finals questions

12. A newly married couple is seeking genetic counseling because they are both carriers of the sickle cell trait. How can the nurse best explain the children's risk of inheriting this disease?a.Every fourth child will have the disease; two others will be carriers.b.All of their children will be carriers, just as they are.c.Each child has a one in four chance of having the disease and a two in four chance of being a carrier.d.The risk levels of their children cannot be determined by this information.

ANS: CThe sickle cell gene is inherited from both parents; therefore, each offspring has a one in four chance of inheriting the disease.

1. A parent comments that her infant has had several ear infections in the past few months. Why are infants more susceptible to otitis media?a.Infants are in a supine or prone position most of the time.b.Sucking on a nipple creates middle ear pressure.c.They have increased susceptibility to upper respiratory tract infections.d.The Eustachian tube is short, straight, and wide.

ANS: DAn infant's Eustachian tubes are short, wide, and straight, allowing microorganisms easy access to the middle ear.

2. What statement by a patient's mother leads the nurse to determine she understands instructions about administering an oral antibiotic for otitis media?a."I will continue using the medication until symptoms are relieved."b."I will share the medicine with siblings if their symptoms are the same."c."I will give the medication with a glass of milk."d."I will administer prescribed doses until all the medication is used.

ANS: DAntibiotic therapy for otitis media is continued until the prescribed amount has been completed, even if symptoms are alleviated.

6. What assessment made by the school nurse would lead to the suspicion of strabismus?a.Reddened sclera in one eyeb.Child covers one eye to read the chalkboardc.Child complains of a headached.Copious tears while watching TV

ANS: BIndicators of strabismus include covering one eye to see, tilting the head to see, and missing objects in attempts to pick them up. Although headaches may be associated with amblyopia, this symptom is too vague to point suspicion to any disorder.

25. A child is diagnosed with nonparalytic strabismus. How will this disorder most likely be corrected?a.Patching the unaffected eyeb.Corrective lensesc.Laser treatmentd.Surgery

ANS: BIn nonparalytic strabismus, the refractory error is usually corrected with eyeglasses.

7. What might the nurse explain as a common treatment for amblyopia?a.Patching the good eye to force the brain to use the affected eyeb.Patching the affected eye to allow the refractory muscles to restc.Using glasses that will slightly blur the image for the good eyed.Using corticosteroids to treat inflammation of the optic nerve

ANS: AEarly detection and treatment are essential for the child with amblyopia. Treatment includes patching the good eye and using glasses to correct refractive errors.

9. The nurse is planning to teach parents about prevention of Reye's syndrome. What information would the nurse include in this teaching?a.Use aspirin instead of acetaminophen for children with viral illness.b.Advise parents to have their children immunized against Reye's syndrome.c.Avoid giving salicylate-containing medications to a child who has viral symptoms.d.Get the child tested for Reye's syndrome if the child exhibits fever, vomiting, and lethargy.

ANS: CPrevention of Reye's syndrome includes educating parents not to give aspirin-containing medication to children with viral symptoms.

10. What symptom leads the nurse caring for a 5-month-old child with viral influenza to suspect the development of Reye's syndrome?a.Respirations drop from 18 to 14 breaths/minuteb.Falling asleep after feedingc.Sudden vomiting without effortd.Development of a macular rash

ANS: CA child with a viral infection is at risk for Reye's syndrome, the onset of which is effortless vomiting, lethargy, and a change in level of consciousness. A 5-month-old child who sleeps after eating is normal.

24. The nurse is caring for a 3-year-old child with a head injury. Which assessment would lead the nurse to report the probability of increasing intracranial pressure (ICP)?a.Temperature increase from 37.2° C (99° F) to 37.7° C (100° F)b.Increase in blood pressure with an attendant decrease in pulsec.Increase in respirationsd.Equilateral pupils

ANS: BIncreasing blood pressure, accompanied by decreasing pulse, and accompanied by unequal pupils are indicators of ICP.

23. The pediatric nurse completes an assessment on all patients assigned during evening shift at the hospital. Which patient assessment requires immediate intervention?a.Toddler with an axillary temperature of 99° Fb.School-age child with widening pulse pressurec.Infant pulse rate of 100 beats/minuted.Adolescent with a respiratory rate of 28 breaths/minute

ANS: BA widening pulse pressure can indicate increased ICP; therefore, it is the priority. An axillary temperature of 99° F, infant pulse of 100 bpm, and adolescent respiratory rate of 28 are expected assessments.

5. What manifestations of increasing ICP in the hydrocephalic child should the nurse be aware of? (Select all that apply.)a.High-pitched cryb.Unequal pupilsc.Bulging fontanellesd.Diarrheae.Hiccups

ANS: A, B, CIncreased ICP is manifested by high-pitched cry, inequality of pupils, and bulging fontanelles.

11. What does the nurse explain to parents of a child with febrile seizures?a.They occur when the body temperature exceeds 38.3° C (101° F).b.They can be prevented by anticonvulsant medication.c.They usually lead to the development of epilepsy.d.They occur when the temperature rises quickly.

ANS: DFebrile seizures occur in response to a rapid rise in temperature, often above 38.8° C (102° F).

12. A parent reports that her child has begun to do poorly at school and experiences episodes where he appears to be staring into space. Of which type of seizure is this behavior a characteristic?a.Absenceb.Akineticc.Myoclonicd.Complex partial

ANS: AAbsence seizures are characterized by transient loss of consciousness where the child appears to stare blankly, and may last only a few seconds.

13. An adolescent has just had a generalized seizure and collapsed in the school nurse's office. When should the nurse should call 911?a.The seizure lasts more than 5 minutes.b.The child is sleepy and lethargic after the seizure.c.The child vomited at the onset of the seizure.d.The child is confused and has slurred speech after the seizure.

ANS: AIf there are multiple seizures or if seizures last more than 5 minutes, call 911 because these are indicators of possible status epilepticus, a medical emergency.

14. What is an appropriate nursing action when a child is experiencing a generalized tonic-clonic seizure?a.Assist the child to bed and then go for help.b.Move objects out of the child's immediate area.c.Stick a padded tongue blade between the child's teeth.d.Manually restrain the child.

ANS: BDuring a generalized tonic-clonic seizure, the immediate area is cleared to protect the child from injury.

15. A child diagnosed with epilepsy had a generalized tonic-clonic seizure that lasted 90 seconds. What would the nurse expect to assess after a generalized tonic-clonic seizure?a.Restlessnessb.Sleepinessc.Nausead.Anxiety

ANS: BFollowing a generalized tonic-clonic seizure, the child may have some confusion and may sleep for a time (postictal lethargy) and then return to full consciousness.

22. A child is admitted to the hospital because she had a seizure. Her parents report that for the past few weeks she has had headaches, with vomiting, that are worse in the morning. What does the nurse suspect?a.Meningitisb.Reye's syndromec.Brain tumord.Encephalitis

ANS: CThe signs and symptoms of a brain tumor are related to its size and location. Most tumors create increased intracranial pressure (ICP) with the hallmark symptoms of headache, vomiting, drowsiness, and seizures.

4. What will the nurse include when documenting a grand mal seizure? (Select all that apply.)a.Presence of incontinenceb.Current dose of antispasmodic medicationc.Activity level prior to and following seizured.Level of consciousness following seizuree.Length of seizure

ANS: A, C, D, EDocumentation on a seizure should include LOC following episode, activity prior to and following seizure, change in color, respiration, muscle tone, and length of seizure. Reporting of medication regimen is not necessary.

4. Which congenital cardiac defect(s) cause(s) increased pulmonary blood flow? (Select all that apply.)a.Atrial septal defects (ASDs)b.Tetralogy of Fallotc.Dextroposition of aortad.Patent ductus arteriosuse.Ventricular septal defects (VSDs)

ANS: A, D, EThe congenital heart defects that cause increased pulmonary blood flow are ASDs, VSDs, and patent ductus arteriosus.

