Pediatric Exam 1

The physician has ordered the postoperative four-year-old child to receive hydromorphine (Dilaudid) intravenously. The drug book lists a therapeutic range for Dilaudid to be 0.01 to 0.015 mg/kg/dose every three to four hours. What would be the maximum therapeutic dose of Dilaudid if the child weighs 30 pounds? Round your answer to the nearest hundredth.

0.2

A child has been admitted to the hospital unit in congestive heart failure (CHF). Symptoms related to this admission diagnosis would include: 1. Tachycardia. 2. Weight loss. 3. Increased blood pressure. 4. Bradycardia.

1

A child has been diagnosed as having a genetic disorder based on a mosaic trisomy. The nurse recognizes that the mother understands the significance of this diagnosis when she states: 1. "Because my child has a mosaic trisomy, he will have some normal cells in his body, which means his disorder may not be as severe as in other children." 2. "Children born with mosaic trisomy do not pass the disorder on to their children." 3. "Mosaic trisomies are inherited from the father's side of the family." 4. "Mosaic trisomies occur in an ovum from an older woman."

1

A child is admitted to the hospital unit with a diagnosis of Kawasaki disease. The physician writes the following orders. Which order would the nurse question? 1. Contact isolation 2. Oral aspirin (dose appropriate for weight) every eight hours 3. Echocardiogram 4. Vital signs every four hours

1

A child is being discharged from the hospital after a three-week stay following a motor vehicle collision. The mother expresses concern about caring for the child's wounds at home. She has demonstrated appropriate technique with medication administration and wound care. What is the priority nursing diagnosis? 1. Parental anxiety related to care of the child at home 2. Family processes, altered related to hospitalization 3. Infection, risk for related to presence of healing wounds 4. Knowledge deficient home care

1

A child with hemophilia comes to the emergency department following an automobile accident. The child presents with multiple injuries. When prioritizing care for the child, the nurse would be most concerned with which injury? 1. Occipital hematoma 2. Radial fracture 3. Dislocated shoulder 4. Abdominal abrasions

1

A child with hemophilia plans on participating in a bicycling club. Which recommendation should the nurse give to the child? 1. Wear kneepads, elbow pads, and a helmet while bicycling. 2. Consider a swim club instead of the bicycling club. 3. Do not join the club. 4. Participate only in the social activities of the club.

1

A child with meningococcemia is being admitted to the pediatric intensive care unit. This child should be placed in which type of room? 1. Private room, in respiratory isolation 2. Private room, in protective isolation 3. Private room, but not in isolation 4. Semiprivate room

1

A couple is evaluated in the genetics clinic, and the male is found to be a carrier of an X-linked dominant disorder. The couple asks the nurse what this means in regard to their future children. The nurse's response will include the information that: 1. All girls born to the family will be affected. 2. About 25% of the boys born to the family will be affected. 3. About 25% of the girls born to the family will be affected. 4. All boys born to the family will be affected.

1

A group of children on one hospital unit are all suffering separation anxiety. When determining the stages of separation anxiety, the nurse recognizes that the child in the "despair" phase is the child who: 1. Lies quietly in bed. 2. Does not cry if his parents return and leave again. 3. Appears to be happy and content with staff. 4. Screams and cries when his parents leave.

1

A neonatal nurse who encourages parents to hold their baby and provides opportunities for kangaroo care most likely is demonstrating concern for which aspect of the infant's psychosocial development? 1. Attachment 2. Assimilation 3. Resilience 4. Centration

1

A nurse is examining different nursing roles. Which best illustrates an advanced practice nursing role? 1. A clinical nurse specialist with whom other nurses consult for her expertise in caring for high-risk children 2. A clinical nurse specialist working as a staff nurse on a medical-surgical pediatric unit 3. A registered nurse who is the circulating nurse in surgery 4. A registered nurse who is the manager of a large pediatric unit

1

A nurse is planning to provide education for a family who has a child with sickle-cell anemia. For the prevention of a sickle-cell crisis, the nurse teaches the family the importance of avoiding which condition? 1. Respiratory infection and dehydration 2. Midrange altitudes 3. Weight loss without dehydration 4. Overhydration

1

A nurse is taking care of a patient in the ICU who has been on opioids for an extended period of time. The nurse understands that the child has to slowly wean from the medication over a period of time. While weaning, the nurse will observe the child for symptoms of too rapid withdrawal, including: 1. Hyperactive deep tendon reflexes, vomiting, and abdominal cramps. 2. Bradycardia and pallor. 3. Decreased blood pressure and drowsiness. 4. Voracious appetite and hypotonicity.

1

A nurse working in the newborn nursery notes that an infant is having frequent episodes of apnea lasting 10 to15 seconds without any changes in color or decreases in heart rate. Which intervention would be the most appropriate? 1. Continue to observe the infant and call the physician if the apnea lasts longer than 20 seconds. 2. Suction the infant's mouth and nares. 3. Call the physician immediately. 4. Turn the infant on its right side.

1

A school-age child with hemophilia falls on the playground and goes to the nurse's office with superficial bleeding above the knee. The nurse should: 1. Apply pressure to the area for at least 15 minutes. 2. Apply a warm, moist pack to the area. 3. Perform some passive range-of-motion to the affected leg. 4. Keep the affected extremity in a dependent position.

1

A seven-year-old girl has been diagnosed with rheumatic fever. The physician has talked with the parents and child and explained the disease and the planned medical treatment. Which statement by the parents needs further clarification? 1. "I understand rheumatic fever is a strep infection of the heart." 2. "My child will be on bed rest for several weeks." 3. "My child will be treated with aspirin and/or corticosteroids." 4. "Once my child has recovered, she will still need to be monitored for sequelae to the disease."

1

A six-year-old child has been newly diagnosed with cystic fibrosis. During discharge teaching, the nurse is instructing the parents on nutritional requirements specifically related to the child's decreased ability to absorb fats. The nurse teaches the family that the child will need supplementation with vitamins that are fat soluble, such as: 1. Vitamin K. 2. Riboflavin. 3. Vitamin B12. 4. Thiamin.

1

A six-year-old child is hospitalized for a surgical procedure. The parents ask if the child's four siblings can visit. The best response by the nurse would be: 1. "Let's plan their visit for a time when the child has received pain medication." 2. "Only those siblings over 16 will be allowed to visit." 3. "I don't think the other children should visit because it might scare them to see their sibling so sick." 4. "Very young children shouldn't visit as they may carry germs."

1

A ten-year-old boy with classic hemophilia is admitted to the hospital for hemorrhage into the knee joint. Treatment is instituted on admission. What would be an appropriate nursing diagnosis for this child? 1. Risk for impaired physical mobility related to joint stiffness and contractures 2. Risk for impaired tissue perfusion (cerebral) related to blood loss. 3. Activity intolerance related to bleeding 4. Disturbed body image related to swollen knee

1

A term infant is found to have a congenital heart defect. During a cardiac catheterization, a stent is inserted to maintain the ductus arteriosus. The parents ask the nurse to explain the purpose of this procedure. The nurse's response would include the information that the stent: 1. Will keep the ductus arteriosus open and oxygenated and unoxygenated blood mixed. 2. Is used to close the ductus arteriosus to prevent mixing of arterial and venous blood. 3. Will redirect the blood so that blood bypasses the right ventricle. 4. Connects the ventricle to the atrium.

1

A toddler has been started on digoxin (Lanoxin) for cardiac failure. The nurse will teach the parents to monitor the child for signs of digoxin (Lanoxin) toxicity including: 1. Bradycardia. 2. Tinnitus. 3. Ataxia. 4. Lowered blood pressure.

1

A two-year-old child recently diagnosed with a seizure disorder will be discharged home on an anticonvulsant. The mother best demonstrates understanding of how to give the medication when she: 1. Draws up the medication correctly in an oral syringe and administers it to the child. 2. Acknowledges understanding of written instructions. 3. Verbalizes how to give the medication. 4. Observes the nurse drawing up the medication and administering it to the child.

1

A very concerned 14-year-old boy presents to the clinic because of an enlargement of his left breast. Except for the breast enlargement, the client's history and physical are normal. The most appropriate intervention for the nurse to implement next would be to inform the child that: 1. This is a normal finding in adolescent males and that the breast tissue generally regresses by the time of full sexual maturity. 2. His condition is related to a high-fat diet and that limiting fat intake usually will resolve the enlargement over a period of a couple of months. 3. A pediatric endocrine consult is being arranged. 4. The healthcare provider is arranging a surgical consult for him.

1

All five of the children in a family were born with a genetic disorder. The disorder is inherited as autosomal dominant. If this is not a statistical rarity, the likelihood would be that: 1. One parent has both chromosomes with the affected gene. 2. Both parents are carriers. 3. One parent is a carrier and the other parent is unaffected. 4. One parent has one chromosome affected and the other parent has none.

1

An adolescent is being seen in the clinic to discuss health promotion behaviors. The nurse develops and implements a health promotion plan. What will the nurse include in the evaluation of the plan? 1. The effectiveness of the health promotion plan and methods to expand and sustain successful approaches 2. Instruction on what is considered healthy behavior 3. Advice to the adolescent that promoting health behaviors will maintain a healthy lifestyle 4. Information on the adolescent's attitude toward health

1

An adolescent who is a vegetarian has been placed on iron supplementation secondary to a diagnosis of iron-deficiency anemia. To increase the absorption of iron, the nurse would instruct the teen to take the supplement with: 1. Orange juice. 2. Black or green tea. 3. Milk. 4. Tomato juice.

1

During the newborn examination, the nurse assesses the infant for signs of developmental dysplasia of the hip. Which finding would strongly suggest this disorder? 1. Asymmetric thigh and gluteal folds 2. Positive Babinski's reflex 3. A negative Moro reflex 4. Flat soles with prominent fat pads

1

For which complication(s) should the nurse observe during administration of Factor VIII to a child with hemophilia? 1. Fever and chills 2. Fat emboli 3. Nausea and vomiting 4. Congestive heart failure

1

Immediately after delivery, the nurse prepares to give the newborn a vitamin K injection. The new father is watching and asks the nurse why the baby is receiving a "shot." The nurse would explain that vitamin K injections are given to newborn infants to: 1. Activate clotting factors. 2. Break up blood clots. 3. Promote red blood cell function and assist in gas exchange. 4. Promote the production of hemoglobin.

