ASSOCIATE DEGREE NURSING PROGRAM
NURSING CARE OF CHILDREN
Methodical Instruction
for
PRACTICAL CLASS # 2 (5 hours)
Theme: UNIT TEST #2
Instructor: Dr. Nataliya Haliyash, MD, BSN
Room No.: _____,
STUDENT OBJECTIVES
1. Which of the following statements represents a true difference between the fluids and electrolytes of a child compared to those of an adult?
A. Water constitutes a smaller percent of the body weight of children.
B. A smaller percent of the body weight is in the extracellular compartment in children.
C. Infants and children have a relatively greater body surface area than adults.
D. Infants and children have a lower basal metabolic rate than adults.
2. Children reach adult water distribution percentages in the body by the time the child is how old?
a) 1 year
b) 3 years
c) 5 years
d) 8 years
3. What percentage of an infant’s body water is located in extracellular spaces?
a) 20%
b) 30%
c) 40%
d) 50%
4. Which of the following substances is the predominant component of extracellular fluid?
a) saline
b) potassium
c) proteins
d) phosphate
5. Regulation of homeostatic changes associated with fluids and electrolytes in infants and young children is much slower than in adults because of children’s:
a) proportionately smaller stomach and intestines
b) immature kidneys and buffering systems
c) differences in the chemical composition of the body
d) immature nervous systems
6. Insensible water loss per unit of body weight is:
a) less in children and infants compared to adults
b) about the same in infants and children compared to adults
c) slightly higher in infants and children
d) significantly higher in infants and children
7. When solutes flow from an area of higher concentration to an area of lower concentration until an equilibrium is reached, given that pressures on either side of the membrane are equal, the movement of the solute across the membrane does so by:
a) filtration
b) osmosis
c) diffusion
d) transference
8. Which of the following types of pressure is a force caused by the amount of plasma proteins in the vascular system and which holds the fluids in the capillaries?
a) oncotic
b) osmotic
c) protein
d) filtration
9. Which kind of pressure is a force within the capillary beds that tends to pull water into the capillaries?
a) oncotic
b) osmotic
c) hydrostatic
d) filtration
10. Which of the following is the pressure of blood against the capillary walls generated by the contraction of the heart?
a) oncotic
b) osmotic
c) hydrostatic
d) filtration
11. When the nurse takes a blood pressure reading, the nurse is measuring which of the following kinds of pressure?
a) hydrostatic
b) viscosity
c) velocity
d) osmotic
12. The formulas for calculating daily fluid requirements for an infant weighing less than
a) 10 milliliters per kilogram
b) 25 milliliters per kilogram
c) 50 milliliters per kilogram
d) 100 milliliters per kilogram
13. What is the daily fluid requirement for an infant weighing
a) 250 milliliters
b) 500 milliliters
c)
d) 1-1/2 liters
14. You are the nurse calculating the minimum acceptable urine output per hour for an infant who weighs
a) 4-9
b) 10-15
c) 16-22
d) 25-30
15. The normal minimum urine output for older school-aged and adolescent children is how many milliliters per kilogram per hour?
a) 5-10
b) 2-3
c) 1-2
d) 0.5-1
16. Which of the following is the electrolyte responsible for establishing and maintaining the osmolarity and volume of the extracellular fluid?
a) calcium
b) potassium
c) sodium
d) phosphate
17. The nurse coming on duty gets a laboratory report on an assigned child, and the serum sodium level is reported as 133 milliequivalents per liter (mEq/L). The nurse would expect this client with a 133 mEq/L sodium level to:
a) be experiencing headache, muscle weakness, and abdominal cramps
b) have flushed skin, an elevated temperature, and intense thirst
c) have a slow pulse rate, decreased respirations, and elevated blood pressure
d) appear perfectly normal because this is a normal serum sodium level for a child
18. When the nurse finds that a child has a sodium level of more than 145 milliequivalents per liter, the nurse would most expect to see:
a) diarrhea and vomiting
b) edema and thirst
c) moist mucous membranes
d) subnormal temperature
19. The difference between the intracellular and the extracellular level of potassium determines the:
a) pulse pressure of an individual
b) viscosity of the blood
c) excitability of neurons and muscles
d) amount of edema a person has
20. You are the nurse assigned to care for a child on the pediatric unit. The lab calls with a potassium level of slightly over 5 milliequivalents per liter. This report comes just as you note a widened QRS complex on the electrocardiogram (EKG). From this information, you realize this:
a) child has a slightly elevated potassium level and you should leave the pediatrician a note
b) could lead to cardiac arrest if not treated quickly
c) is a normal lab report and a slight deviation from a normal EKG
d) should be called to the attention of the oncoming nurse at the end-of-shift report
21. You would expect to see hypokalemia in which of the following conditions?
a) tissue necrosis
b) renal failure
c) rapid infusion of IV potassium
d) loss of gastric or intestinal fluids
22. In which of the following ways does the concentration of hydrogen ions affect the movement of potassium ions into or out of cells, if at all?
a) Hydrogen ions have no effect on the movement of potassium ions.
b) Decreased hydrogen concentration will move potassium out of the bloodstream into the cells.
c) Decreased hydrogen concentration will move potassium from the cells into the bloodstream.
d) Increased hydrogen concentration will move potassium from the bloodstream into the cells.
23. The nurse assesses a child and finds the child to have hypotonic muscles, decreased respirations, and to be irritable. Looking at the lab work, the nurse will likely find:
a) hypernatremia and hypochloremia
b) hypercalcemia and hyperchloremia
c) hypocalcemia and hypernatremia
d) hyponatremia and hypochloremia
24. Acid-base metabolism of the body is controlled by the:
a) respiratory system retaining or releasing carbon dioxide
b) electrolytes at a cellular membrane level
c) digestive system and the release or retention of stomach acid
d) circulatory system through osmotic and oncotic pressure
25. When there are pH changes caused by respiratory problems or a buildup of metabolic acids, compensation will take place by what method?
a) the kidneys controlling hydrogen ion and bicarbonate levels in the blood
b) the baroreceptors in the aortic arch of the heart regulating electrolytes
c) the hormone negative feedback system of the hypothalamic-pituitary-adrenal system
d) regulation of hydrogen and bicarbonate by neurotransmitters in the limbic system
26. The nurse is working with a child who has a drug overdose. Respirations are decreased and shallow. Arterial blood gases show the child’s pH is decreased and the pCO2 is elevated. The nurse realizes that this child is in:
a) respiratory alkalosis
b) respiratory acidosis
c) metabolic alkalosis
d) metabolic acidosis
27. The nurse is assigned to an adolescent who is admitted with out-of-control diabetes. There are high levels of ketones in the urine. The child has Kussmaul’s respirations and is confused and somewhat lethargic. The nurse knows that this child is in:
a) respiratory alkalosis
b) respiratory acidosis
c) metabolic acidosis
d) metabolic alkalosis
28. A child is more susceptible to dehydration states than adults because children:
a) forget to drink enough water unless their parents remind them
b) have diarrhea and vomiting more often than adults
c) have a larger portion of the total body fluid in extracellular spaces
d) don’t regulate their intake of salt and potassium as well as adults do
29. One type of dehydration in children is isotonic dehydration, which occurs when:
a) the loss of sodium exceeds water loss and serum sodium levels are low
b) extracellular sodium is at the same level as intracellular sodium
c) the muscle tone and skin tone remain stable while the child is dehydrated
d) the loss of sodium and water are equal and the serum sodium level remains normal
30. The nurse is working with a child who has a diagnosis of gastroenteritis. The child becomes dehydrated, has serum sodium of 125 milliequivalents per liter, and goes into shock. After corrective measures to restore the child’s electrolyte balance and hydration status, the nurse realizes that this child had which of the following types of dehydration?
