NCLEX - Toddler

The nurse is teaching a parent how to administer antibiotics at home to a toddler with acute otitis media. Which statement by the parent indicates that teaching has been successful?

1. "I'll give the antibiotics for the full 10-day course of treatment."

The nurse is trying to determine if the risks associated with lead poisoning are present in a toddler's home environment. Which question should the nurse ask the toddler's mother?

1. "Is your child ever exposed to well water?"

The mother of a hospitalized 3-year-old girl expresses concern because her daughter is wetting the bed. What should the nurse tell her?

1. "It's common for a child to exhibit regressive behavior when anxious or stressed."

The charge nurse overhears a nurse complaining that she has been assigned to a toddler diagnosed with tetralogy of Fallot for the past 3 days and the mother is very demanding. Which response by the charge nurse is best?

1. "It's important for the child to have someone assigned to him who's familiar with his care."

Which nursing diagnosis takes highest priority for a child in the early stages of burn recovery?

1. Risk for infection

The nurse is admitting a 14-month-old client to the pediatric floor with a diagnosis of croup. Which characteristics would the nurse expect the toddler to have if he is developing normally? Select all that apply:

1. Strong hand grasp 2. Tendency to hold one object while looking for another 3. Recognition of familiar voices (smiles in recognition) 5. Weight that is triple the birth weight

A 2-year-old child with a tracheostomy suddenly becomes diaphoretic and has an increased heart rate, an increased respiratory rate, and a decreased oxygen saturation level. Which of the following should be the nurse's first action?

1. Suction the tracheostomy.

The nurse is teaching a group of mothers about normal toddler development. When talking about toddlers' play, the nurse should include which point?

1. They play with similar objects nearby other children rather than with them.

Which I.M. injection site might the nurse use for a 2-year-old child?

1. Ventrogluteal muscle

A toddler is brought to the emergency department with sudden onset of abdominal pain, vomiting, and stools that look like red currant jelly. To confirm intussusception, the suspected cause of these findings, the nurse expects the physician to order:

1. a barium enema.

A 2-year-old child is brought to the emergency department with a history of upper airway infection that has worsened over the last 2 days. The nurse suspects the child has croup. Signs of croup include a hoarse voice, inspiratory stridor, and:

1. a barking cough.

A 3-year-old child comes to the clinic for a wellness checkup. When the nurse weighs the child, she notes a 10-lb weight gain since his last checkup 1 year ago. The nurse recognizes that this weight gain is:

1. excessive for a toddler, requiring further data collection.

A child with osteomyelitis is to receive nafcillin (Nafcil) I.V. every 6 hours. Before administering the drug, the nurse calculates the appropriate dosage. The recommended dosage is 50 to 100 mg/kg daily; the child weighs 22 lb (10 kg). Which dosage is acceptable?

2. 250 mg every 6 hours

When caring for a toddler, the nurse should understand that a child in this age-group works to achieve which developmental task?

2. Autonomy

An 18-month-old Hispanic toddler admitted to the hospital with bronchitis has red marks on his upper chest over both sides of his body. The mother states that she has been treating him at home. Which treatment has the mother most likely been administering to her toddler?

2. Coin rubbing

The nurse is advising a mother about foods to avoid to prevent choking in her toddler. Which foods should she include in her instruction?

2. Large, round chunks of meat such as hot dog

The nurse is teaching parents about accident prevention for a toddler. Which of the following guidelines is most appropriate?

2. Make sure all medications are kept in containers with childproof safety caps.

The nurse is teaching a group of mothers about accident prevention for toddlers. Which point is important for the nurse to emphasize?

2. Making sure outlets are covered with plastic outlet covers that can't be removed by a child

The nurse observes a 2½-year-old child playing with another child of the same age in the playroom on the pediatric unit. What type of play should the nurse expect the children to engage in?

2. Parallel play

An 18-month-old child immobilized with traction to the legs has a nursing diagnosis of Deficient diversional activity related to immobility. The nurse should include which diversional activity in the plan of care?

2. Playing with a pounding board

A 14-month-old is undergoing bone marrow aspiration because leukemia is suspected. A local anesthetic is administered, but the nurse anticipates that a nonpharmacologic comfort measure will also be needed. Which measure is best for a toddler at this age?

2. Reading the toddler a book during the procedure

The physician prescribes 300,000 U of penicillin G I.M., for an 18-month-old child. What is the best site for the nurse to administer this injection?

2. Thigh (vastus lateralis muscle)

A child's parents state that they childproofed their home for their 2-year-old boy. During a home visit, the nurse discovers some situations that show the parents don't fully understand the developmental abilities of their toddler. Which of the following situations displays misunderstanding by the parent?

