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Test Bank Nursing Care Children Principles Practice 4th Edition, Susan
Chapter 01: Introduction to Nursing Care of Children
1. A nurse is reviewing changes in healthcare delivery and funding for pediatric populations. Which current trend in the pediatric setting should the nurse expect to find?
a. Increased hospitalization of children
b. Decreased number of uninsured children
c. An increase in ambulatory care
d. Decreased use of managed care
2. A nurse is referring a low-income family with three children under the age of 5 years to a program that assists with supplemental food supplies. Which program should the nurse refer this family to?
c. Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program
d. Women, Infants, and Children (WIC) program
3. In most states, adolescents who are not emancipated minors must have parental permission before:
a. treatment for drug abuse.
b. treatment for sexually transmitted diseases (STDs).
c. obtaining birth control.
4. A nurse is completing a clinical pathway for a child admitted to the hospital with pneumonia. Which characteristic of a clinical pathway is correct?
a. Developed and implemented by nurses
b. Used primarily in the pediatric setting
c. Specific time lines for sequencing interventions
d. One of the steps in the nursing process
5. When planning a parenting class, the nurse should explain that the leading cause of death in children 1 to 4 years of age in the United States is:
a. premature birth.
b. congenital anomalies.
c. accidental death.
d. respiratory tract illness.
6. Which statement is true regarding the quality assurance or incident report?
a. The report assures the legal department that there is no problem.
b. Reports are a permanent part of the clients chart.
c. The nurses notes should contain the following: Incident report filed and copy placed in chart.
d. This report is a form of documentation of an event that may result in legal action.
7. Which client situation fails to meet the first requirement of informed consent?
a. The parent does not understand the physicians explanations.
b. The physician gives the parent only a partial list of possible side effects and complications.
c. No parent is available and the physician asks the adolescent to sign the consent form.
d. The infants teenage mother signs a consent form because her parent tells her to.
8. A nurse assigned to a child does not know how to perform a treatment that has been prescribed for the child. What should the nurses first action be?
a. Delay the treatment until another nurse can do it.
b. Make the childs parents aware of the situation.
c. Inform the nursing supervisor of the problem.
d. Arrange to have the child transferred to another unit.
9. A nurse is completing a care plan for a child and is finishing the assessment phase. Which activity is not part of a nursing assessment?
a. Writing nursing diagnoses
b. Reviewing diagnostic reports
c. Collecting data
d. Setting priorities
10. Which patient outcome is stated correctly?
a. The child will administer his insulin injection before breakfast on 10/31.
b. The child will accept the diagnosis of type 1 diabetes mellitus before discharge.
c. The parents will understand how to determine the childs daily insulin dosage.
d. The nurse will monitor blood glucose levels before meals and at bedtime.
Chapter 02: Family-Centered Nursing Care
1. A nurse is teaching parents how to apply time-out as a disciplinary method for their 4 year old. Parents have understood the teaching if they state which formula correctly guides the use of time-out?
a. Use the guideline of 1 minute per each year of the childs age.
b. Relate the length of the time-out to the severity of the behavior.
c. Never use time-out for a child younger than age 4 years.
d. Follow the time-out with a treat.
2. What is the nurses best approach when an 8-year-old boy frequently causes a disruption in the playroom by taking toys from other children?
a. Exclude the child from the playroom.
b. Explain to the children in the playroom that he is very ill and should be allowed to have the toys.
c. Approach the child in his room and ask, Would you like it if the other children took your toys from you?
d. Approach the child in his room and state, I am concerned that you are taking the other childrens toys. It upsets them and me.
3. Families that deal most effectively with stress have which behavior patterns?
a. Focus on family problems.
b. Feel weakened by stress.
c. Expect that some stress is normal.
d. Feel guilty when stress exists.
4. Which family will most likely have the greatest difficulty in coping with an ill child?
a. A single-parent mother who has the support of her parents and siblings
b. Parents who have just moved to the area and are living in an apartment while they look for a house
c. The family of a child who has had multiple hospitalizations related to asthma and has adequate relationships with the nursing staff
d. A family in which there is a young child and four older married children who live in the area
5. Which is the priority nursing intervention for the family of a child who has been admitted to the hospital?
a. Begin discharge teaching.
b. Identify and mobilize internal and external strengths.
c. Identify ways in which the family could have prevented their childs hospitalization.
d. Instruct the parents on normal growth and development.
6. A nurse is planning culturally competent care for a child of Hispanic descent. Which characteristic found in a Hispanic family should the nurse include in the plan of care?
b. Close extended family
c. Docile children are considered weak
d. Very interested in health-promoting lifestyles
7. While reviewing nursing documentation on dietary intake for a 7-year-old child of Asian descent, the nurse notes that he consistently refuses to eat the food on his tray. Which assumption is most likely accurate?
a. He is a picky eater.
b. He needs less food because he is on bed rest.
c. He may have culturally related food preferences.
d. He is probably eating between meals and spoiling his appetite.
8. To resolve family conflict, it is necessary to have open communication, accurate perception of the problem, and a(n):
a. intact family structure.
c. willingness to consider the view of others.
d. balance in personality types.
9. A nurse is planning a parenting class for expectant parents. Which statement is true about the characteristics of a healthy family?
a. The parents and children have rigid assignments for all the family tasks.
b. Young families assume total responsibility for the parenting tasks, refusing any assistance.
c. The family is overwhelmed by the significant changes that occur as a result of childbirth.
d. Adults agree on the majority of basic parenting principles.
10. A nurse determines that a child consistently displays predictable behavior and is regular in performing daily habits. Which temperament is the child displaying?
Chapter 03: Communicating with Children
1. Which information should the nurse include when preparing a 5-year-old child for a cardiac catheterization?
a. A detailed explanation of the procedure
b. A description of what the child will feel and see during the procedure
c. An explanation about the dye that will go directly into his vein
d. An assurance to the child that he and the nurse can talk about the procedure when it is over
2. Who are the experts in planning for the care of a 9-year-old child with a profound sensory impairment who is hospitalized for surgery?
a. The childs parents
b. The childs teacher
c. The case manager
d. The primary nurse
3. Which is an effective technique for communicating with toddlers?
a. Have the toddler make up a story from a picture.
b. Involve the toddler in dramatic play with dress-up clothing.
c. Repeatedly read familiar stories to the child.
d. Ask the toddler to draw pictures of his fears.
