Pediatrics Practice Exam Questions

Nonpharmacologic strategies for pain management

may reduce pain perception

The nurse is assisting with genetic counseling for a couple in which the mother has a rare autosomal dominant condition, and the father does not have the condition. Which of the following statements by the nurse is most accurate?

"With each pregnancy, your child has at least a 50% chance of having the condition."

The clinic nurse provides information to the mother of a toddler regarding toilet training. Which statement by the mother indicates a need for further information regarding toilet training? A. "Bladder control usually is achieved before bowel control." B. "The child should not be forced to sit on the potty for long periods." C. "The ability of the child to remove clothing is a sign of physical readiness." D. "The child will not be ready to toilet train until the age of about 18 to 24 months."

A. "Bladder control usually is achieved before bowel control." Rationale: Bowel control usually is achieved before bladder control. The child should not be forced to sit for long periods . The ability to remove clothing is one of the physical signs of readiness for toilet training. The physical ability to control the anal and urethral sphincters is achieved some time after the child is walking, probably between the ages of 18 and 24 months.

A mother of a 4-year-old expresses concern because her hospitalized child has begun thumb sucking. The mother states that this behavior began 2 days after hospital admission. Which response by the nurse is most appropriate? A. "It is best to ignore the behavior." B. "Your child is acting like a baby." C. "The doctor will need to be notified." D. "A 4-year-old is too old for this type of behavior."

A. "It is best to ignore the behavior." Rationale: In the hospitalized preschooler, the best option is to accept regression if it occurs. Regression is most often a result of the stress of the hospitalization. Parents may be overly concerned about regression and should be told that their child may continue the behavior at home. When regression does occur, the best approach is to ignore it while praising existing patterns of appropriate behavior. Calling the health care provider is not necessary. Options 2 and 4 are inappropriate.

The 2-year-old child is treated in the emergency department for a burn to the chest and abdomen. The child sustained the burn by grabbing a cup of hot coffee that was left on the kitchen counter. The nurse reviews safety principles with the parents before discharge. Which statement by the parents indicates an understanding of measures to provide safety in the home? A. "We will be sure not to leave hot liquids unattended." B. "I guess my children need to understand what the word hot means." C. "We will be sure that the children stay in their rooms when we work in the kitchen." D. "We will install a safety gate as soon as we get home so the children cannot get into the kitchen."

A. "We will be sure not to leave hot liquids unattended." Rationale: Toddlers, with their increased mobility and development of motor skills, can reach hot water or hot objects placed on counters and stoves and can reach open fires or stove burners above their eye level. The nurse should encourage parents to remain in the kitchen when preparing a meal, use the back burners on the stove, and turn pot handles inward and toward the middle of the stove. Hot liquids should never be left unattended or within the child's reach, and the toddler should always be supervised. The statements in options 2, 3, and 4 do not indicate an understanding of the principles of safety.

A 7-year-old child is hospitalized with a fracture of the femur and is placed in traction. In meeting the psychosocial needs of the child, the nurse most appropriately selects which play activity for the child? A. A board game B. A large puzzle C. A finger-painting set D. A coloring book with crayons

A. A board game Rationale: The school-age child becomes organized with more direction with play activities. Such activities include collections, drawing, construction, dolls, pets, guessing games, board and computer games, riddles, hobbies, competitive games, and listening to the radio or television. Options 3 and 4 are appropriate for a preschooler. Option 2 is appropriate for a toddler.

A mother of a 3-year-old asks a clinic nurse about appropriate and safe toys for the child. The nurse should tell the mother that the most appropriate toy for a 3-year-old is which? A. A wagon B. A golf set C. A farm set D. A jack set with marbles

A. A wagon Rationale: Toys for the toddler must be strong, safe, and too large to swallow or place in the ear or nose. Toddlers need supervision at all times. Push-pull toys, large balls, large crayons, large trucks, and dolls are some of the appropriate toys. A farm set, a golf set, and jacks with marbles may contain items that the child could swallow.

The maternity nurse is providing instructions to a new mother regarding the psychosocial development of the newborn infant. Using Erikson's psychosocial development theory, the nurse instructs the mother to take which measure? A. Allow the newborn infant to signal a need. B. Anticipate all the needs of the newborn infant. C. Attend to the newborn infant immediately when crying. D. Avoid the newborn infant during the first 10 minutes of crying.

A. Allow the newborn infant to signal a need. Rationale: According to Erikson, the caregiver should not try to anticipate the newborn infant's needs at all times but must allow the newborn infant to signal needs. If a newborn infant is not allowed to signal a need, the newborn will not learn how to control the environment. Erikson believed that a delayed or prolonged response to a newborn infant's signal would inhibit the development of trust and lead to mistrust of others.

The mother of a 5-year-old child tells the nurse that the child scolds the floor or a table if she hurts herself on the object. According to Piaget's Theory of Cognitive Development, what term or phrase best describes this behavior? A. Animism B. Egocentric speech C. Object permanence D. Global organization

A. Animism

A 4-year-old child diagnosed with leukemia is hospitalized for chemotherapy. The child is fearful of the hospitalization. Which nursing intervention should be implemented to alleviate the child's fears? A. Encourage the child's parents to stay with the child. B. Encourage play with other children of the same age. C. Advise the family to visit only during the scheduled visiting hours. D. Provide a private room, allowing the child to bring favorite toys from home.

