NRSG 4502 Final - Major Topics

2. The nurse is caring for a 3-year-old with an altered state of consciousness. The nurse
determines that the child is oriented by asking the child to:
1. Name the president of the United States.
2. Identify her parents and state her own name.
3. State her full name and phone number.
4. Identify the current month but not the date.
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2. The nurse is caring for a 3-year-old with an altered state of consciousness. The nurse
determines that the child is oriented by asking the child to:
1. Name the president of the United States.
2. Identify her parents and state her own name.
3. State her full name and phone number.
4. Identify the current month but not the date.
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3. The parents of a child with altered consciousness ask if they can stay during the
morning assessment. Select the nurse's best response.
1. "Your child is more likely to answer questions and cooperate with any procedures if
you are not present."
2. "Most children feel more at ease when parents are present, so you are more than
welcome to stay at the bedside."
3. "It is our policy to ask parents to leave during the first assessment of the shift."
4. "Many children fear that their parents will be disappointed if they do not do well
with procedures, so we recommend that no parents be present at this time."
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4. The mother of an unconscious child has been calling her name repeatedly and gently
shaking her shoulders in an attempt to wake her up. The nurse notes that the child is
flexing her arms and wrists while bringing her arms closer to the midline of her body.
The child's mother asks, "What is going on?" Select the nurse's best response.
1. "I think your daughter hears you, and she is attempting to reach out to you."
2. "Your child is responding to you; please continue trying to stimulate her."
3. "It appears that your child is having a seizure."
4. "Your child is demonstrating a reflex that indicates she is overwhelmed with the
stimulation she is receiving."
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5. Which signs best indicate increased intracranial pressure (ICP) in an infant? Select all
that apply.
1. Sunken anterior fontanel.
2. Complaints of blurred vision.
3. High-pitched cry.
4. Increased appetite.
5. Sleeping more than usual
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6. Which of the following would be included in the plan of care for a hospitalized
newborn following surgical repair of a myelomeningocele. Select all that apply.
1. Skull x-rays.
2. Daily head circumference measurements.
3. MRI scan.
4. Vital signs every 6 hours.
5. Holding to breastfeed.
2,3
7. A child with a ventriculoperitoneal (VP) shunt complains of headache and blurry vision and now experiences irritability and sleeping more than usual. The parents ask the nurse what they should do. Select the nurse's best response.
1. "Give her some acetaminophen, and see if her symptoms improve. If they do not improve, bring her to the pediatrician's office."
2. "It is common for girls to have these symptoms, especially prior to beginning their menstrual cycle. Give her a few days, and see if she improves."
3. "You are probably worried that she is having a problem with her shunt. This is very unlikely as it has been working well for 9 years."
4. "You should immediately take her to the emergency room as these may be symptoms of a shunt malfunction."
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8. Which position initially is most beneficial for an infant who has just returned from having a ventriculoperitoneal (VP) shunt placed?
1. Semi-Fowler in an infant seat.
2. Flat in the crib.
3. Trendelenburg.
4. In the crib with the head elevated to 90 degrees.
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19. A child with a seizure disorder has been having episodes during which she drops her
pencil and simply appears to be daydreaming. This is most likely a/an:
1. Absence seizure.
2. Akinetic seizure.
3. Non-epileptic seizure.
4. Simple spasm seizure
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20. A preschooler has been having periods during which he suddenly falls and appears to
be weak for a short time after the event. The preschool teacher asks what she should
do. Select the nurse's best response.
1. "Have the parents follow up with his pediatrician as this is likely an atonic
seizure."
2. "Find out if there have been any new stressors in his life, as it could be
attention-seeking behavior."
3. "Have the parents follow up with his pediatrician as this is likely an absence
seizure."
4. "The preschool years are a time of rapid growth, and many children appear
clumsy. It would be best to watch him, and see if it continues."
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21. The diet that produces anticonvulsant effects from ketosis consists of:
1. High-fat and low-carbohydrate foods.
2. High-fat and high-carbohydrate foods.
3. Low-fat and low-carbohydrate foods.
4. Low-fat and high-carbohydrate foods.
1
22. Which medication should the nurse anticipate administering first to a child in status epilepticus? 1. Establish an intravenous line, and administer intravenous lorazepam. 2. Administer rectal diazepam. 3. Administer an oral glucose gel to the side of the child's mouth. 4. Administer oral diazepam.223. The nurse is providing discharge teaching to the parents of a toddler who experienced a febrile seizure. The nurse knows clarification is needed when the mother says: 1. "My child will likely have another seizure." 2. "My child's 7-year-old brother is also at high risk for a febrile seizure." 3. "I'll give my child acetaminophen when ill to prevent the fever from rising too high too rapidly." 4. "Most children with febrile seizures do not require seizure medicine."224. A child recently diagnosed with epilepsy is being evaluated for anticonvulsant medication therapy. The child will likely be placed on which type of regimen? 1. Two to three oral anticonvulsant medications so that dosing can be low and side effects minimized. 2. One oral anticonvulsant medication to observe effectiveness and minimize side effects. 3. One rectal gel to be administered in the event of a seizure. 4. A combination of oral and intravenous anticonvulsant medications to ensure compliance.225. Which activity should an adolescent just diagnosed with epilepsy avoid? 1. Swimming, even with a friend. 2. Being in a car at night. 3. Participating in any strenuous activities. 4. Returning to school right away.226. Which is the best action for the nurse to take during a child's seizure? 1. Administer the child's rescue dose of oral Valium (diazepam). 2. Loosen the child's clothing, and call for help. 3. Place a tongue blade in the child's mouth to prevent aspiration. 4. Carry the child to the infirmary to call 911 and start an intravenous line.231. The nurse is caring for a child with a skull fracture who is unconscious and has severely increased intracranial pressure (ICP). The nurse notes the child's temperature to be 104°F (40°C). Which should the nurse do first? 1. Place a cooling blanket on the child. 2. Administer Tylenol (acetaminophen) via nasogastric tube. 3. Administer Tylenol (acetaminophen) rectally. 4. Place ice packs in the child's axillary areas.133. A 2-month-old infant is brought to the emergency room after experiencing a seizure. The infant appears lethargic with very irregular respirations and periods of apnea. The parents report the baby is no longer interested in feeding and before the seizure, rolled off the couch. What additional testing should the nurse immediately prepare for? 1. Computed tomography (CT) scan of the head and dilation of the eyes. 2. Computed tomography (CT) scan of the head and electroencephalogram (EEG). 3. X-rays of the head. 4. X-rays of all long bones.135. An infant is born with a sac protruding through the spine, containing cerebrospinal fluid (CSF), a portion of the meninges, and nerve roots. This condition is referred to as: 1. Meningocele. 2. Myelomeningocele. 3. Spina bifida occulta. 4. Anencephaly.236. Which is the nurse's best response to the parents of a neonate with a meningocele who ask what can they expect? 1. "After initial surgery to close the defect, most children experience no neurological dysfunction." 2. "Surgery to close the sac will be postponed until the infant has grown and has enough skin to form a graft." 3. "After the initial surgery to close the defect, the child will likely have motor and sensory deficits." 4. "After the initial surgery to close the defect, the child will likely have future problems with urinary and bowel continence."137. The nurse is caring for an infant with a myelomeningocele. The parents ask the nurse why the nurse keeps measuring the baby's head circumference. Select the nurse's best response: 1. "Babies' heads are measured to ensure growth is on track." 2. "Babies with a myelomeningocele are at risk for hydrocephalus, which shows up as an increase in head size." 3. "Because your baby has an opening on the spinal cord, your infant is at risk for meningitis, which can show up as an increase in head size." 4. "Many infants with myelomeningocele have microcephaly, which can show up as a decrease in head size."238. A parent of a newborn diagnosed with myelomeningocele asks what is a common long-term complication? The nurse's best response is: 1. Learning disabilities. 2. Urinary tract infections. 3. Hydrocephalus. 4. Decubitus ulcers and skin breakdown239. Which is included in the plan of care for a newborn who has a myelomeningocele? 1. Place the child in the prone position with a sterile dry dressing over the defect. Slowly begin oral gastric feeds to prevent the development of necrotizing enterocolitis. 2. Place the child in the prone position with a sterile dry dressing over the defect. Begin intravenous fluids to prevent dehydration. 3. Place the child in the prone position with a sterile moist dressing over the defect. Slowly begin oral gastric feeds to prevent the development of necrotizing enterocolitis. 4. Place the child in the prone position with a sterile moist dressing over the defect. Begin intravenous fluids to prevent dehydration.441. Which does the nurse include in a child with myelomeningocele postoperative plan of care following ligament release? 1. Encourage the child to resume a regular diet, beginning slowly with bland foods that are easily digested, such as bananas. 2. Encourage the child to blow balloons to increase deep breathing and avoid postoperative pneumonia. 3. Assist the child to change positions to avoid skin breakdown. 4. Provide education on dietary requirements to prevent obesity and skin breakdown.354. The parent of an infant diagnosed with a neuroblastoma asks the nurse what the prognosis is. The nurse's best response is: 1. Excellent, as a neuroblastoma is always cured. 2. Excellent, as infants with a neuroblastoma have the best prognosis. 3. Poor, as infants with a neuroblastoma rarely survive. 4. Variable, depending on the site of origin255. Which should be included in the plan of care for a child who has a neuroblastoma with metastasis to the bone marrow and pancytopenia? 1. Administer red blood cells. 2. Limit school attendance to less than 4 hours daily. 3. Administer Coumadin. 4. Encourage a diet high in fresh fruits and vegetables156. The parent of a child with neuroblastoma asks the nurse what the typical signs and symptoms are at first. Select the nurse's best answer. 1. "Most children complain of abdominal fullness and difficulty urinating." 2. "Many children in the early stages of a neuroblastoma have joint pain and walk with a limp." 3. "The signs and symptoms vary depending on where the tumor is located, but typical symptoms include weight loss, abdominal distention, and fatigue." 4. "The signs and symptoms are fairly consistent regardless of the location of the tumor. They include fatigue, hunger, weight gain, and abdominal fullness."357. Which child would likely have experienced a delay in the diagnosis of a brain tumor? 1. 3-month-old, as signs and symptoms would not have been readily apparent. 2. 5-month-old, as signs and symptoms would not have been readily suspected. 3. School-age child, as signs and symptoms could have been misinterpreted. 4. Adolescent, as signs and symptoms could have been ignored and denied.158. A child has been diagnosed with a midline brain tumor. In addition to showing signs of increased intracranial pressure (ICP), she has been voiding large amounts of very dilute urine. Which medication does the nurse expect to administer? 1. Mannitol. 2. Vasopressin. 3. Lasix. 4. Dopamine259. The nurse is caring for a child receiving radiation therapy for a brain tumor. The parents ask if their child will likely have any learning disabilities. Select the nurse's best answer. 1. "All children who receive radiation have some amount of learning disability. As long as they receive extra tutoring, they usually do well in school." 2. "Because your child is so young, she will likely do well and have no problems in the future." 3. "Response varies with each child, but younger children who receive radiation tend to have some amount of learning disability later in life." 4. "Response varies with each child, but younger children who receive radiation tend to have fewer problems later in life than older children360. A child involved in a motor vehicle accident (MVA) is currently on a backboard with a cervical collar in place. The child is diagnosed with a cervical fracture. Which would the nurse expect to find in the child's plan of care? 1. Remove the cervical collar, keep the backboard in place, and administer high-dose methylprednisolone. 2. Continue with all forms of spinal stabilization, and administer high-dose methylprednisolone and ranitidine. 3. Remove the backboard and cervical collar, and prepare for halo traction placement. 4. Remove the cervical collar and backboard, place the child on spinal precautions, and administer high-dose methylprednisolone and ranitidine.261. Which has the potential to alter a child's level of consciousness? Select all that apply. 1. Metabolic disorders. 2. Trauma. 3. Hypoxic episode. 4. Dehydration. 5. Endocrine disorders12345The nurse has documented that a child's level of consciousness is obtunded. Which describes this level of consciousness? a. Slow response to vigorous and repeated stimulation b. Impaired decision making c. Arousable with stimulation d. Confusion regarding time and placeANS: C Obtunded describes a level of consciousness in which the child is arousable with stimulation. Stupor is a state in which the child remains in a deep sleep, responsive only to vigorous and repeated stimulation. Confusion is impaired decision making. Disorientation is confusion regarding time and place.The nurse has received report on four children. Which child should the nurse assess first? a. A school-age child in a coma with stable vital signs b. A preschool child with a head injury and decreasing level of consciousness c. An adolescent admitted after a motor vehicle accident is oriented to person and place d. A toddler in a persistent vegetative state with a low-grade feverANS: B The nurse should assess the child with a head injury and decreasing level of consciousness first (LOC). Assessment of LOC remains the earliest indicator of improvement or deterioration in neurologic status. The next child the nurse should assess is a toddler in a persistent vegetative state with a low-grade fever. The school-age child in a coma with stable vital signs and the adolescent admitted to the hospital who is oriented to his surroundings would be of least worry to the nurse.The nurse is performing a Glasgow Coma Scale on a school-age child with a head injury. The child opens eyes spontaneously, obeys commands, and is oriented to person, time, and place. Which is the score the nurse should record? a. 8 b. 11 c. 13 d. 15ANS: D The Glasgow Coma Scale (GCS) consists of a three-part assessment: eye opening, verbal response, and motor response. Numeric values of 1 through 5 are assigned to the levels of response in each category. The sum of these numeric values provides an objective measure of the patient's level of consciousness (LOC). A person with an unaltered LOC would score the highest, 15. The child who opens eyes spontaneously, obeys commands, and is oriented is scored at a 15.Which neurologic diagnostic test gives a visualized horizontal and vertical cross-section of the brain at any axis? a. Nuclear brain scan b. Echoencephalography c. CT scan d. Magnetic resonance imaging (MRI)ANS: C A CT scan provides a visualization of the horizontal and vertical cross-sections of the brain at any axis. A nuclear brain scan uses a radioisotope that accumulates where the blood-brain barrier is defective. Echoencephalography identifies shifts in midline structures of the brain as a result of intracranial lesions. MRI permits visualization of morphologic features of target structures and permits tissue discrimination that is unavailable with any other techniques.Which is the priority nursing intervention for an unconscious child after a fall? a. Establish adequate airway. b. Perform neurologic assessment. c. Monitor intracranial pressure. d. Determine whether a neck injury is present.ANS: A Respiratory effectiveness is the primary concern in the care of the unconscious child. Establishment of an adequate airway is always the first priority. A neurologic assessment and determination of whether a neck injury is present will be performed after breathing and circulation are stabilized. Intracranial, not intercranial, pressure is monitored if indicated after airway, breathing, and circulation are maintained.Which drug should the nurse expect to administer to a preschool child who has increased intracranial pressure (ICP) resulting from cerebral edema? a. Mannitol (Osmitrol) b. Epinephrine hydrochloride (Adrenalin) c. Atropine sulfate (Atropine) d. Sodium bicarbonate (Sodium bicarbonate)ANS: A For increased ICP, mannitol, an osmotic diuretic, administered intravenously, is the drug used most frequently for rapid reduction. Epinephrine hydrochloride, atropine sulfate, and sodium bicarbonate are not used to decrease ICP.The nurse is teaching nursing students about childhood fractures. Which describes a compound skull fracture? a. Involves the basilar portion of the occipital bone b. Bone is exposed through the skin c. Traumatic