Peds Exam 2

Neuro - In caring for a 9-year-old child immediately following a head injury, which finding is most concerning to the nurse? a. Dilated and nonresponsive pupils b. Minimal response to pain c. Bp: 110/60 d. Slow response to name

a. Dilated and nonresponsive pupils

Neuro - Which client is treated by fluid and vasopressin replacement, along with correction of underlying intercranial pathology? a. Client with diabetes insipidus b. Client with diabetes mellitus c. Client with diabetic ketoacidosis d. Client with WIlm's tumor

a. Client with diabetes insipidus

Neuro - The nurse is caring for a young infant who has been admitted with a possible diagnosis of meningitis. Which of the following assessment findings should the nurse report?

c. Change in feeding pattern.

GU - What is the most important nursing intervention for a 4-year-old child with a diagnosis of nephrotic syndrome? a. Encouraging fluids b. Regulating the diet c. Preventing infection d. Maintaining bedrest

c. Preventing infection

Hematology - A 5-year-old child is admitted with sickle cell disease. Which assessment finding is most concerning to the nurse? a. Heart rate 135 b. Blood pressure 125/79 c. Pulse oximeter reading 90% d. Temp 100.5 orally

c. Pulse oximeter reading 90%

Cancer - A mother believes her son developed osteosarcoma due to playing football. What education should the nurse provide? a. "Football injuries do not contribute to the development of this tumor" b. "Osteosarcoma often follows trauma from a sports injury" c. "Tumor growth in the bones can be related to a decrease in calcium intake. d. "Chemotherapy will increase bone strength so he can play football again'

a. "Football injuries do not contribute to the development of this tumor"

Neuro - When educating the family of a child with seizures, it is appropriate to tell them to call emergency medical services (911) if the child has a seizure and which of the following findings listed below? a. Continuous vomiting for 30 minutes after the seizure. b. Stereotypic or automatous body movements during the onset. c. Lack of expression, pallor, or flushing of the face during the seizure. d. Unilateral or bilateral posturing of one or more extremities during the onset.

a. Continuous vomiting for 30 minutes after the seizure.

Endocrine - . The nurse recognizes that the parent of a 5-year-old female patient who was recently diagnosed with precocious puberty needs additional education about the pharmacologic management when which of the following statement is made? a. "I feel better knowing that she can stop taking those shots for her disease in 2 years." b. "If she misses one of her monthly shots, then her breasts will start growing again." c. "My husband and I will take turns giving her the shot for this problem." d. "I will let my daughter practice giving fake shots to her stuffed animal."

a. "I feel better knowing that she can stop taking those shots for her disease in 2 years."

GU - A child with idiopathic nephrotic syndrome is receiving corticosteroids. What statements by the parent about corticosteroids indicate further instruction is needed? Select all that apply. a. "My child's appetite is decreased because of the steroids." b. "My child will need 7 to 10 days of steroids for nephrotic syndrome." c. "Steroids help decrease how much protein is being lost in the urine." d. "Steroids increase the risk of my child getting an infection." e. "Steroids are commonly prescribed and have few side effects."

a. "My child's appetite is decreased because of the steroids." b. "My child will need 7 to 10 days of steroids for nephrotic syndrome." e. "Steroids are commonly prescribed and have few side effects."

GU - Which statement by a nurse would be the best response to a mother who wants to know what the first indication will be that her child's acute glomerulonephritis is improving? a. "Your child's urine output will increase." b. "Your child's urine will be free from protein." c. "Your child's blood pressure will stabilize." d. "Your child's energy will increase a lot."

a. "Your child's urine output will increase."

Endocrine - A child has blood glucose readings during a 24-hour period. What reading requires the most immediate intervention? a. 50 mg/dL b. 100 mg/dL c. 150 mg/dL d. 200 mg/dL

a. 50 mg/dL (hypoglycemia is much more serious then hyperglycemia)

GU - A child with glomerulonephritis has elevated BP and low urinary output for 12 hours. What should the nurse do next? a. Assess the child's neurological status b. Encourage the child to drink more water c. Advise the child to eat a low-sodium breakfast d. Help the child ambulate in the hallway

a. Assess the child's neurological status

Cancer - The nurse is providing preoperative care for a 7-year-old patient with a brain tumor. Which of the following is the priority intervention? a. Assessing the child's level of consciousness b. Providing a tour of the intensive care unit for the child and parents c. Educating the child and parents about shunts d. Having the child talk to another child who has had this surgery

a. Assessing the child's level of consciousness

Hematology - A toddler with hemophilia is hospitalized with multiple injuries after a fall. What is the nurse's highest priority? a. Assessing the child's level of consciousness frequently b. Administering packed red blood cells as ordered c. Discussing a safe play environment with the parents d. Taking measures to prevent post-injury infection

a. Assessing the child's level of consciousness frequently

Endocrine - The nurse is providing teaching for parents who are planning to administer prescribed growth hormone to their child at home. The parents ask the nurse what the best time is to give the medication. What is the best response? a. At bedtime b. Allow the child to choose the time c. In the morning with breakfast d. After dinner

a. At bedtime

Hematology - A child has recently been admitted to the pediatric unit with lab values indicating an increase in hemoglobin A2. Based on this finding, the nurse should expect to follow a care plan based on which condition? a. Beta-thalassemia trait b. Hemophilia A c. Christmas disease d. Sickle cell anemia

a. Beta-thalassemia trait

Cancer - What discharge instructions are most important for a child with neutropenia secondary to chemotherapy? a. Call provider if temperature is 38.3 C or higher b. Increase child's consumption of raw fruits and vegetables c. Discontinue granulocyte colony stimulating factor d. Administer acetaminophen if the child complains of pain

a. Call provider if temperature is 38.3 C or higher

Neuro - An infant with a myelomeningocele is scheduled for surgery to close the defect. Which nursing action would best facilitate parent-infant relationships in the preoperative period? a. Encouraging the parents to stroke and comfort the infant. b. Allowing the parents to cuddle the infant in their arms. c. Referring the parents to the Spina Bifida Association of America. d. Demonstrating feeding techniques in the prone position.

a. Encouraging the parents to stroke and comfort the infant.

