Exam 5

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The nurse caring for the newly pregnant woman would advise her that ideally prenatal care should begin: Before the first missed menstrual period.>>After the first missed menstrual period.After the second missed menstrual period.After the third missed menstrual period.
A woman arrives at the clinic for a pregnancy test. The first day of her last menstrual period (LMP) was February 14, 2010. Her expected date of birth (EDB) would be: September 17, 2010.>>November 21, 2010.November 7, 2010.December 17, 2010.
Prenatal testing for the human immunodeficiency virus (HIV) is recommended for: >>All women, regardless of risk factors.A woman who has had more than one sexual partner.A woman who has had a sexually transmitted infection.A woman who is monogamous with her partner.
Which symptom is considered a first-trimester warning sign and should be reported immediately by the pregnant woman to her health care provider? Nausea with occasional vomitingUrinary frequencyFatigue>>Vaginal bleeding
A pregnant woman at 10 weeks of gestation jogs three or four times per week. She is concerned about the effect of exercise on the fetus. The nurse should inform her: “You don’t need to modify your exercising any time during your pregnancy.”“Stop exercising because it will harm the fetus.”>>“You may find that you need to modify your exercise to walking later in your pregnancy, around the seventh month.”“Jogging is too hard on your joints; switch to walking now.”
Which blood pressure (BP) finding during the second trimester indicates a risk for pregnancy-induced hypertension? Baseline BP 120/80, current BP 126/85>>Baseline BP 100/70, current BP 130/85Baseline BP 140/85, current BP 130/80Baseline BP 110/60, current BP 110/60
The multiple marker test is used to assess the fetus for which condition? >>Down syndromeCongenital cardiac abnormalityDiaphragmatic herniaAnencephaly
A woman who is 32 weeks’ pregnant is informed by the nurse that a danger sign of pregnancy could be: Constipation.>>Alteration in the pattern of fetal movement.Heart palpitations.Edema in the ankles and feet at the end of the day.
A woman who is 14 weeks’ pregnant tells the nurse that she always had a glass of wine with dinner before she became pregnant. She has abstained during her first trimester and would like to know if it is safe for her to have a drink with dinner now. The nurse would tell her: “Since you’re in your second trimester, there’s no problem with having one drink with dinner.”“One drink every night is too much. One drink three times a week should be fine.”“Since you’re in your second trimester, you can drink as much as you like.”>>“Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy.”
A pregnant woman at 18 weeks of gestation calls the clinic to report that she has been experiencing occasional backaches of mild-to-moderate intensity. The nurse would recommend that she: Do Kegel exercises.Use a softer mattress.>>Do pelvic rock exercises.Stay in bed for 24 hours.
For what reason would breastfeeding be contraindicated? Hepatitis BEverted nipplesHistory of breast cancer 3 years ago>>Human immunodeficiency virus (HIV) positive
A woman is 3 months pregnant. At her prenatal visit she tells the nurse that she doesn’t know what is happening; one minute she’s happy that she is pregnant, and the next minute she cries for no reason. Which response by the nurse is most appropriate? “Don’t worry about it; you’ll feel better in a month or so.”“Have you talked to your husband about how you feel?”“Perhaps you really don’t want to be pregnant.”>>“Hormonal changes during pregnancy commonly result in mood swings.”
The nurse should be aware that the partner’s main role in pregnancy is to: Provide financial support.Protect the pregnant woman from “old wives’ tales.”>>Support and nurture the pregnant woman.Make sure the pregnant woman keeps prenatal appointments.
During the first trimester a woman can expect which of the following changes in her sexual desire? An increase, because of enlarging breasts>>A decrease, because of nausea and fatigueNo changeAn increase, because of increased levels of female hormones
Which behavior indicates that a woman is “seeking safe passage” for herself and her infant? >>She keeps all prenatal appointments.She drives her car slowly.She “eats for two.”She wears only low-heeled shoes.
A 3-year-old girl’s mother is 6 months pregnant. What concern is this child likely to verbalize? How the baby will “get out”Whether her mother will die>>What the baby will eatWhat color eyes the baby has
In her work with pregnant women of various cultures, a nurse practitioner has observed various practices that seemed strange or unusual. She has learned that cultural rituals and practices during pregnancy seem to have one purpose in common. Which statement best describes that purpose? To promote family unityTo ward off the “evil eye”To appease the gods of fertility>>To protect the mother and fetus during pregnancy
What type of cultural concern is the most likely deterrent to many women seeking prenatal care? ReligionIgnorance>>ModestyBelief that physicians are evil
Which statement about pregnancy is accurate? >>A normal pregnancy lasts about 10 lunar months.A trimester is one third of a year.The prenatal period extends from fertilization to conception.The estimated date of confinement (EDC) is how long the mother will have to be bedridden after birth.
