Pediatric's HESI Comp Book

The health care provider prescribes amoxicillin 60 mg PO three times a day for a child who weighs 13 pounds. The pediatric dosage range is 20 to 40 mg/kg/day in three equal doses. What is the maximum dosage in 24 hours that should be given? ________________________________ mg

236 Rationale: First, convert the pounds to kg because the conversion is for kg.1 kg = 2.2 lb13 lb/(2.2 lb/kg) = 5.9 kgSecond, determine the maximum dose the child can have in 24 hours: 40 mg × 5.9 kg = 236 mg. The maximum dose the child can have is 236 mg.

A child with poison ivy weighs 25 kg and receives a prescription for diphenhydramine PO 5 mg/kg. The medication is available as a 125 mg/5 mL solution. How many milliliters should the practical nurse administer? _____________________________ mL

5 ml Rationale: First determine how much of the drug the child should get.The order is 5 mg/kg. Multiply 5 mg by the child's weight. 5 mg × 25 kg = 125 mg.The child would get 125 mg.Next, determine how many milliliters to administer using the following formula:Desired dose/available dose × mL/dose of available drug = mL to administer125/125 × 5 mL = 5 mL

During a well-child visit for a 10 month old, a parent is concerned that the child's development is not progressing as expected. Which comment is of most concern? a. "My baby cannot walk yet." b. "My baby cannot throw a ball overhand yet." c. "My baby cannot sit up yet unless she is propped on something." d. "My baby was 21 inches long at birth, but her length has not doubled yet."

Rationale: By 8 months, the child should be able to sit up unsupported. Most children are not able to walk until 12 months. By age 18 months, the child should be able to throw a ball overhand. Birth length usually doubles by age 4.

A full-term infant is admitted to the newborn nursery. During the initial PO feeding, the practical nurse (PN) observes the infant for possible tracheal esophageal atresia. Which symptoms are likely to be exhibited during the feeding if this condition is present? a. Choking, coughing, and cyanosis b. Projectile vomiting and cyanosis c. Apneic spells and grunting d. Scaphoid abdomen and anorexia

a. Choking, coughing, and cyanosis Rationale: Choking, coughing, and cyanosis are the "3 Cs" of esophageal atresia caused by the overflow of secretions into the trachea.

The nurse is reinforcing instructions for a child diagnosed with iron deficiency anemia. The nurse realizes instructions were effective if the parent/child make which statement? (Select all that apply.) a. "If possible the iron replacement tablets should be taken on an empty stomach." b. "I should make sure the iron tablets are taken with milk or another type of milk product." c. "I should try to provide five or six 8 ounce glasses of milk every day to treat the anemia." d. "I will need to keep this out of the reach of the younger children we have in the home." e. "I will need to still provide foods that are high in iron such as meat and green leafy vegetables."

a. "If possible the iron replacement tablets should be taken on an empty stomach." d. "I will need to keep this out of the reach of the younger children we have in the home." e. "I will need to still provide foods that are high in iron such as meat and green leafy vegetables." Rationale: The nurse should encourage the parents to try giving the iron on an empty stomach whenever possible. Iron toxicity can be fatal, so it should be out of the reach of very young children. The client who has iron-deficiency anemia will still need to eat foods high in iron. The child should take in no more than 32 ounces (four 8 ounce cups) of milk in a 24-hour period.

A child has been treated in the emergency department for a fractured distal radius. The nurse has reinforced instructions for care of the cast at home. The nurse realizes additional instruction is needed if the caregiver makes which comments? (Select all that apply.) a. "It is normal for the child to not be able to move the fingers very well after the cast is applied." b. "If my child is itching under the cast, I can use sterile cotton tipped applicators under the cast to scratch it." c. "If my child's arm is hurting so badly, and pain meds have not worked, I should bring the child back to the emergency department." d. "If my child's fingers begin to be cold or blue, I should try to wrap up his fingers in some warm cloths." e. "I will need to make sure the child does not get the cast wet, I can use plastic wrap around the cast for bathing."

a. "It is normal for the child to not be able to move the fingers very well after the cast is applied." b. "If my child is itching under the cast, I can use sterile cotton tipped applicators under the cast to scratch it." d. "If my child's fingers begin to be cold or blue, I should try to wrap up his fingers in some warm cloths." Rationale: The parents should be educated that not being able to move the fingers after cast application indicates possible compartment syndrome and potential damage to nerves and vessels of the arm. Extreme pain not relieved by analgesics, or cold, blue fingers also indicate possible compartment syndrome. If compartment syndrome is suspected, the nurse should contact the health care provider immediately. The child should not insert any object under the cast because this can cause an infection in the irritated skin area. Parents should be instructed to keep the cast dry while bathing.

The nurse is working with a 3-year-old child who will be having surgery tomorrow to remove a large mole from the arm. Which statement is most appropriate to make to the child during preoperative teaching? a. "Tomorrow you will go to the operating room on a rolling bed." b. "After your surgery, a nurse will take your temperature every hour." c. "Right before we put you to sleep, we will put electrodes on your chest." d. "If you need something for pain, let us know so we can give you a pain shot."

a. "Tomorrow you will go to the operating room on a rolling bed." Rationale: Using the term "rolling bed" is more appropriate for a 3-year-old child, who might associate "stretcher" with something painful to stretch the body out. "Take your temperature" sometimes frightens younger children who believe something will be taken away or removed. "Get put to sleep" also frightens children who have had a pet "put to sleep" or euthanized. "Put electrodes on the chest" can also frighten children; "put a sticker" on the chest sounds less frightening. Using the word "shot" is very frightening for children; use the term "medicine under the skin."

