Pedia 1

The nurse assessing a 2-year-old should expect the child to be able to perform which actions? Select all that apply. 1. Build a tower with blocks 2. Draw a square 3. Hop on one foot 4. Say own name 5. Walk without help

1,4,5

The nurse receives change of shift report on 4 clients. Which client should the nurse assess first? 1. 6-month-old with respiratory syncytial virus and pulse oximetry of 90% 2. 1-year-old with otitis media and a temperature of 102.5 F (39.2 C) rectally 3. 2-year-old with suspected epiglottitis 4. 3-year-old who has a barking-type cough

3

A child with autism spectrum disorder is being admitted to an acute care unit. Which is the most important nursing action? 1. Placing the child in a private room away from the nurses' station 2. Placing the child in a private room near the playroom 3. Placing the child in a semi-private room near the nurses' station 4. Placing the child in a semi-private room with another child with autism spectrum disorder

1

A nurse is planning to complete a physical examination of a toddler. Which approach is an appropriate intervention by the nurse? 1. Encourage the parent to be involved with the child 2. Engage in physical contact by removing the toddler's outer clothing first 3. Have medical equipment lying on a counter within view 4. Perform an examination in a head-to-toe order

1

After giving birth to a full-term neonate, the client informs the nurse that she has been taking hydrocodone on a regular basis for several years. What should the nurse plan as part of the neonate's care? 1. Feed newborn while swaddled 2. Keep newborn close to the nurse's station 3. Position newborn supine after feeding 4. Stimulate newborn with light regularly

1

The nurse is conducting a psychosocial developmental checkup on a 2-year-old child. What is the priority assessment finding that should be reported to the primary health care provider? 1. Does not talk or respond to being talked to or read to 2. Likes to imitate others by playing house and talking on the telephone 3. Rides a Big Wheel and plays with a softball and bat 4. Says "no" to everything and throws temper tantrums

1

The nurse is providing teaching to the parents of a child with Marfan syndrome. Which topic is the priority for the nurse to address? 1. Avoiding participation in contact sports 2. Informing the dentist of the child's condition 3. Monitoring for development of scoliosis 4. Scheduling annual eye examinations

1

The nurse is teaching the parents of a toddler about health promotion. Which statement by one parent requires clarification? 1. "If my child refuses a meal, I will wait a few minutes and try again." 2. "If bedtime brings on a temper tantrum, I will use a time-out." 3. "I will plan the evening meal at least 15 minutes after a play period." 4. "I will offer my child options rather than asking yes or no questions."

1

The nurse is triaging clients from the waiting room. The care of which client is a priority? 1. 2-year-old who ingested a button battery approximately 30 minutes ago and is asymptomatic 2. 4-year-old who started crying and suddenly won't use the left arm after being swung by the arms 3. Child with cerebral palsy and a baclofen pump who has increased muscular spasms 4. Child with osteogenesis imperfecta who walks in reporting being hit on the front of the head with a baseball

1

The nurse receives 4 prescriptions for a child diagnosed with hemophilia A who was brought to the emergency department following an injury on the school playground. The child has vomited once and has a headache. Which prescription should the nurse carry out first? 1. Administer IV factor VIII 2. Administer IV ondansetron 3. Blood draw for hemoglobin 4. CT scan of the head

1

The parent of a 2-year-old tells the nurse at the well-child clinic, "I am concerned because my child does not like to be cuddled, does not respond when called by name, and does not make eye contact when being fed." What is the priority question for the nurse to ask when completing the health history? 1. "How many words can your child say?" 2. "Is your child potty trained?" 3. "What are your child's favorite foods?" 4. "What kind of toys does your child like to play with?"

1

The parents of a hospitalized 3-month-old have to leave the infant while they work. One parent fears that the baby will cry as soon as they walk out. The nurse teaches both parents about separation anxiety. Which statement by the parent indicates that the teaching has been effective? 1. "At this age, my baby will not cry because we are leaving." 2. "I know my baby will feel abandoned when we leave." 3. "My baby is too young to sense my anxiety about leaving." 4. "My baby understands that we will return later in the day."

