NURS 102 - Pediatrics

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Myelination of the spinal cord is almost complete by 2 years of age. As a result of this, which can gradually be achieved?

A. Throwing a ball without falling
B. Slowing of gastrointestinal transit time
C. Visual acuity of 20/20
D. Control of anal and urethral sphincters

D. Control of anal and urethral sphincters

A 2-year-old child has recently started having temper tantrums where she holds her breath and sometimes faints. The nurse should:

A. refer child for respiratory evaluation.
B. refer child for psychological evaluation.
C. explain to parent that this is not harmful.
D. explain to parent that child is spoiled.

C. explain to parent that this is not harmful.

Which statement characterizes toddlers' eating behavior?

A. They have increased appetite.
B. They have few food preferences.
C. Their table manners are predictable.
D. They become fussy eaters.

D. They become fussy eaters.

The nurse is giving anticipatory guidance to the parent of a 5-year-old. Which is the most appropriate to include?

A. Prepare parent for increased aggression.
B. Encourage parent to offer child choices.
C. Inform parent to expect a more tranquil period at this age.
D. Advise parents that this is the age when stuttering may develop.

C. Inform parent to expect a more tranquil period at this age.

A 4 1/2-year-old boy has been having increasingly frequent angry outbursts in preschool. He is very aggressive toward the other children and the teachers. This behavior has been a problem for approximately 8 to 10 weeks. His parent asks the nurse for advice. Which is the most appropriate intervention?

A. Explain that this is normal in preschoolers, especially boys.
B. Refer the child for professional help.
C. Talk to the preschool teacher to obtain validation for behavior parent reports.
D. Encourage the parent to try more consistent and firm discipline.

B. Refer the child for professional help.

By what age would the nurse expect that most children use sentences of 6 to 8 words?

A. 18 months
B. 24 months
C. 3 years
D. 5 years

D. 5 years

Which characteristic best describes the fine motor skills of a 5-month-old infant?

A. Strong grasp reflex
B. Neat pincer grasp
C. Able to build a tower of two cubes
D. Able to grasp object voluntarily

D. Able to grasp object voluntarily

At what age would the nurse expect an infant to be able to say "mama" and "dada" with meaning?

A. 4 months
B. 6 months
C. 10 months
D. 14 months

C. 10 months

A 4-month-old infant is brought to the clinic by his parents for a well-baby checkup. Which of the following should the nurse include at this time about injury prevention?

A. "Never shake baby powder directly on him because it can be aspirated into his lungs."
B. "Keep doors of appliances closed at all times."
C. "When he learns to roll over, you must supervise him whenever he is on a surface from which he might fall."
D. "Lock the crib sides securely because he may stand and lean against them and fall out of bed."

C. "When he learns to roll over, you must supervise him whenever he is on a surface from which he might fall."

According to Erikson, infancy is concerned with acquiring a sense of which of the following?

A. Trust
B. Industry
C. Initiative
D. Separation

A. Trust

Which infant is at risk for developing vitamin D-deficient rickets?

A. An infant who has a lacto-ovovegetarian mother
B. An infant who is breastfed exclusively
C. An infant who takes yogurt as primary source of milk
D. An infant who is exposed to daily sunlight

C. An infant who takes yogurt as primary source of milk

Macrominerals refer to those with daily requirements greater than 100 mg. Which is a macromineral?

A. Iron
B. Calcium
C. Fluoride
D. Vitamin D

B. Calcium

Which food combinations will generally provide the appropriate amounts of essential amino acids for someone who is vegetarian?

A. Grains and legumes
B. Grains and vegetables
C. Legumes and vegetables
D. Milk products and fruit

A. Grains and legumes

According to Erikson, the primary psychosocial task of the preschool period is developing a sense of:

A. identity.
B. intimacy.
C. initiative.
D. industry.

C. initiative.

Which is characteristic of the psychosocial development of school-age children?

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

D. Feelings of inferiority or lack of worth can be derived from children themselves or from the environment.

According to Piaget, at what stage of development do children typically solve problems through trial and error?

A. Sensorimotor
B. Preoperational
C. Formal operational
D. Concrete operational

A. Sensorimotor

A 6-year-old is admitted after being beaten at school by an 11-year-old student. The child's mother and father are constantly by her side. The nurse correctly assesses the child and her family as needing additional resources and classifies them as a:

A. healthy family.
B. high-risk family.
C. communal family.
D. blended family.

B. high-risk family.

*A high-risk family is one experiencing not only violence but also marital conflict, adolescent parents, substance abuse, or illness.

The nurse is about to admit a Hispanic woman to the labor unit for induction of labor. Before starting her assessment, the nurse is aware that it is culturally important to:

A. not touch the woman.
B. have a male family member present.
C. have a female family member present.
D. make "small talk" first.

D. make "small talk" first.

The nurse is assigned to care for a 9-year-old who has a broken leg. The nurse notices that the boy's parents expect complete obedience from him. This parenting style is:

A. authoritarian.
B. authoritative.
C. permissive.
D. mixed.

A. authoritarian.

Studies of families with only one child indicate that only children:

A. tend to be selfish.
B. are similar to firstborn children.
C. are less stimulated toward achievement.
D. grow up lonely and dependent on adults.

