PEDs questions
1.Which of the following would be inappropriate when administering chemotherapy to a child?a.Monitoring the child for both general and specific adverse effects b.Observing the child for 10 minutes to note for signs of anaphylaxis c.Administering medication through a free-flowing intravenous line d.Assessing for signs of infusion infiltration and irritation
1. B. When administering chemotherapy, the nurse should observe for an anaphylactic reaction for 20 minutes and stop the medication if one is suspected. Chemotherapy is associated with both general and specific adverse effects, therefore close monitoring for them is important.
11. Nurse Roy is administering total parental nutrition (TPN) through a peripheral I.V. line to a school-age child. What's the smallest amount of glucose that's considered safe and not caustic to small veins, while also providing adequate TPN? a. 5% glucose b. 10% glucose c. 15% glucose d. 17% glucose
11.Answer B. The amount of glucose that's considered safe for peripheral veins while still providing adequate parenteral nutrition is 10%. Five percent glucose isn't sufficient nutritional replacement, although it's sake for peripheral veins. Any amount above 10% must be administered via central venous access.
1. The parents of a child, age 5, who will begin school in the fall ask the nurse for anticipatory guidance. The nurse should explain that a child of this age: a. Still depends on the parents b. Rebels against scheduled activities c. Is highly sensitive to criticism d. Loves to tattle
1.Answer C. In a 6-year-old child, a precarious sense of self causes overreaction to criticism and a sense of inferiority. By age 6, most children no longer depend on the parents for daily tasks and love the routine of a schedule. Tattling is more common at age 4 to 5, by age 6, the child wants to make friends and be a friend.
10.Which of the following blood study results would the nurse expect as most likely when caring for the child with iron deficiency anemia? a.Increased hemoglobin b.Normal hematocrit c.Decreased mean corpuscular volume (MCV) d.Normal total iron-binding capacity (TIBC)
10. C. For the child with iron deficiency anemia, the blood study results most likely would reveal decreased mean corpuscular volume (MCV) which demonstrates microcytic anemia, decreased hemoglobin, decreased hematocrit and elevated total iron binding capacity.
10. Cristina, a mother of a 4-year-old child tells the nurse that her child is a very poor eater. What's the nurse's best recommendation for helping the mother increase her child's nutritional intake? a. Allow the child to feed herself b. Use specially designed dishes for children - for example, a plate with the child's favorite cartoon character c. Only serve the child's favorite foods d. Allow the child to eat at a small table and chair by herself
10.Answer A. The best recommendation is to allow the child to feed herself because the child's stage of development is the preschool period of initiative. Special dishes would enhance the primary recommendation. The child should be offered new foods and choices, not just served her favorite foods. Using a small table and chair would also enhance the primary recommendation.
11.The nurse answers a call bell and finds a frightened mother whose child, the patient, is having a seizure. Which of these actions should the nurse take? a.The nurse should insert a padded tongue blade in the patient's mouth to prevent the child from swallowing or choking on his tongue. b.The nurse should help the mother restrain the child to prevent him from injuring himself. c.The nurse should call the operator to page for seizure assistance. d.The nurse should clear the area and position the client safely.
11. D. The primary role of the nurse when a patient has a seizure is to protect the patient from harming him or herself.
12.At the community center, the nurse leads an adolescent health information group, which often expands into other areas of discussion. She knows that these youths are trying to find out "who they are," and discussion often focuses on which directions they want to take in school and life, as well as peer relationships. According to Erikson, this stage is known as: a.identity vs. role confusion. b.adolescent rebellion. c.career experimentation. d.relationship testing
12. A. During this period, which lasts up to the age of 18-21 years, the individual develops a sense of "self." Peers have a major big influence over behavior, and the major decision is to determine a vocational goal.
12. David, age 15 months, is recovering from surgery to remove Wilms' tumor. Which findings best indicates that the child is free from pain? a. Decreased appetite b. Increased heart rate c. Decreased urine output d. Increased interest in play
12.Answer D. One of the most valuable clues to pain is a behavior change: A child who's pain-free likes to play. A child in pain is less likely to consume food or fluids. An increased heart rate may indicate increased pain; decreased urine output may signify dehydration
13.The nurse is assessing a 9-month-old boy for a well-baby check up. Which of the following observations would be of most concern? a.The baby cannot say "mama" when he wants his mother. b.The mother has not given him finger foods. c.The child does not sit unsupported. d.The baby cries whenever the mother goes out.
