Peds Exam 1- Practice
A mother of a 16-year old tells a nurse that she is concerned because the child sleeps about 8 hours every night and until noontime every weekend. The most appropriate nursing response is which of the following? A) "Adolescents need that amount of sleep every night." B) "The child shouldn't be staying up so late at night." C) "The child probably is anemic and should eat more foods containing iron." D) "If the child eats properly, that shouldn't be happening."
"Adolescents need that amount of sleep every night." The adolescent needs up to 12 to 15 hours of sleep per night. During this age, with an increase in social activities, school commitments, and possibly work activities, it is important that the adolescent receive enough sleep at night.
A child is scheduled for a tonsillectomy in a day-stay surgical unit. On the day following surgery, the mother calls the surgical unit and expresses concern because the child has a very bad mouth odor. Which of the following responses is most appropriate? A) "Bad mouth odor is normal and may be relieved by drinking more liquids." B) "The child probably has an infection." C) "Have the child gargle with mouthwash every 4 hours." D) "You need to contact the physician immediately."
"Bad mouth odor is normal and may be relieved by drinking more liquids." Bad mouth odor is normal following tonsillectomy and may be relieved by drinking more liquids. Options 1, 2, and 4 are incorrect. In addition, mouthwash gargles (option 4) will irritate the throat.
A nurse is performing an assessment of a 7-year old child who is suspected of having episodes of absence seizures. Which of the following assessment questions to the mother will assist in providing information that will identify the symptoms associated with this type of seizure? A) "Does twitching occur in the face and neck?" B) "Does the muscle twitching occur on one side of the body?" C) "Does the muscle twitching ocur on both sides of the body?" D) "Does the child have a blank expression during these episodes?"
"Does the child have a blank expression during these episodes?" Formerly called petit mal seizures, absence seizures are very brief episodes of altered awareness. There is no muscle activity except eyelid fluttering or twitching. The child has a blank facial expression. These seizures last only 5 ot 10 seconds, but they may occur one after another several times a day.
The mother of a child who underwent a myringotomy with insertion of pressure equalizing tubes (PE Tubes) calls a nurse and reports that the child is complaining of discomfort. Which of the following is the most appropriate response? A) "You need to speak to the physician because the child should not be having any discomfort." B) "I will speak to the physician so that a narcotic can be prescribed." C) "Give the child children's aspirin for the discomfort." D) "Give the child acetaminophen (Tylenol) for the discomfort."
"Give the child acetaminophen (Tylenol) for the discomfort." Aspirin should not be administered to a child. Some discomfort after myringotomy with insertion of tympanostomy tubes is normal.
A student nurse is caring for a 2-year old child diagnosed with croup. A nursing instructor asks the student about the clinical manifestations associated with croup. Which statement by the student indicates a need for further research? A) "Symptoms usually worsen during the day and are relieved during sleep." B) "Symptoms usually worsen at night and are better during the day." C) "The cough is harsh and brassy." D) "Inspiratory stridor and a low-grade fever may be present."
"Symptoms usually worsen during the day and are relieved during sleep." Croup often begins at night and may be preceded by several days of upper respiratory infection symptoms. It is characterized by a sudden onset of a harsh, brassy cough, sore throat, and inspiratory stidor. Symptoms usually worsen at night and are better in the day. It is usually accompanied by a low-grade fever, but occasionally the fever may be as high as 104 degrees F.
A 2-year old child is treated in the emergency room for a burn to the chest and abdomen. The child sustained the burn by grabbing a cup of hot coffee that was left on the kitchen counter. The nurse reviews safety principles with the parents prior to discharge. Which statement, if made by the parents, indicates an understanding of the measures to provide safety in the home? A) "We will be sure that the children stay in their rooms when we work in the kitchen." B) "We will be sure not to leave hot liquids unattended." C) "I guess my children need to understand what the word 'hot' means." D) "We will install a safety gate as soon as we get home so the children can't get into the kitchen."
"We will be sure not to leave hot liquids unattended." Toddlers, with their increased mobility and development of motor skills, can reach hot water or hot objects placed on counters and stoves, and open fires or stove burners above their eye level. Parents should be encouraged to remain in the kitchen when preparing a meal, to use the back burners on the stove, and to turn pot handles inward and toward the middle of the stove. Hot liquids should never be left unattended, and the toddler should always be supervised.
