer 274

C. Rotavirus Rotavirus is the viral pathogen that most frequently causes diarrhea in young children. Giardia is a bacterial pathogen that causes diarrhea. Shigella is a bacterial pathogen that is uncommon in the United States. Salmonella is a bacterial pathogen that causes diarrhea.

Question 275

``` A stool specimen from a child with diarrhea shows the presence of neutrophils and red blood cells. This is most suggestive of which of the following conditions? A. Parasitic infection B. Fat malabsorption C. Protein intolerance D. Bacterial gastroenteritis ```

Answer 275

D. Bacterial gastroenteritis Bacterial gastroenteritis is associated with neutrophils or red blood cells in the stool. The stool will be analyzed for ova and parasites when the bacterial and viral cultures are negative. Malabsorption is characterized by a pH of less than 6 and presence of reducing substances. Diarrhea that develops after introduction of cow’s milk, fruits, or cereals may be related to protein intolerance

Question 276

Therapeutic management of the child with acute diarrhea and dehydration usually begins with which of the following? A. Clear liquids such as fruit juice and soft drinks B. Adsorbents, such as kaolin and pectin C. Oral rehydration solution D. Antidiarrheal medications such as paregoric

Answer 276

C. Oral rehydration solution Oral rehydration solution is the first treatment for acute diarrhea. Clear liquids are not recommended because they usually have a high carbohydrate content, low electrolyte content, and high osmolality. Adsorbents are not recommended. Antidiarrheals are not recommended because they do not get rid of pathogens.

Question 277

A young child is brought to the emergency department with severe dehydration secondary to acute diarrhea and vomiting. Therapeutic management of this child begins with A. intravenous fluids. B. oral rehydration solution. C. clear liquids, 1 to 2 oz at a time. D. administration of antidiarrheal medication.

Answer 277

A. intravenous fluids. In children with severe dehydration, intravenous fluids are initiated. Oral rehydration solution is acceptable therapy if the dehydration is not severe. Diarrhea is not managed by using clear liquids by mouth. These fluids usually have a high carbohydrate content, low electrolyte content, and high osmolality. Antidiarrheal medications are not recommended for the treatment of acute infectious diarrhea.

Question 278

A 2-month-old breastfed infant is successfully rehydrated with oral rehydration solutions for acute diarrhea. Instructions to the mother about breastfeeding should include which of the following? A. Continue breastfeeding. B. Stop breastfeeding until the breast milk is cultured. C. Stop breastfeeding until diarrhea is absent for 24 hours. D. Express breast milk and dilute it with sterile water before feeding it.

Answer 278

A. Continue breastfeeding. Breastfeeding is recommended for infants with acute diarrhea. Continued breastfeeding results in a reduced severity and duration of the illness. There is no need to culture breast milk. Early introduction of nutrients improves outcomes. Diluting expressed breast milk with sterile water before feeding should never be done. It can contribute to an electrolyte imbalance.

Question 279

The nurse is explaining to a parent how to care for a child with vomiting associated with a viral illness. Which of the following should the nurse include? A. Give nothing by mouth for 24 hours. B. Avoid carbohydrate-containing liquids. C. Brush teeth or rinse mouth after vomiting. D. Give plain water until vomiting ceases for at least 24 hours.

Answer 279

C. Brush teeth or rinse mouth after vomiting. It is important to emphasize the need for the child to brush the teeth or rinse the mouth after vomiting to dilute the hydrochloric acid that comes in contact with the teeth. Ad libitum administration of glucose-electrolyte solution to an alert child will help restore water and electrolytes satisfactorily. It is important to include carbohydrates to spare body protein and avoid ketosis.

Question 280

The school nurse is called to the cafeteria because a child “has eaten something he is allergic to.” The child is in severe respiratory distress. The nurse should do which of the following first? A. Determine what the child has eaten. B. Administer diphenhydramine (Benadryl). C. Move the child to the nurse’s office or hallway. D. Have someone call for an ambulance or paramedic rescue squad.

Answer 280

D. Have someone call for an ambulance or paramedic rescue squad. Because the child is in severe respiratory distress, the nurse should remain with the child while someone else calls for the rescue squad. Because severe respiratory distress is occurring, treatment of the response is indicated first. The cause of the response can be determined later. Diphenhydramine will not be effective for this type of allergic reaction. The child should not be moved unless the child is in a place that puts the child at greater hazard.

Question 281

Enteral feedings are ordered for a young child with burns covering 40% of total body surface area. The nurse should know that A. oral feedings are contraindicated. B. enteral feedings must be stopped during painful procedures. C. presence of a paralytic ileus does not preclude use of enteral feedings. D. the feedings will be high carbohydrate and low protein

Answer 281

C. presence of a paralytic ileus does not preclude use of enteral feedings. Because the small bowel maintains mobility and absorptive capabilities, the placement of a small-bore feeding tube into the duodenum allows for safe delivery of enteral nutrition during periods of paralytic ileus associated with sepsis, trauma, and anesthesia. Oral feedings are not contraindicated. This is encouraged; however, most children with burns are unable to consume sufficient calories by mouth. Enteral feedings can continue during procedures. A high-protein, high-calorie diet is recommended.

Question 282

``` Which of the following urine tests of renal function is used to estimate glomerular filtration? A. pH B. Creatinine C. Osmolality D. Protein level ```

Answer 282

B. Creatinine The most useful clinical estimation of glomerular filtration is the clearance of creatinine. The production and secretion of creatinine remain relatively constant from day to day, and its appearance in the urine is determined by the serum level. The pH is a measure of alkalinity, not glomerular filtration. Osmolality is a measure of concentration. The presence of protein is indicative of abnormal glomerular permeability.

Question 283

``` Which of the following factors predisposes the urinary tract to infection? A. Increased fluid intake B. Short urethra in girls C. Ingestion of highly acidic juices D. Frequent emptying of the bladder ```

Answer 283

B. Short urethra in girls The short urethra, which measures approximately 2 cm (0.8 in) in girls and 4 cm (1.6 in) in mature women, provides a ready pathway for invasion of organisms. Increased fluid intake results in frequent emptying of the bladder, preventing urinary stasis. Urine is bacteriostatic at pH of 5.0. This is not achievable by ingestion of juice. Frequent emptying of the bladder helps prevent urinary tract infections.

Question 284

A young child is diagnosed with vesicoureteral reflux. The nurse should know that this usually results in A. incontinence. B. urinary obstruction. C. recurrent urinary tract infections. D. infarction of renal vessels.

Answer 284

C. recurrent urinary tract infections. Reflux allows urine to flow back to the kidneys. When the urine is infected, this contributes to urinary tract infections and pyelonephritis. Incontinence may be associated with urinary tract infections. Reflux, when associated with vesicoureteral reflux, can cause renal scarring but not obstruction. Infarction of renal vessels does not occur.

Question 285

Which of the following best describes the cause of most cases of acute glomerulonephritis? A. Renal vascular anomalies B. Antecedent streptococcal infection C. Results from a urinary tract infection D. Structural anomalies of genitourinary tract

Answer 285

B. Antecedent streptococcal infection Most cases are postinfectious and have been associated with pneumococcal, streptococcal, or viral infections. Renal vascular anomalies are not associated with acute glomerulonephritis. Urinary tract infections and structural anomalies can result in progressive renal injury, not acute glomerulonephritis

Question 286