2. Toy chest in front of a second-story, locked window

When caring for a 2-year-old child, the nurse should offer choices, when appropriate, about some aspects of care. According to Erikson, doing this helps the child achieve:

2. autonomy.

The nurse is caring for a toddler who has just been immunized. When teaching the child's parents about potential adverse effects, the nurse should instruct the parents to immediately report:

2. generalized urticaria.

A 2-year-old is admitted to the pediatric unit with fever, seizures, and vomiting. He's awake and irritable. As the nurse is putting a gown on the child, the nurse notices petechiae across the child's chest, abdomen, and back. The nurse should first:

2. initiate droplet precautions.

An emergency department nurse suspects neglect in a 3-year-old boy admitted for failure to thrive. Signs of neglect in the child would include:

2. poor hygiene and weight loss.

A child, age 2, with a history of recurrent ear infections is brought to the clinic with a fever and irritability. To elicit the most pertinent information about the child's ear problems, the nurse should ask the parent:

3. "Does your child tug at either ear?"

The nurse in the pediatrician's office is teaching the mother of a 3-year-old about car seat safety. The mother questions the nurse as to why her son requires a car seat when he weighs 35 lb. Which response by the nurse is best?

3. "He should ride in the car seat until he's at least 40 pounds and 4 years old."

A family of four involved in a house fire is brought to the hospital for treatment of burns. The local media arrives at the hospital requesting information about the condition of the family members. Which response by the nurse is most appropriate?

3. "I need to obtain permission from the parents or their representative before I can release any information."

To treat a child's atopic dermatitis, a physician prescribes a topical application of hydrocortisone cream twice daily. After medication instruction by the nurse, which statement by the parent indicates effective teaching?

3. "I will avoid using soap and water on the affected area and will apply an emollient cream on this area frequently."

A child, age 15 months, is admitted to the health care facility. During the initial data collection, which statement by the mother most strongly suggests that the child has a Wilms' tumor?

3. "My child's abdomen seems bigger, and his diapers are much tighter."

After the nurse explains dietary restrictions to the parents of a child with celiac disease, which statement by the parents indicates effective teaching?

3. "Our child must maintain these dietary restrictions for life."

A 15-month-old child is being discharged after treatment for severe otitis media and bacterial meningitis. Which statement by the parents indicates effective discharge teaching?

3. "We'll go to the physician if our child pulls on his ears or won't lie down."

When collecting data on an 18-month-old child, the nurse determines that the child's height and weight fall below the 5th percentile on the growth chart. In all previous visits, the child's height and weight fell between the 30th and 40th percentiles. The child's mother expresses concern about the slowed growth rate. How should the nurse respond?

3. "Your child's height and weight should be checked again in 1 month."

When the physician prescribes an antibiotic to treat a child's ear infection, the nurse checks to see whether the ordered antibiotic could cause ototoxicity. Which of the following options belongs in this category?

3. Aminoglycosides

When assisting in developing a plan of care for a toddler with a seizure disorder, which of the following would be inappropriate?

3. Arm restraints while asleep

A nurse who's functioning as the team leader on the infant and toddler unit is working with a licensed practical nurse (LPN) and a nursing assistant. The team leader notices that the nursing assistant is sitting at the desk while the LPN is very busy with her assignment and appears frustrated. What action should the team leader take?

3. Ask the LPN why she's frustrated and ask the nursing assistant to help the LPN with her work.

For a child with a Wilms' tumor, which preoperative nursing intervention takes highest priority?

3. Avoiding abdominal palpation

For a child with a circumferential chest burn, what is the most important factor for the nurse to monitor?

3. Breathing pattern

A parent brings a toddler, age 19 months, to the clinic for a regular checkup. When palpating the toddler's fontanels, what should the nurse expect to find?

3. Closed anterior and posterior fontanels

A toddler with hemophilia is hospitalized with multiple injuries after falling off a sliding board. X-rays reveal no bone fractures. When caring for the child, what is the nurse's highest priority?

3. Frequently monitoring the child's level of consciousness (LOC)

A nurse on the pediatric unit who's assigned to the performance improvement committee identifies that admission assessments aren't being completed within the timeframe designated in their standards. Which action should she take first?

3. Notify the nurse-manager so she can identify contributing factors and devise an action plan.

A toddler is having a tonic-clonic seizure. What should the nurse do first?

3. Remove objects from the child's surroundings.

A 14-month-old child with acquired immunodeficiency syndrome (AIDS) is admitted to the facility with an infection. When assisting in developing a plan of care, the nurse must keep in mind that AIDS in children commonly is associated with:

3. developmental delays.

