NR 328 Exam #1 Questions with Complete Solutions: Nursing Fundamentals, Exams of Nursing

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NR 328 Exam #1 Questions with Complete Solutions.

Which topics should the nurse discuss with the parents of a young child to promote health in their child? a. Dental care needs to be started by age 7. b. Immunization schedule and the importance of immunizations. c. Human milk or iron fortified formula for the first 4 months of life. d. Positioning the car seat in the front passenger seat. - Correct Answer Answer: B Rationale: Immunizations have made a major impact in the prevention of disease in children. The nurse should review individual immunization records at every clinic visit, avoid missing opportunities to vaccinate, and encourage parents to keep immunizations current. Dental caries is the single most common chronic disease of childhood and may begin before the first birthday. Human milk or iron fortified formula for should be given for the first year of life to prevent Iron Deficiency anemia. Children younger than 1 year of age have the highest rate of death from motor vehicle accidents, primarily from a failure to properly use car restraints. What is the leading cause of death in children older than the age of 1 year? a. Drowning b. Burns c. Motor vehicle accidents d. Cancer - Correct Answer Answer(s): C Rationale: a. Drowning is the second leading cause of death in children older than the age of 1 year. b. Burns cause fewer deaths than motor vehicle accidents in children older than the age of 1 year. c. Motor vehicle accidents are the leading cause of death in children older than the age of 1 year. d. Cancer causes fewer deaths than motor vehicle accidents in children older than the age of 1 year. The nurse makes sure that a toddler has a teddy bear and that a nightlight is on in the hospital room at bedtime. What concept would these nursing actions demonstrate? a. Atraumatic care b. Nonmaleficence c. Justice d. Advocacy - Correct Answer Answer(s): A

Rationale: A. Atraumatic care is the provision of therapeutic care in settings, by personnel, and through the use of interventions that eliminate or minimize the psychological and physical distress experienced by children and their families in the health care system. In this case, it is making sure that the toddler has a teddy bear and that a night light is on to prevent a dark environment. B. Nonmaleficence is the obligation to minimize or prevent harm; there is no situation present that would require this. C. Justice is the concept of fairness and is not applicable to this situation. D. Advocacy involves ensuring that families are aware of all available health services, adequately informed of treatments and procedures, involved in the child's care, and encouraged to change or support existing health care practices. True or False: Open ended questions are most likely to encourage parents to talk about their feelings r/t their child's illness. - Correct Answer True When the nurse interviews an adolescent, what is important to help establish a relationship? a. Use the same type of language as the adolescent. b. Emphasize that confidentiality will always be maintained. c. Focus the discussion on the peer group. d. Display a genuine interest in the adolescent. - Correct Answer Answer: D. Rationale: Display a genuine interest in the adolescent.Adolescents accept anyone who shows a genuine interest in them. Although peers are important to this age-group, the focus of the interview should be on the adolescent. The nurse should clarify which information will be shared with other members of the health care team and any limits to confidentiality. The nurse should maintain a professional relationship with adolescents. To avoid misinterpretation of words and phrases that the adolescent may use, the nurse should clarify terms frequently. What approach is the most appropriate when performing a physical assessment on a toddler? a. Demonstrate use of equipment. b. Perform traumatic procedures first. c. Use minimum physical contact initially. d. Always proceed in a head-to-toe direction. - Correct Answer Answer: C. Rationale: Parents can remove clothing, and the child can remain on the parent's lap. The nurse should use minimum physical contact initially to gain the cooperation of the child.

The nurse should introduce the equipment slowly. The child can inspect the equipment, but demonstrations are usually too complex for this age-group. Traumatic procedures should always be performed last. These will most likely upset the child and inhibit cooperation. The head-to-toe assessment can be done in older children but usually must be adapted in younger children. What is the most consistent and commonly used indicator of pain in infants? a. Thrashing of arms and legs. b. Increased heart rate. c. Increased respirations. d. Facial expression of discomfort. - Correct Answer Answer: D. Rationale: Facial expression of discomfort. Facial expression has consistently been validated as an indicator of pain in infants. Behavioral pain measures are most reliable for sharp procedural pain in infants. Increased heart rate and respirations are indicative of a generalized and complex response to stress. They are not specific for pain in infants. Thrashing of arms and legs is a reliable indicator in young children, not infants. True or False: At age 1 month is the normal age for binocularity-ability to fixate on one visual field with both eyes simultaneously. - Correct Answer Answer: False. Rationale: Binocularity is usually achieved by age 3 to 4 months. One month is too young for binocularity. If binocularity is not achieved by 6 to 12 months, the child must be observed for strabismus. What self-report pain rating scales can be used in children as young as 3 years of age? a. FACES Pain Rating Scale b. Visual Analog Scale c. Word-Graphic Rating Scale d. Who Cares? - Correct Answer Answer: A. Rationale: The FACES Pain Rating Scale is for children as young as 3 years of age. The Visual Analog Scale can be used for children older than 4 years of age but is most appropriate for ages 7 and older. The Word-Graphic Rating Scale uses descriptive words and is recommended for children 4 to 17 years of age. An intravenous line is needed in a school-age child. What medication is appropriate analgesic for use with this patient?

