2024 NCLEX Pediatrics Exam Test Bank Practice Test New Latest Version Best Studying Mater, Exams of Pediatrics

Download 2024 NCLEX Pediatrics Exam Test Bank Practice Test New Latest Version Best Studying Mater and more Exams Pediatrics in PDF only on Docsity! 2024 NCLEX Pediatrics Exam Test Bank Practice Test New Latest Version Best Studying Material with All Questions and Answers The nurse is caring for a child who had a tonsillectomy this morning. The child is observed to be swallowing continuously. What is the most appropriate initial nursing action? 1. Administer acetaminophen for pain 2. Place an ice collar around her throat 3. Call the charge nurse or surgeon immediately 4. Encourage the child to suck on ice chips ---------- Correct Answer ------------ 3. Continual swallowing indicates bleeding. The charge nurse or surgeon should be notified at once. None of the other responses is appropriate. The child may be hemorrhaging. When selecting play activites for a healthy 4-year-old, the parent should be guided to understand that the 4-year-old enjoys: ----------- Correct Answer ----------- cooperative play with friends An example of a therapeutic play activity for a preschool child who is recovering from an appendectomy would be: ----------- Correct Answer ----------- blowing bubbles the nurse is guiding a parent concerning techniques of dealing wit ha child with enuresis. The most appropriate suggestion by the nurse would be to: ----------- Correct Answer ----------- limit liquids after dinner and have the child void before going to bed The nurse is caring for a 6-year-old child who had a tonsillectomy this morning. Once the child is fully awake and alert, which liquid is the best to offer her? 1. A cherry popsicle 2. Apple juice 3. Orange juice 4. Cranberry juice ---------- Correct Answer ------------ 2. The child needs clear, cold liquids that are not red and are not citrus. Red would make it difficult to determine if vomitus was blood or juice. A 10-year-old child has had diagnosed bronchial asthma for three years. The child has been admitted to the pediatric unit in acute respiratory distress. Which of the following would be most characteristic of the child's asthmatic attack upon admission? 1. Expiratory wheezing 2. Inspiratory stridor 3. Cyanotic nail beds 4. Prolonged inspiratory phase ---------- Correct Answer ------------ 1. Bronchial constriction occurs in asthma. This increases the airway resistance to airflow. The respiratory difficulty is accentuated during expiration, when the bronchi are supposed to contract and shorten, as opposed to inspiration, when the bronchi are dilating and elongating. Inspiratory stridor is characteristic of croup. Note that answers 2 and 4 both deal with the inspiratory phase. Asthma affects the expiratory phase. The nurse is caring for an 18-month-old child who has been vomiting. Which is the appropriate position to place the child during naps and sleep time? 1.A supine position 2.A side-lying position 3.Prone, with the head elevated 4.Prone, with the face turned to the side ---------- Correct Answer ----------- 2.A side-lying position The vomiting child should be placed in an upright or side-lying position to prevent aspiration. Options 1, 3, and 4 will place the child at risk for aspiration if vomiting occurs. Which interventions should the nurse include when preparing a plan of care for a child with hepatitis? Select all that apply. 1.Providing a low-fat, well-balanced diet 2.Teaching the child effective hand-washing techniques 3.Notifying the primary health care provider if jaundice is present 4.Scheduling play time in the playroom with other children 5.Instructing the parents about the risks associated with taking medications 6.Arranging for indefinite home schooling because the child will not be able to return to school - --------- Correct Answer ----------- 1.Providing a low-fat, well-balanced diet 2.Teaching the child effective hand-washing techniques 5.Instructing the parents about the risks associated with taking medications Because hepatitis can be viral, standard precautions should be instituted in the hospital. The child should be discouraged from sharing toys, so playtime in the playroom with other children is not part of the plan of care. The child will be allowed to return to school 1 week after the onset of jaundice, so indefinite home schooling would not need to be arranged. Jaundice is an expected finding with hepatitis and would not warrant notification of the primary health care provider. Provision of a low-fat, well-balanced diet is recommended. Parents are cautioned about administering any medication to the child because normal doses of many medications may become dangerous because of the liver's inability to detoxify and excrete them. Hand washing is the single most effective measure in control of hepatitis in any setting, and effective hand washing can prevent the compromised child from picking up an opportunistic type of infection. A child is admitted with asthma. Which aspects of the health history would be most closely associated with asthma? 1. The child's grandfather died of emphysema at age 76. 2. The child's grandmother died of lung cancer. 3. The child had respiratory distress syndrome following premature birth. 4. The child had eczema as an infant and toddler. ---------- Correct Answer ------------ 4. Asthma is an allergic condition and frequently follows eczema, also an allergic condition. Having relatives with emphysema or lung cancer is not usually related to childhood asthma. Respiratory The nurse should not remove the child from the croup tent just because his/her clothing is wet. A 5-year-old child has cystic fibrosis. What is best to offer the child on a hot summer day? 1. Kool-Aid 2. Ice cream 3. Lemonade 4. Broth ---------- Correct Answer ------------ 4. The child with cystic fibrosis has a problem with chloride metabolism and loses excessive amounts of salt in sweat. The child should be given something with high amounts of sodium, such as broth. Ice cream contains some sodium, but not as much as broth. Kool-Aid and lemonade contain no sodium. What should the nurse do to protect a child from injury during a seizure? 1. Restrain the child's arms and legs 2. Place a tongue blade in the child's mouth 3. Place a pillow under the child's head 4. Provide a waterproof pad for the bed ---------- Correct Answer ------------ 3. Placing a pillow under the head, using padded side rails, and removing sharp or hard objects from the immediate area all provide for the safety of a child who is having a seizure. No restraints or force should be used during a seizure. Nothing should be put in the mouth of a person who is having a seizure. Although having a waterproof mattress or pad would prevent the bed from being soiled, it has nothing to do with the child's safety. The nurse is teaching the parents of a child who has cerebral palsy to feed the child. What position is best to recommend? 1. A normal eating position and provide stabilization of the jaw 2. A semi-reclining position 3. Upright while using a nasogastric or gastrostomy tube 4. Hyperextension of the neck ---------- Correct Answer ------------ 1. Upright with stabilization of the jaw is important because jaw control is often lacking in a child with cerebral palsy. Feeding in a semi-reclining position does not promote swallowing. A child with cerebral palsy does not usually need tube feeding or a gastrostomy. Hyperextending the neck may interfere with swallowing. A 1-year-old child is admitted to the pediatric unit with the diagnosis of bacterial meningitis. Which room should the nurse assign to this child? 1. A room with a 2-year-old who had surgery for a hernia repair 2. A room with a 1-year-old child who has pneumonia 3. A room with a 2-year-old child who has cerebral palsy 4. A private room with no roommates ---------- Correct Answer ------------ 4. Bacterial meningitis is infectious. The child should be placed in a private room with respiratory precautions. The nurse is caring for an infant who is admitted with bacterial meningitis. What is the first priority when providing nursing care for this child? 1. Administer ordered antibiotics as soon as possible. 2. Keep the room quiet and dim. 3. Explain all procedures to the parents. 4. Begin low-flow oxygen via mask. ---------- Correct Answer ------------ 1. The first priority is to begin antibiotics as soon as possible. The more quickly antibiotics are started, the better the child's prognosis. The nurse will keep the room quiet and dim and will explain actions to the parents. However, these actions are not as high of a priority as administering the antibiotics. Oxygen is administered only if the child's respiratory status is impaired. A newborn has a myelomeningocele. What is the most important nursing action prior to surgery? 1. Turn the infant every two hours 2. Encourage holding and cuddling by the parents 3. Apply sterile, moist, nonadherent dressings over the lesion 4. Administer pain medication every three to four hours ---------- Correct Answer ------------ 3. It is important to prevent the defect from becoming dry and cracked and allowing microorganisms to enter. Infants with myelomeningocele remain in a prone position to prevent excessive pressure or tension on the defect. In most cases, infants with myelomeningocele cannot be held and cuddled as other babies are. The parents should stroke and touch the infant even if they cannot hold him or her. The infant is not usually in pain. A 3-year-old child is being seen in the neurology clinic for a routine visit. The child had a repair of a myelomeningocele shortly after birth. The child's mother asks the nurse when she can accomplish bladder training. What is the best reply? 1. "You need to take your child to the bathroom every two hours." 2. "We will teach you how to do intermittent, clean catheterization." 3. "Continue to diaper the child until school age." 4. "Your child needs to learn how to do self- catheterization." ---------- Correct Answer ----------- - 2. Parents should be taught intermittent, clean catheterization. Parents can begin using this procedure at the age when unaffected children are toilet trained (about 3 years). Children who have myelomeningocele do not usually have bowel and bladder control, so taking him to the bathroom would serve no purpose. The child does not need to wear diapers until he goes to school. He should be as normal as possible. A 3-year-old child is not old enough to learn self- catheterization techniques. He will learn when he is older and has better motor coordination and understanding of the procedure. Which assessment regularly performed on newborns and infants will do most to help with early identification of infants who might have hydrocephalus? 1. Head circumference 2. Weight measurement 3. Length measurement 4. Presence of reflexes ---------- Correct Answer ------------ 1. Head circumference is the most important tool in early identification of hydrocephalus. Head circumference is measured at birth and at all well-baby visits. Measurements above the norm will be seen in infants with hydrocephalus. Weight and length do not have any connection with hydrocephalus. An infant with severe hydrocephalus may have abnormal reflexes, but head circumference will do the most to help with the early identification of infants who might have hydrocephalus. How should the nurse position a 4-month-old infant who has hydrocephalus? 1. Side-lying 2. Sitting up in an infant seat 3. Alternating prone and supine 4. Left Sims' position ---------- Correct Answer ------------ 2. The infant with hydrocephalus should be positioned sitting up in an infant seat to promote drainage as much as possible and reduce intracranial pressure. Side-lying, Sims', prone, and supine are not indicated. These positions would increase intracranial pressure. The parents of a child who has otitis media ask the nurse why the doctor told them to give the child acetaminophen instead of aspirin. What should the nurse include when answering? 1. Acetaminophen is more effective against ear pain than aspirin. 2. Acetaminophen is better at reducing temperature than aspirin. 3. Aspirin may cause gastritis in children. 4. Aspirin is thought to cause Reye's syndrome, a very serious disease. ---------- Correct Answer ------------ 4. Aspirin given to children, especially those who may have a viral infection, is associated with the development of Reye's syndrome, a very serious problem affecting the brain and the liver that is often fatal. Therefore, we do not give aspirin to children. Acetaminophen is nearly as effective as aspirin in relieving pain and fever; it is not more effective. Aspirin can cause gastritis in anyone, but that is not the reason why we do not give it to children. An infant is born with a meningomyelocele. How should the nurse position the infant before surgery? 1. Prone with a pillow under the legs 2. Supine with head elevated 3. Side-lying with a pillow at the back 4. Semi-Fowler's with a small pillow ---------- Correct Answer ------------ 1. Infants with meningomyelocele should be positioned prone with a pillow under the lower legs. Every effort is made to avoid putting pressure on the sac. Breaking the sac would likely cause the infant to develop meningitis. All of the other position choices would put pressure on the sac. The parents of a 2-year-old child who has meningitis ask the nurse why the lights are dim in the child's room even in the daytime. What information should the nurse include in the answer? 1. Rest is essential, and a dimly lit room promotes rest. 2. The child is sensitive to light and may develop seizures. 3. The IV medications are very sensitive to light. 4. Light could cause severe damage to the eyes and possible blindness. ---------- Correct Answer ------------ 2. The child is sensitive to light and may develop seizures. A dimly lit room reduces the chance that seizures will occur. The child does need rest, but that is not the reason for a dimly lit room. The other answer choices are not correct. The nurse is caring for a 5-month-old infant who had a craniotomy following a head injury. Which observation the LPN/LVN makes should be reported to the charge nurse? 