TEST BANK for Nursing Care of Children Principles and Practice 4th Adition Susan James, Kristine Nel

TEST BANK FOR NURSING CARE OF CHILDREN PRINCIPLES AND PRACTICE, (JAMES, NURSING CARE OF CHILDREN) 4TH EDITION IF You Want To Purchase A+ Work Then Click The Link Below , Instant Download

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01: Introduction to Nursing Care of Children Chapter 01: Introduction to Nursing Care of Children

Test Bank MULTIPLE CHOICE 1. A nurse is reviewing changes in healthcare delivery and funding for pediatric populations.

Which current trend in the pediatric setting should the nurse expect to find? 

Increased hospitalization of children



Decreased number of uninsured children



An increase in ambulatory care



Decreased use of managed care

2. A nurse is referring a low-income family with three children under the age of 5 years to a program that assists with supplemental food supplies. Which program should the nurse refer this family to? 

Medicaid



Medicare



Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program



Women, Infants, and Children (WIC) program

3. In most states, adolescents who are not emancipated minors must have parental permission before: 

treatment for drug abuse.



treatment for sexually transmitted diseases (STDs).



obtaining birth control.



surgery.

4. A nurse is completing a clinical pathway for a child admitted to the hospital with pneumonia.

Which characteristic of a clinical pathway is correct? 

Developed and implemented by nurses



Used primarily in the pediatric setting



Specific time lines for sequencing interventions



One of the steps in the nursing process

5. When planning a parenting class, the nurse should explain that the leading cause of death in children 1 to 4 years of age in the United States is: 

premature birth.



congenital anomalies.



accidental death.



respiratory tract illness.

6. Which statement is true regarding the “quality assurance” or “incident” report?  The report assures the legal department that there is no problem. 

Reports are a permanent part of the client’s chart.



The nurse’s notes should contain the following: “Incident report filed and copy placed in chart.”



This report is a form of documentation of an event that may result in legal action.

7. Which client situation fails to meet the first requirement of informed consent?  The parent does not understand the physician’s explanations. 

The physician gives the parent only a partial list of possible side effects and complications.



No parent is available and the physician asks the adolescent to sign the consent form.



The infant’s teenage mother signs a consent form because her parent tells her to.

8. A nurse assigned to a child does not know how to perform a treatment that has been prescribed for the child. What should the nurse’s first action be?

4 Delay the treatment until another nurse can do it.

5

Make the child’s parents aware of the situation.

6

Inform the nursing supervisor of the problem.

7

Arrange to have the child transferred to another unit.

9. A nurse is completing a care plan for a child and is finishing the assessment phase.

Which activity is not part of a nursing assessment?

4 Writing nursing diagnoses 5

Reviewing diagnostic reports

6

Collecting data

7

Setting priorities

10. Which patient outcome is stated correctly?

4 The child will administer his insulin injection before breakfast on 10/31.

4

The child will accept the diagnosis of type 1 diabetes mellitus before discharge.

5

The parents will understand how to determine the child’s daily insulin dosage.

6

The nurse will monitor blood glucose levels before meals and at bedtime.

MULTIPLE RESPONSE 1. A nurse is reviewing the nursing care plan for a hospitalized child. Which statements are collaborative problems? Select all that apply.

4 Risk for injury 5

Potential complication of seizure disorder

6

Altered nutrition: Less than body requirements

7

Fluid volume deficit

8

Potential complication of respiratory acidosis

2. Which nursing activities do not meet the standard of care? Select all that apply.

4 Failure to notify a physician about a child’s worsening condition 5

Calling the supervisor about staffing concerns

6

Delegating assessment of a new admit to the Unlicensed Assistive Personnel (UAP)

7

Asking the Unlicensed Assistive Personnel (UAP) to take vital signs

4

Documenting that a physician was unavailable and the nursing supervisor was notified

02: Family-Centered Nursing Care Chapter 02: Family-Centered Nursing Care Test Bank MULTIPLE CHOICE 1. A nurse is teaching parents how to apply “time-out” as a disciplinary method for their 4 year old. Parents have understood the teaching if they state which formula correctly guides the use of “time-out”?

4 Use the guideline of 1 minute per each year of the child’s age.

5

Relate the length of the time-out to the severity of the behavior.

6

Never use time-out for a child younger than age 4 years.

7

Follow the time-out with a treat.

2. What is the nurse’s best approach when an 8-year-old boy frequently causes a disruption in the playroom by taking toys from other children?

4 Exclude the child from the playroom.

5

Explain to the children in the playroom that he is very ill and should be allowed to have the toys.

6

Approach the child in his room and ask, “Would you like it if the other children took your toys from y Approach the child in his room and state, “I am concerned that you are taking the other children’s toy me.”

7

3. Families that deal most effectively with stress have which behavior patterns?

4 Focus on family problems.

5

Feel weakened by stress.

6

Expect that some stress is normal.

7

Feel guilty when stress exists.

4. Which family will most likely have the greatest difficulty in coping with an ill child?

4 A single-parent mother who has the support of her parents and siblings 5

6

Parents who have just moved to the area and are living in an apartment while they look for a house The family of a child who has had multiple hospitalizations related to asthma and has adequate relatio nursing staff

7

A family in which there is a young child and four older married children who live in the area

5. Which is the priority nursing intervention for the family of a child who has been admitted to the hospital?

4 Begin discharge teaching.

5

Identify and mobilize internal and external strengths.

6

Identify ways in which the family could have prevented their child’s hospitalization.

7

Instruct the parents on normal growth and development.

6. A nurse is planning culturally competent care for a child of Hispanic descent. Which characteristic found in a Hispanic family should the nurse include in the plan of care?

4 Stoicism 5

Close extended family

6

Docile children are considered weak

7

Very interested in health-promoting lifestyles

7. While reviewing nursing documentation on dietary intake for a 7-year-old child of Asian descent, the nurse notes that he consistently refuses to eat the food on his tray. Which assumption is most likely accurate?

4 He is a picky eater.

5

He needs less food because he is on bed rest.

6

He may have culturally related food preferences.

7

He is probably eating between meals and spoiling his appetite.

8. To resolve family conflict, it is necessary to have open communication, accurate perception of the problem, and a(n): 4 intact family structure.

5

arbitrator.

6

willingness to consider the view of others.

7

balance in personality types.

9. A nurse is planning a parenting class for expectant parents. Which statement is true about the characteristics of a healthy family?

4 The parents and children have rigid assignments for all the family tasks.

5

Young families assume total responsibility for the parenting tasks, refusing any assistance.

6

The family is overwhelmed by the significant changes that occur as a result of childbirth.

7

Adults agree on the majority of basic parenting principles.

10. A nurse determines that a child consistently displays predictable behavior and is regular in performing daily habits. Which temperament is the child displaying?

4 Easy 5

Slow-to-warm-up

6 7

Difficult Shy

11. The parent of a child who has had numerous hospitalizations asks the nurse for advice because her child has been having behavior problems at home and in school. In discussing effective discipline, which is an essential component?

4 All children display some degree of acting out and this behavior is normal.

5

The child is manipulative and should have firmer limits set on her behavior.

6

Use positive reinforcement and encouragement to promote cooperation and the desired behaviors. Underlying reasons for rules should be given and the child should be allowed to decide on which rule followed.

7

12. A nurse assesses that parents discuss rules with their children when the children do not agree with the rules. Which style of parenting is being displayed?

4 Authoritarian 5

Authoritative

6

Permissive

7

Disciplinarian

13. Which should the nurse expect to be problematic for a family whose religious affiliation is Jehovah’s Witness?

4

Immunizations

5

Autopsy

6

Organ donation

7

Blood transfusion

MULTIPLE RESPONSE 1. The nurse is caring for a child from a Middle Eastern family. Which interventions should the nurse include in planning care? Select all that apply.

4 Include the father in the decision making.

5

Ask for a dietary consult to maintain religious dietary practices.

6

Plan for a male nurse to care for a female patient.

7

Ask the housekeeping staff to interpret if needed.

2. A nurse is caring for a child with the religion of Christian Science. What interventions should the nurse include in the care plan for this child? Select all that apply.

4 Offer iced tea to the child who is experiencing fluid volume deficit.

5

Inform the Christian Science practitioner that the child has been admitted to the hospital.

6

Allow parents to sign a form opting out of routine immunizations.

4

Ask parents if the child has been baptized and if parents want a pastor to visit.

03: Communicating with Children Chapter 03: Communicating with Children Test Bank MULTIPLE CHOICE 1. Which information should the nurse include when preparing a 5-year-old child for a cardiac catheterization?

4 A detailed explanation of the procedure 5

A description of what the child will feel and see during the procedure

6

An explanation about the dye that will go directly into his vein

7

An assurance to the child that he and the nurse can talk about the procedure when it is over

2. Who are the “experts” in planning for the care of a 9-year-old child with a profound sensory impairment who is hospitalized for surgery?

4 The child’s parents 5

The child’s teacher

6

The case manager

7

The primary nurse

3. Which is an effective technique for communicating with toddlers?

4 Have the toddler make up a story from a picture.

5

Involve the toddler in dramatic play with dress-up clothing.

6

Repeatedly read familiar stories to the child.

7

Ask the toddler to draw pictures of his fears.

4. What is the most important consideration for effectively communicating with a child?

4 The child’s chronological age 5

The parent–child interaction

6

The child’s receptiveness

7

The child’s developmental level

5. Which behavior is most likely to encourage open communication?

4 Avoiding eye contact 5

Folding arms across the chest

6

Standing with head bowed

7

Soft stance with arms loose at the side

6. Which strategy is most likely to encourage a child to express feelings about the hospital experience?

4 Asking close-ended questions 5

Asking direct questions

6

Sharing personal experiences

7

Actively listening

7. Which is the most appropriate question to ask to encourage conversation when interviewing an adolescent?

4 “Are you in school?”

5

“Are you doing well in school?”

6

“How is school going for you?”

7

“How do your parents feel about your grades?”

8. What is the most appropriate response for the nurse to make to the parent of a 3-yearold child found in a bed with the side rails down?

4 “You must never leave the child in the room alone with the side rails down.”

5

“I am very concerned about your child’s safety when you leave the side rails down. The hospital has g that side rails need to be up if the child is in the bed.”

6

“It is hospital policy that side rails need to be up if the child is in bed.”

7

“When parents leave side rails down, they might be considered as uncaring.”

9. Which is an appropriate preoperative teaching plan for a school-age child?

4 Begin preoperative teaching the morning of surgery.

5

Schedule a tour of the hospital a few weeks before surgery.

6

Show the child books and pictures 4 days before surgery.

7

Limit teaching to 5 minutes and use simple terminology.

10. A primary nurse bought a hospitalized child a new toy to replace a broken one. What is the best interpretation of the nurse’s behavior?

4

The nurse is displaying signs of overinvolvement.

5

The nurse is a kind and generous person.

6

The nurse feels a special closeness to the child.

7

The nurse wants to make the child happy.

11. When meeting a toddler for the first time, the nurse initiates contact by: 4 calling the toddler by name and picking the toddler up.

5

asking the toddler for her first name.

6

kneeling in front of the toddler and speaking softly to the child.

7

telling the toddler that you are her nurse.

MULTIPLE RESPONSE 1. A nurse is admitting a school-age child with a visual impairment to the hospital. To effectively communicate the nurse should plan which interventions? Select all that apply.

4 Orient the child to his or her surroundings.

5 Enter quietly and touch the child before speaking.

4 Put the nurse call bell close to the parent.

5

Allow the child to handle equipment.

6

Explain sounds the child may hear frequently.

2. A preschool age child is being admitted for some diagnostic tests and possible surgery. The nurse planning care should use which statements when explaining procedures to the child? Select all that apply.

4

“Fluids will be given through tubing connected to a small tiny tube inserted into your arm.”

5

“After surgery, we will be doing dressing changes.”

6

“You will get a shot before surgery.”

7

“The doctor will give you medicine that will help you go into a deep sleep.”

8

“We will take you to surgery on a bed on wheels.”

Chapter 04: Health Promotion for the Developing Child Chapter 04: Health Promotion for the Developing Child Test Bank MULTIPLE CHOICE 1. A nurse is reviewing developmental concepts for infants and children. Which statement best describes development in infants and children?

4 Development, a predictable and orderly process, occurs at varying rates within normal limits.

5

Development is primarily related to the growth in the number and size of cells.

6

Development occurs in a proximodistal direction with fine muscle development occurring first.

7

Development is more easily and accurately measured than growth.

2.Frequent developmental assessments are important for which reason?

4

Stable developmental periods during infancy provide an opportunity to identify any delays or deficits.

5

Infants need stimulation specific to the stage of development.

6

Critical periods of development occur during childhood.

7

Child development is unpredictable and needs monitoring.

3. Which factor has the greatest influence on child growth and development?

4

Culture

5

Environment

6

Genetics

7

Nutrition

4. A nurse is planning a teaching session with a child. According to Piagetian theory, the period of cognitive development in which the child is able to distinguish fact from fantasy is the _____ period of cognitive development.

4 sensorimotor 5

formal operations

6

concrete operations

7

preoperational

5. The theorist who viewed developmental progression as a lifelong series of conflicts that need resolution is: 4 Erikson.

5

Freud.

6

Kohlberg.

7

Piaget.

6.What does the nurse need to know when observing chronically ill children at play?

4

Play is not important to hospitalized children.

5

Children need to have structured play periods.

6

Children’s play is an indication of a child’s response to treatment.

7

Play is to be discouraged because it tires hospitalized children.

7. Which child is most likely to be frightened by hospitalization?

4 A 4-month-old infant admitted with a diagnosis of bronchiolitis 5

A 2-year-old toddler admitted for cystic fibrosis

6

A 9-year-old child hospitalized with a fractured femur

7

A 15-year-old adolescent admitted for abdominal pain

8. Which statement made by a 15-year-old adolescent with a diagnosis of neurofibromatosis (an autosomal dominant genetic disorder) best demonstrates an understanding of the mechanism of inheritance for the disease?

4 “My babies will probably not have neurofibromatosis.”

5

“My babies have a 50% chance of having neurofibromatosis.”

6

“Whether my babies have problems depends on the father.”

7

“My babies have a 25% chance of having neurofibromatosis.”

9. During a routine healthcare visit, a parent asks the nurse why her 9-month-old infant is not walking as her older child did at the same age. Which response by the nurse best demonstrates an understanding of child development?

4 “She’s a little slow.”

5

“If she is pulling up, you can help her by holding her hand.”

6

“Babies progress at different rates. Your infant’s development is within normal limits.”

7

“Maybe she needs to see a behavioral specialist.”

10. Which “expected outcome” would be developmentally appropriate for a hospitalized 4-year-old child?

4 The child will be dressed and fed by the parents.

5

The child will independently ask for play materials or other personal needs.

6

The child will be able to verbalize an understanding of the reason for the hospitalization.

7

The child will have a parent stay in the room at all times.

11. A nurse has completed a teaching session with parents of preschool aged children. Which statement made by the parent identifies an appropriate level of language development for a 4-yearold child?

4 The child has a vocabulary of 300 words and uses simple sentences.

5

The child uses correct grammar in sentences.

6

The child is able to pronounce consonants clearly.

7

The child uses language to express abstract thought.

12. Which should the nurse evaluate before administering the Denver Developmental Screening Test II (DDST-II)?

4 The child’s height and weight 5

The parent’s ability to comprehend the results

6

The child’s mood

7

The parent–child interaction

13. Which children are at greater risk for not receiving immunizations?

4

Children who attend licensed day care programs

5

Children entering school

6

Children who are home schooled

7

Young adults entering college

14. Which developmental assessment instrument is appropriate to assess a 5-year-old child?

4 Brazelton Behavioral Scale

5

Denver Developmental Screening Test II (DDST-II)

6

Dubowitz Scale

7

New Ballard Scale

15. A 2-month-old child has not received any immunizations. Which immunizations should the nurse give?

4 DTaP, Hib, HepB, IPV, varicella 5

DTaP, Hib, HepB, MMR, IPV

6

DTaP, Hib, HepB, PCV, IPV, rotavirus

7

DTaP, Hib, HepB, PCV, IPV, HepA

16. You are preparing immunizations for a 12-month-old child who is immunocompromised. Which immunization cannot be given?

4 DTaP 5

HepA

6

IPV

7

Varicella

17. Which immunization can cause fever and rash to occur 1 to 2 weeks after administration?

4 HepB 5

DTaP

6

Hib

7

MMR

MULTIPLE RESPONSE 1. The nurse is preparing immunizations for a healthy 11-year-old boy who has received all his primary immunizations. Which immunizations will the nurse consider? Select all that apply.

4 Meningococcal 5

DTaP

6

OPV

7

Smallpox

2. Parents of a 4-month-old child ask the nurse what they can do to help relieve the discomfort of teething. The nurse should include which suggestions for the parents? Select all that apply.

4 Provide warm liquids.

5

Rub the gums with aspirin.

6

Over-the-counter topical medications for gum pain relief can be used as directed.

7

Administer acetaminophen (Tylenol) as directed.

8

Provide a hard food such as a frozen bagel for chewing.

OTHER 1. Place in order the gross motor developmental milestones a nurse expects to assess in an infant. Begin with the earliest gross motor milestone expected and progress to the last gross motor milestone attained.

4 Turns from abdomen to back 5 Lifts head off of bed when in a prone position 6 Walks holding on to furniture 7 Turns from back to abdomen 8 Sits unsupported

Chapter 05: Health Promotion for the Infant Chapter 05: Health Promotion for the Infant Test Bank MULTIPLE CHOICE 1. Which milestone is developmentally appropriate for a 2-month-old infant when the nurse pulls the infant to a sitting position?

4 Head lag is present when the infant’s trunk is lifted.

5

The infant is able to support the head when the trunk is lifted.

6

The infant is briefly able to hold the head erect.

7

The infant is fully able to support and hold the head in a straight line.

2. Approximately what should a newborn weigh at 1 year of age if the newborn’s birth weight was 7 pounds 6 ounces?

4 14 3/4 pounds 5

22 1/8 pounds

6

29 1/2 pounds

7

Unable to estimate weight at 1 year

ANS: B An infant triples the birth weight by 1 year of age. An infant doubles the birth weight by 6 months of age. An infant quadruples the birth weight by 2 years of age. Weight at 6 months, 1 year, and 2 years of age can be estimated from the birth weight.

DIF: Cognitive Level: Application REF: p. 78 OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance 3. Which statement made by a parent would be consistent with a developmental delay?

4 “I have noticed that my 9-month-old infant responds consistently to the sound of his name.”

5

“I have noticed that my 12-month-old child does not get herself to a sitting position or pull to stand.”

6

“I am so happy when my 1 1/2-month-old infant smiles at me.”

7

“My 5-month-old infant is not rolling over in both directions yet.”

4. At a healthy 2-month-old infant’s well-child clinic visit, the nurse should give which immunizations?

4 DTaP, IPV, HepB, Hib, PCV, rotavirus 5

MMR, DTaP, PVC, and IPV

6

Hib, DTaP, rotavirus, and OPV

7

Hib and MMR, IPV, and rotavirus

5. The nurse advises the mother of a 3-month-old infant, exclusively breast-fed, to: 4 start giving the infant a vitamin D supplement.

5

start using an infant feeder and add rice cereal to the formula.

6

start feeding the infant rice cereal with a spoon at the evening feeding.

7

continue breast-feeding without any supplements.

6. At _____ months of age, an infant should first be expected to locate an object hidden from view.

4 4 5

6

6

9

7

20

7. The parents of a newborn infant state, “We will probably not have our baby immunized because we are concerned about the risk of our child being injured.” Which is the best response for the nurse to make?

4 “It is your decision.”

5

“Have you talked with your parents about this? They can probably help you think about this decision.

6

“The risks of not immunizing your baby are greater than the risks from the immunizations.”

“You are making a mistake.”

7

8. The mother of a 9-month-old infant is concerned because the infant cries when she leaves him.

Which is the best response for the nurse to make to the mother?

4 “You could consider leaving the infant more often so he can adjust.”

5

“You might consider taking him to the doctor because he may be ill.”

6

“Have you noticed whether the baby is teething?”

7

“This can be a healthy sign of attachment.”

9. Which statement concerning physiological factors of infancy is true?

4 The infant has a slower metabolic rate than an adult.

5

An infant is not able to digest protein and lactase.

6

Infants have a slower circulatory response than adults.

7

The kidneys of an infant are less efficient in concentrating urine than an adult’s kidneys.

10. Which is a priority in counseling parents of a 6-month-old infant?

4

Increased appetite from secondary growth spurt

5

Allowing the infant to self-feed

6

Securing a developmentally safe environment for the infant

7

Strategies to teach infants to sit up

11. A mother of a 2-month-old infant tells the nurse, “My child doesn’t sleep as much as his older brother did at the same age.” What is the best response for the nurse?

4 “Have you tried to feed the baby more often?”

5

“Infant sleep patterns vary widely, with some infants sleeping only 2 to 3 hours at a time.”

6

“It is helpful to keep a record of your baby’s eating, waking, sleeping, and elimination patterns and to week to discuss them.”

7

“This infant is difficult. It is important for you to identify what is bothering the baby.”

12. The mother of a 10-month-old infant tells the nurse that her infant “really likes cow’s milk.” Which is the best response to this mother?

4 “Milk is good for him.”

5

“It is best to wait until he is a year old before giving him cow’s milk.”

6

“Limit cow’s milk to his bedtime bottle.”

7

“Mix his cereal with cow’s milk and give him formula in a bottle.”

13. The mother of a 10-month-old infant asks the nurse about beginning to wean her child from the bottle.

Which statement by the mother suggests that the child is not ready to be weaned?

4

“My son is frequently throwing his bottle down.”

5

“The baby takes a few ounces of formula from the bottle.”

6

“He is constantly chewing on the nipple. It concerns me.”

7

“He consistently is sucking.”

14. Which is appropriate play for a 6-month-old infant?

4 Pat-a-cake, peek-a-boo 4

Ball rolling, hide and seek game

5

Bright rattles and tactile toys

6

Push and pull toys

15. Which statement by a mother indicates that her 5-month-old infant is ready for solid food?

4 “When I give my baby solid foods, she has difficulty getting it to the back of her throat to swallow.”

5

“She has just started to sit up without any support.”

6

“I am surprised that she only weighs 11 pounds. I expected her to have gained some weight.”

7

“I find that she really has to be encouraged to eat.”

16. A mother asks the nurse, “When should I begin to clean my baby’s teeth?” What is the best response for the nurse?

4 “You can begin when all her baby teeth are in.”

