Unit 4: Practice Questions

Which are appropriate interventions for the nurse to include in the plan of care for a child who is receiving traction? Select all that apply. 1. Monitoring breath sounds 2. Assessing neurovascular status every 2 hours 3. Repositioning every 2 to 3 hours 4. Using moleskin to protect the skin from rough edges 5. Encouraging the parents cuddle with their child

1. Monitoring breath sounds 2. Assessing neurovascular status every 2 hours 5. Encouraging the parents cuddle with their child

Which are appropriate interventions for the nurse to include in the plan of care for a child who is casted? Select all that apply. 1. Monitoring breath sounds 2. Assessing neurovascular status every 4 hours 3. Repositioning every 2 to 3 hours 4. Using moleskin to protect the skin from rough edges 5. Encouraging the parents cuddle with their child

1. Monitoring breath sounds 3. Repositioning every 2 to 3 hours 4. Using moleskin to protect the skin from rough edges 5. Encouraging the parents cuddle with their child

The nurse is providing care to a child who was treated with aspirin during a viral infection. Which clinical manifestations should cause the nurse concern? 1. Nausea, vomiting, and confusion 2. Headache, vomiting, and seizures 3. Sore throat, moist respirations, and cough 4. Fever, rash, and photophobia

1. Nausea, vomiting, and confusion

Which clinical manifestation should the nurse monitor for when assessing a pediatric client who is diagnosed with a basilar skull fracture? 1. Periorbital ecchymosis 2. Subdural hematoma 3. Protruding bone 4. Epidural hematoma

1. Periorbital ecchymosis

Which assessment finding for a 4-month-old infant would require further action by the nurse? 1. The posterior fontanel is open. 2. The infant has good head control when held upright. 3. The infant is able to roll only from abdomen to back. 4. The anterior fontanel is open and soft.

1. The posterior fontanel is open.

A young child admitted to the pediatric unit has fever, irritability, and vomiting with suspected bacterial meningitis. Which cerebrospinal fluid (CSF) result should the nurse anticipate based on these data? 1. Decreased protein count 2. Clear, straw-colored fluid 3. Positive for red blood cells (RBCs) 4. Decreased glucose level

4. Decreased glucose level

Which clinical manifestations should the nurse expect when conducting an assessment for a child who is diagnosed with attention deficit/ hyperactivity disorder (ADHD)? Select all that apply. 1. Arm flapping 2. Language delays 3. Ritualistic behavior 4. Impulsive behavior 5.Sleep disturbances

4. Impulsive behavior 5.Sleep disturbances

Which nursing interventions should the nurse implement for a school-age child who is the victim of physical abuse by a parent? Select all that apply. 1. Referring members of the family for appropriate counseling 2. Protecting the child from further injury 3. Allowing the child to wear clothing during the examination process 4. Discouraging parental participation in the plan of care 5. Documenting the child's response to parental interaction

1. Referring members of the family for appropriate counseling 2. Protecting the child from further injury 3. Allowing the child to wear clothing during the examination process 5. Documenting the child's response to parental interaction

The school nurse recognizes that many adolescents who are currently pregnant are hiding their pregnancies from adults, both at school and at home. Which should the nurse educate the adolescents about based on the current data? 1. Safe haven laws 2. Birth control available to all teenagers 3. Domestic abuse protection 4. The father's financial responsibility for the infant

1. Safe haven laws

The nurse is planning care for a school-age child diagnosed with separation anxiety disorder. Which aspects of cognitive-behavior therapy (CBT) should the nurse include in the teaching plan for the child's family? Select all that apply. 1. Self-talking 2. Relaxation 3. Hypnosis 4. Antidepressant medications 5. Recognition of feelings

1. Self-talking 2. Relaxation 5. Recognition of feelings

The nurse is providing care to a pediatric client who is homeless. Which nursing actions will decrease the risk for the child developing an infectious disease? Select all that apply. 1. Teaching hygienic methods 2. Arranging for medications, as needed 3. Evaluating the family for food security 4. Performing a nutritional assessment 5. Teaching oral hygiene

1. Teaching hygienic methods 2. Arranging for medications, as needed

When the home health nurse visits the home of a 10-month-old child, she observes the environment for risks for injury to the child. Which observation will the nurse discuss with the mother? 1. The mother leaves the filled mop bucket on the floor while in another room. 2. The mother turns all pan handles to the back of the stove. 3. The mother fills the bath tub before bringing the baby into the bathroom. 4. When riding in a car, the child is in a car seat in the middle of the back seat.

1. The mother leaves the filled mop bucket on the floor while in another room.

Which should the nurse include in the neurovascular assessment for an infant following casting of the leg for talipes equinovarus? 1. Warmth 2. Capillary refill 3. Pedal pulse 4. Sensation 5. Movement of the toes

1. Warmth 2. Capillary refil 4. Sensation 5. Movement of the toes

The nurse is teaching a mother of a young child with a newly diagnosed seizure disorder. The child is prescribed valproic acid (Depakote) for control of seizures. Which parental statement indicates the need for further education? 1. "I will not use carbonated beverages to dilute his medication." 2. "I will give his medicine on an empty stomach so he will absorb it better." 3. "I will not let him chew his tablet." 4. "I will bring him to the physician's office for regular blood work to check bleeding times."

2. "I will give his medicine on an empty stomach so he will absorb it better."

An infant presents to the emergency department (ED) with physical injuries. The nurse is taking the child's history. Which parental statement would cause the nurse to be suspicious of abuse? 1. "I was walking up the steps and slipped on the ice and fell while carrying my baby." 2. "The baby's 18-month-old brother was trying to pull the baby out of the crib and dropped the baby on the floor." 3. "I placed the baby in the infant swing. His 6-year-old brother was running through the house and tripped over the swing, causing it to fall." 4. "I did not realize that my baby was able to roll over yet, and I was just gone a minute to check on dinner when the baby rolled off of the couch and onto our tile floor."

2. "The baby's 18-month-old brother was trying to pull the baby out of the crib and dropped the baby on the floor."

