Pediatrics Final Exam

A mother accompanies her 12 month old child to the health clinic for his scheduled immunizations. What statement by the mother would cause the nurse to question immunization administration at this visit? a. "My child has had a runny nose for the past week." b. "Joey hates getting these shots, it makes him so mad- watch yourself." c. "Joey had a slight temperature this morning but it went away after I gave him some Tylenol." d. "Last time Joey got a shot, his little thigh was red and sore afterwards for two days!"

C: "Joey had a slight temperature this morning but it went away after I gave him some Tylenol." Rationale: A child should not receive immunizations generally if he/she has been running a fever or there are signs of moderate to severe illness even without a fever. Choice "A" would not be a contraindication for the immunizations if there are no other signs and symptoms of illness. Choice "B" would not be a contraindication for the immunization, most children do not like shots and object to them. Choice "D" is not a contraindication as this is considered a mild reaction to the injection.

The preschooler's interest in gender sexuality is characterized by an interest in: a. His or her genitalia. b. Learning how and why his or her anatomy differs from that of other children. c. Playing with and developing friendships with children of the opposite sex. d. Spending most of his or her time with the parent of the opposite sex.

a. His or her genitalia.

Which medication used in the management of acne vulgaris has a side effect of elevated triglyceride levels? a. Isotretinoin (Accutane). b. Tretinoin (Retina-A). c. Erythromycin. d. Topical benzoyl peroxide.

a. Isotretinoin (Accutane).

An adolescent with a depressive disorder is more likely than an adult with the same disorder to exhibit: a. Negativism and acting. b. Sadness and crying. c. Suicidal thoughts. d. Weight gain.

a. Negativism and acting.

The development of a 2-year-old child is characterized by: a. Engaging in parallel play. b. Dressing self with supervision. c. Having a vocabulary of at least 500 words. d. Having attained one third of adult height.

a. Engaging in parallel play. - Rationale: Two-year-olds typically play alongside each other.

School phobia is usually treated by: a. Returning the child to school immediately with family support. b. Calmly explaining why attendance in school is necessary. c. Allowing the child to enter the school before the other children. d. Allowing the parent to accompany the child in the classroom.

a. Returning the child to school immediately with family support. - Rationale: Exposure to the feared situation can help in overcoming anxiety.

A female child, age 2, is brought to the emergency department after ingesting an unknown number of aspirin tablets about 30 minutes earlier. On entering the examination room, the child is crying and clinging to the mother. Which data should the nurse obtain first? a. Heart rate, respiratory rate and blood pressure. b. Recent exposure to communicable diseases. c. Number of immunizations received. d. Height and weight.

a. Heart rate, respiratory rate and blood pressure. - Rationale: The most important data to obtain on a child's arrival in the emergency department are vital sign measurements. The nurse should gather the other data later.

A mother of a 3-year-old asks a clinic nurse about appropriate and safe toys for the child. The nurse should tell the mother that the most appropriate toy for 3-year-old is which? a. A wagon. b. A golf set. c. A farm set. d. A jack set with marbles.

a. A wagon.

A nurse has given home care instructions to the parent of a child with head lice. Which of the following statements indicates that the instructions are correctly understood? a. All family members must be treated. b. I must discard all of my child's personal linens. c. I must wash my child's hair with an antibacterial shampoo. d. I must keep my child at home for at least one week after treatment.

a. All family members must be treated. - Rationale: Pediculosis capitis is head lice. They are spread by direct contact and can live up to 3 days between hosts.

While in a skilled nursing facility, a male client contracted scabies, which is diagnosed the day after discharge. The client is living at her daughter's home, where six other persons are living. During their visit to the clinic, she asks a staff nurse, "What should my family do?" The most accurate response from the nurse is: a. All family members will need to be treated. b. If someone develops symptoms, tell him to see a physician right away. c. Just be careful not to share linens and towels with family members. d. After you're treated, family members won't be at risk for contracting scabies.

a. All family members will need to be treated.