1. Respirations of 38 2. Difficulty arousing the baby from a nap 3. Pulse rate of 120 4. The baby cannot sit up by herself. ---------- Correct Answer ------------ 2. Difficulty arousing Preventing joint contractures is not a long- term goal. Preventing infection at the surgical site is also a short-term goal. The nurse is caring for an 8-month-old infant who has had diarrhea for two days. Which is the most useful in assessing the degree of dehydration? 1. Number of stools 2. Skin turgor 3. Mucus membranes 4. Daily weight ---------- Correct Answer ------------ 4. Daily weights are the best indicator of fluid balance. The number of stools gives an indication of fluid loss but is not the best indicator of fluid balance. Skin turgor and assessing mucus membranes are helpful, but daily weights are the best indicator of fluid balance. An infant who has severe diarrhea and dehydration is hospitalized and is NPO. Intravenous fluids are ordered. What is the immediate goal of care? 1. Restoration of intravascular volume 2. Prevention of further diarrhea 3. Promotion of skin integrity 4. Maintenance of normal growth and development ---------- Correct Answer ------------ 1. Restoration of intravascular volume is the immediate goal. This will prevent life- threatening fluid and electrolyte imbalances. The others are goals but are not immediate. The nurse is caring for a 9-month-old infant who is allowed only clear fluids. What are the most appropriate liquids for the nurse to offer? 1. 7-Up and ginger ale 2. Pedialyte and glucose water 3. Half-strength formula 4. Tea and clear broth ---------- Correct Answer ------------ 2. Pedialyte and glucose water are appropriate. The infant needs clear liquids, and these are age appropriate. Pedialyte gives electrolytes, and glucose water gives sugar. A 9-month-old infant does not drink carbonated beverages such as 7-Up and ginger ale. Half-strength formula is not a clear liquid. Tea is not appropriate for an infant, and broth is too salty for an infant. A 3-month-old infant is doing well after the repair of a cleft lip. The nurse wants to provide the client with appropriate stimulation. What is the best toy for the nurse to provide? 1. Colorful rattle 2. String of large beads 3. Mobile with a music box 4. Teddy bear with button eyes ---------- Correct Answer ------------ 3. Anything that can be put in the mouth is inappropriate for a child with cleft lip repair. A rattle and beads can go in the mouth. Button eyes are a hazard for any infant because the infant may swallow them. A mobile with a music box is appropriate for a 3-month-old who lays in a crib, and this item cannot be put in the mouth. Note that a colorful rattle is also age appropriate but not condition appropriate. An 18-month-old child is admitted for a repeat cardiac catheterization. The parents are continuously present and do everything for the child—dress him, feed him, and even play for him. The nurse wants to prepare the child and the parents for the procedure. Which of the following should be included in the care plan? 1. Give the child simple explanations. 2. Talk with the parents to assess their knowledge and how they can help with the child's care. 3. No specific action will be necessary because the child and family have been through a cardiac catheterization previously. 4. Ask the parents to stay away as much as possible because they upset the child. ---------- Correct Answer ------------ 2. An 18-month-old child cannot understand explanations. The nurse needs to assess the clients' knowledge and base teaching on that assessment. The nurse should not assume that no teaching is needed just because the child has had the procedure before. There are no data to indicate that the parents upset the child. They do appear to be smothering the child, but at this time, the child would probably be more miserable without the parents. The nurse may want to teach parents about growth and development needs of the toddler. The nurse is preparing a 6-year-old child for cardiac surgery. Which preoperative teaching technique is most appropriate? 1. Have the child practice procedures that will be performed postoperatively, such as coughing and deep breathing. 2. Arrange for the child to tour the operating room and surgical intensive care unit. 3. Encourage the child to draw pictures illustrating the operation. 4. Arrange for the child to discuss heart surgery and postoperative events with a group of children who have undergone heart surgery. ---------- Correct Answer ------------ 1. A 6-year-old learns best by doing. A 6-year-old cannot conceptualize what he or she cannot see. Touring the operating room and surgical intensive care unit can be very frightening for a 6-year-old. Drawing pictures of the procedure would be more appropriate postoperatively, when the nurse may want to help him in understanding what happened to him. Drawing pictures is a good way to express feelings that a 6-year-old cannot put into words. Group discussion is more appropriate for an adolescent. A 6-year-old does not have the verbal skills to participate in and learn from a discussion group. A 10-year-old girl is being treated for rheumatic fever. Which would be an appropriate activity while she is on bed rest? 1. Stringing large wooden beads 2. Engaging in a pillow fight 3. Making craft items from felt 4. Watching television ---------- Correct Answer ------------ 3. Craft work allows her to accomplish something while meeting her needs for rest. Industry is the developmental task for school-age children. The joint pains with rheumatic fever tend to be in the large joints, not the small ones, so craft work using finger activity would probably not be painful. Stringing large wooden beads is appropriate for younger children. Pillow fighting requires too much energy for a child on bed rest and is not appropriate for a hospital environment. Watching television is a solitary activity with no sense of accomplishment. A 10-year-old boy who is immobilized in a cast following an accident has been squirting other children and the staff with a syringe filled with water. The nurse wants to provide other activities to help him express his aggression. Which activity would be most appropriate? 1. Cranking a wind-up toy 2. Pounding clay 3. Putting charts together 4. Writing a story ---------- Correct Answer ------------ 2. Pounding movements allow for the expression of aggression. The other activities would not allow for an expression of aggression. The scenario describes a child who is expressing aggression in a very physical manner. This child is not likely to respond well to writing a story. Writing a story could be used to help a child express aggression, but pounding clay is more appropriate given the child's aggressive behavior. A 6-year-old boy has tetralogy of Fallot. He is being admitted for surgery. The nurse knows that which problem is not associated with tetralogy of Fallot? 1. Severe atrial septal defect 2. Pulmonary stenosis 3. Right ventricular hypertrophy 4. Overriding aorta ---------- Correct Answer ------------ 1. Atrial septal defect is not associated with tetralogy of Fallot. The four defects are pulmonary stenosis, which causes right ventricular hypertrophy, ventricular septal defect, and overriding aorta. A 6-year-old child with tetralogy of Fallot is being admitted for surgery. While the nurse is orienting the child to the unit, the child suddenly squats with the arms thrown over the knees and knees drawn up to the chest. What is the best immediate nursing action? 1. Observe and assist if needed 2. Place the child in a lying position 3. Call for help and return the child to the room 4. Assist the child to a standing position ---------- Correct Answer ------------ 1. The squatting position will help the child with tetralogy of Fallot to have better hemodynamics. It increases intra-abdominal pressure and increases pulmonary blood flow. Placing the child in a lying or standing position will increase his symptoms and be counterproductive. It is not necessary to call for help because this is not an emergency situation. A 6-year-old child with tetralogy of Fallot is being admitted for surgery. What is most important to teach the child during the preoperative period? 1. Strict handwashing technique. 2. How to cough and deep breathe. 3. The importance of drinking plenty of fluids 4. Positions of comfort ---------- Correct Answer ------------ 2. The child will have to learn to cough and deep breathe postoperatively. Studies demonstrate that preoperative teaching makes it easier for the client to perform coughing and deep breathing exercises in the postoperative period. The nurses will do strict hand washing, not the client. Fluids will likely be restricted postoperatively. It is important to teach the client about positions of comfort, but it is more important to teach the child how to deep breathe and cough. A 6-year-old with tetralogy of Fallot has open heart surgery. The septal defect was closed, and the pulmonic valve was replaced. When the child returns to the unit, he has oxygen, IVs, and closed chest drainage. How should the nurse position the chest drainage system? should be checked. The nurse is discussing dietary needs of a child with a serious heart defect. The child is being treated with digoxin and hydrochlorothiazide (Hydrodiuril). The nurse should stress the importance of giving the child which of the following foods? 1. Cheese and ice cream 2. Finger foods such as hot dogs 3. Apricots and bananas 4. Four glasses of whole milk per day ---------- Correct Answer ------------ 3. The child should be on a sodium-restricted diet with high-potassium foods because he is taking Hydrodiuril, a potassium-depleting diuretic. Apricots and bananas are low in sodium and high in potassium. Cheese and ice cream are high in sodium. Hot dogs are high in sodium. Whole milk is high in sodium. Not only is potassium needed, but excessive sodium should also be avoided because those with severe heart defects are prone to fluid retention. A child with a cyanotic heart defect has a hypoxic episode. What should the nurse do for the child at this time? 1. Administer PRN oxygen and position the child in the squat position 2. Position the child side-lying and give the ordered morphine 3. Ask the parents to leave and start oxygen 4. Give oxygen and notify the physician ---------- Correct Answer ------------ 1. The knee-chest or squat position increases intra-abdominal pressure and increases blood flow to the lungs. Oxygen is also indicated because the child is hypoxic. Positioning on the side is not appropriate because it will not improve the blood flow to the lungs. There is no need to ask the parents to leave. In fact, they need to know how to handle these episodes if they are not yet comfortable doing so. Children with cyanotic heart defects have hypoxic episodes fairly regularly. Positioning in the squat position is more important at this time than notifying the physician. The nurse notes that a child who has had a serious heart condition since birth does not do the expected activities for that age. The child's mother says, "I worry constantly about my child. I don't let the older children or the neighborhood kids play with my child very much. I try to make things as easy for my child as I can." What is the best interpretation of these data? 1. The child is physically incapable due to his cardiac defect. 2. The child's mother is overprotective and allows the child few challenges to develop skills. 3. The child is probably mentally retarded from the effects of continual hypoxia. 4. The child has regressed due to the effects of hospitalization. ---------- Correct Answer ---------- -- 2. The child's mother does not let the child play with others and appears to do everything for the child. She seems to be overprotective. Most children with heart defects are capable of doing most age-appropriate activities. There is no evidence to support that the child is mentally retarded. There are no data to support that the child has regressed. Ten days after cardiac surgery, an 18-month-old child is recovering well. The child is alert and fairly active and is playing well with the parents. Discharge is planned soon. The nurse notes that the parents are still very reluctant to allow the child to do anything without help. What is the best initial action for the nurse to take? 1. Reemphasize the need for autonomy in toddlers 2. Provide opportunities for autonomy when the parents are not present 3. Reassess the parent's needs and concerns 4. Discuss the success of the surgery and how well the child is doing ---------- Correct Answer ------------ 3. Before the nurse can teach the parents, it will be necessary to reassess their needs and concerns. The question asks for the best initial action. Initially, the nurse should assess. Later, the nurse may emphasize the toddler's need for autonomy. The nurse may provide the child with opportunities to develop autonomy, although it would be better to teach the parents. The nurse may also discuss the success of the surgery and how well the child is doing, but this is not the initial action. Sodium salicylate is prescribed for a child with rheumatic fever. What should the nurse assess the child for because the child is on this medication? 1. Tinnitus and nausea 2. Dermatitis and blurred vision 3. Unconsciousness and acetone odor of breath 4. Chills and elevation of temperature ---------- Correct Answer ------------ 1. Tinnitus and nausea are signs of toxicity to salicylate drugs. The nurse makes an initial assessment of a 4-year-old child admitted with possible epiglottitis. Which observation is most suggestive of epiglottitis? 1. Low-grade fever 2. Retching 3. Excessive drooling 4. Substernal retractions ---------- Correct Answer ------------ 3. Excessive drooling is a sign of epiglottitis. A child with epiglottitis is apt to have a high fever. Retching is not typical. Retractions could occur if respiratory distress was great enough, but drooling is the hallmark of epiglottitis. Which nursing action could be life-threatening for a child with epiglottitis? 1. Examining the child's throat with a tongue blade 2. Placing the child in a semi-sitting position 3. Maintaining high humidity 4. Obtaining a nasopharyngeal culture ---------- Correct Answer ------------ 1. Examining the child's throat with a tongue blade may cause the epiglottis to become so irritated that it will close off completely and obstruct the airway. The child should be placed in a semi-sitting to upright position. Humidity is not a problem. A nasopharyngeal culture would not cause problems. The nurse should get a throat culture, however. Which factor would most likely be a cause of epiglottitis? 