NUR 2633 MCH Exam 3 LESSON CONTENT,100% CORRECT

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MODULE 6 LESSON CONTENT: Pediatric assessments need to be completed on all children from day 1 to age 18, and some literature will cite 21 years of age. Much like the approach to adult assessments th... e nurse must introduce herself, identify her patient, provide for privacy and ensure proper communication. Cultural diversity, temperament, age, developmental stage, cognitive or physical disabilities as well as language barriers all must be taken into consideration when approaching the child. Nurses must also keep in mind that the family may be the primary communicator if the child is too young or frightened of the surroundings. Regardless during the interview, do not forget who the patient is and make contact with the child. Immunizations, nutrition, play and activity are essential for the complete physical growth that each child will undergo and needs to be a part of the historical assessment. Remember also that family influences much of the child's health care so you may find yourself providing as much care and information to the family as well as to your primary patient. Communication is of foremost importance. We naturally rely on verbal communication, but children are also extremely sensitive to the non-verbal cues or facial expressions that they see. Be mindful of what you say, how you stand, what equipment you have with you that children can easily view. Using jargon or words that may represent a painful or fearful event will cut short your attempts to integrate with this child. An example: It's just a little bee sting, I am taking your blood. Sometimes it is beneficial to find a transitional object, toy or stuffed teddy that the child can relate to. Have the teddy get the first injection, see how it works, and your patient may become more cooperative. It is also helpful to have a parent assist if they are comfortable doing so. Keeping the child distracted, or 'helpful' (give them the blood tubes to hold as the lab draws the CBC) is also a good tool to keep in your cache of tips. In addition to verbal and non-verbal communication, use of transitional objects, each child may be able to share family roles in pictures, colors or other art work. Use your imagination to peak their imagination and you will learn much. Honesty is also very important, never promise anything you cannot provide. In our zest to have the adolescents share, nurses have been known to promise that no will know of their sexual behaviors. However, it may be necessary to provide information to parents or county health departments to provide save and comprehensive care, therefore setting up a conflicting relationship. Nutrition is the single most important influence in the growth and development of children. Never make assumptions regarding the child's nutritional intake. Asking parents and children that can respond to you, if they can provide a 24 hour recall of food and fluid intake will provide an overview of the nutritional status and deficiencies. That information paired with cultural preference and economic status gives the nurse an idea of cause for growth issues that may occur. Now is the time to make an impact into the health of a child. Using tools to educate will improve the response and understanding of the information you wish to provide. Discussing nutrition that they may be able to manage themselves is received very well. The topic of dental care needs to be approached including daily oral hygiene and preventative care. Activity is crucial for child's growth. Not only will activity impact the risk of obesity, a childhood epidemic, but will improve strength, impact socialization, build confidence, and may influence children to embrace physical activity throughout the lifespan. Play, as you have been reading, is essential for growth. Observing the type of play your patient participates in may also give the nursing staff insight into any developmental delays. Play is the child's work. They take it serious and distractions such as meals and toileting are not tolerated. Viewed as a 'barometer' for health and illness as sick children are not active. Rely on your parents as the experts also to guide your evaluations. Types of play become more complex as the child grows. If a child that formally participated in organized play now is seen only in 'onlooker' play, this may be detrimental and provisions for evaluation may need to be completed. Injury prevention is huge. Do they know how to be safe? Many accidents happen due to lack of knowledge, can you change this? In conclusion no discussion can be complete without adding education. Children are open to learning about themselves and how they are put together. Factual information is key to developing an honest exchange however caution should be taken and involvement of the parents must occur. You will review the anatomy and physiology of each system. This should assist you in identifying norms for the pediatric patient as you complete assessments. As children grow it is also important to keep in mind the influence of peers, school and social affiliations. Since a great deal of their information is gleaned from these sources, it is helpful if you understand those groups and what activities your patient participates in. Immunizations, nutrition, play and activity are essential for the complete physical growth that each child will undergo. Remember also that family influences much of the child's health care MODULE 7 LESSON CONTENT: Care of the hospitalized child can be extremely challenging and somewhat frightening. When it is more common to see healthy children playing and active, it can be very difficult to care for a sick child. Hospitalization represents a stress to children which for some may represent a benefit because this is a method to learn to cope. Depending on temperament some children learn to cope much better than others. Not only the child but the family is undergoing stressors which may influence the behavior of the child as well. Regressive tendencies or withdrawal is not unusual in the strange and frightening surroundings. Habits or activities that they were capable of achieving independently now have been temporarily forgotten. This may cause some conflict with parents so it is best to prepare them of this changes especially in the toddler or young pre-school aged child. Your communication skills will be challenged. Both verbal, nonverbal and