separations of the cranial sutures d. Bone is pushed inward, causing pressure on the brainANS: B A compound fracture has the bone exposed through the skin. A basilar fracture involves the basilar portion of the frontal, ethmoid, sphenoid, temporal, or occipital bone. Diastatic skull fractures are traumatic separations of the cranial sutures. A depressed fracture has the bone pushed inward, causing pressure on the brain.Which statement best describes a subdural hematoma? a. Bleeding occurs between the dura and the skull. b. Bleeding occurs between the dura and the cerebrum. c. Bleeding is generally arterial, and brain compression occurs rapidly. d. The hematoma commonly occurs in the parietotemporal region.ANS: B A subdural hematoma is bleeding that occurs between the dura and the cerebrum as a result of a rupture of cortical veins that bridge the subdural space. An epidural hemorrhage occurs between the dura and the skull, is usually arterial with rapid brain concussion, and occurs most often in the parietotemporal region.The nurse should recommend medical attention if a child with a slight head injury experiences: a. sleepiness. b. vomiting, even once. c. headache, even if slight. d. confusion or abnormal behavior.ANS: D Medical attention should be sought if the child exhibits confusion or abnormal behavior, loses consciousness, has amnesia, has fluid leaking from the nose or ears, complains of blurred vision, or has an unsteady gait. Sleepiness alone does not require evaluation. If the child is difficult to arouse from sleep, medical attention should be obtained. Vomiting more than three times requires medical attention. Severe or worsening headache or one that interferes with sleep should be evaluated.The nurse is assessing a child who was just admitted to the hospital for observation after a head injury. Which is the most essential part of the nursing assessment to detect early signs of a worsening condition? a. Posturing b. Vital signs c. Focal neurologic signs d. Level of consciousnessANS: D The most important nursing observation is assessment of the child's level of consciousness. Alterations in consciousness appear earlier in the progression of an injury than do alterations of vital signs or focal neurologic signs. Neurologic posturing is indicative of neurologic damage. Vital signs and focal neurologic signs are later signs of progression when compared with level-of-consciousness changes.A school-age child has sustained a head injury and multiple fractures after being thrown from a horse. The child's level of consciousness is variable. The parents tell the nurse that they think their child is in pain because of periodic crying and restlessness. The most appropriate nursing action is to: a. discuss with parents the child's previous experiences with pain. b. discuss with practitioner what analgesia can be safely administered. c. explain that analgesia is contraindicated with a head injury. d. explain that analgesia is unnecessary when child is not fully awake and alert.ANS: B A key nursing role is to provide sedation and analgesia for the child. Consultation with the appropriate practitioner is necessary to avoid conflict between the necessity to monitor the child's neurologic status and the promotion of comfort and relief of anxiety. Information on the child's previous experiences with pain should be obtained as part of the assessment, but because of the severity of injury, analgesia should be provided as soon as possible. Analgesia can be safely used in individuals who have sustained head injuries and can decrease anxiety and resultant increased ICP.A 5-year-old girl sustained a concussion when she fell out of a tree. In preparation for discharge, the nurse is discussing home care with her mother. Which statement made by the mother indicates a correct understanding of the teaching? a. "I should expect my child to have a few episodes of vomiting." b. "If I notice sleep disturbances, I should contact the physician immediately." c. "I should expect my child to have some behavioral changes after the accident." d. "If I notice diplopia, I will have my child rest for 1 hour."ANS: C The parents are advised of probable posttraumatic symptoms that may be expected. These include behavioral changes and sleep disturbances. If the child has these clinical signs, they should be immediately reported for evaluation. Sleep disturbances are to be expected.The most common clinical manifestation(s) of brain tumors in children is/are: a. irritability. b. seizures. c. headaches and vomiting. d. fever and poor fine motor control.ANS: C Headaches, especially on awakening, and vomiting that is not related to feeding are the most common clinical manifestation(s) of brain tumors in children. Irritability, seizures, and fever and poor fine motor control are clinical manifestations of brain tumors, but headaches and vomiting are the most common.A 5-year-old boy is being prepared for surgery to remove a brain tumor. Nursing actions should be based on which statement? a. Removal of tumor will stop the various symptoms. b. Usually the postoperative dressing covers the entire scalp. c. He is not old enough to be concerned about his head being shaved. d. He is not old enough to understand the significance of the brain.ANS: B The child should be told what he will look and feel like after surgery. This includes the size of the dressing. The nurse can demonstrate on a doll the expected size and shape of the dressing. Some of the symptoms may be alleviated by the removal of the tumor, but postsurgical headaches and cerebellar symptoms such as ataxia may be aggravated. Children should be prepared for the loss of their hair, and it should be removed in a sensitive, positive manner if the child is awake. Children at this age have poorly defined body boundaries and little knowledge of internal organs. Intrusive experiences are frightening, especially those that disrupt the integrity of the skin.The nurse is teaching nursing students about childhood nervous system tumors. Which best describes a neuroblastoma? a. Diagnosis is usually made after metastasis occurs. b. Early diagnosis is usually possible because of the obvious clinical manifestations. c. It is the most common brain tumor in young children. d. It is the most common benign tumor in young children.ANS: A Neuroblastoma is a silent tumor with few symptoms. In more than 70% of cases, diagnosis is made after metastasis occurs, with the first signs caused by involvement in the nonprimary site. In only 30% of cases is diagnosis made before metastasis. Neuroblastomas are the most common malignant extracranial solid tumors in children. The majority of tumors develop in the adrenal glands or the retroperitoneal sympathetic chain. They are not benign but metastasize.A child is brought to the emergency department after experiencing a seizure at school. There is no previous history of seizures. The father tells the nurse that he cannot believe the child has epilepsy. The nurse's best response is: a. "Epilepsy is easily treated." b. "Very few children have actual epilepsy." c. "The seizure may or may not mean that your child has epilepsy." d. "Your child has had only one convulsion; it probably won't happen again."ANS: C Seizures are the indispensable characteristic of epilepsy; however, not every seizure is epileptic. Epilepsy is a chronic seizure disorder with recurrent and unprovoked seizures. The treatment of epilepsy involves a thorough assessment to determine the type of seizure the child is having and the cause, followed by individualized therapy to allow the child to have as normal a life as possible. The nurse should not make generalized comments regarding the incidence of epilepsy until further assessment is made.Which type of seizure involves both hemispheres of the brain? a. Focal b. Partial c. Generalized d. AcquiredANS: C Clinical observations of generalized seizures indicate that the initial involvement is from both hemispheres. Focal seizures may arise from any area of the cerebral cortex, but the frontal, temporal, and parietal lobes are most commonly affected. Partial seizures are caused by abnormal electric discharges from epileptogenic foci limited to a circumscribed region of the cerebral cortex. A seizure disorder that is acquired is a result of a brain injury from a variety of factors; it does not specify the type of seizure.Which is the initial clinical manifestation of generalized seizures? a. Being confused b. Feeling frightened c. Losing consciousness d. Seeing flashing lightsANS: C Loss of consciousness is a frequent occurrence in generalized seizures and is the initial clinical manifestation. Being confused, feeling frightened, and seeing flashing lights are clinical manifestations of a complex partial seizure.Which of the following types of seizures may be difficult to detect? a. Absence b. Generalized c. Simple partial d. Complex partialANS: A Absence seizures may go unrecognized because little change occurs in the child's behavior during the seizure. Generalized, simple partial, and complex partial seizures all have clinical manifestations that are observable.An important nursing intervention when caring for a child who is experiencing a seizure would be to: a. describe and record the seizure activity observed. b. restrain the child when seizure occurs to prevent bodily harm. c. place a tongue blade between the teeth if they become clenched. d. suction the child during a seizure to prevent aspiration.ANS: A When a child is having a seizure, the priority nursing care is observation of the child and seizure. The nurse then describes and records the seizure activity. The child should not be restrained, and nothing should be placed in the child's mouth. This may cause injury. To prevent aspiration, if possible, the child should be placed on the side, facilitating drainage.A 10-year-old child, without a history of previous seizures, experiences a tonic-clonic seizure at school. Breathing is not impaired, but some postictal confusion occurs. The most appropriate initial action by the school nurse is to: a. stay with child and have someone call emergency medical service (EMS). b. notify parent and regular practitioner. c. notify parent that child should go home. d. stay with child, offering calm reassurance.ANS: A The EMS should be called to transport the child because this is the child's first seizure. Because this is the first seizure, evaluation should be performed as soon as possible. The nurse should stay with the child while someone else notifies the EMS.A child has been seizure-free for 2 years. A father asks the nurse how much longer the child will need to take the antiseizure medications. The nurse includes which intervention in the response? a. Medications can be discontinued at this time. b. The child will need to take the drugs for 5 years after the last seizure. c. A step-wise approach will be used to reduce the dosage gradually. d. Seizure disorders are a lifelong problem. Medications cannot be discontinued.ANS: C A predesigned protocol is used to wean a child gradually off antiseizure medications, usually when the child is seizure-free for 2 years and has a normal electroencephalogram (EEG). Medications must be gradually reduced to minimize the recurrence of seizures. Seizure medications can be safely discontinued. The risk of recurrence is greatest within the first year.Children taking phenobarbital (phenobarbital sodium) and/or phenytoin (Dilantin) may experience a deficiency of: a. calcium. b. vitamin C. c. fat-soluble vitamins. d. vitamin D and folic acid.ANS: D Deficiencies of vitamin D and folic acid have been reported in children taking phenobarbital and phenytoin. Calcium, vitamin C, and fat-soluble vitamin deficiencies are not associated with phenobarbital or phenytoin.Which clinical manifestations would suggest hydrocephalus in a neonate? a. Bulging fontanel and dilated scalp veins b. Closed fontanel and high-pitched cry c. Constant low-pitched cry and restlessness d. Depressed fontanel and decreased blood pressureANS: A Bulging fontanels, dilated scalp veins, and separated sutures are clinical manifestations of hydrocephalus in neonates. Closed fontanel and high-pitched cry, constant low-pitched cry and restlessness, and depressed fontanel and decreased blood pressure are not clinical manifestations of hydrocephalus, but all should be referred for evaluation.The nurse is monitoring a 7-year-old child post-surgical resection of an infratentorial brain tumor. Which vital sign findings indicate Cushing's triad? a. Increased temperature, tachycardia, tachypnea b. Decreased temperature, bradycardia, bradypnea c. Bradycardia, hypertension, irregular respirations d. Bradycardia, hypotension, tachypneaANS: C Cushing's triad is a hallmark sign of increased intracranial pressure (ICP). The triad includes bradycardia, hypertension, and irregular respirations. Increased or decreased temperature is not a sign of Cushing's triad.Which position should the nurse place a 10-year-old child after a large tumor was removed through a supratentorial craniotomy? a. On the inoperative side with the bed flat b. On the inoperative side with the head of bed elevated 20 to 30 degrees c. On the operative side with the bed flat and pillows behind the head d. On the operative side with the head of bed elevated 45 degreesANS: B If a large tumor was removed, the child is not placed on the operative side because the brain may suddenly shift to that cavity, causing trauma to the blood vessels, linings, and the brain itself. The child with an infratentorial procedure is usually positioned on either side with the bed flat. When a supratentorial craniotomy is performed, the head of bed is elevated 20 to 30 degrees with the child on either side or on the back. In a supratentorial craniotomy, the head elevation facilitates CSF drainage and decreases excessive blood flow to the brain to prevent hemorrhage. Pillows should be placed against the child's back, not head, to maintain the desired position.The treatment of brain tumors in children consists of which therapies? (Select all that apply.) a. Surgery b. Bone marrow transplantation c. Chemotherapy d. Stem cell transplantation e. Radiation f. MyelographyANS: A, C, E Treatment for brain tumors in children may consist of surgery, chemotherapy, and radiotherapy alone or in combination. Bone marrow and stem cell transplantation therapies are used for leukemia, lymphoma, and other solid tumors where myeloablative therapies are used. Myelography is a radiographic examination after an intrathecal injection of contrast medium. It is not a treatment.Which are clinical manifestations of increased intracranial pressure (ICP) in infants? (Select all that apply.) a. Low-pitched cry b. Sunken fontanel c. Diplopia and blurred vision d. Irritability e. Distended scalp veins f. Increased blood pressureANS: D, E Diplopia and blurred vision, irritability, and distended scalp veins are signs of increased ICP in infants. Diplopia and blurred vision is indicative of ICP in children. A high-pitched cry and a tense or bulging fontanel are characteristics of increased ICP. Increased blood pressure, common in adults, is rarely seen in children.An infant with hydrocephalus is hospitalized for surgical placement of a ventriculoperitoneal shunt. Which interventions should be included in the child's postoperative care? (Select all that apply.) a. Observe closely for signs of infection. b. Pump the shunt reservoir to maintain patency. c. Administer sedation to decrease irritability. d. Maintain Trendelenburg position to decrease pressure on the shunt. e. Maintain an accurate record of intake and output. f. Monitor for abdominal distention.ANS: A, E, F Infection is a major complication of ventriculoperitoneal shunts. Observation for signs of infection is a priority nursing intervention. Intake and output should be measured carefully. Abdominal distention could be a sign of peritonitis or a postoperative ileus. Pumping of the shunt may cause obstruction or other problems and should not be performed unless indicated by the neurosurgeon. Pain management rather than sedation should be the goal of therapy. The child is kept flat to avoid too rapid a reduction of intracranial fluid.The nurse is monitoring an infant for signs of increased intracranial pressure (ICP). Which are late signs of increased intracranial pressure (ICP) in an infant? (Select all that apply.) a. Tachycardia b. Alteration in pupil size and reactivity c. Increased motor response d. Extension or flexion posturing e. Cheyne-Stokes respirationsANS: B, D, E Late signs of ICP in an infant or child include bradycardia, alteration in pupil size and reactivity, decreased motor response, extension or flexion posturing, and Cheyne-Stokes respirations.A 6-year-old child is having a generalized seizure in the classroom at school. Place in order the interventions the school nurse should implement starting with the highest-priority intervention sequencing to the lowest-priority intervention. Provide answer using lowercase letters separated by commas (e.g., a, b, c, d, e).a. Take vital signs. b. Ease child to the floor. c. Allow child to rest. d. Turn child to the side. e. Integrate child back into the school environment. ANS: b, d, a, c, e The nurse should ease the child to the floor immediately during a generalized seizure. During (and sometimes after) the generalized seizure, the swallowing reflex is lost, salivation increases, and the tongue is hypotonic. Therefore, the child is at risk for aspiration and airway occlusion. Placing the child on the side facilitates drainage and helps maintain a patent airway. Vital signs should be taken next and the child should be allowed to rest. When feasible, the child is integrated into the environment as soon as possible.Which child should the nurse document as being anemic? a. 7-year-old child with a hemoglobin of 11.5 g/dl b. 3-year-old child with a hemoglobin of 12 g/dl c. 14-year-old child with a hemoglobin of 10 g/dl d. 1-year-old child with a hemoglobin of 13 g/dld. 1-year-old child with a hemoglobin of 13 g/dl Anemia is a condition in which the number of red blood cells, or hemoglobin concentration, is reduced below the normal values for age. Anemia is defined as a hemoglobin level below 10 or 11 g/dl. The child with a hemoglobin of 10 g/dl would be considered anemic. The normal hemoglobin for a child after 2 years of age is 11.5 to 15.5 g/dl.The nurse is planning activity for a 4-year-old child with anemia. Which activity should the nurse plan for this child? a. Game of "hide and seek" in the children's outdoor play area b. Participation in dance activities in the playroom c. Puppet play in the child's room d. A walk down to the hospital lobbyc. Puppet play in the child's room Because the basic pathologic process in anemia is a decrease in oxygen-carrying capacity, an important nursing responsibility is to assess the child's energy level and minimize excess demands. The child's level of tolerance for activities of daily living and play is assessed, and adjustments are made to allow as much self-care as possible without undue exertion. Puppet play in the child's room would not be overly tiring. Hide and seek, dancing, and walking to the lobby would not conserve the anemic child's energy.The nurse is teaching parents about the importance of iron in a toddler's diet. Which explains why iron deficiency anemia is common during toddler-hood? a. Milk is a poor source of iron. b. Iron cannot be stored during fetal development. c. Fetal iron stores are depleted by age 1 month. d. Dietary iron cannot be started until age 12 months.a. Milk is a poor source of iron. Children between the ages of 12 and 36 months are at risk for anemia because cow's milk is a major component of their diet and it is a poor source of iron. Iron is stored during fetal development, but the amount stored depends on maternal iron stores. Fetal iron stores are usually depleted by age 5 to 6 months. Dietary iron can be introduced by breastfeeding, iron-fortified formula, and cereals during the first 12 months of life.The nurse is teaching parents of an infant about the causes of iron deficiency anemia. Which statement best describes iron deficiency anemia in infants? a. It is caused by depression of the hematopoietic system. b. It is easily diagnosed because of an infant's emaciated appearance. c. Clinical manifestations are similar regardless of the cause of the anemia. d. Clinical manifestations result from a decreased intake of milk and the premature addition of solid foods.c. Clinical manifestations are similar regardless of the cause of the anemia. 