PEDS Final

18. A child receives a prescription for amantadine 42 mg PO BID. Amantadine is available as a 50 mg/5 mL syrup. Using a supplied calibrated measuring device, how many mL should the nurse administer per dose? (round to nearest tenth)

0.5 mL

17. A child who weights 25 kg is receiving IV ampicillin 300 mg/kg/24 hours in equally divided doses every 4 hours. How many mg should the nurse administer to the child for each dose?

1875mg

4. A child admitted with diabetic ketoacidosis is demonstrating Kussmaul respirations. The nurse determines that the increased respiratory rate is a compensatory mechanism for which acid base alteration? A. Metabolic alkalosis. B. Respiratory acidosis. C. Respiratory alkalosis. D. Metabolic acidosis.

D. Metabolic acidosis.

31. a two year old boy begins to cry when the mother starts to leave. What is the nurse's best response in this situation? a. Let me read this book to you b. Two years old usually stop crying the minute the parent leaves c. Now be a big boy. Mommy will be back soon d. Let's wave bye-bye to mommy

a. Let me read this book to you

29. The nurse is assessing an infant with pyloric stenosis. Which pathophysiological mechanism is the most likely consequence of this infant's clinical picture? a. Metabolic alkalosis b. Respiratory acidosis c. Metabolic acidosis d. Respiratory Alkalosis

a. Metabolic alkalosis

A toddler with hemophilia is being discharged from the hospital. Which teaching should the RN include in the discharge instructions to the mother? A. Apply padding on the sharp corners of the furniture. B. Prevent the client from running inside the house. C. Give an 81 mg tablet of aspirin for pain relief. D. Use a soft bristle toothbrush from frequent cleaning.

A. Apply padding on the sharp corners of the furniture.

A burned child is brought to the emergency department, and the nurse uses a modified rule of nines to estimate the percentage of the body burned. When calculating the percentage of burn, which parts of the child's body are proportionally larger than an adults? A. Head and neck B. Arms and chest C. Legs and abdomen D. Back and abdomen

A. Head and neck

35. The nurse plans to administer 10 mcg/kg of digoxin elixir as a loading dose to a child who weights 55 pounds. Digoxin is available as elixir of 50 mcg/ml. How many ml of the digoxin elixir should the nurse administer to this child?

5 ml

A male child is being prepared for a computed tomography scan when he begins to have a tonic clonic seizure. His mother is hysterical and is trying to hold the child down. What actions should the nurse take? (SATA) A. Adminiter an anticonvulsant medication B. Place pillows inside the side rails C. Ask the mother to release the child D. Close blinds room so is darkened E. Monitor the Childs airway and tongue

A. Adminiter an anticonvulsant medication B. Place pillows inside the side rails C. Ask the mother to release the child E. Monitor the Childs airway and tongue

A school age child is brought to the Emergency center with fever and joint pain and is diagnosed with rheumatic fever. Which explanation should the nurse provide to the parents regarding the cause of this condition? A. A previous bacterial infection causes a chronic condition that affects the heart valves B. An infection in the mitral valve results in a systemic infection that affects the heart valves C. The valves in the heart develop lesions that cause inflammation and scarring D. Scar tissue causes the leaflets in the heart valves to become rigid and closed

A. A previous bacterial infection causes a chronic condition that affects the heart valves

A 12 year old boy with leukemia is being discharged from the hospital with a white blood cell count (WBC) count of 4,000 / mm^3. He is scheduled to receive antineoplastic chemotherapy as an outpatient. What instruction should the RN include in this child's discharge plan? A. Avoid eating at buffets, smorgasbords, and salad bars. B. Spend time resting with family pets, but only cats and dogs. C. Swim weekly at the neighborhood pool for neuromuscular integrity. D. Have all visitors wear protective masks when coming to the home.

A. Avoid eating at buffets, smorgasbords, and salad bars. Neutropenia (WBC below 5,000 mm^3) in a pediatric client with leukemia increases the risk of infection, so it is important for the client to avoid large crowds and situations where there is an elevated risk of exposure to infection organisms, such as public eating places (A). This child should also avoid (b AND c. (D) is impractical and expensive; the child needs protection from the visitors, so it is better to have this child wear a mask

A child is admitted to the hospital for confirmation of a diagnosis of acute lymphoblastic leukemia. During the initial nursing assessment, which symptoms will this child most likely exhibit? A. Bone pain, pallor B. Weakness, tremors C. Nystagmus, anorexia D. Fever, abdominal distention

A. Bone pain, pallor

50. Which nursing intervention is most important to assist in detecting hypopituitarism and hyperpituitarism in children A. Carefully recording the height and weight of children to detect inappropriate growth B. Performing head circumference measurements on infants under one year of age C. Assessing for behavioral problems at home and school by interviewing the parents D. Noting a tracked weight gain without a gain in height on a growth chart

A. Carefully recording the height and weight of children to detect inappropriate

A nurse is preparing to end the shift and receives a laboratory report stating that a child with asthma has a theophylline level of 15 mcg/dL. Which action should the nurse take? A. Communicate the result to the oncoming nurse and document. B. Tell the oncoming nurse that the level is dangerously high. C. Ask the laboratory to redo the test because the result is faulty. D. Hold the next dose of theophylline based on this finding.

A. Communicate the result to the oncoming nurse and document.

6. The nurse is evaluating diet teaching for a client who has nontropical sprue (celiac disease). Choosing which food indicates that the teaching has been effective? A. Creamed corn. B. Pancakes. C. Rye crackers. D. Cooked oatmeal.

A. Creamed corn.

23. 2 year old is admitted to the hospital with possible encephalitis, and a lumbar puncture is scheduled. Which information should the nurse provide this child concerning the procedure? A. Describe the side-lying, knees to chest position that must be assumed during the procedure. B. Tell the child to expect loud clicking noises during the procedure that may be slightly annoying. C. Reassure the child that there will be no restrictions on activity after the procedure is completed. D. Explain that fluids cannot be taken for 8 hours before the procedure and for 4 hours after the procedure.

A. Describe the side-lying, knees to chest position that must be assumed during the procedure.

The nurse is caring for a preschool-aged child with a congenital heart defect who is admitted with intermittent low grade fever, fatigue, and weight loss. Further physical assessment findings include a new murmur, splinter hemorrhages under the nails, and painless red lesions on the palms of the hands. Which diagnostic procedure should the nurse prepare the parents to expect the healthcare provider to prescribe. A. Echocardiogram B. Electrocardiogram C. Chest Radiography D. Computerized tomography (CT) scan

A. Echocardiogram

52. The nurse plans to screen only the highest risk children for scoliosis. Which group of children should the nurse screen first A. Girls between ages 10 and 14 B. Boys between ages 10 and 14 C. Boys and girls between 12 and 14 D. Boys and girls between 8 and 12

A. Girls between ages 10 and 14

A female of child bearing age receives a rubella vaccination. She has two children at home, age 13 months and 3 years. Which instruction s most important for the RN to provide to this client? A. Inquire if anyone in the family is allergic for eggs. B. Tell the mother to isolate the children for 3 days. C. Encourage the client to immunize the children. D. Assess the family history for incidence of rubella.

A. Inquire if anyone in the family is allergic for eggs.

9. A mother brings her 3-week old infant to the clinic because the baby vomits after eating and always seems hungry. Further assessment indicates that the infant's vomiting is projectile, and the child seems listless. Which additional assessment finding indicates the possibility of a life threatening complication? A. Irregular palpable pulse B. Hyperactive bowel sounds C. Underweight for age D. Crying without tears

A. Irregular palpable pulse

21. The nurse is evaluating the effects of thyroid therapy used to treat a 5 months old with hypothyroidism. Which behavior indicates that the treatment has been effective? A. Laughs readily, turns from back to side. B. Has strong Moro and tonic neck reflexes. C. Keeps fists clenched, opens hands when grasping an object. D. Can lift head, but not chest when lying on abdomen.

A. Laughs readily, turns from back to side.

What snack is best to provide a 6 year old on prescribed bedrest while receiving treatment for osteomyelitis? A. Milkshakes. B. Soup broth. C. Apple sauce. D. Popsicle.

A. Milkshakes. A young child with osteomyelitis needs high calorie/ high protein snacks to maintain adequate nutrition and promote healing, and a milkshake (A) is the best choice to meet this dietary objective. (B, C, and D) are low in protein and provide minimal calories.

A toddler is hospitalized with Kawasaki's disease. Pharmacological management includes aspirin therapy. What is the benefit of the aspirin? A. Minimize vascular inflammation B. Reduce joint swelling C. Manage irritability D. Control high fever

A. Minimize vascular inflammation

Several children at a day camp return from playing in a tick infested field. What action should the camp nurse take first? A. Observe the children for attached ticks B. Encourage the children to lie down and rest quietly C. Ask the children if they were using tick repellent D. Assess the children for the presence of the bull's eye rash

A. Observe the children for attached ticks

A preschool aged child is experiencing respiratory distress is brought to the emergency department by the parents. The child is anxious, has a temperature of 102.8F (39.3C) and is drooling from the mouth while leaning forward when sitting. Which action should the nurse prepare the child for NEXT? A. Obtain bedside trays for intubation or tracheotomy by the healthcare provider B. Begin prescribed intravenous antibiotic administration C. Provide a nebulizer treatment with bronchodilators D. Schedule the child for a stat magnetic resonance imaging (MRI) of the neck

A. Obtain bedside trays for intubation or tracheotomy by the healthcare provider

16. A child with acute lymphocytic leukemia (ALL) who is receiving chemotherapy via a subclavian IV infusion, has an oral temperature of 103 degrees. In assessing the IV site, the nurse determines that there are no signs of infection at the site. Which intervention is the most important for the nurse to implement? A. Obtain specimen for blood cultures. B. Assess the CBC. C. Monitor the oral temperature every hour. D. Administer acetaminophen as prescribed.

A. Obtain specimen for blood cultures.

A school age male is brought to the school nurse after he was thrown off his bicycle into a pine tree. The child's face and arms are covered inembedded pine bark. He has copious tearing and complains that there is 'stuff in his eyes'. What action should the nurse implement? A. Patch both eyes and send him to the family ophthalmologist B. Instill pain-relieving eye drops into each eye and keep the head elevated C. Use sterile tweezers to lift bark specks from the sclera of the eye D. Encourage the child to blink frequently to increase bilateral tearing of the eyes

A. Patch both eyes and send him to the family ophthalmologist

An 8 year old is admitted to the emergency Department because of lower right quadrant pain, nausea, and vomiting. Which assessment of the abdomen should the RN conduct after all other assessments are complete? A. Percussion. B. Palpation. C. Inspection. D. Auscultation.