5

“You can easily begin now. Just put some toothpaste on a gauze pad to clean the teeth.”

6

“I don’t think you have to worry about that until she can handle a toothbrush.”

7

“You can begin as soon as your child has a tooth. The easiest way is to take cotton swabs or a face clo teeth. Toothpaste is not necessary.”

MULTIPLE RESPONSE 1. A nurse has completed a teaching session for parents about “baby-proofing” the home. Which statements made by the parents indicate an understanding of the teaching? Select all that apply.

4

“We will put plastic fillers in all electrical plugs.”

5

“We will place poisonous substances in a high cupboard.”

6

“We will place a gate at the top and bottom of stairways.”

7

“We will keep our household hot water heater at 130 degrees.”

8

“We will remove front knobs from the stove.”

Chapter 06: Health Promotion During Early Childhood Chapter 06: Health Promotion During Early Childhood Test Bank MULTIPLE CHOICE 1. The mother of a 14-month-old child is concerned because the child’s appetite has decreased. The best response for the nurse to make to the mother is: 4 “It is important for your toddler to eat three meals a day and nothing in between.”

5

“It is not unusual for toddlers to eat less.”

6

“Be sure to increase your child’s milk consumption, which will improve nutrition.”

7

“Giving your child a multivitamin supplement daily will increase your toddler’s appetite.”

2. Which toy is the most developmentally appropriate for an 18- to 24-month-old child?

4 A push and pull toy 5

Nesting blocks

6

A bicycle with training wheels

7

A computer

3. Which is the priority concern in developing a teaching plan for the parents of a 15-month-old child?

4 Toilet training guidelines 5 6

4

Guidelines for weaning children from bottles Instructions on preschool readiness Instructions on a home safety assessment

4. What is the primary purpose of a transitional object?

4 It helps the parents deal with the guilt they feel when they leave the child.

5

It keeps the child quiet at bedtime.

6

It is effective in decreasing anxiety in the toddler.

7

It decreases negativism and tantrums in the toddler.

5. A nurse is teaching parents of a toddler about language development. Which statement best identifies the characteristics of language development in a toddler?

4 Language development skills slow during the toddler period.

5 6

4

The toddler understands more than he or she can express.

Most of the toddler’s speech is not easily understood.

The toddler’s vocabulary contains approximately 600 words.

6. Parents of a toddler ask the nurse when they should start toilet training. Which statement best addresses their concerns 4 When the child is 18 months of age 5

When the child exhibits signs of physical and psychological readiness

6

When the child has been walking for 9 months

7

When the child is able to sit on the “potty” for 10 to 15 minutes

7. Which statement by a mother of a toddler indicates a correct understanding of the use of discipline?

4 “I always include explanations and morals when I am disciplining my toddler.”

5 6 4

“I always try to be consistent when disciplining the children, and I correct my children at the time the “I believe that discipline should be done by only one family member.”

“My rule of thumb is no more than one spanking a day.”

8. Which comment indicates that the mother of a toddler needs further teaching about dental care?

4 “We use well water so I give my toddler fluoride supplements.”

5

“My toddler brushes his teeth with my help.”

6

“My child will not need a dental checkup until his permanent teeth come in.”

7

“I use a small nylon bristle brush for my toddler’s teeth.”

9. Which assessment finding in a preschooler would suggest the need for further investigation?

4 The child is able to dress independently.

5

The child rides a tricycle.

6

The child has an imaginary friend.

7

The child has a 2-pound weight gain in 12 months.

10. Which is the most appropriate action for the nurse to take when telling a preschool child about an upcoming procedure?

4 Explain all the information in detail to the child.

5

Speak loudly and clearly to the child.

6

Inform the parents of the procedure and ask them to tell the child.

7

Use symbolic play to explain the procedure.

11. In caring for a 4-year-old child with a diagnosis of suspected child abuse, which is the best nursing intervention?

4 Avoid touching the child.

5

Provide the child with play situations that allow for disclosure.

6

Discourage the child from remembering the incident.

7

Deny the suspected perpetrator visiting rights to the child.

12. Which is helpful to tell a mother who is concerned about preventing sleep problems in her preschool child?

4 Have the child always sleep in a quiet, darkened room.

5

Provide high-carbohydrate snacks before bedtime.

6

Communicate with the child’s daytime caretaker to encourage a longer nap.

7

Use a nightlight in the child’s room.

13. Which statement is true about the care of the toddler’s teeth?

4 Because deciduous teeth are not permanent, they are not important to the child.

5

Children can be encouraged to brush their teeth after the teeth have been thoroughly cleaned by the pa

6

Secondary tooth eruption begins at 4 to 5 years of age.

7

Fluoride supplements can be discontinued when the secondary teeth erupt.

14. What do parents of preschool children need to understand about discipline?

4

Both parents and the child should agree on the method of discipline.

5

Discipline should involve some physical restriction.

6

The method of discipline should be consistent with the discipline methods of the child’s peers.

7

Discipline should include positive reinforcement of desired behaviors.

15. Parents of a preschool child ask the nurse, “What can we do to prepare our child for kindergarten?” In response, the nurse should include which critical factor in preparing a child for kindergarten entry?

4 The child’s ability to sit still 5

The child’s sense of learned helplessness

6

The parent’s interactions and responsiveness to the child

7

Attending a preschool program

MULTIPLE RESPONSE 1. Which play patterns does a 3-year-old child typically display? Select all that apply.

4 Imaginary play 5

Parallel play

6

Cooperative play

7

Structured play

2. A nurse is planning care for a hospitalized toddler in the preoperational thinking stage. Which characteristics should the nurse expect in this stage? Select all that apply.

4 Concrete thinking 5

Egocentrism

6

Animism

7

Magical thought

8

Ability to reason

OTHER 1. Place in order the gross motor developmental milestones a nurse expects to assess in a toddler. Begin with the earliest gross motor milestone expected and progress to the last gross motor milestone attained.

Use the following format for your answers: A, B, C, D 4 Throws a ball overhand 5 Walks c Kicks a ball d.

Runs

Chapter 07: Health Promotion for the School-Age Child Chapter 07: Health Promotion for the School-Age Child Test Bank MULTIPLE CHOICE 1. Which statement made by a mother of a school-age boy indicates a need for further teaching?

4 “My child is playing soccer this year.”

5

“He is always busy with his friends playing games. He is very active.”

6

“I limit his television watching to about 2 hours a day.”

7

“I am glad his coach emphasizes the importance of winning in today’s society.”

2. A nurse has completed a teaching session for parents on school-age childrens’ expected developmental milestones. The parents need further teaching if they indicate which behavior is expected in a school-age child?

4 Experiments with profanity and dirty jokes 5

Laughs at silly jokes and enjoys using words

6

Understands the concept of conservation

7

Engages in fantasy and magical thinking

3. The ability to mentally understand that 1 + 3 = 4 and 4 – 1 = 3 occurs in which stage of cognitive development?

4 Concrete operations stage

5

Formal operations stage

6

Intuitive thought stage

7

Preoperations stage

4. Which activity is most appropriate for developing fine motor skills in the school-age child?

4 Drawing 5

Singing

6

Soccer

7

Swimming

5. A school nurse is teaching a health class for fifth grade children. The nurse plans to include which statement to best describe growth in the early school-age period?

4 Boys grow faster than girls do until around age 10.

5

Puberty occurs earlier in boys than in girls.

6

Puberty occurs at the same age for all races and ethnicities.

7

It is a period of rapid physical growth.

6. The comment that is most developmentally typical of a 7-year-old boy is: 4

“I am a Power Ranger, so don’t make me angry.”

5

“I don’t know whether I like Mary or Joan better.”

6

“My mom is my favorite person in the world.”

7

“Jimmy is my best friend.”

7. A school nurse is conducting a class on safety for parents of school-age children. Which statement indicates the parents need further teaching?

4 “Our child needs to wear sunscreen when playing soccer.”

5

“Our young school-age child will continue to ride belted in the back seat.”

6

“We will monitor the volume when our child is listening to music on the i-Pod with ear buds.

7

“We’re glad our child will be home after school to let repairmen in while we are working.”

8. Identify the statement that is the most accurate about moral development in the 9-year-old school-age child.

4 Right and wrong are based on physical consequences of behavior.

5

The child obeys parents because of fear of punishment.

6

The school-age child conforms to rules to please others.

7

Parents are the determiners of right and wrong for the school-age child.

9. Which parental behavior is the most important in fostering moral development?

4

Telling the child what is right and wrong

5

Vigilantly monitoring the child and her peers

6

Weekly family meetings to discuss behavior

7

Living as the parents say they believe

10. Which behavior by parents or teachers will best assist the child in negotiating the developmental task of industry?

4 Identifying failures immediately and asking the child’s peers for feedback 5

Structuring the environment so the child can master tasks

6

Completing homework for children who are having difficulty in completing assignments

7

Decreasing expectations to eliminate potential failures

11. A nurse is assessing an older school-age child recently admitted to the hospital. Which assessment indicates the child is in an appropriate stage of cognitive development?

4 Addition and subtraction ability 5

Ability to classify

6

Vocabulary

7

Play activity

12. Which is an appropriate disciplinary intervention for the school-age child?

4

Time-out periods

5

A consequence that is consistent with the inappropriate behavior

6

Physical punishment

7

Lengthy dialog about inappropriate behavior

MULTIPLE RESPONSE 1. Which demonstrates the school-age child’s developing logic in the stage of concrete operations? Select all that apply.

4 Ability to recognize that 1 pound of feathers is equal to 1 pound of metal 5

Ability to recognize that he can be a son, brother, or nephew at the same time

6

Understands the principles of adding, subtracting, and reversibility

7

Thinking characterized by egocentrism, animism, and centration

2. Which strategies can a nurse teach to parents of a child experiencing uncomplicated school refusal? Select all that apply.

4 The child should be allowed to stay home until the anxiety about going to school is resolved.

5

Parents should be empathetic yet firm in their insistence that the child attends school.

6

A modified school attendance may be necessary.

7

Parents need to pick the child up at school whenever the child wants to come home.

8

Parents need to communicate with the teachers about the situation.

SHORT ANSWER 1. A nurse is planning a class for school-age children on obesity. Which percentile does the BMI need to exceed for a child to be assessed as obese?

Chapter 08: Health Promotion for the Adolescent Chapter 08: Health Promotion for the Adolescent Test Bank MULTIPLE CHOICE 1. A nurse is teaching an adolescent about Tanner stages. Which statement best describes Tanner staging?

4 Predictable stages of puberty that are based on chronological age 5

Staging of puberty based on the initiation of menarche and nocturnal emissions

6

Predictable stages of puberty that are based on primary and secondary sexual characteristics

7

Staging of puberty based on the initiation of primary sexual characteristics

2. Which behavior suggests appropriate psychosocial development in the adolescent?

4 The adolescent seeks validation for socially acceptable behavior from older adults.

5

The adolescent is self-absorbed and self-centered and has sudden mood swings.

6

Adolescents move from peers and enjoy spending time with family members.

7

Conformity with the peer group increases in late adolescence.

3. The parents of a 14-year-old girl are concerned that their adolescent spends too much time looking in the mirror. Which statement is the most appropriate for the nurse to make?

4 “Your teenager needs clearer and stricter limits about her behavior.”

5

“Your teenager needs more responsibility at home.”

6

“During adolescence, this behavior is not unusual.”

7

“The behavior is abnormal and needs further investigation.”

4. Which factor contributes to early adolescents engaging in risk-taking behaviors?

4 Peer pressure

5 6

4

A desire to master their environment Engagement in the process of separation from their parents A belief that they are invulnerable

5. Which statement is the most appropriate advice to give parents of a 16-year-old teenager who is rebellious?

4 “You need to be stricter so that your teenager feels more secure.”

5

“You need to allow your teenager to make realistic choices while using consistent and structured disci

6

“Increasing your teen’s involvement with his peers will improve his self-esteem.”

7

“Allow your teenager to choose the type of discipline that is used in your home.”

6. Which statement by the nurse is most appropriate to a 15-year-old adolescent whose friend has mentioned suicide?

4 “Tell your friend to come to the clinic immediately.”

5

“You need to gather details about your friend’s suicide plan.”

6

“Your friend’s threat needs to be taken seriously and immediate help for your friend is important.”

7

“If your friend mentions suicide a second time, you will want to get your friend some help.”

7. When planning care for adolescents, the nurse should: 4 teach parents first, and they, in turn, will teach the teenager.

5

provide information for their long-term health needs because teenagers respond best to longrange pla

6

maintain the parents’ role by providing explanations for treatment and procedures to the parents only.

7

give information privately to adolescents about how they can manage the specific problems that they i

8. A 17-year-old adolescent tells the nurse that he is not having sex because it would make his parents very angry. This response indicates that the adolescent has a developmental lag in which area?

4 Cognitive development 5

Moral development

6

Psychosocial development

7

Psychosexual development

9. The best response a nurse can make to a 15-year-old girl who has verbalized a desire to have a baby is: 4 “Have you talked with your parents about this?”

5

“Do you have plans to continue school?”

6

“Will you be able to support the baby?”

7

“Can you tell me how your life will change if you have an infant?”

10. In an interview with the nurse, a mother states that she is concerned that her 14-year-old teen is critical and finding fault with her. The nurse counsels the mother that: 4 the family needs to change its value system to meet the teenager’s changing needs.

5

the parent–teen relationship is important for the teenager and conflicts are to be expected.

6

teenagers create psychological distance from the parent to separate from the parent. parents need to relinquish their relationship with their teenager to the teen’s peers.

7

11. A nurse is teaching adolescent boys about pubertal changes. Which is the first sign of pubertal change seen with boys?

4 Testicular enlargement 5

Facial hair

6

Scrotal enlargement

7

Voice deepens

MULTIPLE RESPONSE 1. Parents of a teenager ask the nurse what signs they should look for if their child is in a gang. The nurse should include which signs when answering? Select all that apply.

4 Plans to try out for the debate team at school 5

Skips classes to go to the mall

6

Hangs out with friends they have had since childhood

7

Has an unexplained source of money

8

Fears the police

OTHER 1. Place in order the signs of female sexual maturity beginning with the first sign and ending with the last. Use the following format for your answers: A, B, C, D

4 Growth of pubic hair 5 Menarche 6 Appearance of breast buds 7 Ovulation is established

Chapter 09: Physical Assessment of Children Chapter 09: Physical Assessment of Children Test Bank MULTIPLE CHOICE 1. The nurse is performing an abdominal assessment on a child. When percussing over the stomach, the nurse should hear which sound?

4 Tympany 5 6

4

Resonance Flatness Dullness

2. A nurse is preparing to begin an assessment on a newly admitted child. The nurse should be aware that the single most important component of a pediatric physical examination is: 4 assessment of heart and lungs.

5

measurement of height and weight.

6

documentation of parental concerns.

7

obtaining an accurate history.

3. In which section of the health history should the nurse record that the parent brought the infant to the clinic today because of frequent diarrhea?

4 Review of systems 5

Chief complaint

6

Lifestyle and life patterns

7

Health history

4. A nurse is reviewing pediatric physical assessment techniques. Which statement about performing a pediatric physical assessment is correct?

4 Physical examinations proceed systematically from head to toe unless developmental considerations d 5

The physical examination should be done with parents in the examining room for children of any age.

6

Measurement of head circumference is done until the child is 5 years old.

7

The physical examination is done only when the child is cooperative.

5. A nurse is conducting an assessment on a child during a well-child visit.

Which of the following includes the components of a complete pediatric history?

4 Statistical information, client profile, health history, family history, review of systems, and lifestyle a 5

Vital signs, chief complaint, and a list of previous problems

6

Chief complaint, including body location, quality, quantity, time frame, and alleviating and aggravatin

7

Pertinent developmental and family information

6. At what age can the nurse expect a child’s head and chest circumference to be almost equal?

4 Birth 5

6 months

6

1 year

7

3 years

7. A nurse is teaching unlicensed assistive personnel (UAP) how to take accurate blood pressure on children. The nurse knows the UAPs have understood the teaching if they state that to obtain an accurate measurement of a child’s blood pressure, the cuff should cover which portion of the child’s upper arm?

4 Two-thirds 5

Three-fourths

6

One-half

7

One-third

8. Which chart should the nurse use to assess the visual acuity of an 8-year-old child?

4 Lea chart 5

Snellen chart

6

HOTV chart

7

Tumbling E chart

9. Which action is appropriate when the nurse is assessing breath sounds of an 18month-old crying child?

4 Ask the parent to quiet the child so the nurse can listen.

5

Auscultate breath sounds and chart that the child was crying.

6

Encourage the child to play with the stethoscope to distract and to calm down the child before auscult

7

Document that data are not available because of noncompliance.

10. Which is the most appropriate site for the nurse to use to measure a pulse rate on a 1year-old child?

4 Apical 5

Radial

6

Carotid

7

Femoral

11. What is the most appropriate action for the nurse to take when a crying toddler has a blood pressure measurement of 120/70 mm Hg? 4 Notify the physician of the measurement.

5

Document the blood pressure reading and check it again in 4 hours.

6

Quiet the child and retake the blood pressure.

7

Ask the parent if the child has a history of hypertension.

12. What term should be used in the nurse’s documentation to describe auscultation of breath sounds that are short, popping, and discontinuous on inspiration?

4 Pleural friction rub 5

Bronchovesicular sounds

6

Crackles

7

Wheeze

13. Which strategy should be the best approach when initiating the physical examination of a 9-monthold infant?

4

Undress the infant and do a head-to-toe examination.

5

Have the parent hold the child on his or her lap.

6

Put the infant on the examination table and begin assessments at the head.

7

Ask the parent to leave because the infant will be upset.

14. Which strategy is not always appropriate for a pediatric physical examination?

4 Take the history in a quiet, private place.

5

Examine the child from head to toe.

6

Exhibit sensitivity to cultural needs and differences.

7

Perform frightening procedures last.

15. Which assessment should the nurse perform last when examining a 5-year-old child?

4 Heart 5 Lungs

4

Abdomen

5

Throat

16. When would be the most appropriate time to inspect the genital area during a well-child examination of a 14-year-old female?

4 It is not necessary to inspect the genital area.

5

Examine the genital area first.

6

After the abdominal assessment.

7

Do the genital inspection last.

17. Which measurement is not indicated for a 4-year-old well-child examination?

4 Blood pressure 5

Weight

6

Height

7

Head circumference

18. The nurse inspecting the skin of a dark-skinned child notices an area that is a dusky red or violet color. This skin coloration is associated with which?

4 Cyanosis 5

Erythema

6

Vitiligo

7

Nevi

19. The nurse palpated the anterior fontanel of a 14-month-old infant and found that it was closed.

What would this finding indicate?

4 This is a normal finding.

5

This finding indicates premature closure of cranial sutures.

6

This is an abnormal finding and the child should have a developmental evaluation.

7

This is an abnormal finding and the child should have a neurological evaluation.

20. A nurse is conducting vision screening on preschool children. Which of the following corresponds with the normal range for visual acuity of a 4-year-old child?

4 20/50 to 20/80 5

20/40 to 20/70

4

20/30 to 20/40

5

20/20 to 20/30

21. A child begins to squirm and giggle when the nurse begins to palpate the abdomen. What is the best approach for the nurse to use with a child who is ticklish?

4 Skip the abdominal palpation.

5

Touch the abdomen firmly as the child takes short, quick breaths.

6

Press the abdomen with the child bearing down and holding the breath.

7

Palpate with the child’s hand under the examiner’s hand.

22. Which cranial nerve is assessed when the child is asked to imitate the examiner’s wrinkled frown, wrinkled forehead, smile, and raised eyebrow?

4 Accessory 5

Hypoglossal

6

Trigeminal

7

Facial

23. Which assessment finding is considered a neurological soft sign in a 7-year-old child?

4 Plantar reflex 5

Poor muscle coordination

6

Stereognostic function

7

Graphesthesia

MULTIPLE RESPONSE 1. A nurse is performing an assessment on a newborn. Which vital signs indicate a normal finding for this age group? Select all that apply.

4 Pulse of 80 to 125 a minute 5

B/P of systolic 65 to 95 and diastolic 30 to 60

6

Temperature of 36.5° to 37.3° Celsius (axillary)

7

Temperature of 36.4° to 37° Celsius (axillary)

8

Respirations of 30 to 60 a minute

2. A school nurse is screening children for scoliosis. Which assessment findings should the nurse expect to observe for scoliosis? Select all that apply.

4 Pain with deep palpation of the spinal column 5

Unequal shoulder heights

6

The trouser pant leg length appears shorter on one side

7

Inability to bend at the waist

8

Unequal waist angles

Chapter 10: Emergency Care of Children Chapter 10: Emergency Care of Children Test Bank MULTIPLE CHOICE 1. Which nursing action would facilitate care being provided to a child in an emergency situation?

4 Encourage the family to remain in the waiting room.

5

Assist parents in distracting the child during a procedure.

6

Always reassure the child and family.

7

Give explanations using professional terminology.

2. The father of a child in the emergency department is yelling at the physician and nurses. Which action would be contraindicated in this situation?

4 Provide a nondefensive response.

5

Encourage the father to talk about his feelings.

6

Speak in simple, short sentences.

7

Tell the father he must wait in the waiting room.

3. Which would be an appropriate nursing intervention for a 6-month-old infant in the emergency department?

4 Distract the infant with noise or bright lights.

5

Avoid warming the infant.

6

Remove any pacifiers from the baby.

7

Encourage the parent to hold the infant.

4. Which action should the nurse working in the emergency department initiate to decrease fear in a 2year-old child?

4 Keep the child physically restrained during nursing care.

5 Allow the child to hold a favorite toy or blanket.

4 Direct the parents to remain outside the treatment room.

5

Let the child decide whether to sit up or lie down for procedures.

5. Which nursing action would be most appropriate to assist a preschool-age child in coping with the emergency department experience?

4 Explain the procedures and give the child some time to prepare.

5

Remind the child that she is a big girl.

6

Avoid the use of bandages.

7

Use positive terms and avoid terms such as “shot” and “cut.”

6. Which action should the nurse incorporate into a care plan for a 14-year-old child in the emergency department?

4 Limit the number of choices to be made by the adolescent.

5

Insist that parents remain with the adolescent.

6

Provide clear explanations and encourage questions.

7

Give rewards for cooperation with procedures.

7. The emergency department nurse notices that the mother of a young child is making a lot of phone calls and getting advice from her friends about what she should do. This behavior is an indication of which of the following?

4 Stress 5

Healthy coping skills

6

Attention-getting behaviors

7

Low self-esteem

8. A preschool child in the emergency department has a respiratory rate of 10 breaths per minute. How should the nurse interpret this finding?