A 15-year old girl is grounded for 2 weeks by her parents for smoking in school. The adolescent tells the school nurse, "It's not fair that I get punished when my friends get away with doing the same thing." The nurse's most appropriate response would be: A) "I intend to report your friends to the prinicpal so they can also be punished." B) "The others will pay someday for lying to school authorities." C) "When errors in judgment are made, people must be prepared to take the consequences of their actions." D) "It is difficult enough to get teenagers to tell the truth. When parent don't act, it reinforces deceptive behavior."
"When errors in judgment are made, people must be prepared to take the consequences of their actions." As part of the maturation process, adolescents need to be made to accept the consequences of their actions
An 8-year old has a tonsillectomy. During the immediate postoperative period it is most important for the nurse to ensure that the child maintains: A) Hydration by providing cool liquids frequently B) Consciousness by encouraging the mother to interact with the child C) Airway patency by placing the child in a side-lying position D) Aeration by assisting with coughing and deep breathing
Airway patency by placing the child in a side-lying position Remember, always start with ABC. Airway. This becomes important after a patent airway is established; the client can receive tepid or cool liquids.
The nurse recognizes that behaviors typical of an 9-month old include: A) Smiling spontaneously, clasping hands, and keeping the head steady when sitting B) Drinking from a cup, using the words "mama" and "dada," and standing alone C) Removing some clothing, building a tower of two cubes, and stooping to pick up toys D) Being shy with strangers, playing peek-a-boo, and standing holding on to furniture
Being shy with strangers, playing peek-a-boo, and standing holding on to furniture
A physician has prescribed phenobarbital sodium, 25 mg po BID, for a child with febrile seizures. The medication label reads: phenobarbital sodium, 20 mg per 5 mL. A nurse has determined that the dosage prescribed is a safe dose for the child. The nurse prepares to administer how many milliliters per dose to the child? A) 2 mL B) 4.5 mL C) 6.25 mL D) 7.0 mL
C) 6.25 mL
A mother brings her 4-month old infant to a well baby clinic for immunizations. A nurse would prepare to administer which of the following immunizations to this infant? Incorrect Response A) DTaP (diphtheria, tetanus, acellular pertussis), MMR (measles, mumps, rubella), IPV (inactivated poliovirus vaccine) B) MMR, Hib (Haemophilius influenzae type b), DTaP Correct Answer C) DTaP, Hib, IPV D) Varicella and hepatitis B vaccines
DTaP, Hib, IPV The first does of MMR is administered between 12 and 15 months of age; the second dose is administered at 4 to 6 years of age.
A 10-year old child with asthma is treated for acute exacerbation in the emergency room. A nure reports which of the following, knowing that it is not an indication that the condition is improving? A) Decreased wheezing B) A pulse rate of 90 beats per minute C) Increased wheezing D) Warm, dry skin
Decreased wheezing Decreased wheezing in a child with asthma may be incorrectly interpreted as a positive sign when, in fact, it may signal an inability to move air. A "silent ches" is an ominous sign during an asthma episode. With treatment, increased wheezing may actually signal that the child's condition is improving. The normal pulse rate in a 10 year old is 70 to 110 beats per minute. Warm, dry skin indicates an improvement in condition, as the child is normally diaphoretic during exacerbation.
To bring about effective communication with any child, the nurse must first take into consideration the child's: A) State of health B) Ability of self-expression C) Fear of authoritarian figure D) Developmental level
Developmental level This might modify the approach, but knowing the child's developmental level is the most important. With each age group, there are different means of communication; the approach used with a school aged child should differ from that used with a toddler or a teenager.
A nurse assesses the vital signs of a 12-month old infant with a respiratory infection. The respiratory rate is 35 breaths per minute. On the basis of this finding, which action is most appropriate? A) Notify the physician B) Reassess the respiratory rate in 15 minutes C) Administer oxygen D) Document the findings
Document the findings The normal respiratory rate in a 12-month old infant is 25 to 40 breaths per minute. The normal apical rate is 80 to 120 beats per minute, and the sytolic blood pressure is 80 to 100 with diastolic 55 to 65. The nurse would document the findings.
The mother of an 8-year old child being treated for right lower lobe pneumonia at home calls the clinic nurse. The mother tells the nurse that the child complains of discomfort on the right side and that the acetaminophen (Tylenol) is not very effective. The nurse most appropriately tells the mother to: A) Increase the dose of acetaminophen B) Encourage the child to lie on the left side C) Encourage the child to lie on the right side D) Increase the frequency of acetaminophen
Encourage the child to lie on the right side Splinting of the affected side by lying on that side may decrease discomfort. It is inappropriate to advise the mother to increase the dose frequency of the acetaminophen. Lying on the left side will not be helpful in alleviating discomfort.