Endocrine - Which of the following interventions should the nurse follow when administering a medication intranasally? a. Have the child lie on the same side where the medication was administered for several minutes after the medication is given. b. Have the child blow his or her nose after administering the medication. c. Have the child lie on the opposite side of where the medication was administered for several minutes after the medication is given. d. Ask the child if he or she swallowed the medication, as this indicates that the medication will be absorbed.

a. Have the child lie on the same side where the medication was administered for several minutes after the medication is given.

Hematology - A child is experiencing weight loss, paleness, fatigue, and not growing. What question should the nurse ask? a. How old is the house that you live in? b. Do you have pets in your home c. Do you live near a hydroelectric facility d. Are you a single parent

a. How old is the house that you live in? (Lead poisoning)

GU - The nurse is caring for a child diagnosed with hydronephrosis. Which of the following manifestations is consistent with complications of the disorder? a. Hypertension b. Hypotension c. Hypothermia d. Tachycardia

a. Hypertension

Neuro - The nurse is caring for a 6-month-old just admitted to the unit who is irritable, has bulging fontanels, and has been vomiting for the last six hours. The nurse knows that these clinical manifestations are indicative of which of the following? a. Increased intracranial pressure. b. Skull fracture. c. Myleomeningocele d. Meningocele

a. Increased intracranial pressure.

Hematology - The nurse is providing postoperative care to a pediatric patient with sickle cell disease. What is the most important intervention for the nurse to include in the plan of care? a. Increasing fluids b. Preparing the child psychologically c. Discouraging coughing d. Limiting the use of morphine

a. Increasing fluids

Neuro - An infant has a tense bulging fontanel, sunset eyes, and lethargy. Which diagnostic procedure is contraindicated? a. Lumbar puncture with sedation b. Magnetic response imaging without sedation c. Arterial blood draw by the RN d. Computerized tomography scan with contrast media

a. Lumbar puncture with sedation

Endocrine - All of the following should be followed by the nurse when measuring a child's height except: a. Measure the child to the nearest full inch. b. Use the supine position to measure an 18-month-old child. c. For a supine measurement, place the soles of the feet in a 90-degree angle to the footboard. d. Measure the child when the child is barefoot.

a. Measure the child to the nearest full inch.

Cancer - The nurse is assessing a 3-year-old child whose mother complains that he is listless and has been having trouble swallowing. Which of the following findings would suggest the child has a brain tumor? a. Observation reveals nystagmus and head tilt b. Vital signs show blood pressure measures 120/80 c. Examination shows temperature of 38.50C and headache d. Observation reveals a cough and labored breathing

a. Observation reveals nystagmus and head tilt

Endocrine - In a child with diabetes insipidus, the nurse could expect which characteristics of the urine? a. Pale in color; specific gravity less than 1.006 b. Concentrated; specific gravity less than 1.006 c. Concentrated; specific gravity greater than 1.033 d. Pale in color; specific gravity greater than 1.033

a. Pale in color; specific gravity less than 1.006

GU - Which condition is a protentional complication of vesicoureteral reflux? a. Renal Infection b. Acute glomerulonephritis c. Nephrotic syndrome d. Heart failure

a. Renal Infection

Hematology - A 10-year-old child who is admitted with sickle cell disease and acute severe pain is started on a PCA pump for pain management. Which of the following systems is most important for the nurse to assess? a. Respiratory b. Cardiovascular c. Neurological d. Musculoskeletal

a. Respiratory

Hematology - The nurse is being observed by a group of nursing students while assessing a child in vaso-occlusive crisis. A student asks the nurse why he did not palpate the child's abdomen. What is the most appropriate response by the nurse? a. Risk of splenic rupture b. Risk of inducing vomiting c. Increase in abdominal pain d. Risk of blood cell destruction

a. Risk of splenic rupture

Neuro - A 6-year-old child is admitted to the pediatric intensive care unit (PICU) after suffering a severe closed head injury on the left temporal area. An intracranial pressure (ICP) monitor is in place and reveals and ICP of 40 mm Hg. Based on this assessment data, would of the following would be the best position for the child to be placed? a. Supine with head midline. c. Supine with the head turned to the right. d. Supine with the head turned to the left. e. Side-lying on the left with the head turned to the right.

a. Supine with head midline.

Endocrine - A pediatric client is being treated for hyperthyroidism with propylthiouracil. The nurse suspects that the dose of medication is inadequate when assessing which signs and/or symptoms. Select all that apply. a. Tachycardia b. Diarrhea c. Cold intolerance d. Irritability e. Weight gain

a. Tachycardia b. Diarrhea d. Irritability

GU - A 10-year-old child with acute glomerulonephritis is admitted to the pediatric unit. The nurse should ensure that which action is part of the child's care? a. Taking vital signs every 4 hours and obtaining daily weight. b. Ensuring that albumen infusions are administered every evening. c. Checking every urine specimen for protein and specific gravity. d. Ensuring that the child has accurate input and output and eats a high-protein diet.

a. Taking vital signs every 4 hours and obtaining daily weight.

Neuro - A 3-month old infant has a ventriculoperitoneal (VP) shunt inserted. What intervention should the nurse plan to perform? a. Teach the parents the signs of increased intracranial pressure. b. Keep the infant in the prone position. c. Observe for signs of leakage of cerebrospinal fluid. d. Apply a sterile moist dressing to the incision.

a. Teach the parents the signs of increased intracranial pressure.

Neuro - A 4 year-old child is admitted after being hit in the head by a baseball. Which portion of the head is it most important for the nurse to assess due to the potential for injury to the middle meningeal artery? a. Temporal areas. b. Occipital area. c. Frontal areas. d. Basilar area.

a. Temporal areas.

Neuro - The nurse is palpating the head of a 5-month-old infant and expects to find: a. The anterior fontanel open and the posterior fontanel closed. b. The anterior fontanel closed and the posterior fontanel open. c. Both the anterior fontanel and posterior fontanel closed. d. Both the anterior fontanel and posterior fontanel are open.

a. The anterior fontanel open and the posterior fontanel closed.

