Peds Exam II

A 5-year-old child is brought the Emergency Department with abrupt onset of sore throat, pain with swallowing, fever, and sitting upright and forward. Acute epiglottitis is suspected. What are the most appropriate nursing interventions? (select all that apply)

1. vital signs

2. throat culture

3. medical history

4. assessment of breath sounds

5. emergency airway equipment readily available

1,3,4,5

Vital signs should always be taken as a part of the assessment. Medical history is important in assisting with the diagnosis in addition to knowing immunization status. Assessment of breath sounds is important in assisting with the diagnosis. Suprasternal and substernal retractions may be noted. Emergency airway equipment must be readily available in case the airway becomes obstructed. Throat culture should never be done when diagnosis of epiglottis is suspected. Manipulation of the throat can stimulate the gag reflex in an already inflamed airway and cause laryngeal spasm that will cause occlusion of the airway.

The parent of a child with cystic fibrosis calls the clinic nurse to report that the child has developed tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The nurse should tell the parent to bring the child to the clinic because these symptoms are suggestive of

pneumothorax

bronchodilation

carbon dioxide retention

increased viscosity of sputum

pneumothorax

The child is exhibiting signs of increasing respiratory distress suggestive of a pneumothorax. The child needs to be seen as soon as possible. Bronchodilation would not produce the described symptoms. Carbon dioxide retention would not produce the described symptoms. The increased viscosity of sputum is characteristic of cystic fibrosis. The change in respiratory status is potentially due to a pneumothorax.

A school-age child has undergone a tonsillectomy and is being cared for postoperatively in the hospital setting. The nurse assigned to the patient is developing a plan of care with regard to nutrition and hydration. What factors should be included in the postoperative plan of care for this patient? (select all that apply)

1. medicate for pain around the clock to ensure that the patient will be able to eat and maintain hydration

2. restrict food and oral fluids initially making sure that the patient is fully alert and there is no evidence of bleeding

3. avoid giving fluids that are color tinged red or brown

4. provide milk to help maintain nutritional balance

5. provide pudding to facilitate swallowing

2, 3

Although the patient should receive appropriate analgesics to maintain comfort, medicating the patient around the clock typically is not indicated. Restricting food and oral fluids until fully awake with no evidence of bleeding is prudent proactive. Withholding fluids that are color tinged red or brown is also recommended as it will be hard to distinguish potential bleeding if there is emesis. Providing milk or pudding is not advised as it milk products can lead to clearing of throat as a result of coating effect and therefore may pose an irritation leading to potential bleeding.

Asthma is classified into four categories: mild intermittent, mild persistent, moderate persistent, and severe persistent. Clinical features used to determine these categories include (select all that apply)

1. lung function

2. associated allergies

3. frequency of symptoms

4. frequency and severity of axacerbations

1,3,4

The peak expiratory flow rate is one of the diagnostic criteria for classifying severity. The frequency of symptoms is one of the diagnostic criteria for classifying severity. The frequency and severity of exacerbations are two of the diagnostic criteria for classifying severity. The clinical features that distinguish the categories of asthma do not include other allergies.

The nurse suspects a child is having an adverse reaction to a blood transfusion. What should the nurse's first action be?

notify the physician

take vital signs and blood pressure and compare them with baseline values

dilute infusing blood with equal amounts of normal saline

stop the transfusion and maintain a patent IV line with normal saline and new tubing

stop the transfusion and maintain a patent IV line with normal saline and new tubing

The priority nursing action is to stop the transfusion and maintain a patent intravenous line with normal saline and new tubing. If an adverse reaction is occurring, it is essential to minimize the amount of blood that is infused into the child. The physician should be notified after the blood transfusion is stopped and normal saline is infusing. Vital signs should be assessed after the blood transfusion is stopped and normal saline is infusing. Blood should not be diluted; it should be returned to the blood bank if an adverse reaction has occurred.

Therapeutic management of the patient with systemic lupus erythematosus (SLE) includes

application of cold salts to suppress the inflammtory process

a high-protein, low-salt diet

a rigorous exercise regimen to build up muslce strength and endurance

administration of corticosteroids to control inflammation

administration of corticosteroids to control inflammation

Corticosteroid administration is the primary mode of therapy currently for SLE. The application of cold salts will not affect the inflammatory process associated with SLE. A balanced diet without exceeding caloric expenditures is recommended. Exercise should be done in moderation.

The school nurse is caring for a boy with hemophilia who fell on his arm during recess. What supportive measures should the nurse use until factor replacement therapy can be instituted?

apply warm, moist compressess

apply pressure for at least 1 minute

elevate the area above the level of the heart

begin passive range-of-motion unless the pain is severe

The initial response should include elevation of the arm to minimize bleeding. Cold should be applied to the arm. This will aid in vasoconstriction, minimizing blood loss. Pressure is effective in small areas but would not be as effective for an extremity. Passive range-of-motion is not recommended. The child can perform active range-of-motion after the bleeding episode has resolved.

Sickle cell disease (SCD) occurs through a genetic mutation. Based on the understanding of this genetic form of transmission, the nurse understands that

there are no carrier states associated with this disease

the disease is transmitted as part of a sex-linked mutation

SCD refers to a group of congenital disease expressions

it is a relatively uncommon disease as it is expressed as an autosomal recessive gene trait

SCD refers to a group of heredity disease states in which there is variants exhibited in both heterozygous and homozygous expressions. It is expressed as an autosomal recessive trait and as such there are carrier states. It is not transmitted as a sex-linked mutation. It is one of the most common genetic disorders globally.

The school nurse is discussing prevention of acquired immunodeficiency syndrome (AIDS) with some adolescents. Which statement is appropriate to include?

the virus is easily transmitted

the virus is transmitted only through blood

IV drugs users should not share needles

condoms should be used if a person is sexually active and homosexual

IV drugs users should not share needles

Human immunodeficiency virus (HIV) is spread through blood and body fluids. Intravenous needles that have been used should not be shared. They may be contaminated with the virus. The virus is not easily transmitted. It requires direct contact with blood or body fluids on a nonintact skin surface. Body fluids may also transmit the virus. Condoms should be used for both heterosexual and homosexual sex.

A child is status post hematopoietic stem cell transplantation (HSCT) and is preparing for discharge home. Based on the nurse's knowledge of HSCT, which concepts are important to include in the discharge teaching plan of care? (select all)

preparing the child to return to school within 6 weeks

keeping the child on a high-calcium diet

avoiding live plants and fresh vegetables

avoiding influenza vaccinations

practicing good hygiene

keeping the child on a high-calcium diet

avoiding live plants and fresh vegetables

practicing good hygiene

Children should have a diet high in calcium or be placed on calcium supplements to reduce the risk of osteopenia. Live plants and fresh vegetables should be avoided because they carry bacteria. Practicing good hand hygiene is essential to prevent the spread of infection. Children cannot return to school for 6-12 months after HSCT. Either in-hospital or home schooling is required. Children and their families should be encouraged to get yearly influenza vaccination.