A clinic nurse is reviewing her assessment on a pediatric patient. What would be assessment findings with the intestinal parasite giardiasis? Select all that apply. a. Anorexia. b. Abdominal cramps with intermittent loose stools and constipation. c. Intense perianal itching. d. Bed wetting/poor sleeping. e. Failure to thrive. f. Diarrhea and vomiting.

a. Anorexia. b. Abdominal cramps with intermittent loose stools and constipation. e. Failure to thrive. f. Diarrhea and vomiting.. - Rationale: Clinical manifestations for giardiasis are as follows: anorexia, diarrhea, vomiting, failure to thrive, abdominal cramps with intermittent loose stools and constipation, steatorrhea. Clinical manifestations for pinworms include intense perianal itching, bed wetting/poor sleep, and irritability or restlessness.

The nurse counsels the parent of an infant diagnosed with nonorganic failure to thrive. The nurse notes that the mother appears depressed and is expressing feelings of inadequacy and resentment toward her infant. Which approach by the nurse is MOST appropriate? a. Structure environment so that the mom feels accepted. b. Refer her to a family therapist. c. Tell her she is an unfit mother. d. Recommend that she attend child care classes.

a. Structure environment so that the mom feels accepted. - Rationale: Help parents increase self-esteem by making them feel accepted; nurse should empathize with parents about the difficulty of childrearing.

A child with Rubeola (Measles) is being admitted to the hospital. In preparing for the admission of the child, the nurse should plan to place the child on which precautions? a. Enteric. b. Airborne. c. Protective. d. Neutropenic.

b. Airborne. - Rationale: Rubeola is transmitted via airborne particles or direct contact with infectious droplets. Airborne droplet precautions are required, and persons in contact with the child should wear masks.

Which of the following statements about acne is true? a. It is caused by dirt left on the face. b. Keeping hair clean and off the forehead tends to lessen the severity of the lesions. c. Foods high in caffeine have been demonstrated to increase the occurrence of acne. d. Aggressive washing of the face has been shown to be the best treatment for acne.

b. Keeping hair clean and off the forehead tends to lessen the severity of the lesions.

A nurse in the pediatric clinic is advising the mother of a toddler who has pinworm infestation. What should the nurse teach the mother about caring for her child during and after treatment? Select all that apply. a. How to identify pinworm eggs. b. Strategies to avoid reinfestation. c. Need for medication for the entire family. d. Importance of handwashing before eating. e. Reason for obtaining stool specimen from the child.

b. Strategies to avoid reinfestation. c. Need for medication for the entire family. d. Importance of handwashing before eating. - Rationale: Reinfestation is common because pinworms easily spread to family members who are in close contact with the child. All family members must take the medication to help prevent reinfestation. Toddlers touch dirt and then put their hands in their mouths. Handwashing for all the family members before eating can help prevent reinfestation.

Mara and Cassie are both 2-1/2 years old. They both want to play with the same toy and are fighting, grabbing the toy back and forth. Mara's mother is very upset and asks the nurse why they can't get along. You would most likely suggest that she do which of the following based on your understanding of development? a. Suggest to the mothers that they reprimanded the children and tell them to share the toy. b. Suggest to the mothers that they give each child a toy to play with. Have two toys on hand. c. Suggest that when the children begin to fight over a toy that they have the toy removed and then place the children in separate parts of the room. d. Suggest that they tell the children it is not necessary to fight, there are "plenty of toys," and provide another toy for one of the children.

b. Suggest to the mother that they give each child a toy to play with. Have two toys on hand.

The clinic nurse is assessing a child who is scheduled to receive a live virus vaccine (immunization). What are the general contraindications associated with receiving a live virus vaccine? Select all that apply. a. The child has symptoms of a cold. b. The child had a previous anaphylactic reaction to the vaccine. c. The mother reports that the child is having intermittent episodes of diarrhea. d. The mother reports that the child has not had an appetite and has been fussy. e. The child has a disorder that caused a severely deficient immune system. f. The mother reports that the child has recently been exposed to an infectious disease.

b. The child had a previous anaphylactic reaction to the vaccine. e. The child has a disorder that caused a severely deficient immune system. Rationale: The general contraindications for receiving live virus vaccines include a previous anaphylactic reaction to a vaccine or a component of a vaccine. In addition, live virus vaccines generally are not administered to individuals with a severely deficient immune system, individuals with a severe sensitivity to gelatin, or pregnant women. A vaccine is administered with caution to an individual with a moderate or severe acute illness, with or without fever.