1. Acquiring the child's first puppy the day before the onset of symptoms 2. Exposure to the parainfluenza virus 3. Exposure to Haemophilus influenzae, type B 4. Frequent upper respiratory infections as an infant ---------- Correct Answer ------------ 3. H. influenzae is the usual causative agent of epiglottitis. A puppy would be more apt to cause asthma than epiglottitis. The nurse is caring for a child who has epiglottitis. What position would the child be most likely to assume? 1. Squatting 2. Sitting upright and leaning forward, supporting self with hands 3. Crouching on hands and knees and rocking back and forth 4. Knee-chest position ---------- Correct Answer ------------ 2. Sitting upright and leaning forward, supporting self with hands, is the position typically assumed by children with epiglottitis. It helps to promote the airway and drainage of secretions. Squatting is more typically seen in children who have cyanotic heart defects. The nurse is assessing a child who has epiglottitis and is having respiratory difficulty. Which of the following is the nurse most likely to assess in the child? 1. Flaring of the nares; cyanosis; lethargy 2. Diminished breath sounds bilaterally; easily agitated 3. Scattered rales throughout lung fields; anxious and frightened 4. Mouth open with a protruding tongue; inspiratory stridor ---------- Correct Answer ------------ 4. The child with an edematous glottis will keep his mouth open with his tongue protruding to increase free movement in the pharynx. In the presence of potential laryngeal obstruction, laryngeal stridor can be heard, especially during inspiration. Rales and diminished breath sounds are more typical of croup. Cyanosis is typical of late-stage, extremely critical respiratory distress. Which of the following is the most important goal of nursing care in the management of a child with epiglottitis? 1. Preventing the spread of infection from the epiglottis throughout the respiratory tract 2. Reduction of high fever and prevention of hyperthermia 3. Maintaining a patent airway 4. Maintaining the child in an atmosphere of high humidity with oxygen ---------- Correct Answer ------------ 3. In a child with epiglottitis, the first signs of difficulty in breathing can progress to severe inspiratory distress or complete airway obstruction in a matter of minutes or hours. The child usually has a high fever, but the airway takes precedence. High humidity may also be appropriate, but the highest priority is maintaining an airway. Which of the following is the most important nursing action when caring for a child with epiglottitis? 1. Cardiac monitoring 2. Blood pressure monitoring 3. Temperature monitoring 4. Monitoring intravenous infusion ---------- Correct Answer ------------ 1. Regular monitoring of cardiac rate is essential because a rapidly rising heart rate is an initial indication of hypoxia and impending obstruction of the airway. The blood pressure and temperature may well be monitored, but they are not the most important. An IV will be monitored, if present, but is not the 2. Infants with esophageal atresia will need a gastrostomy tube because the esophagus ends in a blind pouch. There is no connection between the esophagus and the stomach, so a nasogastric tube cannot be passed. Intravenous or total parenteral nutrition (TPN) feedings are not indicated. Gastrostomy tube feedings are much safer. Because there is no connection between the esophagus and the stomach, the infant cannot have anything by mouth. A 3-year-old child is admitted with a tentative diagnosis of Wilms' tumor. What nursing action is essential because of the diagnosis? 1. Avoid palpating the abdomen 2. Encourage the child to eat adequately 3. Give emotional support to the parents 4. Keep the child on strict bed rest ---------- Correct Answer ------------ 1. It is essential not to palpate the abdomen because this may cause the encapsulated tumor to spread. Emotional support to the parents and encouraging the child to eat well are nice but not of the highest priority. Strict bed rest is probably not indicated, although the child will not be allowed to run around. A 3-year-old child is brought to the physician's office by the parent. The parent states that the child was completely toilet trained but has been "having accidents" recently. The parent also tells the nurse that the child is voiding more often than usual and that the urine has a strong odor. What is the best response by the nurse? 1. "These could be symptoms of a urinary tract infection. We should obtain a urine specimen for analysis." 2. "Many preschool children regress when something stressful happens. Has your child been under any stress lately?" 3. "Accidents like these are not unusual. You have nothing to worry about as long as your child does not have a fever." 4. "This is very unusual. Your child will probably need to be hospitalized to receive intravenous antibiotics." ---------- Correct Answer ------------ 1. The symptoms described (frequency, urgency, and a strong odor to urine) are those of a urinary tract infection (UTI). A urinalysis is indicated. It is true that preschool children may regress when they are under stress. However, that does not explain the frequency and the strong odor of the urine. Although a recently toilet-trained child may have an occasional "accident," recurring episodes should be further investigated. Not all persons with a UTI have a fever. If the child does have a UTI as suspected, the treatment is usually oral antimicrobial agents. There are no data to suggest that this child needs to be hospitalized. A 2-year-old child has just been diagnosed with a Wilms' tumor. Surgery is recommended. The parents tell the nurse that they feel they are being pushed into surgery and wonder if they should wait and get more opinions. What information is essential for the nurse to include when responding to the parents? 1. Surgery is one of several options for treating a Wilms' tumor. 2. Surgery is an essential part of the treatment for Wilms' tumor and must be done immediately. 3. Surgery can be safely delayed for up to a year after diagnosis. 4. Wilms' tumor has been successfully treated by chemotherapy and radiation therapy. ---------- Correct Answer ------------ 2. A Wilms' tumor is an encapsulated tumor on the kidney. Surgery is an essential part of the treatment. There is no option. In addition, the child may receive radiation and/or chemotherapy. Surgery must be done immediately before the tumor spreads or the capsule breaks. A 13-month-old child has just been placed in a plaster hip spica cast to correct a congenital anomaly. Which nursing actions should be included in the plan of care? 1. Turn the child no more than every four hours to minimize manipulation of the wet cast. 2. Use only fingertips when moving the child to prevent indentations in the cast. 3. Assess and document neurovascular function at least every two hours. 4. Use a hair dryer to speed the cast-drying process. ---------- Correct Answer ------------ 3. Neurovascular function must be assessed every two hours. The child should be turned at least every two hours to prevent skin damage and to facilitate plaster cast drying. Fingertips should be avoided when handling a wet plaster cast because they can leave indentations on a wet cast. The nurse should palm the cast. A hair dryer should not be used to dry the cast. This causes the cast to dry from the outside in and may leave the inside wet and soft. A 13-year-old child has just arrived on the nursing care unit from the postanesthesia care unit (PACU). This morning, the child underwent a surgical spinal fusion procedure that included the placement of Harrington rods for the treatment of scoliosis. After receiving a report from the PACU nurse, which action should the nurse perform first? 1. Assess the pain level and administer analgesics as needed 2. Offer clear liquids to ensure adequate hydration 3. Drain the Hemovac and record the output on the intake and output record 4. Notify the child's parents of his/her arrival on the unit ---------- Correct Answer ------------ 1. Pain management is a high priority. The child probably is not taking liquids at this time. Even if she is taking clear liquids, pain management is a higher priority. The nurse may drain the Hemovac, but that is not the highest priority. The nurse will notify the child's parents, but pain management is of a higher priority. A newborn has been diagnosed as having mild hip dysplasia. The mother asks the nurse why the physician told her to "triple diaper" the baby. What should the nurse include when responding? 1. It is important that there be no contamination of the area. 2. Extra diapers will abduct the hips and help to put the hip in the socket correctly. 3. Triple diapers cause the baby's legs to be sharply flexed and realign the hip. 4. Hip dysplasia can cause abnormal stooling. ---------- Correct Answer ------------ 2. The treatment for hip dysplasia is abduction. Triple diapers are the easiest way to abduct the hips in mild cases. If that is not successful, then a pillow splint or harness can be used. There is no open wound with hip dysplasia and no worry about contamination of the area. Hip dysplasia does not cause abnormal stooling. Triple diapers do not cause increased flexion; they actually cause less flexion. Less flexion is recommended for children with hip dysplasia. A 6-month-old baby is placed in bilateral leg casts because she has talipes equinovarus. The mother asks how to bathe the baby. What should the nurse tell the mother? 1. "Bathe the baby as you usually do." 2. "Put the baby's buttocks in the bath water, but try to keep the feet out of the water." 3. "Sponge bathe your baby until the casts are removed." 4. "Give the baby a bath in the baby bath tub, but limit the time in the water." ---------- Correct Answer ------------ 3. The baby who has bilateral casts should not be placed in water but should receive a sponge bath. Answers 2 and 4 put the baby in water and are not correct. The nurse should not tell the mother to bathe the baby as usual without knowing what the usual is. By 6 months of age, most babies are being bathed in a baby bath tub. This is not appropriate when there are casts. The nurse has been asked to set up a program to screen children for scoliosis. What age group should the nurse screen? 1. Preschoolers 2. 6- to 8-year-olds 3. Junior high students 4. College-age students ---------- Correct Answer ------------ 3. Junior high girls are the target group for screening for scoliosis. A 12-year-old girl has been diagnosed with scoliosis and is placed in a Milwaukee brace. What instruction should the nurse give about the brace? 1. "Put the brace on underneath all of your clothes." 2. "Wear the brace only when you are exercising." 3. "Wear the brace only when you are in bed or resting." 4. "Put an undershirt on before putting the brace on." ---------- Correct Answer ------------ 4. An undershirt should be worn under the brace to prevent skin injury from the brace. The brace is worn 23 hours a day for three years. The nurse is caring for a child who has Duchenne's muscular dystrophy. What understanding is correct about the progress of the disease? 1. The disease is controllable with aggressive treatment. 2. Most children will die of something else before they die of muscular dystrophy. 3. Brothers of children with muscular dystrophy should be evaluated for the disease. 4. Muscular dystrophy causes its victims to become incoherent and often violent. ---------- Correct Answer ------------ 3. Duchenne's muscular dystrophy is an X-linked disease. Therefore, it appears in boys. It would be appropriate to assess brothers of children with muscular dystrophy for the condition. The disease is not controllable and will eventually kill its victims. Muscular dystrophy does not affect the mental status of those who have it; it is a muscular problem. The nurse at a summer camp for diabetics is assisting a 15-year-old girl with adjusting her daily insulin dosage. Which factor will have the greatest impact on insulin needs? 1. The weather forecast calls for high temperature and high humidity. 2. Activities scheduled for the day include a hike in the woods, swim time, and tennis. 3. The girl started her period the previous evening. 