1. What does the nurse explain that a ventricular septal defect will allow?a.Blood to shunt left to right, causing increased pulmonary flow and no cyanosisb.Blood to shunt right to left, causing decreased pulmonary flow and cyanosisc.No shunting because of high pressure in the left ventricled.Increased pressure in the left atrium, impeding circulation of oxygenated blood in the circulating volume

ANS: APulmonary blood flow is increased when a ventricular septal defect exists. The blood shifts from left to right because of the higher pressure in the left ventricle. This particular shift does not cause cyanosis.

2. Which assessment would lead the nurse to suspect that a newborn infant has a ventricular septal defect?a.A loud, harsh murmur with a systolic thrillb.Cyanosis when cryingc.Blood pressure higher in the arms than in the legsd.A machinery-like murmur

ANS: AA loud, harsh murmur combined with a systolic thrill is characteristic of a ventricular septal defect.

3. What finding would the nurse expect when measuring blood pressure on all four extremities of a child with coarctation of the aorta?a.Blood pressure higher on the right sideb.Blood pressure higher on the left sidec.Blood pressure lower in the arms than in the legsd.Blood pressure lower in the legs than in the arms

ANS: DThe characteristic symptoms of coarctation of the aorta are a marked difference in blood pressure and pulses between the upper and lower extremities. Pressure is increased proximal to the defect and decreased distal to the coarctation.

4. A father asks why his child with tetralogy of Fallot seems to favor a squatting position. What is the nurse's best response?a.Squatting increases the return of venous blood back to the heart.b.Squatting decreases arterial blood flow away from the heart.c.Squatting is a common resting position when a child is tachycardic.d.Squatting increases the workload of the heart.

ANS: AThe squatting position allows the child to breathe more easily because systemic venous return is increased.

5. An infant is experiencing dyspnea related to patent ductus arteriosus (PDA). What does the nurse understand regarding why dyspnea occurs?a.Blood is circulated through the lungs again, causing pulmonary circulatory congestion.b.Blood is shunted past the pulmonary circulation, causing pulmonary hypoxia.c.Blood is shunted past cardiac arteries, causing myocardial hypoxia.d.Blood is circulated through the ductus from the pulmonary artery to the aorta, bypassing the left side of the heart.

ANS: AWhen PDA is present, oxygenated blood recycles through the lungs, overburdening the pulmonary circulation.

6. Which is the most appropriate nursing action related to the administration of digoxin (Lanoxin) to an infant?a.Counting the apical rate for 30 seconds before administering the medicationb.Withholding a dose if the apical heart rate is less than 100 beats/minutec.Repeating a dose if the child vomits within 30 minutes of the previous dosed.Checking respiratory rate and blood pressure before each dose

ANS: BAs a rule, if the pulse rate of an infant is less than 100 beats/minute, the medication is withheld and the physician is notified.

8. Which comment made by a parent of a 1-month-old infant would alert the nurse about the presence of a congenital heart defect?a."He is always hungry."b."He tires out during feedings."c."He is fussy for several hours every day."d."He sleeps all the time.

ANS: BFatigue during feeding or activity is common to most infants with congenital cardiac problems.

1. How would the nurse caring for an infant with congestive heart failure (CHF) modify feeding techniques to adapt for the child's weakness and fatigue? (Select all that apply.)a.Feeding more frequently with smaller feedingsb.Using a soft nipple with enlarged holesc.Holding and cuddling the child during feedingd.Substituting glucose water for formulae.Offering high-caloric formula

ANS: A, B, C, EInfants with CHF fatigue easily. Feeding can be given more frequently in smaller amounts through a soft, large-holed nipple. Formulas with a denser caloric content can be offered. The child may be encouraged to nurse if he or she is held.

1. The nurse is teaching the parents of a young child with iron deficiency anemia about nutrition. What food would the nurse emphasize as being a rich source of iron?a.An egg whiteb.Cream of Wheatc.A bananad.A carrot

ANS: BGood nutritional sources of iron include boiled egg yolk, liver, green leafy vegetables, Cream of Wheat, dried fruits, beans, nuts, and whole-grain breads.

2. Which statement by a mother may indicate a cause for her 9-month-old's iron deficiency anemia?a."Formula is so expensive. We switched to regular milk right away."b."She almost never drinks water."c."She doesn't really like peaches or pears, so we stick to bananas for fruit."d."I give her a piece of bread now and then. She likes to chew on it.

ANS: ABecause cow's milk contains very little iron, infants should drink iron-fortified formula for the first year of life.

25. A child is diagnosed with iron deficiency anemia. What will the nurse explain can occur if this disorder goes untreated?a.Hemorrhageb.Heart failurec.Infectiond.Pulmonary embolism

ANS: BUntreated iron deficiency anemias progress slowly, and in severe cases the heart muscle becomes too weak to function. If this happens, heart failure follows.

4. What are the classic symptoms of thalassemia major (Cooley's anemia)? (Select all that apply.)a.Hepatomegalyb.Jaundicec.Protruding teethd.Pathological fracturese.Renal failure

ANS: A, B, C, DAll of the options are classic signs of thalassemia major except renal failure.

22. The nurse instructs the mother of a 2-year-old child who is taking iron supplements for anemia that some foods reduce the absorption of iron. What would be the best example provided by the nurse?a.Red meatb.Green, leafy vegetablesc.Acidic fruit juicesd.Egg yolks

ANS: DEgg yolks and starches reduce the absorption of iron in the digestive tract and should be limited for persons taking an iron supplement.

10. A 3-year-old child with sickle cell disease is admitted to the hospital in sickle cell crisis with severe abdominal pain. Which type of crisis is the child most likely experiencing?a.Aplasticb.Hyperhemolyticc.Vaso-occlusived.Splenic sequestration

ANS: CVaso-occlusive crisis, or painful crisis, is caused by obstruction of blood flow by sickle cells, infarctions, and some degrees of vasospasm.

11. Which statement made by a parent indicates an understanding of health maintenance of a child with sickle cell disease?a."I should give my child a daily iron supplement."b."It is important for my child to drink plenty of fluids."c."He needs to wear protective equipment if he plays contact sports."d."He shouldn't receive any immunizations until he is older.

ANS: BPrevention of dehydration, which can trigger the sickling process, is a priority goal in the care of a child with sickle cell disease.

7. What should the nurse closely assess in a child receiving a transfusion?a.Feverb.Lethargyc.Jaundiced.Bradycardia

ANS: AThe child receiving a blood transfusion is observed for signs of a transfusion reaction including chills, itching, fever, rash, headache, and back pain.

8. On admission, a child with leukemia has widespread purpura and a platelet count of 19,000/mm3. What is the priority nursing intervention?a.Assessing neurological statusb.Inserting an intravenous linec.Monitoring vital signs during platelet transfusionsd.Providing family education about how to prevent bleeding

ANS: AWhen platelets are low, the greatest danger is spontaneous intracranial bleeding. Neurological assessments are therefore a priority of care.

13. A child with thalassemia major receives blood transfusions frequently. What is a complication of repeated blood transfusions?a.Hemarthrosisb.Hematuriac.Hemoptysisd.Hemosiderosis

ANS: DAs a result of repeated blood transfusions, excessive deposits of iron (hemosiderosis) are stored in tissues.

15. The child receiving a transfusion complains of back pain and itching. What is the best initial action by the nurse?a.Notify the charge nurse.b.Disconnect intravenous lines immediately.c.Give diphenhydramine (Benadryl).d.Clamp off blood and keep line open with normal saline.

ANS: DIf a blood transfusion reaction occurs, the first action is to stop the blood infusion, keep the line open with normal saline, and notify the charge nurse.

17. A 6-year-old child with leukemia asks, "Who will take care of me in heaven?" What is the best response by the nurse?a."Who do you think will take care of you?"b."Your grandparents and God will take care of you."c."Your mom will know more about that than I do."d."Why are you asking me that?