creative techniques will be scrutinized by this little person looking sheepishly over the blanket at you. Again honesty must be stressed. Allow the child to make choices if it is appropriate. Nothing as simple as 'do you want your medication?" You will receive a rousing NO every time, but if you ask in a big or little cup? The child may be more cooperative. Child Life Specialists if on staff at your facility may become indispensable in helping children understand and cooperate with treatment plans. If hospitalization is planned it is always best to pre educate the child on procedures, treatments, rooms and equipment they may encounter during their time at the hospital. Parents are encouraged to stay with their children and literature has shown this not only eases fear but may improve the respiratory status of your patient and decrease the pain perception. Children struggle to move toward independence and so quickly with an admission to a hospital they may lose or perceive the loss of independence and control. Partner with them and their family to adopt some of the routine they are familiar with into the nursing /patient care plan. Typically in the hospital it is also the practice to perform painful or invasive procedures in a designated procedure room. This allows the child to have a peaceful and non -traumatic impression of the area they sleep or stay in. Parents should be invited to participate in appropriate procedures both for their reassurance but also for the child's comfort. Asking the parents to assist in the safety restraint of their child gives them empowerment and reinforces their worth in the child's life. As nurses we never want to discredit a parent but gently nudge them into the appropriate parenting. Education, support groups and demonstrations can assist in countering that knowledge deficit they may have regarding medication administration of OTC meds, temperature taking, sleeping, bathing and dental hygiene rituals. Discipline cannot be ignored during hospitalization. Limit setting is a very appropriate method to counter unacceptable or harmful behavior. And if this is a chronically ill child you are caring for overprotective parents tend to be very lax in discipline which is counter- productive to the development of the child. Peers are a huge influence for children and especially the adolescent. Visiting hours and visitor restrictions need to be viewed in a case by case scenario for the benefit of the child. School is an important topic and the involvement of the teachers or school health advisors should be included in discharge planning. Activity - as discussed earlier - is the barometer of the child's wellness. Encourage activity if it is appropriate. Many of the disease processes that are studied this week however encourage rest and rehabilitation. Quiet games, movies, books, puzzles and electronic games are beneficial for activity and may assist in the reduction of pain perception. The care of the hospitalized child is challenging and frightening if you are not listening and carefully assessing. The nurse must be vigilant and creative, responsive and open. You must be able to critically think through the challenges that the patient and their families present. This patient is not a simple disease process, but a multi- dimensional person that requires your full attention to avoid errors and embrace health. In doing so you have empowered your patient and his/her family to learn more about themselves and what makes them work. MODULE 8 LESSON CONTENT: Children that are admitted to an acute care setting with neurological musculoskeletal or renal issues are a challenge. Each age group also brings a unique set of needs. The pediatric nurse must be knowledgeable in the developmental stages and recognize if a child is demonstrating behavior consistent with the stage that is expected, or if there is a lapse. Hospitalization represents a stressor which may lead to regression and both the health care staff and families must recognize this as a normal phenomenon. In addition this child is more acutely ill. These changes represent a severe change to health that may be either temporary or a permanent and chronic condition. Fear, anxiety and or denial by the patient or family may aggravate the condition and the plan to move toward health. Neurological issues must always begin with level of consciousness. Based on the age of the patient you may be able to ask pertinent questions that they can provide immediate responses. Children younger unable to communicate will need close observation for behavioral changes. It is imperative with all children but now more than ever to partner with the parent in the normal behavior and responses that children have. Neurological assessments are completed timely based on the severity of the issue and unit policy as well as the physicians direct medical orders. Changes are significant and nurse must be vigilant. Nursing interventions but include all physical systems and always with minimizing stress, pain and stimulation. Urinary tract infections are common among children of different ages. The symptoms may be different due to the age and gender of the child. Therefore it is necessary to again be aware of changes in behavior. Urinary tract infections are easily identified through laboratory specimens. Treatment is based on the bacteria and severity of the infection therefore may be either as an outpatient with oral antibiotic or IV therapy. Medication administration may be the challenge and compliance the issue. The nurse and parents will learn creative measure to promote cooperation. Fluid intake is always promoted but again a difficult task if the favored drink is contradictory to the treatment plan. Skin issues are common. Children due to multiple exposure sites and opportunities have rashes and potential infectious lesions. Based on age groups some skin lesions are much more readily seen. A complete and comprehensive skin assessment is essential to a complete assessment upon arrival or admission to the nursing unit. Bathing a patient or assisting the parent is the best time to view the total body. Then you should note rashes, bruising, welts, bites, lacerations and lesions. Then it is important to identify the cause. Diverse cultures may have medical practices that are different from the traditional 'western' medicine and may be seen as dangerous and misinterpreted as abusive. This is a conversation you need to have with your patient's parent and health