Pediatrics
After teaching the parents of a child with Tourette syndrome about motor and vocal tics, the nurse determines that the teaching was successful when the parents state which of the following?
"If we get him focused on an activity, the tics will be less pronounced."
The nurse is caring for a preschooler who requires postsurgical breathing exercises. Which of the following approaches will best elicit the child's cooperation?
"Let's see who can blow these cotton balls off the table first."
A few days after discharge, the parent of an 8-year-old calls the pediatric clinic, concerned about the child's behavior now that she is home. The parent expresses that the child is treating her siblings badly and using language she knows she is not allowed to use. The parent asks the nurse for suggestions regarding how to handle this behavior. Which of the following statements would be most appropriate for the nurse to make to this parent?
"Respond to her behavior in a firm, loving, consistent way."
The nurse is providing family education for the administration of ibuprofen. Which of the following responses indicates a need for further teaching?
"This can be taken with other medications we have at home that didn't require a prescription."
A nurse is conducting a mental status examination with a 5-year-old boy who is playing with trains and blocks of different colors. He repeats the same actions with the trains over and over again throughout the examination. Which of the following questions would be most appropriate?
Why does that red train keep crashing into all of the other trains?
The nurse is caring for a child who has been hospitalized for six days and whose caregivers are unable to stay with the child. The child cried most of the day for the first three days but now is quiet and seems to be accepting the hospitalization and being away from the caregivers. This behavior in the child is an example of which of the following stages of separation?
despair
The nurse working in pediatrics is aware of the special needs of children related to pain assessment. Which of the following is the highest priority for the nurse to consider when completing a pain assessment?
developmental age of the child
A nurse is preparing to give an injection to a 7 year old who appears afraid and hesitant. The nurse tells the patient that it is OK to say "ouch" when the shot is given. This is an example of which of the following pain control techniques?
distraction
The nurse is caring for a 13-year-old girl with a nursing diagnosis of ineffective coping related to inability to deal with life stressors as evidenced by few or no meaningful friendships and low self-esteem. Which intervention would be the priority to promote coping skills?
encourage her to discuss her thoughts and feelings
Which of the following will the nurse view as best maintaining normalcy in the life of a 10-year-old boy who is experiencing a lengthy hospitalization?
keeping up with his schoolwork
A nurse is observing a 10-year-old boy who is in the waiting room of a pediatrician's office. Another child on the other side of the room removes the lid from a toy box, and the 10-year-old boy screams and then cries briefly. Noticing his shoe laces, he begins laughing and untying them. The nurse recognizes this behavior as an example of which of the following?
labile mood
A child with an intellectual disability is evaluated and found to have an intelligence quotient (IQ) of 65. The nurse interprets this as reflecting which category of intellectual disability?
mild
The nurse is performing a physical assessment of 16-year-old girl who is cognitively challenged. This client attended her local public elementary school through fifth grade and has since been enrolled at a special education school where she has received social and vocational training. She plans on getting a job in the coming month and on living independently in a few years. The nurse recognizes this client's level of cognitive challenge as which of the following?
mild
The nurse is caring for a 6-year-old child with burns on both hands. Which of the following pain assessment techniques is the most accurate for this patient?
obtain a self-report
Which of the following signs and symptoms suggest that a 5-year-old boy who does not maintain eye contact or speak may be autistic?
the child constantly opens and closes his hands
A nurse is preparing to start an intravenous (IV) line on a 5 year old. Where does the nurse understand the procedure should be performed so that the child's "safe place" will not be disrupted?
the treatment room
A 12-year-old girl needs a lumbar puncture to collect cerebral spinal fluid for laboratory exam plus injection of medication into the central nervous system. She expresses great fear of the procedure because of anticipated pain and the inability to hold still. The nurse contacts the physician to make which suggestion?
the use of conscious sedation for the lumbar puncture
A nurse is using a doll to explain what will be done when starting an intravenous (IV) line on a 4 year old. What type of play is this considered?
therapeutic play
The nurse is caring for a 10-year-old child admitted for a surgical procedure to be done the next day. The nurse takes the child to a special area in the playroom and lets the child "start" an IV on a stuffed bear. Which of the following is this action an example of?
therapeutic play
Development should continue during hospitalization. What play activities will the nurse choose for toddlers to accomplish this? Select all that apply.
• Putting together a large-piece puzzle • Pulling a toy train • Stacking blocks
The nurse is assessing an infant diagnosed with trisomy 13. Which of the following would the nurse expect to assess? Select all that apply.
• Small eyes • Wide sagittal suture • Extra digits
A 6 year old with leukemia is placed on reverse isolation. What nursing actions could prevent depression and loneliness in this patient? (Select all that apply.)
• Spend extra time to talk while in the room. • Read a story while in the room. • Play a game while in the room.
A nurse realizes that a child's hospitalization is stressful for the family for which of the following reasons? (Select all that apply.)
• past experiences of illness and hospitalizations • disruption in family life • guilt about the illness • cause of the illness • the illness's treatment Correct
The therapy you would expect to see prescribed for an adolescent with anorexia nervosa would be
counseling to improve feelings of control over her body
The five levels of communication are listed below. Put them in the correct order, from first level to fifth:
Cliché conversation Fact reporting Shared personal ideas and judgments Shared feelings Peak communication
A newborn who is suspected of having leukemia is being prepared for bone marrow aspiration. The newborn's mother asks whether any type of sedation or anesthesia will be used. Which of the following should the nurse say in response?
"Because this is a painful procedure, your child will receive conscious sedation to alleviate pain."
