NCLEX 3000 Preschooler

A child, age 4, who has been hospitalized with asthma is to receive oral theophylline at home. Before discharge, the nurse teaches the parents about signs and symptoms of theophylline toxicity and the need to report these promptly. Which statement by the parents indicates effective teaching?

1. "We will report irritability and restlessness."

Which of the following immunizations should the nurse in the pediatrician's office verify the child has had on entering school?

1. Hepatitis B series, 2. Diphtheria-tetanus-acellular pertussis (DTaP) series, 3. Haemophilus influenzae type b series, 4. Varicella zoster (if the child never had chickenpox), 6. Inactivated polio series.

The nurse is caring for a preschooler who was just diagnosed with an allergy to wheat. When teaching the mother about dietary restrictions, the nurse should tell her to eliminate which food from the child's diet?

1. Hot dogs

A preschool child is admitted to the pediatric unit with acute nephritis. Which electrolyte replacement agent is used as an adjunct to treatment for this condition?

1. Magnesium sulfate

Encouraging children to engage in fantasy play and participate in their own care is a useful developmental approach for which pediatric age-group?

1. Preschool age (3 to 5 years)

A preschool-age child with sickle cell anemia is admitted to the health care facility in vaso-occlusive crisis after developing a fever and joint pain. What is the nurse's highest priority when caring for this child?

1. Providing fluids

Which response should alert the nurse caring for a preschooler who underwent surgery that the child is experiencing pain?

1. The child begins clutching at his parents.

The nurse discovers a 5-year-old child who's unresponsive, apneic, and pulseless. The correct sequence of events that should follow is to:

1. call for help, open the airway, provide two rescue breaths, and begin compressions at a rate of 100 per minute.

When telling a 4-year-old child about an upcoming procedure, the nurse's most important consideration is to:

1. use simple terms.

A boy, age 4, begins to use foul language. Concerned about this behavior, his parents ask the nurse how to stop it. Which advice should the nurse offer?

2. "Tell him it isn't acceptable and he'll be disciplined if he continues to do it."

A child, age 3, is admitted to the pediatric unit with dehydration after 2 days of nausea and vomiting. The mother tells the nurse that her child's illness "is all my fault." How should the nurse respond?

2. "Tell me why you think this is your fault."

The grandmother of a preschool-age child calls the clinic to report that the child has had a fever, has been fussy, and now has a rash that started on the neck and has spread to the rest of the child's body. The child was exposed to chickenpox about 3 weeks ago. What advice would be most important to give to the grandmother?

2. "You can help relieve the child's itching by giving him oatmeal baths."

The parents of a child with cystic fibrosis, an autosomal recessive disorder, are considering having a second child. Each parent is heterozygous for the cystic fibrosis trait. What is the chance that their second child will manifest the disorder?

2. 25%

What is a normal systolic blood pressure for a 3-year-old child?

2. 86 mm Hg

Which toy would be most appropriate for a 3-year-old client?

2. A puzzle with large pieces

The physician diagnoses leukemia in a child, age 4, who complains of being tired and sleeps most of the day. Which nursing diagnosis reflects the nurse's understanding of the pathophysiology behind leukemia?

2. Activity intolerance related to anemia

Which method is most reliable for confirming a preschooler's identity before administering a medication?

2. Check the hospital identification bracelet.

In a pediatric client, what is an early sign of acute renal failure (ARF)?

2. Decreased urine output

When collecting data on a child with impetigo, the nurse expects which findings?

2. Honey-colored, crusted lesions

Which documentation is most important when preparing a preschool-age child for surgery?

2. Informed consent

The mother of a preschooler with spina bifida tells the nurse that her daughter sneezes and gets a rash when playing with brightly colored balloons and that recently she had an allergic reaction after eating kiwifruit and bananas. The nurse would suspect that the child may have an allergy to which of the following?

2. Latex

A parent asks the nurse for advice on disciplining a 4-year-old child. During the teaching session, which fact should the nurse emphasize?

2. Parental control should be firm and consistent.

The nurse is caring for a preschool-age child who sustained burns in a house fire. The child is prescribed morphine every 4 hours for pain. Which assessment parameter is most important when monitoring a child who's receiving morphine?

2. Respirations

The grandmother of a preschool-age child calls the clinic to report that the child has had a fever, has been fussy, and now has a rash that started on the neck and has spread to the rest of the child's body. The child was exposed to chickenpox about 3 weeks ago. Which of the following would be the most important advice to give the grandmother?

