Question 1

The school nurse creates a cafeteria menu for a newly enrolled child with celiac disease. Which lunches would be appropriate for this child? Select all that apply.

Accepted Answer

Celiac disease (celiac sprue) is an autoimmune disorder in which the body is unable to process gluten, a protein found in most grains. Gluten consumption will damage the villi of the small intestine; this results in malabsorption of fats (steatorrhea, foul-smelling stools) and other nutrients, which can lead to malnutrition and failure to thrive. The child will need to adhere to a gluten-free diet for life. Rice, corn, and potatoes are gluten free and are allowed in the diet (Options B, C, and E). A child with celiac disease cannot eat barley, rye, oats, or wheat (mnemonic - BROW). (Option A) A child with celiac disease cannot consume barley or French bread as both contain gluten. (Option D) Peanut butter and jelly on rice cakes are permitted but not the oatmeal cookie. Educational objective: Celiac disease is an autoimmune disorder in which an individual cannot tolerate gluten, a protein found in barley, rye, oats, and wheat (BROW). Rice, corn, and potatoes are allowed in the diet and can be used as grain substitutes. Affected individuals must adhere to a gluten-free diet for life.

Question 2

A 3-month-old infant has irritability, facial edema, a 1-day history of diarrhea with adequate oral intake, and seizure activity. During assessment, the parents state that they have recently been diluting formula to save money. Which is the most likely cause for the infant's symptoms?

Accepted Answer

Water intoxication (water overload) resulting in hyponatremia may occur in infants when formula is diluted to "stretch" the feeding to save money. Hyponatremia may also result from ingestion of plain water (eg, caregiver attempting to rehydrate an infant who has been ill). Infants have immature renal systems with a low glomerular filtration rate, which decreases their ability to excrete excess water and makes them susceptible to water intoxication. Symptoms of hyponatremia include irritability, lethargy, and, in severe cases, hypothermia and seizure activity. Breast milk and/or formula are the only sources of hydration an infant needs for the first 6 months of life. Formula should be prepared per the manufacturer's instructions. (Option A) Hypernatremia may be caused by dehydration (eg, decreased oral intake, vomiting, diarrhea) and presents with similar neurological symptoms (eg, restlessness, seizures). The infant's history indicates adequate oral intake and signs of fluid overload (eg, facial edema), not dehydration. (Option B) Hypoglycemia may present with irritability and seizures, but facial edema and recent history of over-diluting the formula should alert the nurse that water intoxication with hyponatremia is the most likely cause. (Option C) Hypokalemia secondary to diarrhea may present with irritability, muscle weakness, and cardiac arrhythmias. Educational objective: Infants are susceptible to hyponatremia secondary to water intoxication, which can present with neurological symptoms (eg, lethargy, irritability, seizures). Breast milk and/or formula provide sufficient hydration for the first 6 months of life. Formula should not be diluted to save money.

Question 3

The clinic nurse supervises a graduate nurse who is teaching the parents of a 2-year-old with acute diarrhea about home management. The nurse would need to intervene when the graduate nurse provides which instruction?

Accepted Answer

During bouts of acute diarrhea and dehydration, treatment focuses on maintaining adequate fluid and electrolyte balance. The first-line treatment is oral rehydration therapy, using oral rehydration solutions (ORSs) to increase reabsorption of water and sodium. Even if the diarrhea is accompanied by vomiting, ORS should still be offered in small amounts at frequent intervals. Continuing the child's normal diet (solid foods) is encouraged as it shortens the duration and severity of the diarrhea. The BRAT (bananas, rice, applesauce, and toast) diet is not recommended as it does not provide sufficient protein or energy. (Option A) Use of antidiarrheal medications is discouraged as these have little effect in controlling diarrhea and may actually be harmful by prolonging some bacterial infections and causing fatal paralytic ileus in children. (Option C) Parents should be taught to monitor their child for signs of dehydration by checking the amount of fluid intake, number of wet diapers, presence of sunken eyes, and the condition of the mucous membranes. (Option D) Protecting the perineal skin from breakdown during bouts of diarrhea can be accomplished by using skin barrier creams (eg, petrolatum or zinc oxide). Educational objective: When a child is experiencing acute diarrhea, the priority is to monitor for dehydration. Treatment is accomplished with oral rehydration solutions and early reintroduction of the child's normal diet (usual foods).

