Pediatrics Practice Exam

74. A full-term infant is admitted to the newborn nursery. After careful assessment, the nurse suspects that the infant may have an esophageal atresia. Which symptoms is this newborn likely to have exhibited? a. Choking, coughing, and cyanosis. b. Projectile vomiting and cyanosis. c. Apneic spells and grunting. d. Scaphoid abdomen and anorexia.

A Rationale "Choking, coughing, and cyanosis" includes the "3 Cs" of esophageal atresia caused by the overflow of secretions into the trachea. Esophageal atresia is a congenital birth defect in which there is no connection between upper esophagus and the lower esophagus and stomach. The upper esophagus ends in a blind pouch.

16. To assess the effectiveness of an analgesic administered to a 4-year-old, what intervention is best for the nurse to implement? a. Use a happy-face/sad-face pain scale. b. Ask the mother if she thinks the analgesic is working. c. Assess for changes in the child's vital signs. d. Teach the child to point to a numeric pain scale.

A Rationale A 4-year-old can readily identify with simple pictures to show the nurse how he/she is feeling.

83. A burned child is brought to the emergency room. In estimating the percentage of the body burned, the nurse uses a modified "Rule of Nines." Which part of a child's body is calculated as a larger percentage of total body surface than an adult's? a. Head and neck. b. Arms and chest. c. Legs and abdomen. d. Back and abdomen.

A Rationale A child's head and neck are proportionately larger to their body than an adult's. The standard "Rule of Nines" is inaccurate for determining burned body surface areas with children, and must be modified for use with children. Specially designed charts for children are commonly used to determine body surface area involvement.

18. The parents of a 3-week-old infant report that the child eats well but, vomits after each feeding. What information is most important for the nurse to obtain? a. Description of vomiting episodes in past 24 hours. b. Number of wet diapers in last 24 hours. c. Feeding and sleep schedule. d. Amount of formula consumed during the past 24 hours.

A Rationale A description of the vomiting episodes will assist the nurse in determining the reason for the symptoms, which may be helpful in developing a plan of care for this infant.

22. A 6-month-old infant with congestive heart failure (CHF) is receiving digoxin elixir. Which observation by the nurse warrants immediate intervention? a. Apical heart rate of 60. b. Sweating across the forehead. c. Doesn't suck well. d. Respiratory rate of 30 breaths per minute.

A Rationale A heart rate of 60 beats per minute is much lower than normal for a 6-month-old and warrants immediate intervention. The normal heart rate for a 6-month-old is 80 to 150 beats per minute when awake, and a rate of 70 while sleeping is considered within normal limits.

7. The nurse is giving a liquid iron preparation to a 3-year-old child. Which technique should the nurse implement to engage the child's cooperation? a. Use a colorful straw. b. Mix the medication in water. c. Administer the medication using an oral syringe. d. Ask the pharmacy to provide an enteric tablet.

A Rationale A liquid iron preparation should be administered through a straw to help prevent staining of the teeth and may help the child to accept the medication since young children consider drinking from a colorful straw fun.

65. A 6-year-old is admitted to the pediatric unit after falling off a bicycle. Which intervention should the nurse implement to assist the child's adjustment to hospitalization? a. Explain hospital schedules to the child, such as mealtimes. b. Use terms, such as "honey" and "dear," to show a caring attitude. c. Provide a list of rules that limits visitation of siblings in the hospital. d. Orient the parents to the hospital unit and refreshment areas.

A Rationale Altered daily schedules and loss of rituals are upsetting to school-aged children and increase separation anxiety, and active sensitivity to the needs of children can minimize the negative effects of hospitalization. Explaining the hospital schedules and establishing an individual schedule familiarizes the child to the hospital environment and should decrease the child's anxiety.

50. As part of the physical assessment of children, the nurse observes and palpates the fontanels. Which child's fontanel finding should be reported to the healthcare provider? a. A 6-month-old with failure to thrive that has a closed anterior fontanel. b. A 24-month-old with gastroenteritis that has a closed posterior fontanel. c. A 2-month-old with chickenpox that has an open posterior fontanel. d. A 28-month-old with hydrocephalus that has an open anterior fontanel.

A Rationale At six months of age the anterior fontanel should be open, and it should not be closed until approximately 18 months of age. Premature closure of the fontanels is a condition called "craniosynostosis". The only treatment for this condition is surgery to reopen the fontanels, to allow and accommodate the infant's growing brain, otherwise if not surgical corrected, the infant will suffer severe neurological damage.

27. Which menu selection by a child with celiac disease indicates to the nurse that the child understands necessary dietary considerations? a. Oven-baked potato chips and cola. b. Peanut butter and banana sandwich. c. Oatmeal-raisin cookies and milk. d. Graham crackers and fruit juice.

A Rationale Celiac disease causes an intolerance to the protein gluten found in oats, rye, wheat, and barley. The child should avoid any products containing these ingredients to avoid symptoms such as diarrhea.

80. The nurse reviews the latest laboratory results for a child who received chemotherapy last week and identifies a reduced neutrophil count. Which nursing diagnosis has the highest priority for this child? a. Risk for infection. b. Risk for hemorrhage. c. Altered skin integrity. d. Disturbance in body image.

A Rationale Chemotherapy (CT) suppresses phagocytotic neutrophils and places the child at risk for infection, which is the priority nursing diagnosis at this time.

60. A 4-year-old girl continues to interrupt her mother during a routine clinic visit. The mother appears irritated with the child and asks the nurse, "Is this normal behavior for a child this age?" The nurse's response should be based on which information? a. Children need to retain a sense of initiative without impinging on the rights and privileges of others. b. Negative feelings of doubt and shame are characteristic of 4-year-old children. c. Role conflict is a common problem of children this age. She is just wondering where she fits into society. d. At this age children compete and like to produce and carry through with tasks. She is just competing with her mother.