A. Percussion.

A 2-year-old child with trisomy 21 (Down syndrome) is brought to the clinic for a routine evaluation. Which assessment finding suggests the presence of a common complication often experienced by those with Down syndrome? A. Presence of systolic murmur B. New onset of patchy alopecia C. Complaints of long bone pain D. Recent projectile vomiting

A. Presence of systolic murmur

53. In assessing a 10 year old newly diagnosed with osteomyelitis, which information is most for the nurse to obtain A. Recent recurrence of infections B. Cultural heritage and belief C. Family history of bone disorder D. Occurrence of increased fluid intake

A. Recent recurrence of infections

A 6 year old male with a body mass index (BMI) in the 95th percentile for gender and age arrives at the clinic after a referral from the school nurse. His laboratory findings include hemoglobin A1c of 5.5% (0.06), blood pressure in the 50th percentile for age, height in the 75th percentile and an LDL cholesterol of 90 mg/dl. (2.33 mmol/L). Which lifestyle modification should the nurse discuss with the parents? A. Recommend increasing daily fruits and vegetables and daily exercise B. Return in one month for another evaluation of serum lipids and blood pressure C. instruct the parents to weigh the child weekly and measure his BP daily D. See a healthcare provider to further assess for diabetes and hypertension

A. Recommend increasing daily fruits and vegetables and daily exercise

The nurse is teaching an adolescent girl with scoliosis about a Milwaukee brace that her health care provider has prescribed. Which instruction should the nurse provide to this client? A. Remove the brace 1 hour each day for bathing only. B. Remove the brace only for back range-of-motion exercises. C. Wear the brace against the bare skin to ensure a good fit. D. Wearing the brace will cure the spinal curvature.

A. Remove the brace 1 hour each day for bathing only.

After receiving a single fluid bolus of 20 mL/kg of NS, a child's heart rate is 140 bpm, blood pressure 70/50, and capillary refill is 6 seconds. The child is anxious and crying. Which intervention should the RN implement first? A. Repeat the NS bolus as prescribed. B. Allow the child to assist with caregiving. C. Recommend age appropriate activities. D. Encourage the caregiver to remain at bedside.

A. Repeat the NS bolus as prescribed.

To take the vital signs of a 4-month-old child, which order will give the most accurate results? A. Respiratory rate, heart rate, then rectal temperature. B. Heart rate, rectal temperature, then respiratory rate. C. Rectal temperature, heart rate, then respiratory rate. D. Rectal temperature, respiratory rate, then heart rate.

A. Respiratory rate, heart rate, then rectal temperature. The respiratory rate should be taken first in infants, since touching them or performing unpleasant procedures usually makes them cry, elevating the heart rate and making respirations difficult to count. Rectal temperature is the most invasive procedure, and is mot likely to precipitate crying, so should be done last.

44. The nurse working on the pediatric unit takes two 8-year old girls to the playroom. Which activity is best for the nurse to plan for these girls? A. Selecting a board game B. Playing Doctor and nurse C. Watching cartoon on TV D. Coloring, cutting and pasting

A. Selecting a board game

A 7-year-old child is admitted to the hospital with a diagnosis of acute rheumatic fever. In obtaining a health history from the child's mother, the recent occurrence of which illness is MOST significant? A. Sore throat B. Chickenpox C. Mumps D. Influenza

A. Sore throat

Which assessment findings should the nurse expect when caring for a child with cystic fibrosis? (Select all that apply.) A. Steatorrhea B. Obesity C. Foul smelling stools D. Delayed growth E. Pulmonary congestion

A. Steatorrhea C. Foul smelling stools D. Delayed growth E. Pulmonary congestion

14. The nurse is assessing an infant with diarrhea and lethargy. Which finding should the nurse identify that is consistent with early dehydration? A. Tachycardia. B. Bradycardia. C. Dry mucous membrane. D. Increased skin turgor.

A. Tachycardia.

A male high school student with Type 1 diabetes tests his blood glucose level before playing a game of soccer, and he obtains a reading of 180 mg/dl. (10mmol/L). Based on this reading, which action should the nurse take? A. Tell him to eat a sandwich and fruit before beginning the game B. Check his urine for ketones C. Give him permission to go ahead and play soccer D. call the healthcare provider

A. Tell him to eat a sandwich and fruit before beginning the game

24. The parents of a 3 y/o boy who has Duchenne muscular dystrophy (DMD) ask "how can our son have this disease? We are wondering if we should have any more children"What information should the nurse provide these parents? A. This is an inherited X-linked recessive disorder, which primarly affects male children in the family B. The male infant had a viral infectrion that went unnoticed and iuntreated, so mucle damage was incurred C. The XXXX muscle groups of males can be impacted by a lack of the protein dystrophyn in the mother D. Birth trauma with a breech vaginal birth causes damage to the spinal cord, thus weakening the muscles

A. This is an inherited X-linked recessive disorder, which primarly affects male

46. How should the nurse instruct the parents of a 4 month old with seborrheic dermatitis (cradle cap) to shampoo the child's hair? A. Use a soft brush and gently scrub the area B. Avoid scrubbing the scalp until the scales disappear C. Avoid washing the child's hair more than once a week D. Use soap and water and avoid shampoos

A. Use a soft brush and gently scrub the area

54. A 3 year old boy in a daycare facility scratches his head frequently and the nurse confirms the presence if head lice. The nurse washes the child's hair with permethrin (Nix) shampoo and call his parents. What instructions should the nurse provide to the parents about treatment of head lice? A. Wash the child's bed linens and clothing In hot soapy water B. Dispose of the child's brushes, comb's and other hair accessories C. Rewash the child's hair following a 24 hour isolation period D. Take the child to a hair salon for a shampoo and shorter haircut

A. Wash the child's bed linens and clothing In hot soapy water

The nurse is assessing a 9-year-old boy who has been admitted to the hospital with possible acute poststreptococcal glomerulonephritis (APSGN) In obtaining his history, what information is MOST significant? A. a sore throat last week B. a history of hypertension C. Diuresis during the night D. Back pain for a few days

A. a sore throat last week

How should the RN respond to the concerned parents of a 15 month old who is not yet able to self-feed with a spoon? A. Tell parents to guide the child's hand when using a spoon. B. Suggest using foods that can be eaten with fingers. C. Discuss possible causes for delay with self-feeding. D. Encourage longer mealtimes to practice eating with a spoon.

B. Suggest using foods that can be eaten with fingers.

2. Following a motor vehicle collision, a 3-year old girl has a spica cast applied. Which toy is best for the nurse for this 3 year old child? A. Duck that squeaks. B. Fashion doll and clothes. C. Set of cloth and hand puppets. D. Hand held video game.

C. Set of cloth and hand puppets.

A RN is evaluating a young child with atopic dermatitis. Which question should the RN ask the parent while obtaining the child's history? A. "Does the child have any nausea or vomiting?" B. "Has the child displayed any symptoms of asthma or hay fever?" C. "Can any particular stress be associated with onset of rash?" D. "What time of the day does the rash appear on the body?"

B. "Has the child displayed any symptoms of asthma or hay fever?" Atopic dermatitis is known to be associated with asthma and hay fever (B). There is no significant association between atopic dermatitis and gastrointestinal symptoms (A). There is no evidence that stress can cause atopic dermatitis, although stress is associated with the disease during exacerbations (C). The rash persists over a period of time, and is not associated with diurnal pattern (D).

The RN should instruct the parents of an 8 year old child who has sickle cell anemia to be alert for which complaint from the child? A. "I'm shorter than everyone else." B. "I'm really hot and thirsty." C. "I don't want to eat any vegetables." D. "I have to urinate every few hours."

B. "I'm really hot and thirsty." Parents needs to be alert to situations where dehydration may be a possibility. Symptoms such as decreased urinary output and increased thirst indicate dehydration, which precipitate a sickle cell crisis (B). (A) Is sometimes expected with children with sickle cell anemia, especially if the child experiences many crisis. Many children do not like vegetables (C). Needing to urinate every few hours is not a warning sign for a possible sickle cell crisis (D); in fact, it may indicate adequate hydration.

The RN is performing a routine examination of a 6-month old infant at the community health clinic. Records indicate that the child weighed 3 kg at birth. The clinic uses lbs to describe weight. When assessing this child, approximately what weight, in lbs, should the RNconsider to be within normal range for this child? A. 15 to 18 lbs. B. 12 to 15 lbs. C. 9 to 11.5 lbs. D. 6 to 7.5 lbs.

B. 12 to 15 lbs.

The RN administers digoxin (Lanoxin) to a 9 month old infant with an apical heart rate of 160 bpm. Which apical pulse rate indicates that the therapeutic effect of the medication has been achieved? A. 180 bpm. B. 120 bpm. C. 80 bpm. D. 60 bpm.

B. 120 bpm.

A female infant recently admitted with vomiting and diarrhea now weighs 10 kg. Her weigh at a previous well-baby visit was 11 kg. What is the percentage of body weight loss for this infant? A. 4 B. 9 C. 10 D. 5

B. 9

41. An adolescent who is taking antiretroviral therapy for HIV infection arrives at the clinic for a follow up visit. Which information is most important for the nurse to obtain? a. Missed medication doses b. A 24-hour dietary recall c. Barrier contraceptive use d. Ingestion of illicit drugs

a. Missed medication doses

The nurse is giving an intramuscular injection of an antibiotic to a 16-month-old toddler with pneumonia. The toddler does not have any known allergies and been walking without assistance for one month. Which technique should the nurse select for administration? A. Use a needle length of 1/2 inch (1.25cm) to avoid deep tissue damage B. Administer the injection into the middle of the lateral aspect of the thigh C. Give the arm, one to 2 inches (2.5 to 5.0 cm) below the acromion process D. Divide the gluteal area into quarters and give IM into the upper outer quadrant

B. Administer the injection into the middle of the lateral aspect of the thigh

During routine screening at a school clinic, an otoscope examination of a child's ear reveals a tympanic membrane that is pearly gray, slightly bulging, and not movable. What action should the nurse take next? A. No action required, as this is an expected finding for a school-aged child. B. Ask the child if he/she has had a cold, runny nose, or any ear pain lately. C. Send a note home advising the parents to have the child evaluated by a healthcare provider as soon as possible. D. Call the parents and have them take the child home from school for the rest of the day.

B. Ask the child if he/she has had a cold, runny nose, or any ear pain lately. More information is needed to interpret these findings. The tympanic membrane is normally pearly gray, not bulging, and moves when the client blows against resistance or a small puff of air is blown into the ear canal. Since this child's findings are not completely normal, further assessment of history and related signs and symptoms is indicated for accurate interpretation of the findings. (A), (C), and (D) are inappropriate actions based on the data obtained from the otoscope examination.

The nurse is preparing a teaching plan for the mother of a child who has been diagnosed with celiac disease. Choosing which lunch will be within the therapeutic management of a child with celiac disease? A. Turkey salad, milk, and oatmeal cookies B. Baked chicken, coleslaw, soda, and frozen fruit dessert C. Tuna salad sandwich on whole wheat bread, milk, and ice cream D. Turkey sandwich on rye bread, orange juice, and fresh fruit E. A child with celiac disease is managed on a gluten-free diet, which eliminates food products containing oats, wheat, rye, or barley.

