Nursing fundamental exam Ped questions with answers tested and verified solutions, Exams of Nursing

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Nursing fundamental exam Ped questions with

answers tested and verified solutions

The progression of function in infants can be described by which patterns of growth and development? Simple to complex General to specific ➢ (^) A rapid pace of growth is common in which age group? From birth to 2 years From puberty to 15 years ➢ (^) A nurse is measuring the height and weight of a 4-year-old child during the well-child visit. The child's parents comment that they are concerned that the child's growth seems to have slowed down since the child was a toddler. The nurse knows that this is because of which factors? Normal growth slows down in this age group. It is normal for children to have slowed patterns of growth between age 2 and the onset of puberty. Rapid growth tends to occur during infancy/toddlerhood and puberty. ➢ (^) A typical dietary pattern for optimal growth and development includes which proportions of fat, carbohydrate, and protein? 20% fat, 50% carbohydrate, and 30% protein These proportions allow infants and children the nutrients to meet metabolic needs. When these proportions are not included in daily meals, children are at increased risk for developing disease. ➢ (^) Multifactorial birth defects result because of a combination of which two factors? Genetics Environment ➢ (^) Which two influences on growth and development increase the risk of occurrence of multifactorial birth defects? If one close relative has a severe form of the defect, then the risk for multifactorial birth defects increases. If several close relatives have the defect, whether mild or severe, it will increase the risk for multifactorial birth defects. ➢ (^) Which are the best resources to find an appropriate growth chart in assessing growth for a 1-year-old child? World Health Organization (WHO) growth standards for this age group

The CDC recommends that health care providers use the World Health Organization (WHO) growth standards to monitor growth for infants and children ages 0 to 2 years of age and the CDC growth charts for children age 2 years and older. The reason is that the data collected for the WHO growth charts represent infants and children who were breastfed during their first year of life, and this is considered to be the optimal standard of measurement for comparison. ➢ (^) A 6-month-old infant is brought to the clinic and after assessing the child's head circumference, the nurse notes that the head circumference for this baby has gone from the 50th percentile to 10th percentile since the 2-month visit. What might this indicate? A delay in skull growth Disturbances in nutrition intake A problem with brain development ➢ (^) The nurse is assessing a newborn and notes that the head circumference is 13 inches and the chest circumference is 11 inches. What conclusion can be made by the nurse about this ratio? The newborn is presenting with a normal growth pattern. The chest circumference of newborns is often smaller than the head circumference and therefore this is a normal presentation at birth. ➢ (^) How does Erickson's theory of child development influence pediatric nursing? It provides a theoretical basis for the emotional care required for nursing. Erikson's main contribution to the study of human development lies in his outline of a universal sequence of phases of psychosocial development influences. This information aids pediatric nursing by providing a framework for how to work with children of different ages and developmental levels. ➢ (^) Which statement reflects a child's ability to develop autonomy according to Erikson? The child is able to pour milk from a cup. Erikson suggested that, for a toddler, one important developmental task is to acquire a sense of autonomy rather than a sense of shame and doubt. ➢ (^) A mother presents to the nurse and states, "just recently my child has developed a positive, 'can-do' attitude towards all of her tasks." Based on this comment the child has recently reached which stage of psychosocial development according to Erikson? Initiative vs guilt ➢ (^) According to Piaget's cognitive theory, which concept is demonstrated by an infant looking for a pacifier that has fallen out of the crib? Object permanence

This scenario reflects the development of object permanence, which is the awareness that objects continue to exist even when they disappear from sight. Object permanence develops in the sensorimotor period, when reflexive behavior is used to adapt to the environment and the child has an egocentric view of the world. ➢ (^) What is a child at the concrete operational stage able to understand? Fact vs. fiction During the period of concrete operations, the child is no longer bound by perceptions and can distinguish fact from fantasy. The concept of time becomes increasingly clear during this stage, although far past and far future events remain obscure. Although reasoning powers increase rapidly during this stage, the child cannot deal with abstractions or with socialized thinking. ➢ (^) Match the period of cognitive development with the appropriate characteristic. Egocentric view of the world - Sensorimotor Thinking is magical and dominated by perception - Preoperational Thinking becomes logical - Concrete operational Situations can be analyzed - Formal operational ➢ (^) A school-age child asks the school nurse about sexual development, which indicates that the child is in which Freudian stage of development? Phallic or Oedipal/Electra stage During this stage the genitals become the focus of sexual curiosity, the superego (conscience) develops, and feelings of guilt emerge. Children at this stage are school age and often ask many questions.

