CPN Practice 459 Questions with Verified Answer,100% CORRECT

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CPN Practice 459 Questions with Verified Answer 2.1 Which is an example of cephalocaudal development? A. A child crawls before he walks; walks before he runs; runs before he jumps B. A child lif... ts his head before lifting his shoulders; sits with support before sitting without support C. A child rakes before developing pincer grasps; develops pincer grasps before feeding himself with a spoon D. A child first develops reflexive behaviors; then develops imitative behaviors - CORRECT ANSWER B. A child lifts his head before lifting his shoulders; sits with support before sitting without support Cephalocaudal development states that a child develops from head to toe 2.2 When assessing a school ages child's development, the nurse understands that a primary developmental task of his group is: A. Developing friends B. Learning to read C. Learning to trust others D. Developing independence - CORRECT ANSWER A. Developing friends Erikson's stage of a school age child is industry vs. inferiority; the primary job of a school age child is to develop competence through achievement in school and development of friendships; important nursing assessment of children in this stage is adjustment and success in school setting as well as the formation of friendships 2.3 Which nursing action would be most important in the psychosocial support of a 2 year old who is having an invasive procedure performed? A. Assuring her that it is not her fault B. Providing for parental presence C. Providing adequate pain control D. Performing the procedure quickly - CORRECT ANSWER B. Providing for parental presence 2 year olds are in Erikson's stage of autonomy vs. shame and doubt and Piaget's sensorimotor stage; toddlerhood is a time of heightened separation anxiety with fear of strangers; the most appropriate psychosocial support is to promote presence of the primary caregiver 2.4 Which of the following would be most helpful when assessing a child's bone age? A. Birth date B. Body mass index C. Blood test D. X-rays - CORRECT ANSWER D. X-rays Bone age is preformed by taking an x-ray of the child's hands and wrists for comparison against an atlas of standard x-rays categorized by age; the test predicts the remaining height growth based on bone age; typically a child's bone age should match their chronological age Delayed bone age: increased height growth prediction advanced bone age: decreased height growth prediction 2.5 Which of the following assessments would be most concerning in a 3 month old? A. Closed posterior fontanel B. In ability to roll over C. Failure to track object through visual fields D. Failure to laugh - CORRECT ANSWER C. Failure to track object through visual fields Infants develop the ability to track objects by 3 months The posterior fontanel closes by 2-3 months Infants do not roll over till 4 months Laughing typically occurs at 4 months 2.6 Which of the following developmental milestones of the 5 month old best reflects the principle of proximodistal growth and development? A. Babbling B. Raking objects C. Rolling over D. Eating solid foods - CORRECT ANSWER B. Raking objects Proximodistal growth and development states children develop from the trunk to the tips of the extremities; raking objects develops at 4 months, pincer grasps develops at 9 months 2.7 You are the nurse at a community health clinic; the mother of a 2 year old male expresses concern to you that her previously healthy child is nonverbal; which of the following responses is most appropriate? A "Try not to worry, language milestones vary, boys have tendency to lag behind girls" B. "Given your son's age, we should probably test his hearing to be sure that is the source of his delayed language skills" C. "Autism is the most frequent reason why children as old as 2 years of age - CORRECT ANSWER B. "Given your son's age, we should probably test his hearing to be sure that is the source of his delayed language skills" 2 year olds should be speaking 2-3 word sentences; hearing deficits are the most common cause for failure to speech development birth order does not affect failure to develop speech autism could explain failure to develop speech, but is far less common than a hearing deficit and would include over behavior abnormalities 2.8 The 5 year old uses how many words in a sentence? A. 3-4 B. 4-5 C. 5-6 D. 6-7 - CORRECT ANSWER C. 5-6 5 year olds typically use 5-6 word sentences typically preschool age children will speak a sentence in the number of words equal to the child's age to one more word than their age 2.9 The nurse would expect a 4 month old to: A. Sit alone B. Attempt to roll over C. Begin to crawl D. Grasp feet and pull them to mouth - CORRECT ANSWER B. Attempt to roll over Infants begin to roll over at 4 months (first from stomach to back then from back to stomach) Infants sit with support at 5 months and sit without support at 8 months Infants will push up from their stomach onto hands and knees at 6 months Crawling begins at 9 months Grasping feet and pulling to month begins at 5 months 2.10 A healthy 6 month old infant brought to the well-baby clinic for checkup; when assessing the infant's anterior fontanel, the nurse expects it to be: A. Open B. Sunken C. Closed D. Bulging - CORRECT ANSWER A. Open The anterior fontanel closes between 12-18 months, a healthy 6 month old should have an open anterior fontanel Sunken - dehydration Bulging - increased intracranial pressure 2.11 The nurse notes that an infant develops arm movements before fine-motor skills and interprets this as an example of which pattern of development? A. Cephalocaudal B. Proximodistal C. Differentiation D. Mass-to-specific - CORRECT ANSWER B. Proximodistal Proximodistal growth and development states children develop from the trunk to the tips of the extremities: this development is manifested in the progressing from gross motor large-muscle movement in the younger infant to fine motor movements in the older infant/toddler 2.12 What is the most important consideration when telling a 4 year old child about an upcoming procedure? A. Use simple terms B. Speak loudly and clearly C. Offer a toy to keep the child happy D. Include every detail - CORRECT ANSWER A. Use simple terms Lots of details can be confusing and lead to fear/anxiety Toys aren't the most important component of OR prep unless being used as a prop/teaching tool 2.13 When assessing a toddler's growth and development, the nurse understands that a child in this age group displays behavior that fosters which developmental task? A. Initiative B. Autonomy C. Trust D. Industry - CORRECT ANSWER B. Autonomy The toddler (1-2 years) is in Erikson's developmental stage of autonomy vs. shame and doubt; the virtue being developed is will: the toddler exerts his/her autonomy with statements like "me do" or "no" and "mine"; the toddler requires opportunities to accomplish independent tasks and respond to simple instructions 2.14 The nurse should expect a 3 year old child to be able to perform which action? A. Ride a tricycle B. Tie his shoelaces C. Roller skate D. Jump rope - CORRECT ANSWER A. Ride a tricycle Tying shoes and jumping rope are motor skills developed in early school age followed later by learning to roller skate 2.15 When performing a physical assessment of a 10 year old girl, the nurse keeps in mind that the first sign of sexual maturity in girls is: A. Breast bud development B. Pubic hair C. Axillary hair D. Menarche - CORRECT ANSWER A. Breast bud development The first sign of puberty in females is breast bud development (10 years) followed by axillary and pubic hair (11 years) then height spurt (around 12 years) and menarche (around 13-14 years) 2.16 A 6 month old infant is brought to the clinic for a well-baby visit, the mother reports that the infant weighed 7 lbs at birth; based on the nurse's knowledge of infant weight gain, which current weight would be considered the minimum weight expected for this infant to be within normal range for weight? A. 10 lbs B. 14 lbs C. 18 lbs D. 21 lbs - CORRECT ANSWER B. 14 lbs Infant doubles in birth weight by 6 months Triples in birth weight by one year 2.17 A parent calls the clinic to express concern over her child's eating habits, she says the child eats very little and consumes only a single type of food for weeks on end; the nurse knows this behavior is characteristic of: A. Toddlers B. Preschool aged children C. School aged children D. Adolescents - CORRECT ANSWER B. Preschool aged children Preschool age children are known for their relatively small appetites and food jag eating behavior; preschoolers have a slow growth rate requiring fewer calories it is recommended that caregivers avoid battles over food with toddlers and preschoolers 2.18 When developing a plan of care for an adolescent, the nurse considers the child's psychosocial needs; during adolescence, psychosocial development depends on: A. Becoming industrious B. Establishing an identity C. Achieving intimacy D. Developing initiative - CORRECT ANSWER B. Establishing an identity Erikson's stage for the adolescent is identity vs. identity confusion; if the adolescent successfully masters this phase, she will develop a sense of identity with regard to personal identity, beliefs/values, sexual identity and goals for a future job/vocation 2.19 What is the best way to prepare 4 year old boy for his admission to the hospital for same-day surgery? A. Allow him to play with the medical equipment at the preoperative office visit and explain that he will be staying in the hospital for a few days B. Do not mention anything to him until he arrives at the hospital on the morning of the operation C. Explain the details of the operation and what will happen D. Tell him that a hospital is a place where kids go and visit each other and eat i - CORRECT ANSWER A. Allow him to play with the medical equipment at the preoperative office visit and explain that he will be staying in the hospital for a few days Preschoolers are magic thinkers It is more developmentally appropriate to give brief and understandable information such as that the child will be staying in the hospital for a few days Allowing the child to handle equipment in a pre-op office visit is a good way to orient the child to the hospital equipment and involve the child in the pre-op teaching The child should be always told the truth while keeping in mind that concrete explanations without lots of detail are most appropriate 2.20 A 2 month old weighed 8 lbs at birth; based on your knowledge of pediatric growth, you know that his weight at 1 year should be at least: A. 16 lbs B. 20 lbs C. 24 lbs D. 32 lbs - CORRECT ANSWER C. 24 lbs Infants should minimally double their birth weight at 5-6 months and triple in weight at 1 year 2.22 Which developmental milestone would you expect to see the 9 month old developing? A. Pincer grasp B. Walking C. Speaking intelligible words D. Sitting up without support - CORRECT ANSWER A. Pincer grasp 9 month old are typically developing the pincer grasp Walking is developed at 12-15 months 9 month olds typically says "ma-ma" and 'da-da" correctly Sitting up without support is developed by 8 months 2.23 You are the nurse caring for a 12 year old, he shares with you that he is concerned about his short stature; based on your knowledge of growth and development you know that: A. In boys, the height spurt occurs later in puberty than in girls B. In boys, the height spurt occurs about the same time during puberty as in girls C. In boys, the height spurt occurs earlier in puberty than in girls D. It is impossible to predict how much more the child will grow - CORRECT ANSWER A. In boys, the height spurt occurs later in puberty than in girls In boys, the height spurt occurs late in puberty, occurring 2 years later than girls; boys have a longer time to grow and a higher rate of growth than girls 2.24 Which of the following assessments would be abnormal in a newborn? A. Closed anterior fontanel B. Red, flaky skin C. Crossed-eyes D. Vernix - CORRECT ANSWER A. Closed anterior fontanel The anterior fontanel closes between 12-18 months, an open anterior fontanel allows for brain growth and compensation of intracranial pressure change 2.25 Which of the following would likely pose the greatest fear for a 7 year old girl who was recently admitting for osteomyelitis treatment? A. Oral medications B. A visit from the doctor C. Having her mother leave for a few minutes D. A rectal temp - CORRECT ANSWER D. A rectal temp School age children are fearful of disruption of their body integrity Stranger anxiety subsides at the end of infancy and resolves after toddlerhood 2.26 Why does the nurse instruct the mother of an infant, who is being introduced to baby foods for the first time, to wait a few days before adding another new type of food to his diet? A. To determine if he has an allergies to the new foods B. To allow his stomach to adjust to the mixture of the various types of foods C. To determine what type of foods he really likes to eat D. To allow his digestive system to adjust to individual foods - CORRECT ANSWER A. To determine if he has an allergies to the new foods Baby foods are introduced intermittently to identify allergies; its best to wait 4-7 days between each new food type in order to identify a particular food 2.27 Which of the following developmental milestones would be most advanced for a 6 month old? A. Reaching for objects B. Rolling over from back to front C. Laughing out loud D. Sitting up unsupported for short periods - CORRECT ANSWER D. Sitting up unsupported for short periods Sitting up unassisted is the most advanced of the milestones listed; infants sit unassisted by 8 months Reaching for objects occurs at 4-6 months Rolling over back to front occurs at 5-6 months The social milestone of laughing out loud occurs at 4 months 2.28 Which of the following would be the most accurate information to share with the mother of an 8 year old girl who is asking about the onset of puberty? A. In girls, puberty begins on average at 10 years with the development of breast buds B. In girls, puberty begins on average at 10 years with the development of pubic hair C. In girls, puberty begins on average at 10 years with the onset of menses D. In girls, puberty begins on average at 10 years with a height spurt - CORRECT ANSWER A. In girls, puberty begins on average at 10 years with the development of breast buds On average, girls start puberty at 10 years with breast bud development then pubic hair at 11, height spurt at 12, menarche at 13 2.29 You expect which of the following developmental assessments of a 2 year old in your primary care clinic? A. Toilet training B. 2-3 word sentences C. Cooperative play D. Sharing willingly - CORRECT ANSWER B. 2-3 word sentences 2 year olds use 2-3 word sentences Toilet training starts around 2-3 years Cooperative play is a characteristic of the school age group Sharing willingly does not occur until children reach late preschool/early school age 2.30 A baby's length is 20 in at birth; you approximate her height at 4 years of age to be: A. 30 in B. 35 in C. 40 in D. 45 in - CORRECT ANSWER D. 40 in A baby birth length roughly doubles at four years of age 2.31 Which of the following assessment finding are normal in a healthy 6 month old? A. Closed anterior and posterior fontanel B. Open anterior and posterior fontanel C. Closed anterior and open posterior fontanel D. Open anterior and closed posterior fontanel - CORRECT ANSWER D. Open anterior and closed posterior fontanel Anterior fontanel closes between 12-18 months Posterior fontanel closes at 2 months 2.32 What is an 18 month old's biggest fear to anticipate for surgery? A. Pain B. Separation anxiety C. Death D. Body integrity - CORRECT ANSWER B. Separation anxiety Separation anxiety is greatest among toddlers Fear of pain/invasion of body integrity are issues with older preschoolers and school age children Fear of death is a more common concern for the adolescent due to abstract thinking 2.33 The mother of a 2 year old voices concern because her child does not share and uses the word "mine"; you know that this is typical of which developmental stage according to Erikson: A. Trust vs. mistrust B. Autonomy vs. shame and doubt C. Initiative vs. guilt D. Industry vs. inferiority - CORRECT ANSWER B. Autonomy vs. shame and doubt Toddlers are in Erikson's stage of autonomy vs. shame and doubt; they are egocentric It is normal for them to have difficulty sharing - this behavior will pass when the child becomes a preschooler and enters the preoperational stage where he/she learns the concepts of sharing and thoughts/feelings of others 2.34 You are the nurse caring for a 14 year old girl who experience menarche one year ago, she is concerned that she is short and wants to know if she will grow much taller; based on your knowledge of growth and development, you know that: A. In girls, menarche occurs early in puberty before the height spurt B. In girls, menarche occurs late in puberty after the height spurt C. In girls, the peak height velocity is usually around 15 years D. It is impossible to predict how much more she will gr - CORRECT ANSWER B. In girls, menarche occurs late in puberty after the height spurt Height spurt occurs earlier in puberty among girls compared to boys; average peak height velocity is 12 years for girls, after menarche girls have an average potential growth of 2.5cm, girls have a shorter growth period and a lower growth rate 2.35 When assessing the development of a 6 month old, which of the following would be most concerning? A. The child weighs twice as much as his birth weight B. The child does not look for hidden objects C. The child does not understand the word "no" D. The child does not transfer objects from one hand to the other - CORRECT ANSWER D. The child does not transfer objects from one hand to the other A 6 month old should weigh at least twice as much as his/her birth weight Looking for hidden objects is an example of object permanence - a phenomenon that occurs between 8-12 months Infants understand the word no by 9 months Infants transfer objects from one hand to another at 5 months - failure to achieve fine motor development task is considered a developmental delay in a 6 month old 2.36 A 4 year old girl is being admitted today, you know she is in which developmental stage according to Erikson? A. Initiative vs. guilt B. Identity vs. role confusion C. Industry vs. inferiority D. Autonomy vs. shame and doubt - CORRECT ANSWER A. Initiative vs. guilt Initiative vs. guilt is the stage for children ages 3-6; initiative is fostered through allowing the child to successfully achieve new skills and become independent 2.37 In which of the following age groups does the child experience the fastest rate of growth in the limbs? A. Infancy B. Preschool C. School age D. Adolescent - CORRECT ANSWER C. School age The limbs experience the fastest rate of growth during the school age years The head - infancy The trunk - toddler/preschool years The trunk, gonads, associated tissue, etc. - adolescent years 2.38 Which of the following statements concerning growth and development is true? A. Growth implies an increase in size an development B. Development refers to the maturation of structures of the body but does not include growth C. Growth and development usually progress from specific to general D. Development refers to the maturation of structures of the body and includes growth - CORRECT ANSWER D. Development refers to the maturation of structures of the body and includes growth Growth and development progress from general to specific; growth implies and increase in size but does not necessarily include development 2.39 The mother of an infant tells the nurse, "my child used to put her hands in her mouth but, now she is placing her feet in her mouth"; the nurse knows that this is an example of what concept of development A. Proximodistal B. Cephaocaudal C. General to specific D. Sterognosis - CORRECT ANSWER B. Cephaocaudal Cephaocaudal refers to het development that occurs from head to toe Proximodistal refers to development that occurs from the trunk to extremities Sterognosis - recognition of an object through the sense of touch 2.40 The father of a 9 month old brings his daughter to the clinic for a well-baby assessment, the father asks why it is important to record her length and weight on a growth chart; select the nurse's best response A. "The growth charts are used to plot her growth and we can see how she is growing compared to other 9 month old girls" B. "It is important to measure her to see if she is too heavy or small for her age" C. "We measure all babies" D. "The growth charts show how her length and weight - CORRECT ANSWER D. "The growth charts show how her length and weight compare to other infants her age as well as show us a pattern over time" Growth charts offer the ability to observe a pattern over time as well as comparison among other children of the same gender (only specific to the U.S.); they are used to assess the infant's growth over time but also the pattern of growth 2.41 A 7 month old infant lives with his parents, is kept clean and dry, and is picked up and comforted when he cries; by consistently meeting his basic needs, which psychological strength are his parents promoting? A. Will B. Hope C. Purpose D. Loyalty - CORRECT ANSWER B. Hope This virtue is developed during the infant years wterm-21hen the child is in the trust vs. mistrust stage The virtue will is developed during the toddler years when the child is in the autonomy vs. shame and doubt stage The purpose virtue is developed during the preschool years when the child is in the initiative vs. guilt stage Loyalty is a virtue developed during the adolescent years when the child is in the identity vs. role confusion 2.42 The nurse is teaching a parenting class when a mother asks when a child develops a conscience; basing her response on Erikson's theory of development, the nurse knows that this usually occurs during which of the following stages? A. By the end of the first year of life B. By the end of the toddler stage C. During the preschool stage D. During the school age years - CORRECT ANSWER C. During the preschool stage Children recognize an "inner voice" during the preschool years; the development of a conscience does not occur during the infant/toddler years Conscience development should occur before the school age years 2.43 The nurse is caring for a child who is very outgoing and likes to talk about his friends, he asks to play a board game and is very concerned about the rules of the game; when the nurse wins the game, he throws the game and says, "you cheated!"; how old is this child likely to be? A. 2 B. 4 C. 7 D. 13 - CORRECT ANSWER C. 7 School age children are very competitive, they focus on the rules and don't like to lose Toddlers are too young to participate in board games Preschool children do not focus on the rules of the board game Adolescents cope with competition in a more constructive manner than a school age child does 2.44 The nurse is caring for a 3 year old who is restricted to bed rest due to a femur fracture; which of the following toys should the nurse select for this child? A. A stuffed bear B. A large ball C. Dress up clothes D. A play hammer and pounding board - CORRECT ANSWER D. A play hammer and pounding board This toy will help develop gross motor skills and release frustration due to immobility 2.45 During the admission of a 15 year old with a history of asthma, the pt. admits that she is currently smoking; the nurse incorporates a long term goal of smoking cessation in her care plan; which of the following interventions would be most effective in helping her quit smoking? A. Ask her open ended questions about why she feels the need to smoke B. Have her attend a smoking cessation group led and attended by other teens C. Talk to her parents about restricting her activity until she stop - CORRECT ANSWER B. Have her attend a smoking cessation group led and attended by other teens An adolescent is likely to identify and share values with other teens; having her attend a peer led group is the most effective manner in influencing and changing her behavior 2.46 The nurse is caring for a 5 year old with leukemia; when planning care for this child, the nurse considers that the child is in which of the following of Erikson's stages? A. Trust vs. mistrust B. Industry vs. inferiority C. Initiative vs. guilt D. Identity vs role confusion - CORRECT ANSWER C. Initiative vs. guilt The 5 year old is in the initiative vs. guilt stage 2.47 According to Piaget, the child who is beginning to imitate behavior is in which of the following stages? A. Intuitive B. Preconceptual C. Sensorimotor D. Reflexive - CORRECT ANSWER C. Sensorimotor The child progresses from reflexive behavior to imitate behavior during the sensorimotor stage Preoperational stage begins at the age of 2, it occurs after the imitative behavior has begun Preconception stage is the first phase of the preoperational stage The intuitive stage is the second phase of the preoperational stage and begins at the age of 4 - represents a height level of development 2.48 You note that your patient's head circumference is now smaller than his chest circumference; his age is most likely: A. 3 months B. 9 months C. 15 months D. 30 months - CORRECT ANSWER D. 30 months The chest circumference is greater than the head circumference after the age of 24 months 2.49 Your patient's physical reveals that her BMI is at the 90th percentile; you correctly explain to her mother: A. "A BMI in the 90th percentile indicates that she is overweight, would you like to talk to a dietician?" B. She is very healthy and is taller than most children her age" C. "A BMI in the 90th percentile indicates a risk of becoming overweight, we can discuss ways to reduce this risk" D. "A BMI in the 90th percentile indicates that she is underweight, let's talk about her dietary i - CORRECT ANSWER A. "A BMI in the 90th percentile indicates that she is overweight, would you like to talk to a dietician?" BMI between 85-95% indicates that the child is overweight (25-29.9) Obesity - greater than 95% (>30) Underweight - less than 5% (<18.5) 2.50 The nurse measures the head circumference of a 6 month old boy and finds that it has changed from the 25th percentile to the 75th percentile; which of the following represents the nurse's best action? A. Immediately notify the physician as this may indicate increase intracranial pressure, a medical emergency B. Reassure his mother that this is a period of growth and changes in head circumference are to be expected C. Prepare his mother for the placement of a helmet as safety is a concern D - CORRECT ANSWER D. Measure his head again and check for accuracy Whenever a change in growth patterns are noted, both the measurement and plotting on the growth chart Chou led be rechecked to assure accuracy 2.51 A group of children are playing in the playroom, the children are tested on the concept of conservation; one child has just mastered this concept, how old is this child most likely to be? A. 4 years B. 6 years C. 8 years D. 12 years - CORRECT ANSWER C. 8 years An 8 year old child is considered to be in the concrete operations phase of cognitive development - an appropriate time to to understand the concept of conservation 4 year old - preoperational phase - not likely to understand the concept of conservation 6 year old - preoperational phase - not likely to understand the concept of conservation 12 year old - formal operations phase - likely to have mastered the concept of conservation 2.52 The nurse is playing with an infant, the nurse hides a toy rattle under a blanket, the infant looks for it while lifting up the blanket: how old is this infant most likely to be? A. 2 months B. 4 months C. 6 months D. 8 months - CORRECT ANSWER D. 8. Months Object permanence is a concept that usually develops between 8-9 months where the infant understands that even though an object can no longer be seen, it still exists 2.53 A 6 year old girl is being seen in the ER after a bike accident; the nurse is preparing to assist with suturing her scalp lacerations, the child cries out, "I'm sorry I didn't wear my helmet, I promise I'll be good next time, please don't hurt me!" which of the following is the nurse's best response? A. "Helmets are very important and protect your head, please make sure that you wear it in the future" B. "We need to fix your head, you are doing such a good job of trying to stay still" C. " - CORRECT ANSWER B. "We need to fix your head, you are doing such a good job of trying to stay still" Actions should be geared toward encouraging the child and helping her to cope with a stressful and potentially painful procedure 2.54 A 14 year old girl is being treated for acute renal failure, in order to help meet her development needs, which of the following is important to include in her plan of care? A. Provide privacy and respect her need for modesty B. Promptly respond to her call light and reassure her that needs will be met C. Encourage one of her parents to spend the night D. Provide opportunities for her to participate in her care and encourage a sense of achievement - CORRECT ANSWER A. Provide privacy and respect her need for modesty The adolescent is in Erickson's stage of identity vs. role confusion It is important to to respect the adolescent's need for privacy and modesty as the child's body is rapidly changing 2.55 A 2 year old boy admitted with RSV is in which of the following stages of psychosocial development? A. Trust vs. mistrust B. Autonomy vs. guilt C. Autonomy vs. shame and doubt D. Initiative vs. guilt - CORRECT ANSWER C. Autonomy vs. shame and doubt This is the developmental stage of toddlerhood 2.56 A 4 year old girl newly diagnosed with diabetes who is frightened of fingers stick; the nurse's best response is: A. Allow her to hold her favorite stuffed animal during finger sticks B. Encourage her mother to coach her during finger sticks C. Encourage her to count backward from 10 during finger stick D. Encourage her to play with the equipment and 'practice' on her dolls - CORRECT ANSWER D. Encourage her to play with the equipment and 'practice' on her dolls Play therapy uses the therapeutic powers of play to help children resolve various challenges 2.57 A teacher brings a 5 year old to a museum where children are encouraged to interact with the attractions, the teacher praises and helps the child explore the museum; what kind of play is this known as? A. Mutual play B. Imaginative play C. Solitary play D. Parallel play - CORRECT ANSWER A. Mutual play This occurs when a parent offers praise and support while encouraging a child to explore their environment 2.58 A group of preschool aged children are playing with dress up clothes; this kind of play in known as: A. Imaginative play B. Dramatic play C. Parallel play D. Team play - CORRECT ANSWER B. Dramatic play Dramatic play is typical of preschool aged children, it often involves dressing up in clothes, hat, and shoes 2.59 A preschooler's mother states she is concerned that her child has an imaginary playmate; which of the following is the nurse's best response? A. "Many 4 year olds have imaginary playmates, it really isn't a cause for concern" B. "This is unusual, has she had a stressful event lately?" C. "It really isn't any cause for concern, as long as she doesn't talk to her" D. "Most children don't develop imaginary playmates until much later in childhood; your child must be smart for her age" - CORRECT ANSWER A. "Many 4 year olds have imaginary playmates, it really isn't a cause for concern" Imaginary playmates are typical of preschool aged children, many children talk to their imaginary playmates - it's not a concern 2.60 The nurse is watching a group of toddlers in the playroom; which of the following type of play is typical of older toddlers? A. Solitary B. Parallel C. Team play D. Mutual play - CORRECT ANSWER B. Parallel Parallel play in which children play side-by-side is associated with toddler years Solitary - infancy Team play - school age Mutual - infancy to school age (caregiver and child, not groups of children) 2.61 The nurse is preparing to provide education to a 9 year old girl with asthma; which of the following should be taken into consideration? A. The child should be the focus of the education B. The parent should be the focus of education C. Information should be provided in written form only D. The parent should be encouraged to ask questions when the child is not present - CORRECT ANSWER B. The parent should be the focus of education Although the child should be included in the education, the parent should still be the focus 2.62 The nurse is teaching a parenting class to a group of expectant parents, one of them asks at what age a child typically begins to develop modesty; which of the following is the nurse's best answer? A. "Most children do not develop modesty until the adolescent years" B. "Most children develop modesty by age 4" C. "Most children develop modesty by age 10" D. "Most children develop modesty bu age 2" - CORRECT ANSWER B. "Most children develop modesty by age 4" Most children develop modesty by the age of 4; it is good idea to reinforce body safety at this time by teaching preschoolers and young school age children that "no one should look or touch where their bathing suit covers unless they are your mom, dad, doctor, or a nurse." 