1

The registered nurse is attending an end-of-year school family picnic. Which situation needs an immediate intervention? 1. A 2-year-old eating a hot dog unsupervised 2. A 3-year-old playing alone in a wading pool 3. A 4-year-old tossing a beach ball 4. A 5-year-old climbing on monkey bars

1

The school nurse is conducting an educational session for middle school teachers that is designed to heighten awareness of school bullying. The nurse recognizes that further instruction is needed when one of the teachers makes which comment? 1. "Bullying is a normal part of childhood growth and development." 2. "Children with physical disabilities are more vulnerable to bullying." 3. "Most children who are victims of a school bully do not tell an adult about it." 4. "The most common form of bullying is verbal aggression, such as insults and intimidation."

1

What is the most therapeutic intervention the nurse should complete when admitting a 10-month-old to the pediatric unit? 1. Allow the child to sit on the primary caregiver's lap while auscultating breath sounds 2. Instruct the primary caregiver to restrain the child's arm while obtaining intravenous access 3. Provide the option for the child to complete the admission in the room or the designated play area 4. Request that the primary caregiver leave the child's room during the physical assessment

1

Which infant is most likely to require oral iron supplementation at this time? 1. 2-month-old born at 34 weeks gestation who is bottle-fed with breast milk 2. 4-month-old born at term who is breast-fed exclusively 3. 6-month-old born at term who is formula-fed 4. 7-month-old who is breast-fed and was recently started on solid foods

1

Which pediatric presentation in the emergency department should the nurse follow up for possible abuse and mandatory reporting? 1. A 2-month-old who rolled off the changing table and is now lethargic 2. A 3-month-old with flat bluish discoloration on the buttock that the mother says has been present since birth 3. A 3-year-old with forehead bruises that the mother says come from running into a table 4. A 4-year-old who pulled boiling water off the stove and has splattered burns on the arms

1

The nurse on a pediatric unit is caring for a preschooler who exhibits separation anxiety when the parents go to work. Which interventions should the nurse implement? Select all that apply. 1. Encourage the parents to leave the child's favorite stuffed animal 2. Establish a daily schedule similar to the child's home routine 3. Give the child time to calm down alone when visibly upset 4. Provide frequent opportunities for play and activity 5. Remove visual reminders of the parents from the room

1,2,4

A nurse on a pediatric unit is reviewing interventions for a toddler with a practical nurse who will be caring for this child. Which of the following are appropriate activities to minimize the effect of hospitalization on a toddler? Select all that apply. 1. Integrate preferred snack foods in the day's routine 2. Plan quiet play prior to usual nap time 3. Point out body changes that may occur 4. Post a daily schedule by the child's bed 5. Provide 1 or 2 options when choosing toys

1,2,5

A nurse is discussing the fine motor abilities of a 10-month-old infant with the infant's parent. Which are developmentally appropriate skills for an infant of this age? Select all that apply. 1. Grasps a small doll by the arm 2. Stacks 3 wooden blocks 3. Transfers small objects from hand to hand 4. Turns single pages in a book 5. Uses a basic pincer grasp

1,3,5

A client denies illicit drug use but has some suspicious behaviors. The client's neonate has a low birth weight. What other signs would lead the nurse to suspect neonatal abstinence syndrome? Select all that apply. 1. Irritability and restlessness 2. Meconium ileus and floppy tone 3. Microencephaly and cleft palate 4. Poor feeding and loose stools 5. Stuffy nose and frequent sneezing

1,4,5

A 10-year-old client with autism spectrum disorder is hospitalized for a diagnostic workup. Which is themostappropriate nursing action? 1. Encouraging visits by friends to decrease social isolation 2. Giving the client a schedule of daily activities 3. Placing the client in restraints during invasive procedures 4. Providing the client with a variety of toys

2

A 15-year-old client with type 1 diabetes mellitus (DM) is admitted to the pediatric intensive care unit with a blood glucose level of 460 mg/dL (25.5 mmol/L). The nurse understands that which factor is contributing to this client's non compliant behavior? 1. Client is depressed and wants to die 2. Client's psychosocial developmental stage 3. Lack of supervision by the client's caregivers 4. Limited understanding of the disease process

2

A nurse is talking with the parent of a 6-year-old regarding sleep and rest. Which information should be included? 1. Active play before bedtime promotes restful sleep 2. Bedtime hours should be established 3. Rest needs are related to the high rate of growth in this age group 4. Seven to 8 hours of sleep are required

2

As the nurse begins to assist with ambulation of a 9-year-old who is one day post appendectomy, the child cries out, "It hurts too much. I can't do it." What is the first action by the nurse? 1. Administer an analgesic 2. Assess the child's level of pain using a numeric rating scale 3. Come back later in the day 4. Tell the child, "Get up and walk if you want to go home soon."

