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Mallari, Pearl Eunice J. BSN IV 7 / Group 26 b. Solitary 1.

. When interviewing a 4 year old client, the nurse should do which of the following? a. Ask detailed questions b. Maintan confidentiality c. Disallow the use of equipment d. Avoid words with double meaning 6. Athena, the mother of a 2 month old is concerned that she may be spoiling her baby by picking her up when she cries. As a registered nurse that graduated in Angeles University Foundation, your best response would be: a. Let her cry for a while before picking her up, so you dont spoil her Gaile, a 5 month old infant was brought to the clinic for her monthly check up. Refer to this situation for questions # 2 - #4. b. Babies need to be held and cuddled; you wont spoil her c. Crying at this age means the baby is hungry; give her a bottle 2. As a nurse in that clinic, how would you assess a healthy growth given these choices: a. Doubling of birth weight b. Tripling of birth weight c. Quadrupling of birth weight a. Mutilation d. Stabiliznig of birth weight b. The dark c. Ghosts 3. Yjay, the father of a Gaile, asked you if he can already introduce solid foods to his daughter. As a knowledgeable nurse, it is appropriate to answer which statement? a. No, you cant yet introduce solid foods to her b. Yes, you can already introduce solid foods to her c. Maybe, you can already introduce solid foods to her d. None of the above 8. Mycklitish is already 2 years of age and is admitted in the hospital. Fiona, her mother, has just left the hospital to check on her other children. Which of the following would best help Mycklitish who is now crying inconsolably? a. Taking a nap b. Peer play group 4. Yjay, now left by his wife, became a single dad in taking care of his daughter, Gaile. But due to the depression in losing his wife, he became an alcoholic and substance abusing person. With what happened, which of the following is Gaile at risk of developing? a. Mistrust b. Shame c. Guilt d. Inferiority a. Let your 1 year old be seen by his Pediatrician because that is already abnormal at his age b. There is nothing to be worried about because most children usually start to walk at 18 month of age 5. Which of the following types of play would the nurse expect to see when assessing a 10 month old infant? a. Parallel d. None of the above c. You can wait 3 months more before being concerned of your childs walking c. Large cuddly dog d. Favorite blanket d. Going to sleep 7. Which of the following fears would the nurse typically associate with toddlerhood? d. If you leave her alone she will learn how to cry herself to sleep c. Associative d. Cooperative

9. When responding to a mother who is concerned that her 1 year old is not yet walking. Having the knowledge about the age when most children should be able to walk, your best response would be:

10. The mother of a 20 month old boy asks the nurse why her son has temper tantrums. Which of the following would be your best response? a. He is probably spoiled and needs discipline b. He cannot express his feelings or frustrations verbally c. It is the only way he can get attention from his mother d.He is expressing his need of identity

15. In a child with reactive airway disease, beta adrenergic agonists, such as albuterol, are administered primarily to do which of the following? a. Decrease postnasal drip b. Dilate bronchioles c. Reduce airway inflammation d. Reduce secondary infections

11. Which of the following statement would you expect Kim, a 5 year old boy, to say whose pet dog has just died? a. Hes not real dead b. The boogie man got him c. Did you hear the joke about.. d. Ill be good so I wont die

Cerebral palsy is the most common disability of childhood. For # 16 only.

permanent

16. Sean is the father of a 4 month old infant. Which of the following statements, if stated by Sean, indicates that his son has Cerebral Palsy? a. Im very worried because my baby has not rolled all the way over yet b. My babys left hip tilts when I pull him to a standing position c. My baby wont lift his head up and look at me; hes so floppy d. He holds his left leg so stiff that I have a hard time putting on his diapers

12. Pam is a child with human immunodeficiency virus (HIV). Which of the following interventions would be inappropriate when caring for Pam? a. Offering large amounts of fresh fruits and vegetables b. Encouraging child to perform at optimal level c. teaching the family about disease transmission d. Using good hand washing before handling the child

