Pediatrics Exam #1

1. Arrange in sequential order the steps of the nursing process in relationship to evidenced based practice (EBP). (Answer with a letter followed by a comma and a space (e.g., A, B, C, D).) a. Collecting research based on the question of interest b. Integrating evidence with clinical expertise to implement care c. Development of the research question d. Evaluation of the effectiveness of the care plan e. Development of the care plan

CAEBD

The nurse is interviewing the parents of a toddler and wants to determine the child's feeding preferences during meal time. Which statement made by the nurse is an example of directed focus? a. "I know we have discussed your son's eating habits but can we now discuss what Sam like to eat for lunch?" b. "How much time does it take for Sam to finish his meals?" c. "Would Sam prefer hot dogs or chicken nuggets, if given a choice?" d. "Would Sam prefer pudding as opposed to cake?"

a. "I know we have discussed your son's eating habits but can we now discuss what Sam like to eat for lunch?"

It is time to give a 3-year-old medication. What approach is most likely to receive a positive response from the child? a. "It's time for your medication now. Would you like water or apple juice afterward?" b. "Wouldn't you like to take your medicine now?" c. "You must take your medicine because the doctor says it will make you better." d. "See how nicely your roommate took medicine? Now take yours."

a. "It's time for your medication now. Would you like water or apple juice afterward?"

A mother tells the nurse that she will visit her 2-year-old son tomorrow about noon. During the child's bath, he asks for Mommy. What is the nurse's best reply? a. "Mommy will be here after lunch." b. "Mommy always comes back to see you." c. "Your Mommy told me yesterday that she would be here today about noon." d. "Mommy had to go home for a while, but she will be here today."

a. "Mommy will be here after lunch."

Which observable behaviors would indicate to the nurse that the patient is experiencing information overload? (Select all that apply.) a. Fidgeting constantly while seated in the chair b. A period of silence noted between a question c. The patient wanting to continue talking about one subject of interest d. The patient is yawning repeatedly e. The patient is scanning the environment avoiding eye contact while the nurse is attempting to ask questions.

a. Fidgeting constantly while seated in the chair d. The patient is yawning repeatedly e. The patient is scanning the environment avoiding eye contact while the nurse is attempting to ask questions.

In consideration of family systems theory, which components form the triangle relationship? (Select all that apply.) a. Mother b. Father c. Child d. Cousin e. Grandparents

a. Mother b. Father c. Child

A 6-year-old is hospitalized with a fractured femur. Based on the nurse's knowledge of pain assessment tools and child development, which assessment tools are most appropriate for this age child? (Select all that apply.) a. Oucher scale b. CRIES scale c. Poker chip tool d. Faces pain scale e. Postoperative pain score

a. Oucher scale c. Poker chip tool d. Faces pain scale

The nurse is caring for a 12-year-old child who sustained major burns when putting charcoal lighter on a campfire. The nurse observes that the child is "very brave" and appears to accept pain with little or no response. What is the most appropriate nursing action? a. Request a psychological consultation. b. Ask why the child does not have pain. c. Praise the child for the ability to withstand pain. d. Encourage continued bravery as a coping strategy.

a. Request a psychological consultation.

Children are taught the values of their culture through observation and feedback on their own behavior. A nurse teaching a class on cultural awareness-competence should be aware of which factor(s) that may be culturally determined? (Select all that apply.) a. Social roles b. Racial variation c. Degree of competition d. Determination of status e. Geographic

a. Social roles c. Degree of competition d. Determination of status

The parents of a ventilator-dependent child tell the nurse that their insurance company wants the child discharged. The child's parents explain that they do not want the child home "under any circumstances." What should the nurse consider when working with this family? a. The parents' desire to have the child home is essential to effective home care. b. Parents should not be expected to care for a technology-dependent child. c. Parents' role in the decision-making process is limited when compared with that of the insurance company because of the costs of hospitalization. d. Having a technology-dependent child at home is better for both the child and the family.

a. The parents' desire to have the child home is essential to effective home care.

Which statement is true concerning folk remedies? a. They may be used to reinforce the treatment plan. b. They are incompatible with modern medical regimens. c. They are a leading cause of death in some cultural groups. d. They are not a part of the culture in large, developed countries.

a. They may be used to reinforce the treatment plan.

In order to determine if a child's "toy" does not present a choking hazard while in the hospital, which type of process would the nurse utilize? a. Use a toilet paper roll to indicate whether the toy will pass the choke test. b. Have the child agree to not place the toy in his/her mouth while in the hospital. c. Drop the toy on the floor to see if any parts break off. d. Have the parents bring a "new" toy that is just bought from the store as that is the best indicator that there will be no loose parts.

a. Use a toilet paper roll to indicate whether the toy will pass the choke test.

A ventilator-dependent child is being discharged home from the hospital. Prior to discharge, the home health care nurse discusses the development of an emergency plan with the family. The most essential component of the plan is a. acquisition of a backup generator. b. designation of an emergency shelter. c. notifying the power company that the child is on life support. d. provision for alternate heating and cooling source if power is lost. e. notifying emergency medical services that child is on life support.

a. acquisition of a backup generator.

The most appropriate method for a nurse to use to view the tonsils and oropharynx of a 6-year-old child is to a. ask child to open mouth wide and say "Ahh." b. ask child to open mouth wide, and then place tongue blade in the center back area of the tongue. c. examine mouth when child is crying to avoid use of tongue blade. d. pinch nostrils closed until child opens mouth, then insert tongue blade.

a. ask child to open mouth wide and say "Ahh."

The nurse is assessing a 3-year-old African-American child who is being seen in the clinic for the first time. The child's height and weight are in the 20th percentile on the commonly used growth chart from the National Center for Health Statistics. When interpreting the data, the nurse recognizes a. child's growth is within normal limits. b. child's growth is not within normal limits. c. growth chart is not accurate for African-American children. d. growth chart is not useful until several measurements are plotted over time.

a. child's growth is within normal limits.