2. Treat the child's symptoms and use diphenhydramine (Benadryl) for itching.

When collecting data on a child with muscular dystrophy, the nurse expects which finding?

2. Waddling gait

A child with leukemia has just completed a course of methotrexate therapy. How soon should the nurse expect to see signs of bone marrow depression in this client?

2. Within 2 weeks

A child is receiving peritoneal dialysis to treat renal failure. To detect early signs of peritonitis, the nurse should stay alert for

2. abdominal tenderness.

When planning care for a child with epiglottitis, the nurse should assign highest priority to:

2. ensuring respiratory patency.

For a child who's admitted to the emergency department with an acute asthma attack, nursing data collection is most likely to reveal:

2. expiratory wheezing.

A child's physician prescribes a drug for home use. Before the child is discharged, the nurse should:

2. provide the family with the drug's name, dosage, route, and frequency of administration.

To calculate drug dosages for a 4-year-old child, the physician might use a formula that involves the child's:

2. weight in kilograms.

The nurse must administer an oral medication to a 3-year-old child. The best way for the nurse to proceed is by saying:

3. "Here is your medicine. Would you like apple juice or grape drink after?"

A child, age 5, is diagnosed with mycoplasmal pneumonia and has a persistent productive cough. When monitoring the child's respirations, the nurse should keep in mind that children normally use which muscles to breathe?

3. Abdominal

When collecting data on a preschooler who has sustained a head trauma, the nurse notes that the child appears to be obtunded. Which of the following denotes the child's level of consciousness?

3. Can be aroused with stimulation

The nurse is finishing her shift on the pediatric unit. Because her shift is ending, which intervention takes top priority?

3. Documenting the care provided during her shift

A child with a fractured left femur receives a cast. A short time later, the nurse notices that the toes on the child's left foot are edematous. Which nursing action would be most appropriate?

3. Elevating the foot of the bed

A preschool-age child scheduled for surgery in the morning is admitted to the facility for the first time. Which nursing action would ease the child's anxiety?

3. Having the child act out the surgical experience using dolls and medical equipment

Which is the most appropriate nursing diagnosis for a preschool child with epiglottitis?

3. Ineffective airway clearance related to laryngospasm

The nurse has just administered a drug to a child. Which organ is most responsible for drug excretion in children?

3. Kidneys

Which complementary therapy might calm a 4-year-old who has separation anxiety when his parents leave the hospital?

3. Music therapy

After collecting data on a newly admitted 5-year-old child, the nurse assists in making the nursing diagnosis of Parental role conflict related to child's hospitalization. Which defining characteristic would most suggest this diagnosis?

3. Parents' failure to use available support systems or agencies to assist in coping

The nurse expects to see a rise in the incidence of infectious diseases in children of which age-group?

3. Preschool age

A child, age 4, is hospitalized because of alleged sexual abuse. What is the best nursing intervention for this child?

3. Providing play situations that allow disclosure

A child, age 3, with lead poisoning is admitted to the facility for chelation therapy. The nurse must stay alert for which of the following adverse effects?

3. Seizures

For a child with tracheobronchitis, the nurse formulates a nursing diagnosis of Ineffective airway clearance related to thick secretions. After implementing interventions, the nurse expects which client outcome?

3. The child exhibits clear breath sounds

The nurse realizes she's 1 hour late in administering a dose of medication for her 4-year-old client. She gives the medication immediately and assesses the client. The client isn't harmed by the delay. Which action should the nurse take next?

3. The nurse should follow facility procedures for reporting an error.

The parents of a preschool-age child ask the nurse about nutrition. Which statement about a preschooler's nutritional requirements is accurate?

3. The quality of food that a preschooler consumes is more important than the quantity.

A 4-year-old child is having a sickle cell crisis. The initial nursing intervention should be to:

3. provide oral and I.V. fluids.

The nurse is preparing a child, age 4, for cardiac catheterization. Which explanation of the procedure is most appropriate?

4. "The special medicine will feel warm when it's put in the tubing."

A 5-year-old client is admitted to the hospital for a tonsillectomy. After the surgery, the physician orders a clear liquid diet. The nurse is correct in giving the child which items?

4. Apple juice, 5. Lime gelatin, 6. Chicken broth

A 3½-year-old Vietnamese child with a fever, decreased urine output, wheezing, and coughing is brought to the emergency department. On data collection, the nurse discovers red, round, weltlike lesions on the child's upper back and chest. The nurse would interpret these lesions to be caused by which of the following?

