Peds week 2 NCLEX questions
Which would be an early sign of respiratory distress in a 2-month-old? A. Breathing shallowly. B. Tachypnea. C. Tachycardia. D. Bradycardia.
B
A child in the PICU with a head injury is comatose and unresponsive. The parent asks if he needs pain medication. Select the nurse's best response. A. "Pain medication is not necessary because he is unresponsive and cannot feel pain." B. "Pain medication may interfere with his ability to respond and may mask any signs of improvement." C. "Pain medication is necessary to make him comfortable." D. "Pain medication is necessary for comfort, but we use it cautiously because it increases the demand for oxygen."
C
A 2-month-old infant is brought to the emergency department after experiencing a seizure. The infant appears lethargic with very irregular respirations and periods of apnea. The parents report the baby is no longer interested in feeding and, before the seizure, rolled off the couch. What additional testing should the nurse immediately prepare for? A. Computed tomography (CT) scan of the head and dilation of the eyes. B. Computed tomography (CT) scan of the head and electroencephalogram (EEG). C. X-rays of the head. D. X-rays of all bones.
A
A child diagnosed with meningitis is having a generalized tonic-clonic seizure. Which should the nurse do first? A. Administer blow-by oxygen and call for additional help. B. Reassure the parents that seizures are common in children with meningitis. C. Call a code and ask the parents to leave the room. D. Assess the child's temperature and blood pressure.
A
A child with a seizure disorder has been having episodes during which she drops her pencil and simply appears to be daydreaming. This is most likely a/an: A. Absence seizure B. Akinetic seizure C. Non-epileptic seizure D. Simple spasm seizure
A
Which child would likely have experienced a delay in the diagnosis of a brain tumor? A. A 3-month-old, because signs and symptoms would not have been readily apparent. B. A 5-month-old, because signs and symptoms would not have been readily suspected. C. School-age child, because signs and symptoms could have been misinterpreted. D. Adolescent, because signs and symptoms could have been ignored and denied.
A
Which of the following would be included in the plan of care for a hospitalized newborn following surgical repair of a myelomeningocele? Select all that apply. A. Skull x-rays B. Daily head circumference measurements C. MRI scan D. Vital signs every 6 hours E. Holding to breastfeed
B, C
A school-age child is admitted to the hospital for a tonsillectomy. During the nurse's postoperative assessment, the child's parent tells the nurse that the child is in pain. Which of the following observations would be of most concern to the nurse? A. The child's heart rate and blood pressure are elevated. B. The child complains of having a sore throat. C. The child is refusing to eat solid foods. D. The child is swallowing excessively.
D
Brain damage in a child who sustained a closed-head injury can be caused by which factor? A. Increased perfusion to the brain and increased metabolic needs of the brain. B. Decreased perfusion to the brain and decreased metabolic needs of the brain. C. Increased perfusion to the brain and decreased metabolic needs of the brain. D. Decreased perfusion of the brain and increased metabolic needs of the brain.
D
The mother of an unconscious child has been calling her name repeatedly and gently shaking her shoulders in an attempt to wake her up. The nurse notes that the child is flexing her arms and wrists while bringing her arms closer to the midline of her body. The child's mother asks, "What is going on?" Select the nurse's best response. A. "I think your daughter hears you, and she is attempting to reach out to you." B. "Your child is responding to you; please continue trying to stimulate her." C. "It appears that your child is having a seizure." D. "Your child is demonstrating a reflex that indicates she is overwhelmed with the stimulation she is receiving."
D
Which child with asthma should the nurse see first? A. A 12-year-old who has a mild cry, is pale in color, has diminished breath sounds, and has an oxygen saturation of 93%. B. A 5-year-old who is speaking in complete sentences, is pink in color, is wheezing bilaterally, and has an oxygen saturation of 93%. C. 9-year-old who is quiet, is pale in color, and is wheezing bilaterally with an oxygen saturation of 92%. D. A 16-year-old who is speaking in short sentences, is wheezing, is sitting upright, and has oxygen saturation of 93%.
A
Which should be included in the plan of care for a child who has a neuroblastoma with metastasis to the bone marrow and pancytopenia? A. Administer red blood cells. B. Limit school attendance to less than 4 hours daily. C. Administer warfarin (Coumadin). D. Encourage a diet high in fresh fruits and vegetables.
