A mom arrives to the ER with her child, stating that she just found the child sitting on the floor next to an empty bottle of aspirin. On assessment, the nurse notes that child is drowsy but conscious. The nurse anticipates that the physician will prescribe which of the following?

a. ipecac syrup

b. activated charcoal

c. magnesium citrate

d. magnesium sulfate

b. activated charcoal

Ipecac is administered to induce vomiting in certain poisoning situations, it is not recommended as the initial treatment in the hospital setting for ingestion of salicylates. This is because ipecac does not totally remove the poison from the child's system. In this situation, the child is conscious and the ingested substance (aspirin) would not damage the esophagus or lungs from vomiting. However, activated charcoal would be prescribed as an antidote in this poisoning situation, because its action is to absorb ingested toxic substances and thus decrease absorption. Options c and d are unrelated to tx for this occurrence.

A preschooler with a history of cleft palate repair comes to the clinic for a routine well-child checkup. To determine whether this child is experiencing a long-term effect of cleft palate, the nurse asks the parents which question?

a. "Does the child play with an imaginary friend?"

b. "Was the child recently treated for pneumonia?"

c. "Is the chid unresponsive when given directions?"

d. "Has the child had any difficulty swallowing food?"

c. "Is the child unresponsive when given directions?"

Unresponsiveness may be an indication that the child is experiencing hearing loss. A child who has a history of cleft palate should be routinely checked for hearing loss. Options 2 and 4 are unrelated to cleft palate after repair. Option 1 is normal behavior for a preschool child. Many preschoolers with vivid imaginations have imaginary friends.

A nurse is closely monitoring a child with ICP who has been exhibiting decorticate posturing. The nurse notes that the child suddenly exhibits decerebrate posturing and interprets that this change in the child's condition indicates which of the following?

a. an insignificant finding

b. an improvement in condition

c. decreased ICP

d. deteriorating neurological function

d. deteriorating neurological function

The progression from decorticate to decerebrate posturing usually indicates deteriorating neurological function and warrants physician notification. Options 1, 2, and 3 are inaccurate interpretations.

Following tonsillectomy, which of the following fluid or food items is appropriate to offer the child?

a. jello

b. cold gingerale

c. vanilla pudding

d. cool cherry kool-aid

a. jello (it didn't say it was red)

Following tonsillectomy, clear, cool liquids should be administered. Citrus, carbonated, and extremely hot or cold liquids need to be avoided because they may irritate the throat. Red liquids need to be avoided because they give the appearance of blood if the child vomits. Milk and milk products (pudding) are avoided because they coat the throat and cause the child to clear the throat, thus increasing the risk of bleeding.

A pediatric nurse specialist provides an educational session to the nursing students about childhood communicable diseases. A nursing student asks the pediatric nurse specialist to describe the signs and symptoms associated with the most common complication of mumps. The pediatric nurse specialism response, knowing that which of the following signs or symptoms is indicative of the most common complication of this communicable disease.

a. pain

b. deafness

c. nuchal rigidity

d. a red swollen testicle

c. nuchal rigidity

The most common complication of mumps is aseptic meningitis, with the virus being identified in the cerebrospinal fluid. Common signs include nuchal rigidity, lethargy, and vomiting.

A red swollen testicle may be indicative of orchitis. Although this complication appears to cause most concern among parents, it is not the most common complication. 

Although mumps is one of the leading causes of unilateral nerve deafness, it does not occur frequently. Muscular pain, parotid pain, or testicular pain may occur, but pain does not indicate a sign of a common complication.

A 5-year-old child is hospitalized with Rocky Mountain spotted fever (RMSF). The nursing assessment reveals that the child was bitten by a tick 2 weeks ago. The child presents with complaints of headache fever, and anorexia, and the nurse notes a rash on the palms of the hands and soles of the feet. The nurse reviews the physician's orders and anticipates that which of the following medications will be prescribed?

a. ganciclovir (cytovene)

b. doxycycline (vibramycin)

c. amantadine (symmetrel)

d. amphotericin B (fungizone)

b. doxycyline (vibramycin)

The nurse caring of a child with RMSF will include the administration of doxycycline. An alternative medication is chloramphenicol. Amphotericin B is used for fungal infections. Ganciclovir is used to treat cytomegalovirus. Amantadine is used to treat Parkinson's disease.

