NUR-227 PEDS Test 2 (text book questions)

Lung maturity may be enhanced by which of the following? Select all that apply. A. Antenatal (maternal) glucocorticoid administration B. Maternal chorioamnionitis C. Neonatal administration of exogenous surfactant D. Maternal diabetes mellitus E. Maternal tobacco smoking

ANS: A C

The type of play in which infants engage is called: A. Solitary B. Parallel C. Associative D. Cooperative

ANS: 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

ANS: A

Which childhood vaccine provides some protection against bacterial meningitis, epiglottitis, and bacterial pneumonia? A. Hib vaccine B. Hepatitis B vaccine C. Varicella vaccine D. Influenza vaccine

ANS: A

Which of the following should be used in the care of all pediatric patients to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection? A. Transmission-Based Precautions B. Airborne Precautions C. Standard Precautions D. Droplet Precautions

ANS: C

Which of the following scenarios are concerning to health care workers? Select all that apply. A. An adolescent using marijuana once to fit in with peers at a party B. An adolescent binging on alcohol every weekend C. An adolescent using prescription drugs along with alcohol D. An adolescent reports feeling jittery until she drinks some alcohol

ANS B C D

Common causes of pelvic inflammatory disease in the United States include which of the following? Select all that apply. A. Neisseria gonorrhoea B. Chlamydia trachomatis C. Treponema pallidum D. Human papillomavirus

ANS: A B

A child with periorbital edema, decreased urine output, pallor, and fatigue is admitted to the pediatric unit. The child is being examined for acute glomerulonephritis. 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.

ANS: A B C

Which of the following conditions may lead to the development of obesity in children? Select all that apply. A. Physical inactivity B. Low socioeconomic status C. Use of food as a positive reinforcement of desired behaviors D. Consumption of energy-dense foods and drinks E. Positive self-esteem

ANS: A B C D

A mother of a child born with Down syndrome is overwhelmed with the future and asks many questions. Which of the 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.

ANS: A B C E

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

ANS: A B C E

An infant born at 27 weeks of gestation is now 3 weeks old and on supplemental oxygen by nasal cannula. Feedings are being administered by gavage: 12 ml of expressed breast milk and human milk fortifier every 2 hours. On assessment the nurse notes that the infant's abdomen appears slightly distended, the infant's activity is decreased from previous assessment, and there is a prefeeding gastric residual of 6 ml. The infant's core temperature is 35.8°C (it was 36.4°C 2 hours before). Based on these findings, what are the nurse's priority interventions? Select all that apply. A. Obtain a full set of vital signs, including BP and pulse oximetry B. Withhold the next feeding (now due) C. Discuss findings with the primary practitioner D. Observe the infant closely and administer the current feeding E. Measure the infant's abdominal girth The nurse recognizes that these symptoms are most likely associated with: A. Transient feeding intolerance B. Respiratory distress syndrome C. Necrotizing enterocolitis D. Bronchopulmonary dysplasia

ANS: A B C E ANS: C

Disordered eating patterns, which may be observed in the female athlete triad, may include which of the following? Select all that apply. A. Use of diet pills and laxatives B. Fasting C. Binge eating D. Restriction of certain foods E. Inadequate caloric intake F. Excessive vitamin consumption

ANS: A B D E

Which of these statements accurately describes Duchenne muscular dystrophy (DMD)? Select all that apply. A. The absence of dystrophin leads to muscle fiber degeneration. B. DMD is inherited as an X-linked recessive trait. C. Cognitive and intellectual impairment are rare in children with DMD. D. Affected children have a waddling gait and lordosis and fall frequently. E. Ambulation usually becomes impossible by 12 years of age, and affected children are confined to a wheelchair. F. Affected children must be hospitalized when ambulation becomes impossible.

ANS: A B D E

A school nurse in middle school (grades 6, 7, and 8) is preparing an outline for a sex education class. Which of these statements represent important concepts to be covered in discussing this topic with this age-group? Select all that apply. A. Consider separating the boys and girls into same-sex groups with a leader of the same sex. B. Answer questions matter-of-factly and honestly and appropriate to the children's level of understanding. C. Use vernacular or slang terms to describe human physiologic functions. D. Avoid discussing sexually transmitted diseases in this age-group. E. Discuss common myths and misconceptions associated with sex and the reproductive process. F. Avoid controversial topics such as birth control.

