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TERNOPIL STATE MEDICAL UNIVERSITY

June 14, 2024

INSTITUTE OF NURSING

INTERNATIONAL NURSING SCHOOL

ASSOCIATE DEGREE NURSING PROGRAM

NURSING CARE OF CHILDREN

Methodical Instruction

for

PRACTICAL CLASS #3 (5 hours)

Theme: UNIT TEST #3

Instructor: Dr. Nataliya Haliyash, MD, BSN

Room No.: Institute of Nursing, room No.16.

STUDENT OBJECTIVES

Identify the choice that best completes the statement or answers the question.

____ 1. The three primary functions of the immune system are to prevent or ameliorate infections, maintain homeostasis, and to:

promote phagocytosis

prevent or ameliorate allergies

produce white blood cells

recognize self from nonself

____ 2. At what age does a child’s immune system mature?

1 to 2 years

7 to 10 years

3 to 4 years

11 to 14 years

____ 3. The processes of immunity are classified in which of the following ways?

innate or acquired

class A and class B

rapid and long-term

grade I and grade II

____ 4. What is the body’s main defense against viruses?

T lymphocytes

interferon

B lymphocytes

interleukin

____ 5. The chemical mediators or messages communicating throughout the immune processes are:

interferon

cytokines or interleukin

helper T cells or T lymphocytes

B lymphocytes

____ 6. Where are the B lymphocytes produced?

bone marrow

spleen

thymus gland

liver

____ 7. Which of the following best defines autoimmunity?

the immediate response to a foreign protein

immunity that is built into the body’s defense system

start-up system to fight invaders that does not require conscious effort

identification of self as foreign and mounting of immune response

____ 8. What are the classic symptoms of juvenile rheumatoid arthritis?

severe joint pain that varies from sharp to burning pain

morning immobility, stiffness, and joint pain

swollen joints that are irregular in shape

nighttime pain that causes difficulty sleeping

____ 9. You are the nurse giving discharge instructions to the caregivers of a child with juvenile rheumatoid arthritis who is going home from the hospital. The caregivers ask about physical activities. Which of the following activities would be best for this child?

swimming and golf

wrestling and karate

football and basketball

ice hockey and skateboarding

____ 10. Parents of a child with juvenile rheumatoid arthritis call the nurse to ask for suggestions on what they can do for their child when the child complains of prolonged stiffness in the morning. Which of the following suggestions by the nurse would be most helpful in relieving this stiffness?

a paraffin bath for the hands and feet

petroleum jelly applied to all extremities

a warm bath or extended warm shower

a 7-to-10-day course of antibiotics

____ 11. One of the treatment goals for a child with juvenile rheumatoid arthritis is to prevent contractures. Which of the following interventions would be best in meeting this goal?

maintain the child in good body alignment

passive range-of-motion each day

whirlpool or warm sitz baths four times a day

hard body cast or splint

____ 12. Which of the following is the telltale sign of systemic lupus erythematosus?

polyarthritis

butterfly-shaped macular rash over the bridge of the nose and cheeks

large nodules

fine irregular rash over the entire body, which fades with sleep or rest

____ 13. The nurse is working with a child who is in for diagnostic tests. The lab results for the child’s antinuclear antibodies (ANA) come back positive. These results support which conclusion?

It is unlikely that this is a case of systemic lupus erythematosus.

The child has negative antibodies to DNA.

The child likely has systemic lupus erythematosus.

The child’s kidneys are involved in one of the autoimmune disorders.

____ 14. Which of the following statements by a caregiver of a child with systemic lupus erythematosus would indicate that the caregiver understood the nurse’s teachings?

“We don’t give the child any milk or milk products.”

“We protect our child from sunlight as much as possible.”

“Our child is not allowed to play with other children.”

“There is no gluten in any of the foods we serve our child.”

____ 15. In order to use the standard enzyme-linked immunosorbent assay (ELISA) human immunodeficiency virus (HIV) antibody test, the nurse is aware that the minimum age for using this exam is which of the following?

15 to 18 months

9 years

3 years

15 years

____ 16. The school nurse is teaching a health education and hygiene course to a group of high school males, which includes a number of young men who are on competitive sports teams. Which of the following health practices will the nurse most stress in preventing the transmission of human immunodeficiency virus (HIV) virus in case any team member has HIV or acquired immunodeficiency syndrome (AIDS)?

no sharing of razors or toothbrushes

avoiding physical contact such as sports hugs or swats

making certain towels have been washed in boiling water

no sharing of underarm deodorant or shower soap

____ 17. The pediatric nurse is working with a hospitalized child who was admitted 2 days ago and who has acquired contact dermatitis. The mother is asking the nurse about what things in the hospital would have caused this dermatitis. Which of the following would be the nurse’s best response?

“Usually it is either the soap used in the laundry or the bath soap we use, so we will perform a skin test on your child to check for allergies to these.”

“On average it takes 5 to 7 days for contact dermatitis to develop, so this may or may not be caused by something the child had contact with prior to admission.”

“It doesn’t matter what caused the dermatitis because we can give some medicine that will reduce the itching.”

“It could be anything, so it is senseless to worry about it as it will eventually go away.”

____ 18. In a clinic where allergy injections are given, the nurse determines the time that the clients must remain in the clinic after the injection according to the amount of time that normally lapses before anaphylaxis occurs. How long will the nurse have the clients receiving injections wait?

30 minutes

90 minutes

60 minutes

100 minutes

____ 19. The nurse teaching the child and parents about anaphylaxis will teach the importance of the child knowing how to use and carrying:

diphenhydramine (Benadryl)

zidovudine (Retrovir)

cortisone (Cortone)

epinephrine (EpiPen)

____ 20. The nurse assessing a child with Stevens-Johnson syndrome will find which of the following signs and symptoms in addition to mucosal and conjunctival lesions?

eyebrows that grow together, appearing as one eyebrow

pupils that are two different colors

loss of hearing or sight

epidermal loss of 10% or less of body surface

____ 21. Which of the following tests are conducted to confirm a diagnosis of growth hormone deficiency?

dexamethasone suppression test

Trousseau’s sign

Chvostek’s sign

pituitary function testing

____ 22. A child with growth hormone deficiency asks the nurse how many hormone shots he will have to take. The nurse will respond with which of the following answers?

“All you need is one injection, and then the problem will be fixed.”

“This is a series of three injections, which will jump-start your production of growth hormone.”

“There will be injections for about a year, and then you will be tall enough.”

“These injections to help you grow can continue for many years.”

____ 23. Which of the following statements best describes the difference between precocious pseudopuberty and true precocious puberty?

In precocious pseudopuberty, the maturational changes are not real and are only in the imagination of the child or parents.

In precocious pseudopuberty, there is an initial activation of reproductive-related hormones, but it is a false start and soon deactivates.

In precocious pseudopuberty, there is early pseudo menses not connected with ovulation, whereas in true precocious puberty menses is associated with ovulation.

In precocious pseudopuberty, there is breast or sexual hair growth but no activation of the hypothalamic-pituitary-gonadal axis.

____ 24. After a child begins treatment for precocious puberty, the child’s growth will be monitored every 3 to 4 months. The areas monitored and evaluated will most likely include serum hormone levels and which one of the following areas?

bone age

cardiac enzymes

mammography

blood sugar

____ 25. A caregiver has just learned that his child has diabetes insipidus and asks the nurse: “Just what is diabetes insipidus?” Which of the following is the nurse’s best answer?