a) isotonic
b) hypotonic
c) hypertonic
d) idiopathic
31. Hypertonic dehydration occurs in which of the following conditions?
a) the vascular space loses fluid and particles in equal proportions
b) with vomiting and diarrhea or in severe blood loss
c) when the vascular space loses more fluid than particles
d) when the vascular space loses a greater portion of particles than fluid
32. Which of the following methods is the most reliable method of diagnosing dehydration in children?
a) specific gravity of urine
b) blood pressure changes
c) skin turgor
d) weight loss
33. Classical symptoms of impending shock in a child who is dehydrated are:
a) decreased skin elasticity, flat fontanel, decreased urine output
b) azotemia, rapid thready pulse, mottled skin, low blood pressure
c) dusky and grayish skin color, increased weak pulse, depressed fontanel
d) decreased tears, oliguria, depressed fontanel, slightly increased pulse
34. The nurse is working with a child who is dehydrated. When the nurse weighs the child and compares the weight obtained with the child’s weight prior to the illness, there has been an 8% weight loss. This weight loss means that this child’s dehydration is:
a) mild
b) moderate
c) severe
d) life-threatening
35. Children with an internal hemorrhage such as bleeding into the thoracic or peritoneal cavity will have the same signs and symptoms of hypovolemic shock as a child with an external hemorrhage, except for one difference, which is:
a) weight loss with external hemorrhage and no weight loss with internal hemorrhage
b) decreased urine loss with external hemorrhage and no decreased urine loss with internal hemorrhage
c) bradycardia with external hemorrhage and tachycardia with internal hemorrhage
d) decreased blood pressure with external hemorrhage and no decrease with internal hemorrhage
36. The nurse is working as a volunteer on a health care team serving in a clinic in a village in a third world country. Several children come to the clinic in a mild or moderate state of dehydration. Which of the following solutions or liquids would be best for rehydrating the dehydrated children?
a) Gatorade
b) fruit juices
c) Pedialyte
d) athletic drinks
37. The nurse will read the label to determine the contents of any solution before using it for rehydration because solutions must contain which of the following substances in order for the intestines to absorb sodium chloride?
a) carbohydrate
b) glucose
c) phosphate
d) aluminum
38. ANSWER: B
39. The nurse is assessing a 5-year-old child. In checking the heart rate, the nurse finds an increase of 25 beats when the child changes from a lying to a standing position. This increase in heart rate is indicative of:
a) hypovolemia
b) hypervolemia
c) normal findings
d) left-sided heart failure
40. The nurse is assessing a child who is dehydrated. The child begins to cry, but there are no tears. The nurse knows that the loss of the ability to produce tears indicates a fluid loss of at least what percent of the child’s body weight?
a) 1%
b) 5%
c) 8%
d) 10%
41. The nurse is preparing to administer intravenous fluids containing potassium for a child who is dehydrated. Which of the following is the most important thing for the nurse to check before administering the potassium?
a) Respirations are over 14.
b) The child does not have a low-grade fever.
c) There is no nausea present; give medication if nausea is present.
d) The child is able to void at least 1 to 2 milliliters per kilogram per hour.
42. The nurse has instructed caregivers on how to care for a dehydrated child at home. The nurse has included instructions on how to decide when the child is doing well and when the caregivers should contact a health professional. The nurse would instruct the family to contact a health professional when which of the following occurs?
a) The child’s urine output decreases.
b) The child is more mentally alert.
c) The child complains of nausea.
d) There is any pain.
43. The majority of cases of acute gastroenteritis in children under 2 years old in the
a) Shigella
b) rotavirus
c) Salmonella
d) Giardia
44. The causes of acute gastroenteritis include viruses, bacteria, and parasites. Which of the following is a parasitic cause of gastroenteritis?
a) Shigella
b) Escherichia coli
c) Yersinia
d) Giardia lamblia
45. When the family of a child with acute gastroenteritis asks about giving their child a diet of bananas, rice, applesauce, and toast or tea, the best response by the nurse would be:
a) “This would be a good diet because it is easily digested; however, the toast needs to be soaked in tea to soften it.”
b) “This diet needs to be modified slightly to include either the applesauce or the bananas but not both.”
c) “Do not use this diet, because it is low in energy, protein, and fat.”
d) “Avoid this diet, because it is low in glucose, sodium, and potassium.”
46. The care plan for a baby with gastroenteritis includes a nursing diagnosis of “Impaired skin integrity related to irritation from frequent stools.” Which of the following interventions by the nurse would be the best intervention?
a) Clean the diaper area with commercial baby wipes after each stool.
b) Keep the diaper area covered and avoid airing the diaper area.
c) Clean the diaper area with water and mild soap after each stool.
d) Do not use any diaper cream to coat the skin.
47. The nurse is assessing a child who is on bed rest to see if the child has edema. If the child has edema, where is the nurse most likely to find it upon assessment?
a) ankles
b) sacral areas
c) periorbital areas
d) hands
48. When the nurse is trying to treat a child’s edema that is due to an allergic reaction, the nurse can reduce blood hydrostatic pressure by decreasing capillary blood flow with which of the following interventions?
a) warm compresses
b) cold compresses
c) restriction of fluid
d) restriction of sodium
49. The nurse is caring for a child who is receiving a diuretic for edema. Which of the following interventions is the most important intervention by the nurse?
a) Monitor blood electrolytes for potassium depletion.
b) Elevate the limbs on pillows to facilitate reabsorption.
c) Elevate the head of the bed.
d) Measure the abdomen daily.
50. The nurse is assessing a child who has significant edema. The nurse finds an increasing respiratory rate and some rales. Which of the following nursing interventions would be best?
a) Place the child in a semi-Fowler’s position.
b) Elevate the head of the bed.
c) Place shock blocks under the foot of the bed.
d) Elevate the child’s legs on pillows.
