Kaplan Pediatric Focused Test A

The nurse visits a Family with three small children who live in a three bedroom home built in 1952. The nurse counsels a family how to avoid lead poisoning. The nurse determines the teaching is affective if the parent makes which statement?

I wet mop all of my floors and wash all the windowsills weekly. Homes with lead paint should be cleaned weekly by wet, cleaning all hard surfaces to remove dust that may contain lead; do not dry sweep.

The nurse is instructing nursing students on care for a newborn client, diagnosed with hemophilia A, which statement about the hemophilia trait should be included?

It is an X-linked recessive trait found primarily in males This trait very rarely shows itself and females since the second sex chromosome is also an X females would need to have the trait linked to both chromosomes in order to show the disease. Since the second sex chromosome in males is a Y, males will show the disease, a female who has the trait linked to one X-chromosome and not the other is considered a carrier.

The nurse assesses a school-age client admitted with a diagnosis of acute asthma. Which statement made by the parent causes the nurse the greatest concern?

My child slept on a new pillow last night Asthma is a chronic inflammatory disorder of the airways and allergy is one of the predominant factors, causing asthma. Bedding often triggers, childhood allergies pillow, should be stuffed with either foam rubber or Decon, and either place in a zippered allergen impermeable, cover or washed in hot water weekly .

The nurse evaluates the parents knowledge of the infant clients immunization schedule. Which statement by the parent indicates a correct understanding of the immunization schedule?

My child will receive 4 haemophilus influenza type B (HIB) vaccines as part of the immunization schedule. Children under age 2 years and who develop a HIB related illness still need to be immunized. The vaccine is not recommended for children over the age of five years since children that age can usually fight off the infection this vaccine is given intramuscularly in the anterior lateral thigh.

The nurse is presenting during a parenting class for developmentally disabled children. Which statement made by the parents of a toddler diagnosed with down syndrome, indicates that further teaching is necessary?

My child's development will become more rapid in time A child, with down syndrome has mild to moderate intellectual, disability, and socially, may be 2 to 3 years beyond mental age.

The nurse is caring for several child clients. The nurse recognizes which child client is at greatest risk for ingesting a poison?

A two year-old A two year old child is very curious and likes to explore the toddler does not have the judgment necessary to avoid dangerous substances a toddler is it the highest risk for poisoning.

A parent of an infant born with a club foot ask the nurse how the deformity is usually treated. Which statement by the nurse is appropriate?

A series of casts will be applied and changed every few days to weeks until the foot is positioned correctly, then the foot is braced. Club foot is a deformity that cannot be moved into proper alignment with manipulation. It is treated by a series of cats that allow for gradual stretching of structures. As they grow, casting usually starts when the infant is a week or two old, the infant will wear a series of 5 to 7 casts over a few weeks or months when the foot is in its final correct position the infant is fitted with a brace.

The nurse plans care for an infant client diagnosed with myelomeningocele. Which principle of nursing care is most important to apply one caring for this infant?

Asepsis This is a birth defect of the spine and spinal cord infection around the area may cause meningitis and damage to the brain. Asepsis is extremely important to prevent the spread of infection to the infant central nervous system.

Parents ask why a premature infant client is prescribed vitamin E. The nurse explains the most common reason why it's given is to prevent which condition?

Vitamin E is prescribed to prevent oxidation of red blood cells Fragile red blood cells break apart since the cell walls are weekend in the absence of sufficient vitamin E. Vitamin E supplementation in the premature infant has been used to prevent hemolytic anemia.

A preschool age client is diagnosed with idiopathic hypopituitarism. Which hormone is most commonly prescribed for a preschool client diagnosed with idiopathic hypopituitarism?

Growth hormone The most common hormone affected in children with this defect is the growth hormone. The growth hormone promotes growth of bone and soft tissues affects linear growth and conserves carbohydrate utilization.

A child client is admitted with chronic lead poisoning which symptoms does the nurse expect to see?

