Peds Exam 1

The nurse is performing cardiopulmonary resuscitation (CPR) on a 9-month-old patient and needs to obtain the baby's pulse. Where is the best place to locate a pulse on a 9-month-old infant during CPR? 1, The inner leg area 2. The neck area of the child 3. Near the surface of the foot 4. The ventral surface of the arm near the cubital fossa

4

Which method is appropriate to verify intubation status? 1. Visualization of bilateral chest wall rise 2. Waveform monitoring of capnogram 3. Auscultation of breath sounds 4. Chest x-ray 5. pH color change on end tidal CO2 detector 6. Patient confirmation of endotracheal tube placement

1, 2, 3, 4, 5

A nurse is aware that an antibiotic medication can be nephrotoxic. What should the nurse do to decrease the risk of toxic drug levels from developing in an 18-month-old patient? 1. Manage the hydration level of the child. 2. Monitor antibiotic peak and trough levels. 3. Evaluate the glomerular filtration rate daily. 4. Examine the child for paradoxical symptoms. 5. Ask the parents about the child's cognitive state.

1, 2, 3, 5

Which position is appropriate for the 2-year-old patient receiving an enema? 1. Sitting upright on the toilet 2. Side-lying 3. Prone 4. Supine

2

Which technique would the nurse utilize to perform chest compressions on an infant? 1. One finger 2. Two fingers 3. Heel of one hand 4. Heel of two hands

2

Which medication is utilized to reverse the effects of opiate narcotics? 1. Lidocaine 2. Magnesium sulfate 3. Calcium chloride 10% 4. Naloxone hydrochloride

4

A nurse in the unit receives a prescription to obtain a urine sample via catheterization. The first attempt was not successful, and the infant starts crying. What should be the nurse's next action because the baby is crying? 1. Let the infant have a rest period 2. Place a urine collection bag on the infant 3. Immediately reattempt to obtain via catheterization 4. Notify the prescribing provider that you were unable to obtain

1

The nurse is preparing to administer a narcotic medication to an 8-year-old patient. Which actions are necessary to ensure safe medication administration? 1. Consult with a second nurse. 2. Review the patient's medication order. 3. Verify the child's weight prior to administration. 4. Obtain permission from the patient's caregivers. 5. Ask the patient's name and check the patient's identification.

1, 2, 3, 5

The nurse is preparing to administer medication to a pediatric patient. Which statements describe how the nurse can encourage and empower the parents of the patient? 1. "Is your child able to swallow pills or capsules whole?" 2. "Please list all current medication allergies for your child." 3. "I am going to document this medication administration in your child's records." 4. "I am going to crush two pills and mix them with applesauce for your child to eat." 5. "This medication is going to alleviate your child's pain. You can administer it while the child sits on your lap." 6. "When your child takes all of the medication, be sure to praise her. A small token, such as a star sticker, can encourage repeat dosing."

1, 2, 4, 5, 6

Which assessment tool, either individually or in addition to another method, can be used to determine placement of a nasogastric feeding tube? 1.Radiographic image 2.Assessment of stomach aspirate color 3.Visual estimate 4.Assessment of stomach aspirate pH 5.Auscultation

1,2,4,5,

A child's sedentary lifestyle and unhealthy eating behaviors may lead to which problems? 1. Dental Caries 2. Childhood Obesity 3. Type 1 Diabetes 4. Hypotension

2

Which statement by the health care provider indicates understanding of how a nasogastric tube (NG) is measured for appropriate placement in an infant or child? 1. "Measuring from the nose to ear to mid-xiphoid is not easy to do in the clinical setting." 2. "The nose-ear-xiphoid is more accurate than the age predictor based on height." 3. "Measuring from the nose to the ear to the mid-xiphoid umbilicus can predict the correct length." 4. "The correct length of the NG tube cannot be measured at the bedside and must be done under fluoroscopy."

3

The nurse is administering medication to a group of pediatric patients. The nurse recognizes that which patient is at the highest risk of experiencing a medication-related adverse event? 1. The 4-month-old infant admitted for diarrhea and vomiting. 2. The 3-year-old child admitted for mononucleosis and fever. 3. The 16-month-old child admitted for strep throat and enlarged tonsils. 4. The 4-year-old child admitted with failure-to-thrive and malnutrition.

1

The nurse is administering oral medication to a pediatric patient. How does the use of an oral syringe facilitate safe medication delivery? 1. Ensures accurate dosing. 2. Calculates correct dosing. 3. Ensures complete delivery. 4. Allow less frequent dosing.

1

The nurse is conducting a primary assessment on a toddler with a respiratory rate of 40, supraclavicular retractions, and nasal flaring. Which is the next appropriate action for the nurse to take? 1. Assess lung sounds 2. Administer nebulizer 3. Perform nasotracheal suction 4. Assess the rectal temperature

1

A 15-year-old boy has been admitted to the emergency department and is recovering from ethanol intoxication. When questioned about his behavior, the adolescent becomes upset, fearful, and anxious. What should the nurse do in this situation? 1. Ensure the child's privacy is maintained 2. Encourage the child to discuss emotions 3. Contact authorities to report the child's alcohol use 4. Remind the child of the dangers of drinking ethanol 5. The nurse should justify the necessity of providing treatment for an impeding alcohol problem

1, 2

Which solutions are the most appropriate for use as an enema in a child? 1. 1 tsp salt in 500 mL tap water1 tsp of table salt dissolved into 500 mL of tap water would create an isotonic solution, which would be appropriate to use as a pediatric enema solution. 2. Pediatric Fleet enemaPediatric Fleet enema ingredients are harsh and should not be used in a child. 3. Hypotonic solution A hypotonic solution would not be appropriate to use as a pediatric enema, as it can cause rapid fluid shifts and fluid overload in a child. 4. Tap water Water is a hypotonic solution and would not be appropriate to use as a pediatric enema, as it can cause rapid fluid shifts and fluid overload in a child. 5. Isotonic solution An isotonic solution would be appropriate to use as a pediatric enema solution.

1, 5

A 12-month-old infant is brought into the emergency department with difficulty breathing. Which action would the nurse perform first? 1. Take the infant's temperature immediately 2. Observe the infant for respiratory rate and effort 3. Obtain a pulse oximetry measurement on the infant 4. Undress the infant to observe if any accessory muscles are being utilized for breathing

2

The nurse is preparing to administer an IM injection to a 4-year-old patient who is afraid of needles. Which approach should the nurse use to engage the pediatric patient's cooperation in medication-administration procedures? 1. Advise the child to view the injection. 2. Ask the child if he would prefer a red or blue bandage afterward. 3. Ensure that the needles are hidden from the child until the injection. 4. Use restraints on the child's arm so it does not move during the injection.

2

The nurse is preparing to administer an oral narcotic to a pediatric patient. The nurse performed the six rights when removing the drug from the storage container, again when preparing the drug, and then asked a colleague to perform a final check. The colleague confirmed the six rights. What is the nurse's next step? 1. Administer the drug. 2. Perform the six rights at the bedside. 3. Review the drug administration with the patient. 4. Confirm the drug dosage with the unit nurse manager.