The appropriate direction to pull the pinna of an infant during an otoscopic examination is a. down and back. b. down and forward. c. up and forward. d. up and back.

a. down and back.

The nurse demonstrates understanding of family-centered care by a. encouraging family visitation. b. assuming total care for the child. c. limiting visitation to three time periods per day. d. expecting the child to perform self-care in activities of daily living.

a. encouraging family visitation.

Bright Futures program provides initiatives that focus on health promotion of child by focusing on (Select all that apply.) a. encouraging use of community resources. b. focus on after school activities as a source of engagement. c. promotion of healthy eating habits. d. limitations on introduction of health and sexuality teaching so as to assure parental support. e. providing a safe environment. f. providing mental health services as needed.

a. encouraging use of community resources. c. promotion of healthy eating habits. e. providing a safe environment. f. providing mental health services as needed.

A 10-year-old child requires daily medications for a chronic illness. The mother tells the nurse that she is always nagging the child to take the medicine before school. The most appropriate nursing intervention to promote the child's compliance is to a. establish a contract with the child, including rewards. b. suggest time-outs when the child forgets her medicine. c. discuss with the child's mother the damaging effects of nagging. d. ask the child to bring her medicine containers to each appointment so that the pills can be counted.

a. establish a contract with the child, including rewards.

Guidelines for a nurse using an interpreter in developing a care plan for an 8-year-old admitted to rule out epilepsy include a. explaining to the interpreter what information is necessary to obtain from the patient and family. b. encouraging the interpreter to ask several questions at a time to make the best use of time. c. not giving the interpreter too much information so that the interview evolves. d. discouraging the interpreter and client from discussing topics that are deemed irrelevant to the original intent of the interview.

a. explaining to the interpreter what information is necessary to obtain from the patient and family.

The nurse observes erythema, pain, and edema at a child's intravenous (IV) infusion site with streaking along the vein. The nurse's priority action is to a. immediately stop the infusion. b. check for a good blood return. c. ask another nurse to check the IV site. d. increase IV drip with normal saline for 1 minute and recheck.

a. immediately stop the infusion.

The nurse is providing education to a group of parents at a health fair in a local kindergarten school. The nurse describes the most common cause of death for children age 5 to 9 years is a. inappropriate use of bike helmets and seat belts. b. childhood immunizations. c. lack of hand washing in the prevention of communicable diseases. d. the obesity epidemic.

a. inappropriate use of bike helmets and seat belts.

The practice of cultural humility is continual and an important concept in the nursing process. Nurses can facilitate this process by (Select all that apply.) a. integrating cultural knowledge. b. recognizing cultural differences. c. acting in a culturally appropriate manner. d. being aware of their own beliefs and practices. e. helping the family adapt to the health care practices.

a. integrating cultural knowledge. b. recognizing cultural differences. c. acting in a culturally appropriate manner. d. being aware of their own beliefs and practices.

The best explanation for using pulse oximetry on young children is that it a. is noninvasive. b. is better than capnography. c. is more accurate than arterial blood gas measurements. d. provides intermittent measurements of oxygen.

a. is noninvasive.

The nurses caring for a child are concerned about the child's frequent requests for pain medication. During a team conference, a nurse suggests that they consider administering a placebo instead of the usual pain medication. This decision should be based on knowledge that a. it is unjustified and unethical to administer placebos instead of pain medication. b. the absence of a response to a placebo means the child's pain has an organic basis. c. a positive response to a placebo will not occur if the child's pain has an organic basis. d. administering a placebo instead of the usual pain medication is effective in determining whether a child's pain is real.

a. it is unjustified and unethical to administer placebos instead of pain medication.

A home health nurse is assigned to an adolescent with recently acquired tetraplegia. The adolescent's mother tells the nurse, "I'm sick of providing all the care while my husband does whatever he wants and whenever he wants." Based on the nurse's knowledge of family-centered care, the most appropriate nursing intervention is to a. listen and reflect the mother's feelings. b. refer the mother for psychological counseling. c. suggest ways the mother can get the husband to help with care. d. meet with the adolescent's father in private and ask why he does not help.

a. listen and reflect the mother's feelings.

Nonpharmacologic strategies for pain management a. may reduce pain perception. b. make pharmacologic strategies unnecessary. c. usually take too long to implement. d. trick children into believing they do not have pain.

a. may reduce pain perception.

The parent of a hospitalized child tells the nurse, "We do not eat meat. We are practicing Buddhists and strict vegetarians." The most appropriate intervention by the nurse is to a. order the child a meatless tray. b. tell the parent to take any meat off the child's meal tray. c. ask the parent if they would like to have a Buddhist priest visit. d. explain to the parent that meat provides protein needed to heal their child.

a. order the child a meatless tray.

The nursing process is a method of problem identification and problem-solving that describes what the nurse actually does. The five-step nursing process model includes (Select all that apply.) a. planning. b. diagnosis. c. evaluation. d. assessment. e. identification. f. implementation.

a. planning. b. diagnosis. c. evaluation. d. assessment. f. implementation.

An adolescent is admitted to the hospital for a fractured femur. The most appropriate nursing intervention(s) in caring for this adolescent is/are to (Select all that apply) a. provide written material about the hospital. b. provide an opportunity for the adolescent to try on surgical attire. c. explain the upcoming surgery to the adolescent using anatomically correct models. d. provide an opportunity for the adolescent to talk with peers who have had a similar experience. e. provide education for the parents of what to teach so they can share with their adolescent.

a. provide written material about the hospital. c. explain the upcoming surgery to the adolescent using anatomically correct models. d. provide an opportunity for the adolescent to talk with peers who have had a similar experience.

A child, age 7 years, is being treated at home and has a fever associated with a viral illness. The principal reason for treating the child's fever is a. relief of discomfort. b. reassurance that illness is temporary. c. prevention of secondary bacterial infection. d. prevention of life-threatening complications.

a. relief of discomfort.

