30. (Answer: B) Rationale: The nurse must emphasize the importance of completing the full course of antibiotic therapy, even though symptoms may have resolved before the antibiotic is finished.
31. (Answer: D) Rationale: Infants and young children have narrower airways and shorter distance between structures; accessory muscles generally used for breathing are immature. The respiratory rate of infants is faster than adults, and parents can be taught to assess the child for respiratory problems.
32. (Answer: C) Rationale: Newborns are unable to coordinate breathing and sucking simultaneously. They are nose-breathers, and anything that interferes with nasal patency impairs feeding as well.
33. (Answer: A) Rationale: In epiglottitis, any manipulation of the throat can cause stimulation of the gag reflex. The inflamed, edematous epiglottis could then completely obstruct the airway. All other assessments should be made.
34. (Answer: C) Rationale: Children with cystic fibrosis require pancreatic enzymes with every meal and snack to counter malabsorption and nutritional problems. Normal bowel movements indicate that enzyme dosage is appropriate. It is important to avoid other children with infections, but physical activity is encouraged within the child's capability. Chest percussion is a normal part of health maintenance for this child.
35. (Answer: C) Rationale: Developmentally, small children practice increased hand-to-mouth activity and explore objects with their mouths. Any small toy or food can be ingested and potentially obstruct the airway. All of the other choices are correct, but option C is most important.
36. (Answer: D) Rationale: Pulmonary pathogens are particularly detrimental to children with cystic fibrosis. Colonization of the lungs with resistant organisms often leads to poor survival rates. Aggressive intravenous administration of high-dose antibiotics is always a priority.
37. (Answer: B) Rationale: Epinephrine is a beta adrenergic drug given via inhalation for emergency relief of acute bronchospasm; action is immediate and the drug may be repeated in 3 to 5 minutes. Methylprednisolone and prednisone are both corticosteroids to reduce the inflammatory process but would not give immediate relief. Cromolyn sodium is a preventive medication.
38. (Answer: D) Rationale: The sudden onset of severe respiratory distr3ess is frightening and very stressful for the family and child. There is no prolonged hospital confinement.
39. (Answer: A) Rationale: Splinting the affected side with a pillow or stuffed animal lessens the discomfort experienced with bacterial pneumonia.
40. (Answer: C) Rationale: Home oxygen therapy and tracheostomy care require access to emergency equipment typically not available on a camping trip. Additionally, campfires are hazardous. All other choices indicate correct information.
41. (Answer: B) Rationale: Children with acyanotic heart defects may have a murmur without other symptoms. Dyspnea and tachycardia are early signs of pulmonary edema, which may lead to congestive heart failure.
42. (Answer: A) Rationale: Pulmonary overload occurs prior to congestive heart failure. Crackles and frothy secretions are signs of moist respirations, a symptom of pulmonary overload.
43. (Answer: A) Rationale: ASO titers indicate history of streptococcal infection, which is a precursor to rheumatic fever. The other symptoms are not related to this diagnosis.
44. (Answer: D) Rationale: Blood pressure will be elevated in upper extremities and reduced in lower extremities with presence of coarctation of aorta. The constriction of the aorta may be progressive. Vital sign assessments provide data related to this progression and should be more frequent than once a day.
45. (Answer: B) Rationale: The knee-chest position decreases venous return to the heart and thereby increases systemic vascular resistance, which leads to decreased cardiac output.
46. (Answer: C) Rationale: Parents need to be prepared for emergencies. Crying for short periods is effective as deep breathing exercises. Increased intracranial pressure is not associated with cardiac failure. Monitoring growth and development would not be the primary concern.
47. (Answer: B) Rationale: Among the symptoms of rheumatic fever is migratory polyarthritis. The child wills complaint of aching joints. At the time of diagnosis, the child is not infectious. CPR is not a priority at this time because the child is hospitalized
48. (Answer: A) Rationale: Aspirin is ordered as an antipyretic and anti-clotting agent, while immunoglobulins decrease fever and inflammation. Reducing symptoms of the disease will increase client comfort. The child's lips are cracked, and soft foods and liquids are comforting. The child will be lethargic and passive range of motion exercises is utilized to facilitate joint movement.
