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As new scientific information becomes available through basic and clinical research, rec- ommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with profes- sional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs.
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I thank my children, Jason, Sarah, and Walker; my grandchildren, Caroline, Darren, Sadie, and Sam; and my friends, especially David, for all their love and support.
To students, graduates, and colleagues: thank you for all you do in caring for children and their families.
Susan P. Wade, MSN, RN, CPN, CCRN
Clinical Assistant Professor Indiana University
Purdue University Fort Wayne, Indiana
Sherrilyn Coffman, DNS, RN, CPN
Professor and Assistant Dean Nevada State College Henderson, Nevada
Dawn Marie Daniels, DNS, RN, PHCNS-BC
Clinical Nurse Specialist Riley Hospital for Children Indianapolis, Indiana
Mary Jo Eoff, RN, MSN, CPNP
Clinical Instructor Indiana University Indianapolis, Indiana
Joyce Foresman-Capuzzi, BSN, RN, CEN, CPN, CCRN, CTRN, CPEN, SANE-A, EMT-P
Clinical Nurse Educator/Emergency Department
Lankenau Hospital Wynnewood, Pennsylvania
Paige Johnson, RN, MSN, MPH, CRNP
Pediatric Nurse Practitioner
Children’s Mercy Hospital, Department of Hematology/Oncology
Kansas City, Missouri
Dominique Leveque, MSN, RN, CPNP, FNP-C
Workplace Health Services Clarian Health Partners Indianapolis, Indiana
Christina Bittles McCarthy, MSN, RN, CPNP
Pediatric Nurse Practitioner Indiana University, Department of Orthopedic Surgery
Indianapolis, Indiana
Patricia A. Normandin, RN, MSN, CEN, CPN, CPEN, DNP(c)
Pediatric Nursing Instructor University of Massachusetts, Lowell Lowell, Massachusetts
Julie A. Poore, RN, MSN
Visiting Lecturer Indiana University Indianapolis, Indiana
Susan P. Wade, MSN, RN, CPN, CCRN
Clinical Assistant Professor Indiana University
Purdue University Fort Wayne, Indiana
Cele Walter, BSN, RN, CPN, NCSN
High School Nurse Paul VI High School
Haddonfield, New Jersey
Candace F. Zickler, RN, MSN, CPNP Supervisor, Health Services Metropolitan School District of Perry Township
Indianapolis, Indiana
vii
Jacoline Sommer Albert, ADN, RN, BScN, DI
Senior Instructor
The Aga Khan University Karachi, Pakistan
Monique Alston-Davis, MSN, Ed, CPN
Assistant Professor Montgomery College Silver Spring, Maryland
Cathryn J. Baack, PhD, RN, CPNP
Assistant Professor
MedCentral College of Nursing Mansfield, Ohio
Joyce Beard, MSN, PHCNS-BC, NCSN, RN
Assistant Clinical Professor
University of North Carolina, Pembroke Pembroke, North Carolina
Vicky H. Becherer, MSN, RN Assistant Teaching Professor University of Missouri, St. Louis St. Louis, Missouri
Stacee Bertolla, RN, MSN, CPNP
Instructor
University of South Alabama Mobile, Alabama
María del Rosario C. Biddenback, RN, MSN, FNP-C
Professor
Napa Valley College Napa, California
Kathleen Borge, MS, RNC
Faculty Chair, Women and Children’s Health
Samaritan Hospital Troy, New York
Pam Bowden, RN, MS, PNP
Faculty
North Hennepin Community College Brooklyn Park, Minnesota
Twila J. Brown, PhD, RN
Assistant Professor
Southeast Missouri State University Cape Girardeau, Missouri
Katherine Bydalek, MSN, FNP-BC, PhD
Assistant Professor University of South Alabama Mobile, Alabama
Dena Christianson, MSN, PNP
Adjunct Faculty
Nova Southeastern University Fort Lauderdale, Florida
Karen Clancy, MS, RN, CNP
Clinical Instructor Ohio State University
Neonatal Nurse Practitioner Columbus Children’s Hospital Columbus, Ohio
Myra L. Clark, MS, FNP-C
Assistant Professor
North Georgia College and State University
Dahlonega, Georgia
Lori Clay, MSN, RN Assistant Professor Arkansas State University Jonesboro, Arkansas
Sallie Coke, PhD, APRN, CPNP, CFNP
Associate Professor
Georgia College and State University Milledgeville, Georgia
ix
x PEDIATRIC SUCCESS
Georgina Colalillo, MS, RN, CNE Associate Professor, Nursing Department Queensborough Community College Bayside, New York
Judith Drumm, DNS, RN, CPN
Professor/Nursing
Palm Beach Atlantic University West Palm Beach, Florida
Elizabeth Fiske, PhD, RN, NNP-BC, PCNS, BC
Associate Professor
Carson-Newman University Jefferson City, Tennessee
Jennifer Bell Frank, MSN, APRN, BC
Instructor