A Rationale Children aged 3 to 6 are in Erickson's "Initiative vs. Guilt" stage, which is characterized by vigorous, intrusive behavior, enterprise, and strong imagination. At this age, children develop a conscience and must learn to retain a sense of initiative without impinging on the rights of others.

40. A 2-year-old child with Down syndrome is brought to the clinic for his regular physical examination. The nurse knows which problem is frequently associated with Down syndrome? a. Congenital heart disease. b. Fragile X chromosome. c. Trisomy 13. d. Pyloric stenosis.

A Rationale Congenital heart disease is the most common associated defect in children with Down syndrome. Clients with trisomy 21 are diagnosed with Down Syndrome. Clients affected by trisomy 13 are affected by a syndrome called "Patau's Syndrome" and clients with trisomy 18 are affected by a syndrome called "Edward's Syndrome". All three of these trisomy syndromes have some form of congenital cardiac anomalies present with these chromosomal defects.

38. A 4-year-old boy was admitted to the emergency room with a fractured right ulna and a short arm cast was applied. When preparing the parents to take the child home, which discharge instruction has the highest priority? a. "Call the healthcare provider immediately if his nail beds appear blue." b. "Check his fingers hourly for the first 48 hours to see that he is able to move them without pain." c. "Be sure your child's arm remains above his heart for the first 24 hours." d. "Take his temperature every four hours for the next two days and call if an elevation is noted."

A Rationale Cyanosis indicates impaired circulation to fingers and should be reported immediately.

48. When discussing discipline with the mother of a 4-year-old child, the nurse should include which guideline? a. Parental control should be consistent. b. Children as young as 4 years rarely need reprimand or punishment. c. Withdrawal of approval is effective. d. Parents should enforce rigid rules to be followed without question.

A Rationale Discipline should be a positive and necessary component of childrearing that is started in infancy and should teach socially acceptable behavior, help children protect themselves from danger, and channel undesirable behavior into constructive activity. Misbehavior may result from inconsistent rules or messages, so parental attention should be clear, reasonable, and consistent. The most important aspect of parenting is being consistent when raising a child, so it helps them to establish structure and boundaries. Structure and boundaries that are consistently followed through will help a child feel more secure and less anxious than no boundaries or consistency.

24. The nurse is having difficulty communicating with a hospitalized 6-year-old child. Which approach by the nurse is most helpful in establishing communication? a. Engage the child through drawing pictures. b. Suggest that the parent read a book to the child. c. Provide paper and pencil for the child to keep a diary. d. Ask the parent if the child is always uncommunicative.

A Rationale Drawing pictures is a valuable form of non-verbal communication. It is easier for a child to express their emotions and feelings through the process of drawing than to express it verbally. As the nurse and child look at the drawings, a verbal story can be told that projects the child's thinking.

78. When assessing a child with asthma, the nurse should expect intercostal retractions during a. inspiration. b. coughing. c. apneic episodes. d. expiration.

A Rationale Intercostal retractions result from respiratory effort to draw air into restricted airways when a child is experiencing an asthma exacerbation.

9. Which finding in a 19-year-old female client should trigger further assessment by the nurse? a. Menstruation has not occurred. b. Reports no tetanus immunization since childhood. c. Denies having any wisdom teeth. d. History of painful, inward growth on bottom of foot.

A Rationale Menstruation is an expected secondary sex characteristic that occurs with pubescence and typically occurs between the ages of 10 to 17, so the fact the client is 18 years old and has not experience menarche, should prompt further investigation to determine the cause of this primary amenorrhea.

28. A 3-month-old infant develops oral thrush. Which pharmacologic agent should the nurse plan to administer for treatment of this disorder? a. Nystatin (Mycostatin). b. Nitrofurantoin (Macrodantin). c. Norfloxacin (Noroxin). d. Neomycin sulfate (Mycifradin).

A Rationale Nystatin (Mycostatin) is an antifungal drug that is effective in treating thrush, an oral fungal infection.

2. The clinic nurse is taking the history for a new 6-month-old client. The mother reports that she took a great deal of aspirin while pregnant. Which assessment should the nurse obtain? a. Type of reaction to loud noises. b. Any surgeries on the ears since birth. c. Drainage from the infant's ears. d. Number of ear infections since birth.

A Rationale Ototoxicity diminishes hearing acuity and causes symptoms of tinnitus and vertigo in older children who can express subjective symptoms, so assessing an infant's reaction to loud noises (A) helps to determine an infant's risk for a hearing deficit related to a history of the mother taking an ototoxic drug, such as aspirin, while pregnant. (B, C, and D) are not associated with exposure to aspirin in utero.

72. A female teenager is taking oral tetracycline HCL (Achromycin V) for acne vulgaris. What is the most important instruction for the nurse to include in this client's teaching plan? a. "Use sunscreen when lying by the pool." b. "Cleanse the skin at least 4 times a day." c. "Take the medication with a glass of milk." d. "Menstrual periods may become irregular."

A Rationale Photosensitivity is a common side effect of tetracycline HCL (Achromycin V) therapy. Severe sunburn can occur with minimal sun exposure and clients should be instructed to avoid sunlight and to use sunscreen.

57. The nurse is assessing the neurovascular status of a child in Russell's traction. Which finding should the nurse report to the healthcare provider? a. Pale bluish coloration of the toes. b. Skin is warm and dry to the touch. c .Toes are wiggled upon command. d. Capillary refill less than 3 seconds.

A Rationale Russell's skin traction is used for fractures of the femur in young children and adolescents whose growth plates remain open and is applied to the lower leg using moleskin and elastic wrap bandages, which can compress the peroneal nerve and arteries that supply the foot. Assessment of adequate circulation, movement, and sensation of the toes and skin distal to the application is made to identify compromised blood flow, so cyanosis of the toes should be reported immediately.

34. The nurse is teaching a 12-year-old male adolescent and his family about taking injections of growth hormone for idiopathic hypopituitarism. Which adverse symptoms, commonly associated with growth hormone therapy, should the nurse plan to describe to the child and his family? a. Polyuria and polydipsia. b. Lethargy and fatigue. c. Increased facial hair. d. Facial bone structure changes.