Cancer - A 9-year-old scheduled for a lumbar puncture is fearful and worried about holding still. a. The use of conscious sedation for the lumbar puncture b. Administration of an oral antianxiety medication prior to the procedure c. Include the child's parent and child life specialist in the procedure room d. Delay the procedure until a better understanding and acceptance occurs

a. The use of conscious sedation for the lumbar puncture

Cancer - A 7-year-old child with osteosarcoma is being treated with chemotherapy. Which medication would the nurse expect the physician to order most commonly as a prophylaxis against Pneumocystis jirovecii? a. Trimethoprim-sulfamethoxazole b. Ketoconazole c. Filgastim d. Prednisone

a. Trimethoprim-sulfamethoxazole

Endocrine - Which of the following assessment findings in the 5-year-old child with diabetes insipidus would warrant the nurse contacting the physician immediately? a. Urinary output of greater than 100 mL/hr b. Serum sodium of 135 mEq/L c. Weight unchanged for 2 consecutive days d. Blood pressure of 90/60.

a. Urinary output of greater than 100 mL/hr

GU - A young school-aged child has been sent to the school nurse for urinary incontinence three times in the past 2 days. The school nurse should recommend that the parents have the child evaluated for which possible problem? a. Urinary tract infection b. Structural defect of kidneys c. School phobia d. Separation anxiety

a. Urinary tract infection (Secondary Enuresis)

Neuro - A 4-month-old is brought to the emergency department following a seizure. Which findings would lead the nurse to suspect the infant has experienced abusive head trauma or shaken baby syndrome? Select all that apply. a. Vomiting b. Difficulty breathing c. Head lag d. Lack of vocalization e. Hypotonia

a. Vomiting b. Difficulty breathing d. Lack of vocalization

Endocrine - The nurse is caring for an adolescent client postoperatively after having a portion of the thyroid gland removed 6 hours prior. The client rates incisional pain 6/10. The prescribed orders include morphine 1 to 2 mg IV every hour as needed for pain. The client is alert with vital signs within normal limits. How will the nurse best manage the client's pain? a. administer morphine 1 mg IV and reassess pain level in 20 minutes b. administer morphine 2 mg IV and reassess pain level in 1 hour c. administer morphine 1 mg IV and repeat the dose in 1 hour d. administer morphine 1 mg IV followed by morphine 2 mg IV in 1 hour

a. administer morphine 1 mg IV and reassess pain level in 20 minutes

Neuro - The nurse is educating the parents of a child being treated with an antiepilepsy drug. Which statement by the parent indicates that the teaching has been effective? a. "My child will wear a medical identification bracelet." b. "I will keep a seizure frequency chart for my child." c. "My child will stay away from potentially hazardous activities." d. "I will stop the drug immediately if my child has a side effect."

b. "I will keep a seizure frequency chart for my child."

Cancer - A 10-year-old boy is being prepared for a bone marrow transplant. The nurse can determine that the child understands this treatment when he says: a. "I'll be much better after this blood goes to my bones." b. "I won't feel too good until my body makes healthy cells." c. "This will help all of the medicine they give me to work better." d. "You won't have to wear a mask and gown after my transplant."

b. "I won't feel too good until my body makes healthy cells."

GU - The nurse is providing discharge teaching to the parents of a 3-year-old girl on how to obtain a clean-catch urine specimen. What is the most appropriate statement by the nurse? a. "Collect the urine sample right after her nap." b. "Never collect the first voided specimen of the day." c. "Collect the urine sample at the beginning of urination." d. "We no longer recommend washing the perianal area before collecting the specimen."

b. "Never collect the first voided specimen of the day."

GU - A nurse is caring for a 9-year-old boy with nocturnal enuresis with no physiologic cause. He says he is embarrassed and wishes that he could stop wetting his pants and the bed at night. How should the nurse respond? a. "You will outgrow this in a few years. You just need to be patient with your body as it grows." b. "There are several things we can do to help you achieve your goal." c. "There are almost 5 million people that have your problem." d. "The pull-ups look just like underwear. No one has to know."

b. "There are several things we can do to help you achieve your goal."

Endocrine - A 12-year-old male was just diagnosed with type 1 diabetes. As the nurse teaches him about insulin injections, he asks why he cannot take the diabetic pills that his uncle takes. What would be the best response by the nurse? a. "You will be able to take the pills once you reach you reach adulthood." b. "You have a different type of diabetes where the pill will not work." c. "We have to test you to see if you can take the diabetic pill." d. "You might be able to switch between taking the pills and insulin if you eat right."

b. "You have a different type of diabetes where the pill will not work."

Cancer - A child receiving chemo develops mucositis and refuses to eat. What should the nurse recommend to the provider. a. Viscous Lidocaine b. 1:1 Benadryl and Maalox c. 1:1 Acetaminophen and Codeine d. Half strength hydrogen peroxide mouth rinse

b. 1:1 Benadryl and Maalox

Neuro - A child has been having periods of unawareness with short periods of staring. The child is probably experiencing: a. Complex partial seizures b. Absence seizures c. Myoclonic seizures d. Tonic seizures

b. Absence seizures

Endocrine - A child is admitted with complaints of weight loss and lack of energy. The child's ears and cheeks are flushed. The nurse observes an acetone odor to the child's breath. The child's serum glucose level is 325 mg/dL, BP is 104/60, pulse is 88 and respirations are 16. Which of the following does the nurse expect the physician to order first? a. Subcutaneous administration of glucagon b. Administration of IV regular insulin by continuous infusion pump c. Administration of regular insulin subcutaneously every 2 hours as needed by sliding scale insulin d. Administration of IV fluids in boluses of 20 mL/kg

b. Administration of IV regular insulin by continuous infusion pump

Cancer - . Which complications are the three main consequences of leukemia? a. Bone deformities, spherocytosis and infection. b. Anemia, infection, and bleeding tendencies. c. Lymphocytopoiesis, growth delays, and hirsutism. d. Polycythemia, decreased clotting time, and infection.

b. Anemia, infection, and bleeding tendencies.

Cancer - An immune compromised client with cancer is being treated for a leg wound infection which has minimal redness and is unchanged since admission. The child's temperature has increased to 99.9 F orally. What should be the nurse's next action? a. Document the findings in the medical record. b. Assess today's white blood cell count. c. Administer 325 mg acetaminophen orally. d. Elevate the leg on two pillows.

b. Assess today's white blood cell count.