1

Nurses working with adolescents should encourage the adolescents to assume more of the responsibility for their healthy behaviors. To promote this personal responsibility, the nurse will want to provide adolescents with information about which health promotion activities? 1. Self-breast exams for girls and self-testicular exams for the boys 2. Immunizations that need to be updated 3. Communicable diseases that are prevalent in the community 4. The importance of eating together as a family several times a week

1

Prior to discharging the child from the hospital, what routine discharge instructions should the nurse discuss with the family? 1. Monitoring signs and symptoms specific to condition 2. Instruction on performing a medical exam on the child 3. No instructions are needed; the family is familiar with the child. 4. A list of all diagnostic tests obtained during the hospitalization and their results

1

Prior to giving an intramuscular injection to a two-and-a-half-year-old child, the most appropriate statement by the nurse would be: 1. "It is all right to cry. I know that this hurts. After we are done, you can go to the box and pick out your favorite sticker." 2. "We will give you your shot when your mommy comes back." 3. "This is medicine that will make you better. First we will hold your leg, then I will wipe it off with this magic cloth that kills the germs on your leg right here. Then I will hold the needle like this and say 'one, two, three, go' and give you your shot. After the shot is over with, I will hold the cotton ball until it stops bleeding and then put the Band-Aid on. Are you ready?" 4. "This is a magic sword that will give you your medicine and make you all better."

1

The nurse is assessing a newborn while the new parents watch. The nurse uses an ophthalmoscope to examine the back of the eye (the retina) and notes a positive red reflex. The nurse would explain to the parents that the red reflex indicates: 1. The absence of congenital cataracts. 2. The presence of intraocular hemorrhage. 3. The optic nerve has been traumatized during delivery. 4. Presence of amblyopia.

1

The nurse is off-duty and watching a youth baseball game when one of the players gets hit in the chest with a ball. The child immediately drops to the ground and is unresponsive. What is the priority action for the nurse to initiate? 1. Initiate CPR. 2. Call 911. 3. Find the parents and offer them comfort. 4. Check the child for hemorrhage.

1

The nurse is taking a health history from the family of a three-year-old child. Which statement or question by the nurse would be most likely to establish rapport and elicit an accurate response from the family? 1. "Tell me about the concerns that brought you to the clinic today." 2. "Does any member of your family have a history of asthma, heart disease, or diabetes?" 3. "Hello, I would like to talk with you and get some information about you and your child." 4. "You will need to fill out these forms; make sure that the information is as complete as possible."

1

The nurse is taking care of a seven-year-old child who is postoperative. The child's mother requests that the child not receive narcotics in the postoperative period because she is afraid the child will become addicted. The nurse would explain to the mother that children who do not receive adequate pain control will be at risk for: 1. Respiratory complications. 2. Urinary complications. 3. Cardiac complications. 4. Bowel complications.

1

The nurse is teaching the parents of a child with idiopathic rheumatoid arthritis about chronic pain. Which statement by the parent indicates teaching has been successful? 1. "When children have chronic pain, they may not have the same behavior as those in acute pain." 2. "It is associated with a single event." 3. "Chronic pain can be managed successfully with NSAIDs." 4. "It is sudden and of short duration."

1

The nurse is working in a pediatric surgical unit. The nurse would expect that patient-controlled analgesia would be most appropriate for which patient? 1. Twelve-year-old who is postoperative for spinal fusion for scoliosis 2. Ten-year-old who has a fractured femur and concussion from a bike accident 3. Five-year-old who is postoperative for tonsillectomy 4. Developmentally delayed 16-year-old who is postoperative for bone surgery.

1

The nurse must perform a procedure on a toddler. The technique most appropriate when performing the procedure is to: 1. Allow the child to cry or scream. 2. Perform the procedure in the child's hospital bed. 3. Ask the child if it is okay to start the procedure. 4. Ask the mother to restrain the child during the procedure.

1

The nurse teaches children with genetic disorders ways to maintain health and avoid complications. The nurse will teach children with which genetic disorder to follow medical guidelines and maintain penicillin prophylaxis? 1. Sickle-cell disease 2. Hereditary idiopathic scoliosis 3. Klinefelter's syndrome 4. Recklinghausen's disease

1

The parents of a one-month-old infant are concerned that their baby seems different from their other child, and they ask the nurse if this is normal. The nurse informs them that it is normal for babies to have different temperaments and that according to the "temperament theory" of Chess and Thomas, one of the characteristics of the "slow-to-warm-up" child is that he: 1. Initially reacts to new situations by withdrawing. 2. Commonly has intense reactions to the environment. 3. Displays a predominately negative mood. 4. Shows a regularity in patterns of eating.

1

The parents of an eight-month-old infant are very distressed that the infant cries for at least one hour when they go out on Friday nights. Which of these statements should the nurse make to the parents? 1. "Your infant is attached to you. This is an expected infant response." 2. "Your baby seems to be afraid of the sitter. Why don't you try another sitter?" 3. "Your infant is too young to be experiencing stranger anxiety; however, you might need to stop going out on Friday nights for a while." 4. "Oh, don't worry. All infants and toddlers display these behaviors until at least 2½ years old."

1

The rationale for nurses utilizing nursing intervention classifications (NICs) when developing a nursing care plan for a child on the unit is to: 1. Improve communication among nurses working with the child. 2. Assist medical records in documenting care provided for insurance purposes. 3. Aid the nursing supervisor in evaluating the nursing staff. 4. Coordinate medical orders with nursing orders.

1

When a parent asks to be present during a procedure, the nurse should understand that: 1. The parent wants to support his child before, during, and immediately after the procedure. 2. The parent wants to ensure that nothing goes wrong with the child. 3. The parent is interested because he is also in the medical field. 4. The parent wants to ensure that the correct medication is being used.

1

When caring for a child diagnosed with aplastic anemia, the nurse would educate the parents regarding which common symptoms? 1. Fatigue and fever 2. Runny nose and cough 3. Nausea and vomiting 4. Cyanosis and bradycardia

1

When discussing injury prevention with the parents of a toddler, which statement indicates teaching has been successful? "The leading cause of death in children is: 1. Unintentional injury." 2. Infectious disease." 3. Congenital anomalies." 4. Cancer."

1

Which athletic activity could the nurse recommend for a school-age child with pulmonary-artery hypertension? 1. Golf 2. Basketball 3. Cross-country running 4. Soccer

1

While assessing a seven-year-old girl, the nurse notices a regular—irregular heartbeat. The nurse listens carefully and notes that the heart rate increases on inspiration and decreases on expiration. What is the most appropriate action for the nurse to take next? 1. Record the finding as normal. 2. Notify the physician. 3. Schedule an EKG. 4. Ask the mother if a murmur has been detected before.

1

While teaching the parents of a newborn about infant care and feeding, the nurse instructs the parents to: 1. Delay supplemental foods until the infant is four to six months old. 2. Begin diluted fruit juice at two months of age, but wait three to five days before trying a new food. 3. Add rice cereal to the nighttime feeding if the infant is having difficulty sleeping after two months of age. 4. Delay supplemental foods until the infant reaches 15 pounds or greater.

1

While trying to inform a five-year-old girl about what will occur during an upcoming CT scan, the nurse notices that the child is engaged in a collective monologue, talking about a new puppy. The nurse's best response would be: 1. "You must be so excited to have a new puppy! They are so much fun. Now let me tell you again about going downstairs in a wheelchair to a special room." 2. "Please stop talking about your puppy. I need to tell you about your CT scan." 3. "I'll come back when you are ready to talk with me more about your CT scan." 4. Ignore the child's responses and continue discussing the procedure.

1

While working on the pediatric unit, the nurse recognizes a neighbor whose child has been admitted to the hospital pediatric intensive care. Out of curiosity, the nurse visits the PICU and reviews the child's chart for information about the child's diagnosis. This nurse: 1. Has violated HIPAA laws. 2. Was working within the legal limitations of his/her job. 3. Was not guilty of violating HIPAA laws unless the nurse shares the information with someone outside the hospital. 4. Was working as a member of the health care team to provide family-centered nursing.

1

The nurse is caring for a four-year-old child who is intellectually disabled and is scheduled for surgery tomorrow. The nurse wants to plan postoperative care and pain relief. The nurse will determine the best pain assessment tool by observing the child's: Standard Text: Select all that apply. 1. Language skills. 2. Understanding of the concept of more and less or otherwise has the ability to quantify pain. 3. Ability to sit for a ten minute evaluation. 4. Ability to perceive pain. 5. Ability to understand pain.

1,2

A child who has undergone a hematopoietic stem cell transplantation (HSCT) is ready for discharge. Which concepts are important for the nurse to include in discharge education? Standard Text: Select all that apply. 1. Keeping the child on a high-calcium diet 2. Practicing good hand washing 3. Avoiding live plants and fresh vegetables 4. Avoiding influenza vaccinations 5. Returning the child to school within six weeks

1,2,3

An infant with tetralogy of Fallot (TOF) is having a hypercyanotic episode ("tet" spell). Which nursing interventions should the nurse implement? Standard Text: Select all that apply. 1. Administer oxygen. 2. Place the child in knee-chest position. 3. Administer morphine and propranolol intravenously as ordered. 4. Draw blood for a serum hemoglobin. 5. Administer Benadryl as ordered.

1,2,3

The clinical nurse specialist is concerned about children's reactions to painful invasive procedures such as intravenous starts. The nurse has decided to use distraction as a means to comfort the school-age child. Depending on the age of the school-age child, which technique might the nurse use to distract the child? Standard Text: Select all that apply. 1. Blowing bubbles 2. Music therapy 3. Guided imagery 4. Hypnosis 5. Sucrose solution

1,2,3

While assessing newborns, the nurse should differentiate normal findings from findings which require further evaluation and intervention. Which would be normal newborn findings? Standard Text: Select all that apply. 1. Swelling over the occiput that crosses suture lines 2. Tiny white papules located primarily on the nose and chin 3. Tiny red macules and pustules that come and go, primarily on the trunk and extremities 4. When the Moro reflex is elicited, the right arm extends and returns to the body. The left arm remains resting against the chest. 5. Greenish discoloration of skin over the entire body that is not removed by the initial bath

1,2,3

An adolescent tells the nurse that the new diagnosis of diabetes has him "stressed out." The nurse will encourage stress reduction activities, including: Standard Text: Select all that apply. 1. Daily exercise, such as walking. 2. Learning more about his illness. 3. Practicing deep breathing and other relaxation techniques. 4. Not thinking about his diagnosis. 5. Allowing the parents control of his disease.

