peds exam 1 practice questions

CRIES is an appropriate pain assessment tool for: A) Cognitively impaired older adults B) Children ages 2 to 8 years C) Infants D) Preterm and term neonates

D. The CRIES score is on tool for the postoperative pain in preterm and term neonates. It measures physiologic and behavioral indicators on a three-point scale.

5. A nurse is caring for a visually impaired 20-month-old who has not begun to walk. Which nursing diagnosis is the most appropriate for this client? a. Delayed growth and development b. Impaired physical mobility c. Self-care deficit d. Impaired home maintenance

a Rationale 1: A 20-month-old child who is not walking is delayed in growth and development. The child's mobility is not due to a physiological problem, so impaired mobility is not appropriate. Self-care deficit does not apply to this age of child. There is not enough data to determine if home maintenance is impaired.

what are the three stages of anxiety that a child may have? a. despair, detachment, anxiety b. potest, despair, denial c. regression, denial, attachment

b. protest, despair and denial denial is also considered detachment

During an otoscopic examination on an infant, in which direction is the pinna pulled?a. Up and back b. Up and forward c. Down and back d. Down and forward

c In infants and toddlers, the ear canal is curved upward. To visualize the ear canal, it is necessary to pull the pinna down and back to the 6 to 9 o'clock range to straighten the canal. In children older than age 3 years and adults, the canal curves downward and forward. The pinna is pulled up and back to the 10 o'clock position. Up and forward and down and forward are positions that do not facilitate visualization of the ear canal.

while caring for a preterm infant you are aware that: a. inhibitory transmitters are insufficient supply by 15 weeks gestation b. the fetus has less capacity to feel pain c. repetitive blood draws have minimal long term consequences d. the preterm infant is more sensitive to painful stimuli

d nhibitory neurotransmitters are insufficient until birth at full. Therefore the preterm infant is rendered more sensitive to painful stimuli.

9.After teaching the parents of a toddler about commonly aspirated foods, which of the following foods, if identified by the parents as easily aspirated, would indicate the need for additional teaching?1.Popcorn.2.Raw vegetables.3.Round candy.4.Crackers.

4.R: Crackers, because they crumble and easily dissolve, are not commonly aspirated. Because children commonly eat popcorn hulls or pieces that have not popped, popcorn can be easily aspirated. Toddlers frequently do not chew their food well, making raw vegetables a commonly aspirated food. Round candy is often difficult to chew and comes in large pieces, making it easily aspirated.

16. Which assessment findings should lead the nurse to suspect that a toddler is experiencing respiratory distress? Select all that apply.1.Coughing.2.Respiratory rate of 35 breaths/min.3.Heart rate of 95 beats/min.4.Restlessness.5.Malaise.6.Diaphoresis.

1, 2, 4, 6.R: Coughing, especially at night and in the absence of an infection, is a common symptom of asthma. Early signs of respiratory distress include restlessness, tachypnea, tachycardia, and diaphoresis. Other signs also include hypertension, nasal flaring, grunting, wheezing, and intercostal retractions. A heart rate of 95 bpm is normal for a toddler. Malaise typically does not indicate respiratory distress.

20. When developing a teaching plan for the mother of an asthmatic child concerning measures to reduce allergic triggers, which of the following suggestions should the nurse include?1.Keep the humidity in the home between 50% and 60%.2.Have the child sleep in the bottom bunk bed.3.Use a scented room deodorizer to keep the room fresh.4.Vacuum the carpet once or twice a week.

1.R: To help reduce allergic triggers in the home, the nurse should recommend that the humidity level be kept between 50% and 60%. Doing so keeps the air moist and comfortable for breathing. When air is dry, the risk for respiratory infections increases. Too high a level of humidity increases the risk for mold growth. Typically, the child with asthma should sleep in the top bunk bed to minimize the risk of exposure to dust mites. The risk of exposure to dust mites increases when the child sleeps in the bottom bunk bed because dust mites fall from the top bed, settling in the bottom bed. Scented sprays should be avoided because they may trigger an asthmatic episode. Ideally, carpeting should be avoided in the home if the child has asthma. However, if it is present, carpeting in the child's room should be vacuumed often, possibly daily, to remove dust mites and dust particles.

Following parental teaching, the nurse is evaluating the parents understanding of environmental control for their childs asthma management. Which statement by the parents indicates appropriate understanding of the teaching?1. We will replace the carpet in our childs bedroom with tile.2. Were glad the dog can continue to sleep in our childs room.3. Well be sure to use the fireplace often to keep the house warm in the winter.4. Well keep the plants in our childs room dusted.

1Global Rationale: Control of dust in the childs bedroom is an important aspect of environmental control for asthma management. When possible, pets and plants should not be kept in the home. Smoke from fireplaces should be eliminated.