In understanding and guiding a woman through her acceptance of pregnancy, a maternity nurse should be aware that: Nonacceptance of the pregnancy very often equates to rejection of the child.>>Mood swings most likely are the result of worries about finances and a changed lifestyle, as well as profound hormonal changes.Ambivalent feelings during pregnancy usually are seen only in emotionally immature or very young mothers.Conflicts such as not wanting to be pregnant or childrearing and career-related decisions need not be addressed during pregnancy, because they will resolve themselves naturally after birth.
With regard to a woman’s reordering of personal relationships during pregnancy, the maternity nurse should be aware that: Because of the special motherhood bond, a woman’s relationship with her mother is even more important than with the father of the child.Nurses need not get involved in any sexual issues the couple has during pregnancy, particularly if they have trouble communicating them to each other.>>Women usually express two major relationship needs during pregnancy: feeling loved and valued and having the child accepted by the father.The woman’s sexual desire is likely to be highest in the first trimester because of the excitement and because intercourse is physically easier.
What represents a typical progression through the phases of a woman’s establishing a relationship with the fetus? Accepts the fetus as distinct from herself—accepts the biologic fact of pregnancy—has a feeling of caring and responsibilityFantasizes about the child’s gender and personality—views the child as part of herself—becomes introspectiveViews the child as part of herself—has feelings of well-being—accepts the biologic fact of pregnancy>>“I am pregnant.”— “I am going to have a baby.”—“I am going to be a mother.”
With regard to the father’s acceptance of the pregnancy and preparation for childbirth, the maternity nurse should know that: >>The father goes through three phases of acceptance of his own.The father’s attachment to the fetus cannot be as strong as that of the mother because it does not start until after birth.In the last 2 months of pregnancy, most expectant fathers suddenly get very protective of their established lifestyle and resist making changes to the home.Typically men remain ambivalent about fatherhood right up to the birth of their child.
With regard to the initial visit with a client who is beginning prenatal care, nurses should be aware that: The first interview is a relaxed, get-acquainted affair in which nurses gather some general impressions.If nurses observe handicapping conditions, they should be sensitive and not inquire about them because the client will do that in her own time.>>Nurses should be alert to the appearance of potential parenting problems such as depression or lack of family support.Because of legal complications, nurses should not ask about illegal drug use; that is left to physicians.
With regard to the initial physical examination of a woman beginning prenatal care, maternity nurses should be aware that: Only women who show physical signs or meet the sociologic profile should be assessed for physical abuse.>>The woman should empty her bladder before the pelvic examination is performed.The distribution, amount, and quality of body hair are of no particular importance.The size of the uterus is discounted in the initial examination because it is just going to get bigger soon.
With regard to follow-up visits for women receiving prenatal care, nurses should be aware that: The interview portions become more intensive as the visits become more frequent over the course of the pregnancy.Monthly visits are scheduled for the first trimester, every 2 weeks for the second trimester, and weekly for the third trimester.>>During the abdominal examination the nurse should be alert for supine hypotension.For pregnant women a systolic blood pressure (BP) of 130 and a diastolic BP of 80 is sufficient to be considered hypertensive.
With regard to their role in the personal hygiene of the expectant mother, maternity nurses should be aware that: >>Tub bathing is permitted even in late pregnancy unless membranes have ruptured.The perineum should be wiped from back to front.Bubble bath and bath oils are permissible because they add an extra soothing and cleansing action to the bath.Expectant mothers should use specially treated soap to cleanse the nipples.
The nurse should be aware that the pinch test is used to: Check the sensitivity of the nipples.>>Determine whether the nipple is everted or inverted.Calculate the adipose buildup in the abdomen.See whether the fetus has become inactive.
With regard to dental care during pregnancy, maternity nurses should be aware that: Dental care can be dropped from the priority list because the woman has enough to worry about and is getting a lot of calcium anyway.Dental surgery, in particular, is contraindicated because of the psychologic stress it engenders.>>If dental treatment is necessary, the woman will be most comfortable with it in the second trimester.Dental care interferes with the expectant mother’s need to practice conscious relaxation.
With regard to work and travel during pregnancy, nurses should be aware that: Women should sit for as long as possible and cross their legs at the knees from time to time for exercise.Women should avoid seat belts and shoulder restraints in the car, because they press on the fetus.Metal detectors at airport security checkpoints can harm the fetus if the woman passes through them a number of times.>>While working or traveling in a car or on a plane, women should arrange to walk around at least every hour or so.
With regard to medications, herbs, shots, and other substances normally encountered, the maternity nurse should be aware that: >>Both prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus.The greatest danger of drug-caused developmental deficits in the fetus is seen in the final trimester.Killed-virus vaccines (e.g., tetanus) should not be given during pregnancy, but live-virus vaccines (e.g., measles) are permissible.No convincing evidence exists that secondhand smoke is potentially dangerous to the fetus.