A child with acute appendicitis who is scheduled for surgery in 3 hours is complaining of abdominal pain. Which intervention should the practical nurse implement? a. Assist the child into a position of comfort. b. Withhold administration of a narcotic analgesic. c. Place a warm compress over the tender area. d. Offer to provide the child with warm tea or broth.

a. Assist the child into a position of comfort. Rationale: Placing the child in a position of comfort best minimizes abdominal pain related to intra-abdominal inflammation of the appendix.

A child is admitted to the hospital for confirmation of a diagnosis of acute lymphoblastic leukemia. When assisting with data collection, which symptoms that are commonly manifested by this condition should the practical nurse (PN) observe in the child? a. Bone pain, pallor b. Weakness, tremors c. Nystagmus, anorexia d. Fever, abdominal distention

a. Bone pain, pallor Rationale: Bone pain and pallor are the most common presenting symptoms of leukemia. Leukemic cells invade the bone marrow, gradually causing a weakening of the bone and a tendency toward pathological fractures. As leukemic cells invade the periosteum, increasing pressure causes severe pain and anemia results from decreased erythrocytes, causing pallor

A short-arm cast is applied to a child with a fractured right ulna. The practical nurse (PN) is preparing the parents with home instructions and should emphasize that the parents follow which discharge instructions? (Select all that apply.) a. Call the health care provider immediately if the nail beds appear "blue" or "empty." b. Check the child's ability to move his fingers without pain hourly for the first 48 hours. c. Elevate the arm above the heart for the first 24 hours. d. Explain that a musty odor under the cast is to be expected. e. Apply a heating pad over the area of the fracture. f. Explain that only soft cotton tipped applicators can be inserted under the cast in the event of itching.

a. Call the health care provider immediately if the nail beds appear "blue" or "empty." b. Check the child's ability to move his fingers without pain hourly for the first 48 hours. c. Elevate the arm above the heart for the first 24 hours. Rationale: Cyanosis indicates impaired circulation to the fingers and should be reported immediately. The child should be able to move the fingers without severe pain. Elevating the arm reduces venous congestion. A musty odor is indicative of an infection. Heat to the area would dilate blood vessels, causing venous congestion. Nothing should be inserted under the cast; scratches under the cast can become infected.

The parents of a 7 month old infant with spastic cerebral palsy bring him to the pediatric clinic. Which symptom reported by the parents warrants immediate intervention by the practical nurse(PN) a. Choking while being fed. b. The child's legs continually cross each other. c. Child gets stiff when shifting to a sitting position. d. Older sibling is jealous of the younger sibling.

a. Choking while being fed. Rationale: Aspiration is a priority when caring for an infant with cerebral palsy and dysphagia.

A 2-year-old child had tympanostomy ventilating tubes inserted into both tympanic membranes (TMs) 1 week earlier. During a postoperative clinic visit, the practical nurse (PN) notes that the child has a purulent discharge from the right ear, and the mother explains that the toddler has had a cold for 3 days. What action should the PN plan to implement? a. Collect a specimen of the otorrhea for culture. b. Refer the child for audiologic screening tests. c. Administer prescribed antibiotics. d. Perform an otoscopic exam for TM tube placement.

a. Collect a specimen of the otorrhea for culture. Rationale: The presence of the purulent drainage indicates that the middle ear is draining a new infectious process, and a specimen of the otorrhea should be collected for culture. Tympanostomy tubes are surgically placed to manage otitis media with effusion (OME) to provide mechanical drainage of fluid and to equalize pressure within the middle ear. Chronic OME can impede TM and ossicle function, necessitating hearing screening. The immediate problem, however, is infection.

A 2-year-old child developed a fever of 103.4° F (39.7° C) and was rushed to the emergency department when the child developed febrile seizures. After the child was stabilized, the health care provider diagnosed otitis media in the child. The concerned caregivers ask the nurse how this can be prevented from happening again. The nurse should reinforce which instructions? a. Contact the child's health care provider if the child starts pulling at the ear. b. If the child develops an elevated temperature, bathe the child in cold water. c. Give the child a bottle to take while in the supine position to relieve the pain. d. Use children's chewable baby aspirin if the child's temperature is over 102° F (38.9° C).

a. Contact the child's health care provider if the child starts pulling at the ear. The parents should be taught to contact the health care provider if the child begins to pull at the ears, an early sign of otitis media. Treating otitis media early can reduce the risk of a high temperature and a resulting febrile seizure. If the child develops an elevated temperature, the child should be bathed in tepid water, not cold water or rubbing alcohol. Taking a bottle in the supine position is not recommended because this increases the risk of developing otitis media. Children should be given acetaminophen as prescribed for pain and fever. Aspirin is not recommended in children due to the risk of Reyes syndrome, a serious neurological disorder. Unfortunately, pleasantly flavored children's chewable aspirin is sometimes described or labeled as "baby aspirin."

The nurse is preparing a child for transport to the operating room for an emergency appendectomy. The anesthesiologist prescribes atropine sulfate IM STAT. What is the primary purpose for administering this drug to the child at this time? a. Decrease the oral secretions. b. Reduce the child's anxiety. c. Potentiate the opioid effects. d. Prevent possible peritonitis.

a. Decrease the oral secretions. Rationale: Atropine sulfate (Atropine), an anticholinergic agent, is given to decrease oral secretions during a surgical procedure.

A child recently diagnosed with acute lymphocytic leukemia is pale, weak and lethargic. The nurse reviews recent laboratory results and recognizes which abnormal finding is associated with these symptoms? a. Decreased hematocrit b. Decreased factor VIII c. Decreased platelet count d. Decreased white blood cell count

a. Decreased hematocrit Rationale: A low hematocrit, hemoglobin, and red blood cell count causes the client to experience pallor, weakness, lethargy, and tiredness. A decreased factor VIII and decreased platelet count would cause excess bleeding. A decreased white blood cell count would cause an increased risk for infection.