B. are similar to firstborn children.

What assessment tool would help the nurse assess a family member's satisfaction with the functional state of the family?

A. Genogram
B. Sociogram
C. Family ECOMAP
D. Family Apgar

D. Family Apgar

*This is a brief screening tool that is designed to assess satisfaction with family functioning.

To administer an IM injection safely to a 6-year-old, the nurse must be aware of the child's developmental stage. This knowledge will assist the nurse in gaining the child's cooperation before the treatment. During this process, the nurse is functioning in the role of:

A. care provider.
B. teacher.
C. advocate.
D. manager.

A. care provider.

In the 19th century, the most common cause of infant death was:

A. tuberculosis.
B. cancer.
C. measles.
D. infectious diarrhea.

D. infectious diarrhea.

Evidence-based practice, a current health care trend, is best described as:

A. gathering evidence of mortality and morbidity in children.
B. meeting physical and psychosocial needs of the child and family in all areas of practice.
C. using a professional code of ethics as a means for professional self-regulation.
D. questioning why something is effective and if there is a better approach.

D. questioning why something is effective and if there is a better approach.

When the nurse uses a standard nursing care plan as a guide in planning care for a hospitalized child, what should be eliminated?

A. Expected outcome/goal
B. Dependent nursing functions
C. Problems not pertinent to child/family
D. Potential health problems of child/family

C. Problems not pertinent to child/family

The parents of 9-year-old twin children tell the nurse, "They have filled up their bedroom with collections of rocks, shells, stamps, and cars." The nurse should recognize that this is:

A. indicative of giftedness.
B. indicative of typical "twin" behavior.
C. characteristic of cognitive development at this age.
D. characteristic of psychosocial development at this age.

C. characteristic of cognitive development at this age.

A parent telephones the nurse and says that her child just knocked out a permanent tooth. The nurse's instructions to the parent should include what information?

A. Rinse tooth in hot water.
B. Hold tooth by crown and not by root area.
C. Take child and tooth to a dentist within 48 hours.
D. Take child to hospital emergency department if mouth is bleeding.

B. Hold tooth by crown and not by root area.

* Reimplantation should occur within 30 minutes by child, parent, or nurse and stabilized by a dentist as soon as possible.

Which behavior is most characteristic of the concrete operations stage of cognitive development?

A. Progression from reflex activity to imitative behavior
B. Inability to put oneself in another's place
C. Increasingly logical and coherent thought processes
D. Ability to think in abstract terms and draw logical conclusions

C. Increasingly logical and coherent thought processes

* This is characteristic of concrete operations. Children in this stage are able to classify objects.

Parents of a 10-year-old child are concerned that their child has been recently showing signs of low self-esteem. Which idea should the nurse consider when discussing this issue with the parents?

A. Changing self-esteem is difficult after about age 5.
B. Self-esteem is the objective judgment of one's worthiness.
C. Transitory periods of lowered self-esteem are expected developmentally.
D. High self-esteem develops when parents show adequate love for the child.

C. Transitory periods of lowered self-esteem are expected developmentally.

Which consideration is important in relation to childhood stress?

A. Children should be protected from stress.
B. Children do not have coping strategies.
C. Parents cannot prepare children for stress.
D. Some children are more vulnerable to stress than others.

D. Some children are more vulnerable to stress than others.

* Children's age, temperament, life situation, and state of health affect their vulnerability, reactions, and ability to handle stress.

How does the onset of the pubertal growth spurt compare in girls and boys?

A. In girls, it occurs about 1 year before it appears in boys.
B. In girls, it occurs about 3 years before it appears in boys.
C. In boys, it occurs about 1 year before it appears in girls.
D. It is about the same in both boys and girls.

A. In girls, it occurs about 1 year before it appears in boys.

In boys, the initial indication of puberty is:

A. testicular enlargement
B. voice changes
C. growth of dark pubic hair
D. increased size of penis

A. testicular enlargement

The nurse observes that a 13-year-old boy has gynecomastia (breast enlargement). The nurse should explain to him that this is:

A. a sign of too much body fat.
B. a sign of hormonal imbalance.
C. a normal occurrence during puberty.
D. an indication of precocious puberty.

C. a normal occurrence during puberty.

* If the gynecomastia persists beyond the 2 years, then a hormonal cause may need to be investigated.

Which statement is most descriptive of the spiritual development of the older adolescent?

A. Beliefs become more abstract.
B. Rituals and practices become increasingly important.
C. Strict observance of religious customs is common.
D. Emphasis is placed on external manifestations, such as whether a person attends church.

A. Beliefs become more abstract.

In planning sex education and contraceptive teaching for adolescents, what should the nurse consider?

A. Most teenagers today are knowledgeable about reproductive anatomy and physiology.
B. Both sexual activity and contraception require planning.
C. Most teenagers who become pregnant do so as an act of hostility, especially toward the parents.
D. Teenagers need contraception education in both oral and written form.

D. Teenagers need contraception education in both oral and written form.

The nurse needs to give an injection in the arm to a young child. What is the best approach to use?