13. C. Over 90% percent of babies can sit unsupported by nine months. Most babies cannot say "mama" in the sense that it refers to their mother at this time.
13. When planning care for a 8-year-old boy with Down syndrome, the nurse should: a. Plan interventions according to the developmental level of a 7-year-old child because that's the child's age b. Plan interventions according to the developmental levels of a 5-year-old because the child will have developmental delays c. Assess the child's current developmental level and plan care accordingly d. Direct all teaching to the parents because the child can't understand
13.Answer C. Nursing care plan should be planned according to the developmental age of a child with Down syndrome, not the chronological age. Because children with Down syndrome can vary from mildly to severely mentally challenged, each child should be individually assessed. A child with Down syndrome is capable of learning, especially a child with mild limitations.
14.Cheska, the mother of an 11-month-old girl, KC, is in the clinic for her daughter's immunizations. She expresses concern to the nurse that Shannon cannot yet walk. The nurse correctly replies that, according to the Denver Developmental Screen, the median age for walking is: a.12 months. b.15 months. c.10 months. d.14 months.
14. A. By 12 months, 50 percent of children can walk well.
14. Nurse Victoria is teaching the parents of a school-age child. Which teaching topic should take priority? a. Prevent accidents b. Keeping a night light on to allay fears c. Explaining normalcy of fears about body integrity d. Encouraging the child to dress without help
14.Answer A. Accidents are the major cause of death and disability during the school-age years. Therefore, accident prevention should take priority when teaching parents of school-age children. Preschool (not school-age) children are afraid of the dark, have fears concerning body integrity, and should be encouraged to dress without help (with the exception of tying shoes).
15.Sally Kent., age 13, has had a lumbar puncture to examine the CSF to determine if bacterial infection exists. The best position to keep her in after the procedure is: a.prone for two hours to prevent aspiration, should she vomit. b.semi-fowler's so she can watch TV for five hours and be entertained. c.supine for several hours, to prevent headache. d.on her right sides to encourage return of CSF
15. C. Lying flat keeps the patient from having a "spinal headache." Increasing the fluid intake will assist in replenishing the lost fluid during this time.
15. The nurse is finishing her shift on the pediatric unit. Because her shift is ending, which intervention takes top priority? a. Changing the linens on the clients' beds b. Restocking the bedside supplies needed for a dressing change on the upcoming shift c. Documenting the care provided during her shift d. Emptying the trash cans in the assigned client room
15.Answer C. Documentation should take top priority. Documentation is the only way the nurse can legally claim that interventions were performed. The other three options would be appreciated by the nurses on the oncoming shift but aren't mandatory and don't take priority over documentation.
16.Buck's traction with a 10 lb. weight is securing a patient's leg while she is waiting for surgery to repair a hip fracture. It is important to check circulation- sensation-movement: a.every shift. b.every day. c.every 4 hours. d.every 15 minutes
16. C. The patient can lose vascular status without the nurse being aware if left for more than 4 hours, yet checks should not be so frequent that the patient becomes anxious. Vital signs are generally checked q4h, at which time the CSM checks can easily be performed.
16. Nurse Alice is providing cardiopulmonary resuscitation (CPR) to a child, age 4. the nurse should: a. Compress the sternum with both hands at a depth of 1½ to 2" (4 to 5 cm) b. Deliver 12 breaths/minute c. Perform only two-person CPR d. Use the heel of one hand for sternal compressions
16.Answer D. The nurse should use the heel of one hand and compress 1" to 1½ ". The nurse should use the heels of both hands clasped together and compress the sternum 1½ "to 2" for an adult. For a small child, two-person rescue may be inappropriate. For a child, the nurse should deliver 20 breaths/minute instead of 12.
17.Carol Smith is using bronchodilators for asthma. The side effects of these drugs that you need to monitor this patient for include: a.tachycardia, nausea, vomiting, heart palpitations, inability to sleep, restlessness, and seizures. b.tachycardia, headache, dyspnea, temp . 101 F, and wheezing. c.blurred vision, tachycardia, hypertension, headache, insomnia, and oliguria. d.restlessness, insomnia, blurred vision, hypertension, chest pain, and muscle weakness.