Question 4

A nurse is performing an assessment of a 12-month-old child. Which of the following findings would the nurse expect? Select all that apply.

Accepted Answer

The first 12 months of life are characterized by rapid growth and development. By age 12 months, the child's birth weight should be about tripled (Option B). A 12-month-old child should have mastered the gross motor skill of sitting down from a standing position without assistance (Option E). The pincer grasp (ie, use of the thumb and forefingers to pick up objects) is an important fine motor skill that should also be fully developed by this age (Option D). (Option A) Stranger anxiety is well developed by age 8 months and continues into the toddler years. At age 12 months, the child typically prefers the parents and exhibits fear when separated. (Option C) The gross motor skills of skipping and hopping on one foot do not usually occur until around age 4. Educational objective: Assessment findings of a 12-month-old child should include a weight that is approximately triple the birth weight. Expected motor skills include the ability to sit from a standing position without assistance and to use a fully developed pincer grasp.

Question 5

The registered nurse is teaching the parent of a 6-year-old about behavioral strategies for treating fecal incontinence due to functional constipation. Which statement by the parent indicates a need for further teaching?

Accepted Answer

Fecal incontinence (ie, encopresis, soiling) refers to the repeated passage of stool in inappropriate places by children age ≥4 years. In more than 80% of cases, it is due to functional constipation (retentive type); in about 20% of cases, it may be caused by psychosocial triggers (nonretentive type). Management of fecal incontinence/constipation primarily includes 3 components: Disimpaction followed by prolonged laxative therapy, dietary changes (increased fiber and fluid intake), and behavior modification. Behavioral strategies are used to promote and restore regular toileting habits and to gain the child's cooperation and participation in the treatment program. Behavioral interventions include the following: Regularly schedule toilet sitting times 5-10 minutes after meals for 10-15 minutes (Option D) Provide a quiet activity for the child during toilet sitting, which will help pass the time and make the experience more "enjoyable" (Option A) Initiate a reward system to boost the child's participation in the treatment program; the reward would be given for effort, not for success of evacuation in the toilet (children with retentive encopresis have dysfunctional anal sphincters and little control over bowel movements; giving a reward for something the child has no control over would not be effective) (Option B) Keep a diary or log of toilet sitting times, stooling, medications, and episodes of soiling to evaluate the success of the treatment (Option C) Educational objective: A reward system is one of the behavioral strategies used in the treatment of functional incontinence (due to constipation). The reward is given to encourage the child's involvement in the treatment to restore normal bowel function. Rewards are given for the child's effort and participation, not for having bowel movements while sitting on the toilet.

Question 6

A nurse is planning to complete a physical examination of a toddler.  Which approach is an appropriate intervention by the nurse?

Accepted Answer

The nurse should plan to assess the toddler client in a nonthreatening environment, taking time to develop rapport prior to beginning the examination. This can be achieved by talking to the toddler about favorite objects and slowly initiating contact. Parent involvement, such as holding the child and assisting the child with examination activities, reduces anxiety and encourages cooperation in toddler clients. Age-appropriate games or toys may be used if needed to gain the client's cooperation. (Option B) Use minimal physical contact initially, and have the parent remove the outer clothing. (Option C) Medical equipment may appear frightening to a toddler and should remain out of sight until needed. It may also be beneficial to allow the child to inspect and touch new pieces of equipment as they are used. (Option D) It is best to order a physical examination for a toddler from least to most invasive, which commonly means assessing ears, nose, and mouth toward the end of a visit. Head-to-toe ordered assessments are more appropriate for school-age children. Educational objective: The nurse should allow a parent to interact with the toddler and assist with the examination process to encourage client cooperation. Examination of a toddler should proceed from least to most invasive, allowing the client to inspect pieces of equipment before use. Use minimal physical contact initially.

Question 7

The nurse is caring for an infant diagnosed with Hirschsprung disease who is awaiting surgery. Which assessment finding requires the nurse's immediate action?