4. Daily insulin dose should never be changed because consistency is important. ---------- Correct Answer ------------ 2. Increase in exercise will affect the insulin dose the most. Heat and humidity might have some effect. Diabetics are taught to adjust their insulin dose within ranges. An following is a priority topic? ----------- Correct Answer ----------- Raising and securing crib side rails A mother expresses concern that her 1-year-old infant is overweight. She states that her family has a tendency to be overweight and wishes to d/c formula feedings and start the infant on low- fat milk. the nurse assesses that the present weight of the infant is 24 pounds. The infant's birth weight was 8lb, 2oz. the best response of the nurse would be: ----------- Correct Answer ----------- to place the infant on regular whole milk because the infant's weight is appropriate for his age A parent states she is having a conflict with her toddler who seems to "always want to do things his way." he insists on putting on his right sock and shoe before his left and has a tantrum if the parent tries to put on the left sock and shoe first. The parent asks the nurse why the child is acting this way. the best response of the nurse would be to: ----------- Correct Answer ----------- Explain that this is normal ritualistic behavior at this age and should be respected The nurse assesses the vital sign of a 2-year-old. A normal respiratory rate would be: ----------- Correct Answer ----------- 25-30 Which statement by the parent would indicate a need for further guidance? ----------- Correct Answer ----------- I use a car seat for my toddler whenever we are in the car, and he is right beside me as I drive so I can keep an eye on him. A mother tells the nurse that her 2-year-old toddler often has temper tantrums at the family dinner table and asks how to handle the behavior. the best response of the nurse would be: -------- --- Correct Answer ----------- parents should agree on a method of discipline, such as time-out, and use it when the child misbehaves One of the developmental hallmarks of the toddler that most gives rise to safety hazards is: ------- ---- Correct Answer ----------- need to explore the appropriate amount of time to use in time-out period for a 3-year-old is : ----------- Correct Answer ----------- 3 minutes A 4-year-old child is in Erikson's stage of: ----------- Correct Answer ----------- initiative The pulse of the school-age child is approximately: ----------- Correct Answer ----------- 85-100 beats/min A parent asks the nurse if it is healthy to allow her school-age child to play computer games after school every day. The best response of the nurse would be that computer and video games: ------- ---- Correct Answer ----------- should only be played on weekends and not on school days While playing in school, a 9-year-old child suffers an injury that knocks his tooth out of his mouth. What should the teacher or school nurse do? ----------- Correct Answer ----------- Place the tooth in a cup of milk, and call the parent to take the child to the dentist The parent of an 8-year-old child seeks advice from the nurse because her child is overweight. What would the nurse advise the parent to do? ----------- Correct Answer ----------- include the child in meal planning and preparation A 9-year-old practicing the piano continues to have difficulty in playing the theme song from a popular movie. she starts to pound on the piano keys in frustration. The best response would be to enter the room and say: ----------- Correct Answer ----------- "that piece sounds hard. I can see how you could be discouraged." One of the tasks of adolescence as defined by Erikson is: ----------- Correct Answer ----------- finding an identity When communicating with an adolescent about safety concerns, which concept of adolescent behavior should be considered? ----------- Correct Answer ----------- Adolescents are risk takers and tend to experiment with potentially dangerous outcomes Puberty can most accurately be defined as the period of life characterized by the: ----------- Correct Answer ----------- occurrence of sexual maturity and appearance of secondary sex characteristics A 16-year-old female towers over her companions, which bothers her. She confides in the nurse and says, "I just hate school---everyone is always staring at me." The nurse's best response would be: ----------- Correct Answer ----------- "tell me more about how this embarrasses you." Which action is most important when planning nutrition management for the adolescent? --------- -- Correct Answer ----------- Incorporating favorite or fad foods into the diet what are the stages of separation anxiety in toddler? ----------- Correct Answer ----------- Protest, despair, and denial Assessment of pain is considered a fifth vital sign to be documented by the nurse. The nurse understands that pain in infants: ----------- Correct Answer ----------- can be assessed by observation of behavior The best way to minimize separation anxiety in a hospitalized infant is to: ----------- Correct Answer ----------- encourage parent to room-in Which statement by the parent of a hospitalized 4-year-old child indicated an understanding of the child's needs? ----------- Correct Answer ----------- "I am going to bring some of his favorite toys from home for him to play with while in the hospital." A 4-year-old hospitalized child wets his bed. The parents tell the nurse that the child was completely toilet trained. What should the nurse understand? ----------- Correct Answer ----------- the child may be experiencing regression Which approach is best when administering an oral medication to a young child? ----------- Correct Answer ----------- "It's time for you medication, David. Would you like water or juice after it?" The preferred site for an intramuscular injection in infants is: ----------- Correct Answer ----------- Vastus lateralis the physician order 10 mg of Demerol for an infant after surgery. If the label reads 50 mg/ml, the nurse would administer: ----------- Correct Answer ----------- 0.2ml When preparing an enema for a young child, the nurse would select which solution? ----------- Correct Answer ----------- Saline the mother and grandmother of a child are at the bedside, rubbing the skin of the child. when the nurse enters the room the visitors are startled and drop the item they were using to rub the child's skin. The nurse picks up the item and recognizes it as a penny. The best response of the nurse is to: ----------- Correct Answer ----------- return the penny to the mother and open a dialogue about the practice they are using. The nurse is caring for a newborn with HIV/AIDS.What is the priority goal? ----------- Correct Answer ----------- prevent infections An adolescent diagnosed with AIDS asks about the mod of transmission for the illness. An accurate response is that is was most likely through: ----------- Correct Answer ----------- contact with contaminated body substance through sex or intravenous needle use When providing play therapy for a child with a communicable disease who is in an isolation room, what would be one priority principle or rationale for toy selection? ----------- Correct Answer ----------- the toy should be washable A parent brings a 4-month-old infant to the clinic for the second in the routine immunization series. The nurse should prepare for administration of which immunizations? ----------- Correct Answer ----------- DTaP, Hib, polio The DTaP immunization is administered: ----------- Correct Answer ----------- intramuscular A school nurse is caring for a child who fell on the playground. Upon examination of the child, the nurse notes multiple bruises in various stages of healing. What is the nurse's initial intervention? 1. Ask the parents who hit the child on the back. 2. Notify the child's primary healthcare provider. 3. Contact the Department of Health and Human Services. 4. Document the findings and observe the child over the next week. ----------- Correct Answer --- 5. Dehydration (2., 3., 4., & 5. Correct: Nausea and vomiting are the most common toxic effects. This can be caused by CNS toxicity or by direct damage to the gastric mucosa. Salicylates can be neurotoxic, and this is manifested by ringing in the ears. Ototoxicity can also lead to hearing loss. Diaphoresis results in the early phase of toxicity. Serious dehydration can result from insensible losses due to hyperventilation and fever, as well as active losses due to vomiting. 1. Incorrect: The first phase of salicylate toxicity is characterized by hyperventilation due to stimulation of the respiratory center in the brain. This is a key feature of salicylate toxicity. 6. Incorrect: Hyperpyrexia is an indication of severe toxicity, especially in younger children.) A 12 year old female, with a history of juvenile rheumatoid arthritis, is being admitted for re- evaluation. The child reported these symptoms for the last week: temperature of 102.9ºF/39.4ºC at 4:00 pm every day, increased pain in joints, loss of appetite, and fatigue. What would be an appropriate room assignment by the charge nurse? 1. Private room only. 2. Rooming with a 12 year old male in skeletal traction due to a fractured femur. 3. Rooming with a 10 year old female that has been admitted for sickle cell disease. 4. Rooming with a 14 month old female that has been admitted for orthopedic surgery. ----------- Correct Answer ----------- 3. Rooming with a 10 year old female that has been admitted for sickle cell disease. (3. Correct: The appropriate answer is to room her with the 10 year old being worked up for sickle cell disease. This is an acceptable age/sex to pair as roommates. Each has a chronic illness and this allows them to see how another person with limitations adjusts. 1. Incorrect: It is not necessary for this child to be in a private room. The fever at a particular time of the day is a symptom of juvenile rheumatoid arthritis and does not mean an infection. 2. Incorrect: It would be inappropriate to room her with a 12 year old male due to opposite sex and age. 4. Incorrect: The 12 year old who is in pain, feverish, and fatigued would be unable to rest as needed in a room with a 14 month old who is postoperative.) What signs and symptoms will the nurse look for when caring for an infant with severe dehydration? Select all that apply 1. Dark, yellow urine 2. Lethargic 3. Bulging fontanels 4. Tachypnea 5. Decreased urine output ----------- Correct Answer ----------- 1. Dark, yellow urine 2. Lethargic 4. Tachypnea 5. Decreased urine output (1., 2., 4., & 5. Correct: These would be signs and symptoms of dehydration in an infant. Amber or dark urine is an indication of dehydration. Urine should be a clear, pale yellow. Fussiness and irritability are seen in infants when they do not feel well. As dehydration worsens, lethargy and unresponsiveness can develop. Tachypnea or rapid respiration along with tachycardia and low blood pressure are present with severe dehydration. With severe dehydration, there will be decreased urine ouput. The body is trying to conserve volume. 3. Incorrect: The fontanels will be sunken rather than bulging. Bulging fontanels indicate brain swelling or fluid build up in the brain. Sunken fontanels are related to dehydration.) The nurse is discussing obesity prevention with a group of parents who have 3 and 4 year old children. What should the nurse include? Select all that apply 1. Ensure at least 11 hour of sleep. 2. Do not put a TV in the child's bedroom. 3. Select a day care center that provides physical activity opportunities every 4 hours. 4. Limit 100% fruit juice to 6 ounces (180 mL) per day. 5. Walk after the evening meal while the child rides a bike or skates. ----------- Correct Answer -- --------- 1. Ensure at least 11 hour of sleep. 2. Do not put a TV in the child's bedroom. 4. Limit 100% fruit juice to 6 ounces (180 mL) per day. 5. Walk after the evening meal while the child rides a bike or skates. (1., 2., 4., & 5. Correct: Children between the ages of 2 and 5 should get between 11-12 hours of sleep each night. Keeping TVs out of bedrooms, creates an environment that promotes naps and nighttime sleep. Establishing sleep routines are all important to promoting healthy sleep habits. Fruit juice should be limited to 4-6 ounces (120-180 mL) per day, as excess consumption can lead to excess weight gain. Preschoolers should be encouraged to drink water. Role modeling behaviors such as exercise and doing it with the child encourages activity and decreases sedentary time. 3. Incorrect: The Institute of Medicine (IOM) stresses the importance of giving young children plenty of opportunity to be active during the day. Several states now require day care centers to provide the opportunity for at least two hours of physical activity during an eight-hour day. Selecting a day care that limits TV time and encourages play will promote a healthy lifestyle.) A child diagnosed with gastroenteritis is being given fluids in the emergency room for severe dehydration. Prior to discharge, the nurse instructs the mother how to prepare a BRATT diet. The nurse knows the teaching was successful when the mother selects what foods for the child? Select all that apply 1. Raisins 2. Bananas 3. Apples 4. Toast 5. Rice 6. Tea ----------- Correct Answer ----------- 2. Bananas 4. Toast 5. Rice 6. Tea (2, 4, 5 and 6. Correct: The Bratt diet is useful for children following any type of gastroenteritis which included nausea, diarrhea or severe vomiting. This bland diet is used in the first 24 hours to allow the gut to rest and readjust slowly to foods that are low protein, low fat and low fiber. The BRATT diet is for short term use only and consists of bananas, rice, apple sauce, toast and tea. 1. Incorrect: Although raisins are normally a natural source of healthy fruit, they have too much fiber for an irritated gastric tract. They are not part of the BRAT diet. 3. Incorrect: Apples are high in fiber and natural sucrose, which is not appropriate for a child 2. Urinalysis for white blood cells (WBC) 3. Oxygen saturation 4. Toxicology screen ----------- Correct Answer ----------- 1. Blood glucose (1. Correct: Type I diabetes usually has a sudden onset and many times diabetic ketoacidosis (DKA) is the first encounter. The symptoms in the stem: unusual odor to the breath, bed wetting, and lethargy are symptoms of DKA. The blood glucose is one of the most important tests for the diagnosis of DKA. 2. Incorrect: A urinalysis to assess WBC will not support the diagnosis of DKA. 3. Incorrect: In this case, oxygen saturation is not the priority. This child is not in respiratory distress. 4. Incorrect: A toxicology screen will not support a diagnosis of DKA; however, if the blood glucose was not elevated, it could provide further assessment data.) The pediatric nurse is planning an educational seminar for new parents. The seminar will focus on tips for administering medication to children. Which points should the nurse include? Select all that apply 1. Demonstrate proper measuring techniques for liquid medications. 2. Put crushed medications into the child's favorite food. 3. Place liquid medication in an 8-ounce bottle of formula. 4. Call medication "candy" to encourage children to take the medicine. 5. Do not place medications in a container other than the original container. ----------- Correct Answer ----------- 1. Demonstrate proper measuring techniques for liquid medications. 5. Do not place medications in a container other than the original container. (1. & 5. Correct: Demonstration with return demonstration by the parent is an appropriate teaching strategy. Give clear examples and demonstrations and speak in layman's terms. Never put medications in dishes, cups, bottles, or other household containers that children or other family members may be unaware of. 2. Incorrect: Do not place crushed drugs into the child's favorite food or snack. The medication can change the taste of the food, and the child may refuse, therefore missing part or all of the dose. Additionally, the effectiveness of some medications may be harmed by the crushing of the drugs. 3. Incorrect: Do not place liquid drugs in a large bottle of formula. Unless the child drinks the entire amount, he or she will not receive the correct dose. 4. Incorrect: Don't refer to drugs as candy. Children may try to take more candy leading to overdose.) A new nurse is preparing to give a medication to a nine month old client. After checking a drug reference book, crushing the tablet and mixing it into 3 ounces of applesauce, the new nurse proceeds to the client's room. What priority action should the supervising nurse take? 1. Tell the new nurse to recheck the drug reference book before administering the medication. 