NCLEX REVIEW

A 3-month-old infant is seen in the clinic with the following symptoms: irritability, crying, refusal to nurse for more than 2 to 3 minutes, rhinitis, and a rectal temperature of 101.8° F (38.8° C). The labor, delivery, and postpartum history for this term infant is unremarkable. The nurse anticipates a diagnosis of: a. Acute otitis media (AOM) b. Otitis media with effusion (OME) c. Otitis externa d. Respiratory syncytial virus (RSV)

a

It is important to consider the child's developmental understanding of death when working with that child. Which option is the preschool child's developmental stage? a. Children of this age believe their thoughts are sufficient to cause death. b. They are still very much influenced by remnants of magical thinking and are subject to feelings of guilt and shame. c. They have a deeper understanding of death in a concrete sense. d. They can perceive events only in terms of their own frame of reference—living.

a

Almost one half of all cases of pelvic inflammatory disease (PID) in the United States are caused by: a. Neisseria gonorrhoeae b. Chlamydia trachomatis c. Treponema pallidum d. Human papillomavirus (HPV)

b

A child is admitted to the pediatric unit. The mother reports that the doctor says her son is anemic. What laboratory findings/manifestations would the nurse expect to see to confirm iron deficiency anemia? a. Cyanosis, due to inadequate oxygen saturation of existing hemoglobin b. A decreased reticulocyte count c. A total iron-binding capacity (TIBC) that is elevated above the normal range d. Decreased blood pressure changes, which are an early sign because of the compensatory mechanisms

c

What is the overriding goal of atraumatic care? a. Prevent or minimize the child's separation from the family b. Do no harm c. Promote a sense of control d. Prevent or minimize bodily injury and pain

b

When assessing a child's injury in the emergency department, a nurse suspects physical abuse. Based on this suspicion, the nurse's primary legal responsibility is: a. Assist the family in identifying resources for support. b. Report the case in which the abuse is suspected to the local authorities. c. Document the child's physical assessment findings accurately and thoroughly. d. Refer the family to the hospital support group.

b

What does the Apgar scoring system assess? Select all that apply. a. Respiratory effort b. Heart rate c. Core temperature d. Reflex irritability e. Muscle tone f. Color

a, b, d, e, f

A 10-year-old child with a peanut allergy would be expected to have which of these as an early manifestation of his allergy? Select all that apply. a. Wheezing b. Nausea c. Headache d. Trouble breathing e. Urticaria

a, d, e

A 15-year-old female diagnosed previously with anorexia nervosa (AN) is admitted to the emergency department. Her mother states that her daughter has not voided in 24 hours and has been lethargic for the last 12 hours. The patient appears cachectic and pale, and her weight is recorded as 78 pounds. She is minimally responsive to painful stimulation. A number of diagnostic tests are obtained. Which one of these represents the most immediate threat to her life requiring intervention? a. Serum sodium of 149 mEq b. Serum potassium of 2.6 mEq c. Hemoglobin of 6.8 mg d. Arterial pH of 7.30

b

A 16-month-old has a history of diarrhea for 3 days with poor oral intake. He received intravenous (IV) fluids, has tolerated some oral fluids in the emergency department (ED), and is being discharged home. Instructions for diet for this child should include: a. BRAT (bananas, rice, applesauce, and toast) diet for 24 hours, then a soft diet as tolerated b. Chicken or beef broth for 24 hours, then resume a soft diet c. Offer a regular diet as child's appetite warrants d. Keep on clear liquids and toast for 24 hours

c

A formerly preterm infant who had surgery for necrotizing enterocolitis is now 6 months old and has short bowel syndrome. He is unable to absorb most nutrients taken by mouth and is totally dependent on parenteral nutrition (PN), which he receives via a Broviac catheter. The clinic nurse following this infant is aware that this infant should be closely observed for the development of: a. Gastroesophageal reflux (GER) b. Chronic diarrhea c. Cholestasis d. Failure to thrive

c

A newborn whose mother is positive for Chlamydia trachomatis should be optimally treated with which of these to prevent ophthalmia? a. Silver nitrate solution (1%) b. Tetracycline ophthalmic ointment (1%) c. Oral erythromycin d. Erythromycin ophthalmic solution (0.5%)

c

As the nurse assigned to a child diagnosed with bacterial meningitis, you know that: a. The child will not need to be placed in isolation because antibiotics have been started. b. Enteric precautions will remain in place for up to 48 hours. c. Respiratory isolation will remain in place for 24 hours after antibiotics are started. d. Due to headache, the child will want the head of the bed elevated with two pillows.

c

Which is the most accurate genetic explanation for a family with hemophilia? a. It is a Y-linked dominant disorder. b. It is equally distributed among males and females. c. It is an X-linked recessive disorder. d. It is an autosomal recessive disorder.