17. A. Bronchodilators can produce the side effects listed in answer choice (A) for a short time after the patient begins using them.
17. A 4-month-old with meningococcal meningitis has just been admitted to the pediatric unit. Which nursing intervention has the highest priority? a. Instituting droplet precautions b. Administering acetaminophen (Tylenol) c. Obtaining history information from the parents d. Orienting the parents to the pediatric unit
17.Answer A. Instituting droplet precautions is a priority for a newly admitted infant with meningococcal meningitis. Acetaminophen may be prescribed but administering it doesn't take priority over instituting droplet precautions. Obtaining history information and orienting the parents to the unit don't take priority.
18.The adolescent patient has symptoms of meningitis: nuchal rigidity, fever, vomiting, and lethargy. The nurse knows to prepare for the following test: a.blood culture. b.throat and ear culture. c.CAT scan. d.lumbar puncture.
18. D. Meningitis is an infection of the meninges, the outer membrane of the brain. Since it is surrounded by cerebrospinal fluid, a lumbar puncture will help to identify the organism involved.
18. Sheena, tells the nurse that she wants to begin toilet training her 22-month-old child. The most important factor for the nurse to stress to the mother is: a. Developmental readiness of the child b. Consistency in approach c. The mother's positive attitude d. developmental level of the child's peers
18.Answer A. If the child isn't developmentally ready, child and parent will become frustrated. Consistency is important once toilet training has already started. The mother's positive attitude is important when the child is ready. Developmental levels of children are individualized and comparison to peers isn't useful.
19.The nurse is drawing blood from the diabetic patient for a glycosolated hemoglobin test. She explains to the woman that the test is used to determine: a.the highest glucose level in the past week. b.her insulin level. c.glucose levels over the past several months. d.her usual fasting glucose level.
19. C. The glycosolated hemoglobin test measures glucose levels for the previous 3 to 4 months.
19. An infant who has been in foster care since birth requires a blood transfusion. Who is authorized to give written, informed consent for the procedure? a. The foster mother b. The social worker who placed the infant in the foster home c. The registered nurse caring for the infant d. The nurse-manager
19.Answer A. When children are minors and aren't emancipated, their parents or designated legal guardians are responsible for providing consent for medical procedures. Therefore, the foster mother is authorized to give consent for the blood transfusion. The social workers, the nurse, and the nurse-manager have no legal rights to give consent in this scenario.
2.Which of the following is the best method for performing a physical examination on a toddler a.From head to toe b.Distally to proximally c.From abdomen to toes, the to head d.From least to most intrusive
2. D. When examining a toddler or any small child, the best way to perform the exam is from least to most intrusive. Starting at the head or abdomen is intrusive and should be avoided. Proceeding from distal to proximal is inappropriate at any age
7. Patrick, a healthy adolescent has meningitis and is receiving I.V. and oral fluids. The nurse should monitor this client's fluid intake because fluid overload may cause: a. Cerebral edema b. Dehydration c. Heart failure d. Hypovolemic shock
7.Answer A. Because of the inflammation of the meninges, the client is vulnerable to developing cerebral edema and increase intracranial pressure. Fluid overload won't cause dehydration. It would be unusual for an adolescent to develop heart failure unless the overhydration is extreme. Hypovolemic shock would occur with an extreme loss of fluid of blood.
8.Which of the following situations increase risk of lead poisoning in children? a.playing in the park with heavy traffic and with many vehicles passing by b.playing sand in the park c.playing plastic balls with other children d.playing with stuffed toys at home
8. A. Lead poisoning may be caused by inhalation of dusk and smoke from leaded gas. It may also be caused by lead-based paint, soil, water (especially from plumbings of old houses).
2. While preparing to discharge an 8-month-old infant who is recovering from gastroenteritis and dehydration, the nurse teaches the parents about their infant's dietary and fluid requirements. The nurse should include which other topic in the teaching session? a. Nursery schools b. Toilet Training c. Safety guidelines d. Preparation for surgery
2.Answer C. The nurse always should reinforce safety guidelines when teaching parents how to care for their child. By giving anticipatory guidance the nurse can help prevent many accidental injuries. For parents of a 9-month-old infant, it is too early to discuss nursery schools or toilet training. Because surgery is not used gastroenteritis, this topic is inappropriate.