Which statement about multifetal pregnancy is NOT accurate? The expectant mother often develops anemia because the fetuses have a greater demand for iron.>>Twin pregnancies come to term with the same frequency as single pregnancies.The mother should be counseled to increase her nutritional intake and gain more weight.Backache and varicose veins often are more pronounced.
The phenomenon of someone other than the mother-to-be experiencing pregnancy-like symptoms such as nausea and weight gain applies to the: Mother of the pregnant woman.Sister of the pregnant woman.Couple’s teenage daughter.>>Expectant father.
In response to requests by the U.S. Public Health Service for new models of prenatal care, an innovative new approach to prenatal care known as centering pregnancy was developed. Which statement would accurately apply to the centering model of care? Group sessions begin with the first prenatal visit.At each visit blood pressure, weight, and urine dipsticks are obtained by the nurse.>>Eight to 12 women are placed in gestational-age cohort groups.Outcomes are similar to those of traditional prenatal care.
A 22-year-old woman pregnant with a single fetus has a preconception body mass index (BMI) of 24. When she was seen in the clinic at 14 weeks of gestation, she had gained 1.8 kg (4 lb) since conception. How would the nurse interpret this? This weight gain indicates possible gestational hypertension.This weight gain indicates that the woman’s infant is at risk for intrauterine growth restriction (IUGR).This weight gain cannot be evaluated until the woman has been observed for several more weeks.>>The woman’s weight gain is appropriate for this stage of pregnancy.
Which meal would provide the most absorbable iron? Toasted cheese sandwich, celery sticks, tomato slices, and a grape drinkOatmeal, whole wheat toast, jelly, and low-fat milk>>Black bean soup, wheat crackers, ambrosia (orange sections, coconut, and pecans), and prunesRed beans and rice, cornbread, mixed greens, and decaffeinated tea
Which nutrient’s recommended dietary allowance (RDA) is higher during lactation than during pregnancy? >>Energy (kcal)Vitamin AIronFolic acid
A pregnant woman’s diet consists almost entirely of whole grain breads and cereals, fruits, and vegetables. The nurse would be most concerned about this woman’s intake of: Calcium.>>Vitamin B12.Protein.Folic acid.
A pregnant woman experiencing nausea and vomiting should: Drink a glass of water with a fat-free carbohydrate before getting out of bed in the morning.>>Eat small, frequent meals (every 2 to 3 hours).Increase her intake of high-fat foods to keep the stomach full and coated.Limit fluid intake throughout the day.
A pregnant woman reports that she is still playing tennis at 32 weeks of gestation. The nurse would be most concerned that during and after tennis matches this woman consumes: >>Several glasses of fluid.Extra protein sources such as peanut butter.Salty foods to replace lost sodium.Easily digested sources of carbohydrate.
Which statement made by a lactating woman would lead the nurse to believe that the woman might have lactose intolerance? “I always have heartburn after I drink milk.”>>“If I drink more than a cup of milk, I usually have abdominal cramps and bloating.”“Drinking milk usually makes me break out in hives.”“Sometimes I notice that I have bad breath after I drink a cup of milk.”
A pregnant woman’s diet history indicates that she likes the following list of foods. The nurse would encourage this woman to consume more of which food to increase her calcium intake? Fresh apricotsSpaghetti with meat sauceCanned clams>>Canned sardines
A 27-year-old pregnant woman had a preconceptual body mass index (BMI) of 18.0. The nurse knows that this woman’s total recommended weight gain during pregnancy should be at least: 20 kg (44 lb).>>12.5 kg (27.5 lb).16 kg (35 lb).10 kg (22 lb).
A woman in week 34 of pregnancy reports that she is very uncomfortable because of heartburn. The nurse would suggest that the woman: Substitute other calcium sources for milk in her diet.Lie down after each meal.Reduce the amount of fiber she consumes.>>Eat five small meals daily.
A woman has come to the clinic for preconception counseling because she wants to start trying to get pregnant in 3 months. She can expect the following advice: “Discontinue all contraception now.”“Lose weight so that you can gain more during pregnancy.”“You may take any medications you have been taking regularly.”>>“Make sure that you include adequate folic acid in your diet.”
To prevent gastrointestinal upset, clients should be instructed to take iron supplements: On a full stomach.After eating a meal.>>At bedtime.With milk.
Women with an inadequate weight gain during pregnancy are at higher risk of giving birth to an infant with: Spina bifida.Diabetes mellitus.>>Intrauterine growth restriction.Down syndrome.
After you complete your nutritional counseling for a pregnant woman, you ask her to repeat your instructions so you can assess her understanding of the instructions given. Which statement indicates that she understands the role of protein in her pregnancy? >>“Protein will help my baby grow.”“Eating protein will prevent me from becoming anemic.”“Eating protein will make my baby have strong teeth after he is born.”“Eating protein will prevent me from being diabetic.”
