School Age Child NCLEX

A child with diabetes insipidus receives desmopressin acetate (DDAVP). When evaluating for therapeutic effectiveness, the nurse would interpret which finding as a positive response to this drug?

1. Decreased urine output

A disabled school-age child whose parents are overprotective might display which of the following sets of characteristics?

1. Dependency, fearfulness, and lack of outside interests

A school-age child is being discharged with a diagnosis of rheumatic fever. Which of the following should be included in the teaching plan for the family?

1. The child should stay on penicillin and return for a follow-up appointment.

When teaching school-age children important injury prevention strategies, the nurse must use creativity to gain cooperation because children tend not to comply with which of the following?

1. Wearing safety apparel (helmets, knee pads, elbow pads)

A child, age 8, is immobilized with a hip spica cast. To minimize the child's feelings of isolation, the nurse should:

1. let the child visit the playroom daily.

Several children in a kindergarten class have been treated for pinworm. To prevent the spread of pinworm, the school nurse meets with the parents and explains that they should:

1. tell the children not to bite their fingernails.

When teaching the parents of a school-age child about signs and symptoms of fever that require immediate notification of the physician, which of the following descriptions should the nurse include?

2. Complaints of a stiff neck

A child is admitted to the pediatric unit with a serum sodium level of 118 mEq/L. Which nursing action takes highest priority at this time?

2. Instituting seizure precautions

A child is admitted with a tentative diagnosis of clinical depression. Which data collection finding is most significant in confirming this diagnosis?

2. Sadness

The nurse is caring for a school-age child whom she suspects has been physically abused. What legal responsibility does the nurse have toward this client?

4. Describing the client's and parent's behavior

A 10-year-old client with asthma is prescribed 2 mg of albuterol syrup four times per day. The syrup comes in a dosage strength of 2 mg/5 ml. How many milliliters of syrup should the nurse administer?

5

In the family of a 7-year-old boy with a chronic illness, his 10-year-old sister and 12-year-old brother often show feelings of resentment, embarrassment, shame, fear of becoming ill, and guilt at causing the illness. How can the parents help the siblings adjust to the child's illness?

3. Spend some quality time with just the older brother and sister and encourage them to talk about how they feel about their sick brother.

A school-age client underwent burn wound grafting 1 day ago. Which wound care principle is true regarding burn grafting during the immediate postoperative period?

3. The nurse shouldn't perform dressing changes.

The nurse is teaching parents how to reduce the spread of impetigo. The nurse should encourage parents to:

3. teach children the importance of proper hand washing.

A child who recovered from bacterial meningitis is scheduled to have his hearing checked before discharge. The mother asks why this test is necessary. Which response by the nurse is best?

4. "Despite treatment, some children with bacterial meningitis suffer neurologic damage, especially to the nerve responsible for hearing."

Parents of a 10-year-old obese client ask the nurse how to encourage good eating habits in their child. Which response by the nurse is best?

4. "Encourage your child to actively participate in meal planning and preparation."

A school-age client is complaining of pain. After asking the client to rate his pain using an age-appropriate pain scale, the nurse determines that the client's pain is minor. What is the drug of choice for treating mild pain in children?

4. Acetaminophen

When administering morphine (the drug of choice for moderate to severe pain in pediatric patients), to a school-age child, which symptom should cause the nurse to be concerned?

4. Anemia

The parents of a child with cystic fibrosis ask the nurse why their child must receive supplemental pancreatic enzymes. Which response by the nurse would be most appropriate?

1. "Pancreatic enzymes promote absorption of nutrients and fat."

A child, age 10, is hospitalized for treatment of acute osteomyelitis. After recognizing swelling and tenderness of the left tibia, the nurse initiates antibiotic therapy as prescribed. The child's left leg is immobilized in a splint. What is an expected outcome for this child?

1. "The client will change position as soon as he feels minimal discomfort."

When teaching parents about fifth disease (erythema infectiosum) and its transmission, the nurse should provide which information?