The mother of an infant tells the nurse that her maternity leave is almost over and she will be returning to work soon. The mother states that she will need to place her infant in a day care facility, and she asks the nurse how to know which day care facility is best. Which topics will the nurse include in the response to the mother? Select all that apply. 1. A day care facility that is close to her work in the event of an emergency 2. A day care facility that requires all staff have criminal background checks 3. A day care facility that is attractive in appearance, with bright colors and interesting visual stimulation 4. A day care facility that provides regular training of the staff and administration 5. A day care facility that has policies regarding child health and emergencies, such as immunization requirements and emergency medical forms

2. A day care facility that requires all staff have criminal background checks 4. A day care facility that provides regular training of the staff and administration 5. A day care facility that has policies regarding child health and emergencies, such as immunization requirements and emergency medical forms

The school nurse is planning a smoking prevention program for middle school students. Which is most likely to be effective in preventing this population from smoking? 1. A demonstration of the pathophysiology of the effects of smoking tobacco on the body given by the school's biology teacher 2. A talk on the importance of not smoking given by a local high school basketball star 3. Colorful posters with catchy slogans displayed throughout the school 4. A pledge campaign during which students sign contracts saying that they will not use tobacco products

2. A talk on the importance of not smoking given by a local high school basketball star

Which characteristics of abusers should the nurse include in the teaching session for elementary school teachers regarding child abuse? Select all that apply. 1. Physical illness 2. Alcoholism 3. Many friends and families nearby 4. Unrealistic expectations for their child 5. The abuser has no relationship to the child.

2. Alcoholism 4. Unrealistic expectations for their child

Which clinical manifestations should the nurse expect when assessing a pediatric client who is diagnosed with congenital hip dysplasia (CHD)? Select all that apply. 1. Limited adduction of the affected hip 2. Asymmetry of thigh fat folds 3. Telescoping of the thigh 4. Muscle weakness 5. Atrophy of the muscles

2. Asymmetry of thigh fat folds 3. Telescoping of the thigh

The father of a school-age child who requires hospital admission for intravenous antibiotics to treat osteomyelitis states, "I don't understand why normal antibiotics can't be used." Which should the nurse include in the response to the father? 1. The antibiotic of choice is not available in oral form. 2. Blood flow to bones is limited, and parenteral administration is necessary to get appropriate blood levels. 3. Because the child is older now, it is harder to get the child to cooperate with oral antibiotics. 4. Because 2 weeks of therapy is necessary, the intravenous route will produce fewer side effects.

2. Blood flow to bones is limited, and parenteral administration is necessary to get appropriate blood levels.

Which should the nurse include in a teaching session for the parents of an infant who will be placed in a Pavlik harness for the treatment of congenital developmental dysplasia? 1. Apply lotion or powder to minimize skin irritation. 2. Check at least 2 or 3 times a day for red areas under the straps. 3. Put clothing over the harness for maximum effectiveness of the device. 4. Place a diaper over the harness, preferably using a thin, superabsorbent, disposable diaper.

2. Check at least 2 or 3 times a day for red areas under the straps.

An infant returns to the unit following surgical correction of bilateral congenital clubfeet. The infant has bilateral long-leg casts. The nurse notes that the toes on both feet are edematous, but there is color, sensitivity, and movement to them. Which action by the nurse is the priority? 1. Apply a warm, moist pack to the feet. 2. Elevate the legs on pillows. 3. Encourage movement of the toes. 4. Call the surgical provider to report the edema.

2. Elevate the legs on pillows.

Which assessment finding would require an immediate nursing action when providing care to an adolescent who is postoperative for spinal fusion surgery? 1. Sleeps when not bothered but arouses easily with stimuli 2. Impaired color, sensitivity, and movement to lower extremities 3. Nausea relieved by antiemetics 4. Pain relieved by analgesics

2. Impaired color, sensitivity, and movement to lower extremities

A pediatric client is admitted to the emergency department with a traumatic brain injury (TBI) that caused a loss of consciousness. The last set of vital signs showed heart rate 48, blood pressure (BP) 148/74 mmHg, respiratory rate 28 and irregular. Which does the nurse suspect based on these data? 1. Spinal cord injury 2. Increased intracranial pressure. 3. Typical for sleep 4. Improvement

2. Increased intracranial pressure.

Which statements should the nurse include in the definition of mental health during a health maintenance fair for pediatric clients? Select all that apply. 1. Mental health is the change in thought that occurs during childhood. 2. Mental health is foundational to a sense of personal well-being. 3. Mental health does not impact physical health. 4. Mental health involves successful engagement in activities. 5. Mental health changes over time.

2. Mental health is foundational to a sense of personal well-being. 4. Mental health involves successful engagement in activities.

Which clinical manifestations should the nurse monitor for when conducting a scoliosis screening for a school-age child? Select all that apply. 1. Lordosis 2. Prominent scapula 3. Pain 4. A one-sided rib hump 5. Uneven shoulders and hips

2. Prominent scapula 4. A one-sided rib hump 5. Uneven shoulders and hips

The nurse is providing care to a 3-year-old client whose mother states, "I am not sure that I have enough money to buy both food for the rest of the month and the antibiotic for my child's ear infection." Which nursing intervention would be beneficial for the child and this family? 1. Talking with the mother about keeping the child's ear clean by using a Q-tip 2. Putting the mother in contact with a local agency that provides food on a regular basis to needy families and helps them access other resources in the community 3. Providing the mother with samples of food and food stamps for the child 4. Giving the mother free samples of an antibiotic

2. Putting the mother in contact with a local agency that provides food on a regular basis to needy families and helps them access other resources in the community

Which assessment data obtained by the nurse during the health history portion of the assessment process support the current diagnosis of Duchenne muscular dystrophy (MD) for an 18-month-old child? 1. Infant was postmature by almost 2 weeks. 2. The child seems very muscular. 3. The child walked early and without support at 10 months. 4. The child's older sister developed scoliosis in the fourth grade.

2. The child seems very muscular.

A child is admitted to the emergency department (ED) for scald burns to the buttocks and thighs. According to the mother, she was preparing the child's bath and before she could test the water, the child fell in and was scalded. Which would cause the nurse to suspect abuse? 1. The burns are uneven, with some burns deeper than others. 2. The child's hands and feet are free of burns. 3. In addition to the main burn site, there are splash burns surrounding the area. 4. The mother was home alone with the child.

2. The child's hands and feet are free of burns.

A recently divorced mother who must return to work is concerned about the effects of placing her child in day care full-time. In counseling the mother, the nurse knows that which factor is most influential in determining whether day care has a positive or negative effect on the child? 1. The amount of time that the children spend playing outside 2. The closeness of the parent-child relationship 3. The ratio of day care workers to children 4. The cleanliness of the day care facility

2. The closeness of the parent-child relationship

A child is admitted to the hospital with a diagnosis of lead poisoning. Which should be included in the home assessment to determine the probable source of the lead poisoning? 1. The home's foundation for a possible radon leak 2. The home's water pipes 3. The dirt surrounding the house 4. The presence of imported toys or antique baby furniture 5. Gas stored in cans in the garage.