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 in iron deficiency anemia. The bone marrow produces red cells that are smaller and contain less hemoglobin than normal red cells. Children who are iron deficient 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.Which should the nurse include when teaching the mother of a 9-month-old infant about administering liquid iron preparations? a. They should be given with meals. b. They should be stopped immediately if nausea and vomiting occur. c. Adequate dosage will turn the stools a tarry green color. d. Allow preparation to mix with saliva and bathe the teeth before swallowing.c. 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. The lack of the 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, then 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.The nurse is recommending how to prevent iron deficiency anemia in a healthy, term, breast-fed infant. Which should be suggested? a. Iron (ferrous sulfate) drops after age 1 month b. Iron-fortified commercial formula by age 4 to 6 months c. Iron-fortified infant cereal by age 2 months d. Iron-fortified infant cereal by age 4 to 6 monthsd. Iron-fortified infant cereal by age 4 to 6 months Breast milk supplies inadequate iron for growth and development after age 5 months. Supplementation is necessary at this time. The mother can supplement the breastfeeding with iron-fortified infant cereal. Iron supplementation or the introduction of solid foods in a breast-fed baby is not indicated. Providing iron-fortified commercial formula by age 4 to 6 months should be done only if the mother is choosing to discontinue breastfeeding.Parents of a child with sickle cell anemia ask the nurse, "What happens to the hemoglobin in sickle cell anemia?" Which statement by the nurse explains the disease process?" a. Normal adult hemoglobin is replaced by abnormal hemoglobin. b. There is a lack of cellular hemoglobin being produced. c. There is a deficiency in the production of globulin chains. d. The size and depth of the hemoglobin are affected.a. Normal adult hemoglobin is replaced by abnormal hemoglobin. Sickle cell anemia is one of a group of diseases collectively called hemoglobinopathies, in which normal adult hemoglobin is replaced by abnormal hemoglobin. Aplastic anemia is a lack of cellular elements being produced. Thalassemia major refers to a variety of inherited disorders characterized by deficiencies in production of certain globulin chains. Iron deficiency anemia affects the size and depth of the color.When both parents have sickle cell trait, which is the chance their children will have sickle cell anemia? a. 25% b. 50% c. 75% d. 100%a. 25% Sickle cell anemia is inherited in an autosomal recessive pattern. If both parents have sickle cell trait (one copy of the sickle cell gene), then for each pregnancy, a 25% chance exists that their child will be affected with sickle cell disease. With each pregnancy, a 50% chance exists that the child will have sickle cell trait. Percentages of 75% and 100% are too high for the children of parents who have sickle cell trait.The nurse is conducting a staff in-service on sickle cell anemia. Which describes the pathologic changes of sickle cell anemia? a. Sickle-shaped cells carry excess oxygen. b. Sickle-shaped cells decrease blood viscosity. c. Increased red blood cell destruction occurs. d. Decreased adhesion of sickle-shaped cells occurs.c. Increased red blood cell destruction occurs. The clinical features of sickle cell anemia are primarily the result of increased red blood cell destruction and obstruction caused by the sickle-shaped red blood cells. Sickled red cells have decreased oxygen-carrying capacity and transform into the sickle shape in conditions of low oxygen tension. When the sickle cells change shape, they increase the viscosity in the area where they are involved in the microcirculation. Increased adhesion and entanglement of cells occurs.Which clinical manifestation should the nurse expect when a child with sickle cell anemia experiences an acute vasoocclusive crisis? a. Circulatory collapse b. Cardiomegaly, systolic murmurs c. Hepatomegaly, intrahepatic cholestasis d. Painful swelling of hands and feet; painful jointsd. Painful swelling of hands and feet; painful joints A vasoocclusive crisis is characterized by severe pain in the area of involvement. If in the extremities, painful swelling of the hands and feet is seen; if in the abdomen, severe pain resembles that of acute surgical abdomen; and if in the head, stroke and visual disturbances occur. Circulatory collapse results from sequestration crises. Cardiomegaly, systolic murmurs, hepatomegaly, and intrahepatic cholestasis result from chronic vasoocclusive phenomena.The parents of a child hospitalized with sickle cell anemia tell the nurse that they are concerned about narcotic analgesics causing addiction. Which is appropriate for the nurse to explain about narcotic analgesics? a. Are often ordered but not usually needed b. Rarely cause addiction because they are medically indicated c. Are given as a last resort because of the threat of addiction d. Are used only if other measures, such as ice packs, are ineffectiveb. Rarely cause addiction because they are medically indicated The pain of sickle cell anemia is best treated by a multidisciplinary approach. Mild to moderate pain can be controlled by ibuprofen and acetaminophen. When narcotics are indicated, they are titrated to effect and are given around the clock. Patient-controlled analgesia reinforces the patient's role and responsibility in managing the pain and provides flexibility in dealing with pain. Few, if any, patients who receive opioids for severe pain become behaviorally addicted to the drug. Narcotics are often used because of the severe nature of the pain of vasoocclusive crisis. Ice is contraindicated because of its vasoconstrictive effects.Parents of a hemophiliac child ask the nurse, "Can you describe hemophilia to us?" Which response by the nurse is descriptive of most cases of hemophilia? a. Autosomal dominant disorder causing deficiency in a factor involved in the blood-clotting reaction b. X-linked recessive inherited disorder causing deficiency of platelets and prolonged bleeding c. X-linked recessive inherited disorder in which a blood-clotting factor is deficient d. Y-linked recessive inherited disorder in which the red blood cells become moon-shapedc. X-linked recessive inherited disorder in which a blood-clotting factor is deficient ANS: C The inheritance pattern in 80% of all of 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 inheritance pattern is X-linked recessive. The disorder involves coagulation factors, not platelets, and does not involve red cells or the Y chromosomes.Which is most descriptive of the pathophysiology of leukemia? a. Increased blood viscosity occurs. b. Thrombocytopenia (excessive destruction of platelets) occurs. c. Unrestricted proliferation of immature white blood cells (WBCs) occurs. d. First stage of coagulation process is abnormally stimulated.c. Unrestricted proliferation of immature white blood cells (WBCs) occurs. Leukemia is a group of malignant disorders of the bone marrow and lymphatic system. It is defined as an unrestricted proliferation of immature WBCs in the blood-forming tissues of the body. Increased blood viscosity may occur secondary to the increased number of WBCs. Thrombocytopenia may occur secondary to the overproduction of WBCs in the bone marrow. The coagulation process is unaffected by leukemia.A boy with leukemia screams whenever he needs to be turned or moved. Which is the most probable cause of this pain? a. Edema b. Bone involvement c. Petechial hemorrhages d. Changes within the musclesb. Bone involvement The invasion of the bone marrow with leukemic cells gradually causes a weakening of the bone and a tendency toward fractures. As leukemic cells invade the periosteum, increasing pressure causes severe pain. Edema, petechial hemorrhages, and changes within the muscles would not cause severe pain.Myelosuppression, associated with chemotherapeutic agents or some malignancies such as leukemia, can cause bleeding tendencies because of a(n): a. decrease in leukocytes. b. increase in lymphocytes. c. vitamin C deficiency. d. decrease in blood platelets.d. decrease in blood platelets. The decrease in blood platelets secondary to the myelosuppression of chemotherapy can cause an increase in bleeding. The child and family should be alerted to avoid risk of injury. Decrease in leukocytes, increase in lymphocytes, and vitamin C deficiency would not affect bleeding tendencies.A child with leukemia is receiving triple intrathecal chemotherapy consisting of methotrexate, cytarabine, and hydrocortisone. The purpose of this is to prevent: a. infection. b. brain tumor. c. drug side effects. d. central nervous system (CNS) disease.d. central nervous system (CNS) disease. For certain children, CNS prophylactic therapy is indicated. This drug regimen is used to prevent CNS leukemia and will not prevent infection or drug side effects. If the child has a brain tumor in addition to leukemia, additional therapy would be indicated.Which is the most effective pain-management approach for a child who is having a bone marrow aspiration? a. Relaxation techniques b. Administration of an opioid c. EMLA cream applied over site d. Conscious or unconscious sedationd. Conscious or unconscious sedation Effective pharmacologic and nonpharmacologic measures should be used to minimize pain associated with procedures. For bone marrow aspiration, conscious or unconscious sedation should be used. Relaxation, opioids, and EMLA can be used to augment the conscious or unconscious sedation.Which immunization should not be given to a child receiving chemotherapy for cancer? a. Tetanus vaccine b. Inactivated poliovirus vaccine c. Diphtheria, pertussis, tetanus (DPT) d. Measles, rubella, mumpsd. Measles, rubella, mumps The vaccine used for measles, mumps, and rubella is a live virus and can result in an overwhelming infection. Tetanus vaccine, inactivated poliovirus vaccine, and diphtheria, pertussis, tetanus (DPT) are not live virus vaccines.Which is often administered to prevent or control hemorrhage in a child with cancer? a. Nitrosoureas b. Platelets c. Whole blood d. Corticosteroidsb. Platelets Most bleeding episodes can be prevented or controlled with the administration of platelet concentrate or platelet-rich plasma. Nitrosoureas, whole blood, and corticosteroids would not prevent or control hemorrhage.A school-age child with leukemia experienced severe nausea and vomiting when receiving chemotherapy for the first time. Which is the most appropriate nursing action to prevent or minimize these reactions with subsequent treatments? a. Encourage drinking large amounts of favorite fluids. b. Encourage child to take nothing by mouth (remain NPO) until nausea and vomiting subside. c. Administer an antiemetic before chemotherapy begins. d. Administer an antiemetic as soon as child has nausea.c. Administer an antiemetic before chemotherapy begins. The most beneficial regimen to minimize nausea and vomiting associated with chemotherapy is to administer the antiemetic before the chemotherapy is begun. The goal is to prevent anticipatory symptoms. Drinking fluids will add to the discomfort of the nausea and vomiting. Remaining until nausea and vomiting subside will help with this episode, but the child will have the discomfort and be at risk for dehydration. Administering an antiemetic as soon as the child has nausea does not prevent anticipatory nausea.Which is a common clinical manifestation of Hodgkin disease? a. Petechiae b. Bone and joint pain c. Painful, enlarged lymph nodes d. Enlarged, firm, nontender lymph nodesd. Enlarged, firm, nontender lymph nodes Asymptomatic, enlarged, cervical or supraclavicular lymphadenopathy is the most common presentation of Hodgkin disease. Petechiae are usually associated with leukemia. Bone and joint pain are not likely in Hodgkin disease. The enlarged nodes are rarely painful.The nurse is planning care for a school-age child admitted to the hospital with hemophilia. Which interventions should the nurse plan to implement for this child? (Select all that apply.) a. Finger sticks for blood work instead of venipunctures b. Avoidance of IM injections c. Acetaminophen (Tylenol) for mild pain control d. Soft tooth brush for dental hygiene e. Administration of packed red blood cellsb. Avoidance of IM injections c. Acetaminophen (Tylenol) for mild pain control d. Soft tooth brush for dental hygiene ANS: B, C, D Nurses should take special precautions when caring for a child with hemophilia to prevent the use of procedures that may cause bleeding, such as IM injections. The subcutaneous route is substituted for IM injections whenever possible. Venipunctures for blood samples are usually preferred for these children. There is usually less bleeding after the venipuncture than after finger or heel punctures. Neither aspirin nor any aspirin-containing compound should be used. Acetaminophen is a suitable aspirin substitute, especially for controlling mild pain. A soft toothbrush is recommended for dental hygiene to prevent bleeding from the gums. Packed red blood cells are not administered. The primary therapy for hemophilia is replacement of the missing clotting factor. The products available are factor VIII concentrates.Parents of a school-age child with hemophilia ask the nurse, "Which sports are recommended for children with hemophilia?" Which sports should the nurse recommend? (Select all that apply.) a. Soccer b. Swimming c. Basketball d. Golf e. Bowlingb. Swimming d. Golf e. Bowling ANS: B, D, E Because almost all persons with hemophilia are boys, the physical limitations in regard to active sports may be a difficult adjustment, and activity restrictions must be tempered with sensitivity to the child's emotional and physical needs. Use of protective equipment, such as padding and helmets, is particularly important, and noncontact sports, especially swimming, walking, jogging, tennis, golf, fishing, and bowling, are encouraged. Contact sport such as soccer and basketball are not recommended.Which should the nurse teach about prevention of sickle cell crises to parents of a preschool child with sickle cell disease? (Select all that apply.) a. Limit fluids at bedtime. b. Notify the health care provider if a fever of 38.5° C (101.3° F) or greater occurs. c. Give penicillin as prescribed. d. Use ice packs to decrease the discomfort of vasoocclusive pain in the legs. e. Notify the health care provider if your child begins to develop symptoms of a cold.b. Notify the health care provider if a fever of 38.5° C (101.3° F) or greater occurs. c. Give penicillin as prescribed. e. Notify the health care provider if your child begins to develop symptoms of a cold. ANS: B, C, E The most important issues to teach the family of a child with sickle cell anemia are to (1) seek early intervention for problems, such as a fever of 38.5° C (101.3° F) or greater; (2) give penicillin as ordered; (3) recognize signs and symptoms of splenic sequestration, as well as respiratory problems that can lead to hypoxia; and (4) treat the child normally. The nurse emphasizes the importance of adequate hydration to prevent sickling and to delay the adhesion-stasis-thrombosis-ischemia cycle. It is not sufficient to advise parents to "force fluids" or "encourage drinking." They need specific instructions on how many daily glasses or bottles of fluid are required. Many foods are also a source of fluid, particularly soups, flavored ice pops, ice cream, sherbet, gelatin, and puddings. Increased fluids combined with impaired kidney function result in the problem of enuresis. Parents who are unaware of this fact frequently use the usual measures to discourage bedwetting, such as limiting fluids at night. Enuresis is treated as a complication of the disease, such as joint pain or some other symptom, to alleviate parental pressure on the child. Ice should not be used during a vasoocclusive pain crisis because it vasoconstricts and impairs circulation even more.62. The client's nephew has just been diagnosed with sickle cell anemia. The client asks the nurse, "How did my nephew get this disease?" Which statement would be the best response by the nurse? 1. "Sickle cell anemia is an inherited autosomal recessive disease." 