2

Which statement by the newly-graduated health care provider indicates understanding of a gavage feeding? 1. "Using gravity, the lower I place the syringe, the faster the flow of formula into the stomach." 2. "Using gravity, the higher I hold the syringe, the faster the formula will flow into the stomach." 3. "Gravity does not influence the flow of formula into the stomach." 4. "The flow of formula into the stomach is dependent on the previous amount of residual stomach contents."

2

Which statement by the parent indicates an understanding of discharge instructions on giving an enema at home for a 2-year-old child? 1. "If I choose not to make my own enema solution, I can just buy a pediatric Fleet's enema from the local drugstore."Fleet's enemas should be avoided due to the harshness of the ingredients. This statement does not indicate understanding by the parent. 2. "Tap water should not be used as an enema solution because it can cause rapid fluid shifts and fluid overload."Tap water should not be used as an enema solution because it can cause rapid fluid shifts and fluid overload. This statement indicates understanding by the parent. 3. "My child should be able to retain the fluid in the enema."Adolescents and teens may be able to retain enema solution as instructed but not a 2-year-old child. This statement does not indicate understanding by the parent. Incorrect 4. "To create an isotonic solution, I mix 1 tsp of salt in 50 mL of tap water."To create an isotonic solution for an enema, dilute 1 tsp of salt in 500 mL of tap water, not 50 mL. This statement does not indicate understanding by the parent.

2

A 9-year-old child tells the nurse that he enjoys picking out his own clothes each morning. The child demonstrates which developmental phase of childhood? 1. InfancyDuring infancy, children develop gross and fine motor skills, cognitive and communication skills, social skills, and emotional skills. Independent decision-making is not part of the infancy phase. 2. Early ChildhoodDevelopmental delays become prominent during early childhood (1-4 years of age); independent decision-making would not be present. 3. Middle ChildhoodDuring middle childhood (5-10 years-old), development is concentrated on self-confidence, self-esteem, and independence, including independent decision-making. Health care providers and parents should continue to cultivate and nurture children during this time. 4. AdolescenceBy the adolescence stage (11-18 years of age), children have been making independent decisions for several years.

3

The nurse is administering medications to a group of pediatric patients. The nurse recognizes that which child is at the highest risk for experiencing an adverse medication reaction? 1. The 6-month-old infant being treated with topical cortisone.Children have a high body surface area-to-weight ratio when compared to adults, resulting in higher absorption of topically applied medications. However, cortisone is not a high-risk medication and this is a larger child than the preemie. 2. The 2-month-old infant receiving a dose of oral acetaminophen.The gastric secretions of infants are less acidic than those of adults However, acetaminophen is considered a safe medication with few adverse events. 3. The premature newborn receiving a dose of intravenous amoxicillin.Smaller, younger babies do not metabolize drugs in the same manner as older infants, children, or adults due to differences in physiology. These differences are most striking in the premature newborn. 4. The 18-month-old child being injected with a newly developed vaccine.The US does not use vaccines in children before being tested and approved. This vaccine is the same risk as any other vaccine.

3

Which aspect of adenosine administration is most important for the nurse to remember? 1. Reverses effects of opiatesAdenosine does not reverse the effects of opiates; that medication is naloxone hydrochloride. 2. Must be given slow IV pushThe medication adenosine has a very short half-life and therefore cannot be administered by slow IV push. Correct 3. Must be given as a rapid IV pushIt is very important to remember that adenosine must be given by rapid flush technique at access point closest to the heart because of its ultra-short half-life. 4. May dilute with standard concentrationAdenosine may not be diluted with standard concentration; sodium bicarbonate can be diluted with standard concentration with an equal volume of saline.

3

Which statement is true regarding pediatric obesity? 1. Body mass index (BMI) is in the 80th percentile.Childhood obesity occurs when a child's body mass index (BMI) is greater than or equal to the 95th percentile. 2. Incidence has doubled over the past 40 years.Childhood obesity has almost quadrupled over the past 40 years. 3. Adult obesity is often a consequence of childhood obesity.Children who are obese tend to continue on with obesity in adulthood. 4. An increase in the use of technology does not correspond with an increase in the rates of pediatric obesity.The increased use of technology has led to a sedentary lifestyle for many children which has led to an increase in pediatric obesity.

3

Which statements concerning a gastronomy procedure are correct? 1. A gastrostomy tube (G-tube) is only inserted during surgery with the patient under anesthesia.A gastrostomy tube (G-tube) is not only inserted during surgery with the patient under anesthesia; it can also be inserted endoscopically with sedation and local anesthetic. 2. Granulation tissue can grow around the stomal site and is an indication of an infection.Granulation tissue can grow around the stomal site, but it is not an indication of an infection. 3. G-tubes, used for children who need prolonged tube feeding, prevent nasal irritation associated with nasogastric (NG) tubes.G-tubes are used for children who need prolonged tube feeding to prevent nasal irritation associated with nasogastric (NG) tubes. 4. The G-tube is directly inserted through the abdomen into the stomach.The G-tube is directly inserted through the abdomen. 5. Gastric secretions are very caustic to the skin.Gastric secretions are very caustic to the skin.

3,4,5

The nurse is preparing a 7-year-old boy with a lower leg fracture for emergency surgery. The child asks, "Will I be able to play baseball in 2 weeks?" Which response by the nurse is most appropriate? 1. "I'm sure you will be okay, you will heal fast, and we will just have to see how the healing process goes."This is not the nurse's best response as the communication offers false reassurance and avoids answering the patient's question. 2. "You have broken your arm before, and this will probably be just like that injury. You will be back outside in no time. "While staying positive and hopeful can be helpful in this situation, the nurse should not offer a false reassurance. This statement also does not answer the patient's question. 3. "You had a traumatic injury that requires surgery and will take a long time to heal. You will likely have pain issues, and will not be playing baseball for a while."This is not the nurse's best response. Though this communication is effective at maintaining honesty, this statement is not kind and gentle and is not appropriate communication for the patient's development stage. 4. "I know you will want to play baseball in 2 weeks. Because of your injury, you may be able to watch the game and support your team, but it is unlikely that you will be able to play in the game."The nurse's best response to the child must be kind and gentle, yet must not mislead the patient. A statement should be made that will establish a trusting relationship and one that is honest.

4

Which nursing action is important to remember when feeding an infant with a nasoduodenal or nasojejunal tube? 1. Continuous feeds are contraindicated. 2. Bolus feeds are preferred, but one can use continuous feeds if better tolerated. 3. Continuous feeds are preferred, but one can use bolus feeds if better tolerated. 4. Bolus feeds are contraindicated.

4

Which interventions are examples of atraumatic care in pediatric nursing? 1. Telling the child what to do without giving them a choice 2. Using pain management interventions during procedures 3. Allowing the child to choose the type of drink with which to take their medication 4. Letting a child use the stethoscope before starting a procedure 5. Keeping any equipment out of the child's sight prior to a procedure

2, 3, 4

Which statements are true regarding infant mortality? 1. It is defined as death during the first year of life. 2. It is lower than the childhood morality rate. 3. It includes congenital anomalies and sudden infant death syndrome. 4. It was approximately 500 deaths per 1000 births in 2014. 5. There has been an overall decrease in infant mortality in the United States in the past decade.

