practice exam 1 questions

Question 1

Decreasing the demands on the heart is a priority in care for the infant with heart failure (HF). In evaluating the infant’s status, which finding is indicative of achieving this goal?

Irritability when awake
Capillary refill of more than 5 seconds
Appropriate weight gain for age
Positioned in high Fowler position to maintain oxygen saturation at 90%

Answer 1

Appropriate weight gain for age

Appropriate weight gain for an infant is indicative of successful feeding and a reduction in caloric loss secondary to the HF. Irritability is a symptom of HF. The child also uses additional energy when irritable. Capillary refill should be brisk and within 2 to 3 seconds. The child needs to be positioned upright to maintain oxygen saturation at 90%. Positioning is helping to decrease respiratory effort, but the infant is still having difficulty with oxygenation.

Question 2

Rectal temperatures are indicated in which situation?

In the newborn period
Whenever accuracy is essential
Rectal temperatures are never indicated
When rapid temperature changes are occurring

Answer 2

Whenever accuracy is essential

Rectal temperatures are recommended when definitive measurements are necessary in infants older than age 1 month. Rectal temperatures are not done in the newborn period to avoid trauma to the rectal mucosa. Rectal temperature is an intrusive procedure that should be avoided whenever possible.

Question 3

A toddler is being sent to the operating room for surgery at 9 AM. As the nurse prepares the child, what is the priority intervention?

Administering preoperative antibiotic

Verifying that the child and procedure are correct

Ensuring that the toddler has been NPO since midnight

Informing the parents where they can wait during the procedure

Answer 3

Verifying that the child and procedure are correct

The most important intervention is to ensure that the correct child is going to the operating room for the identified procedure. It is the nurse’s responsibility to verify identification of the child and what procedure is to be done. If an antibiotic is ordered, administering it is important, but correct identification is a priority. Clear liquids can be given up to 2 hours before surgery. If the child was NPO (taking nothing by mouth) since midnight, intravenous fluids should be administered. Parents should be encouraged to accompany the child to the preoperative area. Many institutions allow parents to be present during induction.

Question 4

The nurse is preparing a staff education program about pediatric asthma. What concepts should the nurse include when discussing the asthma severity classification system? (Select all that apply.)

Children with mild persistent asthma have nighttime signs or symptoms less than two times a month.

Children with moderate persistent asthma use a short-acting -agonist more than two times per week.

Children with severe persistent asthma have a peak expiratory flow (PEF) of 60% to 80% of predicted value.

Children with mild persistent asthma have signs or symptoms more than two times per week.

Children with moderate persistent asthma have some limitations with normal activity.

Children with severe persistent asthma have frequent nighttime signs or symptoms.

Answer 4

Children with mild persistent asthma have signs or symptoms more than two times per week.

Children with moderate persistent asthma have some limitations with normal activity.

Children with severe persistent asthma have frequent nighttime signs or symptoms.

Children with mild persistent asthma have signs or symptoms more than two times per week and nighttime signs or symptoms three or four times per month. Children with moderate persistent asthma have some limitations with normal activity and need to use a short-acting -agonist for sign or symptom control daily. Children with severe persistent asthma have frequent nighttime signs or symptoms and have a PEF of less than 60%.

Question 5

The clinic nurse is administering influenza vaccinations. Which children should not receive the live attenuated influenza vaccine (LAIV)? (Select all that apply.)

A child with asthma
A child with diabetes
A child with hemophilia A
A child with cancer receiving chemotherapy
A child with gastroesophageal reflux disease

Answer 5

A child with asthma

A child with diabetes

A child with cancer receiving chemotherapy

Question 6

The nurse’s approach when introducing hospital equipment to a preschooler who seems afraid should be based on which principle?

The child may think the equipment is alive.

Explaining the equipment will only increase the child’s fear.

One brief explanation will be enough to reduce the child’s fear.

The child is too young to understand what the equipment does

Answer 6

The child may think the equipment is alive

Young children attribute human characteristics to inanimate objects. They often fear that the objects may jump, bite, cut, or pinch all by themselves without human direction. Equipment should be kept out of sight until needed. Simple, concrete explanations about what the equipment does and how it will feel will help alleviate the child’s fear. Preschoolers need repeated explanations as reassurance..

Question 7

The nurse is caring for a child in respiratory distress. What is an early but less obvious sign of respiratory failure?

Stupor
Headache
Bradycardia
Somnolence

Answer 7

Headache

Question 8

When checking the intravenous (IV) site on a child, the nurse should take which action?

Look at the site.
Ask the child if the site “hurts.”
Look at the site while palpating the area.
Take all the tape off, assess the site, and redress.

Answer 8

Look at the site while palpating the area.

To appropriately check the intravenous (IV) site, the nurse should look at the site and palpate the area. The other options would not be adequate assessments of the site.

Question 9

A cancer patient is experiencing neuropathic cancer pain. Which prescription should the nurse expect to be ordered to control anxiety?

Lorazepam (Ativan)
Gabapentin (Neurontin)
Hydromorphone (Dilaudid)
Morphine sulfate (MS Contin)

Answer 9

Gabapentin (Neurontin)

Anticonvulsants (gabapentin, carbamazepine) have demonstrated effectiveness in neuropathic cancer pain. Ativan is an antianxiety agent, and Dilaudid and MS Contin are opioid analgesics.

Question 10

The nurse is caring for a child receiving a continuous intravenous (IV) low-dose infusion of morphine for severe postoperative pain. The nurse observes a slower respiratory rate, and the child cannot be aroused. The most appropriate management of this child is for the nurse to do which first?

 Administer naloxone (Narcan).
 Discontinue the IV infusion.
 Discontinue morphine until the child is fully awake.
 Stimulate the child by calling his or her name, shaking gently, and asking the child to breathe deeply.

Answer 10

Administer naloxone (Narcan).

The management of opioid-induced respiratory depression includes lowering the rate of infusion and stimulating the child. If the respiratory rate is depressed and the child cannot be aroused, then IV naloxone should be administered. The child will be in pain because of the reversal of the morphine. The morphine should be discontinued, but naloxone is indicated if the child is unresponsive.

Question 11

A nurse must do a venipuncture on a 6-year-old child. What consideration is important in providing atraumatic care?

Use an 18-gauge needle if possible.

Show the child the equipment to be used before the procedure.

If not successful after four attempts, have another nurse try.

Restrain the child completely.

Answer 11

Show the child the equipment to be used before the procedure.

To provide atraumatic care the child should be able to see the equipment to be used before the procedure begins. Use the smallest gauge needle that permits free flow of blood. A two-try-only policy is desirable, in which two operators each have only two attempts. If insertion is not successful after four punctures, alternative venous access should be considered. Restrain the child only as needed to perform the procedure safely; use therapeutic hugging.

Question 12

A 2-year-old child is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than which rate?

60 beats/min
90 beats/min
100 beats/min
120 beats/min

Answer 12

90 beats/min

If a 1-minute apical pulse is less than 90 beats/min for an infant or young child, the digoxin is withheld. Sixty beats/min is the cut-off for holding the digoxin dose in an adult. One hundred to 120 beats/min is an acceptable pulse rate for the administration of digoxin.

Question 13

For children who do not have a matched sibling bone marrow donor, the therapeutic management of aplastic anemia includes what intervention?

Antibiotics
Antiretroviral drugs
Iron supplementation
Immunosuppressive therapy

Answer 13

Immunosuppressive therapy

It is thought that aplastic anemia may be an autoimmune disease. Immunosuppressive therapy, including antilymphocyte globulin, antithymocyte globulin, cyclosporine, granulocyte colony-stimulating factor, and methylprednisone, has greatly improved the prognosis for patients with aplastic anemia. Antibiotics are not indicated as the management. They may be indicated for infections. Antiretroviral drugs and iron supplementation are not part of the therapy.

Question 14

At which age should a nurse keep teaching time short (5 minutes)?

Infant
Toddler
Preschool
School age

Answer 14

Toddler

Toddlers have limited time concept, and teaching time should be kept short (5–10 minutes).

Question 15

The nurse is using the CRIES pain assessment tool on a preterm infant in the neonatal intensive care unit. Which are the components of this tool? (Select all that apply.)

 Color
 Moro reflex
 Oxygen saturation
 Posture of arms and legs
 Sleeplessness
 Facial expression

Answer 15

Oxygen saturation
Sleeplessness
Facial expression

Need for increased oxygen, crying, increased vital signs, expression, and sleeplessness are components of the CRIES pain assessment tool used with neonates. Color, Moro reflex, and posture of arms and legs are not components of the CRIES scale.

Question 16

A 10-year-old child requires daily medications for a chronic illness. Her mother tells the nurse that the child continually forgets to take the medicine unless reminded. What nursing action is most appropriate to promote adherence to the medication regimen?

Establish a contract with her, including rewards.

Suggest time-outs when she forgets her medicine.

Discuss with her mother the damaging effects of her rescuing the child.

Ask the child to bring her medicine containers to each appointment so they can be counted.

Answer 16

Establish a contract with her, including rewards.

Many factors can contribute to the child’s not taking the medication. The nurse should resolve those issues such as unpleasant side effects, difficulty taking medicine, and time constraints before school. If these factors do not contribute to the issue, then behavioral contracting is usually an effective method to shape behaviors in children. Time-outs provide negative reinforcement. If part of a contract, negative consequences can work, but they need to be structured. Discussing with her mother the damaging effects of her rescuing the child is not the most appropriate action to encourage compliance. For a school-age child, parents should refrain from nagging and rescuing the child. This child is old enough to partially assume responsibility for her own care. If the child brings her medicine containers to each appointment so they can be counted, this will help determine if the medications are being taken, but it will not provide information about whether the child is taking them by herself.

Question 17

What is the earliest recognizable clinical manifestation(s) of cystic fibrosis (CF)?

Meconium ileus
History of poor intestinal absorption
Foul-smelling, frothy, greasy stools
Recurrent pneumonia and lung infections

Answer 17

Meconium ileus

The earliest clinical manifestation of CF is a meconium ileus, which is found in about 10% of children with CF. Clinical manifestations include abdominal distention, vomiting, failure to pass stools, and rapid development of dehydration. History of malabsorption is a later sign that manifests as failure to thrive. Foul-smelling stools and recurrent respiratory infections are later manifestations of CF.

Question 18

What is an appropriate screening test for hearing that the nurse can administer to a 5-year-old child?

Rinne test
Weber test
Pure tone audiometry
Eliciting the startle reflex

Answer 18

Pure tone audiometry

Pure tone audiometry uses an audiometer that produces sounds at different volumes and pitches in the child’s ears. The child is asked to respond in some way when the tone is heard in the earphone. The Rinne and Weber tests measure bone conduction of sound. Eliciting the startle reflex may be useful in infants.

Question 19

The nurse is preparing to assess a 10-month-old infant. He is sitting on his father’s lap and appears to be afraid of the nurse and of what might happen next. Which initial actions by the nurse should be most appropriate?

Initiate a game of peek-a-boo.

Ask the infant’s father to place the infant on the examination table.

Talk softly to the infant while taking him from his father.

Undress the infant while he is still sitting on his father’s lap.

Answer 19

Initiate a game of peek-a-boo.

Peek-a-boo is an excellent means of initiating communication with infants while maintaining a safe, nonthreatening distance. The child will most likely become upset if separated from his father. As much of the assessment as possible should be done with the child on the father’s lap. The nurse should have the father undress the child as needed during the examination.

Question 20

The school nurse is evaluating the number of school-age children classified as obese. The nurse recognizes that the percentile of body mass index that classifies a child as obese is greater than which?

50th percentile
75th percentile
80th percentile
95th percentile

Answer 20

95th percentile

Question 21

The nurse is planning care for a child with chickenpox (varicella). Which prescribed supportive measures should the nurse plan to implement? (Select all that apply.)

Administration of acyclovir (Zovirax)
Administration of azithromycin (Zithromax)
Administration of Vitamin A supplementation
Administration of acetaminophen (Tylenol) for fever
Administration of diphenhydramine (Benadryl) for itching

Answer 21

Administration of acyclovir (Zovirax)
Administration of acetaminophen (Tylenol) for fever
Administration of diphenhydramine (Benadryl) for itching

Chickenpox is a virus, and acyclovir is ordered to lessen the symptoms. Benadryl and Tylenol are prescribed as supportive treatments. Vitamin A supplementation is used for treating rubeola. Zithromax is an antibiotic prescribed for bacterial infections such as pertussis.

Question 22

A school-age child with cystic fibrosis takes four enzyme capsules with meals. The child is having four or five bowel movements per day. The nurse’s action in regard to the pancreatic enzymes is based on the knowledge that the dosage is what?

Adequate

Adequate but should be taken between meals

Needs to be increased to increase the number of bowel movements per day

Needs to be increased to decrease the number of bowel movements per day

Answer 22

Needs to be increased to decrease the number of bowel movements per day

The amount of enzyme is adjusted to achieve normal growth and a decrease in the number of stools to one or two per day.

Question 23

Which muscle is contraindicated for the administration of immunizations in infants and young children?

Deltoid
Dorsogluteal
Ventrogluteal
Anterolateral thigh

Answer 23

Dorsogluteal

The dorsogluteal site is avoided in children because of the location of nerves and veins. The deltoid is recommended for 12 months and older. The ventrogluteal and anterolateral thigh sites can safely be used for the administration of vaccines to infants.

Question 24

The nurse is testing an infant’s visual acuity. By which age should the infant be able to fix on and follow a target?

1 month
1 to 2 months
3 to 4 months
6 months

Answer 24

3 to 4 months

Visual fixation and ability to follow a target should be present by ages 3 to 4 months. One to 2 months is too young for this developmental milestone. If an infant is not able to fix and follow by 6 months, further ophthalmologic evaluation is needed

Question 25

When assessing a preschooler’s chest, what should the nurse expect? Respiratory movements to be chiefly thoracic Anteroposterior diameter to be equal to the transverse diameter Retraction of the muscles between the ribs on respiratory movement Movement of the chest wall to be symmetric bilaterally and coordinated with breathing

Answer 25

Movement of the chest wall to be symmetric bilaterally and coordinated with breathing Movement of the chest wall should be symmetric bilaterally and coordinated with breathing. In children younger than 6 or 7 years, respiratory movement is principally abdominal or diaphragmatic. The anteroposterior diameter is equal to the transverse diameter during infancy. As the child grows, the chest increases in the transverse direction, so that the anteroposterior diameter is less than the lateral diameter. Retractions of the muscles between the ribs on respiratory movement are indicative of respiratory distress.

Question 26

Pertussis vaccination should begin at which age? Birth 2 months 6 months 12 months

Answer 26

2 months

Question 27

A 4-year-old girl is admitted to outpatient surgery for removal of a cyst on her back. Her mother puts the hospital gown on her, but the child is crying because she wants to leave on her underpants. What is the most appropriate nursing action at this time?? Allow her to wear her underpants. Discuss with her mother why this is important to the child. Ask her mother to explain to her why she cannot wear them. Explain in a kind, matter-of-fact manner that this is hospital policy.

Answer 27

Allow her to wear her underpants. It is appropriate for the child to leave her underpants on. If necessary, the underpants can be removed after she has received the initial medications for anesthesia. This allows her some measure of control in this procedure. The mother should not be required to make the child more upset. The child is too young to understand what hospital policy means.

Question 28

A child is in uncompensated metabolic acidosis. What should the nurse expect the arterial blood gas to be? HCO3, 24; pH, 7.35 HCO3, 28; pH, 7.50 HCO3, 20; pH, 7.30 HCO3, 26; pH, 7.40

Answer 28

HCO3, 20; pH, 7.30

Question 29

The parents of a preterm infant in a neonatal intensive care unit are concerned about their infant experiencing pain from so many procedures. The nurse’s response should be based on which characteristic about preterm infants’ pain? They may react to painful stimuli but are unable to remember the pain experience. They perceive and react to pain in much the same manner as children and adults. They do not have the cortical and subcortical centers that are needed for pain perception. They lack neurochemical systems associated with pain transmission and modulation.

Answer 29

They perceive and react to pain in much the same manner as children and adults. Numerous research studies have indicated that preterm and newborn infants perceive and react to pain in the same manner as children and adults. Preterm infants can have significant reactions to painful stimuli. Pain can cause oxygen desaturation and global stress response. These physiologic effects must be avoided by use of appropriate analgesia. Painful stimuli cause a global stress response, including cardiorespiratory changes, palmar sweating, increased intracranial pressure, and hormonal and metabolic changes. Adequate analgesia and anesthesia are necessary to decrease the stress response.

Question 30

Pancreatic enzymes are administered to the child with cystic fibrosis. What nursing consideration should be included in the plan of care? Give pancreatic enzymes between meals if at all possible. Do not administer pancreatic enzymes if the child is receiving antibiotics. Decrease the dose of pancreatic enzymes if the child is having frequent, bulky stools. Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal.

Answer 30

Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal. Enzymes may be administered in a small amount of cereal or fruit at the beginning of a meal or swallowed whole. Enzymes should be given just before meals and snacks. Pancreatic enzymes are not a contraindication for antibiotics. The dose of enzymes should be increased if child is having frequent, bulky stools.

Question 31

A child with hemophilia A will have which abnormal laboratory result? PT (ProTime) Platelet count Fibrinogen level PTT (partial thromboplastin time)

Answer 31

PTT (partial thromboplastin time) The basic defect of hemophilia A is a deficiency of factor VIII. The partial thromboplastin time measures abnormalities in the intrinsic pathway (abnormalities in factors I, II, V, VIII, IX, X, XII, HMK, and KAL). The prothrombin time measures abnormalities of the extrinsic pathway (abnormalities in factors I, II, V, VII, and X). Fibrinogen level is not dependent on the intrinsic pathway. Platelets are not affected with hemophilia A.

Question 32

Which coanalgesics should the nurse expect to be prescribed for pruritus? (Select all that apply.) ``` Naloxone (Narcan) Inapsine (Droperidol) Hydroxyzine (Atarax) Promethazine (Phenergan) Diphenhydramine (Benadryl) ```

Answer 32

Naloxone (Narcan) Hydroxyzine (Atarax) Diphenhydramine (Benadryl) The coanalgesics prescribed for pruritus include naloxone, hydroxyzine, and diphenhydramine. Inapsine and promethazine are administered as antiemetics.

