Pediatric Success - NCLEX Practice Q's

9. The parents of a 12-month-old with HIV are concerned about his receiving routine immunizations. What will the nurse tell them about immunizations? 1. "Your child will not receive routine immunizations today." 2. "Your child will receive the recommended vaccines today 3. "Your child is not severely immunocompromised, but I would still be concerned about his receiving them." 4. "Your child may develop infections if he gets his routine immunizations. Your child will not be immunized today."

Answer: 1. "Your child will not receive routine immunizations today." Rationale: 1. The nurse acknowledges a client's fears and then discusses the concerns to clarify any misconceptions. Immu- nizations and influenza vaccine are recommended to prevent infection. Immunocompromised HIV-infected children should not receive the varicella and MMR live vaccines. 2. Recommended immunizations for a 12-month-old include varicella and MMR (live vaccines), which are not administered to an immunocompromised child. 3. Recommended vaccines will be adminis- tered because the child is not immuno- compromised. 4. The recommendation is for the child to receive routine immunizations unless the child is immunocompromised. TEST-TAKING HINT: The test taker should know that families and patients who are HIV-positive should be taught ways to prevent infections, including the administration of immunizations.

8. Which signs and symptoms would the nurse expect to assess in a child with rheumatic fever? 1. Ankle and knee joint pain. 2. Negative group A beta streptococcal culture. 3. Large red "bulls eye"-appearing rash. 4. Stiff neck with photophobia.

Answer: 1. Ankle and knee joint pain. Rationale: 1.Joint pain or arthritis is the most common symptom of acute rheumatic fever (60% to 80% of first attacks). The joint pain usually occurs in two or more large joints (ankle, knee, wrist, or elbow). 2. Rheumatic fever usually follows group A streptococcal infection, and the culture is usually positive. 3. Large red "bull's-eye" lesions are more characteristic of Lyme disease. The rash associated with rheumatic fever is erythe- matous with a demarcated border. 4. A stiff neck with photophobia is more indicative of meningitis. TEST-TAKING HINT: The test taker should remember the major and minor criteria of rheumatic fever to answer this question.

2. Which would be the priority nursing intervention for a newly admitted child with Kawasaki disease? 1. Continuous cardiovascular and oxygen-saturation monitoring. 2. Vital signs every 4 hours until stable. 3. Strict intake and output monitoring hourly. 4. Begin aspirin therapy after fever has resolved.

Answer: 1. Continuous cardiovascular and oxygen-saturation monitoring. Rationale: 1. Cardiovascular manifestations of Kawasaki disease are the major complications in pediatric patients. Continuous cardiac monitoring is required to alert the nurse of any cardiovascular complications. Decreased oxygen saturation and respiratory changes have been shown to be early indicators of potential complications. 2. Vital signs would be taken every 1 to 2 hours until stable on a new admission with Kawasaki disease. 3. Strict intake and output is very important, but because the major complications with Kawasaki disease are cardiovascular, contin- uous cardiac monitoring is the priority. 4. High-dose aspirin therapy is begun and continued until the child has been afebrile for 48 to 72 hours; then the child is placed on low-dose therapy. TEST-TAKING HINT: The test taker should understand that cardiovascular manifesta- tions of Kawasaki disease are the major complications in pediatric patients.

35. Which would be the most appropriate injury prevention/safety teaching for an adolescent? 1. Inquire which are the favorite sports, discuss the teen's knowledge and application of appropriate safety principles. 2. Tell the teen to be careful performing sports activities because every sport has the potential for injury. 3. Tell the teen not to let friends encourage drinking, smoking, or taking drugs. 4. Ask the mother what sports the teen plays and if a helmet is worn with contact sports.

Answer: 1. Inquire which are the favorite sports, discuss the teen's knowledge and application Rationale: 1.Adolescence is a time of need for inde- pendence and learning to make appropri- ate decisions. Safety is always a concern, and tying a safety discussion to the teen's interest in sports will help keep him safe. The nurse needs to inquire about and build on the teen's interests and knowledge. 2. Lecturing to an adolescent would not be appropriate; the nurse needs to determine what the teen knows about safety mea - sures for that sport and then build on that information. 3. Determining whether the teen drinks, smokes, or uses drugs and what he thinks about those activities is the first step. Lecturing is never appropriate. 4. The teen should be addressed directly. TEST-TAKING HINT: The test taker should understand that age and developmentally appropriate injury prevention teachings are most effective.