1, 3, 5

Which nursing action is appropriate for a patient with a tracheostomy? 1. If the patient needs supplemental oxygen, it must be humidified. 2. Large amounts of bloody secretions are normal after tracheostomy surgery. 3. After the tracheostomy site is well-healed, the tracheostomy tube should only be changed out when visibly soiled. 4. Instilling sterile saline into the tracheostomy prior to suctioning helps to thin secretions and improve the suctioning of secretions.

1

Which statements concerning bronchial (postural) drainage are accurate? 1. Used on infants with acute lung illnesses such as respiratory syncytial virus (RSV) 2. Involves positioning the child to facilitate drainage from all four major lung segments 3. Uses gravity and positioning to enhance the clearance of mucous from the airways 4. Indicated for excessive mucous in the bronchi that is not being removed with normal cough 5. It is performed twice a day for approximately 45-60 minutes

2, 3, 4

A nurse is ordered to administer oral pain medication to a 5-year-old patient who is newly admitted after a vehicle accident. Which action is least likely to help the nurse prevent medication errors? Correct 1. Use the medication calculations provided by the pharmacy.The nurse should always perform an independent double-check of the medication calculations to ensure accuracy and should not rely on calculations provided by the pharmacy. The nurse should discuss any discrepancies with the healthcare provider or pharmacist. 2. Describe in detail the medication procedure to the child's caregivers.Communicating the medication list and administration procedure is an important part of discharge teaching, but will not enhance safety at admission. 3. Ask the patient's caregivers which medications the child typically takes at home.The nurse should always compare the list of medications the child receives at home with those prescribed at the hospital. This will ensure that the child is receiving the appropriate medications. 4. Administer high-risk medications after verifying the prescribed dose with another nurse.The nurse should always have a colleague double-check the administration of high-risk medications.

1

The nurse administers acetaminophen to a group of pediatric patients. Which patient will experience the therapeutic effects of the medication last? 1. The 3-month-old infant experiencing colic pain. 2. The 10-month-old infant with constipation and nausea. 3. The 16-month-old infant who just finished a cup of milk. 4. The 6-month-old infant with gastroesophageal reflux disease (GERD).

1

The nurse is caring for a 3-month-old in respiratory arrest. Upon assessment, the nurse notes the child is apneic and pulseless. Which is the appropriate next action to take? Correct 1. Begin CPRCPR should be initiated for an infant who is pulseless and apneic. 2. Assess the airwayAirway assessment is important, but is not the priority action for a child who is pulseless and apneic. 3. Auscultate lung soundsThe child is apneic, and therefore no lung sounds would be heard. 4. Obtain a blood pressureBlood pressure is a part of the primary survey, but would not be the nurse's priority action for a child who is pulseless and apneic.

1

The nurse is preparing to administer amoxicillin to the pediatric patient who weighs 40 lbs. The dose required is 60 mg/kg/day BID. What should the nurse do first in order to begin dosage calculation? 1. Convert the weight from pounds to kilograms. 2. Multiply the child's weight by the dose prescribed. 3. Administer the prescribed medication to the patient. 4. Divide the total dose by the number of doses per day.

1

When teaching a class on aspects of family, which definition of family-centered care should the nursing instructor share with students? 1. A philosophy that places the family at the center of the child's plan of care 2. A treatment plan that encourages patients' healing by following nontraditional methods and practices 3. A patient plan of care based on the nurse's prerogative and the other health providers' advice 4. Separating the child from the family

1

Which educational method is being used by the nurse practitioner if the discussion is focused on how to best prevent the child from being involved in accidents? 1. Anticipatory Guidance 2. Clinical Reasoning 3. The Nursing Process 4. Evidence-based Practice

1

Which medication is commonly used to treat pulseless ventricular tachycardia? Correct 1. LidocaineLidocaine is commonly used to treat pulseless ventricular tachycardia. 2. Inotropic agentsInotropic agents are not commonly used to treat pulseless ventricular tachycardia; rather it is used in hypotension or hypoperfusion, severe congestive heart failure, or cardiovascular shock. 3. Dextrose (25%, 50%)Dextrose (25%, 50%) is not commonly used to treat pulseless ventricular tachycardia; rather it is used in hypoglycemia, a common complication of dehydration, sepsis, and resuscitation. 4. Calcium chloride 10%Calcium chloride 10% is not commonly used to treat pulseless ventricular tachycardia; rather it is used in hypocalcemia, hypermagnesemia, hyperkalemia, and calcium channel blocker overdose.

1

Which rationale would the nurse provide when questioned about using the PICOT format while conducting research? 1. PICOT is used to formulate a clinical question.In order to formulate a clinical question that clearly defines the problem and can be used in evidence-based practice (EBP), nurses should use the standardized PICOT format. 2. PICOT is used as a format for the appraisal during the literature process to evaluate journal articles.The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria are used during the literature review and appraisal of the literature process to evaluate the articles, not PICOT. 3. PICOT is the basis for the nursing process.Clinical reasoning, not PICOT, is the basis for the nursing process. The nursing process is a scientific process used to select a plan of care based on assessment, planning, intervention, and evaluation. 4. PICOT is the process of analyzing published research and translating it into everyday nursing practice.Analyzing published research and translating it into everyday nursing practice is at the root of evidence-based practice (EBP). The PICOT format helps to formulate the research question as a part of this process, but it does not define the whole of EBP. EBP is the process of analyzing published research and translating it into everyday nursing practice.

1

Which statement by the nurse to the parent of a child patient demonstrates an understanding of family-centered care? 1. "Each day we will discuss your child's plan of care and what the goals are for the plan."Family-centered care is a philosophy that places the family at the center of the child's plan of care. 2. "Each day I will write down my goal for your child's health."Family-centered care is a philosophy that places the family, not the nurse, at the center of the child's plan of care. The family and the child should decide on the goals, not the nurse. 3. "We will not discuss your child's plan of care in front of the child."Family-centered care is a philosophy that places the family at the center of the child's plan of care. The philosophy also includes consulting with the child. 4. "Your child's plan of care will be dictated by your child's attending health care provider."Family-centered care is a philosophy that places the family at the center of the child's plan of care and in decision making. Health care providers should help and educate the family on the plan of care without dictating it.

1

Which statement provides a rationale for the use of evidence-based practice (EBP) by nursing professionals? Correct 1. Evidence-based practice (EBP) enables the nurse to find a better approach to their practice that is based on research evidence.Evidence-based practice (EBP) allows nurses to question whether current practices are effective and, if not, to find a better approach to the practice. 2. EBP allows the nurse to practice how they want to practice.EBP is based on clinical and researched evidence, not on the opinion or historical preferences of the nurse. 3. EBP allows the nurse to initiate orders without the health care provider's approval.While EBP helps health care providers select protocol orders, these orders are approved by health care providers and backed by research. 4. EBP can help nurses select patient diagnoses.EBP is not meant to help with the diagnosing of patients, but rather to help with the practice behind taking care of those patients.

1

Which statement provides a rationale for use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria? 1. Evaluation and appraisal of scholarly research articles can be accomplished. 2. The GRADE criteria allow for the assignment of a grade to a research paper or article. 3. Formation of PICOT questions for research purposes is part of the GRADE criteria. 4. Only randomized control trial research can be categorized with the GRADE criteria.