A. Encourage the child's parents to stay with the child.

Which nursing intervention fosters the hospitalized infant's development of trust? A. Follow the parent's directions while providing care when parents are away B. Ask parents to name objects in the infant's surroundings C. Encourage different caregivers to interact with the infant D. Instruct caregivers to talk to the infant while providing care

A. Follow the parent's directions while providing care when parents are away

The nurse is caring for a 14-year-old girl who is hospitalized and has been placed in traction using Crutchfield tongs. The child is having difficulty adjusting to the prolonged hospital confinement. Which nursing action would be most appropriate to meet the child's needs? A. Let the child wear her own clothing when friends visit. B. Allow the girl to have her hair dyed if the parent agrees. C. Allow the child to play loud music in the hospital room. D. Allow the child to keep the shades closed and the room darkened at all times.

A. Let the child wear her own clothing when friends visit. Rationale: Adolescents need to identify with their peers and have a strong need to belong to a group. They prefer to dress like the group and wear similar hairstyles, which are different from their parents'. The child should be allowed to wear her own clothes to feel a sense of belonging to the group. Because Crutchfield tongs require the use of skeletal pins, hair dye is not appropriate. Loud music may disturb others in the hospital. The child's request for a darkened room may indicate a problem with depression that may need further evaluation and intervention.

Which recommendation would the nurse make to the parent of a 6-month-old regarding safe sleep practices? A. Place the infant in a supine position for sleep B. Avoid positioning the head on alternating sides C. A prone position is more beneficial for sleeping D. If the infant is restless, place it on one side to sleep

A. Place the infant in a supine position for sleep

Which behavior would the nurse determine is developmentally appropriate in a healthy 7-month-old infant? Select all that apply. One, some, or all responses may be correct. A. Play peek-a-boo B. Turning completely over C. Reaching to be picked up D. Pulling up to a standing position E. Sitting for a short time with support

A. Play peek-a-boo B. Turning completely over C. Reaching to be picked up E. Sitting for a short time with support

Which interventions are appropriate for the care of an infant? SELECT ALL THAT APPLY A. Provide swaddling. B. Talk in a loud voice. C. Provide the infant with a bottle of juice at nap time. D. Hang mobiles with black and white contrast designs. E. Caress the infant while bathing or during diaper changes. F. Allow the infant to cry for at least 10 minutes before responding.

A. Provide swaddling. D. Hang mobiles with black and white contrast designs. E. Caress the infant while bathing or during diaper changes.

A parent of a 3-year-old tells a clinic nurse that the child is rebelling constantly and having temper tantrums. Using Erikson's psychosocial development theory, which instructions should the nurse provide to the parent? SELECT ALL THAT APPLY A. Set limits on the child's behavior. B. Ignore the child when this behavior occurs. C. Allow the behavior, because this is normal at this age period. D. Provide a simple explanation of why the behavior is unacceptable. E. Punish the child every time the child says "no" to change the behavior.

A. Set limits on the child's behavior. D. Provide a simple explanation of why the behavior is unacceptable. Rationale: According to Erikson, the child focuses on gaining some basic control over self and the environment and independence between ages 1 and 3 years. Gaining independence often means that the child has to rebel against the parents' wishes. Saying things like "no" or "mine" and having temper tantrums are common during this period of development. Being consistent and setting limits on the child's behavior are necessary elements. Providing a simple explanation of why certain behaviors are unacceptable is an appropriate action. Options 2 and 3 do not address the child's behavior. Option 5 is likely to produce a negative response during this normal developmental pattern.

A 1-year-old child with hypospadias is scheduled for surgery to correct this condition. While preparing the nursing care plan for this child, which factor should the nurse take into consideration? A. This surgery is taking place at a time when fears of separation are great. B. This surgery is taking place at a time when sibling rivalry will cause regression to occur. C. This surgery is taking place at a time when concern over size and function of the penis is present. D. This surgery is taking place at a time when embarrassment about voiding irregularities is common.

A. This surgery is taking place at a time when fears of separation are great. Rationale: At the age of 1 year, a child's fears of separation are great because the child is facing the developmental task of trusting others. No data in the question allow one to determine that siblings exist. The options "concern over size and function of the penis is present" and "embarrassment about voiding irregularities is common" might be issues if the child were older.

The nurse is caring for a 4-year-old child. When experiencing pain, the nurse anticipates which about the child? Select all that apply. A. Views pain as a punishment B. Verbalizes the reason for the pain C. Blames someone else for the pain D. Believes pain will disappear magically E. Fears losing control during the painful episode F. Will be able to explain the sequence of events leading to the pain

A. Views pain as a punishment C. Blames someone else for the pain D. Believes pain will disappear magically

Which are similarities between infants and toddlers? Select all that apply. One, some, or all responses may be correct. A.The grow at a similar rate B.The need an equal amount of sleep C.Both show resistance to skin irritation D.Both awaken frequently during the night E.Both recover easily from upper respiratory tract infections.

A.Both awaken frequently during the night B.Both recover easily from upper respiratory tract infections.

Which parental statement indicates understanding of recommendations when caring for a 7-month-old infant? Select all that apply. One, some, or all responses may be correct. A.I should call my child by name B.I should not change my child's diet C.I should start oral hygiene with my child D.I should not leave my child with an unfamiliar relative E.I should encourage my child to pronounce specific sounds

A.I should call my child by name C.I I should start oral hygiene with my child D.I should not leave my child with an unfamiliar relative

Turner syndrome is suspected in an adolescent girl with short stature. Which is the cause of this syndrome?

Absence of one of the X chromosomes

A nurse has been assigned to take care of a pediatric patient suspected of having chicken pox(varicella). Which type of precaution is required?

Airborne with isolation room

The mother of a 16-year-old tells a nurse that she is concerned because her child sleeps about 8 hours every night and until noontime every weekend. Which nursing response is most appropriate? A. "The child should not be staying up so late at night." B. "Adolescents need that amount of sleep every night." C. "If the child eats properly, that should not be happening." D. "The child probably is anemic and should eat more foods containing iron."