2.63 The nurse is caring for a 3 year old girl with diabetes; which of the following should be included in her plan of care? A. Allow her to handle and play with equipment being used in her care B. Avoid talking about the disease process C. Give her detailed explanations with pictures when possible D. Encourage participation in procedures such as finger sticks and insulin administration - CORRECT ANSWER A. Allow her to handle and play with equipment being used in her care It is important to allow a preschooler the opportunity to handle and play with equipment being used in her care Short simple explanations are most appropriate 2.64 A 9 year old diabetic boy tells the nurse that he is responsible for testing his own blood sugar and administering his own insulin; which of the following is the most appropriate action for the nurse? A. praise and encourage him to continue as he has done a good job with increased responsibility B. contact a social worker as he is assuming too much responsibility for his age C. gather more information about his diabetic care from his parents D. tell him that surely he is exaggerating - CORRECT ANSWER C. gather more information about his diabetic care from his parents It is essential to gather more information prior to forming a plan of care It seems he could be takin on too much responsibility for his age 2.65 The nurse is caring for a 2.5 year old, when selecting a toy for this child, which of the follow is the best? A. A simple board game B. A stuffed animal C. Crayons and coloring books D. Large dump and garbage trucks - CORRECT ANSWER D. Large dump and garbage trucks These will most likely encourage physical activity and are an appropriate choice for a toddler Board games are too advanced Stuffed animal can provide comfort, but not physical activity Toddlers don't have to attention span for crayons and coloring books 2.66 The nurse is caring for an infant who raises her chest when lying on her stomach, is beginning to babble, and follows an object 180 degrees with her eye; how old is this infant most likely to be? A. 4 weeks B. 3 months C. 4 months D. 5 months - CORRECT ANSWER B. 3 months The infant should have master these skills prior to 4 and 5 months The 4 week old cannot do these skills 2.67 Which of the following is a cause for concern in a 6 month old? A. The infant does not sit without support B. The infant does not clap his hands C. The infant does not grasp and hold objects D. The infant does not have a pincer grasp - CORRECT ANSWER C. The infant does not grasp and hold objects The infant should grasp and hold objects by 3 months Sit without support - 8 months Pincer grasp - 9 months Clap Hands - 10-12 months 2.68 The mother of a 3 year old is concerned that he doesn't turn his head toward her when she is talking to him; which of the following is the nurse's best response. A. "The hearing doesn't mature for almost a year, keep an eye on him and we'll talk about it at his next visit." B. "He can most likely hear you, but lacks the muscular maturity to turn his head. His muscles will continue to develop over the next few months." C. "It's not uncommon for an infant's hearing to lack maturity at this a - CORRECT ANSWER D. "The can be a concern, tell me more about things that you've noticed regarding his hearing." A 3 month old should turn his head in response to sound; it is appropriate for the nurse to gather more information since further evaluation is required 2.69 A 4 month old is being evaluated in the development clinic; which of the following would be most concerning? A. He doesn't hold objects in his hands B. He doesn't rake objects with his hands C. He doesn't transfer objects from hand to hand D. He doesn't clap his hands - CORRECT ANSWER A. He doesn't hold objects in his hands Infants should be able to grasp and hold objects by 3 months 2.70 The nurse is caring for a girl and notes that she pushes up from her stomach unto her knees and rocks back and forth; which of the following most likely represents this girls age? A. 4 weeks B. 3 months C. 6 months D. 8 months - CORRECT ANSWER C. 6 months This skill is usually developed between ages 5-6 months 2.71 The mother of an infant asks the nurse at what age should she give her daughter cheerios as a snack; when providing an answer to the mother the nurse remembers that the printer grasp is usually developed by which of the following ages? A. 3 months B. 6 months C. 9 months D. 12 months - CORRECT ANSWER C. 9 months The pincer grasp usually develops by 9 months 2.72 A boy measured 20 inches at birth, he now measures 30 inches; which of the following most likely represents his current age? A. 6 months B. 12 months C. 18 months D. 24 months - CORRECT ANSWER B. 12 months An infant's length usually increases by 50% by 12 months From years 1-2, a toddler grows an average of 5 inches 2-3 years to adolescent age - 2.5 inches on average per year 2.73 A father tells the nurse that he has concerns regarding the manner in which his 12 month old son plays with his toys, he says that his son throws anything that is handed to him; which of the following is the nurse's best response? A. "It sounds like he is going to be a ball player one day!" B. "I wouldn't worry. This is typical behavior for boys." C. "Try not to worry. This is normal behavior. He is learning about his world by feeling hitting, and throwing objects." D. Try not to worry. It - CORRECT ANSWER C. "Try not to worry. This is normal behavior. He is learning about his world by feeling hitting, and throwing objects." 12 month old infants learn about objects and their environments in a variety of ways that include hitting and throwing 2.74 A 2 year old's mother needs to briefly leave the hospital to pick up the patient's sister from preschool, the mother is worried how the 2 year old will react; the nurse's best suggestion is: A. "Tell her that you need to get her sister and you will be back when lunch is over and Dora the Explorer comes on TV." B. " Tell her that you need to leave to get her sister and if she doesn't cry you will bring her a surprise." C. " Wait until she starts her nap and quietly sneak out. You'll be back - CORRECT ANSWER A. "Tell her that you need to get her sister and you will be back when lunch is over and Dora the Explorer comes on TV." 2 year old children understand time in terms of routine A toddler would comprehend that her mother is returning after lunch and at the start of her favorite show It is best to be honest with the toddler and explain when the parent will return in terms that she is capable of comprehending 2.75 The nurse is caring for a child who knows his first and last name, speaks 3-4 word sentences, and knows his age; this child is at least how old? A. 3 years old B. 4 years old C. 5 years old D. 6 years old - CORRECT ANSWER A. 3 years old 3 year olds should be able to speak in 3-4 word sentances 2.76 The nurse is observing a group of children playing at a park; she notes that one child is running and overhears her mother say, "Look at her go! She just learned how to run!" The nurse correctly estimates her age to be which of the following? A. 12 months B. 18 months C. 24 months D. 36 months - CORRECT ANSWER C. 24 months Most children develop the skill of running at 24 months 2.77 The mother of 1 year old asks how many words she should have in her vocabulary; the nurse emphasizes that each child's vocabulary develops in a unique manner and tells the mother that most 12 month olds have a vocabulary consisting of: A. 1-2 words B. 5 words C. 20 words D. 50 words - CORRECT ANSWER B. 5 words Most 1 year old children have a vocabulary of approximately 5 words 50 words is not usually developed until 18 months 2.78 A newborn girl was 22 inches at birth and now measures 44 inches; which of the following ages most likely reflects this girl's age? A. 1 year old B. 2 years old C. 3 years old D. 4 years old - CORRECT ANSWER D. 4 years old The child's birth length typically doubles by the time the child reaches 4 years of age 2.79 The nurse is working in the developmental clinic evaluating a 4 year old girl; which of the following would be the greatest cause for concern? A. She cannot tie her shoes B. She does not have a best friend C. She owes not enjoy board games D. She cannot throw a ball overhand - CORRECT ANSWER D. She cannot throw a ball overhand A child should develop the skill of throwing a ball over hand by the age of 4 The other three skills are developed during the school age years 2.80 A boy enjoys copying shapes and can identify most colors, he draws a picture of the nurse with just two body parts; this boy is most likely to be how old? A. 2 years old B. 3 years old C. 4 years old D. 5 years old - CORRECT ANSWER C. 4 years old The described skills are typical of most 4 year olds 2.81 The nurse asks a child if it is ever OK to tell a fib, the child responds, "I think that telling a lie to get out of trouble is wrong, but telling your mom you like her hair cut when it's really ugly is OK." What age is this child likely to be? A. 7 years old B. 8 years old C. 9 years old D. 10 years old - CORRECT ANSWER D. 10 years old Most 10 year old children can recognize shades of gray and see beyond the firm concept of right and wrong Children ages 7-9 have a rigid concept of right and wrong 2.82 The school nurse is teaching a health education class to a group of adolescents, one of the in the class asks the nurse when she should expect her period to start; the nurse knows that the average age of the start of the menses is which of the following: A. 13 years B. 12 years C. 11 years D. 10 years - CORRECT ANSWER A. 13 years The average age of menarche is 13 years of age 2.83 Which of the following is accurate regarding puberty in females? A. The growth spurt occurs before menarche B. Pubic hair develops after menarche C. Breast development is the last sign of puberty D. Breast development begins between ages 12-13 years - CORRECT ANSWER A. The growth spurt occurs before menarche Profession of female puberty: Breast development at age 10 Pubic hair at age 11 Height spurt at age at age 12 Menarche at age 13 2.84 Which of the following is the first sign of puberty in males? A. Testicular enlargement B. Pubic hair development C. Growth spurt D. There is no specific order of events as puberty follows an individual development pattern - CORRECT ANSWER A. Testicular enlargement Progression of male puberty: Testicular enlargement at age 11 Pubic hair at age 12 Height spurt at age 13-14 2.85 In comparing the height growth spurt among males and females, which of the following is accurate? A. Girls tend to experience the growth spurt at a later age than boys B. Girls have a low potential for growth after the beginning of menarche C. The height growth spurt in males occurs 2 years earlier than girls D. Girls have a longer period in which to grow - CORRECT ANSWER B. Girls have a low potential for growth after the beginning of menarche Menarche is the last pubertal event for females (occurring after the height spurt), females will experience very little linear growth reaching adult height Since the female growth spurt occurs early in puberty, girls have a shorter time period in which to grow 2.86 Which of the following is an important nursing intervention to reduce the risk of sudden infant death syndrome? A. Allow only small stuffed animals, not pillows in the crib B. Encourage the use of a pacifier C. Only encourage infants with gastro-esophageal reflux to be placed on their stomachs for sleep D. Only allow co-sleeping in breast feeding infants - CORRECT ANSWER B. Encourage the use of a pacifier All infants should be placed on their backs to sleep in order to reduce the incidence of SIDS SIDS is associated with: soft crib mattresses, pillows/stuffed animals inside the crib, co-sleeping Recommendations for safe sleep: firm mattress, no soft items placed inside the crib, avoid co-sleeping (suffocation risk or crush risk), pacifier use while sleeping, breast feeding for the first 6 months, no positioning devices for sleep, routine childhood immunizations 2.87 A bottle-fed 3 month infant's is brought to the pediatrician's office for a well-child visit; during the previous visit, the nurse taught the mother about infant nutritional needs; which statement by the mother during the current visit indicates effective teaching? A. "I started the baby on cereals and fruits because he wasn't sleeping through the night." B. " I started putting cereal in the bottle with formula because the baby kept spitting up." C. "I will start my baby on infant cereal b - CORRECT ANSWER C. "I will start my baby on infant cereal between 4-6 months." Infant should begin solid foods in the form of rice cereal and fruits between 4-6 months 2.88 The nurse should begin lead screening when the child reaches what age? A. 6 months B. 12 months C. 18 months D. 24 months - CORRECT ANSWER A. 6 months Should start at the 6 month primary car visit using a standard lead screening questionnaire - then should be continued at regularly scheduled visits 2.89 A mother plans to provide her baby with breast milk postoperatively; the nurse instructs the mother in the use of a breast pump because: A. Pumping will maintain the mother's breast milk supply B. Bottle feeding pumped breast milk is a more accurate way of monitoring intake and output postoperatively C. Giving the mom a task that will help her baby postoperatively will help to promote mother-infant attachment D. Most infants are unable to breast feed postoperatively - CORRECT ANSWER A. Pumping will maintain the mother's breast milk supply Use of a breast milk pump when the infant is NPO will help the mother to maintain her milk supply so that it will be available for the baby postoperatively; pumped breast milk can be stored for use in the event that the mother is unavailable to breast feed the baby 2.90 You are the nurse working at a telephone triage hotline; the mother of a 2 year old reports her son has swallowed an unknown substance; you instruct the mother to call poison control and to: A. Give milk B. Give water C. Give syrup of ipecac D. Make the child NPO and avoid induction of vomiting - CORRECT ANSWER D. Make the child NPO and avoid induction of vomiting Keeping the child NPO and avoidance of vomiting is the treatment of choice for pediatric ingestion Syrup of ipecac is no longer recommended Vomiting could damage the upper GI tract 2.91 A mother is concerned about her healthy infant starting him on baby foods; you know the earliest time to start baby food is: A. 3 months B. 4 months C. 6 months D. When the infant starts waking up at night - CORRECT ANSWER B. 4 months The child is physiologically ready for the introduction of baby foods at 4 months when the tongue extrusion reflex disappears 2.92 Which of the following is not a risk factor for iron deficiency anemia in infants? A. Prematurity B. Multiple birth C. Drinking whole milk at 9 months D. Introduction to baby food - CORRECT ANSWER D. Introduction to baby food This is generally not associated with iron deficiency Prematurity - the majority of of maternal iron transfer to the fetus occurs during the third trimester Multiple birth - maternal iron stores (which are transferred during the third trimester) are shared among multiple fetuses and typically born prematurely Whole milk is a poor source of iron and therefore should not be introduced until 1 year when the infant is eat iron rich foods 2.93 Whole milk is essential in which of the following age groups: A. 9 to 11 months B. 1 to 2 years C. >2 to 3 years D. >3 years to puberty - CORRECT ANSWER B. 1 to 2 years Whole milk is essential for children 1 to 2 years of age because the body requires fat to myelinated the developing brain Children under 12 months of age should not receive whole milk because it is an inadequate source of iron - the should be given breast milk After 2 years of age children can drink 1% or 2% milk to reduces fat and calorie intake while still getting calcium, vit D, and some fat for body growth 2.94 Which of the follow formula feeding patterns would warrant further evaluation for a 1 year old infant? A. 4 feedings of 5oz each B. 5 feedings of 8oz each C. 3 feedings of 6oz each D. 4 feedings of 6oz each - CORRECT ANSWER B. 5 feedings of 8oz each The 1 year old should drink 16-24oz of whole milk 2.95 When you are instructing the mother of a healthy infant about the introduction of baby food to her baby, you know that the recommended order of progression for baby food introduction is: A. Fruit, vegetables, cereals B. Fruit, meat, cereals C. Cereals, fruit, meat D. Cereals, meat, vegetables - CORRECT ANSWER C. Cereals, fruit, meat The order of introduction is iron fortified, single grain cereals, then fruits or yellow/orange vegetables, and then meats 2.96 An 8 year old girl is being admitted today for a diagnostic evaluation; you know that she is in which of the following developmental stages according to Erikson A. Identity vs. role confusion B. Industry vs. inferiority C. Initiative vs. guilt D. Autonomy vs. doubt and shame - CORRECT ANSWER B. Industry vs. inferiority She is a school age child and in the developmental stage of industry vs. inferiority 2.97 A 3 year old is fearful of healthcare professionals; what would be most helpful while performing his assessment? A. Save uncomfortable procedures such as abdominal palpation for the end of the assessment B. Have the boy hold on to a favorite stuffed animal during the assessment C. Encourage him to put the blood pressure cuff on his stuffed bear and take the bear's blood pressure D. Attempt to obtain most of his assessment while he is asleep including painful procedures - CORRECT ANSWER C. Encourage him to put the blood pressure cuff on his stuffed bear and take the bear's blood pressure Play therapy is an effective way to help the child work through the stress of hospitalization 3.1 The parents of a 2 year old with chronic otitis media are concerned that this has affected the child's hearing; which suggests the child has a developed a hearing impairment? A. Stuttering B. Using gestures to express desires C. Babbling continuously D. Playing alongside rather than interacting with peers - CORRECT ANSWER C. Babbling continuously Most common cause for failure to speak/speech delay is a hearing impairment A 2 year old should be speaking in 2-3 word sentences 3.2 A 10 month old child with recurrent otitis media is brought in to clinic; to help determine cause, the nurse asks the parents: A. "Does water ever get into the baby's ears?" B. "Do you give the baby a bottle to take to bed?" C. "Have you noticed a lot of wax in the baby's ears?" D. "Can the baby combine two words when speaking?" - CORRECT ANSWER B. "Do you give the baby a bottle to take to bed?" Primary cause of otitis media is bottle propping and drinking from a bottle in recumbent position. Ear wax is not associated with otitis media. 3.3 Which of the following would be the most concerning finding for the child who has just had a tonsillectomy? A. Fever of 101 B. Increased swallowing C. Pain score of 4/10 D. Pain score of 7/10 - CORRECT ANSWER B. Increased Swallowing Priority nursing intervention is assessment for post-surgical bleeding - increased swallowing is a sign of bleeding 3.4 When planning care for a child with epiglottis is, the nurse should assign highest priority to which of the following interventions? A. Providing psychological support B. Ensuring respiratory patency C. Instituting infection control practices D. Administering prescribed drug therapy - CORRECT ANSWER B. Ensuring respiratory patency Epiglottis is a medical emergency in which the airway closes due to a progressive inflammation caused by infection of the epiglottis Typically effects toddlers and preschoolers Priority nursing intervention is to obtain intubation/tracheostomy equipment The airway should not be examined unless preparing for intubation/tracheostomy 3.5 The nurse is caring for a school age child with cystic fibrosis; which of the following sports would be most appropriate for this child? A. Basketball B. Golf C. Swimming D. Baseball - CORRECT ANSWER C. Swimming Children with cystic fibrosis benefit from exercise that promote deep breathing and adequate pulmonary toilet (hygiene) 3.6 When is the best time to administer pancreatic enzymes for the child with cystic fibrosis? A. 30 min before meals B. Immediately before meals C. In the middle of a meal D. 30 min after a meal - CORRECT ANSWER B. Immediately before meals Pancreatic enzymes for a child with cystic fibrosis should be given immediately before meals; they are given to improve absorption, particularly of fats 3.7 Which of the following respiratory conditions is a medical emergency? A. Asthma B. Cystic fibrosis C. Epiglottitis D. Laryngotracheobronchitis (LTB) - CORRECT ANSWER C. Epiglottitis This should always be treated as a medical emergency - its an infection causing inflammation of the epiglottis that causes an acute narrowing of the supraglottis which can cause acute respiratory arrest and eventually occlusion of the airway The nurse should gather equipment in preparation for an intubation/tracheostomy 3.8 The nurse knows that infants and children are more prone to otitis media because: A. The Eustachian tubes are short and in a horizontal position B. Children are always putting objects and fingers in their ears C. The have immature immune systems D. They eat by sucking, which increases susceptibility to ear infections - CORRECT ANSWER A. The Eustachian tubes are short and in a horizontal position 3.9 The nurse will do which of the following for the child with epiglottitis? A. Avoid using oropharyngeal suctioning due to potential airway obstruction B. Avoid using oropharyngeal suctioning due to contamination C. Use oropharyngeal suctioning to remove secretions D. Prepare to use bag-mask ventilation - CORRECT ANSWER A. Avoid using oropharyngeal suctioning due to potential airway obstruction Epiglottitis is commonly caused by bacteria Haemophilus Infuenzae Type B (HIB) Nurse should be quick to obtain emergency intubation and tracheostomy equipment Nurse should avoid manual assessment of airway or suctioning due to the risk of inducing complete airway obstruction 3.10 A nurse is caring for 5 year old who had a tonsillectomy; which of the following symptoms would indicate immediate postoperative complications? A. Spitting out brown, coffee-ground colored secretions B. Complaining of a sore throat and refusing liquids C. Vomiting bright red blood D. Crying - CORRECT ANSWER C. Vomiting bright red blood The greatest post-op complication of a tonsillectomy is risk of bleeding Tachycardia and increased swallowing are signs of potential bleeding at operative site 3.11 A 2 year old is in a pediatric unit with a diagnosis of pneumonia; in addition to albuterol, the patient is to receive chest physiotherapy, percussion, and postural drainage (PPD); which of the following represents the most effective way in which the treatment should be carried out? A. Administer albuterol immediately before preforming PPD, preform PPD 30 min before the patients next meal. B. Administer albuterol immediately after preforming PPD, preform PPD 30 min before the patients next - CORRECT ANSWER A. Administer albuterol immediately before preforming PPD, preform PPD 30 min before the patients next meal. To maximize the effectiveness of the respiratory treatment, aerosol-nebulized medications should be administered prior to PPD therapy; PPD should not be done after a meal as the child is at risk for vomiting 3.12 The nurse is caring for a 4 year old who is hospitalized with bronchiolitis, the patient has a tracheostomy in place which needs to be suctioned periodically; which of the following represents appropriate care of the child with a tracheostomy? A. Prior to suctioning, the catheter should be measured against the extra tracheostomy tube and not insert more than 0.5cm beyond the length of the tracheostomy tube. B. Instill 2-3 drops of sterile saline into the tracheostomy prior to suctioning to - CORRECT ANSWER A. Prior to suctioning, the catheter should be measured against the extra tracheostomy tube and not insert more than 0.5cm beyond the length of the tracheostomy tube. The will prevent trauma and subsequent inflammation to the tracheal wall Instillation of saline is not recommended as it encourages the colonization of bacteria and leads to infection It is essential that there are 2 additional tracheostomy tubes at the bedside, one that is the current size, and one that is one size SMALLER - the smaller one is used if the stoma can no longer accommodate the larger size 3.13 The nurse is reviewing the following results of a blood gas: pH 7.32; PaO2 88: PCO2 48 Which of the following best describes the results? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis - CORRECT ANSWER A. Respiratory acidosis Normal pediatric pH is: 7.35 - 7.45 Normal CO2 is: 35 - 45 The pH is less - acidosis; elevated CO2 - respiratory disturbance 3.14 Which of the following would be priority treatment for a child diagnosed with respiratory acidosis? A. Have the child slow his breathing down be breathing into a paper bag B. Administer O2 and monitor the child's work of breathing, preparing for intubation as necessary C. Administer bicarbonate via IV infusion D. Have the child's guardian attempt to help calm the child and slow his breathing down - CORRECT ANSWER B. Administer O2 and monitor the child's work of breathing, preparing for intubation as necessary The administration of O2 and preparation for intubation is the treatment for respiratory acidosis which indicates that the child's is in respiratory failure 3.15 The nurse is caring for a child who is noted to have inspiration stridor; the nurse know that is indicated which of the following? A. The child is attempting to prolong the exchange of O2 and CO2 B. Air within the lungs has been replaced by fluid C. There is edema within the upper airway D. There is inflammation within the narrow passages of the lungs - CORRECT ANSWER C. There is edema within the upper airway Stridor is heard wither audibly or on auscultation when there is edema within the upper airway (trachea) 3.16 The nurse is helping a nursing student who is caring for a 12 year old with cystic fibrosis, the patient has had problems with chronic hypoxemia most of his life; Which of the following would indicate that the patient is having acute respiratory distress? A. Barrel shapped chest B. Clubbing of the toes C. Intercostal retractions D. Having to take a breath after each sentence - CORRECT ANSWER C. Intercostal retractions Indicates that the child is having to work harder to maintain respiration's and indicates acute respiratory distress Clubbing of the toes and a having a barrel chests are both chronic findings Having to take a breath after each sentence is an expected finding 3.17 A 10 month old arrives to the clinic with difficulty breathing, the nurse assesses the infant has a respiratory rate of 45, the infant is using assessors muscles and occasionally grunts at the end of a respiration; the patient is awake and alert and appears pale but not cyanotic; which of the following is the most appropriate action fo the nurse to take? A. Allow the infant to remain in her mothers lap while the nurse obtains the patient's history B. Allow the mother to give the infant a b - CORRECT ANSWER D. Administer O2 and complete the assessment while the infant remains in the mother's lap The child is in respiratory distress and will benefit from supplemental O2, the remaining assessment should be obtained quickly and the nurse should call for assistance The child's anxiety should decrease if the infant remains in the mothers lap which could prevent worsening of the respiratory status 3.18 The parents of a 3 year old are concerned that the child may have allergies, they ask the nurse how they can differentiate between allergies and a cold. Which of the following is the nurse's best response? A. "Children with allergies always come from a family with a strong history of allergies." B. "Children with colds tend to sneeze more than children with allergies." C. "Children with colds always have yellow discharge from their noses." D. "Children with allergies tend to complain of it - CORRECT ANSWER D. "Children with allergies tend to complain of itchiness in their throats instead of pain." Allergies tend to cause pruritus of the throat instead of pain Allergies can occur without a familial history Allergies can cause more sneezing than upper respiratory infections 3.19 The nurse is caring for a 3 month old that has an upper respiratory infection and is congested with very thick secretions, the parents of the child are very anxious as this is the first time he has been ill; which of the following statements would be most helpful for the nurse to say to the parents? A. "Before each feeding, place a few drops of saline in each nostril and use the bulb syringe to suction the secretions." B. "Since the infant is so congested, he needs more fluids, replace one - CORRECT ANSWER A. "Before each feeding, place a few drops of saline in each nostril and use the bulb syringe to suction the secretions." In order to help the infant with an upper respiratory infection tolerate feeding, it is essential to help clear the nose so that the infant can breath while feeding The infant should be suctioned prior to feedings 3.20 A 2 week old has a 3 year old sibling with an upper respiratory infection, the parents are concerned that the new baby will also get a cold; which of the following is the nurse's best response? A. "The baby has maternal antibodies, so she won't get the siblings cold." B. "Have the infected child stay with her grandparent for the week for the newborn won't be exposed to the sibling's germs." C. "Have the infected child wash their hands frequently." D. "Have the infected child wear a mask to - CORRECT ANSWER C. "Have the infected child wash their hands frequently." The single most effective way in which to control the spread of organisms is through hand washing Hand washing is more effective than wearing a mask 3.21 The nurse is caring for a 2 year old who just had his tonsils removed; which of the following is the best way for the nurse to assess the patient's level of pain? A. Have the patient rate his pain on a modified scale of 1 to 5 B. Assume that the patient is in pain as a tonsillectomy is a painful procedure and administer analgesic every 4 hours C. Using the FACES scale, record the number corresponding with the face that most resemble the pt appearance at the time of pain assessment D. Assig - CORRECT ANSWER D. Assign a rating based on the FLACC scale The FLACC scale is the most effective way to quantify pain in the young child. A 2 year old is unable to rate their pain. The FACES scale is designed for children over the age of 3 and is correctly used when a child points to the face that resembles the best to the way they feel 3.22 The nurse in the out patient surgery center is caring for a 6 year old who just had a tonsillectomy, the patient is awake and alert and has just received pain medication; the nurse brings the lunch tray to the patient, which of the following should the nurse encourage the patient to try first? A. Vanilla ice cream B. Cherry popsicle C. Diluted apple juice D. Fruit punch - CORRECT ANSWER C. Diluted apple juice Although, clear liquids are usually tolerated best in the immediate post-operative period, liquids that are red in color should be avoided as they may be mistake for blood in the event that vomiting would occur 3.23 The nurse calls a parent to see how their 8 year old child is recovering from a tonsillectomy performed one day ago; which of the following statements would indicate that the child needs to be seen emergently? A. "He is sleeping but appears to be swallowing a lot." B. "He just had a coffee colored Messi." C. "He is complaining that his throat hurts more now than it did earlier today." D. "He is still not back to himself, he just wants to sleep and be left alone." - CORRECT ANSWER A. "He is sleeping but appears to be swallowing a lot." A child that appears to be frequently swallowing can actually be hemorrhaging and needs immediate attention 3.24 A parent asks the nurse if children will eventually outgrow having ear infections; the nurse keeps in mind that young children are more likely to get ear infections because of which of the following? A. Young infants are obligated nose breathers B. Young children have longer Eustachian tubes C. Young children have Eustachian tubes that are more horizontally positioned D. Young children are less likely to complete their dose of oral antibiotics - CORRECT ANSWER C. Young children have Eustachian tubes that are more horizontally positioned The tubes are shorter and are horizontally causing the child to be more susceptible to ear infections 3.25 The nurse is preparing to administer antibiotic ear drops to a 6 month old with otitis media; which of the following represents the correct administration of ear drops? A. Pull the ear down and back to open the canal B. Pull the ear up and back to open the canal C. Pull the ear down and forward to open the canal D. Pull the ear up and forward to open the canal - CORRECT ANSWER A. Pull the ear down and back to open the canal Less than 3 years old - pull down and back 3.26 The clinic nurse caring for a 10 month old with otitis media; which of the following recommendations will most assist in decreasing ear infections? A. If the baby is to receive a bottle, ensure that the baby is cradled and fed in a horizontal position B. Ensure the baby receives the pneumococcal vaccine series C. Eliminate the use of a pacifier D. Rinse the baby's mouth out with water after each feeding - CORRECT ANSWER B. Ensure the baby receives the pneumococcal vaccine series Risk factors for otitis media: - not receiving the pneumococcal vaccine series - being fed horizontally - use of a pacifier beyond 6 months (the vaccine plays a larger role) 3.27 The ER nurse is reviewing information on epiglottitis; which of the following is correct? A. Epigolottitis generally has gradual onset B. Epigolottitis is more common in the elderly C. Epigolottitis is associated with a viral upper respiratory infection D. Most children with epigolottitis refuse to drink - CORRECT ANSWER D. Most children with epigolottitis refuse to drink Epigolottitis can affect anyone at any age - younger children who have not been completely immunized are at higher risk Epigolottitis is associated with bacterial infection that leads to inflammation and obstruction of the epigolottitis - this makes it difficult for the child to drink and swallow 3.28 The ER nurse is scaring for a 3 year old who is suspected of having epiglottitis, the 3 year old who is very irritable and anxious is sheathed in her mother's lap leaning forward, she is drooling and points to her throat when the nurse asks what hurts; Which of the following should be included in the 3 year old's care? A. Allow the 3 year to play with the flashlight and tongue blade prior to examining her throat B. Allow the patient's mother to accompany her to radiology C. Quickly perform - CORRECT ANSWER B. Allow the patient's mother to accompany her to radiology Epiglottitis is a potentially life threatening emergency, inflammation and subsequent obstruction can occur The throat should never be examined unless by the team performing an intubation/tracheostomy Every attempt to keep the child calm should be made Only necessary parts of the assessment should be completed to keep the child calm 3.29 The nurse is caring for a 3 year old who is diagnosed with Croup, the nurse know that the organism that most likely led to croup in this child is: A. Streptococcus pneumonia B. Influenza A & B C. Staphylococcus aureus D. H. Influenzae - CORRECT ANSWER B. Influenza A & B 3.30 The nurse caring for. 4 year old with laryngotracheobronchitis (LTB); when reviewing patient history, the nurse should expect to find which of the following? A. The patient began having a 'seal' like cough immediately after dinner B. The patient's symptoms occurred on a winter evening C. The patient was noted to have inspiratory and expiratory wheezing to the lower lobes bilaterally D. The patient's conditioned worsened when she went outside - CORRECT ANSWER B. The patient's symptoms occurred on a winter evening Symptoms of LTB (croup) typically occur during cold weather, inspiratory stridor accompanies a 'seal' like cough that usually begins late during the night Being exposed to the cool damp outside air often causes symptoms to improve or disappear 3.31 A 3 year old who is being admitted with a diagnosis of croup and moderate respiratory distress; which of the following should be included in the plan of care? A. Encourage bed rest B. Limit fluids in order to decrease the risk of pulmonary edema C. Administer oral decadron D. If oral antibiotics are not well tolerated, administer IV antibiotics - CORRECT ANSWER C. Administer oral decadron Oral decadron serves to decrease inflammation of the upper airway in croup Antibiotics are not necessary since coup is typically viral 3.32 The nurse knows that the majority of cases of bronchiolitis are caused by: A. RSV B. Parainfluenza C. Adenovirus D. Streptococcus - CORRECT ANSWER A. RSV Most cases of bronchiolitis are cause by RSV Parainfluenza and adenovirus can cause RSV too Streptococcus does not cause RSV 3.33 The nurse is caring for a 3 month old who has been diagnosed with RSV; when obtaining history, the patient's mother mentions the patient was around his cousin who had RSV; how many days has it likely been since the patient last saw his cousin? A. 3 days B. 6 days C. 10 days D. 14 days - CORRECT ANSWER B. 6 days RSV incubation period is 5 - 8 days 3.34 The mother of 2 year old triplet boys in which one of them has been diagnosed with RSV, she knows RSV is highly contagious and wants to prevent the other 2 boys from getting infected; she asks the nurse how long RSV lives on toys and other surfaces, what is the nurse's best response? A. "Although RSV is contagious, it is very fragile and doesn't survive very long outside of the human body." B. "RSV can survive 30 - 60 min on things like toys." C. "RSV can survive up to 6 hours on hard surf - CORRECT ANSWER C. "RSV can survive up to 6 hours on hard surfaces." 