a. LMX (4% liposomal lidocaine cream) 30 minutes before the procedure. b. EMLA (eutectic mixture of local anesthetics) immediately before. c. A transdermal fentanyl (Duragesic) patch at the site of venipuncture. d. TAC (tetracaine, epinephrine [Adrenalin], cocaine) 15 minutes before. - Correct Answer Answer: A. Rationale: LMX is an effective analgesic agent when applied to the skin 30 minutes before a procedure. It eliminates or reduces the pain from most procedures involving skin puncture. TAC provides skin anesthesia about 15 minutes after application to nonintact skin. The gel can be placed on the wound for suturing. It is not useful for intact skin. Transdermal fentanyl patches are useful for continuous pain control, not rapid pain control. For maximum effectiveness, EMLA must be applied approximately 60 minutes in advance. A transdermal fentanyl (Duragesic) patch at the site of venipuncture. At what age does Erickson consider the infancy stage? - Correct Answer 0 - 18 months What is the basic conflict and important events of Erickson's infancy stage? - Correct Answer Trust vs. Mistrust Feeding/Comfort At what age does Erickson consider the Early Childhood stage? - Correct Answer 2 - 3 years What is the basic comfort and important events of Erickson's early childhood stage? - Correct Answer Autonomy vs. Shame and Doubt Toilet training/Dressing At what age does Erickson consider the preschool stage? - Correct Answer 3 - 5 years What is the basic conflict and important events of Erickson's preschool stage? - Correct Answer Initiative vs. Guilt Exploration/Play At what age does Erickson consider the school age? - Correct Answer 6 - 11 years What is the basic conflict and important events of Erickson's school age? - Correct Answer Industry vs. Inferiority

School/Activities At what age does Erickson consider the adolescence stage? - Correct Answer 12 - 18 years What is the basic comfort and important events of Erickson's adolescence stage? - Correct Answer Identity vs. Role Confusion Social relationships/Identity What is the outcome of Erickson's infancy stage? - Correct Answer Children develop a sense of trust when caregivers provide reliability, care and affection. A lack of this will lead to mistrust. What is the outcome of Erickson's early childhood stage? - Correct Answer Children need to develop a sense of personal control over physical skills and a sense of independence. Success leads to feeling of autonomy, failure results in feelings of shame and doubt. What is the outcome of Erickson's preschool stage? - Correct Answer Children need to begin asserting control and power over the environment. Success in this state leads to a sense of purpose. Children who try to exert too much power experience disapproval, resulting in a sense of guilt. What is the outcome of Erickson's school age stage? - Correct Answer Children need to cope with new social and academic demands. Success leads to a sense of competence, while failure results in feeling of inferiority. What is the outcome of Erickson's adolescence stage? - Correct Answer Teens need to develop a sense of self and personal identity. Success leads to an ability to stay true to yourself, while failure leads to role confusion and a weak sense of self. What PPE is included in standard/universal precautions? - Correct Answer Hand hygiene Gloves when touching blood, body fluids, secretions, mucous membranes, and non-intact skin. What PPE is included in standard/universal precautions with anticipated splashing? - Correct Answer Hand hygiene Gown Mask

Goggles or shield Gloves What PPE is included in contact precautions? - Correct Answer Hand hygiene Gown Gloves What PPE is included in droplet precautions? - Correct Answer Hand hygiene Gown Mask Gloves What PPE is included in airborne precautions? - Correct Answer Hand hygiene Gown N95 mask Gloves What is the order in which we put on PPE? - Correct Answer Hand hygiene Gown Mask Goggles or shield Gloves What order do we take off PPE? - Correct Answer Gloves Goggles or shield Gown Mask Hand hygiene What communicable diseases do we use airborne precautions for? - Correct Answer M = Measles T = Tuberculosis V = Varicella (MTV is on the AIR) What communicable diseases do we use droplet precautions for? - Correct Answer P = Pertussis

I = Influenza M = Mumps/Meningitis P = Pneumonia ('PIMP my ride' - had to DROP off my car) What is the major goal of pediatric nursing? - Correct Answer To improve the quality of health care for children and their families An important milestone in the infant's life is the development of object permanence. This milestone is represented by which of these statements? a. The infant turns and looks for the mother when she walks out of his view. b. The infant smiles at the mother when she talks to him. c. The infant cries when the mother hands him to a babysitter. d. The infant repeatedly flexes and extends his arms and legs when the mother picks him up. - Correct Answer Answer: A Rationale: A major accomplishment is achieving the concept of object permanence, or the realization that objects that leave the visual field still exist. A typical example of the development of object permanence is when infants are able to pursue objects they observe being hidden under a pillow or behind a chair. This skill develops at approximately 9 to 10 months of age, which corresponds to the time of increased locomotion skills. The type of play in which infants engage is called: a. Onlooker b. Parallel c. Associative d. Cooperative - Correct Answer Answer: A Rationale: when the child watches others at play but does not engage in it. The child may engage in forms of social interaction, such as conversation about the play, without actually joining in the activity. This type of activity is also more common in younger children What are clinical manifestations of failure to thrive? (Select all that apply) a. Growth failure

