NURSING CARE OF A FAMILY WHEN A CHILD HAS A GASTROINTESTINAL DISORDER

1. A mother brings her 6-month-old infant to the clinic. The child has been vomiting since early morning and has
had diarrhea since the day before. His temperature is 38C, pulse 140, and respiratory rate 38. He has lost 6oz
since his well-child visit 4 days ago. He cries before passing a bowel movement. He will not breastfeed today.
What is the priority?

a) Thermoregulation alteration
b) Pain (abdominal) related to diarrhea
c) Fluid volume deficit related to excess losses and inadequate intake
d) Alteration in nutrition, less than body requirements, related to decreased oral intake

2. A child presents with a 2-day history of fever, abdominal pain, occasional vomiting, and decreased oral intake.
Which finding would the nurse prioritize for immediate reporting to the physician?

a) Temperature 101.9F
b) Rebound tenderness and abdominal guarding
c) Parents will be leaving the child alone in the hospital
d) Child can tolerate only sips of fluid without nausea

3. A 3-day-old infant presenting with physiologic jaundice is hospitalized and placed under phototherapy. Which
response indicates to the nurse that the parent needs more teaching?

a) "My infant is at risk for dehydration."

b) "My infant needs to stay under the lights, except during feeding time."
c) "My infant can continue to breastfeed during this time."
d) "My infant has a serious liver disease."

4. A 3-month-old infant presents with a history of vomiting after feeding. The plan for the infant is to rule out GER.
What information from the history would lead the nurse to believe that this infant may need further intervention?

a) Poor weight gain

b) Has small "spits" after feeding
c) Sleeps through the night
d) Is difficult to burp

5. The nurse is caring for a child who has had diarrhea and vomiting for the past several days. What is the priority
nursing assessment?

a) Determine the child's weight

b) Ask if the family has traveled outside of the country
c) Assess circulation and perfusion
d) Send a stool specimen to the lab

6. The nurse is caring for a child admitted with gastroesophageal reflux (GER). Which clinical manifestation
would likely be seen in this child?

a) Bouts of diarrhea with failure to gain weight

b) Effortless vomiting just after the child has eaten
c) Forceful vomiting followed by the child being eager to eat again
d) Severe constipation with occasional ribbon-like stools

7. A child is experiencing an acute exacerbation of Crohn disease for which she is prescribed prednisone. The
nurse teaches the parents and child about this medication. Which statement by the parents indicates that the
teaching was successful?
 a) "We might notice some of the medication in her stool"
b) "She might lose some weight initially."
c) "This drug helps to control the abdominal cramping."
d) "We should not stop this medication abruptly."

8. The nurse is caring for a child admitted with pyloric stenosis. Which clinical manifestation would likely have
been noted in the child with this diagnosis?

a) Frequent urination
b) Projectile vomiting
c) Explosive diarrhea
d) Severe abdominal pain

9. A 2-month-old boy is admitted to the emergency room with severe diarrhea. Intravenous fluid is prescribed for
him. Before adding potassium to this solution, which assessment would you record?

a) He "attunes" to a music box.

b) He has voided.
c) His hands are restrained.
d) He cries with tears.

10. An adolescent boy is diagnosed with hepatitis A. Which problem should be considered when planning care?

a) He will become fatigued easily.

b) His urine will be dark and infectious.
c) Hypothermia is common.
d) He will be very irritable and perhaps require sedation.

11. The nurse is caring for a 13-year-old girl with suspected autoimmune hepatitis. The girl inquiries about the
testing required to evaluate the condition. How should the nurse respond?

a) "You will most likely have a blood test to check for certain antibodies."
b) "You will most likely have viral studies."
c) "You will most likely be tested for ammonia levels."
d) "You will most likely have an ultrasound evaluation."

12. The nurse is discussing the treatment of congenital aganglionic megacolon with the caregivers of a child
diagnosed with this disorder. Which statement is the best explanation of the treatment for this diagnosis?

a) "Your child will be treated with oral iron preparations to correct the anemia."
b) "The treatment for the disorder will be a surgical procedure."
c) "We will give enemas until clear and then teach you how to do these at home."
d) "Your child will receive counseling so the underlying concerns will be addressed."

13. The nurse is examining a 7-year-old with suspected appendicitis. Which physical findings would indicate the
possibility of appendicitis?

a) Tenderness that comes and goes in the lower abdomen

b) Persistent, right lower quadrant pain with rebound tenderness
c) Intermittent, left lower quadrant pain with rebound tenderness
d) Diffuse, intermittent abdominal pain

14. The nurse is providing instructions to the parents of a 10-year-old boy who has undergone a barium
swallow/upper and lower GI for suspected inflammatory bowel disease. Which of the following instructions is
most important?
 a) "Your child could have diarrhea for several days afterward."
b) "Your child might have lighter stools for the next few days."
c) "Please be aware of any signs of infection."
d) "It is very important to drink lots of water and fluids after the test is finished."

15. A mother is alarmed because her 6-week-old boy has begun vomiting almost immediately after every feeding.
In the past week, the vomiting has grown more forceful, with the vomit projecting several feet from his mouth.
He is always hungry again just after vomiting. At the physician's office, the nurse holds the child and gives him
a bottle of water. While he drinks, she notes an olive-size lump in his right abdomen. Which condition should the
nurse suspect in this child?

a) Gastroesophageal reflux
b) Appendicitis
c) Pyloric stenosis
d) Peptic ulcer disease

16. A nurse taking a health history of a newborn notes that there is a maternal history of polyhydramnios. What
GI condition might this history precipitate?

a) Pyloric stenosis
b) Cleft palate
c) Esophageal atresia (EA)
d) Hernia

17. The nurse is teaching the mother of an infant with a temporary ileostomy about stoma care. What is the most
important instruction to emphasize to the mother to avoid an emergency situation?

a) "You may need adhesive remover to ease pouch removal."

b) "You must be meticulous in caring for the surrounding skin."
c) "Gather all of your supplies before you begin."
d) "Call the doctor immediately if the stoma is not pink/red and moist."

18. A nurse reads the medical history of a client who is scheduled for a hernia repair that is termed "reducible."
What best describes this type of hernia?

a) Its contents can be easily manipulated back into the peritoneal cavity.
b) Intestinal obstruction and ischemia may occur.
c) The abdominal contents have become trapped.
d) The herniated intestines are twisted and edematous.