A nurse is conducting a health history on an adolescent. Components of the health history include (Select all that apply.) a. sexual history. b. review of systems. c. physical assessment. d. growth measurements. e. family medical history.

a. sexual history. b. review of systems. e. family medical history.

Prior to accepting an assignment as a home health nurse, the nurse must realize that a. the family is in charge. b. all decisions are made by the health care provider. c. the family will adapt their lifestyle to the needs of the nurse. d. independent decisions regarding emergency care of the child are made by the nurse.

a. the family is in charge.

When caring for a child with an intravenous (IV) infusion, the most appropriate nursing interventions are to (Select all that apply) a. use an infusion pump with a microdropper to ensure the prescribed infusion rate. b. check IV fluids and infusion rate with another licensed professional. c. avoid restraining the child to prevent undue emotional stress. d. observe the insertion site frequently for signs of infiltration. e. change the insertion site every 24 hours.

a. use an infusion pump with a microdropper to ensure the prescribed infusion rate. b. check IV fluids and infusion rate with another licensed professional. d. observe the insertion site frequently for signs of infiltration.

For which scenario would the expectation of confidentiality by the nurse not be withheld during an interview format? (Select all that apply.) a. 15-year-old emancipated minor who wants to discuss birth control methods b. 14-year-old patient who denies abuse but who presents with multiple bruises over arms and legs which appear to be "defensive type" in nature c. 16-year-old patient who appears sad and voices despair over having broken up with his boyfriend states he has no options d. 18-year-old patient who confides in the nurse that she wants to move out and get her own apartment

b. 14-year-old patient who denies abuse but who presents with multiple bruises over arms and legs which appear to be "defensive type" in nature

Which hospitalized children should have their intake and output (I&O) recorded as part of the plan of care? (Select all that apply) a. 14-year-old postoperative for laparoscopic appendectomy with IV access but not receiving any fluids at this time b. 3-year-old receiving parenteral therapy along with antibiotics c. 16-year-old admitted for treatment of diabetes mellitus d. 14-year-old admitted for observation of concussion as a result of motor vehicle accident e. 8-year-old admitted with dehydration

b. 3-year-old receiving parenteral therapy along with antibiotics c. 16-year-old admitted for treatment of diabetes mellitus e. 8-year-old admitted with dehydration

Which is objective information that can be found in a community? a. Individuals from the community who report on the level of food insecurity b. A phone book detailing the community resources c. The mayor's reports about the level of homelessness in the community d. A family member's statements on the lack of resources available in the community

b. A phone book detailing the community resources

Which medication order would require immediate intervention by the nurse in order to prevent potential complications for the pancytopenic cancer pediatric patient? a. Offer fluids to hydrate the patient b. Administer Aleve for relief of joint related pain c. Administer Neupogen as ordered d. Administer morphine for severe pain as ordered

b. Administer Aleve for relief of joint related pain

A nurse is reviewing a family history and notes that the parents are married and living in the same household. This description would be documented as which type of family relationship? a. Consanguineous b. Affinal c. Family of origin d. Communal

b. Affinal

A toddler is hospitalized for an upcoming surgical procedure. Which method might provide the best way to inform the child about the surgery? a. By using anatomical drawings as illustrations and allowing the child to color them with markers. b. Allowing the child to dress up using surgical gown and mask. c. Having the child sign his name with an "X" on an actual surgical consent form. d. Taking the child to the operating theater to view a surgery.

b. Allowing the child to dress up using surgical gown and mask.

Which explains the importance of detecting strabismus in young children? a. Color vision deficit may result. b. Amblyopia, a type of blindness, may result. c. Epicanthal folds may develop in the affected eye. d. Ptosis may develop secondarily.

b. Amblyopia, a type of blindness, may result.

A child with a serious chronic illness will soon be discharged home. The case manager requests that the family provide total care for the child for a couple of days while the child is still hospitalized. Based on the principles of family-centered care, which statement addresses this principle? a. Appropriate because families are usually eager to get involved. b. Appropriate because it can be beneficial to the transition from hospital to home. c. Inappropriate because of legal issues when parents care for their children on hospital property. d. Inappropriate because the family will have to assume the care soon enough and this may increase their stress unnecessarily.

b. Appropriate because it can be beneficial to the transition from hospital to home.

Working with parents in preparation for discharge of a hospitalized child who will need to have wet to dry dressing changes performed at home will require that the nurse include which element in the plan of care? a. Arrange for home health nurse to change dressings as the parents may not understand the complexity of the task. b. Arrange for a step by step training sequence for wet to dry dressing changes with the parents of the child with return demonstration to evaluate understanding. c. Provide the parents with a detailed instruction sheet regarding the dressing change procedure as the method of instruction. d. Arrange for follow up with the child's pediatrician prior to the next scheduled dressing change so that the parents can receive further instruction.

b. Arrange for a step by step training sequence for wet to dry dressing changes with the parents of the child with return demonstration to evaluate understanding.

The nurse is ready to begin a physical examination on an 8-month-old infant. The child is sitting contentedly on the mother's lap, chewing on a toy. What should the nurse do first? a. Elicit reflexes. b. Auscultate the heart and lungs. c. Examine the eyes, ears, and mouth. d. Examine the head, systematically moving toward the feet.

b. Auscultate the heart and lungs.

