Most oral pediatric medications are administered:

a. with the nighttime formula

b. 1/2 hour after meals

c. on an empty stomach

d. with meals

c. on an empty stomach

Most oral pediatric medications are administered on an empty stomach. They aren't usually administered with milk or formula because these can affect gastric pH and alter drug absorption. Because a child's meals usually contain milk or a milk product, the nurse wouldn't administer the drugs with meals or even 1/2 hour after meals.

Before a routine check-up in a pediatrician's office, an 8-month old sits contentedly on the mother's lap, chewing a toy. When preparing to examine this infant, what should the nurse plan to do first?

a. measure the head circumference

b. ausculate the heart and lungs

c. elicit the pupillary reaction

d. weigh the child

b. ausculatate the heart and lungs

Heart and lung auscultation rarely distresses an infant, so it should be done early in the assessment. Placing a tape meaure on the infant's head, shining a light in the eyes, or undressing the infant befor weighting may cause distress, making the rest of the examination more difficult.

A dehydrated infant is receiving I.V. therapy. The mother tells the nurse she wants to hold her infant but is afraid that this might cause the I.V. line to become dislodged. What should the nurse do?

a. tell the mother it's best not to move the infant now

b. inform the mother that only a nurse should hold the infant during I.V. therapy

c. show the mother how to hold the infant properly.

d. advise the mother to let the infant lie quietly in bed

C. Show the mom how ot hold the infant properly

Infants with I.V. lines should be held with care. The nurse should encourage and show the mother how to hold an infant properly and teach her about I.V. care measures to enhance her confidence and skill. The nurse should encourage the mother to participate in the child's care whenever possible.

SIDs is one of the most common causes of death in infants. At what age is the diagnosis of SIDs most likely?

a. 1-2 years

b. 1 week to 1 year, peaking at 2-4 months

c. 6 months to 1 year, peaking at 10 months

d. 6-8 weeks

b. 1 week to 1 year

SIDs can occur anytime between ages 1 week and 1 year. The incidence peaks at ages 2-4 months.

An infant, age 10 months, is brought to the well-baby clinic for a follow-up visit. The mother tells the nurse that she has been having trouble feeding her infant solid foods. To help correct this problem, the nurse should:

a. point out that tongue thrusting is the infant's way of rejecting food

b. instruct the mother to place the food at the back and toward the side of the infant's mouth

c. advise the mother to puree foods if the child resists them in solid form.

d. suggest that the mother force-feed the child if necessary

b. instruct the mother to place the food at the back and toward the side of the infant's mouth

Placing the food at the back and toward the side of the infant's mouth encourages swallowing. Tongue thrusting is a physiologic response to food placed incorrectly in the mouth. Offering pureed foods wouldn't encourage swallowing, which is a learned behavior. Force-feeding may be frustrating for bouth the mouther and child and may cause the child to gag and choke. It may result to higher-than-normal caloric intake, resulting in obesity.

An 8-month-old is admitted to the pediatric unit following a fall from his high chair. The child is awake, alert, and crying. The nurse should know that a brain injury is more severe in children because of:

a. increased myelination

b. intracranial hypotension

c. cerebral hyperemia

d. a slightly thicker cranium

c. cerebral hyperemia

Cerebral hyperemia (excess blood in the brain) causes an initial increase in ICP in the head of an injured child. The brain is less myelinated in a child and more easily injured than an adult brain. Intracranial HTN not hypotension places the child at greater risk for 2ary brain injury. A child's cranium is thinner and more pliable, causing the child to receive a more severe injury.

A 12 month old child fell down the stairs and a basilar skull fracture is suspected. The nurse should look for:

a. CSF otorrhea

b. deafness

c. raccoon eyes

d. Battle's sign

a. CSF otorrhea

Basilar skull fracture is a fracture in any bone of the base of the skull - frontal ethmoid, sphenoid, temporal, or occipital. Otorrhea would be observed. Otorrhea is a discharge from the ear, which may be serous, sanguineous, or purulent if the external or middle ear is infected. Deafness doesn't commonly occur as a result of skull fracture. Battle's sign and raccoon eyes occur primarily in orbital fractures.

In planning the care of an infant undergoing phototherapy for hyperbilirubinemia, which of the following would be least appropriate?

a. reposition the infant frequently to expose all body surfaces

b. obtaining frequent serum bilirubin levels

c. shielding the infant's eyes with an opaque mask to prevent the exposure to the light

d. performing frequent visual assessmetns of jaundice

d. performing frequent visual assessments of jaundice

Visual assessment of jaundice isn't a valid method for assessing jaundice. Serum bilirubin levels must be checked every 4-12 hours. Repositioning the infant and shielding the infant's eyes are appropriate interventions for an infant undergoing phototherapy.