Anemia, seizures, and learning disabilities Anorexia, nausea, vomiting access, salvation, lead line on the gums, abdominal pain, muscle cramps, kidney failure, and cephalopathy and pain in the joints are symptoms of chronic lead poisoning. Treatment includes removal of the child from the lead source. If the lead level is very high treatment will include chelation.

The nurse prepares discharge teaching for parents of a toddler diagnosed with non-organic failure to thrive (NFTT). Which suggestion by the nurse is most appropriate to include about mealtimes with the parents?

Develop a structured routine for all activities Children respond better if activities of daily living are structured. An unstructured lifestyle will be reflected in the child's unwillingness to eat. Bathing dressing, playing sleeping and eating should occur in a structured routine.

The nurse understands which food is most likely to cause an allergy in a six month old client?

Eggs Egg and meat proteins are highly allergenic compared with vegetable and grain proteins. Introduce meat and eggs only when a child is close to nine months of age, when a child is less likely to develop an allergy to them.

The nurse talks with parents of a school age child about ensuring adequate nutrition. Which information does the nurse include in the discussion?

Encourage plenty of whole grains, fresh fruits, and vegetables The nurse encourages a diet high in complex carbohydrates and fresh fruits and vegetables, in addition to physical activity.

Which action does the nurse take to minimize separation anxiety experienced by a toddler client?

Encourages familiar object or toy be brought from home Bringing familiar objects and toys from home provides a familiar environment that will help comfort the toddler. If the toddler has a special blanket or a stuffed animal, which provides comfort or consolation, the parent should bring the object to the hospital.

The nurse talks with a group of adolescence, attending a summer camp about nutritional needs. Which statement made by the nurse is most accurate?

Many adolescents have an increase need for nutrients Because of rapid growth and high activity levels, adolescents have an increase need for nearly all nutrients. It is most accurate for the nurse to emphasize a well balanced diet.

The nurse performs a home care visit for a young adult diagnosed with cystic fibrosis. The nurse intervenes if which finding is disscussed?

She takes pancreatic enzymes one hour after eating. Enzymes should be taken at the beginning of a meal, with a snack, or within 30 mins. of eating.

A school-age client is admitted to the hospital with a diagnosis of idiopathic hypopituitarism. Which clinical manifestation is the nurse most likely to observe?

Short stature Pediatric clients with idiopathic hypopituitarism characteristically have short stature and slow growth.

An 18 month old client is admitted to the hospital when the parents leave the child starts to cry loudly after a while, the child stops crying. It becomes quiet and withdrawn. Which statement about the child's behavior is correct?

The child has entered the second stage of separation anxiety. The second stage of separation anxiety is the spare at this stage, crying stops in the child, becomes depressed, apathetic and withdrawn. The nurse should continue to sue the child.

A preschooler client is admitted to the hospital for a bone marrow aspiration. The nurse expects the test to be performed using which site?

The iliac crest The iliac crest is used for children older than two years of age analgesia or anesthesia is used for the procedure.

The nurse prepares to administer the inactivated polio vaccine to a four month old infant. Which assessment finding does the nurse delay, administering the vaccine?

The infant has otitis media with a fever The polio virus vaccine should not be given to an infant with moderate illness with fever

A preschooler client with a diagnosis of upper respiratory infection has been receiving aspirin as a antipyretic. It is most important for the nurse to monitor for which adverse effect?

Vomiting and lethargy No aspirin is approved for use in children age 3 children and teenagers recovering from chickenpox or flu like symptoms should never take aspirin. Young children receiving aspirin as an antipyretic or pain reliever to treat viral infections are at risk for developing Reyes syndrome. Early symptoms of Reyes syndrome are hyperventilation, persistent, vomiting, and lethargy. Later symptoms include loss of consciousness and convulsions.

The nurse considers the developmental stage of a child client before choosing a toy. A push pool toy is appropriate for which age range?

18 to 20 months A child within this age range is able to walk and learns to coordinate walking with pushing or pulling a toy.

A parent of a preschool age client calls the clinic to report that the child has been exposed to chickenpox. The nurse informs the parent that the incubation period for chickenpox is which length of time?