4. What is the most important consideration for effectively communicating with a child?
a. The childs chronological age
b. The parentchild interaction
c. The childs receptiveness
d. The childs developmental level
5. Which behavior is most likely to encourage open communication?
a. Avoiding eye contact
b. Folding arms across the chest
c. Standing with head bowed
d. Soft stance with arms loose at the side
6. Which strategy is most likely to encourage a child to express feelings about the hospital experience?
a. Asking close-ended questions
b. Asking direct questions
c. Sharing personal experiences
d. Actively listening
7. Which is the most appropriate question to ask to encourage conversation when interviewing an adolescent?
a. Are you in school?
b. Are you doing well in school?
c. How is school going for you?
d. How do your parents feel about your grades?
8. What is the most appropriate response for the nurse to make to the parent of a 3-year-old child found in a bed with the side rails down?
a. You must never leave the child in the room alone with the side rails down.
b. I am very concerned about your childs safety when you leave the side rails down. The hospital has guidelines stating that side rails need to be up if the child is in the bed.
c. It is hospital policy that side rails need to be up if the child is in bed.
d. When parents leave side rails down, they might be considered as uncaring.
9. Which is an appropriate preoperative teaching plan for a school-age child?
a. Begin preoperative teaching the morning of surgery.
b. Schedule a tour of the hospital a few weeks before surgery.
c. Show the child books and pictures 4 days before surgery.
d. Limit teaching to 5 minutes and use simple terminology.
10. A primary nurse bought a hospitalized child a new toy to replace a broken one. What is the best interpretation of the nurses behavior?
a. The nurse is displaying signs of overinvolvement.
b. The nurse is a kind and generous person.
c. The nurse feels a special closeness to the child.
d. The nurse wants to make the child happy.
Chapter 04: Health Promotion for the Developing Child
1. A nurse is reviewing developmental concepts for infants and children. Which statement best describes development in infants and children?
a. Development, a predictable and orderly process, occurs at varying rates within normal limits.
b. Development is primarily related to the growth in the number and size of cells.
c. Development occurs in a proximodistal direction with fine muscle development occurring first.
d. Development is more easily and accurately measured than growth.
2. Frequent developmental assessments are important for which reason?
a. Stable developmental periods during infancy provide an opportunity to identify any delays or deficits.
b. Infants need stimulation specific to the stage of development.
c. Critical periods of development occur during childhood.
d. Child development is unpredictable and needs monitoring.
3. Which factor has the greatest influence on child growth and development?
4. A nurse is planning a teaching session with a child. According to Piagetian theory, the period of cognitive development in which the child is able to distinguish fact from fantasy is the _____ period of cognitive development.
b. formal operations
c. concrete operations
5. The theorist who viewed developmental progression as a lifelong series of conflicts that need resolution is:
6. What does the nurse need to know when observing chronically ill children at play?
a. Play is not important to hospitalized children.
b. Children need to have structured play periods.
c. Childrens play is an indication of a childs response to treatment.
d. Play is to be discouraged because it tires hospitalized children.
7. Which child is most likely to be frightened by hospitalization?
a. A 4-month-old infant admitted with a diagnosis of bronchiolitis
b. A 2-year-old toddler admitted for cystic fibrosis
c. A 9-year-old child hospitalized with a fractured femur
d. A 15-year-old adolescent admitted for abdominal pain
8. Which statement made by a 15-year-old adolescent with a diagnosis of neurofibromatosis (an autosomal dominant genetic disorder) best demonstrates an understanding of the mechanism of inheritance for the disease?
a. My babies will probably not have neurofibromatosis.
b. My babies have a 50% chance of having neurofibromatosis.
c. Whether my babies have problems depends on the father.
d. My babies have a 25% chance of having neurofibromatosis.
9. During a routine healthcare visit, a parent asks the nurse why her 9-month-old infant is not walking as her older child did at the same age. Which response by the nurse best demonstrates an understanding of child development?
a. Shes a little slow.
b. If she is pulling up, you can help her by holding her hand.
c. Babies progress at different rates. Your infants development is within normal limits.
d. Maybe she needs to see a behavioral specialist.
10. Which expected outcome would be developmentally appropriate for a hospitalized 4-year-old child?
a. The child will be dressed and fed by the parents.
b. The child will independently ask for play materials or other personal needs.
c. The child will be able to verbalize an understanding of the reason for the hospitalization.
d. The child will have a parent stay in the room at all times.
Chapter 05: Health Promotion for the Infant
1. Which milestone is developmentally appropriate for a 2-month-old infant when the nurse pulls the infant to a sitting position?
a. Head lag is present when the infants trunk is lifted.
b. The infant is able to support the head when the trunk is lifted.
c. The infant is briefly able to hold the head erect.
d. The infant is fully able to support and hold the head in a straight line.
2. Approximately what should a newborn weigh at 1 year of age if the newborns birth weight was 7 pounds 6 ounces?
a. 14 3/4 pounds
b. 22 1/8 pounds
c. 29 1/2 pounds
d. Unable to estimate weight at 1 year
3. Which statement made by a parent would be consistent with a developmental delay?
a. I have noticed that my 9-month-old infant responds consistently to the sound of his name.
b. I have noticed that my 12-month-old child does not get herself to a sitting position or pull to stand.
c. I am so happy when my 1 1/2-month-old infant smiles at me.
d. My 5-month-old infant is not rolling over in both directions yet.
4. At a healthy 2-month-old infants well-child clinic visit, the nurse should give which immunizations?
a. DTaP, IPV, HepB, Hib, PCV, rotavirus
b. MMR, DTaP, PVC, and IPV
c. Hib, DTaP, rotavirus, and OPV
d. Hib and MMR, IPV, and rotavirus
5. The nurse advises the mother of a 3-month-old infant, exclusively breast-fed, to:
a. start giving the infant a vitamin D supplement.
b. start using an infant feeder and add rice cereal to the formula.
c. start feeding the infant rice cereal with a spoon at the evening feeding.
d. continue breast-feeding without any supplements.
6. At _____ months of age, an infant should first be expected to locate an object hidden from view.
7. The parents of a newborn infant state, We will probably not have our baby immunized because we are concerned about the risk of our child being injured. Which is the best response for the nurse to make?
a. It is your decision.
b. Have you talked with your parents about this? They can probably help you think about this decision.
c. The risks of not immunizing your baby are greater than the risks from the immunizations.
d. You are making a mistake.