Question 33

A mother states that she brought her child to the clinic because the 3-year-old girl was not keeping up with her siblings. During physical assessment, the nurse notes that the child has pale skin and conjunctiva and has muscle weakness. The hemoglobin on admission is 6.4 g/dl. After notifying the practitioner of the results, what nursing priority intervention should occur next? Reduce environmental stimulation to prevent seizures. Have the laboratory repeat the analysis with a new specimen. Minimize energy expenditure to decrease cardiac workload. Administer intravenous fluids to correct the dehydration.

Answer 33

Minimize energy expenditure to decrease cardiac workload. The child has a critically low hemoglobin value. The expected range is 11.5 to 15.5 g/dl. When the oxygen-carrying capacity of the blood decreases slowly, the child is able to compensate by increasing cardiac output. With the increasing workload of the heart, additional stress can lead to cardiac failure. Reduction of environmental stimulation can help minimize energy expenditure, but seizures are not a risk. A repeat hemoglobin analysis is not necessary. The child does not have evidence of dehydration. If intravenous fluids are given, they can further dilute the circulating blood volume and increase the strain on the heart.

Question 34

What pain medication is contraindicated in children with sickle cell disease (SCD)? Meperidine (Demerol) Hydrocodone (Vicodin) Morphine sulfate Ketorolac (Toradol)

Answer 34

Meperidine (Demerol) Meperidine (pethidine [Demerol]) is not recommended. Normeperidine, a metabolite of meperidine, is a central nervous system stimulant that produces anxiety, tremors, myoclonus, and generalized seizures when it accumulates with repetitive dosing. Patients with SCD are particularly at risk for normeperidine-induced seizures.

Question 35

An infant with respiratory syncytial virus (RSV) is being admitted to the hospital. The nurse should plan to place the infant on which precaution? Enteric Airborne Droplet Contact

Answer 35

Contact

Question 36

The nurse is teaching a parent of an infant to limit the amount of formula to encourage the intake of iron-rich food. What amount should the nurse teach to the parent? 500 ml 750 ml 1000 ml 1250 ml

Answer 36

1000 ml

Question 37

The nurse is preparing to give digoxin (Lanoxin) to a 9-month-old infant. The nurse checks the dose and draws up 4 ml of the drug. The most appropriate nursing action is which? Mix the dose with juice to disguise its taste. Do not give the dose; suspect a dosage error. Check the heart rate; administer digoxin if the rate is greater than 100 beats/min. Check the heart rate; administer digoxin if the rate is greater than 80 beats/min.

Answer 37

Do not give the dose; suspect a dosage error. Infants rarely receive more than 1 ml (50 mcg, or 0.05 mg) of digoxin in one dose; a higher dose is an immediate warning of a dosage error. To ensure safety, compare the calculation with that of another staff member before giving digoxin.

Question 38

A 14-year-old adolescent is hospitalized with cystic fibrosis. What nursing note entry represents best documentation of his breakfast meal? Tolerated breakfast well Finished all of breakfast ordered One pancake, eggs, and 240 ml OJ No documentation is needed for this age child.

Answer 38

One pancake, eggs, and 240 ml OJ Specific information is necessary for hospitalized children. It is essential to be able to identify caloric intake and eating patterns for assessment and intervention purposes. That he tolerated breakfast well only provides information that the child did not become ill with the meal. Even if he finished all his breakfast, an evaluation cannot be completed unless the quantity of food ordered is known. Nutritional information is essential, especially for children with chronic illnesses.

Question 39

A 6-year-old boy is hospitalized for intravenous antibiotic therapy. He eats very little on his “regular diet” trays. He tells the nurse that all he wants to eat is pizza, tacos, and ice cream. What nursing action is the most appropriate? Request these favorite foods for him. Identify healthier food choices that he likes. Explain that he needs fruits and vegetables. Reward him with ice cream at the end of every meal that he eats.

Answer 39

Request these favorite foods for him. Loss of appetite is a symptom common to most childhood illnesses. To encourage adequate nutrition, the nurse should request favorite foods for the child. The foods he likes provide nutrition and can be supplemented with additional fruits and vegetables. Ice cream and other desserts should not be used as rewards or punishment.

Question 40

An 18-month-old child has been diagnosed with pediculosis capitis (head lice). Which prescription should the nurse question if ordered for the child? Malathion (Ovide) Permethrin 1% (Nix) Benzyl alcohol 5% lotion Pyrethrin with piperonyl butoxide (RID)

Answer 40

Malathion (Ovide)

Question 41

The nurse is administering the first hepatitis A vaccine to an 18-month-old child. When should the child return to the clinic for the second dose of hepatitis A vaccination? After 2 months After 3 months After 4 months After 6 months

Answer 41

After 6 months

Question 42

A child is in uncompensated respiratory alkalosis. What should the nurse expect the arterial blood gas to be? CO2, 30; pH, 7.50 CO2, 55; pH, 7.30 CO2, 35; pH, 7.28 CO2, 54; pH, 7.35

Answer 42

CO2, 30; pH, 7.50

Question 43

A 3-month-old infant has a hypercyanotic spell. What should be the nurse’s first action? Assess for neurologic defects. Prepare the family for imminent death. Begin cardiopulmonary resuscitation. Place the child in the knee–chest position.

Answer 43

Place the child in the knee–chest position. The first action is to place the infant in the knee–chest position. Blow-by oxygen may be indicated. Neurologic defects are unlikely. Preparing the family for imminent death or beginning cardiopulmonary resuscitation should be unnecessary. The child is assessed for airway, breathing, and circulation. Often, calming the child and administering oxygen and morphine can alleviate the hypercyanotic spell.

Question 44

With the National Center for Health Statistics criteria, which body mass index (BMI)–for-age percentiles should indicate the patient is at risk for being overweight? 10th percentile 75th percentile 85th percentile 95th percentile

Answer 44

85th percentile Children who have BMI-for-age greater than or equal to the 85th percentile and less than the 95th percentile are at risk for being overweight. Children who are greater than or equal to the 95th percentile are considered overweight. Children whose BMI is between the 10th and 75th percentiles are within normal limits

Question 45

Frequent urine tests for specific gravity are required on a 6-month-old infant. What method is the most appropriate way to collect small amounts of urine for these tests? Apply a urine collection bag to the perineal area. Tape a small medicine cup inside of the diaper. Aspirate urine from cotton balls inside the diaper with a syringe without a needle. Use a syringe without a needle to aspirate urine from a superabsorbent disposable diaper.

Answer 45

Aspirate urine from cotton balls inside the diaper with a syringe without a needle. To obtain small amounts of urine, use a syringe without a needle to aspirate urine directly from the diaper. Diapers with superabsorbent gels absorb the urine; if these are used, place a small gauze dressing or cotton balls inside the diaper to collect the urine and aspirate the urine with a syringe. For frequent urine sampling, the collection bag would be too irritating to the child’s skin. It is not feasible to tape a small medicine cup to the inside of the diaper; the urine will spill from the cup.

Question 46

A cardiac defect that allows blood to shunt from the (high pressure) left side of the heart to the (lower pressure) right side can result in which condition? Cyanosis Heart failure Decreased pulmonary blood flow Bounding pulses in upper extremities

Answer 46

Heart failure As blood is shunted into the right side of the heart, there is increased pulmonary blood flow and the child is at high risk for heart failure. Cyanosis usually occurs in defects with decreased pulmonary blood flow. Bounding upper extremity pulses are a manifestation of coarctation of the aorta.

Question 47

A 5-year-old child is admitted to the hospital in a sickle cell crisis. The child has been alert and oriented but in severe pain. The nurse notes that the child is complaining of a headache and is having unilateral hemiplegia. What action should the nurse implement? Notify the health care provider. Place the child on bed rest. Administer a dose of hydrocodone (Vicodin). Start O2 per the hospital’s protocol

Answer 47

Notify the health care provider. Any number of neurologic symptoms can indicate a minor cerebral insult, such as headache, aphasia, weakness, convulsions, visual disturbances, or unilateral hemiplegia. Loss of vision is usually the result of progressive retinopathy and retinal detachment. The nurse should notify the health care provider.

Question 48

Which nonpharmacologic intervention appears to be effective in decreasing neonatal procedural pain? Tactile stimulation Commercial warm packs Doing procedure during infant sleep Oral sucrose and nonnutritive sucking

Answer 48

Oral sucrose and nonnutritive sucking Nonnutritive sucking attenuates behavioral, physiologic, and hormonal responses to pain. The addition of sucrose has been demonstrated to have calming and pain-relieving effects for neonates. Tactile stimulation has a variable effect on response to procedural pain. No evidence supports commercial warm packs as a pain control measure. With resulting increased blood flow to the area, pain may be greater. The infant should not be disturbed during the sleep cycle. It makes it more difficult for the infant to begin organization of sleep and awake cycles.

Question 49

What statement best describes iron deficiency anemia in infants? It is caused by depression of the hematopoietic system. Diagnosis is easily made because of the infant’s emaciated appearance. It results from a decreased intake of milk and the premature addition of solid foods. Clinical manifestations are related to a reduction in the amount of oxygen available to tissues.

Answer 49

Clinical manifestations are related to a reduction in the amount of oxygen available to tissues. In iron-deficiency anemia, the child’s clinical appearance is a result of the anemia, not the underlying cause. Usually the hematopoietic system is not depressed. The bone marrow produces red blood cells that are smaller and contain less hemoglobin than normal red blood cells. Children who have iron deficiency from drinking excessive quantities of milk are usually pale and overweight. They are receiving sufficient calories but are deficient in essential nutrients. The clinical manifestations result from decreased intake of iron-fortified solid foods and an excessive intake of milk.

Question 50

The nurse is assessing breath sounds on a child. Which are expected auscultated breath sounds? (Select all that apply.) ``` Wheezes Crackles Vesicular Bronchial Bronchovesicular ```

Answer 50

Vesicular Bronchial Bronchovesicular Normal breath sounds are classified as vesicular, bronchovesicular, or bronchial. Wheezes or crackles are abnormal or adventitious sounds.

Question 51

The nurse has just collected blood by venipuncture in the antecubital fossa. What should the nurse do next? Keep the child’s arm extended while applying a Band-Aid to the site. Keep the child’s arm extended and apply pressure to the site for a few minutes. Apply a Band-Aid to the site and keep the arm flexed for 10 minutes. Apply a gauze pad or cotton ball to the site and keep the arm flexed for several minutes.

Answer 51

Keep the child’s arm extended and apply pressure to the site for a few minutes. Applying pressure to the site of venipuncture stops the bleeding and aids in coagulation. Pressure should be applied before a bandage or gauze pad is applied.

Question 52

What are signs and symptoms of anemia? (Select all that apply.) ``` Pallor Fatigue Dilute urine Bradycardia Muscle weakness ```

Answer 52

Pallor Fatigue Muscle weakness

Question 53

The nurse is caring for a child with acute respiratory distress syndrome (ARDS) associated with sepsis. What nursing action should be included in the care of the child? Force fluids. Monitor pulse oximetry. Institute seizure precautions. Encourage a high-protein diet.

Answer 53

Monitor pulse oximetry. Careful monitoring of oxygenation and cardiopulmonary status is an important evaluation tool in the care of the child with ARDS. Maintenance of vascular volume and hydration is important and should be done parenterally. Seizures are not a side effect of ARDS. Adequate nutrition is necessary, but a high-protein diet is not helpful.

Question 54

The clinical manifestations of sickle cell anemia (SCA) are primarily the result of which physiologic alteration? Decreased blood viscosity Deficiency in coagulation Increased red blood cell (RBC) destruction Greater affinity for oxygen

Answer 54

Increased red blood cell (RBC) destruction The clinical features of SCA are primarily the result of increased RBC destruction and obstruction caused by the sickle-shaped RBCs. When the sickle cells change shape, they increase the viscosity in the area where they are involved in the microcirculation. SCA does not have a coagulation deficit. Sickled red cells have decreased oxygen-carrying capacity and transform into the sickle shape in conditions of low oxygen tension.

Question 55

What rationale explains why prolonged use of oxygen should be discouraged in a child with anemia? Prolonged use of oxygen can decrease erythropoiesis. Prolonged use of oxygen can interfere with iron production. Prolonged use of oxygen interferes with a child’s appetite. Prolonged use of oxygen can affect the synthesis of hemoglobin.

Answer 55

Prolonged use of oxygen can decrease erythropoiesis. Oxygen administration is of limited value, because each gram of hemoglobin is able to carry a limited amount of the gas. In addition, prolonged use of supplemental oxygen can decrease erythropoiesis. Prolonged use of oxygen does not interfere with iron production, a child’s appetite, or affect the synthesis of hemoglobin.

Question 56

Which is the most consistent and commonly used data for assessment of pain in infants? Self-report Behavioral Physiologic Parental report

Answer 56

Behavioral Behavioral assessment is useful for measuring pain in young children and preverbal children who do not have the language skills to communicate that they are in pain. Infants are not able to self-report. Physiologic measures are not able to distinguish between physical responses to pain and other forms of stress. Parental report without a structured tool may not accurately reflect the degree of discomfort.

Question 57

The nurse is interviewing the mother of an infant. The mother reports, “I had a difficult delivery, and my baby was born prematurely.” This information should be recorded under which heading? History Present illness Chief complaint Review of systems

Answer 57

History The history refers to information that relates to previous aspects of the child’s health, not to the current problem. The difficult delivery and prematurity are important parts of the infant’s history. The history of the present illness is a narrative of the chief complaint from its earliest onset through its progression to the present. Unless the chief complaint is directly related to the prematurity, this information is not included in the history of the present illness. The chief complaint is the specific reason for the child’s visit to the clinic, office, or hospital. It should not include the birth information. The review of systems is a specific review of each body system. It does not include the premature birth but might include sequelae such as pulmonary dysfunction.

Question 58

Which parameter correlates best with measurements of total muscle mass? Height Weight Skinfold thickness Upper arm circumference

Answer 58

Upper arm circumference Upper arm circumference is correlated with measurements of total muscle mass. Muscle serves as the body’s major protein reserve and is considered an index of the body’s protein stores. Height is reflective of past nutritional status. Weight is indicative of current nutritional status. Skinfold thickness is a measurement of the body’s fat content.

Question 59

The nurse is assessing a child with croup in the emergency department. The child has a sore throat and is drooling. Examining the child’s throat using a tongue depressor might precipitate what condition? Sore throat Inspiratory stridor Complete obstruction Respiratory tract infection

Answer 59

Complete obstruction If a child has acute epiglottitis, examination of the throat may cause complete obstruction and should be performed only when immediate intubation can take place. Sore throat and pain on swallowing are early signs of epiglottitis. Stridor is aggravated when a child with epiglottitis is supine. Epiglottitis is caused by Haemophilus influenzae in the respiratory tract.

Question 60

The nurse is caring for a child with persistent hypoxia secondary to a cardiac defect. The nurse recognizes the risk of cerebrovascular accidents (strokes) occurring. What strategy is an important objective to decrease this risk? Minimize seizures. Prevent dehydration. Promote cardiac output. Reduce energy expenditure.

Answer 60

Prevent dehydration In children with persistent hypoxia, polycythemia develops. Dehydration must be prevented in hypoxemic children because it potentiates the risk of strokes. Minimizing seizures, promoting cardiac output, and reducing energy expenditure will not reduce the risk of cerebrovascular accidents.

Question 61

In a child with sickle cell anemia (SCA), adequate hydration is essential to minimize sickling and delay the vasoocclusion and hypoxia–ischemia cycle. What information should the nurse share with parents in a teaching plan? Encourage drinking. Keep accurate records of output. Check for moist mucous membranes. Monitor the concentration of the child’s urine.

Answer 61

Check for moist mucous membranes. Children with SCA have impaired kidney function and cannot concentrate urine. Parents are taught signs of dehydration and ways to minimize loss of fluid to the environment. Encouraging drinking is not specific enough for parents. The nurse should give the parents and child a target fluid amount for each 24-hour period. Accurate monitoring of output may not reflect the child’s fluid needs. Without the ability to concentrate urine, the child needs additional intake to compensate. Dilute urine and specific gravity are not valid signs of hydration status in children with SCA.

Question 62

What statement best identifies the cause of heart failure (HF)? Disease related to cardiac defects Consequence of an underlying cardiac defect Inherited disorder associated with a variety of defects Result of diminished workload imposed on an abnormal myocardium

Answer 62

Consequence of an underlying cardiac defect HF is the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures to meet the body’s metabolic demands. HF is not a disease but rather a result of the inability of the heart to pump efficiently. HF is not inherited. HF occurs most frequently secondary to congenital heart defects in which structural abnormalities result in increased volume load or increased pressures on the ventricles.

Question 63

A school-age child has asthma. The nurse should teach the child that if a peak expiratory flow rate is in the yellow zone, this means that the asthma control is what? 80% of a personal best, and the routine treatment plan can be followed. 50% to 79% of a personal best and needs an increase in the usual therapy. 50 % of a personal best and needs immediate emergency bronchodilators. Less than 50% of a personal best and needs immediate hospitalization

Answer 63

50% to 79% of a personal best and needs an increase in the usual therapy. The interpretation of a peak expiratory flow rate that is yellow (50%–79% of personal best) signals caution. Asthma is not well controlled. An acute exacerbation may be present. Maintenance therapy may need to be increased. Call the practitioner if the child stays in this zone.

Question 64

A child who has cystic fibrosis is admitted to the pediatric unit with methicillin-resistant Staphylococcus aureus (MRSA) infection. The nurse recognizes that in addition to a private room, the child is placed on what precautions? Droplet Contact Airborne Standard

Answer 64

Contact MRSA is an increasingly significant source of hospital-acquired infections. This organism meets the criteria of being epidemiologically important and can be transmitted by direct contact. Gowns and gloves should be worn when exposed to potentially contagious materials, and meticulous hand washing is required. S. aureus is not an organism that is spread through airborne or droplet mechanisms. Additional precautions, beyond Standard Precautions, are needed to prevent spread of this organism.

Question 65

The nurse is preparing to administer a measles, mumps, rubella, and varicella (MMRV) vaccine. Which is a contraindication associated with administering this vaccine? The child has recently been exposed to an infectious disease. The child has symptoms of a cold but no fever. The child is having intermittent episodes of diarrhea. The child has a disorder that causes a deficient immune system

Answer 65

The child has a disorder that causes a deficient immune system. The MMRV (measles, mumps, rubella, and varicella) vaccine is an attenuated live virus vaccine. Children with deficient immune systems should not receive the MMRV vaccine because of a lack of evidence of its safety in this population. Exposure to an infectious disease, symptoms of a cold, or intermittent episodes of diarrhea are not contraindications to receiving a live vaccine.

