Peds Exam 3 Practice Questions

A nurse is providing care to a child who is to receive a blood transfusion. The health care provider has prescribed the infusion to run at a rate of 5 ml/kg/hour. The child weighs 55 lb (25 kg). At what rate should the nurse set the infusion pump? Record your answer using a whole number.

25 kg × 5 ml = 125 ml/hour

The nurse is caring for a child recently fitted with braces on both legs due to cerebral palsy (CP). What would the nurse emphasize in the discharge teaching? A) "Check the skin that is covered by the braces for redness and breakdown." B) "It is very important to comply with the use of this brace." C) "Please try and follow the therapist's on and off schedule." D) "If the brace is painful, feel free to take it off."

A) "Check the skin that is covered by the braces for redness and breakdown."

An adolescent with scoliosis is refusing to wear the prescribed body brace. Which instruction is best to progress the adolescent to the treatment goals? A) "It is important to wear the brace now to stabilize your spinal alignment, decreasing your symptoms." B) "It is important to correct spinal curvature before it gets too bad, causing you problems." C) "It is important to prevent herniation of a spinal disk, which is painful." D) "It is important to prevent torticollis."

A) "It is important to wear the brace now to stabilize your spinal alignment, decreasing your symptoms."

The nurse is assessing a 3-year-old boy whose mother reports that he is listless and has been having trouble swallowing. Which finding suggests the child may have a brain tumor? A) Observation reveals nystagmus and head tilt. B) Vital signs show blood pressure measures 120/80 mm Hg. C) Examination shows temperature of 101.4° F (38.6°C) and headache. D) Observation reveals a cough and labored breathing.

A) Observation reveals nystagmus and head tilt.

A 14-year-old adolescent is suspected of having scoliosis. When doing scoliosis screening, what observation would be important for the nurse to note? A) The posterior spine when bending forward B) The angle of the iliac crest when bending forward C) The posterior spine when bending sideways D) The angle of the lower chest when sitting down

A) The posterior spine when bending forward

A nurse is providing instructions for home cast care. Which response by the parent indicates a need for further teaching? A) "We must avoid causing depressions in the cast." B) "Pale, cool, or blue skin coloration is to be expected." C) "The casted arm must be kept still." D) "We need be aware of odor or drainage from the cast."

B) "Pale, cool, or blue skin coloration is to be expected."

A newborn has been diagnosed with a congenital heart disease. Which congenital heart disease is associated with cyanosis? A) coarctation of aorta B) tetralogy of Fallot C) pulmonary stenosis D) aortic stenosis

B) tetralogy of Fallot

A 5-year-old child has frequent visits to the school nurse's office. Which assessment data should alert the nurse that this child may be a victim of physical neglect? A) isolated from classmates with poor self-esteem B) evidence of bruising on multiple parts of the body C) malnourished with frequent absences from school D) inappropriate knowledge of sexual terms and actions

C) malnourished with frequent absences from school

Which of the following is false regarding childhood cancers? A) they affect tissues B) they are usually accidentally detected C) they are less responsive to treatment D) there are minimal to no lifestyle factors

C) they are less responsive to treatment

The nurse suspects sexual maltreatment in a 10-year-old girl. The nurse would assess which primary finding to help make this determination? A) regular menses B) Tanner stage 4 development C) vaginal discharge D) decreased skin turgor

C) vaginal discharge

The nurse explains to the teenager that which alterations may occur when steroids are added to the cancer therapy regimen? A) Loss of appetite B) Nighttime itching C) Urinary incontinence D) Facial changes

D) Facial changes

A child is suspected of having a brain tumor. His symptoms include problems with coordination and muscle control. The nurse suspects that the tumor is in which area of the brain? A) brain stem B) frontal lobe C) pituitary gland D) cerebellum

D) cerebellum

The nurse in a pediatric cardiovascular clinic is talking with the father of a 5-year-old child who underwent cardiac surgery for a heart defect at the age of 3. The father reports that the child has been having increased shortness of breath, tires easily after playing, and has been gaining weight. The nurse is aware that the child is most likely demonstrating symptoms of which acquired cardiovascular disorder? A) infective endocarditis B) cardiomyopathy C) Kawasaki Disease D) heart failure

D) heart failure

Normal blood flow through the heart

superior/inferior vena cava > r atrium > tricuspid valve > r ventricle > pulmonic valve > pulmonic artery > lungs > l atrium > l ventricle > aortic valve > aorta > body

1. Calculate the daily fluid requirements for a child that is 66 lbs. 2. Calculate the hourly fluid requirements.

10 kg x 100 mL/kg = 1000 mL 10 kg x 50 mL/kg = 500 mL 10 kg x 20 mL/kg = 200 mL 1000 mL + 500 mL + 200 mL = 1700 mL (daily) 1700mL/24h= 70.8 mL/hr (hourly)

A nurse is providing care to a child diagnosed with cerebral palsy who is experiencing painful muscle spasms. The health care provider has prescribed baclofen 40 mg/day PO in three divided doses. How many milligrams should the nurse administer in each dose? Record your answer using one decimal place.