B. "Adolescents need that amount of sleep every night." Rationale: An adolescent needs about 8 hours of sleep per night. During this age, with an increase in social activities, school commitments, and possibly work activities, it is important that the adolescent receive enough sleep at night. Nothing in the question indicates that the child is staying up at night. Adolescents need 8 hours of sleep each night, so diet is not a concern. Although anemia can cause fatigue, there is nothing in the question to indicate that the child has anemia, and the nurse should not attempt to diagnose a medical condition.

The clinic nurse has provided instructions regarding dental care for toddlers to the mother of a 2-year-old child. Which statement, if made by the mother, indicates a need for further instruction? A. "It is best to substitute sweets or snacks with food items such as cheese." B. "Proper dental care is not necessary for a toddler until the permanent teeth erupt." C. "My child should have the first dental exam at some point after the second birthday." D. "I do not need to be concerned if the child swallows some toothpaste while brushing the teeth."

B. "Proper dental care is not necessary for a toddler until the permanent teeth erupt." Rationale: The nurse should instruct the mother that proper dental care for a toddler is important. It is important to instruct the mother to substitute sweets with healthy food items to prevent dental caries. The first dental visit should be made after the first primary tooth erupts and no later than 30 months of age. It will not hurt the child if some of the toothpaste is swallowed.

A 2-year-old child has been admitted to the hospital for management of pneumonia. The child is placed in an oxygen tent. Taking into consideration the child's age and developmental level and the treatment being administered, which statement is appropriate for the nurse to make to the parents? A. "He can play in the tent with his blocks and plush stuffed animals." B. "You can sit next to him and hold his hand through the tent, but he needs to remain inside of it." C. "At his age, separation anxiety is high, so bringing in the wool blanket that he usually sleeps with is a good idea." D. "Before you leave for the night, it is a good idea to rock him to sleep. He can be out of the tent for up to 30 minutes without any consequences."

B. "You can sit next to him and hold his hand through the tent, but he needs to remain inside of it." Rationale: Oxygen therapy is an important component of management of pneumonia and is effective only if it is used appropriately. It is important to maintain the toddler in the oxygen environment at all times. With the addition of oxygen therapy, the hospitalized toddler is at risk for increased anxiety. Attachment is critical to optimal growth and development of children, particularly in the infant and toddler years. Therefore sitting with the child and holding the child's hand is important. Wool blankets, stuffed toys, and many toy cars can produce sparks, which could lead to an oxygen tent's catching fire. It is important to educate parents and family members not to bring these types of objects to the hospital.

The mother of a 3-year-old is concerned because her child still is insisting on a bottle at nap time and at bedtime. Which is the most appropriate suggestion to the mother? A. Allow the bottle if it contains juice. B. Allow the bottle if it contains water. C. Do not allow the child to have the bottle. D. Allow the bottle during naps but not at bedtime.

B. Allow the bottle if it contains water Rationale: A toddler should never be allowed to fall asleep with a bottle containing milk, juice, soda pop, sweetened water, or any other sweet liquid because of the risk of nursing (bottle-mouth) caries. If a bottle is allowed at nap time or bedtime, it should contain only water.

Which car safety device should be used for a child who is 8 years old and is 4 feet tall? A. Seat belt B. Booster seat C. Rear-facing convertible seat D. Front-facing convertible seat

B. Booster Seat Rationale: All children whose weight or height is above the forward-facing limit for their car safety seat should use a belt-positioning booster seat until the vehicle seat belt fits properly, typically when they have reached 4 feet 9 inches in height and are between 8 and 12 years of age. Infants should ride in a car in a semireclined, rear-facing position in an infant-only seat or a convertible seat until they weigh at least 20 pounds and are at least 1 year of age. The transition point for switching to the forward-facing position is defined by the manufacturer of the convertible car safety seat but is generally at a body weight of 9 kg (20 pounds) and 1 year of age.

What are the similarities between a preschooler and a toddler? Select all that apply. One, some, or all responses may be correct. A.Both preschoolers and toddlers take daytime naps B.Both preschools and toddlers have nighttime wakening C.Both preschoolers and toddlers have similar dietary requirements D.Both preschoolers and toddlers are eager to independently perform self-care E.Both preschoolers and toddlers have an acceptable heart rate of between 80 and 110 beats per minute.

B. Both preschools and toddlers have nighttime wakening C.Both preschoolers and toddlers have similar dietary requirements D. Both preschoolers and toddlers are eager to independently perform self-care

A nurse is caring for a 2-month-old infant diagnosed with tetralogy of Fallot. Which of the following signs and symptoms is the nurse most likely to observe during a tet spell? A. Rapid, shallow breathing and tachycardia B. Cyanosis and decreased level of consciousness C. Hypotension and bradycardia D. Palpitations and chest pain

B. Cyanosis and decreased level of consciousness During a tet spell, the child's skin turns blue, or cyanotic, and they may become short of breath, irritable, and have difficulty feeding. In severe cases, the child may become lethargic or lose consciousness. Rapid, shallow breathing and tachycardia (option A) may occur but are not the primary symptoms of a tet spell. Hypotension and bradycardia (option C) are not typical signs of a tet spell. Palpitations and chest pain (option D) are not associated with tetralogy of Fallot or tet spells.

The nurse is monitoring a 3-month-old infant for signs of increased intracranial pressure. On palpation of the fontanels, the nurse notes that the anterior fontanel is soft and flat. On the basis of this finding, which nursing action is most appropriate? A. Increase oral fluids. B. Document the finding. C. Notify the health care provider (HCP). D. Elevate the head of the bed to 90 degrees.