19. The nurse has admitted a child with a diagnosis of severe gastroenteritis. To help prevent the risk of
transmitting infection to other patients, the nurse should

a) Follow standard precautions

b) Discourage anyone from visiting
c) Sterilize thermometers between patients
d) Wear a mask when handling articles contaminated with feces

20. A nurse caring for Paulo, an infant born with a cleft palate, notices that the parents rarely interact with their
child. The nurse overhears the mother telling her husband that she "feels like crying" every time she looks at
their son. What would be the best response from the nurse?

a) "Many infants are born with this condition. Your son's palate is not nearly as bad as some cases."
b) "I sense you could use more information on caring for a cleft palate. Would you be interested in meeting
with other parents who have dealt with this?"
 c) "Your son needs you right now. You should put your negative feelings about his condition aside for his
sake."
d) "Keep in mind that your son's condition is not life-threatening and can be corrected eventually."

21. The nurse is preparing an 18-month-old for discharge after treatment for dehydration following diarrhea.
What instruction would the nurse most likely include in the discharge teaching?

a) "Give her plenty of fruit juice or soda."

b) "Encourage bananas, applesauce, and crackers."
c) "Make sure she gets lots of clear liquids."
d) "Offer her flavored gelatin if she is hungry."

22. The nurse is collecting data on a child who has been brought to the clinic. The child has urticaria, pruritus,
stomach pains, and respiratory symptoms. The nurse recognizes that the clinical manifestations noted in this
child are commonly seen in which of the following disorders?

a) Vitamin deficiency
b) Food allergies
c) Protein malnutrition
d) Calcium insufficiency

23. Noah is an 18-month-old who is brought to the ER with flu-like symptoms. He is diagnosed with pneumonia
secondary to aspiration of stomach contents. The nurse explains to the parents that pneumonia is a condition
that often occurs secondary to:

a) cystic fibrosis.
b) Hirschsprung disease.
c) inflammatory bowel disease.
d) gastroesophageal reflux disease.

24. A physician recommends a gastrostomy for a 4-year-old client with an obstruction. The parents ask the
certified wound, ostomy, and continence nurse (CWOCN) what the surgery entails. What is the nurse's best
response?

a) "The surgery is performed to create an opening between the esophagus and the neck."
b) "The surgery will create an opening to the large intestine."
c) "The surgery creates an opening between the stomach and abdominal wall."
d) "The surgery will create an opening to the small intestine."

25. A nurse is caring for a 6-year-old girl recently diagnosed with celiac disease and is discussing dietary
restrictions with the girl's mother. Which response indicates a need for further teaching?

a) "There is gluten hidden in unexpected foods."

b) "My daughter is eating more vegetables."
c) "There are many types of flour besides wheat."
d) "My daughter can eat any kind of fruit."

26. A 6-month-old boy is diagnosed with pyloric stenosis. When you take a health history from his mother, which
symptom would you expect to hear her describe?

a) Vomiting immediately after feeding

b) Vomiting about 2 hours after feeding
c) Refusal to eat
d) Chronic diarrhea
27. You care for a 12-year-old girl with Crohn disease. A primary assessment you would want to make when
caring for her would be to note if:

a) she has a temperature.

b) her joints are not swollen.
c) she has a headache.
d) lung sounds are clear.

28. A father brings Jacob, age 2, to the health clinic with complaints of diarrhea, vomiting, and abdominal pain.
The father tells the nurse that he is a single parent and Jacob is enrolled in a local daycare center. Based on this
information, what gastrointestinal condition might the nurse suspect?

a) Appendicitis
b) Gastroenteritis
c) Pancreatitis
d) Hirschsprung disease

29. In caring for an infant diagnosed with pyloric stenosis, the nurse would anticipate that she would:

a) prepare the infant for surgery.

b) assist in doing a barium enema procedure on the infant.
c) medicate the infant with analgesics.
d) change the infant's diet to lactose-free.

30. A child is scheduled for a urea breath test. The nurse understands that this test is being performed for which
reason?

a) Determine esophageal contractility

b) Detect Helicobacter pylori
c) Evaluate gastric pH
d) Confirm pancreatitis

31. The nurse is teaching an in-service program to a group of nurses on the topic of gastrointestinal disorders.
The nurses in the group make the following statements. Which statement is most true about GER.

a) A partial or complete intestinal obstruction occurs.

b) There are recurrent paroxysmal bouts of abdominal pain.
c) A thickened, elongated muscle causes an obstruction at the end of the stomach.
d) In this disorder the sphincter that leads into the stomach is relaxed.

32. A preschooler has celiac disease. Her mother is preparing a gluten-free diet. By preparing which breakfast
foods would you believe she understands the diet?

a) Rye toast and peanut butter

b) Eggs and orange juice
c) Cheerios (oat cereal) and skim milk
d) Wheat toast and grape jelly

33. A mother brings her 3-year-old son to the ER and tells the triage nurse that he has been vomiting blood. A
medical history determines that the 3-year-old has no history of GI disturbances and his only symptoms are a
slightly elevated fever and vomiting bright red blood. Based on these symptoms, what condition might the nurse
suspect?

a) Acute upper GI bleeding

b) GI tract obstruction
c) Intussusception
 d) Gastroesophageal reflux

32. The nurse caring for an 18-month-old infant with Meckel diverticulum knows that the most common clinical
manifestation of this condition is:

a) Dehydration
b) Painless rectal bleeding
c) Respiratory distress
d) Ischemia

33. A 12-year-old boy has just undergone a liver transplantation and is recovering. After performing a finger stick
puncture and assessing the results, the nurse administers a 10% solution of dextrose IV. What is the correct
rationale for this intervention?

a) Reduction of hypertension
b) Prevention of T-cell rejection of the transplanted liver
c) Maintenance of electrolyte balance
d) Prevention of hypoglycemia

34. A neonatal nurse teaches students how to recognize gastrointestinal disorders in infants. The nurse tells the
students that failure of the newborn to pass meconium in the first 24 hours after birth may indicate what disease?

a) short bowel syndrome (SBS)

b) Hirschsprung disease
c) Gastroenteritis
d) Ulcerative colitis (UC)

35. The nurse is conducting a physical examination of an 18-month-old with suspected intussusception. Which
finding would the nurse identify as the hallmark of this condition?

a) Skin tenting
b) Perianal skin tags
c) Abdominal pain and guarding
d) A sausage-shaped mass in the upper mid-abdomen

36. Which of the following is most correct regarding the gastrointestinal system of the child?

a) The child's gastrointestinal system is fully matured when the child is born.
b) The enzymes secreted by the child's liver and pancreas are much greater in amount than in the adult.
c) The child cannot break down and use complex carbohydrates in the same way the adult can.
d) The speed with which food passes through the gastrointestinal tract in the child is much slower than in
the adult.