c

1. Vitamin A may be administered in significant amounts to children with this childhood communicable illness to decrease morbidity and mortality: a. Pertussis b. Varicella c. Rubella d. Measles

d

A child is brought to the emergency department by his parents after noted to be "acting funny" a few hours ago while he was being cared for by his grandmother. When she went to take her evening medication, the grandmother noted that her pill container had been opened and some pills were missing. The parents state that the grandmother has a heart condition. Anticipating the emergency care this child will receive, you know: a. The majority of medications have a specific antidote. b. In this case, gastric lavage may be used. c. Activated charcoal will most likely be used, and it can be mixed with another drink (milk or juice) to make it more palatable. d. The main concerns are for vital sign assessment, assessment of mental status, and giving cardiac and respiratory support as needed.

d

The newest nurse on the pediatric unit is concerned about maintaining a professional distance in her relationship with a patient and the patient's family. Which comment indicates that she needs more mentoring regarding her patient-nurse relationship? a. "I realize that caring for the child means I can visit them on my days off if they ask me." b. "When the mother asks if I will care for her daughter every day, I explain that the assignments change based on the needs of the unit." c. "When the mother asks me questions about my family, I answer politely, but I offer only pertinent information." d. "I engage in multidisciplinary rounds and listen to the family's concerns."

a

When administering a medication to a child, the nurse knows that: a. The most accurate means for measuring small amounts of medication is the plastic disposable calibrated oral syringe. b. A teaspoon is often the unit of measurement for pediatric medication and is especially helpful when working with families. c. Using a dropper is also acceptable, remembering that thick fluids are easier to measure than viscous fluids. d. For more exact measuring, emptying dropper contents into a medicine cup can be helpful.

a

When assessing BP in a child: a. Knowledge of normal mean is important: newborn, 65/41; 1 month to 2 years old, 95/58; and 2 to 5 years old, 101/57. b. Cuff size is the most important variable and should be measured using limb length. c. The child is considered normotensive if the BP is below the 95th percentile. d. Check upper- and lower-extremity BP to look for abnormalities, such as aortic stenosis, which causes lower-extremity BP to be higher than upper-extremity BP.

a

When caring for a child with acute renal failure, which nursing measure requires immediate attention? a. Serum potassium concentrations in excess of 7 mEq/L b. Sodium level of 135 c. Transfusion for hemoglobin of 8 d. Mannitol and furosemide for a urine output of 2 ml/kg/hr

a

You are working with a new graduate and explaining prevention of infection for a child with acute lymphocytic leukemia. Which statement by this new nurse indicates understanding? a. "Prophylaxis against Pneumocystis pneumonia is routinely given to most children during treatment for cancer." b. "If blood is drawn, firm pressure should be applied to the area for a minimum of 10 minutes." c. "Having a roommate with a routine surgery would be acceptable for this child." d. "The child should be vaccinated completely to avoid childhood diseases."

a

These general approaches can be helpful when performing a physical exam. Select all that apply. a. With toddlers, restraint may be necessary, and requesting a parent's assistance is appropriate. b. When examining a preschooler, giving a choice of which parts to examine may be helpful in gaining the child's cooperation. c. With a school-age child, it is always best to have the parents present when examining. d. Giving explanations about body systems can make adolescents nervous due to their egocentricities. e. An infant physical exam is done head to toe, similarly to the adult.

a, b

You are working with the family of a 4-year-old patient and have concerns about possible exposure to lead poisoning. Which information will determine if follow-up is needed? Select all that apply. a. The child goes daily to the older home of a babysitter. b. One of the child's playmates in the neighborhood has lead poisoning. c. Although living in a newer neighborhood, one of the child's playmates' homes is being renovated. d. The child is out of the danger age range for screening (1 to 2 years old), so screening is not needed. e. Past BLL was 12, so no follow-up is needed at this time.

a, b

During hospitalization there may be a reason to use restraints. Protocol for using restraints may include which of the following? Select all that apply. a. One finger breadth should be left between the skin and the device, and knots should be tied to allow for quick release. b. Elbow restraints fashioned from a variety of materials function well when a child's hands must be kept from his face (for example, after cleft lip or palate surgery). c. A papoose board with straps or a mummy wrap effectively controls the child's movements when an infant or small child requires short-term restraint for examination or treatment that involves the head and neck. d. Before initiating a behavioral restraint, the nurse should assess the patient's mental, behavioral, and physical status to determine the cause for the child's potentially harmful behavior. e. Unless state law is more restrictive, behavioral restraints for children must be reordered every 2 hours for children younger than 9 years old and every 3 hours for children 9 to 17 years old.

a, b, c, d

A mother of a child born with Down syndrome is overwhelmed with the future and asks many questions. Which of 551the following facts should the nurse be aware of? Select all that apply. a. Eighty percent of infants with Down syndrome are born to women younger than 35 years old because younger women have higher fertility rates. b. When feeding infants and young children, use a small, straight-handled spoon to push food to the side and back of the mouth. Feeding difficulties occur due to a protruding tongue and hypotonia. c. Parents generally believe the experience of having this special child makes them stronger and more accepting of others. d. Although some placement in the regular classroom has occurred more recently, this has been found to be detrimental to the child with Down syndrome due to lack of one-on-one teaching. e. The child's lack of clinging or molding is a physical characteristic, not a sign of detachment or rejection. f. Development may be 3 to 4 years beyond the mental age, especially during early childhood.