In reviewing the child's family history, documentation indicates that the child is living in a household in which the two adult caregivers are not married but still continue to care for the child. This represents which type of family structure? a. Polygamous b. Binuclear c. Nuclear d. Communal

b. Binuclear

A camp nurse is assessing a group of children attending summer camp. Based on the nurse's knowledge of special parenting situations, which group of children is at risk for a sense of belonging? a. Children adopted as infants b. Children recently placed in foster care c. Children whose parents recently divorced d. Children who recently gained a stepparent

b. Children recently placed in foster care

Which behavior would most likely be manifested in a young child experiencing the protest phase of separation anxiety? a. Inactivity b. Clinging to the parent c. Depression and sadness d. Forming superficial relationships

b. Clinging to the parent

Which defines a group of people living in a specific geographic area? a. Culture b. Community c. Target population d. Individual countries and states

b. Community

Which physical assessment findings would be associated with the presence of alopecia? (Select all that apply.) a. Excess vitamin C b. Decreased protein intake c. Decreased caloric intake d. Decreased copper e. Decreased zinc

b. Decreased protein intake c. Decreased caloric intake e. Decreased zinc

Which indication if found on a hospitalized child would indicate to the nurse that a potential compromise in skin integrity was occurring? a. No evidence of edema. b. Flushed appearance of child's elbow as it rests on bed. c. Nursing unit protocol requires that child be turned every 2 hours while on the unit. d. Skin turgor is elastic and has recoil.

b. Flushed appearance of child's elbow as it rests on bed.

Which type of disease presentations are associated with recurrent pain in children? (Select all that apply.) a. Daily headache b. Migraine headache c. Abdominal pain d. Complex regional pain syndrome e. Phantom limb pain

b. Migraine headache c. Abdominal pain e. Phantom limb pain

Which statement is true regarding the World Health Organization (WHO) principles of pharmacologic management for the pediatric patient? (Select all that apply.) a. Provide a step-ladder approach b. Provide dosing at regular intervals c. Choice of analgesic as the first step with administration of morphine as the second step d. Using parenteral route for pain therapies e. Individualizing and adapting treatment for each child

b. Provide dosing at regular intervals c. Choice of analgesic as the first step with administration of morphine as the second step e. Individualizing and adapting treatment for each child

A nurse has been assigned as the home health nurse for a technologically dependent child. The nurse recognizes that the background of this family differs widely from the nurse's own. The nurse views some of their lifestyle choices as less than ideal. What is the most appropriate nursing intervention? a. Assign the nurse a different family to follow. b. Respect the differences c. Assess why the family is different d. Determine whether the family is dysfunctional

b. Respect the differences

The role of the pediatric nurse is influenced by trends in health care. Which is an influential trend in pediatric health care? a. Primary focus on treatment of disease or disability b. Shift of focus to maintenance of health and illness prevention c. National health care planning on a distributive or episodic basis d. Accountability to professional codes and international standards

b. Shift of focus to maintenance of health and illness prevention

Which is an important consideration when using the FACES Pain Rating Scale with children? a. Children color the face with the color they choose to best describe their pain. b. The scale can be used with most children as young as 3 years of age. c. The scale is not appropriate for use with adolescents. d. The scale is useful in pain assessment but is not as accurate when assessing physiologic responses.

b. The scale can be used with most children as young as 3 years of age.

A nurse is caring for a dying child whose religion is Islam (Muslim, or Moslem). Which is an important nursing consideration related to the child's impending death and religion? a. There are no special rites. b. There are specific practices to be followed. c. The family is expected to "wait" away from the dying person. d. Baptism should be performed if it has not been done previously.

b. There are specific practices to be followed.

When considering the most common cause of death for children greater than 1 year of age, which represents the most likely cause of death? a. Homicide b. Unintentional injuries c. Violent death d. Congenital diseases

b. Unintentional injuries

Transdermal fentanyl (Duragesic) is being used for an adolescent with cancer who is in hospice care. The adolescent has been comfortable for several hours but now complains of severe pain. The most appropriate nursing action is to a. administer meperidine (Demerol) intramuscularly. b. administer morphine sulfate immediate release (MSIR) intravenously. c. use a nonpharmacologic strategy. d. place another fentanyl (Duragesic) patch on the adolescent.

b. administer morphine sulfate immediate release (MSIR) intravenously.

Studies of families with only one child indicate that only children a. tend to be selfish. b. are similar to firstborn children. c. are less stimulated toward achievement. d. grow up lonely and dependent on adults.

b. are similar to firstborn children.

A 7-year-old child tells the nurse, "Grandpa, Mommy, Daddy, and my sister live at my house." Based on the nurse's knowledge of family structure and function, the nurse identifies this family structure as a a. binuclear family. b. extended family. c. reconstituted family. d. traditional nuclear family.

b. extended family.

A child who has been receiving morphine by the intravenous (IV) route will now start receiving it orally. In order for equianalgesia (equal analgesic effect) to be achieved, the oral dose will be a. same as the IV dose. b. greater than the IV dose. c. one half of the IV dose. d. one fourth of the IV dose.

b. greater than the IV dose.

A physiologic benefit of fever in a child is that it a. indicative of the infectious process being viral in origin. b. increases interferon production. c. prevents spread of infection due to decrease in release of chemical mediators. d. correlates with overall prognosis of medical event.

b. increases interferon production.

A nurse observes a parent-child interaction in which the parent acts indifferently to the child's continued efforts to play with a water cooler in the clinic's waiting room resulting in a small amount of flooding in the area of the room. Based on this assessment, the nurse would determine that the parent's childrearing style would be noted as: a. authoritarian. b. permissive. c. authoritative. d. directive.

b. permissive.

A case manager is assigned to coordinate the care of a child with a complex medical condition. The family is told that one of the goals is to control costs. This goal should be recognized as a. unsafe. b. realistic. c. impossible. d. inappropriate.

b. realistic.

The nurse needs to start an intravenous (IV) line for an 8-year-old child to begin administering IV antibiotics. The child starts to cry and tells the nurse, "Do it later, OK?" The most appropriate action by the nurse is to a. start the IV because allowing the child to manipulate the nurse is not professional behavior. b. start the IV because unlimited procrastination results in heightened anxiety. c. postpone starting the IV until the child is ready so that the child experiences a sense of control. d. postpone starting the IV until the child is ready so that the child's anxiety is reduced.

b. start the IV because unlimited procrastination results in heightened anxiety.