“This disease involves a shortage of a hormone called antidiuretic hormone (ADH) that normally concentrates urine, and a shortage results in excretion of large amounts of dilute urine.”

“It is a form of diabetes mellitus, and although it shares some features, it is somewhat different from type 1 and type 2.”

“It is the only type of diabetes that does not involve the pancreas and insulin deficiency.”

“There is a malfunction of the thirst mechanism in the brain, and the child drinks copious amounts of water without ever being satisfied and is in danger of water intoxication.”

____ 26. The nurse discovers on talking with the parents of a child that the child is waking at night to drink. Once when denied water, the child drank out of the toilet and another time the child drank from a puddle. The nurse most suspects and further assesses this child for:

type 1 diabetes mellitus

diabetes insipidus

type 2 diabetes mellitus

diabetic ketoacidosis

____ 27. The nurse assessing the newborn will most ofteote which of the following signs in a child with congenital hypothyroidism?

recessed jaw, delayed eruption of teeth, and difficulty swallowing at times

low-set ears, wide-set eyes, a particularly wide face, and occasionally polydactylism

exophthalmia, rapid pulse, elevated blood pressure, diarrhea, jitteriness, and difficulty sleeping at night

facial puffiness, swollen eyelids, enlarged tongue, low anterior hairline, flattened nasal bridge, and dull expression

____ 28. The majority of newborns with congenital hypothyroidism are identified in which of the following manners?

in the pediatrician’s office during a physical exam by the pediatrician

mandatory newborn screening using blood obtained from the infants

in the nursery or obstetrical unit by a nurse observing the infant

the mother noticing something is wrong with the newborn baby

____ 29. An infant has been diagnosed as having congenital hypothyroidism. L-thyroxine is ordered for the infant. The infant is being bottle-fed. Why will the nurse who is working with this child and family instruct the caregivers to avoid formulas that are soy-based and provide the family with a list of soy-based formulas?

L-thyroxine’s absorption is affected by formulas that are soy based.

Children who are on L-thyroxine and soy-based formulas often have allergic reactions.

The L-thyroxine interferes with the absorption of calcium in the soy formula.

Infants on soy formula and L-thyroxine will tend to vomit the formula.

____ 30. In assessing a child with acquired hypothyroidism, the nurse will most often find which of the following signs or symptoms?

decreased rate of growth, weight gain, dry skin, coarse or thinning hair, and fatigue

headaches, dizziness, shakiness, disturbed vision, confusion, and frequent hunger

rapid respiratory rate, tachycardia, weakness, and unusual odor to breath

skin rash, loss of taste, mild leukopenia, and abnormal pigmentation of hair

____ 31. A student tells the school nurse that she is concerned about her delayed puberty and a delay in tooth eruption. The nurse will suspect and further assess for:

acquired hypothyroidism

Addison’s disease

hyperthyroidism

Cushing’s disease

____ 32. The nurse instructing caregivers about the administration of L-thyroxine will tell the caregivers to do which of the following?

Mix the medicine with a citrus juice before administration.

Give the medicine with the meal itself.

Give the medicine 30 to 60 minutes prior to a meal.

Give the medicine with only a few sips of water.

____ 33. Which of the following is the most common cause of hyperthyroidism in the pediatric population?

Grave’s disease

infection

cancer

Addison’s disease

____ 34. The nurse assessing a child with hyperthyroidism will most likely find which of the following symptoms?

constipation, bradycardia, slowed respirations, lack of energy, and complaint of tiredness

disorientation, confusion, extreme hunger, agitation, pallor, headaches, and blurred vision

weight loss despite excellent appetite, fine tremors, warm and moist skin, tachycardia, and ophthalmic changes

cardiac arrhythmias, low potassium and high sodium levels, and polyuria

____ 35. Children in the toddler or preschool years who have congenital adrenal hyperplasia will have which of the following symptoms or signs?

depression, loss of energy, and bruising easily

enlarged adrenal glands, hypertension, profuse amounts of dilute urine, and edema of extremities

premature pubic hair development, accelerated growth velocity, hirsutism, and enlarged clitoris in the female

excretion of abnormally large amount of urine, and excessive thirst

____ 36. Which of the following types of breathing will the nurse find when assessing a child who is having pronounced hyperglycemia?

shallow respirations

irregular breathing

Kussmaul’s respirations

Cheyne-Stokes breathing

____ 37. The nurse assessing a child with diabetes type 1 is reviewing the results of a hemoglobin A1ctest done on the child. The nurse knows that this test measurement reflects the:

presence or absence of anemia by measuring the hemoglobin

average blood glucose control of the child over the previous 8 to 12 weeks

average amount of additional insulin the child has taken to cover extra food

presence of an abnormal type of hemoglobin found in circulatory problems

____ 38. The nurse is teaching the nutritional plan to a child who has diabetes and to the child’s parents. Which of the following principles will the nurse teach, following the 2001 nutritional recommendations for diabetes released by the American Diabetes Association?

The child must not participate in events serving treats containing sugar.

The child is to adhere strictly to the prescribed diet and not supplement it for any reason.

The meal plan is no longer a plan that excludes any food automatically.

Exercise does not permit additional caloric intake.

____ 39. The school nurse working with children with diabetes will assess their understanding of the role exercise plays in diabetes management. Which of the following statements by a child would indicate that the child understood the school nurse’s teaching about exercise?

“Children who are diabetic need to restrict their exercise to light exercise.”

“There will be a need for increased insulin before heavy exercise.”

“I don’t need to worry about how much exercise I get.”

“Less insulin or a snack prior to exercise may be necessary.”

____ 40. The nurse is working with a child who is diabetic and asks the child or the caregivers: “How much insulin does the child take, and how long does it take to empty a bottle of insulin?” The reason the nurse asks these questions is to see if the child is:

abusing the insulin

complying with the prescribed insulin regimen

wasting insulin

sharing insulin with other children

____ 41. You are the nurse working with the parents of a child who has been diagnosed with Addison’s disease. You will need to do teaching with the parents on which of the following pieces of information?

The child will need a lot of extra holding with extra attention to developing attachments.

This child may not live much beyond 10 years of age, and the parents need to be prepared for this loss of their child.

The need for treatment, especially replacement cortisone, is lifelong and if treatment is not continued the disease can be life-threatening.

The diet, which is especially restrictive, included no fresh fruits or vegetables. Only canned fruits and vegetables are allowed.

____ 42. The nurse assessing a child with a diagnosis of Cushing’s syndrome will find which of the following signs or symptoms?

rapid weight loss, a gaunt look especially in the face, extremely long extremities, and above-average height

rapid weight gain especially in the abdomen, buffalo hump, tendency to bruise, and decreased or ceased linear growth

visual changes, frequent fever and infection, nausea and vomiting, and allergic reactions to many things

hearing loss, loss of taste, peripheral neuropathies, acne, striae, and petechiae

____ 43. Which of the following is the most common childhood malignancy?

lymphoma

Wilms’ tumor

leukemia

neuroblastoma

____ 44. The nurse is working with a client who has cancer that has been staged as a stage I. The nurse realizes that this cancer is best described as:

a cancer with disseminated metastatic disease

cancer with a certainty of being fatal

a localized disease in just one area or organ

the end stage of cancer

____ 45. The nurse hears the word nadir in a shift report in connection with a child’s blood counts. The nurse is aware that nadir refers to which of the following concepts?

the point at which the child has reached a normal blood cell count and is on the road to recovery

the lowest point in the child’s blood counts or myelosuppression, which occurs about 10 to 14 days after chemotherapy

the point at which the child has been free of cancer symptoms for 5 years and has more likely beaten cancer

a safe level of blood cell counts representing neither a high or a low in cell counts

____ 46. When a child has thrombocytopenia, the nurse must do which of the following in regard to any intramuscular (IM) injections or venipunctures ordered?