Which is descriptive of the nutritional requirements of preschool children? a. Average daily intake of preschoolers should be about 3000 calories. b. The quality of the food consumed is more important than the quantity. c. Nutritional requirements for preschoolers are very different from requirements for toddlers. d. The requirement for calories per unit of body weight increases slightly during the preschool period.

b. The quality of the food consumed is more important than the quantity. - Rationale: It is essential that the child eat a balanced diet with essential nutrients.

A mother arrives at the emergency department with her child, stating that she just found the child sitting on the floor next to an empty bottle of aspirin. On assessment, the nurse notes that the child is drowsy but conscious. The nurse anticipates that the physician will prescribe which of the following? a. ipecac syrup. b. activated charcoal. c. magnesium citrate. d. magnesium sulfate.

b. activated charcoal. - Rationale: Where as ipecac is administered to induce vomiting in certain poisoning situations, it is not recommended as the initial treatment in the hospital setting for ingestion of salicylates. This is because ipecac does not totally remove the poison from the child's system. In this situation, the child is conscious and the ingested substance (aspirin) would not damage the esophagus or lungs from vomiting. However, activated charcoal would be prescribed as an antidote in this poisoning situation, because its action is to absorb ingested toxic substances and thus decrease absorption. Options C and D are unrelated to treatment for this occurrence.

A mother tells the nurse that she is very worried because her 2-year-old child does not finish his meals. What should the nurse advise the mother? a. Make the child sit with the family in the dining room until he finishes his meal. b. Provide quiet environment for the child before meals. c. Do not give snacks to the child before meals. d. Put the child on a chair and feed him.

c. Do not give snacks to the child before meals. - Rationale: If the child is hungry, he/she more likely would finish his meals. Therefore, the mother should be advised not to give snacks to the child. The child is a "busy toddler." He/she will not be able to keep still for a long time.

A mother brings her 8-month-old daughter to the clinic for well-child care. The mother says to a nurse, "My daughter loves to suck her thumb, and I'm worried this habit will cause permanent damage to her teeth." Which of these responses should the nurse give to the mother? a. You should wrap your daughter's thumb in adhesive tape. b. Offer her favorite toy to distract her from sucking her thumb. c. Infants need sucking; it's okay to let your daughter suck her thumb. d. Remove her thumb from her mouth when you see her thumbsucking.

c. Infants need sucking; it's okay to let your daughter suck her thumb.

A mother of a 3-year-old tells a clinic nurse that the child is rebelling constantly and having temper tantrums. The nurse most appropriately tells the mother to: a. Punish the child every time the child says "no", to change the behavior. b. Allow the behavior because this is normal at this age period. c. Set limits on the child's behavior. d. Ignore the child when this behavior occurs.

c. Set limits on the child's behavior.

A mother of a 30-month-old toddler who was treated for pinworm infestation is taught how to prevent a reoccurrence. Which statement by the mother indicates that the teaching is effective? Select all that apply. a. I will keep the cat off my child's bed. b. I will disinfect my child's room every 2 days. c. The family's sheets will be washed every day. d. The school nurse must be told to have the toilets cleaned. e. I will remind family members to take the medication again in 2 weeks.

c. The family's sheets will be washed every day. e. I will remind family members to take the medication again in 2 weeks. - Rationale: Washing clothing and bed linens daily will help limit transmission. Medications are effective, but must be repeated in 2 weeks to prevent reinfestations. Cats do not transmit pinworms. Disinfecting surfaces does not help prevent transmission. Toilets are not the usual mode of transmission; the rectal-oral cycle must be completed for an infestation to occur.

Which of the following actions should be included in the teaching plan for the parents of a preschool-aged child with pediculosis capitis? a. Apply calamine lotion or Burow's solution. b. Comb the child's hair each week. c. Wash all of the family's clothing and linens. d. Administer topical anti-itch medication twice a day.

c. Wash all of the family's clothing and linens.

An emergency department nurse prepares to treat a child with acetaminophen (Tylenol) overdose. The nurse reviews the physicians orders, expecting that which of the following will be prescribed? a. protamine sulfate. b. succimer (chemet). c. acetylcysteine (mucomyst). d. vitamin K (aquaMEPHYTON)

c. acetylcysteine (mucomyst) - Rationale: Acetylcysteine is the antidote for acetaminophen overdose. It is administered orally or via nasogastric tube in a diluted form with water, juice or soda. It can also be administered intravenously. Vitamin K is the antidote for warfarin; protamine sulfate is the antidote for heparin; succimer is used in the treatment of lead poisoning.