a, b, c, e

Which of the following should the nurse discuss with a 14-year-old adolescent female taking isotretinoin (Accutane) for the treatment of acne? Select all that apply. a. Birth control methods b. Feelings of depression c. Sudden thoughts about hurting oneself d. Blurred vision e. Mood swings

a, b, c, e

A child with periorbital edema, decreased urine output, pallor, and fatigue is admitted to the pediatric unit. The child is being examined for acute glomerular nephritis. Which of the following nursing measures should be considered? Select all that apply. a. On examination, there is usually a mild to moderate elevation in blood pressure compared with normal values for age, although severe hypertension may be present. b. Urinalysis during the acute phase characteristically shows hematuria, proteinuria, and increased specific gravity, c. The primary objective is to reduce the excretion of urinary protein and maintain protein-free urine. d. Assessment of the child's appearance for signs of cerebral complications is an important nursing function because the severity of the acute phase is variable and unpredictable. e. Because these children are particularly vulnerable to upper respiratory tract infection, protect them from contact with infected roommates, family, or visitors.

a, b, d

A family you are caring for on the pediatric unit asks you about nutrition for their baby. What facts will you want to include in this nutritional information? Select all that apply. a. Breastfeeding provides micronutrients and immunological properties. b. Eating preferences and attitudes related to food are established by family influences and culture. c. Most children establish lifelong eating habits by 18 months old. d. During adolescence, parental influence diminishes and adolescents make food choices related to peer acceptability and sociability. e. Due to the stress of returning to work, most mothers use this as a time to stop breastfeeding.

a, b, d

A mother comments to a nurse working on the pediatric unit, "My second child just does not seem to be acting like or responding the same way as my first child." Nursing interventions to respond to this inquiry should include which of the following? Select all that apply. a. Assessment for dysmorphic syndromes (e.g., multiple congenital anomalies, microcephaly) b. Inquiring about temperament: irritability or lethargy c. Explaining that all children are different and that it can be detrimental to compare them d. Noting language development appropriate for the child's age e. Meeting the siblings to assess similarities that may be familial rather than problematic

a, b, d

Because many children with celiac disease require parenteral nutrition therapy, they are at risk for which of the following nutritional deficiencies when the PN is discontinued? Select all that apply. a. Iron deficiency anemia b. Folic acid deficiency c. Zinc deficiency d. Vitamin A, D, E, and K deficiency e. Vitamin B12 deficiency

a, b, d

You are working with a family that brought their child into the pediatric clinic. The mother describes what may be a type of seizure. What subjective data will help you determine the type? Select all that apply. a. The presence or absence of an aura b. If the child appeared disoriented after the seizure c. Presence of vomiting after the seizure d. The duration of the seizure e. If the seizure was related to certain foods or occurred after a certain activity

a, b, d

Identify the anatomic changes that occur shortly after birth that affect the newborn's adaptation to extrauterine existence. Select all that apply. a. Closure of the foramen ovale b. Closure of the ductus arteriosus c. Increase in pulmonary vascular resistance d. Closure of the ductus venosus e. Decrease in pulmonary vascular resistance

a, b, d, e

Which of the following factors should a nurse consider when managing the pain of a terminally ill child? Select all that apply. a. Pain medications are given on an as-needed schedule, and extra doses for breakthrough pain are available to maintain comfort. b. Opioid drugs, such as morphine, are given for severe pain, and the dosage is increased as necessary to maintain optimum pain relief. c. Addiction is a factor in managing terminal pain in a child, and the nurse plays an important role in educating parents that their child may become addicted. d. Nurses often express concern that administering dosages of opioids that exceed those with which they are familiar will hasten the child's death; (principle of double effect). e. In addition to pain medication, techniques such as music therapy, distraction, and guided imagery should be combined with medications to provide the child and family strategies to control pain.

a, b, d, e

A 5-year-old is recovering from a tonsillectomy and adenoidectomy and is being discharged home with his mother. Home care instructions should include which of the following? Select all that apply. a. Observe the child for continuous swallowing. b. Encourage the child to take sips of cool, clear liquids. 686 c. Administer codeine elixir as necessary for throat pain. d. Observe the child for restlessness or difficulty breathing. e. Encourage the child to cough every 4 to 5 hours to prevent pneumonia. f. Administer an analgesic such as acetaminophen for pain.

a, b, d, f

You tell the parent of a 4-year-old patient being admitted that you need to ask some questions. She asks, "Why do you have to ask so many questions?" Which explanations should you offer? Select all that apply. a. "It is something we are required to do for every child who is hospitalized." b. "By learning about your child's routines, we can try to minimize some of the changes he will be going through." c. "Knowing more about your child can help predict how the hospital stay will go and will also help us choose a good roommate for him when more children arrive at the hospital." d. "Gaining more information about your child, such as current medications she is taking, will help us provide the best care." e. "This will give you an opportunity to ask questions as well."