``` In acute glomerulonephritis, the nurse is aware that an early warning sign of encephalopathy is which of the following? A. Seizures B. Psychosis C. Dizziness D. Transient loss of vision ```

Answer 286

C. Dizziness Acute and severe hypertension can cause the protective autoregulation of cerebral blood flow to fail, leading to hyperperfusion of the brain and cerebral edema. The premonitory signs of encephalopathy are headache, dizziness, abdominal discomfort, and vomiting. Seizures and transient loss of vision are signs that the condition is progressing. Psychosis is not an early warning sign of hypertensive encephalopathy. Seizures and transient loss of vision are signs that the condition is progressing.

Question 287

The clinical manifestations of nephrotic syndrome include which of the following? A. Hematuria, bacteriuria, and weight gain B. Gross hematuria, albuminuria, and fever C. Hypertension, weight loss, and proteinuria D. Proteinuria, hypoalbuminemia, and edema

Answer 287

D. Proteinuria, hypoalbuminemia, and edema Edema, proteinuria, hypoalbuminemia, and hypercholesterolemia are the clinical manifestations of nephrotic syndrome in children. Bacteriuria is not a diagnostic criterion for nephrotic syndrome. Fever is not associated with nephrotic syndrome. Weight gain occurs secondary to the edema.

Question 288

``` Therapeutic management of nephrotic syndrome includes which of the following? A. Corticosteroids B. Long-term diuretics C. Antihypertensive agents D. Fluid and salt restrictions ```

Answer 288

A. Corticosteroids Most children with nephrotic syndrome respond to corticosteroids, making this group the drug of choice. Corticosteroid therapy is begun as soon as the diagnosis has been determined. Children with nephrotic syndrome usually do not respond to diuretics. Furosemide, in combination with metolazone, is useful for severe edema. Antihypertensive agents are not indicated in the management. Fluids are rarely restricted. The child is placed on a no-added-salt diet.

Question 289

``` Which of the following is the primary clinical manifestation of acute renal failure? A. Oliguria B. Hematuria C. Proteinuria D. Bacteriuria ```

Answer 289

A. Oliguria Oliguria is the primary clinical symptom of acute renal failure. Generally, urinary output is less than 1 ml/kg/hr. Hematuria, proteinuria, and bacteriuria may be present in renal disease, but they are not the primary manifestations of acute renal failure.

Question 290

Dialysis or transplantation becomes necessary for chronic renal failure when A. anemia develops. B. acidosis develops. C. glomerular filtration rate falls below 50% of normal. D. glomerular filtration rate falls below 10% to 15% of normal.

Answer 290

D. glomerular filtration rate falls below 10% to 15% of normal. Treatment with dialysis or transplantation is required when the glomerular filtration rate falls below 10% to 15% of normal. Anemia and acidosis may be present as part of the underlying disorder. The glomerular filtration rate determines the need for dialysis. The kidneys are able to maintain the chemical composition of fluids within normal limits until more than 50% of functional renal capacity is destroyed by disease or injury.

Question 291

Which of the following is an advantage of continuous cycling peritoneal dialysis or continuous ambulatory peritoneal dialysis for adolescents who require dialysis? A. Dietary restrictions are no longer necessary. B. Hospitalization is only required several nights per week. C. Adolescents can carry out procedures themselves. D. Insertion of a catheter does not require surgical placement.

Answer 291

C. Adolescents can carry out procedures themselves. Continuous cycling peritoneal dialysis or continuous ambulatory peritoneal dialysis provide the most independence for adolescents with end-stage renal disease and their families. Adolescents can carry out the procedure themselves. Dietary restrictions are still required but are less strict. The procedure can be done at home. The catheter is surgically implanted in the abdominal cavity.

Question 292

If the mother of a child is hepatitis B surface antigen (HBsAg) negative, the nurse knows that the child should receive his or her first dose of the hepatitis B virus (HBV) vaccine at A. 2 months of age, at the first well-child visit. B. birth before discharge from the hospital. C. 6 months of age, at the third well-child visit. D. no time (this vaccine is not currently recommended).

Answer 292

B. birth before discharge from the hospital. It is recommended that newborns receive the hepatitis B vaccine before hospital discharge if the mother is HBsAg negative. The second dose of the vaccine is given at the first well-child visit. The third dose of the vaccine is given at the third well-child visit. The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention and the Committee on Infectious Diseases of the American Academy of Pediatrics govern the recommendations for immunization, which include the hepatitis B virus vaccine.

Question 293

``` Which of the following is the appropriate site to administer an intramuscular (IM) vaccine to a newborn? A. The dorsal gluteal muscle B. The vastus lateralis muscle C. The ventral gluteal muscle D. The biceps muscle ```

Answer 293

B. The vastus lateralis muscle If the vaccine is given intramuscularly, then it is given in the vastus lateralis in newborns or in the deltoid for older infants and children. Regardless of age, the dorsogluteal site should be avoided because it has been associated with low antibody seroconversion rates, indicating a reduced immune response, and it is no longer an acceptable evidence-based practice site for IM injections. The ventral gluteal muscle and the biceps muscle are not appropriate sites for IM injections.

Question 294

``` The hepatitis A vaccine is now recommended at which of the following ages? A. 1 year B. 1 month C. 12 years D. It is not recommended at any age. ```

Answer 294

A. 1 year Hepatitis A has been recognized as a significant child health problem, particularly in communities with unusually high infection rates. Hepatitis A virus is spread by the fecal–oral route and from person-to-person contact, by ingestion of contaminated food or water, and rarely by blood transfusion, so the immunization is recommended at 1 year of age.

