Exam #5
A nurse is preparing a child admitted from the ER with a diagnosis of acute appendicitis for an appendectomy, to be performed in an hour the child tells the nurse that the acute abdominal pain has suddenly subsided. The priority nursing intervention is which? 1. Contact the surgeon 2. Document the findings 3. Tell the parents that the pain was probably a result of gastroenteritis 4. Inform the Operating room that the surgery will be canceled
1.
An adolescent is seen in the emergency department following an athletic injury, and it is suspected that the child sprained an ankle. X-rays are taken, and a fracture has been ruled out. The nurse provides instructions to the adolescent regarding home care for treatment of the sprain and tells the adolescent which of the following? 1. Apply ice to the injured area for a period of 30 minutes every 4 to 6 hours for the first 24 hours. 2. Apply heat to the injured area every 4 hours for the first 48 hours, then begin to apply ice. 3. Immobilize the extremity and maintain the extremity in a dependent position. 4. Elevate the extremity and maintain strict bedrest for a period of 7 days.
1
The nurse is reviewing a pediatrician's prescriptions for a child with sickle cell anemia who was admitted to the hospital for the treatment of vaso-occlusive crisis. Which prescriptions documented in the child's record would the nurse question? Select all that apply. 1.Restrict fluid intake. 2.Position for comfort. 3.Avoid strain on painful joints. 4.Apply nasal oxygen at 2 L/minute. 5.Provide a high-calorie, high-protein diet. 6.Give meperidine, 25 mg intravenously, every 4 hours for pain.
1,6
A nurse is reviewing the immunization schedule for a child with human immunodeficiency virus (HIV) infection with the mother. Which of the following will be a component of the instructions that the nurse provides to the mother? 1. The immunization schedule needs to altered because of the HIV infection. 2. No live virus vaccines should be administered to the child. 3. Immunizations will not be given to the child with HIV infection. 4. Immunizations will be given to the child with HIV infection but will not be initiated until the child is 3 years old.
2
The nurse is assisting a primary health care provider (PHCP) in the examination of a 3-week-old infant with developmental dysplasia of the hip. What test or sign would the nurse expect the PHCP to assess? 1. Babinski's sign 2. The Moro reflex 3. Ortolani's maneuver 4. The palmar-plantar grasp
3
****A nurse is providing instructions to the mother of a child with juvenile idiopathic arthritis regarding measures to take if a painful exacerbation of the disease occurs. Which statement by the mother indicates the need for further instructions? 1. "The full range-of-motion [ROM] exercises must be performed every day, even during the exacerbations." 2. "Hot or cold packs will assist in reducing discomfort." 3. "The painful joint should be splinted and positioned in a neutral position." 4. "I should have my child perform simple isometric exercises during exacerbations."
1
***A nurse has provided discharge instructions to the mother of an 18-month-old child following surgical repair of hypospadias. Which statement by the mother indicates a need for further instruction? 1. "I should carry my child by straddling the child on my hip." 2. "I should use double diapers to hold the surgery site in place." 3. "I should avoid toilet training right now." 4. "I should encourage fluid intake."
1
A nurse is monitoring a child who is receiving calcium disodium edetate (EDTA) for the treatment of lead poisoning. The nurse reviews the laboratory results of the child during treatment with this medication and is particularly concerned with monitoring which laboratory test result? 1. Blood urea nitrogen 2. Hemoglobin and hematocrit (H&H) level 3. Complete blood cell (CBC) count 4. Cholesterol level
1
A 10-year-old child with asthma is treated for acute exacerbation in the emergency department. The nurse caring for the child would monitor for which sign, knowing that it indicates a worsening of the condition? 1. Warm, dry skin 2. Decreased wheezing 3. Pulse rate of 90 beats per minute 4. Respirations of 18 breaths per minute
2
***A nursing student is preparing a clinical conference, and the topic of the discussion is caring for the child with cystic fibrosis (CF). The student prepares a handout for the group and lists which of the following on the handout? Select all that apply. 1. It is a disease that causes mucus formation to be abnormally thick. 2. It is a chronic multisystem disorder affecting the exocrine glands. 3. It is transmitted as an autosomal recessive trait. 4. It is a disease that causes dilation of the passageways of all organs. 5. It is a disease that affects males only. 6. It is a disease that affects the lungs only.
1, 2, 3
The nurse is performing an assessment on a child admitted to the hospital with a probable diagnosis of nephrotic syndrome. Which assessment findings would the nurse expect to observe? Select all that apply. 1.Pallor 2.Edema 3.Anorexia 4.Proteinuria 5.Weight loss 6.Decreased serum lipids
1,2,3,4
A child with a history of sickle cell disease is seen in the emergency department where acute sequestration crisis is diagnosed. The nurse should immediately prepare to take which action? 1. Administer pain medication 2. Start an intravenous (IV) line 3. Obtain informed consent for a splenectomy 4. Place a cold pack on the abdomen over the area of the spleen
2
The nurse is preparing for the admission of an infant with a diagnosis of bronchiolitis caused by respiratory syncytial virus (RSV). Which interventions would the nurse include in the plan of care? Select all that apply. 1.Place the infant in a private room. 2.Ensure that the infant's head is in a flexed position. 3.Wear a mask, gown, and gloves when in contact with the infant. 4.Place the infant in a tent that delivers warm humidified air. 5.Position the infant on the side, with the head lower than the chest. 6.Ensure that nurses caring for the infant with RSV do not care for other high-risk children.
1,3,6
****A nurse is assisting in admitting to the hospital a 4-month-old infant with a diagnosis of vomiting and dehydration. The nurse assists in developing a plan of care for the infant and suggests including in the plan to position the infant in a(n): 1. Prone position 2. Side-lying position 3. Modified Trendelenburg's position 4. Infant car seat with the head of the seat in a flat position
2
A nurse is providing home care instructions to the mother of a child with juvenile idiopathic arthritis. Which action should the nurse tell the parents to take during a painful exacerbation? 1. Splinting the painful joints and avoiding any joint movement 2. Encouraging the child to perform simple isometric exercises 3. Alternating splinting of the painful joints with joint exercises every hour 4. Encouraging the child to perform the prescribed joint exercises to maintain muscle and joint integrity
2
A nurse is providing home care instructions to the mother of a child who has undergone cleft lip repair. Which statements by the mother indicate an understanding of these instructions? Select all that apply. 1. "I should put her on her stomach to sleep." 2. "I shouldn't brush her teeth for 1 to 2 weeks." 3. "I should rinse her mouth with water after feeding her." 4. "I should watch for signs/symptoms of infection like drainage or fever." 5. "I should never use a bulb syringe to clear secretions from her mouth."