20.The twelve-year-old boy has fractured his arm because of a fall from his bike. After the injury has been casted, the nurse knows it is most important to perform all of the following assessments on the area distal to the injury except: a.capillary refill b.radial and ulnar pulse. c.finger movement d.skin integrity
20. D. Capillary refill, pulses, and skin temperature and color are indicative of intact circulation and absence of compartment syndrome. Skin integrity is less important.
20. A child is undergoing remission induction therapy to treat leukemia. Allopurinol is included in the regimen. The main reason for administering allopurinol as part of the client's chemotherapy regimen is to: a. Prevent metabolic breakdown of xanthine to uric acid b. Prevent uric acid from precipitating in the ureters c. Enhance the production of uric acid to ensure adequate excretion of urine d. Ensure that the chemotherapy doesn't adversely affect the bone marrow
20.Answer A. The massive cell destruction resulting from chemotherapy may place the client at risk for developing renal calculi; adding allopurinol decreases this risk by preventing the breakdown of xanthine to uric acid. Allopurinol doesn't act in the manner described in the other options
21. A 10-year-old client contracted severe acute respiratory syndrome (SARS) when traveling abroad with her parents. The nurse knows she must put on personal protective equipment to protect herself while providing care. Based on the mode of SARS transmission, which personal protective should the nurse wear? a. Gloves b. Gown and gloves c. Gown, gloves, and mask d. Gown, gloves, mask, and eye goggles or eye shield
21.Answer D. The transmission of SARS isn't fully understood. Therefore, all modes of transmission must be considered possible, including airborne, droplet, and direct contact with the virus. For protection from contracting SARS, any health care worker providing care for a client with SARS should wear a gown, gloves, mask, and eye goggles or an eye shield.
22. A tuberculosis intradermal skin test to detect tuberculosis infection is given to a high-risk adolescent. How long after the test is administered should the result be evaluated? a. Immediately b. Within 24 hours c. In 48 to 72 hours d. After 5 days
22.Answer C. Tuberculin skin tests of delayed hypersensitivity. If the test results are positive, a reaction should appear in 48 to 72 hours. Immediately after the test and within 24 hours are both too soon to observe a reaction. Waiting more than 5 days to evaluate the test is too long because any reaction may no longer be visible.
23. Nurse Oliver s teaching a mother who plans to discontinue breast-feeding after 5 months. The nurse should advise her to include which foods in her infant's diet? a. Iron-rich formula and baby food b. Whole milk and baby food c. Skim milk and baby food d. Iron-rich formula only
23.Answer D. The American Academy of Pediatrics recommends that infants at age 5 months receive iron-rich formula and that they shouldn't receive solid food - even baby food - until age 6 months. The Academy doesn't recommend whole milk until age 12 months, and skim milk until after age 2 years.
24. Gracie, the mother of a 3-month-old infant calls the clinic and states that her child has a diaper rash. What should the nurse advise? a. "Switch to cloth diapers until the rash is gone" b. "Use baby wipes with each diaper change." c. "Leave the diaper off while the infant sleeps." d. "Offer extra fluids to the infant until the rash improves."
24.Answer C. Leaving the diaper off while the infant sleeps helps to promote air circulation to the area, improving the condition. Switching to cloth diapers isn't necessary; in fact, that may make the rash worse. Baby wipes contain alcohol, which may worsen the condition. Extra fluids won't make the rash better.
25. Nurse Kelly is teaching the parents of a young child how to handle poisoning. If the child ingests poison, what should the parents do first? a. Administer ipecac syrup b. Call an ambulance immediately c. Call the poison control center d. Punish the child for being bad
25.Answer C. Before interviewing in any way, the parents should call the poison control center for specific directions. Ipecac syrup is no longer recommended. The parents may have to call an ambulance after calling the poison control center. Punishment for being bad isn't appropriate because the parents are responsible for making the environment safe.