37. The nurse is teaching an in-service program to a group of nurses on the topic of gastrointestinal disorders.
The nurses in the group make the following statements. Which statement is most accurate related to the
diagnosis of colic?

a) In this disorder the sphincter that leads into the stomach is relaxed.
b) A thickened, elongated muscle causes an obstruction at the end of the stomach.
c) There are recurrent paroxysmal bouts of abdominal pain.
d) A partial or complete intestinal obstruction occurs.

38. The nurse is caring for a 2-year-old boy with an umbilical hernia and is teaching the mother about this
condition. Which response from the mother indicates a need for further teaching?

a) "I need to watch for pain, tenderness, or redness."

 b) "I can tape a quarter over the hernia to reduce it."
c) "Incarceration is rare, but it can occur."
d) "My son could have some appearance-related self-esteem issues."

39. The nurse is collecting data on a 2 ½-year-old child admitted with a diagnosis of gastroenteritis. When
interviewing the caregivers, which question is most important for the nurse to ask?

a) "How many times a day does your child urinate?"

b) "What foods has your child eaten during the last few days."
c) "Tell me about the types of stools you child has been having."
d) "How long has your child been toilet trained?"

40. A child is diagnosed with intussusception. The nurse anticipates that what action would be attempted first to
reduce this condition?

a) Endoscopic retrograde cholangiopancreatography

b) Surgery
c) Barium enema
d) Upper endoscopy

NURSING CARE OF A FAMILY WHEN A CHILD HAS AN IMMUNE DISORDER

1. The nurse is administering the prescribed intravenous immunoglobulin to a 10-year-old boy. Which of the
following would be most important for the nurse to do?

a) Administer with food.

b) Monitor for signs of Cushing syndrome.
c) Have epinephrine available.
d) Monitor urine for glucose.

2. When caring for a child experiencing anaphylactic shock, the most important nursing action would be to

a) enhance the action of histamine.

b) reverse sympathetic nervous system responses.
c) counteract hypertension.
d) facilitate breathing.

3. Food allergies have become more and more common in the last few decades. Which of the following are
common food allergies of childhood? Select all that apply.

a) Cheerios
b) Apples
c) Milk
d) Peanuts
e) Eggs

4. The nurse is caring for a child who is beginning to show signs and symptoms of anaphylaxis. Which
intervention would be the priority?

a) Administering IV diphenhydramine (Benadryl)

b) Obtaining brief history of allergen exposure
c) Administering corticosteroids
d) Assessing patency of the airway
5. Which is the immunoglobulin associated with allergic reactions?

a) IgA
b) IgM
c) IgG
d) IgE

6. To avoid anaphylactic reactions in children, which question would be most important to ask a parent before
administering penicillin to her infant?

a) "Is there any family history of allergy to penicillin?"

b) "Do you have a telephone to call us immediately if she develops trouble breathing?"
c) "What do you give her to alleviate itching?"
d) "Has she ever had penicillin before?"

7. A child with HIV, weighing 25 kg, is about to receive an infusion of IVIG. The recommended dose is 400
mg/kg/dose. The medication is available in a concentration of 50 mg/mL. What is the proper amount of infusion
that the child will receive?

a) 1000 mL
b) 2000 mL
c) 200 mL
d) 100 mL

8. The nurse is explaining patterns of incidence and transmission of HIV to a group of adolescent girls. She
explains that the risks for this population are much higher because of the possibility of both vertical and horizontal
transmission. Horizontal transmission refers to transmission of the disease during which of the following?

a) Sexual contact
b) The birthing process
c) Pregnancy
d) Feeding with breast milk

9. The nurse is preparing to administer an intravenous immunoglobulin infusion. While reconstituting the product
according the manufacturer's instructions, the nurse knows to take which step for proper preparation?

a) Reconstitute the medication 2 hours prior to administration.

b) Gently roll the vial to mix the medication.
c) Store the reconstituted medication no longer than 4 hours in the refrigerator
d) Shake the vial vigorously to disperse the diluent.

10. A young patient is admitted to the hospital directly from the clinic. The physician suspects a problem with the
patient's immune system. What test does the nurse anticipate the physician will order for this patient?

a) urine analysis
b) blood analysis
c) x-ray
d) EKG

11. A young patient comes to the clinic with multiple symptoms of an infection. The nurse realizes that the patient
has been seen in the clinic every month for the last 6 months for the same problems. Which body system does
the nurse suspect is malfunctioning in this patient?

a) cardiovascular
b) respiratory
c) immune
 d) gastrointestinal

12. A child with primary immune deficiency is about to receive an infusion of IVIG. Which of the following is the
most appropriate premedication to minimize the reaction?

a) Ketorolac
b) Ibuprofen
c) Diphenhydramine
d) Solu-Medrol

13. A group of nursing students are reviewing information about the immune system. The students demonstrate
understanding of the information when they identify which of the following being produced by the thymus?

a) White blood cells

b) Stem cells
c) Lymphocyte T cells
d) Antibodies

14. The nurse is instructing a group of women of childbearing age about HIV during pregnancy. Which of the
following should be a priority recommendation in this setting?

a) Screening for HIV

b) Screening for STIs
c) Prophylactic treatment for HIV
d) Proper nutrition

15. The nurse is caring for an infant exposed to HIV. The polymerase chain reaction (PCR) test was negative at
birth. The nurse tells the mother that the child will most likely be tested again at what age?

a) 12 months
b) 4 to 7 weeks
c) 8 to 10 weeks
d) 2 to 3 months

16. When describing anaphylaxis to a group of parents whose children have experienced anaphylaxis from insect
stings, the nurse integrates knowledge that this response is related to which immunoglobulin?

a) IgG
b) IgM
c) IgE
d) IgA

17. A nursing student correctly identifies the inability to distinguish self from nonself, causing the immune system
to carry out immune responses against normal cells, as which of the following?