51. The extent of burns in children are normally assessed and expressed in:
a) percentages of total body surface area (TBSA)
b) terms of how deep the deepest burns are
c) the severity of the burns on a 1 to 5 burn scale
d) the amount of body surface that is unburned
52. If burns are severe enough, the child will require fluid replacement. Which of the following fluids is most often used as replacement?
a) dextrose 5% in water
b) one-half strength normal saline
c) normal saline solution
d) lactated Ringer’s solution
53. Fluid resuscitation for burn victims is based on formulas; however, the adequacy of the amount is based on:
a) skin turgor of the unburned area of skin and how normal or abnormal it is
b) thirst levels of the victims by self-assessment
c) urine output of 1-2 milliliters per kilogram per hour, stable vital signs, alertness, and orientation
d) amount of weeping taking place in the area of the burns
54. The nurse working with children with severe burns who are in pain and anxious will best help the child by:
a) touching the child even if this hurts
b) holding the hands 2-
c) taking as much time as necessary when having to touch the child
d) not touching the child and staying at least
55. For hydrotherapy and debridement of a child’s burn wound, the nurse will most help the child by:
a) medicating the child first
b) moving swiftly and getting it done
c) asking the parents to leave
d) explaining the procedure fully
56. Hydrotherapy before the debridement of a wound is done to soften tissue and to:
a) get rid of dead skin so debridement will be faster
b) make the area sterile
c) soothe the nerves in the area
d) improve circulation to the wound
57. Skin grafts made from cadaver skin are called:
a) homografts
b) heterografts
c) c-grafts
d) humano grafts
58. The nurse caring for clients with severe burns that have required grafts will expect which of the following types of grafts to be more likely to be replaced every day or every other day?
a) cadaver skin
b) pig skin
c) nylon
d) nonnylon synthetics
59. A child presents with complaints of numbness and tingling in toes and fingers and light-headedness. Upon assessment, the child is found to be diaphoretic and tachypneic. Which of the following blood gas findings does the nurse anticipate given the client’s clinical presentation?
a) respiratory alkalosis
b) respiratory acidosis
c) metabolic alkalosis
d) metabolic acidosis
60. The nurse is aware that prolonged nasogastric suctioning, overuse of antacids, and diuretic use place the client at risk for which of the following acid-base disturbances?
a) respiratory alkalosis
b) respiratory acidosis
c) metabolic alkalosis
d) metabolic acidosis
61. A nurse is providing education to the parents of a child with gastroenteritis. Which of the following prevention strategies is the most effective for preventing a recurrence?
a) handwashing after defecating or diapering
b) cooking all food to the appropriate temperature
c) encouraging ongoing fluid replacement/hydration
d) maintaining a bananas, rice, applesauce, and toast (BRAT) diet for 1 to 2 weeks following the acute onset
62. A hospitalized child presents with severe, widespread edema. The lab results indicate a marked decrease in the level of serum albumin. Which of the following conditions does the nurse suspect the client is experiencing?
a) nephrotic syndrome
b) heart failure
c) hypersensitivity reaction
d) impaired lymph drainage
63. A nurse is providing education to the parents of a child with a history of dehydration. Which of the following fluids should the nurse encourage the parents to offer the child upon discharge?
a) Pedialyte
b) water
c) fruit juices
d) carbonated beverages
64. Which of the following makes it easy to palpate a full bladder on infants and children?
a) Their skin is thinner than adults’ skin.
b) Their bladders can be filled fuller than adults’ bladders.
c) Their bladders are closer to the anterior abdominal wall.
d) The bladder is oversized at birth.
65. Which of the following makes the kidneys of a child more susceptible to trauma compared to those of an adult?
a) The kidneys are less protected in the child due to unossified ribs and less fat padding.
b) Backward falls are associated with direct compression of the kidneys.
c) The kidneys are much smaller and closer to the surface.
d) There are not as many renal tubules, and the kidneys themselves are not as thick as the adult kidneys.
66. Prior to birth, the main function of the kidney is to maintain which of the following?
a) electrolyte balance in the body
b) adequate amniotic fluid levels
c) a system free of harmful substances
d) acid-base balance of the fetus
67. The ability to concentrate urine varies between adults and newborns. Which of the following describes the ability of the newborn to concentrate urine when compared to the adult?
a) better
b) about the same
c) much more poorly
d) slightly less
68. The bladder capacity of a 4-year-old child is how many ounces?
a) 4
b) 6
c) 8
d) 10
69. Which of the following statements is true regarding a urinary tract infection (UTI) in the newborn?
a) The incidence is higher in female newborns.
b) After the first year, the incidence is more common in boys.
c) Boys who are uncircumcised are more likely to have a UTI.
d) UTI is more common in African-American girls than in Caucasian girls.
70. Which of the following is the most common bacteria to infect the urinary tract?
a) Escherichia coli
b) Enterobacter
c) Proteus species
d) Pseudomonas
71. The nurse assessing a child who has a urinary tract infection will suspect pyelonephritis rather than cystitis when the child exhibits which of the following symptoms?
a) scant amounts of strong-smelling urine of a very dark orange or brown color
b) fever greater than 38.3 degrees C (101 degrees F), chills, back pain, and appearing quite ill
c) low-grade fever, urgency, hesitancy, burning on urination, and cloudy urine
d) low specific gravity of urine, extreme thirst, and nausea and vomiting
72. Untreated urinary tract infections could most likely lead to which of the following problems?
a) renal scarring
b) loss of bladder capacity
c) septicemia
d) loss of bladder tone
73. The nurse working with the parents of a school-aged child is teaching the parents about recognizing the symptoms of urinary tract infections. Which of the following symptoms would the nurse include along with hesitancy, dysuria, and urgency?
a) increased restlessness just before urinating
b) bed-wetting wheighttime control has already been established
c) less frequent voiding but greater volume of urine passed
d) urine that is darker yellow and stronger smelling than previously passed
74. The nurse is teaching a caregiver who is staying in the hospital with a child who has a urinary tract infection. The nurse most needs to assess which of the following in planning a time when the caregiver will be able to concentrate on learning new concepts?
a) the child’s level of comfort
b) when the child is likely to be discharged
c) the time lapse since the caregiver’s last meal
d) the caregiver’s intelligent quotient (IQ)
75. The nurse is assigned to work with a child who has a urinary tract infection. The child is having bladder spasms. Which of the following interventions would be best initially to try to relieve the bladder spasms?
a) pain medication
b) bladder massages
c) ice packs, provided they do not induce chills
d) warm, moist heat if it does not increase fever
76. The nurse completed discharge teaching for the family of a child with a urinary tract infection. Which of the following statements by one of the caregivers would indicate an understanding of the nurse’s teaching about the antibiotics?
a) “We will stop the antibiotics when the child is fever free or the urine culture comes back negative.”
b) “We will give the antibiotics until they are all gone, even if the child is feeling well and looks well.”
c) “We will fill half the prescription for antibiotics and if there are still symptoms when those are gone, we will fill the other half.”
d) “We will save a few of the antibiotic tablets and then the next time our child has this problem, we can start them early.”
77. The school nurse is talking with caregivers and school-aged girls about the prevention of urinary tract infections. Which of the following teachings will be most helpful in preventing urinary tract infections?
a) “Children will benefit from warm bubble baths to keep the external urinary openings clean.”
b) “Have the children wear nylon underwear rather than cotton underwear.”
c) “Girls should always wipe with the toilet tissue from front to back and never from back to front.”
d) “Children can learn to hold their urine for 3-4 hours to strengthen the bladder muscle tone.”