A
Which would be appropriate nursing care management of a child with the diagnosis of mononucleosis? A. Only family visitors. B. Bedrest. C. Clear liquids. D. Limited daily fluid intake.
A
Who is the highest priority to receive the flu vaccine? A. A healthy 8-month-old who attends day care. B. A 3-year-old who is undergoing chemotherapy. C. A healthy 7-year-old who attends public school. D. An 18-year-old who is living in a college dormitory.
A
Which has the potential to alter a child's level of consciousness? Select all that apply. A. Metabolic disorder B. Trauma C. Hypoxic episode D. Dehydration E. Endocrine disorders
A, B, C, D, E
How does the nurse interpret the laboratory analysis of a stool sample containing excessive amounts of azotorrhea and steatrorrhea in child with cystic fibrosis (CF)? A. Not compliant with taking her vitamins. B. Not compliant with taking her enzymes. C. Eating too many foods high in fat. D. Eating too many foods high in fiber.
B
The nurse is aware that cloudy cerebrospinal fluid (CSF) most likely indicates: A. Viral meningitis. B. Bacterial meningitis. C. No infection, because CSF is usually cloudy. D. Sepsis.
B
Which child is at increased risk for cerebral palsy (CP)? A. An infant born at 34 weeks with an Apgar score of 6 at 5 minutes. B. A 17-day-old infant with group B Streptoccus meningitis. C. A 24-month-old child who has experienced a febrile seizure. D. A 5-year-old with a closed-head injury after falling off a bike.
B
Which child is in the greatest need of emergency medical treatment . A. A 3-year-old who has a barky cough, is afebrile, and has mild intercostal retractions. B. A 6-year-old who has high fever, no spontaneous respiratory cough, and frog-like croaking. C. A 7-year-old who has abrupt onset of moderate respiratory distress, a mild fever, and a barky cough. D. A 13-year-old who has a high fever, stridor, and purulent secretions.
B
Which laboratory result will provide the most important information regarding the respiratory status of a child with an acute asthma exacerbation? A. CBC. B. ABG. C. BUN. D. PTT.
B
A child fell off his bike and sustained a closed-head injury. The child is currently awake and alert, but his mother states that he "passed out" for approximately 2 minutes. The mother appears highly anxious and is very tearful. The child was not wearing a helmet. Which is a priority for the triage nurse to say at this time? A. "Was anyone else injured in the accident?" B. "Tell me more about the accident." C. "Did he vomit, have a seizure, or display any other behavior that was unusual when he woke up?" D. "Why was he not wearing a helmet?"
C
A parent asks the nurse how it will be determined whether their child has respiratory syncytial virus (RSV). Which is the nurse's best response? A. "We will do a simple blood test to determine whether your child has RSV." B. "There is no specific test for RSV. The diagnosis is made based on the child's symptoms." C. "We will swab your child's nose and send the specimen for testing." D. "We will have to send a viral culture to an outside lab for testing."
C
The nurse is caring for a child who has been in a motor vehicle accident (MVA). The child falls asleep unless her name is called or she is gently shaken. This state of consciousness is referred to as: A. Coma B. Delirium C. Obtunded D. Confusion
C
To treat a common manifestation of Reye syndrome, which medication would the nurse expect to have readily available? A. Furosemide (Lasix) B. Insulin C. Glucose D. Morphine
C
Which is diagnostic for epiglottitis? A. Blood test. B. Throat swab. C. Lateral neck x-ray of the soft tissue. D. Signs and symptoms.
C
A child is being admitted with the diagnosis of meningitis. Select the procedure that nurse should do first: A. Administration of intravenous antibiotics B. Administration of maintenance intravenous fluids C. Placement of a Foley catheter D. Send the spinal fluid and blood samples to the laboratory for cultures
D
A child with a ventriculoperitoneal (VP) shunt complains of headache and blurry vision and now experiences irritability and sleeping more than usual. The parents ask the nurse what they should do. Select the nurse's best response. A. "Give her some acetaminophen (Tylenol), and see if her symptoms improve. If they do not improve, bring her to the health-care provider's office." B. It is common for girls to have these symptoms, especially prior to beginning their menstrual cycle. Give her a few days, and see if she improves." C. "You are probably worried that she is having problems with her shunt. This is very unlikely because it has been working well for 9 years." D. "You should immediately take her to the emergency department because these may be symptoms of a shunt malfunction."