A child is admitted to the hospital with a diagnosis of possible meningitis. Which information is the most important to ask at the time of admission? a. "Are there any pets in the household?" b. "Is anyone else in the household ill?" c. "Are the immunizations up to date?" d. "Has the child had a recent injury?"

c. "Are the immunizations up to date?"

The nurse is interviewing the mother of Adam, age 9 years. Which question would be the most appropriate as the nurse begins to assess Adam's school performance? a. "Did Adam go to preschool?" b. "Does Adam have problems at school?" c. "How is Adam doing in school?" d. "How well does Adam seem to be doing in school?"

c. "How is Adam doing in school?"

Which statement is true concerning the increased use of telephone triage by nurses? a. Telephone triage has led to an increase in health care costs. b. Emergency department visits are not recommended by nurses, and therefore they are not a component of telephone triage. c. Access to high-quality health care services has increased through telephone triage. d. Home care is often recommended when it is not appropriate.

c. Access to high-quality health care services has increased through telephone triage.

A nursing student is discussing the technique of interviewing with his instructor and conveys that he is somewhat reluctant to talk with potential patients as he fears he may have nothing to say and there would be periods of silence. Which statement represents the best response by the nursing instructor in response to the students' expressed concerns? a. Telling the student that everyone feels like this at first but that the feeling and anxiety will reside during the next interview experience. b. Encourage the student to practice interviewing technique skills with peers and family members to increase his confidence level. c. Acknowledge that his reluctance is normal but that the utilization of silence may well eventually represent the ability of a confident interviewer in knowing that sometimes it is equally important to listen rather than to keep talking. d. Provide the student with practice questions for interviewing and have him look at himself in the mirror while voicing the questions to increase his confidence level.

c. Acknowledge that his reluctance is normal but that the utilization of silence may well eventually represent the ability of a confident interviewer in knowing that sometimes it is equally important to listen rather than to keep talking.

A pediatric patient is brought to the clinic for follow up immunizations and is apprehensive about injections and needles. Which method could the nurse implement to facilitate administration of immunization without causing the child undue anxiety? a. Offer the child an ice cream if you are allowed to give the injection. b. Tell the patient's mother that she must swaddle him and cover his eyes tightly once the medication is drawn up and ready to be injected. c. Encourage the child to talk about the toy he is holding and focus on the conversation to allay the child's fears. d. Instead of an injection, provide the medication via a topical route.

c. Encourage the child to talk about the toy he is holding and focus on the conversation to allay the child's fears.

Which term refers to a shared cultural, social, and linguistic heritage? a. Beliefs b. Culture c. Ethnicity d. Socialization

c. Ethnicity

Which is appropriate advice for parents who are preparing to tell their children about their decision to divorce? a. Avoid crying in front of children. b. Avoid discussing the reason for the divorce. c. Give reassurance that the divorce is not the children's fault. d. Give reassurance that the divorce will not affect most aspects of the children's life.

c. Give reassurance that the divorce is not the children's fault.

Nurses play an important role in current issues and trends in health care. Which is a current trend in pediatric nursing and health care today? a. The patient is the unit of care for the health care provider. b. Discharge planning begins when the physician writes the order. c. Health promotion resources enable children to achieve their full potential. d. The focus of pediatric health care is trending toward acute hospital care.

c. Health promotion resources enable children to achieve their full potential.

A nurse has been working with a family who has 2 children, ages 5 and 7 years of age, to provide health teaching related to healthy nutritional patterns. Which observation if noted would indicate that additional instruction should be given related to health teaching in this area? a. The children demonstrate application of skills by identifying healthy food snacks. b. The parents are able to identify which foods are poor examples of "healthy food snacks." c. In response to the family's identification of healthy food snacks, the nurse provides limited feedback since the answers are correct. d. The nurse provides an interactive learning environment using age appropriate learning strategies.

c. In response to the family's identification of healthy food snacks, the nurse provides limited feedback since the answers are correct.

With regard to the varied definitions of the term, family, which variable would best represent the psychological definition? a. Focus on childbearing attributes b. Productivity of its members c. Interpersonal skill development d. Consanguineous relationships

c. Interpersonal skill development

A 12-year-old child is admitted for an emergency appendectomy and rushed into surgery. The parents tell the nurse that they also have a 4-year-old son at home and wonder if they should tell him about his older brother being in the hospital. The best response by the nurse to this query would be to? a. Tell the parents to refrain from telling the 4-year-old as he will not be able to understand the concepts of hospitalization and surgery. b. Have the parents go home and bring their 4-year-old back to the hospital so he can be present throughout this family stress experience. c. It is important to tell their 4-year-old son about his older brother using words and terms that he can understand at his age. d. Have the parents bring their son in during visiting hours and arrange for a tour of the hospital unit.

c. It is important to tell their 4-year-old son about his older brother using words and terms that he can understand at his age.

A nurse is preparing to administer a gavage feeding to an infant. Which type of restraining method would be indicated? a. Jacket restraint b. Arm restraints c. Mummy restraint d. Car seat restraint

c. Mummy restraint

The nurse is using the C.R.I.E.S. pain assessment tool on a preterm infant in the neonatal intensive care unit (NICU). Which is a component of this tool? a. Color b. Reflexes c. Oxygen saturation d. Posture of the arms and legs

c. Oxygen saturation

A nurse is caring postoperatively for an 8-year-old child with multiple fractures and other trauma resulting from a motor vehicle injury. The child is experiencing severe pain. Which is an important consideration in managing the child's pain? a. Give only an opioid analgesic at this time. b. Increase the dosage of analgesic until the child is adequately sedated. c. Plan a preventive schedule of pain medication around the clock. d. Give the child a clock and explain when he or she can have pain medications.

c. Plan a preventive schedule of pain medication around the clock.