b. Developmental delays c. Avoidance of eye contact d. Smiling e. Fear of strangers - Correct Answer Answers: A, B, C Rationale: Clinical manifestations of failure to thrive include growth failure, developmental delays, malnutrition, apathy, withdrawn behavior, feeding or eating disorders, and avoidance of eye contact. Smiling and fear of strangers are not clinical manifestations of failure to thrive. What must the nurse teach the parents of the child with cystic fibrosis about the use of pancreatic enzymes? a. Extra enzymes must be taken with high-fat foods. b. Enteric-coated beads may be chewed or crushed. c. Mix the powder-form enzyme with the entire meal. d. Fat-soluble forms of vitamins are added with the food. - Correct Answer Answer: A Rationale: The child with cystic fibrosis is unable to digest the fat content in foods. Therefore, the child must be encouraged to take extra enzymes when high-fat foods are eaten. Enteric-coated beads must not be chewed or crushed, because destroying the enteric coating can lead to inactivation of the enzymes and excoriation of oral mucosa. The beads prevent the neutralization of enzymes by gastric acids, thus allowing activation to occur in the alkaline environment of the small bowel. The powder form should be mixed with only a small amount of food to be taken at the beginning of the meal, because it predigests the food, making it unpalatable. Enzymes must be taken within 30 minutes of eating. Water-soluble forms of vitamins are given along with the food and enzymes, because the uptake of fat-soluble forms of vitamins is decreased. A nurse is teaching an adolescent about the appropriate use of his asthma medications. Which of the following medications should the nurse instruct the adolescent to use before he participates in exercise? a. Albuterol b. Prednisone c. Montelukast d. Fluticasone/salmeterol - Correct Answer Answer: A Rationale: Exercise is advantageous for children with asthma, and most children can participate in activities at school and in sports with minimal difficulty, provided their

asthma is under control. Evaluate participation on an individual basis. Appropriate prophylactic treatment with short-acting β-adrenergic agents or cromolyn sodium before exercise usually permits full participation in strenuous exertion. A child with asthma is undergoing pulmonary function tests. What is the purpose of the peak expiratory flow rate test? a. Used to assess the severity of asthma. b. Used to determine the cause of asthma c. Used to identify the triggers of asthma d. Used to confirm the diagnosis of asthma - Correct Answer Answer: A Rationale: The peak expiratory flow rate (PEFR) test is a measure of the maximal amount of air that can be forcefully exhaled in 1 minute. This can provide an objective measure of pulmonary function when compared with the child's baseline. The diagnosis of asthma is made on the basis of clinical manifestations, history, and physical examination, not pulmonary function tests such as the PEFR. The cause of asthma is inflammation, bronchospasm, and obstruction, which are not identified by the PEFR. Some of the triggers of asthma are identified with allergy testing, not with the PEFR. A 5 - year-old is recovering from a tonsillectomy and adenoidectomy and is being discharged home with his mother. Home care instructions should include which of the following? a. Observe the child for continuous swallowing. b. Encourage the child to take sips of hot, clear liquids. c. Administer codeine elixir as necessary for throat pain. d. Encourage the child to drink cranberry juice with a straw - Correct Answer Answer: A Rationale: Discharge instructions include (1) avoiding foods that are irritating or highly seasoned, (2) avoiding the use of gargles or vigorous toothbrushing, (3) discouraging the child from coughing or clearing the throat or putting objects in the mouth, (4) using analgesics and opioids for pain, and (5) limiting activity to decrease the potential for bleeding. Hemorrhage may occur up to 10 days after surgery as a result of tissue sloughing from the healing process. Any sign of bleeding warrants immediate medical attention. Objectionable mouth odor and slight ear pain with a low-grade fever are common for a few days postoperatively. However, persistent severe earache, fever, or cough requires medical evaluation. Most children are ready to resume normal activity within 1 to 2 weeks after the operation.

What assessment finding does the nurse recognize as a manifestation of acute otitis media (AOM)? a. Presence of fever and otalgia, or earache b. Presence of tinnitus or a feeling of fullness c. Presence of rhinitis, cough, and diarrhea d. Presence of discolored tympanic membrane - Correct Answer Answer: A Rationale: An inflammation of the middle ear space with a rapid onset fever and otalgia indicates AOM. A diagnosis of AOM is made if inspection of the tympanic membrane reveals a purulent discolored effusion and a bulging or full, opacified, or reddened immobile membrane. The patient with chronic otitis media has a feeling of fullness, tinnitus, or vertigo. Nonspecific symptoms such as rhinitis, cough, or diarrhea are often present in otitis media with effusion (OME). An immobile tympanic membrane or an orange, discolored membrane also indicates OME. A 5 - year-old is seen in the urgent care clinic with the following history and symptoms: sudden onset of severe sore throat after going to bed, drooling and difficulty swallowing, axillary temperature of 102.2°F (39.0°C), clear breath sounds, and absence of cough. The child appears anxious and is flushed. Based on these symptoms and history, the nurse anticipates a diagnosis of: a. Acute epiglottitis b. Acute tracheitis c. Group A β-hemolytic streptococcus (GABHS) pharyngitis d. Acute laryngotracheobronchitis - Correct Answer Answer: A Rationale: The onset of epiglottitis is abrupt, less often preceded by cold symptoms and more often by a sore throat. It can rapidly progress to severe respiratory distress. The child usually goes to bed asymptomatic to awaken later complaining of sore throat and pain on swallowing. The child has a fever and appears sicker than clinical findings suggest. The child insists on sitting upright and leaning forward (tripod position), with the chin thrust out, mouth open, and tongue protruding. Drooling of saliva is common because of the difficulty or pain on swallowing and excessive secretions. Age Group effected is 2 - 5 years but varies. A 5 - year-old child is brought to the emergency department with abrupt onset of sore throat, pain with swallowing, fever, and sitting upright and forward. Acute epiglottitis is suspected. What are the most appropriate nursing interventions? (Select all that apply.) a. Vital signs