A 4-year old child diagnosed with leukemia is hospitalized for chemotherapy. The child is fearful of the hospitalization. Which nursing intervention would be most appropriate to alleviate the child's fears? A) Encouraging the chld's parents to stay with the child B) Provide a private room, allowing the child to bring the favorite toys from home C) Encourage play with other children of the same age D) Advise the family to visit only during the scheduled visiting hours
Encouraging the child's parents to stay with the child Although the preschooler may already be spending some time away from parents at a day care center or preschool, illness adds stress that makes separation more difficult. The child may repeatedly ask when parents will be coming for a visit or may be constantly wanting to call the parents.
A young baby has an open repair of a fractured sternum and has a chest tube. The nurse explains to the baby's mother that the chest tube: A) Is left in to drain the air from the chest cavity that entered during surgery B) Does not cause discomfort and is put in place for emergency use C) Will be removed once the baby is feeding well and is afebrile D) Drains the extra air in the baby's chest that accumulated following the punctured lung
Is left in to drain the air from the chest cavity that entered during surgery The chest was open during surgery for the sternal repair, and air was allowed into the thorax; the air must be removed for the lungs to expand properly.
A 15 months old come into the clinic for a well-child check-up. The child was last seen at 9 months and was up to date for his immunizations at his 9 month check-up. What immunization should the 15 month old recieve today (if we only give one shot)? A) Diphtheria, tetanus, and pertussis vaccine B) Measles, mumps, rubella vaccine C) Tetanus toxoid D) Polio vaccine
Measles, mumps, rubella vaccine The key with this question is that the MMR would be the most important immunization to give since the child has not yet received the immunization and has previously received the other immunizations. The infant should have received this immunization at 2 months, 4 months; the next booster can be given between 6 and 18 months.
An appropriate toy for a 3-month old infant would be a: A) Stuffed animal B) Metallic mirror C) Push-pull toy D) Large plastic ball
Metallic mirror
The social development of a 9-month old infant is best promoted by having the infant: A) Play with a large ball with a bell B) Manipulate soft clay C) Pound on a pegboard D) Play peek-a-boo and bye-bye
Play peek-a-boo and bye-bye This is age-appropriate for the toddler,; it promotes gross and fine motor development, not social development. These age-appropriate games help the infant's social development by fostering a sense of object constancy and object permanence.
Before giving a 2-month old child the first DTaP immunization, the nurse discusses with the mother the possible reactions that may occur because these reactions are: A) Sometimes responsible for deep ulceration at the site of injection B) Often serious and may require hospitalization C) Quite common and may be either local or systemic D) Often responsible for permanent neurologic damage
Serious reactions are not common. Mild reactions are redness and induration at the injection site, slight fever, and irritability.
When teaching parents to instill eardrops in an 18-month-old child, the nurse shows them how to: A) Straighten the auditory canal by pulling the pinna down and back B) Apply medicated ear wicks tightly before instilling the ear drops C) Cleanse the ear canal by pulling the pinna up and down D) Straighten the auditory canal by pulling the ear lobe up and back
Straighten the auditory canal by pulling the pinna down and back The canal curves upward in children, and this straightens the canal so that medication will reach the inflamed eardrum.
A clinic nurse prepares to administer an MMR (measles, mumps, rubella) vaccine to a 5-year old child. The nurse administers the vaccine: A) Subcutaneously in the outer aspect of the upper arm B) Subcutaneously in the gluteal muscle C) Intramuscularly in the anterolateral aspect of the thigh D) Intramuscularly in the deltoid muscle
Subcutaneously in the outer aspect of the upper arm MMR is administered subcutaneously in the outer aspect of the upper arm. The gluteal muscle is most often used for intramuscular injections. MMR is not administered by the intramuscular route.
A nurse is assigned to care for an 8-year old child with a diagnosis of a basilar skull fracture. The nurse reviews the physician's orders and contacts the physician to question which order? A) Clear liquid intake only B) Suction prn C) Maintain a patent IV line D) Daily weight
Suction prn he child is either maintained on an NPO status or restricted to clear liquids until it is determined that vomiting will not occur. Nasotracheal suctioning is contraindicated in a child with a basilar skull fracture. Because of the nature of the injury, there is a high risk of secondary infection and the probability of the catheter entering the brain through the fracture.