2. Suggest the new nurse reconsider the client's developmental needs. 3. Check the prescription order and the client dose. 4. Observe the new nurse administer the medication. ----------- Correct Answer ----------- 2. Suggest the new nurse reconsider the client's developmental needs. (2. Correct. Mixing medication with applesauce is appropriate in some circumstances, but the volume of 3 ounces is excessive for a nine month old. The nurse will want to make sure the client gets all of the medication. Additionally, applesauce may or may not have been introduced into the diet, and it is inappropriate to introduce a new food during an illness. 1. Incorrect. There is nothing in the stem about a problem with the medication dose or route. The drug reference book does not provide guidelines for meeting developmental needs when administering the medication. This is something that the nurse must look up if uncertain about developmental tasks. 3. Incorrect. There is nothing in the stem about a problem with the medication dose or route. Once the medication has been mixed in applesauce, the supervising nurse would not be able to compare the dose to the prescribed amount. Therefore, this would not be an appropriate action. It would not address the developmental task that is the underlying issue here. 4. Incorrect. This is an appropriate action. However, it is not the priority. The new nurse should be competent in medication administration but is needing guidance with the developmental considerations related to medication to a nine month old.) The nurse is providing care to a 5 year old client who has been experiencing moderate pain. Which intervention is appropriate for the nurse to use with this client? 1. Encourage the client to talk about the pain. 2. Provide distraction by turning on the TV. 3. Contact the primary healthcare provider for a pain medication prescription. 4. Request that the parents leave the room. ----------- Correct Answer ----------- 2. Provide distraction by turning on the TV. (2. Correct: Distraction is a good technique to use with the toddler/preschooler. Other distractions might be to read a book, or look at pictures. Heat and cold therapies should also be considered. 1. Incorrect: The client at this age does not have the cognitive abilities to discuss pain other than to say that he/she has pain and to tell where it is. They can rate their pain at age 5-8 but describing or qualifying pain occurs at age 10 and older. 3. Incorrect: Distraction and other techniques should be used before pain medication. If there is something you can do to fix the problem, do that first. 4. Incorrect: Separation from the parents could cause more anxiety for the child. Parents should be allowed to stay with the client unless they are hindering safe care.) The nurse is talking with a group of teenagers who have expressed an interest in getting a tattoo. What information about tattoos should the nurse provide? Select all that apply 1. Apply a moisturizer to the tattooed skin once a day. 2. Carefully consider the tattoo location as weight gain can distort the image. 3. Bloodborne risks of tattooing include Hepatitis and HIV. 4. Tattoo dyes can cause allergic skin reactions. 5. Tattoos can be inexpensively removed with little discomfort. 6. Make sure the tattoo artist removes the needle and tubes from sealed packages. ----------- Correct Answer ----------- 2. Carefully consider the tattoo location as weight gain can distort the image. 3. Bloodborne risks of tattooing include Hepatitis and HIV. 4. Tattoo dyes can cause allergic skin reactions. 6. Make sure the tattoo artist removes the needle and tubes from sealed packages. (2., 3., 4., & 6. Correct: Weight gain, including pregnancy weight gain, might distort the tattoo or affect its appearance. If the equipment is contaminated with infected blood, the client can contract various bloodborne diseases, hepatitis B, hepatitis C, and HIV. Tattoo dyes, especially Flush port with normal saline. Flush port with heparin solution. (Obtaining blood from a Port-a-cath decreases other needle sticks to an immunocompromised client. Drawing blood cultures is a slightly different process than obtaining blood for other lab work. First: Wash hands and don non-sterile gloves. As a nurse, you know that any procedure begins with hand washing! Since there is no option for sterile gloves, this option must be the first step. Second: If the nurse has donned gloves, prepping the client would be the next logical step. Cleaning the port, in this case with an alcohol wipe, is all that is necessary. However, if port access is completed as a sterile technique, you may observe a nurse cleaning the diaphragm with chlorhexidine. Again, this question does not provide you that choice. Third: Now that the diaphragm is clean, it is accessed with the Huber needle. The needle would already be primed and connected to the adapter (small tubing with a vacutainer) into which the blood vial is inserted to withdraw the sample. Fourth: The nurse will withdraw 10 mL of blood into the appropriate blood vial or tube for the blood cultures. For blood cultures, the first vial of blood is not discarded, as with other types of laboratory tests. Fifth: The port is flushed with normal saline to rinse the inner catheter and clear any remaining blood out of the diaphragm. In some situations, the process may end with the saline flush. But not in this example. Sixth: The final step is to flush the port and inner tubing with heparin to prevent blood clots or occlusion from occurring inside the port itself. Again, this step is dependent upon the type of port and the sample needed.) A school-aged child is being admitted for probable viral meningitis. What arrangement does the nurse need to make in order to prepare for this client? 1. Private room. 2. Negative air-flow room. 3. Droplet precautions including mask. 4. Needs standard precautions only. ----------- Correct Answer ----------- 4. Needs standard precautions only. (4. Correct: Viral meningitis is caused by a group of enteroviruses, such as those that also cause mumps or measles. School-aged clients generally fare better than very young children or infants. The Center for Disease (CDC) has determined that standard precautions are adequate for older children and adults. 1. Incorrect: A private room would be appropriate for bacterial meningitis and other highly contagious illnesses. This is not needed in the case of viral meningitis. 2. Incorrect: Negative air-flow is needed for serious illnesses such as active tuberculosis, SARS, Ebola or even certain types of chickenpox. Such a room would not be necessary for viral meningitis. 3. Incorrect: If there is close contact with a person who has viral meningitis, you may become infected with the virus that made that person sick. However, you are not likely to develop meningitis. That's because only a small number of people who get infected with the viruses that cause meningitis will actually develop viral meningitis. Standard precautions is the best way to prevent this virus.) The nurse is discussing appropriate toys for toddlers with a group of parents. What toys should the nurse include? Select all that apply 1. Board games 2. Finger paint 3. Swing set 4. Water squirting toys 5. Play telephone 6. Wooden spoons ----------- Correct Answer ----------- 2. Finger paint 4. Water squirting toys 5. Play telephone 6. Wooden spoons (2., 4., 5., & 6. Correct: Finger painting, water squirting toys, play phones, and wooden spoons are appropriate toys for the toddler. 1. Incorrect: Simple board games are appropriate for the preschooler. It is too soon to introduce board games to a toddler. 3. Incorrect: A swing set is appropriate for the preschooler if they are supervised.) A child diagnosed with AIDS is scheduled for grade school immunizations. Which immunizations are safe for the nurse to administer to the child? Select all that apply 1. MMR (measles, mumps, rubella) 2. DTaP (diphtheria, tetanus, pertussis) 3. VAR (varicella) 4. HiB (haemophilus influenza) 5. OPV (oral polio virus) ----------- Correct Answer ----------- 2. DTaP (diphtheria, tetanus, pertussis) 4. HiB (haemophilus influenza) (2 & 4. Correct: Children with AIDS are immunocompromised because of the HIV virus. Vaccines are crucial to provide protection against common childhood diseases. However, only vaccines which contain synthetic or inactivated viral components are acceptable for children with active AIDS. Diphtheria, tetanus, pertussis is inactive and is provided in multiple doses, starting at 2 months of age, with a booster at age 6. Haemophilus influenza is critically important since this flu virus can lead to meningitis, pneumonia or epiglottitis. This vaccine is also administered in multiple injections over a period of months, starting at 2 months, and then yearly throughout life. 1. Incorrect: The combination vaccine of measles, mumps, and rubella contains a live virus. Although research is ongoing, the Center for Disease Control (CDC) suggests while children diagnosed HIV+ may receive the vaccine, those with active AIDS should not be administered this vaccine. 3. Incorrect: Varicella is a live vaccine administered to protect children from chickenpox and the potential for shingles later in life. Though the disease and its dormancy in the body can have serious long-term effects, the vaccine is considered inappropriate for children with AIDS. 5. Incorrect: Oral polio vaccine contains the live polio virus and could be deadly to those with an immunocompromised system. The correct form of polio vaccine for AIDS clients is called IPV, or inactivated polio vaccine, and is given by injection.) A nurse is attempting to assess lung sounds on a 3 year old with a history of asthma. Which indicates the best method to encourage the hospitalized child to take a deep breath? 1. Allow the child to blow out a lighted candle. 2. Encourage child to blow bubbles from a wand. 6. Incorrect: The first rubella vaccination is recommended at 12 months in Canada and between 12-18 months in the US.) The parents of a toddler ask the nurse how to stop their child's temper tantrums when they occur. What is the best advice the nurse should provide? 1. Spank the child gently when the tantrum occurs. 2. Promise the child a new toy if the child stops the tantrum. 3. Ignore the tantrum if the child is safe. 4. Restrain the child during a tantrum. ----------- Correct Answer ----------- 3. Ignore the tantrum if the child is safe. (3. Correct: When a tantrum occurs, the best course of action is to ignore the behavior and ensure that the child is safe during the tantrum. 1. Incorrect: Physical punishment will probably just prolong the tantrum and in fact produce more intense negative behavior. 2. Incorrect: Providing a reward to stop an inappropriate behavior will reinforce that behavior. Throw a temper tantrum, get a reward. 4. Incorrect: Restraining a child may prolong the temper tantrum and produce a more intense negative behavior. If the tantrum occurs in public, it may be necessary to immobilize the child with a big bear hug and use a calm voice to soothe the child.) The nurse is talking with parents of school-aged children about promoting healthy eating in their children. What information should the nurse provide? Select all that apply 1. Skipping breakfast will decrease energy level and could lower school grades. 2. Freeze fruit before placing in lunch box to keep it tasting fresh. 3. Limit snacks to when the child is hungry, rather than bored. 4. Enforce rule that child must eat food even if they do not like it. 5. The parent should eat a variety of foods as an example to children. 6. Prepare homemade healthy version of favorite take out meals. ----------- Correct Answer ------- ---- 1. Skipping breakfast will decrease energy level and could lower school grades. 2. Freeze fruit before placing in lunch box to keep it tasting fresh. 3. Limit snacks to when the child is hungry, rather than bored. 5. The parent should eat a variety of foods as an example to children. 6. Prepare homemade healthy version of favorite take out meals. (1., 2., 3., 5., & 6. Correct: Don't let the child skip breakfast. The child will have less energy to play well later in the day. Skipping breakfast can also lower grades in school as concentration decreases. Freeze fruits before putting them in the lunch box. This will keep the lunch items cool and the fruit fresh tasty. Canned pineapple, bananas, and grapes freeze well. Children need to learn to eat only when they are hungry. Children often eat out of boredom. Discourage nonstop grazing by planning activities to occupy the child. Lead by example. Children eventually adopt the eating patterns of their parents. If they see the parents eat vegetables, they will eventually try them. Prepare homemade healthy versions of take out favorites. 4. Incorrect: Forcing children to eat foods they do not like will only deepen their dislike for them. Give them the healthy foods they do enjoy and eventually they will explore more options.) A pediatric nurse is providing anticipatory guidance to a group of parents who have children nearing the age of 1 year old. What milestones should the nurse teach the parents to expect to see in their 1 year old child? Select all that apply 1. Gets to a standing position without help. 2. Puts out arm or leg to help with dressing. 3. Able to say several single words. 4. Pulls toys while walking. 5. Builds a tower of 4 blocks. ----------- Correct Answer ----------- 1. Gets to a standing position without help. 2. Puts out arm or leg to help with dressing. (1., & 2. Correct: A 1 year old should be able to get to a standing position without help. May stand alone. Can assist in getting dressed by putting out arm or leg. 3. Incorrect: Children at 18 months are able to say several single words. 4. Incorrect: Children at 18 months are able to pull toys while walking. 5. Incorrect: Children at 2 years of age can build a tower of 4 or more blocks.) The nurse is working on a health promotion plan for a young family whose child has severe allergies and asthma symptoms. Which interventions would be important to include in the health promotion plan? Select all that apply 1. Wash stuffed animals/toys frequently in hot water. 