1,2,3,

While completing the health history of a 15-year-old girl, the nurse learns that the girl is sexually active. Based on this finding, the nurse will screen for which conditions? Standard Text: Select all that apply. 1. Herpes simplex virus 2. Gonorrhea 3. Chlamydia 4. Impetigo 5. Mononucleosis

1,2,3,

A 10-month-old infant is seen in the emergency department for a heart rate of 226 beats per minute. Supraventricular tachycardia is diagnosed. The emergency department nurse will prepare to assist with which possible treatments? Standard Text: Select all that apply. 1. Administration of intravenous adenosine (Adenocard) 2. Administration of intravenous amiodarone (Cardarone) 3. Preparation for cardioversion 4. Application of ice to the face 5. Having the child perform a Valsalva maneuver

1,2,3,4

A two-month-old infant is admitted to the hospital with a diagnosis of "failure to thrive" (FTT). The nurse recognizes that the infant will be evaluated for: Standard Text: Select all that apply. 1. Over-dilution of formula concentrate. 2. Parental neglect. 3. Rumination. 4. Malabsorption syndromes. 5. Pica

1,2,3,4

The policy of the pediatric clinic is that head circumferences are performed at each visit, if appropriate. The nurse should plan to check head circumferences on which of the children being seen today? Standard Text: Select all that apply. 1. One-month-old child who is coming for his first well-child visit 2. Two-month-old child with failure to thrive 3. Nine-month-old child with otitis media 4. 18-month-old well-child visit for a child with Down's syndrome

1,2,3,4

While promoting participation in physical activities at school, the nurse recognizes that factors which may inhibit the adolescent from participating would include: Standard Text: Select all that apply. 1. The family members do not regularly participate in physical activity. 2. The adolescent is overweight. 3. The public school does not have sports programs available. 4. Participating in sports may require financial resources. 5. Physical activities are limited to the best athletes.

1,2,4

A seven-year-old child is admitted in sickle-cell crisis. The nurse is concerned with reducing the child's pain. Recognizing that any activity that reduces the sickling will reduce the pain, nursing activities will include: Standard Text: Select all that apply. 1. Administration of narcotics. 2. Administration of NSAIDs. 3. Cold application. 4. Encouraging oral fluids. 5. Maintaining bed rest.

1,2,4,5

An infant with a congenital heart defect is being discharged home until the infant reaches an appropriate weight for the corrective surgery. The nurse would teach the parents infant feeding techniques including: Standard Text: Select all that apply. 1. Breastfeed if possible. 2. Complete each feeding within 30 minutes. 3. Position the infant flat to promote swallowing. 4. Dilute the formula with extra water to ensure adequate fluid intake. 5. Burp the infant frequently.

1,2,5

The nurse is discussing autosomal recessive inheritance with a patient. The nurse will include which statements in the discussion? Standard Text: Select all that apply. 1. "The disorder may appear to skip generations." 2. "Boys and girls are affected in equal numbers." 3. "The disorder passes from mother to son but not from father to daughter." 4. "Daughters that are affected will be more severely involved than sons." 5. "Both parents must be carriers for the disorder."

1,2,5

A registered nurse has been asked to join the ethics committee of the hospital. In considering this appointment, the nurse would recognize that the committee might be considering ethical situations including: Standard Text: Select all that apply. 1. Issuance of a "Do Not Resuscitate" (allow natural death) order on a child who has been determined brain dead against the wishes of the parents. 2. Determining if a minor child who disagrees with the parents about the treatment plan can make an informed decision. 3. Determining if a non-salvageable newborn can be used as an organ donor. 4. Investigating a medication error. 5. Consulting and intervening when parents are not in agreement on decisions of health care for their child.

1,3

A two-year-old child is admitted to the hospital for chronic diarrhea. After investigation, the child is diagnosed with celiac disease. The nurse teaches the family to avoid all glutens and to carefully read all labels. In evaluating the parents' understanding, the nurse allows the family to complete the child's menus. The nurse recognizes the family understands glutens when they choose which foods? Standard Text: Select all that apply. 1. Milk 2. Mashed potatoes with gravy 3. Apple sauce 4. Corn in cream sauce 5. Rice cakes

1,3

The nurse working with a family has observed that the older children have a large number of dental caries, so the nurse plans to provide the mother with information to prevent the development of dental caries in her new infant. What instructions will the nurse include in the teaching provided to the mother? Standard Text: Select all that apply. 1. Wiping the infant's gums with soft, moist gauze once or twice daily 2. Giving foods high in sugar only at breakfast time 3. Not allowing the infant to sleep with a bottle in the bed 4. Reminding the mother that dental care is not needed until the permanent teeth erupt 5. Using a topical anesthetic daily, beginning as soon as the first tooth begins to erupt

1,3

The physician has ordered the toddler to receive an oral medication. The toddler has fought medication administration in the past. Strategies the nurse will use to administer the medication would include: Standard Text: Select all that apply. 1. Request the medication in liquid form and draw the medication in an oral syringe. 2. Put the medication in a favorite drink in the child's sippy cup. 3. Allow the mother to administer the medication to the child. 4. Notify the physician to change the route to intravenous. 5. Hold the child down and squirt the medication in the corner of his mouth.

1,3

A nurse is working with pediatric clients in a research facility. The nurse recognizes that federal guidelines are in place to delineate which pediatrics clients must give assent for participation in research trials. Based upon the client's age, the nurse would seek assent from which children? Standard Text: Select all that apply. 1. The 13-year-old client beginning participation in a research program for ADHD treatments 2. The precocious four-year-old starting as a cystic fibrosis research study participant 3. The 10-year-old starting in an investigative study for clients with precocious puberty 4. The seven-year-old leukemia client electing to receive a newly developed medication being researched

1,3,4

Following an automobile accident, an eight-year-old child is admitted to the emergency department with injuries that lead to hemorrhaging. The nurse would recognize the early signs of hypovolemic shock would include: Standard Text: Select all that apply. 1. Increased work of breathing. 2. Pulse rate of 56. 3. Heart rate 130. 4. Capillary refill time greater than three seconds. 5. Blood pressure 72/42.

1,3,4

The four-year-old child is undergoing cardiac surgery. To reduce the child's stress in the pre-operative period, the nurses will: Standard Text: Select all that apply. 1. Explain the procedure to the child in simple terms of what the child will see, hear, and feel while awake. 2. Explain to the child that the surgery will fix her "broken" heart. 3. Allow the parents to accompany the child to the surgical holding room and wait with the child. 4. Allow the child to hold onto their special "teddy bear" while awake. 5. Wait until the child is in the holding room to insert the Foley catheter.

1,3,4

The new mother tells the nurse that sometimes her infant seems to become frantic when crying and asks what she can do when this happens. Which actions would the nurse recommend? Standard Text: Select all that apply. 1. Offer breast or bottle if it has been two hours or longer since the last feeding. 2. If the infant is not hungry or wet, allow the infant to cry it out. 3. Swaddle the infant in a blanket and rock the infant. 4. Try patting the infant on the back to help the baby expel gas. 5. Take the infant to a different room or outside to distract the infant.

1,3,4

Which of the following are major risks during the post-transplant phase of hematopoietic stem cell transplantation (HSCT)? Standard Text: Select all that apply. 1. Bleeding 2. Thrombosis 3. Pancytopenia 4. Infection 5. Fluid volume overload

1,3,4

The nurse recommends to the mother of a 10-month-old child that cow's milk not be introduced into the diet until after 12 months of age. The mother asks why she can't switch to cow's milk earlier. The nurse explains that cow's milk can lead to iron deficiency anemia because: Standard Text: Select all that apply. 1. Cow's milk is a poor source of iron. 2. The child may be exposed to an antibiotic in processed milk. 3. Cow's milk has a high fat content. 4. In young children, cow's milk can lead to bleeding from the gastrointestinal tract. 5. Cow's milk contains no vitamin C, which is necessary for iron absorption.

1,4

Hospitalization is a stressor for all children. Parents often have other responsibilities that prevent them from staying with their child during hospitalization. Which age groups can best tolerate separation from parents during hospitalization? Standard Text: Select all that apply. 1. Infants birth to five months 2. Infants five months to one year 3. Toddlers and preschoolers 4. School-age children 5. Adolescents

1,4,5

A premature infant is being tube fed. The physician ordered the feeding to total 120 kcal/kg/day. The infant weighs 1.86 kg. The formula contains 20 kcal per ounce. How many ounces of formula should the infant receive per day? Round your answer to the hundredth.

11.16

A 14-month-old child is admitted to the hospital. During the admission process, the nurse determines that the child and family are visiting this country from a foreign country. The nurse is unaware of the cultural traditions and values of that country. How can the nurse best provide culturally competent health care? 1. Read about that country on the internet. 2. Ask the family members how care would be provided in their own country. 3. Ask a nurse who has visited the child's home country about life in that country. 4. Ask a coworker who comes from the same region about customs and cultures in their country.

2

A 14-year-old with cystic fibrosis suddenly becomes noncompliant with the medication regimen. The intervention by the nurse that would most likely improve compliance would be to: 1. Give the child a computer-animated game that presents information on the management of cystic fibrosis. 2. Set up a meeting with some older teens who have cystic fibrosis and have been managing their disease effectively. 3. Arrange for the physician to sit down and talk to the child about the risks related to noncompliance with medications. 4. Discuss with the child's parents that privileges, such as a cell phone, can be taken away if compliance fails to improve.