Iron deficiency anemia predisposes children at the Toddlerhood and adolescence period, due to the fact that these periods are periods of rapid growth. For # 17 only. 17. Micah is a toddler who is recently admitted at AUFMC with a admitting diagnosis of iron deficiency anemia. Upon admission of Micah, her mother Tifa asked you what are the foods encouraged for her daughter to eat. Upon instruction, which statement suggests further instructions? a. Im going to let her nanny buy Lean meats at the supermarket later b. Can you look for her for a while? I will just go downstairs to buy whole grain breads c. I will cook any dishes containing fish for her d. Oh! I can cook yellow vegetables for her then

13. As a competent nurse, what would you stress when teaching parents to maintain a consistent bedtime schedule for their 9 year old? a. The childs need for sleep is greater now than adolescence b. Nightmares and night terrors are common c. The child often is unaware of his own fatigue level d. Ten hours of sleep every night is the minimum requirement in

14. Lae, a 3 year old, was brought to the emergency room of AUFMC by her parent, with a chief complaint of difficulty of breathing and a presenting sign of nasal flaring with over usage of her accessory muscles upon breathing. Her parent verbalized Lae as having history of asthma. Initial usual interventions were unresponsive on Lae. What do you call this severe and acute condition? a. Intrinsic asthma b. Status asthmaticus c. Reactive airway disease d. Extrinsic asthma

Diabetes Mellitus does not only occur on adults, but also at children. For # 18 only. 18. Which of the following actions should you, as a nurse, instruct the parents to take when their child with diabetes mellitus type 1 displays symptoms of hypoglycemia? a. Give the child honey b. Give the child nothing by mouth c. Give the child milk d. Contact the health care provider before doing anything

a. Infants Cancer is the second leading cause of death in children between ages 1 and 14 years. For # 19 and 20 only. 19. Which of the following would be an appropriate nursing diagnosis for a child who is receiving chemotherapy? a. Ineffective breathing pattern b. Constipation c. Impaired skin integrity d. Impaired oral mucous membrane 23. While assessing a neonate with cleft lip (CL), you would be alert that which of the following will most likely be compromised? a. Respiratory Status b. Sucking ability 20. Leukemia is the most common cause of childhood cancer. Cloud is a 4 year old child with leukemia. He was admitted at AUFMC because of pneumonia. As a nurse, what would you think is most likely the cause of his current condition? a. Anemia b. Leukopenia c. Thrombocytopenia a. Rice d. Eisinophilia b. Milk c. Chicken 21. Vincent, 6 month old child is currently having diarrhea. As a nurse knowledgeable of the principles of acid base disorders, what would you most likely think will Vincent develop secondary to diarrhea? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory Alkalosis d. Wheat 24. Harold is the father of a child with celiac disease. Discharge instructions to Harold for his child would be avoiding what kinds of food? c. Locomotion d. GI function b. Toddlers c. Preschoolers d. School age children

25. What would be your best response to a mother who asks you what to do when her toddler cries and clings to her as she attempts to leave the hospital? a. Dont worry, hell stop crying as soon as you leave b. Its probably better if you didnt visit that often c. Ill stay with him while you leave

22. When performing a procedure related to a genitourinary (GU) problem, what would you anticipate that which of the following age groups would find it especially stressful?