➢ (^) Match Freud's stage of psychosexual development to the corresponding activity. Child is found playing with contents of diaper - Anal stage Child has an increased interest in genitals - Phallic stage Child's superego represses thoughts of sexuality - Latency stage Child experiences personal and family turmoil - Puberty stage ➢ (^) Order the stage of psychosexual development as they occur in chronological order. Oral Stage—infancy Anal Stage—toddlerhood Phallic Stage—pre-school Latency Stage—school-age Puberty—adolescence ➢ (^) A child prefers to be with friends rather than with parents. The child is demonstrating which of Kohlberg's levels of morality? Level of self-accepted moral principles This is a stage that reflects a time when a child is social and will want to be with friends. The individual will develop a conscience at this stage. This stage is usually experienced by adolescents who will be social and want to spend time with friends rather than with parents. ➢ (^) Match the scenarios with the corresponding stages or levels of morality as stated by Kohlberg. Premorality or preconventional morality, stage 0 Decisions are made on the basis of what pleases the child. Morality of conventional role conformity Morality is based on avoiding disapproval or disturbing the conscience. Morality of self-accepted moral principles Right is determined by what is best for the majority. Premorality or preconventional morality, stage 2 Child conforms to rules out of self-interest. ➢ (^) A 5-year-old who steals money from his or her mother's purse and does not understand consequences is likely at which stage of morality? Premorality/preconventional morality Instrumental hedonism and concrete reciprocity

➢ (^) The nurse is creating safety brochures about the prevention of poisoning for different population groups. The nurse identifies which recommendations to include for parents and caregivers of infants? Lock all medication cabinets. Place all houseplants out of reach. Evaluate your home for lead sources. ➢ (^) The nurse is teaching the mother of a newborn about the prevention of infant asphyxiation. Which priority strategy does the nurse recommend the parents implement even before the infant is mobile? Remove crib decorations and fluffy bedding. ➢ (^) An infant is in the clinic for a six-month well visit. Height and weight are in the 50th percentile. The infant can sit and shows an interest in food. Which foods should the nurse recommend the parents introduce at this stage? Rice cereal mixed with breast milk or formula ➢ (^) The parents of a six-month-old infant report excessive drooling, fussiness, and loss of appetite. Which practices should the nurse recommend that may relieve these symptoms? Teething ring Frozen bagels Clean wet washcloth ➢ (^) The public health nurse is teaching community nurses about factors affecting the health of infants. Which factors that may affect infant risk for dental caries should the nurse include in the lesson? Coming from a low family income Using bottled water to mix formula Drinking after a mother with cavities Offering soda in a sippy cup to the baby ➢ (^) A mother of a male baby reported smoking occasionally while pregnant. She reports allowing the baby to sleep in the bed with her, on a firm mattress without any covers. Which factors put this baby at risk for SIDS? Being a male baby Smoking occasionally in the house Allowing the baby to sleep in the bed ➢ (^) The mother of a one-month-old infant asks the nurse for advice on establishing safe and consistent sleep practices. What recommendations does the nurse provide?

Place the baby to sleep on the back. Give the baby a warm bath before bed. Put the baby to sleep at the same time every night. Put the baby to sleep when the baby is drowsy, but awake. ➢ (^) A new mother reports that the baby is sleeping next to her own bed in a bassinet with a small pillow. She reports laying the baby on the back to sleep and says she has banned cigarette smoking in the house. The nurse identifies which practice as putting the baby at risk for SIDS? Using a small pillow in the bassinet ➢ (^) The mother of an infant asks the nurse for suggestions about ways to calm her infant's crying. Which response(s) by the nurse are appropriate? "Crying may cause increased gas causing pain." "You can try swaddling. This can be very calming." "Using a baby swing can comfort an irritable infant." ➢ (^) Match the infant age with the most appropriate developmental action. Takes one or two naps- 12 months old Can begin to self-soothe - Four months old Sleeps 16 hours per day - Newborn Consistently sleeps all night - Six months ➢ (^) The nurse would expect to observe which behaviors in an infant with an insecure parental attachment? The infant is more easily comforted by a babysitter than the parent. ➢ (^) The nurse is teaching new parents about motor vehicle safety recommendations for their new baby. Place the safety recommendations in chronological order, starting with those necessary for a newborn. Use a rear-facing car seat with three or five-point harness. Use a front-facing car seat with three or five-point harness. Use a forward-facing car or booster seat in the back seat. Use the back seat with a three-point seat belt. ➢ (^) A patient has had an extended hospital stay and is demonstrating symptoms of low self- esteem. Which action by the nurse would allow the child to gain a sense of autonomy? Provide the child instruction on his wound care Allow the child to decide on times of medication administration. Encourage the patient to discuss feelings about low self-esteem and personal experiences in the