2. The home's water pipes 3. The dirt surrounding the house 4. The presence of imported toys or antique baby furniture

Which teaching topic is the priority for the nurse who is teaching the family of an infant diagnosed with osteogenesis imperfecta? 1. Cast care 2. Trunk and extremity support during everyday care 3. Postoperative spinal surgery care 4. Traction care

2. Trunk and extremity support during everyday care

Which statement from the parent of a child diagnosed with attention deficit/hyperactivity disorder (ADHD) indicates the need for further education by the nurse? 1. "I will develop a reward system for desired behaviors." 2. "I will take my child to the physician every 3 months for a weight and height check." 3. "I will let him do his homework while he is watching his favorite television show." 4. "I will stick to the same routine each day after school."

3. "I will let him do his homework while he is watching his favorite television show."

The mother of a 22-month-old child states, "My child does not seem to be developing like my sister's daughter, who is the same age." Which screening test should the nurse plan to conduct based on the current data? 1. Magnetic resonance imaging (MRI) of the head 2. An electroencephalogram (EEG) 3. A Denver II 4. Chromosomal study

3. A Denver II

A child diagnosed with autism spectrum disorder (ASD) is admitted to the hospital with dehydration. Which should the nurse include in the plan of care for this child? 1. Discourage the parents from bringing favorite toys from home that might be lost. 2. Take the child on a tour of the pediatric unit. 3. Assign the child to a single-bed hospital room. 4. Take the child to the playroom for arts and crafts.

3. Assign the child to a single-bed hospital room.

Which finding, noted during the newborn admission assessment, would lead the nurse to suspect unilateral congenital hip dysplasia? 1. Lordosis 2. Trendelenburg sign 3. Asymmetry of the gluteal and thigh fat folds 4. Telescoping of the affected limb

3. Asymmetry of the gluteal and thigh fat folds

Which is the priority nursing action when working with a parent who is suspected of Munchausen syndrome by proxy? 1. Try to keep the parent separated from the child as much as possible. 2. Explain to the child that the parent is causing the illness and that the healthcare team will prevent the child from being harmed. 3. Carefully document parent-child interactions. 4. Confront the parent with concerns of possible abuse.

3. Carefully document parent-child interactions.

Which nursing action assists in the diagnosis of mental health and cognitive disorders that occur during childhood? 1. Monitoring vital signs 2. Administering prescribed medications 3. Conducting a developmental assessment 4. Documenting an accurate history and physical

3. Conducting a developmental assessment

Which activities should the nurse include in the plan of care for a child diagnosed with attention deficit/hyperactivity disorder (ADHD) to improve behavior and learning? Select all that apply. 1. Asking the mother to seek a prescription for methylphenidate (Ritalin) for the child 2. Placing the child's desk at the back of the room to reduce distractions 3. Developing a consistent routine for the classroom 4. Limiting the decorations in the classroom 5. Determining areas where the child performs well and using these areas to promote self-esteem

3. Developing a consistent routine for the classroom 4. Limiting the decorations in the classroom 5. Determining areas where the child performs well and using these areas to promote self-esteem

A school-age child is diagnosed with a learning disorder that is characterized by problems with manual dexterity and coordination. Which term should the nurse use when documenting this child's disorder in the medical record? 1. Dysgraphia 2. Dyscalculia 3. Dyspraxia 4. Dyslexia

3. Dyspraxia

The nurse is caring for a 9-month-old infant who just returned from the postanesthesia care unit (PACU) after a shunt placement for hydrocephalus. Which healthcare provider prescription should the nurse question? 1. Vital signs and neurologic checks hourly 2. Small, frequent formula feedings 3. Elevate head of bed 4. Daily head circumference

3. Elevate head of bed

Which data, noted by the nurse during the physical assessment, would indicate the need to refer an adolescent client for further treatment due to possible depression? Select all that apply. 1. Agoraphobia 2. Somatic complaints 3. Focus on violence 4. Poor self-care 5. Poor school performance

3. Focus on violence 4. Poor self-care 5. Poor school performance

Which side effect should the nurse include in the parent teaching for a child who is prescribed a baclofen pump for cerebral palsy? 1. Diarrhea 2. Hypertonia 3. Hypotonia 4. Restlessness

3. Hypotonia

The nurse is assessing a child with Down syndrome. Which illness should the nurse monitor for due to the increased risk for children with Down syndrome? 1. Rheumatic heart disease 2. Glomerulonephritis 3. Leukemia 4. Hepatitis

3. Leukemia

Which factor, noted by the nurse during the pediatric health history portion of the assessment process, would indicate the child is at risk for attention deficit/hyperactivity disorder (ADHD)? 1. Measles, mumps, and rubella vaccine 2. Advanced parental age 3. Prenatal exposure to smoke 4. Immune response

3. Prenatal exposure to smoke

Which clinical data noted by the nurse during the shift assessment indicate the pediatric client may be experiencing compartment syndrome? Select all that apply. 1. Pink, warm extremity 2. Dorsalis pedis pulse present 3. Prolonged capillary refill time 4. Pain not relieved by pain medication 5. Paresthesia of the leg

3. Prolonged capillary refill time 4. Pain not relieved by pain medication 5. Paresthesia of the leg

Which adolescent behavior, reported by a parent, would cause the nurse to suspect possible substance abuse? 1. Becoming very involved with friends and in activities related to basketball 2. Becoming moody, crying, and weeping one minute and then cheerful and excited the next 3. Receiving numerous detentions for sleeping in class 4. Wearing baggy, oversized clothing and dyeing hair black

3. Receiving numerous detentions for sleeping in class

A school-age client presents to the pediatric clinic with a history of abdominal pain 3 to 4 mornings per week over the last 2 months. The mother states the child usually complains on school days and always seems to be better by afternoon. Which mental health disorder does the nurse suspect? 1. Separation anxiety 2. Depression 3. School phobia 4. Bipolar disorder

3. School phobia

Which assessment finding for a toddler-age child in balanced Bryant traction for a fractured right femur would require immediate action by the nurse? 1. The child keeps trying to turn and lie on his belly. 2. The ropes are unequal in length. 3. The child's buttocks are resting on the bed. 4. The Ace bandage wrapping the legs is wrinkled.

3. The child's buttocks are resting on the bed.

A nurse is educating a family about the type of fracture their 8-year-old child has experienced. Which description would be an accurate way to explain a closed fracture of the radius to the family? a. One of the bones in the arm broke completely and penetrated the skin. b. One of the bones in the arm broke completely but did not penetrate the skin. c. One of the bones in the arm is broken incompletely, like a green twig. d. One of the bones in the arm is crushed and broken incompletely.

b. One of the bones in the arm broke completely but did not penetrate the skin.