Endocrine - The nurse is educating a group of older school-age children who were recently diagnosed with type 1 diabetes and their parents about disease management. Which guideline is most accurate regarding insulin injections? a. Self-injection techniques should only be taught when the child can reach all injection sites. b. At age 11, the child should be old enough to administer most of their injections. c. Self-injection techniques are not usually taught until the child reaches age 16. d. The parents do not need to be involved in learning how to administer the injections.

b. At age 11, the child should be old enough to administer most of their injections.

Neuro - The nurse is assessing a child that experienced a traumatic injury to the head. What statement identifies a difference between children and adults that may produce a life-threatening complication for a child? a. Cerebral tissues in children are softer, thinner, and more flexible. b. A child's skull can expand more than an adult's can. c. Greater portions of a child's blood volume flows to the head. d. Hematomas in children can include subdural, epidural, and intracerebral.

b. Because a child's skull can expand more than an adult's can, a greater amount of posttraumatic edema can occur before we are able to assess any neurological problems or deficits. The suture lines and fontanels allow for expansion of the skull.

Neuro - A child hospitalized with hydrocephalus is being treated with an externalized ventricular drain (EVD). A nurse begins the afternoon assessment and discovers that the drain is positioned several inches below the level of the child's external meatus. What should be the nurse's priority action? a. Raise the drain to the level of the child's external meatus. b. Clamp the drain and complete a neurological assessment. c. Quickly elevated the head of the bed. d. Leave the drain as is and monitor the CSF drainage hourly.

b. Clamp the drain and complete a neurological assessment.

Hematology - A child with sickle cell anemia is being discharged after treatment for a crisis. Which instructions for avoiding future crises would the nurse provide to the child and family? Select all that apply. a. Avoid foods high in folic acid. b. Drink plenty of fluids. c. Use cold packs to relieve joint pain. d. Report a sore throat to an adult immediately. e. Restrict activity to quiet board games. f. Wash hands before meals and after playing.

b. Drink plenty of fluids. d. Report a sore throat to an adult immediately. f. Wash hands before meals and after playing.

Cancer - An adolescent is admitted to the hospital with a diagnosis of acute lymphocytic leukemia. Which clinical manifestations require the most urgent nursing interventions? a. Fatigue & anorexia b. Fever & petechiae c. Swollen neck lymph nodes & lethargy d. Enlarged liver & spleen

b. Fever & petechiae

GU - What is the most important intervention for the nurse to include in the care plan for a male infant following surgical repair of hypospadias? a. Sterile dressing changes every 4 hours b. Frequent assessment of the tip of the penis c. Removal of the suprapubic catheter on the 2nd postoperative day d. Urethral catheterization if voiding does not occur over an 8-hour period

b. Frequent assessment of the tip of the penis

Hematology - An iron dextran (INFeD) injection has been ordered for an 8-month-old infant with iron deficiency anemia. How should the nurse administer the injection? a. Subcutaneously to avoid a Z-track method b. Intramuscularly using the Z-track method c. Intramuscularly at a 45-degree angle d. Subcutaneously at a 90-degree angle

b. Intramuscularly using the Z-track method

Hematology - Which discharge instructions will the nurse provide for the parent of a child with iron deficiency anemia? a. Take 2 iron supplements after missing a dose b. Iron supplements should be taken between meals with orange juice c. Increased vitamin D milk consumption in infants less than 12 d. Avoid foods high in vitamin C since they decrease iron absorption

b. Iron supplements should be taken between meals with orange juice

Hematology - A nurse is developing a teaching plan for parents of a toddler who has just been diagnosed with sickle cell disease. Which statement is important to emphasize in the teaching plan? a. If they have any children, those children will probably have sickle cell disease too. b. Knowing how to prevent vaso-occlusive crisis is an important part of the parent's role. c. The child will have a greater tendency to bleed and should avoid contact sports. d. Vaso-occlusive crisis will occur eventually, requiring medical care in the emergency department.

b. Knowing how to prevent vaso-occlusive crisis is an important part of the parent's role.

GU - An adolescent client was diagnosed with acute glomerulonephritis 1 day ago. Which finding requires immediate action a. Blood pressure of 100/60 b. Large amounts of RBCs in the urine c. Urine specific gravity of 1.025 d. 24-hour output of 1,000 mL

b. Large amounts of RBCs in the urine

Neuro - A child is brought to the emergency department with a head injury. When assessing a child with an acute head trauma, which of the following would the nurse initially check? a. Ocular signs. b. Level of consciousness. c. Muscular strength. d. Superficial injuries to the head.

b. Level of consciousness.

Endocrine - The nurse is reviewing lab results of a neonate who has the possible diagnosis of congenital hypothyroidism. The nurse is most concerned by which results? a. High level of T4 and low level of TSH b. Low level of T4 and high level of TSH c. Normal TSH and high level of T4 d. Normal T4 and low level of TSH

b. Low level of T4 and high level of TSH

Cancer - A 3-year-old girl with a Wilms tumor is returning to the unit after a simple nephrectomy. Which of the following actions have the highest priority in caring for this child? a. Maintaining NPO. b. Monitoring the BP every 2 hours. c. Turning her every 2 hours. d. Administering pain medication every 4 hours.

b. Monitoring the BP every 2 hours.

Hematology - . Which treatment would be most appropriate for a child diagnosed with iron-deficiency anemia? a. Packed red blood cell transfusion b. Oral ferrous sulfate c. An iron-fortified cereal d. Intramuscular iron dextran

b. Oral ferrous sulfate

Hematology - The nurse is caring for a child with hemophilia. Which nursing action should be implemented into the plan of care? a. Encourage increased fluid intake b. Pad the sides of rails on the bed c. Adminster IV immunoglobulin d. Monitor temperature every 2 hours

b. Pad the sides of rails on the bed

Hematology - Which of the following assessment findings would indicate vaso-occlusive crisis in a child with sickle cell disease? a. Painful urination b. Pain with ambulation c. Complaints of sore throat d. Fever with associated rash

b. Pain with ambulation

Cancer - The nurse is assessing a 14-year-old girl with a tumor. Which of the following findings would indicate Ewing' sarcoma? a. Child complains of dull bone pain just above the knee. b. Palpation reveals non-tender swelling on the right ribs. c. Parents report a mass on the abdomen that crosses the midline. d. Palpation reveals asymptomatic mass on the upper back.

b. Palpation reveals non-tender swelling on the right ribs.

