CHAPTER 26 - Nursing Care of a Family With a High-Risk Newborn

1. Which response by Mrs. Atkins, whose infant was born prematurely, would alert the nurse she may need further teaching?
a. “Holding my baby directly on my chest will help with warmth and temperature stability.”
b. “I like singing to him and notice that helps his temperature stay even.”
c. “I’ll use this adorable little hat I was given to help him stay warm.”
d. “I’m afraid he’ll suffocate if he sleeps on a warmed mattress.”

Correct answer: C. It is critical to guard against hypothermia in low–birth-weight infants because they are unable to
increase their metabolic rate to warm themselves. The study revealed that stockinette caps alone are not adequate to do this.
The nurse should provide teaching to Mrs. Atkins regarding precautions to prevent hypothermia

2. Baby Atkin’s father plays in a garage band for a hobby, and his mother enjoys knitting. The nurse’s care team has agreed to
design a developmental care environment for Baby Atkins that will both make him feel secure and help his parents interact
more with him. The care team determines which action is best?
a. Turning up the lights in his part of the nursery so he can see his parents better
b. Asking the father to bring in a recording of his band to play for the baby
c. Arranging a blanket Mrs. Atkins has knit into a circle or “nest” for the baby
d. Reminding the parents that he must stay awake for extended periods for his eyes to fully develop

Correct answer: C. Developmental care is aimed at instilling a sense of safety and security into the child by reducing stimuli
such as loud noise or bright lights. The nurse recommending a homemade blanket could give him a feeling of being sheltered.
None of the other listed actions would have this beneficial effect.

3. Baby Atkins has surfactant administered at birth. When Mrs. Atkins asks why her baby had to receive surfactant, the nurse
determines which response is best?
a. “Surfactant helps him raise his lung secretions by relaxing his airway.”
b. “Surfactant keeps his tiny lung sacs open and this improves his breathing.”
c. “Surfactant relaxes his respiratory muscles to synchronize his breathing pattern.”
d. “Surfactant reduces the amount of lung secretions that he produces.”

Correct answer: B. The nurse should teach Mrs. Atkins that surfactant is not a relaxant, and it does not influence respiratory
rate. It acts on the surface of the alveoli to help them not to stick together upon expiration. Without surfactant, the sticky
alveoli collapse, the sides stick together, and are very difficult to inflate.

4. Baby Atkins is at risk for having apnea and bradycardia. What initial nursing intervention should the nurse initiate during
these events to maintain his vital signs in a safe range?
a. Administer 2 drops (gtt) of oral theophylline by a small syringe into his mouth.
b. Gently flick the sole of his foot to stimulate the baby to breathe again.
c. Monitor rectal temperatures to prevent him from becoming cold or hot.
d. Vigorously suction him every 2 hours to keep the airway clear of secretions.

Correct answer: B. The nurse should flick the foot gently to stimulate the infant to remember to breathe. Theophylline
would not be an initial intervention. Both rectal temperature assessment and vigorous suctioning can produce a vagal
stimulation causing bradycardia. In addition, the infant should only be suctioned as needed, not every 2 hours.

5. The nurse is concerned that Baby Atkins will develop hyperbilirubinemia because of his immaturity. Because the prevention
of jaundice is one of the NICU’s quality indicators, what priority nursing intervention would the nurse initiate to best prevent
hyperbilirubinemia in Baby Atkins?
a. Administering phenobarbital to all infants to help prevent jaundice
b. Urging all mothers to breastfeed early to promote infants’ bowel motility
c. Placing all preterm and SGA infants in warm, dark, comforting environments
d. Immediately placing all infants under phototherapy following birth

Correct answer: B. Nurses should urge all mothers to breastfeed early. Early feeding enhances bilirubin clearance. Infants
should be in a well-lit environment to enhance binding of bilirubin. Phototherapy is not initiated until the infant’s total serum
bilirubin level rises to a specific age- and gestational age–dependent level. An older therapy, phenobarbital is rarely used
today to combat neonatal jaundice

6. Mrs. Atkins asks the nurse why the baby in the incubator next to her baby whose mother has diabetes mellitus was fed so
soon after birth. Why is it important for infants of women with diabetes to be fed early?
a. Their stomachs are larger than usual due to overgrowth.
b. This helps prevent rebound hypoglycemia from occurring.
c. The mother probably didn’t eat much during her labor.
d. This helps clear thick mucus from the lower intestinal tract.

Correct answer: A. The nurse should explain that if a woman with diabetes has hyperglycemia during pregnancy; her baby
is apt to be born large and lethargic—facts that are a potential source of stress. The infant will not necessarily have diabetes,
impaired respiratory function, or cognitive deficits.
CHAPTER 40 Nursing Care of a Family When a Child Has a Respiratory Disorder
1. Michael, a 6-year-old, has a nosebleed, and his parents cannot get it to stop. It has been on and off for the past 30 minutes.
The child has congestion and a history of seasonal allergies. The parents have called their pediatric provider for assistance,
and the advice nurse answered the call. Which action by a nurse is best?
a. Advise the parent to pinch the lower part of the nose (alae nasi) for 10 minutes without releasing pressure.
b. Have Michael lean his head back to allow the blood to drain down the back of the throat.
c. Have Michael blow his nose to remove any congestion and clotted blood.
d. Have Michael stop the bleeding with ice packs applied to the face.

Correct answer: A. The nurse should advise the parent to pinch the lower part of the nose (alae nasi) for 10 minutes without
releasing pressure. The nurse should also advise the parent to keep the child in an upright position with his head tilted slightly
forward to minimize the amount of blood pressure in nasal vessels and to keep blood moving forward, not back into the
nasopharynx.