ANS: A B E

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.

ANS: A C E

The nurse is caring for a 4-year-old girl with a history of frequent urinary tract infections. 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.

ANS: A C E

When a child with a visual impairment is hospitalized, the nurse should ensure that 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.

ANS: A C E

A good understanding of enuresis will help the nurse work with children and their families. Which of the following teaching points should be included? Select all that apply. A. Enuresis is primarily an alteration of neuromuscular bladder functioning and as such is benign and self-limiting. B. Spontaneous remission of nocturnal enuresis occurs in approximately 35% of cases. C. Normal bladder capacity (in ounces) is the child's age plus 4; therefore normal bladder capacity for a 6-year-old is 10 ounces (600 ml). D. Success has also been achieved with desmopressin acetate nasal spray, which reduces nighttime urinary output to a volume less than functional bladder capacity. E. Parents need reassurance that bed-wetting is not a manifestation of emotional disturbance but just represents willful misbehavior.

ANS: A D

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

ANS: A D E

The nurse caring for a preschool child understands which of the following developmental concepts? Select all that apply. A. Preschoolers have egocentric thought and believe that everyone thinks as they do. B. Play can be therapeutic and enlightening into a child's level of understanding. C. Explanations are helpful when using detail to allay the preschooler's stress. D. Preschoolers understand inferences and can relate to others' feelings with empathy. E. Preschoolers have magical thinking and believe their thoughts have power.

ANS: A B E

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 min). 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.

ANS: B C

Which of the following immunization booster vaccines should be considered for a 13-year-old adolescent who has completed all recommended routine childhood vaccinations? Select all that apply. A. DTaP vaccine B. Tdap vaccine C. Meningococcal vaccine D. Pneumococcal vaccine E. Hepatitis B vaccine F. Hib vaccine

ANS: B C

According to Jean Piaget, adolescent cognitive development is represented by the stage of formal operational thought that includes which of the following? Select all that apply. A. Believing that thoughts are all-powerful B. Thinking in abstract terms C. Thinking about hypotheses D. Using a future time perspective E. Thinking in the here and now

ANS: B C D

A 4-month-old infant is brought to the well-child clinic for immunizations. The mother indicates that the infant often strains to have a bowel movement, so she has been giving him honey and has stopped feeding him iron-fortified formula, based on her sister's recommendations. The nurse recognizes that the infant is at risk for the development of which of the following? Select all that apply. A. Obesity B. Iron-deficiency anemia C. Rickets D. Infant botulism E. Cow's milk allergy

ANS: B D

Which child should receive further diagnostic testing for chronic abdominal pain? Select all that apply. A. An 11-year-old boy with a 1-month history of generalized periumbilical pain B. An 8-year-old girl with a 1-week history of right lower quadrant pain C. A 12-year-old girl with a 6-week history of constipation D. A 6-year-old boy with a 1-month of diarrhea and a rectal fistula

ANS: B D

As a nurse caring for children, an understanding of childhood depression is essential. Some important information about depression includes which of the following statements? Select all that apply. A. Authorities agree that childhood depression exists, and the manifestations are often similar to adult depression. B. Identification of the depressed child requires a careful history taking (e.g., health, growth and development, social and family health); interviews with the child; and observations by the nurse, parents, and teachers. C. If antidepressants are prescribed, the child and family need to know that antidepressants must be at a therapeutic level for 4 to 6 weeks to achieve a beneficial effect. D. Depressed children often exhibit a distinctive style of thinking characterized by low self-esteem, hopelessness, poor social engagement with peers, and a tendency to explain negative events in terms of personal shortcomings. E. Nurses should be aware that depression is a problem that can be easily overlooked in the school-age child and one that can interrupt normal growth and development.

ANS: B D E

A 2-day-old infant in the newborn nursery is diagnosed with developmental dysplasia of the hip, and treatment is started by the orthopedist. The nurse assists the parents by providing home care instructions that include: A. Return to the orthopedist's office in 2 weeks to remove the hip spica cast B. The infant's bilateral foot casts should be elevated on pillows as much as possible C. Remove the Pavlik harness once a day for no more than an hour and inspect skin D. Remove the Pavlik harness while the infant is awake to allow "tummy time"