4 The child is relaxed.

5

Respiratory failure is likely.

6

This child is in respiratory distress.

7

The child’s condition is improving.

Chapter 11: The Ill Child in the Hospital and Other Care Settings Chapter 11: The Ill Child in the Hospital and Other Care Settings Test Bank MULTIPLE CHOICE 1. In which situation should the nurse address anxiety as a priority problem in planning care for the child and family?

4

Twenty-four hour observation

5

Emergency hospitalization

6

Outpatient admission

7

Rehabilitation admission

2. What is the primary disadvantage associated with outpatient and day facility care?

4 Increased cost 5

Increased risk of infection

6

Lack of physical connection to the hospital

7

Longer separation of the child from the family

3. In planning care, the nurse recognizes that which child should have the most difficulty with separation from family during hospitalization?

4 A 5-month-old infant 5 A 15-month-old toddler 4 A 4-year-old child 5

A 7-year-old child

4. A 2-year-old child has been hospitalized for 4 days. The nurse notes the child is quiet and withdrawn. Which is the best explanation for this behavior?

4 The child is protesting because of separation from caregivers.

5

The child has adjusted to the hospitalization.

6

The child is experiencing the despair stage of separation.

7

The child has reached the stage of detachment.

5. A 3-year-old child cries, kicks, and clings to the father when the parents try to leave the hospital room. What is the nurse’s best response to the parents about this behavior?

4 “Your child is showing a normal response to the stress of hospitalization.”

5

“Your child is not coping effectively with hospitalization. We’ll need to get a psychological consult fr

6

“It is helpful for parents to stay with children during hospitalization.”

7

“You can avoid this if you wait to leave after your child falls asleep.”

6. A preschool aged child tells the nurse “I was bad, that’s why I got sick.” Which is the best rationale for this child’s statement?

4 The child has a fear that mutilation will lead to death.

5

The child’s imagination is very active, and he may believe the illness is a result of something he did.

6

The child has a general understanding of body integrity at this age.

7

The child will not have fear related to an IV catheter initiation but will have fear of an impending surg

7. A nurse caring for a hospitalized adolescent should implement which most developmentally appropriate intervention?

4 Encouraging peers to call and visit when the adolescent’s condition allows 5

Being sure the adolescent wears a hospital gown or pajamas throughout the hospitalization

6

Discouraging questions and concerns about the effects of the illness on the adolescent’s appearance

7

Asking the parents how the adolescent usually copes in new situations

8. The nurse is discussing toddler development with the mother of a 2 1/2-year-old child. Which statement by the mother indicates she has an understanding of the toddler’s developmental task?

0

“I always help my daughter complete tasks to help her achieve a sense of accomplishment.”

1

“I provide many opportunities for my daughter to play with other children her age.”

2

“I consistently stress the difference between right and wrong to my daughter.”

3

“I encourage my daughter to do things for herself when she can.”

9. Which interventions would best help a hospitalized toddler feel a sense of control?

0 Assign the same nurse to care for the child.

1

Put a cover over the child’s crib.

2

Require parents to stay with the child.

3

Follow the child’s usual routines for feeding and bedtime.

10. Parents ask the nurse why observation for 24 hours in an acute-care setting is often appropriate for children. Which is the best response by the nurse?

0 “Longer hospital stays are more costly.”

1

“Children become ill quickly and recover quickly.”

2 3 0 1

“Children feel less separation anxiety when hospitalized for just 24 hours.”

“Families experience less disruption during short hospital stays.”

11. The nurse is aware that separation is the major stressor for which age group?

0 Newborns and infants 1

Infants and toddlers

2

Toddlers and preschoolers

3

Preschoolers and school-age children

12. The nurse recognizes that the stress of hospitalization is increased by an active imagination during unfamiliar experiences for which age group?

0 Toddlers 1

Preschoolers

2

School-age children

3

Adolescents

13. Which play activity should the nurse implement to enhance deep breathing exercises for a toddler? ᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀ℀ĀĀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀ̀​̀0 Blowing bubbles ᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀ℀ĀĀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀ̀​̀1

Throwing a Nerf ball

ᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀ℀ĀĀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀ̀​̀2

Using a spirometer

ᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀ℀ĀĀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀ̀​̀3

Keeping a chart of deep breathing

14. The nurse should plan to explain procedures and encourage selection of their own meals from hospital menus for which age group of patients? 

Toddlers



Preschoolers



School-age children



Adolescents

15. What is the best action for the nurse to take when a 5-year-old child cries, screams, and resists having his IV restarted because an IV antibiotic is due? 

Exit the room and leave the child alone until he stops crying.



Tell the child big boys and girls “don’t cry.”



Let the child decide which color arm board to use with his IV.



Proceed quickly with the IV insertion to decrease stress.

16. What is the best nursing response to the mother of a 4-year-old child who asks what she can do to help the child cope with a sibling’s repeated hospitalizations? 

Recommend that the child be sent to visit the grandmother until the sibling returns home.



Inform the parent that the child is too young to visit the hospital.



Assume the child understands that the sibling will soon be discharged because the child asks no quest Help the mother give the child a simple explanation of the treatment and encourage the mother to hav

hospitalized sibling.

17. Parents are expressing concerned about their preschooler’s current sleep habits, which were disrupted by a recent hospitalization, stating that the child now awakens frequently at night. Which response by the nurse best addresses this problem? 

Regressive behavior after a hospitalization is normal and is usually short term.



The child is probably expressing anger.



Egocentric behavior often manifests itself when the child is left alone to sleep.



The child is probably feeling pain and needs further evaluation.

18. Which nursing intervention is appropriate for the hospitalized neonate?  Assign the neonate to a room with other neonates. 

Provide play activities in the hospital room.



Offer the neonate a pacifier between feedings.



Request that parents bring a security object from home.

19. Which approach will best help a 7-year-old child cope with a lengthy course of intravenous antibiotic therapy? 

Arrange for the child to go to the playroom daily.



Ask the child to draw you a picture about himself.



Allow the child to participate in injection play.



Give the child stickers for cooperative behavior.

20. A 6-year-old child tells the nurse that she does not like the food at the hospital. A review of intake reveals she has eaten very little for the past 2 days. Which intervention is appropriate for the nursing diagnosis: Imbalanced Nutrition: Less than body requirements? 

Select nutritious foods on the menu for the child.



Permit the child to eat junk foods at snack times.



Arrange the child’s meal tray with generous portions of food.



Encourage family members to bring foods from home.

21. A 3 1/2-year-old child who is toilet trained has had several “accidents” since hospital admission. What is the nurse’s best action in this situation? 

Find out how long the child has been toilet trained at home.



Tell the parent it is necessary to begin toilet training again.



Explain how to use a bedpan and place it close to the child.



Follow home routines of elimination.

22. Which question would most likely elicit information about how a family is coping with a child’s hospitalization? 

“Was this admission an emergency?”



“How has your child’s hospitalization affected your family?”



“Who is taking care of your other children while you are here?”

“Is this the child’s first hospitalization?”



23. What would the nurse advise the mother of a 4-year-old child to bring for the child on the day of outpatient surgery? 

Snacks



Fruit juice boxes



All of the child’s medications



One of the child’s favorite toys

MULTIPLE RESPONSE 1. Which developmental approaches should the nurse implement for the hospitalized adolescent? Select all that apply. 

Expect regression.



Provide privacy.



Encourage peers to call.



Answer questions with simple concrete explanations.



Encourage questions about appearance.

2. Parents of a school-age child ask the nurse about services provided by school-based clinics. Which statement made by the nurse is accurate with regard to school-based clinic services? Select all that apply. 

Vision, hearing, and growth screening are provided.



Education about health-related topics is provided to children and parents.



Minor outpatient surgical procedures can be performed.



Emergency first aid treatment is provided.



Casts can be applied to broken bones.

Chapter 12: The Child with a Chronic Condition or Terminal Illness Chapter 12: The Child with a Chronic Condition or Terminal Illness Test Bank MULTIPLE CHOICE 1. A family has just learned their child has cystic fibrosis. They told the nurse “this won’t change anything, our child is not that sick.” The nurse recognizes that the family is in which stage of the grieving process? 

Anger and resentment



Sorrow and depression



Shock and disbelief



Acceptance and adjustment

2. A nurse is planning care for a dying child. Which priority intervention is planned to address the primary concern parents have for the dying child? 

Pain



Safety



Food intake



Fluid intake

3. A parent of an infant states that she will room-in while her child is hospitalized. The nurse supports her decision knowing that the major fears of infants during illness and hospitalization are: 

bodily injury and pain.



separation from caregivers and fear of strangers.



loss of control and altered body image.



the unknown and being left alone.

4. A nurse has just completed a teaching session for parents about children’s understanding of death.

Parents of a 5-year-old child understood the teaching if they indicate which corresponds to their child’s understanding of death? 

Loss of a caretaker



Reversible and temporary



Permanent



Inevitable

5. A nurse plans to include family in the aspects of care for a dying 12-month-old child. The nurse bases this plan on the understanding that death for an infant is understood as: 

temporary.



permanent.



loss of caretaker.



punishment.

6. Which activity should the nurse implement for the toddler hospitalized with a chronic illness to promote autonomy? 

Playing with a push-pull toy.



Putting a puzzle together.

Playing a simple card game.

Watching cartoons on TV.





7. How can chronic illness and frequent hospitalization affect the psychosocial development of an adolescent? 

They can lead to feelings of inadequacy.



They can interfere with parental attachment.



They can block the development of identity.



They can prevent the development of imagination.

8. Which is an important focus of nursing care for the dying child and his or her family?  Nursing care should be organized to minimize contact with the child. 

Adequate oral intake is crucial to the dying child.



Families should be made aware that hearing is the last sense to stop functioning before death.



It is best for the family if nursing care takes place during periods when the child is alert.

9. What is the most appropriate response to a school-age child who asks if she can talk to her dying sister? 

“You need to talk loudly so she can hear you.”



“Holding her hand would be better because at this point she can’t hear you.”



“Although she can’t hear you, she can feel your presence so sit close to her.”



“Even though she will probably not answer you, she can still hear what you say to her.”

10. The nurse recognizes that the priority goal for the child with a chronic illness is to:  maintain the intactness of the family. 

eliminate all stressors.



achieve complete wellness.



obtain the highest level of wellness.

11. Which is the predominant trait of the resilient family associated with chronic illness?  Social separation 

Family flexibility



Family cohesiveness



Clear family boundaries

12. Parents express recurrent feelings of grief, loss, and fear related to their child’s chronic condition. The nurse understands that this is: 

anticipatory grieving.



chronic sorrow.



bereavement.



illness trajectory.

13. Which would be a priority nursing diagnosis for the child with chronic illness?  Risk for delayed development related to chronic illness or disability 

Chronic pain related to frequent injections



Anticipatory grieving related to impending death



Anxiety related to frequent hospitalizations

14. Which is the most appropriate response for the nurse when parents say that “living with this disease our child has is really hard; it’s not fair”? 

“Tell me about what is hard for you.”



“I know exactly how you must feel.”



“I know a local support group for families.”



“I am going to ask the grief counselor to meet with you.”

15. Which is the most appropriate response to a parent who tells the nurse, “I don’t want my child to know she is dying?” 

“I shall respect your decision. I won’t say anything to your child.”



“Don’t you think she has a right to know about her condition?”



“Would you like me to arrange for the physician to speak with your child?”



“I’ll answer any questions she asks me as honestly as I can.”

MULTIPLE RESPONSE 1. Which indicators of imminent death in a child should the nurse expect to assess? Select all that apply. 

Heart rate increases.



Blood pressure increases.



Respirations become rapid and shallow.



The extremities become warm.



Peripheral pulses become stronger.

OTHER

1. Place the stages of grieving in order starting with the initial stage and ending with the final stage. 

Anger



Depression



Denial



Acceptance

 Bai ni ng

Chapter 13: Principles and Procedures for Nursing Care of Children Chapter 13: Principles and Procedures for Nursing Care of Children Test Bank MULTIPLE CHOICE 1. Which is the most appropriate statement for the nurse to make to a 5-year-old child who is to have a venipuncture? 

“You must hold still or I’ll have someone hold you down. This is not going to hurt.”



“This will hurt like a pinch. I’ll get someone to help you hold your arm still so it will be over fast and “Be a big boy and hold still. This will be over in just a second.”

“I’m sending your mother out so she won’t be scared. You are big, so hold still and this will be over s





2. The nurse should obtain informed consent for which situation?



For any procedure that will be performed on a child



For any invasive procedure involving a risk to a child



Only if the child is not able to give consent



Only if the parents are not present

3. Which nursing diagnosis is appropriate for a 5-year-old child in isolation because of immunosuppression? 

Spiritual distress



Social isolation



Diversional activity deficit



Sleep disturbance

4. Which nursing action is most appropriate when giving a child a sponge bath to decrease fever?  Use alcohol in the bath water to lower the child’s temperature rapidly. 

Use cold water to hasten the procedure.



Stop the sponge bath immediately if the child starts to shiver.



Bathe the child for 45 to 60 minutes.

5. Which action is appropriate when the nurse is bathing a small child?



Test the water on the inside of the wrist or elbow for comfort.



Allow children older than 2 years to bathe themselves.



Check that the water temperature does not exceed 120° F.



Step out of the room to give the child privacy while bathing.

6. Which is the best response for a nurse to make to a parent who has asked, “When should I start dental care for my child?” 

“The recommendation is for children to have a dental examination no later than 2 1/2 years.”



“Children should see a dentist at least one time before kindergarten.”



“The recommendation is for children to have a dental examination before first grade.”



“A dental examination by 1 year of age is the current recommendation.”

7. Which action is appropriate to promote a toddler’s nutrition during hospitalization?  Allow the child to walk around during meals. 

Require the child to empty his or her plate.



Ask the child’s parents to bring a cup and utensils from home.



Select new foods for the child from the menu.

8. Which concept is important for the nurse to know when taking a child’s temperature?  The method used should be consistent. 

Rectal temperatures should always be taken on infants.



Oral temperatures can be taken on all children older than 5 years of age.



Axillary temperatures should be taken at night.

9. A parent calls the pediatrician’s office because her 1-year-old child has a 100° F temperature. What would be the most appropriate initial nursing response to make to the parent?



“Did you feel your child’s forehead?”



“Tell me about the child’s behavior.”



“Has anyone in your home been sick lately?”



“There is no need for concern if the child’s temperature is less than 101° F.”

10. Which nursing action is appropriate for specimen collection? 

Follow sterile techniques for specimen collection.



Sterile gloves are worn if the nurse plans to touch the specimen.



Use standard precautions when handling body fluids.

Avoid wearing gloves in front of the child and family.

ANS: C 

11. What information should the nurse include in teaching parents to care for a child’s gastrostomy tube at home? 

Never turn the gastrostomy button.



Clean around the insertion site daily.



Expect some leakage around the button.



Remove the tube for cleaning once a week.

12. Which nursing action is the most appropriate when applying a face mask for oxygen therapy to a child? 

The oxygen flow rate should be less than 6 liters per minute.



Make sure the mask fits properly.



Keep the child warm.



Remove the mask for 5 minutes every hour.

13. Which information is appropriate to include in the care plan for a family of a child with a tracheostomy? 

Suction of the tracheostomy every 2 to 4 hours or as needed



Application of powder around the stoma to decrease irritation



Suction catheter insertion limited to less than 30 seconds



Hygiene that includes showers, not baths

14. Which action by the nurse indicates that the correct procedure has been used to measure vital signs in a toddler? 

Measuring oral temperature for 5 minutes



Counting apical heart rate for 60 seconds



Observing chest movement for respiratory rate



Recording blood pressure as P/80

15. Which action by a nurse is appropriate when preparing a child for a procedure?  Discourage the child from crying during the procedure. 

Use professional terms so the child will understand what is happening.



Give the child choices whenever possible.



Discourage the parents from staying in the room during the procedure.

16. Which is the most reliable method that indicates the end of a nasogastric tube is correctly placed? 

Swallowing, coughing, and gagging reflex are intact.



The pH of aspirated fluid is 5 or lower.



The fluid has a grassy green appearance.



Insufflation of air is auscultated over the epigastrium.

17. Which is critical for the nurse to know when using restraints on children?  Use the least restrictive type of restraint. 

Tie knots securely so they cannot be untied easily.



Secure the ties to the mattress or side rails.



Remove restraints every 4 hours to assess skin.

18. Where would the nurse locate the apical pulse on a 6-year-old child?



Second right intercostal space



Second intercostal space at the sternal border



Fourth intercostal space lateral to the midclavicular line



Fifth intercostal space at the midclavicular line

SHORT ANSWER 1. A nurse is totaling the intake of a child who is on oral feedings, enteral feedings, and parenteral IV fluids. During the 8 hour shift the child took 4 ounces of formula, by mouth. The child also had a supplemental feeding per gastrostomy tube that ran at 20 mL per hour for 4 hours. The child’s IV ran continuously at 25 mL per hour for the whole 8 hours. What is the child’s total intake for the 8 hour shift?

Chapter 14: Medication and Administration Safety of Infants and Children Chapter 14: Medication and Administration Safety of Infants and Children Test Bank MULTIPLE CHOICE 1. Which should the nurse use to prepare liquid medication in volumes less than 5 milliliters?  Calibrated syringe 

Paper measuring cup



Plastic measuring cup



Household teaspoon

2. Which food choice is appropriate to mix with medication? 

Formula or milk



Applesauce



Syrup



Orange juice

3. Which physiological difference would affect the absorption of oral medications administered to a 3month-old infant? 

More rapid peristaltic activity



More acidic gastric secretions



Usually more rapid gastric emptying



Variable pancreatic enzyme activity

4. Which factor should the nurse remember when administering topical medication to an infant?



Infants require a larger dosage because of a greater body surface area.



Infants have a thinner stratum corneum that absorbs more medication.



Infants have a smaller percentage of muscle mass compared with adults.



The skin of infants is less sensitive to allergic reactions.

5. What is the appropriate nursing response to a parent who asks, “What should I do if my child cannot take a tablet?” 

“You can crush the tablet and put it in some food.”



“Find out if the medication is available in a liquid form.”



“If the child can’t swallow the tablet, tell the child to chew it.”



“Let me show you how to get your child to swallow tablets.”

6. What is the maximum safe volume that an infant (aged 1 to 12 months) can receive in an intramuscular injection? 

0.25 milliliter



0.5 milliliter 1 milliliter 1.5 milliliters





7. Which muscle would the nurse select to give a 6-month-old infant an intramuscular injection?  Deltoid 

Ventrogluteal



Dorsogluteal



Vastus lateralis

8. The nurse is planning to administer an intramuscular injection to a 13-year-old child. What is the maximum volume of medication that can be injected into the ventrogluteal site? 

0.5 to 1 milliliter



1 to 1.5 milliliters



1.5 to 2 milliliters



2 to 2.5 milliliters

9. Which parameter should guide the nurse when administering a subcutaneous injection?



Do not give injections in edematous areas.



Attach a clean 1-inch needle to the syringe.



The maximum volume injected into one site is 2 milliliters.



Do not pinch up tissue before inserting the needle.

10. Which action is correct when administering ear drops to a 2-year-old child?  Administer the ear drops straight from the refrigerator. 

Pull the pinna of the ear back and down.



Massage the pinna after administering the medication.



Pull the pinna of the ear back and up.

11. A nurse is preparing to start a continuous IV infusion on a child. The nurse selects a Buretrol (volume-control) attachment as part of the IV tubing set-up. The main purpose for selecting a Buretrol attachment is to:





avoid fluid overload.



aid in measuring intake.



administer antibiotics. ensure adequate intravenous fluid intake.

12. Which is the most important nursing action before discharge for a mother who is apprehensive about giving her child insulin? 

Review the side effects of insulin with the mother.



Have the mother verbalize that she knows the importance of follow-up care.



Observe the mother while she administers an insulin injection.



Help the mother devise a rotation schedule for injections.

13. A nurse has just initiated an intravenous piggyback of gentamicin (Garamycin). What is the best time for a trough serum level to be measured? 

Just before the next dose



When the infusion is finished



One hour after the medication is administered



Depends on the specific medication

14. A nurse should routinely ask a colleague to double-check a medication calculation and the actual medication before administering which medications? 

Antibiotics



Acetaminophen



Anticonvulsants



Anticoagulants

15. Which nursing action is correct when administering heparin subcutaneously?  Insert the needle with the bevel up at a 15-degree angle. 

Insert the needle into the skin at a 45-degree angle.



Inject the needle into the tissue on the upper back.



Massage the injection site when the injection is complete.

16. Which indicates that a school-age child is using a metered-dose inhaler correctly? 

The child uses his inhaled steroid before the bronchodilator.



The child exhales forcefully as he squeezes the inhaler.



The child holds his breath for 10 seconds after the first puff.



The child waits 10 minutes before taking a second puff.

17. Which step is appropriate when using EMLA cream before intravenous catheter insertion?  Rub a liberal amount of cream into the skin thoroughly. 

Cover the skin with a gauze dressing after applying the cream.



Leave the cream on the skin for 1 to 2 hours before the procedure.



Use the smallest amount of cream necessary to numb the skin surface.

18. A child is receiving intravenous fluids. How frequently should the nurse assess and document the condition of the child’s intravenous site? 

Every hour



Every 2 hours



Every 4 hours



Every shift

19. What is the hourly maintenance fluid rate for an intravenous infusion in a child weighing 19.3 kilograms? 

19 milliliters



45 milliliters



61 milliliters



95 milliliters

20. The nurse administering an IV piggyback medication to a preschool child should take which action? 

Dilute the medication in at least 20 milliliters and infuse over at least 15 minutes.



Flush the IV tubing before and after the infusion with normal saline solution.



Inject the medication into the IV catheter using the port closest to the child.



Inject the medication into the IV tubing in the direction away from the child.

21. What nursing action is indicated when a child receiving a unit of packed red blood cells complains of chills, headache, and nausea? 

Continue the infusion and take the child’s vital signs.



Stop the infusion immediately and notify the physician.



Slow the infusion and assess for cessation of symptoms.



Start a dextrose solution and stay with the child.

22. What is the best action for the nurse to take when giving medications to a 3-year-old child?  Tell the child to take the medication “right now.” 

Tell the child to take the medication or he will have to get a shot.



Allow the child to choose fruit punch or apple juice when giving the medication.



Tell the child that another child his age just took his medication like a “good boy.”

MULTIPLE RESPONSE 1. Which are advantages of using an Electronic Medical Record System (EMR) for medication administration to children? Select all that apply. 