While weighing a 12-month-old in the clinic, the nurse notes six nickel-sized bruises on the child's buttocks. The bruises range in color from purple to greenish-yellow. The nurse also notes a looped cord mark on the child's thigh. What is the priority action for the nurse to take in this situation? a. Inform the parents that she thinks the child has been abused. b. Document the assessment findings in detail. c. Report suspected child abuse to the appropriate authority. d. Do nothing, because these findings are normal for a child who is learning to walk.

c. Report suspected child abuse to the appropriate authority.

The school nurse is concerned about physical inactivity at the middle school. For which disease process should the nurse screen the children? a. Scoliosis b. Thyroid disease c. Depression d. Type 2 diabetes

d. Type 2 diabetes

A mother of two children, an 8-year-old and a 10-year-old, tells you that her husband has recently been deployed to the Middle East. The mother is concerned about the children's constant interest in watching TV news coverage of activities in the Middle East. Which suggestion by the nurse to the mother is most appropriate? 1. "Spend time with your children, and take cues from them about how much they want to discuss." 2. "Allow the children to watch as much television as they want. This is how they are coping with their father's absence." 3. "The less that you discuss this, the quicker the children will adjust to their father's absence. Try to keep them busy and use distractions to keep their mind off of it." 4. "It will just take some time to adjust to their father's absence and then everything will return to normal."

1. "Spend time with your children, and take cues from them about how much they want to discuss."

A high school student calls to ask the nurse for advice on how to care for a new navel piercing. Which response by the nurse is appropriate? 1. "Avoid contact with another person's bodily fluids until the area is well healed." 2. "Do not move or turn the jewelry for the first 3 days." 3. "Apply lotion to the area, rubbing gently, to prevent skin from becoming dry and irritated." 4. "Apply warm soaks to the area for the first 2 days to minimize swelling."

1. "Avoid contact with another person's bodily fluids until the area is well healed."

The nurse is providing care to a child who is admitted to the hospital due to environmental exposure to a toxic agent. Which questions should the nurse ask the child and the parent during the assessment process? 1. "Do you work around harmful substances that could have been brought to the home environment?" 2. "What year was your home built?" 3. "Does your child have a hobby that includes working with glue?" 4. "Does your home have a smoke detector?" 5. "Does your home have a carbon monoxide detector?"

1. "Do you work around harmful substances that could have been brought to the home environment?" 2. "What year was your home built?" 3. "Does your child have a hobby that includes working with glue?" 5. "Does your home have a carbon monoxide detector?"

The nurse is providing care to a child who is diagnosed with Legg-Calvé-Perthes disease. Which parental statement regarding the child's care required further teaching from the nurse? 1. "We're glad this will only take about 6 weeks to correct." 2. "We understand abduction of the affected leg is important." 3. "We know to watch for areas on the skin that the brace might rub." 4. "We understand swimming is a good sport for Legg-Calvé-Perthes."

1. "We're glad this will only take about 6 weeks to correct."

Which child should the nurse refer for further assessment due to a probable diagnosis for autism spectrum disorder (ASD)? 1. A 4-year-old girl who doesn't make eye contact with mother and resists the mother's touch 2. A 3-year-old boy who joins one group of children, then moves to another group of children without joining their activities 3. An 18-month-old child who walks around the area using the furniture to provide balance 4. A 6-year-old boy who chatters constantly to anyone who will listen

1. A 4-year-old girl who doesn't make eye contact with mother and resists the mother's touch

Which clinical manifestations should the nurse expect when conducting an assessment for a child who is diagnosed with autism spectrum disorder (ASD)? Select all that apply. 1. Arm flapping 2. Language delays 3. Ritualistic behavior 4. Impulsive behavior 5. Sleep disturbances

1. Arm flapping 2. Language delays 3. Ritualistic behavior

A parent is concerned about her 8-year-old child's recent behavior and calls the nurse for advice. According to the parent, her child is constantly crying, is not sleeping well, has withdrawn from activities, and does not want to attend school. Which should the nurse explore in more detail with the parent? 1. Bullying 2. Sexual abuse 3. Lead poisoning 4. Drug abuse

1. Bullying

The nurse is assessing a child and suspects the child's mother is abusing an opiate. Which clinical manifestations exhibited by the child's mother lead the nurse to this conclusion? 1. Constricted pupils 2. Mood swings 3. Impaired memory 4. Tremors 5. Psychosis

1. Constricted pupils 2. Mood swings 3. Impaired memory

Which information should the nurse include in the teaching plan for the parents of a child who is diagnosed with autism spectrum disorder (ASD) as methods to increase the child's socialization? 1. Create a reward system when the child interacts with a person. 2. Punish the child when the child's social behaviors are inappropriate. 3. Use dolls to demonstrate appropriate social interactions to the child. 4. Enroll the child in a day care facility to encourage interaction with other children.

1. Create a reward system when the child interacts with a person.

The pediatric public health nurse visits a facility for the homeless. Which types of medical issues will the nurse assess these children for based on the current data? Select all that apply. 1. Dental caries 2. Infections secondary to tattoos 3. Lack of immunizations 4. Nutritional deficits 5. Munchausen syndrome by proxy

1. Dental caries 3. Lack of immunizations 4. Nutritional deficits

Which injury prevention strategies should the nurse include in the plan of care for a pediatric client who is diagnosed with muscular dystrophy? 1. Develop a home fire evacuation plan. 2. Provide information regarding oxygen safety. 3. Recommend the use of portable generator. 4. Teach safe transfer methods. 5. Perform neurovascular checks every 2 hours.

1. Develop a home fire evacuation plan. 2. Provide information regarding oxygen safety. 3. Recommend the use of portable generator. 4. Teach safe transfer methods.