ANS: C

After the sudden death of a 14-year-old seemingly healthy basketball player, his parents ask the school administration to install an automatic external defibrillator (AED) in a central area of the athletic center. The school nurse is asked to participate in a meeting with the parents in which the administrators insist that such a device is not necessary. The school nurse advocates by providing which information about AEDs and children? A. An AED should be used only by health care persons trained in its use. B. An AED provides too much of an energy shock dose for children under 12 years of age. C. An AED can be effective in the resuscitation of a child or adolescent with a shockable rhythm. D. An AED is more commonly used in adults who have heart attacks than in children with undiagnosed heart conditions

ANS: C

The most common complication that should be anticipated and observed for in an infant with myelomeningocele after surgical repair of the defect is: A. Urinary stress B. Chiari malformation C. Hydrocephalus D. Latex allergy

ANS: C

At an appointment at the pediatrician's office, a patient's mother states, "My son gets rough with some of the neighborhood kids. I am worried that he is becoming a bully." Which statements by the mother need more teaching? Select all that apply. A. When my son becomes aggressive, I feel he needs to be punished. B. I think it is good for him to bond with his dad, so they often watch TV together. C. I am trying to get him to learn to say what he is upset about in words. D. Boys will be boys, so I think this can be considered a normal stage in development. E. I am thinking that a time-out would be a better strategy than spanking when my son shows this behavior.

ANS: C E

A 12-year-old who was in an ATV accident has a long-leg fiberglass cast on his left leg for a tibia-fibula fracture. He requests pain medication at 2:00 AM for pain he rates at a 10/10 on the numeric scale. The nurse brings the pain medication and notes that he has removed the pillows that kept his leg elevated. He complains of pain in the left foot, and she notes that there is 3+ edema in the exposed leg and foot and she is unable to slip a finger under the cast. The nurse's priority interventions in this situation should include: A. Administer the pain medication and elevate the child's leg on the pillows B. Elevate the leg on the pillows and follow up within 2 to 3 hours to see if the edema has decreased C. Let the child know he cannot have any additional pain medication until 6:00 AM D. Notify the surgeon of the findings immediately

ANS: D

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 whether 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.

ANS: A B

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

ANS: A B D

Because children with celiac disease must limit their intake of products containing gluten in wheat, rye, oats, and barley, they are at risk for which of the following nutritional deficiencies? 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

ANS: A B D

Which of the following are the primary causes of mortality among adolescents in the United States? Select all that apply. A. Injuries B. Suicide C. Congenital anomalies D. Homicide E. Chronic illness

ANS: A B D

Toddlers are often known to be finicky eaters and may exhibit abnormal eating patterns that may concern parents. Which of the following actions for feeding toddlers should be suggested so adequate amounts of nutrients for growth and development are consumed? Select all that apply. A. Avoid placing large food portions on the toddler's plate B. Allow the child to graze on nutritious (not "junk" food) snacks during the day C. Insist that the child sit at the table until all persons have completed their meals D. Allow the child to make certain food choices (within reasonable limits)—for example, "Would you like a half peanut butter or ham sandwich?" E. Provide meals at the same time of day as much as possible so the toddler has a sense of consistency F. Make the child eat all of the food provided, and provide disciplinary actions such as a "time-out" if the plate is not cleaned

ANS: A B D E

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

ANS: A B D E F

Which of the following hormones have the most impact on the development of puberty in females and males? Select all that apply. A. Follicle-stimulating hormone (FSH) B. Insulin C. Luteinizing hormone (LH) D. Estrogen E. Testosterone

ANS: A C

Nursing care of a 2-day-old infant undergoing phototherapy in the mother's hospital room should include: A. Ensure proper fit of eye covering (patches) B. Monitor bilirubin levels with transcutaneous monitor every 8 hours C. Record number of infant voidings and stools D. Examine infant's eyes for presence of drainage every 8 hours or as warranted E. Avoid removing the infant from phototherapy except for brief periods of feeding and cuddling

ANS: A C D

Nursing care of a healthy term newborn aimed at preventing significant hyperbilirubinemia includes: A. Encourage mother to breastfeed the infant frequently B. If the mother cannot breastfeed at night, give the infant feedings of water and dextrose C. Observe the number of voids and stools, especially in the first 72 hours D. Promote newborn rooming-in with the mother E. Observe infant for appearance of jaundice and obtain transcutaneous bilirubin reading F. Feed the infant formula on a schedule of every 4 to 5 hours

ANS: A C D E

The nurse notes that a healthy term infant appears jaundiced at 12 hours of age. The nurse understands that there is probably an ABO incompatibility based on the following information: A. The direct Coombs test is weakly positive. B. The infant's hemoglobin is 11.3 mg/dl. C. The mother's blood type is O positive. D. This is the mother's first pregnancy. E. The infant's serum bilirubin (indirect) is 2.6 mg/dl.