ANS: AThis response gives the child an opportunity to verbalize his or her feelings and concerns, whereas closed responses shut off communication. The asking of a "why" question is not therapeutic as it calls for justification.

3. On the second day of hospitalization for a 3-month-old brought in for treatment for gastroenteritis, the nurse makes all of the assessments listed below. Which assessment finding indicates ineffectiveness of treatment?a.Weight loss of 4 ouncesb.Dry mucous membranesc.Decreased skin turgord.Depressed fontanelle

ANS: AWeight loss is the most significant indicator of dehydration because an infant's weight comprises 77% water.

21. A 7-month-old infant is admitted to the hospital with a diagnosis of acute gastroenteritis. What will be the nurse's priority goal of the infant's care?a.Prevent fluid and electrolyte imbalance.b.Prevent nutritional deficiency.c.Prevent skin breakdown.d.Prevent malabsorption.

ANS: AThe priority goal of care in gastroenteritis is preventing fluid and electrolyte imbalance.

22. The nurse is speaking to the parent of a 3-year-old child who has mild diarrhea. What dietary modification would the nurse advise?a.Soft foods with rice, bananas, toast, and applesauceb.Small amounts of clear fluids such as gelatinc.An oral rehydrating solution, such as Pedialyted.Chicken soup because it is high in sodium

ANS: CAn oral rehydrating solution is recommended to replace fluids and electrolytes lost from frequent bowel movements.

30. The nurse is caring for an 18-pound child who has had one stool of diarrhea. The nurse knows that the child needs to consume how many milliliters of oral fluid to make up for the fluid loss?a.18b.36c.64d.81

ANS: DThe formula for oral fluid replacement is 10 mL/kg. 18 pounds = 8.1 kg ´ 10 = 81 mL.

10. A mother reports that her 2-year-old child experiences constipation frequently. Which food would the nurse recommend to include in the child's diet?a.Cooked vegetablesb.Pretzelsc.Whole-grain cereald.Yogurt

ANS: CDietary modifications for constipation include eating more high-roughage foods such as whole-grain breads and cereals.

1. The nurse explains the medically accepted definition of constipation is fewer than _____ bowel movements in a 2-week period.

ANS:sevenThe medically accepted definition of constipation is fewer than seven bowel movements in a 2-week period.

16. The nurse is planning a parent education program about lead poisoning prevention. What will be included regarding primary sources of lead in the community?a.Increased lead content of airb.Use of aluminum cookwarec.Deteriorating paint in older buildingsd.Inhaling smog

ANS: CThe primary source of lead is paint from old, deteriorating buildings.

17. A frightened mother calls the pediatrician's office because her child swallowed dishwashing detergent. What is the most appropriate action?a.Induce vomiting by giving the child syrup of ipecac.b.Take the child to the local emergency department.c.Give the child activated charcoal mixed with juice.d.Give the child milk to soothe affected mucous membranes.

ANS: BInducing vomiting is no longer recommended because it may pose additional problems. The child should be taken immediately to the nearest emergency department along with the packaging of the ingested substance.

31. Which statement made by a parent alerts the nurse to the need for additional education about poison prevention?a."I keep the poison control center phone number easily accessible."b."All medication is kept out of reach in a locked cabinet."c."I keep a bottle of syrup of ipecac handy."d."Our garden is free from marigolds.

ANS: CTraditionally, syrup of ipecac was the treatment of choice to remove some types of poisons from a child's system and parents were advised to keep a supply on hand in the home. However, the American Academy of Pediatrics (AAP) revised this policy in 2003. Parents are now advised to call the poison control center and bring the container of the substance ingested to the hospital emergency department as quickly as possible because stomach lavage is rarely effective 1 hour or more after ingestion. Ipecac syrup should not be kept in the home. Uncontrolled vomiting can cause serious complications.

19. What does the nurse expect the appearance of the stools of a child with celiac disease to be?a.Ribbon likeb.Hard, constipatedc.Bulky, frothyd.Loose, foul-smelling

ANS: CCeliac disease causes malabsorption. Stools that are large, bulky, and frothy may indicate malabsorption.

20. The nurse has reviewed dietary restrictions for celiac disease with concerned parents. Which grain will the nurse explain can be eaten with celiac disease?a.Wheatb.Oatsc.Barleyd.Rice

ANS: DRice is a gluten-free grain that can be eaten by children afflicted with celiac disease. These children will have a lifelong restriction of wheat, oats, barley, and rye.

23. What would the nurse expect to find in a child admitted to the hospital for nonorganic failure to thrive?a.Cry to be picked upb.Be limp like a rag dollc.Be responsive to cuddlingd.Weigh in the 10th percentile for age

ANS: BSome children with failure to thrive have rag-doll limpness (hypotonia) and appear wary of their caregivers.

24. Which nursing interventions will be implemented for the mother of a 10-month-old infant with nonorganic failure to thrive?a.Pointing out errors that the nurse observes when the mother is caring for the infantb.Discussing negative characteristics of the infant with the motherc.Having the nurse provide as much of the infant's care as possibled.Teaching the mother about the developmental milestones to expect in the next few months

ANS: DThe nurse can increase parent's knowledge of growth and development by providing anticipatory guidance about normal developmental milestones.

1. Which assessments would cause the pediatric nurse to suspect the probability of an ear infection in a 6-month-old child? (Select all that apply.)a.Hypersensitivity to noiseb.Irritabilityc.Ecchymotic ear canald.Rolls head from side to sidee.Temperature of 39.4° C (103° F)

ANS: B, D, EInfants signal ear infections by being irritable, rolling their heads from side to side, spiking a temperature, and pulling at or rubbing their ears.

7. The nurse is providing education to parents of a child with cleft palate. What will the nurse instruct the parents to report immediately?a.Facial paralysisb.Ear infectionsc.Increased intracranial pressure (ICP)d.Drooling

ANS: BChildren with cleft palate are at risk of ear infections and dental disorders. Parents should be instructed to take the child to the health care provider at the first sign of earache.

8. A child had a burn, evidenced by pink skin and blistering. The child complains of pain and is crying. How does the nurse classify this burn when documenting?a.First-degreeb.Second-degree superficialc.Second-degree deep dermald.Third-degree

ANS: BA second-degree superficial burn appears blistered, moist, and pink or red. The pain associated with this burn indicates tissue viability.

9. A child has sustained a second-degree deep thermal burn to the hand. What is the best first action to take?a.Immerse the burned area in cold water.b.Apply ice to the burned area.c.Break any blisters that are present.d.Apply petroleum jelly to the burned skin.

ANS: AFirst aid treatment of a second-degree deep thermal burn is immersion of the burned area in water to halt the burning process.

10. Which allergy would contraindicate the use of silver sulfadiazine (Silvadene) as a topical agent for burns?a.Penicillinb.Iodinec.Tetanus immunizationsd.Sulfa

ANS: DThe use of Silvadene cream on burns is contraindicated if the patient has a sulfa allergy.

11. What would help the child with a serious burn meet nutritional needs during the subacute phase of recovery?a.Decrease calories because the child will be on bed rest and will not need as many.b.Increase calories and protein to compensate for the healing process.c.Increase fat to replace the layer of fat next to the burned skin.d.Decrease carbohydrates and starches because the pancreas is strained by the healing process.

ANS: BFrequent meals and snacks high in calories, protein, and iron are needed to meet the increased metabolic needs of the child with burns.

13. On the first day following a severe burn, the body's fluid reserves have left the circulating volume and entered the interstitial space, causing massive edema. What should the nurse monitor for very closely in the burn victim?a.Increasing intracranial pressureb.Reduced urine outputc.Eschar formationd.Fluid overload

ANS: BWith the fluid shift associated with severe burns, the nurse must be observant for the reduction of urine, an indication of altered renal function.

20. A child is brought to the emergency department with burns on the face and chest. What is the nurse's first priority?a.Assess respiratory status.b.Administer pain medication.c.Remove clothing.d.Insert a Foley catheter.