During a funduscopic examination of a school-age child, the nurse notes a brilliant, uniform red reflex in both eyes. The nurse should recognize that this is which? a. A normal finding b. A sign of a possible visual defect and a need for vision screening c. An abnormal finding requiring referral to an ophthalmologist d. A sign of small hemorrhages, which usually resolve spontaneously

ANS: A a brilliant, uniform red reflex is an important normal finding. It rules out many serious defects of the cornea, aqueous chamber, lens, and vitreous chamber.

14. A 12-year-old with asthma wants to exercise. Which of the following activities should the nurse suggest to improve breathing?1.Soccer.2.Swimming.3.Track.4.Gymnastics.

2.R: Swimming is appropriate for this child because it requires controlled breathing, assists in maintaining cardiac health, enhances skeletal muscle strength, and promotes ventilation and perfusion. Stop-and-start activities, such as soccer, track, and gymnastics, commonly trigger symptoms in asthmatic clients.

23. A 9-month-old child with cystic fibrosis does not like taking pancreatic enzyme supplement with meals and snacks. The mother does not like to force the child to take the supplement. The most important reason for the child to take the pancreatic enzyme supplement with meals and snacks is:1.The child will become dehydrated if the supplement is not taken with meals and snacks.2.The child needs these pancreatic enzymes to help the digestive system absorb fats, carbohydrates, and proteins.3.The child needs the pancreatic enzymes to aid in liquefying mucus to keep the lungs clear.4.The child will experience severe diarrhea if the supplement is not taken as prescribed.

2.R: The child must take the pancreatic enzyme supplement with meals and snacks to help absorb nutrients so he can grow and develop normally. In cystic fibrosis, the normally liquid mucus is tenacious and blocks three digestive enzymes from entering the duodenum and digesting essential nutrients. Without the supplemental pancreatic enzyme, the child will have voluminous, foul, fatty stools due to the undigested nutrients and may experience developmental delays due to malnutrition. Dehydration is not a problem related to cystic fibrosis. The pancreatic enzymes have no effect on the viscosity of the tenacious mucus. Diarrhea is not caused by failing to take the pancreatic enzyme supplement.

13. An 11-year-old is admitted for treatment of an asthma attack. Which of the following indicates immediate intervention is needed?1.Thin, copious mucous secretions.2.Productive cough.3.Intercostal retractions.4.Respiratory rate of 20 breaths/minute.

3.R: Intercostal retractions indicate an increase in respiratory effort, which is a sign of respiratory distress. During an asthma attack, secretions are thick, the cough is tight, and respiration is difficult (and shortness of breath may occur). If mucous secretions are copious but thin, the client can expectorate them, which indicates an improvement in the condition. If the cough is productive it means the bronchospasms and the inflammation have been resolved to the extent that the mucus can be expectorated. A respiratory rate of 20 breaths/min would be considered normal and no intervention would be needed.

21. After discussing asthma as a chronic condition, which of the following statements by the father of a child with asthma best reflects the family's positive adjustment to this aspect of the child's disease?1."We try to keep him happy at all costs; otherwise, he has an asthma attack."2."We keep our child away from other children to help cut down on infections."3."Although our child's disease is serious, we try not to let it be the focus of our family."4."I'm afraid that when my child gets older, he won't be able to care for himself like I do."

3.R: Positive adjustment to a chronic condition requires placing the child's illness in its proper perspective. Children with asthma need to be treated as normally as possible within the scope of the limitations imposed by the illness. They also need to learn how to manage exacerbations and then resume as normal a life as possible. Trying to keep the child happy at all costs is inappropriate and can lead to the child's never learning how to accept responsibility for behavior and get along with others. Although minimizing the child's risk for exposure to infections is important, the child needs to be with his or her peers to ensure appropriate growth and development. Children with a chronic illness need to be involved in their care so that they can learn to manage it. Some parents tend to overprotect their child with a chronic illness. This overprotectiveness may cause a child to have an exaggerated feeling of importance or later, as an adolescent, to rebel against the overprotectiveness and the parents.

15. When preparing the teaching plan for the mother of a child with asthma, which of the following should the nurse include as signs to alert the mother that her child is having an asthma attack?1.Secretion of thin, copious mucus.2.Tight, productive cough.3.Wheezing on expiration.4.Temperature of 99.4°F (37.4°C).