A 2-year-old child who is hospitalized with an acute upper respiratory infection (URI) is crying uncontrollably because her mother went to the cafeteria for lunch. Which action should the practical nurse implement? a. Distract the child with a favorite toy. b. Tell the child that her mother will return. c. Take the child to the cafeteria. d. Calm the child with a dietary treat.

a. Distract the child with a favorite toy. Rationale: The best action is to refocus the child's attention by distracting with a favorite toy.

The nurse observes that a 3-year-old child combines words in short phrases and understands the concepts of hot and cold and big and little. Which intervention should the PN implement? a. Document that the child's expressive speech is age appropriate. b. Request immediate referrals for speech and hearing evaluations. c. Review the child's history for prior evaluations of developmental lags. d. Ask the parent to leave the room so that findings can be reevaluated.

a. Document that the child's expressive speech is age appropriate. Rationale: A 3 year old should be able to distinguish between common opposites and speak in short phrases, so the child's age-appropriate speech pattern should be documented.

The practical nurse (PN) is assessing a child with asthma for retractions during respirations. When should the PN recognize the absence or presence of intercostal retractions? a. Inspiration b. Coughing c. Apneic episodes d. Expiration

a. Inspiration

A child with cystic fibrosis is receiving ticarcillin disodium for Pseudomonas pneumonia. What adverse effect should the nurse assess for and report promptly to the health care provider? a. Petechiae b. Tinnitus c. Oliguria d. Hypertension

a. Petechiae Rationale: Adverse effects of ticarcillin disodium include hypothrombinemia and decreased platelet adhesion, which can result in the presence of petechiae.

Minocycline 50 mg PO every 8 hours is prescribed for an 18-year-old adolescent girl diagnosed with acne. The nurse discusses self-care with the client while she is taking the medication. Which teaching points should be included in the discussion? (Select all that apply.) a. Report vaginal itching or discharge. b. Take the medication at 0800, 1500, and 2200 hours. c. Protect skin from natural and artificial ultraviolet light. d. Avoid driving until response to medication is known. e. Take with an antacid tablet to prevent nausea. f. Use a nonhormonal method of contraception if sexually active.

a. Report vaginal itching or discharge. c. Protect skin from natural and artificial ultraviolet light. d. Avoid driving until response to medication is known. f. Use a nonhormonal method of contraception if sexually active. Rationale: Adverse effects of tetracyclines include superinfections, photosensitivity, and decreased efficacy of oral contraceptives. Therefore, the client should report vaginal itching or discharge, protect the skin from ultraviolet light, and use a nonhormonal method of contraception while on the medication. Minocycline is known to cause dizziness and ataxia, so until the client's response to the medication is known, driving should be avoided

The practical nurse (PN) should take the vital signs of a 4-month-old child in which sequence to collect the most accurate results? a. Respiratory rate, heart rate, then axillary temperature b. Heart rate, axillary temperature, then respiratory rate c. Axillary temperature, heart rate, then respiratory rate d. Axillary temperature, respiratory rate, then heart rate

a. Respiratory rate, heart rate, then axillary temperature Rationale: The respiratory rate should be taken first in infants, because touching them or performing unpleasant procedures usually makes them cry, which elevates the heart rate and makes respirations difficult to count.

A 7-year-old child is diagnosed with a streptococcal infection of the throat (strept throat). The parent asks the nurse "Why does my child need to take antibiotics? His sister had a sore throat last month and all she took was acetaminophen and diphenhydramine." The nurse responds by explaining that "strept throat" is associated with which complications? (Select all that apply.) a. Rheumatic heart disease b. Ventral septal defects c. Complete heart block d. Nephrotic syndrome e. Acute glomerulonephritis f. Vesicoureteral reflux

a. Rheumatic heart disease e. Acute glomerulonephritis Rationale: "Strept throat" is a serious streptococcal infection which can lead to serious complications such as rheumatic heart disease and acute glomerulonephritis. Ventral septal defects are congenital. Complete heart block is a dysrhythmia not associated with strept throat. Nephrotic syndrome often has an idiopathic causation. Vesicoureteral reflux is frequently congenital.

A 15-year-old male with a mild cognitive deficit who is hospitalized for minor surgery tells a female practical nurse (PN), "Wow, you have big ones." Which response is best for the PN to make? a. "Do you really think so?" b. "That language is not permitted." c. "You should not speak to me like that, such language offends me." d. "I'll notify your parents if you continue to talk that way."

b. "That language is not permitted." Rationale: Limit setting is necessary for inappropriate behavior or suggestive interaction. Sets limits without threatening or degrading the client.

The nurse is caring for an adolescent male who has just been diagnosed with cancer and will be receiving chemotherapy. The client asks if he will lose his hair with the chemotherapy. Which is the most appropriate response from the nurse? a. "Yes, but other side effects are a great deal more life threatening." b. "Yes, it's one of the side effects, how do you think that will affect you?" c. "Yes, but having cancer could be fatal, why do not you focus on that first?" d. "Yes, but you can always wear a ball cap or you could wear a wig to cover it up."

b. "Yes, it's one of the side effects, how do you think that will affect you?" Rationale: An adolescent is frequently concerned about body image changes. He should be told honestly what side effects could occur and then asked what concerns he has about that. It is not appropriate for the nurse to mention life-threatening side effects at this point, because the client's concern today is the potential hair loss. The nurse should not remind the adolescent to focus on other things or to begin the conversation with giving advice on ways to cover up the hair loss.