8. The mother of a 9-month-old infant is concerned because the infant cries when she leaves him. Which is the best response for the nurse to make to the mother?
a. You could consider leaving the infant more often so he can adjust.
b. You might consider taking him to the doctor because he may be ill.
c. Have you noticed whether the baby is teething?
d. This can be a healthy sign of attachment.
9. Which statement concerning physiological factors of infancy is true?
a. The infant has a slower metabolic rate than an adult.
b. An infant is not able to digest protein and lactase.
c. Infants have a slower circulatory response than adults.
d. The kidneys of an infant are less efficient in concentrating urine than an adults kidneys.
10. Which is a priority in counseling parents of a 6-month-old infant?
a. Increased appetite from secondary growth spurt
b. Allowing the infant to self-feed
c. Securing a developmentally safe environment for the infant
d. Strategies to teach infants to sit up
Chapter 06: Health Promotion During Early Childhood
1. The mother of a 14-month-old child is concerned because the childs appetite has decreased. The best response for the nurse to make to the mother is:
a. It is important for your toddler to eat three meals a day and nothing in between.
b. It is not unusual for toddlers to eat less.
c. Be sure to increase your childs milk consumption, which will improve nutrition.
d. Giving your child a multivitamin supplement daily will increase your toddlers appetite.
2. Which toy is the most developmentally appropriate for an 18- to 24-month-old child?
a. A push and pull toy
b. Nesting blocks
c. A bicycle with training wheels
d. A computer
3. Which is the priority concern in developing a teaching plan for the parents of a 15-month-old child?
a. Toilet training guidelines
b. Guidelines for weaning children from bottles
c. Instructions on preschool readiness
d. Instructions on a home safety assessment
4. What is the primary purpose of a transitional object?
a. It helps the parents deal with the guilt they feel when they leave the child.
b. It keeps the child quiet at bedtime.
c. It is effective in decreasing anxiety in the toddler.
d. It decreases negativism and tantrums in the toddler.
5. A nurse is teaching parents of a toddler about language development. Which statement best identifies the characteristics of language development in a toddler?
a. Language development skills slow during the toddler period.
b. The toddler understands more than he or she can express.
c. Most of the toddlers speech is not easily understood.
d. The toddlers vocabulary contains approximately 600 words.
6. Parents of a toddler ask the nurse when they should start toilet training. Which statement best addresses their concerns
a. When the child is 18 months of age
b. When the child exhibits signs of physical and psychological readiness
c. When the child has been walking for 9 months
d. When the child is able to sit on the potty for 10 to 15 minutes
7. Which statement by a mother of a toddler indicates a correct understanding of the use of discipline?
a. I always include explanations and morals when I am disciplining my toddler.
b. I always try to be consistent when disciplining the children, and I correct my children at the time they are misbehaving.
c. I believe that discipline should be done by only one family member.
d. My rule of thumb is no more than one spanking a day.
8. Which comment indicates that the mother of a toddler needs further teaching about dental care?
a. We use well water so I give my toddler fluoride supplements.
b. My toddler brushes his teeth with my help.
c. My child will not need a dental checkup until his permanent teeth come in.
d. I use a small nylon bristle brush for my toddlers teeth.
9. Which assessment finding in a preschooler would suggest the need for further investigation?
a. The child is able to dress independently.
b. The child rides a tricycle.
c. The child has an imaginary friend.
d. The child has a 2-pound weight gain in 12 months.
10. Which is the most appropriate action for the nurse to take when telling a preschool child about an upcoming procedure?
a. Explain all the information in detail to the child.
b. Speak loudly and clearly to the child.
c. Inform the parents of the procedure and ask them to tell the child.
d. Use symbolic play to explain the procedure.
Chapter 07: Health Promotion for the School-Age Child
1. Which statement made by a mother of a school-age boy indicates a need for further teaching?
a. My child is playing soccer this year.
b. He is always busy with his friends playing games. He is very active.
c. I limit his television watching to about 2 hours a day.
d. I am glad his coach emphasizes the importance of winning in todays society.
2. A nurse has completed a teaching session for parents on school-age childrens expected developmental milestones. The parents need further teaching if they indicate which behavior is expected in a school-age child?
a. Experiments with profanity and dirty jokes
b. Laughs at silly jokes and enjoys using words
c. Understands the concept of conservation
d. Engages in fantasy and magical thinking
3. The ability to mentally understand that 1 + 3 = 4 and 4 1 = 3 occurs in which stage of cognitive development?
a. Concrete operations stage
b. Formal operations stage
c. Intuitive thought stage
d. Preoperations stage
4. Which activity is most appropriate for developing fine motor skills in the school-age child?
5. A school nurse is teaching a health class for fifth grade children. The nurse plans to include which statement to best describe growth in the early school-age period?
a. Boys grow faster than girls do until around age 10.
b. Puberty occurs earlier in boys than in girls.
c. Puberty occurs at the same age for all races and ethnicities.
d. It is a period of rapid physical growth.
6. The comment that is most developmentally typical of a 7-year-old boy is:
a. I am a Power Ranger, so dont make me angry.
b. I dont know whether I like Mary or Joan better.
c. My mom is my favorite person in the world.
d. Jimmy is my best friend.
7. A school nurse is conducting a class on safety for parents of school-age children. Which statement indicates the parents need further teaching?
a. Our child needs to wear sunscreen when playing soccer.
b. Our young school-age child will continue to ride belted in the back seat.
c. We will monitor the volume when our child is listening to music on the i-Pod with ear buds.
d. Were glad our child will be home after school to let repairmen in while we are working.
8. Identify the statement that is the most accurate about moral development in the 9-year-old school-age child.
a. Right and wrong are based on physical consequences of behavior.
b. The child obeys parents because of fear of punishment.
c. The school-age child conforms to rules to please others.
d. Parents are the determiners of right and wrong for the school-age child.