Question 295

The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) and American College of Obstetricians and Gynecologists has recommended that pregnant adolescents and women who are not protected against pertussis receive the tetanus, diphtheria and pertussis (Tdap) vaccine optimally at which of the following times? A. Between 27 and 36 weeks of gestation or postpartum before discharge from the hospital B. During the first pre-natal visit when pregnancy is confirmed C. The vaccine should be administered 24 hours prior to delivery D. This vaccine is only recommended during the first trimester

Answer 295

A. Between 27 and 36 weeks of gestation or postpartum before discharge from the hospital The ACIP of the CDC and American College of Obstetricians and Gynecologists has recommended that pregnant adolescents and women who are not protected against pertussis receive the Tdap vaccine optimally between 27 and 36 weeks of gestation or postpartum before discharge from the hospital. The vaccine is not recommended during the first trimester. The vaccine is not recommended between 27 and 36 weeks to allot for antibody formation that will protect the mother and passive immunity to the infant.The vaccine is not recommended during the first trimester

Question 296

``` The nurse understands that respiratory hygiene and cough etiquette is recommended by the Centers for Disease Control and Prevention (CDC) to prevent which of the following? A. HBV, Hib, and pertussis B. HSV, influenza, and HBV C. RSV, influenza, and adenovirus D. RSV, pertussis, and varicella ```

Answer 296

C. RSV, influenza, and adenovirus The CDC (2007) recommends respiratory hygiene and etiquette to prevent the transmission of RSV, influenza, adenovirus, and other droplet-transmitted unknown viruses. HBV, HSV, and varicella are not transmitted via droplets.

Question 297

``` What is the most common piece of medical equipment that can transmit harmful microorganisms among patients? A. Thermometer B. Stethoscope C. Injection needle D. Disposable gloves ```

Answer 297

B. Stethoscope A stethoscope is commonly used between patients, and if not correctly disinfected, it can be a dangerous source of spreading microorganisms. Thermometers of all types have barriers to prevent this. Needles are discarded immediately after injections and never reused, so they are not a common source of transmission. Disposable gloves are not reused, so they are not a common source of transmission.

Question 298

A 12-month-old child presents to the clinic for a well visit after missing several appointments. The child began her immunization schedule but has missed several follow-up appointments and immunization doses. The nurse knows that the most appropriate action is what? A. The child must receive initial immunizations from the beginning. B. The child cannot receive missed immunizations if the schedule is not followed. C. The child should only receive the missed doses of immunizations. D. The child should receive double-strength immunizations at this well visit.

Answer 298

C. The child should only receive the missed doses of immunizations. Children who began primary immunization at the recommended age but fail to receive all the doses do not need to begin the series again but instead should receive only the missed doses. The child may receive missed vaccinations on a catch-up schedule per CDC guidelines.

Question 299

The change from the exclusive use of oral polio vaccine (OPV) to the exclusive use of inactivated poliovirus vaccine (IPV) related to the rare risk of vaccine-associated polio paralysis (VAPP) from OPV has resulted in which of the following? A. An increase in the risk of VAPP B. An increased number of injections and increased cost C. A better antibody conversion than the oral formulation D. A measureable decrease in immunity in the community

Answer 299

B. An increased number of injections and increased cost There is an increased number of injections and increased cost associated with IPV. The exclusive use of IPV eliminates the risk of VAPP. There is no increased antibody conversion from IPV. The same immunity is provided by both vaccines.

Question 300

Which of the following vaccinations are included in health promotion during infancy? (Select all that apply.) A. Haemophilus influenzae type b (Hib) B. Hepatitis C virus (HCV) C. Diphtheria, tetanus, and pertussis (DTaP) D. Poliovirus E. Hepatitis B virus (HBV)

Answer 300

A. Haemophilus influenzae type b (Hib) C. Diphtheria, tetanus, and pertussis (DTaP) D. Poliovirus E. Hepatitis B virus (HBV) The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention and the Committee on Infectious Diseases of the American Academy of Pediatrics govern the recommendations for immunization, which include diphtheria, tetanus, and pertussis (DTaP using acellular pertussis); poliovirus; measles, mumps, and rubella (MMR); Hib; HBV; hepatitis A virus (HAV); meningococcal; pneumococcal conjugate vaccine (PCV); and influenza (and H1N1) during infancy. There is no current vaccination to prevent the transmission of hepatitis C virus.

Question 301

``` The Hib conjugate vaccines protect an infant against which of the following diseases? (Select all that apply.) A. Bacterial meningitis B. Epiglottitis C. Bacterial pneumonia D. Septic arthritis E. Sepsis ```

Answer 301

``` A. Bacterial meningitis B. Epiglottitis C. Bacterial pneumonia D. Septic arthritis E. Sepsis ``` Hib conjugate vaccines protect against a number of serious infections caused by Haemophilus influenza type b, especially bacterial meningitis, epiglottitis, bacterial pneumonia, septic arthritis, and sepsis.

Question 302

Which of the following is an important consideration in understanding the reactions of parents when their infant is born with physical defects? A. Grief lasts until the defects are repaired. B. Denial is a common maladaptive reaction. C. The psychologic reaction is similar to that with the death of an infant. D. Reactions

Answer 302

C. The psychologic reaction is similar to that with the death of an infant. Parents need to grieve for the loss of the expected child. They also must adapt to the needs of a child with physical defects and the additional demands this will place on the family. The grief usually consists of several stages, including shock, frustration, and anger. The grief response may last for years. Denial and disbelief during the shock phase are not maladaptive. They can serve to protect the parents as they begin to deal with the impact of the initial stress. Parents are sensitive and responsive to the behaviors of others. Health professionals’ interactions with the infant and parents provide cues to the parents that can greatly influence their reaction to the infant.

Question 303

An infant is born with anencephaly. When discussing this condition with the parents, the nurse should know that A. many treatment options exist. B. immediate surgery is necessary. C. the condition is incompatible with life. D. the child will have permanent disabilities.

Answer 303

C. the condition is incompatible with life. Anencephaly is the most serious neural tube defect. Both hemispheres of the brain are absent. Anencephaly is incompatible with life. Some infants with mature brainstem function can maintain vital functions for a short period. Currently, there are no medical or surgical treatment options

Question 304

``` Which of the following problems is most often associated with myelomeningocele? A. Biliary atresia B. Hydrocephalus C. Craniosynostosis D. Tracheoesophageal fistula ```

Answer 304

B. Hydrocephalus Hydrocephalus is a frequently associated anomaly in 80% to 90% of children. Biliary atresia and tracheoesophageal fistula are not associated with myelomeningocele. Craniosynostosis is the premature closing of the cranial sutures and is not associated with myelomeningocele.

Question 305

Latex allergy is suspected in a child with spina bifida. Appropriate nursing interventions include which of the following? A. Avoid using any latex product. B. Use only nonallergenic latex products. C. Teach the family about long-term management of asthma. D. Administer medication for long-term desensitization.

Answer 305

A. Avoid using any latex product. Care must be taken that individuals who are at high risk for latex allergies do not come in direct or secondary contact with products or equipment containing latex at any time during medical treatment. Nonallergenic latex products do not exist. The child does not have asthma. The parents are taught about allergy and the risk of anaphylaxis. At this time, desensitization is not an option.

Question 306

An infant with hydrocephalus is hospitalized for surgical placement of a ventriculoperitoneal shunt. Postoperative nursing care should include which of the following? A. Monitor closely for signs of infection. B. Place the child with the operated side of the head on the bed. C. Pump the shunt reservoir often to maintain patency. D. Maintain a Trendelenburg position to decrease pressure on the shunt.

Answer 306

A. Monitor closely for signs of infection. Infection is the greatest hazard in the postoperative period. The nurse is vigilant for signs of cerebrospinal fluid infection, including elevated temperature, poor feeding, vomiting, decreased responsiveness, and seizure activity. The child is placed with the operative side of the head up to reduce pressure on the valve. The shunt reservoir, when placed, is used for access to the ventricular system. It should not be pumped. Maintaining a Trendelenburg position to decrease pressure on the shunt is contraindicated. The Trendelenburg position can increase intracranial pressure. The child should be placed flat.

Question 307