2

The nurse cares for a 4-year-old who is on long-term, strict bed rest. Which toy is most appropriate to provide diversion and minimize developmental delays? 1. Board games 2. Puppets 3. Soap bubbles 4. Stacking and nesting toys

2

The nurse is preparing to administer an influenza injection to a 6-year-old. After using developmentally appropriate language to inform the child that there will be a needle stick, what is the next action by the nurse? 1. Administer the injection in the deltoid muscle 2. Ask the child to sing a song 3. Ask the parent to hold the child down 4. Tell the child he/she will hardly feel a thing

2

The parents of a hospitalized preschooler are concerned because their toilet-trained child has started wetting the bed. Which response by the nurse is most helpful? 1. "Discipline your child by taking away playroom privileges." 2. "It is normal for your child to regress while hospitalized." 3. "Restricting fluids at nighttime will solve this problem." 4. "Your child is acting out due to the hospitalization."

2

What socioeconomic indicators would the nurse identify as risk factors for a 2-month-old infant to develop failure to thrive (FTT)? Select all that apply. 1. Both caregivers work outside the home 2. Infant lives only with mother, who is currently unemployed 3. Infant's primary caregiver has cognitive disabilities 4. Parents are socially and emotionally isolated 5. Parents live together but are not married

2,3,4

The pediatric nurse is preparing to administer an acetaminophen suppository to an 11-month-old with pyrexia. Which actions are appropriate? Select all that apply. 1. Advance past the external sphincter only 2. Guide suppository along the rectal wall 3. Hold buttocks together firmly after insertion 4. Position client supine with knees and feet raised 5. Use gloved fifth finger for insertion

2,3,4,5

The nurse is performing an assessment on a 2-day-old infant with suspected Hirschsprung disease. Which findings should the nurse anticipate? Select all that apply. 1. Bright red bleeding from anus 2. Distended abdomen 3. Has not passed stool (meconium) 4. Nonbilious vomiting 5. Refusal to feed

2,3,5

The nurse provides teaching for the parents of a 6-year-old diagnosed with nocturnal enuresis. What instructions will the nurse include? Select all that apply. 1. "Allow your child to wear a diaper at bedtime for emotional security." 2. "Have your child assist with wet linen changes." 3. "Prepare a calendar with your child for logging wet and dry nights." 4. "Restrict oral fluids to 8 ounces with each meal." 5. "Wake your child at a specified time each night to void."

2,3,5

The student nurse is reviewing the medical record of a 4-year-old diagnosed with failure to thrive (FTT). The nurse correctly identifies which clinical and psychosocial factors that have likely contributed to the child's condition? Select all that apply. 1. Child has 3 older siblings 2. Child is bottle fed 4 times a day and at bedtime 3. Child's parent is incarcerated for spousal abuse 4. Parent works part time as a teacher's aide 5. Parent worries about having enough money to buy food 6. The children eat at various times of the day in front of the television

2,3,5,6

The nurse in a clinic is obtaining a developmental history of an 18-month-old during a well-child visit. Which activities should the child be able to perform? Select all that apply. 1. Calls self by name 2. Goes up stairs while holding a hand 3. Stacks 6 blocks in a tower 4. Turns 2 pages in a book at a time 5. Twists doorknob to open doors

2,4

What communication strategies would the nurse have in place when establishing rapport with the caregiver and an 8-year-old during a health history interview? Select all that apply. 1. Ask only closed-ended questions to obtain information 2. Allow the child to describe their current issue 3. Isolate the child from the parents and interview them separately 4. Maintain an eye level position when speaking with the child 5. Use language that both the child and caregiver can understand

2,4,5

Which findings in a newborn are considered abnormal and should be reported to the health care provider (HCP)? Select all that apply. 1. Cyanosis of the hands and feet 2. Decreased muscle tone 3. Heart rate of 150/min 4. Sacral dimple 5. Single artery in the umbilical cord

2,4,5

A 10-year-old is implementing behavioral strategies to manage nocturnal enuresis. The client tells the nurse, "I want to go to sleep-away camp during the summer, but if I have an 'accident,' I'm afraid that other kids will tease me." What is the best response by the nurse? 1. "Don't worry. Your problem will be resolved by then." 2. "It would be better if you thought about going to day camp instead." 3. "We can ask your health care provider about a medication trial that may help." 4. "You could always wear a pull-up just in case."