2. "He was born with it and both his parents were carriers of the disease." 3. "At this time, the cause of sickle cell anemia is unknown." 4. "Your sister was exposed to a virus while she was pregnant."1. This is the etiology for sickle cell anemia (SCA), but a layperson would not under- stand this explanation. ***2. This explains the etiology in terms that a layperson could understand. When both parents are carriers of the disease, each pregnancy has a 25% chance of producing a child who has sickle cell anemia. 3. The cause of SCA is known, and genetic counseling can explain it to the prospec- tive parent. 4. A virus does not cause sickle cell anemia. TEST-TAKING HINT: When discussing dis- ease processes with laypersons, the nurse should explain the facts in terms that the person can understand. Would a layperson know what "autosomal recessive" means? The test taker should consider terminol- ogy when selecting an answer. Content - Medical: Category of Health Alteration - Hematology: Integrated Nursing Process - Implementation: Client Needs - Safe Effective Care Environment, Management of Care: Cognitive Level - Application.63. The client diagnosed with sickle cell anemia comes to the emergency department complaining of joint pain throughout the body. The oral temperature is 102.4˚F and the pulse oximeter reading is 91%. Which action should the emergency room nurse implement first? 1. Request arterial blood gases STAT. 2. Administer oxygen via nasal cannula. 3. Start an IV with an 18-gauge angiocath. 4. Prepare to administer analgesics as ordered.1. The health-care provider could order STAT ABGs, but caring directly for the client is always the first priority. ***2. A pulse oximeter reading of less than 93% indicates hypoxia, which warrants oxygen administration. 3. The nurse should start an 18-gauge IV catheter because the client may need blood, but this is not the nurse's first intervention. 4. The medication will be administered intravenously, so the IV will have to be started before administering the medication. TEST-TAKING HINT: If the test taker can eliminate two (2) options and cannot decide between the other two (2), the test taker should apply a rule such as Maslow's hierarchy of needs and select the inter- vention that addresses oxygenation or airway. Content - Medical: Category of Health Alteration - Hematology: Integrated Nursing Process - Implementation: Client Needs - Safe Effective Care Environment, Management of Care: Cognitive Level - Synthesis.68. Which is a potential complication that occurs specifically to a male client diagnosed with sickle cell anemia during a sickle cell crisis? 1. Chest syndrome. 2. Compartment syndrome. 3. Priapism. 4. Hypertensive crisis.1. Chest syndrome refers to chest pain, fever, and a dry, hacking cough with or without pre-existing pneumonia, and is not a fatal complication. It can occur in either gender. 2. Compartment syndrome is a complication of a cast that has been applied too tightly or a fracture in which there is edema in a muscle compartment. ***3. This is a term that means painful and constant penile erection that can occur in male clients with SCA during a sickle cell crisis. 4. A hypertensive crisis is potentially fatal, but it is not a complication of SCA. The client with sickle cell anemia usually has cardiomegaly or systolic murmurs; both genders have this. TEST-TAKING HINT: This is a knowledge- based question, but if the test taker realized that priapism could only occur in males, this might help the test taker select option "3" as a correct answer. Whenever there is a gender for the client, it usually has something to do with the correct answer. Content - Medical: Category of Health Alteration - Hematology: Integrated Nursing Process - Diagnosis: Client Needs - Physiological Integrity, Physiological Adaptation: Cognitive Level - Analysis3. Which is most descriptive of the pathophysiology of leukemia? a. Increased blood viscosity occurs. b. Thrombocytopenia (excessive destruction of platelets) occurs. c. Unrestricted proliferation of immature white blood cells (WBCs) occurs. d. First stage of coagulation process is abnormally stimulated.c. Unrestricted proliferation of immature white blood cells (WBCs) occurs ANS: C Leukemia is a group of malignant disorders of the bone marrow and lymphatic system. It is defined as an unrestricted proliferation of immature WBCs in the blood-forming tissues of the body. Increased blood viscosity may occur secondary to the increased number of WBCs. Thrombocytopenia may occur secondary to the overproduction of WBCs in the bone marrow. The coagulation process is unaffected by leukemia. DIF: Cognitive Level: Understand REF: p. 826 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation4. A boy with leukemia screams whenever he needs to be turned or moved. Which is the most probable cause of this pain? a. Edema b. Bone involvement c. Petechial hemorrhages d. Changes within the musclesb. Bone involvement ANS: B The invasion of the bone marrow with leukemic cells gradually causes a weakening of the bone and a tendency toward fractures. As leukemic cells invade the periosteum, increasing pressure causes severe pain. Edema, petechial hemorrhages, and changes within the muscles would not cause severe pain. DIF: Cognitive Level: Analyze REF: p. 826 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation5. Myelosuppression, associated with chemotherapeutic agents or some malignancies such as leukemia, can cause bleeding tendencies because of a(n): a. decrease in leukocytes. b. increase in lymphocytes. c. vitamin C deficiency d. decrease in blood platelets..d. decrease in blood platelets. ANS: D The decrease in blood platelets secondary to the myelosuppression of chemotherapy can cause an increase in bleeding. The child and family should be alerted to avoid risk of injury. Decrease in leukocytes, increase in lymphocytes, and vitamin C deficiency would not affect bleeding tendencies. DIF: Cognitive Level: Apply REF: p. 828 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation6. A child with leukemia is receiving triple intrathecal chemotherapy consisting of methotrexate, cytarabine, and hydrocortisone. What will the triple intrathecal chemotherapy prevent? a. Infection b. Brain tumor c. Drug side effects d. Central nervous system (CNS) diseased. Central nervous system (CNS) disease ANS: D For certain children, CNS prophylactic therapy is indicated. This drug regimen is used to prevent CNS leukemia and will not prevent infection or drug side effects. If the child has a brain tumor in addition to leukemia, additional therapy would be indicated. DIF: Cognitive Level: Analyze REF: p. 831 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies8. Which is the most effective pain-management approach for a child who is having a bone marrow aspiration? a. Relaxation techniques b. Administration of an opioid c. EMLA cream applied over site d. Conscious or unconscious sedationd. Conscious or unconscious sedation ANS: D Effective pharmacologic and nonpharmacologic measures should be used to minimize pain associated with procedures. For bone marrow aspiration, conscious or unconscious sedation should be used. Relaxation, opioids, and EMLA can be used to augment the conscious or unconscious sedation. DIF: Cognitive Level: Apply REF: p. 824 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies9. Which immunization should not be given to a child receiving chemotherapy for cancer? a. Tetanus vaccine b. Inactivated poliovirus vaccine c. Diphtheria, pertussis, tetanus (DPT) d. Measles, rubella, mumpsd. Measles, rubella, mumps ANS: D The vaccine used for measles, mumps, and rubella is a live virus and can result in an overwhelming infection. Tetanus vaccine, inactivated poliovirus vaccine, and diphtheria, pertussis, tetanus (DPT) are not live virus vaccines. DIF: Cognitive Level: Apply REF: p. 825 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies10. Which is often administered to prevent or control hemorrhage in a child with cancer? a. Nitrosoureas b. Platelets c. Whole blood d. Corticosteroidsb. Platelets ANS: B Most bleeding episodes can be prevented or controlled with the administration of platelet concentrate or platelet-rich plasma. Nitrosoureas, whole blood, and corticosteroids would not prevent or control hemorrhage. DIF: Cognitive Level: Apply REF: p. 826 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies12. A school-age child with leukemia experienced severe nausea and vomiting when receiving chemotherapy for the first time. Which is the most appropriate nursing action to prevent or minimize these reactions with subsequent treatments? a. Encourage drinking large amounts of favorite fluids. b. Encourage child to take nothing by mouth (remain NPO) until nausea and vomiting subside. c. Administer an antiemetic before chemotherapy begins. d. Administer an antiemetic as soon as child has nausea.c. Administer an antiemetic before chemotherapy begins ANS: C The most beneficial regimen to minimize nausea and vomiting associated with chemotherapy is to administer the antiemetic before the chemotherapy is begun. The goal is to prevent anticipatory symptoms. Drinking fluids will add to the discomfort of the nausea and vomiting. Waiting until nausea and vomiting subside will help with this episode, but the child will have the discomfort and be at risk for dehydration. Administering an antiemetic as soon as the child has nausea does not prevent anticipatory nausea. DIF: Cognitive Level: Apply REF: p. 826 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies.17. The nurse is admitting a child with a Wilms tumor. Which is the initial assessment finding associated with this tumor? a. Abdominal swelling b. Weight gain c. Hypotension d. Increased urinary outputa. Abdominal swelling ANS: A The initial assessment finding with a Wilms (kidney) tumor is abdominal swelling. Weight loss, not weight gain, may be a finding. Hypertension occasionally occurs with a Wilms tumor. Urinary output is not increased, but hematuria may be noted. DIF: Cognitive Level: Understand REF: p. 820 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation15. Which is a common clinical manifestation of Hodgkin disease? a. Petechiae b. Bone and joint pain c. Painful, enlarged lymph nodes d. Enlarged, firm, nontender lymph nodesd. Enlarged, firm, nontender lymph nodes ANS: D Asymptomatic, enlarged, cervical or supraclavicular lymphadenopathy is the most common presentation of Hodgkin disease. Petechiae are usually associated with leukemia. Bone and joint pain are not likely in Hodgkin disease. The enlarged nodes are rarely painful. DIF: Cognitive Level: Understand REF: p. 829 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation20. The nurse is teaching nursing students about childhood nervous system tumors. Which best describes a neuroblastoma? a. Diagnosis is usually made after metastasis occurs. b. Early diagnosis is usually possible because of the obvious clinical manifestations. c. It is the most common brain tumor in young children. d. It is the most common benign tumor in young children.ANS: A Neuroblastoma is a silent tumor with few symptoms. In more than 70% of cases, diagnosis is made after metastasis occurs, with the first signs caused by involvement in the nonprimary site. In only 30% of cases is diagnosis made before metastasis. Neuroblastomas are the most common malignant extracranial solid tumors in children. The majority of tumors develop in the adrenal glands or the retroperitoneal sympathetic chain. They are not benign but metastasize. DIF: Cognitive Level: Apply REF: p. 835 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation21. The nurse is monitoring a 7-year-old child post surgical resection of an infratentorial brain tumor. Which vital sign findings indicate Cushing's triad? a. Increased temperature, tachycardia, tachypnea b. Decreased temperature, bradycardia, bradypnea c. Bradycardia, hypertension, irregular respirations d. Bradycardia, hypotension, tachypneac. Bradycardia, hypertension, irregular respirations ANS: C Cushing's triad is a hallmark sign of increased intracranial pressure (ICP). The triad includes bradycardia, hypertension, and irregular respirations. Increased or decreased temperature is not a sign of Cushing's triad. DIF: Cognitive Level: Understand REF: p. 831 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation22. In which position should the nurse place a 10-year-old child after a large tumor was removed through a supratentorial craniotomy? a. On the inoperative side with the bed flat b. On the inoperative side with the head of bed elevated 20 to 30 degrees c. On the operative side with the bed flat and pillows behind the head d. On the operative side with the head of bed elevated 45 degreesb. On the inoperative side with the head of bed elevated 20 to 30 degrees ANS: B If a large tumor was removed, the child is not placed on the operative side because the brain may suddenly shift to that cavity, causing trauma to the blood vessels, linings, and the brain itself. The child with an infratentorial procedure is usually positioned on either side with the bed flat. When a supratentorial craniotomy is performed, the head of bed is elevated 20 to 30 degrees with the child on either side or on the back. In a supratentorial craniotomy, the head elevation facilitates CSF drainage and decreases excessive blood flow to the brain to prevent hemorrhage. Pillows should be placed against the child's back, not head, to maintain the desired position. DIF: Cognitive Level: Apply REF: p. 831 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation23. A nurse is conducting a staff in-service on childhood cancers. Which is the primary site of osteosarcoma? a. Femur b. Humerus c. Pelvis d. Tibiaa. Femur ANS: A Osteosarcoma is the most frequently encountered malignant bone cancer in children. The peak incidence is between ages 10 and 25 years. More than half occur in the femur. After the femur, most of the remaining sites are the humerus, tibia, pelvis, jaw, and phalanges. DIF: Cognitive Level: Understand REF: p. 836 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential24. The nurse is taking care of an adolescent with osteosarcoma. The parents ask the nurse about treatment. The nurse should make which accurate response about treatment for osteosarcoma? a. Treatment usually consists of surgery and chemotherapy. b. Amputation of the affected extremity is rarely necessary. c. Intensive irradiation is the primary treatment. d. Bone marrow transplantation offers the best chance of long-term survival.a. Treatment usually consists of surgery and chemotherapy. ANS: A The optimal therapy for osteosarcoma is a combination of surgery and chemotherapy. Intensive irradiation and bone marrow transplantation are usually not part of the therapeutic management. DIF: Cognitive Level: Understand REF: p. 836 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation25. An adolescent with osteosarcoma is scheduled for a leg amputation in 2 days. The nurse's approach should include which action? a. Answering questions with straightforward honesty b. Avoiding discussing the seriousness of the condition c. Explaining that, although the amputation is difficult, it will cure the cancer d. Assisting the adolescent in accepting the amputation as better than a long course of chemotherapya. Answering questions with straightforward honesty ANS: A Honesty is essential to gain the child's cooperation and trust. The diagnosis of cancer should not be disguised with falsehoods. The adolescent should be prepared for the surgery so he or she has time to reflect on the diagnosis and subsequent treatment. This allows questions to be answered. To accept the need for radical surgery, the child must be aware of the lack of alternatives for treatment. Amputation is necessary, but it will not guarantee a cure. Chemotherapy is an integral part of the therapy with surgery. The child should be informed of the need for chemotherapy and its side effects before surgery. DIF: Cognitive Level: Apply REF: p. 836 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance26. The nurse is caring for an adolescent with osteosarcoma being admitted to undergo chemotherapy. The adolescent had a right above-the-knee amputation 2 months ago and has been experiencing "phantom limb pain." Which prescribed medication is appropriate to administer to relieve phantom limb pain? a. Amitriptyline (Elavil) b. Hydrocodone (Vicodin) c. Oxycodone (OxyContin) d. Alprazolam (Xanax)a. Amitriptyline (Elavil) ANS: A Amitriptyline (Elavil) has been used successfully to decrease phantom limb pain. Opioids such as Vicodin or OxyContin would not be prescribed for this pain. A benzodiazepine, Xanax, would not be prescribed for this type of pain. DIF: Cognitive Level: Apply REF: p. 836 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies1. The nurse is preparing to give oral care to a school-age child with mucositis secondary to chemotherapy administered to treat leukemia. Which preparations should the nurse use for oral care on this child? (Select all that apply.) a. Chlorhexidine gluconate (Peridex) b. Lemon glycerin swabs c. Antifungal troches (lozenges) d. Lip balm (Aquaphor) e. Hydrogen peroxidea. Chlorhexidine gluconate (Peridex) c. Antifungal troches (lozenges) d. Lip balm (Aquaphor) ANS: A, C, D Preparations that may be used to prevent or treat mucositis include chlorhexidine gluconate (Peridex) because of its dual effectiveness against candidal and bacterial infections, antifungal troches (lozenges) or mouthwash, and lip balm (e.g., Aquaphor) to keep the lips moist. Agents that should not be used include lemon glycerin swabs (irritate eroded tissue and can decay teeth), hydrogen peroxide (delays healing by breaking down protein), and milk of magnesia (dries mucosa). DIF: Cognitive Level: Apply REF: p. 819 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity: Physiologic AdaptationAt a follow-up visit for an 8-year-old who is being evaluated for short stature, the nurse measures and plots the child's height on the growth chart. Which explanation should the nurse give the child and family? 1."We want to make sure you were measured accurately the last two visits." 2."We need to calculate how tall you will be when you grow to adult height." 3."We need to see how much you have grown since your last visit." 