B. Document the finding. Rationale: The anterior fontanel is diamond-shaped and located on the top of the head. The fontanel should be soft and flat in a normal infant, and it normally closes by 12 to 18 months of age. The nurse would document the finding because it is normal. There is no useful reason to increase oral fluids, notify the HCP, or elevate the head of the bed to 90 degrees.

The nurse assesses the vital signs of a 12-month-old infant with a respiratory infection and notes that the respiratory rate is 35 breaths/minute. On the basis of this finding, which action is most appropriate? A. Administer oxygen. B. Document the findings. C. Notify the health care provider. D. Reassess the respiratory rate in 15 minutes.

B. Document the findings Rationale: The normal respiratory rate in a 12-month-old infant is 20 to 40 breaths/minute. The normal apical heart rate is 90 to 130 beats/minute, and the average blood pressure is 90/56 mm Hg. The nurse would document the findings.

Which strategy would the nurse use to soothe a 2-month-old infant who is crying? A. Offering the infant a bottle of diluted juice B. Holding and rocking the infant in a quiet room. C. Changing the diaper before returning the infant to the crib D. Wrapping a blanket around the infant and placing them in a supine position.

B. Holding and rocking the infant in a quiet room.

A nurse is caring for a 4-year-old child diagnosed with Kawasaki disease. Which of the following is a priority nursing intervention? A. Administering antibiotics as prescribed B. Monitoring for signs of heart failure C. Providing education on hand hygiene D. Assessing for skin changes

B. Monitoring for signs of heart failure Explanation: Kawasaki disease is an acquired heart disease that primarily affects young children. It is characterized by inflammation of the blood vessels, particularly those in the heart, and can lead to the development of coronary artery aneurysms and other cardiac complications. Monitoring for signs of heart failure, such as tachycardia, dyspnea, and pulmonary edema, is a priority nursing intervention in children with Kawasaki disease. Antibiotics may be prescribed to prevent secondary infections (option A), but they are not the priority intervention in this case. Providing education on hand hygiene (option C) and assessing for skin changes (option D) may also be important but are not as high a priority as monitoring for cardiac complications.

A nurse is assigned to care for a hospitalized toddler. The nurse plans care, knowing that what should be the highest priority? A. Providing a consistent caregiver B. Protecting the toddler from injury C. Adapting the toddler to the hospital routine D. Allowing the toddler to participate in play and divisional activities

B. Protecting the toddler from injury Rationale: The toddler is at high risk for injury as a result of developmental abilities and an unfamiliar environment. Although consistency, adaptation, and diversionare important, protection from injury is the highest priority.

The nurse at a well-baby clinic is providing nutrition instructions to the mother of a 1-month-old infant. What instruction should the nurse give to the mother? A. To introduce strained fruits one at a time B. That breast milk or formula is the main food C. To introduce strained vegetables one at a time D. To offer rice cereal mixed with breast milk or formula

B. That breast milk or formula is the main food Rationale: Breast milk or formula is the main food throughout infancy. Rice cereal mixed with breast milk or formula is introduced at 4 months of age. Strained vegetables, fruits, and meats are introduced one at a time and can begin at 6 months of age.

Which statement explains the importance of play in toddlers? Select all that apply. One, some, or all responses may be correct. A. Toddlers have imaginations and fantasies B. Toddlers prefer to play beside other children C. Toddlers like to pretend and play different roles D. Toddlers prefer to stay close to parents while playing E. Toddlers should watch television to expand their vocabulary

B. Toddlers prefer to play beside other children D. Toddlers prefer to stay close to parents while playing

The nurse is evaluating the developmental level of a 2-year-old. Which does the nurse expect to observe in this child? A. Uses a fork to eat B. Uses a cup to drink C. Pours own milk into a cup D. Uses a knife for cutting food

B. Uses a cup to drink Rationale: By age 2 years, the child can use a cup and spoon correctly but with some spilling. By age 3 to 4, the child begins to use a fork. By the end of the preschool period, the child should be able to pour milk into a cup and begin to use a knife for cutting.

The mother of an 8-year-old child tells the clinic nurse that she is concerned about the child because the child seems to be more attentive to friends than anything else. Using Erikson's psychosocial development theory, the nurse should make which response? A. "You need to be concerned." B. "You need to monitor the child's behavior closely." C. "At this age, the child is developing his own personality." D. "You need to provide more praise to the child to stop this behavior."

C. "At this age, the child is developing his own personality." Rationale: According to Erikson, during school-age years (6 to 12 years of age), the child begins to move toward peers and friends and away from the parents for support. The child also begins to develop special interests that reflect his or her own developing personality instead of the parents. Therefore options 1, 2, and 4 are incorrect responses.

A 6-month-old infant is admitted to the hospital. The nurse weighs the infant and notes that the infant weighs 14 pounds. Which statement by the mother indicates that further teaching is needed? A. "His weight for his age is just right." B. "I am so glad he is gaining the correct amount of weight for his age." C. "I will have to increase his milk intake because he is not gaining enough weight." D. "He weighed 7 pounds when he was born so he is at the correct weight for his age."

C. "I will have to increase his milk intake because he is not gaining enough weight." Rationale: Newborns double their birth weight at 5 to 6 months of age and triple it by 1 year. Therefore, options 1, 2, and 4 are correct statements. Option 3 indicates the need for further teaching.

The nurse is instructing the caregiver of a child about reprimanding the child. The nurse recognizes that additional teaching is needed if the caregiver makes which statement to the child? A. "I like it when you obey." B. "I need you to listen to me." C. "You need to stop hitting your sister." D. "I don't like it when you hit your sister."