13.3

An infant with poor feeding is suspected of having a congenital heart defect. The parents are asking why a chest x-ray is necessary in their infant. What is the best response from the nurse? A) "It will determine if the heart is enlarged." B) "It will determine disturbances in heart conduction." C) "It will show if blood is being shunted." D) "This image will clarify the structures within the heart."

A) "It will determine if the heart is enlarged."

The nurse is speaking with the parents of a child who has a cast. The parents state that the child reports itching in the area of the cast. What is the best response by the nurse? A) "Itching is common. It's nothing to worry about." B) "Blowing cool air with a fan or hair dryer may relieve the feeling." C) "You can put a pencil or coat hanger and scratch the area but don't let your child put anything down the cast without you there." D) "A small amount of lotion or baby oil can be poured in the cast to moisturize the area."

B) "Blowing cool air with a fan or hair dryer may relieve the feeling."

Parents ask why their child just diagnosed with leukemia needs a "spinal tap." Which is the best response by the nurse? A) "It will help rule out a second malignancy." B) "Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central nervous system." C) "The spinal tap will help relieve pressure and headache for your child." D) "A sample of cerebrospinal fluid is needed to check for possible central nervous system infection."

B) "Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central nervous system."

The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with rheumatic fever. The nurses in the group make the following statements. Which statement is most accurate regarding the diagnosis of rheumatic fever? A) "This disorder is caused by genetic factors." B) "Children who have this diagnosis may have had strep throat." C) "Being up-to-date on immunizations is the best way to prevent this disorder." D) "The onset and progression of this disorder is rapid."

B) "Children who have this diagnosis may have had strep throat."

The nurse is caring for children at a local hospital. Which child warrants immediate attention from the nurse? A) 2-year-old child with clubbing noted on the fingers B) 1-week-old newborn whose oxygenation is not improving with oxygen C) 6-month-old infant with edema on the face and presacral area D) 1-year-old child with a temporal temperature of 101°F (38.3°C)

B) 1-week-old newborn whose oxygenation is not improving with oxygen

Which nursing diagnosis would best apply to a child with rheumatic fever? A) Ineffective breathing pattern related to cardiomegaly B) Activity intolerance related to inability of heart to sustain extra workload C) Disturbed sleep pattern related to hyperexcitability D) Risk for self-directed violence related to development of cerebral anoxia

B) Activity intolerance related to inability of heart to sustain extra workload

Coarctation of the aorta demonstrates few symptoms in newborns. What is an important assessment to make on all newborns to help reveal this condition? A) Observing for excessive crying B) Assessing for the presence of femoral pulses C) Recording an upper extremity blood pressure D) Auscultating for a cardiac murmur

B) Assessing for the presence of femoral pulses

What information would be included in the care plan of an infant in heart failure? A) Encourage larger, less frequent feedings. B) Begin formulas with increased calories. C) Maintain child in the supine position. D) Administer digoxin even if the infant is vomiting.

B) Begin formulas with increased calories.

The nurse is administering medications to the child with congestive heart failure (CHF). Large doses of what medication are used initially in the treatment of CHF to attain a therapeutic level? A) Albuterol sulfate B) Digoxin C) Ferrous sulfate D) Spironolactone

B) Digoxin

The nurse is discussing treatment for a child diagnosed with scoliosis. Which statement indicates the parents understand the nurse's education? A) "Because our child has scoliosis, treatment will include halo traction." B) "The treatment for our child's scoliosis is anticipated to last between 3 to 4 months." C) "Because our child is being treated by using braces, the braces will have to be worn almost all the time." D) "The most successful treatment for scoliosis is surgery before reaching adult age."

C) "Because our child is being treated by using braces, the braces will have to be worn almost all the time."