2,3,4
An infant has just returned to the nursing unit after surgical repair of a cleft lip on the right side. The nurse would place the infant in which best position at this time? 1. Prone position 2. On the stomach 3. Left lateral position 4. Right lateral position
3
The nurse is assessing a child admitted with a diagnosis of rheumatic fever. Which significant question would the nurse ask the child's parent during the assessment? 1. "Has your child had difficulty urinating?" 2. "Has your child been exposed to anyone with chicken pox?" 3. "Has any family member had a sore throat within the past few weeks?" 4. "Has any family member had a gastrointestinal disorder in the past few weeks?"
3
The nurse is assigned to care for an 8-year-old child with a diagnosis of a basilar skull fracture. The nurse reviews the pediatrician's prescriptions and would contact the pediatrician to question which prescription? 1. Obtain daily weight. 2. Provide clear liquid intake. 3. Nasotracheal suction as needed. 4. Maintain a patent intravenous line.
3
****A nurse is providing information to the mother of a child with nephrotic syndrome regarding the edematous appearance of the child. Which of the following statements should the nurse make to the mother? 1. "Dress the child in loose-fitting clothing to hide the extra weight." 2. "Children always look a little bit fat, so don't be concerned." 3. "The fluid retention should be controlled by medication and diet." 4. "The child will always have this appearance, and preparing the child for the body image change is important."
3
***A child is admitted to the hospital, and a diagnosis of bacterial meningitis is suspected. A lumbar puncture is performed, and the results reveal cloudy cerebrospinal fluid (CSF) with high protein and low glucose levels. The nurse determines that these results are indicative of: 1. The need to repeat the test 2. Possible contamination of the specimen 3. Confirmation of the diagnosis 4. A negative test
3
The nurse reviews the record of a newborn infant and notes that a diagnosis of esophageal atresia with tracheoesophageal fistula is suspected. The nurse expects to note which most likely sign of this condition documented in the record? 1. Incessant crying 2. Coughing at nighttime 3. Choking with feedings 4. Severe projectile vomiting
3
The parents of a child with juvenile idiopathic arthritis call the clinic nurse because the child is experiencing a painful exacerbation of the disease. The parents ask the nurse if the child can perform range-of-motion exercises at this time. The nurse would make which response? 1. "Avoid all exercise during painful periods." 2. "Range-of-motion exercises must be performed every day." 3. "Have the child perform simple isometric exercises during this time." 4. "Administer additional pain medication before performing range-of-motion exercises."
3
A child with rheumatic fever will be arriving at the nursing unit for admission. On admission assessment, the nurse would ask the parents which question to elicit assessment information specific to the development of rheumatic fever? 1. "Has the child complained of back pain?" 2. "Has the child complained of headaches?" 3. "Has the child had any nausea or vomiting?" 4. "Did the child have a sore throat or fever within the last 2 months?"
4
A new parent expresses concern to the nurse regarding sudden infant death syndrome (SIDS). The parent asks the nurse how to position the new infant for sleep. In which position would the nurse tell the parent to place the infant? 1. Side or prone 2. Back or prone 3. Stomach with the face turned 4. Back rather than on the stomach
4
A nurse is reviewing the primary health care provider preoperative prescription for a child who is scheduled for an appendectomy, which prescription should the nurse request? 1.Check vital signs hourly 2. Insert IV line 3. Administer a fleet enema before surgery 4. Apply cold pack to the abdomen as needed for comfort.
3.
Which question would the nurse ask the parents of a child suspected of having glomerulonephritis? 1. "Did your child fall off a bike onto the handlebars?" 2. "Has the child had persistent nausea and vomiting?" 3. "Has the child been itching or had a rash anytime in the last week?" 4. "Has the child had a sore throat or a throat infection in the last few weeks?"
4
****A nurse is assigned to care for an infant with tetralogy of Fallot. The mother of the infant calls the nurse to the room because the infant suddenly seems to be having difficulty breathing. The nurse enters the room and notes that the infant is experiencing a hypercyanotic episode. The initial nursing action is to: 1. Call a code. 2. Contact the respiratory therapy department. 3. Place the infant in a prone position. 4. Place the infant in a knee-chest position.
4
***A nurse caring for a child with nephrotic syndrome reviews the medication record. The nurse notes that prazosin hydrochloride (Minipress) is prescribed for the child. The nurse determines that this medication has been prescribed to: 1. Reduce proteinuria 2. Decrease inflammation 3. Suppress the autoimmune response 4. Control hypertension
4
A nurse is caring for a child with a fracture who is placed in skeletal traction. The nurse monitors for the most serious complication associated with this type of traction by checking for: 1. An increase in the blood pressure 2. A decrease in the urinary output 3. A lack of appetite 4. An elevated temperature
4
The nurse notes documentation that a child is exhibiting an inability to flex the leg when the thigh is flexed anteriorly at the hip. Which condition does the nurse suspect? 1. Meningitis 2. Spinal cord injury 3. Intracranial bleeding 4. Decreased cerebral blood flow
1
***A nurse is providing home care instructions to the mother of a child diagnosed with pneumonia. Which statement by the mother indicates the need for further instructions? 1. "I can administer acetaminophen [Tylenol] for a fever." 2. "I can use a warm mist humidifier to keep the secretions loose." 3. "I should administer the antibiotics until the prescribed amount is completed." 4. "I can give my child warm liquids to loosen secretions."
2
***A nursing student is asked to administer a tepid bath to a child with a fever. The student avoids which of the following when performing this procedure? 1. Squeezes water over the child's body, using a washcloth 2. Applies alcohol-soaked cloths over the child's body 3. Uses a water toy to distract the child during the bath 4. Places lightweight pajamas on the child after the bath
2
A child is placed in skeletal traction for treatment of a fractured femur. The nurse creates a plan of care and would include which intervention? 1. Ensure that all ropes are outside the pulleys. 2. Ensure that the weights are resting lightly on the floor. 3. Restrict diversional and play activities until the child is out of traction. 4. Check the primary health care provider's (PHCP's) prescriptions for the amount of weight to be applied.