You are meeting with a family that has learned that their 11-year-old daughter has some intellectual disabilities. They tell you that she is having trouble coping with different situations at school. Which of the following is the best response?
"Coping and adaptation are often affected by intellectual disabilities."
A couple who are pregnant with their first child have made an appointment with a clinical geneticist to discuss prenatal screening. The man states that they, "just want to make sure that there is nothing wrong with our baby." How could the clinician best respond to this statement?
"Testing the umbilical blood and performing amniocentesis can give us some information, but not a guarantee."
The nurse is working with a group of caregivers of school-age children diagnosed with attention deficit hyperactivity disorder. Which of the following statements would be most appropriate for the nurse to make to this group of caregivers?
"The medications your child is on may cause a decreased appetite."
The nurse recognizes that which individual or couple would most benefit from obtaining genetic counseling?
23-year-old female, 25-year-old-male, both with family history of sickle cell disorder
A child with a diagnosis of Down syndrome has had which of the following chromosome abnormalities occur?
3 copies of trisomy 21 has occurred instead of 2 copies.
For a diagnosis of Klinefelter syndrome, what would be the chromosome pattern to identify this disorder?
47, XXY
Which of the following scenarios demonstrates the nurse's knowledge when using guided imagery to relieve pain in pediatric patients?
After achieving a relaxed state, beginning a guided imagery of walking down a sandy beach and collecting seashells, a favorite activity of the 13-year-old female patient
A nurse is preparing to administer medication to a preschooler. What can the nurse do to ensure communication with the child is effective?
Allow the child to choose between juice, water, or soda to take the medication.
Which of the following children would be best characterized as having a separation-anxiety disorder?
An 8-year-old who will not stay overnight at a friend's house
Conscious sedation is a pain-management technique that is used with children. During conscious sedation for a preschooler, which of the following actions would be most important?
Assessing vital signs frequently, because they can become depressed
A nurse working with a 7 year old who has had a hernia repair realizes that discharge planning starts when?
immediately upon admission
The nurse is preparing a teaching plan for the parents of a child diagnosed with achondroplasia. Which of the following would the nurse include? Select all that apply.
• Middle ear infections may be a persistent problem. • The child will probably average about 4 feet in height. • Limb-lengthening surgeries may need to be done.
The 2½-month-old infant needs a capillary blood specimen obtained. In addition to having the father hold the infant, the nurse will: Select all that apply.
• Provide a pacifier for the child. • Give the baby a small amount of sucrose just prior to the procedure
A 10-year-old girl has been referred for evaluation due to difficulties integrating with her peers at her new school. The counselor believes she is at risk for situational low self-esteem due to problematic relationships with both family members and peers. Which of the following is the best approach?
Engage the girl in dialogue regarding feelings about self/personal appearance.
You care for a 12-month-old with autistic disorder. Which of the following descriptions would you expect to elicit from his mother on history-taking?
He stares at a rotating wheel on his crib mobile.
Which statement by the parent of a 12-month-old child diagnosed with Down syndrome shows the need for further education?
I will need to delay any further immunizations
A nurse is teaching about pharmacological management to families with children who have diseases caused by inborn errors of metabolism. It is important for the nurse to include which of the following information?
In most cases, treatment is lifelong
The nurse is caring for a 10-year-old recently diagnosed with attention deficit/hyperactivity disorder (ADHD). The nurse would expect to provide teaching regarding which of the following medications?
Methylphenidate
Which of the following would suggest that a 5-year-old boy might have a developmental disorder?
The child is not able to follow directions
The nurse is working with school-age children who are having enuresis or encopresis. Which of the following will most likely be the first step in this child's treatment?
The child will have a complete physical exam
The nurse is educating the parents of an 8-year-old boy about his learning disorder. Which of the following facts would be included in the discussion?
The disorder is caused by a difference in brain development
The nurse caring for a 6-month-old infant can best reduce the stress of hospitalization by:
Supporting the parent in his or her presence and caregiving
A nurse is caring for an 18-month-old girl undergoing traction therapy in a rehabilitation unit. The nurse understands that the girl is in the second phase of separation anxiety when she observes what behavior?
The toddler is quiet, looks sad, and is disinterested in playing.
The nurse is assessing a 6-year-old with attention deficit/hyperactivity disorder (ADHD). The nurse observes the boy making repeated clicking noises and notes he has a slight grimace. The nurse recommends the boy receive further evaluation for which of the following?
Tourrette syndrome
The nurse is caring for a 2-year-old postoperative PET patient. Which of the following considerations is the most appropriate for this patient's developmental stage?
Uses words for pain such as owie, boo-boo, or hurt
An advance practice pediatric nurse practitioner (APPNP) is conducting a mental status examination with a 6-year-old girl. Which of the following questions would be most appropriate?
Why does your pink doll hit the other dolls?
A 3-day-old male infant is newly diagnosed with Tay-Sachs disease. The nurse reviews information about the disease process with the parents after the doctor has met with the family. Which statement by the parents demonstrates that the nurse has reviewed the disease process with the parents effectively?
"He will have normal development for about 6 months before developmental delays develop."
n a preadmission visit, 9-year-old Bridget says she is afraid to come for her tonsillectomy the following week because it will hurt too much. Which of the following statements would be best for the nurse to make to help the child feel more comfortable and less afraid?
"I understand that you're worried. It will hurt but only for a few days; we'll give you something to help stop the pain when you need it."
The nurse is providing teaching about the potential side effects of lithium for the parents of a girl recently diagnosed with bipolar disorder. Which statement by the parents indicates a need for additional teaching?
"If she loses weight, we know the medication is working."
