A nurse is caring for an infant with meningitis. which nursing action is a priority?

The nurse is caring for an infant with an acyanotic defect. WHy must the nurse continue to monitor this infant's mucous membranes, fingers, and toes?

a-bc it explains hemodynamics involved
b-bc cyanotic defects are easily identified
c-bc that is part of the standardized assessment
d-acyanotic heart defects may have cyanosis if another problem arises or if the current one becomes worse.

d-children with traditional named acyontic defects may be slightly cyanotic and children with traditionally classified cyanotic defects may appear pink, although they may eventually become cyanotic.  

The beneficial effect of performing surgery for PDA is to prevent which complication?

a-pulmonary infection
b-right to left shunt of blood
c-decrease workload on left side of heart
d-increase pulmonary vascular congestion

d-PDA allows blood flow from the aorta (high pressure) to the pulmonary artery (low pressure). If the PDA stays open, increased pulmonary congestion can occur

Which condition is classified as a mixed blood cardiac defect?

a-PS
b-ASD
c-PDA
d-TGA

d-TGA allows the mixing of blood in the heart

Which of the characterisitic of fractures in children?

a-speed with healing occurs is inversely related to the age of the child
b-fractures rarely occur at the growth plate site bc it absorbs shock well
c-pliable bones of growing children are less porous than those of the adult, thus slower to heal
d-periosteum of a child's bone is thinner & weaker and less osteogenic potential than that of an adult

a-fractures heal in children inless time than they do in adults. As the child ages, the healing time increases

A child returned from surgery in a hip spica cast. What is the priority nursing intervention?

a-check lower extremity circulation
b-elevate the HOB
c-turn the child to the right side
d-offer sips of water

a-chief concern is that the extremity may continue to swell, compartment syndrome 

Which statement best describes DMD?

a-its inherited as an autosomal dominant disorder
b-onset occurs in later childhood & adolescence
c-characterized by weakness of proximal muscles of both pelvic & shoulder girdles
d-its characterized by muscle weakness usually begining about 3 years of age

d-usually children with DMD reach the early developmental milestones but the muscular weakness is usually observed in third year of life

A young child with tetralogy of Fallot may assume a posturing position as a compensatory mechanism. What position is automatically assumed by the child? A) Low Fowler's
B) Prone
C) Supine
D) Knee-chest

D. The squatting or knee-chest position decreases the amount of blood returning to the heart and allows the child time to compensate.

Which sign would alert the nurse that congestive heart failure could be developing?
A) Tachypnea
B) Bradycardia
C) Inability to sweat
D) Increased urine output

A. Tachypnea is one of the early signs that should be identified. Tachycardia at rest, dyspnea, retractions, and activity intolerance are other physical signs and symptoms.

As part of the treatment for congestive heart failure, a child is taking the diuretic furosemide (Lasix). As part of the discharge teaching plan, what should the nurse explain as the function of furosemide (Lasix)? A) It is a diuretic, which means that it eliminates extra fluid from the body.
B) It is a beta blocker, which decreases the child’s blood pressure.
C) It is a form of digitalis that regulates the heart rate and rhythm.
D) It is an ACE inhibitor, which regulates the amount of fluid that goes through the kidney.

a-Furosemide (Lasix) is a diuretic used to eliminate excess water and salt to prevent reaccumulation of the fluid.

The nurse is preparing to administer digoxin (Lanoxin) orally to a 9-month-old infant. The nurse checks the dose and prepares to draw up 4 mL of the drug. What are the most appropriate nursing actions?
A) Mix the dose with several milliliters of juice to disguise the drug’s taste.
B) Check the dosage with another nurse after checking the orders then hold the dose.
C) Check the heart rate, then administer the dose by placing it at the back and side of the mouth.
D) Check the heart rate, then administer the dose by letting the infant suck it through a nipple.

B. Digoxin is often prescribed in micrograms. Rarely is more than 1 mL administered to an infant. Because it is a potentially dangerous drug, administration guidelines are very precise. Pediatric medication dosages should be checked with another licensed professional before administration.

What is included in nursing care of the infant or child with congestive heart failure?
A) Forcing fluids appropriate for the patient's age
B) Monitoring respirations during active periods
C) Giving larger feedings less often to conserve energy
D) Organizing activities to allow for uninterrupted sleep

D. The child needs to be well rested before feeding. The child's needs should be met as quickly as possible to minimize crying. The nurse must organize care to facilitate a decrease in the child's energy expenditure which is known as clustering care.