Eliminates the need to perform the six rights of medication administration



Reduces medication errors



Is a cost effective means of medication administration



Improves communication of patient medication lists



Improves communication of patient allergies

SHORT ANSWER

1.You need to administer ibuprofen, 120 mg, to your 4-year-old patient. Ibuprofen comes in liquid form in a dose of 100 mg/5 mL. How many milliliters will you give?

Chapter 15: Pain Management for Children Chapter 15: Pain Management for Children Test Bank MULTIPLE CHOICE 1. The nurse is aware when assessing a child for pain that:  neonates do not feel pain. 

pain is an individualized experience.



children do not remember pain.



a child must cry to express pain.

2. When pain is assessed in an infant, it would be inappropriate to assess for:  facial expressions of pain. 

localization of pain.



crying.



thrashing of extremities.

3. The nurse is aware that physiological changes associated with pain in the infant include which finding(s)? 

Increased blood pressure and decreased arterial saturation



Decreased blood pressure and increased arterial saturation





Increased urine output and increased heart rate Decreased urine output and increased blood pressure

4. Which statement best reflects a myth that may interfere with the treatment of pain in infants and children? 

Infants may have sleep difficulties after a painful event.



Children and infants are more susceptible to respiratory depression from narcotics.



Pain in children is multidimensional and subjective.



A child’s cognitive level does not influence the pain experience.

5. The nurse caring for the child in pain knows that distraction:



can give total pain relief to the child.



is effective when the child is in severe pain.



is the best method for pain relief.



must be developmentally appropriate to refocus attention.

\ 6. Which medication is the most effective choice for treating pain associated with inflammation?  Opioids 

Acetaminophen



Ibuprofen



Midazolam

7. When using the Poker Chip Tool, it is important for the nurse to know which fact?  Any number of chips can be used. 

Only a specified number of chips can be used.



The assessment tool is used with adolescents.



The assessment tool is most effectively used with 2-year-old children.

8. An appropriate tool to assess pain in a 3-year-old child would be the:



Visual Analogue Scale (VAS).



Adolescent and Pediatric Pain Tool.



Oucher Tool.



Poker Chip Tool.

9. At which developmental stage is the child first able to localize pain and describe both the amount and the intensity of the pain felt? 

Toddler stage



Preschool stage



School-age stage



Adolescent stage

10. Which statement indicates a nurse’s lack of understanding about the use of patientcontrolled analgesia (PCA) therapy? 

Children as young as 3 years old can effectively and successfully use a PCA pump.



Two registered nurses (RNs) are required to double check the dosage and programmed administration



The child should be carefully monitored for signs and symptoms of overmedication with opioids.



Naloxone (Narcan) should be readily available.

11. Which assessment indicates to a nurse that a 2-year-old child is in need of pain medication?  The child is restless and guarding the painful site. 

The child’s current vital signs are consistent with vital signs over the past 4 hours.



The child is quieted when held and cuddled.



The child has just returned from the recovery room and is crying.

12. When assessing pain in any child, the nurse should consider which information?  Any pain assessment tool can be used to assess pain in children. 

Children as young as age 1 year use words to express pain.



The child’s behavioral, physiological, and verbal responses are valuable when assessing pain.



Pain assessment tools are minimally effective for communicating about pain.

MULTIPLE RESPONSE 1. A nurse is administering an opioid medication to a child. Which side effects should the nurse watch for with this classification of medication? Select all that apply. 

Respiratory depression



Hepatic damage



Constipation



Pruritus



Gastrointestinal bleeding

2. A nurse is assessing pain on a 12-year-old child. Which pain assessment tools are developmentally appropriate for the nurse to use? Select all that apply. 

CRIES pain scale



Numeric Rating Scale



Visual Analog Scale



FLACC

Chapter 16: The Child with a Fluid and Electrolyte Alteration Chapter 16: The Child with a Fluid and Electrolyte Alteration Test Bank MULTIPLE CHOICE 1. The parents of a child with acid-base imbalance ask the nurse about mechanisms that regulate acidbase balance. Which statement by the nurse accurately explains the mechanisms regulating acid-base balance in children? 

The respiratory, renal, and chemical-buffering systems regulate acid-base in the body.



The kidneys balance acid; the lungs balance base.



The cardiovascular and integumentary systems work together to control acid-base.



The skin, kidney, and endocrine systems control the body’s acid-base.

2. A child has a 2-day history of vomiting and diarrhea. He has hypoactive bowel sounds and an irregular pulse. Electrolyte values are sodium, 139 mEq/L; potassium, 3.3 mEq/L; and calcium, 9.5 mg/dL. This child is likely to have which of the following electrolyte imbalances? 

Hyponatremia



Hypocalcemia



Hyperkalemia



Hypokalemia

3. Which statement best describes why infants are at greater risk for dehydration than older children? 

Infants have an increased ability to concentrate urine.



Infants have a greater volume of intracellular fluid.



Infants have a smaller body surface area.



Infants have an increased extracellular fluid volume.

4. Which assessments are most relevant to the care of an infant with dehydration?



Temperature, heart rate, and blood pressure



Respiratory rate, oxygen saturation, and lung sounds



Heart rate, capillary refill, and skin color



Diet tolerance, bowel function, and abdominal girth

5. Which factor is the most important in determining the rate of fluid replacement in the dehydrated child? 

The child’s weight



The type of dehydration



Urine output



Serum potassium level

6. Which is the priority nursing intervention for a 6-month-old infant hospitalized with diarrhea and dehydration? 

Estimating insensible fluid loss



Collecting urine for culture and sensitivity



Palpating the posterior fontanel



Measuring the infant’s weight

7. What assessment should the nurse make before initiating an intravenous (IV) infusion of dextrose 5% in 0.9% normal saline solution with 10 mEq of potassium chloride for a child hospitalized with dehydration? 

Fluid intake



Number of stools



Urine output



Capillary refill

8. A nurse is teaching parents about diarrhea. Which statement by the parents indicates understanding of the teaching? 

Diarrhea results from a fluid deficit in the small intestine.



Organisms destroy intestinal mucosal cells, resulting in an increased intestinal surface area.



Malabsorption results in metabolic alkalosis.



Increased motility results in impaired absorption of fluid and nutrients.

9. Which is the best nursing response to a parent asking about antidiarrheal medication for her 18-month-old child?  

“It is okay to give antidiarrheal medication to a young child as long as you follow the directions on th dosage.”

 

“Antidiarrheal medication is not recommended for young children because it slows the body’s attemp pathogen.”



“I’m sure your child won’t like the taste so give her extra fluids when you give the medication.”

“Antidiarrheal medication will decrease the frequency of stools, but give your child Gatorade to main balance.”

10. Which is the primary intervention in treating a child with persistent vomiting?  Detecting the cause of vomiting 

Preventing metabolic acidosis



Positioning the child supine



Recording intake and output

11. Which is the best nursing response to give a parent about contacting the physician regarding an infant with diarrhea?



“Call your pediatrician if the infant has not had a wet diaper for 6 hours.”



“The pediatrician should be contacted if the infant has two loose stools in an 8-hour period.”



“Call the doctor immediately if the infant has a temperature greater than 100° F.”



“Notify the pediatrician if the infant naps more than 2 hours.”

12. Which diet would the nurse recommend to the mother of a child who is having mild diarrhea? 

Rice, potatoes, bread, and cereal



Bananas, rice, applesauce, and toast



Apple juice, hamburger, and salad



Whatever the child would like to eat

MULTIPLE RESPONSE 1. Which assessment findings indicate to the nurse that a child has fluid volume excess? Select all that apply. 

Weight gain



Decreased blood pressure



Moist breath sounds



Poor skin turgor



Rapid bounding pulse

SHORT ANSWER 1. A nurse is totaling an 8 hour output for a child admitted with vomiting and diarrhea. The child had an emesis at 0800 of 50 mL and an emesis at 1200 of 35 mL. The child had 3 diapers weighed and calculated during the 8 hour shift: 1 diaper (urine and stool) = 30 mL; 1 diaper (urine only) = 25 mL; and 1 diaper (stool only) = 20 mL. What is the total 8 hour output for this child?

Chapter 17: The Child with an Infectious Disease Chapter 17: The Child with an Infectious Disease Test Bank MULTIPLE CHOICE 1. Which statement made by an adolescent girl indicates an understanding about the prevention of sexually transmitted diseases (STDs)? 

“I know the only way to prevent STDs is not to be sexually active.”



“I practice safe sex because I wash myself right after sex.”



“I won’t get any kind of STD because I take the pill.”



“I have sex only if my boyfriend wears a condom.”

2. Which sexually transmitted disease would the nurse suspect when an adolescent girl comes to the clinic because she has a vaginal discharge that is white with a fishy smell? 

Human papillomavirus



Bacterial vaginosis



Trichomonas



Chlamydia

3. An immunosuppressed child is admitted to the hospital with varicella (chickenpox). The nurse should be prepared to administer which prescribed medication?



Erythromycin (Pediazole)



Varicella vaccine



Acetylsalicylic acid (Aspirin)



Acyclovir (Zovirax)

4. A nurse is conducting a health education class for a group of school-age children. Which statement, made by the nurse, is correct about the body’s first line of defense against infection in the innate immune system? 

Nutritional status



Skin integrity



Immunization status



Proper hygiene practices

5. The mother of an infant with multiple anomalies tells the nurse that she had a viral infection in the beginning of her pregnancy. Which viral infection is associated with fetal anomalies? 

Measles



Roseola



Rubella



Herpes simplex virus (HSV)

6. What is the best response to a parent of a 2-month-old infant who asks when the infant should receive the measles vaccine? 

“Your baby can get the measles vaccine now.”



“The first dose is given any time after the first birthday.”



“She should be vaccinated between 4 and 6 years of age.”



“This vaccine is administered when the child is 11 years old.”

7. Which statement made by a parent indicates incorrect information about an intervention for a child’s fever? 

“I should keep her covered lightly when she has a fever.”



“I’ll give her plenty of liquids to keep her hydrated.”



“I can give her acetaminophen (Tylenol) for a temperature higher than 101° F.”



“I’ll look for over-the-counter preparations that contain salicylates (Aspirin).”

8. A 6-month-old infant is due for routine immunizations. The parent reports the infant was exposed to pertussis 2 days ago. The nurse should: 

give the 6 month immunizations as scheduled.



hold the 6 month immunizations until the next visit. hold the 6 month immunizations for 3 weeks. notify the physician.





9. Which symptom should be reported to the primary care provider if it occurs when a child with an infectious disease is febrile? 

Anorexia



Fatigue



Itching



Headache

10. A parent asks the nurse how she would know whether her child has fifth disease. The nurse would advise the parent to be alert for which manifestation? 

Bull’s-eye rash at the site of a tick bite



Lesions in various stages of development on the trunk



Maculopapular rash on the trunk that lasts for 2 days



Bright red rash on the cheeks that looks like slapped cheeks

11. Which intervention is appropriate for a hospitalized child who has crops of lesions on the trunk that appear as a macular rash and vesicles? 

Place the child in strict isolation and on airborne precautions.



Continue to practice standard precautions.



Pregnant women should avoid contact with the child.



Screen visitors for immunity to measles.

12. How should the nurse respond to a parent who asks, “How can I protect my baby from whooping cough?”  

“Don’t worry; your baby will have maternal immunity to pertussis that will last until your baby is app months old.”



“Make sure your child gets the pertussis vaccine.”



“See the doctor when the baby gets a respiratory infection.”



“Have your pediatrician prescribe erythromycin.”

13. Which statement indicates that a parent understands the treatment for a child who has scarlet fever? 

“I can stop the medicine when my daughter feels better.”



“I will apply antibiotic cream to her rash twice a day.”



“I will give the penicillin for the full 10 days.”



“My daughter can go back to school when she has been on the antibiotic for a week.”

14. Which should be included in the follow-up care for a neonate who received aminoglycoside therapy for sepsis? 

Hemoglobin level monitoring



Hearing test



Serial platelet counts



Glucose testing

15. What discharge information should the nurse give to the parents of an adolescent who has been diagnosed with the Epstein-Barr virus?  



It is particularly important to protect the adolescent’s head during physical activities.

The teen will feel like himself and be back to his usual routines in a week.

The treatment of the Epstein-Barr virus is prolonged bed rest, usually lasting several months.



Fatigue may persist, and the adolescent may need to increase school activities gradually.

16. Which should the nurse teach parents to expect to observe in the prodromal phase of rubeola?  Macular rash on the face 

Koplik’s spots



Petechiae on the soft palate



Crops of vesicles on the trunk

17. Health teaching to prevent Lyme disease would include which action?



Complete the immunization series in early infancy.



Wear long sleeves and pants tucked into socks while in wooded areas.



Give low-dose antibiotics to the child before exposure.

Restrict activities that might lead to exposure for the child.



18. Which action is initiated when a child is scratched by a rabid animal?



No intervention unless the child becomes symptomatic



Administration of immune globulin around the wound



Administration of rabies vaccine on days 3, 7, 14, and 28



Administration of both immune globulin and vaccine as soon as possible after exposure

MULTIPLE RESPONSE 1. A hospitalized child has developed a methicillin-resistant Staphylococcus aureus (MRSA) infection.

The nurse plans which interventions when caring for this child? Select all that apply.



Airborne isolation



Administration of vancomycin (Vancocin)



Contact isolation



Administration of mupirocin (Bactroban) ointment to the nares



Administration of cefotaxime (Cefotetan)

2. The nurse should provide which information to parents about the prevention of parasitic infections? Select all that apply. 

Perform good handwashing.



Diaper a child when swimming.



Avoid cleaning the bathroom facilities with bleach.



Shoes should be worn outside.



Fruits and vegetables should be washed before eating.

Chapter 18: The Child with an Immunologic Alteration Chapter 18: The Child with an Immunologic Alteration Test Bank MULTIPLE CHOICE 1. A nurse in a well-child clinic is teaching parents about their child’s immune system.

Which statement, made by the nurse, is correct? 

The immune system distinguishes and actively protects the body’s own cells from foreign substances.



The immune system is fully developed by 1 year of age.



The immune system protects the child against communicable diseases in the first 6 years of life.



The immune system responds to an offending agent by producing antigens.

2. A nurse is teaching parents about the importance of immunizations for infants because of immaturity of the immune system. The parents demonstrate that they understand the teaching if they make which statement? 

“The spleen reaches full size by 1 year of age.”



“IgM, IgE, and IgD levels are high at birth.”



“IgG levels in the newborn infant are low at birth.”



“Absolute lymphocyte counts reach a peak during the first year.”

3. Which statement is true regarding how infants acquire immunity?



The infant acquires humoral and cell-mediated immunity in response to infections and immunizations



The infant acquires maternal antibodies that ensure immunity up to 12 months of age.



Active immunity is acquired from the mother and lasts 6 to 7 months.



Passive immunity develops in response to immunizations.

4. A nurse is teaching parents about transmission of human immunodeficiency virus (HIV) in the pediatric population. The nurse should relate that the most common mode of transmission of HIV virus is:  Perinatal transmission 

Sexual abuse



Blood transfusions



Poor hand washing

5. A nurse is preparing to administer routine immunizations to an infant who is HIV positive. What is the American Academy of Pediatrics recommendation for immunizing infants who are HIV positive? 

Follow the routine immunization schedule.



Routine immunizations are administered. Assess CD4+ counts before administering the MMR and va



Do not give immunizations because of the infant’s altered immune status.



Eliminate the pertussis vaccination because of the risk of convulsions.

6. Which recommendation by the nurse is appropriate for a mother who has a preschool child who refuses to take the medications for HIV infection? 

Mix medications with chocolate syrup or follow with chocolate candy.



Mix the medications with milk or an essential food.



Skip the dose of medication if the child protests too much.



Mix the medication in a syringe, hold the child down firmly, and administer the medication.

7. What is the primary nursing concern for a hospitalized child with HIV infection?  Maintaining growth and development 

Eating foods that the family brings to the child

 

Consideration of parental limitations and weaknesses Resting for 2 to 3 hours twice a day

8. What should the nurse include in a teaching plan for a mother of a toddler who will be taking prednisone for several months?



The medication should be taken between meals.



The medication needs to be discontinued because of the risks associated with long-term usage.



The medication should not be stopped abruptly.



The medication may lower blood glucose so the mother needs to observe the child for signs of hypogl

9. A nurse assesses a child on long-term systemic corticosteroid therapy for which condition?  Hypotension 

Dilation of blood vessels in the cheeks



Growth delays



Decreased appetite and weight loss

10. Which statement by the parent of a 5-year-old child with acquired immunodeficiency syndrome (AIDS) regarding prescribed antiretroviral agents indicates that she has a good understanding of disease management?  

 

“When my child’s pain increases, I double the recommended dosage of antiretroviral medication.”

“Addiction is a risk, so I use the medication only as ordered.”

“Doses of the antiretroviral medication are selected on the basis of my child’s age and growth.”

“By the time my child is an adolescent, she will not need her antiretroviral medications any longer.”

11. A mother of a child in the terminal stages of AIDS tells the nurse that her child wants to celebrate his birthday early because he won’t be here on his birthday. Which is the best response the nurse can make to this mother? 

“What does your husband think about giving the party for the child?”



“How does the family feel about your giving in to the child?”



“Ill children can be very manipulative.”



“Is this the first time he has spoken about death?”

12. Which intervention is appropriate for a child receiving high doses of steroids?  Limit activity and receive home schooling. 

Decrease the amount of potassium in the diet.



Administer a killed virus vaccine.



Monitor for seizure activity.

13. The nurse observes a red rash that spreads across the child’s cheeks and nose. This assessment finding is characteristic of which of the following conditions? 

Systemic lupus erythematosus (SLE)



Rheumatic fever



Kawasaki disease



Anaphylactic reaction

14. What is the major nursing concern for a child having an anaphylactic reaction?  Identifying the offending allergen 

Ineffective breathing pattern



Increased cardiac output



Positioning to facilitate comfort

15. What is the drug of choice the nurse would administer in the acute treatment of anaphylaxis?  Diphenhydramine (Benadryl) 

Cimetidine (Tagamet)



Epinephrine (Adrenaline)



Albuterol (Ventolin)

MULTIPLE RESPONSE 1. Which home care instructions should the nurse provide to the parents of a child with acquired immunodeficiency syndrome (AIDS)? Select all that apply. 

Give supplemental vitamins as prescribed.



Avoid yearly influenza vaccination.



Administer trimethoprim-sulfamethoxazole (Bactrim) as prescribed.



Notify the physician if child develops a cough or congestion.



Missed doses of antiretroviral medication do not need to be recorded.

OTHER

1. A child is having an anaphylactic response. Place in order the interventions a nurse should perform beginning with the initial (highest priority) intervention and ending with the lowest priority intervention. Use the following format for your answers: A, B, C, D 

Administer steroids and antihistamines as prescribed.



Ensure an adequate airway.



Administer epinephrine as prescribed.



Administer oxygen.



Determine the cause of the reaction. ANS:

Chapter 19: The Child with a Gastrointestinal Alteration Chapter 19: The Child with a Gastrointestinal Alteration Test Bank MULTIPLE CHOICE 1. Which is the best nursing response to a mother asking about the cause of her infant’s bilateral cleft lip? 

“Did you have trouble with this pregnancy?”



“Do you know of anyone in your or the father’s family born with cleft lip or palate problems?”



“This defect is associated with intrauterine infection during the second trimester.”



“Was your husband in the military and involved in chemical warfare?”

2. Which nursing intervention is most helpful to parents of a neonate with bilateral cleft lip?  Assure the parents that the correction will be immediate and uncomplicated. 

Show the parents “before-and-after” pictures of an infant whose cleft lip has been successfully repaire



Teach the parents about long-term enteral feedings.



Refer the parents to a community agency that addresses this problem.

3. The postoperative care plan for an infant with surgical repair of a cleft lip includes which intervention? 

A clear liquid diet for 72 hours



Nasogastric feedings until the sutures are removed



Elbow restraints to keep the infant’s fingers away from the mouth



Rinsing the mouth after every feeding

4. A nurse is teaching a group of parents about tracheoesophageal fistula. Which statement, made by the nurse, is accurate about tracheoesophageal fistula (TEF)? 

This defect results from an embryonal failure of the foregut to differentiate into the trachea and esoph



It is a fistula between the esophagus and stomach that results in the oral intake being refluxed and asp



An extra connection between the esophagus and trachea develops because of genetic abnormalities.



The defect occurs in the second trimester of pregnancy.

5. Which maternal assessment is related to the infant’s diagnosis of TEF?



Maternal age more than 40 years



First term pregnancy for the mother



Maternal history of polyhydramnios



Complicated pregnancy

6. What clinical manifestation should a nurse should be alert for when a diagnosis of esophageal atresia is suspected? 

A radiograph in the prenatal period indicates abnormal development.



It is visually identified at the time of delivery.



A nasogastric tube fails to pass at birth.



The infant has a low birth weight.

7. The nurse admits an infant with vomiting and the diagnosis of hypertrophic pyloric stenosis. Which metabolic alteration should the nurse plan to assess for with this infant? 

Metabolic alkalosis



Metabolic acidosis



Respiratory acidosis



Respiratory alkalosis

8. What is the most important information to be included in the discharge planning for an infant with gastroesophageal reflux? 

Teach the parents to position the infant on the left side.



Reinforce the parent’s knowledge of the infant’s developmental needs.



Teach the parents how to do infant cardiopulmonary resuscitation (CPR).



Have the parents keep an accurate record of intake and output.

9. Which information does the nurse include when teaching the parents of a 5-week-old infant about pyloromyotomy? 

The infant will be in the hospital for a week.



The surgical procedure is routine and “no big deal.”



The prognosis for complete correction with surgery is good.



They will need to ask the physician about home care nursing.

10. A nurse has admitted a child to the hospital with a diagnosis of “rule out” peptic ulcer disease. Which test will the nurse expect to be ordered to confirm the diagnosis of a peptic ulcer? 

A 24-hour dietary history



A positive Hematest result on a stool sample



A fiberoptic upper endoscopy



An abdominal ultrasound

11. What should the nurse teach a school-age child and his parents about the management of ulcer disease? 

Eat a bland, low-fiber diet in small frequent meals.



Eat three balanced meals a day with no snacking between meals.

The child needs to eat alone to avoid stress.

Do not give antacids 1 hour before or after antiulcer medications.