The nurse is discussing health concerns and issues with a group of caregivers of adolescents. Which of the following statements made by the caregivers would indicate a need for follow-up by the nurse?
"Our daughter has never had any health problems, and now she has developed so many cavities."
The nurse is preparing a 6-year-old for a venipuncture. The boy appears anxious and is crying. How can the nurse foster feelings of control to help minimize his anxiety about the procedure?
"Pick your favorite Band-Aid and show me which arm to use."
The telephone triage nurse answers the call from a stay-at-home father of an infant; the father is unable to describe clearly the signs and symptoms the child displays but keeps saying, "She doesn't act like herself," and "Things with her are just not right." The best response by the nurse is:
"Please bring the child to the clinic to be seen. You seem concerned."
The mother with a child following abdominal surgery holds his hand and smoothes his hair. When the nurse appears to administer a scheduled analgesic, the mother says she believes the child has been in pain the last hour or more. The nurse's best response is:
"Please tell me and all of the nurses when you believe he is in pain."
The nurse is caring for a 10-year-old girl with a history of inappropriate behavior. Which statement by the mother would lead the nurse to suspect possible conduct disorder?
"She recently trampled our neighbors flower bed."
A 5-year-old child asks the nurse what happens at the hospital in which the nurse works. Which of the following statements would be the most appropriate response for the nurse to give this child?
"Some people come here to have babies, or when they're sick or hurt, so we can try to help them get better."
The nurse is working with the caregivers and families of children who are hospitalized. Members of the group make the following statements. Which statement gives an indication of an issue that would likely be a major factor influencing the family's response to the child's illness?
"Sometimes I wonder if the reason she is sick is because I have so many responsibilities at work and at home."
A nurse is assessing a child and finds several major congenital anomalies. Which of the following might these be? Select all that apply.
• Limb asymmetry • Cardiac conduction disorder • Cleft lip
The nurse is admitting a 14-year-old girl for a tonsillectomy and is preparing her for the procedure. Which of the following is the best statement or question?
"Are you wondering about anything related to your tonsillectomy?"
The nurse is discussing the treatment for a child with attention deficit hyperactivity disorder with a group of school nurses. Which of the following would be an appropriate learning setting for a child with ADHD?
A classroom with a plan of study that is followed each day.
The nurse is working with the caregivers of a child who is being discharged from a healthcare setting. Which of the following statements is most accurate regarding discharge planning?
A conference to review information and procedures with the family caregivers is important to do as part of discharge planning.
Which of the following statements is the goal of distraction techniques used to control pain?
A goal of distraction interventions is to divert the child's attention away from the pain through controlled, purposeful behaviors.
The nurse is caring for a 6-year-old patient with chronic pain. Which of the following is the best choice of pain management for this patient?
PO morphine PRN
A 7-year-old boy tells the nurse that his head sometimes hurts after he eats ice cream. The nurse recognizes that this type of pain is which of the following?
acute referred pain
The drug most commonly abused by children and adolescents is which of the following?
alcohol
A nursing instructor teaching students about pain control in children realizes a need for further instruction when a student states which of the following?
"Familiarity with procedures lessens the pain experienced."
An adolescent comes to the office of the school nurse and after being quiet for several minutes states, "I think the world will be better when I am gone." Which of the following statements should be the nurse's first response to this adolescent?
"Have you made a plan to commit suicide?"
When providing education to a mother regarding pain management for a toddler with otitis media, which statement by the mother indicates further teaching needs for this parent?
"I should give my child one baby aspirin."
The nurse is caring for a 7-year-old patient with persistent chronic pain. After assessing the child and speaking with the child and parents, the nurse believes the current pain management is not effective. The nurse prepares to call the physician to report her findings. Which of the following statements is the best example of effective communication with the physician?
"The patient received morphine one hour ago and is sitting on her mother's lap crying and complaining of stomach pain."
A mother in the outpatient setting is explaining how she plans to prepare her 5-year-old for hospital admission. What remark indicates the parent requires additional teaching?
"We told him to use his manners and behave like a big, brave boy."
The nurse is caring for a 14-year-old child who is scheduled to have surgery the next day. Which of the following would be most appropriate for the nurse to do to help prepare this child for surgery?
Give the child a book to read which describes the people who are involved in the preoperative, surgical, and postoperative areas.
The nurse is providing hair care for an African-American 10-year-old girl hospitalized with a painful disorder. What should the nurse do first?
Ask the girl and/or her family about any preferences in hair care or for usual procedures used.
A nurse is instructing the parents of a toddler on the use of an anesthetic cream in advance of an upcoming procedure the child will have. Which of the following should the nurse mention to them?
Be careful not to let your son remove the dressing, as the cream can cause damage to his eyes if he rubs them
A child is admitted for treatment of a congenital cardiac disorder. The extremely upset parents ask, "How could this happen? Will our child die?" What can the nurse do to help the family meet the healthcare needs of the child?
Be honest with the family and allow them to express concerns and ask questions.
A pregnant woman asks about phenylketonuria (PKU). She states that she understands what the defect is but wants to know if her child will be born with it. She adds that she was told that she carries the gene for it, but that her husband does not. What should the nurse tell this woman?
Both parents must carry the recessive gene for PKU for the child to have it.
A 5-year-old boy is brought to the emergency room with a possible broken arm. His 18-year-old sister, who is also his primary caregiver, has come with him. The boy is relatively calm, but his sister is so upset she is nearly hysterical. The nurse notes that as her behaviors show more anxiety, the boy is getting more upset and his anxiety is also increasing. Which of the following would be best for the nurse to do in this situation?
Reassure the child. Tell him you need to ask his sister some questions, and then gently remove his sister from the room.