1. Fifth disease is transmitted by respiratory secretions.

When collecting data on a child with juvenile hypothyroidism, the nurse expects which finding?

1. Goiter

When examining school-age and adolescent children, the nurse routinely screens for scoliosis. Which statement accurately summarizes how to perform this screening?

1. Have the child stand firmly on both feet and bend forward at the hips, with the trunk exposed.

The mother of a school-age child reports that her child is having some problems in school. Which of the following would be the priority action?

1. Obtain more information from the mother and the child.

A 10-year-old client diagnosed with acute glomerulonephritis is admitted to the pediatric unit. The nurse should expect that which of the following is a part of the child's care?

1. Taking vital signs every 4 hours and obtaining daily weight

Which of the following uses of restraints would be contraindicated in a school-age child?

1. To substitute for observation

When collecting data on a girl, age 10, the nurse keeps in mind that the first sign of sexual maturity in girls is:

1. breast bud development.

The physician prescribes corticosteroids for a child with systemic lupus erythematosus (SLE). The nurse knows that the purpose of corticosteroid therapy for this child is to:

1. combat inflammation.

A child, age 6, is anxious and upset before a scheduled bone marrow aspiration. During client preparation, the nurse should keep in mind that:

1. describing what the child will hear, see, smell, and feel will help the child cope with the procedure.

A 7-year-old boy is hospitalized with cystic fibrosis. To help him manage secretions and avoid respiratory distress, the nurse should:

1. perform frequent chest physiotherapy.

A school-age child experiences symptoms of excessive polyphagia, polyuria, and weight loss. The physician diagnoses type I diabetes mellitus and admits the child to the facility for insulin regulation. The physician prescribes an insulin regimen of insulin (Humulin R) and isophane insulin (Humulin N) administered subcutaneously. How soon after administration can the nurse expect the regular insulin to begin to act?

1. ½ to 1 hour

The charge nurse on the pediatric unit informs the staff nurse that four of her clients require attention. Which client should the nurse see first?

2. A 10-year-old with asthma whose oxygen saturation levels are dropping

A 7-year-old client is admitted to the hospital for treatment of facial cellulitis. He is admitted for observation and for administration of a 10-day course of I.V. antibiotics. Which interventions would help this client cope with the insertion of a peripheral I.V. line?

2. Applying a topical anesthetic to the I.V. site before the procedure, 3. Asking the child which hand he uses for drawing

What should the nurse do first when admitting an 11-year-old client in sickle cell crisis?

2. Begin I.V. fluids after obtaining the child's history.

When caring for a child, age 12, who's diagnosed with osteomyelitis of the left femur, the nurse should take which action first?

2. Drawing blood for cultures as ordered

What is the most common data collection finding in a child with ulcerative colitis?

2. Profuse diarrhea

The nurse is planning care for a 10-year-old child in the acute phase of rheumatic fever. Which activity would be most appropriate for the nurse to schedule in the care plan?

2. Reading books

The nurse is developing a plan of care for a 10-year-old child who has recently been diagnosed with type 1 diabetes mellitus. Which of the following would be inappropriate to include in a teaching plan focusing on proper hygiene?

2. Teach blood glucose monitoring.

A child is receiving total parenteral nutrition (TPN). During TPN therapy, the most important nursing action is:

2. monitoring the blood glucose level closely.

A pediatric client with iron deficiency anemia is prescribed ferrous sulfate (Ferralyn), an oral iron supplement. When teaching the child and parent how to administer this preparation, the nurse should provide which instruction?

3. "Administer ferrous sulfate with fruit juice to promote absorption."

A school-age child needs an I.V. catheter inserted for administration of I.V. fluids. Which explanation by the nurse empowers the client to deal effectively with the procedure?

3. "You can help by keeping your arm as still as a tree."

The physician prescribes meperidine (Demerol), 30 mg I.M., as preoperative medication for a school-age child who weighs 66 lb (30 kg). The meperidine is supplied as 50 mg/ml. How much meperidine should the nurse administer?