4."We need to know your height so that a dosage of medication can be calculated for you."3."We need to see how much you have grown since your last visit."What key information should be explained to the family of a 3-year-old who has short stature and abnormal laboratory test results? 1.Due to the diurnal rhythm of the body, growth hormone levels are elevated following the onset of sleep. 2.Exercise can stimulate growth hormone secretion. 3.The initial screening tests need to be repeated for accuracy. 4.Growth hormone levels in children are so low that stimulation testing must be done.4.Growth hormone levels in children are so low that stimulation testing must be done.A 6-year-old white girl comes with her mother for evaluation of her acne, breast buds, axillary hair, and body odor. What information should the nurse explain to them? 1. This is a typical age for girls to go into puberty. 2. Encourage the girl to dress and act appropriately for her chronological age. 3. She should be on birth control as she is fertile. 4. She may be short if her epiphyses close early.2. Encourage the girl to dress and act appropriately for her chronological age.A nurse is caring for an infant who is very fussy and has a diagnosis of diabetes in- sipidus (DI). Which parameter should the nurse monitor while the infant is on fluid restrictions? 1. Oral intake. 2. Urine output. 3. Appearance of the mucous membranes. 4. Pulse and temperature.2. Urine output.A 12-year-old comes to the clinic with a diagnosis of Graves disease. What information should the nurse discuss with the child? 1. Suggest weight loss. 2. Encourage attending school. 3. Emphasize that the disease will go into remission .4. Encourage the child to take responsibility for daily medications.4. Encourage the child to take responsibility for daily medications.The school nurse notices that a 14-year-old who used to be an excellent student and very active in sports is losing weight and acting very nervous. The teen was recently checked by the primary care provider (PCP), who noted the teen had a very low level of TSH. The nurse recognizes that the teen has which condition? 1. Hashimoto thyroid disease. 2. Graves disease. 3. Hypothyroidism. 4. Juvenile autoimmune thyroiditis.2. Graves disease.A newborn develops tetany and has a seizure prior to discharge from the nursery. The newborn is diagnosed with hypocalcemia secondary to hypoparathyroidism and is started on calcium and vitamin D. Which information would be most important for the nurse to teach the parents? 1. They should observe the baby for signs of tetany and seizures. 2. They should observe for weakness, nausea, vomiting, and diarrhea. 3. They should administer the calcium and vitamin D daily as prescribed. 4. They should call the clinic if they have any questions about care of the newborn.2. They should observe for weakness, nausea, vomiting, and diarrhea.A teen who was hospitalized for chronic renal failure (CRF) develops symptoms of polyuria, polydipsia, and bone pain. Which body mineral might be causing these symptoms? 1. Elevated calcium. 2. Low phosphorus. 3. Low magnesium. 4. High aluminum hydroxide.1. Elevated calcium.The family of a young child has been told the child has diabetes insipidus (DI). What information should the nurse emphasize to the family? 1. One caregiver needs to learn to give the injections of vasopressin. 2. Children should wear MedicAlert tags if they are over 5 years old. 3. Diabetes insipidus is different from diabetes mellitus. 4. Over time, the child may grow out of the need for medication.3. Diabetes insipidus is different from diabetes mellitus.A nurse is working with a child who has had a bone age evaluation. Which explanation of the test should the nurse give? 1. "The bone age will give you a diagnosis of your child's short stature." 2. "If the bone age is delayed, the child will continue to grow taller." 3. "The x-ray of the bones is compared with that of the age-appropriate, standardized bone age." 4. "If the bone age is not delayed, no further treatment is needed."3. "The x-ray of the bones is compared with that of the age-appropriate, standardized bone age."Which descriptive terms should be used to describe a school-aged child with myxedematous skin/eyes/hair changes? 1. The skin is oily and scaly. 2. The skin has pale, thickened patches. 3. The eyes are sunken, and the hair is thickened. 4. The eyes are puffy, the hair is sparse, and the skin is dry.4. The eyes are puffy, the hair is sparse, and the skin is dry.A child is brought to the ED with what is presumed to be acute adrenocortical insufficiency. Which of the following should the nurse do first? 1. Insert an IV line to administer fluids and cortisol. 2. Prepare for admission to the intensive care unit. 3. Indicate the likelihood of a slow recovery 4. Discuss the likelihood of the child's imminent death.1. Insert an IV line to administer fluids and cortisol.A child with Addison disease takes oral cortisol supplements and receives monthly injections of desoxycorticosterone acetate injections. What teaching should be done at each visit for the injections? 1. "Keep an extra month's supply of all medications on hand at all times." 2. "Wear a MedicAlert bracelet at all times." 3. "The drug has a bitter taste." 4. "Weight gain is inevitable."1. "Keep an extra month's supply of all medications on hand at all times."The nurse is instructing a family on the side effects of oral cortisone. What aspects of administering the medication should the nurse emphasize? 1. Weight gain and dietary management. 2. Bitterness of the taste of the medication. 3. Excitability results from the medication. 4. Taking the medication with food to decrease gastric irritation.4. Taking the medication with food to decrease gastric irritation.An infant is born with ambiguous genitalia. Genetic testing and an ultrasound are or- dered. The infant has a large clitoris, but there is no vaginal orifice. The labia appear to be sac-like, darkened tissue. No testes are located. What suggestion should the nurse offer the family? 1. Take the baby home, and wait until the gender is determined to name it. 2. Because the parents wanted a boy, give the baby a boy's name. 3. Give the baby a neutral name that fits either a boy or a girl. 4. Call the infant baby until they know the gender.3. Give the baby a neutral name that fits either a boy or a girl.A baby has hypertension as a result of partial 21-hydroxylase deficiency. The parents ask the nurse to clarify why the baby is being sent home on cortisone. Which is the nurse's best response about cortisone? It: 1. Increases the utilization of fatty acids for energy. 2. Depresses the secretion of ACTH. 3. Stimulates the adrenal glands. 4. Increases the response to inflammation.2. Depresses the secretion of ACTH.A school-aged child is diagnosed with bilateral pheochromocytomas. Which clinical manifestations should the nurse check for in this child? 1. Hypertension headache, and decreased gastrointestinal activity. 2. Hypoglycemia, lethargy, and increased gastrointestinal activity. 3. Bradycardia, diarrhea, and weight gain. 4. Hypotension, constipation, and anuria.1. Hypertension headache, and decreased gastrointestinal activity.A teen comes into the clinic with complaints of having been under a lot of stress recently. The teen is being treated for Addison disease and is taking cortisol and aldosterone orally. Today, the teen shows symptoms of muscle weakness, fatigue, salt craving, and dehydration. What should the nurse discuss with the teen regarding the medications? 1. The dosages may need to be decreased in times of stress. 2. The dosages may need to be increased in times of stress. 3. The aldosterone should be stopped, and the cortisol should be increased. 4. The cortisol may need to be given IV to raise its level.2. The dosages may need to be increased in times of stress.A 6-year-old is diagnosed with growth hormone deficiency. A prescription is written for a dose of 0.025 mg/kg of somatotropin subcutaneously three times weekly. The child weighs 59.4 lb. Which dose of medication should the nurse administer three times weekly? 1. 0.5 mg. 2. 0.675 mg. 3. 1 mg. 4. 2 mg.2. 0.675 mg.Somatotropin comes in a vial of 5 mg and is mixed with a diluent of 5 mL. There is 5 mL of solution in each vial. What amount of the solution should the nurse draw up to give the appropriate dose each time? 1. 0.5 mL. 2. 0.675 mL. 3. 1 mL. 4. 2 mL.2. 0.675 mL.A 7-year-old is diagnosed with central precocious puberty. The child is to receive a monthly intramuscular (IM) injection of leuprolide acetate (Lupron). The child has great fear of pain and needles and requires considerable stress reduction techniques each time an injection is due. What could the nurse suggest that might help manage the pain? 1. Apply a eutectic mixture of local anesthetics (EMLA) of lidocaine and prilocaine to the site at least 60 minutes before the injection. 2. Have extra help on hand to help hold the child down. 3. Apply cold to the area prior to injection. 4. Identify a reward to bribe the child to behave during the injection.1. Apply a eutectic mixture of local anesthetics (EMLA) of lidocaine and prilocaine to the site at least 60 minutes before the injection.A child weighs 21 kg. The parent asks for the weight in pounds. Which is the correct equivalent? 1. 9.5 lb. 2. 46.2 lb 3. 50 lb. 4. 60 lb.2. 46.2 lbParents bring their teen to the clinic with a tender, enlarged right breast. The nurse explains that which hormone(s) secreted by the anterior pituitary influence(s) this process? Select all that apply. 1. Thyrotropin. 2. Gonadotropin. 3. Oxytocin. 4. Somatotropin.2. Gonadotropin.A toddler is admitted to the pediatric floor for hypopituitarism following removal of a craniopharyngioma. The toddler has polyuria, polydipsia, and dehydration. Which area of the brain was most affected by the surgery? 1. Posterior pituitary. 2. Anterior pituitary. 3. Autonomic nervous system. 4. Sympathetic nervous system.1. Posterior pituitary.Which hormone(s) does the anterior pituitary secrete? Select all that apply. 1. Thyroxine. 2. Luteinizing hormone. 3. Prolactin (luteotropic hormone). 4. ACTH. 5. Epinephrine. 6. Cortisol.2,3,4The adrenal cortex secretes sex hormones. Identify which hormones would result in feminization of a young male child. Select all that apply. 1. Estrogen. 2. Testosterone. 3. Progesterone. 4. Cortisol. 5. Androgens.1,3Which test(s) could be utilized to determine cortisol levels in a child with suspected Cushing syndrome? Select all that apply. 1. Fasting blood glucose. 2. Thyroid panel (TSH, T3, T4). 3. 24-hour urine for 17-hydroxycorticoids. 4. Radiographic studies of the bones. 5. Cortisone suppression test. 6. Urine culture. 7. Complete blood count.3,5A teen comes into the clinic with anxiety. Over the last 2 weeks, the teen has had some muscle twitching and has a positive Chvostek sign. Which explanation could the nurse provide to the parent about a Chvostek sign? 1. It is a facial muscle spasm elicited by tapping the facial nerve. 2. Muscle pain that occurs when touched. 3. The sign occurs because of increased intracranial pressure. 4. The sign is a result of a vitamin D overdose.1. It is a facial muscle spasm elicited by tapping the facial nerve.A school-aged girl is working on a school project on glands and asks the clinic nurse to explain the function of the thymus gland. Which answer would the nurse provide her? 1. It produces hormones that help with digestion. 2. It is a gland that disappears by the time a baby is born. 3. A major function is to stimulate the pituitary to act as the master gland. 4. The gland helps with immunity in fetal life and early childhood.4. The gland helps with immunity in fetal life and early childhood.A parent with a toddler who has ambiguous genitalia asks the nurse how long it will be before the child identifies his or her gender. Which is the best answer? 1. "A child does not know his or her gender until he or she is a teen." 2. "A child knows his or her gender by the age of 18 to 30 months." 3. "A child knows from the time of birth what his or her gender is." 4. "A child of 4 to 6 years is beginning to learn his or her gender."2. "A child knows his or her gender by the age of 18 to 30 months."According to the growth chart below, an 8-kg boy who is 9 months old is in the ____________ percentile of weight-for-age?10th percentileThe parent brings the growth record along with the 21-month-old child to a new clinic for a well-child visit. The record shows a birth weight of 8 lb; the 6-month weight was 16 lb; the 12-month weight was 18 lb; and the 15-month weight was 19 lb. With the record showing that the toddler's weight-for-age has been decreasing, the nurse should do what initially? 1. Omit plotting the previous weight-for-age on the new growth chart. 2. Point out the growth chart to the new health-care provider (HCP). 3. Consider the toddler a child with failure to thrive. 4. Weigh the child, and plot on a new growth chart.2. Point out the growth chart to the new health-care provider (HCP).The thyroid gland secretes two types of hormones, thyroid hormone (TH) and thyrocalcitonin (TC). Mark TH or TC in the correct spaces below. 1.____________ This hormone regulates the metabolic rate of all cells. 2.___________ This hormone regulates body heat production. 3.____________ This hormone affects milk production during lactation; it also affects menstrual flow. 4.____________ This hormone maintains calcium metabolism. 5.____________ This hormone affects appetite and the secretion of gastrointestinal substances. 6.___________ This hormone increases gluconeogenesis and utilization of glucose.1. TH 2. TH 3. TC 4. TC 5. TH 6. THA child with adrenal insufficiency is sick with influenza. The parent calls the office and wants to know what to do. What is the first thing the nurse should advise this parent? 1. Withhold all medications, and bring the child to the office. 2. Encourage the child to drink water and juices. 3. Give the child a dose of hydrocortisone, and bring the child to the office. 4. Let the child rest; the child will be better in the morning.3. Give the child a dose of hydrocortisone, and bring the child to the office.A toddler is being evaluated for syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should observe the child for which symptoms? Select all that apply. 1. Dehydration. 2. Fluid retention. 3. Hyponatremia. 4. Hypoglycemia. 5. Myxedema.2,3What should the parent of a child with diabetes insipidus (DI) be taught about administering desmopressin acetate nasal spray? Select all that apply. 1. The use of the flexible nasal tube. 2. Nasal congestion causes this route to be ineffective. 3. The medication should be administered every 48 hours. 4. The medication should be administered every 8 to 12 hours. 5. Overmedication results in signs of SIADH. 6. Nasal sprays do not always work as well as injections.1,2,4,5A school-aged child comes in with a sore throat and fever. The child was recently diagnosed with Graves disease and is taking propylthiouracil. What concerns should the nurse have about this child? 1. The child must not be taking her medication. 2. The child may have leukopenia. 3. The child needs to start an antibiotic. 4. The child is not getting enough sleep.2. The child may have leukopenia.An 8-year-old with type 1 diabetes mellitus is complaining of a headache and dizzi- ness and is visibly perspiring. Which of the following should the nurse do first? 1. Administer glucagon intramuscularly. 2. Offer the child 8 oz of milk. 3. Administer rapid-acting insulin lispro (Humalog). 4. Offer the child 8 oz of water or calorie-free liquid.2. Offer the child 8 oz of milk.The nurse is caring for a 10-year-old post parathyroidectomy. Discharge teaching should include which of the following? 1. How to administer injectable growth hormone. 2. The importance of supplemental calcium in the diet. 3. The importance of increasing iodine in the diet. 4. How to administer subcutaneous insulin.2. The importance of supplemental calcium in the diet.The nurse is teaching the family about caring for their 7-year-old, who has been diagnosed with type 1 diabetes mellitus. What information should the nurse provide about this condition? 1. Best managed through diet, exercise, and oral medication. 2. Can be prevented by proper nutrition and monitoring blood glucose levels. 3. Characterized mainly by insulin resistance. 4. Characterized mainly by insulin deficiency.4. Characterized mainly by insulin deficiency.The most appropriate nursing diagnosis for a child with type 1 diabetes mellitus is which of the following? 1. Risk for infection related to reduced body defenses. 2. Impaired urinary elimination (enuresis). 3. Risk for injury related to medical treatment. 4. Anticipatory grieving.1. Risk for infection related to reduced body defenses.The nurse caring for a patient with type 1 diabetes mellitus is teaching how to self- administer insulin. Which is the proper injection technique? 1. Position the needle with the bevel facing downward before injection. 2. Spread the skin prior to intramuscular injection. 3. Aspirate for blood return prior to injection. 4. Elevate the subcutaneous tissue before injection.4. Elevate the subcutaneous tissue before injection.The nurse is caring for a child who complains of constant hunger, constant thirst, frequent urination, and recent weight loss without dieting. Which can the nurse expect to be included in care for this child? 1. Limiting daily fluid intake. 2. Weight management consulting. 3. Strict intake and output monitoring. 4. Frequent blood glucose testing.4. Frequent blood glucose testing.The nurse is obtaining the medical history of an 11-year-old diagnosed with hypopi- tuitarism. An important question for the nurse to ask the parents is which of the following? 1. "Is the child receiving vasopressin intramuscularly or subcutaneously?" 2. "What time of day do you administer growth hormone?" 3. "Does your child have any concerns about being taller than the peer group?" 4. "How often is your child testing blood glucose?"2. "What time of day do you administer growth hormone?"Which is an important nursing intervention for a child with a diagnosis of hyperthyroidism? 1. Encourage an increase in physical activity. 2. Do pre-operative teaching for thyroidectomy. 3. Promote opportunities for periods of rest. 4. Do dietary planning to increase caloric intake.3. Promote opportunities for periods of rest.A 13-year-old with type 2 diabetes mellitus asks the nurse, "Why do I need to have this hemoglobin A1c test?" The nurse's response is based on which of the following? 