b. Medical history c. Assessment of breath sounds d. Ready availability of emergency airway equipment (tracheostomy tray or oral/nasal intubation) e. Throat culture - Correct Answer Answers: A, B, C, D Rationale: Vital signs should always be taken as a part of the assessment. Medical history is important because it aids diagnosis and allows the medical team to know the child's immunization status. Assessment of breath sounds is important because it aids diagnosis. Suprasternal and substernal retractions may be noted. Emergency airway equipment must be readily available in case the airway becomes obstructed. Throat culture should never be done when epiglottis is suspected. Manipulation of the throat could stimulate the gag reflex in an already inflamed airway and cause laryngeal spasm that could occlude the airway. What is an important nursing intervention in the care of a child with bacterial conjunctivitis? a. Intermittent warm, moist compresses to remove crusts on the eye area b. Oral antihistamines to minimize itching c. Continuous cold compresses to relieve discomfort d. Application of optic corticosteroids to reduce inflammation - Correct Answer Answer: A Rationale: The eye should be kept clean. Intermittent warm, moist compresses can soften the crusting for easier removal, maintaining the cleanliness of the eye. Antihistamines are not usually necessary for bacterial conjunctivitis. Continuous, occlusive compresses would promote bacterial growth. Antibiotics are the treatment of choice for bacterial infections; optic corticosteroids are not warranted. The school nurse is concerned about an outbreak of chickenpox, because two children at the school have cancer and are immunodeficient as a result of chemotherapy. What is the most appropriate recommendation the school nurse can give to the two children's parents? a. Administer varicella zoster immune globulin (VZIG) to prevent chickenpox. b. No precautions are necessary c. Temporarily stopping chemotherapy will allow the immune system to recover. d. Acyclovir should be taken to minimize the symptoms of chickenpox. - Correct Answer Answer: A

Rationale: VZIG is an antibody to the virus that causes chickenpox. Administration of VZIG can prevent development of the disease in children who are immunocompromised due to chemotherapy. Chickenpox can be a life-threatening event for a child who is immunocompromised and must be addressed. The administration of VZIG does not place the child at any greater risk; therefore, there is no need to stop chemotherapy. Acyclovir is effective in reducing the number of lesions from chickenpox, but in immunodeficient children the disease itself should be prevented. An infant has a low-grade fever, is sneezing, has tearing eyes, and exhibits a short and rapid cough that occurs mainly at night and is followed by a crowing sound. Which nursing actions are appropriate for this patient? Select all that apply. a. Provide humidified oxygenation and suction. b. Place the patient on droplet precautions. c. Place the child on the bed in a supine position. d. Restrict oral fluids since these can aggravate the cough. e. Administer mild sedatives to the child as necessary. - Correct Answer Answers: A, B Rationale: The child's symptoms are indicative of pertussis (whooping cough). Therefore, the nurse should provide humidified oxygen to the child and suction him or her as needed. The nurse should also use droplet precautions for the child, because pertussis can be transmitted through droplets. The child is at risk of aspiration during coughing fits. Therefore, the child should be placed on his or her side rather than in the supine position in the bed. The child needs oral fluids for adequate hydration. Mild sedatives are given to children with poliomyelitis, because they help to relieve anxiety and promote rest; they are not used when children have pertussis. Strict isolation is required for a child who is hospitalized with which infectious disease? a. Chickenpox b. Mumps c. Exanthema subitum (roseola) d. Erythema infectiosum (Fifth disease) - Correct Answer Answer: A Rationale: Chickenpox is communicable through direct contact, droplet spread, and contaminated objects. The child hospitalized for chickenpox should therefore be strictly isolated. Mumps is transmitted by way of direct contact with saliva of an infected person and is most communicable before the onset of swelling. The transmission and cause of exanthema subitum (roseola) are unknown. Erythema infectiosum (Fifth disease) is communicable before the onset of symptoms.