A child with sickle cell anemia develops severe chest pain, fever, a cough, and dyspnea. The nurse's first action is to

administer 100% oxygen to relieve hypoxia

administer pain medication to relieve symptoms

notify practitioner because chest syndrome is suspected

notify practitioner because child may be having a stroke

notify practitioner because chest syndrome is suspected

Severe chest pain, fever, a cough, and dyspnea are the signs and symptoms of chest syndrome. The nurse must notify the practitioner immediately. Breathing 100% oxygen to relieve hypoxia may be ordered by the practitioner, but the first action is notification because these symptoms indicate a medical emergency. Pain medications may be indicated, but evaluation is necessary first. Severe chest pain, fever, cough, and dyspnea are not signs of a stroke.

Nursing care of the child with myelosuppression from leukemia or chemotherapeutic agents should include to

restrict oral fluids

institute strict isolation

use good hand washing technique

give immunizations appropriate for age

Good hand washing technique is the most effective means to prevent disease transmission in children with myelosuppression. There is no indication to reduce fluids in children with myelosuppression. Strict isolation is not necessary in children with myelosuppression. The child should not receive any live vaccines, because the immune system is not capable of responding appropriately to them.

A child has been diagnosed with aplastic anemia and undergoing therapeutic treatment. Therapeutic therapy would focus on

palliative treatment to maintain comfort

initiation of steroid therapy

anticipation of bone marrow transplant

asking parents if they want to consider organ donation

anticipation of bone marrow transplant

Although a clinical diagnosis of aplastic anemia can lead to increased morbidity and mortality treatment measures focusing on immunosuppressive therapy, removal of potential exacerbating etiology, and bone marrow replacement. Palliative treatment methods may be included but they are not the mainstay of therapeutic management. Steroid therapy is not indicated as that may lead to an increased susceptibility to infection. Asking the parents about organ donation at this time may cause considerable distress and anxiety.

Which question would the nurse utilize in order to assess family stress levels with regard to chronic disease of their 4-year-old child?

do you find satisfaction in your work?

what is your educational level?

how do you think your other children feel about their brother's condition?

are there any other problems that I could help you with?

Finding out how other members of the family feel about the chronic illness of a member may help to provide additional insight into family relationship dynamics. Asking about "other problems" is too general of a question and may not provide the nurse with any additional information. The family member could also respond to that question with a yes or no answer and as such the question could be viewed as closed ended. Satisfaction in one's work and educational level are not directly related to family stress with regard to chronic disease.

A 4 y/o concept of death is that

death is temporary

death is permanent

death is personified in various forms

death is inevitable at some age

death is temporary

Death is seen as a temporary departure, and the child assumes that the individual who has "died" will be back soon. The preschooler thinks of death as being an impermanent state. The 4-year-old believes that life and death can change places with each other. The concept of death as being personified in various forms is more typical of the beliefs of school-age children. The concept of the inevitability of death is more representative of the understanding of 9- and 10-year-olds.

The nurse is caring for a child dying from cancer. A physical sign that the child is approaching death is

rapid pulse

change in respiratory pattern

sensation of cold although body feels hot

loss of hearing followed by loss of other senses

change in respiratory pattern

In the final hours of life, the respiratory pattern may become labored, with periods of apnea. In the hours nearing death, the pulse becomes weak and slowed, not rapid. When nearing death, the opposite is true; there is a sensation of heat, although the body feels cold. When nearing death, hearing is the last sense to fail.

In reaction to a child's death which individuals may exhibit going through the grief stage reactions? (select all)

family members

nurses involved in patient's care

physicians taking care of the patient and family

only family members who were at the hospital with the patient

family members

nurses involved in patient's care

All members of the health care team may exhibit grief stage reactions. It is not limited to individuals or family members who were with the patient.

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

hindered mobility

poorly defined body image

limited opportunities for socialization

limited opportunities to achieve and accomplish

hindered mobility

The inability to move about and master the environment will inhibit the toddler's developing autonomy, the critical task of toddlerhood. A sense of body image begins to develop in the preschool years. The task of socialization occurs during the preschool years as the child begins to develop peer relationships. A child's sense of achievement and accomplishment begins to develop during the school-age years.

What is an important nursing responsibility when a dysrhythmia is suspected?

order an immediate electrocardiogram

count the radial pulse every 1 minute for 5 times

count the apical pulse for 1 full minute, and compare the rate with the radial pulse rate

have someone else take the radial pulse simultaneously with the apical pulse

count the apical pulse for 1 full minute, and compare the rate with the radial pulse rate

This is the nurse's first action. If a dysrhythmia is occurring, the radial pulse rate may be lower than the apical pulse rate. This may be indicated after conferring with the practitioner. The radial pulse rate needs to be compared with the apical pulse rate. It does not need to be counted for 1 minute five times. Only one nurse is needed to carry out this action.

After a patient returns from cardiac catheterization, the nurse notes that the pulse distal to the catheter insertion site is weaker (+1). The most appropriate nursing intervention is to

elevate the affected extremity

document the findings and continue to monitor

notify the health care provider of the finding

apply warm compresses to the insertion site

document the findings and continue to monitor

The pulse distal to the catheter insertion site may be weaker for the first few hours after catheterization. It should gradually increase in strength. The extremity is kept straight and immobile, but elevation is not necessary. Because a weaker pulse is an expected finding, the nurse should document it and continue to monitor it. There is no need to notify the physician. The insertion site is kept dry. Warm compresses would increase the risk of bleeding from the insertion site.

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

confusion

sleepiness

hypotension

apprehensiveness

apprehensiveness

Apprehensiveness is indicative of compensated shock. Confusion is indicative of uncompensated shock. Sleepiness is not an indication of shock. Hypotension is a symptom of irreversible shock.

If a child is being treated with ACE inhibitors as part of the therapeutic regimen for heart failure, which observation is noted would alert the nurse to a potential interaction?

diuretic therapy with Aldactone

child complains of being slightly dizzy at times

maintaining normal urine output

blood pressure monitoring at lower end of normal range

diuretic therapy with Aldactone

The use of ACE inhibitors in combination with Aldactone, which is a potassium sparing inhibitor can lead to potential hyperkalemia. As such this type of diuretic therapy should not be used. ACE inhibitors typically are not associated with dizziness but continued monitoring for this presentation should be included. Normal urine output is a favorable sign. ACE inhibitors can cause hypotension so continued monitoring would be needed at this point.

A physician suspects that a child may have congenital cardiac disease. Which noninvasive diagnostic procedure would help to confirm the possibility of heart disease?

EKG

Echocardiogram

chest x-ray

pulse oximetry

Echocardiogram

An echocardiogram is the most common test used to identify either a cardiac anomaly or evidence of heart disease. EKG provides evidence of electrical system conduction. Pulse oximetry provides information relative to perfusion. And a chest x-ray focuses on lungs and airway exchange, it may not be sensitive and specific to determine cardiac pathology.

A diagnosis of rheumatic fever is being ruled out for a child. Which lab test(s) is/are the most reliable? (select all)

throat culture

c-reactive protein (CRP)

antistreptolysin-O titer (ASO) titer

elevated white blood count

erythrocyte sedimentation rate (ESR)

antistreptolysin-O titer (ASO) titer

The most reliable and best standardized lab for antistreptococcal antibodies is an Antistreptolysin-O (ASO) titer. A throat culture indicates a current streptococcal infection. C-reactive protein (CRP) lab test indicates inflammation. An elevated white blood count (WBC) may indicate a possible infection but does not indicate a causative agent. An erythrocyte sedimentation rate (ESR) indicates inflammation.