a, b, e

When discharging the pediatric patient from the outpatient setting, the nurse knows which of the following responses indicate a need for more teaching? Select all that apply. a. "The physician said my son can have clear liquids when we return home, which would include Jell-O, pudding, and apple juice." b. "The other nurse explained that I can use other things to help with the pain, such as distraction (reading a book, music, or a movie), after the pain medication is given." c. "I can get my child's prescription tomorrow, so I can go to my regular pharmacy where they can explain the medication to me." d. "I am waiting for my husband to come so he can drive us, and I can watch my son in the car on the way home." e. "I understand that I will be contacted tomorrow for follow-up on my child but that I should not hesitate to call if I have any concerns before then."

a, c

Play is children's work, even in the hospital. Which of the following are functions of play? Select all that apply. a. Provides diversion and brings about relaxation b. Keeps the child occupied and directs concerns away from himself or herself c. Helps the child feel more secure in a strange environment d. Lessens the stress of separation and the feeling of homesickness e. Provides a means for release of tension and expression of feelings f. Allows the parents to have a break from the unit for a respite period

a, c, d, e

A 2-month-old formerly healthy infant born at term is seen in the urgent care clinic with intercostal retractions, respiratory rate of 62, heart rate of 128, refusal to breastfeed, abundant nasal secretions, and a pulse oximeter reading of 88% in room air. The diagnosis of respiratory syncytial virus (RSV) is made, and a bronchodilator is administered. The infant's oxygen saturation (SaO2) remains 95% in room air, and the respiratory rate is 54, with intercostal retractions; heart rate is 120 bpm. After 2 hours of observation and an intravenous (IV) bolus of fluids, the infant is being discharged home. The nurse provides which of the following home care instructions for this infant? Select all that apply. a. Continue breastfeeding infant. b. Discontinue breastfeeding and administer Pedialyte for 24 hours. c. Observe infant for labored breathing or apnea (cessation of breathing). d. Instill normal saline drops in both nares and suction thoroughly before feeding and before placing to sleep. e. Place infant to sleep on his side with the head of bed slightly elevated to facilitate breathing. f. Keep the infant out of daycare or nursery.

a, c, d, f

When interacting with a parent at her child's well visit, which statement by the mother would be an indication for a speech referral? Select all that apply. a. Failure to speak any meaningful words spontaneously in a 2-year-old child b. Using different words or nicknames for certain people c. Failure to use sentences of three or more words in a 3-year-old d. Stuttering or any other type of dysfluency e. Omission of word endings (e.g., plurals, tenses of verbs) in a 3-year-old f. Frequent omission of final consonants in a 3-year-old

a, c, d, f

The mother of a 4-year-old health clinic patient asks the nurse about night terrors. Which statement by the mother reveals a need for further teaching? Select all that apply. a. He will grow out of this stage when he is a little older. b. Getting into a specific routine is helpful and can be calming to my son. c. Watching TV with an adult is helpful so that he understands what is real. d. I can help my child with sleep by giving him his favorite stuffed animal or using a night-light. e. Our family often sleeps together, and this seems to help.

a, c, e

The nurse is caring for a 4-year-old girl with a history of frequent urinary tract infections (UTIs). What should the nurse be aware of before obtaining a urine sample? Select all that apply. a. To obtain a clean-catch urine specimen, have the child sit on the toilet facing backward toward the tank. b. Because children who have a UTI will have painful urination, have the child drink a large amount of fluid before obtaining the sample. c. The specimen must be fresh—less than 1 hour after voiding with storage at room temperature or less than 4 hours after voiding with refrigeration. d. If a urinalysis obtained by a bag specimen is negative, a specimen still needs to be obtained by catheterization or suprapubic aspiration. e. The key to distinguishing a true UTI from asymptomatic bacteriuria is the presence of pyuria. f. Because the child is febrile, the nurse should immediately start an antimicrobial and then obtain a urine culture.

a, c, e

When a child with a visual impairment is hospitalized, the nurse should ensure which of the following interventions are carried out to decrease stress for the child during the hospitalization? Select all that apply. a. Because the child cannot see what may be taking place, the nurse needs to reassure the child and family throughout every phase of treatment. b. The nurse will make sure that the parents are comfortable with the placement of objects in the room. c. Whenever possible, the same nurse should care for the child to ensure consistency in the approach. d. To help the child feel safe, the nurses should take over most of the routine care of the child, unless the parent is present. e. Each health care provider should identify himself or herself as soon as entering the child's room.

a, c, e

When giving discharge instructions to a parent post hypospadias repair, the nurse recognizes a need for more teaching when the mother says which of the following? Select all that apply. a. "I know that I should never clamp off the catheter." b. "My child can take a tub bath when we arrive home because it will soothe the area." c. "An antibacterial ointment may be applied to the penis daily for infection control." d. "Fluids should be monitored and rationed to prevent fluid overload." e. "My child should avoid straddle toys, sandboxes, swimming, and rough activities until allowed by the surgeon."