How can the nurse prepare a child for a painful procedure? a. Involve the child in the use of distraction, such as using bubbles, music, or playing a game. b. Tell the child not to cry. c. Kindly ask parents to leave the room so they don't have to watch the painful procedure. d. Instruct the child that the procedure will not hurt. - Correct Answer Answer: A Rationale: Children should learn to use a specific strategy before pain occurs or before it becomes severe. Instructions for a strategy, such as distraction or relaxation, can be audiotaped and played during a period of comfort. However, even after they have learned an intervention, children often need help using it during a painful procedure. The intervention can also be used after the procedure. This gives the child a chance to recover, feel mastery, and cope more effectively. The nurse works in a vaccination clinic. Which patients should receive the measles, mumps, and rubella (MMR) vaccine? Select all that apply. a. A 12 - month-old baby with a cold b. A 14 - month-old baby allergic to eggs c. A breastfeeding mother d. A pregnant woman in the third trimester e. A pregnant woman in the first trimester - Correct Answer Answers: A, B, C Rationale: A nurse should be aware of some of the common contraindications to all the vaccines. Common cold or flu is not a contraindication to immunization, although severely ill patients should not be given any vaccines. Measles and mumps vaccines, which are grown in chick embryo tissue cultures, do not contain a significant amount of egg cross- reacting proteins. Therefore, egg allergy is not a contraindication to MMR vaccine. Similarly, breastfeeding is not a contraindication to MMR vaccine. However, MMR is a live virus vaccine that should not be given to any pregnant women, irrespective of their gestational age. Which childhood vaccine provides some protection against bacterial meningitis, epiglottitis, and bacterial pneumonia? a. Hib vaccine b. Hepatitis B vaccine c. Varicella vaccine

d. Influenza vaccine - Correct Answer Answer: A Rationale: Hib conjugate vaccines protect against a number of serious infections caused by H. influenzae type b, especially bacterial meningitis, epiglottitis, bacterial pneumonia, septic arthritis, and sepsis (Hib is not associated with the viruses that cause influenza, or "flu"). A nurse is preparing to assess a preschooler. Which of the following actions should the nurse take to prepare the child? a. Allow the child to role play using miniature equipment. b. Use medical terminology to to describe what will happen. c. Separate the child from the caregiver during the examination. d. Begin the assessment in a head to toe fashion. - Correct Answer Answer: A An infant with a congenital heart defect is being given palivizumab. What is the purpose of this medication? a. Prevent respiratory syncytial virus (RSV) infection b. Decrease toxicity of antiviral agents c. Prevent secondary bacterial infection d. Make isolation of the infant who has RSV infection unnecessary - Correct Answer Answer: A Rationale: Palivizumab is a monoclonal antibody specifically used in the prevention of respiratory syncytial virus (RSV). Monthly administration is expected to prevent infection with RSV. The goal of this drug is prevention of RSV. It will not affect the need to isolate the child if RSV develops. Palivizumab is specific to RSV, not bacterial infections. Palivizumab will have no effect on antiviral agents. An infant with a tracheostomy tube starts to display signs of respiratory distress. What situation requires an immediate tube change? a. Inability to pass the suction catheter to the end of the tube b. Contamination of the suction catheter c. Respiratory rate of 30 breaths/min d. Passage of suction catheter after instillation of saline solution - Correct Answer Answer: A

Rationale: An immediate tube change is needed when a suction catheter cannot be passed to the end of the tube despite several attempts and instillation of saline. Passage of the suction catheter after instillation of saline solution does not require an immediate tube change. An immediate tube change is not needed when the respiratory rate that returns to normal (30 breaths/min for infants), because this indicates that the catheter is open. Which intervention will decrease separation anxiety when a child is in the hospital? A. Switching off the lights in the child's room B. Providing chocolate candy when the child cries C. Providing the child's favorite blanket and toy D. Leaving the child alone for small amounts of time - Correct Answer Answer: C Rationale: Providing the child's favorite toy or blanket will give the child a sense of security and familiarity. Because young children associate such inanimate objects with significant people, they gain comfort and reassurance from these possessions. Switching off the lights may scare the child. Providing chocolate candy whenever the child cries will make the child think that he or she will be rewarded with chocolate every time he or she cries. The child may get scared if he or she is left alone in the hospital surroundings. Which are expected findings for otitis media? A. Fever, ear pain noted by tugging of the ear. B. Vomiting, diarrhea & increased appetite. C. Dizziness & nuchal rigidity. D. Clear ear drainage & insomnia. - Correct Answer Answer: A Rationale: Otitis Media is a middle ear infection. Expected findings include fever, purulent drainage (if the tympanic membrane is ruptured), and pain demonstrated by the child tugging at the ear. What does Erikson describe in his theory of psychosocial development as the most important task for school-age children? A. Sense of autonomy, in which children want to do things for themselves B. Sense of industry, in which children enjoy competing tasks. C. Sense of trust, in which children form basic trust in people around them