The toddler needs elbow restraints to keep his hands away from a facial wound. What will the nurse do to best ensure their safe use?
Remove one restraint at a time on a regular basis to check for skin irritation.
The nurse is caring for a patient receiving opioid medication for the treatment of postoperative pain. Which of the following are common side effects that the nurse should observe the patient for?
Respiratory depression, constipation, and pruritis
The nurse is caring for a 12-year-old postoperative spinal rod placement patient with scoliosis. Which of the following factors might intensify the patient's postoperative pain experience?
The patient had painful experience with an appendectomy at age 10.
When a nurse is caring for a child who is admitted for an emergency, which of the following factors most affects the child's sense of security?
The physical needs have a priority over the emotional needs of the child.
When administering parenteral or epidural opioids, the nurse should always have ready access to which medication?
naloxone
The nursing instructor teaching students about the pattern of heredity of metabolic conditions realizes that further teaching is needed when a student makes which of the following statements?
"The pattern of heredity for all metabolic conditions is dominant."
The nurse realizes that many factors influence a child's pain experience. Which pain scale may be most appropriate to use with the African American 6-year-old?
oucher pain scale
A young child is hospitalized with pneumonia. Upon admission he informs the nurse that he is not having pain but just a bad cough. A few hours later, the child he begins to complain of pain in his right lower back. This first report of feeling pain refers to which of the following?
pain threshold
The nurse is caring for a 10-year-old girl with an anxiety disorder. During a physical examination, which of the following physical findings would the nurse expect to find?
patches of hair loss
The 10-year-old girl hospitalized for bladder surgery will be most stressed when nurses provide what care?
perineal and indwelling catheter care
A young boy is in the emergency department with swelling and pain in the right ankle. He states that he was playing soccer, somehow twisted the ankle, and could not walk off the field. The physician tells the patient that it is only a bad sprain. Which type of pain is this patient experiencing?
somatic
The nursing student correctly informs the instructor that the best ways to control enzyme deficiencies is through which of the following?
special diet restrictions and synthetic medical foods
The nurse is talking with the parents of a hospitalized child who has three siblings at home being cared for by the grandparents. The main idea the nurse wants the parents to understand is that siblings may experience:
stress equal to that of the affected child
A child is suspected of having bipolar disorder. Which of the following would the nurse identify if the child was experiencing a manic episode? Select all that apply.
• Flamboyant behavior • Pressured speech • Decreased sleep
A nurse is assisting a physician with suturing a laceration on a preschooler's leg. What distraction methods can the nurse perform to promote atraumatic care? (Select all that apply.)
• Have the child blow bubbles. • Sing a song and have the child sing along. • Ask the child to squeeze your hand.
The nurse is obtaining the history of an adolescent female who is suspected of having anorexia nervosa. Which of the following would the nurse expect to find? Select all that apply.
• Secondary amenorrhea • Syncope • Desire for perfectionism
A client has a diagnosis of type-1 neurofibromatosis. As part of the intake assessment protocol for the facility, the clinical educator is teaching the care staff about the diagnosis. Which of the following statements most accurately conveys an aspect of neurofibromatosis?
"Her diagnosis puts her at higher risk of developing a malignant neoplasm."
A nurse is caring for a boy preparing to undergo a dressing change. Which of the following statements by the father lets the nurse know that the child's pain experience is at risk of being intensified?
"I hope that you will be a brave boy and not cry."
The nurse is discussing substance abuse with an adolescent. Which of the following statements made by the adolescent should the nurse follow-up on first?
"I may drink too much on the weekends but I don't drink during the week."
The nurse is providing teaching for the parents of an 8-year-old girl who has undergone surgery. The nurse emphasizes the importance of maintaining adequate hydration. Which of the following responses by the mother would indicate a need for further teaching?
"I will remind her that she will need an IV if she does not drink."
Parents are concerned because their 18-month-old will eat only when they feed him. They report he was independent with feeding at home but is unwilling in the hospital. The nurse considers this behavior:
regression
The nurse is preparing a toddler for the repair of an eyebrow laceration. The girl is most likely to demonstrate which of the following responses in anticipation of the procedure?
scream and cling tightly to her parents
A 10-year-old girl with ADHD has been on Ritalin for 6 months. The girl's mother calls and tells the nurse that the medication is ineffective and requests an immediate increase in the child's dosage. What should the nurse say?
set up an appointment as soon as possible
A school-age patient is in the clinic for a sprained ankle and is ordered to take NSAIDs for pain control. What should the nurse inform the mother may be associated with long-term administration of any NSAID?
severe gastric irritations
You teach a child to use a FACES pain rating scale prior to surgery. At that time, she points to the smiling face. Following surgery when you suspect she has pain, she points again to the smiling face. You would interpret this as
she is using the scale to predict what she would like, not what she has.