3.R: The child who is experiencing an asthma attack typically demonstrates wheezing on expiration initially. This results from air moving through narrowed airways secondary to bronchoconstriction. The child's expiratory phase is normally longer than the inspiratory phase. Expiration is passive as the diaphragm relaxes. During an asthma attack, secretions are thick and are not usually expelled until the bronchioles are more relaxed. At the beginning of an asthma attack the cough will be tight but not productive. Fever is not always present unless there is an infection that may have triggered the attack.

from you knowledge of the visual analog scale VAS which of the following is correct? a. is a highly subjective evaluation of pain b. is recommended for children who understand the value of numbers c. does not offer an option for "no pain" d. is recommended for children under three years of age

A. is a highly subjective evaluation of pain

8. The nurse teaches parents how to care for their child who has tympanostomy tubes inserted. Which actions by the parents indicate appropriate understanding of the teaching session? (Select all that apply.) 1. Encouraging the child to drink generous amounts of fluids 2. Administering a decongestant for one to two weeks following surgery 3. Restricting the child to quiet activities after surgery 4. Limiting diet to soft, bland foods5. Avoiding getting water in ears during bath time

Answer: 1,3,5Rationale 1: The correct responses include encouraging the child to drink generous amount of water, restricting the child to quiet activities after surgery, and avoiding water in the child's ears at bath time. Incorrect responses include administering a decongestant for one to two weeks following surgery and limiting diet to soft, bland foods—decongestants are not needed after surgery, and a regular diet should be resumed.

10. A school-age child has epistaxis. Which intervention by the school nurse is the most appropriate? 1. Tilting the child's head forward, squeezing the nares below the nasal bone, and applying ice to the nose 2. Tilting the child's head back, squeezing the bridge of the nose, and applying a warm, moist pack to the nose 3. Lying the child down and applying no pressure, ice, or warm pack 4. Immediately packing the nares with a cotton ball soaked with Neo-Synephrine

Answer: 1Rationale 1: The correct initial treatment for a nosebleed is to tilt the head forward, squeeze the nares below the nasal bone for 10 to 15 minutes, and apply ice to the nose or back of the head. Tilting the child's head back may cause the blood to trickle down the throat. Warmth can cause an increase in bleeding because of vasodilation. Lying the child down without application of pressure to the nares may not stop the bleeding. A cotton ball soaked with Neo-Synephrine would only be used if the bleeding does not stop with pressure and ice.

3. The nurse suspects that an infant has a visual disorder caused by abnormal musculature. Which test will the nurse perform to detect this disorder?1. A cover/uncover test2. An ophthalmologic exam3. A vision-acuity exam4. A pupil-reaction-to-light test

Answer: 1Rationale 1: The cover/uncover test can detect abnormal musculature of the eye that can lead to asymmetric eye movement. An ophthalmologic eye exam allows the practitioner to view the internal structures of the eye, not abnormal musculature. A vision acuity test is used to test for myopia. A pupil-reaction-to-light test evaluates neurological status.

14. The child who had a tonsillectomy earlier today is now awake and tolerating fluids. The child asks for something to eat. Which food choice is most appropriate for this client? 1. Orange slices 2. Lemonade 3. Grapefruit juice 4. Applesauce

Answer: 4 Rationale 1: Soft foods such as applesauce can be added as tolerated to a diet following a tonsillectomy. Citric juices or citric fruits should be avoided because they may cause a burning sensation in the throat.

7. An infant is diagnosed with acute otitis media. Which intervention is most appropriate for the nurse to teach the infant's parents? a. Keep the baby in a flat lying position during sleep. b. Administer acetaminophen (Tylenol) to relieve discomfort. c. Administer a decongestant. d. Place baby to sleep with a pacifier.

Answer: b Rationale 1: An infant with a bulging tympanic membrane because of acute otitis media will have pain. Parents are taught to administer acetaminophen (Tylenol) to relieve the discomfort associated with acute otitis media. A flat lying position may exacerbate the discomfort. Elevating the head slightly is recommended. Decongestants are not recommended for treatment of acute otitis media. Placing infants to sleep with a pacifier may increase the incidence of otitis media.

4. The nurse is caring for four clients. Which client has the highest risk of developing retinopathy of prematurity? a. 30-week-gestation infant who was in an Oxy-Hood for 12 hours and weighed 1800 grams. b. 32-week-gestation infant who needed no oxygen and weighed 1850 grams. c. 28-week-gestation infant who has been on long-term oxygen and weighed 1400 grams. d. 28-week-gestation infant who was on short-term oxygen and weighed 1420 grams.

Answer: c Rationale 1: The 28-week-gestation infant on oxygen weighing 1400 grams has the highest risk of retinopathy of prematurity because of gestational age (28 weeks or less), weight (less than 1500 g), and oxygen therapy. The other neonates have fewer risk factors.

While examining the broken arm of a 4-year-old boy, select the appropriate assessment tool to evaluate his pain status. A) 0 to 10 numeric rating scale B) Wong-Baker scale C) Simple descriptor scale D) 0 to 5 numeric rating scale

B.Rating scales can be introduced at 4 to 5 years of age. The Faces Pain Scale-Revised has six drawings of faces that show pain intensity, from "no pain" on the left (score of 0) to "very much pain" on the right (score of 10).