a) immunity
b) autoimmunity
c) delayed hypersensitivity
d) allergen

18. The parents of a child with juvenile idiopathic arthritis bring the child to the emergency department because
the child is very drowsy and breathing heavily. The child also has been vomiting and complaining of ringing in
her ears. The nurse suspects that the child is experiencing a toxic reaction to one of her medications. Which
medication would the nurse suspect?

a) Aspirin
 b) Corticosteroid
c) Etanercept
d) Methotrexate

19. A child with systemic lupus erythematosus is receiving hydroxychloroquine sulfate. Which instruction would
the nurse emphasize when teaching the child and parents about this drug?

a) Importance of yearly eye examinations

b) Avoiding grapefruit juice when taking the drug
c) Giving with foods to minimize gastrointestinal upset
d) Need to gradually taper the drug dosage over time

20. A woman in her fourth month of pregnancy has recently learned that her sexual partner is HIV positive. She
agrees to be tested for the virus but asks the nurse what early symptoms she should be looking for in herself.
Which of the following should the nurse mention to the client?

a) Vaginal discharge
b) Skin rash
c) Mild, flu-like symptoms
d) Genital warts

21. The most accurate screening test for the presence of HIV antigen in young children is

a) ELISA
b) PCR
c) CD4 count
d) Western blot

22. The nurse is working with a pregnant client with HIV who is receiving oral zidovudine. What is the primary
rationale for this intervention?

a) To treat pneumonia
b) To help prevent transmission of the disease to the fetus
c) To halt the growth of Kaposi's sarcoma
d) To restore coagulation ability

23. A 6-month-old boy has been admitted to the hospital with severe bloody diarrhea. The nurse notes petechiae
and eczema with signs of secondary infection. As the nurse documents the boy's history, the parents report easy
bruising and prolonged bleeding after circumcision. Based on these findings, the nurse suspects a diagnosis of
which of the following?

a) von Willebrand's disease

b) Beta-thalassemia major
c) Wiskott-Aldrich syndrome
d) Severe combined immunodeficiency

24. When teaching about primary and secondary humoral responses, what should the nurse identify as the
immunoglobin that is first to appear in the serum?

a) IgD
b) IgE
c) IgG
d) IgM
25. Which of the following nursing problems could be associated with a child with primary immunodeficiency?
Select all that apply.

a) Risk for infection

b) Delayed growth and development
c) Altered skin integrity
d) Altered gastrointestinal function
e) Altered fluid and electrolytes

NURSING CARE OF A FAMILY WHEN A CHILD HAS AN ENDOCRINE OR METABOLIC

DISORDER

1. A child is prescribed glargine insulin. What information would the nurse include when teaching the child and
parents about this insulin?

a) Discard any opened vials after a week

b) Do not mix this insulin with other insulins
c) Give the dose first thing in the morning
d) Store the insulin in the refrigerator until just before giving it

2. The nurse working with the child diagnosed with type 2 diabetes recognizes the disorder can be managed by:

a) Conserving energy with rest periods during the day

b) Increasing carbohydrates in the diet, especially in the evening
c) Taking oral hypoglycemic agents
d) Decreasing amounts of daily insulin

3. 3. A school-aged child is brought into the emergency room, and the preliminary diagnosis is acute
adrenocortical insufficiency. Which of the interventions below should the nurse implement first?

a) Prepare the child for admission to the pediatric intensive care unit
b) Insert an IV line in preparation for giving IV fluids and cortisol
c) Arrange for a bedside electrocardiogram to be performed
d) Administer oxygen via a nonrebreather mask

4. 4. Insulin deficiency, in association with increased levels of counter-regulatory hormones and dehydration, is
the primary cause of:

a) Ketone bodies
b) Ketonuria
c) Diabetic ketoacidosis
d) Glucosuria

5. The parents of a child with congenital adrenal hyperplasia bring the child to the emergency department for
evaluation because the child has had persistent vomiting. What finding would lead the nurse to suspect that the
child is experiencing an acute adrenal crisis?

a) Hypertension
b) Hyperkalemia
c) Bradycardia
d) Hypernatremia

6. An infant on the pediatric floor has diabetes insipidus. Which assessment data are important for the nurse to
monitor while the infant is on strict fluid precautions?

a) Oral intake
 b) Urine output
c) Color of mucous membranes
d) Temperature and heart rate

7. he nurse knows that disorders of the pituitary gland depend on the location of the physiologic abnormality. In
caring for a child that has issues with the anterior pituitary, the nurse knows that this child has issues with which
hormone?

a) Vasopressin
b) Growth hormone
c) Antidiuretic hormone
d) Oxytocin

8. The nurse is educating the parents of a client newly diagnosed with type 1 diabetes. Which statement by the
parents indicates additional teaching is needed?

a) "Our child should not participate in sports or physical activity"

b) "Our child should eat three meals and mid afternoon and bedtime snacks each day"
c) "When our child is sick, we may need to check glucose levels more frequently"
d) "We and our child need to learn to identify carbohydrate, protein, and fat foods"

9. A 10-year-old child has been diagnosed with type 1 diabetes. The child is curious about the cause of the
disease and asks the nurse to explain it. Which explanation will the nurse provide?

a) "Special cells in a part of your body called the pancreas cannot make a chemical called insulin, which
helps control the sugar level in your blood"
b) "The part of your body called the pancreas is broken and produces too much chemical called glucagon,
which makes you really thirsty and have to go to the bathroom a lot"
c) "The pancreas inside your belly makes enough chemical called insulin, but your body does not want to
use it to keep your blood sugar level normal"
d) "The alpha and beta cells in your pancreas are fighting against each other; that is why your blood sugar
stays high and you need insulin injection"

10. The nurse is interpreting the negative feedback system that controls endocrine function. What secretion will
the nurse correlate as decreasing while blood glucose levels decrease?

a) Glucagon
b) Adrenocorticotropic hormone
c) Insulin
d) Glycogen

11. The nurse is taking a history on a 10-year-old child who has a diagnosis of hypopituitarism. Which question
is important for the nurse to ask the parents?

a) "What time each day does your child take his growth hormone?"
b) "How often do you test your child's blood glucose?"
c) "Is your child taking vasopressin IM or SC?"
d) "Does your child get upset about being taller than friends?"