Question 66

The nurse needs to take the blood pressure of a small child. Of the cuffs available, one is too large and one is too small. The best nursing action is which? Use the small cuff. Use the large cuff. Use either cuff using the palpation method. Wait to take the blood pressure until a proper cuff can be located.

Answer 66

Use the large cuff. If blood pressure measurement is indicated and the appropriate size cuff is not available, the next larger size is used. The nurse recognizes that this may be a falsely low blood pressure. Using the small cuff will give an incorrectly high reading. The palpation method will not improve the inaccuracy inherent in the cuff.

Question 67

A 5-year-old child returns from the pediatric intensive care unit after abdominal surgery. The orders state to monitor vital signs every 2 hours. On assessment, the nurse observes that the child’s heart rate is 20 beats/min less than it was preoperatively. What should be the nurse’s next action? Follow the orders and check in 2 hours. Ask the parents if this is the child’s usual heart rate. Recheck the pulse and blood pressure in 15 minutes. Notify the surgeon that the child is probably going into shock.

Answer 67

Recheck the pulse and blood pressure in 15 minutes. In a 5-year-old child, this is a significant change in vital signs. The nurse should assess the child to see if his condition mirrors a drop in heart rate. The assessment and vital signs should be redone in 15 minutes to determine whether the child’s condition is stable. When a disparity in vital signs or other assessment data is observed, the nurse should reassess sooner. Most parents will not know their child’s heart rate. It is important to determine how the child is recovering from surgery. The nurse should collect additional information before notifying the surgeon. This includes blood pressure, respiratory rate, and pain status.

Question 68

A burn patient is experiencing anxiety over dressing changes. Which prescription should the nurse expect to be ordered to control anxiety? Lorazepam (Ativan) Oxycodone (OxyContin) Fentanyl (Sublimaze) Morphine Sulfate (Morphine)

Answer 68

Lorazepam (Ativan) A benzodiazepine such as lorazepam is prescribed as an antianxiety agent. Oxycodone, fentanyl, and morphine sulfate are opioid analgesics.

Question 69

The Asian parent of a child being seen in the clinic avoids eye contact with the nurse. What is the best explanation for this considering cultural differences? The parent feels inferior to the nurse. The parent is showing respect for the nurse. The parent is embarrassed to seek health care. The parent feels responsible for her child’s illness.

Answer 69

The parent is showing respect for the nurse. In some ethnic groups, eye contact is avoided. In the Vietnamese culture, an individual may not look directly into the nurse’s eyes as a sign of respect. The nurse providing culturally competent care would recognize that the other answers listed are not why the parent avoids eye contact with the nurse.

Question 70

The nurse is planning to administer immunizations to a 6-month-old infant. Which interventions should the nurse implement to minimize local reactions from the vaccines? (Select all that apply.) Select a needle length of 1 inch. Administer in the deltoid muscle. Inject the vaccine into the vastus lateralis. Draw the vaccine up from a vial with a filter needle. Change the needle on the syringe after drawing up the vaccine and before injecting.

Answer 70

Select a needle length of 1 inch. Inject the vaccine into the vastus lateralis. To minimize local reactions from vaccines, the nurse should select a needle of adequate length (25 mm [1 inch] in infants) to deposit the antigen deep in the muscle mass and inject it into the vastus lateralis muscle. The deltoid may be used in children 18 months of age or older but not in a 6-month-old infant. A filter needle is not needed to draw the vaccine from a vial. Changing the needle on the syringe after drawing up the vaccine before injecting it has not been shown to decrease local reactions.

Question 71

During examination of a toddler’s extremities, the nurse notes that the child is bowlegged. The nurse should recognize that this finding is which? Abnormal and requires further investigation Abnormal unless it occurs in conjunction with knock-knee Normal if the condition is unilateral or asymmetric Normal because the lower back and leg muscles are not yet well developed

Answer 71

Normal because the lower back and leg muscles are not yet well developed Lateral bowing of the tibia (bowlegged) is an expected finding in toddlers when they begin to walk. It usually persists until all of their lower back and leg muscles are well developed. Further evaluation is needed if it persists beyond ages 2 to 3 years, especially in African American children.

Question 72

The clinic nurse is evaluating causes for iron deficiency due to impaired iron absorption. What should the nurse recognize as causes for iron deficiency due to impaired iron absorption? (Select all that apply.) ``` Gastric acidity Chronic diarrhea Lactose intolerance Absence of phosphates Inflammatory bowel disease ```

Answer 72

Chronic diarrhea Lactose intolerance Inflammatory bowel disease Causes for iron deficiency due to impaired iron absorption include chronic diarrhea, lactose intolerance, and inflammatory bowel disease. Gastric alkalinity, not acidity, and the presence, not absence, of phosphates can be causes of impaired iron absorption.

Question 73

Which heart sound is produced by vibrations within the heart chambers or in the major arteries from the back-and-forth flow of blood? S1 and S2 S3 and S4 Murmur Physiologic splitting

Answer 73

Murmur Murmurs are the sounds that are produced in the heart chambers or major arteries from the back-and-forth flow of blood. S1 and S2 are normal heart sounds. S1 is the closure of the tricuspid and mitral valves, and S2 is the closure of the pulmonic and aortic valves. S3 is a normal heart sound sometimes heard in children. S4 is rarely heard as a normal heart sound. If it is heard, medical evaluation is required. Physiologic splitting is the distinction of the two sounds in S2, which widens on inspiration. It is a significant normal finding.

Question 74

The nurse is assessing heart sounds on a school-age child. Which should the nurse document as abnormal findings if found on the assessment? (Select all that apply.) ``` S4 heart sound S3 heart sound Grade II murmur S1 louder at the apex of the heart S2 louder than S1 in the aortic area ```

Answer 74

S4 heart sound Grade II murmur S2 louder than S1 in the aortic area S4 is rarely heard as a normal heart sound; it usually indicates the need for further cardiac evaluation. A grade II murmur is not normal; it is slightly louder than grade I and is audible in all positions. S3 is normally heard in some children. Normally, S1 is louder at the apex of the heart in the mitral and tricuspid area, and S2 is louder near the base of the heart in the pulmonic and aortic area.

Question 75

A bone marrow aspiration and biopsy are needed on a school-age child. The most appropriate action to provide analgesia during the procedure is which? Administer TAC (tetracaine, adrenalin, and cocaine) 15 minutes before the procedure. Use a combination of fentanyl and midazolam for conscious sedation. Apply EMLA (eutectic mixture of local anesthetics) 1 hour before the procedure. Apply a transdermal fentanyl (Duragesic) “patch” immediately before the procedure.

Answer 75

Use a combination of fentanyl and midazolam for conscious sedation. A bone marrow biopsy is a painful procedure. The combination of fentanyl and midazolam should be used to provide conscious sedation. TAC provides skin anesthesia about 15 minutes after it is applied to nonintact skin. The gel can be placed on a wound for suturing. It is not sufficient for a bone marrow biopsy. EMLA is an effective topical analgesic agent when applied to the skin 60 minutes before a procedure. It eliminates or reduces the pain from most procedures involving skin puncture. For this procedure, systemic analgesia is required. Transdermal fentanyl patches are useful for continuous pain control, not rapid pain control.

Question 76

An 8-year-old girl is receiving a blood transfusion when the nurse notes that she has developed precordial pain, dyspnea, distended neck veins, slight cyanosis, and a dry cough. These manifestations are most suggestive of what complication? Air embolism Allergic reaction Hemolytic reaction Circulatory overload

Answer 76

Circulatory overload The signs of circulatory overload include distended neck veins, hypertension, crackles, a dry cough, cyanosis, and precordial pain. Signs of air embolism are sudden difficulty breathing, sharp pain in the chest, and apprehension. Urticaria, pruritus, flushing, asthmatic wheezing, and laryngeal edema are signs and symptoms of allergic reactions. Hemolytic reactions are characterized by chills, shaking, fever, pain at infusion site, nausea, vomiting, tightness in chest, flank pain, red or black urine, and progressive signs of shock and renal failure.

Question 77

What preparation should the nurse consider when educating a school-age child and the family for heart surgery? Unfamiliar equipment should not be shown. Let the child hear the sounds of a cardiac monitor, including alarms. Explain that an endotracheal tube will not be needed if the surgery goes well. Discussion of postoperative discomfort and interventions is not necessary before the procedure.

Answer 77

Let the child hear the sounds of a cardiac monitor, including alarms. The child and family should be exposed to the sights and sounds of the intensive care unit (ICU). All positive, nonfrightening aspects of the environment are emphasized. The family and child should make the decision about a tour of the unit if it is an option. The child should be shown unfamiliar equipment and its use demonstrated on a doll. Carefully prepare the child for the postoperative experience, including intravenous lines, incision, endotracheal tube, expected discomfort, and management strategies.

Question 78

What describes nonpharmacologic techniques for pain management? They may reduce pain perception. They usually take too long to implement. They make pharmacologic strategies unnecessary. They trick children into believing they do not have pain.

Answer 78

They may reduce pain perception. Nonpharmacologic techniques provide coping strategies that may help reduce pain perception, make the pain more tolerable, decrease anxiety, and enhance the effectiveness of analgesics. The nonpharmacologic strategy should be matched with the child’s pain severity and be taught to the child before the onset of the painful experience. Tricking children into believing they do not have pain may mitigate the child’s experience with mild pain, but the child will still know the discomfort was present.

Question 79

When teaching a mother how to administer eye drops, where should the nurse tell her to place them? At the lacrimal duct On the sclera while the child looks to the outside In the conjunctival sac when the lower eyelid is pulled down Carefully under the eyelid while it is gently pulled upward

Answer 79

In the conjunctival sac when the lower eyelid is pulled down The lower eyelid is pulled down, forming a small conjunctival sac. The solution or ointment is applied to this area. The medication should not be administered directly on the eyeball. The lacrimal duct is not the appropriate placement for the eye medication. It will drain into the nasopharynx, and the child will taste the drug.

Question 80

When the nurse interviews an adolescent, which is especially important? Focus the discussion on the peer group. Allow an opportunity to express feelings. Use the same type of language as the adolescent. Emphasize that confidentiality will always be maintained.

Answer 80

Allow an opportunity to express feelings. Adolescents, like all children, need opportunities to express their feelings. Often they interject feelings into their words. The nurse must be alert to the words and feelings expressed. The nurse should maintain a professional relationship with adolescents. To avoid misunderstanding or misinterpretation of words and phrases used, the nurse should clarify the terms used, what information will be shared with other members of the health care team, and any limits to confidentiality. Although the peer group is important to this age group, the interview should focus on the adolescent.

Question 81

What methods should the nurse use to measure compliance to a treatment plan? (Select all that apply.) ``` Pill counts Chemical assays Direct observation Third-party reporting Monitoring therapeutic response ```

Answer 81

Pill counts Chemical assays Direct observation Monitoring therapeutic response Assessment of compliance must include direct measurement techniques. Pill counts, chemical assays, direct observation, and monitoring therapeutic response are direct measurement techniques. Third-party reporting would not always be available and would not be a method to measure compliance.

Question 82

What is an advantage of the ventrogluteal muscle as an injection site in young children? Easily accessible from many directions Free of significant nerves and vascular structures Can be used until child reaches a weight of 9 kg (20 lb) Increased subcutaneous fat, which provides sustained drug absorption

Answer 82

Free of significant nerves and vascular structures Being free of significant nerves and vascular structure is one of the advantages of the ventrogluteal site. In addition, it is considered less painful than the vastus lateralis. The major disadvantage is lack of familiarity by health professionals and controversy over whether the site can be used before weight bearing. The vastus lateralis is a more accessible site. The ventrogluteal muscle site has safely been used from newborn through adulthood. Clinical guidelines address the need for the child to be walking. The site has less subcutaneous tissue, which facilitates intramuscular deposition of the drug rather than subcutaneous.

Question 83

The nurse is seeing an adolescent and the parents in the clinic for the first time. Which should the nurse do first? Introduce him- or herself. Make the family comfortable. Give assurance of privacy. Explain the purpose of the interview.

Answer 83

Introduce him- or herself. The first thing that nurses must do is to introduce themselves to the patient and family. Parents and other adults should be addressed with appropriate titles unless they specify a preferred name. Clarification of the purpose of the interview and the nurse’s role is the second thing that should be done. During the initial part of the interview, the nurse should include general conversation to help make the family feel at ease. The interview also should take place in an environment as free of distraction as possible. In addition, the nurse should clarify which information will be shared with other members of the health care team and any limits to the confidentiality.

Question 84

What sign/symptom is a major clinical manifestation of rheumatic fever (RF)? Fever Polyarthritis Osler nodes Janeway spots

Answer 84

Polyarthritis Polyarthritis, which is swollen, hot, red, and painful joints, is a major clinical manifestation. The affected joints will change every 1 or 2 days. The large joints are primarily affected. Fever is considered a minor manifestation of RF. Osler nodes and Janeway spots are characteristic of bacterial endocarditis.

Question 85

The nurse is planning pain control for a child. Which is the advantage of administering pain medication by the intravenous (IV) bolus route? Less expensive than oral medications Produces a first-pass effect through the liver Does not need to be administered frequently Provides most rapid onset of effect, usually in about 5 minutes

Answer 85

Provides most rapid onset of effect, usually in about 5 minutes The advantage of pain medication by the IV bolus route is that it provides the most rapid onset of effect, usually in about 5 minutes. IV medications are more expensive than oral medications, and the IV route bypasses the first-pass effect through the liver. Pain control with IV bolus medication needs to be repeated hourly for continuous pain control.

Question 86

Selective cholesterol screening is recommended for children older than the age of 2 years with which risk factor? Body mass index (BMI) = 95th percentile Blood pressure = 50th percentile Parent with a blood cholesterol level of 200 mg/dl Recently diagnosed cardiovascular disease in a 75-year-old grandparent

Answer 86

Body mass index (BMI) = 95th percentile Obesity is an indication for cholesterol screening in children. A BMI in the 95th percentile or higher is considered obese. Children who are hypertensive meet the criteria for screening, but blood pressure in the 50th percentile is within the normal range. A parent or grandparent with a cholesterol level of 240 mg/dl or higher places the child at risk. Early cardiovascular disease in a first- or second-degree relative is a risk factor. Age 75 years is not considered early.

Question 87

A child with sickle cell disease is in a vasoocclusive crisis. What nonpharmacologic pain intervention should the nurse plan? Exercise as a distraction Heat to the affected area Elevation of the extremity Cold compresses to the affected area

Answer 87

Heat to the affected area Frequently, heat to the affected area is soothing. Cold compresses are not applied to the area because doing so enhances vasoconstriction and occlusion. Bed rest is usually well tolerated during a crisis, although the actual rest obtained depends a great deal on pain alleviation and the use of organized schedules of nursing care. Although the objective of bed rest is to minimize oxygen consumption, some activity, particularly passive range of motion exercises, is beneficial to promote circulation. Usually the best course is to let children determine their activity tolerance. Elevating the extremity will not help in sickle cell disease.

Question 88

What interventions should the nurse implement to prevent a pressure ulcer in a critically ill child? (Select all that apply.) ``` Nutrition consults Using skin moisturizers Turning the child every 2 hours Using plastic disposable underpads Using draw sheets to minimize shear ```

Answer 88

Nutrition consults Using skin moisturizers Turning the child every 2 hours Using draw sheets to minimize shear Interventions found to prevent pressure ulcers in critically ill children include nutrition consults, using skin moisturizers, turning the child every 2 hours, and using draw sheets to minimize shear. Dryweave underpads, not underpads with plastic, should be used to reduce moisture.

Question 89

The nurse is giving discharge instructions to the parents of a 5-year-old child who had a tonsillectomy 4 hours ago. What statement by the parent indicates a correct understanding of the teaching? “I can use an ice collar on my child for pain control along with analgesics.” “My child should clear the throat frequently to clear the secretions.” “I should allow my child to be as active as tolerated.” “My child should gargle and brush teeth at least three times per day.

Answer 89

can use an ice collar on my child for pain control along with analgesics.” Pain control after a tonsillectomy can be achieved with application of an ice collar and administration of analgesics. The child should avoid clearing the throat or coughing and does not need to gargle and brush teeth a certain number of times per day and should avoid vigorous gargling and toothbrushing. Also, the child’s activity should be limited to decrease the potential for bleeding, at least for the first few days.

Question 90

What statement is descriptive of most cases of hemophilia? X-linked recessive deficiency of platelets causing prolonged bleeding X-linked recessive inherited disorder in which a blood clotting factor is deficient Autosomal dominant deficiency of a factor involved in the blood-clotting reaction Y-linked recessive inherited disorder in which the red blood cells become moon shaped

Answer 90

X-linked recessive inherited disorder in which a blood clotting factor is deficient The inheritance pattern in 80% of all the cases of hemophilia is X-linked recessive. The two most common forms of the disorder are factor VIII deficiency (hemophilia A, or classic hemophilia) and factor IX deficiency (hemophilia B, or Christmas disease). The disorder involves coagulation factors, not platelets. The disorder does not involve red blood cells or the Y chromosome.

Question 91

A 3-year-old is brought to the emergency department with symptoms of stridor, fever, restlessness, and drooling. No coughing is observed. Based on these findings, the nurse should be prepared to assist with what action? Throat culture Nasal pharynx washing Administration of corticosteroids Emergency intubation

Answer 91

Emergency intubation Three clinical observations that are predictive of epiglottitis are absence of spontaneous cough, presence of drooling, and agitation. Nasotracheal intubation or tracheostomy is usually considered for a child with epiglottitis with severe respiratory distress. The throat should not be inspected because airway obstruction can occur, and steroids would not be done first when the child is in severe respiratory distress.

Question 92

Using knowledge of child development, what approach is best when preparing a toddler for a procedure? Avoid asking the child to make choices. Plan for a teaching session to last about 20 minutes. Demonstrate on a doll how the procedure will be done. Show the necessary equipment without allowing child to handle it.