2

A 17-year-old female presents at a nurse practitioner's office and requests a signature for work papers. The nurse reviews her chart and notes that the last physical examination was within the year. In addition to providing the signature for the work papers, the nurse should use this visit as: 1. A time to discuss exercise and sports participation. 2. A health supervision opportunity. 3. An opportunity to discuss birth control measures. 4. A chance to discuss the importance of pursuing postsecondary education.

2

A child is being prepared for an invasive procedure in the presence of the child's babysitter. The single mother of the child has legal custody but is not present. After details of the procedure are explained, the legal informed consent for treatment on behalf of a minor child will be obtained from: 1. The divorced parent without custody. 2. The babysitter with written proxy consent. 3. A grandparent who lives in the home with the child. 4. The cohabitating unmarried boyfriend of the child's mother.

2

A child is being prepared for surgery. The parent requests to be present during anesthesia induction. How should the nurse respond? 1. The nurse should tell the parent the names of all the medications the child will receive. 2. The nurse should explain what the parent will see and hear when present during induction. 3. The nurse should tell the parent he will be upset to see his child under anesthesia. 4. The nurse should ignore the request and focus on the child.

2

A child who has Beta-thalassemia is receiving numerous blood transfusions. The child is also receiving deferoxamine (Desferal) therapy. The parents ask how the deferoxamine will help their child. Which is an action of deferoxamine that the nurse should convey? 1. Stimulates red blood cell production 2. Prevents iron overload 3. Provides vitamin supplementation 4. Prevents blood transfusion reactions

2

A couple has been referred for genetic counseling. Prior to making the appointment, the couple should understand that: 1. The cost of genetic counseling will be covered by their health insurance. 2. Genetic counseling and testing is voluntary. They have a right to decide not to seek the information. 3. Once genetic counseling has been completed, the physician may require sterilization of the man or woman. 4. Their extended family will benefit from the knowledge the couple gains.

2

A four-year-old is seen in the clinic for a sore throat. In the child's mind, the most likely causative agent is that the child: 1. Was exposed to someone else with a sore throat. 2. Yelled at his brother. 3. Did not eat the right foods. 4. Did not take his vitamins.

2

A nurse is talking to the mother of an exclusively breastfed, African American infant who is three months old and was born in late fall. The nurse would want to make sure that this child is receiving: 1. Iron 2. Vitamin D 3. Calcium 4. Fluoride

2

A six-month-old infant has been hospitalized several times with diarrhea. The nurse evaluates home care to determine the cause of the repeated illnesses. Which is the most likely cause of the repeated gastroenteritis? 1. The infant is allowed to drink from her parents' drinks at meal time. 2. If the infant doesn't finish her bottle, the mother returns it to the refrigerator to be used later in the day. 3. There are three school-age children in the family. 4. The infant often wears only a diaper around the house.

2

A supervisor is reviewing the documentation of the nurses in the unit. The documentation that most accurately and correctly contains all the required parts for a narrative entry is the entry that reads: 1. "1630 catheterized using an 8 French catheter, 45 ml clear yellow urine obtained, specimen sent to lab, squirmed and cried softly during insertion of catheter. Quiet in mother's arms following catheter removal. M. May RN" 2. "1/9/05 2 p.m. g-tube accessed, positive air gurgle over stomach: 5 ml air injected, 10 ml residual stomach contents returned to stomach, PediaSure formula hung on Kangaroo pump infusing at 60 ml/hr for 1 hour. Child grunting intermittently throughout procedure. K. Earnst RN" 3. "Feb. '05 Portacath assessed with Huber needle. Blood return present. Flushed with NaCl sol., IV gamma globulins hung and infusing at 30 ml/hr. Child smiling and playful throughout the procedure. P. Potter, RN" 4. "4:00 Trach dressing removed with dime-size stain of dry serous exudate. Site cleansed with normal saline. Dried with sterile gauze. New sterile trach sponge and trach ties applied. F. Luck RN"

2

Advances in genetic screening provide information with high levels of certainty about genetic disorders a fetus might have. Which is an ethical implication of these advances? 1. The nurse must participate in actions that are completely contradictory to his personal ethics. 2. The nurse must be aware of his own personal feelings about the actions taken after the screening tests are completed. 3. The nurse must be aware of parent feelings regarding the information available to them. 4. The parents must be aware of the nurse's feelings regarding the information available about the fetus.

2

An adolescent who recently moved to a new school in a different town presents to an ambulatory care center and describes the following: "I have no friends in my new school, and I no longer want to go to college. I know I will be lonely there, too." Which takes priority when speaking with the adolescent? 1. Stressing the importance of remaining in a close parent-child relationship during these stressful times 2. Promoting healthy mental health outcomes 3. Acknowledging the fact that it takes several months to make new friends at a new school due to adolescent exclusion behaviors 4. Helping the adolescent realize the value of postsecondary education

2

An infant has been diagnosed with a mild heart defect. Surgery to correct the defect will not be performed for at least two years. The nurse teaches the parents that a child with a mild heart defect should: 1. Have a low-grade fever until the defect is repaired. 2. Maintain normal activity. 3. Not develop congestive heart failure. 4. Not be given antipyretics.

2

During the nurse's initial assessment of a school-age child, the child reports a pain level of 6 out of 10. The child is lying quietly in bed watching television. The nurse should: 1. Reassess the child in 15 minutes to see if the pain rating has changed. 2. Administer the prescribed analgesic. 3. Do nothing, since the child appears to be resting. 4. Ask the child's parents if they think the child is hurting.

2

Following a traumatic birth, an infant is admitted to the neonatal intensive care unit. When the grandparents arrive at the hospital, they question the nurse caring for the baby about its condition and plan of care. The nurse who provides this information without permission from the parents would be committing: 1. Negligence 2. A breach of privacy 3. Malpractice 4. A breach of ethics

2

Following an injury that led to hypovolemic shock, a child is being treated in the emergency department. Which treatment measures would be given the highest priority for this child with hypovolemic shock? 1. Assess the cause of bleeding. 2. Establish an open airway and administer oxygen. 3. Administer analgesics for control of pain. 4. Provide replacement of volume.

2

The 17-month-old infant is terminally ill with cancer and is in constant pain. The nurse recognizes that the best way to control pain in this child would be for the physician to order: 1. Patient-controlled analgesia with the parents controlling the button that administers the dosage. 2. Intravenously administered opioids on a scheduled basis. 3. Intravenously administered opioids on a prn basis. 4. Parenteral administration controls pain more effectively than oral medication as oral absorption may be modified by stomach activities. In addition, providing analgesics on a scheduled basis is preferred over prn.

2

The charge nurse on a hospital unit is developing plans of care related to separation anxiety. The charge nurse recognizes that the hospitalized child who is at greatest risk for experiencing separation anxiety when parents cannot stay is the: 1. Six-month-old. 2. 18-month-old. 3. Four-year-old. 4. Six-year-old.

2

The home health nurse is visiting a family at home when the toddler has an "accident" and has a bowel movement in his diaper. The mother becomes angry with the child and calls him a baby for messing himself. The nurse considers Erikson's theory and recognizes that the mother's behavior may have an effect on the child's: 1. Cognitive development. 2. Sense of independence. 3. Conscience. 4. Development of superego.

2

The mother of a child who is recovering from surgery says to the nurse, "I don't understand why that other nurse told me to stroke his forehead when he is in pain. Why will that make him feel better?" The nurse's response will be based on the knowledge that: 1. Stroking the child's forehead reminds the child of the mother's continued presence, which is reassuring to the child. 2. Stroking causes a non-pain transmission to the brain that competes with the pain transmission and inhibits the pain message from reaching the brain. 3. Stroking causes the release of biochemicals, such as prostaglandins, which block pain transmission. 4. Stroking causes the release of endorphins, which reduce the perception of pain.

2

The nurse has been following the infant in the well-baby clinic and has checked the child's vision on every visit. At four months of age, the nurse will add the cover-uncover test to check the child for: 1. Conjunctivitis. 2. Strabismus. 3. Amblyopia. 4. Cataracts.

2

The nurse is assessing a 15-year-old female. The girl's menses began when she was 12 years old. The girl's body mass index (BMI) is 27.5 and her height is 5 feet, 2 inches. She weighs 160 pounds. Her school performance has been spotty. The priority client teaching would be related to: 1. Menstrual cycle. 2. Nutritional intake. 3. School performance. 4. Adolescent mini mental health status examination.

2

The nurse is checking peripheral perfusion to a child's extremity following a cardiac catheterization. If there is adequate peripheral circulation, the nurse would find that the extremity: 1. Has a capillary refill of greater than three seconds. 2. Is warm, with a capillary refill of less than three seconds. 3. Has decreased sensation with a weakened dorsalis pedis pulse. 4. Has a palpable dorsalis pedis pulse but a weak posterior tibial pulse.

2

The nurse is preparing to administer a blood transfusion to a child with a severe anemia. Which type of transfusion reaction may be within the nurse's realm of prevention? 1. Allergic 2. Hemolytic 3. Febrile 4. Septic

2

The nurse is preparing to perform a heel stick on a neonate. The most appropriate complementary therapy for the nurse to plan to use in the neonate to decrease pain during this quick but painful procedure is: 1. Holding the infant. 2. Sucrose pacifier. 3. Massage. 4. Swaddling.

2

The nurse is preparing to see an adolescent patient to assess his relationships with others. What should the nurse do when conducting this assessment? 1. Let the parents know the nurse will share the information with them after the exam. 2. Provide separate time to communicate with both the adolescent and the parents. 3. Avoid asking the parents their opinions of the adolescent's friends. 4. Tell the parents they are not allowed to come into the examination room.

2

The nurse is speaking with a group of adolescents about what can happen when having unprotected sex. The nurse understands that to communicate effectively with teens, the nurse must: 1. Offer personal opinions on the topic and cite examples of what can happen if they don't listen. 2. Allow for discussion, and bring peers who have had experience related to the topic being discussed. 3. Lecture on the topic for the allotted time without any discussion. 4. Discuss sex education related to religious belief.

2

The nurse is taking care of a child in the ICU. The parent appears very angry and tells the nurse no one is giving her information about her child. How should the nurse respond? 1. Inform the parent she will be asked to leave if she continues this behavior. 2. Apologize for the parent's perception and assure the parent that the staff will keep her informed. Inform the parent of any change in the child's condition as soon as possible. 3. Offer to ask the doctor to come and talk with her. 4. Tell the parent her behavior will upset the child.