Pregnant adolescents are at high risk for _____ because of lower body mass indices (BMIs) and “fad” dieting. Obesity>>Low-birth-weight babiesDiabetesHigh-birth-weight babies
Maternal nutritional status is an especially significant factor of the many that influence the outcome of pregnancy because: It is very difficult to adjust because of people’s ingrained eating habits.>>It is an important preventive measure for a variety of problems.Women love obsessing about their weight and diets.A woman’s preconception weight becomes irrelevant.
Which statement about acronyms in nutrition is accurate? >>Dietary reference intakes (DRIs) consist of RDAs, adequate intakes (AIs), and upper limits (ULs).Recommended dietary allowances (RDAs) are the same as ULs, except with better data.AIs offer guidelines for avoiding excessive amounts of nutrients.They all refer to green, leafy vegetables; whole grains; and fruit.
With regard to protein in the diet of pregnant women, nurses should be aware that: >>Many protein-rich foods are also good sources of calcium, iron, and B vitamins.Many women need to increase their protein intake during pregnancy.As with carbohydrates and fat, no specific recommendations exist for the amount of protein in the diet.High-protein supplements can be used without risk by women on macrobiotic diets.
Which nutritional recommendation about fluids is accurate? >>A woman’s daily intake should be eight to ten glasses (2.3 L) of water, milk, and/or juice.Coffee should be limited to no more than 2 cups, but tea and cocoa can be consumed without worry.Of the artificial sweeteners, only aspartame has not been associated with any maternity health concerns.Water with fluoride is especially encouraged because it reduces the child’s risk of tooth decay.
Which minerals and vitamins usually are recommended to supplement a pregnant woman’s diet? Fat-soluble vitamins A and D>>Iron and folateWater-soluble vitamins C and B6Calcium and zinc
Which vitamins or minerals can lead to congenital malformations of the fetus if taken in excess by the mother? ZincFolic acidVitamin D>>Vitamin A
With regard to nutritional needs during lactation, a maternity nurse should be aware that: The mother’s intake of vitamin C, zinc, and protein now can be lower than during pregnancy.>>Caffeine consumed by the mother accumulates in the infant, who therefore may be unusually active and wakeful.Critical iron and folic acid levels must be maintained.Lactating women can go back to their prepregnant calorie intake.
While taking a diet history, the nurse might be told that the expectant mother has cravings for ice chips, cornstarch, and baking soda. This represents a nutritional problem known as: Preeclampsia.>>Pica.Pyrosis.Purging.
When counseling a client about getting enough iron in her diet, the maternity nurse should tell her that: Milk, coffee, and tea aid iron absorption if consumed at the same time as iron.Iron absorption is inhibited by a diet rich in vitamin C.Iron supplements are permissible for children in small doses.>>Constipation is common with iron supplements.
To help a woman reduce the severity of nausea caused by morning sickness, the nurse might suggest that she: >>Try a tart food or drink such as lemonade or salty foods such as potato chips.Drink plenty of fluids early in the day.Brush her teeth immediately after eating.Never snack before bedtime.
Three servings of milk, yogurt, or cheese plus two servings of meat, poultry, or fish will adequately supply the recommended amount of protein for the pregnant woman. Many clients are concerned about the increased levels of mercury in fish and may be afraid to include this source of nutrients in their diet. Sound advice by the nurse to assist the client in determining which fish is safe to consume would include: Canned white tuna is a preferred choice.>>Avoid shark, swordfish, and mackerel.Fish caught in local waterways are the safest.Salmon and shrimp contain high levels of mercury.
Nutrition is one of the most significant factors in influencing the outcome of a pregnancy. It is an alterable and important preventive measure for a variety of potential problems such as low birth weight and prematurity. While completing the physical assessment of the pregnant client, the nurse can evaluate the client’s nutritional status by observing a number of physical signs. Which sign would indicate that the client has unmet nutritional needs? Normal heart rate, rhythm, and blood pressureBright, clear, shiny eyesAlert, responsive, and good endurance>>Edema, tender calves, and tingling
A young child who has an intelligence quotient (IQ) of 45 would be described as: Within the lower limits of the range of normal intelligence.Mildly cognitively impaired but educable.>>Moderately cognitively impaired but trainable.Severely cognitively impaired and completely dependent on others for care.
When a child with mild cognitive impairment reaches the end of adolescence, what characteristic would be expected? Achieves a mental age of 5 to 6 years>>Achieves a mental age of 8 to 12 yearsUnable to progress in functional reading or arithmeticAcquires practical skills and useful reading and arithmetic to an eighth-grade level
When should children with cognitive impairment be referred for stimulation and educational programs? >>As young as possibleAs soon as they have the ability to communicate in some wayAt age 3 years, when schools are required to provide servicesAt age 5 or 6 years, when schools are required to provide services
The major consideration when selecting toys for a child who is cognitively impaired is: >>Safety.Ability to provide exercise.Age appropriateness.Ability to teach useful skills.