4. Cultural practice

A child, age 5, is diagnosed with hyperphosphatemia secondary to chronic renal failure. When teaching the parents about diet therapy, the nurse should instruct them to eliminate which foods from the child's diet?

4. Dairy products

The nurse is collecting data on whether the client has received all recommended immunizations for his age. Which immunizations should he have received between ages 4 and 6?

4. Diphtheria, tetanus, and acellular pertussis (DTaP), MMR, inactivated polio virus (IPV), and pneumococcal vaccine

A preschool-age child underwent a tonsillectomy 4 hours ago. Which data collection finding would make the nurse suspect postoperative hemorrhage?

4. Frequent swallowing

The parents of a 4-year-old child with sickle cell anemia tell the nurse that they would like to have other children, but they're concerned about passing sickle cell anemia on to them. Which health care team member would be the most appropriate person for the nurse to refer them to?

4. Genetic counselor

The nurse is deciding whether to report a suspected case of child abuse. Which criterion is the most important for the nurse to consider?

4. Incompatibility between the history and the injury

The nurse is providing care to a 5-year-old child with a fractured femur whose nursing diagnosis is Imbalanced nutrition: less than body requirements related to impaired physical mobility. Which of the following is most likely to occur with this condition?

4. Increased carbohydrate need

Which intervention should be included in the care plan for a preschool-age child immobilized by traction?

4. Increasing the child's fluid intake

A 4-year-old girl has a urinary tract infection (UTI). When teaching the parents how to help her avoid recurrent UTIs, the nurse should emphasize which preventive measure?

4. Making sure she avoids bubble baths

The estranged father of a preschool-age child comes to the hospital to visit his child. The child's medical record contains a restraining order that restricts the father from visiting. When approached by the nurse, the father becomes argumentative. Which hospital department should be notified immediately?

4. Security

A preschool-age child refuses to take prescribed medication. Which nursing strategy would be most appropriate?

4. Showing trust in the child's ability to cooperate even with an unpleasant procedure

A mother asks the nurse how to handle her 4-year-old child, who recently started wetting his pants after being completely toilet trained. The child just started attending nursery school 2 days a week. Which principle should guide the nurse's response?

4. The child returns to a level of behavior that increases his sense of security.

When collecting data on a child's cultural background, the nurse should keep in mind that:

4. behavioral patterns are learned within a culture.

A child, age 5, takes theophylline orally three times per day to treat asthma. For the most accurate calculation of a safe dosage, the nurse should use:

4. the child's body surface area.

The nurse is concerned about another nurse's relationship with the members of a family and their ill preschooler. Which of the following behaviors would be most worrisome and should be brought to the attention of the nurse-manager?

2. The nurse attempts to influence the family's decisions by presenting her own thoughts and opinions.

A child, age 5, is to receive potassium added to the I.V. fluid. Before initiating this therapy, the nurse first should:

3. monitor fluid intake and output.

A 5-year-old child is brought to the emergency department with a fever, severe vomiting, irritability, and confusion. The parents state that the child had a recent viral illness but was recovering without difficulty. Numerous diagnostic studies are completed, yielding the results of acute encephalopathy as well as fatty degeneration of the liver and other abdominal organs. Reye's syndrome is diagnosed. Which medication should the nurse suspect was given to the child during his illness?

1. Aspirin

A 5-year-old child suspected of having leukemia is admitted to the hospital for diagnosis and treatment. Which tests aid in diagnosing leukemia?

1. Bone marrow aspiration and analysis, 2. Complete blood count, 3. Lumbar puncture

A preschooler with a history of heart failure is prescribed digoxin (Lanoxin). Which nursing intervention is most important to perform before administering this drug to a child?

1. Checking apical heart rate for 1 minute

Which safety measure should be included when teaching the mother of a preschooler?

1. Teaching the preschooler never to go into the road without an adult

The nurse realizes teaching hasn't been effective when the mother of a preschool-age child with diabetes mellitus makes which statement?

1. "I'll give my daughter skim milk and graham crackers if her breath has a fruity odor."

Which statement indicates that a family of a dying 4-year-old child may be ready to consider organ donation?

1. "My wife and I feel that our real daughter has moved on even though her body is still functioning."

The mother of a 4-year-old child tells the nurse that her child is a very poor eater. What is the nurse's best recommendation for helping her increase her child's nutritional intake?