What is an early sign of congestive heart failure that the nurse should recognize?

tachypnea

bradycardia

inability to sweat

increased urinary output

tachypnea

Tachypnea is one of the early signs of congestive heart failure that should be identified. Tachycardia at rest, dyspnea, retractions, and activity intolerance are other physical signs and symptoms. Tachycardia, not bradycardia, is one of the symptoms suggestive of congestive heart failure. The child may be diaphoretic if experiencing congestive heart failure. There will usually be decreased urinary output in a child experiencing congestive heart failure

The best approach that would facilitate improved outcomes when using surgical treatment for operable cancers is

when there is evidence of adjacent tissue involvement

performing amputation rather than attempting resection

using multiple excisions to remove the tumor

if the tumor is encapsulated and localized

if the tumor is encapsulated and localized

Tumors that are localized and encapsulated represent the best approach for improved outcomes for the surgical cancer patient as this indicates that the tumor is not showing evidence of metastasis. Evidence of adjacent tissue involvement means that the tumor has already metastasized. Resection of bone rather than amputation is associated with improved outcomes. Minimal incision surgical approach is favored to improve functioning and help maintain cosmesis.

Which findings are consistent with tumor lysis syndrome?

hypercalcemia and hyperkalemia

hypochloremia and hypokalemia

hyponatremia and hyperphosphatemia

hyperuricemia and hyperkalemia

hyperuricemia and hyperkalemia

The hallmark characteristics of tumor lysis syndrome are: hyperuricemia, hypocalcemia, hyperphosphatemia, and hyperkalemia.

An example of a disease process with underlying immune adaptation l potentially leading to a cancer diagnosis is?

fanconi anemia

wiskott aldrich syndrome

klinefelter syndrome

retinoblastoma

wiskott aldrich syndrome

Wiskott Aldrich syndrome is an example of an immunodeficiency state may place the individual at increased risk to develop certain cancers. Fanconi anemia and Klinefelter syndrome are examples of chromosomal abnormalities which can potentially lead to development of cancer. Retinoblastoma is an example of "two-hit" hypothesis of inheritance leading to development of cancer states.

You are working with the parents of a pediatric oncology patient who has successfully responded to therapy. The parents have questions regarding what to expect as the child continues to grow and develop throughout the life cycle. Which response would be appropriate with regard to the parent's concern?

as the therapy has been successful, growth and development should proceed along a normal sequence

it may be a good idea to schedule your child for repeat imaging studies on a yearly basis so as to make sure that the child remains in remission

there may be anticipated growth and developmental delays associated with chemotherapy treatments but they are typically self-limiting in nature

genetic counseling may be something to consider as the child reaches adulthood and is considering having children his/herself if the type of cancer that the child had was inherited

genetic counseling may be something to consider as the child reaches adulthood and is considering having children his/herself if the type of cancer that the child had was inherited

Even though medical treatment has been noted as being successful, continued observation and medical follow up is indicated. Growth and development should be monitored in accordance with recommended pediatric screening guidelines. Although imaging studies may be required at some point in time for follow up, yearly imaging studies may not be needed. Genetic counseling when the child reaches adulthood should be considered especially if the type of cancer was inherited. Growth and developmental delays are not considered to be normal and may not be self-limiting.

In taking care of a pediatric oncology patient, which diagnostic finding would indicate a critical concern for the development of infection?

absolute neutrophil count of 250 mm3

temperature of 99.2 degrees Fahrenheit

white blood cell count 7,000 mm3

platelet count 100,000 mm3

absolute neutrophil count of 250 mm3

An absolute neutrophil count of less than 500 mm3 is of critical concern as it indicates the potential for overwhelming infection. None of the other measurement parameters are reflective of this fact

When treating nausea and vomiting as a side effect of chemotherapy and/or radiotherapy, ondansetron (Zofran) is the preferred drug of choice because?

it has a shorter onset of action

it can be administered via several different routes

it does not cause extrapyramidal side effects

it has no adverse side effects if administered appropriately

it does not cause extrapyramidal side effects

Zofran is a 5-hydroxytryptamine-3 receptor antagonist and is considered the antiemetic of choice for oncology patients as it produces no extrapyramidal side effects. Pharmacodynamics and pharmacokinetic features aside, the preference for this medication is due to producing no extrapyramidal side effects. Any medication even if administered properly has the potential to cause side effects. The ability to administer via different routes does not indicate a preferred drug choice.

The nurse is assessing a pediatric oncology patient's nutritional status. Which diagnostic tests would provide best practice approach?

albumin, blood urea nitrogen (BUN) and daily weight

skinfold assessments and daily weight

intake and output with daily calorie count

serum prealbumin, albumin and transferrin

serum prealbumin, albumin and transferrin

No one diagnostic test or measurement provides enough evidence to evaluate the nutritional well-being of an individual patient. BUN provides evidence of hydration status but typically should be viewed using a BUN creatinine ratio to provide detailed information about a patient's renal status. Skinfold assessments while important again do not provide enough evidence even with the addition of a daily weight to evaluate one's nutritional status. Intake and output measurements in combination with daily calorie count are representative of hydration and nutritional support but do not provide information relative to nutritional body stores.

A pediatric oncology patient undergoing chemotherapy treatment is refusing to eat despite providing the child's "favorite foods" and allowing for alternate feeding patterns independent of meal time. What etiological theories might account for the child's loss of desire to eat? (select all that apply)

the patient anticipates that he/she will be nauseous and/or vomit as part of the treatment sequence

the patient is refusing to eat in an attempt to gain control over his/her surroudings

the "correct" food has just not ben found and more food selections should be offered

the patient is experiencing symptoms of depression

the patient is refusing to eat because his/her parents did not make the food

the patient anticipates that he/she will be nauseous and/or vomit as part of the treatment sequence

the patient is refusing to eat in an attempt to gain control over his/her surroudings

the patient is experiencing symptoms of depression

Anorexia and/or a refusal to eat sometimes accompanies chemotherapy interventions in patients. Thus, even in the context of being offered "favorite foods," the child may not want to eat. Theories proposed for this persistent anorexia and/or refusal include but are not limited to: possible depression, attempts at control, gaining control over one's environment, a conditioned response reflecting aversion during treatment and/or stress.

Which findings would the nurse suspect to be observe during a work up for in a pediatric patient suspected of having a brain tumor? (select all that apply)

vomiting following eating

headache upon arising that disspates as the day progresses

decreased pulse pressure

abnormal cranial nerve examination

negative babinski sign

headache upon arising that disspates as the day progresses

decreased pulse pressure

abnormal cranial nerve examination

The presence of brain tumor would cause a variety of clinical symptoms depending on the location and extent of the tumor. Expected physical findings are associated with headache upon arising that subsides as the day progresses, a decreased pulse pressure, abnormal neurological exam which includes cranial nerve abnormalities as well as a positive Babinski reflex. Vomiting specifically associated with eating is not directly correlated with a brain tumor. Vomiting can be present but may or not be associated with nausea or feeding.