9. Which parental behavior is the most important in fostering moral development?
a. Telling the child what is right and wrong
b. Vigilantly monitoring the child and her peers
c. Weekly family meetings to discuss behavior
d. Living as the parents say they believe
10. Which behavior by parents or teachers will best assist the child in negotiating the developmental task of industry?
a. Identifying failures immediately and asking the childs peers for feedback
b. Structuring the environment so the child can master tasks
c. Completing homework for children who are having difficulty in completing assignments
d. Decreasing expectations to eliminate potential failures
Chapter 08: Health Promotion for the Adolescent
1. A nurse is teaching an adolescent about Tanner stages. Which statement best describes Tanner staging?
a. Predictable stages of puberty that are based on chronological age
b. Staging of puberty based on the initiation of menarche and nocturnal emissions
c. Predictable stages of puberty that are based on primary and secondary sexual characteristics
d. Staging of puberty based on the initiation of primary sexual characteristics
2. Which behavior suggests appropriate psychosocial development in the adolescent?
a. The adolescent seeks validation for socially acceptable behavior from older adults.
b. The adolescent is self-absorbed and self-centered and has sudden mood swings.
c. Adolescents move from peers and enjoy spending time with family members.
d. Conformity with the peer group increases in late adolescence.
3. The parents of a 14-year-old girl are concerned that their adolescent spends too much time looking in the mirror. Which statement is the most appropriate for the nurse to make?
a. Your teenager needs clearer and stricter limits about her behavior.
b. Your teenager needs more responsibility at home.
c. During adolescence, this behavior is not unusual.
d. The behavior is abnormal and needs further investigation.
4. Which factor contributes to early adolescents engaging in risk-taking behaviors?
a. Peer pressure
b. A desire to master their environment
c. Engagement in the process of separation from their parents
d. A belief that they are invulnerable
5. Which statement is the most appropriate advice to give parents of a 16-year-old teenager who is rebellious?
a. You need to be stricter so that your teenager feels more secure.
b. You need to allow your teenager to make realistic choices while using consistent and structured discipline.
c. Increasing your teens involvement with his peers will improve his self-esteem.
d. Allow your teenager to choose the type of discipline that is used in your home.
6. Which statement by the nurse is most appropriate to a 15-year-old adolescent whose friend has mentioned suicide?
a. Tell your friend to come to the clinic immediately.
b. You need to gather details about your friends suicide plan.
c. Your friends threat needs to be taken seriously and immediate help for your friend is important.
d. If your friend mentions suicide a second time, you will want to get your friend some help.
7. When planning care for adolescents, the nurse should:
a. teach parents first, and they, in turn, will teach the teenager.
b. provide information for their long-term health needs because teenagers respond best to long-range planning.
c. maintain the parents role by providing explanations for treatment and procedures to the parents only.
d. give information privately to adolescents about how they can manage the specific problems that they identify.
8. A 17-year-old adolescent tells the nurse that he is not having sex because it would make his parents very angry. This response indicates that the adolescent has a developmental lag in which area?
a. Cognitive development
b. Moral development
c. Psychosocial development
d. Psychosexual development
9. The best response a nurse can make to a 15-year-old girl who has verbalized a desire to have a baby is:
a. Have you talked with your parents about this?
b. Do you have plans to continue school?
c. Will you be able to support the baby?
d. Can you tell me how your life will change if you have an infant?
10. In an interview with the nurse, a mother states that she is concerned that her 14-year-old teen is critical and finding fault with her. The nurse counsels the mother that:
a. the family needs to change its value system to meet the teenagers changing needs.
b. the parentteen relationship is important for the teenager and conflicts are to be expected.
c. teenagers create psychological distance from the parent to separate from the parent.
d. parents need to relinquish their relationship with their teenager to the teens peers.
Chapter 09: Physical Assessment of Children
1. The nurse is performing an abdominal assessment on a child. When percussing over the stomach, the nurse should hear which sound?
2. A nurse is preparing to begin an assessment on a newly admitted child. The nurse should be aware that the single most important component of a pediatric physical examination is:
a. assessment of heart and lungs.
b. measurement of height and weight.
c. documentation of parental concerns.
d. obtaining an accurate history.
3. In which section of the health history should the nurse record that the parent brought the infant to the clinic today because of frequent diarrhea?
a. Review of systems
b. Chief complaint
c. Lifestyle and life patterns
d. Health history
4. A nurse is reviewing pediatric physical assessment techniques. Which statement about performing a pediatric physical assessment is correct?
a. Physical examinations proceed systematically from head to toe unless developmental considerations dictate otherwise.
b. The physical examination should be done with parents in the examining room for children of any age.
c. Measurement of head circumference is done until the child is 5 years old.
d. The physical examination is done only when the child is cooperative.
5. A nurse is conducting an assessment on a child during a well-child visit. Which of the following includes the components of a complete pediatric history?
a. Statistical information, client profile, health history, family history, review of systems, and lifestyle and life patterns
b. Vital signs, chief complaint, and a list of previous problems
c. Chief complaint, including body location, quality, quantity, time frame, and alleviating and aggravating factors
d. Pertinent developmental and family information
6. At what age can the nurse expect a childs head and chest circumference to be almost equal?
b. 6 months
c. 1 year
d. 3 years
7. A nurse is teaching unlicensed assistive personnel (UAP) how to take accurate blood pressure on children. The nurse knows the UAPs have understood the teaching if they state that to obtain an accurate measurement of a childs blood pressure, the cuff should cover which portion of the childs upper arm?
8. Which chart should the nurse use to assess the visual acuity of an 8-year-old child?
a. Lea chart
b. Snellen chart
c. HOTV chart
d. Tumbling E chart
9. Which action is appropriate when the nurse is assessing breath sounds of an 18-month-old crying child?
a. Ask the parent to quiet the child so the nurse can listen.
b. Auscultate breath sounds and chart that the child was crying.
c. Encourage the child to play with the stethoscope to distract and to calm down the child before auscultating.
d. Document that data are not available because of noncompliance.
10. Which is the most appropriate site for the nurse to use to measure a pulse rate on a 1-year-old child?
Chapter 10: Emergency Care of Children
1. Which nursing action would facilitate care being provided to a child in an emergency situation?
a. Encourage the family to remain in the waiting room.
b. Assist parents in distracting the child during a procedure.
c. Always reassure the child and family.
d. Give explanations using professional terminology.
2. The father of a child in the emergency department is yelling at the physician and nurses. Which action would becontraindicated in this situation?
a. Provide a nondefensive response.
b. Encourage the father to talk about his feelings.
c. Speak in simple, short sentences.
d. Tell the father he must wait in the waiting room.
3. Which would be an appropriate nursing intervention for a 6-month-old infant in the emergency department?
a. Distract the infant with noise or bright lights.
b. Avoid warming the infant.
c. Remove any pacifiers from the baby.
d. Encourage the parent to hold the infant.