Administer any IM or intravenous (IV) medication very slowly to avoid problems.

Apply pressure to the site for 10 minutes after administration.

Apply ice to any IM or IV site for 15 minutes each hour.

Avoid aspirating after injection, and avoid massaging the site.

____ 47. Which of the following signs or symptoms will the nurse find on assessing a child who is neutropenic and has an infection?

elevated temperature and complaint of a feverish feeling

production of pus

redness of inflammation

no signs except perhaps complaint of pain or swelling

____ 48. The nurse is working with an immunosuppressed child. A parent points out that the child is due to have oral poliovirus vaccine and a measles-mumps-rubella (MMR) vaccine prior to school starting. The nurse will advise the parent to do which of the following?

Have the child get the MMR but not the oral poliovirus.

Take the child to get the oral poliovirus vaccine but not the MMR.

Omit live viral vaccines until the child is no longer immunosuppressed.

Talk with the pediatrician about getting gamma globulin with the vaccines.

____ 49. The nurse assessing a child who is undergoing chemotherapy finds the child to be suffering from mucositis. Which of the following interventions would be most helpful?

good oral care to clean the oral cavity of food particles and debris

sips of ice and lubricating oil to the lips

a room humidifier with a eucalyptus oil added to the water

six to eight glasses of water every day

____ 50. A parent shares with the nurse that his child who is undergoing chemotherapy vomited on the way to the hospital and in the entrance to the outpatient clinic. The nurse will do which of the following things?

Cancel the chemotherapy for the day and reschedule it for another day.

Use interventions such as antiemetics ordered by the physician, relaxation, biofeedback, music, and distraction.

Talk to the physician about ordering a lower dose of chemotherapy or a less-frequent-dosage schedule.

Isolate the child for the next 48 hours to see what is causing the nausea and vomiting.

____ 51. The nurse is caring for a child who is receiving chemotherapeutic agents. Prior to administering the chemotherapy, the nurse must check which of the following and report to the physician if the results are high?

cardiac enzymes

hemoglobin and oxygen saturation levels

thyroxin

liver transaminase and bilirubin levels

____ 52. A child who is undergoing chemotherapy will ask the nurse if her hair will fall out. Which of the following is the nurse’s best response?

“Not all children lose their hair, and you may be one of the lucky ones and not lose your hair at all.”

“Try not to think about your hair. Let’s do something to keep your mind off losing your hair.”

“The hair will probably fall out in 2 weeks or less, but it will grow back when chemotherapy is complete.”

“Let me get you some crayons, and you can draw your feelings about losing your hair.”

____ 53. Which of the following methods of radiation treatment will most likely be used on your client who has a small, distinct tumor that is not surgically accessible?

fractionation

stereotactic irradiation

hyperfractionation

total body irradiation

____ 54. The nurse assigned to work with the child who has had whole brain radiation assesses the child and finds that the child is sleeping up to 20 hours a day and is having some nausea and malaise, a fever, and dysphasia. Based on this assessment, the nurse will work with the parents in which of the following areas?

caring for the dying child

dealing with the side effects of radiation therapy

accepting a reoccurrence of the tumor

accepting the imminent death of their child

____ 55. Which of the following are the most common presenting signs of acute lymphocytic leukemia (ALL)?

blurred vision, dizziness, and changes in behaviors

bleeding and severe hemorrhaging

nodules in various locations on the body

fever, bone pain, pallor, and bruising

____ 56. The nurse caring for a child with acute lymphocytic leukemia is aware that once chemotherapy begins, there is a release of purines from the destroyed leukemic lymphoblasts, which can lead to which of the following problems?

tumor lysis syndrome

altered mental states

metastasis to the lungs

gout

____ 57. You are the nurse assigned to work with a child on the pediatric unit who has a diagnosis of Wilms’ tumor. You will need to post a sign on the child’s bed advising personnel and visitors of which of the following things?

Blood pressure readings are not to be taken on the left arm.

The child’s abdomen is not to be palpated, and bathing and handling must be gentle.

A strict intake and output is required and must be done accurately and promptly.

Touching or holding the child requires the person to don a gown and mask.

____ 58. The nurse examining a child with osteosarcoma or Ewing’s sarcoma will most often find which of the following as presenting symptoms?

a large mass in the abdomen

fainting and sudden drops in blood pressure

hemiparesis and drooping of an eyelid

pain and swelling at the site of the tumor

____ 59. The nurse examining an adolescent who has a rhabdomyosarcoma or soft tissue sarcoma in an extremity will most likely notice which of the following findings?

a raised, easily palpable tumor, which is fixed to the underlying muscle and may involve the skin

a difficult-to-palpate tumor, which is often missed by the examiner

a tumor, which cannot be palpated, but results in pain when the area of the tumor is palpated

nothing, because this tumor can only be visualized on a computed tomography (CAT) scan or magnetic resonance imaging (MRI) scan

____ 60. A parent calls to the nurse’s attention that their baby has a whitish glow in the pupil instead of the red reflex that is usually seen in photographs. This sign, called cat’s eye reflex, will cause the nurse to suspect and suggest further evaluation for which of the following conditions?

retinoblastoma

retinal glioma

astrocytoma

brainstem tumor

____ 61. In addition to protecting people from the harmful effects of ultraviolet light, what else do melanocytes within the epidermis do?

help with assimilation of vitamins

are determinant of skin pigmentation

play a role in skin lubrication

assist in walling off foreign protein

____ 62. The nurse assessing a child with cellulitis will most often find which of the following classic symptoms?

skin breakdown and areas of ulceration resulting from inflammation of cells

complaint of burning and tightness in the area of the cellulitis

erythema, swelling, warmth, pain, and diffuse borders of the infected area

no visible signs but the child will complain of varying types of pain

____ 63. When a breastfeeding baby is found to have thrush, which of the following should be done?

Stop the breastfeeding immediately, and start on the bottle.

Evaluate the mother for candidiasis of the nipple.

Pump the breast, and use this milk in a bottle.

Paint the baby’s mouth and the mother’s nipples with gentian violet.

____ 64. The nurse working with the mother of an infant who has candidal diaper dermatitis will teach the mother which of the following supportive measures to take, in addition to medication, to clear up the condition?

Keep the affected area dry and exposed to air when feasible.

Use a diaper cream all the time, applying it several times a day.

Powder the area well after all voidings, and use cloth diapers.

Apply baby lotion to the diaper area several times a day.

____ 65. Which of the following causes tinea infections?

fomites

dermatophytes

mites

bacterium

____ 66. The nurse is working with a child who has a tinea capitis infection and is taking griseofulvin. The nurse will teach the parents that this medication is best absorbed:

when taken on an empty stomach

when taken with a full glass of water

when taken with foods high in fat

when taken with the meal

____ 67. The nurse is talking to parents about a wart on their child’s hand. The wart does not appear to be bothering the child. The parents want to know if it should be surgically removed. Which of the following is the nurse’s best response?