A. Smile while giving the injection to help child relax.
B. Smile while giving the injection so child knows you like him or her.
C. Explain that child will experience "a little stick in the arm."
D. Explain with a concrete term such as "putting medicine under the skin."

D. Explain with a concrete term such as "putting medicine under the skin."

The nurse is interviewing the mother of a 9-year-old. Which question would be the most appropriate as the nurse begins to assess his school performance?

A. "Did he go to preschool?"
B. "Does he have problems at school?"
C. "How is he doing in school?"
D. "How well does he seem to be doing in school?"

C. "How is he doing in school?"

* This is an open-ended question without any descriptive terms that may limit the mother's responses.

The nurse is assessing a 3-year-old black child who is being seen in the clinic for the first time. The child's height and weight are at the 20th percentile on the commonly used growth chart from the National Center for Health Statistics. When interpreting these data, the nurse should recognize that the:

A. child's growth is within normal limits.
B. child's growth is not within normal limits.
C. chart is not accurate for black children.
D. chart is not useful until several measurements are plotted over time.

A. child's growth is within normal limits.

* The chart is useful both for screening and for assessment over time.

Which method should the nurse use to view the tonsils and oropharynx of a cooperative 6-year-old child?

A. Ask child to open mouth wide and say "Ahh."
B. Ask child to open mouth wide and place tongue blade in the center back area of the tongue.
C. Examine mouth when child is crying to avoid use of tongue blade.
D. Pinch nostrils closed until child opens mouth, then insert tongue blade.

A. Ask child to open mouth wide and say "Ahh."

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. What is the best nursing action?

A. Use the small cuff.
B. Use the large cuff.
C. Use either cuff, using palpation method.
D. Wait to take blood pressure until proper cuff can be located.

B. Use the large cuff.

* Although the larger cuff may give a falsely lowered blood pressure, it is preferable to the smaller cuff, which gives a falsely increased blood pressure. The size cuff used should be documented.

During an otoscopic examination of an infant, in which direction is the pinna pulled?

A. Down and back
B. Down and forward
C. Up and forward
D. Up and back

A. Down and back

Because of the preschooler's egocentric thought, the best approach for effective communication is through:

A. speech.

C. drawing.
D. actions.

B. play.

*Play is the child's way to understand and adjust to situations.

Which behavior would most likely be manifested in a young child experiencing the protest phase of separation anxiety?

A. Inactivity
B. Clinging to parent
C. Depression, sadness
D. Regression to earlier behavior

B. Clinging to parent

* In the protest phase, the child aggressively responds to separation from parents.

The psychosexual conflicts of preschool children make them extremely vulnerable to which threats?

A. Separation anxiety
B. Loss of control
C. Bodily injury and pain
D. Loss of identity

C. Bodily injury and pain

* Intrusive procedures, whether or not they are perceived as painful, are threatening to the preschooler because of the poorly developed concept of body integrity.

A mother tells the nurse that she will visit her 2-year-old son tomorrow about noon. During the child's bath, he asks for Mommy. The nurse's best reply is:

A. "Mommy will be here after lunch."
B. "Mommy always comes back to see you."
C. "Your Mommy told me yesterday that she would be here today about noon."
D. "Mommy had to go home for a while, but she will be here today."

A. "Mommy will be here after lunch."

* Because toddlers have a limited concept of time, the nurse should translate the mother's statement about being back around noon, to a familiar activity that takes place at that time.

When should clear liquids be stopped before scheduled surgery?

A. Two hours before surgery
B. Six hours before surgery
C. The night before surgery, at 8 P.M.
D. The night before surgery, at midnight

A. Two hours before surgery

* This is the recommended time period to reduce the risk of pulmonary aspiration in healthy patients.

A neonate had corrective surgery 3 days ago for esophageal atresia. The nurse notices that after his gastrostomy feeding, there is often a backup of feeding into the tube. As a result, the nurse should:

A. put the child in a supine position after feedings.
B. position the child on his or her left side after feedings.
C. leave the gastrostomy tube open and suspended after feedings.
D. leave the gastrostomy tube clamped after feedings.

C. leave the gastrostomy tube open and suspended after feedings.

* The formula is backing up into the tube due to delayed emptying. By keeping the tube open to air, it will prevent the build up of pressure on the operative site.

* The child should be positioned on the right side with head elevated at approximately 30 degrees.

A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because it:

A. liquefies secretions.
B. improves oxygenation.
C. promotes ventilation.
D. soothes inflamed mucous membrane.

D. soothes inflamed mucous membrane.

The nurse is caring for an infant with a tracheostomy when accidental decannulation occurs. The nurse is unable to reinsert the tube. What should the nurse's next action be?

A. Notify surgeon.
B. Perform oral intubation.
C. Try inserting larger tube.
D. Try inserting smaller tube.

D. Try inserting smaller tube.

* A smaller tube should be available. This will keep the stoma open until further action can be taken.

A 7-year-old girl has a fever associated with a viral illness. She is being cared for at home. The nurse should recognize that the principal reason for treating fever in this child is:

A. relief of discomfort.
B. reassurance that illness is temporary.
C. prevention of secondary bacterial infection.
D. prevention of life-threatening complications.