2

The nurse is teaching the parents of a four-month-old infant about good feeding habits. The nurse emphasizes the importance of holding the baby during feedings and not letting the infant go to sleep with the bottle, as this is most likely to increase the incidence of both dental caries and: 1. Aspiration. 2. Otitis media. 3. Malocclusion problems. 4. Sleeping disorders.

2

The nurse is working with first-time parents. Which of these activities will the nurse suggest to encourage the development of good muscle tone? 1. Placing the infant in an infant seat rather than lying down in a crib 2. Surrounding the infant with toys and other stimulating items to encourage motor movement 3. Swaddling the infant 4. Putting the infant to bed each night at 8 p.m., even if the infant protests with crying

2

The nurse will want to screen all adolescents for problems associated with the primary developmental task of adolescents. In that area, the nurse will ask questions about: 1. The adolescent's adaptation to high school. 2. Establishing positive peer relationships. 3. Finding a life career. 4. Developing a healthy lifestyle.

2

The parents of a child who is critically injured wish to stay in the room while the child is receiving emergency care. The nurse should: 1. Ask the physician if the parents can stay with the child. 2. Allow the parents to stay with the child. 3. Escort the parents to the waiting room and assure them that they can see their child soon. 4. Tell the parents that they do not need to stay with the child.

2

The pediatric nurse's best defense against an accusation of malpractice or negligence is that the nurse: 1. Is a nurse practitioner or clinical nurse specialist. 2. Met the Society of Pediatric Nurses standards of practice. 3. Was acting on the advice of the nurse manager. 4. Followed the physician's written orders.

2

The role of the registered nurse as a nurse educator is to: 1. Provide primary care for healthy children. 2. Assist the family in making informed decisions by providing information about the pros and cons of the treatment plan. 3. Assist the primary care nurse with procedures requiring advanced practice skills. 4. Communicate with the hospitalized school-aged child's classroom teacher to assist the child in achieving classroom goals.

2

The school nurse recognizes that an adolescent comes from a family with limited financial resources. The nurse is developing a nursing care plan to assist the adolescent with his needs. An appropriate nursing diagnosis would be: 1. Altered financial support related to inadequate parental support. 2. Imbalanced nutrition: Less than body requirements related to familial financial difficulties. 3. Knowledge deficit related to sources of financial support. 4. Risk for injury related to imbalanced nutrition.

2

To accurately access blood pressure on a child, the nurse would select a cuff: 1. By the cuff label—infant, child, adult. 2. That covers 2/3 of the upper arm with a bladder that wraps around at least 80% of the circumference of the arm. 3. Based on availability as the size of the cuff will not influence the blood pressure. 4. That extends up to 50 % of the upper arm and the bladder covers 1/4 of the circumference of the arm.

2

What would be the best way for the nurse to teach adolescents regarding health promotion and health maintenance? 1. Contact the parents and ask what issues they have with their adolescents. 2. Have the adolescents identify a personal health goal. 3. Ask the advice of the counselors at school. 4. Tell the adolescents what you will include in the lecture.

2

When a parent reports multiple male miscarriages, the nurse should confer with the health care provider about a possible genetics referral for which type of conditions? 1. Anticipation autosomal dominant conditions 2. X-linked recessive conditions 3. X-linked dominant conditions 4. Autosomal recessive conditions

2

While assessing the blood pressure of an eight-year-old child, the nurse notes the following: Systolic sound is heard at 98, but the sound continues until it reaches 0. There is a distinct sound softening at 48. How should the nurse record this finding? 1. 98/48 2. 98/48/0 3. 98/0 4. 48/0

2

While changing the diaper on a newborn in the presence of the mother, the nurse notes a belly binder wrapped around the umbilical cord. When questioned, the mother states this is the way the umbilical area is cared for in her culture. The nurse should: 1. Accept this practice as a cultural variation and allow the mother to care for the umbilicus. 2. Explain to the mother the risks associated with belly binders and encourage her to remove it. 3. Remove the belly binder and discard it. 4. Replace the belly binder with a coin as a safer cultural practice.

2

While inspecting a five-year-old child's ears with an otoscope, the nurse notes that the right membrane is red and there is an absence of light reflex. In view of these findings, which vital sign parameter would most concern the nurse? 1. Heart rate 2. Temperature 3. Blood pressure 4. Respirations

2

While teaching parents of a newborn about normal growth and development, the nurse informs them that their child's weight should: 1. Triple by nine months of age. 2. Double by five months of age. 3. Triple by six months of age. 4. Double by one year of age.

2

A preschooler is hospitalized following an injury. The mother has been staying with the child but now must leave to care for the other children. The mother asks the nurse what is the best way to leave. The nurse's response will include: Standard Text: Select all that apply. 1. Leave the child after he falls asleep so he won't know you are going. 2. Tell the child you are leaving and identify when you will return by the child's schedule (e.g., after you eat supper). 3. Have the mother leave an article of clothing behind. 4. Tell the nurse when she is leaving so the nurse can stay with the child while the parents are absent. 5. Plan to leave when the child is having procedures performed as the child will be busy and less aware of the parents' absence.

2,3

In responding to the needs of pediatric patients in pain, the nurse has numerous nonpharmacologic interventions available. These interventions include: Standard Text: Select all that apply. 1. Regional nerve block. 2. Cutaneous stimulation. 3. Application of heat. 4. Electroanalgesia. 5. Use of EMLA cream.

2,3,4

The mother of a six-week-old infant tells the nurse that her baby has had colic for several days, crying for up to three hours and drawing his legs up on his abdomen. The mother says she is at "wits end" and wonders what she can do. The nurse learns that the infant is formula fed and gaining weight satisfactorily. The nurse would recommend: Standard Text: Select all that apply. 1. Breastfeeding the infant. 2. Switching to a bottle that has a collapsible bag inside. 3. Putting the infant in a baby swing after feeding. 4. Burping the baby more frequently. 5. Giving the baby a suppository once each morning.

2,3,4

The nurse is explaining fetal circulation to a woman pregnant with a fetus with a congenital heart defect. The nurse explains that there are three fetal structures and explains that blood flow from the umbilical vein flows through the three fetal structures in the following order: Standard Text: Click and drag the options below to move them up or down. Choice 1. Ductus arteriosus Choice 2. Ductus venosus Choice 3. Foramen ovale

2,3,4

The nurse is teaching parents of the child with sickle-cell disease how to avoid precipitating factors that can contribute to a sickle-cell crisis. Which are precipitating factors that could contribute to a sickle-cell crisis? Standard Text: Select all that apply. 1. Regular exercise 2. Fever 3. Dehydration 4. Altitude 5. Increased fluid intake

2,3,4

An adolescent reports that after hearing about all the hazards of cigarette smoking, he has changed to chewing tobacco. The nurse will want to inform that adolescent of the risk factors associated with smokeless tobacco, including: Standard Text: Select all that apply. 1. Lung cancer. 2. Nicotine addiction. 3. Mouth cancers. 4. Emphysema . 5. Mouth ulcers.

2,3,5

While assessing risk factors in adolescents, the nurse recognizes that dental issues may be related to: Standard Text: Select all that apply. 1. Fluoridated water. 2. Failure to use a mouth guard when playing physical sports. 3. Adolescent obesity. 4. Diagnosis of bulimia.

2,4

A seven-year-old presents to the clinic with an exacerbation of asthma symptoms. On physical exam, the nurse would expect which of the following findings? Standard Text: Select all that apply. 1. Increased tactile fremitus 2. Decreased vocal resonance 3. Bronchophony 4. Decreased tactile fremitus 5. Wheezing

2,4,5

The parents of a two-and-a-half-year-old are concerned about their child's finicky eating habits. While counseling the parents, which statements by the nurse would be accurate? Standard Text: Select all that apply. 1. "Nutritious foods should be made available at all times of the day so that the child is able to 'graze' whenever he is hungry." 2. "The child is experiencing physiologic anorexia, which is normal for this age group." 3. "A general guideline for food quantity at a meal is one-quarter cup of each food per year of age." 4. "It is more appropriate to assess a toddler's nutritional demands over a one-week period rather than a 24-hour one." 5. "The toddler should drink sixteen to twenty-four ounces of milk daily."

2,4,5

A 10-year-old child has been struggling with his self-esteem. Which activity would best help this child have a positive resolution of Erikson's Industry versus Inferiority stage? 1. Playing sports with his older brother and the brother's friends. 2. Have his mother compliment him when he completes his homework. 3. Encourage the child to participate in boy scouts and earn badges. 4. Suggest to the mother that she allow the child to babysit his younger siblings.

3

A 12-year-old child is being admitted to the unit for a surgical procedure. The child is accompanied by two parents and a younger sibling. The level of involvement in treatment decision making for this child is: 1. That of a mature minor. 2. That of an emancipated minor. 3. That of assent. 4. None.

3

A child diagnosed with congestive heart failure is started on digoxin (Lanoxin) and spironolactone (Aldactone). The mother questions why the child was placed on spironolactone (Aldactone) instead of furosemide (Lasix), which her elderly grandmother uses. The nurse explains that spironolactone (Aldactone) is a diuretic that: 1. Produces rapid diuresis. 2. Blocks reabsorption of sodium and water in renal tubules. 3. Spares potassium. 4. Promotes vascular relaxation.

3

A child has been hospitalized for an extended time period and is being discharged home. This child requires complex, long-term care and will have a home health nurse visit daily. In addition to a central line, the child is on oxygen by nasal cannula. What should the nurse teach the family members? 1. How to insert an IV line 2. Nothing, the family is familiar with the care. 3. Instruction on oxygen administration 4. How to remove a central line

3

A child has had a heart transplant. In preparation for discharge, the nurse provides teaching about home medications. The nurse recognizes that postoperative teaching has been successful when the parents state that the child is on cyclosporin A to: 1. Treat hypertension. 2. Reduce serum cholesterol level. 3. Prevent rejection. 4. Treat infections.