The nurse is performing an assessment of a 6-year-old girl with Turner syndrome. Which of the following would the nurse most likely assess?
short stature and slow growth
The nurse is working with a 5-year-old boy who must receive repeated intravenous injections as part of his treatment. He hates the injections, however, and is frightened whenever he sees the syringe and needle. In an attempt to overcome this fear, the nurse holds the syringe up for him to see and tells him, "This looks kind of like a space rocket, don't you think? Here comes the space rocket—it needs to refuel." Which pain management technique is the nurse using here?
substitution of meaning
The nurse working in the emergency department is caring for an 8-year-old male who was hit by a car while running across the street and has suffered extensive abrasions, contusions, and broken bones. IV morphine analgesia has been given. The child is unable to follow simple directions to allow for procedures to be completed. Which of the following is the best action to take for this child?
the child should be sedated
As many as 50% of children with autistic spectrum disorder are also cognitively challenged.
true
The nurse is caring for a 6-year-old girl who has been diagnosed with neurofibromatosis. Which of the following would the nurse implement as the priority?
urging the parents to schedule yearly physical exams
To feed lunch to a child with autistic disorder, which of the following actions would be most important to take?
use a repetitive series of movement
A nurse getting ready to conduct preoperative teaching with a 9 year old realizes that the best method when teaching young patients is which of the following?
use short sessions
A nurse caring for a 5 year old who had abdominal surgery yesterday is trying to teach the child how to take deep breaths. The best way that the nurse can accomplish this is by doing which of the following?
using a pinwheel
A 5 year old arrives at the emergency department and reports abdominal pain. After performing an assessment and laboratory work, the physician diagnoses appendicitis. The nurse knows that this child is experiencing which type of pain?
visceral
The nurse is describing some of the developmental milestones the mother of a 3-month-old boy with Down syndrome can expect to see in her child. Which statement describes the milestones that are expected in a child with Down syndrome?
you can expect him to eat with his hands by age 12 months
The nurse is assessing the abdomen of a preschooler admitted for lower right quadrant pain. Which questions or requests are appropriate to use with this child? Select all that apply.
• "Touch the spot on your tummy where it hurts." • "Choose the face that shows how you feel now." (FACES pain rating scale)
A nurse is assessing a child and finds several major congenital anomalies. Which of the following might these be? Select all that apply.
• Cleft lip • Cardiac conduction disorder • Limb asymmetry
A nursing student correctly identifies that heat is primarily used after the first 24 hours of an injury and does which of the following? (Select all that apply.)
• Dilates capillaries • Increases blood flow to the area • Reduces edema
The nurse is preparing a 4-year-old girl for a lumbar puncture. The child is extremely fearful and crying. The nurse needs to quickly gain the child's cooperation so the procedure can move forward as ordered. Which approach by the nurse should be used?
engage the mother in therapeutic hugging
Infants learn best by affective learning.
false
A 5-year-old patient whose mother is rooming-in during the child's hospitalization will benefit in which of the following areas?
feelings of security
A young hospitalized patient is crying because his mother is going to work to take care of some important business but has promised to return in a few hours. What could the mother do to allay the child's fear that she will not return?
give him her scarf to keep for her
A nurse is admitting a 7 year old to the pediatric unit of the hospital. While the nurse is showing the child and parents the room and explaining where things are, the child becomes upset and frightened. What is the best action by the nurse?
go slowly with the acquaintance process
The school nurse is caring for an 8-year-old boy with asthma. Which of the following is most likely to be part of the child's Individualized Health Plan?
helping the child modify his physical activity requirements
Anna is a 12-year-old cancer patient who is receiving opioids via epidural for pain relief. Which of the following side effects of the medication will need to be monitored?
hypotension and bradycardia
You are caring for an infant who will have surgery. What type of pain assessment would you use?
observation of facial and body actions
The nurse is caring for a child with an eating disorder. Which of the following is the highest priority in treatment of the disorder?
correct fluid and electrolyte imbalances
The nurse is caring for a 12-year-old patient in sickle-cell crisis. The nurse determines that the patient is very tense and might benefit from relaxation techniques. Which of the following is the best approach for the nurse to take when implementing this pain reduction technique?
Close the door to the patient's room, dim the lights, and close the curtains before beginning.
A 6 year old will be hospitalized for a surgical procedure. How can the nurse best ease the stress of hospitalization for this child?
Prepare the child for hospitalization by explaining what to expect and showing him or her around the hospital.
The nurse is working with a group of caregivers of children in a community setting. The topic of hospitalization and the effects of hospitalization on the child are being discussed. Which of the following statements made by the caregivers supports the most effective way for children to be educated about hospitals?
"We are going to take our child to an open house at the hospital so she can see the pediatric unit."
The nurse is teaching the parents of a 14-year-old boy who has been diagnosed with Klinefelter syndrome. Which response by the parents indicates a need for more teaching?
"We could have also had a girl with male characteristics."
A clinician who works on a cardiac care unit of a hospital is providing care for a number of clients. Which client most likely has a genetic disorder arising from inheritance of a single gene?
A tall, thin, myopic, 28-year old woman with mitral valve prolapse
Which couple would the nurse document as being at highest risk for having a child with a trisomy 21 disorder?
a couple in their 40s
The nurse is caring for a burn patient with orders for oral ibuprofen and morphine PRN to control pain. Which of the following nursing interactions is the most beneficial for the nurse to implement fpr pain management?
Alternate these medications around the clock to diminish peaks and valleys in pain control.
Upon assessment, the nurse notices that the infant's ears are low-set. What is the priority action by the nurse?
Continue to assess the infant to look for other abnormalities
A nurse working in a pediatric clinic is examining a child with symptoms indicating a possible inborn error of metabolism. Which of the following is most important for the nurse to do at this time?
Counsel the family to have all siblings evaluated.
The nurse is caring for a preoperative pediatric patient. Of the following, which would be best for the nurse to do with this patient?
Determine how much the child knows and is capable of understanding.
The nurse is caring for a technology-dependent school-age child in his home. Which of the following actions best builds a trusting relationship?
Discussing care and treatment with the parent and child together
A 5-year-old boy is scheduled for hospitalization in 2 weeks. Which of the following is the best intervention to help ease the stress of hospitalization in this patient?
Encourage the family to participate in the child-life program.