2. Make sure that bathrooms and high humidity areas are properly vented. 3. Limit carpet in the bedrooms. 4. Use humidifiers regularly. 5. Vacuum floors and upholstered furniture regularly. ----------- Correct Answer ----------- 1. Wash stuffed animals/toys frequently in hot water. 2. Make sure that bathrooms and high humidity areas are properly vented. 3. Limit carpet in the bedrooms. 5. Vacuum floors and upholstered furniture regularly. (1., 2., 3. & 5. Correct: The frequent washing in hot water removes dust mites. Adequate venting lessens the likelihood of fungal/mold spores. Carpet harbors dust and other allergens. The floors and upholstered furniture may harbor dust, pollen from clothing, and other irritants. 4. Incorrect: Humid air may contribute to mold or fungal spores in the house. Less humidity is appropriate.) A concerned mother is asking the nurse about activities that would be best for her child who has been diagnosed with asthma. In order to minimize the risk of exercise induced asthma, which activity would be best for the nurse to suggest? 1. Track 2. Basketball 3. Baseball 4. Soccer ----------- Correct Answer ----------- 3. Baseball (3. Correct: Baseball is an activity that is considered "asthma friendly". It requires short, intermittent periods of exertion and is therefore tolerated better by children with asthma. 1. Incorrect: This activity requires extended periods of exertion and is not considered "asthma friendly" and often not tolerated by clients with asthma. 2. A semi private room with a roommate who has a similar problem. 3. Either a private or a semi private room. 4. Direct admission to the seclusion room until his activity level becomes more subdued. --------- -- Correct Answer ----------- 1. A private bedroom. (1. Correct: A private room will help to decrease stimulation. The client with bipolar disorder needs a calm environment especially when in the manic phase. Avoid excessive stimulation. 2. Incorrect: Don't put two manics together. This room assignment will not help to decrease stimulation which is what the manic client needs. 3. Incorrect: They need a private room. The client with psychosis maybe suspicious and have delusion or hallucinations. 4. Incorrect: There's no need for this right now. The client is hyperactive and has difficulty sleeping. A seclusion room is needed for severe agitation and acute aggression.) The nurse is conducting a developmental screening by first gathering history information from the parent of a toddler. What information obtained by the parent would the nurse consider a risk factor for developmental problems? Select all that apply 1. Birthweight less than 3 pounds, 4 ounces (1.5 kg). 2. Gestational age less than 36 weeks. 3. Chronic otitis media with effusion for more than 3 months. 4. Lead level of 5.5 mg/dL 2 months ago. 5. Parents with 8th grade education. ----------- Correct Answer ----------- 1. Birthweight less than 3 pounds, 4 ounces (1.5 kg). 3. Chronic otitis media with effusion for more than 3 months. 4. Lead level of 5.5 mg/dL 2 months ago. 5. Parents with 8th grade education. (1., 3., 4., & 5. Correct: Factors placing the infant or toddler at risk for developmental problems include birthweight less than 3 pounds, 4 ounces (1.5 kg), chronic otitis media with effusion for more than 3 months, lead levels above 5.0 mg/dL, and parents with less than a high school education. The months a baby spends in the uterus, along with the first 12 months after birth, are the most important time of brain development. During this period neurons are forming connections with each other, creating the networks that underlie thinking, learning, and feeling. In the last weeks of pregnancy, as many as 40,000 new synapses are being formed every second. Preterm birth (less than 37 weeks gestational age) and low birth weight (less than 2.5 kg) are well-documented risk factors. In addition to threatening healthy overall growth and maturation, premature infants and low birth weight term infants may experience a disruption of important processes involved in early brain development. As a result, preterm and low birth weight children, are at increased risk for a variety of developmental problems related to health, psychological adjustment, and intellectual functioning. There is evidence that sensorineural hearing loss may result from chronic otitis. There is also evidence that the auditory deprivation associated with childhood otitis media may lead to language and speech delays. Lead is a neurotoxic substance that has been shown in numerous research studies to affect brain function and development. Children who have been exposed to elevated levels of lead are at increased risk for cognitive and behavioral problems during develop A clinic nurse completed teaching the parents of a 9 month old baby how to prevent otitis media infections in their baby. Which statement by the parents indicates to the nurse that further teaching is necessary? 1. "Our baby should sit up for feedings." 2. "It is fine to prop up a juice bottle for our baby to drink at night." 3. "Since our baby has ear tubes, ear plugs should be worn when swimming." 4. "We need to keep our baby away from people who are smoking." ----------- Correct Answer --- -------- 2. "It is fine to prop up a juice bottle for our baby to drink at night." (2. Correct: Propping up a bottle can contribute to otitis media and dental caries with a propped bottle, the liquid pools in the back of the mouth and can back up through the eustachian tube. Bacteria may then enter through the tube and cause an ear infection. 1. Incorrect: This is a correct response. Reflux of milk up the eustachian tubes is less likely in the vertical or semi-vertical position during feedings. 3. Incorrect: This is a correct statement. Parents should keep bath water and shampoo water out of the ear, if possible. Swimming without earplugs poses a slightly increased risk of infection. 4. Incorrect: This is a correct statement. Second hand smoking increases the risk of persistent middle ear effusion by enhancing attachment of the pathogens that cause otitis to the middle ear space, prolonging the inflammatory response and impeding drainage through the eustachian tube.) A 9 month old client is admitted to the hospital with a diagnosis of pertussis. Which interventions should the nurse initiate? Select all that apply 1. Initiate droplet precaution. 2. Place client under mist tent with low humidity. 3. Administer erythromycin 10 mg/kg/dose 4 times daily for 7 days. 4. Use client dedicated and disposable equipment. 5. Keep NPO. ----------- Correct Answer ----------- 1. Initiate droplet precaution. 3. Administer erythromycin 10 mg/kg/dose 4 times daily for 7 days. 4. Use client dedicated and disposable equipment. (1., 3., & 4. Correct: Pertussis is a very contagious disease that spreads from person to person by coughing or sneezing or when spending a lot of time near one another where you share breathing space. The nurse should place the child on droplet precautions in addition to standard precautions. For infants older than 1 month of age, macrolides drugs such as erythromycin are the drugs of choice. With droplet precautions you should use client dedicated or disposable equipment to prevent the spread of infection. If this is not possible, you must clean and disinfect shared/reusable equipment between use. This includes IV pumps, cell phones, pagers, other electronics, supplies, equipment. Clean prior to removing from the room. 2. Incorrect: A mist tent with high humidity may be used. The purpose is to improve a child's respiratory status by liquefying pulmonary secretions. 5. Incorrect: This child needs fluids, either by mouth or IV to keep from getting dehydrated, and to liquefy secretions.) The parents of a 1 month old report that their baby wakes up startled and stretches out the arms throughout the night. What suggestion should the nurse provide to the parents to decrease this reflex? 1. Rock to sleep. 2. Place in a baby swing. 3. Provide a pacifier. 4. Swaddle the baby. ----------- Correct Answer ----------- 4. Swaddle the baby. (4. Correct: Swaddling makes the baby feel more secure and decreases the baby's sense of falling. 1. Incorrect: The nurse wants to suggest something that will decrease the baby's sensation of 5. Incorrect: When checking the developmental milestones of a 9 month old, the nurse should expect to see the baby watch the path of something as it falls.) Which assignment by the charge nurse would be most appropriate for a general pediatric nurse being reassigned to the hematology/oncology pediatric unit? Select all that apply 1. Child dying with leukemia who has been on the hematology/oncology unit for two weeks. 2. Teenager with sickle cell disease in for pain management. 3. Child admitted following a bicycle accident that has idiopathic thrombocytopenic purpura (ITP). 4. New admit scheduled for bone marrow transplant. 5. Child diagnosed with leukemia admitted for stomatitis. ----------- Correct Answer ----------- 2. Teenager with sickle cell disease in for pain management. 3. Child admitted following a bicycle accident that has idiopathic thrombocytopenic purpura (ITP). 5. Child diagnosed with leukemia admitted for stomatitis. (2., 3., & 5. Correct: The nurse should be given an assignment similar to the type of clients and skill level the nurse is accustomed to on the general pediatric unit. Therefore, the choices should be these three clients. Even though one of the clients has leukemia, the child is being treated for stomatitis, not the leukemia. Sickle cell clients are frequently cared for on general pediatric units. The reassigned nurse has the knowledge and skills needed to meet the clients needs for pain management and treatment for the sickle cell disease. The general pediatric nurse should be competent in caring for children with low platelet counts, so the child with ITP could be assigned to this nurse. The nurse would be familiar with bleeding precautions, monitoring for bleeding, and associated care. 1. Incorrect: This client is dying with leukemia and needs consistency in the staff assigned to care for them. Although the general pediatric nurse could competently care for a dying child, the focus should be on the client. This child needs and deserves consistent care and care by those that are familiar to this child. 4. Incorrect: A child who is to receive a bone marrow transplant would not be the best assignment, since the nurse must have special preparation and an understanding of the protocol with a bone marrow transplant client. This is not something that a general pediatric nurse would typically do. Therefore, this client would need to be cared for by the nurses on the hematology/oncology unit who has this special training and/or knowledge.) A nurse is triaging a 2 year old child in the pediatric emergency department. The nurse notes that the child will not lie down and is consistently drooling. A croaking sound is heard on inspiration. What is the priority nursing intervention? 1. Examine the oral pharynx using a tongue depressor. 2. Administer a sedative so the child can be examined. 3. Have a second nurse hold the child down for the assessment. 4. Notify the primary healthcare provider immediately. ----------- Correct Answer ----------- 4. Notify the primary healthcare provider immediately. (4. Correct: This is the safest answer. The child could suddenly obstruct the airway upon examination of throat. 1. Incorrect: If it looks like epiglottitis, do not examine as this could cause sudden airway obstruction which could be fatal. 2. Incorrect: The client is having trouble breathing, so do not sedate the client. Sedatives would depress the respirations more and potentially cause the client to go into respiratory arrest. Remember, the NCLEX® lady does not want you to be a killer nurse. 3. Incorrect: This will cause more respiratory and emotional distress to the child. This is an unsafe answer.) The nurse is reviewing the immunization record of a 3 month old. Which immunization does the nurse expect the child to have received by this age? 1. First Hepatitis B vaccination. 2. Second diphtheria vaccination. 3. Third Hib vaccination. 4. Influenza vaccination. ----------- Correct Answer ----------- 1. First Hepatitis B vaccination. (1. Correct: In the US the first dose is recommended at birth. In Canada, the first dose is recommended between birth and two months. 2. Incorrect: In both the US and Canada, the first diphtheria vaccination is recommended at 2 months, and the second at 4 months. 3. Incorrect: In both the US and Canada, the first Hib vaccination is recommended at 2 months, the second at 4 months, and the third at 6 months. 4. Incorrect: In both the US and Canada, all healthy children ages 6 months and older should receive a yearly influenza vaccination.) An 18 month old is admitted to the unit with a diagnosis of pertussis. The mother asks the nurse, "How did my child get this disease? I didn't think anyone got that anymore." What is the appropriate response by the nurse? 1. "Pertussis is a common childhood disease since there is no vaccine." 2. "Since not all children are immunized against pertussis, the disease has reemerged." 3. "Your baby got this disease because you didn't have your child immunized." 4. "Since your child is already sick, let's just focus on getting well." ----------- Correct Answer --- -------- 2. "Since not all children are immunized against pertussis, the disease has reemerged." (2. Correct: This is a correct statement. Therapeutic communication means providing information that will help clients make better choices.Not all parents have had their children immunized against pertussis, so this disease is being seen in clients again. DPaT should be given at 2, 4 and 6 months of age. A booster is given at 15-18 months old and then at 4-6 years old. 1. Incorrect: This is not true. There is a vaccine. DPaT should be given at 2, 4, and 6 months of age. A booster is given at 15-18 months old and then at 4-6 years old. 3. Incorrect: Don't be confrontational. This puts the mother on the defensive. This is not therapeutic communication. Giving one's own opinion, evaluating, moralizing or implying one's values by using words such as "nice" "bad" "right" "wrong" "should" and "ought". "You shouldn't do that. It is wrong". Everyone who does not get immunized gets the disease. 