4. Which action should the nurse working in the emergency department initiate to decrease fear in a 2-year-old child?
a. Keep the child physically restrained during nursing care.
b. Allow the child to hold a favorite toy or blanket.
c. Direct the parents to remain outside the treatment room.
d. Let the child decide whether to sit up or lie down for procedures.
5. Which nursing action would be most appropriate to assist a preschool-age child in coping with the emergency department experience?
a. Explain the procedures and give the child some time to prepare.
b. Remind the child that she is a big girl.
c. Avoid the use of bandages.
d. Use positive terms and avoid terms such as shot and cut.
6. Which action should the nurse incorporate into a care plan for a 14-year-old child in the emergency department?
a. Limit the number of choices to be made by the adolescent.
b. Insist that parents remain with the adolescent.
c. Provide clear explanations and encourage questions.
d. Give rewards for cooperation with procedures.
7. The emergency department nurse notices that the mother of a young child is making a lot of phone calls and getting advice from her friends about what she should do. This behavior is an indication of which of the following?
b. Healthy coping skills
c. Attention-getting behaviors
d. Low self-esteem
8. A preschool child in the emergency department has a respiratory rate of 10 breaths per minute. How should the nurse interpret this finding?
a. The child is relaxed.
b. Respiratory failure is likely.
c. This child is in respiratory distress.
d. The childs condition is improving.
Chapter 11: The Ill Child in the Hospital and Other Care Settings
1. In which situation should the nurse address anxiety as a priority problem in planning care for the child and family?
a. Twenty-four hour observation
b. Emergency hospitalization
c. Outpatient admission
d. Rehabilitation admission
2. What is the primary disadvantage associated with outpatient and day facility care?
a. Increased cost
b. Increased risk of infection
c. Lack of physical connection to the hospital
d. Longer separation of the child from the family
3. In planning care, the nurse recognizes that which child should have the most difficulty with separation from family during hospitalization?
a. A 5-month-old infant
b. A 15-month-old toddler
c. A 4-year-old child
d. A 7-year-old child
4. A 2-year-old child has been hospitalized for 4 days. The nurse notes the child is quiet and withdrawn. Which is the best explanation for this behavior?
a. The child is protesting because of separation from caregivers.
b. The child has adjusted to the hospitalization.
c. The child is experiencing the despair stage of separation.
d. The child has reached the stage of detachment.
5. A 3-year-old child cries, kicks, and clings to the father when the parents try to leave the hospital room. What is the nurses best response to the parents about this behavior?
a. Your child is showing a normal response to the stress of hospitalization.
b. Your child is not coping effectively with hospitalization. Well need to get a psychological consult from the doctor.
c. It is helpful for parents to stay with children during hospitalization.
d. You can avoid this if you wait to leave after your child falls asleep.
6. A preschool aged child tells the nurse I was bad, thats why I got sick. Which is the best rationale for this childs statement?
a. The child has a fear that mutilation will lead to death.
b. The childs imagination is very active, and he may believe the illness is a result of something he did.
c. The child has a general understanding of body integrity at this age.
d. The child will not have fear related to an IV catheter initiation but will have fear of an impending surgery.
7. A nurse caring for a hospitalized adolescent should implement which most developmentally appropriate intervention?
a. Encouraging peers to call and visit when the adolescents condition allows
b. Being sure the adolescent wears a hospital gown or pajamas throughout the hospitalization
c. Discouraging questions and concerns about the effects of the illness on the adolescents appearance
d. Asking the parents how the adolescent usually copes in new situations
8. The nurse is discussing toddler development with the mother of a 2 1/2-year-old child. Which statement by the mother indicates she has an understanding of the toddlers developmental task?
a. I always help my daughter complete tasks to help her achieve a sense of accomplishment.
b. I provide many opportunities for my daughter to play with other children her age.
c. I consistently stress the difference between right and wrong to my daughter.
d. I encourage my daughter to do things for herself when she can.
9. Which interventions would best help a hospitalized toddler feel a sense of control?
a. Assign the same nurse to care for the child.
b. Put a cover over the childs crib.
c. Require parents to stay with the child.
d. Follow the childs usual routines for feeding and bedtime.
10. Parents ask the nurse why observation for 24 hours in an acute-care setting is often appropriate for children. Which is the best response by the nurse?
a. Longer hospital stays are more costly.
b. Children become ill quickly and recover quickly.
c. Children feel less separation anxiety when hospitalized for just 24 hours.
d. Families experience less disruption during short hospital stays.
Chapter 12: The Child with a Chronic Condition or Terminal Illness
1. A family has just learned their child has cystic fibrosis. They told the nurse this wont change anything, our child is not that sick. The nurse recognizes that the family is in which stage of the grieving process?
a. Anger and resentment
b. Sorrow and depression
c. Shock and disbelief
d. Acceptance and adjustment
2. A nurse is planning care for a dying child. Which priority intervention is planned to address the primary concern parents have for the dying child?
c. Food intake
d. Fluid intake
3. A parent of an infant states that she will room-in while her child is hospitalized. The nurse supports her decision knowing that the major fears of infants during illness and hospitalization are:
a. bodily injury and pain.
b. separation from caregivers and fear of strangers.
c. loss of control and altered body image.
d. the unknown and being left alone.
4. A nurse has just completed a teaching session for parents about childrens understanding of death. Parents of a 5-year-old child understood the teaching if they indicate which corresponds to their childs understanding of death?
a. Loss of a caretaker
b. Reversible and temporary
5. A nurse plans to include family in the aspects of care for a dying 12-month-old child. The nurse bases this plan on the understanding that death for an infant is understood as:
c. loss of caretaker.
6. Which activity should the nurse implement for the toddler hospitalized with a chronic illness to promote autonomy?
a. Playing with a push-pull toy.
b. Putting a puzzle together.
c. Playing a simple card game.
d. Watching cartoons on TV.
7. How can chronic illness and frequent hospitalization affect the psychosocial development of an adolescent?
a. They can lead to feelings of inadequacy.
b. They can interfere with parental attachment.
c. They can block the development of identity.
d. They can prevent the development of imagination.
8. Which is an important focus of nursing care for the dying child and his or her family?
a. Nursing care should be organized to minimize contact with the child.
b. Adequate oral intake is crucial to the dying child.
c. Families should be made aware that hearing is the last sense to stop functioning before death.
d. It is best for the family if nursing care takes place during periods when the child is alert.