A child has a long standing history of abuse which has triggered many emotional problems. Which type of therapy would be indicated to possibly help the child explore these emotional problems? a. Dramatic play b. Therapeutic play c. Play therapy d. Creative expression

c. Play therapy

When the nurse uses a standard nursing care plan as a guide in planning care for a hospitalized child, which should be eliminated? a. Expected outcome or goal b. Dependent nursing functions c. Problems not pertinent to the child and family d. Potential health problems of the child and family

c. Problems not pertinent to the child and family

A nurse is assessing a pediatric patient in the intensive care unit. Which finding on the COMFORT score if noted would not require intervention relative to pain management? a. Score of 8 b. Score of 10 c. Score of 25 d. Score of 40

c. Score of 25

What is the most overwhelming adverse influence on health? a. Race b. Customs c. Socioeconomic status d. Genetic constitution

c. Socioeconomic status

When interviewing a patient, which statement/action indicates that the nurse is displaying empathy? a. The nurse offers the patient a tissue when the patient is crying after hearing some sad news before giving the patient medication. b. The nurse and patient discuss their families and discover they each have two brothers. c. The patient appreciates that the nurse has sat by her bedside and held her hand while they spoke about health concerns. d. The nurse provided the patient's family with Advanced Directive Form to fill out acknowledging that it has to be done in order to fulfill the patient's wishes.

c. The patient appreciates that the nurse has sat by her bedside and held her hand while they spoke about health concerns.

When should clear liquids be stopped before scheduled surgery? a. 2 hours before surgery b. 6 hours before surgery c. Varies according to the surgical procedure to be done d. The night before surgery, at midnight

c. Varies according to the surgical procedure to be done

Informed consent is valid when (Select all that apply) a. universal consent is used. b. it is completed only for major surgery. c. a person is over the age of majority and competent. d. information is provided to make an intelligent decision. e. the choice exercised is free of force, fraud, duress, or coercion.

c. a person is over the age of majority and competent. d. information is provided to make an intelligent decision. e. the choice exercised is free of force, fraud, duress, or coercion.

The nurse in considering ethical dilemmas that may affect delivery of care with regard to pediatric patients, must consider that the patient's well-being is of paramount importance. This concept is best described by a. fairness. b. applying equity. c. beneficence. d. prevention of harm.

c. beneficence.

The psychosexual conflicts of preschool children make them extremely vulnerable to a. separation anxiety. b. loss of control. c. bodily injury and pain. d. loss of identity.

c. bodily injury and pain.

A 4-year-old child is scheduled for cardiac surgery in a week. The child's parents call the hospital to ask how to prepare the child for the upcoming hospitalization and surgical procedure. The nurse's reply should be based on the knowledge that a. preparation at this age will only increase the child's stress. b. preparation needs to be at least 2 to 3 weeks before hospitalization to be effective. c. children who are prepared experience less fear and stress during hospitalization. d. children who are prepared experience overwhelming fear by the time hospitalization occurs.

c. children who are prepared experience less fear and stress during hospitalization.

Successful adaptation to the stress of transition to parenthood involves two types of family resources. These resources include (Select all that apply.) a. adaptation. b. integration. c. coping strategies. d. internal resources e. community resources.

c. coping strategies. d. internal resources

In helping a child to adapt to a hospitalization experience, the best approach would be to a. allow the child to bring in all of his favorite toys to the hospital so as to represent a more familiar environment. b. let the parents bring in food from home that the child is used to eating for all meals. c. establish a daily routine and schedule with the child and parent to help maintain consistency. d. allow the child to select his room on the unit.

c. establish a daily routine and schedule with the child and parent to help maintain consistency.

Standard precautions for infection control include a. gloves are worn anytime a patient is touched. b. needles are capped immediately after use and disposed of in a special container. c. gloves are worn to change diapers when there are loose or explosive stools. d. masks are needed only when caring for patients with airborne infections.

c. gloves are worn to change diapers when there are loose or explosive stools.

Several types of long-term central venous access devices are used in practice. The benefit of using a long-term central venous access device such as a Port-a-Cath is that a. implanted devices are easy to use for self-administered infusions. b. implanted devices do not require piercing the skin for access. c. implanted devices do not require limiting regular physical activity, including swimming. d. implanted devices cannot dislodge, even if child "plays" with the port site.

c. implanted devices do not require limiting regular physical activity, including swimming.

A neonate had corrective surgery 3 days ago for esophageal atresia. The nurse notices that after gastrostomy feedings, there is often a backup of feeding into the tube. The most appropriate intervention by the nurse is to a. position the child in a supine position after feedings. b. position the child on the left side after feedings. c. leave the gastrostomy tube open and suspended after feedings. d. leave the gastrostomy tube clamped after feedings.

c. leave the gastrostomy tube open and suspended after feedings.

A 2 1/2-year-old ventilator-dependent child will be discharged home soon. The family expresses concern that their child might change the ventilator settings by exploring the control knobs and buttons. Based on the nurse's knowledge of child development, the most appropriate intervention by the nurse is to a. teach the child not to touch controls. b. explain that the child cannot be left alone because of the risk of the child changing the settings. c. recommend ways to cover the controls to reduce the risk of the child changing the settings. d. reassure the family that developmentally the child is unable to change the ventilator settings.

c. recommend ways to cover the controls to reduce the risk of the child changing the settings.

The nurse is caring for a comatose child with multiple injuries. The nurse should recognize that pain a. cannot occur if child is comatose. b. may occur if child regains consciousness. c. requires astute nursing assessment and management. d. is best assessed by family members who are familiar with child.

c. requires astute nursing assessment and management.

The nurse is working with the parents of a young pediatric patient for which it is noted that the child is adopted. The parents ask the nurse when would be the best time to discuss the child's adoption status with the child. The nurse suggests that: a. to wait until the child asks about his birth status. b. to refrain from bringing up the subject for fear of isolation and distrust developing. c. to begin the dialogue at an early age when the time seems right to bring up the subject. d. when the child reaches the age of consent.

c. to begin the dialogue at an early age when the time seems right to bring up the subject.