7. Which would be the priority intervention for a child diagnosed with chickenpox (varicella) who was prescribed diphenhydramine (Benadryl) for itching? 1. Give a warm bath with mild soap before lotion application. 2. Avoid Caladryl lotion while taking diphenhydramine (Benadryl). 3. Apply Caladryl lotion generously to decrease itching. 4. Give a cool shower with mild soap to decrease itching.

Answer: 2. Avoid Caladryl lotion while taking diphenhydramine (Benadryl). Rationale: 1. To help decrease itching, a cool bath is a better option. Soap and warm water can cause more itching. 2.Caladryl lotion contains diphenhy- dramine (Benadryl), and the child would be at risk for toxicity if the Caladryl is applied to open lesions. 3. Caladryl lotion is applied in an amount to cover the lesions. 4. A cool shower can be soothing and decrease itching. Mild soap is drying to the lesions and can cause more itching. TEST-TAKING HINT: The test taker should understand that Caladryl lotion contains Benadryl.

13. Which teaching would be important to discuss with the family of a newborn with PKU? 1. Studies have shown that children with PKU outgrow the disease. 2. Consumption of decreased amounts of protein and dairy products is advised. 3. High-protein and high-dairy products consumption must be maintained. 4. Exclusive breastfeeding is encouraged for maximal nutrition for the child.

Answer: 2. Consumption of decreased amounts of protein and dairy products is advised. Rationale: 1. PKU is a genetic autosomal-recessive inherited trait. Phenylalanine is an essential amino acid, which makes it impossible to remove totally from the diet. Treatment is a low-phenylalanine diet, which includes some vegetables, fruits, juice, bread, and starches. 2.Many high-protein foods such as meats and dairy products are restricted or eliminated from the diet due to the high phenylalanine content. 3. High-protein foods such as meat and dairy products are restricted to small amounts or eliminated because of their high pheny- lalanine content. 4. Breast milk contains PKU and, if the mother wanted to breast feed, the infant would need careful monitoring of PKU levels. TEST-TAKING HINT: The test taker should understand that PKU is a genetic autosomal-recessive inherited trait. Strict, lifelong dietary restrictions and monitoring are required. Diet management includes meeting the child's nutritional and growth needs while maintaining phenylalanine levels within a safe range.

6. Which would be the priority intervention for a child suspected of having varicella (chickenpox)? 1. Contact precautions. 2. Contact and droplet respiratory precautions. 3. Droplet respiratory precautions. 4. Universal precautions and standard precautions.

Answer: 2. Contact and droplet respiratory precautions. Rationale: 1. The primary source of transmission is secre- tions from the respiratory tract (droplet) of infected persons (airborne). Transmission occurs by direct contact, skin lesions to a lesser extent, and contaminated objects. 2. Varicella (chickenpox) is highly contagious. Contact and droplet respiratory precau- tions should be started immediately because the primary source of transmission is secretions of the respiratory tract (droplet) and also by contaminated objects. 3. Droplet precaution is very important because that is the primary source of transmission. Transmission also occurs by direct contact and contaminated objects. 4. Standard precautions (formerly universal precautions) should always be maintained; the term refers to protecting oneself from patient's blood or body fluids. TEST-TAKING HINT: The test taker understands that the primary source of transmission of varicella (chickenpox) is secretions of the respiratory tract of infected persons (airborne). Transmission occurs by direct contact, skin lesions to a lesser extent, and contaminated objects.

21. What would be the priority nursing action on finding the varicella vaccine at room temperature on the shelf in the medication room? 1. Ensure the varicella vaccine's integrity is intact; if intact, follow the five rights of medication administration. 2. Do not administer this batch of vaccine. 3. Ensure the varicella vaccine's integrity is intact; if intact, give the vaccine after verifying proper physician orders. 4. Ask the mother if the child has had any prior reactions to varicella.

