Test Bank for Foundations of Maternal and Pediatric Nursing, 3rd Edition : White

Test Bank for Foundations of Maternal and Pediatric

Nursing, 3rd Edition : White

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 Chapter 7—Infants with Special Needs

MULTIPLE CHOICE

1. Which of these factors places infants at a greater risk of developing otitis media than adults?
a. horizontal position of eustachian tubes
b. immature immune systems
c. increased number of upper respiratory infections
d. no overt initial symptoms

ANS: A
The eustachian tubes, which allow for drainage from the middle ear to the nasopharynx, are shorter,
wider, and more horizonal in infants than in adults.

PTS: 1 DIF: Comprehension REF: White (2010)

2. Which of these factors will contribute to preventing otitis media in infants up to 12 months old?
a. a smoke-free environment
b. bottle-feeding infants on a flat surface
c. breastfeeding
d. keeping infant’s room at 72 degrees Fahrenheit

ANS: A
Prevention of otitis media includes proper positioning during feeding, getting immunizations, and
proving a smoke-free environment.

PTS: 1 DIF: Application REF: White (2010)

3. An infant’s mother reports the child had a “cold” for several days. The nurse observes the client has
profuse nasal drainage, increased respiratory effort, inspiratory stridor, cough, and hoarse cry. The
nurse should suspect this infant has developed which of these conditions?
a. cystic fibrosis c. pneumonia
b. laryngotracheobronchitis (LTB) d. respiratory distress syndrome

ANS: B
Laryngotracheobronchitis (croup) is a viral illness that causes narrowing of the upper airway.
Symptoms include inspiratory stridor, a barking cough, and hoarseness. The child may have a
persistent low-grade fever and a history of profuse nasal drainage with increased respiratory effort for
several days.

PTS: 1 DIF: Comprehension REF: White (2010)

4. An infant exhibiting a bluish discoloration surrounding the mouth would be experiencing:

a. acrocyanosis c. circumoral cyanosis
b. central cyanosis d. peripheral cyanosis

ANS: C
A bluish discoloration surrounding the mouth due to hypoxia is known as circumoral cyanosis.
 PTS: 1 DIF: Comprehension REF: White (2010)

5. Which of these conditions usually occurs in preterm infants and requires immediate administration of
surfactant through an endotracheal tube at the time of birth?
a. bronchopulmonary dysplasia c. pneumothorax
b. cystic fibrosis d. respiratory distress syndrome

ANS: D
Respiratory distress syndrome is another respiratory illness that occurs because the infant’s lungs are
deficient in surfactant, which reduces the surface tension of the air spaces. Clinical signs include
tachypnea (70 to 120), retractions, grunting, crackles, pallor, cyanosis, slow capillary refill,
hypothermia, peripheral edema, flaccid muscle tone, GI shutdown, jaundice, and acidosis.
Administration of surfactant through the endotracheal tube and continuous positive airway pressure are
used to treat this syndrome.

PTS: 1 DIF: Comprehension REF: White (2010)

6. What is the earliest manifestation of cystic fibrosis?

a. circumoral cyanosis c. meconium ileus
b. insufficient lecithin level d. salty-tasting skin

ANS: C
Cystic fibrosis is a major dysfunction of all exocrine glands that affects the lungs, pancreas, liver, and
reproductive organs. The disorder is characterized by an increased viscosity of mucus, elevated sweat
electrolytes, and increased enzymatic constituents in the saliva. Both parents must be carriers of the
disease to pass it on to their child. The earliest signs may be meconium ileus or intussusception. Rectal
prolapse is common. The client has a chronic, moist, productive cough and frequent infections. The
infant’s skin tastes salty. Diagnosis is made with the sweat test.