B. Baked chicken, coleslaw, soda, and frozen fruit dessert

The RN of a 6 year old girl is concerned about her child's obesity. The child's weight plots at the 75th percentile, and height at the 25th percentile. The child's body mass index (BMI) is at the 85th percentile for age and gender. Which interventions should the RN implement? (Select All That Apply) A. Explain that the child is likely to grow into her weight. B. Determine the child's usual physical activity pattern. C. Obtain the child's 3- day diet history based on the mothers input. D. Inquire as to whether or not the school has a physical education program. E. Tell the mother that girls hit their growth spurt before boys so eating more is expected.

B. Determine the child's usual physical activity pattern. C. Obtain the child's 3- day diet history based on the mothers input. D. Inquire as to whether or not the school has a physical education program.

41. When screening a 5 year old for strabism, what action should the nurse take A. Have the child identify colored patterns on polychromatic cards B. Direct the child through the six cardinal position of glaze C. Inspect the child for the setting sun sign D. Observe the child for blank, sunken eyes

B. Direct the child through the six cardinal position of glaze

The RN is palpating the lymph nodes of an 18 month old. Which finding should the RN call to the attention of the healthcare provider? A. Small, firm, mobile nodules in the axilla. B. Enlarged, warm, tender, pre-auricular node. C. Enlarged, non-tender, movable occipital node. D. Small, discrete, mobile, non-tender, inguinal node.

B. Enlarged, warm, tender, pre-auricular node.

During the physical exam of an 11 year old girl, the nurse observes budding breasts and scant pubic hair. Which Tanner Stage should the nurse choose when documenting these findings? A. V B. II C. III D. IV

B. II

A 17 year old male student with cystic fibrosis talks with the school RN about his disease and wonders how it will affect getting married and having children. Which relevant information would the RN include in this discussion? A. He should undergo cystic fibrosis screening before having children. B. Impotence is a frequent problem for males with cystic fibrosis. C. If the father is a carrier, 50 % chance of the offspring will have cystic fibrosis. D. He is likely to have infertility problems and needs further evaluation.

B. Impotence is a frequent problem for males with cystic fibrosis.

15. While auscultating the lung sounds of a 5 year old Chinese boy who recently completed antibiotic therapy for pneumonia, the nurse notices symmetrical, round, bruise-like blemishes on his chest. What action is best for the nurse to take? A. Identify the antibiotic used to treat the pneumonia. B. Inquire about the use of alternative methods of treatment. C. Ask the parents if the child has been in a recent accident. D. Report suspected child abuse to the authorities.

B. Inquire about the use of alternative methods of treatment.

While administering the final dose of oral amoxicillin to a preschool aged boy, he tells the nurse that his throat hurts. Which intervention is MOST important for the nurse to implement? A. Document the childs comments B. Inspect the child's oropharynx C. Review the child's history of sore throats D. Assess skin for signs of allergic reaction

B. Inspect the child's oropharynx

During a routine clinic visit, the RN determines the 5 year old girl's systolic blood pressure is greater than the 90th percentile. What action should the RN implement next? A. Take the blood pressure two more times during the visit and determine the average of the three readings. B. Measure the child's blood pressure three times during the visit and determine the highest of the readings. C. Conduct a head to toe assessment and omit repeated blood pressures during the examination. D. Refer the child to the HCP and schedule evaluation of blood pressure in two weeks.

B. Measure the child's blood pressure three times during the visit and determine the highest

A child who has been vomiting for the past 3 days is admitted for correction of fluid and electrolyte imbalances. What acid based imbalance is this child likely to exhibit? A. Respiratory acidosis. B. Metabolic alkalosis. C. Respiratory alkalosis. D. Metabolic acidosis.

B. Metabolic alkalosis.

18. The nurse is caring for an infant scheduled for reduction of intussusceptions. The day before the scheduled procedure the infant passes a soft-formed brown stool. Which intervention should the nurse implement? A. Instruct the parents that the infant needs to be NPO. B. Notify the healthcare provider of the passage of brown stool. C. Obtain a stool specimen for laboratory analysis. D. Ask the parents about recent changes in the infant's diet.

B. Notify the healthcare provider of the passage of brown stool.

A hospitalized child stiffens and starts to seize as the RN enters the room. What actions should the RN take? (Select All That Apply) A. Instruct the parents to leave the room. B. Pad side rails with available pillows and blankets. C. Notify the emergency response team. D. Monitor duration and progress of the seizure. E. Turn client to the side if possible.

B. Pad side rails with available pillows and blankets. D. Monitor duration and progress of the seizure. E. Turn client to the side if possible.

8. The nurse is measuring the frontal occipital circumference (FOC) of a 3-months old infant, and notes that the FOC has increased 5 inches since birth and the child's head appears large in relation to body size. Which action is most important for the nurse to take next? A. Measure the infant's head-to-toe length. B. Palpate the anterior fontanel for tension and bulging. C. Observe the infant for sunken eyes. D. Plot the measurement on the infant's growth chart.

B. Palpate the anterior fontanel for tension and bulging.

When developing a teaching plan for an adolescent male who was recently diagnosed with Type 1 Diabetes Mellitus, the RN should instruct the client to eat a source of sugar if which symptom occurs? A. Excessive thirst. B. Racing pulse. C. Profuse perspiration. D. Seeing spots.

B. Racing pulse.

1. The nurse is caring for a 3-year old child who is 2 hours postop from a cardiac catheterization via the right femoral artery. Which assessment finding is an indication of arterial obstruction? A. Blood pressure trend is downward and pulse is rapid and irregular. B. Right foot is cool to the touch and appears pale and blanched. C. Pulse distal to the femoral artery is weaker on the left foot than right foot. D. The pressure dressing at right femoral area is moist and oozing blood.

B. Right foot is cool to the touch and appears pale and blanched.

An 18-month-old child returns to the unit following a cardiac catheterization with a cannulated femoral artery site. Which intervention should the nurse implement? A. Teach the parents how to ambulate the child in the room safely. B. Show the parents how to hold the child with the extremity extended. C. Restrain the child's lower extremities for a minimum of 4 hours. D. Place the child in a prone position to apply pressure to the site.

B. Show the parents how to hold the child with the extremity extended.

A breast feeding mother returns to work when her infant is 5 months old. She is having difficulty pumping enough milk to mete her infant's dietary requirements. Which suggestion should the RN provide to this mother? A. Mix infants formula with breast milk. B. Supplement with an iron-rich formula. C. Introduce baby food for one meal daily. D. Offer a follow-up transitional formula.

B. Supplement with an iron-rich formula.

10. The nurse is planning for a 5-month old with gastroesophageal reflux disease whose weight has decreased by 3 ounces since the last clinic visit one month ago. To increase caloric intake and decrease vomiting, what instructions should the nurse provide this mother? A. Give small amounts of baby food with each feeding. B. Thicken formula with cereal for each feeding. C. Dilute the childs formula with equal parts of water. D. Offer 10 % dextrose in water between most feedings.

B. Thicken formula with cereal for each feeding.

A 4 year old girl returns to the pediatrician's office for a postoperative visit following hospitalization for minor surgery. When observing the child in the waiting area, which behavior should the nurse consider normal for this age child? A. Ignores other children in the play area B. Draws picture of self with facial features C. "Talks" to an imaginary friend D. Sits quietly in her mother's lap

C. "Talks" to an imaginary friend

A 3-month-old infant weighing 10 lb. 15 oz has an axillary temperature of 98.9° F. What caloric amount does this child need? A. 400 calories/day B. 500 calories/day C. 600 calories/day D. 700 calories/day

C. 600 calories/day An infant requires 108 calories/kg/day. The first step is to change 10 lb. 15 oz to 10.9 lb. Then convert pounds to kilograms by dividing pounds by 2.2, which is 10.9/2.2 = 4.954 kg, rounded to 5 kg.The second step is to multiply 108 calories/kg/day (108 × 5 = 540 calories/day). However, this infant requires 10% more calories because of the 1° F temperature elevation. Ten percent of 540 (calories/day) is 54, and 540 + 54 = 594. This infant will require approximately 600 calories/day. Options A, B, and D are incorrect.

A clinic nurse is assessing infants and toddlers for fine and gross motor development. Which child should the nurse refer to the healthcare provider for further follow up? A. An 18-month-old attempting to scribble on paper B. A 5-month-old with use of hand grasp in both hands C. A 3-year-old preferring to walk only on tip toes D. A 3-year-old with diminished Moro reflex

C. A 3-year-old preferring to walk only on tip toes

Which client requires immediate intervention by the RN? A. A child with cystic fibrosis who is constipated. B. A toddler with chicken pox who is scratching, C. A child with acute renal failure and hyperkalemia. D. An adolescent with a migraine and photophobia.

C. A child with acute renal failure and hyperkalemia.

51. A 7 year old child is admitted to the hospital with acute glomerulonephritis (AGN). When Obtaining the nursing history which finding should the nurse expect to obtain? A. High blood cholesterol level on routine screening B. Increased thirst and urination C. A recent strep throat infection D. A recent DPT immunization

C. A recent strep throat infection

The RN is planning care for a newborn infant scheduled for a cardiac catheterization. Which occurrence poses the greatest risk for this child? A. Loss of pulses proximal to the entry site of the cardiac catheter. B. Allergic response to the plastics in the catheter used for catheterization. C. Acute hemorrhage from the entry site of the catheter after the procedure. D. Fever associated with nausea and vomiting after the procedure.

C. Acute hemorrhage from the entry site of the catheter after the procedure.

48. When assessing the breath sounds of an 18 month old child who is crying, what action should the nurse take? A. Document that the assessment is not available because the child is crying B. Ask the parents to quiet the child so breath sounds can be auscultated C. Allow the child to initially play with stethoscope, and distract during auscultation D. Auscultate and document breath sounds, noting that the child was crying at the time

C. Allow the child to initially play with stethoscope, and distract during auscultation

The nurse is communicating with a 12 year old who is hearing impaired. Which action is best for the nurse to use when attempting to communicate with this child? A. Use a board to communicate needs B. Convey ideas by writing short sentences C. Attract the child's attention before speaking D. Emphasize emotions with facial expressions

C. Attract the child's attention before speaking

A hospitalized adolescent female demands that her mother stay with her. The mother tells the nurse that she cannot understand her daughter acting this way. What response is best for the nurse to provide? A. "Try not to reward her manipulation" B. "It is likely she is regressing to an earlier age" C. "Possibly, she is lonely for her friends" D. "She is probably feeling insecure"

D. "She is probably feeling insecure"

A 3 month old with myelomeningocele and atonic bladder is catheterized every 4 hours to prevent urinary retention. The home health RN notes that the child developed episodes of sneezing, urticaria, watery eyes, and a rash in the diaper area. What action is most important for the RN to take? A. Auscultate the lungs for respiratory pneumonia. B. Draw blood to analyze for streptococcal infection. C. Change to latex free gloves when handling infant. D. Apply zinc oxide to perineum with each diaper change.