1

The nurse has to give the 6-year-old patient with diabetes a dose of insulin. Which statement(s) describes what the nurse should do before administering the medication? Correct 1. Record the time.As part of the six rights of medication administration, the nurse must ensure the patient is receiving medication at the appropriate time. The nurse must document this Correct 2. Verify the dosage calculation and the order.The dosage calculation of the drug should be performed before administering any medication. The nurse should discuss any discrepancies in calculations with the prescribing health care provider and pharmacist. Correct 3. Ask another nurse to double-check the medication.Insulin is a drug that requires a second nurse to check before administration, as defined by the Institute for Safe Medication Practices. 4. Administer the insulin as soon as the dose is prepared.Insulin is a drug that falls under the Institute for Safe Medication Practices policy and the nurse must stop after preparation to confirm the six rights. 5. Confirm the six rights of medication administration after receiving the medication order.The six rights of medication administration should be followed when the drug is removed from storage, when it is prepared, and at bedside prior to administration, not just after receiving the order.

1, 2, 3

The nurse is caring for an infant in the emergency department. The nurse must be careful of all the patient's IV lines, but also recognizes that to provide developmentally appropriate care she should perform which actions in caring for the infant? 1. Swaddle the infant 2. Touch and rock the infant 3. Allow the use of a pacifier 4. Leave infant in crib at all times 5. Talk in normal volume and tone to infant

1, 2, 3

Which patient outcomes are consistent with the concept of atraumatic care? 1. Prevent/Minimalize pain and injury 2. Promote a sense of control for both child and family 3. Limit separation between child and family 4. Separating the child from the family when possible 5. Ensure the procedure is completed in a timely manner

1, 2, 3

A 10-year-old, tearful patient presents to the emergency department with a burn on the left foot. The nurse notes a partial thickness burn and erythema. After vitals are assessed and the child is provided with comfort measures, which are the next appropriate actions to take? 1. Monitor the surface of the injury 2. Assess range of motion in all extremities 3. Obtain information on past hospitalizations 4. Carefully monitor the patient's temperature 5. Pain management primarily through nonpharmacologic measures

1, 2, 3, 4

The health care facility supplies the nurse with which tools to prevent medication errors in the pediatric population? Correct 1. Limiting variations in drug preparation by using standardized doses.The standardization of pediatric medications will reduce medication errors by limiting the variations in drug preparation. Correct 2. Universal procedures for drug administration facilitates proper usage.The establishment of universal procedures for drug administration facilitates proper usage and reduces the risk of medication errors by providing a standard mechanism that is followed by all health care providers. Correct 3. Use of kilograms for weight in all dose calculations and medical records.The use of kilogram weight in children for prescriptions, dose calculations, medical records, and staff communication will standardize communication procedures and reduce the risk of medication errors. Correct 4. Dose-range software programs to provide alerts for potentially incorrect doses.The use of software programs to alert about incorrect doses is a protocol that will help catch medication errors. 5. Eliminating use of bar-coding technology for medications that require a nurse perform a second check.Bar-coding technology is a safety intervention for all medications, including high-risk medications that require two nurses to verify the drug rights. Elimination, therefore, would not help to prevent medication errors.

1, 2, 3, 4

Which clinical signs could indicate respiratory distress following extubation of a pediatric patient? Correct 1. StridorSigns of respiratory distress following extubation of a pediatric patient include stridor, increasing respiratory rate, use of accessory muscles while breathing, and decreasing oxygenation levels. Correct 2. Increased respiratory rateSigns of respiratory distress following extubation of a pediatric patient include stridor, increasing respiratory rate, use of accessory muscles while breathing, and decreasing oxygenation levels. Correct 3. Decreasing oxygenationSigns of respiratory distress following extubation of a pediatric patient include stridor, increasing respiratory rate, use of accessory muscles while breathing, and decreasing oxygenation levels. Correct 4. Using accessory muscles to breatheSigns of respiratory distress following extubation of a pediatric patient include stridor, increasing respiratory rate, use of accessory muscles while breathing, and decreasing oxygenation levels. Increasing temperatureSigns of respiratory distress following extubation of a pediatric patient include stridor, increasing respiratory rate, use of accessory muscles while breathing, and decreasing oxygenation levels. 5. Increasing temperature does not indicate respiratory distress after extubation.

1, 2, 3, 4

Which factors impact the choices children and adolescents make regarding eating habits and food preferences? 1. Family and Culture 2. Peer Pressure 3. Social Influences 4. Lack of Resources 5. State where the child lives

1, 2, 3, 4

Which processes can be used to help resolve a clinical problem encountered in pediatric nursing care? Correct 1. Evidence-based PracticeEvidence-based practice (EBP) allows nurses to question whether current practices in use are effective and, if not, find a better approach to the practice. Correct 2. PICOT Question DevelopmentThe nurse can use the PICOT format in order to formulate a clinical question related to the clinical problem. Correct 3. GRADE CriteriaThe GRADE criteria can be used during the literature review process. Health care practitioners may use the GRADE criteria to appraise articles being researched related to the clinical problem being examined. Correct 4. Clinical ReasoningThe nurse can use clinical reasoning to help resolve a clinical problem, by applying expertise and knowledge to move towards a solution. 5. Atraumatic carePediatric nurses use atraumatic care to help minimize the stress on the child and family during treatment. While this may apply to the clinical situation in the case study, it is not a nursing process.

1, 2, 3, 4

When caring for a patient with mechanical ventilation, which findings should be continuously monitored and assessed at all times? 1. Observation of chest rise 2. Level of consciousness 3. Oxygen saturation 4. Patient temperature 5. Auscultation of breath sounds

1, 2, 3, 5

Which actions are most appropriate for assessing a postsurgical intubated patient with a sudden oxygen saturation deterioration? Correct 1. Displacement of the endotracheal tube (ETT)Sudden deterioration requires a quick assessment using the D.O.P.E. mnemonic: displacement, obstruction, pneumothorax, and equipment status. 2. Obstruction of the ETT Sudden deterioration requires a quick assessment using the D.O.P.E. mnemonic: displacement, obstruction, pneumothorax, and equipment status. 3. Oxygen source Sudden deterioration requires a quick assessment using the D.O.P.E. mnemonic: displacement, obstruction, pneumothorax, and equipment status which includes assessing the delivery of oxygen. 4. End-tidal CO2 capnometry Sudden deterioration requires a quick assessment using the D.O.P.E. mnemonic: displacement, obstruction, pneumothorax, and equipment status. Measuring end-tidal CO2 capnometry should not be quickly assessed first. 5. Equipment status Sudden deterioration requires a quick assessment using the D.O.P.E. mnemonic: displacement, obstruction, pneumothorax, and equipment status.

1, 2, 3, 5

Which atraumatic interventions would the nurse consider when starting an intravenous (IV) infusion in a 5-year-old child? 1. Applying EMLA cream to the IV site prior to the procedurePediatric nurses can use different interventions to help alleviate pain during procedures. EMLA cream can help to numb the area prior to the IV start. 2. Showing the child the equipment that will be used during the procedureAllowing the child to view and manipulate the equipment may help the child alleviate fears and anxiety about a situation. 3. Allowing the child to choose whether they want the IV in the left or right armChildren can feel in control when they are given choices regarding treatments or medications. The choice to take a medication is not an option, but what type of drink would you like to take your medication with can be. 4. Not allowing the child to see the equipment until just before the procedureChildren should be allowed to see any equipment being used and receive an explanation on that equipment prior to the procedure. Allowing the child to view and manipulate the equipment may help the child alleviate fears and anxiety about a situation. 5. Allowing the child to choose a sticker once the procedure is completeChildren can feel in control when they are given choices. The choice of which sticker the child wants after the procedure is a reward and can be introduced before the procedure as an incentive.