A nursing instructor assigns a student nurse to present a clinical conference to the student group about brain tumors in children younger than 3 years of age. The nursing student prepares for the conferences and includes which of the following information in the presentation?

a. radiation is the tx of choice

b. the most significant symptoms are headaches and vomiting

c. head shaving is not required before removal of the brain tumor

d. surgery is not normally performed because of the risk of functional deficits occurring as a result of the surgery

b. the most significant symptoms are headaches and vomiting

The hallmark symptoms of children with brain tumors are headaches and vomiting. The treatment of choice is total surgical removal of the tumor without residual neurological damage. Before surgery, the child's head will be shaved, although every effort is made to shave only as much hair as necessary. Radiation therapy is avoided in children younger than 3 years of age due to the toxic side effects on the developing brain, particularly in very young children.

A child is hospitalized with a diagnosis of lead poisoning, and chelation therapy is prescribed. The nurse caring for the child would prepare to administer which of the following medications?

a. ipecac syrup

b. activated charcoal

c. sodium bicarbonate

d. calcium disodium edetate (EDTA)

d. calcium disodium edetate (EDTA)

EDTA is a chelating agent that is used to treat lead poisoning. Sodium bicarbonate may be used in salicylate poisoning. Ipecac may be prescribed for use in the hospital setting but would not be used to treat lead poisoning. Activated charcoal is used to decrease absorption in certain poisoning situations.

A nurse is teaching the parents of a child with celiac disease about dietary measures. In the teaching plan, the nurse will instruct the parents to:

a. restrict corn and rice in the diet

b. restrict fresh vegetables in the diet

c. substitute grain cereals with pasta products

d. read all label ingredients carefully to avoid hidden sources of gluten

d. read all label ingredients carefully

Gluten is found primarily in grains of wheat and rye. (BROW, barley, rye, oats, wheat.) Corn and rice become substitute foods. Gluten is added to many foods as hydrolyzed vegetable protein that is derived from cereal grains, therefore labels need to be read. Corn and rice as well as vegetables are acceptable in a gluten-free diet. Many pasta products contain gluten. Grains are frequently added to processed foods for thickness or fillers.

A child is admitted to the hospital with a suspected diagnosis of pneumococcal pneumonia. The nurse prepares to implement which of the following. 

a. start antibiotic therapy stat

b. monitor the child's RR and breath sounds

c. allow the child to go to the playroom to play with other children

d. have a chest radiograph done to determine how much consolidation is in the lungs

b. monitor the child's RR and breath sounds

A complication of pneumococcal pneumonia is pleural effusion, so the respiratory status of the child needs to be monitored. Antibiotic therapy is not started until cultures are obtained. The child should not be allowed to be around other children at the time. A chest radiograph needs to be prescribed by the physician.

A child is admitted to the hospital with a diagnosis of rheumatic fever. The nurse reviews the blood laboratory findings, knowing that which of the following will confirm the likelihood of this disorder?

a. increased leukocyte count

b. decreased hemoglobin count

c. increased antistreptolysin-O (ASO)

d. decreased erythrocyte sedimentation rate

c. increased antistreptolysin-O (ASO)

Children suspected of having rheumatic fever are tested for streptococcal antibodies. The most reliable and best standardized test to confirm the diagnosis is the ASO titer. An elevated level indicates the presence of rheumatic fever.

A child is admitted to the pediatric unit with a diagnosis of celiac disease. Based on this diagnosis, the nurse expects that the child's stools will be:

a. malodorous

b. dark in color

c. unusually hard

d. abnormally small in amount

a. malodorous

The stools of a child with celiac disease are characteristically malodorous, pale, large (bulky), and soft(loose). Excessive flatus is common, and bouts of diarrhea may occur.