Appropriate interventions to facilitate socialization of the cognitively impaired child include to: Provide age-appropriate toys and play activities.>>Provide peer experiences such as scouting when older.Avoid exposure to strangers who may not understand cognitive development.Emphasize mastery of physical skills because they are delayed more often than verbal skills.
When caring for a newborn with Down syndrome, the nurse should be aware that the most common congenital anomaly associated with Down syndrome is: Hypospadias.>>Congenital heart disease.Pyloric stenosis.Congenital hip dysplasia.
Mark, a 9 year old with Down syndrome, is mainstreamed into a regular third grade for part of the school day. His mother asks the school nurse about programs such as Cub Scouts that he might join. The nurse’s recommendation should be based on knowing that: Programs such as Cub Scouts are inappropriate for children who are cognitively impaired.>>Children with Down syndrome have the same need for socialization as other children.Children with Down syndrome socialize better with children who have similar disabilities.Parents of children with Down syndrome encourage programs such as scouting because they deny that their children have disabilities.
A newborn assessment shows separated sagittal suture, oblique palpebral fissures, depressed nasal bridge, protruding tongue, and transverse palmar creases. These findings are most suggestive of: Microcephaly.Cerebral palsy.>>Down syndrome.Fragile X syndrome.
The child with Down syndrome should be evaluated for what characteristic before participating in some sports? Hyperflexibility>>Atlantoaxial instabilityCutis marmorataSpeckling of iris (Brushfield spots)
Many of the physical characteristics of Down syndrome present nursing problems. Care of the child should include: Delaying feeding solid foods until the tongue thrust has stopped.Modifying diet as necessary to minimize the diarrhea that often occurs.Providing calories appropriate to the child’s age.>>Using a cool-mist vaporizer to keep mucous membranes moist.
Fragile X syndrome is: A chromosome defect affecting only females.A chromosome defect that follows the pattern of X-linked recessive disorders.>>The second most common genetic cause of cognitive impairment.The most common cause of noninherited cognitive impairment.
Distortion of sound and problems in discrimination are characteristic of what type of hearing loss? ConductiveMixed conductive-sensorineural>>SensorineuralCentral auditory imperceptive
The most common type of hearing loss, which results from interference of transmission of sound to the middle ear, is called: >>Conductive.Mixed conductive-sensorineural.Sensorineural.Central auditory imperceptive.
Hearing is expressed in decibels, or units of loudness. In decibels the softest sound a normal ear can hear is: >>0.40 to 50.10100
The nurse should suspect a hearing impairment in an infant who demonstrates which behavior? Absence of the Moro reflex>>Absence of babbling by age 7 monthsLack of eye contact when being spoken toLack of gesturing to indicate wants after age 15 months
The nurse is talking with a 10-year-old boy who wears bilateral hearing aids. The left hearing aid is making an annoying whistling sound that the child cannot hear. The most appropriate nursing action is to: Ignore the sound.Ask him to reverse the hearing aids in his ears.>>Suggest that he reinsert the hearing aid.Suggest that he raise the volume of the hearing aid.
An implanted ear prosthesis for children with sensorineural hearing loss is a(n): Hearing aid.Auditory implant.>>Cochlear implant.Amplification device.
What facilitates lip reading by the hearing-impaired child? >>Speaking at an even rateExaggerating pronunciation of wordsAvoiding using facial expressionsRepeating in exactly the same way if child does not understand
Prevention of hearing impairment in children is a major goal for the nurse. This can be achieved through: >>Being involved in immunization clinics for children.Assessing a newborn for hearing loss.Answering parents’ questions about hearing aids.Participating in hearing screening in the community.
Which term refers to the ability to see objects clearly at close range but not at a distance? >>MyopiaCataractAmblyopiaGlaucoma
Which term refers to opacity of the crystalline lens that prevents light rays from entering the eye and refracting on the retina? Myopia>>CataractAmblyopiaGlaucoma
A nurse would suspect possible visual impairment in a child who displays: >>Excessive rubbing of the eyes.Rapid lateral movement of the eyes.Delay in speech development.Lack of interest in casual conversation with peers.
The school nurse is caring for a child with a penetrating eye injury. Emergency treatment includes: Applying a regular eye patch.>>Applying a Fox shield to the affected eye and any type of patch to the other eye.Applying ice until the physician is seen.Irrigating eye copiously with a sterile saline solution.