4
***A nurse is providing instructions to a child with cystic fibrosis regarding how to perform the "huff" maneuver. The child asks the nurse about the purpose of this type of breathing. The appropriate nursing response is which of the following? 1. "This type of breathing is used to mobilize secretions so that they can be easily coughed out." 2. "This type of breathing prolongs inspiration time." 3. "This type of breathing moves air out of the lower lungs." 4. "This type of breathing moves air through the lungs."
1
A nurse is performing an assessment of a child admitted to the hospital with suspected rheumatic fever. About which recent occurrence should the nurse ask the parents as a means of eliciting data relevant to the cause of illness? 1. A sore throat 2. Blunt chest injury 3. A swollen knee joint 4. Recent loss of appetite
1
A nurse is performing an assessment of a child with nephrotic syndrome. Which manifestation would the nurse most likely note? 1. Periorbital edema 2. Weight loss of 1.5 kg 3. Temperature of 99.2° F (37.3°C) 4. Blood pressure of 128/86 mm Hg
1
A nurse is planning diversional activities for a school-age child hospitalized with acute febrile rheumatic fever. Which activity is appropriate? 1. Board games 2. Twice-daily visits to the playroom 3. Frequent visits from the child's friends 4. Visits from other children who are hospitalized
1
A nurse is preparing to administer digoxin to an infant. The nurse notes that the infant's heart rate is 110 beats/min. What is the appropriate action for the nurse to take? 1. Administer the prescribed dose 2. Contact the primary health care provider 3. Obtain a blood sample to check the digoxin level 4. Withhold the dose and reassess the heart rate in 1 hour
1
A nurse is providing information to the mother of a child with newly diagnosed celiac disease. What piece of information should the nurse include? 1. An infection can precipitate a celiac crisis. 2. The disease can be cured with medication. 3. Pasta is an appropriate part of the child's diet. 4. Temporary dietary modifications may be necessary to heal the gastrointestinal tract.
1
A nurse is reviewing the results of an infant's serum digoxin test. The digoxin level is 0.6 ng/mL (0.77 nmol/L). In light of this finding, which action should the nurse take? 1. Administering the prescribed dose because the level is within the therapeutic range 2. Calling the primary healthcare provider with the results and asking for further prescriptions 3. Giving the prescribed dose and notifying the primary healthcare provider of the low digoxin level 4. Holding the dose and immediately notifying the primary healthcare provider of the toxic digoxin level
1
A nurse provides home care instructions to the mother of an infant with gastroesophageal reflux disease (GERD). Which statement by the mother indicates a need for further instruction? 1. "I shouldn't give the baby a pacifier." Correct 2. "I should thicken feedings with rice cereal." 3. "I should put the baby on her right side with her head raised." 4. "I need to give the baby small, frequent feedings and use a predigested formula."
1
An HIV-positive woman delivers an infant. The pediatrician prescribes testing for the newborn, and the nurse prepares for which action? 1. Ask the laboratory to perform virologic testing 2. Obtain blood from the umbilical cord to send to the laboratory 3. Perform a heel stick to obtain a specimen for a Western blot assay 4. Perform a fingerstick to obtain a specimen for an enzyme-linked immunosorbent assay (ELISA)
1
Which pediatric client is at least risk for otitis media? 1. A breastfed infant 2. A bottle-fed infant 3. A child who attends a daycare center 4. A child exposed to environmental smoke
1
A nurse of a well-baby clinic prepares to administer an immunization to a child. The mother of the child tells the nurse that the child has had a fever and is taking antibiotics. The nurse takes the child's temperature and notes that it is 101.5° F rectally. The nurse plans to implement which of the following? 1. Administer the immunization. 2. Delay the immunization. 3. Administer one half of the prescribed dose of each scheduled immunization. 4. Administer one of the three scheduled immunizations.
2
A nurse is providing instructions on the use of a metered-dose inhaler (MDI) to an adolescent with asthma. Which statements by the adolescent indicates an understanding of the instructions? Select all that apply. 1. "I need to shake the inhaler well before I use it." 2. "I really need to use the spacer when I inhale the corticosteroid." 3. "After I breathe the medication in, I should hold my breath for 1 or 2 seconds." 4. "I have to put my lips tightly around the mouthpiece, press down on the inhaler, and breathe in slowly." 5. "The doctor has prescribed two inhalations, so I need to breathe in the second inhalation immediately after the first."
1,2,4
The nurse is assigned a child who has been admitted to the hospital with suspected cystic fibrosis (CF). Which tests does the nurse anticipate will be prescribed to diagnosis CF? Select all that apply. 1. Chest x-ray 2. Barium swallow 3. Intestinal biopsy 4. Sweat chloride assay 5. Stool examination for ova and parasites
1,4
A child has been in the hospital for several days for treatment of severe vomiting related to his HIV- positive status. Which assessment finding is the best indication that the child's condition is improving? 1. No lesions in the mouth and throat 2. Weight increase of 1 lb (0.45 kg) over 3 days 3. Temperature change from 100.2° F to 99.2° F (37.3°C) 4. Capillary refill slowing from 2 seconds to 3 seconds
2
A nurse has an order to give ear drops to a 2-year-old child. The nurse positions the child's ear properly by pulling the pinna of the ear: 1. Downward and outward 2. Downward and backward 3. Upward and outward 4. Upward and backward
2
A nurse is caring for an infant with hypospadias. What does the nurse make a priority when assessing the infant? 1. Blood pressure 2. Urinary output 3. Level of consciousness 4. Gastrointestinal function
2
A nurse is providing information to the parents of a child with suspected Hirschsprung's disease. The nurse informs the parents that diagnosis is definitively confirmed by the findings of which action? 1. Blood tests 2. Rectal biopsy 3. Barium enema 4. Rectal examination
2
A nurse provides information to new parents about measures to reduce the risk of sudden infant death syndrome (SIDS). Which measure should the nurse tell the parents to implement? 1. Obtain a soft crib mattress and soft bedding 2. Place the infant in a supine position for sleep 3. Place the infant in a face-down position for sleep 4. Be sure that the infant sleeps in a crib in the parent's room until the age of 12 months
2
A nurse providing home care instructions to a mother of a HIV-positive child discusses measures to prevent transmission of the virus. Which statement by the mother indicates a need for further instruction? 1. "I won't let my children share toothbrushes." 2. "I'll wash up blood spills with soap and hot water and allow them to air dry." 3. "I'll wash my hands with soap and water if I touch any blood from my child." 4. "I'll rinse bloodstained clothing with hydrogen peroxide and then wash it as usual."