Accepted Answer

11ecbb05_caab_09f3_b433_e9c40c3c7f67_MD0009_00 Hirschsprung disease (HD) occurs when a child is born with some sections of the distal large intestine missing nerve cells, rendering the internal anal sphincter unable to relax. As a result, there is no peristalsis and stool is not passed. These newborns exhibit symptoms of distal intestinal obstruction. They have a distended abdomen and will not pass meconium within the expected 24-48 hours. They also have difficulty feeding and often vomit green bile. Surgical removal of the defective section of bowel is necessary and colostomy may be required. A potentially fatal complication is Hirschsprung enterocolitis, an inflammation of the colon, which can lead to sepsis and death. Enterocolitis will present with fever; lethargy; explosive, foul-smelling diarrhea; and rapidly worsening abdominal distension. (Option A) Mild to moderate abdominal distension is an expected finding with a diagnosis of HD; however, increasing abdominal girth is a serious finding that must be reported. (Option B) Failure to pass meconium or stool within 24-48 hours after birth is an expected finding of HD. (Option D) Bilious vomiting and excessive crying are expected findings of HD. In enterocolitis, vomiting can occur more frequently and the client appears more ill. Educational objective: Enterocolitis, a potentially fatal complication of Hirschsprung disease, is characterized by explosive, foul-smelling diarrhea; fever; and worsening abdominal distension.

Question 8

The nurse teaching the parents of a child diagnosed with cystic fibrosis will advise the parents to choose foods that satisfy which recommended diet?

Accepted Answer

In cystic fibrosis (CF), a protein responsible for transporting sodium and chloride is defective and causes the secretions from the exocrine glands to be thicker and stickier than normal. These abnormal secretions plug smaller airway passages and ducts in the gastrointestinal (GI) tract. The thick secretions block pancreatic ducts, resulting in a deficient amount of pancreatic enzymes entering the bowel to aid in digestion and nutrient absorption. Clients require multiple vitamin supplements and supplemental pancreatic enzymes that are administered with meals. To meet the growth needs of clients with CF, a diet high in calories, fat, and protein is required. (Options A, C, and D) A gluten-free diet is required for clients with celiac disease who cannot tolerate barley, rye, oats, or wheat (mnemonic: BROW). Low-phosphate diets are indicated for clients with certain kidney disorders. Low-sodium diets are indicated for volume overload states (eg, heart failure, ascites) and hypertension. Educational objective: Cystic fibrosis causes damage to the GI tract and pancreas, leading to impaired absorption of nutrients and resulting growth deficits. Clients must consume a diet high in calories, fat, and protein.

Question 9

The nurse is reinforcing discharge teaching for the parents of a 1-year-old with a newly diagnosed cow's milk allergy. Which nutrients normally provided by milk should be obtained from other sources? Select all that apply.

Accepted Answer

11ecbb05_caae_1736_b433_7731dba08c24_MD0009_00 Calcium and vitamin D are nutrients in cow's milk that are essential for proper bone development in children and adolescents (Options A and D). To obtain the recommended 500 mg of daily calcium (for ages 1-3 years), the parents should serve foods such as beans, dark green vegetables, and calcium-fortified cereals and juices. Vitamin D, which enhances the absorption of calcium, is synthesized in the skin by exposure to direct sunlight. Alternate dietary sources include fish oils, egg yolks, and vitamin D-fortified foods (eg, orange juice). (Option B) Fiber, which is important for digestive health, is found in only small amounts in cow's milk. Fiber-rich foods include whole grains, beans, and berries. (Option C) Cow's milk is not a significant source of iron. Dietary sources of iron include meats and spinach. (Option E) Vitamin K is an important nutrient for coagulation. Vitamin K is produced by bacteria in the large intestine and is found in food sources such as dark green vegetables, fish, and eggs, not in cow's milk. Educational objective: Calcium and vitamin D are nutrients in cow's milk that are essential for proper bone development in children and should be obtained from other sources for clients with a cow's milk allergy. Alternate sources of calcium include beans, dark greens, and calcium-fortified cereal and juices. Vitamin D is synthesized in the skin when exposed to sunlight and can be obtained in foods such as fish, egg yolks, and vitamin D-fortified foods.

Question 10

The nurse is teaching a group of new parents about oral hygiene for their children. One of the parents asks, "When should I take my child to the dentist?" What would be the best response from the nurse?