A father calls the emergency department nurse saying that his daughter’s eyes burn after getting some dishwasher detergent in them. The nurse recommends that the child be seen in the emergency department or by an ophthalmologist. What should the nurse recommend before the child is transported? Keep the eyes closed.Apply cold compresses.>>Irrigate eyes copiously with tap water for 20 minutes.Prepare a normal saline solution (salt and water) and irrigate eyes for 20 minutes.
An adolescent gets hit in the eye during a fight. The school nurse, using a flashlight, notes the presence of gross hyphema (hemorrhage into anterior chamber). The nurse should: Apply a Fox shield.Instruct the adolescent to apply ice for 24 hours.Have adolescent rest with eye closed and ice applied.>>Notify parents that adolescent needs to see an ophthalmologist.
The most common clinical manifestation of retinoblastoma is: Glaucoma.>>White eye reflex.Amblyopia.Sunken eye socket.
An accurate description of anemia is: Increased blood viscosity.Depressed hematopoietic system.Presence of abnormal hemoglobin.>>Decreased oxygen-carrying capacity of blood.
Several blood tests are ordered for a preschool child with severe anemia. She is crying and upset because she remembers the venipuncture done at the clinic 2 days ago. The nurse should explain that: Venipuncture discomfort is very brief.Only one venipuncture will be needed.>>Topical application of local anesthetic can eliminate venipuncture pain.Most blood tests on children require only a finger puncture because a small amount of blood is needed.
The most appropriate nursing diagnosis for a child with anemia is: >>Activity Intolerance related to generalized weakness.Decreased Cardiac Output related to abnormal hemoglobin.Risk for Injury related to depressed sensorium.Risk for Injury related to dehydration and abnormal hemoglobin.
What explains why iron deficiency anemia is common during toddlerhood? >>Milk is a poor source of iron.Iron cannot be stored during fetal development.Fetal iron stores are depleted by age 1 month.Dietary iron cannot be started until age 12 months.
When teaching the mother of a 9-month-old infant about administering liquid iron preparations, the nurse should include that: They should be given with meals.They should be stopped immediately if nausea and vomiting occur.>>Adequate dosage will turn the stools a tarry green color.Preparation should be allowed to mix with saliva and bathe the teeth before swallowing.
Iron dextran is ordered for a young child with severe iron deficiency anemia. Nursing considerations include: Administering with meals.Administering between meals.>>Injecting deeply into a large muscle.Massaging injection site for 5 minutes after administration of drug.
The nurse is recommending how to prevent iron deficiency anemia in a healthy, term, breastfed infant. What should he or she suggest? Iron (ferrous sulfate) drops after age 1 month.Iron-fortified commercial formula can be used by ages 4 to 6 months.Iron-fortified infant cereal can be used by age 2 months.>>Iron-fortified infant cereal can be used at approximately 6 months of age.
A condition in which the normal adult hemoglobin is partly or completely replaced by abnormal hemoglobin is: Aplastic anemia.Thalassemia major.>>Sickle cell anemia.Iron deficiency anemia.
What describes the pathologic changes of sickle cell anemia? Sickle-shaped cells carry excess oxygen.Sickle-shaped cells decrease blood viscosity.>>Increased red blood cell destruction occurs.Decreased red blood cell destruction occurs.
Which clinical manifestation should the nurse expect when a child with sickle cell anemia experiences an acute vasoocclusive crisis? Circulatory collapseCardiomegaly, systolic murmursHepatomegaly, intrahepatic cholestasis>>Painful swelling of hands and feet, painful joints
A school-age child is admitted in vasoocclusive sickle cell crisis. The child’s care should include: Correction of acidosis.>>Adequate hydration and pain management.Pain management and administration of heparin.Adequate oxygenation and replacement of factor VIII.
The parents of a child hospitalized with sickle cell anemia tell the nurse that they are concerned about narcotic analgesics causing addiction. The nurse should explain that narcotic analgesics: Are often ordered but not usually needed.>>Rarely cause addiction because they are medically indicated.Are given as a last resort because of the threat of addiction.Are used only if other measures such as ice packs are ineffective.
Which statement best describes β-thalassemia major (Cooley’s anemia)? All formed elements of the blood are depressed.Inadequate numbers of red blood cells are present.>>Increased incidence occurs in families of Mediterranean extraction.Increased incidence occurs in persons of West African descent.
In which condition are all the formed elements of the blood simultaneously depressed? >>Aplastic anemiaThalassemia majorSickle cell anemiaIron deficiency anemia
A possible cause of acquired aplastic anemia in children is: >>Drugs.Deficient diet.Injury.Congenital defect.