4. Incorrect: Do not change the subject. This does not address the mother's concern. Changing the subject, or introducing new topic inappropriately, can create anxiety. The nurse needs to address the mother's question of how the child contracted the disease.) What information should be included in the health promotion plan for parents regarding the promotion of adequate bowel elimination in their toddler? Select all that apply 1. Include adequate fiber in the diet through whole grains and fruits. 2. Increase intake of water daily. 3. Provide toileting opportunities that are free from distractions. 4. Encourage the toddler to go to the bathroom at least three times daily. 5. Take away attention from the toddler unable to potty. ----------- Correct Answer ----------- 1. (3. Correct: Though many of the laboratory results are abnormal, the most concerning is the urine specific gravity in Client three, treated for sickle cell crisis. This result indicates the client is extremely dehydrated, which could lead to more complications, further exacerbating the crisis. 1. Incorrect: A child newly diagnosed with type I diabetes requires some time for the body to respond to treatment and insulin injections. Even though hospitalized, the child may periodically have elevated blood glucose readings during this adjustment period. The slightly elevated specific gravity is to be expected since hyperglycemia causes dehydration in the body. 2. Incorrect: Glomerulonephritis is an inflammatory process within the glomeruli of the kidneys, caused by a type of beta-hemolytic streptococcal infection. The elevated renal labs are to be expected with this illness, and are not abnormal enough to cause undue concern. 4. Incorrect: The client has been transferred to this unit with a diagnosis of pneumococcal pneumonia, which is very serious in children. Because of this illness, an elevated white blood count is expected. The remaining labs are within normal limits. No need to report any values here.) The nurse is working on health promotion plans for a small group of school-aged children who are at risk for obesity. Which baseline data would support the risk for obesity? 1. Spends one hour playing sports or swimming daily. 2. Spends at least two hours watching TV after dinner each day. 3. Assists mom in preparing low carb snacks for the family. 4. Participates in the marching band at school. ----------- Correct Answer ----------- 2. Spends at least two hours watching TV after dinner each day. (2. Correct: Sedentary activities, such as watching television, playing video games and using a computer to surf the internet or engage with friends can also contribute to obesity and cardiovascular health problems in later life. 1. Incorrect: The more active the child is, the less likely he is to be overweight. Activity for at least one or more hours per day should be encouraged. 3. Incorrect: Children who are exposed to healthy snacks are less likely to be overweight and are more likely to choose healthy snacks. 4. Incorrect: The marching band is an excellent source of exercise for the child. This information does not support the risk for obesity.) What would be most important for the nurse to teach parents in order to promote sleep and rest in the preschool child? 1. Allow the child to choose own bedtime based on degree of fatigue. 2. Develop a consistent routine before going to bed. 3. Assess how much sleep the child requires. 4. Set a consistent wake-up schedule. ----------- Correct Answer ----------- 2. Develop a consistent routine before going to bed. (2. Correct: A consistent routine helps to prepare the child for sleep. Reading or telling stories before bedtime may help the child to relax and fall asleep more easily. Routines are very important for this age group. Doing specific things before bedtime can signal to the child that it is time to get ready for bed and to go to sleep. 1. Incorrect: Although important, this is not the priority. Establishing a routine is most important. A cool environment will promote rest. A child's sleep cycle is sensitive to light and temperature. Melatonin levels help to regulate the drop in internal temperature needed to sleep. 3. Incorrect: Assessing the amount of sleep needed can help with promoting sleep and rest but routine is priority in the preschool age group. 4. Incorrect: Setting a wake-up time prevents a child from over sleeping on weekends and holidays. Those extra hours can disturb the sleep cycle. For a preschooler routine is the priority answer to promote sleep and rest at night.) A 6 year old admitted from the emergency department (ED) with a fractured tibia is scheduled for surgery in the morning. All of the private rooms are full so the child must be admitted to a semi-private room. What room assignment is appropriate for the nurse to make for this client? 1. Rooming with an 8 year old in sickle cell crisis. 2. Rooming with a 2 year old admitted with bacteremia. 3. Rooming with a 3 year old with pneumonia. 4. Rooming with a 4 year old with gastroenteritis. ----------- Correct Answer ----------- 1. Rooming with an 8 year old in sickle cell crisis. (1. Correct: Sickle cell disease and a child in a sickle cell crisis is not considered contagious. This is the only option that does not have an infectious process, so this would be the best room assignment for the child with the fracture. In addition, the children are close in age with the same development tasks, so activities for the children may be similar. 2. Incorrect: Bacteremia is an infectious process in which there is viable bacteria in the blood stream. The source of the infection is not noted. The child with a fracture who will be having surgery should not be placed in a room with a child who has a known infection. 3. Incorrect: The child with pneumonia has an infectious process that may be viral or bacterial. The child with the fracture should not be assigned to this room due to the risk of air-borne exposure to the infectious agent. 4. Incorrect: Gastroenteritis is a diarrheal illness with inflammation in the stomach and small intestine. This is contagious, so if all possible, this child should be kept in a private room, so other children would be less likely to contract the gastroenteritis. It may be viral, bacterial, or parasitic in origin. The child with the fracture should not be assigned to the room with the child with gastroenteritis.) At what age does the nurse expect to see a child build a tower of 9 blocks? 1. One 2. Two 3. Three 4. Four ----------- Correct Answer ----------- 3. Three (3. Correct: By the age of 3 years, the nurse would expect the child to build a tower of 9-10 blocks. 1. Incorrect: At one the child is working on gross motor skills rather than dexterity skills. 2. Incorrect: By age 2 the child can build a tower of at least 4 blocks. 4. Incorrect: The four year old can build high towers of more than 10 blocks.) A pediatric nurse is teaching a group of new parents about what to expect regarding their infants eyes and vision. What points should the nurse include? Select all that apply 1. At 4 weeks of age, the infant should be able to gaze at objects. 2. Infants should have tears by the age of 1 month. 3. Visual acuity is about 20/300 at 4 months of age. 4. During the first 2 months of life, infant's eyes may appear to be crossed. 5. Depth perception begins around the 5th month of age. ----------- Correct Answer ----------- 1. At 4 weeks of age, the infant should be able to gaze at objects. 3. Visual acuity is about 20/300 at 4 months of age. 1.It is a complete small intestinal obstruction. 2.It is a congenital aganglionosis or megacolon. 3.It is a severe inflammation of the gastrointestinal tract. 4.It is a condition that causes the pyloric valve to remain open. ---------- Correct Answer ---------- - 2.It is a congenital aganglionosis or megacolon. Hirschsprung's disease, also known as "congenital aganglionosis" or "megacolon," is the result of an absence of ganglion cells in the rectum and to varying degrees upward in the colon. Options 1, 3, and 4 are incorrect. An infant returns to the nursing unit following surgery for an esophageal atresia with tracheoesophageal fistula (TEF). The infant is receiving intravenous (IV) fluids, and a gastrostomy tube is in place. The nurse assisting in caring for the infant should ensure that which action is done to the gastrostomy tube? 1.Elevated 2.Placed to gravity 3.Attached to low suction 4.Taped to the bed linens ---------- Correct Answer ----------- 1.Elevated In the immediate postoperative period, the gastrostomy tube is elevated, allowing gastric contents to pass to the small intestine and air to escape. This promotes comfort and decreases the risk of leakage at the anastomosis. Options 2, 3, and 4 are incorrect The nurse prepares to administer a pancreatic enzyme powder to the child with cystic fibrosis (CF). Which food item should the nurse mix with the medication? 1.Tapioca 2.Applesauce 3.Hot oatmeal 4.Mashed potatoes ---------- Correct Answer ----------- 2.Applesauce Pancreatic enzyme powders are not to be mixed with hot foods or foods containing tapioca or other starches. Enzyme powder should be mixed with nonfat, nonprotein foods such as applesauce. Pancreatic enzymes are inactivated by heat and are partially degraded by gastric acids. The nurse is reviewing the record of a child with a diagnosis of pyloric stenosis. Which data should the nurse expect to note as having been documented in the child's record? 1.Watery diarrhea 2.Projectile vomiting 3.Increased urine output 4.Vomiting large amounts of bile ---------- Correct Answer ----------- 2.Projectile vomiting Signs and symptoms of pyloric stenosis include projectile, nonbilious vomiting; irritability; hunger and crying; constipation; and signs of dehydration, including a decrease in urine output. The nurse is reinforcing instructions to the parents of a child with a hernia regarding measures that will promote reducing the hernia. The nurse determines that the parents understand these measures if they make which statement? ."We will encourage our child to cough every few hours on a daily basis." 2."We will make sure that our child participates in physical activity every day." 3."We will provide comfort measures to reduce any crying periods by our child." 4."We will be sure to give our child a Fleet enema every day to prevent constipation." ---------- Correct Answer ----------- 3."We will provide comfort measures to reduce any crying periods by our child." A warm bath and comfort measures to reduce crying periods are all simple measures to promote reducing a hernia. Coughing and crying increase the strain on the hernia. Likewise, physical activities and enemas of any type would increase the strain on the hernia. The nurse is checking the status of jaundice in a child with hepatitis. Which location should the nurse check to ascertain if the child is jaundiced? 1.The mucous membranes 2.The skin in the sacral area 3.The skin in the abdominal area 4.The membranes in the ear canal ---------- Correct Answer ----------- 1.The mucous membranes Jaundice, if present, is best checked in the sclera, nail beds, and mucous membranes. Generalized jaundice will appear in the skin throughout the body. Option 4 is not an appropriate assessment area for the presence of jaundice. The nurse is monitoring a newborn with a suspected diagnosis of imperforate anus. Which assessment finding is unassociated with this diagnosis? 1.The presence of stool in the urine 2.Failure to pass a rectal thermometer 3.The passage of currant jelly-like stool 4.Failure to pass meconium in the first 24 hours after birth ---------- Correct Answer ----------- 3.The passage of currant jelly-like stool During the newborn assessment, imperforate anus should be easily identified visually. However, a rectal thermometer or tube may be necessary to determine patency if meconium is not passed in the first 24 hours after birth. The presence of stool in the urine or vagina should be reported immediately as an indication of abnormal anorectal development. Currant jelly-like stool is not a symptom of this disorder. The nurse is caring for an infant with a diagnosis of Hirschsprung's disease. The nurse should check for which clinical findings that are consistent with Hirschsprung's disease? Select all that apply. 1.Fever 2.Constipation 3.Failure to thrive 4.Intolerance to wheat 5.Abdominal distention 6.Explosive, watery diarrhea ---------- Correct Answer ----------- 1.Fever 2.Constipation 3.Failure to thrive 5.Abdominal distention 6.Explosive, watery diarrhea Clinical symptoms of Hirschsprung's disease during infancy include failure to thrive, constipation, abdominal distention, episodes of diarrhea and vomiting, signs of enterocolitis, explosive and watery diarrhea, and fever. The infant appears significantly ill. Intolerance to wheat occurs in celiac disease. A 2-year-old child is diagnosed with constipation due to encopresis. Which description is a characteristic of this disorder? 1.Anorexia in the evening 2.Incomplete development of the anus 3.The infrequent and difficult passage of dry stools 4.Invagination of a section of the intestine into the distal bowel ---------- Correct Answer --------- -- 3.The infrequent and difficult passage of dry stools Constipation can affect any child at any time, although its incidence peaks at ages 2 to 3 years. Option 3 describes encopresis, which can develop as a result of constipation and is one of the major concerns regarding constipation. Encopresis generally affects preschool and school-age children. Option 1 is not associated with encopresis. Option 2 describes imperforate anus, which is diagnosed in the neonatal period. Option 4 describes intussusception, which is the most common cause of bowel obstruction in children ages 3 months to 6 years. The nurse is monitoring for fluid volume deficit in an infant who is vomiting and having diarrhea. The nurse weighs the infant's diaper after each voiding and stool and carefully calculates fluid volume based on which knowledge? 1.Each gram of diaper weight is equivalent to 0.5 mL of urine. 2.Each gram of diaper weight is equivalent to 1 mL of urine. 3.Each gram of diaper weight is equivalent to 2 mL of urine. 