A child who was found face down in a water-filled ditch is brought to the emergency room. The child, who has a pulse of 50 beats per minute but no spontaneous respirations, is intubated and bagged with 100% oxygen. The most important nursing measure at this time is to: A) Start an intravenous line to provide fluid and electrolytes B) Suction the endotracheal tube, mouth, and nasal passages C) Call the pediatric ICU to inform them of the child's admission D) Assist the physician in delivering intracardiac medications
Suction the endotracheal tube, mouth, and nasal passages An IV can be started later; suctioning to ensure airway patency is the priority. Maintenance of a patent airway is always the priority.
A 3-month old infant has a ventriculoperitoneal shunt inserted. The nurse plans to: A) Observe for signs of leakage of cerebrospinal fluid B) Keep the infant in the prone position C) Apply sterile moist dressings to the incision D) Teach the parents the signs of increased intracranial pressure
Teach the parents the signs of increased intracranial pressure The prone position places too much pressure on the shunt; the infant should be flat and turned on the unoperative side. Dry, sterile dressings are applied to postoperatively to prevent infection.
An emergency room nurse is caring for a child diagnosed with epliglottitis. Assessing the child, the nurse monitors for which indication that the child may be experiencing airway obstruction? A) Nasal flaring and bradycardia B) The child is leaning backward, supporting himself with the hands and arms C) The child is leaning forward with the chin thrust out D) A low-grade fever and complaints of a sore throat
The child is leaning forward with the chin thrust out Clinical manifestations suggestive of airway obstruction include tripod positioning (leaning forward while supported by arms, chin thrust out, mouth open), nasal flaring, tachycardia, a high fever, and a sore throat.
A mother brings her 6-year old child to the clinic because the child has developed a rash on the trunk and on the scalp. The mother reports that the child has had a low-grade temperature, has not felt like eating, and has been generally tired. The child is diagnosed with chickenpox. The mother inquires about the communicable period associated with chikdenpox. A nurse plans to base the response on which of the following? A) The communicable period is unknown B) The communicable period ranges from 2 weeks or less to several months C) The communicable period is 10 days before the onset of symptoms to 15 days after the rash appears D) The communicable period is 1 to 2 days before the onset of the rash to 6 days after the first crop of vessicles, when the crusts have formed
The communicable period is 1 to 2 days before the onset of the rash to 6 days after the first crop of vessicles, when the crusts have formed In roseola, the communicable period is unknown. The communicable period for chicken pox is 1 to 2 days before the onset of the rash to 6 days after the first crop of vessicles, when crusts have formed.
Penicillin V, 250 mg po every 8 hours, is prescribed for a child with a respiratory infection. The child's weight is 45 pounds. The safe pediatric dosage is 25 ot 50 mg/kg/day. The nurse determines that: A) The dose is too low B) The dose is too high C) The dose is within the safe dosage range D) There is not enough information to determine the safe dose
The dose is within the safe dosage range
The abnormal finding that a nurse would expect to observe during an assessment of a 1-month old infant admitted to the hospital with hydrocephalus would be that: A) The infant demonstrates poor eye muscle coordination B) The infant's head circumference is larger than the chest circumference C) The infant is unable to support the head and shoulders while prone D) The infant's anterior fontanel is tense on palpation
The infant's anterior fontanel is tense on palpation This sign is indicative of increased intracranial pressure, which is caused by the fluid accumulation associated with hydrocephalus. This is a normal finding; the head is the largest part of the body at this age.
The parents of a 2-year old arrive at a hospital to visit their child. The child is in the playroom when the parents arrive. When the parents enter the playroom, the child does not readily approach the parents. The nurse interprets this behavior as indicating that: A) The child is withdrawn B) The child is self-centered C) The child has adjusted to the hospitalized setting D) This is a normal pattern
This is a normal pattern The phases through which young children progress when separated from parents include protest, despair, and denial or detachment. In the stage of despair, the child may not readily approach them, or may cling to a parent. In denial or detachment, when the parents return, the child becomes cheerful, interested int eh environment and new persons (seemingly unaware of the lost parents), friendly with the staff, and interested in developing superficial relationships. Options 1, 2, and 3 are incorrect interpretations of the child's behavior.