ANS: AAirway assessment and establishing an airway are the initial priorities.

2. The nurse observes a tarry stool from a 16-year-old burn victim who has been in the ICU for 2 weeks. Which complication does the nurse anticipate?a.Diverticulitisb.Stress diarrheac.Curling's ulcerd.Perforated bowel

ANS: CCurling's ulcer is a complication of burn victims resulting from the stress of their trauma.

26. The nurse is caring for a 3-year-old child with severe burns. What is the nurse aware is the minimum adequate hourly urine output?a.5 mL/hrb.10 mL/hrc.15 mL/hrd.20 mL/hr

ANS: DThe minimum acceptable hourly urine output for children over the age of 2 years is 20 to 30 mL/hr.

29. What should the nurse keep in mind when providing care to the school-age child hospitalized with a burn injury?a.Hospitalization will be brief.b.Analgesics should be given immediately after dressing changes.c.Contact with peers should be maintained.d.Parents usually handle injury worse than the child.

ANS: CA burn injury is taxing to the child and parents. It requires long periods of hospitalization and frequent readmissions. The accident itself is terrifying for the child but is made even worse if caused by disobedience. Nurses encourage children to express their feelings. Analgesics are administered before painful procedures. The long-term patient requires diversions of various types. School tutors are requested, and contact is maintained with peers through cards or e-mail.

2. The nurse assesses a major burn as a full-thickness burn involving _____% or more of the body surface.

ANS:10A full-thickness burn involving 10% or more of the body surface is considered a major burn.

1. A 5-year-old boy is brought to the emergency department with a second-degree burn of his entire right arm and hand, anterior trunk and genital area, and front of right thigh. The nurse assesses the body surface area (BSA) percentage burn as ______%.

ANS:26Using the Burn Size Estimation Table on page 695, the nurse can determine that for a 5-year-old child, the upper and lower arm = 5.5%, the hand = 2.5%, anterior trunk = 13%, genital area = 1%, and half of the thigh = 4%. Together this totals to 26% BSA burn.

21. The nurse is caring for a macrosomic newborn whose mother has diabetes. What should the nurse assess for with this neonate?a.Hypoglycemiab.Erythroblastosis fetalisc.Intracranial hemorrhaged.Pancreatic failure

ANS: AThe newborn of a mother with diabetes is prone to hypoglycemia.

7. The nurse is caring for a macrosomic newborn of a woman diagnosed with gestational diabetes immediately after birth. What assessment findings can the nurse anticipate? (Select all that apply.)a.High blood glucose levelsb.Weight of 9 pounds or morec.Decreased subcutaneous fatd.Hypocalcemiae.Hyperbilirubinemia

ANS: B, D, EMany newborn infants of diabetic mothers have serious complications. When the mother is hyperglycemic, large amounts of glucose are transferred to the fetus.

3. On what understanding does the nurse plan the care of a child with a new diagnosis of type 1 diabetes mellitus?a.There is an absolute deficiency of insulin.b.Insufficient quantities of insulin are produced by the pancreas.c.Oral hypoglycemic agents can control it.d.Insulin deficiency is caused by another disease affecting the pancreas.

ANS: AType 1 insulin-dependent diabetes mellitus is characterized by an absolute or complete deficiency of insulin.

5. Although the child with type 1 diabetes had her prescribed insulin at 7:30 AM, the child is complaining of hunger and thirst and is drowsy at 10:30 AM. What should the nurse do first?a.Walk the patient in the hall for 10 minutes.b.Allow the patient a short nap.c.Give her a cup of orange juice.d.Test her blood with a glucometer and give insulin according to the sliding scale.

ANS: CThe immediate remedy is to give orange juice to raise the blood glucose. Giving more sugar will increase the blood glucose in a hyperglycemic child. Walking exercise will use up even more glucose. The treatment for hyperglycemia is to give the patient more insulin.

6. Which comment made by a school-age child indicates that he needs more teaching about diabetes mellitus and exercise?a."I carry a piece of hard candy with me in case I start to feel shaky."b."I make sure I have emergency money when I have soccer practice or a game."c."Sometimes I skip my breakfast when I have a game in the morning."d."I play in soccer games that are scheduled after dinner.

ANS: CBlood glucose is high after meals. The child with type 1 diabetes mellitus who skips a meal before exercise is at risk for hypoglycemia.

7. Which statement made by a 7-year-old child with type 1 diabetes mellitus indicates a need for more teaching?a."My pancreas is sick and needs insulin until it is well."b."I will need to take my insulin every day."c."I need to keep a piece of candy in my pocket in case I start to feel shaky."d."My mom has to give me insulin shots twice a day.

ANS: AThe child with type 1 diabetes mellitus has an insulin deficiency and will require lifelong management of this disease. Insulin does not cure the pancreas.

8. Which general dietary measure should the nurse include in a teaching plan for the child with type 1 diabetes mellitus?a.Control intake of carbohydrates and consume fewer calories.b.Focus on complex carbohydrates and eat foods high in fiber.c.Obtain most calories from proteins and fats.d.Eat a diet low in fat and low in complex carbohydrates.

ANS: BThe nutritional needs of a child with diabetes mellitus are essentially the same as those of the nondiabetic child, with the exception of the elimination of concentrated carbohydrates such as sugar. Fiber has been shown to reduce blood glucose levels.

9. A child with diabetes is brought to the emergency department. He is flushed and drowsy, and his skin is dry. His father states that the child has been feeling progressively worse since the morning. What is this child most likely experiencing?a.Somogyi phenomenonb.Dawn syndromec.Ketoacidosisd.Water intoxication

ANS: CIn ketoacidosis, the child's skin is dry, and the face is flushed. Patients appear dehydrated. They may perspire and be restless. The breath has a fruity odor, and there is no rest period between inspiration and expiration.

11. What is an important consideration for the school-age child taking DDAVP for diabetes insipidus?a.Observe for signs of water deprivation.b.Restrict his physical education program.c.Arrange for the child to use the bathroom when needed.d.Limit fluid intake other than during the lunch period.

ANS: CThe child with diabetes insipidus needs liberal access to bathrooms and water fountains. Arrangements may have to be made with the school to allow access.

12. What condition does the nurse suspect when a child with type 1 diabetes mellitus has hyperglycemia, diaphoresis, and headaches in the morning?a.Dawn phenomenonb.Somogyi phenomenonc.Honeymoon effectd.Ketoacidosis

ANS: BThe Somogyi phenomenon (rebound hyperglycemia) occurs when the blood glucose level is lowered to the point at which the body's counter-regulatory hormones are released, producing the symptoms described.

15. After a closed head injury, the unconscious 10-year-old child begins to excrete copious amounts of pale urine with an attendant drop in blood pressure (BP). Based on these symptoms, what does the nurse suspect has developed?a.Diabetes insipidusb.Diabetes mellitusc.Hypothyroidismd.Hyperthyroidism

ANS: ADiabetes insipidus can be acquired as the result of a head injury or tumor, and suppression of the posterior pituitary causes copious urine output with an attendant drop in BP. The child can become dehydrated very quickly if some remedy is not applied.

16. The nurse is teaching the parents of a child with diabetes insipidus about water intoxication. The nurse would tell the parents to be alert for what symptom?a.Polyuriab.Coughc.Weight lossd.Lethargy

ANS: DSigns of water intoxication include edema, lethargy, nausea, and central nervous system signs.

17. The parents of a child newly diagnosed with diabetes mellitus tell the nurse, "Our son's body is resistant to insulin." With what does the nurse recognize this description is consistent?a.Type 1, insulin-dependent diabetes mellitusb.Type 2, non-insulin-dependent diabetes mellitusc.Maturity-onset diabetes of youthd.Drug-induced diabetes

ANS: BType 2, non-insulin-dependent diabetes mellitus is caused by insulin resistance or failure of the body to use the insulin.