9. What is the most appropriate response to a school-age child who asks if she can talk to her dying sister?
a. You need to talk loudly so she can hear you.
b. Holding her hand would be better because at this point she cant hear you.
c. Although she cant hear you, she can feel your presence so sit close to her.
d. Even though she will probably not answer you, she can still hear what you say to her.
10. The nurse recognizes that the priority goal for the child with a chronic illness is to:
a. maintain the intactness of the family.
b. eliminate all stressors.
c. achieve complete wellness.
d. obtain the highest level of wellness.
Chapter 13: Principles and Procedures for Nursing Care of Children
1. Which is the most appropriate statement for the nurse to make to a 5-year-old child who is to have a venipuncture?
a. You must hold still or Ill have someone hold you down. This is not going to hurt.
b. This will hurt like a pinch. Ill get someone to help you hold your arm still so it will be over fast and hurt less.
c. Be a big boy and hold still. This will be over in just a second.
d. Im sending your mother out so she wont be scared. You are big, so hold still and this will be over soon.
2. The nurse should obtain informed consent for which situation?
a. For any procedure that will be performed on a child
b. For any invasive procedure involving a risk to a child
c. Only if the child is not able to give consent
d. Only if the parents are not present
3. Which nursing diagnosis is appropriate for a 5-year-old child in isolation because of immunosuppression?
a. Spiritual distress
b. Social isolation
c. Diversional activity deficit
d. Sleep disturbance
4. Which nursing action is most appropriate when giving a child a sponge bath to decrease fever?
a. Use alcohol in the bath water to lower the childs temperature rapidly.
b. Use cold water to hasten the procedure.
c. Stop the sponge bath immediately if the child starts to shiver.
d. Bathe the child for 45 to 60 minutes.
5. Which action is appropriate when the nurse is bathing a small child?
a. Test the water on the inside of the wrist or elbow for comfort.
b. Allow children older than 2 years to bathe themselves.
c. Check that the water temperature does not exceed 120 F.
d. Step out of the room to give the child privacy while bathing.
6. Which is the best response for a nurse to make to a parent who has asked, When should I start dental care for my child?
a. The recommendation is for children to have a dental examination no later than 2 1/2 years.
b. Children should see a dentist at least one time before kindergarten.
c. The recommendation is for children to have a dental examination before first grade.
d. A dental examination by 1 year of age is the current recommendation.
7. Which action is appropriate to promote a toddlers nutrition during hospitalization?
a. Allow the child to walk around during meals.
b. Require the child to empty his or her plate.
c. Ask the childs parents to bring a cup and utensils from home.
d. Select new foods for the child from the menu.
8. Which concept is important for the nurse to know when taking a childs temperature?
a. The method used should be consistent.
b. Rectal temperatures should always be taken on infants.
c. Oral temperatures can be taken on all children older than 5 years of age.
d. Axillary temperatures should be taken at night.
9. A parent calls the pediatricians office because her 1-year-old child has a 100 F temperature. What would be the most appropriate initial nursing response to make to the parent?
a. Did you feel your childs forehead?
b. Tell me about the childs behavior.
c. Has anyone in your home been sick lately?
d. There is no need for concern if the childs temperature is less than 101 F.
10. Which nursing action is appropriate for specimen collection?
a. Follow sterile techniques for specimen collection.
b. Sterile gloves are worn if the nurse plans to touch the specimen.
c. Use standard precautions when handling body fluids.
d. Avoid wearing gloves in front of the child and family.
Chapter 14: Medication and Administration Safety of Infants and Children
1. Which should the nurse use to prepare liquid medication in volumes less than 5 milliliters?
a. Calibrated syringe
b. Paper measuring cup
c. Plastic measuring cup
d. Household teaspoon
2. Which food choice is appropriate to mix with medication?
a. Formula or milk
d. Orange juice
3. Which physiological difference would affect the absorption of oral medications administered to a 3-month-old infant?
a. More rapid peristaltic activity
b. More acidic gastric secretions
c. Usually more rapid gastric emptying
d. Variable pancreatic enzyme activity
4. Which factor should the nurse remember when administering topical medication to an infant?
a. Infants require a larger dosage because of a greater body surface area.
b. Infants have a thinner stratum corneum that absorbs more medication.
c. Infants have a smaller percentage of muscle mass compared with adults.
d. The skin of infants is less sensitive to allergic reactions.
5. What is the appropriate nursing response to a parent who asks, What should I do if my child cannot take a tablet?
a. You can crush the tablet and put it in some food.
b. Find out if the medication is available in a liquid form.
c. If the child cant swallow the tablet, tell the child to chew it.
d. Let me show you how to get your child to swallow tablets.
6. What is the maximum safe volume that an infant (aged 1 to 12 months) can receive in an intramuscular injection?
a. 0.25 milliliter
b. 0.5 milliliter
c. 1 milliliter
d. 1.5 milliliters
7. Which muscle would the nurse select to give a 6-month-old infant an intramuscular injection?
d. Vastus lateralis
8. The nurse is planning to administer an intramuscular injection to a 13-year-old child. What is the maximum volume of medication that can be injected into the ventrogluteal site?
a. 0.5 to 1 milliliter
b. 1 to 1.5 milliliters
c. 1.5 to 2 milliliters
d. 2 to 2.5 milliliters
9. Which parameter should guide the nurse when administering a subcutaneous injection?
a. Do not give injections in edematous areas.
b. Attach a clean 1-inch needle to the syringe.
c. The maximum volume injected into one site is 2 milliliters.
d. Do not pinch up tissue before inserting the needle.
10. Which action is correct when administering ear drops to a 2-year-old child?
a. Administer the ear drops straight from the refrigerator.
b. Pull the pinna of the ear back and down.
c. Massage the pinna after administering the medication.
d. Pull the pinna of the ear back and up.
Chapter 15: Pain Management for Children
1. The nurse is aware when assessing a child for pain that:
a. neonates do not feel pain.
b. pain is an individualized experience.
c. children do not remember pain.
d. a child must cry to express pain.
2. When pain is assessed in an infant, it would be inappropriate to assess for:
a. facial expressions of pain.
b. localization of pain.
d. thrashing of extremities.