3. 0.6 ml

A chronically ill school-age child is most vulnerable to which stressor?

3. Anxiety over school absences

The nurse is giving instructions to parents of a school-age child diagnosed with sickle cell disease. The instructions should include which of the following?

3. Avoid areas of low oxygen concentration such as high altitudes.

A school-age child with terminal leukemia is admitted to the pediatric unit. The nurse must discuss advance directives with the child's parents. The nurse should include which information?

3. Comfort care options

The nurse is caring for an 8-year old child with acute asthma. Which data collection finding should the nurse immediately report to the charge nurse?

3. During auscultation, breath sounds are diminished bilaterally and no wheezing is audible.

The parents of a school-age child with asthma express concern about letting the child participate in sports. What should the nurse tell the parents about the relationship between exercise and asthma?

4. Taking prophylactic drugs before the activity can prevent asthma attacks and enable the child to engage in most sports.

The school nurse is examining a student at an elementary school. Which findings would support the diagnosis of impetigo?

4. Vesicular lesions that ooze, forming crusts on the face and extremities

A child is receiving chemotherapy for treatment of acute lymphoblastic leukemia. During discharge preparation, which topic is most important for the nurse to discuss with the child and parents?

4. Ways to prevent infection

A child, age 8, complains of leg pain shortly after being admitted with a fractured tibia sustained in a fall. The most effective way for the nurse to assess the severity of the pain is to:

4. ask the child to rate the pain using an age-appropriate pain scale.

The parents of a school-age child ask the nurse what to expect from their child during this stage of development. When developing a plan of care to address this matter, the nurse should keep in mind that this child's cognitive development is characterized by:

4. conservation skills.

After a head injury, a child experiences enuresis, polydipsia, and weight loss. Based on these findings, the nurse should monitor closely for signs and symptoms of:

4. hypokalemia.

A local elementary school has requested scoliosis screening for its students from the hospital's community outreach program. The school should be informed that:

4. this is an appropriate request and arrangements will be made as soon as possible.

Why might a physician be reluctant to approach the parents of a school-age child who's dying of brain cancer about a do-not-resuscitate order?

2. The physician may lack knowledge and experience with palliative care principles.

A school-age child's family asks the nurse to describe palliative care. Which statement best describes palliative care?

3. Total care given when disease doesn't respond to curative treatment

The health care team in the intensive care unit assesses a school-age child and believes his prognosis is grave. The team feels that life support should be withdrawn. After the team discusses withdrawing life support with the parents, the parents agree. How should the nurse intervene during this difficult time?

1. Explain to the family what will happen when life support is withdrawn.

According to Erikson's theory of development, chronic illness can interfere with which stage of development in an 11-year-old child?

3. Industry versus inferiority

A 10-year-old boy falls, injures his left shoulder, and is taken to the emergency department. While the client waits to be seen by the physician, what intervention should the nurse perform first?

3. Keep him in a comfortable position and apply ice to the injured shoulder.

Which health care team members are necessary to ensure a pediatric approach that combines physical, emotional, social, and spiritual issues?

1. Social worker, chaplain, nurses, nursing assistants, child life specialist, and physicians

A child who was hospitalized for sickle cell crisis is being discharged. Which client outcome demonstrates effective teaching regarding prevention of future crises?

1. The client verbalizes the need to stay away from anyone with a known or suspected infection.

An 8-year-old child is suspected of having meningitis. Signs of meningitis include:

3. Kernig's sign.

The nurse is caring for a school-age child with cerebral palsy. The child has difficulty eating using regular utensils and requires a lot of assistance. Which of the following referrals is most appropriate?

3. Occupational therapist

The mother of several young children calls the nurse when her school-age child comes down with chickenpox. The nurse provides instruction on communicability and home management of this disease. Which response by the mother indicates effective teaching?

2. "I should have my child soak in oatmeal baths twice daily."