PTS: 1 DIF: Application REF: White (2010)

7. A client who has cystic fibrosis has a nursing diagnosis of Delayed growth and development related to
inability to digest nutrients. Which of these nursing interventions would be indicated?
a. calculating and maintaining required fluid intake
b. ensuring high-caloric intake
c. initiating aerosol therapy 1 hour before or after meals
d. referring the family for genetic counseling

ANS: B
Cystic fibrosis is a major dysfunction of all exocrine glands that affects the lungs, pancreas, liver, and
reproductive organs. The disorder is characterized by an increased viscosity of mucus, elevated sweat
electrolytes, and increased enzymatic constituents in the saliva. Interventions include ensuring a
high-caloric intake to meet the metabolic needs.

PTS: 1 DIF: Application REF: White (2010)

8. What is the leading cause of death of infants over 1 month of age?

a. congenital heart disease c. physical abuse
 b. meningitis d. sudden infant death syndrome

ANS: D
Sudden infant death syndrome (SIDS) is the sudden, unexpected death of a previously healthy infant.
It is the leading cause of death in infants over 1 month of age. Most deaths caused by SIDS occur by 6
months. The child is often found huddled in the corner of a disheveled bed, with blankets over the
head. Deaths caused by SIDS are not predictable or preventable.

PTS: 1 DIF: Comprehension REF: White (2010)

9. A 6-month-old client with a severe congenital heart defect is likely to exhibit signs and symptoms of:
a. congestive heart failure c. intussusception
b. hyaline membrane disease d. iron-deficiency anemia

ANS: A
Heart defects are categorized according to blood flow patterns: (1) increased pulmonary flow, (2)
decreased pulmonary flow, (3) obstructed blood flow out of the heart, and (4) mixed blood flow. The
child’s behavioral patterns, cardiac and respiratory function, fluid status, and growth and development
should be assessed. Severe congenital heart defect can lead to the accumulation of fluids which can
result in congestive heart failure.

PTS: 1 DIF: Application REF: White (2010)

10. Infants who have congenital heart disease are often treated with which of these therapies to improve
the heart’s contractility and increase cardiac output?
a. digoxin c. oxygen administration
b. furosemide d. potassium supplements

ANS: A
Digoxin (Lanoxin) is the drug most often used to improve the heart’s contractibility and increase its
output.

PTS: 1 DIF: Comprehension REF: White (2010)

11. The main objective of treatment of hyperbilirubinemia is to reduce the amount of which element in the
infant’s blood?
a. conjugated bilirubin c. unconjugated bilirubin
b. lumirubin d. urobilinogen

ANS: C
Hyperbilirubinemia is jaundice that results from excessive bilirubin and deposition of bile pigments.
High levels can cause severe neural symptoms or kernicterus. Assess for jaundice by applying pressure
on the skin over the tip of the nose or sternum in natural daylight. For dark-skinned infants, assess the
sclera, conjunctiva, and oral mucosa. Treatment includes the reduction of the amount of unconjugated
bilirubin.

PTS: 1 DIF: Application REF: White (2010)

12. When does iron-deficiency anemia generally appear in infants?
a. birth to 6 months c. 5 to 6 months
b. 2 to 8 months d. 9 months or older

ANS: D
Iron-deficiency anemia is caused by the infant’s consumption of large amounts of milk and foods that
do not contain iron, usually seen in children 9 months or older. Cow’s milk can cause the infant to be
obese and can lead to a loss of blood in the stool. Symptoms may include extreme pallor, tachycardia,
lethargy, irritability, and low hemoglobin, hematocrit, and iron levels.

PTS: 1 DIF: Comprehension REF: White (2010)

13. Which of these instructions should the nurse give to parents of children who have sickle-cell anemia?
a. Allow the child to lead a normal life.
b. Have the child immunized with pneumococcal, meningococcal, and hepatitis B vaccines.
c. Supplement the child’s diet with oral iron drops.
d. Seek symptomatic treatment before crises arise.