1. To determine how balanced the child's diet has been. 2. To make sure the child is not anemic. 3. To determine how controlled the child's blood sugar has been. 4. To make sure the child's blood ketone level is normal.3. To determine how controlled the child's blood sugar has been.The nurse caring for a 14-year-old girl with diabetes insipidus (DI) understands which of the following about this disorder? 1. DI is treated on a short-term basis with hormone replacement therapy. 2. DI may cause anorexia if proper meal planning is not addressed. 3. DI is treated with vasopressin on a lifelong basis. 4. DI requires strict fluid limitation until it resolves.3. DI is treated with vasopressin on a lifelong basis.A 7-year-old is tested for diabetes insipidus (DI). Twenty-four hours after his fluid restriction has begun, the nurse notes that his urine continues to be clear and pale, with a low specific gravity. Which is the most likely reason for this? 1. Twenty-four hours is too early to evaluate effects of fluid restriction. 2. The urine should be concentrated, and it is unlikely the child has DI. 3. The child may have been sneaking fluids and needs closer observation. 4. In DI, fluid restriction does not cause urine concentration.4. In DI, fluid restriction does not cause urine concentration.The nurse has completed discharge teaching for the family of a 10-year-old diag- nosed with diabetes insipidus (DI). Which statement best demonstrates the family's correct understanding of DI? 1. "The disease was probably brought on by a bad diet and little exercise." 2. "Diabetes seems to run in my family, and that may be why my child has it." 3. "My child will need to check blood sugar several times a day." 4. "My child will have to use the bathroom more often than other children."4. "My child will have to use the bathroom more often than other children."The nurse is interviewing the parent of a 9-year-old girl. The parent expresses con- cern because the daughter already has pubic hair and is starting to develop breasts. Which statement would be most appropriate? 1. "Your daughter should get her period in approximately 6 months." 2. "Your daughter is developing early and should be evaluated for precocious puberty." 3. "Your daughter is experiencing body changes that are appropriate for her age." 4. "Your daughter will need further testing to determine the underlying cause."3. "Your daughter is experiencing body changes that are appropriate for her age."The nurse is taking care of a 10-year-old diagnosed with Graves disease. Which could the nurse expect this child to have recently had? 1. Weight gain, excessive thirst, and excessive hunger. 2. Weight loss, difficulty sleeping, and heat sensitivity. 3. Weight gain, lethargy, and goiter. 4. Weight loss, poor skin turgor, and constipation.2. Weight loss, difficulty sleeping, and heat sensitivity.A 12-year-old with type 2 diabetes mellitus presents with a fever and a 2-day history of vomiting. The nurse observes that the child's breath has a fruity odor and breath- ing is deep and rapid. Which should the nurse do first? 1. Offer the child 8 oz of clear non-caloric fluid. 2. Test the child's urine for ketones. 3. Prepare the child for an IV infusion. 4. Offer the child 25 g of carbohydrates.3. Prepare the child for an IV infusion.Which would the school nurse expect in a student who has an insulin-to-carbohydrate ratio of 1:10? 1. The student administers 10 U of regular insulin for every gram of carbohydrate consumed. 2. The student is trying to limit carbohydrate intake to 10 g per insulin dose. 3. The student administers 1 U of regular insulin for every 10 grams of carbohydrate consumed. 4. The student plans to eat 10 g of carbohydrate for every dose of insulin.3. The student administers 1 U of regular insulin for every 10 grams of carbohydrate consumed.Which is the reason a student takes metformin (Glucophage) three times a day? 1. Type 1 diabetes mellitus. 2. Diabetes insipidus. 3. Inflammatory bowel disease. 4. Type 2 diabetes mellitus.4. Type 2 diabetes mellitus.Which is the most likely reason an adolescent with diabetes has problems with low self-esteem? 1. Managing diabetes decreases independence. 2. Managing diabetes complicates perceived ability to "fit in." 3. Obesity complicates perceived ability to "fit in." 4. Hormonal changes are exacerbated by fluctuations in insulin levels.2. Managing diabetes complicates perceived ability to "fit in."The school nurse is talking to a 14-year-old about managing type 1 diabetes mellitus. Which statement indicates the student's understanding of the disease? 1. "It really does not matter what type of carbohydrate I eat as long as I take the right amount of insulin." 2. "I should probably have a snack right after gym class." 3. "I need to cut back on my carbohydrate intake and increase my lean protein intake." 4. "Losing weight will probably help me decrease my need for insulin."1. "It really does not matter what type of carbohydrate I eat as long as I take the right amount of insulin."The nurse is assigned to care for a newborn with goiter. The nurse's primary concern is which of the following? 1. Reassuring the parents that the condition is only temporary and will be treated with medication. 2. Maintaining a patent airway and preparing for emergency ventilation. 3. Preparing the infant for surgery and initiating pre-operative teaching with the parents. 4. Obtaining a detailed history, particularly of medications taken during the mother's pregnancy.2. Maintaining a patent airway and preparing for emergency ventilation.A 13-year-old is being seen for an annual physical examination. The child has lost10 lb despite reports of excellent appetite. Appearance is normal, except for slightly protruding eyeballs, and the parents report the child has had difficulty sleeping lately. The nurse should do which of the following? 1. Prepare the family for a neurology consult. 2. Explain the need for an ophthalmology consult. 3. Discuss the plan for thyroid function tests. 4. Explain the plan for an 8-hour fasting blood glucose test.3. Discuss the plan for thyroid function tests.A 12-year-old with hyperthyroidism is being treated with standard antithyroid drug therapy. A parent calls the office stating that the child has a sore throat and fever. Which is the nurse's best response? 1. "Bring your child to the office or emergency room immediately." 2. "Slight fever and sore throat are normal side effects of the medication." 3. "Give your child the appropriate dose of ibuprofen, and call back if symptoms worsen." 4. "Give your child at least 8 oz of clear fluids, and call back if symptoms worsen."1. "Bring your child to the office or emergency room immediately."Hypofunction of which endocrine gland might cause type 2 diabetes mellitus?pancreasHyperfunction of which endocrine gland might cause Cushing syndrome?adrenalExophthalmic goiter is caused by hyperfunction of which endocrine gland?thyroid1. Parents of a toddler with hypopituitarism ask the nurse, "What can we expect with this condition?" The nurse should respond with which statement? a. Growth is normal during the first 3 years of life. b. Weight is usually more retarded than height. c. Skeletal proportions are normal for age. d. Most of these children have subnormal intelligence.c. Skeletal proportions are normal for age ANS: C In children with hypopituitarism, the skeletal proportions are normal. Growth is within normal limits for the first year of life. Height is usually more delayed than weight. Intelligence is not affected by hypopituitarism. DIF: Cognitive Level: Apply REF: p. 911 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation.2. A child with hypopituitarism is being started on growth hormone (GH) therapy. Nursing considerations should be based on which knowledge? a. Treatment is most successful if it is started during adolescence. b. Treatment is considered successful if children attain full stature by adulthood. c. Replacement therapy requires daily subcutaneous injections. d. Replacement therapy will be required throughout the child's lifetime.c. Replacement therapy requires daily subcutaneous injections. ANS: C Additional support is required for children who require hormone replacement therapy, such as preparation for daily subcutaneous injections and education for self-management during the school-age years. Young children, obese children, and those who are severely GH deficient have the best response to therapy. When therapy is successful, children can attain their actual or near-final adult height at a slower rate than their peers. Replacement therapy is not needed after attaining final height. They are no longer GH deficient. DIF: Cognitive Level: Analyze REF: p. 911 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies3. A child with growth hormone (GH) deficiency is receiving GH therapy. When is the best time for the GH to be administered? a. At bedtime b. After meals c. Before meals d. On arising in the morninga. At bedtime ANS: A Injections are best given at bedtime to more closely approximate the physiologic release of GH. After or before meals and on arising in the morning do not mimic the physiologic release of the hormone. DIF: Cognitive Level: Apply REF: p. 911 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies4. An adolescent is being seen in the clinic for evaluation of acromegaly. The nurse understands that which occurs with acromegaly? a. There is a lack of growth hormone (GH) being produced. b. There is excess growth hormone (GH) after closure of the epiphyseal plates. c. There is an excess of growth hormone (GH) before the closure of the epiphyseal plates. d. There is a lack of thyroid hormone being produced.b. There is excess growth hormone (GH) after closure of the epiphyseal plates. ANS: B Excess GH after closure of the epiphyseal plates results in acromegaly. A lack of growth hormone results in delayed growth or even dwarfism. Gigantism occurs when there is hypersecretion of GH before the closure of the epiphyseal plates. Cretinism is associated with hypothyroidism. DIF: Cognitive Level: Understand REF: p. 912 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential5. A child will start treatment for precocious puberty. The nurse recognizes that this will involve the injection of which synthetic medication? a. Thyrotropin b. Gonadotropins c. Somatotropic hormone d. Luteinizing hormone-releasing hormoned. Luteinizing hormone-releasing hormone ANS: D Precocious puberty of central origin is treated with monthly subcutaneous injections of luteinizing hormone-releasing hormone. Thyrotropin, gonadotropins, and somatotropic hormone are not the appropriate therapies for precocious puberty. DIF: Cognitive Level: Understand REF: p. 912 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies6. The nurse is conducting a staff in-service on childhood endocrine disorders. Diabetes insipidus is a disorder of: a. anterior pituitary. b. posterior pituitary. c. adrenal cortex. d. adrenal medulla.b. posterior pituitary. ANS: B The principal disorder of posterior pituitary hypofunction is diabetes insipidus. The anterior pituitary produces hormones such as GH, thyroid-stimulating hormone, adrenocorticotropic hormone, gonadotropin, prolactin, and melanocyte-stimulating hormone. The adrenal cortex produces aldosterone, sex hormones, and glucocorticoids. The adrenal medulla produces catecholamines. DIF: Cognitive Level: Understand REF: p. 912 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation7. The nurse is caring for a preschool child with suspected diabetes insipidus. Which clinical manifestation should the nurse expect to observe? a. Oliguria b. Glycosuria c. Nausea and vomiting d. Polyuria and polydipsiad. Polyuria and polydipsia ANS: D Excessive urination accompanied by insatiable thirst is the primary clinical manifestation of diabetes. These symptoms may be so severe that the child does little other than drink and urinate. Oliguria is decreased urine production and is not associated with diabetes insipidus. Glycosuria is associated with diabetes mellitus. Nausea and vomiting are associated with inappropriate antidiuretic hormone (ADH) secretion. DIF: Cognitive Level: Apply REF: p. 917 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation8. A nasal spray of desmopressin acetate (DDAVP) is used to treat which disorder? a. Hypopituitarism b. Diabetes insipidus c. Acute adrenocortical insufficiency d. Syndrome of inappropriate antidiuretic hormoneb. Diabetes insipidus ANS: B The drug of choice for the treatment of diabetes insipidus is DDAVP, which is a synthetic analogue of vasopressin. DDAVP is not used to treat hypopituitarism, acute adrenocortical insufficiency, or syndrome of inappropriate antidiuretic hormone. DIF: Cognitive Level: Understand REF: p. 917 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies9. The nurse is admitting a toddler with the diagnosis of juvenile hypothyroidism. Which is a common clinical manifestation of this disorder? a. Insomnia b. Diarrhea c. Dry skin d. Accelerated growthc. Dry skin ANS: C Dry skin, mental decline, and myxedematous skin changes are associated with juvenile hypothyroidism. Children with hypothyroidism are usually sleepy. Constipation is associated with hypothyroidism. Decelerated growth is common in juvenile hypothyroidism. DIF: Cognitive Level: Apply REF: p. 919 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation10. A goiter is an enlargement or hypertrophy of which gland? a. Thyroid b. Adrenal c. Anterior pituitary d. Posterior pituitarya. Thyroid ANS: A A goiter is an enlargement or hypertrophy of the thyroid gland. Goiter is not associated with the adrenal, anterior pituitary, or posterior pituitary organs. DIF: Cognitive Level: Remember REF: p. 919 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation11. What condition may cause exophthalmos (protruding eyeballs) in children? a. Hypothyroidism b. Hyperthyroidism c. Hypoparathyroidism d. Hyperparathyroidismb. Hyperthyroidism ANS: B Exophthalmos is a clinical manifestation of hyperthyroidism. Hypothyroidism, hypoparathyroidism, and hyperparathyroidism are not associated with exophthalmos. DIF: Cognitive Level: Understand REF: p. 920 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation12. The nurse is teaching the parents of a child who is receiving methimazole (Tapazole) for the treatment of hyperthyroidism (Graves disease). Which statement made by the parent indicates a correct understanding of the teaching? a. "I would expect my child to gain weight while taking this medication." b. "I would expect my child to experience episodes of ear pain while taking this medication." c. "If my child develops a sore throat and fever, I should contact the physician immediately." d. "If my child develops the stomach flu, my child will need to be hospitalized."c. "If my child develops a sore throat and fever, I should contact the physician ANS: C Children being treated with Tapazole must be carefully monitored for the side effects of the medication. Parents must be alerted that sore throat and fever accompany the grave complication of leukopenia. These symptoms should be immediately reported. Weight gain, episodes of ear pain, and concern for hospitalization with the stomach flu are not concerns related to taking Tapazole. DIF: Cognitive Level: Apply REF: p. 920 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies13. Which clinical manifestation may occur in the child who is receiving too much methimazole (Tapazole) for the treatment of hyperthyroidism (Graves disease)? a. Seizures b. Enlargement of all lymph glands c. Pancreatitis or cholecystitis d. Lethargy and somnolenced. Lethargy and somnolence ANS: D Parents should be aware of the signs of hypothyroidism that can occur from overdosage of the drug. The most common manifestations are lethargy and somnolence. Seizures and pancreatitis are not associated with the administration of Tapazole. Enlargement of the salivary and cervical lymph glands occurs. DIF: Cognitive Level: Apply REF: p. 920 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies14. A child with hypoparathyroidism is receiving vitamin D therapy. The parents should be advised to watch for which sign of vitamin D toxicity? a. Headache and seizures b. Physical restlessness and voracious appetite without weight gain c. Weakness and lassitude d. Anorexia and insomniac. Weakness and lassitude ANS: C Vitamin D toxicity can be a serious consequence of therapy. Parents are advised to watch for signs, including weakness, fatigue, lassitude, headache, nausea, vomiting, and diarrhea. Renal impairment is manifested through polyuria, polydipsia, and nocturia. Headaches may be a sign of vitamin D toxicity, but seizures are not. Physical restlessness and a voracious appetite with weight loss are manifestations of hyperthyroidism. Anorexia and insomnia are not characteristic of vitamin D toxicity. DIF: Cognitive Level: Apply REF: p. 921 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies15. What secretes glucocorticoids, mineralocorticoids, and sex steroids? a. Thyroid gland b. Parathyroid glands c. Adrenal cortex d. Anterior pituitaryc. Adrenal cortex ANS: C These hormones are secreted by the adrenal cortex. The thyroid gland produces thyroid hormone and thyrocalcitonin. The parathyroid gland produces parathyroid hormone. The anterior pituitary produces hormones such as GH, thyroid-stimulating hormone, adrenocorticotropic hormone, gonadotropin, prolactin, and melanocyte-stimulating hormone. DIF: Cognitive Level: Understand REF: p. 923 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation16. What is chronic adrenocortical insufficiency also called? a. Graves disease b. Addison disease c. Cushing syndrome d. Hashimoto diseaseb. Addison disease ANS: B Addison disease is chronic adrenocortical insufficiency. Graves and Hashimoto diseases involve the thyroid gland. Cushing syndrome is a result of excessive circulation of free cortisol. DIF: Cognitive Level: Remember REF: p. 924 TOP: Integrated Process: Nursing Process: Problem Identification MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation`17. A neonate born with ambiguous genitalia is diagnosed with congenital adrenogenital hyperplasia. What does therapeutic management include? a. Administration of vitamin D b. Administration of cortisone c. Administration of stool softeners d. Administration of calcium carbonateANS: B Cortisone is administered to suppress the abnormally high secretions of adrenocorticotropic hormone (ACTH). This in turn inhibits