With regard to the nutritional well-being, at what age should the nurse instruct the parents that lifelong learning habits have been fostered? a. By 1 year of age b. When the child enters kindergarten c. At 6 months of age when solid food introduction takes place d. By age 3

d

Research notes that birth position of children affects their personalities. According to ordinal position, what is a characteristic of the youngest child? a. Able to identify more with their parents than with their peers b. Are expected to do more household chores c. More dependent than firstborn children d. Are more flexible in their thinking

d. Are more flexible in their thinking

A nurse is performing a family assessment and determines that the family unit structure is composed of a father, mother, step-father, two children, a boy and a girl, and the maternal grandparents all living in the same residence. Based on this information, the nurse would indicate which family type in the electronic health record? a. Nuclear and extended b. Extended c. Blended d. Blended and extended

d. Blended and extended

With regard to separation anxiety displayed in a child who is hospitalized, which behavior would indicates the stage of despair? a. Child clings to parents for comfort. b. Child tells nurses and staff to "go away." c. Child is constantly crying and sobbing. d. Child demonstrates regressive behavior.

d. Child demonstrates regressive behavior.

Which phrase is descriptive of homosexual or gay-lesbian families? a. Nurturing environment is lacking b. Stability needed to raise healthy children is lacking c. Sexual identities of children are at risk d. Family environment can be just as healthy as any other

d. Family environment can be just as healthy as any other

Superficial palpation of the abdomen is often perceived by the child as tickling. Which measure by the nurse is most likely to minimize this sensation and promote relaxation? a. Palpate another area simultaneously. b. Ask the child not to laugh or move if it tickles. c. Begin with deeper palpation and gradually progress to superficial palpation. d. Have the child "help" with palpation by placing his or her hand over the palpating hand.

d. Have the child "help" with palpation by placing his or her hand over the palpating hand.

The nurse needs to take the blood pressure of a preschooler for the first time. What action would be best for gaining the child's cooperation? a. Take the blood pressure when a parent is there to comfort the child. b. Tell the child that this procedure will help the child to get well faster. c. Explain to the child how blood flows through the arm and why taking the blood pressure is important. d. Permit the child to handle equipment and see the dial move before putting the cuff in place.

d. Permit the child to handle equipment and see the dial move before putting the cuff in place.

The etiology component of the nursing diagnosis describes the: a. Projected changes in an individual's health status, clinical conditions, or behavior b. Individual's responses to health pattern deficits in the child, family, or community c. Cluster of cues and/or defining characteristics that are derived from patient assessment and indicate actual health problems d. Physiologic, situational, and maturational factors that cause the problem or influence its development

d. Physiologic, situational, and maturational factors that cause the problem or influence its development

The nurse is doing preoperative teaching with a child and the parents. The parents say the child "is dreading the shot for before surgery." On which of the following facts should the nurse's response be based? a. Preanesthetic medication can only be given intramuscularly. b. In children, the intramuscular (IM) route is safer than the intravenous (IV) route. c. The child will have no memory of the injection because of amnesia. d. Preanesthetic medication should be "atraumatic," using oral, existing IV, or rectal routes.

d. Preanesthetic medication should be "atraumatic," using oral, existing IV, or rectal routes.

Which statement explains why it can be difficult to assess a child's dietary intake? a. No systematic assessment tool has been developed for this purpose. b. Biochemical analysis for assessing nutrition is expensive. c. Families usually do not understand much about nutrition. d. Recall of children's food consumption is frequently unreliable.

d. Recall of children's food consumption is frequently unreliable.

What is the most accurate method of determining the length of a child younger than 12 months of age? a. Standing height b. Estimation of length to the nearest centimeter or 1/2 inch c. Recumbent length measured in the prone position d. Recumbent length measured in the supine position

d. Recumbent length measured in the supine position

An expectation of the patient in a health care setting in terms of charting and documentation is that? a. Information will be shared only with physicians in the hospital or clinic setting regardless of whether they are taking care of the patient. b. The use of nursing informatics requires that passwords be changed upon access to maintain patient confidentiality. c. The patient is assured that anyone in the hospital facility can access their chart. d. Safeguard systems are in place within the hospital or clinic setting to help maintain confidentiality of patient records.

d. Safeguard systems are in place within the hospital or clinic setting to help maintain confidentiality of patient records.

Which nursing intervention would be most effective in decreasing mortality from unintentional injury? a. Teaching children the dangers of contact sports b. Encouraging potential parents to obtain genetic counseling c. Educating parents-caretakers about the benefits of immunizations d. Teaching parents-caretakers about proper use of vehicle restraint seats

d. Teaching parents-caretakers about proper use of vehicle restraint seats

Prior to returning to school, an individualized home care plan (IHCP) needs to be developed for which child? a. The child recently identified with a penicillin allergy. b. The child being treated for pediculosis capitis (head lice). c. The child out of school for two week due to mononucleosis. d. The child recently diagnosed with insulin-dependent diabetes mellitus.

d. The child recently diagnosed with insulin-dependent diabetes mellitus.

The nurse is caring for an infant with a tracheostomy when accidental decannulation occurs. The nurse is unable to reinsert the tube. What action should the nurse take next? a. Notify the surgeon. b. Perform oral intubation. c. Try inserting a larger tracheostomy tube. d. Try inserting a smaller tracheostomy tube.

d. Try inserting a smaller tracheostomy tube.

Which is descriptive of family system theory? a. Family is viewed as the sum of individual members. b. Change in one family member cannot create a change in other members. c. Individual family members are readily identified as the source of a problem. d. When the family system is disrupted, change can occur at any point in the system.

d. When the family system is disrupted, change can occur at any point in the system.

The most consistent indicator of pain in infants is a. increased respirations. b. increased heart rate. c. clenching the teeth and lips. d. a facial expression of discomfort.

d. a facial expression of discomfort.