ANS: B
Sickle cell anemia is a genetic disorder. Red blood cells sickle when the child has an infection,
dehydration, hypoxia, trauma, or general physical or emotional stress. Common symptoms include
abdominal pain, fever, severe leg pain, and hot, swollen joints. High altitudes, poorly pressurized
airplanes, and exposure to heat and cold must be avoided.

PTS: 1 DIF: Application REF: White (2010)

14. A nurse caring for an infant undergoing antibiotic therapy sees that the infant has painless white
patches on the oral mucosa. The nurse suspects this to be:
a. colic c. pruritus
b. dysplasia d. thrush

ANS: D
Thrush is an oral fungal infection characterized by painless, white patches that look like curdled milk
on the oral mucosa. Boiling bottles and nipples for 20 minutes will kill the spores. Anyone who feeds
the baby must use proper hand washing.

PTS: 1 DIF: Application REF: White (2010)

15. What is the MOST important nursing intervention for the infant who has acute gastroenteritis?
a. administering antibiotics prophylactically
b. ensuring adequate hydration and replacing lost fluids
c. ensuring that immunizations are current
d. providing frequent small feedings

ANS: B
Acute gastroenteritis is inflammation of the stomach and intestine. The infant will have green, liquid
stools tinged with mucus and blood. Common symptoms include cramping, fluid and electrolyte
imbalance, extreme irritability, and vomiting. Assess the infant for dehydration.
 PTS: 1 DIF: Application REF: White (2010)

16. Which of these statements about surgical repair of cleft lip and palate malformations in a 4-week-old
infant is TRUE?
a. It will be delayed until the growth of the craniofacial bones is complete.
b. It will be done in stages with the lip being the last repair done.
c. The lip will be repaired at 6 to 12 weeks and the palate at 12 to 18 months.
d. Only the palate will be repaired, and the lip can be done later if cosmetic surgery is
desired.

ANS: C
Cleft lip/palate is the failure of the palate, lip, or both to fuse. Nasal, lip, and palate distortions are
common and apparent at birth. The infant with cleft palate is at risk for aspiration, feeding difficulties,
and respiratory infections. Care is directed at closing the defects (the lip is repaired at 6 to 12 weeks
and the palate at 12 to 18 months) and preventing complications. The infant’s ability to suck, swallow,
breathe, and handle secretions must be assessed.

PTS: 1 DIF: Application REF: White (2010)

17. What is the MOST common prognosis for an infant with pyloric stenosis?
a. complete recovery with surgical treatment
b. dependence on the actual extent of the defect
c. ongoing treatment with commercially prepared pancreatic enzymes
d. prevalent neurological disabilities

ANS: A
Pyloric stenosis occurs when the circular muscle surrounding the pylorus blocks the gastric emptying.
The infant will have projectile vomiting, ravenous hunger, hyperactive bowel sounds, irritability,
decreased number and volume of stools, an olive-shaped mass in the right upper quadrant, and visible
peristaltic waves. Surgery is required to correct the problem and usually has no lasting effects.

PTS: 1 DIF: Comprehension REF: White (2010)

18. During the first 24 hours of life, which of these signs may be the FIRST indication that a newborn may
have Hirschsprung’s disease?
a. has projectile vomiting and visible peristaltic waves
b. fails to pass a stool
c. has numerous black, tarry, mucous stools
d. turns dusky and chokes during any attempt at oral feedings

ANS: B
Hirschsprung’s disease/megacolon is a partial or complete mechanical obstruction resulting from
inadequate motility of part of the colon. There is an absence of parasympathetic ganglion cells, which
causes an absence of peristalsis. The affected portion of the bowel narrows, becomes dilated, and fills
with feces and gas. An infant usually does not have a bowel movement within the first 24 hours. The
nurse should assess for passage of stool in the first 24 hours, observe for constipation and malformed
stools, and assess weight gain and nutritional status.
 PTS: 1 DIF: Comprehension REF: White (2010)

19. Which of these congenital defects may recur, even after correction?
a. congenital talipes equinovarus c. hydrocephalus
b. hip dysplasia d. pyloric stenosis

ANS: A
Congenital talipes equinovarus (clubfoot) is characterized by a foot with a clublike appearance; the
entire foot is inverted, the heel is drawn up, and the forefoot is adducted. Manipulation and casting of
the foot is needed. After several weeks of casting, a splint with a shoe attached is used for several
months. If the condition does not improve, surgery is needed. The nurse must teach cast care, monitor
for complications, and facilitate normal development.