hospital. ➢ (^) Organize the stages of separation anxiety in a 9-month-old patient. The parents exit the room and the child becomes angry and upset. The child begins crying and rejecting the nurse. The child's crying decreases and the child becomes apathetic. The child is happy and begins to play with the nurse. ➢ (^) A 4-year-old patient starts expressing fear whenever she needs to get her blood drawn. Which action can a nurse take to help the pediatric patient cope during an uncomfortable procedure? Allow the parents to participate in the procedure. Instruct the patient in performing breathing exercises. ➢ (^) A patient draws a picture of her parents with anger expressed in their faces. What is the priority nursing action? Ask the child what the drawing means. ➢ (^) A nurse has been working with a patient in the therapeutic-play setting for two weeks and notices an improvement in the child's ability to cope with painful procedures. Which is the next effective strategy to continuing improving the child's ability to tolerate painful procedures? Begin to incorporate more unstructured play. ➢ (^) A patient admitted to the pediatric unit is upset because she misses playing with her sister, who's at home. What is the most appropriate action by the nurse? Encourage the sibling to visit and to engage in activities with the patient. ➢ (^) During a procedure in the pediatric outpatient center, the nurse notices the patient's sibling is looking on with both concern and curiosity. Which action by the nurse would be most appropriate? Explain the procedure to the sibling. Ask the sibling if she has any questions pertaining to the procedure. ➢ (^) A non-English speaking family member of a child is having difficulty understanding the child's diagnosis. What is the most appropriate action by the nurse? Allow an interpreter to translate for the family members. ➢ (^) The nurse is providing discharge instructions to the parent of the pediatric patient and states, "your child may resume regular activities after discharge." Which statement by the parent indicates a need for further teaching? "I will try to avoid bathing the child until the child feels better."

"I will not allow my child to attend his gymnastics class tomorrow." ➢ (^) The nurse is preparing a community program to decrease the incidence of water-related accidents and deaths. The nurse should plan to implement teaching about water-safety issues in which ways? Prepare handouts with parent education about home water safety precautions. Promote education about life jacket use on boats among summer camp populations. Organize community outreach sessions and material on swimming classes for children and water safety programs. Provide pamphlets with information on preventing drowning deaths to community pool locations. ➢ (^) The nurse is evaluating the teaching provided to parents about fall prevention for toddlers. Which statement(s) by the parents indicate that the teaching was effective? "We need to install screen guards in our windows." "We should remove any furniture that can be easily moved or tilted." ➢ (^) The nurse is teaching the mother of a toddler about safety precautions necessary to prevent accidents and injuries. The nurse determines that the teaching has been effective when the mother identifies which situation(s) as requiring close supervision? Taking a bath Taking medicine Climbing a tree Helping to cook in the kitchen ➢ (^) A three-year-old girl is brought to the emergency department with a third-degree burn on her hand. The mother is extremely distressed and says to the nurse: "My daughter is so active and curious—it is hard to predict her behavior." Why is it important for the nurse to discuss developmental milestones when advising this parent about safety measures? Discussing developmental milestones will help the mother prepare for the type of behavior the child will exhibit now and in the future. Discussing motor milestones, including increased motor capacity, explains why the child will be reaching and moving quickly, making the child more prone to accidents. Discussing cognitive milestones, including increased curiosity and the desire to explore without understanding the consequences of actions, will help the parent understand the need for child- proofing the home and close supervision of the child at this age. ➢ (^) The parents of a toddler are worried that the child is not eating at meal times. Which suggestions should the nurse make to promote healthy eating for the child?

Offer three meals and two snacks per day. ➢ (^) The parent of a two-and-a-half-year-old with 19 teeth reports that they do not have fluoridated city water at home and do not have access to a dentist for preventative care. Which actions should the nurse take? Tell the parents to apply a topical fluoride varnish every six months. Recommend that the parents give the child an oral supplement of 0.25 mg of fluoride daily. ➢ (^) The nurse makes which recommendation(s) to the parents of a three-year-old who throws a tantrum every night at bedtime? -Set appropriate limits. -Establish a regular bedtime routine. -Set a behavior expectation plan. -Identify the triggers for the tantrums. ➢ (^) Which role does the nurse play in toilet training? Teaching parents the importance of physical readiness Teaching the parents about developmental signs of toilet training readiness ➢ (^) The parent of a toddler reports that the two-year-old sometimes screams and hits himself in the head with a toy when it is close to bedtime. How would the nurse describe this behavior? Temper tantrum ➢ (^) The pediatric nurse is teaching a new nurse how to recognize signs that a toddler is ready for toilet training. The nurse includes which indicators as signs of readiness for toilet training? The child shows an interest in toilets and putty chairs. The child is able to pull up and remove his or her pants. The child is eager to please the parents with a dry diaper. The child notices his or her own wet diaper and may try to remove it. ➢ (^) A 10-year-old patient with scoliosis comes to the clinic and asks the nurse a question about an uncomfortable medical procedure. Which is the nurse's most appropriate response? "The procedure can be uncomfortable; let's talk about things you can do to help you through it." ➢ (^) A 14-year-old patient with cancer asks the nurse about dying. The nurse knows that the parents don't want that information shared with the child. What should the nurse do? Pursue an ethics consult. ➢ (^) In evaluating a child with a chronic illness, which additional actions by the nurse assist in identifying the child's expected developmental process?