2. Michael’s history reveals he was born with choanal atresia. What assessment may be performed at birth to determine whether
a newborn has this condition?
a. Observe if the infant can breathe well while lying in a prone position.
b. Close the infant’s mouth and observe if he can breathe through his nose.
c. Assess if the infant’s palatine tonsils are blocking the back of the throat.
d. Listen for the sound of either stridor or wheezing upon inhalation.

Correct answer: B. Choanal atresia is blockage of the posterior nares in newborns. The nurse may assess this health problem
by holding the newborn’s mouth closed, then gently compressing first one nostril, and then the other. If atresia is present,
infants will struggle as they experience air hunger when their mouth is closed.

3. Michael has had two recent streptococcal pharyngitis infections. Education on the importance of completing the full course of
prescribed antibiotics is necessary to prevent which complication?
a. Epiglottitis
b. Dental abscesses
c. Rheumatic fever
d. Emphysema

Correct answer: C. The nurse should teach the parents a full course of prescribed antibiotics is necessary to prevent
glomerulonephritis or rheumatic fever.

4. Michael’s 4-year-old roommate in the care unit is scheduled for a tonsillectomy later today. The caregiver wants to know
what types of food they can have at home for him after his tonsillectomy. Which of the following would be appropriate?
a. Grilled cheese sandwich
b. Tomato juice and pretzels
c. Potato chips and dip
d. An ice pop

Correct answer: D. Cold decreases edema and promotes healing. Foods that are salty, have sharp edges, or tarts are difficult
to swallow and should be avoided.

5. Michael has a barking cough, sore throat, and fever. The nurse wants to see whether his throat looks sore and swollen. What
is the safest and most accurate way of performing this assessment?
a. Gag Michael with a tongue blade so you can inspect his tonsils.
b. Ask Michael to press down on his tongue with one of his fingers.
c. Elicit a gag reflex using only one gloved finger.
d. Ask Michael to open his mouth and then visually inspect his throat.

Correct answer: D. Because initiating gagging may cause further airway closure, the nurse should never elicit a gag reflex
on children with a high fever, barky cough, and sore throat. Instead, the nurse should assess his throat with a simple
inspection.

6. The nurse wants to teach Michael’s 3-year-old roommate about peak flow testing. During this diagnostic test, what
instruction should the nurse provide?
a. “Hold your breath until I say and then cough forcefully.”
b. “When I put the meter in your mouth, take a big, deep breath.”
c. “I need you to blow out through the meter as hard and fast as you can.”
d. “Breathe like you usually do when I put the meter against your mouth.”

Correct answer: C. The nurse should instruct the child who is undergoing peak flow testing to place the meter in his or her
mouth and blow out as hard and fast as possible.
CHAPTER 41 Nursing Care of a Family When a Child Has a Cardiovascular Disorder
1. Children with CHF are often prescribed digoxin (Lanoxin). Knowing that this drug possesses a high risk of adverse effects if
given incorrectly, the nurse provides educational materials to Megan’s parents. Which statement by Megan’s mother would
alert the nurse that she has not received all the education that she needs?
a. “I know the drug is thought to help Megan’s heart pump better.”
b. “It’s important I give the exact dose every time.”
c. “If I happen to miss a dose, I will not give double the dose the next time.”
d. “Nausea and vomiting are expected side effects for the first few weeks of treatment.”

Correct answer: D. The nurse would be alerted to the mother’s comment that nausea and vomiting are expected side effects
for the first few weeks of treatment. Although nausea and vomiting are side effects of digoxin (and many medications), the
child would not automatically experience these symptoms after initiation of the medication. If the child does experience these
symptoms, the provider should be contacted immediately and the family should not wait several weeks. All of the other
statements are true.

2. Henry is a 2-month-old with Down syndrome and a VSD (ventricular septal defect). He is in CHF and has been having
difficulty gaining weight so surgery has been scheduled. Based on this study, what will you include in your preoperative
discussions with his family?
a. VSDs are very difficult to repair and children can have many complications after surgery.
b. Because Henry has Down syndrome and his weight is less than expected for his age, he may need a few extra days
on the ventilator or in the ICU, but overall, he should do fine.
c. Henry’s age, being less than 12 months old, puts him at greater risk for complications after VSD surgery.
d. A VSD repair is not done with cardiopulmonary bypass so the risk of complications is significantly less than for
other defects.

Correct answer: B. Henry’s surgery to repair his VSD is open-heart surgery, performed through the breastbone, and he does
require cardiopulmonary bypass. But overall, children who have a VSD repaired do very well. There was a recent study in
2017 where the researchers noted that VSD surgeries overall go very well and infrequently have significant complications.
They did note that children with genetic syndromes and low weight for age at the time of surgery do tend to have prolonged
ICU stays with longer mechanical ventilation times, but they ultimately did well. Therefore, Henry may need his breathing
tube in the ICU for a few days, but he should recover without major complications.

3. After cardiac surgery, infants and children have limitations to their activity and handling. When teaching parents how to help
their children with daily activities, the nurse recognizes it is most important to emphasize which statement?
a. Children are very resilient and recover quickly after cardiac surgery. Parents don’t need to do anything different
when handling their children when they go home.
b. Infants and children should remain in bed or on the couch at home and not be allowed to perform any activities other
than go to the bathroom to prevent pain and injury until they have at least two follow-up visits with their
cardiologist.
c. Infants and children should be restricted from all physical activity for 6 months from the time of their surgery. They
should not lift their arms over their head or be lifted under their arms for the same time period.
d. Infants and children should not be lifted under their arms for 6 weeks from the time of sternal closure. They should
also not participate in physical activity or lift heavy items for this same time period.