PTS: 1 DIF: Application REF: White (2010)

20. To help parents prevent their infant from developing positional plagiocephaly, the nurse should teach
the parents to:
a. alternate the infant’s head position during sleep
b. allow the infant to sleep in an infant carrier
c. place the infant in a high Fowler’s position during the day and in the tummy position for
sleep
d. keep the infant on an air mattress for play and sleep

ANS: A
Positional plagiocephaly or flattened head syndrome, is a condition in which one side or the back of
the head is flattened. This can be caused when the infant is put to sleep in the same position repeatedly
or by neck muscle problems.

PTS: 1 DIF: Application REF: White (2010)

21. To assist parents of an infant who has atopic dermatitis to realistically reduce the number of causative
factors in their child’s environment, which of these suggestions should the nurse offer?
a. removal of all actual or potential allergens from the home environment
b. frequent bathing in mild baby soap to remove sebaceous secretions from the scalp
c. frequent diaper changes, exposing affected areas to air, and use of a barrier ointment or
cream
d. moving the family pet outside of the home

ANS: D
Atopic dermatitis, or eczema, is a chronic superficial inflammatory skin disorder characterized by
severe itching. The condition may be an allergic reaction to irritants. Papules and vesicles usually
begin on the cheeks and spread to the arms, legs, and trunk. A hypoallergenic diet and a soy formula
are usually recommended. Parents should be advised to avoid cow’s milk, eggs, fish, corn, citrus,
peanuts, nuts, and chocolate. Dust, mold, animals, and cigarette smoke should also be avoided. The
nurse’s goal is to soothe and relieve itching and to maintain skin integrity.

PTS: 1 DIF: Application REF: White (2010)

22. Which of these is thought to be a causative factor of spina bifida?

 a. maternal rubella infection c. maternal folic-acid deficiency
b. fetal prematurity d. fetal infection

ANS: C
Spina bifida is a neural tube defect caused by an incomplete closure of the vertebrae and neural tube;
the meninges and spinal cord protrude through the opening secondary to maternal folic-acid
deficiency. The degree of neurological impairment depends on the location and the size of the defect.
The infant may have hydrocephalus and genitourinary and orthopedic defects. Surgery is required. The
infant’s membranous sac must be assessed for intactness. The infant must also be assessed for reflexes
and neurological impairment.

PTS: 1 DIF: Comprehension REF: White (2010)

23. As intracranial pressure increases in the infant who has hydrocephalus, the anterior fontanel becomes
tense and bulges, and the eyes appear to be pushed downward. What is this condition called?
a. circumoral cyanosis c. meningitis
b. intussusception d. sunset eyes

ANS: D
In hydrocephalus, the balance between the rate of cerebrospinal fluid formation and absorption is
disturbed. The infant has an excessively large head at birth, or rapid head growth along with widening
cranial sutures. The anterior fontanelle becomes tense and bulges, and the eyes appear to be pushed
downward, with the sclera visible above the iris (“sunset eyes”). Increased intracranial pressure causes
irritability, restlessness, a high-pitched cry, vomiting, seizures, and a change in level of consciousness.
Surgery is necessary. Vital signs, head circumference, and neurological signs must be monitored.
Infections must be prevented.