3.35 A nursing student asks how RSV is spread, the nurse bases her response on which on the following? A. RSV is spread by direct contact with secretions and inhalation of droplets B. RSV is spread only by direct contact with secretions C. RSV is spread through direct contact with all body fluids D. RSV has been found in all body fluids including stool - CORRECT ANSWER A. RSV is spread by direct contact with secretions and inhalation of droplets 3.36 The nurse is caring for a 6 month old who is admitted with RSV was born 8 weeks premature and lives with parents who both smoke; the patient is very congested and is not interested in playing; which of the following would the nurse expect to see included in the plan of care? A. Place the patient on pulse oximetry and administer O2 as necessary B. Administer IV fluids at half maintenance rate C. Administer broad spectrum IV antibiotics D. Administer Albuterol every 4 hours as needed - CORRECT ANSWER A. Place the patient on pulse oximetry and administer O2 as necessary Patients with RSV should have their oxygen saturations monitored and given supplemental oxygen as required The patient is most likely not feeding well and probably dehydrated and should have IVF at more than half maintenance rate RSV does not require antibiotics - it's viral Albuterol is no longer used for RSV treatment 3.37 The school nurse is teaching a class about asthma to a group of teachers; which of the following should be included in the education? A. Asthma is the leading cause of acute illness in children B. Most children with asthma have a cough that disappears at night C. Asthma is the number on cause of hospitalizations among children D. Asthma has the potential to be fatal - CORRECT ANSWER D. Asthma has the potential to be fatal Asthma is the third leading cause of hospitalization among children less than 15 years old Asthma is the leading cause of chronic illness in children 3.38 The nursing student is preparing a poster project on pediatric asthma; when reviewing her poster, the nursing instructor questions which of the following statements? A. Inflammation only occurs when the child with chronic asthma is exposed to triggers B. Swelling of the airway and mucus production occurs during the acute phase of asthma C. The narrowing of the airway occurs due to bronchospasm D. Most children with chronic asthma have allergies - CORRECT ANSWER A. Inflammation only occurs when the child with chronic asthma is exposed to triggers Inflammation is thought to always be present in the child with chronic asthma 3.39 A 11 year old who has just been diagnosed with asthma; when reviewing the patient's history, the nurse would expect to hear which of the following? A. The patient has been complaining that she just can't get a 'deep enough breath' B. The patient has been having trouble on concentrating at school as she seems to cough a lot during the early afternoon C. The patient looks exhausted as she is not sleeping well at night D. The patient has noticed that breathing is difficult at times and she he - CORRECT ANSWER C. The patient looks exhausted as she is not sleeping well at night Children newly diagnosed with asthma often experience difficulty sleeping as they many have coughing spells during the night Children typically complain that they have chest tightness and difficulty with expiration, not inspiration Wheezing is usually noted on expiration, not inspiration 3.40 An 8 year old newly diagnosed with asthma is being discharged with several medications; when discussing potential side effects of her asthma medications, the nurse knows the mother needs more education when she makes which of the following statements A. "The patient may appear nervous and jittery after taking her quick relief medication." B. "The patient may complain of headache after taking her quick relief medication." C. "The patient may vomit after taking her quick relief medication." - CORRECT ANSWER D. "The patient may be irritable and sleep more while she gets used to her quick relief medication." Children usually complain of sleeplessness Sides effects from quick relief medications are nervousness, tremors, vomiting, headaches 3.41 After a patient on a pulmonary clinic takes his controller medication, the nurse instructs the patient to do the following? A. Breath in and out several times and cough vigorously B. Meticulously wash his hands C. Rinse his mouth D. Lie down and rest - CORRECT ANSWER C. Rinse his mouth Controller medications can lead to thrush, so the child should be instructed to rinse his mouth 3.42 An 11 year old with chronic asthma, after being exposed to smoke, complains that her chest feels tight and it is difficult to breathe, the patient is speaking in 2 word sentences and audibly wheezing on expiration; which medication is indicated? A. Leukotriene modifier B. Long-acting inhaled beta 2 agonist C. Oral corticosteroids D. All of the above - CORRECT ANSWER C. Oral corticosteroids These are considered to be a medication of choice for the acute asthma exacerbation Leukotriene modifier and long-acting inhaled beta 2 agonist are used for long term control of asthma 3.43 The nurse is reviewing information regarding cystic fibrosis; which of the following is true? A. The exocrine glands are dilated and release excessive amounts of abnormally thick mucus B. It is an inherited autosomal dominant disease C. Most children have an excess of lipase, amylase, and trypsin D. Adolescents with cystic fibrosis may develop diabetes - CORRECT ANSWER D. Adolescents with cystic fibrosis may develop diabetes Cystic fibrosis is an autosomal recessive disease where the exocrine glands are obstructed by the abnormally thick mucus Most children are lacking in lipase, amylase, and trypsin due to pancreatic mucus obstruction Secondary diabetes is attributed to the obstruction of the pancreas 3.44 The nurse is caring for a 2 year old who has just been diagnosed with cystic fibrosis; when performing the assessment and reviewing history, which of the following would the nurse expect to find? A. Stools containing undigested food B. A chronic dry cough C. Although short stature, the patient is over the 75th percentile for weight D. a tendency to produce and excessive amount of sweat - CORRECT ANSWER A. Stools containing undigested food Children with cystic fibrosis have difficulty with absorption and tend to have stools that contain fat and undigested food. Due to malabsorption - child with CF are usually very small and may be diagnosed with failure to thrive Typically have a wet cough due to excessive mucus 3.45 The mother of a 10 year old with cystic fibrosis asks the nurse if there is a specific diet that should be followed; which of the following is the nurse's best response? A. "Your child should eat foods that are high in calories and protein." B. "Your child should eat foods that are high in calories and protein but low in salt." C. "Your child should eat foods that are low in protein and calories to help avoid diabetes." D. "Your child should eat foods that are low in calories but high in p - CORRECT ANSWER A. "Your child should eat foods that are high in calories and protein." Children should not avoid salt as they lose salt in their sweat Avoiding the consumption of high calories will not prevent development of secondary diabetes 3.46 The nurse is evaluating an 8 year old who has cystic fibrosis, the patient currently has a fever and is complaining of feeling congested and coughing more, the nurse notes course lungs sounds; which of the following would the nurse expect to be included in the plan of care? A. Admit the patient for IV antibiotic administration B. Send the patient home with oral antibiotics C. Send the patient home with oral antibiotics and suggest to take a cough suppressant as necessary D. Send the patien - CORRECT ANSWER A. Admit the patient for IV antibiotic administration Children with CF are at high risk for pulmonary infections a bacteria tend to grow in mucus and should be treated aggressively with antibiotics Cough suppressants are not recommended - the child needs to cough and expectorate the mucus to prevent obstruction 3.47 The nurse knows that a mother knows how to administer pancreatic enzymes to her a 3 year old with cystic fibrosis when she says which of the following? A. "Take the enzymes with meals, but not with snacks." B. "Take extra enzymes when the child eats a low fat meal." C. "Give more enzymes if the child has more than 3 stools in a day." D. "As long as the child is not losing weight, I will know the child is getting her enzymes." - CORRECT ANSWER C. "Give more enzymes if the child has more than 3 stools in a day." Enzymes are given with all snacks and meals Extra enzymes are required with meals high in fat' Enzymes are adjusted by the number of stools in a day - the goal is to have 2-3 stools per day 3.48 The nurse is providing education to a group of adolescents when one teen asks if people with cystic fibrosis have fertility problems; when answering the questions, the nurse considers which of the following? A. Females with CF are almost always infertile B. Males with CF are almost always infertile C. People with CF do not have a higher incidence of infertility than is found in the general public D. There is not enough data to support an answer, as not enough children with CF have survived - CORRECT ANSWER B. Males with CF are almost always infertile Although females with CF may have difficulty conceiving due to thickened cervical mucus, pregnancy remains a strong possibility Most males are infertile due to the blockage of the vas deferens People with CF are surviving into adulthood so enough data exists to draw conclusions regarding fertility 3.49 A 3 year old is suspected of having a foreign body aspirations; which of the following is true concerning foreign body aspiration? A. The aspiration of an item such as a bean usually has fewer repercussions than the aspiration of a small toy like a lego or Barbie shoe B. Aspiration of an item within the larynx poses less danger than aspiration within the lungs C. Items are more likely to end up in the left bronchus than the right bronchus D. It is possible for some items to be expelled spo - CORRECT ANSWER D. It is possible for some items to be expelled spontaneously Can occur when the child coughs An item such as a bean can absorb moisture and swell causing an obstruction Items in the larynx can cause complete airway obstruction Items are more likely to end up in the right bronchus because it is straighter and wider than the left 3.50 The nurse is teaching a class on sudden infant death syndrome (SIDS) to a group of new parents; the nurse knows that more education is needed when one parent states that their child is at increased risk for SIDS because: A. They place their infant in the prone position for sleep B. They like to place several thick blankets on their infant during sleep C. They sleep with their infant D. There infant was very large at birth - CORRECT ANSWER D. There infant was very large at birth The cause of SIDS remains unknown Risk factors are: sleeping prone, exposure to smoke, overheating, co-sleeping, low birth weight Large birth weight does not increase the risk for SIDS 3.51 The nurse is teaching a class to expectant parents about how to prevent sudden infant death syndrome; which of the following should be included in education? A. Promote pacifier use after the first 6 months B. Place the infant to sleep on one of its sides C. Avoid exposure to passive smoke D. Feed in an upright position - CORRECT ANSWER C. Avoid exposure to passive smoke Strategies to reduce risk: pacifier use IN the first 6 months, avoiding passive smoke, placing the infant on back to sleep, avoiding over heating, avoiding co-sleeping Feeding upright prevents otitis media, not SIDS 3.52 Which of the following is a late symptom of carbon monoxide poisoning? A. Dull headache B. Dizziness C. Weakness D. Chest pain - CORRECT ANSWER D. Chest pain Early symptoms: dull headache, dizziness, weakness Late symptom: chest pain, loss of consciousness, death 3.53 Which of the following acid-base imbalance is present in the following ABG? pH: 7.32; CO2: 48; HCO3: 23 A. Respiratory acidosis B. Metabolic acidosis C. Respiratory alkalosis D. Metabolic alkalosis - CORRECT ANSWER A. Respiratory acidosis pH: 7.35-7.45 CO2: 35-45 (acid) (respiratory) HCO3: 22-26 (base) (metabolic) 3.54 Which of the following acid-base imbalance is present in the following ABG? pH: 7.31; CO2: 43; HCO3: 19 A. Respiratory acidosis B. Metabolic acidosis C. Respiratory alkalosis D. Metabolic alkalosis - CORRECT ANSWER B. Metabolic acidosis pH: 7.35-7.45 CO2: 35-45 (acid) (respiratory) HCO3: 22-26 (base) (metabolic) 3.55 Which of the following acid-base imbalance is present in the following ABG? pH: 7.48; CO2: 30; HCO3: 24 A. Respiratory acidosis B. Metabolic acidosis C. Respiratory alkalosis D. Metabolic alkalosis - CORRECT ANSWER C. Respiratory alkalosis pH: 7.35-7.45 CO2: 35-45 (acid) (respiratory) HCO3: 22-26 (base) (metabolic) 3.56 Which of the following acid-base imbalance is present in the following ABG? pH: 7.47; CO2: 41; HCO3: 28 A. Respiratory acidosis B. Metabolic acidosis C. Respiratory alkalosis D. Metabolic alkalosis - CORRECT ANSWER D. Metabolic alkalosis pH: 7.35-7.45 CO2: 35-45 (acid) (respiratory) HCO3: 22-26 (base) (metabolic) 4.1 48 hours after birth, a neonate has not passed meconium; the nurse suspects which condition? A. Cystic fibrosis B. Celiac disease C. Intussusception D. An abdominal wall defect - CORRECT ANSWER A. Cystic fibrosis Failure to pass meconium in the first 48 hours of life is associated with cystic fibrosis 4.2 The nurse is providing dietary teaching for the parents of a child with celiac disease; this child should avoid: A. Vegetables B. Fruits C. Prepared pudding D. Rice - CORRECT ANSWER C. Prepared pudding Celiac diseases is a gluten induced enteropathy caused by an insensitivity to gluten found in wheat 4.3 A toddler is brought to the ED with sudden onset of abdominal pain, vomiting and stools that look like red currant jelly; to confirm intussusception, the nurse expects the doctor to order which of the following test? A. A barium enema B. Suprapubic catheter insertion C. Nasogastric tube insertion D. In dwelling urinate catheter insertion (foley) - CORRECT ANSWER A. A barium enema Intussusception is a telescoping/invagination of a bowel segment into itself. The classic symptom is currant jelly-like stools. Diagnosis is made based on the administration of a barium or water-soluble contrast with air pressure enema in order to reduce the invagination of the bowl segment Unsuccessful enema - surgery is then indicated to remove the gangrenous portion of the bowel 4.4 What is the most common assessment finding in a child with ulcerative colitis? A. Abdominal cramps B. Bloody diarrhea C. Anal fissures D. Abdominal distention - CORRECT ANSWER B. Bloody diarrhea Ulcerative colitis is a form of inflammatory bowel disease (IBD) involving symmetrical and contiguous bowel ulcers attacking th mucosa of the bowel wall in the large intestine Edema and inflammation in the bowel leads to the bloody diarrhea, weight loss, anorexia, nausea, and vomitting 4.5 When caring for a 12 month old infant with dehydration and metabolic acidosis, the nurse expects to see which of the following? A. A reduced white blood cell count B. A decreased platelet count C. Shallow respirations D. Tachypnea - CORRECT ANSWER D. Tachypnea A child with metabolic acidosis will develop compensatory tachypnea in order to blow-off CO2 (physiologic acid) and thereby reduce overall acidosis 4.6 A 10 month old is admitted to the hospital with dehydration and metabolic acidosis; what is the most common cause of dehydration and acidosis in infants? A. Early introduction of solid foods B. Inadequate perianal hygiene C. Tachypnea D. Diarrhea - CORRECT ANSWER D. Diarrhea Diarrhea is a common cause of metabolic acidosis among infants The infant with diarrhea loses HCO3 in the stool, therefore develops metabolic acidosis 4.7 You are the nurse caring for a newborn who was just delivered and you suspect the child has tracheo-esophageal fistula; which set of symptoms would suggest this problem? A. Drooling and diarrhea B. Increased mucus production and oral secretions C. Air distension in the stomach and vomiting D. Persistent cyanosis and visible peristaltic waves - CORRECT ANSWER B. Increased mucus production and oral secretions Tracheo-esophageal fistula involves the communication between trachea and esophagus Infants born with this condition have symptoms of respiratory distress and difficulty managing oral secretions Nursing interventions include keeping the child NPO, assuring suction and ventilation equipment are available at the bedside to manage excessive oral secretions and respiratory distress 4.8 Your patient is suspected of having Hirschsprung's disease; the nurse would expect the child's history of present illness to include which of the following? A. Anemia, abdominal distention, fecal soiling B. Abdominal distention, constipation, foul smelling stools C. Blood diarrhea, fever, vomiting D. Irritability, severe abdominal cramps, fecal soiling - CORRECT ANSWER B. Abdominal distention, constipation, foul smelling stools Hirschsprung's disease is a congenital anomaly of decreased intestinal motility resulting in obstruction of the large intestine Clinical manifestations in newborns are: vomiting, constipation, and abdominal distention Clinical manifestations in older infants are: chronic constipation with ribbon-like, foul smelling stools, and chronic abdominal distention 4.9 You are caring for a newborn who is being evaluated for imperforate anus; which of the following nursing interventions would be most important? A. Maintaining NPO status B. Taking auxiliary temperatures only C. Providing warm soaks to eat anal area D. Maintaining the child in a supine position - CORRECT ANSWER A. Maintaining NPO status The newborn with imperforate anus will require surgical correction soon after birth Maintaining NPO status for operation is most important 4.10 You are caring for a 7 month old who is suspected of having intussusception; what clinical manifestations would most likely be present? A. Abdominal pain, vomiting, olive shaped mass to the right of the umbilicus B. Anorexia, abdominal distention, constipation C. Malnourished looking child, fever, diarrhea D. Inconsolable crying, abdominal pain, sausages shaped mass in the right lower quadrant - CORRECT ANSWER D. Inconsolable crying, abdominal pain, sausages shaped mass in the right lower quadrant Intussusception is an acute condition involving the telescoping of one portion of the bowel in on itself causing acute lymphatic and venous obstruction that results in ischemia, mucous back flow into the intestine and leaking of blood into the intestine The classic sign is currant jelly like stool A palpable sausage shaped mass can often be felt in the right lower quadrant Other clinical manifestations: episodic acute abdominal pain, drawing up of the knees, inconsolability, bilious vomiting 4.11 Which of the following is the most appropriate discharge teaching for the nurse caring for the child with Celiac disease? A. Eliminating corn, rice, and millet from the diet B. Adding iron, folic acid, and fat-soluble vitamins to the diet C. Reinforcing the short-term effects of the disease and the need to adhere to dietary restrictions until the disease is in remission D. Eliminating wheat, rye, barely, and oats from the diet - CORRECT ANSWER D. Eliminating wheat, rye, barely, and oats from the diet Celiac disease is an enteropathy caused by an insensitivity to gluten found in wheat; the result is a decreased area for nutrient absorption in the intestine Clinical manifestations are: failure to thrive, chronic diarrhea, abdominal distention, anorexia, muscle wasting 4.12 Which of the following assessments would you expect to mote when caring for the child with pyloric stenosis? A. Projectile vomiting of bile-tinged emesis B. Visible peristaltic waves C. Metabolic acidosis D. Non-projectile vomiting - CORRECT ANSWER B. Visible peristaltic waves Pyloric stenosis is the narrowing of the pyloric sphincter at the outlet of the stomach- as the pylorus narrows causing obstruction of the pyloric sphincter Clinical manifestations are: projectile vomiting of non-bilious vomitus, visible peristaltic waves across the epigastrum, signs of malnutrition and dehydration, abnormal electrolytes with signs of metabolic alkalosis 4.13 You are caring for a 3 year old admitted for diarrhea and dehydration, pt is ordered for IV fluids, pt weight is 13 kg; you calculate the hourly IVF rate to be approximately: A. 52 ml/hour B. 46 ml/hour C. 36 ml/hour D. 26 ml/hour - CORRECT ANSWER B. 46 ml/hour (1st 10 kg —> 4 ml/hour) + (2nd 10 kg —> 2 ml/hour) + (each additional kg —> 1 ml/hour) = IVF maintenance rate (10 kg x 4 ml/hour) + (3 kg x 2 ml/hour) = 46 ml/hour 4.14 A 3 year old's mother reported the child opening a bottle of medication she had in her purse; a diagnosis of accidental overdose is made, to verify the placement of the NG tube for charcoal administration, the nurse should: A. Instill air and auscultate over the upper left epigrastrum for a popping sound B. Assume correct placement as long as there is no choking or decreased oxygen saturation's C. Instill air and auscultate the upper chest to ensure the tube is not in the lungs D. After th - CORRECT ANSWER D. After the tube is placed, aspirate the contents and verify that the pH is less than 6 The contents of the NG tube should be aspirated and tested for pH, ph < 6 implies the contents are acidic and are from the stomach 4.15 The nurse is teaching a class to a group of new parents when one parent tells the nurse that her neighbor's infant was treated for esophageal burns from formula that was too hot; which of the following is the nurse's best response? A. "That is very unusual since most infants will spit out anything that is too hot or not palatable." B. "Although it is essential to warm a baby's bottle it should never be done in the microwave." C. "It is always important to test the temperature of the formul - CORRECT ANSWER C. "It is always important to test the temperature of the formula since a young baby will automatically swallow what is in it's mouth." 4.16 A 3 month old infant who is receiving tube feeds due to temporary malformation in the GI system; which of the following should the nurse encourage the parents to do during feedings? A. Sing of play music that is calming B. Stroke the infants hair and talk to it during feedings C. Give the infant a pacifier during the feeding D. Encourage the infant to creep during the feeding - CORRECT ANSWER C. Give the infant a pacifier during the feeding It is important for the infant receiving tube feedings to have episodes of non nutritive sucking - if offered concurrently with a feeding, sucking and mouth stimulation is associated with a positive content feeling 4.17 A 6 year old with severe cerebral palsy (CP) is the youngest of 4 siblings and is cared for at home; the nurse and parent are discussing daily rituals, which of the following is important for the child and family? A. The child receives tube feedings at the table during family meal times B. The child receives tube feedings before the family meal, so the at he can nap while the rest of the family is together, allowing the parents to have more time with siblings C. In order to save time, the - CORRECT ANSWER A. The child receives tube feedings at the table during family meal times It is important for the child that is unable to eat in a traditional manner to feel included and a member of the family 4.18 A 4 year old has been vomiting for 24 hours; several labs have been dropped, the nurse would expect the results to show which of the following A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis - CORRECT ANSWER B. Metabolic alkalosis Loss of stomach acid associated with vomiting leads to metabolic alkalosis 4.19 The nurse is caring for an 18 month old who has moderate diarrhea; which of the following should be included in the plan of care? A. Encourage drinking apple juice and sports drinks B. Have the infant eat bananas, rice, applesauce, and toast (BRAT diet) C. Ensure that all diapers are weighed D. keep the infant NPO for 4-6 hours to see if diarrhea subsides - CORRECT ANSWER C. Ensure that all diapers are weighed Pt should be placed on strict intake and output measures 4.20 The nurse is working in the ER when a 4 year old is brought in for evaluation, the patient has been vomiting and having diarrhea for 2 days; the nurse notes the patient is pale, has dark circles around eyes, lethargic, doesn't cry or move when vitals are being performed; which of the following should the nurse anticipate will be included in the plan of care? A. Administer an IV bonus of normal saline B. Administer an IV bonus with fluids containing both saline and glucose to help correct d - CORRECT ANSWER A. Administer an IV bonus of normal saline The child has been experiencing vomiting and diarrhea and is lethargic and is already severely dehydrated and needs immediate rehydration It is essential to administer a hypotonic solution such as normal saline A solution containing glucose should never be given as a bonus as it could lead to cerebral edema and death 4.21 A 6 month old who vomited twice the morning had one episode of diarrhea; which of the following would indicate that the infant is no longer in the early stages of dehydration, but has progressed to severe dehydration? A. Increased heart rate B. Sunken fontanel C. Dry mucus membranes D. Decreased capillary refill - CORRECT ANSWER D. Decreased capillary refill Early signs of dehydration include a sunken fontanel, dry mucus membranes, increased HR Decreased capillary refill is a sign of blood pressure is a late and ominous sign 4.22 A 30kg child who is admitted for dehydration, currently NPO and receiving IVF at maintenance; what is the hourly rate that the IVF should be running at? A. 60 ml/hour B. 70 ml/hour C. 80 ml/hour D. 90 ml/hour - CORRECT ANSWER B. 70 ml/hour (1st 10 kg —> 4 ml/hour) + (2nd 10 kg —> 2 ml/hour) + (each additional kg —> 1 ml/hour) = IVF maintenance rate (10 kg x 4 ml/hour) + (10 kg x 2 ml/hour) + (10 x 1 ml/hour) = 70 ml/hour 40 + 20 + 10 =70 4.23 The nurse is caring for an 18 month old who is being evaluated for gastroesophageal reflux (GER); when reviewing history, the nurse would expect to find which of the following? A. The child was born 3 days after due date B. The child has a history of asthma C. The child is in the 50th percentile for both height and weight D. The child recently had intussusception reduced by a barium enema - CORRECT ANSWER B. The child has a history of asthma Risk factors for GER include prematurity, conditions that cause increased abdominal pressure such as coughing associated with asthma of a respiratory infection No correlation between GER and intussusception 4.24 The nurse is providing education to the parents of a 6 week old with gastroesophageal reflux (GER); which of the following should the the nurse include in her teaching plan? A. Although, most children should be put on their backs to sleep, this child should be placed on her side to avoid aspiration. B. The child should be fed smaller amounts in each feeding C. The time between the child's feedings should be stretched out as much as possible to assure that the stomach has fully emptied D. T - CORRECT ANSWER B. The child should be fed smaller amounts in each feeding Infants with GER tolerate small frequent feedings and held in an upright position for 30 minutes following a feeding The seated position should be avoided for 30 minutes following a feeding All infants should be placed on their backs during sleep to prevent SIDS - the side is considered an unstable position as infants can easily roll prone Caloric density of feedings may be increased, not decreased 4.25 A Parent asks the nurse if it matters when they give their infant ranitidine; which of the following is the nurse's best response? A. "Since ranitidine is an antacid it doesn't really matter when you give it to him." B. "It would probably be easiest to give it with feedings." C. "It would be best to give the medication 30 minutes before meals." D. "It would be easiest to give the medication 30 minutes after meals." - CORRECT ANSWER C. "It would be best to give the medication 30 minutes before meals." Antacids reduce esophagitis by decreasing the amount of acid present in the stomach contents It's most effective when given 30 minutes before a feeding 4.26 The clinic nurse is evaluating a 6 year old who has chronic constipation; which of the following should be included in the nurse's dietary recommendations to the patient and family? A. Increase liquids and fat while decreasing protein and fiber B. Increase liquids and protein while decreasing fiber and fat C. Increase liquids and fiber while decreasing protein and fat D. Increase liquids, fiber, and protein, while decreasing fat - CORRECT ANSWER C. Increase liquids and fiber while decreasing protein and fat 4.27 A 5 year old who is being evaluated for encopresis; which of the would the nurse expect to hear while obtaining patient history A. The child has adjusted well to kindergarten B. The child has been having fatty stools that float in the toilet water C. The child typically has soft formed stools 2-3 times a day D. The child has been having liquid stool stained underwear - CORRECT ANSWER D. The child has been having liquid stool stained underwear Encopresis is the involuntary leakage of stool in a child that has a history of severe constipation The bowel becomes so stretched from the amount of hard stool that there is interference with the muscle tone and nerves causing some stool to eventually leak out There is pain associated with the passing of hard stools and occasionally fissures are formed creating more resistance to the passage of stool Often a stressful change that the child is not coping with can lead to encopresis 4.28 The nurse is providing education on cleft lip and palate to a group of nursing students; it is apparent that more education is needed when a student states that the infants are at risk for: A. Pneumonia B. Otitis Media C. Altered bonding with parents D. Gastroesophageal reflux (GER) - CORRECT ANSWER D. Gastroesophageal reflux (GER) There is not an increase in GER in children with cleft lip/palate There is an increased risk of: aspiration (and subsequent pneumonia), otitis (cleft palate allows microorganisms to easily enter the ear canal), parent bonging (disfiguring defects can cause alterations in parents coping with their child) 4.29 The mother of an infant with a cleft palate tells the nurse that she is so disappointed because she probably wont be able to nurse; which of the following is the nurse's best response? A. "Some mothers are still able to nurse their babies, have you tried yet?" B. "I understand you're frustrated, let's talk about other ways to feel close to your child." C. "The risk of aspiration is too great, I know you want what's best for your child." D. "It will be hard enough to feed her with a bottle, - CORRECT ANSWER A. "Some mothers are still able to nurse their babies, have you tried yet?" In many cases, the mother's breast helps to fill in the cleft, allowing the infant to creat suctioning in it's mouth The mother may be assuming that breastfeeding is not an option Breastfeeding does not increase the risk of aspiration pneumonia 4.30 A 4 week old with a cleft lip and palate is scheduled for a surgical repair of the lip; the patients mother ask the nurse why the lip and palate aren't being repaired at the same time; the nurse's best response is: A. "They prefer to schedule the repairs separately to avoid using too much anesthesia." B. "The palate is generally not repaired until the patient has begun talking." C. "The palate needs to have an opportunity to grow and the repair requires the patient to be drinking from an o - CORRECT ANSWER C. "The palate needs to have an opportunity to grow and the repair requires the patient to be drinking from an open cup, usually about 6-12 months of age." The palate and lip are usually not repaired together as the palate needs time to grow and the child needs to be weaned to an open cup for drinking - it's typically repaired between 6 and 12 