12. A nurse who is caring for a 7-year-old is providing client education to the child and caregiver. Which response
by the caregiver demonstrates to the nurse that the caregiver understands the diagnosis of type 1 diabetes
mellitus?

a) "I will just feed my child healthy foods and sign her up for more sports"
b) "Her body doesn't have any insulin"
 c) "Her body fights against the insulin"
d) "We will just have our child exercise and take medicine to cure this"

13. A nurse is educating a family about the Chvostek sign after their teen tested positive for Chvostek sign.
Which statements by the caregivers shows the nurse that they understand the Chvostek sign?

a) "The sign means my child is not getting enough vitamin D"

b) "When I tap on my child's facial nerve, the reaction is a facial muscle spasm"
c) "The sign occurs because my child is having increased intracranial pressure"
d) "The sign occurs when there is muscle pain and the muscle is stimulated"

14. Which findings should the nurse expect to assess when completing the health history of a child admitted for
possible type 2 diabetes? Select all that apply.

a) Polyphagia
b) Marked weight loss
c) Polyuria
d) Abrupt onset of symptoms
e) Polydipsia

15. A nurse is reviewing with an 8-year-old how to self-administer insulin. Which of the following is the proper
injection technique for insulin injections?

a) Spread the skin before the injection

b) Aspirate the syringe for blood return before the injection
c) Elevate the subcutaneous tissue before the injection
d) Place the needle with the bevel facing down before the injection

16. A nurse is working in a clinic where high-risk pregnancies are prevalent. The nurse is assisting with diagnostic
screening for pregnant clients and fetuses. A client comes to the clinic newly diagnosed with an absence of
hexosaminidase. The client is upset and does not know how this will affect the fetus. Prior to the appointment
with the health care provider, which information is best for the nurse to explain?

a) It is an autosomal-recessive inherited disease

b) It is a disease that has no cure
c) It is a genetic disease that affects lipid metabolism
d) It is a disease that occurs in the Ashkenazi Jewish population

17. The nurse is obtaining a health history from parents whose 4-month-old boy has congenital hypothyroidism.
What would the nurse most likely assess?

a) It is difficult to keep the child awake

b) The skin is pink and healthy looking
c) The child has above-normal growth for his age
d) The child is active and playful

18. An adolescent is found wandering around. The client is confused, sweaty, and pale. Which test will the nurse
prepare to perform first?

a) Serum ketone testing

b) Blood toxicology
c) Blood glucose level
d) Computed tomography (CT) scan
19. The nurse knows that which condition is caused by excessive levels of circulating cortisol?

a) Graves disease
b) Addison disease
c) Cushing syndrome
d) Turner syndrome

20. From which pair of metabolic disorders must the nurse instruct the parents to eliminate breast and cow's milk
from the diet?

a) Galactosemia and phenylketonuria

b) Maple syrup urine disease and galactosemia
c) Congenital hypothyroidism and phenylketonuria
d) Turner syndrome and maple syrup urine disease

21. What should be included in the teaching plan for a child with type 1 diabetes who is going home on insulin
therapy?

a) All children should be on at least two types of insulin to establish glucose control
b) It is absolutely normal for the growing child to require an increase in insulin; this does not mean his/her
condition is getting worse
c) Children show an increased need for insulin during the first months after glucose control is established
d) Once glucose control is established, there will never be a need for an increase in the amount of insulin
administered

22. A 6-year-old boy has a moon-face, stocky appearance but with thin arms and legs. His cheeks are unusually
ruddy. He is diagnosed with Cushing syndrome. What is the most likely cause of this condition in this child?

a) Tumor of the thyroid

b) Tumor of the parathyroid
c) Tumor of the pancreas
d) Tumor of the adrenal cortex

23. The nurse is assessing a 13-year-old boy with type 2 diabetes mellitus. What would the nurse correlate with
this disorder?

a) Auscultation reveals Kussmaul breathing

b) The parents report that their child had "a cold or flu" recently
c) Blood pressure is decreased when checking vital signs
d) The parents report that their son "can't drink enough water"

24. A 12-year-old is being seen in the office and has hyperthyroidism; the nurse knows that the most common
cause of hyperthyroidism is:

a) Cushing disease
b) Graves disease
c) Plummer disease
d) Addison disease

25. A child is diagnosed with hyperthyroidism. What finding would the nurse expect to assess?

a) Constipation
b) Weight gain
c) Facial edema
d) Heat intolerance
27. The nurse is caring for a child admitted to the emergency center in diabetic ketoacidosis. Which clinical
manifestations would the nurse most likely note in this child?

a) Pale and moist skin

b) Drowsiness and fruity odor to breath
c) Slow pulse and elevated blood pressure
d) Hyperactive and restless behavior

28. A 9-year-old child with Graves disease is seen at the pediatrician's office reporting sore throat and fever. The
nurse notes in the history that the child is taking propylthiouracil. Which of the following would concern the nurse?

a) The child may have developed leukopenia

b) The child must be participating in sports
c) The child needs to be started on an antibiotic drug
d) The child may not be taking the medication

29. A 15-year-old girl is brought to the clinic by her mother because the girl has been experiencing irregular and
sporadic menstrual periods and excessive body hair growth. Polycystic ovary syndrome is suspected. Which
additional assessment finding would help to support this suspicion?

a) Decreased serum levels of free testosterone

b) Darkened pigmentation around the neck area
c) Body mass index as normal
d) Short stature

30. A 12-year-old boy arrives at the emergency room experiencing nausea, vomiting, headache, and seizures.
He is diagnosed with bacterial meningitis. Other findings include a decrease in urine production, hyponatremia,
and water intoxication. Which pituitary gland disorder would be most associated with these symptoms?

a) Hyposecretion of somatotropin
b) Syndrome of inappropriate antidiuretic hormone
c) Hypersecretion of somatotropin
d) Diabetes insipidus

NURSING CARE OF A FAMILY WHEN A CHILD HAS A HEMATOLOGIC DISORDER

1. An 8-month-old girl appears pale, irritable, and anorexic. On blood testing, the red blood cells are hypochromic
and microcytic. The hemoglobin level is less than 5 g/100 mL, and the serum iron level is high. Which symptom
should the nurse most expect as a result of excessive iron deposits?

a) An enlarged heart
b) Enlarged lymph nodes
c) An enlarged thyroid gland
d) An enlarged spleen

2. The mother of a 5-year-old girl brings the child to the clinic for an evaluation. The mother tells the nurse, "She
seems to be so tired and irritable lately. And she looks so pale." Further assessment reveals pale conjunctiva
and oral mucous membranes. The nurse suspects iron-deficiency anemia. Which additional finding would help
provide additional evidence for this suspicion?