Jacksonville State University Jacksonville, Alabama
Marianne Fraser, MSN, RN, BC
Assistant Professor University of Utah Salt Lake City, Utah
Susan Golden, MSN, RN
Nursing Faculty
Eastern New Mexico University, Roswell Roswell, New Mexico
Heather Janiszewski Goodin, PhD, RN, AHN-BC
Professor
Capital University Columbus, Ohio
Kathy L. Ham, RN, EdD
Assistant Professor
Southeast Missouri State University Cape Girardeau, Missouri
Brenda J. Walters Holloway, APRN, FNP, DNSc
Clinical Assistant Professor University of South Alabama Spanish Fort, Alabama
Teresa L. Howell, DNP, RN, CNE Associate Professor of Nursing Morehead State University Morehead, Kentucky
Mary C. Kishman, PhD, RN
Associate Professor
College of Mount St. Joseph Cincinnati, Ohio
Katherine R. Kniest, RN, MSN, CNE
Professor
William Rainey Harper College Palatine, Illinois
Robyn Leo, MSN Associate Professor Worcester State College Worcester, Massachusetts
Barbara J. MacDougall, MSN, ARNP
Nova Southeastern University Ft. Lauderdale, Florida
Sheila Matye, MSN, RN, CNE
Associate Clinical Professor
Montana State University, College of Nursing
Great Falls, Montana
Kathleen T. Mohn, RN, MSEd, CLNC
Instructor
College of Southern Nevada Las Vegas, Nevada
Jennifer Morton, MS, MPH, RN
Assistant Professor University of New England Portland, Maine
Irene Owens, MSN, APRN
Instructor
Lake Sumter Community College Leesburg, Florida
Brenda Pavill, RN, FNP, PhD, IBCLC
Professor
Misericordia University Dallas, Pennsylvania
Delia Pittman, PhD
Nursing Professor
MidAmerica Nazarene University Olathe, Kansas
Janine T. Reale, MS, RN, CNE Instructor, Nursing Faculty Rivier University
Nashua, New Hampshire
Deborah A. Roberts, RN, BSN, MSN, EdD
Instructor
Sonoma State University, Department of Nursing
Sonoma, California
Rebecca L. Shabo, RN, PNP-BC, PhD
Associate Professor Kennesaw State University Kennesaw, Georgia
Cynthia A. Shartle, RN, MSN, APRN, BC-FNP
ADN Faculty
South Texas College McAllen, Texas
Patsy M. Spratling, RN, MSN
Nursing Instructor
Holmes Community College Ridgeland, Mississippi
Linda Strong, MSN, RN, CPNP, CNE Assistant Professor, Pediatric Nursing Cuyahoga Community College Cleveland, Ohio
REVIEWERS FOR PREVIOUS EDITIONS xi
Bev Valkenier, BScN, RN, MSN
Lecturer
University of British Columbia Vancouver, British Columbia, Canada
Linda Walters, RN, MSN, PhD (a.b.d.)
Nursing Instructor Indiana State University Terre Haute, Indiana
Elizabeth M. Wertz, RN, BSN, MPM, EMT-P, PHRN, FACMPE
Chief Executive Officer Pediatric Alliance, PC Carnegie, Pennylvania
Sarah Whitaker, DNS, RN Nursing Program Director Dona Ana Community College Las Cruces, New Mexico
Barbara White, RN, MSN, CCRN
Nursing Instructor Southwestern Michigan College Dowagiac, Michigan
1 Fundamentals of Critical Thinking Related to Test Taking:
The RACE Model 1
HOW TO USE THIS REVIEW BOOK 1
Test Preparation 1
RACE Model 2
2 Pharmacology 3
KEYWORDS 3
ABBREVIATIONS 3
CONVERSIONS 4
QUESTIONS 4
ANSWERS AND RATIONALES 12
3 Growth and Development 21
KEYWORDS 21
ABBREVIATIONS 21
QUESTIONS 21
ANSWERS AND RATIONALES 31
4 Pediatric Health Issues 43
KEYWORDS 43
ABBREVIATIONS 43
QUESTIONS 44
ANSWERS AND RATIONALES 53
5 Respiratory Disorders 67
KEYWORDS 67
ABBREVIATIONS 67
QUESTIONS 68
ANSWERS AND RATIONALES 77
6 Cardiovascular Disorders 91
KEYWORDS 91
ABBREVIATIONS 91
QUESTIONS 91
ANSWERS AND RATIONALES 100
7 Gastrointestinal Disorders 109
KEYWORDS 109
ABBREVIATIONS 110
QUESTIONS 110
ANSWERS AND RATIONALES 121
8 Genitourinary Disorders 133
KEYWORDS 133
ABBREVIATIONS 133
QUESTIONS 133
ANSWERS AND RATIONALES 144
9 Endocrine Disorders 155
KEYWORDS 155
ABBREVIATIONS 155
xiii
xiv PEDIATRIC SUCCESS
QUESTIONS 155
ANSWERS AND RATIONALES 165
10 Hematological/Oncology Disorders 177
KEYWORDS 177
ABBREVIATIONS 177
QUESTIONS 177
ANSWERS AND RATIONALES 186
11 Neuromuscular Disorders 197
KEYWORDS 197
ABBREVIATIONS 197
QUESTIONS 197
ANSWERS AND RATIONALES 207
12 Orthopedic Disorders 219
KEYWORDS 219
ABBREVIATIONS 219
QUESTIONS 219
ANSWERS AND RATIONALES 229
13 Neurological Disorders 239
KEYWORDS 239
ABBREVIATIONS 239
QUESTIONS 240
ANSWERS AND RATIONALES 250
14 Leadership and Management 261
KEYWORDS 261
ABBREVIATIONS 261
QUESTIONS 261
ANSWERS AND RATIONALES 271
15 Comprehensive Exam 285
QUESTIONS 285
ANSWERS AND RATIONALES 301