1. When discussing possible causes of diabetes in children, the nurse mentions chromosomal defects. Which chromosomes are associated with diabetes? (Select all that apply.)a.6b.7c.12d.20e.21

ANS: A, B, C, DDefects in chromosomes 6, 7, 12, and 20 and other genetic disorders are associated with diabetes mellitus syndrome.

3. What does the nurse remind the adolescent with diabetes that soluble fiber in the diet can reduce? (Select all that apply.)a.Blood glucoseb.Serum cholesterolc.Incidence of infectionsd.Absorption of sugare.Insulin requirements

ANS: A, B, D, ESoluble fiber can reduce blood glucose, serum cholesterol, absorption of sugar, and insulin requirements. It has no effect on infections.

6. What makes keeping diabetes in control in an adolescent difficult? (Select all that apply.)a.Hormonal changesb.Developmental conflictsc.Preference for fast foodd.Growth spurtse.Knowledge of disease

ANS: A, B, C, DThe adolescent who is in a growth spurt and filled with raging hormones resents and denies the need to be dependent on a medication. Medication schedules and diet restrictions do not correlate well with the adolescent's lifestyle of eating fast foods. Denial of disease is prevalent in the adolescent.

7. A child with diabetes mellitus is observed to have cold symptoms. What signs and symptoms will alert parents of the possibility of ketoacidosis? (Select all that apply.)a.Chest congestionb.Ear painc.Fruity breathd.Hyperactivitye.Nausea

ANS: C, ESymptoms of ketoacidosis are compared with those of hypoglycemia. Signs and symptoms include a fruity odor to the breath, nausea, decreased level of consciousness and dehydration. Lab values include ketonuria, decreased serum bicarbonate concentration (decreased CO2 levels) and low pH, and hypertonic dehydration.

2. The nurse explains that the diagnosis of diabetes is made when the fasting blood glucose level is _______ mg/dL on two separate occasions, and the history is positive for indication of the disease.

ANS:126An elevated blood glucose level of 126 mg/dL on two separate occasions is grounds for the diagnosis of diabetes mellitus when the history is positive for the disease.

10. A mother reports that her 4-month-old infant is lethargic, sleeps 18 hours a day, and snores. The nurse recognizes these signs are characteristic of what?a.Hypothyroidismb.Hyperthyroidismc.Type 1 diabetes mellitusd.Tay-Sachs disease

ANS: AThe infant with hypothyroidism will appear sluggish, and the tongue will be enlarged, causing noisy respiration.

5. The home health nurse is monitoring an 8-month-old child with hypothyroidism taking levothyroxine (Synthroid). Which symptoms does the nurse recognize as signs of overdose? (Select all that apply.)a.Tachycardiab.Irritabilityc.Vomitingd.Weight gaine.Diaphoresis

ANS: A, B, EAll the options with the exception of weight gain and vomiting are indications of overdose of Synthroid. Weight loss is a symptom of overdose, however.

11. An infant is hospitalized for RSV bronchiolitis. Which type of precautions would the nurse use when caring for the infant?a.Large-droplet infection precautionsb.Airborne-infection precautionsc.Contact precautionsd.Protective precautions

ANS: CContact precautions are used when the condition transmits organisms via skin-to-skin contact or indirect touch of a contaminated fomite.

5. When auscultating breath sounds of an infant with respiratory syncytial virus, which assessment would the nurse immediately report?a.Respiration rate decreases from 40 to 32 breaths/minuteb.Heart rate decreases from 110 to 100 beats/minutec."Quiet chest" from previous assessment of wheezingd.Oxygen saturation of 90%

ANS: CA "quiet chest" after assessment of wheezing indicates occlusion of air pathways and impending respiratory arrest. All other options are within normal range for infants undergoing oxygen administration.

1. After the 3-month-old child with respiratory syncytial virus is given a protocol of antiviral medications, the nurse explains that routine immunizations will need to be delayed for _______ months.

ANS:9After a protocol of antiviral medications, the routine immunizations should be delayed because the antiviral medications affect the integrity of the immunizations.

11. Which physical assessment technique will the nurse omit when caring for a 2-year-old child diagnosed with Wilms' tumor?a.Performing range-of-motion exercises on lower extremitiesb.Palpating the abdomenc.Assessing for bowel soundsd.Percussing ankle and knee reflexes

ANS: BPalpation of the abdomen could disturb the tumor and cause the malignancy to spread.

6. The nurse is interviewing parents of an infant with pyloric stenosis. What would the nurse expect the parents to report?a.Diarrheab.Projectile vomitingc.Poor appetited.Constipation

ANS: BVomiting is the outstanding symptom of pyloric stenosis. Food is ejected with considerable force, which is described as projectile vomiting.

29. Following surgery for pyloric stenosis, an infant awoke from anesthesia hungry and crying. What is the most appropriate nursing action?a.Delay feeding the child for 6 hours.b.Offer regular formula thinned with water.c.Give small amounts of regular formula thickened with cereal.d.Allow 1 ounce of glucose water at frequent intervals.

ANS: DSmall oral feedings of glucose water are given after recovery from anesthesia. Feedings are gradually increased to larger amounts of regular formula.

1. What interventions will the nurse perform when feeding a child with pyloric stenosis? (Select all that apply.)a.Give a formula thinned with water.b.Burp the infant before and during feeding.c.Give the feeding slowly.d.Refeed if the infant vomits.e.Position infant on left side after feeding.

ANS: B, C, DChildren with pyloric stenosis are given formula thickened with cereal; the infant is burped before and during feeding to get rid of any gas in the stomach; the infant is fed slowly and refed if vomiting occurs. The infant is positioned on the right side to allow the weight of the feeding to stay in the stomach against the pyloric valve.

15. A child is brought to the emergency department because he ingested an unknown quantity of acetaminophen (Tylenol). What does the nurse expect this child to receive following gastric lavage?a.Activated charcoalb.N-acetylcysteinec.Vitamin Kd.Syrup of ipecac

ANS: BGastric lavage is followed by N-acetylcysteine (Mucomyst), the antidote for acetaminophen.

2. What assessment(s) would lead a nurse to suspect Hirschsprung's disease in a 1-month-old infant? (Select all that apply.)a.Ribbon-like stoolsb.Feverc.Failure to thrived.Vomitinge.Diminished peristalsis

ANS: A, B, C, D, EAll options are significant indicators of Hirschsprung's disease.

17. The nurse observes that the legs of a child with cerebral palsy cross involuntarily, and the child exhibits jerky movements with his arms as he tries to eat. The nurse recognizes that he has which type of cerebral palsy?a.Athetoidb.Ataxicc.Spasticd.Mixed

ANS: CSpasticity is characterized by tension in certain muscle groups, which makes voluntary movements of muscles jerky and uncoordinated.

4. The nurse is advising parents of a 10-year-old boy about the most developmentally supportive experiences for their son. What is the best experience for this child according to Erikson's theory?a.Constant variety of activitiesb.Successful performance in Little Leaguec.Feeling healthy and strongd.Having a girlfriend

ANS: BThe child who is successful in activities will feel positively about himself or herself.

12. When asked about her activities, a 10-year-old girl responded, "I like school. I play the flute in the school band, and I take tennis lessons." What does the nurse know these activities will help this child develop?a.Initiativeb.Industryc.Identityd.Intimacy

ANS: BThe school-age period is referred to by Erikson as the stage of industry. Successful participation in activities facilitates the child's sense of industry.

13. What activity would the nurse choose to meet Erikson's developmental task of industry when caring for a 7-year-old child?a.Completing a 50-piece jigsaw puzzleb.Looking at a comic bookc.Playing a game of "I Spy" with the nursed.Coloring a picture in a coloring book

ANS: AIn the developmental period of late childhood, children are striving to develop a sense of industry. The completion of a jigsaw puzzle is industrious play.