care providers. Hand washing and infection prevention is the beginning education for all children and their families. Children in an air of friendship and demonstrating the ability to 'share' may lead to exposure of bacterial and fungal infections as well as the insidious pediculosis (lice) which is every parent's nightmare. Musculoskeletal problems can be a benign as a minor sprain to as major as a bone cancer that leads to amputation. Care of the child with a mobility issue is a big deal. Children are mobile and dependent on the age this inability to be active may lead to other cascading events. Parents and nurses may fatigue at the need to find creative and entertaining methods to help the child assimilate into this new limitation. If it is a temporary issue the return to mobility will be celebrated. If it is to be a permanent change based on a child's age coping may or may not be an easy transition. The younger the child often it is easier for them to cope with the new restrictions. Adolescents specifically may not recover from the loss they may experience with the new diagnosis or disability. Grief also may affect the parents and they will also struggle with this change. It is at this time the nurse is reminded that the role now encompasses both the patient and the parent. Support groups need to be introduced and alternative and realistic long term goals can be explored. In addition the nurse must remember that immobility affects every system of the body and patient care plans should include treatment plans to prevent debilitation and return to health as quickly as possible or prevent the consequences of this immobility at all. In conclusion, these system alterations of normal can be very debilitating. Nurses must think beyond the obvious when dealing with children. Children may tend to reinjure themselves or push beyond reasonable limits and complicate the healing process. Cultural diversity remains an issue and communication is paramount to identify what families believe is a normal healing method. Parents are always the expert on their children. Nurse must recognize, empower and educate whenever possible and appropriate. Through it all the beginning is the assessment. Skin, neurological, development, pain, mobility, nutrition, habits, and cognitive and sensory assessments are made often. Encouragement, trust and communication will be the best practices in your nursing care toolbox. Chapter 20: 1. The pediatric nurse assesses the toddler's fine motor skills by observing which task? A. Buttoning a shirt B. Writing with a pencil C. Holding a spoon to eat D. Using the pincer grasp 2. According to Piaget, an infant uses his or her senses to learn and explore the environment. Which action is the most appropriate for the nurse to implement to determine object permanence? A. Playing the game of peek-a-boo B. Encouraging the infant to shake a rattle C. Pushing a button on an overhead mobile D. Placing the child in a stroller and going for a walk 3. The pediatric nurse is promoting anticipatory guidance about safety to the mother of a 10-month-old infant. Which statement is not appropriate for the nurse to include in the teaching session? A. “Do not leave small objects on the floor because your baby will be crawling soon.” B. “Keep the side rails up to prevent your baby from falling out of the crib.” C. “Put safety locks on all cabinets to prevent accidents.” D. “Allow your baby to stay alone for short periods of time to promote independence.” 4. The mother of a 26-month-old toddler tells the pediatric nurse that she is having trouble disciplining her daughter. The mother states, “She really knows how to push me to my limit. I don't know what to do with her!” Which response by the nurse is the most therapeutic? A. “The terrible twos are a difficult time. You have to show her that you are the boss!” B. “When she does something wrong, tell her she is a bad girl and has to be punished for her actions.” C. “A 2-minute time-out combined with praise for good behavior is very effective for this age group.” D. “Take away her favorite doll and tell her that she cannot have it back until she changes her behavior.” 5. The parents of a toddler ask the nurse how to best prepare the toddler for a planned medical procedure. What should the nurse recognize when answering the toddler's parents? A. The toddler is too young to understand what will happen and does not need an explanation. B. The use of short explanations can best help the toddler understand the planned procedure. C. Allowing the toddler to explore the procedure room may be helpful. D. It is beneficial for the nurse to demonstrate the upcoming procedure to the toddler. 6. The father of a 4-year-old is concerned about his son's reaction to an injury of his friend. He told the nurse that the child stayed in his room over the weekend and cried himself to sleep. When the pediatric nurse questioned the child, he described an argument that he and his friend had about a week prior to his friend's injury. Based on the assessment, what is this preschool child exhibiting? A. Magical thinking B. Inferiority C. Guilt complex D. A morality issue 7. What is not a key aspect in a teen's environment that helps when making good decisions? A. Ability to think abstractly B. Ability to use deductive reasoning C. Ability to make long-term plans D. Ability to use logical thinking 8. A nurse is planning an educational class for new families based on Duvall's family development theory. Based on the theory, how are family stages determined? A. Number of children in the family B. The oldest child in the family C. The youngest child in the family D. Years the couple has been married 9. A mother is complaining to the nurse that her 3-year-old child often has difficulty falling and staying asleep. The following day, the child is cranky and uncooperative. Which action by the nurse is the most appropriate? A. Assess the child's usual nighttime routine. B. Assure mom that sleep and behavior are not related. C. Encourage active play before bedtime. D. Have mom put the child to bed only when sleepy. 