C. Change to latex free gloves when handling infant. A rash with urticaria, sneezing, and watery eyes are classic symptoms of an allergic reaction. Latex allergy is a serious threat created by the repeated catheterizations using pre-packaged gloves, so the RN should use latex free gloves (C). The skin rash and urticaria are not typical of (A or B). (D) is ineffective in treating an allergic reaction.

A 3 year old boy was successfully toilet trained prior to his admission to the hospital for injuries sustained from a fall. His parents are very concerned about this regression in toileting. Which information should the RN provide to the parents? A. A retraining program will need to be initiated when the child returns home. B. Diapering will be provided since hospitalization is stressful to preschoolers. C. Children usually resume their toileting behaviors when they leave the hospital. D. A potty chair should be brought from home so he can maintain his toileting skills.

C. Children usually resume their toileting behaviors when they leave the hospital.

When providing care for a child who is in a balanced suspension skeletal traction using a Thomas splint and Pearson attachment to the right femur, which intervention is most important for the RN to implement? A. Assess skin for redness and signs of tissue breakdown. B. Change position every 2 hours. C. Cleanse pin sites as prescribed. D. Monitor peripheral pulses and sensation in the right leg.

C. Cleanse pin sites as prescribed.

During a well child visit for their child, one of the parents who have an autosomal dominant disorder tells the RN, "We don't plan on having any more children, the next child is likely to inherit this disorder." How should the RN respond? A. Explain that the risk of inheriting the disorder decreases by 50% with each child the couple has. B. Encourage the couple to reconsider their decision since the inheritance pattern may be sex linked. C. Confirm that there is a 50% chance of their future child inheriting this disorder. D. Acknowledging that the next child will inherit the disorder since the first child did not.

C. Confirm that there is a 50% chance of their future child inheriting this disorder.

A 12 year old is admitted to the hospital with possible encephalitis, and a lumbar puncture is scheduled. Which information should the RN provide this child concerning the procedure? A. Explain that fluids can't be taken for 8 hours before the procedure and for 4 hours after the procedure. B. Tell the child to expect loud clicking noises during the procedure that may be slightly annoying. C. Describe the side lying, knees to chest position that must be assumed during the procedure. D. Reassure the child that there will be no restrictions on activity after the procedure is completed.

C. Describe the side lying, knees to chest position that must be assumed during the procedure. Lying still on one side with he knees to chest (C) is the position required to conduct a lumbar puncture (LP). Encephalitis is diagnosed with LP and analysis of CSF cultures. Keeping the client NPO is not required prior to an LP, and fluids are encouraged, not restricted (A) following an LP to replace the CSF that was removed. (B) Happens when the MRI is done. Activity is restricted (D) following an LP because the child must lie flat to avoid having a spinal headache.

Which restraint should be used for a toddler after a cleft palate repair? A. Clove hitch. B. Mummy. C. Elbow. D. Jacket.

C. Elbow. Elbow restraints prevent children from bending their arms and bringing their hands to the oral surgical site. A clove hitch restrains the hands, but the child can bend and bring their head to their hands. A mummy restraint is used during procedures. A jacket restraint restrains the body torso and is not appropriate.

25. The nurse finds a 6 month old infant unresponsive and calls for help. After opening the airway and finding the XXXX the infant is still no breathing. Which action should thenurse take? A. Palpate femoral pulse and check for regularity B. Deliver cycles of 30 chest compressions and 2 breaths C. Give two breath that makes the chest rise D. Feel the carotid pulse and check for adequate breathing.

C. Give two breath that makes the chest rise

45. The nurse is developing the plan of care for a hospitalized child with von Willebrand disease. What priority nursing intervention should be included in this child plan of care A. Reduce exposure to infection B. Eliminate contact with cold grafts (crafts? Is not legible) C. Guard against bleeding injuries D. Reduce contact with other children

C. Guard against bleeding injuries

The RN is assessing an 8 month old who has a cough, axillary temperature of 100, and rhinorrhea. What information is most important for the RN to obtain from this child's mother? A. Living conditions. B. Labor and delivery history of the infant. C. Immunization status of the infant. D. Alcohol and drug intake of the mother.

C. Immunization status of the infant. A milder form of pertussis occurs in children who are partially immunized, so immunization status (C) Is important in planning care. In the catarrhal stage, the clinical manifestations resemble upper respiratory infection. Information on (A) is not an immediate concern, but discharge planning should include discussion of family health problems or environmental conditions that could affect the infant. (B and D) are more important in planning the care of a newborn infant, but are not significant for a child 8 months of age.

An infant who has been diagnosed with a tracheoesophageal fistula (TEF). What nursing intervention is indicated for this infant prior to surgical repair? A. Provide frequent sips of liquid. B. Give isotonic enemas as prescribed. C. Maintain nothing by mouth status. D. Prepare the infant for a barium enema.

C. Maintain nothing by mouth status.

The nurse is caring for a child with intussusception who is scheduled for a barium enema prior to a surgical procedure. Which action should the nurse take first? A. Evacuate the bowel of impacted feces B. Administer magnesium sulfate C. Place the child on a clear liquid diet D. Assess the stool for white color

C. Place the child on a clear liquid diet

3. An infant with tetralogy of Fallot becomes acutely cyanotic and hyperpneic. Which action should the nurse implement first? A. Administer morphine sulphate. B. Start IV fluids. C. Place the infant in a knee-chest position. D. Provide 100% oxygen by face mask.

C. Place the infant in a knee-chest position.

43. A child is brought to the clinic complaining of fever and joins pain, and is DX with rheumatic fever. When planning care for this child what is the goal of nursing care? A. Reduce fever B. Maintain fluid and electrolytes C. Prevent cardiac damage D. Maintain join mobility and function

C. Prevent cardiac damage

A HCP prescribes antipyrine and benzocaine (Auralgan Otic), an anesthetic ear drop, for a 2 year old child with otitis media in the right ear. After positioning the child with the affected ear up, what action should the RN take? A. Cleanse the ear canal with saline. B. Put upward traction on the ear lobe. C. Pull pinna of the ear down and back. D. Gently massage in front of ear.

C. Pull pinna of the ear down and back.

The mother of a 14-month-old tells the nurse that she feeds her child nothing but prepared toddler foods and feels they provide the best nutrition for her child, but is concerned about the cost. How should the nurse respond? A. Teach the mother how to develop a budget to allow her to continue to provide the needed prepared toddler foods B. Advise the mother that these foods will only be needed until the growth spurt of the toddler years is complete C. Reassure the mother that beginning to replace prepared foods with table foods can provide the needed nutrients D. Affirm that these prepared foods are the best way to ensure that the toddler gets all the needed nutrients

C. Reassure the mother that beginning to replace prepared foods with table foods can provide the needed nutrients

12. The parents of a newborn infant with hypospadia are concerned about when the surgical correction should occur. What information should the nurse provide? A. Repair should be done by one month to prevent bladder infection. B. To form a proper urethra repair, it should be done after sexual maturity. C. Repairs typically should be done before the child is potty trained. D. Delaying the repair until school age reduces castration fears.

C. Repairs typically should be done before the child is potty trained.

A 7 year old male is referred to the school clinic because he fainted on the playground. His height is 3 feet, 7 inches (107.5 cm), he weighs 55 pounds (25 kilograms), and his body mass index (BMI) is 20.9. Which assessment finding is most important for the RN to address? A. He consumed 2 bottles of water in 30 minutes prior to fainting. B. Since age 3 he has experienced exercise induced asthma. C. Reports drinking 3-4 high calorie, carbonated beverages daily. D. The child's father has a history of fainting when exercising.

C. Reports drinking 3-4 high calorie, carbonated beverages daily.

5. 7 years old is admitted to the hospital with persistent vomiting, and a nasogastric tube attached to low intermittent suction is applied. Which finding is most important for the nurse to report to the healthcare provider? A. Gastric output of 100 mL in the last 8 hours. B. Shift intake of 640 mL IV fluids plus 30 mL PO ice chips. C. Serum potassium of 3.0 mg/dL. D. Serum pH of 7.45.

C. Serum potassium of 3.0 mg/dL.

A breastfeeding infant, screened for congenital hypothyroidism, is found to have low levels of thyroxine (T4) and high levels of thyroid stimulating hormone (TSH). What is the best explanation for this finding? A. High thyroxine levels normally occur in breastfeeding infants B. The thyroid gland does not produce normal levels of thyroxine for several weeks after birth C. The thyroxine level is low because the TSH is high D. The TSH is high because of the low production of T4 by the thyroid

C. The thyroxine level is low because the TSH is high

11. While teaching a parenting class to new parents the nurse describes the needs of infants and toddlers regarding discipline and limit setting. What is the most important reason for implementing such parenting behaviors? A. Children need help in developing social skills. B. This age child fears loss of self control. C. They provide the child with a sense of security. D. Children must to learn to deal with authority.

C. They provide the child with a sense of security.

19. The mother of a 4-month old asks the nurse for advice in preventing diaper rash. What suggestion should the nurse provide? A. At diaper change generously powder the baby's diaper area with talcum powder to promote dryness. B. Wash the diaper area every 2 hours with soap and water to help prevent skin breakdown. C. Use a barrier cream, such as zinc oxide, which does not have to be completely removed with each diaper change. D. Place a cloth diaper inside the disposable diaper for overnight periods when increased wearing time is likely.

C. Use a barrier cream, such as zinc oxide, which does not have to be completely removed with each diaper change.

A 2 year old boy who had hypospadias repair yesterday goes to the hospital playroom with his mother. Which activity should the nurse recommend? A. Peddling a tricycle in the hall B. Riding a rocking horse C. Using a large piece puzzle D. Playing catch ball with others

C. Using a large piece puzzle

A one month old male infant is brought to the clinic by his mother who states that her son has been vomiting forcefully after each meal for the last three days. The infant is afebrile, dehydrated, and pyloric stenosis is suspected. What other findings should the RN identify that are consistent with pyloric stenosis? A. Perianal diaper rash from persistent diarrhea. B. Rooting, hunger, and irritability. C. Bile-stained emesis. D. An olive-shaped mass in the abdominal area.

D. An olive-shaped mass in the abdominal area.

The nurse is giving preoperative instructions to a 14-year-old female client who is scheduled for surgery to correct a spinal curvature. Which statement by the client best demonstrates that learning has taken place? A. "I will read all the literature you gave me before surgery." B. "I have had surgery before when I broke my wrist in a bike accident, so I know what to expect." C. "All the things people have told me will help me take care of my back." D. "I understand that I will be in a body cast and I will show you how you taught me to turn."

D. "I understand that I will be in a body cast and I will show you how you taught me to turn." Outcome of learning is best demonstrated when the client not only verbalizes an understanding, but also can provide a return demonstration. A 14-year old may or may not follow through with reading material and there is no way of measuring that way of learning. Have a previous surgery may help the client understand the surgical process, but wrist surgery is very different from spinal surgery and emergency surgery is different than elective surgery. In (C), the client may be saying what the nurse wants to hear, without expressing any real understanding of what to do after surgery.