A pediatric oncology patient is undergoing chemotherapy. Which treatment option would the nurse anticipate being included in the plan of care in order to prevent the development of sterile hemorrhagic cystitis?

restrictive fluid intake

inclusion of dairy foods in the diet

implementing a frequent voiding plan throughout the course of the day to the patient

limiting mobility during course of chemotherapy

implementing a frequent voiding plan throughout the course of the day to the patient

Providing a frequent voiding plan to encourage the patient to void upon urge, immediately upon arising, before bedtime and one nighttime void will help to prevent possibility of urinary stasis. Encouraging fluid intake rather than restricting fluid is the mainstay of treatment. Dairy foods in the diet provide no effective treatment against the development of sterile hemorrhagic cystitis. Similarly, limiting mobility is not indicated.

Parents bring in their son for evaluation of hearing telling the nurse that he seems to hear what is going on around him but that at times the child is unable to fully understand what is being asked of him. Which observations by the nurse would lead to suspicion of sensorineural hearing loss?

child states that he hears things but they are not loud

parents state that they listen to music in the home for several hours each evening

child has a recent middle ear infection which was treated with antibiotics

child denies having any ear pain or discomfort

parents state that they listen to music in the home for several hours each evening

Causes of sensorineural hearing loss can occur from music or exposure to excessive noise. The nurse should investigate further at what level the music is being played and the exact length of exposure time. Conductive hearing loss is associated with middle ear infections and can manifest with level of sound. Sensorineural hearing loss involves distortion of sound and causes problems with discrimination.

What is defined as reduced visual acuity in one eye despite appropriate optical correction?

myopia

hyperopia

amblyopia

astigmatism

amblyopia

The definition of amblyopia is the reduction of visual acuity in one eye despite appropriate optical correction. Myopia is near-sightedness, which is the ability to see objects up close but not clearly at a distance. Hyperopia is far-sightedness, which is the ability to clearly see distant objects but not close ones. Astigmatism is an alteration in vision caused by unequal curvature in the eye's refractive apparatus.

Diagnostic testing for treatable inborn errors of metabolism in the newborn include confirmation of which disease processes? (select all)

Down's syndrome

galactosemia

phenylkeotnuria

hyperthyroidism

neural tube defect

galactosemia

phenylkeotnuria

Galactosemia and phenylketonuria (PKU) can be diagnosed via Guthrie test as part of newborn diagnostic testing. Down's syndrome is confirmed via genetic testing. Determination of neural tube defects can be done via alpha fetoprotein biomarkers. Hyperthyroidism would be confirmed by serum blood tests.

The correct interpretation of the notation, legally blind refers to?

a medical diagnosis that indicates visual impairment is a priority problem

acuity tests reveal a finding of 20/100 in both eyes

a legal definition that determines whether the individual can receive benefits from government or ancillary agencies

that the individual requires glasses in order to be able to see properly

a legal definition that determines whether the individual can receive benefits from government or ancillary agencies

Legally blind refers to the legal description confirmed by acuity test results of 20/200 that indicate severe permanent visual impairment. It allows for the individual to be able to receive assistance from government agencies and/or ancillary services. It is not a medical diagnosis. Prescriptive glasses will not restore visual sight for these individuals.

the diagnosis of intellectual disability is based on the presence of

intelligence quotient (IQ) of 75 or less

IQ of 70 or less

subaverage intellectual functioning, deficits in adaptive skills, and onset at any age

subaverage intellectual functioning dficits in adaptive skills and onset before 18 y/o

subaverage intellectual functioning dficits in adaptive skills and onset before 18 y/o

The diagnosis of intellectual disability is made with the presentation of subaverage intellectual functioning, deficits in adaptive skills, and an onset before age 18. IQ is only one component of the diagnosis of intellectual disability. The onset of the deficit in adaptive skills and subaverage intellectual functioning must occur before age 18 years to meet the diagnosis of intellectual disability.

Autism is a complex developmental disorder. Diagnostic criteria for autism include delayed or abnormal functioning in which area(s) before 3 years of age? (select all that apply)

parallel play

social interaction

gross motor development

inability to maintain eye contact

language as used in social communication

social interaction

inability to maintain eye contact

language as used in social communication

Children diagnosed with autism show delayed or abnormal functioning in social interactions. A hallmark characteristic of autism is the child's inability to make and maintain eye contact. A characteristic of autism is the child's delay of language at an early age or the sudden deterioration in extant expressive speech. Parallel play is not an area in which autistic children may show delay. When interacting with other children in other forms of play they display functional limitations. Gross motor development is not an area in which autistic children show delayed or abnormal functioning.

A 6-year-old has difficulty hearing faint or distant speech. The child's speech is normal, but the child is having problems with school performance. This hearing loss would most likely be classified as

slight

severe

moderate

inattentiveness rather than hearing loss

slight

The definition of a slight hearing loss includes normal speech with difficulty hearing faint and/or distant speech. With severe hearing loss, the child may hear a loud voice if nearby and may be able to identify loud environmental noises. Moderate hearing loss results in symptoms of being able to understand conversation at a distance of 3 to 5 feet. Children with difficulty hearing faint or distant speech, but who have normal speech themselves, are by definition experiencing slight hearing loss.

A 2-week-old infant with Down syndrome is being seen in the clinic. The mother tells the nurse that the infant is difficult to hold. "The baby is like a rag doll and doesn't cuddle up to me like my other babies did." The nurse interprets the infant's behavior as a

sign of maternal deprivation

sign of detachment and rejection

sign of autism associated with Down syndrome

result of the physical characteristics of Down syndrome

result of the physical characteristics of Down syndrome

Lack of clinging (or molding) between child and mother is a result of the muscle hypotonicity and hyperextensibility of the joints associated with Down syndrome. Mothers may have difficulty with attachment to their child due to the lack of clinging or molding behavior characteristic of Down syndrome. The nurse should recommend swaddling and wrapping the baby before picking up. There is no indication of maternal deprivation. Lack of clinging or molding is not symptomatic of detachment and rejection. These physical signs are characteristic of Down syndrome. Autism is not associated with Down syndrome.

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

reassure them that the syndrome is not inherited

assess for family history of the syndrome

recommend that they do not have another child

explain that prenatal diagnosis of the syndrome is now available

explain that prenatal diagnosis of the syndrome is now available

Fragile X syndrome can now be detected prenatally. The family should be referred for genetic counseling. Fragile X syndrome is inherited on the X chromosome. This should be done, but it does not address the parents' concern and need for genetic counseling. Nurses do not make recommendations related to whether parents should become pregnant and have other children. A referral for genetic counseling is indicated, and, based on findings, the geneticist can present family planning options, but the decision is strictly up to the family.

moderate cognitive impairment IQ range

35-55

lower limit of normal intelligence (IQ)

70

mild cognitive impairment but educable IQ range

50-70

severe cognitive impairment IQ range

20-40

A young child has an intelligence quotient (IQ) of 45. The nurse should document this finding as:

a. within the lower limits of the range of normal intelligence.

b. mild cognitive impairment but educable.

c. moderate cognitive impairment but trainable.

d. severe cognitive impairment and completely dependent on others for care.