The grandmother of a 1-year-old cancer patient comes to visit the child in the PICU. She sits in a chair near the child's bed but doesn't touch him. Which of the following actions by the nurse would be most appropriate?
Encourage the grandmother to rock the child in a rocking chair.
A nurse is preparing to discharge Josephine, a neonate diagnosed with maple syrup urine disease. Which one of the following is recommended teaching for home care of Josephine?
Focus on reinforcing the need for the prescribed lifelong dietary regimen.
A group of students are reviewing the role of neurotransmitters in the development of depression. The students demonstrate a need for additional study when they identify which neurotransmitter as being involved?
GABA
Which of the following nursing interventions demonstrates proper use of cutaneous stimulation to relieve pain with pediatric patients?
Gently massaging a pre-term infant's leg for two minutes prior to obtaining a blood sample from a heel stick
Sixteen-year-old Candace is being seen for a long overdue checkup. Her caregiver has come with her. Candace is calm, pleasant, and in good spirits. The caregiver reports to the nurse that she is relieved because for the past six months Candace has been lethargic, angry, and sad. The mother reports that since she got her driver's license two days earlier, her child's mood has changed dramatically. Rather than resist this appointment, Candace had simply smiled and said, "It won't matter much, but okay, I'll be ready in a minute." The nurse recognizes that the child's seeming well-being and drastic change in behavior should be further investigated to determine which of the following?
If the child is planning on committing suicide
A nurse is teaching about pharmacological management to families with children who have diseases caused by inborn errors of metabolism. It is important for the nurse to include which of the following information?
In most cases, treatment is lifelong.
The nurse is assessing a 7-year-old girl with Down syndrome. Which of the following would the nurse be least likely to assess?
Inspection finds the nasal passages clear and open.
An adolescent would benefit from being out of his hospital room. What can the nurse do to promote this? Select all that apply.
Invite the adolescent to meet with other teens for lunch in a common space. • Challenge the adolescent to a video game in the recreation area.
The mother of an 8-year-old boy is concerned that her son has attention-deficit/hyperactivity disorder. She describes the symptoms he demonstrates. Which of the following behaviors should the nurse recognize as an example of impulsiveness?
Jumping out of his seat in the middle of class and running to the bathroom without the teacher's permissio
The nurse has been assigned to care for a child who is on transmission-based precautions. This nurse has not cared for this child before. Which of the following actions would be the best way to help the child feel comfortable with the nurse?
Let the child see his or her face before the mask is put on.
The nurse is caring for a child who has been hospitalized repeatedly at multiple hospitals. There is no clear medical diagnosis and the mother is threatening to leave the hospital against medical advice. The nurse suspects which of the following?
Munchhausen syndrome by proxy
The nurse is caring for a 10-year-old boy who had an appendectomy 2 days ago. Prior to surgery he had expressed that he was worried that after the procedure he would hurt and have lots of pain. The nurse asks the child what his pain level is on a scale of 0 to 10, with 10 being the worst pain. He tells the nurse he has no pain. The most appropriate action by the nurse would be to
Observe him for physical signs which might indicate pain.
Adam is a 14-year-old post-op scoliosis rod surgery patient. As the nurse enters the room, she observes the 3-year-old sibling with the PCA button in his hand, pressing the button multiple times. The patient and his mother are both asleep. Which of the following is the correct term for this action?
PCA by proxy
A woman brings an infant to the emergency department and informs the nurse that the 6 month old has been projectile vomiting for the last 36 hours. When changing the diaper, the nurse notices that the urine has a musty odor. Which of the following should the nurse suspect?
PKU
A 12-year-old girl nervously asks the nurse several questions about menstruation and then expresses a concern in a stammering, roundabout way. When she is finished talking, the nurse replies by saying, "so, you are telling me that you are afraid of getting your period while at school and it showing through your clothing, is that correct?" Which communication technique is the nurse using here?
Perception checking
Which of the following conditions is a part of normal newborn screening?
Phenylketonuria
A mother is concerned because whenever she takes her 4-year-old son out to play in the yard, he begins eating dirt as soon as her back is turned. The nurse explains that this behavior is known as which of the following?
Pica
The nurse is preparing a postsurgical care plan for an infant girl located on a general hospital unit that only occasionally admits children. To ensure the infant's safety, what should the nurse include in the plan?
Place the infant in a room close to the nurses' station.
The pediatric unit in the hospital is designed to be comfortable for the child and to make the child feel secure. Which of the following aspects of the pediatric unit would be most likely to support the child who is hospitalized?
Procedures and treatments are done in a room other than the child's hospital room.
The nurse is about to assess pain in the child and will use the QUESTT acronym as a guide to objective and subjective data collection. This acronym stands for: Select all that apply.
Question the child, take action
The neonatal nurse caring for children with inborn errors of metabolism explains to the student nurse that prompt treatment is an essential intervention to successful management of the diseases. Which of the following is a recommended treatment for these conditions?
Replacing deficient enzymes through intravenous administration
A mother is telling the school nurse about her concerns regarding her 13-year-old daughter, who complains of headaches. Her grades have dropped, and she is sleeping late and going to bed early every night. The nurse advises the mother that the first priority should be which of the following:
Schedule an immediate history and physical
The nurse is providing home care for a 4-year-old girl with a chronic respiratory illness. Which of the following is a case management activity?
Scheduling intravenous and respiratory therapy services needed by the child
The nurse is providing home care for an 8-year-old girl who is dependent on a ventilator and for her family. Which of the following is a part of case management for the child and family?
Scheduling respite care of the child with a child care provider
A group of nursing students are reviewing the actions of various drugs used to treat mental health disorders in children. The students demonstrate understanding of the information when they identify which drug as potentiating the activity of serotonin in the brain?