D. Sense of initiative, children explore their world with all their senses - Correct Answer Answer: B Rationale: In his theory of psychosocial development, Erikson posits that the most important task for school-age children is to develop a sense of industry, in which children have access to tasks that need to be done and are able to complete them. A sense of autonomy, in which children want to do things for themselves, is the task for psychosocial development in children ages 1 to 3 years. A sense of trust, in which children form basic trust in the people around them, is the task for psychosocial development in children from birth to 1 year of age. A sense of initiative, in which children form basic trust in the people around them, is the task for psychosocial development in children ages 3 to 6 years. True or False: As a rule of thumb, an infant's birth weight should double by one year of age. - Correct Answer Answer: False Rationale: In a normally developing infant, the body weight at the end of one year is approximately three times the birth weight of the Infant. Example: the approximate weight of the neonate who weighs 7 pounds at the end of one year would be (7 x 3 = 21); 21 pounds. Birth weight typically doubles at 6 months of age. A nurse is educating mothers about infant safety & injury prevention. Which information should the nurse include? A. Administer medications as a candy to get cooperation from an infant. B. Mobile walkers increase coordination and prevent falls in infants. C. Keep the infant's play area free of rugs, mats, and large objects. D. Maintain one hand on the infant at all times while in the bath tub. - Correct Answer Answer: D Rationale: Keeping one hand on the infant at all times helps prevent bath tub drowning. Telling the infant that medications are candy to get cooperation confuses the infant and creates a safety hazard, because when the infant discovers a medication independently, they will want to eat it also. Mobile walkers do not increase coordination or prevent falls. It is not necessary to keep the infant's play area free of rugs, mats, and large objects; however, it is necessary to keep the area free of small objects that the infant may ingest that could cause an airway obstruction. A milestone in the infant's life is the development of object permanence. Which statement best indicates this? A. The infant turns and looks for the mother when she walks out of his view.

B. The infant repeatedly flexes and extends his arms and legs when the mother picks him up. C. The infant cries when the mother hands him to a babysitter. D. The infant smiles at the mother when she talks to him. - Correct Answer Answer: A Rationale: This is an example of object permanence that usually develops by 8 months. B & C are not. D is an example of separation anxiety that begins around 6 months and lasts until 36months. True or False: A symptom of Enterobiasis (Pinworms) is intense anal itching. - Correct Answer Answer: True Rationale: Enterobiasis (Pinworms) Enterobiasis, or pinworms, caused by the nematode Enterobius vermicularis, is the most common helminthic infection in the United States. Transmission is favored in crowded conditions, such as in classrooms and day care centers. Infection begins when the eggs are ingested or inhaled (the eggs float in the air). The eggs hatch in the upper intestine and then mature and migrate through the intestine. After mating, adult females migrate out the anus and lay eggs. The movement of the worms on skin and mucous membrane surfaces causes intense itching. What is the normal age that the anterior fontanel closes? A. 6 weeks B. 14 months C. 8 weeks D. 36 months - Correct Answer Answer: B Rationale: The anterior fontanel usually closes between 12 to 18 months of age (average, 14 months). The posterior fontanel closes by 6 weeks to 8 weeks of age. By 36 months of age, all fontanels in the cranium are closed. What is the recommended age for a child to begin primary immunizations? A. 2 months B. 4 months C. 12 months D. At birth - Correct Answer Answer: D Rationale: The recommended age for children to begin primary immunizations is from birth to 2 weeks, according to the Committee on Infectious Diseases of the American

Academy of Pediatrics and the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC). For children who were not immunized at birth, there is a catch-up schedule on the CDC website. The ages 2 months, 4 months, and 12 months are too late and will require catch-up immunizations. A mom calls the HCP to report her child has a T of 102° F & a large red welt on his thigh after an immunization. What should the nurse advise the mother to do? A. Give the child a baby aspirin every 4 hours. B. This is normal after an immunization and will resolve soon. C. Tell her the symptoms could not be related to the immunizations. D. Have her bring the child in to be evaluated by the HCP. - Correct Answer Answer: D Rationale: Only mild fever and discomfort are expected after an immunization. More serious symptoms should be assessed by the HCP. Aspirin usually is not given to children because of its relationship to Reye's syndrome (especially with varicella immunizations). True or False: A nurse is preparing immunizations for a 12 - mon-old who is immunocompromised. The varicella vaccine can be given safely. - Correct Answer Answer: False Rationale: In general, live virus vaccines such as varicella and MMR should not be administered to persons who are severely immunocompromised. Rotavirus too. Nurse is teaching child-safety classes to parents of preschoolers. Which is helpful to prevent foreign body aspiration? A. Knowledge of the most common objects that preschoolers aspirate. B. Knowledge of the therapeutic management of foreign body aspiration. C. Knowledge of the risks associated with foreign body aspiration. D. Knowledge of the signs and symptoms of foreign body aspiration. - Correct Answer Answer: A Rationale: Without knowing what objects preschoolers most commonly aspirate, it is difficult to teach parents what objects to keep out of reach of the child, and what objects they should avoid having in the house. Nurses are in a position to teach prevention in a variety of settings. They can educate parents singly or in groups about hazards of aspiration in relation to the developmental level of their children and encourage them to teach their children safety. Parents should be cautioned about behaviors that their children might imitate (e.g., holding foreign objects, such as pins, nails, and toothpicks, in their lips or mouth)