A child with hemophilia arrives at the clinic with a swollen knee after falling off a bicycle. What action should the RN implement first? A. Initiate an IV site and begin infusing normal saline. B. Type and cross for possible transfusion. C. Monitor the child's vital signs frequently. D. Apply ice pack and compression dressing to knee.

D. Apply ice pack and compression dressing to knee. Rest, Ice, Compression (D), and elevation are immediate treatments that should be implemented to reduce swelling and bleeding in the joint. Blood loss within the knee is not immediately life threatening, so further assessment is needed to determine if an infusion of normal saline (A), or a blood transfusion (B) are indicated. Baseline vitals should be obtained, but frequent vital signs (C) are not immediately indicated.

When assessing a newborn, the nurse includes which assessment for early signs of congenital hip dysplasia? A. Shortening of the leg on the unaffected side B. Limited adduction of the affected leg C. Depressed dance reflex D. Asymmetry of the gluteal folds

D. Asymmetry of the gluteal folds

22. The HR for a 3 year old with a congenital heart defect has steadily decreased over the last few hours, now it's 76 bpm, the previous reading 4 hours ago was 110 bpm. Which additional finding should be reported immediately to a healthcare provider? A. Oxygen saturation 94%. B. RR of 25 breaths/minute. C. Urine output 20 mL/hr. D. BP 70/40.

D. BP 70/40.

The heart rate of a 3 year old with a congenital heart defect has steadily decreased over the last few hours, and is now at 76 beats/minutes; the previous reading 4 hours ago was 110 beats/minutes. Which additional clinical finding should be reported immediately to the healthcare provider? A. Respiratory rate of 25 bpm. B. Urine output of 20 mL/hr. C. Oxygen saturation of 94%. D. Blood pressure of 70/40

D. Blood pressure of 70/40

Which nursing intervention is most important to assist in detecting hypopituitarism and hyperpituitarism in children? A. Assessing for behavioral problems at home and school by interviewing the parents B. Performing head circumference measurements on infants under one year of age. C. Noting a marked weight gain without a gain in height on a growth chart D. Carefully recording the height and weight of children to detect inappropriate growth rates

D. Carefully recording the height and weight of children to detect inappropriate growth rates

Which toy is most appropriate for a 10-year-old child with rheumatic fever who is on strict bedrest? A. Doctor kit B. Play dough C. Punching bag D. Checkers- easy to keep clean

D. Checkers- easy to keep clean

When administering indomethacin to a premature infant who has patent ductus arteriosus, the nurse should anticipate which outcome? A. Increased respiratory effort B. Increased number of red blood cells C. Decreased urinary output D. Decreased cardiac murmur

D. Decreased cardiac murmur

42. The nurse is assessing a 6 month old infant. Which response requires further evaluation by the nurse? A. Has doubled birth weight B. Turn head to locate sound C. Plays pick a boo D. Demonstrate startle reflex

D. Demonstrate startle reflex

In making the initial assessment of a 2-hour-old infant, which finding should lead the nurse to suspect a congenital heart defect? A. Irregular respirations and heart rate B. Gagging C. Blue hands and feet D. Diminished femoral pulses

D. Diminished femoral pulses

An adolescent with non- Hodgkin's lymphoma (NHL) is complaining of a sore mouth two days after beginning chemotherapy. What activity should the RN implement? A. Encourage large meals during steroid and chemotherapy. B. Provide lemon glycerin swabs and dilute peroxide oral rinses. C. Recommend fluids using citrus juices and drinking with a straw. D. Frequent use of saline oral rinses and a soft sponge toothbrush.

D. Frequent use of saline oral rinses and a soft sponge toothbrush.

A 10 year old girl is diagnosed with inflammatory bowel disease (IBD). Her mother is concerned that she will experience developmental delays as the result of this disorder. How should the RN respond? A. She will only experience developmental delays if weight loss can't be controlled. B. Scheduling a private tutor can help to prevent developmental delays. C. She is at high risk for a number of different problems, including developmental delays. D. Growth failure is a concern, but developmental delays are not likely to occur.

D. Growth failure is a concern, but developmental delays are not likely to occur.

The RN is assessing an infant with aortic stenosis and identifies bilateral fine crackles in both lung fields. Which additional finding should the RN expect to obtain? A. Vigorous feeding and sanitation. B. Hemiplegia. C. Fever. D. Hypotension and tachycardia.

D. Hypotension and tachycardia.

20. Which statement by a school aged client going to summer camp indicates the best understanding of the mode of transmission of Lyme disease? A. I'll cover my mouth with a wet cloth if there's too much dust blowing. B. Cuts and scrapes need to be washed out and covered right away. C. I'm not going to swim where the water is standing still or feels too hot. D. I have to wear long sleeves and pants when we're hiking around the pond.

D. I have to wear long sleeves and pants when we're hiking around the pond.

55. The nurse on a pediatric unit observes a distraught mother in the hallway scolding her 3 year old son for wetting his pants. What initial action should the nurse take? A. Suggest that the mother consult a pediatric nephrologists B. Provide disposable training pants while calming the mother C. Refer the mother to a community parent education program D. Inform the mother that toilet training is slower for boys

D. Inform the mother that toilet training is slower for boys

A 4-year-old child has cystic fibrosis. Which stage of Erikson theory of psychosocial development is the nurse addressing when teaching inhalation therapy? A. Autonomy B. Industry C. Trust D. Initiative

D. Initiative

The RN is evaluating the effects of thyroid therapy used to treat a 5 month old with hypothyroidism. Which behavior indicates that the treatment has been effective? A. Keeps fists clenched, opens hands when grasping an object. B. Has strong Moro and tonic neck reflexes. C. Can lift head, but not chest when lying on abdomen. D. Laughs readily, turns from back to side.

D. Laughs readily, turns from back to side.

13. Which drink choice on a hot day indicates to the nurse that a teenager with sickle cell anemia understands dietary consideration related to the disease? A. Milkshake. B. Iced tea. C. Diet cola. D. Lemonade.

D. Lemonade.

7. During a well-baby check, the nurse hides a block under the baby's blanket, and the baby looks for the block. Which normal growth and development milestone is the baby developing? A. Separation anxiety. B. Associative play. C. Object prehension. D. Object permanence.

D. Object permanence.

What preoperative nursing intervention should be included in the plan of care for an infant with pyloric stenosis? A. Monitor for signs of metabolic acidosis. B. Estimate the quantity of diarrhea stools. C. Place in a supine position after feeding. D. Observe for projectile vomiting.

D. Observe for projectile vomiting. Projectile vomiting which contributes to metabolic alkalosis, is the classic sign of pyloric stenosis. Estimating the quantity of diarrhea stools is not indicated. Placing the child in a supine position is dangerous due to the potential for aspiration with frequent vomiting.

A child with possible Duchenne muscular dystrophy (MD) undergoes an electro-myelogram (EMG). Following the procedure, the child's parents tell the RN that the child is complaining of sore muscles. How should the RN respond? A. Explain that muscle aches and pain are commonly experienced by children with this form of muscular dystrophy. B. Advise the parents that children with chronic diseases may seek attention by reporting pain or other unpleasant symptoms. C. Encourage the parents to monitors the child's body temperature for the next 24 hours and report a rise above 101 degree F. D. Offer reassurance that muscle soreness following this procedure is temporary and does not indicate a problem.

D. Offer reassurance that muscle soreness following this procedure is temporary and does not indicate a problem.

The nurse is measuring the frontal occipital circumference (FOC) of a 3-months old infant, and notes that the FOC has increased 5 inches since birth and the child's head appears large in relation to body size. Which action is most important for the nurse to take next? A. Plot the measurement on the infant's growth chart B. Observe the infant for sunset eyes C. Measure the infant's head to heel length D. Palpate the anterior fontanel for tension and bulging

D. Palpate the anterior fontanel for tension and bulging

The RN is examining an infant for possible cryptorchidism. Which examine technique should be used? A. Place the infant in a side lying position to facilitate the exam. B. Hold the penis and extract the foreskin gently. C. Cleanse the penis with an antiseptic-soaked pad. D. Place the infant in a warm room and use a calm approach.

D. Place the infant in a warm room and use a calm approach.

9. The nurse is preparing a 10 year old with a lacerated forehead for suturing. Both Parents and 12 year old sibling are at the child's bedside. Which instruction best Supports family? A. While waiting for the healthcare provider, only one visitor may stay with the child. B. All of you should leave while the healthcare provider sutures the child's forehead. C. It is best if the sibling goes to the waiting room until the suturing is completed. D. Please decide who will stay when the healthcare provider begins suturing.

D. Please decide who will stay when the healthcare provider begins suturing.

49. The mother of a one month old calls the clinic to report that the back of her infant is flat. How should the nurse respond A. Turn the infant on the left side braced against the crib when sleeping B. Prop the infant in a sitting position with a cushion when no sleeping C. Place a small pillow under the infant's head while lying on the back D. Position the infant on the stomach occasionally when awake and active

D. Position the infant on the stomach occasionally when awake and active

26. A 3 year old with HIV infection is staying with a foster family who is caring for 3 other foster children in their home. When one of the children acquires pertussis, the foster mother calls the clinic and asks the nurse what she should do. Which action should the nurse take first? A. Remove the child who has HIV from the foster home B. Report the exposure of the child with HIV to the health department C. Place the chuld who has HIV in reverse isolation D. Review the immunization documentation of the child who has HIV

D. Review the immunization documentation of the child who has HIV

A child with acute laryngotracheobronchitis (croup) received epinephrine 2 hours ago in the emergency room, and now is being prepared for discharge to go home. The RN should instruct the parents to take which action if the child's uncontrolled coughing reoccurs? A. Call for emergency transportation to the hospital. B. Increase the fluid intake to liquefy the secretions. C. Administer a dose of the prescribed cough medicine. D. Sit with the child in the bathroom with hot steam.

D. Sit with the child in the bathroom with hot steam. Moist, warm air (D) promotes bronchodilation, which helps relieve spasms that cause the coughing. If the symptoms continue or worsen, the child may need to be transported to the hospital (A). Fluids will thin the secretions (B) and cough medicine (C) may decrease cough, but neither of these interventions decrease swelling or dilate the airway to improve breathing.