For an 8 month infant, which toy promotes cognitive development?

a. finger paint

b. jack-in-the-box

c. small rubber ball

d. play gym strung across the crib

b. jack-in-the-box

According to Piaget's theory of cognitive development, an 8-month-old child will look for an object once it disappears from sight to develop the cognitive skill of object permanence. Finger paint and small balls are potentially dangerous because infants fequently put their fingers or objects in their mouths. Anything strung across a crib, such as a play gym, is a safety hazard - especially to a child who may use it to pull up to a standing position.

When caring for children who are sick, who have sustained traumas, or who are suffering from nutritional inadequacies, the nurse should know the correct hemoglobin (Hb) values for children. Which of the following ranges would be inaccurate?

a. neonates: 10.6 - 16.5 g/dL

b. 3 months: 10.6 - 16.5 g/dL

c. 3 years: 9.4 to 15.5 g/dL

d. 10 years: 10.7 - 15.5 g/dL

a. neonates 10.6 to 16.5 g/dL is inaccurate

To sustain them until active erythropoiesis begins, neonates have Hb concentrations higher than those of older children. The normal value for Hb for neonates is 18-27 g/dL. Disease as well as such nonpathologic conditions as age, sex, altitude, and the degree of fluid retention or dehydration can affect Hb values. The values for a 3 month old, 3 y.o., and 10 y.o. are correct as stated.

A 10 month old child with PKU is being weaned from breast-feeding. When teaching the parents about the proper diet for their child, the nurse should stress the importance of restricting:

a. vegetables

b. meats

c. grains

d. sugar

b. meats

PKU is an inherited disorder characterized by the inability to metabolize phenylalanine, an essential amino acid. Phenylalanine accumulation in the blood results in CNS damage and progressive mental retardation. However, early detection of PKU and dietary restriction of phenylalanine can prevent disease progression. Intake of high-protein foods, such as meats and dairy products, must be restricted because they contain large amounts of phenylaline.

Veggies, grains, and sugar are low in phenylalanine.

During a well-baby visit, a 2 mo. infant gets DPT, vaccine, trivalent oral poiliovirus vaccine, and haemophilus influenzae b (Hib) vaccine. The parents state that the child's older brother has never received the Hib vaccine and ask why the baby must have it. How should the nurse respond?

a. This vaccine prevents infection by various strains of the flu virus

b. This vaccine protects against bacterial infections, such as meningitis and bacterial pneumonia.

c. This vaccine prevents infection by the hepatitis B virus.

d. This vaccine prevents chickenpox.

b. This vaccine protects against bacterial infections

The Hib vaccine provides protection against serious childhood infections caused by H. influenzae type B virus.

The influenza virus vaccine provides immunity to variuos strains of the flu virus.

THe Heptavax vaccine prevents infection by the hepatitis B. virus.

Chickenpox is caused by the varicella virus and a vaccine for it is now available.

Which of the following is the recommended immunization schedule for DPT?

a. birth, 2 months, 6 months, 15-18 months and 10-12 years

b. 2 months, 4 months, 6 months, 15-18 months, and 4-6 years

b. 2 months, 4 months, 6 months, 15-18 months, and 4-6 years

According to the American Academy of Pediatrics and the Committe of Infectious Diseases, the DTP vaccine should be administered at 2 months, 4 months, 6 months, 15-18 months, and 4-6 years (before the start of school).

Which finding would be least suggestive of necrotizing enterocolitis (NEC) in an infant?

a. hepatomegaly

b. distended abdomen

c. gastric retention

d. blood in the stool

a. hepatomegaly

Hepatomegally is most commonly observed in neonatal sepsis, not NEC. A distended abdomen, gastric retention, and blood in the stool are all signs of NEC and should be monitored closely in infants who are at risk.

A 10 month-old infant is admitted to the facility with dehydration and metabolic acidosis. What is the most common cause of dehydration and acidosis in infants?

a. early introduction of solid foods

b. inadequate perianal hygiene

c. tachypnea

d. diarrhea

D. diarrhea

Diarrhea is the most common cause of dehydration and acidosis in infants. Early introduction of foods may cause loose stools but not dehydration or acidosis. Poor perianal hygiene may cause diaper dermatitis. Tachypnea is a sign, not a cause of acidosis.

When assessing the chest of a 4 month old infant, the nurse identifies which ratio of the anteroposterior-to-lateral diameter as normal?

a. 1:1

b. 1:3

c. 2:1

d. 3:1

a. 1:1

In an infant, the anteroposterior diameter normally equals the lateral diameter. In a toddler, the anteroposterior diameter should be less than the lateral diameter.