10. A nurse is providing anticipatory guidance to the parents of a preschool-aged child regarding discipline. Which information is most beneficial? A. Children at this age lie frequently and without reason. B. Consequences should be natural and fit the behavior. C. Explaining the rules is not as important as discipline. D. Taking away privileges is a powerful tool for this age group. Chapter 21: 1. When preparing a 4-year-old child for a procedure, the pediatric nurse must be aware of the child's developmental status. Which nursing action demonstrates awareness of the child's developmental status? A. Demonstrating the procedure on the child's teddy bear. B. Providing a peer video of the procedure for the child to view. C. Explaining the procedure to the child the day before the actual procedure occurs. D. Discussing the procedure at length with the child. 2. The 10-year-old child is receiving preoperative teaching prior to a tonsillectomy. Which response by the nurse uses a developmentally appropriate explanation of the operation? A. “Don't worry; the doctor will cut your tonsils out while you are asleep.” B. “The shot that you will receive in your arm will only help the pain a little bit.” C. “Don't worry about the operation; it is really not a big deal.” D. “The doctor will give you special sleeping medicine before she operates.” 3. There are many myths regarding children and pain levels. Which statement regarding pain management in pediatrics is true? A. Children cannot tell where they hurt. B. The child who is neurologically impaired does not feel pain. C. Children should not receive narcotics because they will become addicts. D. The use of special pain scales allows children to better express their level of pain. 4. The pediatric nurse uses the head-to-toe approach when conducting a physical assessment on an infant. Which sequence represents correct technique? A. Heart rate, urine output, respiratory rate, and presence of bowel sounds B. Head circumference, lung sounds, presence of bowel sounds, urine output C. Presence of eye drainage, abdominal pain, lung sounds, and urine output D. Urine output, skin color, skin turgor, heart rate, and bowel sounds 5. During a well-baby visit, the pediatric nurse initiates teaching related to health promotion and prevention of illness. Which nursing statement is appropriate to include in the teaching session? A. “Call the pediatrician if the baby has a temperature of 99°F (37.2°C).” B. “If you smoke, be sure to blow the smoke away from the baby's face.” C. “Call the pediatrician if you notice a change in the baby's activity level or feedings.” D. “We want to watch the baby's weight gain, so feed the baby when she cries.” 6. The nurse is caring for a toddler hospitalized after a motor vehicle accident. Based on Erikson's developmental model, which behavior would you anticipate can occur as a result of the hospitalization? A. Regression to a previous behavior B. The belief that they are being punished C. Fear of bodily mutilation D. Loss of independence 7. What is the nurse's responsibility in educating families about how to care for their child at home after minor surgery? A. Taking the child's rectal temperature B. Assessing their child's level of consciousness C. Teaching about the signs and symptoms of infection D. Teaching about the signs of poor air exchange 8. A parent in the pediatric clinic states that she has been giving her 1-year-old aspirin (ASA) for his fever. What response by the nurse is best? A. Ensure the parent knows the normal dose of 10 mg/kg. B. Teach the parent to only use 5 doses per day. C. Instruct the parent not to use aspirin on a child. D. Make sure the parent can take the child's temperature. 9. A child with special needs has moved into the community. Which health-care resource should the school nurse direct the child's family toward? A. Medical home B. Pediatric clinic C. Home health care D. Community center 10. A nurse is providing anticipatory guidance to the parents of an infant. The nurse explains that, for children of this age, the most common fatal injury is which of the following? A. Drowning B. Suffocation C. Electrocution D. Heavy metal poisoning Chapter 23: 1. The pediatric nurse is aware that the child with cystic fibrosis has discharge planning needs. Which is important to communicate to the family during discharge teaching? A. Importance of a well-balanced, low-protein, high-calorie diet B. When and how to administer pancreatic enzymes C. Use of vitamin supplements is not needed with pancreatic enzymes D. Nature and course of the disease including self-limiting nature 2. A 2-year-old child is discharged from the outpatient surgical unit after having a tonsillectomy. What statement by the parent indicates to the nurse that discharge teaching has been effective? A. “I will administer cherry-flavored acetaminophen (Tylenol) for pain.” B. “It is important to have my child gargle to prevent an infection.” C. “I will bring my child to the emergency department if I see excessive swallowing.” D. “I will offer my child ice cream to help soothe the pain in the throat.” 3. The nurse is providing care to an infant being discharged after surgical correction of choanal atresia. Which topic is appropriate for the nurse to include in the discharge teaching for this infant? A. Gastrostomy feedings B. Direct observation therapy C. Nebulizer treatments D. Appropriate technique for cleaning nostrils 4. What information about pediatric respiratory anatomy and physiology is important for nursing care? A. Newborns are obligatory nose breathers. B. Sinuses are not developed until around age 10. C. Neonates are able to breathe from the diaphragm. D. Babies and children are not prone to aspiration. 5. The nurse is teaching home care to the parents of a child with chronic sinus infections. What information does the nurse provide? A. Have the child blow his nose vigorously before using decongestant spray. B. Steroids are usually required in children who have sinus infections. C. Ice packs over the inflamed sinuses will help with comfort and swelling. D. Using decongestant sprays for more than 3 days can cause rebound swelling. 6. An emergency department physician is preparing to directly visualize the larynx of a child suspected of having epiglottitis. What action by the nurse is most important? A. Allow the child to assume a position of comfort. B. Have an intubation tray at the bedside. C. Put on a face mask in addition to gloves. D. Have the parents sign an informed consent. 