``` Which of the following clinical manifestations of developmental dysplasia of the hip would be seen in a newborn? A. Lordosis B. Ortolani sign C. Trendelenburg sign D. Telescoping of the affected limb ```

Answer 307

B. Ortolani sign In the newborn period, the dysplasia usually appears as hip joint laxity. During the Ortolani test, the examiner places forward and then backward pressure on the trochanter. If the femoral head is felt to slip, dysplasia may be present. This test is most reliable from birth to 2 to 3 months. Lordosis, the Trendelenburg sign, and telescoping of the affected limb are signs that appear in older infants and children.

Question 308

A newborn with congenital clubfoot is being treated with successive casts. The parents ask why so many casts are required. The nurse should explain that A. casts are needed for the traction. B. each cast is good for only 6 weeks. C. surgical intervention will not be necessary. D. they allow for gradual stretching of tight structures.

Answer 308

D. they allow for gradual stretching of tight structures. Serial casting is begun shortly after birth and before discharge from the nursery. Successive casts allow for gradual stretching of skin and tight structures on the medial side of the foot. Manipulation and casting of the leg are repeated frequently (every week) to accommodate the rapid growth of early infancy. Traction is not indicated. The casts can last longer than 6 weeks. They are changed to facilitate manipulation and accommodate the growth of the child. Surgical intervention may be necessary if serial casting is not successful.

Question 309

``` Which of the following is a major long-term problem for a child with a cleft lip and palate? A. Faulty dentition B. Nutritional deficits C. Aspiration pneumonia D. Abnormally small maxilla ```

Answer 309

A. Faulty dentition A comprehensive team approach is used for children with a cleft lip and palate. Extensive orthodontics and prosthodontics are usually required to correct the malposition of the teeth and other bony structures. The child can be adequately nourished before and after surgical repair takes place. Aspiration is a possibility before repair of the cleft palate, but it is not a long-term problem. The nonunion of the maxilla usually requires surgery and possible bone grafts to close

Question 310

A newborn was admitted to the nursery with a complete bilateral cleft lip and palate. The physician explained the plan of therapy and its expected good results. However, the mother refuses to see or hold her baby. Initial therapeutic approach to the mother should be which of the following? A. Encourage her to express her feelings. B. Suggest holding the baby but without eye contact. C. Restate what the physician has told her about plastic surgery. D. Recognize that attachment usually does not occur until after initial surgery.

Answer 310

A. Encourage her to express her feelings. For parents, cleft lip and cleft palate deformities are particularly disturbing. The nurse must emphasize not only the infant’s physical needs but also the parents’ emotional needs. The mother needs to be able to express her feelings before she can accept her child. As the mother expresses her feelings, the nurse’s actions should convey to the parents that the infant is a precious human being. The child’s normalcy is emphasized, and the mother is assisted in recognizing the child’s uniqueness.

Question 311

The nurse assesses the neonate immediately after birth. Esophageal atresia or tracheoesophageal fistula is suspected if which of the following is present? A. Jaundice B. Absence of sucking C. Hyperactive bowel sounds D. Excessive amount of frothy saliva in the mouth

Answer 311

D. Excessive amount of frothy saliva in the mouth Frothy saliva in the mouth and nose, drooling, choking, and coughing in a newborn are associated with esophageal atresia and tracheoesophageal fistula. Jaundice in a neonate is indicative of a hematologic problem. Absence of sucking and hyperactive bowel sounds are not signs of esophageal atresia or tracheoesophageal fistula.

Question 312

``` Which of the following is the earliest clinical manifestation of biliary atresia? A. Jaundice B. Vomiting C. Hepatomegaly D. Absence of stooling ```

Answer 312

A. Jaundice Jaundice is the earliest and most striking manifestation of biliary atresia. It is first observed in the sclera and may be present at birth, but it is usually not apparent until ages 2 to 3 weeks. Vomiting is not associated with biliary atresia. Hepatomegaly and abdominal distention are common but occur later. Stools are large and lighter in color than expected because of the lack of bile.

Question 313

The nurse is caring for a neonate born with an omphalocele. Initial management after delivery includes A. beginning breastfeeding. B. supine positioning with nasogastric feedings. C. covering the omphalocele with saline-soaked gauze and a plastic drape. D. using a radiant warmer to dry the sac and maintain a neutral thermal environment

Answer 313

C. covering the omphalocele with saline-soaked gauze and a plastic drape. The sac is covered to prevent drying and excessive fluid loss from the neonate. The child will not be fed. With the abdominal contents outside of the infant, the stomach is decompressed and the infant is maintained with parenteral nutrition. A neutral thermal environment is desired, but the sac is not allowed to dry.

Question 314

Hypospadias refers to which of the following? A. Absence of a urethral opening B. Penis shorter than usual for age C. Urethral opening along dorsal surface of penis D. Urethral opening along ventral surface of penis

Answer 314

D. Urethral opening along ventral surface of penis Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis. The urethral opening is present but not at the glans. Hypospadias refers to the urethral opening, not to the size of the penis. When the urethral opening is located along the dorsal surface of the penis, this is known as epispadias.

Question 315

Mr. and Mrs. Wilson have a newborn with ambiguous genitalia. Tests are being done to assist in gender assignment. The parents tell the nurse that family and friends are asking what caused the baby to be this way. The nurse’s intervention should include which of the following? A. Explain the disorder so they can explain it to others. B. Help the parents understand that this is a minor problem. C. Encourage the parents not to worry while the tests are being done. D. Suggest that the parents avoid family and friends until the gender is assigned

Answer 315

A. Explain the disorder so they can explain it to others. Although ambiguous genitalia may appear as one entity, there are many causes. It is essential that the parents understand the complex issues that are involved in gender assignment as they work with the multidisciplinary team. Depending on the etiology, this can be a lifelong problem. Gender assignment should be a slow, deliberative process. Telling the parents not to worry negates their concern about their child. Suggesting that parents avoid family and friends until the gender is assigned is not realistic.

Question 316

Which of the following situations places infants at risk for developing vitamin D–deficiency rickets? A. Exclusively formula fed B. Exposure to daily sunlight C. Mothers who are lacto-ovovegetarians D. Families using yogurt as primary source of milk

Answer 316

D. Families using yogurt as primary source of milk Yogurt does not contain adequate amounts of vitamins A and D. Commercial formulas have recommended amounts of vitamin D. Lack of sunlight is a causative factor. Individuals who follow a lacto-ovovegetarian diet use dairy products and can obtain sufficient vitamin D.