3

A 12-month-old is found to have a moderately elevated blood lead level. Which of the following is the most serious concern for this child? 1. Gastrointestinal bleeding 2. Growth retardation 3. Neurocognitive impairment 4. Severe liver injury

3

A 15-month-old begins to seize during assessment for a high-grade fever. What is the most appropriate nursing action? 1. Administer aspirin to lower the client's body temperature 2. Prepare client for administration of anti-seizure medication 3. Stay with the client and monitor oxygen saturation levels 4. Use a bag valve mask to ensure proper ventilation

3

A 15-year-old parent brings a 4-month-old infant for a well-baby checkup. The parent tells the nurse that the baby cries all the time; the parent has tried everything to keep the infant quiet but nothing works. What is the priority nursing action? 1. Advise the parent to give a pacifier whenever the infant cries 2. Ask the parent to describe what is done to "keep the baby quiet" 3. Assess the infant's pattern and frequency of crying 4. Explore the parent's support system

3

A 5-year-old child is receiving morphine sulfate for pain. Which statement by the caregiver indicates that further teaching is necessary? 1. "I will call the nurse if my child begins to act aggressively." 2. "I'm concerned that my child thinks the pain is punishment." 3. "My child is playing and so does not need pain medication." 4. "The FACES pain scale seems to be working very well."

3

A distraught parent informs the nurse of bleeding in a 1-day-old girl. What is an appropriate response by the nurse after assessing a small amount of bloody mucus in the newborn's diaper? 1. "Laboratory work will need to be completed to determine your newborn's hormone levels." 2. "The health care provider will prescribe a dose of medication to stop the bleeding." 3. "We will continue to monitor the amount, color, and consistency of the drainage." 4. "What visitors have been present since the baby was born?"

3

A newborn client is seen in the emergency department for vomiting. Which assessment finding indicates a possible emergency? 1. Frequent vomiting since birth 2. Tiny blood streaks in the vomit 3. Vomit that is green 4. Vomiting through the nose

3

A nurse in a pediatric clinic is performing a physical examination of a 30-month-old child.Which finding requires further evaluation? 1. Bladder and bowel control achieved 2. Chest circumference is greater than abdominal circumference 3. Current weight is 6 times greater than birth weight 4. Head circumference increased by 1 in (2.5 cm) in the past year

3

A nurse is discussing parallel play with the parent of a 2-year-old. Which statement by the parent indicates understanding of the discussion? 1. "I encourage working in a group to build towers with large blocks." 2. "I have a chalk board available to teach the alphabet and numbers." 3. "I set out a basket of various balls in the backyard when other children come to play." 4. "I try to organize games that involve a team approach."

3

Several clients check into the emergency department at the same time. Which client should be seen first? 1. 6-year-old with blood-streaked stools 2. 10-year-old with epilepsy who had a short seizure at home and is asleep 3. 15-year-old with dental trauma and tooth avulsion 4. Newborn who spits up after every feed

3

The clinic nurse is caring for a 3-year-old client. Which task, if not observed or reported by the parents as accomplished, will cause the nurse concern? 1. Catches a ball at least 50% of the time 2. Copies a square with a pencil or crayon 3. Eats with a spoon 4. Hops on one foot

3

The nurse assesses 4 infants. Which assessment finding would require follow-up by the health care provider? 1. 3-week-old whose anterior fontanelle bulges with crying 2. 4-week-old whose posterior fontanelle is soft 3. 6-month-old with birth weight of 7 lb 3 oz (3.3 kg) who now weighs 12 lb (5.4 kg) 4. 12-month-old with birth weight of 6 lb 4 oz (2.8 kg) who now weighs 20 lb (9.1 kg)

3

The nurse is admitting an infant who has severe growth deficiency and facial characteristics of indistinct philtrum, a thin upper lip, and short palpebral fissures. Which question should the nurse ask to assess the cause of these clinical findings? 1. "Is the mother of advanced age?" 2. "Is there a history of cigarette use during pregnancy?" 3. "Is there a history of exposure to alcohol in utero?" 4. "Is there a maternal history of valproate use?"