2
A pancreatic enzyme preparation is prescribed for a child with cystic fibrosis (CF). The nurse instructs the child's mother to administer the pancreatic enzyme in what way? 1. At noon only 2. With meals and snacks 3. 2 hours after breakfast and dinner 4. At bedtime and in the morning when the child awakens
2
Hydrostatic reduction is performed in a hospitalized child with a diagnosis of intussusception. Which outcome indicates that the procedure was successful? 1. Passage of barium in the stool 2. Passage of stool without blood 3. Visible peristalsis across the abdomen 4. Presence of a sausage-shaped abdominal mass
2
The use of a Pavlik harness has been prescribed for an infant with developmental dysplasia of the hip, and the nurse provides instructions to the mother about the use of the harness. Which statement by the mother indicates the need for further instruction? 1. "The diaper is put on under the harness." 2. "The harness is placed against the skin to provide support." Correct 3. "I need to support her hips and buttocks when the harness is off." 4. "The harness straps should be secure enough to keep her hips flexed but not tight."
2
Which laboratory result would the nurse expect to see in a child admitted to the hospital with acute glomerulonephritis? 1. Hematocrit of 38% 2. 2+ protein in the urine 3. Serum potassium of 3.8 mEq/L (3.8 mmol/L)mg/dL 4. White blood cell (WBC) count of 9800 cells/mm 3 (9.8 x 109/L)
2
A nurse receives a telephone call from the admissions office and is told that a child with acute bacterial meningitis will be admitted to the pediatric unit. The nurse prepares for the child arrival and plans to implement which type of precautions? 1. Enteric 2. Contact 3. Droplet 4. Neutropenic
3
A nurse is providing home care instructions to the mother of a child who has undergone cleft lip repair. Which statements by the mother indicate an understanding of these instructions? Select all that apply. 1. "I should put her on her stomach to sleep." 2. "I shouldn't brush her teeth for 1 to 2 weeks." 3. "I should rinse her mouth with water after feeding her." 4. "I should watch for signs/symptoms of infection like drainage or fever." 5. "I should never use a bulb syringe to clear secretions from her mouth."
2,3,4
The nurse is assessing a child suspected of having meningitis. The nurse knows that what specific diagnostic tests could indicate a diagnosis of meningitis? Select all that apply. 1. Romberg Test 2. Nuchal rigidity 3. Positive Kernig's sign 4. Positive Chvostek's sign 5. Positive Trousseau's sign 6. Positive Brudzinski's sign
2,3,6
A child who is experiencing wheezing during an acute asthma episode is brought to the emergency department by the parents. Which intervention does the nurse prepare to implement first? 1. A chest x-ray 2. Administration of a corticosteroid 3. Administration of a bronchodilator 4. Insertion of an intravenous (IV) catheter
3
A child with severe respiratory distress is seen in the emergency department and treated for an acute asthmatic episode. Which assessment finding indicates that the child's condition is improving? 1. Stridor 2. Shortness of breath 3. Increased wheezing 4. Dyspnea on exertion
3
A nurse is admitting a child with respiratory syncytial virus (RSV) infection to the hospital. The nurse tells the parents that the best way to prevent the spread of the infection is to implement which measure? 1. Restricting visitors 2. Wearing goggles and a mask 3. Washing the hands meticulously 4. Wearing goggles and a protective gown
3
A nurse is providing home care instructions to the parents of a child with bacterial conjunctivitis. The nurse should provide which information to the parents? 1. That the child may attend school if antibiotics have been started 2. To save any unused eye medication in case a sibling gets the eye infection 3. That the childs towels and washcloths should not be used by other members of the household 4. To wipe any crusted material from the eye with a cotton ball soaked in warm water, starting at the outer aspect of the eye and moving toward the inner aspect
3
A nurse provides instructions to the mother of a child with cystic fibrosis (CF) on the correct procedure for administering pancrelipase. The nurse tells the child's mother that the medication may be administered with which item? 1. Oatmeal 2. Hot milk 3. Applesauce 4. Mashed potatoes
3
***A mother brings her child to the health care clinic because the child has developed lesions located around the mouth and nose, and mild impetigo is diagnosed. The nurse provides instructions to the mother regarding care of the child. Which statement by the mother indicates the need for further instructions? 1. "The impetigo is extremely contagious." 2. "The lesions should be washed gently three times a day with a warm, soapy washcloth." 3. "The crusts on the lesions need to be soaked and carefully removed." 4. "My child will need to be treated with oral antibiotics."
4
A newborn is found to have esophageal atresia (EA) with tracheoesophageal fistula (TEF). In which position does the nurse immediately place the infant? 1. Trendelenburg 2. Flat and side-lying 3. Prone, with the head of the bed flat 4. Supine, with the head of the bed elevated
4
What manifestation of hypertrophic pyloric stenosis should the nurse reviewing the record of an infant with this disorder expect to see documented? 1. Fever 2. Profuse diarrhea 3. Alternating constipation and diarrhea and fecal impaction 4. Olive-shaped mass palpated in the right upper abdominal quadrant
4
What manifestation of hypertrophic pyloric stenosis should the nurse reviewing the record of an infant with this disorder expect to see documented? 1. Fever 2. Profuse diarrhea 3. Alternating constipation and diarrhea and fecal impaction 4. Olive-shaped mass palpated in the right upper abdominal quadrant Correct
4
The nurse provides home care instructions to the parents of a child with celiac disease. The nurse would teach the parents to include which food item in the child's diet? 1. Rice 2. Oatmeal 3. Rye toast 4. Wheat bread
1
The parent of a 3-year-old child arrives at a clinic and tells the nurse that the child has been scratching the skin continuously and has developed a rash. The nurse assesses the child and suspects the presence of scabies. The nurse bases this suspicion on which finding noted on assessment of the child's skin? 1. Fine grayish red lines 2. Purple-colored lesions 3. Thick, honey-colored crusts 4. Clusters of fluid-filled vesicles
1
***A nurse is providing instructions to a mother of a child with atopic dermatitis (eczema) regarding the application of topical cortisone cream to the affected skin sites. Which of the following statements, if made by the mother, indicates an understanding of the use of this medication? 1. "I need to wash the sites gently before I apply the medication." 2. "The medication is applied everywhere except the face." 3. "I need to apply the medication generously and allow it to absorb." 4. "I shouldn't rub the medication into the skin."