Question 317

``` Deficiency of which of the following vitamins correlates with increased morbidity and mortality in children with measles and increased complications from diarrhea and infections? A. A B. C C. Niacin D. Folic acid ```

Answer 317

A. A Vitamin A deficiency contributes to increased morbidity in measles, diarrhea, and infections. The American Academy of Pediatrics recommends that supplementation be considered in children with measles and related disorders. No correlation exists between vitamin C, niacin, and folic acid and increased morbidity and mortality with measles.

Question 318

``` Which of the following vitamins increases the absorption of iron? A. B12 B. C C. D D. Biotin ```

Answer 318

B. C Vitamin C increases the absorption of iron for hemoglobin formation. No correlation exists between vitamins B12, D, and biotin and iron absorption.

Question 319

``` Which of the following foods should the nurse recommend as a good source of potassium for a child receiving diuretics? A. Grains B. Grains and legumes C. Dairy products D. Dark green vegetables ```

Answer 319

B. Grains and legumes One combination of foods that provides the appropriate amounts of essential amino acids is grains (cereal, rice, pasta) and legumes (beans, peas, lentils, peanuts). Grains alone do not provide the appropriate amounts of essential amino acids. Dairy products and dark green vegetables do not provide the appropriate amounts of essential amino acids.

Question 320

``` Which of the following food combinations will generally provide the appropriate amounts of essential amino acids for someone who is a vegetarian? A. Grains and legumes B. Grains and vegetables C. Legumes and vegetables D. Milk products and fruit ```

Answer 320

A. Grains and legumes Eating grains (cereal, rice, and pasta) and legumes (beans, peas, lentils, and peanuts) at the same meal provides the appropriate amount of essential amino acids. Grains and vegetables, legumes and vegetables, and milk products and fruit are combinations that do not provide the appropriate amounts of essential amino acids.

Question 321

Which of the following is most descriptive of kwashiorkor? A. Has a multifactorial etiology B. Occurs primarily in breastfed infants C. Results from excessive amounts of vitamin K D. Is related to inadequate calories but adequate protein

Answer 321

A. Has a multifactorial etiology Current evidence suggests a multifactorial causation, including cultural, psychologic, and infective factors that interact to place the child at risk. Kwashiorkor appears in infants after being weaned from the breast after the birth of another child. No correlation exists between vitamin K and kwashiorkor. Protein deficiency exists in children with kwashiorkor.

Question 322

``` Although infants may be allergic to a variety of foods, the most common allergens are A. fruit, eggs, and rice. B. fruit, vegetables, and wheat. C. eggs, cow’s milk, and peanuts. D. cow’s milk and green vegetables. ```

Answer 322

C. eggs, cow’s milk, and peanuts. Milk products, eggs, and peanuts are three of the most common food allergens. Ingestion of these products can cause sensitization and, with subsequent exposure, an allergic reaction. Eggs are a common allergen but not fruit or rice. Wheat is a common allergen but not fruit and vegetables. Cow’s milk is a common allergen but not green vegetables.

Question 323

Parent guidelines for relieving colic in an infant include which of the following? A. Avoid using a pacifier. B. Avoid touching the abdomen. C. Change the infant’s position frequently. D. Place the infant where the family cannot hear the crying.

Answer 323

C. Change the infant’s position frequently. Changing the infant’s position frequently may be beneficial. The parent can walk holding the child face down and with the child’s abdomen across the parent’s arm. The parent’s hand can support the child’s abdomen, applying gentle pressure. Pacifiers can be used for meeting additional sucking needs. Gently massaging the abdomen is effective in some children. The child should not be placed where he or she cannot be monitored. The child can be placed in the crib and allowed to cry. Periodically, the child should be picked up and comforted.

Question 324

Which of the following is an important nursing consideration when caring for an infant with failure to thrive? A. Establish a structured routine, which is followed consistently. B. Limit sensory stimulation and play activities to alleviate fatigue. C. Place the child in an infant’s seat during feedings to prevent overstimulation. D. Maintain a nondistracting environment by not speaking to the child during feeding.

Answer 324

A. Establish a structured routine, which is followed consistently. An infant with failure to thrive should have a structured routine that is followed consistently. Disruptions in other activities of daily living can have a great impact on feeding behaviors. Bathing, sleeping, dressing, playing, and feeding are structured. The child can engage in sensory and play activities at times other than mealtimes. Young children should be held while being fed, and older children can sit at a feeding table. The child should be fed in the same manner at each meal. The nurse should talk to the child by giving directions about eating. This will help the child maintain focus.

Question 325

``` Nursing care of the infant with atopic dermatitis (eczema) should focus on which of the following? A. Keeping the baby content B. Maintaining adequate nutrition C. Preventing infection of lesions D. Applying antibiotics to lesions ```

Answer 325

C. Preventing infection of lesions The lesions of atopic dermatitis are itchy. New lesions develop when the skin is scratched. This cycle leads to the possibility of infection. Although keeping the baby content and maintaining adequate nutrition are important, decreasing the amount of scratching is a primary aim. Antibiotics are not the primary treatment of atopic dermatitis.

Question 326

Which of the following interventions lowers the risk of sudden infant death syndrome (SIDS)? A. Smoking near the infant B. Having the infant sleep in the supine position C. Having the infant sleep with the parents instead of alone in a crib D. Making certain the infant is kept very warm while sleeping

Answer 326

B. Having the infant sleep in the supine position The supine position is recommended for all infants while sleeping. Smoking in the infant’s environment increases the infant’s risk for SIDS by 1.9%. There is a positive association between bed sharing with parents and SIDS. Thermal stress or overheating is associated with an increased risk of SIDS.

Question 327

Which of the following statements best describes hypopituitarism? A. Skeletal proportions are normal for age. B. Weight is usually more retarded than height. C. Growth is normal during the first 3 years of life. D. Most of these children have subnormal intelligence.

Answer 327

A. Skeletal proportions are normal for age. Skeletal proportions are normal for age, but these children appear young for their age. Growth in height is usually more delayed than in weight. Growth is normal for the first year of age, and then these children follow a slowed growth curve. Most of the children have normal intelligence. Often they are considered precocious because their educational ability seems to exceed their size. Emotional problems are common because of their small stature.

Question 328

Which of the following should the nurse include when discussing a child’s precocious puberty with the parents? A. The child is not yet fertile. B. Heterosexual interest is usually advanced. C. Dress and activities should be appropriate to chronologic age. D. Appearance of secondary sexual characteristics does not proceed in the usual order.

Answer 328

C. Dress and activities should be appropriate to chronologic age. Because of the early sexual maturation of the child, both the family and child require extensive teaching. Included in this is the information that the child should be engaged in activities according to chronologic age. Functioning sperm or ova may be produced, thereby making the child fertile at an early age. Heterosexual interest is usually appropriate to chronologic age. Development of the secondary sexual characteristics proceeds in the usual order.