The nurse assists the parents of a child on a ketogenic diet to make which menu selection? a. Baked potato b. Pecan pie with ice cream c. Creamed corn d. Roast beef sandwich

b. Pecan pie with ice cream

Neuro - Which nursing intervention should be included to support the goal of avoiding injury, respiratory distress, and aspiration during a seizure? a. Placing a rolled blanket or towel under the neck to hyperextend the head. b. Placing a hand under the child's head for support. c. Using pillows to prop the child into the sitting position. d. Place a padded tongue blade or small plastic airway between the teeth.

b. Placing a hand under the child's head for support.

Endocrine - A child has demonstrated a sudden onset of thyrotoxicosis. The nurse anticipates that, besides anti-thyroid therapy, the child is likely also to receive which medication? a. ibuprofen (Motrin) b. Propranolol (Inderal) c. Digoxin (Lanoxin) d. metformin (Glucophage)

b. Propranolol (Inderal)

Neuro - The nurse knows that which is a risk factor for developing Reye syndrome? a. Recent history of infectious cystitis by Candida b. Recent history of viral gastroenteritis c. Recent history of Haemophilus influenza meningitis d. Recent history of bacterial otitis media

b. Recent history of viral gastroenteritis

GU - When obtaining a child's daily weight, the nurse notes a 6 lb. (2.7 kg) loss after 3 days of hospitalization for acute glomerulonephritis. The nurse determines that this is most likely the result of which factor? a. Poor appetite b. Reduction of edema c. Decreased salt intake d. Restriction to bedrest

b. Reduction of edema

Cancer - A parent of a child with Wilms tumor asks the nurse about surgery. Which statement concerning the type of surgery for Wilms tumor is most accurate? a. Surgery is only done if chemotherapy and radiation fail. b. Surgery is usually performed within 24 to 48 hours of admission. c. Surgery is the least favorable therapy for the treatment of Wilms tumor. d. Surgery will be delayed until the child's overall health status improves.

b. Surgery is usually performed within 24 to 48 hours of admission.

Neuro - A 5-year-old child is brought to the emergency department unconscious after being hit by a car. The most helpful information for the nurse performing the neurological assessment is the nurse's knowledge of: a. Normal growth and development. b. The child's usual behavior and status. c. The child's past medical history. d. The child's growth and developmental progress during infancy.

b. The child's usual behavior and status.

Neuro - A child returns to the unit from the PACU after undergoing placement of an internal VP shunt on the left side. Which nursing interventions are appropriate for the client's postoperative care? Select all that apply. a. Place a pillow under the child's head so the neck is flexed. b. Turn the child on the right side. c. Place pillows under the child's legs to promote venous return. d. Maintain the child in a supine position. e. Apply a soft collar to keep the child's neck in a neutral position.

b. Turn the child on the right side. e. Apply a soft collar to keep the child's neck in a neutral position.

Neuro - A child with an EVD has a headache and nausea after breakfast. The EVD tube is clamped. What action should the nurse take? a. Assess the child's vital signs and neurological status b. Unclamp the tubing that leads to the drainage c. Notify the provider that the child has a headache and nausea d. Call the rapid response team and the charge nurse

b. Unclamp the tubing that leads to the drainage

Neuro - The nurse is caring for a child who was not wearing a helmet, fell off of a bike, and sustained a head injury. Which of the following clinical manifestations would indicate the child is experiencing increased intracranial pressure? a. Hypotension b. Widened pulse pressure. c. Narrow pulse pressure. d. Tachycardia.

b. Widened pulse pressure.

Hematology - The nurse is assessing a patient in the ED suspected of being in vaso-occlusive crisis. Which assessment findings would indicate that the patient is having a vaso-occlusive crisis? a. Hypotension and thready pulse b. Pallor and poor capillary refill c. Anemia, jaundice and reticulocytosis d. Acute leg pain and swelling of both hands

d. Acute leg pain and swelling of both hands

GU - A nurse is questioned by a nursing student about the difference between hypospadias and epispadias. Which response by the nurse is best? a. "Episadias defects can only occur in males, affects sterility and the urethra is longer than normal. Hypospadias defects can occur in either sex, never affects sterility or the urethral meatus is proportionally larger than the length of the meatus." b. "The difference between the defects is the length of the urethra, size of the urethral meatus, the sex of the child, and the position of the opening. In hypospadias, the abnormal opening occurs dorsal to the penis. In epispadias, the abnormal opening occurs below the vagina." c. "Hypospadias is an abnormal opening on the ventral side of the penis and epispadias is an abnormal opening of the dorsal side of the penis." d. "Hypospadias is an abnormal opening on the dorsal side of the penis and epispadias is an abnormal opening on the ventral side of the penis."

c. "Hypospadias is an abnormal opening on the ventral side of the penis and epispadias is an abnormal opening of the dorsal side of the penis."

GU - What statement made by the parents of a child undergoing hypospadias repair implies the need for further teaching about the primary objective of surgical correction? a. "The purpose is to improve the physical appearance of the genitalia for psychological reasons." b. "The purpose is to enhance the child's ability to void in the standing position." c. "The purpose is to decrease the chance of developing urinary tract infections." d. "The purpose is to preserve a sexually adequate organ."

c. "The purpose is to decrease the chance of developing urinary tract infections."

Neuro - Which of the following statements is true regarding assessment of the fontanels of a 2-month-old? a. Place the infant in the supine position to assess the fontanels. b. A sunken, depressed fontanel indicates the infant has decreased cognitive functioning. c. A bulging, tense fontanel indicates increased intracranial pressure. d. The anterior fontanel should be closed be almost closed by age 2-months.

c. A bulging, tense fontanel indicates increased intracranial pressure.