78. A parent asks the nurse to explain what is meant by a secondary enuretic, because the pediatrician referred to this parent’s child as a secondary enuretic. Which of the following statements by the nurse would best explain a secondary enuretic?
a) “A child who primarily has encopresis and secondarily has enuresis as a problem.”
b) “In secondary enuresis the cause is not the structure of the urinary system but some pathogen or problem that has come into the system.”
c) “Secondary enuretics have suffered enuresis in the past, and this is a repeat of the problem.”
d) “A secondary enuretic is a child who has been dry for at least 3 to 6 months and then resumes wetting.”
79. When the nurse uses the terms enuresis and incontinence correctly, the nurse uses these terms keeping in mind which of the following facts?
a) These terms mean the same thing.
b) Incontinence is caused by a malformation of the urinary tract, and enuresis is not.
c) Incontinence can occur anytime, while enuresis only occurs with bed-wetting at night.
d) Incontinence is a term used only for adults, and enuresis is a term used only for children.
80. In addition to oxybutynin chloride (Ditropan), which of the following medications is the one most commonly used to treat enuresis in children?
a) imipramine hydrochloride (Tofranil)
b) carbamazepine (Tegretol)
c) propranolol hydrochloride (Inderal)
d) tacrine (Cognex)
81. The nurse is reviewing discharge teaching with caregivers of a school-aged child who is going to be taking oxybutynin chloride (Ditropan) at home. The nurse will most need to instruct the caregivers to do which of the following?
a) Give the medication just before bedtime with at least
b) Keep the medication secure from the child in a childproof bottle because this medication in overdose can be fatal due to cardiac arrhythmias.
c) Take the blood pressure before giving the medication, hold, and call the pediatrician if the blood pressure is elevated above the baseline blood pressure.
d) Have the child take this medication while sitting down because of the side effects of dizziness and fainting spells.
82. Which of the following is the most widely used form of treatment for enuresis?
a) medication
b) surgery
c) bed-wetting alarms
d) behavior modification
83. The nurse is working on dietary interventions in a care plan for a child who has enuresis. Which of the following interventions would the nurse most likely include?
a) Eliminate carbonated beverages, dairy products, citric foods, and caffeine.
b) Reduce the amount of carbohydrate and protein in the diet.
c) Reduce salt and fluid intake as well as reduce foods high in potassium.
d) Decrease intake of foods high in cholesterol, magnesium, and zinc.
84. Which of the following problems most needs to be addressed at the same time as enuresis in order for the enuresis interventions to be successful?
a) low self-esteem
b) impaired skin integrity
c) sleep pattern disturbance
d) constipation
85. Why would the nurse advise a family trying to help a younger child overcome nocturnal enuresis to have the child practice using the alarm system with a doll or stuffed animal?
a) to help the child feel comfortable with the system
b) to make sure the child can operate the system independently
c) to ensure that the child won’t throw the system out of the bed at night
d) to perfect the child’s technique in using the system
86. The nurse is assigned to work with a child who has a diagnosis of vesicoureteral reflux (VUR). The nurse is aware that this means the child has which of the following problems?
a) backflow of urine from the bladder up the ureter to the kidney
b) backflow of urine from the bladder up the ureter
c) a flow of urine between the bladder and the rectum
d) exchange of urine between the inner and outer layers of the bladder
87. In hypospadias the urethral meatus is located in which of the following places?
a) on the dorsal side of the penis toward the distal end
b) at any point along the ventral side of the penis or on the scrotum or perineum
c) slightly under a larger-than-normal foreskin if uncircumcised or at the outer perimeter of the head of the penis if circumcised
d) at the end of the ventral side of the penis, near, but not on the head of, the penis
88. A nurse is instructing a caregiver about the side effects of testosterone cream applied to the penis of a child prior to surgery to correct hypospadias. The nurse will most likely tell the caregiver:
a) The testosterone may cause the child to have erections and possibly ejaculation, but when the cream is discontinued, the erections will stop.
b) The testosterone was used to increase the size of the penis to make surgery easier. This size and any pubic hair will go away when the cream is stopped.
c) The testosterone cream was used to thicken the skin of the penis to make surgery easier. This thickening will go away when the cream is stopped.
d) Sometimes the testosterone will cause the child to be more aggressive or agitated, but these behaviors will go away when the medication is stopped.
89. Which of the following best describes the problem of cryptorchidism?
a) where one testicle is greatly enlarged and hangs somewhat lower than the other testicle
b) where one, or in rare cases both, of the testes is twisted in the scrotal sac
c) a congenital anomaly in which one, or in rare cases both, of the testicles is absent
d) failure of one or both of the testes to descend through the inguinal canal into the scrotum
90. Upon assessment of a child, the nurse finds a testis that has descended normally but easily retracts with physical examination. Which of the following terms describes this finding?
a) cryptorchidism
b) retractile testis
c) ectopic testis
d) torticollis
91. Upon examining a child, the nurse found a bulge or swelling in the groin and suspected an inguinal hernia. Which of the following tests will the nurse use to verify that this is a hernia?
a) “Strain or push down as if you were trying hard to pee or poop.”
b) “Take as deep a breath as you can, and hold it as long as you can.”
c) “Stand up and jump up and down several times.”
d) “Lie down with your knees bent, and try to bring them up to your tummy.”
92. On finding an inguinal hernia in a child, the nurse in the pediatric clinic will teach the mother that until the child has surgery for the hernia, the mother should do which of the following if the child has pain and intense inconsolable irritability, with or without vomiting and abdominal distension?
a) Make an appointment with the physician as soon as possible.
b) Apply ice to the groin area for 30 minutes on and 30 minutes off for 8 hours.
c) Contact the physician immediately, or take the child to the emergency room.
d) Keep the child on bed rest to see if the symptoms subside.