What is the primary therapy for secondary hypertension in children?
A) Eating a diet that contains low amounts of salt
B) Reducing body weight to a normal weight
C) Determining, then treating the underlying cause
D) Increasing exercise and therefore fitness

C. Secondary hypertension is a result of an underlying disease process or structural abnormality. It is usually necessary to treat the problem before the hypertension will be controlled.

A 3-week-old neonate has been admitted to the hospital because inability to feed well and not growing as expected. What actions should the nurse implement when caring for this infant with suspected heart failure? (Select all that apply.)
A) Allow extra time to feed the infant.
B) Hold the infant securely in a supine position during feeding.
C) Allow 45 minutes for each feeding to provide the ordered amount of formula.
D) Watch for diaphoresis or tachypnea while feeding the infant.
E) Encourage the mother to breastfeed, but allow 30 minutes for the total feeding.
F) Watch for signs of hunger and irritability soon after the feeding is finished.

A. Allowing extra time to feed the infant should help the nurse provide a relaxed environment which this infant needs. Knowing that 30 minutes should be allocated for each feeding helps the nurse with time management.
D. If diaphoresis or tachypnea is seen while the infant is feeding, then the infant may need a feeding tube to conserve energy.
E. Encourage the mother to breastfeed but allow 30 minutes for the total feeding.
F. Signs of hunger and irritability soon after the feeding is finished may indicate that the feeding did not fill up the infant so that comfort and fullness would be felt.

The nurse would check the lab reports of which two electrolytes prior to administering digoxin (Lanoxin) because of the risk for digoxin toxicity?
__________ and _____________

potassium and magnesium

(Hypokalemia and hypomagnesemia can increase the risk for digoxin toxicity. In children with altered renal function, the dose needs to be decreased.)

A child is being discharged home on a regimen of oral corticosteroids. What information is most important for the nurse to explain to the parents?
A) Reduce the dosage as quickly as possible so dependence on the medication is avoided.
B) Any new cuts should be washed with soap and water then covered with a bandage.
C) All spurts of energy and increased appetite are interpreted as a positive response.
D) If the child becomes ill, notify the physician who ordered the medication.

D. If the child becomes ill, the physician who ordered the medication should be notified because of the increased stress. Supplemental glucocorticoids might be necessary during times of increased stress to prevent adrenal insufficiency.

Which is a secondary effect when a child has decreased muscle strength, tone, and endurance from immobilization?
A) Increased metabolism
B) Increased venous return
C) Increased cardiac output
D) Decreased exercise tolerance

D. Muscle disuse leads to tissue breakdown and loss of muscle mass. It may take weeks or months to recover.

Which measure is important in managing hypercalcemia in a child who is immobilized?
A) Promote adequate hydration.
B) Change position frequently.
C) Encourage eating a diet high in calcium.
D) Provide a diet that is high in protein and calories.

A. Hydration is extremely important to help remove the excess calcium from the body. This can help prevent hypercalcemia

The nurse is providing care for a child with a sprained ankle. What is the rationale for the nurse to elevate the extremity after this soft tissue injury?
A) It increases metabolism in the tissues.
B) It produces a deep tissue vasodilation.
C) The pain threshold is reduced.
D) Edema formation is reduced

D. Elevating the extremity uses gravity to facilitate venous return to reduce edema

An infant is born with one lower limb deficiency. What is the optimum time for the child to be fitted with a prosthetic device?
A) As soon as possible after birth.
B) About age 12 to 15 months, when most children are walking.
C) When the infant begins sitting up and can maintain balance.
D) About 4 years of age, when the healthy limb is not growing so rapidly.

C. When the infant begins sitting up and can maintain balance is the most optimum time for the child to be fitted with a prosthetic device. The child is ready to stand, and the prosthetic device will be integrated into his or her capabilities

Which statement best describes pseudohypertrophic (Duchenne) muscular dystrophy?
A) It is inherited as an autosomal dominant disorder.
B) Onset occurs in later childhood and adolescence.
C) It is characterized by weakness of proximal muscles of both pelvic and shoulder girdles.
D) It is characterized by muscle weakness usually beginning about 3 years of age.

d-Usually children with Duchenne muscular dystrophy reach the early developmental milestones, but the muscular weakness is usually observed in the third year of life.