14. What does the nurse recognize as an example of Piaget's concrete operational thinking?a.A 2-year-old child says, "It's nighttime" when his room is darkened.b.A 4-year-old child refers to the hospital as "my house."c.A 5-year-old child coloring a picture of a puppy says, "This is my puppy."d.A 7-year-old child says, "I am sick because I have germs in my chest.

ANS: DThe 7-year-old child's remark reflecting the cause and effect of germs and illness is an example of operational thinking. All other options are examples of preoperational thought, which is egocentric and symbolic.

2. What should the nurse keep in mind when planning to teach a class on nutrition to fourth-grade students?a.School-age children can concentrate on only one aspect of a situation.b.School-age children can think abstractly.c.School-age children are egocentric in their thinking.d.School-age children think logically and concretely.

ANS: DPiaget refers to the thought process of this period as concrete operations, which involves logical thinking and an understanding of cause and effect.

16. Which stage of cognitive development is a 9-year-old child in according to Piaget?a.Formal operationsb.Preoperationalc.Concrete operationsd.Sensorimotor

ANS: CSchool-age children are in the concrete operations stage of cognitive development.

2. The school nurse is preparing an educational program for new teachers regarding school-age children. What information is accurate for the nurse to include? (Select all that apply.)a.Participation in group activity increasesb.Egocentricity prevailsc.Thinking is logicald.Preference is toward family interactione.Understand cause and effect

ANS: A, C, EPiaget refers to the thought processes of the school-age period as concrete operations. Concrete operations involve logical thinking and an understanding of cause and effect. The egocentric view of the preschool child is replaced by the ability to understand the point of view of another person. Between 6 and 12 years of age, children prefer friends of their own sex and usually prefer the company of their friends to that of their brothers and sisters.

13. When planning to answer a 16-year-old girl's questions about menstruation, the nurse must consider cognitive development. What is developed during adolescence according to Piaget?a.The ability to view a situation from multiple perspectivesb.The ability to focus more on the past than present situationsc.The ability to exercise concrete reasoningd.The ability to consider hypothetical situations

ANS: DAccording to Piaget, in the formal operations stage adolescents have the ability to think abstractly.

19. A 4-year-old child insists he has more money with a nickel than his father has with a dime. What is this perception, as described in Piaget's theory?a.Egocentrismb.Artificialismc.Animismd.Intuition

ANS: DThe intuitive stage, as described by Piaget, is prelogical thinking that is based on the outside appearance of objects. A nickel is larger than a dime and therefore more valuable.

18. The nurse using the PACE interview guide for persons at risk for substance abuse arrives at a score of 2 for an adolescent patient. How would the nurse interpret this score?a.Nonindicative of potential substance abuseb.Normal experimentation of the adolescentc.Need to schedule another PACE interview in 3 monthsd.Indication for referral for counseling

ANS: DThe PACE guide recommends that a score of 2 or higher would suggest the need for a referral for counseling about substance abuse.

14. When the nurse is collecting a nursing history, an adolescent states that she has tried speed. For what does the nurse recognize this as the street name?a.Barbituratesb.Cocainec.Methamphetamined.Marijuana

ANS: C"Speed" is the street name for methamphetamine.

18. Which observation is most likely to cause the nurse to consider the possibility of child abuse when a mother says that her young child fell down the basement stairs?a.Red, green, and yellow bruises on his body.b.Bruises are dispersed on his head, arms, and legs.c.A broken arm last year, and the child being described as accident-prone.d.The mother is very anxious for her son to get medical attention.

ANS: AAs bruises heal, they change color in stages. Different colors of bruises indicate that injuries have not all occurred at the same time. The nurse must consider whether the bruises match the caretaker's explanation of what happened.

24. A pediatric nurse is assisting with the care of a child diagnosed with a fractured femur. What type of fracture would be the most likely to alert the nurse to the possibility of physical abuse?a.Stress fractureb.Compound fracturec.Spiral fractured.Greenstick fracture

ANS: CA spiral fracture of the femur is caused by a forceful twisting motion. When the history of an injury does not correlate with x-ray findings, child abuse should be suspected because spiral fractures can be the result of manual twisting of the extremity.

25. A child is sent to the school nurse for assessment because she comes to school every day disheveled, unbathed, and hungry. The assessment does not indicate any bruises or marks on the body. What do these finding indicate?a.Sexual abuseb.Physical abusec.Physical neglectd.Emotional abuse

ANS: CPhysical neglect is the failure to provide for the basic physical needs of the child, including food, clothing, shelter, and basic cleanliness.

1. What factor(s) may trigger abuse in a parent? (Select all that apply.)a.Being abused as a childb.High self-esteemc.Substance abused.Overwhelming responsibilitye.Knowledge deficit relative to child care

ANS: A, C, D, EAll options except high self-esteem are possible triggers for a parent to become abusive.

9. The parents of a 3-month-old infant with cystic fibrosis (CF) want to know how their child got this disease, because no one in either of their families has CF. What is the nurse's best response based on the understanding of CF?a.Only one parent carries the CF gene.b.Both parents are carriers of the CF gene.c.The inheritance pattern is multifactorial.d.The result is probably a genetic mutation.

ANS: BCystic fibrosis is an inherited disease. Both parents must be carriers of the CF gene for the child to have the disease.

10. Which statement indicates that the child's parents understand how to perform respiratory therapy?a."We do her postural drainage before the aerosol therapy."b."We give her respiratory treatments when she is coughing a lot."c."We give the aerosol followed by postural drainage before meals."d."She needs respiratory therapy every day when she has an infection.

ANS: CPostural drainage for the child with CF is done following nebulization. Therapy is best scheduled before meals or at least 1 hour after eating to prevent vomiting.

11. What will the nurse teach the child with cystic fibrosis to take in order to facilitate digestion and absorption of nutrients?a.Pancreatic enzymesb.Water-soluble mineralsc.Fat-soluble vitaminsd.Salt supplements

ANS: AAn oral pancreatic enzyme is given to the child with every meal and with snacks to replace the pancreatic enzymes that the child's body cannot produce.

19. Which is the most appropriate nursing action when planning care for a child with cystic fibrosis?a.Provide chest physiotherapy before meals every day.b.Assess weight monthly.c.Administer pancreas with protein food at mealtime.d.Ensure high-protein, high-calorie diet.

ANS: DThe maintenance of adequate nutrition is essential. The diet is high in protein and calories. Chest physiotherapy should be done between meals. Pancreatic enzyme powder should be given with applesauce or other nonstarch, nonfat, nonprotein food. Children with cystic fibrosis should be weighed daily.

24. The parents of a child diagnosed with cystic fibrosis ask the nurse what caused this disorder. What is the most appropriate response?a."Cystic fibrosis is a chromosomal defect."b."Cystic fibrosis is a metabolic defect."c."Cystic fibrosis is a malformation present at birth."d."Cystic fibrosis is a blood disorder.

ANS: BInborn errors of metabolism include a number of inherited diseases that affect body chemistry. There may be an absence or a deficiency of a substance necessary for cell metabolism. The deficient substance is usually an enzyme.

5. A 3-year-old child, while playing with his favorite toy in the playroom of the pediatric unit, is approached by another child who also wants to play with the same toy. What behavior will the nurse anticipate from this child?a.Will play well with the other child.b.Will give the toy up and then not play anymore.c.Will become angry and a physical response might ensue.d.Will ignore the toy and go on to something else.

ANS: CThe 3-year-old child is egocentric and likely will become angry when others attempt to take his or her possessions.

21. Which is an example of associative play?a.Two children playing in house, one playing the role of the dad and the other playing the role of the momb.Two children playing in a sand box, one building a wall and the other digging a holec.Two children playing with sports-associated items, one with a football and the other with a batd.Two children playing with a coloring book, one coloring pictures and the other looking at pictures

ANS: AAssociative play allows the preschoolers to use their enlarged vocabulary in play with other children to carry on conversations and describe scenarios for each to play.