2 to 3 weeks The incubation period for varicella zoster is about 10 to 21 days approximately 2 to 3 weeks chickenpox spread by direct contact, droplet via contaminated objects. A person with chickenpox is contagious beginning 1 to 2 days before rash onset until all the chickenpox lesions have crusted over. Vaccinated people who get chickenpox may develop lesions that do not crust. Those individuals are considered contagious until no new lesions have appeared for 24 hours.

The nurse observes a child client walk up and down steps the nurse notes. The child has a steady gait and can use short sentences. The nurse estimates the child's age to be how many months?

24 months The 24 month old child goes up and downstairs alone runs well with a wide stance, build a tower of 67 blocks and has a vocabulary of about 300 words.

An infant client is able to stand holding onto objects, plays, peekaboo, and is starting to say "mama" and "dada". The nurse identifies these behaviors are characteristic of which age?

9 months. At nine months of age, the infant is able to pull self up and assumes a seated position as well as say words, such as dada, mama and baba.

The nurse instructs the parents of a school-age client about how to collect a 24 hour urine specimen at home using a clean, empty container. Which size container does the nurse recommend that the client use for the collection?

A 48 ounce (1440 ml) collection container. The expected amount of urine output in a 24 hour period for school age child is about 1200 mL. A 48 ounce collection container would be best to hold the expected 40 ounces of urine .

The nurse assesses an adolescent client in the pediatric clinic. Which assessment finding causes the nurse the most concern?

A flat, expressionless gaze The nurse would be concerned about a flat expressionless gays because adolescents are prone to depression and emotional lability. Adolescence is a time when symptoms of schizophrenia can emerge or when the client may become involved in substance-abuse. The nurse should further assess the clients mental and emotional health and psychosocial relationships.

The nurse in the emergency department provides care for a toddler client with a fever. The parents report the toddler has received a regular adult acetaminophen 325 mg every four hours for the past four days. Which medication does the nurse have available for the treatment of acetaminophen overdose?

Acetylcystine This is given as an antidote following a acetaminophen overdose this toddler received more acetaminophen. Then the recommended dose of 10 to 15 mg per kilogram per dose not to exceed five doses in 24 hours. Acetaminophen has been excessive and absorbed into the bloodstream over four days.

A client delivers a healthy 8-lb, 2 oz. newborn. The client mentions to the nurse that the newborn's "soft spot" bulges out when the newborn cries. Which statement made by the nurse is most appropriate?

Anterior fontanel will normally bulge out when the newborn coughs/cries. Fontanels should feel flat, firm, and well-demarcated when the newborn is at rest. Coughing/crying may cause the anterior fontanel to bulge.

When assessing the nine month old client, the nurse expects which reflex to be present?

Babinski reflex Balinski reflex disappears at 12 months to two years; stroking the outer sole of the foot upward from the heel across the ball of the foot, causes the big toe to dorsiflex and the toes to hyperextend.

Which artery does the nurse use to assess the pulse rate of an infant client during cardiopulmonary resuscitation?

Brachial artery This artery located near the axilla in the infant. Gently palpating just under the axilla can provide the rescuer with an accurate assessment of the circulation in a cardiac arrest.

The nurse in a pediatric clinic is completing health record audits and noticed that a preschool client is on a delayed immunization schedule per the parents request. The client is five years old and it has been three weeks since the initial administration of the measles, mumps, and rubella (MMR) vaccine, which is the best response by the nurse?

Call the parents and explained that the child will need to be seen in the next week to receive the second dose of the MMR vaccine. According to the CDC, the MMR vaccine requires a 4 week time period between the first and second doses.

An adolescent client diagnosed with attention deficit hyperactive disorder (ADHD) asked why methylphenidate was prescribed. The nurse educates the client and parents that methylphenidate is prescribed for which desired effect?

Central nervous system stimulant Central nervous system stimulants improve concentration and adaptive behavior. Pharmacological therapy is useful in the management of attention deficit hyperactive disorder.

A parent of a preschool age client diagnosed with frequent acute otitis media ask the nurse why this keeps happening to the child. The nurses explanation is based on which correct information?