Observe for the presence of developmental delays. Observe for age-appropriate responses by the ill child. Observe errors in the child's perception of the chronic illness. Monitor for miscommunication between family members regarding the child's illness. ➢ (^) The mother of a 4-year-old child with a heart defect is feeling overwhelmed with explaining an upcoming surgery to the child. What should the nurse do to help the parent's communication in this circumstance? Describe the operation in appropriate terms using dolls and a model of the heart ➢ (^) A child with sickle cell disease expresses a desire to spend more time with a sibling who has not been seen because the family lives far away from the hospital. Which actions by the nurse should be most appropriate? Ask the parents to bring the sibling to visit in the next few days when possible. ➢ (^) A nurse is discussing disease management options with a family who is coping with chronic illness. The nurse notices a sibling who is withdrawn. What should the nurse do to help the sibling feel more involved? Engage with and ask if the sibling has any questions. Enquire about how much time the sibling spends with the parents. Ask whether the sibling would like to help change the child's bandage. Express interest and ask about the extracurricular activities the sibling is involved in. ➢ (^) A 16-year-old patient with cerebral palsy is having a birthday party and receiving a lot of attention from family and the home health care staff. A younger sibling is at the birthday party but looking unhappy. Which actions by the home health nurse are appropriate in this situation?

Ask the sibling about a special personal birthday event. Talk with the parents about reading a book to the sibling every night. Talk with the parents about taking the sibling to a movie later that day. Encourage the sibling to help cut the birthday cake and scoop ice cream. ➢ (^) Parents of a child with type 1 diabetes tell the nurse, "Our child will never have the life we dreamed for him." Which response by the nurse is appropriate? "There have been great advances in treating type 1 diabetes. Let me share them with you." ➢ (^) Parents of a 3-year-old patient are expressing fear over treatments used for their child's illness. What action by the nurse should be most effective for reducing fear in the parents? Provide information related to the illness and current treatment modalities ➢ (^) A young child explains to the nurse that her uncle often hits her on the bottom when she misbehaves. Which information is the most important for the nurse obtain from the child before action is taken? The nature and circumstances of the physical contact ➢ (^) When educating a caregiver about personal safety for a preschooler, which information would the nurse indicate as most important for the child to learn? Identification of a dangerous person ➢ (^) A nurse is teaching caregivers appropriate safety guidelines for their four-year-old child regarding firearm safety, burn safety, and personal safety. Which teaching from the nurse is appropriate for all safety situations? "Make the child aware of the danger." "The child should go to a trusted adult if there is a safety concern." "Communicate your safety rules in a clear and precise manner." ➢ (^) The nurse is discussing sleeping habits with the parents of a five-year-old child. Which assessment findings would be concerning to the nurse? Parents allow the child to stay up until tired. Parents offer the child snacks while in bed to encourage going to bed. Parents withhold playtime until the child agrees to go to bed at a certain time. ➢ (^) The parents of a young child report that the child is not eating well during mealtime. What information should the nurse ascertain to appropriately assess the eating concern? Accessibility to food How the child snacks Which foods are provided

➢ (^) The parent of a four-year old child is concerned because the child has lost several teeth. What response by the nurse is most appropriate? "It is normal at this age for your child to begin losing deciduous teeth." ➢ (^) The parents of a four-year-old patient are concerned about their child's stuttering. The nurse should advise the parents to take which actions to address this problem? Try to focus on the child's ideas, not the stutter ➢ (^) The parent of a five-year-old child is frustrated by the child's tendency to hit and pull hair when angry. The nurse assures the parent that this lack of impulse control can be normal for children and to address the problem in which ways? Clearly define rules Enforce rules consistently Explain truthfully why the rule is set ➢ (^) A parent of a four-year-old child is frustrated at the child's new habit of acting out and hitting other children. The nurse should recommend which actions to address this behavior? Offering hugs and physical encouragement when positive behavior is experienced Explaining to the child that he/she will not be able to play with other children when the behavior occurs ➢ (^) A 10-year-old child with leukemia is dying after a failed bone marrow transplant. The child is anxious when approached by the nurses, expresses fear about going to sleep at night, and cries when the parents are not present in the room. The nurse is concerned with the child's ability to cope with dying. Which actions should the nurse take next? Stay in the room with the child while they fall asleep. Have a volunteer stay with the child while the parents are gone. ➢ (^) The hospice nurse is caring for a school-aged child who has a glioblastoma with metastasis throughout the body. The toddler has been declining in health for the past 7 days, has had no oral intake, has a labored, irregular respiratory rate of 6 breaths per minute and is bradycardic at 50 bpm. The parents ask the nurse what they can do to help the child through the process. Which is an appropriate response by the nurse? "Tell the child it is ok to die." ➢ (^) A four-year-child with 6 months to live tells parents about angels who come to visit her at night. The parents are concerned and ask the nurse how they should handle this. What is the nurse's best response? "This is a normal response for a 4-year-old child who is terminally ill. Continue to allow the