D
The nurse is caring for a 6-month-old infant diagnosed with meningitis. When the child is placed in the supine position and flexes his neck, the nurse notes he flexes his knees and hips. This is referred to as: A. Brudzinski sign B. Cushing triad C. Kernig sign D. Nuchal rigidity
A
The parent of a 4-year-old with cystic fibrosis (CF) asks the nurse what time to begin the child's first chest physiotherapy (CPT) each day. Which is the nurse's best response? A. "Thirty minutes before feeding the child breakfast." B. "After deep-suctioning the child each morning." C. "Thirty minutes after feeding the child breakfast." D. "Only when the child has congestion or coughing."
A
What would the nurse advise the parent of a child with a barky cough that gets worse at night? A. Take the child outside into the more humid night air for 15 minutes. B. Take the child to the ED immediately. C. Give the child an over-the-counter cough suppressant. D. Give the child warm liquids to soothe the throat.
A
The nurse is caring for a child with a skull fracture who is unconscious and has severely increased intracranial pressure (ICP). The nurse notes the child's temperature to be 104 F (40 C). Which should the nurse do first? A. Place a cooling blanket on the child. B. Administer acetaminophen (Tylenol) via nasogastric tube. C. Administer acetaminophen (Tylenol) rectally. D. Place ice packs in the child's axillary areas.
A
An infant is born with a sac protruding through the spine, containing cerebrospinal fluid (CSF), a portion of the meninges, and nerve roots. This condition is referred to as: A. Meningocele B. Myelomeningocele C. Spina bifida occulta D. Anencephaly
B
A 6-week-old is admitted to the hospital with influenza. The child is crying, and the father tells the nurse that his son is hungry. The nurse explains that the baby is not to have anything by mouth. The parent does not understand why the child cannot eat. Which is the nurse's best response to the parent? A. "We are giving your child intravenous fluids, so there is no need for anything by mouth." B. "The shorter and narrower airway of infants increases their chances of aspiration so your child should not have anything to eat now." C. "When your child eats, he burns too many calories; we want to conserve the child's energy." D. "Your child has too much nasal congestion; if we feed the child by mouth, the distress will likely increase."
B
A child recently diagnosed with epilepsy is being evaluated for anticonvulsant medication therapy. The child will likely be placed on which type of regimen? A. Two or three oral anticonvulsant medications so that dosing can be low and side effects minimized. B. One oral anticonvulsant medication to observe effectiveness and minimize side effects. C. One rectal gel to be administered in the event of a seizure. D. A combination of oral and intravenous anticonvulsant medications to ensure compliance.
B
A school-age child has been diagnosed with nasopharyngitis. The parent is concerned because the child has had little or no appetite for the last 24 hours. Which is the nurse's best response? A. "Do not be concerned; it is common for children to have a decreased appetite during a respiratory illness." B. "Be sure your child is taking an adequate amount of fluids. The appetite should return soon." C. "Try offering the child some favorite foods. Maybe that will improve the appetite." D. "You need to force your child to eat whatever you can; adequate nutrition is essential."
B
A 6-month-old male has been diagnosed with positional brachycephaly. The nurse is providing teaching about the use of a helmet for his therapy. Which statement indicates that the parents understand the education? Select all that apply. A. "We will keep the helmet o him when he is awake and remove it only for bathing and sleeping." B. "He will start wearing the helmet when he is closer to 9 months because he will be more upright and mobile." C. "He will wear the helmet 23 hours every day." D. "Most children need to wear the helmet for 6 to 12 hours." E. "Most children gain some improvement."
C, E
The nurse knows that young infants are at risk for injury from shaken baby syndrome (SBS) because: A. The anterior fontanel is open. B. They have insufficient musculoskeletal support and a disproportionate head-to-body ratio. C. They have an immature vascular system with veins and arteries that are more superficial. D. There is immature myelination of the nervous system in a young infant.
B
Which medication should the nurse anticipate administering first to a child in status epilepticus? A. Establish an intravenous line and administer intravenous lorazepam (Ativan). B. Administer rectal diazepam (Valium). C. Administer oral glucose gel to the side of the child's mouth. D. Administer oral diazepam (Valium).