1
***A nurse is collecting data on a child recently diagnosed with glomerulonephritis. Which of the following questions to the mother would elicit information about the cause of this disease? 1. "Did your child sustain any injuries to the kidney area?" 2. "Did your child recently complain of a sore throat?" 3. "Has your child had any diarrhea?" 4. "Have you noticed any rashes on your child?"
2
The clinic nurse is instructing the parent of a child with human immunodeficiency virus (HIV) infection regarding immunizations. The nurse would provide which instruction to the parent? 1. The hepatitis B vaccine will not be given to the child. 2. The inactivated influenza vaccine will be given yearly. 3. The varicella vaccine will be given before 6 months of age. 4. A Western blot test needs to be performed and the results evaluated before immunizations.
2
The day care nurse is observing a 2-year-old child and suspects that the child may have strabismus. Which observation made by the nurse indicates the presence of this condition? 1. The child has difficulty hearing. 2. The child consistently tilts the head to see. 3. The child does not respond when spoken to. 4. The child consistently turns the head to hear.
2
The nurse admits a child to the hospital with a diagnosis of pyloric stenosis. On assessment, which data would the nurse expect to obtain when asking the parent about the child's symptoms? 1. Watery diarrhea 2. Projectile vomiting 3. Increased urine output 4. Vomiting large amounts of bile
2
***A nurse is assisting in developing a plan of care for a 10-year-old child diagnosed with acute glomerulonephritis. Following review of the plan of care, the nurse determines that which of the following is the priority for the child? 1. Restricting oral fluids 2. Allowing the child to play with the other children in the playroom 3. Promoting bedrest 4. Encouraging visits from friends
3
***A nurse is caring for a child with congestive heart failure and provides instructions to the mother regarding the procedure for administration of the prescribed lanoxin (Digoxin). Which statement by the mother indicates a need for further instruction? 1. "If the child vomits after the medication is given, I should not repeat the dose." 2. "I need to take the child's pulse before administering the medication." 3. "I can mix the medication with food." 4. "If more than one dose is missed, I need to call the physician."
3
A child has fluid volume deficit. The nurse performs an assessment and determines that the child is improving and the deficit is resolving if which finding is noted? 1. The child has no tears. 2. Urine specific gravity is 1.035. 3. Capillary refill is less than 2 seconds. 4. Urine output is less than 1 mL/kg/hr.
3
The school nurse has provided an instructional session about impetigo to parents of the children attending the school. Which statement, if made by a parent, indicates a need for further instruction? 1. "It is extremely contagious." 2. "It is most common in humid weather." 3. "Lesions most often are located on the arms and chest." 4. "It might show up in an area of broken skin, such as an insect bite."
3
the nurse is providing medication instructions to a parent. Which statement by the parent indicates a need for further instruction? 1. "I need to cuddle my child after giving the medication." 2. "I can give my child a frozen juice bar after my child swallows the medication." 3. "I need to mix the medication in the baby food and give it when I feed my child." 4. "If my child does not like the taste of the medicine, I need to encourage my child to pinch the nose and drink the medication through a straw."
3
***A nurse employed in an emergency department is instructed to monitor a child diagnosed with epiglottitis. The nurse notes that the child is leaning forward with the chin thrust out. The nurse interprets this finding as indicating: 1. The presence of dehydration 2. The presence of pain 3. Extreme fatigue 4. An airway obstruction
4
***A nurse is collecting data on a child with a diagnosis of rheumatic fever. Which of the following questions would the nurse initially ask the mother of the child? 1. "Has the child had any diarrhea?" 2. "Has the child been vomiting?" 3. "Does the child complain of chest pain?" 4. "Has the child complained of a sore throat within the past few months?"
4
The clinic nurse instructs parents of a child with sickle cell anemia about the precipitating factors related to sickle cell crisis. Which, if identified by the parents as a precipitating factor, indicates the need for further instruction? 1. Stress 2. Trauma 3. Infection 4. Fluid overload
4
The clinic nurse is providing instructions to the parent of a child with cystic fibrosis regarding the immunization schedule for the child. Which statement would the nurse make to the parent? 1. "The immunization schedule will need to be altered." 2. "The child should not receive any hepatitis vaccines." 3. "The child will receive all of the immunizations except for the polio series." 4. "The child will receive the recommended basic series of immunizations along with a yearly influenza vaccination."
4
The clinic nurse reviews the record of an infant and notes that the primary health care provider (PHCP) has documented a diagnosis of suspected Hirschsprung's disease. The nurse reviews the assessment findings documented in the record, knowing that which sign most likely led the parent to seek health care for the infant? 1. Diarrhea 2. Projectile vomiting 3. Regurgitation of feedings 4. Foul-smelling ribbon-like stools
4
The parent of a 6-year-old child arrives at a clinic because the child has been experiencing itchy, red, and swollen eyes. The nurse notes a discharge from the eyes and sends a culture to the laboratory for analysis. Chlamydial conjunctivitis is diagnosed. On the basis of this diagnosis, the nurse determines that which requires further investigation? 1. Possible trauma 2. Possible sexual abuse 3. Presence of an allergy 4. Presence of a respiratory infection
2
A 6-year-old child with human immunodeficiency virus (HIV) infection has been admitted to the hospital for pain management. The child asks the nurse if the pain will ever go away. The nurse would make which best response to the child? 1. "The pain will go away if you lie still and let the medicine work." 2. "Try not to think about it. The more you think it hurts, the more it will hurt." 3. "I know it must hurt, but if you tell me when it does, I will try to make it hurt a little less." 4. "Every time it hurts, press on the call button and I will give you something to make the pain go all away."