3. The nurse is aware that physiological changes associated with pain in the infant include which finding(s)?
a. Increased blood pressure and decreased arterial saturation
b. Decreased blood pressure and increased arterial saturation
c. Increased urine output and increased heart rate
d. Decreased urine output and increased blood pressure
4. Which statement best reflects a myth that may interfere with the treatment of pain in infants and children?
a. Infants may have sleep difficulties after a painful event.
b. Children and infants are more susceptible to respiratory depression from narcotics.
c. Pain in children is multidimensional and subjective.
d. A childs cognitive level does not influence the pain experience.
5. The nurse caring for the child in pain knows that distraction:
a. can give total pain relief to the child.
b. is effective when the child is in severe pain.
c. is the best method for pain relief.
d. must be developmentally appropriate to refocus attention.
6. Which medication is the most effective choice for treating pain associated with inflammation?
7. When using the Poker Chip Tool, it is important for the nurse to know which fact?
a. Any number of chips can be used.
b. Only a specified number of chips can be used.
c. The assessment tool is used with adolescents.
d. The assessment tool is most effectively used with 2-year-old children.
8. An appropriate tool to assess pain in a 3-year-old child would be the:
a. Visual Analogue Scale (VAS).
b. Adolescent and Pediatric Pain Tool.
c. Oucher Tool.
d. Poker Chip Tool.
9. At which developmental stage is the child first able to localize pain and describe both the amount and the intensity of the pain felt?
a. Toddler stage
b. Preschool stage
c. School-age stage
d. Adolescent stage
10. Which statement indicates a nurses lack of understanding about the use of patient-controlled analgesia (PCA) therapy?
a. Children as young as 3 years old can effectively and successfully use a PCA pump.
b. Two registered nurses (RNs) are required to double check the dosage and programmed administration of opioids.
c. The child should be carefully monitored for signs and symptoms of overmedication with opioids.
d. Naloxone (Narcan) should be readily available.
Chapter 16: The Child with a Fluid and Electrolyte Alteration
1. The parents of a child with acid-base imbalance ask the nurse about mechanisms that regulate acid-base balance. Which statement by the nurse accurately explains the mechanisms regulating acid-base balance in children?
a. The respiratory, renal, and chemical-buffering systems regulate acid-base in the body.
b. The kidneys balance acid; the lungs balance base.
c. The cardiovascular and integumentary systems work together to control acid-base.
d. The skin, kidney, and endocrine systems control the bodys acid-base.
2. A child has a 2-day history of vomiting and diarrhea. He has hypoactive bowel sounds and an irregular pulse. Electrolyte values are sodium, 139 mEq/L; potassium, 3.3 mEq/L; and calcium, 9.5 mg/dL. This child is likely to have which of the following electrolyte imbalances?
3. Which statement best describes why infants are at greater risk for dehydration than older children?
a. Infants have an increased ability to concentrate urine.
b. Infants have a greater volume of intracellular fluid.
c. Infants have a smaller body surface area.
d. Infants have an increased extracellular fluid volume.
4. Which assessments are most relevant to the care of an infant with dehydration?
a. Temperature, heart rate, and blood pressure
b. Respiratory rate, oxygen saturation, and lung sounds
c. Heart rate, capillary refill, and skin color
d. Diet tolerance, bowel function, and abdominal girth
5. Which factor is the most important in determining the rate of fluid replacement in the dehydrated child?
a. The childs weight
b. The type of dehydration
c. Urine output
d. Serum potassium level
6. Which is the priority nursing intervention for a 6-month-old infant hospitalized with diarrhea and dehydration?
a. Estimating insensible fluid loss
b. Collecting urine for culture and sensitivity
c. Palpating the posterior fontanel
d. Measuring the infants weight
7. What assessment should the nurse make before initiating an intravenous (IV) infusion of dextrose 5% in 0.9% normal saline solution with 10 mEq of potassium chloride for a child hospitalized with dehydration?
a. Fluid intake
b. Number of stools
c. Urine output
d. Capillary refill
8. A nurse is teaching parents about diarrhea. Which statement by the parents indicates understanding of the teaching?
a. Diarrhea results from a fluid deficit in the small intestine.
b. Organisms destroy intestinal mucosal cells, resulting in an increased intestinal surface area.
c. Malabsorption results in metabolic alkalosis.
d. Increased motility results in impaired absorption of fluid and nutrients.
9. Which is the best nursing response to a parent asking about antidiarrheal medication for her 18-month-old child?
a. It is okay to give antidiarrheal medication to a young child as long as you follow the directions on the box for correct dosage.
b. Antidiarrheal medication is not recommended for young children because it slows the bodys attempt to rid itself of the pathogen.
c. Im sure your child wont like the taste so give her extra fluids when you give the medication.
d. Antidiarrheal medication will decrease the frequency of stools, but give your child Gatorade to maintain electrolyte balance.
10. Which is the primary intervention in treating a child with persistent vomiting?
a. Detecting the cause of vomiting
b. Preventing metabolic acidosis
c. Positioning the child supine
d. Recording intake and output
Chapter 17: The Child with an Infectious Disease
1. Which statement made by an adolescent girl indicates an understanding about the prevention of sexually transmitted diseases (STDs)?
a. I know the only way to prevent STDs is not to be sexually active.
b. I practice safe sex because I wash myself right after sex.
c. I wont get any kind of STD because I take the pill.
d. I have sex only if my boyfriend wears a condom.
2. Which sexually transmitted disease would the nurse suspect when an adolescent girl comes to the clinic because she has a vaginal discharge that is white with a fishy smell?
a. Human papillomavirus
b. Bacterial vaginosis
3. An immunosuppressed child is admitted to the hospital with varicella (chickenpox). The nurse should be prepared to administer which prescribed medication?
a. Erythromycin (Pediazole)
b. Varicella vaccine
c. Acetylsalicylic acid (Aspirin)
d. Acyclovir (Zovirax)
4. A nurse is conducting a health education class for a group of school-age children. Which statement, made by the nurse, is correct about the bodys first line of defense against infection in the innate immune system?
a. Nutritional status
b. Skin integrity
c. Immunization status
d. Proper hygiene practices
5. The mother of an infant with multiple anomalies tells the nurse that she had a viral infection in the beginning of her pregnancy. Which viral infection is associated with fetal anomalies?
d. Herpes simplex virus (HSV)
6. What is the best response to a parent of a 2-month-old infant who asks when the infant should receive the measles vaccine?
a. Your baby can get the measles vaccine now.
b. The first dose is given any time after the first birthday.
c. She should be vaccinated between 4 and 6 years of age.
d. This vaccine is administered when the child is 11 years old.