A. relief of discomfort.

The nurse suspects a child is having an adverse reaction to a blood transfusion. The first action by the nurse should be to:

A. notify physician.
B. take vital signs and blood pressure and compare them with baseline values.
C. dilute infusing blood with equal amounts of normal saline.
D. stop transfusion and maintain a patent intravenous line with normal saline and new tubing.

D. stop transfusion and maintain a patent intravenous line with normal saline and new tubing.

* This is the priority nursing action. If an adverse reaction is occurring, it is essential to minimize the amount of blood that is infused.

A child who is terminally ill with bone cancer is in severe pain. Nursing interventions should be based on knowledge that:

A. children tend to be overmedicated for pain.
B. giving large doses of opioids causes euthanasia.
C. narcotic addiction is common in terminally ill children.
D. large doses of opioids are justified when there are no other treatment options.

D. large doses of opioids are justified when there are no other treatment options.

* Large doses may be needed because the child has become physiologically tolerant to the drug, requiring higher doses to achieve the same degree of pain control.

What is the most consistent indicator of pain in infants?

A. Increased respirations
B. Increased heart rate
C. Squirming and jerking
D. Facial expression of discomfort

D. Facial expression of discomfort

The nurse is starting an intravenous line on a school-age child with cancer. The child says "I have had a million IVs. They hurt." The nurse's response should be based on knowledge that children:

A. tolerate pain better than adults.
B. become accustomed to painful procedures.
C. often lie about experiencing pain.
D. often demonstrate increased behavioral signs of discomfort with repeated painful procedures.

D. often demonstrate increased behavioral signs of discomfort with repeated painful procedures.

An important consideration when using the FACES Pain Rating scale with children is:

A. children color the face with the color they choose to best describe their pain.
B. the scale can be used with most children as young as 3 years.
C. the scale is not appropriate for use with adolescents.
D. the FACES scale is useful in pain assessment but not as accurate as physiologic responses.

B. the scale can be used with most children as young as 3 years.

The nurses caring for a child are concerned about the child's frequent requests for pain medication. During a team conference a nurse suggests that they consider administering a placebo instead of the usual pain medication. What should this decision be based on?

A. This practice is unjustified and unethical.
B. This practice is effective to determine if a child's pain is real.
C. The absence of a response to a placebo means the child's pain has an organic basis.
D. A positive response to a placebo will not occur if the child's pain has an organic basis.

A. This practice is unjustified and unethical.

* Placebos should never be given by any route in the assessment or management of pain.

A child who has been receiving morphine intravenously will now start receiving it orally. The nurse should anticipate that to achieve equianalgesia (equal analgesic effect), the oral dose will be:

A. the same as the IV dose.
B. greater than the IV dose.
C. one-half of the IV dose.
D. one-quarter of the IV dose.

B. greater than the IV dose.

* Oral morphine is not as effective at the same dosage as IV morphine.

Transdermal fentanyl (Duragesic) is being used for an adolescent with cancer who is in hospice care. The adolescent has been comfortable for several hours but now complains of severe pain. The most appropriate nursing action is to:

A. administer meperidine IM.
B. administer an immediate-release opioid IV.
C. try a nonpharmacologic strategy.
D. place another Duragesic patch on the adolescent.

B. administer an immediate-release opioid IV.

The nurse is caring postoperatively for an 8-year-old child with multiple fractures and other trauma resulting from a motor vehicle injury. The child is experiencing severe pain. What is an important consideration in managing the child's pain?

A. Give only an opioid analgesic at this time.
B. Increase dosage of analgesic until the child is adequately sedated.
C. Plan a preventive schedule of pain medication around the clock.
D. Give the child a clock and explain when (s)he can have pain medications.

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

* An around-the-clock administration strategy should be used for a child recovering from trauma and surgery. This schedule will help prevent low plasma levels of the drug leading to breakthrough pain.

Which of the following is described as the time interval between early manifestations of disease and the overt clinical syndrome?

A. Incubation period
B. Prodromal period
C. Desquamation period
D. Period of communicability

B. Prodromal period

The nurse is concerned with the prevention of communicable disease. Primary prevention results from:

A. immunizations.
B. early diagnosis.
C. strict isolation.
D. handwashing.

A. immunizations.

The school nurse is concerned about an outbreak of chickenpox because there are two children at the school who have cancer and are immunodeficient as a result of chemotherapy. What should the nurse recommend?

A. No precautions are necessary.
B. Acyclovir (Zovirax) is used to minimize the symptoms of chickenpox.
C. Varicella-zoster immune globulin (VZIG) is used to prevent chickenpox.
D. Chemotherapy should be temporarily stopped to allow the immune system to recover.

C. Varicella-zoster immune globulin (VZIG) is used to prevent chickenpox.

* VZIG is an antibody to the virus that causes chickenpox. Administration of VZIG can prevent the development of the disease.

What is an appropriate intervention to provide comfort for the child with itching associated with chickenpox?

A. Encourage frequent warm baths.
B. Give aspirin or acetaminophen.
C. Give an antipruritic medication such as Benadryl.
D. Apply a thick coat of Caladryl lotion over open lesions.

C. Give an antipruritic medication such as Benadryl.

hat is the causative agent for erythema infectiosum (Fifth disease)?