Correct answer: D. The nurse should emphasize that after heart surgery requiring a median sternotomy approach, infants
and children will require 6 weeks for the sternum to heal. Limiting participation in physical activities and heavy lifting
(including heavy backpacks for school) will ensure strong healing of the bone and minimal pain for the child. During this
time, children should not be lifted under their arms or pulled by the arms as this will cause significant pain for the child.
Infants should be scooped behind the neck and under their bottoms. Children should be assisted by supporting behind the
back. Surgeries that require a lateral thoracotomy approach are also very painful, and maintaining these same guidelines is
appropriate. Regardless of the surgical approach, all children should use car seat belts, booster seats, or car seats as
recommended. Appropriate placement and fit of these safety restraints will not harm the child after surgery.

4. Marcus is a 12-year-old boy who presents to the emergency department complaining of chest pain and a racing heart that
started suddenly about 1 hour earlier. He says he feels a little tired and dizzy, but otherwise, he is appropriate for age. The
nurse notices during the assessment that his heart rate is 185 beats/min, and the ECG demonstrates a very narrow complex
with P waves that are not visible. The heart rate does not change when Marcus is talking or resting. His blood pressure is
95/70 mmHg, his respiratory rate is 22 breaths/min, and his oxygen saturation is 98% on room air. Based on this assessment
and data, the nurse recognizes Marcus is experiencing which of the following?
a. Sinus tachycardia
b. Supraventricular tachycardia
c. Torsades de pointes
d. Ventricular tachycardia

Correct answer: B. The nurse notes that this heart rate is exceptionally high for a child of this age. This rate and rhythm
meet all of the criteria for SVT: The rate is greater than 160 bpm, it is a narrow complex that does not change with activity
level, and the P waves are not visible. Sinus tachycardia would most likely not have a rate this high, and the P waves would
be visible. Torsades de pointes is a chaotic and pulseless rhythm so the child would not have other vital signs that were life
sustaining. Ventricular tachycardia in children is typically a very wide complex rhythm; it may or may not have associated
vital signs that are near normal. This child has presented with classic symptoms, ECG, and onset pattern of SVT.
5. The nurse is caring for James, a 2-year-old boy who has been admitted to the pediatric floor after his parents noted a fever of
103°F (39.4°C) for 2 days. He had an ASD (atrial septal defect) repaired approximately 4 weeks earlier and has since
developed a pericardial effusion. The effusion was drained, and the fluid was purulent. He is now being treated with IV
antibiotics. The nurse enters the room and notes that James is only breathing about 5 breaths/min and his heart rate on the
monitor is 40 beats/min. What is the nurse’s first action?
a. Call for help and wait for direction when the arrest team arrives.
b. Run from the room and get the defibrillator, calling for help as you go.
c. Call the pediatric cardiologist to perform an echocardiogram and evaluate for reaccumulation of the pericardial fluid.
d. Call for help and begin providing compressions per basic life support (BLS) protocol (CPR).

Correct answer: D. The nurse knows that regardless of the child’s underlying medical disorder or etiology of a pediatric
arrest, ensuring a patent airway and providing appropriate respirations is paramount. Children more frequently experience a
pure respiratory decompensation or arrest prior to any cardiac involvement, even in children with underlying cardiac
disorders. Positioning the child in a sniffing position to ensure an optimal airway and providing respiratory support through
bag/mask ventilation will likely reverse the bradycardia. Regardless, the nurse should begin with respiratory support and
provide cardiac support with compressions once the nurse is able or when help arrives. The nurse should never leave a child
who is decompensating to retrieve equipment or personnel. As more personnel arrive, they will fill the other necessary roles
of CPR provider, documentation, medications, and medical support.

6. Charlene is a 15-year-old female with a family history of hypertension. She is overweight and is being evaluated because she
has had four separate blood pressure readings that are higher than 95% for her gender, age, and height. Her mother is with her
and wants to know what she can do to get her daughter’s blood pressure down. Which response by the nurse is best?
a. Explain to Charlene’s mother that the high blood pressure is genetic and her daughter can only take medications to
treat the problem.
b. Tell her mother that Charlene should decrease her salt intake.
c. Discuss with Charlene and her mother heart-healthy changes such as increasing her activity level, increasing her
vegetable intake, and decreasing her sodium intake.
d. Develop an exercise plan and review it with Charlene’s mother to implement with her daughter in the coming
months.

Correct answer: C. It is important for the nurse to include the child when discussing management strategies. Adolescents
(and many school-age children) are quite capable of participating in conversations about their health and wellness, and any
treatment plan will be better followed if the child was included in its development or has an understanding of the importance
of such a plan. Charlene needs to address not only her diet but also her weight and most likely her activity level. By working
with both Charlene and her mother, the nurse’s treatment strategies are more likely to be effective.
CHAPTER 42 Nursing Care of a Family When a Child Has an Immune Disorder
1. Dexter is at his primary care provider’s office and the nurse has been asked to assist with his physical examination. What
safety intervention should the nurse use with Dexter because he’s known to have many allergies?
a. Assess his blood pressure using a new blood pressure cuff.
b. Distract him by showing him a tropical fish tank.
c. Spot-check his oxygen saturation using pulse oximetry.
d. Use non latex gloves to conduct the examination.

Correct answer: D. The nurse is aware that repeated exposures to latex can create allergies in sensitive children. Distraction
does not help protect his safety, and the use of a new blood pressure cuff does not prevent allergic reactions.