A Rationale Signs and symptoms of diabetes or hyperglycemia need to be reported. Clients who are receiving growth hormones should be monitored to detect elevated blood sugars and glucose intolerance.

33. When evaluating the effectiveness of interventions to improve the nutritional status of an infant with gastro-esophageal reflux, which intervention is most important for the nurse to implement? a. Record weight daily. b. Assess for signs of anemia. c. Document sleeping patterns. d. Teach parenting skills.

A Rationale The most definitive measure of improved nutrition in an infant is obtaining the infant's daily weight at the same time and ideally using the same scale and the infant fully naked.

69. To take the vital signs of a 4-month-old child, which order will give the most accurate results? a. Respiratory rate, heart rate, then rectal temperature. b. Heart rate, rectal temperature, then respiratory rate. c. Rectal temperature, heart rate, then respiratory rate. d. Rectal temperature, respiratory rate, then heart rate.

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

26. The nurse receives a lab report stating a child with asthma has a theophylline level of 15 mcg/dl. What action will the nurse take? a. Pass the information on in the report. b. Notify the healthcare provider because the value is high. c. Repeat the lab study because the value is too high. d. Hold the next dose of theophylline.

A Rationale The therapeutic level of theophylline is 10 to 20 mcg/dl, so the child's level is within the therapeutic range. This information evaluates the prescribed therapy and should be communicated in the nurse's report.

23. A 17-year-old male student reports to the school clinic one morning for a scheduled health exam. He tells the nurse that he just finished football practice and is on his way to class. The nurse assesses his vital signs: temperature 100 F, pulse 80, respirations 20, and blood pressure 122/82. What is the best action for the nurse to take? a. Tell the student to proceed directly to his regularly scheduled class. b. Call the parent and suggest re-taking the student's temperature at home. c. Give the student a glass of cool fluids, then retake his temperature. d. Send the student to class, but re-verify his temperature after lunch.

A Rationale This student has just completed football practice, and increased muscle activity increases body heat production. A temperature of 100 F is normal for this student at this time. The student should attend class since no further nursing action is required.

4. A 3-week-old newborn is brought to the clinic for follow-up after a home birth. The mother reports that her child bottle feeds for 5 minutes only and then falls asleep. The nurse auscultates a loud murmur characteristic of a ventricular septal defect (VSD), and finds the newborn is acyanotic with a respiratory rate of 64 breaths per minute. What instruction should the nurse provide the mother to ensure the infant is receiving adequate intake? (Select all that apply.) a. Monitor the the infant's weight and number of wet diapers per day. b. Increase the infant's intake per feeding by 1 to 2 ounces per week. c. Mix the dose of prophylactic antibiotic in a full bottle of formula. d. Allow the infant to rest and refeed on demand or every 2 hours. e. Use a softer nipple or increase the size of the nipple opening.

A, B, D, E Rationale Neonates who have VSD may fatigue quickly during feeding and ingest inadequate amounts. They should be monitored for weight gain and at least 6 wet diapers per day. A one-month old infant should ingest 2 to 4 ounces (60-120mL) of formula per feeding and progress to about 30 ounces (900mL) per day by 4-months of age. Due to fatigue, the infant should rest, but feed at least every 2 hours to ensure adequate intake. A softer (preemie) nipple or a larger slit in the nipple helps to reduce the sucking effort and energy expenditure, thus allowing the infant to ingest more with less effort. Antibiotic prophylaxis is recommended for infants with VSDs, but should not be mixed in a bottle of formula because it is difficult to ensure that the total dose is consumed.

30. Which measurements should be used to accurately calculate a pediatric medication dosage? (Select all that apply.) a. Child's height and weight. b. Adult dosage of medication. c. Body surface area of child. d. Average adult's body surface area. e. Average pediatric dosage of medication. f. Nomogram determined mathematical constant.

A, C, F Rationale The most accurate calculations of pediatric dosages use the child's height and weight. The child's BSA is calculated using the square root of weight in kg times height in cm divided by 3600 or the square root of weight in pounds times height in inches divided by 3131, then the child's BSA is multiplied by the recommended published dose per BSA. The nomogram is used to plot the child's height and weight, and the point at which they intersect is the BSA mathematical constant used to calculate the child's dose.

29. The nurse is assigning care for a 4-year-old child with otitis media and is concerned about the child's increasing temperature over the past 24 hours. When planning care for this child, it is important for the nurse to consider that a. only an RN should be assigned to monitor this child's temperature. b. a tympanic measurement of temperature will provide the most accurate reading. c. the licensed practical nurse should be instructed to obtain rectal temperatures on this child. d. the healthcare provider should be asked to prescribe the method for measurement of the child's temperatures.

B Rationale (B) A tympanic membrane sensor is an excellent site because both the eardrum and hypothalamus (temperature-regulating center) are perfused by the same circulation. The sensor is unaffected by cerumen and the presence of suppurative or unsuppurative otitis media does not effect measurement. RULE OF THUMB: for management--sterile procedures should be assigned to licensed personnel. Management skills will be tested on the NCLEX! An RN is not required (A). Rectal temperature measurement (C) is less accurate because of the possibility of stool in the rectum. (D) is unnecessary.

70. The nurse assigning care for a 5-year-old child with otitis media is concerned about the child's increasing temperature over the past 24 hours. Which statement is accurate and should be considered when planning care for the remainder of the shift? a. An RN should be assigned to take temperatures frequently. b. Tympanic and oral temperatures are equally accurate. c. The PN should take rectal temperatures on this child. d. The pediatrician should decide how to assess the temperature.

B Rationale A tympanic membrane sensor approximates core temperatures because the hypothalamus and eardrum are perfused by the same circulation. Tympanic readings obtained using proper technique correlated moderately to strongly with oral temperatures in recent research studies. The sensor is unaffected by cerumen or the presence of suppurative or unsuppurative otitis media.