Accepted Answer

The recommendation from pediatric professional organizations, including the American Dental Association, American Academy of Pediatrics, and Canadian Dental Association, is that children have their first dental visit within 6 months of first tooth eruption or by their first birthday (Option C). A child's first tooth usually erupts around age 6 months, and the child should be seen by a dentist soon after. The purposes of the first visit include: Assessing risk for dental disease Providing dental care and treatment of dental caries Providing anticipatory guidance about dental hygiene, fluoride, diet and dietary habits, and non-nutritive sucking Establishing care with a licensed dentist and scheduling future visits Taking a child to the dentist at an early age also helps the child become accustomed to the dentist's office, oral examinations, and dental care. (Option A) Children should have their first dental visit by their first birthday. (Option B) Most children have all of their primary teeth by age 2 or 3. Dental care is needed at a much earlier age. (Option D) Most children start preschool around age 4. A routine of regular dental visits and care needs to be established at an earlier age. Educational objective: Regular visits to the dentist, starting within 6 months of first tooth eruption or by the first birthday, are recommended by pediatric professional organizations. Early assessment, dental care, anticipatory guidance, and education about periodontal disease prevention facilitate good oral health for children.

Question 11

A nurse in a pediatric clinic is performing a physical examination of a 30-month-old child. Which finding requires further evaluation?

Accepted Answer

Weight gain slows during the toddler years with an average yearly weight gain of 4-6 lb (1.8-2.7 kg). By age 30 months, current weight should be approximately 4 times greater than birth weight. A toddler weighing 6 times the initial birth weight requires further evaluation. Family nutrition and meal habits should be discussed. (Option A) A toddler achieves bowel and bladder sphincter control by age 24 months as bladder capacity increases. (Option B) Chest circumference exceeds abdominal circumference after age 2, resulting in a taller and more slender appearance. (Option D) Head circumference increases by 1 in (2.5 cm) during the second year and then slows to a growth rate of 0.5 in (1.25 cm) per year until age 5. Educational objective: Weight gain slows during the toddler years. By age 30 months, a toddler's weight should be approximately 4 times greater than the birth weight.

Question 12

The nurse is performing a well-child assessment on a sleeping 2-month-old client. Organize the assessment in the correct order based on the developmental age of the client. All options must be used.

Accepted Answer

The sequence of examination steps for infants requires a different approach than the typical head-to-toe order used for older clients. The steps are altered to accommodate the developmental needs of the infant, minimize the infant's stress, and increase assessment accuracy. The correct order of assessment in infants is: Before handling the infant, the nurse first observes the infant for activity level, skin color, and respiratory rate and pattern to obtain findings during a calm state (Option D). Auscultation is performed next while the infant is still quiet, allowing the nurse to hear sounds clearly (Option B). Palpation and percussion are then performed while the infant remains relatively still. This allows the nurse to accurately assess the abdomen while the abdominal muscles are relaxed. The fontanelles are also palpated while the infant is calm, as crying can cause temporary bulging (Option E). Traumatic procedures (eg, examine eyes, ears, mouth) are performed near the end of the assessment after completing any procedures that require accurate observation or counting (Option A). Elicitation of the Moro reflex (ie, reflexive startle and cry to a sudden dropping or jarring motion) is performed last because the infant is usually awake and moving around by this point (Option C). Educational objective: When assessing an infant, the nurse should observe, auscultate, palpate, and then perform traumatic procedures (eg, examine eyes, ears, mouth). Elicitation of the Moro reflex should be performed last.

Question 13

A 12-month-old client has a high blood lead level of 18 mcg/dL (0.87 µmol/L). The nurse educates the parents about lead poisoning. Which statements made by the parent indicate that teaching is successful? Select all that apply.

Accepted Answer

Lead poisoning occurs from repeated lead exposure, either via ingestion of lead-based paints (eg, walls, toys), glazes (eg, pottery) or water from lead pipes, or by inhalation of contaminated dust or soil found around older homes. Elevated blood lead levels (BLLs) impair neural, blood, and renal development. A BLL screening is recommended between ages 1 and 2, or up to age 6 if the child was not previously screened. Clients with elevated BLLs (≥5 mcg/dL [0.24 µmol/L]) require follow-up blood work to ensure that levels decrease (Option E). Chelation therapy may be required if levels remain elevated. The priority intervention for clients with elevated BLLs is preventing continued exposure. The home environment should be assessed for lead sources (Option A). Pediatric and pregnant clients should not live in homes being renovated until the work is complete. Handwashing, especially before eating, is important to remove lead residue (Option C). (Option B) Vacuuming spreads lead dust in the air, which increases inhalation exposure. Hard surfaces should be wet-dusted or mopped at least weekly. (Option D) Hot tap water dissolves lead from older pipes; therefore, cold water should be used for consumption if lead plumbing is present. Taps should be flushed for several minutes to clear out contaminated water before use. Educational objective: Pediatric clients are at risk for lead poisoning from environmental exposure in the home (eg, paint, dust, plumbing). Clients with elevated blood lead levels require monitoring. Lead sources in the home should be removed or mitigated (eg, handwashing, wet-dusting/mopping) to prevent further exposure.