3

The nurse is caring for a 10-year-old diagnosed with osteomyelitis. What is the best activity the nurse can suggest to promote age-specific growth and development during hospitalization? 1. Fantasy play with puppets 2. Invite friends to come visit 3. Provide missed schoolwork 4. Watch favorite movies

3

The nurse is caring for an infant with suspected meningitis and preparing to assist with a spinal tap. What is the appropriate nursing intervention? 1. Administer oxygen via nasal cannula for client comfort and safety 2. Clean area with povidone iodine in a circular motion moving outward 3. Hold the child with the head and knees tucked in and the back rounded out 4. Monitor and record vital signs every 15 minutes throughout the procedure

3

The parent of a 1-year-old says to the nurse, "I would like to start toilet training my child as soon as possible." What information does the nurse provide to the parent that correctly describes a child's readiness for toilet training? 1. "A good time to start toilet training is when your child can dress and undress autonomously." 2. "When your child can sit on the toilet until urination occurs, you can start toilet training." 3. "Your child may be ready to start toilet training when able to communicate and follow directions." 4. "Your child will be ready to start toilet training at about age 15 months."

3

The parents of a 4-year-old tell the nurse that the child won't go to sleep at night due to fear of tigers living under the bed. Which response by the nurse is most helpful? 1. "Have you recently visited the zoo?Maybe the tigers looked scary." 2. "If you agree with your child, the fears could continue through this developmental stage." 3. "Night fears are common at this age.Look under the bed with your child." 4. "This is very unusual.Maybe the child saw something scary on TV."

3

When assessing a preterm newborn for cold stress, a graduate nurse in the newborn nursery needs further teaching when stating the need to assess for which finding? 1. Irritability 2. Poor feeding 3. Shivering 4. Weak cry

3

When performing developmental screenings in the well-child clinic, the registered nurse understands that which child is at highest risk of developing autism spectrum disorder? 1. 2-year-old who has a vocabulary of 10 words 2. 3-year-old who received measles, mumps, and rubella immunization at age 1 year 3. 4-year-old whose 10-year-old sibling has the disorder 4. 5-year-old whose parents were age 42 at the time of birth

3

A nurse is performing an assessment of a 12-month-old infant. Which findings would the nurse expect? Select all that apply. 1. Approaches strangers with ease 2. Eruption of 3 teeth 3. Equal head and chest circumference 4. Places a raisin in a small bottle 5. Sits from a standing position

3,5

A 10-year-old weighs 99 lb (44.9 kg) and has a BMI of 24.8 kg/m2 (>95th percentile). Which is the most important assessment for the nurse to make before initiating a weight loss plan? 1. Child's pattern of daily physical activity 2. Family's eating habits 3. Family's financial resources for purchasing healthy foods 4. Family's readiness for change

4

A 14-year-old is scheduled for surgery to treat scoliosis. The child will be hospitalized for about a week and then discharged home to recuperate for 3-4 weeks before returning to school. What is the best activity the nurse can recommend to promote age-specific growth and development during this time? 1. Attending selected after-school events and social activities 2. Keeping up with schoolwork 3. Reading teen magazines 4. Visits from friends

4

A 2-month-old infant has been admitted to the hospital with suspected shaken baby syndrome (abusive head trauma). In reviewing the infant's chart, the nurse expects to encounter which of these clinical findings? 1. A reported history of recent trauma 2. Abdominal bruising 3. External signs of trauma 4. Irritability and vomiting

4

A 3-month-old infant has irritability, facial edema, a 1-day history of diarrhea with adequate oral intake, and seizure activity. During assessment, the parents state that they have recently been diluting formula to save money. Which is the most likely cause for the infant's symptoms? 1. Hypernatremia due to diarrhea 2. Hypoglycemia due to dilute formula intake 3. Hypokalemia due to excess gastrointestinal output 4. Hyponatremia due to water intoxication