49. (Answer: B) Rationale: The child needs to take prescribed antibiotics indefinitely to prevent future infection and possible endocarditis from streptococcal infection. Complete bed rest is not required in the recovery period, but the child is maintained with limited activities. Complications of rheumatic fever are cardiac, not CNS.
50. (Answer: A) Rationale: When pulmonary circulation is impaired, hemoglobin may not be reoxygenated which leads to the cyanotic appearance. The respirations and heart rate increase during a cyanotic episode and the child experiences agitation or irritability
51. (Answer: B) Rationale: Brudzinski's sing indicates meningeal irritation. As the head and neck are flexed toward the chest, the legs flex at both the hips and the knees in response. Brudzinski's sign may be seen in the other options because of the Meningeal irritation.
52. (Answer: A) Rationale: Increased intracranial pressure in infants is characterized by lethargy, irritability, bradycardia, tachycardia, apnea, bulging fontanels, setting-sun eyes, vomiting, and hypertension. Myelomeningocele refers to a neural tube defect, which is obvious on the back. Skull fractures indicate injury to the head and may be asymptomatic or may be accompanied by other pathology that could lead to increased intracranial pressure. Hypertension does not display symptoms of setting-sun eyes.
53. (Answer: C) Rationale: The most common mechanisms for the development of hydrocephalus include decreased reabsorption (communicating hydrocephalus) and obstruction to the flow of CSF (non-communicating). Obstruction may result from congenital anomalies, inflammation, external blockage, and other causes.
54. (Answer: B) Rationale: Most children with spina bifida cystic (myelomeningocele include) have the level of their defect at a point, which does affect the innervation to both the colon and anal sphincter. The result is constipation and incontinence. Any lack of mobility increases the risk for constipation, and all children need a pattern of regular bowel movements
55. (Answer: C) Rationale: Clients are considered contagious until the causative organism is determined and antibiotic therapy has been initiated. Children are usually placed in respiratory or droplet isolation. Twenty-four hours of antibiotic therapy usually eliminates the necessity of isolation.
56. (Answer: D) Rationale: The child with meningitis will hyperextend the neck and head in an arcing position referred to as opisthotonic. The child does this to relieve discomfort from the meningeal irritation. Decerebrate posturing is a symptom of dysfunction at the level of the midbrain and is characterized by rigid extension and pronation of arms and legs. Decorticate posturing is a symptom of a dysfunction of the cerebral cortex and characterized by adduction of the arms at the shoulders, the arms flexed on the chest with hands in fists and wrists flexed, lower extremities extended and adducted. Jacksonian seizure is a simple motor seizure characterized by clonic movements that begin in a foot, hand, or face and then spread to include sometimes the entire body.
57. (Answer: C) Rationale: Turning the head to one side can occlude the flow of CSF, increasing the ICP. Oxygen can serve as a vasodilator, decreasing the ICP. Keeping the head of the bed slightly elevated also promotes flow of CSF. Diuretics are often part of the medical treatment to decrease ICP.
58. (Answer: A) Rationale: Epidural hematomas are characterized by arterial bleeding. Onset of symptoms occurs within minutes to hours. Other types of bleeding are often venous, which has a slower onset of symptoms.
59. (Answer: C) Rationale: Obtunded indicates a diminished level of consciousness with response only to vigorous stimulation. Semicomatose is when a child only responds to painful stimuli; lethargy is when a child sleeps if left undisturbed but is normally alert when awake.
60. (Answer: B) Rationale: The most common form of cerebral palsy involves spasticity of muscles. Because of the excessive energy expended, these children often need more calories than other children their age and size. Feeding difficulties are often a component of cerebral palsy, but whether a child needs assistance with feedings is dependent upon the muscle groups affected.
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