47. Prior to discharge, the parents of a child with cystic fibrosis are demonstrating chest physiotherapy (CPT) that they will perform for their child at home. Which action requires intervention by the nurse? A. Plan to perform CPT when the child awakens in the morning B. A Copped hand is used when percussing the lung field C. A bronchodilator is administered before starting CPT D. The child is placed in a supine position to begin percussion

D. The child is placed in a supine position to begin percussion

The nurse is caring for a school age child who has laboratory results that reveal the presence of anti-glad in and anti-endomysial immunoglobulin G and immunoglobulin A antibodies. The nurse should identify with the parent and child which food to avoid after discharge to home? A. Swiss cheese B. sweet potatoes C. orange juice D. Wheat bread

D. Wheat bread

21. The nurse is caring for a boy with probable intussusception. He had diarrhea before admission but, while waiting for administration of air pressure to reduce the intussusception, he passes a normal brown stool. Which nursing action is the most appropriate? a. Notify practitioner b. Measure abdominal girth. c. Auscultate for bowel sounds. d. Take vital signs, including blood pressure

a. Notify practitioner

10. The nurse is performing a routine assessment of a 3-year old at a community health center. Which behavior by the child should alert the nurse to request a follow-up for a possible autistic spectrum disorder? a. Performs odd repetitive behaviors b. Shows indifference to verbal stimulation c. Strokes the hair of a hand held doll d. Has a history of temper tantrums

a. Performs odd repetitive behaviors

12. Which is instituted for the therapeutic management of minimal change nephrotic syndrome? a. Corticosteroids b. Antihypertensive agents c. Long-term diuretics d. Increased fluids to promote diuresis

a. Corticosteroids

25. What are the most common signs and symptoms of leukemia related to bone marrow involvement? a. Petechiae, infection, fatigue b. Headache, papilledema, irritability c. Muscle wasting, weight loss, fatigue d. Decreased intracranial pressure, psychosis, confusion

a. Petechiae, infection, fatigue

35. In developing a behavior modification program for an extremely aggressive 10 year old boy, what should the nurse do first? a. Determine what activities, foods, and toys the child enjoys b. Evaluate the child's previous reactions to punishment c. Provide the child with positive feedback d. Encourage other children on the unit to describe the token system

a. Determine what activities, foods, and toys the child enjoys

42. A 5-year-old boy with leukemia is receiving chemotherapy through a peripherally inserted central catheter (PICC). Twenty minutes after the infusion is begun, the child feels dizzy and complains of itching. Which intervention should the nurse implement first? a. Discontinue the medication infusion b. Flush IV line with saline c. Obtain emergency resuscitation equipment d. Measure current blood pressure and pulse

a. Discontinue the medication infusion

7. The nurse determines that an infant admitted for surgical repair of an inguinal hernia voids a urinary stream from the ventral surface of the penis. What action should the nurse take? a. Document the finding b. Palpate scrotum for testicular descent c. Assess for bladder distension d. Auscultate bowel sounds

a. Document the finding

While obtaining the vital signs of a 10 year old who had a tonsillectomy this morning, the nurse observes the child swallowing every 2-3 minutes. Which assessment should the nurse implement? a. Inspect the posterior oropharynx b. Assess for teeth clenching or grinding c. Touch the tonsillar pillars to stimulate the gag reflex d. Ask the child to speak to evaluate change in voice tone

a. Inspect the posterior oropharynx

4. A premature infant with respiratory distress syndrome (RDS) receives artificial surfactant. How does the nurse explain surfactant therapy to the parents? a. "Surfactant improves the ability of your baby's lungs to exchange oxygen and carbon dioxide." b. "The drug keeps your baby from requiring too much sedation." c. "Surfactant is used to reduce episodes of periodic apnea." d. "Your baby needs this medication to fight a possible respiratory tract infection."

a. "Surfactant improves the ability of your baby's lungs to exchange oxygen and carbon dioxide."

15. The nurse is admitting a child with a Wilms tumor. Which is the initial assessment finding associated with this tumor? a. Abdominal swelling b. Weight gain c. Hypotension d. Increased urinary output

a. Abdominal swelling

34. a 6 year old who has asthma is demonstrating a prolonged expiratory phase and wheezing and has a35% of personal best peak expiratory flow rate (PEFR) based on these finding, actions should the nurse take first? a. Administer a prescribed bronchodilator b. Encourage the child to cough and deep breath c. Report findings to the heath care provider d. determine what triggers precipitated this attack

a. Administer a prescribed bronchodilator

46. A mother brings her 2-month old son to the clinic for a well-baby exam. During the assessment the nurse finds that the right testicle is not distended into the scrotum but the left is palpable. Which action should the nurse take? a. Ask if the right testis has been seen in the scrotum before b. Address possible concerns about the child's future fertility c. Schedule an IV pyelogram to validate presence of the testicle d. Prepare to obtain a catheterized urine specimen for culture

a. Ask if the right testis has been seen in the scrotum before

12. A mother brings her 2 year old son to the clinic because he has been crying and pulling on his earlobe for the past 12 hours. The child's oral temperature is 101.2 F. Which intervention should the nurse implement? a. Ask the mother if the child has had a runny nose b. Cleanse purulent exudate from the affected ear canal c. Apply a topical antibiotic to the periauricle area d. Provide parent education to prevent recurrence

a. Ask the mother if the child has had a runny nose

22. A middle school male student was recently diagnosed with attention-deficit hyperactivity disorder (ADHD) and is having trouble with his grades. He is referred to the school nurseby the teacher because he continues to have learning problems. xf school nurse take? a. Ask the parents to have the child seen by a clinical psychologist b. Ask the parents to become involved in helping the child with his homework c. Refer the child to the school counselor for educational testing d. Seek the advice of the school principle regarding the child's learning needs

a. Ask the parents to have the child seen by a clinical psychologist

28. The nurse is implementing care for a school-age child admitted to the pediatric intensive care in diabetic ketoacidosis (DKA). Which prescribed intervention should the nurse implement first? a. Begin 0.9% saline solution intravenously as prescribed. b. Administer regular insulin intravenously as prescribed. c. Place child on a cardiac monitor. d. Place child on a pulse oximetry monitor.

a. Begin 0.9% saline solution intravenously as prescribed.

40. The nurse is caring for a 3-year old child who has been recently diagnosed with cystic fibrosis, which discharge instruction by the nurse is most important to promote pulmonary function? a. Chest physiotherapy should be performed before meals and at bedtime b. Cough suppressants can be used up to four times a day for relief c. Oxygen should be given through a nasal cannula between 4-6 L/min d. Exercise is discouraged in order to preserve pulmonary vital capacity

a. Chest physiotherapy should be performed before meals and at bedtime

23. A child diagnosed with Kawasaki disease is brought to the clinic. The mother reports that her child is irritable, refuses to eat, and has skin peeling on both his hands and feet.Which intervention should the nurse instruct the mother to implement first? a. Place the child in a quiet environment b. Make a list of foods that the child likes c. Encourage the parents to rest when possible d. Apply lotion to hands and feet

a. Place the child in a quiet environment

39. A 9-week-old infant is scheduled for cleft lip repair. Which information is most important for the nurse to convey to the surgeon before transporting the infant to the surgical suite? a. Red blood cell count of 2.3 million/mm3 b. White blood cell count of 10,000/mm3 c. Weight gain of 2 pounds since birth d. Urine specific gravity is 1.011

a. Red blood cell count of 2.3 million/mm3 Normal levels of RBCs at birth range from 5.1 to 5.3 million/mm3 for term newborns and 4.6 to 5.3 million/mm3 for premature neonates.

21. A mother of a 3-year old boy has just given birth to a new baby girl. The little boy asks the nurse, "why is my baby sister eating my mommy's breast?" how should the nurse respond? Select all that apply a. Remind him that his mother breastfed him too b. Clarify that breastfeeding is the mother's choice c. Reassure the older brother that it does not hurt his mother d. Explain that newborns get milk from their mothers in this way e. Suggest that the baby can also drink from a bottle

a. Remind him that his mother breastfed him too c. Reassure the older brother that it does not hurt his mother d. Explain that newborns get milk from their mothers in this way e. Suggest that the baby can also drink from a bottle

7. What is an early sign of congestive heart failure that the nurse should recognize? a. Tachypnea b. Bradycardia c. Inability to sweat d. Increased urinary output

a. Tachypnea

17. A mother brings her school-aged daughter to the pediatric clinic for evaluation of her anti-epileptic medication regimen. What information should the nurse provide to the mother? a. The medication dose will be tapered over a period of 2 weeks when being discontinued b. If seizures return, multiple medications will be prescribed for another 2 years c. A dose of valproic acid (Depakote) should be available in the event of status epilepticus d. Phenytoin (Dilantin) and phenobarbital (Luminal) should be taken for life

a. The medication dose will be tapered over a period of 2 weeks when being discontinued

3. The parents of a 3-year old boy who has Duchenne muscular dystrophy ask, "How can our son have this disease? We are wondering if we should have any more children." What information should the nurse provide to parents? a. This is an inherited X-linked recessive disorder, which primarily affects male children in the family b. The striated muscle groups of males can be impacted by a lack of the protein dystrophin in their mothers c. The male infant had a viral infection that went unnoticed and untreated so muscle damage was incurred d. Birth trauma with a breech vaginal birth causes damage to the spinal cord, thus weakening the muscles

a. This is an inherited X-linked recessive disorder, which primarily affects male children in the family

34. A 10-year-old girl who has had type 1 diabetes mellitus (DM) for the past two years tells the nurse that she would like to use a pump instead of insulin injections to manage her diabetes. Which assessment of the girl is most important for the nurse to obtain? a. Understanding of quality control process used to troubleshoot the pump b. Interpretation of fingerstick glucose levels that influence diet selections c. Knowledge of her glycosylated hemoglobin A1c levels for past year d. Ability to perform the pump for basal insulin with mealtime boluses

a. Understanding of quality control process used to troubleshoot the pump

30. The nurse provides information about the human papilloma virus (HPV) vaccine to the mother of a 14-year-old adolescent who came to the clinic this morning complaining of menstrual cramping. Which explanation should the nurse provide to support administering the HPV vaccine to the adolescent who came to the clinic this morning complaining of menstrual cramping. a. Use of protective barriers during sexual activity prevents most strains of HPV infection b. Most adolescents are not honest about being sexually active c. Not all strains of HPV will be covered if given at a later date d. Immunity must be established to prevent future HPV infection and risk for cervical cancer

a. Use of protective barriers during sexual activity prevents most strains of HPV infection

18. The nurse is caring for a neonate with a suspected tracheoesophageal fistula. Nursing care should include: a. elevating the head but give nothing by mouth. b. elevating the head for feedings. c. feeding glucose water only. d. avoiding suctioning unless infant is cyanotic.

a. elevating the head but give nothing by mouth.