Answer: 2. Do not administer this batch of vaccine. Rationale: 1. Varicella vaccine should be kept frozen in the lyophilized form. After reconstitution, the varicella vaccine should be given within 30 minutes to ensure viral potency. The five rights of patient medication should always be followed prior to administration. 2.The varicella vaccine integrity cannot be assured if the vaccine is at room temperature, so do not administer. 3. Varicella vaccine should be kept frozen in the lyophilized form. After reconstitution, the varicella vaccine should be given within 30 minutes to ensure viral potency. If the vaccine is not frozen, do not administer. 4. This is an important question to ask the mother but does not address the questions of the nurse finding the varicella vaccine at room temperature. TEST-TAKING HINT: Varicella vaccine should be kept frozen in the lyophilized form. The vaccine diluents can be kept at room temperature.

34. A child with a newly applied left leg cast initially feels fine, then starts to cry and tells his mother his leg hurts. Which assessment would be the nurse's first priority? 1. Cast integrity. 2. Neurovascular integrity. 3. Musculoskeletal integrity. 4. Soft-tissue integrity.

Answer: 2. Neurovascular integrity. Rationale: 1. Neurovascular integrity should be assessed first and frequently because neurovascular compromise may cause serious conse- quences. Neurovascular integrity should be assessed using the 5 Ps: increased Pain out of proportion with injury, Pallor of extremity, Paresthesia, Pulselessness at distal part of extremity, and Paralysis post cast application. Cast integrity would be assessed, but neurovascular integrity is the highest priority. 2.Neurovascular integrity should be assessed first and frequently because neurovascular compromise may cause serious consequences. Neurovascular integrity should be assessed using the 5 Ps: increased Pain out of proportion with injury, Pallor of extremity, Paresthesia, Pulselessness at distal part of extremity, and Paralysis post cast application. 3. Neurovascular integrity should be assessed first and frequently because neurovascular compromise may cause serious conse- quences. Neurovascular integrity should be assessed using the 5 Ps: increased Pain out of proportion with injury, Pallor of extremity, Paresthesia, Pulselessness at distal part of extremity, and Paralysis post cast application. Musculoskeletal integrity would be assessed after neurovascular integrity. 4. Neurovascular integrity should be assessed first and frequently because neurovascular compromise may cause serious conse- quences. Neurovascular integrity should be assessed using the 5 Ps: increased Pain out of proportion with injury, Pallor of extremity, Paresthesia, Pulselessness at distal part of extremity, and Paralysis post cast application Soft-tissue integrity is assessed last. TEST-TAKING HINT: The test taker should understand that neurovascular integrity should be assessed first.

17. Which signs and symptoms would the nurse expect to assess in a newborn with congenital hypothyroidism? 1. Preterm, diarrhea, and tachycardia. 2. Post-term, constipation, and bradycardia. 3. High-pitched cry, colicky, and jittery. 4. Lethargy, diarrhea, and tachycardia.

Answer: 2. Post-term, constipation, and bradycardia. Rationale: 1. Congenital hypothyroidism clinical manifestations may include bradycardia, constipation, poor feeding, lethargy, galactose-1-phosphate uridyl transferase, jaundice prolonged for more than 2 weeks, cyanosis, respiratory difficulties, hoarse cry, large anterior/posterior fontanels, post- term, birth weight greater than 4000 g. 2.Congenital hypothyroidism clinical manifestations may include bradycardia, constipation, poor feeding, lethargy, jaundice prolonged for more than 2 weeks, cyanosis, respiratory difficul- ties, hoarse cry, large anterior/posterior fontanels, post-term, and birth weight greater than 4000 g. 3. High-pitched cry, being colicky and jittery usually indicate drug withdrawal or a neurological problem. 4. Congenital hypothyroidism clinical manifestations may include bradycardia, constipation, poor feeding, lethargy, jaundice prolonged for more than 2 weeks, cyanosis, respiratory difficulties, hoarse cry, large anterior/posterior fontanels, post-term, and birth weight greater than 4000 g. TEST-TAKING HINT: The test taker needs to know clinical manifestations of hypothyroidism to answer this question.