Question 14

A nurse is discussing the fine motor abilities of a 10-month-old infant with the infant's parent. Which are developmentally appropriate skills for an infant of this age? Select all that apply.

Accepted Answer

11ecbb05_cab2_ab17_b433_2174da343beb_MD0009_00 Fine motor skills of infants develop around the ability to grasp and pick up objects. By 3 months, infants will reflexively grasp a rattle placed in their hand. At 5 months, they are able to voluntarily clasp it with their palm. Around 7 months, infants are able to transfer an object from one hand to the other. By 8-10 months, infants have replaced the palmar grasp with a crude pincer grasp (use of thumb, index, and other fingers) to pick up round oat cereal and other finger foods. By 11 months, this develops into a neat pincer grasp (use of thumb and index finger). (Options B and D) By 12 months, infants may attempt to turn multiple book pages at once, and they also begin attempts to stack 2 blocks. These skills require finer muscle control than is expected of a 10-month-old. Educational objective: Fine motor skills of infants develop around the ability to grasp objects. Voluntary grasping with the palm begins around 5 months, followed by the ability to transfer an object between hands by 7 months and the development of a crude pincer grasp (using the thumb, index, and other fingers) around 8-10 months.

Question 15

The nurse plans care for a pediatric client who has just undergone a cleft palate repair. Which of the following interventions should the nurse include in the plan of care? Select all that apply.

Accepted Answer

A cleft palate is a malformation of the roof (palate) of the mouth occurring from incomplete fusion of the palatine bones and maxilla during fetal development. Cleft palate causes an opening (cleft) in the mouth into the nasal cavity, which leads to difficulty in sucking and feeding. Clients with cleft palate typically undergo surgical repair between age 6-24 months. Postoperative nursing interventions for clients with a cleft palate repair include: Implementing pharmacological and nonpharmacological pain management (eg, encouraging caregiver soothing), as uncontrolled pain leads to crying, which stresses the surgical site and promotes hemorrhage (Option A) Positioning the child in an upright, supine position, particularly after feedings, to prevent airway compromise and obstruction from secretions and/or feedings (Option C) Utilizing elbow restraints to prevent the child from disrupting the surgical site by placing hands or objects into the mouth, and monitoring skin and neurovascular status by removing elbow restraints per agency policy (Option D) (Options B and E) Hard objects (eg, utensils, tongue depressors, pacifiers, straws) should not be placed into the mouth as they may damage the surgical site, which can lead to hemorrhage. Educational objective: Following cleft palate repair, the nurse should position the client supine with elevated head of bed, implement pain reduction measures, and remove elbow restraints per facility policy for skin and neurovascular assessment. To prevent damage to the surgical site, hard objects should not be placed into the mouth.

Question 16

The nurse is gathering data on a 5-week-old admitted with a suspected diagnosis of pyloric stenosis.  The nurse should expect to find which laboratory value?

Accepted Answer

11ecbb05_caac_b7a4_b433_c31a04000fb2_MD0009_00 In pyloric stenosis, a hypertrophied pyloric muscle causes postprandial projectile vomiting secondary to an obstruction at the gastric outlet. An olive-shaped mass may be palpated in the epigastric area just to the right of the umbilicus. Emesis is nonbilious (formula in/formula out) and leads to progressive dehydration. Infants will be hungry constantly despite regular feedings. A hematocrit of 57% (0.57) is elevated and indicative of hemoconcentration caused by dehydration (Option B). Elevated blood urea nitrogen is also a sign of dehydration. (Option A) The stomach contains acid, which becomes depleted with excess vomiting (or during nasogastric [NG] suctioning), leading to metabolic alkalosis (increased bicarbonate and pH of >7.45). (Option C) A potassium level of 5.2 mEq/L (5.2 mmol/L) is considered slightly elevated. However, vomiting or prolonged NG suctioning would cause hypokalemia, not hyperkalemia. (Option D) A white blood cell count of 28,500/mm³ (28.5 x 10⁹/L) is elevated, indicating infection. However, pyloric stenosis is not an infectious process. Educational objective: Hypertrophic pyloric stenosis results in recurrent projectile vomiting, which leads to dehydration and hypokalemic metabolic alkalosis. Dehydration is manifested by hemoconcentration (elevated hematocrit) and elevated blood urea nitrogen.