26. A child has third-degree burns of the hands, face, and chest. Which nursing diagnosis takes priority? a. Ineffective airway clearance related to edema b. Disturbed body image related to physical appearance c. Impaired urinary elimination related to fluid loss d. Risk for infection related to epidermal disruption
26.Answer A.Initially, when a preschool client is admitted to the hospital for burns, the primary focus is on assessing and managing an effective airway. Body image disturbance, impaired urinary elimination, and infection are all integral parts of burn management but aren't the first priority.
27. A 3-year-old child is receiving dextrose 5% in water and half-normal saline solution at 100 ml/hour. Which sign or symptom suggests excessive I.V. fluid intake? a. Worsening dyspnea b. Gastric distension c. Nausea and vomiting d. Temperature of 102°F (38.9° C)
27.Answer A. Dyspnea and other signs of respiratory distress signify fluid volume excess (overload), which can occur quickly in a child as fluid shifts rapidly between the intracellular and extracellular compartments. Gastric distention may suggest excessive oral fluid intake or infection. Nausea and vomiting or an elevated temperature may indicate a fluid volume deficit.
28. Which finding would alert a nurse that a hospitalized 6-year-old child is at risk for a severe asthma exacerbation? a. Oxygen saturation of 95% b. Mild work of breathing c. Absence of intercostals or substernal retractions d. History of steroid-dependent asthma
28.Answer D. A history of steroid-dependent asthma, a contributing factor to this client's high-risk status, requires the nurse to treat the situation as a severe exacerbation regardless of the severity of the current episode. An oxygen saturation of 95%, mild work of breathing, and absence of intercostals or substernal retractions are all normal findings.
29. Nurse Mariane is caring for an infant with spina bifida. Which technique is most important in recognizing possible hydrocephalus? a. Measuring head circumference b. Obtaining skull X-ray c. Performing a lumbar puncture d. Magnetic resonance imaging (MRI)
29.Answer A. Measuring head circumference is the most important assessment technique for recognizing possible hydrocephalus, and is a key part of routine infant screening. Skull X-rays and MRI may be used to confirm the diagnosis. A lumber puncture isn't appropriate.30.Answer A. Itching underneath a cast can be relieved by directing blow-dyer, set, on the cool setting, toward the itchy area. Skin breakdown can occur if anything is placed under the cast. Therefore, the client should be cautioned not to put any object down the cast in an attempt to scratch.
3.Which of the following organisms is responsible for the development of rheumatic fever? a.Streptococcal pneumonia b.Haemophilus influenza c.Group A β-hemolytic streptococcus d.Staphylococcus aureus
3. C. Rheumatic fever results as a delayed reaction to inadequately treated group A β-hemolytic streptococcal infection
3. Nurse Betina should begin screening for lead poisoning when a child reaches which age? a. 6 months b. 12 months c. 18 months d. 24 months
3.Answer C. The nurse should start screening a child for lead poisoning at age 18 months and perform repeat screening at age 24, 30, and 36 months. High-risk infants, such as premature infants and formula-fed infants not receiving iron supplementation, should be screened for iron-deficiency anemia at 6 months. Regular dental visits should begin at age 24 months.
4.Which of the following is most likely associated with a cerebrovascular accident (CVA) resulting from congenital heart disease? a.Polycythemia b.Cardiomyopathy c.Endocarditis d.Low blood pressure
4. A. The child with congenital heart disease develops polycythemia resulting from an inadequate mechanism to compensate for decreased oxygen saturation
6. A parent brings a toddler, age 19 months, to the clinic for a regular check-up. When palpating the toddler's fontanels, what should the nurse expects to find? a. Closed anterior fontanel and open posterior fontanel b. Open anterior and fontanel and closed posterior fontanel c. Closed anterior and posterior fontanels d. Open anterior and posterior fontanels
6.Answer C. By age 18 months, the anterior and posterior fontanels should be closed. The diamond-shaped anterior fontanel normally closes between ages 9 and 18 months. The triangular posterior fontanel normally closes between ages 2 and 3 months.
7.The nurse is assessing a newborn who had undergone vaginal delivery. Which of the following findings is least likely to be observed in a normal newborn? a.uneven head shape b.respirations are irregular, abdominal, 30-60 bpm c.(+) moro reflex d.heart rate is 80 bpm
7. D. Normal heart rate of the newborn is 120 to 160 bpm. Choices A, B, and C are normal assessment findings (uneven head shape is molding).