the secretion of adrenocorticosteroid, which stems the progressive virilization. Vitamin D, stool softeners, and calcium carbonate have no role in the therapy of adrenogenital hyperplasia. DIF: Cognitive Level: Understand REF: p. 923 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies18. The parents of a neonate with adrenogenital hyperplasia tell the nurse that they are afraid to have any more children. The nurse should explain which statement about adrenogenital hyperplasia? a. It is not hereditary. b. Genetic counseling is indicated. c. It can be prevented during pregnancy. d. All future children will have the disorder.b. Genetic counseling is indicated. ANS: B Some forms of adrenogenital hyperplasia are hereditary and should be referred for genetic counseling. Affected offspring should also be referred for genetic counseling. There is an autosomal recessive form of adrenogenital hyperplasia. A prenatal treatment with glucocorticoids can be offered to the mother during pregnancy to avoid the sex ambiguity, but it does not affect the presence of the disease. If it is the heritable form, for each pregnancy, a 25% risk occurs that the child will be affected. DIF: Cognitive Level: Apply REF: p. 923 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation19. Which is characteristic of the immune-mediated type 1 diabetes mellitus? a. Ketoacidosis is infrequent. b. Onset is gradual. c. Age at onset is usually younger than 20 years. d. Oral agents are often effective for treatment.c. Age at onset is usually younger than 20 years. ANS: C The immune-mediated type 1 diabetes mellitus typically has its onset in children or young adults. Infrequent ketoacidosis, gradual onset, and effectiveness of oral agents for treatment are more consistent with type 2 diabetes. DIF: Cognitive Level: Analyze REF: p. 931 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation20. Which is considered a cardinal sign of diabetes mellitus? a. Nausea b. Seizures c. Impaired vision d. Frequent urinationd. Frequent urination ANS: D Hallmarks of diabetes mellitus are glycosuria, polyuria, and polydipsia. Nausea and seizures are not clinical manifestations of diabetes mellitus. Impaired vision is a long-term complication of the disease. DIF: Cognitive Level: Understand REF: p. 936 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation21. Hyperglycemia associated with diabetic ketoacidosis is defined as a blood glucose measurement equal to or greater than _____ mg/dl. a. 100 b. 120 c. 180 d. 200d. 200 ANS: D Diabetic ketoacidosis is a state of relative insulin insufficiency and may include the presence of hyperglycemia, a blood glucose level greater than or equal to 200 mg/dl. The values 100 mg/dl, 120 mg/dl, and 180 mg/dl are too low for the definition of ketoacidosis. DIF: Cognitive Level: Understand REF: p. 940 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation22. Type 1 diabetes mellitus is suspected in an adolescent. Which clinical manifestation may be present? a. Moist skin b. Weight gain c. Fluid overload d. Poor wound healingd. Poor wound healing ANS: D Poor wound healing may be present in an individual with type 1 diabetes mellitus. Dry skin, weight loss, and dehydration are clinical manifestations of type 1 diabetes mellitus. DIF: Cognitive Level: Understand REF: p. 928 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation23. A parent asks the nurse why self-monitoring of blood glucose is being recommended for her child with diabetes. The nurse should base the explanation on which knowledge? a. It is a less expensive method of testing. b. It is not as accurate as laboratory testing. c. Children are better able to manage the diabetes. d. Parents are better able to manage the disease.c. Children are better able to manage the diabetes. ANS: C Blood glucose self-management has improved diabetes management and can be used successfully by children from the time of diagnosis. Insulin dosages can be adjusted based on blood glucose results. Blood glucose monitoring is more expensive but provides improved management. It is as accurate as equivalent testing done in laboratories. The ability to self-test allows the child to balance diet, exercise, and insulin. The parents are partners in the process, but the child should be taught how to manage the disease. DIF: Cognitive Level: Apply REF: p. 928 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation24. The parent of a child with diabetes mellitus asks the nurse when urine testing will be necessary. The nurse should explain that urine testing is necessary for which? a. Glucose is needed before administration of insulin. b. Glucose is needed four times a day. c. Glycosylated hemoglobin is required. d. Ketonuria is suspected.d. Ketonuria is suspected. ANS: D Urine testing is still performed to detect evidence of ketonuria. Urine testing for glucose is no longer indicated because of the poor correlation between blood glucose levels and glycosuria. Glycosylated hemoglobin analysis is performed on a blood sample. DIF: Cognitive Level: Apply REF: p. 929 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation25. The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. Which should the nurse explain about exercise in type 1 diabetes? a. Exercise will increase blood glucose. b. Exercise should be restricted. c. Extra snacks are needed before exercise. d. Extra insulin is required during exercise.c. Extra snacks are needed before exercise. ANS: C Exercise lowers blood glucose levels, which can be compensated for by extra snacks. Exercise lowers blood glucose and is encouraged and not restricted, unless indicated by other health conditions. Extra insulin is contraindicated because exercise decreases blood glucose levels. DIF: Cognitive Level: Apply REF: p. 929 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation26. A child eats some sugar cubes after experiencing symptoms of hypoglycemia. What should follow this rapid-releasing sugar? a. Fat b. Fruit juice c. Several glasses of water d. Complex carbohydrate and proteind. Complex carbohydrate and protein ANS: D Symptoms of hypoglycemia are treated with a rapid-releasing sugar source followed by a complex carbohydrate and protein. Fat, fruit juice, and several glasses of water do not provide the child with complex carbohydrate and protein necessary to stabilize the blood glucose. DIF: Cognitive Level: Apply REF: p. 930 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation27. The nurse is caring for an 8-year-old child with type 1 diabetes. The nurse should teach the child to monitor for which manifestation of hypoglycemia? a. Lethargy b. Thirst c. Nausea and vomiting d. Shaky feeling and dizzinessd. Shaky feeling and dizziness ANS: D Some of the clinical manifestations of hypoglycemia include shaky feelings; dizziness; difficulty concentrating, speaking, focusing, or coordinating; sweating; and pallor. Lethargy, thirst, and nausea and vomiting are manifestations of hyperglycemia. DIF: Cognitive Level: Apply REF: p. 931 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation28. The nurse is caring for an 11-year-old boy who has recently been diagnosed with diabetes. Which should be included in the teaching plan for daily injections? a. The parents do not need to learn the procedure. b. He is old enough to give most of his own injections. c. Self-injections will be possible when he is closer to adolescence. d. He can learn about self-injections when he is able to reach all injection sites.b. He is old enough to give most of his own injections. ANS: B School-age children are able to give their own injections. Parents should participate in learning and giving the insulin injections. He is already old enough to administer his own insulin. The child is able to use thighs, abdomen, part of the hip, and arm. Assistance can be obtained if other sites are used. DIF: Cognitive Level: Apply REF: p. 931 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies29. The nurse is discussing with a child and family the various sites used for insulin injections. Which site usually has the fastest rate of absorption? a. Arm b. Leg c. Buttock d. Abdomend. Abdomen ANS: D The abdomen has the fastest rate of absorption but the shortest duration. The arm has a fast rate of absorption but short duration. The leg has a slow rate of absorption but a long duration. The buttock has the slowest rate of absorption and the longest duration. DIF: Cognitive Level: Apply REF: p. 931 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies30. To help the adolescent deal with diabetes, the nurse must consider which characteristic of adolescence? a. Desire to be unique b. Preoccupation with the future c. Need to be perfect and similar to peers d. Need to make peers aware of the seriousness of hypoglycemic reactions...ANS: C Adolescence is a time when the individual wants to be perfect and similar to peers. Having diabetes makes adolescents different from their peers. Adolescents do not wish to be unique; they desire to fit in with the peer group and are usually not future oriented. Forcing peer awareness of the seriousness of hypoglycemic reactions would further alienate the adolescent with diabetes. The peer group would focus on the differences. DIF: Cognitive Level: Analyze REF: p. 940 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development31. The nurse is implementing care for a school-age child admitted to the pediatric intensive care in diabetic ketoacidosis (DKA). Which prescribed intervention should the nurse implement first? a. Begin 0.9% saline solution intravenously as prescribed. b. Administer regular insulin intravenously as prescribed. c. Place child on a cardiac monitor. d. Place child on a pulse oximetry monitor.a. Begin 0.9% saline solution intravenously as prescribed. ANS: A All patients with DKA experience dehydration (10% of total body weight in severe ketoacidosis) because of the osmotic diuresis, accompanied by depletion of electrolytes, sodium, potassium, chloride, phosphate, and magnesium. The initial hydrating solution is 0.9% saline solution. Insulin therapy should be started after the initial rehydration bolus because serum glucose levels fall rapidly after volume expansion. The child should be placed on the cardiac and pulse oximetry monitor after the rehydrating solution has been initiated. DIF: Cognitive Level: Analyze REF: p. 933 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation32. The nurse should teach parents of a preschool child with type 1 diabetes that which can raise the blood glucose level? a. Exercise b. Steroids c. Decreased food intake d. Lantus insulinb. Steroids ANS: B Parents should understand how to adjust food, activity, and insulin at the time of illness or when the child is treated for an illness with a medication known to raise the blood glucose level (e.g., steroids). Exercise, insulin, and decreased food intake can cause hypoglycemia. DIF: Cognitive Level: Apply REF: p. 939 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies33. A nurse is reviewing the laboratory results on a school-age child with hypoparathyroidism. Which results are consistent with this condition? a. Decreased serum phosphorus b. Decreased serum calcium c. Increased serum glucose d. Decreased serum cortisol levelb. Decreased serum calcium ANS: B The diagnosis of hypoparathyroidism is made on the basis of clinical manifestations associated with decreased serum calcium and increased serum phosphorus. A decreased serum phosphorus level would be seen in hyperparathyroidism, elevated glucose in diabetes, and a decreased serum cortisol level in adrenocortical insufficiency (Addison disease). DIF: Cognitive Level: Analyze REF: p. 921 TOP: Integrated Process: Nursing Process: Evaluation MSC: Area of Client Needs: Physiologic Integrity: Physiologic AdaptationWhat can an electrocardiogram (ECG) detect? Select all that apply. 1. Ischemia. 2. Injury. 3. Cardiac output (CO). 4. Dysrhythmias. 5. Systemic vascular resistance (SVR). 6. Occlusion pressure. 7. Conduction delay.1, 2, 4, 7, 1. An electrocardiogram can indicate ischemia of the heart muscle. 2. An electrocardiogram can indicate injury to the heart muscle. 3. An electrocardiogram does not indicate CO. 4. An electrocardiogram can show dysrhythmias. 5. An electrocardiogram does not show SVR. 6. An electrocardiogram does not show occlusion pressures. 7. An electrocardiogram does show conduction delays.A newborn is diagnosed with a congenital heart defect (CHD). The test results reveal that the lumen of the duct between the aorta and pulmonary artery remains open. This defect is known as _____________________.PDA (Patent ductus arteriosus)Tetralogy of Fallot (TOF) involves which defects? Select all that apply. 1. Ventricular septal defect (VSD). 2. Right ventricular hypertrophy. 3. Left ventricular hypertrophy. 4. Pulmonic stenosis (PS). 5. Pulmonic atresia. 6. Overriding aorta. 7. Patent ductus arteriosus (PDA).1, 2, 4, 6. 1. TOF is a congenital defect with a ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 2. TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 3. TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 4. TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 5. TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 6. TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 7. PDA is not one of the defects in tetralogy of Fallot.What should the nurse assess prior to administering digoxin? Select all that apply. 1. Sclera. 2. Apical pulse rate. 3. Cough. 4. Liver function test.2. The apical pulse rate is assessed because digoxin decreases the HR, and if the HR is <60, digoxin should not be administered.Which statement by a parent of an infant with congestive heart failure (CHF) who is being sent home on digoxin indicates the need for further education? 1. "I will give the medication at regular 12-hour intervals." 2. "If he vomits, I will not give a make-up dose." 3. "If I miss a dose, I will not give an extra dose" 4. "I will mix the digoxin in some formula to make it taste better."4. If the medication is mixed in his formula, and he refuses to drink the entire amount, the digoxin dose will be inadequate.Which interventions decrease cardiac demands in an infant with congestive heart failure (CHF)? Select all that apply. 1. Allow parents to hold and rock their child. 2. Feed only when the infant is crying. 3. Keep the child uncovered to promote low body temperature. 4. Make frequent position changes. 5. Feed the child when sucking the fists. 6. Change bed linens only when necessary. 7. Organize nursing activities.1, 4, 5, 6, 7. 1. Rocking by the parents will comfort the infant and decrease demands. 4. Frequent position changes will decrease the risk for infection by avoiding immobility with its potential for skin breakdown. 5. An infant sucking the fists could indicate hunger. 6. Change bed linens only when necessary to avoid disturbing the child. 7. Organize nursing activities to avoid disturbing the childWhile assessing a newborn with respiratory distress, the nurse auscultates a machine-like heart murmur. Other findings are a wide pulse pressure, periods of apnea, increased PaCO2, and decreased PO2. The nurse suspects that the newborn has: 1. Pulmonary hypertension. 2. Patent ductus arteriosus (PDA). 3. Ventricular septal defect (VSD). 4. Bronchopulmonary dysplasia.2. The main identifier in the stem is the machine-like murmur, which is the hallmark of a PDAWhich are the most serious complications for a child with Kawasaki disease (KD)? Select all that apply. 1. Coronary thrombosis. 2. Coronary stenosis. 3. Coronary artery aneurysm. 4. Hypocoagulability. 5. Decreased sedimentation rate. 6. Hypoplastic left heart syndrome.1, 2, 3. 1. Thrombosis, stenosis, and aneurysm affect blood vessels. The child with KD has hypercoagulability and an increased sedimentation rate due to inflammation. 2. Thrombosis, stenosis, and aneurysm affect blood vessels. The child with KD has hypercoagulability and an increased sedimentation rate due to inflammation. 3. Thrombosis, stenosis, and aneurysm affect blood vessels. The child with KD has hypercoagulability and an increased sedimentation rate due to inflammation.A child who has reddened eyes with no discharge; red, swollen, and peeling palms and soles of the feet; dry, cracked lips; and a "strawberry tongue" most likely has _____________________.Kawasaki disease or KDThe nurse is caring for a child with Kawasaki disease (KD). A student nurse who is on the unit asks if there are medications to treat this disease. The nurse's response to the student nurse is: 1. Immunoglobulin G and aspirin. 2. Immunoglobulin G and ACE inhibitors. 3. Immunoglobulin E and heparin. 4. Immunoglobulin E and ibuprofen.1. High-dose immunoglobulin G and salicylate therapy for inflammation are the current treatment for KD.Congenital heart defects (CHDs) are classified by which of the following? Select all that apply. 1. Cyanotic defect. 2. Acyanotic defect. 3. Defects with increased pulmonary blood flow. 4. Defects with decreased pulmonary blood flow. 5. Mixed defects. 6. Obstructive defects. 7. Pansystolic murmurs.3, 4, 5, 6. Heart defects are now classified as defects with increased or decreased pulmonary blood flow.During a well-child checkup for an infant with tetralogy of Fallot (TOF), the child develops severe respiratory distress and becomes cyanotic. The nurse's first action should be to: 1. Lay the child flat to promote hemostasis. 2. Lay the child flat with legs elevated to increase blood flow to the heart. 3. Sit the child on the parent's lap, with legs dangling, to promote venous pooling. 4. Hold the child in knee-chest position to decrease venous blood return.4. The increase in the SVR would increase afterload and increase blood return to the pulmonary artery.Hypoxic spells in the infant with a congenital heart defect (CHD) can cause which of the following? Select all that apply. 1. Polycythemia. 2. Blood clots. 3. Cerebrovascular accident. 4. Developmental delays. 5. Viral pericarditis. 6. Brain damage. 7. Alkalosis.1, 2, 3, 4, 6. 1. Hypoxia causes polycythemia, which can lead to increased blood viscosity, which can lead to blood clots and a stroke. 2. Hypoxia causes polycythemia, which can lead to increased blood viscosity, which can lead to blood clots and a stroke. 3. Hypoxia causes polycythemia, which can lead to increased blood viscosity, which can lead to blood clots and a stroke. 4. Developmental delays can be caused by multiple hospitalizations and surgeries. The child usually catches up to the appropriate level. 