Answer 92

Demonstrate on a doll how the procedure will be done. Prepare toddlers for procedures by using play. Demonstrate on a doll but avoid the child’s favorite doll because the toddler may think the doll is really “feeling” the procedure. In preparing a toddler for a procedure, the child is allowed to participate in care and help whenever possible. Teaching sessions for toddlers should be about 5 to 10 minutes. Use a small replica of the equipment and allow the child to handle it.

Question 93

A family requires home care teaching with regard to preventative measures to use at home to avoid an asthmatic episode. What strategy should the nurse teach? Use a humidifier in the child’s room. Launder bedding daily in cold water. Replace wood flooring with carpet. Use an indoor air purifier with HEPA filter.

Answer 93

Use an indoor air purifier with HEPA filter.

Question 94

One of the goals for children with asthma is to maintain the child’s normal functioning. What principle of treatment helps to accomplish this goal? Limit participation in sports. Reduce underlying inflammation. Minimize use of pharmacologic agents. Have yearly evaluations by a health care provider

Answer 94

Reduce underlying inflammation. Children with asthma are often excluded from exercise. This practice interferes with peer interaction and physical health. Most children with asthma can participate provided their asthma is under control. Inflammation is the underlying cause of the symptoms of asthma. By decreasing inflammation and reducing the symptomatic airway narrowing, health care providers can minimize exacerbations. Pharmacologic agents are used to prevent and control asthma symptoms, reduce the frequency and severity of asthma exacerbations, and reverse airflow obstruction. It is recommended that children with asthma be evaluated every 6 months.

Question 95

A 5-year-old child is admitted with bacterial pneumonia. What signs and symptoms should the nurse expect to assess with this disease process? Fever, cough, and chest pain Stridor, wheezing, and ear infection Nasal discharge, headache, and cough Pharyngitis, intermittent fever, and eye infection

Answer 95

Fever, cough, and chest pain Children with bacterial pneumonia usually appear ill. Symptoms include fever, malaise, rapid and shallow respirations, cough, and chest pain. Ear infection, nasal discharge, and eye infection are not symptoms of bacterial pneumonia.

Question 96

The parents of a young child with heart failure (HF) tell the nurse that they are nervous about giving digoxin. The nurse’s response should be based on which knowledge? It is a safe, frequently used drug. Parents lack the expertise necessary to administer digoxin. It is difficult to either overmedicate or undermedicate with digoxin. Parents need to learn specific, important guidelines for administration of digoxin.

Answer 96

Parents need to learn specific, important guidelines for administration of digoxin. Digoxin has a narrow therapeutic range. The margin of safety between therapeutic, toxic, and lethal doses is very small. Specific guidelines are available for parents to learn how to administer the drug safely and to monitor for side effects. Parents may lack the expertise to administer the drug at first, but with discharge preparation, they should be prepared to administer the drug safely.

Question 97

When caring for a child after a tonsillectomy, what intervention should the nurse do? Watch for continuous swallowing. Encourage gargling to reduce discomfort. Apply warm compresses to the throat. Position the child on the back for sleeping.

Answer 97

Watch for continuous swallowing. Continuous swallowing, especially while sleeping, is an early sign of bleeding. The child swallows the blood that is trickling from the operative site. Gargling is discouraged because it could irritate the operative site. Ice compresses are recommended to reduce inflammation. The child should be positioned on the side or abdomen to facilitate drainage of secretions.

Question 98

Guidelines for intramuscular administration of medication in school-age children include what standard? Inject medication as rapidly as possible. Insert needle quickly, using a dartlike motion. Have the child stand if at all possible and if the child is cooperative. Penetrate the skin immediately after cleansing the site while the skin is moist.

Answer 98

Insert needle quickly, using a dartlike motion. The needle should be inserted quickly in a dartlike motion at a 90-degree angle unless contraindicated. Inject medications slowly. Allow skin preparation to dry completely before the skin is penetrated. Place the child in a lying or sitting position.

Question 99

What interventions can the nurse teach parents to do to ease respiratory efforts for a child with a mild respiratory tract infection? (Select all that apply.) ``` Cool mist Warm mist Steam vaporizer Keep child in a flat, quiet position Run a shower of hot water to produce steam ```

Answer 99

Cool mist Warm mist Steam vaporizer Run a shower of hot water to produce steam Warm or cool mist is a common therapeutic measure for symptomatic relief of respiratory discomfort. The moisture soothes inflamed membranes and is beneficial when there is hoarseness or laryngeal involvement. A time-honored method of producing steam is the shower. Running a shower of hot water into the empty bathtub or open shower stall with the bathroom door closed produces a quick source of steam. Keeping a child in this environment for 10 to 15 minutes may help ease respiratory efforts. A small child can sit on the lap of a parent or other adult. The child should be quiet but upright, not flat. The use of steam vaporizers in the home is often discouraged because of the hazards related to their use and limited evidence to support their efficacy.

Question 100

The nurse is giving discharge instructions to the parent of a 6-year-old child who had a cardiac catheterization 4 hours ago. What statement by the parent indicates a correct understanding of the teaching? “My child should not attend school for the next 5 days.” “I should change the bandage every day for the next 2 days.” “My child can take a tub bath but should avoid taking a shower for the next 4 days.” “I should expect the site to be red and swollen for the next 3 days.”

Answer 100

“I should change the bandage every day for the next 2 days.” Discharge instructions for a parent of a child who recently had a cardiac catheterization should include changing the bandage every day for the next 2 days. The child should avoid strenuous exercise but can go back to school. The child should avoid a tub bath, but an older child could take a shower the first day after the catheterization. The site should not have swelling or redness; if there is, it should be reported to the health care practitioner.

Question 101

Cystic fibrosis (CF) may affect single or multiple systems of the body. What is the primary factor responsible for possible multiple clinical manifestations in CF? Hyperactivity of sweat glands Hypoactivity of autonomic nervous system Atrophic changes in mucosal wall of intestines Mechanical obstruction caused by increased viscosity of mucous gland secretions

Answer 101

Mechanical obstruction caused by increased viscosity of mucous gland secretions The mucous glands produce a thick mucoprotein that accumulates and results in dilation. Small passages in organs such as the pancreas and bronchioles become obstructed as secretions form concretions in the glands and ducts. The exocrine glands, not sweat glands, are dysfunctional. Although abnormalities in the autonomic nervous system are present, it is not hypoactive. Intestinal involvement in CF results from the thick intestinal secretions, which can lead to blockage and rectal prolapse.

Question 102

Because children younger than 5 years are egocentric, the nurse should do which when communicating with them? Focus communication on the child. Use easy analogies when possible. Explain experiences of others to the child. Assure the child that communication is private.

Answer 102

Focus communication on the child. Because children of this age are able to see things only in terms of themselves, the best approach is to focus communication directly on them. Children should be provided with information about what they can do and how they will feel. With children who are egocentric, analogies, experiences, and assurances that communication is private will not be effective because the child is not capable of understanding.

Question 103

What primary nursing intervention should be implemented to prevent bacterial endocarditis? Counsel parents of high-risk children. Institute measures to prevent dental procedures. Encourage restricted mobility in susceptible children. Observe children for complications, such as embolism and heart failure.

Answer 103

Counsel parents of high-risk children. The objective of nursing care is to counsel the parents of high-risk children about the need for both prophylactic antibiotics for dental procedures and maintaining excellent oral health. The child’s dentist should be aware of the child’s cardiac condition. Dental procedures should be done to maintain a high level of oral health. Restricted mobility in susceptible children is not indicated. Parents are taught to observe for unexplained fever, weight loss, or change in behavior.

Question 104

What medication used to treat heart failure (HF) is a diuretic? Captopril (Capten) Digoxin (Lanoxin) Hydrochlorothiazide (Diuril) Carvedilol (Coreg)

Answer 104

Hydrochlorothiazide (Diuril) Hydrochlorothiazide is a diuretic. Captopril is an ACE inhibitor, digoxin is a digital glycoside, and carvedilol is a beta-blocker

Question 105

The nurse finds that a 6-month-old infant has an apical pulse of 166 beats/min during sleep. What nursing intervention is most appropriate at this time? Administer oxygen. Record data on the nurses’ notes. Report data to the practitioner. Place the child in the high Fowler position.

Answer 105

Report data to the practitioner. One of the earliest signs of HF is tachycardia (sleeping heart rate >160 beats/min) as a direct result of sympathetic stimulation. The practitioner needs to be notified for evaluation of possible HF. Although oxygen or a semiupright position may be indicated, the first action is to report the data to the practitioner.

Question 106

When auscultating an infant’s lungs, the nurse detects diminished breath sounds. What should the nurse interpret this as? Suggestive of chronic pulmonary disease Suggestive of impending respiratory failure An abnormal finding warranting investigation A normal finding in infants younger than 1 year of age

Answer 106

An abnormal finding warranting investigation Absent or diminished breath sounds are always an abnormal finding. Fluid, air, or solid masses in the pleural space all interfere with the conduction of breath sounds. Further data are necessary for diagnosis of chronic pulmonary disease or impending respiratory failure. Diminished breath sounds in certain segments of the lungs can alert the nurse to pulmonary areas that may benefit from chest physiotherapy. Further evaluation is needed in all age groups.

Question 107

The clinic nurse is reviewing the immunization guidelines for hepatitis B. Which are true of the guidelines for this vaccine? (Select all that apply.) The hepatitis B vaccination series should be begun at birth. The adolescent not vaccinated at birth does not have a need to be vaccinated. Any child not vaccinated at birth should receive two doses at least 4 months apart. An unimmunized 10-year-old child should receive three doses administered 4 weeks apart.

Answer 107

The hepatitis B vaccination series should be begun at birth. An unimmunized 10-year-old child should receive three doses administered 4 weeks apart.

Question 108

Which are effective auscultation techniques? (Select all that apply.) Ask the child to breathe shallowly. Apply light pressure on the chest piece. Use a symmetric and orderly approach. Place the stethoscope over one layer of clothing. Warm the stethoscope before placing it on the skin.

Answer 108

Use a symmetric and orderly approach. Warm the stethoscope before placing it on the skin. Effective auscultation techniques include using a symmetric approach and warming the stethoscope before placing it on the skin. Breath sounds are best heard if the child inspires deeply, not shallowly. Firm, not light, pressure should be used on the chest piece. The stethoscope should be placed on the skin, not over clothing.

Question 109

A 3-year-old child is experiencing pain after a tonsillectomy. The child has not taken in any fluids and does not want to drink anything, saying, “My tummy hurts.” The following health care prescriptions are available: acetaminophen (Tylenol) PO (orally) or PR (rectally) PRN, ice chips, clear liquids. What should the nurse implement to relieve the child’s pain? Ice chips Tylenol PO Tylenol PR Popsicle

Answer 109

Tylenol PR The throat is very sore after a tonsillectomy. Most children experience moderate pain after a tonsillectomy and need pain medication at regular intervals for at least the first 24 hours. Analgesics may need to be given rectally or intravenously to avoid the oral route.

Question 110

What type of drug reduces hypertension by interfering with the production of angiotensin II? Diuretics Vasodilators Beta-blockers Angiotensin-converting enzyme (ACE) inhibitors

Answer 110

Angiotensin-converting enzyme (ACE) inhibitors ACE inhibitors act by interfering with the production of angiotensin II, which is a potent vasoconstrictor. Diuretics lower blood pressure by increasing fluid output. Vasodilators act on the vascular smooth muscle. By causing arterial dilation, blood pressure is lowered. Beta-blockers interfere with beta stimulation and depress renin output.

Question 111

The clinic nurse is evaluating lab results for a child. What recorded hemoglobin (Hgb) result is considered within the normal range? ``` 9 g/dl 10 g/dl 11 g/dl 12 g/dl Normal hemoglobin (Hgb) determination is 11.5 to 15.5 g ```

Answer 111

12 g/dl Normal hemoglobin (Hgb) determination is 11.5 to 15.5 g/dl.

Question 112

What do the initial signs of respiratory syncytial virus (RSV) infection in an infant include? Rhinorrhea, wheezing, and fever Tachypnea, cyanosis, and apnea Retractions, fever, and listlessness Poor breath sounds and air hunger

Answer 112

Rhinorrhea, wheezing, and fever Symptoms such as rhinorrhea and a low-grade fever often appear first. OM and conjunctivitis may also be present. In time, a cough may develop. Wheezing is an initial sign as well. Progression of illness brings on the symptoms of tachypnea, retractions, poor breath sounds, cyanosis, air hunger, and apnea.

Question 113

The nurse needs to take the blood pressure of a preschool boy for the first time. What action would be best in gaining his cooperation? Tell him that this procedure will help him get well faster. Take his blood pressure when a parent is there to comfort him. Explain to him how the blood flows through the arm and why the blood pressure is important. Permit him to handle the equipment and see the cuff inflate and deflate before putting the cuff in place.

Answer 113

Permit him to handle the equipment and see the cuff inflate and deflate before putting the cuff in place. A preschooler is at the stage of preoperational thought. The nurse needs to explain the procedure in simple terms and allow the child to see how the equipment works. This will help allay fears of bodily harm. Blood pressure measurement is used for assessment, not therapy, and will not help him get well faster. Although the parent will be able to support the child, he may still be uncooperative. Also, the assessment of blood pressure may be needed before the parent is available. Explaining to a preschooler how the blood flows through the artery and why the blood pressure is important is too complex.

Question 114

The nurse is preparing to obtain a nasal washing from a child. What equipment should the nurse gather for the procedure? (Select all that apply.) ``` Sterile water A sterile swab Syringe with tubing Sterile normal saline Tracheal suction catheter ```

Answer 114

Syringe with tubing Sterile normal saline Nasal washings may be obtained to identify viral pathogens and guide therapy in some respiratory conditions. The child is placed supine, and 1 to 3 ml of sterile normal saline is instilled with a sterile syringe (without a needle) into one nostril. The contents are aspirated with a syringe with 5 cm (2 inches) of 18- to 20-gauge tubing. The saline is quickly instilled and then aspirated to recover the nasal specimen. A tracheal suction catheter would not trap the mucus. Normal saline is used, not sterile water. A sterile swab is used for a throat culture, not for nasal washings.

Question 115

The nurse is preparing to admit a 5-year-old child who developed lesions of varicella (chickenpox) 3 days ago. Which clinical manifestations of varicella should the nurse expect to observe? (Select all that apply.) Nonpruritic rash Elevated temperature Discrete rose pink rash Vesicles surrounded by an erythematous base Centripetal rash in all three stages (papule, vesicle, and crust)

Answer 115

Elevated temperature Vesicles surrounded by an erythematous base Centripetal rash in all three stages (papule, vesicle, and crust)

Question 116

The nurse is caring for a non–English-speaking child and family. Which should the nurse consider when using an interpreter? Pose several questions at a time. Use medical jargon when possible. Communicate directly with family members when asking questions. Carry on some communication in English with the interpreter about the family’s needs.

Answer 116

Communicate directly with family members when asking questions. When using an interpreter, the nurse should communicate directly with family members when asking questions to reinforce interest in them and to observe nonverbal expressions. Questions should be posed one at a time to elicit only one answer at a time. Medical jargon should be avoided whenever possible. The nurse should avoid discussing the family’s needs with the interpreter in English because some family members may understand some English.

Question 117

To facilitate the administration of an oral medication to a preschool-age child, what action should the nurse take? Dilute the medication in a large amount of favorite liquid and allow the child to hold the cup. Set limits about the need to take medication and offer praise immediately after the task is accomplished. Mix the medication in a moderate amount of the child’s favorite food. Explain the purpose of the medication and allow the child time to express resistance before giving the medication.

Answer 117

Set limits about the need to take medication and offer praise immediately after the task is accomplished. Nurses who approach children with confidence and who convey the impression that they expect to be successful are less likely to encounter difficulty. It is best to approach a child as though cooperation is expected. The medication should not be placed in a favorite liquid or food. Allowing the child time to express resistance will delay administration of the medication.

Question 118

What activity should the school nurse recommend for a child with hemophilia A? (Select all that apply.) ``` Golf Soccer Rugby Jogging Swimming ```

Answer 118

Golf Jogging Swimming Children and adolescents with severe hemophilia can participate in noncontact sports such as swimming, golf, walking, jogging, fishing, and bowling. Contact sports such as football, boxing, hockey, soccer, and rugby are strongly discouraged because the risk of injury outweighs the physical and psychosocial benefits of participating in these sports.

Question 119

Which action should the nurse implement when taking an axillary temperature? Take the temperature through one layer of clothing. Add a degree to the result when recording the temperature. Place the tip of the thermometer under the arm in the center of the axilla. Hold the child’s arm away from the body while taking the temperature.

Answer 119

Place the tip of the thermometer under the arm in the center of the axilla. The thermometer tip should be placed under the arm in the center of the axilla and kept close to the skin, not clothing. The temperature should not be taken through any clothing. The child’s arm should be pressed firmly against the side, not held away from the body. The temperature should be recorded without a degree added and designated as being taken by the axillary method.

Question 120

Which are components of the FLACC scale? (Select all that apply.) ``` Color Capillary refill time Leg position Facial expression Activity ```

Answer 120

Leg position Facial expression Activity Facial expression, consolability, cry, activity, and leg position are components of the FLACC scale. Color is a component of the Apgar scoring system. Capillary refill time is a physiologic measure that is not a component of the FLACC scale.

Question 121

A child, age 7 years, has a fever associated with a viral illness. She is being cared for at home. What is the principal reason for treating fever in this child? Relief of discomfort Reassurance that illness is temporary Prevention of secondary bacterial infection Avoidance of life-threatening complications

Answer 121

Relief of discomfort The principal reason for treating fever is the relief of discomfort. Relief measures include pharmacologic and environmental intervention. The most effective is the use of pharmacologic agents to lower the set point. Although the nurse can reassure the child that the illness is temporary, the child is often uncomfortable and irritable. Intervention helps the child and family minimize the discomfort. Most fevers result from viral, not bacterial, infections. Few life-threatening events are associated with fever. The use of antipyretics does not seem to reduce the incidence of febrile seizures.

Question 122

Which data should be included in a health history? Review of systems Physical assessment Growth measurements Record of vital signs

Answer 122

Review of systems A review of systems is done to elicit information concerning any potential health problems. This further guides the interview process. Physical assessment, growth measurements, and a record of vital signs are components of the physical examination.