Which items noted in a pediatric client's medical record indicate the child may be experiencing a learning disability? Select all that apply. 1. Dyslexia 2. Dysphagia 3. Dyspraxia 4. Scoliosis 5. Hypotonia

1. Dyslexia 3. Dyspraxia

Which interventions should the nurse include in the plan of care for an adolescent client who is on complete bed rest after spinal fusion surgery secondary to scoliosis to prevent complications associated with immobility? Select all that apply. 1. Encouraging use of the spirometer every 2 hours while the child is awake 2. Log-rolling the client every 2 hours while awake 3. Increasing intake of milk to maintain bone calcium 4. Increasing fruit and grains in the diet 5. Limiting fluid intake to reduce the need to void

1. Encouraging use of the spirometer every 2 hours while the child is awake 2. Log-rolling the client every 2 hours while awake 4. Increasing fruit and grains in the diet

The nurse is assessing a 4-year-old child with a possible alteration in mental health. Which findings indicate a need for further investigation? Select all that apply. 1. Fails to make eye contact 2. Flinches when touched on the arm 3. History of limited prenatal care and precipitate delivery 4. Head circumference has not changed in over 1 year 5. Flat facial expressions

1. Fails to make eye contact 2. Flinches when touched on the arm 3. History of limited prenatal care and precipitate delivery 5. Flat facial expressions

A child is brought to the emergency department in a coma. The mother thinks the child may have ingested a poison. Which will the nurse assess based on this information? Select all that apply. 1. For oral burns 2. The child's breath 3. The child's vomitus 4. Hair samples 5. Blood and urine toxicology screens

1. For oral burns 2. The child's breath 3. The child's vomitus 5. Blood and urine toxicology screens

A 9-month-old infant who is not sitting independently has been diagnosed with ataxic cerebral palsy (CP). Which clinical manifestations would the nurse expect to see in the baby? 1. Hypotonia and muscle instability 2. Hypertonia and persistence primitive reflexes 3. Tremors and exaggerated posturing 4. Hemiplegia and hypertonia

1. Hypotonia and muscle instability

Which is the priority nursing diagnosis when planning care for a pediatric client who is diagnosed with bacterial meningitis? 1. Impaired Gas Exchange 2. Risk for Infection 3. Anxiety (parental) 4. Acute Pain

1. Impaired Gas Exchange

Which clinical manifestations should the nurse anticipate when providing care to a pediatric client who huffing glue? Select all that apply. 1. Impaired coordination 2. Elevated liver enzymes 3. Delirium 4. Dementia 5. Giddiness

1. Impaired coordination 2. Elevated liver enzymes 3. Delirium

Which should the nurse include in the plan of care for a hospitalized school-age child with myelodysplasia? Select all that apply. 1. Implementing interventions for a client of normal intelligence 2. Using latex precautions when providing client care 3. Allowing the client to self-catheterize 4. Ensuring that the client has a low-fiber diet 5. Encouraging the client to shift positions hourly when in the wheelchair

1. Implementing interventions for a client of normal intelligence 2. Using latex precautions when providing client care 3. Allowing the client to self-catheterize 5. Encouraging the client to shift positions hourly when in the wheelchair

Which preventative strategies should the nurse include in a teaching session for a mother whose infant is at risk for febrile seizures? Select all that apply. 1. Increasing oral intake of fluids 2. Administering dose-appropriate aspirin 3. Providing a sponge bath with cold water 4. Decreasing oral fluid intake 5. Patting the child dry after a tepid bath

1. Increasing oral intake of fluids 5. Patting the child dry after a tepid bath

The nurse is planning a teaching session for the parents of a child who is diagnosed with simple partial seizures. Which causes should the nurse include when teaching the parents? Select all that apply. 1. Lesions 2. Cysts 3. Tumor 4. Brain abscesses 5. Brain trauma

1. Lesions 2. Cysts 3. Tumor 4. Brain abscesses

The nurse is providing care for a pediatric client in the emergency department (ED) with a diagnosis of decreased level of consciousness (LOC) secondary to increased intracranial pressure (ICP). Which healthcare provider order should the nurse question? 1. Passive range-of-motion exercises to promote hip flexion 2. Oxygen at 2 L nasal cannula to keep saturation above 95% 3. Hourly vital signs and neurologic checks 4. Elevate head of bed 30 degrees

1. Passive range-of-motion exercises to promote hip flexion

Which interventions should the nurse include in the plan of care for a child who is diagnosed with an intellectual disability? Select all that apply. 1. Providing emotional support to the family 2. Maintaining a safe environment for the client 3. Educating the family that maintenance of activities of daily living (ADL) is impossible to achieve 4. Participating in the individualized education program (IEP) process 5. Recommending permanent institutionalization

1. Providing emotional support to the family 2. Maintaining a safe environment for the client 4. Participating in the individualized education program (IEP) process

Which interventions will facilitate positive coping in a preschool-age child after a deadly explosion in the neighborhood where the child lives? (Select all that apply.) a. Spending time with the child b. Postponing planned family events c. Accepting delayed reactions in the child d. Initiating detailed discussion about the event e. Limiting the amount of television the child watches following the event

a. Spending time with the child c. Accepting delayed reactions in the child e. Limiting the amount of television the child watches following the event

The single mother of a 10-year-old tells the clinic nurse that lately, her daughter has been withdrawn and waking up in the middle of the night crying. Which event does the nurse suspect after speaking with the child and her mother? (Select all that apply.) a. The child started a new school last week. b. The mother is recently divorced. c. The mother has a new boyfriend. d. The child is popular in school e. Mother and father share visitation.

a. The child started a new school last week b. The mother is recently divorced c. The mother has a new boyfriend e. Mother and father share visitation.

A 3-year-old is hospitalized with a fractured femur. Which assessment represents a protective factor that will facilitate the child's adaptation to the hospitalization? a. The child's parents take turns staying with him so that he is never alone. b. The parents state that they do not have insurance and will have to pay for the hospitalization. c. The child's sister must remain at the hospital because there is no one to take care of her at home. d. The parents state that the child's immunization status is not current.

a. The child's parents take turns staying with him so that he is never alone.

A nurse is caring for a 15-year-old male who is recovering from a concussion after hitting his head during a fall while playing basketball. Which educational statement would be important for the nurse to present to this family? a. The client can experience personality changes within the next 6 months. b. Concussions usually are associated with skull fractures. c. If the client has another concussion in the near future, recovery time should remain the same. d. The client should not play sports for 1 year after the concussion.

a. The client can experience personality changes within the next 6 months.

A nurse is making a home visit for a 6-year-old with intellectual disability. Which assessment finding would indicate the need for further discussion with the family? a. The nurse notices household cleaners stored under the kitchen sink. b. The parents state that they are comfortable with caring for the child's toileting needs. c. The child has an individualized education plan (IEP). d. The family has support watching the child from a grandparent.

a. The nurse notices household cleaners stored under the kitchen sink.

The nurse is working with a 3-year-old client. Which finding is the most indicative of abuse in a toddler? a. The toddler is extremely compliant with the nurse during the initial assessment. b. The child tries to push the nurse away during the assessment. c. The nurse observes that the child has multiple bottle caries. d. The toddler cries when the nurse does her assessment.

a. The toddler is extremely compliant with the nurse during the initial assessment.