6. What is the best suggestion by the nurse for an appropriate toy for a hospitalized 6-year-old boy?a.Handheld video gameb.MP3 playerc.Adventure bookd.Jigsaw puzzle

ANS: AThe 6-year-old child can perform numerous feats that require muscle coordination. At this age, the handheld video game will offer competition without overexertion.

18. When a small group of preschool-age children were playing house, each child was pretending to be a particular family member. What type of play does the nurse recognize these children are participating in?a.Parallelb.Cooperativec.Symbolicd.Fantasy

ANS: BIn cooperative play, children play with each other, each taking a specific role.

24. What toy is developmentally appropriate for the nurse to suggest to entertain a 5-year-old child?a.Jack-in-the-boxb.Book of nursery rhymesc.Model airport with toy planesd.Model car construction kit

ANS: CAt this age children are into creative play. The model airport with toy planes is the most developmentally appropriate.

4. The nurse observed three toddlers playing side by side with dolls. Closer observation revealed that the children were not interacting with one another. What type of play is this?a.Solitaryb.Parallelc.Associatived.Cooperative

ANS: BToddlers engage in parallel play. Children play next to, but not with, each other.

9. What is the most appropriate toy for the nurse to select for a normal 2-year-old child?a.Bicycle with training wheelsb.Dump truckc.Wind-up toyd.Building block set

ANS: BThe 2-year-old child enjoys playing with objects that can be pushed or pulled.

19. What is the most appropriate activity to recommend to parents to promote sensorimotor stimulation for a 1-year-old infant?a.Ride a tricycle.b.Spend time in an infant swing.c.Play with push-pull toys.d.Read large picture books.

ANS: CPush-pull toys are appropriate to promote sensorimotor stimulation for a 1-year-old infant.

14. What should the nurse suggest as the most appropriate toy choice for a 3-year-old?a.A board gameb.A small pet, such as a goldfishc.A large construction setd.Push-pull toys

ANS: CLarge construction sets are suitable toys for the preschool-age child.

17. The nurse is caring for an Rh-negative mother on the labor and birth unit. What scenario indicates this patient will require RhoGAM administration?a.She has had one Rh-negative child and is pregnant with an Rh-negative child.b.She has had an Rh-positive infant and is pregnant with an Rh-positive fetus.c.She has had an O-negative child and is pregnant with a B-negative child.d.She is a primipara with an O-negative child.

ANS: BThe only woman with antibodies against the Rh-positive infant is the Rh-negative woman who has had one Rh-positive child and is now pregnant with another.

16. What would the nurse include when creating a teaching plan that includes the long-term administration of phenytoin (Dilantin)?a.The medication should be given on an empty stomach.b.Insomnia can be a significant side effect.c.Gums should be massaged regularly to prevent hyperplasia.d.Blood pressure should be closely monitored.

ANS: CDilantin can cause gum overgrowth, which can be minimized by regular massaging. Dilantin frequently causes drowsiness and should be given with meals at the same time each day.

4. Which finding would lead the nurse to delay the administration of DTaP for an infant?a.Diarrheab.Temperature of 40.5° C (105° F) from the previous inoculationc.Teethingd.Traveling to Europe in a week

ANS: BA contraindication to giving the DTaP vaccine is a 40.5° C (105° F) temperature following the previous vaccination.

14. The nurse is preparing to administer immunizations at a well-child clinic. Which method of administration will the nurse implement?a.DTaP subcutaneouslyb.Hib vaccine prepared in a separate syringec.Varicella intramuscularlyd.Varicella 1 week after the MMR vaccine

ANS: BHib vaccine must be given in a separate syringe from other vaccines administered at the same time.

17. What intervention should the nurse implement after topical administration of hydrocortisone cream to the buttocks and abdomen of an infant?a.Diaper the infant snugly with a disposable diaper.b.Cover the area with a transparent dressing.c.Apply a cloth diaper.d.Place the infant on a plastic pad, undiapered.

ANS: CPlastic coverings increase the absorption of drugs. The diaper should be cloth, or the infant should be left undiapered on a cloth pad.

2. Which specific drug(s) should be checked with a second licensed nurse prior to administration? (Select all that apply.)a.Insulinb.Digoxinc.Vasodilatorsd.Calcium saltse.Anticoagulants

ANS: A, B, D, EInsulin, hypoglycemics, narcotics, digoxin, inotropic drugs, anticoagulants, potassium, and calcium salts all must be checked by a licensed nurse prior to administration.

9. The mother of a newborn asked the nurse, "When will my baby get the hepatitis B vaccine?" When will the nurse explain the first dose of Comvax should be given to infants born to a hepatitis B-positive mother?a.Within 12 hours after birthb.Within 2 weeks after birthc.Within 1 month after birthd.Within 2 months after birth

ANS: AThe American Academy of Pediatrics recommends that Comvax, the only thimerosal-free hepatitis B vaccine, should be used for infants born to HBsAg-positive mothers within 12 hours of birth

13. The nurse is planning to administer immunizations at a well-child visit when a parent reports the 18-month-old child is allergic to eggs. Which vaccine would be contraindicated?a.Influenzab.Inactivated polio vaccinec.Diphtheria, tetanus, acellular pertussisd.Hepatitis B

ANS: AThe influenza vaccine should not be given to children who are allergic to eggs.

19. Which is an example of an opportunistic infection?a.Measlesb.Pneumocystis jirovecic.Clostridium difficiled.Smallpox

ANS: BPneumocystis jiroveci is the most common of opportunistic diseases.

3. The well-child clinic nurse is preparing to give which immunizations to a healthy 2-month-old infant? (Select all that apply.)a.DTaPb.Hibc.IPVd.MMRe.PCV

ANS: A, B, C, EAll the options are the expected inoculations of a healthy 2-month-old with the exception of MMR. Mumps, measles, and rubella are not expected until the child is 1-year old.

23. The nurse urges the mother of a 6-month-old child to get her child inoculated with Haemophilus influenzae type B. What does this immunization protect against?a.Encephalitisb.Influenzac.Bacterial meningitisd.Otitis media

ANS: CH. influenzae type B and conjugated pneumococcal vaccines have decreased the incidence of bacterial meningitis.

5. The nurse is educating parents of a 2-month-old infant about immunizations. What immunizations against illness should their child receive? (Select all that apply.)a.Pertussis (whooping cough)b.Influenzac.Diphtheriad.Tetanuse.Polio

ANS: A, B, C, D, EThe first DPT, polio, and flu immunizations are given at the age of 2 months.

8. The mother of a 5-year-old child taking prednisone for nephrotic syndrome tells the nurse he needs to get immunizations to enter kindergarten. What does the nurse clarify about receiving immunizations while on prednisone?a.Can interfere with the treatment for nephrosis.b.Require that the child have antibiotic coverage.c.Can be given in smaller, divided doses.d.Should be delayed.

ANS: DNo vaccinations or immunizations should be administered while the disease is active and during immunosuppressive therapy.

5. What special considerations are related to long-term prednisone therapy in preschoolers? (Select all that apply.)a.Delayed immunizationb.Hypertensionc.Enlargement of the sex organsd.Alteration in nutritione.Increased risk for infection

ANS: A, EDelayed immunization and greater risk for infection are concerns relative to long-term prednisone therapy.

10. What foods does the nurse recommend the child with acute glomerulonephritis avoid to prevent hyperkalemia?a.Dairy productsb.Whole-grain cerealsc.Organ meatsd.Bananas

ANS: DBananas are very high in potassium and should be avoided.

6. A 7-year-old child with acute glomerulonephritis has gross hematuria and has been confined to bed. What is the most appropriate nursing intervention for this child?a.Providing activities for the child on restricted activityb.Feeding the child a protein-restricted dietc.Carefully handling edematous extremitiesd.Observing the child for evidence of hypotension

ANS: AAlthough children may feel well, activity is limited until hematuria resolves.