Question 17

The nurse is reinforcing education with the parents of a 2-year-old child about diet choices to promote growth. The family observes a strict vegan diet. Which of the following statements by the nurse are appropriate? Select all that apply.

Accepted Answer

With careful monitoring of nutritional intake, a vegan diet (ie, excluding all animal-derived products [eg, meat, dairy, eggs]) can be appropriate for clients in all age groups. Pediatric clients consuming a vegan diet are at increased risk for nutritional deficiencies (eg, protein, calories, calcium, vitamin D, iron, vitamin B₁₂) due to rapid growth and development. Nurses educating clients about preventing nutritional deficiencies in vegan diets should include information about: Iron: Plant sources of iron, which are in smaller quantities and difficult to absorb, should be supplemented with fortified cereals and breads to decrease risk of iron-deficient anemia (Option B) Vitamin C: Iron absorption is improved when dietary sources of iron and vitamin C are taken together (Option D) Calcium: Without animal sources of calcium (eg, dairy, eggs, fish), vegan diets require supplementation of calcium and vitamin D for bone health (Option E) (Option A) Many plant-based proteins (eg, legumes, grains) do not individually contain all the essential amino acids to support growth and tissue repair; therefore, vegan clients will require further teaching on combinations of protein sources. (Option C) Fruits and vegetables do not provide vitamin B₁₂. The nurse should educate the parents on the need for multivitamins or fortified grains as quality vitamin B₁₂ sources. Educational objective: Pediatric clients consuming a vegan diet are at risk for dietary deficiencies (eg, iron, protein, calories, vitamin B₁₂, calcium, vitamin D). Parent education about supplementation and adequate food sources of these nutrients is necessary.

Question 18

The nurse in a clinic is obtaining a developmental history of an 18-month-old during a well-child visit. Which activities should the child be able to perform? Select all that apply.

Accepted Answer

11ecbb05_cab2_f938_b433_49c71057aa77_MD0009_00 A toddler's development centers on both fine and gross motor skills. By 18 months, the toddler can manage stairs while holding a hand and turn 2 or 3 pages in a book. The direction in development is on improving the skill of locomotion (Options B and D). (Options A, C, and E) A 24-month-old should be able to build a tower of 6 or 7 blocks, call self by name, and use a doorknob to open a door. Educational objective: An 18-month-old is developing both fine and gross motor skills, which include going up stairs while holding a hand and turning 2 or 3 pages in a book.

Question 19

The nurse assesses a child with intussusception. Which assessment findings require priority intervention?

Accepted Answer

Intussusception occurs when part of the intestine telescopes into another adjacent part and causes a blockage. This leads to swelling and decreased blood supply to the intestine. Tissue death as well as perforation to the bowel may result. If perforation occurs, the client could develop peritonitis in which the peritoneum in the abdomen becomes inflamed due to infection. This can quickly lead to sepsis and multiple organ failure. Peritonitis is characterized by fever, abdominal rigidity, guarding, and rebound tenderness. This condition can be fatal if it is not treated quickly. (Option B) Absence of tears in a painful procedure during which the client is crying is a sign of dehydration. This is very common in clients with intussusception and should be treated. IV fluids should be started, and the client's hydration status (vital signs, mucus membranes, capillary refill) should be assessed frequently. (Option C) A classic sign of intussusception is blood-streaked mucous stool, sometimes referred to as "currant jelly-like" stool. This is expected with intussusception. Treatment is an enema of either air or barium to unfold the intestine. (Option D) A "sausage-shaped" right-sided mass is commonly felt on palpation in clients with intussusception. This is an expected finding for this condition. Educational objective: Intestinal perforation and peritonitis are common complications of intestinal obstruction (eg, intussusception). Peritonitis is characterized by fever, abdominal rigidity, guarding, and rebound tenderness and is a surgical emergency.

Question 20

The clinic nurse is interviewing the parents of a 6-month-old client about the infant's diet. Which statement by the parents is most concerning?