A nurse is caring for an immobilized preschool child. Which would be helpful during this period of immobilization while in the hospital?
A) Encourage the child to wear pajamas.
B) Let the child have few behavioral limitations.
C) Take the child for a “walk" by wagon outside the room.
D) Keep the child away from other immobilized children if possible.

C. It is important for children to have activities outside of the room if possible. This increases environmental stimuli and provides social contact with others.

The nurse is caring for a child in skeletal traction because of multiple fractures from an accident. What nursing interventions are essential in the care of this child? (Select all that apply.)
A) Making sure the weights are resting on the bed frame
B) Repositioning the child sidelying for brief periods of time
C) Checking the position of the weights, knots and pulleys whenever in the room
D) Performing pin care every other day
E) Assuring there is a proper amount of countertraction
F) Releasing the traction every 8 hours to decrease stress on the bone

C. The position of the weights, knots and pulleys should be checked whenever the nurse is in the room. It takes a brief glance to make sure the alignment is proper and the equipment is in proper position. A diagram with the amount of weight at the time can be placed on the traction near the foot of the bed.
E. Countertraction must be correct or the skeletal traction will be ineffective. If the child weighs very little, then the foot of the bed can be elevated and a pediatric jacket restraint used for maintaining position can be used. This would be part of the protocol from the orthopedic department.

A 16-year-old female is being discharged tomorrow after a spinal fusion with rods has been done for correction of her scoliosis. What information should the nurse include during the teaching session? (Select all that apply.) A) Continue oral pain medication as needed for the next few weeks.
B) Notify the surgeon’s office if fever occurs.
C) Check with the surgeon about antibiotics before dental work.
D) Avoid tattoos and body piercing for at least one month after discharge.
E) Remain as sedentary as possible after returning to school.
F) The patient needs to be followed up until she is 21 years of age.

A. Oral pain medication can be used for the next few weeks and tapered as healing occurs.
B. Fever could signify infection; the surgeon needs to know.
C. Prophylactic antibiotics might be prescribed before dental work because of the implanted metal in the patient’s body.

When explaining the destruction of pancreatic beta cells, which produce insulin, to a parent whose child is running high glucose levels, the nurse is explaining what happens to cause which problem?
A) Type 1 diabetes.
B) Type 2 diabetes.
C) Impaired glucose tolerance.
D) Gestational diabetes.

A. Type 1 diabetes is characterized by destruction of the insulin-producing pancreatic beta cells.

The mother of a child with type 1 diabetes mellitus asks why her child cannot avoid all those "shots" and take pills as an uncle does. What is the most appropriate response by the nurse?
A) "The pills work with an adult pancreas only."
B) "The drugs affect fat and protein metabolism, not sugar."
C) "Your child needs insulin replaced, and the oral hypoglycemics stimulate the pancreas to release the existing supply of insulin."
D) "Perhaps when your child is older, the pancreas will produce its own insulin, and then your child can take oral hypoglycemics.

C. In type 1 diabetes the beta cells have been destroyed. It is necessary to supply the insulin no longer produced by the beta cells.

During the summer many children are more physically active. What changes in the management of the child with diabetes would the camp nurse expect as a result of more exercise?
A) Increased food intake
B) Decreased food intake
C) Increased risk of hyperglycemia
D) Decreased risk of insulin shock

A. Food intake should be increased in the summer when the child is more active. Exercise lowers blood glucose and hypoglycemia needs to be prevented.

A 17-year-old boy with diabetes mellitus tells the school nurse that he has recently started drinking alcohol with his friends on weekends. What is the most appropriate action by the nurse?
A) Tell him not to do this.
B) Ask him why he is drinking alcohol.
C) Teach him about the effects of alcohol on diabetes.
D) Recommend that he attends counseling.

C. The nurse is taking a proactive approach. The adolescent is provided with information to facilitate the correct management of his illness.

Which of the following is a clinical manifestation of increased intracranial pressure in infants?
A) Irritability
B) Photophobia
C) Pulsating anterior fontanel
D) Vomiting and diarrhea

A. Irritability is one of the changes that may indicate increased intracranial pressure.

The temperature of an adolescent who is unconscious is 105º F(ax). What is the priority nursing action?
A) Initiate a pain assessment.
B) Apply a hypothermia blanket.
C) Continue to monitor temperature.
D) Administer acetaminophen or ibuprofen.