“Yes, because children’s warts often spread and are hard to control.”

“Two-thirds of warts will go away spontaneously within 2 years.”

“Surgery is the first line of therapy, but this wart may disappear by itself.”

“It is better to freeze the wart first before cutting it off. You can talk to the doctor about this.”

____ 68. The nurse is working with the family of a child who is bothered by a wart and tends to pick at it. The family has been trying to remove the wart with a nonprescription product. The nurse assesses to see if the family is using the correct technique with a topical agent such as Duofilm, Mediplast, or Trans-plantar to treat the wart. Which of the following statements by the family would indicate correct technique?

“We used an emery board to sand the wart, soaked it in warm water, applied the medication, and when dry, reapplied it to cover the whole wart.”

“We put the topical agent on the wart and covered it with an Elastoplast bandage wrapped with an Ace bandage to prevent picking.”

“We cut the wart off, applied the medication, and left it open to the air.”

“We applied a strong vinegar solution and then applied the medication.”

____ 69. The nurse is doing some teaching with the parents of a child with herpes simplex virus type I (HSV-1) virus. The nurse will teach that 20%-40% of those with HSV-1 infections will have recurrent infections precipitated by:

alcohol or caffeine

sunlight, wind, injury, or stress

contact with someone else with the virus

exposure to allergens

____ 70. The nurse is preparing to take a viral culture of a lesion suspected of being herpes simplex virus type I (HSV-1) infection. How will the nurse take the culture?

Swab the base of the newest lesion or the vesicular fluid, doing so within 7 days of the appearance of new lesions and within 2 days of the appearance of recurrent ones.

Scrape a small amount of the lesion tissue with a tongue blade, and apply it to a slide.

Use a swab to collect fluid from the center of a lesion that is still weeping, and apply this to a slide.

Spray the lesion with ether, collect a specimen, and place it in a collection tube containing ether.

____ 71. The nurse examining a 1-year-old child finds some nits and lice. The nurse is aware that children of this age should be treated for nits and lice in which of the following ways?

weight dosed for permethrin (Nix)

manual removal of nits and lice

lice shampoo diluted with water

wash the hair several times a day

____ 72. Which of the following is the most important message the nurse can give the parents of a child with head lice?

“Any child from any home can get pediculosis (head lice).”

“You will have to wash the child’s hair more often.”

“Shaving the child’s head would make it easier to get rid of the lice.”

“You should not have any children over to play until you get rid of the lice.”

____ 73. The nurse assessing a child finds the classic symptoms of scabies, which are:

tracklike raised red areas, which burn and hurt but do not itch at all

constant itching and secondary infections from itching, in addition to primary dry scaly lesions on the arms and trunk

daytime itching and vesicles containing fluid in a tracklike pattern

nighttime itching and minute grayish-brown, threadlike burrow tracks with a black dot at the end of the track

____ 74. The nurse will recommend to the family of a child with scabies that every member be treated prophylactically for scabies for which of the following reasons?

The incubation period is 2 to 6 weeks.

Scabies is highly contagious for months.

It is difficult to kill scabies.

Psychologically they will feel better.

____ 75. The nurse working in pediatrics will find that the majority of cases of atopic dermatitis or eczema occur in which of the following age groups?

infants and young children

latency age

school-aged children

adolescents and young adults

____ 76. When developing a nursing care plan for a child with atopic dermatitis who has a nursing diagnosis of risk for infection (secondary to scratching of lesions), the nurse will most likely select which of the following interventions?

Keep the environment warm.

Dress the child in clothing that is light, clean, and loose.

Teach the family to use antibacterial hand soap.

Avoid lotions and creams.

____ 77. The nurse is teaching a group of expectant mothers about the prevention of diaper dermatitis. The nurse will explain that one of the preventive measures is the use of:

plastic panties over diapers

absorbent disposable diapers

cloth diaper

baby powder or cornstarch

____ 78. The nurse working with an infant or child with seborrheic dermatitis will do which of the following in the initial treatment phase?

Shampoo the hair every 3 days.

Be gentle when shampooing and avoid scrubbing.

Avoid putting oil on the scalp.

Remove the crusts with good hygienic methods.

____ 79. The school nurse is talking with a scoutmaster and the scouts about prevention of poison ivy, poison oak, and poison sumac. In addition to addressing the issue of wearing protective clothing, the nurse will advise the scouts and scoutmaster to do which of the following after exposure to plants in wooded areas?

Immediately apply calamine lotion to the exposed skin surfaces.

If there is sap on the hands or other body surfaces, clean with alcohol.

Expose the skin to the sun, which will kill the allergen.

Avoid strenuous exercise after exposure.

____ 80. The nurse is working with an adolescent who has acne. The adolescent is concerned about the inflamed lesions but is more concerned about the blackheads and asks the nurse to explain what causes blackheads. The nurse will teach the adolescent which of the following about the cause of blackheads?

These lesions are caused by oxidation of melanin.

The lesions are caused by dirt clogging the pores.

No one knows what causes blackheads.

Initially a hair shaft was irritated.

____ 81. When a caregiver calls the clinic to talk to the nurse about her child being bitten by a cat (which had a current rabies inoculation), it is important for the nurse to advise the caregiver of which of the following things?

Cat bites carry a high risk of infection, and the child needs to be seen so the bite can be cultured and treated.

Wash the cat bite thoroughly, apply an antibiotic ointment, and watch it for several days for signs of infection.

Take the pet to the health department for an examination.

Even cats with rabies inoculation can cause children to get rabies.

____ 82. The nurse is educating parents and children about spider bites. The nurse will advise the parents that the bite of the black widow spider is:

drop for drop more potent than that of the prairie rattlesnake

has a more delayed pain response than that of the brown recluse spider

likely to produce symptoms that last for weeks and months

diagnosed immediately due to a distinctive bite mark

____ 83. Which of the following tests is best for the nurse to use to see if a child is color-blind?

the Ishihara color plates

the Snellen E

a color matching test designed by the nurse

red versus green test of distinguishment

____ 84. The nurse working with the parents of a child who stutters will advise the parents to do which of the following and model the behavior with children?

talk faster, as this decreases the chance of stuttering

adopt a slow rate of speech and avoid appearing hurried

talk in front of a mirror to concentrate on speaking without stuttering

talk with marbles in their mouth

____ 85. A parent tells the school nurse that his child has had extensive hearing tests and has been found to have a sensorineural hearing loss. The nurse will respond to the parent based on the knowledge that this type of hearing loss:

can be helped by one or more of the four types of hearing aids available today

has benefited in some cases by the relatively new technique of a cochlear implant

has not been helped by hearing aids or other techniques

is best adapted to by learning to speak sign language and attending a school for people who are deaf

____ 86. In working with parents who have just learned that their child has a hearing loss, the nurse will realize that before working on the goal of promoting the child’s communication, the nurse must do which of the following?

Explain everything about all the various causes of hearing loss to the parents.

Get the parents to accept that they are not to blame for the child’s loss of hearing.

Help the family to realize that their child is not the only child who ever suffered hearing loss.

Assist the caregivers to accept and adapt to the impairment and go through the grieving process.