Children have shorter Eustachian tubes than adults The tubes of children are shorter, wider and straighter than those of adults the organism causing the infection travels from the fox via the tube into the middle ear.

The nurse knows DTaP vaccine protects against which diseases?

Diphtheria, tetanus, pertussis

Soon to be new parents are taking a class at the hospital. The nurse is educating on prevention of dysfunctional. Parent child interactions, which is the most important action to include?

Discuss with the parents, any problems or fears about child rearing. It is important that parents become active listeners and become actively involved in their child's well-being.

Which action is most important for the nurse to take after surgical repair of a congenital heart defect is performed on an infant client?

Elevate the infants, head to reduce respiratory effort Following surgery, the nurse should monitor the infants, respiratory effort. Elevating the head of the bed will facilitate respiratory effort and optimize lung volume. The nurse must monitor, vital signs and oxygen saturation carefully.

The nurse assesses a young child who has socialization skills characterized by associative, play eagerness to place a parent, and a strong identification with the parent. At which age are these behaviors most consistent with normal developmental activities?

Five years old A five year old child participates in associative play, has eagerness to plays a parent and identifies with the parent. Growth and development of a preschooler includes: increasing musculoskeletal strength and coordination, dresses without help, has a 2100 word vocabulary and imitates adult patterns and roles. Appropriate toys for this age are playground materials, housekeeping, toys, coloring books. Safety instruction includes use of a bicycle helmet, safety restraints in the car and teach to look both ways before crossing a street. The Ericksons stage is initiative versus guilt.

During a well child, check up for a six month old client. The parent reports the client received the first DTaP at two months of age and has received no other vaccinations. Which action by the nurse is most appropriate?

Give second DTaP. By the age of six months, the child should be ready for the third immunization when the schedule has been interrupted it is appropriate to simply continue with the schedule.

The nurse counsels parents of a school-age client diagnosed with attention, deficit, hyperactivity disorder (ADHD). Which statement by the nurse is most appropriate?

Hug and praise your child after a task is correctly performed. The school aged child diagnosed with ADHD, is often a underachiever in school and may display impulsive, aggressive and hostile behavior. The child responds to positive reinforcement. The parent should recognize and praised desired behavior.

A toddler diagnosed with cystic fibrosis is admitted to the hospital with a respiratory infection. The nurse expect to see which characteristic feature of cystic fibrosis?

Increase viscosity of mucus Cystic fibrosis is an autosomal recessive trait with generalized involvement of the exocrine glands, resulting in altered viscosity of mucus secreting glands, mucus becomes thick and tenacious.

An adolescent client is evaluated for scoliosis. The client asked the nurse what is scoliosis. Which statement by the nurse best describes scoliosis?

It is a lateral curvature of a portion of the spine Scoliosis is a lateral curvature of a portion of the spine. It is diagnosed by having a client bend at the waist to assess the spine. If the client wears a brace, good skin care under pressure areas is necessary and the brace is 23 hours per day.

The office nurse receives a phone call from a parent of an infant client who received the DTaP vaccine three days ago. The nurse is most concerned if the parent makes which statement?

My baby is continuously crying High pitched, continuous crying is a serious adverse effect of the DTaP vaccine. Other serious adverse effects include convulsions, high fever, and loss of consciousness.

The nurse cares for a toddler, client with nausea, vomiting, and diarrhea. Which intervention is best for the nurse to perform to maintain an adequate fluid intake?

Offer oral rehydration solutions (ORS) to rehydrate. If the child is vomiting, the nurse gives a small amount of oral rehydration solution at frequent intervals. Oral rehydration solution contain sodium potassium chloride, citrate, and glucose, which are necessary for homeostasis.

Parents brought a preschool age client to the emergency department with acute epiglottitis. During the assessment, which parental statement is most significant?

Our child started drooling a few hours ago Drooling of saliva indicates the child is losing the ability to swallow, and the airway is compromised.

The newborn nursery nurse provides care for a client diagnosed with hip dysplasia. The nurse anticipated which treatment to be prescribed for the client?