months of age before the speech patterns fully develop 4.31 The nurse's is caring for a 12 month old toddler who just had a cleft palate repair; which of the following should be including in the patients plan of care? A. Position the patient so that secretions drain from the mouth and suction her with a soft tipped catheter B. Encourage parents to hold and rock her frequently C. Attempt to keep the patient from crying, encourage the patient to hold favorite toys and to use a pacifier D. Keep the patient hydrated by offering her juice and liquids in - CORRECT ANSWER B. Encourage parents to hold and rock her frequently The child who has had a cleft palate repair should not do any activities that would interfere with the integrity of the suture line Any form of suctioning (pacifier, sippy cup) should be prohibited and the child should not cry 4.32 When developing a postoperative plan of care for an infant scheduled for cleft lip repair, the nurse should assign highest priority to which intervention? A. Comforting the child as quickly as possible B. Maintaining the child in a prone position C. Restraining the child's arms at all times, using elbow restraints D. Avoiding disturbing any crusts that form on the suture line - CORRECT ANSWER C. Restraining the child's arms at all times, using elbow restraints Nursing interventions following cleft lip repairs focus on monitoring for respiratory distress and maintaining an intact suture line The infant should be place supine an arms kept away from the surgical site with elbow restraints 4.33 You are caring for a 12 month old who has recently had surgery to repair a cleft palate; which of the following would be the best toy to stimulate this infant? A. Rattle B. A mobile C. Teething ring D. Something to bang - CORRECT ANSWER B. A mobile The key intervention following a cleft palate repair is to keep anything out of the mouth in order to prevent injury to the surgical site 4.34 The nurse is caring for a 12 month old who has just had a cleft palate repair, you would use which of the following to provide fluids to the child? A. Rubber-tipped syringe B. Bottle C. Medicine dropper D. Cup - CORRECT ANSWER D. Cup Objects must be kept away from the inside of the mouth to avoid rupture of the surgical site The cup is the most appropriate method for feeding 4.35 A 3 month old infant undergoes a surgical repair of a cleft lip; after the surgery would should the nurse teach the parents regarding how to feed with infant? A. Breast/bottle feeding B. Use a cup to to feed C. Use a paper straw D. Use a medicine dropper - CORRECT ANSWER A. Breast/bottle feeding An infant who undergoes cleft lip repair can be fed by bottle or breast after surgery being carful to reduce tension on the suture line 4.36 The greatest post-operative danger from a cleft palate repair is: A. Pain B. Rupture of suture lines C. Infection D. Dehydration - CORRECT ANSWER B. Rupture of suture lines The nurse should assess for bleeding, increased swallowing, tachycardia - which would indicate rupture of suture lines 4.37 An 8 week old is admitted for surgery to repair a cleft lip; what is the most important nursing intervention following surgery? A. Lay the baby prone to prevent aspiration B. Provide adequate oral nutrition C. Decrease stress on the suture line D. Use a hard nipple and pacifier in order to teach the child how to suck properly - CORRECT ANSWER C. Decrease stress on the suture line This is the most important nursing intervention - to prevent rupture of suture line 4.38 A newborn is diagnosed with tracheoesophageal fistula (TEF); when reviewing history, the nurse would expect to find which of the following? A. Tolerating feedings for a few days , them experienced projectile vomiting B. The mother to state she barely looked pregnant and never needed to wear maternity clothes C. Continuously appeared hungry despite being fed every 2 hours D. Appeared to have a lot of secretions and became cyanotic when fed - CORRECT ANSWER D. Appeared to have a lot of secretions and became cyanotic when fed The child with TEF is at risk for aspiration and respiratory distress due to the communication between the esophagus and trachea Children with TEF had an abundance of secretions and cough and choke and become cyanotic when eating - this child should be NPO and have the head of bed elevated Suction is needed and should be set up at bedside 4.39 The nurse is caring for a newborn with suspected tracheoesophageal fistula (TEF); when the parent tried to feed the newborn for the first time, the newborn became cyanotic coughed and choked; which of the following would the nurse expect to be after of the patient's care? A. Allow the parents to fed the newborn pedialyte slowly in a monitored area, stopping all feeds 6 hours before surgery B. Begin IV fluids and IV antibiotics C. Admit the newborn to the ICU and immediately place on 100% O - CORRECT ANSWER B. Begin IV fluids and IV antibiotics Oral feedings are immediately stopped when TEF is suspected An IV is placed and IVF are started to prevent dehydration IV antibiotics are started to prevent/treat pneumonia that is caused from aspiration 4.40 A 3 week old who is diagnosed with tracheoesophageal fistula (TEF), this defect was extensive and surgery needed to be done in multiple stages; the patient also had a gastrostomy tube (G-tube) placed until complete correction; when providing discharge instructions, the nurse would include which of the following: A. Clean around the G-tube site with hydrogen peroxide or betadine twice daily B. If the G-tube comes out during the night, it is acceptable to skip one feeding and call the pediat - CORRECT ANSWER D. Always check for residual formula before beginning the next feeding by attaching a syringe and gently withdrawing It is generally recommended that the parents check for residual feedings by gently withdrawing gastric contents Soap and water should be used to clean the G-tube site - hydrogen peroxide and betadine can cause skin breakdown If the G-tube comes out, it needs to be replaced with 2-4 hours to prevent the stoma from closing 5-10 mL should be used to flush the G-tube 4.41 A 1 day old neonate is suspected to have tracheoesophageal fistula (TEF); which nursing intervention is most appropriate for this infant? A. Avoiding suctioning unless cyanosis occurs B. Elevating the head of bed/crib and giving nothing by mouth C. Elevating the neonate's head for 1 hour after feedings D. Giving the neonate only glucose water for the first 24 hours - CORRECT ANSWER B. Elevating the head of bed/crib and giving nothing by mouth The child should remain NPO and the head of bed should be elevated Suction equipment is needed to handle excess secretions Ventilation equipment is indicated due to respiratory distress 4.42 The nurse is reviewing information on pyloric stenosis; which of the following reflects accurate information? A. It only occurs in males B. Vomiting will gradually become more projectile and contain more bile as the pyloric muscle thickens C. Surgical correction involves spreading open the muscle around the pyloric valve D. A sausage shaped mass can be palpated in the lower abdomen - CORRECT ANSWER C. Surgical correction involves spreading open the muscle around the pyloric valve Thereby relieving the obstruction by enlarging the plyorus The emesis should not include bile An olive-shaped mass can be palpated in the right upper abdomen 4.43 The nurse is caring for a 2 month old male with pyloric stenosis, the patient was admitted for rehydration prior to the pyloromyotomy; when the nurse reviews the patients blood work, the nurse is not surprised to find which of the following results? A. pH - 7.49; HCO3 - 29 B. pH - 7.49; HCO3 - 18 C. pH - 7.32; HCO3 - 29 D. pH - 7.32; HCO3 - 18 - CORRECT ANSWER A. pH - 7.49; HCO3 - 29 Children who require rehydration for pyloric stenosis have experience excessive vomiting and therefore have lost hydrogen and chloride ions This results in metabolic alkalosis where the pH an HCO3 are elevated 4.44 The nurse in a pediatric clinic asks a mother to bring her baby in for evaluation, the nurse suspects that the baby will be tested for pyloric stenosis when the mother states the following: A. "My baby spits up a little 45 minutes after every feeding." B. "My baby vomits right before I begin to give the next feeding." C. "When my baby vomits, it is forceful and green." D. "My baby still wants to eat right after vomiting." - CORRECT ANSWER D. "My baby still wants to eat right after vomiting." Infants with pyloric stenosis vomit within 30 minutes after feeding Their vomits can contain blood, but not bile (green) as the feeding does not advance beyond the pylorus Infants remain hungry after vomiting and usually want to feed again 4.45 The nurse is obtaining a history on a toddler with Hirschsprung's disease, the nurse asks about his bowel patterns and is not surprised when the patient's parent says which of the following? A. "My child tends to have long skinny stools." B. "My child occasionally has bloody stools that contain mucus." C. "My child always has large amounts of liquid diarrhea." D. "My child has very small constipated white stools." - CORRECT ANSWER A. "My child tends to have long skinny stools." Toddlers with Hirschsprung's tend to have long thin ribbon-like stools Diarrhea is associated with stool leaking around the constipated obstruction and tends to be infrequent small amounts Bloody stool is associated with intussusception The child with typically have constipation, stools are not white as there is not an absence of bilirubin 4.46 The nurse is teaching a group of nursing students about pathophysiology o Hirschsprung's disease; the nurse knows that a student understands the teaching when the student says which of the following? A. "In Hirschsprung's disease, there is an over abundance of ganglion cells which lead to the clinical manifestations." B. "In Hirschsprung's disease, the over active ganglion cells can cause inflammation of the bowel leading to obstruction." C. "In Hirschsprung's disease, the entire bowel is - CORRECT ANSWER D. "In Hirschsprung's disease, there is a section without peristalsis." In Hirschsprung's disease, there is an absence of ganglion cells in a segment of the bowel which leads to the lack of normal peristalsis activity in that specific area 4.47 A 1 year old diagnosed with Hirschsprung's disease; the toddler is likely going to have surgery in a few days; in the mean time, the nurse suggest with of the following diets? A. Low fiber, high calorie, high protein B. High fiber, high calorie, high protein C. Low fiber, low calorie, high protein D. High fiber, low calories, high protein - CORRECT ANSWER A. Low fiber, high calorie, high protein The recommended diet consists of foods that are low in fiber to lessen the stool bulk High calorie and high protein diets are recommended to help the child grow and heal from future surgical procedures 4.48 The nurse is caring for a 6 year old who has just been diagnosed with appendicitis; when the nurse is performing an assessment and gathering history, what should the nurse expect? A. The patient complains of increased pain when the nurse releases a hand from the patient's right lower quadrant B. The patient complains of increased pain when the nurse presses down on the patient's right lower quadrant C. The patient has a decreased white blood cell count D. The patient has increased bowel so - CORRECT ANSWER A. The patient complains of increased pain when the nurse releases a hand from the patient's right lower quadrant Rebound tenderness is considered a classic sign of appendicitis Increased white blood cell count and decreased bowel sounds are also seen in acute appendicitis 4.49 The nurse is caring for a 9 year old being evaluated for appendicitis, the patient initially complained of generalized pain, but now points to the right lower quadrant when asked where it hurts; the nurse knows that this location is referred to as which of the following? A. Rovsing sign B. McBurney's point C. Psoas sign D. Obtruator sign - CORRECT ANSWER B. McBurney's point It is located in the right lower quadrant of the abdomen and is commonly the location for the most tenderness in appendicitis Rovsing sign - occurs when pain is felt in the RLQ when the LLQ is palpated Psoas sign - is considered positive when abdominal pain is felt when the hips are flexed Obtruator sign - occurs when abdominal pain is felt when the thigh is flexed and rotated 4.50 A 4 year old who has just had their appendix removed, wakes up with parents at bedside; which of the following comments by the nurse would be the most developmentally appropriate? A. "When you fell better, your friends can come to visit." B. "There is a Band-Aid where the doctors took your appendix out." C. "You'll be able to return to preschool soon!" D. "Let's close the curtains while I look at your tummy." - CORRECT ANSWER B. "There is a Band-Aid where the doctors took your appendix out." The preschooler typically shows fear concerning body integrity, telling her that her wound is covered with a bandage will help dispel any fears that her body will leak through her wound Body integrity is usually a bigger concern compared to modesty at age 4 Concerns regarding school and friends are typical of school aged children 4.51 A 12 year old who has just returned from the recovery room after having an appendectomy, the patient had a perforated appendix and subsequently developed peritonitis; which of the following is the best position for the patient at this time? A. Prone B. Right side lying C. Left side lying D. Supine - CORRECT ANSWER B. Right side lying This is the ideal post-operative position for a child with periodontitis - this allows the peritoneal cavity to drain and decrease the risk of abscess formation 4.52 The nurse working in a clinic is told that a child with inflammatory bowel disease (IBD) is coming in for lab work; in order to care for this child, the nurse reviews IBD information, which of the following is accurate? A. Ulcerative colitis attacks all but the mucosa of the bowel B. Crohn's disease affects all layers of the bowel wall C. Ulcerative colitis unusually involves the small intestine D. Crohn's disease causes more blood loss than Ulcerative colitis - CORRECT ANSWER B. Crohn's disease affects all layers of the bowel wall Ulcerative colitis attacks the mucosa of the bowel while Crohn;s disease affects call layers of the bowel Ulcerative colitis usually involves the large intestine Ulcerative colitis generally causes more blood loss than Crohn's disease 4.53 The nurse is providing discharge instructions to a 14 year old with ulcerative colitis; which is the nurse's best advice regarding her diet? A. "You'll know what to eat and what to avoid by how your body responds. Keeping a journal is always a good idea." B. "It's recommended that you eat high protein, high calorie, and low fat foods." C. "It's recommended that you eat high protein, high calorie, and foods high in fat." D. "That is a good question; I'll have the dietician come talk to you. - CORRECT ANSWER B. "It's recommended that you eat high protein, high calorie, and low fat foods." The diet recommended for children with inflammatory bowel diseases (IBD) consists of foods, high in calories and protein to promote growth High fat foods are avoided as they can cause bowel irritability and cramping 4.54 A 12 year old diagnosed with inflammatory bowel diseases (IBD) has recently developed mouth ulcers and arthritis in joints; which of the following is likely occurring? A. The patient likely has Crohn's disease B. The patient likely has Ulcerative colitis C. It is impossible to distinguish the type of IBD that the patient has, but likely has a secondary inflammatory illness unrelated to the IBD D. The medications used to treat IBD have caused mouth ulcers and arthritis - CORRECT ANSWER A. The patient likely has Crohn's disease Crohn's disease is associated with extra intestinal manifestations such as arthritis Ulcerative colitis only affects the large intestine 4.55 The nurse is caring for a 4 year old with Celiac disease; when reviewing history, the nurse would expect to find which of the following? A. The patient has been tall for his age B. The patient has a history of fatty stools C. The patient didn't start solid food until 8 months of age D. The patient has elevated hematocrit and hemoglobin - CORRECT ANSWER B. The patient has a history of fatty stools People with Celiac disease do not absorb fat, therefore the stools tend to be fatty 4.56 The nurse is caring for a 6 year old with pneumonia who also has celiac disease, the dietary aide brings the lunch trays and asks what this patient can eat; which of the following lunches would be acceptable? A. Beef and barley soup, vanilla pudding, orange juice B. Pizza, applesauce, sprite C. Cheeseburger, corn chips, milk D. Grilled chicken, corn - CORRECT ANSWER D. Grilled chicken, corn People with celiac diseases should avoid foods that contain barley, wheat, oats, rye Corn is generally well tolerated 4.57 The nurse is presenting a review of necrotizing enterocolitis (NEC); the nurse knows that more information is needed when one of the students states which of the following? A. "Infants who receive CPR are at risk for developing NEC." B. "When the bowel dies, more mucus invades the bowel." C. "Extra gas would be seen on x-ray." D. "Bacteria can grow in formula." - CORRECT ANSWER B. "When the bowel dies, more mucus invades the bowel." When the bowel becomes necrotic, protective mucus is decreased 4.58 The nurse is caring for a premature infant in which the nurse is concerned with necrotizing enterocolitis (NEC) development; which of the following could indicate NEC? A. Prior to administering a feeding via nasogastric tube (NG-tube), the nurse checks for residual feeds and sic overs that none of the previous feed remains B. The patient has a low body temperature C. The patient's stool is soft and formed D. The patient's abdominal girth has decreased - CORRECT ANSWER B. The patient has a low body temperature Signs of NEC include: abdominal distention, increase gastric residuals, bloody stools, an unstable temperature 4.59 The nurse taking care of an infant in the ICU diagnosed with necrotizing enterocolitis (NEC) anticipates that which of the following will be included in care? A. Decrease the amount of feeding and change it from formula to pedialyte B. Connect the NG-tube to low intermittent wall suction in between feedings C. Decrease visitors and only allow the parents to hold the infant D. Administer antibiotics - CORRECT ANSWER D. Administer antibiotics The infant with NEC should not receive anything by mouth in order to allow the bowel to rest An NG-tube should be placed and to low intermittent suction No one should handle the infant as it may increase the infant's stress Antibiotics are administered 4.60 The nurse is caring for a 2 month old who has been diagnosed with biliary atresia; when reviewing history, the nurse would expect: A. Very pale urine B. Black tarry stools C. Very poor weight gain D. Bluish tinted sclera - CORRECT ANSWER C. Very poor weight gain In biliary atresia, the unconjugated bilirubin is trapped within the liver as it is unable to pass to the intestines - the buildup of bilirubin eventually leads to liver failure Symptoms include: jaundice, dark urine, light stools, yellow sclera The infant typically has failure to thrive and does not gain weight 4.61 A 3 month old with biliary atresia has been irritable Enid restless, the parent asks why this is; which of the following is the nurse's best response? A. "Your child's enlarged leaver is probably placing pressure on other areas of her body, I'll give her some pain medication." B. "Your child is probably restless because she must remain in the crib and can't be held and cuddled." C. "Your child probably needs more stimulation, let's put a music box near the crib." D. "Your child is probably - CORRECT ANSWER D. "Your child is probably feeling very itching, I'll give her some medication for that." It is very common for children with biliary atresia to have extreme pruritis from the build up of bile and irritation of nerve endings 4.62 A parent calls the nurse and expresses the worry of the child getting pinworms like a neighborhood child did; which of the following should the nurse tell the parent? A. "Be sure to avoid the children and their pets." B. "If you notice your child scratching their perinatal area, we'll need to obtain blood and stool samples." C. "It is impossible for children to catch pinworms, it is only spread within a family." D. "Your child should be treated with medication if they have been around your - CORRECT ANSWER D. "Your child should be treated with medication if they have been around your neighbors." Parasitic worms are very communicable and can be spread with any contacts It is not spread through pets Hand washing is essential to helping control the spread of pinworms All contacts are treated with oral medication Children suspected of infestation are tested by placing tape in the anus at night - the worms lay eggs on the tape and a diagnosis can be made 4.63 A parent calls the nurse and states a classmate of their child has been diagnosed with hepatitis A and would like to know when symptoms would likely present; the nurses best response on the knowledge that the incubation period of hepatitis A is which of the following? A. Less than 1 week B. 2 weeks C. 4 weeks D. Up to 1 year - CORRECT ANSWER C. 4 weeks 4.64 The nurse is doing a presentation on hepatitis for a group of day-care workers; the nurse knows that clarification is needed when one of the day-care teachers makes which of the following statements? A. "Most children have been vaccinated against hepatitis B." B. "In order to prevent the spread of hepatitis A, we should not allow the toddlers to assist with toileting." C. "I would be best to have the cook not help care for the children." D. "We need to make sure that everyone is washing th - CORRECT ANSWER B. "In order to prevent the spread of hepatitis A, we should not allow the toddlers to assist with toileting." It is important that toddlers learn the importance of hand hygiene; instead of not allowing them to assist with toileting, it would be more beneficial to teach them hand washing techniques 4.65 A parent of a 1 year old call the nurse to report the child having an episode where the child drew their legs up to their abdomen and then vomited, the parent later check their diaper and found that it contained a small amount of stool stained with mucus and blood; which of the following represents the nurse's best response to the parent? A. "It sounds like your child is feeling better now, feel free to call us back if it happens again." B. "It sounds like everything is alright, but just t - CORRECT ANSWER C. "You should bring your child to the emergency room to be evaluated to make sure that nothing serious is going on." The described symptoms are indicative of intussusception which requires emergency intervention - the child should be evaluated immediately 4.66 The nurse working in a large children's hospital is preparing to receive a transfer from a small community hospital, a toddler diagnosed with intussusception arrives lethargic with a very rapid heart rate and a blood pressure that is only palpable, the patients abdomen is rigid and the child does not respond vigorously when examined; the nurse correctly expects: A. The child will immediately be brought to the operating room for surgical correction B. The child will be brought to radiology - CORRECT ANSWER A. The child will immediately be brought to the operating room for surgical correction Although in most cases of intussusception are reduced by enema, the child is in shock The child may have experienced a perforation in the bowel which represents a surgical emergency 4.67 The nurse is caring for a 12 year old who has taken an acetaminophen overdose; the child's parents ask the nurse when she will be considered 'out of the woods'; how long must the child be monitored for liver damage? A. 8 hours B. 12 hours C. 36 hours D. 48 hours - CORRECT ANSWER C. 36 hours 4.68 The nurse is working in the emergency room when a 16 year old is admitted with a diagnosis of acetaminophen poisoning, the teen admits to taking the medication 50 minutes ago; which of the following should be included in the plan of care? A. Administer active charcoal as soon as lab results come back B. Prepare to administer a whole bowel lavage C. Administer N-acetylcysteine within 8 hours of ingestion D. Administer syrup of ipecac - CORRECT ANSWER C. Administer N-acetylcysteine within 8 hours of ingestion Activated charcoal is most effective when given within an hour of ingestion therefore, the medication should not be withheld till the labs come back N-acetylcysteine should be given within 8 hours of ingestion Syrup of ipecac should not be administered as the risk of induced vomiting include aspiration 5.1 A infant undergoes surgery to repair a myelomeningocele; to detect increased intracranial pressure (ICP) as early as possible, the nurse should stay alert for which postoperative finding? A. Decreased urine output B. Increased heart rate C. Bulging fontanel D. Sunken eyeballs - CORRECT ANSWER C. Bulging fontanel The anterior fontanel (which is open in infants till 18 months) allows for compensation of pressure in the intracranial space 5.2 A neonate born within the past 24 hours with myelomeningocele is scheduled for corrective surgery; postoperatively, what is the most important nursing goal? A. Preventing infection B. Ensuring adequate hydration C. Providing adequate nutrition D. Preventing contracture deformity - CORRECT ANSWER A. Preventing infection Preventing infection is most important for a child with a myelomeningocele because the defect involves exposure of the spinal cords and meninges in a CSF-filled sac externally protruding from a child's back 5.3 Following the repair of a myelomeningocele, the nurse watches for symptoms of hydrocephalus; what symptoms indicate increased intracranial pressure? A. Sunset sign, increased pulse, lethargy B. High shrill cry, decreased pulse, positive Ortolani sign C. Vomiting, increased pulse, bulging fontanels D. Bulging fontanel, decreased pulse, irritability - CORRECT ANSWER D. Bulging fontanel, decreased pulse, irritability Sunset eyes are a late sign of increased ICP Vomiting is typically a sign of increased ICP in older kids A positive Ortolanoi sign is felt and heard when the neonate with congenital hip dysphasia's hip is flexed and abducted 5.4 A child is born with a myelomeningocele in their lumbar are; what pre-operative nursing care should be provided? A. Position supine B. Apply lotion and gently message they meningocele C. exercise the legs and arms to prevent atrophy of the muscles D. Place prone with a light sterile dressing on the meningocele - CORRECT ANSWER D. Place prone with a light sterile dressing on the meningocele Myelomeningocele is a condition in which the posterior portion of the vertebrae laminate fails to close anywhere along the spinal cord There is a protruding sac that contains cerebral spinal fluid, meninges, and a portion of the spinal cord Pre-operative nursing care is aimed at preventing infection, keeping the sac moist, assessing for motor function before the sac 5.5 You are the nurse performing discharge teaching for an 8 year old with epilepsy; you know that an important part of your discharge teaching are the side effects of Dilantin (phenytoin) including: A. Respiratory acidosis B. Tachycardia C. Gum hyperplasia D. Hearing loss - CORRECT ANSWER C. Gum hyperplasia To manage the side effect of gum hyperplasia, the child should use a soft toothbrush 5.6 A 21 month old is being treated with a lead chelating agent; the following would be most appropriate information to include in your patient-family education regarding its mechanism os action: A. It alters the acid-base balance in the gastrointestinal system B. It alter neurological damage done by the lead C. It combines with hemoglobin in the liver D. It aids in eliminating lead - CORRECT ANSWER D. It aids in eliminating lead The lead binds to the chelating agent and is eliminated through the urine 5.7 What is the most important nursing intervention immediately following post-operative placement of a ventriculoperitoneal (VP) shunt? A. Place the child in reverse trendelenburg position B. Place the child on his non-operative side flat for 24 hours C. Keep the child in a sitting position to assist in drainage D. Pump the shunt intermittently for 8 hours - CORRECT ANSWER B. Place the child on his non-operative side flat for 24 hours Immediately following surgical placement of the VP shunt, the child will be in a recumbent position on their non-operative side 5.8 The nurse would expect which of the following as an early symptom seen in a toddler with lead intoxication? A. Hyperactivity B. Intellectual disability C. Diarrhea and dehydration D. Dyspnea - CORRECT ANSWER A. Hyperactivity Early signs of lead intoxication: mild behavior changes, distractibility, hyperactivity, learning problems Later signs of lead intoxication: mental retardation, seizure, coma, death Other signs: anemia, glycosuria, proteinuria, ketonuria, abdominal pain, vomiting, constipation, anorexia, delayed linear growth 5.9 The nurse is caring for a 6 yer old with a history of myelomeningocele that was repaired during infancy; which of the following foods should the child avoid? A. Bananas and kiwi B. Peanut butter C. Dairy products D. Meats and high protein foods - CORRECT ANSWER A. Bananas and kiwi Children with myelomeningocele are typically sensitive to latex exposure which can cause anaphylaxis Children with a latex allergy are typically sensitive to foods such as bananas, kiwi, avocados, chestnuts 5.10 Lead poisoning is suspected in a 21 month old; what might be the source of the lead ingestion? A. Lives near a paint factory B. Teethed on a 35 year old crib C. The home has asbestos ceilings that are in poor condition D. Ingested a crayon at 19 months - CORRECT ANSWER B. Teethed on a 35 year old crib Sources of lead ingestion include: lead based paint chips/dust, contain instead drinking water from lead-based pipes, dust from lead ammunition, battery casings, collectible toys, jewelry 5.11 The first symptom in a toddler with lead intoxication might be: A. Poor coordination B. Intellectual disability retardation C. Diarrhea and dehydration D. Dyspnea - CORRECT ANSWER A. Poor coordination First signs are behavioral changes, poor coordination, distractibility 5.12 The most detrimental long-term effects of lead intoxication are caused by: A. Mayocardial ischemia B. Hepatic necrosis C. Neurotoxicity D. Renal calculi - CORRECT ANSWER C. Neurotoxicity As lead is deposited into the developing brain of a fetus or young infant, the lead disrupts the development of neuronal connections leading to neurocognitive deficiits 5.13 What would you expect the course of treatment for a toddler with a blood lead level of 70? A. Administer oral lead chelation and follow up for serum blood lead level though primary care provider B. Administer both oral and intramuscular injectable lead chelation therapy and follow up for serum blood lead levels through primary care provider C. If asymptomatic, treat as outpatient with oral and intramuscular lead chelation; If symptomatic, treat inpatient with IV lead chelation D. Hospitali - CORRECT ANSWER D. Hospitalize immediately for inpatient lead chelation therapy Blood lead levels (BLL) of 70 or greater should be hospitalized immediately BLL 45-70 require hospitalization if symptomatic or when non-compliant with outpatient treatment BLL greater than/equal to 5 treatment varies 5.14 The nurse is testing the reflexes of a 6 week old, the nurse charts that the child has a positive fencing reflex; which of the following describes the fencing reflex? A. When the cheek is crooked, the infant with turn their head toward the stimuli and begin to suck B. When the infant is lying on their back with their head turned to one side, the infant will flex the opposite arm and leg C. When the infant is held upright with their feet touching a hard surface, the infant will move their l - CORRECT ANSWER B. When the infant is lying on their back with their head turned to one side, the infant will flex the opposite arm and leg Rooting reflex: When the cheek is crooked, the infant with turn their head toward the stimuli and begin to suck Stepping reflex: When the infant is held upright with their feet touching a hard surface, the infant will move their legs and feet as if walking Moro reflex: The infant will react to loud noises or sudden movement by extending their arms and legs them retracting them 5.15 An 18 month old toddler is being evaluated in the developmental clinic, when the sole of the foot is stroked upward from the heel to the ball of the foot - the toes hyperextend, a parent asks what this means; which of the following is the nurse's best response? A. "Your child seems very ticklish, it;s not something to worry about." B. "Your child has a positive Babinski reflex which is expected in this age group." C. "Your child has a reflex that usually disappears at a younger age. We'll - CORRECT ANSWER B. "Your child has a positive Babinski reflex which is expected in this age group." This is normally present until the age of 2 years 5.16 The parent of an infant tells the nurse that their child used to hold onto their finger whenever the parent touched the child's hand and that this stopped a few weeks ago; based on this information, the nurse knows that the child is most likely how old? A. 1 month B. 3 months C. 5 months D. 7 months - CORRECT ANSWER C. 5 months Infant reflexes (expect for the Babinski reflex) disappear by 5 months 5.17 A 4 year old has been diagnosed with amblyopia in the left eye, the parents are concerned and would like to know about treatment; select the nurse's best response. A. "Your child's eye condition will be treated with prescription glasses, we should encourage them to help select the glasses they like the most." B. "Your child will most likely outgrow this condition, we will evaluate again before school starts." C. "Your child will need to wear a patch on their right eye." D. " your child wil - CORRECT ANSWER C. "Your child will need to wear a patch on their right eye." Children with amblyopia ('lazy eye') are treated by patching the healthy eye in order to make the affected eye work 5.18 A 5 year old lost their vision 1 year ago from an air bag deployment in a MVA; what should the nurse do when obtaining their assessment? A. Explain everything that the nurse will be doing, what body parts they will be touching, and how