C. "You need to stop hitting your sister." Rationale: When reprimanding children, the person reprimanding should focus only on the misbehavior, not on the child. "I" messages rather than "you" messages should be used to express personal feelings without accusation. An "I" message attacks the behavior, not the child.

The nurse at a well-baby clinic is assessing the language and communication developmental milestones of a 4-month-old infant. On the basis of the age of the infant, what should the nurse expect to note as the highest-level developmental milestone? A. Cooing sounds B. Use of gestures C. Babbling sounds D. Increased interest in sounds

C. Babbling sounds Rationale: Babbling sounds are common between the ages of 3 and 4 months. Additionally, during this age, crying becomes more differentiated. Between the ages of 1 and 3 months, the infant will produce cooing sounds. The use of gestures occurs between 9 and 12 months. An increased interest in sounds occurs between 6 and 8 months.

The nurse is developing a plan of care for a 4-year-old child scheduled for a renal biopsy. What developmental characteristic of this child should the nurse consider? A. Masturbation is common in this age group. B. Body image may be a concern for the child. C. Fears of mutilation may be present in the child. D. The urination pattern will cause embarrassment for the child.

C. Fears of mutilation may be present in the child. Rationale: During the preschool years, a child's fears of separation and mutilation are great, because the child is facing the developmental task of trusting others. As the child gets older, fears about virility and reproductive ability may surface. Masturbation is most common in the toddler age group as they discover their genital organs. Body image is a concern for the adolescent. Options 1, 2, and 4 are not accurate occurrences in this age group.

A mother tells the nurse in a pediatrician's office that she is concerned because her children must let themselves into the house after school each day while she is at work. The nurse explores which suggestion with the mother to decrease the children's sense of isolation and fear? A. Instruct the children never to cook. B. Let the children play in neighborhood homes. C. Find community after-school programs or activities. D. Have the children call the mother at work every hour.

C. Find community after-school programs or activities.

A nurse is caring for an infant diagnosed with patent ductus arteriosus (PDA). Which of the following medications is typically used to treat PDA in infants? A. Furosemide (Lasix) B. Captopril C. Indomethacin (Indocin) D. Digoxin (Lanoxin)

C. Indomethacin (Indocin) Explanation: Patent ductus arteriosus (PDA) is a common congenital heart defect in which the ductus arteriosus, a blood vessel that connects the pulmonary artery to the aorta, fails to close after birth. This can result in abnormal blood flow and cause complications such as heart failure and pulmonary hypertension. Indomethacin (Indocin) is a nonsteroidal anti-inflammatory drug (NSAID) that is often used to treat PDA in infants. It works by inhibiting the production of prostaglandins, which are hormones that help keep the ductus arteriosus open. Furosemide (Lasix) (option A) is a diuretic that is often used to treat edema or fluid overload but is not used to treat PDA. Captopril (option B) is an ace inhibitor that is used to treat heart failure, but is not used to treat PDA. Digoxin (Lanoxin) (option D) is a cardiac glycoside that is used to treat heart failure and certain arrhythmias but is not used to treat PDA.

With which age group should the nurse use "magical thinking" as a developmental strategy when administering medications? A. Infant B. Toddler C. Preschool D. School-age

C. Preschool

A two-month-old infant has a ventricular septal defect (VSD). Which statement below best describes the blood flow in the heart due to this congenital heart defect? A. The blood in the heart is shunting from the right ventricle to the left ventricle, which is increasing pulmonary blood flow. B. The blood in the heart is shunting from the left ventricle to the right ventricle, which is decreasing pulmonary blood flow. C. The blood in the heart is shunting from the left ventricle to the right ventricle, which is increasing pulmonary blood flow. D. The blood in the heart is bypassing the left ventricle and is being shunted to the right ventricle, which is decreasing lung blood flow.

C. The blood in the heart is shunting from the left ventricle to the right ventricle, which is increasing pulmonary blood flow.

The parents of a 2-year-old arrive at a hospital to visit their child. The child is in the playroom when the parents arrive. When the parents enter the playroom, the child does not readily approach the parents. Which is the correct interpretation of the behavior? A. The child is withdrawn. B. The child is self-centered. C. The child exhibits detachment. D. The child has adjusted to the hospital setting.

C. The child exhibits detachment. Rationale: The phases through which young children progress when separated from their parents include protest, despair, and denial or detachment. In detachment, when the parents return, the child becomes more interested in the environment and new persons (seemingly unaware of the lost parents), friendly with the staff, and interested in developing superficial relationships. In the stage of protest, the child may cry, scream, and search for a parent. In the stage of despair, the child may be withdrawn and uninterested in the environment. That the child is withdrawn, self-centered, or that the child has adjusted to the hospital setting are incorrect interpretations of the child's behavior.

The nurse prepares to take the blood pressure of a school-age child. To obtain an accurate measurement, how should the nurse position the blood pressure cuff? A. One half of the distance between the antecubital fossa and the shoulder B. One third of the distance between the antecubital fossa and the shoulder C. Two thirds of the distance between the antecubital fossa and the shoulder D. One quarter of the distance between the antecubital fossa and the shoulder

C. Two thirds of the distance between the antecubital fossa and the shoulder Rationale: The size of the blood pressure cuff is important. Cuffs that are too small will cause falsely elevated values, and those that are too large will cause inaccurate low values. The cuff should cover two thirds of the distance between the antecubital fossa and the shoulder.

The clinic nurse assesses the communication patterns of a 5-month-old infant. Which assessment finding should lead the nurse to determine that the infant is demonstrating the highest level of developmental achievement expected? A. Coos when comforted B. Links syllables together C. Uses monosyllabic babbling D. Uses simple words such as mama

C. Uses monosyllabic babbling Rationale: Using monosyllabic babbling occurs between 3 and 6 months of age. Cooing begins at birth and continues until 2 months of age. Linking syllables together when communicating occurs between 6 and 9 months of age. Using simple words such as mama occurs between 9 and 12 months of age.