12. Which prescribed formula should the nurse plan to provide for an infant with lactose intolerance? 

Isomil



Enfamil



Similac



Good Start

13. Which dietary foods high in calcium should the nurse encourage a lactose intolerant child to eat? 

Yogurt



Green leafy vegetables



Cheese



Rice

14. Which food choice by a parent of a 2-year-old child with celiac disease indicates a need for further teaching? 

Oatmeal



Rice cake



Corn muffin



Meat patty

15. Which assessment finding should the nurse expect in an infant with Hirschsprung’s disease?  “Currant jelly” stools 

Constipation with passage of foul-smelling, ribbon-like stools



Foul-smelling, fatty stools



Diarrhea

16. Which would be an expected outcome for the parents of a child with encopresis?  The parents will give the child an enema daily for 34 months.  



The parents will develop a plan to achieve control over incontinence.

The parents will have the child launder soiled clothes.

The parents will supply the child with a low-fiber diet.

17. Which intervention should be included in the nurse’s plan of care for a 7-year-old child with encopresis who has cleared the initial impaction? 

Have the child sit on the toilet 30 minutes when he gets up in the morning and at bedtime.



Increase sugar in the child’s diet to promote bowel elimination.



Use a Fleet enema daily.



Give the child a choice of beverage to mix with a laxative.

18. A nurse is assisting a child with inflammatory bowel disease to choose items from the dietary menu. Which dietary item should be avoided because it is high in residue? 

Eggs



Cheese



Grapes



Jello

19. What is an expected outcome for the child with irritable bowel disease? 

Decreasing symptoms



Adherence to a low-fiber diet



Increasing milk products in the diet



Adapting the lifestyle to the lifelong problems

20. An infant has been admitted to the Neonatal Intensive Care Unit (NICU) with a congenital gastroschisis. Which intervention should the nurse perform first upon admission to the unit? 

Place the infant flat and prone.



Cover the defect with sterile warm, moist gauze and wrap with plastic.



Begin a gestational age assessment.



Wrap the infant in a warm blanket and allow the father to hold the infant briefly.

21. What is an appropriate statement for the nurse to make to parents of a child who has had a barium enema to correct an intussusception? 

“I will call the physician when the baby passes his first stool.”



“I am going to dilate the anal sphincter with a gloved finger to help the baby pass the barium.”



“I would like you to save all the soiled diapers so I can inspect them.”



“Add cereal to the baby’s formula to help him pass the barium.”

22. Which is the best response for the nurse to make to parents who ask why their infant has a nasogastric tube to intermittent suction after abdominal surgery? 

“The nasogastric tube decompresses the abdomen and decreases vomiting.”



“We can keep a more accurate measure of intake and output with the nasogastric tube.”



“The tube is used to decrease postoperative diarrhea.”



“Believe it or not, the nasogastric tube makes the baby more comfortable after surgery.”

23. Which stool characteristic should the nurse expect to assess with a child diagnosed with intussusception? 

Ribbon-like stools



Hard stools positive for guaiac



“Currant jelly” stools



Loose, foul-smelling stools

24. Which is a priority concern for a 14-year-old child with inflammatory bowel disease?  Compliance with antidiarrheal medication therapy 

Long-term complications



Dealing with the embarrassment and stress of diarrhea



Home schooling

25. A nurse is conducting a teaching session to adolescents about Crohn’s disease. Which statement, made by the nurse, is the most accurate? 

Crohn’s disease is responsive to dietary modifications.



Crohn’s disease can occur anywhere in the gastrointestinal tract.



Edema usually accompanies this disease.



Symptoms of Crohn’s disease usually disappear by late adolescence.

26. A child is admitted to the pediatric floor for appendicitis. Which assessment finding will the nurse monitor that indicates the appendix has ruptured? 

Abdominal pain shifts from the left to the right side.



Vomiting and diarrhea become more intense.



Elevated temperature decreases to normal.



Abdominal pain is relieved.

27. What is the most important action to prevent the spread of gastroenteritis in a daycare setting? 

Administering prophylactic medications to children and staff



Frequent hand washing



Having parents bring food from home



Directing the staff to wear gloves at all times

28. What is an expected outcome for a 1-month-old infant with biliary atresia? 

Correction of the defect with the Kasai procedure



Adequate nutrition and age-appropriate growth and development



Increased blood pressure and adherence to a salt-free diet



Adequate protein intake

29. Which assessment findings would be significant for a child with cirrhosis?  Weight loss 

Change in level of consciousness



Soft, smooth skin



Pallor and cyanosis

30. Which nursing diagnosis has the highest priority for the child with celiac disease?  Pain related to chronic constipation 

Altered growth and development related to obesity



Fluid volume excess related to celiac crisis



Imbalanced nutrition: Less than body requirements related to malabsorption

31. The nurse notes on assessment that a 1-year-old child is underweight, with abdominal distention, thin legs and arms, and foul-smelling stools. The nurse suspects failure to thrive associated with which condition? 

Celiac disease



Intussusception



Irritable bowel syndrome



Imperforate anus

32. A 10-year-old boy is admitted to the hospital with a diagnosis of appendicitis. He is nauseated, febrile, and complaining of severe abdominal pain radiating to the right lower quadrant. During a routine nursing check, he states that his “stomach” doesn’t hurt anymore. The nurse should suspect that: 

he is anxious about surgery.



his appendix has ruptured.



he does not communicate effectively about pain.



his nausea and vomiting have decreased, thereby relieving his abdominal pain.

33. The nurse caring for a child with suspected appendicitis should question which physician prescriptions? 

Keep patient NPO.



Start IV of D5/0.45 normal saline at 60 mL/hr.



Apply K-pad to abdomen prn for pain.



Obtain CBC on admission to the nursing unit.

34. Which order should the nurse question when caring for a child after surgery for Hirschsprung’s disease?  Monitor rectal temperature every 4 hours and report an elevation greater than 38.5° C. 

Assess stools after surgery.



Keep the child NPO until bowel sounds return.



Maintain IV fluids at an ordered rate.

35. Which diagnosis has the highest priority for the child with irritable bowel syndrome? 

Alteration in nutrition: Less than body requirements related to malabsorption



Altered growth and development related to inadequate nutrition



Pain related to hyperperistalsis



Constipation related to maldigestion

36. A 7-year-old child is admitted to the hospital with severe abdominal pain, bloody “currant jelly” diarrhea, and fever. What is his probable diagnosis? 

Hirschsprung’s disease



Celiac disease



Ruptured appendix



Intussusception

37. Which goal has the highest priority for a child with malabsorption associated with lactose intolerance? 

The child will experience no abdominal spasms.



The child will not experience constipation associated with malabsorption syndrome.



The child will not experience diarrhea associated with malabsorption syndrome.



The child will receive adequate nutrition as evidenced by a weight gain of 1 kg/day.

38. What would be an appropriate meal for a school-age child with celiac disease?  Baked chicken and cornbread 

Hot dog and bun



Bean with barley soup and rice cakes



Cheeseburger on rye bread

39. What should the nurse stress in a teaching plan for the mother of an 11-year-old boy with ulcerative colitis? 

Preventing the spread of illness to others



Nutritional guidance and preventing constipation



Teaching daily use of enemas



Coping with stress and adjusting to a chronic illness

40. An infant with Hirschsprung’s disease has a temporary colostomy. Which statement by the infant’s mother indicates she understands how to care for the infant’s colostomy at home? 

“I need to be careful to check the skin around the colostomy for breakdown and be sure I keep it clean



“I’ll call my home health nurse if the colostomy bag needs to be changed.”



“I’ll call the doctor if I notice that the colostomy stoma is pink.”



“I’ll have my mother help me with the care of the colostomy.”

41. Careful hand washing before and after contact can prevent the spread of _____ in day care and school settings. 

irritable bowel syndrome



ulcerative colitis



hepatic cirrhosis



hepatitis A

MULTIPLE RESPONSE 1. Which interventions should a nurse implement when caring for a child with hepatitis? Select all that apply. 

Provide a well-balanced low-fat diet.



Schedule play time in the playroom with other children.



Teach parents not to administer any over-the-counter medications.



Arrange for home schooling as the child will not be able to return to school.



Instruct parents on the importance of good hand washing.

2. The nurse is providing home care instructions to the parents of an infant being discharged after repair of a bilateral cleft lip. Which instructions should the nurse include? Select all that apply. 

Acetaminophen (Tylenol) should not be given to your infant.



Feed your infant in an upright position.



Place your infant prone for a period of time each day.



Burp your child frequently during feedings.



Apply antibiotic ointment to the lip as prescribed.

Chapter 20: The Child with a Genitourinary Alteration Chapter 20: The Child with a Genitourinary Alteration Test Bank MULTIPLE CHOICE 1. Which statement made by a school-age girl indicates the need for further teaching about the prevention of urinary tract infections?  



“I always wear cotton underwear.”

“I really enjoy taking a bubble bath.”

“I go to the bathroom every 3 to 4 hours.”



“I drink four to six glasses of fluid every day.”

2. The nurse assessing a child with acute poststreptococcal glomerulonephritis should be alert for which finding? 

Increased urine output



Hypotension



Tea-colored urine



Weight gain

3. The mother of a child who was recently diagnosed with acute glomerulonephritis asks the nurse why the physician keeps talking about “casts” in the urine. The nurse’s response is based on the knowledge that the presence of casts in the urine indicates: 

glomerular injury.



glomerular healing.



recent streptococcal infection.



excessive amounts of protein in the urine.

4. What is a clinical finding that warrants further intervention for the child with acute poststreptococcal glomerulonephritis? 

Weight loss to within 1 pound of the preillness weight



Urine output of 1 milliliter per kilogram per hour



A normal blood pressure



Inspiratory crackles

5. Which diagnostic finding is assessed by the nurse when a child has primary nephrotic syndrome? 

Hyperalbuminemia



Positive ASO titer



Leukocytosis



Proteinuria

6. Which finding indicates that a child receiving prednisone for primary nephrotic syndrome is in remission? 

Urine is negative for casts for 5 days.



Urine is 0 to trace for protein for 5 to 7 days.



Urine is negative for protein for 2 weeks.



Urine is 0 to trace for blood for 1 week.

7. Which of the following statements made by a parent of a child with nephrotic syndrome indicates an understanding of a no-added-salt diet? 

“I only give my child sweet pickles.”



“My child just puts a little salt on his food.”



“I let my child have ‘slightly’ salted potato chips.”



“I do not put any salt in foods when I am cooking.”

8. Which is an appropriate intervention for a child with nephrotic syndrome who is edematous?  Teach the child to minimize body movements. 

Change the child’s position every 2 hours.



Avoid the use of skin lotions.



Bathe every other day.

9. A child with secondary enuresis who complains of dysuria or urgency should be evaluated for which condition? 

Hypocalciuria



Nephrotic syndrome



Glomerulonephritis



Urinary tract infection

10. What should the nurse include in a teaching plan for the parents of a child with vesicoureteral reflux? 

Screening for urinary tract infection (UTI) if febrile



Suggestions for how to maintain fluid restrictions



The use of bubble baths as an incentive to increase bath time



The need for the child to hold urine for 6 to 8 hours

11. Which intervention is appropriate when examining a male infant for cryptorchidism?  Cooling the examiner’s hands 

Taking a rectal temperature



Placing the infant on the examination table



Warming the room

12. Parents ask the nurse, “When should our child’s hypospadias be corrected?” The nurse responds based upon the knowledge that correction of hypospadias should be accomplished by the time the child is: 

1 month of age.



6 to 8 months of age.



school age.



sexually mature.

13. A nurse is teaching a class on acute renal failure. The nurse relates that acute renal failure as a result of hemolytic-uremic syndrome is classified as: 

prerenal.



intrarenal.



postrenal.



chronic.

14. Which dietary modification is appropriate for a child with chronic renal failure?  Decreased salt 

Decreased fat



Increased potassium



Increased phosphorus

15. Which condition is characterized by a history of bloody diarrhea, fever, abdominal pain, and low hemoglobin and platelet counts? 

Acute viral gastroenteritis



Acute glomerulonephritis



Hemolytic-uremic syndrome



Acute nephrotic syndrome

16. Which is a true statement describing the differences in the pediatric genitourinary system compared with the adult genitourinary system? 

The young infant’s kidneys can more effectively concentrate urine than can an adult’s kidneys.



After 6 years of age, kidney function is nearly like that of an adult.



Unlike adults, most children do not regain normal kidney function after acute renal failure.



Young children have shorter urethras, which can predispose them to urinary tract infections.

MULTIPLE RESPONSE 1. A nurse is planning care for a child admitted with nephrotic syndrome. Which interventions should be included in the plan of care? Select all that apply.





Administration of antihypertensive medications



Daily weights



Salt-restricted diet



Frequent position changes Teach parents to expect tea-colored urine

2. A nurse is assessing an infant for urinary tract infection (UTI). Which assessment findings should the nurse expect? Select all that apply. 

Change in urine odor or color



Enuresis



Fever or hypothermia



Voiding urgency



Poor weight gain

Chapter 21: The Child with a Respiratory Alteration Chapter 21: The Child with a Respiratory Alteration Test Bank MULTIPLE CHOICE 1. A nurse in the labor and delivery room is assessing respirations on a newborn. The nurse understands that which change in the respiratory system occurs postnatally? 

Respirations are stimulated by hypoxemia.



It takes up to 48 hours for most of the alveoli to expand.

Surfactant in the lungs interferes with lung expansion.

Pulmonary blood flow decreases after birth.





2. Which information should the nurse teach families about reducing exposure to pollens and dust? 

Replace wood and tile floors with wall-to-wall carpeting.



Do not use an air conditioner.



Put dust-proof covers on pillows and mattresses.



Keep humidity in the house above 60%.

3. A child has had cold symptoms for more than 2 weeks, a headache, nasal congestion with purulent nasal drainage, facial tenderness, and a cough that increases during sleep. The nurse recognizes these symptoms are characteristic of which respiratory condition? 

Allergic rhinitis



Bronchitis



Asthma



Sinusitis

4. The child with chronic otitis media with effusion should be evaluated for which problem?  Brain abscess 

Meningitis



Hearing loss



Perforation of the tympanic membrane

5. The nurse should expect the initial plan of care for a 9-month-old child with an acute otitis media infection to include: 

symptomatic treatment and observation for 48 to 72 hours after diagnosis.



an oral antibiotic, such as amoxicillin, several times a day for 7 days.



pneumococcal conjugate vaccine.



myringotomy with tympanoplasty tubes.

6. Which statement made by a parent indicates understanding about treatment of streptococcal pharyngitis? 

“I guess my child will need to have his tonsils removed.”



“A couple of days of rest and some ibuprofen will take care of this.”



“I should give the penicillin three times a day for 10 days.”



“I am giving my child prednisone to decrease the swelling of the tonsils.”

7. A nurse is planning care for a child with laryngomalacia. Which symptom should the nurse plan to assess that is characteristic of laryngomalacia? 

Stridor



High-pitched cry



Nasal congestion



Irritability

8. The nurse should assess a child who has had a tonsillectomy for which problem?  Frequent swallowing 

Inspiratory stridor



Rhonchi



Elevated white blood cell count

9. A nurse is teaching parents about manifestations of spasmodic croup. Which is a

distinguishing manifestation of spasmodic croup that should be included in the teaching session?  It has a gradual onset. 

It is characterized a harsh barky cough.



It is bacterial in nature.



The child has a high fever.

10. Which intervention for treating croup at home should be taught to parents?



Have a decongestant available to give the child when an attack occurs.



Have the child sleep in a dry room.



Sit with the child in the bathroom with the shower on when an attack occurs.



Give the child an antibiotic at bedtime.

11. A 5-year-old child is brought to the emergency department with copious drooling and a croaking sound on inspiration. Her mother states that the child is very agitated and only wants to sit upright. What should be the nurse’s first action in this situation? 

Prepare intubation equipment and call the physician.



Examine the child’s oropharynx and call the physician.



Obtain a throat culture for respiratory syncytial virus (RSV).



Obtain vital signs and listen to breath sounds.

12. Which action for care can be taught to the parents of a 3-year-old child with pneumonia who is not hospitalized? 

Offer the child only cool liquids.



Offer the child a favorite warm liquid drink.



Use a warm mist humidifier.



Call the physician for a respiratory rate less than 28 breaths/minute.

13. Which sign is indicative of respiratory distress in infants?  Nasal flaring 

Respiratory rate of 55 breaths/minute



Irregular respiratory pattern



Abdominal breathing

14. Once an allergen is identified in a child with allergic rhinitis, what would be the treatment of choice? 

Use appropriate medications.



Begin desensitization injections.



Eliminate the allergen.



Remove the adenoids.

15. A child has returned to the postsurgical floor after having had a tonsillectomy. Which assessment finding should the nurse report to the physician?



Vomiting bright red blood



Pain at the surgical site



Pain on swallowing



The ability to only take small sips of liquids

16. Teaching safety precautions with the administration of antihistamines is important due to which common side effect? 

Dry mouth



Excitability



Drowsiness



Dry mucous membranes

17. Which is an appropriate beverage for the nurse to give to a child who had a tonsillectomy earlier in the day? 

Chocolate ice cream



Orange juice



Fruit punch



Apple juice

18. Which intervention should the nurse implement as a priority in the management of a child with epiglottitis? 

Adequate hydration



Maintaining a patent airway



Cessation of coughing



Decreasing fever

19. What information should the nurse teach workers at a day care center about respiratory syncytial virus (RSV)? 

RSV is transmitted through particles in the air.



RSV can live on skin or paper for up to a few seconds after contact.



RSV can survive on nonporous surfaces for about 60 minutes.



Frequent hand washing can decrease the spread of the virus.

20. Which intervention is appropriate for the infant hospitalized with bronchiolitis?



Position on the side with neck slightly flexed.



Administer antibiotics as ordered.



Restrict oral and parenteral fluids if tachypneic.



Give cool, humidified oxygen.

21. The nurse is caring for a child hospitalized for status asthmaticus. Which assessment finding suggests that the child’s condition is worsening? 

Hypoventilation



Thirst



Bradycardia



Clubbing

22. Which finding is expected when assessing a child hospitalized for asthma?  Inspiratory stridor 

Harsh, barky cough

 

Wheezing Rhinorrhea

23. Which statement indicates that a parent of a toddler needs more education about preventing foreign body aspiration? 

“I keep objects with small parts out of reach.”



“My toddler loves to play with balloons.”



“I won’t permit my child to have peanuts.”



“I never leave coins where my child could get them.”

24. A nurse is teaching a class to parents on respiratory distress syndrome (RDS). Which statement about RDS indicates the parents understood the teaching? 

Factors causing chronic fetal stress increase the incidence of RDS.



RDS is the leading cause of respiratory failure in premature infants.



RDS is caused by an overproduction of surfactant in fetal development.



The incidence of RDS is significantly lower as gestational age decreases.

25. What is a common trigger for asthma attacks in children?



Febrile episodes



Dehydration



Exercise



Seizures

26. Which child would require a Mantoux test? 

The child who has episodes of nighttime wheezing and coughing



The child who has a history of allergic rhinitis



The child whose babysitter is diagnosed with tuberculosis



The premature infant who is being treated for apnea of infancy

27. What explanation should the nurse give to a parent of a child with asthma about using a peak flowmeter? 

It is used to monitor the child’s breathing capacity.



It measures the child’s lung volume.



It will help the medication reach the child’s airways.



It measures the amount of air the child breathes in.

28. What is the best nursing response to the parent of a child with asthma who asks if his child can still participate in sports? 

“Children with asthma are usually restricted from physical activities.”



“Children can usually play any type of sport if their asthma is well controlled.”



“Avoid swimming because breathing underwater is dangerous for people with asthma.”



“Even with good asthma control, I would advise limiting the child to one athletic activity per school y

29. Which response indicates that a school-age child understands the interpretation of peak flowmeter results? 

“When my peak flow is in the green zone, I need more medication.”



“The red zone means my peak flow is 80% to 100%.”



“When my peak flow is in the yellow zone, I might need to take more medicine.”



“The yellow zone means I need to take albuterol right away.”

30. A nurse is admitting a client with an asthma exacerbation. Which drug should the nurse be prepared to administer to relieve an acute asthma episode?



Systemic corticosteroids



Inhaled corticosteroids



Leukotriene blockers



Long-acting bronchodilators

31. The nurse is getting an end-of-shift report on a child with status asthmaticus.

Which intervention should the nurse question? 

Administer oxygen at 6 liters by nasal cannula.



Assess intravenous (IV) maintenance fluids and site every hour.



Notify the physician for signs of increasing respiratory distress.



Organize care to allow for uninterrupted rest periods.

32. Which intervention should be included in the plan of care for a child hospitalized for an exacerbation of cystic fibrosis? 

Perform chest physiotherapy 30 minutes after meals.



Administer low-flow oxygen (less than 2 L/min).



Position with the head lower than the rest of the body.



Provide privacy during coughing episodes.

33. What should the nurse teach a child about using an albuterol metered-dose inhaler for exercise-induced asthma? 

Take two puffs every 6 hours around the clock.



Use the inhaler only when he is short of breath.



Use the inhaler 15 minutes before exercise.



Take one to two puffs every morning on awakening.

34. A preterm infant is being discharged from the hospital. Which immunization should the nurse prepare to administer to protect the infant from the respiratory syncytial virus (RSV)? 

 

Pavilizumab (Synagis) Ribaviran (Virazole) Hemophilus influenza type B (HIB)



Pneumococcal (Prevnar)

35. Which statement, if made by parents of a child with cystic fibrosis, indicates that they understood the nurse’s teaching on pancreatic enzyme replacement? 

“Enzymes will improve my child’s breathing.”



“I should give the enzymes 1 hour after meals.”



“Enzymes should be given with meals and snacks.”



“The enzymes are stopped if my child begins wheezing.”

36. Which vitamin supplements are necessary for children with cystic fibrosis?



Vitamin C and calcium



Vitamins B6 and B12



Magnesium



Vitamins A, D, E, and K

37. Why do infants and young children develop respiratory distress more quickly in acute and chronic alterations of the respiratory system? 

They have a widened, shorter airway.



There is a defect in their sucking ability.



The gag reflex increases mucus production.



Mucus and edema obstruct small airways.

38. Which statement made by a parent would indicate an understanding about the genetic transmission of cystic fibrosis (CF)? 

“Only one parent carries the cystic fibrosis gene.”



“Both parents are carriers of the cystic fibrosis gene.”



“The presence of the disease is most likely the result of a genetic mutation.”



“The mother is usually the carrier of the cystic fibrosis gene.”

39. A small child with cystic fibrosis cannot swallow pancreatic enzymes capsules. The nurse would teach parents to mix enzymes with which food? 