6. Brain damage can be caused by hypoxia, blood clots, and stroke.A 6-month-old who has episodes of cyanosis after crying could have the congenital heart defect (CHD) of decreased pulmonary blood flow called _____________________.Tetralogy of Fallot or TOF.What associated manifestation might the nurse occasionally find in a child diagnosed with Wilms tumor? 1. Atrial fibrillation. 2. Hypertension. 3. Endocarditis. 4. Hyperlipidemia.2. Because Wilms tumor sits on the kidney, it can be associated with secondary hypertension. It does not affect or cause the other conditionsThe _____________________ serves as the septal opening between the atria of the fetal heart.Foraman ovaleWhile looking through the chart of an infant with a congenital heart defect (CHD) of decreased pulmonary blood flow, the nurse would expect which laboratory finding? 1. Decreased platelet count. 2. Polycythemia. 3. Decreased ferritin level. 4. Shift to the left.2. Polycythemia is the result of the body attempting to increase the oxygen supply in the presence of hypoxia by increasing the total number of red blood cells to carry the oxygen.The nurse is caring for a 9-month-old who was born with a congenital heart defect (CHD). Assessment reveals a HR of 160, capillary refill of 4 seconds, bilateral crackles, and sweat on the scalp. These are signs of _____________________.Congestive heart failure or CHF.The following are examples of acquired heart disease. Select all that apply. 1. Infective endocarditis. 2. Hypoplastic left heart syndrome. 3. Rheumatic fever (RF). 4. Cardiomyopathy. 5. Kawasaki disease (KD). 6. Transposition of the great vessels.1, 3, 4, 5. 1. Infective endocarditis is an example of an acquired heart problem. 3. RF is an acquired heart problem. 4. Cardiomyopathy is an acquired heart problem. 5. KD is an acquired heart problem.A child diagnosed with congestive heart failure (CHF) is receiving maintenance doses of digoxin and furosemide. She is rubbing her eyes when she is looking at the lights in the room, and her HR is 70 beats per minute. The nurse expects which laboratory finding? 1. Hypokalemia. 2. Hypomagnesemia. 3. Hypocalcemia. 4. Hypophosphatemia.1. The rubbing of the child's eyes may mean that she is seeing halos around the lights, indicating digoxin toxicity. The HR is slow for her age and also indicates digoxin toxicity. A decrease in serum potassium because of the furosemide can increase the risk for digoxin toxicity.Which plan would be appropriate in helping to control congestive heart failure (CHF) in an infant? 1. Promoting fluid restriction. 2. Feeding a low-salt formula. 3. Feeding in semi-Fowler position. 4. Encouraging breast milk.3. The infant has a great deal of difficulty feeding with CHF, so even getting the maintenance fluids is a challenge. The infant is fed in the more upright position so fluid in the lungs can go to the base of the lungs, allowing better expansion.In which congenital heart defect (CHD) would the nurse need to take upper and lower extremity BPs? 1. Transposition of the great vessels. 2. Aortic stenosis (AS). 3. Coarctation of the aorta (COA). 4. Tetralogy of Fallot (TOF).3. With COA there is narrowing of the aorta, which increases pressure proximal to the defect (upper extremities) and decreases pressure distal to the defect (lower extremities). There will be high BP and strong pulses in the upper extremities and lowerthan- expected BP and weak pulses in the lower extremities.A child born with Down syndrome should be evaluated for which associated cardiac manifestation? 1. Congenital heart defect (CHD). 2. Systemic hypertension. 3. Hyperlipidemia. 4. Cardiomyopathy1. CHD is found often in children with Down syndrome.A child has a Glasgow Coma Scale of 3, HR of 88 beats per minute and regular, respiratory rate of 22, BP of 78/52, and blood sugar of 35 mg/dL. The nurse asks the caregiver about accidental ingestion of which drug? 1. Calcium channel blocker. 2. Beta blocker. 3. ACE inhibiter. 4. ARB.2. The beta blocker not only affects the heart and lungs but also blocks the beta sites in the liver, reducing the amount of glycogen available for use, causing hypoglycemia. The lower HR and BP also suggest ingestion of a cardiac medication.Exposure to which illness should be a cause to discontinue therapy and substitute dipyridamole (Persantine) in a child receiving aspirin therapy for Kawasaki disease (KD)? 1. Chickenpox or influenza. 2. E. coli or staphylococcus. 3. Mumps or streptococcus A. 4. Streptococcus A or staphylococcus1. Both chickenpox and influenza are viral in nature, so consider stopping the aspirin because of the danger of Reye syndrome.A nursing action that promotes ideal nutrition in an infant with congestive heart failure (CHF) is: 1. Feeding formula that is supplemented with additional calories. 2. Allowing the infant to nurse at each breast for 20 minutes. 3. Providing large feedings every 5 hours. 4. Using firm nipples with small openings to slow feedings.1. Formula can be supplemented with extra calories, either from a commercial supplement, such as Polycose, or from corn syrup. Calories in formula could increase from 20 kcal/oz to 30 kcal/oz or more.Treatment for congestive heart failure (CHF) in an infant began 3 days ago and has included digoxin and furosemide. The child no longer has retractions, lungs are clear , and HR is 96 beats per minute while the child sleeps. The nurse is confident that the child has diuresed successfully and has good renal perfusion when the nurse notes the child's urine output is: 1. 0.5 cc/kg/hr. 2. 1 cc/kg/hr. 3. 30 cc/hr. 4. 1 oz/hr2. Normal pediatric urine output is 1 cc/kg/hr.A 3-month-old has been diagnosed with a ventricular septal defect (VSD). The flow of blood through the heart is _____________________.Left to right. The pressures in the left side of the heart are greater, causing the flow of blood to be from an area of higher pressure to lower pressure, or left to right, increasing the pulmonary blood flow with the extra blood.The parents of a 3-month-old ask why their baby will not have an operation to correct a ventricular septal defect (VSD). The nurse's best response is: 1. "It is always helpful to get a second opinion about any serious condition like this." 2. "Your baby's defect is small and will likely close on its own by 1 year of age." 3. "It is common for physicians to wait until an infant develops respiratory distress before they do the surgery." 4. "With a small defect like this, they wait until the child is 10 years old to do the surgery."2. Usually a VSD will close on its own within the first year of life.The flow of blood through the heart with an atrial septal defect (ASD) is _____________________.Left to right. The pressures in the left side of the heart are greater, causing the flow of blood to be from an area of higher pressure to lower pressure, or left to right, increasing the pulmonary blood flow with the extra blood.Patent ductus arteriosus causes what type of shunt? _____________________Left to right. Blood flows from the higher pressure aorta to the lower pressure pulmonary artery, resulting in a left to right shunt.The school nurse has been following a child who comes to the office frequently for vague complaints of dizziness and headache. Today, she is brought in after fainting in the cafeteria following a nosebleed. Her BP is 122/85, and her radial pulses are bounding. The nurse suspects she has: 1. Transposition of the great vessels. 2. Coarctation of the aorta (COA). 3. Aortic stenosis (AS). 4. Pulmonic stenosis (PS).2. In the older child, COA causes dizziness, headache, fainting, elevated blood pressure, and bounding radial pulses.Which medication should the nurse give to a child diagnosed with transposition of the great vessels? 1. Ibuprofen. 2. Betamethasone. 3. Prostaglandin E. 4. Indocin.3. Prostaglandin E inhibits closing of the PDA, which connects the aorta and pulmonary artery.Which physiological changes occur as a result of hypoxemia in congestive heart failure (CHF)? 1. Polycythemia and clubbing. 2. Anemia and barrel chest. 3. Increased white blood cells and low platelets. 4. Elevated erythrocyte sedimentation rate and peripheral edema.1. The hypoxemia stimulates erythropoiesis, which causes polycythemia, in an attempt to increase oxygen by having more red blood cells carry oxygen. Clubbing of the fingers is a result of the polycythemia and hypoxemia.During play, a toddler with a history of tetralogy of Fallot (TOF) might assume which position? 1. Sitting. 2. Supine. 3. Squatting. 4. Standing.3. The toddler will naturally assume this position to decrease preload by occluding venous flow from the lower extremities and increasing afterload. Increasing SVR in this position increases pulmonary blood flow.A heart transplant may be indicated for a child with severe heart failure and: 1. Patent ductus arteriosus (PDA). 2. Ventricular septal defect (VSD). 3. Hypoplastic left heart syndrome. 4. Pulmonic stenosis (PS).3. Hypoplastic left heart syndrome is treated by the Norwood procedure, or heart transplant.Family discharge teaching has been effective when the parent of a toddler diagnosed with Kawasaki disease (KD) states: 1. "The arthritis in her knees is permanent. She will need knee replacements." 2. "I will give her diphenhydramine (Benadryl) for her peeling palms and soles of her feet." 3. "I know she will be irritable for 2 months after her symptoms started." 4. "I will continue with high doses of Tylenol for her inflammation."3. Children can be irritable for 2 months after the symptoms of the disease start.Which assessment indicates that the parent of a 7-year-old is following the prescribed treatment for congestive heart failure (CHF)? 1. HR of 56 beats per minute. 2. Elevated red blood cell count. 3. 50th percentile height and weight for age. 4. Urine output of 0.5 cc/kg/hr.3. The 50th percentile height and weight for age shows good growth and development, indicating good nutrition and perfusion.Which is best described as the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures? A. Pulmonary congestion B. Congenital heart defect C. Heart failure D. Systemic venous congestionC. Heart failureWhich is a clinical manifestation of the systemic venous congestion that can occur with heart failure? A. Tachypnea B. Tachycardia C. Peripheral edema D. Pale, cool extremitiesC. Peripheral edemaThe nurse is preparing to administer a dose of digoxin (Lanoxin) to a child in heart failure (HF). Which is a beneficial effect of administering digoxin (Lanoxin)? A. It decreases edema. B. It decreases cardiac output. C. It increases heart size. D. It increases venous pressure.ANS: A Digoxin has a rapid onset and is useful for increasing cardiac output, decreasing venous pressure, and, as a result, decreasing edema. Cardiac output is increased by digoxin. Heart size and venous pressure are decreased by digoxin.A nurse is preparing to administer an angiotensin-converting enzyme (ACE) inhibitor. Which drug should the nurse be administering? A. Captopril (Capoten) B. Furosemide (Lasix) C. Spironolactone (Aldactone) D. Chlorothiazide (Diuril)A. Captopril (Capoten)An 8-year-old child is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than _____ beats/min. A. 60 B. 70 C. 90 D. 100B. 70A 6-month-old infant is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than _____ beats/min. A. 60 B. 70 C. 90 to 110 D. 110 to 120C. 90 to 110The nurse is teaching parents about signs of digoxin (Lanoxin) toxicity. Which is a common sign of digoxin toxicity? A. Seizures B. Vomiting C. Bradypnea D. TachycardiaB. VomitingThe parents of a young child with heart failure tell the nurse that they are "nervous" about giving digoxin (Lanoxin). The nurse's response should be based on which statement? A. It is a safe, frequently used drug. B. It is difficult to either overmedicate or undermedicate with digoxin. C. Parents lack the expertise necessary to administer digoxin. D. Parents must learn specific, important guidelines for administration of digoxin.D. Parents must learn specific, important guidelines for administration of digoxin.The nurse is talking to a parent of an infant with heart failure about feeding the infant. Which statement about feeding the child is correct? A. "You may need to increase the caloric density of your infant's formula." B. "You should feed your baby every 2 hours." C. "You may need to increase the amount of formula your infant eats with each feeding." D. "You should place a nasal oxygen cannula on your infant during and after each feeding."A. "You may need to increase the caloric density of your infant's formula."As part of the treatment for heart failure, the child takes the diuretic furosemide (Lasix). As part of teaching home care, the nurse encourages the family to give the child foods such as bananas, oranges, and leafy vegetables. These foods are recommended because they are high in: A. chlorides. B. potassium. C. sodium. D. vitamins.B. potassium.The nurse is caring for a child with persistent hypoxia secondary to a cardiac defect. The nurse recognizes that a risk exists of cerebrovascular accidents (strokes). Which is an important objective to decrease this risk? A. Minimize seizures. B. Prevent dehydration. C. Promote cardiac output. D. Reduce energy expenditure.B. Prevent dehydration.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. The nurse's reply should be based on which statement? A. Child needs opportunities to play with peers. B. Child needs to understand that peers' activities are too strenuous. C. Parents can meet all of the child's needs. D. Constant parental supervision is needed to avoid overexertion.A. Child needs opportunities to play with peers.Which is the leading cause of death after heart transplantation? A. Infection B. Rejection C. Cardiomyopathy D. Heart failureB. RejectionThe nurse is conducting discharge teaching about signs and symptoms of heart failure to parents of an infant with a repaired tetralogy of Fallot. Which signs and symptoms should the nurse include? (Select all that apply.) A. Warm flushed extremities B. Weight loss C. Decreased urinary output D. Sweating (inappropriate) E. FatigueC. Decreased urinary output D. Sweating (inappropriate) E. FatigueCauses vasodilation that decreases pulmonary and systemic vascular resistance, decreased blood pressure, reduced after load, and decreased right and left atrial pressures.Angiotensin-converting enzyme (ACE) inhibitorBlocks reabsorption of sodium and water to produce diuresisfurosemideUsed because of its rapid onset and decreased risk for toxicity; increases the force of contraction (positive inotropic effect), decreases the heart rate (negative chronotropic effect), slows the conduction of impulses through the AV node (negative dromotropic effect), and indirectly enhances diuresisDigoxinACE inhibitors that are frequently used in pediatricslisinopril, catopril, enalaprilthe process of the formation of the heart's atrial septum results in a temporary flap called the a) truncus arteriosus b) foramen ovale c) sinus venosus d) ductus venosusb) foramen ovaleIn fetal circulation, the umbilical vein divides and sends blood directly to the inferior vena cava by way of the ductus venosus. This division occurs at the: a) heart b) lungs c) liver d) placentac) liverIn fetal circulation the majority of the oxygenated blood is pumped through the: a) foramen ovale b) lungs c) liver d) coronary sinusa) foramen ovaleWhen obtaining a history from the parents of an infant suspected of having altered cardiac function, the nurse would expect: a) specific concerns related to palpitations the infant is having b) feeding difficulty, sweating with activity, and poor weight gain c) specific concerns about the infant's shortness of breath d) concerns related to the infant's lack of cryingb) feeding difficulty, sweating with activity, and poor weight gainA clue in the mother's history that is important in the diagnosis of congenital heart disease is: a) rheumatoid arthritis b) rheumatic fever c) streptococcal infection d) rubellad) rubellacoarctation of the aorta should be suspected when: a) the blood pressure in the arms is different from the blood pressure in the legs b) the blood pressure in the right arm is different from the blood pressure in the left arm c) apical pulse is stronger than the radial pulse d) point of maximum impulse is shifted to the lefta) the blood pressure in the arms is different from the blood pressure in the legsIn children, the usual approach to the left ventricle of the heart in a cardiac catheterization is through the: a) left side of the heart b) right side of the heartb) right side of the heartWhen children develop heart failure from a congenital heart defect, the failure is usually: a) right sided only b) left sided only c) both right and left sidedc) both right and left sidedwhich one of the following heart rates would be considered tachycardia in an infant? a) a resting hr of 120 bpm b) a crying hr of 200 bpm c) a resting hr of 170 bpm d) a crying hr of 180 bpmc) a resting hr of 170 bpmair embolism may form in the venous system, traveling directly to the brain in the child with: a) a right to left shunt b) a left to right shunt c) dehydration and hypoxemia d) hypernatremia and hypokalemiaa) a right to left shuntwhich one of the following defects has the best prognosis? a) tetrology of fallot b) ventricular septal defect c) atrial septal defect d) hypoplastic left heart syndromec) atrial septal defectwhich of the following defects has the worst prognosis? a) tetrology of fallot b) atrial ventricular canal defect c) transposition of the great vessels d) hypoplastic left heart syndromed) hypoplastic left heart syndrometetrology of fallot consists of these defects: a) VSD b) ASD c) right ventricular hypertrophy d) pulmonic stenosis e) overriding aorta f) patent ductus arteriosusa) VSD c) right ventricular hypertrophy d) pulmonic stenosis e) overriding aortathe peak age for the incidence of kawasaki disease is in the: a) infant age group b) toddler age group c) school age group d) adolescent age groupb) toddler age groupThe standard treatment for kawasaki disease is: a) aspirin and immune globulin b) aspirin and cryoprecipitate c) meperidine hydrochloride and immune globulin d) meperidine hydrochloride and cryoprecipitatea) aspirin and immune globulinBecause of the medication used for long term therapy, children with kawasaki disease are at increased risk for: a) chickenpox b) influenza c) reye syndrome d) myocardial infarctionc) reye syndrome