A nurse is caring for an infant who has diarrhea. The nurse monitors the infant for which early sign of dehydration?

a. cool extremities

b. gray, mottled skin

c. capillary refill of 2 seconds

d. apical pulse rate of 200 beats per minute

d. apical pulse rate

Dehydration causes interstitial fluid to shift to the vascular compartment in an attempt to maintain fluid volume. When the body is unable to compensate for fluid lost, circulatory failure occurs. The blood pressure will decrease and the pulse rate will increase. this will be followed by peripheral symptoms. 

Options a, b, and c are wrong, and these assessment findings relate to peripheral circulatory status.

The parents of a male newborn who is not circumcised request information on how to clean the newborn's penis. The nurse tells the parents to:

a. retract the foreskin and cleanse the glans with every diaper change

b. retract the foreskin and clean the glans when bathing the newborn

c. avoid retracting the foreskin to cleanse the glans because this may cause adhesions

d. retract the foreskin no farther than it will go and replace it over the glans after cleaning

c. avoid retracting the foreskin to clean the glans because this may cause adhesions

In newborn males, prepuce is continuous with the epidermis for the glans and is nonretractable. Forced retraction may cause adhesions to develop. It is best to allow separation to occur naturally, which will happen between 3 years and puberty. Most foreskins are retractable by 3 years of age and should be pushed back gently for cleaning once a week. Therefore, option c is correct.

A child is sent to the school nurse by the teacher. On assessment, the school nurse notes that the child has a rash. The nurse suspects that the child has erythema infectiosum (5th disease) because the skin assessment revealed a rash that is:

a. a discrete rose-pink maculopapular rash on the trunk

b. a highly pruritic, profuse macule to papule rash on the trunk

c. an erythema on the face that has a "slapped face" appearance

d. a discrete pinkish red maculopapular rash that is spreading to the trunk

c. an erythema on the face that has a "slapped face" appearance

The classic rash of erythema infectiosum, or 5th disease, is the erythema on the face. The discrete rose-pink maculopapular rash is the rash of an exanthema subitum (roseala). The highly pruritic, profuse macule to papule rash is the rash of varicella (chickenpox). The discrete pinkish red maculopapular rash is the rash of rubella (german measles).

A home care nurse visits a 3 year old child with chickenpox. The child's mother tells the nurse that the child keeps scratching the skin at night and asks the nurse what to do. The nurse tells the mother to:

a. place soft cotton gloves on the child's hands at night

b. apply generous amounts of a cortisone cream to prevent itching

c. give the child a glass of warm milk at bedtime to help the child sleep

d. keep the child in a warm room at night so the covers will not  cause the child to scratch

a. place soft cotton gloves on the child's hands at night

Gloves will keep the child from scratching the open lesions from chickenpox. Generous amounts of any topical cream can lead to drug toxicity. A warm room will increase the child's skin temperature and make itching worse. Warm milk will have no affect on itching.

A community health nurse is providing instructions to a group of mothers regarding the safe use of car seats for toddlers. The nurse determines that the mother of a toddler understands the instructions if the mother states which of the following?

a. the car seat should never be placed in a face-forward position

b. the car seat can be placed in a face-forward position at any time

c. the car seat is suitable for the toddler until the toddler reaches the weight of 40 pounds

c. the car seat is suitable for the toddler until the toddler reaches the weight of 40 pounds

The transition point for switching to the forward-facing position is defined by the manufacturer of the safety seat but is generally at a body weight of 9 kg (20 pounds). The car safety seat should be used until the child weighs at least 40 pounds, regardless of age. 

A clinical nurse instructs an adolescent with iron deficiency anemia about the administration of oral iron preparations. The nurse tells the adolescent that it is best to take the iron with:

a. cola

b. soda

c. water

d. tomato juice

d. tomato juice

Iron should be administered with vitamin-C-rich fluids, because vitamin C enhances the absorption of the iron preparation. Tomato juice has a high ascorbic acid (vitamin C) content, whereas water, soda, and cola do not contain vitamin C. 

A clinic nurse provides instruction to a mother regarding the care of her child who is diagnosed with croup. which statement by the mother indicates the need for further instructions?

a. I will give Tylenol for fever.

b. I will give cough syrup every night at bedtime.

c. Sips of warm fluids during a croup attack will help.

d. I will place a cool-mist humidifier next to my child's bed.

b. I will give cough syrup every night at bedtime.