1, 2, 3, 5

Which explanation should a pediatric nurse provide to parents regarding why health promotion activities need to be ongoing? 1. Health risks can be identified early. 2. Nutrition can be optimized. 3. Healthy behavior habits can become a lifestyle. 4. Health promotion activities are mandated by the government. 5. Childhood is when habits for lifelong health begin to form.

1, 2, 3, 5

Which type of safety information should the nurse recommend to parents of a toddler? 1. Water safetyDrowning, choking, car accidents, poisoning, and burns are some of the most common injuries among children. Parents should be taught water safety, car safety, and kitchen safety. Parents should also learn cardiopulmonary resuscitation (CPR) among other childhood safety lessons. 2. Car safetyDrowning, choking, car accidents, poisoning, and burns are some of the most common injuries among children. Parents should be taught water safety, car safety, and kitchen safety. Parents should also learn cardiopulmonary resuscitation (CPR) among other childhood safety lessons. 3. Kitchen safetyDrowning, choking, car accidents, poisoning, and burns are some of the most common injuries among children. Parents should be taught water safety, car safety, and kitchen safety. Parents should also learn cardiopulmonary resuscitation (CPR) among other childhood safety lessons. 4. Depression preventionHomicide and suicide are common causes of injury in adolescence, not in early childhood. 5. CPR course informationDrowning, choking, car accidents, poisoning, and burns are some of the most common injuries among children. Parents should be taught water safety, car safety, and kitchen safety. Parents should also learn cardiopulmonary resuscitation (CPR) among other childhood safety lessons.

1, 2, 3, 5

Which behaviors would a nurse demonstrate to patients and parents that would build a trusting relationship for effective communication? 1. Make eye contactNurses can establish effective communication and trusting relationships with the children and family by making eye contact with the child and family when having conversations. 2. Call the child by nameNurses can establish effective communication and trusting relationships with children and family by calling the child by name to personalize care. 3. Avoid fearful subjectsNurses can establish effective communication and trusting relationships with children and family by acknowledging and addressing the child's and family's fears. Avoiding fearful subjects would not facilitate trust and may lead to greater miscommunication. 4. Provide updates when availableNurses can establish effective communication and trusting relationships with children and family by checking back with the family often and by providing periodic updates if the child and family are separated. 5. Offer silence as much as possibleNurses can establish effective communication and trusting relationships with children and family by talking to the family often; silence is a form of communication that is easily misinterpreted.

1, 2, 4

Which factors make it possible to have two patients that are both at the same age yet behave very differently in an emergency setting? 1. Maturity levels 2. Past experiences 3. Health care agency 4. Cultural differences 5. Health care provider

1, 2, 4

Which statements by the pediatric nurse to the parent of a child patient show an understanding of the nurse's role of advocate? 1. "It is important to ensure that your child has regular dental checkups to maintain oral health."Advocacy includes encouraging health promotion initiatives. 2. "The local YMCA offers basic CPR courses. It is important for you to learn CPR just in case you need to use it on your child."Advocacy includes health education and injury prevention initiatives such as suggesting that parents learn basic CPR. 3. "As a nurse, I am not allowed to give you information regarding services for your child."As an advocate it is well within the rights and responsibilities of the nurse to provide any information they can regarding any services that will help a child and their family. 4. "Based on your child's age, it is important that he or she sit in the back seat of your car with the seatbelt on."Advocacy includes health promotion, health education, injury prevention, support, and collaboration. 5. "I am not at liberty to discuss your child's plan of care with you. You must work with your child's health care provider regarding your child's plan of care."The nurse helps the family and child coordinate care and make informed decisions. The discussion of the child's plan of care is not the sole responsibility of the health care provider.

1, 2, 4

A lack of physical activity and increased consumption of unhealthy foods by teenagers may lead to which conditions? 1. ObesityLack of physical activity and unhealthy food consumption can lead to weight gain and an increase in body mass index (BMI). Childhood obesity occurs when a child's BMI is greater than or equal to the 95th percentile. 2. Type 2 DiabetesLack of physical activity and unhealthy food consumption can lead to weight gain and obesity, which can lead to many diseases, such as type 2 diabetes. 3. Dental CariesWhile dental caries can be caused by consumption of unhealthy foods, lack of physical activity does not affect oral health. 4. HypertensionLack of physical activity and unhealthy food can lead to weight gain and obesity, which can lead to many diseases, such as hypertension. 5. HyperlipidemiaLack of physical activity and unhealthy food consumption can lead to weight gain and obesity, which can lead to many diseases, such as hyperlipidemia. 6. Type 1 DiabetesPediatric obesity has led to an increase in type 2 diabetes diagnoses, but not type 1 diabetes diagnoses in children.

1, 2, 4, 5

Which approach should the nurse use when engaging a pediatric patient in the medication administration process? 1. Tell the child if a medication may have an unpleasant taste. 2. Describe how long an injection site might be uncomfortable. 3. Leave injection sites uncovered so the child can see the skin. 4. Describe how the child can help during medication administration. 5. Offer words of support and encouragement to the child for any cooperative behaviors.

1, 2, 4, 5

Which are advantages of pulse oximetry monitoring over transcutaneous oxygen monitoring? Correct 1. Pulse oximetry does not need to be recalibrated with every site change.Unlike transcutaneous monitoring, pulse oximetry monitoring does not need to be recalibrated with every site change. Correct 2. Pulse oximetry does not require heating of the skin to obtain oxygen saturation levels, so there is no risk of burns using pulse oximetry.Unlike transcutaneous monitoring, pulse oximetry monitoring does not require heating of the skin to obtain oxygen saturation levels, so there is no risk of skin burns. 3. Pulse oximetry devices can measure the partial pressure of arterial CO2.Pulse oximetry devices cannot measure the partial pressure of arterial carbon dioxide. Correct 4. Pulse oximetry devices maintain accurate measurements regardless of the disease process.Pulse oximetry devices can maintain accurate measurement of oxygen saturation regardless of the disease process. Correct 5. Skin color and skin thickness do not affect the pulse oximetry reading.Skin color and skin thickness do not affect the pulse oximetry reading, which is an advantage over transcutaneous monitoring.

1, 2, 4, 5

The nurse is preparing to administer an ophthalmic solution to an 8-year-old patient who is refusing to open his eyes. How should the nurse respond to facilitate administration of the medication by the parents? 1. Demonstrate the administration for the parents.The nurse should teach the parents how to deliver the medication so that they are confident in their approach. 2. Allow the parents to practice prior to administration.The parents should be allowed to practice administering the medication prior to actual administration to ensure confidence in both the parents and the child. 3. Explain to the parents the necessity of the medication.Although it is important to thoroughly explain the necessity of the medication to the parents, this will not facilitate administration of an ophthalmic solution to a patient who refuses to open his or her eyes. 4. Withhold the medication until the parents are available to assist.The medication should not be withheld from the patient. Proper administration, including correct timing, is crucial for patient safety. 5. Encourage the parents to use a reward after administering the medicationThe nurse should encourage the parents to use positive reinforcement to build trust and help reduce the fear that the child is feeling.