3
A lumbar puncture is performed on a child suspected to have bacterial meningitis, and cerebrospinal fluid (CSF) is obtained for analysis. The nurse reviews the results of the CSF analysis and determines that which results would verify the diagnosis? 1. Clear CSF, decreased pressure, and elevated protein level 2. Clear CSF, elevated protein, and decreased glucose levels 3. Cloudy CSF, elevated protein, and decreased glucose levels 4. Cloudy CSF, decreased protein, and decreased glucose levels
3
The nurse prepares a teaching plan for the parent of a child diagnosed with bacterial conjunctivitis. Which, if stated by the parent, indicates a need for further teaching? 1. "I need to wash my hands frequently." 2. "I need to clean the eye as prescribed." 3. "It is okay to share towels and washcloths." 4. "I need to give the eye drops as prescribed."
3
A 9-year-old child is diagnosed with chlamydial conjunctivitis. The nurse consults with the primary health care provider regarding necessary follow-up because this infection can be associated with: 1. The presence of systemic allergies 2. The cleanliness of the home environment 3. The presence of otitis media 4. Possible sexual abuse
4
A child has a right femur fracture caused by a motor vehicle crash and is placed in skin traction temporarily until surgery can be performed. During assessment, the nurse notes that the dorsalis pedis pulse is absent on the right foot. Which action would the nurse take? 1. Administer an analgesic. 2. Release the skin traction. 3. Apply ice to the extremity. 4. Notify the primary health care provider (PHCP).
4
The nurse provides home care instructions to the parents of a child with heart failure regarding the procedure for administration of digoxin. Which statement made by the parent indicates the need for further instruction? 1. "I will not mix the medication with food." 2. "If more than one dose is missed, I will call the pediatrician." 3. "I will take my child's pulse before administering the medication." 4. "If my child vomits after medication administration, I will repeat the dose."
4
The nurse reviews the laboratory results for a child with a suspected diagnosis of rheumatic fever, knowing that which laboratory study would assist in confirming the diagnosis? 1. Immunoglobulin 2. Red blood cell count 3. White blood cell count 4. Anti-streptolysin O titer
4
The parent of an 8-year-old child being treated for right lower lobe pneumonia at home calls the clinic nurse. The parent tells the nurse that the child complains of discomfort on the right side and that ibuprofen is ineffective. Which instruction would the nurse provide to the parent? 1. Increase the dose of ibuprofen. 2. Increase the frequency of ibuprofen. 3. Encourage the child to lie on the left side. 4. Encourage the child to lie on the right side.
4
A 1-month-old infant is seen in a clinic and is diagnosed with developmental dysplasia of the hip. On assessment, the nurse understands that which finding would be noted in this condition? 1. Limited range of motion in the affected hip 2. An apparent lengthened femur on the affected side 3. Asymmetrical adduction of the affected hip when the infant is placed supine with the knees and hips flexed 4. Symmetry of the gluteal skinfolds when the infant is placed prone and the legs are extended against the examining table
1
An infant of a birth parent infected with human immunodeficiency virus (HIV) is seen in the clinic each month and is being monitored for symptoms indicative of HIV infection. With knowledge of the most common opportunistic infection of children infected with HIV, the nurse assesses the infant for which sign? 1. Cough 2. Liver failure 3. Watery stool 4. Nuchal rigidity
1
The home care nurse provides instructions regarding basic infection control to the parent of an infant with human immunodeficiency virus (HIV) infection. Which statement, if made by the parent, indicates the need for further instruction? 1. "I will clean up any spills from the diaper with diluted alcohol." 2. "I will wash baby bottles, nipples, and pacifiers in the dishwasher." 3. "I will be sure to prepare foods that are high in calories and high in protein." 4. "I will be sure to wash my hands carefully before and after caring for my infant."
1
***A licensed practical nurse (LPN) is assigned to assist in caring for a hospitalized child who is receiving a continuous infusion of intravenous (IV) potassium for the treatment of dehydration. The LPN monitors the child closely and notifies the registered nurse if which of the following is noted? 1. Temperature of 100.8° F rectally 2. Weight increase of 0.5 kg 3. A decrease in urine output to 0.5 mL/kg/hr 4. Blood pressure (BP) unchanged from baseline
3
A child is brought to the emergency department, and a fracture of the left lower arm is suspected. The mother states that the child was Rollerblading and attempted to break a fall with an outstretched arm. The child receives diagnostic x-rays, from which it has been determined that a fracture is present. A plaster of paris cast is applied to the arm, and the nurse provides instructions to the mother regarding cast care at home. Which of the following instructions would the nurse provide to the mother? 1. The cast should be dry in about 6 hours. 2. The cast is water resistant, so the child is able to take a bath or a shower. 3. The cast will not mold to the body and should heal the fracture in no time at all. 4. The cast needs to be kept dry, because when wet it will begin to disintegrate.
4
The nurse provides feeding instructions to the parent of an infant diagnosed with gastroesophageal reflux disease. Which instruction would the nurse give to the parent to assist in reducing the episodes of emesis? 1. Provide less frequent, larger feedings. 2. Burp the infant less frequently during feedings. 3. Thin the feedings by adding water to the formula. 4. Thicken the feedings by adding rice cereal to the formula.
4
A nurse is collecting data on an infant with a diagnosis of suspected Hirschsprung's disease. Which of the following questions to the mother will most specifically elicit information regarding this disorder? 1. "Does your infant have foul-smelling, ribbon-like stools?" 2. "Is your infant constantly vomiting?" 3. "Does your infant constantly spit up feedings?" 4. "Does your infant have diarrhea?"