The mother needs to be instructed that cough syrup and cold medicines are not to be administered, because they may dry and thicken secretions. Sips of warm fluid will relax the vocal cords and thin the mucus. A cool-mist humidifier rather than a steam vaporizer is recommended because of the danger of the child pulling the machine over and causing a burn. Acetaminophen (Tylenol) will reduce the fever.

A nurse is providing discharge instructions to the mother of an 8-year-old child who had a tonsillectomy. The mother tells the nurse that the child loves tacos and asks when the child can safely eat one. The appropriate response to the mother is:

a. in 1 week

b. in 3 weeks

c. six days after surgery

d. when the doctor says it is okay

b. in 3 weeks

Rough or scratchy foods as well as spicy foods are avoided for 3 weeks after a tonsillectomy. Citrus juices that irritate the throat need to be avoided for 10 days. Red liquids are avoided because they will give the appearance of blood if the child vomits. 

A child with a diagnosis of umbilical hernia has been scheduled for surgical repair in 2 weeks. The clinical nurse instructs the parents about the signs of possible hernial strangulation. The nurse tells the parents that which sign would require physician notification?

a. fever

b. diarrhea

c. vomiting

d. constipation

c. vomiting

The parents of a child with an umbilical hernia need to be instructed regarding the signs of strangulation, which include vomiting, pain, and an irreducible mass at the umbilicus. The parents should be instructed to contact the physician immediately if strangulation is suspected.

A teenager returns from the gynecological clinic for a follow-up visit for a sexually transmitted infection (STI). Which statement by the teenager indicates the need for further teaching?

a. I know you won't tell my parents I'm sick

b. I finished all the antibiotics, just like you said

c. I always make sure that my boyfriend uses a condom

d. my boyfriend doesn't have to come in for tx, does he?

d. 

When treating STIs, all sexual contacts must be contacted and treated with medication. Client's should always use a condom with any sexual contact. The treatment of a teenager at a gynecological clinic is confidential, and parents will not be contacted, even if the client is less than 18. Clients should always finish the course of antibiotics prescribed by the health care provider.

A clinic nurse is performing an assessment on a 12 month old infant. The nurse determines that the infant is demonstrating the highest level of development achievement if the 12 month old is able to:

a. produce cooing sounds

b. obey simple commands

c. produce babbling sounds

d. begin to use simple words

d. begin to use simple words

1-3 months old infant will produce cooking sounds.

Babbling is common in a 3-4 months old.

8-9 months, infant starts to understand and obey simple commands such as "wave bye-bye"

The use of single consonant babbling occurs between the ages of 6-8 months.

An infant who has been diagnosed with acute chalasia is admitted to the hospital. During the nursing history, the mother tells the nurse, "I am concerned that I am somehow causing my infant to vomit after feeding her." Considering this statement, which nursing diagnosis is most appropriate?

a. anxiety r/t hospitalization of the infant for chalasia

b. impaired parenting r/t an unrealistic expectation of self

c. noncompliance r/t denial that chalasia is a physiological defect

d. deficient knowledge r/t a lack of exposure to feeding an infant with chalasia

The infant is vomiting because of a physiological problem that is not caused by the parent. The misconception that the mother is responsible for the problem is an unrealistic expectation of self and may result in the mother having a decreased perception of her ability to adequately parent the child. The nurse should assist the mother with understanding that she is not responsible for the child's condition. The mother's statement does not reflect symptoms of Anxiety regarding the child's hospitalization. The mother states a concern regarding her own behavior. There are no data in the question to support that the mother is experiencing denial that chalasia is a physiological defect. Again, there are insufficient data to support that the mother has not been instructed on feeding techniques for a child with chalasia.

A clinic nurse in a well-baby clinic is collecting data regarding the motor development of a 15 month old child. Which of the following is the highest level of development that the nurse would expect to observe in this child?

a. turning a doorknob

b. unzips a large zipper

c. builds a tower of 2 blocks

d. puts on simple clothes independently

c. builds a tower of 2 blocks

At the age of 15 months, the nurse would expect that the child could build a tower of 2 blocks. A 24 month old child would be able to turn a doorknob and unzip a large zipper. At the age of 30 months, the child would be able to put on simple clothes independently.