PTS: 1 DIF: Comprehension REF: White (2010)

24. What is the preferred treatment for the majority of children who have febrile seizures?
a. administrating anticonvulsants to reduce the number of subsequent seizures
b. teaching parents about seizure precautions
c. doing nothing, since most febrile seizures stop before the infant can be taken for medical
attention
d. treating the underlying disease processes only

ANS: C
Febrile convulsions or seizures may be caused by a fever associated with otitis media, upper
respiratory infections, meningitis, or other infections or unknown causes. Febrile seizures usually
occur early in the course of a high fever and subside before the infant can be taken for medical
attention. Nursing care focuses on teaching the parents and treating the fever.

PTS: 1 DIF: Application REF: White (2010)

25. In addition to administering antibiotics, nursing care of the infant with meningitis includes which of
these interventions?
a. maintaining isolation for a minimum of 72 hours
b. monitoring neurological status every 4 hours
c. observing the infant’s developmental status
 d. ensuring the parents receive prophylactic treatment

ANS: B
Meningitis or infection of the meninges is the most common infection of the central nervous system.
The infant has a high-pitched cry, fever, seizures, irritability, vomiting, bulging fontanelle, and poor
feeding. A lumbar puncture will be required, and the infant will have to be in isolation. It is important
to note any food and fluid intake, nausea, vomiting, or loss of appetite, as well as recent
immunizations, illnesses, surgery, or injury. A complete neurological assessment is needed.

PTS: 1 DIF: Application REF: White (2010)

26. To improve ambulation in a child who has cerebral palsy, which of the following surgical interventions
is indicated?
a. closure of the defect
b. lengthening of the Achilles tendon and releasing the hamstrings
c. placement of a VP shunt to relieve cerebral pressure
d. placing affected limbs in flexible casts

ANS: B
Cerebral palsy results from damage to the motor centers of the brain. The infant may have delayed
gross motor development, alterations in muscle tone, abnormal motor performance, and reflex
abnormality. Improvements in ambulation can be made with the surgical lengthening of the Achilles
tendon and releasing the hamstrings.

PTS: 1 DIF: Comprehension REF: White (2010)

27. Which of these conditions is often associated with hypospadias?

a. Down syndrome c. neural tube defects
b. hydrocele d. undescended testes

ANS: D
Hypospadias is a condition in which the urethral opening is on the ventral surface of the penis and
often associated with undescended testes. Surgery is required. The nurse must teach catheter care and
reassure caregivers that normal urination will be restored and sexual function will not be threatened.

PTS: 1 DIF: Comprehension REF: White (2010)

28. Which of the following outcomes demonstrates a knowledge deficit in a caregiver’s role of managing
the child’s sickle cell anemia?
a. seeks medical care at the first sign of an infection
b. gives narcotics to assist with pain management in crisis episodes
c. prohibit the child from playing football or soccer
d. limits fluids in the evening to discourage bed-wetting

ANS: D
Treatment of sickle cell anemia includes seeking medical care at the first sign of an infection, being
immunized for viral infections such as influenza, maintaining good hydration, avoid extreme heat or
cold, and giving narcotics to assist with pain management in crisis episodes.
 PTS: 1 DIF: Application REF: White (2010)

29. Which of the following assessment findings would the nurse expect in an infant with Hirschsprung’s
disease?
a. foul-smelling fatty stool
b. currant jelly-like stool
c. thick, black, tarry stool
d. constipation alternating with ribbonlike stools.

ANS: D
Hirschsprung’s disease/megacolon is a partial or complete mechanical obstruction resulting from
inadequate motility of part of the colon. There is an absence of parasympathetic ganglion cells, which
causes an absence of peristalsis. The affected portion of the bowel narrows, becomes dilated, and fills
with feces and gas. An infant usually does not have a bowel movement within the first 24 hours. The
nurse should assess for passage of stool in the first 24 hours, observe for constipation and malformed
or ribbonlike stools, and assess weight gain and nutritional status.