Accepted Answer

11ecbb05_caad_2cd5_b433_e99205474c64_MD0009_00 Clostridium botulinum spores in honey or soil can colonize an infant's immature gastrointestinal system and release a toxin that causes botulism, a rare but serious illness. The toxin attacks the neuromuscular system, causing progressive muscle paralysis that can potentially lead to respiratory failure and death. Initial manifestations may include constipation, generalized weakness, difficulty feeding, and decreased gag reflex. Iron-fortified infant cereals (eg, oatmeal) mixed with formula or breastmilk are appropriate for infants >6 months; however, honey (especially raw or wild) is not recommended for infants age <12 months due to the risk of botulism (Option C). (Option A) Although apple pie adds excessive amounts of fat and sugar to the infant's diet, this is not the priority over honey, which can be life-threatening. (Option B) Small portions (<1 tablespoon) of solid food are appropriate for infants. Continuing to feed an infant who acts disinterested in food (eg, turns away) can contribute to future obesity. The nurse should explore this behavior further; however, the priority is to address the danger of feeding an infant honey. (Option D) TV dinners and various canned foods have high sodium and sugar content and therefore are not the best sources of nutrition for an infant. However, TV dinners are not immediately life threatening. Educational objective: Clostridium botulinum spores in honey can colonize an infant's (age <12 months) immature gastrointestinal system and release a toxin that causes botulism, a rare but potentially life-threatening illness.

Exam 2: Child Health

The school nurse creates a cafeteria menu for a newly enrolled child with celiac disease. Which lunches would be appropriate for this child? Select all that apply.

A 3-month-old infant has irritability, facial edema, a 1-day history of diarrhea with adequate oral intake, and seizure activity. During assessment, the parents state that they have recently been diluting formula to save money. Which is the most likely cause for the infant's symptoms?

The clinic nurse supervises a graduate nurse who is teaching the parents of a 2-year-old with acute diarrhea about home management. The nurse would need to intervene when the graduate nurse provides which instruction?

A nurse is performing an assessment of a 12-month-old child. Which of the following findings would the nurse expect? Select all that apply.

The registered nurse is teaching the parent of a 6-year-old about behavioral strategies for treating fecal incontinence due to functional constipation. Which statement by the parent indicates a need for further teaching?

A nurse is planning to complete a physical examination of a toddler. Which approach is an appropriate intervention by the nurse?

The nurse is caring for an infant diagnosed with Hirschsprung disease who is awaiting surgery. Which assessment finding requires the nurse's immediate action?

The nurse teaching the parents of a child diagnosed with cystic fibrosis will advise the parents to choose foods that satisfy which recommended diet?

The nurse is reinforcing discharge teaching for the parents of a 1-year-old with a newly diagnosed cow's milk allergy. Which nutrients normally provided by milk should be obtained from other sources? Select all that apply.

The nurse is teaching a group of new parents about oral hygiene for their children. One of the parents asks, "When should I take my child to the dentist?" What would be the best response from the nurse?

A nurse in a pediatric clinic is performing a physical examination of a 30-month-old child. Which finding requires further evaluation?

The nurse is performing a well-child assessment on a sleeping 2-month-old client. Organize the assessment in the correct order based on the developmental age of the client. All options must be used.

A 12-month-old client has a high blood lead level of 18 mcg/dL (0.87 µmol/L) . The nurse educates the parents about lead poisoning. Which statements made by the parent indicate that teaching is successful? Select all that apply.

A nurse is discussing the fine motor abilities of a 10-month-old infant with the infant's parent. Which are developmentally appropriate skills for an infant of this age? Select all that apply.

The nurse plans care for a pediatric client who has just undergone a cleft palate repair. Which of the following interventions should the nurse include in the plan of care? Select all that apply.

The nurse is gathering data on a 5-week-old admitted with a suspected diagnosis of pyloric stenosis. The nurse should expect to find which laboratory value?

The nurse is reinforcing education with the parents of a 2-year-old child about diet choices to promote growth. The family observes a strict vegan diet. Which of the following statements by the nurse are appropriate? Select all that apply.

The nurse in a clinic is obtaining a developmental history of an 18-month-old during a well-child visit. Which activities should the child be able to perform? Select all that apply.

The nurse assesses a child with intussusception. Which assessment findings require priority intervention?

The clinic nurse is interviewing the parents of a 6-month-old client about the infant's diet. Which statement by the parents is most concerning?