17. A 5-year-old boy is admitted to the hospital with acute glomerulonephritis. In taking the child's history, what does the nurse recognize as the probable cause?a.Recovery from German measles 2 months agob.Dysuria since the previous nightc.A history of allergyd.A sore throat 2 weeks ago

ANS: DAcute glomerulonephritis develops from 1 to 3 weeks after a streptococcal infection, which causes an allergic-type response that alters the effectiveness of the glomeruli.

2. When asked about correcting the hypospadias of a newborn, what does the nurse explain about this condition?a.No intervention is necessary as the defect will correct itself over time.b.Surgical repair of the hypospadias is done before 18 months of age.c.Corrective surgery is usually delayed until the preschool age.d.Repairing the defect will increase the risk of testicular cancer.

ANS: BTreatment of hypospadias consists of surgical repair and is usually performed before 18 months of age.

13. A 13-year-old girl is diagnosed with functional scoliosis. What does the nurse explain as the cause of this spinal curvature defect?a.Juvenile rheumatoid arthritisb.Poor posturec.Heredityd.Myelomeningocele

ANS: BFunctional scoliosis usually is caused by poor posture, and it is not a spinal disease.

14. What intervention is appropriate for a nurse assessing a preadolescent child for scoliosis?a.Ask the child to bend forward at the waist and observe the child's back for asymmetry.b.Observe the gait while the child is walking forward heel to toe.c.Have the child flex the knees and look for uneven knee height.d.Look at the child's shoulders and hips while fully clothed.

ANS: AThe nurse looks at the back as the child bends forward for general body alignment and asymmetry.

17. What instruction would the nurse provide to an adolescent who has been fitted with a Milwaukee brace?a.Wear the brace directly against the skin.b.Wear the brace over regular clothing.c.Wear the brace over a T-shirt 23 hours a day.d.Remove the brace before sleeping.

ANS: CA Milwaukee brace is worn approximately 23 hours a day over a T-shirt, which protects the skin.

6. What classic sign would the nurse, auscultating the breath sounds of a child hospitalized for an acute asthma attack, expect to find?a.Fine cracklesb.Coarse rhonchic.Expiratory wheezingd.Decreased breath sounds at lung bases

ANS: CThe child experiencing an acute asthma attack wheezes as air moves in and out of the narrowed airways. The expiratory wheeze is most pronounced.

7. What is the best intervention for the nurse caring for a child experiencing an acute asthma attack?a.Offer plenty of fluids, particularly carbonated beverages.b.Place the child in a humidified cool mist tent with oxygen.c.Administer sedatives as ordered to decrease anxiety.d.Position the child with arms resting on the overbed table.

ANS: DThis position is comfortable and allows maximum use of the accessory muscles for breathing. Sedatives would mask symptoms of increasing air hunger. Carbonated beverages are contraindicated in persons with dyspnea.

8. What should the nurse explain to the parent of a child with exercise-induced asthma about when to inhale Cromolyn?a.Before exercise to prevent attacksb.At the initial onset of the attackc.During the attack to relieve symptomsd.As often as 4 times a day

ANS: AAnti-inflammatory inhalants are taken before exercise to prevent attacks. These drugs can do nothing for the attack in progress. They are meant to be used as prophylactic therapies.

13. The nurse offers a variety of fluids to a 5-year-old asthmatic child to compensate for the fluid loss through dyspnea. Which fluids are most appropriate?a.Room temperature waterb.Carbonated beveragesc.Iced fruit juiced.Cold milk

ANS: ARoom temperature fluids are the best. Carbonated and iced beverages increase spasm. Milk stimulates mucus production.

14. The asthmatic child who has been taking theophylline complains of stomachache and tachycardia and is sweating profusely. What does the nurse recognize as the cause of these symptoms?a.Severe asthma attackb.Allergic response to theophyllinec.Onset of bronchitisd.Drug toxicity

ANS: DThe symptoms described are the signs of theophylline toxicity.

17. The teaching plan for the use of a dry powder inhaler for the treatment of asthma should include the warning to rinse the mouth after inhaling the powder. What does this prevent?a.Discoloration of tooth enamelb.Halitosisc.Irritation of oral membranesd.Candidiasis

ANS: DInhalant powders can cause candidiasis (yeast) infection of the mouth.

2. The nurse would suggest the parents of an asthmatic child to encourage participation in which sport(s)? (Select all that apply.)a.Swimmingb.Gymnasticsc.Baseballd.Cross-country skiinge.Distance running

ANS: A, B, CSports that require bursts of energy rather than long-term output of energy are suitable pursuits for asthmatics. Swimming, gymnastics, and baseball fit this criterion.

4. What would the nurse teaching an asthmatic child the technique of pursed-lip breathing include? (Select all that apply.)a.Inhale deeply through nose with mouth closed.b.Make exhalation twice as long as inhalation.c.Use medicated inhaler prior to perform breathing exercise.d.Exhale through mouth as if whistling.e.Exhale forcefully.

ANS: A, B, DThe technique requires that breath be inhaled through the nose and exhaled through pursed lips in a nonforceful manner. The exhalation should be twice as long as the inhalation.

8. What will the nurse discourage when providing education to parents of a child with asthma? (Select all that apply.)a.Stuffed toysb.Pet ownershipc.Gymnasticsd.Basketballe.Cotton blankets

ANS: A, DUse of stuffed toys is discouraged due to potential allergens. Basketball might not be well tolerated because of the constant physical exertion. Certain pets are encouraged, gymnastics is usually well tolerated, and cotton blankets are recommended for children with asthma.

2. What risk is increased with children who have been diagnosed with infantile eczema?a.Pneumoniab.Acnec.Sun sensitivityd.Asthma

ANS: DSome children with eczema also develop asthma and hay fever-type allergies.

3. What is an initial sign of nephrosis that the nurse might note in a child?a.Raspberry-like rashb.Periorbital edemac.Temperature elevationd.Abdominal pain

ANS: BThe edema of nephrotic syndrome is generalized and not readily noticed, even by the parents, but an early sign that can be assessed is periorbital edema.

4. What is it important to assess in a child receiving prednisone to treat nephrotic syndrome?a.Infectionb.Urinary retentionc.Easy bruisingd.Hypoglycemia

ANS: APrednisone depresses the immune response and increases susceptibility to infection. Because steroids mask signs of infection, the child must be assessed for more subtle symptoms of illness.

9. Diuresis has not occurred on a child with nephrotic syndrome after a month on corticosteroids. What protocol can the nurse encourage to bring about diuresis?a.Ibuprofen, an anti-inflammatory agentb.Furosemide (Lasix), a diureticc.Ciprofloxacin (Cipro), an antibioticd.Cyclophosphamide (Cytoxan), an antisuppressant

ANS: DA potent antisuppressant such as Cytoxan can bring about diuresis when corticosteroids have proven ineffective.

15. What is an appropriate intervention for the edematous child with reduced mobility related to nephrotic syndrome?a.Reach the child to minimize body movements.b.Change the child's position frequently.c.Keep the head of the child's bed flat.d.Keep edematous areas moist and covered.

ANS: BThe child should be turned frequently to prevent respiratory tract infection and to prevent pressure on delicate skin.

16. Which statement made by a parent of a child with nephrotic syndrome indicates an understanding of discharge teaching?a."I will make sure he gets his measles vaccine as soon as he gets home."b."He can stop taking his medication next week."c."I should check his urine for protein when he goes to the bathroom."d."He should eat a low-protein diet for the next few weeks.

ANS: CThe parents should be instructed to keep a daily record of the child's urinary proteins.

3. The nurse caring for a child with nephrotic syndrome is alert to which classic symptoms of this disorder? (Select all that apply.)a.Proteinuriab.Grossly bloody urinec.Hyperalbuminemiad.Fatiguee.Generalized edema

ANS: A, B, D, EAll options listed are those of nephrotic syndrome with the exception of hyperalbuminemia. The nephrotic child has hypoalbuminemia, as most of the protein has been spilled in the urine.