The nurse takes an infant's apical pulse before administering digoxin. What is the usually accepted level of pulse rate considered safe for administering digoxin to an 8-month-old infant? A) 60 beats per minute B) 80 beats per minute C) 100 beats per minute D) 150 beats per minute

C) 100 beats per minute

The nurse is discussing types of treatment used when working with children who have orthopedic disorders. Which form of treatment covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open? A) Internal fixation device B) External fixation device C) Spica cast D) Stockinette

C) Spica cast

The nurse caring for a client diagnosed with muscular dystrophy would expect which laboratory values to be most abnormal? A) bilirubin B) serum potassium C) creatine kinase D) sodium

C) creatine kinase

A nurse is preparing to administer a prescribed dose of digoxin to an 6-month-old infant. After assessing the infant's apical pulse, the nurse decides to withhold the dose and notify the health care provider. The nurse bases this decision on which apical pulse rate? A) 118 beats/min B) 102 beats/min C) 94 beats/min D) 80 beats/min

D) 80 beats/min

The nurse is caring for an 8-month-old infant in Bryant traction for developmental dysplasia of the hip (DDH) and is monitoring for complications. Which assessment finding most concerns the nurse? A) decreased oral intake B) mild fussiness C) temperature 100.2°F (37.9°C) D) a weak pedal pulse

D) a weak pedal pulse

Wilms tumor is suspected in a 5-year-old child. Which action would be avoided? A) fiber intake B) aspirin administration C) rectal suppository use D) abdominal palpation

D) abdominal palpation

Which of the following is true regarding child sexual abuse? A) perpetrator is often a stranger B) the child often tells an adult of the abuse C) perpetrators often have a single victim D) abuse may be repeated over years

D) abuse may be repeated over years

The nurse is caring for a child diagnosed with Duchenne muscular dystrophy and notes the presence of a Gower sign on the assessment form. What action by the child would support this assessment? A) the presence of a waddling gait and difficulty climbing stairs B) a short heel cord caused by walking on the toes C) meeting motor milestones such as sitting, walking, and standing but at a later age than the average child D) when on the floor, rising to the knees and pressing the hands against the ankles, knees, and thighs to stand

D) when on the floor, rising to the knees and pressing the hands against the ankles, knees, and thighs to stand

The parents of a 2-year-old toddler newly diagnosed with tricuspid atresia ask the nurse, "I do not understand why our toddler's fingertips are spread out and rounder than normal fingertips?" Which response by the nurse is best? A) "The low blood oxygen levels from the heart defect causes the lack of oxygen to the fingers, causing these changes." B) "Increased cardiac workload from your toddler's heart defect affects various parts of the body, including the fingers." C) "The number of red blood cells has significantly increased from the heart defect, resulting in the cells pooling in the fingertips." D) "This is a common complication of tricuspid atresia. Unfortunately, there is nothing we can do to treat it."

A) "The low blood oxygen levels from the heart defect causes the lack of oxygen to the fingers, causing these changes."

The nurse is caring for a 14-year-old boy in Buck traction for a slipped capital femoral epiphysis (SCFE). What information would the nurse include when completing a neurovascular assessment of the affected leg? Select all that apply. A) Color B) Sensation C) Pulse D) Capillary refill E) Vital signs

A) Color B) Sensation C) Pulse D) Capillary refill

The nurse is performing echocardiography on a newborn who is suspected of having a congenital heart defect. The child's mother is concerned about the safety of using this on a newborn and wants to know how this technology works. The nurse assures her that this technology is very safe and may be repeated frequently without added risk. What should the nurse mention in explaining how this diagnostic test works? A) High-frequency sound waves are directed toward the heart B) X-rays are directed toward the heart C) A radioactive substance is injected intravenously into the bloodstream and is traced and recorded on video D) A microphone is placed on the child's chest to record heart sounds and translate them into electrical energy

A) High-frequency sound waves are directed toward the heart

The nurse is caring for a child who has been hospitalized repeatedly at multiple hospitals. There is no clear medical diagnosis and the mother is threatening to leave the hospital against medical advice. The nurse suspects what issue? A) caregiver-fabricated illness (formerly Munchausen syndrome by proxy) B) bipolar disorder C) anxiety disorder D) sexual abuse

A) caregiver-fabricated illness (formerly Munchausen syndrome by proxy)

The nurse is assessing a 10-year-old girl recently fitted with a cast on her wrist. Which assessment finding would alert the nurse to a possible infection? A) drainage on the cast B) pallor of the fingers C) delayed capillary refill D) diminished pulse

A) drainage on the cast

The nurse is caring for a 10-year-old girl in traction. The girl is experiencing muscle spasms associated with the traction. What would the nurse expect to administer if ordered? A) opioid analgesics B) diazepam C) alendronate D) pamidronate