93. Which of the following statements best describes a hydrocele?
a) an outpouching on the scrotum that contains water
b) a collection of water or fluid in the foreskin
c) an inguinal hernia containing fluid
d) a collection of fluid in the scrotal sac
94. Parents of a child admitted to the pediatric ward ask the nurse to tell them what causes acute glomerulonephritis because the pediatrician has mentioned this as a possible diagnosis. The correct answer by the nurse would be to tell the family that acute glomerulonephritis is an inflammation of glomeruli within the kidney caused by which of the following?
a) a bacterial or viral agent invading the child’s system
b) habitual failure to flush the kidneys with sufficient fluid
c) an uncommon genetic defect involving a renin deficiency
d) failure of the adrenal glands to produce sufficient aldosterone
95. You are the nurse assigned to care for a child with acute glomerulonephritis. After receiving report and doing an initial assessment, you check the lab reports. You would not be surprised to find which of the following signs and symptoms consistent with the diagnosis of acute glomerulonephritis?
a) pale yellow urine in copious amounts, low specific gravity, increased glomerular filtration rate
b) hypotension, dry skin, decreased serum sodium levels, and decreased potassium
c) hematuria, dependent edema, elevated serum sodium, diminished glomerular filtration rate, proteinuria
d) ketone bodies in the urine, diminished serum sodium, orthostatic hypotension
96. You are the nurse assigned to work with a child with acute glomerulonephritis. By following the prescribed treatment regimen, the child experiences a remission. You are now checking to make sure the child does not have a relapse. Which finding would most lead you to the conclusion that a relapse was happening?
a) a temperature of 37.8 degrees C (100 degrees F), flank pain, burning, frequency, urgency on voiding, and cloudy urine
b) a urine dipstick measurement of 2+ proteinuria or more for 3 days, or the child found to have 3-4+ proteinuria plus edema
c) elevated temperature, cough, sore throat, changing complete blood count (CBC) with differential
d) the urine dipstick showing glucose in the urine for 3 days, extreme thirst, increase in urine output, and a moon face
97. In which of the following groups is hemolytic uremic syndrome, although rare, most often found?
a) industrialized nations
b) children under 4 years old
c) male children
d) female children
98. Sucking and swallowing are automatic reflexes at birth, but they come under voluntary control by how many weeks of age?
a) 2
b) 4
c) 6
d) 8
99. The nurse will teach the caregivers about the need for small, frequent feedings by explaining to them that newborns and infants have:
a) a slower metabolic rate than adults
b) slower peristalsis
c) decreased emptying rate
d) a 10- to 20-milliliter stomach capacity at birth
100. Which of the following is the initial symptom of hypertrophic pyloric stenosis?
a) nonbilious vomiting starting between the 2nd and 4th week of life
b) cramping and abdominal pain starting around the 3rd day after birth
c) refusal to take the bottle or nurse
d) a high-pitched and unusual cry
101. The infant with hypertrophic pyloric stenosis will eventually:
a) experience spontaneous recovery in 75% of cases
b) stop eating and go into a life-threatening decline
c) have projectile vomitus propelled up to several feet
d) pass an unusually large bowel movement
102. A preferred and highly accurate method of diagnosing hypertrophic pyloric stenosis is:
a) ultrasonography with delay in gastric emptying and one or two narrow pyloric channels
b) upper gastrointestinal series
c) passing a lighted tube from the mouth into the stomach
d) doing a pH test on the stomach contents collected over a 48-hour period
103. Following surgical correction of hypertrophic pyloric stenosis, the nurse will teach the family members to save diapers for which of the following reasons?
a) to check the color of the urine as an indicator of bladder functioning
b) to determine the number of soaked diapers per shift
c) to measure urine output by weighing the diapers
d) to test the urine for sugar and ketones
104. Which of the following signs is most often the first sign when cleft palate is not diagnosed at birth?
a) inability to nurse or take the bottle
b) coughing when given formula or breast milk
c) choking during feedings
d) formula coming from the nose
105. The parents of a newborn who was born with a cleft lip asks the nurse when surgery is usually performed on this condition. The nurse will inform the parents that closure of the lip is usually performed when the infant is:
a) 2 weeks old or at least
b) 3 months of age or
c) 1 year old or
d) 18 months old or
106. When the mother of a newborn with a cleft lip or a cleft palate decides to bottle feed, the nurse will have the mother to first try:
a) the breast
b) a regular nipple and bottle
c) a special nipple designed for clefts
d) a special bottle
107. The mother of a newborn with esophageal atresia asks the nurse to explain this condition to her. The best response by the nurse would be to say that esophageal atresia is:
a) characterized by incomplete formation of the esophagus so it ends before it gets to the stomach
b) an extreme narrowing of the esophagus so that no liquids can get through the opening
c) an outpouching of the esophagus just before it reaches the top of the stomach
d) a narrowing of the top of the esophagus with a ballooning out in the middle and narrowing at the bottom
108. Infants born with esophageal atresia with tracheoesophageal fistula are more often:
a) male
b) female
c) lower-than-average birth weight
d) of American Indian heritage
109. When the nurse is working with a new mother whose child was born with esophageal atresia with tracheoesophageal fistula, the mother says: “He looks perfect, and I am glad he only has these two things wrong because they can be fixed.” In responding therapeutically to the mother, the nurse keeps in mind which of the following as a finding with babies born with esophageal atresia and tracheoesophageal fistula?
a) It is rare for children born with this condition to have other anomalies.
b) One-half of the children born with this condition have other anomalies.
c) The only other defects found in children with this condition are rectal anomalies.
d) These children rarely live to be older than 5 or 6 years old.
110. In Hirschsprung’s disease the normal portion of the bowel:
a) becomes atrophied and shrinks
b) loses function
c) becomes hypertrophied and dilated
d) functions normally
111. The nurse assessing newborn babies and infants during their hospital stay after birth will notice which of the following symptoms as a primary manifestation of Hirschsprung’s disease?
a) failure to pass meconium during the first 24 to 48 hours after birth
b) high-grade fever
c) the skin turns yellow and then brown over the first 48 hours of life
d) a fine rash over the trunk
112. An infant’s trachea and lower airway are approximately what portion of the size of an adult’s trachea and lower airway?
A. one-tenth
B. one-fourth
C. one-third to one-half
D. five-eighths to two-thirds
113. Which of the following factors are age-related physical differences in infants that most increase this population’s risks for developing a respiratory system dysfunction?
A. small airways and fewer alveoli
B. shape of the chest, smaller ribs
C. abdominal breathing
D. greater weight-to-height ratio
114. When a premature newborn is showing signs of developing respiratory distress syndrome or bronchopulmonary dysplasia, which of the following treatments is most likely given to reduce the chance of the infant having these problems?
A. exogenous surfactant therapy
B. oxygen therapy
C. hyperbaric chamber treatments
D. light therapy
115. Which of the following respiratory alterations is the same as nasopharyngitis?
A. sinusitis
B. bronchitis
C. common cold
D. strep throat
116. A parent shares with the nurse that she is using an over-the-counter pediatric cold and stuffy nose medication that contains a decongestant. The mother mentions that the child is diabetic. The nurse responds that decongestants should be used with caution in children with diabetes. Which statement represents the rationale for using decongestants with caution in children with diabetes?
A. “When decongestants are given daily, the child will develop a tolerance for the medication and it will cease to work after a while.”
B. “Decongestants work by vasoconstricting the small blood vessels of the nose and this vasoconstriction effect occurs all through the body.”
C. “Decongestants tend to interact with insulin in an unusual way, producing adverse side effects.”
D. “When a child with diabetes takes decongestants, it can create a situation of insulin-resistant diabetes.”
117. The mother of a 2-1/2-year old child who has had tonsillitis asks about the possibility of a tonsillectomy for the child. The nurse informs the mother that tonsillectomies are usually performed when the child is over 3 years old. The mother wants to know why children younger than 3 have to wait for a tonsillectomy. Which of the following is the nurse’s best answer?