Macaroni and cheese



Tapioca



Applesauce



Hot chocolate

40. The nurse should teach parents of a child with cystic fibrosis to adjust enzyme dosage according to which indicator? 

Stool formation



Vomiting



Weight



Urine output

41. Which finding would confirm a diagnosis of cystic fibrosis?  A chest radiograph shows alveolar hyperinflation. 

Stool analysis indicates significant amounts of fecal fat.



Sweat chloride is greater than 60 mEq/L.



Liver function levels are abnormal.

MULTIPLE RESPONSE 1. The nurse should provide what information to the parents of a healthy newborn infant to help prevent sudden infant death syndrome (SIDS)? Select all that apply. 

Place the infant on his back to sleep.



Use a soft mattress.



Offer a pacifier for sleep.



Bed sharing with parents is recommended.

2. The nurse should implement which interventions for an infant experiencing apnea? Select all that apply. 

Stimulate the infant by gently tapping the foot.



Shake the infant vigorously.



Have resuscitative equipment available.



Suction the infant.



Maintain a neutral thermal environment.

3. A nurse is planning care for an asymptomatic child with a positive tuberculin test. The nurse should include which in the plan? Select all that apply.



Administration of daily isoniazid (INH)



Instructing family members about administration of isoniazid (INH) to all close contacts of the child



Administration of the Bacillus Calmette-Guérin vaccine



Reporting the case to the Health Department



Administration of isoniazid (INH) and rifampin (Rifadin) simultaneously

SHORT ANSWER 1. Which childhood vaccine has dramatically reduced the incidence of epiglottitis?

Chapter 22: The Child with a Cardiovascular Alteration Chapter 22: The Child with a Cardiovascular Alteration Test Bank MULTIPLE CHOICE 1. A nurse is conducting a class for nursing students about fetal circulation.

Which statement is accurate about fetal circulation and should be included in the teaching session? 

Oxygen is carried to the fetus by the umbilical arteries.



Blood from the inferior vena cava is shunted directly to the right ventricle through the foramen ovale.



Pulmonary vascular resistance is high because the lungs are filled with fluid.



Blood flows from the ductus arteriosus to the pulmonary artery.

2. Which postoperative intervention should be questioned for a child after a cardiac catheterization? 

Continue intravenous (IV) fluids until the infant is tolerating oral fluids.



Check the dressing for bleeding.



Assess the peripheral circulation on the affected extremity.



Keep the affected leg flexed and elevated.

3. Which information should be included in the nurse’s discharge instructions for a child who underwent a cardiac catheterization earlier in the day? 

The pressure dressing is changed daily for the first week.



The child may soak in the tub beginning tomorrow.



Contact sports can be resumed in 2 days.



The child can return to school on the third day after the procedure.

4. A nurse is preparing to assess a 9-month-old infant admitted to the hospital for further evaluation of an atrial septal defect (ASD). Which should the nurse do first for the cardiac assessment? 

Percussion



Palpation



Auscultation



History and inspection

5. In which situation is there a risk that a newborn infant will have a congenital heart defect (CHD)? 

Trisomy 21 detected on amniocentesis



Family history of myocardial infarction



Father has type 1 diabetes mellitus



Older sibling was born with Turner’s syndrome

6. Before giving a dose of digoxin (Lanoxin), the nurse checked an infant’s apical heart rate and it is 114 beats per minute. What should the nurse do next? 

Administer the dose as ordered.



Hold the medication until the next dose.



Wait and recheck the apical heart rate in 30 minutes.



Notify the physician about the infant’s heart rate.

7. Which intervention should be included in the plan of care for an infant with the nursing diagnosis Fluid volume excess related to congestive heart failure? 

Weigh the infant every day on the same scale at the same time.



Notify the physician when weight gain exceeds more than 20 g/day.



Put the infant in a car seat to minimize movement.



Administer digoxin (Lanoxin) as ordered by the physician.

8. The nurse assessing a premature newborn infant auscultates a continuous machinery-like murmur. This finding is associated with which congenital heart defect? 

Pulmonary stenosis



Patent ductus arteriosus



Ventricular septal defect



Coarctation of the aorta

9. Which is an expected assessment finding in a child with coarctation of the aorta?

Orthostatic hypotension 

Systolic hypertension in the lower extremities



Blood pressure higher on the left side of the body



Disparity in blood pressure between the upper and lower extremities

10. A nurse is assessing an infant with chronic hypoxia due to tetralogy of Fallot. Which finding does the nurse expect to assess?  

Polycythemia Pulmonary hypotension



Dehydration



Anemia

11. Which statement made by a parent indicates understanding of activity restrictions for a child after cardiac surgery? 

“My child needs to get extra rest for a few weeks.”



“My son is really looking forward to riding his bike next week.”



“I’m so glad we can attend services as a family this coming Sunday.”



“I am going to keep my child out of day care for 6 weeks.”

12. A child had a ventricular septal defect surgically repaired 3 months ago. Which antibiotic prophylaxis is indicated for an upcoming dental procedure? 

No antibiotic prophylaxis is necessary.



Amoxicillin is taken orally 1 hour before the procedure.



Oral penicillin is given for 7 to 10 days before the procedure.



Parenteral antibiotics are administered for 4 to 8 weeks after the procedure.

13. A nurse is assessing a 7-day-old infant. The nurse detects a soft murmur. The nurse notifies the primary care physician because the nurse is aware that fetal shunts are closed in the infant at what point in time? 

When the umbilical cord is cut



Within several days of birth



Within a month after birth



By the end of the first year of life

14. When assessing a child for possible congenital heart defects, where should the nurse measure blood pressure? 

The right arm



The left arm



All four extremities



Both arms while the child is crying

15. What should be the nurse’s first action when planning to teach the parents of an infant with a congenital heart defect? 

Assess the parents’ readiness to learn.



Gather literature for the parents.



Secure a quiet place for teaching.



Discuss the plan with the nursing team.

16. A nurse is explaining a patent ductus arteriosus defect to the parents of a preterm infant. The parents indicate understanding of the defect when they state that a patent ductus arteriosus: 

involves a defect that results in a right-to-left shunting of blood in the heart.



involves a defect in which the fetal shunt between the aorta and the pulmonary artery fails to close.



is a stenotic lesion that must be surgically corrected at birth.



causes an abnormal opening between the four chambers of the heart.

17. Why might a newborn infant with a cardiac defect, such as coarctation of the aorta resulting in a right-to-left shunt, receive prostaglandin E1? 

To decrease inflammation



To control pain



To decrease respirations



To keep the ductus arteriosus patent

18. Which congenital heart defect results in increased pulmonary blood flow? 

Ventricular septal defect



Coarctation of the aorta



Tetralogy of Fallot



Pulmonary stenosis

19. Which statement suggests that a parent understands how to correctly administer digoxin?  “I measure the amount I am supposed to give with a measuring spoon.” 

“I put the medicine in the baby’s bottle.”



“When she spits up right after I give the medicine, I give her another dose.”



“I give the medicine at 8 in the morning and evening every day.”

20. What nursing action is appropriate to take when an infant with a congenital heart defect has an increased respiratory rate and sweating and is not feeding well? 

Check the infant’s temperature.



Alert the physician.



Withhold oral feeding.



Increase the oxygen rate.

21. Nursing care for the child in congestive heart failure includes which action?  Counting the number of saturated diapers 

Putting the infant in the Trendelenburg position



Removing oxygen while the infant is crying



Organizing care to provide rest periods

22. Which strategy is appropriate when feeding the infant with congestive heart failure?  Continue the feeding until a sufficient amount of formula is taken. 

Limit feedings to no more than 30 minutes.



Always bottle feed every 4 hours.



Feed larger volumes of concentrated formula less frequently.

23. A nurse is teaching an adolescent about primary hypertension. Which statement made by the adolescent indicates an understanding about primary hypertension? 

Primary hypertension should be treated with diuretics as soon as it is detected.



Congenital heart defects are the most common cause of primary hypertension.



Primary hypertension may be treated with weight reduction.



Primary hypertension is not affected by exercise.

24. A nurse is planning care for a child with secondary hypertension. The nurse plans to include which initial treatment of secondary hypertension? 

Weight control and diet



Treating the underlying disease



Administration of digoxin



Administration of beta-adrenergic receptor blockers

25. Which should the nurse include in discharge teaching for the child with a cardiac arrhythmia?  CPR instructions 

Repeating digoxin if the child vomits



Resting if dizziness occurs



Checking the child’s pulse after digoxin administration

26. A nurse is assigned to care for an infant with an unrepaired tetralogy of Fallot. What should the nurse do first when the baby is crying and becomes severely cyanotic? 

Place the infant in a knee-chest position.



Administer oxygen.



Administer morphine sulfate.



Notify the physician.

27. The nurse caring for a child with a diagnosis of rheumatic fever should assess the child for which finding? 

Sore throat



Elevated blood pressure



Desquamation of the fingers and toes



Tender, warm, inflamed joints

28. A nurse is caring for a child admitted to the hospital with Kawasaki disease. Which cardiac complication of Kawasaki disease should the nurse monitor for? 

Cardiac valvular disease



Cardiomyopathy



Coronary aneurysm



Rheumatic fever

MULTIPLE RESPONSE 1. Which congenital heart disease causes cyanosis when not repaired? Select all that apply.  Patent ductus arteriosus (PDA) 

Tetralogy of Fallot



Pulmonary atresia



Transposition of the great arteries

2. A child has a total cholesterol level of 180 mg/dL. What dietary recommendations should the nurse make to the child and the child’s parents? Select all that apply. 

Replace whole milk for 2% or 1% milk



Increase servings of red meat



Increase servings of fish



Avoid excessive intake of fruit juices



Limit servings of whole grain

3. A nurse is conducting discharge teaching to parents about the care of their infant after cardiac surgery. The nurse instructs the parents to notify the physician if which occurs? Select all that apply.





Respiratory rate of 36 at rest



Appetite slowly increasing



Temperature above 37.7° C (100° F).



New, frequent coughing Turning blue or bluer than normal

Chapter 23: The Child with a Hematological Alteration Chapter 23: The Child with a Hematological Alteration Test Bank MULTIPLE CHOICE 1. The nurse is assessing a client admitted with cyanotic heart disease. Which hematology laboratory result does the nurse expect to assess? 

Anemia



Polycythemia



Normal



Decreased hemoglobin

2. What is the best response to a parent who asks the nurse whether her 5-month-old infant can have cow’s milk?  

“You need to wait until she is 8 months old and eating solids well.”

“Yes, if you think that she will eat enough meat to get the iron she needs.”



“Infants younger than 12 months need iron-rich formula to get the iron they need.”



“Try it and see how she tolerates it.”

3. An assessment of a 7-month-old infant with a hemoglobin level of 6.5 mg/dL is likely to reveal which of the following? 

An infant who is lethargic, pale, and irritable



An infant who is thin, energetic, and sleeps little



An infant who is anorexic, vomiting, and has watery stools



An infant who is flushed, fussy, and tired

4. Which suggestion is not appropriate for a 14-month-old child with iron-deficiency anemia?



Decrease the infant’s daily milk intake to 24 ounces or less.



Give oral iron supplements between meals with orange juice.



Include apricots, dark-green leafy vegetables, and egg yolk in the infant’s diet.



Allow the infant to drink the iron supplement from a small medicine cup.

5. Which is true about the genetic transmission of sickle cell disease? 

Both parents must carry the sickle cell trait.



Both parents must have sickle cell disease.



One parent must have the sickle cell trait.



Sickle cell disease has no known pattern of inheritance.

6. What are the nursing priorities for a child with sickle cell disease in vaso-occlusive crisis?  Administration of antibiotics and nebulizer treatments 

Hydration and pain management



Blood transfusions and an increased calorie diet



School work and diversion

7. A child with sickle cell disease is seen in the emergency department with increasing back and leg pain for the past 2 days. What is this child most likely experiencing? 

A vaso-occlusive crisis



Acute splenic sequestration



Erythroblastopenia



Acute chest syndrome

8. What should the discharge plan for a school-age child with sickle cell disease include?  Restricting the child’s participation in outside activities 

Administering aspirin for pain or fever



Limiting the child’s interaction with peers



Administering penicillin daily as ordered

9. How should the nurse respond when asked by the mother of a child with beta-thalassemia why the child is receiving deferoxamine? 

“To improve the anemia.”

  

“To decrease hepatosplenomegaly.”

“To prevent organ damage.”

“To prepare your child for a bone marrow transplant.”

10. What is the priority nursing intervention for a child hospitalized with hemarthrosis resulting from hemophilia? 

Immobilization and elevation of the affected joint



Administration of aspirin for pain relief



Assessment of the child’s response to hospitalization



Assessment of the impact of hospitalization on the family system

11. The mother of a child with hemophilia asks the nurse how long her child will need to be treated for hemophilia. What is the best response to this question? 

“Hemophilia is a life-long blood disorder.”



“There is a 25% chance that your child will have spontaneous remission and treatment will no longer



“Treatment is indicated until after your child has progressed through the toddler years.”



“It is unlikely that your child will need to be treated for his hemophilia because your first child does n disease.”

12. What is an expected outcome for the child with von Willebrand’s disease?  Prevention of injury 

Maintaining adequate hydration



Compliance with chronic transfusion therapy



Prevention of respiratory infections

13. A child has a platelet count of 45,000/mm3 with petechiae and excessive bruising covering his body. The nurse is aware that these signs are clinical manifestations of: 

erythroblastopenia.



von Willebrand’s disease.



hemophilia.



immune thrombocytopenia purpura (ITP).

14. What is the priority in the discharge plan for a child with immune thrombocytopenic purpura (ITP)? 

Teaching the parents to report excessive fatigue to the physician



Monitoring the child’s hemoglobin level every 2 weeks



Providing a diet that contains iron-rich foods



Establishing a safe, age-appropriate home environment

15. The care plan for a child with disseminated intravascular coagulation (DIC) includes:  hospitalization at the first sign of bleeding. 

teaching the child relaxation techniques for pain control.



management in the intensive care unit.



provision of adequate hydration to prevent complications.

16. What would be the nurse’s best response to a parent with questions about her child’s blood disorder? 

“That sounds pretty serious.”



“What did the physician tell you?”

 

“Blood diseases are transient, so there is no need to worry.”

“Your child will be tired for awhile and then be back to her old self.”

MULTIPLE RESPONSE 1. The nurse is caring for a child with aplastic anemia. Which of the following nursing diagnoses would be appropriate? Select all that apply. 

Acute pain related to vaso-occlusion



Risk for infection related to inadequate secondary defenses or immunosuppression



Ineffective protection related to thrombocytopenia



Ineffective tissue perfusion related to anemia

2. A nurse is caring for a neonate requiring phototherapy for a high bilirubin. Which interventions should the nurse implement? Select all that apply. 

Cover the neonate’s eyes with an opaque mask.



Limit repositioning of the neonate.



Dress the neonate in a T-shirt and diaper.



Monitor the bilirubin level.



Monitor temperature ever 2 to 4 hours.

3. A nurse is teaching home care instructions to parents of a child with sickle cell disease. Which instructions should the nurse include? Select all that apply.



Limit fluid intake.



Administer aspirin for fever.



Administer penicillin as ordered.



Avoid cold and extreme heat.



Provide for adequate rest periods.

Chapter 24: The Child with Cancer Chapter 24: The Child with Cancer Test Bank MULTIPLE CHOICE 1. The nurse notes that a child’s gums bleed easily and bruising and petechiae are evident on the extremities. Which laboratory value would be consistent with these symptoms? 

Platelet count of 19,000/mm3



Prothrombin time of 11 to 15 seconds



Hematocrit of 34



Leukocyte count of 14,000/mm3

2. The nurse understands that the type of precautions needed for children receiving chemotherapy is based on which action of chemotherapeutic agents? 

Gastrointestinal upset



Bone marrow suppression



Decreased creatinine level



Alopecia

3. The nurse should base a response to a parent’s question about the prognosis of acute lymphoblastic leukemia (ALL) on which information? 

Leukemia is a fatal disease although chemotherapy provides increasingly longer periods of remission.



Research to find a cure for childhood cancers is very active.



The majority of children go into remission and remain symptom free when treatment is completed.



It usually takes several months of chemotherapy to achieve a remission.

4. Bone marrow transplantation is the standard treatment for which childhood cancer?  Acute lymphoblastic leukemia (ALL) 

Non-Hodgkin’s lymphoma



Wilms’ tumor



Acute myeloblastic leukemia (AML)

5. A child with a history of fever of unknown origin, excessive bruising, lymphadenopathy, and fatigue is exhibiting symptoms most suggestive of which condition? 

Ewing’s sarcoma



Wilms’ tumor

 

Neuroblastoma Leukemia

6. A nurse assesses a whitish reflection instead of the expected red reflex when evaluating an infant’s eyes. Which action should the nurse take? 

Notify the physician.



Chart the finding.



Check the chart to verify that the infant received eye prophylaxis at birth.



Reassess for a red reflex in 1 month.

7. Which nursing diagnosis is a priority for the 4-year-old child newly diagnosed with leukemia?  Ineffective breathing pattern related to mediastinal disease 

Risk for infection related to immunosuppressed state



Disturbed body image related to alopecia



Impaired skin integrity related to radiation therapy

8. A nurse determines that parents understood the teaching from the pediatric oncologist if the parents indicate that which test confirms the diagnosis of leukemia in children? 

Complete blood cell count (CBC)



Lumbar puncture



Bone marrow biopsy



Computed tomography (CT) scan

9. Which statement made by a nurse to the parents of a child with leukemia should be included in discharge instructions? 

“Your son’s blood pressure must be taken daily while he is on chemotherapy.”



“Limit your son’s fluid intake just in case he has central nervous system (CNS) involvement.”



“Your son must receive all of his immunizations in a timely manner.”



“Your son’s temperature should be taken daily.”

10. What is the most appropriate nursing action when the nurse notes a reddened area on the forearm of a neutropenic child with leukemia? 

Massage the area.



Turn the child more frequently.



Document the finding and continue to observe the area.



Notify the physician immediately.

11. What is the nurse’s best response to a mother whose child has a diagnosis of acute lymphoblastic leukemia and is expressing guilt about not having responded sooner to her child’s symptoms? 

“You should always call the physician when your child has a change in what is normal for him.”



“It is better to be safe than sorry.”



“It is not uncommon for parents not to notice subtle changes in their children’s health.”



“I hope this delay does not affect the treatment plan.”

“It is better to be safe than sorry” are flippant and reinforce the belief that the mother was

12. Which is an appropriate nursing action before surgery when caring for a child diagnosed with a Wilms’ tumor? 

Limit fluid intake.



Do not palpate the abdomen.



Force oral fluids.



Palpate the abdomen every 4 hours.

13. A child with acute lymphocytic leukemia (ALL) is getting chemotherapy for the first time and is at risk for tumor lysis syndrome (TLS). The nurse monitors for which risk associated with TLS? 

Liver failure



Central nervous system (CNS) deficit



Kidney failure



Respiratory distress

14. Which is a symptom of a brain tumor in an infant? 

Blurred vision



Increased head circumference



Vomiting when getting out of bed



Headache

15. Which is an expected physical assessment finding for an adolescent with a diagnosis of Hodgkin’s disease?  Protuberant, firm abdomen 

Enlarged painless, firm cervical lymph nodes



Soft tissue swelling



Soft to hard, nontender mass in the pelvic area

16. Which nursing intervention should not be included in the postoperative plan of care for a child undergoing surgery for a brain tumor? 

Position with head lower than body.



Perform neurological assessments.



Assess dressings for drainage.



Monitor temperature.

17. A child with non-Hodgkin’s lymphoma will be starting chemotherapy. Which intervention is initiated before chemotherapy to prevent tumor lysis syndrome? 

Insertion of a central venous catheter



Intravenous (IV) hydration containing sodium bicarbonate



Placement of an externalized ventriculoperitoneal (VP) shunt



Administration of pneumococcal and H. influenzae type B vaccines

18. The nurse is aware that an abdominal mass found in a 10-month-old infant corresponds with which cancer? 

Osteogenic sarcoma



Rhabdomyosarcoma



Neuroblastoma



Non-Hodgkin’s lymphoma

19. Which is an appropriate intervention for a hospitalized child with an absolute neutrophil count (ANC) of 900/mm3? 

Inspect the child’s skin for breaks and redness every shift.



Administer the measles, mumps, rubella (MMR) vaccine if the child is not fully immunized.



Check urine and stools for blood.



Teach the child to blow the nose gently.

20. A child with acute myeloblastic leukemia is scheduled to have a bone marrow transplant (BMT). The donor is the child’s own umbilical cord blood that had been previously harvested and banked. What type of BMT would this be? 

Autologous



Allogeneic



Syngeneic



Stem cell

21. What should the nurse teach parents about oral hygiene for the child receiving chemotherapy? 

Brush the teeth briskly to remove bacteria.



Use a mouthwash that contains alcohol.



Inspect the child’s mouth daily for ulcers.



Perform oral hygiene twice a day.

22. Which is the best choice when a child with mucositis asks for something to drink?  Hot chocolate  Lemonade



Popsicle



Orange juice

MULTIPLE RESPONSE 1. When an adolescent with a new diagnosis of Ewing’s sarcoma asks the nurse about treatment, the nurse’s response should be based on which information? Select all that apply. 

This type of tumor invades the bone.



Management includes chemotherapy, surgery, and radiation.



Ewing’s sarcoma is usually not responsive to either chemotherapy or radiation.



Affected bones such as ribs and proximal fibula may be removed to excise the tumor.

2. A child with a brain tumor is undergoing radiation therapy. The nurse should include which information in the discharge instructions to the child’s parents? Select all that apply. 

Apply over-the-counter creams to the area daily.



Avoid excessive skin exposure to the sun.



Use a washcloth when cleaning the area receiving radiation.



Plan for adequate rest periods for the child.



A darkening of the skin receiving radiation is expected.

SHORT ANSWER 1. What is the absolute neutrophil count (ANC) for a WBC of total count 3000 with 30% neutrophils and 25% bands?

Chapter 25: The Child with an Integumentary Alteration Chapter 25: The Child with an Integumentary Alteration Test Bank MULTIPLE CHOICE 1. What should be included in teaching a parent about the management of small red macules and vesicles that become pustules around the child’s mouth and cheek? 

Keep the child home from school for 24 hours after initiation of antibiotic treatment.



Clean the rash vigorously with Betadine three times a day.



Notify the physician for any itching.



Keep the child home from school until the lesions are healed.

2. When taking a history of a child with cellulitis, which information would be most pertinent for the nurse to assess? 

Any medication the child is taking



Enlarged, mobile, and nontender lymph nodes



Child’s urinalysis results



Recent infections or signs of infection

3. Which statement made by a parent indicates an understanding about the management of a child with cellulitis? 

“I am supposed to continue the antibiotic until the redness and swelling disappear.”