a, c, e

Children and adolescents should be prepared for procedures according to their level of development and understanding. Which interventions by the nurse would be helpful? Select all that apply. a. Explain procedure in relation to what child will see, hear, taste, smell, and feel. b. Although older children may associate objects, places, or persons with prior painful experiences, infants will not have a memory of past experiences. c. For school-age children, preparation can take several days in advance of the procedure to allow for processing of information. d. Provide privacy; describe how the body will be covered and what will be exposed. e. Allowing adolescents to talk with other adolescents who have had the same procedure may increase their level of anxiety and is not recommended.

a, d

The parents of a child with Hodgkin disease ask how the physician will know what type of cancer their child has. Which of the following definitive signs and symptoms should the nurse describe? Select all that apply. a. The most common finding is enlarged, firm, nontender, movable nodes in the supraclavicular or cervical area. b. Tests include complete blood count, prothrombin time and glucose-6-phosphate dehydrogenase (G6PD), erythropoietin, and sedimentation rate. c. Generally a bone marrow biopsy is done to look for the presence of blast cells. d. The presence of Sternberg-Reed cells is considered diagnostic of Hodgkin disease. e. The presence of a white reflection as opposed to the normal red pupillary reflex in the pupil of a child's eye is a classic sign.

a, d

growth measurement is a key element in children of their health status. One measurement for height is linear growth measurement. What should the nurse do to perfect this technique? Select all that apply. a. Understand the difference in measurement for children who can stand alone and for those who must lie recumbent. b. Use a length board and footboard or a stadiometer, which is the best technique, or use a tape measure. c. Two measurers are usually required for a recumbent child, although one measurer may be sufficient for a cooperative child. d. Reposition the child and repeat the procedure. Measure at least twice (ideally three times). Average the measurements for the final value. e. Demonstrate competency when measuring the growth of infants, children, and adolescents. Refresher sessions should be taken when a lack of standardization occurs.

a, d, e

A 5-month-old infant is seen in the well-child clinic for a complaint of vomiting and failure to grow. His birth weight was 7 pounds, and he now weighs 8 pounds, 10 ounces. The infant's mother reports that he is taking 4 to 7 ounces of formula every 4 to 5 hours, but he "spits up a lot after eating and then is hungry again." The child is noted to be alert but appears malnourished. The mother reports his stools are 736brown in color, and he has one to two bowel movements every day. Based on these findings, the nurse anticipates the infant has: a. Meckel diverticulum b. Hypertrophic pyloric stenosis (HPS) c. Intussusception d. Hirschsprung disease

b

A father calls the pediatrician's office concerned about his 5-year-old type 1 diabetic child who has been ill. He reports that upon checking the child's urine, it was positive for ketones. What is the nurse's best response to this father? a. "Come to the office immediately." b. "Encourage the child to drink calorie-free liquids." c. "Hold the next dose of insulin." d. "Administer an extra dose of insulin now."

b

A healthy infant is born to a mother with known high-risk behaviors whose HIV status is undetermined. The mother states that she wishes to breastfeed her infant. The nurse's response to the mother's request should be based on which of the following information? a. HIV is rarely transmitted to the newborn through maternal milk. b. Breastfeeding should be withheld until HIV status (maternal) is determined. c. Breastfeeding should be avoided completely in mothers with high-risk behaviors. d. In such infants, antiretroviral medication should be started within 12 hours of birth.

b

In the newly born infant, thermogenesis is achieved by: a. Shivering b. Brown fat metabolism c. Overhead warming unit d. Skin-to-skin contact with mother

b

Joanna, a 19-year-old pregnant female, is at the clinic for her first prenatal care visit. She is in her first trimester. Joanna has been recently diagnosed with HIV and is concerned about the health of her unborn fetus. The nurse counsels Joanna that treatments are available to prevent or minimize perinatal transmission of HIV. The current evidence-based recommendations to prevent perinatal transmission of HIV are to: a. Administer intravenous zidovudine 24 hours before delivery b. Start a combination of antiviral drugs as soon as possible c. Avoid giving antiretroviral drugs until the 28th week of gestation d. Wait until the infant is born because perinatal transmission before delivery is very rare

b

The nurse caring for a 4-month-old infant with biliary atresia (BA) and significant urticaria can anticipate administering: a. Diphenhydramine b. Ursodiol (ursodeoxycholic acid) c. Loratadine d. Ranitidine (Zantac)

b

What is the 24-hour fluid requirement for a child weighing 32 kg? a. 1920 ml/day b. 1740 ml/day c. 1840 ml/day d. 1620 ml/day

b

When caring for a 4-year-old with a disability, the nurse notes that while encouraging the child to take part in his care, the mother constantly gives into the child, allowing him to have his own way. What anticipatory guidance can the nurse give to promote normalization in this relationship? a. "Giving in" is not a detriment to the child when he or she has a disability and limitations. b. Explain that when parents establish reasonable limits, children are likely to develop independence that is appropriate for their age and achievement equal to their limitations. c. Advise the parent to wait to explain any procedure to the child until they are at the health care setting or just before the procedure to avoid unduly upsetting the child. d. Have the parent realize that it would be unfair to the siblings to expect similar rules to apply to all of the children in the family.