Question 329

``` Which of the following is the primary clinical manifestation of diabetes insipidus? A. Oliguria B. Glycosuria C. Nausea, vomiting D. Polyuria, polydipsia ```

Answer 329

D. Polyuria, polydipsia Diabetes insipidus results from the hyposecretion of antidiuretic hormone. Because insufficient amounts are produced, excessive amounts of urine are produced. When allowed access to fluids, the child maintains balance with an almost insatiable thirst. Oliguria is diminished urinary output. Children with diabetes insipidus have increased urinary output. Glycosuria is not a manifestation of diabetes insipidus. It may be a manifestation of diabetes mellitus. Nausea and vomiting are not manifestations of diabetes insipidus. They can occur with oversecretion of antidiuretic hormone.

Question 330

``` A 13-year-old girl is brought to the clinic with the complaint of insomnia and hyperactivity. Other symptoms include gradual weight loss despite a good appetite; warm, flushed, and moist skin; and unusually fine hair. These manifestations are most suggestive of which of the following? A. Hypothyroidism B. Hyperthyroidism C. Hypoparathyroidism D. Hyperparathyroidism ```

Answer 330

B. Hyperthyroidism These symptoms are suggestive of hyperthyroidism. Other symptoms include academic difficulties resulting from a short attention span and an inability to sit still, unexplained fatigue and sleeplessness, and difficulty with fine motor skills. Hypothyroidism is seen with decelerated growth from chronic deprivation of thyroid hormone. Other manifestations are myxedematous skin changes (dry skin, puffiness around the eyes, sparse hair), constipation, sleepiness, and mental decline. Early manifestations of hypoparathyroidism may be anxiety and mental depression followed by paresthesia and evidence of heightened neuromuscular excitability. Hyperparathyroidism results in hypercalcemia, which can be manifested by a change in behavior, gastrointestinal symptoms, and cardiac irregularities.

Question 331

The nurse is caring for a child hospitalized with acute adrenocortical insufficiency. Because of the sudden, severe nature of the disease, the family needs a great deal of emotional support. The most appropriate nursing action is which of the following? A. Prepare the family for the child’s impending death. B. Prepare the family for each procedure. C. Prepare the family for the long-term consequences of paralysis. D. Reassure the family that flaccid paralysis is not problematic.

Answer 331

B. Prepare the family for each procedure. By preparing the family for each procedure, the nurse is showing sensitivity to the family’s emotional needs. Acute adrenocortical insufficiency is a reversible condition when associated with adrenocortical insufficiency. Flaccid paralysis is problematic if not reversible.

Question 332

Which of the following statements best describes Cushing syndrome? A. It is caused by excessive production of cortisol. B. Treatment involves replacement of cortisol. C. The major clinical features are exophthalmia and pigmentary changes. D. The diagnosis is suspected with findings of hypotension, hyperkalemia, and polyuria.

Answer 332

A. It is caused by excessive production of cortisol. Cushing syndrome is a description of the clinical manifestations caused by too much circulating cortisol. In children, this is caused by a tumor or excessive and prolonged steroid therapy. The treatment is reduction of circulating cortisol. If the cause is a pituitary tumor, surgery is indicated. Exophthalmia is a manifestation of hyperthyroidism, not Cushing syndrome. Hypertension and hypokalemia are expected findings.

Question 333

The parent of a 10-year-old child with diabetes asks the nurse why home blood glucose monitoring is being recommended. The nurse should base the explanation on which of the following? A. It is an easier method of testing. B. Parents are better able to manage the diabetes. C. Children have a greater sense of control over the diabetes. D. Fewer visits to the primary care provider will be necessary.

Answer 333

C. Children have a greater sense of control over the diabetes. Blood glucose monitoring affords the child a greater sense of control. The immediate feedback allows for regulation of insulin doses. Home blood glucose monitoring provides a more accurate assessment of control than urine testing. Although the parents are involved in the management, a 10-year-old child should take responsibility for testing. The same number of visits will be necessary, but the blood glucose monitoring will enable better control.

Question 334

A school-age child recently diagnosed with type 1 diabetes mellitus asks the nurse if he can still play soccer, play baseball, and swim. The nurse’s response should be based on knowledge that A. exercise is contraindicated. B. the level of activity depends on the type of insulin required. C. exercise is not restricted unless indicated by other health conditions. D. soccer and baseball are too strenuous, but swimming is acceptable.

Answer 334

C. exercise is not restricted unless indicated by other health conditions. Exercise is encouraged for children with diabetes because it lowers blood glucose levels. Insulin and meal requirements require careful monitoring to ensure that the child has sufficient energy for exercise. Exercise is highly encouraged. The decrease in blood glucose can be accommodated by having snacks available. The level of activity is not dependent on the type of insulin used. Long- and short-acting insulin both may be used to compensate for the effects of training and sporting events. Sports are encouraged to help regulate the insulin, and food should be adjusted according to the amount of exercise. The child needs to be cautioned to monitor responses to the exercise.

Question 335

The nurse should recognize that when a child develops diabetic ketoacidosis, this is which of the following? A. Expected outcome B. Best treated at home C. A life-threatening situation D. Best treated at practitioner’s office or clinic

Answer 335

C. A life-threatening situation Diabetic ketoacidosis is the state of complete insulin deficiency. It is a medical emergency that must be diagnosed and treated. The child is usually admitted to an intensive care unit for assessment, insulin administration, and fluid and electrolyte replacement. Diabetic ketoacidosis is a medical emergency needing prompt assessment and intervention, usually in an intensive care environment.

Question 336

``` . The nurse is reviewing opioid medications and remembers that a significant, common side effect that occurs with opioid administration is: Select one: a. Euphoria b. Constipation c. Allergic reactions d. Diuresis ```

Answer 336

b. Constipation

Question 337

``` . The nurse is reviewing the pain assessment on a 7 month-old infant. The nurse recognizes that components of the FLACC scale include: 1. Color 2. Leg position 3. Facial expression 4. Activity Select one: a. 3, 4 b. 1, 3, 4 c. 1, 3 d. 2,3,4 ```

Answer 337

d. 2,3,4

Question 338

``` . The nurse is discussing pain management with the parents of a child with chronic pain. The nurse explains that management will include interdisciplinary care to promote the goal of: Select one: a. Medication compliance b. Fewer behavior problems c. Maximum functioning d. Elimination of the pain ```

Answer 338

c. Maximum functioning

Question 339

. A child is being admitted to the intensive care unit after a motor vehicle accident. The child has numerous fractures and is in pain that is rated 9 or 10 on a 10-point scale. In planning the child’s care, the nurse recognizes that the indicated action is to: Select one: a. Give the child a clock and explain when she or he can have pain medication b. Plan a preventive schedule of pain medication around the clock c. Increase dosage of analgesic until the child is adequately sedated d. Give only an opioid analgesic at this time

Answer 339

b. Plan a preventive schedule of pain medication around the clock

Question 340

The nurse is planning postoperative care for a 9 year-old child. Nursing considerations include which of the following? Select one: a. The immature nervous system in young children provides them with an increased pain threshold b. A child’s behavioral response to pain is affected by age and developmental level c. Opioid analgesic use in children is dangerous because of increased risk of addiction and respiratory depression d. Recovery from a painful procedure occurs at a faster rate in children compared to adults

Answer 340

b. A child’s behavioral response to pain is affected by age and developmental level

Question 341