____ 87. How often should a hearing aid be changed for children under 4 months of age?

once a month

once a year

every 3 to 6 months

every 2 years

____ 88. Which of the following would the nurse do to care for the hearing aid of a hospitalized child?

Keep the hearing aid in a warm place such as near a heat register.

Leave the hearing aid turned on all the time except when washing it.

Wash the entire hearing aid with the battery taken out.

If the aid whistles, take it out, refit it, and turn down the volume.

____ 89. The nurse will advise parents or caregivers that a feeling of adequacy and self-confidence is most likely to be established in children who are deaf if they:

are given more attention than children with hearing

learn to play with other children, especially children with hearing

are protected a lot by members of the family and extended family

play with lots of educational toys beginning at an early age

____ 90. At what age is binocularity established?

birth

6 months

3 months

1 year

____ 91. Which of the following definitions of visual impairment most emphasizes the clearness of vision at various distances (visual acuity)?

educational

legal-medical

functional

common usage

____ 92. The nurse wants to assess visual acuity with a preschool child who is developmentally delayed. The nurse selects the Blackbird Preschool Vision test, which is best described as a test that:

presents the letter B in various positions

is named after a person by the name of Blackbird

uses blackbirds of various sizes flying in different directions

offers various birds of various colors doing various things

____ 93. The nurse will teach the family and the child who is wearing contacts for the first time that care and cleaning directions must be followed explicitly. The reason for following the instructions exactly is mainly to prevent:

dirt and dust from getting into the eye

discomfort from itching and burning

complications such as corneal damage

redness of the eyes

____ 94. The nurse will begin screening babies for strabismus at 3 to 6 months of age. A parent asks the nurse why this screening is being done at this early age. Which of the following is the nurse’s best response?

Surgery needs to be done before the child is 1 year old if he or she has strabismus.

This is the best time to begin the eye exercises if strabismus is present.

Identification of strabismus requires a regimen of vitamin E to be started early.

The longer a child has uncorrected strabismus, the more vision loss he or she tends to have.

____ 95. The nurse is talking with a parent of a child with strabismus. The nurse is talking about alternatives to surgery and explains that there is a correction for strabismus, which is an alternative to surgery, and it is successful in about 50% of clients. Which of the following substances is involved in this treatment?

smallpox vaccine

influenza vaccine

botulism toxin

tetanus toxin

____ 96. The nurse doing presurgery preparation and teaching with the family of a child scheduled for surgery for strabismus will teach about dressing changes, eyedrops, eye patches, and restraints. The nurse will also advise the parents, and the child if she is old enough to understand, that surgery:

is almost always successful in correcting vision as well as aligning the eyes

will not correct the vision and may correct the alignment or it may be unsuccessful, requiring another surgery

must be done in stages and at least two surgeries will be required: one for alignment and one for vision correction

will correct vision, but the alignment problems will only partially be corrected

____ 97. The nurse doing screenings for eye problems in children realizes that amblyopia is going to present in children at which of the following ages or periods in a child’s life?

before the age of 7 years

after the child begins to read

during latency

after the age of 8 years

____ 98. Which of the following signs will the nurse find on the eye assessment if cataracts are present in an infant?

cotton wool patches seen when checking the eye with an ophthalmoscope

nystagmus

a white pupillary reflex and an absent or abnormal red reflex

the pupils are a deep black color and light reflects off them

____ 99. The nurse is assessing a toddler and finds that the toddler has excessive tearing, involuntary closing of the eyelid, light sensitivity, enlargement of the eyeball, clouding of the cornea, and pain. The nurse recognizes these signs as classic signs of:

conjunctivitis

cataract

amblyopia

glaucoma

____ 100. When conjunctivitis is allergic in origin, the nursing management consists primarily of which of the following interventions?

antibiotics

antiviral eye drops or ointments

cool eye compresses, reduced lighting, and acetaminophen

use of baby shampoo to remove crusting and antibiotic eye ointment

____ 101. The legal definition of blindness is peripheral fields narrowed to an angle of 20 degrees or less, or which of the following visual acuities or less with correction?

200/200

20/200

20/300

300/300

____ 102. When you come upon the scene of an accident and you find a child with a hyphema, you will do which of the following things?

Apply a tourniquet for 5 minutes on and 5 minutes off.

Place the child in the Trendelenburg position.

Place an eye patch over the injured eye, immobilize the head, and transport to the hospital.

Irrigate the eye with water or saline from the inner to outer canthus, and transport to the hospital.

____ 103. The nurse assessing an infant finds the following signs and symptoms: sunsetting eyes with sclera seen above the iris, a high-pitched cry, a bulging fontanel, dilated scalp veins, slight alteration in consciousness, and vomiting. The nurse is aware that these signs and symptoms are most consistent with:

increased intracranial pressure

encephalitis caused by a virus

spinal cord trauma

severe hypoxia

____ 104. The nurse reporting on duty learns that the nursing unit is using the AVPU scale on one of the nurse’s assigned clients. The nurse recalls that the AVPU scale is used for:

determining the level of pain of an intubated child

measuring the weight of a child who cannot stand

obtaining a measure of the level of consciousness

obtaining a gross measure of intracranial pressure

____ 105. Refractory seizures last more than how many minutes?

____ 106. You are caring for a child who has a seizure that begins with tonic contractions of the fingers of the left hand. You notice the spasms progressing into tonic/clonic movements that proceed up the muscles of the left side of the body. Which of the following types of seizures will you report that this child experienced?

Jacksonian

sylvian

Rolandic

complex partial

____ 107. If you are walking with a child who begins to have a seizure, you will ease the child to the floor to prevent injury. Which of the following additional actions will you most need to take?

Get the child onto a stretcher.

Place the child on his or her side.

Obtain a set of baseline vital signs.

Put a pillow under the child’s head.

____ 108. Which of the following statements by the family of a child who has a nursing diagnosis of “high risk for continued seizure activity” most indicates that the family has followed the teaching of the nurse?

“Our child has had a growth spurt, so we made an appointment to review the medication to prevent seizures.”

“We remind our child every day of what he cannot do and what he should not do in terms of activities.”

“Most of our time is spent with our child who has seizures, so we have little time for the other children.”

“We miss administering an occasional dose of the antiseizure medication, but we don’t miss very many.”

____ 109. Older children and adolescents who develop hydrocephalus usually have hydrocephalus due to which of the following causes?

aqueductal stenosis

various congenital malformations

meningomyelocele

intracranial tumors, fever, or injury

____ 110. You are the nurse assigned to work with a child who has just returned from the recovery room postoperatively for placement of a shunt as a treatment for hydrocephalus. Which of the following positions will you place this child in?

elevated 45 degrees in a supine position

flat and lying on the unoperated side

flat and lying on the operated side

elevated 30 degrees and prone

____ 111. The nurse is answering questions for the parents of a newborn who has spina bifida. The parents ask when surgery can be done. Which of the following responses by the nurse is most accurate?

“Surgery is usually performed within the first few hours or days of life.”

“It is possible that the spina bifida can be reduced and closed without surgery.”

“Often the surgeons like to wait until the child is at least 2 years old to do surgery.”

“Surgery needs to be done before the child stands and begins to walk.”