B) diazepam

A nurse is performing a well child visit on a 2 month old. Which of the following would the nurse recognize is not a parental risk for abuse? A) poverty B) divorced C) drug and alcohol abuse D) domestic violence

B) divorced

The health care provider has just informed the parents of a 3-year-old that their child has leukemia. The mother begins crying and tells the nurse she does not want her baby to die. What is the nurse's best response? A) "Don't worry, the health care provider is very good at treating leukemia." B) "I don't blame you for being upset; any parent would be scared too." C) "I know this is scary, but leukemia has a high cure rate in children these days." D) "You are very lucky to have caught it so early; that makes the treatments easier."

C) "I know this is scary, but leukemia has a high cure rate in children these days."

A parent calls the pediatric oncology clinic about the child having headaches after chemotherapy. What is the nurse's best advice? A) Administer ibuprofen every 6 hours. B) Use an ice pack on the child's head. C) Administer acetaminophen as needed. D) Administer oral hydrocodone as needed.

C) Administer acetaminophen as needed.

The pediatric nurse is explaining to a new graduate nurse the differences in planning well-child maintenance for a child with cancer. Which statement by the new nurse demonstrates understanding of the teaching? A) Siblings and parents should not receive nonlive vaccines. B) Growth may be stunted due to chemotherapy. C) No routine live vaccines are administered while on chemotherapy. D) Eliminate second-hand smoke within the home.

C) No routine live vaccines are administered while on chemotherapy.

The nurse is preparing a discharge teaching plan for the parents of an 8-year-old girl with leukemia. Which instruction would be the priority? A) Keeping a written copy of the treatment plan B) Writing down phone numbers and appointments C) Using acetaminophen if the child needs an analgesic D) Calling the doctor if the child gets a sore throat

D) Calling the doctor if the child gets a sore throat

When caring for a child with a congenital heart defect, which assessment finding may be a sign the child is experiencing heart failure? A) Bradycardia B) Inability to sweat C) Splenomegaly D) Tachycardia

D) Tachycardia

A child is diagnosed with rheumatic fever. For which medication will the nurse educate the caregivers? A) nonsterioidal anti-inflammatory drugs (NSAIDs) B) antiviral C) insulin D) phenytoin

A) nonsterioidal anti-inflammatory drugs (NSAIDs)

The nurse is providing education on ALL. Which of the following statements by the nurse extern would indicate the need for further teaching? A) ALL has a peak onset around 4 years old B) it mainly effects RBCs, granulocytes, monocytes, and platelets C) there is a high cure rate D) most go into remission within weeks of starting treatment

B) it mainly effects RBCs, granulocytes, monocytes, and platelets

A nurse is caring for a child with Hodgkin disease who is in the induction phase of a chemotherapy regimen. The nurse explains to the parents that the goal of this phase is to: A) destroy any remaining cancer cells. B) kill enough cancerous cells to induce remission. C) destroy any residual cancer cells. D) follow up for recurrent disease or late effects.

B) kill enough cancerous cells to induce remission.

A 1-year-old with tetralogy of Fallot turns blue during a temper tantrum. What will the nurse do first? A) Assess for an irregular heart rate. B) Listen for an increased respiratory rate. C) Place child in the knee-to-chest position. D) Explain to the child the need to calm down.

C) Place child in the knee-to-chest position.

The nurse is conducting a physical examination of a 10-year-old boy with a suspected neuromuscular disorder. Which finding is a sign of Duchenne muscular dystrophy? A) Gowers sign B) appearance of smaller than normal calf muscles C) indications of hydrocephalus D) lordosis

A) Gowers sign

The father of an 8-year-old boy who is receiving radiation therapy is upset that his son has to go through 6 weeks of treatments. He doesn't understand why it takes so long. In explaining the need for radiation over such a long time, what should the nurse mention? A) Cells are only susceptible to treatment by radiation during certain phases of the cell cycle B) It is difficult to locate where the cancer cells are in the body, so the entire body must be irradiated C) Radiation therapy is very weak, and therefore it takes a long time to achieve therapeutic doses D) Insurance companies typically allow only a short radiation treatment per week, to contain costs

A) Cells are only susceptible to treatment by radiation during certain phases of the cell cycle

Through which mechanism is Duchenne muscular dystrophy acquired? A) virus B) heredity C) autoimmune factors D) environmental toxins

B) heredity

The nurse is caring for a child who has had an open reduction with cast placement on the forearm. While assessing the cast, the nurse notes serosanguineous fluid on the cast. What action by the nurse is appropriate? A) Using a magic marker, color over the entire spot of fluid. Mark the date and time. B) Notify the health care provider of the drainage and prepare to place a new cast. C) Nothing needs to be done at this time. This is a normal assessment finding after this type of surgery. D) Using a ballpoint pen, outline the fluid stain. Mark the time it is outlined.