child to share the experiences with you." ➢ (^) A 4-year-old child with chronic sickle cell crisis is terminal and unable to walk, requires continuous oxygen administration, is moaning and crying with position changes, and has refused to eat meals for the last 2 days. The parents ask the nurse how they will care for their child and what they should do now. Which response by the nurse is appropriate? "Learning about hospice care services would be appropriate at this time." ➢ (^) A 7-year-old child has recently died after being treated for leukemia for the past 5 years. The child was unresponsive for days prior to dying and the parents were at the bedside the entire time. The nurse overhears the parents say statements such as, "I feel like this is a dream. I don't know what to do now." "Thank God it is finally over; he's at peace." "Is it wrong to feel this way?" Which emotions or reactions are being expressed? Indifference to activities of daily living Relief that the child is no longer suffering Numbness to any emotions when around others Guilt related to being relieved over the death of the child ➢ (^) The mother of a 14-year-old child who recently died tells the nurse that the 10-year-old sibling has become very withdrawn, angry, and aggressive. The child has said to the mother, "It should have been me." The mother asks the nurse how to respond to the child. Which responses by the nurse are appropriate? "A child's response to death is varied because of age and developmental level." "Your child is working through the stages of grief. Sometimes a child stays in one stage longer than others." "Your child may be experiencing survivor's guilt related to the death of your child and needs to express feelings." ➢ (^) A child is dying of sickle cell disease and parents are expressing concern over the large amounts of opiates needed to control the child's pain. The father states, "I am worried that my child will become addicted to the medication." Which statement by the nurse addresses this parent's concern? "Our goal with your child is to effectively manage the pain and maintain an acceptable comfort level which may include using larger doses of opiates." ➢ (^) A parent is taking care of her child dying of cancer and asks the nurse about oral care since the child often complains of a dry mouth. What education on oral care can the nurse provide to this parent? "You can moisten her lips with this sponge swab."

"Use the artificial saliva drops as needed to provide comfort." "Petroleum jelly on the lips provides moisture for a longer period of time." ➢ (^) A nurse is caring for a child and notices that as the child's last days are approaching, the family is becoming more withdrawn. Which action is most important to ensure the child is not left alone during the dying process? Discuss the need to talk to the child, touch the child, and remain at the bedside of the child during the last days. ➢ (^) A dying child, who has been unresponsive for the past two days in hospice at the hospital, opens his eyes and softly talks to his mother. He asks his mother how she is and where his siblings are and can he see them. The mother tells the nurse, "I think he is getting better." Which response by the nurse is appropriate? "It is not uncommon to be more alert and interested in the family right before a child die." ➢ (^) A parent of a child who has terminal cancer is concerned with the child's weight loss due to a decrease in appetite. The parent becomes frustrated and expresses to the nurse, "My child needs to be fed; she is starving!" What is the best response? "Your child's lack of interest in food is a normal part of the dying process." ➢ (^) A family has decided to gather in the room of a child who has impending death. A prayer has started and then all the family members begin praying and laying their hands on the patient. What action will the nurse take? Observe the child for restlessness, moaning, or increased muscle tension. ➢ (^) A mother discusses options about hospice care for an only child who has three months to live. The child has osteosarcoma (bone cancer) and has had frequent admissions to the hospital for pain control. The mother states they live on a farm 30 miles from the hospital. Which piece of information is most important in influencing the decision for hospital-based hospice care? The family lives 30 miles from the hospital. ➢ (^) A 12-year-old patient has been in hospice for one month and expresses feelings of discontent and would like to go back to the hospital. The patient states missing being with other children and liking the food there better. How will the nurse respond? "It is okay to change your mind." "Tell me more about how you are feeling." "I'll let your parents know you want to go back to the hospital." ➢ (^) The parent of a 15-year-old with terminal cancer approaches the nurse and asks what care options are available for when the child is dying. The parent states the child is very close