“I have been putting ice on my son’s arm to relieve the swelling.”



“I should call the doctor if the redness disappears.”



“I have been putting a warm soak on my son’s arm every 4 hours.”

4. What should the parents of an infant with thrush (oral candidiasis) be taught about medication administration? 

Give nystatin suspension with a syringe without a needle.



Apply nystatin cream to the affected area twice a day.



Give nystatin just before the infant is fed.



Rub nystatin suspension onto the oral mucous membranes with a gloved finger after feedings.

5. What beverage should the parents of a child with ringworm be taught to give along with the prescribed griseofulvin (Fulvicin)? 

Water



A carbonated drink



Milk



Fruit juice

6. Which assessment is applicable to the care of a child with herpetic gingivostomatitis?  Comparison of range of motion for the upper and lower extremities 

Urine output, mucous membranes, and skin turgor



Growth pattern since birth



Bowel elimination pattern

7. Parents of the child with lice infestation should be instructed carefully in the use of antilice products because of which potential side effect? 

Nephrotoxicity



Neurotoxicity



Ototoxicity



Bone marrow depression

8. When assessing the child with atopic dermatitis, the nurse should ask the parents about a history of which problem? 

Asthma

  

Nephrosis Lower respiratory tract infections Neurotoxicity

9. What should the nurse teach an adolescent who is taking tretinoin (Retin-A) for treatment acne? 

The medication should be taken with meals.



Apply sunscreen before going outdoors.



Wash with benzoyl peroxide before application.



The effect of the medication should be evident within 1 week.

10. When changing an infant’s diaper, the nurse notices small bright red papules with satellite lesions on the perineum, anterior thigh, and lower abdomen. This rash is characteristic of which condition? 

Primary candidiasis



Irritant contact dermatitis



Intertrigo



Seborrheic dermatitis

11. The depth of a burn injury may be classified as: 

localized or systemic.



superficial, superficial partial thickness, deep partial thickness, or full thickness.



electrical, chemical, or thermal.



minor, moderate, or major.

12. What is the major difference between caring for an infant with burns and an adolescent with burns? 

An increased risk of cardiovascular problems in the infant



A decreased need for caloric intake in the infant



An increased risk for hypervolemia in the adolescent



A decreased need for electrolyte replacement in the infant

13. Which procedure is contraindicated in the care of a child with a minor partial-thickness burn injury wound? 

Cleaning the affected area with mild soap and water



Applying antimicrobial ointment to the burn wound



Changing dressings daily



Leaving all loose tissue or skin intact

14. The process of burn shock continues until which physiological mechanism occurs?  Heart rate returns to normal. 

Airway swelling decreases.



Body temperature regulation returns to normal.



Capillaries regain their seal.

15. To assess the child with severe burns for adequate perfusion, the nurse monitors which area?  Distal pulses 

 

Skin turgor Urine output Mucous membranes

16. Which medication would be best for the nurse to administer before a dressing change for the severely burned child? 

Codeine



Benadryl



Morphine



Acetaminophen

17. Which nursing assessment and care holds the highest priority in the initial care of a child with a major burn injury? 

Establishing and maintaining the child’s airway



Establishing and maintaining intravenous access



Insertion of a catheter to monitor hourly urine output



Insertion of a nasogastric tube into the stomach to supply adequate nutrition

MULTIPLE RESPONSE 1. A nurse is teaching parents about prevention of diaper dermatitis. Which should the nurse include in the teaching plan? Select all that apply.



Clean the diaper area gently after every diaper change with a mild soap.



Use a protective ointment to clean dry intact skin.



Use a steroid cream after each diaper change.



Use rubber or plastic pants over the diaper.



Wash cloth diapers in hot water with a mild soap and double rinse.

2. A nurse is instructing parents on treatment of pediculosis (head lice). Which should the nurse include in the teaching plan? Select all that apply. 

Bedding should be washed in warm water and dried on a low setting.



After treating the hair and scalp with a pediculicide, shampoo the hair with regular shampoo.



Retreat the hair and scalp with a pediculicide in 7 to 10 days.



Items that cannot be washed should be dry cleaned or sealed in plastic bags for 2 to 3 weeks.



Combs and brushes should be boiled in water for at least 10 minutes.

Chapter 26: The Child with a Musculoskeletal Alteration Chapter 26: The Child with a Musculoskeletal Alteration Test Bank MULTIPLE CHOICE 1. Which is an accurate statement concerning a child’s musculoskeletal system and how it may be different from adults? 

Growth occurs in children as a result of an increase in the number of muscle fibers.



Infants are at greater risk for fractures because their epiphyseal plates are not fused.



Because soft tissues are resilient in children, dislocations and sprains are less common than in adults.



Their bones have less blood flow.

2. When infants are seen for fractures, which nursing intervention is a priority?  No intervention is necessary. It is not uncommon for infants to fracture bones. 

Assess the family’s safety practices. Fractures in infants usually result from falls.



Assess for child abuse. Fractures in infants are often nonaccidental.



Assess for genetic factors.

3. Which nursing assessment is appropriate for determining neurovascular competency?  Degree of motion and ability to position the extremity 

Length, diameter, and shape of the extremity



Amount of swelling noted in the extremity and pain intensity



Skin color, temperature, movement, sensation, and capillary refill of the extremity

4. A mother whose 7-year-old child has been placed in a cast for a fractured right arm reports he will not stop crying even after taking Tylenol with codeine. He also will not straighten the fingers on his right arm. The nurse tells the mother to do which? 

Take him to the emergency department.



Put ice on the injury.



Avoid letting him get so tired.



Wait another hour. If he is still crying, call back.

5. A 4-year-old child with a long leg cast complains of “fire” in his cast. The nurse should:  notify the physician on his next rounds. 

chart the complaint in the nurse’s notes.



notify the physician immediately.



report the complaint to the next nurse on duty.

6. Which statement is most correct with regard to childhood musculoskeletal injuries?  After the injury is iced, the swelling decreases, indicating the injury is not severe. 

The presence of localized tenderness indicates a more serious injury.



The more swelling there is, the less severe the injury is.



The less willing the child is to bear weight, the more serious the injury is.

7. A child with osteomyelitis asks the nurse, “What is a ‘sed’ rate?” What is the best response for the nurse? 

“It tells us how you are responding to the treatment.”



“It tells us what type of antibiotic you need.”



“It tells us whether we need to immobilize your extremity.”



“It tells us how your nerves and muscles are doing.”

8. Which intervention is part of the discharge plan for a child with osteomyelitis?  Instructions for a low-calorie diet 

A referral to a home healthcare agency



Instructions for a high-fat, low-protein diet



Instructions for the parent to return the child to team sports immediately

9. During a 14-year-old adolescent’s physical examination, the nurse identifies that he plays soccer and football and is complaining of knee pain when he rises from a squatting position.

The nurse should suspect: 

Legg-Calvé-Perthes disease.



osteomyelitis.



Duchenne muscular dystrophy.



Osgood-Schlatter disease.

10. The nurse caring for a child with Osgood-Schlatter disease should evaluate the child’s:  knowledge of activity restrictions. 

understanding of traction.



acceptance of life-long limitations.



knowledge of skin care.

11. Which factor is important to include in the teaching plan for parents of a child with Legg-Calvé-Perthes disease?   

It is a chronic disease with long-term sequelae.

It affects children in the toddler stage.

There is a disturbance in the blood supply to the femoral epiphysis.



It is caused by a virus.

12. The major concern guiding treatment for the child with Legg-Calvé-Perthes disease is to:  avoid permanent deformity. 

minimize pain.



maintain normal activities.



encourage new hobbies.

13. What is a realistic outcome for the child with osteogenesis imperfecta?  The child will have a decreased number of fractures. 

The child will demonstrate normal growth patterns.



The child will participate in contact sports.



The child will have no fractures after infancy.

14. Discharge planning for the child with juvenile arthritis includes the need for:  routine ophthalmological examinations to assess for visual problems. 

a low-calorie diet to decrease or control weight in the less mobile child.



avoiding the use of aspirin to decrease gastric irritation.



immobilizing the painful joints, which is the result of the inflammatory process.

15. During painful episodes of juvenile arthritis, a plan of care should include which nursing intervention? 

A weight-control diet to decrease stress on the joints



Proper positioning of the affected joints to prevent musculoskeletal complications



Complete bed rest to decrease stress to joints



High-resistance exercises to maintain muscular tone in the affected joints

16. When assessing a child for an upper extremity fracture, the nurse should know that these fractures most often result from: 

automobile accidents.



falls.



physical abuse.



sports injuries.

17. In caring for a child with a compound fracture, what should the nurse carefully assess for?  Infection 

Osteoarthritis



Epiphyseal disruption



Periosteum thickening

18. A nurse is teaching parents the difference between pediatric fractures and adult fractures.

Which observation is true about pediatric fractures? 

They seldom are complete breaks.



They are often compound fractures.



They are often at the epiphyseal plate.



They are often the result of decreased mobility of the bones.

19. Patient and parent education for the child who has a synthetic cast should include which information? 

Apply a heating pad to the cast if the child has swelling in the affected extremity.



Wrap the outer surface of the cast with an Ace bandage.



Split the cast if the child complains of numbness or pain.



Cover the cast with plastic and waterproof tape to keep it dry while bathing or showering.

20. A 6-year-old patient in skeletal traction for a femur fracture has pain and edema of the thigh and is febrile. The nurse should suspect which condition? 

Meningitis



Crepitus



Osteomyelitis



Osteochondrosis

21. A child who has fractured his forearm is unable to extend his fingers. The nurse knows that this: 

is normal following this type of injury.



may indicate compartmental syndrome.



may indicate fat embolism.



may indicate damage to the epiphyseal plate.

22. When teaching care for a child immobilized in a spica cast, which is the most appropriate intervention? 

Application of talcum powder to the skin twice daily



Fluid restriction to prevent loose stools or diarrhea



Assessment for a sluggish capillary refill



Instructing that insertion of small objects into the cast for itching or discomfort is helpful

23. When assessing the child with osteogenesis imperfecta, the nurse should expect to make which observation? 

Discolored teeth



Below-normal intelligence



Increased muscle tone



Above-average stature

24. When teaching the parents of a child with osteogenesis imperfecta about nutrition, the nurse should emphasize a diet that is: 

high in protein.



high in calories.



low in fiber.



high in calcium.

25. A nurse understands that which type of exercise would be best for a child with juvenile arthritis? 

Jogging



Tennis



Gymnastics



Swimming in a heated pool

26. Juvenile arthritis should be suspected in a child who exhibits which symptom?



Frequent fractures



Joint swelling and pain lasting longer than 6 weeks



Increased joint mobility



Lurching and abnormal gait, limited abduction

27. When providing education for the parents of a child with Duchenne muscular dystrophy, the nurse plans to include: 

testing all female children for the disease.



testing the father for the presence of the trait on the Y chromosome.



genetic counseling for all female relatives.



testing the parents to determine the carrier.

28. The nurse knows that treatment of Osgood-Schlatter disease includes which intervention?  Limitation of knee bending or kneeling 

Increasing range of motion (ROM) of the knee



Encouraging flexion of the hip



Limitation of adduction of the hip

29. What is the most appropriate intervention for an adolescent with a mild scoliosis?  Long-term monitoring 

Surgical intervention



Bracing



No follow-up

30. Which statement made by the mother of an adolescent being discharged after spinal fusion for severe scoliosis indicates the need for further teaching? 

“I am glad we chose surgery. Now it is all over and done.”



“I’ll see you in a month; we’ll be back fairly regularly.”



“I have to pick up some more T-shirts on the way home.”



“Those exercises the physical therapist showed us were not too hard.”

31. Which factor should the nurse include when teaching a parent about the care of a child in a Pavlik harness for hip dysplasia? 

The harness may be removed with every diaper change.



The harness is used to maintain the infant’s hips in flexion and abduction and external rotation.



The harness is only the first step of treatment.



The harness is worn for only 2 weeks.

32. Which nursing intervention is a priority when caring for a child in a Pavlik harness?  Skin care 

Bowel function



Feeding patterns



Respiratory function

33. When instructing parents about the care of an infant in a cast for a clubfoot, the nurse should include: 

reassurance that clubfoot usually resolves spontaneously.



instructions on washing the cast daily to keep it clean.



the importance of analogous blood donations for impending surgery.



notifying the physician of any vascular problems, such as toe swelling.

34. During a well-child visit, the nurse identifies that an 18-month-old infant is bow legged. The nurse is aware that this assessment is: 

common in children between the ages of 2 and 7 years.



a common variation until 1 year after walking begins.



a serious condition needing further evaluation.



an indication of neurological impairment.

35. Which statement made by the parent of a 6-month-old infant undergoing serial casting for treatment of clubfoot indicates the parent is correctly following the treatment plan? 

“I am careful to leave him in his bed with his leg elevated as much as possible.”



“I monitor the temperature of his foot often to make sure that the cast still fits.”



“It’s okay that he’s not trying to roll over; he’ll catch up later.”



“It’s okay if the cast gets wet during baths because it will be changed often.”

36. The teaching plan for the child with structural disorders of the bones and joints, such as developmental dysphasia of the hip, should include which instruction? 

Importance of limiting physical activity to decrease the chance of injury



Need for long-term hospitalization to ensure adequate treatment



Importance of follow-up until the child reaches skeletal maturity



Importance of avoiding child-resistant devices, as these can exacerbate the condition

Chapter 27: The Child with an Endocrine or Metabolic Alteration Chapter 27: The Child with an Endocrine or Metabolic Alteration Test Bank MULTIPLE CHOICE 1. A nurse is describing the endocrine system to a nursing student.

Which statement best describes the negative feedback system of the pituitary gland? 

The pituitary gland produces five hormones that are interdependent.



Target organs stimulate the hypothalamus, which in turn produces hormones.



The anterior pituitary stimulates the production of posterior pituitary hormones.



The pituitary gland secretes hormones that stimulate target organs to produce specific hormones. As h of the target organs increase, the pituitary gland decreases the secretion of the stimulating hormone.

2. Which is the priority outcome of mandatory newborn screening for hypothyroidism?  Appropriate community referral for affected families 

Parental education about raising a special needs child



Early identification of the disorder



Facilitation of parent–child bonding

3. What is a nursing goal for a 12-year-old child with Graves’ disease?



Relief of constipation



Allowing the adolescent to make decisions about taking her medication



Verbal demonstration of an understanding about the medication regimen



Development of alternative educational goals

4. Which symptom should be reported to the healthcare provider when a child is taking propylthiouracil? 

Nausea and vomiting



Fever and sore throat



Increased appetite and diarrhea



Weight gain and mood swings

5. What information provided by the nurse would be helpful to a 15-year-old adolescent taking propylthiouracil three times a day? 

Pill dispensers and alarms on her watch can remind her to take the medication as ordered.



She can take the medication when she is nervous and feels she needs it.



She can take two pills before school and one pill at dinner, which will be easier for her to remember.



Her mother can be responsible for reminding her when it is time to take her medication.

6. A nurse is assessing a child with diabetes insipidus. Which sign should the nurse expect to note? 

Weight gain



Increased urine specific gravity



Increased urination



Serum sodium level of 130 mEq/L

7. What should the nurse include in the teaching plan for parents of a child with diabetes insipidus who is receiving DDAVP intranasally? 

Increase the dosage of DDAVP as the urine specific gravity (SG) increases.



Give DDAVP only if the urine output decreases.



Child should have free access to water and toilet facilities at school.



Cleanse the skin before administering the transdermal patch.

8. A nurse is explaining growth hormone deficiency to parents of a child admitted to rule out this problem. Which metabolic alteration should the nurse explain to the parent that is related to growth hormone deficiency? 

Hypocalcemia



Hypoglycemia



Diabetes insipidus



Hyperglycemia

9. Which is the most appropriate intervention for the parents of a 6-yearold child with precocious puberty? 

Advise the parents to consider birth control for their daughter.



Explain the importance of having the child foster relationships with same-age peers.



Assure the child’s parents that there is no increased risk for sexual abuse because of her appearance.



Counsel parents that there is no treatment currently available for this disorder.

10. A neonate is displaying tremors, twitching, and irritability. This is suggestive of:  hypocalcemia. 

hypothyroidism.



hypoglycemia.



phenylketonuria (PKU).

11. What is the best time for the nurse to assess the peak effectiveness of subcutaneously administered Regular insulin? 

Two hours after administration



Four hours after administration



Immediately after administration



Thirty minutes after administration

12. Which statement made by a 14-year-old adolescent who is newly diagnosed with insulindependent diabetes mellitus (IDDM) indicates a need for further teaching? 

“I should eat meals and snack at the same time every day.”



“Exercise will decrease my insulin requirements.”



“It is okay to drink chocolate milk with meals.”



“I need to check my sugars before meals and at bedtime.”

13. What is the primary concern for a 7-year-old child with insulin-dependent diabetes mellitus (IDDM) who asks his mother not to tell anyone at school that he has diabetes? 

The child’s safety



The privacy of the child



Development of a sense of industry



Peer group acceptance

14. Which is the best nursing action when a child with insulin-dependent diabetes mellitus is sweating, trembling, and pale? 

Offer the child a glass of water.



Give the child 5 units of Regular insulin subcutaneously.



Give the child a glass of orange juice.



Give the child glucagon subcutaneously.

15. Which sign is the nurse most likely to assess in a child with hypoglycemia?  Urine positive for ketones and serum glucose greater than 300 mg/dL 

Normal sensorium and serum glucose greater than 160 mg/dL



Irritability and serum glucose less than 70 mg/dL



Increased urination and serum glucose less than 120 mg/dL

16. When would a child diagnosed with insulin-dependent diabetes mellitus most likely demonstrate a decreased need for insulin? 

During the “honeymoon” phase



During adolescence



During growth spurts



During minor illnesses

17. What should a nurse suggest to the parent of a child with insulin-dependent diabetes mellitus (IDDM) who is not eating as a result of a minor illness? 

Give the child half his regular morning dose of insulin.



Substitute calorie-containing liquids for solid food to maintain normal serum glucose levels.

Give the child plenty of unsweetened, clear liquids to prevent dehydration.

Take the child directly to the emergency department.

 

18. Which is the nurse’s best response to the parents of a 10-year-old child newly diagnosed with insulin-dependent diabetes mellitus (IDDM) who are concerned about the child’s continued participation in soccer? 

“Consider the swim team as an alternative to soccer.”



“Encourage intellectual activity rather than participation in sports.”



“It is okay to play sports such as soccer when the weather is moderate.”



“Give the child an extra 15 to 30 grams of carbohydrate snack before soccer practice.”

19. Which comment made by a 12-year-old child with insulin-dependent diabetes mellitus (IDDM) indicates a knowledge deficit? 

“I rotate my insulin injection sites every time I give myself an injection.”



“I keep records of my glucose levels and insulin sites and amounts.”



“I’ll be glad when I can take a pill for my diabetes like my uncle does.”



“I keep Lifesavers in my school bag in case I have a low-sugar reaction.”

20. Which laboratory findings would confirm that a child with insulin-dependent diabetes mellitus (IDDM) is experiencing diabetic ketoacidosis? 

No urinary ketones



Low arterial pH



Elevated serum carbon dioxide



Elevated serum phosphorus

MULTIPLE RESPONSE 1. A child is diagnosed with hypothyroidism. The nurse should expect to assess which symptoms associated with hypothyroidism? Select all that apply. 

Weight loss



Fatigue



Diarrhea



Dry, thick skin



Cold intolerance

OTHER 1. A nurse is preparing to administer 10 units of Regular insulin and 5 units of Lente insulin.

Place in order the steps the nurse should follow to administer the total dosage of 15 units of

insulin. Place the initial step first and end with the final step. Use the following format for your 

Inject 5 units of air into the Lente insulin vial.



Draw up the 5 units of Lente insulin.



Inject 10 units of air into the Regular insulin vial.



Cleanse the insulin vials with alcohol wipes.



Draw up the 10 units of Regular insulin. ANS:

Chapter 28: The Child with a Neurological Alteration Chapter 28: The Child with a Neurological Alteration Test Bank MULTIPLE CHOICE 1. A nurse is explaining to parents how the central nervous system of a child differs from that of an adult. Which statement accurately describes these differences? 

The infant has 150 milliliters of cerebrospinal fluid compared with 50 milliliters in the adult.



Papilledema is a common manifestation of increased intracranial pressure in the very young child.



The brain of a term infant weighs less than half of the weight of the adult brain.



Coordination and fine motor skills develop as myelinization of peripheral nerves progresses.

2. A nurse is assessing a 1-year-old child for increased intracranial pressure (ICP). Which sign should the nurse assess for with this age of child? 

Headache



Bulging fontanel



Tachypnea



Increase in head circumference

3. The nurse should give a child who is to have magnetic resonance imaging (MRI) of the brain which information? 

“Your head will be restrained.”



“You will have to drink a special fluid before the test.”



“You will have to lie flat after the test is finished.”



“You will have electrodes placed on your head with glue.”

4. A child with spina bifida is being admitted to the hospital for a shunt revision? The nurse admitting the child anticipates which type of precautions to be ordered for the child? 

Latex



Bleeding



Seizure



Isolation

5. Nursing care of the infant who has had a myelomeningocele repair should include which intervention? 

Securely fastening the diaper



Measurement of pupil size



Measurement of head circumference



Administration of seizure medications

6. When a 2-week-old infant is seen for irritability, poor appetite, and rapid head growth with an observable distended scalp vein, the nurse recognizes these signs as indicative of which condition? 

Hydrocephalus

  

SIADH (syndrome of inappropriate antidiuretic hormone) Cerebral palsy Reye’s syndrome

7. A child is admitted to the hospital with spastic cerebral palsy. The nurse will assess for which manifestations associated with this disorder? 

Tremulous movements at rest and with activity



Sudden jerking movement caused by stimuli



Writhing, uncontrolled, involuntary movements



Clumsy, uncoordinated movements

8. Which finding in an analysis of cerebrospinal fluid (CSF) is consistent with a diagnosis of bacterial meningitis? 

CSF appears cloudy.



CSF pressure is decreased.



Few leukocytes are present.



Glucose level is increased compared with blood.

9. Which would be an appropriate nursing intervention for the child with a tension headache?  Assess for an aura. 

Maintain complete bed rest.



Administer pharmacological headache relief measures.



Assess for nausea and vomiting.

10. How should the nurse explain positioning for a lumbar puncture to a 5-year-old child?  “You will be on your knees with your head down on the table.” 