Cancer - The nurse is teaching the parents of a 15-year-old who is being treated for acute myelogenous leukemia about the side effects of chemotherapy. For which of the following symptoms should the parents seek medical care immediately? a. Ear ache, stiff neck or sore throat b. Blisters, ulcers or a rash appear c. A temperature of 101.5 degrees Fahrenheit d. Difficulty or pain when swallowing

c. A temperature of 101.5 degrees Fahrenheit

GU - The nurse is administering cyclophosphamide as ordered to a 12-year-old child with nephrotic syndrome. Which of the following instructions is most accurate regarding administration of this cytotoxic drug? a. Administer in the evening on an empty stomach and cannot void for 30 minutes after administration b. Provide adequate hydration and encourage voiding as needed during administration c. Administer in the morning, encourage fluids and voiding during and after administration d. Encourage fluids, adequate food intake and voiding before and after administration

c. Administer in the morning, encourage fluids and voiding during and after administration

Hematology - A client with a history of sickle cell disease reports abdominal pain. What is the priority nursing intervention? a. Obtaining a history of the sequence of symptoms b. Keeping the client NPO c. Administering IV fluids d. Preparing the client for a CT scan of the abdomen

c. Administering IV fluids

Neuro - Which of the following is the priority for the nurse to assess in the plan of care for a child who had a closure of a neural tube defect? a. The presence of a urinary tract infection. b. An alteration in bowel function. c. An increased intracranial pressure. d. An alteration in the motor function in the legs.

c. An increased intracranial pressure.

Neuro - The nurse assesses an 8-month-old infant for a possible head injury and skull fracture after a fall of about 3 feet. The child is awake, alert and crying. The vital signs are within normal limits. What action should the nurse take next? a. Interview the parents about the fall. b. Obtain immediate intravenous access. c. Assess the infant's pupillary response. d. Apply 100% supplemental oxygen.

c. Assess the infant's pupillary response.

Hematology - What is the treatment of choice for severe aplastic anemia? a. Liver transplantation b. Exchange transfusions c. Bone marrow transplantation d. Administration of IV immunoglobulins

c. Bone marrow transplantation

Neuro - An adolescent is admitted to the hospital with a head injury and possible temporal skull fracture sustained when riding a bicycle without a helmet. On admission, the client was conscious but lethargic. The vital signs indicated temperature 990F, pulse 100 bpm, respirations 18 breaths/min, and BP 130/80. The nurse should report which changes to the provider if they occur? Select all that apply. a. Decreasing urinary output b. Decreasing systolic BP c. Bradycardia d. Widening pulse pressure e. Increasing diastolic BP

c. Bradycardia d. Widening pulse pressure

GU - A school-aged child with acute glomerulonephritis has a nursing diagnosis of impaired urinary elimination related to fluid retention and impaired glomerular filtration. Which patient goal best addresses the expected outcome for this diagnosis? a. Exhibits no evidence of infection b. Engages in activities appropriate to capabilities c. Demonstrates no periorbital, facial or body edema d. Maintains a fluid intake of more than 2000 mL in a 24-hour period

c. Demonstrates no periorbital, facial or body edema

Endocrine - Which observation when plotting height and weight on a growth chart would indicate that a 4 year-old child has a growth hormone deficiency? a. Upward shift of 1 percentile or more b. Upward shift of 5 percentiles or more c. Downward shift of 2 percentiles or more d. Downward shift of 5 percentiles or more

c. Downward shift of 2 percentiles or more

Endocrine - The nurse is assessing a child with juvenile hypothyroidism. The nurse documents which of the assessment findings that is consistent with this condition? a. Accelerate growth b. Diarrhea c. Dry skin d. Yellow sclera

c. Dry skin

Neuro - After talking with the parents of a child with Down syndrome, the nurse should help the parents establish which goal? a. Encourage more lenient behavior limits for the child b. Teach the child something new everyday c. Encourage self-care skills in the child d. Achieve age-appropriate social skills

c. Encourage self-care skills in the child

Endocrine - A teenage mother arrives at the clinic with her newborn infant who was recently diagnosed with congenital hypothyroidism. When instructing the mother about administering levothyroxine, what information should the nurse include? a. Crush the medication and place it in a full bottle of formula or breast milk to disguise the taste. b. Administer the medication every 3rd day for 2 weeks, then every other day for 2 weeks and then prn. c. Give the crushed medication in a syringe or in the nipple mixed with a small amount of formula. d. Explain that the medication will no longer be needed after the child reaches 5 years of age.

c. Give the crushed medication in a syringe or in the nipple mixed with a small amount of formula.

Cancer - The nurse is caring for a 4-year-old child following surgical removal of a stage I neuroblastoma. Which of the following interventions will be most appropriate for this child? a. Applying aloe vera lotion to irradiated areas of skin b. Administering antiemetics as prescribed for nausea c. Giving medications as ordered via least invasive route d. Maintaining isolation as prescribed to avoid infection

c. Giving medications as ordered via least invasive route

GU - The nurse is assessing an infant with suspected hemolytic uremic syndrome. Which of the following characteristics of this condition would the nurse expect to assess, including information from the electronic medical record? a. Hemolytic anemia, acute renal failure, & hypotension b. Dirty green colored urine, elevated erythrocyte sedimentation & depressed serum complement level c. Hemolytic anemia, thrombocytopenia & acute renal failure d. Thrombocytopenia, hemolytic anemia, & nocturia several times each night

c. Hemolytic anemia, thrombocytopenia & acute renal failure

Neuro - After a head injury, a client has enuresis, polydipsia, and weight loss. The nurse should monitor closely for: a. Hyperglycemia b. Hyperkalemia c. Hyponatremia d. Hypokalemia

c. Hyponatremia

Hematology - A 4-year-old child has a petechial rash but is otherwise well. The platelet count is 20,000/mL. The hemoglobin level and white blood cell count are normal. Which diagnosis is most likely? a. Acute lymphoblastic leukemia (ALL) b. Disseminated intravascular coagulation (DIC) c. Idiopathic thrombocytopenic purpura (ITP) d. Systemic lupus erythematosus (SLE)

c. Idiopathic thrombocytopenic purpura (ITP)

Cancer - Which of the following findings would be most indicative of retinoblastoma for an 18-month old child? a. Orbital inflammation of the right eye and head tilt when standing. b. Cat's eye reflex and yellow discharge from the left eye. c. Leukocoria and hyphema noted for the right eye. d. Strabismus in the left eye and light sensitivity in the opposite eye.

c. Leukocoria and hyphema noted for the right eye.

Neuro - Which one of the following nursing assessment findings would supply data about a major complication in an infant with a myelomeningocele? a. Obtaining the infant's weight. b. Monitoring the infant's urinary output every shift. c. Measuring the infant's head circumference daily. d. Assessing the infant's blood pressure every 12 hours.

c. Measuring the infant's head circumference daily.