The nurse is caring for a toddler with Down syndrome. To help the toddler cope with painful procedures, the nurse can:

3. hold and rock him and give him a security object.

The parents of a 2-year-old scheduled for surgical repair of an inguinal hernia are fearful and their fears are affecting their child. A play therapist is consulted to help with the child's care. The nurse should explain to the parents that the play therapist will:

3. use puppets to gain insight into how the child feels about his hospitalization and fears.

A boy, age 3, develops a fever and rash and is diagnosed with rubella. His mother has just given birth to a baby girl. Which statement by the mother best indicates that she understands the implications of rubella?

4. "I'll call my neighbor who's 2 months pregnant and tell her not to have contact with my son."

The nurse in a clinic walks into a client's room and finds the mother of a 15-month-old child in tears. The mother states that her child doesn't love her because the child says "no" to everything. Which of the following would be an appropriate response?

4. "Saying 'no' is part of toddler development and is normal at this age."

When teaching the mother of a 17-month-old child about toilet training, which instruction would initially be most appropriate?

4. Be sure the child is ready before starting to toilet train.

A toddler with bacterial meningitis is admitted to the inpatient unit. Which infection control measure should the nurse be prepared to use?

4. Droplet precautions

A toddler is brought to the emergency department in cardiac arrest. The physician tries three times to insert an I.V. catheter but is unsuccessful. By which alternate route can the physician administer emergency medications?

4. Intraosseously

A toddler requires emergency intervention for an obstructed airway. Which nursing intervention is appropriate?

4. Performing the tongue-jaw lift and removing the foreign object only if it's visible

Which of the following objects poses the most serious safety threat to a 2-year-old child in the hospital?

4. Side rails in the halfway position

The nurse is caring for a child with a fractured leg. The child's mother becomes concerned when she visits her son and notices him sucking his thumb, a behavior that he had previously given up. What does this behavior indicate?

4. The child is responding to stress.

Which desired outcome demonstrates effective parent teaching about disciplining a toddler?

4. The parents will call immediate attention to undesirable behavior.

A toddler is ordered 350 mg of amoxicillin and clavulanate (Augmentin) by mouth, four times per day. The pharmacy sends a bottle with a concentration of 250 mg/5 ml. How many milliliters should the nurse administer per dose?

7

A physician prescribes 150 mg of ibuprofen (Advil) for a toddler whose temperature didn't lower after receiving acetaminophen (Tylenol). The oral suspension available contains 100 mg per 5 ml. How many milliliters of suspension should the nurse administer?

7.5

A 2 ½-year-old child, admitted with nephrotic syndrome, has been in the hospital for 24 hours. When the nurse makes her 8 a.m. rounds she notices that no care has been documented for this child since 6 a.m. Which action by the nurse takes priority?

1. Repositioning the child

The nurse should expect a 3-year-old child to be able to perform which action?

1. Ride a tricycle

When attempting to reduce the risk of impaired skin integrity related to immobility in a toddler, which action should the nurse take?

1. Gently massage the skin with a lubricating substance.

A child, age 2, is brought to the emergency department after ingesting an unknown number of aspirin tablets about 30 minutes earlier. On entering the examination room, the child is crying and clinging to his mother. Which data should the nurse obtain first?

1. Heart rate, respiratory rate, and blood pressure

A 2-year-old child is brought to the emergency department with suspected croup. Which data collection finding reflects increasing respiratory distress?

1. Intercostal retractions

The physician prescribes acetaminophen (Tylenol) elixir, 160 mg every 4 hours, for a 14-month-old child who weighs 20 lb (9.08 kg). This drug, supplied in a bottle labeled 160 mg/tsp, has a safe dosage of 10 mg/kg/dose. The nurse should administer how many milliliters?

1. None because this isn't a safe dose

A mother tells the nurse that she wants to begin toilet training her 22-month-old child. The most important factor regarding toilet-training that the nurse should stress to her is:

1. developmental readiness of the child.

A nurse on the pediatric floor is caring for a toddler. The nurse should keep in mind that toddlers:

1. express negativism.

A parent calls the pediatric clinic to express concern over her toddler's eating habits. She says the toddler eats very little and consumes only a single type of food for weeks on end. The nurse knows that this behavior is characteristic of:

1. normal toddler behavior.

A toddler is diagnosed with iron deficiency anemia. When teaching the parents about using supplemental iron elixir, the nurse should provide which instruction?

2. "Give the elixir with water or juice."

The nurse explains hospice care to the parents of a 15-month-old toddler with terminal neuroblastoma. Which explanation by the nurse is best?