A nurse is providing discharge teaching to the family of a child that just had a ventriculoperitoneal shunt placed. Which statements would indicate that the parents understand the teaching? a. "There is no chance that my child will have a seizure as long as the shunt is functioning correctly." b. "We should let our doctor know if the child complains of double vision." c. "Our child does not need to be followed by any early-intervention programs unless a problem develops." d. "We will observe for symptoms of shunt malfunction until our child has had the shunt for 6 months."

b. "We should let our doctor know if the child complains of double vision."

A nurse is caring for a child hospitalized for osteomyelitis. Which interventions should be included in the child's plan of care? (Select all that apply.) a. Assess for rising ESR levels, which indicate healing. b. Assess the child for signs of infection. c. Encourage increased fluid intake. d. Avoid administration of opioid analgesics for pain. e. Administer intravenous antibiotics.

b. Assess the child for signs of infection c. Encourage increased fluid intake e. Administer intravenous antibiotics.

A nurse is evaluating an 8-year-old female who demonstrates the following behaviors: "daydreaming," poor school performance, constant fidgeting, interrupting others, and mood swings. Her speech development is appropriate for her age. Which disorder would the nurse suspect? a. Depression b. Attention-deficit hyperactivity disorder c. Mental retardation d. Autism

b. Attention-deficit hyperactivity disorder

The night nurse is performing an assessment on a 7-year-old who presented to the emergency department with a crush injury following a bike accident this morning and who now has a cast on his leg. The nurse notes the child is crying despite the morphine given 20 minutes ago, has tight skin around the cast, and complains of a burning sensation in the limb. Which condition does the nurse suspect? a. Dislocation of the joint b. Compartment syndrome c. Osteogenesis imperfecta d. Marfan syndrome

b. Compartment syndrome

A nurse is evaluating a 16-year-old female with bipolar disorder. Which finding would indicate that she is responding to her medication and therapy? a. Absence of hallucinations b. Demonstrated interest in school, family, and other life events c. Absence of perfectionist behavior d. No complaints of anxiety

b. Demonstrated interest in school, family, and other life events

A 5-year-old is admitted to the hospital with suspected meningitis. Which nursing intervention would be included in the child's plan of care? a. Measure the head circumference. b. Dim the lights and quiet room as needed. c. Play music that the child enjoys. d. Provide a high-calorie diet.

b. Dim the lights and quiet room as needed.

The nurse is obtaining health histories on pediatric clinic clients. Which history finding would support the diagnosis of intellectual disability? a. Cerebral palsy b. Fragile X syndrome c. Schizophrenia d. Tourette syndrome

b. Fragile X syndrome

Which interventions would be appropriate in providing care for a child in skeletal traction? (Select all that apply.) a. Rotate pins every hour while traction is in place. b. Make sure the weights are in the proper position. c. After traction equipment is removed, provide skin care every hour. d. Apply an antibiotic ointment around the pin, if ordered. e. Clean the pins, when ordered, with normal saline.

b. Make sure the weights are in the proper position d. Apply an antibiotic ointment around the pin, if ordered e. Clean the pins, when ordered, with normal saline.

Which nursing interventions would be appropriate for a child with muscular dystrophy? (Select all that apply.) a. Provide resources to the parents related to developmental norms for the child's age. b. Teach the family proper body mechanics. c. Suggest swimming as a good exercise for this child. d. Encourage the parents to perform all care for the child. e. Immunize the child on the recommended schedule.

b. Teach the family proper body mechanics c. Suggest swimming as a good exercise for this child e. Immunize the child on the recommended schedule.

A nurse is assessing the wound of an 8-year-old female who suffered a scalp laceration while playing Frisbee. Which observation by the nurse is the most concerning? a. The extensive bleeding b. The indentation from the Frisbee c. The length of the laceration d. The hypovolemia from the bleeding

b. The indentation from the Frisbee

If the nurse is triaging a child with autism, which intervention would be appropriate? a. While caring for the child, move her to several different areas of the office. b. Use speech and pictures to communicate with the child. c. Play music at a high volume. d. Let the child sit in the waiting room as long as possible to reduce movement.

b. Use speech and pictures to communicate with the child.

Which situation would alert the school nurse that a child requires additional assessment for Legg-Calvé-Perthes disease? a. A 16-year-old girl with swollen knees and ankles who is limping b. A 10-year-old boy with a fever and complaints of knee pain c. A 7-year-old boy who limps and states that his hip hurts d. A 7-year-old girl complaining of a muscle spasm in her calf

c. A 7-year-old boy who limps and states that his hip hurts

A nurse is evaluating a child for compartment syndrome after fracture reduction. Which assessment finding would alert the nurse to the presence of this complication? a. Capillary refill under 3 seconds b. Pink extremities distal to the cast c. Absence of space between the cast and extremity d. Pain relieved by medication

c. Absence of space between the cast and extremity

The community health nurse has performed an assessment of an economically depressed neighborhood and recognizes that the area's children are exposed to several hazards. What should the nurse plan to do first? a. Plan a program that teaches parents about child safety. b. Refer children in the neighborhood for drug screening. c. Assess young children in the neighborhood for symptoms of lead poisoning. d. Ask the city council to provide a safe place for children to play.

c. Assess young children in the neighborhood for symptoms of lead poisoning.

Parents bring a 3-year-old to the emergency department stating that the child has just had her first seizure. The seizure lasted less than 5 minutes and involved jerking movements over the entire body. Prior to the seizure, the child had been sick and started running a fever. Based on the description, the nurse suspects that the child experienced which type of seizure? a. Partial b. Status epilepticus c. Febrile d. Generalized

c. Febrile

When assessing a 6-year-old female diagnosed with intellectual disability during a routine clinic visit, the nurse notes the child has a low nasal bridge with a short upturned nose and a history of hearing loss and poor coordination. Which type of intellectual disability does the nurse suspect? a. Fragile X syndrome b. Down syndrome c. Fetal alcohol syndrome d. Maternal infection

c. Fetal alcohol syndrome

The nurse is evaluating a 14-year-old on a selective serotonin reuptake inhibitor. Which assessment findings would be indicative of a side effect known as serotonin syndrome? (Select all that apply.) a. Headaches b. Hirsutism c. Fever d. Muscle twitching e. Confusion

c. Fever d. Muscle twitching e. Confusion

Which assessment finding would the nurse not find in a 4-year-old child with neurofibromatosis? a. Walking with a limp b. Seizure activity c. Increased head circumference d. Café au lait spots

c. Increased head circumference

A nurse is evaluating a 3-year-old with a developmental delay. Which assessment finding would indicate that this child might have a type of autistic spectrum disorder? a. The child does not enjoy playing with the same toy repeatedly. b. The child enjoys imaginative play. c. The 3-year-old is using echolalia. d. The child goes to bed without a nighttime routine.

c. The 3-year-old is using echolalia.