1
A nurse is monitoring a 3-year-old with diarrhea for signs/symptoms of dehydration. The child now weighs 42 lb (19 kg), a decrease from his weight of 44 lb (20 kg) 24 hours ago. In addition to dry mucous membranes and lack of tears, what assessment finding would the nurse find? 1. Decreased heart rate 2. Bilateral 1+ pedal pulses 3. Increased blood pressure 4. Urine output of 80 mL in the last 3 hours
2
A nurse is monitoring a school-age child who is being treated for dehydration. The nurse notes that the child's urine output has been 1 mL/kg/hr over the past 3 hours and that the specific gravity of the urine is 1.020. Which is the appropriate nursing action? 1. Contact the pediatrician 2. Document the findings 3. Encourage the child to drink more fluids 4. Increase the rate of flow of the intravenous (IV) solution
2
A nurse is providing home care instructions to the mother of a child with juvenile idiopathic arthritis. Which action should the nurse tell the parents to take during a painful exacerbation? 1. Splinting the painful joints and avoiding any joint movement 2. Encouraging the child to perform simple isometric exercises 3. Alternating splinting of the painful joints with joint exercises every hour 4. Encouraging the child to perform the prescribed joint exercises to maintain muscle and joint integrity
2
***A nurse is reviewing the physician's orders for a child with rheumatic fever who is suspected of having a viral infection. The nurse notes that acetylsalicylic acid (aspirin) is prescribed for the child. Which of the following nursing actions is appropriate? 1. Administer the aspirin if the child's temperature is elevated. 2. Administer the aspirin if the child experiences any joint pain. 3. Consult with the registered nurse to verify the prescription. 4. Administer acetaminophen (Tylenol) instead of the aspirin for temperature elevation.
3
A nurse is assisting in admitting a child who arrived from the emergency department after treatment for acetaminophen (Tylenol) overdose. The nurse reviews the child's record and expects to note that the child received which of the following for the acetaminophen overdose? 1. Calcium disodium edetate (EDTA) 2. Protamine sulfate 3. Epoetin alfa (Epogen) 4. Acetylcysteine (Mucomyst)
4
A nurse is providing information to parents about the transmission of Hepatitis the nurse should tell the parents that the hepatitis A virus is primarily transmitted 1. During Birth 2. By way of sexual contact 3. In blood and blood products 4. In contaminated food or water
4
A pediatrician prescribes an intravenous (IV) solution of 5% dextrose and half-normal saline (0.45%) with 40 mEq of potassium chloride for a child with hypotonic dehydration. The nurse performs which priority assessment before administering this IV prescription? 1. Obtains a weight 2. Takes the temperature 3. Takes the blood pressure 4. Checks the amount of urine output
4
A pediatrician prescribes laboratory studies for the infant of a birthing parent positive for human immunodeficiency virus (HIV). The nurse anticipates that which laboratory study will be prescribed for the infant? 1. Chest x-ray 2. Western blot 3. CD4+ cell count 4. p24 antigen assay
4
A topical corticosteroid is prescribed by the pediatrician for a child with contact dermatitis (eczema). Which instruction would the nurse give the parent about applying the cream? 1. Apply the cream over the entire body. 2. Apply a thick layer of cream to affected areas only. 3. Avoid cleansing the area before application of the cream. 4. Apply a thin layer of cream and rub it into the area thoroughly.
4
Permethrin is prescribed for a child with a diagnosis of scabies. The nurse would give which instruction to the parents regarding the use of this treatment? 1. Apply the lotion to areas of the rash only. 2. Apply the lotion and leave it on for 6 hours. 3. Avoid putting clothes on the child over the lotion. 4. Apply the lotion to cool, dry skin at least 30 minutes after bathing.
4
A nurse is collecting data from a child suspected of having juvenile idiopathic arthritis (JIA). Which findings would the nurse expect to note if JIA were present? Select all that apply. 1. Malaise, fatigue, and lethargy 2. Painful, stiff, and swollen joints 3. Limited range of motion of the joints 4. Stiffness that develops later in the day 5. Cool temperature of the skin over the affected joints 6. History of late afternoon temperature, with temperature spiking up to 105° F
1, 2, 3, 6
Antibiotics are prescribed for a child with otitis media who underwent a myringotomy with insertion of tympanostomy tubes. The nurse provides discharge instructions to the parents regarding the administration of the antibiotics. Which statement, if made by the parents, indicates understanding of the instructions provided? 1. "Administer the antibiotics until they are gone." 2. "Administer the antibiotics if the child has a fever." 3. "Administer the antibiotics until the child feels better." 4. "Begin to taper the antibiotics after 3 days of a full course."
1
A nurse is reviewing the health care record of an infant suspected of having unilateral hip dysplasia. Which assessment finding would the nurse expect to note documented in the infant's record regarding this condition? 1. Asymmetric adduction of the affected hip when placed supine with the knees and hips flexed 2. Asymmetry of the gluteal skin folds when the infant is placed prone and the legs are extended against the examining table 3. An apparent short femur on the unaffected side 4. Full range of motion in the affected hip
2
The emergency department nurse is caring for a child diagnosed with epiglottitis. In assessing the child, the nurse would monitor for which indication that the child may be experiencing airway obstruction? 1. The child exhibits nasal flaring and bradycardia. 2. The child is leaning forward, with the chin thrust out. 3. The child has a low-grade fever and complains of a sore throat. 4. The child is leaning backward, supporting self with the hands and arms.
2
The nurse is caring for an infant with bronchiolitis, and diagnostic tests have confirmed respiratory syncytial virus (RSV). On the basis of this finding, which is the most appropriate nursing action? 1. Initiate strict enteric precautions. 2. Move the infant to a private room. 3. Leave the infant in the present room, because RSV is not contagious. 4. Inform the staff that using standard precautions is all that is necessary when caring for the child.
2
A 4-year-old child sustains a fall at home and is brought to the emergency department by the mother. Following x-ray examination, it has been determined that the child has a fractured arm, and a plaster cast is applied. The nurse provides instructions to the mother regarding cast care for the child. Which statement by the mother indicates a need for further instructions? 1. "The cast will feel warm when it is dried." 2. "If the cast becomes wet, a fan may be used to dry the cast." 3. "I need to call the physician if any blood or drainage appears on the cast." 4. "I can apply ice to the casted area to prevent swelling."
1
A nurse has provided discharge instructions to the mother of an 18-month-old child following surgical repair of hypospadias. Which statement by the mother indicates a need for further instruction? 1. "I should carry my child by straddling the child on my hip." 2. "I should use double diapers to hold the surgery site in place." 3. "I should avoid toilet training right now." 4. "I should encourage fluid intake."