The mother of a 6 month old asks the practical nurse (PN) when her baby will get the first measles, mumps, and rubella (MMR) vaccine. Based on the recommended childhood immunization schedule published by the Centers for Disease Control and Prevention, which response is accurate? a. 3 to 6 months b. 12 to 15 months c. 18 to 24 months d. 4 to 6 years

b. 12 to 15 months Rationale: The first measles, mumps, and rubella (MMR) vaccine should be given no sooner than 12 months of age, and ideally between 12 and 15 months of age. Because of the presence of maternal antibodies, the MMR vaccine is not recommended sooner.

The practical nurse (PN) is taking the temperature of a 5-year-old child with otitis media. During the previous 24 hours, the child's temperature readings have ranged from 101.2° F oral to 102° F tympanic. Which statement accurately evaluates these findings and should be considered when planning care for the remainder of the shift? a. The PN should confer with the nursing staff about the temperature method to use. b. A tympanic temperature and an oral temperature are equally accurate techniques in evaluating the child's fever. c. A rectal temperature should be taken q4h to evaluate effectively the clinical course of the fever. d. The pediatrician should be notified of the variances in the oral and tympanic readings.

b. A tympanic temperature and an oral temperature are equally accurate techniques in evaluating the child's fever. Rationale: Tympanic readings obtained using proper technique correlated moderately to strongly with oral temperatures in recent research studies. A tympanic membrane sensor approximates core temperatures because the same circulation perfuses the hypothalamus and eardrum. The sensor is unaffected by cerumen or the presence of suppurative or unsuppurative otitis media.

The nurse receives a phone call at the pediatric clinic from the parent of a child with cystic fibrosis. The health care provider has left for the day. The parent reports the child has had thicker secretions over the day, and the color of the sputum has changed from clear to light beige. Which triage question is most appropriate to ask? a. Ask the parents "Have you completed the child's chest percussions today?" b. Ask the parents "On what number can the on-call health care provider contact you?" c. Ask the parents "Is there now an increase in the saltiness of the child's skin?" d. Ask the parents "Is there also an increase in the number of fatty, bulky stools?"

b. Ask the parents "On what number can the on-call health care provider contact you?" Rationale: It is most important to ask for a contact number, because the thicker sputum and change in color indicate the child is likely experiencing a respiratory infection. Respiratory infections are a major concern for a child with cystic fibrosis. A child with cystic fibrosis usually has chest percussions prescribed to be administered by the parents. Whether or not those were done today is not as high a priority as taking care of the infection. Salty taste to the skin and fatty bulky stools are part of the disease process and do not indicate the severity of the respiratory disorder.

To minimize separation anxiety in a hospitalized 2 year old, which nursing intervention is best for the practical nurse to implement? a. Provide for privacy. b. Encourage parents to room-in. c. Explain procedures and routines. d. Encourage contact with children of the same age.

b. Encourage parents to room-in. Rationale: Separation anxiety is especially threatening for toddlers, so encouraging parents to room-in helps the toddler cope with this threat.

The practical nurse (PN) has reviewed signs and symptoms of congestive heart failure with the parents of a 2-year-old child with a congenital heart defect. The nurse realizes the education has been effective if the parents identify which behavior as most important for the parents to report to the health care provider? a. Sits or squats frequently when playing outdoors. b. Exhibits a sudden and unexplained weight gain. c. Is not completely toilet trained and has some "accidents." d. Demonstrates irritation and fatigue 1 hour before bedtime.

b. Exhibits a sudden and unexplained weight gain. Rationale: Sudden and unexplained weight gain can indicate fluid retention and is a sign of congestive heart failure.

The nurse is caring for a child with a cleft palate. The nurse expects to provide which aspects of care for this child? (Select all that apply.) a. Position the child supine for feedings. b. Feed slowly with frequent burping. c. Use small, firm nipples when using bottles. d. Provide formula with additional calories. e. Use rubber-tipped syringe if nipple use is not possible. f. Support the parents who may be grieving.

b. Feed slowly with frequent burping. d. Provide formula with additional calories. e. Use rubber-tipped syringe if nipple use is not possible. f. Support the parents who may be grieving. Rationale: The child with a cleft palate should be fed slowly with frequent burping. Formula should have additional calories. If nipple use is not possible, use a rubber-tipped Asepto syringe. Parents often experience grieving and will require emotional support and education. The child should be fed in an upright position, and soft, large nipples can be helpful.

The nurse is caring for a newborn affected by Down syndrome. The nurse expects which aspect to be included in the child's plan of care? a. Provide additional perineal care to newborn's abnormal genitalia. b. Feed the newborn to the back and side of the newborn's mouth. c. Support the newborn's long neck when picking up the newborn. d. Provide massage and warm packs to muscles when spasms occur.

b. Feed the newborn to the back and side of the newborn's mouth. Rationale: The child affected by Down's syndrome frequently has feeding difficulty, and has a protruding tongue. It is helpful to feed the child to the back and side of the mouth. Abnormal genitalia and muscle spasms are not associated with Down's syndrome. The newborn affected by Down's syndrome typically has a short neck.

A newborn who has mild transitional (positional) clubfeet is placed in bilateral casts in an overcorrected valgus (outward) position. What is the primary issue the practical nurse should review with the parents during discharge teaching? a. Prevent cast soiling and maintain the cast's edge by petaling. b. Observe for skin and circulation compromise from the cast. c. Manipulate the cast surfaces with the palms of the hands. d. Support and elevate both legs on pillows continuously.

b. Observe for skin and circulation compromise from the cast. Rationale: Reinforcing information with parents about their role in care and about vigilant observation for potential problems of the infant at home such as skin and circulation compromise is the most important nursing intervention

The teacher reports that a 7-year-old child frequently daydreams in school, experiences abrupt interruptions in conversations, and stares into space. Which action should the practical nurse take?

b. Observe the child's behavior in the classroom. Rationale: Absence (petit mal) seizures are often manifested as daydreaming behaviors. The child should be observed to confirm what the teacher is describing because this child might be experiencing petit mal seizures.