Which of the following is the leading cause of death in infants younger than 1 year of age? A. Sudden infant death syndrome B. Respiratory distress syndrome C. Congenital anomalies D. Infections specific to the perinatal period - Correct Answer Answer: C Rationale: Congenital anomalies are the leading cause of death in the first year of life. A previously "potty-trained" 3yr old has reverted to wearing diapers while hospitalized. What explains this behavior? A. Developmental delays occur because of the hospitalization. B. Regression is frequently seen during hospitalization. C. The child was too young to be "potty-trained." D. The child is experiencing urinary urgency because of hospitalization. - Correct Answer Answer: B Rationale: Regression is expected and normal for all age-groups when hospitalized. Nurses should assure the parents this is temporary and the child will return to the previously mastered developmental milestone when back home. This does not indicate a developmental delay. The child should not be experiencing urinary urgency because of hospitalization and this would not be normal. Successful "potty-training" can be started at 2 years of age if the child is ready. A 5 - year-old tells the nurse that she "needs a Band-Aid" where she had an injection. Which is the best intervention? A. Ask her why she wants a Band-Aid. B. Explain why a Band-Aid is not needed. C. Show her that the bleeding has already stopped. D. Apply a Band-Aid after the injection site. - Correct Answer Answer: D Rationale: Because of toddlers' and preschool children's poorly defined body boundaries, the use of bandages may be particularly helpful. For example, telling children that the bleeding will stop after the needle is removed does little to relieve their fears, but applying a small Band-Aid usually reassures them. This age group is concerned with body integrity.

Which would be a preferred oral fluid choice to offer a child in the initial post op period following a Tonsillectomy? A. Cola (room temperature) B. Crushed ice C. Cherry popsicle D. Chocolate milkshake - Correct Answer Answer: B Rationale: Cold, clear liquids are well tolerated following a tonsillectomy. Liquids that are brown or red should be avoided in order to tell the difference between liquid or blood. Dairy products increase the viscosity of the mucous—causing the child to clear the throat frequently and can lead to bleeding. Speaking of food. What is an appropriate snack choice for a toddler? A. Fruit snacks B. Grapes C. Bananas D. Hot dogs - Correct Answer Answer: C Rationale: Children are at increased risk of choking until about the age of 4. A toddler can have difficulty chewing and swallowing grapes/fruit snacks/hot dogs. They should avoid circular foods. True or False: A neat pincer grasp is a fine motor skill of a 2 - month-old. - Correct Answer Answer: False Rationale: A 2 - month-old infant has a strong grasp. The neat pincer grasp is the fine motor skill of a 10 - month-old infant. Clinical manifestations of varicella are? SATA A. Fever B. Itchy vesicles C. 3 stages of rash (papule, vesicle & crusted) D. Fine red rash - Correct Answer Answers: A, B, C Rationale: Slight fever, malaise, and anorexia for first 24 hours; rash highly pruritic; begins as macule, rapidly progresses to papule and then vesicle (surrounded by erythematous

base; becomes umbilicated and cloudy; breaks easily and forms crusts); all three stages (papule, vesicle, crust) present in varying degrees at one time. Which vaccine should the nurse be cautious administering if the child has an egg allergy? A. Polio vaccine B. Hib vaccine C. Hepatitis B D. Influenza - Correct Answer Answer: D Rationale: The American Academy of Pediatrics (2015) recommends an assessment of the egg allergenic reaction—mild (such as hives alone) versus severe (such as an anaphylactic reaction)—before making a decision about the vaccine administration to children who have a history of egg allergy. A toddler is in isolation. Which toys are developmentally appropriate? A. Large plastic blocks B. Playdough C. Hanging crib mobile D. Crayons and a coloring book - Correct Answer Answer: A Rationale: Large plastic blocks are appropriate for this age group and for isolation. True or False: Intercostal retractions are signs of respiratory distress in children and requires immediate intervention. - Correct Answer Answer: True Rationale: The use of accessory muscles shows an increased work of breathing and is a sign of respiratory distress. Nasal flaring and grunting newborn period. True or False: The infant should sit unsupported by 6 months old. - Correct Answer Answer: False Rationale: The infant should sit unsupported by 8 months old. By 10 months old the infant should change from a prone to a sitting position and stand while holding onto furniture. Which topics should the Pediatric nurse discuss with parents of a young child to promote health in their child? A. Dental care needs to be started by age 7.

B. Immunization schedule and the importance of immunizations. C. Human milk or iron fortified formula for the first 4 months of life. D. Positioning the car seat in the front passenger seat. - Correct Answer Answer: B Rationale: Immunizations have made a major impact in the prevention of disease in children. The nurse should review individual immunization records at every clinic visit, avoid missing opportunities to vaccinate, and encourage parents to keep immunizations current. Dental caries is the single most common chronic disease of childhood and may begin before the first birthday. Human milk or iron fortified formula for should be given for the first year of life to prevent Iron Deficiency anemia. Children younger than 1 year of age have the highest rate of death from motor vehicle accidents, primarily from a failure to properly use car restraints. An infant is undergoing phototherapy. What is priority in the nursing care management? A. Apply lotion to the skin B. Ensure NPO status C. Expose to light 20 minutes per day D. Count the wet diapers - Correct Answer Answer: D Rationale: Fluid losses caused by phototherapy lights could lead to dehydration; therefore counting wet diapers is crucial in ensuring that the infant is well hydrated. Ensuring that the infant's skin is fully exposed to an adequate amount of a light source is another important nursing intervention for the nurse to implement with this infant. Usually the infant is exposed to light for more than 30 minutes a day. Lotions are not used on infants undergoing phototherapy because they may predispose the infant to increased tanning, or the "frying" effect. Because the infant is at high risk for dehydration, which can lead to poor perfusion as a result of the large surface area, nothing-by-mouth (NPO) status is not appropriate. What self-report pain rating scales can be used in children as young as 3 years of age? A. FACES Pain Rating Scale B. Visual Analog Scale C. Word-Graphic Rating Scale D. Who Cares? - Correct Answer Answer: A Rationale: The FACES Pain Rating Scale is for children as young as 3 years of age. The Visual Analog Scale can be used for children older than 4 years of age but is most