1. Allow the child to feed herself.

A child is to receive phenytoin (Dilantin), 5 mg/kg by mouth each day. When teaching the parents about the medication regimen, the nurse should use which approach?

1. Conduct brief teaching sessions, provide written materials during each visit, and repeat information as appropriate.

A child, age 4, with a recent history of nausea, vomiting, and diarrhea is admitted to the pediatric unit with a diagnosis of gastroenteritis. During data collection, the nurse detects tenting. This finding supports a nursing diagnosis of:

1. Deficient fluid volume related to dehydration.

The nurse is evaluating a child with acute poststreptococcal glomerulonephritis (APSGN) for signs of improvement. Which finding typically is the earliest sign of improvement?

1. Increased urine output

The nurse is observing the parents of a 4-year-old child who has been admitted to the hospital. Which of the following actions indicate that the parents understand how to best minimize anxiety during their child's hospitalization?

1. The parents bring the child's favorite toy to the hospital., 3. The parents remain at the child's side during the hospitalization., 4. The parents bring the child's siblings for a brief visit.

A child is admitted to the pediatric unit with a fractured hip. The physician orders Russell traction. This type of traction is:

1. skin traction applied to a lower extremity, with the extremity suspended above the bed.

A 4-year-old child is receiving dextrose 5% in water and half-normal saline solution at 100 ml/hour. The nurse should suspect that the child's I.V. fluid intake is excessive if data collection reveals:

1. worsening dyspnea.

The mother of a child with sickle cell anemia confides in the nurse that she feels guilty about letting the child run and play with the neighborhood children and that if she had been a better mother, the child wouldn't have suffered a sickle cell crisis. Which response would be most appropriate?

2. "Tell me more about how you feel."

Which category of transmission precautions is most appropriate for the hospitalized preschooler who has varicella (chickenpox)?

2. Airborne, 3. Standard

A preschool child presents with a history of vomiting and diarrhea for 2 days. Which data collection finding indicates that the child is in the late stages of shock?

2. Bradycardia

When assisting in developing a plan of care for a hospitalized child, the nurse knows that children in which age-group are most likely to view illness as a punishment for misdeeds?

2. Preschool age

For a child with hemophilia, what is the most important nursing goal?

2. Preventing bleeding episodes

The parents of a 5-year-old child call the clinic to tell the nurse that they think their child has been abused by her day-care provider. What should the nurse should advise them to do?

2. Schedule an immediate appointment with their health care provider.

A child with suspected rheumatic fever is admitted to the pediatric unit. When collecting data on the child's history, the nurse considers which information to be most important?

3. A recent episode of pharyngitis

When administering gentamicin to a preschooler, which of the following monitoring schedules is best for determining the drug's effectiveness?

3. A serum trough and peak level with the third dose

The nurse is teaching the mother of an ill child about childhood immunizations. The nurse should tell the mother that live virus vaccines shouldn't be administered to children with:

2. leukemia.

A preschooler has vomiting, diarrhea, and a potassium level of 3.0 mEq/L. The physician prescribes an I.V. infusion of dextrose 5% in water and half-normal saline solution with 10 mEq of potassium chloride. The nurse knows that a child with vomiting and diarrhea needs fluids and potassium chloride to:

2. meet physiologic needs.

A child is diagnosed with nephrotic syndrome. When planning the child's care, the nurse understands that the primary goal of treatment is to:

2. reduce the excretion of urinary protein.

A physician orders phenytoin (Dilantin) 150 mg by mouth twice per day for a child. The dosage strength of the oral suspension on hand is 30 mg/5 ml. How many milliliters of suspension should the nurse administer with each dose?

25

The nurse suspects that a child, age 4, is being neglected physically. To best collect data on the child's nutritional status, the nurse should ask the parents which question?

3. "What did your child eat for breakfast?"

The nurse is preparing to administer short-acting insulin to a child with type 1 diabetes mellitus. When should the nurse measure the child's blood glucose level?

3. 1 hour after administering insulin

How should the nurse prepare a suspension before administration?

3. By shaking it so that all the drug particles are dispersed uniformly

The nurse is obtaining the history of a pediatric client, age 4. Which area usually takes longer to evaluate in a child than in an adult?

3. Developmental status

Which sign is least likely to indicate abuse in a 4-year-old child?

3. Disheveled parental appearance and low socioeconomic status

A child with hemophilia is hospitalized after falling. Now the child complains of severe pain in the left wrist. What should the nurse do first?

3. Elevate the affected arm and apply ice to the injury site.

Which of the following techniques is most effective in preventing nosocomial infection transmission when caring for a preschooler?