A. Paramyxovirus
B. Human parovirus B19
C. Human herpes virus type 6
D. Group A beta-hemolytic Streptococcus

B. Human parovirus B19

Which statement best represents infectious mononucleosis?

A. Herpes virus hominis, type II, is the principal cause.
B. Herpes-like Epstein-Barr virus is the principal cause.
C. Diagnosis is established by a complete blood count, which reveals a characteristic leukopenia.
D. 4. Diagnosis is established by clinical manifestations, because diagnostic tests cannot confirm diagnosis.

B. Herpes-like Epstein-Barr virus is the principal cause.

What is a secondary effect when a child experiences decreased muscle strength, tone, and endurance from immobilization?

A. Increased metabolism
B. Increased venous return
C. Increased cardiac output
D. Decreased exercise tolerance

D. Decreased exercise tolerance

Which is characteristic of fractures in children?

A. Fractures rarely occur at the growth plate site, because it absorbs shock well.
B. Rapidity of healing is inversely related to the age of the child.
C. Pliable bones of growing children are less porous than those of an adult.
D. Periosteum of a child's bone is thinner and weaker and has less osteogenic potential than that of an adult.

B. Rapidity of healing is inversely related to the age of the child.

The callus that develops at the fracture site is important because it provides:

A. functional use of injured part.
B. sufficient support for weight bearing.
C. means for adequate blood supply.
D. means for holding bone fragments together.

D. means for holding bone fragments together.

* New bone cells are formed in large numbers and stimulated to maximum activity. They are found at the site of the injury. In time, calcium salts are absorbed to form the callus.

An infant is born with one lower limb deficiency. When is the optimum time for the child to be fitted with a prosthetic device?

A. As soon as possible after birth
B. When the infant is developmentally ready to stand up
C. At about age 12 to 15 months, when most children are walking
D. At 4 years, when the healthy limb is not growing so rapidly

B. When the infant is developmentally ready to stand up

Which statement is true concerning osteogenesis imperfecta?

A. It is easily treated.
B. It is an inherited disorder.
C. Later-onset disease usually runs a more difficult course.
D. Braces and exercises are of no therapeutic value.

B. It is an inherited disorder.

An appropriate nursing intervention when caring for the child with chronic osteomyelitis is:

A. provide active range-of-motion exercises of affected extremity.
B. administer antibiotics with meals.
C. encourage frequent ambulation.
D. move and turn child carefully and gently to minimize pain.

D. move and turn child carefully and gently to minimize pain.

The diagnosis of mental retardation is based on the presence of what criteria?

A. Intelligence quotient (IQ) of 75 or less
B. Intelligence quotient (IQ) of 70 or less
C. Subaverage intellectual functioning, deficits in adaptive skills, and onset at any age
D. Subaverage intellectual functioning, deficits in adaptive skills, and onset before 18 years of age

D. Subaverage intellectual functioning, deficits in adaptive skills, and onset before 18 years of age

The genetic testing of a child with Down syndrome (DS) showed that it was caused by translocation. The parents ask about further genetic testing. Recommendations should include:

A. no further genetic testing is indicated.
B. child should be retested to confirm diagnosis of DS.
C. mother should be tested if she is over age 35.
D. parents can be tested since it might be hereditary.

D. parents can be tested since it might be hereditary.

* The child does not require further genetic testing, but parents and siblings do.

A 2-week-old infant with Down syndrome is being seen in the clinic. His mother tells the nurse that he is difficult to hold, that "He's like a rag doll. He doesn't cuddle up to me like my other babies did." The nurse's best interpretation of this lack of clinging or molding is which of the following?

A. Sign of maternal deprivation
B. Sign of detachment and rejection
C. Suggestive of autism associated with Down syndrome
D. Result of the physical characteristics of Down syndrome

D. Result of the physical characteristics of Down syndrome

* This is a result of the muscle hypotonicity and hyperextensibility of the joints associated with Down syndrome.

The parents of a child with fragile X syndrome want to have another baby. They tell the nurse that they worry another child might be similarly affected. What is the most appropriate nursing action?

A. Reassure them that the syndrome is not inherited.
B. Assess for family history of the syndrome.
C. Recommend that they not have another child.
D. Explain that prenatal diagnosis of the syndrome is now available.

D. Explain that prenatal diagnosis of the syndrome is now available.

The nurse is caring for a dying boy whose religion is Islam (Muslim/Moslem). Which is an important nursing consideration related to his impending death and religion?

A. There are no special rites.
B. There are specific practices to be followed.
C. The family is expected to "wait" away from the dying person.
D. Baptism should be performed if not done previously.

B. There are specific practices to be followed.

* This religion has specific rituals for bathing and wrapping the body in cloth before it is to be moved.

The nurse is caring for an 8-year-old child who has a chronic illness. The child has a tracheostomy, and a parent is rooming-in during this hospitalization. The parent insists on providing almost all of the child's care and tells the nurses how to care for the child. When planning the child's care, the primary nurse should recognize that the parent is:

A. controlling and demanding.
B. assuming the nurse's role.
C. the expert in care of the child.
D. not allowing nurses to function independently.

C. the expert in care of the child.

Denial is a common reaction to the diagnosis of a disability or chronic illness. Which statement applies to denial as a defense mechanism?