ANS: A C D E

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

ANS: A C D F

In terms of social development, the school-age child does which of the following? Select all that apply. A. Begins to explore the environment beyond the family B. Has an increased interest in persons of the opposite sex (gender) C. May actively participate in same-sex groups or clubs D. Strives to be different from those in the peer group E. Begins to form strong relationships with persons of the same sex (gender)

ANS: 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 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."

ANS: A C E

You are working with a family whose 7-year-old has just been diagnosed with attention-deficit/hyperactivity disorder. Which statements by the mother indicate a need for further teaching? Select all that apply. A. "My child will respond best to verbal instructions, since that will help him learn to pay attention and listen intently." B. "A consistent schedule for homework and activities will help him be organized." C. "I need to bring him for routine checkups while he is taking his medication because the medication can affect his appetite and growth." D. "I am going to ask the principal if my son can change classrooms because his current teacher has too many rules and he seems to get in trouble." E. "We might consider counseling because this has been stressful for the whole family."

ANS: A D

At the clinic appointment, a 4-year-old's mother wants to discuss several concerns. Which statements require more teaching by the nurse? Select all that apply. A. My husband feels that TV is okay as long as it is educational. B. I think it is okay for my son to play dress-up along with the girls. C. I told my son that his imaginary playmate moved away because it did not seem normal. D. My mother-in-law thinks I should be working around the house all the time, but I believe playing with my son is very important. E. My neighbor gave me some flash cards with letters and numbers for my son to use, but I said, "What's the rush? He's only 4."

ANS: A C E

Hepatitis A virus 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

ANS: 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

ANS: B C

The potential physiologic and psychologic effects of prolonged immobilization on a 9-year-old child who has experienced significant trauma in a motor vehicle crash include which of the following? Select all that apply. A. Orthostatic intolerance B. Deep vein thrombosis C. Pressure ulcer formation D. Pneumonia E. Diarrhea F. Kidney stones G. Sense of euphoria and elation H. Constipation

ANS: a b c d f h

A common cause of accidental death in children ages 1 to 19 years involves motor vehicle crashes. Evidence from test crashes indicates that the safest action to prevent accidental deaths in toddlers includes: A. Placing the child in a rear-facing weight-appropriate car restraint seat until the child has outgrown the car seat manufacturer's height and weight recommendations B. Allowing the child to ride in the front seat with a lap-shoulder seat restraint to avoid emotional outbursts C. Allowing the child to ride in a forward-facing booster restraint seat after 12 months of age D. Placing the child in the regular seat using the lap-shoulder belt as long as the child weighs at least 45 pounds

ANS: A

A hallmark of cognitive development in the school-age child is in what Piaget describes as concrete operations. In this stage the child: A. Uses thought processes to experience events and actions B. Is unable to see things from another's point of view C. Has a limited perspective of how others' interpretations of a given event differ D. Makes judgments based on what he or she sees

ANS: A

One indication that the toddler is ready to begin toilet training is: A. Child recognizes urge to void and is able to communicate this sensation to the parent B. Child is able to stay dry all night C. Child demonstrates mastery of dressing and undresssing self D. Child asks parent to have wet or soiled diaper changed

ANS: A

One of the key factors in addressing the health concerns and needs of the adolescent in a clinic or primary care office setting is to: A. Provide confidentiality B. Include the parent(s) in a discussion about the adolescent's sexual health C. Ask the adolescent if she or he is sexually active D. Discuss the negative effects of tobacco use

ANS: A

School-age children are prone to accidental injury primarily because of: A. Peer pressure and risk-taking behaviors B. Physical awkwardness and clumsiness C. Parents' lack of supervision D. Attempts to impress members of the opposite sex

ANS: A

A 14-year-old male with a spinal cord injury is placed on a standing table and suddenly begins to sweat profusely and complain of a headache. The nurse takes a set of vital signs and notes a significant increase in systolic blood pressure and a heart rate of 50 beats per minute. The most helpful intervention in this situation would be for the nurse to: A. Place the adolescent back in his wheelchair and take him to his room B. Palpate the bladder for distention C. Administer a routine analgesic for his headache and discontinue the therapy D. Place the standing table in a horizontal position and allow the adolescent to rest for a few minut