Neuro - A 12-year-old child was admitted to the neurosurgical unit for observation after receiving a head injury. The details of how the injury occurred are unknown. It is now 12 hours after the injury and the child has demonstrated no signs or symptoms of a head injury. Which of the following would be the priority intervention for the nurse to perform? a. Promote rest by creating a quiet environment. b. Administer opioids for complaints of a headache. c. Monitor the level of consciousness every hour as ordered. d. Question the child about the circumstances leading to the injury.

c. Monitor the level of consciousness every hour as ordered.

Neuro - A newborn arrives in a neonatal intensive care unit with a myelomeningocele. A physician writes orders to keep the infant in the prone position. A nurse should know that which one of the following is the most important rationale behind this order? a. Prevent infection. b. Promote circulation to the lower extremities. c. Prevent trauma to the meningeal sac. d. Promote comfort.

c. Prevent trauma to the meningeal sac.

Cancer - The nurse is caring for a 6-year-old child with leukemia who is having an oncological emergency. Which of the following signs and symptoms would indicate hyperleukocytosis? a. Bradycardia and distinct S1 and S2 sounds b. Wheezing and diminished breath sounds c. Respiratory distress and poor tissue perfusion d. Intermittent fever and frequent vomiting

c. Respiratory distress and poor tissue perfusion

Endocrine - A child has experienced symptoms of hypoglycemia and has eaten sugar cubes. The priority intervention by the nurse would be to have the child ingest which of the following next? a. Four cups of water b. Candy bar or cake frosting c. Slice of bread with peanut butter d. Chicken or fish without bread

c. Slice of bread with peanut butter

Cancer - The nurse would be surprised if the parents of a child with leukemia report that which one was the first sign received? a. A loss of appetite b. Paleness of the skin c. Sores in the mouth d. Purplish spots on the skin

c. Sores in the mouth

Endocrine - Which finding is a possible side effect of being treated with daily oral levothyroxine for congenital hypothyroidism? a. Anorexia b. Constipation c. Sweating d. Sleepiness

c. Sweating

GU - The nurse is caring for an 11-year-old boy diagnosed with acute glomerulonephritis. When reviewing the boy's health history, which of the following will likely be noted? a. The boy has a history of recurrent urinary tract infections b. The boy has a family history of renal disorders c. The boy has a recent history of an upper respiratory infection d. The boy has a history of hypotension

c. The boy has a recent history of an upper respiratory infection

Neuro - What instructions should the nurse give the parents of a child with a seizure disorder to promote growth and development? a. The child will need activity l imitation and may not perform as well as peers b. There is potential for a learning disability and tutoring may be required c. The child will likely have normal intelligence and attend regular school d. Problems associated with social stigma may occur and require home schooling

c. The child will likely have normal intelligence and attend regular school

GU - The nurse is caring for a 9-year-old girl presenting with fever, dysuria, flank pain, urgency and hematuria. The nurse would expect which of the following tests to be ordered first to reveal preliminary information about the urinary tract? a. Total protein, globulin and albumin b. Creatinine clearance c. Urinalysis d. Urine culture and sensitivity

c. Urinalysis

Endocrine - The nurse is administering methimazole (Tapazole) to a 12-year-old recently diagnosed with hyperthyroidism. The child has been receiving the medication 3 times a day for 2 weeks. She suddenly reports onset of a severe sore throat. What would be the appropriate nursing action? a. Continue to give the medication or she will continue to exhibit signs of hyperthyroidism. b. Offer lozenges for the relief of the sore throat. c. Withhold the dose and report this to the physician. d. Ask the child's parents to rate the pain on a scale from 0 - 10.

c. Withhold the dose and report this to the physician.

Endocrine - A school-age client in the 2nd percentile of height and weight for age due to an endocrine disorder will be treated with: a. desmopressin acetate (DDAVP) b. antidiuretic hormone (ADH) c. biosynthetic growth hormone d. testosterone or estrogen

c. biosynthetic growth hormone

GU - The nurse knows that teaching is required when the new nurse states which finding is expected with nephrotic syndrome? a. elevated triglycerides b. elevated cholesterol c. hyperalbuminemia d. proteinuria

c. hyperalbuminemia (nephrotic syndrome is hypo)

Hematology - To help prevent complications from sickle cell disease during ages 2 months to 5 years, which medication is prescribed on a daily basis? a. diphenhydramine b. acetaminophen c. penicillin d. hydroxyurea

c. penicillin

Cancer - The nurse is preparing an adolescent diagnosed with leukemia for a lumbar puncture. The nurse determines that the child understands the reason for the procedure when the child states that the procedure is done to: a. "Make sure I don't have meningitis along with my cancer." b. "Relieve some of the pressure on my brain." c. "Remove the blood cancer cells so I don't have to have surgery." d. "Check to see if the cancer has spread through my spinal cord and brain."

d. "Check to see if the cancer has spread through my spinal cord and brain."

Neuro - A nurse and nursing student are caring for a child who sustained a head injury as a result of a fall from a play structure. Which statement by the nursing student best indicates that the student is prepared to care for the child? a. "I will be sure to let you know if the child's pupils become fixed and dilated." b. "I will keep the child straight in the supine position." c. "I will notify the physician if the child becomes sleepy." d. "I will look for any changes in the child's respirations, pulse or blood pressure."

d. "I will look for any changes in the child's respirations, pulse or blood pressure."

Hematology - The nurse is reviewing the interventions listed in the plan of care for a child in vaso-occlusive crisis. What is the most important intervention for the nurse to implement? a. Administering analgesics b. Monitoring fluid restrictions c. Encouraging activity as tolerated d. Administering oxygen as ordered

d. Administering oxygen as ordered

Hematology - A child with hemophilia fell and has a moderately bruised knee. Which action should the nurse take to manage hemarthrosis? a. Use active range of motion to prevent immobility b. Apply cold packs to promote vasoconstriction c. Notify the health care provider (HCP) of the injury d. Apply pressure and immobilize the joint

d. Apply pressure and immobilize the joint

Cancer - What is the priority discharge instructions for a child recovering from a resection of a Wilms' tumor? a. Low-sodium diet b. Restrict fluid intake c. Limit protein intake d. Avoid contact sports