Question 123

A laboratory technician is performing a blood draw on a toddler. The toddler is holding still but crying loudly. The nurse should take which action? Have the lab technician stop the procedure until the child stops crying. Do nothing. It’s Okay for a child to cry during a painful procedure. Tell the child to stop crying; it’s only a small prick. Tell the child to stop crying because the procedure is almost over.

Answer 123

Do nothing. It’s Okay for a child to cry during a painful procedure. The child should be allowed to express feelings of anger, anxiety, fear, frustration, or any other emotion. It is natural for children to strike out in frustration or to try to avoid stress-provoking situations. The child needs to know that it is all right to cry.

Question 124

Which is the leading cause of death in infants younger than 1 year in the United States? Congenital anomalies Sudden infant death syndrome Disorders related to short gestation and low birth weight Maternal complications specific to the perinatal period

Answer 124

Congenital anomalies Congenital anomalies account for 20.1% of deaths in infants younger than 1 year compared with sudden infant death syndrome, which accounts for 8.2%; disorders related to short gestation and unspecified low birth weight, which account for 16.5%; and maternal complications such as infections specific to the perinatal period, which account for 6.1% of deaths in infants younger than 1 year of age.

Question 125

A child has a central venous access device for intravenous (IV) fluid administration. A blood sample is needed for a complete blood count, hemogram, and electrolytes. What is the appropriate procedure to implement for this blood sample? Perform a new venipuncture to obtain the blood sample. Interrupt the IV fluid and withdraw the blood sample needed. Withdraw a blood sample equal to the amount of fluid in the device, discard, and then withdraw the sample needed. Flush the line and central venous device with saline and then aspirate the required amount of blood for the sample.

Answer 125

Withdraw a blood sample equal to the amount of fluid in the device, discard, and then withdraw the sample needed. The blood specimen obtained must reflect the appropriate hemodilution of the blood and electrolyte concentration. The nurse needs to withdraw the amount of fluid that is in the device and discard it. The next sample will come from the child’s circulating blood. With a central venous device, the trauma of a separate venipuncture can be avoided. The blood sample will be diluted with either the IV fluid being administered or the saline.

Question 126

The nurse is preparing to perform a physical assessment on a 10-year-old girl. The nurse gives her the option of her mother staying in the room or leaving. This action should be considered which? Appropriate because of child’s age Appropriate, but the mother may be uncomfortable Inappropriate because of child’s age Inappropriate because child is same sex as mother

Answer 126

Appropriate because of child’s age It is appropriate to give older school-age children the option of having the parent present or not. During the examination, the nurse should respect the child’s need for privacy. Children who are 10 years old are minors, and parents are responsible for health care decisions. The mother of a 10-year-old child would not be uncomfortable. The child should help determine who is present during the examination.

Question 127

The clinic nurse is teaching parents about when to call the office immediately for a child with a fever. What should the nurse include in the teaching session? (Select all that apply.) The child has a stiff neck. The fever is over 40.6° C (105° F). The child is younger than 2 months. The fever has lasted for more than 3 days. The fever went away for more than 24 hours and then returned.

Answer 127

The child has a stiff neck. The fever is over 40.6° C (105° F). The child is younger than 2 months Parents should call the office immediately if a child has a fever over 40.6° C (105° F), the child is younger than 2 months, or the child has a stiff neck. Parents are to call within 24 hours if the fever went away for more than 24 hours and then returned or the fever has lasted for more than 3 days.

Question 128

A critically ill child has hyperthermia. The parents ask the nurse to give an antipyretic such as acetaminophen. How should the nurse respond to the parents? Febrile seizures can result. Antipyretics may cause malignant hyperthermia. Antipyretics are of no value in treating hyperthermia. Liver damage may occur in critically ill children.

Answer 128

Antipyretics are of no value in treating hyperthermia. Unlike with fever, antipyretics are of no value in hyperthermia because the set point is already normal. Cooling measures are used instead. Antipyretics do not cause seizures. Malignant hyperthermia is a genetic myopathy that is triggered by anesthetic agents. Antipyretic agents do not have this effect. Acetaminophen can result in liver damage if too much is given or if the liver is already compromised. Other antipyretics are available, but they are of no value in hyperthermia.

Question 129

What play activities should the nurse implement to encourage fluid intake for a child? (Select all that apply.) ``` Have a tea party. Use a crazy straw. Cut gelatin into fun shapes. Place liquid in large Styrofoam cups. Make ice pops using the child’s favorite juice. ```

Answer 129

Have a tea party. Use a crazy straw. Cut gelatin into fun shapes. Make ice pops using the child’s favorite juice. Play activities to encourage fluid intake for a child include tea parties, crazy straws, cutting gelatin into fun shapes, and making ice pops using the child’s favorite juice. Small cups, not large Styrofoam cups, should be used.

Question 130

The nurse is administering a unit of blood to a child. What are signs and symptoms of a transfusion reaction? (Select all that apply.) ``` Chills Shaking Flank pain Hypothermia Sudden severe headache ```

Answer 130

Chills Shaking Flank pain Sudden severe headache

Question 131

A 4-year-old girl is brought to the emergency department. She has a “froglike” croaking sound on inspiration, is agitated, and is drooling. She insists on sitting upright. The nurse should intervene in which manner? Make her lie down and rest quietly. Examine her oral pharynx and report to the physician. Auscultate her lungs and prepare for placement in a mist tent. Notify the physician immediately and be prepared to assist with a tracheostomy or intubation.

Answer 131

Notify the physician immediately and be prepared to assist with a tracheostomy or intubation. This child is exhibiting signs of respiratory distress and possible epiglottitis. Epiglottitis is always a medical emergency requiring antibiotics and airway support for treatment. Sitting up is the position that facilitates breathing in respiratory disease. The oral pharynx should not be visualized. If the epiglottis is inflamed, there is the potential for complete obstruction if it is irritated further. Although lung auscultation provides useful assessment information, a mist tent would not be beneficial for this child. Immediate medical evaluation and intervention are indicated.

Question 132

The nurse is performing an otoscopic examination on a child. Which are normal findings the nurse should expect? (Select all that apply.) Ashen gray areas A well-defined light reflex A small, round, concave spot near the center of the drum The tympanic membrane is a nontransparent grayish color A whitish line extending from the umbo upward to the margin of the membrane

Answer 132

A well-defined light reflex A small, round, concave spot near the center of the drum A whitish line extending from the umbo upward to the margin of the membrane Normal findings include the light reflex and bony landmarks. The light reflex is a fairly well-defined, cone-shaped reflection that normally points away from the face. The bony landmarks of the eardrum are formed by the umbo, or tip of the malleus. It appears as a small, round, opaque, concave spot near the center of the eardrum. The manubrium (long process or handle) of the malleus appears to be a whitish line extending from the umbo upward to the margin of the membrane. The tympanic membrane should be light pearly pink or gray and translucent, not nontransparent. Ashen gray areas indicate signs of scarring from a previous perforation.

Question 133

The parents of a 3-year-old child with congenital heart disease are afraid to let their child play with other children because of possible overexertion. How should the nurse reply to this concern? The parents should meet all the child’s needs. The child needs opportunities to play with peers. Constant parental supervision is needed to avoid overexertion. The child needs to understand that peers’ activities are too strenuous.

Answer 133

The child needs opportunities to play with peers. The child needs opportunities for social development. Children are able to regulate and limit their activities based on their energy level. Parents must be encouraged to seek appropriate social activities for the child, especially before kindergarten. The child needs to have activities that foster independence

Question 134

A 3-month-old infant is admitted to the pediatric unit for treatment of bronchiolitis. The infant’s vital signs are T, 101.6° F; P, 106 beats/min apical; and R, 70 breaths/min. The infant is irritable and fussy and coughs frequently. IV fluids are given via a peripheral venipuncture. Fluids by mouth were initially contraindicated for what reason? Tachypnea Paroxysmal cough Irritability Fever

Answer 134

Tachypnea Fluids by mouth may be contraindicated because of tachypnea, weakness, and fatigue. Therefore, IV fluids are preferred until the acute stage of bronchiolitis has passed. Infants with bronchiolitis may have paroxysmal coughing, but fluids by mouth would not be contraindicated. Irritability or fever would not be reasons for fluids by mouth to be contraindicated.

Question 135

The nurse is planning to administer a nonopioid for pain relief to a child. Which timing should the nurse plan so the nonopioid takes effect? 15 minutes until maximum effect 30 minutes until maximum effect 1 hour until maximum effect 1 1/2 hours until maximum effect

Answer 135

1 hour until maximum effect Nonsteroidal antiinflammatory drugs (NSAIDs) can provide safe and effective pain relief when dosed at appropriate levels with adequate frequency. Most NSAIDs take about 1 hour for effect, so timing is crucial.

Question 136

The nurse is preparing to administer a unit of packed red blood cells to a hospitalized child. What is an appropriate action that applies to administering blood? Take the vital signs every 15 minutes while blood is infusing. Use blood within 1 hour of its arrival from the blood bank. Administer the blood with 5% glucose in a piggyback setup. Administer the first 50 ml of blood slowly and stay with the child.

Answer 136

Administer the first 50 ml of blood slowly and stay with the child. The nurse should administer the first 50 ml of blood or initial 20% of volume (whichever is smaller) slowly and stay with the child. Vitals signs should be taken 15 minutes after initiation and then every hour, not every 15 minutes. Blood should be used within 30 minutes, not 1 hour. Normal saline, not 5% glucose, should be the IV solution.

Question 137

The nurse is teaching the family of a child, age 8 years, with moderate hemophilia about home care. What should the nurse tell the family to do to minimize joint injury? Administer nonsteroidal anti-inflammatory drugs (NSAIDs). Administer DDAVP (synthetic vasopressin). Provide intravenous (IV) infusion of factor VIII concentrates. Encourage elevation and application of ice to the involved joint.

Answer 137

Provide intravenous (IV) infusion of factor VIII concentrates. Parents are taught home infusion of factor VIII concentrate. For moderate and severe hemophilia, prompt IV administration is essential to prevent joint injury. NSAIDs are effective for pain relief. They must be given with caution because they inhibit platelet aggregation. A factor VIII level of 30% is necessary to stop bleeding. DDAVP can raise the factor VIII level fourfold. Moderate hemophilia is defined by a factor VIII activity of 4.9. A fourfold increase would not meet the 30% level. Ice and elevation are important adjunctive therapy, but factor VIII is necessary.

Question 138

An 11-month-old hospitalized boy is restrained because he is receiving intravenous (IV) fluids. His grandmother has come to stay with him for the afternoon and asks the nurse if the restraints can be removed. What nurse’s response is best? “Restraints need to be kept on all the time.” “That is fine as long as you are with him.” “That is fine if we have his parents’ consent.” “The restraints can be off only when the nursing staff is present.”

Answer 138

“That is fine as long as you are with him.” The restraints are necessary to protect the IV site. If the child has appropriate supervision, restraints are not necessary. The nurse should remove the restraints whenever possible. When parents or staff members are present, the restraints can be removed and the IV site protected. Parental permission is not needed for restraint removal.

Question 139

A 7-year-old is identified as being at risk for skin breakdown. What intervention should the nursing care plan include? Massaging reddened bony prominences Teaching the parents to turn the child every 4 hours Ensuring that nutritional intake meets requirements Minimizing use of extra linens, which can irritate the child’s skin

Answer 139

Ensuring that nutritional intake meets requirements Children who are hospitalized and NPO (taking nothing by mouth) for several days are at risk for nutritional deficiencies and skin breakdown. If NPO status is prolonged, parenteral nutrition should be considered. Massaging bony prominences can cause deep tissue damage. This should be avoided. Although parents can participate, turning the child is the nurse’s responsibility. If the child is alert and can move, position shifts should be done more frequently. If the child does not move, the nurse should reposition every 2 hours. The number of linens is not an issue. The child should not be dragged across the sheet. Children should be lifted and moved to avoid friction and shearing.

Question 140

What is a significant common side effect that occurs with opioid administration? Euphoria Diuresis Constipation Allergic reactions

Answer 140

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

Question 141

What disease processes require contact isolation? (Select all that apply.) ``` Rotavirus Hepatitis A Streptococcal pharyngitis Mycoplasmal pneumonia Respiratory syncytial virus ```

Answer 141

Rotavirus Hepatitis A Respiratory syncytial virus In addition to Standard Precautions, use contact precautions for patients known or suspected to have serious illnesses easily transmitted by direct patient contact or by contact with items in the patient’s environment. Examples of such illnesses include rotavirus, hepatitis A, and respiratory syncytial virus. Streptococcal pharyngitis and mycoplasmal pneumonia require droplet precautions.

Question 142

The nurse is planning care for an infant with candidiasis (moniliasis) diaper dermatitis. Which topical ointments may be prescribed for the patient? (Select all that apply.) ``` Nystatin Bactroban Neosporin Miconazole Clotrimazole ```

Answer 142

Nystatin Miconazole Clotrimazole Candidiasis diaper dermatitis skin lesions are treated with topical nystatin, miconazole, and clotrimazole. Bactroban and Neosporin are used to treat bacterial dermatitides.

Question 143

The nurse is having difficulty communicating with a hospitalized 6-year-old child. Which technique should be most helpful? Recommend that the child keep a diary. Provide supplies for the child to draw a picture. Suggest that the parent read fairy tales to the child. Ask the parent if the child is always uncommunicative.

Answer 143

Provide supplies for the child to draw a picture. Drawing is one of the most valuable forms of communication. Children’s drawings tell a great deal about them because they are projections of the children’s inner self. A diary should be difficult for a 6-year-old child, who is most likely learning to read. The parent reading fairy tales to the child is a passive activity involving the parent and child; it should not facilitate communication with the nurse. The child is in a stressful situation and is probably uncomfortable with strangers, not always uncommunicative.

Question 144

The nurse is preparing an airborne infection isolation room for a patient. Which communicable disease does the patient likely have? Varicella Pertussis Influenza Scarlet fever

Answer 144

Varicella

Question 145

A child with cystic fibrosis (CF) receives aerosolized bronchodilator medication. When should this medication be administered? After chest physiotherapy (CPT) Before chest physiotherapy (CPT) After receiving 100% oxygen Before receiving 100% oxygen

Answer 145

Before chest physiotherapy (CPT) Bronchodilators should be given before CPT to open bronchi and make expectoration easier. These medications are not helpful when used after CPT. Oxygen is administered only in acute episodes, with caution, because of chronic carbon dioxide retention.

Question 146

What strategies should the nurse implement to assist in feeding a sick child? (Select all that apply.) Serve large portions. Make mealtimes pleasant. Avoid foods that are highly seasoned. Provide finger foods for young children. Ensure a variety of foods, textures, and colors.

Answer 146

Make mealtimes pleasant. Avoid foods that are highly seasoned. Provide finger foods for young children. Ensure a variety of foods, textures, and colors. To assist in feeding a sick child mealtimes should be pleasant; highly seasoned foods should be avoided; finger foods should be provided for young children; and a variety of foods, textures, and colors should be ensured. Small portions, not large, should be served.

Question 147

What respiratory condition or disease results in both increased compliance and increased resistance? Asthma Atelectasis Surfactant deficiency Bronchopulmonary dysplasia

Answer 147

Asthma

Question 148

A quantitative sweat chloride test has been done on an 8-month-old child. What value should be indicative of cystic fibrosis (CF)? Less than 18 mEq/L 18 to 40 mEq/L 40 to 60 mEq/L Greater than 60 mEq/L

Answer 148

Greater than 60 mEq/L Normally sweat chloride content is less than 40 mEq/L, with a mean of 18 mEq/L. A chloride concentration greater than 60 mEq/L is diagnostic of CF; in infants younger than 3 months, a sweat chloride concentration greater than 40 mEq/L is highly suggestive of CF.

Question 149

What medication is contraindicated in children post tonsillectomy and adenoidectomy? Codeine b. Ondansetron (Zofran) Amoxil (amoxicillin) Acetaminophen (Tylenol)

Answer 149

Codeine

Question 150

Which drug is usually the best choice for patient-controlled analgesia (PCA) for a child in the immediate postoperative period? Codeine sulfate (Codeine) Morphine (Roxanol) Methadone (Dolophine) Meperidine (Demerol)

Answer 150

Morphine (Roxanol) The most commonly prescribed medications for PCA are morphine, hydromorphone, and fentanyl. Parenteral use of codeine is not recommended. Methadone in parenteral form is not used in a PCA but is given orally or intravenously for pain in the infant. Meperidine is not used for continuous and extended pain relief.

Question 151

The nurse is preparing a community outreach program about the prevention of iron-deficiency anemia in infants. What statement should the nurse include in the program? Whole milk can be introduced into the infant’s diet in small amounts at 6 months. Iron supplements cannot be given until the infant is older than 1 year of age. Iron-fortified cereal should be introduced to the infant at 2 months of age. Breast milk or iron-fortified formula should be used for the first 12 months.

Answer 151

Breast milk or iron-fortified formula should be used for the first 12 months. Prevention, the primary goal in iron-deficiency anemia, is achieved through optimal nutrition and appropriate iron supplements. The American Academy of Pediatrics recommends feeding an infant only breast milk or iron-fortified formula for the first 12 months of life. Whole cow’s milk should not be introduced until after 12 months, iron supplements can be given during the first year of life, and iron-fortified cereals should not be introduced until the infant is 4 to 6 months old.

Question 152

A 16-year-old girl comes to the pediatric clinic for information on birth control. The nurse knows that before this young woman can be examined, consent must be obtained from which source? Herself Her mother Court order Legal guardian

Answer 152

Herself Contraceptive advice is one of the conditions that is considered “medically emancipated.” The adolescent is able to provide her own informed consent.

Question 153

The nurse understands that blocks to therapeutic communication include what? (Select all that apply.) ``` Socializing Use of silence Using clichés Defending a situation Using open-ended questions ```

Answer 153

Socializing Using clichés Defending a situation Blocks to communication include socializing, using clichés, and defending a situation. Use of silence and using open-ended questions are therapeutic communication techniques.

Question 154

A child with hemophilia A is scheduled for surgery. What precautions should the nurse institute with this child? Handle the child gently when transferring to a cart. Caution the child not to brush his teeth before surgery. Use tape sparingly on postoperative dressings. Do not administer analgesics before surgery.

Answer 154

Handle the child gently when transferring to a cart. The goal of prevention of bleeding episodes is directed toward decreasing the risk of injury. The child should be handled carefully when transferring to a cart. Brushing teeth, use of tape, and giving analgesics will not risk a bleeding episode.