3

A child is admitted to the hospital and diagnosed with aplastic anemia. The parents ask the nurse what aplastic anemia is. Which would be the best description of aplastic anemia? 1. Causes a proliferation of white blood cells 2. Is characterized by abnormally shaped red blood cells 3. Is characterized by failure of the bone marrow to produce adequate numbers of cells 4. Is a disorder that occurs following a viral illness

3

A child who has chronic pain of long duration will exhibit which behavior? 1. Increased respiratory rate 2. Normal temperature 3. Normal heart rate 4. Decreased blood pressure

3

A five-year-old child is being discharged from the outpatient surgical center. Which statement by the parent would indicate the need for further teaching? 1. "I will call the office tomorrow if the pain medicine is not relieving the pain." 2. "I can expect my child to have some pain for the next few days." 3. "Because my child just had surgery today, I can expect the pain level to be higher tomorrow." 4. "I will plan to give my child pain medicine around the clock for the next day or so."

3

A five-year-old is in the playroom when the respiratory therapist arrives on the pediatric unit to give the child a scheduled breathing treatment. The nurse should: 1. Escort the child to his room and ask the child life specialist to bring toys to the bedside. 2. Reschedule the treatment for a later time. 3. Assist the child back to his room for the treatment but reassure him that he may return when the procedure is completed. 4. Show the respiratory therapist to the playroom so the treatment can be performed.

3

A foster mother is caring for an infant who experienced an intrauterine drug exposure to cocaine. The infant often is irritated and cries for several hours each day. Which of these interventions will assist the infant in developing self-regulatory behaviors? 1. Encouraging the infant to suck as a comfort measure by placing the infant's fingers in the mouth while crying 2. Placing the infant about 15 inches from the TV and turning on an infant show such as Sesame Street 3. Swaddling the infant 4. Allowing the infant to cry but observing the infant to prevent injury

3

A hospitalized three-year-old needs to have an IV restarted. The child begins to cry when carried into the treatment room by the mother. Which is the most appropriate nursing diagnosis? 1. Knowledge deficit of the procedure 2. Fear related to the unfamiliar environment 3. Anxiety related to anticipated painful procedure 4. Ineffective individual coping related to an invasive procedure

3

A nurse caring for a nine-year-old notices some swelling in the child's ankles. The nurse presses against the ankle bone for five seconds, then releases the pressure, noticing a markedly slow disappearance of the indentation. Based on these physical findings, the nurse would be most concerned with assessing: 1. Skin integrity, especially in the lower extremities. 2. Level of consciousness. 3. Urine output. 4. Range of motion and ankle mobility.

3

A parent asks the nurse if there is anything that can be done to reduce pain that his three-year-old experiences each morning when blood is drawn for lab studies. The most appropriate method the nurse can suggest to relieve pain associated with the venipuncture is: 1. Intravenous sedation 15 minutes prior to the procedure. 2. Use of guided imagery during the procedure. 3. EMLA cream (lidocaine 2.5% and prilocaine 2.5%) applied to the skin at least one hour prior to the procedure. 4. Use of muscle-relaxation techniques.

3

A two-month-old infant with a congenital heart defect has been admitted to the pediatric intensive care unit with congestive heart failure. Nursing care for this child should include which intervention? 1. Monitor respirations during active periods. 2. Give larger feedings less often to conserve energy. 3. Organize activities to allow for uninterrupted sleep. 4. Force fluids appropriate for age.

3

All of the following adolescents are in the emergency room for treatment. Which adolescent would be an emancipated minor? 1. The 15-year-old adolescent who disagrees with the parents in regard to the medical plan of care 2. The 14-year-old adolescent who understands the risks and benefits of treatment 3. The 17-year-old adolescent who is self-supporting and maintains her own apartment 4. The 16-year-old adolescent who ran away from home and is living with a friend

3

An adolescent comes to the clinic because of a concern with a skin lesion, and he is accompanied by a parent. When the adolescent is called back to the exam room, the parent comes with the adolescent. What approach by the nurse would be most appropriate? 1. Instruct the parent to stay in the waiting room and tell him that the adolescent will give him a report on the exam. 2. Tell the parent he cannot come into the exam room with the adolescent. 3. Reassure the parent that you will talk with him about any of his concerns and questions. 4. Allow the parent to come into the exam room with the adolescent.

3

An analgesic is ordered for a post-surgical patient to be given every three to four hours. The nurse knows that a delay in giving the medication will cause a(n): 1. Decrease in the chance of withdrawal symptoms. 2. Decrease in the chance of addiction. 3. Increase in the chance of breakthrough pain. 4. Increase in the child's pain tolerance.

3

An infant is born at 24 weeks' gestational age. Which of these interventions should the nurse plan when the infant is discharged home? 1. Instructing the parents that infants need warmed milk and to heat the milk in a microwave for no more than 15 seconds 2. Giving the parents information on HIV screening that is necessary for infants born at this gestational age 3. Referring the infant for developmental screening 4. No particular instructions are necessary because discharge teaching is completed immediately after the birth of the infant.

3

An obese adolescent who adamantly denies sexual activity has a positive pregnancy test. Which statements would be most appropriate for the nurse to make to this adolescent? 1. "When was your last menstrual period (LMP)?" 2. "Tell me how you feel about your body image." 3. "Let's discuss some activities that you have done within the past few months that could possibly lead to pregnancy." 4. "Why are you denying sexual intercourse?"

3

As medical care has evolved, it has become more common for children with genetic disorders to live longer. What impact does this have on health care delivery for the nurse providing care for these children? 1. Health care delivery is becoming more complex, despite these children requiring less care as they age. 2. Nurses should not spend much time at the bedside, as these children will eventually die of these disorders. 3. Nurses must be familiar with increasing numbers of genetic disorders and the care these children require. 4. Health care delivery will become more and more expensive until children with genetic disorders will have to do without.

3

Despite the availability of the Children's Health Insurance Program (CHIP), families often fail to obtain coverage for eligible children because: 1. They do not see the importance of insurance coverage. 2. Families do not have adequate time to complete the enrollment process. 3. They do not know their child is eligible. 4. Parents do not value medical interventions for their children.

3

During discharge teaching to parents of a child hospitalized with sickle-cell crisis, the nurse should emphasize which of the following as a priority home care intervention? 1. Rapid weaning of pain medications 2. Promotion of a diet high in protein 3. Encouraging adequate hydration 4. Restriction of activities

3

During genetic testing, one parent is found to have a chromosomal abnormality without any physical or mental disability; however, the offspring has inherited physical and/or mental disability. During patient education, the nurse explains that the type of individual who can have a chromosomal abnormality without any disability but can cause his offspring to receive chromosomal alterations and disability is the parent with: 1. Dominant-gene structural chromosomal inversions. 2. Mosaicism. 3. Dominant-gene structural chromosomal balanced translocations. 4. Dominant-gene structural chromosomal deletions.

3

Following carrier testing, it is determined that both the husband and wife have sickle-cell trait. Which statement by the wife indicates correct understanding of autosomal recessive inheritance? 1. "Because both my husband and I carry the trait but do not have the disease, I don't need to have prenatal testing because my baby will also be a carrier." 2. "Because both my husband and I are both carriers, I don't need to have prenatal testing because all of our children will have the disease. 3. "When I become pregnant, I need to have an amniocentesis or other prenatal test to determine whether my baby is affected with sickle-cell disease." 4. "There is no use undergoing prenatal testing as sickle-cell anemia cannot be diagnosed prenatally."

3

Following treatment for iron deficiency anemia, the physician orders lab tests. Which lab value would indicate an improvement in the child's condition? 1. Low hemoglobin 2. Normal platelet count 3. High reticulocyte count 4. Low hematocrit

3

In addition to separation anxiety, infants between six and 18 months of age also might display: 1. Fear of disfigurement. 2. Fear of death. 3. Stranger anxiety. 4. Fear of bodily injury.

3

The clinic administrator has suggested that the nurse teach all children newly diagnosed with diabetes in a single class to save nursing time. The children recently diagnosed range in age from 6 to 15. The argument the nurse will use in to advocate for more than one group session would be based on: 1. Freud's theory of psychosexual development, which states that the six-year-old child's sexual energy is at rest while the adolescent has developed mature sexuality. 2. Erikson's psychosocial theory, which discusses how children learn to relate to others. 3. Piaget's cognitive development theory, which says the six-year-old learns by concrete examples while the 15-year-old can think abstractly. 4. Kohlberg's theory, which says the young child is conventional in his thinking and will want to learn to please others while the older child can internalize values and will learn for his own principles.

3

The nurse administered morphine intravenously to a four-year-old postoperative patient. Thirty minutes later, the nurse assesses the child. Which assessment finding requires further evaluation? 1. Pulse decreased from 136 to 104 2. Blood pressure dropped from 110/72 to 90/55 3. Respiratory rate went from 42 to 16 4. Child pulls away from nurse who wants to assess surgical site

3

The nurse finds that an infant has stronger pulses in the upper extremities than in the lower extremities and higher blood pressure readings in the arms than in the legs. This could be indicative of what heart defect? 1. Transposition of the great vessels 2. Patent ductus arteriosus 3. Coarctation of the aorta 4. Atrial septal defect

3

The nurse has admitted a child with a cyanotic heart defect. Which initial lab result will the nurse anticipate? 1. A low platelet count 2. A high white blood cell count 3. A high hemoglobin 4. A low hematocrit

3

The nurse has been discussing behaviors to promote infant sleep with the mother of a two-month-old. Which statement by the mother indicates the need for additional discussion? 1. "I will read to my baby every night when getting him ready for bed." 2. "I will not bring him into my bed when he is having trouble falling asleep." 3. "I will have active play at bedtime to tire him out so he will sleep better." 4. "It is okay for my baby to have a "blankie" as a security object when he is put in his bed."

3

The nurse in a pediatric acute care unit is assigned the following tasks. Based on recognition that the action defined requires training beyond the preparation of a registered nurse, the nurse would refuse to: 1. Diagnose a six-year-old with diversional activity deficit related to placement in isolation. 2. Listen to the concerns of an adolescent about being out of school for a lengthy surgical recovery. 3. Diagnose an eight-year-old with acute otitis media and prescribe an antibiotic. 4. Provide information to a mother of a newly diagnosed four-year-old diabetic about local support group options.