1, 2, 5

The nurse is administering an injection to a 4-year-old patient who is fearful of the procedure. What can the nurse do to facilitate cooperation of the patient? Correct 1. Ask the child to hold a toy.Providing a distraction, such as a favorite toy, helps the child accept the injection in a more favorable light. 2. Explain in detail how the medication works.Children should be approached according to their developmental level, with the nurse providing appropriate explanations about medication procedures. Describing medication mode of action to a 4-year-old child will not facilitate cooperation. Correct 3. Tell the child they get a fun bandage after the injection.Adhesive bandages following an injection help the child feel better about receiving the medication because children of this age tend to think "magically." Therefore, the bandage will "make it all better." Correct 4. Tell the child how well she did after administering the injection.Praising the child will help her feel good about herself and facilitate the child being less afraid of future injections. Correct 5. Tell the child she will receive a sticker of her choice after the procedure.Rewarding good behavior will help the child focus on something positive and not what she is afraid of.

1, 3, 4, 5

Which statements are appropriate when providing education to a newly-graduated health care provider about oxygen therapy? 1. "Oxygen therapy can be delivered by various methods." 2. "Prolonged exposure to oxygen can cause skin breakdown." 3. "Mode of delivery is based on the child's disease process and how much oxygenation is needed." 4. "Prolonged exposure to oxygen can affect the retinas of premature infants." 5. "Mode of delivery is partly based on the child's ability to cooperate."

1, 3, 4, 5

A child has just presented to the emergency department. Which three factors must a triage nurse first assess in a young infant? 1. Skin colorObserving the skin color will be important as this can give an indication of the child's level of blood oxygenation. 2. TemperatureTemperature is an important assessment in triage; however, it is not one of the top three factors that the triage nurse first assesses. 3. Level of arousalAssessing the child's level of arousal will be a priority since this can give the nurse a clue to the child's level of consciousness. 4. Hydration statusHydration status is an important assessment in triage; however, it is not one of the top three environmental factors that the triage nurse first assesses. 5. Respiratory rate and effort Respiratory rate and effort are two of the essential factors to assess, because the child may need to be set up on emergency respiratory equipment.

1, 3, 5

Pediatric airways utilized in an emergency are classified into different categories. What are the names of the airways that may be utilized in a pediatric emergency? 1. Laryngeal 2. Chest tube 3. Oropharyngeal 4. Nasoesophageal 5. Nasopharyngeal

1, 3, 5

Which teaching instructions would be included for the parents of a 5-year-old with a newly-placed ostomy? 1. Change the pouches on a routine basis.Changing the pouch on a routine basis is a correct statement and should be included in the teaching instructions. 2. Ostomy pouches are usually changed four times a week in children.Ostomy pouches are usually changed twice a week in children, not four times a week; this would not be included in the teaching instructions. 3. Protection of the skin around the stoma is a main priority.Protection of the skin around the stoma is a main priority and should be included in the teaching instructions. 4. To protect the skin, pouches should be changed only when they are almost full.Pouches should be changed when they are one third to one half full, not almost full. Therefore, the statement should not be included in the teaching instructions. 5. Pediatric pouches come in various sizes; as your child grows, you will need to buy bigger ostomy pouches.Pediatric ostomy pouches come in various sizes and as the child grows, bigger ostomy pouches will be needed. This is a correct statement and should be included in the teaching instructions.

1, 3, 5

A mother calls the clinic and states that upon giving her 18-month-old child a prescribed medication, the child has become hyperactive. Her older child takes the same medication and it makes her sleepy. Which physiological mechanism(s) describes the differences in the children's responses to the medicine? 1. The liver's metabolism of drugs can differ by age.The metabolic enzyme systems in the liver are immature in young children, which can lead to differences in the metabolism of the medication. In a young child, all of the drug may not be metabolized resulting in a higher concentration of the drug in the blood. 2. The medication is able to access the brain of the older child faster.The blood-brain barrier of younger, not older, children (typically < 2 years) is immature and can allow access of medication to the central nervous system. 3. Plasma proteins are higher in concentration in a young child because of the smaller blood volume.Albumin, a plasma protein, binds many medications. However, this protein occurs in lower levels in infants and toddlers. The result is that more medication is unbound and free to act on its target, which could account for differences in effects. 4. The body fluid of older children is a larger percentage of body weight resulting in drug dilution.Older children have a smaller percentage of body fluid per unit of body weight compared to infants and toddlers. 5. The development of the nervous system is not complete, resulting in different reactions in children of different ages.The immaturity of the infants' and toddlers' nervous system can lead to paradoxical effects in infants and toddlers compared to the same drug's effects in older children.

1, 5

Which factors are most frequently associated with pediatric cardiopulmonary arrest? 1. Shock 2. Choking 3. Cardiac arrest 4. Lethal arrhythmia 5. Respiratory failure

1, 5

The nurse is caring for a 12-year-old child who was found unresponsive and requires cardiopulmonary resuscitation. Which aspect of a child's medical history would the nurse suspect to be involved in the child's emergency condition? 1. Bee sting allergyHaving a hymenoptera allergy can cause low blood pressure and shock in children if left untreated and therefore could be the cause of cardiopulmonary arrest in this child. This is something the nurse would need to consider. 2. History of asthmaRespiratory failure that can be caused by severe asthma can lead to cardiopulmonary arrest in children. A medical history of asthma would be key information for understanding the cause of this child's current condition. 3. Tension headachesHaving a history of tension headaches would not be a priority in understanding the cause of this child's unresponsiveness requiring cardiopulmonary resuscitation. 4. Greenstick fractureThe child's history of having a greenstick fracture would not be the information required for understanding the child's need for cardiopulmonary resuscitation. 5. Low blood pressureLow blood pressure can lead to shock, which is one of the causes of cardiopulmonary arrest in children. This would therefore be information the nurse needs to know to understand the cause of this child's current condition.

1,2,5

The nurse is caring for a 36-week-old premature infant who recently started enteral feeds through a nasojejunal (NJ) tube. The infant has had two episodes of emesis in the past 30 minutes. After notifying the provider, which prescription can the nurse anticipate receiving first? 1. Pulling back of the NJ tube 3 cm Since vomiting episodes could indicate displacement of the nasojejunal (NJ) tube, the nurse should anticipate receiving an abdominal x-ray prescription to verify placement of the tube. Pulling back on the tube 3 cm is not the appropriate action. 2. X-ray of abdomen Since vomiting episodes could indicate displacement of the NJ tube, the nurse should anticipate receiving an abdominal x-ray prescription to verify placement of the tube. 3. Lab work to assess for dehydration Since vomiting episodes could indicate displacement of the NJ tube, the nurse should anticipate receiving an abdominal x-ray prescription to verify placement of the tube. Lab work to assess for dehydration is not the appropriate action. 4. Continuing with enteral feeds as prescribed. Since vomiting episodes could indicate displacement of the NJ tube, the nurse should anticipate receiving an abdominal x-ray prescription to verify placement of the tube. Continuing with enteral feeds is not the appropriate action.