A 16-year-old is admitted to the hospital for acute appendicitis and an appendectomy is performed. Which nursing intervention is most appropriate to facilitate normal growth and development postoperatively? A. Encourage the child to rest and read. B. Encourage the parents to room in with the child. C. Allow the family to bring in the child's favorite computer games. D. Allow the child to interact with others in his or her same age group.

D. Allow the child to interact with others in his or her same age group. Rationale: Adolescents often are not sure whether they want their parents with them when they are hospitalized. Because of the importance of their peer group, separation from friends is a source of anxiety. Ideally, the members of the peer group will support their ill friend. Options 1, 2, and 3 isolate the child from the peer group.

Which statement is true regarding an autosomal recessive disorder?

For a child to inherit the disease, both parents must have one copy of the defective gene

A 6-year-old child is brought to the clinic with a 2-day history of nausea and vomiting. The child has a fever of 101.8°F and episodic abdominal pain at the umbilicus and right lower quadrant. What diagnostic tests are expected?

Diagnostic tests will include a detailed physical examination, complete blood count and electrolyte evaluation, and ultrasound evaluation of the abdomen. An abdominal x-ray may be included.

A 15-year-old is injured and sustains a fractured jaw. The fractured jaw has been surgically wired, and the health care provider has prescribed a full liquid diet. Which nursing action would best promote compliance and provide an adequate nutrient value with the full liquid diet for this teenager? A. Offer chocolate milkshakes between meals. B. Explain the importance of good nutrition to the teenager. C. Offer commercial nutritional supplements four to six times per day. D. Ask the teenager for food preferences and blenderize these foods into liquids.

D. Ask the teenager for food preferences and blenderize these foods into liquids. Rationale: A 15-year-old may have difficulty maintaining compliance with a diet that is only liquids. To encourage compliance it is important to have the teenager participate in as much decision making in the diet as possible. Although blenderized foods may be unappealing under many circumstances, the nutrient value is unchanged. The teenager will have an opportunity to "eat" the same foods that he or she was eating before the jaw fracture. Option 1 may be beneficial but does not offer the teenager any choices. Teenagers may or may not respond to reasoning and explanations as with option 2. Commercial supplements also are beneficial nutritional sources but will not be effective unless the client is willing to drink them.

The nurse in the pediatric unit is admitting a 2½-year-old child. The nurse plans care, knowing that the child is in which stage of Erikson's psychosocial stages of development? A. Trust versus Mistrust B. Initiative versus Guilt C. Industry versus Inferiority D. Autonomy versus Shame and Doubt

D. Autonomy versus Shame and Doubt Rationale: A 2½-year-old child, a toddler, is in the Autonomy versus Shame and Doubt stage. In this stage the toddler develops a sense of control over the self and bodily functions. Trust versus Mistrust characterizes the stage of infancy. Initiative versus Guilt characterizes the preschool age. Industry versus Inferiority characterizes the school-aged child.

The nurse is caring for a 4-year-old child with human immunodeficiency virus (HIV) infection. The nurse should plan care with the understanding that which childhood psychosocial need occurs at this age? A. Expressing fear, withdrawal, and denial B. Beginning to understand that something is wrong C. Unable to grasp the concept of illness and death D. Beginning to conceptualize the death process as involving physical harm

D. Beginning to conceptualize the death process as involving physical harm Rationale: A preschool child begins to conceptualize the death process as involving physical harm. A child from birth to 2 years of age is unable to grasp the concept of illness and death. A school-age child begins to understand that something is wrong. An adolescent expresses fear, withdrawal, and denial.

The nurse is preparing to care for a 5-year-old who has been placed in traction following a fracture of the femur. The nurse plans care, knowing that which is the most appropriate activity for this child? A. A radio B. A sports video C. Large picture books D. Crayons and a coloring book

D. Crayons and a coloring book Rationale: In the preschooler, play is simple and imaginative, and includes activities such as crayons and coloring books, puppets, felt and magnetic boards, and Play-Doh. A radio or sports video are most appropriate for the adolescent. Large picture books are most appropriate for the infant.

A mother arrives at a clinic with her toddler and tells the nurse that she has a difficult time getting the child to go to bed at night. What measure is most appropriate for the nurse to suggest to the mother? A. Allow the child to set bedtime limits. B. Allow the child to have temper tantrums. C. Avoid letting the child nap during the day. D. Inform the child of bedtime a few minutes before it is time for bed.

D. Inform the child of bedtime a few minutes before it is time for bed. Rationale: Toddlers often resist going to bed. Bedtime protests may be reduced by establishing a consistent before-bedtime routine and enforcing consistent limits regarding the child's bedtime behavior. Informing the child of bedtime a few minutes before it is time for bed is the most appropriate option. Most toddlers take an afternoon nap and, until their second birthday, also may require a morning nap. Firm, consistent limits are needed for temper tantrums or when toddlers try stalling tactics.

Which recommendation would the nurse provide the parent of a 3-year-old who is concerned that their child is afraid to sleep alone because of monsters under the bed? A. Tell the child that monsters don't exist. B. Allow the child to sleep with the parent temporarily C. Look under the bed and say "I don't see monsters." D. Leave a small light on at night and say, "Monsters aren't allowed in the house."