Question 155

The nurse is taking a sexual history on an adolescent girl. Which is the best way to determine whether she is sexually active? Ask her, “Are you sexually active?” Ask her, “Are you having sex with anyone?” Ask her, “Are you having sex with a boyfriend?” Ask both the girl and her parent if she is sexually active.

Answer 155

Ask her, “Are you having sex with anyone?” Asking the adolescent girl if she is having sex with anyone is a direct question that is well understood. The phrase sexually active is broadly defined and may not provide specific information for the nurse to provide necessary care. The word “anyone” is preferred to using gender-specific terms such as “boyfriend” or “girlfriend.” Using gender-neutral terms is inclusive and conveys acceptance to the adolescent. Questioning about sexual activity should occur when the adolescent is alone.

Question 156

A 4-month-old infant comes to the clinic for a well-infant checkup. Immunizations she should receive are DTaP (diphtheria, tetanus, acellular pertussis) and IPV (inactivated poliovirus vaccine). She is recovering from a cold but is otherwise healthy and afebrile. Her older sister has cancer and is receiving chemotherapy. Nursing considerations should include which? DTaP and IPV can be safely given. DTaP and IPV are contraindicated because she has a cold. IPV is contraindicated because her sister is immunocompromised. DTaP and IPV are contraindicated because her sister is immunocompromised.

Answer 156

DTaP and IPV can be safely given. These immunizations can be given safely. Serious illness is a contraindication. A mild illness with or without fever is not a contraindication. These are not live vaccines, so they do not pose a risk to her sister.

Question 157

The nurse needs to start an intravenous (IV) line on an 8-year-old child to begin administering intravenous antibiotics. The child starts to cry and tells the nurse, “Do it later, okay?” What action should the nurse take? Postpone starting the IV until the next shift. Start the IV line and then allow for expression of feelings. Change the route of the antibiotics to PO. Postpone starting the IV line until the child is ready.

Answer 157

Start the IV line and then allow for expression of feelings. A school-age child may try to delay the procedure, but it is best to complete the procedure and allow time for the child to express his or her feelings. The nurse should not postpone administering the antibiotic, change it to PO, or wait to start the IV line until the child is ready.

Question 158

What does impetigo ordinarily results in? No scarring Pigmented spots Atrophic white scars Slightly depressed scars

Answer 158

No scarring

Question 159

The diagnosis of hypertension depends on accurate assessment of blood pressure (BP). What is the appropriate technique to measure a child’s BP? Assess BP while the child is standing. Compare left arm with left leg BP readings. Use a narrow cuff to ensure that the readings are correct. Measure BP with the child in the sitting position on three separate occasions.

Answer 159

Measure BP with the child in the sitting position on three separate occasions. The diagnosis of hypertension is made after the BP is elevated on three separate occasions. Take the BP in a quiet area with the appropriate size cuff and the child sitting. Although left arm and left leg BP readings may be compared, it is not the procedure to diagnose hypertension. The appropriate size cuff is indicated. The most common cause of inaccurate readings is the use of a cuff that is too small

Question 160

Which is the single most important factor to consider when communicating with children? Presence of the child’s parent Child’s physical condition Child’s developmental level Child’s nonverbal behaviors

Answer 160

Child’s developmental level The nurse must be aware of the child’s developmental stage to engage in effective communication. The use of both verbal and nonverbal communication should be appropriate to the developmental level. Nonverbal behaviors vary in importance based on the child’s developmental level and physical condition. Although the child’s physical condition is a consideration, developmental level is much more important. The presence of parents is important when communicating with young children but may be detrimental when speaking with adolescents.

Question 161

Which is the most frequently used test for measuring visual acuity? Snellen letter chart Ishihara vision test Allen picture card test Denver eye screening test

Answer 161

Snellen letter chart The Snellen letter chart, which consists of lines of letters of decreasing size, is the most frequently used test for visual acuity. The Ishihara Vision Test is used for color vision. The Allen picture card test and Denver eye screening test involve single cards for children ages 2 years and older who are unable to use the Snellen letter chart.

Question 162

Which explains the importance of detecting strabismus in young children? Color vision deficit may result. Amblyopia, a type of blindness, may result. Epicanthal folds may develop in the affected eye. Corneal light reflexes may fall symmetrically within each pupil.

Answer 162

Amblyopia, a type of blindness, may result. By the age of 3 to 4 months, infants are able to fixate on one visual field with both eyes simultaneously. In strabismus, or cross-eye, one eye deviates from the point of fixation. If misalignment is constant, the weak eye becomes “lazy,” and the brain eventually suppresses the image produced from that eye. If strabismus is not detected and corrected by age 4 to 6 years, blindness from disuse, known as amblyopia, may occur. Color vision is not the only concern. Epicanthal folds are not related to amblyopia. In children with strabismus, the corneal light reflex will not be symmetric for each eye.

Question 163

A preterm infant has just been admitted to the neonatal intensive care unit. The infant’s parents ask the nurse about anesthesia and analgesia when painful procedures are necessary. What should the nurse’s explanation be? Nerve pathways of neonates are not sufficiently myelinated to transmit painful stimuli. The risks accompanying anesthesia and analgesia are too great to justify any possible benefit of pain relief. Neonates do not possess sufficiently integrated cortical function to interpret or recall pain experiences. Pain pathways and neurochemical systems associated with pain transmission are intact and functional in neonates.

Answer 163

Pain pathways and neurochemical systems associated with pain transmission are intact and functional in neonates. Pain pathways and neurochemical systems associated with pain transmission are intact and functional in neonates. Painful stimuli cause a global stress response, including cardiorespiratory changes, palmar sweating, increased intracranial pressure, and hormonal and metabolic changes. Adequate analgesia and anesthesia are necessary to decrease the stress response. The pathways are sufficiently myelinated to transmit the painful stimuli and produce the pain response. Local and systemic pharmacologic agents are available to permit anesthesia and analgesia for neonates.

Question 164

A 1-month-old infant is admitted to the hospital. The infant’s mother is 17 years old and single and lives with her parents. Who signs the informed consent for the 1-month-old infant? The infant’s mother The maternal grandparents of the infant The paternal grandparents of the infant Both the infant’s mother and the maternal grandparents

Answer 164

The infant’s mother An emancipated minor is one who is legally under the age of majority but is recognized as having the legal capacity of an adult under circumstances prescribed by state law, such as pregnancy, marriage, high school graduation, independent living, or military service.

Question 165

A 6-year-old child has patient-controlled analgesia (PCA) for pain management after orthopedic surgery. The parents are worried that their child will be in pain. What should your explanation to the parents include? The child will continue to sleep and be pain free. Parents cannot administer additional medication with the button. The pump can deliver baseline and bolus dosages. There is a high risk of overdose, so monitoring is done every 15 minutes.

Answer 165

The pump can deliver baseline and bolus dosages. The PCA prescription can be set for a basal rate for a continuous infusion of pain medication. Additional doses can be administered by the patient, parent, or nurse as necessary. Although the goal of PCA is to have effective pain relief, a pain-free state may not be possible. With a 6-year-old child, the parents and nurse must assess the child to ensure that adequate medication is being given because the child may not understand the concept of pushing a button. Evidence-based practice suggests that effective analgesia can be obtained with the parents and nurse giving boluses as necessary. The prescription for the PCA includes how much medication can be given in a defined period. Monitoring every 1 to 2 hours for patient response is sufficient.

Question 166

A 2-year-old child has to receive Rocephin IM injections every 12 hours. What nursing intervention should be implemented for the child? Hold the child while rocking in a chair after each injection. Prepare the child several hours before the injection is given. Allow the child to watch a younger child receive an injection. Encourage the child to draw a picture of the pain experienced when an injection is given.

Answer 166

Hold the child while rocking in a chair after each injection. After the procedure, the child continues to need reassurance that he or she performed well and is accepted and loved. The other options are not appropriate for a toddler.

Question 167

Children who are taking long-term inhaled steroids should be assessed frequently for what potential complication? Cough Osteoporosis Slowed growth Cushing syndrome

Answer 167

Slowed growth

Question 168

A child is in the intensive care unit after a motor vehicle collision. The child has numerous fractures and is in pain that is rated 9 or 10 on a 10-point scale. In planning care, the nurse recognizes that the indicated action is which? Give only an opioid analgesic at this time. Increase dosage of analgesic until the child is adequately sedated. Plan a preventive schedule of pain medication around the clock. Give the child a clock and explain when she or he can have pain medications.

Answer 168

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

Question 169

During a routine health assessment, the nurse notes that an 8-month-old infant has a significant head lag. Which is the most appropriate action? Recheck head control at next visit. Teach the parents appropriate exercises. Schedule the child for further evaluation. Refer the child for further evaluation if the anterior fontanel is still open.

Answer 169

Schedule the child for further evaluation. Significant head lag after age 6 months strongly indicates cerebral injury and is referred for further evaluation. Head control is part of normal development. Exercises will not be effective. The lack of achievement of this developmental milestone must be evaluated.

Question 170

The nurse is preparing a 9-year-old boy before obtaining a blood specimen by venipuncture. The child tells the nurse he does not want to lose his blood. What approach is best by the nurse? Explain that it will not be painful. Suggest to him that he not worry about losing just a little bit of blood. Discuss with him how his body is always in the process of making blood. Tell the child that he will not even need a Band-Aid afterward because it is a simple procedu

Answer 170

Discuss with him how his body is always in the process of making blood. School-age children can understand that blood can be replaced. Explain the procedure to him using correct scientific and medical terminology. The venipuncture will be uncomfortable. It is inappropriate to tell him it will not hurt. Even though the nurse considers it a simple procedure, the boy is concerned. Telling him not to worry will not allay his fears.

Question 171

Examination of the abdomen is performed correctly by the nurse in which order? Inspection, palpation, percussion, and auscultation Inspection, percussion, auscultation, and palpation Palpation, percussion, auscultation, and inspection Inspection, auscultation, percussion, and palpation

Answer 171

Inspection, auscultation, percussion, and palpation The correct order of abdominal examination is inspection, auscultation, percussion, and palpation. Palpation is always performed last because it may distort the normal abdominal sounds. Auscultation is performed before percussion. The act of percussion can influence the findings on auscultation.

Question 172

A child is in uncompensated metabolic alkalosis. What should the nurse expect the arterial blood gas to be? HCO3, 24; pH, 7.35 HCO3, 28; pH, 7.50 HCO3, 20; pH, –7.30 HCO3, 26; pH, 7.40

Answer 172

HCO3, 28; pH, 7.50 Metabolic alkalosis results in an elevated plasma pH (normal pH is 7.35–7.45) that occurs when there is an excess of bicarbonate (normal HCO3 is 22–26).

Question 173

A child with sickle cell anemia (SCA) develops severe chest and back pain, fever, a cough, and dyspnea. What should be the first action by the nurse? Administer 100% oxygen to relieve hypoxia. Notify the practitioner because chest syndrome is suspected. Infuse intravenous antibiotics as soon as cultures are obtained. Give ordered pain medication to relieve symptoms of pain episode.

Answer 173

Notify the practitioner because chest syndrome is suspected. These are the symptoms of chest syndrome, which is a medical emergency. Notifying the practitioner is the priority action. Oxygen may be indicated; however, it does not reverse the sickling that has occurred. Antibiotics are not indicated initially. Pain medications may be required, but evaluation by the practitioner is the priority.

Question 174

Children as young as age 3 years can use facial scales for discrimination. What are some suggested anchor words for the preschool age group? “No hurt.” “Red pain.” “Zero hurt.” “Least pain.”

Answer 174

“No hurt.” “No hurt” is a phrase that is simple, concrete, and appropriate to the preoperational stage of the child. Using color is complicated for this age group. The child needs to identify colors and pain levels and then choose an appropriate symbolic color. This is appropriate for an older child. Zero is an abstract construct not appropriate for this age group. “Least pain” is less concrete than “no hurt.”

Question 175

The nurse is preparing to admit a 2-year-old child with rubella (German measles). Which clinical manifestations of rubella should the nurse expect to observe? (Select all that apply.) ``` Sore throat Conjunctivitis Koplik spots Lymphadenopathy Discrete, pinkish red maculopapular exanthema ```

Answer 175

Sore throat Conjunctivitis Lymphadenopathy Discrete, pinkish red maculopapular exanthema

Question 176

What nursing consideration is important when suctioning a young child who has had heart surgery? Perform suctioning at least every hour. Suction for no longer than 30 seconds at a time. Expect symptoms of respiratory distress when suctioning. Administer supplemental oxygen before and after suctioning.

Answer 176

Administer supplemental oxygen before and after suctioning. When suctioning is indicated, supplemental oxygen is administered with a manual resuscitation bag before and after the procedure to prevent hypoxia. Suctioning should be done only as indicated and very carefully to avoid vagal stimulation. The child should be suctioned for no more than 5 seconds at a time. Symptoms of respiratory distress are avoided by using appropriate technique.

Question 177

Which serious reaction should the nurse be alert for when administering vaccines? Fever Skin irritation Allergic reaction Pain at injection site

Answer 177

Allergic reaction

Question 178

Where is the best place to observe for the presence of petechiae in dark-skinned individuals? Face Buttocks Oral mucosa Palms and soles

Answer 178

Oral mucosa Petechiae, small distinct pinpoint hemorrhages, are difficult to see in dark-skinned individuals unless they are in the mouth or conjunctiva.

Question 179

What is an important consideration when using the FACES pain rating scale with children? Children color the face with the color they choose to best describe their pain. The scale can be used with most children as young as 3 years. The scale is not appropriate for use with adolescents. The FACES scale is useful in pain assessment but is not as accurate as physiologic responses.

Answer 179

The scale can be used with most children as young as 3 years The FACES scale is validated for use with children ages 3 years and older. Children point to the face that best describes their level of pain. The scale can be used through adulthood. The child’s estimate of the pain should be used. The physiologic measures may not reflect more long-term pain.

Question 180

The nurse is caring for a child with hemophilia A. The child’s activity is as tolerated. What activity is contraindicated for this child? Ambulating to the cafeteria Active range of motion Ambulating to the playroom Passive range of motion exercises

Answer 180

Passive range of motion exercises Passive range of motion exercises should never be part of an exercise regimen after an acute episode because the joint capsule could easily be stretched and bleeding could recur. Active range of motion exercises are best so that the patient can gauge his or her own pain tolerance. The child can ambulate to the playroom or the cafeteria

Question 181

The nurse on a pediatric unit is writing guidelines for age-specific preparation of children for procedures based on developmental characteristics. What guideline is accurate? Inform toddlers about an upcoming procedure 2 hours before the procedure is to be performed. Inform school-age children about an upcoming procedure immediately before the procedure is scheduled to occur. Discourage parent presence during procedures on infants and toddlers. Use simple diagrams of anatomy and physiology to explain a procedure to a school-age child.

Answer 181

Use simple diagrams of anatomy and physiology to explain a procedure to a school-age child. To assist the school-age child in meeting Erickson’s developmental stage of industry, using simple diagrams of anatomy and physiology to explain a procedure is the accurate guideline. Toddlers should be told about a procedure right before the procedure. School-age children should know about the procedure in advance, not right before, and parents should be present for procedures for infants and toddlers.

Question 182

During an otoscopic examination on an infant, in which direction is the pinna pulled? Up and back Up and forward Down and back Down and forward

Answer 182

Down and back In infants and toddlers, the ear canal is curved upward. To visualize the ear canal, it is necessary to pull the pinna down and back to the 6 to 9 o’clock range to straighten the canal. In children older than age 3 years and adults, the canal curves downward and forward. The pinna is pulled up and back to the 10 o’clock position. Up and forward and down and forward are positions that do not facilitate visualization of the ear canal.

Question 183

A parent of a 7-year-old girl with a repaired ventricular septal defect (VSD) calls the cardiology clinic and reports that the child is just not herself. Her appetite is decreased, she has had intermittent fevers around 38° C (100.4° F), and now her muscles and joints ache. Based on this information, how should the nurse advise the mother? Immediately bring the child to the clinic for evaluation. Come to the clinic next week on a scheduled appointment. Treat the signs and symptoms with acetaminophen and fluids because it is most likely a viral illness. Recognize that the child is trying to manipulate the parent by complaining of vague symptoms.

Answer 183

Immediately bring the child to the clinic for evaluation. These are the insidious symptoms of bacterial endocarditis. Because the child is in a high-risk group for this disorder (VSD repair), immediate evaluation and treatment are indicated to prevent cardiac damage. With appropriate antibiotic therapy, bacterial endocarditis is successfully treated in approximately 80% of the cases. The child’s complaints should not be dismissed. The low-grade fever is not a symptom that the child can fabricate

Question 184

What action by the school nurse is important in the prevention of rheumatic fever (RF)? Encourage routine cholesterol screenings. Conduct routine blood pressure screenings. Refer children with sore throats for throat cultures. Recommend salicylates instead of acetaminophen for minor discomforts.

Answer 184

Refer children with sore throats for throat cultures. Nurses have a role in prevention, primarily in screening school-age children for sore throats caused by group A streptococci. They can actively participate in throat culture screening or refer children with possible streptococcal sore throats for testing. Routine cholesterol screenings and blood pressure screenings do not facilitate the recognition and treatment of group A hemolytic streptococci. Salicylates should be avoided routinely because of the risk of Reye syndrome after viral illnesses.

Question 185

The nurse is taking a health history of an adolescent. Which best describes how the chief complaint should be determined? Request a detailed listing of symptoms. Ask the adolescent, “Why did you come here today?” Interview the parent away from the adolescent to determine the chief complaint. Use what the adolescent says to determine, in correct medical terminology, what the problem is.

Answer 185

Ask the adolescent, “Why did you come here today?” The chief complaint is the specific reason for the child’s visit to the clinic, office, or hospital. Because the adolescent is the focus of the history, this is an appropriate way to determine the chief complaint. Requesting a detailed list of symptoms makes it difficult to determine the chief complaint. The parent and adolescent may be interviewed separately, but the nurse should determine the reason the adolescent is seeking attention at this time. The chief complaint is usually written in the words that the parent or adolescent uses to describe the reason for seeking help.