b

When obtaining a heel stick for lab results: a. The heel stick is performed because it is less invasive and less painful than a venipuncture. b. Breastfeeding during a neonatal heel lance is effective in reducing pain and has been found to be more effective than sucrose in some studies. c. Although safe for use in preterm infants when applied correctly, eutectic mixture of local anesthetics (EMLA) has been found to be much more effective than placebo in preventing pain during heel lancing. d. To avoid osteochondritis (underlying calcaneus bone, infection, and abscess of the heel), the puncture should be no deeper than 1 mm and should be made at the inner aspect of the heel.

b

You are working in the emergency department, and a 10-year-old child with type 1 diabetes mellitus (DM) has just been admitted. He has been diagnosed with diabetic ketoacidosis (DKA). Which assessment data will you expect to note in this child? a. Shallow or normal respirations, hypertension, and tachycardia b. Fruity breath odor and decreasing level of consciousness c. Headache, hunger, and excessive irritability d. Normal urine output with specific gravity less than 1.020 and a trace of ketones

b

You are working with a nurse who is new to your endocrine unit and has never worked with an infant born with congenital adrenal hyperplasia (CAH). You want to make sure he has a full understanding of this diagnosis. Which statement by the nurse indicates a need for further teaching? a. "Definitive diagnosis is confirmed by evidence of increased 17-ketosteroid levels in most types of CAH." b. "Blood studies to identify elevated calcium and decreased phosphorus levels are routinely performed." c. "Another test that can be used to visualize the presence of pelvic structures, such as female reproductive organs is ultrasonography." d. "This deficiency is an autosomal recessive disorder that results in improper steroid hormone synthesis."

b

You are working with a pediatric nurse who has just transferred to the pediatric clinic. You are role-playing phone triage related to a child with a head injury. You ascertain that the nurse needs more teaching based on what response? a. "After initial physical exam, if there was no loss of consciousness with the head injury, the child can be observed at home." b. "If there is a language barrier, written instructions can be given, followed by discharge." c. "Another physical exam should take place in 1 or 2 days." d. "Parents should call the doctor if their child has any of these signs: blurred vision, walking unsteadily, or is hard to awaken."

b

A 3-month-old is being seen in the well-child clinic for positional plagiocephaly. The nurse knows that the initial interventions for this condition involve which of the following? Select all that apply. a. Place the infant to sleep in the prone position. b. Place the infant in a prone position when awake (approximately 15 minutes). c. Alternate the infant's head position (side of head) when asleep. d. Have the infant wear a soft helmet for 23 to 24 hours a day. e. Place the infant to sleep in an infant seat twice a day.

b, c

Hepatitis A virus (HAV) is transmitted by which of the following? Select all that apply. a. Breast milk from mother with HAV b. Ingestion of contaminated food c. Fecal-oral route d. Casual contact with infected person e. Blood transfusion

b, c

The recommended treatment for cow's milk protein allergy is the substitution of cow's milk-based formula for: a. Goat's milk b. Soy milk or a hydrolyzed formula c. Whole milk d. Evaporated milk

b, c

Identify the interventions that can be safely used to manage diaper dermatitis. Select all that apply. a. Blow dry heat on skin with hair dryer. b. Apply a skin barrier paste such as zinc oxide. c. Keep skin surface irritants such as urine and stool off skin. d. Expose skin to air. e. Use only cloth diapers.

b, c, d

While interviewing parents who have just arrived in the health care clinic, the nurse begins the interview. Which statement below involves therapeutic communication techniques? Select all that apply. a. Allow the parents to direct the conversation so that they feel comfortable and in control. b. Use broad, open-ended questions so that parents can feel open to discuss issues. c. Redirect by asking guided questions to keep the parents on task. d. Use careful listening, which relies on the use of clues and verbal leads to help move the conversation along. e. Ask carefully worded, detailed questions to get accurate information.

b, c, d

You are working with a new nurse to give an intramuscular (IM) injection. Which principles do you want to include when doing this teaching? Select all that apply. a. Usually 2 ml is the maximum volume that should be administered in a single site to small children and older infants. b. New evidence suggests that immunizations at the ventrogluteal site have been found to have fewer local reactions and fever. c. Distraction and prevention of unexpected movement may be more easily achieved by placing the child supine on a parent's lap for ventrogluteal site use. d. The deltoid muscle advantages are less pain and fewer side effects from the injectate compared with the vastus lateralis. e. Aspiration during IM vaccine administration is always recommended.

b, c, d

Which of the following conditions may lead to the development of obesity in children and adolescents? Select all that apply. a. Hereditary low metabolism b. Physical inactivity c. Socioeconomic status d. Use of food as a positive reinforcer of desired behaviors e. Availability of energy-dense foods and drinks f. Positive self-esteem

b, c, d, e

At a visit to the pediatric clinic, a mother is concerned by her 4-year-old's symptoms over the last few weeks. Which of the following symptoms described by the mother would lead the nurse to be concerned about an oncologic disorder? Select all that apply. a. Bruising in various stages, mainly on the legs b. Frequent complaints of respiratory infections, while siblings remain healthy c. Enlarged, firm lymph nodes d. Asthma symptoms with increase in wheezing e. Fever for more than 1 week

b, c, e

Because injuries are the most common cause of death and disability in children in the United States, which stage of development correctly determines the type of injury that may occur? Select all that apply. a. A newborn may roll over and fall off an elevated surface. b. The need to conform and gain acceptance from his peers may make a child accept a dare. c. Toddlers who can run and climb may be susceptible to burns, falls, and collisions with objects. d. A preschooler may ride her two-wheel bike in a reckless manner. e. A crawling infant may aspirate due to the tendency to place objects in his mouth.