a) Spooned nails
b) Oxygen saturation: 99%
c) Negative splenomegaly
d) Bradycardia
3. The nurse is caring for a toddler taking ferrous sulfate for severe iron-deficiency anemia. Which report by the
parent is most concerning?

a) "I mix ferrous sulfate with milk in a bottle"

b) "My child takes ferrous sulfate after meals"
c) "My child's stools are darker than usual"
d) "I brush my child's teeth once every day"

4. A 5-year-old girl is diagnosed with iron-deficiency anemia and is to receive iron supplements. The child has
difficulty swallowing tablets, so a liquid formulation is prescribed. After teaching the parents about administering
the iron supplement, which statement by the parents indicates the need for additional teaching?

a) "We'll try to get her to drink lots of fluids throughout the day"
b) "She needs to eat foods that are high in fiber so she doesn't get constipated"
c) "We will place the liquid in the front of her gums, just below her teeth"
d) "We need to measure the liquid carefully so that we give her the correct amount"

5. In discussing the causes of iron-deficiency anemia in children with a group of nurses, the following statements
are made. Which of these statements is a misconception related to iron-deficiency anemia?

a) "Milk is a perfect food, and babies should be able to have all the milk they want"
b) "A family's economic problems are often a cause of malnutrition"
c) "Caregivers sometimes don't understand the importance of iron and proper nutrition"
d) "Children have a hard time getting enough iron from food during their first few years"

6. The nurse develops a meal plan for a child with iron-deficiency anemia. Which meal would the nurse teach
the parent has the highest amount of iron?

a) Red meat, eggs, oatmeal, and dried fruit

b) Chicken, corn, brown rice, and oranges
c) Pork, broccoli, white rice, and strawberries
d) Tuna salad with eggs, whole wheat crackers, and blueberries

7. The parents of a 6-year-old child with idiopathic thrombocytopenic purpura (ITP) ask the nurse conducting an
assessment of the child what causes the disease. What is the nurse's best response?

a) "ITP is characterized by the loss of surface area on the red blood cell membrane"
b) "ITP is a serious bleeding disorder characterized by a decreased, absent, or dysfunctional procoagulant
factor"
c) "ITP is primarily an autoimmune disease in which the immune system attacks and destroys the body's
own platelets, for an unknown reason"
d) "ITP occurs when the body's iron stores are depleted due to rapid physical growth, inadequate iron intake,
inadequate iron absorption, or loss of blood"

8. A 9-year-old boy will be undergoing a hematopoietic stem cell transplantation, with donor cells being provided
by his 12-year-old sister. The nurse recognizes that this type of transplantation is:

a) Syngeneic
b) Autologous
c) Allogeneic
d) Heterologous

9. Which site is most frequently used to perform a bone marrow aspiration?

a) Femur
b) Rib cage
 c) Humerus
d) Iliac crest

10. 11. A nurse is providing teaching to the parents of a child diagnosed with sickle cell anemia. The discussion
is focused on precipitating factors for sickle cell crisis. Which statement by the parents requires the nurse to
reinforce the teaching?

a) "Our family is taking a fun hiking trip up in the mountains next week"
b) "We always take water along when we are on an outing"
c) "I make sure our child is up to date on all immunizations"
d) "I make sure my child wears a good warm coat and gloves during winter"

11. 2. A mother asks the nurse why her infant who was born at 34 weeks' gestation is being prescribed ferrous
sulfate. Which response by the nurse is most appropriate?

a) "Infants with pyloric stenosis require ferrous sulfate"

b) "Your infant may have been having excessive diarrhea"
c) "Ferrous sulfate helps improve red blood cell formation"
d) "Preterm infants are at risk for iron-deficiency anemia"

12. When developing the postoperative plan of care for a child with sickle cell anemia who has undergone a
splenectomy, which would the nurse identify as the priority?

a) Risk for delayed growth and development

b) Risk for infection
c) Deficient fluid volume
d) Impaired skin integrity

13. A 15-year-old client diagnosed with von Willebrand disease has reached menarche. Based on this fact, what
information is most important for the nurse to convey to the client?

a) Bruising may occur in the perineal area

b) The duration of each period will be short
c) Expect menstrual bleeding to be heavy
d) Occasional skipped periods can be expected

14. nursing instructor is describing childhood hematologic disorders to students. Which would the instructor
include as being commonly affected by hematologic disorders? Select all that apply.

a) Thrombocytes
b) Erythrocytes
c) Plasma
d) Whole blood
e) Leukocytes

15. A child is prescribed monthly injections of vitamin B12. When developing the teaching plan for the family, the
nurse would focus on which type of anemia?

a) Sickle cell anemia

b) Folic acid anemia
c) Aplastic anemia
d) Pernicious anemia

17. A toddler who is beginning to walk has fallen and hit his head on the corner of a low table. The caregiver has
been unable to stop the bleeding and brings the child to the pediatric clinic. The nurse is gathering data during
the admission process and notes several bruises and swollen joints. A diagnosis of hemophilia is confirmed.
This child most likely has a deficiency of which blood factor?

a) Factor X
b) Factor XIII
c) Factor V
d) Factor VIII

18. A 14-year-old girl who is a vegetarian has recently developed anemia. Blood smear results show large,
fragile, immature erythrocytes. She claims to take an iron supplement regularly and is surprised to learn that she
is anemic, as she is otherwise healthy. As the nurse considers all of the data in the case, which anemia will the
nurse discuss when collaborating with the primary healthcare provider?

a) sickle-cell disorder
b) Vitamin B12 deficiency
c) Iron deficiency
d) Acute blood loss

19. The nurse is caring for a child who has been admitted for a sickle cell crisis. What would the nurse do first to
provide adequate pain management?

a) Initiate pain assessment with a standardized pain scale

b) Administer a nonsteroidal anti-inflammatory drug (NSAID) as ordered
c) Use guided imagery and therapeutic touch
d) Administer meperidine as ordered

20. A child diagnosed with hemophilia presents with warm, swollen, painful joints. Which action will the nurse
take first?

a) Prepare to administer factor replacement medication

b) Assess the client's urine and stool for blood
c) Document the presence of hemarthrosis in the client's chart
d) Notify the client's primary health care provider

21. A couple is expecting a child. The fetus undergoes genetic testing and the couple discover the fetus has
sickle cell disease. The couple ask the nurse how most commonly happens. Which statement is accurate for the
nurse to provide?