4. A 2-week-old female infant is hospitalized for the surgical repair of an umbilical hernia. After returning to the postoperative neonatal unit, her RR and HR have increased during the last hour. Which intervention should the nurse implement? a. Notify the HCP of these findings b. Administer a PRN analgesic prescription c. Record the findings in the child's record d. Wrap the infant tightly and rock in rocking chair

b. Administer a PRN analgesic prescription

32. A two year old child with a heart failure (HF) is admitted for replacement of a graft for coarctation of the aorta. Prior to administering the next dose of digoxin (Lanoxin) the nurse obtains an apical heart rate of 128 bpm. What action should the nurse implement? a. Determine the pulse deficit b. Administer the scheduled dose c. calculate the safe dose range d. review the serum digoxin level

b. Administer the scheduled dose

33. A child with leukemia is admitted for Chemotherapy and the nursing diagnosis "altered nutrition, less those body requirements related to anorexia, nausea and vomiting" is identified. Which intervention the nurse included in this child plan of care? a. Encourage a variety of large portions of food at every meal b. Allow the child to eat any food desired and tolerated c. Recommended eating the food as sibling eat at home d. Restrict food brought form fast food restaurants

b. Allow the child to eat any food desired and tolerated

13. During a follow up clinical visit a mother tells the nurse that her 5 month old son who had surgical correction for tetralogy of fallot has rapid breathing, often takes a long time to eat, and requires frequent rest periods. The infant is not crying while being held and his growth is in the expected range. Which intervention should the nurse implement? a. Stimulate the infant to cry to produce cyanosis b. Auscultate heart and lungs while infant is held c. Evaluate infant for failure to thrive d. Obtain a 12-lead electrocardiogram

b. Auscultate heart and lungs while infant is held Complications following repair of TOF include rhythm disturbance and low cardiac output due to right ventricular outflow obstruction, which contributes to right-sided heart failure. A focused assessment should be conducted, including auscultating heart and lung sounds while the infant is quiet (B), to identify findings that might be contributing to the infants fatigue and tachypnea. Stimulating the infant is unnecessary (A). (C) Is not indicated. (D) Should be obtained after auscultations.

9. A diagnosis of rheumatic fever is being ruled out for a child. Which lab test(s) is/are the most reliable? (Select all that apply.) a. Throat culture b. C-reactive protein (CRP) c. Antistreptolysin-O titer (ASO) titer d. Elevated white blood count (WBC) e. Erythrocyte sedimentation rate (ESR)

b. C-reactive protein (CRP) c. Antistreptolysin-O titer (ASO) titer e. Erythrocyte sedimentation rate (ESR)

38. A 3 year-old boy is receiving a weekly chemotherapy treatment. Which toy is best for the nurse to provide for this child? a. Bouncy ball b. Coloring book with crayons c. Duck that squeaks d. Remote-controlled care

b. Coloring book with crayons

33. A child with Grave's disease who is taking propranolol (Inderal) is seen in the clinic. The nurse should monitor the child for which therapeutic response? a. Increased weight gain b. Decreased heart rate c. Reduce headaches d. Diminished fatigue

b. Decreased heart rate

20. An 8-year-old male client with nephrotic syndrome is receiving salt-poor human albumin IV. Which findings indicate to the nurse that the child is manifesting a therapeutic response? a. Decreased urinary output b. Decreased periorbital edema c. Increased periods of rest d. Weight gain 0.5 kg/day

b. Decreased periorbital edema

5. A 2-year-old girl is brought to the clinic by her 17 year old mother. When the nurse observes that the child is drinking sweetened soda from her bottle, what information should the nurse discuss with this mother? a. A 2-year old should be speaking in 2 word phrases b. Dental caries are associated with drinking soda c. Drinking soda is related to childhood obesity d. Toddlers should be sleeping 10 hours a night e. Toddlers should be drinking from a cup by age 2

b. Dental caries are associated with drinking soda c. Drinking soda is related to childhood obesity e. Toddlers should be drinking from a cup by age 2

38. During a well baby visit the parents explain that a soft bulge appears in the groin of their 4 month old son when he cries or strain stooling. The infant is schedule for surgical repair of the inguinal; hernia in two weeks. The parent should be instructed to take which measure if the hernia becomes incarcerated prior to the surgery? a. Use rectal thermometer for straining on stool b. Gently manipulate the hernia for reduction c. Offer oral electrolyte fluids for comfort d. Give acetaminophen or aspirin for crying

b. Gently manipulate the hernia for reduction

13. The nurse closely monitors the temperature of a child with minimal change nephrotic syndrome. The purpose of this assessment is to detect an early sign of which possible complication? a. Infection b. Hypertension c. Encephalopathy d. Edema

b. Hypertension

24. The nurse is preparing a teaching plan for the parents of a 6 month-old infant with GERD. What instruction should the nurse include when teaching the parents measures to promote adequate nutrition? a. Alternate glucose water with formula b. Mix the formula with rice cereal c. Add multivitamins with iron to the formula d. Use water to dilute the formula

b. Mix the formula with rice cereal

39. A 16 year old male client who has been treated in the past for a seizure disorder is admitted to the hospital. Immediately after admission he begins to have a grand mal seizure. Which action should the nurse take? a. Obtain assistance in holding him to prevent injury b. Observe him carefully c. Call a CODE d. Place a padded tongue blade between the teeth

b. Observe him carefully

15. The mother of a 4-month-old baby girl asks the nurse when she should introduce solid foods to her infant. The mother states, "My mother says I should put rice cereal in the baby's bottle now." The nurse should instruct the mother to introduce solid foods when her child exhibits which behavior? a. Stops rooting when hungry b. Opens mouth when food comes her way c. Awakens once for nighttime feedings d. Gives up a bottle for a cup

b. Opens mouth when food comes her way

32. The parents of 15-month old boy tell the nurse that they are concerned because their son brings his spoon to his mouth but does not turn it over. What action should the nurse implement first? a. Discuss referral to an occupational therapist b. Question the parents about their concern c. Tell the parents to hold the spoon correctly in the child's hand d. Suggest longer mealtimes so the child can finish eating

b. Question the parents about their concern

36. In assessing a 10-year old newly diagnosed with osteomyelitis, which information s most important for the nurse to obtain? a. Family history of bone disorders b. Recent occurrence of infection c. Cultural heritage and beliefs d. Occurrence of increased fluid intake

b. Recent occurrence of infection

10. The nurse is teaching parents about prevention of urinary tract infections in children. Which factor predisposes the urinary tract to infection? a. Increased fluid intake b. Short urethra in young girls c. Prostatic secretions in males d. Frequent emptying of the bladder

b. Short urethra in young girls

37. A 6-year-old child is diagnosed with rheumatic fever and demonstrates associated chorea (sudden aimless movements of the arms and legs). Which information should the nurse provide to the parents? a. Permanent life style changes need to be made to promote safety in the home b. The chorea or movements are temporary and will eventually disappear c. Muscle tension is decreased with fine motor project skills, so these activities should be encouraged d. Consistent discipline is needed to help the child control the movements

b. The chorea or movements are temporary and will eventually disappear

26. The nurse is conducting an admission assessment of an 11-month old infant with CHF who is scheduled for repair of restenosis of coarction of the aorta hat was repaired 4 days after birth. Findings include blood pressure higher in the arms than the lower extremities, pounding brachial pulses, and slightly palpable femoral pulses. What pathophysiologic mechanisms support these findings? a. The aortic semilunar valve obstructs blood flow into the systemic circulation b. The lumen of the aorta reduces the volume of the blood flow to the lower extremities c. The pulmonic valve prevents adequate blood volume into the pulmonary circulation d. An opening in the atrial septum causes a murmur due to a turbulent left to right shunt

b. The lumen of the aorta reduces the volume of the blood flow to the lower extremities

45. When assessing a 5-year-old, which ability should the nurse expect the child to be developing at this age? a. Learning to ride a tricycle b. Tying shoelaces c. Buttoning clothes d. Cutting with scissors

b. Tying shoelaces

2. A child is admitted with extensive burns. The nurse notes that there are burns on the child's lips and singed nasal hairs. The nurse should suspect that the child has a(n): a. chemical burn b. inhalation injury. c. electrical burn. d. hot-water scald.

b. inhalation injury.

16. A 6-year-old boy with bronchial asthma takes the beta-adrenergic agonist agent albuterol (Proventil). The child's mother tells the nurse that she uses this medication to open herson's airway when he is having trouble breathing. What is the nurse's best response? a. Recommend that the mother bring the child in for immediate evaluation b. Advise the mother that over-use of the drug may cause chronic bronchitis c. Assure the mother that she is using the medication correctly d. Confirm that the medication helps to reduce airway inflammation

c. Assure the mother that she is using the medication correctly

11. Following admission for cardiac catheterization, the nurse is providing discharge teaching to the parents of a 2-year-old toddler with Tetralogy of Fallot. What instruction should the nurse give the parents if their child becomes pale, cool, lethargic? a. Encourage oral electrolyte solution intake b. Assess the child to a recumbent position c. Contact their HCP immediately d. Provide a quiet time by holding or rocking the toddler

c. Contact their HCP immediately

8. What is an important nursing responsibility when a dysrhythmia is suspected? a. Order an immediate electrocardiogram. b. Count the radial pulse every 1 minute for five times. c. Count the apical pulse for 1 full minute, and compare the rate with the radial pulse rate d. Have someone else take the radial pulse simultaneously with the apical pulse.

c. Count the apical pulse for 1 full minute, and compare the rate with the radial pulse rate

1. Which best describes a full-thickness (third-degree) burn? a. Erythema and pain b. Skin showing erythema followed by blister formation c. Destruction of all layers of skin evident with extension into subcutaneous tissue d. Destruction injury involving underlying structures such as muscle, fascia, and bone

c. Destruction of all layers of skin evident with extension into subcutaneous tissue

23. The school nurse is caring for a boy with hemophilia who fell on his arm during recess. What supportive measures should the nurse use until factor replacement therapy can be instituted? a. Apply warm, moist compresses. b. Apply pressure for at least 1 minute. c. Elevate the area above the level of the heart. d. Begin passive range-of-motion unless the pain is severe.

c. Elevate the area above the level of the heart.

27. The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. Which should the nurse explain about exercise in type 1 diabetes? a. Exercise will increase blood glucose. b. Exercise should be restricted. c. Extra snacks are needed before exercise. d. Extra insulin is required during exercise.

c. Extra snacks are needed before exercise.