d. Try to sneak away while he is playing

Answer Key: TOPIC: Pediatric Nursing 1. D. Preschoolers are prelogical and understand only one meaning of a word. Words with more than one meaning will create confusion and possible apprehension. The prelogical thought patterns are too immature to allow preschoolers to understand detailed questions. Although important, confidentiality is a more relevant concern for older children and adolescents. Nurses should encourage preschoolers to handle equipments. Doing so alleviate fears that are common to the preschoolers. 2. A. By the time an infant is 5 months old, her body weight typically doubles. It triples by age 1 year and quadruples by age 4 years. Infancy is a period of rapid growth exhibited by rapid weight gain. 3. B. Solid foods are not recommended before age 4 months because of the sucking reflex and the immaturity of the GI tract and immune system. Therefore, the earliest age at which to introduce foods is 4 months old. Any time earlier would be inappropriate. 4. A. According to Erikson, infants need to have their needs met consistently and effectively to develop a sense of trust. An infant whose needs are consistently unmet or who experiences significant delays in having them met, such as in the case of the infant of a substance abusing and alcoholic father, will develop a sense of uncertainty, leading to mistrust of caregivers and environment. Toddlers develop a sense of shame when their autonomy needs are not consistently met. Preschoolers develop a sense of guilt when their sense of initiative is thwarted. School age children develop a sense of inferiority when they do not develop a sense of industry. 5. B. Infants from the age of 1 month to 1 year typically engage in solitary play. That is, the infants play is non interactive. Toddlers typically engage in parallel play (playing alongside others, but not with others), preschoolers engage in associative play (playing interactively and cooperatively with others). 6. B. Infants need to have their security needs met by being held and cuddled. At 2 months of age, they are unable to make the connection between crying and attention. This association does not occur until late infancy or early toddlerhood. Letting the infant cry for a time before picking up the infant or letting the infant alone to cry herself to sleep interferes with meeting the infants need for security at this very young age. Infants cry for many reasons. Assuming that the child is hungry may cause overfeeding problems such as obesity. 7. D. During toddlerhood, typical fears include going to sleep, loss of parents, stranger anxiety, loud noises and large animals. Fear of mutilation, the dark and ghosts are fears commonly associated with preschoolers. 8. D. The mothers departure has triggered the protest stage of separation anxiety in this child. Therefore, a favorite blanket or other transitional object (representation of parent) will help best ease separation fears. A 2 year old is too young to interact with peers, older than in parallel play. Toddlers are usually fearful of large dogs. 9. C. Normal neuromascular development should allow most children to walk without help by age 15 months. Many children walk by age 1 year, but a child is not considered abnormal if he is not walking by this age. By 18 months, the child is usually able to walk upstairs with one hand held; by 24 months, the child walks up and down stairs one step at a time. 10. B. Temper tantrums are mans for the toddler to exert independence because the child is unable to express his feelings or frustrations verbally. Temper tantrums usually decrease when a child learns words to express himself. Stating that tantrums are the only way to get attention is inappropriate because toddlers use many methods to get their parents attention. Telling a parent that the child is spoiled is an inappropriate response. Identity is not an issue for toddlers; separation and individualization are. 11. A. A 5 year old view death in degrees, so the child would most likely say that the pet is not real dead. Personification of death, such as using the term boogie man, occurs at ages 7 to 9 year. Denying death, such as with jokes and attributing life qualities to the dead, such as the dead being able to eat, occurs during ages 3 to 5. Thinking that being good will avoid death occurs in children between ages 7 and 9. 12. A. The child with HIV is immunosuppressed. Fresh fruits and vegetables, which may be contaminated with organisms and pesticides, can be harmful, if not fatal to the child. Therefore, these items should be avoided. Children with HIV infection should be encouraged to perform at their optimal level to increase their self esteem. Families need to learn about transmission modes to prevent the spread of infection and to dispel possible myths. Good hand washing, always a mean of infection control, plays an even greater role when caring for the child with HIV. Because the child is immunosuppressed, good hand washing decreases the chance of transmitting an infection to the child. 13. C. School-age children are often unaware of their own fatigue level. If allowed to remain awake, they will be tired the next day. Because of the slowing growth rate during this period, school-age children require less sleep than adolescents do. Nightmares and night terrors are common during preschool period. Although the requirements may vary, school-age children typically require approximately 8 to 9 hours of sleep every night. 14. B. Status asthmaticus is an acute, prolonged, severe asthma attack that is unresponsive to usual treatment. Typically, the child requires hospitalization. Intrinsic is a term used to denote internal precipitating factors, such as viruses. Reactive airway disease is another general term for asthma. Extrinsic is a term used to denote external precipitating factors, such as allergens.