2. When Dexter’s mother heard he had another allergic diagnosis, she wanted Dexter worked up for an immune system disorder
“because he has colds all of the time.” When reviewing the blood work of a child with allergic rhinitis, what results are most
helpful? Select all that apply.
a. Specific IgE levels to cat, dog, tree, grass, and weed mix
b. Serum immunoglobulins (IgG, IgA, and IgM)
c. Complete blood count with differential
d. Basic metabolic panel
Correct answer: A, C. A complete blood count with differential is always the best starting point to evaluate a child like
Dexter. Allergic children generally have a higher number or proportion of eosinophils in the blood. Children with
immunodeficiencies may have elevated neutrophil counts if they have an active bacterial infection. At baseline, a reduced
lymphocyte count or percentage may be a “red flag” for an immunodeficiency. Allergic children generally have elevated IgE
levels, both the overall serum IgE as well as allergen-specific IgE.

3. Dexter’s mother asks the nurse about the potential risks and benefits of immunotherapy, stating that some websites she has
consulted convey dire warnings against the practice. What potential benefit could the nurse describe to Dexter’s mother to
alleviate her anxiety?
a. Dexter will recover more quickly from infections.
b. Dexter will be protected against secondary infections.
c. Dexter’s level of helpful immunoglobulins will be increased.
d. The overall health of Dexter’s immune system will be increased.

Correct answer: C. The nurse should teach that hyposensitization increases the number of IgG immunoglobulins, which
then block the action of IgE immunoglobulins that are involved in an allergic response. Immunotherapy does not improve the
broader function of the immune system or protect against infection.

4. Any child can have an anaphylactic reaction to a food, drug, or insect sting, and Dexter is at risk because of his allergy
history. If Dexter, who weighs 48 kg, had an anaphylactic reaction after a bee sting, what is the correct dose of epinephrine
for a school nurse or staff member to give him?
a. 0.03 mg
b. 0.15 mg
c. 0.3 mg
d. 3.0 mg

Correct answer: C. Epinephrine is the drug of choice for an anaphylactic reaction because it quickly causes bronchodilation,
immediately enlarging a constricted airway. The nurse would administer 0.3 mg of the drug.

5. Dexter is prone to allergies. When planning his care, what desired outcome should the nurse prioritize?
a. Dexter states that his symptoms do not interfere with being able to play with his friends.
b. Dexter is able to describe the cause of his allergic response.
c. Dexter states that he no longer has allergies.
d. Dexter states he enjoys taking medicine to prevent his allergy symptoms.

Correct answer: A. The nurse would deem treatment successful if the child is able to maintain age appropriate activities
despite having allergies. “Curing” allergies is not always a possibility.

6. Based on the previous study and the fact that Dexter is allergic to peanuts, which statement by Dexter’s mother should cause
a nurse the most concern?
a. “I pack his lunch every day so I’ll know what he eats.”
b. “He doesn’t need one of those EpiPen things. They are too expensive, and it’s not like he has a bee sting allergy. If
he goes to a party, I’ll ask if peanuts will be served.”
c. “I know how to read food labels to limit Dexter’s food to things I know are safe.”

Correct answer: B. The nurse knows that many accidental ingestions occur because food was offered by another person. A
willingness to share may include sharing food and a consequent allergic reaction that would best be treated by an EpiPen.
CHAPTER 43 Nursing Care of a Family When a Child Has an Infectious Disorder
1. The nurse determines which action is most effective to ensure Jack, a 10-year-old, constantly washes his hands before meals?
a. Continue to remind him to wash his hands as often as possible.
b. Talk to Jack’s mother about the importance of modeling good hand hygiene practices.
c. Explain to Jack the role that bacteria play in the transmission of illness.
d. Stress that washing his hands makes him look grown-up and responsible

Correct answer: B. The nurse should stress handwashing and the role parents have in setting a good example with this
practice. Parents’ hand-washing practices were noted to influence handwashing in their children. Frequent reminders,
teaching children about bacteria, and characterizing hand hygiene as “grown up” were not specifically noted to be effective
interventions.

2. A nurse is preparing to enter Jack’s room. Because his infection involves potential airborne transmission, what isolation
precautions should the nurse use?
a. Goggles and nonsterile gloves
b. Gown and nonsterile gloves
c. Mask, gown, and nonsterile gloves
d. No precautions provided Jack wears a mask

Correct answer: C. The nurse knows that coughing and sneezing requires droplet precautions (gloves, mask, and gown). If
Jack wears a mask, there may be contaminated surfaces in the room so the nurse needs to guard against these surfaces.

3. Jack’s rash is causing him to scratch his skin. To maintain skin integrity and promote comfort, which action should the nurse
prioritize in his plan of care?
a. Allow him to keep his nails long.
b. Administer an antihistamine as prescribed.
c. Instruct Jack not to ever scratch the lesions.
d. Cover his hands and fingernails with mittens.

Correct answer: B. Although rating his pain would be informative, to stop the itching, administration of an antihistamine by
the nurse would be most effective. Children need their hands free to facilitate self-care.

4. Jack’s sister is home with “mono,” or infectious mononucleosis. In the event that she requires hospital care, assessment
protocols should emphasize what action?
a. Lymph nodes should be palpated before being percussed.
b. The spleen should be evaluated by non touching maneuvers using the scratch test.
c. Lymph nodes should be assessed by Doppler.
d. Petechiae should be lightly massaged.

Correct answer: B. The nurse would assess for mono by evaluating the spleen by non touching maneuvers using the scratch
test. The spleen enlarges to destroy the affected cells, so the spleen could rupture easily on pressure. Petechiae should not be
massaged; percussion and the use of a Doppler are unnecessary during assessment.

5. A nurse on the care team calls off work because she’s worried she has contracted mumps (infectious parotitis). Which of the
following symptoms is most associated with mumps?
a. A productive cough and a severe runny nose
b. Pronounced swelling behind both of her ears
c. Swelling above the jawline in front of the ear, obscuring the jaw line
d. Adenoid tonsils are reddened and swollen and hurt

Correct answer: C. Mumps cause a parotid gland enlargement without skin erythema in the majority of patients. This
enlargement will obscure the angle of jaw and therefore is helpful from differentiating it from submaxillary adenitis
(inflammation of lymph nodes). The best method of differentiation is to place a hand along the jawline. If the major amount
of swelling is above the hand, it is probably mumps.