it will feel B. Enter the room and call the child's name in a loud manner C. Gently touch the child's, arm so that they know the nurse is near D. Give the child details about what to expect during the hospital stay including how they will feel after surgery - CORRECT ANSWER A. Explain everything that the nurse will be doing, what body parts they will be touching, and how it will feel 5.19 A 9 year old has been complaining of itching and burning behind both eyelids, the nurse notes that their eyes are red with yellow discharge, the child is diagnosed with bacterial conjunctivitis to both eyes; which of the following statements by the child's parent indicates the need for more education? A. "I will encourage my child to wash their hands a lot." B. "I will apply prescription eye antibiotic on the lower eyelid from the outer to inner eye." C. "I will encourage my child to wear - CORRECT ANSWER B. "I will apply prescription eye antibiotic on the lower eyelid from the outer to inner eye." The ointment need to be applied from the inner to outer canthus 5.20 The nurse is assessing a newborn when the nurse notes that their right ear is lower than the left and is shaped abnormally; the nurse correctly expects referral to a: A. Neonatologist B. Neurologist C. Plastic surgeon D. Urologist - CORRECT ANSWER D. Urologist The infant should be referred to a urologist as any abnormalities in the shape or location of the ear can indicate a potential kidney malformation since the two organs develop simultaneously 5.21 The nurse is caring for a child with cerebral palsy (CP); which of the following statements is correct? A. CP is a progressive disorder characterized by abnormal coordination and muscle tone B. The majority of children with CP have some degree of intellectual disability C. CP is always caused by trauma that occurs at birth D. Children with CP often have speech, vision, or hearing difficulties - CORRECT ANSWER D. Children with CP often have speech, vision, or hearing difficulties CP is non-progressive Less than half of children with CP have some degree of intellectual disability CP is sometime caused by trauma that occurs at birth, it can also be cause by anoxia that occurs before/after birth 5.22 The nurse is providing education to the foster parents regarding a 3 year old with spastic CP; which of the following should be included in the care? A. The child should wear high top basketball shoes B. The child should consume a low calorie diet C. The child should attend a school for children with severe intellectual disabilities D. The child's activity should be limited and stimulation kept to a minimum - CORRECT ANSWER A. The child should wear high top basketball shoes Children with spastic CP experience muscle contraction making them prone to contractures- high top shoes will help prevent contractures Children with CP need high calorie diets There is no reason to limit activity 5.23 A 3 year old is diagnosed with ataxic cerebral palsy (CP), the child began walking at around 2 1/2 years old and is learning to run and climb stairs; which of the following should the nurse recommend to the parents? A. The child should wear a helmet B. The child should consume a low calorie diet as obesity could lead to difficulty with mobility C. The child should be referred to PT so that an exercise plan can be developed to prevent contractures D. The child should have their own vision e - CORRECT ANSWER A. The child should wear a helmet Children with ataxic CP are at risk for falls due to poor equilibrium Children with ataxic CP are not at risk for developing contractures 5.24 The parents of a 6 year old with dyskinetic-athetoid cerebral palsy are describing symptoms to the nurse; which of the following would the nurse expect to hear regarding involuntary movements? A. "My child seems to twitch more while he's sleeping." B. "My child seems to twitch more in their arms and legs than face." C. "My child seems to twitch more in their face than anywhere else." D. "My child seems to twitch less when awake." - CORRECT ANSWER C. "My child seems to twitch more in their face than anywhere else." Children with dyskinetic-athetoid cerebral palsy tend to have more involuntary movements in their faces than their extremities They tend to have no involuntary movements while asleep and increased movements when awake 5.25 The nurse is caring for a 2 year old when their mom calls out, "Someone come quick, something's wrong with my baby!" When the nurse enters, they see the child lying in the crib having a generalized seizure; which of the following should the nurse do. A. Administer scheduled Dilantin B. Turn the child on their side and suction their mouth C. Ensure that the crib rails are up and go get additional help D. Observe the seizure and call for help if necessary - CORRECT ANSWER D. Observe the seizure and call for help if necessary The nurse should always remain with the child during a seizure, if additional help is needed, the nurse should call out Oral medications should not be given The child should be placed on their side but, a suctioning device should not be used to prevent injury or pushing the tongue into a position of obstruction 5.26 A 10 year old with epilepsy has been taking phenytoin for several years, the child complains to the nurse that she wishes she didn't have to take the "dumb medicine" because of the side effects; which of the following side effects would the patient most likely be complaining of? A. Alopecia B. Halitosis C. Difficulty falling asleep D. Hirsutism - CORRECT ANSWER D. Hirsutism Hirsutism (excessive hair growth) is a common side effect Gum hyperplasia is a side effect of phenytoin, with dental hygiene, halitosis (chronic bad breath) can be prevented Difficulty falling asleep and alopecia (hair loss) are not side effects of phenytoin 5.27 The nurse is teaching a class to a group of parents when one father asks for information about febrile seizures; which of the following should the nurse include? A. There is no family pattern associated with febrile seizures B. Once a child has a febrile seizure, they will rarely have an additional seizure C. Febrile seizure tend to occur as the temperature is rapidly rising D. Febrile seizures are more common in children over the age of 5 - CORRECT ANSWER C. Febrile seizure tend to occur as the temperature is rapidly rising There tends to be a family pattern to febrile seizures When a child has on febrile seizure, there is an increased risk for that child to have an additional seizure Febrile seizure are more common in children under 5 5.28 The nurse is working in the emergency room, when am ambulance arrives with a 10 year old who is having generalized seizure for 35 minutes, the EMT was unable to establish an IV line; which of the following should the nurse do first A. Administer rectal Diastat B. Ask for assistance to hold the patient's rm and attempt to place an IV so that anti-epileptics can be given C. Gather and prepare intubation equipment D. Observe and record the patient's seizure - CORRECT ANSWER A. Administer rectal Diastat An IV should be attempted after Diastat has been administered - usually the seizure will stop of a short amount of time and an IV can be started It is important to plan for intubation and observe and record the seizure, but the priority is to stop the seizure 5.29 The nurse is caring for a 6 month infant with increased intracranial pressure (ICP); when reviewing the chart, the nurse would have likely found which of the following? A. Irritability B. Vomiting without complaints of nausea C. Blurred vision D. Headache - CORRECT ANSWER A. Irritability This is a common sign of increased ICP Infants cannot communicate that they are experiencing nausea, blurred vision, or a headache 5.30 The nurse is caring for a 2 year old with altered consciousness and increased intracranial pressure (ICP), when the nurse checks the patient's vital signs, she finds that they have change and immediately calls the physician; which of the following can indicate a medical emergency in the child with increased ICP? A. Increased BP, decreased HR, decreased RR B. Decreased BP, decreased HR, decreased RR C. Increased BP, decreased HR, increased RR D. Decreased BP, increased HR, decreased RR - CORRECT ANSWER A. Increased BP, decreased HR, decreased RR These are signs of increased ICP and could lead to cardio-respiratory collapse 5.31 A 14 year old was an unrestrained passenger in a motor vehicle accident (MVA), the teen is unresponsive but stable with increased intracranial pressure, a parent is visiting and begins to gently shake the teen and loudly cry, "Wake Up!" The parent then asks the nurse if there is anything else that should be done; which of the following is the nurse's best response? A. "Continue to do what you're doing as it is important to not allow the patient to get into too deep a state of sleep. Your c - CORRECT ANSWER D. "Your child's brain is very sensitive and needs to heal. Let's keep the light turned down and occasionally speak in quiet soothing tones." Children with increase ICP should have a quiet non-stimulating environment A visit from other teenagers may be too stimulating for an adolescent with increased ICP Although telling the parent that the child will do better in a quiet environment is appropriate, the nurse should expand on why this is the case 5.32 The nurse is caring for a child with increased intracranial pressure (ICP); which of the following should the nurse question when reviewing the child's plan of care A. Provide IVF at one to one and half times maintenance to increase perfusion B. Elevate the head of bed slightly C. Administration of corticosteroids D. Administration of an osmotic diuretic - CORRECT ANSWER A. Provide IVF at one to one and half times maintenance to increase perfusion IVF should be limited so that cerebral edema is reduced The head of bed should be slightly elevated and an osmotic diuretic should be given to decreased cerebral edema Corticosteroids are given to reduce brain inflammation 5.33 A child is diagnosed with hydrocephalus due to an abnormality in the absorption of cerebral spinal fluid in the arachnoid space; this type of hydrocephalus is also called: A. Communicating hydrocephalus B. Non-communicating hydrocephalus C. Arnold Chiari malformation D. Hydrocephalus insipidus - CORRECT ANSWER A. Communicating hydrocephalus Communicating hydrocephalus occurs when there is impaired absorption of cerebral spinal fluid Non-communicating hydrocephalus occurs when there is an obstruction to the flow of cerebral spinal fluid Arnold Chiari malformation occurs when the cerebral lair components are displaced through into the spinal canal The is no such diagnosis as hydrocephalus insipidus 5.34 A 4 week old infant who has been diagnosed with hydrocephalus; while reviewing history and assessing the infant, the nurse would expect to find: A. Head circumference less than the 5th percentile B. A dull cry when stimulated C. Sunset sign D. Large bulging posterior fontanel - CORRECT ANSWER C. Sunset sign The sunset sign (where the sclera is visible above the iris) is often noted in children with increased ICP associated with hydrocephalus Head circumference would be increased in a child with hydrocephalus The infant with hydrocephalus typically has a high pitch cry A large bulging anterior fontanel is often seen, the posterior fontanel is not used for assessing increased ICP 5.35 A 12 year old with a ventriculoperitoneal (VP) shunt has a headache and photophobia after playing basketball; which of the following is the nurse"s best instruction for the child's parent? A. "Give Tylenol and see if the child feels better in a few hours." B. "Give Aspirin and see if the child feels better in a few hours." C. "The child was probably over stimulated, see how the child feels better when they wake up D. "You need to bring your child to the emergency room to be evaluated." - CORRECT ANSWER D. "You need to bring your child to the emergency room to be evaluated." When a child with a VP shunt has signs that could possibly indicate increased ICP, it is important to rule out a shunt malfunction Although Tylenol can be given, it is important to detergent that the headache and photo sensitivity are not caused be increased ICP associated with VP malfunction Aspirin is generally not recommended for children 5.36 A 7 year old admitted to the pediatric ICU with a VP shunt infection, the child had surgery to externalize the shunt; the nurse would expect her drainage bag to kept aligned with which of the following? A. Ear B. Eyebrow C. Jaw D. Axilla - CORRECT ANSWER A. Ear The VP shunt is usually kept at the level of the child's ear to avoid rapid changes in ICP 5.37 A 4 year old is being evaluated for bacterial meningitis; which of the following signs are often seen in the cerebral spinal fluid (CSF) obtained from a LP in a child with bacterial meningitis A. Increased pressure is when the CSF sample is obtained B. CSF that is clear and foul smelling C. CSF that contains a decreased protein count D. CSF that contain an increased glucose count - CORRECT ANSWER A. Increased pressure is when the CSF sample is obtained Increased pressure is often noted when the CSF sample is obtained With bacterial meningitis, the CSF is usually cloudy with an increased protein count and decreased glucose level CSF does not usually have a detectable odor 5.38 The nurse receives a call from the admitting nurse in the ER, a 6 year old with bacterial meningitis is being admitted; which of the following types of precautions will be necessary? A. Gloves and gown B. Mask, gown, gloves C. Standard precautions D. Mask and gown - CORRECT ANSWER B. Mask, gown, gloves Bacterial meningitis is spread by droplets that enter the blood from the nasopharyngeal or middle ear - mask, gown, and gloves are required 5.39 A 10 year old is admitted with a head injury, the radiologist's report of the CT scan states that the bleeding is located between the dura mater and skull; the nurse knows that this type of head injury is called a: A. Epidural bleed B. Subdural hematoma C. Intraventricular hemorrhage D. Skull fracture - CORRECT ANSWER A. Epidural bleed An epidural bleed is bleeding that occurs between the dura mater and the skull Subdural hematoma - bleeding that occurs between the dura mater and the arachnoid layer of the meninges Intraventricular hemorrhage - bleeding within one of the brain's ventricles 5.40 The nurse is caring for an 11 year old who has been diagnosed with a concussion; which of the following would you expect the Glasgow Coma Scale score to be? A. 13 B. 11 C. 9 D. 7 - CORRECT ANSWER A. 13 A concussion is considered a mild head injury with a Glasgow Coma Score (GCS) of 13-15 Moderate head injury: GCS of 9-12 Severe head injury: GCS of les than/equal to 8 5.41 The nurse is caring for a 3 year old who was injured in a motor vehicle accident (MVA), the child is being observed and diagnosed with a closed head injury; which of the following should be included in the child's plan of care? A. Assess ear and nose drainage for low glucose counts B. Monitor vital signs every shift C. Assess level of consciousness every 4 hours while awake D. Promote bed rest and limit unnecessary movements - CORRECT ANSWER D. Promote bed rest and limit unnecessary movements Bed rest should be promoted and unnecessary movements should be limited to prevent increased in intracranial pressure Ear and nose drainage should be assessed for the presence of glucose indicating the presence of cerebral spinal fluid Vital signs should be obtained more than every shift Level of consciousness should be assessed every 2 hours continuously 5.42 The nurse is caring for a newborn with myelomeningocele who had just been transferred from another hospital; when reviewing plan of care, which of the following does the nurse questions? A. Monitor head circumference B. Anticipate corrective surgery within 24-48 hours C. Place in IV in the newborn's foot or scalp D. Keep the newborn prone or side lying - CORRECT ANSWER C. Place in IV in the newborn's foot or scalp Th scale should not be used for IV placement since she is at risk for hydrocephalus Since children with myelomeningocele are at risk to develop hydrocephalus, the head circumference should be monitored Corrective surgery is usually done within 24-48 hours The prone position or side lying is preferred so that pressure to the exposed sac is avoided 5.43 An 8 year old with past medical history of myelomeningocele repair resulting in need for routine urinary catheterization is being cared for in the pediatric unit, the child has been diagnosed with a urinary tract infection; when reviewing the plan of care, which of the following does the nurse question? A. Encourage a diet high in fruits and vegetables such as bananas B. Encourage the use of foot splints C. Anticipate the use of stool softeners D. Promote the use of lamb skin to protect th - CORRECT ANSWER A. Encourage a diet high in fruits and vegetables such as bananas Children with myelomeningocele are placed on latex precautions and should avoid bananas as they can cause allergic reactions Foot splints are used to prevent contractures Children with myelomeningocele usually have a neurogenic bowel and require the use of stool softener to prevent constipation La,b skin should be used to prevent skin breakdown associated with paralysis 5.44 The nurse is caring for an 8 year old who has been admitted with a diagnosis of Reye syndrome; when obtaining history, the parent stated that the child was given aspirin while he was sick, the nurse asks what type of illness the child had and expected the parent to reply with which of the following? A. Strep throat B. Pink eye C. Influenza D. Rocky Mountain Spotted Fever - CORRECT ANSWER C. Influenza Reye syndrome is most often associated with the administration of salicylate as during a viral illness such as influenza or varicella. Strep throat is a bacterial infection Conjunctivitis can be caused by a virus, it is not usually associated with Reye syndrome Rocky Mountain Spotted Fever is associated with a bacteria - carrying tick 5.45 The nurse is caring for a 6 year old diagnosed with Reye syndrome; which of the following would the nurse expect to see in the child's plan of care? A. Promote hydration through maintenance and bolus IV fluids B. Monitor liver function test results C. Assist with daily eye exams D. Provide education to the parents regarding the avoidance of aspirin in children under 10 years of age - CORRECT ANSWER B. Monitor liver function test results In Reye syndrome, liver function test results are monitored regularly to assess the degree of fatty changes in the liver Since Reye syndrome is associated ties increased intracranial pressure, IVF are usually given at less than maintenance requirements There is no need for daily eye exams Aspirin should not be given to children under the age of 18 5.46 The nurse is teaching a health maintenance class to a group of parents when someone asks about the lead poisoning; the nurse knows that, regarding lead poisoning, which of the following is true? A. Lead poisoning is defined as the presence of blood lead levels greater 18 mcg/dL B. Lead is only excreted through the bile C. Hyperactivity can be a sign of lead poisoning D. Lead screening is always done as a blood test - CORRECT ANSWER C. Hyperactivity can be a sign of lead poisoning A blood lead level (BLL) of concern is greater than or equal to 5 mcg/dL Hyperactivity can be a sign of lead poisoning Lead is excreted through the bile and urine Lead screening is typically conducted with a questionnaire at routine childhood primary care visits 5.47 The clinic nurse is caring for a teenager who has been taking Phenobarbital for a few years; the nurse recognizes this medication is a barbituate and expects the vital signs to be affected in which of the following ways A. Decreased RR, HR, BP, and body temp B. Decreased RR and HR, increased BP and body temp C. Decreased RR, HR, BP, and no affect on body temp D. Increased RR and HR, decreased BP and body temp - CORRECT ANSWER A. Decreased RR, HR, BP, and body temp Since phenobarbital is a barbituate, it depresses brain function —> decreased RR, HR, BP, Body temperature 5.48 A 6 year old male with new onset seizures and is being place on phenobarbital, the nurse is providing education to the parents; which of the following should be included in the teaching plan? A. Sam should avoid sunlight as much as possible B. Phenobarbital will always increase hyperactivity in children C. The child may develop a decreased attention span D. The child should avoid any contact with other children while on this medication - CORRECT ANSWER C. The child may develop a decreased attention span Decreased attention span and memory loss are common side effects of phenobarbital Because phenobarbital has been associated with bone loss, it is recommended that children spend some time outside to help the body process vitamin D There is no reason to avoid other children 5.49 A 3 year old who had had febril seizures in the past few months, the use of phenobarbital has been discussed; which of the following represents the most effective way to use phenobarbital in managing febrile seizures A. Administer an oral dose of phenobarbital as soon as the child has a seizure B. Administer an oral dose of phenobarbital as soon as the child develops a fever C. Administer a rectal dose of phenobarbital as soon as the child has a seizure D. Administer a prophylactic daily - CORRECT ANSWER D. Administer a prophylactic daily dose of phenobarbital Although, most febrile seizures are not treated with anti-epileptic drugs, phenobarbital may be prescribed for frequent recurrent febrile seizures - it is administered daily to establish a blood level prior to the development of a fever If the child was not to receive an oral dose until he/she developed a fever or had a seizure, there should not be enough medication in the circulating blood volume to prevent/control a seizure 5.50 The nurse caring for a 16 year old who takes phenobarbital for a seizure disorder; it is especially important for the nurse to ask which of the following questions? A. "Are you bothered that you have a seizure disorder?" B. "How are you doing in school?" C. "Are you sexually active?" D. "Do you ever forget to take a dose of your medication?" - CORRECT ANSWER C. "Are you sexually active?" Although all questions are important, is is imperative that the nurse asks about the adolescent's sexual activity Phenobarbital decreases the efficacy of oral contraceptives and can potentially lead to birth defects in the unborn child 6.1 The parent of several school age children calls the nurse when one of their children comes down with chicken pox, the nurse provides instruction on community and home management of this disease; which response by the parent indicates effective teaching? A. "I should keep my child at home until the fever is gone." B. "I should have my child soak in oatmeal baths twice daily." C. "I should give my child aspirin every 4 hours until the fever is gone." D. "I should start checking my other child - CORRECT ANSWER B. "I should have my child soak in oatmeal baths twice daily." Oatmeal baths help soothe skin discomfort and itching for the child with chicken pox. The child should state at home while the chicken pox is communicable, until the chicken pox are scabbed over Aspirin is contraindicated in children under 18 6.2 how should the nurse instruct the parent of a child with chicken pox to limit the chances of developing a secondary infection? A. Keep hands clean and nails short B. Use daily bicarbonate baths C. Use calamine lotion liberally D. Use antibiotic ointment - CORRECT ANSWER A. Keep hands clean and nails short Keeping hands clean and nails short helps to prevent the development of secondary infections caused by scratching vesicles, thus providing a route for the entry of bacteria into the body Bicarbonate baths and antibiotic ointments are not recommended Application of calamine lotion does not prevent secondary infection 6.3 As the nurse providing patient and family education for a 16 year old with mononucleosis you discuss the importance of avoiding which of the following in order to prevent complications of the disease? A. Alcoholic beverages B. Close contact with people C. Contact sports D. Swimming - CORRECT ANSWER C. Contact sports Splenic rupture, which can be fatal, is a risk factor for the child with mononucleosis who has an enlarged spleen (splenomegaly) - the spleen remains enlarged for about 3 weeks after the other acute symptoms resolve - therefore, contact sports should be avoided 3 weeks after acute symptoms go away to assure the spleen has returned to baseline 6.4 A parent of a 10 year old with chicken pox asks about the child's return to school; which of the following is the most appropriate nursing response? A. "The child can return to school when the chicken pox are dried, crusted, and scabbed." B. "The child can return to school once they have taken antibiotics for 48 hours." C. "The child can return to school once their temperature is normal." D. "The child can return to school when the skin is completely clear of lesions." - CORRECT ANSWER A. "The child can return to school when the chicken pox are dried, crusted, and scabbed." Chicken pox is contagious from 1-2 days prior to the development of the hallmark rash (pox) until all of the chicken pox are dried, crusted, and scabbed over This usually take about 10 days It is not necessary for the skin to be completely clear of lesions for return to school Antibiotics are not indicated since the illness is caused by a virus 6.5 What is the incubation period for chicken pox? A. 24-72 hours B. 5-8 days C. 10-21 days D. 48 hours - CORRECT ANSWER C. 10-21 days Incubation period - the time from which the individual comes in contact with a disease until the person demonstrates sympotoms 6.6 A mother breastfeeding her infant is an example of what kind of immunity protection? A. Naturally acquired active B. Naturally acquired passive C. Artificially acquired active D. Artificially acquired passive - CORRECT ANSWER B. Naturally acquired passive Naturally acquired active - when antibodies are made after illness exposure Artificially acquired active - vaccines Artificially acquired passive - injection of antibodies into the person 6.7 The nurse is conduction vaccine education with the parents of a 9 month old; the nurse knows that the parent requires more education when they state that their child experienced a serious side effect such as: A. Low grade fever B. Behavioral changes C. Hoarseness D. Pallor - CORRECT ANSWER A. Low grade fever This a common reaction to immunizations and does not indicate a serious reaction 6.8 After reviewing information on immunizations, the nurse knows that which of the following are true A. Immunization status should only be reviewed at health assessments when the child is due for immunizations B. The greatest number of vaccines should be administered at each visit C. The preferred site of administration of most immunizations is the dorsolgluteal site D. The more vaccines a child receives, the more likely they are to experience side effects - CORRECT ANSWER B. The greatest number of vaccines should be administered at each visit Immunization status should be reviewed at every health assessments regardless of whether or not the child is due for immunizations The preferred site of administration of immunizations in infants and young toddlers is the vastus lateralis, the deltoid is the preferred site for older toddlers to adults There is not an increased risk of side effects associated with multiple vaccine administeration 6.9 A 6 month old infant is being seen in the pediatric clinic, after reviewing immunizations status, it is discovered that the child did not receive the 4 month DTaP immunization as the family was moving to a new city; which of the following should the nurse recommend? A. The child will have to receive the 2 and 4 month immunization as too much time as elapsed B. The child will receive the 4 month dose now and the 6 month dose in 4 weeks C. The child will skip the 4 month dose and continue wi - CORRECT ANSWER B. The child will receive the 4 month dose now and the 6 month dose in 4 weeks When an immunization schedule is interrupted, a catch up schedule is recommended usually spacing the immunizations 4 weeks apart When an immunization schedule is interrupted, earlier doses should not be repeated nor skipped, but caught up according to the recommended schedule 6.10 The nurse receives a call from an 8 month old's mother and the child's two older siblings have both been diagnosed with measles, the mother would like to know if the infant should be vaccinated; Which of the following is the nurse's best response? A. "It's not recommended for an infant to receive the first dose of MMR until 12-15 months." B. "The infant should have received the first dose of MMR at the 6 month visit, so the child should be protected." C. "The infant should receive the MMR - CORRECT ANSWER D. "The infant should receive the MMR vaccine. In cases of outbreaks, it is OK to give an extra dose of MMR before the age of 12 months." As long as the infant is older than 6 months, it is recommended that the child receive an extra dose of MMR in the case of a measles outbreak For 12 month old, it is okay to receive an extra dose of MMR, but this dose should not replace the scheduled first dose at 12-15 months Normally, it is not recommended for an infant to receive the first dose of MMR until 12-15 months (due to the presence of maternal antibodies prior to 12 months) unless an outbreak of measles has occured 6.11 The nurse is working in the immunization clinic preparing to administer vaccines; which of the following is an example of best practice? A. The nurse checks the expiration date and knows that the vaccine is permitted to be administered as long as the vaccine is no more than 30 days past the expiration date B. The vaccine is stored in the door of the refrigerator until ready to administer C. The vaccine is placed on the counter and allowed to warm to room temperature for up to 4 hours after - CORRECT ANSWER D. The varicella vaccine is kept frozen until reconstitution The vaccine should not be give if past the expiration date The vaccine should not be stored in the door, but in the middle of the refrigerator Vaccines should be protected from light and not left on a counter after reconstitution 6.12 A 5 year old has been diagnosed with Fifth's disease; the nurse would expect the child's rash would display which of the following characteristics? A. A red rash noted to the face that resembles a slapped cheek, progressing to the trunk, arms and legs B. A red rash noted to the face that resembles a slapped cheek, progressing to the extremities especially the palms of the hands and soles of the feet C. A red rash starting on the upper back and neck, spreading down the trunk and to the extr - CORRECT ANSWER A. A red rash noted to the face that resembles a slapped cheek, progressing to the trunk, arms and legs The rash typically spears the plans of hands and soles of feet A rash starting on the upper back and neck spreading down the trunk and to the extremities is usually associated with rosella The rash of fifths disease does not have crush associated with it 6.13 A child's mother tells the nurse that the school will not allow the child to return until the rash of fifths disease has completely disappeared; which of the following is the nurse's best response A. "The rash of fifth's disease can last for 3 weeks. Since it is not realistic to keep him home from school for that amount of time." B. "I will call the school and talk to them as fifths disease is no longer considered contagious once the rash appears." C. "They are right in saying that you mus - CORRECT ANSWER B. "I will call the school and talk to them as fifths disease is no longer considered contagious once the rash appears." The rash is an immune response and not an indication of active infection The child is contagious during the initial phase of the disease before the rash appears or when the child has signs of upper respiratory infection It is acceptable for the child to return to school as the rash is usually present after the infection has passed 6.14 The clinic nurse is obtaining the history from the parent of a 6 year old with fifth's disease; which of the following would most likely be included in her history? A. The child had a blister like rash on their hands and feet B. The child had a rash on their trunk that consisted of red bumps, blisters and blisters with crusts C. The child was exposed to a dog with parvovirus D. The child had a low grade fever and a runny nose for a few days - CORRECT ANSWER D. The child had a low grade fever and a runny nose for a few days Fifths disease often begins with a low grade fever and signs of a mild upper respiratory infection Child are usually asymptomatic prior to the appearance of the characteristic rash 6.15 The nurse is caring for a 7 year old diagnosed with pertussis; which of the following should be included in the plan of care? A. Monitor oxygen saturation's and suction airway as necessary B. Encourage the child to participate in active play in their room to help loosen and expel secretions C. Encourage the child's classmates to send cards and visit when possible D. Administer acyclovir as ordered - CORRECT ANSWER A. Monitor oxygen saturation's and suction airway as necessary Maintaining a patent airway is the highest priority of care Active play is discourage until coughing has subsided The child should not be meeting with other students as pertussis is highly communicable Acyclovir is an antiviral drug, pertussis is bacterial 6.16 The nurse is caring for an infant with pertussis; which of the following personal protective equipment should the nurse use when caring for the infant A. Gloves B. Gloves and mask C. Gloves, mask, and gown D. Universal precautions are considered adequate and no other precautions are necessary - CORRECT ANSWER C. Gloves, mask, and gown Contact, droplet, airborne 6.17 The clinic nurse receives a phone call from a parent stating that their unimmunized child was exposed to a child with pertussis; the nurse knows that signs may begin to appear as early as: A. 2 days after exposure B. 6 days after exposure C. 2 weeks after exposure D. 6 weeks after exposure - CORRECT ANSWER B. 6 days after exposure The incubation period is 6-20 days 6.18 The nurse is caring for a 9 year old who has diagnosed with varicella, the child parent ask when the child was most likely exposed to chicken pox; the nurse bases their response on the knowledge that the incubation period is which of