d. Avoid contact sports

Endocrine - Which instructions should be provided when a child with diabetes insipidus will be receiving desmopressin nasal spray a. Give desmopressin only when urine output begins to decrease b. Clean the skin around the nares with an alcohol pad before each use c. Increase the dose if polyuria occurs prior to the next scheduled dose d. Call the provider if the child has allergic or upper respiratory infection

d. Call the provider if the child has allergic or upper respiratory infection

Hematology - The nurse is caring for a patient with suspected anemia. Which objective finding is significant? a. History of pica b. Daily aspirin therapy c. Tonsillectomy 3 days ago d. Cheilosis and and glossitis

d. Cheilosis and and glossitis

Hematology - Which sickle cell client should the nurse see first? a. Child with icteric sclera, pallor, and fatigue b. Child with abdominal pain after eating high-fat meal c. Child complaining of painful swelling of feet and hands d. Child whose speech is slurred and has hemiparesis

d. Child whose speech is slurred and has hemiparesis

Hematology - The child who is diagnosed with thalassemia major (Cooley anemia) typically suffers complications from the disease and treatment. The nurse is aware that this child is at risk for which of the following? a. Hypertrophy of the thyroid b. Hypertrophy of the thymus c. Polycythemia vera and thrombosis d. Chronic hypoxia and iron overload

d. Chronic hypoxia and iron overload

Hematology - Which of the following conditions most warrants the pediatric patient with sickle cell disease to receive a blood transfusion? a. Hemoglobin 6.9 b. Pain unrelieved by morphine c. Elevated reticulocyte count d. Coughing and respiratory difficulty

d. Coughing and respiratory difficulty

Neuro - The nurse is caring for an infant who is born with hydrocephalus and has a shunt inserted. Which of the following signs indicates that the shunt is functioning properly? a. Positive sunset sign. b. A bulging fontanel. c. Widened suture lines. d. Decreasing daily head circumference.

d. Decreasing daily head circumference.

Endocrine - The nurse is working with a newborn in adrenal crisis. All of the following interventions by the nurse are appropriate except a. Address the newborn with ambiguous genitalia as "baby," not he, she or it. b. Support the family until sexual assignment of the newborn can be determined. c. Administer cortisone as prescribed. d. Describe the sex organs of the newborn as penis until corrective surgery can take place.

d. Describe the sex organs of the newborn as penis until corrective surgery can take place.

Cancer - Which of the following interventions would be best for the child who has developed mucositis as a side effect of chemotherapy? a. Using lemon glycerin swabs for oral hygiene. b. Keeping the child NPO until all sores are healed. c. Having the child swish and swallow viscous lidocaine. d. Giving the child pudding for breakfast.

d. Giving the child pudding for breakfast.

Neuro - Which assessment leads the nurse to suspect extensive upper brain stem damage in a child with a head injury? a. Hyperflexion of the arms and hyperextension of the legs b. Hyperflexion of both arms and legs c. Hyperextension of the arms and hyperflexion of the legs d. Hyperextension of both arms and legs

d. Hyperextension of both arms and legs

Endocrine - Which statement indicates a need for further teaching for a parent of a child with diabetes insipidus? a. "This condition could be familial or congenital" b. "An infection such as meningitis may be the reason she has the problem" c. "My child might have a tumor that's causing these symptoms" d. "Inflammation of the pancreas is why this is happening to her"

d. Inflammation of the pancreas is why this is happening to her

Endocrine - The nurse is assessing an infant with diabetes insipidus. What initial observation would the nurse expect? a. Dehydration b. Inability to be aroused c. Extreme hunger d. Irritability

d. Irritability

Neuro - Which statement from the parent of a toddler should alert the nurse to suspect that the child has had a febrile seizure? a. My child has had a low-grade fever for b. No one in our family has ever had a convulsion c. My child stopped breathing when the seizure happened d. My child has had an upper respiratory infection for 2 days

d. My child has had an upper respiratory infection for 2 days

Neuro - A 2-year-old child is admitted to the neurosurgical unit following a head injury. The nurse is using the pediatric Glasgow Coma Scale to measure neurological function. Which assessment finding indicates the lowest level of functioning for this child? a. Confusion. b. Irritable and cries. c. Eyes open only to pain. d. No response to painful stimuli.

d. No response to painful stimuli.

Cancer - A child is seen in the pediatrician's office for complaints of bone and joint pain. Which other assessment finding may indicate leukemia? a. Abdominal pain b. Increased activity level c. Increased appetite d. Petechiae

d. Petechiae

Neuro - An 18-month-old child is observed having a seizure. The nurse notes that the child's jaws are clamped. What is the priority responsibility of the nurse at this time? a. Start oxygen via a face mask and apply a pulse oximeter. b. Insert a padded tongue blade and turn child to side. c. Restrain the child and put the side rails up. d. Protect the child from harm from the environment.

d. Protect the child from harm from the environment.

Cancer - Which condition assessed by the nurse would be an early warning sign of childhood cancer? a. Difficulty swallowing b. Frequent cough or hoarseness c. Change in bowel and bladder habits d. Swellings, lumps or masses anywhere on the body.

d. Swellings, lumps or masses anywhere on the body.

GU - A child with nephrotic syndrome has these prescriptions: 1. D/C prednisone 40 mg po daily 2. prednisone 30 mg po QOD: a. The nurse will discontinue the prednisone 40 mg and give the 30 mg dose today b. The nurse will check MAR to see when the last dose of prednisone was given c. The nurse will start the 30 mg dose of prednisone tomorrow d. The nurse will call the provider for clarification of the orders

d. The nurse will call the provider for clarification of the orders

GU - A child who had a recent surgery for hypospadias had a urinalysis. Which results should be reported to the provider? a. Urine specific gravity of 1.017 b. Ten red blood cells per high-powered field c. Urine pH of 6.0 d. Twenty-five white blood cells per high-powered field

d. Twenty-five white blood cells per high-powered field

Neuro - A child with a shunt infection has an EVD placed. Which finding indicates over drainage of the ventricles? a. Tachycardia b. Polydipsia c. Ataxia d. Vomiting

d. Vomiting

Endocrine - The nurse is caring for a child with diabetes insipidus weighing 25 kg. Which assessment finding is most concerning a. Dilute urine output of 40 mL/hr b. Increased head circumference c. Serum sodium level of 142 mEq/L d. Weight loss of 2 kg in past 48 hour

d. Weight loss of 2 kg in past 48 hour