6. Jack, who has varicella, is missing his school friends so is eager to return to school. When should the nurse inform the school
nurse that it would be safe for Jack to return to school?
a. Whenever he feels that he is strong enough
b. When all the lesions have dried and there are no new lesions
c. As soon as his fever is within normal range
d. One week after he began the antibiotic

Correct answer: D. The nurse would inform the school nurse that scarlet fever is contagious for 1 to 7 days after the
appearance of disease symptoms, so Jack will no longer be infectious after a week. A faster return to school may result in the
infection of other children.
CHAPTER 44 Nursing Care of a Family When a Child Has a Hematologic Disorder
1. Lana, who has thalassemia major, is scheduled for a bone marrow transplant, and her mother is highly anxious about this
upcoming procedure. The nurse recognizes which statement is most accurate and best exemplifies patient-centered care?
a. “If you can hold her still during the procedure, the pain will pass more quickly for her.”
b. “We will go to great lengths to make sure Lana doesn’t develop an infection.”
c. “Lana will need to lie still while the new bone marrow infuses into her bones.”
d. “She will not need any further bone marrow aspirations after this.”

Correct answer: B. The nurse reassuring Lana’s mother that the consequent risks of infection will be addressed
acknowledges potential risks while still providing reassurance. It would be inappropriate for the nurse to have the child’s
mother restrain her during a painful procedure. It would also be inaccurate to reassure her that this is a one time event.

2. Lana has received iron chelation therapy by deferoxamine in the past. Which statement by her mother would best assure the
nurse she understands the use and action of iron chelation therapy?
a. “I know the drug acts to remove excess iron from my child.”
b. “I have to check Lana’s pulse before I turn on the pump.”
c. “The drug is used to increase the level of iron in bone cells.”
d. “The drug has minimal side effects, so I can’t really give it wrong.”

Correct answer: A. The nurse knows the mother understands iron chelation therapy when she states that the drug acts to
remove excess iron from her child. Iron chelation therapy removes excess iron from the body to prevent hemosiderosis. The
mother needs to assess voiding, not pulse, before administration.

3. Which would be the best exercise for Joey, who has sickle-cell disease, and his father who has the sickle-cell trait?
a. Playing video games with each other
b. Joining a swimming program at their local YMCA
c. Watching sports together on TV each evening
d. Organizing a touch (no contact) football game each weekend

Correct answer: B. The nurse could suggest that swimming would be a healthy and low-risk activity. To protect the father,
playing football would be inadvisable. Sedentary activities are not an advantage for either father or son.

4. Joey, who has sickle-cell anemia, is being treated for sickle-cell crisis. Which statement by his father would best assure the
nurse that Joey is receiving adequate nursing care?
a. “He never used to understand why he had these crises, but now, he can describe the reason.”
b. “He says that his pain is actually quite manageable now.”
c. “He says that the nurses he’s met so far are such nice people.”
d. “He’s looking forward to getting home, but he really doesn’t mind it here.”

Correct answer: B. Pain control is paramount during sickle-cell crises. As a result, evidence of adequate pain control is a
nursing priority over positive expressions about his time in hospital, even though these are certainly desirable. The nurse
should perform health education also, but pain control is the priority.

5. Autoimmune acquired hemolytic anemia can occur in any child. The nurse identifies which usual cause of this disorder as
important for team members to know?
a. Allergy to the protein found in fish or shrimp
b. A mutant gene similar to sickle-cell anemia
c. An elevated (increased) eosinophil cell count
d. Antibody production against red blood cells

Correct answer: D. The nurse should inform the team members that autoimmune acquired hemolytic anemia affects red
blood cell counts and a CBC should be performed promptly.

6. Lana develops idiopathic thrombocytopenic purpura (ITP) after a viral infection. The nurse identifies which action as most
important?
a. Caution Lana and her mother that she will bruise easily.
b. Show Lana how to do a finger-stick test for glucose.
c. Tell Lana to report if she develops a sharp headache.
d. Show her mother how to test Lana’s urine for protein.

Correct answer: A. Idiopathic thrombocytopenia purpura (ITP) is a deficiency of platelets so the nurse should caution Lana
and her mother that Lana will bruise easily. Assessments related to blood glucose levels, headache, and proteinuria are not
priorities.
CHAPTER 45 Nursing Care of a Family When a Child Has a Gastrointestinal Disorder
1. Barry has frequent bouts of vomiting. If the nurse is caring for Barry in a hospital setting after repeated bouts of vomiting, the
nurse would expect the diagnostic testing to reveal which health problem?
a. Respiratory acidosis
b. Fluid volume excess
c. Metabolic alkalosis
d. Hyperchlorosis

Correct answer: C. The nurse would expect metabolic alkalosis, which occurs because of the loss of gastric acid that occurs
with emesis.

2. Barry’s mother tells the nurse she is anxious about the possibility of “food poisoning” and that she particularly wants to
prevent Salmonella poisoning in her family. Which actions would the nurse suggest?
a. Urge family members to keep their immunizations up to date.
b. Avoid excessive intake of dairy products.
c. Don’t cut vegetables on a cutting board used to cut raw chicken.
d. Wash fruits such as strawberries and grapes with soap and water before eating.

Correct answer: C. The nurse should teach that raw chicken is a potential source of Salmonella. None of the other listed
actions prevents this foodborne illness.