ANS: C

Moderate cognitive impairment IQs range between 35 and 55. The lower limit of normal intelligence is approximately 70. Individuals with IQs of 50 to 70 are considered to have mild cognitive impairment but educable. An IQ of 20 to 40 results in severe cognitive impairment.

When a child with mild cognitive impairment reaches the end of adolescence, which characteristic should be expected?

a. Achieves a mental age of 5 to 6 years

b. Achieves a mental age of 8 to 12 years

c. Unable to progress in functional reading or arithmetic

d. Acquires practical skills and useful reading and arithmetic to an eighth-grade level

ANS: B

By the end of adolescence, the child with mild cognitive impairment can acquire practical skills and useful reading and arithmetic to a third- to sixth-grade level. A mental age of 8 to 12 years is obtainable, and the child can be guided toward social conformity. The achievement of a mental age of 5 to 6 years and being unable to progress in functional reading or arithmetic are characteristics of children with moderate cognitive impairment. Acquiring practical skills and useful reading and arithmetic to an eighth-grade level is not descriptive of cognitive impairment.

A newborn assessment shows separated sagittal suture, oblique palpebral fissures, depressed nasal bridge, protruding tongue, and transverse palmar creases. Of what are these findings most suggestive?

a. Microcephaly

b. Down syndrome

c. Cerebral palsy

d. Fragile X syndrome

ANS: B

These are characteristics associated with Down syndrome. The infant with microcephaly has a small head. Cerebral palsy is a diagnosis not usually made at birth. No characteristic physical signs are present. The infant with fragile X syndrome has increased head circumference; long, wide, and/or protruding ears; long, narrow face with prominent jaw; hypotonia; and high arched palate.

The child with Down syndrome should be evaluated for which condition before participating in some sports?

a. Hyperflexibility

b. Cutis marmorata

c. Atlantoaxial instability

d. Speckling of iris (Brushfield spots)

ANS: C

Children with Down syndrome are at risk for atlantoaxial instability. Before participating in sports that put stress on the head and neck, a radiologic examination should be done. Hyperflexibility, cutis marmorata, and speckling of iris (Brushfield spots) are characteristic of Down syndrome, but they do not affect the child's ability to participate in sports.

Many of the physical characteristics of Down syndrome present nursing problems. Care of the child should include which intervention?

a. Delay feeding solid foods until the tongue thrust has stopped.

b. Modify diet as necessary to minimize the diarrhea that often occurs.

c. Provide calories appropriate to child's age.

d. Use a cool-mist vaporizer to keep mucous membranes moist.

ANS: D

The constant stuffy nose forces the child to breathe by mouth, drying the mucous membranes and increasing the susceptibility to upper respiratory tract infections. A cool-mist vaporizer will keep the mucous membranes moist and liquefy secretions. The child has a protruding tongue, which makes feeding difficult. The parents must persist with feeding while the child continues the physiologic response of the tongue thrust. The child is predisposed to constipation. Calories should be appropriate to the child's weight and growth needs, not age.

A child has just been diagnosed with fragile X syndrome. What is fragile X syndrome?

a. A chromosomal defect affecting females only

b. A chromosomal defect that follows the pattern of X-linked recessive disorders

c. The second most common genetic cause of cognitive impairment

d. The most common cause of noninherited cognitive impairment

ANS: C

Fragile X syndrome is the second most common cause of cognitive impairment after Down syndrome. Fragile X primarily affects males, and follows the inheritance pattern of X-linked dominant with reduced penetrance. This is in distinct contrast to the classic X-linked recessive pattern in which all carrier females are normal, all affected males have symptoms of the disorder, and no males are carriers.

A school nurse is performing hearing screening on school children. The nurse recognizes that distortion of sound and problems in discrimination are characteristic of which type of hearing loss?

a. Conductive

b. Sensorineural

c. Mixed conductive-sensorineural

d. Central auditory imperceptive

ANS: B

Sensorineural hearing loss, also known as perceptive or nerve deafness, involves damage to the inner ear structures or the auditory nerve. It results in the distortion of sounds and problems in discrimination. Conductive hearing loss involves mainly interference with loudness of sound. Mixed conductive-sensorineural hearing loss manifests as a combination of both sensorineural and conductive loss. Central auditory imperceptive hearing loss includes all hearing losses that do not demonstrate defects in the conduction or sensory structures.

A school nurse is performing hearing screening on school children. The nurse recognizes that the most common type of hearing loss resulting from interference of transmission of sound to the middle ear is characteristic of which type of hearing loss?

a. Conductive

b. Sensorineural

c. Mixed conductive-sensorineural

d. Central auditory imperceptive

ANS: A

Conductive or middle-ear hearing loss is the most common type. It results from interference of transmission of sound to the middle ear, most often from recurrent otitis media. Sensorineural, mixed conductive-sensorineural, and central auditory imperceptive are less common types of hearing loss.

Hearing is expressed in decibels (dB), or units of loudness. Which is the softest sound a normal ear can hear?

a. 0 dB

b. 10 dB

c. 40 to 50 dB

d. 100 dB

ANS: A

By definition, 0 dB is the softest sound the normal ear can hear. Ten decibels is the sound of the heartbeat or the rustling of leaves. 40 to 50 dB is in the range of normal conversation. The noise of a train is approximately 100 dB.

The nurse should suspect a hearing impairment in an infant who demonstrates which behavior?

a. Absence of the Moro reflex

b. Absence of babbling by age 7 months

c. Lack of eye contact when being spoken to

d. Lack of gesturing to indicate wants after age 15 months

ANS: B

The absence of babbling or inflections in voice by age 7 months is an indication of hearing difficulties. The absence of the Moro reflex and eye contact when being spoken to does not indicate a hearing impairment. The child with hearing impairment uses gestures rather than vocalizations to express desires at this age.

Which is an implanted ear prosthesis for children with sensorineural hearing loss?

a. Hearing aid

b. Cochlear implant

c. Auditory implant

d. Amplification device

ANS: B

Cochlear implants are surgically implanted, and they provide a sensation of hearing for individuals who have severe or profound hearing loss of sensorineural origin. Hearing aids and amplification devices are external devices for enhancing hearing. Auditory implants do not exist.

Prevention of hearing impairment in children is a major goal for the nurse. This can be achieved through which intervention?

a. Being involved in immunization clinics for children

b. Assessing a newborn for hearing loss

c. Answering parents' questions about hearing aids

d. Participating in hearing screening in the community

ANS: A

Childhood immunizations can eliminate the possibility of acquired sensorineural hearing loss from rubella, mumps, or measles encephalitis. Assessing a newborn for hearing loss, answering parents' questions about hearing aids, and participating in hearing screening in the community are interventions to screen for the presence of hearing loss or deal with an identified loss, not prevention.

A nurse should suspect possible visual impairment in a child who displays which characteristic?

a. Excessive rubbing of the eyes

b. Rapid lateral movement of the eyes

c. Delay in speech development

d. Lack of interest in casual conversation with peers

ANS: A

Excessive rubbing of the eyes is a clinical manifestation of visual impairment. Rapid lateral movement of the eyes, delay in speech development, and lack of interest in casual conversation with peers are not associated with visual impairment.