What is descriptive of most cases of hemophilia? Autosomal dominant disorder causing deficiency in a factor involved in the blood-clotting reactionX-linked recessive inherited disorder causing deficiency of platelets and prolonged bleeding>>X-linked recessive inherited disorder in which a blood-clotting factor is deficientY-linked recessive inherited disorder in which the red blood cells become moon shaped
An acquired hemorrhagic disorder that is characterized by excessive destruction of platelets is: Aplastic anemia.Thalassemia major.Disseminated intravascular coagulation.>>Idiopathic thrombocytopenic purpura.
What is most descriptive of the pathophysiology of leukemia? Increased blood viscosity occurs.Thrombocytopenia (excessive destruction of platelets) occurs.>>Unrestricted proliferation of immature white blood cells (WBCs) occurs.The first stage of coagulation process is abnormally stimulated.
A boy with leukemia screams whenever he needs to be turned or moved. The most probable cause of this pain is: Edema.Petechial hemorrhages.>>Bone involvement.Changes within the muscles.
Myelosuppression associated with chemotherapeutic agents or some malignancies such as leukemia can cause bleeding tendencies because of a/an: Decrease in leukocytes.Vitamin C deficiency.Increase in lymphocytes.>>Decrease in blood platelets.
A child with leukemia is receiving triple intrathecal chemotherapy consisting of methotrexate, cytarabine, and hydrocortisone. The purpose of this is to prevent: Infection.Brain tumor.Drug side effects.>>Central nervous system (CNS) disease.
A young boy will receive a bone marrow transplant (BMT). This is possible because one of his older siblings is a histocompatible donor. This type of BMT is termed: Syngeneic.Monoclonal.>>Allogeneic.Autologous.
What is often administered to prevent or control hemorrhage in a child with cancer? NitrosoureasWhole blood>>PlateletsCorticosteroids
A school-age child with leukemia experienced severe nausea and vomiting when receiving chemotherapy for the first time. The most appropriate nursing action to prevent or minimize these reactions with subsequent treatments is to: Encourage drinking large amounts of favorite fluids.Encourage child to take nothing by mouth (remain NPO) until nausea and vomiting subside.>>Administer an antiemetic before chemotherapy begins.Administer an antiemetic as soon as child has nausea.
The nurse is preparing a child for possible alopecia from chemotherapy. What should be included? Explaining to the child that hair usually regrows in 1 year.Advising the child to expose the head to sunlight to minimize alopecia.Explaining to the child that wearing a hat or scarf is preferable to wearing a wig.>>Explaining to the child that when hair regrows it may have a slightly different color or texture.
A common clinical manifestation of Hodgkin’s disease is: Petechiae.Bone and joint pain.Painful, enlarged lymph nodes.>>Enlarged, firm, nontender lymph nodes.
What is caused by a virus that primarily infects a specific subset of T lymphocytes, the CD4+ T cells? Wiskott-Aldrich syndromeIdiopathic thrombocytopenic purpura (ITP)>>Acquired immunodeficiency syndrome (AIDS)Severe combined immunodeficiency disease
A young child with human immunodeficiency virus is receiving several antiretroviral drugs. The purpose of these drugs is to: Cure the disease.>>Delay disease progression.Prevent spread of disease.Treat Pneumocystis carinii pneumonia.
Which immunization should be given with caution to children infected with human immunodeficiency virus? InfluenzaPneumococcal>>VaricellaInactivated poliovirus
The nurse is planning care for an adolescent with acquired immunodeficiency syndrome. The priority nursing goal is to: >>Prevent infection.Restore immunologic defenses.Prevent secondary cancers.Identify source of infection.
An inherited immunodeficiency disorder characterized by absence of both humoral and cell-mediated immunity is: >>Severe combined immunodeficiency syndrome (SCIDS).Acquired immunodeficiency syndrome.Wiskott-Aldrich syndrome.Fanconi syndrome.
Several complications can occur when a child receives a blood transfusion. An immediate sign or symptom of an air embolus is: Chills and shaking.Irregular heart rate.Nausea and vomiting.>>Sudden difficulty in breathing.
An 8-year-old girl is receiving a blood transfusion when the nurse notes that she has developed precordial pain, dyspnea, distended neck veins, slight cyanosis, and a dry cough. These manifestations are most suggestive of: Air emboli.Hemolytic reaction.Allergic reaction.>>Circulatory overload.
The parents of a child with cancer tell the nurse that a bone marrow transplant (BMT) may be necessary. What should the nurse recognize as important when discussing this with the family? BMT should be done at time of diagnosis.Parents and siblings of child have a 25% chance of being a suitable donor.>>Finding a suitable donor involves matching antigens from the human leukocyte antigen (HLA) system.If BMT fails, chemotherapy or radiotherapy must be continued.
Which statement best describes hypopituitarism? Growth is normal during the first 3 years of life.Weight is usually more retarded than height.>>Skeletal proportions are normal for age.Most of these children have subnormal intelligence.