A. “Surgery is too difficult on a younger child, because their mouths are so small, making it difficult to get to the tonsils.”
B. “It is too scary for younger children, and they don’t understand what is happening.”
C. “Younger children are more prone to excessive blood loss and the tonsils growing back.”
D. “Separation from the parents or caregivers is much more difficult in the child under 3.”
118. Otitis media can occur with or without an effusion. Which of the following best describes an effusion?
A. accumulation of fluid such as in the middle ear or pleural cavity
B. movement of fluid back and forth between the outer ear and inner ear
C. a blocked eustachian tube causes pressure in the middle ear
D. escape of fluid from the middle ear into surrounding tissues
119. Which of the following characterizes the course of acute otitis media?
A. lengthy duration after slow onset
B. insidious onset and varied duration
C. exacerbations and remissions
D. sudden onset and short duration
120. The nurse assessing a child with a respiratory problem finds stridor, which is best described by which of the following?
A. excursion of the chest wall beyond that normally seen in the healthy child
B. substernal retractions and nasal flaring
C. a high-pitched sound produced by an obstruction of the trachea or larynx
D. a triad of respiratory symptoms
121. Which of the following body structures is infected when a child has croup?
A. epiglottis
B. lungs
C. alveoli, bronchioles, and pleura
D. larynx, trachea, and large bronchi
122. Which of the following pathogens causes bronchitis?
A. viruses
B. bacteria
C. spirochete
D. protozoa
123. The nurse assessing a child with respiratory syncytial virus (RSV) bronchiolitis looks up the disorder as a review and is most likely to find which of the following classic symptoms associated with this disorder?
A. clubbing of the fingers, poor circulation of extremities, and bluish color
B. barklike cough and thick yellow nasal discharge
C. patchy rash on the body, rapid respirations, and exhaustion
D. respiratory distress, drooling, fever, agitation, and lethargy
124. Which of the following outcomes is the primary criterion for evaluating the resolution of ineffective airway clearance?
A. regular respirations
B. ability to cough effectively
C. clear airway sounds
D. resolved coughing
125. Pneumonia in children appears:
A. in a more primitive form, which is easier to cure than that found in adults
B. as a secondary disease
C. as a tertiary disease
D. as a primary disease or a complication of another disease
126. The nurse who is teaching the caregivers of children who are going to be skin tested for allergies will teach them to avoid giving the child which of the following medications for several days to weeks before the test?
A. Tylenol and like products
B. antihistamines
C. antacid medications
D. vitamin supplements
127. The nurse who is giving allergy injections to a child will instruct the caregiver that the child can leave how many minutes after receiving the allergy injection?
A. 10 minutes minimum, 20 if they have had a reaction in the past
B. 20 minutes and as long as 2 hours if they are high risk for a reaction
C. 40 minutes for all children regardless of circumstances in the past
D. 1 hour minimum, 2 hours if they had a reaction or are at high risk for a reaction
128. Which of the following statements best defines cystic fibrosis?
A. an acquired lung condition that occurs at birth due to oxygen deficiency
B. a congenital anomaly occurring during fetal development as a result of dietary deficiencies of the mother
C. an autosomal recessive disorder that mainly affects the exocrine glands and does multiple system damage
D. a respiratory condition affecting people of Mediterranean descent, involving mainly exchange at a microscopic level in the lungs
129. In working with children with cystic fibrosis, the nurse expects to carry out and provide teaching on which of the following treatments?
A. dietary modification involving a low-protein, high-fat, low-carbohydrate diet
B. range of motion and a highly regimented exercise program
C. preparation for renal dialysis and strict intake and output
D. aggressive pulmonary toilet methods, digestive enzymes, and vitamin supplements
130. What is the purpose of the ductus arteriosus while the fetus is developing in utero?
A. to divert blood from the fetal lungs to the fetal aorta
B. to circulate blood throughout the fetal body and back to the placenta
C. to move blood between the various chambers of the fetal heart
D. to direct blood immediately to the fetal liver
131. What two critical events differentiate fetal circulation from postnatal circulation?
A. interruption of the umbilical cord and spontaneous respiration
B. the exposure to atmospheric gases and first exposure to cold
C. increase in both adrenocorticotropic hormone (ACTH) and cortisone at the time of birth
D. physical contact on the skin and crying
132. While assessing a child the nurse finds hepatomegaly. The nurse is aware that this condition is most associated with which of the following?
A. congestive heart failure
B. congenital heart defects
C. maternal alcoholism
D. prematurity
133. When assessing a child for any possible cardiac anomalies, the nurse takes the right arm blood pressure (BP) and the BP in one of the legs. She finds that the right arm BP is greater than that found in the child’s leg. The nurse reacts to these findings in which of the following ways?
A. charts the findings and realizes they are normal
B. suspects the child may have coarctation of the aorta
C. places the child in the Trendelenburg position
D. notifies the physician and alerts the surgery team
134. The nurse caring for a child who has had a heart catheterization is aware that the child’s activity level is:
A. unrestricted because this is a minor procedure
B. restricted to being up and about with no exercise, lifting, or other activity, which would increase heart rate
C. restricted to sitting in a chair for 4 hours after the procedure
D. bed rest with the affected extremity straight for 4 to 8 hours, subject to hospital policy and physician’s orders
135. Which of the following conditions is the most common cause of chronic heart failure in infants?
A. cardiomyopathy
B. endocarditis
C. congenital heart disease
D. myocarditis
136. Which of the following symptoms would the nurse most likely find in assessing a child with right ventricular failure?
A. rales and rhonchi, falling oxygen saturation, and labored breathing
B. falling blood pressure, falling pulse rate, and increased respirations
C. diaphoresis, nausea and vomiting, and tingling in extremities
D. hepatomegaly, jugular venous distention, and peripheral edema
137. Which of the following positions is used to evaluate jugular vein distention in older children?
A. sitting
B. standing
C. lying flat
D. head slightly elevated
138. You are caring for a child who is on a diuretic and digoxin. Prior to giving the medications, you assess this child and find that the child has a bradycardia, has a ventricular arrhythmia, and is nauseated and wanting to vomit. What is the most likely explanation for these signs and symptoms?
A. hyperkalemia
B. drug incompatibility
C. digitalis toxicity
D. dehydration
139. The nurse planning nutritional interventions for an infant with chronic heart failure who has a nursing diagnosis of “Imbalanced nutrition: Less than body requirements related to poor caloric intake and increased metabolic demands as evidenced by poor weight gain and weight loss” would most likely include in the nursing care plan which of the following interventions?
A. Increase calorie density slowly by adding less water when mixing formula or powdered formula to expressed breast milk.
B. Quickly increase the calorie density by adding less water when mixing formula or powdered formula to expressed breast milk.