2

The nurse is caring for a 9-year-old with an abdominal wound. Which factor is most important to consider when teaching the child about care of the wound? 1. Nine-year-olds need little time lag between the explanation of a procedure and its completion.Preschool age group characteristics are that they need little time lag between the explanation of a procedure and its completion because of their imaginative nature. Correct 2. Nine-year-olds have extensive vocabularies, and they can understand simple explanations of procedures.School-age children are able to understand the cause of illness and injury and are much less likely to fantasize and exaggerate. They have extensive vocabularies, and they can understand simple explanations of procedures; this should be kept in mind when caring for this age group. 3. Nine-year-olds have little understanding of time, so procedures should be introduced just before they are initiated.Toddler age group characteristics are that they have little understanding of time, so procedures should be introduced just before they are initiated in this age group. 4. Nine-year-olds may appear physically mature, they might not be emotionally mature, and they continue to require support.Adolescent age group characteristics are that they may appear physically mature; however, they might not be emotionally mature, and they continue to require support.

2

When caring for a patient whose oxygen saturation is being monitored by pulse oximetry, what is important to remember? 1. Pulse oximetry is an invasive measurement of the saturation of hemoglobin with oxygen. 2. Change the pulse oximetry probe sites every 4 to 8 h to prevent skin breakdown. 3. Intravenous (IV) dyes and nail polish increase the ability of the pulse oximetry sensor to detect oxygen saturation. 4. Normal oxygen saturation levels range between 90% and 93%.

2

Which action would the nurse perform to help the parents understand a 5-year-old's needs during IV insertion? 1. Ask the parents to leave the patient's bedside. 2. Ensure that she communicates honestly about procedures 3. Explain that she will be telling the patient that starting the IV will not hurt 4. Ask the parents to remove the child's video game if the child does not cooperate with procedure of starting the IV

2

Which statement demonstrates understanding on the part of the nurse regarding use of fluoridated toothpaste for a 1-year-old child? 1. "Children under the age of 3 should not use any fluoridated product."The American Academy of Pediatric Dentistry (2014) recommends a "smear" of fluoridated toothpaste for children younger than 2 years of age and a pea-sized amount for those 2 years to 5 years of age. 2. "Children can begin using fluoridated water as soon as they have their first tooth come in."Fluoridated water is recommended for all children from the time the first tooth erupts as it is an essential mineral for building teeth free of caries. 3. "Children should not use any fluoridated toothpaste without a prescription from their dentist."Fluoridated toothpaste is recommended for all children from the time the first tooth erupts; a prescription is not needed for fluoridated toothpaste. 4. "It is not necessary for your child to use fluoridated toothpaste."Dental caries are one of the most common chronic diseases in children. Fluoridated toothpaste and regular dental visits can help prevent dental caries. Fluoridated toothpaste is recommended for all children from the time the first tooth erupts.

2

What information does the nurse need to know in order to calculate body surface area (BSA) for the pediatric patient receiving chemotherapy? 1. Age 2. Height 3. Weight 4. Temperature 5. Body mass index

2, 3

Regular physical exercise has which effects during childhood? 1. Optimized nutritionWhile regular physical activity in childhood has benefits related to improved health and reduced levels of obesity, this does not equate to optimal nutrition or best eating habits, which are more learned behaviors from family. 2. Improved bone healthPhysical activity improves bone health through weight-bearing activities. 3. Decreased levels of obesityPhysical activity decreases the tendencies for being overweight and obese in children of all ages. 4. Improved cognitive skillsPhysical activity improves cognitive skills through the release of brain chemicals key for memory, concentration, and mental sharpness. 5. Decreased risk of sports participation injuryWhile regular physical activity can help with an increase in muscle tone and bone strength, it has not been shown to decrease the risk of sports participation injury.

2, 3, 4

The nurse is caring for a 2-year-old in respiratory distress related to epiglottitis who has a patent airway. The child is sitting in the mother's lap and appears calm. Which is the appropriate action for the nurse to take? 1. Place the child in a supine positionPlacing a child in respiratory distress into a supine position inhibits the ability for full lung expansion and may worsen the child's respiratory symptoms. This could also possibly agitate the child, which can worsen the symptoms. Correct 2. Administer supplemental oxygen via blow byA child in respiratory distress would require supplemental oxygen by blow by, as long as it does not agitate the child. Correct 3. Allow the mother to continue to hold the infantThe nurse should continue to let the mother hold the infant, as long as the infant's oxygenation is adequate; the infant should also be allowed to maintain whatever position is comfortable. 4. Use a tongue depressor to assess airway patencyFor children in severe respiratory distress related to epiglottitis, the nurse would not agitate the child further to assess the airway. Correct 5. Contact anesthesiology as this is a medical emergencyRespiratory distress related to epiglottitis is a medical emergency and can cause a complete patent airway. The anesthesiologist will need to be called in to intubate the child.

2, 3, 5

Which processes are included as part of clinical reasoning? 1. Formatting a PICOT question 2. Determination and implementation of actions 3. Using the GRADE criteria 4. Confirmation of clinical problems 5. Awareness of clinical cues 6. Evaluation and reflection

2, 4, 5, 6

A child is brought to the emergency department with a fever. The caregiver becomes anxious and tells the nurse he had a family member die from a high-fever and sore throat 30 years ago. Which statement is the appropriate response by the nurse? 1. "That was long ago; let's worry about what is going on right now." 2. "I'm so sorry to hear about your brother; health care has changed so much in 30 years." 3. "That must have been very traumatic; now let's get your son assessed so we can begin his care." 4. "I do not know what could cause his fever to be this high; he should have been brought to the emergency department earlier."

3

A patient is diagnosed with torsades de pointes. What medication can the nurse anticipate the health care provider prescribing as part of the care plan for this patient? 1. AmiodaroneThe nurse will not administer amiodarone as part of the care plan for this patient. Amiodarone would be administered as part of the care plan of a patient with pulseless arrest or supraventricular or ventricular tachycardia. 2. Atropine sulfateThe nurse will not administer atropine sulfate as part of the care plan for this patient. Atropine sulfate would be administered as part of the care plan for a patient with symptomatic bradycardia and toxins/overdose. Correct 3. Magnesium sulfateThe nurse will administer magnesium sulfate as part of the care plan for this patient suffering from torsades de pointes. 4. Sodium bicarbonateThe nurse will not administer sodium bicarbonate as part of the care plan for this patient. Sodium bicarbonate would be administered as part of the care plan for a patient with severe metabolic acidosis, hyperkalemia, and sodium channel blocker overdose.

3

Based on the developmental level of a 7-year-old child, what should the nurse do before administering an IM medication to enhance cooperation? 1. Demonstrate the injection using puppets.Toddlers, not 7-year-old children, should be prepared with age-appropriate explanations, using play if possible. 2. The nurse should give a sticker or lollipop as a reward.The 7-year-old should be given a reward for good behavior; however, it should occur after the medication is delivered. Correct 3. Ask the child which arm he or she would prefer for the injection.A school-aged child, such as a 7-year-old child, should be offered as many choices as possible to help feel in control. 4. Provide a detailed explanation about the mode of action of the medication.Details about the mode of action of the medication will not be understood by 7-year-old, but are a good method of eliciting cooperation from an adolescent.