A. Denial is maladaptive.
B. Denial is a necessary cushion to prevent disintegration.
C. Denial prevents a sense of hope.
D. Denial prevents the mobilization of energies toward goal-directed, problem-solving behavior.

B. Denial is a necessary cushion to prevent disintegration.

* It enables the family to mobilize energies toward goal-directed problem solving.

The potential effects of chronic illness or disability on a child's development vary at different ages. Which effect is a threat to a toddler's normal development?

A. Hindered mobility
B. Poorly defined body image
C. Limited opportunities for socialization
D. Sense of guilt that child caused the illness or disability

A. Hindered mobility

* The inability to move about and master the environment will inhibit the toddler's developing autonomy.

Which statement best describes the 4-year-old's concept of death?

A. Death is temporary.
B. Death is permanent.
C. Death is personified in various forms.
D. Death is inevitable at some age.

A. Death is temporary.

A 5-year-old girl's sibling dies from sudden infant death syndrome. The parents are concerned because she showed more outward grief when her cat died than now. The nurse should explain that:

A. this is suggestive of maladaptive coping and referral is needed for counseling.
B. the child is not old enough to have a concept of death.
C. the child is not old enough to have formed a significant attachment to her sibling.
D. the death may be so painful and threatening that the child must deny it for now.

D. the death may be so painful and threatening that the child must deny it for now.

* This age child has limited defense mechanisms. Often the child will react with more overt grief to a less significant loss than to the loss of a very significant person.

Several nurses tell their nursing supervisor that they want to be able to attend the funeral of a child for whom they had cared. They say they felt especially close to both the child and the family. The supervisor should recognize that attending the funeral is:

A. appropriate, because families expect this expression of concern.
B. appropriate, because it can assist in the resolution of personal grief.
C. inappropriate, because it is unprofessional.
D. inappropriate, because it increases burnout.

B. appropriate, because it can assist in the resolution of personal grief.

* The nurse should attend the funeral of a child if there was closeness with the family. This will help the nurse to grieve and gain closure.

The parents of a child on a ventilator tell the nurse that their insurance company wants the child discharged. They explain that they do not want the child home "under any circumstances." What should the nurse consider when working with this family?

A. Desire to have the child home is essential to effective home care.
B. Parents should not be expected to care for a technology-dependent child.
C. Parents are not part of the decision-making process because of the costs of hospitalization.
D. Having a technology-dependent child at home is better for both the child and the family.

A. Desire to have the child home is essential to effective home care.

* To provide quality home care for children, parental desire and ability are essential. The community must have adequate resources, including capable professional support.

A child with a serious chronic illness will soon go home. The case manager requests that the family provide total care for the child for a couple of days while the child is still hospitalized. This request should be considered:

A. appropriate, because families are usually eager to get involved.
B. appropriate, because it can be beneficial to the transition from hospital to home.
C. inappropriate, because of legal issues.
D. inappropriate, because the family will have to assume the care soon enough.

B. appropriate, because it can be beneficial to the transition from hospital to home.

A case manager is assigned to coordinate the care of a child with a complex medical condition. The family is told that one of the goals is to control cost. This goal should be recognized as being:

A. unsafe.
B. realistic.
C. impossible.
D. inappropriate.

B. realistic.

A nurse has been assigned as a home health nurse for a child who is technology dependent. The nurse recognizes that the background of this family differs widely from the nurse's own. Some of their lifestyle choices can be seen as less than ideal. The most appropriate nursing intervention is to:

A. change the family.
B. respect the differences.
C. assess why the family is different.
D. determine if family is dysfunctional.

B. respect the differences.

* The nurse must respect the family's culture and background. The family is the constant in the child's life.

A 2 1/2-year-old child who is ventilator dependent will be discharged soon. The family expresses concern that their child might change the ventilator settings by exploring the control knobs and buttons. The nurse should:

A. teach the child not to touch controls.
B. explain that the child cannot be left alone because of the risk of changing settings.
C. recommend ways to cover the controls to reduce the risk of the child changing settings.
D. 4. reassure the family that developmentally the child is unable to change settings.

C. recommend ways to cover the controls to reduce the risk of the child changing settings.

* If the equipment does not have "lock-out" capabilities, then clear plastic covers and tape should be applied.

Which factors predispose an infant to fluid imbalances?

A. Decreased surface area
B. Lower metabolic rate
C. Immature kidney functioning
D. Decreased daily exchange of extracellular fluid

C. Immature kidney functioning

* The infant's kidneys are unable to concentrate or dilute urine, to conserve or excrete sodium, and to acidify urine.

When evaluating the extent of an infant's dehydration, the nurse should recognize that the symptoms of severe dehydration (15%) include:

A. tachycardia, decreased tears, and 5% weight loss.
B. pulse and blood pressure, and intense thirst.
C. irritability, moderate thirst, and normal eyes and fontanel.
D. tachycardia, parched mucous membranes, and sunken eyes and fontanel.