The nurse is teaching the mother of a 5 month old infant dxed with bronchiolitis. Which statement by the mother indicates that teaching has been effective?

a. I hope my baby will come home from the hospital.

b. I know that this disease is serious and can lead to asthma.

c. My baby needs to be cured this time so it won't happen again.

d. My baby has been sick. This machine helps him breathe.

b. I know that this disease is serious and can lead to asthma.

Bronchiolitis places the child at risk for developing asthma. If diagnosed and treated promptly, most infants recover from the illness and return home. Infants typically dont' have recurrences of bronchiolitis. Infants dxed with bronchiolitis rarely require mechanical ventilation.

When assessing a child, age 3 months, who has been diagnosed with heart failure, the nurse expects which finding?

a. bounding peripheral pulses

b. a gallop heart rhythm

c. widened pulse pressure

d. bradycardia

b. a gallop heart rhythm

Heart failure may cause a gallop rhythm in a child. Bounding peripheral pulses, widened pulse pressure, and bradycardia aren't associated with heart failure.

A 4 month old infant is taken to the pediatrician by his parents because they are concerned about his frequent respiratory infections, poor feeding habits, frequent vomiting, and colic. The physician notes that the baby has failed to gain expected weight and recommends that the baby have a sweat test performed to detect possible cystic fibrosis. To prepare the parents for the test, the nurse should explain that:

a. the baby will need to fast before the test

b. a sample of blood will be needed

c. a low-intensity, painless electrical current is applied to the skin

c. a low-intensity, painless electrical current is applied to the skin

Because CF clients have elevated levels of Na and Cl in their sweat, a sweat test is performed to confirm this disorder. After pilocarpine (a cholinergic medication that induces sweating) is applied to a gauze pad and placed on the arm, a low-intensity, painless electrical current is applied for several minutes. The arm is then washed off, and a filer paper is placed over the site with forceps to collect the sweat. Elevated levels of soidum and chloride are diagnostic of cystic fibrosis. No fasting is needed before this test and no blood sample is required. A low sodium diet isn't required before the test.

The nurse is preparing for the discharge of a neonate with a cleft lip and palate. One of the nurse's major concerns is to:

a. institute prescribed antibiotic therapy

b. administer supplemental vitamins

c. apply a sterile dressing to the lip

d. establish an adequate feeding pattern

d. establish an adequate feeding pattern

Major concerns for a neonate with a cleft lip and palate relate to feeding. Establishing an adequate feeding patterns requires specific teaching and use of a special nipple. Antibiotics and vitamins aren't administered routinely to a neonate with this defect. Sterile dressings aren't indicated for this congenital disorder.

An infant, age 8 months, has a tentative diagnosis of congenital heart disease. During physical assessment, the nurse measures a heart rate of 170 bpm and a respiratory rate of 70 bpm. How should the nurse position the infant?

a. lying on the back

b. lying on the abdomen

c. sitting in an infant seat

d. sitting in high fowler's

c. sitting in an infant seat

Beacuse the infant's assessment findings suggest that respiratory distress is developing, the nurse should position the infant with the head elevated 45 degree angle to promtoe maximum chest expansion; an infant seat maintains this position. Placing an infant flat on the back or abdomen or in high fowler's could increase respiratory distress by preventing maximal chest expanation.

For children from infancy through the preschool years, what is the major stressor posed by hospitalization?

a. separation from the family

b. fear of bodily injury

c. loss of control

d. fear of pain

a. separation from the family

For infants through pre-schoolers, separation from the family is the major stressor posed by hospitalization. To minimize the effects of separation, the nurse may suggest that a family member stay with the child as much as possible. Reducing this stressor may help a young child withstand other stressors of hospitalization, such as fear of bodily injury, loss of control, and fear of pain.

A 9 month old infant is admitted with diarrhea and dehydration. The nurse plans to assess the child's vital signs frequently. Which other action should provide the most important assessment information?

a. measuring the infant's weight

b. obtaining a stool specimen for analysis

c. obtaining a urine specimen for analysis

d. inspecting the infant's posterior fontanel

a. measuring the infant's weight

Frequent weight measurement provides the most important information about fluid balance and the infant's response to fluid replacement. Although the results of stool or urine analysis may provide some information, they typically aren't available for at least 24 hours. The posterior fontanel usually closes from ages 6-8 weeks and therefore doesn't reflect bluid balance in a 9 month old infant.

When feeding a neonate with a cleft lip, the nurse should expect to:

a. administer I.V. fluids

b. use a bulb syringe with a rubber tip

c. provide thickened formula

d. performed gastric gavage

b. use a bulb syringe with a rubber tip

A bulb syringe with a rubber tip is a safe, effective feeding device for a neonate with a cleft lip. I.V. fluids are required only during the immediate postoperative period, until the neonate can tolerate oral fluids. Thickened formula and gastric gavage rarely are necessary for a neonate with a cleft lip.