A child with growth hormone (GH) deficiency is receiving GH therapy. The best time for the GH to be administered is: >>At bedtime.Before meals.After meals.On arising in the morning.
A condition that can result if hypersecretion of growth hormone (GH) occurs after epiphyseal closure is: Dwarfism.Gigantism.>>Acromegaly.Cretinism.
At what age is sexual development in boys and girls considered to be precocious? Boys, 11 years; girls, 9 years>>Boys, 9 years; girls, 8 yearsBoys, 12 years; girls, 10 yearsBoys, 10 years; girls, 9.5 years
A child will start treatment for precocious puberty. This involves injections of synthetic: Thyrotropin.Gonadotropins.Somatotropic hormone.>>Luteinizing hormone–releasing hormone.
Diabetes insipidus is a disorder of the: Anterior pituitary.Adrenal cortex.>>Posterior pituitary.Adrenal medulla.
The nurse is caring for a child with suspected diabetes insipidus. Which clinical manifestation would he or she expect to observe? OliguriaNausea and vomitingGlycosuria>>Polyuria and polydipsia
A common clinical manifestation of juvenile hypothyroidism is: Insomnia.>>Dry skin.Diarrhea.Accelerated growth.
A goiter is an enlargement or hypertrophy of which gland? >>ThyroidAnterior pituitaryAdrenalPosterior pituitary
Exophthalmos (protruding eyeballs) may occur in children with: Hypothyroidism.Hypoparathyroidism.>>Hyperthyroidism.Hyperparathyroidism.
The nurse is teaching the parents of a child who is receiving propylthiouracil for the treatment of hyperthyroidism (Graves’ disease). Which statement made by the parent indicates a correct understanding of the teaching? “I would expect my child to gain weight while taking this medication.”“I would expect my child to experience episodes of ear pain while taking this medication.”>>“If my child develops a sore throat and fever, I should contact the physician immediately.”“If my child develops the stomach flu, my child will need to be hospitalized.”
A child with hypoparathyroidism is receiving vitamin D therapy. The parents should be advised to watch for which sign of vitamin D toxicity? Headache and seizuresPhysical restlessness and voracious appetite without weight gain>>Weakness and lassitudeAnorexia and insomnia
Glucocorticoids, mineralocorticoids, and sex steroids are secreted by the: Thyroid gland.>>Adrenal cortex.Parathyroid glands.Anterior pituitary.
Chronic adrenocortical insufficiency is also referred to as: Graves’ disease.Cushing syndrome.>>Addison’s disease.Hashimoto’s disease.
A neonate born with ambiguous genitalia is diagnosed with congenital adrenogenital hyperplasia. Therapeutic management includes administration of: Vitamin D.Stool softeners.>>Cortisone.Calcium carbonate.
What is characteristic of the immune-mediated type 1 diabetes mellitus? Ketoacidosis is infrequent.Onset is gradual.>>Age at onset is usually younger than 18 years.Oral agents are often effective for treatment.
What is considered a cardinal sign of diabetes mellitus? NauseaImpaired visionSeizures>>Frequent urination
Hyperglycemia associated with diabetic ketoacidosis is defined as a blood glucose measurement equal to or greater than: 185 mg/dl280 mg/dl220 mg/dl>>330 mg/dl
Type 1 diabetes mellitus is suspected in an adolescent. Which clinical manifestation may be present? Moist skinFluid overloadWeight gain>>Poor wound healing
A parent asks the nurse why self-monitoring of blood glucose is being recommended for her child with diabetes. The nurse should base the explanation on knowing that: It is a less expensive method of testing.It is not as accurate as laboratory testing.>>Children are better able to manage the diabetes.The parents are better able to manage the disease.
The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. The nurse should explain that: Exercise will increase blood glucose.Exercise should be restricted.>>Extra snacks are needed before exercise.Extra insulin is required during exercise.
A child eats some sugar cubes after experiencing symptoms of hypoglycemia. This rapid-releasing sugar should be followed by: Saturated and unsaturated fat.Several glasses of water.Fruit juice.>>Complex carbohydrate and protein.
Manifestations of hypoglycemia include: Lethargy.Nausea and vomiting.Thirst.>>Shaky feeling and dizziness.
The nurse is caring for an 11-year-old boy who has recently been diagnosed with diabetes. What should be included in the teaching plan for daily injections? The parents do not need to learn the procedure.>>He is old enough to give most of his own injections.Self-injections will be possible when he is closer to adolescence.He can learn about self-injections when he is able to reach all injection sites.
The nurse is discussing with a child and family the various sites used for insulin injections. Which site usually has the fastest rate of absorption? ArmButtockLeg>>Abdomen
Chelation therapy is begun on a child with β-thalassemia major. The purpose of this therapy is to: Treat the disease.Decrease the risk of hypoxia.>>Eliminate excess iron.Manage nausea and vomiting.



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