Exam 1 practice questions PEDS

The school nurse is planning an educational program centered on abstinence for adolescents. Which of the following methods does the nurse recognize as the most effective way to present this program? a. Use peer-led programs that emphasize the consequences of unprotected sexual contact. b. Teach students methods to resist peer pressure. c. Offer the students the opportunity to care for a simulator infant for 1 week. d. Offer statistics, pamphlets and films discussing the consequences of unprotected sexual contact.

A Adolescents wil1 respond better to peers than to adults telling them what to do. Pamphlets can be easily ignored. Infant simulators are an excellent way to learn about how difficult caring for newborns can be-this may or may not also encourage teens to postpone sex/pregnancy.

Discharge planning for children with lead poisoning includes: a. Confirmation that the child will be going to a home without lead hazards. b. Immediate referral for speech therapy. c. Home Health care for intravenous treatment at home. d. Explanation that no follow-up is needed.

A After lead has been removed from a child's blood, they should go to a lead free environment so that they are not exposed to more lead causing levels to rise again. Child will need frequent follow-up to check levels and need for developmental interventions but any referrals will most likely not be immediate. By discharge chelation therapy is complete so IV therapy at home would not be needed.

A pre-school child is found rocking her stuffed bear, talking to him and says he "feels tired." This is an example of? A. Animism. B. Transductive reasoning. C Regression. E. Stress.

A Animism is when a child believes an inanimate object is actually alive and has feelings and emotions. Nurses often put arm bands on teddy bears and cast the legs of dolls.

A 7 year old female is being admitted to the hospital for a diagnosis of acute lymphocytic leukemia. The nurse wants to gather information from the child regarding her feelings about her diagnosis. Which nursing action is most appropriate to gain information about how the child is feeling? a. The nurse should provide the child with some paper to draw a picture of how she is feeling. b. The nurse should actively attempt to make friends with the child before asking her about her feelings. c. The nurse should ask the child's parents what feelings she has expressed in regard to her diagnosis. d. The nurse should ask the child direct questions about how she is feeling.

A Drawing is an excellent way for children to express their feelings and would work well with school-aged children. A seven year old may not have a sophisticated enough vocabulary to describe her feelings about serious illness. Child's report about her feelings is more accurate than the parent's description.

By what age would the nurse expect that an infant will be able to roll from his abdomen to his back? a. 3 months. b. 5months. c. 7 months. d. 9 months

B

The nurse has just taken vital signs in a 6 week-old child: HR 76, RR 22, BP 90/60. What should the nurse do next? a. Retake the blood pressure with a smaller cuff. b. Call the physician. c. Document the finding. d. Recheck all vital signs in 5 minutes.

B Blood pressure is normal for a 6 week old but heart rate and respiratory rate are significantly low. Baby may be becoming septic. This infant should be examined by the physician right away.

A 17 year-old male is being seen in the ER. In order to obtain the adolescent's health information, his nurse should: a. Interview the adolescent using direct questions. b. Gather information during a conversation. c. Interview the adolescent only in the presence of his parents. d. Gather information only from the parents.

B Conversation is apt to give the nurse time to establish some rapport with the adolescent and give the nurse more opportunities to listen to him. Direct questioning may not get as complete responses and may not uncover the teen's major concerns. It is important to interview teenagers separately from parents but be clear about what can and cannot remain confidential. Interview the parents as well as the adolescent, since their viewpoint is also helpful.

A male infant is visiting the pediatrician for his 6 month well child checkup. His mother tells the nurse she wants to advance the infant's diet. Which statement by the infant's mother leads the nurse to believe that she needs further education about the nutritional needs of a 6 month old? a. I will continue to breastfeed my son and will give him rice cereal 3 times a day. b. I will start my son on fruits and vegetables first c. I will start my son on carrots and will introduce one new vegetable every few days. d. I will not give my son any more than 4-8 ounces of baby juice per day.

B First food should be fortified cereal, with fruits and vegetables added later. It is fine to continue breastfeeding while the child eats solid foods. When other foods are started the best way is to introduce 1 food at a time, adding a new food every few days to watch for allergic response. It is important to limit the amount of juice that infants receive since it has limited nutritional value.

The incidence of accidental drowning in highest in what age group? a. Less than 1 year b. 1 to 4 years c. 5 to 14 years d. 15 to 24 years

B We can figure this out by looking at developmental abilities. Toddlers/young preschoolers are able to walk, are curious, are able to reach potentially dangerous sources of water and do not have an understanding of the danger that may be involved. Other ages of children do drown but their development either makes it harder for them to reach water (infants) or makes them more aware of danger or makes it more likely that they can swim.

A 38 month old female is hospitalized with a femur fracture. What nursing action would help foster the child's sense of autonomy? a. Allow the child to choose what time to take her oral antibiotics. b. Allow the child to have a doll for medical play. c. Allow the child to choose her own sticker. d. Allow the child to administer her own dose of Keflex via oral syringe.

C Choice is a good way to foster autonomy but nurses must be careful not to offer choices when the alternatives are not equally acceptable. Child needs to take antibiotics at a particular time so she has no real choice about this. A 30 month-old is too young to understand much from medical play and also too young to administer her own medication. Choosing a sticker is the best answer.

The nurse understands that which of the following comfort measures is contraindicated for school aged children with communicable disease: a. Acetaminophen for pain control. b. Diphenhydramine for itching. c. Aspirin for fever control. d. Lozenges for sore throat.

C Communicable disease is likely to be viral and aspirin should never be given to children with viruses. A good rule of thumb is not to give aspirin to children at all. All the other interventions would be fine for a school aged child.