36. Which assessment is most important after any injury in a child? 1. History of loss of consciousness and length of time unconscious. 2. Serial assessments of level of consciousness. 3. Initial neurological assessment. 4. Initial vital signs and oxygen saturation level.

Answer: 2. Serial assessments of level of consciousness. Rationale: 1. History of loss of consciousness and length of time unconscious is important information, but serial assessments give current information. 2.Serial assessments of level of consciousness are the most important observations of a child after any injury. That information tells you if the child's condition is changing. 3. Initial neurological assessments are impor- tant but only provide a baseline. 4. Initial vital signs and oxygen saturation level give a baseline and help when looking at serial assessments. TEST-TAKING HINT: The test taker should understand that serial observations of the child's level of consciousness are the most important nursing observations.

33. Which would be the most appropriate discharge instructions for a child with a right wrist sprain 3 hours ago? 1. "You should rest, elevate the wrist above the heart, apply heat wrapped in a towel, and use the sling when walking." 2. "You can use the wrist, but stop if it hurts; elevate the wrist when not in use, and use the sling when walking." 3. "You should rest, apply ice wrapped in a towel, elevate the wrist above the heart, and use the sling when walking." 4. "You do not have to take any special precautions; do not use any movements that cause pain, and apply alternate heat and ice, each wrapped in a towel.

Answer: 3. "You should rest, apply ice wrapped in a towel, elevate the wrist above the heart, Rationale: 1. For the first 24 hours, rest, ice, compres- sion, and elevation (RICE) are recom- mended for acute injury. The wrist should be kept immobile and elevated. 2. The wrist should be kept immobile and elevated. 3.For the first 24 hours, rest, ice, compression, and elevation (RICE) are recommended for acute injury. 4. For the first 24 hours, rest, ice, compres- sion, and elevation are recommended for acute injury. TEST-TAKING HINT: The test taker should remember the acronym RICE (rest, ice, compression, and elevation) or ICES (ice, compression, elevation, support).

12. Which treatment would the nurse anticipate for a 2-week-old boy diagnosed with PKU? 1. There is no treatment or special diet. 2. A high-phenylalanine diet. 3. A low-phenylalanine diet. 4. The mother would be advised not to breastfeed the infant.

Answer: 3. A low-phenylalanine diet. Rationale: 1. PKU is inherited as an autosomal- recessive trait. The enzyme phenylalanine hydroxylase controlling the conversion of phenylalanine to tyrosine is missing. A low-phenylalanine diet is the treatment to prevent brain damage. 2. PKU is inherited as an autosomal- recessive trait. The enzyme phenylalanine hydroxylase controlling the conversion of phenylalanine to tyrosine is missing. A low-phenylalanine diet is the treatment to prevent brain damage. 3.PKU is inherited as an autosomal- recessive trait. The enzyme phenylala- nine hydroxylase controlling the con- version of phenylalanine to tyrosine is missing. A low-phenylalanine diet is the treatment to prevent brain damage. 4. Breast milk has low amounts of phenylala- nine, so the mother can breastfeed with monitoring of phenylalanine levels in the infant. TEST-TAKING HINT: The test taker should understand that PKU is a genetic inher- ited autosomal-recessive trait caused by a missing enzyme. This enzyme is needed to metabolize the essential amino-acid phenylalanine.

1. The mother of a 3-week-old tells the nurse she is residing in a homeless shelter and is concerned about his mild cough, poor appetite, low-grade fever, weight loss, and fussiness over the last 2 weeks. Which nursing intervention would be the nurse's highest priority? 1. Weigh the baby to have an accurate weight using standard precautions. 2. Reassure the mother that the baby may only have a cold, which can last a few weeks. 3. Immediately initiate droplet face-mask precautions, and isolate the infant. 4. Take a rectal temperature while completing the assessment using standard precautions.