Glossary of English Words Commonly Encountered on Nursing Examinations 319
Index 323
Pediatric Success: NCLEX ®-Style Q&A Review is designed to help you, the student, complete your nursing program as well as succeed on the NCLEX-RN® examination.
This book applies critical-thinking skills primarily to multiple choice questions and to some alternate test items. It provides practice test questions and test-taking hints to help you analyze each item and choose the correct response.
Another book in the Success series, Fundamentals Success by Nugent and Vitale, explains critical thinking and the RACE Model, which are used in each book in the series. This information will help you answer questions on tests in your nursing courses and on the NCLEX-RN® examination. The key to successful studying is knowing the material that will be covered on the examinations. Course notes should be studied every night and cor- responding readings done before class. This will help you learn the material and retain it longer. Once you know the material, it is important for you to be able to answer primarily multiple choice questions correctly. The RACE Model will help you succeed with answer- ing questions.
HOW TO USE THIS REVIEW BOOK
The book contains 14 chapters, a final comprehensive examination, and practice questions online. Test-taking hints are included with each question.
This chapter, Chapter 1, provides guidelines for course test preparation and includes an example of how to use the RACE Model.
Chapter 2 focuses on pharmacology and has been included because of the expressed need of students for extra testing in this area. In the NCLEX-RN® test plan (www. ncsbn.org), pharmacology and management of care have a large number of test items. This chapter includes questions centered on what the student nurse caring for children of all ages needs to know about administering medications, drug actions, dosages, expected effects, adverse effects, and teaching families. Chapter 3 covers growth and development of children from infancy through adolescence. Chapter 4 covers material on issues related to pediatric health. Chapters 5 through 13 follow pediatric health problems through each of the body systems. Each chapter contains practice questions, answers, and rationales for the correct answer, including test-taking hints, keywords, and abbreviations.
Chapter 14, “Leadership and Management,” relates to pediatric nursing. Graduates need to have a working knowledge of issues in these areas. Chapter 15 is a final 100-ques- tion comprehensive examination. There are also questions available online that you can access free for 30 days. Questions in this book are written primarily at the application and analysis level and are either multiple choice, with four response choices, or alternate item format. Nursing faculty members write tests in these formats to familiarize students with the NCLEX-RN® examination style.
Test Preparation
One of the most important strategies for you is to study your course materials thoroughly and know the assigned concepts for each examination in your class. It is best to study daily
1
2 PEDIATRIC SUCCESS
so that you really learn the material. Don’t wait and try to learn it all at once. The more time you spend studying the topic, the better you will retain the material.
After you feel confident that you know the material, choose the chapter(s) in this book that correspond(s) with the assigned test material in your nursing course. Answer the prac- tice questions to determine your level of knowledge about the topic. Carefully review the questions you miss, making sure you read and understand the rationale for choosing the wrong distracter and why the correct response is indeed correct. The rationales provide a great deal of information about the correct and incorrect options, which helps you under- stand the content more completely. The test-taking hints are strategies to help you logi- cally determine the correct response. If you still feel uncomfortable with the content area, review that chapter in your textbook for better understanding. This method of preparing for an examination will help you identify your strengths and areas to focus on as you con- tinue to study.