3. Hand washing

A 4-year-old client has just returned from surgery. He has a nasogastric (NG) tube in place and is attached to intermittent suction. The child says to the nurse, "I'm going to throw up." What should the nurse do first?

3. Irrigate the NG tube to ensure patency.

When collecting data on a 5-year-old child with hemophilia, the nurse identifies which of the following as an early sign of hemarthrosis?

3. Joint stiffness

The mother of a preschooler recently diagnosed with type 1 diabetes mellitus makes an urgent call to the pediatrician's office. She says her child had an uncontrollable temper tantrum while playing and now is lethargic and hard to arouse. The nurse should instruct the mother to take which action first?

3. Measure the child's blood glucose level.

When collecting data on a child with bronchiolitis, which finding does the nurse expect?

4. Productive cough

The parent of a preschooler with chickenpox asks the nurse about measures to make the child comfortable. The nurse instructs the parent to avoid administering aspirin or any other product that contains salicylates. When given to children with chickenpox, aspirin has been linked to which disorder?

3. Reye's syndrome

Which finding might cause the nurse to suspect child abuse in a preschool-age child?

3. The child willingly goes to the nurse and cries when he's returned to the parents.

A 5-year-old child is brought to the emergency department after being stung multiple times on the face by yellow jackets. Which symptom of anaphylaxis requires priority medical intervention?

4. Pulse rate of 60 beats/minute

A child, age 5, is brought to the pediatrician's office for a routine visit. When inspecting the child's mouth, the nurse expects to find how many teeth?

3. Up to 20

The nurse is teaching the parents of a young child how to handle suspected poisoning. If the child ingests poison, the parents should first:

3. call the poison control center.

A child with a full-thickness burn is scheduled for debridement using hydrotherapy. Before hydrotherapy begins, the nurse should:

3. implement pain control measures.

A child, age 3, is admitted to the hospital for surgery. The physician orders meperidine (Demerol), 25 mg I.M., to be administered at 7 a.m. on the morning of surgery. To carry out this order, the nurse should:

3. let the child choose which leg will receive the injection.

A mother complains to the nurse that her 4-year-old son often lies. What is the nurse's best response?

4. "Acknowledge him by saying, 'That's a pretend story.'"

At a wellness visit, the parents report that their daughter, age 4, resists going to bed at night. After instruction by the nurse, which statement by the parents indicates effective teaching?

4. "We'll read her a story and let her play quietly in her bed until she falls asleep."

A child, age 3, who tests positive for the human immunodeficiency virus (HIV) is placed in foster care. The foster parents ask the nurse how to prevent HIV transmission to other family members. How should the nurse respond?

4. "Wear gloves when you're likely to come into contact with the child's blood or body fluids."

Which instruction should the nurse include in teaching about diet to parents of a preschool-age child who's prescribed corticosteroids?

4. "You need to make sure your child consumes a low-sodium diet."

The nurse is assisting in developing a teaching plan for a child with acute poststreptococcal glomerulonephritis. What is the most important point to address in this plan?

4. Blood pressure monitoring

A mother brings her preschool child to the emergency department after he ingested an unknown quantity of acetaminophen (Tylenol). Which treatment will the physician probably prescribe next?

4. Gastric lavage and administration of activated charcoal

A preschooler goes into cardiac arrest. When performing cardiopulmonary resuscitation (CPR) on a child, how should the nurse deliver chest compressions?

4. With the heel of one hand

A child experiences nausea and vomiting after receiving cancer chemotherapy drugs. To help prevent these problems from recurring, the nurse should:

4. administer an antiemetic 30 to 60 minutes before the next chemotherapy session.

A child is diagnosed with Wilms' tumor. During data collection, the nurse expects to detect:

4. an abdominal mass.

Tepid sponge baths effectively reduce hyperthermia in children. The best way to give such a bath is by:

4. continuing the bath for 20 to 30 minutes.

A preschool-age child with cystic fibrosis is being discharged and must use a mist tent at home. The nurse should explain the rationale for this treatment, which is to:

4. relieve dyspnea.

A preschooler is in danger of becoming dehydrated as a result of vomiting and diarrhea. The nurse realizes that dehydration can be prevented if intake is sufficient to produce an hourly urine output of 3 ml/kg/hr. The preschooler weighs 44 lb. What is the minimum urine output in milliliters that should be achieved in an 8-hour shift in order to prevent dehydration?

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