When assessing the eyes of a neonate, the nurse observes opacity of the lens. This represents which impairment?

a. Blindness

b. Glaucoma

c. Cataracts

d. Retinoblastoma

27. The school nurse is caring for a child with a penetrating eye injury. Emergency treatment includes which intervention?

a. Apply a regular eye patch.

b. Apply a Fox shield to affected eye and any type of patch to the other eye.

c. Apply ice until the physician is seen.

d. Irrigate eye copiously with a sterile saline solution.

The nurse is talking to the parent of a 13-month-old child. The mother states, "My child does not make noises like 'da' or 'na' like my sister's baby, who is only 9 months old." Which statement by the nurse would be most appropriate to make?

a. "I am going to request a referral to a hearing specialist."

b. "You should not compare your child to your sister's child."

c. "I think your child is fine, but we will check again in 3 months."

d. "You should ask other parents what noises their children made at this age."

ANS: A

By 11 months of age a child should be making well-formed syllables such as "da" or "na" and should be referred to a specialist if not. "You should not compare your child to your sister's child," "I think your child is fine, but we will check again in 3 months," and "You should ask other parents what noises their children made at this age," are not appropriate statements to make to the parent.

Parents of a child with Down syndrome ask the nurse about techniques for introducing solid food to their 8-month-old child's diet. The nurse should give the parents which priority instruction?

a. It is too early to add solids; the parents should wait for 2 to 3 months.

b. A small but long, straight-handled spoon should be used to push the food toward the back and side of the mouth.

c. If the child thrusts the food out, the feeding should be stopped.

d. Solids should be offered only three times a day.

ANS: B

Down syndrome children have a protruding tongue which can interfere with feeding, especially of solid foods. Parents need to know that the tongue thrust is not an indication of refusal to feed but a physiologic response. Parents are advised to use a small but long, straight-handled spoon to push the food toward the back and side of the mouth. If food is thrust out, it should be re-fed. Six months is the time to introduce solid foods to a child, so waiting 2 to 3 months is inappropriate. Small frequent feedings should be initiated to prevent the child from tiring. Three times a day is too infrequent.

Autism is a complex developmental disorder. The diagnostic criteria for autism include delayed or abnormal functioning in which areas with onset before age 3 years? (Select all that apply.)

a. Language as used in social communication

b. Parallel play

c. Gross motor development

d. Growth below the 5th percentile for height and weight

e. Symbolic or imaginative play

f. Social interaction

ANS: A, E, F

These are three of the areas in which autistic children may show delayed or abnormal functioning: language as used in social communication, symbolic or imaginative play, and social interaction. Parallel play is typical play of toddlers and is usually not affected. Gross motor development and growth below the 5th percentile for height and weight are usually not characteristic of autism.

Which assessment findings indicate to the nurse a child has Down syndrome? (Select all that apply.)

a. High arched narrow palate

b. Protruding tongue

c. Long, slender fingers

d. Transverse palmar crease

e. Hypertonic muscle tone

ANS: A, B, D

The assessment findings of Down syndrome include high arched narrow palate, protruding tongue, and transverse palmar creases. The fingers are stubby and the muscle tone is hypotonic, not hypertonic.

A nurse is instructing a nursing assistant on techniques to facilitate lipreading with a hearing-impaired child who lip reads. Which techniques should the nurse include? (Select all that apply.)

a. Speak at eye level.

b. Stand at a distance from the child.

c. Speak words in a loud tone.

d. Use facial expressions while speaking.

e. Keep sentences short.

ANS: A, D, E

To facilitate lipreading for a hearing-impaired child who can lip read, the speaker should be at eye level, facing the child directly or at a 45-degree angle. Facial expressions should be used to assist in conveying messages, and the sentences should be kept short. The speaker should stand close to the child, not at a distance, and using a loud tone while speaking will not facilitate lipreading.

The nurse case manager is planning a care conference about a young child who has complex health care needs and will soon be discharged home. Who should the nurse invite to the conference?

a. Family and nursing staff

b. Social worker, nursing staff, and primary care physician

c. Family and key health professionals involved in the child's care

d. Primary care physician and key health professionals involved in the child's care

ANS: C

A multidisciplinary conference is necessary for coordination of care for children with complex health needs. The family is included, along with key health professionals who are involved in the child's care. The nursing staff can address the child's nursing care needs with the family, but other involved disciplines must be included. The family must be included in the discharge conferences, which allows them to determine what education they will require and the resources needed at home. A member of the nursing staff must be included to review the child's nursing needs.

Which represents a common best practice in the provision of services to children with special needs?

a. Care is now being focused on the child's chronologic age.

b. Children with special needs are being integrated into regular classrooms.

c. Children with special needs no longer have to be cared for by their families.

d. Children with special needs are being separated into residential treatment facilities.

ANS: B

Normalization refers to behaviors and interventions for the disabled to integrate into society by living life as persons without a disability would. For children, normalization includes attending school and being integrated into regular classrooms. This affords the child the advantages of learning with a wide group of peers. Care is necessarily focused on the child's developmental age. Home care by the family is considered best practice. The nurse can assist families by assessing social support systems, coping strategies, family cohesiveness, and family and community resources.

Families progress through various stages of reactions when a child is diagnosed with a chronic illness or disability. After the shock phase, a period of adjustment usually follows. This is often characterized by which of the following responses?

a. Denial

b. Guilt and anger

c. Social reintegration

d. Acceptance of the child's limitations

ANS: B

For most families, the adjustment phase is accompanied by several responses. Guilt, self-accusation, bitterness, and anger are common reactions. The initial diagnosis of a chronic illness or disability often is met with intense emotion, characterized by shock and denial. Social reintegration and acceptance of the child's limitations are the culmination of the adjustment process.

Which nursing intervention is especially helpful in assessing parental guilt when a disability or chronic illness is diagnosed?

a. Ask the parents if they feel guilty.

b. Discuss guilt only after the parents mention it.

c. Discuss the meaning of the parents' religious and cultural background.

d. Observe for signs of overprotectiveness.

ANS: C

Guilt may be associated with cultural or religious beliefs. Some parents are convinced that they are being punished for some previous misdeed. Others may see the disorder as a sacrifice sent by God to test their religious beliefs. The nurse can help the parents explore their religious beliefs. The parents may not be able to identify the feelings of guilt. It would be appropriate for the nurse to explore their adjustment responses. Overprotectiveness is a parental response during the adjustment phase. The parents fear letting the child achieve any new skill and avoid all discipline.

The nurse comes into the room of a child who was just diagnosed with a chronic disability. The child's parents begin to yell at the nurse about a variety of concerns. Which is the nurse's best response?

a. "What is really wrong?"

b. "Being angry is only natural."

c. "Yelling at me will not change things."

d. "I will come back when you settle down."

ANS: B

Parental anger after the diagnosis of a child with a chronic disability is a common response. One of the most common targets for parental anger is members of the staff. The nurse should recognize the common response of anger to the diagnosis and allow the family to vent. "What is really wrong?"/"Yelling at me will not change things"/"I will come back when you settle down" will place the parents on the defensive and not facilitate communication.