The nurse is planning care for a patient with a different ethnic background from the nurse's own. The most appropriate goal for the nurse in caring for this patient is to a. strive to keep ethnic background from influencing health care. b. encourage continuation of ethnic practices in the hospital setting. c. attempt, in a nonjudgmental way, to change ethnic beliefs. d. adapt, as necessary, ethnic practices to health needs.

d. adapt, as necessary, ethnic practices to health needs.

A home health nurse is caring for a 2-week-old infant and notes on assessment that the infant has a string tied around the wrist. The nurse checks for adequate circulation. The most appropriate nursing intervention by the nurse is to a. ask the parents to remove the string. b. report the parents to Social Services for child endangerment. c. remove the string and inform the parents that the string is dangerous. d. ask the parents the meaning of the string and leave the string in place.

d. ask the parents the meaning of the string and leave the string in place.

The nurse is assessing skin turgor in a child. The nurse grasps the skin on the abdomen between the thumb and index finger, pulls it taut, and quickly releases it. The tissue remains suspended, or tented, for a few seconds, and then slowly falls back on the abdomen. Based on the nurse's knowledge of assessing skin turgor, the assessment finding is that the a. tissue shows normal elasticity. b. child is properly hydrated. c. assessment is done incorrectly. d. child has poor skin turgor.

d. child has poor skin turgor.

A nurse is starting an intravenous (IV) line for a school-age child with cancer. The child says, "I have had a million IVs. They hurt." The nurse's response should be based on the knowledge that a. children tolerate pain better than adults. b. children become accustomed to painful procedures. c. children often lie about experiencing pain. d. children often demonstrate increased behavioral signs of discomfort with repeated painful procedures.

d. children often demonstrate increased behavioral signs of discomfort with repeated painful procedures.

Nurses counseling parents regarding the home care of the child with a cardiac defect before corrective surgery should stress the a. importance of reducing caloric intake to decrease cardiac demands. b. importance of relaxing discipline and limit-setting to prevent crying. c. need to be extremely concerned about cyanotic spells. d. desirability of promoting normalcy within the limits of the child's condition.

d. desirability of promoting normalcy within the limits of the child's condition.

The nurse needs to give an injection to a 4-year-old in the deltoid muscle. Based on the nurse's knowledge of preschool development, the most appropriate approach by the nurse is to a. smile while giving the injection to help the child relax. b. tell the child that you will be so quick, the injection won't even hurt. c. explain that child will experience "a little stick in the arm." d. explain with concrete terms such as "putting medicine under the skin."

d. explain with concrete terms such as "putting medicine under the skin."

The nurse working in an outpatient surgery center for children should understand that a. children's anxiety is minimal in such a center. b. waiting is not stressful for parents in such a center. c. accurate and complete discharge teaching is the responsibility of the surgeon. d. families need to be prepared for what to expect after discharge.

d. families need to be prepared for what to expect after discharge.

One of the most pressing problems in the United States is the growing number of the homeless population. Currently the fastest-growing segment of the homeless population is a. "runaway" and "throwaway" adolescents. b. individuals with mental disorders. c. migrant farm worker families. d. families with children.

d. families with children.

A nurse is assessing a family for effective coping and defensive strategies. The family social system theory the nurse will use is the: a. family systems theory, as derived from general systems theory. b. Resiliency Model of Family Stress, Adjustment, and Adaptation. c. family developmental theory. d. family stress theory.

d. family stress theory.

A child who is terminally ill with bone cancer is in severe pain. Nursing interventions should be based on the knowledge that a. children tend to be overmedicated for pain. b. giving large doses of opioids causes euthanasia. c. narcotic addiction is common in terminally ill children. d. large doses of opioids are justified when there are no other treatment options.

d. large doses of opioids are justified when there are no other treatment options.

The nurse needs to take the blood pressure of a small child. Of the cuffs available, one is too large and one is too small. The best nursing action is to a. use the small cuff. b. use the large cuff. c. use either cuff, using palpation method. d. locate the proper-sized cuff before taking the blood pressure.

d. locate the proper-sized cuff before taking the blood pressure.

When assessing a preschooler's chest, the nurse would expect a. respiratory movements to be chiefly thoracic. b. anteroposterior diameter to be equal to the transverse diameter. c. intercostal retractions on respiratory movement. d. movement of the chest wall to be symmetric bilaterally and coordinated with breathing.

d. movement of the chest wall to be symmetric bilaterally and coordinated with breathing.

The nurse is preparing a plan to teach a mother how to administer 11/2 teaspoons of medicine to her 6-month-old child. Based on the nurse's knowledge of administering pediatric medications, the nurse teaches the parent to use a a. household measuring spoon. b. regular silverware teaspoon. c. paper cup measure in 5-ml increments. d. plastic syringe (without needle) calibrated in milliliters.

d. plastic syringe (without needle) calibrated in milliliters.

A child is being seen in the emergency department with multiple facial abrasions and lacerations. The combination agent lidocaine, adrenaline, and tetracaine (LAT) is applied topically to the wounds. The purpose of this combination therapy is to a. cleanse the wound. b. promote scab formation. c. prevent infection of the wound. d. provide anesthesia to the wound.

d. provide anesthesia to the wound.

A nurse is preparing an educational workshop on atraumatic care in pediatric patient care. The most appropriate nursing intervention to include in the workshop is to a. prepare the child that their parents will not be able stay during hospitalization by watching a video. b. help the child to accept the pain associated with any treatments, procedures, or surgery. c. tell the child that the loss of control and privacy in the hospital is temporary. d. provide the child play activities for expression of fear and aggression.

d. provide the child play activities for expression of fear and aggression.

The main objective of the nursing role in the community is to focus on a. cost of health care. b. emergency management. c. population-based programs. d. wellness and health promotion.

d. wellness and health promotion.