7. A child has otitis externa with a swollen ear canal. What intervention does the nurse teach the parents for instilling eardrops? A. Use a warm moist pack prior to the eardrops. B. Have the child lay flat for 20 minutes afterwards. C. Drip the medication onto the cotton ear wick. D. Chill the eardrops before administering them. 8. The nurse reads on a child's chart that she is having a tempanocentesis. For what medical condition is this warranted? A. Conductive hearing loss B. Otitis externa C. Infected eustachian tubes D. Otitis media 9. The nurse is caring for a 16-year-old admitted with suspected bacterial pneumonia. Which action by the nurse takes priority? A. Administer antibiotics as ordered. B. Obtain a sputum sample for culture. C. Start an IV for maintenance fluids. D. Give acetaminophen (Tylenol) for fever. 10. A child is brought to the emergency department, and the parents report frequent episodes of harsh coughing that causes the child's face to turn red. The parents also report the child's eyes are red, and she frequently coughs so hard she vomits. What question by the nurse is most important? A. Is anyone else in the family sick? B. Is she allergic to anything known? C. Has she had a high fever lately? D. Are her immunizations up to date? Chapter 24: 1. A 6-week-old infant is admitted to the hospital with possible hypertrophic pyloric stenosis. Which symptom is most descriptive of pyloric stenosis in infants? A. Abdominal peristaltic waves passing from right to left B. Does not appear hungry without projectile vomiting C. Emesis usually occurs after a feeding and is projectile D. Decreased interest in feedings with weight loss 2. The pediatric nurse is monitoring a child for signs of bowel perforation. Which assessment finding supports the diagnosis of a bowel perforation? A. Acute pain over affected area B. Frequent bradycardia C. Increased urinary output D. An episode of bloody diarrhea 3. A neonate has the diagnosis of imperforate anus. Which definition of this diagnosis will the nurse provide to the neonate's parents? A. Complete obstruction preventing passage of stool B. Imperfect formation of the anus C. Partial occlusion of the anal opening D. Absence of a rectal opening 4. Which pediatric gastrointestinal disease is characterized by “skipped” areas of lesions? A. Crohn's disease B. Ulcerative colitis C. Hirschsprung's disease D. Malabsorption 5. A child has severe Crohn's disease that has not responded to any pharmacological therapies. Which classification of medication does the nurse anticipate being added to the medication regime? A. Corticosteroids B. Antibiotics C. Immunosuppressants D. Biological agents 6. Which nursing action is appropriate when assessing an obturator sign on pediatric patient? A. Perform deep palpation, letting up quickly B. Passively rotate flexed right thigh C. Percuss all four quadrants of the abdomen D. Flex the patient's neck sharply to the chest 7. What will the nurse assess with the pediatric patient to determine hematochezia? A. Blood in the vomit B. Blood in the stool C. Bile-colored vomit D. Straining with stool 8. A child with cyclical vomiting syndrome is seen in the clinic for another episode of vomiting. Which finding would indicate the need for further assessment by the nurse? A. Headache B. Photophobia C. Fever D. Vertigo 9. Which type of lactose intolerance is most prevalent in the pediatric population? A. Congenital lactase deficiency B. Primary lactase deficiency C. Secondary lactase deficiency D. Developmental lactose deficiency 10. The nurse is working with the family of a child diagnosed with nonalcoholic fatty liver disease. Which nursing action is the priority? A. Encouraging all family members to make healthy lifestyle changes B. Preparing the child and family for future liver transplantation C. Instructing parents to have genetic testing prior to future pregnancies D. Teaching the child and family about having a Kasai's procedure CHAPTER 25: 1. The nursing faculty explains to a group of students about the body's immune response. What action by the immune response is most important for its functioning? A. Creating and maintaining immunoglobulins B. Inducing a febrile response to an invading organism C. Producing a mechanical barrier against infection D. Recognizing non-self material and reacting to it 2. A child with a congenital immunodeficiency is scheduled for a routine vaccination. What instruction is most important for the nurse to provide the parent before they leave the clinic? A. “If your child has a little temperature give acetaminophen (Tylenol).” B. “Keep your child away from other children for the next few days.” C. “Let's schedule your return visit to have blood drawn for a titer.” D. “Put ice on the injection site 4 times a day for 15 minutes.” 3. A 1-year-old child who is HIV positive has a recurrent diaper infection. Which medication does the nurse anticipate teaching the parents about? A. Amoxicillin (Amoxil) B. Clotrimazole (Mycelex) C. Fluconazole (Diflucan) D. Nystatin (Mycostatin) 4. The pediatric intensive care unit nurse receives a report from the emergency department about a 10-year-old child being admitted with Stevens-Johnson syndrome. Which medication does the nurse prepare to administer to this child? A. Acyclovir (Zovirax) B. Fluconazole (Diflucan) C. Intravenous immune globulin (IVIG) D. TMP-SMZ (Bactrim) 5. The nurse is teaching a teen and family about systemic lupus erythematosus. Which information about this disease is correct? A. Excessive fatigue makes symptoms worse. B. High-dose steroids will make you drowsy. C. Pain control usually requires narcotics. D. Sunlight will help get rid of the facial rash. 6. The nurse reads on a child's medical record that he has a heliotropic violaceous rash around his eyes. Which disease process does the nurse suspect? A. Dermatomyositis B. Rheumatoid arthritis C. Scleroderma D. Systemic lupus erythematosus 7. A parent rushes her child to the emergency pediatric clinic after she picks up her baby from day care and sees a bright red spot on his cheek that looks as if he was slapped by a caregiver. Which information does the nurse anticipate providing to the mother? A. Keep your child away from any pregnant women while he is sick. B. The rash will probably spread to the trunk, arms, and legs. C. Warm baths with oatmeal will decrease the pain from the rash. D. You can treat your child's fever with salicylates (baby aspirin). 