``` When assessing the musculoskeletal system on a newborn infant the nurse notes that the newborn is sleeping prone with his legs in a “frog leg” position. The nurse recognizes this as: Select one: a. Hypotonia b. Hyperextension c. Immature muscle development d. Normal muscle tone for a newborn ```

Answer 341

a. Hypotonia

Question 342

A 14-year-old is admitted to the emergency department with a fracture of the right humerus at the epiphyseal plate. The nurse knows that this fracture will: Select one: a. Necessitate complete immobilization of the shoulder for 4 to 6 weeks b. Affect growth in the arm if not treated c. Heal slowly, since this is the weakest part of the bone d. Require shorter casting time because of remodeling

Answer 342

b. Affect growth in the arm if not treated

Question 343

``` The nurse is assessing for ischemia in a child with a fractured tibia. Which of the following findings requires notifying the physician? Select one: a. Pulsation b. Paresthesia c. Posturing d. Petaling ```

Answer 343

b. Paresthesia

Question 344

``` While caring for a child immobilized due to traction, the nurse recognizes that physiologic effects of immobilization on children include: 1. Peripheral neurovascular dysfunction 2. Vasodilation and venous stasis 3. Muscle atrophy 4. Increased respiratory depth Select one: a. 1, 2, 3 b. 2, 4 c. 1, 3 d. 1, 3, 4 ```

Answer 344

a. 1, 2, 3

Question 345

The nurse must evaluate for possible complications following closed reduction and casting of a left tibial fracture. Which of the following assessment findings indicates a potential circulatory complication? Select one: a. Capillary refill of 2 seconds in both feet b. Numbness and tingling of toes on the left foot c. Poor dorsiflexion of the left foot d. Skin is cool to touch on both feet

Answer 345

b. Numbness and tingling of toes on the left foot

Question 346

``` The nurse is assessing a preschooler admitted to the pediatric floor with a cast on her right lower leg. The child has a high level of pain on the FACES scale and her right foot is cool and pale with a capillary refill of 5 seconds. What assessment should the nurse perform next? Select one: a. Toe movement on right foot b. Deep tendon reflexes c. Femoral pulses d. Pedal pulse on left foot ```

Answer 346

a. Toe movement on right foot

Question 347

The clinic nurse is explaining the difference between a sprain and a strain to the parents of a child who is being seen for a sprained ankle. The nurse explains that a sprain is a: Select one: a. Muscle injury due to overuse b. Problem before the growth plate closes c. Stretch or tear of a ligament d. Weakness in tendon attachment

Answer 347

c. Stretch or tear of a ligament

Question 348

A nurse is admitting a child to the pediatric unit after an open reduction of a right fractured femur. The nurse understands that a sign that compartment syndrome could be occurring would be: Select one: a. Pain relieved by analgesics within 30 minutes b. Dorsalis pedis pulse present but femoral pulse weak c. Pain more severe than expected with tingling and numbness of the extremity d. Right toes warmer than left toes

Answer 348

c. Pain more severe than expected with tingling and numbness of the extremity

Question 349

. While reviewing for the NCLEX the student nurse remembers that Duchenne Muscular Dystrophy is: Select one: a. Characterized by muscle hypertrophy b. Diagnosed in later childhood during the growth spurt c. Inherited as an autosomal dominant disorder d. Characterized by delayed milestones and a waddling gait

Answer 349

d. Characterized by delayed milestones and a waddling gait

Question 350

The nurse is caring for a young boy who was just diagnosed with Duchenne Muscular Dystrophy. Which of the following should the nurse include in her discussion with the parents? Select one: a. Suggest ways for the child to limit use of his muscles b. Assist the family in finding a nursing facility to provide the child’s care c. Explain that this is a non-progressive disorder d. Recommend genetic counseling for family planning

Answer 350

d. Recommend genetic counseling for family planning

Question 351

When reviewing concepts discussed during the nursing program, the student nurse recognizes that disruptions in cognition may be seen as problems with: Select one: a. gross motor skills and abstract thinking b. Vocabulary, abstract thinking and fine motor skills c. Memory, vocabulary and attention d. Orientation, attention and gross motor coordination

Answer 351

c. Memory, vocabulary and attention

Question 352

During an in-service on neurological assessments for new graduates in the pediatric unit, the RN explains that acute neurological checks are completed frequently to: Select one: a. Determine if the parent can stay at the child’s bedside b. Monitor for subtle changes in neurological function c. Monitor the child’s fluid balance d. Determine cranial nerve involvement

Answer 352

b. Monitor for subtle changes in neurological function

Question 353

When assessing the function of an infant’s cranial nerves, the nurse understands that: Select one: a. Having the child smile tests the vagus nerve b. Watching the infant track a toy tests more than one cranial nerve c. Asking a toddler to stick out their tongue tests the glossopharyngeal nerve

Answer 353

b. Watching the infant track a toy tests more than one cranial nerve

Question 354

The mother of a one month-old infant tells the nurse that she is worried her baby will get meningitis like her oldest son had when he was an infant. The nurse should base his/her response on which of the following? Select one: a. Meningitis rarely occurs in children less than one year of age b. Often a genetic predisposition to meningitis exists c. Vaccination for Hib meningitis has decreased the frequency of this disease d. Vaccination to treat all types of meningitis is now available

Answer 354

c. Vaccination for Hib meningitis has decreased the frequency of this dis

Question 355

A mother comes to the emergency room with her 4-year old child who is complaining of diplopia, blurred vision and following a fall from a bicycle. The nurse should recognize that: Select one: a. The child should see an ophthalmologist b. These are signs of a concussion c. These are normal complaints for a 4 year old child d. These are signs of hypoglycemia, the child needs carbohydrates

Answer 355

b. These are signs of a concussion

Question 356

``` The school nurse is presenting a lesson on head injuries to a group of high school physical education teachers. The school nurse explains that complications of a head injury include: Select one: a. Post-concussion syndrome b. Dizziness c. Headache d. Alteration in mental status ```