A mother is concerned because her child was exposed to varicella in daycare. What is the nurse's best response? a. Initially, the rash appears as fluid filled blisters. b. The treatment of choice is aspirin. c. Varicella usually has an incubation period of 5 to 10 days. d. A child is no longer contagious once the rash has crusted over.

d. A child is no longer contagious once the rash has crusted over. - Rationale: Once every varicella lesion has crusted over, the child is no longer considered contagious. The rash is typically a maculopapular vesicular rash. The rash first appears as pink or red bumps which occur over several days. Following the rash, fluid filled vesicles form over the next 24 hours before breaking and leaking. THe use of aspirin has been associated with Reye's syndrome and is contraindicated in varicella. The incubation period for varicella is 10-20 days.

A child is receiving a series of the hepatitis B vaccine and arrives at the clinic with his parent for the second dose. Before administering the vaccine, the nurse should ask the child and parent about a history of severe allergy to which substance? a. Eggs. b. Penicillin. c. Sulfonamides. d. A previous dose of hepatitis B vaccine or component.

d. A previous dose of the hepatitis B vaccine or component. Rationale: A contraindication to receiving the hepatitis B vaccine is a previous anaphylactic reaction to a previous dose of hepatitis B vaccine or to a component (aluminum hydroxide or yeast protein) of the vaccine. An allergy to eggs, penicillin, and sulfonamides is unrelated to the contraindication to receiving this vaccine.

In which child population would the nurse be alert for giardiasis, the most common parasitic infection in the United States? a. Children riding a school bus. b. Children playing on a playground. c. Children attending sporting event. d. Children attending group day care or nursery school.

d. Children attending group day care or nursery school. - Rationale: Giardiasis is caused by protozoa and is prevalent among children in crowded environments, such as classrooms or day care centers.

Which statement by a 14-year-old girl receiving isotretinoin (Accutane) indicates that more teaching is needed? a. If I were to become pregnant, the medication could have severe effects on my baby. b. Use of this medication is reserved for people with severe inflammatory acne who have not responded to standard therapies. c. I will need to have my blood checked to monitor for side effects of this medication. d. If this medication does not work within two weeks, I will not be able to ever receive it again.

d. If this medication does not work within two weeks, I will not be able to ever receive it again.

A 7-year-old is seen in a clinic, and the primary health care provider documents a diagnosis of primary nocturnal enuresis. When the mother asks a nurse about the diagnosis, the nurse plans to respond knowing that: a. Primary nocturnal enuresis does not respond to treatment. b. Primary nocturnal enuresis is caused by a psychiatric problem. c. Primary nocturnal enuresis requires surgical intervention to improve the problem. d. Most children outgrow the bed-wetting problem without therapeutic interventions.

d. Most children outgrow the bed-wetting problem without therapeutic interventions. - Rationale: Primary nocturnal enuresis occurs in a child who has never been dry at night for extended periods. The condition is common in children, and most children eventually outgrow bed-wetting without therapeutic intervention. The child is unable to sense a full bladder and does not awaken to void. The child may have delayed maturation of the CNS. The condition is not caused by a psychiatric problem.

A mother asks the nurse how to handle her 5-year-old child, who recently started wetting the 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? a. The child forgets previously learned skills. b. The child experiences growth while regressing, regrouping, and then progressing. c. The parents may prefer less mature behaviors. d. The child returns to a level of behavior that increases the sense of security.

d. The child returns to a level of behavior that increases the sense of security.

The nurse provides home care instructions to the parents of a child hospitalized with pertussis who is in the convalescent stage and is being prepared for discharge. Which statement by a parent indicates a need for further instruction? a. We need to encourage our child to drink fluids. b. Coughing spells may be triggered by dust or smoke. c. Vomiting may occur when our child has coughing episodes. d. We need to maintain droplet precautions and a quiet environment for at least 2 weeks.

d. We need to maintain droplet precautions and a quiet environment for at least 2 weeks. - Rationale: Pertussis is transmitted by direct contact or respiratory droplets from coughing. The communicable period occurs primarily during the catarrhal stage. Respiratory precautions are not required during the convalescent phase. Options A, B, and C are accurate components of home care instructions.