D) Using a ballpoint pen, outline the fluid stain. Mark the time it is outlined.

The nurse is preparing an education program for parents of a child diagnosed with Legg-Calvé-Perthes disease (LCPD) disorder. What information does the nurse need to include? Select all that apply. A) This disorder has four stages that last over several years. B) The initial stage symptoms include a limp and guarding of the hip while moving. C) The second stage can last up to 2 years and includes breakdown or fragmentation of the bone in the head of the femur. D) In children over 6, surgical placement of a containment device over the head of the femur is the typical treatment. E) If left untreated, the femur head will deform, which can lead to chronic pain.

A) This disorder has four stages that last over several years. B) The initial stage symptoms include a limp and guarding of the hip while moving. E) If left untreated, the femur head will deform, which can lead to chronic pain.

A child with a congenital heart defect is getting an echocardiogram. How would the nurse describe this test to the parent? A) This test will check how blood is flowing through the heart. B) This noninvasive test will check the electrical impulses in the heart. C) This test will only determine the size of the heart. D) This invasive test will measure the blockage in the heart.

A) This test will check how blood is flowing through the heart.

A child with a brain tumor is having symptoms of increased ICP. The nurse recognizes the following as late signs of increased ICP (select all that apply): A) fixed and dilated pupils B) extension/flexion posturing C) headache D) bradycardia

A) fixed and dilated pupils B) extension/flexion posturing D) bradycardia

The nurse is assessing a child and notices pinpoint hemorrhages appearing on several different areas of the body. The hemorrhages do not blanch on pressure. The nurse documents this finding as: A) petechiae. B) purpura. C) ecchymosis. D) poikilocytosis.

A) petechiae.

The nurse is preparing an in-service for the staff about abusive head trauma (shaken baby syndrome). When planning to review risk factors, what should be included? Select all that apply. A) teen parents B) married parents C) infant with colic D) premature infants E) financial concerns in the family.

A) teen parents C) infant with colic D) premature infants E) financial concerns in the family.

The student nurse is developing a care plan for a child who suffered a fractured tibia and will have a cast on his lower leg for approximately 6 weeks. Which nursing diagnosis would be the priority for this client? A) Deficient diversional activities related to a need for imposed activity restriction for 6 weeks B) Impaired physical mobility related to a cast on the leg C) Situational low self-esteem related to the use of a walker D) Pain related to chronic inflammation of the lower leg

B) Impaired physical mobility related to a cast on the leg

A preschooler who received chemotherapy in the pediatric oncology outpatient department 1 week ago now has a temperature of 101.5°F (38.6°C). Which is the most appropriate response by the nurse? A) Tell the parent to administer acetaminophen every 4 hours until the fever dissipates. B) Ask whether any family members or other close associates are ill. C) Have the parent bring the child to the pediatric oncology clinic as soon as possible. D) Instruct the parent to immediately obtain and give the antibiotic that the oncologist will order.

C) Have the parent bring the child to the pediatric oncology clinic as soon as possible.

At what stage can a nurse utilize palliative care for a child with AML? A) 6 months from suspected death B) during the maintenance stage of chemotherapy C) at any stage during their treatment D) during their 6 weeks of radiation treatment

C) at any stage during their treatment

The nurse is caring for a child with leukemia. Which nursing intervention would be the highest priority for this child? A) encouraging the child to share feelings B) grouping nursing care C) following guidelines for reverse isolation D) providing age-appropriate activities

C) following guidelines for reverse isolation

A school nurse is teaching a group of parents about signs and symptoms of cancer in children. Which symptom is an early sign of a brain tumor? A) projectile vomiting, lethargy, and coma B) headache, epistaxis, and dizziness C) headache, vision changes, and vomiting D) nystagmus, ataxia, and seizures

C) headache, vision changes, and vomiting

Preterm infants have more fragile capillaries in the periventricular area than term infants. This put these infants at risk for which problem? A) moderate closed-head injury B) early closure of the fontanels (fontanelles) C) congenital hydrocephalus D) intracranial hemorrhaging

D) intracranial hemorrhaging