7. Which statement made by a parent indicates incorrect information about an intervention for a childs fever?
a. I should keep her covered lightly when she has a fever.
b. Ill give her plenty of liquids to keep her hydrated.
c. I can give her acetaminophen (Tylenol) for a temperature higher than 101 F.
d. Ill look for over-the-counter preparations that contain salicylates (Aspirin).
8. A 6-month-old infant is due for routine immunizations. The parent reports the infant was exposed to pertussis 2 days ago. The nurse should:
a. give the 6 month immunizations as scheduled.
b. hold the 6 month immunizations until the next visit.
c. hold the 6 month immunizations for 3 weeks.
d. notify the physician.
9. Which symptom should be reported to the primary care provider if it occurs when a child with an infectious disease is febrile?
10. A parent asks the nurse how she would know whether her child has fifth disease. The nurse would advise the parent to be alert for which manifestation?
a. Bulls-eye rash at the site of a tick bite
b. Lesions in various stages of development on the trunk
c. Maculopapular rash on the trunk that lasts for 2 days
d. Bright red rash on the cheeks that looks like slapped cheeks
Chapter 18: The Child with an Immunologic Alteration
1. A nurse in a well-child clinic is teaching parents about their childs immune system. Which statement, made by the nurse, is correct?
a. The immune system distinguishes and actively protects the bodys own cells from foreign substances.
b. The immune system is fully developed by 1 year of age.
c. The immune system protects the child against communicable diseases in the first 6 years of life.
d. The immune system responds to an offending agent by producing antigens.
2. A nurse is teaching parents about the importance of immunizations for infants because of immaturity of the immune system. The parents demonstrate that they understand the teaching if they make which statement?
a. The spleen reaches full size by 1 year of age.
b. IgM, IgE, and IgD levels are high at birth.
c. IgG levels in the newborn infant are low at birth.
d. Absolute lymphocyte counts reach a peak during the first year.
3. Which statement is true regarding how infants acquire immunity?
a. The infant acquires humoral and cell-mediated immunity in response to infections and immunizations.
b. The infant acquires maternal antibodies that ensure immunity up to 12 months of age.
c. Active immunity is acquired from the mother and lasts 6 to 7 months.
d. Passive immunity develops in response to immunizations.
4. A nurse is teaching parents about transmission of human immunodeficiency virus (HIV) in the pediatric population. The nurse should relate that the most common mode of transmission of HIV virus is:
a. Perinatal transmission
b. Sexual abuse
c. Blood transfusions
d. Poor hand washing
5. A nurse is preparing to administer routine immunizations to an infant who is HIV positive. What is the American Academy of Pediatrics recommendation for immunizing infants who are HIV positive?
a. Follow the routine immunization schedule.
b. Routine immunizations are administered. Assess CD4+ counts before administering the MMR and varicella vaccinations.
c. Do not give immunizations because of the infants altered immune status.
d. Eliminate the pertussis vaccination because of the risk of convulsions.
6. Which recommendation by the nurse is appropriate for a mother who has a preschool child who refuses to take the medications for HIV infection?
a. Mix medications with chocolate syrup or follow with chocolate candy.
b. Mix the medications with milk or an essential food.
c. Skip the dose of medication if the child protests too much.
d. Mix the medication in a syringe, hold the child down firmly, and administer the medication.
7. What is the primary nursing concern for a hospitalized child with HIV infection?
a. Maintaining growth and development
b. Eating foods that the family brings to the child
c. Consideration of parental limitations and weaknesses
d. Resting for 2 to 3 hours twice a day
8. What should the nurse include in a teaching plan for a mother of a toddler who will be taking prednisone for several months?
a. The medication should be taken between meals.
b. The medication needs to be discontinued because of the risks associated with long-term usage.
c. The medication should not be stopped abruptly.
d. The medication may lower blood glucose so the mother needs to observe the child for signs of hypoglycemia.
9. A nurse assesses a child on long-term systemic corticosteroid therapy for which condition?
b. Dilation of blood vessels in the cheeks
c. Growth delays
d. Decreased appetite and weight loss
10. Which statement by the parent of a 5-year-old child with acquired immunodeficiency syndrome (AIDS) regarding prescribed antiretroviral agents indicates that she has a good understanding of disease management?
a. When my childs pain increases, I double the recommended dosage of antiretroviral medication.
b. Addiction is a risk, so I use the medication only as ordered.
c. Doses of the antiretroviral medication are selected on the basis of my childs age and growth.
d. By the time my child is an adolescent, she will not need her antiretroviral medications any longer.
Chapter 19: The Child with a Gastrointestinal Alteration
1. Which is the best nursing response to a mother asking about the cause of her infants bilateral cleft lip?
a. Did you have trouble with this pregnancy?
b. Do you know of anyone in your or the fathers family born with cleft lip or palate problems?
c. This defect is associated with intrauterine infection during the second trimester.
d. Was your husband in the military and involved in chemical warfare?
2. Which nursing intervention is most helpful to parents of a neonate with bilateral cleft lip?
a. Assure the parents that the correction will be immediate and uncomplicated.
b. Show the parents before-and-after pictures of an infant whose cleft lip has been successfully repaired.
c. Teach the parents about long-term enteral feedings.
d. Refer the parents to a community agency that addresses this problem.
3. The postoperative care plan for an infant with surgical repair of a cleft lip includes which intervention?
a. A clear liquid diet for 72 hours
b. Nasogastric feedings until the sutures are removed
c. Elbow restraints to keep the infants fingers away from the mouth
d. Rinsing the mouth after every feeding
4. A nurse is teaching a group of parents about tracheoesophageal fistula. Which statement, made by the nurse, is accurate about tracheoesophageal fistula (TEF)?
a. This defect results from an embryonal failure of the foregut to differentiate into the trachea and esophagus.
b. It is a fistula between the esophagus and stomach that results in the oral intake being refluxed and aspirated.
c. An extra connection between the esophagus and trachea develops because of genetic abnormalities.
d. The defect occurs in the second trimester of pregnancy.
5. Which maternal assessment is related to the infants diagnosis of TEF?
a. Maternal age more than 40 years
b. First term pregnancy for the mother
c. Maternal history of polyhydramnios
d. Complicated pregnancy
6. What clinical manifestation should a nurse should be alert for when a diagnosis of esophageal atresia is suspected?
a. A radiograph in the prenatal period indicates abnormal developme
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