Pavlik harness Pavlik harness is used to treat hip dysplasia in newborn clients to stabilize and keep the hip joint in proper alignment.

The nurse provides care for an infant client diagnosed with a cyanotic congenital heart defect. The nurse understands that chronic hypoxia from this disorder can result in which findings?

Polycythemia In chronic hypoxia, the body tries to compensate by producing more red blood cells to carry the limited amount of oxygen available to the tissues.

An infant client is diagnosed with a cyanotic congenital heart defect (CCHD). The nurse knows a cyanotic congenital heart defect is associated with which symptom as reported by the parent?

Poor feeding with no or very poor weight gain. Reports of poor feeding, difficulty feeding, and poor weight gain or no weight gain are symptoms that occur in infants with congenial heart defects.

A parent brings a newborn to the healthcare providers office. The newborn is vomiting, has a domino distention, and is diagnosed with pyloric stenosis. Which characteristic of the newborns emesis does the nurse expect?

Projectile and forceful An infant with pyloric stenosis will present with projectile, vomiting and abdominal distention. Other symptoms include weight loss, constipation, dehydration, and visible peristaltic waves.

The nurse is teaching a parenting class which action does. The nurse include as the most important to promote mobility in infants?

Provide safe toys and play area Be aware of safety concerns for the infant, including aspirating, foreign objects poisoning, burns and falls from infant seats, high chairs, walkers and swings.

During a visit, the home care nurse observes a preschool age. Client sitting near a fireplace. The clients clothing catches fire and covers the client in flames. Which action does the nurse take first?

Push the client to the ground and make the client roll. The nurse will smother the flames And not let the child run because it will fan the flames a preschool age child can be taught to stop drop and roll in the event of a fire. Another person can pull the child to the ground and roll with the child until the flames are smothered.

The nurse teaches about early signs and symptoms of rubeola that may appear before the notable rash. Which are included in the instructions?

Runny nose, sneezing, and coughing. The client will likely exhibit respiratory symptoms, such as runny nose, sneezing, and coughing before the rush appears rubeola is a communicable during the prodromal phase. The client should be isolated until the fifth day after the rash appears, and should maintain bed rest during the first 3 to 4 days.

The nurse understands that, according to Erikson, adolescence is regarded as a period associated with establishment of which developmental goal?

Sense of identity and intimacy According to Erikson, there's an overlap of late adolescence and early adulthood in which the individual tries to develop intimate relationships.

The clinic nurse teaches a parent how to care for a child with impetigo. Which information does the nurse include in the teaching plan?

Soften and remove crust and debris. Care of the affected skin is important to prevent worsening wounds The parent should remove crust in debris by softening then with solution compresses, then apply topical bactericidal ointment to the affected areas.

A parent of an infant client diagnosed with croup. Ask the nurse what to do for the child at home to alleviate mild symptoms. Which suggestion by the nurse is most appropriate?

Stand with your child in front of an open freezer until symptoms improve. Cool air will constrict edematous blood vessels during an episode of Largeotracheobronchitis.

A toddler client is brought to the emergency department with a history of vomiting and diarrhea for the past three days. Which finding is the nurse most likely to see?

Sunken eyes A toddler who has had vomiting and diarrhea for three days will exhibit signs of fluid volume deficit, such as sunken eyes.

Which immunizations does the nurse administer to an adolescent client who has never been immunized?

Tdap, MMR and polio. The tetanus and diphtheria toxoid and a cellular pertussis (TDAP) vaccine is given to people after the age of six years. Nursing responsibilities include teaching the client and parent to observe for severe reactions of extremely high temperature and redness at the injection site a fever may occur within 24 to 48 hours. The vaccine is given intramuscularly (IM). IPV (inactivated polio) vaccine is given at ages two months, four months, 18 months, and 4 to 6 years and reactions are very rare.

A parent of an infant client newly diagnosed with non-organic failure to thrive (NFTT) appears sudden and expresses feelings of inadequacy and resentment toward the infant. Which approach by the nurse is most appropriate?