Which consideration would be important in planning nursing care for an infant following surgical insertion of a ventriculoperitoneal shunt? a. Pain relief interventions are not utilized routinely for infants. b. Some nuchal rigidity is expected after this procedure. c. The infant is placed in a flat supine position immediately after surgery. d. Administration of intravascular volume expanders is necessary to maintain shunt function.

c. The infant is placed in a flat supine position immediately after surgery.

The nurse has instructed the parents of a 4-year-old with genu valgum. Which statement made by the parents demonstrates understanding of the teaching? a. "This deformity was caused by a vitamin D deficiency." b. "Casting will be needed to correct the deformity." c. "This deformity is a manifestation of Blount disease." d. "This is a normal developmental issue that will improve as the child grows."

d. "This is a normal developmental issue that will improve as the child grows."

Which adolescent would the nurse identify as being at highest risk to commit suicide? a. A male varsity athlete who has been depressed over losing a job b. A female honor student who just broke up with a boyfriend c. A female who has talked about killing herself but stated that she feels supported by her mother d. A male who has guns at home and just broke up with a girlfriend

d. A male who has guns at home and just broke up with a girlfriend`

A school nurse is evaluating a child whose leg was hurt in gym class. The nurse thinks it is a muscle strain but is still going to refer the child to the primary healthcare provider (PCP). Which instruction should the child follow until seen by the PCP? a. Increase motion to the extremity. b. Try to walk on it, even if pain is experienced. c. Go back to gym class and participate. d. Apply ice for 20 minutes at a time.

d. Apply ice for 20 minutes at a time.

A nurse is caring for an infant with myelomeningocele following surgical postoperative repair. What would be an important nursing intervention for this client? a. Place the infant in a supine position with the head elevated. b. Cover the surgical site with sterile, saline-soaked gauze. c. Measure the head circumference every other day. d. Assess the surgical site for cerebrospinal fluid leakage and symptoms of infection.

d. Assess the surgical site for cerebrospinal fluid leakage and symptoms of infection.

The mother of a 15-year-old boy with facial trauma brings him into the emergency department. Upon completion of the admission history, the nurse suspects that another person intentionally caused the child's injuries. What are the appropriate nursing actions in this situation? (Select all that apply.) a. Calling the police b. Calling Protective Services c. Asking the intern to validate the nurse's suspicion d. Following the facility's policy e. Questioning the client without the parent present

d. Following the facility's policy e. Questioning the client without the parent present

When evaluating a child who complains of headaches, which description would lead the nurse to suspect migraine headaches? a. Headaches associated with stress only b. Headaches associated with frequent use of acetaminophen c. Headaches associated with sinus pressure and upper-respiratory symptoms d. Headaches associated with an aura prior to onset

d. Headaches associated with an aura prior to onset

Which clinical manifestations support the diagnosis of viral meningitis? Select all that apply. 1. Abrupt onset of fever 2. Headache 3. Myalgia 4. Hemorrhagic rash 5. Purpura

1. Abrupt onset of fever 2. Headache 3. Myalgia

During a well-child examination, the parents of a 4-year-old client inform the nurse that they are thinking of buying a television for their child's bedroom and ask for advice as to whether this is appropriate. Which response by the nurse is most appropriate? 1. "It is okay for children to have a television in their room as long as you limit the amount of time they watch it to less than 2 hours per day." 2. "Research has shown that watching educational television shows improves a child's performance in school." 3. "Don't buy a television for your child's room; he is much too young for that." 4. "Research has shown that children with a television in their bedroom spend significantly less time playing outside than other children."

4. "Research has shown that children with a television in their bedroom spend significantly less time playing outside than other children."

Which parental statement would cause the nurse to include further education related to the care required for a child who is diagnosed with congenital clubfoot? 1. "We're getting a special car seat to accommodate the casts." 2. "We'll watch for any swelling of the feet while the casts are on." 3. "We'll keep the casts dry." 4. "We're happy this is the only cast our baby will need."

4. "We're happy this is the only cast our baby will need."

Which children should the nurse identify as exhibiting a delay in meeting developmental milestones? Select all that apply. 1. An 18-month-old toddler who is unable to speak in sentences 2. A 2-year-old child who is unable to cut with scissors 3. A 2-year-old child who cannot recite her phone number 4. A 6-year-old child who is unable to sit still for a short story 5. A 5-year-old child who is unable to button his shirt

4. A 6-year-old child who is unable to sit still for a short story 5. A 5-year-old child who is unable to button his shirt

Which action by the nurse is appropriate for a child who presents in the emergency department with an ankle injury? 1. Avoid compressing the area to allow tissue swelling as necessary. 2. Perform passive range-of-motion to the extremity. 3. Lower the extremity below the level of the heart. 4. Apply ice to the extremity.

4. Apply ice to the extremity.

A 7-year-old child is seen in the pediatric clinic 3 times in the last 2 months for complaints of abdominal pain. On each occasion, the physical examination and all ordered laboratory work have been normal. Which is the priority nursing assessment at this time? 1. The child's normal eating habits 2. Recent viral illnesses or other infectious symptoms 3. Review of the child's immunization history 4. Changes in school or home life

4. Changes in school or home life

A 4-year-old client with intractable seizures has been on a ketogenic diet for the last 6 months, with a decrease in seizure activity. This child is now admitted to the pediatric unit with left-sided pain. Which possible complication to this diet does the nurse suspect? 1. Appendicitis 2. Bowel obstruction 3. Urinary tract infection 4. Kidney stones

4. Kidney stones

A child with a history of seizures arrives in the emergency department (ED) in status epilepticus. Which is the priority nursing action? 1. Take vital signs. 2. Establish an intravenous line. 3. Perform rapid neurologic assessment. 4. Maintain patent airway.

4. Maintain patent airway.

Which clinical manifestations should the nurse expect when assessing a pediatric client who is diagnosed with Legg-Calvé-Perthes disease? Select all that apply. 1. Limited abduction of the affected hip 2. Asymmetry of thigh fat folds 3. Telescoping of the thigh 4. Muscle weakness 5. Atrophy of the muscles

4. Muscle weakness 5. Atrophy of the muscles

A neonate with a meningomyelocele is to have surgery in the morning. Which nursing action is appropriate for this neonate? 1. Applying a diaper to prevent contamination of sac 2. Positioning the newborn in a side-lying position 3. Encouraging the mother to hold the newborn because she will not be able to pick him up after surgery 4. Positioning the newborn in a prone position

4. Positioning the newborn in a prone position

A child is admitted to the hospital unit for physical injuries. The mother's boyfriend is suspected of child abuse. Which is the primary role of the nurse in addition to reporting the information to the proper authorities? 1. Gathering information about how the injuries occurred. 2. Collecting evidence against the suspected abuser. 3. Encouraging the child to talk about his experience. 4. Protecting the child from further injury.