You may want to start with Chapter 2, “Pharmacology,” because you will be admin- istering medications to children throughout your pediatric nursing course. This chapter will help you focus on teaching strategies for families of children receiving medications, differences in delivering drugs to children, and calculating dosages.
RACE Model
The RACE Model is a critical-thinking strategy to be used when answering multiple choice questions. The RACE Model helps you analyze the question stem and determine the correct response. For more detailed information about the RACE Model, see Test Success: Test-Taking Techniques for Beginning Nursing Students by Nugent and Vitale.
The RACE Model comprises:
R - Recognize the keywords in the stem.
A - Ask what the question is asking the nurse to do.
C - Critically analyze each option in relation to the information in the stem.
E - Eliminate as many options as possible to narrow your choice to the correct response.
Some students believe they know the material but have difficulty choosing the correct response when answering multiple choice questions. Using the RACE Model will greatly increase your chances of choosing the correct response. To use it effectively during timed tests, you need to practice. Using the RACE Model as you prepare yourself with the chapter tests will help you. Following is a sample question:
1. A 6-month-old is being seen in the clinic for a well-child checkup. The parents want to know about starting solid foods. How should the nurse counsel them?
1. “Since you started rice cereal from a spoon 2 months ago, you can add a new strained vegetable each week.”
2. “Introduce some mashed fruits first. After the infant is eating that well, start vegetables and rice cereal.”
3. “Infants do best eating solids if you spoon-feed a new strained vegetable every other day to see what their preferences are.”
4. “Add rice cereal to each bottle. Next you can add fruits and vegetables fed by spoon.”
Using the RACE Model:
R - The client in the stem is the parent.
A - The parents want to know how to add solid foods to their infant’s diet.
C - Infants start rice cereal between 4 and 6 months. This is fed to the infant by spoon unless there is an indication to place it in the bottle. That is not stated in the stem of this question. Either strained fruits or vegetables are added to the infant’s diet at about 6 months of age. The infant stays on that choice for several days to determine whether the infant is allergic.
E - Now you can eliminate choices 2, 3, and 4 because they do not contain choices that you know are correct. The remaining choice is 1, the correct response.
KEYWORDS
The following words include English vocabulary, nursing/medical terminology, concepts, princi- ples, or information relevant to content specifically addressed in the chapter or associated with topics presented in it. English dictionaries, your nursing textbooks, and medical dictionaries such as Taber’s Cyclopedic Medical Dictionary are resources that can be used to expand your knowl- edge and understanding of these words and related information.
Acetaminophen (Tylenol) Albuterol (Proventil) Amoxicillin (Amoxil)
Amoxicillin/clavulanate potassium (Augmentin)
Amphotericin B Anticholinergic Baclofen
Diphenhydramine (Benadryl) Benzoyl peroxide Carbamazepine (Tegretol) Chlorhexidine (Hibiclens) Ciprofloxacin (Cipro) Collagenase (Santyl) Cyclophosphamide (Cytoxan) Dexamethasone (Decadron) Diclofenac (Voltaren) Digoxin (Lanoxin)
Diltiazem (Cardizem) Erythromycin Filgrastim (Neupogen) Gamma globulin
Gentamicin (Garamycin) Growth hormone Ibuprofen (Advil, Motrin) Ifosfamide (Ifex)
Indomethacin (Indocin) Intradermal
Isotretinoin (Accutane) Levothyroxine (Synthroid) Lindane (Kwell, G-Well) Mesna (Mesnex) Metoclopramide (Reglan) Morphine sulfate (Duramorph) Nasal decongestant
NPH insulin Oxybutynin (Ditropan) Pancreatic enzymes Penicillin
Phenytoin (Dilantin) Prednisone Prostaglandin E
Pyrantel pamoate (Antiminth) Ribavirin (Virazole)
Rifampin (Rifadin) Salicylic acid Sympathomimetic Terbinafine (Lamisil)
Trimethoprim/sulfamethoxazole (Septra, Bactrim)
Vancomycin Vastus lateralis
ABBREVIATIONS
Cerebral palsy (CP) grain (gr)
gram (g)
milligram (mg) pound (lb)
3
4 PEDIATRIC SUCCESS
CONVERSIONS
1 fl ounce = 30 mL (fluid volume) 1 g = 15 gr
1 g = 1000 mg
1 gr = 60 mg (or 65 mg for Tylenol or aspirin)
1 in = 2.54 cm
1 kg = 2.2 lb
1 L = 1000 mL
1 lb = 454 g
1 lb = 16 ounces
1 mg = 1000 mcg
1 ounce = 28 g (weight)
QUESTIONS
1. A child is to receive phenytoin [Show Less]