15. B. Beta adrenergic agonists, such as albuterol are highly effective bronchodilators and are used to dilate narrow airways associated with asthma, or also known as reactive airway disease. Decongestants may be given to decrease postnasal drip. Corticosteroids may be used for their anti - inflammatory effect; antibiotics are used to prevent secondary infection. 16. C. Hypotonia or floppy infant is an early manifestation of cerebral palsy. Typically, the infant lifts his head to a 90 degree angle by age 4 months with only a partial head lag by age 2 months. Rolling completely over usually does not occur until the infant is age 6 months. Tilting of the hip is an indication of developmental dysplasia of the hip (DDH). Although rigidity and tenseness are [possible signs of cerebral palsy, a limitation in one leg suggests DDH. 17. D. If the parent states that they should stress the intake of yellow vegetables, they need additional teaching because yellow vegetables are not good sources of Iron. Lean meats, whole grain breads and fish are good food sources of iron and should be encouraged. 18. A. Prompt action is necessary. Thus, giving a little sugar temporarily corrects low serum glucose levels. A simple sugar, such as honey, is preferred because it is converted to glucose more quickly than a complex sugar. A child with hyperglycemia needs fluids to prevent dehydration. Because complex sugars, such as milk, are absorbed more slowly, they do not provide an immediate response. Immediate action is necessary to prevent complications of hypoglycemia. Contacting the health care provider wastes valuable time during which emergency measures could be started to raise the childs glucose level. 19. D. Chemotherapy destroys rapidly growing cells, including those in the GI tract, resulting in stomatitis, an inflammatory condition of the mouth. In general, chemotherapy should have no effect on the respiratory system. Because chemotherapy affects the GI tract, the child most likely would have diarrhea, not constipation. In general, chemotherapy should have no effect on skin integrity. 20. B. Leukopenia, the decrease in functioning white blood cells in leukemia, causes the increased risk of infection in children with leukemia. Anemia would result in fatigue. Thrombocytopenia, decreased platelet count, would result in bleeding. An increased in eosinophil count is not related to leukemia. 21. A. Because a 6 month old has an immature homeostasis regulating system, metabolic acidosis would be most likely, resulting from a loss of base such as that would occur in diarrhea. Metabolic alkalosis, produced by a gain in base or a loss of acid, would most likely result from vomiting. Respiratory acidosis results from diminished or inadequate pulmonary ventilation, leading to elevated PCO level. Respiratory alkalosis results from an increase in the rate and depth of respiration leading to a decreased PCO level. 22. C. In general, preschoolers have more fear because of their fantasies, contributing to fears of the simplest procedures. Castration fears / anxiety also are prominent at this age and may be heightened by procedures related to GU problems. Typically, GU procedures do not create greater stress in infants, toddlers and school age children. 23. B. Because of the defect, the child will be unable to form the mouth adequately around the nipple, thereby requiring special devices to allow for feeding and sucking gratification. Respiratory status may be compromised if the child is fed improperly or during postoperative period. Locomotion would be a problem for the older infant because of the use of restraints, GI functioning is not compromised in the child with Cleft lip. 24. D. Children with celiac disease cannot tolerate or digest gluten. Therefore, because of its gluten content, wheat and wheat containing products must be avoided. Rice, milk and chicken do not contain gluten and need not be avoided. 25. C. The toddler is exhibiting manifestations of separation anxiety. Staying with a toddler who is experiencing separation anxiety is an appropriate intervention for both the child and the parent. Doing so offers reassurance and feeling of security for both. The child will not stop crying when the mother leaves. Visiting should be encouraged, not discouraged. Parents should never sneak away because doing so could injure the childs sense of trust.

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