4. When caring for an 11-month-old infant with dehydration and metabolic acidosis, the nurse expects to see which of the following? a. A reduced white blood cell count b. A decreased platelet count c. Shallow respirations d. Tachypnea
4.Answer D. The body compensates for metabolic acidosis via the respiratory system, which tries to eliminate the buffered acids by increasing alveolar ventilation through deep, rapid respirations, altered white blood cell or platelet counts are not specific signs of metabolic imbalance.
5.How does the nurse appropriately administer mycostatin suspension in an infant? a.Have the infant drink water, and then administer mycostatin in a syringe b.Place mycostatin on the nipple of the feeding bottle and have the infant suck it c.Mix mycostatin with formula d.Swab mycostatin on the affected areas
5. D. Mycostatin suspension is given as swab. Never mix medications with food and formula.
5. After the nurse provides dietary restrictions to the parents of a child with celiac disease, which statement by the parents indicates effective teaching? a. "Well follow these instructions until our child's symptoms disappear." b. "Our child must maintain these dietary restrictions until adulthood." c. "Our child must maintain these dietary restrictions lifelong." d. "We'll follow these instructions until our child has completely grown and developed."
5.Answer C. A patient with celiac disease must maintain dietary restrictions lifelong to avoid recurrence of clinical manifestations of the disease. The other options are incorrect because signs and symptoms will reappear if the patient eats prohibited foods.
6.A mother tells the nurse that she is very worried because her 2-year old child does not finish his meals. What should the nurse advise the mother? a.make the child seat with the family in the dining room until he finishes his meal b.provide quiet environment for the child before meals c.do not give snacks to the child before meals d.put the child on a chair and feed him
6. C. If the child is hungry he/she more likely would finish his meals. Therefore, the mother should be advised not to give snacks to the child. The child is a "busy toddler." He/she will not able to keep still for a long time.
8. An infant is hospitalized for treatment of nonorganic failure to thrive. Which nursing action is most appropriate for this infant? a. Encouraging the infant to hold a bottle b. Keeping the infant on bed rest to conserve energy c. Rotating caregivers to provide more stimulation d. Maintaining a consistent, structured environment
8.Answer D. The nurse caring for an infant with nonorganic failure to thrive should maintain a consistent, structured environment that provides interaction with the infant to promote growth and development. Encouraging the infant to hold a bottle would reinforce an uncaring feeding environment. The infant should receive social stimulation rather than be confined to bed rest. The number of caregivers should be minimized to promote consistency of care.
9.An inborn error of metabolism that causes premature destruction of RBC? a.G6PD (glucose-6-phosphate dehydrogenase deficiency) b.Hemocystinuria c.Phenylketonuria d.Celiac Disease
9. A. Glucose-6-phosphate dehydrogenase deficiency (G6PD) is an X-linked recessive hereditary disease characterized by abnormally low levels of glucose-6-phosphate dehydrogenase (abbreviated G6PD or G6PDH), a metabolic enzyme involved in the pentose phosphate pathway, especially important in red blood cell metabolism.
9. The mother of Gian, a preschooler with spina bifida tells the nurse that her daughter sneezes and gets a rash when playing with brightly colored balloons, and that she recently had an allergic reaction after eating kiwifruit and bananas. The nurse would suspect that the child may have an allergy to: a. Bananas b. Latex c. Kiwifruit d. Color dyes
9.Answer B. Children with spina bifida often develop an allergy to latex and shouldn't be exposed to it. If a child is sensitive to bananas, kiwifruit, and chestnuts, then she's likely to be allergic to latex. Some children are allergic to dyes in foods and other products but dyes aren't a factor in a latex allergy.
30. An adolescent who sustained a tibia fracture in a motor vehicle accident has a cast. What should the nurse do to help relieve the itching? a. Apply cool air under the cast with a blow-dryer b. Use sterile applicators to scratch the itch c. Apply cool water under the cast d. Apply hydrocortisone cream under the cast using sterile applicator.
a Itching underneath a cast can be relieved by directing blow-dryer. set. on the cool setting. toward the itchy area. Skin breakdown can occur if anything is placed under the cast. Therefore. the client should be cautioned not to put any object down the cast in an attempt to scratch.