3. Barry’s mother is concerned her new baby will develop pyloric stenosis. To detect vomiting from this, the nurse would assess
the infant at what time?
a. Immediately after feeding
b. An hour after feeding
c. On arising in the morning
d. When the infant cries

Correct answer: A. The nurse should assess the baby for vomiting immediately after feeding because that is a symptom of
pyloric stenosis. The vomiting occurs due to the thickened pylorus muscle causing a delay in gastric emptying.

4. Barry’s family likes to celebrate family events by eating crab, lobster, and shrimp. The nurse recognizes which form of
hepatitis is most apt to be contracted by eating contaminated shellfish?
a. Hepatitis B
b. Hepatitis A
c. Hepatitis E
d. Hepatitis C

Correct answer: B. The nurse recognizes that hepatitis A can be transmitted via fecally contaminated shellfish. The nurse
should advise parents to carefully consider the origin of sushi or shellfish served to their family.

5. The nurse determines which strategy is most effective to decrease parental anxiety when parents are unable to stay with their
child for several hours during the day?
a. Offer to take notes on the medical rounds and verbally provide them to the parents when they arrive.
b. Offer to call them during medical team rounds, so they can participate.
c. Reassure them their child may receive more attentive care than a child whose parent is present.
d. Ensure the parents their child will be well cared for and they can call anytime to check on them

Correct answer: A. The nurse should keep the parents informed by encouraging daily interaction with the medical team.

6. Barry’s aunt and uncle adopted a toddler from a developing country. The nurse learns that a dietitian has been working with
the family because of the child’s history of kwashiorkor. The nurse would expect the dietitian to prioritize what nutrients in
this child’s diet?
a. Water-soluble vitamins
b. Fats and triglycerides
c. Quality protein
d. Vitamin K

Correct answer: C. Kwashiorkor results from a deficiency of protein in the diet; therefore, the nurse would anticipate the
dietitian to prioritize quality protein in the diet.
CHAPTER 46 Nursing Care of a Family When a Child Has a Renal or Urinary Tract Disorder
1. Carey is undergoing a VCUG to help diagnose whether she has vesicoureteral reflux. A nurse collaborates with the radiology
technician to ensure an accurate test that does not cause distress for Carey. What should the nurse emphasize in order to
achieve these goals?
a. The technician will have to read the instructions for the test to Carey.
b. Lying in a large, metal tube is frightening for most children.
c. Children often feel uncomfortable voiding in public.
d. The dye capsules may be too large for Carey to swallow.

Correct answer: C. The nurse should keep in mind that because preschoolers have recently been taught that voiding is a
private activity, voiding while an X-ray is taken may feel uncomfortable. Dye capsules are not used, and the test does not
occur in a metal tube.

2. Carey’s grandmother is concerned because Carey had two UTIs last year. Which of the following statements best shows that
Carey’s grandmother received adequate patient education on the prevention of UTIs?
a. “I won’t allow Carey to drink too much milk or eat foods like yogurt.”
b. “I’ll try to have Carey bathe with bath salts to discourage bacteria in her groin area.”
c. “I’ll be certain to administer all of the antibiotic pills that the doctor prescribes.”
d. “I’ll make sure that Carey doesn’t overexert herself when she’s playing with her friends.”

Correct answer: C. The nurse realizes that the grandmother received adequate education on the prevention of UTIs when
she says she will be certain to administer all the antibiotic pills prescribed. Taking the full antibiotic prescription helps
prevent recurrence of infection. Avoidance of dairy and exercise is unnecessary. The use of bath salts is not recommended.

3. Carey’s grandmother tells the nurse that Carey had symptoms of acute glomerulonephritis last week that were greatly
distressing. The nurse identifies which reported symptom as a typical first symptom of glomerulonephritis?
a. Carey said her left knee hurt, although she didn’t remember bumping it.
b. Carey asked her grandmother why there was blood in the toilet bowl.
c. Carey cried because she was starting to experience cramps.
d. Carey told her grandmother her stomach hurt after using the bathroom

Correct answer: B. The nurse recognizes that the first symptom of poststreptococcal glomerulonephritis is often bright red
hematuria. Abdominal pain and joint pain are atypical.

4. Carey is subsequently diagnosed with nephrotic syndrome. The nurse determines which action is best to provide patient
education for the grandmother?
a. Caution her grandmother to not feed her foods high in salt because salt irritates glomeruli.
b. Encourage her to walk to school daily for exercise.
c. Teach her grandmother to test Carey’s urine for protein using a dipstick.
d. Teach her grandmother how to take Carey’s tympanic temperature daily.

Correct answer: C. The nurse teaches the grandmother that testing for urine protein is important with nephrotic syndrome
because a large amount of protein is lost in urine. The other listed actions do not directly address this health problem.

5. Carey’s grandmother is deeply concerned that Carey will develop chronic kidney disease later in life. What findings in
Carey’s laboratory workup would suggest that her kidneys are failing? (Select all that apply.)
a. She has an elevated serum phosphorus level.
b. She is developing normocytic anemia.
c. Her serum vitamin D level is below normal.
d. Her serum creatinine level is steadily falling.
e. Her blood pressure is steadily increasing

Correct answer: A, B, C, E. The following findings suggest to the nurse that Carey’s kidneys are failing: Anemia develops
from a lack of erythropoietin and vitamin D cannot be synthesized, phosphorus cannot be excreted, and fluid overload causes
hypertension. Creatinine levels increase, not decrease, in cases of renal failure.

6. If Carey developed chronic kidney disease, which action by a nurse would be most helpful?
a. Assure the grandmother she can call the clinic at any time if she has a concern.
b. Ask the grandmother to keep a daily record of conversations she has with Carey.
c. c. Review with the grandmother ways that Carey will require even more care in the future.
d. Help the grandmother learn to say “no” when other family members ask her to help them.