64. A nurse provides the parents with information on health maintenance for their child with sickle cell disease. Which information reflected by the parents indicates understanding of the child's care? a. Daily iron supplements should be given. b. Plenty of fluids should be consumed daily. c. Immunizations should be delayed for a few years. d. Protective equipment should be worn for contact sports.

B Rationale Adequate fluid intake decreases the viscosity of the blood which helps decrease the incidence of vasocclusive crisis.

39. At 8 a.m. the unlicensed assistive personnel (UAP) informs the charge nurse that a female adolescent client with acute glomerulonephritis has a blood pressure of 210/110. The 4 a.m. blood pressure reading was 170/88. The client reports to the UAP that she is upset because her boyfriend did not visit last night. What action should the nurse take first? a. Give the client her 9 a.m. prescription for an oral diuretic early. b. Administer PRN prescription of nifedipine (Procardia) sublingually. c. Notify the healthcare provider and inform the nursing supervisor of the client's condition. d. Attempt to calm the client and retake the blood pressure in thirty minutes. Submit

B Rationale After the nurse has verified the client's elevated blood pressure, the sublingual Procardia should be administered first because it lowers the blood pressure very quickly, before implementing any of the other interventions.

6. All of the following interventions can be used to evaluate the effectiveness of nursing and medical interventions used to treat diarrhea. Which intervention is least useful in the nurse's evaluation of a 20-month-old child? a. Weighing diapers. b. Assessing fontanels. c. Checking skin turgor. d. Observing mucous membranes for moisture.

B Rationale All of these interventions are used to evaluate fluid status in infants, but with a 20 month old, assessing the fontanels would not be appropriate. The posterior fontanel should be closed at 2 months and anterior fontanel closed by 18 months of age.

11. The nurse is assessing a 13-year-old girl with suspected hyperthyroidism. Which question is most important for the nurse to ask her during the admission interview? a. "Have you lost any weight in the last month?" b. "Are you experiencing any type of nervousness?" c. "When was the last time you took your synthroid?" d. "Are you having any problems with your vision?"

B Rationale Assessing the client's psychophysiologic state upon admission is a priority, and nervousness, apprehension, hyperexcitability, and palpitations are signs of hyperthyroidism. Weight loss (even with a hearty appetite) occurs in those with hyperthyroidism, but assessing the client's neurological state has a higher priority.

81. A 6-month-old boy and his mother are at the healthcare provider's office for a well-baby check-up and routine immunizations. The healthcare provider recommends to the mother that the child receive an influenza vaccine. What medications should the nurse plan to administer today? a. The routine immunizations and schedule another appointment to administer the influenza vaccine. b. All the immunizations with the influenza vaccine given at a separate site from any other injection. c. The influenza vaccine and schedule another appointment to administer the immunizations. d. The influenza vaccine and the polio vaccine and schedule another appointment to administer the remaining immunizations.

B Rationale At 6-months of age, the routine immunizations include Hepatitis B, DTaP, Hib (Haemophilus influenza type b) , PCV (Pneumococcal), IPV (inactivated poliovirus) and influenza. To ensure the infant receives the influenza vaccine, it should be given that same visit, at a separate site from any other injection site.

14. Which action by the nurse is most helpful in communicating with a preschool-aged child? a. Speak clearly and directly to the child. b. Use a doll to play and communicate. c. Approach when a parent is not present. d. Play a board game with the child.

B Rationale Communicating through play with a doll or other toy gives time for the child to feel comfortable with a stranger.

52. Which growth and development characteristic should the nurse consider when monitoring the effects of a topical medication for an infant? a. A lower sensitivity reactions to skin irritants. b. A thin stratum corneum that increases topical absorption. c. A smaller percentage of muscle mass. d. A greater body surface area that requires larger dosages.

B Rationale Infants have a thin outer skin layer (stratum corneum), so the nurse should monitor the infant for a prompt onset and response to the application of topical medication.

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

B Rationale More information is needed to interpret these findings. The tympanic membrane is normally pearly gray, not bulging, and moves when the client blows against resistance or a small puff of air is blown into the ear canal. Since this child's findings are not completely normal, further assessment of history and related signs and symptoms is indicated for accurate interpretation of the findings.

1. The mother of a preschool-aged child asks the nurse if it is all right to administer bismuth subsalicylate (Pepto Bismol, Bismylate) to her son when he "has a tummy ache." After reminding the mother to check the label of all over-the-counter drugs for the presence of aspirin, which instruction should the nurse include when replying to this mother's question? a. If the child's tongue darkens, discontinue the Pepto Bismol immediately. b. Do not give if the child has chickenpox, the flu, or any other viral illness. c. Avoid the use of Pepto Bismol until the child is at least 16 years old. d. Pepto Bismol may cause a rebound hyperacidity, worsening the "tummy ache."

B Rationale Pepto Bismol, Bismylate contains subsalicylate and if used in the presence of a viral illness, there is the potential of developing Reye's syndrome, a sometimes fatal condition for children.

66. A 5-month-old is admitted to the hospital with vomiting and diarrhea. The pediatrician prescribes dextrose 5% and 0.25% normal saline with 2 mEq KCl/100 ml to be infused at 25 ml/hour. Prior to initiating the infusion, the nurse should obtain which assessment finding? a. Frequency of emesis in the last 8 hours. b. Serum BUN and creatinine levels. c. Current blood sugar level. d. Appearance of the stool.

B Rationale Regardless of a client's age, adequate renal function must be present before adding potassium to IV fluids.

17. A six-month-old returns from surgery with elbow restraints in place. What nursing care should be included when caring for any restrained child? a. Keep restraints on at all times. b. Remove restraints one at a time and provide range of motion exercises. c. Remove all restraints simultaneously and provide play activities. d. Renew the healthcare provider's prescription for restraints every 72 hours.

B Rationale Removing restraints one at a time is safer than removing all of both at once. The child needs to exercise and should not be kept in restraints at all times and skin assessments and neurovascular checks should be done.