How can the nurse best facilitate the trust relationship between infant and parent while the infant is hospitalized? a. The nurse should encourage the parents to remain at their child's bedside as much as possible. b. The nurse should keep the parents informed about all aspects of their child's condition. c. The Nurse should encourage the parents to hold their child as much as possible. d. The nurse should encourage the parents to participate actively in their child's procedures.

C Holding the infant will facilitate trust between infant and parent more than simply being at the bedside. Informing parents about all aspects of the child's care is important but will not facilitate the trust relationship between parent and baby. Parents have different levels of comfort related to participating in or being present for procedures. Family centered care lets the parents decide how much they want to be active in procedures-this does not relate directly to establishing trust between parent and child.

Which treatment would the nurse anticipate for a 2-week-old boy diagnosed with PKU? a. There is no special treatment. b. A high-phenylalanine diet. c. A low-phenylalanine diet. d. The mother will be advised not to breastfeed the infant.

C PKU requires long term (some say lifelong) treatment with special low phenylalanine diet. Breast milk is low in phenylalanine so breastfeeding can be encouraged.

The nurse caring for a 4 year old female in the EU is about to start a peripheral IV. The best method for explaining the procedure to the child is to: a. Show the child a pamphlet with pictures showing the IV placement procedure. b. Have the 5 year old placement next door tell the 4 year old about her experience with her IV placement. c. Show the child the IV placement equipment and demonstrate the procedure on a doll. d. Tell the child that if she remains still, the procedure will be over quickly.

C This is the best way for a pre-school child to see the equipment for IV placement and how it is used. Preschoolers have animism ways of thinking that can ascribe human characteristics to non-human things {like dolls) and IV placement will not hurt the doll. Pamphlets/pictures would be less helpful since child would not be able to see how they are work and that they are safe. Another patient may or may not be helpful and pt still would not be able to understand how IV placement would work for her. Telling the child to "hold still, it will be over quickly" does nothing to explain procedure to the child.

The nurse is teaching parents about ways to treat their 9 month old baby's diaper rash. The nurse will be sure to include: a. Use a hair dryer to dry skin during diaper changes. b. Clean skin frequently with commercial baby wipes. c. Avoid removing all barrier cream with each diaper change. d. Type of diaper chosen has no effect on diaper rash.

C While it is good to expose skin to air hot air should be avoided, so do not use hairdryer. Commercial baby wipes usually contain astringents that would further irritate the baby's skin—cleaning with non-perfumed soap and water is preferred. Barrier creams (like desitin) should not be completely rubbed off with diaper change—this is also hard on the skin. Instead remove soiled layer of cream and apply more. Super absorbent disposable diapers are better for times of diaper rash—these keep the skin dryer.

The nurse is caring for an 8 month old girl. The child's mother asks if the unit has any toys that her child can play with. The nurse goes to the toy area to search for a toy for the child. Which toy is the best choice for this child? a. A doll. b. A board book. c. Colorful beads. d. A musical rattle

D An 8-month-old will enjoy a musical rattle-will be able to move it from hand to hand, enjoy the ability to make music with it and like putting it in her mouth. She is too young to play with the other toys and the beads could be a choking hazard.

The nurse is caring for a 7 year old female on the school-age unit. Her mother is concerned that she may have some developmental delays. Which of the following statements would indicate to the nurse that the child is not developmentally on track for her age: a. The child is able to follow a 4 to 5 step command. b. The child started wetting the bed on this admission to the hospital. c. The child enjoys playing board games with her sister. d. The child has an imaginary friend named Kelly.

D It is normal for children to "regress" to earlier behaviors while hospitalized and bed-wetting could be a symptom of this. Playing board games and following 4-5 step commands are normal behaviors for a young school-aged child. Imaginary friends are more common in toddlers and preschoolers.

The nurse is giving information on preventing sudden infant death syndrome (SIDs) to the mother of a young infant. Which statement indicates the mother understands appropriate measures to take? A. "I will keep my baby's room nice and very warm." B. "I won't use a pacifier to help my baby sleep." C. "I will be sure my baby never spends any time on her abdomen." D. "I will keep my baby's crib in my bedroom."

D Keeping room at moderate temperature, using pacifiers to go to sleep, and having baby sleep in parents' room (but not their bed) are all recommendations to reduce SIDS. Tummy time when baby is awake will help to avoid plagiocephaly (flat head) that comes from always laying supine.

A 16 year old male is hospitalized for cystic fibrosis. He will be an in-patient for 2 weeks while he receives IV antibiotics. What action should the nurse take that will most enhance his psychosocial development? a. Fax the teen's teacher and have her send his homework. b. Encourage the teen's grandparents to visit frequently. c. Tell the teen he is free to use the phone to call his friends. d. Encourage the teen's friends to visit him in the hospital.

D Part of the adolescent's psychosocial development is developing relationships with his peers-friends are very important to teenagers. Since this boy will be in the hospital for a fairly long time it is a good idea to encourage friends to visit (rather than just talk on phone). Homework and grandparents do not promote psychosocial development.

The general contraindication for all immunizations is: a. Febrile seizure 14 days after receiving a prior dose of vaccine. b. Breastfeeding c. Pregnancy d. Severe febrile illness

D Vaccine would not be given to a child who had a seizure within several days of receiving a prior dose but 2 weeks should be okay. Pregnancy is contraindicated got MMR vaccine but okay for other vaccines. In general vaccines should not be given to children who are severely ill.