14. Which is the most appropriate nursing diagnosis for the child with acute glomerulonephritis? a. Risk for Injury related to malignant process and treatment b. Fluid Volume Deficit related to excessive losses c. Fluid Volume Excess related to decreased plasma filtration d. Fluid Volume Excess related to fluid accumulation in tissues and third spaces

c. Fluid Volume Excess related to decreased plasma filtration

8. A 16 year old with acute myelocytic leukemia is receiving chemotherapy (CT) via an implanted medication port at the out-patient oncology clinic. What action should the nurse implement when the infusion is complete? a. Administer Zofran b. Obtain blood samples for RBCs, WBCs, and platelets c. Flush mediport w/ saline and heparin solution d. Initiate an infusion of normal saline

c. Flush mediport w/ saline and heparin solution

50. While auscultating the lung sounds of a 5 year-old Chinese boy who recently completed antibiotic therapy for pneumonia, the nurse notices symmetrical, round, bruise-like blemishes on his chest. Which action is best for the nurse to take? a. Identify the antibiotic used to treat the pneumonia b. Report suspected child abuse to the proper authorities c. Inquire about the use of alternative methods of treatment d. Ask the parents if the child has been in a recent accident

c. Inquire about the use of alternative methods of treatment

43. A nurse is teaching a class for mothers of premature infants, and is asked about "a shot for respiratory virus." What information about plaibizumab (Synagis) is correct? a. It is required immunization for all infants under the age of 3 months b. It must be repeated every two months to be effective c. It is recommended for infants who meet established high-risk criteria d. It provides protection for one year with a single injection

c. It is recommended for infants who meet established high-risk criteria

52. A male infant with bronchiolitis is brought to the clinic by his mother. The infant is congested and febrile with a capillary refill of 2 seconds. Which information should the nurse discuss with the mother? a. Encourage infant to play b. Limit the amount of oral intake c. Keep infant isolated from others d. Lay infant on back for naps

c. Keep infant isolated from others

A mother brings her 8 mo. old baby boy to clinic because he has been vomiting and had diarrhea for last 3 days. Which assessment is most important for nurse to make? a. Assess infant abdomen for tenderness b. Determine if the infant was exposed to a virus c. Measure the infant's pulse d. Evaluate the infant's cry

c. Measure the infant's pulse

25. A child with pertussis is receiving azithromycin (Zithromax Injection) IV. Which intervention is most important for the nurse to include in the child's plan of care? a. Obtain vital signs at onset of fluid overload b. Change IV site dressing q3 days and PRN c. Monitor for signs of facial swelling or urticartia d. Assess for abdominal pain and vomiting

c. Monitor for signs of facial swelling or urticartia

19. Which observation made of the exposed abdomen is most indicative of pyloric stenosis? a. Abdominal rigidity b. Substernal retraction c. Palpable olive-like mass d. Marked distention of lower abdomen

c. Palpable olive-like mass

28. The nurse is assessing a child for neurological soft signs, which finding is most likely demonstrated in the child's behavior? a. Inability to move tongue in a direction b. Presence of vertigo c. Poor coordination and sense of position d. Loss of visual acuity

c. Poor coordination and sense of position

6. A mother brings her 3 month old infant to the clinic because the baby does not sleep through the night. Which finding is most significant in planning care for this family? a. The mother is a single parent and lives with her parents b. The mother states the baby is irritable during feedings c. The infant's formula has been changed twice d. The diaper area shows severe skin breakdown

d. The diaper area shows severe skin breakdown

3. A child has been admitted to the pediatric unit with a severe asthma attack. What types of acid base imbalance should the nurse expect the child to develop? a. Metabolic alkalosis caused by excessive production of acid metabolites b. Respiratory alkalosis caused by accelerated respirations and loss of carbon dioxide c. Respiratory acidosis caused by impaired respirations and increased formation of carbonic acid d. Metabolic acidosis caused by the kidneys' inability to compensate for increased carbonic acid formation

c. Respiratory acidosis caused by impaired respirations and increased formation of

27. A child who is admitted to the hospital with anemia is anxious, fearful, and hyperventilating. The nurse anticipates the child developing which acid base imbalance? a. Metabolic acidosis b. Respiratory acidosis c. Respiratory alkalosis d. Metabolic alkalosis

c. Respiratory alkalosis

20. The nurse is caring for an infant with suspected pyloric stenosis. Which clinical manifestation would indicate pyloric stenosis? a. Abdominal rigidity and pain on palpation b. Rounded abdomen and hypoactive bowel sounds c. Visible peristalsis and weight loss d. Distention of lower abdomen and constipation

c. Visible peristalsis and weight loss

24. A child with sickle cell anemia develops severe chest pain, fever, a cough, and dyspnea. The nurse's first action is to: a. administer 100% oxygen to relieve hypoxia. b. administer pain medication to relieve symptoms. c. notify practitioner because chest syndrome is suspected d. notify practitioner because child may be having a stroke.

c. notify practitioner because chest syndrome is suspected

16. The nurse notes that a child has lost 8 pounds after 4 days of hospitalization for acute glomerulonephritis. This is most likely the result of: a. poor appetite. b. increased potassium intake. c. reduction of edema d. restriction to bed rest.

c. reduction of edema

37. Which nursing intervention is most important to include in the plan of care for a child with acute glomerulonephritis A. encourage fluid intake b. promote complete bed rest c. weight the child daily d. administer vitamin supplements

c. weight the child daily

29. The mother of a 14-year old who had a below-the-knee amputation for osteosarcoma tells the nurse that her child is angry and blaming her for allowing the amputation to occur.Which response is best for the nurse to provide? a. "I will ask the HCP for a psychiatric consult for your child" b. "This type of acting out behavior is normal for adolescents" c. "It is important to focus on your child's needs at this difficult time" d. "A reaction of anger is your child's attempt to cope with this loss"

d. "A reaction of anger is your child's attempt to cope with this loss"

11. The nurse is admitting a newborn with hypospadias to the nursery. The nurse expects which finding in this newborn? a. Absence of a urethral opening is noted. b. Penis appears shorter than usual for age c. The urethral opening is along the dorsal surface of the penis. d. The urethral opening is along the ventral surface of the penis.

d. The urethral opening is along the ventral surface of the penis.

48. An 8-year-old girl with precocious sexual development is being treated medically with injections of luteinizing hormone-releasing hormone (LRHR) to regulate the pituitary gland. Which statement by the parents indicates that they understand the treatment? a. "We should be sure to start our daughter on birth control pills" b. "Our daughter will be on this hormone treatment the rest of her life" c. "We should encourage her to dress in clothing that suits her sexual maturity level" d. "Sexual maturity differences between my daughter and her peers will disappear within a few years"

d. "Sexual maturity differences between my daughter and her peers will disappear within a few years"

During a routine physical exam, a male adolescent client tells the nurse, "sometimes, my mother gets angry because I want to be with my own friends." What is the best initial response by the nurse? b. Offer reassurance that his mother's concern is normal c. Determine is his friends are engaged in unsafe behaviors d. Ask about the client's response to his mother's anger e. Offer to discuss his concerns together with his mother

d. Ask about the client's response to his mother's anger

40. The mother of a 9 month old who was diagnosed with respiratory syncytial virus yesterday calls the clinic to inquire if it will be all right to take her infant to the first b-day party of a friend's child the following day. What response should the nurse provide this mother? a. The child will not longer be contagious, no need to take any further precaution b. Make sure there are not children under the age of 6 months around the infected child c. The child can be around other children but should wear mask at all times d. Do not expose other children to RSV. It is very contagious even without direct contact

d. Do not expose other children to RSV. It is very contagious even without direct contact

1. An adolescent's mother calls the primary HCP's office to inquire about the results of her daughter's serum test results that were drawn last week. Since it is the teenager's 18th birthday, how should the nurse respond to this mother's inquiry? a. Ask when the adolescent was last seen in the clinic b. Tell the mother to have the teenager call the clinic c. Since the serum samples were drawn last week provide the mother with the findings d. Explain that the information cannot be released without the 18-year olds permission

d. Explain that the information cannot be released without the 18-year olds permission

19. A male toddler is brought to the emergency center approximately three hours after swallowing tablets from his grandmother's bottle of digoxin (Lanoxin). What prescription should the nurse implement first? a. Administer activated charcoal b. Prepare gastric lavage c. Obtain a 12-lead electrocardiogram d. Give IV digoxin immune fab (Digibind)

d. Give IV digoxin immune fab (Digibind)

36. the nurse observes a mother giving her 11 month-old ferrous sulfate, followed by two ounces of orange juice. What should the nurse do next? a. suggest placing the iron drops in the orange juice and feed the infant b. Tell the mother to follow the iron drops with formula instead of orange juice c. instruct the mother to feed the infant nothing in the next 30 minutes after the iron d. Give positive feedback about the way she administered the sulfate

d. Give positive feedback about the way she administered the sulfate

14. The mother of an 11-year old boy who has juvenile arthritis tells the nurse, "I really don't want my son to become dependent on pain medication, so I only allow him to take itwhen he is really hurting." Which information is most important for the nurse to provide this mother? a. The child should be encouraged to rest when he experiences pain b. Encourage quiet activities such as watching television as a pain distracter c. The use of hot baths can be used as an alternative for pain medication d. Giving pain medication around the clock helps control the pain

d. Giving pain medication around the clock helps control the pain

27. . A 16 y/o female student with a history of asthma controlled with both an oral antihistamine and an albuterol (Provenfil) metere-dose inhaler (MDI) comes to the school nurse. The student complains that she cannot sleep at night, feels shaky and herheart feels like it is "beating a mile per minute" Which information is most important for the nurse to obtain? a. When she last took the antihistamine b. When her last Asthma attack occurred c. Duration of most asthmas attacks d. How often the MDI is used daily

d. How often the MDI is used daily

28. The mother of a toddler reports to the nurse working in the pediatric clinic that her child has had a fever and sore throat for the past two days. The nurse observes several swollen red spots in the child's body, a few of which are fluid filled blisters. Which action shouldthe nurse implement? a. Obtain fluid culture from blisters b. Administer a fever reducing salicylate c. Cover drainage vesicles with a dressing d. Implement transmission precautions

d. Implement transmission precautions

51. Which instructions should the nurse include in the discharge teaching plan of 7 year old girl with history of frequent urinary tract infections? a. Take frequent bubble baths b. Perform intermittent catheterization c. Check oral temperature daily d. Monitor for changes in urinary odor

d. Monitor for changes in urinary odor

26. Type 1 diabetes mellitus is suspected in an adolescent. Which clinical manifestation may be present? a. Moist skin b. Weight gain c. Fluid overload d. Poor wound healing

d. Poor wound healing

22. A nurse is planning preoperative care for a newborn with tracheoesophageal fistula (TEF). Which interventions should the nurse plan to implement? (Select all that apply.) a. Positioning with head elevated on a 30-degree plane b. Feedings through a gastrostomy tube c. Nasogastric tube to continuous low wall suction d. Suctioning with a Replogle tube passed orally to the end of the pouch e. Gastrostomy tube to gravity drainage

d. Suctioning with a Replogle tube passed orally to the end of the pouch e. Gastrostomy tube to gravity drainage

17. Which therapeutic management treatment is implemented for children with Hirschsprung disease? a. Daily enemas b. Low-fiber diet c. Permanent colostomy d. Surgical removal of affected section of bowel

d. Surgical removal of affected section of bowel

30. A 4 month-old girl is brought to the clinic by her mother because she has had a cold for 2 o 3 days and woke up this morning with a hacking cough and difficulty breathing.Which additional assessment finding should alert the nurse that the child is in acute respiratory distress? a. Bilateral bronchial breath sounds b. Diaphragmatic respiration c. A resting respiratory rate of 35 breathe per minute d. flaring of the nares

d. flaring of the nares

6. Surgical repair for patent ductus arteriosus (PDA) is done to prevent the complication of: a. pulmonary infection b. right-to-left shunt of blood. c. decreased workload on left side of heart. d. increased pulmonary vascular congestion.

d. increased pulmonary vascular congestion.

5. Congenital heart defects have traditionally been divided into acyanotic or cyanotic defects. Based on the nurse's knowledge of congenital heart defects, this system in clinical practice is: a. helpful, because it explains the hemodynamics involved. b. helpful, because children with cyanotic defects are easily identified. c. problematic, because cyanosis is rarely present in children. d. problematic, because children with acyanotic heart defects may develop cyanosis

d. problematic, because children with acyanotic heart defects may develop cyanosis