3

The nurse is caring for a 5-year-old patient after a motor vehicle collision. The child's parents were killed on impact. One of the family members who has arrived at the bedside is emotional, crying, and getting louder. Which action would the nurse take to maintain effective communication with the patient and the family? 1. The nurse calls hospital security to have the family member removed.The nurse does not need to obtain hospital security officers as the behaviors from the family are not violent or abusive. 2. The nurse knows that she must ask for the family member to leave the hospital.To maintain effective communication, the nurse does not need to ask the family member to leave, as the patient may eventually need their support. 3. The nurse knows she must encourage the person in crisis to move to a quiet place.To maintain effective communication, the nurse encourages the person in crisis to move to a quiet place, because observers and stimuli from other sources tend to aggravate a crisis. 4. The nurse addresses the family member about appropriate behavior in the hospital setting.To maintain effective communication, the nurse does not need confront or offer explanation regarding appropriate behavior in the hospital setting at this point in time.

3

The nurse is caring for a 9-year-old child brought to the emergency department by ambulance after a motor vehicle collision. The patient is not accompanied by any family. Which assessment finding would be obtained during the secondary assessment? 1. Lung soundsThe primary, not secondary, assessment would incorporate lung sounds, as the primary assessment focuses on the ABCDE's. 2. Blood pressureThe primary, not secondary, assessment would incorporate blood pressure, as the primary assessment focuses on the ABCDE's. Correct 3. Family presenceThe secondary assessment would incorporate family presence information, because the secondary assessment focuses on the needs of the family for support and inclusion in care. 4. Level of consciousnessLevel of consciousness is assessed during the primary, not secondary assessment.

3

When giving an enema to a 4-year-old child, the appropriate insertion distance (in inches) of the enema is

3

Which practice regarding oral health should the nurse suggest to the parents of a 4-year-old child? 1. Maintain diet of beverages and food containing added sugars. 2. Delay the use of fluoride in the child's dental treatment. 3. Visit the dentist regularly. 4. Delay dental interventions until all of the child's teeth have erupted.

3

Which referral is appropriate for the 17-year-old patient with Crohn's disease who had an ostomy placed earlier that day? 1. Referral to physical therapist 2. Referral to immunologist 3. Referral to psychologist 4. Referral to wound-care specialist

3

The emergency department nurse is caring for a 7-year-old child who presents with frequent abdominal pain. The child reports bullying at school and poor test grades. Which factors are most important for the nurse consider when providing care? 1. Grade levelThe child's grade level is not an important factor to consider when providing emergency care. Though it may offer insight on the child's cognitive ability, it is not a priority assessment. 2. Height and weightEmergency nursing care will not need to address both height and weight, although they do vary with age. Correct 3. Child's developmental levelEmergency nursing care will need to address the child's development. The developmental level will affect the nurse-patient interaction. Correct 4. Child's abdominal discomfortEmergency nursing care of children needs to address both the child's physical symptoms and emotional status. Correct 5. How the child responds to bullyingThe nurse would consider the child's coping strategies when providing care because that determines how the child deals with stressful situations.

3, 4, 5

A mother requests the use of a numbing agent on the infant's skin before starting an IV. Which response from the nurse best explains the concerns with using a topical numbing agent? 1. "Infants are prone to skin irritation and contact dermatitis."The development of contact dermatitis, while increased in infants, is not a primary consideration when deciding to use a numbing agent on the infant's skin. 2. "Numbing agents can change the blood flow and affect the IV medication."Numbing agents may alter peripheral blood flow subcutaneously; however, this alteration would not be a primary consideration in the use of topical medications in infants and would not affect the IV medication. 3. "The use of a numbing agent will not be effective when applied to the skin of an infant."The metabolism and absorption of drugs in infants is much different than that seen in adults. However, there is no evidence that the numbing agent will be ineffective in this situation. Correct 4. "Infants and young children have a higher body surface area-to-weight ratio and thinner skin than adults."The large body surface area-to-weight ratio of infants coupled with thinner outer skin layer results in a higher absorption of topical medications. Therefore, the nurse must be careful in the use of a numbing agent and ensure the agent is approved for use in infants

4

The nurse is preparing for her admission of a 2-year-old with respiratory distress. Which oxygen delivery method is most appropriate for the patient? 1. Oxygen croup tent Oxygen croup tents are no longer used in developed countries due to difficulty controlling oxygen and saturation of child's clothes with water while enclosed in the tent. 2. Oxygen hood Oxygen hoods are better suited for infants not toddlers. 3. Oxygen face mask Oxygen face masks are better suited for older children since a snug fit is required. A toddler, most likely, would continuously pull at the mask which would not allow for a snug fit. 4. Oxygen face tent An oxygen face tent would be a good choice for a toddler as it does not require the face to be covered and is better tolerated than an oxygen face mask.

4

The nurse understands that the priority of the emergency situation is addressing the adolescent's physical problems. After physical problems have been addressed, the nurse should complete which step next? 1. Ensure the parents are at the bedsideThe nurse's next step would not be to ensure that the parents are at the patient's bedside. Adolescents may delay the presence of the parents at the bedside. 2. Ensure the patient can reach the phoneAlthough the adolescent has stabilized from physical problems, the nurse's next step would not be to first ensure that the patient can reach the phone. This may occur later, if applicable. 3. Ensure the television is on for the patientAlthough the adolescent has stabilized from physical problems, the nurse's next step would not be to first ensure that the television is on for the patient. This may occur later, if applicable. 4. Ensure the patient's modesty is preservedThe nurse's next step would be to ensure that the patient's modesty is preserved, because this is a major priority for most adolescents.

4

Which is the best position to place a child in after a gavage feeding through a gastrostomy tube if the nurse was concerned her patient was experiencing reflux? 1. Semi-Fowler's positionPositioning the child on the right side or in Fowler's position after a gastrostomy feeding would be the best position, not the semi-Fowler's position. 2. Either left or right side, but not pronePositioning the child on the right side or in Fowler's position after a gastrostomy feeding would be the best position, not prone and not on the left side. 3. Left side or in Fowler's positionPositioning the child on the right side or in Fowler's position after a gastrostomy feeding would be the best position, not on the left side. 4. Right side or in Fowler's positionPositioning the child on the right side or in Fowler's position after a gastrostomy feeding would be the best position.

4

A 3-year-old child is brought to the emergency department unconscious, and the nurse notes a very abnormal skin color. Based on this observation, which factors must be addressed immediately since they indicate a great threat to the child's life? 1. HypertensionHypertension would not be associated with skin color and therefore would not be one of the factors indicating a threat to the child's life. 2. HypoventilatingHypoventilating is not one of the greatest threats to the child's life. 3. Abdominal distentionAbdominal distention is not one of the greatest threats to the child's life, though it could ultimately lead to abnormal skin color. 4. Respiratory distress or failureAbnormal skin color could result from ineffective gas exchange causing respiratory distress or failure, which is one of the greatest threats to the child's life. 5. Inadequate tissue perfusion (shock)Abnormal skin color could result from inadequate tissue perfusion or shock, which is one of the greatest threats to the child's life.

4, 5