Question 186

What disease processes require airborne precautions? (Select all that apply.) ``` Measles Varicella Pertussis Meningitis Tuberculosis ```

Answer 186

Measles Varicella Tuberculosis In addition to Standard Precautions, use airborne precautions for patients known or suspected to have serious illnesses transmitted by airborne droplet nuclei. Examples of such illnesses include measles, varicella (including disseminated zoster), and tuberculosis. Pertussis and meningitis require droplet precautions.

Question 187

Superficial palpation of the abdomen is often perceived by the child as tickling. Which measure by the nurse is most likely to minimize this sensation and promote relaxation? Palpate another area simultaneously. Ask the child not to laugh or move if it tickles. Begin with deeper palpation and gradually progress to superficial palpation. Have the child “help” with palpation by placing his or her hand over the palpating hand.

Answer 187

Have the child “help” with palpation by placing his or her hand over the palpating hand. Having the child “help” with palpation by placing his or her hand over the palpating hand will help minimize the feeling of tickling and enlist the child’s cooperation. Palpating another area simultaneously will create the sensation of tickling in the other area also. Asking the child not to laugh or move will bring attention to the tickling and make it more difficult for the child. Superficial palpation is done before deep palpation.

Question 188

A child with heart failure is on Lanoxin (digoxin). The laboratory value a nurse must closely monitor is which? Serum sodium Serum potassium Serum glucose Serum chloride

Answer 188

Serum potassium A fall in the serum potassium level enhances the effects of digoxin, increasing the risk of digoxin toxicity. Increased serum potassium levels diminish digoxin’s effect. Therefore, serum potassium levels (normal range, 3.5–5.5 mmol/L) must be carefully monitored.

Question 189

What drug is an angiotensin-converting enzyme (ACE) inhibitor? Furosemide (Lasix) Captopril (Capoten) Chlorothiazide (Diuril) Spironolactone (Aldactone)

Answer 189

Captopril (Capoten) Captopril is an ACE inhibitor. Furosemide is a loop diuretic. Chlorothiazide works on the distal tubules. Spironolactone blocks the action of aldosterone and is a potassium-sparing diuretic.

Question 190

The nurse is aware that skin turgor best estimates what? Perfusion Adequate hydration Amount of body fat Amount of anemia

Answer 190

Adequate hydration Skin turgor is one of the best estimates of adequate hydration and nutrition. It does not indicate amount of body fat and is not a test for anemia.

Question 191

An 8-year-old girl asks the nurse how the blood pressure apparatus works. The most appropriate nursing action is which? Ask her why she wants to know. Determine why she is so anxious. Explain in simple terms how it works. Tell her she will see how it works as it is used.

Answer 191

Explain in simple terms how it works. School-age children require explanations and reasons for everything. They are interested in the functional aspect of all procedures, objects, and activities. It is appropriate for the nurse to explain how equipment works and what will happen to the child so that the child can then observe during the procedure. The nurse should respond positively for requests for information about procedures and health information. By not responding, the nurse may be limiting communication with the child. The child is not exhibiting anxiety in asking how the blood pressure apparatus works, just requesting clarification of what will occur.

Question 192

The nurse is caring for a child after cardiac surgery. What interventions should the nurse implement with regard to chest tubes placed to a water-seal drainage system? (Select all that apply.) Maintain sterility. Check for tube patency. Do not interrupt the water-seal drainage system. Clamp the chest tube when ambulating the child. Measure the drainage by emptying the collection chamber every shift.

Answer 192

Maintain sterility. Check for tube patency. Do not interrupt the water-seal drainage system. Nursing considerations with regard to chest tubes attached to a water-seal drainage system include (1) do not interrupt water-seal drainage unless the chest tube is clamped, (2) check for tube patency (fluctuation in the water-seal chamber), and (3) maintain sterility. The chest tube should not be clamped when ambulating the child and the drainage is measured in the collection chamber, not emptied.

Question 193

The nurse is caring for a child with Kawasaki disease in the acute phase. What clinical manifestations should the nurse expect to observe? (Select all that apply.) ``` Osler nodes Cervical lymphadenopathy Strawberry tongue Chorea Erythematous palms Polyarthritis ```

Answer 193

Cervical lymphadenopathy Strawberry tongue Erythematous palms Clinical manifestations of Kawasaki disease in the acute phase include cervical lymphadenopathy, a strawberry tongue, and erythematous palms. Osler nodes are a clinical manifestation of endocarditis. Chorea and polyarthritis are seen in rheumatic fever.

Question 194

A chest radiography examination is ordered for a child with suspected cardiac problems. The child’s parent asks the nurse, “What will the x-ray show about the heart?” The nurse’s response should be based on knowledge that the radiograph provides which information? Shows bones of the chest but not the heart Evaluates the vascular anatomy outside of the heart Shows a graphic measure of electrical activity of the heart Supplies information on heart size and pulmonary blood flow patterns

Answer 194

Supplies information on heart size and pulmonary blood flow patterns Chest radiographs provide information on the size of the heart and pulmonary blood flow patterns. The bones of the chest are visible on chest radiographs, but the heart and blood vessels are also seen. Magnetic resonance imaging is a noninvasive technique that allows for evaluation of vascular anatomy outside of the heart. A graphic measure of electrical activity of the heart is provided by electrocardiography.

Question 195

A 5-month-old infant is in respiratory distress. What should the nurse expect to find? Nasal flaring Bradycardia Abdominal breathing Capillary refill of 2 seconds

Answer 195

Nasal flaring

Question 196

The nurse is preparing to give acetaminophen (Tylenol) to a child who has a fever. What nursing action is appropriate? Retake the temperature in 15 minutes after giving the Tylenol. Place a warm blanket on the child so chilling does not occur. Check to be sure the Tylenol dose does not exceed 15 mg/kg. Use cold compresses instead of Tylenol to control the fever.

Answer 196

Check to be sure the Tylenol dose does not exceed 15 mg/kg. Nurses must have an understanding of the safe dosages of medications they administer to children, as well as the expected actions, possible side effects, and signs of toxicity. The recommended doses of acetaminophen should never be exceeded.

Question 197

An appropriate method for administering oral medications that are bitter to an infant or small child should be to mix them with which? Bottle of formula or milk Any food the child is going to eat One teaspoon of something sweet-tasting such as jam Carbonated beverage, which is then poured over crushed ice

Answer 197

One teaspoon of something sweet-tasting such as jam Mix the drug with a small amount (about 1 tsp) of sweet-tasting substance. This will make the medication more palatable to the child. The medication should be mixed with only a small amount of food or liquid. If the child does not finish drinking or eating, it is difficult to determine how much medication was consumed. Medication should not be mixed with essential foods and milk. The child may associate the altered taste with the food and refuse to eat this food in the future.

Question 198

What is the major cause of death for children older than 1 year in the United States? Heart disease Childhood cancer Unintentional injuries Congenital anomalies

Answer 198

Unintentional injuries Unintentional injuries (accidents) are the leading cause of death after age 1 year through adolescence. The leading cause of death for those younger than 1 year is congenital anomalies, and childhood cancers and heart disease cause a significantly lower percentage of deaths in children older than 1 year of age.

Question 199

Nursing care of the child with Kawasaki disease is challenging because of which occurrence? The child’s irritability Predictable disease course Complex antibiotic therapy The child’s ongoing requests for food

Answer 199

The child’s irritability Patient irritability is a hallmark of Kawasaki disease and is the most challenging problem. A quiet environment is necessary to promote rest. The diagnosis is often difficult to make, and the course of the disease can be unpredictable. Intravenous gamma globulin and salicylates are the therapy of choice, not antibiotics. The child often is reluctant to eat. Soft foods and fluids should be offered to prevent dehydration.

Question 200

A child with severe anemia requires a unit of red blood cells (RBCs). The nurse explains to the child that the transfusion is necessary for which reason? Allow her parents to come visit her. Fight the infection that she now has. Increase her energy so she will not be so tired. Help her body stop bleeding by forming a clot (scab).

Answer 200

Increase her energy so she will not be so tired. The indication for RBC transfusion is risk of cardiac decompensation. When the number of circulating RBCs is increased, tissue hypoxia decreases, cardiac function is improved, and the child will have more energy. Parental visiting is not dependent on transfusion. The decrease in tissue hypoxia will minimize the risk of infection. There is no evidence that the child is currently infected. Forming a clot is the function of platelets.

Question 201

Where in the health history does a record of immunizations belong? History Present illness Review of systems Physical assessment

Answer 201

History The history contains information relating to all previous aspects of the child’s health status. The immunizations are appropriately included in the history. The present illness, review of systems, and physical assessment are not appropriate places to record the immunization status.

Question 202

The nurse is preparing to admit a 1-year-old child with pertussis (whooping cough). Which clinical manifestations of pertussis should the nurse expect to observe? (Select all that apply.) ``` Earache Coryza Conjunctivitis Low-grade fever Dry hacking cough ```

Answer 202

Coryza Low-grade fever Dry hacking cough

Question 203

The parent of a child with cystic fibrosis (CF) calls the clinic nurse to report that the child has developed tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The nurse should tell the parent to bring the child to the clinic because these signs and symptoms are suggestive of what condition? Pneumothorax Bronchodilation Carbon dioxide retention Increased viscosity of sputum

Answer 203

Pneumothorax Usually the signs of pneumothorax are nonspecific. Tachypnea, tachycardia, dyspnea, pallor, and cyanosis are significant signs and symptoms and are indicative of respiratory distress caused by pneumothorax. If the bronchial tubes were dilated, the child would have decreased work of breathing and would most likely be asymptomatic. Carbon dioxide retention is a result of the chronic alveolar hypoventilation in CF. Hypoxia replaces carbon dioxide as the drive for respiration progresses. Increased viscosity would result in more difficulty clearing secretions.

Question 204

Which is considered a block to effective communication? Using silence Using clichés Directing the focus Defining the problem

Answer 204

Using clichés Using stereotyped comments or clichés can block effective communication. After the nurse uses such trite phrases, parents often do not respond. Silence can be an effective interviewing tool. Silence permits the interviewee to sort out thoughts and feelings and search for responses to questions. To be effective, the nurse must be able to direct the focus of the interview while allowing maximum freedom of expression. By using open-ended questions and guiding questions, the nurse can obtain the necessary information and maintain a relationship with the family. The nurse and parent must collaborate and define the problem that will be the focus of the nursing intervention.

Question 205

The nurse is assessing a child’s capillary refill time. This can be accomplished by doing what? Inspect the chest. Auscultate the heart. Palpate the apical pulse. Palpate the nail bed with pressure to produce a slight blanching.

Answer 205

Palpate the nail bed with pressure to produce a slight blanching. Capillary refill time is assessed by pressing lightly on the skin to produce blanching and then noting the amount of time it takes for the blanched area to refill. Inspecting the chest, auscultating the heart, and palpating the apical pulse will not provide an assessment of capillary refill time.

Question 206

The nurse has just started assessing a young child who is febrile and appears ill. There is hyperextension of the child’s head (opisthotonos) with pain on flexion. Which is the most appropriate action? Ask the parent when the neck was injured. Refer for immediate medical evaluation. Continue assessment to determine the cause of the neck pain. Record “head lag” on the assessment record and continue the assessment of the child.

Answer 206

Refer for immediate medical evaluation. Hyperextension of the child’s head with pain on flexion is indicative of meningeal irritation and needs immediate evaluation. No indication of injury is present. This situation is not descriptive of head lag.

Question 207

A 6-year-old child has had a tonsillectomy. The child is spitting up small amounts of dark brown blood in the immediate postoperative period. The nurse should take what action? Notify the health care provider. Continue to assess for bleeding. Give the child a red flavored ice pop. Position the child in a Trendelenburg position.

Answer 207

Continue to assess for bleeding. Some secretions, particularly dried blood from surgery, are common after a tonsillectomy. Inspect all secretions and vomitus for evidence of fresh bleeding (some blood-tinged mucus is expected). Dark brown (old) blood is usually present in the emesis, as well as in the nose and between the teeth. Small amounts of dark brown blood should be further monitored. A red-flavored ice pop should not be given and the Trendelenburg position is not recommended.

Question 208

The nurse is administering an IM injection into a vastus lateralis muscle of a 6-month-old infant. What should the length of the needle and amount to be given be? 5/8 to 1 inch; 0.5 to 1.0 ml 1 inch to 1 1/2 inch; 1.0 to 2.0 ml 1 inch to 1 1/2 inch; 0.5 to 1.0 ml 5/8 to 1 inch; 0.75 to 2 ml

Answer 208

5/8 to 1 inch; 0.5 to 1.0 ml The length of a needle for an infant should be 5/8 to 1 inch, and the amount of solution should not exceed 1 ml.

Question 209

The nurse is caring for a 1-month-old infant with respiratory syncytial virus (RSV) who is receiving 23% oxygen via a plastic hood. The child’s SaO2 saturation is 88%, respiratory rate is 45 breaths/min, and pulse is 140 beats/min. Based on these assessments, what action should the nurse take? Withhold feedings. Notify the health care provider. Put the infant in an infant seat. Keep the infant in the plastic hood.

Answer 209

Notify the health care provider. The American Academy of Pediatrics practice parameter (2006) recommends the use of supplemental oxygen if the infant fails to maintain a consistent oxygen saturation of at least 90%. The health care provider should be notified of the saturation reading of 88%. Withholding the feedings or placing the infant in an infant seat would not increase the saturation reading. The infant should be kept in the hood, but because the saturation reading is 88%, the health care provider should be notified to obtain orders to increase the oxygen concentration.

Question 210

Heart failure (HF) is a problem after the child has had a congenital heart defect repaired. The nurse knows a sign of HF is what? Wheezing Increased blood pressure Increased urine output Decreased heart rate

Answer 210

Wheezing A clinical manifestation of heart failure is wheezing from pulmonary congestion. The blood pressure decreases, urine output decreases, and heart rate increases.

Question 211

When caring for the child with Kawasaki disease, what should the nurse know to provide safe and effective care? Aspirin is contraindicated. The principal area of involvement is the joints. The child’s fever is usually responsive to antibiotics within 48 hours. Therapeutic management includes administration of gamma globulin and salicylates.

Answer 211

Therapeutic management includes administration of gamma globulin and salicylates. High-dose intravenous gamma globulin and salicylate therapy are indicated to reduce the incidence of coronary artery abnormalities when given within the first 10 days of the illness. Aspirin is part of the therapy. Mucous membranes, conjunctiva, changes in the extremities, and cardiac involvement are seen. The fever of Kawasaki disease is unresponsive to antibiotics. It is responsive to anti-inflammatory doses of aspirin and antipyretics.

Question 212

What nutritional component should be altered in the infant with heart failure (HF)? Decrease in fats Increase in fluids Decrease in protein Increase in calories

Answer 212

Increase in calories Infants with HF have a greater metabolic rate because of poor cardiac function and increased heart and respiratory rates. Their caloric needs are greater than those of average infants, yet their ability to take in calories is diminished by their fatigue. The diet should include increased protein and increased fat to facilitate the child’s intake of sufficient calories. Fluids must be carefully monitored because of the HF.

Question 213

An immunocompromised child has been exposed to chickenpox. What should the nurse anticipate to be prescribed to the exposed child? Acyclovir (Zovirax) Valacyclovir (Valtrex) Amantadine (Symmetrel) Varicella-zoster immune globulin

Answer 213

Varicella-zoster immune globulin

Question 214

A school-age child is admitted in vasoocclusive sickle cell crisis (pain episode). The child’s care should include which therapeutic interventions? Hydration and pain management Oxygenation and factor VIII replacement Electrolyte replacement and administration of heparin Correction of alkalosis and reduction of energy expenditure

Answer 214

Hydration and pain management

Question 215

A bone marrow biopsy will be performed on a 7-year-old girl. She wants her mother to hold her during the procedure. How should the nurse respond? Holding your child is unsafe. Holding may help your child relax. Hospital policy prohibits this interaction. Holding your child is unnecessary given the child’s age.

Answer 215

Holding may help your child relax. The mother’s preference for assisting, observing, or waiting outside the room should be assessed, as well as the child’s preference for parental presence. The child’s choice should be respected. This will most likely help the child through the procedure. If the mother and child agree, then the mother is welcome to stay. Her familiarity with the procedure should be assessed and potential safety risks identified (mother may sit in chair). Hospital policies should be reviewed to ensure that they incorporate family-centered care.

Question 216

In addition to injuries, what are the leading causes of death in adolescents ages 15 to 19 years? Suicide and cancer Suicide and homicide Drowning and cancer Homicide and heart disease

Answer 216

Suicide and homicide

Question 217

A child has been diagnosed with scabies. Which statement by the parent indicates understanding of the nurse’s teaching about scabies? “The itching will stop after the cream is applied.” “We will complete extensive aggressive housecleaning.” “We will apply the cream to only the affected areas as directed.” “Everyone who has been in close contact with my child will need to be treated.”

Answer 217

Everyone who has been in close contact with my child will need to be treated.” Because of the length of time between infestation and physical symptoms (30 to 60 days), all persons who were in close contact with the affected child need treatment. Families need to know that although the mite will be killed, the rash and the itch will not be eliminated until the stratum corneum is replaced, which takes approximately 2 to 3 weeks. Aggressive housecleaning is not necessary, but surface vacuuming of heavily used rooms by a person with crusted scabies is recommended. The prescribed cream should be thoroughly and gently massaged into all skin surfaces (not just the areas that have a rash) from the head to the soles of the feet.

Question 218

A child is in uncompensated respiratory acidosis. What should the nurse expect the arterial blood gas to be? O2, 95; CO2, 45; pH, 7.40 O2, 88; CO2, 55; pH, 7.30 O2, 88; CO2, 35; pH, 7.28 O2, 92; CO2, 54; pH, 7.35

Answer 218

O2, 88; CO2, 55; pH, 7.30 Respiratory acidosis results from diminished or inadequate pulmonary ventilation that causes an elevation in plasma Pco2 and thus an increased concentration of dissolved carbonic acid, which leads to elevated carbonic acid and hydrogen ion concentration. This tends to lower the pH. CO2 of 55 is elevated (normal CO2 is 35–45), and a pH of 7.30 is low (normal pH is 7.35–7.45).

Question 219

When giving instructions to a parent whose child has scabies, what should the nurse include? Treat all family members if symptoms develop. Be prepared for symptoms to last 2 to 3 weeks. Carefully treat only areas where there is a rash. Notify practitioner so an antibiotic can be prescribed.