8. The clinic nurse is evaluating a teen who reports extreme fatigue and a sore throat. On physical exam, the nurse notes swollen, tender occipital lymph nodes and an enlarged area on abdominal palpation. Which diagnostic testing does the nurse anticipate being ordered as the priority? A. Complete blood count B. Monospot test C. Rheumatoid factors D. Titer for Epstein-Barr virus 9. A nurse is providing community education on preventing mosquito-borne diseases in children. Which instruction is most appropriate for the nurse to provide? A. Avoid spraying repellent directly onto your child's skin. B. DEET-containing repellent can be sprayed on the clothes. C. Dress your baby warmly even on hot days when going outside. D. Keep babies less than 1 year of age inside at all times. 10. The family practice nurse is teaching a student about different types of vaccines. Which information about vaccines is correct? A. Attenuated vaccines are used only in adults. B. Inactivated vaccines prevent disease reactivation. C. Live virus vaccines need occasional boosters. D. Toxoid vaccines contain highly potent viruses. CHAPTER 26: 1. Which heart valve prevents regurgitation of blood from the pulmonary artery into the right ventricle? A. Aortic B. Mitral C. Pulmonary D. Tricuspid 2. A nurse suspects an infant of having advanced heart failure. Which clinical manifestation of heart failure did the nurse assess to reach this conclusion? A. Enlarged liver B. Feeding problems C. Poor growth D. Sweating excessively 3. A nurse is teaching parents of a child who has an atrial septal defect (ASD) about possible treatment options. Which treatment option does the nurse include in the teaching session? A. Heart transplant B. Spontaneous closure C. Surgical repair D. Use of a closure device 4. Which hormone is partly responsible for ensuring that the ductus arteriosus closes normally? A. Estrogen B. Human growth hormone C. Progestin D. Prostaglandin 5. A child has aortic stenosis. What manifestation does the nurse assess for? A. Aortic aneurysm B. Left ventricular failure C. Right ventricular atrophy D. Tricuspid regurgitation 6. A nurse is caring for a child hospitalized with possible channelopathy. What nursing action is most important for this child? A. Continuous cardiac monitoring B. Frequent blood pressures C. Total bedrest until corrected D. Treatment of hypertension 7. The parents of a child diagnosed with Kawasaki's disease ask the nurse to explain the disease and symptoms. Which response by the nurse is the most appropriate? A. Bacterial infection after an invasive procedure B. Chronic viral infection of unknown origin C. Genetic defect causing vessel abnormalities D. Vasculitis affecting all organs of the body 8. A child has restrictive cardiomyopathy. What information given to parents by the nurse is correct? A. Caused by toxic agents B. Least common form C. Most common form D. Often a familial disorder 9. A child with cardiomyopathy is prescribed a beta blocker. Which drug does the nurse teach the parents about? A. Carvedilol (Coreg) B. Flecainide (Tambocor) C. Quinidine (Quinaglute) D. Verapamil (Calan) 10. A child has been diagnosed with long QT syndrome. The nurse counsels the family to have genetic testing. Which family members does the nurse encourage to be tested? A. All female siblings B. All male siblings C. Parents only D. Parents and all siblings CHAPTER 27: 1. The pediatric nurse understands that which endocrine gland is responsible for calcium metabolism? A. Adrenal B. Hypothalamus C. Parathyroid D. Thyroid 2. A nurse is assessing a child who is in the 3rd percentile for growth. When arranging laboratory and other assessments, the nurse places priority on which endocrine gland? A. Adrenal B. Hypothalamus C. Pituitary D. Thyroid 3. The mother of a 7-year-old girl brings her daughter to the pediatrician's office for an annual examination. On assessment, the pediatric nurse notes signs or symptoms that may suggest a diagnosis of precocious puberty. Which assessment finding is inconsistent with the nurse's knowledge of this condition? A. Breast development B. Brittle hair C. Menstruation D. Some pubic hair 4. A child presents in the pediatric clinic where the parent reports that his facial features appear “coarser” than before and new onset of hyperhidrosis. Which diagnostic test does the nurse prepare the patient and parent for? A. 24-hour urinalysis B. Anti-insulin antibody C. Oral glucose tolerance test D. Serum hormone assay 5. A child has been diagnosed with a pituitary tumor. What medical management does the nurse prepare the child and family for? A. Chemotherapy B. Radiation treatments C. Steroid infusions D. Surgical removal 6. A child with diabetes insipidus is being monitored for fluid balance. Which assessment is the most accurate way to determine fluid balance? A. Daily weight B. Hemodynamic monitoring C. Intake and output D. Urine osmolality 7. The pediatric nurse monitoring electrolytes understands that at what level does hyponatremia pose the threat of causing seizures? A. Less than 150 mEq/L B. Less than 145 mEq/L C. Less than 130 mEq/L D. Less than 125 mEq/L 8. The pediatric nurse is providing care to a pediatric patient with primary adrenal insufficiency. Which item in the patient's history is the most likely cause of this condition? A. Autoimmune destruction B. Genetic abnormality C. Infectious process D. Steroid therapy 9. A nurse is reviewing laboratory findings in a child suspected of having Addison's disease. Which finding would be consistent with this condition? A. Albumen 4.0 g/dL B. Cortisol 2 mg/dL C. Potassium 4.4 mEq/L D. Sodium 139 mEq/L 10. A parent brings a child to the clinic and reports the child has episodes of sweating, headaches, and heart palpitations. Which medication does the nurse provide education to the parents on? A. Desmopressin (DDAVP) B. Methylprednisolone (Solu-Medrol) C. Phenoxybenzamine (Dibenzyline) D. Spironolactone (Aldactone) CHAPTER 28: 1. A pediatric nurse is offering a health prevention lecture in the community. Which topic is appropriate to include in this lecture? A. The use of DEET-containing products is contraindicated in school-aged children. B. Avoiding areas infested with mosquitoes can be helpful in preventing encephalitis. C. The incidence of Reye's syndrome has increased because of the use of acetaminophen (Tylenol). D. The varicella vaccine is not to be given to children with arthritis or Kawasaki's disease. 