the following? A. Approximately 10 to 21 days from exposure B. Approximately 1 to 2 days from exposure C. Approximately 1 week from exposure D. The incubation period varies, but tends to be short in immunocompromised children - CORRECT ANSWER A. Approximately 10 to 21 days from exposure 6.19 The nurse is working in a clinic when a 4 year old is brought in to be evaluated for chicken pox; when assessing the child, the nurse would expect to find: A. A history of the child being exposed to their cousins a day ago who had varicella at the time B. A rash with lesions that are similar in appearance and size throughout their body C. A history that the rash first appeared on the child's lower extremities D. Vesicles noted in the child's mouth - CORRECT ANSWER D. Vesicles noted in the child's mouth Although a vesicular rash is characteristic of chicken pox, the hallmark is that the lesions are present at different stages throughout the body The incubation period is 10-21 days Vesicles are often noted on the child's mucus membranes 6.20 A 9 year old receiving gentamycin IV; which of the following statements made by the child's parent would lead the nurse to suspect that the child is experiencing a potentially dangerous adverse effect associated with gentamycin administration? A. "The child hasn't wanted to eat anything!" B. "The child wants the lights turned off.' C. "The child keeps Turing the volume on the TV up." D. "the child has really foul smelling diarrhea." - CORRECT ANSWER C. "The child keeps Turing the volume on the TV up." Gentamycin is associated with ototoxicity that is potentially irreversible 6.21 The nurse is providing education regarding haemophilus influenzae type B (Hib); which of the following is an accurate statement? A. Most cases of Hib occur in teenagers B. Risk factors for Hib include crowded conditions such as day care and preschool C. Hib can lead to cervical cancer later in life D. The immunization preventing Hib should not be given until the child is at least 8 years old - CORRECT ANSWER B. Risk factors for Hib include crowded conditions such as day care and preschool Most cases occur in children under the age of 5 Hib was the leading cause of bacterial meningitis prior to the vaccine Cervical cancer is associated with HPV (human papilloma virus), not Hib The vaccine preventing Hib should be given early in infancy 6.22 A school nurse working where several children have been diagnosed with mononucleosis knows that which of the following is true: A. Mononucleosis is always caused by the Epstein-Barr virus (EBV) B. Mononucleosis is transmitted through oropharyngeal secretions C. Although rare in young children, the severity of illness tends to be higher D. It has a very short incubation period of 3-5 days - CORRECT ANSWER B. Mononucleosis is transmitted through oropharyngeal secretions It can be transmitted through kissing and sharing eating utensils/straws Although mononucleosis is often caused by EBV, it can be caused by other organisms such as cytomegalovirus Younger children diagnosed with Mononucleosis tend to have a less severe form of the illness It has a long incubation period of 2-6 weeks 6.23 The nurse is caring for a 16 year old diagnosed with Mononucleosis; when gathering assessment data, the nurse would expect to find which of the following: A. Jaundice noted to the sclera and skin B. Complaints of insomnia C. Lab work showing decreased atypical lymphocytes D. Physical exam revealing a smaller that expected liver - CORRECT ANSWER A. Jaundice noted to the sclera and skin Mononucleosis can lead to an enlarged liver which can result in jaundice Fatigue is the hallmark manifestation associated with mononucleosis Increased atypical lymphocytes are seen in mononucleosis 6.24 The nurse is providing home care instructions to a 13 year old diagnosed with mononucleosis and family; which of the following should be included in the plan of care? A. Avoid gum and hard candy B. Offer fruit smoothies and shakes to help meet some of the child's nutritional demands C. Once the fever has disappeared, it is important to return to school and activities to continue to meet the child developmental needs D. While the child has a fever, it is important to isolate them as much as - CORRECT ANSWER B. Offer fruit smoothies and shakes to help meet some of the child's nutritional demands This can be helpful for the anorexic child Gum and hard candy can be used to help ease the discomfort of a sore throat Although the child can return to school once the fever has disappeared, not all activities should be resumed Contact sports should be avoided as the potential for splenic rupture exists Isolation is not necessary as Mononucleosis is not spread through casual contacts Good hand washing should be maintained and oropharyngeal secretions should be avoided 6.25 A nurse is administering a tuberculin skin test (TST) and knows that which of the following is true? A. Although the the test cannot be read until 48 hours, any redness and swelling in the first 24 hours usually indicates probable exposure B. The area of redness is measured after 48-72 hours C. A positive reaction does not indicate that the child has an active infection D. A positive TST indicates that the child requires further testing - CORRECT ANSWER D. A positive TST indicates that the child requires further testing A chest X-ray is required Any initial swelling and redness is due to a neutrophil response The area of induration, not redness is measured after 48-72 hours A positive reaction indicates that the child was exposed to TB The child may have only TB infection (no replication in the lungs) or may have TB disease (replication in the lungs) 6.26 The nurse is caring for an adolescent with active tuberculosis; which of the following should be included in the child's plan of care? A. Ensure that contact isolation precautions are strictly followed B. Encourage screening and appropriate treatment of all family members C. Encourage the child's classmates to visit so that the child doesn't feel isolated from peers D. Administer first line drugs such as ampicillin - CORRECT ANSWER B. Encourage screening and appropriate treatment of all family members It is essential to screen and treat all family members TB is airborne, therefore requiring more than just contact precautions Although it is important to prevent social isolation, additional children should not be exposed to a child with an active TB infection Ampicillin is not considered a first line drug in the treatment of TB 6.27 Which of the following are the commonly used medications in the initial treatment of tuberculosis (TB)? A. Pyrazinamide, Ethambutol, Isoniazid, and Rifampin B. Erythromycin, Ethambutol, Isoniazid, and Rifampin C. B. Erythromycin, Ethambutol, and Isoniazid D. Pyrazinamide, Ethambutol, and Rifampin - CORRECT ANSWER A. Pyrazinamide, Ethambutol, Isoniazid, and Rifampin 6.28 The nurse is caring for a 3 week old infant with sepsis who is very irritable and had several seizures in the emergence room; which of the following would likely be found in the infants history? A. A history of hypothermia B. A sunken fontanel C. Increased appetite in an attempt to compensate for increased metabolic needs D. Blood cultures and cerebral spinal fluid positive for viral infection - CORRECT ANSWER A. A history of hypothermia Neonates with sepsis often present with fever in addition to hypothermia Fontanels are typically increased Appetite is decreased Blood cultures and cerebral spinal fluid is usually positive for bacteria 6.29 Which of the following age groups of children are at greatest risk for sepsis? A. Newborns B. Toddlers cared in the home C. Toddlers in day care D. Adolescents - CORRECT ANSWER A. Newborns Newborns have the weakest immune system 6.30 The nurse expects to see a rise in the incidence of infectious disease in children of which age group? A. Infancy B. Toddler C. Preschool age D. School age - CORRECT ANSWER D. School age They have increased exposure through the school system 6.31 You know that the best site for an intramuscular (IM) injection for an infant is: A. Anterior outer quadrant of the thigh B. Deltoid muscle of the arm C. Upper outer quadrant of the buttocks D. Either the thigh or the buttocks - CORRECT ANSWER A. Anterior outer quadrant of the thigh 6.32 You are preparing to give an intramuscular (IM) injection to a 5 year old; you know that the best site for administration is: A. Anterior outer quadrant of the thigh B. Deltoid muscle of the arm C. Upper outer quadrant of the buttocks D. Either the thigh or the buttocks - CORRECT ANSWER B. Deltoid muscle of the arm 6.33 A 6 year old has a positive reaction to a tuberculosis skin test; which of the following would be the most accurate explanation of the result for the child's parent? A. The child has tuberculosis B. The child was infected with tuberculosis but does not have the disease C. The child is protected against tuberculosis by having a positive tiger D. The child was infected with tuberculosis and further tests will be required to see if he has the disease - CORRECT ANSWER D. The child was infected with tuberculosis and further tests will be required to see if he has the disease The positive reaction to the tuberculosis skin test indicates infection with TB A positive chest x-ray for tuberculosis indicates active TB disease 6.34 The child who develops a case of pertussis will develop what type of immunity against pertussis? A. Naturally acquired active B. Naturally acquired passive C. Artificially acquired active D. Artificially acquired passive - CORRECT ANSWER A. Naturally acquired active Immunity that is conferred to an individual through an active case of the disease is called naturally acquired active immunity; this is the strongest type of immunity lasting for life Naturally acquired passive immunity occurs through placental transfer during pregnancy and through breast feeding: there is no active immune process involved because the antibodies are received Artificially acquired active immunity is the type of immunity conferred by immunizations Artificially acquired passive antibodies are injected without stimulating the immune response (gamma globulin); the antibodies provide immediate protection that lasts for weeks 6.35 You are teaching parents and school age children in a community center about Lyme disease; which of the following is an accurate statement A. There is no treatment for Lyme disease but the child should be monitored with supportive care B. Once a child has contracted Lyme disease, the child will have the best clinical outcome if it is treated when the bulls-eye rash is present C. It is very hard to prevent Lyme disease D. Ticks should be removed by carefully touching the tick with the tip o - CORRECT ANSWER B. Once a child has contracted Lyme disease, the child will have the best clinical outcome if it is treated when the bulls-eye rash is present The bulls-eye rash appears 70-80% of cases of Lyme disease at the site of the tick bite The rash usually starts about 7 days after the tick bite during what is called the early localized stage of Lyme disease - this is the best time to identify and treat the disease with oral antibiotics 6.36 A 7 year old is receiving vancomycin IV for cellulitis, the child parent calls you to the room say that the child is complaining of itching, flushing is noted to the child's face along with erythema toys rash to their upper body; after notifying the provide, the nurse anticipates that the child's care will include: A. Documentation of an allergy to Vancomycin in the child's health record B. Administration of diphenhydramine IV and slowing the rate of the vancomycin C. Administration of oxy - CORRECT ANSWER B. Administration of diphenhydramine IV and slowing the rate of the vancomycin Red Man Syndrome is a common reaction to the administration of vancomycin 6.37 A patient who has tested positive for human immunodeficiency virus (HIV) delivers a girl, when the mother asks if her baby has acquired immunodeficiency syndrome (AIDS), how should the nurse respond? A. "Don't worry. It's too soon to tell." B. "Chances are the baby will be okay since you don't have AIDS yet." C. "The child may have acquired HIV in utero, but we wont know for sure until the baby is older." D. "All babies born to HIV-positive women are infected with HIV, but your baby won't - CORRECT ANSWER C. "The child may have acquired HIV in utero, but we wont know for sure until the baby is older." The majority of child in the U.S. who contact HIV disease, do so in utero or perinatal by being born to an HIV-positive mother An HIV-positive woman who is treated with a antiretroviral (ARV) durning pregnancy, avoids breast feeding, and avoids feeding her baby premasticated (pre-chewed) food will have only a 1-5% risk of transmitting HIV to her baby However, at birth, the HIV status of an infant born to an HIV-positive woman cannot be confirmed due to the presence of maternal antibodies Infants born to HIV-positive women, should receive AZT and Bactria during infancy until the HIV status is confirmed (virologist testing during first 6 months of life) 6.38 A 3 year old who tests positive for the human immunodeficiency virus (HIV) is placed in foster care; the foster parent asks the nurse how to prevent HIV transmission to other family members, how should the nurse respond? A. "Make sure the child uses disposable plates and utensils." B. "Use isopropyl alcohol to clean surfaces contaminated with the child's blood or body fluids." C." Do no let the child share toys with other children." D. "Wear gloves when you're likely to come in contact wit - CORRECT ANSWER D. "Wear gloves when you're likely to come in contact with the child's blood or body fluids." HIV is not spread through casual contact with an infected child, only via exchange of body fluids including breast milk 6.39 A 3 year old has an absolute neutrophil count (ANC) of 325; this means that the child: A. Has a severe infection B. Is at severe risk for infection C. Is at moderate risk for infection D. Is at low risk for infection - CORRECT ANSWER B. Is at severe risk for infection ANC is a measure of the integrity of the immune system Normal ANC for infants is >2500 An ANC count of <1000 is considered neutropenia A child's ANC <500 is considered a severe risk of life threatening infection 6.40 An increased estimated serum sedimentation rate (ESR) indicates which of the following? A. Red bone marrow activity is depressed B. Hyperactive bone marrow activity C. An inflammatory process present in the body D. Increased hemolysis of red blood cells - CORRECT ANSWER C. An inflammatory process present in the body The ESR is a test that reflect inflammatory process in the body Bone marrow activity is reflected by the reticulocyte count An indirect reflection of red blood cell hemolysis is reflected by unconjugated bilirubin, a byproduct of red blood cell hemolyisi 6.41 You are caring for a child who is immunosuppressive; you know that which of the following will be most helpful in determine the child's ability to fight infection? A. Estimated serum sedimentation rate (ESR) B. Absolute neutrophil count (ANC) C. White blood cell count D. Bone marrow cell count - CORRECT ANSWER B. Absolute neutrophil count (ANC) ANC - total number of neutrophils in the peripheral blood ANC is a reflection of the integrity of the immune system and the body's overall ability to fight infection ESR - measure of inflammation 6.42 Which immune globulin is passed through the placenta providing the newborn with passive immunity? A. IgM B. IgG C. IgD D. IgE - CORRECT ANSWER B. IgG IgM - found in blood and lymphocytes and is the first to respond to infection IgD - not well understood IgE - associated with allergic reactions 6.43 A normal ANC in children is: A. >2500 B. >1500 C. >1000 D. >500 - CORRECT ANSWER A. >2500 6.44 To manage a spill of HIV outside the body, which of the body following is indicated? A. 75% solution of household bleach in water over 1 minute B. 50% solution of household bleach in water over 1 minute C. 25% solution of household bleach in water over 1 minute D. 10% solution of household bleach in water over 1 minute - CORRECT ANSWER D. 10% solution of household bleach in water over 1 minute 7.1 A preschool aged child with sicle cell disease is addmitted to the health care facility with vaso-occlusive crisis and fever; what is the nurse's highest priority when caring for this child? A. Providing fluids B. Maintaining protective isolation C. Applying cool compresses to painful areas D. Administering antibiotics, as prescibed - CORRECT ANSWER D. Administering antibiotics, as prescibed Children with sickle cell disease is at increased risk for infection due to the disease or absent splenic funciton Fever is the first sign of infection -requires medical attention and an antibiotic 2.21 When examining a 6 month old who is quietly sitting on her mother's lap, which of the following should the nurse do first? A. Assessment of the fontanel B. Palpation of pulses C. Auscultation of the chest D. Palpation of the abdomen - CORRECT ANSWER C. Auscultation of the chest 6 month olds develop stranger anxiety and may cry during invasive procedures; it is best to preform assessments that require the child to be quiet first, then fontanel and pulse assessments, palpations should be preformed last 7.3 you have just admitted a 4 year old with sickle cell disease vaso-occlusive crisis; you know that the primary aim of your treatment is to: A. decrease the child's fever B. prevent the spread of infection C. Provide for dehydration, oxygenation, and pain D. prevent necrosis and gangrene of the ischemic body part - CORRECT ANSWER C. Provide for dehydration, oxygenation, and pain The child with sickle cell disease in crisis requires methods to reduce red blood cell sickling such as hydration and qxygenation Pain relieving measures are also required 7.4 You are caring for a school aged child with idiopathic/immune thrombocytopenia purpura (ITP); which of the following poses the greatest risk for this child? A. Infection B. Ibuprofen C. Steriods D. Trauma - CORRECT ANSWER D. Trauma the child with ITP demonstrates a low platelet count below 20,000 A normal range is 150,000 - 400,000 Signs and symptoms: petichiae, brusing, and bleeding Truama poses the greatest risk for the child with ITP, ibuprofen is associated with hindering platelet function and not recommended 7.5 You recognize that which of the following is a clinical manifestation of chronic anemia experienced by children with sickle cell disease? A. Excessive weight gain B. Cardiac murmur C. Early sexual maturation D. A ruddy complexion - CORRECT ANSWER B. Cardiac murmur Symptoms of chronic anemia include: growth retardation, caridac murmur, delayed sexual maturation, and hyperbilirubinemia Growth retardation adn delayed sexual maturation - occur due to the body's innate ability to spare less-essential functions in favor of more essential ones (brain growth and cardiac funiction) Caridac murmur - reslut from the ongoing backflow of blood throught the cadiac valves caused by baseline tachycardia and increased cardiac output 7.6 A toddler is diagnosed with iron-deficiency anemia; when teaching the parents about using supplemental iron elixir the nurse should provide which instruction? A. "Give the iron with milk." B. "Give the iron with citrus fruit or juice." C. "Monitor the child for episodes of diarrhea." D. "Give the iron before meals." - CORRECT ANSWER B. "Give the iron with citrus fruit or juice." Iron is absorbed best when given between meals and with citrus fruit of juice 7.2 A toddler with hemophilia is hospitalized with multiple injuries after falling off a sliding board, x-ray revealed no bone fractures; when caring for the child, what is the nurses highest priority? A. Administering platelets, as prescribed B. Taking measures to prevent infection C. Frequently assessing the child's level of consciousness D. Discussing a safe play environment with the parents - CORRECT ANSWER C. Frequently assessing the child's level of consciousness A child with hemophilia must be monitored for bleeding sequelae after an injury One of the greatest risks for childrenwith hemophilia is a head injury - neurologic status should be monitored for evidence of a head bleed 7.7 The nurse is reviewing a poster presentation on redblood cells from a group of nursing students, it involes a game of true and false; which of the following is a correct statement? A. Approximately 50% of the plasma is water B. When a red blood cell dies, most of the iron also dies C. Normal red blood cells live approximately 150 days D. Immature red blood cells are reffered to as reticulocytes - CORRECT ANSWER D. Immature red blood cells are reffered to as reticulocytes 90% of plasma is water Red blood cells live 90-120 days Iron is conserved when red blood cells die 7.9 The nurse is caring for an 18 month old who is being treated for iron deficiency anemia, the child's parents ask what most likely led to this type of anemia; which of the following is the nurse's best response? A. "The child's body is likely breaking down his red blood cells." B. "The child is probably not drinking enough milk." C. "The child's body is probably not producing enough red blood cells." D. "The child may be drinking too much milk." - CORRECT ANSWER D. "The child may be drinking too much milk." Milk is a good source for vitamin D and calcium, but not iron child who drink too much milk tend to not have enought of a remaining appetite to eat foods rich in iron 7.8 The nurse is caring for a 2 year old who is being evaluated for anemia; which of the following would the nurse expect to hear when obtaining the child's history? A. The child has been unusually hungry B. The child has been scratching their arms and legs C. The child has just had a growth spurt D. The child has been complaining of pain in their legs - CORRECT ANSWER B. The child has been scratching their arms and legs Increased breakdown of red blood cells seen in some anemias can lead to pruritus due to the presence of unconjugated bilirubin 7.10 The nurse is caring for a 6 month old who has sickle cell disease and notes th child is tachy cardic and hypertensive, the child's hand is reddened; which of the following should be the priority of care? A. Administer morphine to relieve pain associated with sickle cell disease B. Administer conrtisone cream to relieve pruritis associated with the irritation of reddened hands C. Administation of antibiotics to treat cellulitis of hands D. Administration of sedative to help induce rest - CORRECT ANSWER A. Administer morphine to relieve pain associated with sickle cell disease Dactylitis (hand/foot syndrome) is a painful swelling and redness of the hands/feet caused by vaso-occlusionof the small vessels of the hands and feet It's treated with pain medication 7.12 The nurse is caring for an 8 year old who is admitted with the diagnosis of sickle cell crisis, the child's O2 saturation is at 85% when the nurse applies O2; which of the following is the rationale for why the child needs oxygen? A. Oxygen will reverse the sickling process B. Oxygen will help decrease the sickling process C. Oxygen will help decrease the viscosity of the blood D. Oxygen will help increase the viscosity of the blood - CORRECT ANSWER B. Oxygen will help decrease the sickling process Oxygen wil not reverse the sickling process, it will help decrease it 7.11 The parent of a 3 year old calls the clinic stating that the child, who has a history of sickle cell disease, has a fever and a cough, the parent asks what to do; which of the following is the nurse's best response? A. "The child needs to be evaluated in the emergecy room." B. "Give the child some tylenol and see if the fever goes away." C. "It sounds like the child has a viral illness, keep and eye on the child and call us tomorrow if the symptoms have not yet improved." D. "It's probably - CORRECT ANSWER A. "The child needs to be evaluated in the emergecy room." early diagnosis and treatment of any potentially infectious process because a child with sickle cell disease is at increased risk for infection related to splenic dysfunction A fever and cough could indicate acute chest syndrome 7.14 The nurse is providing genetic counseling to a couple wishing to start a family, one parent has hemophilia and the other does not and is not a carrier; which of the following is true? A. All of their daughters will be carriers for hemophilia, but none of their sons will B. Each child has a 50% chance of having hemophilia C. Each child has a 25% chance of having hemophilia D. All of their sons will have hemophilia, but none of their daughters will - CORRECT ANSWER A. All of their daughters will be carriers for hemophilia, but none of their sons will Hemophilia is a sex-linked recessive disorder 7.15 The nurse is caring for an 8 year old with Idiopathis Thrombocytopenic Purpura (ITP); which of the following is considered a standard of care? A. Intramuscular injections are avoided B. Oral steriods are given when platelet counts are elevated above 150,000 C. Strict bedrest is the standard of care D. Iron supplementation is the mainstay of therapy - CORRECT ANSWER A. Intramuscular injections are avoided IM injections are avoided in children with ITP due to the risk of bleeding 7.16 In caring for a patient with acute anemia, you know that which of the following hemoglobin ranges would warrant consideration of a PRBC transfusion? A. 10-11 B. 9-10 C. 8-9 D. 7-8 - CORRECT ANSWER D. 7-8 Normal hemoglobin level is 11.5-14.5 8.1 During the initial nursing assessment of a 15 month old, which statement by the mother most strongly suggests that the child has Wilms' Tumor? A. "My child has grown 3 inches in the past 6 months." B. "My child seems to be napping for longer periods." C. "My child's abdomen seems bigger an the diapers are much tighter." D. "My child's appetite has increased so much lately." - CORRECT ANSWER C. "My child's abdomen seems bigger an the diapers are much tighter." Wilms' Tumor (nephroblastoma) is an embryonal tumor of the kidney that is typically unilateral and generally manifests in the toddler and early pre-school age-groups with symptoms including abdominal distention, abdominal pain, hypertension, constipation, anemia, and hematuria 8.2 For a child with Wilms' Tumor, which per-operative nursing intervention takes highest priority? A. Avoiding abdominal palpation B. Restricting oral intake C. Monitoring acid-base balance D. Maintaining strict isolation - CORRECT ANSWER A. Avoiding abdominal palpation The prognosis for the child with Wilms' tumor is generally good if the tumor remains encapsulated The key nursing intervention is to avoid any palpation of the abdomen in order to avoid dissemination of the tumor cells from the encapsulation Care should be taken to loosen clothes near the abdomen and to handle the child carefully Operation is required within 24-48 hours of diagnosis 8.3 You would expect which symptoms in a 4 year old admitted with acute lymphocytic leukemia? A. Weight loss, petechiae, high platelet count B. Weight gain, anemia, elevated WBC count C. Petechiae, anorexia, anemia D. Low platelet count, anemia, hunger - CORRECT ANSWER C. Petechiae, anorexia, anemia The child with acute lymphocytic leukemia would have suppression of any blood cells originating from the bone marrow (red blood cells and hemoglobin, white blood cells and platelets) As a result - you would expect low platelet count and petechiae, lowered RBC and anemia The child will typically demonstrate malaise and anorexia 8.4 What is the best approach to preparing a 4 year old for having their blood drawn the afternoon? A. Avoid telling the child until right before the procedure B. Let the child's parents explain the test to her C. Have the child withdraw the blood their self after you place the needle into their arm D. Have the child play with a doll and a pretend needle first - CORRECT ANSWER D. Have the child play with a doll and a pretend needle first Preschool age children are magical thinkers and enjoy play through pretending and make-believe Encouraging the preschooler to manipulate equipment and pretend on a doll facilitates understanding and reduces anxiety 8.5 What is the best approach to a 4 year old when drawing their blood? A. Explain that it will make the child feel better B. Ambulated the child in the hall afterward C. Offer a reward afterward D. Try to distract the child with a toy - CORRECT ANSWER C. Offer a reward afterward Preschool age children are magical thinkers who often fear that treatment and illness are punishments Offering a reward after the blood is drawn is a developmentally supportive intervention that focuses on positive reinforcement 8.6 Chemotherapy is used to treat acute lymphocytic leukemia; a side effect of this treatment is: A. Ischemia B. Alopecia C. Cardiac toxicity D. Cerebral edema - CORRECT ANSWER B. Alopecia 8.7 A child with leukemia is particularly susceptible to infection because: A. Enlarge lymph nodes are not functional B. Immature leukocytes are not capable of normal phagocytosis C. Severe anemia conditions exist D. The liver cannot detoxify the toxins - CORRECT ANSWER B. Immature leukocytes are not capable of normal phagocytosis The child with leukemia has bone marrow that is invaded by immature, non-functional leukocytes called blasts, these blasts invade the bone marrow and interfere with the production of normal blood cells such as leukocytes needed to fight infection 8.8 The nurse is reviewing information about pediatric cancer; which of the following is an accurate statement? A. Cancer is the leading cause of death in children B. Central nervous system tumors is the most common type of pediatric cancer C. The incidence of cancer increase with age D. Childhood cancers grow slower than adult cancers - CORRECT ANSWER C. The incidence of cancer increase with age Leading cause of death in children are accidents Tumors of the central nervous system are the second most common type of pediatric cancer Pediatric cancers grow faster than adult cancers 8.9 A 6 year old who is receiving chemotherapy to treat a childhood malignancy, the child is currently anemic and is about to receive pRBCs; which of the following should be in clouded in the child's plan of care? A. Start a second large bore IV B. Administer Zoltan prior to the administration of the blood C. Administer oxygen by nasal cannula D. Limit the child's visitors and anticipate the need for protective isolation - CORRECT ANSWER C. Administer oxygen by nasal cannula This can assist the child with anemia by helping RBCs meet the tissue's need for oxygen 8.10 A 4 year old who has been diagnosed with acute lymphocytic leukemia (ALL); when reviewing the child's history, the nurse would expect to find which of the following in history? A. Recent history of enuresis B. Frequent complaints of leg pain C. Insomnia D. Ruddy complexion - CORRECT ANSWER B. Frequent complaints of leg pain Increased proliferation of white blood cells causes hypertrophy of the bone marrow which can lead to bone pain 8.11 A parent asks how the diagnosis of leukemia will be confirmed in their 3 year old; Which of the following is the nurse's best response? A. "The lab will closely look at the child's blood under a microscope." B. "There are many different ways to diagnose leukemia but the treatment will be the same." C. "The physician will obtain a sample of the child's bone marrow from their sternum." D. "The physician will obtain a sample of the child's bone marrow from their hip." - CORRECT ANSWER D. "The physician will obtain a sample of the child's bone marrow from their hip." The iliac crest is considered the ideal location for a pediatric bone marrow aspiration, which is a definitive diagnostic test for leukemia 8.12 The nurse is working with a group of students in the pediatric cancer clinic; in reviewing a student nurse's project on leukemia, the nurse correctly challenges which of the following statements? A. Acute lymphocytic leukemia (ALL) is the most common type of leukemia in children B. Acute lymphocytic leukemia (ALL) peaks in school age children C. In adolescents, acute myelogenous leukemia (AML) is more common than Acute lymphocytic leukemia (ALL) D. Only about 65% of children diagnosed with - CORRECT ANSWER B. Acute lymphocytic leukemia (ALL) peaks in school age children ALL peaks in children between the age of 2-5 and is the most common type of leukemia in children In adolescents, AML is more common than ALL Survival from AML increased to a national average of 65% 8.13 The nurse is caring for a 15 year old who is getting ready to be discharged following an amputation of the right leg for osteogenic sarcoma, the child is distraught and says to the nurse, "I don't want to go back to school."; which of the following is the nurse's best response? A. "I understand that you're feeling uncomfortable, lets talk about ways to make you feel better about this." B. "You know, it could be so much worse, you're really very lucky." C. "I understand, this must be diffic - CORRECT ANSWER A. "I understand that you're feeling uncomfortable, lets talk about ways to make you feel better about this." This response acknowledges the child feelings and potentially discusses ways to help them feel less alienated 8.14 The nurse is caring for a toddler with end stage cancer, the child's parents ask the nurse if their child is likely afraid to die; which of the following is the nurse's best response? A. "The child is most likely afraid that dying will hurt, so we will promise to keep them comfortable." B. "The child is most likely afraid to be separated from you, so we'll keep reminding your child that you are with her." C. "The child is too young to understand that anything unusual is going on, this is r - CORRECT ANSWER B. "The child is most likely afraid to be separated from you, so we'll keep reminding your child that you are with her." The toddler has a very limited concept of death - their greatest fear is separation from the parent 8.15 A 4 year old who has attended the funeral of their grandparent, the parents express concern because a week after the funeral - the child asks if their grandparent is going to come to their birthday party; which of the following is the nurse's best response? A. "Most children of the same age don't understand that death is final." B. "Most children of the same age are very self focused and cannot think beyond an exciting event involving themselves such as a birthday party." C. "Most children - CORRECT ANSWER A. "Most children of the same age don't understand that death is final." A preschooler's sense of time is not fully developed 9.1 A 10 month old infant with tetralogy of fallot experiences