Answer 219

Be prepared for symptoms to last 2 to 3 weeks. The mite responsible for the scabies will most likely be killed with the administration of medications. It will take 2 to 3 weeks for the stratum corneum to heal. That is when the symptoms will abate. Initiation of therapy does not wait for clinical symptom development. All individuals in close contact with the affected child need to be treated. Permethrin, a scabicide, is the preferred treatment and is applied to all skin surfaces.

Question 220

A 3-year-old child woke up in the middle of the night with a croupy cough and inspiratory stridor. The parents bring the child to the emergency department, but by the time they arrive, the cough is gone, and the stridor has resolved. What can the nurse teach the parents with regard to this type of croup? A bath in tepid water can help resolve this type of croup. Tylenol can help to relieve the cough and stridor. A cool mist vaporizer at the bedside can help prevent this type of croup. Antibiotics need to be given to reduce the inflammation.

Answer 220

A cool mist vaporizer at the bedside can help prevent this type of croup. Acute spasmodic laryngitis (spasmodic croup, “midnight croup,” or “twilight croup”) is distinct from laryngitis and LTB and characterized by paroxysmal attacks of laryngeal obstruction that occur chiefly at night. The child goes to bed well or with some mild respiratory symptoms but awakens suddenly with characteristic barking; a metallic cough; hoarseness; noisy inspirations; and restlessness. However, there is no fever, and the episode subsides in a few hours. Children with spasmodic croup are managed at home. Cool mist is recommended for the child’s room. A tepid water bath will not help, but steam provided by hot water may relieve the laryngeal spasm. The child will not need Tylenol, and antibiotics are not given for this type of croup.

Question 221

The nurse is aware that which age group is at risk for childhood injury because of the cognitive characteristic of magical and egocentric thinking? Preschool Young school age Middle school age Adolescent

Answer 221

Preschool

Question 222

The nurse gives an injection in a patient’s room. How should the nurse dispose of the needle? Remove the needle from the syringe and dispose of it in a proper container. Dispose of the syringe and needle in a rigid, puncture-resistant container in the patient’s room. Close the safety cover on the needle and return it to the medication preparation area for proper disposal. Place the syringe and needle in a rigid, puncture-resistant container in an area outside of the patient’s room

Answer 222

Dispose of the syringe and needle in a rigid, puncture-resistant container in the patient’s room. All needles (uncapped and unbroken) are disposed of in a rigid, puncture-resistant, tamper-proof container located near the site of use. Consequently, these containers should be installed in the patient’s room. Needles and syringes are disposed of uncapped and unbroken. A used needle should not be transported to an area distant from use for disposal.

Question 223

What tests aid in the diagnosis of cystic fibrosis (CF)? Sweat test, stool for fat, chest radiography Sweat test, bronchoscopy, duodenal fluid analysis Sweat test, stool for trypsin, biopsy of intestinal mucosa Stool for fat, gastric contents for hydrochloride, radiography

Answer 223

Sweat test, stool for fat, chest radiography

Question 224

The nurse is teaching a staff development program about levels of sedation in the pediatric population. Which statement by one of the participants should indicate a correct understanding of the teaching? “With minimal sedation, the patient’s respiratory efforts are affected, and cognitive function is not impaired.” “With general anesthesia, the patient’s airway cannot be maintained, but cardiovascular function is maintained.” “During deep sedation, the patient can be easily aroused by loud verbal commands and tactile stimulation.” “During moderate sedation, the patient responds to verbal commands but may not respond to light tactile stimulation.”

Answer 224

“During moderate sedation, the patient responds to verbal commands but may not respond to light tactile stimulation.” When discussing levels of sedation, the participants should understand that during moderate sedation, the patient responds to verbal commands but may not respond to light tactile stimulation, cognitive function is impaired, and respiratory function is adequate. In minimal sedation, the patient responds to verbal commands and may have impaired cognitive function; the respiratory and cardiovascular systems are unaffected. In deep sedation, the patient cannot be easily aroused except by painful stimuli; the airway and spontaneous ventilation may be impaired, but cardiovascular function is maintained. With general anesthesia, the patient loses consciousness and cannot be aroused with painful stimuli, the airway cannot be maintained, and ventilation is impaired; cardiovascular function may or may not be impaired.

Question 225

In providing nourishment for a child with cystic fibrosis (CF), what factors should the nurse keep in mind? Fats and proteins must be greatly curtailed. Most fruits and vegetables are not well tolerated. Diet should be high in calories, proteins, and unrestricted fats. Diet should be low fat but high in calories and proteins.

Answer 225

Diet should be high in calories, proteins, and unrestricted fats Children with CF require a well-balanced, high-protein, high-caloric diet, with unrestricted fat (because of the impaired intestinal absorption).

Question 226

The clinic nurse is evaluating causes for iron deficiency caused by inadequate supply of iron. What should the nurse recognize as causes for iron deficiency caused by an inadequate iron supply? (Select all that apply.) ``` Prematurity Slow growth rate Excessive milk intake Severe iron deficiency in the mother Exclusive breastfeeding of infant from birth to 3 months ```

Answer 226

Slow growth rate | Exclusive breastfeeding of infant from birth to 3 months

Question 227

An infant has been diagnosed with staphylococcal pneumonia. Nursing care of the child with pneumonia includes which intervention? Administration of antibiotics Frequent complete assessment of the infant Round-the-clock administration of antitussive agents Strict monitoring of intake and output to avoid congestive heart failure

Answer 227

Administration of antibiotics Antibiotics are indicated for bacterial pneumonia. Often the child has decreased pulmonary reserve, and clustering of care is essential. The child’s respiratory rate and status and general disposition are monitored closely, but frequent complete physical assessments are not indicated. Antitussive agents are used sparingly. It is desirable for the child to cough up some of the secretions. Fluids are essential to kept secretions as liquefied as possible.

Question 228

What information should the nurse include when teaching the mother of a 9-month-old infant about administering liquid iron preparations? Give with meals. Stop immediately if nausea and vomiting occur. Adequate dosage will turn the stools a tarry green color. Allow preparation to mix with saliva and bathe the teeth before swallowing.

Answer 228

Adequate dosage will turn the stools a tarry green color. The nurse should prepare the mother for the anticipated change in the child’s stools. If the iron dose is adequate, the stools will become a tarry green color. A lack of color change may indicate insufficient iron. The iron should be given in two divided doses between meals when the presence of free hydrochloric acid is greatest. Iron is absorbed best in an acidic environment. Vomiting and diarrhea may occur with iron administration. If these occur, the iron should be given with meals, and the dosage reduced and gradually increased as the child develops tolerance. Liquid preparations of iron stain the teeth; they should be administered through a straw and the mouth rinsed after administration.

Question 229

A child is in the hospital for cystic fibrosis. What health care provider’s prescription should the nurse clarify before implementing? Dornase alfa (Pulmozyme) nebulizer treatment bid Pancreatic enzymes every 6 hours Vitamin A, D, E, and K supplements daily Proventil (albuterol) nebulizer treatments tid

Answer 229

Pancreatic enzymes every 6 hours The principal treatment for pancreatic insufficiency that occurs in cystic fibrosis is replacement of pancreatic enzymes, which are administered with meals and snacks to ensure that digestive enzymes are mixed with food in the duodenum. The enzymes should not be given every 6 hours, so this should be clarified before implementing this prescription. Dornase alfa (Pulmozyme) is given by nebulizer to decrease the viscosity of secretions, vitamin supplements are given daily, and Proventil nebulizer treatments are given to open the bronchi for easier expectoration.

Question 230

A child is recovering from Kawasaki disease (KD). The child should be monitored for which? Anemia Electrocardiograph (ECG) changes Elevated white blood cell count Decreased platelets

Answer 230

Electrocardiograph (ECG) changes The most serious complication of KD is the development of coronary artery aneurysms and the potential for myocardial infarction in children with aneurysm formation. The nurse should monitor any ECG changes.

Question 231

The nurse notices that a child is increasingly apprehensive and has tachycardia after heart surgery. The chest tube drainage is now 8 ml/kg/hr. What should be the nurse’s initial intervention? Apply warming blankets. Notify the practitioner of these findings. Give additional pain medication per protocol. Encourage child to cough, turn, and deep breathe.

Answer 231

Notify the practitioner of these findings. The practitioner is notified immediately. Increases of chest tube drainage to more than 3 ml/kg/hr for more than 3 consecutive hours or 5 to 10 ml/kg in any 1 hour may indicate postoperative hemorrhage. Increased chest tube drainage with apprehensiveness and tachycardia may indicate cardiac tamponade—blood or fluid in the pericardial space constricting the heart—which is a life-threatening complication. Warming blankets are not indicated at this time. Additional pain medication can be given before the practitioner drains the fluid, but the notification is the first action. Encouraging the child to cough, turn, and deep breathe should be deferred until after evaluation by the practitioner.

Question 232

What is the earliest age at which a satisfactory radial pulse can be taken in children? 1 year 2 years 3 years 6 years

Answer 232

2 years Satisfactory radial pulses can be taken in children older than 2 years. In infants and young children, the apical pulse is more reliable.

Question 233

The parents of a child with sickle cell anemia (SCA) are concerned about subsequent children having the disease. What statement most accurately reflects inheritance of SCA? SCA is not inherited. All siblings will have SCA. Each sibling has a 25% chance of having SCA. There is a 50% chance of siblings having SCA.

Answer 233

Each sibling has a 25% chance of having SCA. SCA is inherited as an autosomal recessive disorder. In this inheritance pattern, each child born to these parents has a 25% chance of having the disorder, a 25% chance of having neither SCA nor the trait, and a 50% chance of being heterozygous for SCA (sickle cell trait). SCA is an inherited hemoglobinopathy.

Question 234

Which type of breath sound is normally heard over the entire surface of the lungs except for the upper intrascapular area and the area beneath the manubrium? Vesicular Bronchial Adventitious Bronchovesicular

Answer 234

Vesicular This is the definition of vesicular breath sounds. They are heard over the entire surface of the lungs, with the exception of the upper intrascapular area and the area beneath the manubrium. Bronchial breath sounds are heard only over the trachea near the suprasternal notch. Adventitious breath sounds are not usually heard over the chest. These sounds occur in addition to normal or abnormal breath sounds. Bronchovesicular breath sounds are heard over the manubrium and in the upper intrascapular regions, where the trachea and bronchi bifurcate.

Question 235

The nurse is caring for a 12-year-old child who is on fall precautions secondary to seizures. What interventions should be included in the child’s care plan? (Select all that apply.) Place a call light and desired items within reach. Keep the bed in the highest position with the two side rails up. Turn off the lights and television at night. Keep personal belongings and clutter contained in one area of the floor. Have the child wear an appropriate-size gown and nonskid footwear.

Answer 235

Place a call light and desired items within reach. Have the child wear an appropriate-size gown and nonskid footwear. Prevention of falls requires alterations in the environment, including keeping call light and desired items within reach and having the child wear appropriate-size gowns and nonskid footwear. The bed should be in the lowest position possible with all the side rails up; at least a dim light should be left on at night; and personal belongings and clutter should not be on the floor—they should be in a cabinet.

Question 236

A preschool child has asthma, and a goal is to extend expiratory time and increase expiratory effectiveness. What action should the nurse implement to meet this goal? Encourage increased fluid intake. Recommend increased use of a budesonide (Pulmicort) inhaler. Administer an antitussive to suppress coughing. Encourage the child to blow a pinwheel every 6 hours while awake.

Answer 236

Encourage the child to blow a pinwheel every 6 hours while awake. Play techniques that can be used for younger children to extend their expiratory time and increase expiratory pressure include blowing cotton balls or a ping-pong ball on a table, blowing a pinwheel, blowing bubbles, or preventing a tissue from falling by blowing it against the wall. Increased fluids, increased use of a Pulmicort inhaler, or suppressing a cough will not increase expiratory effectiveness.

Question 237

What is the appropriate placement of a tongue blade for assessment of the mouth and throat? On the lower jaw Side of the tongue Against the soft palate Center back area of the tongue

Answer 237

Side of the tongue The side of the tongue is the correct position. It avoids the gag reflex yet allows visualization. On the lower jaw and against the soft palate are not appropriate places for the tongue blade. Placement in the center back area of the tongue elicits the gag reflex.

Question 238

A 2-year-old child is being admitted to the hospital for possible bacterial meningitis. When preparing for a lumbar puncture, what should the nurse do? Set up a tray with equipment the same size as for adults. Apply EMLA to the puncture site 15 minutes before the procedure. Prepare the child for conscious sedation being used for the procedure. Reassure the parents that the test is simple, painless, and risk free.

Answer 238

Prepare the child for conscious sedation being used for the procedure. Because of the urgency of the child’s condition, conscious sedation should be used for the procedure. Pediatric spinal trays have smaller needles than do adult trays. EMLA should be applied approximately 60 minutes before the procedure; the emergency nature of the spinal tap precludes its use. A spinal tap is not a simple procedure and does have associated risks; analgesia will be given for the pain.

Question 239

Which is a complication that can occur after abdominal surgery if pain is not managed? Atelectasis Hypoglycemia Decrease in heart rate Increase in cardiac output

Answer 239

Atelectasis Pain associated with surgery in the abdominal region (e.g., appendectomy, cholecystectomy, splenectomy) may result in pulmonary complications. Pain leads to decreased muscle movement in the thorax and abdominal area and leads to decreased tidal volume, vital capacity, functional residual capacity, and alveolar ventilation. The patient is unable to cough and clear secretions, and the risk for complications such as pneumonia and atelectasis is high. Severe postoperative pain also results in sympathetic overactivity, which leads to increases in heart rate, peripheral resistance, blood pressure, and cardiac output. Hypoglycemia, decreases in heart rate, and increases in cardiac output are not complications of poor pain management.

Question 240

During a funduscopic examination of a school-age child, the nurse notes a brilliant, uniform red reflex in both eyes. The nurse should recognize that this is which? A normal finding A sign of a possible visual defect and a need for vision screening An abnormal finding requiring referral to an ophthalmologist A sign of small hemorrhages, which usually resolve spontaneously

Answer 240

A normal finding A brilliant, uniform red reflex is an important normal finding. It rules out many serious defects of the cornea, aqueous chamber, lens, and vitreous chamber.

Question 241

preschool child needs a dressing change. To prepare the child, what strategy should the nurse implement? Explain the procedure using medical terminology. Plan a 30-minute teaching session. Give choices when possible but avoid delay. Allow time after the procedure for questions and discussion.

Answer 241

Give choices when possible but avoid delay. Involving children helps to gain their cooperation. Permitting choices gives them some measure of control. The other options would not be appropriate for a preschool child.

Question 242

The mother of a 20-month-old boy tells the nurse that he has a barking cough at night. His temperature is 37° C (98.6° F). The nurse suspects mild croup and should recommend which intervention? Admit to the hospital and observe for impending epiglottitis. Provide fluids that the child likes and use comfort measures. Control fever with acetaminophen and call if cough gets worse tonight. Try over-the-counter cough medicine and come to the clinic tomorrow if no improvement.

Answer 242

Provide fluids that the child likes and use comfort measures. In mild croup, therapeutic interventions include adequate hydration (as long as the child can easily drink) and comfort measures to minimize distress. The child is not exhibiting signs of epiglottitis. A temperature of 37° C is within normal limits. Although a return to the clinic may be indicated, the mother is instructed to return if the child develops noisy respirations or drooling.

Question 243

An infant with bronchiolitis is hospitalized. The causative organism is respiratory syncytial virus (RSV). The nurse knows that a child infected with this virus requires what type of isolation? Reverse isolation Airborne isolation Contact Precautions Standard Precautions

Answer 243

Contact Precautions

Question 244

What are the advantages of an implanted port (Port-a-Cath)? (Select all that apply.) Reduced risk of infection Reduced cost for the family Placed completely under the skin Easy to use for self-administered infusions Removal does not require a surgical procedure

Answer 244

Reduced risk of infection Reduced cost for the family Placed completely under the skin The advantages of an implanted port include reduced risk of infection, reduced cost for the family, and placed completely under the skin. Because it is implanted and must be accessed, it is not easy to use for self-administered infusions, and removal does require a surgical procedure.

Question 245

What drug is usually given first in the emergency treatment of an acute, severe asthma episode in a young child? Ephedrine Theophylline Aminophylline Short-acting beta2-agonists

Answer 245

Short-acting beta2-agonists

Question 246

What statement is the most descriptive of asthma? It is inherited. There is heightened airway reactivity. There is decreased resistance in the airway. The single cause of asthma is an allergic hypersensitivity.

Answer 246

There is heightened airway reactivity. In asthma, spasm of the smooth muscle of the bronchi and bronchioles causes constriction, producing impaired respiratory function. Atopy, or development of an immunoglobulin E (IgE)–mediated response, is inherited but is not the only cause of asthma. Asthma is characterized by increased resistance in the airway. Asthma has multiple causes, including allergens, irritants, exercise, cold air, infections, medications, medical conditions, and endocrine factors.

Question 247

The nurse is teaching the parents of a child with recurrent headaches methods to modify behavior patterns that increase the risk of headache. Which statement by the parents indicates understanding the teaching? “We will allow the child to miss school if a headache occurs.” “We will respond matter-of-factly to requests for special attention.” “We will be sure to give much attention to our child when a headache occurs.” “We will be sure our child doesn’t have to perform at a band concert if a headache occurs.”

Answer 247

“We will respond matter-of-factly to requests for special attention.” To modify behavior patterns that increase the risk of headache or reinforce headache activity, the nurse instructs the parents to avoid giving excessive attention to their child’s headache and to respond matter-of-factly to pain behavior and requests for special attention. Parents learn to assess whether the child is avoiding school or social performance demands because of headache.

Question 248

Which is described as an elevated, circumscribed skin lesion that is less than 1 cm in diameter and filled with serous fluid? Cyst Papule Pustule Vesicle

Answer 248

Vesicle

Question 249

The nurse is caring for a school-age child with severe anemia and activity intolerance. What diversional activity should the nurse plan for this child? Playing a musical instrument Playing board or card games Participating in a game of table tennis Participating in decorating the hospital room

Answer 249

Playing board or card games Plan diversional activities that promote rest but prevent boredom and withdrawal. Because short attention span, irritability, and restlessness are common in anemia and increase stress demands on the body, plan appropriate activities such as playing board or card games. Playing a musical instrument, participating in a game of table tennis, or decorating the hospital room would cause undue exertion.