A 3 day infant has had surgery to reconstruct the anus due to an anorectal malformation noted at birth. The nurse will implement which aspect of postoperative care? a. Assess the child's temperature rectally every 4 hours. b. Position the child side-lying prone with the hips elevated. c. Inform the parents toilet training should begin on schedule. d. Passing stools in the urine is expected to occur after surgery.

b. Position the child side-lying prone with the hips elevated. Rationale: The child should be positioned in the side-lying prone position with the hips elevated to decrease pressure on the perineal sutures. No rectal temperatures should be taken postoperatively, because this could disrupt the sutures. Toilet training is frequently delayed and full continence may not be achieved. It is not normal for the child to pass stools in the urine

The practical nurse (PN) is preparing a child with an intussusception for a prescribed barium enema. The PN should explain to the parent that the purpose for conducting this procedure before surgical intervention is to achieve what objective? a. Evacuate the bowel of impacted feces. b. Reduce the invaginated bowel segment. c. Locate the presence of diverticula. d. Identify the area of esophageal atresia.

b. Reduce the invaginated bowel segment. Rationale: Intussusception, an invagination or telescoping of one portion of the intestine into another, causes intestinal obstruction in children (usually occurs between 3 months and 5 years of age). Nonsurgical treatment is attempted with hydrostatic pressure created by barium instillation, which often reduces the area of bowel intussusception, thereby negating the need for surgical intervention.

An 8-year-old girl is being treated for her third urinary tract infection (UTI) in a year. The nurse should reinforce which instructions for the girl and her parents? a. Teach the child to learn to hold her urine as long as possible. b. Teach the child to clean the genital area from front to back. c. Teach the child to bathe in warm bubble bath to relieve pain. d. Teach the parents to restrict fluids when an infection is present.

b. Teach the child to clean the genital area from front to back. Rationale: The child and parents should be taught to clean the genital area from front to back. The child should void frequently, and avoid bubble baths. Fluids should be increased, rather than restricted when an infection is present.

A 2-month-old infant is scheduled to receive the first DPT immunization. What is the preferred injection site to administer this immunization? a. Dorsal gluteal b. Vastus lateralis c. Ventral gluteal d. Deltoid

b. Vastus lateralis Rationale: The preferred intramuscular site for children younger than 2 years of age is the vastus lateralis.

The nurse has reinforced instructions for a child who has been hospitalized with a sickle cell crisis. The nurse realizes the instruction has been effective if the parents make which statements?(Select all that apply.) a. "if my child's joints are swollen and painful, I should apply ice." b. "My child keeps wetting the bed, so I should restrict fluid intake." c. "I will ask the physical education teacher allow extra fluid intake while exercising." d. "If my child is having a crisis, morphine intravenously is likely going to be necessary." e. "If we are planning any trips, we need to make sure we do not travel to any high altitudes."

c. "I will ask the physical education teacher allow extra fluid intake while exercising." d. "If my child is having a crisis, morphine intravenously is likely going to be necessary." e. "If we are planning any trips, we need to make sure we do not travel to any high altitudes." Rationale: A child with sickle cell disease should have additional fluids while exercising. During a crisis, parenteral morphine is likely necessary. The child should not travel to high altitude areas, due to decreased oxygenation. If the child's joints are painful, warmth, not ice packs, should be applied. Even though bedwetting is occurring, additional fluids are still necessary to treat and prevent a crisis.

A 6-year-old child arrives to the urgent care center with symptoms of an asthma exacerbation. The child's oxygen saturation is 90%, the pulse is 120 beats/min, and the respiratory rate 32 per minute. The nurse should prepare for which priority intervention? a. Administration of a long-acting bronchodilator b. Monitoring for signs of an infection masked by steroid use c. Administration of oxygen and subcutaneous injection of epinephrine d. Reviewing with the caregivers the possible triggers for an exacerbation of asthma

c. Administration of oxygen and subcutaneous injection of epinephrine Rationale: The priority of care for an acute asthma attack is oxygen administration and administration of epinephrine, which is a rapid-acting bronchodilator. After the acute attack has subsided, and the child's respiratory status is stable, the nurse can anticipate administration of a long-acting bronchodilator. Monitoring for signs of an infection is important, but the immediate priority is oxygen administration and use of a rapid-acting bronchodilator. Education regarding asthma triggers is also crucial, but should take place after the child is stable.

Which action should the practical nurse (PN) implement first when obtaining the tympanic temperature of a 2-year-old child? a. Point the thermometer probe tip anteriorly. b. Remove drainage from the external auditory meatus. c. Apply the probe cover to the electronic thermometer. d. Ask the mother to help stabilize the child's head.

c. Apply the probe cover to the electronic thermometer. Rationale: Before a tympanic temperature is obtained, the equipment should be prepared for use without manipulating the electronic thermometer in front of the child, so a clean probe cover should be applied first.

What is the most important information for the practical nurse (PN) to review with a 12 year old who is receiving long-term and rescue medications for routine management of asthma? a. Drink a large amount of cold fluids after exercising to restore hydration. b. Avoid swimming, which increases the need for oxygen while underwater. c. Before swimming, use albuterol for prevention of exercise-induced bronchospasm. d. Keep a prescription for a premeasured dose of epinephrine available.

c. Before swimming, use albuterol for prevention of exercise-induced bronchospasm. Rationale: When used before exercise, the beta-adrenergic agonist albuterol can prevent an asthma attack.

The health care provider prescribes carbamazepine for a child whose tonic-clonic seizures have been poorly controlled. The nurse informs the mother that the child must have blood tests every week. The mother asks why so many blood tests are necessary. What complication is assessed through frequent laboratory testing that the nurse should explain to this mother? a. Renal toxicity b. Inner ear toxicity c. Bone marrow suppression d. Liver damage

c. Bone marrow suppression Rationale: Myelosuppression (bone marrow toxicity) is the highest priority complication that can potentially affect clients managed with carbamazepine therapy. The client requires close monitoring for this condition by weekly laboratory testing.