Correct answer: A. Parents thought support from healthcare professionals was important; therefore, it was an appropriate
action for the nurse to assure the grandmother that she can call the clinic any time with questions. Asking the grandmother to
keep a journal or ignore family members could make her time management even more stressful.
CHAPTER 47 Nursing Care of a Family When a Child Has a Reproductive Disorder
1. Suppose Navi, 15 years of age, had undergone diagnostic testing and been diagnosed with precocious puberty. What advice
would a nurse give her parents?
a. Restrict the amount of physical and mental stimulation she receives daily to halt abnormal growth.
b. Although her sexual appearance is advanced, she is not able to conceive.
c. Treat her appropriately for her chronologic age rather than her physical appearance.
d. Do not allow her to eat processed meats, which contain growth hormones.

Correct answer: C. The nurse would teach the parents that although children with precocious puberty appear older, they
function at their chronologic age. Both sexes can be fertile even at such a young age. Dietary and activity restrictions are
unnecessary.

2. Results of the study showed that a yoga program can improve menstrual pain intensity and menstrual distress (Yang & Kim,
2016). Based on this study, what would the nurse recommend to Navi?
a. Make a list of menstrual symptoms each month because listing them helps reduce discomfort.
b. Nonpharmacologic measures can help with coping psychologically with pain.
c. Some exercise programs can genuinely help reduce menstrual pain.
d. The more vigorous the exercise, the less pain the patient is likely to have.

Correct answer: C. The nurse would recommend that Navi participate in an exercise program. Yoga may be an effective
measure to reduce symptoms of dysmenorrhea. Increased exercise intensity is not a guarantee of a proportionate reduction in
pain. The benefits of yoga were not limited to improved coping.

3. The symptoms of PCOS can begin with adolescence. If Navi had this, which of the following facts would a nurse want her to
describe after an educational session?
a. PCOS can be easily treated with an antibiotic.
b. This condition can cause both obesity and interfere with future fertility.
c. The condition usually fades with full maturity at the end of adolescence.
d. Polycystic ovaries are easy to identify because they are so painful.

Correct answer: B. The nurse should teach Navi that polycystic ovary syndrome leads to obesity, hirsutism, irregular
menstrual cycles, and subfertility. It is not easy to reverse the syndrome.

4. Navi, 15 years of age, asks whether it would be safe for her to have breast augmentation. What advice should the nurse give
her?
a. She would not likely be able to breastfeed after undergoing augmentation.
b. Breast implants increase her risk of developing fibrocystic disease.
c. It is safe for girls her age to have this surgery, but careful consideration is needed.
d. Implants increase her risk of breast cancer in later life.

Correct answer: C. The nurse should counsel Navi that if having small breasts interferes with self esteem, a girl can have
surgical augmentation, but this needs careful consideration regarding whether it is necessary at this young age. There is no
increase in disease risk, and breastfeeding is unaffected.

5. Candidal vaginal infections can occur as an opportunistic infection when adolescents are prescribed antibiotics. A nurse
would refer an adolescent for medical treatment of this problem if she reported which of the following?
a. Many yellow pinpoint vaginal lesions
b. Green-tinged pruritic vaginal walls
c. White, cheese-like vaginal discharge
d. Vaginal atrophy with final scarring

Correct answer: C. The nurse would refer the adolescent for further treatment if she had a white, cheese-like vaginal
discharge. Candidal vaginal infections usually cause a thick, pruritic, white vaginal discharge. All of the listed complaints
warrant follow-up, but they are not indicative of candidiasis.

6. Navi does not seem concerned about the possibility she could contract gonorrhea again. What additional health teaching does
she need to better understand how this disease is spread?
a. The microorganism of gonorrhea can be spread via anal, oral, and vaginal intercourse.
b. It is possible for the gonorrhea organism to be spread by anal/penile contact.
c. The low pH of saliva prevents this from being spread by oral/penile contact.
d. Gonorrhea is a virus that can be treated effectively if diagnosed early.

Correct answer: A. The nurse needs to teach Navi that gonorrhea may be spread by singular sexual contact. The disease has
a bacterial etiology. All forms of sexual contact carry risks, and saliva is not bactericidal.
CHAPTER 48 Nursing Care of a Family When a Child Has an Endocrine or a Metabolic Disorder
1. Sandy, Rob’s 14-year-old girlfriend, often comes to the pediatric clinic with him. Sandy has hypopituitarism, and she and Rob
first met at the endocrine clinic. Which of Sandy’s statements would make the nurse believe she needs more education about
her disorder? Select all that apply.
a. “Taking growth hormone subcutaneously is a bother; I hope I’ll be changed to pills soon.”
b. “I know I have to take growth hormone for life but it’s okay; I’ll be alright.”
c. “Growth hormone makes me pee a lot; I asked for a locker near the bathroom.”
d. “Growth hormone turned my cheeks red, but I cover it with makeup so it’s okay.”
e. “I’m determined not to let this take away my quality of life.”

Correct answer: A, B. The nurse should teach that growth hormone is an injectable and can be discontinued in adolescence
when full growth is achieved. It is not recommended to take in the oral form.

2. Rob has a cousin who has developed hyperthyroidism with puberty. Which of the effects of this health problem might a
school nurse need to support Rob’s cousin in dealing with?
a. Slow, lethargic movements
b. Swollen, protuberant abdomen
c. Jittery, nervous mannerisms
d. Reduced intellectual processing

Correct answer: C. The school nurse should be aware that hyperthyroidism increases metabolism, so it leads to rapid, jittery
movements.