A child is hospitalized with a diagnosis of nephrotic syndrome. Which assessment would the nurse expect to note in the child?

a. weight loss 

b. constipation

c. hypotension

d. abdominal pain

d. abdominal pain

Clinic manifestations associated with nephrotic syndrome include edema, anorexia, fatigue, and abdominal pain from the presence of extra fluid in the peritoneal cavity.

Diarrhea caused by the edema of the bowel occurs and may cause the decreased absorption of nutrients. Increased weight and a normal blood blood pressure is noted.

A child is admitted to the hospital with a suspected diagnosis of von Willebrand's disease. On assessment of the child, which symptom would most likely be noted?

a. hematuria

b. presence of hematomas

c. presence of hemarthrosis

d. bleeding from the mucous membranes

d. bleeding from the mucous membranes

The primary clinical manifestations of von Willebrand's disease are bruising and mucous membrane bleeding from the nose, mouth, and GI tract. Prolonged bleeding after trauma and surgery, including tooth extraction may be the first evidence of abnormal hemostasis in those with mild disease.

In females, menorrhagia and profuse postpartum bleeding may occur. Bleeding associated with von Willebrand's disease may be severe and lead to anemia and shock, but, unlike what is seen in clients with hemophilia, deep bleeding into joints and muscles are rare. 

Options 1, 2, and 3 are characteristic of those signs found in clients with hemophilia.

A nurse is assessing the level of consciousness of a child with a head injury and documents that the child is obtunded. On the basis of this documentation, which observation did the nurse note?

a. The child is unable to think clearly and rapidly

b. The child is unble to recognize place or person

c. The child requires considerable stimulation for arousal

d. The child sleeps unless aroused and, when aroused, has limited interaction with the environment.

d. The child sleeps unless aroused and, when aroused, has limited interaction with the environment.

If the child is obtunded, the child sleeps unless aroused and, when aroused, has limited interaction with the environment.

a. describes confusion

b. describes disorientation

c. describes stupor

A mother brings her child to the health care clinic. The child has been complaining of severe headaches and has been vomiting. The child has a high fever, and the nurse notes the presence of nuchal rigidity and suspects a possible diagnosis of bacterial meningitis. The nurse continues to assess the child for the presence of Kernig's sign. Which finding would indicate the presence of this sign?

a. calf pain when the foot is dorsiflexed

b. pain when the chin is pulled down to the chest

c. the inability of the child to extend the legs fully when lying supine

d. the flexion of the hips when the neck is flexed from a lying position

c. the inability of the child to extend the legs fully when lying supine

Kernig's sign is the inability of the child to extend the legs fully when lying supine. Brudzinski's sign is flexion of the hips when the neck is flexed from a supine position. Both of these signs are frequently present in clients with bacterial meningitis. Nuchal rigidity is also present with bacterial meningitis, and it occurs when pain prevent the child from toughing the chin to the chest. Homan's sign is elicited when pain occurs in the calf region when the foot is dorsiflexed. It is present in clients with thrombophlebitis.

What is the normal value of sodium in a child's blood chemistry?

Intravenous immune globulin (IVIG) therapy is prescribed for a child with idiopathic thrombocytopenic purpura (ITP.) The nurse determines that this medication is prescribed for the child to:

a. increase the number of circulating platelets

b. provide immunity to the child against infection

c. decrease the production of antiplatelet antibodies

d. prevent infection after exposure to communicable diseases

a. increase the number of circulating platelets

IVIG is usually effective to rapidly increase the platelet count. It is thought to act by interfering with the attachment of antibody-coded platelets to receptors on the macrophage cells of the reticuloendothelial system. Corticosteroids may be prescribed to enhance vascular stability and to decrease the production of antiplatelet antibodies. Options b, c, and d are unrelated to giving this medication.