ANS: B

A 15-year-old female diagnosed previously with anorexia nervosa 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 lb. 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

ANS: B

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 lb, and he now weighs 8 lb, 10 oz. The infant's mother reports that he is taking 4 to 7 oz 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 that his stools are brown in color, and he has 1 to 2 bowel movements every day. Based on these findings, the nurse anticipates the infant has: A. Meckel diverticulum B. Hypertrophic pyloric stenosis C. Intussusception D. Hirschprung disease

ANS: 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.

ANS: B

A late-preterm infant (estimated 35 weeks of gestation) is admitted to the neonatal intensive care nursery at 2 hours of age with the following: respiratory rate 68; heart rate 132; bilateral nasal flaring; audible grunting on expiration; intercostal retractions; systolic blood pressure 35; hypotonia; and acrocyanosis and pulse oximetry reading of 89% on 30% inspired oxygen. The radiograph shows a diffuse ground glass appearance. The nurse recognizes these as signs of: A. Hypoglycemia B. Respiratory distress syndrome C. Meconium aspiration D. Apnea of prematurity

ANS: B

Characteristics of bullying include: A. Unintentional harm inflicted on another person that is part of the socialization process in childhood B. The infliction of repetitive physical, verbal, or emotional abuse on another person with intent to harm C. An attempt to gain acceptance and be liked by same-sex peers D. An early sign of a severely disturbed personality disorder that escalates in adulthood

ANS: 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

ANS: B

Nursing care of a 9-month-old who has recently undergone cleft palate repair can be expected to include feeding with a(n): A. Plastic spoon B. Open cup C. Pigeon bottle D. Special Needs feeder

ANS: B

One of the concerns of the preschool period is adequate nutrition. What can the nurse say to give anticipatory guidance to parents? A. Preschoolers are growing during this period and need to increase their caloric intake to 110 kcal/kg, for an average daily intake of 2200 calories. B. There is some evidence that children self-regulate their caloric intake. If they eat less at one meal, they compensate at another meal or snack. C. To monitor fat intake, dairy and meat should be limited to twice a day. D. For children who do not like milk, consumption of fruit juices is a healthy alternative.

ANS: B

One of the most common intestinal parasitic pathogens in the United States acquired from a contaminated water source such as a lake or swimming pool is: A. Tinea capitis B. Giardia intestinalis C. Pediculosis capitis D. Enterobiasis

ANS: B

One of the primary reasons for monitoring the toddler's activities and intervening to prevent accidental injury is that: A. Toddlers have oppositional defiant behavior and negativism B. Toddlers do not understand the concept of "cause and effect," so explaining that certain actions will result in serious injury is useless C. Toddlers will often listen to reasoning about why an activity should be avoided D. Toddlers enjoy making their parents worry about their safety and like to see the parents' reactions to the behavior

ANS: B

The nurse caring for a 4-month-old infant with biliary atresia and significant urticaria can anticipate administering: A. Diphenhydramine B. Ursodiol (ursodeoxycholic acid) C. Loratidine D. Zantac

ANS: B

The primary risk factor for the development of cerebral palsy is: A. Maternal chorioamnionitis B. Premature birth C. Birth asphyxia D. Intraventricular hemorrhage

ANS: B

The typical play activity in which toddlers engage is called: A. Solitary B. Parallel C. Associative D. Cooperative

ANS: 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

ANS: 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 to 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

ANS: B

When her preschool son is in the hospital, the parent tells the nurse, "I think there is something wrong with him because he is so skinny." The most appropriate answer by the nurse is: A. Most preschoolers weigh between 10 and 14 kilograms. B. The legs of a preschooler, rather than the trunk, increase in length, which may make him look slimmer. C. Preschoolers usually keep that pot-bellied appearance until about 4 years old. D. Most preschoolers gain 2 to 3 pounds per year.

ANS: B

ou 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 examination, 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 examination 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."