a cyanotic episode, or 'blue spell'; to improve oxygenation the nurse should place the infant in with position? A. Knee-to -chest B. Fowler's C. Trendelenburg's D. Prone - CORRECT ANSWER A. Knee-to -chest This increase systemic vascular resistance thereby shunting blood to the lungs and improving overall oxygentation to alleviate the cyanotic event Administering O2 is also indicated 9.2 A child with suspected rheumatic fever is admitted, when obtaining the child's history the nurse considers which information to be most important? A. A fever that started 3 days ago B. Lack of interest in food C. A recent episode of pharyngitis D. Vomiting for 2 days - CORRECT ANSWER C. A recent episode of pharyngitis Rheumatic fever is an autoimmune complex disorder occurring several weeks after a group A beta-hemolytic streptococcal infection Antibodies are produced against the toxin of the streptococci, which then attack and destroy the heart valves 9.3 Which of the following instructions would the nurse include in a teaching plan that focuses on initial prevention of rheumatic fever? A. Using a corticosteroid to reduce inflammation B. Treating streptococcal throat infections with antibiotics C. Providing a antibiotic before dental work D. Giving penicillin to clients with rheumatic fever - CORRECT ANSWER B. Treating streptococcal throat infections with antibiotics Rheumatic fever is an autoimmune complex disorder occurring several weeks after a group A beta-hemolytic streptococcal infection Antibodies are produced against the toxin of the streptococci, which then attack and destroy the heart valves The primary prevention is teaching parents the importance of administering the complete course of antibiotics for the child with a strep throat infection 9.4 Am 8 year old has rheumatic fever; you correctly note that which symptom of the disease leaves permanent sequelae? A. Carditis B. Polyarthritis C. Gingivitis D. Anemia - CORRECT ANSWER A. Carditis Occurs as part of rheumatic fever causes permanent heart damage This is the greatest long-term sequelae caused by the condition 9.5 You correctly identify that the abnormal changes in the heart structure in tetralogy of fallot are: A. Stenosis of the pulmonary vein, hypertrophy of the right ventricle, dextraposition of the aorta, ventricular septal defect B. Stenosis of the pulmonary vein, hypertrophy of the left ventricle, dextraposition of the aorta, ventricular septal defect C. Stenosis of the pulmonary artery, hypertrophy of the right ventricle, dextraposition of the aorta, ventricular septal defect D. Stenosis of t - CORRECT ANSWER C. Stenosis of the pulmonary artery, hypertrophy of the right ventricle, dextraposition of the aorta, ventricular septal defect Dextraposition of the aorta - overriding aorta Ventricular septal defect - VSD 9.6 A child is having surgery to repair tetralogy of fallot, and has now developed polycythemia; due to this development, your best action is: A. Allow rest periods B. Keep the child hydrated C. Keep the child in a semi-Fowler's position D. Perform passive range of motion - CORRECT ANSWER B. Keep the child hydrated Polycythemia is an increased RBC count which occurs in tetralogy of fallot Polycythemia results in a more viscous blood due to an increased number of cells per unit of fluid Hydration with an isotonic fluid will hydrate the intravascular space and help to dilute the RBC count 9.7 A 4 year old is admitted with congenital heart disease; when assessment reveals a bounding radial pulse coupled with a weak femoral pulse, the nurse suspects that the child has: A. Patent ductus arteriosus B. Coarctation of the aorta C. Ventricular septal defect D. Truncus arteriosis - CORRECT ANSWER B. Coarctation of the aorta Coarctation of the aorta - narrowing of the aorta - results increased pressure proximal to the defect and decreased pressure distal to the defect Clinical manifestations - bounding pulses and increased BPs in upper extremities, weak/absent pulses and decreased BPs in lower extremities Patent ductus arteriosus (PDA) - failure of the fetal ductus arteriosus to close completely after birth - results in blood flowing from the aorta through the PDA and back to the pulmonary artery and lungs Clinical manifestations range from asymptomatic (small PDA) to a loud, machine-like cardiac murmur, repeated respiratory infections, poor feeding, fatigue, poor weight gain and tachypnea Ventricular septal defect (VSD) - abnormal opening between right and left ventricles - results in increased pulmonary vascular resistance, enlarged right side of the heart Clinical manifestations - asymptomatic, failure to thrive, diaphoresis, fatigue, increased pulmonary infections Trunc 9.8 Children with congenital heart conditions are extremely susceptible to: A. Gastrointestinal disorders B. Skin infections C. Allergic conditions D. Upper respiratory infections - CORRECT ANSWER D. Upper respiratory infections Due to increases likelihood of congestive heart failure 9.9 The nurse is reviewing the anatomy and physiology of the heart; which of the following statements is accurate? A. Prior to birth the pressure is highest of the left side of the heart B. The area of highest pressure in the heart of a healthy child is the right ventricle C. A right to left shunt creates increased pulmonary blood flow D. Relaxation of the heart is called diastole - CORRECT ANSWER D. Relaxation of the heart is called diastole Prior to birth the pressure is highest of the right side of the heart The area of highest pressure in the heart of a healthy child is the left ventricle A left to right shunt creates increased pulmonary blood flow 9.10 The nurse is caring for a child who is at risk for congestive heart failure secondary to a congenital heart defect that increases pulmonary blood flow; which of the following is an example of a heart defect that increases pulmonary blood flow? A. Coarctation of the aorta B. Atrial septal defect C. Tetralogy of fallot D. Pulmonary stenosis - CORRECT ANSWER B. Atrial septal defect Since the pressure on the left side of the heart, an atrial septal defect results in a left to right shunt, increasing pulmonary blood flow Coarctation of the aorta - decreased circulation to the lower extremities but does not increase pulmonary blood flow Tetralogy of fallot and pulmonary stenosis - there is a narrowing in the pulmonary artery or valve causing decreased pulmonary blood flow 9.11 The child with tetralogy of fallot experiences which of the following types of shunting of blood? A. Left to right B. Right to left C. Upper to lower D. Lower to upper - CORRECT ANSWER B. Right to left There is increased pressure in the right ventricle, causing blood to shunt from right to left 9.12 The nurse is caring for a 4 year old with an unrepaired ventricle septal defect (VSD); which of the following would the nurse expect to find in the child's history? A. Tachypnea with a congested cough B. History of test spells C. Weight for age at 95th percentile D. Baseline oxygen saturations of 85% - CORRECT ANSWER A. Tachypnea with a congested cough The increased blood flow to the lungs can cause tachypnea with a congested cough Children with congenital heart defects are often small as they require increased energy for breathing Tet spells are associated with tetralogy of fallot, not VSD The child with VSD should have oxygen saturations that are within normal limits 9.13 A 3 week old is admitted with congestive heart failure secondary to an atrial septal defect (ASD); the care plan should include: A. Monitor strict I&Os, weigh all diapers and weigh the child weekly B. Cluster all care so that oxygen demands are decreased C. Provide high calorie formula and allow the child to feed slowly over an hour D. Allow the child to cry to encourage expansion and clearing of lung fields - CORRECT ANSWER B. Cluster all care so that oxygen demands are decreased The child should be weighed daily, not weekly Feedings should not last one hour as this increases energy expenditure and oxygen demands Crying increases oxygen demands and should therefore be prevented as much as possible 9.14 A 3 year old with congenital heart anomalies is diagnosed with Subacute Bacterial Endocarditis (SBE); while assessing the child and obtaining history, the nurse would expect to find which of the following? A. Weight loss B. Ruddy complexion C. Edema to the extremities D. Restlessness and inability to sleep - CORRECT ANSWER A. Weight loss Complexion is usually pale The child typically does not present with edema The child is usually very tired and sleeps more more than usual 9.15 The nurse is reviewing information regarding Kawasaki's disease; which of the following is correct? A. Without treatment 50% of all children diagnosed with Kawasaki's disease will have permanent cardiac sequelae B. It is second only to rheumatic fever as the leading cause of acquired pediatric heart disease C. It generally affects children over 10 years old D. It is treated with salicylate (aspirin) therapy - CORRECT ANSWER D. It is treated with salicylate (aspirin) therapy Without treatment 25% of all children diagnosed with Kawasaki's disease will have permanent cardiac sequelae It is the leading cause of acquired pediatric heart disease It generally affects children under 5 years old 9.16 The nurse caring for a 3 year old diagnosed with Kawasaki's disease; while assessing and reviewing results, the nurse would expect to find which of the following? A. Swelling of the conjunctiva B. A very distinctive rash to extremities C. Inflammation of the mouth, lips, and tongue D. Lab results showing a positive ASO titer - CORRECT ANSWER C. Inflammation of the mouth, lips, and tongue Also known as strawberry tongue 9.17 Which of the following is true concerning the subacute phase of Kawasaki's disease? A. Children in this phase experience a high persistent fever that does not respond to antipyretics B. Cervical lymphadenopathy is most prominent during this phase C. Peeling of the hands and feet occur during this phase D. This phase begins with the resolution of all clinical signs and normalization of lab values - CORRECT ANSWER C. Peeling of the hands and feet occur during this phase The subacute phase begins with the resolution of the fever and is characterized by peeling hands and feet Acute phase - nonresponsive high persistent fever and cervical lymphadenopathy Convalescent phase - resolution of all clinical signs and normalization of lab values 10.1 An infant is diagnosed with developmental dysplasia of the hip; on assessment, the nurse expects to note: A. Symmetrical thigh and gluteal folds B. Ortolani sign C. Increased hip abduction D. Femoral lengthening - CORRECT ANSWER B. Ortolani sign The clicking sound that occurs when the healthcare provider manually abducts the hip through a frog-legged position causing the affected hip to slide out of the acetabulum 10.2 Which of the following assessments would the nurse expect to see in an infant with development dysplasia of the hip? A. Asymmetric gluteal folds B. Symmetric gluteal folds C. Trendelenburg's sign D. Bone growth disruption - CORRECT ANSWER A. Asymmetric gluteal fold Developmental dysplasia of the hip is a condition involving displacement of the femoral head from the acetabulum - the acetabulum is not deep enough for the femoral head to remain in the proper position Clinical manifestations - asymmetric gluteal folds, Ortolani's sign (clicking of the femoral head and dislocation upon abduction in a frog-leg position), limited abduction of the affected hip 10.3 The nurse is preparing to teach a health maintenance class on bones; While reviewing the material, the nurse questions which of the following statements? A. Most fracture in a 4 year old will heal in 4 weeks B. Injuries that damage the epiphyseal plate usually result in infection C. Clavicular fractures are one of the most common fractures in children D. Toddlers with fractures tend to heal quicker than adolescents with fractures - CORRECT ANSWER B. Injuries that damage the epiphyseal plate usually result in infection Damage to the epiphyseal plate can result in bone growth abnormalities 10.4 A 3 month old has been diagnosed with developmental dysplasia of the hip and is to be placed in a Pavlik harness, the parents appear hesitant and ask the nurse what its purpose is; which of the following is the nurse's best response? A. "The Pavlik harness will help enlarge the hip socket by keeping the child's legs in an abducted." B. "The Pavlik harness will help reduce the hip socket by keeping the child's legs in an abducted position." C. "The Pavlik harness will help enlarge the hip s - CORRECT ANSWER A. "The Pavlik harness will help enlarge the hip socket by keeping the child's legs in an abducted." 10.5 The nurse helps apply a cast to a 6 year old's fractured arm; which of the following is most important to remember while helping with the application of the cast and caring for it afterwards? A. Use only the fingertips while holding the cast B. Petal the rough edges by applying tape from the outside to the inside of the cast C. Assess the child's ability to wiggle fingers D. Encourage the use of powder to absorb any orders and help with discomfort - CORRECT ANSWER C. Assess the child's ability to wiggle fingers This is to monitor neurovascular status 10.6 A 4 year old is being cared for and placed in skeletal traction until their femur fracture can be surgically connected; which of the following should be included in the care plan? A. Limit fluids so that the discomfort of toileting can be minimized B. Give the child bubbles to blow C. Rearrange traction weights every 4 hours D. Administer sedatives to help the child stay still and sleep more - CORRECT ANSWER B. Give the child bubbles to blow This is an excellent diversional activity that also promotes lung expansion 10.7 The nurse is caring for a 5 year old with Duchenne's muscular dystrophy (MD), while documenting assessment, the nurse notes that Gower's sign was observed; which of the following best describes Gower's sign? A. A waddling gait noted while ambulating B. Oxygen saturation drop during sleep due to hypoventilation C. Muscle wasting and contractures noted on lower extremities D. While rising from a squatting position, the child walks their hands up their legs - CORRECT ANSWER D. While rising from a squatting position, the child walks their hands up their legs This is due to muscle weakness of the lower extremities 10.8 A 13 year old diagnosed with juvenile idiopathic arthritis (JIA) tells the nurse that they "are tired of being left out at school" and wants to join an activity; which of the following is the nurse's best response? A. "You may want to try soccer as it includes a lot of running." B. "Football is a good sport as it will help you run and stretch." C. "Swimming is a good way to exercise and stretch." D. "Have you thought about being a team helper? You could still be involved but not have any r - CORRECT ANSWER C. "Swimming is a good way to exercise and stretch." Children with JIA are discourage from contact sports as it may lead to joint inflammation 10.9 The nurse is caring for a 6 month old who has been diagnosed with severe osteogenesis imperfects (OI); which of the following are long term complications of OI? A. Deafness B. Polycythemia C. Cognitive impairment D. Increased whitening of the teeth - CORRECT ANSWER A. Deafness Bones of the ear are impacted 10.10 The nurse is caring for a 16 year old who has just had a spinal fusion to correct scoliosis; which of the following should the nurse include in the patient's immediate plan of care during the first 24 hours after surgery? A. Encourage the use of the inspirometer to avoid any pulmonary complications and ensure lung expansion B. Encourage the patient's parent to assist with administration of morphine via patient controlled analgesics (PCA) pump while the patient is sleeping to assure a cont - CORRECT ANSWER A. Encourage the use of the inspirometer to avoid any pulmonary complications and ensure lung expansion The child is the only person allowed to push the PCA button The child will be able to ambulated 8 hours after surgery Discoloration of the teeth occurs as the enamel cracks away 10.11 Which of the following describes the technique the nurse would use to screen the school age child for scoliosis? A. Have the child stand firmly on both feet and bend forward at the hips with the trunk exposed B. Listen for clicking sound as the child abducts the hips C. Have the child run the heel on one foot down the shin of the other leg while standing D. Have the child shrug their shoulders as the nurse applies mild pressure to the shoulders - CORRECT ANSWER A. Have the child stand firmly on both feet and bend forward at the hips with the trunk exposed If the child has scoliosis, the nurse notes that the spine fails to straighten when the child bends foward 11.1 The parent of a preschooler diagnosed with insulin dependent diabetes melitus says their child had an uncontrollable emper tantrum while playing and is now lethargic and difficult to arrouse; the nurse should instruct the mother to take which action first? A. Obtain a urine sample and measure the glucose level B. Force the child to drink orange juice C. Measure the child's blood glucose D. Call 911 because this is an emegency - CORRECT ANSWER C. Measure the child's blood glucose This will provide accurate informations about the chil'd present glucose level As the nurse you should suspect that the child is experiencing a low blood glucose level due to the mental status change and lethargy 11.2 A child receives NPH insulin daily in the morning; what is essential for the child to know in relations to the insulin's effect? A. Give the injection 30 minutes before breakfast B. Have a mid-afternoon snack C. Check their urine after each meal D. Follow the American Diabetic Association menu carefully - CORRECT ANSWER B. Have a mid-afternoon snack NPH is intermediate-acting insulin the child would want to eat a mid-afternoon snack to maintain a steady blood glucose when the NPH is at its peak effect 11.3 You are teaching an adolescent who has been diagnosed wth diabetes about taking Humalog insulin; what is essential for the adolescent to know in relation to the insulin's effect? A. Give the injection 30 monutes before breackfast B. Have a mid-afternoon snack C. Check their urine after each meal D. Give the injection immediately before their meal - CORRECT ANSWER D. Give the injection immediately before their meal Humalog is immediate-acting insulin It has its peak effet 5-10 minutes after administration 11.4 As the nurse performing routine diabetic teaching with the child and family you know that it is important to reinforce that the body's need for insulin decreases in the presence of: A. Overeating B. Increased physical activity C. Acute infections D. Increased emotional strain - CORRECT ANSWER B. Increased physical activity This decreases the bodies lood glucose, which decreases the need for insulin 11.5 Which are symptoms of insulin shock? A. Sweaing and behavior changes B. Thirst and increased appetite C. Dry flushed skin D. Polyuria and polydipsia - CORRECT ANSWER A. Sweaing and behavior changes Inculin shock is characterized by a blood glucose < 70mg/dL Manifestations - sweating, shaking, tachycardia, behavior changes (confusion, irritability, poor coordination) 11.6 The best reason to encourage the patient to rotate sites for their insulin injections is to: A. Decrease the amount of bruising B. Decrease the amount of pain for each injection C. Prevent atrophy of the subcutaneaous fat D. Equally spread out the insulin in the body - CORRECT ANSWER C. Prevent atrophy of the subcutaneaous fat To prevent scar formation and prevent poor insulin absorption 11.7 Which of the following is commonly seen in hypothyroidism? A. Bradycardia B. Diarrhea C. Weight loss D. Tachycardia - CORRECT ANSWER A. Bradycardia 11.8 A 5 year old has just been diagnosed with type 1 diabetes; while assessing and review history, the nurse would expect to find which of the following: A. Hgb A1C of 7 B. Clammy, diaphoretic skin C. History of anorexia D. Dry, flushed skin - CORRECT ANSWER D. Dry, flushed skin Typical for the newly diagnosed diabetic patient 7.13 The nurse is leasding a support group for parents of children with sickle cell disease; the nurse knows that more education is needed when one parent states: A. "I know that my child's wounds may take longer to heal because of sickle cell disease." B. "Instead of tylenol, Aspirin helps with the pain of sickle cell disease." C. "I always send a bottle of water to school with my child." D. "We don't let our child shovel the driveway." - CORRECT ANSWER B. "Instead of tylenol, Aspirin helps with the pain of sickle cell disease." Aspirin should be avoided as it increases sickling by placing the body in a state of acidosis and should be avoided in children due to its association with Reye Syndrome 11.9 The school nurse is called to the second grade classroom to check on a 7 year old who is a type 1 diabetic, the child is found lethargic and confused, falls to the ground but is still awake; which of the following should the nurse do first? A. Immediately obtain a finger stick blood sugar B. Immediately call EMS for an ambulance C. Immediately administer a dose of rapid acting insulin D. Immediately give a fast acting carbohydrate such as cake frosting or gatorade - CORRECT ANSWER D. Immediately give a fast acting carbohydrate such as cake frosting or gatorade Sugar should be given since the nurse is unsure what kind of reaction the child is having. It is important to treat the patient as hypoglycemic vs. hyperglycemic when unknown because death can result 11.11 A 6 year old with type 1 diabetes receives a dose of Humalog at 8:00 a.m.; which of the following is most important to do in order to prevent a hypoglycemic reaction? A. Check a finger stick glucose at 9:00 a.m. B. Encourage the child to eat breakfast at 9:00 a.m. C. Encourage the child to immediately eat breakfast D. Administer an additional dose of Humalog at noon - CORRECT ANSWER C. Encourage the child to immediately eat breakfast Waiting 1 hour from getting a dose of Humalog (an immediate-acting insulin) could result in hypoglycemia 11.10 An 11 year old with type 1 diabetes was playing football, the child suddenly stops with the ball and can't remember which way to run, the child appears very sweaty and stumbles toward the sidelines; which of the following could have lead to this reaction? A. The child forgot to take their earlier dose of insulin B. The child did not take enough insulin to cover his exercise regimen C. The child consumed too many carbohydrates priorto his exercise regimen D. The child did not eat enough be - CORRECT ANSWER D. The child did not eat enough before exercising The reaction appears to be hypoglycemia which could result from not eating enough prior to exercising Treatment would be to give a fast acting carbohydrate 11.12 The nurse is providing education about type 1 diabetes to an 11 year old and parents; which of the following should be included? A. A preferred infection location should be chosen as it will lead to desensitizaqtion and less discomfort B. Insulin should be shaken prior to administration C. When administering both regular and NPH, draw up the regular, then the NPH in the same syringe D. Always administer the same insulin ose at the same time everyday - CORRECT ANSWER C. When administering both regular and NPH, draw up the regular, then the NPH in the same syringe Regular insulin is always draw up first to prevent the contamination with the NPH Insulin should be gently rotated, not shaken Injection loscations should be rotated Doses and timing may be altered for best blood glucose control 11.13 Which of the following would the nurse expect to find while reviewing history of a 13 year old diagnosed with type 2 diabetes? A. A history of polyphagia with recent weight loss B. Unusually low lipid level C. A history of snoring D. Hypotension - CORRECT ANSWER C. A history of snoring A history of snoring is seen in sleep apnea which is associated with type 2 diabetes 11.15 When providing education to an obese 16 year old on metformin (glucophage), the nurse knows that metformin's mechanism of action is best illustrated by which of the following? A. Glucophage increases the production of insulin in the pancreas B. Glucophage decreases the production of glucose in the liver C. Glucophage decreases the production of insulin in the pancreas D. Glucophage increases the production of glucose in the liver - CORRECT ANSWER B. Glucophage decreases the production of glucose in the liver 11.14 The parents of a 10 year old diagnosed with type 2 diabetes ask the nurse for more information about the diagnosis; the nurse bases the response on whic of the following: A. Most children with type 2 diabetes develop thinkening and darkening of the skin in the neck and axillary areas B. Most children with type 2 diabetes have no fmaily history of diabetes C. Due to a greater awareness and increased education, the occurrence of type 2 diabetes has slightly decreased over the past decade D. - CORRECT ANSWER A. Most children with type 2 diabetes develop thinkening and darkening of the skin in the neck and axillary areas 90% of children with type 2 diabetes develop a thickening and darkeningof the skin around te neck and axillary areas (acanthosis nigricans) 11.16 A parent was just told their newborn has been diagnosed with PKU, after explaining the condition, the nurse provides further educaion; which of the following is the nurse's most accurate statement? A. "Your baby will need to take additional phenylalanime supplements throughout the child's life." B. "Unfortunately, babies with PKU don't usually survive the first year of life, I am very sorry." C. "Because of a dietary deficiency, your baby will need to consume additional proteins." D. "You - CORRECT ANSWER D. "Your baby will need to avoid foods such as milk, meat, and eggs." Children with PKU need to avoid foods that are hihg in protein In PKU, there is a build up of phenylalanine that leads to brain damage 11.17 The nurse is caring for a child diagnosed with diabetes insipidus (DI); which of the following would support this diagnosis? A. Sodium level of 128 mEq/L B. Sodium level of 153 mEq/L C. Glucose level of 58 mg/dL D. Glucose level of 328 mg/dL - CORRECT ANSWER B. Sodium level of 153 mEq/L DI is a disorder where thers is an inadequate secretion of antidiuretic hormone - results in intense diuresis and hypernatremia Normal serum sodium (Na) is 135-145 mEq/L 11.18 The nurse is caring for a child who has developed syndrome of inappropriate antidiuretic hormone (SIADH); while assessing the child, it is most important to focus on: A. Neuroloic status B. Size of liver C. Heart rate and blood pressure D. Body temperature - CORRECT ANSWER A. Neuroloic status In SIADH, there is excessive secretion of antidiuretic hormone, resulting in extensive fluid retention and hyponatremia Normal serum sodium (Na) is 135-145 mEq/L 12.1 You are providing education to the parents of a child with tinea corporis (ring worm); which of the following statements made by the mother indicates a need for more education? A. "I will be sure that none of my children will share towels." B. "I will keep my child home from school until the rash is gone." C. "I will check my dog to see if it has ring worm too." D. "I will wash all of my child's bedding in hot water." - CORRECT ANSWER B. "I will keep my child home from school until the rash is gone." It is not necessary to keep the child home from school while treating ring worm Ring worm is caused by a fungus that spreads through contact with an infected person or animal or through contact with towels, clothing, and bedding 11.19 A child with hyperthyroidism expoeriences a rapid heart rate and a flushed, hot feeling; this is considered: A. Thyroid storm B. A side effect of the medication C. Normal symptoms of the conditon D. Unrelated to the condition - CORRECT ANSWER A. Thyroid storm Thyroid storm is an acute emergency that occur in children with hyperthyroidiam in which their body overheats and they develop a rapid heart heart Is a medical emergency and requires immediate medical attention 12.2 You are the nurse caring for a child with small, localized area of tinea corporis (ring worm) on their leg and their parent wants to know how to treat it; you correctly tell the parent: A. Apply antifungal cream twice daily B. Take antifungal oral medication twice daily C. There is no treatment for ring worm; it goes away in 7-10 days D. Apply corticosteroid cream twice daily for 10 days - CORRECT ANSWER A. Apply antifungal cream twice daily Ring worm is treated first with an over the counter antifungal cream If the cream is not effective, an oral antifungal may be prescribed 12.3 You are performing teaching with the parents of a toddler with scabies; you correctly teach the parents which of the following regarding treatment: A. Take antibiotics twice a day for 10 days as ordered B. Apply scabicide cream to all skin areas below the neck and leave on for 8-12 hours and then wash off, then repeat one week later C. Apply scabicide cream to affected areas twice per day D. Take scabicide oral mediation twice a day for 10 days as ordered - CORRECT ANSWER B. Apply scabicide cream to all skin areas below the neck and leave on for 8-12 hours and then wash off, then repeat one week later 12.4 You are teaching the parents of school age children how to prevent head lice; which of the following should be included? A. Lice can be prevented through personal hygiene such as bathing the body and shampooing the hair daily B. If lice is present in one child in the household, it can be prevented by having the other children coat their heads in vaseline and place a shower cap on at bedtime C. Hats and other clothing should be stored in separate bins at school D. Pets can also carry lice a - CORRECT ANSWER C. Hats and other clothing should be stored in separate bins at school Lice infestation is not related to cleanliness or socio-economic status The use of vaseline and a shower cap should not be recommended as it an lead to suffocation Pets do not carry lice 12.5 You are caring for a school aged child with Steven's Johnson's syndrome (SJS); which of the following would be anticipated to be included in care? A. Examine the urine for catecholamines B. Apply lubricant to eyes C. Apply calamine lotion to leasons D. Administer antibiotic to treat the causative organism - CORRECT ANSWER B. Apply lubricant to eyes SJS is the most commonly a reaction to a drug (mainly Penicillins, anticonvulsants, non-steroidal anti-inflammatory drugs SJS can also be caused by an infection (herpes, influenza, HIV) or physical stimuli (radiation therapy) Treatment includes discontinuing the drug causing the reaction, apply moist dressings to healing skin, eye lubricant to decrease dryness 13.1 A 3 year old has been receiving prednisone for a few weeks; what side effect would you most likely observe? A. Addisonian crisis B. ypoglycemia C. Cushing's syndrome D. Koplik's spot - CORRECT ANSWER C. Cushing's syndrome side effects of corticosteriods include: fluid retention, edema, altered growth patterns and Cushing's syndrome, which includes moon face, increased BP, hyperglycemia 13.3 The urine specimen of a child with acute glomerulonephritis would probably be A. Normal in color but very scant amount B. Normal in color but cloudy due to loss of albumin C. Normal in color and amount D. Rusty brown color due to loss of blood - CORRECT ANSWER D. Rusty brown color due to loss of blood 13.2 A 2 year old is admitted to the ER due to ingestion of an unknown amount of aspirin 45 minutes earlier; to detect symptoms of aspirin toxicity, whihc of these assessments of the child should be made? A. The character of respirations B. The reactions of pupils to light C. The ability to flex and hyperextend their neck D. The presence of abdominal distention - CORRECT ANSWER A. the character of respirations Aspirin ingestion is a source of metablic acidosis - the child ingests aspirin (acid) which lowers the child's pH to < 7.35 The body responds to the acidosis by increasing respirations the respiratory rate in an effort to "blow off" CO2 and thereby decrease the overal pH 13.4 The nurse is reviewing the following results of a blood gas: pH: 7.33 HCO3: 16 PaO2: 26 PaCO2: 35 A. Metabolic acidosis B. Respiratory acidosis C. Metabolic alkalosis D. Respiratory alkalosis - CORRECT ANSWER A. Metabolic acidosis pH: 7.35-7.45 HCO3: 22-26 PaCO2: 35-45 pH < 7.35 HCOS < 22 13.5 The nurse is reviewing the following results of a blood gas: pH: 7.48 HCO3: 28 PaO2: 96 PaCO2: 35 Which of the following could cause this result? A. Severe diarrhea B. Kidney failure C. Pyloric stenosis D. Aspirin overdose - CORRECT ANSWER C. Pyloric stenosis The body loses acid in cases of vominting which can result in metabolic alkalosis (as indicated in the results of the blood gas) 13.6 A 15kg child is in acute renal failure, IVF is to run at half maintenance; the nurse knows that the IVF is running at the correct rate when the pump says which of the following? A. 90mL/hr B. 50mL/hr C. 45mL/hr D. 25mL/hr - CORRECT ANSWER D. 25mL/hr If the child weighs 15kg, they receive 40mL for the first 10kg (10 x 4mL) and 10mLfor the next 5 kg (5 x 2mL/hr) The hourly maintenance is 50mL/hr, therefore half maintenance is 25mL/hr 13.8 The parents of a 6 year old tell the nurse that they are concerned that their child started bedwetting and ask the nurse what they should do. Which of the following is the nurse's best response A. "Tell your child that they can no longer drink milk with their bedtime snack until they stop having accidents." B. "Take turns getting your child up every few hours during the night to help them empty their bladder." C. "Place a calender on the fridge showing which nights their child was wet and - CORRECT ANSWER D. "When their child does wake up wet, have them change their own cloths and help change the sheets." Having the child assist with changing the sheets and their clothes ma help foster a sense of industry 13.7 The nurse is caring for a 4 year old with a urinary tract infection (UTI); in order to prevent subsequent UTI's, the nurse should teach the parents to do which of the following? A. Encourage their daughter to drink large amounts of clear fluids such as Sprite B. Encourage the paretns not to allow their daughter to do her own hygiene after toileting C. Encourage a low fiber diet D. Offer their daughter a reward when she uses the toilet every 2 hours - CORRECT ANSWER D. Offer their daughter a reward when she uses the toilet every 2 hours Offering a reward to a 4 year old is appropriate