A child is admitted to the hospital with a suspected diagnosis of bacterial endocarditis. The child has been experiencing fever, malaise, anorexia, and a headache, and diagnostic studies are performed on the child. Which of the following studies will primarily confirm the diagnosis?

a. a blood culture

b. a sedimentation rate

c. a white blood cell count

d. an ECG

a. a blood culture

The diagnosis of bacterial endocarditits is primarily established on the basis of a positive blood culture of the organisms and the visualization of vegetation on ECG studies. Other lab tests that may help to confirm the diagnosis are an ESR and C-reactive protein level. An EGC is not usually helpful for the diagnosis of bacterial endocarditis. 

A child is admitted to the hospital with a suspected diagnosis of idiopathic thrombocytopenic purpura, and diagnostic studies are performed. Which of the following diagnostic results are indicative of this disorder?

a. an elevated platelet count

b. elevated hemoglobin and hematocrit levels

c. a bone marrow exam showing an increased number of megakaryocytes

d. a bone marrow exam indicating an increased number of immature WBCs

c. a bone marrow exam showing an increased number of megakaryocytes

The lab manifestations of ITP include the presence of a low platelet count of usually less than 20,000 cells/mm3. Thrombocytopenia is the only lab abnormality expected with ITP. If there has been significant blood loss, there is evidence of anemia in the blood cell count. If a bone marrow exam is performed, the results with ITP show a normal or increased number of megakaryocytes, which are the precursors or platelets. Option d indicates the bone marrow result that would be found in a child with leukemia.

A nurse is caring for an infant with laryngomalacia (congenital laryngeal stridor.) Which position would the nurse place the infant in to decrease the incidence of stridor?

a. prone

b. supine

c. supine with neck flexed

d. prone with the neck hyperextended

d. prone with the neck hyperextended

The prone position with the neck hyperextended improves the child's breathing. Options a, b, and c are not appropriate positions.

A nurse is preparing to suction a tracheotomy on an infant. The nurse prepares the equipment for the procedure and turns the suctioning to which setting?

a. 60 mm Hg

b. 90 mm Hg

c. 110 mm Hg

d. 120 mm Hg

b. 90 mm Hg

The suctioning procedure for pediatric clients varies from that used for adults. Suctioning in infants and children requires the use of a smaller suction catheter and lower suction settings as compared with those used for adults. Suction settings for a neonate are 60 to 80 mm Hg; for an infant, they are 80 to 100 mm Hg; and, for larger children, they are 100 to 120 mm Hg.

A home-care nurse visits a child with a diagnosis of celiac disease. Which finding best indicates that a gluten-free diet is being maintained and has been effective?

a. the child is free of diarrhea

a. the child is free of diarrhea

Watery diarrhea is a frequent clinical manifestation of celiac disease. The absence of diarrhea indicates effective treatment. Bloody stools are not associated with this disease. The grains of wheat and rye contain gluten and are not allowed. A balance of fluids and electrolytes does not necessarily demonstrate the improved status of celiac disease.

A nurse is caring for a child with a dx of Kawasaki disease, and the mother of the child asks the nurse about the disorder. The nurse bases the response to the mother on which description of this disorder?

a. it is an acquired cell-mediated immunodeficiency disorder

b. it is a chronic multisystem autoimmune disease characterized by the inflammation of connective tissues

b. it is an antiinflammatory autoimmune disease that affects theconnective tissue of the heart, joints, and subQ tissues

d. it is also called mucocutaneous lymph node syndrome and is a febrile generalized vasculitis of unknown etiology

d. it is also called mucocutaneous lymph node syndrome and is a febrile generalized vasculitis of unknown etiology

Kawasaki disease, also called mucocutaneous lymph node syndrome, is a febrile generalized vasculitis of unknown etiology. Option 1 describes human immunodeficiency virus infection. Option 3 describes rheumatic fever. Option 2 describes systemic lupus erythematosus.

A nurse is preparing to teach the parents of a child with anemia about the dietary sources of iron that are easy for the body to absorb. Which food item would the nurse include in the teaching plan?

a. fruits

b. poultry

c. apricots

d. vegetables

b. poultry

Dietary sources of iron that are easy for the body to absorb include meat, poultry, and fish. Vegetables, fruits, cereals, and breads are also dietary sources of iron, but they are harder for the body to absorb.