4. Protecting the child from further injury.

The nurse is providing care to homeless adolescents at an outreach clinic. Which concept is important for the nurse to consider when providing care to this population? 1. Teens who are homeless will get a job and somewhere to live. 2. Teens who are homeless will seek help when needed. 3. Teens who are homeless will not be fearful of authority figures. 4. Teens who are homeless are most likely to have unprotected sex.

4. Teens who are homeless are most likely to have unprotected sex.

A teacher states to the school nurse, "I have a student who will often just stare at me for 15 seconds after asking a question; then the student blinks and asks me to repeat the question. Should I be concerned?" Which should the nurse include in the response to the teacher? 1. The child has a crush on the teacher. 2. The child has increased intracranial pressure. 3. The child may have had a head injury. 4. The child is experiencing absence seizures.

4. The child is experiencing absence seizures.

A school nurse suspects that a child who fell at recess has a fractured arm. Which should the nurse consider when applying a splint to transport the child to the hospital? 1. The splint is applied firmly enough to prevent swelling. 2. The arm is fully extended in the splint. 3. The splint is fully padded to prevent skin damage. 4. The joints above and below the suspected fracture are immobilized by the splint.

4. The joints above and below the suspected fracture are immobilized by the splint.

While taking the history of a 10-year-old child, the parents admit to owning firearms. Which should the nurse suggest to enhance the child's safety based on this information? 1. Keeping all the guns put away and out of the child's reach 2. Taking the child to a shooting range for lessons on how to use a gun properly 3. Storing the guns and ammunition in the same place 4. Using a gun lock on all firearms in the house

4. Using a gun lock on all firearms in the house

The nurse learns that a homeless 12-year-old brought into the clinic due to flu symptoms is also mentally handicapped. What other risk factors to healthcare might the family be experiencing? (Select all that apply.) a. Poverty b. Mental illness c. Lack of access to resources d. Financial stability e. Racial disparities

a. Poverty b. Mental illness c. Lack of access to resources e. Racial disparities

A nurse is evaluating an adolescent for a mental health problem. Which assessment criteria would be the most important? (Select all that apply.) a. Review of systems b. How many hours of television are watched per day c. Blood pressure d. Height e. Substance-use activity

a. Review of systems c. Blood pressure d. Height e. Substance-use activity

A nurse is evaluating a 1-year-old for possible cerebral palsy. Which findings could be indicators of cerebral palsy? (Select all that apply.) a. Presence of the rooting reflex b. No demonstration of hand dominance c. Vocabulary limited to three words: "mama," "dada," and "ball" d. Frequent arching of the back e. Crawling with three extremities

a. Presence of the rooting reflex d. Frequent arching of the back e. Crawling with three extremities

The nurse is assessing the level of consciousness of a 10-year-old client in the emergency department. What would be important questions for the nurse to ask the child or the parent? (Select all that apply.) a. "Has the child been huffing (ingesting) any household products?" b. "Has the child had recent head trauma?" c. "Has the child ever had a brain tumor or shunt?" d. "Does the child have animals at home?" e. "Has the child been sick?"

a. "Has the child been huffing (ingesting) any household products?" b. "Has the child had recent head trauma?" c. "Has the child ever had a brain tumor or shunt?" e. "Has the child been sick?"

A nurse is caring for a child who has just received a cast. Which considerations would be the most important in providing care for this child? a. Assess the casted extremity every 15-30 minutes the first 2 hours after cast application. b. When handling the cast in the first 24 hours, use fingertips only. c. Give the child a blunt object to help with the itching under the cast. d. Apply powder to the inside edges of the cast to help decrease moisture.

a. Assess the casted extremity every 15-30 minutes the first 2 hours after cast application.

A 16-year-old female involved in an MVC had to have her left arm amputated. Which nursing diagnosis is most important when planning care for this client? a. Body Image, Altered b. Mobility: Physical, Impaired c. Infection, Risk for d. Low Self-Esteem, Situational

a. Body Image, Altered

The nurse is assessing an adolescent. The nurse notes that the teen has bloodshot eyes and dilated pupils and has lost weight. What should the nurse suspect based on these assessment findings? a. Drug abuse b. Suicidal ideations c. Smoking d. Intoxication

a. Drug abuse

A nurse is evaluating a child for a learning disability. The child has trouble only with math. Which diagnosis supports this type of learning disability? a. Dyscalculia b. Dyslexia c. Dyspraxia d. Dysgraphia

a. Dyscalculia

The nurse is planning a class on safety for a group of middle school-age children. Which safety intervention is the most important for the nurse to include in the class? a. Helmet use when riding a bike b. Use of a helmet and kneepads with indoor roller-skating c. Use of knee pads when Rollerblading d. Need for elbow pads when riding a scooter

a. Helmet use when riding a bike

What is the most appropriate nursing diagnosis for an adolescent who smokes? a. Knowledge Deficit regarding dangers of smoking related to developmental focus on the present b. Impaired Social Interaction related to altered thought processes c. Risk for Injury related to altered sensorium and perception d. Hopelessness related to stressful home environment

a. Knowledge Deficit regarding dangers of smoking related to developmental focus on the present

The school nurse is screening the 6th-graders for scoliosis. The nurse notes that one of the students has excessive convex curvature of the cervical thoracic spine. What does this finding indicate? a. Kyphosis b. Torticollis c. Scoliosis d. Lordosis

a. Kyphosis

The nurse is planning care for a child with an intellectual disability. Which intervention does the nurse teach is most important? a. Maintaining a safe environment b. Transitioning to a group home c. Allowing the child to provide self-care d. Teaching communication skills

a. Maintaining a safe environment

A child has been seen six times in the clinic in the last month because of "severe vomiting." The child's physical exam is normal, electrolytes are within normal limits, and the child is gaining weight appropriately. The mother expresses to the nurse that she is very concerned about her child's health. Based on this information, the child should be further evaluated for which of the following conditions? a. Munchausen syndrome by proxy b. Sexual abuse c. Physical abuse d. Physical neglect

a. Munchausen syndrome by proxy

A nurse is caring for an 18-year-old with a C2 injury to the spine following an MVC. Which intervention by the nurse is the most important? a. Observing for ventilator tube displacement b. Positioning the client upright c. Teaching the client how to self-catheterize d. Ensuring proper placement of gastrostomy tube

a. Observing for ventilator tube displacement