ANS: B

A 16-month-old has a history of diarrhea for 3 days with poor oral intake. He received intravenous fluids, has tolerated some oral fluids in the emergency department, and is being discharged home. Instructions for diet for this child should include: A. BRAT diet (bananas, rice, applesauce, and toast) 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

ANS: 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, which he receives via a central venous catheter. The clinic nurse following this infant is aware that this infant should be closely observed for the development of: A. Gastroesophageal reflux B. Chronic diarrhea C. Cholestasis D. Failure to thrive

ANS: C

A mother brings her 3-year-old daughter to the well-child clinic and expresses concern that the child's behavior is worrisome and possibly requires therapy or medication at minimum. The mother further explains that the child constantly responds to the mother's simple requests with a "no" answer even though the activity has been a favorite in the recent past. Furthermore, the child has had an increase in the number of temper tantrums at bedtime and refuses to go to bed. The mother is afraid her daughter will hurt herself during a temper tantrum because she holds her breath until the mother picks her up and gives in to her request. The nurse's best response to the mother is that: A. The child probably would benefit from some counseling with a trained therapist. B. The mother and father should evaluate their childrearing practices. C. The child's behavior is normal for a toddler and may represent frustration with control of her emotions; further exploration of events surrounding temper tantrums and possible interventions should be explored. D. The child's behavior is typical of toddlers, and the parents should just wait for the child to finish this phase because this will end soon.

ANS: C

A newborn whose mother is positive for Chlamydia trachomitis 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%)

ANS: C

An important milestone in the infant's life is the development of object permanence. This milestone is represented by which of these statements? A. The infant smiles at the mother when she talks to him. B. The infant repeatedly flexes and extends his arms and legs when the mother picks him up. C. The infant turns and looks for the mother when she walks out of his view. D. The infant cries when the mother hands him to a babysitter.

ANS: C

An important nutritional supplement recommended to prevent rickets in infants who are exclusively breastfeeding is: A. Vitamin A B. Fluoride C. Vitamin D D. Folic acid

ANS: C

An infant born at term and weighing 3.0 kg (6 lb, 6 oz) has Apgar scores of 8 and 9 at 1 and 5 minutes, respectively, and is in the nursery until the mother's blood pressure is stabilized. The infant has some tremors of the extremities but is otherwise alert and active at 4 hours of age with vital signs within normal limits for age. Prenatal history and delivery are uneventful, and the infant is appropriate for gestational age. A priority nursing intervention should include: A. Obtain vital signs every hour until stable B. Consider transferring the infant to a transitional unit for closer observation C. Obtain bedside serum glucose per standing orders D. Feed infant 20 ml of infant formula

ANS: 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

ANS: C

In addition to hypoglycemia, the infant of a diabetic mother should be observed for: A. Hydrocephalus B. Hyperglycemia C. Respiratory distress D. Sepsis

ANS: C

In relation to developmental milestones, the infant can be expected to roll over from back to abdomen at approximately: A. 2 months B. 4 months C. 6 months D. 8 months

ANS: C

Nursing care of a child in the hospital with suspected abuse should include which of the following actions? 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.

ANS: 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

ANS: C

What is the most common treatable cause of male-related impaired fertility, especially if diagnosed and treated early? A. Paraphimosis B. Trauma to the penis C. Idiopathic varicocele D. Epididymitis

ANS: C

Which childhood vaccine provides protection against streptococcal infections such as otitis media, sinusitis, and pneumonia? A. Rotavirus B. Hib C. Pneumococcal D. MMR

ANS: C

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.

ANS: D

A warning sign of self-harm includes which one of the following? A. Multiple bruises on arms and legs B. Poor school performance C. Finding tobacco products hidden in the adolescent's room D. Spending long periods of time in a locked bedroom or bathroom

ANS: D

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

ANS: D

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

ANS: D

Which vaccine do the Centers for Disease Control and Prevention (CDC) and American College of Obstetricians and Gynecologists recommend that pregnant adolescents and women who are not protected against pertussis receive optimally between 27 and 36 weeks of gestation or postpartum before discharge from the hospital? A. DTaP B. Td C. IPV D. Tdap

ANS: 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. 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 that 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

ANS: D

Urinary system distress (neurogenic bladder) in children with spina bifida is managed by: A. DDAVP (1-deamino-8-D-arginine vasopressin) B. Clean intermittent catheterization C. Continuous urinary catheterization D. Mitrofanoff procedure

ANS:B

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, which he receives via a central venous catheter. The clinic nurse following this infant is aware that this infant should be closely observed for the development of: A. Gastroesophageal reflux B. Chronic diarrhea C. Cholestasis D. Failure to thrive

ANS:C