a) "Sickle cell disease can be passed to the fetus in many ways. We will know more at birth"
b) "Sickle cell disease is passed to a fetus when one of the parents has the gene"
c) "Sickle cell disease occurs from a random genetic mutation"
d) "Sickle cell disease is passed to a fetus when both parents have the gene"

22. A nurse is preparing a teaching plan for a child with hemophilia and his parents. Which information would
the nurse be least likely to include to manage a bleeding episode?

a) Administer factor VIII replacement

b) Apply direct pressure to the area
c) Elevate the injured area such as a leg or arm
d) Apply heat to the site of bleeding

23. The nurse is providing care for a 13-year-old child diagnosed with iron-deficiency anemia. The client's current
hemoglobin level is 11 g/dL (110 g/L). Which intervention will the nurse anticipate including in the client's care?

a) Increasing the daily intake of fresh fruits and vegetables

b) Giving ferrous sulfate with orange juice between meals
 c) Providing a high dose of intravenous immunoglobulin weekly
d) Packed red blood cell transfusions

24. What nursing action should the nurse take when caring for a child with aplastic anemia?

a) Assess the child's blood pressure every hour

b) Ensure the child is offered a low-fiber diet
c) Provide toys that do not have sharp corners or edges
d) Encourage visits from friends and family

25. When assessing a child for a possible hematologic disorder, which would the nurse need to keep in mind as
most important?

a) Sequelae are rare with chronic problems

b) Multiple body sites can be affected
c) Demographic data is of little relevance
d) A child's nutritional status is key

26. A nurse is providing care for a child with disseminated intravascular coagulation (DIC). What would alert the
nurse to possible neurologic compromise?

a) Equal pupillary response

b) Hematuria
c) Widely fluctuating blood pressure
d) Petechiae

27. A nurse caring for an 8-year-old with a bleeding disorder documents the following nursing diagnosis:
ineffective tissue perfusion related to intravascular thrombosis and hemorrhage. This diagnosis is most
appropriate for a client with:

a) Disseminated intravascular coagulation (DIC)

b) Hemophilia
c) von Willebrand disease
d) Iron-deficiency anemia

28. A group of students is reviewing information about glucose-6-phosphate dehydrogenase (G-6-PD)

deficiency. The students demonstrate understanding of the material when they identify what as the cause of the
disorder?

a) Autosomal recessive inheritance

b) An excess supply of iron
c) Deficiency in clotting factors
d) X-linked recessive inheritance

29. When evaluating the hemogram of an 8-month-old infant, the nurse would identify which type of hemoglobin
as being the predominant type?

a) Hemoglobin A2
b) Hemoglobin A
c) Hemoglobin F
d) Hemoglobin S

30. A 1-year-old child is diagnosed with pernicious anemia due to lack of intrinsic factor and is prescribed vitamin
B12 injections. After teaching the child's parents about this treatment, the nurse determines that the teaching
was successful based on which statement?
 a) "We should give our child the injection daily for one month and then stop it"
b) "The injections are a temporary measure until our child outgrows the condition"
c) "We must give the injection on the days when our child doesn't eat well"
d) "We will give the injection once a month for the rest of our child's life"

NURSING CARE OF A FAMILY WHEN A CHILD HAS A RENAL OR URINARY TRACT DISORDER

1. child is hospitalized with nephrotic syndrome. Which measurement is best for the nurse to determine the
child's edema?

a) Amount of protein in the urine

b) Abdominal circumference
c) Weight, daily
d) Urine output, every shift

2. The caregiver of a child being treated at home for acute glomerulonephritis calls the nurse reporting that her
daughter has just had a convulsion. The child is resting comfortably but the caregiver would like to know what to
do. The nurse would instruct the caregiver to take which action?

a) Give the child fluids and report back to the nurse in a few hours
b) Give the child a diuretic and report back to the nurse in a few hours
c) Take the child's blood pressure and report the findings to the nurse while the nurse is still on the phone
d) Weigh the child in the same clothes she had been weighed in the day before and report the two weights
to the nurse while the nurse is on the phone

3. The nurse is providing care to a child with acute renal failure. What assessment would be a priority for the
nurse to determine if this child is developing hyperkalemia?

a) Pulse rate and rhythm

b) Muscle tone
c) Abdominal pain
d) Blood pressure

4. A school nurse is trying to prevent post streptococcal glomerulonephritis in children. What would be the best
way to prevent this?

a) All children in the child's class should be tested for strep throat if one child has a positive test
b) Tell parents to give ibuprofen if their child has a sore throat
c) Encourage the child to take all the antibiotics if diagnosed with strep throat
d) Prophylactic antibiotics after strep throat are important

5. The nurse is collecting data on a 6-year-old child admitted with acute glomerulonephritis. Which vital sign
would the nurse anticipate with this child's diagnosis?

a) Respirations 24 per minute

b) Blood pressure 136/84
c) Pulse oximetry 93% on room air
d) Pulse rate 112 bpm

6. A nurse is caring for a 7-year-old girl scheduled for an intravenous pyelogram (IVP). Which action would be
the priority before the test?

a) Ensuring adequate hydration

b) Screening her for pregnancy
c) Giving the girl an enema
d) Checking with the parents for any allergies
7. The nurse is caring for a child admitted with acute glomerulonephritis. Which clinical manifestation would likely
have been noted in the child with this diagnosis?

a) Jaundiced skin
b) Strawberry-red tongue
c) Tea-colored urine
d) Loose, dark stools

8. The nurse determines that interventions for a voiding disorder have been effective when the family of a child
with enuresis demonstrates evidence of which of the following?

a) Parents/family use positive coping mechanisms in response to the child and the voiding disorder
b) Parents administer medications for enuresis
c) Parents/family accept the child and the voiding disorder
d) Parents take the child for surgery

9. A child who has been diagnosed with minimal change nephrotic syndrome (MCNS) is being discharged after
a 3-week hospitalization. Her edema has been greatly reduced and her appetite is beginning to return. Her
caregivers have promised to have a family party to celebrate her return. The child has requested the following
foods for the party. Which of these foods would the nurse suggest is appropriate for this child's diet?

a) Orange soda
b) Popcorn
c) Potato chips
d) Banana splits

10. The nurse is reinforcing teaching with the caregiver of 5-year-old twins regarding urinary tract infections
(UTIs). The caregiver is puzzled about why her daughter has had three urinary tract infections but her son has
had none. She reports that their diets and fluid intake is similar. Which statement would be accurate for the nurse
to tell this mother?