2. A 3-year-old with a history of hydrocephalus has recently undergone a ventriculo-peritoneal shunt insertion. Which postoperative intervention is the most appropriate? A. Assessing for signs of infection and for neurological function B. Maintaining the head of the bed at a 90-degree angle C. Encouraging the patient to lie on the operative side D. Encouraging the patient to lie supine for the first 24 hours 3. The pediatric nurse is admitting a child with a history of seizure activity. What will the nurse ensure is at the bedside to implement seizure precautions? A. A ventilator B. Suction equipment C. Intubation equipment D. Soft restraints 4. A child is admitted to the intensive care unit following a motor vehicle crash. The student nurse uses the Glasgow Coma Scale to evaluate the child's neurological status. When using this tool, for which assessment does the registered nurse intervene? A. Verbal response B. Orientation C. Eye opening D. Motor response 5. A child has a hearing loss following several ear infections. Which area of assessment is a priority for this child? A. Language problems B. Balance problems C. Head size out of the norm D. Metabolic disorders 6. A child is brought to the emergency department with a chemical burn to the eye. Which action by the nurse takes priority? A. Attaching the child to the cardiac monitor B. Determining the composition of the chemical C. Assessing how this injury could have occurred D. Flushing the eye with saline or water for 15 minutes 7. An infant has been fitted with amplification devices for a hearing loss. What will the nurse include in the teaching plan for this infant? A. Wash the devices with cool water and pat dry weekly. B. Irritability can indicate the devices are turned up too loud. C. The child will eventually need surgery to correct the hearing loss. D. Very few children need amplification devices for mild hearing loss. 8. A nurse is assessing growth and development in a 4-year-old child. Which sentence indicates the child is probably speaking appropriately for her age? A. “I hungry.” B. “No! No nap!” C. “Play ball with me.” D. “I want to go to the park.” 9. A child is being assessed with the Ishihara Test plates. The nurse understands that this tests what part of neurological function? A. Expressive speech B. Color blindness C. Ocular nerve function D. Coordination 10. A child's medical record states he has an altered level of consciousness. What is the priority problem for the nurse to assess for this child? A. Trauma B. Abusive head trauma C. Infection of the brain or meninges D. Brainstem abnormality CHAPTER 29: 1. The pediatric nurse is caring for a 5-year-old child in traction related to a broken femur. Which action by the nurse takes priority? A. Assess neurovascular status every 4 hours. B. Provide diversional activities for the child. C. Educate parents on the principles of traction. D. Provide high-protein, high-fiber menu items. 2. The nurse consults the child life specialist to help plan care for a child who is immobilized and is increasingly anxious. Which is the priority intervention for this child? A. Allowing the school to provide a tutor B. Providing diversional activities C. Consulting a social worker D. Administering pain medication 3. The nurse is preparing a 7-year-old child to have a cast removed from his leg. Which statement would be most appropriate to prepare the child for the procedure? A. “As soon as the cast comes off, you can get up and move around.” B. “The sound of the cast saw is very loud and may be a little scary.” C. “You must sit very still so we don't accidentally hurt your leg.” D. “Don't worry; you will be asleep during the cast removal.” 4. A nurse reads the diagnosis of neurogenic clubfoot on an infant's chart. Which other diagnosis does the nurse expect to find when reviewing the medical record? A. Osteogenesis imperfecta B. Spina bifida C. Muscular dystrophy D. No associated diagnosis 5. The pediatric nurse is aware that which is the precipitating cause of Legg-Calvé-Perthes disease? A. Genetic abnormality B. Interruption in blood flow C. Birth trauma D. Dietary deficiency 6. The pediatric nurse understands that which classification of fracture has the most potential to affect growth? A. Type III B. Type V C. Closed D. Open 7. Which explanation by the pediatric nurse is most appropriate for a child with ankylosis? A. ROM restrictions in the vertebrae B. Adhesions causing joint immobility C. Curvature of the cervical spine D. Bowed legs caused by low calcium 8. A nurse visiting a day care notices a boy trying to get up off the floor by kneeling, rising to his feet while keeping his hands on the floor, then walking his hands up his legs until he is standing. Which assessment finding does this nurse document? A. Positional instability B. Gowers’ maneuver C. Kernig's sign D. Grey Turner's sign 9. The nurse is providing care to a child diagnosed with lordosis. Which common term might the parents have heard to describe this condition? A. Hunchback B. Swayback C. Spinal curvature D. Flat feet 10. A nurse admitting a child to the intensive care unit is told the child has risus sardonicus. Which disease process does the nurse suspect the child has? A. Scoliosis B. Osteogenesis imperfecta C. Duchenne's muscular dystrophy D. Tetanus CHAPTER 30: 1. The nursing instructor is explaining the layers of skin to students. Which layer is inconsistent with knowledge of this topic? A. Dermis B. Epidermis C. Intradermis D. Subcutaneous fatty layer 2. When assessing for primary skin lesions on children, what does the nurse specifically look for? A. Crusts B. Keloids C. Scales D. Wheals 3. An adolescent is experiencing severe acne and has recently been diagnosed with prediabetes. Which medication does the nurse educate the adolescent about? A. clindamycin (Cleocin) B. metformin (Fortamet) C. tetracycline (Sumycin) D. trenitoin (Retin A) 4. A parent calls the clinic to ask about signs and symptoms of impetigo. Which information does the nurse provide? A. Erythema and swelling of the fingers B. Groups of small flesh colored or pink papules C. Painful, watery blisters often near the nose D. Pustules that have honey-colored exudate 5. A teen is prescribed griseofulvin (Grifulvin V). What teaching does the nurse provide the child and parents? A. Apply this medication only at night. B. Avoid sun exposure and tanning beds. C. Have liver enzymes checked every 6 weeks. D. Use two forms of birth control if you have sex. 6. A child has lice. The parent wants to know what to do with the child's stuffed animals. Which response by the nurse is most appropriate? A. Seal in a plastic bag in the garage for 2 weeks. B. Spray with an anti-lice fumigating product. C. Throw them away; they cannot be cleaned. D. Wash in hottest water possible and line dry. 7. A mother reports seeing “burrows” on her child's hands. Which medication