Sertraline
A 6-year-old girl has a fractured left leg and has been crying. She denies having any pain while continuing to lie still without movement of the extremity. What should the nurse anticipate as the reason for this behavior?
She received an injection last time she was in the emergency room.
Which of the following includes negative effects that chronic pain can have on the pediatric population?
Sleep disturbances, exhaustion, irritability, mood disturbances, and depression
The nurse is working in the pediatric unit of the hospital and is making observations about the safety issues related to the pediatric unit. Which of the following is the biggest concern related to safety of the hospitalized child?
Taking a child in and out of bed, doing frequent checks and procedures, and caregivers sitting at the side of the bed leaves opportunity for the siderails to be left down.
A nurse is teaching a child and parents about an outpatient surgical procedure the child will have the next day. The child is "shy" and does not maintain eye contact with the nurse. What is the best way for the nurse to approach the child?
Talk to the parents first to give the child a chance to "warm up."
The neonatal nurse performs a focused health history on the family of a new patient. The father tells the nurse that his family comes from a long line of Ashkenazi Jews. Based on this information, for what disease should the nurse be vigilant?
Tay-Sachs disease
Which of the following is an example of impaired adaptive functioning in an 8-year-old girl with a developmental disorder?
The child cannot properly dress herself
Which of the following signs and symptoms suggest that a 5-year-old boy who does not maintain eye contact or speak may be autistic?
The child constantly pats his leg
The nurse is collecting data on an 18-month-old old child with a diagnosis of autism. Which of the following clinical manifestations would likely have been noted in the child with this diagnosis?
The child does not respond or talk to the nurse when asked simple questions.
A nurse is preparing to administer an intravenous (IV) medication to a child but the child is in the playroom in the pediatric unit. What is the best action by the nurse?
The nurse should request that the child come with the nurse to the treatment room to have the medication administered.
A nurse is caring for an infant admitted with diarrhea. The parent tells the nurse that she has to leave to care for another child at home and will be back shortly. What is the most effective way for the nurse to communicate with the infant and meet the child's needs?
Use a soothing and calming tone when speaking to the infant.
The nurse is observing a group of two and three year olds in a play group setting. Which of the following behaviors noted in one of the children indicates to the nurse that the child may be autistic?
While the other children are eating a snack, the child walks around the room feeling the walls and ignores the caregiver who offers him a snack.
The nurse is caring for a child who has been prescribed fentanyl (Duragesic) for pain. Which of the following actions is a priority nursing function for this child?
assess respiratory status frequently
When a child is hospitalized and must be away from the caregiver, the child goes through stages of response to the separation. The child who cries and refuses to let the nurse or anyone else comfort them and is continually looking out the door to see if the caregiver is returning is in which of the following stages of separation?
protest
Parents are to bring their kindergarten child to the outpatient department for a venous blood sample. They have EMLA cream to apply at home prior to the procedure and have been shown two areas on the child's arms where they should place the cream. Transportation time is 15 minutes. Their appointment is for 2:45 p.m. At what time should the parents apply the cream and occlusive dressings to both arms?
between 1:15 and 1:45 pm
The nurse who wishes to be as supportive as possible to the hospitalized preschooler makes great effort to avoid threatening the 4-year-old's:
body integrity
A 4-year-old patient is scheduled for an MRI. The child's mother is informed that the child will be free of pain but sedated to ensure stillness during the procedure. Which type of anesthesia does the nurse expect this child to have?
conscious sedation
A nurse is preparing a presentation about genetic disorders in children. Which of the following would the nurse include as the most common inherited cause of intellectual disability?
fragile x syndrome
After teaching a class of students about genetics and inheritance, the instructor determines that the teaching was successful when the students identify which of the following as the basic unit of heredity?
gene
To teach an adolescent about his or her disease, the best technique would be to
help him or her understand how new information about the disease will improve health status now.
Which method of pain tools can be used to assess the pain in relation to events and times of day?
log and diaries
One of the characteristic signs in prepubertal males with fragile X syndrome is:
macro-orchidism
A nurse is describing the underlying cause of trisomy 21 to a group of parents, integrating knowledge that the disorder is due to which of the following?
nondisjunction
The nurse is performing a physical examination on a 1-week-old girl with trisomy 13. Which of the following would the nurse expect to assess?
observation reveals a microcephalic head
The nurse is performing a physical examination on a 1-week-old girl with trisomy 13. Which of the following would the nurse expect to assess?
observation reveals microcephalic head
A nurse is assessing a child diagnosed with Sturge-Weber syndrome. Which of the following would the nurse expect to find when assessing the skin?
port wine stain
The nurse is assessing an adolescent for a rule-out appendicitis. The nurse is aware the appendix is located in the right lower quadrant. The teenager is complaining of pain in the left lower quadrant. What type of pain should the nurse document?
referred pain
A 6-year-old girl with a diagnosis of Marfan syndrome is being assessed at a community health clinic. Which of the following assessment would be the health care professional's lowest priority?
tests of kidney functions
A 16-year-old girl confides in the nurse that her parents are difficult to deal with and that it stresses her out. The nurse responds by saying, "You think that's stressful, you should see some of the patients I have to deal with in here!" Which barrier to communication is this nurse demonstrating?
topping up
A nursing instructor overhears a student state, "Nearly all metabolic disorders negatively affect growth and development." The nursing instructor identifies this statement to be which of the following?
true
A 5 year old scheduled for surgery in the morning wakes at 2 am and asks the nurse for something to eat and drink. What should the nurse tell this patient?