B. Brain damage can occur at temperatures this high. It is extremely important to institute temperature-lowering interventions, such as hypothermia blankets and tepid water baths.

A nurse is caring for a comatose child with multiple injuries. The nurse should recognize that pain
A) Cannot occur if the child is comatose
B) May occur if child regains consciousness
C) Requires astute nursing assessment and management
D) Is best assessed by family members who are familiar with the child

C. Because the child cannot communicate pain through one of the standard pain rating scales, the nurse must be focused on physiologic and behavioral manifestations.

A nursing intervention to prevent increased intracranial pressure (ICP) in an unconscious child includes A) Suctioning any secretions frequently.
B) Providing environmental stimulation.
C) Turning the head side to side every hour.
D) Avoiding activities that cause pain.

D. Nursing interventions should focus on assessments and interventions that minimize pain. The activities in the other options can cause the intracranial pressure to increase.

A nurse is caring for a toddler status post surgery for a brain tumor. During an assessment the nurse notes that the toddler is becoming irritable and that the pupils are unequal and sluggish. What is the most appropriate nursing action?
A) Notify the physician immediately.
B) Assess for level of consciousness.
C) Observe closely for signs of increased intracranial pressure (ICP).
D) Administer pain medication and assess for response.

A. The worsening of symptoms may indicate that the ICP is increasing. The physician should be notified immediately.

The nurse is admitting a young child to the hospital with possible bacterial meningitis. What is the major priority of nursing care?
A) Initiate isolation precautions as soon as the diagnosis is confirmed.
B) Administer antibiotic therapy as soon as it is ordered.
C) Initiate isolation precautions as soon as the causative agent is identified.
D) Administer sedatives/analgesics on a preventive schedule to manage pain.

B. Administration of antibiotic therapy as soon as it is ordered is the priority action. Antibiotics are begun as soon as possible to prevent death and avoid resultant disabilities.

The nurse is planning care for a school-age child with bacterial meningitis. Which of nursing actions should be included?
A) Keep environmental stimuli at a minimum.
B) Avoid giving pain medications that could dull sensorium.
C) Measure head circumference to assess developing complications.
D) Have the child move his head side to side at least every 2 hours.

A. Children with meningitis are sensitive to noise, bright lights, and other external stimuli. The nurse should keep the room as quiet as possible, with a minimum of external stimuli.

A young child is having a seizure that has lasted 35 minutes with loss of consciousness. What type of seizure would the nurse document?
A) An absence seizure.
B) Status epilepticus.
C) A generalized seizure.
D) A simple partial seizure.

B. Status epilepticus is a generalized seizure that lasts more than 30 minutes.

What are two of the most common causes of cerebral palsy?
A) A sex-linked recessive inheritance pattern and neonatal disease
B) Birth-related brain anoxia and post-maturity status
C) Prematurity and brain fragility/anomalies
D) Faulty mother-infant bonding and neonatal meningitis

C. Cerebral palsy results from faulty development (brain anomalies) during the prenatal period or from damage during the perinatal period, including brain anoxia and cerebral trauma during delivery and prematurity.

What is a major goal of therapy for children with cerebral palsy?
A) Reverse the degenerative processes that have occurred.
B) Cure the underlying defect causing the disorder.
C) Prevent spread to individuals in close contact with child.
D) Promote optimal development by identifying the condition early.

D. Because cerebral palsy is, so far as is known, a permanent disorder, the goal of therapy is to promote optimal development. This is done through early recognition and beginning of therapy.

What is a neural tube defect that may not be visible externally in the lumbosacral area called? A) A meningocele
B) A myelomeningocele
C) Spina bifida cystica
D) Spina bifida occulta

D. Spina bifida occulta is completely enclosed. Often this defect will not be noticed.

A woman 6 weeks pregnant tells the nurse that she is worried the baby might have spina bifida because of a family history. What response would be most helpful to the patient? A) “There is no definite genetic basis for the defect.”
B) “Low levels of folic acid at the time of conception has been strongly linked to neural tube defects.”
C) “Chromosomal studies done on amniotic fluid can diagnose the defect prenatally.”
D) “The concentration of alpha-fetoprotein in amniotic fluid can indicate the presence of the defect prenatally.”

D. Fetal ultrasonography and elevated concentrations of alpha-fetoprotein in amniotic fluid may indicate the presence of neural tube defects.