D. Leave a small light on at night and say, "Monsters aren't allowed in the house."

The clinical manifestations of nephrosis include which of the following? A. Hematuria, bacteriuria, weight gain B. Gross hematuria, albuminuria, fever C. Hypertension, weight loss, proteinuria D. Massive proteinuria, hypoalbuminemia, edema

D. Massive proteinuria, hypoalbuminemia, edema

The pediatric nurse is caring for a hospitalized toddler. What does the nurse determine is the most appropriate play activity for the toddler? A. Listening to music B. Playing peek-a-boo C. Hand sewing a picture D. Playing with a push-pull toy

D. Playing with a push-pull toy Rationale: The toddler has increased use of motor skills and enjoys manipulating small objects such as toy people, cars, and animals. Push-pull toys are appropriate for this age. Listening to music is most appropriate for an adolescent. Playing peek-a-boo is most appropriate for an infant. Hand sewing a picture is most appropriate for a school-age child.

A nurse recognizes which physiologic responses as a manifestation of acute pain in a neonate? (Select all that apply.)

Diaphoresis Increased heart rate Increased blood pressure

The nurse is admitting a 10-month-old infant who is being hospitalized for a respiratory infection. The nurse develops a plan of care for the infant and includes which most appropriate intervention? A. Keeping the infant as quiet as possible B. Restraining the infant to prevent dislodging of tubes C. Placing small toys in the crib to provide stimulation for the infant D. Providing a consistent routine with touching, rocking, and cuddling throughout hospitalization

D. Providing a consistent routine with touching, rocking, and cuddling throughout hospitalization Rationale: A 10-month-old is in the Trust versus Mistrust stage of psychosocial development according to Erikson. The infant is developing a sense of self, and the nurse should appropriately provide a consistent routine for the child. Hospitalization may have an adverse effect, and the nurse should touch, rock, and cuddle the infant to promote a sense of trust and provide sensory stimulation. Keeping the infant as quiet as possible will not provide sensory stimulation. The infant should not be restrained. Placing small toys in the crib is an unsafe action

A 7-year-old child with acute diarrhea has been rehydrated with oral rehydration therapy. Which of the following changes in the child's diet should the nurse recommend? A. Clear liquids B. BRAT diet (banana, rice, apple, toast or tea) C. High-carbohydrate diet D. Regular diet

D. Regular diet

The nurse at a well-baby clinic is assessing the motor development of a 24-month-old child. On the basis of the age of the child, the nurse expects to note what as the highest-level developmental milestone? A. The child snaps large snaps. B. The child builds a tower of two blocks. C. The child puts on simple clothes independently. D. The child opens a door by turning the doorknob.

D. The child opens a door by turning the doorknob. Rationale: A 24-month-old child should be able to open a door using the doorknob. At age 15 months, the nurse should expect that the child could build a tower of two blocks. At age 30 months, the child should be able to snap large snaps and put on simple clothes independently.

Which would be the highest expected growth and development occurrence expected at 12 months of age for an infant who has had appropriate growth assessed at each well-child visit? A. Imitates sounds B. Smiles spontaneously C. Sits steadily unsupported D. Walks holding on to someone's hand

D. Walks holding on to someone's hand Rationale: Growth and development are sequential and predictable. One task builds on another. Mastery of a lower level task must occur before higher-level tasks are completed. At 12 months a child can walk holding on to someone's hand. Smiling, imitating sounds, and sitting steadily unsupported begins at 6 months of age.

Which parental statement would the nurse recognize as indicating the need for further education about cognitive changes in preschoolers? A.Preschoolers are most fearful about physical harm B.Preschoolers re closely linked to concrete experiences C.Preschoolers are able to classify objects on the basis of color D.Preschoolers are less likely to believe that inanimate objects have lifelike qualities

D.Preschoolers are less likely to believe that inanimate objects have lifelike qualities

Which intervention would the nurse provide to meet the developmental needs of hospitalized preschool-aged children? A.Helping them learn to read B.Playing simple games with them C.Encouraging visits from family members D.Providing materials for stimulation activities

D.Providing materials for stimulation activities

Which assessment would the nurse make when observing an infant use their thumb and index finger to hold an object? A.The infant is exhibiting the Moro reflex B.The infant is exhibiting the tonic neck reflex C.The infant is exhibiting the parachute reflex D.The infant is exhibiting the crude pincer grasp reflex

D.The infant is exhibiting the crude pincer grasp reflex

Which is the causative agent of scarlet fever?

Group A β-hemolytic streptococci (GABHS)

Vitamin A supplementation may be recommended for the young child who has which disease?

Measles (rubeola)

A patient on an intravenous opioid analgesic is having respiratory depression. The nurse should implement which interventions? (Select all that apply.)

Place the patient on continuous pulse oximetry to assess SaO2. Administer the prescribed naloxone (Narcan) dose by slow IV push. Prepare to calm the child as analgesia is reversed.

It is determined that the child has acute appendicitis and will require emergent surgery. What are the nursing priorities postoperatively?

Postoperative priorities of care include pain management, proper dietary management (at first, nothing by mouth; then, advancing the diet as tolerated), and wound care. Deep breathing, assessment of bowel sounds, ambulation, and ongoing supportive care will also be needed. Children may be discharged when they have flatus versus having a bowel movement.

It is determined that the child has acute appendicitis and will require emergent surgery. What are the nursing priorities preoperatively?

Preoperatively, the nurse will be responsible for establishing an intravenous line, providing pain management, and providing support to the family and child. Safety, communication, and proper hand-off after consent has been completed will be paramount. The child will be admitted.

What is described as the time interval between early manifestations of a disease and the overt clinical syndrome

Prodromal period

A group of nurses are reviewing potential health environmental for the spread of nosocomial infections in the hospital. Which equipment should the nurse include as having a high risk potential for transmission? (Select all that apply.)