“You will be able to sit up with your chin against your chest.”



“You will be on your side with the head of your bed slightly raised.”



“You will lie on your side and bend your knees so that they touch your chin.”

11. A mother reports that her child has episodes in which he appears to be staring into space.

This behavior is characteristic of which type of seizure? 

Absence



Atonic



Tonic-clonic



Simple partial

12. What is the best response to a father who tells the nurse that his son “daydreams” at home and his teacher has observed this behavior at school? 

“Your son must have an active imagination.”



“Can you tell me exactly how many times this occurs in one day?”



“Tell me about your son’s activity when you notice the daydreams.”



“He is probably getting tired and needs a rest.”

13. The nurse teaches parents to alert their healthcare provider about which adverse effect when a child receives valproic acid (Depakene) to control generalized seizures? 

 

Weight loss Bruising Anorexia



Drowsiness

14. A child with a head injury sleeps unless aroused, and when aroused responds briefly before falling back to sleep. Which term corresponds to this child’s level of consciousness? 

Disoriented



Obtunded



Lethargic



Stuporous

15. What is the most appropriate nursing action when a child is in the tonic phase of a generalized tonic-clonic seizure? 

Guide the child to the floor if he is standing and go for help.



Turn the child’s body on his side.



Place a padded tongue blade between the teeth.



Quickly slip soft restraints on the child’s wrists.

16. After a tonic-clonic seizure, it would not be unusual for a child to display which symptom?  Irritability and hunger 

Lethargy and confusion



Nausea and vomiting



Nervousness and excitability

17. What should the nurse teach parents when the child is taking phenytoin (Dilantin) to control seizures? 

The child should use a soft toothbrush and floss his teeth after every meal.



The child will require monitoring of his liver function while taking this medication.



Dilantin should be taken with food because it causes gastrointestinal distress.



The medication can be stopped when the child has been seizure free for 1 month.

18. What is the most appropriate nursing response to the father of a newborn infant with myelomeningocele who asks about the cause of this condition? 

“One of the parents carries a defective gene that causes myelomeningocele.”



“A deficiency in folic acid in the father is the most likely cause.”



“Offspring of parents who have a spinal abnormality are at greater risk for myelomeningocele.”



“There may be no definitive cause identified.”

19. Which assessment noted in an infant 1 day after placement of a ventriculoperitoneal shunt is indicative of surgical complications? 

Hypoactive bowel sounds



Congestion in upper airways



Increasing lethargy



Mild incisional pain

20. Which change in vital signs should alert the nurse to increased intracranial pressure (ICP) in a child with a head injury?  

Rapid, shallow breathing Irregular, rapid heart rate



Increased diastolic pressure with narrowing pulse pressure



Confusion and altered mental status

21. The nurse should expect a child who has frequent tension-type headaches to describe his headache pain with which statement? 

“There is a rubber band squeezing my head.”



“It’s a throbbing pain over my left eye.”



“My headaches are worse in the morning and get better later in the day.”



“I have a stomachache and a headache at the same time.”

22. A nurse is performing a Glasgow Coma Scale assessment. Which assessment should the nurse not include?





Eye opening



Verbal response



Sensory response Motor response

23. Which statement made by an adolescent indicates an understanding about factors that can trigger migraine headaches? 

“I should avoid loud noises because this is a common migraine trigger.”



“Exercise can cause a migraine. I guess I won’t have to take gym anymore.”



“I think I’ll get a migraine if I go to bed at 9 PM on week nights.”



“I am learning to relax because I get headaches when I am worried about stuff.”

24. What is the priority nursing intervention for the child with ascending paralysis as a result of Guillain-Barré syndrome (GBS)? 

Immunosuppressive medications



Respiratory assessment



Passive range-of-motion exercises



Anticoagulant therapy

25. A child is brought to the emergency department in generalized tonic-clonic status epilepticus.

Which medication should the nurse expect to be given initially in this situation? 

Clorazepate dipotassium (Tranxene)



Fosphenytoin (Cerebyx)



Phenobarbital



Lorazepam (Ativan)

26. What should be the nurse’s first action when a child with a head injury complains of double vision and a headache and then vomits? 

Immobilize the child’s neck.



Report this information to the physician.



Darken the room and put a cool cloth on the child’s forehead.



Restrict the child’s oral fluid intake.

MULTIPLE RESPONSE 1. Which interventions should the nurse perform if a child is having a tonic-clonic seizure?

Select all that apply. 

Place a padded tongue blade in the child’s mouth.



Place the child in a supine position.



Time the seizure.



Restrain the child.



Stay with the child.



Loosen the child’s clothing.

2. A nurse should expect which cerebral spinal fluid (CSF) laboratory results on a child diagnosed with bacterial meningitis? Select all that apply. 

Elevated white blood count (WBC).



Decreased protein



Decreased glucose



Cloudy in color



Increase in red blood cells (RBC).

Chapter 29: Psychosocial Problems in Children and Families Chapter 29: Psychosocial Problems in Children and Families Test Bank MULTIPLE CHOICE 1. A nurse is assessing a child with a depressive disorder. Which symptom is likely to be manifested by the child? 

Increased nighttime waking



Impulsivity and distractibility



Carelessness and inattention to details



Refusal to leave the house

2. A nurse is teaching parents about symptoms associated with suicide. Which statement about suicide should the nurse include in the teaching plan? 

Children younger than 10 years of age do not attempt suicide.



A child who attempts suicide is usually depressed and has low self-esteem.



Suicide is usually an isolated event in a school community.



The suicide rate among females is higher than among males.

3. What is the best response for the nurse to make to an adolescent who states, “I am very sad. I wish I wasn’t alive.”?





“Everyone feels sad once in a while.”



“You are just trying to escape your problems.”



“Have you told your parents how you feel?”

“Have you thought about hurting yourself?”

4. A nurse is teaching parents about family relationship patterns associated with eating disorders.

Which family relationship pattern should the nurse teach that is consistent for an adolescent female diagnosed with an eating disorder? 

The adolescent is viewed as an extension of the parent.



There is an overprotective mother and an emotionally distant father.



The mother is domineering and the father is passive.



The adolescent is the youngest child or is an only child.

5. The long-term treatment plan for an adolescent with an eating disorder focuses on:  managing the effects of malnutrition. 

establishing sufficient caloric intake.



improving family dynamics.



restructuring the perception of body image.

6. A parent of a child with a psychosocial disorder states, “I don’t know how my child developed this problem.” The nurse should base a response on which information?  

Neurobiological, family, and sociocultural factors can contribute to the development of psychosocial children.



Like many conditions affecting children, the etiology of psychosocial disorders is unknown.



The majority of psychosocial disorders have a clear pattern of genetic inheritance.



Dysfunctional family patterns are usually identified as the cause of a psychosocial disorder.

7. A nurse is caring for a child admitted for substance abuse. The nurse plans care with the recognition that substance abuse primarily affects which organ of the body? 

Heart



Liver



Brain



Lungs

8. A 14-year-old child admits to using marijuana every day. Which phase of substance abuse should the nurse assess for? 

Experimentation



Early drug use



True drug addiction



Severe drug addiction

9. The school nurse observes an unkempt child dressed in inappropriate clothing who repeatedly asks for food. The nurse is concerned about which problem?



Physical abuse



Physical neglect



Emotional abuse



Sexual abuse

10. Which should be the most appropriate nursing intervention for the infant who is not gaining weight? 

Instruct the primary caregiver on proper feeding techniques.



Observe and document the parent–infant interaction.



Assign different nurses to care for the infant.



Feed the infant on a predetermined schedule.

11. Which statement made by a parent of a toddler who is not gaining weight indicates the need for education about feeding small children? 

“He doesn’t want to eat, so I put the cereal in his bottle.”



“I put him in a high chair for meals and snacks.”



“I turn off the television and we eat together for every meal.”



“I try to feed him at the same times every day.”

12. Which intervention should the nurse teach parents about caring for an infant experiencing drug withdrawal?   

Keep rooms in the home well lighted.

Play music or the television continuously.

Organize care to minimize disruptions.



Let the infant calm himself if irritable.

13. A child who has symptoms of irritable mood and changes in sleep and appetite patterns lasting 3 weeks meets the criteria for which depressive disorder? 

Major depressive disorder



Dysthymic disorder



Cyclothymic disorder



Panic disorder

14. What is the goal of therapeutic management for a child diagnosed with attention-deficit hyperactivity (ADHD) disorder? 

Administer stimulant medications.



Assess the child for other psychosocial disorders.



Correct nutritional imbalances.



Reduce the frequency and intensity of unsocialized behaviors.

15. Which behavior demonstrated by an adolescent should alert the school nurse to a problem of substance abuse? 

States feelings of worthlessness



Increased desire for social conformity



Does not feel the need for peer approval



Rebellious behavior

16. A nurse is caring for an infant with neonatal abstinence syndrome. Which manifestation should the nurse expect to assess? 

Weight gain



Respiratory acidosis



High-pitched persistent cry



Hypotonus

17. Which finding noted by the nurse on a physical assessment may suggest that a child has been sexually abused? 

Swelling of the genitalia and pain on urination



Smooth philtrum and thin upper lip



Speech and physical development delays



History of constipation, drowsiness, and constricted pupils

18. A nurse is assessing a child with attention-deficit hyperactivity disorder (ADHD). Which manifestation should the nurse not expect to assess? 

Talking incessantly



Blurting out the answers to questions before the questions have been completed



Acting withdrawn in social situations



Fidgeting with hands or feet

MULTIPLE RESPONSE 1. A nurse working on the pediatric unit should be aware that children admitted with which assessment findings are suggestive of physical child abuse? Select all that apply. 

Bruises in various stages of healing



Bruises over the shins or bony prominences



Burns on the palms of the hands



A fracture of the right wrist from a sports accident



Rib fractures in an infant

2. The nurse is aware that suicide risk increases if the child displays which characteristics? Select all that apply. 

Previous suicide attempt



No previous exposure to violence in the home



Recent loss



Effective social network



History of physical abuse

Chapter 30: The Child with a Developmental Disability Chapter 30: The Child with a Developmental Disability Test Bank MULTIPLE CHOICE 1. A parent whose child has been diagnosed with a cognitive deficit should be counseled that intellectual impairment: 

is usually due to a genetic defect.



may be caused by a variety of factors.



is rarely due to first-trimester events.



is usually caused by parental intellectual impairment.

2. A parent asks the nurse why a developmental assessment is being conducted for a child during a routine well-child visit. The nurse answers based on the knowledge that routine developmental assessments during well-child visits are: 

not necessary unless the parents request them.



the best method for early detection of cognitive disorders.



frightening to parents and children and should be avoided.



valuable in measuring intelligence in children.

3. The father of a child recently diagnosed with developmental delay is very rude and hostile toward the nurses. This father was cooperative during the child’s evaluation a month ago. What is the best explanation for this change in parental behavior?  

The father is exhibiting symptoms of a psychiatric illness.

The father may be abusing the child.



The father is resentful of the time he is missing from work for this appointment.



The father is in the anger stage of the grief process.

4. An appropriate nursing diagnosis for a child with a cognitive dysfunction who has a limited ability to anticipate danger is:



Impaired social interaction.



Deficient knowledge.



Risk for injury.



Ineffective coping.

5. Anticipatory guidance for the family of a preadolescent with a cognitive dysfunction should include information about: 

institutional placement.



sexual development.



sterilization. o clothing.

6. The mother of a 9-year-old child with Down syndrome discusses the child’s language abilities. The nurse is not surprised to learn which information about the child’s language development? 

Can take turns during conversation



Has good grammar



Can speak a foreign language



Has difficulty in carrying on a conversation

7. The infant with Down syndrome is closely monitored during the first year of life for which condition? 

Thyroid complications



Orthopedic malformations



Dental malformation



Cardiac abnormalities

8. Which action is contraindicated when a child with Down syndrome is hospitalized?  Determine the child’s vocabulary for specific body functions. 

Assess the child’s hearing and visual capabilities.



Encourage parents to leave the child alone.



Have meals served at the child’s usual meal times.

9. A nurse is giving a parent information about autism. Which statement made by the parent indicates understanding of the teaching? 

Autism is characterized by periods of remission and exacerbation.



The onset of autism usually occurs before 2 1/2 years of age.



Children with autism have imitation and gesturing skills.



Autism can be treated effectively with medication.

10. Which should the nurse keep in mind when planning to communicate with a child who is autistic? 

The child has normal verbal communication.



Expect the child to use sign language.



The child may exhibit monotone speech and echolalia.



The child is not listening if she is not looking at the nurse.

11. What is the best intervention when a child with autism is hospitalized?  Limit the individuals who enter the child’s room. 

Perform all of the child’s activities of daily living for her.



Make sure the nurses know this child may be violent.



Assign the strongest nurse to control the child.

OBJ: Nursing Process Step: Planning MSC: Psychosocial Integrity 12. Intense stress and isolation as a result of caring for a child with developmental disabilities often lead parents to: 

heightened parental achievement.



overuse of the healthcare system.



overindulgence and obesity.



child abuse.

13. A child with Asperger syndrome has also been diagnosed with depression. The nurse understands that two or more disorders in an individual is termed: 

comorbidity.



congenital syndrome.



mental retardation.



developmental impairment.

14. Self-injury, fecal smearing, and severe temper tantrums in a preschool child are symptoms of: 

mild intellectual impairment.



severe intellectual impairment.



psychosocial deprivation.



separation anxiety.

15. Throughout their life span, cognitively impaired children are less capable of managing environmental challenges and are at risk for which problem? 

Nutritional deficits



Visual impairments



Physical injuries



Psychiatric problems

16. The parents of a child born at 36 weeks of gestation who had respiratory problems requiring 3 days of oxygen therapy are concerned that the infant may have an intellectual impairment. The best nursing statement to the parents is which of the following? 

“A diagnosis of intellectual impairment is not made until the child enters school and experiences acad



“Routine assessment of development during pediatric visits is the best method of early detection.”



“The baby is not at risk for an intellectual impairment.”



“Tests for intellectual impairments are not reliable for children younger than 3 years.”

17. Parents of a child with fragile X syndrome ask the nurse about genetic transmission of this syndrome. In response, the nurse correctly explains that fragile X syndrome is: 

most commonly seen in girls.



acquired after birth.



usually transmitted by the male carrier.



usually transmitted by the female carrier.

18. The best setting for daytime care for a 5-year-old autistic child whose mother works is:  private day care. 

public school.



his own home with a sitter.



a specialized program that facilitates interaction by use of behavioral methods.

19. Parents have learned that their 6-year-old child is autistic. The nurse may help the parents to cope by explaining that the child will: 

have abnormal ways of interacting with other children and adults.



outgrow the condition by early adulthood.



have average social skills.



probably have age-appropriate language skills.

20. An autistic child is hospitalized with asthma. The nurse should plan care so that the:  parents’ expectations are met. 

child’s routine habits and preferences are maintained.



child is supported through the autistic crisis.



parents need not be at the hospital.

MULTIPLE RESPONSE 1. Which of the following treatment guidelines would be contraindicated when counseling the family of an infant with fragile X syndrome? Select all that apply. 

Advise genetic testing for family members.



Delay speech therapy until the child is 2 years of age.



Educate the family that their child will probably have normal intelligence.



Refer the family to an early intervention program.

2. A nurse is assessing a newborn for facial feature characteristics associated with fetal alcohol syndrome. Which characteristics should the nurse expect to assess? Select all that apply. 

Short palpebral fissures



Smooth philtrum



Low set ears



Inner epicanthal folds



Thin upper lip

3. A nurse should plan to implement which interventions for a child admitted with inorganic failure to thrive? Select all that apply. 

Observation of parent–child interactions



Assignment of different nurses to care for the child from day to day



Use of 28 calorie per ounce concentrated formulas



Administration of daily multivitamin supplements



Role-modeling appropriate adult–child interactions

Chapter 31: The Child with a Sensory Alteration Chapter 31: The Child with a Sensory Alteration Test Bank MULTIPLE CHOICE 1. A child tells the school nurse that he can’t see things at a distance very clearly but he can read up close fine. The nurse knows that the refractive disorder causing the ability to see distant objects less clearly than those close up is termed: 

hyphema.



astigmatism.



amblyopia.



myopia.

2. The parents of a child needing glasses ask the nurse “when can we consider contact lenses for our child?” The nurse should respond to this question relating that contact lenses should be prescribed for a child who is: 

at least 12 years of age.



able to read all the written information and instructions.



able to independently care for the lenses in a responsible manner.



confident that she really wants contact lenses.

3. Which statement best describes how a cataract affects a child’s vision?  It increases intraocular pressure. 

It alters the ability to distinguish between colors.



It causes double vision.



It prevents a clear image from forming on the retina.

4. Which statement about conjunctivitis made by a parent would indicate that further teaching is needed? 

“I’ll have separate towels and washcloths for each family member.”



“I’ll notify my doctor if the eye gets redder or the drainage increases.”



“When the eye drainage improves, we’ll stop giving the antibiotic ointment.”



“After taking the antibiotic for 24 hours, my child can return to school.”

5. Which teaching guideline would help prevent eye injuries during sports and play activities?  Restrict helmet use to those who wear eye glasses or contact lenses.



Discourage the use of goggles with helmets.



Wear eye protection when participating in high-risk sports such as paintball.



Wear a face mask when playing any sport or playing roughly.

6. A nurse is admitting a child with a chemical burn to the eye. The nurse questions the EMS personnel about initial care at the time of the injury. The nurse understands that initial care of the child with a chemical burn to the eye(s) is focused on: 

irrigation of the affected eye(s).



application of topical steroids.



administration of an analgesic.



administration of medication to constrict the pupils.

7. Which type of hearing loss in a child is usually irreversible? 

Conductive



Sensorineural



Central



Nonconductive

8. On the second postoperative day following an eye surgery, the child has puffy eyes, increased drainage, and tearing. Which is the most applicable nursing diagnosis? 

Risk for infection related to the surgical procedure



Risk for injury related to increased intraocular pressure



Disturbed sensory perception (visual) related to the surgical procedure



Acute pain related to recent surgical intervention

9. Parents of a 4-year-old child are concerned because he continues to stutter.

Which nursing intervention is correct? 

Remind the parents that stuttering is normal in children younger than 10 years.



Ask the parents to have a speech evaluation performed if the stuttering continues beyond the age of 5



Reinforce the fact that this common speech defect requires no treatment.



Tell the parents that speech problems are most treatable during the child’s teen years.

10. A 13-year-old adolescent is diagnosed with a sensory alteration and is scheduled for diagnostic tests. She asks the nurse to tell her “the truth” about the tests. Which response is the best? 

“Don’t worry about anything. We’re here to take good care of you.”



“Ask your parents. They have talked with the physicians.”



“Most of the tests are painless and noninvasive.”



“Trust the doctors. They know what is best for you.”

11. Teaching parents about the use and application of an eye patch to treat strabismus should include which information? 

Check the patched eye four times a day by removing the patch and replacing it after inspection.



Apply the patch directly to the face.



Sometimes patching alone will straighten the eye.



Negotiate with the child for the number of hours per day that the patch is to be worn.

12. The correct position for the postoperative child who has had a cataract removed from the right eye is the _____ position. 

supine

  

prone knee-chest right lateral Sims’

13. Which manifestation in a 5-month-old child could indicate visual problems?  Lack of binocularity 

Visual acuity of 20/50



Strabismus



Hyperopia

14. The nurse should teach parents that the results of untreated amblyopia in the child may result in: 

impaired depth perception.



strabismus.



color deficiency.



ptosis.

15. The teaching plan for the parents of a 3-year-old child with amblyopia should include which instructions? 

Apply a patch to the child’s eyeglass lenses.



Apply a patch only during waking hours.



Apply a patch over the “bad” eye to strengthen it.



Cover the “good” eye completely with a patch.

16. The teaching plan for a 7-year-old boy with color deficiency should include which instruction? 

Buy only one color of clothing to ensure the child’s ability to match items himself.



Patching the weaker eye will improve his color vision.



Teach him an alternate way to distinguish between the colors of traffic signals.



Botulism toxin drops will need to be administered every 2 months to improve color vision.

17. A 2-year-old girl has excessive tearing and corneal haziness. The nurse knows that these symptoms may indicate: 

viral conjunctivitis.

  

paralytic strabismus. congenital cataract. infantile glaucoma.

18. Which should be the most significant nursing intervention in caring for a child who has just returned from eye surgery to prevent increasing intraocular pressure? 

Monitor for hypertension, which is a symptom of increased intraocular pressure.



Prevent coughing and vomiting.



Lower the head of the bed slightly and place the eye in a dependent position.



Avoid use of steroids after the surgery.

19. A 5-year-old girl diagnosed with chlamydial conjunctivitis should be carefully assessed for:  sexual abuse. 

immune deficiency.



congenital cataract.



secondary glaucoma.

20. Which statement made by a parent indicates understanding of the instructions on the care of a child with conjunctivitis? 

“I should treat my other children with these eye drops to prevent the spread of the disease.”



“My child must remain home from school until he has received 72 hours of antibiotic drops.”



“I should avoid touching the tip of the ointment tube to my child’s eye.”



“My child may go back to wearing his contact lens 24 hours after treatment has started.”

21. Discharge planning for an 8-year-old child with a patched eye after a corneal abrasion should include: 

removing the patch after 8 hours for instillation of antibiotic ointment.



gently massaging the affected eye to prevent edema.



instilling antibiotic ointment after patching for 24 hours.



returning after 7 days of patching for reassessment.

22. A patient who has a hyphema would be at risk for development of which complication?  Glaucoma  Strabismus  Diplopia 

Astigmatism

23. A mother brings her 18-month-old son to the pediatrician for a routine well-child visit. She is concerned about her child’s speech. He has been babbling and cooing since 6 months of age but is not yet saying any words. Which response by the nurse would be the most appropriate? 

“Don’t worry, he should catch up soon. Boys are always slower at speaking than girls.”



“The doctor will want to refer your son to an audiologist and speech pathologist.”



“This is normal speech development for an 18-month-old child.”



“Your son has an expressive language disorder and will need a referral for further evaluation.”

MULTIPLE RESPONSE 1. The nurse should plan which interventions when caring for a child with a visual impairment? Select all that apply. 

Touch the child upon entering the room before speaking.



Keep items in the room in the same location.



Describe the placement of the eating utensils on the meal tray.

 Use color examples to describe something to a child who has been blind since birth.

Identify noises for the child.

2. The nurse should plan which interventions when caring for a child with a hearing loss? Select all that apply. 

Speak loudly.



Speak slowly.



Do not slow speech.



Use visual aids.



Eliminate background noise.

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