The practical nurse(PN) in the clinic receives a phone call from the mother of a 6 year old child with a newly applied cast for a fracture of the femur. The master reports that the child Is in pain and is crying and that child's foot appears swollen and blue. Which should be the nurse's instruction to the mother? a. Ask the child to use crutches for mobility. b. Apply ice to the site of the fracture c. Bring the child immediately to the clinic d. Administer the prescribed pain medication

c. Bring the child immediately to the clinic. Rationale: Because the child is exhibiting indications of impaired circulation (pain and cyanosis), the child is having altered peripheral tissue perfusion. The PN should instruct the mother to bring the child into the clinic or emergency room immediately for evaluation.

The health care provider prescribes the anticonvulsant carbamazepine for an adolescent client with a seizure disorder. The nurse should instruct the client to notify the health care provider if which condition occurs? a. Experiences dry mouth. b. Experiences dizziness. c. Develops a sore throat. d. Develops gingival hyperplasia.

c. Develops a sore throat. Rationale: Blood dyscrasias (aplastic anemia, leukopenia, anemia, and thrombocytopenia) can be an adverse effect of carbamazepine. Flulike symptoms, such as pallor, fatigue, sore throat, and fever, are indications of such dyscrasias.

The practical nurse (PN) is evaluating the play behaviors of a 2-year-old child. Which behavior should the PN expect the toddler to exhibit? a. Builds a house with blocks. b. Rides a small tricycle 6 feet. c. Displays possessiveness with toys. d. Looks at a picture book for 15 minutes.

c. Displays possessiveness with toys. Rationale: Two-year-old children are egocentric and unable to share with other children.

The practical nurse (PN) is orienting a new nurse employee as they care for a toddler who is admitted for cleft palate repair. The nurse realizes the new employee understands the plan of care if the new employee gathers which type of restraint to apply in the postoperative period? a. Wrist b. Mummy c. Elbow d. Jacket

c. Elbow Rationale: Elbow restraints prevent children from bending their arms and bringing their hands to the oral surgical site.

The nurse is assisting with data collection for a 2-week-old infant who has been diagnosed with pyloric stenosis. The nurse recognizes which is a sign or symptom associated with pyloric stenosis? a. Occasional burping episodes after swallowing air. b. Vomiting which appears to contain brownish colored bile. c. Mass in the upper right abdominal quadrant, shaped like an olive. d. Emesis which looks and smells as if it had feces backed up into it.

c. Mass in the upper right abdominal quadrant, shaped like an olive. Rationale: An infant with pyloric stenosis will have an olive-shaped mass in the upper right abdominal quadrant. The child will frequently have projectile vomiting, and is hungry, loses weight and may quickly dehydrate. Pyloric stenosis is not associated with occasional burping or bile-colored emesis. Emesis that looks and smells like feces is associated with bowel obstruction

An infant is born with a ventricular septal defect (VSD), and surgery is planned to correct the defect. The practical nurse (PN) should understand that the surgical correction is designed to achieve which hemodynamic outcome? a. Stop the flow of unoxygenated blood into systemic circulation. b. Increase the flow of unoxygenated blood to the lungs. c. Prevent the return of oxygenated blood to the lungs. d. Reduce peripheral tissue hypoxia and nail bed clubbing.

c. Prevent the return of oxygenated blood to the lungs. Rationale: Closure of the VSD will stop shunting of oxygenated blood from the left ventricle (higher pressure) to the right ventricle.

The practical nurse (PN) is caring for a child with an acute respiratory condition. When the PN is monitoring for impending respiratory distress, what sign is the child likely to exhibit first? a. Cyanosis b. Sternal retraction c. Restlessness d. Crowing respiration

c. Restlessness Rationale: Restlessness is an early sign of hypoxemia.

A 12 year old with type 1 diabetes mellitus complains of abdominal pain and has experienced increased thirst during the previous 24 hours. What action should the practical nurse implement first? a. Obtain blood for a complete blood count (CBC) test. b. Initiate D10W at 50 mL/hour IV. c. Test urine for ketones and glucose. d. Assess temperature and blood pressure.

c. Test urine for ketones and glucose. Rationale: This child is exhibiting signs of impending diabetic ketoacidosis (DKA), so the child's urine should be tested for ketones and glucose to assess for DKA.

The nurse and the health care team are participating in a long-term care planning session for a child and family affected by muscular dystrophy. The team plans for which long-term need of the child? a. The child's muscle spasms will eventually worsen. b. The child will slowly develop a loss of consciousness. c. The child will eventually become wheelchair dependent. d. The child will eventually develop chronic kidney disease.

c. The child will eventually become wheelchair dependent. Rationale: The child will eventually become wheelchair dependent, and then will be confined to bed. The child has weak muscles, not muscle spasms. The child will not lose consciousness or develop chronic kidney disease.

A 12-year-old child has been experiencing right lower quadrant abdominal pain and acute appendicitis has been diagnosed. The child rates the pain level as an 8 on the 0-10 scale. An hour later, the child says the pain suddenly went away. The nurse contacts the health care provider for which reason? a. To report the pain has been relieved b. To inform the on call surgical team that surgery will not be needed c. To inform the health care provider that the pain abruptly stopped, indicating possible rupture d. To ask if liquids can be prescribed by mouth and to ask to change the intravenous antibiotics to be given orally

c. To inform the health care provider that the pain abruptly stopped, indicating possible rupture Rationale: A person experiencing a ruptured appendix will experience an abrupt relief of pain. The nurse is contacting the health care provider because this indicates surgery will be necessary very quickly to prevent peritonitis and sepsis. The nurse is not notifying the health care provider to report pain relief, or to notify the surgical team that surgery is not needed. The child will be kept NPO (nothing by mouth status), until the surgeon prescribes fluids after surgery. The child should not be given fluids by mouth prior to surgery, because this could contribute to aspiration.