3

The nurse in the genetics clinic is working with families undergoing testing for genetic disease. If the initial testing is positive, more extensive testing is required to confirm: 1. Prenatal diagnostic testing. 2. Carrier screening. 3. Newborn screening. 4. Pre-implantation genetic diagnosis.

3

The nurse is administering packed red blood cells to a child with sickle-cell disease (SCD). The nurse knows that a transfusion reaction will most likely occur: 1. Six hours after the transfusion is given. 2. At the end of the administration of the transfusion. 3. Within the first 20 minutes of administration of the transfusion. 4. Never; children with SCD do not have reactions.

3

The nurse is caring for a client in the pediatric intensive care unit. The parents have expressed anger over the nursing care their child is receiving. The nursing intervention most appropriate for these parents would be to: 1. Explain to the parents that their anger is affecting their child, and they will not be allowed to visit the child until they calm down. 2. Ask the physician to talk with the family. 3. Acknowledge the parents' concerns and collaborate with them regarding the care of their child. 4. Call the chaplain to sit with the family.

3

The nurse is presenting a program on healthy eating habits to the parents of children attending the clinic. In the discussion period of the program, parents make the following comments. Which parent needs more information about safe food preparation? 1. "We always wash our hands well before any food preparation." 2. "We use separate utensils for preparing raw meat and for preparing fruits, vegetables, and other foods." 3. "We take the meat out of the freezer and then allow it to thaw on the counter for two to three hours before cooking it thoroughly." 4. "If our baby doesn't drink all the formula in his bottle, we throw the rest out."

3

The parents have requested to be present during their child's procedure. How should the nurse plan for this request? 1. Explain in detail, using medical terms, what will occur. 2. Explain to the family that it is not permitted for family members to be present. 3. Prepare family members for what they should anticipate and what is expected of them. 4. Prepare the family to speak with the physician.

3

The pediatric unit manager is making changes to the unit to reduce the stress of the hospitalized children. Which changes have been shown to reduce stress for the children? 1. Having only female nurses on the unit 2. Assigning nurses one-on-one with patients 3. Allowing the nurses to wear colored scrubs in place of white uniforms 4. Having the nurses avoid entering the patient room unless a procedure is to be performed

3

The school nurse is performing health screenings during the physical education class. The nurse plans to weigh, measure, and determine body mass index of the adolescents. The scale has been set up in the open gym to speed the process. What should the nurse do to maintain confidentiality of the findings? 1. Have a student worker record the screening findings on the appropriate adolescent's record. 2. Have a volunteer weigh and measure the adolescents and verbally give the findings to the nurse to calculate the body mass index and record. 3. Provide a privacy screen and have the health aid record the findings directly on the record. The nurse will then calculate body mass index. 4. Use a buddy system with the students, having the students measure each other and record the findings.

3

Two three-year-olds are playing in a hospital playroom together. One is working on a puzzle, while the other is stacking blocks. The mother of one of the children scolds them for not sharing their toys. The nurse counsels this mother that this is normal developmental behavior for this age, and the term for it is: 1. Cooperative play. 2. Solitary play. 3. Parallel play. 4. Associative play.

3

Which of the following parental demonstrations indicates that the parents understand the nurse's teaching with regard to prevention of iron-deficiency anemia? 1. The parents feed their infant with a formula that is not iron-fortified. 2. The child's vitamin C consumption is limited after one year of age. 3. The parents start iron-fortified infant cereal at four to six months of age. 4. Cow's milk is introduced into the child's diet at six months of age.

3

Which parent statement shows understanding of the cause of the child's genetic condition in such a way that the nurse can document that no further teaching about the cause is needed? 1. "I was angry on the day he was conceived; that is why he got this sickness." 2. "My nephews had chickenpox in my seventh month of pregnancy with my son, so that is how he got this way." 3. "My child has this disease because the code in the genes just changed, and it is no one's fault." 4. "Our child is like this because I sunbathed too much during the pregnancy when I carried him."

3

While assessing a 10-month-old African American infant, the nurse notices that the sclerae have a yellowish tint. Which organ system would the nurse suspect as having an ongoing disease process? 1. Genitourinary 2. Cardiac 3. Gastrointestinal 4. Respiratory

3

While being comforted in the emergency department, the six-year-old sibling of a pediatric trauma victim blurts out to the nurse, "It's all my fault! When we were fighting yesterday, I told him I wished he was dead!" The nurse, realizing that the child is experiencing magical thinking, should respond by: 1. Asking the child if he would like to sit down and drink some water. 2. Sitting the child down in an empty room with markers and paper so that he can draw a picture. 3. Reassuring the child that it is normal to get angry and say things that we do not mean, but that we have no control over whether an accident happens. 4. Calmly discussing the catheters, tubes, and equipment that the patient requires, and explaining to the sibling why the patient needs them.

3

While evaluating development of children, the nurse notes that the development of secondary sexual characteristics follows a typical pattern. Place the appearance of secondary sexual characteristics in the female in order of appearance from earliest to latest. Standard Text: Click and drag the options below to move them up or down. Choice 1. Appearance of pubic hair Choice 2. Menarche Choice 3. Breast budding Choice 4. Breast Tanner stage 5, areola strongly pigmented

3,1,2,4

As children grow and develop, their style of play changes. Place the following descriptions of play styles in order from infancy to school-age. Standard Text: Click and drag the options below to move them up or down. Choice 1. Plays beside but not with other children Choice 2. Plays games with other children and is able to follow the rules of the game Choice 3. Plays alone with play directed by others Choice 4. Plays with others in loose groups

3,1,4,2

The nurse is assessing a new admission to the newborn nursery. Which physical findings suggest the infant was preterm? Standard Text: Select all that apply. 1. The ear pinna quickly returns to original position after being bent manually. 2. The infant's resting position is tightly flexed. 3. Labia widely separated with clitoris prominent. 4. Breast area barely perceptible with flat areola, no bud. 5. Sole creases do not extend the length of the foot. 3

3,4,5

The school nurse is working with an adolescent who reports that he gets six hours or less of sleep at night. The nurse explains to the adolescent that some of the common consequences of inadequate sleep include: Standard Text: Select all that apply. 1. Hyperactivity. 2. Increased nocturnal emissions. 3. Increased risk of automobile accidents when driving. 4. Moodiness. 5. Being unable to perform well at school.

3,4,5

While in the pediatrician's office for their child's 12-month well-child exam, the parents ask the nurse for advice on age-appropriate toys for their child. Based on the child's developmental level, the nurse should suggest which types of toys? Standard Text: Select all that apply. 1. Soft toys that can be manipulated and mouthed 2. Toys with black-and-white patterns 3. Toys that can pop apart and go back together 4. Jack-in-the-box toys 5. Push-and-pull toys

3,4,5

A nurse is reviewing the charts of children in the pediatric units to determine which parents would benefit from referral to the genetics clinic. The nurse recognizes that the parents of children with genetic and chromosomal disorders would benefit most from this referral. Therefore, the nurse refers the parents of the: Standard Text: Select all that apply. 1. Neonate born at 28 weeks with respiratory distress syndrome. 2. Two-year-old child who is terminally ill with a brain tumor. 3. Child diagnosed at age six with cystic fibrosis. 4. Four-year-old child with nephrotic syndrome. 5. Child with Duchenne muscular dystrophy being treated for respiratory symptoms.

3,5

Nurses need to know normal development so they can recognize infants who fail to meet developmental milestones. Place the following developmental milestones in order from the earliest to appear to the latest to appear. Standard Text: Click and drag the options below to move them up or down. Choice 1. Responds to name Choice 2. Waves bye-bye when directed Choice 3. Lifts head when prone Choice 4. Rolls from front to back Choice 5. Makes cooing sounds

3,5,4,1,2

A 12-year-old pediatric client is in need of surgery. The health care member who is legally responsible for obtaining informed consent for an invasive procedure is the: 1. Nurse. 2. Social worker. 3. Unit secretary. 4. Physician.

4

A 14-year-old girl is being admitted to the eating disorders unit of the hospital. The girl has a two-year history of anorexia nervosa and recently has sustained additional weight loss and electrolyte imbalances. During hospitalization, the priority concern for the health care team will be: 1. Individual counseling. 2. Family therapy. 3. Regulation of antidepressant drugs. 4. Nutritional support.

4

A 7-year-old child has been admitted for acute appendicitis. The parents are questioning the nurse about expectations during the child's recovery. Which information tool would be most useful in answering a parent's questions about timing of key events? 1. Healthy People 2020 2. National clinical practice guidelines 3. Child mortality statistics 4. Critical clinical pathways

4

A child has a planned hospitalization in a few weeks, and the patient and family appear very stressed. What is the best way to minimize the stress for the patient and family? 1. Tell the patient and family that everything will be fine. 2. Explain to the patient and family how the child will benefit from the surgery. 3. Tell the patient and family that the surgeon is very good. 4. Give a tour of the hospital unit or surgical area.

4

A child has been diagnosed with sickle-cell disease. Both parents deny having the disease themselves. The parents ask the nurse how their child got this disease. The nurse recognizes that the only possible explanation of the etiology is: 1. The father is not the biological father of the infant. 2. The mother of the child has the trait, but the father doesn't. 3. The father of the child has the trait, but the mother doesn't. 4. The mother and the father of the child have the sickle-cell trait.

4

A diagnosis of rheumatic fever is being ruled out for a child. The parents cannot remember the child having a recent streptococcal infection. Which lab test would confirm a recent streptococcal infection? 1. Erythrocyte sedimentation rate 2. Throat culture 3. C-reactive protein 4. Antistreptolysin-O (ASO) titer

4

A four-year-old child is being emotionally prepared for open heart surgery. The nurse will want to provide the child with which information? 1. Who will be performing the surgery 2. What the surgical procedure will entail 3. The purpose of the heart-lung machine 4. What the ICU will look and sound like when the child wakes up

4

A nurse asks the mother to undress her four-month-old infant. The nurse observes the mother taking off several layers of clothing, knowing that the outdoor temperature is 70°F. Which of these statements should the nurse make to the mother? 1. "When you leave the office, only put one layer of clothing on your baby." 2. "My, you are dressing your infant warmly today." 3. "Did you think it was it cold when you left your home this morning?" 4. "I see that you have many layers of clothing on your baby. This could cause your baby's temperature to rise."