Stethoscope Computer keyboard Nurse's station desktop

A 6-year-old child is brought to the clinic with a 2-day history of nausea and vomiting. The child has a fever of 101.8°F and episodic abdominal pain at the umbilicus and right lower quadrant. What are the nursing priorities for this child?

The nursing priorities include further assessment of the child, taking the history, and performing a physical examination. Pain management and fluid and electrolyte assessment are physical priorities. Family support and emotional support of the child are psychological priorities of nursing care.

The nurse is assessing an infant and notes epicanthal folds, a low nasal bridge, low-set ears, single palmar creases, and a protruding tongue. Which of the following results does the nurse most likely expect from the patient's chromosomal microarray?

Three copies of chromosome 21

A nurse is examining a toddler and is discussing with the mother psychosocial development according to Erikson's theories. Based on the nurse's knowledge of Erikson, the most age-appropriate activity to suggest to the mother at this stage is to:

allow the toddler to start making choices about what to wear.

The nurse is assisting with genetic counseling for a couple with a history of hemophilia A in their families. Which of the following statements by the nurse is true regarding X-linked diseases like hemophilia A?

X-linked recessive diseases disproportionately affect males

A nurse enters the room of an 8-year-old child newly admitted and diagnosed with type I diabetes. His mother is sitting in a chair at his bedside. What should the nurse do first? a. Go the bedside and meet the child. b. Stand by the door, and say "I am the assigned nurse today." c. Go over to the mother and ask what brought the child into the hospital today. d. Explain the use of the call light to child.

a. Go the bedside and meet the child.

What is characteristic of fractures in children? a. Fractures rarely occur at the growth plate site because it absorbs shock well. b. Rapidity of healing is inversely related to the child's age. c. Pliable bones of growing children are less porous than those of adults. d. The periosteum of a child's bone is thinner, is weaker, and has less osteogenic potential compared with that of the adult.

b. Rapidity of healing is inversely related to the child's age.

A 9 month old is sitting on his father's lap at the bedside. The nurse needs to do a shift assessment. How should the nurse proceed? a. Ask the father to put the child in bed, and proceed with the exam. b. Talk with the father for a few minutes, before examining child. c. Listen to the heart and lungs of the child. d. Take the child from the father, and proceed with the exam.

b. Talk with the father for a few minutes, before examining child.

Which hospitalized child would the nurse be most worried about as needing support or follow-up? a. The 9-month-old that cries when the nurse walks in the room. b. The 2-year-old that holds still during an IV start. c. An adolescent that asks her father to leave the room during an assessment. d. A school-age child that angrily throws his food tray on the floor.

b. The 2-year-old that holds still during an IV start.

A nurse is conducting an admission interview with the mother of a 2 year old child. What history question is most important at this time? a. How many children are in the family? b. What is your child's normal routine? c. Does your child attend daycare? d. What toys are most important to your child?

b. What is your child's normal routine?

Which statement is true concerning osteogenesis imperfecta (OI)? a. OI is easily treated. b. OI is an inherited disorder. c. With a later onset, the disease usually runs a more difficult course. d. Braces and exercises are of no therapeutic value.

b.OI is an inherited disorder.

What nursing intervention would be most appropriate for a 10-year-old child with type I diabetes in order to meet their needs (as described by Erikson). a. Explain carefully to the mother the need to rigidly adhere to dietary modifications. b. Allow the child to eat whatever he or she wants and administer insulin to maintain optimum glucose levels. c. Allow the child to perform his or her own Accuchecks and administration of insulin. d. Perform Accuchecks four times a day and at bedtime.

c. Allow the child to perform his or her own Accuchecks and administration of insulin.

Which nursing intervention best supports the concept of atraumatic care for a hospitalized child? a. Allowing parents to visit once every shift. b. Encouraging six year old to be brave during an IV start. c. Allowing adolescent to keep the hospital door shut. d. Asking parents of baby to wait outside treatment room door during spinal tap.

c. Allowing adolescent to keep the hospital door shut.

A six year old is in the recovery room following an appendectomy. He is not yet fully awake, though he opens his eyes when his name is called. Which pain assessment tool would be most effective for the nurse to use at this time? a. OUCHER assessment tool. b. Wong's FACES assessment tool. c. FLAACC pain assessment tool. d. 1-10 verbal assessment scale.

c. FLAACC pain assessment tool.

Which statement most accurately describes bowel function in children born with a myelomeningocele? a. Incontinence cannot be prevented. b. Enemas and laxatives are contraindicated. c. Some degree of fecal continence can usually be achieved. d. A colostomy is usually required by the time the child reaches adolescence.

c. Some degree of fecal continence can usually be achieved.

During their school-age years, children best understand concepts that can be seen or illustrated. The nurse knows this type of thinking is termed as

concrete operations

A 16 year old female comes for a sport's physical in the clinic. During the nursing history, the teenage states she is bothered that she "towers over her companions and everyone is staring at her at school." What would be the most therapeutic response by the nurse? a. "Just ignore the other kids at school." b. "You are so lucky to be tall. You can play basketball or whatever you want." c. "This will resolve itself in time." d. "Tell me more about how this embarasses you."

d. "Tell me more about how this embarasses you."

Cerebral palsy (CP) may result from a variety of causes. It is now known that the most common cause of CP is a. birth asphyxia. b. neonatal diseases. c. cerebral trauma. d. prenatal brain abnormalities

d. prenatal brain abnormalities

The nurse is developing a plan of care to prevent separation behaviors in children who are hospitalized for long periods of time. Which of the following statements should the nurse include in the plan? Select all that apply.

provide the child with the child's favorite transitional object. When possible, assign the same nurse to care for the child each day. Tape pictures of the child's friends and family to the walls of the child's hospital room.