____ 112. The pediatric nurse is assigned to work with a child who has craniosynostosis. The nurse will most expect to find which of the following during the initial contact and assessment?

hydrocephalus

signs of infection

skull deformity

cyanosis

____ 113. If a child has a headache described as migrainelike and also has a seizure, the nurse should have a high suspicion of:

ruptured cerebral aneurysm

astrocytoma

arteriovenous malformation

encephalitis

____ 114. Which of the following statements best describes the neuronal phase of encephalitis?

the period during which the neurological signs and symptoms are the worst found in the illness

from the point of origin of the infection seeding to the invasion into the central nervous system

the period in which the neuropathy is improving

the time in which the nerves have recovered by 50% or better and motor function is returning

____ 115. Head injuries are categorized as primary or secondary iature. Which of the following injuries is an example of both primary and secondary head injury?

hitting the windshield of a car that was hit from behind

being hit with a baseball bat

falling out of a tree onto a hard surface

a severe blow in a boxing match

____ 116. Which of the following findings constitutes a grave preterminal sign in the head-injured child?

bradycardia followed by tachycardia

increasingly frequent episodes of hypertension

nausea and vomiting

severe migraine-type headache

____ 117. A child has a total Glasgow score of 6 and a motor score of 2. The nurse realizes that this child has which of the following types of head injury in terms of severity?

mild

normal

moderate

severe

____ 118. The nurse administering mannitol (Osmitrol) must observe closely for a rebound effect of the intracranial pressure. If there is a rebound effect with mannitol, which of the following courses of action does the nurse need to take?

Call neurosurgery at once.

Leave a message for the physician at his or her office.

Write a nursing order for vital signs every 4 hours.

Start an intravenous infusion of Ringer’s lactate.

____ 119. The nurse is working with an adolescent boy who has some neurological sequelae from a head injury. The nurse can best help the adolescent accept the disability by initiating which of the following interventions?

Tell the adolescent how lucky he is to be alive and all the things he has to live for.

Have the adolescent make a list of all the things he is thankful for and talk about it.

Encourage ventilation for frustrations, provide positive feedback, and help set up needed support.

Ask the chaplain to make an appointment to talk with this adolescent about his future.

____ 120. The nurse working with a child suffering from spinal shock as a result of a spinal cord trauma 2 days ago will expect most to see which of the following signs?

inability to perspire

hypothermia causing severe chills along with high fevers

loss of sphincter control with urinary retention and priapism

loss of consciousness

____ 121. Which of the following is the most common cause of cerebral palsy?

cord around the neck in the birth canal

forceps delivery

premature birth or very low birth weight

preeclampsia in the mother

____ 122. The nurse is working with a 2-year-old toddler who has cerebral palsy. The child does not sit up alone. The nurse knows that the chance of the child learning to walk alone or with crutches falls into which of the following categories?

most probably none

moderate

slim to good

excellent

____ 123. What differences in the musculoskeletal system of children make their bones able to absorb more energy before breaking and to heal more quickly?

Adults do not take in as much calcium as children do, thus their bones are weaker.

Children’s bones have more cartilage and a stronger periosteum.

The muscles and ligaments in adults are not as strong as those of children.

Children have a better diet and take in more vitamins and minerals than adults do.

____ 124. Where is fat stored in bones?

surrounding the epiphyseal growth plate

in the gray marrow of the medullary cavity

in the yellow marrow of the medullary cavity

in the metaphysis section of the bone

____ 125. Growth hormone is produced in the:

posterior lobe of the pituitary

thalamus

anterior lobe of the pituitary

hypothalamus

____ 126. A parent asks the nurse for advice in letting her child pursue an interest in sports. The parent asks which sports are the most dangerous. The nurse will advise this parent that most injuries in organized sports occur in which of the following sports?

ice hockey, wrestling, and football

karate, gymnastics, and dance

swimming, horseshoes, and hiking

tennis, handball, and racquetball

____ 127. The school nurse is seeing students who have experienced sports injuries. The nurse will talk with the students about ways to prevent sports injuries and will advise them that a major way to prevent sports injuries is:

adequate conditioning, including warm-ups and cooldowns

to increase calcium, carbohydrates, and protein in the daily diet

weight lifting, sit-ups, and push-ups on a daily basis

relaxation exercises, deep breathing, and mind training

____ 128. You are the school nurse assessing the neurovascular status of a child who had a sports injury. You check the skin color, capillary refill, skin temperature, and pulses of distal extremities. You report the capillary refill as within the normal range if it is less than:

6 minutes

4 minutes

5 minutes

3 minutes

____ 129. The nurse arrives for the shift report and finds out that one of his assigned clients has a compound or open fracture and is going to surgery sometime during the shift. The nurse knows that this type of fracture involves:

a bone that has broken, and the two sections of broken bone are not aligned

a broken bone that is protruding through the skin, causing an open wound

two or more types of fractures, thus compounding or making the situation worse

significant bleeding into the area surrounding the fracture

____ 130. Injuries of the growth plate can be classified with the Salter-Harris system. Which of the following classifications have the best prognosis?

I and II

III and IV

____ 131. The nurse is doing discharge planning with the family of an African-American child who is going home after open reduction of a fracture. Which of the following is important for the nurse to ask the caregivers before telling them about the best foods to serve the child to facilitate healing?

“How much does your child typically eat at a meal?”

“What foods does your child like?”

“Is your child lactose intolerant?”

“Do you cook at home or eat out most of the time?”

____ 132. Which of the following explains why synthetic casts are not recommended for young children or serious fractures?

They are not as colorful as the plaster casts.

People cannot sign them like they do the plaster casts.

They do not mold as well as plaster casts.

Plaster casts allow the person more mobility.

____ 133. The nurse is working with a client who is in cervical traction. How much should the head of the bed be elevated?

20-30 degrees

70-90 degrees

45-60 degrees

95-120 degrees

____ 134. The nurse is working with a child who is experiencing a complication of fractures known as compartment syndrome. Which of the following signs and symptoms is this child most likely to have?

headache, dizziness, blurred vision, and sensitivity to the sun

nausea, vomiting, and diarrhea for 2 weeks

a shifting of fluid and electrolytes into the intracellular space

paresthesia, severe pain, and severe swelling of the digits below the affected compartment

____ 135. A parent of a child experiencing compartment syndrome asks the nurse to explain what this means. Which of the following is the nurse’s best response?

“This is a serious condition involving increased pressure in sheaths of inelastic fascia leading to massive impairment of circulation.”

“In this condition, the blood has shifted from the circulation to the interstitial spaces, creating a dramatic change in blood pressure.”

“The child is sorting out all experiences into either good or bad and cannot see gray areas.”

“A lot of the blood from the stomach and large muscles has gone to the area of injury to help in healing.”