A child has a myelomeningocele at the L2 level. What degree of bowel control would be anticipated when toilet training is complete? A) Periodic incontinence
B) Moderate control using enemas and laxatives
C) Total fecal continence
D) The need for a colostomy

C. Total fecal continence should be present with the defect at the L2 level.

Which nursing intervention is important when caring for an infant with myelomeningocele in the preoperative stage?
A) Place the child in the sidelying position to decrease pressure on the spinal cord.
B) Apply a heat lamp to facilitate drying and toughening of the sac.
C) Keep skin clean and dry to prevent irritation from diarrheal stools.
D) Measure head circumference and examine fontanels for signs that might indicate developing hydrocephalus.

D. Hydrocephalus is frequently associated with myelomeningocele. Assessment of the fontanels and daily measurements of head circumference will aid in early detection.

A child with spina bifida has a latex allergy from exposure to numerous bladder catheterizations and surgeries. What is a priority nursing intervention in this child’s care?
A) Recommend allergy testing.
B) Provide a latex-free environment.
C) Use only powder-free latex gloves.
D) Limit use of latex products as much as possible.

B. Providing a latex-free environment is the most important nursing intervention. From birth on, the limitation of exposure to latex is essential in an attempt to minimize sensitization

A school-age child begins to have a tonic-clonic seizure in bed as the nurse walks into her room. What actions should the nurse take? (Select all that apply.)
A) Gently place an oral airway in the child’s mouth.
B) Turn the child on her side.
C) Hold the child’s head so it doesn’t hit the headboard.
D) Get additional pillows to pad the siderails.
E) Note how long the seizure lasts.
F) Note whether any incontinence occurs during or after the seizure.

B. The side should be placed on her side.
E. The nurse should note how long the seizure lasts, what body parts are involved, any vocalizations made during the seizure, presence or absence of incontinence, and level of consciousness after the seizure ends.
F. Presence or absence of incontinence should be noted, and if it occurs when, whether during the seizure or afterward.

A nurse caring for a child who has absence seizure. Which of the following findings can the nurse expect? (select all that apply)

a-loss of consciousness

b-appearence of daydreaming

c-dropping held objects

d-falling to the floor

e-having a piercing cry

a-loss of consciousness

b-appearence of daydreaming

c-dropping held objects

A nurse caring for a child who just experienced a generalized seizrue. which of the following is the priopity action for the nurse to take?

a-maintain inside-lying position

b-monitor vital signs

c-reorient the child to the environment

d-assess for injuries

a-maintain inside-lying position

A nurse teaching a group of parents about the risk factors for seizures. which of the following should be included in the teaching? (select all that apply)

a-febrile episodes

b-hypoglycemia

c-sodium imbalances

d-low serum lead levels

e-presence of diphtheria

a-febrile episodescan cause tonic-clonic

b-hypoglycemia late manifestation

c-sodium imbalances is a manifestation of hypo-Na & hyper-Na

A nurse caring for an adolescent who has susutained a closed head injury, which of th following are the clincal manifestation of IICP? (select all that apply)

a-report of headache

b-aleration in pupillary response

c-increased motor response

d-increased sleeping

e-increased sensory response

a-report of headache

b-aleration in pupillary response

d-increased sleeping

A nurse caring for a child who has IICP, which of the following are appropriate actions by the nurse? (select all that apply)

a-suction the endotracheal tube Q2

b-maintain a quiet environment

c-use 2 pillows to elevate the head

d-administer a stool softener

e-maintain body alignment

b-maintain a quiet environment

d-administer a stool softener

e-maintain body alignment

A nurse caring for a child who has a concussion, which of the following are clinincal manifestations of a minor head injury? (select all that apply)

a-vomiting

b-delayed pupillary

c-drowsiness

d-pallor

e-confusion

a-vomiting

c-drowsiness

d-pallor

e-confusion

A 16 y/o boy has a dx of new onset of diabetes. The child is meeting with the nurse educator regarding changes that will need to be made in his diet, what would be the most influence?

a-parents & their dietary choices

b-cultural background

c-peers & their dietary choices

d-TV & other forms of media influences

c-peers & their dietary choices

A nurse caring for a 5y/o who has a fracture of the tibia innvolvinnng growth plate; when involvinnnnng info to parents nurse indicate?

a-serious injusy that could cause long-term growth issues
b-fracture usually heals within 6wks w/o complications
c-child will never be able to play contact sports
d-fractures involving the groeth plate require pain meds

a-fracture of the growth plate are serious