Parents of a 6-year-old child tell a physician that the child has been having periods of unawareness with short periods of staring. Based on his history, the child is probably having which type of seizure?

3. Typical absence

Individuals of which ethnicity typically don't approve of children and parents sleeping in the same bed?

3. Whites

The nurse is caring for a 10-year-old child with cystic fibrosis. The child's parents tell the nurse that they're having difficulty coping with their child's disease. Which action would be most appropriate for the nurse to take?

2. Consulting with the social worker to help the family find appropriate resources

An 8-year-old child enters a health care facility. During data collection, the nurse discovers that the child is experiencing separation anxiety from his parents. The nurse assists in making a nursing diagnosis of Fear related to separation from familiar environment and family. Which nursing intervention is most likely to help the child cope with fear and separation?

4. Have the parents stay with the child and participate in his care.

A 12-year-old boy with diabetes tests his glucose level before lunch using a glucometer. He receives a reading of 245 mg/dl and notifies the nurse. What should the nurse do next?

2. Tell the client to administer his regular insulin according to his sliding scale., 5. Give the client his lunch tray.

One day after an appendectomy, a 9-year-old client rates his pain at 4 out of 5 on the pain scale but is playing video games and laughing with his friend. Which of the following would the nurse document on the child's chart?

2. The child rates pain at 4 out of 5. Pain medication administered as prescribed.

When talking with 10-year-old children about death, the nurse should incorporate which guidelines?

2. The children will be curious about the physical aspects of death., 3. The children will know that death is inevitable and irreversible., 4. The children will be influenced by the attitudes of the adults in their lives.

Where should the nurse instill an ophthalmic medication in a 6-year-old child?

2. The lower conjunctival sac

In the parents of a chronically ill child, which behavior may indicate feelings of guilt about the child's illness?

4. Overindulgence

An 8-year-old client with Down syndrome is admitted to the hospital with pneumonia. Which nursing intervention is most appropriate for this child?

4. Performing ongoing respiratory assessments to monitor for signs of distress

Which statement should the nurse include when teaching an 11-year-old child about crutch use?

3. "Don't rest by hanging on the crutches at your armpits."

An 8-year-old client has tested positive for West Nile virus infection. The nurse suspects the client has the severe form of the disease when she recognizes which signs and symptoms?

3. Fever, muscle weakness, and change in mental status

Which of the following would be an effective relaxation strategy for a school-age child to use during a painful procedure?

3. Having the child take a deep breath and blow it out until told to stop

According to Erikson's psychosocial theory of development, an 8-year-old child would be in which stage of development?

3. Industry versus inferiority

The parents of a child, age 6, who will begin school in the fall ask the nurse for anticipatory guidance. The nurse should explain that a child of this age:

3. is highly sensitive to criticism.

The parents of a 9-year-old child in the terminal phase of a fatal illness ask the nurse for guidance in discussing death with their child. Which response is appropriate?

4. "At this developmental stage, most children have an adult concept of death and should be encouraged to discuss it."

A school-age child is admitted to the facility with a diagnosis of acute lymphoblastic leukemia (ALL). The nurse recognizes a nursing diagnosis of Risk for infection. What is the most effective way for the nurse to reduce the child's risk of infection?

4. Practicing thorough hand washing

A 10-year-old child is in the hospital for the first time. The nurse has provided support and teaching to help the family and child adjust and to reduce their anxiety related to the child's hospitalization. Which of the following would the nurse view as unexpected?

4. The parents choose to leave to let the child build a relationship with the staff.

When teaching safety measures to 10-year-old children and their parents, the nurse should stress which safety precaution?

2. Wearing a helmet whenever riding a bicycle, 3. Wearing protective sports equipment

The nurse is taking a history from the parents of an 11-year-old girl admitted with Reye's syndrome. Which illness would the nurse expect the parents to report their child having the previous week?

1. Chickenpox

Which points should the nurse keep in mind when administering methylphenidate (Ritalin) to a client with attention-deficit hyperactivity disorder?