A common parental reaction to a child with special needs is parental overprotection. What parental behavior is suggestive of this behavior?

a. Giving inconsistent discipline

b. Providing consistent, strict discipline

c. Forcing child to help self, even when not capable

d. Encouraging social and educational activities not appropriate to child's level of capability

ANS: A

Parental overprotection is manifested by the parents' fear of letting the child achieve any new skill; they allow the child to avoid all discipline and cater to every desire to prevent frustration. Overprotective parents do not set limits and or institute discipline; prefer to remain in the role of total caregiver; do not allow the child to perform self-care; and do not encourage the child to participate in social and educational activities.

The feeling of guilt that the child "caused" the disability or illness is especially critical in which child?

a. Toddler

b. Preschooler

c. School-age child

d. Adolescent

ANS: B

Preschoolers are most likely to be affected by feelings of guilt that they caused the illness or disability or are being punished for wrongdoings. Toddlers are focused on establishing their autonomy. The illness will foster dependence. The school-age child will have limited opportunities for achievement and may not be able to understand limitations. Adolescents face the task of incorporating their disabilities into their changing self-concept

Which is the most appropriate nursing intervention to promote normalization in a school-age child with a chronic illness?

a. Give the child as much control as possible.

b. Ask the child's peer to make the child feel normal.

c. Convince the child that nothing is wrong with him or her.

d. Explain to parents that family rules for the child do not need to be the same as for healthy siblings.

ANS: A

The school-age child who is ill may be forced into a period of dependency. To foster normalcy, the child should be given as much control as possible. It is unrealistic to expect one individual to make the child feel normal. The child has a chronic illness. It would be unacceptable to convince the child that nothing is wrong. The family rules should be similar for each of the children in a family. Resentment and hostility can arise if different standards are applied to each child.

The parents of a child born with disabilities ask the nurse for advice about discipline. What information about disciple should the nurse's response include?

a. It is essential for the child.

b. It is too difficult to implement with a special-needs child.

c. It is not needed unless the child becomes problematic.

d. It is best achieved with punishment for misbehavior.

ANS: A

Discipline is essential for the child. It provides boundaries on which to test out their behavior and teaches them socially acceptable behaviors. The nurse should teach the parents ways to manage the child's behavior before it becomes problematic. Punishment is not effective in managing behavior.

Which best describes how preschoolers react to the death of a loved one?

a. A preschooler is too young to have a concept of death.

b. A preschooler may feel guilty and responsible for the death.

c. Grief is acute but does not last long at this age.

d. Grief is usually expressed in the same way in which the adults in the preschooler's life are expressing grief.

ANS: B

Because of egocentricity, the preschooler may feel guilty and responsible for the death.

At what age do most children have an adult concept of death as being inevitable, universal, and irreversible?

a. 4 to 5 years

b. 6 to 8 years

c. 9 to 11 years

d. 12 to 16 years

ANS: C

By age 9 to 11 years, children have an adult concept of death. They realize that it is inevitable, universal, and irreversible.

Which is most descriptive of a school-age child's reaction to death?

a. Is very interested in funerals and burials

b. Has little understanding of words such as forever

c. Imagines the deceased person to be still alive

d. Has an idealistic view of the world and criticizes funerals as barbaric

ANS: A

The school-age child is interested in post-death services and may be inquisitive about what happens to the body.

At what developmental period do children have the most difficulty coping with death, particularly if it is their own?

a. Toddlerhood

b. Preschool

c. School-age

d. Adolescence

ANS: D

Adolescents, because of their mature understanding of death, remnants of guilt and shame, and issues with deviations from normal, have the most difficulty coping with death.

A school-age child is diagnosed with a life-threatening illness. The parents want to protect their child from knowing the seriousness of the illness. What should the nurse tell the parents?

a. This will help the child cope effectively by denial.

b. This attitude is helpful to give parents time to cope.

c. Terminally ill children know when they are seriously ill.

d. Terminally ill children usually choose not to discuss the seriousness of their illness.

ANS: C

The child needs honest and accurate information about the illness, treatments, and prognosis. Children, even at a young age, realize that something is seriously wrong and that it involves them. The nurse should help the parents understand the importance of honesty.

At the time of a child's death, the nurse tells his mother, "We will miss him so much." What is the best interpretation of this statement?

a. Pretending to be experiencing grief

b. Expressing personal feelings of loss

c. Denying the mother's sense of loss

d. Talking when listening would be better

ANS: B

A patient's death is one of the most stressful aspects of critical care or oncology nursing. Nurses experience reactions similar to those of family members because of their involvement with the child and family during the illness. Nurses often have feelings of personal loss when a patient dies.

Parents are asking about an early intervention program for their child who has special needs. The nurse relates that this program is for which age of child?

a. Birth to 1 year of age

b. Birth to 3 years of age

c. Ages 1 to 4

d. Ages 4 and 5

ANS: B

A variety of supplemental programs have been designed in the school system to accommodate special needs, both at school age and younger, through early intervention, which consists of any sustained and systematic effort to assist children from birth to age 3 years with disabilities and those who are developmentally vulnerable.

A nurse is planning palliative care for a child with severe pain. Which should the nurse expect to be prescribed for pain relief?

a. Opioids as needed

b. Opioids on a regular schedule

c. Distraction and relaxation techniques

d. Nonsteroidal anti-inflammatory drugs

ANS: B

Pain medications, for children in palliative care, should be given on a regular schedule, and extra doses for breakthrough pain should be available to maintain comfort. Opioid drugs such as morphine should be given for severe pain, and the dose should be increased as necessary to maintain optimal pain relief. Techniques such as distraction, relaxation techniques, and guided imagery should be combined with drug therapy to provide the child and family strategies to control pain. Nonsteroidal anti-inflammatory drugs are not sufficient to manage severe pain for children in palliative care.

A mother of a 5-year-old child, with complex health care needs and cared for at home, expresses anxiety about attending a kindergarten graduation exercise of a neighbor's child. The mother says, "I wish it could be my child graduating from kindergarten." What should the nurse recognize the mother is experiencing?

a. Abnormal anxiety

b. Ineffective coping

c. Chronic sorrow

d. Denial

ANS: C

Home care nurses should be aware that parents may experience chronic sorrow as a parental stressor. Chronic sorrow as a normal grief response is associated with a living loss (the loss of a healthy child) that is cyclical in nature. This is a normal response and does not indicate abnormal anxiety, ineffective coping, or denial.

Which are appropriate statements the nurse should make to parents after the death of their child? (Select all that apply.)

a. "We feel so sorry that we couldn't save your child."

b. "Your child isn't suffering anymore."

c. "I know how you feel."

d. "You're feeling all the pain of losing a child."

e. "You are still young enough to have another baby."

ANS: A, D

By saying, "We feel so sorry that we couldn't save your child," the nurse is expressing personal feeling of loss or frustration, which is therapeutic. Stating, "You're feeling all the pain of losing a child," focuses on a feeling, which is therapeutic. The statement, "Your child isn't suffering anymore," is a judgmental statement, which is nontherapeutic. "I know how you feel" and "You're still young enough to have another baby" are statements that give artificial consolation and are nontherapeutic.