2. "Hospice provides services to improve the quality of life for the child who's suffering from a terminal illness and for his family."

The nurse is collecting data on a 3-year-old child who has ingested toilet bowl cleaner. What finding should the nurse expect?

2. Edematous lips

A 13-month-old client is admitted to the pediatric unit with a diagnosis of gastroenteritis. The toddler has experienced vomiting and diarrhea for the past 3 days, and laboratory tests reveal that he is dehydrated. Which nursing interventions are correct to prevent further dehydration? Select all that apply:

2. Give clear liquids in small amounts. 4. Encourage the child to eat nonsalty soups and broths. 5. Monitor the I.V. solution per the physician's order.

A 16-month-old with a history of hydrocephalus is admitted with an infected ventriculoperitoneal shunt. Which assessment takes priority in this toddler?

2. Monitor for signs of increased intracranial pressure.

A 15-month-old admitted with meningitis develops a rectally obtained fever of 105° F (40.5° C). The registered nurse inserts an I.V. catheter and antibiotics are administered. Which step should be taken next by the licensed practical nurse caring for the toddler?

2. Obtaining an order for an antipyretic and administering it immediately

A 3-year-old client is admitted to the pediatric unit with pneumonia. He has a productive cough and appears to have difficulty breathing. The parents tell the nurse that the toddler hasn't been eating or drinking much and has been very inactive. Which interventions to improve airway clearance should be included by the nurse in the care plan? Select all that apply:

2. Perform chest physiotherapy as ordered. 3. Encourage coughing and deep breathing. 5. Perform postural drainage. 6. Maintain humidification with a cool mist humidifier.

The nurse is teaching accident prevention to the parents of a toddler. Which of the following instructions is appropriate for the nurse to tell the parents?

2. Place locks on cabinets containing toxic substances.

A toddler is hospitalized with multiple injuries. Although the parent states that the child fell down the stairs, the child's history and physical findings suggest abuse as the cause of the injuries. What should the nurse do first?

2. Report the incident to the proper authorities.

The parents of a 2-year-old child with chronic otitis media are concerned that the disorder has affected their child's hearing. Which behavior suggests that the child has a hearing impairment?

2. Using gestures to express desires

The best way for the nurse to monitor pain in an 18-month-old child is to:

2. observe for behavioral changes.

When caring for a toddler with epiglottitis, the nurse should first:

2. prepare him for tracheotomy.

Which statement by the mother of a toddler with nephrotic syndrome indicates that the nurse's discharge teaching was effective?

3. "I've been checking the urine for protein so I'll be able to do it at home."

The physician prescribes meperidine (Demerol), 1.1 mg/kg I.M., for a 16-month-old child who has just had abdominal surgery. When administering this drug, the nurse should use a needle of which size?

3. 23G

A mother brings her child, age 3, to the clinic for an annual checkup. After plotting the child's height and weight on a pediatric growth chart, the nurse identifies which percentile range as normal?

3. 5th to 95th percentile

Before administering a tube feeding to a toddler, which of the following methods should the nurse use to check the placement of the nasogastric (NG) tube?

3. A check of the pH of fluid aspirated from the tube

An 18-month-old male child is admitted to the pediatric unit with a diagnosis of celiac disease. What finding would the nurse expect in this child?

3. A protuberant abdomen

When the nurse collects data on a 2-year-old child with suspected dehydration, which condition should be reported to the physician immediately?

3. Decreased blood pressure

When a toddler with croup is admitted to the facility, the physician orders treatment with a mist tent. As the parent attempts to put the toddler in the crib, the toddler cries and clings to the parent. What is the nurse's best approach for gaining the child's cooperation with the treatment?

3. Encourage the parent to stand next to the crib and stay with the child.

What is the best advice for a nurse to give to the parents of a 2-year-old child who frequently throws temper tantrums?

3. Ignore the behavior when it happens.

A 2-year-old who's admitted to the pediatric unit for a tonsillectomy is in foster care. The nurse assists the physician in gaining informed consent. Who can legally give informed consent for this elective procedure?

3. Parents or guardian

A mother tells the nurse that her 22-month-old child says no to everything. When scolded, the toddler gets angry and starts crying loudly but then immediately wants to be held. What is the best interpretation of this behavior?

3. This behavior is normal in a 2-year-old child.

The nurse should determine a child's body surface area by using:

3. a nomogram.

A 3-year-old child with Down syndrome is admitted to the pediatric unit with asthma. The child doesn't enunciate words well and holds onto furniture when he walks. The nurse should ask the mother:

3. how the child's condition today differs from his normal condition.