C. Administer bolus feedings via a nasogastric tube every 2 to 3 hours.
D. Start rice cereal earlier than is normally recommended.
140. Which of the following statements best describes cardioplegia?
A. shocking the heart, injecting of stimulants, or making any other effort to get the stopped heart to start beating again
B. the cessation of cardiac function following an injection of cold high-potassium solution into the heart
C. any serious medical condition that requires immediate surgery to correct
D. a series of treatments usually done in the cardiac catheterization lab by a specially trained nurse specialist
141. Why are clients put into deep hypothermia during open-heart surgery?
A. Because less inhalation anesthesia is needed, which makes the operation much safer.
B. Surgeries are usually very long, and hypothermia preserves oxygen to the brain more effectively.
C. Doing so slows the circulating blood so the chance of hemorrhage is much less.
D. Doing so lowers the body’s metabolic rate and protects vital organs during cardiac bypass.
142. When the nurse is listening to the chest of an infant who has a murmur associated with a patent ductus arteriosus, the murmur will best be heard in which of the following locations?
A. at the apex of the heart
B. just below the left clavicle
C. at the fifth intercostals space
D. over the mitral valve
143. The nurse is caring for a premature infant who is receiving an infusion of a substance in an attempt to close a patent ductus arteriosus. The nurse will explain to the mother that this substance is:
A. indomethacin, which inhibits the synthesis of prostaglandin, the substance that maintains the patency of the ductus arteriosus
B. a hypertonic saline solution that will draw the ductus into closure
C. a cardiac stimulant, which increases the firing in the Purkinje fibers, thus causing a greater force for closing the ductus arteriosus
D. an estrogen product, which will build up the tissue in the ductus arteriosus and cause an eventual closure
- The nurse is working with an infant who has a diagnosis of severe valvular pulmonary stenosis (PS). Although infants who have mild PS are asymptomatic, this infant with severe PS will most likely demonstrate which of the following signs and symptoms on assessment?
A. nasal flaring, substernal retraction, restlessness, and crying with a shrill distinctive cry
B. increase in right ventricular pressure, no symptoms at rest, intolerance of activity, and cyanosis with activity
C. cyanosis at rest and with activity, increase in left ventricular pressure, listlessness, and lethargy
D. rapid shallow respirations, increase in heart rate, and decrease in blood pressure at rest or with activity
- Which of the following is the treatment for moderate to severe valvular pulmonary stenosis?
A. balloon valvuloplasty
B. valvular shunt
C. Jones procedure
D. valve replacement
- An infant with tetralogy of Fallot who has multiple hypercyanotic spells will likely have a procedure to ensure pulmonary blood flow until surgical repair is performed. Which of the following is this procedure?
A. coil
B. Fontan procedure
C. Blalock-Taussig (BT) shunt or modified BT shunt
D. Jones procedure
- When a newborn has a transposition of the great arteries (TGA), the only chance for survival is:
A. administration of continuous oxygen
B. serial blood transfusions to exchange the blood and increase the amount of oxygen in the newborn’s blood
C. administration of sufficient potassium
D. an intra-atrial connection such as a patent ductus arteriosus that allows mixing of oxygenated and deoxygenated blood
- Acute rheumatic fever follows which of the following health problems?
A. chickenpox
B. an untreated or partially treated staphylococcal skin lesion or infection
C. an untreated or partially treated group A streptococcal pharyngitis
D. rubella
- Following the acute inflammatory phase of rheumatic fever, which of the following cardiac pathologies is evident?
A. enlargement of the heart
B. inflammation of the pleura
C. changes in the firing from the Purkinje fibers with irregular beats
D. valvulitis with the most affected valve being the mitral valve
- The criteria for diagnosis of acute rheumatic fever are known as:
A. Smith criteria
B. Jones criteria
C. Aims test
D. Rockwood test
- A nurse is working with children and adolescents who have a known heart problem. The nurse is aware that when a child undergoes a procedure, the prevention of infectious endocarditis will involve which of the following interventions as a prophylaxis?
A. gamma globulin 10 cubic centimeters in each of two deep muscle sites at least 24 hours before the procedure
B. antibiotics, with the most frequent being penicillin or clindamycin for those with penicillin allergies
C. intravenous glucose solution
D. aspirin or Coumadin
- Treatment for supraventricular tachycardia will most often include which of the following regimens?
A. have an older child hold his or her breath and bear down, do a headstand, or place the face in ice water; use an ice bag on the face of an infant
B. a major tranquilizer bolused intravenously
C. sedation for 24 hours to induce a subconscious state and to slow down the heart rate
D. place the child in a knee-chest position or in a squatting position until the tachycardia converts to a normal heart rate
- An infant who is less than 2 hours old is noted to have profound cyanosis. The nurse administers oxygen immediately. Upon reassessment, the nurse notices no signs of improvement in the cyanosis. The nurse suspects which of the following conditions given the client’s clinical presentation?
A. tricuspid atresia
B. coarctation of the aorta
C. truncus arteriosus
D. transposition of the great arteries
- A nurse is providing education to the parents of a pediatric client who is having the Ross procedure for valve replacement. The nurse educates the family on the benefits of the Ross procedure when compared to other methods of valve replacement. Which of the following statements accurately captures one of the benefits of using this method?
A. “Your child will not require lifelong anticoagulant therapy.”
B. “Your child’s recovery will be accelerated by using this method.”
C. “Your child will be able to lead a normal life with this procedure.”
D. “Your child will not require antirejection therapy.”
- Where are blood cells produced during fetal development?
A. bone marrow
B. stem cells
C. liver and spleen
D. heart and lungs
- What features of red blood cells (RBCs) allow them to reach all the tissues of the body?
A. shape, size, and structure
B. gelatinous quality
C. propulsive DNA energy
D. compacting of various cells
- The primary function of white blood cells (WBCs) is to guard against microorganisms and to do which of the following?
A. produce erythrocytes
B. remove debris
C. disperse platelets
D. boost antibiotics
- What is the main function of platelets?
A. to wall off foreign proteins, preventing infection
B. to carry nutrients to tissues throughout the body
C. to be involved in the recovery process in infection
D. to facilitate blood coagulation to control bleeding
- The pediatric nurse doing assessments on infants and young children is aware that the most common blood disorder in children is:
A. leukemia
B. anemia
C. thalassemia minor
D. von Willebrand’s disease
- Which of the following types of anemia would the nurse most expect to find in infants and toddlers?
A. iron deficiency
B. aplastic
C. sickle cell
D. decreased production
- Parents ask the nurse why their adolescent daughter and several of her friends tend to be anemic. Which of the following is the nurse’s best response?
A. “There is decreased production of red blood cells (RBCs) during adolescence as the body focuses on growth in other areas.”
B. “Some adolescent girls are anemic because of pregnancy and others because the body is preparing for pregnancy.”
C. “This is a time when girls have a very heavy menstrual flow, which reduces the amount of hemoglobin.”
D. “While there are several causes of anemia, teenage girls tend to make poor dietary choices at a time when they are growing.”
- When a child progresses to moderate iron-deficiency anemia, the caregivers or the nurse will notice which of the following signs?