b, c, e

Discharge teaching for parents of a school-age patient with diabetes insipidus (DI) should include which of the following? Select all that apply. a. Education and support regarding the rationale for fluid restrictions b. Information for school personnel regarding the diagnosis so that they can grant children unrestricted use of the lavatory c. A thorough explanation regarding the condition with specific clarification that DI is a different condition from diabetes mellitus (DM) d. Understanding that treatment will only be needed until the child reaches puberty e. Knowing that school-age children may assume full responsibility for their care

b, c, e

You are discharging a patient with hemophilia. Which of the following responses by the parents indicate an understanding of this disorder? Select all that apply. a. "My child should remain active to decrease joint problems, and most children with hemophilia can participate in the same activities as peers." b. "Care should be taken to avoid bleeding of gums, and softening the toothbrush in warm water before brushing or using a sponge-tipped disposable toothbrush may be helpful." c. "Signs of internal bleeding should be recognized, such as headache, slurred speech, loss of consciousness (from cerebral bleeding), and black, tarry stools (from gastrointestinal bleeding)." d. "If there is bleeding in a joint, elevation, ice, and rest should help and may prevent the need for factor VIII replacement." e. "All of my son's teachers need to be aware of what to do if he gets a bloody nose."

b, c, e

The National Children's Study is the largest prospective, long-term study of children's health and development in the United States. Which of these options are the goals of this study? Select all that apply. a. Ensure that every child is immunized at the appropriate age. b. Provide information for families to eradicate unhealthy diets, dental caries, and childhood obesity. c. Enlist the help of school lunch programs to reach the goal of vegetables and fruits as 30% of each lunch. d. Significantly reduce violence, substance abuse, and mental health disorders among the nation's children. e. Decrease tardiness and truancy and increase the high school graduation rate in each state over the next 5 years.

b, d

. Children with disabilities or chronic illness and their families may have different methods of coping than those of healthy children. Often they have a resilience that is to be admired. Which of these statements reflect ways that they foster this resilience? Select all that apply. a. Protect the child from having to learn about his or her disability or illness on a repeated basis. b. Develop relationships with other children and their families with similar circumstances to build support. c. The parents set long-term goals to create a sense of hope. d. Focus on the child's strengths and encourage independence. e. Accept that chronic illness is part of living.

b, d, e

A child with sickle cell anemia (SCA) is admitted in a vasoocclusive crisis (VOC). Which of the following interventions should the nurse expect to see ordered? Select all that apply. a. Cold compresses to painful joints b. IV fluids started, and oral fluids encouraged c. Meperidine ordered every 4 hours for pain d. High-calorie, high-protein diet e. Antibiotics ordered for any existing infection

b, d, e

The nurse taking care of a 5-year-old cancer patient with ulcerative stomatitis is getting ready to perform mouth care. Which of the following principles should be followed? Select all that apply. a. Due to pain of the stomatitis, viscous lidocaine should be used to swish the mouth three times per day. b. A soft, bland diet, although not the favorite of the child, will help with the pain. c. Lemon glycerin swabs are helpful because they remind children of lemon drops. d. Using a soft sponge-type toothbrush will decrease the tendency for gums to bleed. e. A solution of 1 tsp of baking soda and tsp of table salt in 1 quart of water is helpful for mouth rinse.

b, d, e

While orienting a new nurse to the ICU, she asks, "How do these children sleep and not become frightened with all the lights and noises?" How should you respond? Select all that apply. a. "These children are sicker than those on the pediatric unit, so the noises and lights are necessary." b. "We try to organize care into clusters so that infants and children can sleep and we can turn down lights." c. "We silence alarms to allow for periods of sleep, especially at night." d. "When possible, we allow for uninterrupted sleep cycles—for infants 90 minutes and for older children 60 minutes." e. "We encourage parents to sit with and touch their child as often as possible."

b, e

A 12-year-old child is in the urgent care clinic with a complaint of fever, headache, and sore throat. A diagnosis of group A beta-hemolytic streptococcus (GABHS) pharyngitis is established with a rapid-strep test, and oral penicillin is prescribed. The nurse knows which of the following statements about GABHS is correct? a. Children with a GABHS infection are less likely to contract the illness again after the antibiotic regimen is completed. b. A follow-up throat culture is recommended following the completion of antibiotic therapy. c. Children with a GABHS infection are at increased risk for the development of rheumatic fever (RF) and glomerulonephritis. d. Children with a GABHS infection are at increased risk for the development of rheumatoid arthritis in adulthood.