3. Rob has his adrenal gland function assessed through diagnostic testing. What is the effect on a child when sufficient
aldosterone cannot be produced?
a. Substantially fewer red blood cells are produced.
b. There is an overall decreased urine output.
c. An excessive amount of sodium is lost in urine.
d. The child’s growth rate increases abnormally.

Correct answer: C. A function of aldosterone is to retain sodium in the body.

4. Rob tells the nurse that he experienced a “honeymoon” period when he was first diagnosed with diabetes mellitus. The nurse
recognizes that this would be demonstrated by which of the following signs?
a. He developed an unnatural craving for sweets.
b. His metabolism increased because of glucose stimulation.
c. He became light-headed or “giddy” every afternoon.
d. His need for injected insulin was drastically reduced.

Correct answer: D. The nurse understands that when children with diabetes first begin injections of insulin, it “reminds”
their pancreas to produce insulin, so for a short period, the child may not need exogenous insulin administered or may need
minimal amounts.

5. Rob needs to adjust his regular insulin dose to the amount of carbohydrates he eats in order to prevent dangerous
complications of his disease. If his insulin-to carbohydrate ratio is 1:10, how many units of insulin should he inject if his
lunch will consist of a hotdog on a bun (24 g), 1 cup chicken noodle soup (7 g), an apple (19 g), and a glass of milk (25 g)?
a. 3 units
b. 7.5 units
c. 9 units
d. 12 units

Correct answer: B. The total amount of carbohydrates included in this lunch is 75 g. At a ratio of 1:10, he would inject 7.5
units of regular insulin.

6. Which comment by LaRoya, a 12-year-old girl who comes to the clinic because she has galactosemia, would make the nurse
believe LaRoya’s family’s quality life is not ideal?
a. “My mother still loves to cook, although no one comes over anymore.”
b. “We go to church every Sunday; my dad helps teach church school.”
c. “We’ve lived in the same house for 10 years; the carpet is getting old.”
d. “My grandmother is hard of hearing, so we have to shout so she hears us.”
Correct answer: A. Based on the study, the nurse would believe LaRoya’s family situation is not ideal because she has lost
friends. The study found that loss of friends had a negative effect on quality of life. The other statements do not reflect an
influence on quality of life.
CHAPTER 49 Nursing Care of a Family When a Child Has a Neurologic Disorder
1. Tasha, 3 years old, is scheduled for a full neurologic examination. What explanation would best prepare her for this?
a. “You’ll need to answer questions carefully so you can pass this test.”
b. “I’ll be asking you to move in different ways, almost like a game.”
c. “I need to find out how healthy or unhealthy your brain seems to be.”
d. “Seizures can be caused by a brain tumor, so that needs to be ruled out.”

Correct answer: B. Neurologic examinations are lengthy so it’s difficult to keep children’s attention unless the nurse
presents the examination as being interesting. There is no “pass” or “fail.” Alluding to the possibility of tumors or an
“unhealthy brain” will likely cause undue anxiety.

2. Tasha’s diagnostic workup will include a lumbar puncture. When collaborating with the physician to perform this procedure,
what nursing action should the nurse prioritize?
a. Explain to Tasha that her back will be washed with a cold liquid.
b. Apply EMLA cream to Tasha’s lumbar region 5 to 10 minutes before the procedure
c. Reassure Tasha that the procedure will not hurt.
d. Help Tasha into a prone position on the procedure table

Correct answer: A. The nurse should inform Tasha that before a lumbar puncture is performed, the lumbar region is
cleansed with a solution that creates a temporary sensation of cold. The procedure is not necessarily painless, and EMLA
should be applied approximately 1 hour beforehand. A side-lying position is used to perform a lumbar puncture.

3. Tasha’s sister Wanda was diagnosed with CP as an infant. What information would the nurse want her parents to know about
her prognosis?
a. Symptoms of CP typically begin to wane just after puberty.
b. The severity of cognitive deficits parallels the severity of physical deficits.
c. CP may occasionally be caused by a childhood vaccine reaction.
d. Symptoms may seem to grow worse as fine motor skill is needed.

Correct answer: D. The nurse should teach the parents that as the child needs fine motor control to achieve at writing or
ambulating, the loss of function may seem more acute. Cognitive and physical effects of the disease do not necessarily exist
to the same degree. Vaccinations do not cause cerebral palsy.

4. Tasha is diagnosed as having bacterial meningitis, and her plan of care is being amended in light of this diagnostic finding.
How long should the care team maintain respiratory precautions for this condition after Tasha begins an antibiotic?
a. 4 hours
b. 24 hours
c. Until her core body temperature returns to normal
d. Until her arterial blood gases return to normal

Correct answer: B. The nursing team should maintain respiratory precautions for at least 24 hours following the beginning
of antibiotic therapy.

5. If Tasha is found to have recurrent seizures, which statement by her mother at a healthcare visit would concern a nurse the
most?
a. “I forgot to give Tasha her medicine twice last week; I have to try harder.”
b. “I feel really sad when children call Tasha names because of her seizures.”
c. “I don’t like having to miss work due to Tasha’s clinic visits.”
d. “I think Tasha’s medicine is giving her headaches; maybe she needs glasses.”

Correct answer: B. The nurse should suspect depression when Tasha’s mother expresses sadness. None of the other listed
statements is as clearly suggestive of depression.

6. Suppose Tasha has a tonic–clonic seizure while in the hospital. Which of the following items should the nurse keep available
at the bedside for a child known to have generalized seizures? (Select all that apply.)
a. Suction
b. Tracheostomy tube
c. Oxygen
d. Call bell
e. Padded tongue blade
Correct answer: A, C, D. It is not likely a child would require a tracheostomy. The nurse should have the call bell, suction,
and supplementary oxygen available to maintain safety and the integrity of the child’s airway.