____ 136. Which of the following statements best defines the term child maltreatment?

intentional injury of a child

not giving a child what he or she wants

failure to provide what a child needs

accidental harm to a child by someone

____ 137. Which of the following statements best defines the term physical abuse?

bodily injury to a person that seems to have been inflicted by other than accidental means

purposefully beating a child so that there are highly visible marks on the child’s body

use of the hands applied to a child in an excessively forceful manner

any damage to a child that involves the use of muscle-applied force

____ 138. The school nurse observes parents interacting with a school-aged child and notices that they do not show any affection toward the child and there is no evidence of emotional support or supervision. Later the nurse learns from the child that he must take care of all his own hygiene tasks, has to find something to eat on his own, and his parents never say anything nice about him. The nurse at this point believes that the parents are engaging in:

physical abuse

poor parenting

psychological abuse

withholding of love

____ 139. The majority of child abuse victims fall into which of the following age ranges?

over 10 years

6 to 8 years

8 to 10 years

under 6 years

____ 140. Which of the following is the most common type of mistreatment of children?

physical abuse

sexual abuse

neglect

emotional maltreatment

____ 141. In the sociological model of family violence, family violence is viewed as:

a pattern of behavior that is passed from generation to generation

a pattern of harm within the nuclear family with no outside persons involved

any harmful action(s) between related persons no matter how distant the relationship is

harmful activities within a group designated as family no matter what the relationship

____ 142. When family violence is passed from generation to generation, this type of abuse has which of the following characteristics?

It continues without changing to another type.

The form of abuse may change.

It usually gets more violent.

It is very much passed on also.

____ 143. Which of the following examples best defines the term role reversal?

The child assumes a caregiver role toward the caregiver.

The good child takes on a bad child role.

A person who has been a good provider quits his or her job.

A lazy person becomes very productive in the family.

____ 144. When there is a depressed parent in the family, it is most likely that the depression will have which of the following effects?

will not affect the person’s ability or performance in parenting

will cause the parent who is depressed to try harder to be a good parent

places the parent at risk for physically or emotionally abusing the children

will be seen in the child during the growing-up years

____ 145. When families are in situational crises, the children are often aware that:

minor misbehavior on their part can bring about an abusive interaction

their parents will appreciate any help and support they can give

this crisis is just one of many ongoing crises

in most situations, they are much better off if they lie

____ 146. Asian parents bring their child to the hospital with what appears to be burns or abrasions on the neck, spines, and ribs. The parents use the words cao gao. The nurse is aware that these physical findings and the term cao gao refer to:

an Asian practice of burning and inflicting pain on children who won’t obey

parents rubbing a pumice stone over a child’s body to sand off evil spirits

rubbing a coin or a spoon heated in oil on an ill child’s neck, spine, and ribs

burning incense on a rice paper on a child’s upper body to bring good luck

____ 147. A child of Russian parentage is brought to the hospital with what appears to be second-degree burns. The nurse is aware of a Russian practice of treating headaches and abdominal pain by creating a vacuum under a cup or glass when a small amount of burning material is placed on the skin. This practice is called:

tassos

ventosos

mal de vaso

veritas

____ 148. The nurse is assessing a baby who has dark spots on the lower back and buttocks. The nurse suspects that these spots could be bruises, but is careful because they are most likely:

Mongolian spots

dye

birthmarks

gentian violet

____ 149. In a case of suspected sexual abuse, the nurse is given a piece of clothing that appears to be soiled with semen. The nurse must identify this piece of clothing in the client’s record. The nurse must also:

keep the clothing in sight until it is turned over to another professional and document the chain of custody

spray the suspected semen with a fixative solution

pin a note to the area of suspected semen so that when it dries the laboratory will still know where it was

draw a picture of the clothing and the suspected area

____ 150. The school nurse observes bruising and marks around the mouth of a child. The nurse will suspect and follow up on which of the following probable causes of the bruising and marks?

The child fell down while playing.

The bruises and marks come from running into furniture.

A bully at school hit the child in the mouth.

This child has been bound and gagged.

Answer Section

15. The standard ELISA HIV antibody test can be used for anyone older than 15 to 18 months of age. Children ages 3 years, 9 years, and 15 years are not the minimum ages established for the ELISA test.

16. Because HIV is transmitted by blood or body fluids, it would be necessary for the clients to not share razors or toothbrushes due to the potential for bleeding. Sports hugs and swats are noninvasive and would not need to be avoided. Further, it would not be necessary to launder towels in boiling water. Sharing shower soap or underarm deodorant do not cause HIV transmission.

17. Contact dermatitis usually takes 5 to 7 days to develop; therefore, identifying the etiology of the reaction can be challenging. For the child who was admitted 2 days prior to the development of the rash, it is not likely the child is having a reaction to the hospital laundry or bath soap. It would be beneficial to determine the cause so that future exposure can be limited. Suggesting to the mother that it is senseless to worry would likely impede communication between the nurse and the caregiver. Such comments should be avoided.

18. Anaphylaxis typically occurs within 5 to 30 minutes after exposure. Therefore, the clients will need to remain in the clinic for 30 minutes. Because reactions typically occur within 30 minutes, it is not necessary to have the client wait 60 minutes, 90 minutes, or 100 minutes as long as no signs of reaction are present.

19. For the client at risk for anaphylaxis, it is necessary for the nurse to educate the child and caregivers about the importance of knowing how to use and carrying an EpiPen. An EpiPen contains a precalculated dose of epinephrine that the child or parents should have available at all times in case of an exposure to an allergen. Diphenhydramine, cortisone, and zidovudine would not be used in the emergency treatment for an exposure to a known allergen.

20. A severe form of erythema multiforme, Stevens-Johnson syndrome results in epidermal loss of 10% or less of the body surface area. Stevens-Johnson does not result in eyebrows growing together, pupils of two different colors, or the loss of hearing or sight.

36. In pronounced hyperglycemia, the respiratory compensation of the resulting metabolic acidosis leads to the presence of Kussmaul’s respirations. Kussmaul’s respirations are characterized by deep, slow, and labored breathing. Shallow respirations, irregular breathing, and Cheyne-Stokes breathing are not typical in pronounced hyperglycemia.

37. The glycosylated hemoglobin level reflects the average blood glucose control of the individual over the previous 8 to 12 weeks. The hemoglobin A1c test does not reflect the presence or absence of anemia, the average amount of additional insulin taken to cover food, or the presence of an abnormal type of hemoglobin found in circulatory problems.

38. According to the 2001 nutritional recommendations for diabetes, the meal plan does not automatically exclude any food. Therefore, a child would not be excluded from events serving treats that contain sugar. The child is no longer required to strictly adhere to the prescribed diet and not supplement. Further, exercise may require additional caloric intake.

39. For a client with diabetes who exercises, insulin dosages may need to be adjusted. Exercise has been associated with potentiating the hypoglycemic effect of insulin. Therefore, regular exercise may require insulin dosage changes, or changes in food intake may be required. Exercise should not be restricted in the child. Further, there will not be a need for increased insulin before exercise, as this may lead to hypoglycemia. Children need to be aware of how much exercise they are getting, as food intake and insulin may need to be adjusted.

40. By asking the child and parents to identify the dosage of insulin taken and the duration of time a single vial of insulin lasts, the nurse can gain valuable information that will suggest the status of complying with the recommendations for administration. Such information would not likely be elicited to identify abuse of insulin, wasting of insulin, or the sharing of insulin with other children.

41. For the client with Addison’s disease, the replacement of deficient hormones, including cortisone, is necessary. The caregivers of a child with Addison’s disease must be aware of the need for lifelong therapy. Extra holding and attention may be therapeutic for the child, but will not take the place of the lifelong required replacement therapy. With the necessary treatment, the client with Addison’s disease should not experience early mortality. The diet should not restrict fresh fruits and vegetables.