D. tachycardia, parched mucous membranes, and sunken eyes and fontanel.

The nurse is interviewing the parents of a 4-month-old male infant brought to the hospital emergency department. The infant is dead on arrival and no attempt at resuscitation is made. The parents state that the baby was found in his crib with a blanket over his head, lying face down in bloody fluid from his nose and mouth. They say he was "just fine" when they put him in his crib asleep. The nurse should suspect his death was caused by what?

A. Suffocation
B. Child abuse
C. Infantile apnea
D. Sudden infant death syndrome

D. Sudden infant death syndrome

* Although the child was found under the blanket, the bloody fluid is consistent with SIDS.

It is important that a child with acute streptococcal pharyngitis be treated with antibiotics to prevent:

A. otitis media.
B. diabetes insipidus.
C. nephrotic syndrome.
D. acute rheumatic fever.

D. acute rheumatic fever.

When caring for a child following a tonsillectomy, what should the nurse do?

A. Watch for continuous swallowing.
B. Encourage gargling to reduce discomfort.
C. Position the child on the back for sleeping.
D. Apply warm compresses to the throat.

A. Watch for continuous swallowing.

* This is the most obvious early sign of bleeding from the operative site.

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. What should the nurse do?

A. Examine her oral pharynx and report to the physician.
B. Make her lie down and rest quietly.
C. Auscultate her lungs and make preparations for placement in a mist tent.
D. Notify the physician immediately and be prepared to assist with a tracheostomy or intubation.

D. Notify the physician immediately and be prepared to assist with a tracheostomy or intubation.

* Sitting upright, drooling, agitation, and a froglike cough are indicative of epiglottitis. This is a medical emergency and tracheostomy or intubation may be necessary.

An infant with a congenital heart defect is receiving palivizumab (Synagis). The purpose of this is to:

A. prevent RSV infection.
B. make isolation of infant with RSV unnecessary.
C. prevent secondary bacterial infection.
D. decrease toxicity of antiviral agents.

A. prevent RSV infection.

* Synagis is a monoclonal antibody specific for RSV. Monthly administration is expected to prevent infection with RSV.

A child with asthma is having pulmonary function tests. Which explains the purpose of the peak expiratory flow rate (PEFR)?

A. Confirm diagnosis of asthma
B. Determine cause of asthma
C. Identify "triggers" of asthma
D. Assess severity of asthma

D. Assess severity of asthma

The parent of a child with cystic fibrosis 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 symptoms are suggestive of:

A. pneumothorax.
B. bronchodilation.
C. carbon dioxide retention.
D. increased viscosity of sputum.

A. pneumothorax.

* The child is exhibiting signs of increasing respiratory distress suggestive of a pneumothorax. The child needs to be seen as soon as possible.

Because the absorption of fat-soluble vitamins is decreased in cystic fibrosis, supplementation of which vitamins is necessary?

A. C and D
B. A, E, and K
C. A, D, E, and K
D. C and folic acid

C. A, D, E, and K

* A, D, E, and K are fat-soluble vitamins that need to be supplemented in higher doses.

What ages should children receive the DTaP vaccine?

2, 4, 6, and 15 months, (4-5 doses) + 4 years.

What ages should children receive the Hepatitis B vaccine?

At birth, 2 months, and 6 months.
(3 doses)

What ages should children receive the Haemophilus Influenzae Type B (Hib) vaccine?

2, 4, 6, and 12-15 months.
(4 doses)

What ages should children receive the Influenza vaccine?

Infants: 6 months (2 doses 4 weeks apart)

What ages should children receive the Measles, Mumps, & Rubella (MMR) vaccine?

12-15 months, and 4-6 years
(2 doses)

What ages should children receive the Pneumococcal (PCV) vaccine?

2, 4, 6, & 12-15 months.
(4 doses)

What ages should children receive the Poliovirus (IPV) vaccine?

2, 4, 6 months and 4 years.
(4 doses)

What ages should children receive the Rotavirus vaccine?

2 & 4 months, (& 6 months of RotaTeq was given)

What ages should children receive the Varicella vaccine?

12 moths and 4 years.
(2 doses)

For the child who has ingested a corrosive product, what does emergency care include?

A. Induce vomiting to remove corrosive agent.
B. Give activated charcoal to decontaminate stomach.
C. Drink vinegar or lemon juice for neutralization.
D. Drink water to dilute corrosive agent.

D. Drink water to dilute corrosive agent.

A 4-year-old child has ingested a toxic dose of iron. The parent reports that the child vomited and had gastric pain 1 hour earlier but "feels fine" now. The parent is not sure when the child ingested the iron tablets. What should the nurse recommend?

A. Observe the child closely for 2 more hours.
B. Bring the child to the hospital immediately.
C. Administer activated charcoal.
D. Administer syrup of ipecac to induce vomiting if the child does not vomit again within 1 hour.

B. Bring the child to the hospital immediately.

* The child should be transported to the hospital immediately for gastric lavage.

When a child is hospitalized for chelation therapy to treat lead poisoning, an important nursing consideration is to:

A. maintain bed rest.
B. maintain isolation precautions.
C. keep accurate record of intake and output.
D. institute measures to prevent skeletal fracture.

C. keep accurate record of intake and output.

* The metal binds with the chelation agent and is excreted through the kidneys. Adequate hydration and monitoring of intake and output are essential.