4

A 9-year-old has terminal cancer, but the parents do not want the child to know the prognosis. The child has been asking questions such as what dying is like and whether the child will die.Which action by the nurse is most appropriate? 1. Encourage the child to ask the parents these questions 2. Notify the health care provider (HCP) about the child's questions 3. Reassure the child that everyone is trying to help the child get better 4. Tell the parents about the child's questions

4

A nurse in a clinic is talking with a parent about the onset of puberty in boys. What is the first sign of pubertal change that occurs? 1. Appearance of upper lip hair 2. Increase in height 3. Presence of axillary hair 4. Testicular enlargement

4

A nurse is discussing parallel play with parents of toddlers. Which statement should be included in the discussion? 1. "One toddler will take on a follower role." 2. "One toddler's choice of a toy determines the choices of others." 3. "The child may actively watch other children in the group." 4. "The children play without group goals."

4

The clinic nurse is asked by the mother of a 15-month-old, "I am worried about my child's thumb sucking and its effects on tooth alignment. What should I do?" What is the nurse's best response? 1. "As long as your child's thumb sucking stops by age 2-3 years when all of the primary teeth have erupted, there is little concern." 2. "Because your child already has teeth, it is important to implement a plan to stop the thumb sucking as soon as possible." 3. "Newer research shows that thumb sucking has little effect on a child's teeth." 4. "The risk for misaligned teeth occurs when thumb sucking persists after eruption of permanent teeth."

4

The clinic nurse reviews teaching provided to the parent of a child being considered for growth hormone replacement therapy at home. Which statement by the parent indicates that teaching has been effective? 1. "Treatment will be considered a success when my child grows at a rate equal to peers." 2. "Treatment will be required throughout my child's life." 3. "Treatment will begin when my child becomes an adolescent." 4. "Treatment will require a daily injection under my child's skin."

4

The nurse is discussing child safety with the parents of a 12-month-old who is just beginning to walk. Which statement by the parents indicates a need for further instruction? 1. "Our swimming pool is fenced in with a lock on the gate." 2. "We have installed childproof gates at the top and bottom of our stairs." 3. "We need to lower the mattress in our child's crib." 4. "When we can't be watching, we put our child in a mobile child walker."

4

The parent of a 3-year-old calls and tells the nurse of finding the child in the bathroom with an empty bottle of mouthwash.The parent thinks that the bottle was about one quarter full.What is the nurse's priority response? 1. "Call the poison control center.I will give you the number." 2. "Give your child about a cup of water to dilute the mouthwash." 3. "How did your child get hold of the mouthwash?" 4. "What is your child doing right now?"

4

The parent of an 8-year-old asks the nurse for guidance on how to help the child cope with the recent death of the other parent. The nurse's response will be based on the knowledge that the child most likely does which? 1. Believes death is reversible 2. Is aware that death eventually affects everyone 3. Thinks about the religious or spiritual aspects of death 4. Understands that death is permanent

4

The public health nurse conducts a teaching program for parents of infants. Which statement by a participant indicates that teaching has been successful? 1. "I can offer my 7-month-old an egg white omelet with soft, mushy vegetables." 2. "I will switch my 1-year-old to low-fat milk instead of commercial formula." 3. "It is safe to sweeten my 4-month-old infant's formula with honey." 4. "My infant should be able to pick up small finger foods by age 10 months."

4

The public health nurse has received a referral to make a follow-up home visit to a 1-year-old recently diagnosed with failure to thrive (FTT). Which intervention is the prioritynursing action for this child? 1. Assess overall parenting skills 2. Complete a 24-hour dietary intake 3. Measure the child's height, weight, and head circumference 4. Observe the child feeding

4

The registered nurse has completed a well-baby assessment of an 18-month-old. Which assessment findings prompted the nurse to make a referral for a formal developmental screening test? 1. Cannot climb steps by self, pulls a toy, turns the pages of a book 2. Is bottle fed, can hold a spoon, creeps down stairs 3. Throws a ball, is able to point to 2 or 3 body parts, cannot draw a picture 4. Uses 2 words, cannot hold a cup, can seat self in a small chair

4

The triage nurse has one isolation room left in the emergency department. Which priority client should be assigned to this room? 1. Child with chickenpox for the past 14 days; all lesions are crusted and dried 2. Child with impetigo who has been on antibiotics for 3 days 3. Child with leg rash secondary to poison ivy exposure 4. Child with suspected pertussis who has paroxysms of coughing

4

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