as it may help remind the child to empty their bladder - preventing urinary stasis which is a leading cause of UTI's 13.9 The nurse is caring for a 3 year old diagnosed with nephrotic syndrome; when receiving lab results, the nurse would expect to find which of the following? A. Frank hematuria B. Hyperalbuminemia C. Proteinuria D. Urine with a low specific gravity - CORRECT ANSWER C. Proteinuria Proteinuria occurs as large amounts of proteins are lost in the urine 13.10 The nurse is caring for a 5 year old with glomerulonephritis; when reviewing the child's lab results the nurse would expect to find which of the following? A. Decreased sedimentation rate (ESR) B. Decreased antistreptolysin O (ASO) titer C. Anemia D. Low protein in the urine - CORRECT ANSWER C. Anemia Anemia occurs due to blood lost in urine In glomerulonephritis, there is an increased sedimentation rate (ESR) indicating the inflammatory response The antistreptolysin O (ASO) titer is increased indicating that there was a recent streptococus infection There is high, not low protein 13.11 The nurse is caring for a 2 year old diagnosed with hemolytic uremic syndrome (HUS); which of the following should be included in the care? A. Weigh the child each week on the same scale B. Encourage the child to run and play in the activity room to help meet her developmental needs C. Encourage the child to drink clear liquids D. Monitor urine and stool for blood - CORRECT ANSWER D. Monitor urine and stool for blood The child with HUS has thrombocytopenia therefore the urine and stool should be monitored for blood The child with HUS should be weighed daily The child with HUS is prone to bleeding and bruising and should be encouraged to participate in calm activities that are less liklely to cause injury Liquids may be restricted due to acute renal failure 13.12 The nurse caring for a 10 year old with acute renal failure; when reviewing lab results, the nurse would expect to find which of the following? A. Decreased BUN and Creatinine and increased sodium B. Increased BUN and Creatinine and decreased sodium C. Decreased BUN and Creatinine and decreased sodium D. Increased BUN and Creatinine and increased sodium - CORRECT ANSWER B. Increased BUN and Creatinine and decreased sodium In acute renal failure, the glomerular filtration rae decreases leading to an elevated BUN and creatinine level There is also a decrease in the sodium level due to the dilution of the extracellular fluid 13.13 The nurse is caring for a newborn diagnosed with hypospadias, the parent asks if the child could be cicumcised; which of the following is the nurse's best response? A. "There is no reason to not circumcise your child, would you like to had it scheduled before discharge?" B. "Children with hypospadis cannot be circumcised." C. "The foreskin is sometimes used when the hypospadias is corrected, so we can anticipate that your child will be circumcised then." D. "Circumcision is no longer a re - CORRECT ANSWER C. "The foreskin is sometimes used when the hypospadias is corrected, so we can anticipate that your child will be circumcised then." The child with hypospadias will require reconstructive surgery that may necessitate the use of the foreskin Circumcision is not done prior to surgery Many children can be circumcised after the hypospadias has been repaired The nurse should provide education about caring dor the uncircumcised penis and reventing urinary tract infection 13.14 A 4 year old girls has a urinary tract infection (UTI); when teaching the parent how to help her avoid recurrent UTIs, the nurse should mphasize which preventive measure? A. Wiping her perineum from back to front after she uses the toilet B. Administering prophylatic antibiotics C. Giving her a warm bath for 15 min daily D. Making sure she avoids bubble baths - CORRECT ANSWER D. Making sure she avoids bubble baths Bubble baths are associated with UTIs in young children and should, therefore, be avoided Girls should wipe front to back Prophylactic antibiotics are not indicated 13.15 You are caring for a 3 year old who has just been diagnosed with nephrotic syndrome, the child is pale, edematous and has a poor appetite; Which of the following laboratory findings would expect? A. Glycosuria B. Gross hematuria C. Proteinuria D. Hyperalbuminemia - CORRECT ANSWER C. Proteinuria Children with nephrotic syndrome demonstrate proteinuria because they experience increased glomerular permeability to protein Other lab findings include microscopic hematuria (not frank hematuria) and hypoalbuminemia 13.16 Acute glomerulonephritis can be prevented by: A. Keeping te kidneys flushed by increased amounts of fluids B. Taking a full course of antibiotics following strep throat C. Getting immunization against influenzae D. keeping urine acidic - CORRECT ANSWER B. Taking a full course of antibiotics following strep throat Acute glomerulonephritis is an autoimmune immune-complex disorder occuring one to two weeks after group A beta-streptococci (or less commonly a pneumococcal or viral) infection Antibodies are made against the toxin of the streptococci but attack the glomerulus of the kidney because of similarities in their antigenic markers Prevention of this condition is promoted by instruction parents about the importance of administering the full dose of antibiots during a strep throat infection 13.17 Which of the following symtoms would you expect to see in the child with Cushing's syndrome? A. Hypotension, muscle wasting and precocious puberty B. Moon face, obesity and delayed puberty C. Muscle wasting, growth retardation and hypertension D. Muscle wasting, growth retardation and hypotension - CORRECT ANSWER C. Muscle wasting, growth retardation and hypertension Cushing syndrome is a cluster of clinical abnormalities that occur as a result of an increase in adrenocortical hormones Common symptoms include: moon face, muscle wasting, thin extremities, a protruding abdomen, retarded linear growth, precocious puberty Does not involve delayed puberty or hypotension 14.1 A child is admitted to treatment of bulimia nervosa; when developing a plan of care, the nurse anticipates including interventions that address which metabolic disorder? A. Hypoglycemia B. Metabolic alkalosis C. Metabolic acidosis D. Hyperkalemia - CORRECT ANSWER B. Metabolic alkalosis The child with nulimia nervous typically exhibits habtis of binging and purging - they frequently induce vomitting which is a source of metabolic alkalosis as the acid contents of the stomach are purged 14.2 A 5 year old with autism is playing with five chips that have been stacked and the child is starring at; how would the nurse initiate theraputic interaction? A. Tap the child on the shoulder and say their name B. Rearrange the chips C. Pick the child up and put them on your lap D. Sit three feet away from the child on the floor - CORRECT ANSWER D. Sit three feet away from the child on the floor The child with autism has difficulty engaging in interpersonal interactions It is best for the nurse to be present and attentive while also keeping a physical distance 14.3 A child with autism will have a deficit in: A. Vision B. Hearing C. Speech D. Movement - CORRECT ANSWER C. Speech Children with austimhave difficulty communicating due to their inability to process and interact with the worold around them 14.4 The nurse is teaching a groupd of parents about adolescent health issues and the topic of anorexia is discussed; which of the followingis ture? A. Anorexia is often the result of poor self-esteem B. Anorexics have <5% of expected body weight C. Anorexia only affects female adolecents D. Children with anorexia have an over inflated opinion of their importance - CORRECT ANSWER A. Anorexia is often the result of poor self-esteem Anorexics weigh <85% of expected body weight Anorexia is more common in females but occur in both males and females Anorexics typically have a low opinion of themselves 14.6 A 14 year old is diagnosed with anorexia nervosa; which of the following would the nurse expect the teen's parent to report? A. The teen's periods have been lasting longer than they used to B. The teen has been spending more time with friends C. The teen has been sleeping a lot more at night D. The teen has been reading cookbooks and svaing recipes - CORRECT ANSWER D. The teen has been reading cookbooks and saving recipes Many children with anorexia become obsessed with food and recipes Most children with eating disorders report difficulty sleeping, females experience amenorrhea, experience depression - become less social with friends 14.5 The nurse is caring for a 13 year old with anorexia, a group of the childs friends come to visit and they stop first and talk to the nurse; which of the following comments would the nurse most expect the peers to say? A. "Our friend was probably stressed because they struggle in school so much." B. "I'm surprised this happened to our friend, the patient's family seems to be perfect." C. "Our friend alwasy loved showing us how skinny they were getting." D. "Our friends house is always a mes - CORRECT ANSWER B. "I'm suprised this happened to our friend, the patient's family seemed to be perfect." Children with anorexia often come from families where the expectations are high - many families appear 'perfect' to outsiders but in reality pressures are high within the family Children with anorexia mostly are high acheivers and do well in school Typically children with anorexia wont brag how skinny they are because they dont believe they are thin 14.7 The nurse is performaing an assessment on an 11 year old being evaluated for an eating disorder, the child has lost a significant amount of weight and currently weighs les than 85% of their expected body weight; which of the following would be an expected finiding in a child with an eating disorder? A. Tachycardia, hypotension, vague abdominal complaints, diarrhea B. Bradycardia, hypotension, vague abdominal complaints, diarrhea C. Bradycardia, hypotension, vague abdominal complaints, con - CORRECT ANSWER C. Bradycardia, hypotension, vague abdominal complaints, constipation 14.8 The nurse is caring for a 17 year old with severe bulimia; the nurse analyzes the adolescent's labs and is not surprised to find wich of the following? A. Metabolic acidosis, hyperkalemia B. Metabolic alkalosis, hyperkalemia C. Metabolic acidosis, hypokalemia D. Metabolic alkalosis, hypokalemia - CORRECT ANSWER D. Metabolic alkalosis, hypokalemia The child with bulima loses excessive acid and potassium when vomiting 14.10 A 3 year old is being evaluated for autism; which of the following would the nurse expect the parent to report? A. The child likes to play with children who are much younger than them B. The child often rocks back and forth C. The child like to stay busy and doesn't do well with a rigid routine D. The child has periods of extreme lethargy - CORRECT ANSWER B. The child often rocks back and forth Children with autism often comfort themselves with self stimulating behavior such as rocking Perfer to play alone Perfer structured routines Experience hyperactivity, not lethargy 14.9 The nurse knows that the most successful therapy for a 14 year old with an eating disorder involves: A. Counseling for the child and the child's friends and fmaily B. Counseling for the child, isolating the child from friends and family C. Counseling for the child and family, isolating the child from friends D. Counselingfor the child and friends, isolating the child from family - CORRECT ANSWER A. Counseling for the child and the child's friends and fmaily 14.11 When providing education to the parents of a 6 year old with autism, the nurse includes which of the following? A. When giving the child directions, be sure to provide detailed explanations of why the tasks need to be performed B. When giving the child directions, get down to their level and gently hold both shoulders to help keep the child's attention focused C. Keep the child's room interesting by brightly painting the walls and ceiling D. Help the child gradually become aware of others - CORRECT ANSWER D. Help the child gradually become aware of others and slowly begin interacting with them The child with autism should be helped to developan awareness of others Directions should be specific and without rationale - to help complete the task Touch and excessive stimulation should be avoided as it may increse anxiety 14.12 Which of the following is true concerning learning disabilities? A. The child typically has a slightly lower IQ B. The child typically has a high self-esteem C. There is no know cause associated with learning disabilities D. The child must have a normal IQ to be diagnosed with a learning diability - CORRECT ANSWER D. The child must have a normal IQ to be diagnosed with a learning diability 14.13 The nurse is teaching a class about keeping children safe, one of the parens asks a question about teen suicide; Which of the following is accurate concerning suicide? A. Girls are more likely to die from suicide than boys B. Boys are more liklely to attempt suicide than girls C. Suicide is either the 2nd or 3rd leading cause of death amoung adolescents depending on race D. There are rarely warning signs before teens attemps to take their life - CORRECT ANSWER C. Suicide is either the 2nd or 3rd leading cause of death amoung adolescents depending on race Suicide is the 2nd leading cause of death amoung Caucasian adolescents and 3rd leading cause of death amoung African Americans Boys are more likely to die from suicide becuase they use more violent methods Girls are more likely to make uncompleted attemps at suicide becuase of less violent methods There are usually many warning signs before a teen attempts to take their life (depression, withdrawal, etc) 14.14 The nurse is caring for a 14 year old who admits to suicidal ideation, after discussing suicide, the teen asks the nurse to keep any information that was shared private; which of the following is the nurse's best option? A. In order to not destroy the teen's trust, keep their confidence but remain with the teen to keep them safe B. Keep the teen's confidence since they do not have a plan and therefore not likely to harm themself C. Tell the teen that their confidence will be kept private - CORRECT ANSWER D. Explain to the teen that in order to keep them safe, it is important to share this discussion with the rest of the health care team The exceptions to maintaining confidentiality are if the patient tells the nurse he/she is going to do harm to self, harm to others, or that someone is harming him/her 15.1 The pediatric nurse collaborates with the child, family, amd healthcare team in providing centered care; this is an example of which of the following? A. Standard of care B. Standard of professional performace C. Evidence based practice D. Atraumatic care - CORRECT ANSWER B. Standard of professional performace Collaboration is one of the standards of professional performance developed by ANA and Society of Pediatric Nurses 15.2 A new pediatric nurse who enjoys work and strives to develop therapeutic relationships among families they care for; Which of the following would indicate that this nurse needs more education regarding therapeutic communication? A. The nurse is taking a class on educating families of new diabetes B. The nurse frequently interviews families to get more information on their feelings and concerns C. The nurse frequently attends the birthday parties of children who have been discharged D. - CORRECT ANSWER C. The nurse frequently attends the birthday parties of children who have been discharged It is important for the nurse for the nurse to develop a relationship that is meaningful yet distinctively separate from their own personal relationships - attending birthday parties is not appropriate 15.3 With regards to evidence based practice in pediatrics, which of the following is the most accurate? A. Evidence based practice offers the nurse a variety of ways to accomplish a goal B. Evidence based practice is essential but may sometimes decrease quality of care C. Clinical practice guidelines are rooted in tradition D. Evidence based practice allows individual characteristics to be taken into consideration - CORRECT ANSWER D. Evidence based practice allows individual characteristics to be taken into consideration EBP leads to decrease in the variations in care but increases quality as care is based on the collection and interpretation of research 15.4 Which of the following is correct? A. Evidence based practice compliments the nursing process B. Evidence based practice replaces the nursing process C. Evidence based practice is unrelated to the nursing process D. Evidence based practice is an acronym for the nursing process - CORRECT ANSWER A. Evidence based practice compliments the nursing process Critical thinking os used to make decisions from knowledge that has been gathered and evaluated 15.5 A experienced pediatric nurse is serving on a unit based committee, several peers of this nurse have voiced concerns regarding a specific policy and would like to change this policy using evidence based practice; Which of the following are the steps of evidence based practice in the correct sequential order? A. Evaluating effectiveness, searching for evidence, analyzing the evidence, applying the evidence to practice, asking the question B. Searching for evidence, asking the question, anal - CORRECT ANSWER C. Asking the question, searching for evidence, analyzing the evidence, applying the evidence to practice, evaluating effectiveness 15.6 There are many rules and regulations surrounding the privacy of pediatric clients; which of the following represents following the rules and regulations regarding privacy? A. A health care provider faxes immunizations records to a child's school after receiving permission from a parent B. A sign in sheet in a health care clinic that asks for the child's name and basic complaint C. A chart with the patient's name left in a public place D. A heath care provider charging information with a pa - CORRECT ANSWER A. A health care provider faxes immunizations records to a child's school after receiving permission from a parent As long as there is written permission from a parent, it is considered acceptable to fax records to a school The child's diagnosis/chief complaint should be omitted Charts should never be left in public There are state laws protecting the confidentiality of adolescents seeking medical care 15.7 A nursing instructor who is teaching clinical to a group of nursing students, one of the students is caring for a 9 year old who lost a finger from a dog bite. The nursing instructor wants to take a picture of the wound to use in research the instructor is conducting, consent is received. The child becomes very agitated and doesn't want other people to see the injury; how should the instructor proceed? A. The instructor should wait until the child is asleep and take the picture since the p - CORRECT ANSWER C. The instructor should respect the child's wishes and not take the picture Even though the child is a minor, their "assent" should also be obtained and wished respected - this assent is an adjunct to parental consent 15.8 A pediatric nurse is considered becoming involved in the hospital's ethics committee; which of the following is true of ethical dilemmas? A. Alternatives to treatment are usually not available B. Noncompeting moral values usually exist C. Instead of the most beneficial, sometimes the least harmful action must be considered D. Societal norms do not play a role in ethics - CORRECT ANSWER C. Instead of the most beneficial, sometimes the least harmful action must be considered - in order to minimize or prevent harm 15.9 The nurse is caring for a 15 year old with end stage kidney cancer and will require dialysis, the child's parent wants 'everything done', but the child wants to be left alone and is aware they will die without dialysis; an emergency meeting of the ethics committee is called. A. The nurse should not be involved as the nurse is too emotionally involved to the child and family B. The nurse should be involved and show empathy with the parent of the child as they should be allowed to have as mu - CORRECT ANSWER D. The nurse should be involved and should present unbiased physical and psychosocial data 15.10 Which of the following can improve communication amount health care providers and decrease the potential for error? A. Return to tape recorded hand off report so that opportunities to verify information by reviewing the recording exist B. Have hand off report at the bedside with the immediate family present C. Have hand off report at the bedside when only the patient is present D. Vary the way in which hand off report is done based on staffing needs - CORRECT ANSWER B. Have hand off report at the bedside with the immediate family present Assessments and medications can be immediately verified It is ideal to have family present as they can verify information and have the opportunity to ask questions 15.11 Which of the following is the nurse's primary responsibility? A. The child and family B. The nursing profession C. The place of employment D. The nurse themself - CORRECT ANSWER A. The child and family 15.12 An essential role of the pediatric nurse is to function as an advocate, which of the following is an accurate statements regarding advocacy? A. In order to be an advocate for the hospitalized child, the nurse must be involved in patient care B. The United Nations provides guideline to assist the nurse in functioning as an advocate C. Advocacy is a model that is intended only for ethical issues D. Nursing is the main department in a hospital that functions in advocacy - CORRECT ANSWER B. The United Nations provides guideline to assist the nurse in functioning as an advocate The United Nations provides declaration of child rights that helps to serve as a guideline for optimal care The nurse does not need to be active at the bedside/in patient care to be an advocate 15.13 The nurse is caring for an 8 year old boy with cancer in a small community hospital that rarely sees children with cancer, the nurse caring for this patient performs several tasks; which of the following would indicate that the nurse needs more education regarding functioning as an advocate? A. The nurse assists in arranging the child's transfer to a larger children's hospital 200 miles away B. The nurse gathers information on local lodging for her child's family C. The nurse listens to t - CORRECT ANSWER D. The nurse commiserated with the child's family regarding their town's lack of resources Commiserating and focusing on the negative does not empower the family and is therefore not an example of advocacy 15.14 A 6 year old with leukemia was admitted with general consent sign by parents, parents are now out of town and the child requires a blood transfusion but this medical intervention requires signed consent; Which of the following represents the best way for the nurse to proceed? A. The nurse should use the general consent as it will cover all hospital procedures B. The nurse should use the general consent as the child has likely received previous transfusions C. The nurse should attempt to c - CORRECT ANSWER C. The nurse should attempt to call the parents and get verbal consent Universal consent is not considered sufficient when a medical treatment that involves a degree of risk is indicated The best option is to obtain verbal consent over the phone from the parents 15.15 A pediatric nurse is interested in becoming involved in disaster preparedness; which of the following represents the correct sequence of the 4 phases of disaster preparedness? A. Mitigation, preparedness, response, recovery B. Response, mitigation, preparedness, recovery C. Preparedness, mitigation, response, recovery D. Recovery, mitigation, preparedness, response - CORRECT ANSWER A. Mitigation, preparedness, response, recovery Mitigation - the prevention of the disaster Preparedness - the way in which workers will respond and what resources will be used Response - the period immediately following the event Recovery - the short and long term plans 15.16 The nurse is working at a safety fair, one of the booths is handing out helmets to children and families who complete a brief survey, only a few helmets remain and there are several families in line; which of the following ethical principles addresses this dilemma? A. Beneficence B. Autonomy C. Non-maleficence D. Justice - CORRECT ANSWER D. Justice - distributing resources in a fair manner Beneficence - promoting well-being Autonomy - the right to make informed choices Non-maleficence - preventing harm 15.17 Which of the following statements are true? A. If a nurse delegates a task that is not performed correctly, the nurse is the only one who may face legal action B. If a delegated task is not preformed correctly, only the person performing the task is at fault C. A task that is delegated to a nursing assistive personnel (NAP) must be performed by that NAP D. If a nurse delegates a task to a nursing assistive personnel (NAP), the NAP cannot delegate that task to another NAP - CORRECT ANSWER D. If a nurse delegates a task to a nursing assistive personnel (NAP), the NAP cannot delegate that task to another NAP 15.18 A nurse asks one of the nursing aids to remove a Foley catheter from a 6 year old who had their appendix removed, the aid is new and removes the catheter without the deflating the balloon causing urethral irritation and bleeding; which of the following is the most accurate concerning this situation? A. The aid should not have removed the catheter B. The nurse should have determined if the delegated task was within the aid's capabilities C. The nurse should have checked with the state's nu - CORRECT ANSWER B. The nurse should have determined if the delegated task was within the aid's capabilities Whenever a task is delegated, it is the nurse's responsibility to determine whether the task is appropriate and whether the person being asked to perform the task has received sufficient education The aid should not have removed the catheter without first receiving education 15.19 The nurse is having a busy day and delegates a task to a nurse assistant; Which of the following would indicate that the nurse requires additional information regarding delegation? A. The nurse asks the nursing assistant to obtain vital signs on a child receiving IV antibiotics B. The nurse asks the nursing assistant to draw blood from a child C. The nurse asks the nursing assistant to obtain a blood glucose in a new diabetic D. The nurse asks the nursing assistant to perform an asses - CORRECT ANSWER D. The nurse asks the nursing assistant to perform an assessment at change of shift Assessments should not be delegated to NAPs as they do not require the knowledge and specialized education of a nurse Training and comfort level of the unlicensed care provider should always be taken into considerations 15.20 Which of the following is accurate concerning malpractice? A. Many malpractice claims involving nurses involve a failure of communication B. Many malpractice claims involve the use of equipment that the nurse use on a regular basis C. Many malpractice claims involve delegation to appropriate personnel D. Many malpractice claims involve documentation that was too detailed - CORRECT ANSWER A. Many malpractice claims involving nurses involve a failure of communication It is essential that the nurse is familiar with the equipment that they are using Appropriate delegation is essential and does not lead to malpractice claims Documentation is a critical aspect in the prevention of lawsuits - if a task is not documented, it can be argued that it was not done If a portion of an assessment is documented as abnormal but no actions were taken or documented - the nurse can be held responsible 15.21 Which of the following could result in malpractice? A. The nurse leaves the side rails down on a crib but the parent catches the toddler before he falls B. When discharging a child after conscious sedation, the nurse realizes they failed to check vitals signs as often as the standard dictates C. The nurse notifies child protective services when he suspects that his patient is being sexually abused D. The nurse removes an infiltrated IV and notes that the site has not been assessed as freq - CORRECT ANSWER D. The nurse removes an infiltrated IV and notes that the site has not been assessed as frequently as the policy dictates A failure to follow a standard of care can result in malpractice when an injury such as infiltration is present If the failure to follow a standard of care does not result in injury, the requirements of malpractice have not been met The nurse has the duty to protect the patient and is doing so by notifying child protective services when maltreatment is suspected 15.22 The pediatric nurse discharging a patient, prior to this - the nurse arranges for home care and creates an individualized plan for the child; which of the following best describes the role that the nurse is performing? A. Consultant and collaborator B. Primary nurse and team leader C. Patient advocate D. Home care coordinator - CORRECT ANSWER A. Consultant and collaborator 15.23 The nurse is teaching a group of nursing students about documentation; which is true about nursing documentation? A. Narrative note type documentation is the most effective form of documentation as it allows the nurse to thoroughly express their thoughts B. Narrative note type documentation can be very restrictive C. Electronic documentation lacks flexibility and can lead to inadequate documentation D. Electronic documentation allows for consistent uniform documentation - CORRECT ANSWER D. Electronic documentation allows for consistent uniform documentation - offering cues so that information is not forgotten Narrative charting is not effective form of documentation as it lacks guidelines so that documentation omissions are common 15.24 Which of the following is true regarding cultural awareness? A. The nurse's cultural background influences the manner in which care is delivered B. The nurse should rely on their own values and experiences to guide themselves when caring for a family from a different culture C. It is most important for the family to adapt to the predominant culture within the hospital D. It is easy for nurses to be nonjudgmental when working with families of a different culture - CORRECT ANSWER A. The nurse's cultural background influences the manner in which care is delivered It is important that nurses are aware of their own values and experience but to not rely on them to serve as a guideline when caring for families of a different culture 15.25 A nurse who is caring for a family of a different culture and wishes to explore the feelings and needs of the family; which of the following actions will help foster appropriate communication? A. Allow the family to chose the location for the discussion B. Maintain eye contact with all members of the family C. Speak slowly and loudly to assist with comprehension D. Use hand gestures to assist in communication - CORRECT ANSWER A. Allow the family to chose the location for the discussion This will empower the family - this will also help the nurse determine appropriate body space as this distance varies amount cultures and whether standing or sitting is preferred 15.26 A parent shares with you that they like to bring gifts in for staff to thank them for caring for their child; as the nurse, your best response is: A. "That's very nice. We suggest that you provide food like donuts or pizza." B. "We suggest that you choose an individual gift for each nurse." C. "We do not except gifts. If you feel that you want to give a gift, a token of appreciation for the entire staff to share like food is best." D. "We are not permitted to accept gifts." - CORRECT ANSWER C. "We do not except gifts. If you feel that you want to give a gift, a token of appreciation for the entire staff to share like food is best." It is important that the nurse convey that gifts are not expected and that when they are given they should be given to the entire staff and not to individual staff members 15.27 Which of the following is an acceptable component of safe handoff? A. There should be ample opportunity for questions B. The report should not be standardized but allow for variables and individuality C. In order to maintain confidentiality, report should not be given in the prescience of family D. Handoff should be written or recorded - CORRECT ANSWER A. There should be ample opportunity for questions Handoff procedures include standardization of components to be included in the handoff, clear communication of handoff procedures to staff, the opportunity to ask and respond to questions, and the involvement of the patient and family as appropriate in the handoff 15.28 You are the nurse serving on the professional practice council, you are assigned a nursing policy to review and update; the process of reviewing the most current research and applying it to practice is considered which of the following: A. Research B. Evidence based practice C. Best practice D. Standard of care - CORRECT ANSWER B. Evidence based practice It is the process of applying what we know from the literature to practice 15.29 You are caring for a 10 year old with Down syndrome and an intellectual disability; which of the following classroom placements would be most appropriate for this child? A. Classroom of same aged peers without disabilities B. Classroom of kids with varying aged peers with similar disabilities C. Special education classroom D. Home schooling - CORRECT ANSWER A. Classroom of same aged peers without disabilities This is consistent with the provision for the least restrictive environment within which to learn This child may leave class at points in the day to attend special education classes, however, the child should be placed in a typical classroom 15.30 Which of the following special accommodations within the Individual with Disabilities Act (IDEA) is most appropriate for the child with inattentive attention deficit hyperactivity disorder (ADHD) A. Wide classroom doors for wheelchairs B. 2nd set of books so one can stay at school and one at home C. Special education classroom D. A health aid to assist the child in the classroom - CORRECT ANSWER B. 2nd set of books so one can stay at school and one at home Forgetting text books is a common instance for a child with this condition - therefore, having 2 sets of textbooks is an accommodation the school system can make in order to assist this child with success in the school environment [Show More]

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