The practical nurse (PN) is examining a child with an exacerbation of juvenile rheumatoid arthritis (JRA) and notes that the child's mobility is greatly reduced. What factor should the PN observe that affects the child's mobility? a. Pathological fractures b. Poor alignment of joints c. Dyspnea on exertion d. Joint inflammation

d. Joint inflammation Rationale: Joint inflammation and pain are the typical manifestations of an exacerbation of JRA.

A high-school graduate with attention deficit hyperactivity disorder (ADHD) presents to the family health care provider for a precollege physical and tells the practical nurse (PN), "I do not want to take my amphetamine-dextroamphetamine in college." How should the PN respond? a. "There are other medications you can use for ADHD." b. "Your ADHD probably will not be a problem in college." c. "What will happen if you stop your Adderall?" d. "What are your concerns about continuing Adderall?"

d. "What are your concerns about continuing Adderall?" Rationale: It is important to understand the client's concerns about taking amphetamine-dextroamphetamine before making a judgment about his future use of the drug.

A 5-year-old children tells the practical nurse (PN) that she "needs a Band-Aid" when she has an injection. Which action is best for the PN to take? a. Show her that the bleeding has already stopped. b. Explain why a Band-Aid is not needed. c. Ask her why she wants a Band-Aid. d. Apply a Band-Aid over the injection site

d. Apply a Band-Aid over the injection site. Rationale: Preschool children sometimes think that any hole (e.g., an injection or incision) made in their bodies allow their "insides to leak out," so applying a Band-Aid over the hole prevents this from occurring.

A child with a history of tonic-clonic seizures is hospitalized with a fractured ulna. The child is sitting up on the side of the bed when suddenly the child begins to have a tonic-clonic seizure. Which action should the nurse take first? a. Restrain the child's arms to prevent injury. b. Insert a padded tongue blade into the child's open mouth. c. Remind other care providers the child appears to be daydreaming. d. Assist the child to move from a sitting position to side-lying position on the bed.

d. Assist the child to move from a sitting position to side-lying position on the bed. Rationale: Since the child was sitting up when the seizure began, it is necessary to ensure the child's safety by moving the child to a side-lying position on the bed. Turning the child side lying aids ventilation and maintains the airway. The extremities should not be restrained because the violent jerking of the extremities during a seizure could cause a fracture if the extremity were restrained. A padded tongue blade should not be placed into the child's open mouth. A care provider with specialized education could insert an oral airway if indicated. A child who appears to be daydreaming may have absence seizures, not tonic-clonic seizures, which result in violent spasms and relaxation.

A mother phones the clinic because her 6-year-old child has been taking prescribed antibiotics for 7 of the previous 10 days and continues to cough. She also reports that the cough is worsening and is nonproductive. What information should the practical nurse (PN) provide to this mother? a. Watch the child a few more days and see if the cough begins to produce sputum. b. Complete the full 10-day course of antibiotics and reevaluate the cough then. c. Give the child plenty of fluids and an over-the-counter cough suppressant. d. Bring the child to the clinic today for an examination related to the cough.

d. Bring the child to the clinic today for an examination related to the cough. Rationale: The child should be evaluated as soon as possible for pneumonia. Antibiotics usually improve symptoms during the first few days of treatment but should be continued for the full prescribed course. A continued cough after 7 days of antibiotic treatment may indicate an infectious process in the lower lungs, which could cause a nonproductive cough. Children with pneumonia can deteriorate unexpectedly and rapidly and can become seriously ill with no sputum production.

Which intervention should the practical nurse implement when a child cannot swallow prescribed tablets? a. Give the tablets with a very cold beverage of the child's choice. b. Put intact tablets in 1 tablespoon of corn syrup. c. Place the crushed tablet in a gelatin capsule and give with food. d. Crush tablets to a fine powder and mix with a small amount of soft food.

d. Crush tablets to a fine powder and mix with a small amount of soft food. Rationale: For children who have difficulty swallowing tablets, crushing the prescribed dose of tablets (except sustained-released capsules and enteric-coated medications) into a fine powder and mixing in a small amount of applesauce, yogurt, or pudding helps the child swallow the medication.

The practical nurse (PN) is caring for a child who had a cleft lip repair. What is the most important reason to minimize this child's crying during the postoperative recovery period? a. Tear formation increases salivation. b. This behavior increases respirations. c. Lack of comforting can enhance pain. d. Crying stresses the suture line.

d. Crying stresses the suture line. Rationale: Prevention of stress on the lip suture line is essential for optimum healing and the cosmetic appearance of a cleft lip repair.

The parents of a 1-year-old child, who was recently diagnosed with hypospadias, state that they plan to delay the corrective surgery to see if the child will outgrow the problem. What information is best for the practical nurse (PN) to provide to these parents? a. The prognosis will worsen if surgery is delayed. b. Some children do outgrow this type of problem and waiting may be beneficial. c. Regardless of the decision, the staff is available to assist with the process. d. Discuss the child's diagnosis with the health care provider for additional information and clarity.

d. Discuss the child's diagnosis with the health care provider for additional information and clarity. Rationale: The PN should first ensure that the parents have adequate and correct information. Hypospadias is a congenital anomaly resulting in an abnormally located urethral meatus. Surgical correction is usually done early in childhood, which is considered the best time for the child to face surgery with the fewest fears.