That not having food or drink before surgery will prevent an upset stomach
Which of the following activities would be most beneficial in educating children regarding hospitals and hospitalization?
The caregivers take all of the children in the family to an open house at the hospital.
The nurse in the well-child clinic observes that a 5-year-old child in the waiting room is having trouble using a crayon to color. During the visit, the same child climbs off the table several times even after the nurse has asked him to stay on the table. Each time the nurse reminds him he says, "Oh, yeah," and happily climbs back up. The nurse suspects that which of the following applies to this child?
The child has ADHD
When teaching about Turner's syndrome, what should the nurse include?
timing and use of growth hormone
Which laboratory or diagnostic test would the nurse anticipate to rule out complications related to Down syndrome?
echocardiogram
The nurse is caring for a 1-year-old boy with Down syndrome. Which of the following would the nurse be least likely to include in the child's plan of care?
educating the parents on how to deal with seizures
A parent asks why a physical therapist is needed for the 6-month-old child diagnosed with Down syndrome. What is the best response by the nurse?
To optimize the child's development and functioning
You plan to apply EMLA cream to decrease the pain of an injection. Which of the following would be the best technique?
apply it at least one hour prior to the procedure
The nurse is assessing a 3-month-old boy with abnormally small vertebrae who has had a colostomy. Which assessment finding would suggest the child has VATER association?
assessment shows the child was born with only one arm
A nurse is preparing a presentation about genetic disorders in children. Which of the following would the nurse include as the most common inherited cause of intellectual disability?
Fragile X syndrome
The nurse is teaching the mother of a child with phenylketonuria (PKU) about diet and realizes the mother needs further instruction when she makes which of the following statements?
lots of fish and meat will help him
The nurse is caring for a term infant suffering from meconium aspiration in the nursery. The nurse reviews orders for a peripherally inserted central catheter (PICC) line placement and intubation. Which of the following statements demonstrates the nurse's knowledge of painful procedures and the newborn?
The newborn's pain pathway components are developed enough at birth to experience pain.
When 4-year-old Vernon's mother returns to room-in at the hospital with him after a 3-day trip back home, she is anxious and excited to hug him. When she leans over his bed to pick him up, he turns his back and scoots away. Which of the following statements made by the nurse would be an explanation for the child's reaction?
His distrust is normal and may have lingering effects, but you should touch and soothe him as much as possible."
A toddler needs to be transported to a far area of the hospital for noninvasive diagnostic testing. The nurse chooses to:
Place the child on the mother's lap and push the two in a wheelchair.
When educating a parent how to support their child while experiencing a painful procedure, which of the following is the best information for the nurse to convey to the parents?
Explain in detail the role of the parent as a coach and emphasize the coping plan.
The nurse is caring for a 12-year-old cerebral palsy patient who is unable to communicate verbally. Which of the following pain assessment tools is the most appropriate for the nurse to use when assessing pain in this patient?
Face, leg, activity, cry, and consolability (FLACC) descriptors
An 11-year-old boy has come to the school nurse more than 15 times for somatic complaints during the first quarter of school and has subsequently left school after each visit. What should the school nurse do?
contact the child's parent to discuss the situation
The nurse is providing postsurgical care for a 4-year-old boy following hernia repair. Before surgery, the nurse taught the child to use the poker chip tool to rate his pain. When assessing the child's postsurgical pain, the boy refuses to touch the chips and clings to his mother. How should the nurse respond?
Give the mother the FACES pain rating scale to use with her son.
A 6 year old boy who has mental retardation secondary to fragile-X syndrome has been admitted to hospital with a mitral valve prolapse. A health care worker who is providing care for the family should have which of the following statements as part of her knowledge base around the disease?
The boy will pass the gene to all his future daughters who will become carriers.
The nurse is teaching a child with PKU about his or her special diet during a checkup visit. It would be appropriate to teach the child that he can eat which of the following foods? Select all that apply.
a potato and a banana
A young couple seeks pregnancy counseling in the women's health clinic. They tell the nurse performing a focused health history that they are of Jewish descent and are worried about conceiving a baby with Tay-Sachs disease. No known metabolic disorders exist in the family medical history. What is the nurse's best response to this couple's concerns?
"Carrier testing is warranted for couples who have an elevated risk for Tay-Sachs disease due to their ethnic origin."
A newborn has just been diagnosed with phenylketonuria (PKU). The physician and nurse have taught the parents about the defect. What statement by the parents demonstrates a need for further instruction?
"Nothing can be done medically to manage this condition."
A 3-year-old you meet has phenylketonuria. Which of the following foods would you question if you saw it on his lunch tray?
Chocolate pudding
Which of the following physical assessment findings would the physician be more likely to find in an examination of a client with Down syndrome than of other clients without Down syndrome?
congenital heart defects
A nurse is preparing to teach an 8 year old recently diagnosed with diabetes how to give an insulin injection. Which is the best technique for the nurse to use?
demonstration
A nurse is aware that Healthy People 2020 has an objective to increase the proportion of people who report that their health care providers have satisfactory communication skills. What significance does this have for effective communication?
It will promote the inclusion of children and families in health conversations.
A nurse working in a high-risk pregnancy clinic is assisting with screening for women and fetuses. The client from which of the following ethnic groups should be screened for Tay-Sachs disease?
Jewish ethnicity
What benefits does effective therapeutic communication have in the nurse-patient relationship?
Leads to increased knowledge and health care behaviors.
A 1-day-old infant is diagnosed with maple syrup urine disease. Which of the following treatments would the nurse expect to see ordered?
Low-protein, low-amino-acid diet