c

A 5-year-old is seen in the urgent care clinic with the following history and symptoms: sudden onset of severe sore throat after going to bed, drooling and difficulty swallowing, axillary temperature of 102.2° F (39.0° C), clear breath sounds, and absence of cough. The child appears anxious and is flushed. Based on these symptoms and history, the nurse anticipates a diagnosis of: a. Group A beta-hemolytic streptococcus (GABHS) pharyngitis b. Acute tracheitis c. Acute epiglottitis d. Acute laryngotracheobronchitis (LTB)

c

A nurse looks over her assignment for the day that includes an infant, a preschool-age child, a third-grader, and a sophomore in high school. Which techniques take into consideration developmental stages when working with pediatric patients? a. Being aware that infants will become agitated due to stranger anxiety around 4 months old b. When a preschooler is getting blood drawn, giving a detailed explanation will be helpful c. Explaining and demonstrating what the BP machine does to the third-grader before taking her blood pressure d. Using a single consistent approach with the adolescent will help allay anger and hostility

c

A nurse working on a pediatric unit is assigned to an infant with hypothyroidism. She knows that the assessment may include: a. Thyroid function tests that are usually normal, although thyroid-stimulating hormone (TSH) levels may be slightly or moderately elevated b. Increased secretion of pituitary TSH in response to decreased circulating levels of thyroid hormone (TH) or from infiltrative neoplastic or inflammatory processes c. Dry skin, puffiness around the eyes, sparse hair, constipation, sleepiness, lethargy, and mental decline d. Clinical features, including irritability, hyperactivity, short attention span, tremors, insomnia, and emotional lability

c

As the nurse caring for a culturally diverse population, it is important to understand cultural health beliefs of families. This can best be accomplished by: a. Asking the parents how their extended families feel about their child's illness b. Exploring the use of alternative medicines and therapies c. Understanding the parents' perception of the seriousness or severity of the illness or disability, as well as concerns and worries they have about the condition d. Acknowledging that language constraints may make it necessary for the health care team to make some decisions

c

Nursing care of a child in the hospital with suspected abuse should include: a. Assign a variety of nurses to the child so that he can get to know and trust the whole staff. b. Praise the child's ability to minimize feelings of shame and guilt. c. Treat the child as someone with a specific problem, not as an "abuse" victim, to promote self-esteem and minimize feelings of guilt. d. Talk with and ask questions as often as possible to show interest and get to know the child better.

c

Separation anxiety is something that affects children when they are hospitalized. Each developmental stage has a somewhat different reaction as they deal with this difficulty. Which stage corresponds to the adolescent stage? a. May demonstrate separation anxiety by refusing to eat, experiencing difficulty in sleeping, crying quietly for their parents, continually asking when the parents will visit, or withdrawing from others. b. Separation anxiety comes in stages: protest, despair, and detachment. c. Loss of peer group contact may pose a severe emotional threat because of loss of group status, inability to exert group control or leadership, and loss of group acceptance. d. May need and desire parental guidance or support from other adult figures but may be unable or unwilling to ask for it.

c

Understanding autism spectrum disorders (ASDs) is very important for those who care for children. Goals of treatment for these children include: a. Helping with placement in a long-term care setting, because most children cannot remain at home b. Putting the child hospitalized with an ASD in a room with another child to help him or her feel more comfortable in the strange environment c. Providing a structured routine, whether at home or in the health care setting d. Providing comfort for young children by holding or cuddling when able, because the disruption of routine can be frightening

c

Which factors are considered protective factors for sudden infant death syndrome (SIDS)? a. Side sleeping position, breastfeeding, updated childhood immunization status b. Supine sleeping position, breastfeeding, soft bedding c. Prone sleeping position, exposure to maternal tobacco use, updated childhood immunization status d. Supine sleeping position, breastfeeding, updated childhood immunization status

d

You are caring for a child on the pediatric unit with a suspected abdominal tumor. Which criteria would lead you to determine this tumor is a neuroblastoma rather than a Wilms tumor? a. Most children present with neuroblastoma around age 4. b. Neuroblastoma is a firm, nontender, irregular mass confined to one side, generally deep in the flank. c. Hypertension is often noted due to secretion of excess amounts of rennin by the tumor. d. Most tumors develop in the adrenal gland or the retroperitoneal sympathetic chain.

d

You are caring for a child with hydrocephalus who is postoperative from a shunt revision. Which assessment finding is your priority for increased intracranial pressure (ICP)? a. Nausea and refusal to eat postoperatively b. Complaint of a headache 909 c. Irritability and wanting to sleep d. Decrease in heart rate over the last hour

d

You are the nurse assigned to care for a child with a basilar skull fracture. Your most important nursing observation is change in level of consciousness (LOC). You will be highly alert for: a. Alterations in vital signs that often appear before alterations in consciousness or focal neurologic signs b. Bleeding from the ear, which is indicative of an anterior basal skull fracture c. Seizures, which are relatively uncommon in children at the time of head injury d. Changes in posturing, such as any signs of extension or flexion posturing, unusual response to stimuli, and random versus purposeful movement

d