to family and siblings and loves to be around the pet dogs. Which is the best response? "You could use home hospice care so the child is in a comfortable and relaxed environment." The nurse is treating a child who is approaching death within hours. Which respiratory responses are likely findings in a child who is approaching death? Apneic episodes of 40 seconds between respirations Retraction of muscles under the sternum and ribcage Loud sighing at the end of each respiration with a loud rattle noise ➢ (^) Administration of diphenhydramine can help with which physiologic response expected near the time of death? Death rattle ➢ (^) The nurse wishes to educate parents on what to expect as the child is approaching death. Which response regarding the child's breathing pattern is most appropriate? The child will have Cheyne-Stokes respirations, leading to respiratory arrest. ➢ (^) Which scenario reflects the type of interaction allowed in the hospital moments after a child passes away? The family members remain in the room with the child immediately following the death of the child and the nurse provides privacy. ➢ (^) A sibling is noticeably upset at the death of a sister. Which is an example of an activity that allows the sibling to assist in the immediate care of the body? The sibling washes the hands and face of the sibling alongside the nurse during death care. ➢ (^) What is the purpose in allowing family members to interact with the body after the patient dies? It allows the family members to say their final good-byes. ➢ (^) A young nurse who does not deal well with death is looking for support. What is the best way a more experienced nurse can respond? The experienced nurse offers to mentor the young nurse. Inform the young nurse about availability and time to talk. The experienced nurse refers the young nurse to grief programs offered at the hospital. ➢ (^) At the end of every shift a nurse feels drained and begins crying, grieving the loss of patients. What can the nurse do to increase coping mechanisms? Ask a more experienced pediatric nurse to mentor the nurse. Obtain at least 8 hours of uninterrupted sleep every night. Meet monthly with other pediatric nurses to discuss the past month's events.

➢ (^) A young nurse developed a friendship with a teenaged patient who died. What can this nurse expect during the grieving process? The grieving process for the nurse may take a lot longer to get over. ➢ (^) Which fire safety recommendation is a priority for school-aged children, as it takes advantage of their developing cognitive abilities? How to use appliances safely ➢ (^) Which pedestrian safety recommendations are common to enforce in children who ride bikes, inline skates, and skateboards? Do not listen to music Do not ride when sunlight is dim Wear appropriate head protection ➢ (^) The parent of an eight-year-old reports that the child has trouble getting to sleep at night. Which practices should the nurse recommend to promote sleep? Reading before bed Keeping the room dark and quiet Limiting media exposure prior to bedtime ➢ (^) The parents of an overweight nine-year-old are concerned about their child's eating habits. Which recommendations can the nurse make for family-wide changes that may impact their child's food choices? Avoid giving food for reward Increase the number of home-cooked meals Match the student's behavioral problem with the relevant manifestation. Complaint of feeling sick while at school - School refusal Pushing another child to assert authority - Peer victimization Drinking alcohol while home alone after school - Problems associated with self-care ➢ (^) The caregivers of an 11-year-old child report that the child is worried about upcoming tests and is not sleeping well. The nurse tells the parents to watch for which signs of stress? Screaming during the night ➢ (^) The parent of a 10-year-old child is distressed by the child's recent tendency to post embarrassing photos of other children on social media sites. Which common behavioral problem do these actions exemplify? Peer victimization

➢ (^) The nurse assesses the 14-year-old patient for suicide risk after the parents reported the patient was cutting. Which intervention is the priority action by the nurse? Assess the patient for a suicide plan. ➢ (^) The school administrators are trying to help an adolescent who constantly gets in trouble for fighting. Which of the following are risk factors for adolescent use of violence? Being raised by an abusive parent Playing video games involving shooting ➢ (^) The 16-year-old patient talks excitedly with the nurse about the freedom of having a driver's license. Which statements by the patient need clarification by the nurse? "My friends and I are headed to the water fall this weekend for a camping trip." "It feels good to know that if things get too out of control at home that I can leave." ➢ (^) An adolescent experience an avulsed tooth while playing football. The family recovers the tooth and brings the adolescent to the emergency room. What is the priority action by the nurse? Place tooth in milk ➢ (^) An adolescent reports feeling fatigued and unable to focus during the day. Which lifestyle changes can the nurse recommend for this patient? Implementing a sleep routine Avoiding caffeine before bed Discontinuing use of electronic devices at least one hour before bedtime ➢ (^) An adolescent report eating primarily salads with low-fat dressing and raw vegetables. Which recommendations should the nurse make to ensure the patient consumes a healthy nutritious diet? "Include chicken, tuna, or tofu in your salad." "Add a slice of whole wheat bread to your meal."