1. Extended-release capsules can be sprinkled onto 1 tbs of applesauce before administering., 2. Therapy shouldn't continue indefinitely., 4. Don't crush extended-release tablets., 5. In a child who has responded to therapy, the drug should be discontinued periodically to assess his condition.

A 6-year-old child with a history of varicella and aspirin intake is brought to the emergency department. The nurse suspects Reye's syndrome. Which data collection findings are consistent with this syndrome?

1. Fever, decreased level of consciousness (LOC), and impaired liver function

A school-age child has a fever, joint inflammation, and a nonpruritic rash. Knowing that these are signs of rheumatic fever, the nurse should ask the parents:

2. "Has your child had strep throat recently?"

A 6-year-old female is brought to the pediatrician's office by her mother for evaluation. The child recently started wetting the bed and running a low-grade fever. A urinalysis is positive for bacteria and protein. A diagnosis of a urinary tract infection (UTI) is made and the child is prescribed antibiotics. Which interventions are appropriate?

2. Asses the mother's understanding of UTIs and its causes., 3. Instruct the mother to administer the antibiotic as prescribed, even if the symptoms diminish., 5. Discourage the use of bubble bath.

A school-age child begins to have a seizure while walking to the bathroom. What should the nurse do first?

2. Ease the child to the floor and turn him on his side.

A school-age child with fever and joint pain has just received a diagnosis of rheumatic fever. The child's parents ask the nurse whether anything could have prevented this disorder. Which intervention is most effective in preventing rheumatic fever?

4. Early detection and treatment of streptococcal infections

Which action is most appropriate for the nurse caring for a school-age child and his parents?

4. Encouraging the parents to remain with the child as much as possible while considering the parents' needs

An 10-year-old boy is brought to a rural clinic listless and pale. The parents state that the child had a "bad sore throat" 2 weeks ago and that they had him gargle with salt water. The parents report that they saw improvement but now the child has flulike symptoms. The child is diagnosed with rheumatic fever. Which of the following signs and symptoms are associated with rheumatic fever?

2. Polyarthritis, 3. Chorea, 5. Carditis, 6. Rash

An 8-year-old client is dying of leukemia. Which intervention should be included in the child's nursing care plan?

2. Setting some limits with the child to provide a sense of security and normalcy

A child is sent to the school nurse because, according to his teacher, he's constantly scratching his head. When the nurse checks his hair and scalp, she finds evidence of lice. What does the nurse see?

2. Small white spots that adhere to the hair shaft, close to the scalp

After a car accident, a child, age 10, is treated in the emergency department for a fractured clavicle and evaluated for a possible head injury. She is alert and oriented but is crying and asking for her parents. The nurse formulates a nursing diagnosis of Anxiety related to separation from parents and an unfamiliar environment. What strategies should be implemented to decrease the child's anxiety?

2. Stay with her until her parents arrive. Try distracting her by having her talk about her favorite activities.

A child with asthma is receiving theophylline. The nurse knows that theophylline is administered primarily to:

2. dilate the bronchioles.

The nurse is caring for a terminally ill school-age child. Which resource might be most helpful in caring for this child?

3. Child life specialist

The mother of a child with chickenpox (varicella) asks the nurse when her child may return to school. The nurse responds correctly by telling the mother that the child can return:

3. when all of the lesions are crusted over.

A 10-year-old girl visits the clinic for a check-up before entering school. The child's mother questions the nurse about what to expect of her daughter's growth and development at this stage. Which response is most appropriate?

4. "Friends will be very important to her, and she'll develop an interest in the opposite sex."

During chemotherapy, a boy, age 10, loses his appetite. When teaching the parents about his food intake, the nurse should include which instruction?

4. "Let your child eat any food he wants."

After a series of tests, a 6-year-old client weighing 50 lb (22.7 kg) is diagnosed with complex partial seizures. The physician prescribes phenytoin (Dilantin), 125 mg by mouth twice per day. After the nurse administers phenytoin, where is the drug metabolized?

4. Liver