The practical nurse (PN) is caring for a child with a diagnosis of acquired aplastic anemia. What should the PN expect in the child's health history that is a common cause of this type of anemia? a. Bacterial infections b. A diet deficient in iron c. Congenital heart defects d. Exposure to certain drugs

d. Exposure to certain drugs Rationale: Aplastic anemia often follows exposure to certain drugs such as chloramphenicol, sulfonamides, phenylbutazone, insecticides such as DDT, and chemicals, in particular benzene.

The practical nurse (PN) is caring for an infant with pyloric stenosis. What nursing intervention should be included in the preoperative period? a. Monitor for signs of metabolic acidosis. b. Estimate the quantity of diarrhea stools. c. Place in a supine position after feeding. d. Observe for projectile vomiting.

d. Observe for projectile vomiting. Rationale: Projectile vomiting, the classic sign of pyloric stenosis, contributes to metabolic alkalosis.

The parent of a 4 year old often observes his child at day care via a video camera hookup to his computer. The parent tells the practical nurse (PN) at the day care center that the child frequently eats with her fingers rather than with utensils. How should the PN respond? a. Explain that the day care center employs certified child care specialists with knowledge of growth and development. b. Advise the parent that an in-service program will be provided to staff regarding mealtime behavior to be expected of preschoolers. c. Schedule the child for an Ages and Stages Questionnaire to evaluate the child's developmental skill level. d. Offer reassurance that this behavior is normal but that the child can now be taught how to use utensils.

d. Offer reassurance that this behavior is normal but that the child can now be taught how to use utensils. Rationale: Preschoolers should learn to use utensils but often prefer to use their fingers.

An 18-month-old child is taken to the emergency department with symptoms of epiglottitis. The nurse anticipates which aspect will be included in the plan of care? a. Soft diet b. Semi-Fowler's position c. Discourage child from sitting upright with chin out d. Prepare to assist with bedside tracheostomy placement

d. Prepare to assist with bedside tracheostomy placement Rationale: The nurse will need to prepare for bedside intubation or tracheostomy, as epiglottitis can progress rapidly, causing acute airway obstruction. The child will not likely be able to tolerate a soft diet, and if airway obstruction occurs, the child could aspirate. The child will likely breathe more easily if allowed to sit in an upright sitting position (not Semi-Fowler's) with the chin out, and the tongue protruding. This is sometimes called the tripod position.

The practical nurse (PN) is caring for a child with Wilms' tumor. Which preoperative intervention should the PN implement? a. Gently percuss the abdomen for evidence of trapped air. b. Observe the abdomen for any noticeable discolorations. c. Apply cold compresses to the abdomen to reduce edema. d. Put a sign above the bed reading, "Do not palpate abdomen."

d. Put a sign above the bed reading, "Do not palpate abdomen." Rationale: Prevention of abdominal palpation minimizes the risk of rupturing the encapsulated tumor and subsequent metastasis.

While examining a 6 year old visiting the clinic for fever and a rash, the practical nurse (PN) notices several elevated 1- to 3-mm white spots on the buccal mucosa. What other signs should the PN expect this child to exhibit? a. Pruritic vesicular skin eruptions on trunk b. Honey-colored crusted exudate from ruptured skin vesicles c. Irregular red macular rash in the perianal area d. Red blotchy macular rash on the face and neck

d. Red blotchy macular rash on the face and neck Rationale: Elevated white spots on the oral mucosa of a child are likely Koplik's spots and are indicative of rubeola. They are accompanied by a red blotchy rash that starts on the face and spreads to the neck, the trunk, and the rest of the body.

The practical nurse (PN) observes the unlicensed assistive personnel (UAP) placing a tongue blade at the bedside of a child admitted with a seizure disorder. Which intervention should the PN implement? a. Determine if the tongue blade is the correct size based on the child's height and weight. b. Advise the UAP that a nurse should assume this responsibility. c. Assist the UAP to tape padding securely around the tongue blade. d. Tell the UAP that tongue blades should not be inserted during a seizure.

d. Tell the UAP that tongue blades should not be inserted during a seizure. Rationale: Tongue blades can cause damage or force the tongue to obstruct the airway and should not be inserted during seizure activity. Nothing should be placed in the child's mouth. During a seizure, the airway can be opened with jaw thrust technique, and the child can be turned to the side to prevent pooling of secretions.

An 11-year-old boy is admitted after being hit in the head with a baseball during a Little League game. Which subject is most important for the practical nurse to explore during history taking? a. Inspection of wound for lacerations and bleeding b. Description of the character and quality of pain c. Independent observer's account of the event d. The level of consciousness exhibited after the injury

d. The level of consciousness exhibited after the injury Rationale: The priority concern when taking the history involving a head injury is to determine the level of consciousness following the injury.

A child with nephrotic syndrome is receiving prednisone. The practical nurse (PN) reviews breakfast foods at a fast food restaurant with the child's mother. Which selections indicate that the mother understands the dietary guidelines necessary for her child? a. French toast sticks and orange juice b. Sausage-egg muffin and grape juice c. Canadian bacon slices and hot chocolate d. Toasted oat cereal and low-fat milk

d. Toasted oat cereal and low-fat milk Rationale: A child receiving a corticosteroid for nephrotic syndrome should follow a low-sodium, low-fat, and low-sugar diet. Based on these guidelines, the best breakfast choice is toasted oat cereal and low-fat milk.

The practical nurse (PN) is assessing an 8 month old who has a medical diagnosis of tetralogy of Fallot. The child demonstrates cyanosis with crying and exertion. Which other symptom is this infant most likely to exhibit? a. Bradycardia b. Squatting posture c. Weak pedal pulses d. Weak pedal pulses

d. Weak pedal pulses Rationale: Tetralogy of Fallot, a cyanotic heart defect, causes clubbing of fingers and toes resulting from tissue hypoxia.