The nurse is providing dietary teaching for the parents of a child with celiac disease. This child should avoid:

3. prepared puddings.

The nurse is planning a health teaching session for parents of a toddler. When describing a toddler's typical eating pattern, the nurse should mention that many children of this age exhibit:

3. strong food preferences.

A physician is administering a medication by intraosseous infusion to a child. Intraosseous drug administration is typically used for a child who is:

3. younger than age 3 in an emergency situation when I.V. access isn't available.

An 18-month-old toddler comes into the emergency department after being found face down in the bathtub by his mother. She was able to administer cardiopulmonary resuscitation as instructed by the emergency telephone dispatcher. The toddler fully recovers and is ready for discharge. Which instruction should the nurse include during discharge teaching?

4. "Don't leave your child unattended in the bathtub even for a few minutes."

A 2-year-old is brought to the clinic by his mother for his annual examination. Which statement by the mother alerts the nurse to the toddler's risk for malnutrition?

4. "He drinks a bottle of whole milk several times a day."

A toddler is in the hospital. Which response to the parents, who are concerned about the seriousness of the child's illness, would be the most appropriate?

4. "It must be difficult for you when your child is ill and hospitalized."

A mother brings her toddler to the clinic for a wellness checkup. When the nurse asks the mother if she has questions or concerns, the mother tells the nurse she is frustrated because it's so difficult to get her child to bed at night. Which response by the nurse is best?

4. "Toddlers need a consistent bedtime routine, such as having a set bedtime, eating a light snack before going to bed, or reading a book."

When teaching the parents of a toddler with congenital heart disease, the nurse should explain all medical treatments and emphasize which instruction?

4. "Try to maintain your child's usual lifestyle to promote normal development."

A mother asks a nurse about measures for disciplining her toddler. Which recommendation by the nurse is best?

4. "When using a time-out, make sure your child knows the rules ahead of time."

The nurse teaches a mother how to provide adequate nutrition for her toddler, who has cerebral palsy. Which of the following observations indicates that teaching has been effective?

4. The child eats finger foods by himself.

A toddler is hospitalized for treatment of injuries that the staff believes were caused by child abuse. A staff member states that the parents "shouldn't be allowed to visit because they caused the child's injuries." When responding to this staff member, the nurse should base the comments on which understanding?

4. The parents should be encouraged to visit frequently and should be welcomed by the staff.

A 2-year-old child is brought to the emergency department with suspected croup. The child appears frightened and cries as the nurse approaches him. The nurse needs to listen to the child's breath sounds. The best way to approach the 2-year-old child is to:

4. allow the child to handle the stethoscope before listening to his lungs.

The physician prescribes digoxin (Lanoxin) elixir for a toddler with heart failure. Immediately before administering this drug, the nurse must check the toddler's:

4. apical pulse.

A 14-month-old child weighing 26 lb (11.8 kg) is admitted for traction to treat congenital hip dislocation. When preparing the client's room, the nurse anticipates using which traction system?

1. Bryant's traction

A mother brings her 13-month-old toddler to the clinic. The toddler has erythema and small vesicles that ooze on his buttocks. Which instruction should the nurse give the mother.

1. Change diapers frequently and use air-drying when possible.

The nurse is teaching parents about otitis media. When discussing why children are predisposed to this disorder, the nurse should mention the significance of which anatomical feature?

1. Eustachian tubes

Which of the following would be the best approach when trying to take a crying toddler's temperature?

3. Talk to the mother first and then to the toddler.

What should the nurse do to ensure a safe hospital environment for a toddler?

4. Move the equipment out of reach.

A toddler is diagnosed with a dislocated right shoulder and a simple fracture of the right humerus. Which behavior most strongly suggests that the child's injuries stem from abuse?

4. Not crying when moved

A toddler is admitted to the facility for treatment of a severe respiratory infection. The child's recent history includes fatty stools and failure to gain weight steadily. The physician diagnoses cystic fibrosis. By the time of the child's discharge, the child's parents must be able to perform which task independently?

4. Performing postural drainage

Which of the following activities should a 2-year-old child to be able to do?

4. Remove a garment.

A 2-year-old is admitted with failure to thrive. The child's mother expresses to the nurse that she doesn't have enough money to buy food for her child. Based on this information the nurse should request from the physician an order to consult which department?

4. Social services

The nurse is preparing to administer morning care to a 24-month-old admitted with respiratory syncytial virus bronchiolitis. Keeping in mind the extent to which a child in this age-group can help to meet his own hygiene needs, the nurse can expect to:

4. allow the toddler to bathe as much of himself as he can with supervision.