4.Each gram of diaper weight is equivalent to 2.5 mL of urine. ---------- Correct Answer ---------- - 2.Each gram of diaper weight is equivalent to 1 mL of urine. When monitoring for fluid volume deficit, the nurse should weigh the infant's diaper after each Answer ----------- 2."I will insert a glycerin suppository before the dilation." Following this surgery, anal dilation at home by the parents is necessary to achieve and maintain bowel patency. Inserting a glycerin suppository before dilation is not a component of this procedure. Options 1, 3, and 4 are accurate instructions and will prevent damage to the rectal mucosa. The nurse provides feeding instructions to a mother of an infant diagnosed with gastroesophageal reflux (GER). To assist in reducing the episodes of emesis, which instruction should the nurse provide the mother 1.Provide less frequent, larger feedings. 2.Burp less frequently during feedings. 3.Thin the feedings by adding water to the formula. 4.Thicken the feedings by adding rice cereal to the formula. ---------- Correct Answer ----------- 4.Thicken the feedings by adding rice cereal to the formula. Small, more frequent feedings with frequent burping are often tried as the first line of treatment in gastroesophageal reflux. Feedings thickened with rice cereal may reduce episodes of emesis. However, thickened feedings do not affect reflux time. If thickened formula is prescribed, 1 to 3 teaspoons of rice cereal per ounce of formula is most commonly used and may require cross- cutting the nipple. Options 1, 2, and 3 are incorrect. The nurse reinforces home-care instructions to the parents of a child with hepatitis regarding the care of the child and the prevention of the transmission of the virus. Which statement by a parent indicates a need for further teaching? 1."Frequent hand washing is important." 2."I need to provide a well-balanced, high-fat diet to my child." 3."I need to clean contaminated household surfaces with bleach." 4."Diapers should not be changed near any surfaces that are used to prepare food." ---------- Correct Answer ----------- 2."I need to provide a well-balanced, high-fat diet to my child." The child with hepatitis should consume a well-balanced, low-fat diet to allow the liver to rest. Options 1, 3, and 4 are components of the homecare instructions to the family of a child with hepatitis. The nurse provides instructions to the parents of an infant with gastroesophageal reflux (GER) regarding proper positioning to manage reflux. The nurse should tell the parents that the infant should be maintained in which position? 1.A 30-degree angle when supine 2.A 60-degree angle when prone 3.A 60-degree angle when supine 4.A 20-degree angle when side-lying ---------- Correct Answer ----------- 3.A 60-degree angle when supine Proper positioning is an important component of reflux management. Ideally the goal is to maintain the infant in an upright angle 24 hours a day, at a 60-degree angle when supine, and at a 30-degree angle when prone. This position is maintained until the infant remains asymptomatic for 6 weeks. A 4-year-old child is hospitalized for severe gastroenteritis. The child is crying and clinging to the mother. The mother becomes very upset and is afraid to leave the child. Which nursing intervention would be most appropriate to alleviate the child's fears and the mother's anxiety? 1.Reassure the mother that the child will be fine after she leaves. 2.Ask the mother if she would like to stay overnight with the child. 3.Give the mother the telephone number of the pediatric unit, and tell the mother to call at any time. 4.Tell the mother to bring the child's favorite toys the next time she comes to the hospital to visit. ---------- Correct Answer ----------- 2.Ask the mother if she would like to stay overnight with the child. Although a 4-year-old may already be spending some time away from his or her parents at a day care center or preschool, illness adds a stressor that makes separation more difficult. The only option that addresses the mother's anxiety and alleviates the fears of the child is option 2. Options 1, 3, and 4 do not address the fears and anxieties of the mother and child. The nurse reviews the record of an infant who is seen in the clinic. The nurse notes that a diagnosis of esophageal atresia with tracheoesophageal fistula (TEF) is suspected. The nurse expects to note which most likely manifestation of this condition in the medical record? 1.Incessant crying 2.Coughing at nighttime 3.Choking with feedings 4.Severe projectile vomiting ---------- Correct Answer ----------- 3.Choking with feedings Any child who exhibits the "3 Cs"—coughing and choking during feedings and unexplained cyanosis—should be suspected of having TEF. Options 1, 2, and 4 are not specifically associated with TEF. The nurse is preparing to feed a 1-year-old hospitalized child. The nurse prepares the amount of formula to be given to this child, knowing that generally a 1-year-old consumes approximately which amount? 1.90 mL per feeding 2.100 mL per feeding 3.175 mL per feeding 4.380 mL per feeding ---------- Correct Answer ----------- 3.175 mL per feeding A 1-year-old child consumes approximately 175 mL (6 ounces) of formula per feeding. Options 1, 2, and 4 are incorrect. A newborn infant is diagnosed with gastroesophageal reflux (GER). The mother of the infant asks the nurse to explain the diagnosis. The nurse plans to base the response on which description of this disorder? 1.Gastric contents regurgitate back into the esophagus. 2.The esophagus terminates before it reaches the stomach. 3.Abdominal contents herniate through an opening of the diaphragm. 4.A portion of the stomach protrudes through the esophageal hiatus of the diaphragm. ---------- Correct Answer ----------- 1.Gastric contents regurgitate back into the esophagus. Gastroesophageal reflux is regurgitation of gastric contents back into the esophagus. Option 2 describes esophageal atresia. Option 3 describes a congenital diaphragmatic hernia. Option 4 describes a hiatal hernia The nurse is assisting in admitting to the hospital a 4-month-old infant with a diagnosis of vomiting and dehydration. The nurse assists in developing a plan of care for the infant and suggests which position for the infant? 1.Prone position 2.Side-lying position 3.Modified Trendelenburg's position 4.Infant car seat with the head of the seat in a flat position ---------- Correct Answer ----------- 2.Side-lying position The vomiting infant or child should be placed in an upright or side-lying position to prevent aspiration. The positions identified in options 1, 3, and 4 will increase the risk of aspiration if vomiting occurs. The nurse has reinforced dietary instructions to the mother of a child with celiac disease. The nurse determines that the mother understands the dietary instructions if she indicates eliminating which products? Select all that apply. 1.Rice 2.Corn 3.Millet 4.Oatmeal 5.Rye crackers 6.Wheat bread ---------- Correct Answer ----------- 4.Oatmeal 5.Rye crackers 6.Wheat bread Dietary management is the mainstay of treatment for the child with celiac disease. Because gluten occurs mainly in the grains of wheat and rye, but also in smaller quantities in barley and oats, these four foods are eliminated. Corn, rice, and millet are substitute grain foods. 3.Vaccines are available to prevent hepatitis A (HAV) and hepatitis B (HBV). 4.Enteric precautions are necessary for hepatitis B (HBV) but not for hepatitis A (HAV). --------- - Correct Answer ----------- 4.Enteric precautions are necessary for hepatitis B (HBV) but not for hepatitis A (HAV). Prevention of the spread of infection is an essential intervention for hepatitis A. This should include enteric precautions for at least 1 week after the onset of jaundice and strict hand washing. Options 1, 2, and 3 are accurate regarding hepatitis. The nurse is assisting a primary health care provider with an assessment of a child with a diagnosis of suspected appendicitis. In assessing the intensity and progression of the pain, the primary health care provider palpates the child at McBurney's point. What response does the nurse expect the child to have during the examination? 1.Pain in the upper right side 2.Pain when extending the leg 3.Pain when the right thigh is drawn up 4.Pain in the lower right side between the umbilicus and the iliac crest ---------- Correct Answer - ---------- 4.Pain in the lower right side between the umbilicus and the iliac crest Pain in the lower right side, halfway between the umbilicus and the crest of the ileum at McBurney's point is the best known symptom of appendicitis. Extending the leg causes pain but is not the McBurney's point. The client may rest with the right thigh drawn up to relieve pain. The nurse is reviewing the health record of a child with a diagnosis of celiac disease. Which clinical manifestation should the nurse expect to note documented in the health record? 1.Frothy diarrhea 2.Foul-smelling ribbon stools 3.Profuse watery diarrhea and vomiting 4.Diffuse abdominal pain unrelated to meals or activity ---------- Correct Answer ----------- 3.Profuse watery diarrhea and vomiting Celiac disease causes profuse watery diarrhea and vomiting. Option 1 is a symptom of lactose intolerance. Option 2 is a symptom of Hirschsprung's disease. Option 4 is a symptom of irritable bowel syndrome. The nurse is caring for a child who is scheduled for an appendectomy. When the nurse reviews the primary health care provider's preoperative prescriptions, which should be questioned? 1.Administer a Fleet enema. 2.Maintain nothing per mouth (NPO) status. 3.Maintain intravenous (IV) fluids as prescribed. 4.Administer preoperative medication on call to the operating room ---------- Correct Answer ---- ------- 1.Administer a Fleet enema. In the preoperative period, enemas or laxatives should not be administered. No heat should be applied to the abdomen because this may increase the chance of perforation secondary to vasodilation. IV fluids would be started and the child would be NPO. Prescribed preoperative medications most likely would be administered on call to the operating room. The nurse reinforces home-care instructions to the parents of a child with celiac disease. Which food item should the nurse advise the parents to include in the child's diet? 1.Rice 2.Oatmeal 3.Rye toast 4.Wheat bread ---------- Correct Answer ----------- 1.Rice Dietary management is the mainstay of treatment for celiac disease. All wheat, rye, barley, and oats should be eliminated from the diet and replaced with corn and rice. Vitamin supplements, especially fat-soluble vitamins and folate, may be required during the early period of treatment to correct deficiencies. These restrictions are likely to be life long, although small amounts of grains may be tolerated after the gastrointestinal ulcerations have healed. The nurse is admitting a child with a diagnosis of lactose intolerance. Which finding does the nurse expect to note? 1.Frothy stools 2.Foul-smelling ribbon stools 3.Profuse, watery diarrhea and vomiting 4.Diffuse abdominal pain unrelated to meals or activity ---------- Correct Answer ----------- 1.Frothy stools Lactose intolerance causes frothy stools. Abdominal distention, crampy abdominal pain, and excessive flatus may also occur. Option 2 is a clinical manifestation of Hirschsprung's disease. Option 3 is a clinical manifestation of celiac disease. Option 4 is a symptom of irritable bowel syndrome. 3-year-old child is seen in the health care clinic, and a diagnosis of encopresis is made. The nurse reviews the record, expecting to note which sign as evidence of this disorder? 1.Diarrhea 2.Malaise anorexia 3.Nausea and vomiting 4.Evidence of soiled clothing ---------- Correct Answer ----------- 4.Evidence of soiled clothing Encopresis is defined as fecal incontinence and is a major concern if the child is constipated. Signs include evidence of soiled clothing, scratching, or rubbing the anal area because of irritation, fecal odor without apparent awareness by the child, and social withdrawal. The nurse reinforces instructions to the mother about dietary measures for a 5-year-old child with lactose intolerance. The nurse should tell the mother that which supplement will be required as a result of the need to avoid lactose in the diet? 1.Fats and vitamin A 2.Zinc and vitamin C 3.Calcium and vitamin D 4.Thiamine and vitamin B ---------- Correct Answer ----------- 3.Calcium and vitamin D Lactose intolerance is the inability to tolerate lactose, the sugar that is found in dairy products. Removing milk from the diet can provide relief from symptoms. Additional dietary changes may be required to provide adequate sources of calcium and vitamin D. A child is diagnosed with lactose intolerance. The child's mother asks the nurse about the disease. Which statement is the appropriate nursing response? 1."It is the inability to tolerate sugar found in dairy products." 2."It results from the absence of ganglion cells in the rectum." 3."It results from increased bowel motility that leads to spasm and pain." 4."It is the inability to fully digest the protein part of wheat, barley, rye, and oats." ---------- Correct Answer ----------- 1."It is the inability to tolerate sugar found in dairy products." Lactose intolerance is the inability to tolerate lactose, the sugar found in dairy products. It results from absence or deficiency of lactase, an enzyme found in the secretions of the small intestine required for the digestion of lactose. Option 2 describes Hirschsprung's disease. Option 3 describes irritable bowel syndrome. Option 4 describes celiac disease. The nurse is assigned to care for a child who is scheduled for an appendectomy. Which prescriptions should the nurse anticipate to be prescribed? Select all that apply. 1.Administer a Fleet enema. 2.Initiate an intravenous line. 3.Maintain nothing-by-mouth status. 4.Administer intravenous antibiotics. 5.Administer preoperative medications. 6.Place a heating pad on the abdomen to decrease pain. ---------- Correct Answer ----------- 2.Initiate an intravenous line. 3.Maintain nothing-by-mouth status. 4.Administer intravenous antibiotics. 5.Administer preoperative medications. During the preoperative period, enemas or laxatives should not be administered. In addition, heat should not be applied to the abdomen. Any of these interventions can cause the rupture of the appendix and resultant peritonitis. Intravenous fluids would be started, and the child should receive nothing by mouth while awaiting surgery. Antibiotics are usually administered because of the risk of perforation. Preoperative medications are administered as prescribed.