4

A nurse is assessing language development in all the infants presenting at the physician's office for well-child visits. The nurse would want to evaluate the child further who is not able to verbalize the words "dada" and "mama" by the age of: 1. 18 months. 2. 8 months. 3. 5 months. 4. 12 months.

4

A six-year-old postoperative patient IV has infiltrated and has to be restarted immediately for medication. There is no time for placing local anesthetic cream on the skin. What other complementary therapies would be most helpful when placing this IV? 1. Restraints 2. Moderate sedation 3. Anesthesia 4. Distraction

4

Despite the availability of Children's Health Insurance Programs (CHIP), many eligible children are not enrolled. The nursing intervention that can best help eligible children to become enrolled is: 1. Educating the family about the need for keeping regular well-child visit appointments. 2. Assessing details of the family's income and expenditures. 3. Limiting costly, unnecessary duplication of services through case management. 4. Advocating for the child by encouraging the family to investigate CHIP eligibility.

4

During a four-month-old infant's well-child checkup, the nurse discusses introduction of solid foods into the infant's diet. Although the nurse recommends delaying the introduction of many foods into the diet, which food(s) will the nurse discuss delaying because they increase the risk for food allergy? 1. Honey 2. Carrots, beets, and spinach 3. Pork 4. Cow's milk, eggs, and peanuts

4

During a hurricane emergency, a child with hemophilia is injured and bleeding internally. The child is transported to the hospital. Due to the emergency, the appropriate factor is not available. What blood product would be the next best option to promote clotting? 1. Platelets 2. Whole blood 3. Packed cells 4. Fresh or fresh frozen plasma

4

During a sports physical, a client is found to have myopia, long digits, tall stature, an arm span greater than his height, scoliosis, and a hollow chest. The nurse should suspect: 1. Phenylketonuria. 2. Turner's syndrome. 3. Huntington's chorea. 4. Marfan's syndrome.

4

During shift report, the night nurse reports that the child who is terminally ill has developed tolerance to the morphine that the child has been receiving. The oncoming nurse realizes that the child: 1. Is physically dependent on morphine. 2. Is addicted to morphine. 3. Is showing physical signs of withdrawal. 4. Will need more medication to achieve the same effect.

4

Parents of a baby who died shortly after birth from a genetic disorder have been referred to a genetics clinic. The physician has explained to the parents why the referral was made. Which statement by the parents indicates that they understand the reason for the referral? 1. "I think going to the genetics clinic will help us get over the loss of our baby." 2. "I'm afraid the genetics clinic will tell us we cannot have another baby." 3. "The genetics clinic will prevent this from happening to us again." 4. "The genetics clinic will give us the information we need to decide whether we want to try again."

4

The eating disorders clinic sees a number of overweight adolescent girls. In addition to monitoring these adolescents for the health problems related to obesity, the nurse will monitor the girls for which mental health problem? 1. Substance abuse 2. School phobia 3. Spiritual distress 4. Negative self-esteem

4

The mother of a six-year-old boy who has recently had surgery for the removal of his tonsils and adenoids complains that he has begun sucking his thumb again. The nurse caring for the child should assure the mother that this is a normal response for a child who has undergone surgery and that it is a coping mechanism that children sometimes use called: 1. Repression. 2. Rationalization. 3. Fantasy. 4. Regression.

4

The nurse has admitted a child with a ventricular septal defect (VSD) to the unit. Which nursing diagnosis is appropriate for this child? 1. Hypothermia related to decreased metabolic state 2. Acute pain related to the effects of a congenital heart defect 3. Ineffective tissue perfusion (peripheral) related to cyanosis secondary to congenital heart defect 4. Impaired gas exchange related to pulmonary congestion secondary to the increased pulmonary blood flow

4

The nurse is caring for a child who has been sedated for a painful procedure. What is the priority nursing activity for this child? 1. Place the child on a cardiac monitor. 2. Allow parents to stay with the child. 3. Monitor pulse oximetry. 4. Assess the child's respiratory effort.

4

The nurse is caring for a child with disseminated intravascular coagulation (DIC). Which would be a priority nursing intervention for this child? 1. Preparation for radiograph procedures 2. Monitoring of fluid restriction 3. Frequent ambulation 4. Monitoring of oxygen saturation and vital signs

4

The nurse is caring for a two-year-old child in the postoperative period. The pain assessment tool most appropriate for assessment of pain intensity in a two-year-old is the: 1. Poker Chip Tool. 2. Oucher Scale. 3. Faces Pain Rating Scale. 4. FLACC Behavioral Pain Assessment Scale.

4

The nurse is caring for an infant diagnosed with "failure to thrive." The nurse observes the physician taking blood pressures in all four extremities and recognizes that the physician suspects which congenital cardiac defect? 1. Tetralogy of Fallot 2. Ventricular septal defect 3. Pulmonary atresia 4. Coarctation of the aorta

4

The nurse is completing a physical examination of a four-year-old child. The best position in which to place the child for assessment of the genitalia would be: 1. Supine, with legs at a 50-degree angle. 2. Right side-lying. 3. In prone position, with knees drawn up under the body. 4. Frog-leg position.

4

The nurse is discussing genetic referral with the parents of children being seen in the pediatric clinic. The child who would benefit from a genetic referral is the child whose family has a history of: 1. Prominent epicanthal folds, resonant lungs, or absent tinnitus in Asian families. 2. Broad face, lower-extremity lichenification, or spider angiomas. 3. Normocephalic head, euthyroid, or five digits per extremity. 4. Cleft lip and/or cleft palate, diaphragmatic hernia, or cataract.

4

The nurse is teaching family members of a child getting ready for discharge how to administer medication to the child via a G-tube. The nurse created a nursing care plan with the diagnosis: knowledge deficit medication administration per G-tube. The most appropriate outcome for this goal would be that prior to discharge, the family: 1. Understands how to administer the medication. 2. Is able to give a return demonstration. 3. Repeats the instructions. 4. Administers the medication through the G-tube.

4

The nurse is teaching the parents of a group of cardiac patients. The nurse includes in the information that any child who has undergone cardiac surgery: 1. Should not receive routine immunizations. 2. Should be restricted from most play activities. 3. Can be expected to have a fever for several weeks following the surgery. 4. Should receive prophylactic antibiotics for any dental, oral, or upper respiratory tract procedures.

4

The nurse wants to do a quick evaluation of a one-month-old infant's hearing. Which assessment will provide the best information? 1. Examining the ear canal with an otoscope 2. Using a vibrating tuning fork placed against the child's skull 3. Using tympanometry 4. Using a noisemaker in the infant's presence to evaluate the child's response

4

The nursing supervisor is observing the staff on the pediatric unit. Which nurse is providing family-centered care? 1. The nurse who delays morning care until after the family has visited the child 2. The nurse who suggests the mother take a break and get breakfast while the nurse changes the child's dressings 3. While admitting a new client, the nurse explains the visitation rules of the unit to the parents and grandparents. 4. During discharge planning, the nurse recognizes the mother is unable to perform wound care on the client, so the nurse works with the family to determine which family member will be available to meet this child's health care needs.

4

The physician has ordered the child to receive a unit of packed red blood cells. In preparing to administer the blood, the nurse will initiate an intravenous line and hang what fluid? 1. D5W 2. D5LR 3. D5 1/4NS 4. NS

4

The postoperative unit of the pediatric hospital has several children who had surgery this morning. While making rounds, the nurse observes all of the following behaviors. Which child should be further evaluated as to postoperative pain? 1. The six-month-old in deep sleep 2. The two-year-old who is cooperative when the nurse takes his vital signs 3. The four-year-old who is actively watching cartoons 4. The 14-month-old who is thrashing his arms and legs

4

The school nurse performs screenings on all students in the high school. In addition, the nurse will perform selected screenings on individual teenagers. When planning the screenings for the year, the nurse will include which screening for all teenagers? 1. Respiratory rate 2. Hepatitis B profile 3. Chest X-ray 4. Scoliosis

4

The telephone triage nurse at a pediatric clinic knows that each call is important. However, recognizing that infant deaths are most frequent in this group, the nurse must be extra attentive during the call from the parent of an infant who is: 1. Between six and eight months old. 2. Of a Native American family. 3. Of a non-Hispanic black family. 4. Younger than three weeks old.

4

Utilizing Bronfenbrenner's ecologic theory of development, the nurse caring for a child would discuss the parents' work environment as part of an assessment of that child's: 1. Chronosystem. 2. Mesosystem. 3. Macrosystem. 4. Exosystem.

4

Which of the following is a priority nursing diagnosis for the child with idiopathic thrombocytopenic purpura (ITP)? 1. Ineffective breathing pattern 2. Nausea 3. Fluid-volume deficit 4. Risk for injury

4

While assessing the development of a nine-month-old infant, the nurse asks the mother if the child actively looks for toys when they are placed out of sight. The nurse is trying to determine whether the infant has developed: 1. Transductive reasoning 2. Conservation 3. Centration 4. Object permanence

4

With regard to child mortality statistics, which nursing intervention would be most effective in decreasing mortality from unintentional injury? 1. Teaching children about dangers of contact sports 2. Encouraging parents to obtain genetic counseling 3. Educating parents about the benefits of immunizations 4. Teaching parents about proper use of vehicle restraint seats

4

With regard to infant mortality statistics, which nursing intervention would be most effective in decreasing post-neonatal mortality? 1. Teaching parents about "baby-proofing" their home 2. Educating parents on acceptable feeding techniques 3. Providing support for first-time mothers 4. Educating parents on the importance of positioning the baby on his back whenever sleeping

4

Put the following nursing assessments of a toddler in the best order for the nurse to proceed (from first assessment to last assessment). Standard Text: Click and drag the options below to move them up or down. Choice 1. Auscultation of chest Choice 2. Examination of eyes, ears, and throat Choice 3. Palpation of abdomen Choice 4. General appearance

4,1,3,2