Teach effective parenting skills, and give examples The nurse should teach the parent effective parenting skills to increase the parents knowledge of child care and growth and development. The nurse should serve as a supportive role model for the parent.

The nurse performs assessments on infants at the health department. The nurse identifies which finding as an early indication of cerebral palsy (CP)?

The 4-month-old infant lacks head control. The earliest indicator of CP is delayed gross motor development. Signs include stiff/rigid arms/legs, arching back, and floppy/limp body posture.

Which guideline is appropriate for the nurse to give a parent concerning the normal developmental of a young school-age child?

The child's periods of shyness should be tolerated A young school age child may become shy at times because of experiencing a conflict regarding independence from the parent. In order to allow the child to become independent, parent should allow these episodes of shyness.

A toddler is newly diagnosed with a seizure disorder. The nurse intervenes if which finding is observed during a visit in the family's home?

The child's temperature is taken using a oral electronic thermometer Seizures can occur without warning. It is dangerous to have a thermometer in the mouth because the child may start seizing.

A toddler client diagnosed with autism is admitted to the pediatric unit with a tracheostomy after swallowing a small toy. The unlicensed assistive personnel reports to the nurse that the child does not respond to questions, which response by the nurse is best?

The inability to respond to questions is a characteristic of autism This response office staff member an explanation about the lack of response. While in the hospital parents should be encouraged to stay with the child. The plan of care should include decreased stimulation as physical contact may upset a child with autism and the nurse should establish trust.

A four month old full-term infant is seen in the well child clinic. The nurse is most concerned when which finding is observed?

The infants head lags when pulled from a lying to sitting position. The nurse anticipates almost no head lag at four months of age this, finding in a full-time infant, demonstrates poor neurological behavior and suggest complications in motor development.

The nurse supervisor is a Family caring for a toddler diagnosed with cerebral palsy. The nurse intervenes in which finding is observed?

The older sibling place is a soft toy in the toddler's hands This action requires a nurse to intervene, because it is important to offer the toddler with cerebral palsy incentive to move. Placing a toy out of the immediate reach of the toddler is one way to provide incentive.

The health department, nurse, assesses, preschool age children. Which is the most commonly used tool for assessment of physical development?

The weight and height compared to standard tables Growth charts are the basic tool of assessment of physical growth of a school age child.

The nurse prepares to administer an immunization for a toddler client who begins to cry. Which statement by the nurse is most appropriate?

I know you are frightened. It will be over with soon. This is the best response by the nurse the statement does not minimize the child reaction. The statement response to the child. In an honest and reassuring tone. The statement also confirms that experience will be over soon.

The nurse instructs a parent about the appropriate way to instill eardrops in the right ear of a toddler client. The nurse determines teaching is effective if the parent makes which statement?

I should pull my child's ear down and back. In children younger than three years of age, the nurse which straight in the ear canal by pulling the pinna down and straight back. In children, older than three years of age the nurse should pull the pin up and back.

The nurse is caring for an eight month old client. Which statement made by the clients parent indicates a possible delay in growth and development?

My child has almost doubled the birth weight An infants birth weight should double by 5 to 6 months of age. Since the client is eight months old, the fact that the client has only now almost double the birthweight may indicate a possible delay in growth and development.

At birth, it is noted an infant client has widely spread nipples and Adema of the hands and feet a chromosomal study reveals 45 chromosomes. The nurse identifies the signs and symptoms are from which condition?

Turner syndrome Turner syndrome is a genetic abnormality, resulting from a female, having only one X-chromosome. Clinical manifestations include widely spaced nipples, edema of the extremities, short stature, webbed neck, low posterior, headline, shield shaped chest, sexual infantilism, and amenorrhea.

The nurse instructs the parents of a child. Client diagnosed with cystic fibrosis about needed dietary modifications. The nurse knows teaching is affected when the parents make which statement?

We will make sure we increase calories our child receives Are children with cystic fibrosis tend to need additional calories and protein for growth because they have increase metabolic needs due to a high incidence of infection. They require additional protein and calories in the diet.