Answer: 3. Immediately initiate droplet face-mask precautions, and isolate the infant. Rationale: 1. Weighing the child would be important but not the priority when concerned about an infectious cause. Initiating droplet precau- tions to prevent infecting others would be a priority, then weighing the infant. 2. The symptoms are not suggestive of a cold but something more serious. Infants do not usually lose weight, nor are they irritable with a simple cold. 3. Children with tuberculosis may have a history of living in a crowded home or could be homeless. Other symptoms may include a cough, cold symptoms, low-grade fever, irritability, poor appetite, and exposure to a person with tuberculosis. Initiation of droplet precautions and isolation of the infant would be warranted in this situation. 4. Taking the infant's temperature is important, but initiating droplet precautions would be the priority. TEST-TAKING HINT: The test taker should be highly suspicious of tuberculosis given the family and patient history. Health-care personnel need to be vigilant to contain and prevent further spread of communicable diseases. This child could have meningitis, which would also require isolation and respiratory precautions.

5. The mother of a child diagnosed with erythema infectiosum (fifth disease). is crying, and says, "I am afraid. Will my unborn baby die? I have a planned cesarean section next week." Which statement would be the most therapeutic response? 1. "Let me get the physician to come and talk with you." 2. "I understand. I would be afraid, too." 3. "Would you like me to call your obstetrician to have you seen as soon as possible?" 4. "I understand you are afraid. Can we can talk about your concerns?"

Answer: 4. "I understand you are afraid. Can we can talk about your concerns?" Rationale: 1. Having the physician come back and talk with the pregnant mother of a 2-year-old with fifth disease is appropriate, but these are certainly concerns the nurse can address by using therapeutic communication. 2. Acknowledging the mother's fear is thera- peutic, and it is appropriate to intervene. 3. Informing the obstetrician would be appro- priate after dealing therapeutically with the mother's concerns. 4.There is less risk of fetal death in the second half of the pregnancy. It is more therapeutic to acknowledge a client's fears. After acknowledging her fears, the appropriate response would be to discuss concerns and clarify any misconceptions. TEST-TAKING HINT: The test taker should understand there is a 10% risk of death if a mother is exposed to erythema infectiosum (fifth disease) during the first half of her pregnancy.

14. Which teaching is most important for a child with PKU? 1. The child is able to eat a quarter-pound hamburger and drink a milkshake daily. 2. If the child wants soda, diet soda is preferred over milk or dairy products. 3. The child may have ice cream in an unlimited quantity once a week. 4. Diet soda or anything with the sweetener aspartame should be avoided.

Answer: 4. Diet soda or anything with the sweetener aspartame should be avoided. Rationale: 1. High-protein foods like meats and dairy products are restricted because of their high phenylalanine content. 2. The sweetener aspartame (NutraSweet, Equal) should be avoided because it is converted to phenylalanine in the body. 3. Because of their high-protein content, dairy products are limited or eliminated from the diet. 4.The artificial sweetener aspartame (NutraSweet, Equal) should be avoided because it is converted to phenylala- nine in the body. TEST-TAKING HINT: The test taker should understand how PKU is treated to successfully answer this question.

44. Which nursing intervention would be of highest priority for a 2-year-old suspected of ingestion digoxin? 1. Provide supplemental oxygen. 2. Establish intravenous access. 3. Draw blood for a STAT digoxin level. 4. Provide continuous cardiac monitoring.

Answer: 4. Provide continuous cardiac monitoring. Rationale: 1. Continuous cardiac monitoring would be the priority because of the bradycardia and dysrhythmias that can occur with digoxin toxicity. Oxygen may be needed if there is enough bradycardia causing a decrease in oxygen saturation. 2. The priority is to establish continuous cardiac monitoring. If it is determined that venous access is necessary, then that can be established. 3. The digoxin level would be good to know, but that is not the priority. 4.Bradycardia and cardiac dysrhythmias are common signs of digoxin toxicity in children. Continuous cardiac monitor- ing is the highest priority to detect dysrhythmias before they became lethal. TEST-TAKING HINT: The test taker should understand that bradycardia and cardiac dysrhythmia are common signs of digoxin toxicity in children.