CHILD HEALTH

1. A 9-year-old with severe esophagitis is 12 hours status/post-Nissen

fundoplication for gastroesophageal reflux (GER). To implement appropriate
nursing care, the nurse should do which of the following?
A. Encourage him to take small amounts of clear liquids every four hours
B. Administer NG or gastrostomy feedings every four hours
C. Ask him to rank his pain on a scale of zero to 10 when zero is no pain and 10
is the worst possible pain
RATIONALE: A gastrostomy tube or nasogastric tube placed during surgery is
kept in place to maintain gastric decompression. The child is kept NPO until
bowel function returns. Appropriate pain management is an ethical nursing
obligation; a pain rating scale recognizes the childs right to be in control.
STRATEGY: Options A and B focus on feeding. Recall that feedings cannot be
restarted until bowel sounds have returned.
D. Insert a pH probe to monitor esophageal acidity
2. A child has been admitted to the unit with nephrotic syndrome. In talking with
the mother, she reports that a cousin had acute glomerulonephritis (AGN) last
year. The mother asks how these two diseases compare, as they both affect the
kidneys. The nurses response would include the information that
A. both diseases produce smoky colored urine.
B. both diseases cause greatly reduced urine output.
RATIONALE: Typical symptoms of nephrotic syndrome are clear, frothy urine
that is diminished in volume. AGN presents with smoky urine that is also
diminished in volume. AGN is a postinfectious disease with no genetic basis.
Antibiotics are not used in nephrotic syndrome. Oliguria is usually defined as
0.5 to 1.0 mL/kg/hr.
STRATEGY: The core issue of the question is knowledge of the similarities and
differences between nephrotic syndrome and glomerulonephritis. Use nursing
knowledge and the process of elimination to make a selection.
C. both diseases have a genetic basis.
D. treatment for both involves antibiotic therapy.
3. A 10-month-old female infant with biliary atresia is being discharged after a
Kasai procedure. Which statement, if made by the parents, indicates that
teaching with regard to prognosis has been understood?
A. We are glad this problem was found so early; now everything will be fine.
B. We will stop her liver medicine now that she is being discharged.
C. We are happy to be able to stop that special formula and many of those
vitamins.
D. We know that even though surgery is over, she will likely need a liver
transplant.
RATIONALE: Kasai procedure is palliative, and prognosis is best if performed
before 10 weeks of age. Its purpose is to achieve biliary drainage and avoid
liver failure. A liver transplant is required in 80 to 90% of cases.
STRATEGY: The core issue of the question is knowledge of the typical success
of surgery with Kasai procedure in an infant with biliary atresia. Use nursing
knowledge and the process of elimination to make a selection.

4. A child with Hirschsprung disease is being discharged after Soave endorectal

pull-through procedure for colostomy closure. Which of these measures should
the nurse include in the home care plan?
A. Refer the parents to an enterostomal therapist for ostomy care
B. Teach parents how to perform weekly rectal irrigations
C. Teach parents signs and symptoms of infection
RATIONALE: It is important that any signs of infection be reported at once.
After Soave procedure, the colostomy is usually closed and normal bowel
function is expected.
STRATEGY: Remember that the stem states for colostomy closure, even if the
medical name of the procedure is not recalled. This should help to eliminate
most of the options.
D. Teach parents PCA pain-control methods
5. The nurse is working with a teenager diagnosed with eczema. In order to
increase treatment compliance, the nurse will explain:
A. The appearance of the skin will improve in a few days.
B. Avoiding foods with eggs and milk will speed healing.
C. Scarring is not likely if the treatment plan is followed.
RATIONALE: A teenager can and should be part of the treatment plan. If
itching is avoided to prevent excoriation and secondary infection, scarring is
unlikely. Improvement is often slow, and the problem may persist into
adulthood. Food avoidance will not change the course of the disease.
STRATEGY: The key to this question is to increase treatment compliance.
Learning that scarring can be prevented will encourage compliance.
D. This problem will not likely recur past adolescence.
6. A 12-year-old boy is hospitalized and diagnosed with the recent development of
human immunodeficiency virus (HIV) infection secondary to factor transfusions
for hemophilia. The family is very concerned about their ability to manage his
care, risk of infection to family members, and whether the client should remain
in the home. Which action by the nurse will best promote family coping at this
time?
A. Explain to the family that the infection cannot be spread by casual contact.
B. Demonstrate positive acceptance of the child with each contact.
RATIONALE: The family has stated multiple concerns, and demonstrating
acceptance of the child is the best way to foster acceptance of the child and
development of further coping skills. Prevention of transmission,
handwashing, and drug therapy are all important, but none of these
individually targets the global concerns of the family.
STRATEGY: The core issue of the question is the best action of the nurse to
model acceptance of the child and lead to enhanced coping skills by the
family. Select the option that is the most global in nature because the family
has multiple concerns, and use the process of elimination to make a
selection.
C. Explain that prophylactic drugs will prevent the virus from speaking.
D. Show the family how to wash their hands properly.
7. A child will be undergoing chemotherapy. The nurse discusses the issue of hair
loss with the child and family before chemotherapy begins. Later the family asks

the nurse why this information was given to the child at this time. The nurses
response will include the information that:
A. Hair loss is a symptom of toxic blood levels of chemotherapy, so the child
should be watching for this phenomenon.
B. The presence or absence of hair is related to body image. Strategies for
handling hair loss should precede the event.
RATIONALE: Preparation helps individuals handle stressful situations. If the
child had not been prepared for hair loss, it could be more anxiety-provoking
for the child. Hair loss cannot be prevented.
STRATEGY: Knowledge of the affect of hair loss on the child and the need to
prepare the child prior to this stressful event to facilitate coping will help to
identify the correct answer.
C. It is the nurses legal responsibility to discuss this issue with the child.
D. Hair loss can be prevented with appropriate nursing interventions.
8.