5. The nurse is planning care for school-aged children at a community care center. Which activity is best for the children? a. Building model airplanes. b. Playing follow-the-leader. c. Stringing large and small beads. d. Playing with Playdough and clay.

B Rationale School-aged children strive for independence and productivity (Erikson's Industry vs. Inferiority) and enjoy individual and group activities related to real-life situations, such as playing follow-the-leader.

49. Which class of antiinfective drugs is contraindicated for use in children under 8 years of age? a. Aminoglycosides. b. Tetracyclines. c. Penicillins. d. Quinolones.

B Rationale Tetracyclines cause enamel hypoplasia and tooth discoloration in children under 8 years of age.

76. A premature newborn girl, born 24 hours ago, is diagnosed with a patent ductus arteriosus (PDA) and placed under an oxygen hood at 35%. The parents visit the nursery and ask to hold her. Which response should the nurse provide to the parents? a. "Studies have shown that handling a sick newborn is not good for the baby and upsets the parents." b. "The oxygen hood is holding the baby's oxygen level just at the point which is needed. You may stroke and talk to her." c. "Since your baby has been doing well under oxygen for 24 hours, I can let you hold the baby without oxygen." d. "You can hold the baby with the oxygen blowing in the baby's face since the level is very close to room air."

B Rationale The baby is at 35% FiO2 which is much more than room air (21% FIO2) and at this time the baby should not be moved from under the oxyhood. The nurse should offer the parents an alternative such as to stroke the infant and talking to the baby. The baby should recognize the parent's voices because at 5 months gestation in utero, the sense of hearing is developed. Even though, holding sick babies is beneficial and recommended for the infant and the parents, the infant's need for oxygenation has a higher priority at this time.

10. The nurse is caring for a 12-year-old with Syndrome of Inappropriate Antidiuretic Hormone (SIADH). This child should be carefully assessed for which complication? a. Poor skin turgor resulting from dehydration. b. Changes in level of consciousness. c. Premature aging as the disease progresses. d. Severe edema from an excess of water and sodium.

B Rationale The child must be monitored for signs and symptoms of hyponatremia, which creates secondary central nervous system alterations such as changes in level of consciousness, seizure, and coma.

42. The vital signs of a 4-year-old child with polyuria are: BP 80/40, Pulse 118, and Respirations 24. The child's pedal pulses are present with a volume of +1, and no edema is observed. What action should the nurse implement first? a. Insert an indwelling urinary catheter. b. Start an IV infusion of normal saline. c. Send a specimen to the lab for urinalysis. d. Document the child's vital signs and pulses.

B Rationale The current blood pressure reading of 80/40 mmHg and the decreased peripheral pulse volume indicates that the child is experiencing fluid volume deficit due to the polyuria, so the priority action is to restore fluid volume. Normal range for blood pressure levels for 3-5 year olds according to the American Heart Association and the American Academy of Pediatrics if 104-116/63-74 mmHg dependent on the height and weight of the child. The other vital signs for the child are considered within normal limits; normal heart rate for a 3-4 year old at rest while awake is (80-120 beats per minute) and respirations for a 3-6 year old is (22-34 respirations per minute).

84. A 3-year-old client with sickle cell anemia is admitted to the Emergency Department with abdominal pain. The nurse palpates an enlarged liver, an x-ray reveals an enlarged spleen, and a CBC reveals anemia. These findings indicate which type of crisis? a. Aplastic. b. Sequestration. c. Hyperhemolytic. d. Vaso-occlusive.

B Rationale The findings support a sequestration crisis, where blood pools in the spleen and sometimes in the liver, and is characterized by abdominal pain and anemia.

31. The mother of a 6-month-old asks the nurse when her baby will get the first measles, mumps, and rubella (MMR) vaccine. Based on the recommended childhood immunization schedule published by the Centers for Disease Control, which response is accurate? a. 3 to 6 months. b. 12 to 15 months. c. 18 to 24 months. d. 4 to 6 years.

B Rationale The first measles, mumps, and rubella (MMR) immunization should be given no sooner than 12 months of age, and ideally between 12 and 15 months of age. The second dose of MMR is routinely administered at 4 to 6 years old, providing that the first MMR immunization was administered between 12-15 months of age.

25. A 3-year-old boy is brought to the emergency room because he swallowed an entire bottle of children's vitamin pills. Which intervention should the nurse implement first? a. Insert N/G tube for gastric lavage. b. Determine the child's pulse and respirations. c. Assess the child's level of consciousness. d. Administer an IV D5/0.25 NS as prescribed.

B Rationale The most important principle in dealing with a poisoning is to treat the child first, not the poison. Initiate immediate life support measures with assessment of vital signs, in particular, respirations. Inserting an airway or initiating mechanical ventilation may be necessary.

68. The nurse is preparing a health teaching program for parents of toddlers and preschoolers and plans to include information about prevention of accidental poisonings. It is most important for the nurse to include which instruction? a. Tell children they should not taste anything but food. b. Store all toxic agents and medicines in locked cabinets. c. Provide special play areas in the house and restrict play in other areas. d. Punish children if they open cabinets that contain household chemicals.

B Rationale The only reliable way to prevent poisonings in young children is to make them inaccessible by storing them out of reach of children in locked cabinets.

41. The nurse is teaching a mother to give 4 ml of a liquid antibiotic to a 10-month-old infant. Which statement by the parent indicates a need for further teaching? a. "I will give this antibiotic to my child until it is finished." b. "Using a teaspoon will help me measure this correctly." c. "I will call the clinic if my child develops a rash or itching." d. "My baby should begin to feel better within a few days."

B Rationale The prescribed medication is 4 ml per dosage and is measured with the most accuracy using an oral syringe, so if the parent uses a teaspoon, which is equivalent to 5 ml, further teaching is indicated.

20. During discharge teaching of a child with juvenile rheumatoid arthritis, the nurse should stress to the parents the importance of obtaining which diagnostic testing? a. Hearing tests. b. Eye exams. c. Chest x-rays. d. Fasting blood glucose tests.