Answer 356

a. Post-concussion syndrome

Question 357

``` A 16 year-old high school student gets tackled and bangs the back of his head on the ground during football practice. Knowing that the student suffered a mild concussion the previous week, the school nurse suspects that the student may experience: Select one: a. Second-injury syndrome b. A severe traumatic brain injury c. Post concussion syndrome d. Chronic migraines ```

Answer 357

a. Second-injury syndrome

Question 358

The nurse is planning care for a 14 year-old child admitted with bacterial meningitis. Which of the following should be included in the plan of care? Select one: a. Measure head circumference to assess developing complications b. Keep environmental stimuli to a minimum c. Avoid giving pain medications that could dull sensorium d. Have child move head from side to side every 2 hours

Answer 358

b. Keep environmental stimuli to a minimum

Question 359

The nurse is explaining the neurological assessment to the parents of a 4 year-old child admitted with a severe concussion. The nurse explains that the Glascow Coma Scale score is an assessment of the child's Select one: a. Eye opening, motor response and verbal response b. Brainstem function and language development c. Motor skills and verbal develoopment d. Pupil reactivity and motor response

Answer 359

a. Eye opening, motor response and verbal response

Question 360

A 2 year-old starts to have a seizure while in a crib in the hospital. The child’s teeth are clamped shut. The most important nursing action at this time is to: Select one: a. Place a padded tongue blade between the child’s teeth b. Restrain the child to prevent injury c. Stay with the child and observe his respiratory status and duration of the seizure d. Prepare the suction equipment

Answer 360

c. Stay with the child and observe his respiratory status and duration of the seizure

Question 361

Match the indication or mechanism of action with the drug classification Reduce cerebral edema: _______________ Treatment of seizures: _______________ Treat infectious disease processes: _______________ Reduction of increased intracranial pressure: _______________

Answer 361

Reduce cerebral edema: osmotic diuretics Treatment of seizures: anticonvulsant, antiepileptic Treat infectious disease processes: antibiotics or antivirals Reduction of increased intracranial pressure: paralytic agents

Question 362

The pediatric ICU nurse is receiving report from the ED on a 4 year-old child with splenic-sequestration. The nurse understands that splenic-sequestration: Select one: a. Is caused by severe bleeding in the joints b. Frequently causes extreme abdominal pain c. Is a self-limiting complication of sickle cell anemia d. Results in hypovolemia and shock

Answer 362

d. Results in hypovolemia and shock

Question 363

``` The nurse is caring for a 10 year-old with myelosuppression (bone marrow suppression) following chemotherapy. The nurse is concerned with the potential for bleeding tendencies due to which of the following? Select one: a. Decrease in platelets b. Decrease in hemoglobin c. Decrease in leukocytes d. Decrease in WBC’s ```

Answer 363

a. Decrease in platelets

Question 364

The nurse is preparing a 2 year-old for chemotherapy. The mother is upset that the child was sick with nausea and vomiting after the previous chemotherapy infusion. The appropriate nursing intervention that would address this side effect would be to: Select one: a. Keep the child NPO for 2 hours after the infusion b. Offer oral fluids frequently to combat dehydration c. Administer IV fluids for 4 hours d. Give anti-emetics at the start of the treatment and on a fixed schedule

Answer 364

d. Give anti-emetics at the start of the treatment and on a fixed schedule

Question 365

``` the mother of a child receiving maintenance therapy for leukemia asks the nurse why her child is also receiving CNS prophylactic therapy. The nurse explains that the CNS prophylactic therapy is being given to Select one: a. Decrease the number of lymphocytes b. Treat the child’s CNS lesion c. Increase the number of leukocytes d. Prevent CNS involvement ```

Answer 365

d. Prevent CNS involvement

Question 366

A 7 year-old child with leukemia is being admitted to the pediatric oncology unit. The nurse explains to the parents that nursing management of leukemia includes: 1. Maintaining nutrition and hydration 2. Promoting bedrest for the first week 3. Managing chemotherapy side effects 4. Taking care of the child’s ADL’s for him Select one: a. 1, 3 b. 1, 2, 3 c. 2, 3 d. 1, 3, 4

Answer 366

a. 1, 3

Question 367

The highest priority nursing care of a child who is neutropenic due to chemotherapy treatment for leukemia should include: Select one: a. Maintain contact isolation precautions b. Restricting oral fluids c. Reverse isolation and proper handwashing technique at all times d. Providing a high protein diet

Answer 367

c. Reverse isolation and proper handwashing technique at all times

Question 368

``` The clinic nurse is assessing an adolescent diagnosed with iron deficiency anemia. The nurse explains to the parent that iron deficiency anemia may be caused by: Select one or more: a. Impaired absorption of iron b. Poor eating habits c. Involvement in sports d. Inadequate iron supply ```

Answer 368

a. Impaired absorption of iron b. Poor eating habits d. Inadequate iron supply

Question 369

``` Ferrous sulfate 2 mL bid is ordered for a 2 year-old child who has iron deficiency anemia. For optimal absorption the nurse should administer the medication with which of the following? Select one: a. Orange juice b. soy milk c. Tea d. Milk ```

Answer 369

a. Orange juice

Question 370

``` While caring for a child during the recovery/management phase of burn treatment the nurse recognizes the most common complication seen in children is: Select one: a. Metabolic acidosis b. Asphyxia c. Wound infection d. Shock ```

Answer 370

c. Wound infection

Question 371

``` While caring for a child with burn injuries in the pediatric intensive care unit, which of the following should the nurse plan to implement about one-half hour before the daily whirlpool bath and dressing change? Select one: a. Remove the dressing b. Soak the dressing c. Slit the dressing with blunt scissors d. Administer an analgesic ```

Answer 371

d. Administer an analgesic

Question 372

``` The most common burn in children is a scalding burn which may have the following characteristics: weeping blisters, swelling and hypersensitivity to touch. The nurse knows that this type of burn is categorized as: Select one: a. Third degree b. Second degree burn c. Fourth Degree d. First degree burn ```

Answer 372

b. Second degree burn

Question 373

A child is being treated for burns in the emergency room. The parents have provided information relative to the origin of the burn event but the patterns of injury are not consistent with their description. The nurse would suspect that: Select one: a. b. the parents are too upset to provide information at this time, so additional questions can be answered later c. the child may have not told the parents the truth about the event d. there is no real concern as the burn injuries are minimal and non life threatening.

Answer 373

the answer was not included... but probably something about child abuse

Question 374

Which is an important consideration for the nurse when changing dressings and applying topical medication to a child’s abdomen and leg burns? Select one: a. Wash hands and forearms before and after dressing change. b. Apply topical medication with clean hands. c. Apply dressing so that movement is limited during the healing process. d. If dressings adhere to the wound, soak in hot water before removal.

Answer 374

a. Wash hands and forearms before and after dressing change.

Question 375

The nurse knows that Nutritional needs are to be met when a child is healing from burns. What are the two most important aspects of nutrition that are known when caring for burn patients. Select one: a. Increased fluid and caloric intake throughout the day. b. increased salt intake and fluid intake c. Fluid restriction and limit protein intake

Answer 375

a. Increased fluid and caloric intake throughout the day.