does the nurse teach the mother about? A. lindane (Kuell) B. malathion (Ovide) C. permethrin 5% (Elimite) D. spinosad (Natroba) 8. The emergency department nurse knows that which type of bite has the highest risk of infection? A. Cat B. Dog C. Human D. Squirrel 9. The nurse provides anticipatory guidance to parents telling them the maximum water temperature for bathing children is which temperature? A. 100°F (37.8°C) B. 110°F (43.3°C) C. 120°F (48.9°C) D. 140°F (60°C) 10. The nurse working with children knows that which burn is the most common type of burn in the pediatric population? A. Contact B. Flame C. Scald D. Thermal CHAPTER 31: 1. A nurse is reviewing the laboratory values for a child with a genitourinary condition. Which lab value would require the nurse to intervene as the priority? A. Blood urea nitrogen (BUN): 32 mg/dL B. Creatinine: 3.6 mg/dL C. Creatinine clearance: 135 mg/minute D. Urinalysis: trace blood 2. A nurse is explaining to a group of students that pediatric patients are at greater risk for fluid and electrolyte imbalances than adults. Which is the best explanation for this condition? A. Higher percentage of total body water B. Hypernatremia caused by frequent drinking C. Kidneys with high concentrating abilities D. Smaller body surface area as compared with adults 3. A teenager participates in outdoor summer sports. The coach finds the teen sitting under a tree obviously dehydrated and with severe muscle weakness. For what electrolyte imbalance should the nurse assess as the priority? A. Hypercalcemia B. Hyperkalemia C. Hypomagnesemia D. Hyponatremia 4. A school-aged child is brought to the clinic by a parent who reports enuresis and malodorous urine. A routine urinalysis is normal. Which action by the nurse is best? A. Assess the child for toileting practices. B. Encourage the child to drink extra water. C. Facilitate a voiding cystourethrogram. D. Send urine for a culture and sensitivity. 5. A nurse is teaching a community parent group about various childhood genitourinary diseases. Which prevention method does the nurse teach the parents related to hemolytic uremic syndrome? A. Cook ground beef to an internal temperature of at least 160°F (71.1°C). B. Encourage your child to drink plenty of water throughout the day. C. Monitor your child's urinary output and report a decrease immediately. D. Seek rapid medical care if your child develops an upper respiratory illness. 6. The nurse assesses a child for Grey-Turner's sign. What technique is most appropriate for the nurse to use? A. Auscultates for renal bruits over the flanks B. Inspects for bruising over the flank area C. Palpates for an obvious abdominal mass D. Percusses for tympany over the kidney area 7. The nurse caring for a child with chronic kidney disease understands that which is the most common complication from this disorder? A. Anemia B. Bone disease C. Growth failure D. Hypertension 8. A nurse is assessing children at risk for chronic kidney disease. Which laboratory finding is most consistent with this condition? A. Calcium: 9.2 mg/dL B. pH: 7.16 C. Potassium: 4.2 mg/dL D. Sodium: 140 mg/dL 9. A child is receiving peritoneal dialysis. Which potential complication does the nurse place greatest emphasis on preventing? A. Infection B. Migrating catheter C. Pain D. Urinary tract infection 10. A nurse is teaching a parent group about potty training. Which information does the nurse provide? A. A girl will be able to stay dry all day long by about 20 months. B. Choose a potty chair that is a little too big so the child feels grown up. C. If the child tells you after the fact about a wet diaper, he is not ready to train. D. Your child may show interest in toileting at around 2 years of age. CHAPTER 32: 1. A nurse is reviewing the lab values for a toddler. The child's hemoglobin is 7.7 g/dL. How would the nurse characterize the child's results? A. Normal B. Slightly anemic C. Moderately anemic D. Polycythemia 2. A student nurse is teaching the mother of an infant ways to prevent iron-deficiency anemia. Which instruction causes the registered nurse to intervene and correct the teaching? A. “Give your child whole milk instead of low-fat milk.” B. “Be sure to feed your child iron-fortified cereals.” C. “Offer solid foods first, then give your child a bottle.” D. “WIC can provide you with iron-fortified infant formula.” 3. A nurse is reviewing a chart on a child who has sickle cell disease and notes the diagnosis “dactylitis.” What does the nurse understand about this condition? A. Prolonged painful erection B. Atypical pneumonia C. Avascular necrosis of the hip D. Hand-foot syndrome 4. The pediatric nurse is aware that which disease process is the most commonly inherited genetic disease worldwide? A. Sickle cell anemia B. Beta-thalassemia C. Cooley's anemia D. Hemosiderosis 5. A child's lab values show red blood cells that are small, dense, and round with a hemoglobin value of 8.5 g/dL. Based on these laboratory findings, which disease process does the nurse suspect? A. Hemosiderosis B. Cooley's anemia C. Hereditary spherocytosis D. Hemophilia 6. A school-aged child is diagnosed with hemarthrosis after tripping and falling. Which diagnostic testing is the priority for this child? A. Hemoglobin and hematocrit B. Bilateral knee radiographs C. Partial thromboplastin time D. Plasma factor activity 7. When teaching the parents of a child diagnosed with von Willebrand's disease, which information is most appropriate for the nurse to provide? A. Boys are affected twice as often as girls. B. Only female children will be affected. C. Boys and girls are affected equally often. D. This disease is not inherited and occurs randomly. 8. A child is diagnosed with chronic immune thrombocytopenia. Which diagnostic platelet count supports this diagnosis? A. Below 5,000 B. Below 10,000 C. Below 50,000 D. Below 150,000 9. A pediatric intensive care nurse is providing care to a patient with disseminated intravascular coagulation. Which treatment option is most appropriate for this patient? A. Treat the underlying condition B. Administer massive blood transfusions C. Therapeutic hypothermia D. Routine vitamin K administration 10. A child is admitted with neutropenia. Which nursing action takes priority? A. Place the child on contact isolation. B. Maintain strict handwashing. C. Disinfect belongings brought from home. D. Do not allow visitors in the child's room. [Show More]

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