B Rationale Visual changes leading to blindness can occur in children with juvenile idiopathic arthritis (JIA). The most common eye problem for clients with JIA is uveitis which can lead to glaucoma, cataracts, and permanent visual damage. These complications can be prevented if detected early, so it is important the parents are educated about the importance of eye exams for their child diagnosed wit JIA.

19. A three-month old boy weighing 10 lbs 15 oz has an axillary temperature of 98.9 F. The nurse determines the daily caloric need for this child is approximately a. 400 calories per day. b. 500 calories per day. c. 600 calories per day. d. 700 calories per day.

C Rationale 10 lbs 15 oz = 10.9 lbs. Convert lbs to kg by dividing pounds by 2.2; 10.9/2.2 = 4.954 kg, rounded to 5 kg. An infant requires 108 calories/kg/day (108 x 5 = 540 calories/day). However, this infant requires 10% more calories because he has one degree temperature elevation. 10% of 540 is 54 and 540 + 54 = 594. This infant will require approximately 600 calories/day. Tough question! You know that 400 calories are too few and 700 are too much, and a temperature elevation necessitates consumption of more calories, so choose the higher of the two choices left!

63. A 12-month-old boy is admitted with a respiratory infection and possible pneumonia. He is placed in a mist tent with oxygen. Which nursing intervention has the greatest priority for this infant? a. Give small, frequent feedings of fluids. b. Accurately chart observations regarding breath sounds. c. Have a bulb syringe readily available to remove secretions. d. Encourage older siblings to visit.

C Rationale A patent airway has the highest priority. Humidification will liquefy the nasal secretions thereby increasing the amount of secretions and having suction equipment at the crib side the highest priority to maintain a patent airway.

82. A child falls on the playground and is brought to the school nurse with a small laceration on the forearm. Which action should the nurse implement first? a. Slowly pour hydrogen peroxide over the open wound. b. Apply ice to the area before rinsing with cold water. c. Wash the wound gently with mild soap and water. d. Gently cleanse with a sterile pad using povidone-iodine.

C Rationale A small, superficial laceration to the skin should be washed gently with mild soap and water for several minutes, followed by thorough rinsing. Washing the superficial laceration will help prevent an infection and/or tetanus. Hydrogen peroxide should be avoided because it can irritate the already injured tissue.

47. Surgery is being delayed for an infant with undescended testes. In collaboration with the healthcare provider and the family, which prescription should the nurse anticipate? a. A trial of adrenocorticotrophic hormone injections. b. Frequent stimulation of the cremasteric reflex. c. A trial of human chorionic gonadotrophic hormone. d. Frequent warm baths to gently dilate the scrotal area.

C Rationale A trial of HCG (human chorionic gonadotrophic hormone) may aid in testicular descent, but does not replace surgical repair for true undescended testes. Undescended testes (cryptorchidism) may be found in the inguinal canal due to exaggerated cremasteric reflex.

3. A 16-year-old is brought to the Emergency Center with a crushed leg after falling off a horse. The adolescent's last tetanus toxoid booster was received eight years ago. What action should the nurse take? a. Dispense a tetanus antitoxin. b. Prepare human tetanus immune globulin. c. Administer tetanus toxoid booster. d. Delay the tetanus toxoid booster until due.

C Rationale After the completion of the initial tetanus immunization schedule, the recommended booster for an adolescent or adult is every ten years or less if a traumatic injury occurs that is contaminated by dirt, feces, soil, or saliva, such as puncture or crushing injuries, avulsions, wounds from missiles, burns, or frostbite. The adolescent's injury is considered a contaminated wound requiring prophylactic therapy, so the tetanus toxoid booster should be administered.

35. A hospitalized 16-year-old male refuses all visits from his classmates because he is concerned about his distorted appearance. To increase the client's social interaction, what intervention is best for the nurse to initiate? a. Encourage the client to use a hand-held video game that is popular with all his friends. b. Assign a 25-year-old female nursing student to offer support to the client. c. Arrange for an Internet connection in the client's room for email communication. d. Encourage the client's mother to arrange a surprise get together in the cafeteria.

C Rationale Body image and peer acceptance are key concerns for the adolescent. Communication via email allows for social interaction without face to face contact, thus protecting his self-image while also promoting social interaction.

21. In developing a teaching plan for a 5-year-old child with diabetes, which component of diabetic management should the nurse plan for the child to manage first? a. Food planning and selection. b. Administering insulin injections. c. Process of glucose testing. d. Drawing up the correct insulin dose.

C Rationale Developmentally, a 5-year-old has the cognitive and psychomotor skills to use a glucometer (C) and to read the number (it is especially helpful if the nurse presents this activity as a game). (A, B, and D) require more advanced cognitive and psychomotor skills and have greater potential for errors.

43. The nurse must prevent a 2-year-old with severe eczema on the face, neck, and scalp from scratching the affected areas. Which nursing intervention is most effective in preventing further excoriation due to the pruritis? a. Obtain gloves for the child's hands. b. Apply finger cots on the child's fingers. c. Place elbow restraints on the child's arms. d. Apply soft restraints to the child's wrists.

C Rationale Elbow restraints prevent arm flexion and the ability to reach to scratch the involved areas, but do not inhibit use of the hands for play activities.

46. Which restraint should be used for a toddler after a cleft palate repair? a. Clove hitch. b. Mummy. c. Elbow. d. Jacket.

C Rationale Elbow restraints prevent children from bending their arms and bringing their hands to the oral surgical site.

32. The nurse is developing a plan of care for a 3-year-old who is scheduled for a cardiac catheterization. To assist in decreasing anxiety for the child on the day of the procedure, which intervention is best for the nurse to implement? a. Reassure the parents that 3-year-olds are cooperative and therefore are less likely to be anxious. b. Obtain a video film of a cardiac catheterization to show to the child prior to the procedure. c. Give the child a ride on a gurney to visit the cardiac catheterization lab and meet a nurse who works there. d. Obtain a cardiac catheter and demonstrate the procedure by pretending to put the catheter in a doll or stuffed animal.