➢ (^) Why would an adolescent engage in "sexting"? Fit in with peers Attract a partner Make himself feel more important ➢ (^) What are potential adverse effects when adolescents do not use sunscreen? Wrinkles Melanoma ➢ (^) The nurse teaches the 14-year-old patient about reliable resources for sexual education. The nurse knows further teaching is needed when the patient makes what statements? "I have a friend whose older brother has had a bunch of girlfriends." "Sometimes I go to my friends' house and we look at videos of naked girls." "I talk about sex with my older friends who know things because they've done 'it'." ➢ (^) The nurse is teaching the parents of a child with encopresis about potential symptoms. Which statement by the parents indicates teaching was effective? "Our child's feces will have a very foul odor most of the time." ➢ (^) Which dietary modification should be made for a child with encopresis? Eat granola bars Increase water intake Eat whole grain cereals ➢ (^) A 9-year old boy is brought into the health care provider's office with concerns about his reaction to his parent's divorce. The child has been unusually withdrawn and stays in his room, refusing to see anyone, often not even coming out to go to the bathroom. On assessment the nurse notes a foul fecal odor coming from the child. Which complication of constipation would the nurse suspect? Secondary encopresis ➢ (^) A child with gastroenteritis is receiving treatment for dehydration. Which assessment findings indicate treatment has been effective? Serum potassium 3.9 mEq/L ➢ (^) A child presents with diarrhea after eating at a local restaurant. Which intervention should the nurse implement first? Inform the health department ➢ (^) Child has severe diarrhea from gastroenteritis. In which ways can the nurse determine whether the child is experiencing dehydration? Decreased urine output

Tenting on the back of the hand ➢ (^) The nurse is giving discharge instructions to the parents of a 6-month-old boy who has been diagnosed with gastroesophageal reflux disease (GERD). Which statement by one of the parents shows a correct understanding of how to care for the infant? "I will lay him on his back and give him a pacifier to help him sleep." ➢ (^) The nurse is caring for an infant with gastroesophageal reflux disease (GERD). Which assessment findings indicate potential complications? 10th percentile on the growth chart Crackles heard in the lungs on auscultation Elevated axillary temperature of 103.6° F ➢ (^) The nurse is caring for a child with gastroesophageal reflux disease (GERD). Which medications would the nurse anticipate being ordered? Omeprazole ➢ (^) The nurse is caring for a child with Hirschsprung disease who has been diagnosed with colon inflammation. Which provider orders would the nurse anticipate? Begin preoperative checklist. Initiate intravenous administration of normal saline. Match the complication with the appropriate intervention for a child with Hirschsprung disease. Impaired skin integrity related to colostomy and surgical repair Clean the ostomy site. Risk for deficient fluid volume or excess fluid volume related to surgical preparation Administer fluid bolus. Constipation related to aganglionic bowel and inadequate peristalsis Increase dietary fiber. ➢ (^) The nurse is preparing a child and the parents for a colostomy. Which situations, facilitated by the nurse, are most appropriate? The child and parents are given the opportunity to see the equipment before surgery. The child and parents are given the opportunity to manipulate the equipment before surgery. ➢ (^) The nurse is caring for a child with celiac disease. The mother reports that the child attended a birthday party and ate cake. Which assessment finding would the nurse anticipate? Watery stools ➢ (^) An infant who presents with suspected celiac crisis would have which assessment findings? Drowsiness; Metabolic acidosis ➢ (^) The nurse is speaking with the family of a pediatric patient with celiac disease. Which patient symptom, reported by the parents, requires immediate action?

Tearless crying ➢ (^) A 5-year-old with severe burns weighs 25 kg. The child has a urine output 30 mL in the last two hours, serum sodium of 122, and serum potassium of 5.1. Which action is most important for the nurse to take? Administer IV fluids as ordered ➢ (^) A child recovering from a moderate burn to the anterior trunk and abdomen has Hgb 12, Na 140, K 4.7, and serum albumin 2.8. Which action is most important for the nurse to take? Provide high-calorie, high-protein foods ➢ (^) A 17-year-old girl has burns to the face and neck after a kitchen accident. The parents tell the nurse that the girl does not interact with friends or family, spends most of her time in her room, and avoids going to school. Which actions should the nurse take? Assess for suicidal ideation. Consult with a child life specialist. Encourage the patient to verbalize feelings about her appearance. Discuss ways to use cosmetics to minimize the perceived disfigurement. ➢ (^) The nurse is educating new parents on environmental safety concerns to make in the home. A new mother states that she uses the microwave to heat the infant's bottles because it is convenient and quick. Which response by the nurse is most appropriate? "The microwave heats unevenly and can cause scalding injuries to the mouth and throat." ➢ (^) A child recovering from major burns four weeks ago complains of nausea, vomiting, and epigastric pain that worsen with eating. The nurse notes tenderness on palpation and a positive gastric aspirate positive for blood. Which provider orders should the nurse anticipate?