42. Cushing’s syndrome, the result of hypercortisolism or excessive free cortisol, is characterized by rapid weight gain, particularly in the abdomen, face, and cervical fat pad (buffalo hump). Linear growth is decreased or stops because the cortisol suppresses the release of growth hormone. Assessment findings such as rapid weight loss, long extremities, and above-average height are not characteristic of Cushing’s disease. Cushing’s disease is also not associated with visual changes, frequent fever and infection, nausea and vomiting, and allergic reactions. Further, hearing loss, loss of taste, peripheral neuropathies, acne, striae, and petechiae are not typically found in Cushing’s syndrome.

44. For a client with cancer identified as stage I, the nurse is aware that the cancer is a localized disease in just one area or organ. Disseminated metastatic disease is suggestive of stage IV. Because the cancer is localized, it is not certain to be fatal, nor is it considered to be the end stage of cancer.

45. Occurring 10 to 14 days after most chemotherapy is administered, the nadir represents the lowest point in the client’s blood counts or myelosuppression. Therefore, the nadir would not used to describe the point at which a normal blood cell count has been achieved, nor would it be indicative of the time I which the child has been free of cancer symptoms for 5 years. The nadir is not described as a safe level of blood cell counts representing neither a high or low cell count.

46. Thrombocytopenia, which results from a decrease in the number of platelets, places the pediatric client at risk for bleeding. Therefore, it will be necessary for the nurse to apply pressure to the injection site for at least 10 minutes following the administration of the medication. The slow administration of IM and IV medications is not identified as being a necessary intervention. Ice would not be necessary to the IM or IV site. Massaging the site would be contraindicated, as doing so may promote bleeding at the site.

61. In addition to protecting people from the harmful effects of ultraviolet light, melanocytes within the dermis are determinants of skin pigmentation. Melanocytes are not associated with the assimilation of vitamins, nor do they have a role in skin lubrication. Further, melanocytes do not have an immune function of walling off foreign protein.

62. The classic symptoms of cellulitis include erythema, swelling, warmth, and pain. Additionally, the borders of the infection will be irregular and diffuse, extended as the infection progresses. Skin breakdown and an area of ulceration is not a classic symptom of cellulitis. Further, client reports of burning and tightness in the area are not considered classic symptoms of cellulitis. The client’s report of varying types of pain is also not considered a classic symptom.

98. Upon assessment, the pediatric client with cataracts will present with a white pupillary reflex or an abnormal red reflex. Cotton wool patches seen upon assessment with an ophthalmoscope are not characteristic of cataracts. Nystagmus is also not a clinical manifestation associated with cataracts. Further, deep-black-colored pupils are not characteristic of cataracts.

99. The clinical manifestations of glaucoma include excessive tearing, involuntary closure of the eyelid, light sensitivity, enlargement of the eyeball, clouding of the cornea, and pain. These clinical manifestations are not suggestive of conjunctivitis, amblyopia, or cataract.

100. For the client with allergic conjunctivitis, the treatment is symptomatic. Interventions such as a cool eye compress, reduced lighting, and acetaminophen are examples of symptomatic treatment. Antibiotic or antiviral eye drops are typically used for infectious conjunctivitis rather than allergic conjunctivitis. Baby shampoo would not be recommended for the client with conjunctivitis.

101. Legal blindness is defined as a visual acuity of 20/200 or less with correction. Blindness is not defined by a visual acuity of 200/200, 20/300, or 300/300.

102. For the client with a hyphema, the nurse should apply an eye patch over the injured eye, remind the client not to move the head, and transport the client to the hospital. Because a hyphema is a nonpenetrating eye wound, the application of a tourniquet would not be an effective intervention. For the client with hyphema, the head of the bed should be elevated 30 degrees. This would serve to further control bleeding in the eye and prevent an increase in intraocular pressure. Therefore, the client should not be placed in the Trendelenburg position. The nurse should not irrigate the eye with water or saline.

104. The AVPU scale is used to evaluate the child’s level of consciousness. The AVPU scale is not used for determining pain status or the weight of the child. The AVPU scale is not used in obtaining a gross measure of intracranial pressure.

105. Refractory seizures last longer than 60 minutes. Refractory seizures are not characterized by seizures lasting 30, 40, or 50 minutes.

106. Jacksonian seizures are motor episodes that begin with tonic contractions of either the fingers of one hand, toes of one foot, or one side of the face. The spasms progress into tonic/clonic movements that extend up adjacent muscles of the affected extremity or side of the body. These physical presentations are not consistent with Rolandic or sylvian seizures, which are manifested as tonic/clonic movements of the face with increased salivation and arrested speech that often occurs during sleep. Complex partial seizures are characterized by a change in mental status, followed by purposeless behaviors or assuming an unusual posture.

107. When ambulating a child who begins to have a seizure, it is necessary to ease the child to the floor and to turn the child onto his or her side. Turning the head to the side prevents secretions from pooling in the mouth. Getting the child onto a stretcher would not be the safest action. While obtaining a set of baseline vitals should be initiated once the child is stabilized, it would be most important to protect the child’s airway. Putting a pillow under the child’s head would not prevent the pooling of secretions in the mouth and, therefore, is not recommended.

124. Fat is stored in the yellow marrow of the medullary cavity in the bones. Fat is not stored in the epiphyseal growth plate, the gray matter of the medullary cavity, or the metaphysis section of the bone.

125. Growth hormone is produced in the anterior lobe of the pituitary. Growth hormone is not produced in the posterior lobe of the pituitary, thalamus, or hypothalamus.

126. Ice hockey, wrestling, and football are among the sports considered to be the most likely to result in injury. Swimming, horseshoes, hiking, karate, gymnastics, dance, tennis, handball, and racquetball are not associated with the same potential for injury. However, it is essential to advise parents of all potential injuries associated with both contact and noncontact sports.

136. Child maltreatment is the intentional injury of a child. Maltreatment is not considered the failure to provide what a child needs, not giving a child what the child wants, or accidental harm to a child by someone else.

137. Physical abuse is defined as bodily injury to a person that seems to have been inflicted by other than accidental means. Such injuries may include damage to the skin, including bruises, burns, bite marks, and lacerations; damage to the head; or shaken baby syndrome. In physical abuse, marks may not be visible on the child’s body. For example, with shaken baby syndrome, there may not be any visible signs of injury. Physical abuse may include more than the use of the hands applied to a child in an excessively forceful manner. Muscle-applied force may not be the etiology of physical abuse in the child.

138. Psychological abuse results from the recurrent lack of attention to the child’s needs, and includes lack of affection, emotional support, or supervision. These characteristics are not specific for physical abuse, poor parenting, or withholding of love.

READINGS

1) Potts, N.L., Mandleco, B.L.; Pediatric Nursing: Caring for Children and Their Families. – Chapters 15, 19, 20. – Pp. 417-452, 537-573.

2) Clinical Manual to Accompany Potts, N.L., Mandleco, B.L.; pp.

3) Wong D.L. and Whaley L.F.. Clinical Manual of Pediatric Nursing. – 3rd edition. – Mosby Company, 1990. – 619 p. – 235 ill.

Students discussion (11:00 am till 12:00 pm)

WRITING a TEST (12:30 pm till 14:15 pm)

You will have 80 multiple-choice questions and 100 min to answer them.

Mobile phones and any talks are strictly forbidden.

WEB RESOURCES

American Academy of Pediatrics www.aap.org

National Maternal and Child Health Clearinghouse (NMCHC) www.nmchc.org

Association for Professionals in Infection Control and Epidemiology www.apic.org