B
Which order would the nurse question for a child just admitted with the diagnosis of bacterial meningitis? A. Maintain isolation precautions until 24 hours after receiving intravenous antibiotics. B. Intravenous fluids at 1 ½ times regular maintenance. C. Neurological checks every hour. D. Administer acetaminophen (Tylenol) for temperatures higher than 38 C (100.4 F).
B
Which child would benefit most from having ear tubes place? Select all that apply. A. A 9-month-old who has had one ear infection. B. A 13-month-old with recurrent ear infections. C. A 2-year-old who has had five previous ear infection. D. A 3-year-old whose sibling has had four ear infections. E. A 7-year-old who has had two ear infections this year.
B, C
A child with Reye syndrome is described in the nurse's notes as follows: 1200-comatose with sluggish pupils; when stimulated, demonstrates decerebrate posturing. 1400- unchanged except that now demonstrates decorticate posturing when stimulated. The nurse concludes that the child's condition is: A. Worsening and progressing to a more advanced stage of Reye syndrome. B. Worsening, and the child may likely experience cardiac and respiratory failure C. Improving and progressing to a less advanced stage of Reye syndrome. D. Improving because the child's posturing reflexes are similar.
C
The nurse is caring for a 1-year-old who has just been diagnosed with viral encephalitis. The parents ask if their child will be admitted to the hospital. Select the nurse's best response. A. "Your child will likely be sent home because encephalitis is usually caused by a virus and not bacteria." B. "Your child will likely be admitted to the pediatric floor for intravenous antibiotics and observation." C. "Your child will likely be admitted to the PICU for close monitoring and observation." D. "Your child will likely be sent home because she is only 1-year-old. We see fewer complications and shorter disease process in the younger child."
C
The nurse prepares baclofen for a child with cerebral palsy (CP) who just had her hamstrings surgically released. The child's parents ask what the medication is for. Select the nurse's best response. A. "It is a medication that will help decrease the pain from her surgery." B. "It is a medication that will prevent her from having seizures." C. "It is a medication that will help control her spasms." D. It is a medication that will help with bladder control."
C
Which should be included in instructions to the parent of a child prescribed amoxicillin to treat an ear infection? A. "Continue the amoxicillin until the child's symptoms subside." B. "Administer an over-the-counter antihistamine with the antibiotic." C. "Administer the amoxicillin until all the medication is gone." D. "Allow your child to administer his own dose of amoxicillin."
C
A 7-month-old has a low-grade fever, nasal congestion, and a mild cough. What should the nursing care management of this child include? Select all that apply. A. Maintaining strict bedrest. B. Avoiding contact with family members. C. Instilling saline nose drops and bulb suctioning. D. Keeping the head of the bed flat. E. Providing humidity, and propping the head of the bed up.
C, E
Which signs best indicate increased intracranial pressure (ICP) in an infant? Select all that apply. A. Sunken anterior fontanel B. Complaints of blurred vision C. High-pitched cry D. Increased appetite E. Sleeping more than usual
C, E
A child with severe cerebral palsy is admitted to the hospital with aspiration pneumonia. What is the most beneficial educational information that the nurse can provide to the parents? A. The signs and symptoms of aspiration pneumonia. B. The treatment plan for aspiration pneumonia. C. The risks associated with recurrent aspiration pneumonia. D. The prevention of aspiration pneumonia.
D
The parents of a 12-month-old with a neurogenic bladder ask the nurse if their child will always have to be catheterized. Select the nurse's best response. A. "Your child will never feel when her bladder is full, so she will always have to be catheterized. Because she is female, she will always need assistance." B. "As your child ages, she will likely be able to sense when her bladder is full and will be able to empty it on her own." C. "Although your child will not be able to feel when her bladder is full, she can learn to urinate every 4 to 6 hours and therefore will not require catheterizations. D. "Your child will never be able to completely empty her bladder spontaneously, but there are other options to traditional catheterization. An opening can be made surgically through the abdomen, allowing a catheter to be placed into the opening."
D
What is the most important piece of information that the nurse must ask the parent of a child in status asthmaticus? A. "What time did your child last eat?" B. "Has your child been exposed to any of the usual asthma triggers?" C. "When was your child last admitted to the hospital for asthma?" D. "When was your child's last dose of medication?"
D
Which physical findings would be of most concern in an infant with respiratory distress? A. Tachypnea. B. Mild retractions. C. Wheezing. D. Grunting.
D