C Rationale Familiarizing the child and mother with the department by visiting the cath lab and meeting the personnel there prior to the procedure day should help decrease anxiety of the child and mother (who may have more anxiety than the child).

67. The nurse observes a 4-year-old boy in a daycare setting. Which behavior should the nurse consider normal for this child? a. Has a temper tantrum when told he must share his toys. b. Plays by himself most of the day. c. Demonstrates aggressiveness by boasting when telling a story. d. Begins to cry and is fearful when separated from his parents.

C Rationale Four-year-old children are aggressive in their behavior and enjoy "tale telling" (C). Behaviors in (A and D) are typical of toddlers. The play of a preschooler is cooperative, so playing alone (B) is not typical.

71. The nurse is assessing a 2-year-old child. What behavior indicates that the child's language development is within normal limits? a. Is able to name four colors. b. Can count five blocks. c. Is capable of making a three word sentence. d. Half of child's speech is understandable.

C Rationale Normal language skills within the toddler development period is the ability of making two to three word sentences.

36. The nurse is teaching the parents of a 5-year-old child with cystic fibrosis about respiratory treatments. Which statement indicates to the nurse that the parents understand? a. Perform postural drainage before starting the aerosol therapy. b. Give respiratory treatments when the child is coughing a lot. c. Administer aerosol therapy followed by postural drainage before meals. d. Ensure respiratory therapy is done daily during any respiratory infection.

C Rationale Postural drainage for a child with cystic fibrosis is most effective when performed after nebulization and one hour before meals and/or at least 2 hours after eating to prevent nausea and vomiting and potential aspiration. Postural drainage uses gravity to promote mucous removal after the nebulization treatments has liquefied the secretions, therefore helps open the airways. Pulmonary toileting or respiratory treatments should be given 3 to 4 times daily.

37. During administration of a blood transfusion, a child complains of chills, headache, and nausea. Which action should the nurse implement? a. Start another IV of dextrose solution and stay with the child. b. Continue the transfusion and monitor the child's vital signs. c. Stop the infusion immediately and notify the healthcare provider. d. Slow the transfusion and assess for cessation of symptoms.

C Rationale The child is exhibiting signs of a reaction to the blood transfusion. The blood transfusion should be stopped immediately and the healthcare provider notified.

55. A 15-year-old girl tells the school nurse that all of her friends have started their periods and she feels abnormal because she has not. Which response is best for the nurse provide? a. Refer the adolescent to the healthcare provider for a pregnancy screen. b. Schedule a conference with her parents to recommend hormone therapy. c. Explain that menarche varies and occurs between the ages of 12 and 18 years. d. Suggest that she use diversions to help her not worry about delayed menarche.

C Rationale The nurse should provide a factual and reassuring explanation that focuses on individual variations of menarche, which can normally occur between 10 and 17 years of age.

15. A preschool-age child who is hospitalized for hypospadias repair is most strongly influenced by which behavior? a. Ability to communicate verbally. b. Response to separation from family. c. Concern for body integrity. d. Socialization with other children.

C Rationale The preschooler's major stressor is concern for his body integrity. He fears that his "insides will leak out." A child undergoing surgery to his genitalia is even more concerned about body integrity.

79. Which behavior would the nurse expect a two-year-old child to exhibit? a. Build a house with blocks. b. Ride a tricycle. c. Display possessiveness of toys. d. Look at a picture book for 15 minutes.

C Rationale Two-year-old children are egocentric and unable to share with other children. Toddlers demonstrate "parallel" play where they will play alongside with others, but not with others.

61. An infant is born with a ventricular septal defect (VSD) and surgery is planned to correct the defect. The nurse recognizes that surgical correction is designed to achieve which outcome? a. Stop the flow of unoxygenated blood into systemic circulation. b. Increase the flow of unoxygenated blood to the lungs. c. Prevent the return of oxygenated blood to the lungs. d. Reduce peripheral tissue hypoxia and nailbed clubbing.

C Rationale VSDs are a common congenital heart defect which means there is a hole in the septum wall separating the left and right ventricles. Dependent upon the size of the hole, will impact how much of oxygenated blood is shunted over to the right ventricle of the heart, decreasing amount of oxygenated blood pumped out to the rest of the body. The closure of VSDs will stop the oxygenated blood from being shunted from the left ventricle to the right ventricle.

58. A 14-year-old female client tells the nurse that she is concerned about the acne she has recently developed. Which recommendation should the nurse provide? a. Remove all blackheads and follow with an alcohol scrub. b. Use medicated cosmetics only to help hide the blemishes. c. Wash the hair and skin frequently with soap and hot water. d. Encourage her to see a dermatologist as soon as possible.

C Rationale Washing the hair and skin with soap and hot water (C) removes oil and debris from the skin and helps prevent and treat acne. Oily skin is especially bothersome during adolescence when hormones cause enlargement of sebaceous glands and increased glandular secretions which predispose the teenager to acne. (A) is contraindicated. Cosmetics ("medicated" or not) should be used sparingly to avoid further blocking sebaceous gland ducts (B). (D) might be indicated at a later time, if healthcare recommendations are not successful.

54. A 2-year-old child with gastro-esophageal reflux has developed a fear of eating. What instruction should the nurse include in the parents' teaching plan? a. Invite other children home to share meals. b. Accept that he will eat when he is hungry. c. Reward the child with a nap after eating. d. Consistently follow a set mealtime routine.

D Rationale A 2-year-old child is comforted by consistency, so following a set mealtime routine and ensuring the child remains upright at least two hours after eating to reduce symptoms should help in alleviating the child's fear of experiencing GERD after eating.

51. A child is rescued from a burning house and brought to the emergency room with partial-thickness burns on the face and chest. Which action should the nurse implemented first? a. Insert an indwelling urinary catheter. b. Administer IV pain medication. c. Collect blood specimen for laboratory studies. d. Assess the child's respiratory status.