PTS: 1 DIF: Application REF: White (2010)

30. A caregiver of a child with cystic fibrosis understands the use of a pancreatic enzyme if the caregiver
states:
a. “is a bronchodilator to help my child’s lungs”
b. “is a medication to break down white blood cells in the lungs”
c. “should be given with meals and snacks to aid digestion”
d. “should be stopped if my child begins wheezing”

ANS: C
Cystic fibrosis is a major dysfunction of all exocrine glands that affects the lungs, pancreas, liver, and
reproductive organs. The disorder is characterized by an increased viscosity of mucus, elevated sweat
electrolytes, and increased enzymatic constituents in the saliva. Commercially prepared pancreatic
enzymes are given with meals and snacks to aid digestion and absorption of fats and proteins.

PTS: 1 DIF: Application REF: White (2010)

31. A child is born with clubfeet. When the caregiver ask the nurse how this will be treated, the nurse
would explain that the initial management is to:
a. try traction first
b. use surgical intervention as soon as possible
c. do a frequent series of casting
d. wait and monitor only as the child will usually outgrow this condition after learning to
walk

ANS: C
Congenital talipes equinovarus (clubfoot) is characterized by a foot with a clublike appearance; the
entire foot is inverted, the heel is drawn up, and the forefoot is adducted. Manipulation and casting of
the foot is needed. After several weeks of casting, a splint with a shoe attached is used for several
months. If the condition does not improve, surgery is needed. The nurse must teach cast care, monitor
for complications, and facilitate normal development.
Test Bank for Foundations of Maternal and Pediatric Nursing, 3rd Edition : White

PTS: 1 DIF: Application REF: White (2010)

32. Cystic fibrosis is suspected in a child with frequent respiratory infections and failure to thrive. The
nurse would expect which of the following tests ordered to make a definite diagnosis?
a. electrolytes and CBC c. chest X-ray
b. sweat chloride test d. endoscopy

ANS: B
Cystic fibrosis is a major dysfunction of all exocrine glands that affects the lungs, pancreas, liver, and
reproductive organs. The disorder is characterized by an increased viscosity of mucus, elevated sweat
electrolytes, and increased enzymatic constituents in the saliva. Both parents must be carriers of the
disease to pass it on to their child. The client has a chronic moist, productive cough, and frequent
infections. The infant’s skin tastes salty. Diagnosis is made with the sweat test.

PTS: 1 DIF: Application REF: White (2010)

33. A child has a diagnosis of croup (laryngotracheobronchitis). He has received a corticosteroid and cool
mist therapy. His caregiver asks the nurse why the doctor did not order antibiotics. The MOST
appropriate response is:
a. the child is too young to receive antibiotics
b. the child may be allergic to antibiotics so the risks outweigh the benefit.
c. most antibiotics are used for bacterial germs and his type of croup is due to a virus.
d. the doctor would rather wait and see if he can get better without them.

ANS: C
Laryngotracheobronchitis (croup) is a viral illness that causes narrowing of the upper airway.
Symptoms include inspiratory stridor, a barking cough, and hoarseness. The child may have a
persistent low-grade fever and a history of profuse nasal drainage with increased respiratory effort for
several days.

PTS: 1 DIF: Application REF: White (2010)

34. During a routine nursing assessment of a small child, the nurse palpates a mass in the abdomen. Which
of these actions is essential at this time?
a. Ask the parents if they had previously noted the abnormality.
b. Assess the mass site for indication of pain.
c. Continue the exam, noting the approximate size of the mass boundaries.
d. Stop palpation immediately.

ANS: D
Wilms’ tumor is found in the kidney area and is the most common early childhood cancer. The infant
will have an abdominal mass located on one side of the midline, abdominal pain, malaise, anemia, and
fever. If a mass is felt in the abdomen, palpation should be stopped immediately, as cells can be
dislodged, spreading the tumor. Surgery and chemotherapy are required.

PTS: 1 DIF: Application REF: White (2010)

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