Which are adaptive coping patterns used by children with special needs? (Select all that apply.)

a. Feels different and withdraws

b. Is irritable, moody, and acts out

c. Seeks support

d. Develops optimism

ANS: C, D

Adaptive coping patterns used by children with special needs include seeking support and developing optimism. Maladaptive behaviors are seeing themselves as different and withdrawing and becoming irritable, moody, and beginning to act out.

A child dependent on medical technology is preparing to be discharged from the hospital to home. Which predischarge assessments should the nurse ensure? (Select all that apply.)

a. Emergency care and transport plan

b. Reliance on private duty nurses to teach the family infection control practices

c. Financial arrangements

d. Individualized home plan to be completed within the first month of the child's discharge

ANS: A, C

The predischarge plan for a child dependent on medical technology going home should include emergency care and transport plan and financial arrangements. The infection control practices and individualized home plan should be completed before discharge, not after the child goes home.

Which explains why cool-mist vaporizers rather than steam vaporizers are recommended in home treatment of childhood respiratory tract infections?

a. They are safer.

b. They are less expensive.

c. Respiratory secretions are dried.

d. A more comfortable environment is produced.

ANS: A

Cool-mist vaporizers are safer than steam vaporizers, and little evidence exists to show any advantages to steam. The cost of cool-mist and steam vaporizers is comparable. Steam loosens secretions, not dries them. Both may promote a more comfortable environment, but cool-mist vaporizers present decreased risk for burns and growth of organisms.

Decongestant nose drops are recommended for a 10-month-old infant with an upper respiratory tract infection. Instructions for nose drops should include which action?

a. Avoid using for more than 3 days.

b. Keep drops to use again for nasal congestion.

c. Administer drops until nasal congestion subsides.

d. Administer drops after feedings and at bedtime.

ANS: A

Vasoconstrictive nose drops such as phenylephrine (Neo-Synephrine) should not be used for more than 3 days to avoid rebound congestion. Drops should be discarded after one illness because they may become contaminated with bacteria. Vasoconstrictive nose drops can have a rebound effect after 3 days of use. Drops administered before feedings are more helpful.

The parent of an infant with nasopharyngitis should be instructed to notify the health professional if the infant displays which clinical manifestation?

a. Fussiness

b. Coughing

c. A fever over 99° F

d. Signs of an earache

ANS: D

If an infant with nasopharyngitis shows signs of an earache, it may mean a secondary bacterial infection is present and the infant should be referred to a practitioner for evaluation. Irritability is common in an infant with a viral illness. Cough can be a sign of nasopharyngitis. Fever is common in viral illnesses.

When is it generally recommended that a child with acute streptococcal pharyngitis may return to school?

a. When sore throat is better.

b. If no complications develop.

c. After taking antibiotics for 24 hours.

d. After taking antibiotics for 3 days.

ANS: C

After children have taken antibiotics for 24 hours, they are no longer contagious to other children. Sore throat may persist longer than 24 hours after beginning antibiotic therapy, but the child is no longer considered contagious. Complications may take days to weeks to develop.

A child is diagnosed with influenza. Management includes which recommendation?

a. Clear liquid diet for hydration

b. Aspirin to control fever

c. Oseltamivie (Tamiflu)

d. Antibiotics to prevent bacterial infection

ANS: C

Oseltamivie (Tamiflu) may reduce symptoms related to influenza A if administered within 24 to 48 hours of onset. A clear liquid diet is not necessary for influenza, but maintaining hydration is important. Aspirin is not recommended in children because of increased risk of Reye syndrome. Acetaminophen or ibuprofen is a better choice. Preventive antibiotics are not indicated for influenza unless there is evidence of a secondary bacterial infection.

How is chronic otitis media with effusion (OME) differentiated from acute otitis media (AOM)?

a. A fever as high as 40° C (104° F)

b. Severe pain in the ear

c. Nausea and vomiting

d. A feeling of fullness in the ear

ANS: D

OME is characterized by feeling of fullness in the ear or other nonspecific complaints. Fever is a sign of AOM. OME does not cause severe pain. This may be a sign of AOM. Nausea and vomiting are associated with otitis media.

Parents have understood teaching about prevention of childhood otitis media if they make which statement?

a. "We will only prop the bottle during the daytime feedings."

b. "Breastfeeding will be discontinued after 4 months of age."

c. "We will place the child flat right after feedings."

d. "We will be sure to keep immunizations up to date."

ANS: D

Parents have understood the teaching about preventing childhood otitis media if they respond they will keep childhood immunizations up to date. The child should be maintained upright during feedings and after. Otitis media can be prevented by exclusively breastfeeding until at least 6 months of age. Propping bottles is discouraged to avoid pooling of milk while the child is in the supine position.

An infant's parents ask the nurse about preventing OM. Which should be recommended?

a. Avoid tobacco smoke.

b. Use nasal decongestant.

c. Avoid children with OM.

d. Bottle-feed or breastfeed in a supine position.

ANS: A

Eliminating tobacco smoke from the child's environment is essential for preventing OM and other common childhood illnesses. Nasal decongestants are not useful in preventing OM. Children with uncomplicated OM are not contagious unless they show other upper respiratory tract infection (URI) symptoms. Children should be fed in an upright position to prevent OM.

A school-age child had an upper respiratory tract infection for several days and then began having a persistent dry, hacking cough that was worse at night. The cough has become productive in the past 24 hours. This is most suggestive of which diagnosis?

a. Bronchitis

b. Bronchiolitis

c. Viral-induced asthma

d. Acute spasmodic laryngitis

ANS: A

Bronchitis is characterized by these symptoms and occurs in children older than 6 years. Bronchiolitis is rare in children older than 2 years. Asthma is a chronic inflammation of the airways that may be exacerbated by a virus. Acute spasmodic laryngitis occurs in children between 3 months and 3 years of age.

Which frequency is recommended for childhood skin testing for tuberculosis (TB) using the Mantoux test?

a. Every year for all children older than 2 years

b. Every year for all children older than 10 years

c. Every 2 years for all children starting at age 1 year

d. Periodically for children who reside in high-prevalence regions

ANS: D

Children who reside in high-prevalence regions for TB should be tested every 2 to 3 years. Annual testing is not necessary. Testing is not necessary unless exposure is likely or an underlying medical risk factor is present.

The mother of a toddler yells to the nurse, "Help! He is choking to death on his food." The nurse determines that lifesaving measures are necessary based on which symptom?

a. Gagging

b. Coughing

c. Pulse over 100 beats/min

d. Inability to speak

ANS: D

The inability to speak is indicative of a foreign-body airway obstruction of the larynx. Abdominal thrusts are needed for treatment of the choking child. Gagging indicates irritation at the back of the throat, not obstruction. Coughing does not indicate a complete airway obstruction. Tachycardia may be present for many reasons.

The nurse is caring for a child with acute respiratory distress syndrome (ARDS) associated with sepsis. What is the priority nursing intervention?

a. Forcing fluids

b. Monitoring pulse oximetry

c. Instituting seizure precautions

d. Encouraging a high-protein diet

ANS: B

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