a) "It is unlikely that your daughter is practicing good cleaning habits after she voids"
b) "Girls tend to urinate less frequently than boys, making them more susceptible to UTI's"
c) "Girls need more vitamin C than boys to keep their urinary tract healthy, so your daughter may be deficient
in vitamin C"
d) "A girl's urethra is much shorter and straighter than a boy, so it can be contaminated fairly easily"

11. A 16-year-old girl has had several cases of cystitis in the past year. Which of the following should the nurse
suspect as the cause, based on this finding?

a) Wiping from front to back after voiding

b) Frequent voiding
c) Regular participation in a strenuous sport
d) Sexual activity

12. The nurse is caring for a 10-year-old boy with end-stage kidney disease (ESKD) with metabolic acidosis.
What would the nurse expect to administer if ordered?

a) Sodium bicarbonate tablets

b) Vitamin D
c) Erythropoietin
d) Ferrous sulfate

13. When providing care to a child with vesicoureteral reflux (VUR), which nursing diagnosis would be the
priority?
 a) Excess fluid volume
b) Activity intolerance
c) Imbalanced nutrition less than body requirements
d) Risk for infection

14. A client has just been admitted to the unit with a history of recent strep infection, hematuria, and proteinuria.
Based on these findings, the nurse would suspect which condition?

a) Renal failure
b) Acute glomerulonephritis
c) Prune belly syndrome
d) Urinary tract infection

15. Most urinary tract infections seen in children are caused by:

a) Fungal infections
b) Hereditary causes
c) Dietary insufficiencies
d) Intestinal bacteria

16. Which instructions should a nurse give to a client who has a history of urinary tract infections to prevent
recurrence? Select all that apply.

a) Wipe from front to back

b) Limit bathing to once a week
c) Finish all antibiotics prescribed
d) Encourage fluids throughout the day
e) Use bubble bath to wash

17. The nurse is caring for an 8-year-old child hospitalized with nephrotic syndrome. Which nursing intervention
would be appropriate for this child?

a) Test the urine for ketones twice a day

b) Weigh the child once a week
c) Administer antipyretics as needed
d) Measure the abdominal girth daily

18. The nurse is reviewing lab work prior to shift handoff on a client with a subnormal urine output. Which is the
nurse most correct to report?

a) Polyuria
b) Oliguria
c) Glycosuria
d) Pyuria

19. teacher sends a child to see the school nurse for irritability and bruising. Which symptom would be indicative
of hemolytic uremic syndrome?

a) Polyuria and diarrhea

b) Oliguria and jaundice
c) Dysuria and lethargy
d) Weight gain and high fever
20. When developing the preoperative plan of care for an infant with bladder exstrophy, which intervention would
the nurse least likely include?

a) Placing the infant in a side-lying position

b) Sponge-bathing instead of tub bathing
c) Changing soiled diapers immediately
d) Covering the bladder with a sterile plastic bag

21. The nurse is taking a health history of a 12-year-old boy presenting with scrotal pain. Which assessment
finding would indicate testicular torsion?

a) Enlarged inguinal glands and fever

b) Fever, scrotal swelling, and urethral discharge
c) Hardened and tender epididymitis with edema and erythema of scrotum
d) Sudden onset of severe scrotal pain with significant hemorrhagic swelling

22. The caregiver of a child with a history of ear infections calls the nurse and reports that her son has just told
her his urine "looks funny." He also has a headache, and his mother reports that his eyes are puffy. Although he
had a fever 2 days ago, his temperature is now down to 100℉ (37.8℃). The nurse encourages the mother to
have the child seen by the care provider because the nurse suspects the child may have:

a) Rheumatic fever
b) A urinary tract infection
c) Acute glomerulonephritis
d) Lipoid nephrosis (idiopathic nephrotic syndrome)

23. The nurse is caring for a client newly diagnosed with acute glomerulonephritis. When receiving the pediatric
client's history, which is anticipated?

a) Increased thirst, sweating, and shakiness since yesterday

b) A sports injury to the kidney two weeks ago
c) Onset of a streptococcus infection last week
d) Fatigue from viral infection onset 3 days ago

24. The nurse is monitoring the fluid balance of a 9-year-old child. When evaluating urine output for the day,
which output would the nurse identify as being within normal limits?

a) 1200 mL
b) 800 mL
c) 2000 mL
d) 600 mL

25. The nurse is caring for a 7-month-old female infant diagnosed with a urinary tract infection (UTI). The parents
are upset as this is the infant's second UTI with a fever. Which instruction is most helpful? Select all that apply.

a) UTI's are common in male infants at this age

b) A fever is commonly noted with a UTI
c) After 3 days on antibiotics, the infection is clear
d) Change diapers promptly, especially after bowel movements
e) Female urethras are shorter and straighter than males

26. A parent is asking how to help the child deal with the peer ridicule at school in regards to enuresis. What is
the best response by the nurse?

a) Demonstrate love and acceptance at home

b) Demonstrate how to urinate in the bathroom every time the child has an occurrence
 c) Take away a toy every time the child urinates in his or her pants
d) Discuss how the child can continue to go to the bathroom instead of in his or her underwear

27. A child is being evaluated for renal and urinary tract disease. What would the nurse expect to be ordered to
evaluate the child's glomerular filtration rate?

a) Creatinine clearance rate

b) Computed tomography scan
c) Urinalysis
d) Kidneys, ureter, and bladder x-ray

28. Which cause of pediatric enuresis must be ruled out before psychological causes are investigated? Select
all that apply.

a) Small bladder capacity

b) Lack of awareness
c) Urinary tract infection
d) Cognitive dysfunction
e) Stress incontinence

29. The nurse is caring for a child diagnosed with a urinary tract infection. The caregiver asks the nurse why it is
so important for the child to have so much fluid. What is the most important reason the child needs increased
fluids?

a) To dilute the urine and flush the bladder

b) To decrease the pain of urination
c) To prevent the child from developing a fever
d) To fill the bladder so a specimen can be obtained

30. A 3-year-old child is exhibiting irritability, fever, and decreased appetite. A recent history of which of the
following would make the nurse suspicious of a urinary tract infection (UTI)?

a) Lymphadenopathy
b) Abdominal pain
c) Rash
d) Leg pain