1
A nurse provides instruction to an adolescent client with exercise-induced asthma which statement by the client indicates a need for further instruction 1. I should use a bronchodilator after I finish working out 2. The s/s usually begin after 5-10 minutes after exercise 3. I should use progressive muscle relaxation techniques to keep from hyperventilating 4. When I exercise in cold weather I should cover my nose and mouth with a scarf to warm up the air I'm breathing
1
A child has been diagnosed with acute otitis media of the right ear. Which interventions would the nurse include in the plan of care? Select all that apply. 1. Provide a soft diet. 2. Position the child on the left side. 3. Administer an antihistamine twice daily. 4. Irrigate the right ear with normal saline every 8 hours. 5. Administer ibuprofen for fever every 4 hours as prescribed and as needed. 6. Instruct the parents about the need to administer the prescribed antibiotics for the full course of therapy."
1,5,6
The nurse performing an admission assessment on a 2-year-old child who has been diagnosed with nephrotic syndrome notes that which most common characteristic is associated with this syndrome? 1. Hypertension 2. Generalized edema 3. Increased urinary output 4. Frank, bright red blood in the urine
2
The nurse reviews the record of a child who is suspected to have glomerulonephritis. Which statement that relates to this diagnosis would the nurse expect to hear from the child's parents? 1. "The pediatrician said the kidneys are working well." 2. "I noticed the urine was the color of cola lately." 3. "I'm so glad they didn't find any protein in the urine." 4. "The nurse who admitted my child said the blood pressure was low."
2
A nurse is providing instructions to the mother of a child who has been exposed to human immunodeficiency virus (HIV) infection. The nurse instructs the mother to notify the physician if which of the following symptoms occur in the child? 1. Lethargy or fatigue 2. Hyperactivity 3. Coughing or chest congestion 4. Irritability and fussiness
3
***A nurse provides instructions to the parents of an infant with hip dysplasia regarding care of the Pavlik harness. Which statement, if made by one of the parents, indicates an understanding of the use of the harness? 1. "I need to remove the harness to feed my infant." 2. "I need to remove the harness to change the diaper." 3. "My infant needs to remain in the harness at all times." 4. "I can remove the harness to bathe my infant."
4
The nurse has just administered ibuprofen to a child with a temperature of 102° F (38.8° C). The nurse would also take which action? 1. Withhold oral fluids for 8 hours. 2. Sponge the child with cold water. 3. Plan to administer salicylate in 4 hours. 4. Remove excess clothing and blankets.
4
The nurse is planning care for a child with acute bacterial meningitis. Based on the mode of transmission of this infection, which precautionary intervention would be included in the plan of care? 1. Maintain enteric precautions. 2. Maintain neutropenic precautions. 3. No precautions are required as long as antibiotics have been started. 4. Maintain respiratory isolation precautions for at least 24 hours after the initiation of antibiotics.
4
The nurse is preparing to care for a child with a diagnosis of intussusception. The nurse reviews the child's record and expects to note which sign of this disorder documented? 1. Watery diarrhea 2. Ribbon-like stools 3. Profuse projectile vomiting 4. Bright red blood and mucus in the stools
4
A child with a tracheal obstruction is brought to the emergency department by emergency medical services. The child aspirated a grape, and the foreign body was removed by direct laryngoscopy. Following the procedure, the nurse plans to inform the mother of the child that: 1. The child will need to be hospitalized for observation. 2. The child may go home with a prescription for antibiotics. 3. The child will need to return to the hospital for a chest x-ray in 1 week. 4. The child will require a bronchoscopy for follow-up evaluation in 1 month.
1
A CD4+ count has been ordered for a child with human immunodeficiency virus (HIV) infection. The mother asks the nurse about the purpose of the test and why the test needs to be done if it is already known that the child has HIV. The nurse should provide which information to the mother? Select all that apply. 1. The CD4+ count is used to determine the child's immune status. 2. The CD4+ count is used to identify the risk for disease progression. 3. The CD4+ count identifies the need for Pneumocystis jiroveci pneumonia prophylaxis after 1 year of age. 4. The CD4+ count identifies the specific diagnosis of HIV infection. 5. The CD4 count is measured at ages 1 and 3 months, every 3 months until the age of 2 years, and at least every 6 months thereafter. 6. More frequent monitoring of CD4+ counts is indicated when pneumonia prophylaxis and antiretroviral therapy are administered.
1, 2, 3, 5, 6
***A nurse is caring for a hospitalized infant with a diagnosis of bronchiolitis. The nurse positions the infant: 1. With the head at a 60-degree angle with the neck slightly flexed 2. In a supine, side-lying position 3. With the head and chest at a 30-degree angle, with the neck slightly extended 4. Prone, with the head of the bed elevated 15 degrees
3
***A nurse is preparing for the administration of ribavirin (Virazole) to a child with respiratory syncytial virus. Which of the following supplies will the nurse obtain for the administration of this medication? 1. An intravenous (IV) pole 2. An intramuscular (IM) syringe 3. A pair of goggles 4. A protective isolation gown
3
A nurse provides home care instructions to the mother of a child with impetigo. Which statement by the mother indicates the need for further instruction? 1. "It's OK for him/her to go to school tomorrow." 2. "I need to wear gloves while I'm taking care of him/her." 3. "My husband and I shouldn't share towels or utensils with him/her." 4. "I need to soak the crusts and then wash them off with a warm, soapy washcloth three times a day."
1
A birthing parent with human immunodeficiency virus (HIV) infection brings a 10-month-old infant to the clinic for a routine checkup. The pediatrician has documented that the infant is asymptomatic for HIV infection. After the checkup the parent tells the nurse about being so pleased that the infant will not get HIV infection. The nurse would make which most appropriate response to the parent? 1. "I am so pleased also that everything has turned out fine." 2. "Because symptoms have not developed, it is unlikely that your infant will develop HIV infection." 3. "Everything looks great, but be sure to return with your infant next month for the scheduled visit." 4. "Most children infected with HIV develop symptoms within the first 9 months of life, and some become symptomatic sometime before they are 3 years old."
4