An adolescent girl is brought to the hospital emergency department by her parents after being raped. The girl is very calm and controlled throughout the interview and examination. The nurse should recognize that this behavior is:

A. one of a variety of behaviors normally seen in rape victims.
B. indicative of a higher-than-usual level of maturity in the adolescent.
C. suggestive that a rape has not actually occurred.
D. suggestive that the adolescent had severe emotional problems before the rape occurred.

A. one of a variety of behaviors normally seen in rape victims.

* Rape victims display a wide range of behaviors. A controlled manner may be an attempt to maintain composure while hiding the inner turmoil.

Which sign should the nurse recognize as an early clinical sign of compensated shock in a child?

A. Confusion
B. Sleepiness
C. Hypotension
D. Apprehensiveness

D. Apprehensiveness

What is the most appropriate action to stop an occasional episode of epistaxis (nosebleed)?

A. Have child sit up and lean forward.
B. Apply ice under the nose and above lip.
C. Have child lay down quietly with feet elevated.
D. Apply continuous pressure to nose with thumb and forefinger for at least 1 minute.

A. Have child sit up and lean forward.

* Continuous pressure for 10 minutes is recommended.

The temperature of an adolescent who is unconscious is 105º F. The priority nursing action is to:

A. continue to monitor temperature.
B. initiate a pain assessment.
C. apply a hypothermia blanket.
D. administer acetaminophen or ibuprofen.

C. apply a hypothermia blanket.

Which factor promotes wound healing?

A. Antiseptics
B. Eschar formation
C. Dry wound environment
D. Moist, crust-free wound environment

D. Moist, crust-free wound environment

An occlusive dressing, Derm-a-lot, is applied to a large abrasion. This is advantageous because the dressing will:

A. provide an antiseptic for wound healing.
B. deliver vitamin C to wound.
C. maintain a moist environment for healing.
D. promote mechanical friction for healing.

C. maintain a moist environment for healing.

* Occlusive dressings such as Derm-a-lot provide a dressing that is not adherent to the wound site. It provides a moist wound surface and provides insulation to the wound.

When applying wet compresses or dressings to the skin, what should the nurse do?

A. Apply dressing so that the area is totally immobilized.
B. Apply dressing when it is saturated and dripping.
C. Pour or syringe new solution over a dressing that has become dry.
D. Apply desired solution on cotton gauze or soft cotton cloths, such as clean handkerchiefs.

D. Apply desired solution on cotton gauze or soft cotton cloths, such as clean handkerchiefs.

Which is the most important in the management of cellulitis?

A. Burow solution compresses
B. Oral or parenteral antibiotics
C. Topical application of an antibiotic
D. Incision and drainage of severe lesions

B. Oral or parenteral antibiotics

The school nurse is seeing a child who brought poison ivy to school in his leaf collection. He says only his hands touched it. The most appropriate nursing action is to:

A. apply Burow solution compresses.
B. soak hands in warm water.
C. rinse hands in cold, running water.
D. scrub hands thoroughly with antibacterial soap.

C. rinse hands in cold, running water.

* The antibacterial soap removes protective skin oils and dilutes the urushiol, allowing it to spread.

When giving instructions to a parent whose child has scabies, the school nurse should tell them to:

A. treat all family members if symptoms develop.
B. be prepared for symptoms to last 2 to 3 weeks.
C. notify their practitioner so an antibiotic can be prescribed.
D. carefully treat only those areas where there is a rash.

B. be prepared for symptoms to last 2 to 3 weeks

Which statement is most descriptive of atopic dermatitis (eczema) in the infant?

A. Worse in summer
B. Worse in humid climates
C. Associated with upper respiratory infections
D. Associated with hereditary allergies

D. Associated with hereditary allergies

* The majority of children with atopic dermatitis have a family history of eczema, asthma, food allergies, or allergic rhinitis. This suggests a genetic predisposition.

Enteral feedings are ordered for a young child with burns covering 40% of total body surface area. The nurse should know that:

A. oral feedings are contraindicated.
B. enteral feedings must be stopped during painful procedures.
C. paralytic ileus precludes use of enteral feedings.
D. the feedings will be high in carbohydrate, low in protein.

C. paralytic ileus precludes use of enteral feedings.

The nurse is caring for a 12-year-old boy who sustained major burns when he put charcoal lighter on a campfire. The nurse observes that he is "very brave" and appears to accept pain with little or no response. What is the most appropriate nursing action related to this?

A. Request a psychological consultation.
B. Ask child why he does not have pain.
C. Praise the child for his ability to withstand pain.
D. Encourage continued bravery as a coping strategy.

A. Request a psychological consultation.

During the rehabilitative phase of care, pressure dressings are primarily applied to burned areas to:

A. relieve pain.
B. decrease blood supply to scar.
C. limit motion during healing process.
D. encourage healing through scar formation.

B. decrease blood supply to scar.

What is characteristic of children with posttraumatic stress disorder?

A. Denial as a defense mechanism is unusual.
B. Traumatic effects cannot remain indefinitely.
C. Previous coping strategies and defense mechanisms are not useful.
D. Children often play out the situation over and over again in an attempt to come to terms with their fear.

D. Children often play out the situation over and over again in an attempt to come to terms with their fear

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