NPO

Endoscopy IV protonix ➢ (^) The nurse is caring for an 8-year-old patient with second degree burns over 15% of the total body surface area (TBSA). On assessment, the nurse notes the following vital signs: HR 134, RR28, BP 82/48, Temp 97.4. Which action should the nurse take first? Initiate IV fluid resuscitation as ordered ➢ (^) The parent of a 7-year-old with deep partial thickness burns on the legs from a camping accident asks the nurse about the healing time for the child's injury. Which response by the nurse is most appropriate? "You can expect it to take 30 days to several months for complete healing." ➢ (^) What is the extent of injury for a 1-year-old with burns to the posterior trunk, buttocks, and bilateral thighs? 29% ➢ (^) A 12-year-old child has burns to the face, hands, legs, and palms after a house fire. Which action by the nurse is most important? Assess the airway for patency ➢ (^) Upon entering the room of a child with minor burns on the back and anterior trunk after a trip to the beach, the child complains of itching to the area. Which actions should the nurse take? Administer PO Benadryl as ordered Encourage parents to apply lotion to the area Itching is normal part of healing process ➢ (^) Parents of a 6-year-old comment that their son enjoys playing outside most of the day during summer break. They apply SPF 10 sunscreen in the morning, and provide beverages to maintain the child's hydration. Which information is important to include in teaching for these parents? Sunscreen should be reapplied frequently. Avoid sun exposure between 1000 and

Sunscreen should be SPF 15 or higher and have UVA and UVB protection. ➢ (^) The nurse is educating parents of a child with sunburn on the upper back and shoulders. Which statement, made by the parents, indicates the need for further teaching? "My child needs to be on bedrest for 3-4 days." ➢ (^) A patient with burns on the face and neck has an order to apply moist sterile gauze and

silver sulfadiazine to all burns. Which action should the nurse take first? Question the order for Silvadene. ➢ (^) A 9-year-old child with severe burns on the face, trunk, and abdomen is lethargic and pale 24 hours after the initial burn. The nurse notes edema in the extremities, heart rate 135, urine output 60 mL over the past four hours. Which actions should the nurse take? Administer colloids as ordered Increase the rate of IV fluids as ordered ➢ (^) The nurse is caring for a child with circumferential burns to the abdomen. On assessment, the nurse notes tachycardia, tachypnea, and diminished bowel sounds. Which additional questions should the nurse ask? "Have you expelled any gas?" "Are you experiencing any pain?" "When was your last bowel movement?" ➢ (^) A patient who sustained an electrical injury from a toaster complains of pain 9/10 to the right arm. Lab results show pH of 7.2, HCO3 of 17, and PCO2 of 40. Normal saline is running at 125 mL/hr, IV pain medications are ordered for every four hours. Which action should the nurse take first? Change IV fluids to Ringer's Lactate as ordered ➢ (^) A child with electrical burns from touching an active power line reports numbness in the fingers. The nurse notes the hands and arms are edematous. Which actions should the nurse take? Assess capillary refill Assess the peripheral pulses Perform neurovascular checks ➢ (^) A child who sustained an electrical burn reports shortness of breath and chest heaviness. The nurse notes diaphoresis, and pallor. Which additional assessment(s) are a priority for the nurse to obtain? Heart rate Obtain an order for an ECG ➢ (^) A 2-month-old boy was born prematurely and has bilateral cryptorchidism. What information should the nurse give the parents regarding immediate treatment? Patient will be observed for spontaneous descent of the testes which is common in the first 6 months of life.

➢ (^) Match the disorder with management options: Hydrocele in newborn Observation Phimosis (mild) Cleaning and manual retraction Testicular torsion Emergency surgery Bladder exstrophy Surgery ➢ (^) Which other conditions should the nurse assess for in a patient with hypospadias? Patients with hypospadias might also have inguinal hernias. ➢ (^) A nurse is working at a urology clinic and arrives at work to an assignment caring for four young children: Child A: A 3-year-old with urethritis Child B: A 15-year-old with cystitis Child C: A newborn with suspected VUR Child D: A 7-year-old with pyelonephritis Which patient should she see first? Child D ➢ (^) Immediately after delivery, the nurse notices signs of possible UTI in the neonate. What is the likely bacterial route of the infection? Blood A nurse is caring for a 7-year-old male who is not circumcised. The child has had recurrent UTIs. What information should the nurse share with the child to help reduce the likelihood of repeat UTIs? "Make sure to clean your foreskin carefully each time you go to the bathroom."