A. yellow color of skin, fatigue, and increased aggressiveness
B. mottling of skin, joint pain, and muscular weakness
C. general irritability, weakness, and lack of interest in play
D. respiratory distress, cardiac irregularities, seizures
- As iron-deficiency anemia progresses beyond the moderate stage, the nurse assessing the child will most likely find which of the following signs?
A. decreased reticulocytes and increased serum ferritin
B. systolic murmurs, hair falling out, brittle nails, and enlarged spleen
C. elevated blood pressure and pulse
D. seizures and loss of consciousness
- The nurse is assessing a child who has anemia. The child has a yellowish skin color. This skin color is most likely indicative of which of the following conditions associated with severe anemia?
A. increased destruction of red blood cells
B. compensatory polycythemia
C. increased melatonin
D. liver disease
- Why are premature infants more at risk for iron-deficiency anemia than full-term infants?
A. They do not nurse or take formula as well as full-term infants, so their intake of iron is considerably less.
B. Their liver and spleen are smaller and functionally less well-developed than full-term infants.
C. Premature infants use up their stores of hemosiderin within 6 to 8 weeks compared to approximately 20 weeks for full-term infants.
D. The bone marrow production of iron is depressed and does not come up to the production level of full-term infants for several months.
- The nurse is working with a mother who is breastfeeding her 2-month-old infant with blood-loss anemia. The blood loss has been stopped, and efforts are made to increase the infant’s supply of iron. The nurse will advise the mother to:
A. switch to a formula high in iron
B. feed half formula with iron and half breast milk
C. feed formula with iron and iron-fortified cereal
D. give only mother’s breast milk
- The school nurse is working with a pregnant adolescent. The nurse will advise the young woman to eat foods high in iron and also high in which of the following vitamins to increase the absorption of iron?
A. the B vitamins
B. vitamin E
C. vitamin C
D. vitamin D
- A parent calls the nurse and frantically reports that a child has gotten into the mother’s ferrous sulfate pills and ingested a number of these pills. The child is vomiting, has bloody diarrhea, and is complaining of abdominal pain. The nurse will tell the mother to:
A. call the poison control center
B. administer syrup of ipecac
C. call emergency medical services (
D. relax because these symptoms will pass and the child will be fine
- What is the primary focus of nursing intervention when the child has iron-deficiency anemia?
A. caregiver education
B. reduction of episodes of constipation
C. control of acute pain
D. reduction of febrile episodes
- The nurse is doing discharge teaching with caregivers who will be giving their toddler a liquid iron supplement. The nurse will teach the parents to administer the liquid iron supplement in which of the following ways?
A. mixed half and half with water
B. through a straw, a medicine dropper, or a syringe in the back part of the mouth
C. with food such as eggs, milk, cheese, or a slice of toasted whole grain bread with butter
D. mixed with antacids
- The nurse is talking to the working parents of a child with sickle cell anemia. The nurse explores the feelings of the parents and finds that both parents are admitting to feeling guilty a lot of the time. Which of the following causes will the nurse most likely find as the greatest contributor or cause of this guilt?
A. Both parents are carrying at least one recessive gene for sickle cell anemia.
B. Both parents are working and cannot spend as much time with the child as they would like.
C. The parents are not able to help their child more, and they fear that the child is suffering a great amount of the time.
D. The child wants more and more things that cost more and more money, and the parents can’t comply because of hospital bills.
- In talking with parents about the life expectancy of children who have the sickle cell trait, the nurse will share with the parents that children with the sickle cell trait:
A. often live only into their 20s or early 30s
B. usually die at about age 45
C. most often do not live past age 55
D. do not have a decreased life expectancy
- Parents of children with sickle cell anemia need to know the risks of various activities. The nurse will teach the parents of a child with sickle cell anemia that on rare occasions children who have the sickle cell trait can have vaso-occlusive episodes and severe crisis caused by which of the following activities?
A. being in very hot water (e.g., in a bathtub or a hot tub) that is 40.5 degrees C (105 degrees F) or higher
B. failure to take rest periods morning and afternoon and to get 9 hours sleep daily
C. flying at high altitudes in depressurized aircraft, exercising at high altitudes, or using anesthesia
D. doubling up on medication either on purpose or by accident, when forgetting that the medicine was already been taken
- When the nurse realizes that a child is in sequestration crisis, the nurse will assess for and most likely need to initiate interventions for:
A. shock
B. bleeding
C. breathing difficulty
D. cardiac arrest
- Which of the following statements about thalassemia is true?
A. It involves the inheritance of recessive genes from both parents.
B. It is characterized by an impaired rate of hemoglobin chain synthesis.
C. It always involves early death.
D. It involve years of transfusions, which cause few side effects if any.
- Five to ten percent of children with aplastic anemia will develop which of the following conditions?
A. myelogenous leukemia
B. kidney tumors
C. esophageal varices
D. oat cell carcinoma
- A parent asks the nurse if there is any cure for Fanconi’s anemia. Which of the following is the nurse’s best response?
A. “Liver transplantation is helpful, but it is difficult to obtain a donor match.”
B. “Renal dialysis helps, but it does not cure the anemia.”
C. “The only potential cure for this disorder is a bone marrow transplant.”
D. “There is no cure and no treatment that really cures this anemia.”
- Which of the following statements about hemophilia A is true?
A. It is the most common type of hemophilia.
B. It affects 1 in 5,000 females.
C. It is caused by a defect of factors X and XI.
D. It is also called Christmas A
- The coagulation cascade can be initiated by which of the following events?
A. increase in platelets and white blood cells
B. damage to blood vessels or to body tissues
C. low oxygen saturation
D. lack of vitamins C, D, and E
- Which of the following is present with von Willebrand’s disease?
A. a liver function deficiency, which produces tissue bleeds that are serious and difficult to control, including epistaxis
B. deficiency or defectiveness of a factor, which is a protein that facilitates adhesion between platelets and injured vessels
C. a recessive trait involving absence of factor XII
D. increased production of erythrocytes and platelets
- The nurse is assigned to work with a child who has immune thrombocytopenic purpura (ITP). The nurse is aware that children with this disease are most likely to:
A. die within the year of diagnosis
B. require renal dialysis
C. recover completely within 3 months
D. have a chronic course
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 14:45 pm)
You will have 100 multiple-choice questions and 120 min to answer them.
Mobile phones and any talks are strictly forbidden.
WEB RESOURCES
National Maternal and Child Health Clearinghouse (NMCHC) www.nmchc.org
Association for Professionals in Infection Control and Epidemiology www.apic.org
Centers for Disease Control and Prevention www.cdc.gov
Immunization Action Coalition www.iminunize.org
Prepared by Nataliya Haliyash
Sep. 10, 2007
Approved by Department of General Patient Care. Minute #2 from Oct.2, 2007
Revised by Department of General Patient Care. Minute #12 from June 17, 2008.
Revised by Department of General Patient Care. Minute #___ from ____, 200__.
Head of the Department Associated Prof. Svitlana Yastremska, Ph.D., BSN