appropriate for ages 7 and older. The Word-Graphic Rating Scale uses descriptive words and is recommended for children 4 to 17 years of age. What is the most consistent and commonly used indicator of pain in infants? A. Thrashing of arms and legs. B. Increased heart rate. C. Increased respirations. D. Facial expression of discomfort. - Correct Answer Answer: D Rationale: Facial expression of discomfort. Facial expression has consistently been validated as an indicator of pain in infants. Behavioral pain measures are most reliable for sharp procedural pain in infants. Increased heart rate and respirations are indicative of a generalized and complex response to stress. They are not specific for pain in infants. Thrashing of arms and legs is a reliable indicator in young children, not infants. FLACC scale is most commonly used. What are some warning signs of physical abuse in children? (Select all that apply). A. Delay in seeking medical care B. History incompatible with the pattern or degree of injury C. Multiple 'old' fractures noted on skeletal survey D. Inappropriate response of the child in relation to the child's injury - Correct Answer Answer: A, B, C, D Rationale: Warning signs of physical abuse in children include multiple fractures, delay in seeking medical care, inappropriate affect in relation to the injury, and incompatible history with the pattern or degree or injury. Histories are similar among caregivers, not inconsistent. What does the DTaP vaccine prevent? - Correct Answer DTaP vaccine can prevent diphtheria, tetanus, and pertussis. Diphtheria and pertussis spread from person to person. Tetanus enters the body through cuts or wounds. Who receives the DTaP vaccine? - Correct Answer DTaP is only for children younger than 7 years old. Different vaccines against tetanus, diphtheria, and pertussis (Tdap and Td) are available for older children, adolescents, and adults.

What is the recommended vaccine schedule for the DTaP vaccine? - Correct Answer It is recommended that children receive 5 doses of DTaP, usually at the following ages: 2 months 4 months 6 months 15 - 18 months 4 - 6 years When should the DTaP vaccine not be given? - Correct Answer Children with minor illnesses, such as a cold, may be vaccinated. Children who are moderately or severely ill should usually wait until they recover before getting DTaP. Has seizures or another nervous system problem. Has ever had Guillain-Barré Syndrome What are common reactions after receiving a DTaP vaccine? - Correct Answer Soreness or swelling where the shot was given, fever, fussiness, feeling tired, loss of appetite, and vomiting sometimes happen after DTaP vaccination What does the Hib vaccine prevent? - Correct Answer Hib vaccine can prevent Haemophilus influenzae type b (Hib) disease. When should the Hib vaccine be given? - Correct Answer Hib vaccine is usually given as 3 or 4 doses (depending on brand). Hib vaccine may be given as a stand-alone vaccine, or as part of a combination vaccine (a type of vaccine that combines more than one vaccine together into one shot). Infants will usually get their first dose of Hib vaccine at 2 months of age, second dose at 4 months of age, and will usually complete the series at 12 - 15 months of age. What does the rotavirus disease prevent? - Correct Answer Rotavirus vaccine can prevent rotavirus disease. Rotavirus causes diarrhea, mostly in babies and young children. The diarrhea can be severe, and lead to dehydration. Vomiting and fever are also common in babies with rotavirus.

When and how should the rotavirus vaccine be administered? - Correct Answer Rotavirus vaccine is administered by putting drops in the child's mouth. Babies should get 2 or 3 doses of rotavirus vaccine, depending on the brand of vaccine used. The first dose must be administered before 15 weeks of age. The last dose must be administered by 8 months of age. What are some common adverse effects of the rotavirus vaccine? - Correct Answer Irritability or mild, temporary diarrhea or vomiting can happen after rotavirus vaccine. What is a more severe adverse effect of the rotavirus vaccine? What should you look for?

• Correct Answer There is also a small risk of intussusception from rotavirus vaccination, usually within a week after the first or second vaccine dose. For intussusception, look for signs of stomach pain along with severe crying. Early on, these episodes could last just a few minutes and come and go several times in an hour. Babies might pull their legs up to their chest. Your baby might also vomit several times or have blood in the stool, or could appear weak or very irritable. These signs would usually happen during the first week after the first or second dose of rotavirus vaccine, but look for them any time after vaccination. What does the varicella vaccine prevent? - Correct Answer Varicella vaccine can prevent chickenpox. What is the recommended vaccination schedule for the varicella vaccine? - Correct Answer Children need 2 doses of varicella vaccine, usually: First dose: 12 through 15 months of age Second dose: 4 through 6 years of age Older children, adolescents, and adults also need 2 doses of varicella vaccine if they are not already immune to chickenpox. When is the varicella vaccine contraindicated? - Correct Answer Has a weakened immune system, or has a parent, brother, or sister with a history of hereditary or congenital immune system problems. Is taking salicylates (such as aspirin). Has recently had a blood transfusion or received other blood products. Has tuberculosis.