D Rationale Assessing the airway and the respiratory status is the highest priority since burns to the face and chest place the child at risk for smoke inhalation injury and compromised airway.

77. The nurse is assessing a 2-year-old. What behavior indicates that the child's language development is within normal limits? a. Is able to name four colors. b. Can count five blocks. c. Is capable of making a three word sentence. d. Half of child's speech is understandable.

D Rationale Between approximately 15 and 24 months of age, a child's speech is only half understandable. A child can begin counting and name colors usually between 3 and 5 years of age. And a child is capable of two - four word sentences between 18 months to 24 months of age.

62. A 2-year-old child recently diagnosed with hemophilia A is discharged home. What information should the nurse include in a teaching plan about home care? a. Minimize interactive play with other children to lessen chances for injury. b. Give low-dose children's chewable aspirin in orange flavor for joint discomfort. c. Use a firm and dry toothbrush to clean teeth at least twice per day. d. Apply pressure and ice for bleeding while elevating and resting the extremity.

D Rationale Hemophilia, a blood disorder, causes joint bleeding which is treated with rest, ice, compression, and elevation (RICE).

53. An 18-month-old is admitted to the hospital with possible Hirschsprung's disease. When obtaining a nursing history, the nurse asks about bowel habits. What description of the disease? a. Foul-smelling and fatty. b. Bile-colored and watery. c. Semi-solid and yellow. d. Ribbon-like and brown.

D Rationale Hirschsprung's disease is a mechanical obstruction caused by inadequate motility in a part of the intestines. The condition results from failure of ganglion cells to migrate craniocaudally along the GI tract during gestation. The lack of peristalsis in the affected bowel segment causes constipation and small diameter, brown-colored stools (D). (A) is associated with cystic fibrosis. (B) is common in gastroenteritis. (C) is normal in breastfed neonates.

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

D Rationale In pyloric stenosis, the valve between stomach and small intestine enlarges blocking the passage of food. The nurse needs to ensure suctioning equipment is closed by to help prevent aspiration from the projectile vomiting episodes and monitor for the state of metabolic alkalosis, which is a classic sign of pyloric stenosis.

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

D Rationale Outcome of learning is best demonstrated when the client not only verbalizes an understanding, but can also provide a correct return demonstration.

85. Preoperative nursing care for a child with Wilms' tumor should include which intervention? a. Gently percuss the abdomen for evidence of trapped air. b. Observe the abdomen for any noticeable discolorations. c. Apply cold compresses to the abdomen to reduce edema. d. Put a sign on the bed reading, "DO NOT PALPATE ABDOMEN."

D Rationale Prevention of abdominal palpation minimizes the risk of rupturing the encapsulated tumor and subsequent metastasis.

45. When planning the care for a child who has had a cleft lip repair, the nurse knows that crying should be minimized because it a. increases salivation. b. increases the respiratory rate. c. leads to vomiting. d. stresses the suture line.

D Rationale Prevention of stress on the lip suture line is essential for optimum healing and the cosmetic appearance of a cleft lip repair.

59. The mother of a 4-year-old child asks the nurse what she can do to help her other children cope with their sibling's repeated hospitalizations. Which is the best response that the nurse should offer? a. Inform the parent that the other children are too young to visit the hospital. b. Suggest that the other children visit a grandmother until the sibling returns home. c. Ask the mother if the children ask when the sibling will be discharged. d. Encourage the mother to have the children visit the hospitalized sibling.

D Rationale Siblings of a sick child will often be scared, concerned or confused. Needs of a sibling will be better met with factual information and contact with the ill child, so sibling visitation should be encouraged. Children may have difficulty expressing concerns, so the support of parents and other caregivers are needed to help alleviate their fears.

8. When taking the health history of a child, the nurse knows that which finding is an early indication of hypothyroidism in children? a. Hyperactive behavioral traits. b. Delay in the eruption of permanent teeth. c. Slow sexual development, but within normal range. d. Cessation of growth in a child that had been normal.

D Rationale Since the thyroid gland is responsible for metabolism, cessation of growth which was previously within normal range, is the most common sign for hypothyroidism in children.

13. A child with cystic fibrosis is having stools that float and are foul smelling. Which descriptive term should the nurse use to document the finding? a. Diarrhea. b. Rhinorrhea. c. Galactorrhea. d. Steatorrhea.

D Rationale Steatorrhea is defined as stools with an abnormally high fat content that are usually foul smelling and float on water. Cystic fibrosis is an autosomal recessive gene condition that affects the secretory glands and can affect many parts of the body. The digestion system is affected by blockage of the glands involved in digestion such as the pancreas and gall bladder which results in the presence of steatorrhea stools reflective of the fats not digested and absorbed in the child's intestines.

56. The nurse is assessing an 8-month-old child who has a medical diagnosis of Tetrology of Fallot. Which symptom is this client most likely to exhibit? a. Bradycardia. b. Machinery murmur. c. Weak pedal pulses. d. Clubbed fingers.

D Rationale Tetrology of Fallot, a cyanotic heart defect, causes clubbing of fingers and toes (D) due to tissue hypoxia. Tachycardia, not (A), is a manifestation of congenital heart disease. (B) is a classic sign of ventricular septal defect. (C) is characteristic of coarctation of the aorta.

73. The mother of a 2-year-old boy consults the nurse about her son's increased temper tantrums. The mother states, "Yesterday he threw a fit in the grocery store, and I did not know what to do. I was so embarrassed. What can I do if this occurs again?" Which recommendation is best for the nurse to provide this mother? a. Paddle him gently as soon as the behavior is initiated. b. Immediately put him in "time-out." c. Quietly remind him that others are watching him. d. Walk away from him and ignore the behavior.

D Rationale The best approach for a toddler's inappropriate behavior is to ignore the attention-seeking behavior. The parent should be somewhat nearby, within view of the child, but should avoid reinforcing the behavior in any way. Tantrums can sometimes be avoided by talking to the child before the situation occurs.